Striving toward safe abortion services in Nepal: A review of barriers and facilitators.

Background and Aims: Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion-related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services. Methods: A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed. Results: Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal/policy, socio-cultural, health systems, and other factors. Facilitators improving access were categorized as economic/geographic/societal, legal/policy, socio-cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal/policy, socio-cultural, geographic/accessibility, and health systems factors. Conclusion: The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse-midwives and community health volunteers are key facilitators.

Osteoporosis and its associated factors among patients attending Manakamana Hospital, Chitwan, Nepal.

BACKGROUND: Osteoporosis is the most common skeletal disorder that weakens bones and increases their susceptibility to fractures. It is becoming an urgent and serious global epidemic. Early diagnosis and treatment are essential to reduce morbidity and mortality associated with it. This study aimed to find out the prevalence of osteoporosis among patients attending at Manakamana Hospital, Bharatpur, Chitwan, Nepal. METHODS: A cross-sectional study was adopted and 623 patients attending at orthopaedic outpatients department (OPD) of Manakamana Hospital were selected using non-probability consecutive sampling technique. Data were collected from 15th October 2021 to 15th April, 2022, by using interview schedule, chart review and Bone Mineral Density (BMD) measurement through calcaneal ultrasonography. Ethical approval was obtained from Nepal Health Research Council Ethical Review Board prior to study procedures. Obtained data were analysed using descriptive statistics. Association between the variables were measured using chi-square test. RESULTS: The mean age of the patients was 43.5 (±14.26) years. Nearly half (44%, n = 274) were middle aged adults, 59.7% were female and 56.0% were involved in agriculture and household chores. Nearly half of the patients (45.7%) were overweight/ obese, 7.9% were smokers and 13.5% had habit of alcohol use. Osteopenia or low bone density was detected in 58.9% patients and 19.4% had osteoporosis. The prevalence of osteoporosis was significantly associated with age group (p = <0.001) and educational status (p = 0.013) of the patients. CONCLUSIONS AND RECOMMENDATIONS: Osteoporosis and osteopenia are prevalent in patients attending in the hospital. Hence, awareness, early screening, and treatment are necessary for the hospital attended patients to enhance their health and, minimize the risk of osteoporosis and the consequences associated with it.

Menstruation hygiene management among secondary school students of Chitwan, Nepal:a cross-sectional study.

BACKGROUND: Despite significant progress in reproductive health, many societies still treat menstruation as disgraceful and shameful process and relate it with negative consequences. This belief and attitude may increase the incidence of reproductive tract infection, leading to significant negative impact on women's health. To manage menstruation hygienically and with dignity, it is essential that women and adolescent girls have sufficient knowledge on menstruation hygiene management. Thus, this study aims to identify the knowledge, associated factors related to menstrual hygiene management (MHM) and effectiveness of health education on MHM. METHODS: A school-based study was conducted between August 2021 to April 2022 among 400 secondary school girls. The sampling unit was selected by using systematic random sampling method. Health education was given in the interval between the pretest and posttest of knowledge assessment on MHM. Logistic regression analysis and Wilcoxon rank test were applied to identify predictors and to evaluate the effectiveness of health education. RESULTS: Overall, 57.7% of the girls had unsatisfactory level of knowledge. Around two third (61.4%) missed school days during the menstrual period. Almost 99.5% had experienced some form of cultural restrictions during the menstrual period. After imparting health education, the level of knowledge on menstruation hygiene had significantly improved (z = 17.129, p = < 0.001) to satisfactory compared to the baseline knowledge level (42.3% vs. 92.5%). During multivariate analysis, factors such as having studied in public schools (AoR = 1.7, p = 0.026), having no or one close female friend (AoR = 2.2, p = 0.011), caste other than Brahmin/Chhetri (AoR = 1.4, p = 0.05) and factors such as living in joint family (AoR = 1.6, p = 0.048) were significantly associated with unsatisfactory level of knowledge on MHM. CONCLUSIONS: A substantial number of respondents had unsatisfactory level of knowledge on MHM. Factors such as ethnicity status, types of family, number of close female friends, types of schools and mothers' education were associated with unsatisfactory level of knowledge. School absenteeism and cultural restriction were found to be common/frequent. Imparting of health education was found to be an effective measure to enhance knowledge on MHM.

Internet Addiction and Associated Factors among Undergraduates.

