Associated criteria used in investigating suspected septic transfusion reactions: A scoping review

BACKGROUND AND OBJECTIVES

Septic transfusion reactions (STRs) occur as a result of bacterial contamination of blood or blood products, resulting in sepsis. This scoping review aimed to identify, explore and map the available literature on the STR criteria triggering the investigation of STR.

MATERIALS AND METHODS

Four electronic databases (MEDLINE, Web of Science, Science Direct, Embase) were searched to retrieve scientific literature reporting such criteria, published from 1 January 2000 to 5 May 2022. Grey literature was also searched from open web sources.

RESULTS

Of 1052 references identified, 43 (21 peer-reviewed and 22 grey literature) met the eligibility criteria for inclusion and data extraction after full article screening. Of them, most (27/43, 62.79%) were found to report a single set of criteria, and only two reported four or more sets of criteria. The analysis of 66 sets of criteria collected from the selected references revealed 57 different sets. A few sets of criteria used only one sign and symptom (s/s) (12.12%, n = 8), whereas 16 sets used 7-15 s/s (n = 16/66; 24.24%). Of the total 319 occurrences of s/s associated with the 66 sets of criteria, post-transfusion hyperthermia, body temperature increase and hypotension were the most common s/s categories. Of all the literature available, only one study tested the diagnostic accuracy of the STR criteria.

CONCLUSION

This scoping review revealed a substantial variation in criteria used to identify suspected STR. Consequently, conducting further studies to enhance the diagnostic accuracy of these criteria, which trigger STR investigations, is imperative for advancing clinical practice.

Impact of COVID-19 pandemic on the health-related quality of life of frontline workers: the case of seven low-income Eastern African countries

PURPOSE

This study aimed to explore the potential impact of the COVID-19 pandemic on the health-related quality of life (HRQoL) of humanitarian and healthcare workers and its related factors in seven Eastern African countries (EAC).

METHODS

A sample of frontline workers filled out an online cross-sectional survey questionnaire comprising socio-demographic, degree of symptoms of depression, anxiety, insomnia, and distress, alcohol and tobacco consumption, health-related quality of life (HRQoL) using Short Form 6-Dimension version 2 (SF-6Dv2) and Clinical Outcomes in Routine Evaluation 6-Dimension (CORE-6D), and fear of COVID-19 (FCV-19S) questionnaires. Multivariate regressions were conducted to identify independent factors associated with HRQoL.

RESULTS

Of total 721 study participants, mean (standard deviation) scores for SF-6Dv2 and CORE-6D were 0.87 (0.18) and 0.81 (0.14), respectively. Participants with an education level below a university degree, having chronic diseases, been tested positive to COVID-19, with traumatic memories, depression, insomnia, distress, and stress were found to have lower HRQoL likelihood in terms of SF-6Dv2 scores during the COVID-19 pandemic. Similarly, participants with chronic diseases, exposure to COVID-19 patients, depression, insomnia, distress, stress, tested positive with COVID-19, and high level of fear of COVID-19, had lower HRQoL likelihood in terms of CORE-6D scores. Participants who were married had higher HRQoL likelihoods in terms of SF-6Dv2 scores.

CONCLUSION

Some personal and mental health characteristics, and COVID-19 related factors, were predictors of lower HRQoL of frontline workers in EAC. These findings should be meaningful while designing sustainable interventions and guidelines aiming to improve the HRQoL of frontline workers during a pandemic situation.

Association of Blood Mercury Level with Liver Enzymes in Korean Adults: An Analysis of 2015-2017 Korean National Environmental Health Survey

Increased liver enzymes as a result of exposure to mercury and their toxic effects are not well understood in Korea at the population level. The effect of blood mercury concentration on alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was evaluated after adjusting for sex, age, obesity, alcohol consumption habit, smoking, and exercise parameters in 3712 adults. The risk of abnormal liver function was measured using a multiple logistic regression analysis. Blood mercury concentration was divided into quartiles, and liver enzyme levels were compared for each quartile. ALT and AST levels were 10-20% higher in the second, third, and fourth quartiles compared to the first quartile. The risk of liver dysfunction or elevated liver enzymes was significantly higher in the second, third, and fourth quartiles than in the first quartile. As blood mercury levels increased, liver enzymes and mercury-induced hepatotoxicity increased. The increase in liver enzymes caused by mercury was more pronounced in the low-mercury concentration range. To reduce the long-standing problem of abnormal liver enzymes and liver function in Korea and other similar settings, it is important to decrease exposure to mercury through effective implementation of specific health and environmental strategies.

