Acceptability and feasibility of using vaginal menstrual cups among schoolgirls in rural Nepal: a qualitative pilot study.

INTRODUCTION: Menstrual hygiene management can be challenging in low-income settings and among school-aged girls due to traditional beliefs, lack of knowledge and information on best hygienic practices, and limited access to appropriate and affordable menstrual hygiene products. An alternative method for menstrual hygiene management, instead of sanitary pads or tampons, is the vaginal menstrual cup. As evidence on the use of menstrual cups is relatively limited, this study aimed to explore the acceptability and feasibility of using vaginal menstrual cups among school-aged girls in Thokarpa, Sindupalchowk, Nepal. METHODS: This is an exploratory study based on four focus group discussions with a purposive sample of 28 schoolgirls between 13 and 19 years of age who were provided with vaginal menstrual cups in Thokarpa, Sindupalchowk, Nepal. The data were collected between February and March 2019, i.e. approximately three months after the distribution of the menstrual cup. Participants were included in the study if they had started their menstruation and never given birth. Conventional content analysis was applied. RESULTS: Most participants perceived the menstrual cup positively. Not missing a single class in school due to problems related to menstrual hygiene management was described as a major benefit. The participants found using the menstrual cup easy and convenient, and described economic and environmental advantages of using it. Cleaning the menstrual cup did not cause any problems, according to the participants. Discomforts mentioned by the participants were: pain when inserting the menstrual cup, feeling the menstrual cup sticking out of the vagina, feeling a constant urge to urinate and leakage. Concerns were related to the size, shape and texture of the menstrual cup, and that it may "get stuck" in the vagina, while relatives were said to be concerned about the use of the menstrual cup leading to reduced fertility or losing virginity. CONCLUSION: The use of vaginal menstrual cups for menstrual hygiene management among schoolgirls in Thokarpa, Sindupalchowk, Nepal, appears feasible and acceptable, as it involves practical, economic and environmental advantages. However, the scale-up of menstrual cups will require resolving described concerns and discomforts and fostering peer and family support.

A first step to improving maternal mortality in a low-literacy setting; the successful use of singing to improve knowledge regarding antenatal care.

BACKGROUND: Preventable maternal mortality is related to delays in recognizing the problem, transport to a facility, and receiving appropriate care on arrival. Reducing maternal mortality in low-literacy settings is particularly challenging. In the rural villages of Nepal, the maternal mortality rate is among the highest in the world; the reasons include illiteracy and lack of knowledge of the needs of pregnant women. Culturally, singing and dancing are part of Nepalese daily life and present an opportunity to transmit knowledge of antenatal care and care at birth with a view to reducing the first 2 delays. OBJECTIVE: We hypothesized that health messages regarding the importance of antenatal care and skilled birth assistance would be effectively transmitted by songs in the limited literacy environment of rural Nepal. STUDY DESIGN: We randomly grouped 4 rural village development committees comprising 36 villages into 2 (intervention and control) clusters. In the intervention group, local groups were invited to write song lyrics incorporating key health messages regarding antenatal care to accompany popular melodies. The groups presented their songs and dances in a festival organized and judged by the community. The winning songs were performed by the local people in a song and dance progression through the villages, houses, and fields. A wall chart with the key health messages was also provided to each household. Knowledge of household decision makers (senior men and women) was assessed before and after the intervention and at 12 months using a structured questionnaire in all households that also assessed behavior change. RESULTS: Structured interviews were conducted at baseline, immediately postintervention in the control and intervention areas (intervention n = 735 interviews, control n = 775), and at 12 months in the intervention area only (n = 867). Knowledge scores were recorded as the number of correct items out of 36 questions at baseline and postintervention, and of 21 questions at follow-up. Postintervention, test score doubled in the intervention group from a mean of 11.60/36-22.33/36 (P < .001), with no practically significant change in the control population (17.48/36-18.26/36). Improvement was greatest among the most illiterate members of the community (6.8/36-19.8/36, P < .001). At 12 months follow-up, a majority of the participants (63.9%) indicated that they provided information learned from the songs to their neighbors and friends, and 41.3% reported still singing the songs from the intervention. CONCLUSION: The use of songs bypassed the limitations of literacy in communicating health messages that are key to improving maternal care in this low-literacy rural setting within a developing country. The improvements were maintained without further intervention for 12 months. With appropriate sociocultural adaptation to local contexts, this low-cost method of community education may be applicable to improving maternal health knowledge and behavior change in other low-resource and limited literacy settings that may lead to reductions in maternal mortality.

