Reproductive Age In Nepal Research Articles

Trends and determinants of clustering for non-communicable disease risk factors in women of reproductive age in Nepal.

Understanding the clustering of two or more risk factors of non-communicable disease, such as smoking, overweight/obesity, and hypertension, among women of reproductive age could facilitate the design and implementation of strategies for prevention and control measures. This study examined the factors associated with smoking, overweight/obesity, and hypertension among Nepalese women of reproductive age (15-49 years). This study used the Nepal Demographic and Health Surveys (NDHS) 2016 (6,079 women for smoking and overweight/obesity, 6076 for hypertension) and 2022 (6,957 women for overweight/obesity and smoking status and 3,749 women for hypertension) for comparison of trends of NCD risk factors among women aged 15-49 years. Additionally, for each participant, risk factors score (range of 0 to 3) was created by summing individual risk factors. We assessed the determinants of risk factor clustering using multivariable Poisson regression models with robust sandwich variance estimator to calculate adjusted prevalence ratios using NDHS 2022. The national prevalence of overweight/obesity increased from 22.2% in 2016 to 29.2% in 2022 among women of reproductive age. In 2022, the prevalence for smoking, overweight/obesity, and hypertension were 3.8%, 29.2%, and 9.6%, respectively. More than one in four women (28.7%) had one NCD risk factor, while 6.5% had two such risk factors. Higher aged women (40-49 years) were more likely to have multiple NCD risk factors than those aged 15-29 years (APR: 3.19; 95% CI: 2.68-3.80). Those in the richest wealth quintile (APR: 1.52; 95% CI: 1.24-1.85), as well as married (APR: 3.02; 95% CI: 2.43-3.76) and widowed/divorced (APR: 2.85; 95% CI: 2.14-3.80) were more likely to have multiple NCD risk factors. Women from Koshi province (APR: 1.74; 95% CI: 1.41-2.15) had more NCD risk factors than those from the Sudurpaschim province. Working women also had a higher prevalence of NCD risk factors compared to non-working women (APR: 1.23; 95% CI: 1.06-1.43). Additionally, Hill Janajatis (APR: 1.44; 95% CI: 1.21-1.72) and Dalits (APR: 1.42; 95% CI: 1.15-1.75) women were more likely to have NCD risk factors compared to women of Brahmin hill origin. Clustering of two or more NCD risk factors was higher among women aged ≥30 years, those who are currently married or widowed/divorced/separated, working women, and individuals from the wealthiest socioeconomic groups. A higher burden of risk factors underscores the importance of targeted public health interventions, particularly among women from advantaged socio-economic groups, those of affluent regions, and in the workplace.

Tetanus Toxoid Injection During Last Pregnancy Among Women in Reproductive Age in Nepal

Tetanus toxoid injection is important as one mandatory vaccine for pregnant women to prevent maternal and neonatal tetanus. This study purposed to examine the barriers of not receiving tetanus toxoid vaccine among women of reproductive age in Nepal. This study used the secondary data using “Multiple Indicators Clusters Survey” round 6 in 2019. Total sample of this study are 2,494 women of reproductive aged 15 to 49 years. The data analysis was done for univariate, bivariate, and multivariate using binary logistic regression. The results in this study revealed that increasing child ever born (CEB) as the main predictor for not receiving TT vaccine, following by higher educational level and wealth index. In conclusion, the TT vaccine is a critical intervention to prevent maternal and neonatal tetanus. Understanding the determinants of TT vaccination coverage, ensuring accessibility to the vaccine, and addressing knowledge gaps among pregnant women are essential for improving TT vaccination rates during pregnancy

Factors associated with miscarriage in Nepal: Evidence from Nepal Demographic and Health Surveys, 2001-2016.

