The road to tuberculosis treatment in rural Nepal: A qualitative assessment of 26 journeys

BACKGROUND: The fact that tuberculosis can be treated with the DOTS strategy (Directly Observed Treatment, Short-course) is not enough to control the disease. Patients have to find their way to tuberculosis treatment first. To better understand the route to tuberculosis treatment in rural Nepal we interviewed twenty-six patients under treatment. METHODS: In semi-structured interviews patients shared their disease history and health seeking behaviour. The analysis focused on the encounters with the health care system before enrolment in the tuberculosis treatment program. RESULTS: Patient routes often started in the medical shop and led via intricate routes with multiple providers to facilities with higher qualified and more competent staff where tuberculosis was diagnosed. Several factors influenced the route to tuberculosis treatment. Besides known patients factors (such as severity of complaints, the ability to pay for services, availability of services and peer support for choosing a provider) specific health services factors were also identified. These included the perceived quality, costs and service level of a provider, and lack of provider initiated referral. Self referral because of waned trust in the provider was very common. In contrast, once tuberculosis was considered a possible diagnosis, referral to diagnostic testing and tuberculosis treatment was prompt. CONCLUSION: Patient routes towards tuberculosis treatment are characterised by self referral and include both private and public health care providers. Once tuberculosis is suspected referral for diagnosis and treatment is prompt. Given the importance of the private practitioners in the patient routes, quality improvement initiatives need to address not only the public sector but the private health care sector as well

Challenges in prevention and timely care of uterine prolapse in Nepal

Background: Uterine prolapse is a common reproductive health problem in low-income countries like Nepal. Physical symptoms of this condition influence women’s quality of life. Current data insufficiently determine women’s awareness of this condition. Health care seeking practices for uterine prolapse in Nepal are inadequate. Aims: This Thesis aimed to assess women’s knowledge of uterine prolapse and its associated factors, explore how this affects quality of life, and describe health care seeking practices. We also aimed to determine the prevalence of UP in both rural and peri-urban settings of Nepal. Methods: This Thesis used cross-sectional descriptive studies. The mixed-method approach included quantitative interviews with 115 respondents and qualitative in-depth interviews with 16 UP-affected women in rural Nepal. Nationally, we conducted structured interviews with 4,693 married women aged 15–49 years in 25 districts that represent all 5 administrative regions and 3 ecological zones of Nepal. To assess how uterine prolapse affects quality of life, we conducted structured interviews with 3,124 women during a household survey in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site outside Kathmandu and also with 48 attendees at a screening camp for uterine prolapse. A community-based case control study traced self-reported cases identified by a previous household survey and in a control group (women not having uterine prolapse) from the screening camp. Results: Most participants (>85%) described major physical discomforts, including difficulty with walking, standing, working, sitting, and lifting. Compared to stage I, women with Stage III uterine prolapse suffered adverse effects on quality of life. They endured humiliation, harassment, torture, and severe emotional stress from their husbands and other family members due to their inability to perform household chores or fulfill their husband’s sexual desires. The prevalence of uterine prolapse in our peri-urban setting was 2.11%, where more than 53% of our participants had comprehensive knowledge of uterine prolapse (compared to only 37% in a national survey). Contributing factors included parity, education, and family structure. Knowledge gaps in the national survey associated with geography, age group, education, caste/ethnic group, and media exposure. Possible factors that influenced women’s health care seeking practices for uterine prolapse included access barriers, low socioeconomic status, gender inequality, a culture of silence, lack of autonomy for health care, and lack of regular community-based services. Conclusions: Major challenges for the prevention and timely care of uterine prolapse include knowledge gaps and associated factors such as geography, caste/ethnic group, education, and media exposure

Factors Associated with Childhood Pneumonia and Care Seeking Practices in Nepal: Further Analysis of 2019 Nepal Multiple Indicator Cluster Survey

