Bio-mechanical risk factors for uterine prolapse among women living in the hills of west Nepal: A case-control study.

OBJECTIVE:To investigate whether heavy load carrying, wearing a patuka, and body position at work are risk factors for uterine prolapse among Nepali women. METHODS:Community-based case-control study of 448 women (170 cases of uterine prolapse; 278 controls) aged 18-60 years in Kaski district, Nepal was conducted. Women diagnosed with uterine prolapse were cases. Two controls were recruited for each case, frequency-matched by residential area and age. Multivariate logistic regression was used to investigate associations between outcome and exposures. RESULTS:No association of heavy load carrying with uterine prolapse was observed; women who never used a patuka had lower odds of uterine prolapse (odds ratio = 0.18, 95% confidence interval = 0.05-0.71). Women working in a sitting position had higher odds than those working in a standing position (odds ratio = 2.94, 95% confidence interval = 1.74-4.96), as did women who mainly worked in a bending position (odds ratio = 2.45, 95% confidence interval = 1.12-5.34). Housewives were more prone to uterine prolapse than women engaged in farming (odds ratio = 2.13, 95% confidence interval = 1.31-3.47). CONCLUSION:Using a patuka, occupation, and body position during work were all associated with uterine prolapse. No association was found with heavy load carrying, although that might be attributable to the cross-sectional nature of study recruitment

Environmentalism and Contraceptive Use: How people in less developed settings approach environmental issues

The rise in environmental concerns around the globe has prompted increasing research on the links between such concerns and behavior. However, most studies have focused on pro-environmental behaviors in affluent western societies, such as willingness to pay for environmental protection, pro-environmental political actions, and consumption patterns. Using multiple data sets from the Chitwan Valley Family Study in Nepal, this paper examines the impact of environmental perceptions on contraceptive use in a rural agricultural setting. The results of our analyses show that perceptions about certain aspects of the environment are related to individuals' subsequent use of contraceptives. Specifically, those individuals who think that their environment—agricultural productivity—has deteriorated are more likely to use contraceptives than those who think that their environment has improved or has remained about the same. This study thus provides a first step in our understanding of the relationships between environmental perceptions and fertility behavior in a less developed setting.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43510/1/11111_2005_Article_12.pd

Land Use and First Birth Timing in an Agricultural Setting

The dramatic changes in the earth’s landscape have prompted increased interest in the links between population, land use, and land cover. Previous research emphasized the notion of population pressure (population pressure increases demands on natural resources causing changes in land use), overlooking the potentially important effects of changes in land use on humans. Using multiple data sets from the Chitwan Valley Family Study in Nepal, we test competing hypotheses about the impact of land use on first birth timing. We argue that while agricultural land should encourage early childbearing, land area devoted to public infrastructure should discourage it. The results show that individuals from neighborhoods with larger proportions of land under agriculture experienced first birth at rates higher than those from neighborhoods with smaller proportions. On the other hand, individuals from neighborhoods with larger proportions of land under public infrastructure experienced first birth at rates lower than those from neighborhoods with smaller proportions. However, the effects of public infrastructure are not as strong as the land area devoted to agriculture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60429/1/Ghimire Hoelter 2007 (2).pd

Early Women, Late Men: Timing Attitudes and Gender Differences in Marriage

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138327/1/jomf12426_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138327/2/jomf12426.pd

Modifying and validating the Composite International Diagnostic Interview (CIDI) for use in Nepal

