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Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and mid...

This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1:n=94, Study 2:¬n=213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control (F2,91=6.37, p=0.003). In Study 2 (depression and psychosis), there were no differences among the three arms (F2,210=2.07, p=0.13). When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos with depression and psychosis (t(31)=-3.04, p=0.005). In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for different strategies based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761

Background: This study aims to determine the predictors of anemia among pregnant women of underprivileged ethnic groups attending antenatal care at provincial level hospital of Province 2.Methods: A hospital based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face to face interviews using structured questionnaire was undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the predictors of anemia. Analyses were performed using IBM SPSS version 23 software.Results: The overall anemia prevalence in the study population was 66.9% (95% CI 61.1-72.3). The women from most under-privileged ethnic groups (Terai Dalit, Terai Janajati and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity.Conclusions: The prevalence of anemia is a severe public health problem among the pregnant women of under-privileged ethnic groups in Province 2. Being Dalit, Janajati and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication and having inadequate dietary diversity are found to be the significant predictors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from most-marginalized ethnic groups and those with lower education.

Background Globally in 2017 neonatal death accounted for 46% of under-five deaths. Nepal is among the developing countries which has a high number of neonatal deaths. The rates are high among poor socio-economic groups, marginalized, as well as people living in remote areas of Nepal. This paper, thus tries to examine the utilization pattern and maternal, household, and health service factors affecting underprivileged ethnic groups in Midwest Nepal. Methods A cross-sectional mixed method study was conducted from September 2017 to April 2018 in Bardiya district. Quantitative data were collected from a household survey of women who gave live births within the last 12 months prior to data collection (n = 362). Interviews were also undertaken with 10 purposively selected key informants. Logistic regression model was used to determine the factors associated with essential neonatal care utilization. Thematic analysis was undertaken on the qualitative data. Results Overall, neonatal care utilization was 58.6% (53.3–63.7%), with big variations seen in the coverage of selected neonatal care components. Factors such as birth order (2.059, 1.13–3.75), ethnicity (2.28, 1.33–3.91), religion (2.37, 1.03–5.46), perceived quality of maternal and neonatal services (2.66, 1.61–4.39) and awareness on immediate essential newborn cares (2.22, 1.28–3.87) were identified as the determining factors of neonatal care utilization. Conclusions The coverage of birth preparedness and complication readiness, adequate breastfeeding, and postnatal care attendance were very low as compared to the national target for each component. The determinants of essential neonatal care existed at maternal, household as well as health facility level and included ethnicity, religion, perceived quality of maternal and neonatal services, birth order and awareness on immediate essential newborn care. Appropriate birth spacing, improving the quality of maternal and neonatal services at health facilities and raising mother’s level of awareness about neonatal care practices are recommended. Electronic supplementary material The online version of this article (10.1186/s12884-019-2465-6) contains supplementary material, which is available to authorized users.

Modern contraceptives are highly effective and proven means of preventing unintended pregnancy and reducing maternal mortality. Social and economic characteristics are some of the key determinants of health and utilization family planning. However, studies examining the factors associated with utilization of long acting reversible contraception (LARC) are limited in Nepal. This study assessed the factors associated with utilization of LARC methods among married women of reproductive age in Nepal. Secondary data analysis was conducted using the 2016 Nepal Demographic and Health Survey (NDHS). A logistic regression model examined the association of socioeconomic, demographic, or fertility related characteristics with the use of LARCs among 9875 ever married women of reproductive age. The overall utilization rate of LARC in this study was 4.7%. Women in the age group of

Background: Timely initiation of breastfeeding has the potential to prevent 22% of neonatal deaths if breastfed within an hour after birth. Although breastfeeding is almost universal in Nepal, ranges of regional differences in timely initiation of breastfeeding have been documented. The aim of this study was to identify the prevalance and the determinants of early initiation of breastfeeding among disadvantaged ethnic women in Midwest Nepal. Methods: The data was obtained from a household survey of women who had their last child less than one year of age. Descriptive statistics were used to analyze respondents’ demographic, socioeconomic, obstetric and health services related characteristics. Determinants of timely initiation of breastfeeding were assessed using univariate analysis and further evaluated using multivariable logistic regression analysis.Results: Of 362 mothers, 65.5% initiated breastfeeding within one hour of childbirth. Mothers belonging to Tharu ethnic groups (aOR 1.788; 95% CI: 1.014, 3.152), health facility delivery (aOR 3.381; 95% CI: 1.795, 6.369) and mothers who were counseled on breastfeeding during ANC attendance (aOR 2.898; 95% CI: 1.038, 8.096) were more likely to initiate breastfeeding within the first hour of child birth. Conclusions: Almost two in every three mothers had initiated breastfeeding within one hour of childbirth. The factors influencing timely initiation of breastfeeding were Tharu ethnic mothers, health facility delivery and Ante Natal Care counseling. We need to aim at increasing institutional deliveries and counseling during ANC which may increase the early initiation of breastfeeding among disadvantaged ethnic groups. Keywords: Breastfeeding; determinants; Nepal; prevalence; timely initiation

