Nutritional status and its association with quality of life among people living with HIV attending public anti-retroviral therapy sites of Kathmandu Valley, Nepal.

BACKGROUND: Little evidence exists on the connections between nutrition, diet intake, and quality of life (QoL) among people living with HIV (PLHIV). The study aimed to estimate the prevalence of under-nutrition among PLHIV in Nepal, and identify risk factors and assess correlations with PLHIVs' QoL and nutritional status. METHODS: This quantitative cross-sectional study used Body Mass Index (BMI) as an indicator for nutritional status, and additional information on opportunistic infections (OIs), CD4 count, and World Health Organization (WHO) clinical staging was collected from medical records. Participants were asked to complete surveys on food security and QoL. Descriptive analysis was used to estimate the prevalence of under nutrition. To assess associations between nutrition status and independent variables, bivariate and multivariate analysis was completed. Spearman's rank correlation test was used to assess the association between nutritional status and QoL. RESULTS: One in five PLHIVs was found to be under nourished (BMI <18.5 kg/m(2)). Illiteracy, residence in care homes, CD4 cells count <350 cells/mm(3), OIs, and illness at WHO clinical stages III and IV were found to be significant predictors of under nutrition. BMI was significantly correlated with three domains of QoL (psychological, social and environmental). CONCLUSION: Nutrition interventions should form an integral part of HIV care programs. Understanding the presence of OI, decline in CD4 count, and advancing WHO clinical stages as risk factors can be helpful in preventing under nutrition from developing. Longitudinal research is necessary to further explicate associations between nutritional status and QoL.

Women's experiences and health care-seeking practices in relation to uterine prolapse in a hill district of Nepal.

BACKGROUND: Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women's experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices. METHODS: Using a convenience sampling method, we conducted 115 semi-structured and 16 in-depth interviews with UP-affected women during September-December 2012. All interviews occurred in outreach clinics in villages of the Dhading district. RESULTS: Study participants were 23-82 years of age. Twenty-four percent were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to make healthcare decisions. Most participants (>85%) described the major physical discomforts of UP as difficulty with walking, standing, working, sitting, and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%), and difficulty with sexual activity (73.9%). Due to inability to perform household chores or fulfill their husband's sexual desires, participants endured humiliation, harassment, and torture by their husbands and other family members, causing severe emotional stress. Following disclosure of UP, 24% of spouses remarried and 6% separated from the marital relationship. Women perceived the causes of UP as unsafe childbirth, heavy work during the postpartum period, and gender discrimination. Prior to visiting these camps some women (42%) hid UP for more than 10 years. Almost half (48%) of participants sought no health care; 42% ingested a herb and ate nutritious food. Perceived barriers to accessing health care included shame (48%) and feeling that care was unnecessary (12.5%). Multiple responses (29%) included shame, inability to share, male service provider, fear of stigma and discrimination, and perceiving UP as normal for childbearing women. CONCLUSIONS: UP adversely affects women's daily life and negatively influences their physical, mental, and social well-being. The results of our study are useful to generate information on UP symptoms and female health care seeking practices. Our findings can be helpful for effective development of UP awareness programs to increase service utilization at early stages of UP and thereby might contribute to both primary and secondary prevention of UP.

Perceived social support and professional quality of life of health professionals during COVID-19 pandemic in Nepal: a cross-sectional study.

OBJECTIVE: To assess the perceived social support and professional quality of life (ProQOL) among healthcare professionals during COVID-19 pandemic in Nepal, encompassing both positive (compassion satisfaction) and negative (compassion fatigue) dimensions as well as the factors associated with them. DESIGN: A cross-sectional web-based study. SETTING: Nepal PARTICIPANTS: We carried out a convenience sampling technique to enrol 313 health professionals aged 18-60 years old. OUTCOME MEASURES: We employed the ProQOL V.5 questionnaire (comparing 30 self-report items) and the Multidimensional Scale of Perceived Social Support with 12 items to assess the ProQOL and social support, respectively. A χ2 test was performed to determine associated factors of different dimensions of ProQOL. RESULTS: The study included a total of 313 participants, mostly consisting of frontline health workers. More than one-third of the participants worked in places where precautionary measures were insufficient. However, the majority of them (73.8%) had high social support. Concerning the ProQOL, the percentage of health professionals that had moderate compassion satisfaction (CS), moderate Burnout (BO) and moderate secondary traumatic stress (STS) were 57.5%, 58.2% and 75.4%, respectively. Factors like sex, marital status, profession, work-shift, type of health institution and status of precautionary measures at the workplace were associated with the different dimensions of ProQOL at the significance level of 0.05. CONCLUSION: This study findings revealed a considerable proportion of BO and STS among health professionals during COVID-19 pandemic in Nepal. Implementation of appropriate interventions and support systems are needed to enhance CS, alleviate BO and mitigate STS among health professionals to combat future health emergencies.

