Papers by Shailes Neupane
… to Nepalese Studies, 2002
ASSESSING THE QUALITY OF SURVEY DATA ON ADOLESCENT SEXUALITY BY TALKING WITH THE FIELD STAFF Shya... more ASSESSING THE QUALITY OF SURVEY DATA ON ADOLESCENT SEXUALITY BY TALKING WITH THE FIELD STAFF Shyam Thapa, Mala Dhital and Shailes ... One said, "Our daughters and sons could at least learn something useful about health from you." Now and then a ...
Research on nutrition in low and middle-income countries (LMICs) has mainly focused on how policy... more Research on nutrition in low and middle-income countries (LMICs) has mainly focused on how policy and project interventions can bring about changes in diets, while changes in physical activity has been largely overlooked. Productivity-enhancing activities can impact the calorie deficits of the undernourished via their effects on energy intakes and energy expenditure. Rural transformation also has an effect on lifestyles of rural people. Changes in diets and physical activity patterns has a profound effect on livelihoods. The energy expenditure dimension has previously not been incorporated in the analysis of agriculture-nutrition linkages and livelihood analysis. Most studies capturing energy expenditure in rural households in LMICs have use methods that require a controlled setting. These can be quite expensive and are often very practical for population-level studies. Accelerometry has advanced in recent years, providing a new opportunity to collect more accurate population-level ...
role of the private health sector in providing abor-tion services is particularly deficient. Pete... more role of the private health sector in providing abor-tion services is particularly deficient. Peters et al.’s review reported that, of the 71 out of 700 articles that met the inclusion criteria of the review, only one addressed abortion. This paper seeks to contribute to the literature on the role of non-governmental organizations (NGOs) in providing abortion services in Nepal, a low-income country. After decades of restriction, the role of NGOs in Nepal significantly expanded in the 1990s following political change and liber-alization of the economy (10-12). Since then, the NGO sector has played an increasingly important role in advocacy, creation of awareness, commu-nity mobilization, and delivery of both preventive and curative health services. Abortion is a recent policy and programme innovation in the country (13). The combination of this recent development and the growing presence of international as well as local NGOs in the health sector provides an op-portune context in whic...
International Journal of Environmental Research and Public Health, 2021
The Washington Group (WG) tools capture self-reported functional limitations, ranging from 6 doma... more The Washington Group (WG) tools capture self-reported functional limitations, ranging from 6 domains in the Short Set (SS) to 11 in the Extended Set (ESF). Prevalence estimates can vary considerably on account of differences between modules and the different applications of them. We compare prevalence estimates by WG module, threshold, application and domain to explore these nuances and consider whether alternative combinations of questions may be valuable in reduced sets. We conducted secondary analyses of seven population-based surveys (analyses restricted to adults 18+) in Low- and Middle-Income Countries that used the WG tools. The prevalence estimates using the SS standard threshold (a lot of difficulty or higher in one or more domain) varied between 3.2% (95% Confidence Interval 2.9–3.6) in Vanuatu to 14.1% (12.2–16.2) in Turkey. The prevalence was higher using the ESF than the SS, and much higher (5 to 10-fold) using a wider threshold of “some” or greater difficulty. Two of t...
International Journal of Environmental Research and Public Health, 2021
This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate ... more This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate the prevalence of disability among older adults and (ii) compare experiences and participation in key life areas among older people with and without disabilities which may show vulnerability during the COVID-19 pandemic. Data were analysed from district-level or national surveys in Cameroon, Guatemala, Haiti, India, Nepal and the Maldives, which across the six databases totalled 3499 participants aged 60 years and above including 691 people with disabilities. Disability was common among adults 60+, ranging from 9.7% (8.0–11.8) in Nepal to 39.2% in India (95% CI 34.1–44.5%). Mobility was the most commonly reported functional difficulty. In each setting, older people with disabilities were significantly less likely to be working and reported greater participation restrictions and environmental barriers in key life areas compared to people in the same age categories without disabilities (p ...
Oxford Development Studies, 2021
To meet the Sustainable Development Goals target of ending poverty "in all its forms", it is crit... more To meet the Sustainable Development Goals target of ending poverty "in all its forms", it is critical to monitor progress towards poverty alleviation, including amongst people with disabilities. This research used data from a population-based nested case control studies (n=667) and compares monetary and multidimensional poverty levels amongst people with and without disabilities in the districts of Cam Le, Vietnam and Tanahun, Nepal. Overall, there were no significant differences in incidence of monetary poverty between people with and without disabilities. However, approximately half of people with disabilities were multidimensionally poor in both settings, twice as frequent as compared to people without disabilities. Amongst people with disabilities, multidimensional poverty was associated with having a functional limitation affecting cognition and self-care, disability severity and younger age. The high incidence of multidimensional poverty amongst people with disabilities even in the absence of monetary poverty indicates a need for social protection and other interventions.
