Chhabi Lal Ranabhat

The Correlation of Different Cotinine Levels With Questionnaire Results A Comparative Study for Different Measurement Methods of the Adolescent Smoking Rate in Korea

This study compares the results of the Korea National Health and Nutrition Examination Survey (Self-Reported; KNHANEs [SR]) survey with urine-cotinine concentration (UCC) and the official index issued by the Korea Youth Risk Behavior Web-based Survey (KYRBS). We established standard cutoffs of 20 ng/mL, 30 ng/mL, 50 ng/mL, and 100 ng/mL to compare the results of UCC testing with those of self-reporting methods. The KYRBS demonstrated an overall current smoking rate of 12.25%, while the KNHANEs measured an overall rate of 9.63%. The UCC20 reported the highest current smoking rate at 25.6% overall. Methods that detected a lower prevalence of current smoking, in declining order, were the UCC30, UCC50, UCC100, online survey, and the KNHANEs (SR). The results of this study show that online surveys on smoking administered to adolescents have fewer false responses compared with the KNHANEs (SR). However, compared with UCC testing, online surveys still significantly underreport adolescent smoking rates.

Consequence of Indoor Air Pollution in Rural Area of Nepal: A Simplified Measurement Approach

People of developing countries especially from rural area are commonly exposed to high levels of household pollution for 3–7 h daily using biomass in their kitchen. Such biomass produces harmful smoke and makes indoor air pollution (IAP). Community-based cross-sectional study was performed to identify effects of IAP by simplified measurement approach in Sunsari District of Nepal. Representative samples of 157 housewives from household, involving more than 5 years in kitchen were included by cluster sampling. Data were analyzed by SPSS and logistic regression was applied for the statistical test. Most (87.3%) housewives used biomass as a cooking fuel. Tearing of eyes, difficulty in breathing, and productive cough were the main reported health problems and traditional mud stoves and use of unrefined biomass were statistically significant (p < 0.05) and more risk (AOR > 2) with health problems related to IAP. The treatment cost and episodes of acute respiratory infection was >2 folders higher in severe IAP than mild IAP. Simplified measurement approach could be helpful to measure IAP in rural area. Some effective intervention is suggested to reduce the severe level of IAP considering women and children.

Chhaupadi Culture and Reproductive Health of Women in Nepal

Different sociocultural barriers concerning women’s health are still prevalent. Chhaupadi culture in Nepal is that threat wherein menstruating women have to live outside of the home in a shed-like dwelling. Our study aims to determine the factors of reproductive health problems related to Chhaupadi. A cross-sectional study was performed with women of menstrual age (N = 672) in Kailali and Bardiya districts of Nepal. Data were collected with stratified sampling and analyzed using SPSS. Reproductive health problems were observed according to the World Health Organization reproductive health protocol. Regression analysis was performed to show the association between relevant variables. Results reveal that one fifth (21%) of households used Chhaupadi. Condition of livelihood, water facility, and access during menstruation and precisely the Chhaupadi stay was associated (P < .001) with the reproductive health problems of women. The study concludes that Chhaupadi is a major threat for women’s health. Further research on appropriate strategies against Chhaupadi and menstrual hygiene should be undertaken.

Impact of Spiritual Behavior on Self-Reported Illness: A Cross-Sectional Study among Women in the Kailali District of Nepal

