Health Care Services In Nepal Research Articles

Exploring Antenatal Health Care Service Utilization in Nepal: A Comprehensive Analysis

The utilization of maternal health care is one of the important factors in reducing the incidence of maternal mortality. Studies in Nepal and in developing countries shows that various demographic, socio-economic and economic factors are associated with ANC service utilization. The main objective of this study is to identify and examine socio-demographic and economic factors affecting antenatal healthcare service utilization in Nepal. This study used data from the Nepal Demographic and Health Survey 2016 and analyzed the data using logistic regression analysis. This research analyzes ANC (antenatal care) concerning dependent variables: age, birth order, religion, ethnicity, educational attainment, province, residence, and wealth indices. Maternal health has been receiving increased attention in the global health, development, and human rights agenda, representing a priority area for accelerating progress on the SDGs and sustaining the gains of the MDGs. Bivariate analysis was conducted for all variables, and some of them were statistically significant at the 5 percent significance level (since p < 0.05). The dichotomous use of modern maternal healthcare utilization, namely whether a woman utilized maternal health care or not, employed dichotomous logistic regression to determine which factors best explain and predict the outcome of maternal health care utilization during pregnancy. A positive estimated value indicates that the odds favor the event and the event is likely to occur, while a negative value indicates that the event is not likely to occur. ANC visits of women decrease with birth order. Based on empirical results, the major factors for ANC services were income, awareness, access to health care services, and birth order attended. The level of awareness among women about the utilization of maternal healthcare in the study area was low. Maternal healthcare service utilization differed across various components of maternity. It would be better to increase awareness about the utilization of modern maternal healthcare for mothers and improve access to healthcare services in their villages to minimize transportation costs and waiting times from the government's side, thus increasing the utilization of maternal health care services in Nepal.

Hospital Equipment Maintenance Management for Reliable and Effective Health Care Services in Nepal

The management of biomedical engineering instruments accuracy in Nepali hospitals has been a pressing issue, largely attributed to the lack of qualified biomedical engineering operations management teams. This challenge becomes even more complex due to the vast array of biomedical equipment imported from abroad, many of which are not only diverse but also relatively expensive. The primary concern in Nepal is to establish an efficient and competent biomedical equipment accuracy management system that can optimize the precision, longevity, and reliability of these crucial medical devices. The absence of well-organized biomedical engineering operations management teams has far-reaching consequences, as it hinders the healthcare sector's ability to deliver superior and consistent services to patients, ultimately affecting diagnostic accuracy. To overcome this challenge, it is imperative to develop a well-managed and qualified biomedical engineering operations management workforce in hospitals and healthcare centers. This entails the acquisition of modern skills to effectively oversee, test, calibrate, and validate medical devices, thereby extending the lifespan of these instruments and ensuring consistent and accurate diagnostics for reliable healthcare services. The integration of such skills is essential for elevating the standards of healthcare in Nepal and enhancing the well-being of its population.

A cross-sectional assessment of burnout presence among pharmacy professionals at Kathmandu Valley, Nepal

Introduction: Burnout is a significant concern among healthcare professionals, including pharmacists, as it can lead to adverse effects on their well-being, job satisfaction, and patient care delivery. However, no previous study was conducted among pharmacy professionals in Nepal to assess their burnout cases. This study aimed to evaluate burnout presence and explore its associated factors among pharmacy professionals in Nepal. Methods: A cross-sectional study was conducted among pharmacy professionals of Kathmandu Valley, Nepal. The validated Burnout Assessment Tool measured burnout across multiple domains. Data on demographic and work-related characteristics were also collected. Descriptive statistics and Chi-square tests were used to analyze the data and identify significant associations among the variables. Results: Most participants were in the age group of 21–30 (64.7%), had a graduate degree (47.3%), and worked in hospital pharmacy settings (49.1%). Exhaustion was the most common (39.7%) burnout experienced, while mental distance and emotional and cognitive impairment were reported in one-fourth of the participants. Alternatively, only one in five participants showed secondary symptoms of burnout. Gender, working hours, exercise frequency, and substance abuse were significantly associated with burnout domains. Conclusion: This study provides valuable insights into the prevalence and factors associated with burnout among pharmacy professionals in Nepal. The findings highlight the significance of addressing burnout in this crucial healthcare sector, with gender, exercise frequency, and substance use emerging as notable contributors. These results underscore the need for targeted interventions and support systems to promote the well-being of pharmacy professionals and ensure the continued delivery of high-quality healthcare services in Nepal.

