Factors associated with bypassing primary healthcare facilities for childbirth among women in Devchuli municipality of Nepal

BACKGROUND

It is crucial to deliver a child at nearby primary healthcare facilities to prevent subsequent maternal or neonatal complications. In low-resource settings, such as Nepal, it is customary to forgo the neighboring primary healthcare facilities for child delivery. Reports are scanty about the extent and reasons for bypassing local health centers in Nepal. This study sought to determine the prevalence and contributing factors among women bypassing primary healthcare facilities for childbirth.

METHOD

A community-based cross-sectional study was carried out in the Devchuli municipality of Nawalparasi East district of Nepal. Utilizing an online data collection tool, structured interviews were conducted among 314 mothers having a child who is less than one year of age.

RESULTS

This study showed that 58.9% of the respondents chose to bypass their nearest primary healthcare facility to deliver their babies in secondary or tertiary hospitals. Respondent's husband's employment status; informal employment (AOR: 4.2; 95% CI: 1.8-10.2) and formal employment (AOR: 3.2; 95% CI: 1.5-6.8), wealth quintile (AOR: 3.7; 95% CI: 1.7-7.7), parity (AOR): 3.0; 95% CI: 1.6-5.7], distance to nearest primary healthcare facility by the usual mode of transportation (AOR: 3.0; 95% CI: 1.5-5.6) and perceived service quality of primary healthcare facility (AOR: 3.759; 95% CI: 2.0-7.0) were associated with greater likelihood of bypassing primary healthcare facility.

CONCLUSION

Enhancing the quality of care, and informing beneficiaries about the importance of delivering children at primary healthcare facilities are essential for improving maternal service utilization at local primary healthcare facilities.

Breast self-examination: Knowledge, practice and associated factors among 20 to 49 years aged women in Butwal sub-metropolitan, Rupandehi, Nepal

BACKGROUND

Breast cancer is the second most common cancer in the world and also among Nepalese women. Breast self-examination is an important, cheap, and easy method for early diagnosis of breast cancer which can be cured in the majority of cases if diagnosed in the early stages. In developing countries like Nepal where the awareness regarding breast cancer and breast self-examination is poor, breast cancers are diagnosed at late stages resulting in a poor prognosis of the disease. The study assessed knowledge, practice, and factors associated with breast self-examination.

METHODS

A cross-sectional survey was carried out among 262 women in the Butwal sub-metropolitan adopting multi-stage sampling. A pre-tested structured interview schedule and an observation checklist were used to collect the data. Data was entered in EPI-data and necessary univariate, bivariate, and multivariate analyses were done in SPSS.

RESULTS

The study found that more than half of the participants (55.3%) had poor knowledge of BSE. Only one-fourth (27.1%) of them were practicing BSE and among them, most of them (93.0%) had poor practice. The factors such as ethnicity from Brahmin/Chhetri [AOR = 2.099, 95% CI (1.106-3.981)], use of contraceptive devices [AOR = 9.487, 95% CI (2.166-41.558)], personal history of breast lump [AOR = 12.502, 95% CI (1.639-95.387)], family history of breast cancer [AOR = 5.729, 95% CI (1.337-97.512)], and knowledge of BSE [AOR = 4.407, 95% CI = 2.160-34.650)] were significant determinants of BSE practice among 20-49 years women.

CONCLUSION

The study concluded that most of the women had poor knowledge and practice of breast self-examination. The study also indicated the influence of ethnicity, contraceptives, personal and family history of cancer/early warning signs, and knowledge for practicing breast self-examination. There is an immediate need to increase the knowledge and practice of breast self-examination to prevent and detect breast cancer in its early stage.

Intimate partner violence during pregnancy among married women in Putalibajar municipality, Nepal

Introduction

Intimate partner violence during pregnancy (IPVDP) is increasingly being recognized as a significant problem in the developing world due to its adverse health consequences on both pregnant women and children. The objective of the study is to measure the magnitude of intimate partner violence during pregnancy and the factors associated with IPVDP.

Methods

A community-based cross-sectional study was conducted among 263 married women in their extended postpartum period between October 2019 and March 2020 in Putalibajar municipality, Nepal. A face-to-face interview was conducted and data were collected using an interview schedule. A Chi-square test and logistic regression analysis were performed to examine the association between IPVDP and the independent variables.

Results

Among the 263 women interviewed, 30% experienced IPV during pregnancy, the most common type of violence was controlling behavior (20.2%) followed by emotional (18.6%), sexual (10.6%), economic (6.1%), and physical violence (5.3%). It was observed that IPV was more likely to occur among women whose husbands consumed alcohol (AOR = 3.171; CI 95%: 1.588-9.167), women whose husbands consumed tobacco (AOR =3.815; CI 95%: 2.157-7.265), women who sometimes received family support during pregnancy (AOR =2.948; CI 95%: 1.115-7.793) and women who did not decide on marriage timing (AOR =2.777; CI 95%: 1.331-5.792).

