Prevalence and distribution of intestinal parasitic infestations among school children in Kaski District, Western Nepal

This study was conducted to estimate the prevalence of intestinal parasitic infestations among school children in Kaski District of Western Nepal. A total of 2091 stool samples were collected from school children selected from 11 rural and eight urban schools. The stool samples were examined for evidence of parasitic infections by direct microscopic examination. Prevalence of intestinal parasites was 21.3%. There was a significant difference in prevalence between urban (18.7%) and rural (24.1%) school samples. Giardia lamblia (13.2%), Ascaris lumbricoides (2.1%) and Entamoeba histolytica (1.7%) were the commonest parasites isolated. The results indicate that intestinal parasitic infestation among school children in the study area is mainly water-borne. The burden of parasitic infestations among the school children, coupled with the poor sanitary conditions in the schools, should be regarded as an issue of public health priority. This strongly supports the need for school health programmes that will involve periodic deworming, health education and improvement of school sanitation

Infant feeding practices of mothers in an urban area in Nepal

Abstract Background: Child health in developing countries including Nepal is a matter of serious concern as the prevalence of malnutrition among children continues to be high with 48.6% of children under five in Nepal being underweight. Since infant feeding practices adopted by mothers play a major role in influencing health of these children, there is a need to study the infant feeding practices prevalent in different areas in order to have pragmatic approaches to solve this problem. Materials and methods: A cross sectional study was conducted among mothers who attended the immunization clinics of 18 wards of Pokhara municipality area. They were interviewed with a semi-structured questionnaire on various aspects of infant feeding. Result: A total of 168 mothers were interviewed and prevalence of breastfeeding was 99.4% (167). Only 43.5% of the mothers initiated breastfeeding within one hour of birth and 60.5% were practicing exclusive breastfeeding at 5 months. Almost 40% of the mothers started complementary feeding before the recommended age of 6 months and 22.5 % delayed introduction of complementary feeding beyond the recommended age. Conclusion: Breast feeding practices adopted by mothers of Pokhara urban area are still lacking in terms of late initiation of and early starting of complementary feeding. There is a need to educate the mothers regarding proper infant feeding practices

Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal Demographic and Health Survey-2006

<p>Abstract</p> <p>Background</p> <p>Nearly four-fifths of estimated 1.1 million smokers live in low or middle-income countries. We aimed to provide national estimates for Nepal on tobacco use prevalence, its distribution across demographic, socio-economic and spatial variables and correlates of tobacco use.</p> <p>Methods</p> <p>A secondary data analysis of 2006 Nepal Demographic and Health Survey (DHS) was done. A representative sample of 9,036 households was selected by two-stage stratified, probability proportional to size (PPS) technique. We constructed three outcome variables 'tobacco smoke', 'tobacco chewer' and 'any tobacco use' based on four questions about tobacco use that were asked in DHS questionnaires. Socio-economic, demographic and spatial predictor variables were used. We computed overall prevalence for 'tobacco smoking', 'tobacco chewing' and 'any tobacco use' i.e. point estimates of prevalence rates, 95% confidence intervals (CIs) after adjustment for strata and clustering at primary sampling unit (PSU) level. For correlates of tobacco use, we used multivariate analysis to calculate adjusted odds ratios (AORs) and their 95% CIs. A p-value < 0.05 was considered as significant.</p> <p>Results</p> <p>Total number of households, eligible women and men interviewed was 8707, 10793 and 4397 respectively. The overall prevalence for 'any tobacco use', 'tobacco smoking' and 'tobacco chewing' were 30.3% (95% CI 28.9, 31.7), 20.7% (95% CI 19.5, 22.0) and 14.6% (95% CI 13.5, 15.7) respectively. Prevalence among men was significantly higher than women for 'any tobacco use' (56.5% versus 19.6%), 'tobacco smoking' (32.8% versus 15.8%) and 'tobacco chewing' (38.0% versus 5.0%). By multivariate analysis, older adults, men, lesser educated and those with lower wealth quintiles were more likely to be using all forms of tobacco. Divorced, separated, and widowed were more likely to smoke (OR 1.49, 95% CI 1.14, 1.94) and chew tobacco (OR 1.36, 95% CI 0.97, 1.93) as compared to those who were currently married. Prevalence of 'tobacco chewing' was higher in eastern region (19.7%) and terai/plains (16.2%). 'Tobacco smoking' and 'any tobacco use' were higher in rural areas, mid-western and far western and mountainous areas.</p> <p>Conclusions</p> <p>Prevalence of tobacco use is considerably high among Nepalese people. Demographic and socioeconomic determinants and spatial distribution should be considered while planning tobacco control interventions.</p

Socialization, legitimation and the transfer of biomedical knowledge to low- and middle-income countries: analyzing the case of emergency medicine in India

BACKGROUND: Medical specialization is a key feature of biomedicine, and is a growing, but weakly understood aspect of health systems in many low- and middle-income countries (LMICs), including India. Emergency medicine is an example of a medical specialty that has been promoted in India by several high-income country stakeholders, including the Indian diaspora, through transnational and institutional partnerships. Despite the rapid evolution of emergency medicine in comparison to other specialties, this specialty has seen fragmentation in the stakeholder network and divergent training and policy objectives. Few empirical studies have examined the influence of stakeholders from high-income countries broadly, or of diasporas specifically, in transferring knowledge of medical specialization to LMICs. Using the concepts of socialization and legitimation, our goal is to examine the transfer of medical knowledge from high-income countries to LMICs through domestic, diasporic and foreign stakeholders, and the perceived impact of this knowledge on shaping health priorities in India. METHODS: This analysis was conducted as part of a broader study on the development of emergency medicine in India. We designed a qualitative case study focused on the early 1990s until 2015, analyzing data from in-depth interviewing (n = 87), document review (n = 248), and non-participant observation of conferences and meetings (n = 6). RESULTS: From the early 1990s, domestic stakeholders with exposure to emergency medicine in high-income countries began to establish Emergency Departments and initiate specialist training in the field. Their efforts were amplified by the active legitimation of emergency medicine by diasporic and foreign stakeholders, who formed transnational partnerships with domestic stakeholders and organized conferences, training programs and other activities to promote the field in India. However, despite a broad commitment to expanding specialist training, the network of domestic, diasporic and foreign stakeholders was highly fragmented, resulting in myriad unstandardized postgraduate training programs and duplicative policy agendas. Further, the focus in this time period was largely on training specialists, resulting in more emphasis on a medicalized, tertiary-level form of care. CONCLUSIONS: This analysis reveals the complexities of the roles and dynamics of domestic, diasporic and foreign stakeholders in the evolution of emergency medicine in India. More research and critical analyses are required to explore the transfer of medical knowledge, such as other medical specialties, models of clinical care, and medical technologies, from high-income countries to India