Ethical and Practical Challenges in Conducting Fieldwork on a Sensitive Topic (HIV) in Nepal

This short one-page piece addresses issues that arose during the fieldwork of the first author. He as a PhD student experienced a number of practical issues and challenges while conducting fieldwork for his PhD thesis in Nepal at the end of 2009. The key issues that arose involved gaining access to and conducting interviews in hospitals in Nepal, especially in out-patient departments. Obtaining access to people living with HIV was a major challenge. He faced difficulties getting approval/support for the research because HIV is a stigmatising and sensitive issue in Nepal, and research is still not considered a priority area. Delays increased the costs of research and shortened the time available to complete the fieldwork. Without obtaining written approval from the hospital director, it was not possible to start and the absence of such a key person on the days of fieldwork caused delays in obtaining approval and consequently resulted in delayed data collection. Ethical issues and challenges inevitably arose during the fieldwork. Confidentiality was a major issue, and conducting interviews in out-patient departments made recruitment difficult due to lack of privacy

Nepalese trekking guides: A quantitative study of sexual health knowledge and sexual behaviour

Background: Tourism, a global industry, brings with it a number of public health problems, one of which is the spread of sexually transmitted infections transmitted between travellers and hosts. Previous studies have largely focused on sex workers and sex tourists. This study assesses sexual behaviour, knowledge and condom use among male trekking guides in Nepal. Methods: A self-administered questionnaire survey (n=324) was conducted using snowball sampling amongst men working as mountain trekking guides in Nepal. Results: Most respondents (59%) had initiated sex before the age of 18. Most (84 %) reported sexual relations with a woman other than their partner, 46% reported foreign partners, 43% had Nepalese partners, and 28% had concurrent foreign and Nepalese partners. Most (70 %) reported ever having sex with a foreign woman and two-thirds had had sexual intercourse with foreign women in the previous 12 months. Participants’ age, education status, age of first sex, smoking and drinking habits and English proficiency were significant predictors of having sex with foreign women. About 60% reported condom use during their most recent occasion of extra-martial sex. A similar proportion had used a condom during last sexual intercourse with a foreign woman. The likelihood of condom use was associated with a guide’s age, educational level, ethnicity, age of first sex and work experience. Conclusions: Most trekking guides reported sexual relations with foreign women as well as irregular use of condoms. Although sexual health knowledge about among trekking guides is high, some misconceptions still result in unsafe sex. Hence there is an urgent need to revise the existing training for trekking guides and implement appropriate health promotion programmes

Factors that promote or hinder maternal health service provision by female community health volunteers in rural Nepal

Female Community Health Volunteers (FCHVs) provide basic Maternal Health Services (MHSs) to pregnant women and mothers in their communities. Their contribution to maternal health has been praised, as Nepal managed to reduce its maternal mortality by more than two-thirds and met the Millennium Development Goal 5. However, little published evidence is available on FCHVs’ views and the factors that promote or hinder their services. This thesis explores the role of FCHVs in MHS provision in two regions (the hill and Terai ) of Nepal, from the perspectives of health workers, service users, and FCHVs themselves. A qualitative approach was adopted using semi-structured interviews, focus group discussions (FGDs) and field notes. Interviews were conducted with 20 FCHVs, 11 health workers and 26 women in villages from the two study regions. In addition, four FGDs were held with 19 FCHVs and field notes were taken throughout the data collection. Data were analysed using thematic analysis. Findings indicate that FCHVs play an important role in MHS provision in the hill villages where there is limited access to professional healthcare. The FCHVs detected pregnancies, referred them for health check-ups, accompanied them for deliveries and assisted in child-births. They also distributed medicines and informed women on the availability of safe abortion services. In both regions, the FCHVs raised health awareness among pregnant women/mothers casually or through organised meetings. In the hill villages, they used interesting casual approaches to share maternal health information, for example, singing folk songs with health messages in them or visiting new mothers with nutritious food hampers. Such services were beneficial to the women in the remote villages, who otherwise would not have received any healthcare. The FCHVs also shared maternal health messages through regularly organised mothers' group meetings. Unfortunately, these meetings were also used for monetary discussions, which left a little time for discussion on health topics. Such activity combined with the lack of FCHVs’ education often proved to be counterproductive on their service provision. They have a desire to volunteer, as they saw their service as social responsibility, felt empowered and enjoyed community recognition. However, a lack of financial and non-financial incentives was the key hindrance for them followed by perceived community misconceptions regarding their voluntary status. The FCHVs’ illiteracy and older age also affected their services. Finally, various health systems related factors also hindered their services: a lack of access to medical supplies, inadequate training and supervision. In general, volunteers in the terai region were less supported than those in the hill region. In addition, a perceived lack of respect by some health workers towards volunteers and a lack of coordination between government health centres and NGOs were noted. Overall, the study found that most interviewees perceived FCHVs as a valuable resource in improving the maternal health of the poor women. In some remote hill villages, they are the only MHS providers. Therefore, their contribution to MHS needs to be recognised and respected by both the health workers and the communities. It is important that FCHVs are provided with context specific support - incentives, access to supplies and supportive supervision - to enable them to deliver services more productively and to ensure that these services flourish in the future

