Dharma Nand Bhatta

Involvement of males in antenatal care, birth preparedness, exclusive breast feeding and immunizations for children in Kathmandu, Nepal

BackgroundMen in patriarchal societies of developing countries are often identified as decision makers in all aspects of day-to-day life. The study explores the factors associated with male involvement in ANC, birth plans, exclusive breastfeeding and immunization of children.MethodsA cross-sectional survey was conducted among 2178 married males between May and December 2010 in Kathmandu, Nepal. Twenty one clusters were selected for data collection using structured questionnaire. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CI) of associated factors were estimated by stepwise backward likelihood ratio method.ResultsThis study determined the percentage of males who accompanied their partners for ANC (39.3%), arranged SBA (47.9%) and accompanied them for child immunization (10.9%). Factors found associated with respect to different activities were as follows: accompanied their partners on antenatal visits – uneducated or primary level education (AOR, 5.68, 95% CI, 4.44-7.27), income NPR 5001 (1USD = 85 NPR) or above (1.47, 1.20-1.80) and aged above 25 years (2.51, 1.89-3.33); arranged money for delivery – uneducated or primary level education (7.34, 5.84-9.23), income NPR 5001 or above (1.80, 1.48-2.20) and aged above 25 years (1.55, 1.18-2.03); arranged SBA – uneducated or primary level education (17.14, 12.65-23.22) and income NPR 5001 or above (2.89, 2.36-3.54); arranged transportation – uneducated or primary level education (17.65, 11.84-26.32), income NPR 5001 or above (1.69, 1.40-2.04) and aged above 25 years (1.69, 1.27-2.24); encouraged exclusive breast feeding – uneducated or primary level education (5.48, 4.39-6.83) and aged above 25 years (1.35, 1.03-1.77); accompanied their partners for immunization their children – uneducated or primary level education (3.88, 2.53-5.96) and aged above 25 years (1.72, 1.11-2.64).ConclusionsMen who were uneducated or had primary level education, aged above 25 years, had higher income, formal employment, came from Hindu religion and non-indigenous ethnicities demonstrated greater involvement and these factors should be emphatically considered during maternal health program development.

Shadow of domestic violence and extramarital sex cohesive with spousal communication among males in Nepal

BackgroundPublic health and human right issues are challenging in low and middle income countries. The main objectives of this paper were to determine the prevalence and factors associated with domestic violence, extramarital sex, and spousal communication among male.MethodsA cross-sectional study among 2466 married males in Kathmandu, Nepal was conducted using random sampling method. Adjusted odds ratios (AORs) and 95% confidence intervals (CI) of associated factors were estimated by stepwise backward likelihood ratio method.ResultsPrevalence of domestic violence was 63.14% (95% CI 61.20-65.05), extramarital sex was 32.12% (95% CI 30.27-34.00), and spousal communication was 48.87% (95% CI 46.85-50.90). Nearly one in five male (18.20%) had not used condom during extramarital sex.Interestingly, male who had more than three or equal children were less likely to have perpetrated domestic violence compared with those who had less children. Older male aged 25 and above were more likely (AORs = 1.55, 95% CI 1.19-2.03) to have extramarital sex compared with male aged 24 or below. Those male who had studied secondary or higher level of education were less likely to have extramarital sex compared to those who had primary level or no education. Male who had higher income were more likely to have spousal communication compared to those who had less income. Surprisingly, those male who had extramarital sex were less likely to have spousal communication compared with those was not involved in extramarital sex.ConclusionPractice of domestic violence and extramarital sex is quite common among married male in Nepal, where spousal communication is sparse. These findings can be used to advocate for immediate attention and activities needs to be endorsed by policymakers and programmers.

HIV-related sexual risk behaviors among male-to-female transgender people in Nepal.

