Female Community Health Volunteers Research Articles

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.

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.

Role of female community health volunteers in the prevention and early detection of chronic kidney disease in Nepal

Role of female community health volunteers in the prevention and early detection of chronic kidney disease in Nepal

Sustainability of a 12-month lifestyle intervention delivered by community health workers in reducing blood pressure in Nepal: 5-year follow-up of the COBIN open-label, cluster randomised trial

The sustainability and scalability of limited-duration interventions in low-income and middle-income countries remain unclear. We aimed to investigate the sustainability in reduction of blood pressure through a 12-month lifestyle intervention led by community health workers to reduce blood pressure in Nepal, 4 years after the intervention ceased. The Community-Based Intervention for Control of Hypertension in Nepal (COBIN) trial was a non-blinded, cluster-randomised trial done in Kaski, Nepal. Adults aged 25-65 years were eligible. People were excluded if they declined consent, were severely ill, unlikely to be in the community throughout the intervention, or pregnant. During the 12-month intervention, female community health volunteers (FCHVs) visited participants in the intervention groups and provided lifestyle counselling and blood pressure measurement every 4 months. At the end of the 12-month intervention, systolic blood pressure was significantly lower in the intervention group than in the usual care group in all cohorts, ranging from -2·3 mm Hg (95% CI -3·8 to -0·8) lower in those with normal blood pressure to -4·9 mm Hg (-7·8 to -2·0) in the hypertensive cohort. The primary outcome for this follow-up study was a mean change in systolic blood pressure from baseline to follow-up at 60 months. We did an intention-to-treat analysis. Between April 1, 2015, and Dec 31, 2015, 1638 participants were recruited in COBIN (939 [57·3%] assigned to intervention and 699 [42·7%] assigned to usual care). Of the 1468 (89·6%) who completed the 12-month assessments, we followed up 1352 (92·1%) participants at 60 months, between Oct 11, 2020, and May 5, 2022. 964 (71·3%) participants were women and 388 (28·7%) were men. From baseline to 60 months, the mean systolic blood pressure increased by 10·4 mm Hg (95% CI 9·1-11·6) in the intervention group and 6·0 mm Hg (4·6-7·5) in the usual care group (adjusted mean difference 4·1 mm Hg [2·2 to 5·8]). Lifestyle counselling and blood pressure monitoring by community health workers is effective in substantially reducing blood pressure while adults are being monitored in a trial but, following cessation of the intervention, this benefit is not maintained in the long term, with potential for harm. This finding could have important implications for funders and research communities to regularly target participants for education and follow-up at an optimal timepoint to reduce any likelihood of harm. Monash University (Melbourne, VIC, Australia) and the Jayanti Memorial Trust (Kathmandu, Nepal). For the Nepali translation of the abstract see Supplementary Materials section.

Assessment of knowledge of diabetes mellitus among female community health volunteers (FCHV) of Jiri, Nepal

Introduction: Type 2 diabetes mellitus (DM) has become a global epidemic with significant disability and premature death. Identification of the level of knowledge related to diabetes among the health workers is important in strategies for prevention of diabetes mellitus. Method: This study was conducted as a community based study in Jiri Hospital in Dolakha district. All the FCHV working in the Dolakha district were selected for this study. Data was collected using Diabetes Knowledge Questionnaire (DKQ). Data was analysed using SPSS programme version 16.0. Result: A total of 90 participants were included in the study. Average score obtained was 15 out of 24. There was not significant association found between educational background and score (p-value=0.8835) No significant difference between the age groups and scores was found (p-value=0.5485). No FCHV’s had received training on diabetes mellitus. Having a family member with diabetes did not impact the obtained score (p-value= 0.9511). Conclusion: This study did not show any relation on knowledge with age, educational background or having a family member with diabetes.

Exploring the feasibility of integrating health, nutrition and stimulation interventions for children under three years in Nepal's health system: A qualitative study.

Community-based primary care settings are a potential entry point for delivering Early Childhood Development (ECD) interventions in Nepal. Past studies have suggested that integrating stimulation with nutrition interventions is an effective way to deliver multiple benefits for children, but there is limited knowledge of how to do this in Nepal. We conducted a qualitative study in Nepal's Dhanusha district to explore how stimulation interventions for early learning could be integrated into existing health and nutrition programmes within the public health system. Between March and April 2021, we completed semi-structured interviews with caregivers (n = 18), health service providers (n = 4), district (n = 1) and national stakeholders (n = 4), as well as policymakers (n = 3). We also carried out focus group discussions with Female Community Health Volunteers (FCHVs) (n = 2) and health facility operation and management committee members (n = 2). We analysed data using the framework method. Respondents were positive about introducing stimulation interventions into maternal and child health and nutrition services. They thought that using health system structures would help in the implementation of integrated interventions. Respondents also highlighted that local governments play a lead role in decision-making but must be supported by provincial and national governments and external agencies. Key factors impeding the integration of stimulation into national programmes included a lack of intersectoral collaboration, poor health worker competency, increased workload for FCHVs, financial constraints, a lack of prioritisation of ECD and inadequate capacity in local governments. Key barriers influencing the uptake of intervention by community members included lack of knowledge about stimulation, caregivers' limited time, lack of paternal engagement, poverty, religious or caste discrimination, and social restrictions for newlywed women and young mothers. There is an urgent need for an effective coordination mechanism between ministries and within all three tiers of government to support the integration and implementation of scalable ECD interventions in rural Nepal.

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic.

