Cross-cultural Adaptation and Psychometric Properties of Nepali Version of Developmental Coordination Disorder Questionnaire.

Background Revised developmental coordination disorder questionnaire (DCDQ'07) is the best available population-based screening tool to identify developmental coordination disorder and being a parent reported tool, it needs to be available in Nepali language for its application in Nepali population. Objective The objective of this study was to cross-culturally adapt developmental coordination disorder questionnaire into Nepali (DCDQ-NP). The psychometric properties of Nepali version of Developmental coordination disorder questionnaire were established. Method The adaptation was done following Beaton's guideline and the psychometric properties was studied in the community sample of 165 parents of school going children of 5-15 years. Fifty parents were asked to refill the questionnaire after the two weeks period. The study determines internal consistency, test retest reliability, floor and ceiling effect and construct validity. Result Significant cultural adaptation was required to obtain relevant Nepali version. The Nepali version of Developmental coordination disorder questionnaire demonstrates high internal consistency (α = 0.912), excellent test-retest reliability (IC = 0.901) and the floor and ceiling effect were acceptable. Principal component analysis showed three factor structure accounting 62% of variance. Conclusion The developmental coordination disorder questionnaire into Nepali were successfully translated and culturally adapted preserving its original concept. It showed good psychometric properties in a Nepali population. The adapted questionnaire shall be of significance in carry out further research in developmental coordination disorder in Nepal.

Impact of maternal decision-making autonomy and self-reliance in accessing health care on childhood diarrhea and acute respiratory tract infections in Nepal.

OBJECTIVE: This study aimed to examine the impact of maternal decision-making autonomy and self-reliance in accessing health care on childhood diarrhea and acute respiratory tract infection (ARI) in Nepal. STUDY DESIGN: This was a cross-sectional study. METHODS: This study used data from the Nepal Demographic and Health Survey 2016. Mothers aged 15-49 years provided information about the health of 5308 children included in this analysis. Composite measures of maternal decision-making autonomy and self-reliance in accessing health care were used as exposure variables. Childhood diarrhea and ARI in the 2 weeks preceding the survey were primary outcome variables. Descriptive statistics and multivariable survey-weighted logistic regression methods were used in the analyses. RESULTS: Maternal decision-making autonomy was high for approximately one-fourth (24.7%) of the children's mothers, and 81.7% of children's mothers reported self-reliance in accessing health care as a big problem. Diarrhea among children in the prior 2 weeks was reported among 8% (95% confidence interval [CI]: 6.9-8.4), whereas ARI was reported among 22% (95% CI: 21.1-23.5). The children of women who viewed a lack of self-reliance as a big problem had a 88% (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.26-2.82, P < 0.01) higher odds of diarrhea and 59% (aOR = 1.59, 95% CI: 1.29-1.95, P < 0.001) higher odds of ARI compared with children of women who did not view self-reliance as a big problem. CONCLUSIONS: The study found a significant effect of maternal self-reliance in accessing health care on childhood diarrhea and ARI, independent of other sociodemographic factors. Improvement in maternal self-reliance in accessing health care of women is essential, particularly their autonomy with regard to healthcare seeking behavior and financial empowerment.

Translation with Cross-cultural Adaptation of Cerebral Palsy Quality of Life Questionnaire for Children into Nepali and its Psychometric Properties.

Background Cerebral Palsy Quality of Life questionnaire for children primary caregiver version is the widely used condition specific outcome measure which assesses the wellbeing of the child. It has been translated to many languages and shows excellent psychometric properties. Availability in Nepali would facilitate the use in clinical practice and research in Nepali population. Objective The objective of this study was translation with cross-culturally adaption of Cerebral Palsy Quality of Life questionnaire for children primary caregiver version into Nepali and assess its psychometric properties. Method Cross-cultural adaptation was performed using forward and backward translation protocol. Pretesting was done on six participants to confirm that the original concept was preserved. The Nepali version of questionnaire was administered twice for data collection. The feasibility, sensitivity, internal consistency and test-retest reliability was determined. Result Culturally adapted Nepali version showed good feasibility only the domain "Access to service" had a highest missing score related to use of the special equipment, attending kindergarten and applying for respite care. Floor and ceiling effect were < 15% in all the domains except in few items of "Pain and impact of disability" and "Social well being and acceptance". Test retest reliability (0.82 - 0.91) and internal consistency (0.68 - 0.84) was good. There were weak association of domains with the gross motor functional classification system level. Conclusion Cross-culturally adapted Nepali Cerebral Palsy Quality of Life questionnaire for children primary caregiver was developed. It demonstrates good psychometric properties confirming to assess quality of life of children with Cerebral palsy in Nepal.

Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study.

Background Pregnant and breastfeeding women are more susceptible to viral infection and in the year 2020 they have to face the COVID-19 pandemic. Since, no successful treatment and vaccine has been developed so far, efforts to enhance the knowledge, attitudes, and practice of the public, especially the high-risk groups like pregnancy and postpartum period are crucial to manage COVID-19 pandemic. Objective To analyze the knowledge, attitude, practice and hospital experience regarding COVID-19 among post-partum mothers at a tertiary care center of Nepal Method The data collection was based on direct interview after receiving written consent from the research participants, using a semi-structured questionnaire. The questionnaire consisted of 4 major domains- knowledge (8 questions), attitude (6 questions), practice (5 questions) and experience (5 questions). Standard descriptive statistics were used for the data, mean and standard deviation for continuous variables whereas frequencies and percentages for categorical variables. Result A total of 203 post-partum women participated in the study. Almost all the participants had heard about COVID-19 (96.6%). A majority of them were aware about how COVID-19 gets transmitted and its preventive measures. Most of the participants (88.2%) knew that COVID-19 has effects on pregnancy. Almost all of participants (97%) wore mask during hospital stay. All of the women washed their hands with soap water or alcohol based sanitizer. A majority of the mothers (79.3%) wore mask while breastfeeding their baby. Conclusion The post-partum mothers have good knowledge, attitude, practice and experiences regarding the COVID-19 pandemic.

The Effectiveness of Accelerated Skill Acquisition Program for Upper Extremity Motor Training in Bilateral Stroke.

The bilateral stroke is an added challenge for functional recovery. The evidence of effective therapy intervention for bilateral stroke is rare. A protocol of 30 hours (5 hours/week for 6 weeks) of accelerated skill acquisition program (ASAP) has been administered to a patient with bilateral ischemic middle cerebral artery syndrome at sub-acute stage. Two sessions per day (separately for right and left) were administered. Nepali Wolf Motor Function Test (WMFT) was used to evaluate performance time before and after the treatment. The performance time on Wolf Motor Function Test got largely and consistently reduced on all items of both extremities. There was improvement in grip strength and weight lifting items. Bilateral hand items and turn key in lock were successfully completed after the treatment. Thus, the accelerated skill acquisition program yielded large reduction in performance time, improved hand skills and demonstrated functional improvement of both upper extremities in individual with bilateral stroke.

Impairment and Functional Status of People with Disabilities Following Nepal Earthquake 2015.

Background An earthquake of 7.8 magnitude with an epicenter at Gorkha on 25th April 2015 and a second earthquake of 6.5 magnitude with an epicenter at Sindhupalchwok on 12th May 2015 struck Nepal, killing more than 8,500 people and injuring over 18,500 individuals, and leading to various forms of disabilities. Objective To investigate the impairments and functional status of the earthquake victims through a survey. Method A survey was carried out in the catchment area of Bahunepati and Manekharka outreach centers of Sindhupalchowk district and Gaurishankar outreach center of Dolakha district of Dhulikhel Hospital. These were some of the most earthquake affected areas. Physical disability was identified using a disability survey form given by the Ministry of Women, Children and Social Welfare, Government of Nepal. World health organization disability assessment schedule (WHODAS 2.0) was used to identify the level of disability. Result Twenty-nine persons with disability (PWD) at Bahunepati, four PWD at Manekharkha and two PWD at Gaurishankar and their catchment areas were identified. Level of disability was an average of 56%, with the majority of survivors having upper extremities fractures (27.6%), followed by lower extremities fractures (17.2%) and miscellaneous injury (17.2%). A few spinal cord injuries and head injuries were also identified. Conclusion The level of disability among the injured people was high. Therefore, an urgent need of physiotherapy rehabilitation is warranted to improve the quality of life of the earthquake victims.

Reliability and Validity of the Nepali Wolf Motor Function Test following Cross-cultural Adaptation.

