Years In Nepal Research Articles

Choice of contraceptive methods by women’s status: Evidence from large-scale microdata in Nepal

ObjectiveWe aimed to investigate how improvement in women’s status affects the choice of contraceptive methods in Nepal. Study designWe regressed the choice of contraceptive methods on women’s status and other controlling variables by employing large-scale microdata representing over 12,000 married women aged 15–49 years in Nepal. Years of schooling and literacy were defined as women’s status variables. We estimated how educational attainment affects the choice of contraceptive methods. We also analyzed how fear of their partners affected women’s choices. ResultsFemale sterilization was the most common choice among the contraceptive methods (25.5% of contraceptive users) in Nepal, followed by injections (19.9%). However, our estimation results showed that these options change with an improvement in women’s status. An additional year of education increased the probability that women would choose condoms by 1.2 percentage points (95% confidence interval [CI]: 0.7, 1.6) and decreased the probability of choosing female sterilization by 1.4 percentage points (95% CI: −1.9, −0.8). For the well-educated women, injections and condoms became the first and second choices (29.5% and 21.5%), respectively, while female sterilization was the third option (17.9%) for contraceptive methods. Women’s fear of their partners also affected the choice of contraceptive methods. The women who feared their partners were 7.0 percentage points more likely to choose female sterilization than condoms. ConclusionImprovement in women’s status (more education and less fear of their partners) changed their contraceptive behaviors by increasing the probability of choosing condoms and decreasing the probability of choosing female sterilization in Nepal.

Individual, household, and community level risk factors of stunting in children younger than 5years: Findings from a national surveillance system in Nepal.

Despite substantial reductions in recent years in Nepal, stunting prevalence in children younger than 5years remains high and represents a leading public health concern. To identify factors contributing to the stunting burden, we report multilevel risk factors associated with stunting in 4,853 children aged 6-59months in a nationally and agroecologically representative random sample from the first year of the Policy and Science for Health, Agriculture, and Nutrition Community Studies, a community-based observational, mixed-panel study. Mixed effects logistic regressions controlling for multilevel clustering in the study design were used to examine the association of individual-, household-, and community-level factors associated with stunting. Stunting prevalence was 38% in our sample. After adjustment for potential confounding variables, maternal factors, including maternal height and education, were generally the strongest individual-level risk factors for stunting, adjusted odds ratio (AOR)=2.52, 95% CI [1.96, 3.25], short (<145cm) versus not short mothers; AOR=2.09, 95% CI [1.48, 2.96], uneducated mothers versus secondary school graduates. Among the household- and community-level factors, household expenditure and community infrastructure (presence of paved roads, markets, or hospitals) were strongly, inversely associated with increased stunting risk, AOR=1.68, 95% CI [1.27, 2.24], lowest versus highest household expenditure quintile; AOR=2.38, 95% CI [1.36, 4.14], less developed (lacking paved roads, markets, or hospitals) versus more developed communities. Although most factors associated with stunting are not rapidly modifiable, areas for future research and possible interventions emerged.

Distribution of Cancer by Sex and Site in Nepal

Background:Cancer is one of the leading causes of death throughout the world. The indicators of cancer by site are significant to identify the problem of cancer. The purpose of this retrospective study is to perform the incidence of all cancers both in males and females over the ten years in Nepal.Methods:The data collected from all the seven hospital based cancer registries of Nepal have taken for the study. This retrospective study has presented the number of cases, frequencies, and crude incidence of all cancers by sex and site.Results:A total of 55,931 cancer cases with known age were registered throughout the hospital based seven cancer registries of Nepal from 2003 to 2012. Throughout the ten years, Lung (incl. trachea and bronchus) cancer (19.08%) was the major cancer in males followed by stomach cancer (7.86%) and Pharynx cancer (5.4%). Similarly, Cervix cancer (21.9%) was the most common cancer in females followed by breast (15.48%) and Lung (incl. trachea and bronchus) cancer (10.47%) over the ten years. This retrospective study presented the distribution of the cancer site over the ten years in Nepal.Conclusion:This retrospective study showed that lung cancer is the major cancer in male while in female cervix uteri is the most common cancer ranging from 2003 to 2012.