Maternal and dietary behavior-related factors associated with preterm birth in Southeastern Terai, Nepal: A cross sectional study

Background

Preterm birth (PTB) is a global issue although its burden is higher in low- and middle-income countries. This study examined the risk factors of PTB in Southeastern Terai, Nepal.

Methods

In this community-based cross-sectional study, a total of 305 mothers having children under the age of 6 months were selected using systematic random sampling. Data were collected by structured interviewer-administered questionnaires and maternal antenatal cards from study participants for some clinical information. Predictors of PTB were identified using multi-level logistic regression analysis at a P-value < 0.05.

Results

Of the total 305 mother-live-born baby pairs, 13.77% (42/305) had preterm childbirth. Maternal socio-demographic factors such as mothers from Dalit caste/ethnicity [adjusted odds ratio (AOR) = 12.16, 95% CI = 2.2-64.61] and Aadibasi/Janajati caste/ethnicity (AOR = 3.83, 95% CI = 1.01-14.65), family income in the first tercile (AOR = 6.82, 95% CI = 1.65-28.08), than their counterparts, were significantly positively associated with PTB. Likewise, other maternal and dietary factors, such as birth order first-second (AOR = 9.56, 95% CI = 1.74-52.53), and birth spacing ≤ 2 years (AOR = 5.16, 95% CI = 1.62-16.42), mothers who did not consume additional meal (AOR = 9.53, 95% CI = 2.13-42.55), milk and milk products (AOR = 6.44, 95% CI = 1.56-26.51) during pregnancy, having <4 antenatal (ANC) visits (AOR = 4.29, 95% CI = 1.25-14.67), did not have intake of recommended amount of iron and folic acid tablets (IFA) (<180 tablets) (AOR = 3.46, 95% CI = 1.03-11.58), and not having adequate rest and sleep (AOR = 4.83, 95% CI = 1.01-23.30) during pregnancy had higher odds of having PTB than their counterparts.

Conclusion

Some socio-demographic, maternal, and dietary behavior-related factors were independently associated with PTB. These factors should be considered while designing targeted health interventions in Nepal. In addition, we recommend specific measures such as promoting pregnant women to use available antenatal care and counseling services offered to them, as well as having an adequate diet to a level that meets their daily requirements.

Seroepidemiologic evidence of Q fever and associated factors among workers in veterinary service laboratory in South Korea

The incidence of Q fever has rapidly increased in South Korea since 2015. This study was undertaken to investigate the seroprevalence and seroreactivity of Q fever and the risk factors associated with its seroprevalence among workers in the veterinary service laboratory (VSL) in South Korea. This seroepidemiologic study was conducted in a total of 661 human subjects out of 1,328 subjects working in 50 VSL existing in South Korea between July 15 and July 29, 2019. Data were collected by administering survey questionnaires and by analyzing collected blood samples to determine the presence of antibodies against Coxiella burnetii. The seroprevalence and seroreactivity of C. burnetii infection were determined based on serum titers as (phase II IgG ≥1:256 and/or IgM ≥1:16) and (phase II IgG ≥1:16 and/or IgM ≥1:16) as determined by indirect immunofluorescent assay. Work, work environment, behavioral risk and protective factors associated with seroprevalence of Q fever were assessed by employing multivariable logistic regression analysis. Among the 661, the seroprevalence and seroreactivity of C. burnetii infection were 7.9% and 16.0%, respectively. Multivariate logistic regression analysis showed the risk factors significantly associated with seroprevalence were the antemortem inspection of cattle, goats, or sheep (APR (adjusted prevalence ratio), 2.52; 95% CI, 1.23–4.70)), animal blood splashed into or around eyes (APR, 2.24; 95% CI, 1.04–4.41), and contact with animals having Q fever (APR, 6.58; 95% CI, 3.39–10.85) during the previous year. This study suggests the need for precautions when contact with cattle, goats, or sheep is expected, especially during the antemortem inspection, when dealing with C. burnetii infected animals, or when there is a risk of ocular contact with animal derivatives. Therefore, we recommend the consistent use of appropriate personal protective equipment and other protective measures including PPE treatment and washing of body surfaces after work to prevent C. burnetii infections among VSL staff in South Korea.

