The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study.

BACKGROUND: There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs. METHODS: This study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household's perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations. RESULTS: Average total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$30.2/month), which was 28.5$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs. CONCLUSIONS: The study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households

Nepali migrant workers and the need for pre-departure training on mental health: a qualitative study

Every year around 1,000 Nepali migrant workers die abroad. Every one in three females and one in ten males commit suicide, reflecting a high mental health risk among Nepali migrant workers. This study aims to identify triggers of mental ill-health among Nepali migrant workers and their perception on need of mental health components in the pre-departure orientation programme. We conducted five focus group discussions (FGD) and seven in-depth interviews with Nepali migrant workers and eight semi-structured interviews with stakeholders working for migrants. Participants were invited at Kathmandu’s international airport on return from abroad, at hotels or bus stations near the airport, through organisations working for migrants, and participants’ network. All FGD and interviews were conducted in Kathmandu and audio recorded, transcribed and translated into English. Data were analyzed thematically. High expectations from families back home, an unfair treatment at work, poor arrangements of accommodation, loneliness and poor social life abroad were frequently reported factors for poor mental health. Access to mental health services abroad by Nepali migrant was also poor. We found little on mental health in the pre-departure orientation. We need to improve our knowledge of mental health risks to provide better, more focused and more up-to-date pre-departure training to new migrant workers leaving Nepal

Measuring What Works: An Impact Evaluation of Women's Groups on Maternal Health Uptake in Rural Nepal.

BACKGROUND: There is a need for studies evaluating maternal health interventions in low-income countries. This paper evaluates one such intervention designed to promote maternal health among rural women in Nepal. METHODS AND RESULTS: This was a five-year controlled, non-randomised, repeated cross-sectional study (2007, 2010, 2012) of a participatory community-based maternal health promotion intervention focusing on women's groups to improve maternal health services uptake. In total 1,236 women of childbearing age, who had their last child ≤ two years ago, were interviewed. Difference-in-Difference estimation assessed the effects of the intervention on selected outcome variables while controlling for a constructed wealth index and women's characteristics. In the first three years (from 2007 to the 2010), the intervention increased women's likelihood of attending for antenatal care at least once during pregnancy by seven times [OR = 7.0, 95%CI (2.3; 21.4)], of taking iron and folic acid by three times [OR = 3.0, 95%CI (1.2; 7.8)], and of seeking four or more antenatal care visits of two times, although not significantly [OR = 2.2, 95%CI (1.0; 4.7)]. Over five years, women were more likely to seek antenatal care at least once [OR = 3.0, 95%CI (1.5; 5.2)], to take iron/folic acid [OR = 1.9, [95% CI (1.1; 3.2)], and to attend postnatal care [OR = 1.5, [95% CI (1.1; 2.2)]. No improvement was found on attending antenatal care in the first trimester, birthing at an institution or with a skilled birth attendant. CONCLUSION: Community-based health promotion has a much stronger effect on the uptake of antenatal care and less on delivery care. Other factors not easily resolved through health promotion interventions may influence these outcomes, such as costs or geographical constraints. The evaluation has implications for policy and practice in public health, especially maternal health promotion

Mental health training for community maternity workers in Nepal

Background: Mental health is a difficult topic to discuss in Nepal. This makes it hard for front-line maternity-care providers to start a discussion about mental health issues with women. As Nepal has not yet recognised midwifery as a profession, this UK-funded programme (THET) aims to train community health workers i.e. Auxiliary Nurse Midwives (ANMs) on mental health issues related to pregnancy. Purpose/Objective: This needs assessment, of all ANMs working in one district, assesses knowledge of perinatal mental health issues and future training needs. Method: This quantitative study used a structure questionnaire in Nepali at the start of the training of ANMs. The questions covered knowledge, views on mental health and illness and previous training on the topic. Ethical approval was granted by the Nepal Health Research Council (NHRC). Key Findings: In total 74 questionnaires were returned (out of 76). With 97% of ANMSs reporting they never had specific training issues around perinatal mental health. Their knowledge on perinatal mental health is poor, half of them are not aware that pregnancy and childbirth can cause mental illness. People do not talk openly about mental health problem in their local community. Most ANM thought specialised training on perinatal mental health would be useful. Discussion: Mental health in pregnancy/childbirth is often ignored especially in low-income countries like Nepal. In a country without recognised midwives there is a great need to improve attitudes and skills among community-based maternity workers who lacking training on maternity-related mental health issues. There is a great need for a national curriculum to facilitate relevant training

Anomalous hysteresis studies in Bi-2223/Bi-2212 superconductors by non-resonant microwave absorption (NRMA) with special reference to energy stabilized Josephson (ESJ) fluxons

