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

该项目旨在增进对尼泊尔偏远农村地区5岁以下儿童在健康和保健方面的不平等现象的学术认识，并制定适当的应对办法。这些持续的不平等现象对尼泊尔促进社会和经济发展和实现可持续发展目标的努力是一个重大挑战。虽然众所周知，各种社会和地理因素有助于决定健康结果(包括性别、种姓/种族和地区)，但目前可用的数据缺乏粒度，无法有力地探讨这些不同形式的不平等与下列因素之间的关系：1)健康状况；2)保健服务的利用；3)接受治疗的质量/适当性。虽然尼泊尔政府公布的现有数据只能以汇总形式提供，但尼泊尔阶段--一个备受瞩目和备受尊敬的非政府组织，支持该国一些最偏远地区的政府卫生设施--大约有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，因为这些记录目前只有纸质格式。这里提议的项目将首次允许对这些个人患者层面的数据进行数字化和严格分析，以进一步了解不平等，并解决与该国社会和地理不平等有关的一系列研究问题：RQ1：地理、年龄、性别、族裔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？RQ2：营养不良的诊断和治疗是否受到地理和儿童年龄、性别、种族和种姓的影响？RQ3：地理和儿童的年龄、性别、种族和种姓如何影响求医行为和医疗服务的利用？RQ4：地理和儿童的年龄、性别、种族和种姓如何影响5岁以下儿童在医疗中心接受的治疗？该项目建立在谢菲尔德大学和阶段尼泊尔之间牢固的现有关系的基础上。上一次由IAA资金资助的合作为尼泊尔阶段的工作人员提供了研究方法培训，并对阶段的数据资产和数据管理战略进行了初步分析。在此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现象，并制定政策和实践建议，该项目是由尼泊尔阶段的工作人员Pohl博士和Baidya博士以及设在谢菲尔德的小组成员共同设计的，以确保研究对尼泊尔阶段本身以及对其他卫生系统利益攸关方(尤其是尼泊尔卫生和人口部)以及更广泛的学术研究人员群体具有价值。

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.