KEY FACTORS ASSOCIATED WITH LOW BIRTH WEIGHT AT TERM IN NEPAL: A CASE CONTROL STUDY

Background:Low Birth Weight (LBW) is a major public health problem in developing countries including Nepal. Nepal has a prevalence of LBW of 21%. There are various factors associated to high prevalence of LBW. This study aimed to identify specific factors associated to LBW at term in hospital settings in Nepal. Methodology: This study used a hospital based case control design. Hospital nurses interviewed mothers aged 15-45 years who had delivered a full term, single and live baby. Results: A total of 1533 respondents (511 cases and 1022 controls) were taken which is slightly more than the estimated sample size. The mean weight of newborns among case group was 2215 gm (SD:203); and among control group was 3012gm (SD:367). This study revealed that factors such as mothers under 20 years old (OR=1.436, 95% CI:1.074-1.920); height below 145cm (OR=1.504, 95% CI:1.087 -2.083); primigravida (OR=1.423, 95% CI:1.132-1.788); illiterate (OR=1.407 95% CI:1.011-1.957); <4 ANC visits (OR=1.534, 95% CI:1.202-1.957); and iron supplement <180 tabs (OR=1.434, 95% CI:1.152-1.786) were associated with LBW. However, variables like <20 years at the first pregnancy (OR=1.139, 95% CI: 0.904-1.433), disadvantaged ethnicity (OR=1.077, 95% CI: 0.861-1.347) were not associated with LBW in this study.Conclusion: Maternal height, education, number of ANC visits, and iron consumption were strong predictors for LBW in Nepal. It would benefit the country to develop effective strategies on maternal nutrition, female education, and quality ANC to overcome LBW.KEYWORDS: Low Birth Weight; Socio-demographic and antenatal care, Case control design

KEY FACTORS ASSOCIATED WITH LOW BIRTH WEIGHT AT TERM IN NEPAL: A CASE CONTROL STUDY

Background:Low Birth Weight (LBW) is a major public health problem in developing countries including Nepal. Nepal has a prevalence of LBW of 21%. There are various factors associated to high prevalence of LBW. This study aimed to identify specific factors associated to LBW at term in hospital settings in Nepal. Methodology: This study used a hospital based case control design. Hospital nurses interviewed mothers aged 15-45 years who had delivered a full term, single and live baby. Results: A total of 1533 respondents (511 cases and 1022 controls) were taken which is slightly more than the estimated sample size. The mean weight of newborns among case group was 2215 gm (SD:203); and among control group was 3012gm (SD:367). This study revealed that factors such as mothers under 20 years old (OR=1.436, 95% CI:1.074-1.920); height below 145cm (OR=1.504, 95% CI:1.087 -2.083); primigravida (OR=1.423, 95% CI:1.132-1.788); illiterate (OR=1.407 95% CI:1.011-1.957); <4 ANC visits (OR=1.534, 95% CI:1.202-1.957); and iron supplement <180 tabs (OR=1.434, 95% CI:1.152-1.786) were associated with LBW. However, variables like <20 years at the first pregnancy (OR=1.139, 95% CI: 0.904-1.433), disadvantaged ethnicity (OR=1.077, 95% CI: 0.861-1.347) were not associated with LBW in this study.Conclusion: Maternal height, education, number of ANC visits, and iron consumption were strong predictors for LBW in Nepal. It would benefit the country to develop effective strategies on maternal nutrition, female education, and quality ANC to overcome LBW.KEYWORDS: Low Birth Weight; Socio-demographic and antenatal care, Case control design

Sleep quality, internet addiction and depressive symptoms among undergraduate students in Nepal

