Publications
68 results found
Shariq S, Cardoso Pinto AM, Budhathoki SS, et al., 2023, Barriers and facilitators to the recruitment of disabled people to clinical trials: a scoping review, Trials, Vol: 24, Pages: 1-13, ISSN: 1745-6215
IntroductionUnderrepresentation of disabled groups in clinical trials results in an inadequate evidence base for their clinical care, which drives health inequalities. This study aims to review and map the potential barriers and facilitators to the recruitment of disabled people in clinical trials to identify knowledge gaps and areas for further extensive research. The review addresses the question: ‘What are the barriers and facilitators to recruitment of disabled people to clinical trials?’.MethodsThe Joanna Briggs Institute (JBI) Scoping review guidelines were followed to complete the current scoping review. MEDLINE and EMBASE databases were searched via Ovid. The literature search was guided by a combination of four key concepts from the research question: (1) disabled populations, (2) patient recruitment, (3) barriers and facilitators, and (4) clinical trials. Papers discussing barriers and facilitators of all types were included. Papers that did not have at least one disabled group as their population were excluded. Data on study characteristics and identified barriers and facilitators were extracted. Identified barriers and facilitators were then synthesised according to common themes.ResultsThe review included 56 eligible papers. The evidence on barriers and facilitators was largely sourced from Short Communications from Researcher Perspectives (N = 22) and Primary Quantitative Research (N = 17). Carer perspectives were rarely represented in articles. The most common disability types for the population of interest in the literature were neurological and psychiatric disabilities. A total of five emergent themes were determined across the barriers and facilitators. These were as follows: risk vs benefit assessment, design and management of recruitment protocol, balancing internal and external validity considerations, consent and ethics, and systemic factors.ConclusionsBoth barriers and facilitators were often highly spec
Cardoso Pinto A, Shariq S, Ranasinghe L, et al., 2023, Reasons for reductions in routine childhood immunisation uptake during the COVID-19 pandemic in low- and middle-income countries: a systematic review, PLOS Global Public Health, Vol: 3, Pages: 1-17, ISSN: 2767-3375
The coronavirus disease 2019 (COVID-19) pandemic has resulted in a substantial decline in routine immunisation coverage in children globally, especially in low- and middle-income countries (LMICs). This study summarises the reasons for disruptions to routine child immunisations in LMICs. A systematic review (PROSPERO CRD42021286386) was conducted following PRISMA 2020 guidelines. Six databases were searched: MEDLINE, Embase, Global Health, CINAHL, Scopus and MedRxiv, on 11/02/2022. Observational and qualitative studies published from January 2020 onwards were included if exploring reasons for missed immunisations during the COVID-19 pandemic in LMICs. Study appraisal used National Heart, Lung, and Blood Institute and Critical Appraisal Skills Programme tools. Reasons for disruption were defined with descriptive codes; cross-sectional (quantitative) data were summarised as mean percentages of responses weighted by study population, and qualitative data were summarised narratively. A total of thirteen studies were included describing reasons behind disruptions; 7 cross-sectional (quantitative), 5 qualitative and 1 mixed methods. Seventeen reasons for disruptions were identified. In quantitative studies (total respondents = 2,853), the most common reasons identified were fear of COVID-19 and consequential avoidance of health centres (41.2%, SD ±13.3%), followed by transport challenges preventing both families and healthcare professionals from reaching vaccination services (11.1% SD ±16.6%). Most reasons stemmed from reduced healthcare-seeking (83.4%), as opposed to healthcare-delivery issues (15.2%). Qualitative studies showed a more even balance of healthcare-seeking (49.5%) and healthcare-delivery issues (50.5%), with fear of COVID-19 remaining a major identified issue (total respondents = 92). The most common reasons for disruption were parental fear of COVID-19 and avoidance of health services. Health systems must therefore prioritise public health me
Cardoso Pinto AM, Malone E, Ramesh N, et al., 2022, Community partnerships in medical education: Narratives of medical students, Public Health Challenges, Vol: 1, Pages: 1-6, ISSN: 2769-2450
While medical education has traditionally been designed, led and delivered exclusively by clinicians and academics, there has been an increasing shift towards diversifying actors involved in training future generations of health professionals. Public and patient involvement in learning increases the likelihood that learning is relevant to the communities we purport to serve. This article explores the experiences of medical students who were partnered with a community-based organisation (CBOs) as part of the intercalated Global Health BSc at Imperial College London. Students involved in this programme highlight opportunities to understand the needs of communities they were placed with, beyond what is possible to understand in clinical practice; this is essential to support them in becoming holistic, patient-centred practitioners. Students also found this opportunity helpful to gain insight into the role and value of the voluntary sector in healthcare and develop transferrable skills in project leadership and management. It is hypothesised that the benefits of this partnership extend to community-organisations; they gain experience working with students, who provide an external view of their services and may be helpful in the delivery of quality-improvement projects. Communities could also benefit from interactions with students by sharing insight into their needs and priorities, and in turn, shaping students’ priorities as future health professionals and co-designers of voluntary-sector initiatives within the community. Whilst the establishment of these partnerships does not come without its challenges, this article also highlights lessons for students and institutions undergoing similar programmes, including clarification of goals, stakeholder consultation, sustainability of interventions, voicing the community, timetable flexibility and funding.
