Women In Rural Nepal Research Articles

Social networks and gender inequitable attitudes among men and women in rural Nepal

ABSTRACT Gender-inequitable attitudes are known factors associated with women’s experience of intimate partner violence (IPV). The current study aims to identify social network factors associated with gender-inequitable attitudes among men and women in Nepal. Data came from the baseline assessment for evaluating Change Starts at Home- an IPV prevention intervention in rural Nepal (N = 1994). Linear regression models adjusted for participant demographics provided the associations between participants’ gender-inequitable attitude scores (GIAS) and their social network characteristics. Results show that women who nominated their parents (beta = −1.29) or neighbours (beta = −1.18) had better GIAS while those nominating their brother-in-law/sister-in-law (beta = 0.36) had worse GIAS. Men with higher degree (beta = −0.27) and those who nominated their spouse (beta = −0.75) had better GIAS. Women’s GIAS was strongly associated with their alters’ when the alter was within their household, had a closer relationship, or the alter was male. Men’s GIAS was strongly associated with their alters’ attitudes when the alter was not from the same household or if they had a weak tie. Findings indicate that IPV prevention programmes must consider men’s and women’s network characteristics separately. For example, interventions for women should focus on relationships within their households, while interventions for men should focus on relationships outside their households.

Risk Factors of Pelvic Floor Disorders Among Women in Rural Nepal: A Case-Control Study.

Risk factors for pelvic floor disorders (PFDs) are not well understood in lower resource settings. The objective of this study is to determine the risk factors associated with stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) among women of reproductive age in rural Nepal. This is a case-control study nested within a community-based cross-sectional survey of parous women of reproductive age with PFDs in the Sarlahi District of Nepal. The presence of PFDs was confirmed by clinical assessment. Detailed sociodemographic information and histories were captured. We examined 406 women; the mean (SD, range) age was 32.7 (8.5, 16-49) years, mean BMI (SD) was 19.7 (3.3) kg/m2, and median (range) number of pregnancies was 4 (1-11). Two hundred and three women (50.0%) had either SUI or UUI, 85 (17.8%) had both SUI and UUI, and 71 (17.5%) had POP at or beyond the hymen. After controlling for other variables significant on bivariate analysis, age (adjusted odds ratio [aOR] 1.06 [95% CI 1.03-1.09]), illiteracy (aOR 2.24 [95% CI 1.04-4.80]), and presence of upper gastrointestinal issues (aOR 3.30, [95% CI 1.77-6.16]) were independently associated with SUI/UUI. Age (aOR 1.05 [95% CI 1.02-1.09]), bispinous diameter (aOR 2.88 ([95% CI 1.11-7.47]), and subpubic angle (aOR 2.78 [95% CI 1.55-5.03]) were independently associated with POP. Risk factors for PFDs in a homogenous community of parous women of reproductive age in rural Nepal are similar to those found in parous women in higher income countries.

Diabetes Prevalence and Associated Risk Factors among Women in a Rural District of Nepal Using HbA1c as a Diagnostic Tool: A Population-Based Study.

Given the scarcity of data on diabetes prevalence and associated risk factors among women in rural Nepal, we aimed to examine this, using glycated hemoglobin (HbA1c) as a diagnostic tool. A cross-sectional survey addressing reproductive health and non-communicable diseases was conducted in 2012–2013 among non-pregnant, married women in Bolde, a rural district of Nepal. HbA1c ≥ 6.5% (48 mmol/mol) was used as diagnostic criterion for diabetes, a cut-off of 7.0% (53 mmol/mol) was used to increase the specificity. HbA1c was measured in 757 women (17–86 years). The prevalence of diabetes and prediabetes was 13.5% and 38.5%, respectively. When using 7.0% as a cut-off, the prevalence of diabetes was 5.8%. Aging, intake of instant noodles and milk and vegetarian food (ns) were associated with increased risk for diabetes. Waist circumference was higher among women with diabetes, although not significant. The women were uneducated (87.6%), and only 12% had heard about diabetes. In conclusion, we observed a higher prevalence of diabetes and prediabetes than anticipated among rural, Nepalese women. The increased risk was mainly attributed to dietary factors. In contrast to most previous studies in Nepal, we used HbA1c as diagnostic criterion.