Validation of an obstetric fistula screening questionnaire in rural Nepal: a community-based cross-sectional and nested case-control study with clinical examination.

OBJECTIVE: To validate a symptom-based fistula screening questionnaire and estimate obstetric fistula (OF) prevalence in rural Nepal. DESIGN: Cross-sectional and nested case-control study. SETTING: Sarlahi District, Nepal. POPULATION: Parous, reproductive age women. METHODS: The questionnaire assessed symptoms of vesicovaginal and rectovaginal fistula (VVF and RVF, respectively), stress and urge urinary incontinence (SUI and UUI, respectively), fecal incontinence (FI), and included interviewer observations on the smell and presence of urine and/or stool. All women who screened positive for OF and a randomly selected group of women who screened negative for OF were included in a nested case-control study (one case, four normal controls, and four incontinent controls) and underwent confirmatory clinical examinations. MAIN OUTCOME MEASURES: Clinically confirmed OF, and questionnaire sensitivity (Se) and specificity (Sp). RESULTS: Of the 16 893 women who completed cross-sectional screening, 68 were screened-positive cases. Fifty-five (82%) screened-positive cases, 203 screened-negative normal controls, and 203 screened-incontinent controls participated in the case-control study, which confirmed one case of VVF and one case of both VVF and RVF without any false-negative cases. For VVF, the screening tool demonstrated Se 100% (95% CI 34.2-100.0%), Sp 86.9% (95% CI 83.3-89.9%), and estimated VVF prevalence as 12 per 100 000 (95% CI 3-43); for RVF, it demonstrated Se 100% (95% CI 20.7-100.0), Sp 99.8% (95% CI 98.6-100.0), and estimated RVF prevalence as 6 per 100 000 (95% CI 1-34). CONCLUSIONS: The OF screening questionnaire demonstrated high sensitivity and specificity in this low-prevalence setting. TWEETABLE ABSTRACT: Community-based obstetric fistula screening tool validation study, Nepal, n = 16 893: High Se, Sp & feasibility.

Fatal aconite poisoning in a rural Nepali traditional healer: clinical challenges and management strategies.

Introduction and importance: Aconite, also known as Aconitum spp., is a group of highly toxic flowering plants used historically in traditional medicine despite their potent neurotoxic and cardiotoxic effects. In rural Nepal, where traditional healing practices are prevalent, accidental ingestion of Aconite remains a significant public health concern due to its resemblance to medicinal herbs. Case presentation: The authors present a case of severe Aconite poisoning in a 45-year-old male traditional healer from rural Nepal. Following ingestion of a homemade herbal tea containing Aconitum species, the patient developed rapid-onset symptoms, including paresthesia around the mouth, severe abdominal pain, and progressive weakness. Upon admission, he exhibited signs of cardiovascular compromise and metabolic acidosis. Despite aggressive management, including gastric lavage, fluid resuscitation, and symptomatic treatment, the patient succumbed to cardiovascular collapse within 12 h of admission. Clinical discussion: Aconite poisoning manifests with early neurological symptoms and progresses to severe gastrointestinal and cardiovascular complications. Its toxicity is attributed to aconitine, which disrupts cellular function by binding to voltage-gated sodium channels. Management focuses on supportive care and symptomatic treatment, given the absence of a specific antidote and challenges in rural healthcare settings. Conclusion: This case underscores the critical need for awareness among healthcare providers and the public regarding the dangers of Aconite. Improved education, healthcare infrastructure, and early intervention are essential in mitigating the morbidity and mortality associated with Aconite poisoning in resource-limited settings.

Delayed diagnosis of pemphigus vulgaris in rural Nepal due to healthcare inaccessibility and harmful traditional practices: A case report.

