Health facilities readiness for standard precautions to infection prevention and control in Nepal: A secondary analysis of Nepal Health Facility Survey 2021.

BACKGROUND: Improvements in standard precaution related to infection prevention and control (IPC) at the national and local-level health facilities (HFs) are critical to ensuring patient's safety, preventing healthcare-associated infections (HAIs), mitigating Antimicrobial Resistance (AMR), protecting health workers, and improving trust in HFs. This study aimed to assess HF's readiness to implement standard precautions for IPC in Nepal. METHODS: This study conducted a secondary analysis of the nationally-representative Nepal Health Facility Survey (NHFS) 2021 data and used the Service Availability and Readiness Assessment (SARA) Manual from the World Health Organization (WHO) to examine the HF's readiness to implement standard precautions for IPC. The readiness score for IPC was calculated for eight service delivery domains based on the availability of eight tracer items: guidelines for standard precautions, latex gloves, soap and running water or alcohol-based hand rub, single use of standard disposal or auto-disable syringes, disinfectant, safe final disposal of sharps, safe final disposal of infectious wastes, and appropriate storage of infectious waste. We used simple and multiple linear regression and quantile regression models to examine the association of HF's readiness with their characteristics. Results were presented as beta (ß) coefficients and 95% confidence interval (95% CI). RESULTS: The overall readiness scores of all HFs, federal/provincial hospitals, local HFs, and private hospitals were 59.9±15.6, 67.1±14.4, 59.6±15.6, and 62.6±15.5, respectively. Across all eight health service delivery domains, the HFs' readiness for tuberculosis services was the lowest (57.8±20.0) and highest for delivery and newborn care services (67.1±15.6). The HFs performing quality assurance activities (ß = 3.68; 95%CI: 1.84, 5.51), reviewing clients' opinions (ß = 6.66; 95%CI: 2.54, 10.77), and HFs with a monthly meeting (ß = 3.28; 95%CI: 1.08, 5.49) had higher readiness scores. The HFs from Bagmati, Gandaki, Lumbini, Karnali and Sudurpaschim had readiness scores higher by 7.80 (95%CI: 5.24, 10.36), 7.73 (95%CI: 4.83, 10.62), 4.76 (95%CI: 2.00, 7.52), 9.40 (95%CI: 6.11, 12.68), and 3.77 (95%CI: 0.81, 6.74) compared to Koshi. CONCLUSION: The readiness of HFs to implement standard precautions was higher in HFs with quality assurance activities, monthly HF meetings, and mechanisms for reviewing clients' opinions. Emphasizing quality assurance activities, implementing client feedback mechanisms, and promoting effective management practices in HFs with poor readiness can help to enhance IPC efforts.

Unmet need for family planning and associated factors among currently married women in Nepal: A further analysis of Nepal Demographic and Health Survey-2022.

