Utilization of social health security scheme among the households of Illam district, Nepal.

BACKGROUND: Nepal has implemented the social health security program in certain health facilities to improve access to quality health services. The aim of the study is to understand the utilization pattern of social health security schemes and community's perception of the social health security program. METHOD: A descriptive cross-sectional mixed-method study was conducted among 300 households of Illam district who had enrolled in the social health security scheme. A multi-stage random sampling method was used. A semi-structured questionnaire was used to collect quantitative data whereas focus group discussions (FGDs) were conducted for qualitative data. Descriptive analysis, bivariate and multivariate analysis was done. FGDs were transcribed and thematic analysis was done. FINDINGS: The utilization rate of social health security scheme was 88.7%. Factors associated with the utilization of program included: presence of under-five children and chronic illness in households, sex and age group. Focus group discussion revealed that people were aware of social health insurance and pleased with program implemented by government. However, the hospitals under the social health insurance were not able to meet their expectations. CONCLUSION: Although the utilization of social health security scheme was high, people were dissatisfied with the service provided by the hospital under the social health security scheme. Therefore, the social health insurance board should closely monitor the hospitals and develop a feedback mechanism from the users.

Using long-range freeze-preventive vaccine carriers in Nepal: A study of equipment performance, acceptability, systems fit, and cost.

Preventing vaccine freezing is one of the biggest challenges in vaccine management. Until 2018, vaccine carriers used in the immunization program lacked features to prevent vaccine freezing. Freeze-preventive vaccine carriers (FPVCs) have an engineered liner that buffers vaccines from direct exposure to frozen ice packs. A field evaluation of three FPVCs was conducted in 24 health posts in eastern Nepal. The objective was to evaluate the FPVCs' performance, acceptability, systems fit, and cost, to inform prequalification and introduction planning. The study was carried out in two phases: in the first phase, FPVCs containing dummy vaccines (labeled "Not for Human Use") were transported to outreach sessions along with a standard vaccine carrier (SVC); in the second phase, the FPVCs were used for transporting vaccines taken to outreach sessions and used for vaccinating eligible children. The study gathered quantitative and qualitative data from health workers, logbooks, and electronic temperature monitors placed inside and outside the FPVCs. Results indicate the FPVCs successfully prevented temperatures below 0 °C more than 99% of the time-except at one site, where ambient temperatures were below the minimum rated testing temperature specified by the World Health Organization. Internal cool-down times for the FPVCs were highly variable, as were mean kinetic temperatures, possibly driven by the wide range of ambient temperatures and higher-than-expected variations in freezer performance, which, along with the need to transport ice packs to some locations, affected ice-pack temperatures. Almost all health workers requested smaller, lighter-weight FPVCs but appreciated the FPVCs' ability to prevent vaccines from freezing while avoiding undue heat exposure. FPVCs had benefit-cost ratios greater than 1 and hence good value for money. Results point to the importance of understanding the intended environment of use and the need for smaller, short-range as well as long-range carriers.

Forty years after Alma-Ata: primary health-care preparedness for chronic diseases in Mozambique, Nepal and Peru.

BACKGROUND: Four decades after the Alma-Ata Declaration, strengthening primary health care (PHC) remains a priority for health systems, especially in low- and middle-income countries (LMICs). Given the prominence of chronic diseases as a global health issue, PHC must include a wide range of components in order to provide adequate care. OBJECTIVE: To assess PHC preparedness to provide chronic care in Mozambique, Nepal and Peru, we used, as 'tracer conditions', diabetes, hypertension and a country-specific neglected tropical disease with chronic sequelae in each country. METHODS: By implementing a health system assessment, we collected quantitative and qualitative data from primary and secondary sources, including interviews of key informants at three health-system levels (macro, meso and micro). The World Health Organization's health-system building blocks provided the basis for content analysis. RESULTS: In total, we conducted 227 interviews. Our findings show that the ambitious policies targeting specific diseases lack the support of technical, administrative and financial resources. Data collection systems do not allow the monitoring of individual patients or provide the health system with the information it requires. Patients receive limited disease-specific information. Clinical guidelines and training are either non-existent or not adapted to local contexts. Availability of medicines and diagnostic tests at the PHC level is an issue. Although medicines available through the public health care system are affordable, some essential medicines suffer shortages or are not available to PHC providers. This need, along with a lack of clear referral procedures and available transportation, generates financial issues for individuals and affects access to health care. CONCLUSION: PHC in these LMICs is not well prepared to provide adequate care for chronic diseases. Improving PHC to attain universal health coverage requires strengthening the identified weaknesses across health-system building blocks.

