Knowledge, Attitude and Practice Regarding Environmental Tobacco Smoke among Pregnant Women of Sunsari.

Background Second hand tobacco smoke or Environmental Tobacco Smoke (ETS), contains toxic substances and carcinogens that cause serious health effects in humans. Studies show that ETS exposure during pregnancy is injurious to the mother-infant pair with long term consequences. Limited studies are found in context of ETS in pregnancy in Nepal. Objective To explore the knowledge about harmful effect of ETS exposure in pregnant women and to know the behavior of avoidance from exposure to ETS during pregnancy. Method A cross sectional study was conducted among 303 pregnant women attending antenatal clinics at the District Hospital Inaruwa and BPKIHS Dharan. A pre-tested semi-structured questionnaire was used to collect data regarding socio-demographic characteristics, knowledge, attitude and practice regarding Environmental tobacco smoke. Data was entered in Excel and analyzed in SPSS 11.5. Result The mean age of the respondents was 23.86±4.68 years. The proportion of primigravida was 53.5% and multi-gravida was 46.5%. Among the respondents, 14% were illiterate and 91% were unemployed. A similar proportion of the husbands (12%) were illiterate. Three-fourth (75%) of the respondents lived in joint family. It was found that 86% of their husbands were smokers. There were 61% of pregnant women who had heard about ETS, mainly through television (35%) and radio (30%). There was 86% of the households who had initiated some measures to prevent smoking inside the house. Conclusion The pregnant women in this study are aware about ETS. However a significant number of them believe that ETS is not harmful compared to active smoking. There is a need for further studies to identify interventions to avoid ETS exposure among the pregnant women.

Non medical interventions for childhood diarrhoea control: way forward in Nepal.

BACKGROUND: Diarrhoeal diseases remain a major cause of mortality of children aged under-five years in the developing countries including Nepal. The transmission of diarrhoea mostly caused by biological agents and is facilitated by the behavioural, social and environmental factors. More recently, the concept of prevention altering these factors is getting momentum. OBJECTIVE: To recommend the most effective non medical intervention that can prevent and control childhood diarrhoeal disease in Nepal. METHODS: Literature review was conducted to analyse the successful interventions in developing countries. Peer review articles were accessed from "Science Direct", "Google Scholar", and "PubMed". Interventions focussing on social and environmental determinants of diarrhoea were included. RESULTS: Four interventions (with primary focus in social and environmental determinants of diarrhoeal disease) were purposively selected, summarized and discussed. Saniya programme (Burkina Faso 1995 to 1998) is considered successful in modifying the risk behaviours. Intensive hand washing programme (Pakistan 2002 to 2003), a cluster randomized controlled trail, was not sustainable as the results did not last long once the free supply of soap was stopped. School Led Total Sanitation (Nepal 2006) is a participatory, community centred program whose focus is on local ownership. This program approach is effective and feasible for scaling up in Nepal. Global Public Private Partnership for Hand washing with Soap (Ghana 2002) was based on the marketing researches and hence yielded effective results. CONCLUSION: Combination of School Led Total Sanitation and Global Public Private Partnership for hand washing with soap suits Nepal. These interventions focus on creating demand, changing behaviour and thereby, improving the sanitation status.

Practices and perceptions on contraception acceptance among clients availing safe abortion services in Nepal.

BACKGROUND: The Government of Nepal has implemented safe abortion policy since 2002. There are 245 approved sites providing safe abortion services to women across the country. Family planning counselling is one of the components of the safe abortion policy, which is important to reduce unwanted pregnancy, maternal morbidity and mortality due to the consequences of unsafe abortion and the service burden. OBJECTIVES: This study explains the perceptions, practices and factors affecting the use of family planning among abortion clients attending safe abortion services in Nepal. METHODS: A cross sectional study was carried out on September, 2008 enrolling 58 women who were waiting in the dressing room for safe abortion services in Paropkar Maternity Hospital, Nepal. All women attending hospital clinic for receiving safe abortion services were approached for interview till the targeted number was fulfilled. A convenience sampling was applied to reach the sample size. RESULTS: Of the 58 respondents, majority of the respondents were Hindus (83%), residing in Kathmandu district (76%); of the age group 20-29 years (69%); and 98% were married. One fifth (20.68 %) of the respondents had previous history of spontaneous or induced abortion. The main reason for abortion did not want any more babies/ complete family (45%). The knowledge of modern contraception was high (98.27%). The knowledge of emergency contraception was low (25.9%). Side effects was the main reason (48%, n=31) for discontinuation of contraceptives. Intention to use some modern family planning methods after the abortion was expressed by 83% clients. The major enabling factor for continued contraceptive use was the absence of side effects. The family planning counselling was acceptable for 91% clients. CONCLUSION: Knowledge, acceptance of counselling service and intention to use family planning measure was high in the study participants. There is need to provide skills on adapting with the adverse effect of family planning measure through continuous education and reinforcement.

Tobacco use among rural Nepalese women: Cross-sectional community based study.