Trend Analysis of Maternal Health Care Services in Nepal

This study attempts to analyze the trend in maternal health care utilization: antenatal care, delivery care, and postnatal care in Nepal. Maternal health remains a major challenge in developing countries despite improvements in medical technology and several efforts to improve maternal health care services. This study is based on Nepal Demographic and Health Survey data from 2006, 2011, and 2016. It covers 4,066 women in 2006, 4,148 in 2011 and 3,998 in 2016 for antenatal care. In the study, this analysis is confined to women aged (15-49) who had a live birth in the five years preceding the survey. Data on delivery care were obtained for all births that occurred in the five or two years preceding the survey. This study comprises 2030 women in 2011 and 1,978 women in 2016 aged 15–49 years who had a live birth in the two years preceding the survey on childbirth, and postnatal care. Especially, the study deals with antenatal, delivery care, and postnatal care. There is a substantial increase in the utilization of antenatal care (ANC) by skilled health providers from, 44 percent in 2006 to 84 percent in 2016 respectively. Still, six percent percentage do not seek even one-time ANC care and the percentage of women who seek 4 or more ANC care from a skilled service provider is low. Still, two fifth percent of delivery take place at home. postnatal service is still very low in Nepal. This study’s results suggest the need for efforts to be addressed to improve the use of maternal health care services in Nepal. There is a need to increase the use of postnatal checkup as well as delivery assisted by skilled attendants.

Utilization of Maternal Health Care Services in Province 2, Nepal

This study aims at assessing the utilization of maternal health care service in province 2. Maternal health still remains a public health problem in province 2 though it has been improving in the last decade since the number of women seeking antenatal care has increased. This study helps to analyze the pregnancy risk can be identified, control, managed and contributes to reducing factor the maternal mortality. This study is based on data of Nepal Demographic and Health Survey 2016. The sample size consists of 571 currently married women, age groups 15-49 who had a live birth in the 5 years preceding the survey. This study showed that dependent variables means women who had attend ANC as 4 or more visits and the women who had attended ANC as less than 4 times visits. In this study the utilization of maternal health care based on factors like women’s age, level of education, poor wealth quintile are responsible. In province 2, fewer women are using ANC services. In order to address the existing gap and variation in ANC service utilization, particular attention should be given to women from less education, poor wealthquintile, utilization of services among older age group. In province 2, ANC visit and 4 times is highest of age group 35-49 (44%) followed by 25-34 age group (31%) and least of age group 15- 24 (29%) mothers are using ANC services. While talking about education level, near about one third percent (32%) of respondents do not have any formal education. These factors still make problem to mothers using of ANC services .Special emphasis on women’s education plays a vital role to increase the utilization of maternal health care. This study put forward the need for efforts from government and other agencies should implement the proper policies and programs to bring an improvement in the use of maternal health care services in Nepal.

Comprehensive reproductive health care services during COVID19 in Nepal: An ethical analysis through Reproductive Justice Framework

Reproductive health care services are fundamental human rights of every individual, which are also stated by various international instruments. Nepal is also part of these international commitments and has reflected its commitment in the nation’s plan, strategy, and programs. Though significant efforts have been made to fulfill and improve the sexual and reproductive health care services in Nepal, women and marginalized communities are still deprived of the services. During the COVID-19 pandemic, the utilization of reproductive health services declined which is aggravating the situation and threatening to reverse the progress made so far. The article reviews the accessibility of comprehensive reproductive health services through the framework of reproductive justice during the COVID-19 in Nepal. Reproductive Justice is not only a framework for liberty for marginalized communities but also ethical guidance for policymakers and service providers.

Determinants of Maternal Health Care Utilization in Nepal

This study aims to analyze the determinants of maternal health care utilization in Nepal. Maternal health still remains a public health problem in Nepal though it has been improving in the last decade since the number of women seeking antenatal care and opting for institutional delivery has increased. This study is based on Nepal Demographic and Health Survey data of 2016. The sample size consists of 3998 married women aged 15-49 years who had a live birth in the five years preceding the survey. Bivariate analysis is used to examine the association between adequate ANC visits and institutional delivery. A strong association is observed between women’s higher level of education and women involved in non-agricultural occupation with receipt of antenatal care and choosing of institutional delivery. The study findings conclude that there is a significant gap among different sub-groups of women in Nepal in the utilization maternal health care based on factors like women’s age, place of residence, level of education, occupation and wealth status. In order to address the existing gap and variation in ANC service utilization, particular attention should be given to women from less education, poor wealth quintile, living in rural areas, utilization of services among older age group. The results of this study put forward the need for efforts from government bodies and agencies in implementation of appropriate policies and programs to bring an improvement in the use of maternal health care services in Nepal.

