Female Community Health Volunteers Research Articles

P029 PERCEPTIONS AND PERSPECTIVES OF RURAL NEPALESE PATIENTS WITH HYPERTENSION: A QUALITATIVE STUDY GUIDED BY THE LEVESQUE FRAMEWORK

Background and objective: High blood pressure is a major risk factor for heart disease and stroke. These diseases can be reduced if hypertension is identified, managed and controlled. Disease burden in Nepal is high, resources are limited, and the population is socioeconomically vulnerable. Developing tailored interventions for hypertension management requires understanding of challenges and facilitators of healthcare. This qualitative study investigated barriers and facilitators impacting treatment and control of patients with hypertension in rural Nepal. Methods: We conducted in-depth interviews among hypertensive patients(n=15), medical officers(n=3), Female Community Health Volunteers(FCHVs)(n=9), Frontline Health Workers(FLHWs)(n=15), medical officers(n=3), and local government representatives(n=5) from Panchkhal and Bethanchowk municipalities of Kavrepalanchok district, Nepal. Focus group discussions with FCHVs(n=7) were also conducted. Recordings were coded, transcribed and themes were identified. Patients with hypertension were approached door-to-door by FCHVs. FCHVs and FLHWs were accessed through health facilities. The framework developed by Levesque et al., was used to conceptualize access to care from the viewpoints of various stakeholders. Emerging themes were mapped as the ability to-perceive, seek, reach, pay and engage. Results: Most participants felt the need for care after experiencing symptoms like headaches, dizziness, and blurred vision. Trust in health facilities facilitated care, although unavailability of medicines and insufficient qualified staff were important obstacles. Some used homemade therapies for hypertension control highlighting a gap in awareness of treatment methods. Geographical inaccessibility of health facilities, as well as financial difficulties, were other important barriers identified. Patient's expected prompt service and reduced out-of-pocket expenditure. Medication-taking behavior was influenced by factors including forgetfulness, perceived need and side effects. Support from family, community, and local levels was identified as crucial for hypertension management. Conclusions: This qualitative study highlights the multifaceted challenges for hypertension treatment and control in rural Nepal. Addressing identified barriers and leveraging facilitating factors are essential for reducing hypertension.

P213 UNDERSTANDING THE INFLUENCE OF SOCIAL SUPPORT ON ANTIHYPERTENSIVE MEDICATION ADHERENCE IN URBAN NEPAL: A QUALITATIVE STUDY

Background and objective: Hypertension is a critical public health challenge in Nepal, particularly in urban settings, contributing to the high morbidity and mortality from cardiovascular diseases. Despite the presence of effective treatment options, adherence to antihypertensive medication remains suboptimal. Emerging evidence suggests that social support plays a crucial role in improving medication adherence. This study aims to explore the influence of social support on antihypertensive medication adherence among hypertensive patients in urban Nepalese communities, specifically within the Community-based management of non-communicable disease in Nepal (COBIN cohort) located in the eastern part of Pokhara Metropolitan City, Nepal. Methods: A qualitative study was conducted involving in-depth interviews with 19 hypertensive patients. An individual was eligible if 318 years old, taking antihypertensive medications for 3 two months and living in Lekhnath area of Pokhara. Interviews were conducted by an English-speaking researcher, with support from translator speaking both English and Nepali, using the interview guide. The study utilized a thematic analysis to explore patients’ perceptions and experience related to social support while taking antihypertensive medicines regularly. Results: The findings revealed a complex interplay of positive and negative influences of social support on antihypertensive medication adherence. Positive influence, being reminders from family members and healthcare providers, appeared to improve participants’ self-esteem and self-efficacy on adhering to medications. In contrast, social interactions including suggestions of taking traditional remedies and misinformation about prescribed antihypertensive medications appeared to diminish medication adherence. The role of Female Community Health Volunteers (FCHVs) was overall positive, bridging the gap between healthcare services and community needs, however its sustainability needs to be addressed. Conclusion: Social support is perceived to be pivotal in enhancing medication adherence among hypertensive patients in urban Nepal. Strengthening such support through community-based interventions and enhancing the role of FCHVs could significantly improve health outcomes. This study underscored the need for comprehensive strategies that integrate social support into hypertension management programs in low-resource settings.