Factors associated with low back pain among construction workers in Nepal: A cross-sectional study.

BACKGROUND: Low back pain (LBP) is the commonest cause of disability throughout the world. This study aimed to determine the prevalence and factors associated with LBP among the construction workers in Nepal. METHODS: A community-based cross-sectional study was conducted among the construction workers working in Banepa and Panauti municipalities of Kavre district, from September 2019 to February 2020. Data was collected purposively by face-to-face interview from 402 eligible participants from the both municipalities using semi-structured questionnaire. Mobile-based data collection was done using KoboCollect. Data were exported to and analysed using R-programming software (R-3.6.2). Univariate and multivariate logistic regressions were performed. All tests were two tailed and performed at 95% confidence interval (CI). RESULT: One-year prevalence of LBP among construction workers were 52.0% (95%CI: 47.0-57.0). The higher odds of LBP was reported among females [adjusted odds ratio (aOR) = 2.42; 95%CI: 1.12-5.23], those living below poverty-line (aOR = 2.35; 95%CI: 1.32-4.19), participants with more than five years of work experience (aOR = 1.66; 95%CI: 1.01-2.73) and those with intermediate sleep quality (aOR = 2.06; CI: 1.03-4.11). About 80.0% of construction workers with LBP never seek healthcare services due to: a) time constraints (90.9%), b) financial constraints (18.1%) and c) fear of losing wages on seeking healthcare services (40.9%). The majority of the participants (94.8% among those without LBP and 72.3% among those with LBP) did nothing to prevent or manage LBP. CONCLUSION: The prevalence of LBP in the past one year was high among construction workers where majority of workers never did anything to prevent or manage LBP. Therefore, the public health professionals should set up the health promotion, education, and interventions aimed at increasing awareness on preventive techniques and predisposing factors of LBP.

Factors Associated with Pelvic Organ Prolapse in Eastern Region of Nepal: A Case Control Study.

BACKGROUND: Pelvic organ prolapse is a significant public health problem in Nepal affecting a large number of women. This study was carried out to identify the factors associated with pelvic organ prolapse among the women of eastern part of Nepal. METHODS: This was a matched case-control study. Cases were women aged ?15 years with at least one parity having stage 2 and above pelvic organ prolapse attending Gynecology OPD of BP Koirala Institute of Health Sciences, Dharan and the control were the women without prolapse with at least one parity in neighborhood matched with age. A total of 230 respondents (1 Case:1 Control) were included in the study. A semi structured interview was carried out to obtain the information for both groups. Bivariate analysis along with conditional logistic regression analysis was carried out to identify the association between selected variables with pelvic organ prolapse. RESULTS: We found a significant association between age at first child birth (OR 1.98, CI 1.06-3.68), heavy load carrying during pregnancy (OR 3.97, CI 1.93-8.16), smoking (OR 3.49, CI 1.42, CI 8.61) and history of constipation (OR 3.57, CI 1.13-11.22) with pelvic organ prolapse. CONCLUSIONS: The finding showed that the significant factors for prolapse were age at first child birth, heavy load carrying during pregnancy, smoking and history of constipation.

A Cross-Sectional Survey of Contraceptive Use and Birth Spacing Among Multiparous Women in Eastern Nepal.