BACKGROUND Transgender women are a vulnerable and key risk group for HIV, and most research has shown an increased frequency of HIV infection among this minority population. This study examined the prevalence of HIV-related sexual risk behaviors and the socio-demographic correlates with HIV-related sexual risk behaviors among male-to-female (MtF) transgender persons. METHODS Data were collected from a sample of 232 individuals through venue-based and snowball sampling and face-to-face interviews. RESULTS The HIV-related sexual risk behaviors among the MtF transgender persons were: sex without using a condom (48.3%; 95% confidence interval (CI) 41.8-54.8), unprotected anal sex (68.1%; 95% CI 62.0-74.2), and unprotected sex with multiple partners (88.4%; 95% CI 84.3-92.5). Statistically significant differences were found for age, income, education, alcohol habit, and sex with more than two partners per day for these three different HIV-related sexual risk behaviors. MtF transgender persons with a secondary or higher level of education were three times (OR 2.93) more likely to have unprotected sex with multiple partners compared to those with a primary level or no education. CONCLUSIONS Age, education, income, frequency of daily sexual contact, and an alcohol habit remain significant with regard to HIV-related sexual risk behavior. There is an urgent need for programs and interventions to reduce risky sexual behaviors in this minority population.

Efficacy of a Social Self-Value Empowerment Intervention to Improve Quality of Life of HIV Infected People Receiving Antiretroviral Treatment in Nepal: A Randomized Controlled Trial

We developed a comprehensive and culturally applicable empowerment intervention social self-value package with an aim to assess its efficacy in order to improve the quality of life (QoL) of HIV infected people receiving antiretroviral treatment. Participants were randomly allocated to receive either six weekly intervention sessions or standard care. Nonlinear mixed-effects models were performed to compare changes in empowerment scores over time. Between September and November 2014, 1447 individuals were screened, of whom 132 were randomly assigned to either the intervention or control group. The mean scores of empowerment, social support and quality of life increased and stigma scores were reduced in the intervention group at 3- and 6-months. An intervention effect on social support, stigma and QoL was significantly increased by time and group with low and high empowerment. No adverse events were reported. The empowerment intervention was efficacious in improving QoL of HIV infected people.ResumenHemos desarrollado un fortalecimiento completo y cultural applicable a la intervención social del paquete del valor propio con la intención de evaluar su eficacia para mejorar la calidad de vida de las personas infectadas por el VIH que están recibiendo ART. A los participantes se les adjudicó aleatoriamente la asignación de seis dosis semanales o los cuidados estandar. El resultado de los efectos se presentó para comparar los cambios en los valores del fortalecimiento a lo largo del tiempo. Entre septiembre y noviembre de 2014, 1447 individuos fueron moritonizados, de los cuales 132 fueron aleatoriamente asignados para cada intervención o grupo de control. La media del valor del fortalecimiento, apoyo social y calidad de vida incrementaron y los valores del estigma fueron reducidos en la intervención grupal entre 3 y 6 meses. Los efectos de una intervención al apoyo social, estigma y calidad de vida se incrementaron significativamente en ese periodo y el grupo con un bajo y alto fortalecimiento. No hubo efectos secundarios notificados. La intervención en el fortalecimiento fue satisfactoria en la mejora de la calidad de vida de la gente infectada por el VIH.

Design and feasibility of a social self-value intervention package to empower people living with HIV

ABSTRACT Human immunodeficiency virus (HIV) infection affects the quality of life of infected people. It is well known that empowerment is important for appropriate access to health care and quality of care. However, there is currently limited availability of explicit methods to increase the empowerment of HIV-infected people. This study aimed to develop and test the feasibility of a social self-value package as an empowerment intervention method for HIV-infected people. One group included 8–10 participants and each session lasted for one and half hours. Six sessions in total were developed and one session was conducted in one week. A total of 66 participants were randomly selected for participating in the package, assessed its feasibility both quantitatively and qualitatively. Attitudes towards HIV-related issues significantly and positively changed after each session. Client satisfaction and acceptability of the intervention was very high indicating high feasibility with good design. The qualitative findings also supported the quantitative findings where both participants and counselors accepted and were satisfied with the structure and contents of the package. This study revealed that providing an inclusive six-week social self-value package for HIV-infected Nepali people appears to be feasible. Its effect on empowerment intervention will be measured by a randomized controlled trial.

