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

尼泊尔农村健康的决定因素：利用 PHASE 尼泊尔数据调查 5 岁以下儿童健康和医疗保健方面的社会不平等

• 批准号: ES/T010436/1
• 负责人: Simon Rushton
• 金额: $ 20.57万
• 依托单位: University of Sheffield
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FT010436%2F1
• 关键词: Determinants; health; rural; Nepal; Utilising

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.

该项目旨在提高学术理解，并制定适当的选择，以应对尼泊尔偏远农村地区5岁以下儿童在健康和医疗保健方面的不平等。这些持续存在的不平等现象对尼泊尔促进社会和经济发展以及实现可持续发展目标的努力构成了重大挑战。虽然众所周知，各种社会和地理因素有助于确定健康结果（包括性别、种姓/种族和地区），但目前可用的数据缺乏粒度，无法有力地探索这些各种形式的不平等与（一）健康状况;（二）保健服务的利用;（三）所接受治疗的质量/适当性之间的关系。虽然尼泊尔政府公布的现有数据仅以汇总格式提供，但PHASE Nepal -一个在该国一些最偏远地区支持政府卫生设施的知名度高、备受尊敬的非政府组织-拥有大约50，000份5岁以下儿童访问卫生设施的记录，这些记录以前没有进行过分析，因为它们目前仅以纸质格式存在。这里提出的项目将首次允许数字化和严格分析这一个体患者层面的数据，以进一步了解不平等现象，并解决与该国社会和地理不平等有关的一系列研究问题：RQ 1：地理、年龄、性别、种族和种姓如何影响尼泊尔偏远卫生设施中5岁以下儿童的营养状况？区域问题2：营养不良的诊断和治疗是否受到地理、儿童年龄、性别、种族和种姓的影响？区域问题3：地理位置以及儿童的年龄、性别、种族和种姓如何影响寻求保健的行为和利用保健服务？区域问题4：地理位置以及儿童的年龄、性别、族裔和种姓如何影响5岁以下儿童在保健中心获得的治疗？该项目建立在谢菲尔德大学和PHASE Nepal之间牢固的现有关系基础上。先前的一次合作由国际农业科学院的资金资助，为PHASE尼泊尔工作人员提供了研究方法培训，并对PHASE的数据资产和数据管理战略进行了初步分析。这里提出的项目汇集了社会科学家和公共卫生专家，以了解其社会背景下的健康不平等，并制定政策和实践建议，由PHASE Nepal工作人员Pohl博士和Baidya博士以及谢菲尔德共同设计团队成员，确保该研究对PHASE Nepal本身有价值且可操作。同时也对其他卫生系统利益相关者（尤其是尼泊尔卫生和人口部）以及更广泛的学术研究人员社区具有价值。

项目成果

Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a cross-sectional study.

• DOI: 10.1186/s12889-022-14318-y
• 发表时间: 2022-10-20
• 期刊: BMC public health
• 影响因子: 4.5

Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias.

• DOI: 10.1136/bmjopen-2022-069060
• 发表时间: 2023-06-26
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Joshi S;Karki A;Rushton S;Koirala B;Basnet S;Rijal B;Karki J;Pohl G;Baidya M;Chater T;Green D;Lee A
• 通讯作者: Lee A

Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a retrospective cohort study

影响尼泊尔农村卫生中心 5 岁以下儿童利用卫生服务和治疗的决定因素：一项回顾性队列研究

• DOI: 10.21203/rs.3.rs-1250288/v1
• 发表时间: 2022
• 作者: Shrestha B