Study protocol of associated criteria used in investigating septic transfusion reactions (STRs): A scoping review about available evidence

Background and objective

Assessment criteria for septic transfusion reactions (STRs) are variable around the world. A scoping review will be carried out to find out, explore and map existing literature on STRs associated criteria.

Methods

This scoping review will include indexed and grey literatures available in English or French language from January 1, 2000, to December 31, 2021. Literature search will be conducted using four electronic databases (i.e., MEDLINE via PubMed, Web of Science, Science Direct, and Embase via Ovid), and grey literatures accompanying the research questions and objectives. Based on the inclusion criteria, studies will be independently screened by two reviewers for title, abstract, and full text. Extracted data will be presented in tabular form followed by a narrative description of inputs corresponding to research objectives and questions.

Predictors of Vaccine Acceptance, Confidence, and Hesitancy in General, and COVID-19 Vaccination Refusal in the Province of Quebec, Canada

INTRODUCTION

A surge of COVID-19 variants is a major concern, and literatures that support developing an optimum level of herd immunity are meaningful. This study aimed to examine the factors associated with vaccine acceptance, confidence, and hesitancy in general, and COVID-19 vaccination refusal in the general population of Quebec, Canada.

METHODS

A web-based cross-sectional survey was conducted in October and November 2020 among French-speaking participants above 18 years of age employing quota sampling technique. The questionnaire included socio-demographic and attitudinal variables towards vaccination. Logistic regression analyses were conducted to examine the association between independent and outcome variables.

RESULTS

Of total 1599 participants, 88.9%, 87.5%, 78.5%, and 18.2%, respectively, indicated vaccine acceptance, high level of vaccine confidence, low level of vaccine hesitancy, and COVID-19 vaccination refusals. Participants having higher education, income, and fear of COVID-19 (FCV-19S) were more likely to get vaccinated, while smokers were less likely to get vaccinated. Similarly, age groups (40-59, and ≥60 years), higher education, income, permanent resident in Canada, country of parents from Canada, ever faced acute disease in the family, higher sense of coherence, and FCV-19S scores were predictors of high levels of vaccine confidence. Higher education, income, sense of coherence and FCV-19S scores, and higher health-related quality of life (CORE-6D) produced lower levels of vaccine hesitancy. Conversely, those acting as caretaker, other essential worker, smoker, and those with financial losses were more likely to have higher vaccine hesitancy. Additionally, ≥60 years of age, higher education and income, country of parents from Canada, higher scores of willingness to take risk and FCV-19S were less likely to have high level of COVID-19 vaccination refusal.

CONCLUSION

Over three quarters of the participants indicated positive attitudes toward vaccination. Some socio-demographic and health-related quality of life factors were associated with the outcome variables, and these should be sought while designing interventions to improve COVID-19 vaccination rates.

Seroprevalence and Factors Associated with Scrub Typhus Infection among Forestry Workers in National Park Offices in South Korea

