Search

Food security and dietary diversity, defined as providing either physical (availability) or economic (accessibility) access to food, are linked with access to and control over productive resources and is a highly-gendered phenomenon. In Nepal, labor out-migration has increased household income and may have increased people's ability to access diverse food either by increasing investment in agriculture or purchasing various food items from the market. However, the relationship between household dietary improvement and labor out-migration is complex. Drawing on a survey of 1,053 migrant households in three agroecological regions of Nepal, this paper disentangles this complex phenomenon by showing how household dietary diversity and women's dietary diversity are influenced by biophysical, social, economic, and cultural factors. The influence of the amount of remittances, land abandonment, and women confined to the house by household chores are some factors that policy makers should consider seriously in designing gender-sensitive nutrition policies. The expansion of women's agency contributes to enhancing dietary diversity and specifically women's dietary diversity at the household level; however, how these factors determine an individual's dietary diversity depends on intrahousehold dynamics and relations. [ABSTRACT FROM AUTHOR]

Handwashing with soap is a fundamental practice for preventing communicable diseases, particularly in resource-constrained settings like Nepal, where various factors influence maternal handwashing behaviours. A systematic search encompassing PubMed/Medline, Embase, PsycINFO, CINAHL and grey literature source was conducted. Extracted eligible articles underwent descriptive analysis and their quality assessment was carried out following STROBE guidelines. From the initial screening of 187 database articles and 18 from grey literature, a total of 120 full text articles and records were retrieved to evaluated for inclusion in the review, identifying nine articles meeting the inclusion criteria for the review. Maternal handwashing with soap frequencies varied during critical moments ranging from 6% to 100%, and a 47% availability of soap and water at the household level was reported. Factors influencing handwashing included education, wealth, ecology, and participation in health promotion campaigns. Barriers included knowledge gaps, contrary beliefs, unavailability of soap and water, financial constraints, maternal demotivation, and low participation in decision-making. Limitations include study design heterogeneity (cross-sectional, Randomized Controlled Trials-RCT, Cohort), sample size variability, and geographical bias, potentially limiting generalizability of this study, limited reporting on soap and water availability for mothers at the household level is noted, and temporal variability introduces study inconsistency. Availability of soap, water, and effective health education is crucial for promoting sustained handwashing practices. Community-based interventions involving mothers in decision making and policy initiatives are essential for overcoming barriers and promote behavioural change to improve public health outcomes. This paper aims to determine the rates of handwashing with soap among mothers in Nepalese households and explore the factors associated with the uptake of handwashing. [ABSTRACT FROM AUTHOR]

In recent years, overseas labour migration has become a lifeline for many households in Nepal. Using survey data from 465 randomly selected households and 227 overseas labour migrants, this paper examines the factors influencing overseas labour migration and migration intensity in farming households by employing a generalised two-part fractional regression model, and migrants’ destination choice by using the probit model. We find that a higher proportion of educated members in the household, along with household’s credit access, indebtedness, and contacts with manpower agencies significantly increase the likelihood of overseas labour migration and migration intensity in the households, whereas the presence of employed members in the household, larger farms, irrigation access, and higher asset index significantly lower such likelihood. We find a lower likelihood of migration to Malaysia and the Middle East countries among individuals with employed household members and a higher asset index, while those connected to manpower agencies are more likely to choose these countries as destinations. Our findings emphasise the significance of creating and providing decent economic opportunities, including strengthening the agriculture sector, to address the existing surge in overseas labour migration from farming households in Nepal. [ABSTRACT FROM AUTHOR]

