Effect of gender preference on fertility: cross-sectional study among women of Tharu community from rural area of eastern region of Nepal.

BACKGROUND: Son preference is predominant in developing countries especially South Asian countries and its effect is most visible when the fertility is on transition. Nepal is a country in South Asia where the fertility has declined and son is valued highly. This study examines the parent's gender preference for children and its effect on fertility and reproductive behaviors. METHODS: Study was conducted in Sonapur village development committee of Sunsari district among women of Tharu community of reproductive age (15-49) currently in union and having at least one child. Data was collected by house to house survey. Data was analyzed with IBM SPSS 20 version. Multinomial and binary logistic regression were used to analyze the relationship among variables. RESULTS: Three hundred women of reproductive age were included in the study. Current average age of the respondents was 31.97 years and mean age at marriage was 18.87 (SD +/-2.615). Child Sex ratio (male: female) of the respondents who didn't want any more children was 1.41. The birth spacing following male baby was 3.09 years whereas the average birth spacing following female baby was 2.71 years. Age of the respondents and education status of the respondents were also significantly associated with contraceptive practice. Presence of only female children in family significantly increased the desire of other children (AOR = 10.153, 95% CI = 2.357-43.732). CONCLUSION: This study finds that the gender preference affects the fertility and reproductive behavior of the respondents and it is necessary to reduce son preference for the health and well being of children and women.

Demirjian's Eight Teeth Method for Dental age Estimation in Nepalese Population.

BACKGROUND: Demirjian's method is widely used method for dental age estimation. This study was conducted with objectives of applying Demirjian's 8 teeth method to estimate age in Nepalese Population and to determine Nepal-specific formulas. METHODS: We had used the Orthopantomographs of Nepalese people of age above five and below 23 years. The radiographs were compared to the 'Tooth Development Chart' and each tooth studied was assigned with any one of the 10 developmental stages using Demirijian's 8 teeth method and total maturity scores determined. Formulas were derived using regression analysis, wherein the total maturity score obtained for each individual was considered as the independent variable and the corresponding age as the dependent variable in the STATA 15.1 statistical program. RESULTS: There was underestimation of age in both the sexes by the original method. Regression equations were derived for males and females separately for age five to 18 years and again after adding cases up to 23 years. The estimation was better for males up to 18 years [R2=0.94, Mean Absolute Error (MAE) 0.747 years and SD 0.644] than for females up to 18 years (R2 = 0.89, MAE 0.886 years and SD 0.925). The estimation was better for up to 18 years than for up to 23 years in both sexes. CONCLUSIONS: Demirijian's 8 teeth method underestimated age in the study population and thus population specific equations based on the method are better for dental age estimation. The age estimation utilizing the equations from Nepalese population has given acceptable results.

Knowledge of first aid methods and attitude about snake bite among medical students: a cross sectional observational study.

BACKGROUND: Snake bite is a neglected public health problem in tropical and subtropical region. The study was conducted with objectives to determine the knowledge of first aid methods in snake bite and the perception of snake bite among the medical students of Gandaki Medical College, Pokhara, Nepal. METHODS: We conducted a cross sectional survey among 302 (231 preclinical and 71 clinical) Bachelor of Medicine and Bachelor of Surgery (MBBS) students of Gandaki Medical College using a pretested questionnaire to assess the knowledge of first aid of snake bite based on WHO protocol and perception of snakebite. The study duration was from January to May 2018. The total score of the knowledge was obtained and compared among variables using Mann-Whitney U test. Chi square test was used for comparing the responses with the level of students. P value of < 0.05 was considered as significant. RESULTS: Among 302 respondents, 193(63.9%) were from Mountain districts. The families of 25 (8.3%) respondents were bitten by snakes. The correct responses were significantly higher from the 71 (23.5%) clinical students for most of the questions and the knowledge score of clinical students was significantly higher than the 231 (76.5%) preclinical students. Twenty eight (9.27%) students believed that the snake should be killed after it bites the victim and 25 (8.28%) believed that the snake will capture the image of the offender who teases it and takes revenge later. School books were the commonest source of such knowledge among the preclinical students. CONCLUSION: Most of the preclinical students had inadequate knowledge of first aid of snake bite. The common source of the knowledge was school books which often provide faulty knowledge. Only a few students had negative perception about snakes. Incorporation of proper first aid measures in the textbooks of various levels is essential.

