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Approximately 3.5 million Nepalese are working as migrant workers in the Gulf countries, Malaysia, and India. Every year there are more than 1000 deaths and many hundreds cases of injuries among Nepalese workers in these countries excluding India. A postmortem examination of migrant workers is not carried out in most of these countries, and those with work-related injuries are often sent back to home. Uninsured migrant workers also do not have easy access to health care services in host countries due to the high medical and hospital fees. Greater efforts are needed to protect the health and well-being, labor rights, and human rights of migrant workers from Nepal and other South-Asian nations. There is a need to enforce universal labor laws in these countries and to develop accurate records of mortality and morbidity and their causes.

This editorial concludes that prevention is still better than cure, but instead of a mass Vitamin A supplementation in Nepal, we need a health promotion intervention aiming to increase the intake of relatively cheap vegetables and fruit (containing β carotene). In addition we need better surveillance and help to identify children with Vitamin A Deficiency and provide them with Vitamin A supplements. The primary focus should be on adopting sustainable food based approaches to combat vitamin A deficiency. In Public Health terms: rather than a blanket coverage of Vitamin A supplementation to whole population we should consider a targeted intervention aimed at those who need it most.

Health promotion moves beyond changing the health-related knowledge, attitudes and behaviour of individuals and covers a wide range of social and environmental interventions. Nepal has also introduced health promotion policies targeting health education, information and communication. Auxiliary Nurse Midwives (ANMs), who are responsible for delivering primary care maternity services, especially in birthing centres located in rural areas of Nepal, also have an important role to play in the promotion of women’s health during pregnancy, intra-partum and post-partum. However, in the present context, health promotion provided by ANMs in Nepal is confined mostly to health education and behavioural-change communication. There are a range of health promotion activities relevant to maternity care and midwifery that ANMs can practice even in low-technology rural birthing centres. Such health promotion offers an opportunity to move away from a very medical and behavioural model to a more empowering one in order to prevent health problems in a cost-effective way.

Objective: The Mother-Generated Index (MGI) is a validated tool to assess postnatal quality of life. It is usually administered several weeks or months after birth and correlates with indices of post partum mood states and physical complaints. The instrument had not been translated into German before or validated for use among German-speaking women, nor have the results of the tool been assessed specifically for the administration directly after birth. This paper aims to describe the systematic translation process of the MGI into German and to assess the convergent validity of the German version of the instrument directly after birth and seven weeks post partum. Design: Prospective two-stage survey. Setting: Two rural hospitals in the south of Germany and in the north of Switzerland. Participants: All women giving birth between 1st October and 15th December 2012 with sufficient knowledge of German and whose babies were not referred to a neonatal care unit; 226 women were eligible to participate. Measurement instruments: Two questionnaires including questions relating to socio-demographic factors and perinatal care, and incorporating the MGI, the Hospital Anxiety and Depression Scale (HADS) and the Postnatal Morbidity Index (PMI). All instruments were subjected to forward and back translation and pilot-tested; the first questionnaire was then administered in the first two days after birth and the second six weeks post partum. Parametric and non-parametric tests were computed using SPSS. Findings: 129 surveys were returned an average of three days after birth and 83 after seven weeks. Higher postnatal quality of life showed a significant correlation with a lower anxiety and depression score (p

Background: Nepal is a growing supplier of migrant labour for factories in Malaysia and building sites in the Middle East. This study assessed the extent of workplace accidents among Nepalese migrant workers in Malaysia, Qatar and Saudi Arabia.Methododology: A questionnaire survey was conducted at Nepal’s main international airport with men who returned from working in Malaysia, Qatar and Saudi Arabia. The questionnaire was completed by 403 migrant workers from these three countries. Where possible the questionnaire was self-administered and interview-administered for those migrant workers with poor literacy skills. A logistic regression was conducted to identify factors associated with accidents at work and health risks perceived by migrant workers themselves.Results: One in six (17%) experienced accidents at work in their host country. This proportion is lower than that reported in previous studies of Nepali migrant workers. Age, country of work, doctor registration and perceived standard of work environment and accommodation are significantly associated with accidents at work.Conclusion: To help improve Nepalese men’s health and well-being whilst working abroad, host countries and the Government of Nepal should ensure that migrants hold health insurance. Mandatory pre-departure and arrival health and safety training is also recommended as a way to reduce risks to the health of migrant workers.

This editorial highlights the importance of the 2017 local elections in Nepal on the running of community-based health services in the large rural areas. These are the first local elections for decades.

