BACKGROUND: Malnutrition is one of the leading causes of child morbidity and mortality. The severity of hunger in mountain and hill districts of Mid- and Far-Western Development Regions is a serious concern. Mugu, is one of the most remote and least developed districts of Nepal, periodically facing food insufficiency. This study was carried out to evaluate the malnutrition status of the most vulnerable group of children (6-59 months age group) in Mugu district.
METHODS: This study conducted in Mugu district was prospective and observational. Nutritional status of children aged 6-59 months were assessed by measuring mid-upper arm circumference by using MUAC tape and data was collected by interviewing caretakers. The data were analyzed and compared to the national figure.
RESULTS: Altogether 198 children aged 6-59 months were recruited for this study. Among them 49% were boys and 51% were girls. According to MUAC criteria, 1% of children had suffered from Severe Acute Malnutrition (SAM), 17% had Moderate Acute Malnutrition (MAM) and 82% had adequate nutritional status.
CONCLUSIONS: The prevalence of Acute Malnutrition is high in Mugu district. The important factors, among numerous others are food scarcity, poor hygiene and environmental practices, lack of care of the mother towards her child due to priority given to work and lack of knowledge about proper child feeding/care.
BACKGROUND: The problem of uterine prolapse exists throughout Nepal and negatively affects women's health and quality of life (QOL). The Government of Nepal recognizes it as a priority problem.
METHODS: This study was conducted in eight districts to examine the status and problems of women who have undergone prolapse surgery. Qualitative and quantitative methods were used to examine the issues of prolapse. Survey method was used to administer the questionnaire.
RESULTS: Sixty-six percent women reported pelvic organ prolapse at an early age. The mean age of its occurrence was 28 years. In the hill/mountain districts, 52% women among the non-poor and 72% among the poor went to health camps for surgery indicating that the camps were fulfilling the demands of the poor. Majority (>75%) of them from remote districts went to health camps for surgery indicating the camps were more beneficial to women in remote areas. Counseling was weak in the health camps and the use of IEC materials was minimal. Majority had improved health status after surgery. The incidence of post-surgery problems were as follows: 10.1% in government hospitals, 11.1% in non-government hospitals and 15.1% in health camps.
CONCLUSIONS: Despite improved performance of health camps, the program for prolapse management still seems weak due to lack of ownership of local health institutions and lack of proper coordination among the stakeholders/ partners. However, these camps need to be scaled up for the benefit of the unreached population.
BACKGROUND: The Family Health Division along with the MoHP developed a policy that recommended provision of incentives to all delivering mother by removing the parity condition and termed Safe Delivery Incentive Programme (SDIP) to make it more appropriate. The SDIP was branded as AamaSurakshyaKaryakram (ASK). The main objective of the study was to find out the effectiveness and efficiency of AamaSurakshyaKaryakram to address barrier in accessing maternal health services in Nepal.
METHODS: An exploratory and cross sectional descriptive study was conducted by quantitative and qualitative tools and techniques. To provide comprehensive coverage, five districts have been selected representing four development (eastern, central, western and far-western) and three (mountain, hill and flat) ecological region were selected.
RESULTS: Out of 47 exit client interviews conducted in this study, 51 percent were done in Sunsari, followed by Sarlahi (17%), Dadeldhura (17%), and Arghakhanchi (15%). Most of these mothers (94%) delivered their children in the hospitals, and rest (6%) in PHCCs. Sixty percent mothers were in the age group of 20-25 years, while 45 percent were from Tarai/Madhesi group followed by Brahmins/Chhetries group (34%). Total 70% mothers were found to be literate. 55% mothers were found to be visiting health facilities during labour pain. 2% mothers were visiting heath facilities before labour pain started. Rest mothers were visiting health facilities after one or two days of labour pain. Total 70% mothers were able to reach the health facility within 60 minutes, while 13 percent mothers were able to reach the facility more than 3 hours, and 17% were in between. All mothers who visited PHCCs were able to reach the facility within 60 minutes while analyzing health facility-wise.
CONCLUSIONS: Mothers delivered at home as they were not well prepared to go to health facility. Lack of transportation facility hindered for institutional delivery. None of them figured out that there was a provision of transport incentive; they only knew that there was a cash payment, but they didn't know exactly for what specific purpose mothers were receiving such payments. Ask found to be effective and efficient in order to address barriers occurring inside the health facility and financial barrier except geo-graphical barrier in accessing maternal health services in Nepal.
BACKGROUND: Nepal's Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the intention of increasing utilisation of professional care at childbirth. It provided cash to women giving birth in a health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We explored early implementation of the programme at the district-level to understand the factors that have contributed to its low uptake.