INTRODUCTION: Family planning (FP) is crucial for improving maternal and newborn health outcomes, promoting gender equality, and reducing poverty. Unmet FP needs persist globally, especially in South Asia and Sub-Saharan Africa leading to unintended pregnancies, unsafe abortions, and maternal fatalities. This study aims to identify the determinants of unmet needs for FP from a nationally representative survey. METHODS: We analyzed the data of 11,180 currently married women from nationally representative Nepal Health Demographic Survey 2022. We conducted weighted analysis in R statistical software to account complex survey design and non-response rate. We conducted univariate and multivariable binary and multinomial logistic regression to assess association of unmet need for FP with independent variables including place of residence, province, ecological belt, ethnicity, religion, current age, participant's and husband's education, occupation, wealth quintile, parity, desire for child, and media exposure. RESULTS: The total unmet FP need was 20.8% (95%CI: 19.7, 21.9) accounting 13.4% (95%CI: 12.5, 14.4) for unmet need for limiting and 7.4% (95%CI: 6.8, 8.0) for unmet for spacing. Lower odds of total unmet need for FP were present in 20-34 years and 35-49 years compared to <20 years, women belonging to Madhesi ethnic group (AOR: 0.78; 95%CI: 0.64, 0.95) compared to Brahmin/Chhetri, women from richest (AOR: 0.69; 95%CI: 0.56, 0.84), richer (AOR: 0.82; 95%CI: 0.68, 0.97) and middle wealth quintile (AOR: 0.82; 95%CI:0.70, 0.98) groups compared poorest wealth quintile group and women belonging to rural area (AOR: 0.89; 95%CI: 0.80, 0.99) compared to urban area. Higher odds of unmet need for FP were present among women with basic (AOR: 1.34; 95%CI: 1.17, 1.54), and secondary level (AOR: 1.32; 95%CI: 1.12, 1.56) education compared to women without education, among women from Madhesh (AOR: 1.56; 95%CI: 1.22, 1.98), Gandaki (AOR: 2.11; 95%CI: 1.66, 2.68), Lumbini (AOR: 1.97; 95%CI: 1.61, 2.42) and Sudurpashchim province (AOR: 1.64; 95%CI: 1.27, 2.10) compared to Koshi province and among women whose husband education was basic level (AOR:1.37; 95%CI: 1.15, 1.63), or secondary level (AOR: 1.32; 95%CI: 1.09, 1.60) education. CONCLUSION: Nepal faces relatively high unmet FP needs across various socio-demographic strata. Addressing these needs requires targeted interventions focusing on age, ethnicity, religion, education, and socio-economic factors to ensure universal access to FP services.

Factors associated with uptake of breast and cervical cancer screening among Nepalese women: Evidence from Nepal Demographic and Health Survey 2022.

Breast cancer screening (BCS) and cervical cancer screening (CCS) are integral parts of initiatives to reduce the burden associated with these diseases. In this context, we aimed to determine factors associated with BCS and CCS uptake among Nepalese women aged 30 to 49 years using data from the Nepal Demographic Health Survey (NDHS) 2022. We performed a weighted analysis to account complex survey design of the NDHS 2022. We employed univariable and multivariable logistic regression to determine factors associated with the uptake of BCS and CCS and results were presented as crude odds ratio and adjusted odds ratio (AOR) along with 95% confidence interval (CI). The uptake of BCS and CCS among Nepalese women aged 30 to 49 years were 6.5% and 11.4% respectively. Women from Terai compared to mountain region (AOR = 0.54, 95%CI: 0.31, 0.93) and those engaged in agriculture compared to non-working (AOR = 0.59, 95%CI: 0.42, 0.82) women had lower odds of BCS uptake. Conversely, Dalit women compared to Brahmin/Chhetri (AOR = 2.08, 95%CI: 1.37, 3.16), and women with basic (AOR = 1.49, 95%CI: 1.04, 2.13), secondary (AOR = 1.96, 95%CI: 1.33, 2.88), and higher education (AOR = 2.80, 95% CI: 1.51, 5.19) compared to those with no education had higher odds of BCS uptake. Women from rural areas (AOR = 0.76, 95%CI: 0.61, 0.96), and those living in Bagmati (AOR = 2.16, 95% CI: 1.44, 3.23) and Gandaki (AOR = 2.09, 95%CI: 1.40, 3.14) provinces had higher odds of CCS uptake compared to their urban counterparts and those living in Koshi province, respectively. The odds of CCS increased with age (AOR = 1.06, 95%CI: 1.04, 1.08). Women with secondary education (AOR = 1.47, 95%CI: 1.06, 2.04) had higher odds of CCS uptake compared to those without education. Similarly, married women (AOR = 8.24, 95%CI: 1.03, 66.21), and those with health insurance (AOR = 1.41, 95%CI: 1.08, 1.83) had higher odds of CCS. In conclusion, the uptake of both BCS and CCS was relatively poor among Nepalese women indicating a need for targeted and tailored intervention to increase BCS and CCS uptake.

