Where Is Nepal in the Demographic Transition within the Wider Context of the Nutrition Transition?

Historically, the process of nutrition transition begins with the shifts in demographic transition, moving away from high to low mortality, high to low fertility, high percentage of young population to high proportion of elderly population, high to low population growth rate; and short to long life expectancy at birth. The objective is to identify where Nepal is in demographic transition and whether demographic transition is considered as one of the proximate covariates of nutrition transition. Nepal’s position in the demographic transition has been identified by using Popkin’s framework which is scaled from Pattern I to Pattern V. The time series trends indicated that new patterns of demographic transition have been observed during 1995-2010, which is similar to the pattern IV of the nutrition transition as described by Popkin. Before 1970, the death rates were fluctuating around 30 to 50 deaths per thousand populations. The birth rate per thousand populations was more than 44, which was really high. Both fertility and mortality appear to start declining from 1970. During 1995-2010, birth rate declined from 38 to 24 per thousand populations. The time series trends indicated that new patterns of demographic transition have been observed during 1990-2010, which is similar to the transition between Pattern III and IV of the nutrition transition. Nepal is a country with faster declined in mortality followed by fertility decline, increasing life expectancy above 60 years, decreasing age-structure of below 15 years of population, increasing trends of urban population and beginning of large scale international migration. It may be concluded from above evidences that Nepal is across the new pattern of transition after 1990s in the demographic transition including the increasing risk of chronic diseases of elderly people related to excess consumption of fat, sugar and process foods

High rates of suicide and violence in the lives of girls and young women in Bangladesh: Issues for feminist intervention

Deaths by suicide in Bangladesh have an atypical sex ratio, with higher rates in females than in males-a characteristic shared with several countries in Southern Asia. Reasons for this are explored in this paper. An examination of the social structure of Bangladesh suggests that girls and women are subjected to higher rates of sexual and physical violence compared with males, especially in rural and urban slum areas. This violence is often linked to the enforced marriage of young girls to older men. A systematic review of 24 studies on suicide and suicidal behaviors in Bangladesh has shown that suicide death rates are exceptionally high in younger women, at a rate of about 20 per 100,000, more than twice the rate in males aged less than 49. In girls aged 15 to 17, the estimated suicide rate is 14 per 100,000, 50% higher than in males. Because of problems in obtaining systematic data on deaths by suicide, these rates are likely to be underestimates. Extreme poverty and lack of education have been recorded as factors in deaths by suicide, although there are methodological problems in reaching such conclusions. We speculate that some of the "suicides" (especially those using poison) may in fact be cases of murder. A dowry system (not sanctioned by Islam) is thought to be a major cause of family poverty, and violence experienced by young girls. In proposing solutions, we argue the case (as Muslims) for the support of an Islamic feminism which urges better support for girls growing up in extreme poverty. © 2017 by the authors

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

Is Economic Transition One of the Proximate Determinants of Nutrition Transition in Nepal?

Background: Historically, the process of nutrition transition begins with changes in economic structures which move away from agrarian economies to successful industrialisation, with high economic growth, urbanisation and increased real per capita income. Objective: The objective is to identify where Nepal is in economic transition and whether economic transition is considered as one of the proximate determinants of nutrition transition in Nepal. Results: Nepal’s position in the economic transition has been identified by using Popkin’s framework which is scaled from Pattern I to Pattern V. The time series trends indicated that new patterns of economic transition had been observed during 1995-2010, which was similar to the pattern IV of the Nutrition Transition as described by Popkin. The national income of Nepal increased over the past four decades. The GDP of Nepal has shown an annual increase at a rate of 3.92 per cent between 1970 and 2010. Conclusion: Economic growth and agricultural trade liberalization have induced plant fats supply in Nepal. Tourism has also transferred the taste and preferences of western foods to tourist destinations and urban centres, including potential negative health consequences related to excess consumption of fat, sugar and process foods

Discussions around Primary Health Care and the Private Sector during the Global Symposia on Health Systems Research 2018

The aim of this report is to provide an overview of core discussions around Primary Health Care (PHC) and the Private Sector, which took place during the 5th Global Symposium on Health Systems Research 2018: Advancing health systems for all in the SDG era. Universal Health Coverage (UHC) and how health systems are working to deliver this global goal by 2030 was a major theme of the conference. Conference sub-themes revolved around broad topics of: Multi-sectoral Action; Engaging the Private Sector; Leaving No-one Behind and Community Health Systems. Discussions were captured through two core methods: ‘in session data capture’ and semi-structured interviews. 26 conference rapporteurs captured data in 93 sessions; and 21 interviews were conducted with policy makers, implementers and practitioners from the public and private sector. The findings are mainly focused on research from low and middle-income countries (LMIC) with some examples from upper middle and high-income countries. This focus was chosen as the opportunities to promote and report health research from resource-poor settings is limited (Siriwardhana, 2015). The conference provided an opportunity for shared learning due to the many scholarships that supported attendance of health actors and researchers from LMICs. Ethical clearance was obtained from the Liverpool John Moores University (LJMU) Ethics Committee. The following broad themes were identified through data capture and interviews. Findings that are more detailed can be located in the main body of the report and include case study examples

