Mortality In Nepal Research Articles

An Analysis of Factors Linked to the Decline in Maternal Mortality in Nepal

Nepal experienced a steep decline in maternal mortality between 1996 and 2006, which had again dropped by 2010. The aim of this study was to investigate any trends in factors that may be responsible for this decline. The study was based on a secondary data analysis of maternity care services and socio-demographic variables extracted from the Nepal Demographic Health Surveys (1996, 2001, 2006 and 2011). Complex sample analysis was performed to determine the trends in these variables across the four surveys. Univariate logistic regression was performed for selected maternity care service variables to calculate the average change in odds ratio for each survey. Multivariate logistic regression was performed to determine the trends in the health service uptake adjusting for socio-demographic variables. There were major demographic and socio-economic changes observed between 1996 and 2011: notably fewer women delivering at ‘high risk’ ages, decreased fertility, higher education levels and migration to urban areas. Significant trends were observed for improved uptake of all maternity care services. The largest increase was observed in health facility delivery (odds ratio = 2.21; 95% confidence interval = 1.92, 2.34) and women making four or more antenatal visits (odds ratio = 2.24; 95% confidence interval = 2.03, 2.47). After adjusting for all socio-demographic factors, the trends were still significant but disparities become more pronounced at the extremes of the socio-economic spectrum. The odds ratios for each maternity care service examined decreased slightly after adjusting for education, indicating that improved levels of education could partly explain these trends. The improved utilisation of maternity care services seems essential to the decline in maternal mortality in Nepal. These findings have implications for policy planning in terms of government resources for maternity care services and the education sector.

Antenatal iron‐folic acid supplementation reduces mortality in children less than 5 years of age in Nepal (624.18)

Objective To examine the effect of antenatal IFA supplements on the risk of childhood mortality in Nepal using pooled data from 3 Nepal DHS (2001, 2006 & 2011).Methods Survival information was used from 13,009 singleton most recent live‐born infants. Primary outcomes were mortality indicators in children <5 years and the main exposure variable was any use of IFA supplements. Analyses used multivariate Cox proportional hazards regression adjusted for X potential confounders and the sampling design.Results Any use of IFA supplements significantly reduced risk of neonatal deaths by 42%, and by 45% for early neonatal deaths (aHR: 0.55, 95% CI: 0.38, 0.79, p=0.002). These protective effects of any IFA extended to 4 years of age. For mothers who started <4 months of pregnancy and used 蠅120 supplements under‐5 mortality was significantly reduced by 55%. 15% of under‐5 deaths were attributed to non‐use of IFA, and 29,000 under‐5 deaths could be prevented in the next 5 years with universal coverage of IFA.Conclusion IFA significantly reduces the risk of under‐5 deaths in Nepal, with the greatest impact on child survival in women who started early in pregnancy and took 蠅120 supplements.Grant Funding Source: Supported by UNICEF Nepal

Enhanced iron‐folic acid supplementation program reduces risk of under 5 mortality in Nepal (636.2)

Objective To investigate the impact of a program to improve coverage of antenatal IFA supplementation on child survival in Nepal using pooled data from 3 Nepal DHS (2001, 2006 and 2011).Methods Survival information from 13,009 singleton most recent live‐born infants within the 5 years prior to each interview was used. The primary outcomes were mortality indicators for under‐5 children and the main exposure variable was implementation of enhanced IFA program. Multivariate Cox proportional hazards regression analyses was conducted and adjusted for X potential confounders and the sampling design.Results After the implementation of enhanced IFA program, early neonatal mortality was significantly reduced by 53% (aHR: 0.47, 95% CI 0.26, 0.84, p=0.012) compared to before the program started. The risk of infant mortality was significantly reduced by 49% (aHR: 0.51, 95% CI 0.31, 0.82, p=0.006), and by 38% (aHR: 0.62, 95% CI 0.39, 0.99, p=0.043) for under‐5 mortality after implementation of the enhanced program.Conclusion A program to improve IFA coverage significantly reduced the risk of under‐5 deaths in Nepal by nearly 40%. The greatest magnitude of risk reduction was for early neonatal deaths.