Pinder R, Budhathoki S, Qavi A, et al., 2022, Developing partnerships for learning in Global Health: medical students in community-based organisations, Transform MedEd 2022
Thapa J, Budhathoki SS, Niraula SR, et al., 2022, Prehypertension and its predictors among older adolescents: A cross-sectional study from eastern Nepal, PLOS Global Public Health, Vol: 2, Pages: 1-17, ISSN: 2767-3375
Prehypertension is a state of transition between normal blood pressure and hypertension. Adolescent prehypertension is a strong predictor of hypertension in adults and is now considered for cardiovascular intervention or risk reduction. This study was conducted among adolescents to assess the burden of pre-hypertension and its predictors. A cross-sectional study was conducted among grade 11 and 12 students in three districts in eastern Nepal namely Jhapa, Morang and Sunsari. Sampling was done using a multistage stratified proportionate random method. A semi-structured questionnaire adapted from the WHO STEPwise approach to the non-communicable disease risk factor surveillance (STEPS) instrument was used as a study tool after modification and pre-testing in addition to the anthropometric and blood pressure measurements by the investigators. The prevalence of prehypertension was assessed along with the identification of its predictors through multivariable binary logistic regression modelling. A total of 806 participants aged 15 to 19 years, with 57.1% female, participated in the study. Prehypertension was found in 20.8% (24.6% in males and 18.0% in females) of the participants, while 7.1% of them were hypertensive (9.2% males and 5.4% females). Obesity and central obesity were seen among 6.3% and 17.7% of the respondents respectively. Age, sex, ethnicity and obesity were found to be significantly associated with prehypertension. A significant proportion of prehypertension was seen among the adolescent population along with a notable presence of risk factors such as smoking, alcohol consumption, obesity, and eating out. This warrants careful consideration and identification of relevant strategies to reduce the burden of prehypertension via school-based interventions to reduce the modifiable risk factors.
Poudel M, Ojha A, Thapa J, et al., 2022, Morbidities, health problems, health care seeking and utilization behaviour among elderly residing on urban areas of eastern Nepal: a cross-sectional study, PLoS One, Vol: 17, Pages: 1-16, ISSN: 1932-6203
Background: Morbidity increases with age and enhances the burden of health problems that result in new challenges to meet additional demands. In the ageing population, health problems, and health care utilization should be assessed carefully and addressed. This study aimed to identify chronic morbidities, health problems, health care seeking behaviour and health care utilization among the elderly.Methods: We conducted a community based, cross-sectional study in urban areas of the Sunsari district using face-to-face interviews. A total of 530 elderly participants were interviewed and selected by a simple proportionate random sampling technique.Results: About half, 48.3%, elderly were suffering from pre-existing chronic morbidities, of which, 30.9% had single morbidity, and 17.4% had multi-morbidities. This study unfurled more than 50.0% prevalence of health ailments like circulatory, digestive, eye, musculoskeletal and psychological problems each representing the burden of 68.7%, 68.3%, 66.2%, 65.8% and 55.7% respectively. Our study also found that 58.7% preferred hospitals as their first contact facility. Despite the preferences, 46.0% reported visiting traditional healers for treatment of their ailments. About 68.1% reported having difficulty seeking health care and 51.1% reported visits to a health care facility within the last 6 months period. The participants with pre-existing morbidity, health insurance, and an economic status above the poverty line were more likely to visit health care facilities. Conclusion: Elderly people had a higher prevalence of health ailments, but unsatisfactory health care seeking and health care utilization behaviour. These need further investigation and attention by the public health system in order to provide appropriate curative and preventive health care to the elderly. There is an urgent need to promote geriatric health services and make them available at the primary health care level, the first level of contact with a national
Osborne RH, Cheng CC, Nolte S, et al., 2022, Health literacy measurement: embracing diversity in a strengths-based approach to promote health and equity, and avoid epistemic injustice, BMJ Global Health, Vol: 7, Pages: 1-6, ISSN: 2059-7908
Definitions of health literacy have evolved from notions of health-related literacy to a multidimensional concept that incorporates the importance of social and cultural knowledge, practices and contexts. This evolution is evident in the development of instruments that seek to measure health literacy in different ways. Health literacy measurement is important for global health because diverse stakeholders, including the WHO, use these data to inform health practice and policy, and to understand sources of inequity. In this Practice paper, we explore the potential for negative consequences, bias and epistemic injustice to occur when health literacy instruments are used across settings without due regard for the lived experiences of people in various contexts from whom data are collected. A health literacy measurement approach that is emic-sensitive, strengths based and solution oriented is needed to minimise biased data interpretation and use and to avoid epistemic injustice.
