| 1. |
- Shrestha, Binjwala, et al.
(författare)
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Knowledge, prevalence and treatment practices of uterine prolapse among women of reproductive age in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal
- 2014
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Ingår i: Journal of Kathmandu Medical College. - : Kathmandu Medical College (KMC). - 2091-1785. ; 3:4, s. 136-143
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Tidskriftsartikel (refereegranskat)abstract
- Background: Uterine prolapse (UP) is a main contributor to reproductive health problems that influence women’s quality of life. In Nepal, the UP prevalence ranges from 7-27%. Women experience various difficulties and symptoms due to UP, which are determined by the type as well as thestage of UP.Objectives: This study aimed to explore the knowledge, prevalence and treatment practices of uterine prolapse among women of reproductive age in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) in the Bhaktapur district of Nepal.Methods: This cross-sectional study collected data in two stages. A structured survey of 3,124 households in JD-HDSS, incorporating 60% of all women of reproductive age, assessed knowledge of uterine prolapse and identified self-reported disease prevalence (symptomatic). Next, we organised a five day clinical screening camp at JD-HDSS to identify the prevalence of uterine prolapse in attendees. The household survey was conducted on September-December 2012 and the UP screening camp on May-June 2013. Descriptive statistics was used to analyse the proportion of comprehensive knowledge regarding UP and the prevalence of UP.Results: Ninety-three percent of women in JD-HDSS had heard of uterine prolapse and 55% of those had comprehensive knowledge. Self-reported (symptomatic) prevalence was 2.11% (8.5% including women who had undergone hysterectomy for uterine prolapse). Among these, 52.6% had received no treatment. The most common reported treatments of uterine prolapse included surgery (53.2%), exercise and medicine (35.5%) and pessary (11.3%). Among women attending the outreach camp (N=303), UP prevalence was 15.18%.Conclusion: Knowledge of uterine prolapse among women in JD-HDSS is almost double that reported in a national survey. Similarly, the prevalence of self-reported uterine prolapse in JD-HDSS is almost three fold less than the national prevalence. Knowledge, early healthcare practices and availability of surgical care for uterine prolapse might have contributed to these findings.
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| 2. |
- Choulagai, Bishnu, et al.
(författare)
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Barriers to using skilled birth attendants' services in mid- and far-western Nepal : a cross-sectional study
- 2013
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Ingår i: BMC International Health and Human Rights. - : BioMed Central (BMC). - 1472-698X. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal.METHODS: This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women's background characteristics.RESULTS: Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs.CONCLUSIONS: Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women's knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal's health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services.
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| 3. |
- Choulagai, Bishnu, et al.
(författare)
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Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants
- 2015
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Estimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted at the end of 2010. We also report on the use of skilled birth attendants (SBAs) and associated factors in the JD-HDSS at the follow-up point. Design: We used a structured questionnaire to survey 3,505 households in the JD-HDSS, Bhaktapur, Nepal. To investigate the use of SBAs, we interviewed 434 women who had delivered a baby within the prior 2 years. We compared demographic and health indicators at baseline and follow-up and assessed the association of SBA services with background variables. Results: Due to rising in-migration, the total population and number of households in the JD-HDSS increased (13,669 and 2,712 in 2010 vs. 16,918 and 3,505 in 2012). Self-reported morbidity decreased (11.1% vs. 7.1%, respectively), whereas accidents and injuries increased (2.9% vs. 6.5% of overall morbidity, respectively). At follow-up, the proportion of institutional delivery (93.1%) exceeded the national average (36%). Women who accessed antenatal care and used transport (e.g. bus, taxi, motorcycle) to reach a health facility were more likely to access institutional delivery. Conclusions: High in-migration increased the total population and number of households in the JD-HDSS, a peri-urban area where most health indicators exceed the national average. Major morbidity conditions (respiratory diseases, fever, gastrointestinal problems, and bone and joint problems) remain unchanged. Further investigation of reasons for increased proportion of accidents and injuries are recommended for their timely prevention. More than 90% of our respondents received adequate antenatal care and used institutional delivery, but only 13.2% accessed adequate postnatal care. Availability of transport and use of antenatal care was associated positively with institutional delivery.
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| 4. |
- Choulagai, Bishnu P., et al.