Background: The HIV/AIDS epidemic remains of global significance and there is a need to target sub-Saharan Africa since it is the hardest hit region worldwide. Religion, and more specifically faith-based organisations, can have an effect on socio-cultural factors that increase or decrease the risk of infection in society; and offer preventative interventions to their followers or the wider community. Objective: To understand the influence of faith-based organisations on HIV prevention in Africa. Method: The Bournemouth University (UK) the main search engine of a British university ‘mysearch’ was used as this incorporates all relevant databases. Studies were also retrieved by searches within Google scholar, PubMed, the British Library and reference lists of included papers and citations in key papers were hand searched. The authors assessed the relevance of each article separately against the inclusion criteria. The data extraction form was piloted by the first author and the other two authors cross-checked the extracted data and necessary amendments were made after discussions. Results: Seven studies met all inclusion criteria and were reviewed. Five were qualitative, one systematic and one of quantitative methodology. Seven individual themes were identified. However, for the purposes of focus within this paper only two themes will be focused on. Conclusion: Given the accessibility of FBOs and the coverage of religion among the population, FBOs are potentially important players in HIV prevention and are often in the forefront of responding to the HIV/AIDS epidemic. Therefore, more resources and support should be given to support their strategies to deliver health promotion messages.

BACKGROUND AND OBJECTIVES: Mental illness is increasingly recognized as a global health problem. However, in many countries, including Nepal, it is difficult to talk about mental health problems due to the stigma associated with it. Hence a training programme was developed to train auxiliary nurse midwives, who otherwise are not trained in mental health as part of their pre-registration training in rural Nepal, on issues related to maternal mental health. After the training programme a selection of auxiliary nurse midwives were interviewed to establish their views on the training, its usefulness and ways to improve it. METHODS: This qualitative study reports on the analysis of interviews conducted with auxiliary nurse midwives who participated in the training programme. The interviews addressed issues associated with the training programme as well as perceptions around mental health in rural Nepal. Transcripts were thematically analysed. RESULTS: Three themes emerged from analysis: (1) issues related to training; (2) societal attitudes; and (3) support for women. The 'training' theme describes the benefits and limitations of training sessions. 'Societal attitudes' describes society's attitude towards mental health which is largely negative. 'Support' describes the positive behaviour and attitude towards pregnant women and new mothers. CONCLUSION: The study supports the need for continued training for auxiliary nurse midwives who are based in the community. This gives them the opportunity to reach the whole community group and potentially have influence over reduction of stigma; offer support and diagnosis of mental ill-health. There is still stigma around giving birth to a female child which can lead to mental health problems. It is imperative to increase awareness and educate the general public regarding mental health illnesses especially involving family members of those who are affected.

Pulmonary tuberculosis (TB) in children is a neglected global health problem, with an increasing proportion of TB cases in Indonesia. Children with TB are most often impacted by TB transmission in the population at large, especially adult TB that exists in the child’s household. This study aimed to find protective factors that can keep children healthy despite household adult TB contacts. This study reports on 132 respondents with a case-control study conducted at nine referred hospitals and several health centers based on medical records at Special Region of Yogyakarta Province. The study lasted from January to December 2014, while the data analysis was used by both of bivariate (chi-square) and multivariate (multiple logistic regression) analysis. The study found that healthy houses, especially those with healthy bedrooms and fewer exposures to adult TB sufferer, influenced by confounder variables, protected children from TB even though they were exposed to adult TB in their environment. Longer periods of living together is not a risk factor for children to contract TB when living with adult TB patients at home. However, this risk increases with frequent exposure among children to adult TB patients at home. AbstrakTuberkulosis paru (TB) pada anak kian menjadi masalah kesehatan global yang masih terlupakan seiring dengan peningkatan proporsi TB di Indonesia. Penularan penyakit ini di populasi umum seringkali berdampak pada anak, terlebih ketika kontak TB terjadi di rumah tangga. Penelitian ini bertujuan untuk memperoleh faktor protektif sehingga anak tetap sehat meskipun memiliki kontak dengan penderita TB dewasa serumah. Penelitian ini dilakukan dengan pendekatan kasus-kontrol pada 132 responden anak yang berasal dari delapan rumah sakit rujukan dan beberapa puskesmas di Provinsi Daerah Istimewa Yogyakarta. Penelitian dilakukan dalam periode Januari hingga Desember 2014 yang hasilnya dianalisis dengan uji bivariat (kai kuadrat) dan multivariat (regresi logistik ganda). Hasil penelitian menunjukkan bahwa rumah yang memenuhi syarat kesehatan, yakni ruang tidur yang sehat, serta paparan yang jarang diterima dari penderita TB dewasa mampu memproteksi anak agar tetap sehat meskipun tinggal serumah dengan penderita dewasa penyakit ini. Penelitian ini menyimpulkan bahwa lama tinggal bersama bukanlah faktor risiko penyakit TB pada anak.Hal ini karena meskipun lama tinggal bersama antara penderita TB dewasa dengan anak, namun apabila memiliki paparan yang jarang, hal ini pun tidak signifikan menjadikan anak untuk terkena TB.