Cardoso Pinto A, Ranasinghe L, Dodd P, et al., 2022, Disruptions to routine childhood vaccinations in low- and middle-Income countries during the COVID-19 pandemic: a systematic review, Frontiers in Pediatrics, Vol: 10, ISSN: 2296-2360
BackgroundThe COVID-19 pandemic has disrupted routine childhood vaccinations worldwide with low- and middle-income countries (LMICs) most affected. This study aims to quantify levels of disruption to routine vaccinations in LMICs. MethodsA systematic review (PROSPERO CRD42021286386) was conducted of MEDLINE, Embase, Global Health, CINAHL, Scopus and MedRxiv, on the 11th of February 2022. Primary research studies published from January 2020 onwards were included if they reported levels of routine paediatric vaccinations before and after March 2020. Study appraisal was performed using NHLBI tool for cross-sectional studies. Levels of disruption were summarised using medians and interquartile ranges. ResultsA total of 39 cross-sectional studies were identified. These showed an overall relative median decline of 10.8% (interquartile range [IQR] -27.6%, -1.4%) across all vaccines. Upper-middle-income countries (upper-MICs) (-14.3%; IQR -24.3%, -2.4%) and lower-MICs (-18.0%; IQR 48.6%, 4.1%) showed greater declines than low-income countries (-3.1%; IQR -12.8%, 2.9%), as did vaccines administered at birth (-11.8%; IQR -27.7%, -3.5%) compared to those given after birth (-8.0%; IQR -28.6%, -0.4%). Declines during the first three months of the pandemic ( 8.1%; IQR -35.1%, -1.4%) were greater than during the remainder of 2020 (-3.9%; IQR 13.0%, 11.4%) compared to baseline. ConclusionThere has been a decline in routine paediatric vaccination, greatest in MICs and for vaccines administered at birth. Nations must prioritise catch-up programmes alongside public health messaging to encourage vaccine uptake.
Basnet B, Chapagain P, Subedi S, et al., 2022, Experiences of nurses providing maternity care in a public hospital during the COVID-19 pandemic in Nepal: a qualitative study, PLOS Global Public Health, Vol: 2, ISSN: 2767-3375
Maternity service providers have struggled to provide high-quality services to women and newborns during the ongoing COVID-19 pandemic which has substantially impacted health systems and disrupted maternity services globally. Nepal is a resources-limited country that reported a significant impact of the pandemic on maternal health services. It is therefore important to understand better the perspective of health care professionals in this context. This study intends to explore the experiences of nurses providing maternity care in the public sector during the COVID-19 pandemic in Nepal. A qualitative study using a phenomenological design was conducted. Altogether ten nurses working in maternity services were selected using purposive sampling technique. Data were collected by face-to-face in-depth interviews using a semi-structured interview guide. Thematic analysis was conducted using Clarke and Braun 2006 technique. The findings of the study were organized into codes, sub-themes and themes. The six themes identified were fear of COVID-19 at work, challenges at work, changes at work and services, motivations to work, stigma due to COVID-19, and impact on services. Participants described how maternity services could not be stopped during the pandemic. They had experienced decreased utilization of antenatal services as a consequence of ‘lockdown’ thereby leading to an increase in maternal and neonatal mortality. Respondents reported ineffective human resource management compromising the quality of care. The professional responsibility to cope with adverse circumstances and serve society is a major source of motivation that health workers relied upon to get them through the pandemic period. A wide range of challenges were faced by service providers during the pandemic which requires action and support of all levels of government, institutions and society-at-large to assure the continued provision of safe maternity care during such a protracted period of chal
Panthi S, Bhandari A, Acharya R, et al., 2022, Medical students' attitude towards cultural diversity: a cross-sectional study at a health sciences university in eastern Nepal, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Basnet LB, Budhathoki SS, Adhikari B, et al., 2022, Compliance with the smoke-free public places legislation in Nepal: A cross-sectional study from Biratnagar Metropolitan City, PLoS One, Vol: 17, Pages: 1-15, ISSN: 1932-6203