Persistent inequity in maternal health care utilization in Nepal despite impressive overall gains

ABSTRACT Background: Maternal health care utilization is at the core of global public health provision and an area of focus in the now-concluded Millennium Development Goal agenda. Objective: This study aims to examine trends in maternal health care utilization over the last 15 years in Nepal, focusing on coverage and equity. Methods: This paper used data from the Demographic Health Survey (DHS) 2001, 2006 and 2011 and Multiple Indicator Cluster Survey (MICS), 2014. Coverage rates were calculated and logistic regression models used to examine inequity. Results: Impressive gains were found in antenatal care (ANC) attendance, which increased from nearly half of women attending (49%) in 2001 to 88% in 2014, and the rate of facility delivery increased from just 7–44%. This development did not, however, influence the equity gap in ANC and skilled attendance at birth, as women from low socioeconomic backgrounds were six times more likely to deliver without skilled assistance than those from high socioeconomic backgrounds (AdjOR 6.38 CI 95% 4.57–8.90) in 2014. Conclusion: These persistent equity gaps call for targeted interventions focusing on the most disadvantaged and vulnerable women in order to achieve the new Sustainable Development Goal of universal health coverage.

Maize production in mid hills of Nepal: from food to feed security

This study was undertaken in 2016 to analyze the production and utilization of maize in Nepal. Sixty maize growers from Kavre and Lamjung districts were selected using purposive, cluster and simple random sampling techniques. Similarly, six feed industries and five maize experts from Chitwan district were also interviewed. Study shows 56% of the total areas were used for maize production and 50% of the maize areas were covered by hybrid maize. There was no practice of contract maize production. The results revealed that 60%, 25% and 3% of the grain were used for animal feed, food and seed respectively in hill districts. Whereas the remaining amount of the maize (12%) was sold to the different buyers. The proportion of maize feed supply to different animals in the study area was varying. Result shows that at least 1.5 million tons of maize is required only to the feed industries affiliated with national feed industry association in Nepal. Similarly, out of total maize used in feed production, 87% of the maize was imported from India each year by feed industries. Analysis shows negative correlation between scale of feed production and use of domestic maize due to unavailability of required quantity of maize in time. The major pre-condition of feed industries for maize buying was moisture content which must be equal or less than 14%. Very little or no inert materials and physical injury, free from fungal attack and bigger size were also the criteria for maize buying. However, some of the feed industries were also thinking about protein and amino acid contents. Result shows 13% and 8.5% increasing demand of poultry feed and animal feed, respectively over the last five year in Nepal. Most likely, maize is known as a means of food security in Nepal, however, in the context of changing utilization patterns at the farm level and also tremendous increasing demand of maize at the industry level suggest to give more focus on development and dissemination of maize varieties that can contribute to the feed security issues as well.

Essential newborn care after home delivery in Nepal.

Postnatal care of the newborn is essential in order to reduce neonatal mortality. Nepal has made great efforts to improve maternal and child health by focusing on accessibility and outreach over the past decades. This study aims to examine trends, over the past decade, in levels and equity of facility delivery rates and the provision of newborn care after home delivery in Nepal. Household-level data from the Demographic Health Surveys (DHS) 2006 and 2011 and the Multiple Indicator Cluster Survey (MICS5) from 2014 performed in Nepal was sourced for the study. Coverage rates of facility delivery and newborn care after home delivery were calculated and logistic regression models were used to ascertain inequity. Home delivery rate dropped from 79.2% in 2006 to 46.5% in 2014, a development showing an inequitable distribution, with a larger share of better-off families shifting to facility delivery. For those who still delivered at home there was an increased rate of early initiation of breastfeeding and adequate temperature control, but only 2.2% of women delivering at home received a home visit by a health professional in the first week of delivery. No inequity in receiving newborn care after home delivery could be detected. There have been significant improvements in facility delivery rates over the last 10 years in Nepal and postnatal care at home has improved. There is, however, an alarmingly low level of home visits during an infant's first week.