Abstract Background: Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children is 2.1percent in 2019 and many children from marginalized families suffer disproportionally and many of them die without proper care and treatment. The objective for this study was to describe the factors associated with childhood pneumonia and care-seeking practices in Nepal. Methods: This was an analytical study based on further analysis of Nepal Multiple Indicator Cluster Survey (MICS) 2019. MICS used multi-stage Probability Proportional to Size sampling for the survey. Data from 6,658 children were analyzed using SPSS 22. Chi-square test and logistics regression analysis was conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders. Results: Children among the age group 0 to 23 months had 1.5 times higher odds of pneumonia as compared to age group 24 to 59 months (OR=1.5, CI 1.0 - 2.3) and children from rural area had 1.9 times odds of having pneumonia in comparison to urban area (AOR=1.9, CI 1.2 - 3.2). Underweight Children had 2.3 times greater odds of having pneumonia than normal weight children (AOR=2.3, CI 1.4 - 3.9). The odds of pneumonia was 2.5 higher among the children of currently smoking mothers as compared to children of non-smoker mothers (AOR=2.5, CI 1.1 – 5.7). Only one-fourth of children received treatment from public facilities. Among those who received treatment, less than half of the children did not receive appropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all. Conclusions: Pneumonia still kills so many children despite these deaths are preventable with simple interventions. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized by countries to avert these deaths of innocent children.</jats:p

Nutritional status and the associated factors among people living with HIV: an evidence from cross-sectional survey in hospital based antiretroviral therapy site in Kathmandu, Nepal

Abstract Background Nutritional status is the key concern among the people living with HIV but this issue has been failed to be prioritized in HIV strategic plan of Nepal. This study aims to assess the nutritional status among people living with HIV and determine their associated factors. Methods A hospital based cross-sectional study was conducted where 350 people living with HIV attending the ART clinic were selected using systematic random sampling technique. Nutritional status among people living with HIV was assessed through anthropometry, body mass index; Underweight (body mass index &lt; 18.5 kg/m2) and overweight/obesity (body mass index &gt; 23 kg/m2). HIV related clinical factors such CD4 count, WHO stage, opportunistic infection, antiretroviral therapy regimen etc. were collected from the medical records. Socio-demographic data were collected using pretested structured questionnaire through interview technique. Multiple linear regression method was employed to determine the association between different independent factors and body mass index score. Results The prevalence of underweight was found to be 18.3% (95% CI: 14.3–22.6). Most of the study participants were overweight/obese (39.1%). After subjection to multiple linear regression analysis, it was found that age, being male, being married, being in business occupation, smoking, hemoglobin level and antiretroviral therapy duration were significantly associated with body mass index score. Majority of the participants in our study lacked diversified food (62.3%). Conclusion Overweight/obesity is an emerging problem among people living with HIV. This group of participants should be screened for the presence of non-communicable disease. This study also highlights the importance of nutritional program being an integral part of HIV/AIDS continuum of care. Therefore, an effort should be made to address the burden of malnutrition by addressing the identified determinants. </jats:sec

Perceived Risk of HIV Infection among Spouses of Migrant Workers and Non-migrants in Bardiya District , Nepal

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Factors associated with childhood pneumonia and care seeking practices in Nepal: further analysis of 2019 Nepal Multiple Indicator Cluster Survey

Abstract Background Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal. Methods This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders. Results Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0–2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2–3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4–3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1–5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4–1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all. Conclusions Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized. Keywords: Childhood pneumonia, epidemiology, health care seeking behavior, Nepal. </jats:sec

Nutritional Status of Children and Its Associated Factors in Selected Earthquake-Affected VDCs of Gorkha District, Nepal

