title: Perceived Usefulness of a Microfinance Intervention on Health Awareness and Practices in Nepal.
abstract: BACKGROUND
  Economic constraints may lead to poor health among people from the developing world. Microfinance has proven to be useful in improving health outcomes elsewhere, but it still remains a neglected issue in Nepal. This study aims to assess perceived usefulness of the microfinance on health awareness and practices among different ethnic groups of Nepal.
  
  
  METHODS
  A community-based cross-sectional study was conducted in four districts of western Nepal. A total of 500 microfinance clients representing different ethnic groups (upper caste, aadibasi and janajati, and dalit) were selected by using systemic random sampling. Health awareness and practices among different ethnic groups were compared by logistic regression after adjustment for age, level of education, sex of household heads, occupation, and place of residence. Since participants were asked about their health awareness and practices, before and after microfinance intervention, during a single interview, there was a strong possibility of recall bias with respect to their preintervention awareness and other measures.
  
  
  RESULTS
  Microfinance intervention positively influenced self-reported health awareness and practices among different ethnic groups in Nepal, which was highest among the upper caste group (77-92%, rate ratios around 1.7-2.6), followed by the aadibasi/janajati (60-76%, rate ratios around 1.4-1.8) and dalit group (33-52%, reference group). Self-reported awareness about environment and sanitation, family planning methods, and available health services at local level improved from 11.2 to 69.2, 9.2 to 65.0, and 3.8 to 59.8%, respectively, among the clients after microfinance intervention (p < 0.001). Similarly, the practices of eating nutritious food/balanced diet, drinking safe water, using toilet, immunizing the children, and regularly visiting the healthcare facility were improved from 4.2 to 63.8, 12.6 to 66.8, 15.2 to 70.4, 15.8 to 73.8, and 3.6 to 61.4%, respectively (p < 0.001).
  
  
  CONCLUSIONS
  Despite lack of control group and potential recall bias, this study reports positive effect of microfinance on self-reported health awareness and practices among different ethnic groups of Nepal. This finding supports further implementation and evaluation of equity-based microfinance to improve health and economic conditions of Nepalese people.
authors.affiliation: School of Business, Pokhara University , Pokhara , Nepal.
authors.forename: Bharat Ram
authors.initials: BR
authors.lastname: Dhungana
authors.affiliation: Department of Community Medicine, Janaki Medical College, Tribhuvan University , Janakpur , Nepal.
authors.forename: Jitendra Kumar
authors.initials: JK
authors.lastname: Singh
authors.affiliation: Department of Community Medicine, Devdaha Medical College and Research Institute, Kathmandu University, Devdaha, Nepal; Department of Public Health, Sanjeevani College of Medical Sciences, Purbanchal University, Butwal, Nepal.
authors.forename: Dilaram
authors.initials: D
authors.lastname: Acharya
authors.affiliation: Department of Public Health, Sanjeevani College of Medical Sciences, Purbanchal University , Butwal , Nepal.
authors.forename: Salila
authors.initials: S
authors.lastname: Gautam
authors.affiliation: Clinical and Research Department, Everest International Clinic and Research Centre , Kathmandu , Nepal.
authors.forename: Pravin
authors.initials: P
authors.lastname: Paudyal
keywords: Nepal; ethnicity; health awareness; health practices; microfinance
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