Landslide Hazard Mapping Using GIS : A Case of Pelakot VDC, Syangja

Landslides are one of the major natural disasters in Nepal and responsible for loss of property and lives. Landslide hazard mapping is an important tool for disaster management. The landslide hazard maps provide information about landslide vulnerability condition of certain region, which is beneficial for the community in planning, mitigating, and avoiding the danger. Various methods of hazard assessment have been proposed and demonstrated in Nepal. The use of Geographic Information Systems (GIS) for landslide hazard mapping has been increasing constantly in recent years in Nepal. In this study, GIS technology was applied to investigate zonation of the landslide hazards of the Pelakot VDC, Syagnja, Nepal. The Village Development Committee (VDC) is one of the susceptible areas to landslides in Syangja. In this particular area, several landslides were occurred. The method of landslide zonation used in this study was weighted overlay method. The causative factors include slope, landuse, geology, distance to drainage, distance to fault. The study of the area has been classified into five categories of relative landslide hazard namely, very low, low, moderate, and high. As a result, it can be concluded that 7% of this particular area has a high landslide hazard.

Autologous Blood Transfusion in Surgical Outreach Camp

Poor access to healthcare including surgical care is one of the known problems faced by people living in the remote terrains of Nepal. Reaching to the community with the help of health camps has been exercised for many years in Nepal. However, surgery in such camps is often hindered by many obstacles including unavailability of blood products, lack of or poor storage facility for donated blood. Surgery often needs to be deferred in otherwise healthy patients with rare blood groups. Autologous blood collection with acute normovolaemic haemodilution is one of the blood sparing techniques used in cases where it is difficult to get matched blood or when allogenic blood cannot be used. We report a case of autologous blood collection and subsequent transfusion in a patient undergoing vaginal hysterectomy and pelvic floor repair performed at a surgical outreach camp organized in a remote district of Nepal.Journal of Society of Anesthesiologists of Nepal 2015; 2(1): 28-30

Surgical need in an aging population: A cluster-based household survey in Nepal

With an aging global population comes an obligate and substantial burden of noncommunicable disease, especially in low- and middle-income countries. An unknown proportion of this burden is treatable with surgical expertise. For health system planning, this study aimed to estimate the operative needs of individuals older than 50 of age years in Nepal. A 2-stage, cluster randomized, community-based survey was performed in Nepal using the validated Surgeons OverSeas Surgical Assessment Survey (SOSAS). SOSAS collects household demographics and selects household members randomly for verbal, head-to-toe examinations for surgical conditions; moreover, SOSAS also completes a verbal autopsy for deaths in the preceding year. Only respondents older than 50 years were included in the analysis. The survey sampled 1,350 households, totaling 2,695 individuals (97% response rate). Of these, 273 surgical conditions were reported by 507 persons ages ≥ 50 years. Extrapolating, there are potentially 2.1 million people older than 50 years of age with surgically treatable conditions who need care in Nepal (95% confidence interval 1.8-2.4 million; 46,000-62,600 per 100,000 persons). One in 5 deaths was potentially treatable or palliated by surgical care. Although growths or masses (including hernias and goiters) were the surgical condition reported most commonly (25%), injuries and fractures also were common and associated with the greatest disability. Literacy and distance to secondary and tertiary health facilities were associated with lack of care for operative conditions (P < .05). There is a large, unmet surgical need among the elderly in Nepal. Low literacy and distance from a capable health facility are the greatest barriers to care. As the global population ages, there is an increasing need to improve surgical services and strengthen health systems to care for this group.