Physical activity and its correlates among school teachers in a semi-urban district of Nepal.

Regular physical activity (PA) is one of the effective strategies for mitigating non-communicable diseases, promoting healthy ageing, and preventing premature mortality. In South Asia, up to 34.0% of adults are insufficiently active, and up to 44.1% of adults in Nepal. We sought to assess self-reported PA status and its correlates among teachers in the semi-urban district of Nepal. A cross-sectional descriptive study was conducted among teachers at randomly selected public secondary schools in Bhaktapur, Nepal, from November 2018-April 2019. PA status was assessed in Metabolic Equivalent to task minutes per week using the International Physical Activity Questionnaire (IPAQ)-Long Form. Point estimates and odds ratios were calculated at a 95% confidence interval, and a p-value <0.05 was considered statistically significant. Among the 360 participants, the mean (SD) age was 40.3 (10.2) years, with 52.5% female participation. A low level of PA was seen among 11.9% (95% CI: 8.4-15.2) of teachers, and more than half (56.0%) of the activity was only moderate intensity. Domestic and garden work was the main contributor (43.0%) of total PA, while leisure time was the least (14.0%). Among the socio-demographic factors, only sex was significantly associated (p = 0.005) with PA. Participants living in locations with walkable areas were 3.4 times (95% CI: 1.6-7.3) more likely to be engaged in moderate-to-high level PA than those without. In our study, the point prevalence of insufficient PA among teachers working at public secondary schools was higher than the national point prevalence. PA promotion programs targeting sedentary populations like school teachers should be developed to reduce the point prevalence of insufficient PA.

Health care seeking behavior for common childhood illnesses in Birendranagar municipality, Surkhet, Nepal: 2018.

BACKGROUND: Appropriate and prompt health care seeking by parents or caretakers can reduce morbidity and mortality among under-five year children. Although remarkable progress has been made in the reduction of under-five mortality, still the under-five mortality rate is high in Nepal. There are few studies on health care seeking behavior among caretakers in Nepal. Therefore, this study was conducted to determine the prevailing health care seeking behavior of caretakers on common childhood illness of under five year children and to identify the association of socio demographic, economic, illness related and health system related factors with health care seeking behavior in 2018. METHODS: A community based descriptive cross-sectional study was conducted from September to November 2018. Data were collected using a pretested semi-structured interview schedule. Both descriptive and inferential statistics were used to present the data. Bivariate and multivariate logistic regression analysis was used to identify the factors associated with health care seeking behavior. RESULTS: A total of 387 caretakers participated in the study. Of these, 84.8% sought any type of care and 15.2% did nothing. Amongst those who sought care 42.4% visited the pharmacy directly, 25.3% visited the health facility. Amongst those who visited a health facility, 37.2% of caretakers sought prompt health care. Common danger sign stated by caretakers was fever in children (92.4%). Secondary education(AOR = 0.357, 95%CI = 0.142-0.896), involvement in service as an occupation(AOR = 3.533, 95%CI = 1.096-11.384), distance to reach nearest health facility(0.957, 95%CI = 0.923-0.993) and perceived severity of illness; moderate severity (7.612, 95%CI = 2.127-27.242), severe severity (AOR = 15.563, 95%CI = 3.495-69.308) were found to be significantly associated with health care seeking behavior. CONCLUSION: Strong policies and regulations should be formulated and implemented at Birendranagar municipality of Surkhet district to prevent direct purchase of medicines from pharmacies without any consultation. It is essential to conduct the health awareness program at community level on early recognition of danger signs and importance of consulting health facilities.

Effect of Educational Intervention Based on Theory of Planned Behaviour on Physical Activity Intention among Secondary School Teachers of Nepal.

