Effect of Music Therapy on Intensity of Labor Pain among Primigravid Mothers admitted in a Tertiary Level Hospital.

BACKGROUND: Childbirth is a most welcomed and positive life experience for the majority of women, despite the pain. Most of them manage it well with minimal assistance while few of them require some intervention to reduce the pain. The objective of this study was to find out the effect of music therapy on intensity of labor pain among primigravid women. METHODS: A quasi-experimental pre-test post-test non-equivalent control group design was used. Sample consisted of 42 primigravid women admitted in labor room of a teaching hospital in Kathmandu. The intensity of labor pain was measured using Visual Analogue Scale and Behavior Rating Scale in latent and active phase of labor in both experimental and control groups. Then 30 minutes of music therapy was provided to the experimental group in the latent and active phase of labor. The post-test was carried out in both groups after the music therapy to experimental group during the latent and active phase using the same instruments. The collected data was entered in Statistical Package for Social Sciences version 16. Descriptive statistics and inferential statistics were used to describe the findings. FINDINGS: The mean difference of total pain between experimental and control groups during latent phase was 1.9 (t=2.31, p=0.023) in pre-test and 6.57 (t=3.91, p=0.000) in post-test. The mean difference of total pain between experimental and control groups during active phase was 1.00 (t=1.08, p=0.286) during pre-test and 6.95(t=3.744, p=0.001) during post-test. CONCLUSIONS: Music therapy tends to reduce labor pain both during the latent and active phase of labor.

Health Problems experienced by Peri-menopausal Women and their Perception towards Menopause.

BACKGROUND: Perimenopause is a period of physiologic changes in the women's lives when they approach reproductive senescence along with temporal changes in health and quality of life. During this period, many women present with problems of hot flushes; altered mood and sleep; and vaginal and sexual changes. The objective of this study was to identify the health problems experienced and perception towards menopause among perimenopausal women of Kathmandu. METHODS: This descriptive cross-sectional study was carried out among purposively selected 180 women from two wards of Nagarjun Municipality, Kathmandu, who were aged 45 to 55 years. By using a semi-structured interview schedule, face to face interview was taken at the respondents' residence. The collected data were analyzed using descriptive and inferential statistical techniques. RESULTS: The mean age of the respondents was 48.98±3.908 years and their mean body mass index was 27.42±3.645 kg/ m2. About 35.0 % of the respondents had experienced cessation of menstruation and their mean age at menopause was 47.84±4.41years. The common physical problems reported by them were joint and muscle pain (17.2%), hot flushes (14.4%) and night sweats (13.3%). Vaginal itching (16.7%), loss of libido (10.6%) and dry vagina (5%) were commonly reported sexual problems. Anxiety (16.7%), poor memory (8.9%), and irritability (7.2%) were the psychological problems reported by them. Most (77.8%) of them had a positive perception and the rest (22.2%) had a negative perception towards menopause. Their perception status was significantly associated with their age and family type. CONCLUSIONS: Perimenopausal women experience several physical, sexual and psychological problems during the menopause transition.

The Risk Factors of Cerebral Palsy among the Children Attending a Children's Hospital.

BACKGROUND: Cerebral Palsy is a disorder of movement and posture caused by nonprogressive abnormal brain function. It is a lifelong condition and one of the most common causes of physical disability in children. The objective of this study was to find out the risk factors associated with cerebral palsy among children. METHODS: A case control study was carried out among 330 children where cases and controls were taken in the ratio of 1:2. Cases included children diagnosed with cerebral palsy and attending neurological out-patient department of a Children's Hospital in Kathmandu, Nepal and control included children not having cerebral palsy and attending medical out-patient department of the same hospital for other medical problems. The data were collected from November 29, 2017 to May 20, 2018 by using a pretested interview schedule. The findings were analyzed using frequency, percentage, mean, standard deviation and chi square test and odds ratio. RESULTS: Findings revealed that about one-fourth (24.5%) cases were diagnosed to have CP within one year of age. In terms of sex majority (63.6%) of the cases were male and majority were the first born children. Findings also revealed that infection during pregnancy (OR:2.9, CI: 1.1-7.5), family history of cerebral palsy (OR:5.6, CI: 1.4-21.8), instrumental delivery (OR: 10.9, CI:2.3-50.6), not crying immediately after birth (OR: 17.3, CI: 8.6-34.6), were significantly associated with cerebral palsy. CONCLUSIONS: Most of the identified risk factors are preventable and controllable through proper antenatal and skilled intranatal care. Thus, every pregnant woman should receive proper care during pregnancy as well as during delivery for the prevention of the identified risk factors.

Sexual harassment in public transportation among female student in Kathmandu valley.

PURPOSE: Sexual harassment has been recognized as a serious problem in the world. It reduces the dignity of human rights. Therefore, this study aims to identify the prevalence of sexual harassment in public transportation and its consequences on female students in the Kathmandu valley of Nepal. METHODS: A structured questionnaire was applied for collecting the data from five health science locations in the Kathmandu Valley. Univariate and multivariate logistic regression models were used to identify the association with sexual harassment and its determinants. RESULTS: The female student who lived far away from campus (adjusted odds ratio [AOR] =9.02, 95% confidence interval [CI] =0.56, 14.03) and lived alone (AOR =10.44, 95% CI =2.83, 38.46) had more chance to be harassed. However, those students who traveled sometimes (AOR =0.01, 95% CI =0, 0.03) had a lower chance to face sexual harassment in public transportation. CONCLUSION: Sexual harassment in public transportation was found to be significantly higher in female students who live alone and who travel more frequently in the evening. In addition, the study concluded that public vehicles are strongly associated with sexual harassment among female students in the Kathmandu Valley.