The COVID-19 pandemic affected access to antenatal care in low and middle-income countries where anaemia in pregnancy is prevalent. We analyse how health workers provided antenatal care and the factors affecting access to antenatal care during the COVID-19 pandemic in Kapilvastu district in the western plains of Nepal. We used qualitative and quantitative methodologies, conducting eight semi-structured interviews with health workers who provided antenatal care during the pandemic, and a questionnaire containing open and closed questions with 52 female community health volunteers. Antenatal care was severely disrupted during the pandemic. Health workers had to find ways to provide care with insufficient personal protective equipment and guidance whilst facing extreme levels of stigmatisation which prevented them from providing outreach services. Pregnant women were fearful or unable to visit health institutions during the pandemic because of COVID-19 control measures. Pre-pandemic and during the pandemic health workers tried to contact pregnant and postpartum women and families over the phone, but this was challenging because of limited access to phones, and required pregnant women to make at least one antenatal care visit to give their phone number. The pandemic prevented new pregnancies from being registered, and therefore the possibilities to provide services over the phone for these pregnancies were limited. To reach the most marginalised during a pandemic or other health emergency, health volunteers and households need to exchange phone numbers, enabling proactive monitoring and care-seeking. Strengthening procurement and coordination between the municipal, provincial, and federal levels of government is needed to ensure adequacy of antenatal supplies, such as iron folic acid tablets, in health emergencies. Community engagement is important to ensure women and families are aware of the need to access antenatal care and iron folic acid, and to address stigmatisation of health workers.

Management of COVID-19 and vaccination in Nepal: A qualitative study.

The aim of this research is to investigate the perspective of citizens of Nepal on the management COVID-19, the roll-out of the vaccine, and to gain an understanding of attitudes towards the governments' handling of the COVID-19 pandemic. A qualitative methodology was used. In-depth interviews were conducted with 18 males and 23 females aged between 20 and 86 years old from one remote and one urban district of Nepal. Interviews were conducted in November and December 2021. A thematic approach was used to analyse the data, utilising NVivo 12 data management software. Three major themes were identified: (1) Peoples' perspective on the management of COVID-19,(2) people's perception of the management of COVID-19 vaccinationand (3) management and dissemination of information. It was found that most participants had heard of COVID-19 and its mitigation measures, however, the majority had limited understanding and knowledge about the disease. Most participants expressed their disappointment concerning poor testing, quarantine, vaccination campaignsand poor accountability from the government towards the management of COVID-19. Misinformation and stigma were reported as the major factors contributing to the spread of COVID-19. People's knowledge and understanding were mainly shaped by the quality of the information they received from various sources of communication and social media. This heavily influenced their response to the pandemic, the preventive measures they followedand their attitude towards vaccination. Our study concludes that the study participants' perception was that testing, quarantine centres and vaccination campaigns were poorly managed in both urban and rural settings in Nepal. Since people's knowledge and understanding of COVID-19 are heavily influenced by the quality of information they receive, we suggest providing contextualised correct information through a trusted channel regarding the pandemic, its preventive measuresand vaccination. This study recommends that the government proactively involve grassroots-level volunteers like Female Community Health Volunteers to effectively prepare for future pandemics. This study was based on in-depth interviews with 41 people from diverse socioeconomic backgrounds. This study would not have been possible without their participation.

Nutritional status and its associated factors among under five years Muslim children of Kapilvastu district, Nepal.

Malnutrition is a major public health problem throughout the world especially in Southeast Asia. This study aims to find out nutritional status and its associated factors among under five Muslim children of Kapilvastu district Nepal. Community based cross-sectional study was conducted among 336 under five Muslim children in Kapilvastu district Nepal from December 2021 to May 2022. Multistage probability random sampling was used. Among ten local units, three were selected randomly. Then from selected three units, two wards from each unit which covers large proportion of Muslim were selected purposively. After selecting wards, listing of household having children 6 to 59 months was done with the help of Female Community Health Volunteers and 56 children were selected by simple random sampling from each wards. About half of Muslim children were underweight, 0.9% were overweight, 17.3% were wasted and 63.1% were stunted. Children with >4 members in family (AOR = 2.82, CI: 1.25-6.38), joint/extended family (AOR = 0.33, CI: 0.16-0.68), living with other than parents (AOR = 2.68, CI: 1.38-5.21), mother having primary (AOR = 2.59, CI: 1.09-6.10) and fathers having SLC and above education (AOR = 0.41, CI: 0.19-0.89), school going children (AOR = 0.27, CI: 0.15-0.48), no having agricultural land (AOR = 2.68, CI: 1.55-4.65), history of chronic diseases (AOR = 3.01, CI = 1.06-8.54) were significantly associated with underweight. Mothers having secondary (AOR = 0.30, CI: 0.10-0.88) and fathers having primary education (AOR = 3.50, CI: 1.26-9.74), school going children (AOR = 0.16, CI: 0.06-0.41), no having own land (AOR = 4.73, CI: 2.13-10.48), history of child chronic disease (AOR = 3.55, CI = 1.38-9.12) were significantly associated with wasting. Similarly, male children (AOR = 1.70, CI: 1.01-2.85), living in rural area (AOR = 0.17, CI: 0.09-0.31), joint/extended family (AOR = 0.28, CI: 0.13-0.64), living with other than parents (AOR = 3.71, CI: 1.84-7.49), fathers having secondary education (AOR = 0.50, CI: 0.27-0.94) and no having own land (AOR = 1.95, CI: 1.13-3.37) were significantly associated with stunting. Underweight, wasting and stunting in under-five Muslim children were above the cutoff point from the significant level of public health and higher than national data. Hence, this study suggests collaborative and immediate attention from responsible governmental and non-governmental organizations working in nutrition for providing informal learning opportunity, intervention regarding parental support to child, school enrolment at appropriate age, prevention and treatment of children's chronic diseases, intervention for income generating activities and addressing problems of household food insecurity among Muslim communities.