Background Different health behaviors influence health and illness. Spiritual well-being is one of the most important aspects of health promotion. The aim of this study was to identify the association between spiritual behavior in relation to meditation, worship, and physical exercise during yoga with self-reported disease/illness among women of the Kailali district of Nepal. Methods This was a cross-sectional study with 453 randomly selected women in the Kailali district of Nepal within 1 municipality and 4 village development committees (VDC) using cluster sampling. We used a semi-structured interview to collect the data for selected respondents. Socioeconomics, lifestyle, self-care, and spiritual behavior variables were independent variables, and self-reported illness in the past year was a dependent variable. Descriptive statistics, chi square, hierarchical logistic regression for odds ratio, and 95% CI were used when appropriate. Results Study results showed that 89% of participants were from the rural area, 29.3% were housewives, 51.4% had no formal education, 43.2% used tobacco, 42.1% did yoga, and 16.9% engaged in regular worship. Self-reported illness was associated with safe toilet-using behavior, tobacco use, junk food consumption, yoga and regular exercise, worship, and regular sleeping habits. Comparing odds ratios and 95% CIs, the women who had safe toilet behavior and did not use tobacco were 2.48 (1.98–7.98) and 2.86 (1.74–7.34) times less likely to be ill, respectively. Likewise, women who consumed junk food; did not regularly exercise, meditate, or worship; and had irregular sleeping habits were 1.65 (1.32–4.61), 2.81(1.91–5.62), 2.56 (2.01–4.88), 4.56 (3.91–8.26), and 2.45 (2.12–5.03) times more likely to become ill, respectively. Conclusion Our study concludes that spiritual behavior is effective for better health and low risk for disease occurrence. A spiritual health policy and separate curriculum for basic education and medical education should be promoted globally, and further research is recommended.

A Comparative Study on Outcome of Government and Co-Operative Community-Based Health Insurance in Nepal

Background There are different models for community-based health insurance (CBHI), and in Nepal, among them, the government and the local communities (co-ops) are responsible for operating the CBHI models that are in practice. Aims The aim of this study is to compare the outcomes in relation to benefit packages, population coverage, inclusiveness, healthcare utilization, and promptness of treatment for the two types of CBHI models in Nepal. Methods This study was an observational and interactive descriptive study using the concurrent mixed approach of data collection, framing, and compilation. Quantitative data were collected from records, and qualitative data were collected from key informants in all 12 CBHI groups. Unstructured questionnaires, observation checklists, and memo notepads were used for data collection. Descriptive statistics and the Mann–Whitney U test were used when appropriate. Ethically, written informed consent was obtained from the respondents who participated in the study, and they were told that they could withdraw from the study anytime. Results The study revealed the following: new enrolment did not increase in either group; however, the healthcare utilization rate did (Government 107% and co-ops 137%), while the benefit packages remained almost same for both groups. Overall, inclusiveness was higher for the government group. For the CBHI co-ops, enrollment among the religious minority and the discount negotiated with the hospitals for treatment were significantly higher, and the promptness in reaching a hospital was significantly faster (p < 0.05) than that in the government-operated CBHI. Conclusion Findings indicate that CBHI through co-ops would be a better model because of its lower costs and ability to enhance self-responsiveness and the overall health system. Health insurance coverage is the most important component to achieve universal health coverage.

Determinants of Body Mass Index and Intelligence Quotient of Elementary School Children in Mountain Area of Nepal: An Explorative Study

The physical growth and cognitive development of elementary school children are very crucial and this group is large in number but has little research dedicated to it. The physical growth and cognitive development of children occur simultaneously and can be measured by body mass index (BMI) and intelligence quotient (IQ). Previous studies could not sufficiently focus on both aspects. The aim of this study was to identify determinants of BMI and IQ of students in two elementary schools in the Humla district of Nepal. Two randomly selected elementary schools and all children available there (n = 173) participated in the study. BMI was calculated with the objective of proper measurement of height and weight of the children. Likewise, the updated universal nonverbal intelligence test (UNIT) was applied for IQ. Descriptive statistics, t-test, analysis of variance and multiple linear regressions were used when appropriate. Study findings showed that one-tenth of the children had grade 2 thinness (-2SD) and about one-third had poor IQ (<85). The age of the children (p < 0.05) and household economic status (p < 0.001) were significant for the BMI. Likewise, frequencies of illness in the previous year, mother’s education (p < 0.05) and father’s education (p < 0.001) were significant factors for the IQ score. More commonly, BMI and IQ scores were significantly lower in the ultra-poor group. Economic status and parent education are still major determinants of IQ and BMI in these students. Special programs and strategies should be launched to improve the poor ranking of IQ and BMI.

