Background Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016. Objectives We aimed to study factors and key enablers of child stunting reduction in Peru from 2000–2016. Methods Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca–Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru. Results The distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation. Conclusions Peru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru's experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors.

Background Chronic child malnutrition represents a serious global health concern. Over the last several decades, Nepal has seen a significant decline in linear growth stunting – a physical manifestation of chronic malnutrition – despite only modest economic growth and significant political instability. Objective This study aimed to conduct an in-depth assessment of the determinants of stunting reduction in Nepal from 1996 to 2016, with specific attention paid to national-, community-, household-, and individual-level factors, as well as relevant nutrition-specific and -sensitive initiatives rolled out within the country. Methods Using a mixed-methods approach, 4 types of inquiry were employed: 1) a systematic review of published peer-reviewed and gray literature; 2) retrospective quantitative data analyses using Demographic and Health Surveys from 1996 to 2016; 3) a review of key nutrition-specific and -sensitive policies and programs; and 4) retrospective qualitative data collection and analyses. Results Mean height-for-age z-scores (HAZ) improved by 0.94 SDs from 1996 to 2016. Subnational variation and socioeconomic inequalities in stunting outcomes persisted, with the latter widening over time. Decomposition analysis for children aged under 5 y explained 90.9% of the predicted change in HAZ, with key factors including parental education (24.7%), maternal nutrition (19.3%), reduced open defecation (12.3%), maternal and newborn health care (11.5%), and economic improvement (9.0%). Key initiatives focused on decentralizing the health system and mobilizing community health workers to increase accessibility; long-standing nationwide provision of basic health interventions; targeted efforts to improve maternal and child health; and the prioritization of nutrition-sensitive initiatives by both government and donors. National and community stakeholders and mothers at village level highlighted a mixture of poverty reduction, access to health services, improved education, and increased access to water, sanitation, and hygiene as drivers of stunting reduction. Conclusions Improvements in both nutrition-specific and nutrition-sensitive sectors have been critical to Nepal's stunting decline, particularly in the areas of poverty reduction, health, education, and sanitation.

ObjectivesOur study aimed to assess local data for compliance with IFA supplementation and prevalence of anaemia among the pregnant mothers visiting government health facilities of eastern Nepal.ResultsIn our study samples, IFA compliance rate was 58% during pregnancy and 42% were anaemic. Anemia was 24 times more likely to occur in IFA noncompliant women during pregnancy than their counterparts (aOR = 24.2, 95% CI 10.1–58.3), and anemia was three times less likely to be found in those taking foods rich in heme–iron than their counterparts (aOR = 3.3, 95% CI 1.4–8.1).

Social media, one of the greatest tools for sharing information, are used for various purposes in health like educational and promotional activities, communication - of research findings and during crisis readiness. In addition, online conference and webinar for health purpose, e-procurement of health commodities and telemedicine are some domains where we use social media. In contrast to these, it brings out various ill impacts on health directly or indirectly, such as cyberbullying, depression, anxiety, sleep disorders, physical inactivity- a boost factor for non-communicable diseases and internet addiction. As this field is new in health and being used innovatively, issues of their effectiveness, privacy and confidentiality begin to rise. Moreover, authenticity of the health information available on social media is another issue, all of which need guidance by evidence based acts and regulations. Else, it may harm the belief of users on the platform, which is the future for health information sharing. With very few researches done regarding the use of internet and social media, and increasing addiction towards them possesses an extra threat to health in Nepal. Hence, research regarding possible hazards of social media use and relative effectiveness of social media over other communication channel is needed, to develop necessary strategies to overcome possible threats to health and utilize social media for health to its optimum potential.

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 (β = 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.

Background Different areas of disparities remain a concern in developing countries like Nepal regarding the utilization of maternal, neonatal and child health services like disparities in education, income, administrative regions, ethnic groups, province-level etc. In order to support equitable outcomes for Maternal, Neonatal and Child Health (MNCH) and to scale-up quality services, an Investment case was launched by developmental partners in the Asia-Pacific region. Investment Case (IC) at the local level aims to develop a coherent plan with local level development plans, which is equitable and responsive to the bottlenecks and the local needs. The study aims to identify the factors affecting equitable access to maternal health services in Nepal. Methods The study focuses on the impact of the intervention package developed by applying the investment case (IC) approach in maternal and child health services in Nepal introduced in 2011. Complex sample analysis was carried out to adjust the weight of the sample. Cross tabulation with Confidence Interval (CI) was used to generate weighted disaggregated data. Difference in Difference (DiD) analysis was carried out using a linear regression model. Finally, multivariate linear regression was carried out to figure out the effect of the intervention. Results Based on the data, the improvements before and after the intervention were calculated in both the intervention and comparison districts; no variables showed a significant association. Changes were similar for intervention and comparison areas: four antenatal care seeking (DiD=-4.8, p = 0.547 CI= -0.041-0.022), Skill Birth Attendance (SBA) delivery (DiD = 6.6, p = 0.325, CI= -0.010-0.039). Multivariable regression analysis also did not reveal any significant improvement in aggregate outcomes. The intervention did not play a significant role in any variables, i.e., four antenatal care seeking (p-value 0.062), SBA delivery (p-value 0.939). Conclusion The IC approach is itself a successful approach in most of the developing countries. After the implementation of IC, some of the MNCH indicators like ANC, SBA delivery have shown improvements in the intervention as well as comparison districts but have not shown significant with the intervention.

Introduction: Tobacco use is the underlying cause of ill health, preventable deaths, and disabilities worldwide. The Tobacco Product Control and Regulation Act 2011 prohibits the sale of tobacco in public places including educational institutions but non-compliance to the law had not been assessed. This study aimed to find out the prevalence of non-compliance to the Tobacco Product Control and Regulation Act among vendors in the vicinities of schools in a metropolitan city. Methods: This descriptive cross-sectional study was conducted in a metropolitan city in August 2018. Ethical approval was taken from Institutional Review Committee [Reference number: 23(6-11-E)2/075/076]. A convenience sampling method was used to recruit vendors within 100 meters radius of secondary schools. The data were collected through face-to-face interviews using a semi-structured questionnaire. Point estimate and 95% Confidence Interval were calculated. Results: Out of total 217 vendors, non-compliance to the section 3 of section 11 of Tobacco Product Control and Regulation Act was found in 195 (89.86%) (85.84-93.88 at 95% Confidence Interval). Among the non-compliers, 110 (56.41%) were selling both smoked and smokeless tobacco products, 78 (40%) were selling smoked and 7 (3.59%) were selling smokeless tobacco products. Conclusions: The non-compliance with Tobacco Product Control and Regulation Act's prohibition of tobacco sales within 100 m of schools in Kathmandu Metropolitan was similar with other studies conducted in similar settings.

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.