Corporal Punishment in Nepalese School Children Facts, Legalities and Implications.

While the Convention on the Rights of the Child (CRC) demands that children be respected as human beings with the right to dignity and physical integrity, in Nepal corporal punishment is often considered necessary to children’s upbringing, to facilitate learning and to instill discipline in the children. The existence of this cruel practice towards children is attributed to the weak national policy, unhealthy academic competition among the schools, poorly trained teachers, superstitious traditional beliefs and hierarchical social structure. Consequently, the children are doomed to suffer this practice resulting in negative physical, mental and social welfare. Besides corporal punishment, sexual abuse in school going children seems to be frequent but mostly unreported. This is high time we eliminated this violence against children in schools and it calls for holistic approach. For this, it is necessary to pursue a set code of conduct and raise awareness among the teachers for the child rights in order to stop undignified, inhuman and undisciplined tradition. The awareness and capacity of the health professionals to deal with complexities of the child abuse also needs to be promoted. Furthermore, the need of improvements in the national laws and their proper implementation is a longstanding challenge for the governmental and nongovernmental organizations.

Learning, education and satisfaction after compulsory rotating internship in Kathmandu University Medical School: a qualitative study of interns' response.

BACKGROUND: Internship is an integral part of MBBS training programme and mandatory to all students. Kathmandu University Medical School has adopted a programme of compulsory one year rotating internship including 6 weeks community exposure in out reach clinics for the first batch of students. The purpose of the study is to evaluate interns' feedback concerning learning, education and satisfaction. MATERIALS AND METHODS: A questionnaire with 47 items was administered to 30 interns who had finished one year rotating internship in Kathmandu University Medical School. Fourty-two responses were graded according in Likert scale and 5 open ended questions were analyzed for common themes. RESULTS: The mean age of the interns was 24.77+/-0.67 yrs with female: male ratio of 1.5:1. Confidence level of communication of interns with faculties was lesser than with junior doctors and patients. Junior doctors and colleagues contributed more in interns' learning than faculties. Community exposure for 6 weeks was considered lengthy and lacking of clear objectives. However, 53.3% interns agreed that achievement of objectives of community posting was high or very high. Of the interns, 50% perceived certain degree of physical or mental or sexual harassment during internship. Interns raised the issue of not involving them as a part of team during clinical posting. Clinical competencies for most of the skills were high or very high. CONCLUSION: Interns have learned clinical skills and patient care in one year internship programme but contribution of junior doctors and colleague are more than teachers. Clear objectives are needed before clinical and community postings. Process of providing regular feedback from interns and vice versa should be implemented to improve interns' learning, education and satisfaction.

Antenatal detection of conjoined twin.

Conjoined twin is a sporadic event with prevalence of 1 in 50000 to 1000000 birth. Incomplete division of embryonic disc results in conjoined twin. Ultrasound plays a major role for early detection and proper obstetric management. A case of cephalothoracopagus conjoined twin was detected at 20 weeks pregnancy in a primigravida woman by antenatal ultrasound. The pregnancy was terminated after proper counseling, despite the need to save the baby, as multidisciplinary team to separate the twins was not available.

Cervical spine injuries in a teaching hospital of eastern region of Nepal: a clinico-epidemiological study.

Cervical spine injuries with neural deficits carry significant impact economically, socially and psychologically to the individual and to the society. Risk factors involved, mode of injuries, constraints of management and rehabilitation are different in developing countries. Total 149 patients of cervical spine injuries presented in B.P. Koirala Institute of Health Sciences, Dharan, Nepal were evaluated prospectively for three years. Demographic details, etiology of injury, method and time taken for transportation and treatment method and progression of recovery were recorded. Most commonly involved age group was 30-49 years (44%) with male to female ratio of 4:1. Fall related injury especially from trees was the commonest mode of injury (60%). Patients were transported to hospital without neck immobilization (81%) in a vehicle unsuitable for spinal injuries patient with average delay of two days of injury. 79% had neural deficits among which 42% are with quadriparesis, 31% are with quadriplegia. Associated extra spinal injuries were found in 9% patients. Average hospital stay was 31 days. C5 vertebra was the most commonly injured vertebra. Cervical spine injuries, which has major impact over patient and society is still not adequately addressed by medical and public health system of developing countries like Nepal. Incidence of spinal injuries and its devastating consequences can be reduced by appropriate preventive measures and management along with rehabilitation.

The prevalence and characteristics of disability in Eastern Nepal.

BACKGROUND: Disability is related to poverty and development. Enough information and documentation is not available for developing countries like Nepal. AIMS AND OBJECTIVES: To assess the self-reported prevalence of disability in terms of age, sex, types, cause and age of onset. METHODOLOGY: A cross-sectional house to house census was carried out by means of structured questionnaires. RESULTS: A total of 31,160 individuals (4.87%) were found disabled out of a total of 640,259 individuals. The three most common types of disability are physical affecting limbs, hearing and vision. The most common perceived cause of disability is inborn syndrome followed by injury/accidents. DISCUSSION: Various publications for the prevalence of reported disability show a figure between three and ten percent, with physical disability affecting locomotion and manipulation as the leading type of disability. The prevalence rate can vary depending upon the disability indicators, methods and population surveyed and perceptions of the people. CONCLUSION: The self-reported prevalence of disability in Sunsari District is 4.87%, with inborn-syndrome as the leading perceived cause.

HIV and conflict in Nepal: relation and strategy for response.

Conflict and displacement make affected population more vulnerable to HIV infection. Refugees and internally displaced persons, in particular women and children, are at increased risk of exposure to HIV. In Nepal, there is considerable increase in the number of HIV infection since 1996 when conflict started. Along with poverty, stigma and lack of awareness, conflict related displacement, economic migration, and closure of HIV programmes have exacerbated the HIV situation in Nepal. Government has established "National AIDS Council" and launched HIV/AIDS Strategy. The strategy has not included the specific needs of displaced persons. While launching an HIV prevention programme in the conflict situation, the guidelines developed by Inter Agency Standing Committee (IASS) are important tools. This led to suggestion of an approach with implementations steps in the case of Nepal in this report.

Hepatitis B and C infection among drug abusers in Nepal.

Prevalence of hepatitis B and C virus infection amongst intravenous drug users (IDU) in Nepal is not known. To estimate such prevalence 72 IDU individuals were tested for HBV and HCV markers. About 80% of the drug abusers are both anti-HBc (59/72) and anti-HCV (58/72) sero-positive. However persistent infection with hepatitis B, as indicated by positive HBsAg, was detected in only 5.5% (n = 4). Active hepatitis C infection, as indicated by HCV RNA positivity, was documented in 74% (42/58) of those who were anti-HCV positive. Importance of awareness of this observation among the healthcare workers in the prevention of hepatitis C in the community is stressed.

Factors affecting utilization of health centers in a rural area of Chon Buri Province, Thailand.

A descriptive study was carried out in two subdistricts of Nong Heng and Nong Kakha, Phan Thong District, Chon Buri Province eastern Thailand with the aim to determine factors affecting health center utilization. A cross-sectional survey was conducted on 206 randomly selected households in which household head or senior person in each household was interviewed using a structured questionnaire. The study household was classified as either high or low health center utilization group on the basis of using health services more than 50% of total health services needed in each household. The results revealed that age group, sex, education, family size, and distance from household to health center were not associated with the utilization of health center, whereas occupation, economic status, knowledge and attitude towards health center and quality as well as convenience of health services were found to be associated with health center utilization. It was seemed that underutilization of health centers was multifactorial, in which some factors were related with the personality of individual whereas others were concerned with the health center itself.