Serological prevalence of tularemia in Sistan and Baluchestan Province

Background: Enteric fever continues to remain amajor cause of morbidity and mortality in Nepal. Likewise, S. Typhi and Paratyphi have developed resistance to antibiotics used so it is required to study the current pattern of resistance to antibiotics. Om hospital has been tracking the records of laboratory confirmed S. Typhi and Paratyphi cases of both male and female cases between the ages 5 years and 55 years to assess the trend in enteric fever. Methods & Materials: In the laboratory, the blood culture containers are immediately incubated at 37◦ C for 48hours using various media like Brain Heart Infusion Browth, Blood Agar base, Muller Hinton and Mac Conkey Agar. The disk diffusion method of Kirby and Bauer is used for sensitivity testing of S. Typhi and S. Paratyphi to antibiotics. Blood culture reports are followed up to 5 days. Subculture is done when there is obvious turbidity in the broth on any day. Results: Out of 6,978 blood culture performed, 306 (4.4%) were enteric fever cases. 110 (36%) cases were S. Typhi and 196 (64%) cases were S. Paratyphi. Among 306 cases of the total S. Typhi and Paratyphi cases, 32 (10.4%), 82 (26.8%), 86 (28.1%), 54 (17.65%) and 37 (12.09%) were from less than five years, five to fifteen years, fifteen to thirty years, thirty to fifty five years and above fifty five years respectively. Similarly, 150 (49.02%) and 156 (50.98%) cases were male and female respectively. 15% of the cases were resistant to azithromycin, cephalexin and amoxicillin and 5% caseswere resistant to cefixime. Conclusion: The study of the enteric fever cases are consistent withother reports fromNepal showinghighburdenof enteric fever. However,we realized that the numbers come fromahospital based study and may not represent the population level estimates. Nevertheless, there are more cases of S. Paratyphi than S. Typhi which indicates the importance of needed intervention for control of S. Paratyphi through measures other than vaccines since there is no vaccine available for paratyphi infection. In addition it is imperative to make a case development of vaccines for preventing enteric fever.

S. typhi and S. paratyphi cases in Om Hospital and Research Center, Kathmandu, Nepal 2010-2012

Background: Enteric fever continues to remain amajor cause of morbidity and mortality in Nepal. Likewise, S. Typhi and Paratyphi have developed resistance to antibiotics used so it is required to study the current pattern of resistance to antibiotics. Om hospital has been tracking the records of laboratory confirmed S. Typhi and Paratyphi cases of both male and female cases between the ages 5 years and 55 years to assess the trend in enteric fever. Methods & Materials: In the laboratory, the blood culture containers are immediately incubated at 37◦ C for 48hours using various media like Brain Heart Infusion Browth, Blood Agar base, Muller Hinton and Mac Conkey Agar. The disk diffusion method of Kirby and Bauer is used for sensitivity testing of S. Typhi and S. Paratyphi to antibiotics. Blood culture reports are followed up to 5 days. Subculture is done when there is obvious turbidity in the broth on any day. Results: Out of 6,978 blood culture performed, 306 (4.4%) were enteric fever cases. 110 (36%) cases were S. Typhi and 196 (64%) cases were S. Paratyphi. Among 306 cases of the total S. Typhi and Paratyphi cases, 32 (10.4%), 82 (26.8%), 86 (28.1%), 54 (17.65%) and 37 (12.09%) were from less than five years, five to fifteen years, fifteen to thirty years, thirty to fifty five years and above fifty five years respectively. Similarly, 150 (49.02%) and 156 (50.98%) cases were male and female respectively. 15% of the cases were resistant to azithromycin, cephalexin and amoxicillin and 5% caseswere resistant to cefixime. Conclusion: The study of the enteric fever cases are consistent withother reports fromNepal showinghighburdenof enteric fever. However,we realized that the numbers come fromahospital based study and may not represent the population level estimates. Nevertheless, there are more cases of S. Paratyphi than S. Typhi which indicates the importance of needed intervention for control of S. Paratyphi through measures other than vaccines since there is no vaccine available for paratyphi infection. In addition it is imperative to make a case development of vaccines for preventing enteric fever.

