Practice and Lived Experience of Menstrual Exiles (Chhaupadi) among Adolescent Girls in Far Western Nepal. December 2018

Background: Menstrual exile, also known as Chhaupadi, is a tradition of “untouchability” in far-western Nepal. Forbidden from touching other people and objects, women and girls are required to live away from the community, typically in a livestock shed, during menstruation. We assessed the lived experiences of Chhaupadi among Nepalese adolescent girls in the far-western Achham district of Nepal, observed the safety and sanitation of their living spaces during Chhaupadi, and assessed the perceptions of local adult stakeholders towards the practice of Chhaupadi. Methods: We collected data from 107 adolescent girls using a self-administered survey in two local schools in Achham. We also conducted a focus group discussion with seven girls, held key informant interviews, and observed the girls’ living spaces during Chhaupadi, using a checklist. Descriptive statistics of the quantitative survey and thematic analyses of qualitative interviews are presented. Results: The majority of the girls (n = 77, 72%) practiced exile, or Chhaupadi, during their menstruation, including 3 (4%) exiled to traditional Chhau sheds, 63 (82%) to livestock sheds, and 11 (14%) to courtyards outside their home. The remaining girls (n = 30, 28%) stayed inside the house, yet practiced some form of menstrual taboos. Of the 77 observed living spaces where the girls stayed during exile, only 30% (n = 23) had a toilet facility. Most exiled girls (97.4%) were restricted from eating dairy products. Participants reported having various psychological problems, including lonliness and difficulty sleeping while practicing Chhaupadi. Three of the girls were physically abused; nine were bitten by a snake. Notably high proportions of the living spaces lacked ventilation/windows (n = 20, 26%), electricity (n = 29, 38%), toilets (n = 54, 70%) and a warm blanket and mattress for sleeping (n = 29, 38%). Our qualitative findings supported our quantitative results. Conclusions: Chhaupadi has been condemned by human rights organizations. While the government has banned the practice, implementation on the ban is proceeding slowly, especially in far-western Nepal. Thus, as a temporary measure, public health professionals must work towards promoting the health and safety of Nepalese women and girls still practicing Chhaupadi

Prevalence and study of lipid abnormalities in nephrotic syndrome attending a tertiary hospital, Nepal

Background: The nephrotic syndrome is a common presentation of adult or pediatric kidney diseases characterized by proteinuria, dyslipidemia, edema and hypoalbuminemia. Mainly, two types of dyslipidemia are observed: elevated serum cholesterol alone (hypercholesterolemia) and elevation of serum cholesterol along with triglyceride (combined hyperlipidemia). Therefore, majority of patients could predispose for the development of coronary artery disease and other related complications.Methods: This was the prospective hospital-based study conducted in Tribhuvan University Teaching Hospital (TUTH), Nepal. Total sixty patients who meet the inclusive criteria were selected and enrolled from Nephrology outpatient department (OPD) and ward, attending from May 2009 till August 2010.Results: In this study, total sixty patients were enrolled who was diagnosis as primary nephrotic syndrome that was established by clinical parameters supported by renal biopsy. Minimal change glomerulonephritis was common diagnosis by renal biopsy followed by Focal segmental glomerulosclerosis (FSGS). The total serum cholesterol, TG and HDL was normal in 25%, 15%, 83.3% whereas, it is high among 75%,85% and 1.7% of the study populations. Similarly, 24hour urinary protein was >3.5gm/day in all patients. Total serum protein and albumin was normal in 18.3% and 8.3% respectively whereas, rest of the patients had low serum protein and albumin levels. TC/HDLc ratios were and among them, 70% had moderate to high risk value. Similarly, in this study, the serum cholesterol, TG and TC/HDL level was inversely correlated with low protein and albumin.Conclusions: Majority of patients have derangement of lipid profile among nephrotic syndrome patients, which could also predispose for the development of coronary artery disease

Excess urinary iodine concentration and thyroid dysfunction among school age children of eastern Nepal: a matter of concern.

