Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study.

BACKGROUND: Disparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal. Commonly observed disparities exist in education, income, ethnic groups, administrative regions and province-level in Nepal. In order to improve equitable outcomes for MNCH and to scale-up quality services, an Investment Case (IC) approach was lunched in the Asia Pacific region. The study assessed the impact of the IC intervention package in maternal and child health outcomes in Nepal. METHODS: The study used a quasi-experimental design extracting data from the Nepal Demographic Health Surveys - 2011 (pre-assessment) and 2016 (post-assessment) for 16 intervention and 24 control districts. A Difference in Difference (DiD) analysis was conducted to assess the impact of the intervention on maternal and child health outcomes. The linear regression method was used to calculate the DiD, adjusting for potential covariates. The final models were arrived by stepwise backward method including the confounding variables significant at p < 0.05. RESULTS: The results of the DiD analyses showed at least four antenatal care visits (ANC) decreased in the intervention area (DiD% = - 4.8), while the delivery conducted by skilled birth attendants increased (DiD% = 6.6) compared to control area. However, the adjusted regression coefficient showed that these differences were not significant, indicating a null effect of the intervention. Regarding the child health outcomes, children with underweight (DiD% = 6.3), and wasting (DiD% = 5.4) increased, and stunting (DiD% = - 6.3) decreased in the intervention area compared to control area. The adjusted regression coefficient showed that the difference was significant only for wasting (ß = 0.019, p = 0.002), indicating the prevalence of wasting increased in the intervention group compared to the control group. CONCLUSION: The IC approach implemented in Nepal did not show improvements in maternal and child health outcomes compared to control districts. The use of the IC approach to improve MCH in Nepal should be discussed and, if further used, the process of implementation should be strictly monitored and evaluated.

Knowledge of novel coronavirus disease (COVID-19) among dental surgeons of Nepal: a nationwide study.

BACKGROUND: COVID-19 is an emerging respiratory disease caused by a novel coronavirus. There is not much evidence assessing the knowledge of dental surgeons regarding COVID-19. This study was conducted to assess the knowledge of COVID-19 among dental surgeons of Nepal. METHODS: A web-based cross-sectional study was conducted among registered dental surgeons of Nepal. Ethical approval was obtained. Consent was taken, and knowledge on COVID-19 was assessed via a pre-tested structured questionnaire using Google form. The form was emailed to the participants. Descriptive analysis was performed using frequency, percentage, median and inter-quartile range. Man-Whitney test and Kruskal-Wallis tests were carried out to see the difference in knowledge score. P-value < 0.05 was considered statistically significant. RESULTS: Total 227 dental surgeons responded to the questionnaire (male: 46.4%; female: 53.7%). Almost two-third ( 65.2% ) of the respondents were B.D.S. (Bachelor of Dental Surgery) graduates. Only 29.1% worked in the government hospitals. 17.6% were currently involved in COVID-19 management. Of the participants, 87.7% knew about the condition of the requirement of Personal Protective Equipment (PPE) but only 29.1% could correctly answer the framed question for PPE. The median knowledge score calculated was 14.0 (8.0-18.0). The bivariate analysis showed a statistically significant difference in knowledge score among the age group ≥30 years and < 30 years (p = 0.013); M.D.S. (Master of Dental Surgery) graduate and B.D.S. graduate (0.041); dental surgeons of government healthcare facilities and other healthcare facilities (p <  0.001); dental surgeons of COVID-19 centers and non-COVID-19 centers (0.002). CONCLUSION: The dental surgeons of Nepal have a good knowledge of COVID-19, and they can be utilized for assisting in the management of COVID-19 cases in Nepal.

Dengue among Suspected Patients Admitted to Department of Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Dengue virus incidence has been increasing trends in every year due to the expansion of the vectors Aedes aegypti and Aedes albopictus. The objective of this study was to find out the prevalence of dengue among suspected patients admitted to the department of medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the medicine department from 30 September 2022 to 30 December 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 019/2022). Demographic, clinical characteristics and laboratory profiles were collected from dengue patients by using a structured questionnaire. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 500 patients, 242 (48.40%) (40.66-56.14, 95% Confidence Interval) were found to be dengue positive. The average age of the enrolled patients was 39.13±20.64 years. Most dengue fever patients were diagnosed in the category of dengue with a warning sign of 234 (96.69%). The mean hospital stay of dengue patients was 4.05±2.03 days, 229 (94.62%) of patients stayed less than 7 days before discharge. Conclusions: The prevalence of dengue among suspected patients admitted to the department of medicine is found to be higher than in other similar studies done in similar settings. Patients with clinical symptoms and laboratory findings corroborating with dengue should undergo early diagnosis and facilitate prompt treatment in individual patients. Keywords: dengue virus; public health; tertiary care centre.

