Cardiovascular Risk Factors Among People being Treated for HIV in Nepal: a Cross-Sectional Study.

Background: Human Immunodeficiency Virus (HIV) and antiretroviral therapy (ART) are found to be strongly associated with cardiovascular diseases. Data are sparse on the prevalence and distribution of cardiovascular risk factors among people being treated for HIV in South Asia region. Methods: A cross-sectional study of 103 HIV patients (51 women and 52 men) attending routine follow-up consultations at the largest ART centre in Nepal was conducted. Data on several cardiovascular risk factors were collected through interview questionnaires, biophysical measurements and consulting medical records. Results: The most common cardiovascular risk factors observed were central obesity [34.6%, 95% Confidence Interval (CI): 25.3% to 43.9%], chronic kidney disease [20.7% (95% CI: 11.6% to 29.7%)] and tachycardia [20.6% (95% CI: 12.7% to 28.5%)]. Females were significantly more likely to have central obesity (male 9.8% vs. female 60%, p=0.016) and chronic kidney disease (male 15.4% vs. female 26.3%, p=0.003) as compared to the males. Participants were fairly active but a large proportion, especially men, had smoked [65% (95% CI: 57%-72.3%)], used tobacco products [66% (95% CI: 56.4%-74.4%)] or drugs (53.8% of the men) and consumed alcohol [60.2% (95% CI: 50.5%-69.1%)]. Conclusion: A high prevalence of several cardiovascular risk factors was observed among patients being treated for HIV in Nepal. Further larger studies are warranted to better understand the relevance and public health impact of cardiovascular risk factors in this region

Issues and Problems in Conducting Sensitive Research: A Case of HIV/AIDS in Nepal

The main aim of this paper is to explore the issues and problems along with possible solutions to conduct sensitive research, specifically research related to HIV/AIDS in Nepal. This paper is based on observation, information and experience obtained during research entitled, “The Economic Burden of HIV/AIDS upon Households in Nepal’ and literature reviews. There are many issues and problems in conducting sensitive research. Major issues and problems are adherence to research ethics, use of research design and sampling, and recruitment of respondents in research. The paper concluded that research on sensitive topics like HIV/AIDS is very challenging and researchers need to strictly follow ethical procedures. Maintenance of anonymity and confidentiality are the key factors for encouraging participants to become involved in such sensitive research. Similarly, a mix of qualitative and quantitative methods help to understand the complex situations encountered during sensitive research. A non-probability sampling method is preferred over other methods of sampling in such research because there is often a problem of establishing a sampling frame in populations. Similarly, support from staff from government hospitals and NGOs is crucial if people living with HIV/AIDS are to be involved in the research. The issue of incentives is a highly discussed topic in sensitive research. But, it has been concluded that incentives especially in the monetary form should not be provided in order to avoid response bias and ethical conflicts

Economic Burden of HIV/AIDS upon Households in Nepal: A Critical Review

Thousands of people are infected with HIV/AIDS in Nepal and most of them are adults of working age. Therefore, HIV/AIDS is a big burden in Nepal. This review was conducted to find the existing knowledge gap about the economic burden of HIV/AIDS at the household level in Nepal, the extent of economic burden exerted by the disease, and to provide policy recommendations. It is concluded that there was a considerable knowledge gap about the issue, and the economic burden exerted by HIV/AIDS was big enough to push the affected households into poverty. It is suggested that more studies need to be conducted to fill the knowledge gap. Similarly, Government of Nepal and other organisations working in the field of HIV/AIDS need to provide economic supports (e.g.- support for travel costs) to the HIV positive people and need to increase the awareness level among general population for reducing stigma and discrimination, and reducing economic burden on them

Young people's knowledge, attitude, and behaviour on STI/HIV/AIDS in the context of Nepal: a systematic review.

Sexual and reproductive health of young people has become a major health problem in recent decades. Recent and rapidly increasing Human Immune Deficiency Virus (HIV) rates show an urgent need for Sexually Transmitted Infections (STIs) and HIV prevention interventions in Nepal

Analysis and modeling of ducted and evanescent gravity waves observed in the Hawaiian airglow

Short-period gravity waves of especially-small horizontal scale have been observed in the Maui, Hawaii airglow. Typical small-scale gravity wave events have been investigated, and intrinsic wave propagation characteristics have been calculated from simultaneous meteor radar wind measurements. Here we report specific cases where wave structure is significantly determined by the local wind structure, and where wave characteristics are consistent with ducted or evanescent waves throughout the mesopause region. Two of the documented events, exhibiting similar airglow signatures but dramatically different propagation conditions, are selected for simple numerical modeling case studies. First, a Doppler-ducted wave trapped within relatively weak wind flow is examined. Model results confirm that the wave is propagating in the 85–95 km region, trapped weakly by evanescence above and below. Second, an evanescent wave in strong wind flow is examined. Model results suggest an opposite case from the first case study, where the wave is instead trapped above or below the mesopause region, with strong evanescence arising in the 85–95 km airglow region. Distinct differences between the characteristics of these visibly-similar wave events demonstrate the need for simultaneous observations of mesopause winds to properly assess local propagation conditions

Stakeholders' perceptions of continuing professional development among Nepalese nurses: A focus group study.