OBJECTIVES:Deficiency as well as excess dietary iodine is associated with several thyroid disorders including Grave's disease and goitre. Previously, cross sectional studies conducted among school children in Nepal showed high prevalence of iodine deficiency. In contrast, recently, few studies have revealed emerging trends of excess urinary iodine concentration in children. This paper, reports excess urinary iodine excretion and thyroid dysfunction among school age children from eastern Nepal. RESULTS:It was a community based cross sectional study in which we measured urinary iodine excretion levels among school age children at baseline and after educational program. The educational program consisted of audio-visual and pamphlets on thyroid health. We also screened them for thyroid function status by physical examination and measuring serum thyroid hormones. Our results show that 34.4% of the children had excess urinary iodine concentration above the WHO recommended levels. Overall, 3.2% of the children were identified to have thyroid dysfunction. Urinary iodine concentration was significantly different between types of salt used and between salt iodine content categories

Factors Associated With Health-Related Quality of Life among Hypertensive Patients in Kathmandu, Nepal

IntroductionNepal has a high prevalence of hypertension. While improving the overall health-related quality of life (HRQOL) is a central tenet to public health plans in developed nations, this focus has yet to be articulated in Nepal. Therefore, this study aims to identify the factors associated with HRQOL among hypertensive patients in Nepal.MethodThe EuroQol-5Dimension HRQOL survey was administered to 180 hypertensive patients, attending the outpatient clinic at Shahid Gangalal National Heart Center in Kathmandu, Nepal. Multiple linear regression models, adjusted for age and sex, were used to identify factors associated with HRQOL.ResultsThe mean age and EuroQol visual analytic scale of the participants were 53.2 years and 63.7, respectively. Age [β = −0.56; 95% confidence interval (CI): −0.75 to −0.37], income (β = 0.02; 95% CI: 0.01, 0.03), family size (β = −0.98; 95% CI: −1.89, −0.07), number of antihypertensive drugs use (β = 4.62; 95% CI: 1.33, 7.90), and compliance to dietary salt advise (β = 4.86; 95% CI: 0.29, 9.43) were significant factors associated with HRQOL among participants. In addition, levels of education and self-perceived health were associated in a positive gradient to HRQOL. In mediation analysis, both, dietary low salt compliance and use of antihypertensive drugs, had a significant direct effect on HRQOL, and the use of antihypertensive drugs did not significantly mediate the relationship between dietary salt compliance and HRQOL.ConclusionVarious factors were found to be associated with HRQOL among hypertensive patients in Kathmandu. Assessing HRQOL is a valuable technique to identify populations in need of services and interventions. This assessment can serve as a baseline, and in conjunction with multiple stakeholders, can guide public health policy, planning, and practices, especially those aimed toward improving the HRQOL of Nepalese with hypertension

Nutritional status of participants and associated factors.

<p>Nutritional status of participants and associated factors.</p

Scatter plot and Spearman correlation coefficient (r) of BMI and total MNA score.

<p>BMI, body mass index; MNA, mini nutritional assessment.</p

The burden of malnutrition: Current and prior research results in South Asia among rural populations.

<p>The burden of malnutrition: Current and prior research results in South Asia among rural populations.</p

Life satisfaction among elderly patients in Nepal: associations with nutritional and mental well-being

Abstract Background Nepal’s demography is aging rapidly, yet few studies to date have examined how this has affected the health and well-being of the elderly, defined as those above 60 years in Nepal’s Senior Citizen Act (2006). Our study, abbreviated NepEldQOLII, aims to assess perceived life satisfaction, and evaluate its relationship with nutritional health and mental well-being among the burgeoning Nepalese elderly population. Methods A cross-sectional survey among 289 Nepalese elderly, aged ≥60 years, attending an outpatient clinic of a hospital in Kathmandu, Nepal was conducted. Nutritional status, depression, and life satisfaction were assessed by a mini-nutritional assessment scale (range: 0–14), a geriatric depression scale (range: 0–15), and a satisfaction with life scale (range: 5–35), respectively. Mediation analyses, adjusted for age, sex, marital status, and family type, were used to assess mediating relationships between nutritional and mental wellbeing with life satisfaction as the outcome. Results Approximately 21% of the participants were dissatisfied with their life. Life satisfaction was positively associated with being married, high family income, involvement in active earning, and a high nutritional score. Conversely, life satisfaction was inversely associated with living in a nuclear (as opposed to joint) family, the perception of having worse health than peers, the perception of being ignored/hated due to old age, and a higher depression score. In mediation analyses, both nutrition (β = 0.48, bias-corrected and accelerated (BCa) 95% CI: 0.27, 0.69) and depression (β = − 0.87, BCa 95% CI: -1.01, − 0.74) had significant direct associations with life satisfaction. Furthermore, both nutrition (β = 0.30, BCa 95% CI: 0.13, 0.49) and depression (β = − 0.07, BCa 95% CI: -0.14, − 0.03) mediate each other’s association with life satisfaction. Nutritional score mediated 7% of the total association between depression and life satisfaction; depression mediated 38% of the total association between nutrition and life satisfaction. Conclusions Life satisfaction shows a pattern of decline as nutritional and mental health status decrease. Both depression and under-nutrition had a significant association with life satisfaction. The pathway by which nutrition affects life satisfaction is influenced by depression as a mediator. Moreover, nutritional status explained a small portion of the relationship between depression and life satisfaction. These observed preliminary findings should be confirmed in future longitudinal studies