Obtaining 'informed consent' from every individual participant involved in health research is a mandatory ethical practice. Informed consent is a process whereby potential participants are genuinely informed about their role, risk and rights before they are enrolled in the study. Thus, ethics committees in most countries require 'informed consent form' as part of an ethics application which is reviewed before granting research ethics approval. Despite a significant increase in health research activity in low-and middle-income countries (LMICs) in recent years, only limited work has been done to address ethical concerns. Most ethics committees in LMICs lack the authority and/or the capacity to monitor research in the field. This is important since not all research, particularly in LMICs region, complies with ethical principles, sometimes this is inadvertently or due to a lack of awareness of their importance in assuring proper research governance. With several examples from Nepal, this paper reflects on the steps required to obtain informed consents and highlights some of the major challenges and barriers to seeking informed consent from research participants. At the end of this paper, we also offer some recommendations around how can we can promote and implement optimal informed consent taking process. We believe that paper is useful for researchers and members of ethical review boards in highlighting key issues around informed consent.

Background: The health and well-being of migrant workers from low-income countries is often neglected in travel medicine. This article uses Nepal as a case study to highlight key issues affecting this particular group of international travellers.\ud Methods: This narrative review used a comprehensive systematic literature search to identify relevant studies on Nepal. The included articles were thematically analysed leading to four key themes or risk factors.\ud Results: The search found 18 articles from which we identified 3 key themes related directly to migrant workers: (1) sexual risk taking; (2) occupational health and (3) lifestyles, and a fourth theme related to partners and family of migrant workers who are left behind in Nepal. Of the 18 included articles, 11 articles discussed sexual risk taking and HIV, whilst considerably fewer focused on work-related risk factors and lifestyle factors in migrant workers.\ud Conclusions: Migrant workers who are generally healthy appear to be similar to tourist travellers in regarding sexual health as a key issue related to being abroad. Risky sexual behaviour increases in individuals separated from their usual sexual partners, away from their own communities and families, leading to the so-called ‘situational disinhibition’. Considering the recent media coverage of deaths and injuries among migrant workers in the Middle East, it is interesting to see that their sexual health is more prevalent in the research literature. This article argues that travel medicine should provide more emphasis to the health and well-being of migrant workers as a highly vulnerable group of travellers with additional impact on the health of those left behind.

Men are underrepresented in obesity services, suggesting current weight loss service provision is suboptimal. This systematic review evaluated evidence-based strategies for treating obesity in men. Eight bibliographic databases and four clinical trials’ registers were searched to identify randomized controlled trials (RCTs) of weight loss interventions in men only, with mean/median body mass index of ≥30 kg/m2 (or ≥28 kg/m2 with cardiac risk factors), with a minimum mean/median duration of ≥52 weeks. Interventions included diet, physical activity, behavior change techniques, orlistat, or combinations of these; compared against each other, placebo, or a no intervention control group; in any setting. Twenty-one reports from 14 RCTs were identified. Reducing diets produced more favorable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise program −3.2 kg, 95% confidence interval −4.8 to −1.6 kg, reported p < .01). The most effective interventions combined reducing diets, exercise, and behavior change techniques (mean difference in weight at 1 year compared with no intervention was −4.9 kg, 95% confidence interval −5.9 to −4.0, reported p < .0001). Group interventions produced favorable weight loss results. The average reported participant retention rate was 78.2%, ranging from 44% to 100% retention, indicating that, once engaged, men remained committed to a weight loss intervention. Weight loss for men is best achieved and maintained with the combination of a reducing diet, increased physical activity, and behavior change techniques. Strategies to increase engagement of men with weight loss services to improve the reach of interventions are needed.

BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Faith communities play an important role in health promotion in some parts of the world, notably North America and sub-Saharan Africa. They appear to be less prominent in the United Kingdom, despite the fact that it is a high-income country with a well-developed national public health system. Faith communities can be instigators of health promotion (faith-based health promotion), or they can provide settings where other agencies can conduct health promotion (faith-placed health promotion). Key opportunities and barriers for faith-based and faith-placed health promotion can be found by drawing on examples from the United States and Africa.

Purpose – The purpose of this paper is to analyse cost as a barrier to the uptake of antenatal care (ANC) in rural Nepal amidst a variety of barriers and facilitators. Design/methodology/approach – A qualitative study with face-to-face interviews were conducted with 50 ANC users and non-users participants. The setting is rural Nepal, some 20 kilometres outside the capital Kathmandu. Interviews were audiotaped, transcribed and translated into English and results were presented thematically. Findings – Cost was sometimes a barrier to seeking ANC for poor rural women. It included transport costs, opportunity costs of not being able to work in the household and service-related costs (such as blood or urine tests). The effect of cost as a barrier varied between women of different socio-economic status. Cost was a barrier to accessing ANC partly due to the women's lack of control over household resources. Social implications – It is important to consider cost in the wider socio-economic context of rural people's lives as financial costs alone do not explain the level of uptake of ANC. Originality/value – This study provides an original insight of women's experiences on financial issues relating to the use of ANC services in Nepal. Another important aspect of this study was approached with the multiple respondents (i.e. women, their husbands and their mothers-in-law) regarding the use of ANC and financial impact in the use of services. The findings of this study have important implications in health policy formation by providing clear picture of women's financial situation in access to ANC.

