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Objectives Appropriate infant and young child feeding (IYCF) for children aged 6-23 months includes adequate dietary diversity, appropriate meal frequency, and continued breastfeeding. Mothers receiving antenatal care (ANC) and postnatal care (PNC) may adopt better IYCF. This study examined the association of ANC or PNC attendance with IYCF and child nutrition status. Methods A cross-sectional study was performed on 400 mother-child pairs in rural Nepal. Mothers were interviewed about their history of ANC and PNC attendance and IYCF; the height and weight of their children were measured. IYCF was measured with infant and child feeding index (ICFI) aggregating scores of dietary diversity, meal frequency, continued breastfeeding, and dietary variety. Lower ICFI scores indicated poorer IYCF practices. Multiple regression and logistic regression examined the association of ANC and PNC attendance with ICFI scores and undernutrition, respectively. Results Absence of ANC (β = -1.01, P = 0.011) and absence of PNC (β = -1.01, P = 0.011) were negatively associated with ICFI scores. Additionally, absence of ANC was positively associated with underweight (AOR 3.37; 95 % CI 1.42-9.92 for children 6-11 months, AOR 3.43; 95 % CI 1.41-8.32 for children 12-23 months) and stunting (AOR 6.51; 95 % CI 2.11-20.10 for children 6-11 months, AOR 3.32; 95 % CI 1.50-7.31 for children 12-23 months). Similarly, children tended to be underweight and stunted if their mothers did not receive any PNC. Conclusion Absence of ANC and PNC were associated with poor IYCF, underweight, and stunting in children.

Low zinc levels and chronic inflammation are common in individuals infected with human immunodeficiency virus (HIV). Zinc deficiency may promote systemic inflammation, but research on the role of zinc in inflammation among HIV-positive individuals taking account of anti-retroviral therapy is lacking. We assessed the association between serum zinc and C-reactive protein (CRP) concentration in a cohort of HIV-positive individuals. A cross-sectional survey was conducted among 311 HIV-positive individuals (177 men and 134 women) aged 18-60 years residing in Kathmandu, Nepal. High-sensitive or regular serum CRP concentrations were measured by the latex agglutination nephelometry or turbidimetric method, and zinc concentrations were measured by the atomic absorption method. Relationships were assessed using multiple linear regression analysis. The geometric means of zinc in men and women were 73.83 and 71.93 ug/dL, respectively, and of CRP were 1.64 and 0.96 mg/L, respectively. Mean serum CRP concentration was significantly decreased with increasing serum zinc concentration across zinc tertiles (P for trend = 0.010), with mean serum CRP concentration in the highest tertile of serum zinc concentration was 44.2 % lower than that in the lowest tertile. The mean serum CRP concentrations in men and women in the highest tertile of serum zinc concentrations were 30 and 35.9 % lower, respectively, than that in the lowest tertile (P for trend = 0.263 and 0.162, respectively). We found a significant inverse relation between log zinc and log CRP concentrations (beta for 1 unit change in log zinc; β = -1.79, p = 0.0003). Serum zinc concentration may be inversely associated with serum CRP concentration in HIV-positive individuals.

This study examines the acculturation effects on metabolic syndrome (MetS), and its related factors, among immigrant Japanese-Brazilian men in Japan. Quantitative and qualitative approaches were utilized. In the quantitative study (n = 149), multiple logistic regression analyses estimated the impact of length of residence and arrival age on MetS. For the qualitative study, five focus group discussions were conducted with participants (n = 26) from the quantitative study sample. The oldest arrival age group was more likely to have MetS (OR, 95% CI 4.41, 1.09-17.78) after adjusting for covariates; whereas, length of residence had no association with MetS. The oldest arrival age group, with shorter residence period, was also associated with increased MetS prevalence. Qualitative results identified participants' Brazilian dietary habits as being potential risk factors for MetS. Japanese-Brazilian immigrant men with older arrival age in Japan were more likely to suffer from MetS, especially shortly after arrival.

