R4D Nepal

Effect of supplementation with vitamin A or ß carotene on mortality related to pregnancy. Slight modifications in definitions could alter interpretation of results.

Wed, 16 May 2012 02:56 GMT

Document Type: Miscellaneous
Creator: Ronsmans, C.; Campbell, O.; Collumbien, M.

Production Year: 1999

Citation: Ronsmans, C.; Campbell, O.; Collumbien, M. Effect of supplementation with vitamin A or beta carotene on mortality related to pregnancy. BMJ (1999) 319 (7218) 1201-1201. [DOI: 10.1136/bmj.319.7218.1201a]

Summary: This is a letter written in response to an article published in an earlier issue of the BMJ. West KP Jr., Katz J, Khatry SK, LeClerq SC, Pradhan EK, Shrestha SR, et al. Double blind, cluster randomised trial of low dose supplementation with vitamin A or ß-carotene on mortality related to pregnancy in Nepal. BMJ 1999; 318: 570–575. (27 February.)

Extent of sexual coercion among young female migrant carpet and garment factory workers in Nepal

Thu, 10 May 2012 07:03 GMT

Document Type: Working Paper
Creator: Puri, M.; Cleland, J.

Production Year: 2004

Citation: Puri, M.; Cleland, J. Extent of sexual coercion among young female migrant carpet and garment factory workers in Nepal. Southampton Statistical Sciences Research Institute, Southampton, UK (2004) 16 pp.

Summary: This paper explores sexual coercion of young female migrant workers in the carpet and garment factories in the Kathmandu Valley. Information is drawn from 12 in-depth case histories and a sample survey of 550 respondents aged 14-19 years. The survey found that one in ten young women had ever experienced sexual harassment or coercion in their lifetime. Perpetrators included co-workers, boyfriends, employers and relatives. In-depth interviews revealed that the inability of young working women to communicate effectively with their peers and sex partners, lack of self esteem, job insecurity and other socio-economic problems made them vulnerable to these abuses. The results suggest the need for a range of factory-based interventions.

Factors Affecting Abortion Decisions among Young Couples in Nepal

Wed, 09 May 2012 07:17 GMT

Document Type: Journal Article
Creator: Puri, M.; Ingham, R.; Matthews, Z.

Production Year: 2007

Citation: Puri, M.; Ingham, R.; Matthews, Z. Factors Affecting Abortion Decisions among Young Couples in Nepal. Journal of Adolescent Health (2007) 40 (6) 535-542. [DOI: 10.1016/j.jadohealth.2007.01.010]

Summary:

The purpose of this study was to explore, using both survey data and case studies, factors that are associated with abortion decisions among young couples in the context of recently legalized abortion in Nepal.

This article draws primarily on data collected in detailed case histories of 30 participants selected from a sample of the respondents to a survey of 997 married women aged 15 to 24 years and 499 men aged 15 to 27 years collected in 2003. Bivariate analyses of the survey data are presented in summary form to provide some general contextual background, with the key themes that emerged from analysis of the case histories being described.

Almost half of the young women in the survey reported that they had ever experienced an unintended pregnancy. A considerable proportion of these couples thought about abortion but the majority of them did not take any action. Some of them had attempted abortion but only few had succeeded. Multiple factors, including socio-cultural beliefs, affect the decision-making phase, making the process dynamic and situation-specific. Husbands and health service providers play a major role in the decision-making process.

The study highlights the need to scale up family planning and abortion services to young couples, and emphasizes the importance of involving men and service providers in public education and advocacy campaigns against unsafe abortion. It also points to the need for wider education in the community about family planning and legal abortion services, as well as for the transparent pricing of services and greater efforts to enhance women’s decision-making capacities and control over their reproductive options.

Sexual behavior and perceived risk of HIV/AIDS among young migrant factory workers in Nepal

Wed, 09 May 2012 07:06 GMT

Document Type: Journal Article
Creator: Puri, M.; Cleland, J.