Scrub typhus is caused by the arthropod-borne bacterium Orientia tsutsugamushi and is an endemic infectious disease in the Asia-Pacific area. This study aimed to investigate the seroprevalence of scrub typhus and identify associated risk and protective factors among forestry workers, a neglected risk group for scrub typhus, in National Park Offices in South Korea. A nationwide cross-sectional serosurvey was carried out on 1945 National Park Office forestry workers (NPOFWs) in South Korea during December 2016. We visited 29 main offices and used a structured questionnaire to collect data regarding general characteristics, work activities, work hygiene-related factors, and other potential risk factors. Serum samples from NPOFWs were tested using indirect immunofluorescence assay to detect O. tsutsugamushi immunoglobulin (Ig) G and M antibodies. Of the 1945 NPOFWs, 718 (36.9%) participated in this cross-sectional study. The seroprevalence, defined as ≥1:256 for IgG and/or ≥1:16 for IgM, was 4.9% (35/718). In multivariate logistic analysis, longer duration of work in national parks (≥15 years; odds ratio (OR), 4.19; 95% confidence interval (CI), 1.71-10.28) and dry field farming (OR, 2.47; 95% CI, 1.12-5.46) were significantly associated with a higher risk of scrub typhus infection. Furthermore, the risk of scrub typhus infection was significantly lower among NPOFWs who washed working clothes daily (OR, 0.37; 95% CI, 0.18-0.75). This study indicated that scrub typhus is an important disease among NPOFWs in South Korea. Work hygiene, especially washing working clothes daily, needs to be emphasized among NPOFWs. Additionally, more precautions are required to diminish the rate of scrub typhus infection among NPOFWs who perform dry field farming.

Novel Coronavirus Disease (COVID-19): Social Distancing, Isolation and Quarantine are Key Success Factors of Nepal's Public Health Practices or Something Else?

Novel Coronavirus Disease (COVID-19) is an infectious disease similar form of pneumonia/ SARS-CoV-2- impacting deadly globally. The main objective of this article is to analyze the studies and gather of the current information aimed at COVID-19 and analyze the situation of Nepal. We summarized the published articles from the web pages, Journals, Google search engine. It is declared as a public health emergency. However, why COVID-19 does not register in developing counties (Nepal) rather than China, Europe and North America it is unknown. Nepal has lower experiences of the COVID-19 where only 49 death cases registered and total cases 19,237 cases throughout the country (till 08/1/2020). Nepalese health services need to maintain up than today and follow lockdown, isolation, social distance and an advance screening test kit around the country.

Underweight and Associated Factors Among Teenage Adolescent Girls in Resource-poor Settings: A Cross-sectional Study

Background and Purpose

Understanding the undernutrition status of teenage adolescent girls living in urban slums and its associated factors is meaningful to formulate customized health strategies. This study aimed to determine the prevalence of being underweight and associated factors among teenage adolescent girls in urban slums.

Materials and Methods

In this cross-sectional study, we enrolled a total of 418 teenage adolescent girls from five of 210 urban slums of Varanasi district, Uttar Pradesh, India employing two-stage probability sampling for the selection of households and subjects, between September 2016 and July 2017. The study of underwight subjects was assessed with BMI for age using standard criteria. Factors associated with being underweight were determined by multivariable logistic regression analysis.

Results

Of 418 study subjects, 49.76% (208/418) were underweight. Results revealed that sociodemographic factors such as teenage adolescent girls who were from SC/ST (schedule caste/schedule tribe) caste/ethnicity (adjusted odds ratio (AOR)=2.02, 95%CI: 1.00–4.23), subjects whose father’s education level was primary or lower (AOR=1.87, 95%CI: 1.12–3.11), and number of people in the family >4 (AOR=2.18, 95%CI: 1.18–4.03) were associated with being underweight. Likewise, dietary behavior-related factors such as vegetarian (AOR=2.21, 95%CI: 1.25–3.92), and <3 meals per day (AOR=2.36, 95%CI: 1.40–3.98) than their counterparts were associated with being underweight. In addition, teenage adolescent girls from food-insecure households (AOR=3.33, 95%CI: 2.01–5.51) were more likely to be underweight than those from food-secure households.

Conclusion

The higher burden of underweight among teenage adolescent girls in Indian urban slums needs to be addressed through specific public health interventions such as by improving education, providing education regarding dietary behavior, and having access to sufficient, safe, and nutritious foods.

Socio-demographic and Healthcare-seeking Predictors of Undernutrition among Children Under-five Years of Age in a Western District of Nepal

BACKGROUND

Undernutrition is highly prevalent in Nepal, which interferes with physical and mental development among children. It is one of the severe health problems contributing to the significant portion of the disease burden. This study aimed to explore socio-demographic and healthcare-seeking related predictors of undernutrition among children under five years old in Dang, Nepal.

