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Cooking with polluting and inefficient fuels and technologies is responsible for a large set of global harms, ranging from health and time losses among the billions of people who are energy poor, to environmental degradation at a regional and global scale. This paper presents a new decision-support model–the BAR-HAP Tool–that is aimed at guiding planning of policy interventions to accelerate transitions towards cleaner cooking fuels and technologies. The conceptual model behind BAR-HAP lies in a framework of costs and benefits that is holistic and comprehensive, allows consideration of multiple policy interventions (subsidies, financing, bans, and behavior change communication), and realistically accounts for partial adoption and use of improved cooking technology. It incorporates evidence from recent efforts to characterize the relevant set of parameters that determine those costs and benefits, including those related to intervention effectiveness. Practical aspects of the tool were modified based on feedback from a pilot testing workshop with multisectoral users in Nepal. To demonstrate the functionality of the BAR-HAP tool, we present illustrative calculations related to several cooking transitions in the context of Nepal. In accounting for the multifaceted nature of the issue of household air pollution, the BAR-HAP model is expected to facilitate cross-sector dialogue and problem-solving to address this major health, environment and development challenge. [ABSTRACT FROM AUTHOR]

This paper aims to describe the prevalent forms of intimate partner violence (IPV), and the factors associated with IPV among women and men living in the two migrant communities of Baglung district, Nepal. 357 adult women and men were enrolled following a family model, interviewing young married women with daughter-in-law status in the home, their husbands, and mothers-in-law and fathers-in-laws using an electronic questionnaire. Random effects regression modelling compared men and women, as well as young married women with daughter-in-law status and older women with mothers-in-law with status. 28.6% of women had ever experienced physical and/or sexual violence by an intimate partner compared to 18.2% of men ever perpetrated these forms of violence against their wives. Being older, male controlling behaviour and poor relations with husband increased women’s IPV in their lifetime while perceptions that the mother-in-law is kind were protective. Being ashamed of being unemployed and childhood trauma were associated with men perpetrating IPV in their lifetime. Borrowing money or food increased young married women’s lifetime IPV risk while mother-in-law cruelty and male control increased older married women’s lifetime IPV exposure. Factors associated with IPV in the past year among men were being younger, job seeking, experiences of childhood trauma and depression exposure among men while difficulty accessing money for emergencies, holding inequitable gender attitudes, and depression was associated with women’s increased IPV exposure. Unemployment stress, holding inequitable gender attitudes and mother-in-law kindness were associated with young women’s increased IPV risk and hunger, mother-in-law cruelty and depression with older women’s IPV risk. There is a need to critically challenge harmful social and gender norms by using approaches that are sensitive to young married women’s position and unequal gender relations in the family. IPV prevention interventions need to employ a holistic approach that combines changing social and gender norms and improving socioeconomic conditions of women living in migrant communities. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Health promotion agencies advocate use of mountain climbing goals to encourage regular stair climbing, a current public health target. This paper tests effects of a mountain climbing campaign on objective measures of stair use for the first time. Design: Field interview and quasi-experimental, interrupted time-series study. Method: In field interviews, a convenience sample (n = 1350) responded to questions about different goals, i.e., heights of climb, to encourage stair use in buildings. Subsequently, a point-of-choice intervention with the main message ‘Take the stairs to the top of this building once a day and in a year, you would have climbed Mount Everest almost twice’ was tested in a 12-floor worksite. A no-message baseline was followed by installation of the intervention. Results: Stair ascent (n = 62,716) and descent (n = 61,218) at the ground floor was measured with automated counters at baseline (11 days) and during the intervention (18 days). The majority of interviewees (60%) chose a message based on climbing Mt. Everest as the most motivating, with only 5% of interviewees not motivated by any climbing goal. Nonetheless, the subsequent intervention using the mountain climbing goal had no effect on stair climbing (OR = 0.96). As the campaign specifically targeted stair ascent, it failed to influence the behaviour with the greater public health dividend. Conclusion: The discrepancy between pre-testing and the campaign may reflect the fact that performance goals can only be achieved at the end of the task and may not be continually rewarded during accumulation of behaviour towards the goal. [Copyright &y& Elsevier]