Purpose: In spite of the apparent increases in family and community violence, research into its effects on adolescent mental health has received limited attention in Cambodia. This study examines the association between exposure to violence and depressive symptoms among adolescents controlling for the effects of several factors in family and school domains., Methods: We randomly selected 993 male and 950 female students proportionally from 11 junior high schools and high schools in Battembang provincial city. Students were questioned about the violence to which they were subjected and which they witnessed in their family and community. The Asian adolescent depression scale was used to measure depressive symptoms., Results: In this study, 27.9% of male students and 21.5% of female students had been victimized in at least one case of family violence, while 18.0% of male and 5.8% of female students had been victimized in at least one case of community violence. After adjustment, increased levels of depressive symptoms were significantly associated with being the victim of or witnessing family or community violence among both male and female students. However, the positive association between the levels of depressive symptoms and being a witness to community violence was found only in female students., Conclusions: Efforts to prevent depression in adolescent students should focus on reducing family and community violence; such efforts should also consider gender differences.

Background: Leprosy is a chronic infectious disease that has an impact on the Health-Related Quality of Life (HRQOL) of sufferers as well as their children. To date, no study has investigated the effects of parental leprosy on the well-being of adolescent children., Methods: A cross-sectional study was conducted in the Lalitpur and Kathmandu districts of Nepal. Adolescents with leprosy-affected parents (n = 102; aged 11-17 years) and those with parents unaffected by leprosy (n = 115; 11-17 years) were investigated. Self-reported data from adolescents were collected using the Kinder Lebensqualität Fragebogen (KINDLR) questionnaire to assess HRQOL, the Center for Epidemiological Studies-Depression Scale (CES-D), and the Rosenberg Self-esteem Scale (RSES). Analysis of covariance (ANCOVA) was used to compare scores between the two groups. Multiple regression analysis was conducted to explore the determinants of HRQOL for adolescents with leprosy-affected parents., Results: ANCOVA revealed that the KINDLR and RSES scores were significantly lower among adolescents with leprosy-affected parents compared with unaffected parents. However, the scores of "Friends" and "School" subscales of KINDLR were similar between the two groups. The CES-D score was significantly higher among adolescents with leprosy-affected parents than for adolescents with unaffected parents. The KINDLR scores for adolescents with both parents affected (n = 41) were significantly lower than the scores for those with one parent affected (n = 61). Multiple regression analysis revealed that adolescents with leprosy-affected parents who had higher levels of depressive symptoms were more likely to have lower KINDLR scores. A similar result was seen for adolescents where both parents had leprosy., Conclusions: Adolescents with leprosy-affected parents had higher levels of depressive symptoms, lower levels of self-esteem, and lower HRQOL compared with adolescents whose parents were unaffected by leprosy. Thus, mental health support programs might be necessary for adolescents with leprosy-affected parents, particularly for adolescents where both parents are leprosy-affected. Further studies with larger sample sizes are necessary to draw decisive conclusions.

Background: The number of people newly infected with human immunodeficiency virus (HIV) has been decreasing in sub-Saharan Africa, but prevalence of the infection remains unacceptably high among young people. Despite the alarming pervasiveness of the virus, young people in this region continue to engage in risky sexual behaviors including unprotected sexual intercourse. In developed countries, parents can play important roles in protecting young people from such behaviors, but evidence regarding the impact of parental involvement is still limited in sub-Saharan Africa. Therefore, we conducted this study to examine the magnitude of risky sexual behaviors and the association of parental monitoring and parental communication with condom use at last sexual intercourse among secondary school students in Dar es Salaam, Tanzania., Methods: We conducted this cross-sectional study among 2,217 male and female students aged 15 to 24 years from 12 secondary schools in Dar es Salaam. From October to November 2011, we collected data using a self-administered questionnaire. Multiple logistic regression analyses were conducted to examine the association of parental monitoring and parental communication with condom use at last sexual intercourse, adjusting for potential confounders., Results: A total of 665 (30.3%) secondary school students reported being sexually active within the year prior to data collection. Among them, 41.7% had multiple sexual partners, 10.5% had concurrent sexual partners, and 41.1% did not use a condom at last sexual intercourse. A higher level of parental monitoring was associated with increased likelihood of condom use at last sexual intercourse among male students (AOR: 1.56, 95% CI: 1.05-2.32; p = 0.03) but not among female students (AOR: 1.54, 95% CI: 0.71-3.37; p = 0.28). The association between parental communication and condom use at last sexual intercourse among both male and female students was not statistically significant., Conclusions: A high level of parental monitoring is associated with more consistent condom use among male students in Dar es Salaam, Tanzania -- many of whom have engaged in high-risk sexual behaviors such as multiple sexual partnerships, concurrent sexual partnerships, and unprotected sexual intercourse in the past one year. Interventions should thus be strengthened to reduce multiple sexual partnerships, concurrent sexual partnerships, and to improve parental monitoring among such students toward increasing condom use.