Early intervention is imperative for potentially fatal dermatologic diseases such as pemphigus vulgaris. In rural Nepal, limited public awareness, home remedies, and delays in healthcare access lead to poor outcomes. Although biopsy confirms the diagnosis, experienced dermatologists can make an accurate clinical diagnosis when characteristic skin lesions are present.

Prevalence of Diabetes and Diabetic Retinopathy in Far-western Province of Nepal.

BACKGROUND: Although diabetes is emerging as growing public health problem, there is limited population based data about the prevalence of the disease in Nepal. METHODS: This cross-sectional population-based survey, conducted in the Far-western province of Nepal from April 2020 to April 2021, used standardized RAAB + DR methodology. Diabetes was diagnosed on the basis of treatment history and random blood sugar test results of greater than 200 mg/dl. Diabetic retinopathy screening was done by ophthalmologists. All relevant data were imported into the RAAB software package (RAAB V.6) for analysis. RESULTS: Among 4615 study population, 2.8 % (n=129) had diabetes, and 35.7% (n=46) of the diabetics were newly identified cases. Of the known diabetics, 61.4% (n=51) never had an eye examination, and only 27.7% (n=23) of cases had their eye checked for DR in the last year. Fundus examination showed 13.2 % (n=17) of the diabetic patients to have some form of diabetic retinopathy and 6.2% (n=8) had diabetic maculopathy. Only 0.8% (n=1) of the cases were categorized as sight-threatening DR but a greater number of diabetes patients had severe visual impairment or blindness (3.9%) as compared to non-diabetic patients (1.8%). CONCLUSIONS: Prevalence of diabetes and DR were relatively lower in Far-western Nepal. However poor coverage of screening examinations have left many of these cases undetected in the communities. Effective community-based diabetes and DR screening and referral programs can help to detect and treat diabetes and DR early on to prevent vision loss and other diabetic complications.

Diagnostic pitfalls in young onset parkinsonism and its unique challenges: A case report from rural Nepal.

Parkinson's disease is a neurodegenerative disease resulting from the loss of dopamine-secreting neurons present in the substantia nigra of the brain. Parkinson's disease is classified as early-onset and late-onset disease based on the time of its presentation. Since young patients with Parkinson's disease have an atypical clinical presentation and have to deal with their careers, raising families, or both at the time of diagnosis and also have a higher risk of drug-related side effects, it poses unique challenges for the patient, clinical team, and community. We present the case of a 40-year-old female with young onset Parkinson's disease from rural Nepal and the challenges faced during and after the disease in a resource-limited setting.

Traumatic diaphragmatic hernia in rural Nepal: A rare case report illuminating diagnostic challenges and healthcare discrepancies.

Traumatic diaphragmatic hernia (TDH), a rare condition, often presents with diverse symptoms and can be undiagnosed for a long time. This case study underscores the significance of considering uncommon ailments, particularly in underserved regions with limited medical access. A woman with recurring epigastric pain and respiratory issues, self-treated for gastritis, was eventually diagnosed with a large diaphragmatic hernia caused by prior trauma. This highlights challenges faced by rural patients due to inadequate healthcare access. Timely diagnosis, even for prolonged symptoms, is crucial. Improved health care and education in underserved areas are essential for timely treatment and better outcomes.

Maternal mental health and economic autonomy in lowland rural Nepal: Do parents-in-law provide constraint or support?