BACKGROUND: Evidence on the burden of depression, internet addiction and poor sleep quality in undergraduate students from Nepal is virtually non-existent. While the interaction between sleep quality, internet addiction and depressive symptoms is frequently assessed in studies, it is not well explored if sleep quality or internet addiction statistically mediates the association between the other two variables. METHODS: We enrolled 984 students from 27 undergraduate campuses of Chitwan and Kathmandu, Nepal. We assessed sleep quality, internet addiction and depressive symptoms in these students using Pittsburgh Sleep Quality Index, Young’s Internet Addiction Test and Patient Health Questionnaire-9 respectively. We included responses from 937 students in the data analysis after removing questionnaires with five percent or more fields missing. Via bootstrap approach, we assessed the mediating role of internet addiction in the association between sleep quality and depressive symptoms, and that of sleep quality in the association between internet addiction and depressive symptoms. RESULTS: Overall, 35.4%, 35.4% and 21.2% of students scored above validated cutoff scores for poor sleep quality, internet addiction and depression respectively. Poorer sleep quality was associated with having lower age, not being alcohol user, being a Hindu, being sexually active and having failed in previous year’s board examination. Higher internet addiction was associated with having lower age, being sexually inactive and having failed in previous year’s board examination. Depressive symptoms were higher for students having higher age, being sexually inactive, having failed in previous year’s board examination and lower years of study. Internet addiction statistically mediated 16.5% of the indirect effect of sleep quality on depressive symptoms. Sleep quality, on the other hand, statistically mediated 30.9% of the indirect effect of internet addiction on depressive symptoms. CONCLUSIONS: In the current study, a great proportion of students met criteria for poor sleep quality, internet addiction and depression. Internet addiction and sleep quality both mediated a significant proportion of the indirect effect on depressive symptoms. However, the cross-sectional nature of this study limits causal interpretation of the findings. Future longitudinal study, where the measurement of internet addiction or sleep quality precedes that of depressive symptoms, are necessary to build upon our understanding of the development of depressive symptoms in students

Factors associated with underweight among under-five children in eastern Nepal: community-based cross-sectional study

Undernutrition is a leading cause of morbidity and mortality in children in developing countries including Nepal. This study aimed to identify sociodemographic, environmental, and maternal and child health (MCH) factors associated with objectively assessed underweight among children aged under 5 years in Ilam district of eastern Nepal.A community-based cross-sectional study of 300 mothers of children under 5 years was conducted using interviewer-administered questionnaires from July to August 2012. The sample was derived by randomly selecting three village development committees (VDCs), then three wards from each of these three VDCs were selected making a total sample of nine wards. Finally, individuals were selected from the nine wards using systematic random sampling. Chi-square tests were used to identify factors associated with childhood underweight. Logistic regression analyses were conducted to determine odds ratios for the factors associated with underweight.The prevalence of underweight was 37% [95% confidence interval (CI): 33-43%]. Children who were more than 24 months of age were more likely to be underweight (adjusted odds ratio (aOR) = 2.72; 95% CI: 1.57, 4.70) than children aged less than 24 months. Children of families who consumed water without treatment had higher odds of being underweight (aOR = 2.48; 95% CI: 1.28, 4.78) than those who used water after boiling. Children whose mother perceived their size at birth as normal were more likely to be normal weight (aOR = 0.40; 95% CI: 0.16, 0.99) compared to a smaller size at birth. Children whose growth was monitored had a low chance of being underweight (aOR = 0.35, 95% CI: 0.15, 0.97).Nearly two-fifth of under-five children were found to be underweight. The age of children, drinking water purification practices, growth monitoring, and mother's perception of size at birth were significantly associated with childhood underweight. These findings suggest that interventions focusing on access to child growth monitoring, and water and sanitation practices may reduce the childhood underweight

Difference in factors associated with continuum of care completion rate from pregnancy to postpartum period in rural Nepal: a community-based, cross-sectional study

Objectives This study aimed to investigate the continuum of care (CoC) completion rate in maternal, neonatal and child health and its associated factors among mothers in two ecological regions in Nepal.Design This was a community-based, cross-sectional study, for which data were collected through face-to-face interviews using a structured questionnaire. Multiple logistic regression analyses were conducted to determine the associated factors.Setting This was carried out in two rural districts of Nepal, in different regions: one in the hills (Dhading) and another in the flatlands called Terai (Nawalparasi). The data were collected between July and December 2016.Participants Mothers who gave birth within a year before this study were included as participants. In total, there were 1803 participants.An outcome measure The outcome of this study was measured by the CoC completion rate when a mother completes four antenatal check-ups, deliver at a health facility and receives postnatal care within 24 hours of delivery.Results The CoC completion rates were 41% in Dhading and 28% in Nawalparasi. In Dhading, shorter travel time to a health facility and higher wealth quintiles were associated with a better CoC completion rate. In Nawalparasi, the CoC completion rate was affected by parity and decision-making for pregnancy care.Conclusions The CoC completion rate was low in both districts in Nepal. However, factors associated with the CoC completion rate varied by district. Differences in these factors might be reflected by geographical and socioeconomic conditions and the characteristics of household decision making in these districts