Background: In Nepal and across the globe, the COVID-19 pandemic has primed an environment for increased rates of violence against women (VAW). This paper explores pandemic-driven economic insecurity and increased alcohol use as instigators of VAW and Intimate Partner Violence (IPV) within newly married households in the rural, Nawalparasi region of Nepal. Methods: This study is a secondary analysis of data obtained from the Sumadhur Intervention pilot study that has been previously described and demonstrates successful implementation of group-based, household-level intervention for women's empowerment and sexual and reproductive health education (1). Our three sets of data were collected before and during the COVID-19 pandemic. The first set is from a Longitudinal Cohort of 200 newly married women who were surveyed twice a year from February 2017 through July 2020. The second data set is a subset cohort of newly married women, their husbands, and their mothers-in-law (31 women, 31 husbands and 31 mothers-in-law) who participated in Sumadhur in January 2021. The third data set was obtained through in-depth interviews in July 2021 from 15 households following Sumadhur. The interviews were thematically coded, and subthemes were identified. A t-test of the January 2021 survey data set was run to look at correlations between income loss, alcohol consumption and experience of IPV among newly married women. All other survey data was analyzed for change over time. Results: At three months after the onset of the pandemic (July 2020), the Longitudinal Cohort survey data from newly married women reported increased rates of husbands' alcohol use as well as personal experiences of IPV as compared to pre-pandemic averages. There was a statistically significant difference (p < 0.001) in the effects of income loss on increased alcohol use and experience of IPV. Qualitative results iterated the common theme of alcohol use and economic insecurity as upstream instigators of VAW in the community. Conclusions: In the Nawalparasi district of Nepal, the pandemic has led to unstable economic situations that have instigated alcohol use among men, and increased rates of IPV among young, newly married women, and reports of VAW in the community. We have demonstrated a need for urgent programmatic and policy responses aimed at reducing VAW and IPV and protecting women during times of uncertainty and crisis. [ABSTRACT FROM AUTHOR]

This paper investigates how educational and geographic capital are assorted among households in rural Nepal, and how women's marital age may shape this distribution. Our focus on the timing of marriage adds a new dimension to studies of geographies of youth and marital assortment, while our emphasis on the physical and spatial attributes of households leads us to propose the concept of geographic capital, operationalised here as agrarian landholding and access to rural markets. Using data on 17,284 women from rural lowland Nepal, heat tables showed substantial pairing among uneducated spouses, whereas educated men married women with varying levels of schooling, partly because fewer women were educated. Multivariable logistic regression models showed that the odds of marrying an educated man increased substantially for women with secondary education, and vice versa. Educated women were also more likely to marry into households with geographic capital. However, landowning husbands tended to marry younger wives, perhaps because the natal home was prepared to marry daughters earlier in order to access this geographic capital. The youngest‐marrying women were least likely to marry into households with accessibility to markets. Our findings may help understand the decisions of both a woman's natal and marital household over the timing of her marriage, and the investment in her formal education. These patterns have implications for both spouses because capital not only shapes marital pairing, but also the spatial niche of the household within which women and their children will experience their life‐course. [ABSTRACT FROM AUTHOR]

Background: In a setting such as Nepal with malnutrition and persistent poor maternal and infant health outcomes, developing interventions to improve the nutrition of preconception and pregnant women is essential.Objective: The objectives of this paper are to describe the full design process of an intervention for newly married women, their husbands, and mothers-in-law to improve maternal nutrition and gender norms, and findings from the feasibility and acceptability pilot.Methods: In this paper we describe the three phases of the design of an intervention in rural Nepal. We first conducted a mixed methods formative phase which included in depth interviews with newly married women, their husbands and mothers-in-law (N=60) and a longitudinal study for 18 months with 200 newly married women. We then designed of a household level, group, intervention, in close partnership with community members. Finally, we conducted a pilot intervention with 90 participants and collected both pre/post survey data and in-depth qualitative interviews with a subset (N= 30). All participants from all phases of the study lived in Nawalparasi district of Nepal. Qualitative data was analyzed using a thematic analysis, with inductive and deductive themes and quantitative data was analyzed using descriptive statistics.Results: Our formative work highlighted lack of awareness about nutrition, and how women eating last, limited mobility, household and community inequitable gender norms and poor household-level communication contributed to low quality diets. Thus we designed Sumadhur, an intervention that brought groups of households (newly married wife, husband, and mother-in-law) together weekly for four months to strengthen relationships and gain knowledge through interactive content. We found Sumadhur to be highly feasible and acceptable by all respondents, with most (83%) attending 80% of sessions or more and 99% reporting that they would like it to continue. Pre/post surveys showed a decrease in the proportion of women eating last and increase in knowledge about nutrition in preconception and pregnancy. Qualitative interviews suggested that respondents felt it made large impacts on their lives, in terms of strengthening relationships and trust, understanding each other, and changing behaviors.Conclusions: We show how a designing an intervention in close partnership with the target recipients and local stakeholders can lead to an intervention that is able to target complicated and culturally held practices and beliefs, positively benefit health and wellbeing, and that is very well received.Trial Registration: ClinicalTrials.gov NCT04383847 , registered 05/12/2020. [ABSTRACT FROM AUTHOR]