Vitamin D Status among Women in a Rural District of Nepal: Determinants and Association with Metabolic Profile-A Population-Based Study.

Hypovitaminosis D is prevalent worldwide, and especially in South-Asia. According to the Institute of Medicine (IOM), 25(OH)D levels below 30 nmol/L are defined as vitamin D deficiency (VDD) and levels between 30–50 nmol/L as insufficiency (VDI). Besides its role in calcium homeostasis, it has been postulated that vitamin D is involved in metabolic syndrome. Given the scarcity of data on vitamin D status in Nepal, we aimed to examine the prevalence of VDD and VDI, as well as the determinants and association with metabolic parameters (lipids, HbA1c), in a cohort of women in rural Nepal. Altogether, 733 women 48.5 ± 11.7 years of age were included. VDD and VDI were observed in 6.3 and 42.4% of the participants, respectively, and the prevalence increased by age. Women reporting intake of milk and eggs > 2 times weekly had higher 25(OH)D levels than those reporting intake < 2 times weekly. Women with vitamin D levels < 50 nmol/L displayed higher levels of cholesterol, LDL-cholesterol, triglycerides, and HbA1c. Additionally, a regression analysis showed a significant association between hypovitaminosis D, dyslipidemia, and HbA1c elevation. In conclusion, VDI was prevalent and increased with age. Milk and egg intake > 2 times weekly seemed to decrease the risk of VDI. Moreover, hypovitaminosis D was associated with an adverse metabolic profile.

Beyond household income: the role of commercial vegetable farming in moderating socio-cultural barriers for women in rural Nepal

BackgroundPromoting rural women’s agricultural entrepreneurship in the Global South has become a major policy and program priority for governments and development partners. Women’s income earning is viewed as a pathway to their empowerment and gender equality. The research goal was to understand how patriarchal socio-cultural norms and practices influence women’s participation in commercial vegetable farming (CVF) in the mid-hills of Sudurpashchim Pradesh, Nepal, and identify the specific and evolving strategies that women use to negotiate these changes.MethodologyData for the study were generated through in-depth interviews with 16 smallholder couples, eight each in Dadeldhura and Achham districts. Additionally, 17 key informants who were government agency and development organization agriculture support officials at the district and national level were interviewed. Besides in-depth interviews, focus group discussions (FGDs) with women’s groups, women leaders, development actors, and government officials at district, regional, and national level were also conducted. Interview data analysis using NVivo was complemented with field notes, observations and government agency and development organization reports.ResultsCVF possibilities initially motivated a few women to discuss with their husbands, organize self-help groups, and seek development program subsidies. With strong support from husbands and parents-in-law, they actively engage in CVF, generate income, form cooperatives for savings and credit, and improve household food security and their own economic status. CVF-associated groups, cooperatives, meetings, exposure visits, skill development training, knowledge sharing, counseling, and advocacy are vital tools. Through them, women build self-confidence, contest and transform entrenched socio-cultural barriers, and negotiate new socio-cultural norms and practices within and outside the household. Dissolving gender stereotypes regarding the division of labor in CVF plays a significant role in encouraging more women to join CVF and increases gender parity. However, a diminishing minority of women still struggle to overcome the legacy of prior negative experiences and subconsciously fear community backlash, especially regarding extended travel outside their village.ConclusionSocio-cultural practices restricting women’s income-generating roles can be transformed through investment in women’s group initiatives, enhancing husbands’ and wives’ communication and livelihood planning, and community members increased appreciation for women’s role in contributing household income and food security.

Women’s decision-making roles in vegetable production, marketing and income utilization in Nepal’s hills communities

Women in rural Nepal are increasingly interested in vegetable production and marketing (VPM) to earn income. Such innovative behavior conflicts with traditional patriarchal socio-cultural norms and is still relatively rare. Constrained by limited economic opportunities, smallholder households are increasingly under pressure to meet livelihood needs. In depth interviews, focus group discussions and field observations reveal family members, especially husbands and wives, jointly initiate VPM and collectively contest any unfavorable socio-cultural practices against women in these activities. Earning income, training, exposure visits, peer learning, women’s group activities and program subsidies strongly support women’s negotiations with their husbands and extended family members regarding continued and intensified VPM and expanded decision-making roles. Young and educated women more commonly contest restrictive practices and participate in all types of important decisions. Women manage household cash, have more freedom to spend income, and feel a strong sense of dignity and empowerment. However, some women still rely on their husbands for important decisions and are hesitant to travel to markets for training and exposure visits. Overall, we find clear evidence of women as active decision makers, farm managers and income earners.

