Spousal migration and human papillomavirus infection among women in rural western Nepal

In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal

Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey

Background Menstruation, a natural biologic process is associated with restrictions and superstitious beliefs in Nepal. However, factual data on women’s perspectives on menstrual practices and restrictions are scarce. This study aimed to assess socio-cultural perceptions of menstrual restrictions among urban Nepalese women in the Kathmandu valley. Methods Using a clustered random sampling, 1342 adolescent girls and women of menstruating age (≥15 years) from three urban districts in the Kathmandu valley completed a survey related to menstrual practices and restriction. This was a cross-sectional survey study using a customized program allowing pull-down, multiple choice and open-ended questions in the Nepali language. The self-administered questionnaire consisted of 13 demographic questions and 22 questions related to menstruation, menstrual hygiene, socio-cultural taboos, beliefs and practices. Univariate descriptive statistics were reported. Unadjusted associations of socio-cultural practices with ethnicity, education, four major social classes, three major religions, marital status and family type were assessed using logistic regression models. Results More than half (59%) of the participants were aged between 15- < 25 years. The majority were Hindus (84.5%), reported not praying during menstruation (83.1%) and were encouraged by their mothers (72.1%) to practice a range of menstrual restrictions. Purifying either the kitchen, bed, bedsheets or other household things on the fourth day of menstruation was reported by 66.1% of the participants, and 45.4% saw menstruation as a “bother” or “curse.” There were differences among social classes, where participants of the Janajati caste, an indigenous group, were more likely to enter places of worship [OR (95%CI): 1.74 (1.06–2.86)] and pray [OR (95%CI): 1.79 (1.18–2.71)] while menstruating, compared to the Brahmins. Participants with a master’s degree were more likely to pray while menstruating, compared to participants with less than a high school education [OR (95%CI): 2.83 (1.61–4.96)]. Conclusion This study throws light on existing social discriminations, deep-rooted cultural and religious superstitions among women, and gender inequalities in the urban areas of Kathmandu valley in Nepal. Targeted education and awareness are needed to make changes and balance between cultural and social practices during menstruation

The political, research, programmatic, and social responses to adolescent sexual and reproductive health and rights in the 25 years since the International Conference on Population and Development

Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progressmade in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH-adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day. (C) 2019 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine

Assessing the Role of Caste/Ethnicity in Predicting Menstrual Knowledge, Attitudes, and Practices in Nepal

Menstruation is a natural, physiological process, but it can be a challenging experience for millions of women around the world. In Nepal, a geographically small yet diverse country of 125 caste/ethnic groups, understanding how caste/ethnicity impacts menstrual health is critical for developing context-specific interventions to improve women’s health. A community-based, cross-sectional survey was conducted with 679 women and girls between the ages of 13–51 from the country’s most populous castes/ethnic groups. Forty eight percent had high menstrual knowledge, 60% had positive menstrual attitudes, and 59% had positive menstrual practices. Caste/ethnicity was a significant predictor of menstrual knowledge and practices. The caste/ethnic groups Tarai/Madhesi/Other, Newar, Janajati, and Muslim all had statistically significant fewer odds of positive menstrual practices compared to Brahman/Chhetri (high caste groups), with Janajati (indigenous ethnic groups) having the poorest outcomes. Despite Nepal making impressive advances in health, certain caste/ethnic groups have fallen behind in terms of menstrual health outcomes. Consequently, blanket menstrual health programs may not be sufficient for improving menstrual knowledge and practices for all. Future programming should consider the use of local languages and context-specific content that incorporates indigenous beliefs, as well as cultivate partnerships with indigenous health organizations, and develop outcome indicators disaggregated by caste/ethnicity to ensure improved menstrual health for all

Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey

Abstract Background Menstruation, a natural biologic process is associated with restrictions and superstitious beliefs in Nepal. However, factual data on women’s perspectives on menstrual practices and restrictions are scarce. This study aimed to assess socio-cultural perceptions of menstrual restrictions among urban Nepalese women in the Kathmandu valley. Methods Using a clustered random sampling, 1342 adolescent girls and women of menstruating age (≥15 years) from three urban districts in the Kathmandu valley completed a survey related to menstrual practices and restriction. This was a cross-sectional survey study using a customized program allowing pull-down, multiple choice and open-ended questions in the Nepali language. The self-administered questionnaire consisted of 13 demographic questions and 22 questions related to menstruation, menstrual hygiene, socio-cultural taboos, beliefs and practices. Univariate descriptive statistics were reported. Unadjusted associations of socio-cultural practices with ethnicity, education, four major social classes, three major religions, marital status and family type were assessed using logistic regression models. Results More than half (59%) of the participants were aged between 15- < 25 years. The majority were Hindus (84.5%), reported not praying during menstruation (83.1%) and were encouraged by their mothers (72.1%) to practice a range of menstrual restrictions. Purifying either the kitchen, bed, bedsheets or other household things on the fourth day of menstruation was reported by 66.1% of the participants, and 45.4% saw menstruation as a “bother” or “curse.” There were differences among social classes, where participants of the Janajati caste, an indigenous group, were more likely to enter places of worship [OR (95%CI): 1.74 (1.06–2.86)] and pray [OR (95%CI): 1.79 (1.18–2.71)] while menstruating, compared to the Brahmins. Participants with a master’s degree were more likely to pray while menstruating, compared to participants with less than a high school education [OR (95%CI): 2.83 (1.61–4.96)]. Conclusion This study throws light on existing social discriminations, deep-rooted cultural and religious superstitions among women, and gender inequalities in the urban areas of Kathmandu valley in Nepal. Targeted education and awareness are needed to make changes and balance between cultural and social practices during menstruation.http://deepblue.lib.umich.edu/bitstream/2027.42/173732/1/12978_2020_Article_935.pd

