Correlates of bullying victimization among school adolescents in Nepal: Findings from 2015 Global School-Based Student Health Survey Nepal.

BackgroundBullying is an emerging risk factor for poor mental health outcomes adversely affecting children and adolescents. However, it has rarely caught the attention of the health and education sector due to lack of evidence in many countries including Nepal. This study aimed to assess the prevalence and factors associated with bullying behavior among adolescent students in Nepal.MethodsWe used nationally representative data from the Nepal Global School-Based Student Health Survey that involved two-stage cluster sampling design with the use of a standard set of self-administered questionnaires. Complex sample analysis was done to determine the prevalence and correlates of bullying among 6529 students of 68 schools studying in grade 7 to 11 using descriptive analysis and multivariable logistic regression.ResultsThe overall prevalence of bullying among Nepalese school adolescents was 51% (55.67% in male and 46.17% in female). Bullied adolescents more commonly reported mental health problems with higher risk of loneliness (aOR 1.36, 95% CI: 1.12, 1.64), anxiety (aOR 2.04, 95% CI: 1.65, 2.52), suicide attempt (aOR 2.08, 95% CI: 1.54, 2.81), school absenteeism due to fear (aOR 1.72, 95% CI: 1.34, 2.21) and school truancy (aOR 1.48, 95% CI: 1.17, 1.87). A significant association was seen between bullying victimization and negative health behaviors like involvement in physical fights (aOR 3.64, 95% CI: 2.94, 4.51) and tobacco use (aOR 2.05, 95% CI: 1.15, 3.65).ConclusionSchool bullying is significantly associated with mental health factors like loneliness, anxiety, suicide attempt, school absenteeism and risky behavioral factors like smokeless tobacco use and involvement in physical fight. The insights provided by these findings have important implications for planning anti-bullying strategies in school settings in the Nepalese context

Factors associated with physical and sexual violence among school-going adolescents in Nepal: Findings from Global School-based Student Health Survey.

BackgroundGlobally violence is a matter of public health concern with severe physical and mental health implications and social consequences. Evidence suggest that adolescents have an elevated risk of exposure to physical and sexual violence. However, there is a lack of nationally representative research on violence and its associated factors in Nepal to inform interventions. This paper attempts to find the factors associated with various forms of physical and sexual violence among school-going adolescents in Nepal.MethodsWe analysed the cross-sectional data from the Global School-based Student Health Survey (GSHS) 2015. The GSHS survey applied a two-stage cluster sampling process to select a representative sample of 7 to 11 grade students from 74 schools across the country. We applied logistic regression analysis to identify the factors associated with physical and sexual violence.ResultsOut of the total 6,529 participants, 45.24% of them faced a physical attack, 39.25% were involved in a physical fight, and 11.65% were victims of sexual violence in the survey administered between 7 August 2015 to 14 March 2016. In a multiple regression analysis, the age of participants, parental supervision, feeling unsafe at school, and the number of close friends were found to be associated with a physical attack. Participants who were bullied, had multiple sex partners, and had received corporal punishment in school had a higher engagement in a physical fight. Likewise, school grade, having parents who understand the problems, having multiple sex partners, and corporal punishment at school were associated with instances of sexual violence.ConclusionThe study identified multiple factors associated with experiences of physical attacks, involvement in a physical fight, and sexual violence among school-going adolescents. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions. Since various forms of violence share some common risk factors, a comprehensive strategy could be worth considering to prevent such acts of violence

Health system gaps in cardiovascular disease prevention and management in Nepal

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal's health systems gaps to prevent and manage CVDs. METHODS: We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts' codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. RESULTS: National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. CONCLUSION: Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.</p