Sunil Kumar Joshi

'They just walk away' - women's perception of being silenced by antenatal health workers : a qualitative study on women survivors of domestic violence in Nepal

Background Domestic violence during pregnancy has detrimental effects on the health of the mother and the newborn. Antenatal care provides a ‘window of opportunity’ to identify and assist victims of domestic violence during pregnancy. Little is known about the experience, needs, and expectations from the womens perspective in relation to domestic violence in Nepal. Objective Our study aims to explore how women who have experienced domestic violence evaluate their antenatal care and their expectations and needs from health centers. Design Twelve in-depth interviews were conducted among women who had experienced domestic violence during pregnancy and utilized antenatal care. The women were recruited from two different organizations in Nepal. Results Women in our study concealed their experience of domestic violence due to fear of being insulted, discriminated, and negative attitudes of the health care providers. The women wished that the health care providers were compassionate and asked them about their experience, ensured confidentiality and privacy, and referred them to services that is free of cost. Conclusions Findings from our study may help the health care providers to change their attitudes toward women survivors of domestic violence. Identifying and assisting these women through antenatal care could result in improved services for them and their newborns.

Agenda setting and framing of gender-based violence in Nepal: how it became a health issue.

Gender-based violence (GBV) has been addressed as a policy issue in Nepal since the mid 1990s, yet it was only in 2010 that Nepal developed a legal and policy framework to combat GBV. This article draws on the concepts of agenda setting and framing to analyse the historical processes by which GBV became legitimized as a health policy issue in Nepal and explored factors that facilitated and constrained the opening and closing of windows of opportunity. The results presented are based on a document analysis of the policy and regulatory framework around GBV in Nepal. A content analysis was undertaken. Agenda setting for GBV policies in Nepal evolved over many years and was characterized by the interplay of political context factors, actors and multiple frames. The way the issue was depicted at different times and by different actors played a key role in the delay in bringing health onto the policy agenda. Womens groups and less powerful Ministries developed gender equity and development frames, but it was only when the more powerful human rights frame was promoted by the countrys new Constitution and the Office of the Prime Minister that legislation on GBV was achieved and a domestic violence bill was adopted, followed by a National Plan of Action. This eventually enabled the health frame to converge around the development of implementation policies that incorporated health service responses. Our explicit incorporation of framing within the Kindgon model has illustrated how important it is for understanding the emergence of policy issues, and the subsequent debates about their resolution. The framing of a policy problem by certain policy actors, affects the development of each of the three policy streams, and may facilitate or constrain their convergence. The concept of framing therefore lends an additional depth of understanding to the Kindgon agenda setting model.

Economic and Social Burden Due to Injuries and Violence in Nepal: A Cross-Sectional Study

Introduction: Injury and violence cause five million deaths annually in the world which is around 9% of the global mortality. Eight out of fifteen leading causes of deaths in the age group 15-25 are injury related. Objective: To assess the incidence, severity and socio-economic burden of injuries and violence in two cities of Nepal. Methods: Relevant data was collected from 17th August 2008 to 16th September 2008 from injured patients attending emergency departments at six health centres in two cities. Results: In total, 505 injury cases were reported. 42.5% of the injuries occurred in roads and 34.1% at home. 65% of road traffic injuries involved motorcycles. The majority (57%) of the injured subjects were economically active. A single injury case cost 126.2 US

‘We are looked down upon and rejected socially’: a qualitative study on the experiences of trafficking survivors in Nepal

including all the expenses and the loss due to inability to work. Conclusion: The high incidence of injuries, especially road traffic injuries, adds a huge economic burden to nation.

1634b Brick kilns of nepal: recognising the hazards

Background The successful reintegration of sexual trafficking survivors into Nepalese society is challenging. This paper aims to explore the trafficking process, abuses faced during sexual slavery,and the challenges faced by women and girl survivors for successful reintegration. Method This exploratory study used qualitative methods to identify that poverty, illiteracy, lack of opportunities, and varied social stigma initiate the victimization process, and continuity of this vicious circle increases the risk for (re)entrapment. Result The reasons for sexual trafficking have also become the reasons for restricting survivors from opportunities for growth and mainstreaming. Conclusion Non-existent support systems, detachment from familial ties, being outcast by society, and an uncertain livelihood make reintegration difficult for survivors.Background The successful reintegration of sexual trafficking survivors into Nepalese society is challenging. This paper aims to explore the trafficking process, abuses faced during sexual slavery,and the challenges faced by women and girl survivors for successful reintegration. Method This exploratory study used qualitative methods to identify that poverty, illiteracy, lack of opportunities, and varied social stigma initiate the victimization process, and continuity of this vicious circle increases the risk for (re)entrapment. Result The reasons for sexual trafficking have also become the reasons for restricting survivors from opportunities for growth and mainstreaming. Conclusion Non-existent support systems, detachment from familial ties, being outcast by society, and an uncertain livelihood make reintegration difficult for survivors.

