Journal of Nepal Health Research Council最新文献

Background: In Nepal, a substantial proportion of women marry before the age of 18, which is considered as early marriage (EM). The age at which women marry has a direct impact on fertility patterns, family size, and health outcomes of mothers and children. This study aims to assess the levels of age at first marriage (AFM) and significant determinants associated with EM among Nepali women.

Methods: This is a secondary data analysis for which data were obtained from Nepal Demographic and Health Survey 2022. The survey was based on a cross-sectional study design applying two- stage stratified cluster sampling. The AFM levels were analyzed using basic statistics, and a multiple logistic regression model was utilized to identify significant determinants associated with EM. The model's fit was evaluated using the H-L (????2) and Pearson's tests.

Results: Current age of women, women's education, region of residence, caste/ethnicity, husband's education, spouse age difference and age at first menstruation were identified as significant determinants associated with EM. Women with no education face a significantly higher risk of EM - Odds Ratio (OR): 21.67 compared to those with higher education, while from other Terai caste (OR:1.58), and Dalit communities (OR:1.51), and women in Madhesh (OR:2.38) and Karnali (OR:1.94) provinces also exhibited higher risks compared to their reference groups.

Conclusions: The risk of EM is higher among women with no or basic level education, those in Madhesh and Karnali provinces, and from Terai caste and Dalit communities. A large spousal age gap also contributes to this practice. Addressing these issues can help reduce EM among women in Nepal.

Background: Families caring for individuals with mental illness often encounter significant challenges that impact their daily lives, including work, relationships, and social well-being. These responsibilities can result in high levels of stress and emotional strain. In Nepal, there is limited qualitative research on how family members perceive mental illness, manage caregiving duties, and cope with related stress. This study aims to explore the lived experiences of primary family caregivers, focusing on their challenges, coping strategies, and overall understanding of mental illness.

Methods: The study involved ten family caregivers from the Mental Hospital in Lagankhel and Chiryau Polyclinic in Kathmandu, collected through semi-structured interviews. Data was analyzed using thematic analysis and coded in NVivo, identifying shared patterns and meanings.

Results: Ten caregivers aged 30 to 64 (mean age 47.8) described their roles as deeply demanding and painful. They faced challenging behaviors and often sacrificed their own needs, resulting in emotional distress and exhaustion. The caregivers reported experiencing anxiety, burnout, guilt, anger, and social stigma. To cope, they relied on strategies such as crying, distraction, adaptation, inner resilience, and support from family or social networks. Many also found personal growth, emotional strength, and a clearer understanding of mental illness and its treatment. Finally, participants emphasized the critical need for education, professional and family support, systemic services, government-facilitated healthcare access, and financial assistance to sustain effective caregiving.

Conclusions: This study highlights the intense challenges faced by family caregivers of individuals with mental illness and underscores the need for strong support systems. Understanding their experiences and coping strategies can help guide targeted interventions, ultimately improving support for both caregivers and those they care for.

Background: Long acting reversible contraceptive methods are safe, effective and their uptake is integral to increasing modern contraceptive prevalence rate. Their utilization is influenced by women's reproductive health conditions and socio-economic background. This study aimed to explore the characteristics of women of reproductive age who chose these long-term contraceptive options.

Methods: A cross sectional study using a convenient sampling method was conducted among 74 women of reproductive age group (15-49 years) over a three-month period at Kathmandu Medical College, after obtaining ethical approval. Demographic and obstetric details of the participants were collected and analyzed using Statistical Package for the Social Sciences version (SPSS) version 21, with descriptive statistics employed to describe participants' characteristics.

Results: Among all women seeking contraceptive advice, 28 (37.33%) chose long-acting methods. The subdermal implant was most commonly preferred by women with prior spontaneous abortion and unintended pregnancies. The levonorgestrel intrauterine device was preferred by comparatively advanced aged women (mean age of 38 ± 6.2 years) ,compared to 33.67 ± 3.9 years for copper intrauterine device users and 32.49± 7.6 years for subdermal implant users. Most users 49 (66.21%) were from the Brahmin/Chhetri caste.

