Reproductive morbidity in a village of Kathmandu.

BACKGROUND: Reproductive morbidity has been a less studied area in developing countries. Prevalence of reproductive morbidity and health seeking behavior pertaining to it is little known. To reveal the magnitude, this study was carried out in a village of Kathmandu district. The objective of the study was to find out prevalence of reproductive morbidity and service utilized for them. METHODS: A random cross-sectional study was carried out among 200 women of reproductive age years in a village using household survey and structured questionnaire. RESULTS: The study revealed that 72 percent (144) women of reproductive age years have experienced reproductive problem. Gynecological problems contributed for 81 (40%) women and obstetric problems for about 51% of the married women (48 out of 94). Service seeking was found to be very low for gynecological morbidity. CONCLUSIONS: Reproductive morbidity was found to be very high in the community. The prevalence of obstetric morbidity was almost in half the study population, whereas gynaecological morbidity was about forty percent among the women of reproductive age group. However, seeking care for reproductive morbidity was low which requires more attention.

Implementation status of self-assessment/peer-group discussion program: a bottom-up approach of monitoring/supervision in improving quality of health services.

BACKGROUND: Monitoring/supervision is an essential component for improving the quality of health services including rational use of medicines. A new bottom-up approach of monitoring/supervision consisting of self-assessment/ peer-group discussion was found to be effective in improving prescribing practices. The new strategy significantly improved the prescribing practices based on standard treatment guidelines. The government has implemented it as a Program in primary health care services of Nepal. This article aims to share the implementation status of the self-assessment/peer-group discussion Program for improving the prescribing practices of common health problems and availability of drugs in the district health system. METHODS: Concurrent mixed research design was applied for data collection. The data were collected at different levels of health care system using in-depth interviews, participatory observations and documentary analysis. RESULTS: The Management Division, Department of Health Services implemented the Program in 2009-10 and the PHC Revitalization Division, DoHs is the implementation division since 2010-11. The Program comprised revision of participant's and trainer's manuals, training of trainers and prescribers, finalisation of health conditions and indicators, distribution of carbon copy prescription pads, and conduction of peer-group discussions.The Program was implemented in number of districts. CONCLUSIONS: The government made the policy decision to implement the Program for monitoring prescribing practices and the availability of free drugs in districts. However, it has covered only few districts and needs escalation to cover all 75 districts of the country.

Review of health and health service improvements in Nepal.

Nepal has made great progress regarding maternal and childhood mortality over the past two decades. A visionary leadership, coupled with the implementation of targeted interventions and programmes have resulted in improved MNCH indicators and marked decline in mortality. Maternal deaths have dropped by almost half from 539 per 100,000 live births in 1996 to 281 in 2006. Although neonatal mortality rates have stagnated in recent years, the overall childhood mortality has improved. This article tracks changes made in key indicators (mortality, fertility and service indicators including immunisation, family planning, maternal, neonatal and child over time and provides an overview of successful programmes that have led to this accomplishment.

Testing a scalable community-based approach to improve maternal and neonatal health in rural Nepal.

OBJECTIVE: The aim of the study was to determine the feasibility of improved maternal-neonatal care-seeking and household practices using an approach scalable under Nepal's primary health-care services. STUDY DESIGN: Impact was assessed by pre- and post-intervention surveys of women delivering within the previous 12 months. Each district sample comprised 30 clusters, each with 30 respondents. The intervention consisted primarily of community-based antenatal counseling and dispensing and an early postnatal home visit; most activities were carried out by community-based health volunteers. RESULT: There were notable improvements in most household practice and service utilization indicators, although results regarding care-seeking for danger signs were mixed. CONCLUSION: It is feasible in a Nepal setting to significantly improve utilization of maternal-neonatal services and household practices, using the resources available under the government primary health-care system. This has the potential to significantly reduce neonatal mortality.

Transition of HIV epidemic in Nepal.

Nepal is experiencing transition of HIV epidemic from a high-risk behavior groups to low risk behavior population like housewives. The ratio of housewives infected with HIV among all HIV infected women has almost equaled. The estimation also shows that housewives have acquired HIV three times more than the female sex workers in absolute numbers. It is a matter of concern for all those working in HIV/AIDS and also a serious challenge to achieve the millennium development goals.

Immunisation programme of Nepal: an update.

Nepal initiated Expanded Programme on Immunisation (EPI) in the fiscal year 1978/79. By the next decade the programme was expanded to all the 75 districts of the country. However, due to various structural changes, the programme lagged behind and the national coverage of immunisation to around 80% could be reached by the year 2000 only. By 2004, some Vaccine Preventable Diseases (VPD), namely neonatal tetanus, diphtheria and poliomyelitis are reported to be reduced drastically. However, despite good coverage, measles and tuberculosis still remain prevalent.

HIV / AIDS in Nepal: an update.

HIV/AIDS is a growing problem in Nepal. There has been a 15-fold increase in the number of HIV-infected cases during the period 1990-93. By 1993, 195 cases had been reported to the Ministry of Health. Among the total cases reported, approximately equal numbers of male and female HIV cases are represented. The current estimate of HIV-infected individuals is 5000; however, the number is projected to reach cumulatively 100,000 by the year 2000 if effective preventive measures are not taken. Commercial sex workers and their clients remain the most affected groups. The majority of HIV-infected cases belong to the 20-29 age group. HIV surveillance data indicate that the overall positivity rate increased from 0.20 to 0.70 over the 12-month period, 1991-92. Of the total 195 HIV-infected cases, 24 (12.3%) are reported to be AIDS cases. The AIDS cases doubled between 1991 and 1993. There are three times as many AIDS cases among females than males. Of the total 24 AIDS cases, 11 have died. Case studies illustrate the multi-faceted context in which HIV/AIDS is spreading in Nepal.