BackgroundSmoke-free legislation banning tobacco smoking in public places was implemented across Nepal in 2014 with the ambition to reduce the impact of second-hand smoking. As part of a comprehensive policy package on tobacco control, the implementation of the legislation has seen a marked reduction in tobacco consumption. Yet there remains uncertainty about the level of compliance with smoke-free public places.ObjectivesThis study assesses the compliance with smoke-free laws in public places and the factors associated with active smoking in public places in Biratnagar Metropolitan City, Nepal.MethodsA cross-sectional study was conducted in the Biratnagar metropolitan city in Province 1 of Nepal from July to December 2019. A total of 725 public places within the metropolitan city were surveyed using a structured survey tool. Active smoking was the primary outcome of the study which was defined as smoking by any person during the data collection time at the designated public place.ResultsThe overall compliance with smoke-free legislation was 56.4%. The highest compliance (75.0%) was observed in Government office buildings. The lowest compliance was observed in eateries, entertainment, and shopping venues (26.3%). There was a statistically significant association between active smoking and the presence of ‘no smoking’ notices appended at the entrance and the odds of active smoking in eateries, entertainment, hospitality, shopping venues, transportations and transits was higher compared to education and health care institutions. None of the ‘no smoking’ notices displayed fully adhered to the contents as prescribed by the law.ConclusionAs more than half of the public places complied with the requirements of the legislation, there was satisfactory overall compliance with the smoke-free public places law in this study. The public venues (eateries, shopping venues and transportations) that are more frequently visited and have a high turnover of the
Budhathoki SS, Hawkins M, Elsworth G, et al., 2022, Use of the English health literacy questionnaire (HLQ) with the health science university students in Nepal: a vaildity testing study, International Journal of Environmental Research and Public Health, Vol: 19, Pages: 3241-3241, ISSN: 1660-4601
Research evidence shows that health literacy development is a key factor influencing non-communicable diseases care and patient outcomes. Healthcare professionals with strong health literacy skills are essential for providing quality care. We aimed to report the validation testing of the Health Literacy Questionnaire (HLQ) among health professional students in Nepal. A cross-sectional study was conducted with 419 health sciences students using the HLQ in Nepal. Validation testing and reporting were conducted using five sources outlined by ‘the 2014 Standards for Educational and Psychological Testing’. The average difficulty was lowest (17.4%) for Scale 4. Social support for health, and highest (51.9%) for Scale 6. Ability to actively engage with healthcare providers. One factor Confirmatory Factor Analysis (CFA) model showed a good fit for Scale 2, Scale 7 and Scale 9 and a reasonable fit for Scale 3 and Scale 4. The restricted nine-factor CFA model showed a satisfactory level of fit. The use of HLQ is seen to be meaningful in Nepal and warrants translation into native Nepali and other dominant local languages with careful consideration of cultural appropriateness using cognitive interviews.
Bhatt N, Nepal S, Pinder RJ, et al., 2022, Challenges of hospital oxygen management during the COVID-19 pandemic in rural Nepal, The American Journal of Tropical Medicine and Hygiene, Vol: 106, Pages: 997-999, ISSN: 0002-9637
Oxygen support remains essential for treatment of acute and severe manifestations of COVID-19. In Nepal, like many other low-resource settings, medical oxygen availability was inadequate before the pandemic. The mid-2021 wave of COVID-19 transmission starkly exposed the supply–demand imbalance of medical oxygen across the country. Pre-pandemic, more complex cases were typically referred to hospitals with better resources; however, during the pandemic, these hospitals were overrun. Therefore, resource-poor health facilities have been attempting to provide greater levels of care. However, we are faced with numerous challenges to provide a proper oxygen supply in these health settings. At a logistical level, complex geographies, sparse infrastructure, and inadequate electricity supply pose challenges. On a provider level, a shortage of trained staff and equipment necessary to administer and monitor medical oxygen creates additional pressures. Recognizing the end of the pandemic is still a long way off in many parts of the world, it is imperative that scalable, sustainable approaches to provisioning oxygen to those in greatest need are considered at a policy level.