Miscarriage is a major public health concern in low and middle-income countries (LMICs) like Nepal. This study aims to examine the factors associated with miscarriage among pregnant women of reproductive age (15-49 years) in the past 15 years. There were a total of weighted sample of 26,376 cross-sectional pregnancy data from Nepal Demographic and Health Surveys (NDHS) 2001, 2006, 2011, and 2016 combined together, which was used in the study. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify factors associated with miscarriage among pregnant women of reproductive age in Nepal. The results showed that maternal age, contraception, tobacco smoking, wealth index, respondents' educational status, and, caste/ethnicity were found to be strong factors of miscarriage in Nepal. The likelihood of having a miscarriage among older women (≥40 years) was more than 100% (aOR = 2.12, 95% CI [1.73, 2.59]), among non-users of contraception was 88.9% (aOR = 1.88, 95% CI [1.68, 2.11]) (p<005) and non-smoking women had a 19% lower odds of miscarriage (aOR = 0.81, 95% CI [0.69, 0.95]). Respondents from the richest wealth index had 50% (aOR = 1.50, 95% CI [1.22, 1.85]) higher likelihood of miscarriage. Mothers with only primary education had a 25% higher chance of miscarriage (aOR = 1.25, 95% CI [1.09, 1.44]) compared to those with secondary and higher secondary education. In relation to caste/ethnicity, Dalits had 13% lesser likelihood (aOR = 0.87, 95% CI [0.74, 1.02]) and Janajatis had 26% lower chances of a miscarriage than Brahmin/Chettri (aOR = 0.74, 95% CI [0.64, 0.85]). Findings from this study show that miscarriages are associated with maternal age, use of contraception, smoking, wealth index, caste, and ethnicity. Interventions aimed to improve use of contraceptives, avoiding smoking and pregnancy planning on the basis of maternal age, are needed to prevent miscarriage. Also, women from Brahmin ethinicity and those with the highest income index require greater attention when it comes to miscarriage prevention strategies in Nepal.

Tetanus Toxoid Injection During Last Pregnancy Among Women in Reproductive Age in Nepal

Tetanus toxoid injection is important as one mandatory vaccine for pregnant women to prevent maternal and neonatal tetanus. This study purposed to examine the barriers of not receiving tetanus toxoid vaccine among women of reproductive age in Nepal. This study used the secondary data using “Multiple Indicators Clusters Survey” round 6 in 2019. Total sample of this study are 2,494 women of reproductive aged 15 to 49 years. The data analysis was done for univariate, bivariate, and multivariate using binary logistic regression. The results in this study revealed that increasing child ever born (CEB) as the main predictor for not receiving TT vaccine, following by higher educational level and wealth index. In conclusion, the TT vaccine is a critical intervention to prevent maternal and neonatal tetanus. Understanding the determinants of TT vaccination coverage, ensuring accessibility to the vaccine, and addressing knowledge gaps among pregnant women are essential for improving TT vaccination rates during pregnancy.

Prevalence and Correlates of Underweight among Women of Reproductive Age in Nepal: A Cross-Sectional Study.

This study aimed to examine the prevalence of underweight and determine the sociodemographic and household environmental correlates of underweight among women of reproductive age in Nepal. This study also compared the time trends in the prevalence of underweight with the trends in the prevalence of overweight and obesity. This cross-sectional study was a secondary data analysis of the nationally representative population-based Nepal Demographic and Health Surveys (NDHSs). Firstly, the time trends of the prevalence of underweight (body mass index (BMI) < 18.5 kg/m2) among women aged 15–49 years were examined at five-year intervals, from the 1996, 2001, 2006, 2011, and 2016 NDHSs (n = 33,507). Secondly, the sociodemographic and household environmental correlates of underweight were examined from the latest NDHS 2016 (n = 6165). Univariable and multivariable logistic regression analyses were performed to examine the sociodemographic and household environmental correlates of underweight. From 1996 to 2016, the prevalence of underweight decreased from 25.3% (95% confidence interval (CI) 23.8%, 26.8%) to 16.9% (95%CI 16.0%, 17.8%), while the prevalence of overweight and obesity increased from 1.6% (95%CI 1.2%, 2.1%) to 15.6% (95%CI 14.7%, 16.5%) and 0.2% (95%CI 0.1%, 0.4%) to 4.1% (95%CI 3.6%, 4.6%), respectively. Sociodemographic factors, such as age, educational status, marital status, wealth index, and religion, were independently associated with the risk of underweight. Similarly, household environmental factors, such as province of residence, ecological zone, type of toilet facility, and household possessions, including television and mobile phone, were independently associated with the risk of underweight. Despite the declining trends, the prevalence of underweight among Nepalese women remains a public health challenge. Understanding the key sociodemographic and household environmental correlates of underweight may assist in streamlining the content of health promotion campaigns to address undernutrition and potentially mitigate adverse health outcomes.