Nepal Needs A Two-Pronged Approach to Secure Future of Its Female Community Health Volunteers (FCHVs)

Nepal Needs A Two-Pronged Approach to Secure Future of Its Female Community Health Volunteers (FCHVs)

From stigma to solutions: harnessing local wisdom to tackle harms associated with menstrual seclusion (chhaupadi) in Nepal

In Nepal, menstrual practices, and particularly chhaupadi, impose restrictive norms affecting women’s daily lives. Chhaupadi is a tradition that involves isolating women and girls during menstruation and after childbirth, along with following other restrictions, which have physical and mental health implications. To date, interventions have yet to fully and sustainably address harms associated with chhaupadi across the country. This two-phase study conducted in Dailekh, Nepal facilitated the development of community-created solutions to mitigate chhaupadi’s adverse impacts on women’s health. Using Human Centred Design and a community-engaged approach, the discovery phase identified key stakeholders and contextualised chhaupadi, while the subsequent design phase facilitated the development of five community-created interventions. These included leveraging female community health volunteers (FCHVs) for counselling and awareness, targeting mothers to drive behavioural change, engaging the wider community in behaviour change efforts, empowering fathers to catalyse change at home, and training youth for advocacy. The FCHV intervention concept was selected as the most promising intervention by the women co-design team, warranting broader exploration and testing. Additionally, while it is imperative for interventions to prioritise tackling deleterious aspects of chhaupadi, interventions must also acknowledge its deep-rooted cultural significance and history and recognise the positive aspects that some women may wish to preserve.

Perception of Climate Change Vulnerability and its Impact on Sexual and Reproductive Health and Rights in Khutiya and Banganga River Basins.

Nepal is one of the most vulnerable countries to climate change. The drivers of climate risk include its topography, ecological diversity, climatic variability, natural resource dependency, under-development, and socioeconomic vulnerabilities. Climate change affects women and girls in unique ways. Research conducted in Asia Pacific region highlight negative sexual and reproductive health outcomes from climate change-related stressors such as droughts, floods, and air pollution, factors also linked to decreased SRH services utilization, increased maternal mortality rates, and repercussions on women's mental health. This is a mixed methods study conducted in two river basins including household surveys with 384 females ages 18-49, 12 focus group discussions, and 22 key informant interviews. We conducted descriptive and thematic analysis. More than half relied on agriculture for income (66%). Despite one-third being heads of households, land ownership was low (13%). Climate change perceptions included rising temperatures (88%), increased heat wave (70%), drying water source (99%), and delayed monsoons (83%), impacting agriculture and increasing women's workload (61%) due to displacement and male migration. 64% reported disturbances in antenatal and postnatal care visits . Inaccessible healthcare facilities during the rainy season increased maternal mortality risks. Heavy river flooding hindered female community health volunteers access leading to childbirth complications. 82% of women feared being unable to protect their children post-climate events. Moreover, 21% of women faced gender-based violence during or after climate disasters. Our findings suggest clear impacts of climate change on women and the communities. Thus, climate adaptation efforts must be designed to address the unique impacts of the crisis on women and girls, making space for their increased participation and leadership.

Impact of Suaahara, an at-scale multisectoral nutrition programme, on health workers' maternal and child health, and nutrition knowledge and skills in Nepal.

Suaahara, an at-scale multisectoral nutrition programme in Nepal, aimed to advance knowledge and skills of frontline health workers to improve the quality of nutrition and health services at health facility and community levels. This study assessed the impact of Suaahara interventions on knowledge and skills of health facility workers and Female Community Health Volunteers (FCHVs). The study used a quasi-experimental design in which four Suaahara intervention districts were compared with pair-matched comparison districts. One health facility worker and three FCHVs from each survey cluster were included. Baseline survey consisted of 93 health facility workers (2015) and 118 FCHVs (2012), and endline survey (2022) consisted of 40 health facility workers and 120 FCHVs. Difference-in-differences regression models employing intent-to-treat analysis, accounting for clustering at the district level, assessed the impact of intervention. The intervention, relative to comparison, had no effect on health facility workers' knowledge. There was a positive effect, however, on FCHVs' knowledge in intervention relative to comparison areas on exclusive breastfeeding, timing of introduction of complementary feeding, sick child feeding and growth monitoring and promotion (GMP) for children under 2 years. Health facility workers and FCHVs in intervention versus comparison districts had higher endline scores for skills related to measuring the weight of children and pregnant women, measuring the height/length of children, conducting GMP for children under 2 years and identifying malnourished children. Suaahara interventions improved the capacity of health workers, particularly nutrition-related knowledge among FCHVs and GMP-related skills of both health facility workers and FCHVs.