BACKGROUND: With the surge of internet-based smart gadgets worldwide in 21st century the problem of internet addiction is emerging as a major behavioural addiction pandemic of the contemporary era. Excessive Internet use has become significant mental health concerns especially among students. Internet use has many advantages if used in right fashion, it has an enormous amount of negative consequences as well such as depression, attention deficit and so forth. METHODS: Descriptive cross-sectional study was done among 356 undergraduate students of Bharatpur Metropolitan City of Nepal. Multistaged random sampling was applied to select undergraduate students and semi structured self-administered questionnaire along with structured standard Young's tool for Internet Addiction Test was used for collecting information during June 2019 to August 2019. RESULT: Alarmingly High proportions of participants (73%) were found addicted to Internet, where, 48%, 20.5% and4.5% had mild, moderate and severe Internet addiction respectively. Higher prevalence of Internet addiction was observed among those whose father's occupation was 'foreign employment' as compared to agriculture. (AOR?=?2.34, 95% CI 1.02-5.33, p?=?0.04), Failed in the recent exam as compared to Pass in the recent exam. (AOR = 2.81 CI 1.40 - 3.561, and among non-science stream as compared to science stream (AOR?=?3.10, 95%CI 1.81-5.32), p=<0.001) Conclusions: The finding suggests that prevalence of Internet addiction was tremendously high among undergraduate students. There is critical need of awareness programmes targeted to the students as well as parents regarding the negative impacts of unwise Internet use.

High-Sensitivity Liquid Dielectric Characterization Differential Sensor by 1-Bit Coding DGS.

This paper presents two devices to detect the liquid dielectric characterization. The differential method was used to enhance the robustness and reduce tolerance. A basic sensor based on defected ground structure (DGS) was designed and the optimization for the squares of the DGS via adaptive genetic algorithm was applied to enhance the performance of the microwave sensor, which was shown by the difference of the two resonant frequencies. Furthermore, the electric field distribution was enhanced. Glass microcapillary tubes were used to hold samples to provide an environment of non-invasive. The optimized device exhibited the sensitivity of 0.076, which is more than 1.52 times than the basic structure. It could be considered a sensitive and robust sensor with quick response time for liquid dielectric characterization.

Perception towards Online Teaching-learning in Medical Education among Medical Students during COVID-19 Outbreak in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: The outbreak of coronavirus disease in Nepal led medical colleges to suspend in person teaching-learning activities and ultimately online platform was introduced to deliver the contents of medical education. The objective of this study was to describe the perception of medical students towards online teaching-learning introduced during the COVID-19 outbreak in Nepal. METHODS: An online survey using a descriptive cross-sectional study design was carried out among 515 undergraduate medical students currently enrolled in medical colleges in Nepal. Ethical approval was sought from Nepal Health Research Council to conduct this study, and digital informed consent was taken from study respondents. A semi-structured questionnaire in Google form was utilized to collect data. The link of the Google form was sent to the potential respondents through email and social media. Descriptive statistics, including frequency, percentage, mean, and standard deviation were used to analyze data in Stastical Package for the Social Sciences version 20. Ethical approval was sought from Nepal Health Research Council to conduct this study, and digital informed consent was taken from study respondants. RESULTS: The overall score of perception of online teaching-learning was 17.61±7.19, which indicated many problems in this method of teaching-learning. The mean score of perception of online teaching-learning was found to be different across sex, location of enrolled medical colleges, having a personal electronic device, having an internet connection at residence, having separate room/space for attending online classes, and self-rated computer skills. Moreover, only 28 (5.4%) of respondents had perceived online teaching-learning as a better method of delivering content of medical curricula. CONCLUSIONS: Surveyed medical students in Nepal were found to perceive many problems in online teaching-learning. Moreover, management and faculty members need to take the necessary measures for enhancing the online teaching-learning quality.

Level and Associated Factors of Knowledge regarding Menstrual Hygiene among School-Going Adolescent Girls in Dang District, Nepal.