The smoking behavior of women of reproductive age in Nepal

Smoking, the leading cause of preventable deaths worldwide, which is more detrimental to women not only increases the chances of infertility and miscarriage, but hastens the onset of menopause and causes women to be more susceptible to depression, decreased bone density, cataracts, and skin diseases. This paper investigates the smoking behavior and factors influencing smoking among women of reproductive age in Nepal. The study used secondary data from the 2016 Nepal Demographic and Health Survey. A total of 12,862 women of the reproductive age group were covered in the survey. The association between smoking and the explanatory variables was first assessed in bivariate analysis using the Chi-square test. The associations were further explored using multivariate logistic analysis. Nearly two-fifths (38%) of women were aged 15-24 years. Overall, 8% of women used tobacco products (smoking/chewing). Multivariate analysis showed that women aged 35 and above were almost seven times (aOR=6.52, CI=4.75-8.94) to be smokers than younger women. Separated/divorced/widowed women were nearly twice (aOR=1.86, CI=1.14-3.01) as likely to be smokers than their counterparts. Education is a significant predictor of smoking as women having primary (aOR=0.65, CI=0.54-0.78) and secondary/higher education (aOR=0.21, CI=0.16-0.26) were less likely to smoke than women with no education. Dalit women were nearly two times more likely to be smokers than higher caste Brahmin/Chhetri. Similarly, the richest and richer women were less likely to smoke than the poorest women. Age, education, marital status, caste/ethnicity, and wealth index were significant determinants of smoking among women. Hence, tobacco control interventions need to be focused on women of higher age groups and uneducated and poorer women.

Factors affecting anaemia among women of reproductive age in Nepal: a multilevel and spatial analysis

ObjectiveThe main objective of this study was to explore the factors affecting anaemia among women of reproductive age (WRA) in Nepal using spatial and multilevel epidemiological analysis.DesignThis cross-sectional study analysed...

Association between obesity and miscarriage among women of reproductive age in Nepal.

BackgroundObesity is a major health problem in low and middle income countries (LMICs) and is associated with miscarriage. This study aims to examine the association between obesity and miscarriage among reproductive age women (15–49 years) in Nepal.MethodsThe combined 19160 cross-sectional pregnancy data from the Nepal Demographic and Health Survey (NDHS) for the years 2001, 2006, 2011 and 2016 was utilized. Miscarriage was defined as a spontaneous loss of pregnancy that occurred before the foetus reached 7 months of gestational age. Logistic regression analyses that adjusted for clustering, stratification and sampling weights were used to examine the association between obesity and miscarriage among women of reproductive age.ResultsThe odds of miscarriage were 1.45 times higher (Adjusted odds ratio (AOR) = 1.45; 95%Cl: 1.06, 1.98, P = 0.021) among women with obesity. Women who did not use contraception, younger (15–19 years), and older women (35 years or more) were significantly more likely to have miscarriage. Women who smoked tobacco reported higher odds of miscarriage than women who did not smoke tobacco (AOR = 1.27; 95%Cl: 1.07,1.50, P = 0.006). Stratification of maternal smoking status by maternal Body Mass Index (BMI), after adjusting for contraception, mother age and year of survey revealed that tobacco smoking and obesity are associated with miscarriage (AOR = 1.46; 95%Cl: 1.05,2.04, P = 0.025).ConclusionsFindings from this study show that obesity and tobacco smoking are associated with miscarriage. Smoking cessation, pregnancy planning and counselling on healthy weight for women of reproductive age in Nepal may help promote healthy behaviours and decrease the likelihood of miscarriage.

Nationally representative surveys show gradual shifting of overweight and obesity towards poor and less-educated women of reproductive age in Nepal.