To compare the quality of antenatal care (ANC) between Community-based Health Planning and Services (CHPS) and non-CHPS areas in the Birim North District of Ghana. A cross-sectional study was conducted in May, 2010. We collected data from 600 women (300 from CHPS areas and 300 from non-CHPS areas) recruited from six CHPS and six non-CHPS areas, using a structured questionnaire. Participants were aged 15-49 years, had at least one child within 18 months old, and resided in the district for at least 2 years before data collection. Outcomes included: (1) index of ANC utilization (dichotomized as full and partial), (2) receipt of anti-malarial drugs, (3) testing for HIV infection, and (4) index of knowledge about pregnancy danger signs (expressed in tertiles). Descriptive statistics and multivariate logistic regression methods were employed in the analysis. Multivariate analysis revealed that participants in the CHPS areas were 2.7 times (95% CI: 1.66-4.35) more likely to have full utilization score, 4.5 times (95% CI: 2.37-8.51) more likely to receive HIV testing, and 3.7 times (95% CI: 1.72-7.94) more likely to receive anti-malarial prophylaxis during the ANC period. However, scoring high on the index of knowledge was not significantly associated with the CHPS exposure (OR: 1.2; 95% CI: 0.69-2.00). The CHPS intervention might be useful to improve the quality of ANC. Therefore, increasing the CHPS intervention coverage in non-CHPS areas might serve as a basis for improving the quality of ANC in the Birim North and other rural districts of Ghana.

Introduction: To achieve the global goal of eliminating mother-to-child transmission of HIV, retention of HIV-positive women and their babies throughout the cascade of prevention of mother-to-child transmission of HIV (PMTCT) services is necessary. Little evidence has been published on coverage of the cascade in resource-limited settings. Along with PMTCT service expansion in Cambodia, a national routine reporting system was developed. This study examines coverage of six PMTCT interventions to improve our understanding of retention throughout the cascade., Method: WE DEVELOPED INDICATORS TO MONITOR COVERAGE OF THE SIX KEY INTERVENTIONS: (1) maternal antiretroviral treatment or prophylaxis; (2) delivery in a health facility; (3) infant ARV prophylaxis at birth; (4) infant co-trimoxazole prophylaxis at six weeks; (5) first infant DNA-PCR test at six weeks; and (6) second infant DNA-PCR test at 30 weeks. Programme data from April 2008 to December 2011 in 11 operational districts were used to identify those eligible for each intervention., Results: Women eligible for maternal antiretroviral treatment or prophylaxis in the study were aged 18 to 48 with a median age of 30 years. Coverage of the six interventions were: (1) 79.9% (258/323); (2) 92.2% (236/256); (3) 69.9% (179/256); (4) 73.3% (184/251); (5) 85.7% (215/251); and (6) 61.6% (135/219). Among those eligible, 29.7% (65/219) received all six interventions., Discussion: This study revealed critical gaps in PMTCT service delivery under routine conditions in Cambodia. Service optimization by reducing gaps will help eliminate HIV infection among infants and improve maternal survival. Further operational studies are needed to identify determinants of service uptake.