MANTRA: Improving Knowledge of Maternal Health, Neonatal Health, and Geohazards in Women in Rural Nepal Using a Mobile Serious Game.

Serious games, conveying educational knowledge rather than merely entertainment, are a rapidly expanding research domain for cutting-edge educational technology. Digital interventions like serious games are great opportunities to overcome challenges in low-and-middle-income countries that limit access to health information, such as social barriers like low-literacy and gender. MANTRA: Increasing maternal and child health resilience before, during and after disasters using mobile technology in Nepal takes on these challenges with a novel digital health intervention; a serious mobile game aimed at vulnerable low-literacy female audiences in rural Nepal. The serious game teaches 28 learning objectives of danger signs in geohazards, maternal, and neonatal health to improve knowledge and self-assessment of common conditions and risks to inform healthcare-seeking behavior. Evaluations consisted of recruiting 35 end users to participate in a pre-test assessment, playing the game, post-test assessment, and focus groups to elicit qualitative feedback. Assessments analyzed knowledge gain in two ways; by learning objective with McNemar tests for each learning objective, and by participant scores with paired t-tests of overall scores and by module. Results of assessments of knowledge gain by learning objective (McNemar tests) indicate participants had sufficient prior knowledge to correctly interpret and respond to 26% of pictograms (coded AA), which is a desirable result although without the possibility of improvement through the intervention. The geohazard module had greatest impact as 16% of responses showed knowledge gain (coded BA). The two most successful learning objectives showing statistically significant positive change were evidence of rockfalls and small cracks in the ground (p = < 0.05). Assessment of knowledge gain by participant scores (paired t-tests) showed the 35 participants averaged a 7.7 point improvement (p < 0.001) in the assessment (28 learning objectives). Average change in knowledge of subdivided module scores (each module normalized to 100 points for comparison) was greatest in the geohazard module (9.5 points, p < 0.001), then maternal health (7.4 points, p = 0.0067), and neonatal health (6.0 points, p = 0.013). This evaluation demonstrated that carefully designed digital health interventions with pictograms co-authored by experts and users can teach complex health and geohazard situations. Significant knowledge gain was demonstrated for several learning objectives while those with non-significant or negative change will be re-designed to effectively convey information.

Assessing the unmet need for modern contraceptives among reproductive-aged women in rural Nepal

PurposeThe purpose of this research was to determine the extent of the unmet need for modern contraceptives (MC) and its associated factors.Design/methodology/approachThis community-based cross-sectional survey was conducted via interview among 306 women. Percentages, means, standard deviations, Chi-square tests and multiple logistic regression were completed for data analysis.FindingsIn total, 46.7% of respondents had total unmet need (24.8% spacing and 21.9% limiting). Multiple logistic regression for spacing showed the number of living children (AOR = 40.893, 95% CI = 6.930–241.292), no previous experience of MC (AOR = 30.149, 95% CI = 11.572–78.548) and level of knowledge (AOR = 5.587, 95% CI = 1.366–22.851). With regard to limiting pregnancies, respondent's age (AOR = 12.470, 95% CI = 1.264–86.734), number of living children (AOR = 21.257, 95% CI = 4.825–93.639) and no previous experience of MC (AOR = 120.542, 95% CI = 31.044–486.062) were recorded. Findings revealed that no previous experience of MC (AOR = 714.511, 95% CI = 160.646–3177.955) was a significant predictor of total unmet need.Originality/valueExperience and knowledge of MC play a vital role in the unmet need of MC use. A comprehensive education program to promote decision-making on MC choice and integrated family planning services at local communities by capacity building of service providers should be scaled up.

Adherence to and acceptability of three alcohol-free, antiseptic oral rinses: A community-based pilot randomized controlled trial among pregnant women in rural Nepal.

