Indigenous young people's participation in health promotion in their community: a participatory action research of the Early Marriage and Early Pregnancy Prevention [EMEP] Project of Nepal

Indigenous peoples of Nepal constitute more than one third of the total population, yet they experience marginalization and inequalities in relation to health, education and political participation. Early marriage is one of the traditional practices of Nepali indigenous communities contributing to poverty and the poor health of young people. In some indigenous communities, more than two third of young girls are married before the age of 15 years. The aim of the study was to investigate young people’s participation in the early marriage and early pregnancy prevention (EMEP) project in the highly marginalized Thami indigenous community. The EMEP has been implemented since 2009 with young people as a key stakeholder. Using participatory action research (PAR) the study asked a group of Thami young men and women about their experiences of participating in the project and it explored their recommendations for enhanced participation in future. PAR is a research methodology which involves collaboration with representatives of the population under investigation, with the goal of intervention into a problem. Thami youth in this study viewed their participation in the EMEP project as mostly limited to being recipients of information campaigns. Barriers to participation included high workloads and pressures of work away from home (including migrant work outside Nepal); the delivery of the project mainly through schools; and the lack of priority of the project in the lives of Thami youth, were poverty and lack of education are the major problems they face. Their recommendations for enhanced participation included: provision of financial incentives and skills development and training; and participation of youth in needs’ assessment and project design. Implications for health policy is that marginalised youth such as the Thami have a valuable contribution to make to development, and that it is vital that their needs and views are taken into account when developing strategies. In particular, they stress the importance of addressing the social determinants of their health especially poverty and lack of education. 9 In April 2015 Nepal experienced a devastating earthquake which will have a profound effect on development in future. Youth participation will still be an important issue, perhaps more so in face of the changes that will occur as a result of the crisis

On-farm Diversity Assessment and Evaluation of Finger Millet Genotypes in the Mid Hills of Nepal

The objective of the study is to assess the phenotypic diversity among the finger millet genotypes and evaluate overall performance for the recommendation of genotypes to the farming community of mid hills of Nepal. The overall performance of 8 candidate genotypes selected  from diversity block of 46 varieties in 2015, were assessed in randomized complete block design (RCBD) with three replicates under on-farm conditions in Lamjung district during 2016. Highly significant (p?0.01) variability among the selected 8 genotypes for agro-morphological traits viz., plant height, number of fingers per head, grain yield, 1000 grain weight, straw yield, days to heading and maturity was revealed. Strong inter-correlation among grain yield, plant height, time to flowering and straw yield was detected. The traits viz., plant height, grain yield, straw yield, days to heading and days to maturity were the most important traits contributing to the overall variability and thus, provide options for selection

On-farm diversity assessment and evaluation of finger millet genotypes in the mid-hills of Nepal

The objective of the study is to assess the phenotypic diversity among the finger millet genotypes and evaluate overall performance for the recommendation of genotypes to the farming community of mid hills of Nepal. The overall performance of 8 candidate genotypes selected from diversity block of 46 varieties in 2015, were assessed in randomized complete block design (RCBD) with three replicates under on-farm conditions in Lamjung district during 2016. Highly significant (p≤0.01) variability among the selected 8 genotypes for agro-morphological traits viz., plant height, number of fingers per head, grain yield, 1000 grain weight, straw yield, days to heading and maturity was revealed. Strong inter-correlation among grain yield, plant height, time to flowering and straw yield was detected. The traits viz., plant height, grain yield, straw yield, days to heading and days to maturity were the most important traits contributing to the overall variability and thus, provide options for selection

Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal : a cluster-randomized trial

Background Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal. Methods We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months. Results 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. Theproportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01–4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63–2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001). Conclusions Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal

Barriers to Treatment Compliance of Directly Observed Treatment Shortcourse among Pulmunary Tuberculosis Patients.

