Ethical approval in developing countries is not optional

When conducting health and medical research it is not only important to do the research ethically, but also to apply for prior ethical approval from the relevant authorities. The latter requirement is true for developed countries as well as developing countries. We argue that simply applying for research ethics approval from an institutional review board at a university based in a developed country is not enough to start a health research project in a developing country. The paper also suggests a number of reasons why researchers may fail to seek local research ethics permission in developing countries. We use a recent paper reporting research conducted in Nepal and published in an international journal as a case study to highlight the importance of being sensitive to local requirements regarding applying for and registering health and medical research

The Impact of Federalization on Health Sector in Nepal: New Opportunities and Challenges

The promulgation of constitution of Nepal in 2015 has shifted the unitary government of Nepal towards federalism with significant devolution of power to seven newly created provinces, each with their own unicameral legislature. The major challenges during the transition phase in health sector are spillover effects, unclear roles and responsibilities of local authorities, human resource management and strengthening capacity at local level as per local need. Despite these challenges, federalism brings fertile ground for the local government to work more closely with their people; with more effective financing and planning based on evidences and their need

Submitting a paper to an academic peer-reviewed journal, where to start?

Writing your first paper for a peer-reviewed journal can be scary. You are putting your research, its findings and interpretations out to a wider and knowledgeable audience who may criticise any aspect of it. However, once you have made the mental step that you really want your work to be out in the open, and you are about to draft your paper, then you need to decide to which journal you like to submit. This short paper raises some of the issues novice authors would need to consider. We also outline the process of submitting a paper to an academic journal based on the collective experiences of the three authors. All of us have all published widely, acted as reviewers or referees for many different academic journals and are members of editorial boards

Academic authorship: who, why and in what order?

We are frequently asked by our colleagues and students for advice on authorship for scientific articles. This short paper outlines some of the issues that we have experienced and the advice we usually provide. This editorial follows on from our work on submitting a paper1 and also on writing an academic paper for publication.2 We should like to start by noting that, in our view, there exist two separate, but related issues: (a) authorship and (b) order of authors. The issue of authorship centres on the notion of who can be an author, who should be an author and who definitely should not be an author, and this is partly discipline specific. The second issue, the order of authors, is usually dictated by the academic tradition from which the work comes. One can immediately envisage disagreements within a multi-disciplinary team of researchers where members of the team may have different approaches to authorship order

Importance of Piloting a Questionnaire on Sexual Health Research: Letter to the editor

Letter without Abstrac

Alcohol use among the Nepalese in the UK

Rapid Response to: EDITORIALS: Gurprit Pannu, Shahid Zaman, Neeraj Bhala, and Rashid Zaman Alcohol use in South Asians in the UK. BMJ 2009; 339: b402

“Boys Remain Prestigious, Girls Become Prostitutes”: Socio-Cultural Context of Relationships and Sex among Young People in Nepal

One of the key characteristics of many developing countries compared to more developed countries is that their population is relatively young, and a proportion of those young people are becoming sexually active each year. The last two decades has seen a growing concern worldwide of the spread of HIV/AIDS, but, of course, young people face a range of socio-economic, cultural, psychological and sexual health-related problems at that time of their life. Very little research has been conducted in this area into Nepalese young people’s problems. Our qualitative study explores key problems faced by Nepalese youths with particular emphasis on sexual and reproductive health issues. The findings of ten focus group discussions with a total of 75 participants and 31 in-depth individual interviews indicated that many young people of Nepal face a range socio-economic, psychological, sexual and reproductive health-related problems. Unemployment, less opportunity for sex and entertainment, stress, curiosity, communication gap and poor sex education and sexual health services were frequently reported problems. In addition there was a gender difference around sex with young women (girls) having fewer opportunities and less freedom than young men (boys). In order improve young people’s sexual health, more attention needs to be given to rigorous research and the design and implementation of appropriate interventions. Young people’s ability to make informed choices about their own health and risk behaviour should be enhanced

User costs and informal payments for care in the largest maternity hospital in Kathmandu, Nepal

Background: Maternity care costs in Nepal include formal and informal payment. Formal include for example the cost for blood or drugs; Informal payments can be voluntary such as gratitude payments, or bribes which patients are ‘expected’ to pay to get decent care or any care at all. One problem is that these payments are missing from formal accounts and they are not taken into account in health-policy decision-making. The aim of the present study was to estimate out-of-pocket expenses (formal/informal) for delivery care in the largest government maternity hospital in Kathmandu, Nepal and establish factors that affect informal costs. Methods: We used mixed-methods approach. We used questionnaire-based interviews with 234 women who had delivered in this hospital followed by semi-structured in-depth interviews with sub-sample of ten couples. SPSS software was used for analysis and cross tabulations and chi square tests, binary logistic regression were performed. Results: Women occurred various costs during a hospital confinement. The qualitative data suggested that some, but not all had started to save prior to the delivery. There is a significant association between making informal payments and whether or not the birth was planned to be in hospital or whether it was an emergency, p=0.025, ANC visits, p=0.008, woman’s occupation,p=0.025 and husband’s employment, p=0.022. Logistic regression suggested four factors associated with making informal payments, indicating a possible socio-economic link with ability to make informal payments. Conclusions: Although informal payments around birth itself were not substantial, such payments are very common. Better understanding of informal payments is important as the illegal status of unofficial health care payments means that it is difficult to establish the prevalence of this phenomenon. Moreover it forms a part of the private health expenditure rarely included in the national health statistics, they create perverse incentives, potentially reduce motivation for reform and will provide information about economic barriers to care

Sexual and Reproductive Health Status among Young Peoples in Nepal: Opportunities and Barriers for Sexual Health Education and Services Utilization

This article attempts to summarise the situation of sexual and reproductive health among young people in Nepal. Modernisation and social transformation are occurring rapidly in Nepalese society. Growing expansion of communication and transportation networks, urbanisation and in-migration of population to urban areas is creating a different sociocultural environment, which is conducive to more social interactions between young girls and boys in Nepal. Rising age at marriage has now opened a window of opportunity for pre-marital and unsafe sexual activity among young people in Nepal which creates risks of unwanted pregnancy, STIs/HIV and AIDS. Several socio-economic, demographic and cultural factors have been identifi ed as encouraging factors for risk taking behaviours among young people. Improving access to youth friendly services, implementing peer education programmes for school and out of school going adolescents, developing effective Information, Communication and Education (IEC) materials and curricula have been highly suggested to improve the existing young people’s sexual and reproductive health status

Review of Barriers to Engaging Black and Minority Ethnic Groups in Physical Activity in the United Kingdom

Introduction and Objective: The lower physical activity levels in Black and Minority Ethnic (BME) groups as compared with general population in the United Kingdom (UK) could relate to barriers to engaging these groups in physical activity. Hence, the aim to conduct a review to examine UK primary studies reporting barriers to engaging BME groups in physical activity. Method: This is a narrative review of literature from 1970 to 2008. The search looked for English literature from five bibliographic databases (MEDLINE, Embase, CINAHL, PsyINFO, Ethnicity and Health). Broad search terms ‘physical activity and minority’ were used and views from BME groups were considered in this review. Results & Conclusion: The search yielded 391 studies and 18 were finally included in the review. Our review identified 20 barriers clustered among four broad themes of: (a) perceived personal barriers; (b) socio-economic barriers; (c) cultural barriers; and (d) environmental barriers. Overcoming these barriers in these broad areas is important in development of sensitive multicultural health promotion addressing physical inequalities