Rajendra Karkee

Epidemiology of road traffic injuries in Nepal, 2001-2013: systematic review and secondary data analysis

Objective To investigate the epidemiology of road traffic injury (RTI) in Nepal for the period 2001–2013. Methods 2 approaches, secondary data analysis and systematic literature review, were adopted. RTI data were retrieved from traffic police records and analysed for the incidence of RTI. Electronic databases were searched for published articles that described the epidemiology of RTI in Nepal. Results A total of 95 902 crashes, 100 499 injuries and 14 512 deaths were recorded by the traffic police over the 12-year period, 2001–2013. The mortality rate increased from 4/100 000 population in 2001–2002 to 7/100 000 population in 2011–2012. There were relatively more reported crashes yet fewer deaths in Kathmandu valley than the rest of the country. Of the 20 articles related to RTI, only 11 articles met the eligibility criteria, but these were mainly descriptive case series or cross-sectional hospital-based studies. The majority of RTI were reported to occur among motorcyclists and pedestrians, in males, and in the age group 20–40 years. The common sites of injury were lower and upper extremities. Only 3 articles mentioned possible causes of accidents that include pedestrian road behaviour, alcohol consumption and improper bus driving. Conclusions Nepal suffers a heavy burden of RTI, with higher fatalities on highways out of Kathmandu valley caused by bus crashes in hilly districts. The majority of published studies on RTI are descriptive and hospital based, indicating the need for more thorough investigation of causes of RTI and systematic recording of crashes for the development of effective interventions.

Prevalence and factors associated with prelacteal feeding in Western Nepal.

BACKGROUND Newborn infants are often given prelacteal feeds in Nepal despite government policies encouraging exclusive breastfeeding for the first six months of life. AIM This study investigated the prevalence, reasons, types and factors associated with prelacteal feeding in the south-western region of Nepal. METHODS Information on prelacteal feeding was obtained from 735 recently delivered women who were recruited for a prospective community-based cohort study conducted during 2014 in the Rupandehi district of Nepal. Factors associated with prelacteal feeding were assessed using logistic regression analysis. FINDINGS A total of 225 (30.6%) mothers reported giving prelacteal feeds to their infants. The most popular prelacteal food was formula milk (41.7%), followed by cow or buffalo milk (26.6%), and sugar/glucose water (12.4%). Caesarean delivery (17.3%), cultural preference (16.4%) and being tired after childbirth (10.6%) were the most commonly cited reasons. Almost half (48%) of the mothers were advised by their mother/mother-in-law on prelacteal feeding method. Higher parity (adjusted odds ratio (OR) 2.05; 95% confidence interval (CI) 1.18-3.54), low birthweight (OR 1.97; 95% CI 1.23-3.16), caesarean delivery (OR 3.70; 95% CI 2.37-5.80) and wealthy status (OR 2.49; 95% CI 1.52-4.06) were associated with prelacteal feeding. CONCLUSION Nearly one-third of the infants in this study were given prelacteal feeds. Future breastfeeding promotion programmes should focus on the mothers with low birthweight infants, of high parity, from a wealthy family and those who had caesarean delivery.

NGOs, Foreign Aid, and Development in Nepal

The number of non-governmental organizations (NGOs) working in Nepal has grown significantly since the 1990s due to a range of factors. A total of 39,759 NGOs and 189 international non-governmental organizations were registered in Nepal between 1977 and 2014 in various sectors, including health, agriculture, poverty alleviation, and good governance. Despite thousands of NGOs and significant amounts of foreign aid, Nepal remains one of the poorest countries in South Asia. The case of Nepal indicates that aid and donor support alone are insufficient for sustained development.

