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Methodological considerations and cost to measure coverage of multisectoral nutrition interventions: protocol for the One Nutrition Coverage Survey in Bangladesh

Por: Manohar · S. · Nguyen · P. H. · Neupane · S. · Munos · M. K. · Heidkamp · R. · Banerjee · A. · Pandya · N. · Kim · S. S.
Introduction

Despite global commitments to eliminate malnutrition, over half the world’s population remains affected. Multisectoral nutrition interventions targeting both proximate and distal causes of malnutrition are essential across the lifespan. Yet, current data collection lacks comprehensive nutrition intervention coverage measures, risking inaccuracies in tracking progress. The One Nutrition Coverage Survey (ONCS) aims to test new and refined coverage measurement methods, assess coverage equity and guide integration into large-scale household surveys.

Methods and analysis

The ONCS will be a cross-sectional, population-representative household survey conducted in four districts of Bangladesh (Rangpur, Sylhet, Dhaka and Khulna), selected for their geographic spread and urban–rural balance. A stratified multistage sampling approach will be used to select enumeration areas, and a total of approximately 3280 households randomly selected within each EA will be included in the survey. The survey will interview women of reproductive age (15–49 years), caregivers of children (0–9 years), adolescents (10–19 years) and pregnant women, collecting data on multisectoral nutrition interventions relevant to these groups. It will use both existing and new measures, while also capturing monetary and non-monetary costs for survey design to implementation. Data will be analysed to assess coverage, co-coverage and equity by sociodemographic characteristics, as well as the feasibility, accuracy and costs of the survey approach.

Ethics and dissemination

The study protocol and instruments were reviewed and approved by the International Centre for Diarrhoeal Disease Research, Bangladesh’s (icddr,b) Ethical Review Board in Bangladesh and the International Food Policy Research Institute’s Institutional Review Board in Washington, DC, USA. Adults provided signed informed consent and adolescents their assent. Findings will be shared through peer-reviewed publications, conferences and presentations in Bangladesh with key stakeholders. This study will yield new tools, methods and evidence for measuring multisectoral nutrition intervention coverage, applicable to other low-income and middle-income countries. Learnings from ONCS will enhance data collection aligned with national strategies, helping governments improve coverage assessments, inform decisions and strengthen programme monitoring.

Occupational health risks and safety awareness among welders in Nepal, a qualitative study

Por: Koirala · B. · Rijal · B. · KC · S. · Nepal · S. · Khadka · A. · Karki · A. · Joshi · S. · Basnet · S. · Adhikari · U. · Neupane · R. · Karki · J. K.
Background

Globally, over 2.3 million people die each year as a result of diseases or injuries related to their jobs, and 313 million suffer from non-fatal ailments. Welding is one such profession, which is a hazard-prone job with several potential risks, including burns, electrocution and the potentially deadly risk of fume exposure. In Nepal, people taking the welding profession are aware of the risks associated with their jobs, but they often do not take preventive measures because of ignorance, perceived discomfort in their jobs and lack of knowledge about occupational safety laws and regulations. This increases the probability of accidents.

Objective

The objective of this study was to explore occupational health risks and safety awareness among welders and their adherence to occupational safety and health regulations in Nepal.

Design

A qualitative, cross-sectional study employing a thematic analysis approach was adopted.

Setting

The research was conducted in small-scale welding workshops located in a semiurban area in Bhaktapur District, central Nepal, reflecting the informal industrial sector.

Participants

26 male welders, aged 18–42 years, originally from nine districts across Nepal, participated, each from a different workshop, thus reaching 26 small-scale welding workshops. All were engaged in welding work at the time of the study. Participants were selected using snowball sampling. Most had not completed secondary education and had work experience ranging from 1 to 22 years.

Primary and secondary outcome measures

As a qualitative study, the primary outcome was the thematic exploration of welders’ experiences. The main themes included occupational health risks and injury management, personal protective equipment (PPE) use and barriers, access to healthcare and insurance, and awareness of occupational health and safety (OHS) policies and training opportunities.