This paper investigates implications of male labour migration in gender roles and identity of women, and household food security outcome in the Kaligandaki Basin, Nepal. The study covers three study-clusters located at different ecological zones: Meghauli in Tarai, Lumle in Middle-Mountains, and Upper-Mustang in Trans-Himalaya. Data on private domain were collected through face-to-face interview in 360 households while data on public domain were obtained from group discussions conducted in 24 communities, and Key Informants Interviews taken with 75 individuals. The findings indicate that out-migration of men compelled women shoulder additional work-burden. Feminisation of agriculture and communities has reduced farm-production and increased food insecurity in terms of self-production. However, it is compensated by remittance sent by migrants and associated increase in access to marketed food. Despite male out-migration giving opportunity to women to be a household manager, it is limited to be a de facto household-head who lacks control over household assets. They have poor influence in community decision-making too, though increased the participation. Women in the basin are performing the roles of both men and women so are lacking particular gender identity. These findings indicate the need of integrating gender policy with migration, agriculture, and food security policies of Nepal. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic led to surging concerns about food insecurity status throughout the world. In response to global and national concerns on food and nutrition security, this study aimed to examine the prevalence and determining factors of household food insecurity and dietary diversity among people from selected rural municipalities of Lalitpur district, Nepal. Methods: A community-based cross-sectional study was conducted among 432 households. Pretested structured questionnaires were used to collect socio-demographic characteristics of the participants, household income; influence of COVID-19 on their income and livelihood, household's access to food and dietary diversity. Food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS) and the Household Dietary Diversity Score (HDDS). A multivariable analysis was done using binary logistic regression model following a bivariate analysis to assess the association between the dependent and independent variables. Results: More than one-third (36%) of the households reported some form of food insecurity. The overall mean score for Household Dietary Diversity Score (HDDS) was 6.0 (±1.1). Multivariable logistic regression analysis showed that participants aged 41–64 years (aOR = 0.35, 95% CI: 0.21–0.59), those over 64 years (aOR = 0.22, 95% CI: 0.07–0.66), as well as those in service occupation (aOR = 0.22, 95% CI: 0.06–0.77) were associated with lower odds of HFIAS. Conversely, Participants belonging to a disadvantaged ethnic group (aOR = 2.73, 95% CI: 1.23–6.07), having no education (aOR = 3.70, 95% CI: 1.16–11.71) or primary education (aOR = 3.67, 95% CI: 1.23–9.89), and those suffering from chronic illness (aOR = 3.12, 95% CI: 1.53–6.35) were associated with higher odds of HFIAS. As for HDDS, participants aged 41–64 years (aOR = 0.48, 95% CI: 0.28–0.83) were associated with lower odds of HDDS, while participants having no education (aOR = 10.05, 95% CI: 4.05–24.01) were associated with significantly higher odds of HDDS. Conclusion: Owing to the pandemic, our study showed a substantial prevalence of food insecurity among diverse community residing in rural outskirts of Kathmandu Valley, particularly among disadvantaged ethnic group and people with lower level of education. Interventions targeting these particular groups may help in improving HFIAS and HDDS among them during emergencies. [ABSTRACT FROM AUTHOR]