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Summary Introduction Childhood overweight/obesity is a global health problem because of adverse health and nutrition consequences worldwide. Currently, there is a paucity of information on childhood overweight/obesity in Nepal. Therefore, the objective of this study was to assess the prevalence of, and the factors associated with, childhood overweight/obesity among primary school children. Methods A cross-sectional study was conducted in June-December, 2013. We collected data using the structured self-administered questionnaire with parents of children aged 6–13 years in grades 1–6 studying at private schools of the Lalitpur district of Nepal. Height and weight measurements of 986 children were taken, and the corresponding body mass index (BMI)-for-age was calculated. The prevalence of childhood overweight/obesity was reported in proportion. Factors associated with childhood overweight/obesity were examined using the Chi-square tests followed by multiple logistic regression analyses. Results Of 986 children, 144 (14.6%) were overweight and 111 (11.3%) were obese. Overall, 255 (25.9%) children were found to be overweight/obese. Children from families, having ≤2 siblings (adjusted odds ratio (aOR) = 1.958, 95% confidence interval (CI): 1.163–3.296), upper class family (aOR = 3.672; 95% CI: 1.154–11.690), and advantaged ethnic group (aOR = 1.561; 95% CI: 1.00–2.437) and children who were of larger birth weight (>4.0 kg) had a greater likelihood of being (aOR = 2.557, 95% CI: 1.222–5.349) overweight/obese. Conclusions A quarter of children were found to be overweight/obese in private primary schools. Preventive interventions should focus on the advantaged ethnic groups, families with fewer siblings, and upper class families. A greater emphasis ought to be placed on formulation and implementation of policies aimed at addressing the newly emerging problems of childhood overweight/obesity in Nepal. New school health programs are to be launched and strengthened including avoidance of high energy junk food, and promoting outdoor activities.

A cross-sectional study was conducted among women of different ethnic groups aged 40 to 60 years and health workers in different parts of Nepal using focus group discussions (FGDs), key informant interviews (KIIs) and clinical examinations to determine the symptoms and complains related to menopause. The mean age at menarche was 15 years and the mean age of menopause was 47. The highest menarche and menopause (50 years) was found to be among the Gurung women. Mean age of menopause was found to be higher among currently older women (52 years among 60+ women vs 41 years among Most of the women had heard about menopause but did not have detailed knowledge on it. Loss of sexual interest (95.3%), decreased visual activity (58%), joint pain (31.3%) and body pain (31.3%) were the most commonly reported menopausal symptoms. Mean body mass index (BMI) was highest among the Gurung women (both perimenopausal and postmenopausal). Pap smear was normal in all 138 women but around 50% had some cervical and vaginal-related problems. One-third of Tharu postmenopausal women had atropic labia and onethird of Tamang women had leukoderma. Since, very little knowledge is known about the postmenopausal symptoms and problems in Nepal, this study can serve as the basis for further researches in this area with an increased sample size. How to cite this article Rajbhandari S, Amatya A, Giri K. Relation of Ethnicity and Menopausal Symptoms in Nepal. J South Asian Feder Menopause Soc 2013;1(2):50-55.

Background Nepal is experiencing a public health issue similar to the rest of the world, i.e., the geographical maldistribution of physicians. Although there is some documentation about the reasons physicians elect to leave Nepal to work abroad, very little is known about the salient factors that influence the choice of an urban versus rural practice setting for those physicians who do not migrate. In recent years, around 1000 medical students became doctors within Nepal, but their distribution in rural locations is not adequate. The purpose of this study was to explore what factors influence the choice of urban or rural location for the future clinical practice of Nepalese medical students in the final year of their program Methods A cross-sectional descriptive study design was used for this study involving Nepalese medical students in their final year of study and currently doing an internship in a medical college. The sample consisted of 393 medical students from four medical colleges in Nepal that were selected randomly. An anonymous self-administered questionnaire was used for data collection. To determine the association with rural location choice for their future practice setting, a comparison was done that involved demographic, socio-economic, and educational factors. Data were entered in EpiData and analyzed by using SPSS version 16. Results Among the 393 respondents, two thirds were male (66.9%) and more than half were below 25 years of age. Almost all (93%) respondents were single and about two thirds (63.4%) were of Brahmin and Chhetri ethnic origin. About two thirds (64.1%) of the respondents were born in a rural setting, and 58.8% and 53.3% had a place of rearing and permanent address in a rural location, respectively. The predictors of future rural location choice for their clinical practice (based on the bivariate analysis) included:Rural (versus urban) place of birth, place of rearing, and permanent addressSource of family income (service, business, and agriculture)Occupation of father (service, business and agriculture)Wealth ranking (higher, middle, and lower wealth rank)Educational factors: location, type of secondary education, and type of higher secondary education Conclusion For medical students who were soon to complete their studies, demographic and educational factors were found to be significant predictors for a rural location choice, as opposed to socio-economic factors. Our findings indicate that to ensure the rural retention of physicians, the government of Nepal should attract potential medical students from those who were reared and educated in a rural setting.