The costs of Suaahara II, a complex scaled-up multisectoral nutrition programme in Nepal.

Limited evidence exists on the costs of scaled-up multisectoral nutrition programmes. Such evidence is crucial to assess intervention value and affordability. Evidence is also lacking on the opportunity costs of implementers and participants engaging in community-level interventions. We help to fill this gap by estimating the full financial and economic costs of the United States Agency for International Development-funded Suaahara II (SII) programme, a scaled-up multisectoral nutrition programme in Nepal (2016-2023). We applied a standardized mixed methods costing approach to estimate total and unit costs over a 3.7-year implementation period. Financial expenditure data from national and subnational levels were combined with economic cost estimates assessed using in-depth interviews and focus group discussions with staff, volunteers, community members, and government partners in four representative districts. The average annual total cost was US$908,948 per district, with economic costs accounting for 47% of the costs. The annual unit cost was US$132 per programme participant (mother in the 1000-day period between conception and a child's second birthday) reached. Annual costs ranged from US$152 (mountains) to US$118 (plains) per programme participant. Personnel (63%) were the largest input cost driver, followed by supplies (11%). Community events (29%) and household counselling visits (17%) were the largest activity cost drivers. Volunteer cadres contributed significant time to the programme, with female community health volunteers spending a substantial amount of time (27 h per month) on SII activities. Multisectoral nutrition programmes can be costly, especially when taking into consideration volunteer and participant opportunity costs. This study provides much-needed evidence of the costs of scaled-up multisectoral nutrition programmes for future comparison against benefits.

A qualitative study on the adaptation of community programmes for the promotion of early detection and health-seeking of perinatal depression in Nepal

BackgroundDespite the high burden of perinatal depression in Nepal, the detection rate is low. Community-based strategies such as sensitization programmes and the Community Informant Detection Tool (CIDT) have been found to be effective in raising awareness and thus promoting the identification of mental health problems. This study aims to adapt these community strategies for perinatal depression in the Nepalese context.MethodsWe followed a four-step process to adapt the existing community sensitization program manual and CIDT. Step 1 included in-depth interviews with women identified with perinatal depression (n=36), and focus group discussions were conducted with health workers trained in community mental health (n=13), female community health volunteers (FCHVs), cadre of Nepal government for the prevention and promotion of community maternal and child health (n=16), and psychosocial counsellors (n=5). We explored idioms and understanding of depression, perceived causes, and possible intervention. Step 2 included draft preparation based on the qualitative study. Step 3 included a one-day workshop with the psychosocial counsellors (n=2) and health workers (n=12) to assess the understandability and comprehensiveness of the draft and to refine the content. A review of the CIDT and community sensitization program manual by a psychiatrist was performed in Step 4.ResultsThe first step led to the content development for the CIDT and community sensitization manual. Multiple stakeholders and experts reviewed and refined the content from the second to fourth steps. Idioms of depression and commonly cited risk factors were incorporated in the CIDT. Additionally, myths of perinatal depression and the importance of the role of family were added to the community sensitization manual.ConclusionBoth the CIDT and community sensitization manual are grounded in the local context and are simple, clear, and easy to understand.

