Introductions: Child health indicators of under-five and infant mortality has improved in Nepal, ... more Introductions: Child health indicators of under-five and infant mortality has improved in Nepal, but neonatal mortality remains high. The aim of this study is to assess neonatal care practices among mothers in rural Nepal.Methods: A household survey was conducted in the village of Daman in Makwanpur district, Nepal. All households that had an infant less than one year of age, and had been residing in Daman for greater than six months were included in the study.Results: There were 117 mothers with neonate assessed. The average age of mothers was 24 years and 39 (33.3%) were illiterate, 53 (45.3%) were home births and 36 (30.8%) births were registered. Ninety seven (82.9%) neonates cried immediately after birth, 95 (81.1%) used a new or boiled blade for umbilical cord, 20 (16.7%) applied oil to the cord stump and 71 (61%) breastfed within first hour of birth. There was a significant relationship between non-exclusive breastfeeding and sickness.Conclusions: In Daman village community a...
Each year, 1.2 million intrapartum stillbirths occur globally. In Nepal, about 50 % of the total ... more Each year, 1.2 million intrapartum stillbirths occur globally. In Nepal, about 50 % of the total number of stillbirths occur during the intrapartum period. An understanding of the risk factors associated with intrapartum stillbirth will facilitate the development of preventative strategies to reduce the associated burden of death. This study was conducted in a tertiary-care setting with the aim to identify risk factors associated with intrapartum stillbirth. A case-control study was completed from July 2012 to September 2013. All women who had an intrapartum stillbirth during the study period were included as cases, and 20 % of women with live births were randomly selected upon admission to create the referent population. Relevant information was retrieved from clinical records for case and referent women. In addition, interviews were completed with each woman to determine their demographic and obstetric history. During the study period, 4,476 women were enrolled as referents and 13...
Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital reg... more Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital registration is extremely deficient. Currently available methods to measure maternal mortality, such as the sisterhood method, pose problems with respect to validity, precision, cost and time. We conducted this field study to test a community-based method (the motherhood method), to measure maternal and child mortality in a developing country setting. Motherhood method was field tested to derive measures of maternal and child mortality at the district and sub-regional levels in Bara district, Nepal. Information on birth, death, risk factors and health outcomes was collected within a geographic area as in an unbiased census, but without visiting every household. The sources of information were a vaccination registry, focus group discussions with local health workers, and most importantly, interview in group setting with women who share social bonds formed by motherhood and aided by their pee...
Background & objectives: Measuring maternal mortality in developing countries poses a major chall... more Background & objectives: Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital registration is extremely deficient. Currently available methods to measure maternal mortality, such as the sisterhood method, pose problems with respect to validity, precision, cost and time. We conducted this field study to test a community-based method (the motherhood method), to measure maternal and child mortality in a developing country setting. Methods: Motherhood method was field tested to derive measures of maternal and child mortality at the district and sub-regional levels in Bara district, Nepal. Information on birth, death, risk factors and health outcomes was collected within a geographic area as in an unbiased census, but without visiting every household. The sources of information were a vaccination registry, focus group discussions with local health workers, and most importantly, interview in group setting with women who share social bonds formed by...
BACKGROUND In response to continuing health disparities between rural and urban population, Patan... more BACKGROUND In response to continuing health disparities between rural and urban population, Patan Academy of Health Sciences (PAHS) was established in 2008. It aimed to produce physicians who would be able and willing to serve in the rural areas. In order to empower them with understanding and tools to address health issues of rural population, an innovative curriculum was developed. This paper aims to describe the community based learning and education (CBLE) system within the overall framework of PAHS undergraduate medical curriculum. METHODS A Medical School Steering Committee (MSSC) comprising of a group of committed medical educators led the curriculum development process. The committee reviewed different medical curricula, relevant literatures, and held a series of consultative meetings with the stakeholders and experts within and outside Nepal. This process resulted in defining the desirable attributes, terminal competencies of the graduates, and then the actual development o...
Background Influenza illness burden is substantial, particularly among young children, older adul... more Background Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. Methods and findings We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996–31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcas...