ObjectivesAntiseptic oral rinses have been evaluated as interventions to reduce the risk of adverse pregnancy outcomes associated with periodontal disease in pregnant women. Oral rinse use is not common in Nepal or other countries in South Asia, where the prevalence of adverse pregnancy outcomes is high. Understanding whether pregnant women in rural communities in this region would incorporate rinse use into their daily teeth cleaning routine is an important prerequisite to future research on this topic in South Asia.MethodsWe conducted a community‐based pilot randomized controlled trial of three alcohol‐free, antiseptic oral rinses among pregnant women <22 weeks pregnant in rural Nepal with the aim of assessing rinse acceptability, adherence, and effect on clinical periodontal measures. At baseline, participants underwent a clinical periodontal examination, and then were classified as healthy or having at least mild gingivitis (≥1 site with probing depth (PD) 3 mm and bleeding on probing (BOP) or ≥4 mm (PD)). Participants were stratified by periodontal status and randomized within each exposure category to chlorhexidine (CHX) (0.12%), cetylpyridinium chloride (CPC) (0.05%), salt and water (NaCl), or control (no rinse). Rinse participants were followed weekly for 12 weeks, and all participants underwent a second periodontal examination and answered a questionnaire.ResultsPregnant women in the rural Terai region of Nepal showed high adherence to (mean weekly rinse use: 185 mL (standard deviation: 66 mL)) a recommended 210 mL and acceptability of all three rinses. Participants reported greater frequency of tooth brushing with toothpaste and improvements in other recommended oral hygiene behaviours. CHX significantly reduced rates of gingivitis (defined as a participant with BOP ≥ 10% of sites) and the extent of BOP (gingivitis at the end of follow‐up for CHX vs control: RR 0.37, 95% CI: 0.16, 0.84). CPC and NaCl rinse groups had rates of gingivitis and extent of BOP similar to the control group (gingivitis at the end of follow‐up for CPC: RR 0.81, 95% CI: 0.47, 1.38; NaCl: RR 0.92, 95% CI: 0.55, 1.56).ConclusionsAdherence to and acceptability of three alcohol‐free, antiseptic oral rinses were high among pregnant women in rural Nepal. Among participants with mild gingivitis at baseline, CHX rinse was most effective at reducing signs of disease compared to the control group. Oral rinse should be considered as a supplement to current oral self‐care routines for pregnant women in settings where rinse use is uncommon and access to oral health services is limited.

Community-based postpartum contraceptive counselling in rural Nepal: a mixed-methods evaluation

Unmet need for postpartum contraception in rural Nepal remains high and expanding access to sexual and reproductive healthcare is essential to achieving universal healthcare. We evaluated the impact of an integrated intervention that employed community health workers aided by mobile technology to deliver patient-centred, home-based antenatal and postnatal counselling on postpartum modern contraceptive use. This was a pre–post-intervention study in seven village wards in a single municipality in rural Nepal. The primary outcome was modern contraceptive use among recently postpartum women. We performed a multivariable logistic regression to examine contraceptive use among postpartum women pre- and one-year post-intervention. We conducted qualitative interviews to explore the implementation process. There were 445 postpartum women in the pre-intervention group and 508 in the post-intervention group. Modern contraceptive use increased from 29% pre-intervention to 46% post-intervention (p < 0.0001). Adjusting for age, caste, and household expenditure, time since delivery and sex of child in the index pregnancy, postpartum women one-year post-intervention had twice the odds (OR 2.3; CI 1.7, 3.1; p < 0.0001) of using a modern contraceptive method as compared to pre-intervention. Factors at the individual, family, and systems level influenced women’s contraceptive decisions. The intervention contributed to increasing contraceptive use through knowledge transfer, demand generation, referrals to healthcare facilities, and follow-up. A community-based, patient-centred contraceptive counselling intervention supported by mobile technology and integrated into longitudinal care delivered by community health workers appears to be an effective strategy for improving uptake of modern contraception among postpartum women in rural Nepal.

Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal

BackgroundAccess to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women’s groups suggests that group care models may both improve access to care and the quality of care delivered through women’s empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes.MethodsThe study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process.ResultsA total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1–91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics.ConclusionGroup antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system.Trial registrationClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered.