Nguyen Thi Yen C, Hermoso C, Laguilles EM, et al., 2021, Vietnam's success story against COVID-19, Public Health in Practice, Vol: 2, ISSN: 2666-5352
Vietnam's close proximity to China where the COVID-19 outbreak started made it one of the countries expected to have widespread transmission of the virus. However, the country opposed this expectation and attained low spread of COVID-19 infection due to its proactive approaches in containing the disease. As of March 11, 2021, Vietnam has a total of 2529 confirmed cases, equivalent to 26 cases per one million population-compared to the global rate of 15,223 cases. The low-cost model approach used by Vietnam in dealing with previous public health issues, tackle the importance of a strategic public health system, good governance, and citizen cooperation in the fight against COVID 19 pandemic. This paper aims to analyze Vietnam's achievement in its early and continued success in combating COVID-19 by taking into account various aspects of its health system and experience on outbreaks that have previously occurred and how these can be applied to current COVID-19 responses.
Sharma G, Molla YB, Budhathoki SS, et al., 2021, Analysis of maternal and newborn training curricula and approaches to inform future trainings for routine care, basic and comprehensive emergency obstetric and newborn care in the low- and middle-income countries: Lessons from Ethiopia and Nepal, PLoS One, Vol: 16, ISSN: 1932-6203
Program managers routinely design and implement specialised maternal and newborn health trainings for health workers in low- and middle-income countries to provide better-coordinated care across the continuum of care. However, in these countries details on the availability of different training packages, skills covered in those training packages and the gaps in their implementation are patchy. This paper presents an assessment of maternal and newborn health training packages to describe differences in training contents and implementation approaches used for a range of training packages in Ethiopia and Nepal. We conducted a mixed-methods study. The quantitative assessment was conducted using a comprehensive assessment questionnaire based on validated WHO guidelines and developed jointly with global maternal and newborn health experts. The qualitative assessment was conducted through key informant interviews with national stakeholders involved in implementing these training packages and working with the Ministries of Health in both countries. Our quantitative analysis revealed several key gaps in the technical content of maternal and newborn health training packages in both countries. Our qualitative results from key informant interviews provided additional insights by highlighting several issues with trainings related to quality, skill retention, logistics, and management. Taken together, our findings suggest four key areas of improvement: first, training materials should be updated based on the content gaps identified and should be aligned with each other. Second, trainings should address actual health worker performance gaps using a variety of innovative approaches such as blended and self-directed learning. Third, post-training supervision and ongoing mentoring need to be strengthened. Lastly, functional training information systems are required to support planning efforts in both countries.
Kc A, Budhathoki SS, Thapa J, et al., 2021, Impact of stimulation among non-crying neonates with intact cord versus clamped cord on birth outcomes: observation study, BMJ Paediatrics Open, Vol: 5, Pages: 1-8, ISSN: 2399-9772
Background Stimulation of non-crying neonates after birth can help transition to spontaneous breathing. In this study, we aim to assess the impact of intact versus clamped umbilical cord on spontaneous breathing after stimulation of non-crying neonates.Methods This is an observational study among non-crying neonates (n=3073) born in hospitals of Nepal. Non-crying neonates born vaginally at gestational age ≥34 weeks were observed for their response to stimulation with the cord intact or clamped. Obstetric characteristics of the neonates were analysed. Association of spontaneous breathing with cord management was assessed using logistic regression.Results Among non-crying neonates, 2563 received stimulation. Of these, a higher proportion of the neonates were breathing in the group with cord intact as compared with the group cord clamped (81.1% vs 68.9%, p<0.0001). The use of bag-and-mask ventilation was lower among those who were stimulated with the cord intact than those who were stimulated with cord clamped (18.0% vs 32.4%, p<0.0001). The proportion of neonates with Apgar Score ≤3 at 1 min was lower with the cord intact than with cord clamped (7.6% vs 11.5%, p=0.001). In multivariate analysis, neonates with intact cord had 84% increased odds of spontaneous breathing (adjusted OR, 1.84; 95% CI: 1.48 to 2.29) compared with those with cord clamped.Conclusions Stimulation of non-crying neonates with intact cord was associated with more spontaneous breathing than among infants who were stimulated with cord clamped. Intact cord stimulation may help establish spontaneous breathing in apnoeic neonates, but residual confounding variables may be contributing to the findings. This study provides evidence for further controlled research to evaluate the effect of initial steps of resuscitation with cord intact.
