Quality of Life of Menopausal Women in Majhifeda VDC, Kavrepalanchok, Nepal.

Background Menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. This is established fact that the quality of life of menopausal women deteriorates as the effect of menopausal symptoms. Objective To assess the physical domain, psychological domain, vasomotor domain for quality of life and its association with selected socio-demographic variables of menopausal women. Method Descriptive cross-sectional study was conducted among the menopausal women aged 45-60 years whose menstruation has ceased for a complete one year naturally excluding those having thyroid disorders and mentally disable. Structured questionnaire was used adopting Nepali version of Modified Menopause-Specific Quality of Life (MENQOL) questionnaire. Data collection was accomplished during August - September 2016. Data entered in MS excel were analysis using SPSS version 21. Descriptive as well as inferential statistics were applied for the data analysis. Result Among vasomotor domain hot flushes or flashes (81.9%), sweating (76.7%) and night sweats (73.3%); among psychosocial domain accomplishing less than I used to (94.8%), experiencing poor memory (80.2%), being impatient with other people (76.7%), feeling depressed down or blue (71.6%), feeling anxious or nervous (55.2%), feeling of wanting to be alone (55.2%) and being dissatisfied with my personal life (37.1%). Among physical domain aching in muscles and joints (94.8%), decrease in physical strength (94.8%), low backache (88.8%), feeling tired or worn out (84.0%), difficulty sleeping (81.0%), aches in back of neck or head (76.7%) were the major symptoms. Among sexual domain vaginal dryness during sexual intercourse (60.3%), avoiding intimacy (52.6%) and change in sexual desire (55.2%) were the major symptoms. Overall observation is that vasomotor symptoms were highest followed by sexual, psychosocial and physical symptoms having statistically significant association between vasomotor symptoms and ethnicity (p=0.019) and sexual symptoms and marital status (p=0.010). Conclusion Majority of the study subjects were from the marginalized groups of people. Vasomotor symptoms had highest prevalence followed by sexual, psychological and physical symptoms. As significant associations were observed between vasomotor symptoms and ethnicity and sexual symptoms and marital status, awareness and periodical checkups were recommended.

Epidemiology of Work-Related Musculoskeletal Symptoms and Illnesses among Brick Kiln Workers in Kathmandu Valley, Nepal.

Background Workers in the brick manufacturing industries require to carry heavy loads, do repetitive work and remain in awkward postures for extended periods of time. These activities may cause them to develop work-related musculoskeletal symptoms and disorders. Objective To investigate the epidemiology of musculoskeletal symptoms and disorders among brick manufacturing workers as well as similar exposure groups among brick kiln workers. Method An analytical cross-sectional study was conducted during February - March 2015 in the Kathmandu Valley. From 16 brick kilns, 400 interviewees involving green brick molding, green brick stacking/carrying, red brick loading/carrying, coal crushing/ carrying and firing were recruited. An unmatched equal size of reference group of grocery workers was maintained for comparison. Prevalence of all musculoskeletal symptoms and disorders were computed and compared among brick workers and grocery workers as well as similar exposure groups among brick kiln workers. Result The musculoskeletal symptoms and disorders were prevalent in 90.5% of the exposed and 82.2% of the reference group. Brick kiln workers were about two times more likely to experience musculoskeletal symptoms and disorders compared to the reference group. When the associations among similar exposure groups were evaluated, there were significantly high prevalence of musculoskeletal symptoms and disorders among green brick molders, red brick loaders/carriers and coal crushers/ carriers in comparison to firemen. Conclusion This study showed a high prevalence of musculoskeletal symptoms and disorders among brick kilns workers. Among all similar exposure groups, coal crushing/carrying task significantly elevated with all types of musculoskeletal symptoms and disorders.

Airborne Particulate Matter and Health Condition in Brick Kiln Workers in Kathmandu Valley, Nepal.