This paper applies ordinal logistic regression to a survey collected from 225 rural households across four different districts of Nepal to analyze the nonpayment behavior of households at rural water schemes. This study finds that non-payment behavior is highly influenced by a household's perception of how others pay rather than their own paying ability. This shows that the trust issue, which stems from an apparent n-prisoners dilemma, negatively reinforces free-riding behavior among the households. Further, the study also indicates that cultural and geographical distribution influence households relative positions on the nonpayment spectrum. • Language Correction accepted. • Correction in reference section. • Suggested changes accepted. [ABSTRACT FROM AUTHOR]

We develop a conceptual framework to understand linkages between water access and livelihood outcomes. We apply the framework to assess factors altering the likelihood of household indebtedness in rural Nepal, using survey data and probit statistical models. Controlling for different household characteristics, results show that in Nepal's Kamala basin, an additional month of water adequate to sustain crops decreases by 5% the likelihood that an average household in our sample reports high indebtedness. We complement our findings by discussing interacting drivers of agricultural livelihood outcomes; options to improve water availability and access; and geographical targeting of investment in water access. [ABSTRACT FROM AUTHOR]

This study examines the effect of household water accessibility on children's educational attainment in villages situated in the remote hilly and mountainous areas of Nepal. Educational attainment was measured based on school attendance, grade repetition, and completion of primary and lower-secondary schooling. The estimation results show that a one-hour increase in the time spent on a water-fetching trip will decrease the probability of girls completing primary school by about 17 percentage points (in the age group of 14–16 years). Although boys' completion rate is less affected, they are more likely to repeat a grade. Additional analyses indicate that these results are driven by the increased participation of older boys and younger girls in household duties. [ABSTRACT FROM AUTHOR]

Background: Nepal has implemented the social health security program in certain health facilities to improve access to quality health services. The aim of the study is to understand the utilization pattern of social health security schemes and community's perception of the social health security program. Method: A descriptive cross-sectional mixed-method study was conducted among 300 households of Illam district who had enrolled in the social health security scheme. A multi-stage random sampling method was used. A semi-structured questionnaire was used to collect quantitative data whereas focus group discussions (FGDs) were conducted for qualitative data. Descriptive analysis, bivariate and multivariate analysis was done. FGDs were transcribed and thematic analysis was done. Findings: The utilization rate of social health security scheme was 88.7%. Factors associated with the utilization of program included: presence of under-five children and chronic illness in households, sex and age group. Focus group discussion revealed that people were aware of social health insurance and pleased with program implemented by government. However, the hospitals under the social health insurance were not able to meet their expectations. Conclusion: Although the utilization of social health security scheme was high, people were dissatisfied with the service provided by the hospital under the social health security scheme. Therefore, the social health insurance board should closely monitor the hospitals and develop a feedback mechanism from the users. [ABSTRACT FROM AUTHOR]

Sustainability has become a global topic and is pursued in all countries along South Asia—Nepal, that it has become part of the political agenda, specifically visible in Kathmandu, the country’s capital. Household is one of the highest energy-consuming sectors, and women have a higher responsibility for household chores in most cases. However, women are still lagged in the energy sector. The energy studies are more focused on technical policy with limitations of the gender lens. This study analyzes energy, gender, and sustainability interlinkage as a common goal and identifies the economic, environmental, and social sustainability of energy consumption from a gender perspective in Kathmandu’s. The findings show that female participation in energy decisions is likely to increase in female-headed families. Kathmandu urban women still have lack of knowledge, the right information, and affordability. The overall sustainability study indicates that the energy policy needs to be a gender-neutral policy. Conclusively, innovative technical interventions can be combined with the subsidy, increase women’s participation to reduce inequality, encourage efficient cooking technology to reduce the nation’s financial burden. [ABSTRACT FROM AUTHOR]

