Parental international migration is not associated with improved health care seeking for common childhood illnesses and nutritional status of young children left-behind in Nepal.

OBJECTIVE: To examine the impact of parental international migration on health care seeking for common childhood illnesses (diarrhoea, fever, and acute respiratory infections) and nutritional status (stunting, underweight and wasting) in young children in Nepal using the most recent nationally representative Multiple Indicator Cluster Survey. STUDY DESIGN: Nationally representative cross-sectional survey. METHODS: We used multiple logistic regression models to examine the association between parental international migration and the study outcomes adjusting for a range of potential confounders. RESULTS: Of 5310 children, 23.5% had at least one parent living abroad. Health care for common childhood illnesses was sought for 52.1% (95% confidence interval [CI]: 45.0%-59.2%) and 47.0% (95% CI: 42.7%-51.1%) of children from migrant and non-migrant families, respectively. The prevalence of stunting, underweight and wasting among left-behind children were 35.3% (95% CI: 31.5%-39.1%), 28.3% (95% CI: 24.2%-32.2%) and 11.8% (95% CI: 8.8%-14.7%), respectively. In adjusted analyses, there were no statistically significant differences in health care seeking or nutritional status by parent's migration status. CONCLUSIONS: Despite large economic benefits to Nepal due to international labour migration, we did not observe any apparent differences in young left-behind children in terms of seeking health care for common childhood illnesses or prevalence of under-nutrition. Longitudinal studies are needed to accurately measure whether migration has any substantial temporal effect on the nutritional status of young children or seeking for health care.

A study of association between cervical cytology and period of co-habitation with husbands in the wives of serving soldiers.

BACKGROUND: The wives of serving soldiers constitute a special demographic cohort, as they spend variable amount of time in co-habitation with their husbands. The present study aims to find if any independent association, adjusted for age, exists between the time spent living together with the husband and findings on cervical smear. METHODS: Over a period of one year, cervical smears were taken from subjects at two different hospitals. The approximate length of co-habitation with husbands in the last 10 years was elicited through a questionnaire. RESULTS: Among 262 subjects, majority of smears showed normal findings (82.06%). 17.93% of the smears displayed abnormality, the maximum proportion of cases with abnormal findings were seen in the group who have spent 61-90 months, in the last ten years. Age adjusted chi square statistics failed to show statistically significant association between period of co-habitation and abnormal Pap smear. Odds' ratio (OR) for each age stratum varied from each other and was also different from the overall (crude) OR, suggesting that age is an effect modifier. Variation in epithelial cytology did not appear to be an effect of duration of cohabitation but was because of the increasing age. CONCLUSIONS: Cervical cytology does not show association with length of cohabitation with husbands in this study. However, age is seen to be an effect modifier.

Depression, Alcohol Use, Antiretroviral Therapy Adherence and HIV Status among HIV-infected from Multiple Antiretroviral Therapy Clinics in Nepal.

Background Depression and alcohol use disorder are very common among people living with HIV infection, these disorders are not only common among HIV patients but also associated with antiretroviral therapy (ART) non adherence, morbidity and mortality. Objective The objective of our study is to study the prevalence of Depression, Alcohol use, and ART treatment adherence. Method This is a analytical cross-sectional study. Total of 221 participants were included in the study. Convenient method of sampling was used to collect the data from three district Kathmandu, Lalitpur and Kavre ART (Antiretroviral treatment) clinics. Beck Depression Inventory (BDI) was used for the assessment of depression, Alcohol use disorders identification test (AUDIT) was used for alcohol related problems and Visual analogue scale (VAS) was used for treatment adherence. Chi square test and multiple linear regression analysis were conducted for testing bivariate and multivariate relationship of sociodemographic and clinical factors with depression and treatment adherence. Result The 40% participants found to have depression. Variables associated with depression significantly after multiple regression analysis were employment (p value=0.04) and mode of transmission (p value= 0.003). More than half, 56% of the participant's CD4+ cells count was < 500 per cubic millimetre and 71% participant's viral load was undetectable. Clinical variables mode of transmission (pvalue=0.000), duration of illness (p value=0.03) and duration of treatment (p value=0.01) were significantly associated with depression. ART treatment adherence was significantly associated with CD4 cell (p value=0.02) and viral load (p value= 0.05). Conclusion Depression is very prominent among HIV positive patients. Low CD4+ cell count and high viral load has been seen among patients who are not adherent to antiretroviral treatment. It is suggested that clinicians should carefully assess the possibility of depressive symptoms in their patients on ART treatment.

Child maltreatment in Nepal: prevalence and associated factors.

