Background Globally in 2017 neonatal death accounted for 46% of under-five deaths. Nepal is among the developing countries which has a high number of neonatal deaths. The rates are high among poor socio-economic groups, marginalized, as well as people living in remote areas of Nepal. This paper, thus tries to examine the utilization pattern and maternal, household, and health service factors affecting underprivileged ethnic groups in Midwest Nepal. Methods A cross-sectional mixed method study was conducted from September 2017 to April 2018 in Bardiya district. Quantitative data were collected from a household survey of women who gave live births within the last 12 months prior to data collection ( n = 362). Interviews were also undertaken with 10 purposively selected key informants. Logistic regression model was used to determine the factors associated with essential neonatal care utilization. Thematic analysis was undertaken on the qualitative data. Results Overall, neonatal care utilization was 58.6% (53.3–63.7%), with big variations seen in the coverage of selected neonatal care components. Factors such as birth order (2.059, 1.13–3.75), ethnicity (2.28, 1.33–3.91), religion (2.37, 1.03–5.46), perceived quality of maternal and neonatal services (2.66, 1.61–4.39) and awareness on immediate essential newborn cares (2.22, 1.28–3.87) were identified as the determining factors of neonatal care utilization. Conclusions The coverage of birth preparedness and complication readiness, adequate breastfeeding, and postnatal care attendance were very low as compared to the national target for each component. The determinants of essential neonatal care existed at maternal, household as well as health facility level and included ethnicity, religion, perceived quality of maternal and neonatal services, birth order and awareness on immediate essential newborn care. Appropriate birth spacing, improving the quality of maternal and neonatal services at health facilities and raising mother’s level of awareness about neonatal care practices are recommended. Electronic supplementary material The online version of this article (10.1186/s12884-019-2465-6) contains supplementary material, which is available to authorized users.

Background and Aims: Awareness raising is an important component of primary prevention of RHD. Data are lacking on primary prevention activities for rheumatic heart disease (RHD) prevention in Nepal. The aim of this study is to assess the effectiveness of various awareness raising activities on increasing knowledge about throat infection (TI), acute rheumatic fever (ARF) and RHD and their impact on RHD prevention. Methods: Fourteen randomly selected government health facilities in Lalitpur were enrolled in this study. A baseline study conducted in early 2015 analyzed the level of knowledge about RHD among care seekers attending health facilities in Lalitpur. An expansive public awareness raising activities on RHD were performed for 2.5 years starting from February 2015. Data were collected using structured interviews, and review of health facility records. Data were analyzed to compare the postintervention status with the baseline status. Results: The mean knowledge about ARF and RHD increased by over 71% (1.82 to 3.12) and 124% (0.37 to 0.83) respectively in post intervention group. There was significant difference in knowledge about TI, ARF and RHD among baseline and post intervention group (p-value<0.0001). The number of throat infection cases presented at health facilities increased by 30.39% from fiscal year (FY) 2071/72 to FY 2072/073 and by 4.69% in the next FY.  Conclusions: Awareness raising interventions are effective in increasing knowledge about TI, ARF and RHD which further can produce positive impact in the primary prevention of ARF and RHD.

No abstract

Background: Timely initiation of breastfeeding has the potential to prevent 22% of neonatal deaths if breastfed within an hour after birth. Although breastfeeding is almost universal in Nepal, ranges of regional differences in timely initiation of breastfeeding have been documented. The aim of this study was to identify the prevalance and the determinants of early initiation of breastfeeding among disadvantaged ethnic women in Midwest Nepal. Methods: The data was obtained from a household survey of women who had their last child less than one year of age. Descriptive statistics were used to analyze respondents’ demographic, socioeconomic, obstetric and health services related characteristics. Determinants of timely initiation of breastfeeding were assessed using univariate analysis and further evaluated using multivariable logistic regression analysis.Results: Of 362 mothers, 65.5% initiated breastfeeding within one hour of childbirth. Mothers belonging to Tharu ethnic groups (aOR 1.788; 95% CI: 1.014, 3.152), health facility delivery (aOR 3.381; 95% CI: 1.795, 6.369) and mothers who were counseled on breastfeeding during ANC attendance (aOR 2.898; 95% CI: 1.038, 8.096) were more likely to initiate breastfeeding within the first hour of child birth. Conclusions: Almost two in every three mothers had initiated breastfeeding within one hour of childbirth. The factors influencing timely initiation of breastfeeding were Tharu ethnic mothers, health facility delivery and Ante Natal Care counseling. We need to aim at increasing institutional deliveries and counseling during ANC which may increase the early initiation of breastfeeding among disadvantaged ethnic groups. Keywords: Breastfeeding; determinants; Nepal; prevalence; timely initiation

BackgroundAnemia is a global public health problem, consisting 40% of pregnant women being anemic worldwide. Manifold factors directly or indirectly contribute to anemia during pregnancy and amplify the risk of maternal and fetal mortality and morbidity. However, factors associated with anemia among pregnant women are not broadly understood in sub-national level. Thus, this study has made an effort to ascertain the prevalence and associated factors of anemia among pregnant women in AMDA Hospital of Eastern Nepal. MethodsHealth-facility based cross-sectional study was conducted among pregnant women of age 18-49 years attending antenatal care (ANC) in AMDA Hospital. A total of 420 samples were recruited through systematic random sampling. Data was collected through a validated semi-structured questionnaire. Hemoglobin concentration was recorded from laboratory test report. Collected data were entered in EpiData and analyzed in SPSS Version 22 licensed by Chulalongkorn University. Chi-square test was used for bivariate analysis and later, significant variables at p-value<0.10 were processed on multivariate analysis. Finally, the adjusted odd ratio was reported considering significant at p-value <0.05 with 95% confidence interval. ResultsThe overall prevalence of anemia was 42.1% (37.4%–47.0%). Almost 46%, 41% and 14% of women were with mild, moderate and severe types respectively. Factors such as age less than 20 years (7.23, 2.50–20.87) and between 20- 24 years (2.80, 1.31–5.96), religious minorities (3.09, 1.35–7.06), vegetarian diet pattern (4.33, 1.49–12.59), inadequate frequency (DGLV: once a week, fruits: twice in a week) of eating DGLV (8.71, 2.26 – 33.63) and fruits (2.73, 1.41–2.29), inadequate dietary diversity (7.16, 3.15–16.27), as well as no intake of multivitamins during pregnancy (4.23, 1.49– 11.98) were statistically associated with anemia among pregnant women. ConclusionOverall, the prevalence of anemia was found to be high in the study area. The associated factors of anemia ranged from socio-economic, dietary and obstetric care, and included age, religion, diet pattern, and frequency of eating DGLV and fruits, dietary diversity, as well as intake of multivitamins during pregnancy. The study recommends enhancing community-based interventions considering the identified factors.