Conclusion

Three out of ten pregnant women experienced IPVDP. To prevent violence, and ensure women's empowerment, formulating strict laws and discouraging the element of a violent milieu is important.

Mental Health Problems and Social Media Exposure during the COVID-19 Pandemic among Adult Population of Nepal

Background The COVID-19 pandemic is a significant global health crisis that poses a threat to a person's psychological well-being. A very large number of people got exposed to social network sites during this period which can be hazardous and cause psychological difficulties. There is no prior research or limited studies in this area during emergencies in Nepal. Objective To assess the mental health issues and examine their relationship with social media exposure in adults. Method A descriptive cross-sectional study was conducted by using a validated scale of Depression, Anxiety, and Stress (DAAS-21) and the Insomnia Severity Index (ISI) among 18 years above adult population. Data were collected through an online survey. Descriptive statistics was used to describe sociodemographic data. Binary logistic regression analysis were performed to examine the relationship between psychological problems and social media exposure. Result Out of 422 participants, the overall prevalence of depression, anxiety, stress, and insomnia among the study population were 32%, 28.4%, 24.5%, and 47% respectively. Additionally, 86.5% of individuals said they were frequently exposed to social media. Age, ethnicity, gender, past health problems, and health status were significantly associated with psychological problems. Further, social media exposure was associated with gender and marital status. There was no evidence of an association of psychological problems with social media exposure. Conclusion Depression, anxiety, stress and insomnia are common mental health problems found in the adult population during the time of the first wave of COVID-19 pandemic and highly affected were under 25 years age. Female and unmarried adults are using more social media.

Health-related quality of life among menopausal women: A cross-sectional study from Pokhara, Nepal

INTRODUCTION

Menopause is the permanent cessation of menstruation. Quality of life is a broad concept affected by an individual's physical health, psychological state, level of independence, societal relationship, and environmental features. During the menopausal period, women can experience various symptoms affecting their quality of life. This study assesses the factors associated with health-related quality of life among menopausal women.

MATERIALS AND METHODS

A community-based cross-sectional study was carried out among 249 menopausal women to assess their health-related quality of life, associated factors, and self-reported health problems. A pre-tested structured interview schedule was used to conduct face-to-face interviews to obtain the information per the study's objective. The Menopausal Rating Scale (MRS) was used to assess the health-related quality of life. Data was entered in Epi-data, and analysis was done using the Statistical Package for Social Sciences (SPSS). Univariate, bivariate, and multivariate analyses were carried out to obtain results per our objectives.

RESULTS

The study found that 51.4% of menopausal women had poor quality of life. The mean and standard deviation of the total MRS score was found to be 9.5±5.3. Ultimately, the factors such as educational attainment {Adjusted Odds Ratio (AOR) = 5.779, 95% Confidence Interval (CI): 2.029-16.459}, medication/treatment of the health problems (AOR = 4.828, 95% CI: 1.662-14.023), alcohol intake status (AOR = 8.006, 95% CI: 2.016-31.785) and physical activity (AOR = 5.746, 95% CI: 1.144-28.872) were significant determinants of quality of life among menopausal women.

CONCLUSION

There is a need to pay proper attention to factors affecting the quality of life to improve the status of menopausal women.

Raised D-dimer among Admitted COVID-19 Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Patients with COVID-19 are characterised by abnormal levels of inflammatory biomarkers. Elevated D-dimer in COVID-19 patients is associated with increased mortality. This study aimed to find out the prevalence of raised D-dimer among COVID-19 patients in a tertiary care centre.

Methods

This descriptive cross-sectional study was conducted in COVID-19 unit of a tertiary care centre from 23 January 2021 to 19 June 2021. The ethical approval was taken from the Institutional Review Committee (Reference number: 077/078/159). D-dimer values and demographic data of the hospital-admitted COVID-19 patients were recorded. Convenience sampling technique was used. Point estimate and 95% Confidence Interval were calculated.

Results

Out of 180 patients with COVID-19 admitted in the hospital, the D-dimer levels were raised in 85 (47.22%) (39.93-54.51, 95% Confidence Interval) patients.

Conclusions

The prevalence of raised D-dimer among admitted COVID-19 patients was found to be lower when compared to other studies conducted in similar settings.

Keywords

COVID-19; D-dimer; Nepal; prevalence.