Prevalence of symptomatic urinary incontinence and pelvic organ prolapse among women in rural Nepal.

Although pelvic floor disorders (PFDs) are a significant public health issue in higher income countries, less is known about these disorders and associated risk factors in low income countries. We aimed to determine prevalence and associated risk factors for stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) in reproductive age women in Sarlahi District in rural Nepal. We conducted a community-based cross-sectional survey of parous, reproductive age women in rural Nepal and screened for pelvic floor disorders using validated screening questions for PFDs. Overall frequency of self-reported symptoms for SUI, UUI, and POP was estimated and compared across demographic and pregnancy history information. Of 14,469 women available for analysis, the mean (SD, range) age was 33.5 (8.2, 13-52) years, and median (range) number of pregnancies was 4 (1-15). The prevalence of SUI was 24.1% (95% CI: 23.3-24.8), of UUI was 13.5% (95% CI: 13.0-14.1), and of POP was 8.0% (95% CI: 7.5-8.4). Bivariate analysis identified the risk of PFD increased incrementally with age and number of vaginal deliveries; these covariates were highly correlated. Multivariable logistic regression revealed age, vaginal deliveries, and previous pelvic surgeries were independently associated with PFD. PFDs are common in a community of parous, reproductive age women in rural Nepal. Risk factors for these conditions are similar to risk factors found in higher income countries.

A Novel Method to Measure Resilience in Nutrition: Application to Diets and Body Mass Index of Rural Women in Nepal and Bangladesh (FS01-02-19)

ObjectivesThis study aimed to demonstrate feasibility of a novel method for measuring resilience in dietary diversity (DD) and body mass index (BMI) of rural women of reproductive age (WRA) in Nepal and Bangladesh. Resilience is defined as the population’s ability to recover from adverse shocks, measured relative to statistical mean reversion. MethodsWe used regionally representative surveys from Nepal (n = 2187) and Bangladesh (n = 1715) collected annually in Nepal (four panels, 2013–2016) and every 6 months in Bangladesh (3 panels, 2016–2017), for BMI (kg/m2) and DD using 10 food groups (7-day qualitative diet recall, Nepal) and 6 food groups (24-hour diet recall, Bangladesh). We estimated where i is the woman, y is the outcome of interest, and z is a vector of controls. ∆yi, t+j denotes change in y between t + j-1 and t + j. Declinedi,t+1 equals 1 if the change between t and t + 1 is negative, zero otherwise. β2 measures the degree of reversal in decline controlling for mean reversion (β1) and other differences (age, age2, age cube, and socioeconomic status). β2 = 0 is our benchmark of mean reversion around the trend, i.e., recoveries after decline are not significantly different from declines after recovery. ResultsOur technique revealed significant (P < 0.01) resilience of DD in Nepal (Figure 1, Panel A). Among 1682 women in the Terai region, 47% (n = 784) experienced an initial decline in DD, and 61% of that initial decline was recovered. Mean reversion removed only 25% of the initial change among those who gained. We found no significant resilience in Bangladesh (Figure 1, Panel B) or for BMI in either country. ConclusionsThe resilience of DD in Nepal could reflect food aid responses to the 2015 earthquake or other interventions, while lack of resilience in BMI could reflect time lags, measurement errors or limits on the speed and timing of weight change. Lack of resilience of DD in Bangladesh could reflect shorter time intervals. Future work will apply this method to test for differences in resilience associated with exposure to programmatic interventions. Funding SourcesSupport provided by Feed the Future Innovation Lab for Nutrition, funded by the United States Agency for International Development (USAID). Supporting Tables, Images and/or Graphs▪

A Novel Method to Measure Resilience in Nutrition: Application to Diets and Body Mass Index of Rural Women in Nepal and Bangladesh (FS01-02-19)

