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Pokhrel TN, Karki K, Tinkari BS, Upreti SR, Khatiwada SU, Amatya R, Zervos J, Kaljee L, Zenlea K, Prentiss T, Maki G, Shallal A, Joshi S, Zervos M, Latack K, Pokhrel B, Upreti A, Lal BK, Dahal S, Gautam JS, Singh DR, Bajracharya DC. COVID-19 vaccination up-take in three districts of Nepal. Hum Vaccin Immunother 2023; 19:2166321. [PMID: 36691997 PMCID: PMC9988332 DOI: 10.1080/21645515.2023.2166321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Vaccine hesitancy during the COVID-19 pandemic continues to be an issue in terms of global efforts to decrease transmission rates. Despite high demand for the vaccines in Nepal, the country still contends with challenges related to vaccine accessibility, equitable vaccine distribution, and vaccine hesitancy. Study objectives were to identify: 1) up-take and intention for use of COVID-19 vaccines, 2) factors associated with vaccine up-take, and 3) trusted communication strategies about COVID-19 and the vaccines. A quantitative survey was implemented in August and September 2021 through an initiative at the Nepali Ministry of Health and Population Department of Health Services, Family Welfare Division. Data were collected from 865 respondents in three provinces (Bagmati, Lumbini, and Province 1). Ordinal multivariate logistic regression was utilized to determine relationships between vaccination status and associated factors. Overall, 62% (537) respondents were fully vaccinated and 18% (159) were partially vaccinated. Those respondents with higher education (p < .001) and higher household income (p < .001) were more likely vaccinated. There were also significant differences in vaccine up-take across the three provinces (p < .001). Respondents who were vaccinated were significantly more likely to perceive vaccines as efficacious in terms of preventing COVID-19 (p = .004) and preventing serious outcomes (p = .010). Among both vaccinated and unvaccinated individuals, there was a high level of trust in information about COVID-19 vaccines provided through local health-care workers [e.g. nurses and physicians]. These results are consistent with other findings within the South Asia region. Targeted advocacy and outreach efforts are needed to support ongoing COVID-19 vaccination campaigns throughout Nepal.
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Affiliation(s)
| | | | | | | | | | | | - John Zervos
- Global Health Initiative, Henry Ford Health, Detroit, MI, USA
| | - Linda Kaljee
- Global Health Initiative, Henry Ford Health, Detroit, MI, USA
| | - Kate Zenlea
- Global Health Initiative, Henry Ford Health, Detroit, MI, USA
| | - Tyler Prentiss
- Global Health Initiative, Henry Ford Health, Detroit, MI, USA
| | - Gina Maki
- Division of Infectious Diseases, Henry Ford Health, Detroit, MI, USA
| | - Anita Shallal
- Division of Infectious Diseases, Henry Ford Health, Detroit, MI, USA
| | - Seema Joshi
- Division of Infectious Diseases, Henry Ford Health, Detroit, MI, USA
| | - Marcus Zervos
- Division of Infectious Diseases, Henry Ford Health, Detroit, MI, USA
| | - Katie Latack
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Bidushi Pokhrel
- Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal
| | | | - Bibek Kumar Lal
- Family Welfare Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Sagar Dahal
- Family Welfare Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Jhalak Sharma Gautam
- Management Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Dipendra Raman Singh
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
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Bose AS, Rai P, Gupta BP, Pradhan R, Lacoul M, Shakya S, Shrestha D, Gautam A, Bhandari B, Shrestha B, Tinkari BS, Jha R, Khanal B, Shrestha P, Bhusal S, Gautam JS. Nepal Measles outbreak response immunization during COVID-19: a risk-based intervention strategy. Vaccine 2022; 40:2884-2893. [PMID: 35300872 PMCID: PMC8882431 DOI: 10.1016/j.vaccine.2022.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