Birth Spacing of Pregnant Women in Nepal: A Community-Based Study

Background Optimal birth spacing has health advantages for both mother and child. In developing countries, shorter birth intervals are common and associated with social, cultural, and economic factors, as well as a lack of family planning. This study investigated the first birth interval after marriage and preceding interbirth interval in Nepal. Methods A community-based prospective cohort study was conducted in the Kaski district of Nepal. Information on birth spacing, demographic, and obstetric characteristics was obtained from 701 pregnant women using a structured questionnaire. Logistic regression analyses were performed to ascertain factors associated with short birth spacing. Results About 39% of primiparous women gave their first child birth within 1 year of marriage and 23% of multiparous women had short preceding interbirth intervals (<24 months). The average birth spacing among the multiparous group was 44.9 (SD 21.8) months. Overall, short birth spacing appeared to be inversely associated with advancing maternal age. For the multiparous group, Janajati and lower caste women, and those whose newborn was female, were more likely to have short birth spacing. Conclusion The preceding interbirth interval was relatively long in the Kaski district of Nepal and tended to be associated with maternal age, caste, and sex of newborn infant. Optimal birth spacing programs should target Janajati and lower caste women, along with promotion of gender equality in society.

Implications of methodological differences in measuring the rates of exclusive breastfeeding in Nepal: findings from literature review and cohort study

BackgroundCorrect measurement and continuous monitoring of exclusive breastfeeding are essential to promote exclusive breastfeeding. Measuring exclusive breastfeeding is a complex issue as rates can vary according to the definition, measurement period, questions asked, and infant’s age. This article reviewed the methodology of reporting exclusive breastfeeding in Nepal, and compared exclusive breastfeeding rates using data from a cohort study undertaken in western Nepal.MethodsA literature review was first conducted on studies published during 2000–2014. In our cohort study, 735 mother-infant pairs were recruited within the first month postpartum and followed up during the fourth and sixth months.ResultsThe majority of studies in Nepal, including national surveys, used the World Health Organization (WHO) recommended definition (only breastmilk with the exception of medicine and vitamin syrup), and the most common measurement period was a 24-h recall. Our data demonstrated that the exclusive breastfeeding rate during the sixth month was 8.9% using the recall-since-birth method but was 18.7% using the 24-h recall method. Substantial differences in rates were also found during the first (66.3% vs 83.9%) and fourth months (39.2% vs 61.1%).ConclusionWe found that recent studies reporting exclusive breastfeeding in Nepal varied considerably in methodology. The most commonly used measurement, the 24-h recall, leads to over-estimation of the prevalence of exclusive breastfeeding when compared to the recall-since-birth method. A common standard of reporting exclusive breastfeeding is clearly needed for evidence-based decision making.

Globalization, Global Health, and Disaster

The importance of Globalization and its effect on global health often becomes highlighted during disasters, as in the case of a large scale earthquake or the emergence of a new infectious disease. If a disaster occurs in low and middle income countries, such countries often do not have the capacity to handle an immediate response in terms of rescue, treatment, and shelter. This can result in inadequate management of affected people and environment and can lead to further disasters including epidemics and social instability, which in turn may affect global health (3). In this era of Globalization, it is possible to have a timely global response after the occurrence of a disaster and to provide substantial help to affected countries and communities to restore and maintain health services... Language: en

Defining and Developing a Global Public Health Course for Public Health Graduates

Global public health is increasingly being seen as a speciality field within the university education of public health. However, the exact meaning of global public health is still unclear, resulting in varied curricula and teaching units among universities. The contextual differences between high- and low- and middle-income countries, and the process of globalization need to be taken into account while developing any global public health course. Global public health and public health are not separable and global public health often appears as an extension of public health in the era of globalization and interdependence. Though global public health is readily understood as health of global population, it is mainly practiced as health problems and their solutions set within low- and middle-income countries. Additional specialist competencies relevant to the context of low- and middle-income countries are needed to work in this field. Although there can be a long list of competencies relevant to this broad topic, available literature suggests that knowledge and skills related with ethics and vulnerable groups/issues; globalization and its impact on health; disease burden; culture, society, and politics; and management are important.

Public health education in South Asia: a basis for structuring a master degree course

Countries in South Asian Association for Regional Cooperation (SAARC) lack enough public health workforces to address their poor public health situation. Recently, there have been efforts to develop capacity building in public health in these countries by producing competent public health workforce through public health institutes and schools. Considering the wide nature of public health, the public health education and curricula should be linked with skills, knowledge, and competencies needed for public health practice and professionalism. The 3 domains of public health practice and the 10 essential public health services provide an operational framework to explore this link between public health practice and public health education. This framework incorporates five core areas of public health education. A master degree course in public health can be structured by incorporating these core areas as basic and reinforcing one of these areas as an elective followed by a dissertation work.