Human beings take themselves superior for having the capacity of development of culture to their environment for survival. From the beginning of civilization, people prepared, accumulated the knowledge and preserved it as a form of culture. Culture is the body of thought and knowledge both theoretical and practical, which only man can possess. It is the sum total of achievements which develops traits by traits. Among them kulpuja ritual is one of the central traits. In this paper, I explore why rituals like kulpuja are celebrated and what relation they have with the behavior of the indigenous people--the agars of Langaun of Baglung district, western Nepal. The research was carried out by using descriptive and explanatory research design. Participant observation, group discussion and key informant interview were carried out to collect the primary data. The agars are rich in their ritual activities; among them kulpuja is the most important one. Like other castes and many ethnic groups of the world, the agars of Langaun also sacrifice and offer chicken and black pig's heart for their ancestral god. They believe on supreme power which is able for the termination of the evil eyes as well as other obstacles and illness by the happiness of their ancestral god. The offering of a live heart is a unique feature which is carried out emotionally. The rate of generation gap is clearly seen between the members of agars. The elders are worried about the increasing rate of dependency in their offspring and feel how the children are able to survive within their environment. The importance of this ritual bind among the members of the community is deteriorating continuously in the name of modernization in younger members of the community. [ABSTRACT FROM AUTHOR]

Adolescent-friendly health programs have been in place in Nepal since 2008, yet uptake of the services for sexual and reproductive health remains suboptimal. For uptake of these services to improve, a rich understanding is needed of the factors impacting their acceptance and utilization from the perspectives of adolescents, health care staff, and key community informants. This study applied a qualitative research design involving six focus groups with 52 adolescents and in-depth interviews with 16 adolescents, 13 key informants, and 9 health care providers from six adolescent-friendly health facilities in Nepal. Thematic analysis was conducted for data analysis. The key themes identified as barriers include access issues due to travel, institutional health care barriers, perceived lack of privacy and confidentiality, and the unprofessional attitudes of staff towards the sexual health needs of adolescents. These themes are underpinned by gendered ideology and a moral framework around the sexual behavior of adolescents. Interview responses suggested that health care providers take a policing role in prescribing adolescents’ conformity to this moral framework in their delivery of reproductive health care and services. While physical access to health services may be problematic for some adolescents, this is not the priority issue. Attention needs to be given to increasing the capacity of health care providers to deliver services without imposing their own and socially sanctioned moral frameworks around adolescent sexual behavior. Such capacity building should include training that is experiential and emphasizes the importance of confidentiality and non-judgmental attitudes. [ABSTRACT FROM AUTHOR]

