Congenital Genitourinary Anomaly Identification and Referral in Rural Nepal: A Qualitative Study on the Perspective...

Delayed presentation of congenital anomalies is common in Nepal, highlighting the importance of timely diagnosis. Female community health volunteers (FCHVs), who are integral to health care delivery in communities, may offer an opportunity for early identification and referral of these anomalies. This study explored the perceptions, willingness, and motivations of FCHVs in Nepal regarding their potential role in the identification of congenital external genitourinary (GU) anomalies.

Twelve FCHVs from Devdaha municipality, Rupandehi district, Nepal, participated in a focus group discussion (FGD). FCHVs were purposively sampled to ensure diversity in geographic setting (urban/rural), age, and years of experience. A semi-structured FGD guide was used to explore knowledge, attitudes, perceived community acceptance, and recommendations for future training. Data was analyzed using inductive thematic analysis following Braun and Clarke's framework.

Five key themes emerged: (1) lack of confidence in identifying and refering congenital GU anomalies, (2) positive attitude toward community-based screening, (3) perceived barriers (e.g., stigma and parental resistance) and facilitators (e.g., existing child health roles), (4) recommendations for practical, skill-based training, and (5) motivation for FCHVs' work. While FCHVs recognized the importance of identifying congenital anomalies and associated risks or complications, most lacked confidence due to limited prior training. Most FCHVs expressed willingness to participate in screening, particularly when they perceived the role as aligned with their existing responsibilities. There was consensus on the need for targeted training before implementing a formal program.

This study provides early evidence on the feasibility of integrating congenital anomaly screening into community health systems, highlighting training and referral strengthening as next potential steps.