Inequalities in Childhood Immunisation in South Asia.

Identifying the inequalities associated with immunisation coverage among children is crucial. We investigated the factors associated with complete immunisation among 12- to 23-month-old children in five South Asian countries: Afghanistan, Bangladesh, India, Nepal, and Pakistan, using nationally representative data sets from the Demographic and Health Survey (DHS). Descriptive statistics, bivariate association, and logistic regression analyses were employed to identify the prevalence and the factors in each country that affect the likelihood of full childhood immunisation coverage. The complete childhood immunisation coverage varied significantly within each country in South Asia. Afghanistan had the lowest immunisation rates (42.6%), whereas Bangladesh ranked the highest in complete childhood immunisation rates, at 88.2%. Similarly, 77.1% of Indian children, 79.2% of Nepali children, and 62.2% of Pakistani children were completely immunised. Household wealth status strongly correlated with full childhood immunisation in Afghanistan, India, and Pakistan at the bivariate level. The results from the logistic regression showed that a higher maternal educational level had a statistically significant association with complete childhood immunisation in all countries compared to mothers who did not attend any school. In conclusion, the study revealed the inequalities of complete childhood immunisation within South Asia. Governments must be proactive in their endeavours to address universal and equitable vaccine coverage in collaboration with national and international stakeholders and in line with the relevant Sustainable Development Goals.

Migrant workers' health-related research in Nepal: A bibliometric study.

Background: In recent years, the health of migrants has become an important global public health issue. However, less is known about the current status of research activity among Nepalese migrants' health. This study aimed to assess the current status of research activity by analysing published peer review literature on Nepalese migrants' health. Methods: A systematic search of published literature on Nepalese migrant workers' health was conducted in Scopus, Medline, CINAHL, Embase, PsycINFO and Web of Science, and a bibliometric analysis methodology was used. The search of databases retrieved 520 records, and a total of 161 papers were included in the analysis. Bibliometric analyses were performed in R and VoSViewer to create visualisation maps. Results: The retrieved documents were published in the last three decades, and a total of 533 researchers originating from 24 countries contributed to the literature. A large proportion of papers (n=22) were published in a single year, in 2019, and the number of authors per journal ranged from one to 14. The topmost preferred journals for publications in Nepalese migrants' health were PLoS One (n=9), followed by the Journal of Immigration and Minority Health (n=6). The retrieved articles received 2425 citations, with an average of 15.1 citations per article. The study identified nine overlapping research domains (thematic areas) - infectious disease, non-communicable diseases, health and lifestyle, sexual and reproductive health, access to health services, workplace safety, maternal health, gender-based violence, and health system and policy. Conclusion: The present bibliometric study fills an analytical gap in the field of migrat's health research in Nepal and provides evidence and insights to advocate the formulation of strategies to promote the migrants' health vulnerabilities often associated with individual-related hazards such as working in 'difficult, dirty, and dangerous (3Ds) working conditions.

Acculturation Stressors and Academic Adjustment among Nepalese Students in South Korean Higher Education Institutions.

International students are steadily increasing in South Korean higher education institutions. How well international students are adjusted academically and the relationship between acculturation stressors and academic adjustment has not yet been determined. This study aimed to fill this research gap by examining the relationship between acculturation stressors and academic adjustment among Nepalese international students in South Korean higher education institutions. The sample of the study consisted of Nepalese students who enrolled in 36 universities in South Korea. Students' background characteristics and acculturation stressors were selected to examine the association between acculturation stressors and academic adjustment. Pearson correlation and hierarchical multiple regression were utilized. The results from the Pearson correlation revealed the negative correlation of perceived discrimination (r = -0.23, p < 0.01), perceived hate/rejection (r = -0.18, p < 0.05), perceived fear (r = -0.24, p < 0.01), and perceived cultural shock (r = -0.17, p < 0.05) with academic adjustment. Further, the hierarchical regression model revealed that perceived fear (ß = -0.220, p < 0.05) had a negative association with academic adjustment. Addressing acculturation stressors among international students is essential to facilitate a positive academic environment. Mainly, perceived fear has negatively affected students' academic adjustment. Based on these findings, tailored programs must be developed to curtail international students' perceived fear.

Perceived Risk Factors for Suicide among Nepalese Migrant Workers in South Korea.

(1) Background: In South Korea, far from their homeland, Nepalese migrant workers often face tremendous challenges. The most severe outcome for migrant workers is death by suicide-a major cause of premature death among migrant workers. Nevertheless, in the literature, key factors associated with suicide among Nepalese migrant workers are not specifically identified. Thus, we aimed to delineate the main suicide risk factors for this group of migrants. (2) Methods: We used qualitative research methodology (sample = 20; male =17, female = 3) and employed nominal group techniques to identify the perceived primary risk factors for suicide. (3) Results: Study participants identified and ranked eight sources of distress and perceived risks for suicide, both from home and in the host country. Perceived risks for suicide include a complex set of socio-cultural, behavioral, occupational, physical, and mental health issues as well as communication barriers. (4) Conclusions: The findings suggest the need to design tailored mental health promotion programs for migrant workers before departure from Nepal as well as after arrival as migrant workers in South Korea.

Inequalities in complete childhood immunisation in Nepal: results from a population-based cross-sectional study.