Perceived barriers to accessing Female Community Health Volunteers' (FCHV) services among ethnic minority women in Nepal: A qualitative study

Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- and -middle income countries, members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions. A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups such as Dalits, Madhesi, Muslim, Chepang and Tamang. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres. We conclude that community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups, and the programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the FCHVs and local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in low- and -middle income countries

Nepal's Response to Earthquake 2015: Experience of Emergency Responders and Humanitarian Assistance providers in Inclusive and Accessible Humanitarian Assistance Delivery

The earthquake that hit Nepal in 2015 received worldwide attention for the devastation it caused to lives and infrastructures. Yet, the impact of it on people with disabilities (PWDs) and experiences of emergency responders and humanitarian assistance providers have remained under researched. This study aims to explore first hand experiences faced by emergency responders and humanitarian assistance providers to evaluate the effectiveness in implementation of disability inclusive and accessible emergency response during disaster; and to identify good practices and barriers faced by them in facilitating inclusive and accessible recovery and rehabilitation post disaster. Lessons learnt from barriers and challenges faced by the service providers, when addressed, will promote improved policies, processes and programmes around inclusive and accessible emergency and humanitarian response, recovery and rehabilitation. This study is based on semi-structured interviews with 20 key informants/stakeholders, and thematic analysis of the data generated. Findings suggest that most stakeholders were engaged in disability inclusive disaster risk management (DiDRM), capacity building and resilience developing awareness campaigns. However, there are significant gaps in policies, training and practices. These gaps include, a dire lack of inclusive and accessible equipment and resources; lack of and failure to implement and utilise knowledge and resources available; lack of data and guidelines on disability inclusive emergency response (DIER); and lack of communication and coordination between emergency responders and DPOs. These challenges hindered search and rescue (SAR) and relief efforts resulting in inappropriate and slow recovery and rehabilitation for PWDs. This study recommends for including PWDs in planning, designing and building inclusive and accessible emergency preparedness, response, SAR toolkit and emergency shelters. Nepal now has opportunities to integrate accessible infrastructures, DiDRM and implementation at community level. One way of achieving DiDRM at community level could be building a bank of desegregated data, skilled volunteers and accessible equipment to meet the emergency needs of PWDs

Ghrelin for the management of cachexia associated with cancer

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the efficacy and safety of ghrelin on improving food intake, body composition and survival in patients with cachexia associated with cancer. © 2016 The Cochrane Collaboratio

Factors Influencing COVID-19 Vaccine Uptake among Nepali People in the UK: A Qualitative Study.

Vaccination saves lives and can be an effective strategy for preventing the spread of the COVID-19, but negative attitudes towards vaccines lead to vaccine hesitancy. This study aimed to explore the factors influencing the uptake of the COVID-19 vaccine in the Nepali community in the United Kingdom (UK). This qualitative study included in-depth interviews with 20 people from Nepal living in the UK. Interviews were conducted by a native-Nepali speaker and all interviews were audio-recorded, transcribed, and translated into English before being analysed thematically. Our study found that attitudes towards COVID-19 are generally positive. Nine overlapping themes around barriers to COVID-19 vaccination were identified: (a) rumours and mis/disinformation; (b) prefer home remedies and yoga; (c) religion restriction; (d) concern towards vaccine eligibility; (e) difficulty with online vaccine booking system; (f) doubts of vaccine effectiveness after changing the second dose timeline; (g) lack of confidence in the vaccine; (h) past bad experience with the influenza vaccine; and (i) worried about side-effects. Understanding barriers to the uptake of the COVID-19 vaccine can help in the design of better targeted interventions. Public health messages including favourable policy should be tailored to address those barriers and make this vaccination programme more viable and acceptable to the ethnic minority communities in the UK

Assessing whether medical language is a barrier to receiving healthcare services in Bangladesh: an exploratory study.

BACKGROUND: In many global settings, medical language acts as a barrier to accessing and using health services. However, this issue remained unexplored in Bangladesh, where the non-native English language is commonly used for health care. AIM: To examine whether medical language is an obstacle for obtaining health services in Bangladesh and to provide policy recommendations. DESIGN & SETTING: An exploratory study was undertaken to identify the impact of medical language on general practice. Data were collected online from Bangladeshi people between July-November 2014. METHOD: A semi-structured questionnaire was developed through Google Forms for data collection. The snowball technique was applied to obtain data purposively from 50 participants. With prior consent, the questionnaire along with the online link was sent to responders by email. When responders clicked on the 'submit' option of the questionnaire, responses were stored online automatically in the pre-built system. Quantitative data were analysed using SPSS (version 22). Textual data analyses (especially of suggestions of the responders) were conducted using a thematic approach. RESULTS: Among study participants, 44% (n = 22) said that English language was the choice for writing prescriptions by health service providers in Bangladesh, and 26% said that a mixture of Bengali and English was used. Around 30% of the study participants could not understand medical language used by doctors (this includes those who were not sure or preferred not to say). Among responders, 78% said that medical language was affecting the treatment process and 48% were of the opinion that it was acting as a barrier in receiving health services. CONCLUSION: Medical language is acting as a barrier in the health services of Bangladesh. Tailored interventions must be developed and implemented to overcome medical language barriers in health services in order to strengthen the health system