Treatment compliance is an important aspect for tuberculosis prevention and control. Poor compliance to treatment can lead to the development of drug-resistant tuberculosis. The aim of this study was to explore the factors affecting treatment compliance for tuberculosis patients. Facility based unmatched case control study was done among the forty non-compliance and eighty compliance pulmonary tuberculosis patients registered at selected directly observed treatment short-course centers of six districts. Data were collected using in-depth interview guideline with the tuberculosis focal person and Focus Group Discussion with tuberculosis patients. A total of 120 respondents, 40 cases and 80 controls were enrolled in the study. About 72.5% of the cases and 56.2% of the controls were male. Five significant independent risk factors for non-compliance to TB treatment were identified. The qualitative session confirmed geographical barriers, inaccessibility to health facility, economic barriers, difficulty in convincing people, knowledge about Directly observed treatment shortcourse program, longer medication period, migration and stigma as a major barrier for treatment compliance. Wider ranges of barriers are prevalent in context of tuberculosis treatment pathway and outcome. Knowledge of the tuberculosis patients and attitude of the family plays a vital role in treatment compliance. Directly observed treatment shortcourse playing tremendous role to ensure treatment adherence has been identified as major barrier to adherence as well. Enablers of adherence need to be emphasized to address the barriers

Prevalence of cardiovascular health risk behaviors in a remote rural community of Sindhuli district, Nepal

BACKGROUND: Cardiovascular disease (CVD) is emerging as a public health menace among low and middle income countries. It has particularly affected the poorest. However, there is paucity of information about CVD risk factors profile among Nepalese rural communities where the majority of people live in poverty. Therefore, this study aimed to identify the prevalence of cardiovascular health risk behaviors in an outback community of Nepal. METHODS: We conducted a descriptive cross-sectional study in Tinkanya Village Development Committee (VDC), Sindhuli between January and March, 2014. Total 406 participants of age 20 to 50 years were selected randomly. Data were collected using WHO-NCD STEPwise approach questionnaires and analyzed with SPSS V.16.0 and R i386 2.15.3 software. RESULT: The mean age of participants was 36.2 ± 9 years. Majority of participants (76.3%) were from lower socio-economic class, Adibasi/Janajati (63.1%), and without formal schooling (46.3%). Smoking was present in 28.6%, alcohol consumption in 47.8%, insufficient fruits and vegetables intake in 96.6%, insufficient physical activity in 48.8%; 25.6% had high waist circumference, 37.4% had overweight and obesity. Average daily salt intake per capita was 14.4 grams ±4.89 grams. Hypertension was detected in 12.3%. It had an inverse relationship with education and socio-economic status. In binary logistic regression analysis, age, smoking, body mass index (BMI) and daily salt intake were identified as significant predictors of hypertension. CONCLUSION: Present study showed high prevalence of smoking, alcohol consumption, insufficient fruit and vegetable intake, daily salt intake, overweight and obesity and hypertension among remote rural population suggesting higher risk for developing CVD in future. Nepalese rural communities, therefore, are in need of population-wide comprehensive intervention approaches for reducing CVD health risk behaviors

Community Services and Out-Migration

This paper investigates the relationship between changing community context and out-migration in one of today’s poor countries, seeking to document the various mechanisms by which infrastructure affects the migratory behavior. We focus on the expansion of social and physical facilities and services near to rural people’s homes, including transportation, new markets, employment, schools, health clinics, and mass media outlets such as movie halls. We draw upon detailed data from Nepal to estimate the hypothesized effects. The direct effects of expanding economic and human capital infrastructure are clearly negative, reducing out-migration. However, increased economic infrastructure is associated with a greater accumulation of human and social capital among respondents and their parents. Through these intervening mechanisms, economic and social infrastructure increased the odds of migrating out. These results reveal the often countervailing nature of short- and long-term effects of economic and social change, and the complex pathways influencing migration outcomes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78714/1/j.1468-2435.2009.00581.x.pd

Electrocardiogram abnormalities and renal impairment in patients with type 2 diabetes mellitus: a healthcare facilities-based cross-sectional study in Dang district of Nepal