Despite the known benefits of the use of contraceptives, notably birth spacing, the use of contraceptives in Nepal has remained stagnant since 2006. The purpose of this article is to assess the knowledge and use of contraceptives, and to ascertain preceding interbirth spacing in an eastern plain district of Nepal. A cross-sectional survey was completed on 406 multiparous women aged 18 to 49 years to collect data via structured questionnaires in Jhapa district of Nepal. The majority of the participants (96.1%) had knowledge of at least one modern contraceptive: injectable and oral contraceptives were the most common. Female sterilization was the most commonly used method of contraception. The median birth spacing was 41.5 months, and the majority of participants (79.1%) had preceding interbirth spacing greater than 24 months. The average preferred birth spacing was 51.3 months, and about half of the participants said that 60 months was the appropriate birth spacing. Though knowledge of contraceptives use is almost universal in this population, the use is still low. The preferred birth spacing is longer than the actual birth spacing, signifying an unmet need of contraception.

Study of Health-Related Quality of Life and Healthcare Utilization among Type 2 Diabetic Population in an Urban Area of Eastern Nepal.

INTRODUCTION: Diabetes mellitus is a major cause of morbidity and mortality and places huge burden on public health funding. Diabetes affects quality of life through associated complications, comorbidity, and disease burden. Consequently, people have frequent healthcare visits. This study assessed quality of life and healthcare utilization patterns among type 2 diabetic populations in an urban area of eastern Nepal. METHODS: A cross-sectional study was conducted among 270 participants of age ≥20 years with type 2 diabetes in Itahari using a semistructured questionnaire. A D-39 questionnaire was used to assess quality of life. Five wards were selected by systematic random sampling, and the population was proportionate according to the sample size. Multiple linear regressions were conducted to identify the factors associated with quality of life and its domains. RESULTS: The highest mean score ± SD was found in the domain anxiety and worry (57.34 ± 11.08). About 18.5% of the participants perceived extremely affected quality of life. Hypertension (55.55%) was the most common comorbidity. Age, marital status, literacy, alcohol, disease duration, comorbidity, and complications were significantly associated with overall quality of life. In last 6 months of duration, 93.7% had hospital visits. Among them, 8.1% had emergency visit and 5.9% were admitted in the hospital. CONCLUSION: People with diabetes in this study were more affected in the domain anxiety and worry. The frequency of healthcare access and utilization in patients with type 2 diabetes was high. The quality of life among them could be improved by taking care on healthy behavior, comorbid conditions, and complications.

Study of the magnitude of diabetes and its associated risk factors among the tuberculosis patients of Morang, Eastern Nepal.

BACKGROUND: WHO addresses the infectious disease like Tuberculosis, and non- communicable disease like Diabetes among the top 10 causes of death worldwide, which collectively leads to increasing mortality and premature death especially in developing countries. Hence, the present study aims to assess the prevalence of diabetes and its associated risk factors among the tuberculosis patient of Morang, Eastern Nepal. METHODS: A cross-sectional study was carried out among the 320 respondents undergoing tuberculosis treatment of Morang district. Respondents from eight randomly selected DOTS centers were selected purposively. The Fasting Blood Sugar and 2-h Post-Prandial Blood Sugar were assessed in the laboratory of respective DOTS center by the glucose oxidase method. An interview for socio-demographic and other variables was conducted using a pretested semi-structured questionnaire based on WHO-STEP Instrument for chronic disease and excerpt from DASS-21 was used for the variable stress. RESULTS: The prevalence of diabetes, pre-diabetic and glucose intolerance among tuberculosis patient was 11.9, 17.2, and 17.8% respectively. Additionally, the univariate analysis reported, user of tobacco products, current alcohol consumers, family history of diabetes and stress level, to have positive association with diabetes, while the multivariate analysis reported, the current alcohol consumer as the significant predictor of diabetes among the tuberculosis patient. CONCLUSION: A significant portion of the respondents were diabetic, impaired glucose tolerance and pre-diabetic, which supports the fact of diabetes being comorbid with tuberculosis. Hence, it shifts the focus on the bidirectional screening of tuberculosis and diabetes.