Study of the impact of a telemedicine service in improving pre-hospital care and referrals to a tertiary care university hospital in Nepal.

Background:Telemedicine is a process which involve medical experts to exchange valid information for diagnosis, clinical management, treatment and counseling for both healthcare workers and patients remotely in rural setting from urban healthcare center. Providing quality healthcare services in Nepal is challenging due to many reasons such as difficult geographic terrain, limited availability of funding and many other issues.Methods:The study design was a cross sectional and will adopt an interpretative case study approach which supports the researcher to develop a deep insight in to study phenomenon and outcomes. Study was conducted at in two rural-telemedicine programme implementation sites, namely Patle, Fikkal Bazaar and one central consultation site BPKIHS Dharan.Result:A total of 315 patients were undergone teleconsultation process during the study period. The total patients consulted after teleconsultation program in each of center were 1386 (Phikal) and 508 (Patle). Among them 205 (Phikal) and 110 (Patle) were called on the teleconsultation day. Among the patients who were seen via teleconsultation, 36 (2.6 %) from Phikal and 22 (4.3%) from Patle were referred to BPKIHS. The total number of referred patient from those center to other center were 327(Phikal) and 208 (Patle) among those referred 205 (Phikal) and 110 (Patle) came during teleconsultation Process.Conclusion:Telemedicine can be used as a critical component in the solution of the healthcare crisis. Telemedicine will be the best as a substitute to improve the access to healthcare, to provide the healthcare cost-effectively. The current paradigm of care can be taken by telemedicine due to which improved health outcomes can be achieved in cost effective Ways.

Diabetes-Related Healthcare Services in Nepal—A Qualitative Exploration of Healthcare Professionals’ Opinions

Healthcare professionals’ level of engagement in diabetes care and their perceptions of challenges to effective diabetes care are key indicators impacting diabetes management. This study investigated diabetes-related healthcare services provided in Nepal, and explored healthcare professionals’ opinions of the barriers to, and strategies for, effective diabetes care. In-depth face-to-face interviews were conducted with thirty healthcare professionals providing healthcare or medication-related services to patients with type 2 diabetes within Kathmandu Valley. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Participants were physicians, dieticians, nurses and pharmacy staff. Diabetes care services varied between healthcare institutions, between healthcare professionals and between patients, with the overall patient-care model reported as sub-optimal. Diabetes related services were mostly limited to physician-patient consultations. Only a few hospitals or clinics provided additional diabetes education classes, and individual dietician or nurse consultations. Limited collaboration, large patient-load and workforce shortages (particularly lack of diabetes educators) were reported as major issues affecting diabetes care. Regulatory measures to address healthcare system barriers were identified as potential facilitators for effective diabetes management. Whilst the findings are specific to Nepal, there are lessons to be learnt for other healthcare settings as the fundamental barriers to optimal diabetes care appear to be similar worldwide.

Comparative analysis of performance of private and public healthcare systems in Nepal

Background: Though government of every country has their own health delivery system, private sector in the delivery of health service is undeniable and same is true for Nepal. Private healthcare services in Nepal are making better efforts as compared to public health care services. The aim of the study was to compare the performance of private and public healthcare systems in Nepal.Methods: A hospital based cross sectional study was conducted in which five hospitals each from private and public healthcare systems were chosen purposively from five developmental regions of Nepal. The patients visiting the healthcare systems were randomly chosen for the study from the admission registers of the hospitals. This study was approved from the Annamalai University, Tamil Nadu (India). Before data collection, permission was taken from corresponding hospital administration and written consent was taken from respondents of the study. Bivariate analysis was performed to compare the performance of the private and public hospitals.Results: Most of the patients visiting the private hospitals were patients with higher education and income. Public hospitals were more accessible and transparent than the private hospital. Doctors’ punctuality and responsibility were higher in public healthcare systems. Overall patient satisfaction and quality of services provided were significantly higher in the private healthcare systems. Fairness, responsiveness and behavior of the health personnel were almost equally satisfactory in both public and private healthcare systems.Conclusions: The overall services quality and patient satisfaction is higher in private healthcare systems so Government of Nepal should focus on improving services quality, facilities of public healthcare systems so that patient can get easily accessible quality health services with better patient satisfaction.

Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements.

