title: Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants.
abstract: BACKGROUND
  Estimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted at the end of 2010. We also report on the use of skilled birth attendants (SBAs) and associated factors in the JD-HDSS at the follow-up point.
  
  
  METHODS
  We used a structured questionnaire to survey 3,505 households in the JD-HDSS, Bhaktapur, Nepal. To investigate the use of SBAs, we interviewed 434 women who had delivered a baby within the prior 2 years. We compared demographic and health indicators at baseline and follow-up and assessed the association of SBA services with background variables.
  
  
  RESULTS
  Due to rising in-migration, the total population and number of households in the JD-HDSS increased (13,669 and 2,712 in 2010 vs. 16,918 and 3,505 in 2012). Self-reported morbidity decreased (11.1% vs. 7.1%, respectively), whereas accidents and injuries increased (2.9% vs. 6.5% of overall morbidity, respectively). At follow-up, the proportion of institutional delivery (93.1%) exceeded the national average (36%). Women who accessed antenatal care and used transport (e.g. bus, taxi, motorcycle) to reach a health facility were more likely to access institutional delivery.
  
  
  CONCLUSIONS
  High in-migration increased the total population and number of households in the JD-HDSS, a peri-urban area where most health indicators exceed the national average. Major morbidity conditions (respiratory diseases, fever, gastrointestinal problems, and bone and joint problems) remain unchanged. Further investigation of reasons for increased proportion of accidents and injuries are recommended for their timely prevention. More than 90% of our respondents received adequate antenatal care and used institutional delivery, but only 13.2% accessed adequate postnatal care. Availability of transport and use of antenatal care was associated positively with institutional delivery.
authors.affiliation: Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.|Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Bishnu P
authors.initials: BP
authors.lastname: Choulagai
authors.affiliation: Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
authors.forename: Umesh Raj
authors.initials: UR
authors.lastname: Aryal
authors.affiliation: Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.|Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Binjwala
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Vaidya
authors.affiliation: Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Sharad
authors.initials: S
authors.lastname: Onta
authors.affiliation: Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Department of Biomedicine and Public Health, School of Health and Education, University of Skövde, Skövde, Sweden.|Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; alexandra.krettek@his.se.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Krettek
mesh_terms: D000293:Adolescent; D000328:Adult; D000488:Allied Health Personnel / Q000600:supply & distribution; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D003710:Demography; D004641:Emigration and Immigration; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009390:Nepal; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: JD-HDSS; Nepal; health demographic surveillance site; health systems research; public health; skilled birth attendants