There were differences in frequency of important characteristics acting as confounders between non-RBA HHs and RBA HHs (Table ). There are caste differences between the non-RBA and RBA groups in that the non-RBA group has a higher proportion of Brahims and Chetris (35.4% cf. 18.3%). Other differences between the groups are smaller, but with the RBA group having more females, being more literate (66.9% to 60.8%), having less food security (55.5% to 51.5%) and experiencing a birth in the past 3
years more frequently (33.1% to 24.4%). Hence, in further analysis there are multiple adjustments for these differences between the non-RBA and RBA groups.
Evaluation of health knowledge/experiences of infections
In general, RBA groups held greater knowledge of infections of tuberculosis, HIV and sexually transmitted diseases. Both RBA and non-RBA groups had good understanding of diarrhoeal diseases; pneumonia and malaria, but non-RBA groups had lower responses in terms of care.
Tuberculosis (TB) remains a common infectious illness in Nepal and TB control is exercised by a National Tuberculosis Programme, to which The Britain-Nepal Medical Trust contributes. Hence understanding this disease in terms of symptoms, transmission, prevention and treatment is important. In this study, 568 HHs had heard about TB, with more HHs in the RBA groups (96.3%) being aware of the disease than those in non-RBA HHs (81.3%) Table . After multiple adjustments for confounders, the Odds Ratios (ORs) for the RBA group knowledge was 1: 8.95 (95% CIs: 4.48 to 17.88) or almost 9 times more knowledgeable than the non-RBA group. With this expression of TB awareness in 568 HHs, those in non-RBA groups were less aware of symptoms, transmission, prevention and freely available treatment than RBA groups, see Additional file 1
: Table 2a-d.
Odds Ratio (95% CIs) of Knowledge of Tuberculosis
Infection with HIV is much less common in Nepal, but promoting awareness of the disease, its pattern of transmission and means of prevention were important to the RBA process. For those who had heard of HIV infection in this survey (463), information by radio was most common (above 77% in both groups). RBA HHs were additionally more informed by friends and by health workers. Specific knowledge of transmission and prevention of HIV was less common in non-RBA groups compared with RBA groups see Additional file 1
Understanding of other sexually transmitted diseases (STDs) were understood less in non-RBA groups than RBA groups for those who knew of STDs (298) (83.3% : 93.8%, ORs 1:5.86, 95%CIs 2.24 – 15.36) but the overall understanding in all households was less than 50%, see Additional file 1
HHs were surveyed for prevention and treatment of diarrhoea. Table illustrates the components of prevention examined by HH interviews and the advantage to RBA households of their greater knowledge.
Odds ratio (95% confidence interval) for knowledge of diarrhoea prevention amongst all 628 participants
RBA groups had a better understanding of water hygiene for prevention of diarrhoea and for drinking clean water. Treatment with oral rehydration solution, navajeevan and jeevan jal, was well understood by both groups as were sources of provision. See Additional file 1
Knowledge of the symptoms of pneumonia was well understood in both non-RBA and RBA groups, with RBA groups having greater understanding of specific symptoms. See Additional file 1
Both groups, who had heard of malaria (477), appreciated knowledge of the symptoms of the disease (91.4% : 95.7%) see Additional file 1
Tables 7a-d. There was also good knowledge of transmission of the disease, sources of treatment and means of prevention in both RBA and non-RBA groups. The regular use of nets in HHs was reported as less in non-RBA groups than RBA groups Table .
Odds ratio (95% confidence interval) for use of mosquito net amongst 477 participants who had heard of malaria
Toilets, waste & water
Toilets at the house were less common in non-RBA groups than RBA groups ( 58.4% : 65.3%, OR 1:2.02, 95% CIs 1.28 – 3.18) but the percentages in each were not high. A quarter of both groups used waste land (khet bari) and other locations for toileting.
Waste materials were less likely to be disposed of in a pit or burnt in non-RBA groups and these groups tended to dispose of rubbish on waste land (bari), (65.9% : 48.0%, OR 1: 0.44, 95%CIs 0.31 – 0.62). Water was commonly sourced from piped sources or from hand pumps by both groups. See Additional file 1
Evaluation of reproductive health & family planning
There was a lower level of knowledge of good reproductive health in terms of the benefits of Ante Natal Care and the course of pregnancy and delivery for both RBA and non-RBA groups, with non-RBA groups at a greater disadvantage. Family Planning was well understood by women especially in both groups. There was a low level of knowledge of the legality of abortion.
In responses to interviews with the HH decision-maker, 416 females replied compared with 212 males. There was a higher% of female responders in the RBA group compared with the non-RBA group (70.0% : 62.4%) For reproductive health, 66.4% of responders overall in the RBA group were aware of the recommended x4 Ante Natal Visits compared with 55.6% in the non-RBA group Table . Awareness of these recommended levels was not high in either group.
Odds ratio (95% confidence interval) for knowledge of antenatal visit frequency amongst all 628 participants
Little difference accrued to either group in terms of knowledge of danger signs in pregnancy, but awareness of specific dangers, apart from excessive bleeding, was low.
Knowledge of the Nepalese Birth Preparedness Package (BPP) was known to only 242 HHs, less than 50%. There was little difference in awareness of the BPP between the two groups. No more than 24% had health institutional births. Only 14% had help from a Skilled Birth Attendant and only 55% knew of Clean Birthing Kits.
The need for care of the newborn in general was well understood in both groups, but there were advantages to the RBA group around specific care although these were of low appreciation. Danger signs in the newborn was less understood in the non-RBA group.
For Family Planning (FP), there was little difference in knowledge between the two groups in methods of contraception (96.9% : 97.4% ) or of specific methods in the 602 responding HHs.see Additional file 1
Tables 9a-p. Permanent contraception was well known for 1female tubal ligation/laparoscopy in both groups (79.7% : 87.5%, OR 1:1.81, 95%CIs 1.14 – 2.88) and for vasectomy for the RBA group compared with the non-RBA group(57.4% : 76.5%, OR 1:3.39, 95%CIs 2.28 – 5.05). Sources of temporary contraceptives was known to both groups (95.8% : 97.4%) and in particular these sources centred around health institutions (95.2% : 95.8%).
There is a low level of knowledge of the legality of abortion in these HHs. Non-RBA groups understood legal grounds less than RBA groups (20.9% : 41.3%, OR 1:3.38, 95%CIs 2.24 – 5.09). There was a similar low understanding of the grounds which made abortion illegal (12.9% : 35.7%, OR 1: 4.32, 95%CIs 2.77 – 6.73) see Additional file 1
Health institutions, health workers & health rights
Knowing to use the Health Institution, usually a Health Post or Sub-Health Post, when sick was appreciated by both non-RBA and RBA groups (97.1% : 98.7%). But little more than half for RBA groups and less than half for non-RBA groups appreciated functions for health education, family planning, ante-natal care, immunisation and free TB treatment.
Satisfaction with use of the services of the Dhami Jankari (traditional healer) was 61.5% of non-RBA groups and 50.3% of RBA groups (OR 1: 0.63, 95% CIs 0.45 – 0.87). See Additional file 1
There was limited knowledge of the concept of Health Rights. Only 11.0% in HHs in the non-RBA group and 44.3% of HHs in the RBA group (OR 1:10.5, 95%CIs 6.40 – 17.22) understood their Health Rights, Table .
Odds (95% CI) of Health Rights knowledge