Nutritional Status of Children Seeking Medical Treatment in a Rural Hospital in Ilam District, Nepal

Introduction: Childhood malnutrition is a leading cause of mortality and morbidity in children under five years in Nepal. There is evidence to show that childhood malnutrition varies from region to region, within Nepal. But there is no data available about nutritional status of children in the 75 districts in Nepal. The aim of this study was to evaluate the nutritional status of children less than five years of age in Ilam district. Material and Methods: We analysed the anthropometric data for the children of Ilam district who visited Dr. Megh Bahadur Parajuli Community Hospital in Ilam district. Results: Our data showed that 15.7% of girls and 21.2% of boys under-five years suffered from moderate malnutrition. Severe malnutrition was present in 6.7% of girls and 9.6% of boys. Stunting was seen in 32.6% girls and 30.16% boys. Moderate stunting was present in 19.6% of girls and 19% of boys; while severe stunting was present in 11% of the boys and 13% of the girls. Conclusion: Our data shows that stunting among under-fives in Ilam is less as compared to that reported for Nepal, but underweight is comparable to the national data. However, a systematic study needs to be carried out in Ilam before drawing firm conclusions. J Nepal Paediatr Soc 2014;34(3):207-215-220 DOI: http://dx.doi.org/10.3126/jnps.v34i3.10737

Cholera outbreaks (2012) in three districts of Nepal reveal clonal transmission of multi-drug resistant Vibrio cholerae O1.

BackgroundAlthough endemic cholera causes significant morbidity and mortality each year in Nepal, lack of information about the causal bacterium often hinders cholera intervention and prevention. In 2012, diarrheal outbreaks affected three districts of Nepal with confirmed cases of mortality. This study was designed to understand the drug response patterns, source, and transmission of Vibrio cholerae associated with 2012 cholera outbreaks in Nepal.MethodsV. cholerae (n = 28) isolated from 2012 diarrhea outbreaks {n = 22; Kathmandu (n = 12), Doti (n = 9), Bajhang (n = 1)}, and surface water (n = 6; Kathmandu) were tested for antimicrobial response. Virulence properties and DNA fingerprinting of the strains were determined by multi-locus genetic screening employing polymerase chain reaction, DNA sequencing, and pulsed-field gel electrophoresis (PFGE).ResultsAll V. cholerae strains isolated from patients and surface water were confirmed to be toxigenic, belonging to serogroup O1, Ogawa serotype, biotype El Tor, and possessed classical biotype cholera toxin (CTX). Double-mismatch amplification mutation assay (DMAMA)-PCR revealed the V. cholerae strains to possess the B-7 allele of ctx subunit B. DNA sequencing of tcpA revealed a point mutation at amino acid position 64 (N → S) while the ctxAB promoter revealed four copies of the tandem heptamer repeat sequence 5'-TTTTGAT-3'. V. cholerae possessed all the ORFs of the Vibrio seventh pandemic island (VSP)-I but lacked the ORFs 498–511 of VSP-II. All strains were multidrug resistant with resistance to trimethoprim-sulfamethoxazole (SXT), nalidixic acid (NA), and streptomycin (S); all carried the SXT genetic element. DNA sequencing and deduced amino acid sequence of gyrA and parC of the NAR strains (n = 4) revealed point mutations at amino acid positions 83 (S → I), and 85 (S → L), respectively. Similar PFGE (NotI) pattern revealed the Nepalese V. cholerae to be clonal, and related closely with V. cholerae associated with cholera in Bangladesh and Haiti.ConclusionsIn 2012, diarrhea outbreaks in three districts of Nepal were due to transmission of multidrug resistant V. cholerae El Tor possessing cholera toxin (ctx) B-7 allele, which is clonal and related closely with V. cholerae associated with cholera in Bangladesh and Haiti.

Who is willing to pay for micronutrient powders for children 2‐5 years of age in Nepal? (250.2)