Overweight and obesity are considered major public health concerns all over the world. They have the potential to increase the risk of developing non-communicable diseases in reproductive age women, increasing their risk of pregnancy related complications and adverse birth outcome. This study was carried out to identify the trend of prevalence of overweight and obesity, along with their determinants, among reproductive age women (15-49 years) in Nepal. Data were taken from the nationally representative 2006, 2011 and 2016 Nepal Demographic and Health Surveys (NDHSs). Women were considered to be overweight or obese when their BMI was 23.0-27.5 kg/m2 or ≥27.5 kg/m2, respectively. Univariate, bivariate and multivariate analyses were performed, with significance taken at p<0.05. The prevalences of overweight and obesity both showed rising trends in women of reproductive age in Nepal from 2006 to 2016, particularly among those with no education, only primary education and poor women. The presence of overweight and obesity was found to be significantly associated with the sample women's age, educational status, wealth index, place of residence, ecological zone, developmental region, number of household members, marital status and ethnicity. In 2016 one in every three women of reproductive age in Nepal was either overweight or obese. As overweight and obesity have detrimental effects on women's health, the Government of Nepal, in collaboration with other government and non-government organizations, should take action to halt the rising trends in overweight and obesity in the country.

Factors associated with anaemia in a nationally representative sample of nonpregnant women of reproductive age in Nepal.

We used cross‐sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anaemia among a nationally representative sample of nonpregnant women 15– 49 years (n = 1, 918). Haemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood. Soil‐transmitted helminth and Helicobacter pylori infections were assessed from stool. Sociodemographic, household, and health characteristics and diet were ascertained by interview. We conducted bivariate analyses between candidate predictors and anaemia (haemoglobin <12.0 g/ dL, altitude‐ and smoking‐adjusted). Candidate predictors that were significant in bivariate models (P < 0.05) were included in the multivariable logistic regression model, accounting for complex sampling design. Anaemia prevalence was 20.2% (95% confidence interval [CI] [17.6, 22.8]). Associated with reduced anaemia odds were living in the Mountain and Hill ecological zones relative to the Terai (adjusted odds ratio [AOR] 0.35, 95% CI [0.21, 0.60] and AOR 0.41, 95% CI [0.29, 0.59], respectively), recent cough (AOR 0.56, 95% CI [0.38, 0.82]), hormonal contraceptive use (AOR 0.58; 95% CI [0.38, 0.88]), ln ferritin (micrograms per litre; AOR 0.43, 95% CI [0.35, 0.54]), and ln retinol binding protein (micrograms per litre; AOR 0.20, 95% CI [0.11, 0.37]). Residing in a house with an earth floor (AOR 1.74, 95% CI [1.18, 2.56]), glucose‐6‐ phosphate dehydrogenase deficiency (AOR 2.44, 95% CI [1.66, 3.60]), and haemoglobinopathies (AOR 6.15, 95% CI [3.09, 12.26]) were associated with increased anaemia odds. Interventions that improve micronutrient status, ensure access to hormonal birth control, and replace dirt floors to reduce infection risk might help reduce anaemia in this population.

Determining factors for the prevalence of anemia in women of reproductive age in Nepal: Evidence from recent national survey data.

Anemia is a condition in which the number of red blood cells is not sufficient to meet the physiological need of the body. Women of reproductive age and pregnant women are at a high risk of anemia, which in turn may contribute to maternal morbidity and mortality. We aimed to describe the prevalence of anemia and the factors associated with the risk of developing anemia in women of reproductive age in Nepal. Additionally, we examined the association of women’s decision-making autonomy regarding healthcare and experience of intimate partner violence (IPV) with anemia. Data from the 2016 Nepal Demographic and Health Survey (NDHS) were used in this study. The data were adjusted for sampling weight, stratification, and cluster sampling design. A battery-operated portable HemoCue was used to measure hemoglobin and detect anemia. Using complex sample logistic regression, the association between dependent and independent variables were examined; crude and adjusted odds ratio were reported. The mean (± SD) hemoglobin concentration was 12.13 g/dL (± 1.48). Overall, about 41% (95% CI 38.6–43.0%) of women aged 15–49 years were anemic. Women in households with wells as the source of drinking water (aOR 1.93; 95% CI 1.58–2.37) were significantly associated with an increased risk of developing anemia. While women who were currently using hormonal contraceptives (aOR 0.63, 95% CI 0.52–0.76) were significantly less likely to be anemic. After adjusting for background characteristics among women who were married at the time of the survey, decision-making autonomy regarding healthcare, and experience of IPV did not have a significant association with anemia. The high prevalence of anemia suggests the need for substantial improvement in the nutritional status of women. The increased disease burden compared with the past survey highlights the needs to reconsider the existing nutritional policy in Nepal.

