Adult Children's Migration and Health-Related Quality of Life Among Older Nepali Adults.

Traditionally, adult children have served as primary caretakers and providers for older Nepali adults. However, out-migration of adult children for employment and other opportunities is increasing. Health-related quality of life (HRQOL) in older Nepali adults in general and in the context of adult children's migration is poorly understood. This study aims to assess HRQOL of older Nepali adults and its relationship with adult children's migration. We used existing cross-sectional survey data on 260 older adults from Krishnapur municipality, which has witnessed a high rate of adult migration. HRQOL, quantified using the SF-12 scale, is expressed in terms of a physical (PCS) and mental (MCS) health component. A higher PCS and MCS score, each ranging from 0 to 100, indicates better physical and mental health, respectively. The correlates of HRQOL were assessed in simple and multiple linear regression. Participants had suboptimal HRQOL [mean (± SD): PCS = 40.4 ± 9.2 and MCS = 45.2 ± 7.7]. After adjusting for covariates, adult children's migration was associated with lower MCS scores (ß: -2.33, 95%CI: -4.21, -0.44). Individuals with more than one child had higher MCS scores (ß: 2.14, 95%CI: 0.19, 4.09). Females (ß: -3.64, 95%CI: -7.21, -0.06) and those with a history of unemployment (ß: -6.36, 95%CI: -10.57, -2.15) had lower PCS scores than their respective counterparts. The presence of chronic conditions was associated with significantly lower PCS and MCS scores. Our findings suggest that adult children's migration may negatively affect HRQOL among older Nepali adults, specifically their psychological well-being. Further research investigating potential moderating factors that may serve as important buffers is needed.

Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization.

This study aims to evaluate factors associated with health care utilization (HCU) and to assess vertical and horizontal equity in utilization among Nepali older adults. Data are from an existing cross-sectional study involving systematic random sampling of 260 older adults in Far-Western (Sudurpaschim) Province of Nepal. Andersen's theoretical framework was used to assess predisposing, enabling, and need factors that have the potential to influence health care utilization. Multivariable logistic regression analyses were conducted to examine potential correlates of HCU. Horizontal and vertical equity were assessed using concentration curve and index. More than one-third of participants had not visited a health facility in the prior 12 months. Nine in 10 participants did not know about the government's free health service for older adults. Joint/extended family type, Ayurvedic/Homeopathic health care preference, higher-income tertile, and presence of chronic conditions were associated with higher odds of health care utilization in adjusted analyses. The concentration curve for HCU lies below the line of equity, and the subsequent index is positive, indicating that HCU was concentrated among richer individuals. If the government of Nepal is to achieve its goal of universal health care, the existing pro-rich inequity in HCU needs to be addressed.

Food insecurity among senior citizens in high out-migration areas: evidence from Western Nepal.

BACKGROUND: Food insecurity is a critical public health challenge, particularly in low- and middle-income countries such as Nepal. The demographic transition has resulted in a growing population of senior citizens. However, the determinants of food insecurity among Nepali senior citizens remain unknown. This study aims to fill this gap by assessing food insecurity among the older populations in the far-western region, one of the poorest regions of the country. Further, we also aim to assess the potential association between adult children's migration and the food insecurity status of the left behind older parents. METHODS: A community-based cross-sectional study was conducted among 260 randomly selected senior citizens in the Kanchanpur district in far-western Nepal. The short form of the household food security scale, originally developed by the United States Department of Agriculture, was used to measure household food security. Associations were examined by logistic regression. RESULTS: The prevalence of food insecurity in senior citizens' households was 41.1%. Senior citizen households with their adult children's migration (AOR = 0.47, 95% CI: 0.24-0.95) had lower odds of being food insecure whereas households with lower family income (<$100 compared to ≥ $100) had two times higher odds of being food insecure (AOR = 2.26, 95% CI: 1.08-4.76). Also, households owning a cultivable land/farm (AOR = 0.14, 95% CI: 0.05-0.40), primary source of income as service/pension (AOR = 0.26, 95% CI: 0.08-0.89) or business (AOR = 0.15, 95% CI: 0.03-0.59) and participants who received geriatric allowances (AOR = 0.05, 95% CI = 0.01-0.16) had lower odds of being food insecure. CONCLUSION: The prevalence of food insecurity among households with a senior citizen in Kanchanpur district was high and associated with the migration status of adult children, and household socioeconomic status. This calls for a greater policy response focused specifically on households with older adults and the integration of gerontological evidence into the existing food security and nutrition strategies.

Factors associated with newborn care knowledge and practices in the upper Himalayas.

