Social inequality, noise pollution, and quality of life of slum dwellers in Pokhara, Nepal.

This work is a cross-sectional comparative study conducted on 528 residents in the slum and non-slum areas of Pokhara, Nepal. Of the total number of respondents, 90.2% in the slums and 63.3% in the non-slums indicated the existence of a main source of noise, and 80.7% in the slums and 66.0% in the non-slums replied that they had been highly annoyed by noise. The indoor noise levels measured for 24 h were higher in slums than in non-slums, ranging from 59 to 78 dBA and from 51 to 69 dBA, respectively. The Mann-Whitney U test showed a significantly poorer status of slum dwellers in four health domains. Logistic regression analysis identified that living in a slum was a significant predictor (OR, 2.35; 95% CI, 1.35-4.09) of a low level of health. Meanwhile, a high level of noise annoyance was a good determinant (OR, 6.71; 95% CI, 3.13-14.36) of low quality of life among slum dwellers revealing a distinguishing negative effect of the high level of noise annoyance in the slum areas.

Medical abortion kit dispensing practices of community pharmacies in Pokhara Metropolitan, Nepal.

BACKGROUND: Medical abortion (MA) refers to the use of medicines to terminate the pregnancy. There is an urgent need to spread safe abortion services in the community. This study assessed the MA kit dispensing practices of community pharmacies in Pokhara Valley, Nepal. METHODS: A cross-sectional descriptive study was conducted in Pokhara Valley, Nepal from December 2017 to November 2018. Among the community pharmacies of Pokhara Valley, 115 community pharmacies were selected using a consecutive sampling method. A semi-structured questionnaire was used to collect data. MA kit and related information were requested by simulated male clients visiting the community pharmacies. The information obtained from the pharmacy workers was recorded in the data collection sheet. RESULTS: Nine brands of MA kit from eight manufacturing companies were found in practice in Pokhara Valley, out of those only five (56%) were registered in Nepal. Seven brands were sold at more than the labeled price. The pharmacy workers asked about the gestational age and confirmation of pregnancy in all the cases. Most of them counseled the clients on the frequency, duration, and direction of use. Dispensing practice and level of counseling were found to be significantly correlated (r = 0.40, p value = 0.01). CONCLUSION: Despite the awareness of the pharmacy workers on the MA kit, most of them provided limited information to the clients. Nearly half unregistered MA kits were found in practice at the community pharmacies. Thus, the Department of Drugs Administration and other concerned authorities must provide relevant training and awareness programs to the pharmacy workers of the community pharmacies for preventing the malpractice of MA kit. The Government of Nepal must restrict the illegal entry of unregistered brands and assure the standards of MA kit by regulating drug acts and policies effectively.

Workplace Violence and its Associated Factors among Nurses.

BACKGROUND: Workplace violence among nurses is prevalent worldwide. If nurses become aware of the workplace violence and its risk factors then only they can protect themselves. This study assessed the prevalence of workplace violence and its associated factors among nurses in Pokhara, Nepal. METHODS: A hospital-based descriptive cross-sectional study was conducted in Pokhara. The required sample size of the study was 200 nurses. We adopted self-administered questionnaire developed by International Labor Office, International Council of Nurses, World Health Organization (WHO), and Public Services International. Out of 21 hospitals of Pokhara, we selected five hospitals using simple random sampling method. The number of nurses in each hospital was fixed proportionately considering the total number of employed nurses. Individual nurses were selected on the first meet first basis to gain the required number. RESULTS: Two-thirds (64.5%) nurses experienced some type of violence in the last six months at their workplace. The proportion of verbal violence was higher (61.5%) compared to the physical (15.5%) and sexual violence (9%). Most perpetrators of the violence were the relatives of patients and hospital employees. Age of nurses and working stations had statistically significant association with workplace violence (p-value < 0.05). CONCLUSIONS: Workplace violence among nurses is a noteworthy problem in Pokhara whereas nearly two-thirds of nurses faced some type of violence in last six months. It is an urge to widen awareness level of nurses on the violence thus, they can take precaution themselves and ask hospital administration and other stakeholders to address the workplace violence.

Safe delivery care practices in western Nepal: Does women's autonomy influence the utilization of skilled care at birth?

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives-women's autonomy-plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women's autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women's autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women's education had a strong positive association (odds ratio = 24.11, CI = 9.43-61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women's education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband's education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women's autonomy may be an important mediating factor in this pathway.

Women's Autonomy and Its Correlates in Western Nepal: A Demographic Study.

Despite various efforts for enhancing women's autonomy in developing countries, many women are deprived of their capacity in decision-making on their household affairs as well as social issues. This paper aimed to examine women's autonomy and its associated factors in the Kapilvastu district of Nepal. We measured women's autonomy using a recently developed women's autonomy measurement scale from June to October 2014. Descriptive statistics, chi-square test and logistic multivariate modeling technique were applied for assessing the association of demographic and socio-economic characteristics of women and their autonomy. Mean score for women's autonomy was 23.34 ± 8.06 out of the possible maximum 48. It was found to be positively associated with higher age difference at marriage, advantaged caste/ethnicity, better employment for the husband, couple's education more than 10 years schooling, and higher economic status of the household. We found strong direct effect of women's education (OR = 8.14, CI = 3.77-17.57), husband's education (OR = 2.63, CI = 1.69-4.10) and economic status of household (OR = 1.42, CI = 1.01-2.03) on women's autonomy. When we adjusted women's education for husband's education, the odds ratio decreased by around 22% {from (OR = 8.14, CI = 3.77-17.57) to (OR = 6.32, CI = 2.77-14.46)} and was a mediator effect. The economic status of household also had mediator effect on women's autonomy through their education. Education status of women is a key predictor of women's autonomy in Kapilvastu district. Husband's education and economic status of the household are other important predictors of women's autonomy which have a mediator effect on women's autonomy. Improving educational status and economic conditions of both women and their husbands may be the best solution to promote women's autonomy.