Suicide and deliberate self-harm among women in Nepal: a scoping review.

BACKGROUND: Suicide is a growing public health problem globally. Suicide accounts for 70% of violent deaths among women in low and middle income countries. In Nepal suicide is the single leading cause of death among women of reproductive age. The aim of this scoping review is to explore and understand the various contexts related to vulnerability of Nepalese woman towards suicide and deliberate self-harm. METHODS: A scoping review based on Arksey and O'Malley's methodological framework including a combination of peer-reviewed publications and grey literature was conducted. The National Library of Medicine's PubMed and Google Scholar search engines were used during July 2019 applying a Boolean search strategy. RESULTS: Suicide incidence was found to be higher among younger age group and married women, with poisoning as the most common means of suicide. Psychosocial and economic factors such as abuse, interpersonal conflicts, marital disputes, relationship problems, adjustment problems, unpaid loans and financial losses; and mental health conditions such as mood disorder, adjustment disorder and substance abuse disorder were found to be contributing factors for suicide and deliberate self-harm among women in Nepal. CONCLUSION: Socio-cultural and economic factors shape family and marital relationships which impacts psycho-social and mental wellbeing of women in Nepal inciting suicidal attempts and deliberate self-harm. However, very few studies were found that explore the context of poverty, social exclusion, gender inequality, education, traditional/cultural and patriarchal system in which suicide among women in Nepal occurs.

A preliminary study of skin bleaching and factors associated with skin bleaching among women living in Zimbabwe.

BACKGROUND: Skin bleaching was reported to be commonly practiced among women and Africa was reported to be one of the most affected yet the subject is not given much attention in public health research in Zimbabwe despite the adverse effects of skin bleaching on health. METHOD: This study was an exploratory cross-sectional survey to explore skin bleaching, skin bleaching patterns and factors associated with skin bleaching among women living in Zimbabwe. An online self-administered questionnaire was sent out to women on social network i.e. WhatsApp, Facebook, LinkedIn and Twitter. FINDINGS: A total number of 260 respondents, mean age 31.69 (SD, 8.12) years participated in the survey. The prevalence of skin bleaching among the participants was 31.15%. The major reason reported for skin bleaching was to have smooth and healthy skin alongside other factors such as beauty, gaining social favours for example getting married and good jobs. Occupation, complexion and marital status were associated with skin bleaching. The odds of skin bleaching for participants who were employed was 1.45(95% confidence interval [CI],0.32-1.91);p-value 0.02, dark skinned participants 2.56(95% CI, 0.76-2.87);p-value 0.01 and unmarried participants 2.87(95% CI,0.29-3.58);p-value 0.03. CONCLUSION: Evidence from the research suggests skin bleaching might be common among women living in Zimbabwe and possibly poses serious health threats to the women. Skin bleaching seems to be deep rooted in colourism. The colourism seems to be taken advantage of by the cosmetic industry which produce the potentially hazardous products which promise the revered light skin to women but which comes with a price. However, the study provides a base for future studies to explore more on skin bleaching practices among women living in Zimbabwe.

Health-Related Quality of Life After the 2015 Gorkha Earthquakes, Among Older Adults Living in Lalitpur District of Central Nepal.

OBJECTIVE: Health-related quality of life (HQL) among older adults is often neglected and underprioritized in developing countries and is further burdened during natural disasters, such as earthquakes. The main objective of this study was to explore the factors affecting HQL among older adults living in Lalitpur District of Nepal. METHODS: A total of 362 older adults participated in this study. Questionnaires were used to interview the respondents on various aspects, such as posttraumatic stress disorder (PTSD) and depression, functional ability, and social support. An analysis was made to explore the factors affecting HQL. RESULTS: HQL scores ranged between 3.13 and 90.63. A majority of the respondents (215/362; 59.4%) scored ≤ 50, indicating poorer HQL. The multivariate analysis found the impact of the following factors on HQL: functional status (ß = 0.295; P < 0.001), PTSD (ß = -0.225; P < 0.001), chronic disease (ß = -0.168; P < 0.001), social support (ß = 0.120; P = 0.019), injury (ß = -0.104; P = 0.024), age (ß = -0.116; P < 0.001), and accessibility to resources. CONCLUSION: Poor HQL of older adults was dependent on various factors. The disaster preparedness program in Nepal needs urgent attention to address the concerns of older adults by incorporating the findings from this study.