Background Air quality monitoring in brick kilns indicates very high concentrations of airborne particulate matter. Air pollution from brick kilns poses an enhanced threat to the environment and to human health. Objective To evaluate airborne particulate matter concentration and health status of brick kiln workers. Method A cross-sectional comparative study was conducted in the Kathmandu valley targeting all brick industries and their workers during January - March 2015 and March - April 2016. A total of 16 brick kilns and 800 participants (400 brick workers as exposed and 400 grocery workers as referent) were selected for study. A direct-reading, Dusttrak model 8533 was used for air sampling. Nepali version questionnaire was applied to obtain epidemiological data. SPSS version 16 was used to perform statistical analysis. Median, mean, range and proportion were calculated and Mann-Whitney U test, Kruskal-Wallis test and chi square (c2) test were applied to test significance. Result Mean values of particulate matter concentrations for brickfields were as follows: Total Suspended Particulate Matter (TSPM): 5.179 mg/m3, PM10: 4.958 mg/m3, respirable suspended particulate matter (RSPM): 4.140 mg/m3, PM2.5: 3.965 mg/m3, and PM1: 3.954 mg/m3. The mean concentrations for grocery workers were; TSPM: 0.089 mg/ m3, PM10: 0.089 mg/m3, RSPM: 0.085 mg/m3, PM2.5: 0.082 mg/m3 and PM1: 0.082 mg/m3. Among brickfield workers, red and green brick loading zones had results that exceeded the ACGIH Threshold Limit Values for TSPM and RSPM. Workers complaints of injury were 52% and 44.2%, and illnesses were 88.5% and 82.2%, respectively among exposed and referent. The occurrence of injuries/illnesses during work showed significant association between exposed and the referent groups at 0.05 level. Conclusion The high level of airborne particulate matter in the brick fields requires action for the protection of workers. The availability of health services within brick industries needs to be enhanced.

Study of Depression among the Nursing Students in a University Medical College of Nepal.

Nursing students pass through many stressful situations during their academic course. Depression is frequently observed in this student group. Objective To quantify and compare the level of depression among the students undertaking undergraduate and graduate level nursing education in Kathmandu University School of Medical Sciences, Nepal. Method A questionnaire based cross-sectional study was carried out among all the students of Proficiency Certificate Level, Bachelor in Nursing Sciences and B.Sc. Nursing in Kathmandu University School of Medical Sciences, studying in different years during the academic year (2013-14) using Beck Depression Inventory. Descriptive statistics was used for computing scores of Beck Depression Inventory while Pearson correlation was used for analysis of association. Result Among the total 227 students consenting for the study, 212 were amenable for analysis. All of the participants were females, with mean age 20.10 (± 2.2). Almost 40% were found to be having depressive symptoms in variable degrees of severity (Mild-27.4%, Moderate-9%, Severe-1.4%). Frequency of depression was higher among the senior grade students. Agitation, fatigability and sadness were the items having highest mean score; (0.82 ± 0.72), (0.76 ± 0.63), and (0.74 ± 0.52) respectively, while weight loss and loss of libido had the least score, (0.10 ±0.33) and (0.19 ±0.55) respectively. Item on suicidal ideation was significantly correlated with age (p=0.038) and BDI score (< 0.001). Conclusion Depression is common among the nursing students in Nepal; which may also be related to the multitude of stressors they experience during their studentship.

Assessment of Knowledge Regarding Oral Hygiene among Parents of Pre-School Children Attending Pediatric Out Patient Department in Dhulikhel Hospital.

BACKGROUND: Level of knowledge regarding oral hygiene among the parents of pre-school children plays an important role on maintaining the good oral hygiene of their children. In Nepal, sufficient research has not been carried out on this area. OBJECTIVE: Objective of this study is to assess the level of knowledge on oral hygiene of preschool children's parents attending pediatric outpatient department in Dhulikhel Hospital. METHOD: A descriptive study was conducted from November 2012 to January 2013 among one hundred parents of preschool children visiting pediatrics outpatient department of Dhulikhel Hospital. Paper and pencil based semi structured questionnaire was used for collecting data. Questions related to demographic information and knowledge were asked. Thirty questions were used for assessing knowledge level. Knowledge score was calculated by allocating one point for each correct answer and zero point for each wrong answer. Analyzed data were presented in terms of numbers and percentages. Total knowledge scores were categorized based on percentage. Knowledge score was categorized on four group - exclusive intervals - namely-poor (0-40%), moderate (40-60%), good (60-80%) and excellent (80-100%). Mann-Whitney U test and Kruskal-Wallis test were applied to check significance difference and chisquare test was used to check association among different background characteristic. RESULT: It was found that 81% had moderate knowledge, 15% had poor knowledge and 4% had good knowledge about oral hygiene. Median knowledge score was found to be 15 with range 10 to 21. Following variables were found to be significant difference on knowledge category: Education status (p<0.001), education level (p= 0.041), past experience about oral health problem (p = 0.008), Further significant association was found between knowledge category and educational status (p<0.001) and between knowledge category and past experience (p< 0.001). CONCLUSION: Knowledge regarding oral hygiene was found satisfactory among the parents of preschool children visiting pediatric OPD of Dhulikhel Hospital.