Clinical profile and outcome of acute encephalitis syndrome (AES) patients treated in College of Medical Sciences-Teaching Hospital

Objective: Acute encephalitis syndrome is a cause of significant morbidity and mortality in Nepal. Although Japanese encephalitis virus (JEV) was thought to be a major cause for acute encephalitis syndrome, more non-Japanese encephalitis virus cases are reported. The outcome of patients with acute encephalitis syndrome is variable. Our study was designed to study the clinical profile and outcome of patients with acute encephalitis syndrome managed in tertiary care center in central Nepal. Methods: The record of patients admitted with diagnosis of acute encephalitis syndrome,from January 2010 to December 2010 in College of Medical Sciences-Teaching Hospital (CMS-TH) was reviewed. They were classified clinically as meningitis, encephalitis and meningoencephalitis. The clinical details and reports of the patients were recorded and analyzed. Results: Total of 85 cases of meningitis and encephalitis were identified. Mean age was 19.18 years. Fifty-six (65.9%) patients were males and 29 (34.1%) were females. Sixty (70.58%) patients had meningitis, 8 (9.41%) had encephalitis, and 17 (20.0%) had meningoencephalitis. JE serology was positive in 4 patients (4.7%). Seventy-two (84.7%) patients made full recovery and were discharged from hospital. Thirteen (15.3%) patients left against medical advice (LAMA). Conclusion: Acute encephalitis syndrome is still a major public health problem in Nepal. Few of these patients have Japanese Encephalitis. There is a trend towards improved outcome because of availability of improved health services. However, financial constraint remains a challenge in management of acute encephalitis syndrome. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 31-37 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9685

Neonatal mortality in Nepal: A multilevel analysis of a nationally representative

ObjectivesThis study investigated individual, community and district level factors associated with neonatal mortality among a national sample of Nepalese women. MethodsData were drawn from the 2006 Nepalese Demographic and Health Survey on women aged 15–49 who delivered within three years prior to the survey (N=4136). Multilevel logistic regression models with three levels were fitted to assess the influences of measured individual, community and district level variables on neonatal mortality. ResultsThe total neonatal mortality in three years preceding the survey was 4.5 deaths per 100 live births (N=190), with neonatal mortality rate (NMR)=46 per 1000 live births. Having a partner with no formal education, being in the middle on the wealth index and residing in less developed district were associated with neonatal death in bivariate analysis. Women who were assisted by skilled personnel during delivery were less likely to have neonatal death (adjusted OR for no assistance = 2.26, 95% CI=1.19–4.26). Having prenatal care with skilled attendant was associated with less likelihood of neonatal death (adjusted OR for no care = 1.75, 95% CI=1.17–2.62). Older women, mother’s education, parity and wealth index were associated with neonatal mortality. Considerable variations in neonatal mortality at community and district levels were found. ConclusionsThese findings emphasize the need for interventions at the individual level with regard to access and utilization of healthcare in order to reduce the neonatal mortality in Nepal.

Unmet need for family planning in Nepal during the first two years postpartum.

Contraceptive use during the postpartum period is critical for maternal and child health. However, little is known about the use of family planning and the determinants in Nepal during this period. This study explored pregnancy spacing, unmet need, family planning use, and fertility behaviour among postpartum women in Nepal using child level data from the Nepal Demographic and Health Surveys 2011. More than one-quarter of women who gave birth in the last five years became pregnant within 24 months of giving birth and 52% had an unmet need for family planning within 24 months postpartum. Significantly higher rates of unmet need were found among rural and hill residents, the poorest quintile, and Muslims. Despite wanting to space or limit pregnancies, nonuse of modern family planning methods by women and returned fertility increased the risk of unintended pregnancy. High unmet need for family planning in Nepal, especially in high risk groups, indicates the need for more equitable and higher quality postpartum family planning services, including availability of range of methods and counselling which will help to further reduce maternal, perinatal, and neonatal morbidity and mortality in Nepal.

