Background Chhaupadi is a deeply rooted tradition and a centuries-old harmful religio-cultural practice. Chhaupadi is common in some parts of Karnali and Sudurpaschim Provinces of western Nepal, where women and girls are considered impure, unclean, and untouchable in the menstrual period or immediately following childbirth. In Chhaupadi practice, women and girls are isolated from a range of daily household chores, social events and forbidden from touching other people and objects. Chhaupadi tradition banishes women and girls into menstruation huts’, or Chhau huts or livestock sheds to live and sleep. These practices are guided by existing harmful beliefs and practices in western Nepal, resulting in poor menstrual hygiene and poor physical and mental health outcomes. This study examined the magnitude of Chhaupadi practice and reviewed the existing policies for Chhaupadi eradication in Nepal. Methods We used both quantitative survey and qualitative content analysis of the available policies. First, a quantitative cross-sectional survey assessed the prevalence of Chhaupadi among 221 adolescent girls in Mangalsen Municipality of Achham district. Second, the contents of prevailing policies on Chhaupadi eradication were analysed qualitatively using the policy cube framework. Results The current survey revealed that most adolescent girls (84%) practised Chhaupadi in their most recent menstruation. The Chhaupadi practice was high if the girls were aged 15–17 years, born to an illiterate mother, and belonged to a nuclear family. Out of the girls practising Chhaupadi, most (86%) reported social and household activities restrictions. The policy content analysis of identified higher-level policy documents (constitution, acts, and regulations) have provisioned financial resources, ensured independent monitoring mechanisms, and had judiciary remedial measures. However, middle (policies and plans) and lower-level (directives) documents lacked adequate budgetary commitment and independent monitoring mechanisms. Conclusion Chhaupadi remains prevalent in western Nepal and has several impacts to the health of adolescent girls. Existing policy mechanisms lack multilevel (individual, family, community, subnational and national) interventions, including financial and monitoring systems for Chhaupadi eradication. Eradicating Chhaupadi practice requires a robust multilevel implementation mechanism at the national and sub-national levels, including adequate financing and accountable systems up to the community level.

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Background: Nepal has made a significant improvement in child survival in the last few decades and the involvement of female community health volunteers (FCHVs) has been crucial in such achievement. While there have been many studies on child health in Nepal however, rarely explored the status and factors associated with the child health service provided by these volunteers. This study aimed to identify the factors associated with the child health service delivery by FCHVs. Methods: A national survey was conducted in 2014 in Nepal that included 4302 FCHVs using the structured questionnaire across the 13 geopolitical domains of the country. Factors associated with the use of child health services was examined using Chi-square test (χ 2) followed by logistic regression. Results: Overall, 62.6% of FCHVs provided at least one child health service. Those FCHVs who utilized money from the FCHV fund, conducted health mothers' group meeting, involved in local committees and those who supported antenatal care and outreach clinics related activities had higher odds of providing child health services. Similarly, FCHVs equipped with the stock of Cotrimoxazole tablet, Zinc tablet, Oral Rehydration Salt packets were more likely to provide child health services. The province-wise analysis showed that FCHVs from Province 5 and Sudur Paschim Province were more likely to provide child health services compared to their counterparts from province 1. Technologywise, FCHVs who were using mobile were more likely to provide child health services. Conclusions: FCHVs are important human resource in providing child health services in Nepal. To improve child health service delivery by FCHVs; availability of key commodities, involvement of FCHVs in regular health mothers' group meeting, use of mobile phone, involvement in other public health programs and social networks, and utilization of the FCHV fund need to be taken into consideration.

Social phenomena that are related to human beings cannot be performed under controlled conditions, making it difficult for policy planners to have an idea about the expected future conditions in the society under varying situations and forming policies. However, modelling can be really helpful to planners in these situations. The present paper attempts to find the distributions of age at last conception of women with the help of stochastic modelling for human fertility taking into consideration different parity progression behaviours among couples. This may be helpful to planners for having at least a rough idea of estimated proportion of women of different age groups who will be completing their childbearing and willing to go for sterilization after marriage under different stopping rules regarding desired family size and sex composition of children. Accordingly, these estimates will help planners to optimize the cost and service provision for sterilization programs for women. 1

Chlorhexidine is a broad-spectrum antiseptic, effective on gram positive and gram negative bacteria as well as some viruses, having strong skin binding effect. Randomized controlled trials conducted in South Asian countries have proven that the use of chlorhexidine (4% weight/weight) for cord care can reduce neonatal mortality and prevent severe cord infections. Between 2011 and 2017, Nepal completed nationwide scale-up of the use of chlorhexidine by integrating with ongoing maternal and neonatal health programs, under the leadership of the Child Health Division. The chlorhexidine coverage and compliance study (2017) has revealed that the country has achieved 59% coverage of the intervention to date, with lowest use among home births. The strategy should be further strengthened to ensure that every newborn in need is reached with chlorhexidine. Keywords: Chlorhexidine; cord care; Nepal experience, Newborn.

Chlorhexidine is a broad-spectrum antiseptic, effective on gram positive and gram negative bacteria as well as some viruses, having strong skin binding effect. Randomized controlled trials conducted in South Asian countries have proven that the use of chlorhexidine (4% weight/weight) for cord care can reduce neonatal mortality and prevent severe cord infections. Between 2011 and 2017, Nepal completed nationwide scale-up of the use of chlorhexidine by integrating with ongoing maternal and neonatal health programs, under the leadership of the Child Health Division. The chlorhexidine coverage and compliance study (2017) has revealed that the country has achieved 59% coverage of the intervention to date, with lowest use among home births. The strategy should be further strengthened to ensure that every newborn in need is reached with chlorhexidine.

Back Background ground Ten years ago-in the late 2000s-the government of Nepal was confronted with high infection-attributable neonatal mortality. There was new, locally-generated evidence that use of the antiseptic chlorhexidine for care of the newborn cord stump could substantially reduce the risk of such deaths but-at the time-no global-level recommendation. This paper traces the evolution of chlorhexidine introduction and scale up and documents program performance once the program had reached national scale, in terms of "implementation strength" and population-level "effective coverage." Methods Methods Mixed methods implementation research, including a narrative account of the evolution of the program and results from a large, nationally-representative household survey of 3,661 live births over the preceding 12 months to assess use of chlorhexidine for newborn cord-care. These results are triangulated with survey findings from: a national survey of female community health volunteers (2015), a national survey of health facilities (2015), the Nepal Demographic and Health Survey (2016), and data from the government's Health Management Information System (2016-7). Findings Findings The Ministry of Health, with USAID-funded technical assistance, first piloted the intervention in 4 districts beginning in 2009, decided in 2011 to move forward with national scale-up, and fully expanded delivery of the intervention to national scale by 2017. As of 2017, chlorhexidine was applied to the cord of about 90% of newborns born in health facilities and about 40% of those born at home, for an overall population coverage of approximately 70%. Chlorhexidine for cord-care was found to be in stock in 85% of public hospitals and 75% of peripheral level government health facilities offering childbirth care. C Conclusions onclusions Important lessons can be drawn from this example on factors contributing to successful scale-up. However, the unreached 30% remain particularly vulnerable, as they are disproportionately from among the less affluent; tailored strategies are needed to better reach them. Furthermore, circumstances on the ground are changing and it will require renewed efforts to sustain the gains that have been made. In low-income countries, the burden of infection-attributable newborn deaths is approximately 100-fold greater than in high-income countries. 1 There are several factors accounting for this, notably differences in: resilience (birth