Migrants' risky sexual behaviours in India and at home in far western Nepal

OBJECTIVE

To examine Nepali migrants' vulnerability to HIV/sexually transmitted infections (STIs) and their possible role in causing the epidemic in far western Nepal.

METHODS

From August to October 2000, we conducted six focus group discussions among 53 returned migrants from India, mainly from Mumbai. Data were analysed by interpretative thematic analysis.

RESULTS

Migrants commonly had multiple sexual encounters, changed partners, and used condoms infrequently both in India and at home. Several factors influenced them to practice high-risk sexual behaviours. In India, these included peer norms and pressures, cheaper sex, lack of family restraint, drinking alcohol, and low perceived vulnerability to HIV/STIs. In Nepal, these factors included the migrants' new status, frequent local festivals, and low perceived vulnerability to HIV/STIs. Participants displayed substantial deficits in their knowledge of HIV/STIs.

CONCLUSIONS

This study revealed Nepali migrants' high-risk sexual behaviours both abroad and at home. Understanding these realities will assist in the development of culturally appropriate HIV/STI interventions necessary to halt the spread of HIV/STIs in Nepal.

Community Perception and Readiness for Anti-Helminth Programmes in Rural Nepal

We report on the community perception of helminth infection and readiness to participate in and pay for a community-based anti-helminth programme in rural Nepal. For data collection, 28 focus group discussions (FGDs) were conducted in 28 communities. The FGD results revealed that community members were lacking in scientific knowledge about helminth infection. They also had an unusual perception about it - they believed that a ‘mul juka’ (vital worm) should reside in every person's stomach from birth, and must never be killed. Nonetheless, the results showed that the community members were willing to participate in and were ready to contribute their resources to the anti-helminth programmes as long as modern medicine would not kill the ‘mul juka’. Such community readiness provides us with hope for developing a sustainable anti-helminth programme at the community level through effective health education.

Mumbai disease in far western Nepal: HIV infection and syphilis among male migrant-returnees and non-migrants

OBJECTIVE

To measure the seroprevalence of human immunodeficiency virus (HIV) infection and syphilis, and to assess the behavioural risk factors for these infections among migrant-returnees and non-migrants in far western Nepal.

METHODS

In April 2001, we recruited 97 male migrant-returnees and 40 non-migrants from five rural villages in Doti district where migration to Mumbai is common. For data collection, we conducted a serological examination for HIV and syphilis, and a perception and behaviour survey on HIV and other sexually transmitted infections.

RESULTS

We found that 11 of 137 men (8%) were positive for HIV infection and 30 men (22%) for syphilis. The respondents, especially the migrant-returnees from Mumbai, were engaging in risky behaviours such as pre- or extramarital sex, and sex with multiple partners, including sex workers.

CONCLUSIONS

This study revealed high HIV and syphilis prevalence among the male migrant-returnees and non-migrants in far western Nepal where migration to Mumbai is common. The prevalent behaviours, particularly among the migrant-returnees, imply urgent needs of the behavioural modification programme in this area to prevent the spread of HIV infection to general population.

A traditional healers' training model in rural Nepal: strengthening their roles in community health

In this paper, we evaluated a western medical training model for traditional healers (THs) in rural Nepal. We used semi-structured interviews to compare 48 trainees with 30 randomly selected untrained THs, 1 year after the training was completed. We asked them about their knowledge of the causes, prevention and treatment of common illnesses and HIV/AIDS, and their relationship with government health workers (GHWs) in the area. Nine GHWs were also interviewed about their perceptions of THs. We found that trained THs had a better knowledge of allopathic medicine, practised modern treatment using first aid kits, and were more likely to refer patients to GHWs. They also improved their relationships with the GHWs. Up-scaling this model is a challenge for improving community health care in Nepal in the future.