Early marriage is one of the major traditional practices that affects the life of both boys and girls in many different ways. In this context, this research assessed the prevalence of early marriage and derived its underlying causes. Adopting a mixed methods approach, first, the study surveyed a sample of 1350 households of Nepal in which at least a marriage took place within the five years before the survey. Following a survey, secondly, the study explored 30 unique cases of early marriage, and ten among them were studied in more depth through face-to-face interviews. Logistic regression was applied to determine the factors that could influence the prevalence of early marriage. It was then followed by an analysis of the qualitative data. The research findings demonstrate that there is a high prevalence of early marriage (49.6%) among households within Nepal; nevertheless, the overall trend of early marriage is noted at a decreasing trend over the years. Undoubtedly, factors such as the level of education of the family members, the gender of the head of the household, and religion, influence the predisposition to early marriage within Nepal. Early marriage is undeniably a subjective phenomenon; however, such subjectivity is shaped by the socio-economic situation, as well as individual and family values. Thus, among others, the study implied that improving the strategies that promote higher formal schooling could reduce the prevalence of early marriage and thereby result in associated beneficial welfare effects in Nepal. [ABSTRACT FROM AUTHOR]

About two-thirds of Nepal's final energy is consumed by households. Traditional solid biomass constitutes most of the households' energy needs, and cooking is by far their most important energy-consuming activity. This paper analyzes household energy use patterns in Nepal through the year 2051 based on a bottom-up simulation accounting framework for seven provinces and the capital city, differentiated by rural and urban areas and seven end-uses. Six scenarios involving different growth paths for socio-economic and energy system development are considered. Unlike in developed economies, the study finds that country's household energy demand will continue to rise in the future, but it is heterogeneous across the provinces. With the government's recent SDG7 initiatives, electricity is expected to play a key role in the household's future energy mix, although biomass use will remain significant but in declining trends. The study also identifies priority provinces where additional action is needed to improve access to clean and affordable modern energy services. Assertive policy initiatives are needed beyond 2030 to pursue clean energy market establishments and end-use technological developments for the expected growth of household clean energy demand. • Household end-use energy demand by province and regions through 2051 is analyzed. • Final energy demand reduction is significant under alternative scenarios wrt baseline. • Cooking remains major household end-use activities up to 2031 across the scenarios. • Electricity is key, but biomass remains significant in future energy-mix under SDG7. • Priority provinces/end-uses are identified where clean energy services are lacking. [ABSTRACT FROM AUTHOR]

Background: Women's early marriage (<18 years) is a critical global health issue affecting 650 million women worldwide. It is associated with a range of adverse maternal physical and mental health outcomes, including early childbearing, child undernutrition and morbidity. Poverty is widely asserted to be the key risk factor driving early marriage. However, most studies do not measure wealth in the natal household, but instead, use marital household wealth as a proxy for natal wealth. Further research is required to understand the key drivers of early marriage. Methods: We investigated whether natal household poverty was associated with marrying early, independently of women's lower educational attainment and broader markers of household disadvantage. Data on natal household wealth (material asset score) for 2,432 women aged 18--39 years was used from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Different early marriage definitions (<15, <16, <17 and <18 years) were used because most of our population marries below the conventional 18-year cut-off. Logistic mixed-effects models were fitted to estimate the probabilities, derived from adjusted Odds Ratios, of (a) marrying at different early ages for the full sample and for the uneducated women, and (b) being uneducated in the first place. Results: Women married at median age 15 years (interquartile range 3), and only 18% married ≥18 years. Two-thirds of the women were entirely uneducated. We found that, rather than poverty, women's lower education was the primary factor associated with early marriage, regardless of how 'early' is defined. Neither poverty nor other markers of household disadvantage were associated with early marriage at any age in the uneducated women. However, poverty was associated with women being uneducated. Conclusion: When assets are measured in the natal household in this population, there is no support for the conventional hypothesis that household poverty is associated with daughters' early marriage, but it is associated with not going to school. We propose that improving access to free education would both reduce early marriage and have broader benefits for maternal and child health and gender equality. [ABSTRACT FROM AUTHOR]

