Factors associated with childhood pneumonia and care seeking practices in Nepal: further analysis of 2019 Nepal Multiple Indicator Cluster Survey

BACKGROUND

Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal.

METHODS

This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders.

RESULTS

Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0-2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2-3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4-3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1-5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4-1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all.

CONCLUSIONS

Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized.

Utilization of Cervical Cancer Screening and Associated Factors among Women in Bhaktapur, Nepal

Background Cervical cancer is the most common cancer among women in Nepal causing highest cancer mortality among women of reproductive age. However, it can be prevented through early and regular screening. Objective To assess utilization of cervical cancer screening, its awareness and perception among women, and associated factors. Method A cross-sectional study was conducted where 360 women of age 30-60 years were randomly selected and interviewed from five administrative wards of Bhaktapur municipality. Result Utilization of cervical cancer screening through Pap test or Visual Inspection with Acetic acid was found in 32.2% women and 47.8% were aware of cervical cancer and its screening tests. 100% of them had high level of perceived benefits and facilitators. More than 80% of them had low level of perceived barriers and susceptibility. Women of age group 51-60 years were more likely to perform the screening test (AOR=13.14) whereas unemployed women were at higher odds of performing the test (AOR=3.29). Women who were aware of cervical cancer and its screening were more likely to perform the screening (AOR=53.65). Women having low level of perceived barriers (AOR=5.83) and high level of perceived seriousness (AOR=6.67) were more likely to perform the screening. Conclusion Only one third of women had performed Pap test/VIA and those who were aware of cervical cancer and had high level of perception were more likely to perform the screening. Thus, more rigorous and tailor-made awareness programs should be developed by health program planners to increase the screening rate among younger and working women.

Prevalence and Factors Associated with Postpartum Depression among Mothers Visiting Immunization Clinic at Birendranagar Municipality, Surkhet, Nepal

Background Postpartum depression (PPD) is a disabling but treatable mental disorder that represents one of the most common complications of childbearing which can exert a wide range of effect on social, physical and mental health conditions of the mother and baby. Objective To identify the prevalence and factors associated with postpartum depression among mothers visiting immunization clinic at Birendranagar Municipality, Surkhet in year 2020. Method This study was a cross-sectional study. A total of 347 postpartum mothers were interviewed for data collection. Validated Nepali version of Edinburg Postnatal Depression Scale (EPDS) was used to identify postpartum depression. These mothers were permanent resident of Birendranagar who had delivered their babies in municipal hospital. Analysis was done using SPSS version 21.0. Chi square test was applied to identify association of postpartum depression with major interest of variables namely parity of mother, sex of a baby and recent planned or unplanned pregnancy. Odds ratio (OR) was calculated with 95% Confidence Interval (CI). Result The prevalence of postpartum depression was found to be 32.9% (27.9%, 37.8%). Several factors which were significantly associated with postpartum depression were; sex of the baby, history of abortion and recent pregnancy planned or unplanned. Conclusion Nearly one-third of postpartum mothers had depression. Hence screening of mothers for depression is of prime importance throughout the continuum of care. Likewise, the factors identified for postpartum depression needs to be taken care of well in advance for healthy mother and a baby.

Sleep quality and its correlates among undergraduate medical students in Nepal: A cross-sectional study

Poor sleep quality has been found to affect students' learning abilities, academic performance, and interpersonal relationships. However, little is known about this issue in Nepal. This study aimed to identify the factors associated with poor sleep quality among undergraduate medical students in Nepal. A web-based survey was conducted in March 2021 among 212 undergraduate medical students at the Institute of Medicine, Kathmandu, Nepal. Sleep quality was measured using a 19-item Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression analysis was done to assess the factors associated with sleep quality. In the study participants, 38.2% of the students were identified as poor sleepers. Factors like being depressed (AOR = 4.5, 95% CI; 1.2-5.4), current alcohol use (AOR = 2.5, 95% CI; 1.8-10.8), poor academic achievement (AOR = 3.4, 95% CI; 1.1-10.9), and being a fourth-year student (AOR = 3.6, 95% CI; 1.1-11.8) were significantly associated with poor sleep quality. Poor sleep quality was common among undergraduate medical students. Routine screening of sleep quality and depressive symptoms is necessary to mitigate their impact among medical students. Medical students of the fourth year, current alcohol users, and those who did not have good academic achievement had poor sleep quality. Special attention on these population subgroups is thus needed to enhance sleep quality.