Background and objectives: In patrilocal societies, married women typically co-reside with their parents-in-law, who may act in their son's reproductive interests. These relationships may shape maternal mental health and autonomy. Few studies have examined these dynamics from an evolutionary perspective. Theoretically, marital kin may increase their fitness by increasing maternal investment or by reducing paternity uncertainty. We explored how co-residence with parents-in-law and husband is associated with maternal outcomes to evaluate whether marital kin provide support or constraint. Methodology: We analysed data from 444 households in rural lowland Nepal. Maternal mental health was assessed by General Health Questionnaire. Logistic regression models investigated whether, relative to mothers living with both husband and parents-in-law, those co-resident with other combinations of relatives had poorer mental health and lower household economic autonomy (decision-making, bargaining power), adjusting for socio-economic confounders. Results: Co-residence with husband only, or neither husband nor parents-in-law, was associated with higher odds of mothers reporting feeling worthless and losing sleep but also earning income and making household expenditure decisions. Husband co-residence was associated with overall maternal distress but also with less unpaid care work and greater decision-making responsibility. There were no differences in maternal outcomes for mothers living with parents-in-law only, relative to those living with both husbands and parents-in-law. Conclusions and implications: Co-residence of parents-in-law and husbands was associated with contrasting patterns of maternal mental health and economic autonomy. We suggest that different marital kin place different economic demands on mothers, while restricting their autonomy in different ways as forms of 'mate-guarding'.

Training program for female community volunteers to combat COVID 19 in rural Nepal.

Female Community Health Volunteers (FCHV) in Nepal have identified lack of appropriate training as a barrier to involvement in the COVID 19 response. With more than 50,000 FCHVs serving rural areas of Nepal, they are instrumental in healthcare and are a major source of information delivery to those with the most limited health-care access in Nepal. This communication describes an innovative training programme to rapidly equip FCHVs with knowledge on COVID 19 response. The ongoing programme leverages partnerships between local municipalities and a local community-based organisation and has rapidly trained more than 300 FCHVs across four districts with a population of 1,000,000, and has plans to expand the training across the country. This training programme is a key example of how local partnerships can be utilised for digital training of FCHVs in remote parts of Nepal and leveraged to strengthen response capacity during the pandemic.

Vitamin D Status among Women in a Rural District of Nepal: Determinants and Association with Metabolic Profile-A Population-Based Study.

Hypovitaminosis D is prevalent worldwide, and especially in South-Asia. According to the Institute of Medicine (IOM), 25(OH)D levels below 30 nmol/L are defined as vitamin D deficiency (VDD) and levels between 30−50 nmol/L as insufficiency (VDI). Besides its role in calcium homeostasis, it has been postulated that vitamin D is involved in metabolic syndrome. Given the scarcity of data on vitamin D status in Nepal, we aimed to examine the prevalence of VDD and VDI, as well as the determinants and association with metabolic parameters (lipids, HbA1c), in a cohort of women in rural Nepal. Altogether, 733 women 48.5 ± 11.7 years of age were included. VDD and VDI were observed in 6.3 and 42.4% of the participants, respectively, and the prevalence increased by age. Women reporting intake of milk and eggs > 2 times weekly had higher 25(OH)D levels than those reporting intake < 2 times weekly. Women with vitamin D levels < 50 nmol/L displayed higher levels of cholesterol, LDL-cholesterol, triglycerides, and HbA1c. Additionally, a regression analysis showed a significant association between hypovitaminosis D, dyslipidemia, and HbA1c elevation. In conclusion, VDI was prevalent and increased with age. Milk and egg intake > 2 times weekly seemed to decrease the risk of VDI. Moreover, hypovitaminosis D was associated with an adverse metabolic profile.

Scrub Typhus: Report of Three Cases From Rural Nepal and a Brief Literature Review.

Scrub typhus is endemic among farmers in the rural southern part of Nepal. It is grossly underdiagnosed due to a lack of clinical suspicion and inadequate testing facilities. The most common clinical features of the disease include fever, rashes, vomiting, myalgia, and eschar. The disease may present with ocular changes such as conjunctival injection, gastrointestinal features such as hepatitis and splenomegaly, acute kidney injury (AKI), or neurological findings in the form of meningoencephalitis. Herein, we present a report of three cases of scrub typhus from a rural part of South-west Nepal who failed to receive appropriate treatment initially. One of the patients recovered well with the treatment, the other developed AKI but recovered over the next few weeks. One of the patients died due to sepsis/multiorgan failure secondary to scrub typhus. While managing such cases in places with limited diagnostic facilities, the incorporation of early appropriate empirical therapy for scrub typhus after a careful clinical assessment prevents complications and saves lives.