Adhikari B, Devkota A, Budhathoki SS, et al., 2021, COVID-19 crisis in Nepal: a case of systems and governance failure in a low-income country, Journal of Global Health Economics and Policy, Vol: 1, ISSN: 2806-6073
Sbaiti M, Streule M, Alhaffar M, et al., 2021, Whose voices should shape global health education? Curriculum codesign and codelivery by people with direct expertise and lived experience, BMJ Global Health, Vol: 6, ISSN: 2059-7908
There are contrasting opinions of what Global Health (GH) curricula should contain and limited discussion on whose voices should shape it. In GH education, those with first-hand expertise of living and working in the contexts discussed in GH classrooms are often absent when designing curricula. To address this, we developed a new model of curriculum co-design called Virtual Roundtable for Collaborative Education Design (ViRCoED). This paper describes the rationale and outputs of the ViRCoED approach in designing a new section of the Global Health BSc curriculum at Imperial College London, with a focus on healthcare in the Syrian conflict. The team, importantly, involved partners with lived and/or professional experience of the conflict as well as alumni of the course, and educators in all stages of design and delivery through to marking and project evaluation. The project experimented with disrupting power dynamics and extending ownership of the curriculum beyond traditional faculty by co-designing and co-delivering module contents together with colleagues with direct expertise and experience of the Syrian context. An authentic approach was applied to assessment design using real-time syndromic healthcare data from the Aleppo and Idlib Governorates. We discuss the challenges involved in our collaborative partnership and describe how it may have enhanced the validity of our curriculum with students engaging in a richer representation of key health issues in the conflict. We observed an enhanced self-reflexivity in the students’ approach to quantitative data and its complex interpretation. The dialogic nature of this collaborative design was also a formative process for partners and an opportunity for GH educators to reflect on their own positionality. The project aims to challenge current standards and structures in GH curriculum development and gesture towards a GH education sector eventually led by those with lived experience and expertise to significantly
Dhimal M, Kramer IM, Phuyal P, et al., 2021, Climate change and its association with expansion of vectors and vector-borne diseases in the Hindu Kush Himalayan region: A systematic synthesis of the literature, Advances in Climate Change Research, Vol: 12, Pages: 421-429, ISSN: 1674-9278
Observed weather and projected climate change suggest increases in the transmission of vector-borne diseases (VBDs) in the Hindu Kush Himalayan (HKH) region. In this study, we systematically explore the literature for empiric associations between the climate variables and specific mosquito-borne diseases and their vectors in the Himalaya Hindukush region. We conducted a systematic synthesis of the published literature on weather variables and VBDs in the HKH region to 8th December 2020. The majority of studies show significant positive associations of vector-borne diseases with climatic factors such as temperature, precipitation, relative humidity, etc. This systematic review allowed us to identify the most significant variables to be considered for evidence-based trend estimates of the effects of climate change on VBDs and their vectors in HKH region and set this evidence in to the context of climate change trend and with the observed expansion of VBDs and disease vector in the HKH region. The geographic range of vector-borne diseases expanded into previously considered non-endemic areas of highlands (mountains) in the HKH region. Based on scarce, but clear evidence of positive relationship of most climate variables and VBDs and the trend of climatic changes, we strongly recommend an expansion of vector control and surveillance programmes in previously considered non-endemic areas of the HKH region.
Bhattacharjee NV, Schaeffer LE, Hay SI, 2021, Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000-2018, Nature Human Behaviour, Vol: 5, Pages: 1027-1045, ISSN: 2397-3374
Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030.
