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Background: Providing improved water, sanitation, and hygiene (WASH) at a household level remains one of the major public health challenges in Nepal. Household mothers are likely to have limited access to combined WASH services, this is influenced by individual, and community factors. Individual components of an improved water source, sanitary toilet, fixed place for handwashing, and availability of soap and water were merged into one and called combined WASH. This paper aimed to identify the individual and community factors associated with combined WASH facilities and practices among mothers with children under five years in Nepal. Methods: A cross-sectional study was conducted using data from the Nepal Demographic and Health Survey (NDHS), 2016. The weighted sample size of this study was 4887 mothers with children under five years. The independent variables within the mothers included age, education, occupation, and caste/ethnicity in addition to education of the husband, wealth index, exposure to the newspaper, radio and television, residence, ecological zones, provinces, distance and participation in health mother groups were analyzed with the outcome variable of combined WASH. A multi-level mixed effects logistic regression model was used to assess the relationship of explanatory variables with WASH. Results: At an individual level, a rich wealth index was positively associated with combined WASH (AOR = 6.29; 95%CI: 4.63–8.54). Higher education levels and exposure to television had higher odds of having combined WASH. At the community level, the hill zone, urban residence, and Sudurpashim Provinces were positively associated with combined WASH while Madesh and Karnali Provinces and distance to water source greater than 31 minutes were associated with lower access to combined WASH. Conclusion: Educated and rich household have positive association with combined WASH. It is recommended that both the health and other sectors may be instrumental in improving the combined WASH service for mothers at households. [ABSTRACT FROM AUTHOR]

Background: The benefits of exclusive breastfeeding (EBF) have been universally documented, with evidence of positive impacts on a child's optimal growth, development, and survival. However, EBF practices in Nepal have fluctuated and declined over the last 25 years. In addition to the individual factors of mothers and infants, EBF practices are affected by multiple community-level factors. Understanding these factors is essential for designing breastfeeding promotion programs to improve child nutritional status in Nepal. This study investigated the individual- and community-level determinants of EBF practices among young infants aged 0–5 months in Nepal. Method: We used the dataset from the Nepal Demographic and Health Survey 2022. Information on EBF in the past 24 h was available for 540 infants aged 0–5 months. A multilevel mixed-effect logistic regression was used to identify individual- and community-level factors associated with EBF among infants aged 0–5 months in Nepal. Results: The 24-hour prevalence of EBF among infants aged 0–5 months was 57.46% (95% confidence interval (CI): 52.18, 62.57). The infant's age was inversely associated with EBF prevalence at the individual level. Compared with infants aged < 1 month, infants aged three months (adjusted odds ratio (AOR): 0.14, 95% CI: 0.05, 0.40), four months (AOR: 0.11, 95% CI: 0.04, 0.28), and five months (AOR: 0.07, 95% CI: 0.03, 0.20) were less likely to receive EBF. At the community level, community-level variables such as ≥ 4 ANC visits coverage, maternal employment status, and poverty level were generated by aggregating the individual characteristics in a cluster and were categorized using quartiles into low ("< 25%"), moderate (25–75%), and high (≥ 75%). Mothers from communities with moderate ≥ 4 ANC visits (AOR: 3.30, 95% CI: 1.65, 6.57) and high ≥ 4 ANC visits (AOR: 2.70, 95% CI: 1.40, 5.22) coverage had higher odds of EBF practices than did those from communities with low ≥ 4 ANC visits coverage. Similarly, communities with moderate (AOR: 2.67, 95% CI: 1.34, 5.30) and high (AOR: 2.34, 95% CI: 1.10, 4.99) levels of maternal employment status and moderate levels of poverty (AOR: 2.20, 95% CI: 1.13, 4.28) were associated with a higher likelihood of EBF practices. Subnational level variation was evident, with infants in Lumbini province having lower odds of EBF (AOR: 0.32, 95% CI: 0.13, 0.77) relative to Koshi province. Approximately 9% of the variation in EBF practices was observed among mothers while mapping across clusters in this study. Conclusion: Various individual- and community-level factors influence the uptake of EBF in Nepal, underscoring the need to improve the approaches and strategies of EBF programs. This study highlighted the significant association of community-level factors (≥ 4 ANC visits coverage, poverty level, and maternal employment status) with EBF among infants under 6 months. It revealed approximately 9% variability in EBF across clusters. Future efforts to promote EBF should focus on older infants and communities with low poverty levels and low coverage of recommended ≥ 4 ANC visits. Furthermore, context-specific adaptation of such efforts might be required considering the variation observed between the communities in the present study. [ABSTRACT FROM AUTHOR]