ObjectivesThis study aimed to demonstrate feasibility of a novel method for measuring resilience in dietary diversity (DD) and body mass index (BMI) of rural women of reproductive age (WRA) in Nepal and Bangladesh. Resilience is defined as the population’s ability to recover from adverse shocks, measured relative to statistical mean reversion. MethodsWe used regionally representative surveys from Nepal (n = 2187) and Bangladesh (n = 1715) collected annually in Nepal (four panels, 2013–2016) and every 6 months in Bangladesh (3 panels, 2016–2017), for BMI (kg/m2) and DD using 10 food groups (7-day qualitative diet recall, Nepal) and 6 food groups (24-hour diet recall, Bangladesh). We estimated where i is the woman, y is the outcome of interest, and z is a vector of controls. ∆yi, t+j denotes change in y between t + j-1 and t + j. Declinedi,t+1 equals 1 if the change between t and t + 1 is negative, zero otherwise. β2 measures the degree of reversal in decline controlling for mean reversion (β1) and other differences (age, age2, age cube, and socioeconomic status). β2 = 0 is our benchmark of mean reversion around the trend, i.e., recoveries after decline are not significantly different from declines after recovery. ResultsOur technique revealed significant (P < 0.01) resilience of DD in Nepal (Figure 1, Panel A). Among 1682 women in the Terai region, 47% (n = 784) experienced an initial decline in DD, and 61% of that initial decline was recovered. Mean reversion removed only 25% of the initial change among those who gained. We found no significant resilience in Bangladesh (Figure 1, Panel B) or for BMI in either country. ConclusionsThe resilience of DD in Nepal could reflect food aid responses to the 2015 earthquake or other interventions, while lack of resilience in BMI could reflect time lags, measurement errors or limits on the speed and timing of weight change. Lack of resilience of DD in Bangladesh could reflect shorter time intervals. Future work will apply this method to test for differences in resilience associated with exposure to programmatic interventions. Funding SourcesSupport provided by Feed the Future Innovation Lab for Nutrition, funded by the United States Agency for International Development (USAID). Supporting Tables, Images and/or Graphs▪

No time, no money, no luck: Barriers to prenatal care among dalit women in rural Nepal

In Nepal, a large gap exists between non-dalit and dalit women in regard to maternal mortality and prenatal care. Especially rural Dalits are far behind non-dalits in utilizing prenatal care. We explored rural dalit women’s prenatal practices and barriers to accessing prenatal care. Interviews revealed that lack of cultural and economic capital, unequal domestic and economic burden, and gender and caste discrimination impact the use of prenatal care. The use of prenatal care might be improved by informing women about free services and incentives, better access and transportation, and heightened sensitivity to the situation of these women.

Prevalence of Sexually Transmitted Infections among Married Women in Rural Nepal.

Introduction We have previously determined the prevalence of human papillomavirus (HPV) infection among women in rural Nepal. In the current study, we also wanted to examine the prevalence of and risk factors for other sexually transmitted infections (STIs) in the same population. Methods Population-based study of nonpregnant women ≥ 15 years who were married or had a history of marriage in the past, residing in five rural villages in Nepal. Data on sociodemographic characteristics, reproductive history, and genitourinary symptoms were collected, and a gynecological examination was conducted. Cervical samples were analyzed by real-time PCR for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis and HPV, and a serum sample was analyzed for syphilis, hepatitis B virus (HBV) and HIV infection by serology. Results Of 2416 eligible women, 62% participated. Trichomoniasis, Chlamydia trachomatis infection, HPV and HBV infection, and syphilis were detected in 5.4%, 0.8%, 14.3%, 0.3%, and 0.2% of the women. None had gonorrhea or HIV infection. Of those with genitourinary symptoms, 6.3% had a curable STI. Vaginal discharge classified as abnormal by gynecological examination, but not self-reported discharge, was significantly associated with laboratory diagnosis of a curable STI. Risk factors for trichomoniasis were reproductive age and high cast/ethnicity. Due to low prevalence, risk factors for other STIs could not be disclosed. Conclusion We observed high prevalence of HPV infection followed by trichomoniasis, while other STIs were rare among women in rural Nepal. There was no association between genitourinary symptoms and laboratory-confirmed STIs.