ObjectiveTo understand the feasibility and acceptability of a co-design approach to developing an... more ObjectiveTo understand the feasibility and acceptability of a co-design approach to developing an integrated model of healthcare for people with multi-morbid chronic obstructive pulmonary disease (COPD) in rural Nepal.SettingsA rural setting of Nepal.ParticipantsData collection included five video recordings, five key informant interviews and observation notes from a final co-design workshop that involved a total of 68 stakeholders: persons with COPD and their family members; healthcare providers, including respiratory physicians; local community leaders; representatives from local, provincial and federal government; academics; and representatives from non-government organisations.Primary and secondary outcome measure(s)Feasibility and acceptability of using a co-design approach to develop an integrated model of care for people with multi-morbid COPD in rural Nepal.ResultsOur qualitative evaluation of the Hasso Plattner’s co-design process found that all stakeholders (including peop...
Background Naturally occurring aflatoxins may contribute to poor growth and nutritional statuses ... more Background Naturally occurring aflatoxins may contribute to poor growth and nutritional statuses in children. Objectives We analyzed the relationship between contemporary and lagged aflatoxin exposure and 1) length-for-age z-score (LAZ); and 2) length, knee-heel length, stunting, weight-for-age z-score (WAZ), and weight-for-length z-score (WLZ). Methods We conducted a longitudinal birth cohort study involving 1675 mother-infant dyads in rural Nepal. Participants were repeatedly visited from pregnancy to 2 years of age (2015–2019). One blood sample was collected during pregnancy and 4 samples were collected from the children at 3, 6, 12, and 18–22 months of age to measure concentrations of aflatoxin B1 (AFB1)-lysine adduct. Multivariate linear fixed-effects and logistic models with generalized estimating equations were used to identify associations between child growth and aflatoxin exposure. Results AFB1-lysine adducts were detected in the majority of children (at 3 months, 80.5%; a...
International Journal of Health Policy and Management
When looking at life expectancy (LE) by sex, women live longer than men in all countries. Biologi... more When looking at life expectancy (LE) by sex, women live longer than men in all countries. Biological factors alone do not explain gender differences in LE, and examining structural differences may help illuminate other explanatory factors. The aim of this research is to analyse the influence of gender inequality on the gender gap in LE globally. We have carried out a regression analysis between the gender gap in relativised LE and the UN Gender Inequality Index (GII), with a sensitivity analysis conducted for its three dimensions, stratified by the six World Health Organization (WHO) regions. We adjusted the model by taking into consideration gross national income (GNI), democratic status and rural population. The results indicated a positive association for the European region (ß=0.184) and the Americas (ß=0.136) in our adjusted model. Conversely, for the African region, the relations between gender equality and the LE gender gap were found to be negative (ß=-0.125). The findings s...
Introductions: Transmission of healthcare associated infections through contaminated hands of hea... more Introductions: Transmission of healthcare associated infections through contaminated hands of healthcare workers are common. This study was designed to explore the existing compliance of hand hygiene among the healthcare workers workings in different level of health care centers of Makwanpur district of Nepal. Methods: This was a cross sectional observational study conducted in Makwanpur district, Nepal, during 2015. Healthcare workers from nine healthcare centers were selected randomly for the study. Standard observation checklists and World Health Organization guidelines on hand hygiene were used to assess the compliance of hand hygiene during patient care. Results: There were 74 participants. Overall compliance for hand washing was 24.25% (range 19.63 to 45.56). Complete steps of hand washing were performed by 38.3% of health care workers. The factors associated for noncompliance were lack of time (29.3%), example set by seniors (20%), absence or inadequate institution protocol (...
International Journal of Health Policy and Management
Background: The Nutrition Governance Index (NGI) defines a first standardized approach to quantif... more Background: The Nutrition Governance Index (NGI) defines a first standardized approach to quantifying the ‘quality of governance’ in relation to national plans of action to accelerate improvements in nutrition. It was created in response to growing demand for evidence-based measures that reveal opportunities and challenges as nutrition-related policies on paper are translated into outcomes on the ground. Numerous past efforts to measure ‘governance,’ most notably World Health Organization’s (WHO’s) NGI and the separate Hunger and Nutrition Commitment Index (HANCI), both of which lack granularity below the national level and each of which fails to capture pinch points related to necessary cross-sectoral actions. This paper addresses such caveats by introducing an innovative metric to assess self-reported practices of, and perceptions held by, administration officials tasked with implementing government policy at the sub-national level. The paper discusses the development of this metr...