An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy for uterine perforation because of repeated dilatation and curettagefor persisting vaginal bleeding following molar evacuation.As significant proportion of molar do progress into Gestational trophoblastic Neoplasiawhich in this case was choriocarcinoma; directs our attention to the fact that properfollow up of post molar cases using at least urinary beta HCG and institutingchemotherapy whenever necessary should be advocated in order to avoid such adrastic management.Key Words: Uterine perforation, molar, Gestational Trophoblastic Neoplasia (GTN)

A 17-year-old girl had a large abdominopelvic mass (12 x 8cm) extending from vagina, due to the presence of a complete transverse vaginal septum in its middle third which on resection facilitated the drainage and disappearance of the mass finally diagnosed as a case of mucocolpos.

Chronic vaginal discharge in children and adolescents is a common gynaecological complaint which is often resistant to antibiotic treatment. We present a 14 years old, premenarcheal girl who presented to us with the complaints of recurrent, foul smelling purulent occasionally blood stained vaginal discharge for eight years, where a foreign body in the upper vagina was found after releasing a dense adhesion of the lower vagina which was unable to detect by pelvic ultrasound.

Aims: To study the distribution of different types of ovarian tumors seen in adolescents and children and evaluate the commonest tumor during this period. Methods: A prospective study conducted at Dept of Ob/Gyn, Tribhuvan University Teaching Hospital form January 1999 - January 2008. Results: There were a total of 80 cases of ovarian tumors in childhood and adolescents. Most of the cases had presented to the outpatient department of Ob/Gyn (54%), Medicine (10%), Surgery (21%) and Emergency Unit (15%). Majority of the cases were between the ages of 15 to 19 and tumors in childhood age up to 14 represented 21% of the total ( < 10year being 4). The most frequently occurring tumor was Germ cell tumors accounting for 59 (73.7%) of the total. Out of which dermoid was the most frequently occurring in 45(76.2%). Nineteen (23.71 %) of the total tumor were malignant. All of them underwent laparatomy followed by enucleation (14); Unilateral ophoorectomy (28), unilateral salphingooophorectomy (36) and TAHBSO (2). Conclusion: This study shows the preponderance of germ cell tumor and high percentages of malignancies within germ cell tumor in young children and adolescents. Keywords: childhood, adolescent, ovarian tumors, malignancy doi:10.3126/njog.v3i1.1438 NJOG 2008 May-June; 3(1): 39 - 42

Aim: To compare the effectiveness of oral misoprostol with vaginal misoprostol for induction of labour at or more than 40 weeks of pregnancy. Method: Study design: Prospective comparative study. Duration: March 2005 to February 2006 (12 months)in the Dept of Obs/Gyn, TU Teaching Hospital, Kathmandu. Methods: Hundred nullipara (primi or gravida 2 with 1 spontaneous or induced abortion < 12 gestational weeks) in a singleton pregnancy > 40 but with Bishop's score < 4 were induced equally with either oral (100 mgm) Group A or vaginal (25mcg) Group B: were administered 4 hourly up to maximum of 6 doses. Primary outcome measures: duration of induction to active stage of labour or delivery, spontaneous rupture of membrane (SROM), meconium stained liquor (MSL), caesarean and neonatal morbidity with respect to Apgar score were assessed. Results: In vaginal 33 oral 17 had SROM with higher incidence of MSL (60% versus 12%) and higher caesarean 15%: 4%. Even there was > fetal distress 11/15: 2/7 group B/, which was statistically significant. No significant difference was noted in the pre induction cervical score, number of doses, induction to active stage of labour, induction to delivery time, use of oxytocin, failed induction and Apgar scores. Conclusion: Oral misoprostol found to be associated with less SROM, meconium stained liquor and vaginal birth and comparatively less neonatal care unit admissions outweighs its advantages over the vaginal misopristol, although either route were equally proven to be effective for inducing labour in women with unfavourable cervix (Bishop's score < 4) at term pregnancy. doi:10.3126/njog.v2i1.1472 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 23 - 28 May -June 2007