Background. Malnutrition is a major public health problem and most enveloping cause of morbidity and mortality among children and adolescents throughout the world. This study was aimed at assessing the nutritional status and associated factors among 6-10-year-old children in selected earthquake-affected areas of Gorkha district, Nepal. Methods. A community-based cross-sectional study among 420 mothers having children of age groups 6-10 years (with anthropometric measurement among children) was conducted using a mixed method in selected earthquake-affected areas of Gorkha district, Nepal, from October 2015 to April 2016. Gorkha was selected purposively from 14 earthquake-affected districts. Two village development committees were selected randomly among 6 having severe impact. Randomly, 5 wards were selected from each of the 2 village development committees. As the sample was 420, 42 children were selected randomly from every ward. Result. Among the 420 children, 31.9% were underweight, 51.9% were stunted, and 2.9% were wasted after the earthquake. Children who were more prone to being underweight were the following: male children (RR=1.34 95% CI: 1.01-1.78) and children from illiterate mothers (RR=2.49, 95% CI: 1.85-3.36), illiterate fathers (RR=1.73, 95% CI: 1.32-2.27), and homemaker mothers (RR=0.28, 95% CI: 0.20-0.38); children whose families were using nonimproved sources of water (RR=2.60, 95% CI: 1.07-6.60); and households having food insecurity (RR=12.97, 95% CI: 3.29-51.18). Similarly, children of illiterate fathers (RR=1.67, 95% CI: 1.41-1.97), children of illiterate mothers (RR=2.32, 95% CI: 1.91-2.83), children of homemaker mothers (RR=0.59, 95% CI: 0.49-0.70), children whose family were using treated water (RR=0.32, 95% CI: 0.15-0.67), and children from food insecure households (RR=10.52, CI: 4.05-27.33) were found to be stunted. After adjustment, children from households consuming nonimproved water were 6 times more likely (OR=6.75; 95% CI: 1.59-28.62) to be wasted. Conclusion. Illiterate mothers, illiterate fathers, mothers engaged in occupation other than household work, and food insecure households were found to be independent predictors of underweight and stunting. Nonimproved source of drinking water was found to be independent predictors of wasting

Nutritional Status of Children and Its Associated Factors in Selected Earthquake-Affected VDCs of Gorkha District, Nepal

Background. Malnutrition is a major public health problem and most enveloping cause of morbidity and mortality among children and adolescents throughout the world. This study was aimed at assessing the nutritional status and associated factors among 6-10-year-old children in selected earthquake-affected areas of Gorkha district, Nepal. Methods. A community-based cross-sectional study among 420 mothers having children of age groups 6-10 years (with anthropometric measurement among children) was conducted using a mixed method in selected earthquake-affected areas of Gorkha district, Nepal, from October 2015 to April 2016. Gorkha was selected purposively from 14 earthquake-affected districts. Two village development committees were selected randomly among 6 having severe impact. Randomly, 5 wards were selected from each of the 2 village development committees. As the sample was 420, 42 children were selected randomly from every ward. Result. Among the 420 children, 31.9% were underweight, 51.9% were stunted, and 2.9% were wasted after the earthquake. Children who were more prone to being underweight were the following: male children (RR=1.34 95% CI: 1.01-1.78) and children from illiterate mothers (RR=2.49, 95% CI: 1.85-3.36), illiterate fathers (RR=1.73, 95% CI: 1.32-2.27), and homemaker mothers (RR=0.28, 95% CI: 0.20-0.38); children whose families were using nonimproved sources of water (RR=2.60, 95% CI: 1.07-6.60); and households having food insecurity (RR=12.97, 95% CI: 3.29-51.18). Similarly, children of illiterate fathers (RR=1.67, 95% CI: 1.41-1.97), children of illiterate mothers (RR=2.32, 95% CI: 1.91-2.83), children of homemaker mothers (RR=0.59, 95% CI: 0.49-0.70), children whose family were using treated water (RR=0.32, 95% CI: 0.15-0.67), and children from food insecure households (RR=10.52, CI: 4.05-27.33) were found to be stunted. After adjustment, children from households consuming nonimproved water were 6 times more likely (OR=6.75; 95% CI: 1.59-28.62) to be wasted. Conclusion. Illiterate mothers, illiterate fathers, mothers engaged in occupation other than household work, and food insecure households were found to be independent predictors of underweight and stunting. Nonimproved source of drinking water was found to be independent predictors of wasting.</jats:p