METHODS

This was a descriptive cross-sectional study. A sample of 426 children was participated through stratified proportionate random sampling to identify socio-demographics and healthcare-seeking predictors of undernutrition. Multivariable regression was applied to identify the independent predictors of undernutrition.

RESULTS

This study found that children below 24 months of age were more likely to be undernourished than children aged 24-36 months. Female children (OR=2.32, 95% CI: 1.19-4.54), illiterate or non-formally educated women (OR=4.09, 95% CI: 1.84-9.08), mother's occupation other than a housewife (OR=13.05, 95% CI: 4.19-40.68), labor work of father (OR=2.40, 95% CI: 1.04-5.57) had increased risk of undernutrition among children. Similarly, food insufficiency from their land, antenatal care visit, postnatal care visit, and delivery place were significantly associated with childhood undernutrition among children.  Conclusions: The study showed that undernutrition among children is associated with age and gender of children, educational attainment of the mother, food sufficiency, health-seeking practices of the mother during pregnancy, delivery, and postnatal. Socio-demographics and health-seeking practices related predictors must be explicitly considered to address undernutrition among children under the age of five years.

Mortality Rate and Predictors of Mortality in Hospitalized COVID-19 Patients with Diabetes

Studies have confirmed COVID-19 patients with diabetes are at higher risk of mortality than their non-diabetic counterparts. However, data-driven evidence of factors associated with increased mortality risk among hospitalized COVID-19 patients with diabetes is scarce in South Korea. This study was conducted to determine the mortality rate and identify risk factors of mortality among hospitalized COVID-19 patients with type 2 diabetes in Gyeongsangbuk-do province, South Korea. In this hospital-based, cross-sectional study, we enrolled a total of 324 patients with confirmed COVID-19, hospitalized at two of the tertiary level healthcare facilitates of Gyeongsangbuk-do, South Korea from 18 February to 30 June 2020. Demographic and clinical data and laboratory profiles were analyzed and multivariate logistic regression analysis was used to identify risk factors of mortality among diabetic patients with COVID-19. Of the 324 patients, 55 (16.97%) had diabetes mellitus. The mean age of all study subjects was 55 years, and the mean age of those with diabetes was greater than that of those without (69.8 years vs. 51.9 years). Remarkably, the mortality rate was much higher among those with diabetes (20.0% vs. 4.8%). Multivariate logistic regression analysis revealed that an older age (≥70 years) and a high serum lactate dehydrogenase (LDH) levels significantly predicted mortality among hospitalized COVID-19 patients with diabetes. Our study cautions more attention to be paid to patients with diabetes mellitus hospitalized for COVID-19, especially those aged ≥ 70 years and those with a high serum LDH level, to reduce the risk of mortality.

Effects of Female Community Health Volunteer Capacity Building and Text Messaging Intervention on Gestational Weight Gain and Hemoglobin Change Among Pregnant Women in Southern Nepal: A Cluster Randomized Controlled Trial

Introduction: Public health interventions such as text messaging are commonly evaluated in high-income countries and that the evaluation reports of the effectiveness of community health volunteers in low-income countries like Nepal is scarce. This study aimed to determine whether female community health volunteer (FCHV) capacity building and text messaging to expectant mother increases gestational weights and hemoglobin levels of pregnant women living in southern Nepal.

Methods: A cluster randomized control trial was carried out in 52 clusters of 6 Village Development Committees in southern Nepal between July 2015 and March 2016. A total of 413 pregnant mothers of gestation age between 13 and 28 weeks (214 in the intervention group and 199 in the control group) were included in the analysis. Intervention consisted of FCHV capacity building followed by regular supervision and monitoring and mobile phone text messaging to expectant mothers. Regression analysis, controlled for confounders, was conducted to assess gestational weight gains and changes in hemoglobin levels.

Results: At the end of the pregnancy, the mean weight gain difference between the intervention and control groups was 1.1 kg (95% CI: 1.0, 1.9). Rates of weight increases in the intervention and control groups were 0.504 kg/week (95% CI: 0.371, 0.528), and 0.399 kg/week (95% CI: 0.362, 0.465), respectively. Similarly, the mean inter group difference in hemoglobin levels was 0.11 gm/dl (95% CI: 0.09, 0.15), and rates of hemoglobin increases (gm/dl/week) in the intervention and control groups were 0.02 gm/dl (95% CI: 0.01, 0.09) and 0.004 gm/dl (95% CI: 0.02, 0.12), respectively.