"Our mothers do not tell us": a qualitative study of adolescent girls' perspectives on sexual and reproductive health in rural Nepal.

Adolescent girls in low- and middle-income countries continue to face poor sexual and reproductive health (SRH). In Nepal, early marriage and motherhood, gender-based violence, and unmet need for contraception remain pervasive. Adolescent girls in rural areas bear a disproportionate burden of poor reproductive health outcomes, but there are limited context-specific data. This is a qualitative study to identify factors that impact adolescent girls' utilisation of and access to SRH services in a rural district of Nepal. We conducted 21 individual interviews with adolescent girls aged 15-19 years, and three focus group discussions with community health workers. We used an inductive analytic approach to identify emergent and recurrent themes and present the themes using the social ecological model. Individual-level factors that contribute to low uptake of services among adolescent girls include lack of knowledge, self-perceived lack of need, low decision-making autonomy, and shyness. Interpersonal factors that impact access include unsupportive family norms, absence of open communication, and need for permission from family members to access care. At the community level, disparate gender norms, son preference, and judgment by community members affect adolescent SRH. Inadequate sex education, far travel distance to facilities, lack of female healthcare providers and teachers, and inability to access abortion services were identified as organisational and systems barriers. Stigma was a factor cross-cutting several levels. Our findings suggest the need for multi-level strategies to address these factors to improve adolescent girls' SRH.

Epidemiology of Inflammatory Bowel Diseases in Nepal.

Introduction Inflammatory bowel diseases (IBD) comprise ulcerative colitis (UC) and Crohn's disease (CD). These are diseases of the gastrointestinal tract without a clear etiology but have strong relationships with underlying factors like genetic susceptibility, environmental factors, and intestinal bacteria. In the east, inflammatory bowel diseases predominantly affect the younger population and have an almost equal gender distribution. With urbanization and the adoption of the western lifestyle, the incidence and prevalence of IBD are increasing in Asia. In this study, we describe the epidemiology of IBD in Nepal. Methods This was an observational study conducted in nine endoscopy centers within Nepal. Two years of data of colonoscopies in these centers were collected retrospectively. IBD was diagnosed by endoscopic examination. The incidence of IBD was calculated as the number of patients with IBD per 1000 colonoscopies per year. The demographic profiles of the patients were also collected. Results A total of 7526 colonoscopies were done in nine centers within the two years study period. IBD was seen in 479 patients (6.3%). The incidence of UC was 23.7 per 1000 colonoscopies per year and the incidence of CD was 1.6 per 1000 colonoscopies per year. UC (87%) was more common than CD (13%). Both UC and CD were mostly seen in the 30 to 40 years age group. In patients with UC, the rectum was the most commonly affected site. Discussion IBD in Nepal affects young males in their thirties. Younger age of affliction with a chronic disease and lack of awareness regarding the symptoms and diagnostic modalities of IBD may result in a delayed diagnosis. The target population must be made aware of the presenting symptoms of IBD and a need for colonoscopic examination for diagnosis. There is also a need for creating a national IBD registry for Nepal.

Access to Health Service and Social Support Related to Self-Medication.

BACKGROUND: In developing countries including Nepal, medicine is easy to purchase with or without prescription over the counter. People's self-medication practice is a leading cause of antibiotic resistance. The purpose of this study was to assess self-medication practice and its influencing factors among rural people of Nepal. METHODS: A cross-sectional survey was conducted from total 62 wards in rural Rolpa district of Nepal.The probability proportional to size was applied to select 6 wards, then 115 households from each ward was selected by applying systematic random sampling.  Data collection was done by interviewing 720 household heads age 18 to 70 years old using a structured questionnaire in Nepal Results: The proportion of regular self-medication practice was 54.6%. Among them, 96.4% practiced self-medication when they got diarrhea/dysentery and 94.2% when they got a stomach ache. The factors associated with self-medication practice included gender (OR=2.24,95%CI=0.23-0.42), age (OR=5.59,95%CI=3.68-8.47), religion(OR=0.57,95%CI=0.42-0.77), family type (OR=4.00,95%CI=2.93-5.47), average income (OR=7.31,95%CI=5.04-10.56), decision making (OR=0.6,95%CI=0.44-0.82, health insurance(OR=1.64,95%CI=1.22-2.22), overall access to health service (OR=3.53,95%CI=2.55-4.90), and appraisal support(OR=2.24, 95%CI=1.66-3.02) Conclusions: Prevalence of self-medication in rural areas of Rolpa district was high among female, older people Accessibility to health service should be improved to reduce risk of self-medication practice. The health promotion related with benefit and side effect from self-medication are important for high risk group i.e. people over 30 years .