Cesarean deliveries among Nepalese mothers: changes over time 2001–2011 and determinants

To examine the most recent trends of cesarean delivery in Nepal and the association with socio-demographic characteristics of mothers. Nationally representative cross-sectional data was used from three Demographic and Health Surveys conducted in Nepal in 2001 (N = 4,745), 2006 (N = 4,066) and 2011 (N = 4,148). Cesarean section delivery was measured in two categories with yes and no responses for the delivery in their latest pregnancy. Data on socio-demographic variables was obtained by interviewing the participants. The data was analysed using logistic regression models. The prevalence of cesarean section delivery was increased by more than 4 times from 2001 to 2011 both among rural and urban residents. After adjusting for mother's age, number of births in last 5 years and mother's education the prevalence of cesarean section delivery among all mothers was 1.71 times higher in 2006 (OR = 1.71, 95 % CI 1.23-2.37) and increased further in 2011 (OR = 2.42, 95 % CI 1.78-3.30) compared with year 2001. When adjusted for all the variables simultaneously, all variables except births in last 5 years remained significantly associated with cesarean section delivery of the mother. Older age, urban resident, being educated, having educated partners and being rich according to wealth index were associated with cesarean section delivery. The prevalence of cesarean section delivery continues to rise but still lower than the World Health Organization recommended rates. More studies are needed to examine the non-medical reason of increasing rates of cesarean section deliveries and their effect in maternal and infant morbidity and mortality in Nepal.

Factors Associated with Late Diagnosis of Cervical Cancer in Nepal

The majority of cervical cancers, the most prevalent cancer among Nepali women, are diagnosed in advanced stage leading to high mortality in Nepal. The present study explored factors associated with late diagnosis. A cross-sectional study was carried out in two specialized cancer hospitals of Nepal from August 12 to October 12, 2012. Randomly selected 110 cervical cancer patients were interviewed and their medical records were reviewed. Multivariate logistic regression analysis was performed to predict associations. Mean age of patients was 52.7years (SD=10.6), 66% were illiterate and 77% were rural inhabitants. Medical shops (33.6%) and private hospitals (31%) were major first contact points of patients with health care providers (HCP). There was no cervical/per-speculum examination (78.2%) and symptoms misinterpretation (90%) of patients occurred in initial consultation with HCP. Four in every five cases (80.9%) of cervical cancer had late diagnosis. Literate women (adjusted OR=0.121, CI: 0.030-0.482) and women having abnormal vaginal bleeding as early symptom (adjusted OR=0.160, CI: 0.035-0.741) were less likely to suffer late diagnosis. Women who shared their symptoms late (adjusted OR=4.272, CI: 1.110-16.440) and did so with people other than their husband (adjusted OR=12.701, CI: 1.132-142.55) were more likely for late diagnosis. High level of illiteracy among women and their problematic health seeking behavior for gynecological symptoms are responsible for late diagnosis of cervical cancer in Nepal. In the absence of a routine screening program, prevention interventions should be focused on raising awareness of gynecological symptoms and improving health seeking behavior of women for such symptoms.

Risk Factors for Stunting Among Children: A Community Based Case Control Study in Nepal