Conclusions: The study shows that FCHV capacity building and mobile text messaging have a positive effect on the gestational weights and hemoglobin levels of expectant mothers. Our findings suggest that mobile text messaging coupled with FCHV capacity building services should be supported and would usefully expand in resource poor settings.

Trial registration: ISRCTN60684155.

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017

BACKGROUND

Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea.

METHODS

We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates.

FINDINGS

The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage.

INTERPRETATION

By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health.

FUNDING

Bill & Melinda Gates Foundation.

A Diarrhoeagenic Enteropathogenic Escherichia coli (EPEC) Infection Outbreak That Occurred among Elementary School Children in Gyeongsangbuk-Do Province of South Korea Was Associated with Consumption of Water-Contaminated Food Items

(1) Background: In response to the notification made by an elementary school authority that reported a number of elementary school children being absent in three schools as a result of gastroenteritis symptoms on 4 July 2018, in Gyeongsangbuk-Do Province, South Korea, an epidemic investigation was carried out to determine the extent, cause, and source of the outbreak in order to prevent secondary cases and make recommendations to prevent future recurrences. (2) Methods: In this epidemiologic study, a total of 106 human subjects (school children, staff members, and cooks) who had consumed the possibly contaminated foodstuffs were enrolled retrospectively. Human specimens from clinically defined cases, food and drinks, supply and storage of them, and environmental and sanitary conditions were also assessed by observation, laboratory tests, and survey questionnaires—where and whatever applicable. The attack rate and positive rate for human specimens were first presented followed by the calculation of the relative risk ratio (RR) with 95% CI (confidence intervals) in order to identify the exposure and outcome relationships. (3) Results: The attack rate was 12.26% (13/106) for those who had ingested the food items at the three schools and the positive rate of enteropathogenic Escherichia coli (EPEC) was 15.38% (2/13). The relative risk (RR) of developing food poisoning of those who consumed the cucumber chili with ssamjang and seasoned cucumber and chives were 4.55 (95% CI 1.05–19.54) and 9.20 (95% CI 1.24–68.22), respectively. In addition, within the human specimens as well as the water and environmental samples different strains of diarrhoeagenic enteropathogenic Escherichia coli (EPEC) were detected. (4) Conclusions: Provision of safe and wholesome water access to all elementary schools by concerned authorities, especially during the likely seasons of water source contamination, as well as health education promotion about foodborne outbreaks to all school stakeholders is therefore recommended.

Burden of injuries in Nepal, 1990-2017: findings from the Global Burden of Disease Study 2017

Background

Nepal is a low-income country undergoing rapid political, economic and social development. To date, there has been little evidence published on the burden of injuries during this period of transition.

Methods

The Global Burden of Disease Study (GBD) is a comprehensive measurement of population health outcomes in terms of morbidity and mortality. We analysed the GBD 2017 estimates for deaths, years of life lost, years lived with disability, incidence and disability-adjusted life years (DALYs) from injuries to ascertain the burden of injuries in Nepal from 1990 to 2017.

Results

There were 16 831 (95% uncertainty interval 13 323 to 20 579) deaths caused by injuries (9.21% of all-cause deaths (7.45% to 11.25%)) in 2017 while the proportion of deaths from injuries was 6.31% in 1990. Overall, the injury-specific age-standardised mortality rate declined from 88.91 (71.54 to 105.31) per 100 000 in 1990 to 70.25 (56.75 to 85.11) per 100 000 in 2017. In 2017, 4.11% (2.47% to 6.10%) of all deaths in Nepal were attributed to transport injuries, 3.54% (2.86% to 4.08%) were attributed to unintentional injuries and 1.55% (1.16% to 1.85%) were attributed to self-harm and interpersonal violence. From 1990 to 2017, road injuries, falls and self-harm all rose in rank for all causes of death.