Objectives: We examined the association between maternal experiences of intimate partner violence (IPV) and the risk of undernutrition among children younger than 5 years in Bangladesh., Methods: We used data from the 2007 Bangladesh Demographic Health Survey. Our analyses were based on the responses of 1851 married women living with at least 1 child younger than 5 years. Exposure was determined from maternal reports of physical and sexual IPV. Outcomes included underweight, stunting, and wasting., Results: Twenty-nine percent of the respondents had experienced IPV in the year preceding the survey. Maternal experience of any physical or sexual IPV was associated with an increased risk of stunting (adjusted odds ratio [AOR] =1.59; 95% confidence interval [CI] =1.23, 2.08) and underweight (AOR =1.33; 95% CI=1.04, 1.71) but was not significantly associated with wasting (AOR=1.08; 95% CI=0.78, 1.49)., Conclusions: The association between maternal exposure to physical or sexual IPV and child underweight and stunting suggests that partner violence plays a significant role in compromising child health by impairing child nutrition. Our findings reinforce the evidence that improving child nutrition is an additional reason to strengthen efforts to protect women from physical and sexual IPV.

In many resource-poor countries, home-based care for young children is crucial. Yet little has been known about the negative impacts of sibling caretaking on mental health conditions of adolescent student caretakers. This study explored associations between sibling caretaking, school performance, and depression among 1943 students randomly selected from 11 junior high and high schools in Cambodia. The Asian Adolescent Depression Scale was used to measure depressive symptoms. In bivariate analyses, we used χ(2) test or Fisher's exact test for categorical variables and t-test or one-way analysis of variance for continuous variables. Multiple linear regression models were then constructed. Of total, 60.1% of our participants took care of their younger sibling(s) regularly during the past one year. The number of siblings under their care ranged from one to nine, and the time they spent for sibling care ranged from one to 10h per day. After adjustment, increased levels of depressive symptoms remained significantly associated among boys with sibling caretaking (p<0.001), as well as poor school performance (p=0.001) and perceived likelihood of dropping out of school in the near future (p=0.002). Among girls, increased levels of depressive symptoms retained their significant association with sibling caretaking (p<0.001); also poor school performance (p<0.001). Sibling care responsibility might have negative impact on school performance and the mental health condition of adolescent caretakers., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The authors conducted a community based, cross-sectional study to describe the prevalence of intimate partner violence (IPV) by husbands and the association between wives' attitudes toward gender roles and their experience of IPV in Central Province, Sri Lanka. This article included a representative sample of 624 wives between 15 and 49 years of age and examined the prevalence of physical, psychological, and sexual abuse. Then, using multivariate logistic regression analysis, the authors examined the association between wives' attitudes toward gender roles and IPV. Of the 624 wives, 36% had experienced at least one episode of physical, psychological, or sexual abuse by their husbands during their life time (ever abuse), and 19% had experienced such abuse during the past 12 months (current abuse). The wives were less likely to experience current abuse by husbands if they believed that "outsiders should not intervene to protect abused wives." They were more likely to experience ever and current isolated psychological abuse by husbands if they did not believe that "a good wife always obeys her husband." This study suggests that the prevalence of IPV is high in Sri Lanka. Although several published studies on IPV suggest that traditional gender role attitudes tend to increase women's vulnerability to IPV, this study suggests that in Sri Lanka, the wives who respect cultural norms tend to experience less IPV by husbands.