Older people’s perspectives on an elderly-friendly hospital environment: an exploratory study

Background Many older people are vulnerable with multiple health problems and need of extensive care and support for quality of life. The main objective of this study was to explore the older people’s perspectives on an “elderly-friendly” hospital. Methods Hospital was stratified by four domains including government, semi-government, community, and private. We interviewed 33 hospitalized older patients and four hospital managers between June and December 2014 in Kathmandu, Nepal, using purposive sampling technique. We executed a qualitative content analysis step with extensive review of the interviews. Final name of the theme was given after the agreement between the research team and experts to improve trustworthiness. Elderly-friendly services, expectation from government and hospital, and health policy related to senior citizen were developed as main themes. Results Most of the participants were satisfied with the behavior of health personnel. However, none of the health personnel were trained with geriatric health care. Elderly-friendly hospital guidelines and policy were not developed by any hospitals. Older people health card, advocacy for older people’s health and benefit, and hospital environment were the common expectations of older patients. Government policy and budget constraint were the main obstacles to promote elderly-friendly health care services. Conclusion Elderly-related health policies, physical environments of hospital, elderly-friendly health manpower, advocacy, and other facilities and benefits should be improved and developed. There are urgent needs to develop elderly-friendly hospital policies and guidelines that focus on older people’s health benefits and friendly services.

Paternal Factors and Inequity Associated with Access to Maternal Health Care Service Utilization in Nepal: A Community Based Cross-Sectional Study

Background The threat of maternal mortality can be reduced by increasing use of maternal health services. Maternal death and access to maternal health care services are inequitable in low and middle income countries.The aim of this study is to assess associated paternal factors and degree of inequity in access to maternal health care service utilization. Methods Analysis illustrates on a cross-sectional household survey that followed multistage-cluster sampling. Concentration curve and indices were calculated. Binary logistic regression analysis was executed to account paternal factors associated with the utilization of maternal health services. Path model with structural equation modeling (SEM) examined the predictors of antenatal care (ANC) and institutional delivery. Results The finding of this study revealed that 39.9% and 45.5% of the respondents’ wives made ANC visits and utilized institutional delivery services respectively. Men with graduate and higher level of education were more likely (AOR: 5.91, 95% CI; 4.02, 8.70) to have ANC of their wives than men with no education or primary level of education. Men with higher household income (Q5) were more likely (1.99, 95% CI; 1.39, 2.86) to have ANC for their wives. Similarly, higher household income (Q5) also determined (2.74, 95% CI; 1.81, 4.15) for institutional delivery of their wives. Concentration curve and indices also favored rich than the poor. SEM revealed that ANC visit was directly associated to institutional delivery. Conclusions Paternal factors like age, household wealth, number of children, ethnicity, education, knowledge of danger sign during pregnancy, and husband’s decision making for seeking maternal and child health care are crucial factors associated to maternal health service utilization. Higher ANC coverage predicts higher utilization of the institutional delivery. Wealthier population is more concentrated to maternal health services. The inequities between the poor and the rich are necessary to be addressed through effective policy and programs.

Low-birth-weight babies among hospital deliveries in Nepal: a hospital-based study

Background Birth weight is an important indicator of a population’s health and is associated with numerous interrelated factors in the infant, mother, and physical environment. The objective of this study was to assess the proportion of low birth weight and identify the associated factors for low birth weight in a liveborn infant among the women in Morang, Nepal. Methods A cross-sectional survey was carried out from December 2010 to March 2011 among 255 mothers who gave birth during the study period at the Koshi Zonal Hospital, Nepal. Data were collected using a structured questionnaire with face-to-face interviews. Data were analyzed through logistic regression and presented with crude and adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results The study showed that the prevalence of low-birth-weight babies was 23.1% (95% CI: 17.9–28.1). The mean (standard deviation) age of mothers was 23.23 (4.18) years. The proportion of low birth weight of previous baby was 3.9% (95% CI: 0.1–7.9), and 15.7% (95% CI: 11.5–20.5) of the respondents had preterm delivery. Nearly one-third (36.1%; 95% CI: 26.4–45.6) of the respondents had >2 years’ gap after the previous delivery. Nonformal employment (AOR: 2.14; 95% CI: 0.523–8.74), vegetarian diet (AOR: 1.47; 95% CI: 0.23–9.36), and no rest during pregnancy (AOR: 1.38; 95% CI: 0.41–4.39) were factors more likely to determine low birth weight. However, none of the variables showed a significant association between low birth weight and other dependent variables. Conclusion Low birth weight is an important factor for perinatal morbidity and mortality and is a common problem in the developing world. The proportion of low-birth-weight babies was high in hospital delivery, and ethnicities, Hindu religion, education, nonformal employment, food habit, rest during pregnancy, and type of delivery were found to influence the birth weight. Hence, it is important to strengthen health education services at the basic level of a community to solve this problem.