Health related quality of life and associated factors with medication adherence among tuberculosis patients in selected districts of Gandaki Province of Nepal

Background

Tuberculosis is one of the significant public health problems of Nepal. Adherence to medication is very important for improving quality of life and preventing complication. Adherence to tuberculosis medications has significant economic and therapeutic consequences as non-adherence patients are at greater risk of developing complications which affect their health status and overall quality of life. The study aims to determine the factors associated with medication adherence and its effect on health related quality of life among tuberculosis patients in selected districts of Gandaki Province.

Methods

A health facility based cross-sectional study was carried out among 180 tuberculosis patients registered under DOTS and receiving treatment more than or equal to 60 days. WHOQOL-BREF tools to assess quality of life and Morisky medication adherence scale (MMAS-8) was adopt to assess medication adherence. Data was entered in Epi-data and analysis was performed with the help of the Statistical Package for Social Science (SPSS). The odds ratio with a 95% CI was calculated and p-value of <0.05 was considered as cutoff for statistical significance.

Results

A total 180 TB patients were participated in this study. Overall quality of life ranges from 10.75 to 89.25 with Mean ± SD as 55.96 ± 14.65. More than three-fourth (79.4%) respondents were adhere to medication. Medication adherence and health related quality of life was found statistically significant with relationship with health workers, favourable time at DOTS centre, absence of co-infection. Participants who were highly adhered to medication had good quality of life.

Conclusion

Majority of tuberculosis patients adhering to medication had good quality of life. Especial emphasis should be given to tuberculosis patients with co-infection, health workers should behave friendly and provide appropriate counselling in order to maintain the medication adherence and quality of life.

Anxiety and Depression Among Health Sciences Students in Home Quarantine During the COVID-19 Pandemic in Selected Provinces of Nepal

Aim: This study aimed to assess anxiety and depression among health sciences students at home quarantine during the COVID-19 pandemic in selected provinces of Nepal. Methods: A web-based cross-sectional study was conducted among 409 health science students enrolled at graduate and post-graduate levels in selected universities and their affiliated colleges. Students from selected colleges were asked to fill out a survey, that was made available through email and social media outlets such as Facebook and Viber. The data were downloaded in Excel and imported to SPSS version 16 for analysis. Results : The prevalence of anxiety and depression was 15.7 and 10.7%, respectively. The study showed significant associations between (i) place of province and anxiety; (ii) sleep per day and depression; (iii) hours spent on the internet per day for education and depression; (iv) postponement of final exams and depression. There were no significant associations with the socio-demographic variables. Conclusion: Anxiety and depression in health science students showed correlation with the province, internet use for education, and postponement of exams. These correlations could be common among students in other fields as well. A large-scale study covering a wider geographical area and various fields of education is necessary to further evaluate the impact of COVID-19 on (health sciences) students. The integration of mental health programs both as an intervention and a curriculum level among students is critical to ensure the health of the students.

Maternal and Obstetric Factors Associated with Low Birth Weight

BACKGROUND

Low birth weight is a factor associated with perinatal, neonatal and post-neonatal morbidity and mortality and is associated with development of chronic diseases in adulthood. This study aimed to identify the maternal and obstetric factors associated with low birth weight in selected hospitals of Nepal.

METHODS

Matched case control study was conducted in two tertiary level hospital of Nepal during May 2017 to April 2018. There were 368 mothers with single full term live low birth weight babies (cases) and 736 mothers with single full term live normal birth weight babies (controls) matched on babies' gender and place of delivery included in the study. Multivariable conditional logistic regression analysis was used to eliminate the effects of potential confounders and to identify the independent effect of various risk factors associated with low birth weight.

RESULTS

A total of 1104 respondents (1 case : 2 controls) were included in the study. Multivariable conditional logistic regression analysis revealed that maternal height <146 cm [AOR 5.14, (95%CI:2.03-13.01),(p=0.001)], maternal weight ?50 kg [AOR 3.75,(95%CI:2.15-6.56), (p<0.001)], primi-parity [AOR 4.58, (95%CI:1.71-12.25),(p=0.002)], multi-parity [AOR 3.01,(95%CI: 1.11-8.12),(p=0.030)], rest in day time ?2 hours [AOR 3.68, (95%CI: 2.01-6.75),(p<0.001)], rest in night time for <8 hours [AOR 5.76, (95%CI: 2.32-14.33), (p<0.001)], Iron and folic acid consumption for ?60 days [AOR 5.47, (95%CI: 2.73-10.95),(p<0.001)], Iron and folic acid consumption for 61-120 days [AOR 3.04, (95%CI: 1.90-4.87),(p<0.001), no calcium consumption [AOR 3.00, (95%CI: 1.78-5.04),(p<0.001)] were the significant risk factors associated with Low birth weight Conclusions: Height and weight of women, parity, duration of rest in day time and night time, consumption of Iron and folic acid and calcium were the maternal and obstetric determinants for the occurrence of low birth weight.