The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study.

BACKGROUND: In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai. METHODS: Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis. RESULTS: All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers' group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs. CONCLUSIONS: Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings

Additional file 1 of Stable expression of mucin glycoproteins GP40 and GP15 of Cryptosporidium parvum in Toxoplasma gondii

Additional file 1: Table S1. Primers used in this study

Phylogenetic relationship of <i>Clostridium difficile</i> subtypes.

<p>The relationship of subtypes identified in this study and other subtypes in a previous study <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002437#pntd.0002437-Kato1" target="_blank">[9]</a> was inferred by a neighbor-joining analysis of <i>slpA</i> sequences, based on the p-distance model. Bootstrap values >50% are shown. Novel and known subtypes identified in this study are indicated by black and white triangles, respectively.</p

Phylogenetic relationship of <i>Enterocytozoon bieneusi</i> genotypes.

<p>The relationship of genotypes identified in this study and some other genotypes in GenBank was inferred by a neighbor-joining analysis of <i>ITS</i> sequences, based on the p-distance model. Bootstrap values >50% are shown. Novel and known genotypes identified in this study are indicated by black and white triangles, respectively.</p

Infection rates of study pathogens in case and control wards.

<p>There were 74 children in case ward (Ward A), 283 and 216 children in control wards (Wards C and D).</p

Distribution of study pathogen infections in case (A) and control (C and D) wards by age, gender, and diarrhea status.

a<p>One child from Ward C and one child from Ward D did not have age and gender information, respectively.</p

Phylogenetic relationship of multilocus sequence subtypes of <i>Giardia duodenalis</i>.

<p>Sequences from this and a previous study <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002437#pntd.0002437-Caccio1" target="_blank">[22]</a> are included in the analysis. The relationship of multilocus sequence subtypes was inferred by a neighbor-joining analysis of concatenated sequences of the <i>gdh</i>, <i>tpi</i>, and <i>bg</i> fragments, based on the p-distance model. Bootstrap values >50% are shown. Novel and known genotypes identified in this study are indicated by black and white triangles, respectively.</p

Distribution of <i>Giardia duodenalis</i>, <i>Enterocytozoon bieneusi</i>, and <i>Clostridium difficile</i> infections in pediatric inpatients by ward and <i>Cryptosporidium</i> infection status.

a<p>CI: confidence interval.</p>b<p>Bold numbers: <i>P</i> values≤0.05 by Chi-square test.</p

Additional file 3: Figure S2. of Evolution of mitosome metabolism and invasion-related proteins in Cryptosporidium

A) Syntenic relationship between the genomes of Cryptosporidium parvum and C. ubiquitum or C. andersoni. Syntenic sequences (identity >75%) are connected with lines. The colors of lines represent different chromosomes of C. parvum. B) Venn diagram of shared orthologs and species-specific genes among four Cryptosporidium species. Because of the use of different gene prediction approaches in genome annotation, species-specific genes are generally over-estimated. (DOCX 2376 kb

Additional file 2: Figure S1. of Evolution of mitosome metabolism and invasion-related proteins in Cryptosporidium

A) Similarity in codon usage frequency among Cryptosporidium parvum, C. ubiquitum and C. andersoni. As expected, the third position of the most commonly used codons mostly has A or T, except for the UGG codon for tryptophan and UTG codon for methionine. B) The most over-represented sequence motifs in upstream regions of protein-encoding genes of C. parvum, C. ubiquitum and C. andersoni. The E2F-like motif, 5′-TGGCGCCA-3′, is the dominant one in all Cryptosporidium species. (DOCX 429 kb