In 2020, National Immunization Programme (NIP) of Nepal implemented a measles outbreak response immunization (ORI) campaign, which was additional to an ongoing preventive measles-rubella SIA campaign. Both campaigns were implemented during ongoing COVID-19 transmission. By April, 220 measles cases and two deaths were confirmed from eight districts of Nepal. The NIP triangulated information from surveillance (measles and COVID-19), measles immunization performance and immunity profile, programme capacities and community engagement and applied a logical decision-making framework to the collated data to inform ‘Go/No-Go’ decisions for ORI interventions. This was reviewed by the National Immunization Advisory Committee (NIAC) for endorsement. Outbreak response with non-selective immunization (ORI), vitamin-A administration and case management were implemented in affected municipalities of four districts, while in the remaining districts outbreak response without ORI were undertaken. The structure and iterative application of this logical framework has been described. ORI was implemented without interrupting the ongoing measles-rubella vaccination campaign which had targeted children from 9 to 59 months of age. The age group for ORI was same as SIA in one sub-district area, while for the other three sub-district areas it was from 6 months to 15 years of age. More than 32,000 persons (97% coverage) were vaccinated in ORI response. Overall measles incidence decreased by 98% after ORI. The daily incidence rate of measles was 94 times higher (95% confidence interval: 36.11 – 347.62) before the ORI compared to two weeks after ORI until year end. Close attention to surveillance and other data to inform actions and seamless collaboration between NIP and core immunization partners (WHO, UNICEF), with guidance from NIAC were key elements in successful implementation. This was an example of feasible application of the global framework for implementation of a mass vaccination campaign during COVID-19 through application of a simple decision-making logical framework.
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Affiliation(s)
- Anindya Sekhar Bose
- World Health Organization (WHO), Department of Immunization Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - Pasang Rai
- WHO Immunization Preventable Disease (IPD) Programme, Nepal.
| | | | | | | | | | | | | | - Bharat Bhandari
- Family Welfare Division (FWD), Dept of Health Services (DOHS), Nepal.
| | | | | | - Runa Jha
- National Public Health Laboratory (NPHL), Ministry of Health and Population, Nepal.
| | - Basudha Khanal
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.
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Adhikari N, Bhattarai RB, Basnet R, Joshi LR, Tinkari BS, Thapa A, Joshi B. Prevalence and associated risk factors for tuberculosis among people living with HIV in Nepal. PLoS One 2022; 17:e0262720. [PMID: 35089953 PMCID: PMC8797228 DOI: 10.1371/journal.pone.0262720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Worldwide tuberculosis (TB) takes more lives than any other infectious diseases. WHO estimates around 68,000 incident TB cases in Nepal. However, in 2018 only around 27,232 new TB cases were reported in the national system, resulting around 40,768 incident TB cases missing every year in Nepal. National Tuberculosis Control Center carried out this study in anti-retroviral therapy (ART) sites to estimate the prevalence of TB and identify the associated risk factors for TB among the people living with Human Immunodeficiency Virus (PLHIVs) in Nepal.
Methods
It was a cross-sectional institution-based study conducted between March and August 2018. Six ART sites with high caseloads of PLHIVs were selected. PLHIVs who were equal or above 18 years of age and were in ART program at the selected study sites were considered eligible for the study. Diagnosis of tuberculosis among PLHIVs who agreed to participate in the study was carried out as per the National Tuberculosis Management Guideline of National Tuberculosis Program of Nepal.
Results
Among 403 PLHIVs, tuberculosis was diagnosed in 40 (9.9%) individuals. Median age of the participants was 36 (30–43) years. Prevalence of TB was significantly higher among male PLHIVs than female PLHIVs (13.6% Vs 5.8%; P = 0.02) and Dalit ethnic group compared to Brahmin/Chettri (22.0%Vs5.9%, P = 0.01). The risk of developing TB was found significant among those with HIV stage progressed to WHO stage 3 and 4 (OR = 4.85, P<0.001) and with the family history of TB (OR = 4.50, P = 0.002).
