Practice and lived experience of menstrual exiles (Chhaupadi) among adolescent girls in far-western Nepal.

BACKGROUND: Menstrual exile, also known as Chhaupadi, is a tradition of "untouchability" in far-western Nepal. Forbidden from touching other people and objects, women and girls are required to live away from the community, typically in a livestock shed, during menstruation. We assessed the lived experiences of Chhaupadi among Nepalese adolescent girls in the far-western Achham district of Nepal, observed the safety and sanitation of their living spaces during Chhaupadi, and assessed the perceptions of local adult stakeholders towards the practice of Chhaupadi. METHODS: We collected data from 107 adolescent girls using a self-administered survey in two local schools in Achham. We also conducted a focus group discussion with seven girls, held key informant interviews, and observed the girls' living spaces during Chhaupadi, using a checklist. Descriptive statistics of the quantitative survey and thematic analyses of qualitative interviews are presented. RESULTS: The majority of the girls (n = 77, 72%) practiced exile, or Chhaupadi, during their menstruation, including 3 (4%) exiled to traditional Chhau sheds, 63 (82%) to livestock sheds, and 11 (14%) to courtyards outside their home. The remaining girls (n = 30, 28%) stayed inside the house, yet practiced some form of menstrual taboos. Of the 77 observed living spaces where the girls stayed during exile, only 30% (n = 23) had a toilet facility. Most exiled girls (97.4%) were restricted from eating dairy products. Participants reported having various psychological problems, including lonliness and difficulty sleeping while practicing Chhaupadi. Three of the girls were physically abused; nine were bitten by a snake. Notably high proportions of the living spaces lacked ventilation/windows (n = 20, 26%), electricity (n = 29, 38%), toilets (n = 54, 70%) and a warm blanket and mattress for sleeping (n = 29, 38%). Our qualitative findings supported our quantitative results. CONCLUSIONS: Chhaupadi has been condemned by human rights organizations. While the government has banned the practice, implementation on the ban is proceeding slowly, especially in far-western Nepal. Thus, as a temporary measure, public health professionals must work towards promoting the health and safety of Nepalese women and girls still practicing Chhaupadi.

Depression, malnutrition, and health-related quality of life among Nepali older patients.

BACKGROUND: Little is known about the health, nutrition, and quality of life of the aging population in Nepal. Consequently, we aimed to assess the nutritional status, depression and health-related quality of life (HRQOL) of Nepali older patients and evaluate the associated factors. Furthermore, a secondary aim was to investigate the proposed mediation-moderation models between depression, nutrition, and HRQOL. METHODS: A cross-sectional survey was conducted from January-April of 2017 among 289 Nepali older patients in an outpatient clinic at Nepal Medical College in Kathmandu. Nutritional status, depression and HRQOL were assessed using a mini nutritional assessment, geriatric depression scales, and the European quality of life tool, respectively. Linear regression models were used to find the factors associated with nutritional status, depression, and HRQOL. The potential mediating and moderating role of nutritional status on the relationship between depression and HRQOL was explored; likewise, for depression on the relationship between nutritional status and HRQOL. RESULTS: The prevalence of malnutrition and depression was 10% and 57.4% respectively; depression-malnutrition comorbidity was 7%. After adjusting for age and gender, nutritional score (ß = 2.87; BCa 95%CI = 2.12, 3.62) was positively associated and depression score (ß = - 1.23; BCa 95%CI = - 1.72, - 0.72) was negatively associated with HRQOL. After controlling for covariates, nutritional status mediated 41% of the total effect of depression on HRQOL, while depression mediated 6.0% of the total effect of the nutrition on HRQOL. CONCLUSIONS: A sizeable proportion of older patients had malnutrition and depression. Given that nutritional status had a significant direct (independently) and indirect (as a mediator) effect on HRQOL, we believe that nutritional screening and optimal nutrition among the older patients can make a significant contribution to the health and well-being of Nepali older patients. Nonetheless, these findings should be replicated in prospective studies before generalization.