Assessing the preference and spatial dependence of a solid waste management system in Nepal: A choice experiment approach.

This study deploys a choice experiment method to estimate the preference and willingness to pay for a better solid waste management system in Siddharthanagar municipality in Nepal. A primary survey of 611 households was conducted, and the results from the Generalized Multinomial Logit Model (GMNL) indicate a public preference for a better waste management service. Significant heterogeneity in household preferences is evident after accommodating each choice selection's preference certainty in the GMNL model. On average, households prefer to pay the highest amount for constructing and maintaining a sanitary landfill, which is Nepalese Rupee (NPR) 158/month (USD 1.43). The geographic distribution of the marginal willingness to pay (MWTP) by hot spot analysis from the geocoded location also indicates spatial heterogeneity across the study area. The MWTP for each waste management attribute is spatially autocorrelated, and household awareness and attitude significantly impact this spatial dependence. Overall, both the choice models result and spatial analyses indicate the policy should be targeted at a localized level to increase awareness concerning the proper management of solid waste.

Social entrepreneurship, co-production, and post-disaster recovery.

Post-disaster recovery requires co-production; that is, the inputs of citizens are essential for successful community recovery to occur. Citizens contribute to post-disaster recovery by volunteering, taking on consultative and decision-making roles within their communities, and directly participating in post-disaster reconstruction efforts. Without meaning ful contributions from citizens-the intended beneficiaries-unilateral efforts by public officials and authorities will inevitably fail. This study shows that social entrepreneurs can thus play a critical role in spurring post-disaster recovery by facilitating co-production. It focuses on the role of social entrepreneurs after disasters and centres on one rural village, Giranchaur Namuna Basti in the Sindhupalchowk District of Nepal. Specifically, the study uses the case of the Dhurmus Suntali Foundation's Namuna village project in Giranchaur following the 7.8-magnitude earthquake that struck on 25 April 2015 to examine the pivotal role that social entrepreneurs assume in promoting voluntary activities, community engagement, and participation in post-disaster recovery efforts.

The Stressor in Adolescence of Menstruation: Coping Strategies, Emotional Stress & Impacts on School Absences among Young Women in Nepal.

Throughout the developing world, girls face hardships surrounding menstruation, often resulting in poor emotional wellbeing and missing school. Providing ways to keep girls in school will increase their educational and earning potentials, which will ultimately trickle down to improving the economic standing of nations in the next generation. Informed by the Transactional Model of Stress and Coping, this work evaluates the roles that cultural and school environments play in appraisals of menstruation as a major life stressor for adolescent females and the impacts of emotional stress on missing school. Using primary survey data from schools in Nepal, robust results are found to support the theoretical framework based on conditional mixed-process (CMP) estimation with fixed effects, utilizing multiple index building techniques. Strong cultural norms during menstruation appear to increase the probability of girls self-reporting emotional stress, while the presence of hygiene supporting infrastructure at schools reduces this outcome. Furthermore, there is strong support for the finding that the presence of emotional stress during menstruation increases the likelihood of not only missing school but also for an extended period of time. Our findings motivate increasing government policies to provide stronger hygiene infrastructure in schools to improve successful coping skills and attendance rates.

mHealth: Potentials and Risks for Addressing Mental Health and Well-Being Issues Among Nepali Adolescents.

Adolescents are slowly being recognized as a generation, worldwide, that may require different policy approaches to improve staggering statistics on their failing well-being, including mental health. By providing the support to allow the next generation to achieve better mental health outcomes, they are going to be more economically successful and the future economic growth of nations can be better assured. Adoption of mobile-based health interventions (e.g., mHealth) has garnered a lot of attention toward this end. While mHealth interventions are growing in popularity, many researchers/policy-makers appear to have neglected assessing potential (indirect) costs/negative consequences from their use. Evidence from the developed world shows strong associations between extensive cell phone use and negative mental health outcomes, but similar research is minimal in developing world contexts. Additionally, the bulk of work on the outcomes of mobile phone use is studied using a unidirectional approach with blinders to front-end motivations. Using primary data from a large-scale, school-based survey of older adolescents in southwestern Nepal (N = 539), this work investigates such a tension between mobile/smartphone usage as a true mobile health (mHealth) opportunity in Nepal or as a potential problem, introducing additional deleterious well-being effects from over-use. Founded in Basic Psychological Needs Theory (BPNT), robust results of analyses using full structural modeling approaches (and traditional regression-based sensitivity analyses) indicate support for the BPNT framework in explaining statistically significant positive associations between bullying and anxiety, as well as, negative associations between bullying and grit, including evidence to support the mediating role of problematic mobile phone use in these relationships. More than 56% of the sample showed indicators of mild to moderate anxiety and over 10% claim experiences of bullying, coupled with over 75% of the sample scoring above the midline of a problematic mobile phone use scale, all of which motivates the relevance of our findings. Potential policy implications of these findings, and mention of other intriguing avenues for future work are further discussed.