Predisposing, enabling, and need factors associated with utilization of institutional delivery services: A community-based cross-sectional study in far-western Nepal

ABSTRACT Use of institutional delivery services can be effective in reducing maternal and infant mortality. In Nepal, however, the majority of women deliver at home. Using Andersen’s behavioral model of use of health care services, this cross-sectional study aimed to identify factors associated with use of institutional delivery services in four villages and one municipality in Kailali district, Nepal. Mothers (N = 500) who had given birth in the 5 years preceding the survey (conducted between January and February 2015) were randomly selected by cluster sampling and interviewed using a semi-structured questionnaire. Bivariate analyses and multivariate hierarchical logistic regression analyses were performed. Among the women surveyed, 65.6% had used institutional delivery services for their last delivery, a higher proportion than the national average. Primiparity, having a secondary or higher education level, living in the Durgauli village, having husbands with occupations other than agriculture or professional/technical jobs, and having attended four or more antenatal care (ANC) visits had significantly increased use of institutional deliveries. Also, belonging to the richest 20% of the community and having experienced pregnancy complications were marginally significantly associated. These findings demonstrate the need for improving mother’s education, encouraging them to attend ANC visits and addressing disparities between different regions.

Influence of community satisfaction with individual happiness: comparative study in semi-urban and rural areas of Tikapur, Nepal

Happiness is a subjective indicator of overall living conditions and quality of life. Recently, community- and national-level investigations connecting happiness and community satisfaction were conducted. This study investigated the effects of community satisfaction on happiness in Nepal. A factor analysis was employed to examine 24 items that are used to measure community satisfaction, and a multiple regression analysis was conducted to investigate the effects of these factors on happiness. In semi-urban areas, sanitation showed a positive relationship with happiness. In rural areas, edu-medical services were negatively related to happiness, while agriculture was positively related. Gender and perceived health were closely associated with happiness in rural areas. Both happiness and satisfaction are subjective concepts, and are perceived differently depending on the socio-physical environment and personal needs. Sanitation, agriculture (food) and edu-medical services were critical factors that affected happiness; however, the results of this study cannot be generalized to high-income countries.

The Influence of Universal Health Coverage on Life Expectancy at Birth (LEAB) and Healthy Life Expectancy (HALE): A Multi-Country Cross-Sectional Study

Background: There are substantial differences in long term health outcomes across countries, particularly in terms of both life expectancy at birth (LEAB) and healthy life expectancy (HALE). Socio-economic status, disease prevention approaches, life style and health financing systems all influence long-term health goals such as life expectancy. Within this context, universal health coverage (UHC) is expected to influence life expectancy as a comprehensive health policy. The aim of the study is to investigate this relationship between Universal Health Coverage (UHC) and life expectancy. Method: A multi-country cross-sectional study was performed drawing on different sources of data (World Health Organization, UNDP-Education and World Bank) from 193 UN member countries, applying administrative record linkage theory. Descriptive statistics, t-tests, Pearson correlations, hierarchical linear regressions were utilized as appropriate. Result: Global average healthy life years was shown to be 61.34 ± 8.40 and life expectancy at birth was 70.00 ± 9.3. Standardized coefficients from regression analysis found UHC (0.34), child vaccination (Diphtheria Pertussis Tetanus−3: 0.17) and sanitation coverage (0.31) were associated with significantly increased life expectancy at birth. In contrast, population growth was associated with a decrease (0.29). Likewise, unit increases in child vaccination (DPT 3), sanitation and UHC would increase healthy life expectancy considerably (0.18, 0.31, and 0.40 respectively), whereas the same for population growth reduces healthy life expectancy by 0.28. Conclusion: Universal Health Coverage (UHC) is a comprehensive health system approach that facilitates a wide range of health services and significantly improves the life expectancy at birth and healthy life expectancy. This study suggests that specific programs to achieve UHC should be considered for countries that have not seen sufficient gains in life expectancy as part of the wider push to achieve the Sustainable Development Goal (SDG).