Depression, anxiety and stress among high school students: A cross-sectional study in an urban municipality of Kathmandu, Nepal

Depression and anxiety are the most widely recognized mental issues affecting youths. It is extremely important to investigate the burden and associated risk factors of these common mental disorders to combat them. Therefore, this study was undertaken with the aim to estimate the prevalence and identify factors associated with depression, anxiety, and stress among high school students in an urban municipality of Kathmandu, Nepal. A cross-sectional study was conducted among 453 students of five randomly selected high schools in Tokha Municipality of Kathmandu. Previously validated Nepali version of depression, anxiety, and stress scale (DASS-21) was used to assess the level of symptoms of depression, anxiety and stress (DAS). Multivariable logistic regression was carried out to decide statistically significant variables of symptoms of DAS at p-value<0.05. The overall prevalence of DAS was found to be 56.5% (95% CI: 51.8%, 61.1%), 55.6% (95%CI: 50.9%, 60.2%) and 32.9% (95%CI: 28.6%, 37.4%) respectively. In the multivariable model, nuclear family type, students from science or humanities faculty, presence of perceived academic stress, and being electronically bullied were found to be significantly associated with depression. Female sex, having mother with no formal education, students from science or humanities faculty and presence of perceived academic stress were significantly associated with anxiety. Likewise, female sex, currently living without parents, and presence of perceived academic stress were significantly associated with stress. Prevention and control activities such as school-based counseling services focusing to reduce and manage academic stress and electronic bullying are recommended in considering the findings of this research.

Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial

This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1: n = 94, Study 2: n = 213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control. In Study 2 (depression and psychosis), there were no differences among the three arms. When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos describing depression and psychosis. In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for considering different strategies to address stigma based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761.

Prevalence of Lip Competency among Nepalese Adolescents with different Ethnic group of Kathmandu Valley

Introduction: Esthetic is one of the outcome that is expected from orthodontic treatment. In orthodontic practice, lip protrusion has been observed with proclined upper and lower incisors in bimaxillary protrusion. Such lip protrusion has been shown to be reduced with backward movement of the anterior teeth, which often accompanies premolar extraction. Hence the aim of our study is to find out prevalence of lip competency among Nepalese Adolescents with different ethnic group of Kathmandu valley. Materials & Method: lt is a cross-sectional descriptive study. The study population included 14-18 year-old adolescents studying in high school of all three districts of Kathmandu Valley. An evaluation form was developed categorizing different levels of deep bite following WHO guidelines 1985 and accordingly data were recorded on it. Statistical Analysis: Data were analyzed with descriptive statistics using the Statistical Package for the Social Sciences (SPSS for Windows, Version 23) in which p-values were calculated by Pearson Chi-Square Tests. Result: Out of 935 screened students, 89.6% had competent lips and 10.4% had Incompetent lips. Female showed 91.9% of competent lips and 8.1% of incompetent lips. Male showed 87.8% of competent lips and 12.2% of incompetent lips. Among different ethnic group for lip competency, Advasi/Tharu showed 0.2%, Brahmin/chettri showed 61.6%, Dalit showed 0.6, janajati- Hi showed 35.8%, Madhesi showed 0.7%,Muslim showed 0.6% and others showed 0.3%. Among Brahmin/chettri 56.4% showed competent lips, 5.22% showed incompetent lips. However among Janajati-Hi 30.7% showed competent lips, 5.12% showed incompetent lips. Conclusion: The Prevalence of competent lips was 89.6% and incompetent lips was 10.4%. Among Genders both female and male showed higher percent of competent lips than incompetent lips. However competent lips were more associated with females. Among ethnic groups , Brahmin/chhetri have 61.6% of lip competency whereas Janajati-Hi have 35.8%. Rest of the ethnic group have less than 1% of lip competency. Among Brahmin/chettri 56.4% have competent lips, 5.22% have incompetent lips where as Janajati-Hi 30.7% have competent lips, 5.12% have incompetent lips.