Conclusions
Prevalence of TB among PLHIVs in Nepal was found 9.9%. Risk of developing TB was higher among PLHIVs who were male, Dalit, with HIV stage progressed to WHO stage 3 and 4 and with family history of TB. Hence, targeted interventions are needed to prevent the risk of developing TB among PLHIVs. Similarly, integrated, and comprehensive TB and HIV diagnosis and treatment services are needed for the management of TB/HIV co-infection in Nepal.
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Affiliation(s)
- Nilaramba Adhikari
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- * E-mail: (NA); (RBB)
| | | | - Rajendra Basnet
- National Tuberculosis Control Center, Thimi, Bhaktapur, Nepal
| | - Lok Raj Joshi
- National Tuberculosis Control Center, Thimi, Bhaktapur, Nepal
| | - Bhim Singh Tinkari
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Anil Thapa
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Basant Joshi
- Institut de Recherche pour le Développement (IRD), UMR 1219, University of Bordeaux, Inserm, Bordeaux, France
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Huang XX, Bose AS, Gupta BP, Rai P, Joshi S, Gautam JS, Tinkari BS, Vandelaer J, Cohen AL, Patel MK. Vaccine preventable diseases surveillance in Nepal: How much does it cost? Vaccine 2021; 39:5982-5990. [PMID: 34419305 PMCID: PMC8494117 DOI: 10.1016/j.vaccine.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/03/2022]
Abstract
Assessing the cost of vaccine preventable diseases (VPD) surveillance is becoming more important in the context of the Global Polio Eradication Initiative (GPEI) funding transition, since GPEI support to polio surveillance helped the incremental building of VPD surveillance systems in many countries, including low income countries such as Nepal. However, there is limited knowledge on the cost of conducting VPD surveillance, especially the national cost for surveillance of multiple vaccine-preventable diseases. The current study sought to calculate the economic and financial costs of Nepal's comprehensive VPD surveillance systems from July 2016 to July 2017. At thecentral level, all surveillance units were included in the sample. At sub-national level, a purposive sampling strategy was used to select a representative sample from locations involved in conducting surveillance. The sub-national sample costs were extrapolated to the nationwide VPD surveillance system. Nepal's total annual economic cost of VPD surveillance was USD 4.81 million or USD 0.18 per capita, while the total financial cost was USD 4.38 million or USD 0.16 per capita. Government expenditures accounted for 56% of the total economic cost, and World Health Organization accounting for 44%. The biggest cost driver was personnel accounting for 51% of the total economic cost. WHO supported trained surveillance personnel through donor funding, mainly from Global Polio Eradication Initiative. As a polio transition priority country, Nepal will need to make strategic choices to fully self-finance or seek full donor support or a mixed-financing model as polio program funding diminishes.
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Affiliation(s)
- Xiao Xian Huang
- Immunization, Vaccines, and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland.
| | - Anindya Sekhar Bose
- World Health Organization Country Office for Nepal, United Nations House, Pulchowk, Lalitpur, Nepal.
| | - Binod Prasad Gupta
- World Health Organization Country Office for Nepal, United Nations House, Pulchowk, Lalitpur, Nepal
| | - Pasang Rai
- World Health Organization Country Office for Nepal, United Nations House, Pulchowk, Lalitpur, Nepal.
| | - Sudhir Joshi
- World Health Organization Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India.
| | | | - Bhim Singh Tinkari
- Family Welfare Division, Department of Health Services, Govt. of Nepal, Nepal
| | - Jos Vandelaer
- World Health Organization Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India.
| | - Adam L Cohen
- Immunization, Vaccines, and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland.
| | - Minal K Patel
- Immunization, Vaccines, and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland.