Background: Nepali children have a high burden of micronutrient deficiencies. A 2011 pilot project gave micronutrient powders (MNP) for free to children 6‐23 months. This project is under review to inform future policy decisions. We describe willingness to pay (WTP) for MNP and pricing attitudes to explore potential for purchase of MNP for children 2‐5 years. Methods: Representative household surveys were conducted with mothers of children 6‐23 months in two districts 3 months after the pilot started. Questions explored MNP WTP for children 2‐5 years and attitude about a suggested price (R150/6 mo supply, ~US$2.10). Chi square tests assessed WTP and price attitudes by demographics; and WTP by MNP knowledge and intervention exposure. Results: Overall, 78% of mothers expressed WTP for MNP and 66% had a positive attitude toward the suggested price. WTP and positive price attitude were associated with higher wealth quintiles and higher maternal education. Urban residence was associated with positive pricing attitude. Receipt of MNP education and printed materials were associated with WTP, but use of MNP among younger children was not. Those with knowledge of barriers to MNP use were less likely to show WTP than those with none (66.3% vs. 92.4%, p&lt;0.01). Conclusions: WTP and positive price attitude indicate potential for mothers to purchase MNP for children 2‐5 years in Nepal. Further studies are needed to determine if stated WTP translates into actual purchase.

Household Wealth and Neurocognitive Development Disparities among School‐aged Children in Nepal

BackgroundWealth disparities in child developmental outcomes are well documented in developed countries. We sought to (1) describe the extent of wealth-based neurocognitive development disparities and (2) examine potential mediating factors of disparities among a population-based cohort of children in rural Nepal.MethodsWe investigated household wealth-based differences in intellectual, executive and motor function of n = 1692 children aged between 7 and 9 years in Nepal. Using linear mixed models, wealth-based differences were estimated before and after controlling for child and household demographic characteristics. We further examined wealth-based differences adjusted for three sets of mediators: child nutritional status, home environment, and schooling pattern.ResultsWe observed a positive gradient in child neurocognitive performance by household wealth. After adjusting for child and household control factors, disparities between children in the highest and lowest wealth quintiles persisted in intellectual and motor function, but not executive function. No statistically significant wealth-based differentials in outcomes remained after accounting for nutritional status, home environment, and schooling patterns. The largest differences in neurocognitive development were associated with schooling pattern.ConclusionsHousehold wealth patterns child neurocognitive development in rural Nepal, likely through its influence on nutritional status, the home environment, and schooling. In the current context, improving early and regular schooling in this setting is critical to addressing wealth-based disparities in outcomes.

Determinants of complementary feeding practices among Nepalese children aged 6–23 months: findings from demographic and health survey 2011

BackgroundThe adoption of inappropriate feeding practices is one of the reasons for under nutrition in Nepal and elsewhere. The objective of this study was to describe the rate of and identify the factors associated with providing the World Health Organization (WHO) recommended infant feeding practices of minimum dietary diversity, minimum meal frequency and minimum acceptable diet in Nepal amongst young children between 6–23 months in 2011.MethodsData from Nepal Demographic and Health Survey (NDHS) 2011 was used. Prevalence of minimum dietary diversity, minimum meal frequency and minimum acceptable diet was obtained by using descriptive statistics. A Chi-square test (χ2) followed by multiple logistic regression analyses were used to determine the adjusted effect of potential factors on the outcome variables.ResultsOf the 698 children aged 6–23 months; while 535 (76.6%) received the minimum meal frequency, only 212 (30.4%) children received the minimum dietary diversity, and 185 (26.5%) received an acceptable diet. Children of older mothers (>35 years); educated mothers and fathers; and mothers from all the development regions except the Mid-western region were more likely to have been provided with the recommended dietary diversity. Children of mothers who had attended ≥4 antenatal visits and who lived in the Eastern region were more likely to provide their child with the recommended meal frequency. Children of mothers, who attended ≥ 4 antenatal visits, were educated and whose fathers had at least a secondary education were more likely to meet the recommended acceptable diet standards.ConclusionYoung children aged less than two years in Nepal are at risk for not meeting the WHO recommended infant feeding standards given that only about one in three children were provided with the recommended dietary diversity and acceptable diet. This finding suggests that the majority of children are at risk of under nutrition. An appropriate mix of health education and food supplements could be a feasible option for Nepal to improve the number of children who meet the recommended infant feeding guidelines, reduce under nutrition and improve the survival rates of young children.