OBJECTIVES: Child maltreatment is a global public health problem. There is limited information about this problem in low-income countries. We aimed to document the prevalence and factors associated with physical punishment of children less than 14 years of age in Nepal. STUDY DESIGN: Population-based cross-sectional study. METHODS: We conducted an in-depth analysis using data from the Nepal Multiple Indicator Cluster Survey, a nationally representative multi-stage-stratified cluster sampling survey. Data were collected from 13,000 households in 520 sample enumeration areas. We assessed prevalence of physical punishment and different child violence related acts on 5081 children aged 3-14 years for whom complete information on all acts and attitude towards violence was available. Logistic regression was used to investigate the association between physical punishment of child and factors such as household and maternal demographics. RESULTS: Our results suggested violence is common across Nepal, with data showing one in every second child is physically punished. One in every third (33%) of children were spanked, hit or slapped on the bottom, 25% were hit or slapped on the face and approximately 3% were beaten up hard. Odds of facing physical punishment were higher among children aged 3-5 years (odds ratio [OR] 2.9, 95% confidence interval [CI]: 2.0-4.3), aged 6-8 years (OR 2.8, 95% CI: 2.2-3.7), engaged in child labour activities (OR 1.4, 95% CI: 1.1-1.7), with mother that accepted wife beating by husband is justified (OR 1.2, 95% CI: 1.1-1.4), whose father is currently abroad (OR 1.5, 95% CI: 1.2-1.9) and whose father is away from home but in the same country (OR 1.60, 95% CI: 1.1-2.3). The risk was also higher among children living in households that believe physical punishment of children is necessary (OR 3.5, 95% CI: 2.9-4.3) and from lower caste/indigenous (dalit/janajati) ethnicity (OR 1.3, 95% CI: 1.1-1.7). Those less likely to experience physical punishment included female children (OR 0.7, 95% CI: 0.6-0.9) and children with an older mother (34-49 years; OR 0.5, 95% CI: 0.3-0.9). CONCLUSIONS: Our results suggest that physical punishment of children is common across Nepal with varying severity. Prevention efforts should focus on designing and promoting interventions that support parents to adapt alternative forms of parenting practices.

Dengue outbreak in a large military station: Have we learnt any lesson?

BACKGROUND: An outbreak was reported from a large military station located in South India in 2013. In spite of instituting the preventive measures early, it took more than 2 months to bring the outbreak under control. This paper brings out lessons learnt and suggests strategy for controlling similar outbreak in future. METHOD: The Military station comprises of 6 large Regimental Centres and many smaller units. The approximate strength of the serving personnel and their families is 25,000. Besides the unit Regimental Medical Officers, a large tertiary care hospital and a Station Health Organization is available to provide health care. RESULT: A total of 266 patients including 192 serving personnel and 74 of their dependents were hospitalized for dengue between 15 May 2013 and 28 Jul 2013. Many dependents not having severe symptoms, were not hospitalized and treated on outpatient basis. Health advisories and instructions for constituting Dengue Task Force (DTF) were issued well in advance. Preventive measures were instituted early. But the outbreak was controlled only after intervention from higher administrative authorities. Lessons learnt included correct and timely perception of threat is essential; behavioural change of individuals is desired; availability of adequate health functionaries is mandatory; and complete dataset helps correct perception. CONCLUSION: Future strategy for control of dengue outbreak should include repeated and timely survey of entire area for correct risk perception, assessment of behavioural change among individuals; operational research to assess the impact of ongoing public health campaign.

Outbreak investigation: Salmonella food poisoning.

BACKGROUND: An outbreak of food poisoning was reported from a Military establishment on 29 May 2011 when 43 cases of food poisoning reported sick in a span of few hours. METHODS: A retrospective-prospective study was conducted. Data regarding the onset of symptoms, presenting features and history of food items consumed was collected. A detailed inspection of the mess for hygiene and sanitary status, cooking and storage procedure, and rodent nuisance was also carried out. RESULTS: A total of 53 cases of food poisoning occurred between 29 and 31 May 2011. All cases had symptoms of diarrohea followed by fever (96.2%), headache (84.9%), abdominal pain (50.1%), nausea and vomiting (49.1%) and bodyache (39.6%) respectively. Based on the Attributable Risk (AR = 46.67%) and Relative Risk (RR = 4.5, 95% CI = 1.22-16.54) Potato-bitter gourd vegetable served during dinner on 28 May 2011 was incriminated as the food item responsible for outbreak. CONCLUSION: Symptomatology, incubation period and presence of rodent nuisance suggested contamination of Potato-bitter gourd vegetable with non-typhoidal Salmonella spp.

Tobacco consumption and its association with education among women residing in a rural area of Maharashtra: A cross-sectional study.

BACKGROUND: Tobacco use is increasing among women and girls across the globe as well as in all parts of India. In India, 8 to 10 lakh people die due to tobacco related diseases every year. This tobacco epidemic among women needs to be prevented. OBJECTIVES: Study was conducted to find the prevalence and pattern of tobacco consumption and it's association with education among females (15-49 years) in a rural village of Pune, Maharashtra, India. MATERIAL AND METHODS: A cross-sectional study was carried out among 313 females (15-49 years) in a rural field practice area of a Medical College in Pune during Feb 11 to May 11. Pre-tested questionnaire was used for collecting data by interview after obtaining informed consent. Statistical analysis was performed (Epinfo software version 3.5.3.). RESULTS: Out of 313 female studied, 14.05% (44) and 0.96% (03) were found to be current and former tobacco user respectively while 84.98% (266) never used any form of tobacco in their lifetime. Mishri consumption (45%) was commonest form of smokeless tobacco use followed by quid use (36%). Majority of the tobacco users (54.55%) were illiterate. There was significant association between tobacco consumption and education level (p = 0.0295). Tobacco consumption was more with increasing age. CONCLUSION: Tobacco consumption was found to be prevalent in 14.05% of women. Almost all of them used smokeless tobacco, mainly mishri. Tobacco consumption was directly associated with age and inversely with educational level. Therefore increasing women's literacy may bring down tobacco use among women.