Long acting reversible contraception use and associated factors among married women of reproductive age in Nepal.

Modern contraceptives are highly effective and proven means of preventing unintended pregnancy and reducing maternal mortality. Social and economic characteristics are some of the key determinants of health and utilization family planning. However, studies examining the factors associated with utilization of long acting reversible contraception (LARC) are limited in Nepal. This study assessed the factors associated with utilization of LARC methods among married women of reproductive age in Nepal. Secondary data analysis was conducted using the 2016 Nepal Demographic and Health Survey (NDHS). A logistic regression model examined the association of socioeconomic, demographic, or fertility related characteristics with the use of LARCs among 9875 ever married women of reproductive age. The overall utilization rate of LARC in this study was 4.7%. Women in the age group of <25 years (AOR: 0.65, 95% CI: 0.45–0.92) and 25–35 years (AOR: 0.70, 95% CI: 0.56–0.89), having husbands with primary education (AOR:0.71; 95%CI: 0.64–0.84) and no education (AOR: 0.54; 95%CI: 0.38–0.73), belonging to Janajatis (AOR: 0.55; 95%CI: 0.42–0.71) and Newars (AOR: 0.29; 95%CI: 0.19–42), poor wealth quintile (AOR: 0.60; 95% CI: 0.45–0.86) had negative association with LARC use. On the other hand, women having their husband as a skilled worker (AOR: 1.49; 95%CI: 1.10–2), having two or less than two children (AOR: 1.46; 95% CI: 1.15–1.186), and having desire for children in future (AOR: 3.24; 95% CI: 2.29–4.57) had positive association with the use of LARC. In this study, younger women’s age, low or no husband’s education, from indigenous community such as Janajati and Newer, being in lowest wealth quintile negatively influenced the use of LARC. Conversely, women having her husband as skilled worker, parity less than two, and desire of having future children, positively influenced the use of LARC. The study highlights the need to reach women who were in the lower socioeconomic background to improve LARC use.

The Role of Women's Autonomy and Experience of Intimate Partner Violence as a Predictor of Maternal Healthcare Service Utilization in Nepal.

This study aims to identify the relationship of women’s autonomy and intimate partner violence (IPV) with maternal healthcare service utilization among married women of reproductive age in Nepal. This study used data from the 2016 Nepal Demographic and Health Survey (NDHS), which is a nationally representative sample survey. The association between outcome variables with selected factors were examined by using the Chi-square test (χ2), followed by multiple logistic regression. The sample was adjusted for multi-stage sampling design, cluster weight, and sample weight. Of the total sample, 68.4% reported attending sufficient Antenatal care (ANC) visits throughout their pregnancy, while 59.9% reported having a health facility delivery. The factors associated with both, sufficient ANC visits and institutional delivery includes ethnicity, place of residence, household wealth status, and the number of living children. Women who have access to media, and who have intended pregnancy were more likely to have sufficient ANC visits. Exposure to some forms of violence was found to be the barrier for maternal health service utilization. Attending ANC visits enables mothers to make the decision regarding skilled attendance or health facility delivery. Preventing any forms of violence need to be considered as a vital element in interventions aimed at increasing maternal health service utilization.