Patterns and determinants of essential neonatal care utilization among underprivileged ethnic groups in Midwest Nepal: a mixed method study

BACKGROUND

Globally in 2017 neonatal death accounted for 46% of under-five deaths. Nepal is among the developing countries which has a high number of neonatal deaths. The rates are high among poor socio-economic groups, marginalized, as well as people living in remote areas of Nepal. This paper, thus tries to examine the utilization pattern and maternal, household, and health service factors affecting underprivileged ethnic groups in Midwest Nepal.

METHODS

A cross-sectional mixed method study was conducted from September 2017 to April 2018 in Bardiya district. Quantitative data were collected from a household survey of women who gave live births within the last 12 months prior to data collection (n = 362). Interviews were also undertaken with 10 purposively selected key informants. Logistic regression model was used to determine the factors associated with essential neonatal care utilization. Thematic analysis was undertaken on the qualitative data.

RESULTS

Overall, neonatal care utilization was 58.6% (53.3-63.7%), with big variations seen in the coverage of selected neonatal care components. Factors such as birth order (2.059, 1.13-3.75), ethnicity (2.28, 1.33-3.91), religion (2.37, 1.03-5.46), perceived quality of maternal and neonatal services (2.66, 1.61-4.39) and awareness on immediate essential newborn cares (2.22, 1.28-3.87) were identified as the determining factors of neonatal care utilization.

CONCLUSIONS

The coverage of birth preparedness and complication readiness, adequate breastfeeding, and postnatal care attendance were very low as compared to the national target for each component. The determinants of essential neonatal care existed at maternal, household as well as health facility level and included ethnicity, religion, perceived quality of maternal and neonatal services, birth order and awareness on immediate essential newborn care. Appropriate birth spacing, improving the quality of maternal and neonatal services at health facilities and raising mother's level of awareness about neonatal care practices are recommended.

Occupational Safety and Health Vulnerability among Brick Factory Workers in Dhading District, Nepal

BACKGROUND

Occupational safety and health vulnerability considers multiple dimensions, such as hazard, policy/procedure to protect workers, workers' awareness and their empowerment to participate in injury prevention. This study attempts to bridge the inadequate knowledge regarding the factors associated with occupational safety and health vulnerability in brick factories.

OBJECTIVES

To identify the status and factors associated with occupational safety and health vulnerability among brick factory workers in Dhading district.

METHODS

A cross-sectional descriptive study was carried out in five brick kilns of Dhading district. A two-stage cluster sampling method was used; at the first stage, probability proportionate to sample size was used to select the brick factories and simple random sampling was used to select participants from each selected brick factory. A total of 201 workers with at least a year of experience and who had worked over the last year in brick factories were included in the study. The data was collected through face-to-face interviews using a structured questionnaire. Vulnerability was defined as exposed to hazards and having inadequate policies, procedures, awareness and empowerment. Pearson Chi-square test was used to examine the relationship between vulnerability and demographic, occupational and workplace characteristics.

RESULTS

Four-fifths of the participants experienced occupational safety and health vulnerability. All participants experienced policy/procedure vulnerability; four-fifths experienced hazard vulnerability and about two-thirds experienced awareness and empowerment vulnerability. Younger, nonnative immigrants, workers carrying bricks out of a chimney and workers from small-sized workplaces experienced higher odds of vulnerability across all domains and overall vulnerability.

CONCLUSION

Occupational safety and health vulnerability was very high among the brick factory workers. Young workers, non-native immigrant workers, workers carrying cooked bricks out of a chimney and workers from small-sized workplace were found to be more vulnerable.