The Logarithmic Spiral of Networks of Care for Expectant Families in Rural Nepal: A Descriptive Case Study.

This case study utilizes the four domains of effective Networks of Care (NOC) as a lens to describe the suite of interventions of a biosocial approach to maternal and neonatal health services in rural Nepal: The Network of Safety model, created by the non-governmental organization One Heart Worldwide (OHW) in collaboration with the government health system in Nepal. This approach provides essential guidance in the areas of health financing, governance, sustainability, reflection of user preference, and scalability. OHW addresses the reproductive health needs of women living in remote areas of Nepal in collaboration with local-level health and government workers by emphasizing clinical skill development and mentorship in management and leadership. With Nepal's shift to Federalism, the OHW approach proved flexible and able to deepen its support to leaders in new local-level government structures. The results on the ground were remarkable: using analytic skills gained from their OHW partnership, municipality leaders and health workers demonstrated effective communication and proactive responses to challenges, while maintaining fidelity to the Network of Safety model. The six-year commitment made by OHW to partner municipalities promoted active learning and adaptation and is a clear contributor to the scalability of the OHW Network of Safety. Observing the Network of Safety work through the domains of NOC highlights the interdisciplinary effort required to successfully transform Maternal and Neonatal Health (MNH) services in rural Nepal.

Burden of cervical neoplasia in mid-western rural Nepal: a population-based study.

OBJECTIVE: To assess the burden of cervical neoplasia in mid-western rural, Nepal using cytology, visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). METHOD: A cross-sectional, population-based study was conducted. Total of 2,279 married, non-pregnant women aged 20-65 years participated in a screening clinic from May 2016 to January 2017. All eligible women completed self-report of socio-demographic and reproductive health data followed by screening tests. Biopsies were obtained from areas on the cervix assessed by VIA and or VILI to be abnormal. Final disease was confirmed by biopsy report. RESULTS: A total of 96.09% (n=2,190) women were eligible for this study with mean age 32.78±9.33 years. The overall rate of positive cytology, VIA, and VILI were 3.69%, 12.45%, and 16.89%, respectively. Sixty-two cases were biopsy proven cervical neoplasia. Altogether 78 (3.69%) cases were cytologically abnormal: 25 (1.18%) were atypical squamous cells of undetermined significance, 33 (1.56%) were low-grade squamous intraepithelial lesion, 11 (0.52%) were high-grade squamous intraepithelial lesion, and 9 (0.42%) were squamous cell carcinoma. Illiterate women appeared to be at higher risk for cervical neoplasia (p<0.001). Similarly, age ≥46 years (p<0.013), participant's multiple marriages or sexual partners (p<0.005), and positive human immunodeficiency virus status (p<0.001) were significantly associated with abnormal cytology. CONCLUSION: Based on cytology report, there is 3.69% prevalence of cervical neoplasia among women in a rural region of mid-western, Nepal. A "screen and treat" approach would be more attractive in low resource settings.

Latrine coverage and its utilisation in a rural village of Eastern Nepal: a community-based cross-sectional study.