Conclusions: The subdermal implant emerged as the most preferred Long Acting Reversible Contraceptive method. Caste and education levels significantly influenced contraceptive choices, highlighting the influence of socio-demographic and reproductive health factors in shaping choices for long term birth control methods.

NA.

Background: Maternal perception of fetal movement is an important predictor of fetal wellbeing. Decreased perception of fetal movement by the mother is associated with increased maternal and fetal morbidity. The purpose of this study is to compare the fetomaternal outcome of decreased with normal fetal movement at term pregnancy.

Methods: A comparative study comprising 140 women, 70 cases of normal fetal movement and 70 cases of decreased fetal movement were taken and their fetal and maternal outcomes were compared in terms of maternal and fetal outcome.

Results: The group of females below 20 years old had a higher occurrence of decreased fetal movement 8.7% (n=6) compared to 1.4% (n=1) in the normal fetal movement group. The prevalence of risk factors were similar among both the groups. Induced deliveries were higher in the decreased fetal movement group, 27% (n=19) compared to 21.4% (n=15) in the normal fetal movement. Caesarian section was more in the decreased fetal movement 54.3% (n=38) compared to 27.1% (n=19) in the normal fetal movement group which is statistically significant. The most common indication of caesarian section was non reassuring cardiotocography which comprised of 15.7%(n=11). Incidence of postpartum hemorrhage was higher in the decreased fetal movement (11.4%,n=8) then normal fetal movement (2.9%,n=2).

Conclusions: Decreased fetal movement in comparison to normal fetal movement has increased operative intervention most common indication being non reassuring cardiotocography. Incidence of post partum hemorrhage was higher in the decreased fetal movement group. Fetal outcomes were similar in both groups.

Background: Frozen shoulder (FS) is a painful and debilitating condition characterized by progressive stiffness and restricted shoulder movement. It primarily affects middle-aged individuals, with a higher prevalence in women and those with metabolic disorders such as diabetes and hypertension. While FS is self-limiting, lasting 1-3 years, timely medical management with physiotherapy and interventions can accelerate recovery. This study evaluates the demographic profile, comorbidities, and treatment outcomes of FS patients managed at a pain clinic over four years.

Methods: This retrospective cross-sectional study included patients with frozen shoulder during the painful phase, treated at Nepal Pain Care and Research Center (Oct 2020-Oct 2024). Conservative treatment included analgesics (NASIDs and Paracetamol), Duloxetine, and physiotherapy. Non-responders underwent ultrasound-guided hydrodistension with 5% dextrose, lignocaine, methylprednisolone, and suprascapular block. Outcomes were assessed based on pain reduction, shoulder mobility, and daily function.

Results: All 112 patients with frozen shoulder were initially treated with conservative management. Out of these, 100 patients (89.3%) showed significant improvement. However, 12 patients (10.7%) did not respond well to conservative treatment and were therefore ultrasound-guided hydrodistension was done. Among them, 10 patients (83.3%) experienced noticeable improvement, while 2 patients (16.7%) reported reduced pain but no improvement in their range of motion.

Conclusions: Conservative treatments proved effective in most cases (89.3%), while ultrasound-guided hydrodistension was beneficial for resistant cases (83.3%).

N/A.

Background: Cardiovascular diseases are a leading cause of death globally, with physical inactivity as a significant risk factor. In Nepal, lifestyle-related health issues are rising, necessitating an understanding of physical activity patterns in specific groups like secondary school teachers. This study aims to assess the status of physical activity and associated factors among secondary school teachers in Pokhara, Nepal.

Methods: A cross-sectional study was conducted from December 2022 to April 2023 among 406 secondary school teachers in Pokhara. Physical activity was measured using the IPAQ-long form, and other variables were collected through self-administered questionnaires. Univariate and bivariate analyses were followed by logistic regression to calculate adjusted odds ratios (aOR) for factors associated with moderate and high physical activity.