School Teachers' Knowledge about Epilepsy in Kathmandu Metropolitan City.

Background Studies on Knowledge towards epilepsy among school teachers are very limited on developing countries especially with reference to Nepal. Level of knowledge of schoolteachers plays an important role on providing a greater educational support for epileptic child and to maintain good communication skills between epileptic and normal child. Objective Objective of this study is to assess the level of knowledge about epilepsy and its associated factors among school teachers. Method A cross sectional study was conducted from 10th June to 4th July, 2014 among 165 teachers teaching in six different schools of Kathmandu Metropolitan City. A selfadministrated questionnaire consisting of structured and multiple choice questions were designed to collect information on the teacher's socio-demographic profile and knowledge about epilepsy. A scoring system was developed for each question: each correct answer was given a score of 1, and a score of 0 for wrong answer. Total score was categorized on two categories: Good Knowledge and Poor Knowledge. Result Teacher's age did not correlate significantly with their knowledge about epilepsy but total years of teaching experiences and knowledge about epilepsy were found to be positively correlated (ρ= 0.165, p= 0.01). Academic qualification of teachers and different teaching level were associated with level of knowledge (p= 0.023, p= 0.021). Significant difference on knowledge score was found among teachers having different academic qualification (p= 0.019). Conclusion All teachers were aware about epilepsy, but their knowledge about epilepsy was not sufficient therefore, health education training program about epilepsy is needed for teachers.

Gender-based violence: a crucial challenge for public health.

This article attempts to summarize the situations of gender-based violence, a major public health issue. Due to the unequal power relations between men and women, women are violated either in family, in the community or in the State. Gender-based violence takes different forms like physical, sexual or psychological/ emotional violence. The causes of gender-based violence are multidimensional including social, economic, cultural, political and religious. The literatures written in relation to the gender-based violence are accessed using electronic databases as PubMed, Medline and Google scholar, Google and other Internet Websites between 1994 and first quarter of 2013 using an internet search from the keywords such as gender-based violence, women violence, domestic violence, wife abuse, violence during pregnancy, women sexual abuse, political gender based violence, cultural gender-based violence, economical gender-based violence, child sexual abuse and special forms of gender-based violence in Nepal. As GBVs remain one of the most rigorous challenges of women's health and well-being, it is one of the indispensable issues of equity and social justice. To create a gender-based violence free environment, a lot works has to be done. Hence, it is suggested to provide assistance to the victims of violence developing the mechanism to support them.

Knowledge and practices on preventive measures of blood borne diseases among non-medical attendants working in Dhulikhel Hospital, Kathmandu University Hospital.

BACKGROUND: Blood and certain body fluids pose the greatest threat to health due to sharp injuries spreading blood borne pathogens that cause serious illness when transmitted. Despite the high sickness rate, sanitation staff lacked awareness regarding protections from contacting soiled materials while handling biomedical wastes. OBJECTIVE: The study aims to find out the knowledge and practices on preventive measures of blood borne diseases among non-medical attendants. Method Descriptive cross-sectional study was conducted to find out the knowledge and practices on preventive measures on blood borne diseases among all the 53 non-medical personnel in Dhulikhel Hospital, Kathmandu University Hospital. Respondents scoring ≥50% on knowledge score were taken as having adequate knowledge. A Nepali version of pre-tested structured and semi-structured questionnaire was used to conduct interview. Participation in the study was voluntary and written consent was taken before inquiry. Outcomes were measured in both descriptive and inferential ways. RESULT: The adequate knowledge was found among 86.8% of the respondents on the blood borne diseases whereas 50.9% of them had proper practice on it. Although, there is poor positive correlation between the mean knowledge score and literacy, the correlation was significant (r = 0.341, p < 0.05). Alike, the mean practice score and work experience demonstrated significant correlation (r = 0.319, p <0.05). CONCLUSION: Although knowledge score of male was high, female had higher practices score. Both knowledge and practice score increased due to the participation in the training programs and increment in experience. There was significant positive correlation between the mean knowledge score and literacy, and the mean practice score and work experience.