A step back from the edge: empirical modeling of the role of social integration on suicide and associated deleterious health outcomes across adolescents from six middle-income countries.

PURPOSE: There is economic importance to stimulating awareness about preventing adolescent suicide and other associated deleterious mental and behavioral health outcomes, especially the long-term costs from lost productivity. However, the presence of stigma and poor healthcare reporting systems which often prevent data access have frequently limited research into these topics in low-and-middle income (LMICs) countries. The majority of existing research on these topics using LMICs data primarily focuses on prevalence rates and basic correlational associations, and is often a-theoretic. Empirically rigorous work, mostly found using data from the developed world, has primarily relegated suicide into a box of utility-maximization-based decisions. Social integration theory may be a more relevant approach for researching the mitigating factors to deleterious heath behaviors among adolescents in LMICs. METHODS: Using data from the Global School-based Student Health Survey (GSHS) of six different countries, we estimate a reduced-form, simultaneous model incorporating specialized clustering to determine the influence of social integration on five different deleterious health outcomes, including three levels of suicidal behavior. RESULTS: Robust results indicate that positive parenting and social exclusion reduce and increase the likelihood of all outcomes, respectively, among both pooled and individual country samples. CONCLUSION: Such results provide an impetus for pursuing interventions in LMICs, which focus on social-based, multi-level approaches. Such interventions could include such elements as peer-to-peer training support and awareness/promotion of mental health among parents of adolescents.

Touch for Health: Use of Pavlovian Processes with Physical Touch as a Means to Improve Menstrual Hygiene Management Initiatives, Measured by Willingness to Pay.

BACKGROUND: To combat the lack of proper facilities and menstrual health knowledge in developing countries, many WASH (Water, Hygiene, and Sanitation) initiatives are including menstrual hygiene management (MHM) components. However, evidence shows that prior efforts have not been ultimately successful in inducing relevant behavior changes, due in part to cultural constraints and unidimensional interventions. As such, MHM research may need to include consideration of new theories/approaches. Evidence is growing of the role that physical presence/proximity and ability to touch objects has on incentives for consumers to purchase goods, captured through willingness to pay (WTP) figures. Such findings can be partially explained by Pavlovian processes. OBJECTIVE: This study sought to provide field-work validation of such findings of the role of Pavlovian processes and endowment effect on WTP figures for a female hygiene kit, reflecting motivation to adopt better hygiene behaviors. METHODS: This study used primary survey data collected from females in two upper-level schools in southwestern Nepal (n = 169). When presented in conjunction with a hygiene education session, one group of females was allowed physical interaction with a female hygiene kit, while another was not, before being surveyed on their WTP for the kit. Both non-parametric and parametric statistical analyses were performed to assess the impact of this ability to touch the kits on WTP figures. RESULTS: Results show a statistically significant difference between the WTP figures of those females allowed interaction with the kits prior to being surveyed and those who did not. This confirms the positive impact of physical presence/touch on motivations to use/acquire hygiene-related tools. CONCLUSIONS: Such findings reveal how, through application of the theory of Pavlovian processes, future (menstrual) health education efforts could harness the human instinct to consume, remember, and use those objects presented in physical form, and include personal contact and demonstrations of better health practices in future MHM and WASH education initiatives. Such an approach may allow protocols and interventions to have more success, and dissemination of healthier behaviors and knowledge to be more prominent.

Maternal health care amid political unrest: the effect of armed conflict on antenatal care utilization in Nepal.