Production Year: 2004

Citation: Puri, M.; Cleland, J. Sexual behavior and perceived risk of HIV/AIDS among young migrant factory workers in Nepal. Journal of Adolescent Health (2004) 38 (3) 237-246. [DOI: 10.1016/j.jadohealth.2004.10.001]

Summary: The purpose of this study was to analyze the sexual behavior, perceived risk of contracting STIs and HIV/AIDS, and protective behaviors of migrant workers aged 14–19 years in carpet and garment factories in the Kathmandu Valley, Nepal. A common assumption in Nepal is that young migrant workers experience an increase in vulnerability. Moving away from the social controls of family and community, they become exposed to a mixed-gender environment and therefore might initiate sex earlier or have more casual encounters than might otherwise be the case. The analysis is based on a representative sample survey of 1050 factory workers. Information was also obtained from 23 in-depth case histories. Both bivarite and multivariate techniques were applied to identify the factors associated with involvement in risky sexual behavior. Despite religious and cultural restrictions, one in five boys and one in eight unmarried girls reported experience of sexual intercourse. Early sexual experimentation, multiple partners, and low and irregular use of condoms are not uncommon. Instances of sexual exploitation by factory owners or managers were documented but were rare. Most nonregular sex partners were described as friends from the same factory or community. Despite high-risk behavior, relatively few young people considered themselves to be at risk of getting STIs or HIV/AIDS. Information on the possible consequences of unsafe sex is inadequate. It was concluded that programs aimed at promotion of safer sex practices and life skill training that facilitates communication and utilization of sexual health services should target vulnerable migrant young people.

Leadership, management and technical lessons learnt from a successful public-private partnership for TB control in Nepal

Tue, 24 Apr 2012 03:53 GMT

Document Type: Journal Article
Creator: Newell, J.N.; Pande, S.B.; Baral, S.C.; Bam, D.S.; Malla, P.

Production Year: 2005

Citation: Newell, J.N.; Pande, S.B.; Baral, S.C.; Bam, D.S.; Malla, P. Leadership, management and technical lessons learnt from a successful public-private partnership for TB control in Nepal. International Journal of Tuberculosis and Lung Disease (2005) 9 (9) 1013-1017.

Summary: BACKGROUND: There is considerable interest in involving private practitioners (PPs) in tuberculosis (TB) control, but little experience.

OBJECTIVE: To describe and discuss leadership, management and technical lessons learnt from the successful implementation of a public-private partnership (PPP) for TB control in Nepal.

METHODS: Description and discussion of implementation of the PPP is based on feedback from the working group charged with developing the PPP, PPs involved in diagnosis and referral, NGOs providing direct observation of treatment and tracing of late patients, and members of the Nepal National TB Programme.

FINDINGS: The process of building the partnership was slow and demoralising, yet with perseverance partners gradually increased their involvement and commitment to the PPP. Leadership was needed to foster communication and openness between partners. It was not necessary to involve all PPs: many patients bypassed PPs and went directly to the free DOTS centres.

CONCLUSION: An understanding of issues that arose during development of the Lalitpur PPP may assist assessment of the feasibility of PPPs in other settings, and increase the likelihood of successful implementation. The wider literature on partnerships may be useful to further inform the development of PPPs for health in developing countries.

Decentralisation and TB control in Nepal: understanding the views of TB control staff

Tue, 24 Apr 2012 03:45 GMT

Document Type: Journal Article
Creator: Newell, J.N.; Collins, C.D.; Baral, S.C.; Omar, M.A.; Pande, S.B.

