Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study.

Background: The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal. Methods: We conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers. Results: A total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies. Conclusion: Government stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized.

Disempowered Mothers Have Undernourished Children: How Strong Is the Intrinsic Agency?

OBJECTIVE: Undernutrition is one of the leading causes of morbidity and mortality among under-five children, particularly in low-and-middle-income countries. Since women, including mothers, are the primary caregivers of their children, their empowerment status can inherently influence children's nutritional status. Empowerment is, mainly, an intrinsic agency developed as an affective domain trajectory or attitude that guides the skill or behavior. This study aimed to assess the association between women's empowerment and nutritional status of their children. METHODS: A cross-sectional study was carried out among 300 mothers having children aged 6-59 month in rural municipalities of Kaski district in Nepal. Face to face interview and various anthropometric measurements were used to collect data. Chi-square test was performed to assess the association between women's empowerment and children's nutritional status, and multivariable logistic regression was used to assess the strength of association. RESULTS: Of 300 mothers having 6-59 months' children, nearly half (49%) were highly empowered while around 38% children were in poor nutritional status. More than one-fourth (26.7%) children were stunted, 7% were wasted, 17.7% were underweight, and in overall, nearly 38% were in poor nutrition. There was a five-fold increase in odds of wasting, thirty-fold increase in odds of stunting, and twenty-nine-fold increase in odds of underweight among children whose mothers had low empowerment status compared to their counterparts. CONCLUSION: Overall, this study exhibited that maternal empowerment strongly affected children's nutritional status, especially stunting and underweight. Thus, intrinsic factor, mainly education and community membership are suggested to empower them for making their own decisions. Interventions aiming to improve nutritional status of children should include women empowerment incorporating dimensions of material resources. Further empirical evidence is required from trials and cohort studies.

Dropout Analysis of a National Social Health Insurance Program at Pokhara Metropolitan City, Kaski, Nepal.

BACKGROUND: Nepal's national social health insurance (SHI) program, which started in 2016, aims to achieve universal health coverage (UHC), but it faces severe challenges in achieving adequate population coverage. By 2018, enrolment and dropout rates for the scheme were 9% and 38% respectively. Despite government's efforts, retaining the members in SHI scheme remains a significant challenge. The current study therefore aimed to assess the factors associated with SHI program dropout in Pokhara, Nepal. METHODS: A cross-sectional household survey of 355 households enrolled for at least one year in the national SHI program was conducted. Face-to-face interviews with household heads were conducted using a structured questionnaire. Data was entered in Epi-Data and analysed using SPSS. The factors associated with SHI program dropout were identified using bivariate and multiple logistic regression analyses. RESULTS: The findings of the study revealed a dropout prevalence of 28.2% (95% CI: 23.6%-33.2%). Households having more than five members (adjusted odds ratio [aOR]: 2.19, 95% CI: 1.22-3.94), belonging to underprivileged ethnic groups (Dalit/Janajati) (aOR: 2.36, 95% CI: 1.08-5.17), living on rented homes (aOR: 4.53, 95% CI: 1.87-10.95), absence of chronic illness in family (aOR: 1.95, 95% CI: 1.07-3.59), perceived good health status of the family (aOR: 4.21, 95% CI: 1.21-14.65), having private health facility as first contact point (aOR: 3.75, 95% CI: 1.93-7.27), poor availability of drugs (aOR: 4.75, 95% CI: 1.19-18.95) and perceived unfriendly behaviour of service providers (aOR: 3.09, 95% CI: 1.01-9.49) were statistically significant factors associated with SHI dropout. CONCLUSION: In Pokhara, more than one-fourth of households have dropped out of the SHI scheme, which is a significant number. Dropping out of SHI is most commonly associated with a lack of drugs, followed by rental housing, family members' reported good health status and unfriendly service provider behaviour. Efforts to reduce SHI dropout must focus on addressing drugs availability issues and improving providers' behaviour towards scheme holders. Increasing insurance awareness, including provisions to change first contact points, may help to reduce dropouts among rented households, which make up a sizable proportion of the Pokhara metropolitan area.

Barriers to Utilization of Postnatal Care Services: Mothers and Health Providers Perspective.

