Background: Nepal has made remarkable efforts towards social health protection over the past several years. In 2016, the Government of Nepal introduced a National Health Insurance Program (NHIP) with an aim to ensure equitable and universal access to healthcare by all Nepalese citizens. Following the first year of operation, the scheme has covered 5 percent of its target population. There are wider concerns regarding the capacity of NHIP to achieve adequate population coverage and remain viable. In this context, this study aimed to identify the factors associated with enrolment of households in the NHIP.Methods: A cross-sectional household survey using face to face interview was carried out in 2 Palikas (municipalities) of Ilam district. 570 households were studied by recruiting equal number of NHIP enrolled and non-enrolled households. We used Pearson’s chi-square test and binary logistic regression to identify the factors associated with household’s enrolment in NHIP. All statistical analyses were performed using IBM SPSS version 23 software.Results: Enrolment of households in NHIP was found to be associated with ethnicity, socio-economic status, past experience of acute illness in family and presence of chronic illness. The households that belonged to higher socio-economic status were about 4 times more likely to enrol in the scheme. It was also observed that households from privileged ethnic groups such as Brahmin, Chhetri, Gurung, and Newar were 1.7 times more likely to enrol in NHIP compared to those from underprivileged ethnic groups such as janajatis (indigenous people) and dalits (the oppressed). The households with illness experience in 3 months preceding the survey were about 1.5 times more likely to enrol in NHIP compared to households that did not have such experience. Similarly, households in which at least one of the members was chronically ill were 1.8 times more likely to enrol compared to households with no chronic illness.Conclusion: Belonging to the privileged ethnic group, having a higher socio-economic status, experiencing an acute illness and presence of chronically ill member in the family are the factors associated with enrolment of households in NHIP. This study revealed gaps in enrolment between rich-poor households and privileged-underprivileged ethnic groups. Extension of health insurance coverage to poor and marginalized households is therefore needed to increase equity and accelerate the pace towards achieving universal health coverage.

Background: Nepal’s national social health insurance (SHI) program, which started in 2016, aims to achieve universal health coverage (UHC), but it faces severe challenges in achieving adequate population coverage. By 2018, enrolment and dropout rates for the scheme were 9 percent and 38 percent respectively. Despite government's efforts, retaining the members in SHI scheme remains a significant challenge. The current study therefore aimed to assess the factors associated with social health insurance program dropout in Pokhara, Nepal. Methods: A cross-sectional household survey of 355 households enrolled for at least one year in the national social health insurance program was conducted. A structured questionnaire was used to conduct face-to-face interviews with household heads were conducted using a structured questionnaire. Data was entered in Epi-Data and analysed using SPSS. The factors associated with social health insurance program dropout were identified using bivariate and multiple logistic regression analyses. Results: The findings of the study revealed a dropout prevalence of 28.2% (95% confidence interval: 23.6%-33.2%). Households having more than five members [adjusted odds ratio (aOR) 2.19, 95% CI: 1.22-3.94], belonging to underprivileged ethnic groups (Dalit/Janajati) (aOR 2.36, 95% CI: 1.08-5.17), living on rented homes (aOR: 4.53, 95%CI 1.87-10.95), absence of chronic illness in family (aOR 1.95, 95%CI: 1.07-3.59), perceived good health status of the family (aOR 4.21, 95%CI: 1.21-14.65), having private health facility as first contact point (aOR 3.75, 95%CI: 1.93-7.27), poor availability of drugs (aOR 4.75, 95%CI: 1.19-18.95) and perceived unfriendly behaviour of service providers (aOR 3.09, 95%CI: 1.01- 9.49) were statistically significant factors associated with SHI dropout. Conclusion: In Pokhara, more than one-fourth of households have dropped out of the Social Health Insurance Scheme, which is a significant number. Dropping out of SHI is most commonly associated with a lack of drugs, followed by rental housing, family members’ reported good health status and unfriendly service provider behaviour. Efforts to reduce SHI dropout must focus on addressing drugs availability issues and improving providers’ behaviour towards scheme holders. Increasing insurance awareness, including provisions to change first contact points, may help to reduce dropouts among rented households, which make up a sizable proportion of the Pokhara metropolitan area.

Background. This study aims at determining the factors associated with anemia among pregnant women of underprivileged ethnic groups attending antenatal care at the provincial level hospital of Province 2. Methods. A hospital-based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face-to-face interviews using a structured questionnaire were undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the factors associated with anemia. Analyses were performed using IBM SPSS version 23 software. Results. The overall anemia prevalence in the study population was 66.9% (95% CI, 61.1–72.3). The women from most underprivileged ethnic groups (Terai Dalit, Terai Janajati, and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity. Conclusions. The prevalence of anemia is a severe public health problem among pregnant women of underprivileged ethnic groups in Province 2. Being Dalit, Janajati, and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication, and having inadequate dietary diversity are found to be the significant factors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from the most-marginalized ethnic groups and those with lower education.

Background: This study aims to determine the predictors of anemia among pregnant women of underprivileged ethnic groups attending antenatal care at provincial level hospital of Province 2.Methods: A hospital based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face to face interviews using structured questionnaire was undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the predictors of anemia. Analyses were performed using IBM SPSS version 23 software.Results: The overall anemia prevalence in the study population was 66.9% (95% CI 61.1-72.3). The women from most under-privileged ethnic groups (Terai Dalit, Terai Janajati and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity.Conclusions: The prevalence of anemia is a severe public health problem among the pregnant women of under-privileged ethnic groups in Province 2. Being Dalit, Janajati and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication and having inadequate dietary diversity are found to be the significant predictors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from most-marginalized ethnic groups and those with lower education.