Any bodily movement produced by skeletal muscle which requires energy expenditure is known as physical activity (PA). WHO has recommended that at least 150 minutes of moderate or 75 minutes of vigorous-intensity PA or a combination of both per week is required for health benefits. Physical inactivity is one of the strongest risk factors for noncommunicable diseases (NCDs) and other conditions and is attributable to 6% of global premature death. However, data on the PA of teachers are unavailable in Nepal. They are considered one of the risk groups for NCDs because of the less active nature of their job. So, we aimed to evaluate the effect of the educational intervention based on the theory of planned behaviour on PA intention among secondary school teachers in Bhaktapur district, Nepal. For this study, we recruited 126 teachers from 6 schools. Each intervention and control group contained three randomly selected secondary schools. All the teachers from the selected schools were enrolled in the respective groups. A quasiexperimental (pretest-posttest control group) study design was used to test the effectiveness of the intervention on attitude, behaviour control, subjective norms, and intention for engaging in regular PA. Both groups underwent baseline and follow-up assessments at four weeks using the self-administered questionnaire developed for this study. The intervention group delivered a one-hour lecture session supported by audio-video materials for PA promotion. The effect was analysed by comparing the changes in the theory of planned behaviour (TPB) constructs within and between intervention and control groups. The difference in scores between and within the groups was tested using Student's t-test. Adjusted difference-in-difference scores were calculated through linear regression. Data analysis was done using Statistical Package for Social Science version 26.0. The adjusted mean score increase in TPB constructs due to the interaction of time and intervention increased from 0.641 to 1.381. The highest gain (beta = 1.381) was seen in the intention score, while a minor improvement was seen in perceived behavioural control (beta = 0.641). After the intervention, the net increase in PA intention score was 9.35% compared to the control group. Thus, the promotion package was effective in increasing PA intention. The findings of this study and educational package could be helpful in encouraging teachers to engage in PA in other schools.

Prevalence and Factors Associated with Tobacco Use among High School Students.

BACKGROUND: Tobacco use is the leading cause of morbidity and mortality worldwide. Tobacco use among school-level students is a growing a public health problem in Nepal. A number of factors may be associated with tobacco use, but there is lack of literature showcasing an in-depth understanding of the growing prevalence of tobacco use in the Nepalese context. Therefore, our study aims to determine the prevalence of tobacco use and examine the factors associated with tobacco use among high school students at public schools in Budhanilkantha municipality, Kathmandu, Nepal. METHODS: A cross-sectional survey was conducted, and 378 students were selected for this study. The schools were selected randomly. Data collection was carried out using the self-administered questionnaires adapted from the World Health Organization used Global Youth Tobacco Survey and the Center for Disease Control and Prevention used Youth Tobacco Survey. RESULTS: Overall, 31.7% of the students ever consumed any tobacco products, and 20.1% were current tobacco users. One in five students started smoking when they were less than ten years of age. The proportion of students seeing at least one family member smoking and using smokeless tobacco was 52.1% and 47.1% respectively. Male and older students were significantly more likely to consume tobacco products than female and young students. CONCLUSIONS: This study showed that a significant proportion of school students had experienced tobacco use. Age and sex of the students were significantly associated with the status of current smoking and the use of smokeless tobacco.

Effect of an Educational Intervention on Dietary Diversity Practices among Public School Students.

BACKGROUND: Poor dietary diversity leading to malnutrition among children and adolescents is a serious public health problem in Nepal. Though nutrition education intervention has been effective in changing the dietary intake habits of individuals in school settings, the contextual educational intervention has not been tested in our study area. This study is aimed at assessing the effect of dietary diversity education based on the Health Belief Model among secondary level students in selected schools of Siddhicharan Municipality, Okhaldhunga. METHODS: Quasi-experimental study design was employed during the intervention study. Our study was conducted in 3 phases: Phase I, Baseline Study; Phase II, Education Package Development; and Phase III- Intervention Study (Implementation and evaluation of the package). The data was collected for getting baseline that was used to develop package, pre-intervention assessment and after intervention assessment, using a self-administered structured questionnaire based on constructs of Health Belief Model (HBM). Study participants were students from grade 7 and 8. The collected data was analyzed using SPSS version 21. RESULTS: After the education intervention, dietary diversity knowledge and practice in the intervention group increased from 16.4% to 54.2% and 32.8% to 48.6% respectively. Significant association (P<0.001) was noted between knowledge of dietary diversity with intervention in post-test. Similarly, the mean score of the Health Belief Model construct was significantly improved and showed an association (P<0.001) with nutrition education after the intervention. CONCLUSIONS: Nutrition education based on the Health Belief Model showed a positive impact on knowledge and practice of dietary diversity among school students. Hence, such education intervention should be promoted by educational institutions, the Ministry of Education, Ministry of Health and Population, NGOs and INGOs.

