Determinants of health in rural Nepal: Utilising PHASE Nepal data to investigate social inequalities in health and healthcare amongst under-5s

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This project aims to increase academic understanding, and develop appropriate options for responding to, inequalities in health and healthcare amongst under-5 children in remote rural areas of Nepal. These continuing inequalities represent a significant challenge for Nepal's efforts to promote social and economic development and meet the SDG targets. Whilst it is widely known that a variety of social and geographic factors contribute to determining health outcomes (including gender, caste/ethnicity and region), the currently available data lacks the degree of granularity to enable a robust exploration of the relationships between these various forms of inequality and i) health status; ii) utilisation of health services; and iii) quality/appropriateness of treatment received. Whilst the existing data published by the Government of Nepal is available only in an aggregated format, PHASE Nepal - a high-profile and highly-respected NGO that supports government health facilities in some of the most remote areas of the country - has circa 50,000 records of health facility visits by under-5s that have not previously been analysed as they currently exist only in paper format. The project proposed here will allow, for the first time, for the digitisation and rigorous analysis of this individual patient-level data to further understand inequalities and to address a series of Research Questions related to the country's social and geographic inequalities:RQ1: How do geography, age, gender, ethnicity and caste affect the nutrition status of under-5 children presenting in remote health facilities of Nepal?RQ2: Is diagnosis and treatment for malnutrition affected by geography, and child's age, gender, ethnicity and caste? RQ3: How do geography, and child's age, gender, ethnicity and caste affect health-seeking behaviours and utilisation of health services?RQ4: How do geography, and child's age, gender, ethnicity and caste affect the treatment that under-5s receive at health centres?The project builds upon a strong existing relationship between the University of Sheffield and PHASE Nepal. A previous collaboration, funded by IAA funds, allowed for the delivery of research methods training for PHASE Nepal staff and a preliminary analysis of PHASE's data assets and data management strategies. The project proposed here - which brings together social scientists and public health experts to understand health inequalities in their social context, and to develop policy and practice recommendations - was co-designed by PHASE Nepal staff members Dr. Pohl and Dr. Baidya and the Sheffield-based members of the team, ensuring that the research will be valuable to and actionable by PHASE Nepal themselves, as well as being of value to other health system stakeholders (not least Nepal's Ministry of Health and Population) and to a wider community of academic researchers.