Browsing by Author "Pahari, DP"
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Publication Risk Factors for Stunting Among Children: A Community Based Case Control Study in Nepal(Kathmandu University, 2012) Paudel, R; Pradhan, B; Wagle, RR,; Pahari, DP; Onta, SRABSTRACT Background Stunting, a chronic condition, is an underlying cause of child morbidity and mortality in Nepal. This study intends to identify the factors causing stunting among children that will help to prioritize the strategies at the district level. Objective The objective of the study was to identify the risk factors for stunting among children of age between 6 to 59 months. Methods The study was based on community-based case control design in the mid-west, Surkhet Nepal from August to September 2010. The cases were stunted children and controls were the children without stunting. Data was collected by interviewing those children’s mothers and measured length/height of 118 children as cases and 236 children as controls. Logistic regression analysis was performed to identify the best model of factors leading to stunting. Odds ratio and 95% confidence interval were used as a measure of association. Results Socio-economic risk factors for stunting comprised mothers without earning (OR=3.11, 95% CI 1.26-7.65), food deficit families (OR=4.26, 95% CI 1.73-10.45) and care taker of the children other than mother (OR=3.02, 95% CI 1.19-7.70). Environmental risk factors for stunting consisted of kitchen without ventilation and children exposed to pesticide. Inappropriate exclusive breast feeding (OR=6.90, 95% CI 2.81-16.97), complementary feeding less than four times a day (OR=3.60, 95% CI 1.32-9.95) and dietary diversity below WHO standard (OR=4.06, 95% CI 1.70-9.67) were factors of stunted children. Diarrhea was found significantly associated with stunting (OR=7.46, 95% CI 2.98-18.65). Conclusions Stunting was found to be as a result of multiple factors such as socio-economic, environmental and inappropriate feeding practices. KEY WORDS Children, community, case-control study, risk factors, stuntingPublication Social inclusion in health services use: early changes following fee removal in rural Nepal(Institute of Medicine, 2015) Bhurtyal, A; Poudyal, AK; Adhikari, D; Pahari, DP; Bhurtyal, KK; Maskey, MKAbstract Introduction: User fees for primary health services were removed by a new leadership of health ministry as part of attempt to enhance access by under served people. This study aimed to measure the changes in utilization of health services by marginalized groups of people following fee removal. Methods: Records of 1850 health services users were selected randomly from peripheral health facilities -the district hospital, the primary healthcare centre, and four of eight health posts in Jumla district. Proportions of health services use by privileged and underprivileged ethnicities, men and women, and rich and poor people at two periods, before and after user fee removal, were calculated. Results: After fee removal, use of health services by women, underprivileged ethnicities, and poor people increased by 2.4% (P=0.303, 95% CI 1.41 to 3.39), 6.8% (P<0.001, 95% CI 5.27 to 8.13) and 9.2% (P= 0.003, 95% CI 6.72 to 11.68) respectively in comparison to their privileged counterparts. When service utilization data were disaggregated by individual castes, 10.9% (95% CI 9.01 to 12.87) increment was observed in case of the Dalit caste. Conclusion: Removal of user fees was followed by increased use of health services by marginalized people. Further works may be conducted to examine consistency of the results. Keywords: access to health care, Jumla, universal health coverage, user fees