Socioeconomic Determinants of Inequalities in the Use of Modern Contraception among Currently Married Women.

BACKGROUND: Despite interventions for over four decades, the unmet need for family planning is high in Nepal. This study aims to examine the status and the socioeconomic determinants of inequalities in modern contraception among currently married women. METHODS:  We applied a mixed-method design. We interviewed key informants for qualitative information and analyzed secondary data from the Nepal Multiple Indicator Cluster Survey, 2019, and different rounds of Nepal Demographic and Health Surveys. We calculated ratios, differences in percentages, and concentration indices to analyse the inequality. We ran a binary logistic regression model to estimate the adjusted effect of each factor on the use of modern contraception. RESULTS:  The richest-to-poorest difference in using modern contraception has decreased over 13 years. The richest-to-poorest difference decreased from 23.6 percentage points in 2006 to 13.3 percentage points in 2011 and further to 1.2 percentage points in 2016. The richest-to-poorest difference was negative in 2019, indicating poor people are using more contraception than the richest. Multivariate analysis showed the wealth is a significant predictor for using contraception. Women of richer households (aOR=1.29, 95% CI=1.13-1.48), middle (aOR=1.21, 95% CI=1.05-1.40), poorer (aOR=1.36, 95% CI 1.17-1.58) and poorest (aOR=1.18, 95% CI=1.05-1.34) were more likely to use contraception than women from the richest households. CONCLUSIONS: Poor people are increasingly using the modern contraception, and the gap between the poor and rich people has decreased. However, the trend of contraception use in each wealth quintile indicates that Nepal struggles to meet the sustainable development goal target of reducing the unmet need for family planning to less than 10% by 2030.

A mandatory bonding service program and its effects on the perspectives of young doctors in Nepal.

INTRODUCTION: To address regional differences in the distribution of health workers between rural and urban areas, the Nepal government has adopted the policy of deploying fresh medical graduates to remote areas for 2 years under a compulsory bonding service program. However, the impact of such an approach of redistribution of human resources for health is not well understood, nor is the experience of the health workers who are deployed. This study aimed to understand the experience of the medical graduates who have served under the bonding service program and suggest ways to improve the program as well as to make health service provision easier through the young doctors. METHODS: A semi-structured questionnaire-based survey was administered online to 69 young medical doctors who had worked under the bonding service program. The responses were analysed qualitatively and the findings were presented in separate pre-established domains. RESULTS: Most young doctors felt they were not adequately prepared for the bonding service program. Adapting to the deployed place and to the local culture was a challenge to some young doctors, which hindered their potential to serve the local community. Most found the response from the rural communities to be positive even though they faced some challenges in the beginning. While the young doctors found serving the rural communities motivating, they felt that they were limited in their capacity to provide an optimal level of health service due to limitations of infrastructure and medical equipment. They also felt that the compulsory bonding program had stunted their growth potential as medical doctors without adequately compensating them for their time and service. CONCLUSION: Despite the program's noble intentions, the medical doctors who were involved with the bonding service program felt that the program had yet to address several basic needs of the doctors who were deployed for service provision. In order to motivate the doctors to work in rural areas in future after the compulsory binding has ended, the stakeholders need to address the existing gaps in policies and infrastructure.

Fragmented QRS complexes have predictive value of imperfect ST-segment resolution in patients with STEMI after primary percutaneous coronary intervention.

OBJECTIVES: To investigate the clinical characteristics of patients with the fragmented QRS complexes (fQRS) and the predictive value of fQRS in patients undergoing primary percutaneous coronary intervention (p-PCI). METHODS: The study enrolled 227 consecutive patients with ST-elevation myocardial infarction who underwent p-PCI. Baseline clinical characteristics, the percentage of ST-segment resolution, and parameters of electrocardiography and coronary angiography were investigated. The relationship between fQRS on pre-PCI and post-PCI electrocardiogram and the percentage of ST-segment resolution after PCI were studied. RESULTS: Patients with fQRS have higher troponin I, creatine kinase-MB levels, prolonged QRS duration, higher Gensini score, lower percentage of total ST-segment resolution, and left ventricular ejection fraction compared with patients without fQRS. Gensini score (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.002-1.024; P < .006) and percentage of total ST-segment resolution (OR, 0.384; 95% CI, 0.186-0.795; P = .01) were independently associated with the presence of fQRS. A multivariate logistic regression analysis selected presence of fQRS pre-PCI (OR, 2.908; 95% CI, 1.095-7.723; P = .032) and the number of leads with fQRS before PCI (OR, 1.582; 95% CI, 1.250-2.002; P < .001) as independent predictors of imperfect ST-segment resolution. CONCLUSIONS: The presence of fQRS is a predictor in ST-elevation myocardial infarction patients undergoing p-PCI. The occurrence of fQRS is beneficial to identify the patients with severe coronary lesion, left ventricular contraction dysfunction, and larger areas of ischemic injury.