Bhatt N, Bhatt B, Neupane B, et al., 2021, Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: A qualitative study, PLoS One, Vol: 16, Pages: 1-16, ISSN: 1932-6203
IntroductionFamily planning methods are used to promote safer sexual practices, reduce unintended pregnancies and unsafe abortion, and control population. Young people aged 15–24 years belong to a key reproductive age group. However, little is known about their engagement with the family planning services in Nepal. Our study aimed to identify the perceptions of and barriers to the use of family planning among youth in Nepal.MethodsA qualitative explorative study was done among adolescents and young people aged 15–24 years from the Hattimuda village in eastern Nepal. Six focus group discussions and 25 in-depth interviews were conducted with both male and female participants in the community using a maximum variation sampling method. Data were analyzed using a thematic framework approach.ResultsMany individuals were aware that family planning measures postpone pregnancy. However, some young participants were not fully aware of the available family planning services. Some married couples who preferred ’birth spacing’ received negative judgments from their family members for not starting a family. The perceived barriers to the use of family planning included lack of knowledge about family planning use, fear of side effects of modern family planning methods, lack of access/affordability due to familial and religious beliefs/myths/misconceptions. On an individual level, some couples’ timid nature also negatively influenced the uptake of family planning measures.ConclusionWomen predominantly take the responsibility for using family planning measures in male-dominated decision-making societies. Moreover, young men feel that the current family planning programs have very little space for men to engage even if they were willing to participate. Communication in the community and in between the couples seem to be influenced by the presence of strong societal and cultural norms and practices. These practices seem to affect family planning related te
Rajgopal A, Li CR, Shah S, et al., 2021, The use of telehealth to overcome barriers to mental health services faced by young people from Afro-Caribbean backgrounds in England during the COVID-19 pandemic, Journal of Global Health, Vol: 11, Pages: 1-4, ISSN: 2047-2978
Thakur N, Budhathoki SS, 2021, Failure to initiate medicine in newly diagnosed hypertensives despite sustained high blood pressure in Nepal: an under-discussed dimension of non-adherence, Journal of Nepal Health Research Council, Vol: 18, Pages: 804-806, ISSN: 1999-6217
Hypertension is growing challenge in Nepalese community which is evident from the growing concern from all sectors. Non-adherence to hypertensive medication pose challenge as patients are reluctant to start drug despite receiving physician’s advice. Continuing drug life-long once started, is a fear factor that needs dealing urgently.
Budhathoki SS, Sunny AK, Paudel PG, et al., 2020, Epidemiology of neonatal infections in hospitals of Nepal: evidence from a large- scale study, Archives of Public Health, Vol: 78, Pages: 1-8, ISSN: 0778-7367
BackgroundEvery year, neonatal infections account for approximately 750,000 neonatal deaths globally. It is the third major cause of neonatal death, globally and in Nepal. There is a paucity of data on clinical aetiology and outcomes of neonatal infection in Nepal. This paper aims to assess the incidence and risk factors of neonatal infection in babies born in public hospitals of Nepal.MethodsThis is a prospective cohort study conducted for a period of 14 months, nested within a large-scale cluster randomized control trial which evaluated the Helping Babies Breathe Quality Improvement package in 12 public hospitals in Nepal. All the mothers who consented to participate within the study and delivered in these hospitals were included in the analysis. All neonates admitted into the sick newborn care unit weighing > 1500 g or/and 32 weeks or more gestation with clinical signs of infection or positive septic screening were taken as cases and those that did not have an infection were the comparison group. Bivariate and multi-variate analysis of socio-demographic, maternal, obstetric and neonatal characteristics of case and comparison group were conducted to assess risk factors associated with neonatal infection.ResultsThe overall incidence of neonatal infection was 7.3 per 1000 live births. Babies who were born to first time mothers were at 64% higher risk of having infection (aOR-1.64, 95% CI, 1.30–2.06, p-value< 0.001). Babies born to mothers who had no antenatal check-up had more than three-fold risk of infection (aOR-3.45, 95% CI, 1.82–6.56, p-value< 0.001). Babies born through caesarean section had more than two-fold risk (aOR-2.06, 95% CI, 1.48–2.87, p-value< 0.001) and babies with birth asphyxia had more than three-fold risk for infection (aOR-3.51, 95% CI, 1.71–7.20, p-value = 0.001).ConclusionAntepartum factors, such as antenatal care attendance, and intrapartum fac
Bhatt N, Bhatt B, Gurung S, et al., 2020, Perceptions and experiences of the public regarding the COVID-19 pandemic in Nepal: a qualitative study using phenomenological analysis, BMJ Open, Vol: 10, Pages: e043312-e043312, ISSN: 2044-6055