Advertisement of antibiotics for upper respiratory infections and equity in access to treatment: a cross-sectional study in Nepal.

BACKGROUND: Pharmaceutical companies actively advertise their branded antibiotics, which influence their sales at community pharmacies. The major proportion of out of pocket health spending is on medicine; and affordability of antibiotics has always been a crucial issue in most developing countries. This study identified promotional activities adopted by pharmaceutical companies in community pharmacies and medicine shops and the affordability of selected antibiotics to clients with lowest wages in Kavrepalanchok district of Nepal. METHODS: A cross-sectional study was conducted among all community pharmacies and medicine shops (n = 34) in Dhulikhel and Banepa. Available pharmacists / personnel were interviewed, using a structured questionnaire, on the characteristics of the pharmacies, promotional activities, and sales and prices of antibiotics used to treat acute upper respiratory tract infections. This study looked at the association of promotional activities (financial bonus, free samples, and books/brochure/gifts) with the type of antibiotics. Further, affordability was assessed of the most popular antibiotics by comparing the total treatment cost against the lowest wage for unskilled workers in Nepal. RESULTS: Financial bonus, free samples, and brochures were the most popular promotional activities. It is also noticed that antibiotics which are top selling were those with a high number of promotional activities. Amoxicillin, azithromycin and amoxicillin+clavulanate had 42, 29 and 17 promotional activities respectively. Irrespective of the prices of antibiotics, almost all of the most popular antibiotics for acute upper respiratory infections were unaffordable for unskilled workers costing them more than a day's wage. CONCLUSIONS: Upper respiratory tract antibiotics are widely promoted at community pharmacies. The treatment cost of antibiotics is unaffordable for unskilled workers in Nepal irrespective of the type and unit cost of antibiotics.

The social determinants of health of the Urak Lawoi' of southern Thailand.

BACKGROUND: Traditionally, most Western models of health viewed sickness and disease as a product of individual factors such as personal behaviors and genetic predisposition; consequently, healthcare interventions were largely focused on fixing the individual, with little attention placed on contributing external factors. The WHO's "Social Determinants of Health" (SDH) framework, however, takes a broader ecological perspective that suggests that interventions must occur at multiple levels in order for good health to be achieved on an equitable basis. This model views health as a function of many circumstantial and environmental factors that are continuously and simultaneously interacting across multiple domains. These factors include structural mechanisms, such as laws and policies; socio-economic conditions, such as education and occupation; and intermediary circumstances, such as living and working conditions. Utilizing the SDH framework as a guide, this qualitative study sought to identify which specific determinants are most significant and present the greatest risk to the health and well-being of the Urak Lawoi' (UL), a "sea nomad" group indigenous to southern Thailand. METHODS: Interviews, household surveys, and focus group discussions were utilized to gather primary data from 71 subjects in three different UL communities in southern Thailand. In addition, a comprehensive literature review of relevant international mechanisms, national laws, and national policies was conducted. All data collected was analyzed and coded utilizing HyperRESEARCH. RESULTS: In all three communities, education and livelihoods were found to be the most critical determinants. Additionally, land grabbing and living conditions were identified as dire issues on Ko Lipe. The law and policy review revealed several deviations between international mechanisms and national laws and policies in both enshrinement and enforcement, with the Royal Thai Government (RTG) often overlooking the interests of the UL when formulating laws and policies. CONCLUSIONS: The above-mentioned determinants, along other structural and intermediary determinants, are synergizing, thereby placing the UL at increased risk of poorer health and health outcomes compared to other Thais living in the same vicinities. To rectify this, the RTG must reform national laws and policies that harm the UL, and civil society must hold them accountable. Several recommendations are offered to achieve a better future for the Urak Lawoi'.

Mass Gatherings and Public Health: Case Studies from the Hajj to Mecca.

BACKGROUND: Many new and challenging risks can be introduced during mass gatherings. The Hajj, as one of the largest mass gatherings, provides an excellent annual opportunity to reflect on the public health risk posed by international and multicultural crowds and the value of mitigation strategies. OBJECTIVES: To identify the gap between preparation and training taken before being exposed to the mass gathering and postexposure experiences, and the breach between the expectations and reality of the holy place. METHODS: This was a qualitative study with in-depth interviews using semistructured questionnaires among Hajjis from 4 different countries (Bangladesh, Pakistan, Myanmar, and New Zealand). Purposive sampling was done. The present study was also supported by literature review. FINDINGS: Findings pointed to weaknesses in implementation and enforcement of law, for both the custodian country and countries of origin of Hajjis. Disparities among developed and developing countries were also noticeable. CONCLUSIONS: From a global health and human security perspective, strengthening of core capacities in managing mass gatherings as well as researching risks posed by such gatherings are paramount to safeguard the public's health. Attention of health professionals worldwide and adoption of strategic planning at custodian country and sending countries are obligatory.