Factors associated with the introduction of prelacteal feeds in Nepal: findings from the Nepal Demographic and Health Survey 2011

BackgroundA prelacteal feed is any food except mother’s milk provided to a newborn before initiating breastfeeding. Prelacteal feeding is a major barrier to exclusive breastfeeding. It is a prevalent practice in Nepal. Little is known about the factors associated with providing prelacteal feeds to the Nepalese newborn. This study explored the factors associated with providing prelacteal feeds to children under three years in Nepal using the Nepal Demographic and Health Survey (NDHS) 2011.MethodsThis study utilised the NDHS 2011 child dataset which is a nationally representative study. The rates of providing prelacteal feeds were reported as a proportion. Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multiple logistic regression were used to analyse the factors associated with providing prelacteal feeds.ResultsA sample of 3948 mothers were included in the study. A total of 841 [26.5% (95% CI: 23.1%–30.3%)] weighted proportion) of mothers reported of providing prelacteal feeds to their newborn infants. Plain water (n = 75), sugar/glucose (n = 35), gripe water (n = 3), sugar/salt solution (n = 3), fruit juice (n = 3), infant formula (n = 96), tea (n = 3) and other milk other than breast milk (n = 556) were some of the types of prelacteal feeds reported. The multiple regression analysis showed that the mothers who had no education, were not working, were from the middle wealth quintile, who had not attended four antenatal care visits, were first time mothers and who were from the Terai/Plain region were more likely to provide prelacteal feeds.ConclusionsGiven that one in four infants were provided with prelacteal feeds, there is a need to implement breastfeeding promotion programs to increase the practice of exclusive breastfeeding and reduce prelacteal feeding practices. Breastfeeding counseling at antenatal clinics and peer support for exclusive breastfeeding should be included as part of breastfeeding promotion programs. Mobilisation of female community health volunteers for peer counseling is also a feasible option for Nepal.

Psychiatrist on Mission to Help Mentally Ill People in Poor Countries

Brandon Kohrt, M.D., Ph.D., studied to become a medical anthropologist and psychiatrist. With his formal education completed, he sees his destiny as helping people in low-income countries.

Determinants of tobacco use among students aged 13–15 years in Nepal and Sri Lanka: Results from the Global Youth Tobacco Survey, 2007

Objectives: This study aimed to investigate tobacco use behaviours and their correlates among secondary school students in Nepal and Sri Lanka together with cross-country comparisons. Design: Cross-sectional survey. Methods and Settings: The data were obtained from the Global Youth Tobacco Survey (GYTS), 2007. Current tobacco use was considered as a response variable. Predictors were selected based on existing literature and theories on adolescent tobacco use. The data of 1,444 Nepalese and 1,377 Sri Lankan students aged 13–15 years was used for analysis. Results: Prevalence of tobacco use varies with 9.4% and 9.1% among Nepalese and Sri Lankan students respectively. Boys (13.2 vs. 5.3 for Nepal, 12.4 vs. 5.8 for Sri Lanka), older and senior students was more likely to be tobacco users in both countries. The average age of tobacco initiation was 10.2 years in Nepal and 8.6 years in Sri Lanka. Factors, namely, individual characteristics, tobacco use among friends, smoking at home and public places, free tobacco products, and lessons about negative effects of tobacco in class were significantly associated with tobacco use in Nepal and Sri Lanka. For instance, friends’ tobacco use was a good predictor for adolescents’ usage (odds ratio [OR] = 4.0, confidence interval [CI] = 2.61–6.23 in Nepal; OR = 2.5, CI = 1.50–4.23 in Sri-Lanka). Similarly, course curriculum significantly reduced smoking among students. Conclusion: Prevention of tobacco use among school students should be top priority of a country as they are long-term customers and replacement smokers who quit or die. Therefore comprehensive strategies as we proposed along with existing prevention programmes should be tightened to stop them from hazardous behaviours.