Background: Birth plans are written preferences for labor and birth which women prepare in advance. Most studies have examined them as a novel intervention or "outside" formal care provision. This study considered use of a standard birth plan section within a national, woman-held maternity record. Methods: Exploratory qualitative interviews were conducted with women (42) and maternity service staff (24) in northeast Scotland. Data were analyzed thematically. Results: Staff and women were generally positive about the provision of the birth plan section within the record. Perceived benefits included the opportunity to highlight preferences, enhance communication, stimulate discussions, and address anxieties. However, not all women experienced these benefits or understood the birth plan's purpose. Some were unaware of the opportunity to complete it or could not access the support they needed from staff to discuss or be confident about their options. Some were reluctant to plan too much. Staff recognized the need to support women with birth plan completion but noted practical challenges to this. Conclusions: A supportive antenatal opportunity to allow discussion of options may be needed to realize the potential benefits of routine inclusion of birth plans in maternity notes.

This paper is published as a Commentary. It has no abstract, but the paper links the Millennium Development Goals to the maternity workforce in Nepal and highlights to need for recognition of the midwifery profession in that country.

Public Health professionals and researchers always need to be on their toes as the pool of viruses is forever changing. One recent example of this change is the Nipah virus (NiV). This infection is a type of zoonosis, emerging from the family of Paramyxoviridae, genus Henipavirus (RNA virus) and the natural host is Pteropus fruit bat. For Public Health surveillance and multidisciplinary approaches on investigations and therapy and development of vaccines are vital. As with all emerging viruses harmful to humans, an effective system for the detection of infectious diseases as well as for the identification for new causes, risk factors and characteristics in challenged settings is crucial to reduce the disease burden in the population.

Background: Most health research on Nepali migrant workers in India is on sexual health, whilst work, lifestyle and health care access issues are under-researched. Methods: The qualitative study was carried out in two cities of Maharashtra State in 2017. Twelve focus group discussions (FGDs) and five in-depth interviews were conducted with Nepali male and female migrant workers. Similarly, eight interviews were conducted with stakeholders, mostly representatives of organisations working for Nepali migrants in India using social capital as a theoretical foundation. Results: Five main themes emerged from the analysis: (i) accommodation, (ii) lifestyle, networking and risk-taking behaviours, (iii) work environment, (iv) support from local organisations, and (v) health service utilisation. Lack of basic amenities in accommodation, work-related hazards such as lack of safety measures at work or safety training, reluctance of employers to organise treatment for work-related accidents, occupational health issues such as long working hours, high workload, no/limited free time, discrimination by co-workers were identified as key problems. Nepali migrants have limited access to health care facilities due to their inability to prove their identity. Health system of India also discriminates as some treatment is restricted to Indian nationals. The strength of this study is the depth it offers, its limitations includes a lack of generalizability, the latter is a generic issue in such qualitative research. Conclusion: This study suggests risks to Nepali migrant workers&rsquo, health in India range from accommodation to workplace and from their own precarious lifestyle habit to limited access to health care facilities. We must conduct a quantitative study on a larger population to establish the prevalence of the above mentioned issues and risks. Furthermore, the effectiveness of Nepali migrant support organisations in mitigating these risks needs to be researched.

Midwives usually document women's health and maternal histories during booking appointments. This qualitative study of use of the Scottish Woman Held Maternity Record (SWHMR) found some midwifery teams were asking women to document their own histories before these appointments. Pregnant women and midwives from these teams thought this could save midwives time, improve the accuracy of records and lead to more individually appropriate discussions. However, some women were disappointed that midwives had not fully discussed what they had written. Some midwives from teams that had not asked women to document their own histories were sceptical about the likely accuracy and usefulness of women's entries. If the potential advantages of asking women to document their own histories are to be safely realised, support must be available for women with limited English or reading and writing skills, and midwives must have time to review and discuss what women write.

Enabling children's wellbeing by supporting their social networks is an important role of children's nurses. This article presents the concept of social capital as a cognitive tool to help nurses reflect on why and how supporting these networks is important. Through three case studies the authors introduce the attributes of social capital and how these may be applied and inform practice in hospital and community healthcare settings.