Objective: The HIV/AIDS epidemic has increased the number of orphans who have to care for their younger siblings. However, their caregiving practices are poorly reported. This review aimed to explore and accumulate available evidences on sibling caregiving among children orphaned by AIDS., Methods: We conducted a systematic review of sibling caregiving among AIDS orphans in developing countries and identified 25 relevant articles. We analysed the compiled literature and extracted information on the prevalence of sibling caregiving, the framework of sibling caregiving, factors influencing caregiving, and the impact of sibling caregiving on caregivers and those cared for., Results: Sibling caregiving, which includes economic, physical, psychological, and educational care, was influenced by children's, familial, community, and policy factors. Unlike sibling caregiving that occurs under adequate adult supervision, sibling caregiving among AIDS orphans negatively impacts both the sibling caregivers and the cared for. However, the lack of studies about such sibling caregiving had prevented measurement of the level of burden and impact of sibling caregiving on orphans., Conclusions: Policy makers need to be aware that older children caring for younger siblings risk physical and psychological ill health and information must be collected so that measures can be developed to mitigate this burden on orphans., (Copyright © 2010. Published by Elsevier Ireland Ltd.)

Objectives: We examined (1) whether attending out-of-home day care centres (DCCs) has differential effects on improvement of child nutrition and facilitation of maternal employment depending on availability of non-institutionalised childcare support and (2) whether attendance increases infectious diseases., Methods: In a prospective before-after comparison study at public DCCs in Pokhara, Nepal, we compared weight-for-age Z-score (WAZ) and height-for-age Z-score (HAZ) among children attending DCCs between at admission, after 6 months, and after 1 year and determined differential changes in these measures between those with and without appropriate childcare support. We used repeated measures analysis of variance with interaction terms between support availability and DCC attendance. We compared maternal income and incidence of diarrhoea and fever in children between the periods of waiting and attending., Results: After 6 months, neither WAZ nor HAZ significantly changed. After 1 year, WAZ significantly improved, but HAZ did not change among all participants. Those without appropriate childcare support showed greater improvement in both WAZ and HAZ than those with support. While children were attending, income increased only among those mothers who were already working without any childcare support at baseline. Neither diarrhoea nor fever increased., Conclusions: DCCs can be more beneficial for child nutrition and working mothers in households lacking childcare support than in those with support.

We assessed unsafe sexual behaviors of the Nepalese HIV-positive men and their knowledge about the consequences of unsafe sex. We interviewed 167 participants recruited conveniently in the Kathmandu Valley, Nepal. Of total, 125 participants (75%) had sex in the past 6 months, 47% of whom with multiple partners. Fifty-seven (46%) of 123 participants who had sex did not always use condoms; unsafe sex was common in seroconcordant or serodiscordant relationships or in sero-unknown relationships. Only 41% (50/123) participants knew about the possibility of HIV superinfection. Our results suggest the urgent need of HIV prevention interventions for the Nepalese HIV-positive men.

Nepal has witnessed a humanitarian crisis since the Maoist conflict began ten years ago. The plight of internally displaced persons (IDPs) in Nepal has received little international attention despite being rated one of the worst displacement scenarios in the world. An estimated 200,000 people have been displaced as a result of the conflict, with the far-western districts of Nepal being the worst affected. Internal displacement has stretched the carrying capacity of several cities with adverse physical and mental health consequences for the displaced. Vulnerable women and children have been the worst affected. The government has adopted a discriminatory approach and failed to fulfil its obligations towards IDPs. Non-governmental organisations and international agencies have provided inadequate services to IDPs in their programmes. Tackling the issues of IDPs requires co-operation between government and development agencies: acknowledging the burden of the problem of IDPs, adequate registration and needs assessment, along with health and nutritional surveys, and development of short-term emergency relief packages and long-term programmes for their assistance.

The objective of this study was to assess the trends of sampling locations and methods of studying hard-to-reach populations conducted in Japan. We accessed a Japanese medical database on 30 September 2005 to review 5 study types of hard-to-reach populations conducted in Japan: men who have sex with men, homeless, sex workers, undocumented migrants, and injecting drug users. We then categorized their sampling locations and methods. We found 298 articles on hard-to-reach populations published from 1983 to September 2005. Of the 285 studies sampled, approximately 92% were facility-based studies and the rest were community-based. This tendency was consistent in each subgroup; the majority of the studies were conducted among patients in medical facilities. Our study shows the majority of studies on hard-to-reach populations in Japan adopted a convenience sampling method and were facility-based. We suggest the utilization of comparatively valid techniques, such as time-location or respondent driven sampling to more clearly understand these populations.