Armed conflicts, which primarily occur in low- and middle-income countries, have profound consequences for the health of affected populations, among them a decrease in the utilization of maternal health care services. The quantitative relationship between armed conflict and maternal health care utilization has received limited attention in the public health literature. We evaluate this relationship for a particular type of health care service, antenatal care, in Nepal. Using count regression techniques, household survey data and sub-national conflict data, we find a negative correlation between the number of antenatal care visits and incidents of conflict-related violence within a respondent's village development committee. Specifically, we find that under high-intensity conflict conditions women receive between 0.3 and 1.5 fewer antenatal care check-ups. These findings imply that maternal health care utilization is partially determined by characteristics of the social environment (e.g. political instability) and suggest health care providers need to revise maternal health strategies in conflict-affected areas. Strategies may include decentralization of services, maintaining neutrality among factions, strengthening community-based health services and developing mobile clinics.

Coping with poor water supplies: empirical evidence from Kathmandu, Nepal.

The authors examined the demand for clean drinking water using treatment behaviors in Kathmandu, Nepal. Water supply is inadequate, unreliable and low quality. Households engage in several strategies to cope with the unreliable and poor quality of water supplies. Some of the major coping strategies are hauling, storing, and point-of-use treatment. Boiling, filtering, and use of Uro-guard are some of the major treatment methods. Using Water Survey of Kathmandu, the authors estimated the effect of wealth, education, information, gender, caste/ethnicity and opinion about water quality on drinking water treatment behaviors. The results show that people tend to increase boiling and then filtering instead of only one method if they are wealthier. In addition, people boil and then filter instead of boiling only and filtering only if they think that water delivered to the tap is dirty. Exposure to information has the strongest effect in general for the selection of all available treatment modes.

Healthy mothers, healthy children: does maternal demand for antenatal care matter for child health in Nepal?

Nepal's Safe Motherhood Programme has failed to deliver expected gains in maternal and child health. Nepalese mothers and their children continue to dispense with (or be denied) antenatal care, experience high maternal mortality rates and suffer chronic malnutrition. We address the correlates and consequences of antenatal care utilization in Nepal by applying two-stage least squares, binomial logit and Heckman selection bias estimates to data drawn from the Nepal Health and Demographic Surveys of 1996 and 2001. Results indicate that maternal education, even at low levels, significantly increases the use of antenatal care; paternal education plays a more important role in the use of routine antenatal care than the conventional wisdom suggests; and when mothers use routine professional antenatal care and maintain good health their children tend to stay healthy through infancy and early childhood. Since health-seeking behaviour is circumscribed by patriarchal gender norms in Nepal, health policies should not only focus on female education and women's status, but also involve husbands in the process of maternal care utilization.

Household shocks, child labor, and child schooling: evidence from Guatemala.

Using data from the National Survey of Standards of Living conducted in Guatemala in 2000, this article tests the hypothesis that Guatemalan households use child labor and reduce child schooling to cope with household shocks. First, the authors use factor analysis to estimate the latent household propensity to natural disasters and socioeconomic shocks. Then, they estimate bivariate probit models to identify the determinants of child labor and schooling, including household propensity to natural disasters and socioeconomic shocks. Results suggest that households use child labor to cope with natural disasters and socioeconomic shocks. In contrast, the authors found no evidence that suggests that households reduce child schooling to cope with shocks. Findings also indicate that poor households are more likely to use child labor and schooling reduction as strategies to cope with socioeconomic shocks.

Assessing willingness to pay for cancer prevention.

Cancer is the second leading cause of death in the U.S. and its economic cost is very high. The objective of this study is to analyze the socioeconomic and demographic factors that are related to the willingness to pay (WTP) for cancer prevention. Data from an experimental module in the 2002 Health and Retirement Study (HRS) were used to identify WTP differences across different population subgroups. Respondents were asked whether they were willing and able to pay different dollar amounts per month for a new cancer prevention drug. Years of age were negatively related to WTP whereas income and the probability of developing cancer were positively related to WTP. Risk-relevant numeracy skills were positively related to self-assessed cancer risk, which may suggest that adults with poor numeracy skills underestimate their cancer risk. This has consequences not only on the relative perceived value of different cancer treatments across different population subgroups but also on perceived value as captured by WTP.