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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]

Injuries are the direct and immediate impact of any extreme major event particularly earthquakes, which produce higher injuries than other disasters. How to reduce and avoid earthquake injuries has remained a major concern for disaster managers and policy-makers. With this motivation, this study examines the injury rates at the district level and identifies the major factors responsible for the rates caused by Nepal's two major earthquakes in 2015. Using secondary data, the injury rates were analyzed by the application of One Way Analysis of Variance and by identifying the factors of earthquake injury through two regression models—ordinary least squares (OLS) regression and geographically weighted regression (GWR). In both global (OLS) and local (GWR) models, we included seven independent variables, and the OLS regression identified three statistically significant determinants of 2015 earthquake injury rates in Nepal. Although the global model and local model coefficients are harmonious over Nepal, our results show that the GWR model performs better than the OLS model. Based on the major findings of this study, we conclude that improving the built environment in Nepal by enforcing strict building codes can substantially reduce injuries and collapse of buildings due to earthquakes in the future. [ABSTRACT FROM AUTHOR]

Community governance is an approach of shift from governmentality to governance. This is more flexible approach extends beyond government, and the place of its agencies, to a greater sharing of power between the state, the market and civil society via new network and partnership structures. This paper analyses the determinants of community governance at the grassroots level in Nepal for the efficient delivery of basic services based on primary data sources. 110 locally constituted community based organisations were selected for an organisational survey. Additionally, three focus group discussions and 40 in-depth interviews were employed for information collection. A multiple linear regression model was used for data analysis, which revealed 12 variables such as Inclusive participation (X1), Empowerment of the people (X2), Transparency and accountability (X3) Enabling environment (X4), Practice of local democracy (X5), Service effectiveness (X6), Service integrity (X7), Social capital development (X8), Institution building (X9), Community mobilisation (X10) Planning, implementation, and monitoring (X11), Coordination, linkage, and partnership (X12) are significantly influencing governance practice. Results indicated a 14 percent variance between dependent and independent variables. This shows the overall practice of governance at the community level was malfunctioned, which can be attributed to a number of factors. First, many community-based organisations (CBOs) do not adopt governance mechanisms in their approach to development. Second, despite a crisis in governance, some CBOs have participated in the service delivery process. Third, this crisis has been a foremost obstacle in the working culture of CBOs. This analysis further explores the problem from the perspective of socio-economic structure, power politics and interests, institutional issues, and capacity and resource constraints. [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]

Background: HIV is a major public health issue around the world, especially in developing countries. Although the overall prevalence of HIV in Nepal is relatively low, there are specific sub-populations where the prevalence is far higher than the national average. One of these sub-groups is male people who inject drugs (male PWIDs). In order to understand the reasons for the differences in prevalence, a series of socio-demographic, behavioural and knowledge-based risk factors need to be assessed.Methods: The study used a series of 7 cross-sectional survey datasets from Pokhara (Nepal), collected between 2003 and 2017 (N = 2235) to investigate trends in HIV prevalence among male PWIDs by socio-demographic and behavioural and knowledge-based risk factors. A series of logistic regression models were conducted to investigate the association between study factors and HIV.Results: HIV prevalence decreased from the levels seen in 2003 (22.0%) and 2005 (21.7%), with the lowest prevalence recorded in 2015 (2.6%), however prevalence has increased in the most recent period (4.9%). A lower risk of HIV was associated with younger age (<=24 years compared to > 24 years, OR = 0.17, 95% CI = 0.10-0.31), being married (OR = 1.91, 95% CI = 1.25-3.02) and shorter duration of drug use (<=4 years compared to > 4 years, OR = 0.16, 95% CI = 0.09-0.29). A higher risk of HIV was associated with low (compared to secondary or higher) education level (OR = 2.76, 95% CI = 1.75-4.36), a lack of addiction treatment (OR = 2.59, 95% CI = 1.64-4.08), and recent use of unsterilized injection equipment (OR = 2.22, 95% CI = 1.20-4.11).Conclusion: The prevalence of HIV in male PWIDs in Pokhara has been variable, but overall has reduced in recent years to 2.6% before increasing in 2017 to 4.9%. The main determinants which increase the risk of HIV among male PWIDs in Pokhara are low education level, a lack of treatment for drug addiction and the recent use of unsterilised equipment. Each of these indicate the need to improve addiction treatment and education programs for intra-venous drug use to aid this key population in avoiding risk-taking behaviours. [ABSTRACT FROM AUTHOR]