OBJECTIVE: To investigate the effect of different aspects of inequality on childhood immunisation rates in Nepal. The study hypothesised that social inequality factors (eg, gender of a child, age of mother, caste/ethnic affiliation, mother's socioeconomic status, place of residence and other structural barrier factors such as living in extreme poverty and distance to health facility) affect the likelihood of children being immunised. DESIGN: Using gender of a child, age of mother, caste/ethnic affiliation, mother's socioeconomic status, place of residence and other structural barrier factors such as living in extreme poverty and distance to health facility as independent variables, we performed bivariate and multivariate logistic regression analyses. SETTING: This study used data from the most recent nationally representative cross-sectional Nepal Demographic and Health Survey in 2016. PARTICIPANTS: The analysis reviewed data from 1025 children aged 12-23 months old. OUTCOME MEASURES: The main outcome variable was childhood immunisation. RESULTS: Only 79.2% of children were fully immunised. The complete vaccination rate of ethnic/caste subpopulations ranged from 66.4% to 85.2%. Similarly, multivariate analysis revealed that children from the previously untouchable caste (OR 0.58; CI 0.33 to 0.99) and the Terai caste (OR 0.54; CI 0.29 to 0.99) were less likely to be fully immunised than children from the high Hindu caste. CONCLUSION: Given Nepal's limited resources, we suggest that programmes that target the families of children who are least likely to be fully immunised, specifically those who are not only poor but also in financial crises and 'underprivileged' caste families, might be an effective strategy to improve Nepal's childhood immunisation rates.

Depression, Poverty, and Abuse Experience in Suicide Ideation Among Older Koreans.

We examined to what extent the depression, poverty, and elder abuse experience affect suicide ideation among older Koreans. The data from the Survey of Living Conditions and Welfare Needs of Korean Older Persons were used. A sample of 10,279 members was analyzed. Logistic regression analysis revealed that younger old (65-69 years) were more likely to have suicide ideation that oldest old (80 years and older). After including all predicting variables such as depression, poverty, and abuse experience, results showed that depression, poverty, and abuse experience remained predictors for suicide ideation. Higher level of depression ( OR = 1.19) was positively associated with suicide ideation. Poor older person ( OR = 1.59) and those who experienced abuse ( OR = 2.37) were more likely to have suicide ideation than their counterparts. We conclude that suicide prevention policy needs to take a holistic approach, which integrates the mental health of the older people, family welfare, and economic well-being.

Determinants of child maltreatment in Nepal: Results from the 2014 Nepal multiple indicator cluster survey (the 2014 NMICS).

We examined the prevalence of child maltreatment as measured by the level of physical (moderate to severe) and emotional abuse and child labor, and the associated household level determinants of child maltreatment in Nepal. We used a nationally representative data set from the fifth round of the Nepal Multiple Indicator Cluster Survey (the 2014 NMICS). The main independent variables were household level characteristics. Dependent variables included child experience of moderate to severe physical abuse, emotional abuse, and child labor (domestic work and economic activities). Bivariate analyses and logistic regressions were used to examine the associations between independent and dependent variables. The results showed that nearly half of the children (49.8%) had experienced moderate physical abuse, 21.5% experienced severe physical abuse, and 77.3% experienced emotional abuse. About 27% of the children had engaged in domestic work and 46.7% in various economic activities. At bivariate level, educational level of household's head and household wealth status had shown significant statistical association with child maltreatment (p<0.001). Results from multivariate logistic regressions showed that higher education levels and higher household wealth status protected children from moderate to severe physical abuse, emotional abuse and child labor. In general, child maltreatment is a neglected social issue in Nepal and the high rates of child maltreatment calls for mass awareness programs focusing on parents, and involving all stakeholders including governments, local, and international organizations.

Factors associated with intimate partner violence against married women in Nepal.

This study was to explore the factors associated with intimate partner violence (IPV) in Nepal. A sample of 3,373 married women was taken from the 2011 Nepal Demographic and Health Survey. Multilevel logistic regression methods were used to analyze the data. The results show that 28.31% of the population experienced the IPV in the past year. The results indicate that female illiteracy, low economic status, violent family history, and a lack of decision-making autonomy were associated with IPV. Regarding family background, whether or not the husband was an alcoholic, the husband's level of education, and a higher number of children were risk factors associated with IPV. At the community level, women most at risk of IPV were those living in the Terai region, and women belonging to underprivileged castes and ethnic groups. The findings suggest the need for context-specific policy formation and the need for the creation of the certain intervention programs designed to mitigate IPV in Nepal.

Women's autonomy in negotiating safer sex to prevent HIV: findings from the 2011 Nepal Demographic and Health Survey.

Women with greater autonomy have higher HIV-related knowledge and condom use. Inability to negotiate safer sex in high-risk situations might increase HIV infection. This study examined the relationship between women's autonomy and ability to negotiate safer sex practices among married women. The 2011 Nepal Demographic and Health Survey data were used. The data were collected by two-stage stratified cluster sampling and face-to-face interviews. Autonomy was measured in Decision-Making Participation and Assets Ownership, while ability to negotiate safer sex consists of Refusal of Sex and Ask for Condom Use. Among 12,674 women of 15-49 years, married women were analyzed (n = 8,896). Women with greater autonomy in decision-making participation were more likely to negotiate safer sex. After controlling for socio-demographic factors, odds ratios (OR) for refusal of sex was 2.70 (95% CI [2.14, 3.40]) in women with the highest decision-making participation. These women showed higher OR for 'ask for condom use' in high risk situations (2.10, 95% CI [1.81, 2.44]). Assets ownership also demonstrated a positive statistical relationship with asking for a condom use (OR 1.31, 95% CI [1.10, 1.56]). The results point to the importance of women's autonomy on sexual health. It emphasizes women's empowerment-based approach to curbing HIV/AIDS in developing countries.