Background : Efforts to develop and validate fully‐structured diagnostic interviews of mental disorders in non‐Western countries have been largely unsuccessful. However, the principled methods of translation, harmonization, and calibration that have been developed by cross‐national survey methodologists have never before been used to guide such development efforts. The current report presents the results of a rigorous program of research using these methods designed to modify and validate the Composite International Diagnostic Interview (CIDI) for an epidemiological survey in Nepal. Methods : A five‐step process of translation, harmonization, and calibration was used to modify the instrument. A blinded clinical reappraisal design was used to validate the instrument. Results : Preliminary interviews with local mental health expert led to a focus on major depressive episode, mania/hypomania, panic disorder, post‐traumatic stress disorder, generalized anxiety disorder, and intermittent explosive disorder. After an iterative process of multiple translations‐revisions guided by the principles developed by cross‐national survey methodologists, lifetime DSM‐IV diagnoses based on the final Nepali CIDI had excellent concordance with diagnoses based on blinded Structured Clinical Interview for DSM‐IV (SCID) clinical reappraisal interviews. Conclusions : Valid assessment of mental disorders can be achieved with fully‐structured diagnostic interviews even in low‐income non‐Western settings with rigorous implementation of replicable developmental strategies. Copyright © 2013 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97206/1/mpr1375.pd

Household migration and children’s diet in Nepal: an exploratory study

Abstract Objective Individuals from low-income countries often migrate abroad for employment. The association between such migration and investment in education as well as other societal and familial outcomes has previously been examined. However, we have a limited understanding of the association between migration and children’s nutrition. We aim to determine the extent to which migration of household members influences children’s diet in a semi-urban region of Nepal. Results In our study setting, children in households with a migrant had higher dietary diversity scores, 0.69 on average, than their counterparts in households without a migrant. These children were approximately 43% points more likely to meet a minimum requirement for dietary diversity. These differences originated primarily from higher consumption of meat (41% points) and eggs (20% points). Approximately 37 percent of children in the sample consumed processed food during the 24 h preceding the survey. However, we found no evidence that migration was associated with the consumption of processed foods or with reduced frequency of breastfeeding. Our finding that migration is associated with higher consumption of meat and eggs is particularly encouraging, given that the protein deficiency in Nepal is estimated to be nearly 43 percent.https://deepblue.lib.umich.edu/bitstream/2027.42/152156/1/13104_2019_Article_4430.pd

A Micro-Level Event-Centered Approach to Investigating Armed Conflict and Population Responses

In this article, we construct and test a micro-level event-centered approach to the study of armed conflict and behavioral responses in the general population. Event-centered approaches have been successfully used in the macro-political study of armed conflict but have not yet been adopted in micro-behavioral studies. The micro-level event-centered approach that we advocate here includes decomposition of a conflict into discrete political and violent events, examination of the mechanisms through which they affect behavior, and consideration of differential risks within the population. We focus on two mechanisms: instability and threat of harm. We test this approach empirically in the context of the recent decade-long armed conflict in Nepal, using detailed measurements of conflict-related events and a longitudinal study of first migration, first marriage, and first contraceptive use. Results demonstrate that different conflict-related events independently shaped migration, marriage, and childbearing and that they can simultaneously influence behaviors in opposing directions. We find that violent events increased migration, but political events slowed migration. Both violent and political events increased marriage and contraceptive use net of migration. Overall, this micro-level event-centered approach yields a significant advance for the study of how armed conflict affects civilian behavioral responses

The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys

We previously reported on the cross-national epidemiology of ADHD from the first 10 countries in the WHO World Mental Health (WMH) Surveys. The current report expands those previous findings to the 20 nationally or regionally representative WMH surveys that have now collected data on adult ADHD. The Composite International Diagnostic Interview (CIDI) was administered to 26,744 respondents in these surveys in high-, upper-middle-, and low-/lower-middle-income countries (68.5% mean response rate). Current DSM-IV/CIDI adult ADHD prevalence averaged 2.8% across surveys and was higher in high (3.6%)- and upper-middle (3.0%)- than low-/lower-middle (1.4%)-income countries. Conditional prevalence of current ADHD averaged 57.0% among childhood cases and 41.1% among childhood subthreshold cases. Adult ADHD was significantly related to being male, previously married, and low education. Adult ADHD was highly comorbid with DSM-IV/CIDI anxiety, mood, behavior, and substance disorders and significantly associated with role impairments (days out of role, impaired cognition, and social interactions) when controlling for comorbidities. Treatment seeking was low in all countries and targeted largely to comorbid conditions rather than to ADHD. These results show that adult ADHD is prevalent, seriously impairing, and highly comorbid but vastly under-recognized and undertreated across countries and cultures