Golden Community

Bridging Gaps and Scaling Up: a school readiness program for child-parent-teacher triad in Nepal

admin — Thu, 17 Apr 2025 10:36:21 +0000

Despite the existence of pre-primary education policies in 48% of low- and middle-income countries, significant disparities persist in learning, development and the school readiness. While Nepal’s has established policy commitments to early childhood development, significant gaps remain in delivering quality pre-primary education, particularly in rural areas and for marginalized communities including children with disabilities. Key challenges include inadequately trained teachers, limited inclusive education practices, insufficient parental engagement, and poor learning environments during the critical developmental period. These gaps result in children entering primary school unprepared, leading to poor learning outcomes, higher dropout rates, and widening educational inequalities that undermine long-term educational success.

Every Newborn Reach Up Early Education Intervention for All Children (EN-REACH) project was successfully implemented in five districts of Gandaki Province, including a cohort of children born at the Western Regional Hospital in Ramghat, Pokhara. Best practices and evidence from EN-REACH were then used to scale up the early childhood development (ECD) education intervention to 24 schools in the Nuwakot and Dhading districts. This research project is supported by GPE KIX for a period of 33 months. We have taken a triad approach to make teachers, parents and communities ready to prepare the young children (between 4 to 7 years of age) for the school. In close collaboration with national ECD experts, central, district and local level stakeholders, a customized inclusive teacher training manual will be developed in adherence to the national ECD curriculum. Simultaneously, the ENREACH parenting manual, endorsed by the Central Education Human Resources Development (CEHRD), will be adapted to make it more relevant and effective. Master trainers from districts and municipalities will be trained at the national training center and will then train ECD teachers. Thus, teachers will gain the skills needed to include children with disabilities and implement the ECD approach. The ECD teachers will also take the role of facilitators, conducting sessions with parents to prepare children for Grade 1 together. There will be structured, periodic supervision of classes by the trainers, including the parenting sessions.

Family-Centered Intervention and Epidemiology of Developmental Delays and Disabilities in Kaski Nepal (FINE-DDD)

admin — Tue, 19 Dec 2023 05:30:00 +0000

A recent study estimated that over 200 million children living in Low Middle-Income Countries will not fulfill their developmental potential, due to risk factors such as intrauterine growth restriction, malnutrition, infectious diseases and inadequate cognitive stimulation, and the World Health Organization has estimated that 93 million children in the world are living with a moderate or severe disability. But these numbers are just estimates, and true number of children affected by Developmental Delays and Disabilities (DDD) is not known. The knowledge gap of the problem which often leads not being prioritized in policy making and implementation plans for these population at local, district and national levels. Hence, this calls for an urgent need to do research to define problems and needs of the children with DDD along with the birth and environmental risk factors.

Every Newborn-Reach Up Early Education Intervention for All Children (EN-REACH)

admin — Mon, 13 Mar 2023 08:53:55 +0000

Sustainable Development Goals (SDGs) target 4.2 aims that, by 2030, all children access quality early child development (ECD), pre-primary education and are ready for primary education. However, children most at risk of poor educational outcomes, including those with neuro-developmental delay and disability (NDD/D), are less likely to access school, including pre-school services.

This study is called EN-REACH (Every Newborn – Reach up Early Education intervention for All CHildren) and builds on a previous observational cohort study EN-SMILING, it will evaluate the impact and implementation of a pre-school parenting program aimed at improving school readiness in Bangladesh, Nepal & Tanzania with three objectives.

Essential Newborn Care Now! (ENC NOW!)

admin — Thu, 03 Feb 2022 09:38:36 +0000

Golden Community in collaboration with the Government of Nepal (GoN) and University of Washington, Department of Paediatrics, School of Medicine, Washington for improving key quality improvement (QI) interventions including neonatal resuscitation to skilled health worker who will be in the forefront, providing maternal and neonatal quality of care services in tertiary level hospital, Paropakar
Maternity & Women’s Hospital, Kathmandu.

