Sexual and reproductive health status among young peoples in Nepal: opportunities and barriers for sexual health education and services utilization.

This article attempts to summarise the situation of sexual and reproductive health among young people in Nepal. Modernisation and social transformation are occurring rapidly in Nepalese society. Growing expansion of communication and transportation networks, urbanisation and in-migration of population to urban areas is creating a different socio-cultural environment, which is conducive to more social interactions between young girls and boys in Nepal. Rising age at marriage has now opened a window of opportunity for pre-marital and unsafe sexual activity among young people in Nepal which creates risks of unwanted pregnancy, STIs/HIV and AIDS. Several socio-economic, demographic and cultural factors have been identified as encouraging factors for risk taking behaviours among young people. Improving access to youth friendly services, implementing peer education programmes for school and out of school going adolescents, developing effective Information, Communication and Education (IEC) materials and curricula have been highly suggested to improve the existing young people's sexual and reproductive health status.

Detection of individuals prone to develop hypertension in their future life.

Hypertension is a global burning health problem. Early detection of proneness to hypertension may help an individual to lead a healthy life by altering the life style (by diet restriction, exercise etc.). Subjects at high risk of future hypertension e.g. the persons of hypertensive family and/or having high resting heart rate etc. show blood pressure hyper-responsiveness to stress. Elevated blood pressure due to sympathetic stimulation prevailed longer time in susceptible persons. In the present study sympathetic stimulation exerted through cold pressor test (hand immersion up to the wrist in 4 degrees C water) resulted in elevation of blood pressure and heart rate in all young male normotensive individuals (age 18-35 years, n=72). Nevertheless, blood pressure and heart rate returned to baseline, following 5 minutes of withdrawal of the stressor, in case of volunteers from normotensive families. On the other hand, the subjects whose parents, either or both were reported to be hypertensive showed elevated diastolic blood pressure even after 5 minutes of withdrawal of the said stressor- indicating that the autonomic nervous system in them was not competent enough for lowering the diastolic pressure quickly to baseline as observed in the volunteers from the normotensive families. The present study revealed that the young subjects who showed greater and prolonged responsiveness to diastolic blood pressure due to sympathetic stimulation through cold pressor test are prone to develop hypertension in future.

Prevalence of rheumatic fever and rheumatic heart disease in school children of Kathmandu city.

To find out the prevalence of rheumatic fever/rheumatic heart disease in an urban area, a survey of school children aged between 5 to 16 years studying in randomly selected government schools in Kathmandu city was done. Out of 4984 students enrolled in the study 4736 were examined, the percentage of absentees being five. Revised Jones Criteria (1992) was used for the diagnosis of rheumatic fever. Diagnosis of rheumatic heart disease was confirmed only after Doppler echocardiography in suspected cases. A total of six cases of definite rheumatic heart disease (out of 13 suspected cases) were identified giving overall prevalence rate of 1.2 per 1000. Fifty percent rheumatic heart disease cases gave a history suggestive of rheumatic fever. No case of active rheumatic fever could be identified. The study gave lower result than that reported in most earlier studies from developing countries but it is similar to that reported from rural Kathmandu in 1991. It is concluded that there is some downward trend in rheumatic fever/rheumatic heart disease prevalence but the low prevalence is also due to the use of Doppler echocardiography which has prevented overdiagnosis in the present study. We feel that there is an urgent need to launch a National Programme for the control of rheumatic fever/rheumatic heart disease in Nepal with emphasis on primary and secondary prophylaxis of the disease.