An anthropological history of Nepal’s Female Community Health Volunteer program: gender, policy, and social change

BackgroundCommunity health workers (CHWs) are central to Primary Health Care globally. Amidst the current flourishing of work on CHWs, there often is a lack of reference to history—even in studies of programs that have been around for decades. This study examines the 35-year trajectory of Nepal’s Female Community Health Volunteers (FCHVs).MethodsWe conducted a content analysis of an archive of primary and secondary research materials, grey literature and government reports collected during 1977-2019 across several regions in Nepal. Documents were coded in MAXQDA using principles of inductive coding. As questions arose from the materials, data were triangulated with published sources.ResultsLooking across four decades of the program’s history illuminates that issues of gender, workload, and pay—hotly debated in the CHW literature now—have been topics of discussion for observers and FCHVs alike since the inception of the program. Following experiments with predominantly male community volunteers during the 1970s, Nepal scaled up the all-female FCHV program in the late 1980s and early 1990s, in part because of programmatic goals focused on maternal and child health. FCHVs gained legitimacy as health workers in part through participation in donor-funded vertical campaigns. FCHVs received a stable yet modest regular stipend during the early years, but since it was stopped in the 1990s, incentives have been a mix of activity-based payments and in-kind support. With increasing outmigration of men from villages and growing work responsibilities for women, the opportunity cost of health volunteering increased. FCHVs started voicing their dissatisfaction with remuneration, which gave rise to labor movements starting in the 2010s. Government officials have not comprehensively responded to demands by FCHVs for decent work, instead questioning the relevance of FCHVs in a modern, medicalized Nepali health system.ConclusionsAcross public health, an awareness of history is useful in understanding the present and avoiding past mistakes. These histories are often not well-archived, and risk getting lost. Lessons from the history of Nepal’s FCHV program have much to offer present-day debates around CHW policies, particularly around gender, workload and payment.

Feasibility of NepaDengue mobile application for dengue prevention and control: user and stakeholder perspectives in Nepal

BackgroundDengue has emerged as a significant public health issue in Nepal since 2006, necessitating innovative approaches to disseminating timely information and promoting preventive behaviour. Our study focuses on developing and...

An analysis of Nepal's federal health system in the context of the COVID-19 pandemic and the Sustainable Development Goals

Nepal's public health slogan was 'Health for All' with integrated community health services in 1991. The female community health volunteer network was created. District Public health offices (DPHO) managed these programs in their districts. After 2008 federalism, 2017 brought federal, provincial, and local governments. The federal health system substituted the administrative District Public / Health Offices in districts. The local governments or health institutions now oversee the Sustainable Development Goals (SDGs). The federal and provincial authorities should have employed qualified professionals to oversee public health at local health facilities. Healthcare efficacy and goal attainment are concerns today. This study did a microscopic investigation using health system studies. The researcher conducted field observations and stakeholder interviews and participated in public discussions. Data from Nepal's federal health system's community status was compared using SWOT analysis. The study delved into specific research gaps thoroughly. According to previous research, health infrastructure could be more effective with financial expenditures. A hypothesis was formed after comparing further information to domestic and international situations. The researcher emphasizes the need for good governance and suggests allocating 6% of national GDP to health spending, in line with WHO recommendations. To fulfil the needs of the healthcare sector, deliver quality medical services, and attain SDGs, it is imperative to ensure the presence of adequately trained health professionals at the local government level. The head of the local health institution must conduct administrative work connected to public health. Hence, public health-trained health staff are needed there.

Knowledge and attitude towards hypertension among female community health volunteers of Bharatpur Metropolitan: a cross-sectional study in Nepal

Background: Hypertension is one of the major non-communicable diseases (NCDs) and becoming a serious public health problem globally. The rising burden of hypertension in Nepal requires a community-based intervention that can be provided through female community healthcare volunteers (FCHVs). Our study aimed to assess knowledge and attitudes towards the prevention of hypertension among FCHVs of Bharatpur Metropolitan (BM). Methods: A community-based cross-sectional study was conducted and face-to-face interview was employed to recruit all the participants (n=207). Frequencies and percentages were used to describe the characteristics of the participants. An Independent t-test was used to determine the association between knowledge and attitude of hypertension with participants’ socio-demographical characteristics. All the tests were carried out at the statistically significant of p value <0.05. Results: The majority of participants (40.6%) belonged to the age group 40 to 49 years. Education (7.7±1.5, p=0.001), religion (7.5±1.7, p=0.017,) and family history of hypertension (7.8±1.7, p=0.018) were statistically significant with the knowledge of hypertension. Similarly, education (9.6±0.9, p=0.000), and self-history of hypertension (9.5±0.7, p=0.014) of participants were statistically significant with the attitude of hypertension. Conclusions: Despite having satisfactory knowledge and attitude on hypertension, some of the participants were unable to identify a systolic and diastolic range of blood pressure for hypertension, risk factors, and complications of hypertension. This study highlighted strengthening targeted orientation programs toward hypertension for the FCHVs to improve their knowledge and beliefs about hypertension.

