Knowledge, Practice and Barriers on Cervical Cancer Screening among Married Women.

BACKGROUND: Cervical cancer is a most common preventable public health problem. Despite availability of various screening services at Biratnagar, many barriers restrict its utilization. So, we aimed to assess the knowledge, practice and barriers of cervical cancer screening among 30-60 years married women in Biratnagar, Morang, Nepal. METHODS: We conducted a community based cross sectional study in Biratnagar Morang from December 2020 to December 2021. Consecutive sampling technique was used to collect data from 280 married women of 30-60 years. Ethical approval was obtained from Nepal Health Research Council and informed consent was taken from study participants. Data was collected by face to face interview using a semi structured questionnaire. RESULTS: All participants had heard of cervical cancer. Most (93.9%) responded to multiple sexual partners as a risk factor and 97.9% responded to excessive vaginal bleeding as a symptom. Most (97.1%) responded that cervical cancer is preventable and 44.1% were aware of pap smear test. Eighty-four (30%) participants had ever been screened for cervical cancer. Unavailability of health insurance (85.2%), high cost of treatment (83.1%), lack of nearby service availability (70.9%), embarrassment (44.8%), presence of male doctors (43.8%), problems in time management (28.01%), no advice from health care providers (22.9%), unaware of screening (15.8%) and beliefs on traditional healers (7.1%) were barriers. CONCLUSIONS: In comparison to knowledge, practice of cervical cancer screening is low suggesting existence of know-do gap. Various barriers that prevent cervical cancer screening were evident.

Assessment of Implementation of CB-IMNCI Program at Primary Health Care Centers and Health Posts.

BACKGROUND: Community-based integrated management of neonatal and childhood illness (CB-IMNCI) is a government-run priority one program aimed to decrease neonatal and childhood morbidity and mortality. The objective of our study was to identify the CB-IMNCI implementation gap in terms of health care providers' training status, availability of medicines, follow-up visits and clinical outcome at Primary Health Care Centers and Health Posts of Morang district of Nepal. METHODS: We conducted a community based cross-sectional study in Morang district of Nepal from 25 Oct 2021 to 25 Jan 2022. Ethical approval was taken from ethical review board of the Nepal Health Research Council. We enrolled 9 (53%) out of 17 local governments of Morang district of Nepal by simple random sampling. The collected data was entered in MS Excel and analyzed by SPSS version 23. RESULTS: The majority of healthcare workers were in their early age of 26-35 years (57.2%), male (85.7%) and Auxiliary Health Workers (78.6%). The mean duration of practice was 15.1 years. Only 46.5% of healthcare providers were trained for the CB-IMNCI program. The availability of medicine as per CB-IMNCI guideline was 52.9%. There was no record available for total number of required follow up, total number of actual follow up and clinical outcome in last 6 months. CONCLUSIONS: About half of the human resources were trained with the availability of only half of the required medicines. We also found a lack of adequate record-keeping of follow up of patients and their clinical outcomes.

Women's empowerment for abortion and family planning decision making among marginalized women in Nepal: a mixed method study.

BACKGROUND: Women's empowerment is multidimensional. Women's education, employment, income, reproductive healthcare decision making, household level decision making and social status are vital for women's empowerment. Nepal is committed to achieving women empowerment and gender equality, which directly affects the reproductive health issues. This can be achieved by addressing the issues of the poor and marginalized communities. In this context, we aimed to find the association of women's empowerment with abortion and family planning decision making among marginalized women in Nepal. METHODS: A cross sectional study was conducted at selected municipalities of Morang district of Nepal from February 2017 to March 2018. A mixed method approach was used, where 316 married marginalized women of reproductive age (15-49 years) and 15 key informant interviews from representative healthcare providers and local leaders were taken. From key informants, data were analysed using the thematic framework method. Findings obtained from two separate analyses were drawn together and meta inferences were made. RESULTS: Women's empowerment was above average, at 50.6%. Current use of modern contraceptives were more among below average empowerment groups (p 0.041, OR 0.593 C.I. 0.36-0.98). We could not find any statistically significant differences among levels of women's empowerment, including those women with abortion knowledge (p 0.549); family planning knowledge (p 0.495) and women's decision for future use of modern contraceptives (p 0.977). Most key informants reported that unsafe abortion was practiced. CONCLUSIONS: Women's empowerment has no direct role for family planning and abortion decision making at marginalized communities of Morang district of Nepal. However, different governmental and non-governmental organizations influence woman for seeking health care services and family planning in rural community of Nepal irrespective of empowerment status.