College of Behavioral & Social Sciences
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Item Feasibility study of a family- and school-based intervention for child behavior problems in Nepal(Springer Nature, 2018-03-23) Adhikari, Ramesh P.; Upadhaya, Nawaraj; Satinsky, Emily N.; Burkey, Matthew D.; Kohrt, Brandon A.; Jordans, Mark J. D.This study evaluates the feasibility, acceptability, and outcomes of a combined school- and family-based intervention, delivered by psychosocial counselors, for children with behavior problems in rural Nepal. Forty-one children participated at baseline. Two students moved to another district, meaning 39 children, ages 6–15, participated at both baseline and follow-up. Pre-post evaluation was used to assess behavioral changes over a 4-month follow-up period (n = 39). The primary outcome measure was the Disruptive Behavior International Scale—Nepal version (DBIS-N). The secondary outcome scales included the Child Functional Impairment Scale and the Eyberg Child Behavior Inventory (ECBI). Twelve key informant interviews were conducted with community stakeholders, including teachers, parents, and community members, to assess stakeholders’ perceptions of the intervention. The study found that children’s behavior problems as assessed on the DBIS-N were significantly lower at follow-up (M = 13.0, SD = 6.4) than at baseline (M = 20.5, SD = 3.8), p < 0.001, CI [5.57, 9.35]. Similarly, children’s ECBI Intensity scores were significantly lower at follow-up (M = 9.9, SD = 8.5) than at baseline (M = 14.8, SD = 7.7), p < 0.005, 95% CI [1.76, 8.14]. The intervention also significantly improved children’s daily functioning. Parents and teachers involved in the intervention found it acceptable and feasible for delivery to their children and students. Parents and teachers reported improved behaviors among children and the implementation of new behavior management techniques both at home and in the classroom. Significant change in child outcome measures in this uncontrolled evaluation, alongside qualitative findings suggesting feasibility and acceptability, support moving toward a controlled trial to determine effectiveness.Item Spatial Inequality in Child Nutrition in Nepal: Implications of Regional context and Individual/Household Composition(2011) Bishwakarma, Ramu; Vanneman, Reeve Doering; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)With nearly 42% of children below age five nutritionally stunted, child malnutrition is a social, economic, and public health issue in Nepal. Even more disheartening is the wide variation of malnutrition across sub-regions within country, which seems to disproportionately disadvantage children in certain regions as opposed to others. This dissertation aims to understand the extent and causes of child stunting from a regional inequality perspective. Household data from the Nepal Demographic and Health Surveys (NDHS) 1996, 2001, and 2006 are used to analyze national and regional trends of stunting of children age 6-59 months. Various data sources including the Nepal Census and the Health Management and Information System are used for regional level data. Both household and regional data are then analyzed using two-level Hierarchical Linear Modeling (HLM). The results show that stunting is declining albeit very slowly in Nepal and across all thirteen regions. But there are significant and consistent disparities across regions that are not decreasing over time. HLM analyses show that the regional variance in child stunting is due to both household and regional (i.e. contextual) factors. Specifically, women's literacy at the regional level is found to have a profound impact as it explains 60% of the regional variance in stunting. Among other factors, road accessibility and food production also appear to have important roles but not as large as women's literacy. Together, these three contextual factors explain 75% of the regional variance. Adding household compositional factors- socioeconomics in particular- reduces the residual regional variance only by few additional points. One important finding from the household-level analysis is that the so-called lower caste children are disproportionately stunted compared to other caste groups. Regional women's literacy remains a strong factor influencing child stunting above and beyond mother's education at the household level. Hence, women's literacy at the contextual level should comprise the most important policy agenda against malnutrition in Nepal which is not the case now. Moreover, a special emphasis on the disadvantaged castes is of utmost important so that potential inter-generational transfer of malnutrition could be reduced.