Production Year: 2005

Citation: Newell, J.N.; Collins, C.D.; Baral, S.C.; Omar, M.A.; Pande, S.B. Decentralisation and TB control in Nepal: understanding the views of TB control staff. Health Policy (2005) 73 (2) 212-227. [DOI: 10.1016/j.healthpol.2004.11.014]

Summary: Experience shows that planners need to consider the effect of the process of decentralisation on national health programmes. The aim of this article is to explore the relationship between decentralisation and a national disease control programme by seeking to understand the views and attitudes of staff working in a national TB control programme on the process of change and their involvement in that change. The study to which this paper refers was performed in Nepal, where, in common with several low- and middle-income countries, a Local Self Governance Act has been passed and decentralisation is in the process of being introduced in the health sector. The aim of the study was to develop a process of initial dialogue among programme staff with a view to exemplifying those enabling and disabling factors which could influence the process and content of health systems development and its impact on health and health care. The study used individual interviews and group discussions to increase our understanding of the experience of different stakeholders at both national and district levels. Important problems identified include: confused lines of authority, difficulties of integrated supervision, poor career paths and promotion possibilities, unclear performance management, lack of priority to be given to health and TB control, lack of local accountability, lack of capacity and the risk to the drug supply. The study highlights the need to (a) develop consensus techniques, achieve a balanced appreciation and include all stakeholders in the process of change and (b) define central and local responsibilities, limiting political bias, maintaining quality control, organising different lines of authority, maintaining priorities and programme integration.

Control of tuberculosis in an urban setting in Nepal: public–private partnership

Tue, 24 Apr 2012 01:10 GMT

Document Type: Journal Article
Creator: Newell, J.N.; Pande, S.B.; Baral, S.C.; Bam, D.S.; Malla, P.

Production Year: 2004

Citation: Newell, J.N.; Pande, S.B.; Baral, S.C.; Bam, D.S.; Malla, P. Control of tuberculosis in an urban setting in Nepal: public–private partnership. Bulletin of the World Health Organization (2004) 82 (28) 92-98.

Summary: Objectives To implement and evaluate a public–private partnership to deliver the internationally recommended strategy DOTS for the control of tuberculosis (TB) in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector.

Methods A local working group developed a public–private partnership for control of TB, which included diagnosis by private practitioners, direct observation of treatment and tracing of patients who missed appointments by nongovernmental organizations, and provision of training and drugs by the Nepal National TB Programme (NTP). The public–private partnership was evaluated through baseline and follow-up surveys of private practitioners, private pharmacies, and private laboratories, together with records kept by the Nepal NTP.

Findings: In the first 36 months, 1328 patients with TB were registered in the public–private partnership. Treatment success rates were >90%, and <1% of patients defaulted. Case notification of sputum-positive patients in the study area increased from 54 per 100 000 to 102 per 100 000. The numbers of patients with TB started on treatment by private practitioners decreased by more than two-thirds, the number of private pharmacies that stocked anti-TB drugs by one-third, the number of pharmacies selling anti-TB drugs by almost two-thirds, and sales of anti-TB drugs in pharmacies by almost two-thirds. Private practitioners were happy to refer patients to the public–private partnership. Not all private practitioners had to be involved: many patients bypassed private practitioners and went directly to free DOTS centres. Conclusions: A combination of the strengths of private practitioners, nongovernmental organizations, and the public sector in a public–private partnership can be used to provide a service that is liked by patients and gives high rates of treatment success and increased rates of patient notification. Similar public–private partnerships are likely to be replicable elsewhere, as inputs are not large and no special requirements exist.

Risky sexual behaviour among young men in Nepal

Wed, 11 Apr 2012 02:13 GMT

Document Type: Working Paper
Creator: Dahal, G.P.; Hennink, M.; Hinde, A.

