Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization.

Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe lifethreatening hemoptysis, particularly when other treatment options are unavailable or ineffective.

Myths and misconceptions about abortion among marginalized underserved community.

INTRODUCTION: Unsafe abortion remains a huge problem in Nepal even after legalization of abortion. Various myths and misconceptions persist which prompt women towards unsafe abortive practices. METHODS: A qualitative study was conducted among different groups of women using focus group discussions and in depth interviews. Perception and understanding of the participants on abortion, methods and place of abortion were evaluated. RESULTS: A number of misconceptions were prevalent like drinking vegetable and herbal juices, and applying hot pot over the abdomen could abort pregnancy. However, many participants also believed that health care providers should be consulted for abortion. CONCLUSIONS: Although majority of the women knew that they should seek medical aid for abortion, they were still possessed with various misconceptions. Merely legalizing abortion services is not enough to reduce the burden of unsafe abortion. Focus has to be given on creating awareness and proper advocacy in this issue.

Impact of the integrated Radio Communication Project in Nepal, 1994-1997.

The Radio Communication Project (RCP) in Nepal is an ongoing, theory-based, multimedia reproductive health campaign which began in 1995. It consists of two entertainment-education radio serials (a soap opera for the general public and a dramatized distance education serial for health workers), additional radio spot advertisements and promotions, and complementary print materials. This paper examines impact data from a variety of sources, including a pre- and postpanel survey of currently married women (N = 1905), three waves of clinic-based observations of client-provider interactions (N = 240 per wave) and client exit interviews (N = 240 per wave), and 2 years of clinic service statistics, in order to draw inferences about the separate and combined effects of the RCP components. The study found increased health worker interpersonal interaction skills, improved quality of client-provider interactions, increased client self-efficacy in dealing with health workers, improved client attitudes toward health services and toward the practice of family planning, increased adoption of family planning, and increased family planning service utilization, all attributable to the RCP. The panel data allowed statistical control of the influence of predisposing factors before the campaign on postcampaign ideation and behavior. The effect of the RCP on contraceptive behavior was largely indirect through its influence on ideation. Implications for the design of integrated, multimedia, entertainment-education campaigns and integrated evaluation designs are discussed.

ICPD, reproductive health and population programmes in Nepal -- a reflection.

PIP: This article synthesizes the Program of Action of the 1994 Cairo International Conference on Population and Development and identifies Nepal's programs in reproductive health. Nepal has family planning (FP), child survival, nutrition, and maternal health programs. New programs include the Safe Motherhood and Sexually Transmitted Diseases (STDs) (including AIDS) programs. These health programs are operated by several nongovernmental organizations (NGOs), such as the Family Planning Association of Nepal and the Nepal Red Cross Society. Most sexual and reproductive health care has a core of FP. Program expansion should include gender sensitive education and counseling on sexuality; pregnancy, delivery, and postpartum care; infant development and growth monitoring, especially among girl children; prevention and treatment of STDs and infertility; and prevention and management of unsafe abortion and provision of safe terminal pregnancy processes. FP becomes more acceptable when services are holistic and comprehensive throughout the life cycle and serve multiple health needs. A 1996 survey suggests that the number of modern FP acceptors would increase, if affordable services and information were available. Quality of care requires knowledgeable, skilled providers and trusting, health-seeking clients. Provider improvements are especially needed. Nepal has one of the highest maternal mortality rates in the world. It will take the concerted effort of government, NGOs, and the private sector to expand services, mobilize the community, and educate about health and reproduction.^ieng

Population dynamics and environmental degradation in Nepal: an interpretation.

PIP: This paper examines the special problems that are faced by developing countries, specifically Nepal, which have to sustain increasing populations from a depleting natural resource base. Nepal is an example of a developing country where fertility is high and mortality is decreasing fast, resulting in a high rate of population growth. Nepal's rapid population growth has had a significant impact on natural resource depletion and consequently, environmental degradation. The case of Nepal demonstrates the difficulties confronting developing countries, which attempt practical implementation of the population policy guidelines set out in Agenda 21. Past and current population programs in this country have failed to address the population problem as multidimensional, and have failed to encourage grassroots participation. Economic stagnation and poverty encourage a large family size, and are delaying declines in fertility which subsequently leads to high land encroachment and fast depletion of natural resources like forests and water. The government needs to implement an integrated, multidimensional approach, which emphasizes literacy, education, lowering infant mortality, and providing contraceptives along with follow-ups. Finally, the greatest action must consist of fostering a higher rate of planned economic and social development that must be shown to have meaning for, and impact on the population in general.^ieng

Sex ratio in Nepal.

"This article deals with [the] sex ratio in Nepal since...the first population count was conducted. The author was prompted to investigate this issue because [the] sex ratio in 1981 was the highest among all population counts and censuses of Nepal and slightly above the upper limit of [the] normal range of sex ratio prevalent in other countries of the world."

Sex preference and the value of sons and daughters in Nepal.

Sex preference and the specific value of sons and daughters to parents in Nepal are examined using rural and urban survey data from 1979. Ideal family size among all respondents was, on average, three children, with two sons and one daughter the preferred sex composition for about 90 percent of all respondents. Among those who reported current contraceptive use, the mean number of living sons was higher than the mean number of living daughters for all respondents. Most couples have at least one son before they adopt contraception; respondents had, on average, three to four births before adopting contraception. Sons are preferred to daughters by Nepalese parents mainly for socioeconomic and religious reasons, as opposed to the economic reasons reported elsewhere in many developing societies. The findings indicate that the economic motive for having both sons and daughters may be weakening in Nepal, but that a preference for sons does exist.

PIP: Sex preference and economic and economic utility of sons and daughters in rural Nepal was examined by surveying a town and a rural district of the west central hill region in 1979. 871 women aged 15-39 were asked census type questions, fertility information and questions on the value of children. In this area the total fertility rate is 6.4 in the rural area and 4.3 in the town. Parents and children farm the hillsides, or men migrate out to find work. Most families prefer 2 sons and 1 daughter, or 1 son and 2 daughters as second choice. Although sons are preferred for old age security as well as religious ritual value, daughters are also valued for their role in religious festivals as well as for their emotional contribution to family life. Girls marry early and universally in Nepal because of the religious merit bestowed on those who give them in marriage. The son preference affects contraceptive behavior to the extent that Nepalese rarely begin contraception until their desired number of sons are born. People are beginning to articulate their realization that large families are contributing to shortage of cultivable land and to the deteriorating fuelwood and water supplies in the hills of Nepal.