Socioeconomic Determinants of Inequalities in the Use of Modern Contraception among Currently Married Women.

BACKGROUND: Despite interventions for over four decades, the unmet need for family planning is high in Nepal. This study aims to examine the status and the socioeconomic determinants of inequalities in modern contraception among currently married women. METHODS:  We applied a mixed-method design. We interviewed key informants for qualitative information and analyzed secondary data from the Nepal Multiple Indicator Cluster Survey, 2019, and different rounds of Nepal Demographic and Health Surveys. We calculated ratios, differences in percentages, and concentration indices to analyse the inequality. We ran a binary logistic regression model to estimate the adjusted effect of each factor on the use of modern contraception. RESULTS:  The richest-to-poorest difference in using modern contraception has decreased over 13 years. The richest-to-poorest difference decreased from 23.6 percentage points in 2006 to 13.3 percentage points in 2011 and further to 1.2 percentage points in 2016. The richest-to-poorest difference was negative in 2019, indicating poor people are using more contraception than the richest. Multivariate analysis showed the wealth is a significant predictor for using contraception. Women of richer households (aOR=1.29, 95% CI=1.13-1.48), middle (aOR=1.21, 95% CI=1.05-1.40), poorer (aOR=1.36, 95% CI 1.17-1.58) and poorest (aOR=1.18, 95% CI=1.05-1.34) were more likely to use contraception than women from the richest households. CONCLUSIONS: Poor people are increasingly using the modern contraception, and the gap between the poor and rich people has decreased. However, the trend of contraception use in each wealth quintile indicates that Nepal struggles to meet the sustainable development goal target of reducing the unmet need for family planning to less than 10% by 2030.

Trends and predictors of inequality in childhood stunting in Nepal from 1996 to 2016.

BACKGROUND: Although decreasing in trend, one-in-three children remain stunted in Nepal and its distribution is unequal among different socioeconomic and geographical subgroups. Thus, it is crucial to assess inequalities in stunting for designing equity focused interventions that target vulnerable groups with higher burden of stunting. This study measures trends and predictors of socioeconomic inequalities in childhood stunting in Nepal. METHODS: Data from five rounds (1996-2016) of Nepal Demographic and Health Survey, nationally representative cross-sectional surveys, were used. Levels and trends of absolute and relative disparity in stunting between the poorest and the richest wealth quintiles, and among all quintiles were assessed by calculating absolute and relative difference, concentration curve and index. Average marginal effects of predictors on stunting were calculated using probit regression. The concentration index was subsequently decomposed into contributing factors. RESULTS: Even though stunting consistently declined in all wealth quintiles between 1996 and 2016, reduction was relatively higher among the richer quintiles compared to poorer ones. The absolute difference between the poorest and the richest quintile increased from 24.7 in 1996 (64.5% in poorest - 39.8% in richest) to 32.7 percentage points in 2016 (49.2-16.5%). The relative disparity also increased; the ratio of stunting in the poorest to the richest quintile was 1.6 in 1996 and 3.0 in 2016. The concentration index increased (in absolute value) from - 0.078 in 1996 to - 0.147 in 2016 indicating that stunting was disproportionately concentrated in poorer households and socioeconomic inequalities worsened from 1996 to 2016. Decomposition analysis revealed that in 1996, wealth (61%), caste/ethnicity (12%), mother's education (12%) and birth order (9%) were the major contributors to observed socioeconomic inequalities in stunting; while in 2016, wealth (72%), mother's BMI (12%) and birth order (9%) were the major contributors. CONCLUSIONS: Despite remarkable improvements in average stunting over the last two decades, substantial socioeconomic inequalities in stunting exists and is determined not only by immediate factors but also by underlying and contextual factors which emphasize the need for coherent actions across different sectors. In addition to reducing inequalities in wealth, nutrition programming should be focused on most disadvantaged subgroups which are prone to both stunting and relative poverty.