Factors associated with bypassing primary healthcare facilities for childbirth among women in Devchuli municipality of Nepal.

BACKGROUND: It is crucial to deliver a child at nearby primary healthcare facilities to prevent subsequent maternal or neonatal complications. In low-resource settings, such as Nepal, it is customary to forgo the neighboring primary healthcare facilities for child delivery. Reports are scanty about the extent and reasons for bypassing local health centers in Nepal. This study sought to determine the prevalence and contributing factors among women bypassing primary healthcare facilities for childbirth. METHOD: A community-based cross-sectional study was carried out in the Devchuli municipality of Nawalparasi East district of Nepal. Utilizing an online data collection tool, structured interviews were conducted among 314 mothers having a child who is less than one year of age. RESULTS: This study showed that 58.9% of the respondents chose to bypass their nearest primary healthcare facility to deliver their babies in secondary or tertiary hospitals. Respondent's husband's employment status; informal employment (AOR: 4.2; 95% CI: 1.8-10.2) and formal employment (AOR: 3.2; 95% CI: 1.5-6.8), wealth quintile (AOR: 3.7; 95% CI: 1.7-7.7), parity (AOR): 3.0; 95% CI: 1.6-5.7], distance to nearest primary healthcare facility by the usual mode of transportation (AOR: 3.0; 95% CI: 1.5-5.6) and perceived service quality of primary healthcare facility (AOR: 3.759; 95% CI: 2.0-7.0) were associated with greater likelihood of bypassing primary healthcare facility. CONCLUSION: Enhancing the quality of care, and informing beneficiaries about the importance of delivering children at primary healthcare facilities are essential for improving maternal service utilization at local primary healthcare facilities.

Assessment of rainfall erosivity (R-factor) during 1986-2015 across Nepal: a step towards soil loss estimation.

Rainfall is a main cause of soil erosion which varies spatially and temporarily. R-factor is an erosive power of the rainfall that is responsible for soil detachment and subsequent displacement. Mathematically, it is expressed as a sum of the product of kinetic energy and maximum 30-min rain intensity. A precise assessment of R-factor needs higher temporal resolution rainfall data (sub-hourly) for a period of several years, which is rarely available. Many empirical approaches are used to predict R-factor as a function of mean monthly and annual rainfall amount. In this study, we used Loureiro and Countinho (Journal of Hydrology 250:12-18, 2001) approximation approach to estimate R-factor and explore its intra-annual variability using 30 years (1986-2015) of daily rainfall data from 280 stations distributed across Nepal. This study employs different intra-annual variability indices and calculates erosivity density (ED) and weighted erosivity density (WED). The country average mean annual R-factor (MAR), annual ED, and WED are found to be 9434.8 MJ mm ha-1 h-1 year-1, 4.39 MJ ha-1 h-1,and 1.61 MJ ha-1 h-1, respectively. On a monthly scale, July is the highest erosive month followed by August (> 2000 MJ mm ha-1 h-1 month-1). Likewise, November is the lowest erosive month followed by December (~ 50 MJ mm ha-1 h-1 month-1). Spatial distributions of these indices show clear delineations of areas with different erosivity patterns at different time of the year. In addition, this study explores inter-annual variation, temporal evolution, and trend estimation of R-factors over the country (for the first time). Significant rising trends are observed in the western region of the country. We found that the mean soil erosion for Nepal is estimated at 21.01 ton ha-1 year-1. The smallest R-factors are observed in the north-western region of the country and the maximum values are observed at mid hills and southern plains of the country. Our study could be an initial but important step for effective soil conservation, land use planning, and agricultural production.