Sleep Quality and Its Correlates among Adolescents of Western Nepal: A Population-Based Study.

Sleep quality has a long-term impact on health leading to depression among adolescent students. We conducted a cross-sectional study to assess the prevalence of sleep quality and its associated factors among adolescents of western, Nepal. 514 adolescents from different schools were selected by the probability proportionate to size (PPS) method. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality among adolescents. The collected data were entered in EpiData 3.2 version, then extracted to excel 2019 and was analyzed with the help of RStudio (version 1.2.5033). Frequency distribution and percentage were identified as descriptive analysis whereas chi-square test was done. Variables that were found statistically significant (P < 0.05) were further analyzed using the logistic regression model. The prevalence of sleep quality in this study was 39.1%. In a bivariate analysis, ethnicity, religion, place of residence, drinking status of father, reason for selecting the currently studying faculty, satisfaction with academic performance, use of tobacco, relationship with friends or classmates, more use of internet per day, and use of internet before falling asleep were found to be statistically significant with sleep quality. Those students who left their home without informing their parents were more than three times at the risk of sleep quality than those students who never ran away from their home without informing their parents (AOR = 3.435, CI: 1.237-9.540). The overall prevalence of sleep quality among school going adolescent students was 39.1 percent which was comparatively high.

Investment case approach for equitable access to maternal neonatal and child health services: Stakeholders' perspective in Nepal.

BACKGROUND: Investment Case is a participatory approach that has been used over the years for better strategic actions and planning in the health sector. Based on this approach, a District Investment Case (DIC) program was launched to improve maternal, neonatal and child health services in partnership with government, non-government sectors and UNICEF Nepal. In the meantime, this study aimed to explore perceptions and experiences of local stakeholders regarding health planning and budgeting and explore the role of the DIC program in ensuring equity in access to maternal and child health services. METHODS: This study adopted an exploratory phenomenography design with a purposive sampling technique for data collection. Three DIC implemented districts and three comparison districts were selected and total 30 key informant interviews with district level stakeholders and six focus groups with community stakeholders were carried out. A deductive approach was used to explore the perception of local stakeholders of health planning and budgeting of the health care expenses on the local level. RESULTS: Investment Case approach helped stakeholders in planning systematically based on evidence through collaborative and participatory approach while in comparison areas previous year plan was mainly primarily considered as reference. Resource constraints and geographical difficulty were key barriers in executing the desired plan in both intervention and comparison districts. Positive changes were observed in coverage of maternal and child health services in both groups. A few participants reported no difference due to the DIC program. The participants specified the improvement in access to information, access and utilization of health services by women. This has influenced the positive health care seeking behavior. CONCLUSIONS: The decentralized planning and management approach at the district level helps to ensure equity in access to maternal, newborn and child health care. However, quality evidence, inclusiveness, functional feedback and support system and local resource utilization should be the key consideration.

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.

Out of pocket Expenditure on Health Service Delivery at a Tertiary Care Women's Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Institutional delivery in Nepal is increasing in the past decades and has been the priority program of the government of Nepal. However, due to the hidden costs related to institutional deliveries, the financial burden remains unacceptably high for poor households. The study aimed to find out the major out of pocket expenditure on health service delivery at a tertiary care hospital in Kathmandu, Nepal. METHODS: A descriptive cross-sectional study was carried out at a tertiary care hospital from December 2018 to May 2019. Ethical approval was taken from Nepal Health Research Council (ref. no. 2087) and permission was taken from the hospital. Informed consent was taken from the participants. Convenient sampling was done. A semi-structured questionnaire was used as a tool for the interview. Data was entered into Epidata and analyzed using the Statistical Package of the Social Sciences version 23. Descriptive analysis was done using mean, median, standard deviation, inter-quartile range, frequency, and percentage. RESULTS: The median out of pocket expenditure of the participants to maternal delivery was NRs. 11720 (7610-20263). The median expenditure was found highest for food and drinking NRs. 2500 (1500-5550) and transportation NRs. 2150 (1400-4543) respectively. CONCLUSIONS: Indirect expenditures were found to be higher than direct medical expenditures. Accessibility of the birthing centers and health insurance may reduce the costs related to maternal deliveries.

Status of Maternal and Child Health Seeking Behavior among Women Aged 15-45 Years during Earthquake of 2015 in Nepal: A Mixed Method Study.