Prevalence and Factors Affecting Women with Uterine Prolapse in Lekhnath, Kaski, Nepal

Background: Uterine prolapse is the main public health problem of reproductive age women in Nepal. 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.Objectives: The objectives of this study was to determine prevalence of uterine prolapse, to explore factors affecting women with uterine prolapse and to find association between selected variables and prevalence of uterine prolapse.Methods: A community based cross sectional study was conducted from 7th July, 2016 to 7th of August, 2016 among married women with at least one child in the Ritthepani, Ward No 2, Lekhnath. Participants were selected by purposive sampling techniques, and data were collected through structured interview schedule. Frequency, percentage, mean, SD and chi-square test was performed to identify factors associated with prevalence of uterine prolapse.Results: The major findings were majority 35 (35%) of women were in the age group of 20 to 30 years, followed by 89 (89%) Hindu religion, 48 (48%) belonged to janajati and religious minority which included Newar, Magar, Gurung, Tamang and Muslims. Most of the women 35 (35%) were Illiterate, 44 (44%) earn their living by working in agriculture, 57 (57%) respondents had ≥Rs1500 per month income in the family, 58 (58%) belonged to nuclear families, 76 (76%) of the respondents had knowledge about uterine prolapse and they got information mostly from 24 (24%) friends. The prevalence rate of women with uterine prolapse was found to be 13% whereas mean and standard deviation were 0.87 ±0.33. The findings of association between the prevalence of uterine prolapse with age at first child birth, abortion, sexual intercourse immediate after delivery and constipation were found to be significantly associated. Almost all respondents replied that uterine prolapse can be prevented by avoiding strenuous activities during antenatal and postnatal period followed by avoiding giving birth to too many babies, taking nutritious diet, deliver the baby in health institution by health personnel, avoiding long term coughing and chronic constipation.Conclusion: Uterine prolapse was observed among women of Ritthepani ward no 2; among them most of them were age group between 20 - 30 year early married Illiterate. The perceived service was taken by less number of eligible women. Women awareness towards the problem, limiting frequent pregnancies and provision of educational opportunities are recommended for the prevention of uterine prolapse. Journal of Gandaki Medical CollegeVolume, 09, Number 2, July December 2016, Page: 47-51

The Determinants of Fertility among Women of Reproductive Age in Nepal

This study is conducted on determinants of fertility among women of reproductive age in Nepal. The study takes into account some demographic, socio-cultural, economic and spatial variables. Fertility trends are estimated from the date obtained in the 1996, 2001, and 2006 NDHS with information gathered in the 2011 NDHS. Fertility declined from 4.6 births per woman in the 1996 NFHS to 2.6 births per woman in the 2011 NDHS—a drop of two births per woman in the past 15 years. The decline in fertility is most pronounced in the five years between 2001 and 2006 (a one-child decline). Fertility has declined in every age group over the past 15 years, with largest decline seen among women 25-34 years. But over the past 5 years the largest decline is observed among women 20-24 years. Many factors may have contributed to this quick decline fertility in Nepal, including improved communication and greater access to modern methods of contraception. Extended spousal separations due to migrants seeking work in foreign countries, especially the Gulf countries and other Southeast Asian countries, may be another reason for the fertility decline (NDHS Report 2012). The multivariate analysis is used to show the strength of relationship of fertility with its correlates. It estimates the effect of socio–economic and demographic as well as spatial variables on total Children Ever Born (CEB). This study also attempts to find out variation of fertility among women by using frequency table, rate, ratio, percentage, cross tabulation, correlation and regression analysis and mean CEB. The result shows that when other factors remain unchanged, age of respondents at first birth and educational attainment have strong and significant negative impact on fertility. Similarly son who have died, daughter who have died, parity at sterilization and age at sterilization have strong and significant positive impact on fertility whereas regions, type of place of residence, age at marriage and destination India have weak positive impact on fertility. The Journal of Development and Administrative Studies (JODAS)Vol. 23(1-2), pp. 55-68

Dietary intake patterns and nutritional status of women of reproductive age in Nepal: findings from a health survey.