Women's Satisfaction of Maternity Care in Nepal and Its Correlation with Intended Future Utilization.

The impact of rapid increase in institutional birth rate in Nepal on women's satisfaction and planned future utilization of services is less well known. This study aimed to measure women's satisfaction with maternity care and its correlation with intended future utilisation. Data came from a nationally representative facility-based survey conducted across 13 districts in Nepal and included client exit interviews with 447 women who had either recently delivered or had experienced complications. An eight-item quality of care instrument was used to measure client satisfaction. Multivariate probit model was used to assess the attribution of different elements of client satisfaction with intended future utilization of services. Respondents were most likely to suggest maintaining clean/hygienic health facilities (42%), increased bed provision (26%), free services (24%), more helpful behaviour by health workers (18%), and better privacy (9%). Satisfaction with the information received showed a strong correlation with the politeness of staff, involvement in decision making, and overall satisfaction with the care received. Satisfaction with waiting time (p = 0.035), information received (p = 0.02), and overall care in the maternity care (<0.001) showed strong associations with willingness to return to facility. The findings suggest improving physical environment and interpersonal communication skills of service providers and reducing waiting time for improving client satisfaction and intention to return to the health facility.

Atrial fibrillation: recent advances in understanding the role of microRNAs in atrial remodeling with an electrophysiological overview.

Atrial fibrillation (AF) is a highly prevalent condition associated with pronounced cardiovascular-related morbidity, mortality and socioeconomic burden. It accounts for more hospitalization days than does any other arrhythmia. This article reviews the basic electrophysiology of AF, electrical and structural remodeling in AF and recent advances in understanding the molecular mechanisms of AF in relation to specific microRNAs. This paper also reviews the potential role of microRNAs as novel therapeutic targets as well as biomarkers in the management of AF. AF shows characteristics typical of altered electrophysiology that promote ectopic activity and facilitate reentry, thereby contributing to the progression from short paroxysmal AF to a persistent, permanent form via atrial remodeling, even in the absence of progressive underlying heart disease. MicroRNAs have been suggested to influence the development of AF by regulating gene expression at the post-transcriptional level. Increasing evidence has identified various microRNA modifications and their impacts on AF initiation and maintenance through electrical and structural remodeling. The discovery of specific microRNAs as novel therapeutic targets and some experimental evidence implicating microRNAs as potential molecular diagnostic markers have had a significant impact on the diagnosis and management of AF and demand further research.

Inequalities in the use of family planning in rural Nepal.

This paper explores inequalities in the use of modern family planning methods among married women of reproductive age (MWRA) in rural Nepal. Data from the 2012 Nepal Household Survey (HHS) were utilized, which employed a stratified, three-stage cluster design to obtain a representative sample of 9,016 households from rural Nepal. Within the sampled households, one woman of reproductive age was randomly selected to answer the survey questions related to reproductive health. Only four out of every ten rural MWRA were using a modern family planning method. Short-acting and permanent methods were most commonly used, and long-acting reversible contraceptives were the least likely to be used. Muslims were less likely to use family planning compared to other caste/ethnic groups. Usage was also lower among younger women (likely to be trying to delay or space births) than older women (likely to be trying to limit their family size). Less educated women were more likely to use permanent methods and less likely to use short-term methods. To increase the CPR, which has currently stalled, and continue to reduce the TFR, Nepal needs more focused efforts to increase family planning uptake in rural areas. The significant inequalities suggest that at-risk groups need additional targeting by demand and supply side interventions.

Unmet need for family planning in Nepal during the first two years postpartum.

Contraceptive use during the postpartum period is critical for maternal and child health. However, little is known about the use of family planning and the determinants in Nepal during this period. This study explored pregnancy spacing, unmet need, family planning use, and fertility behaviour among postpartum women in Nepal using child level data from the Nepal Demographic and Health Surveys 2011. More than one-quarter of women who gave birth in the last five years became pregnant within 24 months of giving birth and 52% had an unmet need for family planning within 24 months postpartum. Significantly higher rates of unmet need were found among rural and hill residents, the poorest quintile, and Muslims. Despite wanting to space or limit pregnancies, nonuse of modern family planning methods by women and returned fertility increased the risk of unintended pregnancy. High unmet need for family planning in Nepal, especially in high risk groups, indicates the need for more equitable and higher quality postpartum family planning services, including availability of range of methods and counselling which will help to further reduce maternal, perinatal, and neonatal morbidity and mortality in Nepal.