Exploring the motivations of female community health volunteers in primary healthcare provision in rural Nepal: A qualitative study.

Motivating Community Health Workers (CHWs)-many of whom are volunteers-is crucial for achieving Universal Healthcare Coverage (UHC) for Primary Healthcare (PHC) in resource-poor areas. In rural Nepal, PHC is mostly delivered by female CHWs, locally known as Female Community Health Volunteers (FCHVs), but little is known about them. This paper explores experiential factors influencing FCHVs' motivations, including how motivation intersects with women's livelihoods and consider what this means for achieving PHC in Nepal and globally. We conducted qualitative research in the hill and the Terai (flatland bordering India) areas of Nepal. Data were purposively collected through 31 semi-structured interviews (20 volunteers, 11 paid local health workers) and three focus group discussions with additional 15 volunteers. All interviews were audio-recorded, transcribed verbatim in Nepali and translated into English. Data were coded using NVivo10, analysed thematically at individual, organisational and community levels. FCHVs' motivations to volunteer was affected in several ways. At the individual level, participants wanted and were committed to voluntary work, yet the opportunity costs of volunteering, out-of-pocket expenditure and inadequate family support strained many of the women who were already overburdened. At the community level, perceived lack of appreciation of volunteer efforts by community members, who saw volunteers as paid health workers, undermined FCHVs motivation to volunteer. Finally, at the organizational level, a bureaucratic emphasis on recording and reporting, and lack of respect from local health workers undermined their motivation at work. Our paper illustrates how FCHVs from some of the poorest backgrounds can be highly motivated to volunteer, yet inadequate social and economic support across individual, organisational and community levels undermined this motivation, the security of their livelihoods, and thus wider efforts to achieve PHC. Financial investments are needed to compensate FCHVs, so that they remain motivated to deliver global health goals for PHC.

Awareness of Dengue Disease among Female Community Health Volunteers of Sainamina Municipality, Nepal

Dengue is a mosquito-borne viral infection that is a major public health problem in Nepal. Female community health volunteers play a vital role in dengue prevention and control by providing health education and services to the community. This study aimed to provide a comprehensive understanding of the level of dengue awareness among female community health volunteers in Sainamina Municipality, Nepal. This study involved a cross-sectional survey of 50 female community health volunteers aged 20 and above, actively engaged in health-related activities in Sainamina Municipality. A structured questionnaire was used to gather information on their knowledge of dengue transmission, symptoms, preventive measures, and available treatments. The findings revealed that 98 percentage of the female community health volunteers had a general knowledge of dengue, but there was some confusion regarding the specific mode of transmission. Their knowledge about the signs and symptoms, transmission routes, and preventive measures was inadequate. Only 74 percentage identified that dengue is transmitted through the bite of an infected Aedes mosquito. Additionally, 48 percentage of respondents were able to identify the Aedes mosquito, and 36 percentage knew that there was no specific medicine for dengue patients. Targeted efforts are needed to address the areas of confusion among the female community health volunteers and enhance awareness of comprehensive prevention strategies. It is recommended to conduct training, provide educational materials, and encourage them to share their knowledge with their communities to improve dengue awareness and prevention efforts.

Payment and Motivation: Female Community Health Volunteers in Nepal

The paper attempts to critically discuss the payment issue among Female Community Health Volunteers (FCHV) in Nepal. It examines how the Female Community Health Volunteers experience such issues and the impact on them. The payment issues among Community Health Workers are very contentious, particularly in developing countries. The prevalence of this issue in Nepal merits critical attention. The paper further examines Female Community Health Volunteers’ motivation to work despite the numerous challenges. The paper is based on fieldwork in the Bardiya District of Nepal where most respondents expect to receive some basic remuneration for their service regularly. The question, therefore, arises for examination as to why they are unwilling to leave their position even though they do not receive any financial rewards for community service. Social status, mobility, gaining new knowledge, participating in various programs, and building relationships with others are some of the motivating factors for FCHVs.