Health care workers' knowledge, attitudes and practices on tuberculosis infection control, Nepal

Background

Infection control remains a key challenge for Tuberculosis (TB) control program with an increased risk of TB transmission among health care workers (HCWs), especially in settings with inadequate TB infection control measures. Poor knowledge among HCWs and inadequate infection control practices may lead to the increased risk of nosocomial TB transmission.

Methods

An institution-based cross-sectional survey was conducted in 28 health facilities providing TB services in the Kathmandu Valley, Nepal. A total of 190 HCWs were assessed for the knowledge, attitudes and practices on TB infection control using a structured questionnaire.

Results

The level of knowledge on TB infection control among almost half (45.8%) of the HCWs was poor, and was much poorer among administration and lower level staff. The knowledge level was significantly associated with educational status, and TB training and/or orientation received. The majority (73.2%) of HCWs had positive attitude towards TB infection control. Sixty-five percent of HCWs were found to be concerned about being infected with TB. Use of respirators among the HCWs was limited and triage of TB suspects was also lacking.

Conclusions

Overall knowledge and practices of HCWs on TB infection control were not satisfactory. Effective infection control measures including regular skill-based training and/or orientation for all categories of HCWs can improve infection control practices in health facilities.

Why study global health?

Kathmandu University Medical Journal Vol.12(2) 2014: 87-88

Leprosy incidence: six years follow-up of a population cohort in Bangladesh

BACKGROUND

With approximately 250,000 new leprosy cases detected annually, transmission of M. leprae appears to be ongoing in many areas of the world. By studying prospectively the number of leprosy patients found in a population sample at the beginning of the study (prevalence) and the number of new patients found during the 6-year observation period (incidence), we aim to understand better the transmission of M. leprae and the burden of disease.

METHODOLOGY

To establish the prevalence and incidence rates of leprosy in the general population of a high endemic area in Bangladesh, we followed prospectively 20,218 individuals from a random cluster sample of the population and examined them at 2-yearly intervals for 6 years.

RESULTS

At intake we found 27 new leprosy cases, indicating a prevalence of previously undiagnosed leprosy of 13.3/10,000. Follow-up at 2, 4 and 6 years revealed 17, 16, and eight new cases, respectively, representing incidence rates of 4.0, 4.5 and 2.3/10,000 PYAR, respectively. The incidence rate over 6 years was 3.7/10,000 PYAR. The observed incidence rate is three times higher than the new case detection rate in the same area. Of all 68 new leprosy cases, five (7%) had MB leprosy. The proportion of children under 15 years was 24%. The proportion of female patients was 60%, but the incidence rate of leprosy was the same for males and females.

CONCLUSIONS

The decline in incidence of leprosy in a general population sample is less pronounced than routine data from a control programme led us to expect.

Household passive smoking and acute respiratory infection among under-five children attending Kanti Children's Hospital

BACKGROUND

Worldwide, children are more heavily exposed to passive smoking than any other age group where majority of these occur in child's house.Children's passive smoking and risk of developing respiratory diseases has been well established in several studies. However, such studies are limited in Nepal. Therefore, the objective of this study was to determine association between household passive smoking and acute respiratory infection among under- five children attending Kanti Children's Hospital.

METHODS

A descriptive, cross-sectional study using quantitative method was carried out in Kanti Children's Hospital. Data was collected by face-to-face interview from 198 parents.Bivariate and multivariate analyses were performed to see association between household passive smoking and acute respiratory infection.

RESULTS

Among 198 children, 79(39.9%)were passive smokers. Among the total passive smokers, 31(39.2%) were exposed to paternal smoking, 18(22.8%) to parental smoking, 18(22.8%) to other member's smoking and 12(15.2%) to maternal smoking. Among 36 daily passive smokers, 18(50.0%) were exposed to high amount and 18(50.0%) to low amount of passive smoking. Household passive smoking had a slight risk of developing acute respiratory infection where adjusted odds ratio was 1.35;however it was not statistically significant.

CONCLUSIONS

Children exposed to passive smoking had a slight risk of developing acute respiratory infection than non-passive smokers however, it was not statistically significant.