Adolescence is a transition period of second decade of life. What happen between age 10-19, wheth... more Adolescence is a transition period of second decade of life. What happen between age 10-19, whether goodor bad, determines how girls and boys live out their lives as adults. In addition to change in social relationship,in Nepal, marriage and child bearing are major events which have direct bearing to the health of adolescents.Fertility among adolescents in Nepal is high compare to develop countries and Nepal Family Health Survey2001 reported that only 59.6 percent married adolescent had no children. It was found that during 5 yearsperiod there is slight decrease in the prevalence of adolescent childbearing in Nepal. The best way toprevent adolescent pregnancy, as long-term measure, is by providing opportunities specially for educationand skills development through which their status increases. It is equally important to focus family planningservices and reproductive health education through health program to them.Key Words: Adolescent, adolescent childbearing, fertility, and contrac...
Self-management (SM) includes activities that patients initiate and perform in the interest of co... more Self-management (SM) includes activities that patients initiate and perform in the interest of controlling their disease and maintaining good health and well-being. This review examines the health literacy and patient activation elements of self-management interventions for Chronic Obstructive Pulmonary Diseases (COPD) patients. We investigated the effects of the intervention on health-related quality of life, self-efficacy, depression, and anxiety among people with COPD. We conducted a systematic review of studies evaluating the efficacy of self-management interventions among COPD patients that also included health literacy or patient activation as keywords. Four electronic databases Medline, EMBASE, PsycINFO, and Google Scholar, were searched to identify eligible studies. These studies were screened against predetermined inclusion criteria. Data were extracted according to the review questions. Twenty-seven studies met the criteria for inclusion. All of the included studies incorp...
ObjectiveTo understand the facilitators and barriers to the self-management of chronic obstructiv... more ObjectiveTo understand the facilitators and barriers to the self-management of chronic obstructive pulmonary disease (COPD) in rural Nepal.SettingsCommunity and primary care centres in rural Nepal.ParticipantsA total of 14 participants (10 people with COPD and 4 health care providers) were interviewed.Primary and secondary outcome measure(s)People with COPD and healthcare provider’s experience of COPD self-management in rural Nepal.ResultsFacilitators and barriers affecting COPD self-management in Nepal operated at the patient-family, community and service provider levels. People with COPD were found to have a limited understanding of COPD and medications. Some participants reported receiving inadequate family support and described poor emotional health. At the community level, widespread use of complementary and alternative treatment was found to be driven by social networks and was used instead of western medicine. There were limited quality controls in place to monitor the safe u...
Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating conditi... more Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating condition that affects individuals' quality of life . COPD self-management and supports provided by carers is key to the quality of life people living with COPD. Health literacy (HL) and Patient Activation (PA) are main drivers of self-management practices (SMPs). However, their contribution remains to be fully explored. This study aimed to examine the level of self-management practices, and the relationship with socio-demographic factors, HL and PA among multi-morbid COPD patients from rural Nepal. Methods This is a cross-sectional study conducted between July 2018 and January 2019. Patients completed a survey, including Self-management Practices questionnaire (SMPQ), five domains of the Health Literacy Questionnaire (HLQ), and Patient Activation Measure (PAM). The relationship between HL, PAM, and self-management practice was examined using univariate statistics. Multivariable analysis wa...
Objectives Stunting and wasting in early life increase the risk of mortality. While assessed and ... more Objectives Stunting and wasting in early life increase the risk of mortality. While assessed and diagnosed as individual conditions, these two forms of malnutrition often coexist within the same populations and possibly the same individual. The main objective of our analysis was to assess the magnitude of stunting and wasting among Nepali infants in the first 12 months of life and to investigate the association of early life wasting on later stunting. Methods For this analysis, we utilized anthropometric data collected in a longitudinal birth cohort study with 1675 maternal-infant dyads. Birth length and weight were collected within 72 hours of birth in 95% of the infants and 88% were followed through 12 months of age. Length, weight measurements were collected on the infants at 3, 6, 9 and 12 months of age. Measurements were converted to z-scores for weight-for-length (WLZ) and length-for-age (LAZ) using World Health Organization Standards. Outliers were defined as WLZ 5 and LAZ 6....