Instances of non-communicable diseases such as diabetes are on the rise globally leading to greater morbidity and mortality, with the greatest burden in low and middle income countries [LMIC]. A major contributing factor to diabetes is unhealthy dietary behaviour. We conducted 38 semi structured interviews with patients, health professionals, policy-makers and researchers in Kathmandu, Nepal, to better understand the determinants of dietary behaviour amongst patients with diabetes and high blood glucose levels. We created a social ecological model which is specific to socio-cultural context with our findings with the aim of informing culturally appropriate dietary behaviour interventions for improving dietary behaviour. Our findings show that the most influential determinants of dietary behaviour include cultural practices (gender roles relating to cooking), social support (from family and friends), the political and physical environment (political will, healthy food availability) and individuals’ motivations and capabilities. Using these most influential determinants, we suggest potentially effective dietary interventions that could be implemented by policy makers. Our findings emphasise the importance of considering socio-cultural context in developing interventions and challenges one-size-fits-all approaches which are often encouraged by global guidelines. We demonstrate how multifaceted and multi layered models of behavioural influence can be used to develop policy and practice with the aim of reducing mortality and morbidity from diabetes. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends participatory learning and action (PLA) in women's groups to improve maternal and newborn health, particularly in rural settings with low access to health services. There have been calls to understand the pathways through which this community intervention may affect neonatal mortality. We examined the effect of women's groups on key antenatal, delivery, and postnatal behaviours in order to understand pathways to mortality reduction.Methods and Findings: We conducted a meta-analysis using data from 7 cluster-randomised controlled trials that took place between 2001 and 2012 in rural India (2 trials), urban India (1 trial), rural Bangladesh (2 trials), rural Nepal (1 trial), and rural Malawi (1 trial), with the number of participants ranging between 6,125 and 29,901 live births. Behavioural outcomes included appropriate antenatal care, facility delivery, use of a safe delivery kit, hand washing by the birth attendant prior to delivery, use of a sterilised instrument to cut the umbilical cord, immediate wrapping of the newborn after delivery, delayed bathing of the newborn, early initiation of breastfeeding, and exclusive breastfeeding. We used 2-stage meta-analysis techniques to estimate the effect of the women's group intervention on behavioural outcomes. In the first stage, we used random effects models with individual patient data to assess the effect of groups on outcomes separately for the different trials. In the second stage of the meta-analysis, random effects models were applied using summary-level estimates calculated in the first stage of the analysis. To determine whether behaviour change was related to group attendance, we used random effects models to assess associations between outcomes and the following categories of group attendance and allocation: women attending a group and allocated to the intervention arm; women not attending a group but allocated to the intervention arm; and women allocated to the control arm. Overall, women's groups practising PLA improved behaviours during and after home deliveries, including the use of safe delivery kits (odds ratio [OR] 2.92, 95% CI 2.02-4.22; I2 = 63.7%, 95% CI 4.4%-86.2%), use of a sterile blade to cut the umbilical cord (1.88, 1.25-2.82; 67.6%, 16.1%-87.5%), birth attendant washing hands prior to delivery (1.87, 1.19-2.95; 79%, 53.8%-90.4%), delayed bathing of the newborn for at least 24 hours (1.47, 1.09-1.99; 68.0%, 29.2%-85.6%), and wrapping the newborn within 10 minutes of delivery (1.27, 1.02-1.60; 0.0%, 0%-79.2%). Effects were partly dependent on the proportion of pregnant women attending groups. We did not find evidence of effects on uptake of antenatal care (OR 1.03, 95% CI 0.77-1.38; I2 = 86.3%, 95% CI 73.8%-92.8%), facility delivery (1.02, 0.93-1.12; 21.4%, 0%-65.8%), initiating breastfeeding within 1 hour (1.08, 0.85-1.39; 76.6%, 50.9%-88.8%), or exclusive breastfeeding for 6 weeks after delivery (1.18, 0.93-1.48; 72.9%, 37.8%-88.2%). The main limitation of our analysis is the high degree of heterogeneity for effects on most behaviours, possibly due to the limited number of trials involving women's groups and context-specific effects.Conclusions: This meta-analysis suggests that women's groups practising PLA improve key behaviours on the pathway to neonatal mortality, with the strongest evidence for home care behaviours and practices during home deliveries. A lack of consistency in improved behaviours across all trials may reflect differences in local priorities, capabilities, and the responsiveness of health services. Future research could address the mechanisms behind how PLA improves survival, in order to adapt this method to improve maternal and newborn health in different contexts, as well as improve other outcomes across the continuum of care for women, children, and adolescents. [ABSTRACT FROM AUTHOR]