METHODS: We conducted in ten study districts a series of key informant interviews and focus group discussions with staff from health facilities and the district health office and other stakeholders involved in implementation. Manual content analysis was used to categorise data under emerging themes.
RESULTS: Problems at the central level imposed severe constraints on the ability of district-level actors to implement the programme. These included bureaucratic delays in the disbursement of funds, difficulties in communicating the policy, both to implementers and the wider public and the complexity of the programme's design. However, some district implementers were able to cope with these problems, providing reasons for why uptake of the programme varied considerably between districts. Actions appeared to be influenced by the pressure to meet local needs, as well individual perceptions and acceptance of the programme. The experience also sheds light on some of the adverse effects of the programme on the wider health system.
CONCLUSION: The success of conditional cash transfer programmes in Latin America has led to a wave of enthusiasm for their adoption in other parts of the world. However, context matters and proponents of similar programmes in south Asia should give due attention to the challenges to implementation when capacity is weak and health services inadequate.
CONTEXT: Although gender inequality is often cited as a barrier to improving maternal health in Nepal, little attention has been directed at understanding how sociocultural factors may influence the use of health care. In particular, how a woman's position within her household may affect the receipt of health care deserves further investigation.
METHODS: Data on ever-married women aged 15-49 from the 2001 Nepal Demographic and Health Survey were analyzed to explore three dimensions of women's position within their household-decision making, employment and influence over earnings, and spousal discussion of family planning. Logistic regression models assessed the relationship of these variables to receipt of skilled antenatal and delivery care.
RESULTS: Few women reported participation in household decision making, and even fewer had any control over their own earnings. However, more than half reported discussing family planning with their husbands, and there were significant differences among subgroups in these indicators of women's position. Though associations were not consistent across all indicators, spousal discussion of family planning was linked to an increased likelihood of receiving skilled antenatal and delivery care (odds ratios, 1.4 and 1.3, respectively). Women's secondary education was also strongly associated with the greater use of health care (5.1-5.6).
CONCLUSIONS: Gender inequality constrains women's access to skilled health care in Nepal. Interventions to improve communication and strengthen women's influence deserve continued support. The strong association of women's education with health care use highlights the need for efforts to increase girls' schooling and alter perceptions of the value of skilled maternal health care.
OBJECTIVE: To measure costs and willingness-to-pay for delivery care services in 8 districts of Nepal.
METHOD: Household costs were used to estimate total resource requirements to finance: (1) the current pattern of service use; (2) all women to deliver in a health facility; (3) skilled attendance at home deliveries with timely referral of complicated cases to a facility offering comprehensive obstetric services.
RESULTS: The average cost to a household of a home delivery ranged from 410 RS (5.43 dollars) (with a friend or relative attending) to 879 RS (11.63 dollars) (with a health worker). At a facility the average fee for a normal delivery was 678 RS (8.97 dollars). When additional charges, opportunity and transport costs were added, the total amount paid exceeded 5,300 RS (70 dollars). For a caesarean section the total household cost was more than 11,400 RS (150 dollars). Based on these figures, the cost of financing current practice is 45 RS (0.60 dollar) per capita. A policy of universal institutional delivery would cost 238 RS (3.15 dollars) per capita while a policy of skilled attendance at home with early referral of cases from remote areas would cost around 117 RS (1.55 dollars) per capita. These are significant sums in the context of a health budget of about 400 RS (5 dollars) per capita. Conclusions The financial cost of developing a skilled attendance strategy in Nepal is substantial. The mechanisms to direct funding to women in need must to be improved, pricing needs to be more transparent, and payment exemptions in public facilities must be better financed if we are to overcome both supply and demand-side barriers to care seeking.
OBJECTIVE: To study the gender role in child health care utilization in Nepal.
METHODS: We analysed 8112 individual observations of age </=15 years from 2847 households in 274 communities, obtained from the 1996 Nepal Living Standard Survey. Four steps of a health seeking action, namely illness reporting, choosing an external care, choosing a specific health care provider, and spending money to treat the sick child, were examined using discrete/continuous choice models.
RESULTS: There was no statistically significant difference between boys and girls by demographic, socio-economic and geographical status in the sample. However, gender was associated with all four utilization decision steps. While the net effect of being a boy was modest in illness reporting (p<0.10), it appeared stronger in the choice of external care, in the choice of public provider and in the choice of expenditure with the private provider (p<0.05).
CONCLUSION: Gender role not only affects illness reporting but also affects the decision to choose a health care provider and how much to spend on the sick child, i.e. it affects the entire steps of a health seeking action.