Results

The study revealed significant occupational health risks, including eye burns, electric shocks and physical exhaustion among the welders. Further, the participating welders reported limited access to health insurance and inadequate awareness and access to PPE. Furthermore, awareness of safety policies is also low among welders. While support groups and associations exist, their support is often insufficient, thus perpetuating challenges in workplace safety.

Conclusions

This study provides a glimpse of the ground reality of welding workers in small-scale industries in Nepal, showing gaps and the need for safe occupational practices that must be addressed. Further study and work are needed to establish better occupational safety practices and improve the health and safety status of welders.

A cross-sectional quantitative analysis of production and requirements of medical oxygen during the COVID-19 pandemic in Nepal

Por: Adhikari · S. K. · Aryal · Y. · Nepal · A. · Bingham · M. B. · Neupane · S. · Basnet · A. · Singh · A. K. · Prajapati · B. · Sthapit · D. · Devkota · G. · Rana · S.
Objectives

Medical oxygen supplementation is essential for treating severe illnesses and plays a critical role in managing life-threatening conditions, especially during the period of increased demand, such as the delta wave of COVID-19. The study aims to evaluate oxygen requirements and production to support effective capacity planning for future health crises.

Design and setting

Cross-sectional quantitative study. Data collection was carried out between 15 March and 19 December 2021.

Main outcome measures

The study used secondary data from Nepal’s Health Emergency Operation Centre. Regarding medical oxygen production, calculations included oxygen generated from both hospital-based oxygen plants and private companies, using their highest capacities for comparison. These production capacities were then assessed using three levels of efficiency (100%, 80% and 50%), revealing significant gaps when compared against the oxygen requirements of hospitalised COVID-19 patients, as guided by WHO recommendations. The results were communicated in terms of J-size cylinders, alongside average daily COVID-19 hospitalizations. Data was inputted and analysed using Microsoft Excel and presented in numbers and percentage.

Results

The country’s oxygen demand relies largely on the production from private enterprises, with meeting approximately 85.2% of the total requirement. Optimal production ensures that national oxygen needs will be met. The analysis highlighted that at 80% operational efficiency, 90.8% of the hospital’s requirements could be fulfilled. However, if operational efficiency drops to 50%, the fulfilment rate diminishes to 56.7%. The differences in requirement and production of oxygen are consistent across the provinces; however, a huge disparity was notable in Karnali and Sudurpaschim.

Conclusion

Continuous assessment of production capacities in both hospital and private enterprises producing oxygen is necessary to plan and address the gaps.

Socioeconomic inequalities in overweight and obesity among young adult women in Nepal between two cross-sectional surveys in 2001 and 2022

Por: Shakya · S. · Absetz · P. · Neupane · S.
Objective

To examine the socioeconomic inequalities in overweight-obesity and their changes in two decades, among young adult women aged 18–29 years in Nepal.

Design

Cross-sectional study based on Demographic and Health Surveys conducted in 2001 and 2022.

Setting

Nepal.

Participants

Data of young adult women aged 18–29 years were included for the study.

Outcome measures

Socioeconomic inequalities in education, occupation and household wealth were analysed through regression-based inequality indices: the Relative Index of Inequality, the Slope Index of Inequality and the Concentration Index. A concentration curve was constructed to evaluate whether overweight-obesity skewed towards poverty or wealth.

Results

We found an increase in the prevalence of overweight-obesity prevalence between 2001 (3.99%) and 2022 (15.45%), mostly in the oldest group (25–29 years), and among Janajati and rural residents. Socioeconomic gradients favoured wealthier, educated and employed women. A downward shift in wealth status was initially associated with a lower prevalence of overweight and obesity among women, but over time, it became linked to a higher prevalence.

Conclusions

The social gradient of overweight-obesity from 2001 to 2022 favoured women with higher socioeconomic status, and this shows a decreasing trend.

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