Knowledge, prevalence and treatment practices of uterine prolapse among women of reproductive age in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal

Background: Uterine prolapse (UP) is a main contributor to reproductive health problems that influence women’s quality of life. In Nepal, the UP prevalence ranges from 7-27%. Women experience various difficulties and symptoms due to UP, which are determined by the type as well as thestage of UP.Objectives: This study aimed to explore the knowledge, prevalence and treatment practices of uterine prolapse among women of reproductive age in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) in the Bhaktapur district of Nepal.Methods: This cross-sectional study collected data in two stages. A structured survey of 3,124 households in JD-HDSS, incorporating 60% of all women of reproductive age, assessed knowledge of uterine prolapse and identified self-reported disease prevalence (symptomatic). Next, we organised a five day clinical screening camp at JD-HDSS to identify the prevalence of uterine prolapse in attendees. The household survey was conducted on September-December 2012 and the UP screening camp on May-June 2013. Descriptive statistics was used to analyse the proportion of comprehensive knowledge regarding UP and the prevalence of UP.Results: Ninety-three percent of women in JD-HDSS had heard of uterine prolapse and 55% of those had comprehensive knowledge. Self-reported (symptomatic) prevalence was 2.11% (8.5% including women who had undergone hysterectomy for uterine prolapse). Among these, 52.6% had received no treatment. The most common reported treatments of uterine prolapse included surgery (53.2%), exercise and medicine (35.5%) and pessary (11.3%). Among women attending the outreach camp (N=303), UP prevalence was 15.18%.Conclusion: Knowledge of uterine prolapse among women in JD-HDSS is almost double that reported in a national survey. Similarly, the prevalence of self-reported uterine prolapse in JD-HDSS is almost three fold less than the national prevalence. Knowledge, early healthcare practices and availability of surgical care for uterine prolapse might have contributed to these findings.</p

Knowledge, prevalence and treatment practices of uterine prolapse among women of reproductive age in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal

Background: Uterine prolapse (UP) is a main contributor to reproductive health problems that infl uence women’s quality of life. In Nepal, the UP prevalence ranges from 7-27%. Women experience various diffi culties and symptoms due to UP, which are determined by the type as well as thestage of UP. Objectives: This study aimed to explore the knowledge, prevalence and treatment practices of uterine prolapse among women of reproductive age in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) in the Bhaktapur district of Nepal. Methods: This cross-sectional study collected data in two stages. A structured survey of 3,124 households in JD-HDSS, incorporating 60% of all women of reproductive age, assessed knowledge of uterine prolapse and identifi ed self-reported disease prevalence (symptomatic). Next, we organised a fi ve day clinical screening camp at JD-HDSS to identify the prevalence of uterine prolapse in attendees.The household survey was conducted on September-December 2012 and the UP screening camp on May-June 2013. Descriptive statistics was used to analyse the proportion of comprehensive knowledge regarding UP and the prevalence of UP. Results: Ninety-three percent of womenin JD-HDSS had heard of uterine prolapse and 55% of those had comprehensive knowledge. Self-reported (symptomatic) prevalence was 2.11% (8.5% including women who had undergone hysterectomy for uterine prolapse). Among these, 52.6% had received no treatment. The most common reported treatments of uterine prolapse included surgery (53.2%), exercise and medicine (35.5%) and pessary (11.3%). Among women attending the outreach camp (N=303), UP prevalence was 15.18%. Conclusion: Knowledge of uterine prolapse among women in JD-HDSS is almost double that reported in a national survey. Similarly, the prevalence of self-reported uterine prolapse in JD-HDSS is almost three fold less than the national prevalence. Knowledge,early healthcare practices and availability of surgical care for uterine prolapse might have contributed to these fi ndings