Stipulating citizen's fundamental right to healthcare: Inference from the Constitution of Federal Republic of Nepal 2015

Nepal has a great opportunity to learn from, and collaborate with, non-governmental development partners and private sectors, and from other governments and organizations around the world, but we must move promptly

Nepal Urgently Needs a National Evidence Synthesis Centre

Evidence synthesis is a powerful research process that allows researchers to combine and analyse all relevant data from multiple studies and draw conclusions based on the most up-to-date evidence available. The science to synthesize research evidence has developed considerably in recent years. Evidence-based health care has undergone a revolution over two decades. Several global organizations produce, support and use evidence synthesis, including: the Cochrane Collaboration, the Campbell Collaboration, the Health Evidence Network WHO, Evidence Synthesis International, and several others have been preparing high quality summaries of research about the effectiveness of drugs, interventions and health care in general.1 Many policymakers, clinicians and health managers are drawing on these reliable reviews in their decision making. There is increasing trend of scientific publications on health research in Nepal, therefore this is the right time to assess the quality of published articles and evidence synthesis for evidence-informed decision-making

Health Promotion opportunities for Auxiliary Nurse Midwives in Nepal

Health promotion moves beyond changing the health-related knowledge, attitudes and behaviour of individuals and covers a wide range of social and environmental interventions. Nepal has also introduced health promotion policies targeting health education, information and communication. Auxiliary Nurse Midwives (ANMs), who are responsible for delivering primary care maternity services, especially in birthing centres located in rural areas of Nepal, also have an important role to play in the promotion of women’s health during pregnancy, intra-partum and post-partum. However, in the present context, health promotion provided by ANMs in Nepal is confined mostly to health education and behavioural-change communication. There are a range of health promotion activities relevant to maternity care and midwifery that ANMs can practice even in low-technology rural birthing centres. Such health promotion offers an opportunity to move away from a very medical and behavioural model to a more empowering one in order to prevent health problems in a cost-effective way

Injury and Mortality in Young Nepalese Migrant Workers: A Call for Public Health Action

Approximately 3.5 million Nepalese are working as migrant workers in the Gulf countries, Malaysia, and India. Every year there are more than 1000 deaths and many hundreds cases of injuries among Nepalese workers in these countries excluding India. A postmortem examination of migrant workers is not carried out in most of these countries, and those with work-related injuries are often sent back to home. Uninsured migrant workers also do not have easy access to health care services in host countries due to the high medical and hospital fees. Greater efforts are needed to protect the health and well-being, labor rights, and human rights of migrant workers from Nepal and other South- Asian nations. There is a need to enforce universal labor laws in these countries and to develop accurate records of mortality and morbidity and their causes

Factors affecting the uptake of institutional delivery, antenatal and postnatal care in Nawalparasi district, Nepal

© 2019, Kathmandu University. All rights reserved. Background Maternal deaths and complications are highly preventable with good antenatal, postnatal and skilled care during childbirth. Inadequate information on the factors affecting these services could be barrier to a reduction of maternal deaths in low-income countries. Objective To assess the uptake of antenatal, postnatal and skilled care during childbirth. Method A cross-sectional study was conducted in eight villages of Nawalparasi district in southern Nepal. A total of 447 women who had given birth within the preceding 24 months were recruited using multistage random sampling. Data were collected using a pre-tested semi-structured questionnaire. Chi-square tests were used to assess association between variables. Result Over 70% of women had gone for at least four antenatal care check-ups while only 14.3% had at least three postnatal check-ups in their last pregnancies. The proportion of institution delivery was 54%. Women’s literacy was associated with the uptake of antenatal services (p=<0.001), postnatal care (p=0.04) and institutional delivery (p=<0.001). Knowledge of antenatal (p=<0.001) and postnatal care was also associated with uptake of respective services (p=<0.001). Conclusion The uptake and knowledge of antenatal care was much better than of postnatal care. Home delivery rates were still very high. A scaling-up of education and awareness-raising interventions in this community could help improve the uptake of maternal health services

Mental health issues in pregnant women in Nepal

Mental health of pregnant women and new mothers is a growing area of concern in both low- and high-income countries. This editorial highlights some of the key mental issues faced by women in rural Nepal and outlines an intervention based on training community health care workers by experienced UK volunteers

The Role of Health Promotion during the COVID-19 Pandemic

This short guest article outlines the important role the discipline of health promotion can, and should, play in a global pandemic like the one we are experiencing now with COVID-19. The authors outline some of the key aspects of health promotion related to the prevention of the spread of COVID-19, but also the effects of lockdown on the population and the empowerment of affected population