Background Nepal has made significant progress against the Millennium Development Goals for maternal and child health over the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural lines. Methods Trends and inequalities in the use of maternal health services in Nepal between 1994 and 2011 were examined using four Nepal Demographic and Health Surveys (NDHS), nationally representative cross-sectional surveys conducted by interviewing women who gave birth 3–5 years prior to the survey. Sociodemographic disparities in maternal health service utilization were measured. Rate difference, rate ratios, and concentration index were calculated to measure income inequalities. Findings The percentage of mothers that received four antenatal care (ANC) consultations increased from 9% to 54%, the institutional delivery rate increased from 6% to 47%, and the cesarean section (C-section) rate increased from 1% in 1994 to 6% in 2011. The ratio of the richest and the poorest quintile mothers for use of four ANC, institutional delivery, and C-section delivery were 5.08 (95% CI: 3.82–6.76), 9.00 (95% CI: 6.55–12.37), and 9.37 (95% CI: 4.22–20.83), respectively. However, inequality is reducing over time; for the use of four ANC services, the concentration index fell from 0.60 (95% CI: 0.56–0.64) in 1994–1996 to 0.31 (95% CI: 0.29–0.33) in 2009–2011. For institutional delivery, the concentration index fell from 0.65 (95% CI: 0.62–0.70) to 0.40 (95% CI: 0.38–0.40) between 1994–1996 and 2009–2011. For C-section deliveries, an increase in concentration index was observed, 0.64 (95% CI: 0.51–0.77); 0.76 (95% CI: 0.64–0.88); 0.77 (95% CI: 0.71–0.84); and 0.66 (95% CI: 0.60–0.72) in the periods 1994–1996, 1999–2001, 2004–2006, and 2009–2011, respectively. All sociodemographic variables were significant predictors of use of maternal health services, out of which maternal education was the most powerful. Conclusion To increase equitable use of maternal health services in Nepal there is a need to strengthen the health system to increase access to and utilization of services among poorer women, those with less education, and those living in remote areas. Beyond the health sector stronger efforts are needed to tackle the root causes of health inequality, reduce poverty, increase female education, eradicate caste/ethnicity based social discrimination, and invest in the development of remote areas.

Human Resources and Logistic Requirements in Problem Based Learning Compared to Traditional Learning

Problem-based learning (PBL) is a student-centered pedagogy in which students learn about a subject in the context of complex, multifaceted, and realistic problems. Working in groups, students identify what they already know, what they need to know, and how and where to access new information that may lead to resolution of the problem along with discussion of the solution within the group. Few medical schools in Nepal have already incorporated problem-based learning into their curricula and other medical schools are planning to adopt. However, when PBL is introduced into a curriculum, it has implications for staffing and learning resources and demands a different approach to timetabling, workload, and assessment. So, issues like human resources requirements and logistic requirements need to address specifically from Nepal Medical Council for the assurance quality of medical education which, in turn, has contributed in enhancing the quality of health care services in Nepal. Hence, this paper is prepared for developing further understanding about major difference between conventional method of Medical education and PBL in relation to human resources requirements and infrastructure. This article ends with some of the important recommendations that could be considered additionally to existing minimum requirements from Nepal Medical Council for the Medical Schools/ Universities in Nepal who are running or planning to implement Problem-based Learning in their curricula. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9530 NOAJ July-December 2013, Vol 3, Issue 2, 46-47

Inequalities in utilization of maternal health care services in Nepal

Purpose – The purpose of this paper is to quantify inequalities in utilization of maternal health care services and measure the relative contribution of different factors affecting it in the context of Nepal. Design/methodology/approach – The paper uses data from the latest round of the Nepal Demographic and Health Survey. Two stages of stratified cluster samplings were used. A total of 13,200 women aged 15-49 were interviewed. Findings – Results of concentration index estimates in three selected indicators suggest considerable inequalities in maternal health care utilization. The decomposition analyses indicate that the critical factors contributing to inequalities in <3 antenatal care visits are poor economic status of households (32 percent) and women (23 percent) and their partners’ illiteracy (23 percent). However, in case of no institutional delivery, apart from the poor economic status of household (51 percent) and women's illiteracy (16 percent), the rural place of residence (21 percent) has emerged as critical factors contributing to inequalities. In case of no postnatal care within a day, birth order (21 percent) becomes a significant factor, next to the poor economic status of the household (41 percent) in terms of the relative contribution to total inequalities. Practical implications – Policies and program targeting maternal health interventions need to consider equity with efficiency in utilization of maternal health care services, and further to achieve the targets of millennium development goal 5 in Nepal. Originality/value – This study is an innovative effort to estimate inequalities in maternal health care services in the context of Nepal by using inequality decomposition model. For the first time, this study estimates the relative contribution of different socioeconomic factors contributing to inequalities in maternal health care services in Nepal.