Female community health volunteers' experience in navigating social context while providing basic diabetes services in western Nepal: Social capital and beyond from systems thinking.

The global burden of non-communicable diseases (NCDs) has led to an increased mobilization of community health workers (CHWs) in the prevention and management of NCDs, particularly in resource-poor settings. However, little is known about the experiences of CHWs as they navigate the complex social context while proving home-based NCD management. This study aims to explore the experiences of female community health volunteers (FCHVs) in a community-based pilot project in western Nepal, specially regarding the social challenges they face while delivering basic type 2 diabetes (T2D) services. Using a qualitative phenomenological approach, the study conducted two focus group discussions and nine in-depth interviews with a total of 14 and 9 FCHVs, respectively. Social Capital theory was employed to understand the sociological aspects. The findings shed light on the challenges encountered by FCHVs in expanding their social networks, building trust, and fostering reciprocity among T2D intervention recepients. Notably, social trust was a significant challenge, compounded by power dynamics related to gender and socioeconomic status. FCHVs managed to overcome these challenges through their perseverance, self-motivation, and leaveraging their strong bonding and linking social capital. The recognition they received from the community played a crucial role in sustaining their motivation. The study highlights the importance of FCHVs' strong social capital, supported by available resources and personal motivation, in overcoming social obstacles. It is imperative for community health interventions to anticipate challenges across various elements of social capital to ensure the long-term retention and motivation of CHWs. Establishing appropriate support systems that address personal motivating factors and the strengthen social capital is essential.

Adaptation for Balancing Nourishment among Flood-Affected Children

Purpose: The variety of behaviours and solutions that people, families, communities, and organizations use to help kids who struggle with nutrition issues. The study's objective is to equip politicians, healthcare professionals, and educators with information they can use to create interventions that are more focused and long-lasting to find suitable practices of adaptation for overcoming nourishment among children during floods. Design/Methodology/Approach: To develop a thorough understanding of adaption methods for child feeding, the study used both qualitative and quantitative approaches. Female community health volunteers (FCHVs), mothers, and caregivers participated in semi-structured interviews and focus groups where information was obtained. The study also included prior research to give background and a framework for analysis. The area was selected from a highly flood-affected area of Nepal. Data were collected through home visits and in-depth interviews taken with 3-5 years Childrens’ households’ mothers or caregivers. Children's weight height and Mid Upper Arms circumference (MUAC) were measured. Findings/Result: The results of the study reveal a field adaptive approach utilized to handle issues with infant nutrition. Dietary changes, nutrition education that was sensitive to cultural differences, community-based initiatives, legislative measures, and cutting-edge technological advances were all part of the discipline. The study identifies both successful and unsuccessful tactics. Originality/Value: This is the empirical research to recommend a pragmatic solution for nourishment issues among flood-affected children of Nepal. Paper Type: Research paper

Contribution of female community health volunteers on the utilization of ANC and PNC by mothers in two districts of Nepal: a Qualitative study

Background and Objectives: A group that has been credited behind the reduction in child and maternal mortality through programs like immunization, integrated management of childhood illnesses, family planning, and preparing pregnant women for delivery are known as Female Community Health Volunteers (FCHV). FCHVs’ roles have gradually expanded beyond family planning programs and especially are focused on maternal and child health services at a large scale. FCHV is often spoken about or spoken for, but there is little evidence of FCHV's own characterization of their practice. so, this study is designed to explores the roles, practices and experiences of FCHVs in the utilisation of Antenatal care (ANC) and Postnatal Care (PNC) services in two contexts; rural and urban Nepal. Materials and Methods: This is a qualitative study carried out in two districts (one urban and the next rural) viz. Kathmandu and Terathum. Questionnaires leading to in-depth interviews were carried out with 28 FCHVs and 15 service users and Key- Informant Interview with the 8 health facility staff and 15 service users who were purposely selected Data were analyzed using thematic analysis. Results: The study found out that the FCHVs have been involved rigorously on screening and counseling pregnant women on nutritious foods, counseling family about the birth preparedness, institutional delivery, ANC and PNC services provided at the health facility in rural Nepal. While in urban Nepal, the referrals on ANC existed only in those places which were outside the ringroad. The PNC services were not that used by the mothers in rural Nepal while the PNC referrals were not made by urban FCHVs as the maternity hospital itself called for a follow-up. The motivating factors for FCHVs were self-identity, social responsibility and social recognition and status that kept them in doing voluntary workers over the years. Conclusion: FCHVs have been contributing a lot of their time and effort to every possible way to make the women of their community survive while being pregnant or after delivery. This study also underlines some of the differences in the real picture of their roles in urban and rural Nepal.

