Budgeting and Advocacy to Improve Water, Sanitation, and Hygiene in Health Care Facilities: A Case Study in Nepal.

Barriers to achieving and sustaining access to water, sanitation, hygiene, cleaning, and waste management (WASH) in health care facilities include a lack of supportive policy environment and adequate funding. While guidelines exist for assessing needs and making initial infrastructure improvements, there is little guidance on how to develop budgets and policies to sustain WASH services. We conducted costing and advocacy activities in Thakurbaba municipality, Nepal, to develop a budget and operations and maintenance policy for WASH in health care facilities in partnership with the municipal government. Our objectives for this study were to (1) describe the process and methods used for costing and advocacy, (2) report the costs to achieve and maintain basic WASH services in the 8 health care facilities of Thakurbaba municipality, and (3) report the outcomes of advocacy activities and policy development. We applied bottom-up costing to enumerate the resources necessary to achieve and maintain basic WASH services and their costs. The annual costs to achieve, operate, and maintain basic access to WASH services ranged from US$4881-US$9695 per facility. Cost findings were used to prepare annual budgets recommended to achieve, operate, and maintain basic services, which were presented to the municipal government and incorporated into an operations and maintenance policy. To date, the municipality has adopted the policy and established a recovery fund of US$3831 for repair and maintenance of infrastructure and an additional US$153 per facility for discretionary WASH spending, which were to be replenished as they were spent. Advocacy at the national level for WASH in health care facilities is currently being championed by the municipality, and findings from this project have informed the development of a nationally costed plan for universal access. This study is intended to provide a roadmap for how cost data can be collected and applied to inform policy.

Factors Associated with the Nutritional Status among Male Workers of Iron and Steel Industries in Bara District, Nepal.

BACKGROUND: Overweight and obesity are major serious public health problems, since their prevalence is accelerating rapidly not only in developed but also in developing countries. The aim of this study was to find out the factors associated with the nutritional status of the industrial workers in Bara District of Nepal. METHODS: An industry-based analytical cross-sectional study was conducted among the 271 male workers using pretested semistructured questionnaires, food frequency questionnaire, 24-hour recall method, and anthropometric measurement after obtaining informed consent from the workers. For the categorical independent variables, bivariate and multivariate regression tests were used for the analysis, and for numerical independent variables, Student's t-test was used. A P value less than 0.05 was considered significant. Ethical approval was taken from the Research Committee of the College of Applied Food and Diary Technology (CAFODAT). RESULTS: Overweight /obesity was observed among 27.3% of the participants of which 22.1% were overweight and 5.2% were obese. Age (OR: 2.54; 95% CI: 1.346-4.823); ethnicity, Brahmin/Chhetri (OR: 6.14; 95% CI: 1.971-19.123) and Madhesi (OR: 4.641; 95% CI: 1.534-14.04); and smoking (OR: 4.165; 95% CI: 1.972-8.80) were associated with nutritional status of industrial workers. Additionally, food frequency (OR: 2.232; 95% CI: 1.101-4.522), dietary diversity, and total calorie intake were also significantly associated with nutritional status of industrial workers. CONCLUSIONS: The study has indicated that more than one-fourth of workers of iron and steel industries in Bara District of Nepal are overweight or obese. Different sociodemographic and socioeconomic factors and lifestyle-related factors were associated with overweight and obesity. There is need for programs for industrial workers focused on nutrition education to raise awareness about nutrition-related problems and risk factors.

Cross-cultural adaptation and measurement properties of the Nepali version of the DASH (disability of arm, shoulder and hand) in patients with shoulder pain.

BACKGROUND: Patient-reported outcome measures (PROMs) are important tools in both clinical practice and research. However, no upper extremity PROM to assess physical disability is available in Nepali. The most commonly used and recommended questionnaire for the shoulder is the Disability of Arm, Shoulder and Hand (DASH). Therefore, the aim of the study was to translate and cross-culturally adapt the DASH into Nepali and determine its measurement properties. METHODS: The translation and cultural adaptation process followed international standard procedures. The translated Nepali version of the questionnaire (DASH-NP) was completed by 156 patients with shoulder pain from three Nepali hospitals at an initial assessment and by 121 at follow-up. A Nepali version of Global Rating of Change (GROC-NP) was completed at follow-up to dichotomise improved and stable participants. Measurement properties testing included: internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient, ICC), Minimal Detectable Change (MDC), construct validity - factor analysis, hypothesis testing with the Shoulder Pain and Disability Index (SPADI) (Pearson Correlation = r) and responsiveness - Area Under the Curve with minimal important change. RESULTS: Significant adaptations such as changing measurement units, activities and terminology were incorporated to improve cultural relevance. Internal consistency (α = 0.92) and test-retest reliability (ICC = 0.97, 95% CI: 0.94-0.98, p < 0.001) were excellent. The MDC was 11 out of 100 points. There were moderate-high positive correlations with the SPADI pain and disability items (rs = 0.63 and 0.81, P < 0.001). Four factor solution was retrieved for the DASH-NP. The Area Under the Curve was 0.69 (95% CI: 0.57 - 0.81, p < 0.001) with minimal important change of 11.2/100 points. CONCLUSIONS: The Nepali translation of the DASH is comprehensible, easy to administer via self-report or interview. It is found to be a reliable, valid, and responsive measure in patients with shoulder pain in Nepal. The DASH-NP can be used to assess shoulder pain related disability in Nepal for clinical practice or research.