The Himalayas are a global hotspot for bird diversity with a large number of threatened species, but little is known about seasonal changes in bird communities along elevational gradients in this region. We studied the seasonality of bird diversity in six valleys of the Central Himalayas, Nepal. Using 318 plots with a 50 m radius, located from 2200 to 3800 m a.s.l., and repeated sampling during different seasons (mainly pre-monsoon, monsoon, and post-monsoon), we analyzed 3642 occurrences of 178 species. Birds classified in the literature as resident were more species-rich than migratory birds (140 vs. 38 species). In all six valleys and within the studied elevation range, species richness of all birds showed a peak at mid-elevation levels of 2600 or 3000 m a.s.l. Similar patterns were found for the most species-rich feeding guilds of insectivores (96 species) and omnivores (24 species), whereas the species richness of herbivores (37 species including frugivores) increased towards higher elevations. Among these feeding guilds, only species richness of insectivores showed pronounced seasonal changes with higher species numbers during post-monsoon season. Similarly, individual bird species showed distinct spatio-temporal distribution patterns, with transitions from species dominated by elevational differences to those characterized by strong seasonal changes. In an era of climate change, the results demonstrate that individual bird species as well as feeding guilds might greatly differ in their responses to climate warming and changes in the seasonality of the precipitation regime, two aspects of climate change which should not be analyzed independently. [ABSTRACT FROM AUTHOR]

Background: Mental illness is stigmatized in most of the communities and people with such illness are often subjected to defame. Stigma impairs an individual’s and their caregiver’s physical, social and emotional wellbeing, and health-seeking behavior. Sufficient literature on how often the caregivers of people with mental illness from low and middle-income countries are stigmatized and how they perceive people with mental illness is unavailable. In this study, we examined caregivers’ attitude towards people with mental illness and perceived stigma. Methods: We conducted face-to-face interviews with 170 caregivers in an outpatient clinic of a hospital in Nepal using a structured questionnaire. We calculated median and inter-quartile range of the attitude and perceived stigma scores. To assess the correlates, Kruskal Wallis H test and Mann Whitney U test were carried out. Results: Overall median score for the domains: attitude (score range: 18–90) and perceived stigma (score range: 12–60) were 42 and 28 respectively, inter-quartile range being 8 each. Attitude score differed significantly by the sex of caregiver (p<0.05), educational status of caregiver (p<0.001), sex of patient (p<0.05) and type of mental illness (p<0.05). Perceived stigma score varied significantly by caregiver’s sex (p<0.05), marital status (p<0.001), educational status (p<0.001), occupation (p<0.05), relation with the patient (p<0.005) and use of alternative treatment modalities (p<0.05). Conclusion: Sex of participant, educational status, sex of patient and type of mental illness were the correlates of attitude towards mental illness. Similarly, sex of participant, marital status, educational status, occupation, caregiver’s relation with patient and use of alternative treatment modalities were correlates of perceived stigma. Findings of this study suggest that interventions targeting these high-risk populations might be beneficial to help build a positive attitude and overcome the perceived social stigma. [ABSTRACT FROM AUTHOR]

Modeled rockfill materials were obtained from nine sites (two riverbed and seven quarried) from different projects in India and Nepal, and drained triaxial tests were conducted with specimens that were 381 mm in diameter and 813 mm high. Index properties of the rockfill materials, namely, unconfined compressive strength (UCS) and uncompacted void content (UVC), were determined. An elastoplastic hierarchical singe-surface (HISS) constitutive model was used to characterize the behavior of modeled rockfill materials. The predicted stress-strain-volume change behavior was compared with the observed behavior, and it was found that both observed and predicted behavior matched closely. Procedures have been developed to predict the shear strength and elastic parameters of rockfill materials using the index properties, namely, UCS, UVC, and relative density (RD), and predictions were made satisfactorily. Predicted shear strength and elastic parameters were compared with the experimental values, and it was observed that both values matched closely. Then these procedures were used to predict the elastic and shear strength parameters of large-size prototype rockfill materials. Relationships were also developed between index properties and strength parameters of modeled rockfill materials and were used to predict the strength parameters for the prototype rockfill materials. Using the predicted material parameters, the stress-strain-volume change behavior of prototype rockfill material was predicted using the elastoplastic HISS constitutive model. [ABSTRACT FROM AUTHOR]