Exponentiated Odd Lomax Exponential distribution with application to COVID-19 death cases of Nepal.

This study suggested a new four-parameter Exponentiated Odd Lomax Exponential (EOLE) distribution by compounding an exponentiated odd function with Lomax distribution as a generator. The proposed model is unimodal and positively skewed whereas the hazard rate function is monotonically increasing and inverted bathtubs. Some important properties of the new distribution are derived such as quintile function and median; asymptotic properties and mode; moments; mean residual life, mean path time; mean deviation; order statistics; and Bonferroni & Lorenz curve. The value of the parameters is obtained from the maximum likelihood estimation, least-square estimation, and Cramér-Von-Mises methods. Here, a simulation study and two real data sets, "the number of deaths per day due to COVID-19 of the first wave in Nepal" and ''failure stresses (In Gpa) of single carbon fibers of lengths 50 mm", have been applied to validate the different theoretical findings. The finding of an order of COVID-19 deaths in 153 days in Nepal obey the proposed distribution, it has a significantly positive relationship between the predictive test positive rate and the predictive number of deaths per day. Therefore, the intended model is an alternative model for survival data and lifetime data analysis.

Utilization of Family Planning Methods Among Postpartum Mothers in Kailali District, Nepal.

BACKGROUND: Postpartum contraceptives use offers a distinctive opportunity to maintain appropriate birth spacing for health benefits to both mother and child. However, the concept of postpartum family planning (PPFP) is poorly understood and contraceptives use during the postpartum period remains low in Nepal. Therefore, this study aimed to assess the factors affecting the utilization of family planning (FP) methods among postpartum mothers in the Kailali district, Nepal. METHODS: A community-based cross-sectional study was conducted between September and October 2013 among postpartum mothers in Kailali district. Simple random sampling was applied to select a total of 427 study participants. A pre-tested standard semi-structured questionnaire was used for gathering data. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. RESULTS: Overall, 32.8% of the postpartum women used different types of contraceptives. Condoms (37.1%) followed by Depo-Provera 29.3% were the most used postpartum contraceptives. Half (50%) of the postpartum women had an unmet need for family planning. Multiple logistic regression model revealed that the occupation of husband [AOR=3.2 (95% CI: 2.0-6.00], past use of family planning methods [AOR=4.0 (95% CI:2.4-6.5)] and resumption of menstruation [AOR=2.5 (95% CI:1.6-4.1)] were significantly associated with the use of modern contraceptives during the first year of the postpartum period. CONCLUSION: Contraceptive uptake within the first year of postpartum was found to be low among women in the Kailali district, Nepal. Previous experience with the use of family planning methods, occupation of the husbands, and resumption of menstruation are important factors in the PPFP decisions of women in this population. Therefore, the family planning program should work on improving couples' knowledge of the risk of pregnancy, fertility returning time and modern contraceptives use during the postpartum period targeting women whose husbands are in migrant occupations, who are not menstruating and who have not used FP before.

Fertility Desire and Its Determinants Among People Living with HIV in Antiretroviral Therapy Clinic of Teku Hospital, Nepal.

BACKGROUND: Pregnancy in people Living with HIV/AIDS (PLHIV) involves significant public health risks, including the risk of HIV transmission to uninfected partners and the fetus. Despite the growing importance of fertility issues for HIV-infected people, little is known about their fertility desires in Nepal. This study, therefore, aimed to determine the magnitude of and factors associated with the fertility desire of PLHIV. PATIENTS AND METHODS: A cross-sectional study was conducted among 280 PLHIV attending the antiretroviral therapy (ART) clinic in Teku Hospital, Nepal. A standard semi-structured questionnaire was administered to participants using systematic random sampling. Data were entered using Epi-data 3.1 and analyzed using SPSS software version 20. RESULTS: Out of the total participants, 12.1% desired to have a child. Among those having this desire, 44.1% had not decided when to have a child. Reasons for desiring a child were having no children (44.1%), wanting to have a child of different sex than the previous one (29.4%), followed by wanting to have another child (26.5%). Factors such as being male (COR: 3.1, 95% CI: 1.3-7.0), being ≤40 years of age (COR: 3.8, 95% CI: 1.5-9.4), higher age at marriage (COR: 7.7, 95% CI: 1.5-39.6), middle socio-economic status (COR: 3.5, 95% CI: 1.7-7.3), having no children (COR: 22.9, 95% CI: 8.6-60.8) or fewer children (COR: 74.8, 95% CI: 9.7-575.1), greater CD4 count (COR: 2.8, 95% CI: 1.3-5.9) and having moderate knowledge of prevention of mother-to-child transmission (COR: 5.4, 95% CI: 2.3-12.7) had higher odds of having fertility desire. CONCLUSION: Around one in every ten participants had a desire for fertility despite their HIV status. This calls for special attention in promoting integrated services for HIV and reproductive health. It will be important to include counseling and other services for those with fertility desire alongside providing ART.

Older people's satisfaction with and utilisation patterns of the Old Age Allowance in Nepal.

OBJECTIVE: The Old Age Allowance in Nepal aims to support the welfare of older people, to improve their social and economic status and to encourage independence. The aim of this study was to assess satisfaction with and utilisation patterns of the Old Age Allowance among older people in Nepal. METHODS: A cross-sectional, quantitative study was conducted in Chitwan, Nepal. Face-to-face interviews were carried out with 232 older people asking about demographics, and satisfaction and utilisation of Old Age Allowance. RESULTS: Seventy-two per cent of older people expressed satisfaction with the Old Age Allowance. The highest satisfaction level (81.9%) was associated with the satisfaction scale construct of contribution to religious practices. Satisfaction with the allowance was associated with family relationships and dissatisfaction with higher expectations of allowance. The allowance was predominantly utilised for personal expenditure (91.4%), followed by health and medicine (75.0%). CONCLUSION: The Old Age Allowance is a necessary and important contribution to keeping older people connected with family and community.

Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal: a retrospective cohort study.

OBJECTIVES: Isoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has been no systematic assessment of IPT initiation and completion rates among PLHIV. We aimed to assess IPT initiation and completion rates in the Far-Western Region (FWR) of Nepal. DESIGN: We conducted a retrospective cohort study using secondary data extracted from registers maintained at ART centres. SETTING: All 11 ART centres in the FWR of Nepal. PARTICIPANTS: All PLHIV registered for care between January 2016 and December 2017 in 11 ART centres. PRIMARY OUTCOME MEASURES: IPT initiation and completion rates were summarised as percentages with 95% CI. Independent association between patient characteristics and non-initiation of IPT was assessed using cluster-adjusted generalised linear model (log binomial regression) and adjusted relative risk (RR) with 95% CI was calculated. RESULT: Of the 492 PLHIV included, 477 (97.0%) did not have active TB at registration. Among 477 without active TB, 141 (29.8%, 95% CI 25.7% to 34.1%) had been initiated on IPT and 85 (17.8%) were initiated within 3 months of registration. Of 141 initiated on IPT, 133 (94.3%, 95% CI 89.1% to 97.5%) had completed 6 months of IPT. Being more than 60 years of age (RR-1.3, 95% CI 1.1 to 1.7), migrant worker (RR-1.3, 95% CI 1.1 to 1.4) and not being initiated on ART (RR-1.4, 95% CI 1.1 to 1.8) were significantly associated with IPT initiation. CONCLUSIONS: In FWR of Nepal, three out of 10 eligible PLHIV had received IPT. Among those who have received IPT, the completion rate was good. The HIV care programme needs to explore the potential reasons for this low coverage and take context specific corrective action to fix this gap.

Adherence to antiretroviral treatment and associated factors among people living with HIV and AIDS in CHITWAN, Nepal.

BACKGROUND: Adherence to ART is the primary determinant of viral suppression and the risk of transmission, disease progression and death. Adherence of at least 95% is needed for optimal suppression. This study aimed at determining the adherence to Anti-Retroviral Therapy (ART) and its associated factors among People Living with HIV and AIDS in ART Center of Chitwan, Nepal. METHODS: A descriptive cross-sectional study was conducted among 231 clients aged 18 years to 49 years taking ART from Bharatpur Hospital of Chitwan and those who have been enrolled in ART for at least 6 months, were interviewed. Systematic Sampling technique was used. Semi-structured questionnaire was prepared by taking reference from the AIDS Clinical Trial group questionnaire (ACTG). Adherence was measured by patient self report. Data was entered Epi Data 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) software where the P value of < 0.05 was accepted as being statistically significant. The independent variables which were found significant at p-value 0.10 in bivariate analysis were fitted in multivariable logistic regression model. Multivariable logistic regression model was performed to know the net effect of the independent variables on Adherence to ART medication. RESULTS: The overall adherence in the last month was found to be 87.4%. Wrist watch and mobiles were seen as a facilitating factor for taking ART on time as clients taking ART used to set alarm to get informed of the medication time. Adherence was associated with female sex (AOR = 10.550 CI: 1.854-60.046), family consisting only parents and their children (AOR = 4.877, CI: 1.246-19.079), having no habit of taking alcohol (AOR = 5.842 CI: 1.294-26.383), HIV duration of more than 3 years (AOR = 10.055 CI: 2.383-42.430), picking up ART medications on their own (AOR = 7.861, CI: 1.670-36.998) and not having side effects of ART (AOR = 8.832, CI: 2.059-37.890). CONCLUSION: Identifying and evaluating the problems faced by ARV drug users can foster the achievement of ART related goals and addressing ART related problems in a rational way. Effective and appropriate monitoring of non adherence behaviors can help patients increase adherence level fostering improvement in treatment outcome.

Evaluation of teachers training workshop at Kirkpatrick level 1 using retro-pre questionnaire.

BACKGROUND: Teacher training focusing on teaching learning methodologies, assessment tools, and approaches that motivate the teachers and enhance their confidence is one of the fundamental programs of faculty development. The objective of this study was to assess the self-reported perceived confidence of faculty members after participating in a basic teachers training workshop. METHODOLOGY: The retrospective post-then-pre design questionnaire was used for evaluating the faculty members' self-reported perceived confidence at Kirkpatrick level 1 (evaluation of reaction) after completing basic teachers training workshops. The self-reported perceived confidence on 30 statements were analyzed by 3 categories (not confident, confident, and highly confident) on a Likert scale. RESULTS: Out of 60 participants (18 in the 3rd and 21 each in the 4th and 5th teachers training workshops), 58 (96.67%) responded to all statements. The mean age of the participants was 34.14±5.15 years; 70.7% were male and 29.3% female. Overall, the self-reported perceived confidence level of the participants of the 3rd (pre-training median 57, post-training median 70, p<0.001), 4th (pre-training median 51, post-training median 67, p<0.001) and 5th (pre-training median 51, post-training median 68, p<0.001) training workshops was significantly increased after training. There was a noticeable change in the level of confidence of the participants after training. The observed percentage change in self-reported perceived confidence was 29.63% in those who received no training prior to joining college (n=51, 87.9%); this was 2 times more than those who received some sort of training prior to teachers training (n=7, 12.1%). CONCLUSION: Overall, the self-reported perceived confidence level of the participants was significantly increased after teachers training workshop.