Perceptions of service providers, service recipients and female community health volunteers on a rural obstetric ultrasound program in rural Nepal: a qualitative study

BackgroundIn rural Nepal, where women face financial and geographic barriers in accessing ultrasound scans, the government initiated a Rural Obstetric Ultrasound Program (ROUSG) to train skilled birth attendants (SBAs) in rural birthing centers and expand access to routine ultrasound scans for local pregnant women. This study explores the perceived benefits and limitations of the training and implementation of this program.MethodsA qualitative study was conducted in 15 primary care facilities in Bhojpur and Dhading, two rural districts of Nepal. The research team conducted in-depth interviews with 15 trained SBAs and focus group discussions with 48 service recipients and 30 FCHVs to gain insight into their perceptions. All interviews and focus group discussions were recorded, reviewed, and manually coded into MS Excel.ResultsOverall, our findings indicated that the ROUSG program was very well received among all our study participants, though critical gaps were identified, mostly during the training of the SBAs. These included insufficient guidance or practice opportunities during training and the challenges of implementing the mobile obstetric ultrasound service. Most importantly, though, our results suggest that the implementation of the ROUSG program increased access to prenatal care, earlier identification and referrals for abnormal scans, as well as reduced pregnancy-related stress. There was also a notable anecdotal increase in antenatal care utilization and institutional deliveries, as well as high satisfaction in both service providers and recipients.ConclusionOur findings highlighted that while the training component could use some strengthening with increased opportunities for supervised practice sessions and periodic refresher training after the initial 21-days, the program itself had the potential to fill crucial gaps in maternal and newborn care in rural Nepal, by expanding access not only to ROUSG services but also to other MNH services such as ANC and institutional deliveries. Our findings also support the use of ultrasound in areas with limited resources as a solution to identify potential complications at earlier stages of pregnancy and improve timely referrals, indicating the potential for reducing maternal and neonatal morbidities. This initial study supports further research into the role ROUSG can play in expanding critical MNH services in underserved areas and improving broader health outcomes through earlier identification of potential obstetric complications.

Awareness of Breast Self-Examination among Female Community Health Volunteers of Pokhara.

Breast self-examination is a simple, inexpensive and effective method of examining the breast by woman herself after 20 years of age in order to detect a breast lump in the early stage. Women should have this knowledge for early detection and treatment of breast cancer. So, the present study aimed to assess awareness of female community health volunteers regarding breast self-examination and the effect of a teaching program. One group pre-test post-test study was conducted among 145 female community health volunteers selected from eight wards of Pokhara Metropolitan using convenient sampling technique. Data was collected using a self-administered questionnaire from 27 March to 23 April 2022. Descriptive and inferential statistics were used for data analysis. Before intervention, around two third of respondents (67.6%) had inadequate and only 1.4% had adequate level of awareness. But after the intervention, 68.3% had adequate level of awareness. The post-test mean awareness score (23.87 ± 4.7) was higher than pre-test mean awareness score (12.97 ± 3.93). Test of significance revealed that increment in the awareness due to a structured teaching program was highly significant (p <0 .001). This study also found that there was difference in the mean pretest awareness score according to educational level of the respondents only. Based on the mean score, the score was significantly higher among women with higher level of education (p=<.001). Around two thirds of female community health volunteers have inadequate level of awareness regarding breast self-examination before the intervention. Educational intervention program was found to be effective in improving their awareness.