BACKGROUND: A little more than 1/3rd of the rural households in Nepal have improved latrine facility. The government of Nepal is working towards making an open defecation free area all over Nepal. There is no data found in literature searches regarding the status of latrines and its utilisation in Nepal. This study aims to estimate the coverage and utilisation of latrine and its associated factors in a rural community of Nepal. METHODS: We conducted a cross sectional study in March 2015-September 2015 among 625 households in Hattimuda Village, Morang district in Eastern Nepal using semi-structured pre-tested questionnaire with observational checklists. RESULTS: Out of 623 households, 473 (76.9%) have latrine facilities. There is an increase in latrine coverage in Hattimuda by 37% (38.9% in 2011 to 75.9% in 2016). Majority of the latrines (89.9%) were functional, however 32.3% needs maintenance. The extent of latrine utilisation among those households with a toilet at home was satisfactory (94.3%). Presence of child below 5 years of age at home (OR 2.37, 95% CI 0.05-0.46), functional latrine (OR 27.37, 95% CI 6.84-109.45), frequency of cleaning (OR 3.66, 95% CI 1.09-12.29) and latrine constructed with self-initiation (OR 4.21, 95% CI 1.06-16.66) are factors significantly associated with the utilisation of the latrine. CONCLUSIONS: While the coverage needs to be increased, appropriate interventions to increase the utilisation of latrine needs to be in place so that the village moves closer to open defecation free (ODF) status. As other studies are not found from Nepal, the findings from this study can be used a reference for other rural areas of Nepal.

Work-related injuries among farmers: a cross-sectional study from rural Nepal.

BACKGROUND: Agriculture work is one of the most hazardous occupations across countries of all income groups. In Nepal, 74 % of people are working in the agricultural sector. This study aims to identify patterns and factors associated with injuries among farmers of rural Nepal. METHODS: A community-based cross-sectional study was conducted in a rural village in eastern Nepal. House to house visit was done to collect data from the farmers. The study included 500 farmers from Shanishchare village in Morang district of Nepal. A pre-tested semi-structured questionnaire was used to collect data on socioeconomic profile, agriculture work and injury. Prevalence of injuries among farmers in the last 12 months was calculated along with factors associated with the injuries. RESULTS: The overall prevalence of work- related injuries among farmers was 69 % in the last 12 months. Common injuries among the farmers were cuts (79.7 %), puncture wound (11.3 %) and laceration (7.5 %). Hand tools were responsible for most of the injuries followed by slipping at work, sharp instruments, animals and fall from height. Upper limb injury comprised of 67 % of all injuries and the most involved part was fingers (43 %). The average number of years worked in farming by the respondents was 23.6 ± 13.6 years. Age and working experience of the farmers was found to be significantly associated with the occurrence of injuries among the farmers. CONCLUSIONS: The prevalence of injury among farmers in this study was high. Further research is needed to identify interventions to reduce the agricultural injuries in Nepal.

Burden of cervical neoplasia in mid-western rural Nepal: a population-based study / 부인종양

OBJECTIVE: To assess the burden of cervical neoplasia in mid-western rural, Nepal using cytology, visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). METHOD: A cross-sectional, population-based study was conducted. Total of 2,279 married, non-pregnant women aged 20–65 years participated in a screening clinic from May 2016 to January 2017. All eligible women completed self-report of socio-demographic and reproductive health data followed by screening tests. Biopsies were obtained from areas on the cervix assessed by VIA and or VILI to be abnormal. Final disease was confirmed by biopsy report. RESULTS: A total of 96.09% (n=2,190) women were eligible for this study with mean age 32.78±9.33 years. The overall rate of positive cytology, VIA, and VILI were 3.69%, 12.45%, and 16.89%, respectively. Sixty-two cases were biopsy proven cervical neoplasia. Altogether 78 (3.69%) cases were cytologically abnormal: 25 (1.18%) were atypical squamous cells of undetermined significance, 33 (1.56%) were low-grade squamous intraepithelial lesion, 11 (0.52%) were high-grade squamous intraepithelial lesion, and 9 (0.42%) were squamous cell carcinoma. Illiterate women appeared to be at higher risk for cervical neoplasia (p < 0.001). Similarly, age ≥ 46 years (p < 0.013), participant's multiple marriages or sexual partners (p < 0.005), and positive human immunodeficiency virus status (p < 0.001) were significantly associated with abnormal cytology. CONCLUSION: Based on cytology report, there is 3.69% prevalence of cervical neoplasia among women in a rural region of mid-western, Nepal. A “screen and treat” approach would be more attractive in low resource settings.