PurposeThe purpose of this paper is to review one aspect, impact of the forthcoming assessment of research in UK universities, the Research Excellence Framework (REF) and to examine its meaning and potential for enhanced partnerships between practitioners and academia.Design/methodology/approachThis article debates the increasing requirement of practitioner and academic collaboration as well as outlining how we, as a contributing University, are grappling with the evidence needed to develop a framework that will demonstrate impact outside of formal academia.FindingsIt is difficult to establish the link between cause and effect and to assume that the potential changes in behaviour are the result of certain interventions; capturing learning or useful data which contributes to evidenced based policy is challenging. The problem is compounded by the diversity of funding sources, each with its own scrutinising requirements. The importance of REF for the integration of evidenced based practice is evident and demonstrates the major role that practitioners could play in the future.Originality/valueA considerable amount of UK research is publically funded, hence fuelling the Government's drive to determine impact on society. This paper debates for the first time that practitioners have a role to play in its creation and identification.

There is an urgent need of earthquake forecasting model for Nepal in this current scenario. It can be developed by the scientists of Nepal with the help of experienced international scientists. This will help the Nepalese to take timely and necessary precautions. We would argue that above all we need to use earthquake prediction knowledge to improve the disaster prepardness in local communities, service providers (hospitals, Non-Governmental Organizations, police, etc.), government policy-makers and international agencies. On the whole, both seismology and public health are most successful when focusing on prevention not on prediction per se. J Epidemiol. 2017;7(4); 700-701.

Historically, women have learned about childbirth from their mothers and sisters, and from seeing childbirth in the family or community. In the more recent past, women would have gone to books for advice. Today, we see that women are turning to media to learn about what the experience of childbirth is like. This poses an interesting dilemma for midwives who support mothers during their pregnancy. This chapter will discuss the findings from two closely linked research projects that speak to midwives about their experience with women who are allegedly influenced by the media in their decisions about childbirth. The chapter will explore how midwives understand their profession to be depicted in the media and will also explore how midwives engage with the media. We will provide some suggestions for midwives moving forward who wish to create more positive representations of childbirth and early labour in the media.

Background Antenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of multi-component antenatal care interventions on service delivery and outcomes in many countries since the 1980s. Some have applied entirely new schemes, while others have modified existing care delivery approaches. Systematic reviews (SRs) indicate that some specific antenatal interventions are more effective than others; however the causal mechanisms leading to better outcomes are poorly understood, limiting implementation and future research. As a first step in identifying what might be making the difference we conducted a scoping review of interventions tested in RCTs in order to establish a taxonomy of antenatal care models. Methods A protocol-driven systematic search was undertaken of databases for RCTs and SRs reporting antenatal care interventions. Results were unrestricted by time or locality, but limited to English language. Key characteristics of both experimental and control interventions in the included trials were mapped using SPIO (Study design; Population; Intervention; Outcomes) criteria and the intervention and principal outcome measures were described. Commonalities and differences between the components that were being tested in each study were identified by consensus, resulting in a comprehensive description of emergent models for antenatal care interventions. Results Of 13,050 articles retrieved, we identified 153 eligible articles including 130 RCTs in 34 countries. The interventions tested in these trials varied from the number of visits to the location of care provision, and from the content of care to the professional/lay group providing that care. In most studies neither intervention nor control arm was well described. Our analysis of the identified trials of antenatal care interventions produced the following taxonomy: Universal provision model (for all women irrespective of health state or complications); Restricted ‘lower-risk’-based provision model (midwifery-led or reduced/flexible visit approach for healthy women); Augmented provision model (antenatal care as in Universal provision above but augmented by clinical, educational or behavioural intervention); Targeted ‘higher-risk’-based provision model (for woman with defined clinical or socio-demographic risk factors). The first category was most commonly tested in low-income countries (i.e. resource-poor settings), particularly in Asia. The other categories were tested around the world. The trials included a range of care providers, including midwives, nurses, doctors, and lay workers. Conclusions Interventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproducible approach to describing the purpose and content of models of antenatal care which have been tested in a trial. It highlights a lack of reported detail of trial interventions and usual care processes. It provides a baseline for future work to examine and test the salient characteristics of the most effective models, and could also help decision-makers and service planners in planning implementation. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1186-3) contains supplementary material, which is available to authorized users.

Focus group (FG) discussions are a popular qualitative research method used in health care and health service research. More recently, internet-based FGs have grown in popularity due to the growth of: (a) the internet, both in terms of technical capacity and number of users; and (b) the improved quality of communication software (e.g. Skype). This paper highlights some of the strengths and weaknesses of conducting FGs online. Building on our experience of conducting traditional and internet-based FGs, we offer some practical advice to potential users.