BackgroundImproper dietary intake pattern in women of reproductive age in Nepal has resulted in the deficiency of essential nutrients. Adequate nutritional status and proper dietary intake pattern of women improves maternal and child health. The objective of this study was to assess the nutritional status and dietary intake pattern among the women and associated factors.MethodsData collection at households and health check-up camps were conducted in selected Village Development Committees of nine districts in three ecological regions (Mountain, Hill and Terai) of Nepal from September 2011 to August 2012. Women of reproductive age (15 to 49 years) were the study subjects. At the household interview, structured questionnaires were used to obtain information on socio-demographic characteristics, anthropometric measurements, dietary intake pattern, consumption of junk foods, animal rearing, agricultural products, possession of kitchen garden, pregnancy status and anemia. Dietary intake pattern was determined by information collected through the structured questionnaires comprising of food items-cereals, pulses/legumes, vegetables, meat, fruits and milk and milk products. Health check-up camps were conducted in the local health facilities where qualified doctors, nurses and laboratory technicians performed physical examination of the women, confirmed their pregnancy and conducted hematocrit tests. The data was entered and analyzed using SPSS.ResultsAltogether 21,111 women were interviewed. More than a quarter of the women in Terai were malnourished as indicated by low body mass index (BMI < 18.5 Kg/m2). Among the dietary intake pattern, the majority of women consumed cereals at least once a day in all three ecological regions. The majority of women in Mountain consumed pulses/legumes thrice a week. In Terai, the majority of women consumed vegetables thrice a week. In all three ecological regions, the majority of women consumed meat and meat products and fruits once a week. About thirty percent of women consumed milk and milk products once a day in all three ecological regions. The non-use of iodized salt by Terai women was the highest (5.3 %, n = 303). In all the ecological regions, cereals and vegetables were produced in the majority of the participants’ households in comparison of fruits, poultry and goat/sheep. The women of age 15 to 24 years were 2.7 times more likely to be malnourished than women of 35 to 49 years age (aOR = 2.7, CI = 2.5,3.0). The unemployed women had nearly two times more chances of being malnourished than women doing manual work (aOR = 1.9, 95 % CI = 1.5,2.2). In Terai, women were five times more likely to be malnourished (aOR = 0.2, CI = 0.1,0.2) and 20 times more likely to be anemic (aOR = 0.05, CI = 0.04,0.07) than women in Mountain. The pregnant women were five times more likely to be anemic than non-pregnant women (aOR = 0.2, CI = 0.2,0.3).ConclusionsThe nutritional status of women of reproductive age is still poor especially in Terai and the dietary intake pattern is not adequate. It suggests improving nutritional status and feeding habits especially intake of meat, fruits and vegetables focusing on reproductive aged women.

Why Are So Many Nepali Women Killing Themselves? A Review Of Key Issues

For decades the maternal mortality in Nepal was the lead cause of death among women, with serious improvements in the maternal mortality ratio in the twentieth century the second most common cause has become more prominent. Suicide is now one of the leading causes of death for women of a reproductive age in Nepal. This scoping review brings together the key available literature to identify the causes of suicide among women in Nepal. Published and unpublished studies and the grey literature published on women and suicide related to Nepal between 2000 and 2014 were searched and included in this review. This review suggested a number of explanations for high rate of suicide among women including: partner violence, alcoholism and polygamy, the culture of silence, early age marriage and prolonged child bearing and dependency on men for financial security. This paper highlights some challenges and suggests ways forward in the improvement of mental health in Nepal.DOI: http://dx.doi.org/10.3126/jmmihs.v1i4.12001Journal of Manmohan Memorial Institute of Health Sciences Vol. 1, Issue 4, 2015Page: 43-49

Knowledge on uterine prolapse among married women of reproductive age in Nepal.

BackgroundUterine 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.MethodsOur 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.ResultsMean 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.ConclusionFifty-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.