Background: Adolescents' aspirations have potential to influence their present and future well-being. Limited knowledge exists on adolescent girls' aspirations and their determinants, particularly in low-income contexts. Methods and findings: Using cross-sectional data, collected in 2018 in Nepal, within the Suaahara II Adolescent Panel Survey, (n = 840), adolescent girls' aspirations in several domains—education, occupation, marriage, fertility, health, and nutrition–were described. Regression models were estimated to explore associations between individual, household and community characteristics and these aspirations for all adolescents and separately for younger (10–14 years) and older (15–19 years) girls. Age, school attendance, and self-efficacy, as well as household wealth, caste/ethnicity, size, and agro-ecological zone of residence were significantly associated with aspirations, although effect sizes and significance varied by aspiration domain and age group. Conclusions: Findings underscore the curtailing effect of poverty on aspirations and the dynamic nature of aspirations. Initiatives to foster girls' aspirations must address both individual and contextual factors. [ABSTRACT FROM AUTHOR]

Like other low-income countries in Asia and Africa, Nepal still suffers from food insecurity with a large proportion of food-insecure households being smallholder farmers who rely on rain-fed agriculture for their livelihood. Contributing factors include a lack of production, lack of resources, access to land and market, climate change, extreme events and underlying poverty. In this study, we aimed to examine the prevalence, cause of and response to food insecurity and assess how food security varies with respect to the regional variation. We also explored the role of changing climatic conditions in creating such adversities. Based on an analysis of the results from interviewing 384 farm households from three agro-ecological zones in Bagmati Province, we found that 56% of the farm households experienced food insecurity. The severity varied amongst the households with resource-poor, disadvantaged groups and those with limited land and income suffering the most severely from food insecurity. Households in the Mountains and the Hills zones were more food insecure than in the Terai zone. Climate change impacts were found to have amplified the risks of food insecurity amongst these rural households surviving under a largely subsistence agrarian economy. The results further suggest that the adaptive capacities of smallholder households can be increased by improving agricultural productivity through providing skills and training, better access to markets, extension services, credit and insurance schemes, along with access to climate-smart technologies, micro-irrigation, improved infrastructure, and storage facilities. Support from relevant governmental and non-governmental organizations is needed to help smallholder households, and their communities better manage the risks to their food security. [ABSTRACT FROM AUTHOR]

Because asymptomatic carriers are key source of transmission, information on meningococcal carriage in the community provides a scientific basis for appropriate preventive/control strategies. This longitudinal study (January 2017–December 2019) aimed to estimate carriage rate of meningococci among household contacts of meningococcal meningitis cases within Kathmandu Valley, Nepal. Throat swab samples were collected at first visit from each person in households, twice a month for up to 2 months and subsequently on a monthly basis for a further 4 months. Altogether, 1125 throat samples were processed by conventional culture for the identification of meningococci. To the best of our knowledge, this is the first longitudinal study on meningococcal carriage in Nepal. The meningococcal carriage rate among household contacts was 15%. All carriers were aged 19 years or older. There was no statistically significant gender difference. The duration of carriage was 60 days. Twenty of 36 isolates belonged to serogroup A, and 16 were non-serogroupable (NG). Serogroups isolated from the same individuals did not change within the follow-up period. All meningococcal isolates over the past 38 years in Nepal that have been reported in previous studies have belonged to serogroup A. The detection of NG meningococcal isolates in apparently healthy household contacts clearly indicates the importance of vigilance through surveillance and periodic in-depth studies. [ABSTRACT FROM AUTHOR]