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Sherpa LY, Tinkari BS, Gentle P, Sah RK, Shrestha A, Sahani SK, Aryal K, Ghimire J, Karki DK. A prospective cohort study to assess the acceptability of Sayana Press among 18-49-year-old women in Nepal. Contraception 2021; 104:623-627. [PMID: 34280441 DOI: 10.1016/j.contraception.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We compared acceptability and continuation of Sayana Press, a subcutaneous formulation of depot-medroxyprogesteone acetate (DMPA) in a Uniject injection system, to intramuscular (IM) DMPA, among both current users of DMPA-IM and new users in Nepal. STUDY DESIGN We recruited women seeking injectable contraception at 14 public health facilities in Nepal selected for geographic diversity. We enrolled women who self-selected either Sayana Press or DMPA-IM and used structured interviews to obtain baseline demographics and assess satisfaction and continuation rates at 1, 3, and 6 months. RESULTS Seven hundred ninety-four women (71%) selected and received Sayana Press, while 318 women (28.6%) selected and received DMPA-IM. One hundred and seventy-eight (48%) women continuing Sayana Press injection reported that they experienced "no possible side effects" compared to 29 (22%) among DMPA-IM selectors during the previous 6 months. The continuation rate of Sayana Press at 6 months was higher than DMPA-IM (Sayana Press 46.5% vs DMPA-IM 34.4%; p < 0.001). Selection of Sayana Press method (ORadj. 1.74; 95% confidence interval 1.32-2.3) and approval from husband (ORadj. 1.59; 95% confidence interval 1.21-2.09) were associated with injection continuation. CONCLUSION Sayana Press is acceptable to women in Nepal with the preference for Sayana Press over DMPA-IM (higher proportion chose the method when counseled and given the option, better continuation). IMPLICATIONS The potential for self-injection with Sayana Press® may have implications for continuation and opportunity for future research and strategies to roll out this innovative technology must be explored.
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Affiliation(s)
| | - Bhim Singh Tinkari
- Family Welfare Division, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | | | | | - Kabita Aryal
- Family Welfare Division, Ministry of Health and Population, Kathmandu, Nepal
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Ashish KC, Peterson SS, Gurung R, Skalkidou A, Gautam J, Malla H, Paudel P, Bhattarai K, Joshi N, Tinkari BS, Adhikari S, Shrestha D, Ghimire B, Sharma S, Khanal L, Shrestha S, Graham WJ, Kinney M. The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal. J Glob Health 2021; 11:05010. [PMID: 34055329 PMCID: PMC8141327 DOI: 10.7189/jogh.11.05010] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal. METHODS We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women's residence in a COVID-19 hotspot area. RESULTS The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% (P < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals declined on average by 20.8% (P < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% (P = 0.001). Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care. Respectful provision of care was better in hospitals with low-volume birth (β = 0.446, P < 0.0001) in comparison to high-medium-volume hospitals. There was a positive association between women's residence in a COVID-19 hotspot area and respectful experience of care (β = 0.076, P = 0.001). CONCLUSIONS The COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a "building-back-better" approach in post-pandemic period.
