https://repository.auw.edu.bd/handle/123456789/815 Wed, 09 Sep 2026 15:45:47 GMT 2026-09-09T15:45:47Z https://repository.auw.edu.bd/handle/123456789/1009 Community health workers for non- communicable disease prevention and control in Nepal: a qualitative study Biswas, Tuhin Background/objective The increasing burden of non- communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal. Design We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders’ consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically. Setting Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level. Participants We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non- government organisations (n=7), private sector (n=3) and universities (n=6). Results The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation. Conclusion Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW’s capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal. Wed, 01 Jan 2020 00:00:00 GMT https://repository.auw.edu.bd/handle/123456789/1009 2020-01-01T00:00:00Z https://repository.auw.edu.bd/handle/123456789/1008 Meeting the Global Target in Reproductive, Maternal, Newborn, and Child Health Care Services in Low- and Middle-Income Countries Biswas, Tuhin Introduction: Improving reproductive, maternal, newborn, and child health (RMNCH) care services is imperative for reducing maternal and child mortality. Many low- and middle-income countries (LMICs) are striving to achieve RMNCH-related Sustainable Development Goals (SDGs). We monitored progress, made projections, and calcu- lated the average annual rate of change needed to achieve universal (100%) access of RMNCH service indicators by 2030. Methods: We extracted Demographic and Health Survey (DHS) data of 75 LMICs to estimate the coverage of RMNCH indicators and composite coverage index (CCI) to measure health system strengths. Bayesian linear regression models were fitted to predict the coverage of indicators and the probability of achieving targets. Results: The projection analysis included 64 countries with avail- able information for at least 2 DHS rounds. No countries are pro- jected to reach universal CCI by 2030; only Brazil, Cambodia, Colombia, Honduras, Morocco, and Sierra Leone will have more than 90% CCI. None of the LMICs will achieve universal coverage of all RMNCH indicators by 2030, although some may achieve universal coverage for specific services. To meet targets for universal service access by 2030, most LMICs must attain a 2-fold increase in the coverage of indicators from 2019 to 2030. Coverage of RMNCH indicators, the probability of target attainments, and the re- quired rate of increase vary significantly across the spectrum of sociodemographic disadvantages. Most countries with poor histori- cal and current trends for RMNCH coverage are likely to experience a similar scenario in 2030. Countries with lower coverage had higher disparities across the subgroups of wealth, place of resi- dence, and women’s/mother’s education and age; these disparities are projected to persist in 2030. Conclusion: None of the LMICs will meet the SDG RMNCH 2030 targets without scaling up essential RMNCH interventions, reduc- ing gaps in coverage, and reaching marginalized and disadvan- taged populations. Wed, 01 Jan 2020 00:00:00 GMT https://repository.auw.edu.bd/handle/123456789/1008 2020-01-01T00:00:00Z https://repository.auw.edu.bd/handle/123456789/1007 Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression Biswas, Tuhin Background Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. Objectives To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. Search strategy PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. Selection criteria Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. Data collection and analysis Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. Main results We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. Conclusions An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. Keywords Caesarean section, global incidence, maternal request. Tweetable abstract Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country. Wed, 01 Jan 2020 00:00:00 GMT https://repository.auw.edu.bd/handle/123456789/1007 2020-01-01T00:00:00Z https://repository.auw.edu.bd/handle/123456789/1006 Global variation in the prevalence of suicidal ideation, anxiety and their correlates among adolescents: A population based study of 82 countries Biswas, Tuhin Background: Suicidal ideation and anxiety are common among adolescents although their prevalence has predominantly been studied in high income countries. This study estimated the population prevalence of sui- cidal ideation and anxiety and their correlates with peer support, parent-adolescent relationship, peer vic- timization, conflict, isolation and loneliness across a range of low-income, lower-middle-income, upper- middle-income countries and high-income countries (LMICHICs). Methods: Data were drawn from the Global School-based Student Health Survey (GSHS) of adolescents aged 1217 years between 2003 and 2015 in 82 LM-HICs from the six World Health Organization (WHO) regions. For those countries with repeated time point data in this study, we used data from the most recent survey. We estimated weighted prevalence of suicidal ideation and anxiety by country, region and at a global level with the following questions:-“Did you ever seriously consider attempting suicide during the past 12 months?” and “During the past 12 months, how often have you been so worried about something that you could not sleep at night?”. We used multiple binary logistic regression to estimate the adjusted association between adolescent age, sex, socioeconomic status, peer support, parent-adolescent relationship, peer victimization, conflict, iso- lation and loneliness with suicidal ideation and anxiety. Findings: The sample comprised of 275,057 adolescents aged 1217 years (mean age was 14.6 (SD 1.18) years of whom 51.8% were females). The overall 12 months pooled prevalence of suicidal ideation and anxiety were 14.0% (95% CI 10.017.0%) and 9.0% (7.012.0%) respectively. The highest pooled prevalence of suicidal ideation was observed in the Africa Region (21.0%; 20.021.0%) and the lowest was in the Asia region (8.0%, 8.09.0%). For anxiety, the highest pooled prevalence was observed in Eastern Mediterranean Region (17.0%, 16.017.0%) the lowest was in the European Region (4.0%, 4.05.0%). Being female, older age, having a lower socioeconomic status and having no close friends were associated with a greater risk of suicidal ideation and anxiety. A higher levels of parental control was positively associated with a greater likelihood of experiencing suicidal ideation (OR: 1.65, 1.451.87) and anxiety (1.53, 1.301.80). Parental understanding and monitoring were negatively associated with mental health problems. Similarly, the odds of experiencing suicidal ideation and anxiety were higher among adolescents who had been experiencing peer conflict (1.36, 1.241.50; 1.54, 1.401.70), peer victimization (1.26, 1.151.38; 1.13, 1.021.26), peer isolation (1.69, 1.531.86; 1.76, 1.611.92) and reported loneliness (2.56, 2.332.82; 5.63, 5.216.08). Interpretations: Suicidal ideation and anxiety are prevalent among adolescents although there is significant global variation. Parental and peer supports are protective factors against suicidal ideation and anxiety. Peer based interventions to enhance social connectedness and parent skills training to improve parent-child relationships may reduce suicidal ideation and anxiety. Research to inform the factors that influence country and regional level differences in adolescent mental health problems may inform preventative strategies. Funding: None Wed, 01 Jan 2020 00:00:00 GMT https://repository.auw.edu.bd/handle/123456789/1006 2020-01-01T00:00:00Z