Background Cesarean section (CS) is a major component of emergency obstetric care. There has been a substantial rise in the rate of CS in private institutions in Nepal which might reflect the successful implementation of delivery schemes introduced by the government extended to the private organizations alternatively, it may also reflect the need for more public health care facilities to provide maternal and child health care services. Hence, the objective of this study was to examine the trends in institutional-based CS rates in Nepal along with its correlates over time. Methods We used the National Demographic and Health Survey (NDHS) data collected every 5 years, from 1996 to 2016. The trend in CS rates based on five waves of NDHS data along with its correlates were examined using multivariable logistic regression models after adjusting for socio-demographics and pregnancy-related variables. Results We included 20,824 reproductive-aged women who had a history of delivery within the past 5 years. The population-based CS rate increased from 0.9% in 1996 [95% CI: (0.6–1.2) %] to 10.2% in 2016 [95% CI: (8.9–11.6) %, p < 0.01] whereas the institutional-based CS rate increased from 10.4% in 1996 [95% CI: (8.3–12.9) %] to 16.4% in 2016 [95% CI: (14.5–18.5) %, p < 0.01]. Private institutions had a nearly 3-fold increase in CS rate (8.9% in 1996 [95% CI: (4.8–16.0) %] vs. 26.3% in 2016[95% CI: (21.9–31.3) %]. This was also evident in the trend analysis where the odds of having CS was 3.58 times higher [95% CI: (1.83–7.00), p < 0.01] in 2016 than in 1996 in the private sectors, while there was no evidence of an increase in public hospitals (10.9% in 1996 to 12.9% in 2016; p for trend > 0.05). Education of women, residence, wealth index, parity and place of delivery were significantly associated with the CS rate. Conclusion Nepal has observed a substantial increase in cesarean delivery over the 20 years, which might indicate a successful implementation of the safe motherhood program in addressing the Millennium Development Goals and Universal Health Care agenda on maternal and child health. However, the Nepal government should examine existing disparities in accessibility of emergency obstetric care services, such as differences in CS between public and private sectors, and promote equity in maternal and child health care services accessibility and utilization.

Background Natural disasters have increased during the last several decades all over the world. Due to its geographical and climate conditions, Japan has long been vulnerable to several natural disasters. Coping with disasters is a major challenge overall and even harder for foreigners residing in Japan. Thus, the objective of this study was to examine the perceived knowledge, attitude, practice and perceived barriers of disaster preparedness among Nepalese immigrants in Japan. Methods A cross-sectional study was conducted among Nepalese immigrants residing in Japan with an online survey questionnaire. The questionnaire was validated and then administered. The participants were recruited via Facebook for this survey. Bivariable and multivariable logistic regression analyses were conducted to examine the factors associated with the perceived knowledge, attitude and practice of Nepalese immigrants regarding disaster preparedness. Results A total of 404 respondents were analyzed in this study and among them two-third were male. We found that the mean score of disaster preparedness practice was lowest than the knowledge and attitude (mean $$\pm SD$$ ± S D = 15.86 $$\pm$$ ± 5.52) as evidenced by the majority of the participants not being prepared for disaster situations and a limited proportion had ever taken necessary natural disaster preparedness measures. Japanese language was identified as the major barrier in assessing the knowledge, attitude and practice regarding disaster preparedness and was significantly associated with the knowledge level of disaster preparedness after adjusting for some socio-demographic covariates. (aOR: 1.84, 95% CI: (1.04 – 3.25)). Conclusions This study observed that the perceived knowledge and practices regarding natural disasters are very poor while barriers to access these are substantial among Nepalese immigrants in Japan. As Japanese language was identified as a major barrier, the availability of language translation services in every health care sector also in the government offices of Japan might encourage people to learn more about disaster preparedness.

Background The World Health Organization recommends the Maternal and Child Health Handbook (MCH-HB) to promote health service utilization from pregnancy to early childhood. Although many countries have adopted it as a national health policy, there is a paucity of research in MCH-HB’s implementation. Thus, this study aimed to evaluate the MCH-HB’s implementation status based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), and identify facilitators of, and barriers to its implementation in Angola to understand effective implementation strategies. Methods A cross-sectional survey was conducted targeting all health facilities which implemented MCH-HB, subsamples of health workers, and officers responsible for the MCH-HB at the municipality health office. Using the 14 indicators based on the RE-AIM framework, health facilities’ overall implementation statuses were assessed. This categorized health facilities into optimal-implementation and suboptimal-implementation groups. To identify barriers to and facilitators of MCH-HB implementation, semi-structured interviews were conducted among health workers and municipality health officers responsible for MCH-HB. The data were analyzed via content analysis. Results A total of 88 health facilities and 216 health workers were surveyed to evaluate the implementation status, and 155 interviews were conducted among health workers to assess the barriers to and facilitators of the implementation. The overall implementation target was achieved in 50 health facilities (56.8%). The target was achieved by more health facilities in urban than rural areas (urban 68.4%, rural 53.6%) and by more health facilities of higher facility types (hospital 83.3%, health center 59.3%, health post 52.7%). Through the interview data’s analysis, facilitators of and barriers to MCH-HB were comprehensively demonstrated. MCH-HB’s content advantage was the most widely recognized facilitator and inadequate training for health workers was the most widely recognized barrier. Conclusions Strengthening education for health workers, supervision by municipality health officers, and community sensitization were potential implementation strategies. These strategies must be intensified in rural and lower-level health facilities.

No abstract