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Affiliation(s)
- K C Ashish
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Stefan Swartling Peterson
- Department of Women's and Children's Health, Uppsala University, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Rejina Gurung
- Department of Women's and Children's Health, Uppsala University, Sweden
- Research Division, Golden Community, Lalitpur, Nepal
| | | | | | - Honey Malla
- Research Division, Golden Community, Lalitpur, Nepal
| | - Punya Paudel
- Family Welfare Division, Department of Health Services, Nepal
| | | | - Nisha Joshi
- Family Welfare Division, Department of Health Services, Nepal
| | | | | | | | | | | | | | | | | | - Mary Kinney
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Jha D, Adhikari M, Gautam JS, Tinkari BS, Mishra SR, Khatri RB. Effect of COVID-19 on maternal and neonatal services. Lancet Glob Health 2020; 9:e114-e115. [PMID: 33227253 PMCID: PMC7834357 DOI: 10.1016/s2214-109x(20)30482-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Deepak Jha
- Family Welfare Division, Department of Health Services, Kathmandu, Nepal
| | - Mukesh Adhikari
- Integrated Health Information Management Section, Management Division, Department of Health Services, Kathmandu, Nepal; Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | | | - Bhim Singh Tinkari
- Family Welfare Division, Department of Health Services, Kathmandu, Nepal
| | - Shiva Raj Mishra
- World Heart Federation, Geneva, Switzerland; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Resham Bahadur Khatri
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Pradhan R, Sharma Gautam J, Tinkari BS, Adhikari N, Bose AS. Vaccine safety surveillance informs public health policy beyond immunization: A case-series on bleeding following vaccination, Nepal, 2016-2018. Vaccine 2020; 38:6320-6326. [PMID: 32788134 PMCID: PMC7482439 DOI: 10.1016/j.vaccine.2020.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance for adverse events following immunization (AEFI) is important to monitor vaccine safety and should lead to appropriate responses to improve health and immunization program. Bleeding following vaccination is not recognized as an important AEFI. Without policy of vitamin K (VK) prophylaxis at birth, vitamin K deficiency bleeding (VKDB) could be an important cause of bleeding in young infants and may manifest as AEFI. METHODS We retrospectively analysed all serious AEFI cases that presented with external or internal bleeding reported to Nepal's AEFI surveillance system during 2016-2018. The cases were classified as VKDB, suspected VKDB or non-VKDB. RESULTS During the period, 16 serious AEFI with symptom or sign of bleeding were reported representing 21.3% of all serious AEFI reported. Cases were between 40 and 94 days of age. The National AEFI Investigation Committee classified all cases as coincidental. Fourteen cases (87.5%) had bleeding from injection site. Median time from vaccination to injection site bleeding was 4.3 h (interquartile range: 2.1-11.6 h). Six cases (37.5%) had intra-cranial haemorrhage. Only one case had confirmed history of receiving VK at birth. Ten cases (62.5%) received appropriate treatment (VK injection; blood transfusion if needed). Based on limited laboratory investigations available, three cases (18.75%) could be classified as late onset VKDB and 11 cases (68.75%) as suspected late onset VKDB. CONCLUSION VKDB should be suspected in young infants presenting with bleeding including following vaccination, and prompt treatment should be initiated. Bleeding following vaccination should be recognized as an important AEFI as even a small amount of blood loss in young infants can be catastrophic. We posit that this series is a small subset of VKDB cases in Nepal detected through AEFI surveillance system. In countries without policy of VK prophylaxis at birth including Nepal, the policy should be introduced.
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Affiliation(s)
| | - Jhalak Sharma Gautam
- Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
| | - Bhim Singh Tinkari
- Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
| | - Neelam Adhikari
- National AEFI Investigation Committee, C/O Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
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Kc A, Axelin A, Litorp H, Tinkari BS, Sunny AK, Gurung R. Coverage, associated factors, and impact of companionship during labor: A large-scale observational study in six hospitals in Nepal. Birth 2020; 47:80-88. [PMID: 31765037 DOI: 10.1111/birt.12471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Companionship at the time of birth is a nonclinical intervention that has been proven to improve the quality of intrapartum care. This study aims to evaluate the coverage, associated factors, and impact of companionship during labor at public hospitals in Nepal. METHODS We conducted a cross-sectional observational study in six public hospitals in Nepal. The study was conducted from July 2018 to August 2018. Data were collected on sociodemographic, maternal, obstetric, and neonatal characteristics from patient case notes and through predischarge interviews. Coverage of companionship during labor and its association with intrapartum care was analyzed. Bivariate and multivariate analyses were done to assess the association between companionship during labor and demographic, obstetric, and neonatal characteristics. RESULTS A total of 63 077 women participated in the study with 19% of them having a companion during labor. Women aged 19-24 years had 65% higher odds of having a companion during labor compared with women aged 35 years and older (aOR 1.65 [95% CI, 1.40-1.94]). Women who were from an advantaged ethnic group (Chhetri/Brahmin) had fourfold higher odds of having a companion than women from a disadvantaged group (aOR 3.84; [95% CI, 3.24-4.52]). Women who had companions during labor had fewer unnecessary cesarean births than those who had no companions (5.2% vs 6.8%, P < .001). CONCLUSIONS In Nepal, sociodemographic factors affect women's likelihood of having a companion during labor. As companionship during labor is associated with improved quality of care, health facilities should encourage women's access to birth companions.