How Does Schooling Influence Maternal Health Practices? Evidence from Nepal

Women’s schooling is associated with much of the world’s improvement in child survival and maternal and child health since 1960. Evidence for these associations is widely interpreted as representing a causal influence of formal education on health. The relationships of variations in female school attendance at the levels of individuals, populations, and historical periods to reproductive health outcomes raise new questions for comparative educational research concerning the process involved. This article reports the results of a survey designed to test a theoretical model positing that literacy skills acquired by girls in school are retained into their adult years, facilitating their exposure to public health messages in the media, which in turn influence the health knowledge affecting their health behavior as mothers. This survey was conducted in Nepal, a low-income country in which both mass schooling and demographic transition are recent developments, using direct assessment of literacy skills instead of the self-reports or imputation from school attainment levels often used in demographic and health surveys. After a brief review of the relevant studies to provide an empirical basis for

Modelling the effectiveness of financing policies to address underutilization of children's health services in Nepal.

To estimate the price responsiveness of utilization of formal children's health-care services in Nepal and to use this information to model the impact on utilization of subsidies or increases in user fees. A total of 8112 individual observations (of children aged < 15 years) from 2847 households in 274 communities were obtained from the 1996 Nepal Living Standards Survey. A logit model was applied to determine the net impact of price on a parent or caregiver's decision to seek care for a given instance of illness. The model's coefficients were used to calculate the price responsiveness of utilization decisions. Parents or caregivers reported that 9.7% of children (788/8112) had been ill or injured in the previous month. Parents reported that they had sought care in 566 (71.8%) of these cases; care was most frequently sought from public providers. The price elasticity of demand for children's health-care services in the formal sector was estimated at -0.16. As prices rise, the demand curve exhibits continuous and declining price elasticity. Overall, a 100% subsidy of user fees would increase current utilization rates by 56%, while a 100% increase in fees would lead to a drop in utilization of only 12%. The differential in utilization across income groups was substantial after changes in fees were implemented. While the effect of price on the utilization of children's health-care services in Nepal is statistically significant, the size of the impact is modest. Policies to subsidize fees could increase utilization substantially, while fee increases would lead to modest declines in utilization and generate increased revenue.

Mental health patients in primary health care services in Nepal.

Patients attending two primary care settings in Nepal (a village health post and a district hospital outpatient department) were screened for psychiatric morbidity using the Self Reporting Questionnaire. Approximately one-quarter of all patients screened were found to have psychiatric morbidity. Women presenting were found to have higher frequency of "psychiatric caseness" than men. All these psychiatric patients presented with physical complaints, none with psychological, and the most common physical symptoms presented were abdominal pain, headache and cough. Health worker recognition of these cases was 29% in the health post and 0% in the hospital. Conclusions are drawn regarding the need for sufficient and relevant psychiatric teaching in health worker curriculae.

Construction and Validation of a Women’s Autonomy Measurement Scale with Reference to Utilization of Maternal Health Care Services in Nepal

Women's autonomy is one of the predictors of maternal health care service utilization. This study aimed to construct and validate a scale for measuring women's autonomy with relevance to developing countries. We conducted a study for construction and validation of a scale in Rupandehi and further validated in Kapilvastu districts of Nepal. Initially, we administered a 24-item preliminary scale and finalized a 23-item scale using psychometric tests. After defining the construct of women's autonomy, we pooled 194 items and selected 24 items to develop a preliminary scale. The scale development process followed different steps i.e. definition of construct, generation of items pool, pretesting, analysis of psychometric test and further validation. The new scale was strongly supported by Cronbach's Alpha value (0.84), test-retest Pearson correlation (0.87), average content validity ratio (0.8) and overall agreement- Kappa value of the items (0.83) whereas all values were found satisfactory. From factor analysis, we selected 23 items for the final scale which show good convergent and discriminant validity. From preliminary draft, we removed one item; the remaining 23 items were loaded in five factors. All five factors had single loading items by suppressing absolute coefficient value less than 0.45 and average coefficient was more than 0.60 of each factor. Similarly, the factors and loaded items had good convergent and discriminant validity which further showed strong measurement capacity of the scale. The new scale is a reliable tool for assessing women's autonomy in developing countries. We recommend for further use and validation of the scale for ensuring the measurement capacity.