Stunting, a chronic condition, is an underlying cause of child morbidity and mortality in Nepal. This study intends to identify the factors causing stunting among children that will help to prioritize the strategies at the district level. The objective of the study was to identify the risk factors for stunting among children of age between 6 to 59 months. The study was based on community-based case control design in the mid-west, Surkhet Nepal from August to September 2010. The cases were stunted children and controls were the children without stunting. Data was collected by interviewing those children's mothers and measured length/height of 118 children as cases and 236 children as controls. Logistic regression analysis was performed to identify the best model of factors leading to stunting. Odds ratio and 95% confidence interval were used as a measure of association. Socio-economic risk factors for stunting comprised mothers without earning (OR=3.11, 95% CI 1.26-7.65), food deficit families (OR=4.26, 95% CI 1.73-10.45) and care taker of the children other than mother (OR=3.02, 95% CI 1.19-7.70). Environmental risk factors for stunting consisted of kitchen without ventilation and children exposed to pesticide. Inappropriate exclusive breast feeding (OR=6.90, 95% CI 2.81-16.97), complementary feeding less than four times a day (OR=3.60, 95% CI 1.32-9.95) and dietary diversity below WHO standard (OR=4.06, 95% CI 1.70-9.67) were factors of stunted children. Diarrhea was found significantly associated with stunting (OR=7.46, 95% CI 2.98-18.65). Stunting was found to be as a result of multiple factors such as socio-economic, environmental and inappropriate feeding practices.

Dengue Virus and Japanese Encephalitis Virus Epidemiological Shifts in Nepal: A Case of Opposing Trends

We report on the changing epidemiology of two important flaviviruses in Nepal: Japanese encephalitis (JE) and dengue viruses. Morbidity and mortality in Nepal is in the thousands since JE was introduced in 1978. Nepal launched an extensive laboratory-based JE surveillance in 2004. Nepal experienced a remarkable reduction in disease burden after mass immunizations from 2005 to 2010, when 2,040 JE infections and 205 JE-related deaths were confirmed. With its emergence in 2006, dengue has become a significant challenge in the country, highlighted by a sudden outbreak in 2010 that resulted in 359 confirmed dengue infections. Currently, both viruses cocirculate in Nepal. Here, we document the remarkable expansion of dengue in Nepal, which urgently requires national surveillance to refine the burden and make recommendations regarding control and prevention programs. We believe that the use of existing JE surveillance network for integrated dengue surveillance may represent the most appropriate alternative.

Multiple drug resistant Vibrio cholerae, Salmonella and Shigella from Nepalgunj Cholera outbreak and different hospitals of Nepal

Diarrhoea is a major health problem throughout the world, and responsible for high morbidity and mortality in Nepal. The crosssectional prospective study was carried out to screen ESBL producer from MDR Vibrio Cholerae, Salmonella and Shigella from 268 diarrhoeal stools from Nepalgunj Cholera outbreak and different hospitals of Nepal during April 2010 to January 2011. The specimens were processed by standard microbiological methods and confirmed with serology. Altogether 14.18% of bacteria were isolated with 8.21% V. cholerae O1 El Tor Ogawa, 2.24% Shigella flexneri B and 3.73% Salmonella spp. Highest bacterial culture (47.36%) were isolated in Kathmandu while highest V. cholerae (77.27%) were isolated in Nepalgunj. The highest number of Salmonella spp. and Shigella spp. were isolated from Kanti Children’s Hospital. Highest bacteria isolation (47.36%) and highest V. cholerae isolation (81.81%) were observed in the August. The bacteria isolation was significantly associated with places and months (p<0.05). However, there was no statistical difference in the bacteria isolation with sex (P>0.05). 100% V. cholerae, 100% Shigella spp. and 80% Salmonella spp. were MDR while only one Salmonella Cholerasuis was found ESBL producer. DOI: http://dx.doi.org/10.3126/njbs.v2i0.7487 Nepalese Journal of Biosciences 2 : 31-39 (2012)

Cholera, Shigellosis and Salmonellosis Incidence Among the People of some Districts of Nepal