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Affiliation(s)
- Ashish Kc
- Department of Women and Children, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.,Society of Public Health Physician's Nepal, Kathmandu, Nepal
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Helena Litorp
- Department of Women and Children, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Bhim Singh Tinkari
- Society of Public Health Physician's Nepal, Kathmandu, Nepal.,Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
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Budhathoki SS, Tinkari BS, Bhandari A, Dhimal M, Zhou H, Ghimire A, Basnet O, Wrammert J, KC A. The Association of Childhood Pneumonia with Household Air Pollution in Nepal: Evidence from Nepal Demographic Health Surveys. Matern Child Health J 2020; 24:48-56. [PMID: 31981064 PMCID: PMC7048702 DOI: 10.1007/s10995-020-02882-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Childhood pneumonia is a major cause of mortality worldwide while household air pollution (HAP) is a major contributor to childhood pneumonia in low and middle-income countries. This paper presents the prevalence trend of childhood pneumonia in Nepal and assesses its association with household air pollution. METHODS The study analysed data from the 2006, 2011 and 2016 Nepal Demographic Health Surveys (NDHS). It calculated the prevalence of childhood pneumonia and the factors that cause household air pollution. The association of childhood pneumonia and HAP was assessed using univariate and multi-variate analysis. The population attributable fraction (PAF) of indoor pollution for causing pneumonia was calculated using 2016 NDHS data to assess the burden of pneumonia attributable to HAP factors. RESULTS The prevalence of childhood pneumonia decreased in Nepal between 2006 and 2016 and was higher among households using polluting cooking fuels. There was a higher risk of childhood pneumonia among children who lived in households with no separate kitchens in 2011 [Adjusted risk ratio (ARR) 1.40, 95% CI 1.01-1.97] and in 2016 (ARR 1.93, 95% CI 1.14-3.28). In 2016, the risk of children contracting pneumonia in households using polluting fuels was double (ARR 1.98, 95% CI 1.01-3.92) that of children from households using clean fuels. Based on the 2016 data, the PAF for pneumonia was calculated as 30.9% for not having a separate kitchen room and 39.8% for using polluting cooking fuel. DISCUSSION FOR PRACTICE Although the occurrence of childhood pneumonia in Nepal has decreased, the level of its association with HAP remained high.
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Affiliation(s)
- Shyam Sundar Budhathoki
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- Golden Community, Lalitpur, Nepal
| | - Bhim Singh Tinkari
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Amit Bhandari
- Society of Public Health Physicians Nepal, Kathmandu, Nepal
| | | | - Hong Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Anup Ghimire
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Johan Wrammert
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ashish KC
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Gurung R, Litorp H, Berkelhamer S, Zhou H, Tinkari BS, Paudel P, Malla H, Sharma S, Kc A. The burden of misclassification of antepartum stillbirth in Nepal. BMJ Glob Health 2019; 4:e001936. [PMID: 31908870 PMCID: PMC6936383 DOI: 10.1136/bmjgh-2019-001936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/27/2019] [Accepted: 11/02/2019] [Indexed: 11/04/2022] Open
Abstract
Background Globally, every year 1.1 million antepartum stillbirths occur with 98% of these deaths taking place in countries where the health system is poor. In this paper we examine the burden of misclassification of antepartum stillbirth in hospitals of Nepal and factors associated with misclassification. Method A prospective observational study was conducted in 12 hospitals of Nepal for a period of 6 months. If fetal heart sounds (FHS) were detected at admission and during the intrapartum period, the antepartum stillbirth (fetal death ≥22 weeks prior labour) recorded in patient's case note was recategorised as misclassified antepartum stillbirth. We further compared sociodemographic, obstetric and neonatal characteristics of misclassified and correctly classified antepartum stillbirths using bivariate and multivariate analysis. Result A total of 41 061 women were enrolled in the study and 39 562 of the participants' FHS were taken at admission. Of the total participants whose FHS were taken at admission, 94.8% had normal FHS, 4.7% had abnormal FHS and 0.6% had no FHS at admission. Of the total 119 recorded antepartum stillbirths, 29 (24.4%) had FHS at admission and during labour and therefore categorised as misclassified antepartum stillbirths. Multivariate analysis performed to adjust the risk of association revealed that complications during pregnancy resulted in a threefold risk of misclassification (adjusted OR-3.35, 95% CI 1.95 to 5.76). Conclusion Almost 25% of the recorded antepartum stillbirths were misclassified. Improving quality of data is crucial to improving accountability and quality of care. As the interventions to reduce antepartum stillbirth differ, accurate measurement of antepartum stillbirth is critical. Trial registration number ISRCTN30829654.
