BackgroundMaternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers.MethodsWe conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis.ResultsIrregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center.ConclusionThe rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.
Background Physical activity is believed to enhance body functions and sense of wellbeing in general population. Objectives This study aimed to explore physical activity measures; and the association between those measures, and mental wellbeing among older adults in South and Southeast Asia. MethodsA systematic search was made in CINHAL, EMBASE, PubMed, and PsycINFO. Articles published between 2008 and 2018 were selected with participants aged 60 years and above, living at home, community, supported housing, or residential care homes, with no diagnosed/limiting illness. Results Five observational and four interventional studies on physical activity were analysed. Depression and sleep quality were the commonest outcome variables. Exercise frequency, regularity, and duration were found to positively impact mental wellbeing. Conclusion Physical activity was generally found protecting against depression and improved sleep quality of older adults from South and Southeast Asia. Future studies should focus on more objective measures of physical activity.
Summary. This paper assesses the factors influencing mistimed and unwanted pregnancies in Nepal separately using data from the 2011 Nepal Demographic and Health Survey. Women who had given birth within the five years before the survey were interviewed about the intendedness of their last pregnancy. The data were analysed with a chi-squared test, followed by multiple logistic regression analysis. Among the total 5391 participants, 11.29% and 13.13% reported their last pregnancy as mistimed and unwanted respectively. Logistic regression analysis showed that women from the hill region were more likely to report mistimed pregnancy, while women from the Western and Far-Western development regions were less likely to report mistimed pregnancy. Education status was positively correlated with the reporting of mistimed pregnancy. Women involved in agriculture, with full autonomy on household decision, with some exposure to mass media, belonging to higher age group and having third or higher parity were less likely to report mistimed pregnancy. Similarly, women from the Western development region had relatively higher odds of reporting unwanted pregnancy. Women with husbands involved in a paid job had lower odds of unwanted pregnancy. Women's autonomy was also positively correlated with unwanted pregnancy. Women with the intention to use contraceptive had lower odds of unwanted pregnancy. Interventions targeting the factors identified by this study could be useful in reduction of mistimed and unwanted pregnancies among Nepali women.
BackgroundThe prevalence of hypertension is increasing in Nepal. Thus, there is a need for a programme to improve primary healthcare. One possibility is to assign prevention, diagnosis, and treatment of hypertension to female community health volunteers (FCHVs).ObjectiveTo assess literacy and motivation to be involved in a hypertension prevention and control programme in Nepal among FCHVs.DesignFive focus group discussions (FGDs) were conducted with a total of 69 FCHVs in Lekhnath municipality, Kaski district, Nepal. Seven themes were developed on the basis of data collection: 1) knowledge about hypertension; 2) risk factors of hypertension; 3) prevention and control of hypertension; 4) access to treatment for hypertension in the community; 5) learning about blood pressure measurement; 6) ability to raise blood pressure awareness in the community; 7) possible challenges for their future involvement. Data were analysed using the thematic analysis approach.ResultsFCHVs have some knowledge about diagnosis, risk factors, and complications of hypertension. General unanimity was observed in the understanding that hypertension and risk factors needed to be addressed. The willingness of FCHVs to contribute to prevention, control, and management was strong, and they were confident that with some basic training they could obtain skills in hypertension management.ConclusionsDespite limited knowledge about hypertension, FCHVs expressed willingness and readiness to be trained in hypertension management. This study supports the possibility of involving FCHVs in prevention and control of hypertension in Nepal.
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