Deer surveys play an important role in the estimation of local ecological balance. In the Chitwan National Park of Nepal, the dense tree canopies and tall vegetation often obscure the presence of wild deer, which has a negative effect on the accurate population surveys of wild deer. UAVs equipped with infrared sensors have been increasingly used to monitor wild deer by capturing a lot of images. How to automatically recognize and obtain the number of deer objects from thermal images is becoming an important research topic. Due to the difference between thermal images and true-color images, as well as the variations in deer object sizes in these two types of images, current ready-to-use object detection models, designed for true-color imagery, are ill-suited for the task of detecting small deer objects within thermal imagery. In this paper, an enhanced Faster R-CNN was constructed to detect small deer objects from thermal images, in which a Feature Pyramid Network (FPN) based on a residual network is used to improve feature extraction for small deer objects and multi-scale feature map constrution for the subsequent region proposals searching, bounding box regression, and regions of interest (RoIs) classification. In addition, small-scaled anchor boxes and a multi-scale feature map selection criterion are devised to improve the detection accuracy of small objects. Finally, based on Faster R-CNN, FPN, and different residual networks including ResNet18, ResNet34, ResNet50, ResNet101, and ResNet152, we constructed five object detection models, and evaluated their detection performance by using COCO evaluation matrix. Under the condition of IoU ≥ 0.5 , the integration of Faster R-CNN, FPN, and ResNet18 demonstrated to perform better than others. Specifically, The COCO evaluation results revealed an Average Precision (AP) score of 91.6% for all deer objects. Small deer objects (area ≤ 200 pixels) achieved an AP score of 73.6%, medium deer objects (200 < area ≤ 400 pixels) demonstrated an AP score of 93.4%, and large deer objects (area > 400 pixels) achieved the highest AP score of 94.3%. Our research is helpful for effective wild deer monitoring and conservation and can be a valuable reference for the exploration of small object detection from low-resolution thermal images. • Drones with infrared sensors capture thermal images for wild deer surveys in areas covered by dense canopies. • The objects within thermal imagery are small and less than 30 × 30 pixels. • Existing object detection models, trained on true-color images, struggle with small objects detection from thermal imagery. • Feature Pyramid Network fuses the feature information extracted by residual networks to construct multi-scale feature maps. • Enhanced Faster R-CNN with customized anchor boxes and multi-scale feature maps achieves an average precision. [ABSTRACT FROM AUTHOR]

Background: Miscarriage is a major public health concern in low and middle-income countries (LMICs) like Nepal. This study aims to examine the factors associated with miscarriage among pregnant women of reproductive age (15–49 years) in the past 15 years. Methods: There were a total of weighted sample of 26,376 cross-sectional pregnancy data from Nepal Demographic and Health Surveys (NDHS) 2001, 2006, 2011, and 2016 combined together, which was used in the study. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify factors associated with miscarriage among pregnant women of reproductive age in Nepal. Results: The results showed that maternal age, contraception, tobacco smoking, wealth index, respondents' educational status, and, caste/ethnicity were found to be strong factors of miscarriage in Nepal. The likelihood of having a miscarriage among older women (≥40 years) was more than 100% (aOR = 2.12, 95% CI [1.73, 2.59]), among non-users of contraception was 88.9% (aOR = 1.88, 95% CI [1.68, 2.11]) (p<005) and non-smoking women had a 19% lower odds of miscarriage (aOR = 0.81, 95% CI [0.69, 0.95]). Respondents from the richest wealth index had 50% (aOR = 1.50, 95% CI [1.22, 1.85]) higher likelihood of miscarriage. Mothers with only primary education had a 25% higher chance of miscarriage (aOR = 1.25, 95% CI [1.09, 1.44]) compared to those with secondary and higher secondary education. In relation to caste/ethnicity, Dalits had 13% lesser likelihood (aOR = 0.87, 95% CI [0.74, 1.02]) and Janajatis had 26% lower chances of a miscarriage than Brahmin/Chettri (aOR = 0.74, 95% CI [0.64, 0.85]). Conclusion: Findings from this study show that miscarriages are associated with maternal age, use of contraception, smoking, wealth index, caste, and ethnicity. Interventions aimed to improve use of contraceptives, avoiding smoking and pregnancy planning on the basis of maternal age, are needed to prevent miscarriage. Also, women from Brahmin ethinicity and those with the highest income index require greater attention when it comes to miscarriage prevention strategies in Nepal. [ABSTRACT FROM AUTHOR]