BackgroundMalnutrition is one of the leading causes of morbidity and mortality among children under the age of 5 years in low and middle income countries like Nepal. Children with severe acute malnutrition (SAM) are nine times more likely to die than children without malnutrition. The prevalence of SAM has increased in Nepal over the past 15 years; however, the determinants of SAM have not been clearly assessed in the country.ObjectiveTo assess the determinants of SAM among children aged 6–59 months in the Bara district of Nepal.SettingA community-based case–control study was conducted in 12 randomly selected Village Development Committees (VDCs) of the Bara district of Nepal.ParticipantsA random sample of 292 children aged 6–59 months (146 as cases and 146 as controls) from 12 VDCs were included in this study.ResultsThe prevalence of SAM among children under the age of 5 years was 4.14%. The following factors were significantly associated with SAM: low socioeconomic status (adjusted odds ratio (AOR) 17.13, 95% CI 5.85 to 50.13); mother’s age at birth <20 or >35 years (AOR 3.21, 95% CI 1.30 to 7.94); birth interval <24 months (AOR 4.09, 95% CI 1.87 to 8.97); illiterate father (AOR 3.65, 95% CI 1.62 to 8.20); bottle feeding (AOR 2.19, 95% CI 1.73 to 12.03); and not initiating complementary feeding at the age of 6 months (AOR 2.91, 95% CI 1.73 to 12.03). Mother’s educational level, initiation of breastfeeding, colostrum feeding, and exclusive breastfeeding were not significantly associated with SAM.ConclusionThe mother’s age at birth, birth interval, socioeconomic status, father’s educational level and initiation of complementary feeding at the age of 6 months were important determinants of SAM among children. A multi-sector approach is essential to address SAM. There is a need for further studies not only focusing on SAM but also moderate acute malnutrition.

Background: Antenatal Care (ANC) visits are intended to prevent, identify and treat conditions that may threaten the health of the mother and newborn, and to increase the chance she has a smooth pregnancy and and safe childbirth. The most disadvantaged and underprivileged caste (Dalit) of Nepal has benefitted the least from maternal health service improvements in the recent years. Objective: This study was conducted to determine the rate and factors associated with the antenatal care service utilization among the most disadvantaged ethnic group (Dalit women) and recommend interventions to improve ANC utilisaiton, in the Mahottari district of Nepal. Methods: A cross-sectional study was conducted during July-December 2014 using a structured questionnaire. A total of 328 recently delivered mothers were interviewed covering the entire district. Descriptive statistics, binary and multivariable logistic regression analyses were computed. Statistical significance was considered at p < 0.05 and the strength of statistical association was assessed by odds ratios with 95% confidence intervals. Results: ANC utilization rate (≥ 4 ANC visit) was found to be 42%. Mother's education, husband's education, mother's occupation, perceived “good quality” ANC, hearing about incentive program, maternal health message, non-perception of health workers behaviours as discriminatory, and exposure to Female Community Health Volunteer were found to be significantly associated with ANC utilization. Conclusion: ANC service utilization is low. So, there is an urgent need to address the issue of ANC quality and discriminatory behaviour of health workers toward Dalit. A targeted & comprehensive maternal health program should be developed to raise awareness and motivate pregnant women for maximum utilisation of ANC services.

Introduction The gains in maternal and child health in Nepal was impressive in the last two decade but success was unevenly distributed. The Dalits of Nepal are the most disadvantaged caste group and have benefitted least from the advances in maternal health service. This study investigated the rate of and factors associated with the institutional delivery among the Dalit women of the Mahottari, Nepal. Materials and methods A cross-sectional study was conducted during July-December 2014 using a structured questionnaire. A total of 328 mothers who had their childbirth within one year were interviewed. Descriptive statistics followed by binary and multivariable logistic regression analyses were computed to find the association of key variables with institutional delivery. Results In this study, only 30% of the mother had institutional delivery. Fifty eight percent mothers had no any birth preparedness and complication readiness. Four or more antenatal visits (Adjusted Odds Ratio (AOR): 3.54, CI: 1.82–6.90), birth preparedness (AOR: 3.15, CI: 1.61–6.18), planned pregnancy (AOR: 2.63, CI: 1.37–5.06) and receiving advice from health staffs (AOR: 3.96, CI: 2.00–7.86) and mother's autonomy (AOR: 2.25, CI: 1.03–4.49) were associated with child birth at the health facility. Conclusion This study indicated that birth preparedness, ANC visit frequency, planning of pregnancy, advice for institutional delivery and mother's autonomy were significantly associated with health facility delivery. Less than one-third mothers had institutional delivery and reasons were feeling of un-necessary, far distance, lack of transportation and associated cost; and birth preparedness is also low. Hence, promotion of birth preparedness, uptake of ANC service, proper counselling for institutional delivery, promoting women autonomy and strengthening women to have planned pregnancy were some recommendation to promote institutional delivery for such disadvantage community.