Introductions: Child health indicators of under-five and infant mortality has improved in Nepal, ... more Introductions: Child health indicators of under-five and infant mortality has improved in Nepal, but neonatal mortality remains high. The aim of this study is to assess neonatal care practices among mothers in rural Nepal.Methods: A household survey was conducted in the village of Daman in Makwanpur district, Nepal. All households that had an infant less than one year of age, and had been residing in Daman for greater than six months were included in the study.Results: There were 117 mothers with neonate assessed. The average age of mothers was 24 years and 39 (33.3%) were illiterate, 53 (45.3%) were home births and 36 (30.8%) births were registered. Ninety seven (82.9%) neonates cried immediately after birth, 95 (81.1%) used a new or boiled blade for umbilical cord, 20 (16.7%) applied oil to the cord stump and 71 (61%) breastfed within first hour of birth. There was a significant relationship between non-exclusive breastfeeding and sickness.Conclusions: In Daman village community a...
Each year, 1.2 million intrapartum stillbirths occur globally. In Nepal, about 50 % of the total ... more Each year, 1.2 million intrapartum stillbirths occur globally. In Nepal, about 50 % of the total number of stillbirths occur during the intrapartum period. An understanding of the risk factors associated with intrapartum stillbirth will facilitate the development of preventative strategies to reduce the associated burden of death. This study was conducted in a tertiary-care setting with the aim to identify risk factors associated with intrapartum stillbirth. A case-control study was completed from July 2012 to September 2013. All women who had an intrapartum stillbirth during the study period were included as cases, and 20 % of women with live births were randomly selected upon admission to create the referent population. Relevant information was retrieved from clinical records for case and referent women. In addition, interviews were completed with each woman to determine their demographic and obstetric history. During the study period, 4,476 women were enrolled as referents and 13...
Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital reg... more Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital registration is extremely deficient. Currently available methods to measure maternal mortality, such as the sisterhood method, pose problems with respect to validity, precision, cost and time. We conducted this field study to test a community-based method (the motherhood method), to measure maternal and child mortality in a developing country setting. Motherhood method was field tested to derive measures of maternal and child mortality at the district and sub-regional levels in Bara district, Nepal. Information on birth, death, risk factors and health outcomes was collected within a geographic area as in an unbiased census, but without visiting every household. The sources of information were a vaccination registry, focus group discussions with local health workers, and most importantly, interview in group setting with women who share social bonds formed by motherhood and aided by their pee...
Background & objectives: Measuring maternal mortality in developing countries poses a major chall... more Background & objectives: Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital registration is extremely deficient. Currently available methods to measure maternal mortality, such as the sisterhood method, pose problems with respect to validity, precision, cost and time. We conducted this field study to test a community-based method (the motherhood method), to measure maternal and child mortality in a developing country setting. Methods: Motherhood method was field tested to derive measures of maternal and child mortality at the district and sub-regional levels in Bara district, Nepal. Information on birth, death, risk factors and health outcomes was collected within a geographic area as in an unbiased census, but without visiting every household. The sources of information were a vaccination registry, focus group discussions with local health workers, and most importantly, interview in group setting with women who share social bonds formed by...
BACKGROUND In response to continuing health disparities between rural and urban population, Patan... more BACKGROUND In response to continuing health disparities between rural and urban population, Patan Academy of Health Sciences (PAHS) was established in 2008. It aimed to produce physicians who would be able and willing to serve in the rural areas. In order to empower them with understanding and tools to address health issues of rural population, an innovative curriculum was developed. This paper aims to describe the community based learning and education (CBLE) system within the overall framework of PAHS undergraduate medical curriculum. METHODS A Medical School Steering Committee (MSSC) comprising of a group of committed medical educators led the curriculum development process. The committee reviewed different medical curricula, relevant literatures, and held a series of consultative meetings with the stakeholders and experts within and outside Nepal. This process resulted in defining the desirable attributes, terminal competencies of the graduates, and then the actual development o...
Background Influenza illness burden is substantial, particularly among young children, older adul... more Background Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. Methods and findings We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996–31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcas...