The utilization of health care services and their determinants among the elderly population of Dhulikhel municipality.

BACKGROUND: Population ageing is a common problem faced in many countries world-wide. Due to physiological and biochemical changes in the elderly, increased incidence of diseases is observed. There is often low use of health services by the elderly for a variety of reasons. OBJECTIVE: To examine the status of health care utilization and to determine the factors associated with utilization of health care among the elderly population of Dhulikhel Municipality. METHODS: A quantitative descriptive-cross sectional study, with a total number of 200 elderly people residing in Dhulikhel Municipality, was selected for the study. Data were collected across the months of June - July 2011 applying two-staged cluster and systematic random sampling method. Both descriptive and inferential statistics were measured. RESULTS: Sixty eight percent of the elderly visited medical personnel in the past year. Eight percent of them visited the emergency department where most of them reported with symptoms attributed to heart disease. Among 200 elderly, 12.5% of them were admitted to the hospital and 53.0% utilized diagnostic services. Age, marital status, activities of daily living, and regular medication showed significant association with health services utilization at 95% level of confidence (p >0.05). CONCLUSION: Marital status, daily living habits, existence of chronic disease, and regular medication demonstrated significant association with the utilization of health care. Social support services, informal education, and awareness programs targeting the senior citizens and studies covering a diverse population are recommended.

Assessment of the knowledge and attitude on HIV/AIDS among drivers' wives.

BACKGROUND: It is generally accepted and well-documented that long distance drivers remain one of the key forces in the spread of HIV/AIDS as they are highly mobile and spending long hours on the road away from their families which makes them very likely to use the services of commercial sex workers (CSWs). OBJECTIVES: To identify the knowledge and attitude among Drivers' wives on HIV/AIDS. METHODS: A cross-sectional survey was conducted between August and September 2010 to assess the knowledge and attitude of drivers' wives on HIV/AIDS in Banepa, Dhulikhel and Panuti Municipalities, Kavre district central Nepal. Using social network sampling technique 248 drivers' wives were selected. Data were obtained using the structured and semi-structured questionnaire through interview technique. Verbal consent was taken before collecting data. Both descriptive and inferential statistics were computed. RESULTS: Ninety six percent of the respondents heard of HIV/ AIDS. Majority (65.7%) of the sources of the information were television followed by radio (56.5%), friends (33.5%), husband (19.4%), newspapers (17.7%) and posters (17.3%). The educational status and economic status of the respondents show significant association. The parameters regarding attitude revealed statistical significant. CONCLUSION: The age and ethnicity of the respondents did not exhibit the association with awareness on HIV/ AIDS whereas, educational status and economic status of the respondents and the parameters regarding attitude revealed statistical show significant association.

Antenatal care practices in Tamang community of hilly area in central Nepal.

BACKGROUND: Antenatal care is provided during pregnancy to save lives of mother and foetus. World Health Organization recommends four focused visits as sufficient for normal pregnancy. OBJECTIVE: The objective of the study was to find out antenatal care practices in Tamang community of hilly areas of central Nepal. METHODS: Descriptive cross-sectional study was conducted in Tamang community of Lalitpur district. Systematic random sampling method was used to collect data from April to May 2011. Data of 194 women having ≥ 3 years of children was collected and analyzed in descriptive and inferential ways. RESULTS: Antenatal visits were made by 78.9% (153) of women but only 46.4% (71) completed four antenatal visits. Mean visit was of 3.5 +/- 1.13 times. Ninety four (61.4%) of first antenatal visits attainders completed the fourth visit. Age of women and antenatal visits, taking tetanus toxoid injection and knowledge on work of iron tablets exhibited significant association at 95% level of confidence (p less than 0.05). There was also significant association between numbers of childbirth and antenatal visits at 95% level of confidence (p less than 0.05). CONCLUSIONS: There was a high rate of early marriage and early pregnancy in the Tamang communities. Women did not place high importance on antenatal visits. A large percentage did not complete all four recommended antenatal visits. Use of necessary medicine like iron, albendazole tablets and tetanus toxoid injection was often incomplete.