Production Year: 2005

Summary: We use the Nepal Adolescents and Young Adults (NAYA) Survey of 2000 to analyse the prevalence of sexual activity and risky sexual behaviour among Nepalese males aged 14-22 years. Risky sexual behaviour is considered to be characterised by having multiple partners, or having one non-regular partner with whom a condom was not used, in the 12 months before the survey. About 9 per cent of the sexually active married men aged 14-22 years, and about 20 per cent of sexually active single men in the same age group, are engaged in risky sexual behaviour. Logistic regression analysis shows that, among married men, those who are better educated and who have better educated fathers are more likely to engage in risky sexual behaviour. Among single men, risky sexual behaviour is especially likely in certain rural districts where it is tolerated by the local culture. The quantitative analysis is supported by qualitative data drawn from focus group interviews.

Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for Human Resources for Health (HRH)

Thu, 05 Apr 2012 07:48 GMT

Document Type: Case Study
Creator: McPake, B.; Witter, S.; Ensor, T.; Fustukian, S.; Newlands, D.; Martineau, T.

Production Year: 2011

Citation: McPake, B.; Witter, S.; Ensor, T.; Fustukian, S.; Newlands, D.; Martineau, T. Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for Human Resources for Health (HRH). Queen Margaret University, East Lothian, UK (2011) 196 pp.

Summary:

In the last decade a growing consensus has emerged that user fees are regressive and undermine equitable access to essential health services, and in particular, may negatively affect pregnant women and children under five. A policy shift removing or reducing fees has occurred with consequences for the health system, including the need for replacement revenue and to ensure quality in response to increased utilization. Both of these raise specific concerns for human resources for health (HRH) and suggest that careful planning of the supply side response to the demand stimulated by removal of fees has to take place.

This research responds to this concern. Its objective is to determine the associations and interrelationships between workforce characteristics (stock, distribution, competencies and motivational state) and equitable access to Reproductive, Maternal and Neonatal Health (RMNH) services resulting from the removal of, or exemption from user fees.

The study was conducted in five countries: Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe, and consisted of literature review of international and local published and grey literature, desk based analysis of secondary data from the five countries and field work in two countries, including primary data collection in Zimbabwe.

This document comprises a 6-page policy brief, the main report, the literature review, the 5 case studies and references.

An Assessment of Crop Water Productivity in the Indus and Ganges River Basins: Current Status and Scope for Improvement

Thu, 15 Mar 2012 03:56 GMT

Document Type: Report
Creator: Cai XueLiang; Sharma, B.R.; Matin, M.A.; Devesh Sharma; Sarath Gunasinghe

Production Year: 2010

Citation: Cai XueLiang; Sharma, B.R.; Matin, M.A.; Devesh Sharma; Sarath Gunasinghe. An Assessment of Crop Water Productivity in the Indus and Ganges River Basins: Current Status and Scope for Improvement. International Water Management Institute, Colombo, Sri Lanka (2010) 34 pp. ISBN 978-92-9090-735-0 [DOI: 10.5337/2010.232] IWMI Research Report 140

Summary: This research study was initiated as part of the “Basin Focal Project for the Indus and the Ganges River Basins (BFP-IGB)” (PN 60) of the CGIAR Challenge Program on Water and Food (CPWF). It formed part of the wider network of the “Basin Focal Projects.”

As part of the ‘Basin Focal Project for the IGB’ supported by the CGIAR Challenge Program on Water and Food (CPWF), a study has been carried out to assess the basin agricultural water management performance to reveal the implications for food security while securing sustainable development of the basin. This research report assesses the agricultural WP of the basin with focus on the predominant rice and wheat cropping system. The report presents a new approach to integrate remotely sensed imagery, meteorological data, ground survey, and national crop and land use census to assess crop water productivity at basin scale. The causes for its variations and potential for improvement were also analyzed. The section, The Study Area, briefly describes the characteristics of the study area. The section, Data and Method of Analysis, details the data sources and method of analysis. We present the detailed results of basin crop yield, ET and water productivity and the related maps in the section, Basin Crop Yield, ET and Water Productivity, followed by the causes for variation and scope for improvement of water productivity in the section, Causes for Variation and Scope for Improvement. Major conclusions, recommendations and suggestions are presented in the section, Conclusions.