Factors affecting IUCD discontinuation in Nepal: a nested case-control study.

Information related to contraception discontinuation, especially in the context of Nepal is very limited. A nested case-control study was carried out to determine the factors affecting discontinuation of intrauterine contraceptive devices (IUCDs). A total of 115 cases (IUCD discontinuers) and 115 controls (IUCD continuers) were randomly selected based on the data obtained from the user's record of a family planning center in Kathmandu. Matching criteria were age during insertion and date of insertion of IUCD. Logistic regression was used to analyze the data. When cases were compared with controls, the results showed that place of residence, sex of last child, reproductive intention, experience of side effects, and follow-up practice were associated with discontinuation of the IUCD. Experience of side effects has been seen as the major reason for discontinuation. The results suggest that side effects after IUCD insertion should be properly discussed and promptly treated to reduce the discontinuation rate.

A profile of abdominal and pelvic injuries in medico-legal autopsy.

Abdomino-pelvic region is vulnerable to injury in various forms of trauma. This study was undertaken with objectives to study the pattern and type of external and internal abdominal and pelvic injuries and to identify the risk organs in abdomen and pelvis susceptible to trauma among the medico-legal autopsies at the mortuary of a referral centre in eastern Nepal during the period of one year (n = 80). Males constituted 80% of the cases and the mean age of the victims was 30.76 years. The cause of trauma was Road Traffic Accident in 82.5%. The manner of death was accidental in 87.5% and homicidal in 11.25% cases. Liver (57.5%) was the most common organ injured followed by spleen in 37.5% cases. Multiple organs injury was seen in 67.5% and absence of any external injuries was noted in 31.25% cases. Autopsy can play a role in establishing the missed injuries and be helpful to widen the knowledge of the medical faculty in early diagnosis and management of such injuries.

Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial.

OBJECTIVE: To test the effectiveness of large scale distribution of longlasting nets treated with insecticide in reducing the incidence of visceral leishmaniasis in India and Nepal. DESIGN: Paired cluster randomised controlled trial designed to detect a 50% reduction in incidence of Leishmania donovani infection. SETTING: Villages in Muzaffarpur district in India and Saptari, Sunsari, and Morang districts in Nepal. PARTICIPANTS: 13 intervention and 13 control clusters. 12 691 people were included in the analysis of the main outcome (infection), and 19 810 were enrolled for the secondary (disease) end point. INTERVENTION: Longlasting insecticidal nets (treated with deltamethrin) were distributed in the intervention clusters in December 2006. MAIN OUTCOME MEASURES: Infection was determined by direct agglutination test at 12 and 24 months after the intervention in those who had negative results (titre <1:1600) at baseline. The effect estimate was computed as the geometric mean of the risk ratios for seroconversion for each cluster pair (net/no net), with its 95% confidence interval. Formal tests of effect of no intervention were obtained with a paired t test. RESULTS: There was no significant difference in the risk of seroconversion over 24 months in intervention (5.4%; 347/6372) compared with control (5.5%; 345/6319 people) clusters (risk ratio 0.90, 95% confidence interval 0.49 to 1.65) nor in the risk of clinical visceral leishmaniasis (0.99, 0.46 to 1.40). Adjustment for covariates did not alter these conclusions. CONCLUSIONS: There is no evidence that large scale distribution of longlasting insecticidal nets provides additional protection against visceral leishmaniasis compared with existing control practice in the Indian subcontinent. The observed effect was small and not significant, though the confidence intervals did not exclude a 50% change in either direction. TRIAL REGISTRATION: Clinical Trials NCT 2005-015374.