Health-related quality of life among people living with type 2 diabetes: a community based cross-sectional study in rural Nepal.

BACKGROUND: Diabetes as being a chronic disease with a number of complications deteriorates the quality of life among the people with type 2 diabetes. Health related quality of life is widely used as an important health outcome measure worldwide. This study assessed the quality of life among the people living with type 2 diabetes in rural area of eastern Nepal. METHODS: A cross sectional study was conducted among type 2 diabetic patient of rural area of eastern Nepal. Pre-tested Nepali version of D-39 questionnaire was administered through face to face interview to assess the quality of life. Door to door visit was done to identify all the type 2 diabetic patients residing in Baniyani village. Data was entered in Micro-soft excel 2007 and further processed in SPSS v.11.5 for analysis. RESULTS: Highest quality of life mean (SD) score was in social burden domain (56.26 ± 12.07), followed by sexual functioning domain (54.35 ± 9.47), Anxiety and worry domain (54.33 ± 7.76), energy and mobility domain (51.46 ± 8.73) and diabetes control domain (50.08 ± 10.84). There was negative correlation between age and domains sexual functioning (p = 0.001) and energy and mobility (p = 0.002). In bivariate analysis, there was significance difference by sex in sexual functioning (p = 0.002), educational status in diabetes control (p = 0.021), smoking habit in energy and mobility (p = 0.038), duration of disease in diabetes control (p = 0.002) and sexual functioning (p = 0.001), presence of co-morbidity in social burden (p = 0.034) and family history of diabetes in anxiety and worry (p = 0.042). CONCLUSION: Increasing age affects sexual life and mobility of the type 2 diabetic patient. The domain sexual functioning is difference by sex and presence of co-morbidity. Similarly, domain diabetic control is affected by duration of disease and educational status of the patient. And having family history of diabetes affects the mental state of the type 2 diabetic patient.

Respiratory Problems among Workers of Udayapur Cement Factory in Eastern Nepal.

BACKGROUND: There have been very limited studies regarding health of the cement factory workers in Nepal. This study aimed to find out the prevalence of health problems and the factors associated with respiratory symptoms among the workers of Udayapur cement factory. METHODS: This is a cross-sectional study conducted from March to August 2015 in Udayapur cement factory in eastern Nepal. All the workers working in the factory more than a year were included in the study. Thedata was collected by using a semi-structured questionnaire consisting of socio-demographic characteristics,type of work, reported health problems, use of personal protective measures.Chi-square test was used to determine the association of respiratory symptoms with related variables. RESULTS: A total of 295 workers were included in this study with mean age of 45.9 years (SD=7.7). Majority 279 (94.6%) were males. The most common health problems were musculoskeletal pain (55.6%) followed by eye problems (33.2%). Among them, 17(21.1%) reported that they had at least one respiratory problem and chest tightness while running/climbing and wheeze were the most common. A total of 233 participants (79%) used at least one form of personal protective equipment. Low education, longer duration of work and smoking were found to be positively associated with respiratory symptoms. CONCLUSIONS: Respiratory problems were high among the workers of the cement factory. Proper use of PPEs and dust control measures should be promoted among the workers.

"If you will counsel properly with love, they will listen": A qualitative analysis of leprosy affected patients' educational needs and caregiver perceptions in Nepal.