Estimation of leisure time physical activity and sedentary behaviour among school adolescents in Nepal

Background: Leisure-time physical activity is essential for healthy and physically active life; however, this domain of physical activity is less common in developing countries. Information on leisure time physical activity and sedentary behaviour among Nepalese population is not available. The study was carried out to assess leisure time physical activity and sedentary behaviour among high school adolescents and identify the associated factors in Nepal. Methods: A cross-sectional descriptive study was carried out in Banke district, Nepal in 2013 among higher secondary school students using self-administered questionnaire based on International Physical Activity Questionnaire. A sample of 405 students, 178 females and 227 males, of the age–group 15 to 20 years from seven schools were included in the study. Multivariate logistic regression analysis was carried out to identify factors associated with participation in leisure time physical activity and sedentary behaviour. Results: Engagement of female in leisure time physical activity was lower but mean time spent on sitting per day was higher. Students who walked to school and have playground/parks near home, younger females (OR = 3.09, 95% CI: 1.18-8.08), females living in nuclear families (OR: 2.16, 95% CI: 1.01-4.62) and males who cycled to school (OR: 8.09, 95% CI: 2.35-27.80) and have provision of extra-curricular activities (OR: 2.49, 95% CI: 1.04-5.97) were more likely to be engaged in leisure time physical activity. On the other hand, students who did not have playground in school and lived in rural areas were more likely to sit for more than 6 hours a day. Likewise, male students of private school (OR: 6.41, 95% CI: 2.89-14.21), who used vehicle to reach school (OR: 5.90, 95% CI: 1.26-27.75) and have no provision of extra-curricular activities (OR: 2.98, 95% CI: 1.09-8.07) had longer sitting time. Conclusion: Difference in leisure time physical activity and sedentary behaviour was found among male and female school adolescents. Interventions are needed not only to promote leisure time physical activity but also to reduce sedentary behaviour among this group

Anthropometry at discharge and risk of relapse in children treated for severe acute malnutrition: a prospective cohort study in rural Nepal

Background There is a dearth of evidence on what should be the optimal criteria for discharging children from severe acute malnutrition (SAM) treatment. Programs discharging children while they are still presenting varying levels of weight-for-height (WHZ) or mid-upper-arm circumference (MUAC) deficits, such as those implemented under the current national protocol in Nepal, are opportunities to fill this evidence gap. Methods We followed a cohort of children discharged as cured from SAM treatment in Parasi district, Nepal. Relapse as SAM, defined as the occurrence of WHZ<-3 or MUAC < 115 mm or nutritional edema, was investigated through repeated home visits, during six months after discharge. We assessed the contribution of remaining anthropometric deficits at discharge to relapse risk through Cox regressions. Results Relapse as SAM during follow-up was observed in 33 % of the cohort (35/108). Being discharged before reaching the internationally recommended criteria was overall associated with a large increase in the risk of relapse (HR = 3.3; p = 0.006). Among all anthropometric indicators at discharge, WHZ<-2 led to a three-fold increase in relapse risk (HR = 3.2; p = 0.003), while MUAC < 125 mm significantly raised it only in the older children. WHZ<-2 at discharge came up as the only significant predictor of relapse in multivariate analysis (HR = 2.8, p = 0.01), even among children with a MUAC ≥ 125 mm. Of note, more than 80 % of the events of relapse as SAM would have been missed if WHZ had not been monitored and used in the definition of relapse. Conclusions Our results suggest that the priority for SAM management programs should be to ensure that children reach a high level of WHZ at discharge, at least above or equal to the WHO recommended cut-off. The validity of using a single MUAC cut-off such as 125 mm as a suitable discharge criterion for all age groups is questioned. Further follow-up studies providing a complete assessment of nutritional status at discharge and not based on a restricted MUAC-only definition of relapse as SAM would be urgently needed to set evidence-based discharge criteria. These studies are also required to assess programs currently discounting or omitting WHZ for identification and management of SAM