Patterns and trends of malaria in 25 risk districts of Nepal from 2001 to 2017.

PURPOSE: Malaria has been one of a major infectious parasitic disease in Nepal. Although the number of cases is gradually getting declined since last decade. Therefore, study aims to identify the trends and spatial patterns of malaria among 25 risk districts of Nepal. MATERIALS AND METHODS: This study utilized the secondary data of malaria cases from the annual reports (2001-2017) of Department of Health Services, Ministry of Health and Population of Nepal. Linear regression of log-transformed incidence rates model was used for assessing variation of malaria cases for year and districts. RESULTS: There was evidence of decrease in the trend of malaria (2001-2009); however, the upward trend was revealed in 2010, after that, it starts to decline and again in 2017, it started to grow up. The malaria cases were marked variations by location with higher rates occurring in Dadeldhura, Kanchanpur, Kailali, Bardiya, and Jhapa districts, respectively. CONCLUSION: In this regards, malaria cases are still causing the threat in the Terai district of Nepal; however, there were fluctuating patterns of disease noted during the study periods.

Hand-touch method for detection of neonatal hypothermia in Nepal.

Neonatal hypothermia is the fourth leading causes of neonatal death in Nepal. Thus, it is the caregivers' responsibility to identify the hypothermia by using valid and less time consuming method like hand-touch method. Therefore, we examined the diagnostic validity of hand-touch method against low-reading mercury (LRM) thermometer for detecting neonatal hypothermia. We assessed neonate's temperature first by hand-touch method, then by LRM thermometer and tympanic thermometer among 100 full-term neonates, delivered within 24 h in Maternity Ward of Tribhuvan University Teaching Hospital, Nepal. We used World Health Organization (1997) criteria for classification of neonatal hypothermia. The sensitivity and specificity of the hand-touch method for detection of neonatal hypothermia were 95.6% and 70.1% against LRM thermometer and 76.6% and 83% against the tympanic thermometer, respectively. Touching method is practical and therefore has a good diagnostic validity; it can be introduced in essential newborn care package after giving adequate training to caregivers.

A conceptual model for empowerment of the female community health volunteers in Nepal.

CONTEXT: The existing top-down approach of the training is not appropriate to empower the community health volunteers to produce a sustainable change in their performance. OBJECTIVE: To propose a conceptual model that relies on Freire's theory of empowerment education and the participatory action research methodology to empower the female community health volunteers (FCHVs) to increase their consciousness, competence and confidence in performing their job responsibilities. METHOD: The model explains the empowerment phenomenon as a process and outcome. As a process it occurs in the form of repeated reinforcement cycles with alternating activities of action and reflection and includes developing awareness, skills and confidence among FCHVs through small group activities. As an outcome, it results in the change in FCHVs' performance in increasing contraceptive acceptance among the rural women of reproductive age group. CONCLUSION: It is hoped that empowerment of FCHVs will bring sustainable change in their performance and will consequently produce notable improvement in the health of women and children in particular and in the community in general.

Socio-cultural factors influencing adolescent pregnancy in rural Nepal.

Early child bearing is a widely observed phenomenon in Nepal. However, little information is available in regard to its contributing factors. This retrospective exploratory study was carried out to determine factors contributing to adolescent pregnancy in rural Nepal. Cluster sampling technique was used to select the study settings. The findings on variable contributing to pregnancy from the sample of 575 mothers, who had their first pregnancy at an age below 19 years, were compared with the findings from an equal number of mothers who had their first pregnancy at the age of 20 years or above. The adolescent mothers were married at a comparatively younger age with a mean age of 15.9 years. Parents or elders, with/without the girl's consent, decided the majority of adolescent marriages. The age at marriage exposed women to early pregnancy regardless of who decided the marriage. Comparatively, most adolescent mothers were from a low social class, engaged in agricultural work, and they had low literacy rate. Majorities of the mothers from both groups had no prior knowledge about conception until they conceived. Peers were the main source of information regarding conception. Although the majority of the respondents knew at least one method of contraception, less than 1% had used it before their first pregnancy. To conclude, early pregnancy had put the adolescent mothers at the risk of unwanted pregnancy and obstetric complications. Women empowerment through compulsory girls' education would be the most effective strategy to prepare them for late marriage, planned and delayed pregnancy, and better motherhood.

Increasing contraceptive acceptance through empowerment of female community health volunteers in rural Nepal.

The purpose of the study was to enhance contraceptive acceptance among currently-married women of reproductive age (CMWRA) through empowerment training of female community health volunteers (FCHVs). Seventeen FCHVs, who were working in Kakani Village Development Committee in the hills of central Nepal, attended an empowerment training that used participatory action research and reinforcement mechanisms. Following the training, the FCHVs were expected to empower the CMWRA to increase their contraceptive use. The impact of the intervention was assessed in a sample of 241 CMWRA, who were neither pregnant nor using contraceptives at the time of selection, by interviewing them before and six months after the intervention. The implementation of the intervention significantly increased the proportion of CMWRA knowing at least one contraceptive method (chi2(ldr)=71 .7, p=0.001). The use of modern contraceptives among the CMWRA from none before the intervention increased to 52.3% six months following the intervention. Satisfaction of the CMWRA with services provided by the FCHVs also significantly increased. The study concludes that empowerment training of FCHVs using participatory action research and peer reinforcement help increase the acceptance of contraceptives among CMWRA.