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NSC's Field Research Projects Abstract
Conducted by Nepal Study Center

Health and Awareness

mHealth Innovations for Nepali Adolescents & Potential Indirect Mental Health Costs
Graduate Student: Siobhan Yilmaz

There is a growing trend to use mobile-based mental health interventions to combat high suicide and bullying rates in Nepal within adolescent populations, where 11.8% of the population is estimated to be between 13 and 17. While use of mobile technology is high among adolescent populations and offers a potential avenue for intervention, there is growing evidence of the negative mental health and wellbeing outcomes that can come from overuse/maladaptive uses of mobile/smartphones. Thus, this research aims to investigate the tension between mobile phone/smart phone usage as a true mHealth opportunity in Nepal or as a potential problem, introducing deleterious mental health effects of over-use of mobile phones/systems, based on the Theory of Basic Psychological Needs. Using the urban-rural setting of the Lumbini Zone in Western Nepal (Province Five) researchers affiliated with the University of New Mexico’s (UNM) Nepal Study Center (NSC), conducted a focus group survey of 66 individuals from multiple stakeholder groups relevant to the research (adolescents, mothers, health professionals, and school administrators) in December 2018 in Rupandehi district as an exploratory assessment about the state of mental health knowledge/awareness, current cell phone practices/uses of mobile phones, and insight into those cultural/developmental burdens seen as most detrimental to the mental health of adolescents in the region. A second phase of this research has recently concluded, with close to 750 adolescents in grades 11 and 12 from seven different secondary schools surveyed on topics of emotional health, cell phone usage, life worries/troubles, cultural attitudes, and currently known health/treatment options. Analysis will be undertaken to determine the direct and indirect effects of protective and adverse life factors on mental health outcomes, along with the mediating effect of cell phones on these relationships. Additionally, recommendations will be made as to the means and areas of focus that future mHealth initiatives aimed at Nepali adolescents should likely focus on, to have the greatest likelihood of success. Such policy recommendations may also lead to future research exploring the feasibility of such mobile-based (mHealth) interventions.
Funding agency: PNMF Fellowship through a donor partner

Development of Intervention Tools to Enhance Awareness, Access and Cost Effectiveness of HPV Vaccination in Nepal
Graduate student: Mandy Liu

The aim of the project is to use health communication and educational intervention tools to enhance awareness, access and cost effectiveness of HPV vaccination in Nepal. Using the urban-rural setting of the Lumbini Zone in Western Nepal (Province Five) and in collaboration with the local non-profit paramedical college and its parent NGO organization Pratiman-Neema Memorial Foundation (PNMF), this study makes attempts to understand what current HPV vaccine prevalence and public awareness is, and what the main barriers of HPV vaccine are. A research team from the University of New Mexico’s (UNM) Nepal Study Center (NSC) has just concluded its first phase of its field work about the mothers’ and daughters’ openness to the HPV vaccine as well as their current awareness of HPV. The study uses The Theory of Planned Behavior to examine the link between the individual’s attitude, subjective norm, perceived control and their intention of accepting HPV vaccine. Their willingness to pay for the HPV vaccine will be estimated as their intention to predict their behavior of vaccination. The difference between mothers and daughters will also be compared to select different-target interventions. This project will use the information from the results from the first phase to develop a set of media and technology-driven health communication interventions that are more conducive to local conditions. It will constitute the implementation of the best-practice method in a targeted community and the impact of the implemented intervention will be assessed in the future.
Funding agency: American Cancer Society

Can Social Networks Help Improving The Emotional Health of Cancer Patients? Study from Nepal
Graduate Student: Disha Shende

In the context of developing countries, chronic illness is one of the dominant health burdens, and cancer is responsible for majority of the deaths. This study tries to understand how social networks affect the emotional well-being of the cancer patients. The data for this paper comes from the field survey that we conducted in four major hospitals in Nepal in 2018. The survey collected data on quality of life of cancer patients and patients of other chronic illnesses. The data suggests that the cancer patients suffer from higher levels of emotional stress compared to other patients. We hypothesize that social networks can help reduce this emotional burden and improve their emotional well-being. The social network is measured by the quality of the relationships of cancer patients with their friends, family and colleagues. The emotional burden(depression) is measured using nine questions from Patient Health Questionnaire (PHQ-9) which is used to assess the degree of emotional stress among the patients. The study uses structural equation modelling to understand the role of social networks in cancer patients’ emotional well-being. We find that social network reduces depression among cancer patients. We also find that this effect is higher in case of women cancer patients compare to the men cancer patients. These results strongly advocate for the importance of social networks in improving the quality of life of cancer patients. In conclusion, this study discusses the policies in regard to the welfare of cancer patients.
Funding agency: American Cancer Society