Objectives Perceptions of people regarding COVID-19 influences their health behaviour in terms of seeking public health services. This helps the government in planning appropriate public health strategies. Therefore, this study intends to explore the perceptions of people towards COVID-19 and their experiences during the pandemic in Nepal.Design, setting and participants This qualitative study was conducted among the public in Kathmandu, Kanchanpur, Bajura and Jhapa districts of Nepal. Eight focus group discussions and 40 in-depth interviews were conducted by using a maximum variation sampling method.Results The findings were organised into the following themes: General understanding of COVID-19, Disease prevention, Source of information and misconceptions, Expectation and challenges; and Personal and societal consequences of COVID-19, social distancing and lockdown. There was a good general understanding among respondents about COVID-19, personal preventive measures and population-level strategies. They responded that the use of masks, sanitisers, handwashing and proper lockdown would help to prevent the disease. The respondents acknowledged the vital role of media in increasing awareness. Participants also expressed concerns over the misleading news spread by some media. The lack of social interaction, isolation and loss of income were raised as pertinent issues by the participants as potentially leading to psychological consequences. Health workers and public both raised concerns over inadequate Personal Protective Equipment, under-prepared health system, unorganised public quarantine centres, and public violation of lockdownConclusions This study reports participants’ views on disease prevention measures such as maintaining personal hygiene, adhering to physical distancing, and using personal protective equipments. Additionally, it illuminates the confusion among public due to conflicting public health messages from different sources of information which w
Adhikari B, Budhathoki SS, 2020, Silver-lining in the time of mayhem: The role of local governments of nepal during the covid-19 pandemic, Journal of the Nepal Medical Association, Vol: 58, Pages: 960-964, ISSN: 0028-2715
The COVID-19 pandemic has not only affected health systems but also has had deep socio-economic effects. The lockdown enforced in Nepal, had people running out of means to make ends meet, the public in fear of an unknown disease, and challenges for leaders to deliver better. Local governments of Nepal, established under the federal system, have the closest ties to the community. They have powers entrusted by the constitution to enact laws according to the needs of the community. During the 83 days of lockdown, the local governments came through for their inhabitants by managing quarantines and isolation centers, taking care of diagnostics, providing food and rations, and arranging facilities to bring back their locals stranded in other cities. The local governments improved awareness and helped maintain the lockdown. These undertakings by the local governments of Nepal highlight the importance of a community-based approach to dealing with pandemics.
James SL, Castle CD, Dingels ZV, et al., 2020, Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017, Injury Prevention, Vol: 26, Pages: i96-i114, ISSN: 1353-8047
BACKGROUND: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. METHODS: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). FINDINGS: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). INTERPRETATION: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
James SL, Castle CD, Dingels ZV, et al., 2020, Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study, Injury Prevention, Vol: 26, Pages: i125-i153, ISSN: 1353-8047
BACKGROUND: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. METHODS: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. RESULTS: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. CONCLUSIONS: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
LBD Double Burden of Malnutrition Collaborators, 2020, Author correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017., Nature Methods, Vol: 26, Pages: 1308-1308, ISSN: 1548-7091
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Pyakurel P, Shrestha A, Karmacharya BM, et al., 2020, Worksite intervention study to prevent diabetes in Nepal: a randomised trial protocol, Open Heart, Vol: 7, Pages: 1-8, ISSN: 2053-3624
Introduction In Nepal, approximately 31% of adult industrial employees have diabetes. While the prevention of type 2 diabetes through behavioural intervention has been disseminated, worksite could be an effective platform for the translation of this knowledge into action as employed adults spend most of their workday waking hours at workplaces.Methods and analysis We will conduct a randomised controlled trial to assess the effectiveness of a behavioural and a canteen intervention on diabetes risk reduction among those who are prediabetic at two worksites in eastern Nepal. We will recruit 162 adult full-time factory workers with haemoglobin A1c (HbA1c) of 5.7%–6.4% at baseline or fasting blood sugar of 100–125 mg/dL. The 8–14 months’ control period will be followed by the behavioural intervention where half of the participants will be randomised to receive the behavioural intervention and half will act as a control and will not receive any intervention. Then, all participants will receive the canteen intervention. The analysis will be intent-to-treat, comparing the difference in the change in HbA1c% between the behavioural intervention group and the control group using a two-sample t-test. The within-participant changes in HbA1c after 6 or more months on the canteen intervention among those not randomised to the behavioural intervention in the previous period will be assessed using the paired t-test.Ethics and dissemination Ethical approval was obtained from the Institutional Review Board at Yale School of Public Health, New Havens, USA and the Nepal Health Research Council.Trial registration number NCT04161937 (https://clinicaltrials.gov/ct2/show/NCT04161937).
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.