Social and behavioral interventions for improving quality of life of HIV infected people receiving antiretroviral therapy: a systematic review and meta-analysis

BackgroundImprovement in quality of life is crucial for HIV infected people. Social and behavioral interventions have been implemented in different contexts to improve the quality of life among HIV infected people. This review appraises the evidence for available interventions that focused on quality of life of HIV infected people receiving antiretroviral therapy (ART).MethodsWe searched electronic databases for randomized controlled trials of interventions to improve the quality of life of HIV infected people receiving ART. We searched PUBMED and the Cochrane Centre Register of Controlled Trials (CENTRAL) with the terms “social”, “behavioral”, “educational”, “quality of life”, “HIV”, and “RCT”. Searches were conducted for articles published from 1980 to December 16, 2015. Standardized data abstraction methods and searching steps were applied.ResultsTwenty-eight studies reported the impact of social or behavioral interventions in quality of life among HIV infected people, of which 15 were conducted in United States of America. A total of 4136 participants were enrolled. Of the 28 studies, four studies included females, two studies included males and remaining studies excluded both males and females. The overall reported methodological quality of the studies was subject to a high risk of bias and the study criteria were unclear in most studies. Twenty-one studies reported a significant intervention effect on at least one quality of life domain. Meta-analyses showed significant improvement in general health, mental health, physical function and environment domains of quality of life among intervention groups. However, the expected impact of the intervention was low to moderate because the rigorousness of the studies was low, information was limited, the sample sizes were small and other the quality of the study designs were poor.ConclusionsAlthough the available evidence suggests that existing social and behavioral interventions can improve some quality of life domains, the quality of evidence was insufficient to support the notion that these interventions can improve the overall quality of life of HIV infected people receiving ART. Well-designed and rigorous randomized controlled trials with high methodological quality are required.

Health problems, complex life, and consanguinity among ethnic minority Muslim women in Nepal

Background. Marriage between blood relatives is common among Muslim ethnic minority population in Nepal. Albeit, the adverse effects of such a consanguineous marriage on health are controversial. Objective. To determine the prevalence, characteristics and health outcomes related to consanguineous marriage. Design. A cross-sectional survey was carried out using a cluster sampling technique to select the respondents. A total of 400 women aged 15–49 years were interviewed from September 2011 to February 2012. A structured questionnaire was administered through face-to-face meetings. Adjusted odds ratios (AOR) were estimated by a stepwise likelihood ratio method with binary logistic regression. Results. The overall prevalence of consanguinity was 36.7%. The median age at marriage and age at first childbirth was 15 and 18 years, respectively. The association of being in a consanguineous marriage among women whose husbands education level were secondary or higher was 3.35 (95% CI 1.56, 7.12) times greater than among those whose husbands were unable to read and write. Woman who have consanguineous marriage were less likely to have (AOR 0.46, 95% CI 0.26, 0.82) used contraceptive than those who have non-consanguineous marriage. Women who have consanguineous marriage were more (AOR 1.80; 95% CI 0.90, 3.61) likely to have birth defect in their children than those who have non-consanguineous marriage. The association of having a history of death after live birth among women who experienced emotional violence was 2.60 (95% CI 1.36, 5.00) and physical violence 2.15 (95% CI 1.16, 3.93) times greater than among those who did not experience violence. Conclusions. Several factors like husbands education and dowry practices are associated with consanguineous marriage. Further, these factors including consanguineous marriage and marital violence are also accountable for negative health consequences. Thus, multicomponent interventions are needed in order to improve the health condition of Nepalese Muslim community in rural area.