Background The Wolf motor function test is a standardized, reliable and valid performance-based measure, which evaluates upper-extremity function. Neither there is any evidence of neurological measure in Nepali nor has this tool been cross-culturally adapted to date. Objective To cross-culturally translate and evaluate reliability and validity of Nepali Wolf motor function test. Method Two forward-translators translated the original version into Nepali. After synthesizing, two back- translators translated it into English. The expert committee consolidated and derived a final Nepali version. Two assessors pretested on three participants to confirm that the original concept of the tool is preserved. The agreement and correlation between back-translators were evaluated. The inter- and intra-rater reliability and agreement of two physiotherapists on eight participants were demonstrated through intra-class-correlation- coefficient and weighted-kappa for time and functional ability respectively. Criterion validity was explored against Fugl- Meyer assessment scale. Result A cross-culturally adapted Nepali Wolf motor function test was pretested and ensured that the Nepali version was still retaining its equivalence (rho: 0.74 to 1.0 for time, 0.82 to 1.0 for functional ability). Good-to- excellent inter- and intra-rater reliability {intra-class-correlation-coefficient(2,1) and (3,1): 0.80 to 1.0 and 0.81 to 1.0 respectively} were demonstrated. Excellent agreement (kappa 0.90, p <0.00) and good correlation (rho 0.57 to 1.0) between back-translators were found. An adequate criterion validity (rho -0.95 for time, 0.91 for functional ability) against Fugl-Meyer assessment scale has been demonstrated. Conclusion A cross-culturally adapted Nepali Wolf motor function test, preserving its original concept, was developed, and the reliability and validity of the tool on individuals with stroke has been demonstrated.

Sonography in acute ureteric colic: an experience in Dhulikhel Hospital.

BACKGROUND: Computed tomography is considered as an imaging modality of choice in acute ureteric colic. However due to concerns regarding radiation exposure, sonograms are re-emerging as imaging methods in such situations. OBJECTIVES: To evaluate the role of sonography in detection of calculus in acute ureteric colic. METHODS: Total 384 patients were enrolled. Hydronephrosis was graded as mild, moderate or severe. Calculus was detected as an intraluminal echogenic focus with distal shadowing with twinkling artifact. Number, size and position of the calculi were assessed. Patients were categorized into four groups:I. ureteric colic only II. ureteric colic with hematuria III. ureteric colic with hydronephrosis and IV. ureteric colic with hematuria and hydronephrosis and then the possibility of detection of calculi has been compared among these groups. RESULTS: Out of 384 patients, 254 were found to have calculi ranging between 2.7-27 mm. Nineteen had in the pelvis/ pelviureteric junction, 64 in proximal ureter, 125 in distal ureter, 6 at iliac crossing and 40 at vesicoureteric junction. Two hundred forty one had single and 14 had multiple calculi. Calculus detection is easier in category III and IV patients. The sensitivity and specificity of ultrasonography were 87.98% and 93.07%. Degree of hydronephrosis is strongly correlated with the number of calculi but weakly correlated with the size of the calculus. CONCLUSION: Sonogram can be used in all cases of acute ureteric colic. Hydronephrosis is the most important finding because it paves the way out for the detection of calculus.

Anatomy and physiology of female sexual function and dysfunction: classification, evaluation and treatment options.

Female sexual dysfunction is a significant age-related, progressive and highly prevalent problem that affects a substantial number of women in the United States. The female sexual response cycle is initiated by neurotransmitter-mediated vascular and nonvascular smooth muscle relaxation resulting in increased pelvic blood flow, vaginal lubrication, and clitoral and labial engorgement. These mechanisms are mediated by a combination of neuromuscular and vasocongestive events. Physiological impairments that interfere with the normal female sexual response bring about complaints associated with diminished sexual arousal, libido, vaginal lubrication, genital sensation, and ability to achieve orgasm. Therapy aimed at restoring hormone levels as well as genital blood flow will be discussed.

Human resource development planning for sustainable health and population programmes.

PIP: This article identifies the need for human resource development planning (HRDP) in population and health programs in Nepal. Sustainable development depends upon balancing human numbers, resources, and quality of life. Development strategies must be sensitive to health and population strategies. Health and population strategies must reflect HRDP. Health and population fields tend to intensively use human resources. Health and population manpower need to be managed cost effectively yet meet the development goal of a more accessible, more equitable, and more effective health care and family planning (FP) delivery system. Manpower planning is affected by the type and quality of education, the workplace, and the organization of health and FP manpower. FP entails three processes: planning, production, and management. The former classical approach of FP entailed institutions, sophisticated technology, and specialized manpower. The classical approach did not work. Governments had difficulty finding sufficient funds for investment. Human resources were an untapped source of community and national development. Health and FP manpower should have a variety of skills and knowledge that are complementary at the national and community level. Manpower planning should be responsive to the needs of the health system, the clients, and workers in an intersectoral system. FP workers need to receive training in how to be sensitive to those in greatest need. A functional information system is basic to manpower planning.^ieng