The need for linking healthcare-seeking behavior and health policy in rural Nepal

In Nepal, little emphasis has been placed on the need to link healthcare-seeking behavior (HCSB) with health policy. The purpose of this study is to identify the HCSB of 405 households that were randomly selected from 28 communities in a hilly region of central Nepal. In assessing HCSB, we found that some form of illness strikes about 50% of households each year. When rural Nepalese are moderately or severely ill, they seek healthcare from traditional healers first, before visiting other health workers. Mild illnesses are treated at home. To improve the health of the rural population, health planners should recognize these realities and incorporate them into the development of health policies.

Health promotion approach for the control of food-borne parasitic zoonoses in Nepal: emphasis on an environmental assessment

Green and Kreuter define health promotion as the use of both education and ecology to encourage and support living conditions conducive to good health. Their PRECEDE-PROCEED model delineates a practical way to cope with health problems using this definition. Applying PRECEDE to Nepal helps identify the steps needed to control the ever-increasing incidence of food-borne parasitic zoonoses (FBPZ) there and in other South Asian countries. In executing the first five steps of the model, we focused on behavioral and environmental assessments to find a method for controlling FBPZ. Through these two assessments, we identified the following behavioral and environmental objectives: establish a meat inspection system by 2003, establish training programs on safe meat production and selling practices by 2003, improve slaughterhouses and slaughtering practices by 2003. The educational and ecological assessments revealed that the necessary predisposing, reinforcing and enabling factors for appropriate control of FBPZ are present in Nepal, while an administration and policy assessment shows Nepal meets PRECEDE requirements through its recent meat inspection legislation. Although the data for each element of the PRECEDE-PROCEED model are limited in Nepal, they clearly tell us to move forward to the PROCEED stage to control FBPZ there as well as in all of South Asia.

Controlling Taenia solium in Nepal using the PRECEDE-PROCEED model

Taenia solium is a predominant food-borne parasitic zoonosis (FBPZ) in Nepal. Using the PRECEDE framework, as defined by Green and Kreuter, we can identify the factors behind the high incidence of this disease. Armed with this information, we can define the actions necessary to control T. solium. In accordance with the first step of PRECEDE, social assessment, we set the goal of decreasing the potential for T. solium transmission in Nepal by the year 2003. This goal has yet to be endorsed by policy makers. However, an epidemiological assessment based on hospital data alone showed that T. solium is an endemic problem in urban Nepal that must be addressed. Based on behavioral and environmental assessments (Steps 1 and 2 of PRECEDE-PROCEED), we defined the following action objectives to be achieved by 2003: 1) Train meat producers and sellers to detect contaminated pork and avoid selling it, 2) Improve pig husbandry to limit the animals' access to human feces, 3) Construct hygienic model slaughterhouses. These improvements could control the meat-producing environment, thus limiting the potential for cross-carcass contamination and other hygiene deficiencies associated with the spread of T. solium. An educational and ecological assessment shows all predisposing, reinforcing and enabling factors are present in Nepal, consistent with PRECEDE requirements. While T. solium is clearly defined as a health problem according to PRECEDE, there remain significant hurdles to controlling it. These hurdles lie in administration and policy, where standardized law-enforcement and meat inspection practices are needed. Finally, the government of Nepal must assign high priority to T. solium control, as it is a preventable, yet prevalent disease.

[Eliminating iodine deficiency disorders in Nepal through precede-proceed]

OBJECTIVES

Assess the PRECEDE-PROCEED model's suitability for developing countries. Analyze the Iodine Deficiency Disorders (IDD) control program in Nepal according to PRECEDE-PROCEED.

METHODS

Primary and secondary data analysis within the framework of PRECEDE-PROCEED's first five steps. Key informant interviews. Qualitative data from Nepal's IDD control program participants were assessed according to PRECEDE-PROCEED's third through fifth steps.