Tobacco Use Among Married Women in Nepal: The Role of Women’s Empowerment

This study documented the prevalence and correlates of tobacco use among women of reproductive age in Nepal using nationally representative data. We utilized the 2006 Nepal Demographic and Health Survey that interviewed 10,793 women and 4,397 men. We analyzed the couple's data or households (N = 2,600) in which both husband and wife were interviewed. We examined the effects of women's empowerment-measured by education, employment, intra-household decisions, and age-on their tobacco use controlling for other individual and household characteristics. Women's empowerment had mixed effects on tobacco use. While women's education was inversely associated with their tobacco use, their age, employment and ability to make intra-household mobility decisions were positively associated with smoking. Women with primary and beyond primary education were 48 and 92 % less likely to smoke compared to women with no education, respectively. Tobacco use among women increased dramatically with age from 8 % in teen years to 42 % in their forties. A 1 year increase in age increased the odds of tobacco use by 6 %. Women whose husbands smoked were twice as likely to smoke. Nepal should not only restrict tobacco use in public places by implementing its Tobacco Control and Regulatory Act of 2010 but also focus on encouraging smoke-free homes by increasing awareness about the health consequences of tobacco use and secondhand smoke among populations most likely to smoke that include nearly all men, employed women, women with low levels of education, women whose spouses smoke and those who are 30 and above in age. Additionally, a long term goal should be to ensure at least 5th grade of education for all girls.

Ethnic differentials of the impact of Family Planning Program on contraceptive use in Nepal

Abstract There is wide variation of family planning services use among ethnic groups in Nepal. Despite three decades of implementation the need for family planning services is substantially unmet (25%), and there have been no systematic studies evaluating the impact of the family planning program. This study pooled data from nationally representative surveys conducted in 1996, 2001, and 2006. Multilevel logistic regression analysis of 23,381 married women of reproductive age nested within 764 clusters indicated that Muslims, Janjatis, and Dalits were significantly less likely to use contraceptives than Brahmins and Chhetries (OR=0.27, 0.88 and 0.82 respectively). The odds of using contraceptives by the Newar were higher than the odds for Brahmins and Chhetries, although it was not significant. Exposure of women to family planning messages through health facilities, family planning workers, radio, and television increased the odds of using modern contraceptives. However, the impact of family planning information on contraceptive use varied according to ethnicity. We also found that modern contraceptive use varied significantly across the clusters, and the cluster-level indicators, such as mean age at marriage, mean household asset score, percentage of women with secondary education, and percentage of women working away from home, were important in explaining this. (ProQuest: ... denotes formulae omitted.) 1. Introduction After more than thirty years of family planning program efforts, contraceptive use among married women of reproductive age in Nepal has increased from 26% in 1996 to 44% in 2006. At the same time, fertility has decreased from 4.6 to 3.1 per woman (Pradhan et al. 1997; Ministry of Health and Population (MoHP), New Era, and Macro International Inc. 2007). Yet the need for family planning is partly unmet (25%) (Karki and Krishna 2008) and some ethnic groups use family planning much more than others. For example, almost three times as many Newars (56%) use family planning as Muslims (17%). Use of family planning among Dalits (41%) and Muslims (17%) is less than the national average (44%) (Bennett and Dahal, 2008). This information suggests that family planning efforts are reaching some groups more than others. However the cause of this disparity is not clear, and systematic studies evaluating the impact of the family planning program have not been conducted in Nepal. This paper intends to fill the gap by examining the impact of the family planning program on modern contraceptive use among different ethnic groups in Nepal. The overall objective of this study is to examine whether the observed differences in the levels of modern contraceptive use among different ethnic groups over the last ten years in Nepal are associated with the family planning program. The specific objectives are: * To examine if the family planning program is effective in increasing contraceptive use * To explore if the impact of the family planning program differs by ethnicity * To provide policy recommendations to reduce ethnic disparity in impact. Family planning activities in Nepal were first initiated in 1958 by the Nepal Family Planning Association. The Family Planning Policy was adopted in 1965 and limited family planning services were made available in the Kathmandu Valley in 1968. Services were expanded all over the country only in the early 1990s (Aryal et al. 2008). Over the last two decades various interventions have been implemented to increase knowledge, acceptability, and use of contraceptives, through static and mobile services, door-to-door campaigns, and the mass media. Now knowledge of family planning among women of reproductive age is almost universal in Nepal (MoHP, New Era, and Macro International Inc. 2007). However the unmet contraceptive needs are considerably higher among poorer women (Johnson and Bradley 2008). Regional and ethnic disparities also exist in the utilization of family planning services. …