Mandira Adhikari

Factors associated with the introduction of prelacteal feeds in Nepal: findings from the Nepal Demographic and Health Survey 2011.

BackgroundA prelacteal feed is any food except mother’s milk provided to a newborn before initiating breastfeeding. Prelacteal feeding is a major barrier to exclusive breastfeeding. It is a prevalent practice in Nepal. Little is known about the factors associated with providing prelacteal feeds to the Nepalese newborn. This study explored the factors associated with providing prelacteal feeds to children under three years in Nepal using the Nepal Demographic and Health Survey (NDHS) 2011.MethodsThis study utilised the NDHS 2011 child dataset which is a nationally representative study. The rates of providing prelacteal feeds were reported as a proportion. Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multiple logistic regression were used to analyse the factors associated with providing prelacteal feeds.ResultsA sample of 3948 mothers were included in the study. A total of 841 [26.5% (95% CI: 23.1%–30.3%)] weighted proportion) of mothers reported of providing prelacteal feeds to their newborn infants. Plain water (n = 75), sugar/glucose (n = 35), gripe water (n = 3), sugar/salt solution (n = 3), fruit juice (n = 3), infant formula (n = 96), tea (n = 3) and other milk other than breast milk (n = 556) were some of the types of prelacteal feeds reported. The multiple regression analysis showed that the mothers who had no education, were not working, were from the middle wealth quintile, who had not attended four antenatal care visits, were first time mothers and who were from the Terai/Plain region were more likely to provide prelacteal feeds.ConclusionsGiven that one in four infants were provided with prelacteal feeds, there is a need to implement breastfeeding promotion programs to increase the practice of exclusive breastfeeding and reduce prelacteal feeding practices. Breastfeeding counseling at antenatal clinics and peer support for exclusive breastfeeding should be included as part of breastfeeding promotion programs. Mobilisation of female community health volunteers for peer counseling is also a feasible option for Nepal.

Factors associated with early initiation of breastfeeding among Nepalese mothers: further analysis of Nepal Demographic and Health Survey, 2011

BackgroundTimely initiation of breastfeeding has been reported to reduce neonatal mortality by 19.1%. The World Health Organisation recommends early initiation of breastfeeding i.e. breastfeeding a newborn within the first hour of life. Knowledge on the rate and the determinants of early initiation of breastfeeding may help health program managers to design and implement effective breastfeeding promotion programs. The aim of this study was to determine the rate and the determinants of early initiation of breastfeeding in Nepal.MethodsThis study used the data from Nepal Demographic and Health Survey (NDHS) 2011 which is a nationally representative sample study. Chi square test and multiple logistic regression analysis were used to examine the factors associated with early initiation of breastfeeding (within one hour of birth).ResultsOf 4079 mothers, 66.4% initiated breastfeeding within one hour of delivery. Mothers with higher education (Odds Ratio (OR) 2.56; 95% CI : 1.26, 5.21), mothers of disadvantaged Janjati ethnicity (OR 1.43; 95% CI : 1.04, 1.94), mothers who were involved in agriculture occupation (OR 1.51; 95% CI : 1.16, 1.97), mothers who delivered in a health facility (OR 1.67; 95% CI : 1.25, 2.23), whose children were large at birth (OR 1.46; 95% CI : 1.07, 1.99) were more likely to initiate breastfeeding within the first hour of child birth.ConclusionsResults suggest that two thirds of children in Nepal were breastfed within the first hour after birth. Although there was a higher prevalence of early initiation of breastfeeding among mothers who delivered in health facilities compared to mothers who delivered at home, universal practice of early initiation of breastfeeding should be a routine practice. The findings suggest the need of breastfeeding promotion programs among the mothers who are less educated, and not working. Such breastfeeding promotion programmes could be implemented via Nepal’s extensive network of community-based workers.

Determinants of Postnatal Service utilization in a Western District of Nepal: Community Based Cross Sectional Study

Background: Postnatal care of mothers is essential to reduce maternal morbidity and mortality. The objective of this study was to examine the factors affecting the utilization of postnatal service among the mothers who were currently having young children aged 6 weeks to 23 months in Kapilvastu district of western Nepal. Method: This was a community based cross sectional study conducted from January to February, 2012. Utilization of Postnatal Care (PNC) was reported in proportion. Factors associated with utilization of services were examined by using chi square test followed by regression analysis. Results: Of the 223 participants, 25.1% attended any PNC, 13.5% attended early PNC (within 24 hours of delivery) and 19.3% sought PNC service from health workers. The mothers who consumed iron tablet during pregnancy, who delivered in health facility, and who experienced danger signs during pregnancy were more likely to attend PNC services. The mothers who attended four or more ANC visits; had delivey assisted by health workers; had delivery at health faclity; consumed iron tablet during pregnancy; and attended secondary and above education were more likely to utilize early PNC services than their counterparts. Mothers who had completed secondary or higher education; had attended four or more ANC services or 1-3 ANC visits; who had ANC services by health workers; who had taken iron tablet during pregnancy and who were affected by danger signs during delivery were more likely to receive PNC from health workers than their counterparts. Conclusion: This study revealed that uptake of postnatal care service was very low. Home visits of postnatal mothers by health workers could be effective approach to increase the uptake of PNC services. Initiating incentive schemes for health workers or the mothers could be future direction for intervetion studies to increase postanatal service utilization in Nepal.