Conclusions

The increase in injury-related deaths and DALYs in Nepal between 1990 and 2017 indicates the need for further research and prevention interventions. Injuries remain an important public health burden in Nepal with the magnitude and trend of burden varying over time by cause-specific, sex and age group. Findings from this study may be used by the federal, provincial and local governments in Nepal to prioritise injury prevention as a public health agenda and as evidence for country-specific interventions.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Tuberculosis in Nepal: Situation, Challenges and Ways Forward

Introduction: Globally, tuberculosis is a major public health problem. Moreover, the emergence of drug resistant forms of TB has threatened TB prevention and treatment efforts. Despite the long history of tuberculosis prevention efforts, tuberculosis still ranks among the top ten causes of deaths in Nepal. Furthermore, Nepal being land locked with two high TB burden countries i.e. India and China, it has added difficulties to National Tuberculosis program. Hence this study aims to review the situation of National Tuberculosis Program in Nepal and explore the possible challenges and ways forward for NTP to strengthen the TB diagnostics and treatment services in Nepal. Methods: This study is based on the review of available literatures and data sources related to tuberculosis prevention, care and control. Secondary data published by National Tuberculosis Program in the annual report for the year 2015, 2016 and 2017 were considered for the situation analysis of tuberculosis in Nepal. We used different platforms like Google scholar, PubMed to search relevant literatures. Results: This has been a huge gap between WHO TB estimates and TB cases notification by the national system. It was 22% in 2015, 27% in 2016 and 29% in 2017. However National Tuberculosis Program has maintained treatment success rate consistently above 90%. Tuberculosis program has yet not achieved universal HIV testing, although HIV testing among TB patients has increased rapidly. Similarly, only 75%, 1994 received DST out of 2601 retreatment TB cases have received DST in 2017 despite guideline suggest mandatory drug susceptibility testing for retreatment TB cases. Conclusion: Case notification has reduced gradually. It is difficult to achieve the target envisioned by NSP 2016-21 if the current case notification trend persists. NTP needs to expand service sites ensuring minimum quality standards as well as scale up targeted intervention addressing human right issues to identify the missing TB cases. NTP needs to regulate the quality of diagnosis and treatment TB services offered by private sector.  

Socio-Demographic and Diet-Related Factors Associated with Insufficient Fruit and Vegetable Consumption among Adolescent Girls in Rural Communities of Southern Nepal

Sufficient fruit and vegetable (FV) consumption has been associated with reduced risks of chronic diseases and adverse health conditions. However, the determinants of insufficient of FV intake among adolescent girls in Nepal have not been determined. This study was undertaken to identify associations between socio-demographic and diet-related factors with insufficient fruit and vegetable consumption among adolescent girls living in rural communities. This community-based, cross-sectional study was conducted on 407 adolescent girls from rural communities in the Bateshwar rural municipality of Dhanusha district, Southern Nepal between 12 October, 2018 and 14 December, 2018. The study subjects responded to FV consumption and dietary factor-related questionnaires, and anthropometric measurements were taken. Data were analyzed using the univariate logistic regression followed by multivariable logistic regression analyses. Unadjusted and adjusted odds ratios with 95% confidence intervals (CI) are reported. From the 407 study subjects, 359 (88.2%) reported insufficient FV consumption. The factors significantly associated with insufficient FV consumption were education to under the 10th grade, household income in the first tercile, lack of awareness of the importance of FV consumption, the non-availability of FVs at the household level, the low level of dietary diversity, and undernutrition (BMI (body mass index) (<18.5)). The study shows almost 90% of adolescent girls consumed inadequate amounts of FV and that socio-demographic and dietary factors should be taken into account while designing preventive strategies to increase fruit and vegetable consumption to recommended levels.