BACKGROUND: Delivery of the maternal and child health services are generally affected during the time of disaster. This study aims to assess the maternal and child health service utilization in areas in Nepal affected by the 2015 earthquake. METHODS: A mixed method study was carried in 29 Village Development Committees from nine earthquake-affected districts in Nepal. Quantitative data on maternal, neonatal and child health indicators before and after the earthquake were collected from the Health Management Information System. Focus group discussions and key informant interviews with different stakeholders were conducted to collect qualitative data. Quantitative data was analyzed using Microsoft Excel 2013. Qualitative data was analyzed manually using thematic analysis technique. RESULTS: Most of the indicators were comparable before and after the earthquake. Indicators such as Bacille Calmette-Guerin vs. Measles-Rubella vaccine drop-out rate, 1st antenatal care visit, delivery by skilled birth attendant and 1st postnatal care visit within 24 hours of delivery improved after the earthquake. Though most of the health facilities were damaged, health services resumed under tents or in open spaces. Some of the common problems among pregnant women included stomachache, headache, malnutrition, diarrhea, and mental stress. CONCLUSIONS: There was not much effect in the delivery of maternal neonatal and child health services. This reflects the coordinated efforts from government as well as non-government organizations and civil societies during and after the earthquake in Nepal.

Effect of nutrition education on hemoglobin level in pregnant women: A quasi-experimental study.

BACKGROUND: Anemia during pregnancy is a major public health problem globally with multiple causes including inadequate dietary intakes. The aim of the study was to assess the effect of nutrition education on nutritional knowledge, hemoglobin level and dietary intake of anemic pregnant women. MATERIALS AND METHODS: A quasi-experimental study was conducted among 115 mild to moderately anemic pregnant women attending ante natal clinics. Pregnant women were consecutively enrolled and assigned to receive nutrition education and diet plan in intervention group (n = 58) and general education only in control group (n = 57). The nutrition education was given to pregnant women on individual basis at the time of enrollment and follow-ups were done through biweekly phone calls and every 4 weeks during ANC visits. Baseline data were collected using semi-structure questionnaire for interview and hemoglobin level was also measured. Data were collected after 10 weeks of nutrition education intervention. Independent sample t-test was used to compare differences between the two groups. RESULTS: Out of 115 pregnant women enrolled, 107 completed the study (Intervention: 53; Control: 54). At the end of the nutrition education intervention and iron rich food based diet plan, the change in hemoglobin level was significantly high in the intervention over control group [0.56±0.40gm/dl vs. 0.16±0.82gm/dl, p = 0.002]. The change in the maternal nutritional knowledge score on anemia and iron rich foods was significantly high in the intervention over control group [8.26±4.57 vs. 1.05±6.59, p<0.001].Consumption of iron rich food was significantly high in the intervention group (P<0.05). CONCLUSION: Provision of nutrition education and iron rich food based diet plan was significantly associated with improved hemoglobin levels, improved dietary intake and nutritional knowledge on anemia and iron rich foods.

Association of Lifestyle and Food Consumption with Bone Mineral Density among People Aged 50 Years and Above Attending the Hospitals of Kathmandu, Nepal.

BACKGROUND: Bone mineral density (BMD) is the measure of the minerals, mostly calcium and phosphorous, contained in certain volume of bone to diagnose osteoporosis. The aim of the study was to find out the association of lifestyle and food consumption with BMD. METHODS: An analytical cross-sectional study was conducted among 169 people of age 50 years and above who underwent Dual Energy X-Ray Absorptiometry (DEXA or DXA) scan in the hospitals of Kathmandu valley of Nepal. Food frequency questionnaire and 24-hour recall methods were followed. The DXA reports of the participants were observed to identify osteoporosis. Chi-square test, independent sample t-test, and binary logistic regression were applied to explore the association of BMD with different variables. RESULT: The prevalence of osteoporosis, osteopenia, and normal BMD was 37.3%, 38.5%, and 24.2%, respectively. The prevalence of osteoporosis increased with sex and age (AOR 3.339, CI: 1.240-8.995, p-value 0.017; AOR 3.756, CI: 1.745-8.085, p-value 0.001), respectively. Higher BMI was associated with lower odds of osteoporosis (AOR 0.428, CI: 0.209-0.877, p-value 0.020). Smoking had bad effect on the health of bone (AOR 3.848, CI: 1.179-12.558, p-value 0.026). Daily dietary calcium intake had negative association with osteoporosis with the p-value of 0.003; however, the daily consumption of vitamin D rich food had no association with osteoporosis. CONCLUSION: High prevalence of osteoporosis and osteopenia was found in older people. Osteoporosis was found to be significantly associated with sex, age, lower BMI, smoking habit, and daily calcium consumption. Further research can be conducted by making the relationship of calcium consumption with the numerical T-value of scanned body parts.