No Abstract to this Editorial

It has been recognised that the media can affect our perceptions, views and tastes on a wide-range of issues. The mass media in it various forms (newspapers, television & radio, the internet and Twitter) and formats, have a far reaching influence through, for example news programmes, documentaries, advertising and entertainment. At the same time the media can also be seen as a channel for agencies responsible for public health to get their messages across to the population. Public health agencies are always searching for ways to disseminate health information and messages to their intended audiences. These are, of course, global concerns, but as both public health and the media are part of the society in which they operate there will be locally specific issues and considerations. To date most of the research into the media and public health has been conducted in high-income countries, and there has been very little research in Nepal on the interaction of public health and health promotion with the media.This overview paper highlights some of the key issues that public health practitioners, media editors and journalists, health policy-makers and researchers could consider.Journal of Manmohan Memorial Institute of Health Sciences Vol. 2 2016 p.70-75

Introduction: Male migrants and their sexual partners at home are at increased risk of STIs (Sexually Transmitted Infections) including HIV (Human Immunodeficiency Virus). We aimed to assess the knowledge and attitudes of migrants’ wives regarding HIV and STIs, and to understand risk perception of HIV due to their husbands’ sexual behaviour. Methodology: A cross-sectional survey among 182 migrants’ wives was conducted in two rural villages of Chitwan district in Nepal. The participants were selected through multistage cluster sampling method and data were collected through a questionnaire administered through a face-to-face interview. Results: Nearly all (94%) of migrants’ wives had a good knowledge of HIV, however with some misconceptions. More than two-thirds of the participating migrants’ wives were aware about the risk of HIV infection in migrant husbands and subsequent risk of transmitting themselves through sexual intercourse. Nearly half of the participants reported inability to ask their husbands about HIV and STIs even if they had their doubts. Knowledge of HIV and HIV risk associated with migration were statistically significantly higher in younger women, those who were literate and the longer the period of their husbands’ migration. Conclusion: Despite having generally a good knowledge and awareness of HIV and migration induced HIV risk; migrants’ wives could not discuss sexual health issues with their husbands, thus increasing their vulnerability to HIV and STIs. SAARC J TUBER LUNG DIS HIV/AIDS, 2016; XIII(1), page: 9-15

It is a normal human tendency to 'run for your life' when an earthquake occurs. Adolescent girls and women of reproductive age leave their homes with only the clothes they are wearing to save their own and their families' lives. Immediate disaster relief aid with its (unintentional) lack of gender sensitivity has little or no materials for the appropriate management of menstrual hygiene. The biological needs of disaster-affected women will not change despite the dire need for basic food, shelter and security. Timely identification and preparation beforehand with appropriate and culturally sensitive techniques and locally available materials that are reusable can help introduce sustainable and acceptable means of managing menstrual hygiene in a crisis. The use of reusable sanitary towels is well accepted for menstrual hygiene management in non-disaster situations and is appropriate in post-earthquake relief in Nepal.

Background Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care. Methods A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models’ characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria. Results From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0–32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported. Conclusions The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.

Background: Globally, the number of people living with Diabetes Mellitus (DM) has increased four-fold since 1980. South Asia houses one- fifth of the world’s population living with diabetes, and it was the 8th leading cause of deaths in 2013 for South Asians. Aim: To review and discuss the context of diabetes in South Asia, with a particular focus on, a) contributing factors and impact; b) national health policies around non-communicable diseases in the region, and c) to o ffer recommendations for prevention and management of diabetes. Method: We assessed relevant publications using PubMed, Scopus and OvidSP. Similarly, the World health Organization (WHO) and relevant ministries of each South Asian country were searched for reports and policy documents. Results: Emerging evidence supports that the prevalence of diabetes (ranging from 3.3% in Nepal up to 8.7% in India) in South Asia follows the global trend over the past decades. Urban populations in the region demonstrate a higher prevalence of diabetes, although is also a public health concern for rural areas. Changes in the pattern and types of diet, together with increasingly sedentary, lifestyles are major causes of diabetes. The overall agenda of health promotion to prevent diabetes has not yet been established in the region, and the majority of the countries in the region are inadequately prepared for the therapeutic services for diabetes. Conclusions: The early onset of the diabetes, longevity of morbidity and early mortality may have a significant impact on people’s health expenditure and health systems, as well as on the region’s demographic composition. There is an urgent need to reduce the prevalence of diabetes in the region through evidence-based interventions ranging from prevention and early detection to appropriate treatment and care. We suggest that a multi-sectorial collaboration across all stakeholders is necessary to raise awareness about diabetes, its prevention, treatment and care in the region.

BACKGROUND: There is a need for studies evaluating maternal health interventions in low-income countries. This paper evaluates one such intervention designed to promote maternal health among rural women in Nepal. METHODS AND RESULTS: This was a five-year controlled, non-randomised, repeated cross-sectional study (2007, 2010, 2012) of a participatory community-based maternal health promotion intervention focusing on women's groups to improve maternal health services uptake. In total 1,236 women of childbearing age, who had their last child

BACKGROUND: Considerable debate surrounds the influence media have on first-time pregnant women. Much of the academic literature discusses the influence of (reality) television, which often portrays birth as risky, dramatic and painful and there is evidence that this has a negative effect on childbirth in society, through the increasing anticipation of negative outcomes. It is suggested that women seek out such programmes to help understand what could happen during the birth because there is a cultural void. However the impact that has on normal birth has not been explored. METHODS: A scoping review relating to the representation of childbirth in the mass media, particularly on television. RESULTS: Three key themes emerged: (a) medicalisation of childbirth; (b) women using media to learn about childbirth; and (c) birth as a missing everyday life event. CONCLUSION: Media appear to influence how women engage with childbirth. The dramatic television portrayal of birth may perpetuate the medicalisation of childbirth, and last, but not least, portrayals of normal birth are often missing in the popular media. Hence midwives need to engage with television producers to improve the representation of midwifery and maternity in the media.