Set of quality interventions

Orientation of ENC Now! to concerned stakeholders
A three-day online ENC Now! training around the care of newborn.The main components are Helping Babies Breath integrated with Quality Improvement (QI) module, PDSA approach
Plan Do Study Act meetings to solve the problems related to newborn and maternal services within the department
Mentoring and Review meetings with stakeholders of Hospital

Implementing Respectful Maternity Care (RMC) Intervention to Improve Perinatal Mental Health

admin — Mon, 13 Mar 2023 09:01:11 +0000

Several studies in low- and middle-income settings have shown that mistreatment and disrespectful care during childbirth is a major issue that needs addressing. A multi-country study by Bohren et al. showed that more than a third of women experience disrespectful care during childbirth. Mothers face physical and verbal abuse as well as discrimination based on age, ethnicity and social class . Other types of abuse are non-consented care or painful vaginal examination, and restraining from having companionship or food during childbirth . Lack of dignified care during the vulnerable time during birth not only violates the universal right of childbearing women but also influences the overall quality of care . There is some early evidence to suggest that women experiencing disrespect and abuse are more likely to experience common perinatal mental disorders. Common perinatal mental disorders include depressive, anxiety, adjustment and somatic disorders. In low- and middle-income countries, 19.7% of women suffer common perinatal mental disorders during pregnancy and 39.4% suffer from the disorders during postpartum period . While there is a growing body of literature on disrespectful care in sub-Saharan African and Latin America, there is limited literature on the topic from Asia, including Nepal.

Improving Adherence to Neonatal Resuscitation Using Machine Learning at Quality Improvement Approach (Pre-MALA)

admin — Mon, 13 Mar 2023 08:59:32 +0000

High quality neonatal resuscitation is a key to save newborn lives, prevent brain injury and optimize child development, yet the quality of care remains far below standards. In this project, we investigate the use of video filming of neonatal resuscitation (source of data) to develop a machine learning application which automatically detects neonatal resuscitation activity. This artificial intelligence system will assist to standardize resuscitation in neonates requiring assisted ventilation on the resuscitation table. The MAchine Learning Application (MALA) installed in a tablet mounted on the resuscitation table detects the baby’s crying (sound), breathing (chest movement) and health worker’s resuscitation action (stimulation, suctioning and bag-and-mask ventilation), and provides real-time feedback (reminder) on steps of resuscitation.The real-time feedback will be in the form of audio and visual signals from the tablet during resuscitation. Following the completion of resuscitation, MALA provides a summary feedback on the resuscitation steps followed as per the resuscitation guideline.

Feasibility of Remote General Movements Assessment (GMA) for Early Recognition and Rehabilitation of Cerebral Palsy in Nepal

admin — Mon, 13 Mar 2023 08:58:48 +0000

Cerebral Palsy (CP) is a syndrome of non-progressive movement and posture disorder caused by damage to the developing brain during pregnancy, delivery or first two years of life. It is the most common form of motor disability in childhood affecting around 2-3 children per 1000 live births. Early intervention started during the first two years of life has been shown to improve functional outcome in children at risk of CP. Novel tools enable early recognition of these children, but access to early diagnosis is limited in Low- and Middle-Income Countries (LMIC), where the majority of affected children live. Facility based studies in Nepal show that many children with CP access rehabilitation first around school age. This missed opportunity results in decreased quality of life for both affected children and their parents.

General Movements Assessment (GMA) is a cheap, non-invasive method for recognizing children at high risk of CP based on observing their spontaneous movements. Already at 3 months’ age it can predict CP with over 90% sensitivity and specificity enabling start of early rehabilitation interventions for children at high risk of CP. Lack of doctors and physiotherapists trained in the methodology has thus far limited its spread to LMIC, but smart phone technology can help to overcome this barrier.

Studies in high-income settings have shown that GMA can be administered remotely using video films recorded by parents at home with help of a smart phone application (app).

Study Aim:

We aim to conduct a follow up study on feasibility of remote General Movements Assessment (GMA) using smart phones at home through an application at Paropakar Maternity and Women’s Hospital (PMWH). Term infants at high risk of CP due to birth asphyxia or neonatal seizures will be recruited for the follow-up.

Navigating Food Insecurity During the Pandemic: The Role of Social Networks Among Pregnant Women in Nepal

admin — Mon, 13 Mar 2023 08:58:10 +0000

Food insecurity is defined as a state in which an individual “lacks regular access to sufficient, safe and nutritious food to meet the needs for normal growth and development and to maintain an active and healthy lifestyle” (FAO, 2020). An individual may become food insecure due to a combination of factors, including lack of resources to obtain food and/or unavailability of food are some. Not all people are equally vulnerable to food insecurity at all times. Pregnancy is a particularly vulnerable period as the nutritional requirements of the pregnant woman are higher than normal. The lived experience of food insecurity can be influenced by a number of socio-economic factors. The impact of social networks on health outcomes has been the subject of extensive social and medical research in recent decades.