How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri successively promotes the occurrence of non puerperal uterine inversion over the years as depicted through 3 different illustrations imitating a gradual process; first by forming an indentation in the uterine fundus then progressively causing more dimpling in the verge of uterine inversion until finally giving rise to a full blown picture of complete uterine inversion where the uterine fundus is driven beyond the level of introitus with the consequences of prolapsed incarcerated myoma in a post menopausal woman. A total abdominal hysterectomy and bilateral salpingoophorectomy were performed on all of these 3 women 2 perimenopausal and a postmenopausal; the latter was first facilitated by vaginal myomectomy further supplemented by division of the inversion ring posteriorly as described by Haultain. Key words: Non puerperal uterine inversion, submucous fundal myoma, vaginal myomectomy. doi:10.3126/njog.v1i2.2398 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 51-54 Nov-Dec 2006

Placental site trophoblastic tumor (PSTT) a rare variety of gestational trophobalstic neoplasia described in younger women, usually following term delivery characterized by low serum ß hCG level was met in a 32 year old lactating mother, who resumed normal menstruation after three months of cesarean section up to three cycles followed by amenorrhea for eight months; evacuation for presumed missed abortion prompted the diagnosis of PSTT which at the time of hysterectomy was found invading perimetrium and perforating the uterine cesarean scar. Conclusion: Careful evaluation of lactational amenorrhea is indicated so that the diagnosis of PSST may not be missed in the background of elusive picture such as missed abortion with low serum ß hCG, histological examination of the evacuated material may be relied which may provide the diagnosis at times. Key words: Placental site trophoblastic tumour (PSTT), hysterectomy, low serum ß hCG doi:10.3126/njog.v3i1.1443 NJOG 2008 May-June; 3(1): 55 - 57

Degenerative changes in myomas found in the reproductive age group in day to day life is much lower than reported and in this respect we present as unusual case of myoma size 15 x 20 cm with myxoid degeneration in a 23 year old nulliparous lady presenting with menorrhagia, increased frequency of micturition who underwent myomectomy even after cystic changes was seen on USG and CT scan; this case indicating the importances of organ preserving surgery in young women. Key words: cystic changes, lump in lower abdomen, menorrhagia, myoma, myomectomy doi:10.3126/njog.v1i2.2403 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 66-68 Nov-Dec 2006

Background Cervical cancer is the leading cause of cancer related deaths among women in Nepal. The long symptom to diagnosis interval means that women have advanced disease at presentation. The aim of this study was to identify, estimate and describe the extent of different delays in diagnosis of cervical cancer in Nepal. Methods A cross-sectional descriptive study was conducted in two tertiary cancer hospitals of Nepal. Face to face interview and medical records review were carried out among 110 cervical cancer patients. Total diagnostic delay was categorized into component delays: patient delay, health care providers delay, referral delay and diagnostic waiting time. Results Total 110 patients recruited in the study represented 40 districts from all three ecological regions of the country. Median total diagnostic delay was 157 days with more than three fourth (77.3%) of the patients having longer total diagnostic delay of >90 days. Out of the total diagnostic delay, median patient delay, median health care provider delay, median referral delay and median diagnostic waiting time were 68.5 days, 40 days, 5 days and 9 days respectively. Majority of the patients had experienced longer delay of each type except referral delay. Fifty seven percent of the patients had experienced longer patient delay of >60 days, 90% had suffered longer health care provider delay of >1 week, 31.8% had longer referral delay of >1 week and 66.2% had waited >1 week at diagnostic center for final diagnosis. Variation in each type of delay was observed among women with different attributes and in context of health care service delivery. Conclusions Longer delays were observed in all the diagnostic pathways except for referral delay and diagnostic waiting time. Among the delays, patient delay is of crucial importance because of its longer span, although health care provider delay is equally important. In the context of limited screening services in Nepal, the efforts should be to reduce the diagnostic delay especially patient and health care provider delay for early detection and reduction of mortality rate of cervical cancer.

Background Little evidence exists on the connections between nutrition, diet intake, and quality of life (QoL) among people living with HIV (PLHIV). The study aimed to estimate the prevalence of under-nutrition among PLHIV in Nepal, and identify risk factors and assess correlations with PLHIVs’ QoL and nutritional status. Methods This quantitative cross-sectional study used Body Mass Index (BMI) as an indicator for nutritional status, and additional information on opportunistic infections (OIs), CD4 count, and World Health Organization (WHO) clinical staging was collected from medical records. Participants were asked to complete surveys on food security and QoL. Descriptive analysis was used to estimate the prevalence of under nutrition. To assess associations between nutrition status and independent variables, bivariate and multivariate analysis was completed. Spearman’s rank correlation test was used to assess the association between nutritional status and QoL. Results One in five PLHIVs was found to be under nourished (BMI