Diarrhoea is a major health problem throughout the world, and responsible for high morbidity and mortality in Nepal. The cross-sectional prospective study was carried out to determine the incidence of Cholera, Shigellosis and Salmonellosis with screening of possible extended spectrum â-lactamase producers from 268 diarrhoeal stool samples from Nepalgunj area and different hospitals of Nepal during April 2010 to January 2011. The specimens were processed by standard microbiological methods and the casual organisms confirmed with serology. Altogether 14.18% of bacterial incidence was found with 8.21% incidence of Vibrio cholerae O1, 2.24% of Shigella spp. and 3.73% of Salmonella spp. All isolated Vibrio cholerae O1 were El Tor Ogawa and all Shigella spp. were Shigella flexneri B. Highest bacterial culture positivity (47.36%) were observed in Kathmandu while highest V. cholerae isolation (77.27%) was observed in Nepalgunj. The highest number of Salmonella spp. and Shigella spp. were isolated from Kanti Children’s Hospital. Highest bacterial culture positivity (47.36%) and highest isolation of V. cholerae (81.81%) were observed in August. The bacterial culture positivity was significantly associated with places and months (p <0.05). However, there was no statistical difference in the bacterial culture positivity with sex (P >0.05). 100% Vibrio cholerae, 100% Shigella spp. and 80% Salmonella spp. were multi-drug resistant. Only one Salmonella Cholerasuis was extended spectrum â-lactamase producer. Nepal Journal of Science and Technology Vol. 13, No. 1 (2012) 165-172 DOI: http://dx.doi.org/10.3126/njst.v13i1.7455

“Sometimes they used to whisper in our ears”: health care workers’ perceptions of the effects of abortion legalization in Nepal

BackgroundUnsafe abortion has been a significant cause of maternal morbidity and mortality in Nepal. Since legalization in 2002, more than 1,200 providers have been trained and 487 sites have been certified for the provision of safe abortion services. Little is known about health care workers’ views on abortion legalization, such as their perceptions of women seeking abortion and the implications of legalization for abortion-related health care.MethodsTo complement a quantitative study of the health effects of abortion legalization in Nepal, we conducted 35 in-depth interviews with physicians, nurses, counsellors and hospital administrators involved in abortion care and post-abortion complication treatment services at four major government hospitals. Thematic analysis techniques were used to analyze the data.ResultsOverall, participants had positive views of abortion legalization – many believed the severity of abortion complications had declined, contributing to lower maternal mortality and morbidity in the country. A number of participants indicated that the proportion of women obtaining abortion services from approved health facilities was increasing; however, others noted an increase in the number of women using unregulated medicines for abortion, contributing to rising complications. Some providers held negative judgments about abortion patients, including their reasons for abortion. Unmarried women were subject to especially strong negative perceptions. A few of the health workers felt that the law change was encouraging unmarried sexual activity and carelessness around pregnancy prevention and abortion, and that repeat abortion was becoming a problem. Many providers believed that although patients were less fearful than before legalization, they remained hesitant to disclose a history of induced abortion for fear of judgment or mistreatment.ConclusionsProviders were generally positive about the implications of abortion legalization for the country and for women. A focus on family planning and post-abortion counselling may be welcomed by providers concerned about multiple abortions. Some of the negative judgments of women held by providers could be tempered through values-clarification training, so that women are supported and comfortable sharing their abortion history, improving the quality of post-abortion treatment of complications.

Reducing maternal mortality in Nepal

Please cite this paper as: Bhandari A, Gordon M, Shakya G. Reducing maternal mortality in Nepal. BJOG 2011;118 (Suppl. 2):26–30.

Modeling of malaria incidence in Nepal.

Malaria is a major cause of morbidity and mortality in Nepal. The magnitude of malaria across the country is alarming and varies with location. Therefore, the present study aimed to model malaria incidence rates during 1998 to 2009 in Nepal. Data for the study were obtained from Health Management Information System (HMIS), Ministry of Public Health. A negative binomial model was used to fit malaria incidence rates as a function of year and location and provided a good fit, as indicated by residual plots. In total, 83,345 cases of malaria were reported from 1998 to 2009. The mean incidence rate was 0.30 per 1000 population. The models show trends and spatial variations in disease incidence. There was decreasing trend in the incidence rates of malaria (1998-2004), followed by a more moderate upward trend until 2008, when the rate decreases again. Zero malaria incidences occurred in six districts including Humla, Jajarkot, Manang, Kathmandu, Bhakthapur and Solukhumbu districts for over twelve years. Higher incidence occurred in Kanchanpur, Kailali, Bardiya, Kavre, and Jhapa districts for the study period. Malaria is still a public health problem in Nepal. This study showed a steady decreasing trend in malaria incidence but the numbers of cases are still very high. Higher rates were observed in Terai Region and border areas. These findings highlight the need for more systematic and effective malaria control measures on malaria burden areas of Nepal.