Health Education & Behavior, 2006
To examine young people's reactions to and understanding of HIV prevention messages developed... more To examine young people's reactions to and understanding of HIV prevention messages developed for MTV's global HIV prevention campaign Staying Alive, videotaped campaign materials were shown to focus group discussion (FGD) participants living in urban areas of Brazil, Kenya, Nepal, and Senegal. Responses related to “personal involvement” with the message were identified in the data from these FGDs and were examined in relationship to the emerging message themes, the message format (public service announcements [PSAs] vs. documentary), cultural context (site), and participant gender. Across groups, greater personal involvement (measured by personal connections, emotional reactions, and lessons learned) was found in responses about the documentary format compared to the PSA format. Exceptions were found for specific PSAs that were considered more relevant within specific gender or cultural contexts. Implications of findings for global campaigns were considered.
BMC Pregnancy and Childbirth
Background: We sought to determine if female community health volunteers (FCHVs) and literate wom... more Background: We sought to determine if female community health volunteers (FCHVs) and literate women in Nepal can accurately determine success of medical abortion (MA) using a symptom checklist, compared to experienced abortion providers. Methods: Women undergoing MA, and FCHVs, independently assessed the success of each woman's abortion using an 8-question symptom checklist. Any answers in a red-shaded box indicated that the abortion may not have been successful. Women's/FCHVs' assessments were compared to experienced abortion providers using standard of care. Results: Women's (n = 1153) self-assessment of MA success agreed with abortion providers' determinations 85% of the time (positive predictive value = 90, 95% CI 88, 92); agreement between FCHVs and providers was 82% (positive predictive value = 90, 95% CI 88, 92). Of the 92 women (8%) requiring uterine evacuation with manual vacuum aspiration (n = 84, 7%) or medications (n = 8, 0.7%), 64% self-identified as needing additional care; FCHVs identified 61%. However, both women and FCHVs had difficulty recognizing that an answer in a red-shaded box indicated that the abortion may not have been successful. Of the 453 women with a red-shaded box marked, only 35% of women and 41% of FCHVs identified the need for additional care. Conclusion: Use of a checklist to determine MA success is a promising strategy, however further refinement of such a tool, particularly for low-literacy settings, is needed before widespread use.
Scientific Data
With more than 820 million undernourished people living in rural areas of low-and middle-income c... more With more than 820 million undernourished people living in rural areas of low-and middle-income countries (LMICs), ending hunger and ensuring access to food by all is a global priority. In the past few decades, the adoption of technological innovations in the agricultural sector and related crop yield improvements have not led to expected improvements in the nutritional status of rural households in many LMICs. The increased energy expenditure associated with the adoption of productivity-enhancing innovations may provide an important explanation of the disconnect between agricultural productivity enhancements and improved nutritional outcomes. We develop a methodology for generating reliable livelihood energy/calorie expenditure profiles for rural agricultural households using research-grade accelerometer devices. We integrate the data on physical activity and energy expenditure in rural households with data on time-use and food intakes to generate a data set that provides a unique window into rural livelihoods. This can be a valuable resource to analyse agriculture-nutrition impact pathways and improve the welfare of rural and agricultural households.