DOI: http://dx.doi.org/10.3126/hren.v10i3.7141 Health Renaissance; September-December 2012; Vol 10 (No.3);229-235

Background: Oedema of the hemiplegic upper limb is a common complication following stroke and can restrict mobility and function. Limited evidence is available regarding the assessment and treatment of post-stroke upper limb oedema by occupational therapists. Objective: To determine consensus amongst occupational therapists with regard to the use of light retrograde massage for the treatment of post-stroke upper limb oedema. Method: A Delphi technique was used to gather opinion from a national sample of stroke occupational therapists. Two rounds of questionnaires were undertaken. Data were analysed from the 31 respondents to round two, using the chi-square goodness of fit to determine consensus in relation to statements about the use of light retrograde massage. Results: Of the 85 therapists who volunteered for the study, 58 returned round one questionnaires and 56 were eligible to participate. Most of the therapists who responded to round one (41/56, 73%) used light retrograde massage to reduce post-stroke upper limb oedema. Agreement regarding the definition and application of light retrograde massage was identified in round two. Conclusion: Despite a lack of evidence for the efficacy of light retrograde massage in stroke patients, this study found that it is often used in clinical practice and that consensus exists about many components of the treatment method. Further research is recommended to investigate the efficacy of light retrograde massage for reducing post-stroke upper limb oedema.

Within the European Union, as well as in Canada and the United States (US), health promoters employ a number of strategies to encourage community-based health improvements. This involves the creation of innovative health promotion partnerships to support and enable people to choose and engage in healthy living practices. Compared to the US, in other Western countries, such as the United Kingdom, faith communities have largely been ignored in health promotion partnerships. This study established existing evidence about health promotion in faith communities in Scotland by examining the perceptions and attitudes concerning health promotion among faith leaders and health promotion professionals. We conducted 33 semi-structured interviews with health promotion professionals ( n = 9) and representatives of Christian and non-Christian faith communities ( n = 24). The majority of participants expressed an interest in the concept of health promotion in a faith community and could readily envision its application in their area of work. Both groups identified multiple physical assets, as well as social supports within faith communities that could be directed towards healthy living activities. Faith groups and church organisations may constitute potential partners and new settings to increase community capacity for health promotion. Further research and funding for demonstration projects may be particularly helpful to provide evidence of the strengths and limitations of faith-based health promotion in Scotland, which in turn could inform health promotion practice and policy.

This paper reviews one aspect, impact, of the forthcoming assessment of research in UK universities, the Research Excellence Framework (REF), and examines its meaning and potential for enhanced partnerships between social work practice and academia in the context of the current economic crisis. Examples of case studies being developed to show how research has societal impact are described and some of the complexities of what, on the surface appears to echo social work 19s desire to make a positive difference to the lives of people in society, are drawn out. The importance of the REF for the integration of social work practice and academia have been rehearsed many times. This paper argues that making an impact is everybody 19s concern and practitioners and those who use social work services and their carers have a role to play in its creation and identification.

Patient's adherence is crucial to get the best out of antiretroviral therapy (ART). This study explores in-depth the barriers to and facilitators of ART adherence among Nepalese patients and service providers prescribing ART. Face-to-face semi-structured interviews were conducted with 34 participants. Interviews were audio-taped, transcribed, and translated into English before being analyzed thematically. ART-prescribed patients described a range of barriers for failing to adhere to ART. Financial difficulties, access to healthcare services, frequent transport blockades, religious/ritual obstacles, stigma and discrimination, and side-effects were the most-frequently discussed barriers whereas trustworthy health workers, perceived health benefits, and family support were the most-reported facilitators. Understanding barriers and facilitators can help in the design of an appropriate and targeted intervention. Healthcare providers should address some of the practical and cultural issues around ART whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.