Food insecurity increased rapidly during Covid-19, and the pandemic seriously interrupted severely disrupted social support networks. Nepal is no exception when it comes to consequences of Covid-19 on food insecurity and social networks. The Ministry of Agriculture and Livestock Development in Nepal reported that 58% of the households did not have food stocks for more than a month and three out of ten households lost their income during the worst crisis of Covid-19. While the general importance of social networks for health is well established, few studies have examined the impact of social networks on food insecurity in LMICS.

No studies have explored the role of social networks in the lived experience of food insecurity among pregnant women. However, there are good reasons to believe that the general factors such as social support and access to material resources and goods may also be important in this context. This project explored the lived experiences of food insecurity among pregnant women in Nepal from a qualitative social network perspective in in the Chitwan district including 10 Tharu women who were pregnant during the Covid-19 pandemic.

Investigating heat wave risk perception, vulnerability and adaptation among pregnant women

admin — Mon, 13 Mar 2023 08:58:45 +0000

Over the past 15 years, Nepal has experienced a series of catastrophic weather events, with the Terai region emerging as the hottest part of the country. The prevalence of warm days and nights is increasing in Nepal’s districts. According to the Department of Hydrology and Meteorology, June 2023 marked the hottest month ever recorded in Nepal’s history with temperature rising up to 44 degrees Celsius in some part of the country. Several studies have shown an increase in preterm births in geographical locations where pregnant women is exposed to high ambient temperatures or heatwaves. A meta-analysis of 47 studies found that for every 1-degree Celsius increase in temperature, the odds of preterm birth increased by 1.05 times, and during heatwaves by 1.16 times. Furthermore, the risk of a stillbirth is increased by 1.05 times for every 1-degree Celsius increase in temperature. During periods of extreme heat, pregnant women may exhibit an increased frequency of visits to the emergency room and a higher incidence of cardiovascular events such as myocardial infarction and stroke.

Pregnant women are notably excluded from the definition of “heat-susceptible individuals” as defined in the existing research. There is evidence that extreme maternal stress associated with extreme weather events has adverse effects on the child health outcome. The main aim of this study is to test the hypothesis that women with continuous exposure to high ambient temperatures may experience depressive symptoms during perinatal period and subsequent child developmental delays and disabilities at Bharatpur Hospital, Chitwan involving 745 pregnant mothers in their third trimester using Generalized Anxiety Disorder (GAD) and Edinburgh Postnatal Depression Scale (EPDS) tools. The babies of these cohort mothers were screened for developmental delays and disabilities using SNAP (Special Need Assessment Profile) and IYCD (Infant and Young Child Development) at 6, 12 months, 18 months, and 24 months of age.

Every Newborn – Simplified Measurement Integrating Longitudinal Neuro Development and Growth (EN-SMILING)

admin — Mon, 13 Mar 2023 08:58:02 +0000

In low- and middle-income countries, there has been a noticeable decline in mortality rates among children under 5 years old, a trend expected to continue. However, it is estimated that over 200 million children in these countries have developmental delays or disabilities, highlighting the need for their recognition and inclusion in all health practices and planning. Consequently, the focus has shifted from reducing child mortality rates to improving health and developmental outcomes in childhood. While newborn and early child health present opportunities for early detection and intervention, current approaches to measuring early childhood development (ECD) are often too complex, costly, and time-consuming. Additionally, although basic interventions may improve newborn survival, their impact on ECD outcomes remains poorly understood. ENSMILING aims to address this issue by designing a simplified ECD measurement approach for children from birth to age 5, potentially enabling earlier identification of developmental delays and improved access to evidence-based early intervention.

EN-SMILING builds on the research of EN-BIRTH, a multi-country observational study led by the London School of Hygiene and Tropical Medicine (LSHTM) in Bangladesh, Tanzania, and Nepal. The research project involved follow-up of a group of newborns born in Western Regional Hospital, Pokhara, Nepal who received basic newborn interventions (bag and mask resuscitation, Kangaroo Mother Care (KMC), and treatment for presumed neonatal infection) compared to matched newborns born in the same hospital at the same point of time. Multiple early child development tools were applied for the developmental assessment of these children from birth to 3 years of age at 6, 9, 12, 18, 24, and 36 months of age. The WHO IYCD (Indicators of Infant and Young Child Development) tool, the Caregiver Reported Early Development Instruments (CREDI), the Malawi Developmental Assessment Tool (MDAT), Rapid Neurodevelopmental Assessment (RNDA), Family Care Indicator (FCI) were utilized after pilot testing and cultural adaptation of the tools.