Ethnic differentials of the impact of Family Planning Program on contraceptive use in Nepal

Abstract There is wide variation of family planning services use among ethnic groups in Nepal. Despite three decades of implementation the need for family planning services is substantially unmet (25%), and there have been no systematic studies evaluating the impact of the family planning program. This study pooled data from nationally representative surveys conducted in 1996, 2001, and 2006. Multilevel logistic regression analysis of 23,381 married women of reproductive age nested within 764 clusters indicated that Muslims, Janjatis, and Dalits were significantly less likely to use contraceptives than Brahmins and Chhetries (OR=0.27, 0.88 and 0.82 respectively). The odds of using contraceptives by the Newar were higher than the odds for Brahmins and Chhetries, although it was not significant. Exposure of women to family planning messages through health facilities, family planning workers, radio, and television increased the odds of using modern contraceptives. However, the impact of family planning information on contraceptive use varied according to ethnicity. We also found that modern contraceptive use varied significantly across the clusters, and the cluster-level indicators, such as mean age at marriage, mean household asset score, percentage of women with secondary education, and percentage of women working away from home, were important in explaining this. (ProQuest: ... denotes formulae omitted.) 1. Introduction After more than thirty years of family planning program efforts, contraceptive use among married women of reproductive age in Nepal has increased from 26% in 1996 to 44% in 2006. At the same time, fertility has decreased from 4.6 to 3.1 per woman (Pradhan et al. 1997; Ministry of Health and Population (MoHP), New Era, and Macro International Inc. 2007). Yet the need for family planning is partly unmet (25%) (Karki and Krishna 2008) and some ethnic groups use family planning much more than others. For example, almost three times as many Newars (56%) use family planning as Muslims (17%). Use of family planning among Dalits (41%) and Muslims (17%) is less than the national average (44%) (Bennett and Dahal, 2008). This information suggests that family planning efforts are reaching some groups more than others. However the cause of this disparity is not clear, and systematic studies evaluating the impact of the family planning program have not been conducted in Nepal. This paper intends to fill the gap by examining the impact of the family planning program on modern contraceptive use among different ethnic groups in Nepal. The overall objective of this study is to examine whether the observed differences in the levels of modern contraceptive use among different ethnic groups over the last ten years in Nepal are associated with the family planning program. The specific objectives are: * To examine if the family planning program is effective in increasing contraceptive use * To explore if the impact of the family planning program differs by ethnicity * To provide policy recommendations to reduce ethnic disparity in impact. Family planning activities in Nepal were first initiated in 1958 by the Nepal Family Planning Association. The Family Planning Policy was adopted in 1965 and limited family planning services were made available in the Kathmandu Valley in 1968. Services were expanded all over the country only in the early 1990s (Aryal et al. 2008). Over the last two decades various interventions have been implemented to increase knowledge, acceptability, and use of contraceptives, through static and mobile services, door-to-door campaigns, and the mass media. Now knowledge of family planning among women of reproductive age is almost universal in Nepal (MoHP, New Era, and Macro International Inc. 2007). However the unmet contraceptive needs are considerably higher among poorer women (Johnson and Bradley 2008). Regional and ethnic disparities also exist in the utilization of family planning services. …

Systematic review of community-based studies of unintentional injuries in children in south east Asian countries

AimTo perform a systematic review of community-based studies on unintentional injuries in children in WHO's South-East Asian countries to summarise and compare rates of and risk factors for injuries.BackgroundGlobally, injuries...

Local benefits from community forests in the middle hills of Nepal

Community forestry has been in existence for about 20 years in Nepal, but there are few observations on changes in resource use since its inception. This study aims to investigate how farmers affected by community forestry have adapted to its introduction and whether their livelihood options have changed in response to changes in forest accessibility and forest product availability. A total of 309 households were interviewed in eight forest user groups in the middle hills of Nepal and results on reported changes in forest product collection and livestock numbers analysed. Reported forest product collection has increased since the introduction of community forestry, while livestock numbers have decreased. The main findings of the study are that, despite controlled access to the forest, collection rates have increased slightly in the majority of income groups and households. The number of trees on private land has increased, while the size of livestock herds has decreased. As long as the farmers can continue to adapt without adversely affecting their livelihoods they will support this forestry management system leading to an increased chance of the long term success of common property forest management in Nepal.