BACKGROUND: Adolescent girls in developing countries do not have proper information, and proper information is covered up by sociocultural boundaries resulting in various morbidities. This study aimed to determine level of knowledge and its associated factors regarding menstrual hygiene amongst adolescent school girls in Dang district, Nepal. METHODS: Institution-based cross-sectional study was conducted between April and October 2019 among 406 adolescent girls studying in grades 8-10 between ages of 10-19 years in Dang district, Nepal. From a total of 10 local units, 5 were selected randomly. Out of the selected 5 units, 10 schools consisting of 5 government and 5 private schools were selected through disproportionate stratified random sampling. A further 406 students were then selected randomly from the 10 selected schools. Bivariate analysis was used primarily to assess the association between dependent and independent variables. Variables which were associated with bivariate analysis were entered into a multivariable logistic regression model to identify associated factors of menstrual hygiene practice. RESULTS: The mean age and family size were 15.13 ± 1.19 and 5.58 ± 1.81, respectively. A total of 87.7% of adolescents had good knowledge regarding menstrual hygiene. Adolescents living in rural area (AOR = 0.27, CI: 0.12-0.61, p ≤ 0.001), private schools (AOR = 6.10, CI: 1.58-23.46, p ≤ 0.001), mothers who can read and write (AOR = 0.22, CI: 0.07-0.64, p ≤ 0.001), fathers who have up-to-grade-10 education (AOR = 5.15, CI: 1.84-14.39, p ≤ 0.001), and living only with mothers (AOR = 0.29, CI: 0.12-0.69, p ≤ 0.018) were significantly associated with level of knowledge of menstrual hygiene. CONCLUSIONS: Though the majority of respondents had a good level of knowledge regarding menstrual hygiene, there was a knowledge gap in specific areas. The level of knowledge was significantly poor among adolescents in rural areas and those living only with mothers. Thus, this study concerns the need for policy makers to focus on specific education regarding menstrual hygiene in rural areas including both parents.

Facebook use and its effects on the life of health science students in a private medical college of Nepal.

BACKGROUND: Facebook, a popular social networking site, has been used by people of different ages and professions for various purposes. Its use in the field of medical education is increasing dramatically. At the same time, the pros and cons of facebook use among the health science students has attracted the attention of educators. The data regarding its use and the effect on the life of Nepalese health science students has not yet been documented. Therefore, this study is carried out to evaluate the effect of facebook use on social interactions, behaviour, academics, and the health of students in a medical college of Nepal. RESULTS: A cross-sectional descriptive study conducted among medical, dental, nursing and allied health science students using self-administered questionnaire. The study showed that 98.2 % of participants were facebook users. Among 452 respondents, 224 and 228 were male and female respectively, with a mean age of 20.2 ± 1.2 years. The main reason for using facebook was to remain in contact with family and friend (32 %), while its use for the academic purpose was only 5 %. However, 80.8 % of students acknowledged ease in acquiring academic materials from others, through facebook. One-fourth of the students acknowledged that they are using facebook late at night on a regular basis, while surprisingly 4.2 % of the students admitted accessing facebook during the classroom lectures. Almost two-third of the users, further admitted that facebook has had a negative impact on their studies. Burning eyes (21 %), disturbed sleep (19 %), and headache (16 %) were the most common adverse health effects reported by the facebook users. Many students (71.4 %) tried and most of them (68.7 %) succeeded, in reducing time spent on facebook, to allow for increased time devoted to their studies. CONCLUSION: The widespread use of facebook among the health science students, was found to have both positive and negative effects on their academics, social life, and health.

Multiparameter Microwave Characterization and Probing of Ultralow Glucose Concentration Using a Microfabricated Biochip.

This paper presents a planar biochip consisting of electromagnetically coupled, symmetric, square open loops for the multiparameter microwave characterization of deionized water, a phosphate-buffered saline solution, and a fructose-deionized water solution. The characterization additionally includes the probing of an ultralow glucose concentration in a very small volume of human sera and in solutions of d-glucose powder and deionized water. The interaction between the coupled electromagnetic field and the aqueous solution sample translates into a predictable relationship between the electrical characteristics of the biochip (magnitude and phase of S-parameters, attenuation, phase constant, group delay, characteristic impedance, and effective complex permittivity) and the physical properties of the solution. Owing to the microfabrication technology used for fabricating the proposed microbiochip, it is possible to develop robust, compact square open loops with a microsized coupling gap that characterizes a very small volume (1 µL) of the sample. Additionally, the biochip's impedance peaks at its resonances were modeled using glucose-level-dependent coupling capacitance between folded square open loops and mutual inductance between center-loaded T-shaped stubs. These peaks linearly shifted in frequencies and markedly varied in impedance. Consequently, a physiologically relevant amount of glucose (50⁻400 mg/dL) with a high sensitivity (up to 2.036 Ω/(mg·dL-1)) and an ultralow detection limit (up to 4.8 nmol/L) was linearly detected.