RESULTS

According to the first and second steps of PRECEDE-PROCEED for social and epidemiological assessment, Nepal's IDD control program needs improvement. Limited data were available for the assessment, making it difficult to execute the first two steps with certainty. Social and epidemiological assessments can be problematic in any developing country since the necessary data are typically not available. Behavioral and environmental assessments (step three) showed that: Most people are unaware of IDD and manage iodized salt poorly. The environment within which iodized salt is managed is insufficient for maintaining proper salt iodination at the consumer level. Educational and ecological assessments (step four) pointed out several problems, including: Inadequate understanding of IDD Incorrect beliefs about refined salt Poor supply of refined salt in markets Weak regulation of non-iodized salt importation and sales Finally, administrative and policy assessments (step five) emphasized the need for an active role of the Salt Trading Corporation in Nepal, with a significant manpower and budget, in improving the IDD program. Data for completing PRECEDE-PROCEED steps three through five were readily available. In addition to providing a framework within which to assess Nepal's IDD control program, the model helped highlight specific action goals for behavioral and environmental objectives (consume more iodized salt, improve quality of salt warehouses and increase iodized salt's market availability).

DISCUSSION

Though it was difficult to obtain data for social and epidemiological assessments, the PRECEDE-PROCEED model proved useful in analyzing IDD control in Nepal. The model can comprehensively analyze ongoing interventions and assess the status of various nation-wide health programs, highlighting areas of modification needed to help programs achieve their goals.

Study of Cyclospora cayetanensis in health care facilities, sewage water and green leafy vegetables in Nepal

Cyclospora cayetanensis, a newly emerging parasite, is endemic in Nepal. A total of 2,123 stool specimens were collected from 3 health care facilities based on clinical symptoms during the period between 1995 to October, 1998. Out of these specimens, cayetanensis oocysts were found in 632 (29.8%). To identify possible sources for Cyclospora infection, drinking water, sewage water, green-leafy vegetables including fecal samples of various animals were collected and examined. The vegetable leaves were washed in distilled water then the washings, sewage water and drinking water were centrifuged and the sediment were examined microscopically. As a result, oocyst of Cyclospora were identified in sewage water and vegetable washings on four different occasions in June, August, October and November. The positive results were also confirmed as C. cayetanensis by development of 2 sporocysts after 2 week incubation period in potassium dichromate. A survey of 196 domestic animals from the same areas demonstrated that two chickens were positive for Cyclospora-like organism and others were negative. Although further studies are needed to clarify the direct link between Cyclospora infection and these sources, the results suggest that sewage water, green leafy vegetables are possible sources of infection and chickens could be possible reservoir host of Cyclospora in Nepal.

Role of C fibers in physiological responses to ozone in rats

The purpose of this study was to evaluate the role of C fibers in airway responsiveness after exposure to ozone (O3) in rats. The role of C fibers in the decreases in heart rate (HR) and core body temperature (Tc) that occur after inhalation of O3 was also examined. Neonatal rats were treated with capsaicin (Cap) or the vehicle used to dissolve capsaicin (Veh). Cap has been shown to cause permanent destruction of C fibers. When they reached adulthood, conscious minimally restrained rats were exposed to 2 ppm O3 or to air for 3 h. Two hours after the cessation of exposure, rats were anesthetized and instrumented for the measurement of pulmonary mechanics and airway responsiveness to inhaled aerosolized methacholine. O3 had no effect on baseline pulmonary conductance (GL) in either Veh or Cap rats but did cause a decrease in dynamic compliance (Cdyn) in Cap rats (P < 0.05). In Cap rats, O3 exposure caused a marked increase in airway responsiveness; the doses of inhaled aerosolized methacholine required to decrease GL and Cdyn by 50% were 6.5-fold and 9.8-fold lower in O3-compared with air-exposed rats (P < 0.005). In contrast, in Veh rats, O3 did not alter responsiveness. During O3 exposure, there was a profound, almost 50%, decrease in HR as measured with implanted electrodes. A decrease in Tc (measured with a rectal probe) of approximately 2.5 degrees C also occurred during O3 exposure. There was no significant effect of Cap pretreatment on the magnitude of these O3-induced changes in HR and Tc. Our results are consistent with the hypothesis that C fibers act to inhibit the development of hyperresponsiveness elicited by O3 inhalation but do not contribute to O3-induced changes in HR or Tc.