Understanding smoking and smokeless tobacco usage in Siddharthanagar, Province Five, Nepal
Graduate Student: Aakrit Joshi

Following the Tobacco Product Control and Regulation Act (TPCR) of 2010, several regulations have been enacted to reduce tobacco prevalence in Nepal. One such regulation adopted to curb tobacco prevalence was the restrictions in public smoking. In this study, we aim to assess the consequential impact of restricting smoking in public places towards smokeless tobacco usage among smokers. A research team from the University of New Mexico’s (UNM) Nepal Study Center (NSC) along with the support from Pratiman-Neema Memorial Foundation (PNMF) recently conducted study to understand their smoking behaviors and smokeless tobacco use of residents of Siddharthanagar. This study aims to utilize the information gathered from this survey to understand the scope of smokeless tobacco consumption following restrictions in public smoking. The results of this study would ideally provide information regarding the effectiveness of public policies aimed towards reducing tobacco prevalence. Furthermore, we envision that this study would generate localized evidence needed for future policy considerations aimed towards reducing tobacco prevalence.
Funding agency: South Asian Network for Development and Environmental Economics (SANDEE)

An Analysis of the Socio-Economic Consequences of Cancer in Nepal
Graduate Student: Soumi Roy Chowdhuri (Completed)

In developing countries especially due to data scarcity, studies estimating the economic burden of a rapidly growing non communicable disease, cancer is rare. Our project funded by the American Cancer Society and implemented by The Nepal Study Center (NSC) was a first of a kind comprehensive survey of cancer patients undertaken in Nepal. In 2016, NSC undertook a survey of 600 cancer patients and 200 non-cancerous patients across five different hospitals of Nepal.  The range of the survey extended in understanding the economic hardships that a cancer patient and their family goes through the process of treatment. Questions were asked on the nature of mental burden, social isolations, family level distress, labor market implications of a cancer patient. The project led to a doctoral dissertation and yielded opportunities for future research with two subsequent grants from American Cancer Society. The broader themes of research that emerged from the survey are as follows: First, it was aimed at understanding the retrospective preference of cancer patients in valuing an annual comprehensive cancer-screening program. A structural equation-modeling framework determines how current health status of cancer patients determine their preferences for a preventative screening. Second, a comparative analysis of the cancer and control patients was done to estimate the incremental amount of burden (financial and non-financial) a family with cancer patient borne. It extended the literature by studying the differential impact of gender and cancer sites across different categories of patients. Using propensity score matching methods, it was found that cervical cancer is not only the most prevalent cancer in Nepal, but they also face the highest mental burden pointing to dysfunctional familial relationships. Finally, to highlight a macro picture of the magnitude of economic burden that low resource-setting country like Nepal face, a mortality cost estimations of Nepal was undertaken. This was the first paper to project a social loss due to cancer through estimation of the number of life years lost and the amount of productivity loss.
Funding agency: American Cancer Society

Farmers’ Perception of Climate Change and Willingness to Pay for Weather Index-Based Insurance in Bahunepati, Nepal
Graduate Student: Wenmei Guo (Completed)

From August to October 2014, we conducted a field study in Bahunepati, Nepal to examine the effective mechanism to cope with climate change. The village is located in the Sindhupalchok district in the Hill Belt. We randomly selected 353 households to interview with an overall response rate of 72% for the survey. This is a pioneering study of investigating effects of farmers’ perception of climate change on their willingness to pay (WTP) for a weather-index crop insurance in Nepal. We designed two insurance products: Product A insures rice, and Product B adds five main livestock. The research improves on the previous literature by analyzing two crop insurance products which incorporate both crop and livestock. We used perception of future climate change (ex-ante perception) and perception of past impacts of climate change (ex-post perception) to measure farmers’ perception of climate change. Results show that people who are aware of climate change are around 18% and 16% more likely to pay for insurance product A and B. I also find that the effect of other existing mitigation strategies crowds out people’s WTP. In addition, the annually mean WTPs are 1.6% and 3% of household income for product A and product B, respectively.