Rapid, sensitive, and reusable detection of glucose by a robust radiofrequency integrated passive device biosensor chip.

Tremendous demands for sensitive and reliable label-free biosensors have stimulated intensive research into developing miniaturized radiofrequency resonators for a wide range of biomedical applications. Here, we report the development of a robust, reusable radiofrequency resonator based integrated passive device biosensor chip fabricated on a gallium arsenide substrate for the detection of glucose in water-glucose solutions and sera. As a result of the highly concentrated electromagnetic energy between the two divisions of an intertwined spiral inductor coupled with an interdigital capacitor, the proposed glucose biosensor chip exhibits linear detection ranges with high sensitivity at center frequency. This biosensor, which has a sensitivity of up to 199 MHz/mgmL(-1) and a short response time of less than 2 sec, exhibited an ultralow detection limit of 0.033 µM and a reproducibility of 0.61% relative standard deviation. In addition, the quantities derived from the measured S-parameters, such as the propagation constant (γ), impedance (Z), resistance (R), inductance (L), conductance (G) and capacitance (C), enabled the effective multi-dimensional detection of glucose.

Microstrip triband bandstop filter with sharp stop band skirts and independently controllable second stop band response.

This paper presents a compact planar triband bandstop filter (TBBSF) with compact size and high selectivity. The structure of the filter incorporates two folded trisection stepped-impedance resonators (TSSIRs). One of these resonators is designed to operate at the first and third center frequencies and the other resonator is designed to operate at the second center frequency of the proposed filter. To achieve a compact size filter, alternating impedance lines of the resonators are folded widthwise and also one resonator is embedded within another. Theoretical analysis and design procedures are described, including the synthesis equations for each resonator. The main advantage of the proposed method is that the filter provides flexibility to tune the second center frequency and control the corresponding bandwidth without changing the first and third stop band response. Additionally, several reflection zeros (RZs) are introduced in the pass band to improve its flatness. To demonstrate the feasibility of the proposed design method, both the first and second order TBBSFs were designed, simulated, and fabricated, with center frequencies of 1.92 GHz, 3.55 GHz, and 5.5 GHz.

Pharmacy practice and injection use in community pharmacies in Pokhara city, Western Nepal.

BACKGROUND: Community pharmacies in Nepal serve as the first point of contact for the public with the health care system and provide many services, including administering injections. However, there is a general lack of documented information on pharmacy practice and injection use in these pharmacies. This study aims to provide information about pharmacy practice in terms of service and drug information sources, and injection use, including the disposal of used injection equipment. METHODS: A mixed method, cross-sectional study was conducted in 54 community pharmacies in Pokhara city. Data was collected using a pre-tested, semi-structured questionnaire, and also by the direct observation of pharmacy premises. Interviews with pharmacy supervisors (proprietors) were also conducted to obtain additional information about certain points. RESULTS: Interviews were carried out with 54 pharmacy supervisors/proprietors (47 males and 7 females) with a mean age and experience of 35.54 and 11.73 years, respectively. Approximately a half of the studied premises were operated by legally recognized pharmaceutical personnel, while the remainder was run by people who did not have the legal authority to operate pharmacies independently. About a quarter of pharmacies were providing services such as the administration of injections, wound dressing, and laboratory and consultation services in addition to medicine dispensing and counseling services. The 'Current Index of Medical Specialties' was the most commonly used source for drug information. Almost two-thirds of patients visiting the pharmacies were dispensed medicines without a prescription. Tetanus Toxoid, Depot-Medroxy Progesterone Acetate, and Diclofenac were the most commonly-used/administered injections. Most of the generated waste (including sharps) was disposed of in a municipal dump without adhering to the proper procedures for the disposal of hazardous waste. CONCLUSIONS: Community pharmacies in Pokhara offer a wide range of services including, but not limited to, drug dispensing, counseling, dressing of wounds, and administering injections. However, the lack of qualified staff and adequate infrastructure may be compromising the quality of the services offered. Therefore, the health authorities should take the necessary measures to upgrade the qualifications of the personnel and to improve the infrastructure for the sake of good pharmacy practice and the safer use of injections.