BACKGROUND: Leprosy remains a disease of concern in many countries including Nepal. To achieve the target of elimination, the WHO strategy promotes comprehensive education of patients, healthcare workers (HCWs), and the public on leprosy-related issues. However most educational programs are based on the concerns of HCWs and not on patients' needs. The objective of this paper is to explore the educational needs of leprosy affected patients in Nepal and compare them to the needs perceived by HCWs. METHODOLOGY/PRINCIPAL FINDINGS: Semi directive interviews were conducted with patients and HCWs. The data was analyzed using the basic interpretative qualitative framework. The study was conducted in two leprosy referral centers, one university hospital and one primary health care center: Lalgadh Leprosy Hospital and Services Centre, Anandaban Hospital and its satellite clinic in Patan, B. P. Koirala Institute of Health Sciences in Dharan, and the Itahari primary health care centre. The results show that there remains a lack of knowledge regarding the disease (origins, manifestations, prevention and treatment) contributing to late care seeking behavior and high levels of stigma, with an important psychological and financial stress for patients. All of the HCWs displayed a good understanding of patients' difficulties and needs and acknowledged the key role of patient education. However, they expressed several challenges in managing patients due to lack of time, human resources and training in patient education. CONCLUSIONS/SIGNIFICANCE: Further efforts need to be made to increase patients' general knowledge of the disease in order to motivate them to seek healthcare earlier and change their perception of the disease to reduce stigma. HCWs need proper training in patient education and counseling for them to acquire the necessary skills required to address the different educational needs of their patients. The use of lay and peer counselors would be an option to address the workload and lack of time expressed by HCWs.

Health literacy of future healthcare professionals: a cross-sectional study among health sciences students in Nepal.

Background: There is an assumption that health literacy is higher among health professionals, allowing them to improve the health literacy of their patients. This study explored health literacy profiles of health science students in Nepal, the future health professionals and educators of health literacy. Methods: The multidimensional Health Literacy Questionnaire and demographic questions were administered online to medical and other health science students at the B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Results: More than half (55.8%) of the participants were male, 68.3% were ≤19 y of age, 62.2% had parents with a university degree, 73.5% were studying undergraduate courses and 61.6% were pursuing medicine. Students reported having moderate support and skills to manage their health. Health was regarded as important to them. They reported a moderate ability to engage with health professionals and the healthcare system. Medical students reported higher scores for all scales except social support for health, which was similar across the groups. Conclusions: Universities should target interventions to improve students' access to health information and to develop students' ability to engage actively with healthcare providers. This will likely produce health professionals with improved health literacy levels who are sensitive to the health literacy needs of their patients from different population groups.

Moving from formative research to co-creation of interventions: insights from a community health system project in Mozambique, Nepal and Peru.

Different methodological approaches for implementation research in global health focusing on how interventions are developed, implemented and evaluated are needed. In this paper, we detail the approach developed and implemented in the COmmunity HEalth System InnovatiON (COHESION) Project, a global health project aimed at strengthening health systems in Mozambique, Nepal and Peru. This project developed innovative formative research at policy, health system and community levels to gain a comprehensive understanding of the barriers, enablers, needs and lessons for the management of chronic disease using non-communicable and neglected tropical diseases as tracer conditions. After formative research, COHESION adopted a co-creation approach in the planning of interventions. The approach included two interactions with each type of stakeholder at policy, health system and community level in each country which aimed to develop interventions to improve the delivery of care of the tracer conditions. Diverse tools and methods were used in order to prioritise interventions based on support, resources and impact. Additionally, a COHESION score that assessed feasibility, sustainability and scaling up was used to select three potential interventions. Next steps for the COHESION Project are to further detail and develop the interventions propositioned through this process. Besides providing some useful tools and methods, this work also highlights the challenges and lessons learned from such an approach.

Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study.

OBJECTIVES: The study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal. METHODS: We conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health. RESULTS: Of 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71-282) and US$36 (19-61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector. CONCLUSION: Industrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered.

Socio-demographic characteristics and the utilization of HIV testing and counselling services among the key populations at the Bhutanese Refugees Camps in Eastern Nepal.

OBJECTIVES: This cross-sectional study was conducted to describe the socio-demographic characteristics, assess the utilization of HIV testing and counselling services, and to explore the reasons for the non-utilization of HIV testing and counselling services among the key populations at the Bhutanese refugee camps in eastern Nepal. RESULTS: The HIV testing and counselling services are utilized by less than a third (29%) of the key population among the Bhutanese Refugees. The prime source of information about the HIV testing and counselling sites has been health workers followed by peer/outreach educators and neighbors. Common self-reported barriers for utilization of HIV testing and counselling services by the Bhutanese refugees were self-perceived stigma about HIV, the fear of being discriminated and the lack of knowledge about HIV testing and counselling services. There is a need to analyze the gap between availability and utilization through more qualitative approaches in order to identify interventions to increase the uptake of the HIV testing and counselling services.