Oral health knowledge, behavior, and care seeking among pregnant and recently-delivered women in rural Nepal: a qualitative study

BackgroundOral health behavior and attitudes of pregnant women in low-income countries are rarely examined, yet should be considered when designing preventative or therapeutic studies to reduce burden of oral diseases. We aimed to understand dental care-seeking behavior, as well as oral health knowledge and attitudes of oral health among pregnant women in rural Nepal.MethodsSemi-structured in-depth interviews (n = 16) and focus group discussions (3 groups, n = 23) were conducted among pregnant and recently-delivered women in Sarlahi, Nepal. Transcripts were translated from the local language to English then analyzed using a hybrid approach to thematic coding with Atlas.ti version 7.ResultsWomen felt confident describing the signs and symptoms of tooth decay and gum disease, but were not knowledgeable about where to receive care for tooth and/or gum pain and relied heavily on the knowledge of their community. Some women used a toothbrush and toothpaste at least once a day to clean their teeth, but many reported the traditional use of a branch of a local shrub or tree as their teeth cleaning instrument. Women suggested a willingness to consider using an oral rinse throughout pregnancy, perceiving that it might have a positive impact on infant health.ConclusionsFuture studies should focus on providing adequate and sustainable resources for pregnant women in Nepal and other low income settings to engage in good oral health behaviors (possibly supported through community-based workers), to maintain dental hygiene, and to access qualified dentists as a means of improving their oral health.Trial registrationClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study) and NCT02788786 (Pilot Trial).

Prevalence of human papillomavirus infection among women in rural Nepal.

In this study we aimed to determine the overall and type-specific prevalence of cervical human papillomavirus (HPV) infection and risk factors for such infection among women in rural Nepal, and to investigate the distribution of HPV infection by cervical cytology. The study was conducted among women aged ≥15years in five rural villages within Kavre District in Nepal. Sociodemographic data and information on risk factors for cervical cancer were obtained through an interview, and a cervical specimen was collected for HPV DNA detection and typing using the Anyplex™ ll HPV28 Detection system, and for Papanicolaou test. Among the 1289 women in whom a valid HPV result was obtained the median age was 40years (range 17-86years). Overall, the HPV prevalence was 14.4%, 7.9% for high-risk and 6.5% for low-risk HPV types, and was similar between age groups. The five most common HR types were HPV-18 (2.3%), HPV-51 (1.2%), HPV-59 (1.1%), HPV-31 (0.9%), and HPV-16 (0.8%). The prevalence of high-risk types in women with and without abnormal cytology was 8.3 and 7.7%, respectively. HPV infection was associated with current smoking, formal education, and being married to a husband with at least one previous marriage. This is the first population-based study to report the prevalence of a broad range of HPV types among women from rural Nepal. These data are crucial for development of preventive strategies to reduce cervical cancer burden in the country.

Determinants of institutional birth among women in rural Nepal: a mixed-methods cross-sectional study.

BackgroundEncouraging institutional birth is an important component of reducing maternal mortality in low-resource settings. This study aims to identify and understand the determinants of persistently low institutional birth in rural Nepal, with the goal of informing future interventions to reduce high rates of maternal mortality.MethodsPostpartum women giving birth in the catchment area population of a district-level hospital in the Far-Western Development Region of Nepal were invited to complete a cross-sectional survey in 2012 about their recent birth experience. Quantitative and qualitative methods were used to determine the institutional birth rate, social and demographic predictors of institutional birth, and barriers to institutional birth.ResultsThe institutional birth rate for the hospital’s catchment area population was calculated to be 0.30 (54 home births, 23 facility births). Institutional birth was more likely as age decreased (ORs in the range of 0.20–0.28) and as income increased (ORs in the range of 1.38–1.45). Institutional birth among women who owned land was less likely (OR = 0.82 [0.71, 0.92]). Ninety percent of participants in the institutional birth group identified safety and good care as the most important factors determining location of birth, whereas 60 % of participants in the home birth group reported distance from hospital as a key determinant of location of birth. Qualitative analysis elucidated the importance of social support, financial resources, birth planning, awareness of services, perception of safety, and referral capacity in achieving an institutional birth.ConclusionAge, income, and land ownership, but not patient preference, were key predictors of institutional birth. Most women believed that birth at the hospital was safer regardless of where they gave birth. Future interventions to increase rates of institutional birth should address structural barriers including differences in socioeconomic status, social support, transportation resources, and birth preparedness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1022-9) contains supplementary material, which is available to authorized users.

Employment And Nutritional Status Among Women In Rural Nepal.

Employment And Nutritional Status Among Women In Rural Nepal.