The use of non-standard motorcycle helmets in low- and middle-income countries: a multicentre study.

BACKGROUND: The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. METHODS: Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. FINDINGS: 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. INTERPRETATION: Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.

Adolescent Health, Global Guidelines Versus Local Realities: The Sub-Saharan Africa Experience.

As the field of adolescent sexual and reproductive health (ASRH) evolves, further discussion and documentation of national policy and aspects of its implementation is needed to ensure effectiveness of interventions. Further research is required to foster beneficial shifts in policy advocacy, including resource allocation, and in the prioritization of adolescent programs in health and education systems, in communities and in workplaces. Adolescents are exposed to diverse interventions across all the countries under discussion; however there exist obstacles to realization of ASRH goals. In some countries, there exist a conflict of interest between national laws and global policy guidelines on ASRH; moreover national laws and policies are ambiguous and inconsistent. In addition, there have been strong negligence of vulnerable groups such as HIV positive adolescents, pregnant street youth; young sex workers; orphans; adolescents in conflict areas; adolescent refugees; adolescent girls working in the informal sectors and very young adolescents, likewise many adolescents in rural areas remain largely underserved. Furthermore there are consistently less disaggregated data available on adolescents' key indicators for comparative purposes signifying considerable knowledge gaps. There are multiple obstacles to the realization of ASRH and need for research combining both qualitative and quantitative approaches to determine the extent to which factors are either conducive or impeding to consistency between global guidelines, national ASRH policies, and actual policy implementation.

A pilot use of team-based learning in graduate public health education.

This pilot study was undertaken to determine the impact of team-based learning (TBL) on graduate students of public health in a Thai context. The pilot project adopted Michaelsen's approach with the aim of improving learning among Thai graduate students enrolled in public health ethics. This TBL approach attempted to motivate students to do pre-class reading and be active "in-class" learners. Pre-class preparation allowed teachers to address and concentrate on learning gaps, while team work promoted peer interaction and active learning. TBL was found to be useful in fostering student preparedness and to transform "passive" into "active" learning, which especially benefited students "academically at risk" through peer teaching opportunities. With TBL, students valued the relevance of the course content and learning materials. They had positive opinions regarding the effect of TBL on individual and group learning. TBL was perceived to be instrumental in translating conceptual into applicable knowledge, and stimulated individual efforts as well as accountability. This study should be useful to those considering using TBL for public health education.

Factors affecting decision making of low-income young women with unplanned pregnancies in Bangkok, Thailand.

Unplanned pregnancy is one of the most difficult life experiences for young women. Women are often confused and seek help and support. When the problem occurs, a woman has three choices: parenting the baby, planning for adoption, or terminating the pregnancy. Choosing one of these three options is often difficult. This study aimed to identify the factors (variables) influencing women's decision making when choosing the options available to them. The study was conducted in five shelters and low-income communities in the Bangkok area. Data were collected for five months, November 2003 to March 2004. Young women, age 13-24, who experienced an unplanned pregnancy at least once, or currently experiencing an unplanned pregnancy, were recruited into the study. One hundred and twenty volunteer cases were recruited. Discriminant analysis was used to determine the factors that affecting the choices of young women with unplanned pregnancies. There were 6 potential influencing variables, in three broad categories of factors that influenced their choices. In this study, the influencing factors from the personal history variables were, age of the most recent unplanned pregnancy. The individual psychosocial variables were: attitude towards unplanned pregnancy, attitude towards contraception, and making a decision without consultation. The relationship variables were: relationship with partner, and consulting partner when having a problem. The results from discriminant analysis yielded 68.3% predictive accuracy. This result was satisfactory compared with a 33% chance of accuracy (classified as chance alone would yield a 33% accuracy). Knowing the influencing factors for the choices of young women with unplanned pregnancies allows us to understand the women's decisions and their utilization of services with some degree of confidence. The program managers or implementers should do as much as possible to support the decision making process in these young women in order to provide better information and services to reduce the impact, both physical and mental, of the selected choice.