ObjectiveTo understand the feasibility and acceptability of a co-design approach to developing an... more ObjectiveTo understand the feasibility and acceptability of a co-design approach to developing an integrated model of healthcare for people with multi-morbid chronic obstructive pulmonary disease (COPD) in rural Nepal.SettingsA rural setting of Nepal.ParticipantsData collection included five video recordings, five key informant interviews and observation notes from a final co-design workshop that involved a total of 68 stakeholders: persons with COPD and their family members; healthcare providers, including respiratory physicians; local community leaders; representatives from local, provincial and federal government; academics; and representatives from non-government organisations.Primary and secondary outcome measure(s)Feasibility and acceptability of using a co-design approach to develop an integrated model of care for people with multi-morbid COPD in rural Nepal.ResultsOur qualitative evaluation of the Hasso Plattner’s co-design process found that all stakeholders (including peop...
Background Naturally occurring aflatoxins may contribute to poor growth and nutritional statuses ... more Background Naturally occurring aflatoxins may contribute to poor growth and nutritional statuses in children. Objectives We analyzed the relationship between contemporary and lagged aflatoxin exposure and 1) length-for-age z-score (LAZ); and 2) length, knee-heel length, stunting, weight-for-age z-score (WAZ), and weight-for-length z-score (WLZ). Methods We conducted a longitudinal birth cohort study involving 1675 mother-infant dyads in rural Nepal. Participants were repeatedly visited from pregnancy to 2 years of age (2015–2019). One blood sample was collected during pregnancy and 4 samples were collected from the children at 3, 6, 12, and 18–22 months of age to measure concentrations of aflatoxin B1 (AFB1)-lysine adduct. Multivariate linear fixed-effects and logistic models with generalized estimating equations were used to identify associations between child growth and aflatoxin exposure. Results AFB1-lysine adducts were detected in the majority of children (at 3 months, 80.5%; a...
International Journal of Health Policy and Management
When looking at life expectancy (LE) by sex, women live longer than men in all countries. Biologi... more When looking at life expectancy (LE) by sex, women live longer than men in all countries. Biological factors alone do not explain gender differences in LE, and examining structural differences may help illuminate other explanatory factors. The aim of this research is to analyse the influence of gender inequality on the gender gap in LE globally. We have carried out a regression analysis between the gender gap in relativised LE and the UN Gender Inequality Index (GII), with a sensitivity analysis conducted for its three dimensions, stratified by the six World Health Organization (WHO) regions. We adjusted the model by taking into consideration gross national income (GNI), democratic status and rural population. The results indicated a positive association for the European region (ß=0.184) and the Americas (ß=0.136) in our adjusted model. Conversely, for the African region, the relations between gender equality and the LE gender gap were found to be negative (ß=-0.125). The findings s...
Introductions: Transmission of healthcare associated infections through contaminated hands of hea... more Introductions: Transmission of healthcare associated infections through contaminated hands of healthcare workers are common. This study was designed to explore the existing compliance of hand hygiene among the healthcare workers workings in different level of health care centers of Makwanpur district of Nepal. Methods: This was a cross sectional observational study conducted in Makwanpur district, Nepal, during 2015. Healthcare workers from nine healthcare centers were selected randomly for the study. Standard observation checklists and World Health Organization guidelines on hand hygiene were used to assess the compliance of hand hygiene during patient care. Results: There were 74 participants. Overall compliance for hand washing was 24.25% (range 19.63 to 45.56). Complete steps of hand washing were performed by 38.3% of health care workers. The factors associated for noncompliance were lack of time (29.3%), example set by seniors (20%), absence or inadequate institution protocol (...
International Journal of Health Policy and Management
Background: The Nutrition Governance Index (NGI) defines a first standardized approach to quantif... more Background: The Nutrition Governance Index (NGI) defines a first standardized approach to quantifying the ‘quality of governance’ in relation to national plans of action to accelerate improvements in nutrition. It was created in response to growing demand for evidence-based measures that reveal opportunities and challenges as nutrition-related policies on paper are translated into outcomes on the ground. Numerous past efforts to measure ‘governance,’ most notably World Health Organization’s (WHO’s) NGI and the separate Hunger and Nutrition Commitment Index (HANCI), both of which lack granularity below the national level and each of which fails to capture pinch points related to necessary cross-sectoral actions. This paper addresses such caveats by introducing an innovative metric to assess self-reported practices of, and perceptions held by, administration officials tasked with implementing government policy at the sub-national level. The paper discusses the development of this metr...