Influence of women's autonomy on infant mortality in Nepal

BackgroundNepalese women lag behind men in many areas, such as educational attainment, participation in decision-making and health service utilization, all of which have an impact on reproductive health outcomes. This paper aims to examine the factors influencing infant mortality, specifically, whether women's autonomy has an impact on infant mortality in the Nepali context.MethodsData were drawn from the Nepal Demographic and Health Survey, 2006. The analysis is confined to 5,545 children who were born within the five years preceding the survey. Association between infant mortality and the explanatory variables was assessed using bivariate analysis. Variables were then re-examined in multivariate analysis to assess the net effect of women's autonomy on infant mortality after controlling for other variables.ResultsThe infant mortality rate (IMR) in the five years preceding the survey was 48 deaths per one thousand live births. Infant mortality rate was high among illiterate women (56 per 1000 live births) and among those not involved in decision making for health care (54 per 1000 live births). Furthermore, infant mortality was high among those women who had more children than their comparison group, who had birth intervals of less than two years, who had multiple births, who were from rural areas, who were poor, whose source of water was the river or unprotected sources, and who did not have a toilet facility in their household.Results from logistic regression show that women's autonomy plays a major role in infant mortality after controlling other variables, such as mother's sociodemographic characteristics, children's characteristics and other household characteristics. Children from literate women had a 32 percent lower chance (OR = 0.68) of experiencing infant mortality than did children from illiterate women. Furthermore, infants of women who were involved in decision-making regarding their own health care had a 25 percent lower (OR = 0.75) chance of dying than did infants whose mothers who were not involved in healthcare decisions.ConclusionInfant mortality is high in Nepal. In this context, mother's literacy and involvement in healthcare decision making appear to be the most powerful predictors for reducing infant mortality. Hence, in order to reduce infant mortality further, ongoing female education should be sustained and expanded to include all women so that the millennium development goals for the year 2015 can be attained. In addition, programs should focus on increasing women's autonomy so that infant mortality will decrease and the overall well being of the family can be maintained and enhanced.

The role of mothers in the management of childhood diarrhoea in Nepal

Diarrhoea is a leading cause of childhood morbidity and mortality in Nepal, a developing country where the larger proportion of the population live in rural areas. Poverty, illiteracy, lack of health care facilities at local level, demographical distribution and traditional beliefs are the major obstacles for getting proper and timely healthcare. There is a necessity to consider the cultural beliefs of different ethnic communities before designing any educational protocol or guideline. Educational protocol or guidelines which respect the local cultural beliefs and stimulate the utilization of their locally available facilities can be easily accepted and would be more suitable to achieve the objectives.

Declining Trends of Infant, Child and Under-five Mortality in Nepal

Demographic and Health Surveys conducted quinquennially in 1996, 2001 and 2006 show that infant, child and under-five mortality in Nepal have declined steadily at least over the past 25 years. Estimates based on exponential-decline regression curves fitted to the 15-year data immediately preceding each survey, aggregated by 5-year period, show the infant, child and under-five mortality rates for the period 1986-1990 to be 106, 58 and 158 per 1000 live births and 52, 17 and 67 per 1000 live births for 2001-2005, respectively. The projected rates, assuming that the policy and program efforts are sustained, for the period 2011-2015 are 32, 7 and 38 per 1000 live births. Nepal is most likely to achieve the Millennium Development Goals (MDG) target of a two-thirds reduction in child mortality by 2015, the end of the MDG countdown.