BACKGROUND: Access to and utilization of post-natal care services is a major challenge as the majority of maternal deaths occur during post-natal period. Although geographical factors and access to health facilities in urban area are feasible as compared to rural area the utilization of all three postnatal visits remains low. Hence, this study aims to explore the barriers in utilization of postnatal care services by mothers from the perspective of mother's and health service providers as well. METHODS: A qualitative study was done using community- based exploratory design in urban area of Kathmandu district. In-depth interview with mothers with infants above 45 days to 1 year of age and key informant interviews with health care providers were done using interview guidelines. Thematic analysis was done. RESULTS: Seven themes emerged through thematic analysis, which were further classified into category and sub categories. Poor recording and reporting system, poor health communication, postnatal care visits less prioritized among maternal health services, prerequisites to construction, and postnatal care services/information dependent on female community health volunteer, less utilization of mass media, and perception of people were identified as barrier for utilization of postnatal services. CONCLUSIONS: The common reason for non-utilization of postnatal care service is identified as poor health communication that resulted in lack of knowledge on the benefit and timing of postnatal care. Lack of awareness among women on postnatal care services shows lack of effort in making postnatal care related information easily available and accessible. Hence, education and awareness on postnatal care services along with proper therapeutic communication is seen essential to complete the continuum of care in maternal health services.

Psychosocial Determinants of Vegetable Intake Among Nepalese Young Adults: An Exploratory Survey.

Background: Adequate intake of vegetables facilitates a healthy lifestyle. However, the majority of Nepalese young adults consume inadequate amount of vegetables per day. Objectives: We explored psychosocial determinants of daily intake of two or more servings of vegetables among Nepalese young adults using attitude, social influence, and self-efficacy (ASE) as a theoretical framework, extended with measures of habit and self-identity as additional constructs. Methods/Participants: A cross-sectional study through a web-based questionnaire survey was conducted among 461 Nepalese young adults aged 18-35 years old. Participants were recruited through convenience (snowball) sampling. A factor-based partial least square structural equation modelling was used for analysis. Results: The findings indicated that attitudes (ß = 0.09, p = 0.029), social influence (ß = 0.17, p < 0.001), habit (ß = 0.24, p < 0.001) and self-identity (ß = 0.30, p < 0.001) were significant factors influencing intention to eat two or more servings of vegetables per day. Further, self-efficacy (ß = 0.10, p = 0.011), habit (ß = 0.08, p = 0.034), diet (ß = -0.10, p = 0.014), and place of residence (ß = 0.11, p = 0.007) significantly influenced behaviour to eat two or more servings of vegetables per day. However, self-efficacy (ß = 0.07, p = 0.062) did not significantly influence intention and self-identity (ß = 0.06, p = 0.083), age (ß = -0.02, p = 0.328), gender (ß = 0.02, p = 0.350), and body mass index (ß = -0.04, p = 0.209) did not significantly influence behaviour to eat two or more servings of vegetables per day. Conclusion: The study shows that attitudes, social influence, habit, and self-identity were significant factors influencing intention to eat two or more servings of vegetables per day. Further, self-efficacy and habit significantly influenced behaviour to eat two or more servings of vegetables per day. However, self-efficacy did not significantly influence intention and self-identity did not significantly influence behaviour to eat two or more servings of vegetables per day.

Health related quality of life and associated factors with medication adherence among tuberculosis patients in selected districts of Gandaki Province of Nepal.

BACKGROUND: Tuberculosis is one of the significant public health problems of Nepal. Adherence to medication is very important for improving quality of life and preventing complication. Adherence to tuberculosis medications has significant economic and therapeutic consequences as non-adherence patients are at greater risk of developing complications which affect their health status and overall quality of life. The study aims to determine the factors associated with medication adherence and its effect on health related quality of life among tuberculosis patients in selected districts of Gandaki Province. METHODS: A health facility based cross-sectional study was carried out among 180 tuberculosis patients registered under DOTS and receiving treatment more than or equal to 60 days. WHOQOL-BREF tools to assess quality of life and Morisky medication adherence scale (MMAS-8) was adopt to assess medication adherence. Data was entered in Epi-data and analysis was performed with the help of the Statistical Package for Social Science (SPSS). The odds ratio with a 95% CI was calculated and p-value of <0.05 was considered as cutoff for statistical significance. RESULTS: A total 180 TB patients were participated in this study. Overall quality of life ranges from 10.75 to 89.25 with Mean ± SD as 55.96 ± 14.65. More than three-fourth (79.4%) respondents were adhere to medication. Medication adherence and health related quality of life was found statistically significant with relationship with health workers, favourable time at DOTS centre, absence of co-infection. Participants who were highly adhered to medication had good quality of life. CONCLUSION: Majority of tuberculosis patients adhering to medication had good quality of life. Especial emphasis should be given to tuberculosis patients with co-infection, health workers should behave friendly and provide appropriate counselling in order to maintain the medication adherence and quality of life.

Quality of Life and Nutritional Status of the Geriatric Population of the South-Central Part of Nepal.