INTRODUCTION: Tobacco use is responsible for a considerable number of morbidity and mortality in the world. Annually 14,000 deaths are attributed to tobacco use in Nepal. Despite having social acceptability of tobacco in Nepalese society, little has been known about tobacco use among rural women. The aim of this study was to report the prevalence of and examine the factors associated with tobacco consumption among women of reproductive age in a rural community of Dailekh district of Nepal. MATERIALS AND METHODS: It was descriptive, cross-sectional study carried out among women of reproductive age in the rural community of Dailekh district. A random sampling was used to obtain 110 women aged 15-49 years. RESULTS: More than two in five were tobacco user and among them 4 in 5 used smoked form of tobacco. This study showed early initiation of tobacco using habit (mean: 14.96 year) where 92% of participants initiated <19 years. Influencing factors for initiation of tobacco use was peer's pressure (95.8%), and respondents reported that they used tobacco to reduce stress (37.5%). CONCLUSION: Tobacco using pattern was high in reproductive age group women. Knowledge and perceptions on tobacco use were poor. Hence, an effective and appropriate community based awareness programs are required to discourage the use of tobacco.

Prevalence and factors associated with childhood overweight/obesity of private school children in Nepal.

INTRODUCTION: Childhood overweight/obesity is a global health problem because of adverse health and nutrition consequences worldwide. Currently, there is a paucity of information on childhood overweight/obesity in Nepal. Therefore, the objective of this study was to assess the prevalence of, and the factors associated with, childhood overweight/obesity among primary school children. METHODS: A cross-sectional study was conducted in June-December, 2013. We collected data using the structured self-administered questionnaire with parents of children aged 6-13 years in grades 1-6 studying at private schools of the Lalitpur district of Nepal. Height and weight measurements of 986 children were taken, and the corresponding body mass index (BMI)-for-age was calculated. The prevalence of childhood overweight/obesity was reported in proportion. Factors associated with childhood overweight/obesity were examined using the Chi-square tests followed by multiple logistic regression analyses. RESULTS: Of 986 children, 144 (14.6%) were overweight and 111 (11.3%) were obese. Overall, 255 (25.9%) children were found to be overweight/obese. Children from families, having ≤2 siblings (adjusted odds ratio (aOR)=1.958, 95% confidence interval (CI): 1.163-3.296), upper class family (aOR=3.672; 95% CI: 1.154-11.690), and advantaged ethnic group (aOR=1.561; 95% CI: 1.00-2.437) and children who were of larger birth weight (>4.0kg) had a greater likelihood of being (aOR=2.557, 95% CI: 1.222-5.349) overweight/obese. CONCLUSIONS: A quarter of children were found to be overweight/obese in private primary schools. Preventive interventions should focus on the advantaged ethnic groups, families with fewer siblings, and upper class families. A greater emphasis ought to be placed on formulation and implementation of policies aimed at addressing the newly emerging problems of childhood overweight/obesity in Nepal. New school health programs are to be launched and strengthened including avoidance of high energy junk food, and promoting outdoor activities.

Opportunistic infections and clinical profile of HIV/AIDS patients: A study from eastern region of Nepal.

There is a wide spread availability of highly active antiretroviral treatment but opportunistic illnesses still occur and result in an increased risk of mortality among persons with HIV/AIDS. The spectrum of illness that one observes, changes as the CD4+ cell count declines. The close relationship between clinical manifestation and CD4+ cell count has made measurement of the latter a routine part of evaluation of the progress of HIV infection in individuals: The objective of this study was to reveal the clinical spectrum and explore the different types of opportunistic infections in HIV/AIDS patients. A total of 234 patients with HIV/AIDS from three ART centers of Eastern Nepal were purposively selected for this cross sectional study conducted from May 2009 to April 2010. Statistical analysis was done using SPSS version 11.5. Chi-squared test and Student's t test were applied to find the association between the variables. A p-value less than 0.05 was considered to be significant. Out of the 234 patient, 85% were found to be symptomatic. Most common presenting symptoms were weight loss (74.4%) followed by fever (59.4%). Around 64% of HIV/AIDS patients had a CD4+ cell count below 200 cells/mm3. Most common opportunistic infections were tuberculosis (51.1%) followed by oral candidiasis (21.7%). A significant relationship (p < 0.001) between decrease in CD4+ cell count and occurrence of opportunistic infections in HIV/AIDS patients was seen.

Comment on "risk factors associated with low birth weight".

In 2011 Oct issue, Journal of Nepal Health Research Council published an article "risk factors associated with low birth weight" by Yadav DK affiliated to School of Health and Allied Sciences, Pokhara University, Chaudhary U affiliated to Child Welfare Scheme, Kaski, and Shrestha N from CIST College, Kathmandu, Nepal. As a result, comments were sent to JNHRC, and are published below.

Perceived discrimination among people living with HIV in Nepal.

BACKGROUND: HIV is one of the major public health problems in Nepal, fuelled by several socio-economic factors. The objective of this study was to explore perceived discrimination among people living with HIV in their own family, society and health facilities. METHODS: A qualitative descriptive cross-sectional study was conducted with semi-structured face-to-face in-depth interview of 18 people (10 men, 8 women) living with HIV in four districts of Nepal. RESULTS: Perceived discriminations among people living with HIV were found among family, society and health facilities. In families, the major forms of perceived discrimination were restriction to go outside, exposure to media and use of different utensils for eating purpose. Female HIV positive perceived more violence at household level than males. Financial restriction was also found imposed upon some respondents by the family for being HIV positive. Similarly, restriction to participate in social work, restriction to buy from shops, social harassment and insult were the main forms of discrimination. Perceived discrimination experienced in the health facility yielded very bitter experiences to some respondents, while many had refused treatment because of their HIV status. CONCLUSIONS: People living with HIV faced different forms of perceived discrimination within family, society and health facility which are thought to be crucial in supporting a person at the time of crisis. Intensive programs that can reduce social stigma and discrimination faced by people living with HIV are a most.