Magnetic hysteresis of granular high temperature superconducting Bi-2223/Bi-2212 pellets has been studied by non-resonant microwave absorption (NRMA) method. It has been found that the nature of hysteresis is anomalous at all temperatures below Tc. This nature has been analyzed by considering the role of energy stabilized Josephson (ESJ) fluxons, which was not attempted in its totality previously. A comparative study has also been done which is based on data acquired from literature of both NRMA and DC magnetization measurements on granular superconductors. This comparison distinctly shows the difference, i.e. normal hysteresis in DC magnetization studies, whereas, anomalous hysteresis in NRMA studies under similar conditions of low temperatures and low magnetic fields. The discussion brings out the suggestion that, the anomalous hysteresis observed by NRMA method is a manifestation of inevitable generation and detection of ESJ fluxons

A recycling process for degraded aged bare bulk (Bi,Pb)-2223 tubes – Revival of (Bi,Pb)-2223 phase and superconducting properties

Bare bulk tube superconducting current leads (CLs) of (Bi,Pb)(2) Sr-2 Ca-2 Cu-3 O10+x: 1 0 wt% Ag (Length = 410 mm, outer diameter = 45 mm, and inner diameter = 42 mm) have been found to show a degradation in the normal state affecting the superconducting properties due to ageing of the material. These reference samples (named as RF) have been studied over a period of five and ten years. A decomposition of the Bi-2223 phase has been observed after testing several times during the period affecting normal state and superconducting properties considerably. An attempt has been made in order to obtain reusable product using two recycling methods. In one of the methods, these degraded samples were re-sintered (named as RS) and in the second one, they were reprocessed (named as RP). Those is, in the second method, the steps of crushing, mixing, calcining, cold isostatically pressing into tubes, making silver current contacts at both end portions of this tube and finally of sintering were followed to make reprocessed bare bulk tube current leads. Both these RS and RP samples were sintered under identical conditions as those of the conditions used for the RF samples. Comparative analyses of the two recycling (RS and RP) methods with respect to normal state and superconducting state properties are also presented

Enhanced critical current density (J(c)) and fractural strength of low and high Eu level doped bare bulk (Bi, Pb)-2223 rods for cryogenic applications

The effect of Eu doping (0 to 0.12 M%) on magnetic field dependence of transport critical current density (J(c)) and diametral fracture strength (sigma) of the bare bulk 100mm long (Bi, Pb)-2223 rods is reported. An enhancement in Jc on Eu doping has been observed for low Eu levels/low-magnetic fields and for high Eu levels in relatively high magnetic fields. The diametral fracture strength (sigma) has also increased for both low and high Eu levels. In addition these studies, contact resistivity and magneto are also explored. Thermal cycling tests were performed 50 times to check the long term reliability of these rods by observing any degradation in Jc and contact resistivity which exhibits nearly no change in their values. The nature of flux pinning centers responsible for the low Eu level/low field and high Eu level/high field has been discussed. The improvement in both the transport Jc as well as of s by low/high Eu doping evidences long-term reliability and high importance for potential applications of these bare bulk (Bi, Pb)-2223 rods in low as well as high fields

A Process for Developing Long-Length Superconducting Joint Tube Assembly of Bi-2223 (10 wt% Ag)

A process for developing long-length joint tube assembly of Bi-2223 (10 wt% Ag) superconductor is presented. The process involves sintering of tubes fabricated from cold isostatic pressing of the partially preformed Bi-2223 (10 wt% Ag) superconducting powder. The joint was made between these sintered tubes. For making joints, sintered tubes were physically joined by connecting together on a common superconducting bush coated with a superconducting paste. Subsequently, the combination of the bush and the physically joined portion were sintered. The superconducting properties and phase identification/phase composition of the component tubes and of the joint portions have been investigated. The diametral fractural strength of the component tubes and of the joint portion was also evaluated. In the joint obtained according to this method, it is possible to retain the superconducting properties and the fractural strength of the joint high-temperature superconducting tubes. This technique is very useful for fabrication of very large sized superconducting apparatuses such as external magnetic shielding, transmission cables and electrical current leads, et

Effect of electromagnetic interactions on the undulatory temperature dependent behaviour of non-resonant microwave absorption signal amplitude in Bi2Sr2CaCu2O8+x

Variation of non-resonant microwave absorption (NRMA) signal amplitude in single-phase Bi-2212 (5 wt % Ag) sintered pellets (T-c(o) similar to 96 K) while increasing temperature from 15 to 105 K has been investigated and discussed. These studies show an undulatory behavior of an initial fall in the amplitude (15-71.8K) with a subsequent narrow weak temperature independent region (71.8-75.6 K) and then a rise peaking at similar to 82.5 K followed by a final exponential fall (82.5-105 K). A detailed discussion on earlier reported data has suggested that this undulatory behavior cannot be understood in terms of existing approaches involving effect of Josephson interactions (JI) alone among vortices. In our opinion, the entire undulatory behavior observed in the present samples can be explained with the inclusion of electromagnetic interaction (EMI) along with JI