Predictors of Depression and Anxiety among Medical Students.

BACKGROUND: Medical undergraduates are more prone to emotional distress in comparison to the general population and non-medical undergraduates. This study aimed to identify the prevalence and factors associated with depression and anxiety symptoms among undergraduate medical students. METHODS: A cross-sectional study was conducted among 204 medical students in a medical institute in Kathmandu. Depression, Anxiety and Stress Scale-42 was used to identify the prevalence of depression and anxiety symptoms. The data were analyzed using multivariable logistic regression models. RESULTS: The prevalence of depression and anxiety symptoms was 30.9% and 38.7% respectively. Depression symptoms were more likely to be prevalent among fourth and fifth-year students, with an adjusted odds ratio (aOR 1.96, 95% CI: 1.03-3.75) compared to second and third-year students, and those who failed in the last academic examination (aOR 2.55, 95% CI: 1.28-5.09). Anxiety symptoms were more prevalent among male students (aOR 2.11, 95% CI: 1.04-4.27), those who were from the relatively less advantaged ethnic group (aOR 2.08, 95% CI: 1.04-4.16) and those who stayed outside the dormitory (aOR 2.90, 95% CI: 1.46-5.78). CONCLUSIONS: The prevalence of depression and anxiety symptoms among medical students was high. Psychological support is needed to ensure the mental well-being of medical students.

Factors Associated with Acute Malnutrition among Pregnant Women in Flood Affected Region.

BACKGROUND: Adequate nutrition before and during pregnancy is necessary to maintain women's reproductive health and to ensure healthy foetal outcome. Pregnant women are at high risk of acute malnutrition specifically during humanitarian crisis leading to adverse effects in foetal outcomes and women's health. This study aimed to assess the factors associated with acute malnutrition among pregnant women visiting Antenatal Clinics in two hospitals and a Primary Health Care Centre of Siraha district in the south-eastern plains of Nepal immediately after 2017 flash flood. METHODS: A health-institution based cross-sectional study was conducted among 444 pregnant women of reproductive age (15-49 years) in second and third trimester in three health institutions. Data collection was done in the aftermath of 2017 flash floods through face to face interview. Multiple logistic regression analysis was used to identify the factors associated with acute malnutrition defined as Mid Upper Arm Circumference less than or equals to 21 centimetres. RESULTS: Out of 444 participants, 9.9% were found to be acutely malnourished. Participant's education (AOR[Adjusted Odds Ratio]: 3.09, 95% CI[Confidence Interval]: 1.43-6.70), occupation (AOR: 3.16, 95% CI: 1.08-9.22), husband's occupation (AOR: 6.61, 95% CI: 2.17-20.12), household food security (AOR: 3.39, 95% CI: 1.36-8.49) and participant's dietary diversity (AOR:10.06, 95% CI: 3.35-30.27) were found to be statistically significant factors associated with acute malnutrition among pregnant women. CONCLUSIONS: Participants' silliteracy, unemployment, husband not employed for cash, household food insecurity and low dietary diversity were found to be statistically significant predictors of acute malnutrition among pregnant women during flash floods.

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.

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study.

BACKGROUND: Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6 to 59 months in the two districts of Nepal. METHODS: We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centers (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value < 0.05 was considered as significant. RESULTS: Out of 398 children, 5.8% were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23-12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88-10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06-71.09) children (0-12 vs. 24-59 months). CONCLUSIONS: The findings of this study indicated that household size, household food access, and the child's age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.

Assesssment of Health Facilities for Implementation of Non-communicable Disease Package.

BACKGROUND: Non-communicable Diseases are an alarming public health emergency in Nepal. Owing to the risk of NCD's in Nepal, Government of Nepal has developed a Multisectoral Action Plan for Non-communicable Disease 2014-2020 and has adopted the World Health Organization Package of Essential Non-communicable Disease protocol. Prior for its implementation in Nepal, baseline study has been carried out to assess the status of health facilities in Nepal. METHODS: A descriptive cross-sectional study was carried out in Kailali and Ilam district encompassing a total of 92 health facilities. A set of structured questionnaire and interview guideline was used to obtain the data. Collected data was transferred to Microsoft Excel, cleaned and analyzed in SPSS 16.0. Descriptive analysis was performed to express the frequencies and relative frequencies Results: Of the total health facilities, 49 and 43 health facilities of Ilam and Kailali were interviewed. The hospital of Ilam consisted all the procedure, equipment and medicine for the management of NCDs whilst, health posts lacked Oxygen services. Only 592 posts were fulfilled out of 704 sanctioned post in both the districts of which only 161 were trained in management of NCDs. Atotal of 231 patients were diagnosed with NCDs before the day of study in all the health facilities of both districts. CONCLUSIONS: Study reveals the gaps in capacity of health institution and system in terms of training, supply, equipments, and diagnostics. However, training of health workers, supply of essential medicines and improvising the service delivery would supplement the effective implementation of PEN in Nepal.