Ventriculoperitoneal Shunt Complication in Pediatric Hydrocephalus: Risk Factor Analysis from a Single Institution in Nepal.

OBJECTIVE: Ventriculoperitoneal (VP) shunt surgery is one of the commonly performed neurosurgical procedures. Complications due to shunt failure are associated with high morbidity and mortality. We report an analysis of risk factors for shunt failure in pediatric patients from a single institution in Nepal. MATERIALS AND METHODS: A retrospective analytical study with prospective data was designed. All children younger than 15 years, with first time VP shunting, at a tertiary government hospital in Kathmandu during 2014-2017 were followed up. Association of independent variables with the primary outcome variable (complication of VP shunt) was analyzed using Chi-square test. Bivariate logistic regression was performed to identify unadjusted odds ratio (OR) with 95% confidence interval (CI). Multivariate logistic regression model was designed to calculate adjusted OR with 95% CI. RESULTS: Of 120 patients, more than half (55.8%) of the patients were male. Mean age was 62.97 months. Maximum duration of follow-up was 30 months. Most common cause of hydrocephalus was congenital aqueductal stenosis (40.8%) followed by tumors (29.2%). Overall shunt complication was found in 26.7% (95% CI 19.0%-35.5%). Shunt infection was seen in 5% while malfunction without infection was found in 21.7%. Bivariate logistic regression showed duration of surgery more than 1 h (OR 2.67, 95% CI 1.11-6.42, P = 0.028) compared to 1 h or less, experienced surgeon (OR 0.37, 95% CI 0.16-0.89, P = 0.026) compared to residents, and emergency surgery (OR 3.97, 95% CI 1.69-9.29, P = 0.001) compared to elective surgery as significant risk factors, while emergency surgery was the only significant variable for shunt failure on multivariate regression analysis (OR 3.3, 95% CI 1.16-9.35, P = 0.025). CONCLUSION: Longer duration of surgery, less experience of the surgeon, and the priority of the case (emergency) were independent risk factors for shunt complications.

Knowledge on uterine prolapse among married women of reproductive age in Nepal.

BACKGROUND: Uterine prolapse (UP), which affects about 10% of women of reproductive age in Nepal, is the most frequently reported cause of poor health in women of reproductive age and postmenopausal women. Currently, women's awareness of UP is unknown, and attempts to unravel the UP problem are inadequate. This study aims to assess UP knowledge among married reproductive women, and determine the association between UP knowledge and socioeconomic characteristics. METHODS: Our cross-sectional descriptive study investigated 25 districts representing all five administrative regions, three ecological zones, and urban and rural settings. We used structured questionnaires to interview 4,693 married women aged 15-49 years. We assessed UP knowledge by asking women whether they had ever heard about UP, followed by specific questions about symptoms and preventive measures. Descriptive statistics characterized the study population regarding socioeconomic status, assessed how many participants had ever heard about UP, and determined UP knowledge level among participants who had heard about the condition. Simple regression analysis identified a possible association between socioeconomic characteristics, ever heard about UP, and level of UP knowledge. RESULTS: Mean age of participants was 30 years (SD [standard deviation] 7.4), 67.5% were educated, 48% belonged to the advantaged Brahmin and Chhetri groups, and 22.2% were Janajati from the hill and terai zones. Fifty-three percent had never heard about UP. Among women who had heard about UP, 37.5% had satisfactory knowledge. Any knowledge about UP was associated with both urban and rural settings, age group, and education level. However, satisfactory knowledge about UP was associated with administrative region, ecological zones, caste/ethnic group, and age group of women. CONCLUSION: Fifty-three percent of participants had never heard about UP, and UP knowledge level was satisfactory in 37.% of those who had ever heard about UP. Any knowledge was associated with urban/rural setting, age group, and education level, whereas satisfactory knowledge was associated with geography, caste/ethnic group, and age group. UP-related health promotion programs should target women from all caste/ethnic groups, age groups, and education levels, including urban and rural communities.