Adolescence is a transition period of second decade of life. What happen between age 10-19, wheth... more Adolescence is a transition period of second decade of life. What happen between age 10-19, whether goodor bad, determines how girls and boys live out their lives as adults. In addition to change in social relationship,in Nepal, marriage and child bearing are major events which have direct bearing to the health of adolescents.Fertility among adolescents in Nepal is high compare to develop countries and Nepal Family Health Survey2001 reported that only 59.6 percent married adolescent had no children. It was found that during 5 yearsperiod there is slight decrease in the prevalence of adolescent childbearing in Nepal. The best way toprevent adolescent pregnancy, as long-term measure, is by providing opportunities specially for educationand skills development through which their status increases. It is equally important to focus family planningservices and reproductive health education through health program to them.Key Words: Adolescent, adolescent childbearing, fertility, and contrac...
Self-management (SM) includes activities that patients initiate and perform in the interest of co... more Self-management (SM) includes activities that patients initiate and perform in the interest of controlling their disease and maintaining good health and well-being. This review examines the health literacy and patient activation elements of self-management interventions for Chronic Obstructive Pulmonary Diseases (COPD) patients. We investigated the effects of the intervention on health-related quality of life, self-efficacy, depression, and anxiety among people with COPD. We conducted a systematic review of studies evaluating the efficacy of self-management interventions among COPD patients that also included health literacy or patient activation as keywords. Four electronic databases Medline, EMBASE, PsycINFO, and Google Scholar, were searched to identify eligible studies. These studies were screened against predetermined inclusion criteria. Data were extracted according to the review questions. Twenty-seven studies met the criteria for inclusion. All of the included studies incorp...
ObjectiveTo understand the facilitators and barriers to the self-management of chronic obstructiv... more ObjectiveTo understand the facilitators and barriers to the self-management of chronic obstructive pulmonary disease (COPD) in rural Nepal.SettingsCommunity and primary care centres in rural Nepal.ParticipantsA total of 14 participants (10 people with COPD and 4 health care providers) were interviewed.Primary and secondary outcome measure(s)People with COPD and healthcare provider’s experience of COPD self-management in rural Nepal.ResultsFacilitators and barriers affecting COPD self-management in Nepal operated at the patient-family, community and service provider levels. People with COPD were found to have a limited understanding of COPD and medications. Some participants reported receiving inadequate family support and described poor emotional health. At the community level, widespread use of complementary and alternative treatment was found to be driven by social networks and was used instead of western medicine. There were limited quality controls in place to monitor the safe u...
Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating conditi... more Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating condition that affects individuals' quality of life . COPD self-management and supports provided by carers is key to the quality of life people living with COPD. Health literacy (HL) and Patient Activation (PA) are main drivers of self-management practices (SMPs). However, their contribution remains to be fully explored. This study aimed to examine the level of self-management practices, and the relationship with socio-demographic factors, HL and PA among multi-morbid COPD patients from rural Nepal. Methods This is a cross-sectional study conducted between July 2018 and January 2019. Patients completed a survey, including Self-management Practices questionnaire (SMPQ), five domains of the Health Literacy Questionnaire (HLQ), and Patient Activation Measure (PAM). The relationship between HL, PAM, and self-management practice was examined using univariate statistics. Multivariable analysis wa...
Objectives Stunting and wasting in early life increase the risk of mortality. While assessed and ... more Objectives Stunting and wasting in early life increase the risk of mortality. While assessed and diagnosed as individual conditions, these two forms of malnutrition often coexist within the same populations and possibly the same individual. The main objective of our analysis was to assess the magnitude of stunting and wasting among Nepali infants in the first 12 months of life and to investigate the association of early life wasting on later stunting. Methods For this analysis, we utilized anthropometric data collected in a longitudinal birth cohort study with 1675 maternal-infant dyads. Birth length and weight were collected within 72 hours of birth in 95% of the infants and 88% were followed through 12 months of age. Length, weight measurements were collected on the infants at 3, 6, 9 and 12 months of age. Measurements were converted to z-scores for weight-for-length (WLZ) and length-for-age (LAZ) using World Health Organization Standards. Outliers were defined as WLZ 5 and LAZ 6....
Uploads
Papers by Kedar Baral