We assessed the impact of an HIV/AIDS programme for Nepalese migrants to India that involved writing letters. The programme created opportunities for sending HIV/AIDS-related messages to the migrants in India, and encouraging them practicing safer sex. Initially, they received the messages only from the programme, but later from their colleagues, spouses or other family members. They discussed the messages in groups, disseminated them, and sought more knowledge in their destinations. These findings indicated that using letters could be an effective way to reach inaccessible migrants at their destinations, and help them to improve their HIV/AIDS-related knowledge, and safer sex practices.

Objective: To evaluate HIV/AIDS training for traditional healers (THs) in far western Nepal., Methods: We collected data using a structured questionnaire and assessed THs' knowledge of HIV transmission, misconceptions and preventive measures immediately prior to the initial training conducted from June to December 1999, and then 9-12 months after the training in 2000. We also conducted six focus group discussions (FGD) and assessed THs' performances after the training. We interviewed 12 key informants about their perceptions towards the trained THs., Results: THs significantly improved their knowledge of HIV transmission, misconceptions and preventive measures after the training. The FGD and key informant interview results showed that the trained THs provided culturally acceptable HIV/AIDS education to the local people, distributed condoms and played a role in reducing the HIV/AIDS-related stigma., Conclusions: THs have a potential to work as key players in HIV/AIDS programmes in Nepal.

Objective: To examine Nepali migrants' vulnerability to HIV/sexually transmitted infections (STIs) and their possible role in causing the epidemic in far western Nepal., Methods: From August to October 2000, we conducted six focus group discussions among 53 returned migrants from India, mainly from Mumbai. Data were analysed by interpretative thematic analysis., Results: Migrants commonly had multiple sexual encounters, changed partners, and used condoms infrequently both in India and at home. Several factors influenced them to practice high-risk sexual behaviours. In India, these included peer norms and pressures, cheaper sex, lack of family restraint, drinking alcohol, and low perceived vulnerability to HIV/STIs. In Nepal, these factors included the migrants' new status, frequent local festivals, and low perceived vulnerability to HIV/STIs. Participants displayed substantial deficits in their knowledge of HIV/STIs., Conclusions: This study revealed Nepali migrants' high-risk sexual behaviours both abroad and at home. Understanding these realities will assist in the development of culturally appropriate HIV/STI interventions necessary to halt the spread of HIV/STIs in Nepal.

Objective: To measure the seroprevalence of human immunodeficiency virus (HIV) infection and syphilis, and to assess the behavioural risk factors for these infections among migrant-returnees and non-migrants in far western Nepal., Methods: In April 2001, we recruited 97 male migrant-returnees and 40 non-migrants from five rural villages in Doti district where migration to Mumbai is common. For data collection, we conducted a serological examination for HIV and syphilis, and a perception and behaviour survey on HIV and other sexually transmitted infections., Results: We found that 11 of 137 men (8%) were positive for HIV infection and 30 men (22%) for syphilis. The respondents, especially the migrant-returnees from Mumbai, were engaging in risky behaviours such as pre- or extramarital sex, and sex with multiple partners, including sex workers., Conclusions: This study revealed high HIV and syphilis prevalence among the male migrant-returnees and non-migrants in far western Nepal where migration to Mumbai is common. The prevalent behaviours, particularly among the migrant-returnees, imply urgent needs of the behavioural modification programme in this area to prevent the spread of HIV infection to general population.

This paper explores low levels of women's health service utilization for Sexually Transmitted Infections (STIs) in Nepal. We interviewed 120 women individually and 53 in focus groups. Predictors of lower utilisation were self-medication, consultation with faith healers, inadequate knowledge of STIs, belief about causes, fear, social taboos and stigmatisation, womens secondary status, and presence of male health professionals. Results indicate the importance of peoples belief in their decisions about health care. Strategies to improve access to health services in Nepal should systematically investigate the role of all these factors to improve access to and utilisation of health services for STIs.