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Affiliation(s)
| | - Helena Litorp
- Department of Global Health, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sara Berkelhamer
- Department of Pediatrics, University at Buffalo, Buffalo, New York, United States
| | - Hong Zhou
- Department of Maternal and Child Health, Peking University of Health Sciences, Peking, China
| | | | | | | | | | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Adhikari N, Bhattarai R, Basnet R, Tinkari BS, Gyawali BN, Joshi LR. Prevalence of Human Immunodeficiency Virus Infection among Tuberculosis Patients in Nepal. J Nepal Health Res Counc 2019; 17:15-20. [PMID: 31110370 DOI: 10.33314/jnhrc.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND National Tuberculosis Program has envisioned to provide human immunodeficiency virus testing for all tuberculosis patients. However, human immunodeficiency virus testing coverage among notified tuberculosis patients is very low in Nepal. Hence, it is difficult to reflect the prevalence of human immunodeficiency virus infection among Tuberculosis patients based on the information available from the routine system. Hence National Tuberculosis Program carried out sentinel surveillance to assess the prevalence of human immunodeficiency virus infection among tuberculosis patients and its associated factors in Nepal. METHODS This study is cross-sectional study type conducted at six sentinel sites across the country. This study lasted for six months starting from March 2017 to August 2017. The sample size was calculated using Epiinfo STATCAL application assuming confidence interval at 95%, 85% power and 5% non-response rate. The required sample size was 1672 tuberculosis patients. Ethical approval was obtained from Nepal Health Research Council. All types of tuberculosis patients who were equal or above 15 years were included in the study. Human immunodeficiency viruse testing was performed among tuberculosis patients as per the testing algorithm recommended by national guideline. RESULTS The study was carried out among 1664 tuberculosis patients registered for tuberculosis treatment during the study period. More than two thirds of tuberculosis patients (67%) were male. The median age of tuberculosis patients was found 32 years. During human immunodeficiency virus testing, 41 out of 1664 tuberculosis patients were found human immunodeficiency virus positive resulting human immunodeficiency virus infection seroprevalence among tuberculosis patients to 2.5%. Prevalence of human immunodeficiency virus infection was significantly associated with age (P=0.002), caste/ethnicity (P=0.025), religion (P=0.015) and occupation (P=0.014) of tuberculosis patients. CONCLUSIONS Prevalence of human immunodeficiency virus infection among tuberculosis patients was found 2.5%. Information and access to tuberculosis/human immunodeficiency virus services needs to be increased toaddress tuberculosis-human immunodeficiency virus co-infection in Nepal.
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Affiliation(s)
| | - Ratna Bhattarai
- National Tuberculosis Center/Global Fund Program, Bhaktapur, Nepal
| | - Rajendra Basnet
- National Tuberculosis Center/Global Fund Program, Bhaktapur, Nepal
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