Background: HIV is a major public health issue around the world, especially in developing countries. Although the overall prevalence of HIV in Nepal is relatively low, there are specific sub-populations where the prevalence is far higher than the national average. One of these sub-groups is male people who inject drugs (male PWIDs). In order to understand the reasons for the differences in prevalence, a series of socio-demographic, behavioural and knowledge-based risk factors need to be assessed. Methods: The study used a series of 7 cross-sectional survey datasets from Pokhara (Nepal), collected between 2003 and 2017 (N = 2235) to investigate trends in HIV prevalence among male PWIDs by socio-demographic and behavioural and knowledge-based risk factors. A series of logistic regression models were conducted to investigate the association between study factors and HIV. Results: HIV prevalence decreased from the levels seen in 2003 (22.0%) and 2005 (21.7%), with the lowest prevalence recorded in 2015 (2.6%), however prevalence has increased in the most recent period (4.9%). A lower risk of HIV was associated with younger age (<=24 years compared to > 24 years, OR = 0.17, 95% CI = 0.10-0.31), being married (OR = 1.91, 95% CI = 1.25-3.02) and shorter duration of drug use (<=4 years compared to > 4 years, OR = 0.16, 95% CI = 0.09-0.29). A higher risk of HIV was associated with low (compared to secondary or higher) education level (OR = 2.76, 95% CI = 1.75-4.36), a lack of addiction treatment (OR = 2.59, 95% CI = 1.64-4.08), and recent use of unsterilized injection equipment (OR = 2.22, 95% CI = 1.20-4.11). Conclusion: The prevalence of HIV in male PWIDs in Pokhara has been variable, but overall has reduced in recent years to 2.6% before increasing in 2017 to 4.9%. The main determinants which increase the risk of HIV among male PWIDs in Pokhara are low education level, a lack of treatment for drug addiction and the recent use of unsterilised equipment. Each of these indicate the need to improve addiction treatment and education programs for intravenous drug use to aid this key population in avoiding risk-taking behaviours. [ABSTRACT FROM AUTHOR]

Background: Nepal has committed to the global community to achieve universal health coverage by 2030. Nevertheless, Nepal still has a high proportion of out-of-pocket health payment and a limited risk-pooling mechanism. Out-of-pocket payment for the healthcare services could result in catastrophic health expenditure (CHE). Evidence is required to effectively channel the efforts to lower those expenses in order to achieve universal health coverage. However, little is known about CHE and its determinants in a broad national context in Nepal. Therefore, this study was conducted to explore the cumulative incidence, distribution, and determinants of CHE in Nepal. Methods: Data were obtained from the nationally representative survey, the Nepal Living Standards Survey-third undertaken in 2010/11. Information from 5988 households was used for the analyses. Households were classified as having CHE when their out-of-pocket health payment was greater than or equal to 40% of their capacity to pay. Remaining households were classified as not having CHE. Logistic regression analyses were used to identify determinants of CHE. Results: Based on household-weighted sample, the cumulative incidence of CHE was 10.3% per month in Nepal. This incidence was concentrated in the far-western region and households in the poorer expenditure quartiles. Multivariable logistic regression revealed that households were more likely to face CHE if they; consisted of chronically ill member(s), have a higher burden of acute illness and injuries, have elderly (≥60 years) member(s), belonged to the poor expenditure quartile, and were located in the far-western region. In contrast, households were less likely to incur CHE when their household head was educated. Having children (≤5 years) in households did not significantly affect catastrophic health expenditure. Conclusions: This study identified a high cumulative incidence of CHE. CHE was disproportionately concentrated in the poor households and households located in the far-western region. Policy-makers should focus on prioritizing households vulnerable to CHE. Interventions to reduce economic burden of out-of-pocket healthcare payment are imperative to lower incidences of CHE among those households. Improving literacy rate might also be useful in order to lower CHE and facilitate universal health coverage. [ABSTRACT FROM AUTHOR]

On-farm tree growing is potentially important for livelihood strategies and forest conservation, and varies greatly according to local contexts. A detailed knowledge base is therefore needed, requiring, inter alia, the documentation of factors associated with growing trees on farms. The present study surveyed 304 randomly sampled households in ten community forestry user groups in Nepal, eliciting data on demographics, income and consumption of tree products. All trees on households' farm land were registered by species. Farmers had on average 65 trees per hectare and a total of 92 species were found. The Shannon-Wiener index was 2.46 and Simpson's Dominance index was 0.15. Trees on farmland contributed on average 43 % of households' firewood and fodder consumption. Apparent determinants of tree growing were identified through OLS regression; they included size of land and livestock holdings, education and firewood consumption, while income, ethnicity and sex of household head were not significant. Households' network and distance between household dwellings and the forest were negatively related with on-farm tree growing. Findings indicate that community forestry practices work to the detriment of the poorest households. [ABSTRACT FROM AUTHOR]

Background. Childhood undernutrition and mortality are high in Nepal, and therefore interventions on infant and young child feeding practices deserve high priority. Objective. To estimate infant and young child feeding indicators and the determinants of selected feeding practices. Methods. The sample consisted of 1,906 children aged 0 to 23 months from the Demographic and Health Survey 2006. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results. Breastfeeding was initiated within the first hour after birth in 35.4% of children, 99.5% were ever breastfed, 98.1% were currently breastfed, and 3.5% were bottle-fed. The rate of exclusive breastfeeding among infants under 6 months of age was 53.1%, and the rate of timely complementary feeding among those 6 to 9 months of age was 74.7%. Mothers who made antenatal clinic visits were at a higher risk for no exclusive breastfeeding than those who made no visits. Mothers who lived in the mountains were more likely to initiate breastfeeding within 1 hour after birth and to introduce complementary feeding at 6 to 9 months of age, but less likely to exclusively breastfeed. Cesarean deliveries were associated with delay in timely initiation of breastfeeding. Higher rates of complementary feeding at 6 to 9 months were also associated with mothers with better education and those above 35 years of age. Risk factors for bottle-feeding included living in urban areas and births attended by trained health personnel. Conclusions. Most breastfeeding indicators in Nepal are below the expected levels to achieve a substantial reduction in child mortality. Breastfeeding promotion strategies should specifically target mothers who have more contact with the health care delivery system, while programs targeting the entire community should be continued. [ABSTRACT FROM AUTHOR]