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AbstractIntroductionThere is evidence of increased morbidity, decreased quality of life, and premature mortality in people living with HIV (PLHIV) who smoke tobacco compared to PLHIV who do not smoke tobacco. Evidence-based screening for tobacco dependence, pharmacological treatment, and treatment monitoring and education into relapse prevention are not readily available in low- and middle-income countries (LMIC). We evaluated the effects of a brief tobacco dependence intervention in improving knowledge on the health effects of smoking and intention to quit smoking in PLHIV in Nepal, a low-income country in south Asia.MethodsUsing a quasi-experimental design, we assigned 59 smokers to participate in the intervention and 67 in the control group. The 1.5 h smoking cessation intervention emphasized harms of smoking, reasons for smoking and quitting, causes of relapse in previous quit attempts, and quitting strategies. We collected data at baseline and immediately post-intervention.ResultsFindings indicate that a brief smoking cessation intervention produced a significant increase in smoking-related knowledge and intention to quit among PLHIV. The positive effects of our intervention remained significant after adjusting for potential confounders.ConclusionsOur brief tobacco dependence intervention was effective in improving knowledge on the health effects of smoking and intention to quit among PLHIV. Further studies are required to evaluate the effectiveness of our intervention in increasing smoking cessation among PLHIV in LMIC.

The purpose of this study was to examine the association between perceived family support, either positive or negative, and adherence to antiretroviral medication regimens among HIV-positive individuals in the Kathmandu Valley, Nepal. We measured past 3-month antiretroviral adherence among 233 HIV-positive individuals, in relation to perceived family support, both positive (in terms of emotional and instrumental support) and negative (in the form of negative interactions), using the 10-item Nepali Family Support and Difficulty Scale. Medium and high levels of perceived emotional support from family were associated with reduced risk of antiretroviral nonadherence, compared with low levels of perceived emotional support (adjusted odds ratio [AOR]  = 0.37, 95% confidence interval [CI] [0.16, 0.88], and AOR  = 0.23, 95% CI [0.08, 0.64], respectively). Conversely, higher levels of felt emotional distance (AOR  = 1.46, 95% CI [1.00, 2.14]) and experienced physical harm (AOR  = 2.04, 95% CI [1.07, 3.91]) were associated with increased risk of nonadherence. The results support the recommendation that service providers need to be aware of the significant role of family support in shaping antiretroviral adherence and to consider ways to strengthen positive family support while minimizing negative family interactions to increase adherence rates.

In many developing countries, poor women have multiple roles, and often their time constraints are so severe that their participation in income‐generating activities results in reduced childcare time, which in turn affects child health. Previous studies have tended to investigate how childcare support influences nutrition of children with working mothers' based on comparisons with non‐working mothers. However, non‐working mothers are not a homogeneous group, and we therefore need to distinguish between those who need not work and those who wish to but cannot, for example, due to a lack of substitute caregivers. We examined the association between availability of childcare support and the nutritional status of children of both non‐working and working mothers in poor areas of Pokhara, a submetropolitan city in Nepal. We recruited 150 children of age 10–24 months from the waiting lists of 17 daycare centers and measured their weights and heights. Those with height‐for‐age and weight‐for‐age Zscores of less than −2 were defined as stunted and underweight, respectively. To collect information on childcare practices and socioeconomic characteristics, mothers were interviewed using a pre‐tested structured questionnaire. Unavailability of adult childcare support was associated with increased risk of malnutrition among children of both non‐working and working mothers. Peer childcare was not significantly associated with child malnutrition among children of non‐working mothers, but it was associated with an increased risk of malnutrition among children of working mothers. Although further longitudinal research is required, we suggest that childcare support from adult substitute caregivers is essential for children of non‐working mothers with limited resources. Am. J. Hum. Biol. 18:169–181, 2006. © 2006 Wiley‐Liss, Inc.

We compared the nutritional status of children aged 1-5 years from slums attending two day-care centres (DCCs) in Nepal (one in an urban slum area) with that of non-attendees to evaluate the impact of supplementary feeding. We measured the anthropometrics of 23 children attending two DCCs and 23 matched controls from the same neighbourhood and interviewed their mothers. We found a better nutritional status, particularly the height-for-age Z-score, among the attendees of the DCC with children's longer attendance, but no difference at the other, although attendees who had been fed for longer tended to show better nutrition. Our study indicates that in the least developed countries good quality day-care of sufficient duration has the potential to improve child nutrition.

BackgroundLack of early initiation of antiretroviral therapy (ART) remains a major health concern due to increased risk of premature mortality and further HIV transmission. This study explored CD4+ cell count monitoring in relation to delays in ART initiation among HIV-positive individuals in the Kathmandu Valley, Nepal, where ART coverage was only 23.7% in 2011.DesignWe recruited a total of 87 ART-naïve, HIV-positive individuals aged 18 to 60 years through the networks of five non-government organizations working with HIV-positive individuals. We collected data on the history of ART initiation, CD4+ cell count monitoring, socio-demographic variables, perceived family support (measured with 10-item Nepali Family Support and Difficulty Scale), depression, and HIV symptom burden. Correlates of ART eligibility were examined using multivariable logistic regression analysis.ResultsA total of 72 of the 87 ART-naïve participants (82.8%) had monitored their CD4+ cell count in the past 6 months. Of these, 36 (50%) participants were eligible for ART initiation with CD4+ cell count <350 cells/mm3. A total of 12 participants had CD4+ cell count <200 cells/mm3. Lower level of perceived family support was associated with 6.05-fold higher odds (95% confidence interval =1.95 to 18.73) of being ART eligible with a CD4+ cell count <350 cells/mm3.ConclusionsHigh rate of delays in ART initiation and the strong association of low perceived family support with ART eligibility in our study participants suggest that HIV service providers should consider the role and impact of family support in influencing individual decisions to initiate ART among eligible HIV-positive individuals.