AIM: This study explores perceptions of Continuing Professional Development (CPD) opportunities among stakeholders in the profession of nursing in Nepal. DESIGN: Qualitative study using focus group discussions (FGDs). METHODS: Eight FGDs were conducted in three major cities of Nepal with nursing stakeholders including nurse managers, matrons and directors/managers of private and public nursing colleges, representatives of nursing organizations, government officials, nursing academics and practitioners from the government and private sectors. The data were analysed thematically using Creswell's six steps of analysis and the Standards for Reporting Qualitative Research (SRQR) guideline was followed. RESULTS: The study generated three major themes: (a) policy level including the national situation of CPD, political influence and training guided by the policy; (b) organizational level incorporating perceptions towards forms of CPD, staff shortage, poor staff retention, seniority for training, financial constraints and lack of continuity of training; and (c) individual level including motivation for training and lack of relevant training

Prevalence and Determinants of Anaemia among Women aged 15-49 in Nepal: A Trend Analysis from Nepal Demographic and Health Surveys from 2006 to 2016

Anaemia remains one of the major health problems throughout the world and is most common in underdeveloped or developing countries like Nepal. Most of the studies have presented and analysed the situation on a particular time basis that could be by chance. The paper intended to assess the trends of anaemia prevalence amongst reproductive-age women throughout the decade using nationally representative data. The study used the data from recent three Nepal Demographic and Health Surveys (NDHS) 2006, 2011, and 2016. More than one third (36%, 35%, and 41% in NDHS 2006/2011/2016 respectively) of women of reproductive age were anaemic. Data showed inconsistent trends of anaemia prevalence among the surveys years. The situation of anaemia has not been improved. It was even worse in the latest NDHS 2016. Policymakers should reconsider, re-evaluate, and revise the intervention programmes applied to reduce anaemia

Utilisation of Postnatal Care among Rural Women in Nepal

Background: Postnatal care is uncommon in Nepal, and where it is available the quality is often poor. Adequate utilisation of postnatal care can help reduce mortality and morbidity among mothers and their babies. Therefore, our study assessed the utilisation of postnatal care at a rural community level. Methods: A descriptive, cross-sectional study was carried out in two neighbouring villages in early 2006. A total of 150 women who had delivered in the previous 24 months were asked to participate in the study using a semi-structured questionnaire. Results: The proportion of women who had received postnatal care after delivery was low (34%). Less than one in five women (19%) received care within 48 hours of giving birth. Women in one village had less access to postnatal care than women in the neighbouring one. Lack of awareness was the main barrier to the utilisation of postnatal care. The woman's own occupation and ethnicity, the number of pregnancies and children and the husband's socio-economic status, occupation and education were significantly associated with the utilisation of postnatal care. Multivariate analysis showed that wealth as reflected in occupation and having attended antenatal are important factors associated with the uptake of postnatal care. In addition, women experiencing health problems appear strongly motivated to seek postnatal care. Conclusion: The postnatal care has a low uptake and is often regarded as inadequate in Nepal. This is an important message to both service providers and health-policy makers. Therefore, there is an urgent need to assess the actual quality of postnatal care provided. Also there appears to be a need for awareness-raising programmes highlighting the availability of current postnatal care where this is of sufficient quality

Measuring What Works: An Impact Evaluation of Women's Groups on Maternal Health Uptake in Rural Nepal.

BACKGROUND: There is a need for studies evaluating maternal health interventions in low-income countries. This paper evaluates one such intervention designed to promote maternal health among rural women in Nepal. METHODS AND RESULTS: This was a five-year controlled, non-randomised, repeated cross-sectional study (2007, 2010, 2012) of a participatory community-based maternal health promotion intervention focusing on women's groups to improve maternal health services uptake. In total 1,236 women of childbearing age, who had their last child ≤ two years ago, were interviewed. Difference-in-Difference estimation assessed the effects of the intervention on selected outcome variables while controlling for a constructed wealth index and women's characteristics. In the first three years (from 2007 to the 2010), the intervention increased women's likelihood of attending for antenatal care at least once during pregnancy by seven times [OR = 7.0, 95%CI (2.3; 21.4)], of taking iron and folic acid by three times [OR = 3.0, 95%CI (1.2; 7.8)], and of seeking four or more antenatal care visits of two times, although not significantly [OR = 2.2, 95%CI (1.0; 4.7)]. Over five years, women were more likely to seek antenatal care at least once [OR = 3.0, 95%CI (1.5; 5.2)], to take iron/folic acid [OR = 1.9, [95% CI (1.1; 3.2)], and to attend postnatal care [OR = 1.5, [95% CI (1.1; 2.2)]. No improvement was found on attending antenatal care in the first trimester, birthing at an institution or with a skilled birth attendant. CONCLUSION: Community-based health promotion has a much stronger effect on the uptake of antenatal care and less on delivery care. Other factors not easily resolved through health promotion interventions may influence these outcomes, such as costs or geographical constraints. The evaluation has implications for policy and practice in public health, especially maternal health promotion