Staff perspectives of barriers to women accessing birthing services in Nepal: A qualitative study

Background: Nepal has made significant progress with regard to reducing the maternal mortality ratio but a major challenge remains the under-utilisation of skilled birth attendants who are predominantly facility based. Studies have explored women's views of the barriers to facility birth; however the voices of staff who offer services have not been studied in detail. This research explores the views of staff as to the key reasons why pregnant women do not give birth in a maternity-care facility. Methods: This mixed methods study comprised qualitative interviews and non-participant observation. The study was conducted in two small non-governmental hospitals, one semi-rural and one urban, in Kathmandu Valley. Twenty interviews were conducted with health care providers and other staff in these hospitals. The interviews were undertaken with the aid of a Nepali translator, with some interviews being held in English. Twenty-five hours of non-participant observation was conducted in both maternity hospitals . Both observation and interview data were analysed thematically. Ethical approval was granted by the Nepal Research Health Council and Bournemouth University's Ethics Committee. Results: Key themes that emerged from the analysis reflected barriers that women experience in accessing services at different conceptual levels and resembled the three phases of delay model by Thaddeus and Maine. This framework is used to present the barriers. First Phase Delays are: 1) lack of awareness that the facility/services exist; 2) women being too busy to attend; 3) poor services; 4) embarrassment; and 5) financial issues. Themes for the second Phase of Delay are: 1) birthing on the way; and 2) by-passing the facility in favour of one further away. The final Phase involved: 1) absence of an enabling environment; and 2) disrespectful care. Conclusion: This study highlights a multitude of barriers, not all of the same importance or occuring at the same time in the pregnancy journey. It is clear that staff are aware of many of the barriers for women in reaching the facility to give birth, and these fit with previous literature of women's views. However, staff had limited insight into barriers occuring within the facility itself and were more likely to suggest that this was a problem for other institutions and not theirs

Respiratory symptoms and illnesses related to the concentration of airborne particulate matter among brick kiln workers in Kathmandu valley, Nepal

Abstract Background Bricks have been manufactured in Nepal for hundreds of years and are seen as a component of Nepalese sculpture and architecture. Large quantities of hazardous materials including high concentrations of particulate matter are emitted on a daily basis from brick kilns. Exposure to these hazardous materials can lead to adverse consequences on the environment and human health. This study was conducted to  estimate the prevalence of respiratory symptoms/illnesses and the magnitude of respirable and total dust exposures among Nepalese brick kiln workers. Methods Respiratory symptoms/illnesses were evaluated by questionnaire among brickfield workers (n = 400) and a referent group of grocery workers (n = 400) in Kathmandu valley. Work zones (WZs): green brick molding (GBM), green brick stacking/carrying (GBS/C), red brick loading/carrying (RBL/C), coal preparation (CP) and firemen (FM) were the similar exposure groups (SEGs) from where personal air samples and interviews were taken. Among brickfield workers, personal monitoring was conducted across SEGs for total (n = 89) and respirable (n = 72) dust during February–March 2015 and March–April 2016. Applying multi-stage probability proportionate to size sampling technique, 16 kilns and 400 brick workers for interview were selected. Proportions, means, medians and ranges were calculated for the demographics, samples and respiratory symptoms/illnesses. One-way ANOVA was applied to compare the significance differences of the level of particulate matter among SEGs. Bivariate and multivariate logistic regression analysis were performed to evaluate association between respiratory symptoms/illnesses and participants groups, and SEGs among brick kiln workers at 0.05 level. Statistical analyses were performed using IBM SPSS Statistics 21. Results Chronic cough (14.3%), phlegm (16.6%) and bronchitis (19.0%) were higher (P < 0.05) among brickfield compared with grocery workers (6.8, 5.8 and 10.8%). Mean respirable (5.888 mg/m3) and total (20.657 mg/m3) dust exposures were highest for red brick loading tasks. The prevalence of chronic cough, chronic phlegm, chronic bronchitis, wheezing and asthma were significantly higher for other WZs workers (p < 0.05) compared with CP; for GBM: 22.9, 34.6, 15.0 and 7.5%; for GBS/C: 13.5, 15.8, 10.0, 8.8 and 7.5%; for RBL/C: 11.1, 17.1, 27.4, 19.0 and 11.9%; for FM: 18.4, 12.5, 28.4, 4.9 and 0.0%; and for CP: 4.9, 6.3, 13.3, 9.3 and 4.0% respectively. Conclusion High dust exposures identified in this study may explain the increased prevalence of respiratory symptoms/illnesses among Nepalese brickfield workers, warranting action to reduce exposures

Development of PV grid-connected plants in Nepal. A feasibility study and training programme co-financed by REPIC

This project was co-funded by REPIC and SUPSI. It was achieved through the close collaboration between SUPSI and two Nepalese partner teams: the CES of the Tribhuvan University together with NSES, and Kathmandu University alongside RIDS-Nepal. The project was implemented between October 2008 and June 2010. Although connecting PV modules to the main electric grid is by far the most rational, economical and efficient way to install this technology, it appears that, like in many other developing and transition countries, PV technology has so far been applied in Nepal exclusively through standalone plants (NEA, 2008). Such plants are used in several remote areas of the country and provide very satisfactory service to the rural populations (Zahnd, McKay, & Komp, 2006). However, the urban regions of Nepal, which already have access to the national electricity grid, are so far making use of PV technology without the added advantage of a connection to the grid. As exposed in chapter four, Nepal benefits from extremely favourable climatic conditions for exploiting PV technology. Moreover, despite its extraordinary potential for the production of hydropower, a lack of investments, political instability and the increase in energy demands have brought the country in a severe energy crisis, with as much as sixteen hours of load shedding per day during spring 2009. Solutions and ways out of the energy crisis will certainly be found by diversifying the electricity sources, so as to increase the production capacity in the short and long term, with –hopefully– careful consideration for global sustainability criteria. Grid-connected PV technology could be part of the “package” of Nepal’s future electricity supply scheme, but the conditions and criteria to make it applicable in the given context are manifold and influenced by technical, institutional and economic aspects. These will be analysed in the present work in order to assess its feasibility. Although the investigation for the development of alternative energy sources is a fundamental and acknowledged issue for the energy sector in Nepal, the present study is the first to look specifically at the feasibility of grid-connected PV in the country. The reference context considered in this study is the Kathmandu Valley. In parallel to the feasibility study, a training programme was conducted for TU and KU students at various phases of the project. Moreover, both TU and KU students were directly involved in the study activities, mainly to conduct surveys with potential domestic and industry/service technology users