(författare)
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A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal
- 2017
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Ingår i: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 32:8, s. 1092-1101
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Tidskriftsartikel (refereegranskat)abstract
- Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. The eligible participants for the survey were women that had delivered a baby within the past 12 months preceding the survey. Implementation was administered by trained health volunteers, youth groups, mothers' groups and health facility management committee members. Post-intervention, we used difference-in-differences and mixed-effects regression models to assess and analyse any increase in the utilization of skilled birth care and antenatal care (ANC) services. All analyses were done by intention to treat. Our trial registration number was ISRCTN78892490 (http://www.isrctn.com/ISRCTN78892490). Interviewees included 1746 and 2098 eligible women in the intervention and control groups, respectively. The 1-year intervention was effective in increasing the use of skilled birth care services (OR = 1.57; CI 1.19-2.08); however, the intervention had no effect on the utilization of ANC services. Expanding the intervention with modifications, e.g. mobilizing more active and stable community groups, ensuring adequate human resources and improving quality of services as well as longer or repeated interventions will help achieve greater effect in increasing the utilization of SBA.
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| 5. |
- Onta, S., et al.
(författare)
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Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study
- 2014
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design: We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid-and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results: Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions: Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.
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| 6. |
- Shakya-Vaidya, Suraj, et al.
(författare)
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Understanding and living with glaucoma and non-communicable diseases like hypertension and diabetes in the Jhaukhel-Duwakot Health Demographic Surveillance Site: a qualitative study from Nepal
- 2014
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 7, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Primary open-angle glaucoma (POAG) is one of the most common causes of irreversible blindness. A possible association between POAG and non-communicable diseases such as hypertension and diabetes suggests that the incidence of POAG may increase. People with POAG in Nepal usually present late to hospital and have poor knowledge of glaucoma. Objectives: Anticipating a knowledge gap regarding these diseases, this study aimed to explore the knowledge of POAG, hypertension, and diabetes in the community and barriers to health care. Design: We conducted this qualitative study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), a peri-urban community near Kathmandu, a capital city of Nepal. To study how disease influences knowledge, we conducted focus group discussions separately for men and women with and without pre-existing POAG, hypertension, and diabetes. Data were analyzed using the framework analysis approach. Results: Although people suffering from POAG, hypertension, and/or diabetes exhibited adequate knowledge of hypertension and diabetes, they lacked in-depth knowledge of POAG. People believed mostly in internal health locus of control. Perception of disease consequences and impact of disease on daily life was influenced by pre-existing POAG, hypertension, and/or diabetes but only in men. Gender disparity was observed regarding health literacy, health perception, and health barriers, which put women in a more difficult situation to tackle their health. We also revealed a gap between knowledge, attitude, and practice of health among women and healthy men. Conclusion: Although people in JD-HDSS exhibited adequate knowledge regarding hypertension and diabetes, they lacked in-depth knowledge about POAG. This study demonstrated gender difference in health literacy and access to health care, making women more vulnerable towards disease. We also demonstrated a gap between knowledge, attitude, and practice of health. However, tailored health literacy programs may bring changes in the health status in the community.
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| 7. |
- Shrestha, Binjwala, et al.
(författare)
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Knowledge on uterine prolapse among married women of reproductive age in Nepal
- 2014
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Ingår i: International Journal of Women's Health. - : Dove Medical Press. - 1179-1411. ; 6:1, s. 771-779
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Tidskriftsartikel (refereegranskat)abstract
- Background: Uterine prolapse (UP), which affects about 10% of women of reproductive age in Nepal, is the most frequently reported cause of poor health in women of reproductive age and postmenopausal women. Currently, women's awareness of UP is unknown, and attempts to unravel the UP problem are inadequate. This study aims to assess UP knowledge among married reproductive women, and determine the association between UP knowledge and socioeconomic characteristics. Methods: Our cross-sectional descriptive study investigated 25 districts representing all five administrative regions, three ecological zones, and urban and rural settings. We used structured questionnaires to interview 4,693 married women aged 15-49 years. We assessed UP knowledge by asking women whether they had ever heard about UP, followed by specific questions about symptoms and preventive measures. Descriptive statistics characterized the study population regarding socioeconomic status, assessed how many participants had ever heard about UP, and determined UP knowledge level among participants who had heard about the condition. Simple regression analysis identified a possible association between socioeconomic characteristics, ever heard about UP, and level of UP knowledge. Results: Mean age of participants was 30 years (SD [standard deviation] 7.4), 67.5% were educated, 48% belonged to the advantaged Brahmin and Chhetri groups, and 22.2% were Janajati from the hill and terai zones. Fifty-three percent had never heard about UP. Among women who had heard about UP, 37.5% had satisfactory knowledge. Any knowledge about UP was associated with both urban and rural settings, age group, and education level. However, satisfactory knowledge about UP was associated with administrative region, ecological zones, caste/ethnic group, and age group of women. Conclusion: Fifty-three percent of participants had never heard about UP, and UP knowledge level was satisfactory in 37.% of those who had ever heard about UP. Any knowledge was associated with urban/rural setting, age group, and education level, whereas satisfactory knowledge was associated with geography, caste/ethnic group, and age group. UP-related health promotion programs should target women from all caste/ethnic groups, age groups, and education levels, including urban and rural communities. © 2014 Shrestha et al.