Congenital Talipes Equinovarus (clubfoot) is a condition affecting about one per thousand live births in Europe. Diagnosis of CTEV usually occurs through scanning in pregnancy and treatment of the child begins early after birth. The medical condition and treatment regime have an impact on the child's social environment and on family life. The aim of this qualitative study was to provide a better understanding of the psycho-social demands of parenting a child with CTEV. In-depth interviews were conducted with 15 families (four joint and 11 single interviews) in the UK. We identified three key themes from participants' accounts: (a) emotions and perceptions associated with the diagnosis of CTEV; (b) parenting a child with CTEV and (c) parents' concerns about the child's future. We report that participants experienced a range of negative emotions similar to those experienced by parents of children with what are considered to be more disabling conditions. We propose that more attention should be paid by healthcare professionals to the emotional impact on parents of their child's CTEV diagnosis and treatment. More encouragement, information and support from health professionals could increase parental interest in the treatment as well as their satisfaction and will result in decreased non-compliance with treatment due to a lack of knowledge.

OBJECTIVE: To systematically review the literature of factors affecting adherence to Antiretroviral treatment (ART) in Asian developing countries. METHODS: Database searches in Medline/Ovid Cochrane library CINAHL Scopus and PsychINFO for studies published between 1996 and December 2010. The reference lists of included papers were also checked with citation searching on key papers. RESULTS: A total of 437 studies were identified and 18 articles met the inclusion criteria and were extracted and critically appraised representing in 12 quantitative four qualitative and two mixed-method studies. Twenty-two individual themes including financial difficulties side effects access stigma and discrimination simply forgetting and being too busy impeded adherence to ART and 11 themes including family support self-efficacy and desire to live longer facilitated adherence. CONCLUSION: Adherence to ART varies between individuals and over time. We need to redress impeding factors while promoting factors that reinforce adherence through financial support better accessible points for medicine refills consulting doctors for help with side effects social support and trusting relationships with care providers. (c) 2011 Blackwell Publishing Ltd.

BACKGROUND: In the United Kingdom, general practitioner (GP) involvement in maternity care has declined significantly over the past decade. This is particularly so in remote and rural areas where midwives have stepped up and taken over units to ensure that women in these areas continue to have a service. A recent report by the King’s Fund argues for a greater role for the GP in maternity care provision; however, this raises questions about whether GPs have the skills and training to provide such care.AIM: To explore the views of GPs on the skills and training required to deliver safe and appropriate local intrapartum services in remote and rural settings.METHODS: Mixed-method study consisting of qualitative interviews with a purposive sample of GPs in six remote and rural sites. To triangulate the interview findings and identify features that might have been missed in the interviews, a questionnaire was developed using initial key themes identified.FINDINGS: Maternity care accounted for less than 10% of most remote and rural GPs’ workload, yet interviewees reported that their role required them to be competent in a wide range of procedures. This was seen as a major barrier to recruitment and retention in rural areas. Although self-reported competence and confidence was high, several GPs felt de-skilled and felt that they were fighting a losing battle to maintain skills. GPs regarded isolation, need for comprehensive expertise, limited resources, and transportation difficulties as factors affecting the decline in their contribution to remote and rural maternity care.CONCLUSION: Although rural GPs and midwives might traditionally have been in competition, providing a woman-centered service in remote areas may be easier to achieve through collaborative working. However, if GPs are to play a greater role, then they will need to be prepared to make a strategic commitment to the maintenance of remote and rural maternity care. This will require innovative methods of training, special consideration of educational needs, and incentives for practitioners to settle in rural areas, but it may already be too late for GPs to have a substantial input into maternity care.

Many academics from Nepal do not involve in research activities. There are several factors hindering the involvement such as inadequate human resources and lack of financial resources. Despite limited human and financial resources, we believe it is still possible to attract many Nepali academics in health research. This paper purposes some ideas to increase involvement of Nepali academics in health research.DOI: http://dx.doi.org/10.3126/hprospect.v12i2.9868 Health Prospect Vol.12(2) 2013: 21-23

Faith groups constitute a growing health promotion partner in North America where they help increase community capacity. However, in the United Kingdom this collaboration is seemingly far less developed. This study sought to find evidence of health promotion in faith communities and examine perceptions and attitudes concerning health promotion among faith leaders. It also sought to establish the level to which health-promoting activities currently occur in, and are organized by, places of worship in one Scottish city, Dundee. The authors distributed a self-administered questionnaire to representatives of all faith communities in Dundee (response rate 71%, n = 50). The survey identified existing, well-formed community groups, some of whom already engaged in health-promoting activities, and shared similar interests with health promotion professionals. Generally, faith leaders were positive towards the concept of health promotion and many considered health promotion to be compatible with their mission. Not all denominations were equally involved in health promotion activities, for example, some conducted annual one-off activities, while others had well-established walking groups or exercise classes. The responses suggest a degree of readiness by faith communities to engage, if invited, in health promotion programmes. These results also indicate that faith groups may constitute untapped resources, poised to contribute to local health promotion efforts. The article concludes that as the National Health Service (NHS) invests in community-based health initiatives that can have long-term sustainability, it is reasonable to make links between what is happening in North America, the interest in health promotion reported by faith leaders in this study and the possibilities for their participation in voluntary sector community health partnerships.