Latrine coverage and its utilisation in a rural village of Eastern Nepal: a community-based cross-sectional study.

BACKGROUND: A little more than 1/3rd of the rural households in Nepal have improved latrine facility. The government of Nepal is working towards making an open defecation free area all over Nepal. There is no data found in literature searches regarding the status of latrines and its utilisation in Nepal. This study aims to estimate the coverage and utilisation of latrine and its associated factors in a rural community of Nepal. METHODS: We conducted a cross sectional study in March 2015-September 2015 among 625 households in Hattimuda Village, Morang district in Eastern Nepal using semi-structured pre-tested questionnaire with observational checklists. RESULTS: Out of 623 households, 473 (76.9%) have latrine facilities. There is an increase in latrine coverage in Hattimuda by 37% (38.9% in 2011 to 75.9% in 2016). Majority of the latrines (89.9%) were functional, however 32.3% needs maintenance. The extent of latrine utilisation among those households with a toilet at home was satisfactory (94.3%). Presence of child below 5 years of age at home (OR 2.37, 95% CI 0.05-0.46), functional latrine (OR 27.37, 95% CI 6.84-109.45), frequency of cleaning (OR 3.66, 95% CI 1.09-12.29) and latrine constructed with self-initiation (OR 4.21, 95% CI 1.06-16.66) are factors significantly associated with the utilisation of the latrine. CONCLUSIONS: While the coverage needs to be increased, appropriate interventions to increase the utilisation of latrine needs to be in place so that the village moves closer to open defecation free (ODF) status. As other studies are not found from Nepal, the findings from this study can be used a reference for other rural areas of Nepal.

Consequence of indoor air pollution in rural area of Nepal: a simplified measurement approach.

People of developing countries especially from rural area are commonly exposed to high levels of household pollution for 3-7 h daily using biomass in their kitchen. Such biomass produces harmful smoke and makes indoor air pollution (IAP). Community-based cross-sectional study was performed to identify effects of IAP by simplified measurement approach in Sunsari District of Nepal. Representative samples of 157 housewives from household, involving more than 5 years in kitchen were included by cluster sampling. Data were analyzed by SPSS and logistic regression was applied for the statistical test. Most (87.3%) housewives used biomass as a cooking fuel. Tearing of eyes, difficulty in breathing, and productive cough were the main reported health problems and traditional mud stoves and use of unrefined biomass were statistically significant (p < 0.05) and more risk (AOR > 2) with health problems related to IAP. The treatment cost and episodes of acute respiratory infection was >2 folders higher in severe IAP than mild IAP. Simplified measurement approach could be helpful to measure IAP in rural area. Some effective intervention is suggested to reduce the severe level of IAP considering women and children.

Human immunodeficiency virus and hepatitis C virus coinfection in Nepal.

OBJECTIVES: The study aimed at finding prevalence, mode of transmission, and pattern of CD4 cell count among hepatitis C virus (HCV) coinfected human immunodeficiency virus (HIV)-positive individuals in Nepal. METHODS: This was a descriptive cross-sectional study carried out in three Volunteer Counseling and Testing clinics, one from Dharan and two from Kathmandu, Nepal. Three hundred and thirteen individuals were recruited. RESULTS: Forty-two percent of HIV-infected persons had HCV coinfection. Significant associations with HIV and HCV coinfection were male gender (p <0.001) and injection drug use (IDU) (p <0.001). The mean CD4 cell count was significantly lower in HCV coinfected individuals, compared to those without coinfection, after 1.5 years (p =0.017), 2 years (p =0.0457), 3 years (p =0.011), and 3.5 years (p <0.001) of antiretroviral therapy. CONCLUSION: HCV coinfection was common in HIV-infected individuals in Nepal and was associated with male gender, IDU, and lower CD4 counts.