112 Injuries and musculoskeletal disorders among young workers in the brick kilns of nepal

Objective To evaluate the airborne exposure concentrations of TSPM, RSPM and silica among brickfield workers including exposure of children workers (age >18 years). Methods Personal samples for silica, respirable and total particulate and silica were collected following NIOSH methods. Logistic regression analysis adjusting age, duration of work and smoking practices was carried out at 0.05 level of significances. Results A total of 86 silica samples, 72 samples for RSP and 89 samples for TSPM were collected for the similar exposure groups (SEG) in the brick kilns. Among the SEGs, red brick loaders had the highest mean and maximum exposures to silica, RSP and TSP. To summarise, mean results were as follows for the red brick loaders, respectively for silica, RSPM and TSPM: 0.388 mg/m3, 17.944 mg/m3, 22.657 mg/m3. Other SEGs also had exposures above recognised exposure limits to silica, RSP and TSP. Additionally, several SEGs had workers under the age of 18. Exposures were significantly high and results will be discussed. Conclusions These findings indicate urgent action is required for protection of workers, including working children, from exposures and subsequent diseases associated with particulate matter and silica. Many other hazards exist in the brickfields including heat stress, acute injury and ergonomic hazards that should be addressed.

Prevalence and associated factors of domestic violence among pregnant women attending routine antenatal care in Nepal

Introduction Brick manufacturing is a labour intensive informal industry using young workers as the major work force in Nepal. Young workers are required to use physical strength, carry heavy loads and remain in a squatted posture for longer periods doing repetitive tasks posing threats to musculoskeletal system. The objective of this study was to study prevalence of musculoskeletal disorders and injuries among young workers in the selected brick kilns in Nepal. Methods This was a cross sectional study design involving young workers 17 years and below of age working in brick kilns in Bhaktapur and Sarlahi districts of Nepal. Study group included 101 young workers from Bhaktapur district and 97 from Sarlahi district, whereas, 64 nonworking children from Bhaktapur and 43 from Sarlahi districts were selected as the comparison group. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms and questions on injuries were administered. Result Lack of adequate physical infrastructures, poor working conditions with nonexistent safety procedures have posed risk to physical, metal and overall well-being of children. The risks of fall in the sampled kilns were high. The musculoskeletal disorder related pain and discomfort was experienced by 73 per cent of working children in Bhaktapur and 58 per cent in Sarlahi. It was identified that work related injuries in young workers majorly affected upper and lower limbs. The odds ratio suggests that young workers were 8 times more likely to experience trouble or body pain compared to non-working children. Discussion This study finds that presence of inferior physical environment, working conditions and practices has contributed to musculoskeletal injuries and problems exposing young workers to risks and hazards. This study was based on a small sample; nevertheless it portrays an overview of musculoskeletal disorders in the brick kilns focusing on young workers.

Exposure to respirable silica among clay brick workers in Kathmandu valley, Nepal

Aims: The primary aim of this study was to assess the prevalence of domestic violence (DV) and its associated factors among pregnant women in Nepal. The secondary aims were to investigate disclosure of DV by women to health-care personnel and to assess whether health-care personnel had asked women about their experience of DV. Methods: This cross-sectional study included 2004 pregnant women between 12 and 28 weeks of gestation attending routine antenatal care at two hospitals in Nepal from August 2014 to November 2015. In this study, DV was defined as fear of a family member and/or an experience of physical, emotional or sexual violence. Associated risk factors were analysed using logistic regression analyses. Results: Twenty-one per cent of the women had experienced DV; 12.5% experienced fear only, 3.6% violence only and 4.9% experienced both violence and fear. Less than 2% per cent reported physical violence during pregnancy. This study found that just 17.7% had ever been asked by health-care personnel about DV, and of the women who had reported DV, only 9.5% had disclosed their experience to health-care personnel. Women of young age and low socio-economic status were more likely to have experienced DV. Women who reported having their own income and the autonomy to use it were at significantly lower risk of DV compared to women with no income. Conclusions: A substantial proportion of women reported having experienced DV. Victims had rarely disclosed their experience of DV to health-care personnel. This study underlines the importance of integrating systematic assessment of DV in antenatal care.

Asymptomatic throat carriage rate and antimicrobial resistance pattern of Streptococcus pyogenes in Nepalese school children.

ABSTRACT Previous studies report high respirable silica exposures among clay brick workers globally; however, there are little data on exposures among workers in fixed chimney Bulls trench kilns, the predominant kiln type in Kathmandu valley, Nepal. We investigated respirable silica exposures among workers (N = 46) in five similar exposure groups (SEGs). Mean exposures were highest for red brick loading/carrying (331 μg/m3), followed by green brick stacking (223 μg/m3), fireman (102 μg/m3), coal crushing/carrying (92 μg/m3), and green brick molding (71 μg/m3). The average free silica content (13.8%) in the respirable dust fraction was similar to levels reported for clay brick workers employed in other types of kilns. Dust control measures and respiratory protection are recommended, with priority given to workers assigned to red brick loading and stacking and green brick stacking and carrying.