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| 8. |
- Shrestha, Binjwala, et al.
(författare)
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Uterine prolapse and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal
- 2015
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 8, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Uterine prolapse (UP) is a reproductive health problem and public health issue in low-income countries including Nepal. Objective: We aimed to identify the contributing factors and stages of UP and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site of Bhaktapur, Nepal. Design: Our three-phase study used descriptive cross-sectional analysis to assess quality of life and stages of UP and case-control analysis to identify contributing factors. First, a household survey explored the prevalence of self-reported UP (Phase 1). Second, we used a standardized tool in a 5-day screening camp to determine quality of life among UP-affected women (Phase 2). Finally, a 1-month community survey traced self-reported cases from Phase 1 (Phase 3). To validate UP diagnoses, we reviewed participants' clinical records, and we used screening camp records to trace women without UP. Results: Among 48 affected women in Phase 1, 32 had Stage II UP and 16 had either Stage I or Stage III UP. Compared with Stage I women (4.62%), almost all women with Stage III UP reported reduced quality of life. Decreased quality of life correlated significantly with Stages I-III. Self-reported UP prevalence (8.7%) included all treated and non-treated cases. In Phase 3, 277 of 402 respondents reported being affected by UP and 125 were unaffected. The odds of having UP were threefold higher among illiterate women compared with literate women (OR = 3.02, 95% CI 1.76 5.17), 50% lower among women from nuclear families compared with extended families (OR = 0.56, 95% CI 0.35-0.90) and lower among women with 1-2 parity compared to >5 parity (OR = 0.33, 95% CI 0.14-0.75). Conclusions: The stages of UP correlated with quality of life resulting from varied perceptions regarding physical health, emotional stress, and social limitation. Parity, education, age, and family type associated with UP. Our results suggest the importance of developing policies and programs that are focused on early health care for UP. Through family planning and health education programs targeting women, as well as women empowerment programs for prevention of UP, it will be possible to restore quality of life related to UP.
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| 9. |
- Shrestha, Binjwala, et al.
(författare)
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Women's experiences and health care-seeking practices in relation to uterine prolapse in a hill district of Nepal
- 2014
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Ingår i: BMC Women's Health. - : Springer Science and Business Media LLC. - 1472-6874. ; 14:20
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women’s experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices. Methods Using a convenience sampling method, we conducted 115 semi-structured and 16 in-depth interviews with UP-affected women during September–December 2012. All interviews occurred in outreach clinics in villages of the Dhading district. Results Study participants were 23–82 years of age. Twenty-four percent were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to make healthcare decisions. Most participants (>85%) described the major physical discomforts of UP as difficulty with walking, standing, working, sitting, and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%), and difficulty with sexual activity (73.9%). Due to inability to perform household chores or fulfill their husband’s sexual desires, participants endured humiliation, harassment, and torture by their husbands and other family members, causing severe emotional stress. Following disclosure of UP, 24% of spouses remarried and 6% separated from the marital relationship. Women perceived the causes of UP as unsafe childbirth, heavy work during the postpartum period, and gender discrimination. Prior to visiting these camps some women (42%) hid UP for more than 10 years. Almost half (48%) of participants sought no health care; 42% ingested a herb and ate nutritious food. Perceived barriers to accessing health care included shame (48%) and feeling that care was unnecessary (12.5%). Multiple responses (29%) included shame, inability to share, male service provider, fear of stigma and discrimination, and perceiving UP as normal for childbearing women. Conclusions UP adversely affects women’s daily life and negatively influences their physical, mental, and social well-being. The results of our study are useful to generate information on UP symptoms and female health care seeking practices. Our findings can be helpful for effective development of UP awareness programs to increase service utilization at early stages of UP and thereby might contribute to both primary and secondary prevention of UP.
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