Maternal & Child Nutrition
Developmental delays affect between 150 and 200 million children <5 years of age worldwide. Outsi... more Developmental delays affect between 150 and 200 million children <5 years of age worldwide. Outside of diet supplement studies, relatively little is known about the relationships between diet quality and developmental status in resource-poor settings. We examined associations between different aspects of dietary quality (dietary diversity score [DDS] and animal-source food [ASF] consumption) and child development (assessed using the Ages and Stages Questionnaire-3 [ASQ-3]) among children whose families were enrolled in a community development intervention trial (implemented by Heifer Nepal) in western Nepal. Two sets of analyses were performed: (a) cross-sectional Sample (N = 629) seen at the endline survey and (b) longitudinal sample (N = 269) with complete dietary records (six surveys over 48 months). In both samples, child development was significantly related to household wealth, maternal education, and especially home environmental quality. In the cross-sectional sample, greater consumption of eggs (adjusted odds ratio [aOR] 0.80, p = .04) or dairy products (aOR 0.95, p = .05) over the previous 7 days significantly reduced odds of low total ASQ score, by logistic regression analysis. In the longitudinal sample, only egg consumption and cumulative DDS and ASF scores were associated with significantly reduced odds of low total ASQ score (aORs 0.59-0.89). In adjusted linear regression analysis, both cumulative DDS (β [CI]: 1.92 [0.4, 3.5]) and ASF scores (2.46 [0.3, 4.7]) were significantly associated with greater continuous total child development. Programmes targeting child development must address home environmental quality as well as long-term diet quality. 1 | BACKGROUND Early childhood development plays a crucial role in enabling children to acquire the needed intellectual skills and creativity to function as successful adults (Black et al., 2017). Yet more than 200 million children less than age 5 years in low-and middleincome countries are at risk of not achieving their full developmen
Public Health Nutrition
Table 3 Mixed-effect linear regression showing coefficient (β) and SE for anthropometric measurem... more Table 3 Mixed-effect linear regression showing coefficient (β) and SE for anthropometric measurements, household wealth score and total soap use (hygiene measure). Results are shown by survey round, treatment group and groupby-round interaction as a fixed effect adjusted for child factors (age, gender, baseline anthropometry) and household factors (household animal and wealth score, land ownership, household per capita income, mother's educational attainment)
Disability and Rehabilitation
Aim: Many children with disabilities in low-and middle-income countries do not attend school and ... more Aim: Many children with disabilities in low-and middle-income countries do not attend school and onethird are out of school. In order to ensure that education is for all including children with disabilities, research is needed on barriers to schooling to identify targets for intervention. The study will examine the determinants of school achievement among persons with and without disabilities as well as among each type of impairment. Methods: The study will utilize data from a recent national, representative household survey on living conditions among persons with and without disabilities. The individual level data used in this article comprise 2123 persons with and 2000 persons without disabilities. Results: The results show that an alarmingly high proportion of persons in Nepal have not accessed formal education, with access being significantly lower among persons with disabilities. While the results may be influenced by the assumed relationship between disability and poverty, results from analyzing the cross-sectional data cannot be conclusive on the influence of disability vs. poverty in determining differences in access and school attainments. Increased environmental barriers, higher age, rural location, and increased levels of disability were found to be associated with lower educational achievement. Pronounced differences in access to education were found between impairment types, with individuals with physical impairments achieving the highest level and individuals with multiple impairments, hearing and mental impairments achieving lowest. Conclusions: It is necessary both to strengthen the entire educational sector and at the same time allocate resources that will ensure that all children are on board and that particular efforts are implemented to cater for those who are easily side-lined. ä IMPLICATIONS FOR REHABILITATION An alarmingly high proportion of persons in Nepal have not attended school. Substantially more individuals with than without disabilities have never attended school. Increased environmental barriers, higher age, rural location, and increased levels of disability were found to be associated with lower educational achievement. Pronounced differences in access to education were found between impairment types, with individuals with physical impairments achieving the highest level and individuals with multiple impairments, hearing and mental impairments achieving lowest. It is necessary both to strengthen the entire educational sector in Nepal and at the same time ensure that particular efforts are implemented to cater for those who are easily sidelined.
PLOS ONE
Are current approaches for measuring access to clean water and sanitation inclusive of people wit... more Are current approaches for measuring access to clean water and sanitation inclusive of people with disabilities? Comparison of individual-and household-level access between people with and without disabilities in the Tanahun district of Nepal. PloS one, 14 (10). e0223557- .
Public Health Nutrition
Objective:To compare the impact on child diet and growth of a multisectoral community interventio... more Objective:To compare the impact on child diet and growth of a multisectoral community intervention v. nutrition education and livestock management training alone.Design:Longitudinal community-based randomized trial involving three groups of villages assigned to receive: (i) Full Package community development activities, delivered via women’s groups; (ii) livestock training and nutrition education alone (Partial Package); or (iii) no intervention (Control). Household surveys, child growth monitoring, child and household diet quality measures (diet diversity (DD), animal-source food (ASF) consumption) were collected at five visits over 36 months. Mixed-effect linear regression and Poisson models used survey round, treatment group and group-by-round interaction to predict outcomes of interest, adjusted for household- and child-specific characteristics.Setting:Banke, Nepal.Participants:Households (n 974) with children aged 1–60 months (n 1333).Results:Children in Full Package households...
The European Journal of Development Research
While people with disabilities are often targeted as key beneficiaries of social protection, ther... more While people with disabilities are often targeted as key beneficiaries of social protection, there is little evidence available on their participation in existing programmes. This study uses mixed methods to explore access to disability-targeted and non-targeted social protection programmes in Nepal, particularly the District of Tanahun. In total, 31% of people with disabilities had Disability Identification Cards, which entitles them to a range of different social protection benefits depending on the card level, including disability-targeted social assistance (received by 13% of people with disabilities). Overall, 37% of people with disabilities received social assistance, which was higher than for people without disabilities (21%). The most commonly accessed form of social assistance was the Old Age Allowance, which had universally high coverage amongst both people with and without disabilities. Uptake of disability-targeted social protection entitlements other than social assistance (e.g. scholarships, discounted transportation and health services) was generally low. Factors impacting upon access included the geographic and financial accessibility of the application process, procedures for determining eligibility and compliance of service providers.