Association of water handling and child feeding practice with childhood diarrhoea in rural community of Southern Nepal

Diarrhoea is a major cause of childhood morbidity and mortality globally. While the childhood diarrhoea and its association with child feeding, and hygiene, hand washing and water treatment are studied elsewhere, the association of water handling and child feeding with childhood diarrhoea is an understudied area in Nepal. This study aimed to investigate the association of water handling and child feeding practice with childhood diarrhoea among children of one to five years of age in Southern, Nepal. A cross-sectional study was conducted in the Dhanusha district of Southern Nepal in 2013. A total of 284 mother-child pairs were selected using systemic random sampling. A four-week prevalence of childhood diarrhoea was reported using frequency distribution. The association of childhood diarrhoea with water handling and child feeding practices was ascertained using multiple logistic regressions after adjusting for potential confounders. The result of the study demonstrated that the four-week prevalence of childhood diarrhoea was 36.6%. Our finding showed that unsafe water handling practices were associated independently with childhood diarrhoea: untreated water (aOR 3.55; 95% CI: 1.13-11.10), uncovered water (aOR 2.14; 95% CI: 1.09-4.19). Similarly, partial breast feeding (aOR 4.35; 95% CI: 1.87-10.12) was also associated with higher odds of childhood diarrhoea. One third of children in Southern Nepal still had diarrhoea within the four weeks preceding the survey. As poor water handling and sub optimal infant feeding practice were major risk factors contributing to such a high burden of the disease, health promotion strategies such as promotion of safe water handling, improved hygiene and child feeding practices are recommended for the prevention of childhood diarrhoea in Southern Terai of Nepal.

Utilization of maternal and child health services in western rural Nepal: a cross-sectional community-based study.

BACKGROUND Considering the commitment and investment of Nepal to reduce maternal and child mortality, understanding service utilization and factors associated with a child and maternal health services is important. OBJECTIVES This study was examined the factors associated with utilization of maternal and child health services in Kapilvastu District of Nepal. MATERIALS AND METHODS A cross-sectional study was conducted in 2010 by interviewing 190 mothers having children of aged 12-23 months using the standardized questionnaire. RESULTS Immunization status (97.4%) and vitamin A supplementation (98.4%) was high. However, initiation of breastfeeding within an hour of birth was low (45.3%) and 63.2% had practiced exclusive breastfeeding. Majority (69.5%) of respondents delivered their child at home and 39.5% sought assistance from health workers. The mothers who did not have any education, mothers from Dalit/Janjati and the Terai origin were less likely to deliver at the health facility and to seek the assistance of health workers during childbirth. CONCLUSION The immunization program coverage was high, whereas maternal health service utilization remained poor. Interventions that focus on mothers from Dalit/Janjati group and with lower education are likely to increase utilization of maternal health services.

Factors Associated with Child Health Card Holding among Mothers of Western Rural Nepal: A Cross Sectional Community Based Study

The use of Child Health Card (CHC) has been found effective to assess overall health status of children worldwide. The tool is simple, cost-effective and easy to use yet standard enough to interpret. Nepal recently made contextual modifications in 2006 and has incorporated it into the Health Management Information System. The card is issued to all children during their first visit for immunization. In Nepal, CHC is considered a valid and authentic report for immunization but little has been studied about its holding. The objective of our study was to find its retention rate along with the factors associated. A community-based cross-sectional study was carried out in 10 village development committees of Kapilvastu district between November 15 and December 15, 2010. A total of 190 households were selected using lot quality assurance sampling technique. Higher retention rate (88.9%) of CHC was found while status of complete immunization was significantly associated with its retention (adjusted OR: 41.92, (95%CI; 2.66-658), p=0.008) after adjusting for growth monitoring, ethnicity, place of delivery, antenatal visit, breastfeeding and mothers age. This study can guide the health system and the family members the measures to sustain higher coverage and retention of CHC which can further guide to the best possible health outcomes for the child.