Results: Most participants were male (53%) and Brahmins/Chhetris (69.2%), with a mean age of 38.65 years. The majority (86.3%) met WHO physical activity guidelines, with 65.3% reporting moderate and 21.5% high activity levels. Higher physical activity was associated with being male (aOR: 2.19, 95% CI: 1.11-4.35), higher education (aOR: 2.88, 95% CI: 1.45-5.73), walking while teaching (aOR: 9.13, 95% CI: 4.20-19.87), and access to walking areas (aOR: 2.28, 95% CI: 1.12-4.62).

Conclusion: Male teachers, those with higher education, and those who walked while teaching were more likely to engage in higher physical activity. Access to walking-friendly environments also positively influenced activity levels. Promoting walking friendly spaces and addressing educational and occupational factors could enhance physical activity among teachers. Keyword: Cardiovascular disease; international physical activity questionnaire; metabolic equivalents.

Background: Male involvement in family planning not only enhances the couple's uptake but also provides continuity through spousal coordination to meet the family planning need. The study aims to assess the factors associated with male involvement in family planning utilization.

Methods: A descriptive cross-sectional study design was used in Madhyabindu Municipality from14th August to 10th September 2022. After proportionately selecting from each ward, the data was collected through a systematic random sampling technique among Tharu married males who were living together with reproductive age group wives. Data was analysed by using SPSS version-16. Descriptive and inferential statistics were used for the data analysis.

Results: Of the 151 males, almost half (49.7%) of the male had completed secondary level education. The majority (80.1%) had decided together by husband and wife about the contraceptive use. The majority (67.5%) of the male had active involvement in family planning utilization, while half (51.7%) of them visited family planning clinic and users of modern family planning methods were 40.4%. Most of (95.4%) them had easy access to temporary FP services and majority (74.2%) had easy access to permanent FP services. Education (p = 0.001), prior use of contraception (p = 0.001), and easy access to permanent family planning methods (p = 0.012) were statistically significant with male involvement in family planning utilization.

Conclusions: Two-fifth of the males were users of family planning methods. Education, prior use of contraception and easy access to family planning services were the significant factors associated with male involvement in family planning utilization.

Background: Gastrointestinal (GI) epithelial cancers are a leading cause of cancer-related deaths worldwide. The objective of this study was to analyse the epidemiology, symptomatology and histopathology of gastrointestinal epithelial malignancies in a GI pathology laboratory based in Kathmandu, Nepal.

Methods: An observational study was conducted to using the data collected from biopsy specimens, pathology reports, clinical information, and endoscopic reports of patients diagnosed from March, 2017 to December, 2018 in Samyak Pathology Lab (SPL), Kathmandu. Nonepithelial tumors were excluded. Data analysis was done using Microsoft Excel 365.

Results: Of 203 GI epithelial malignancies, there were 25 (12.3%) esophageal, 81 (39.9%) gastric, 29 (14.3%) duodenal/ampullary, and 68 (33.5%) colorectal carcinomas. Gastric cancer had a mean age of 59.7 years and a male-to-female (M: F) ratio of 2.4. Common symptoms included abdominal pain, nausea/vomiting, and weight loss. The mean age for esophageal cancer was 65.8 years and the M: F ratio was 2.6. Dysphagia was the commonest symptom. Duodenal cancer had a mean age of 57.2 years and an M: F ratio of 1.2. Among these, 17 were periampullary carcinomas, and obstructive jaundice was the most common symptom. For colorectal cancer, the mean age was 54 years, and the M: F ratio was 1.6. Common symptoms included per-rectal bleeding, abdominal pain, and altered bowel habits.

Conclusions: Gastric cancer was the most common type of gastrointestinal (GI) epithelial cancer in this study, followed by colorectal, duodenal/ampullary, and esophageal cancer. There was a male predominance. The rise in colorectal carcinoma points to lifestyle changes as a contributing factor.