BACKGROUND: Globally, neonatal deaths remain a major public health challenge and account for the majority of deaths occurring among children under five years of age. Despite Nepal's significant achievements in meeting the maternal and child health targets of the Millennium Development Goals, an estimated 23,000 Nepalese children under five years die every year, with three out of five babies dying within the first 28 days of life. This study therefore aimed to examine the level of knowledge and practices of newborn care among Nepalese mothers in the upper Himalayas and the factors associated with these. MATERIALS AND METHODS: A community based cross-sectional study was conducted among 302 randomly selected mothers with children under two years of age in Tripurasundari Municipality of Dolpa district, an upper Himalayan region of Nepal. Mothers were interviewed using semi-structured questionnaires. Mean score for knowledge and Bloom's criteria for practice were considered to categorize newborn care knowledge and practices. Multivariate logistic regression was used to identify factors associated with the newborn care knowledge and practices. RESULTS: In this study, 147 (48.7%) of the mothers were found to have inadequate knowledge of newborn care, while 102 (33.8%) mothers had reported unsatisfactory newborn care practices. Mothers with at least secondary level of formal education were more likely to possess adequate newborn care knowledge compared to mothers who never attended school (AOR 4.93 at 95% CI 1.82-13.33). Mothers whose first pregnancy occurred between the ages of 20-24 years (AOR 3.89 at 95% CI 1.81-8.37) were also more likely to possess adequate newborn care knowledge, compared to mothers with a younger age at first pregnancy. Furthermore, mothers who had completed at least four ANC visits (AOR 2.89 at 95% CI 1.04-7.96), mothers who had completed three PNC visits (AOR 2.79 at 95% CI 1.16-6.72) and mothers who reported that their nearest health facility was less than one hour (30-59 minutes) walking distance (AOR 3.66 at 95% CI 1.43-9.33) had higher odds of having adequate newborn care knowledge. Similarly, mothers whose household monthly income was more than $100 (AOR 4.17 at 95% CI 1.75-9.69), mothers who had completed three PNC visits (AOR 3.27 at 95% CI 1.16-9.20) and mothers with adequate newborn care knowledge (AOR 15.35 at 95% CI 5.82-40.47) were found to be more likely to practice a satisfactory level of newborn care practices in adjusted analysis. CONCLUSION: The study revealed high prevalence of inadequate newborn care and knowledge amongst mothers in upper Himalayan dwellings. Approximately one third of all interviewed mothers practiced suboptimal newborn care. The results indicate an urgent need to increase awareness of neonatal services available to mothers and to prioritize investments by local governments in neonatal health services, in order to improve accessibility and quality of care for mothers and newborns.

Undergraduate nursing students' knowledge of aging, attitudes toward and perceptions of working with older adults in Kathmandu Nepal.

OBJECTIVES: This study aims to examine Nepalese undergraduate nursing students' knowledge of aging, attitudes towards older adults and perceptions of working with older adults, and to assess differences in these outcomes by socio-demographic characteristics as well as type of nursing program. METHODS: A cross-sectional study was conducted among 385 undergraduate nursing students in six nursing colleges located in the Kathmandu Valley. Knowledge of aging, attitudes toward older adults and perceptions of working with older adults were assessed using standardized tools, the Palmore Facts on Aging Quiz, Kogan's Attitudes towards Older People Scale, and Nolan's Intent to Work with Older People Questionnaire, respectively. RESULTS: The mean knowledge scores on older adults and aging were relatively low; participants scored an average of 26.9 out of 50. Scores assessing attitudes towards and perceptions of working with older adults were more favorable. Compared to students pursuing a Bachelor of Science in Nursing (BSN), students pursuing a Bachelor of Nursing (BN) had a significantly higher score on the knowledge, attitudes and perception of aging scales. Linear regression analyses showed that the students' knowledge of aging (ß â€¯= 0.55; 95% CI = 0.25-0.86) and perceptions of working with older adults (ß â€¯= 0.22; 95% CI = 0.05-0.38) had a significant positive association with their attitudes toward older adults. CONCLUSIONS: Undergraduate nursing students in the Kathmandu Valley of Nepal displayed a relatively low level of knowledge, but a positive attitude towards older adults, and a positive perception of working with older adults. Observed differences in knowledge, attitude, and perception scores between students in BSN and BN programs needs further investigation; closing this gap may be important for bolstering undergraduate gerontological preparation in Nepal.

Adult Children's Migration and Well-being of Left Behind Nepalese Elderly Parents.

The objective of this study is to assess whether adult children's migration is associated with overall well-being of left-behind elderly parents in Nepal. A cross-sectional house-to-house survey was conducted among 260 community-dwelling elderly residents of Krishnapur municipality, Nepal. Binary logistic regression was used to identify whether migration of adult children was associated with elderly parent's self-reported chronic diseases, depressive symptoms, perceived loneliness and social support. More than half of the study household (51.2%) had at least one adult migrant child. Compared to participants without a migrant child, participants with a migrant child had higher odds of self-reported chronic diseases (OR = 1.79, 95%CI: 0.91-3.54), presence of depressive symptoms (OR = 1.07, 95%CI: 0.64-1.77), and self-perceived loneliness (OR = 1.23, 95%CI: 1.06-1.42) but except for loneliness, the odds ratio for other indicators of well-being were not statistically significant. Although the literature posits an inverse relationship between adult children's migration and the overall well-being of the elderly parents, in our study, adult children's migration was not associated with inverse health outcomes among study participants. However, from a policy perspective, it should be understood that these observations may be transient since the family structure of Nepalese society is rapidly changing.