Asia-Pacific Population Journal
... The other main treatment measures mentioned were taking antibiotics or consulting a health wo... more ... The other main treatment measures mentioned were taking antibiotics or consulting a health worker. ... The rural setting may present even more difficult challenges, although this is outside the ... Battling with HIV/AIDS in Nepal: A Guide to Who s Doing What (Kathmandu, UNICEF). ...
PLOS ONE
To determine if pregnant, literate women and female community health volunteers (FCHVs) in Nepal ... more To determine if pregnant, literate women and female community health volunteers (FCHVs) in Nepal can accurately determine a woman's eligibility for medical abortion (MA) using a toolkit, compared to comprehensive abortion care (CAC) trained providers. Study design We conducted a prospective diagnostic accuracy study in which women presenting for first trimester abortion, and FCHVs, independently assessed each woman's eligibility for MA using a modified gestational dating wheel to determine gestational age and a nine-point checklist of MA contraindications or cautions. Ability to determine MA eligibility was compared to experienced CAC-providers using Nepali standard of care. Results Both women (n = 3131) and FCHVs (n = 165) accurately interpreted the wheel 96% of the time, and the eligibility checklist 72% and 95% of the time, respectively. Of the 649 women who reported potential contraindications or cautions on the checklist, 88% misidentified as eligible. Positive predictive value (PPV) of women's assessment of eligibility based on gestational age was 93% (95% CI 92, 94) compared to CAC-providers' (n = 47); PPV of the medical contraindications checklist and overall (90% [95% CI 88, 91] and 93% [95% CI 92, 94] respectively) must be interpreted with caution given women's difficulty using the checklist. PPV of FCHVs' determinations were 93% (95% CI 92, 94), 90% (95% CI 89,91), and 93% (95% CI 91, 94) respectively. Conclusion Although a promising strategy to assist women and FCHVs to assess MA eligibility, further refinement of the eligibility tools, particularly the checklist, is needed before their widespread use.
Food and nutrition bulletin, Dec 1, 2016
Global commitments to nutrition have supported calls for better evidence to support effective inv... more Global commitments to nutrition have supported calls for better evidence to support effective investments at national level. However, too little attention has so far been paid to the role of governance in achieving impacts. This article explores the ways by which the commitment and capabilities of policy implementers affect collaborative efforts for achieving nutrition goals. Over 1370 structured interviews were held with government and nongovernment officials over 3 years in 21 districts. Coded responses supported quantitative analysis of stakeholders' knowledge, attitudes, and practices regarding policy implementation. Stakeholder commitment was already high in 2013 when a new national policy was adopted, but capabilities were weak. Only one-third of interviewed respondents had any nutrition training. Rollout of training focusing on districts targeted for early implementation of multisector programming. This raised levels of nutrition training among interviewed respondents to ...
Aids Educ Prev, 2007
In 2002 MTV aired a global media campaign, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;a... more In 2002 MTV aired a global media campaign, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Staying Alive,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; to promote HIV prevention among 16- to 25-year-olds. Skeptics believed that a global MTV campaign would reach only a small group of elite young people. MTV increased access to its campaign, however, by making all materials &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;rights free&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; to third-party (non-MTV) broadcasters. Over 789 million households in over 166 countries had access to some or all of the campaign. To understand the level of actual exposure and the types of young people exposed, data were analyzed from population-based household surveys in three diverse urban areas where a campaign evaluation was conducted: Kathmandu, Nepal; São Paulo, Brazil and Dakar, Senegal. Exposure rates ranged from 12% in Kathmandu, 23% in São Paulo, and 82% in Dakar, reaching an estimated 32,000, 400,000, 220,000 16- to 25-year-olds in each city, respectively. A number of personal, social and economic characteristics found to predict campaign exposure were identified in each site; in general, these were related to economic status and use of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;new&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; media technologies. Though this skew toward more exposure by those with greater resources existed, we found that the campaign audience was in no way composed only of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;elite&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; young people. (For example, although more of those exposed to the campaign had used the Internet compared with those not exposed, this was not the majority of those exposed in most countries.) The possibility of reaching millions of young people through global networks with minimal marginal costs after production, creates a new paradigm for reaching an important segment of young people.
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Papers by Shailes Neupane