BACKGROUND: The main objective of the study was to assess the nutritional status and quality of life in the geriatric population of Lahan municipality of Siraha district. METHODS: A cross-sectional analytical study was conducted in Lahan municipality of Siraha district from June to December 2017. The Mini-Nutritional Assessment tool was used to investigate the nutritional status, and World Health Organization Quality of Life-OLD questionnaires were used to assess the quality of life among geriatric population. RESULT: Out of the total participants, one-third (45.7%) of the participants were at risk of malnutrition and 19.8% were malnourished while 34.5% had normal nutritional status. It was seen that 48.2% of participants had good quality of life whereas 51.8% of them had poor quality of life. There was a significant association between nutritional status and quality of life in the elderly population. CONCLUSION: The findings showed the need for active ageing interventions to improve the nutritional status and quality of life of elders at the community settings. Proper attention should be focused on elders' nutrition to reduce the observed prevalence of malnutrition, and focus should be given on the nutrition status that leads to improve the quality of life of elders.

Anxiety and Depression Among Health Sciences Students in Home Quarantine During the COVID-19 Pandemic in Selected Provinces of Nepal.

Aim: This study aimed to assess anxiety and depression among health sciences students at home quarantine during the COVID-19 pandemic in selected provinces of Nepal. Methods: A web-based cross-sectional study was conducted among 409 health science students enrolled at graduate and post-graduate levels in selected universities and their affiliated colleges. Students from selected colleges were asked to fill out a survey, that was made available through email and social media outlets such as Facebook and Viber. The data were downloaded in Excel and imported to SPSS version 16 for analysis. Results : The prevalence of anxiety and depression was 15.7 and 10.7%, respectively. The study showed significant associations between (i) place of province and anxiety; (ii) sleep per day and depression; (iii) hours spent on the internet per day for education and depression; (iv) postponement of final exams and depression. There were no significant associations with the socio-demographic variables. Conclusion: Anxiety and depression in health science students showed correlation with the province, internet use for education, and postponement of exams. These correlations could be common among students in other fields as well. A large-scale study covering a wider geographical area and various fields of education is necessary to further evaluate the impact of COVID-19 on (health sciences) students. The integration of mental health programs both as an intervention and a curriculum level among students is critical to ensure the health of the students.

Depression, Anxiety and Stress among the Undergraduate Students of Pokhara Metropolitan, Nepal.

BACKGROUND: The university period is taken as a risk period for the onset of several mental disorders as this period is stressful and most of the lifetime mental disorders start typically during this young age. The present study aimed to assess the prevalence and risk factors associated with depression, anxiety, and stress among undergraduates residing at Pokhara Metropolitan, Nepal. METHODS: A cross-sectional study was conducted among 681 undergraduates from different academic institutions of Pokhara Metropolitan using DASS-21 to assess the level of depression, anxiety, and stress. RESULTS: The overall prevalence of depression, anxiety, and stress among the participants was found to be 38.2%, 46.9%, and 24.1% respectively. The level of depression and stress was not associated with the academic discipline but the higher prevalence was noted among the students from the non-technical group. The major risk factors associated with depression, anxiety and stress were parental education, family history of psychiatric disorders, self-esteem, and academic performance. CONCLUSIONS: The prevalence of mental disorders is high among the undergraduates. Further assessment of these disorders targeting students from different academic disciplines is recommended.

Prevalence of Risk Factors of Major Non-Communicable Diseases among Adolescents of Higher Secondary Schools of Kaski District.

BACKGROUND: The main aim of this study is to determine the prevalence of major non communicable disease risk factors among higher secondary school students. METHODS: A cross-sectional study was conducted among higher secondary students of grade 11 and 12 of Kaski district in Nepal. The study period was from July 2016 to June 2017. Total sample 640 higher secondary students were recruited through two-stage cluster sampling. Self-administrated questionnaire was used for the data collection tool along with other tools which were used such as UNICEF electronic weighing scale, stature meter and mechanical aneroid sphygmomanometer. Ethical approval was obtained from IRC, Pokhara University. Data were entered intoEpiData software and analysis was performed with the help of the Statistical Package for Social Science (SPSS). RESULTS: The prevalence of smoking was 6.1% which was high in male (11.9%) than female (0.6%). Alcohol consumption practice among the adolescents was 18.9%. Family history of hypertension was seen higher than family history of diabetes.The prevalence of hypertension was 11.7%. High prevalence of abnormal values of systolic and diastolic BP was found in male than female students. Overweight was seen in 6.1% students. Prevalence of obesity was almost equal in both groups. CONCLUSIONS: There is high prevalence of smoking, alcoholism among adolescents. Hypertension was more common than overwieght among adolescents.