Assessment of high-risk human papillomavirus infections using clinician- and self-collected cervical sampling methods in rural women from far western Nepal.

Nepal has one of the highest cervical cancer rates in South Asia. Only a few studies in populations from urban areas have investigated type specific distribution of human papillomavirus (HPV) in Nepali women. Data on high-risk HPV (HR-HPV) types are not currently available for rural populations in Nepal. We aimed to assess the distribution of HR- HPV among rural Nepali women while assessing self-collected and clinician-collected cervico-vaginal specimens as sample collection methods for HPV screening.Study participants were recruited during a health camp conducted by Nepal Fertility Care Center in Achham District of rural far western Nepal. Women of reproductive age completed a socio-demographic and clinical questionnaire, and provided two specimens; one cervical-vaginal specimen using a self-collection method and another cervical specimen collected by health camp auxiliary nurse midwives during a pelvic examination. All samples were tested for 14 different HR-HPV mRNA and also specific for HPV16/18/45 mRNA.Of 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% confidence Interval [CI]: 6.3-13.8). The overall Kappa value assessing agreement between clinician- and self-collected tests was 0.62 (95% CI: 0.43-0.81), indicating a "good" level of agreement. Abnormal cytology was reported for 8 women. One woman identified with squamous cell carcinoma (SCC), and 7 women with high grade squamous intraepithelial lesions (HSIL). Seven of the 8 women tested positive for HR-HPV (87.5%) in clinician-collected samples and 6 in self-collected samples (75.0%).This is the first study to assess HR-HPV among rural Nepali women. Self-collected sampling methods should be the subject of additional research in Nepal for screening HR-HPV, associated with pre-cancer lesions and cancer, in women in rural areas with limited access to health services

Spousal migration and human papillomavirus infection among women in rural western Nepal

BACKGROUND: In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal. METHODS: Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husband's migration status with HR-HPV infection and cervical cytology status. RESULTS: In 265 women, the prevalence of HR-HPV was 7.5% (20/265), while the prevalence of abnormal cervical cytology, defined using the Bethesda system as atypical glandular cells of undetermined significance or worse, was 7.6% (19/251). Half of the study participants (50.8%, 130/256) had husbands who had reported migrating for work at least once. Women aged ≤34 years were significantly less likely to test positive for HR-HPV than women aged >34 years (OR 0.22, 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband's migration. CONCLUSION: Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husband's migration for work could be delaying HR-HPV infections in married women until an older age

Study Sample Size Algorithm according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Guidelines.

<p>Study Sample Size Algorithm according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Guidelines.</p

High-risk Human Papillomavirus (HR-HPV) Test^* Results on Clinician-collected or Self-collected Cervico-vaginal Specimens Stratified by Liquid-based Cytology, Achham District, Nepal (N = 278).

<p>*APTIMA HR-HPV mRNA Assay (Hologic/Gen-Probe, San Diego, CA).</p><p>**ThinPrep PreservCyt medium ((Hologic/Gen-Probe, San Diego, CA).</p>§<p>SCC = Squamous Cell Carcinoma; HSIL = High-grade Squamous Intraepithelial Lesion; ASC-H = Atypical Squamous Cell-cannot exclude HSIL; AGUS = Atypical Glandular Cells of Undetermined Significance; LSIL = Low-grade Squamous Intraepithelial Lesion; ASCUS = Atypical Squamous Cells of Undetermined Significance; UNSAT = Unsatisfactory; WNL = Within Normal Limits; BCC = benign cellular changes; ACTINO = Actinomycosis.</p

Prevalence and Concordance of High Risk-Human Papillomavirus (HR-HPV) Test Results Between Clinician-collected and Self-collected Cervico-vaginal Samples at a Health Camp in Achham District, Nepal in 261 women.

§<p>95% CI = 95% Confidence Interval;</p><p>*High-Risk HPV (HR-HPV) defined as testing positive for one of the following genotypes: (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68);</p><p>**HSIL = High-grade Squamous Intraepithelial Lesion; SCC = Squamous Cell Carcinoma.</p