Quality of routine health facility data for monitoring maternal, newborn and child health indicators: A desk review of DHIS2 data in Lumbini Province, Nepal.

INTRODUCTION: Health-facility data serves as a primary source for monitoring service provision and guiding the attainment of health targets. District Health Information Software (DHIS2) is a free open software predominantly used in low and middle-income countries to manage the facility-based data and monitor program wise service delivery. Evidence suggests the lack of quality in the routine maternal and child health information, however there is no robust analysis to evaluate the extent of its inaccuracy. We aim to bridge this gap by accessing the quality of DHIS2 data reported by health facilities to monitor priority maternal, newborn and child health indicators in Lumbini Province, Nepal. METHODS: A facility-based descriptive study design involving desk review of Maternal, Neonatal and Child Health (MNCH) data was used. In 2021/22, DHIS2 contained a total of 12873 reports in safe motherhood, 12182 reports in immunization, 12673 reports in nutrition and 12568 reports in IMNCI program in Lumbini Province. Of those, monthly aggregated DHIS2 data were downloaded at one time and included 23 priority maternal and child health related data items. Of these 23 items, nine were chosen to assess consistency over time and identify outliers in reference years. Twelve items were selected to examine consistency between related data, while five items were chosen to assess the external consistency of coverage rates. We reviewed the completeness, timeliness and consistency of these data items and considered the prospects for improvement. RESULTS: The overall completeness of facility reporting was found within 98% to 100% while timeliness of facility reporting ranged from 94% to 96% in each Maternal, Newborn and Child Health (MNCH) datasets. DHIS2 reported data for all 9 MNCH data items are consistent over time in 4 of 12 districts as all the selected data items are within ±33% difference from the provincial ratio. Of the eight MNCH data items assessed, four districts reported ≥5% monthly values that were moderate outliers in a reference year with no extreme outliers in any districts. Consistency between six-pairs of data items that are expected to show similar patterns are compared and found that three pairs are within ±10% of each other in all 12 districts. Comparison between the coverage rates of selected tracer indicators fall within ±33% of the DHS survey result. CONCLUSION: Given the WHO data quality guidance and national benchmark, facilities in the Lumbini province well maintained the completeness and timeliness of MNCH datasets. Nevertheless, there is room for improvement in maintaining consistency over time, plausibility and predicted relationship of reported data. Encouraging the promotion of data review through the data management committee, strengthening the system inbuilt data validation mechanism in DHIS2, and promoting routine data quality assessment systems should be greatly encouraged.

A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication.

BACKGROUND: Chhaupadi is a deeply rooted tradition and a centuries-old harmful religio-cultural practice. Chhaupadi is common in some parts of Karnali and Sudurpaschim Provinces of western Nepal, where women and girls are considered impure, unclean, and untouchable in the menstrual period or immediately following childbirth. In Chhaupadi practice, women and girls are isolated from a range of daily household chores, social events and forbidden from touching other people and objects. Chhaupadi tradition banishes women and girls into menstruation huts', or Chhau huts or livestock sheds to live and sleep. These practices are guided by existing harmful beliefs and practices in western Nepal, resulting in poor menstrual hygiene and poor physical and mental health outcomes. This study examined the magnitude of Chhaupadi practice and reviewed the existing policies for Chhaupadi eradication in Nepal. METHODS: We used both quantitative survey and qualitative content analysis of the available policies. First, a quantitative cross-sectional survey assessed the prevalence of Chhaupadi among 221 adolescent girls in Mangalsen Municipality of Achham district. Second, the contents of prevailing policies on Chhaupadi eradication were analysed qualitatively using the policy cube framework. RESULTS: The current survey revealed that most adolescent girls (84%) practised Chhaupadi in their most recent menstruation. The Chhaupadi practice was high if the girls were aged 15-17 years, born to an illiterate mother, and belonged to a nuclear family. Out of the girls practising Chhaupadi, most (86%) reported social and household activities restrictions. The policy content analysis of identified higher-level policy documents (constitution, acts, and regulations) have provisioned financial resources, ensured independent monitoring mechanisms, and had judiciary remedial measures. However, middle (policies and plans) and lower-level (directives) documents lacked adequate budgetary commitment and independent monitoring mechanisms. CONCLUSION: Chhaupadi remains prevalent in western Nepal and has several impacts to the health of adolescent girls. Existing policy mechanisms lack multilevel (individual, family, community, subnational and national) interventions, including financial and monitoring systems for Chhaupadi eradication. Eradicating Chhaupadi practice requires a robust multilevel implementation mechanism at the national and sub-national levels, including adequate financing and accountable systems up to the community level.

Factors associated with child health service delivery by female community health volunteers in Nepal: findings from a national survey.

BACKGROUND: Nepal has made a significant improvement in child survival in the last few decades and the involvement of female community health volunteers (FCHVs) has been crucial in such achievement. While there have been many studies on child health in Nepal however, rarely explored the status and factors associated with the child health service provided by these volunteers. This study aimed to identify the factors associated with the child health service delivery by FCHVs. METHODS: A national survey was conducted in 2014 in Nepal that included 4302 FCHVs using the structured questionnaire across the 13 geopolitical domains of the country. Factors associated with the use of child health services was examined using Chi-square test (χ2) followed by logistic regression. RESULTS: Overall, 62.6% of FCHVs provided at least one child health service. Those FCHVs who utilized money from the FCHV fund, conducted health mothers' group meeting, involved in local committees and those who supported antenatal care and outreach clinics related activities had higher odds of providing child health services. Similarly, FCHVs equipped with the stock of Cotrimoxazole tablet, Zinc tablet, Oral Rehydration Salt packets were more likely to provide child health services. The province-wise analysis showed that FCHVs from Province 5 and Sudur Paschim Province were more likely to provide child health services compared to their counterparts from province 1. Technology-wise, FCHVs who were using mobile were more likely to provide child health services. CONCLUSIONS: FCHVs are important human resource in providing child health services in Nepal. To improve child health service delivery by FCHVs; availability of key commodities, involvement of FCHVs in regular health mothers' group meeting, use of mobile phone, involvement in other public health programs and social networks, and utilization of the FCHV fund need to be taken into consideration.

Nepal Scale up Chlorhexidine as Part of Essential Newborn Care: Country Experience.

Chlorhexidine is a broad-spectrum antiseptic, effective on gram positive and gram negative bacteria as well as some viruses, having strong skin binding effect. Randomized controlled trials conducted in South Asian countries have proven that the use of chlorhexidine (4% weight/weight) for cord care can reduce neonatal mortality and prevent severe cord infections. Between 2011 and 2017, Nepal completed nationwide scale-up of the use of chlorhexidine by integrating with ongoing maternal and neonatal health programs, under the leadership of the Child Health Division. The chlorhexidine coverage and compliance study (2017) has revealed that the country has achieved 59% coverage of the intervention to date, with lowest use among home births. The strategy should be further strengthened to ensure that every newborn in need is reached with chlorhexidine. Keywords: Chlorhexidine; cord care; Nepal experience, Newborn.