Undergraduate nursing students’ knowledge of aging, attitudes toward and perceptions of working with older adults in Kathmandu Nepal

Objectives: This study aims to examine Nepalese undergraduate nursing students’ knowledge of aging, attitudes towards older adults and perceptions of working with older adults, and to assess differences in these outcomes by socio-demographic characteristics as well as type of nursing program. Methods: A cross-sectional study was conducted among 385 undergraduate nursing students in six nursing colleges located in the Kathmandu Valley. Knowledge of aging, attitudes toward older adults and perceptions of working with older adults were assessed using standardized tools, the Palmore Facts on Aging Quiz, Kogan's Attitudes towards Older People Scale, and Nolan's Intent to Work with Older People Questionnaire, respectively. Results: The mean knowledge scores on older adults and aging were relatively low; participants scored an average of 26.9 out of 50. Scores assessing attitudes towards and perceptions of working with older adults were more favorable. Compared to students pursuing a Bachelor of Science in Nursing (BSN), students pursuing a Bachelor of Nursing (BN) had a significantly higher score on the knowledge, attitudes and perception of aging scales. Linear regression analyses showed that the students’ knowledge of aging (β = 0.55; 95% CI = 0.25–0.86) and perceptions of working with older adults (β = 0.22; 95% CI = 0.05–0.38) had a significant positive association with their attitudes toward older adults. Conclusions: Undergraduate nursing students in the Kathmandu Valley of Nepal displayed a relatively low level of knowledge, but a positive attitude towards older adults, and a positive perception of working with older adults. Observed differences in knowledge, attitude, and perception scores between students in BSN and BN programs needs further investigation; closing this gap may be important for bolstering undergraduate gerontological preparation in Nepal. Keywords: Aged, Attitudes, Knowledge, Perceptions, Students, Nursing, Nepa

Depression, malnutrition, and health-related quality of life among Nepali older patients

Abstract Background Little is known about the health, nutrition, and quality of life of the aging population in Nepal. Consequently, we aimed to assess the nutritional status, depression and health-related quality of life (HRQOL) of Nepali older patients and evaluate the associated factors. Furthermore, a secondary aim was to investigate the proposed mediation-moderation models between depression, nutrition, and HRQOL. Methods A cross-sectional survey was conducted from January–April of 2017 among 289 Nepali older patients in an outpatient clinic at Nepal Medical College in Kathmandu. Nutritional status, depression and HRQOL were assessed using a mini nutritional assessment, geriatric depression scales, and the European quality of life tool, respectively. Linear regression models were used to find the factors associated with nutritional status, depression, and HRQOL. The potential mediating and moderating role of nutritional status on the relationship between depression and HRQOL was explored; likewise, for depression on the relationship between nutritional status and HRQOL. Results The prevalence of malnutrition and depression was 10% and 57.4% respectively; depression-malnutrition comorbidity was 7%. After adjusting for age and gender, nutritional score (β = 2.87; BCa 95%CI = 2.12, 3.62) was positively associated and depression score (β = − 1.23; BCa 95%CI = − 1.72, − 0.72) was negatively associated with HRQOL. After controlling for covariates, nutritional status mediated 41% of the total effect of depression on HRQOL, while depression mediated 6.0% of the total effect of the nutrition on HRQOL. Conclusions A sizeable proportion of older patients had malnutrition and depression. Given that nutritional status had a significant direct (independently) and indirect (as a mediator) effect on HRQOL, we believe that nutritional screening and optimal nutrition among the older patients can make a significant contribution to the health and well-being of Nepali older patients. Nonetheless, these findings should be replicated in prospective studies before generalization