Estimating the preference for a better solid waste management system: A case of Siddharthanagar Municipality, Nepal
Graduate Student: Mohammad Mashiur Rahman

The immense pressure on cities from this emerging population creates an unfavorable condition to society and environment especially from an upward shift of household waste production. Illegal dumping beside the river and roads, shortage of municipality resources of collection, and a lack of awareness have a great negative impact on the overall ecosystem mostly incurred by water and air pollution. Siddharthanagar municipality is experiencing faster growth in population leading to a huge burden of unmanaged waste from the lack of resources by the municipality. However, with this current situation, no research has been done to understand the preference and the opinion towards waste management system by the households which is crucial to design a better waste management service. To fill this gap of information from the household level, a group of UNM researchers conducted a survey on household’s waste management behavior, preference, and willingness to pay in June 2019. This research has two main objectives. First, This research is expected to provide information on households current waste management behavior and production as well as their perspective towards engaging in better waste management techniques. Second, this will provide households willingness to pay to the municipality to develop the characteristics (dumping, recycling, composting, etc.)  of better waste management service. Overall, this will help the administrative personnel to formulate policy after accounting for the household's preference.
Funding agency: South Asian Network for Development and Environmental Economics (SANDEE)

Estimating the public preference for air quality improvement and understanding the health effects of exposure to air pollution in Siddharthanagar munipality, Nepal
Graduate Student: Niraj Khatiwada

The air quality measuring devices installed in 2017 and 2018 by the Nepal Study Center (NSC) and Pratiman Neema Memorial Foundation (PNMF) provide evidence that the air in Siddharthanagar municipality is highly polluted. There is currently a huge burden on the municipality to address the problem of air pollution, which has posed a serious threat to the public health and welfare. However, due to the lack of research, there is no ample understanding of the health effects of air pollution in the municipality. Additionally, there is no vivid understanding of public attitude towards improving the air quality in the municipality. In June 2019, a research team from UNM conducted a field study in Siddharthanagar municipality of Nepal. The study has three main objectives. First, it examines the health effects of exposure to air pollution based on proximity to pollution sources such as paved/unpaved roads, factories, etc. The study uses lung capacity as a biomarker of respiratory health. During the field survey, respondents’ lung capacity was measured using a device called Spirometer. Second, the study examines public preferences for air quality improvement in the municipality by estimating households’ willingness to pay for the improvement using the survey-based contingent valuation method. Third, the study estimates the economic cost of air pollution in Siddharthanagar municipality based on the expenditure on air pollution related illness treatment and the opportunity cost of illness measured in terms of lost working days. We envision that the findings of this study will help policymakers in designing interventions and policies to address the problem of air pollution in the municipality.
Funding agency: South Asian Network for Development and Environmental Economics (SANDEE)

Public Preference for River Ecosystem Services in the Danda Basin, Nepal: A Choice Experiment Study
Graduate Student: Samrat Kunwar (Completed)

Freshwater systems have historically been the linchpin of urban centers; however, they are also considered to be one of the most endangered ecosystems in the world. This paper develops a choice experiment method to assess the potential for a sustainable management of a freshwater system, the Danda River, in Nepal. We use a primary survey data from 637 households, and the empirical analysis is conducted using the Generalized Multinomial Logit (GMNL) model. The findings indicate substantial demand for the river ecosystem services. Respondents were willing to pay (WTP) $17.06/year on average for the highest quality of river water and $13.46/year to introduce vegetation in the riverbanks. Our analysis incorporates the respondents’ preference uncertainty, and we also explore the presence of spatial heterogeneity using the hot spot analysis. We find the inclusion of preference uncertainty increased the precision of the marginal willingness to pay estimates, while the hot spot analysis indicates that heterogeneity in preferences for the ecosystem services surfaces from an urban center. We also observe that the public prefers community-based management of the Danda River, which highlights the need for policymakers to decentralize their management to the local communities so as to enhance interest in conservation of common pool resources like river ecosystems.
Funding agency: Open Society Foundation



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