Aims/Introduction: The global burden of diabetes mellitus is rising substantially, with a further increase in cardiovascular and kidney disease burden. These public health problems are highly prevalent in low- and middle-income countries, including Nepal. However, there is limited evidence on cardiac and renal conditions among patients with type 2 diabetes mellitus. We determined the status of electrocardiogram (ECG) abnormalities and renal impairment among patients with type 2 diabetes mellitus in Nepal. Methods: We carried out a cross-sectional study in Tulsipur Sub-Metropolitan City of Nepal using a multistage stratified sampling technique to recruit patients with type 2 diabetes mellitus. We used World Health Organization stepwise approach to surveillance (WHO STEPS) questionnaires and carried out resting ECG to collect data of 345 patients with type 2 diabetes mellitus. Logistic regression analysis assessed the factors associated with ECG abnormalities and renal impairment. Results: The study showed that 6.1% of participants had major ECG abnormalities (95% confidence interval [CI] 3.8–8.6%), which were associated with hypertension (P = 0.01%) and low socioeconomic status (P = 0.01). The proportion of major and/or minor ECG abnormalities was 47.8% (95% CI 40.5–51%), and were significantly associated with age (odds ratio [OR] 1.04, 95% CI 1.01–1.07), higher education (OR 3.50, 95% CI 1.31–9.33), unemployment (OR 3.02, 95% CI 1.08–8.48), body mass index (OR 1.09, 95% CI 1.02–1.17) and duration of type 2 diabetes mellitus >5 years (OR 2.42, 95% CI 1.19–4.93). The proportion of renal impairment was 3.5% (95% CI 1.5–4.5%) which was associated with older age (OR 1.08, 95% CI 1.00–1.17) and hypertension (OR 12.12, 95% CI 1.07–138.22). Conclusion: A significant proportion of patients with type 2 diabetes mellitus had ECG abnormalities and renal impairment, which were significantly associated with hypertension. Therefore, hypertension management and early screening are essential to prevent future cardiorenal complications among patients with type 2 diabetes mellitus

Variation in grain zinc and iron concentrations, grain yield and associated traits of biofortified bread wheat genotypes in Nepal

Wheat (Triticum aestivum L.) is one of the major staples in Nepal providing the bulk of food calories and at least 30% of Fe and Zn intake and 20% of dietary energy and protein consumption; thus, it is essential to improve its nutritional quality. To select high-yielding genotypes with elevated grain zinc and iron concentration, the sixth, seventh, eighth, and ninth HarvestPlus Yield Trials (HPYTs) were conducted across diverse locations in Nepal for four consecutive years: 2015–16, 2016–17, 2017–18, and 2018–19, using 47 biofortified and 3 non-biofortified CIMMYT-bred, bread wheat genotypes: Baj#1, Kachu#1, and WK1204 (local check). Genotypic and spatial variations were found in agro-morphological traits; grain yield and its components; and the grain zinc and iron concentration of tested genotypes. Grain zinc concentration was highest in Khumaltar and lowest in Kabre. Likewise, grain iron concentration was highest in Doti and lowest in Surkhet. Most of the biofortified genotypes were superior for grain yield and for grain zinc and iron concentration to the non-biofortified checks. Combined analyses across environments showed moderate to high heritability for both Zn (0.48–0.81) and Fe (0.46–0.79) except a low heritability for Fe observed for 7th HPYT (0.15). Grain yield was positively correlated with the number of tillers per m2, while negatively correlated with days to heading and maturity, grain iron, grain weight per spike, and thousand grain weight. The grain zinc and iron concentration were positively correlated, suggesting that the simultaneous improvement of both micronutrients is possible through wheat breeding. Extensive testing of CIMMYT derived high Zn wheat lines in Nepal led to the release of five biofortified wheat varieties in 2020 with superior yield, better disease resistance, and 30–40% increased grain Zn and adaptable to a range of wheat growing regions in the country – from the hotter lowland, or Terai, regions to the dry mid- and high-elevation areas