Maternal Factors and the Utilization of Maternal Care Services Associated with Infant Feeding Practices among Mothers in Rural Southern Nepal

This study aimed to investigate the maternal factors and utilization of maternal care services associated with infant feeding practices in rural areas of Southern Nepal. Data from a cluster randomized controlled trial ‘MATRI-SUMAN’(Maternal Alliance for Technological Research Initiative on Service Utilization and Maternal Nutrition) conducted between 2015–2016 were analyzed. A total of 426 pregnant women in their second trimester were recruited from the MATRI-SUMAN trial, which was conducted on six villages in rural areas of the Dhanusha district, Nepal. A total of 379 mothers that had ever breastfed their infants, and followed for at least seven months after birth were included in the analysis. Multivariate logistic regression analysis was used to identify independent risk factors associated with child feeding practices after controlling for potential confounders. Of the 379 mothers, 41.4%, 53%, and 43% initiated breast feeding within the first hour of birth (EIBF), practiced exclusive breastfeeding (EBF), and initiated timely complementary feeding (CF) at six months, respectively. Multiple logistic regression results revealed that maternal education (secondary or higher), an occupation in the service/business/household sectors, receipt of MATRI-SUMAN intervention, more than four ANC (antenatal care) visits, and delivery in a health facility were associated with higher odds ratios of EIBF. Similarly, mothers with a primary, secondary and higher level of education, that worked in the service/business/household sectors, primiparous mothers, those that received MATRI-SUMAN intervention, visited ANC more than four times, and made a PNC (postnatal care) visit had higher odds ratios of EBF, while mothers who were 35–45 years of age were less likely to have used EBF. In addition, education to the secondary or a higher level, a male baby, receipt of MATRI-SUMAN intervention and a PNC visit had higher odds ratios of CF initiation at six months. The promotion of maternal ANC visits, birth at a health institution, and postnatal visits should be recommended in order to improve child feeding practices in Nepal.

Prevalence of behavioral risk factors of cardiovascular diseases and associated socio-economic factors among pregnant women in a rural area in Southern Nepal

BACKGROUND

Cardiovascular diseases (CVDs) have dramatically infiltrated populations living in abject poverty in Low- and Middle-income Countries (LMICs), and poor maternal and child health outcomes have been frequently reported for those with CVD risk factors. However, few studies have explored the behavioral risk factors of CVDs among pregnant women in rural settings. This study aimed at determining the prevalence and identifying the socio-economic predictors of behavioral risk factors of CVDs among pregnant women in rural area in Southern Nepal.

METHODS

A Community-based cross-sectional study was conducted in 52 clusters of Dhanusha District of Nepal in a total of 426 pregnant women in their second trimester using multistage cluster sampling method. Multivariable logistic regression model was used to assess independent associations between behavioral risk factors during pregnancy and maternal socio-economic characteristics.

RESULTS

Of the 426 study participants, 86.9, 53.9, 21.3 and 13.3%, respectively, reported insufficient fruits and vegetables consumption, insufficient physical activity, tobacco use, and harmful alcohol drinking. Socio-economic factors significantly associated with more than one behavioral risk factors in expectant mothers with a primary level education (adjusted odds ratio (AOR) 2.78; 95% Confidence Interval (CI) (1.35-5.72)), 20-34 years age group (Adjusted Odds Ratio (AOR) 0.27; 95% CI (0.13-0.56)), and those with the highest wealth index (AOR 0.36; 95% CI (0.16-0.84)).

CONCLUSION

Higher prevalence of behavioral risk factors for CVDs and their socio-economic factors prevailing among pregnant women living in rural Nepal call for immediate health promotion interventions such as community awareness and appropriate antenatal counseling.

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017.

METHODS

The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised.

FINDINGS

At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases.

INTERPRETATION

Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade.

FUNDING

Bill & Melinda Gates Foundation.

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment.

METHODS

We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.

FINDINGS

The global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.

INTERPRETATION

The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains-curative interventions in the case of NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations.

METHODS

We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.

FINDINGS

In 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low.

INTERPRETATION

By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.

METHODS

We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting.

FINDINGS

Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]).

INTERPRETATION

Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury.

FUNDING

Bill & Melinda Gates Foundation.

Seroreactivity and Risk Factors Associated with Human Brucellosis among Cattle Slaughterhouse Workers in South Korea

The prevalence rate of human brucellosis in high-risk populations, as well as their risk factors, have not been well understood in South Korea. In this cross-sectional study, we investigated the seroreactivity and risk factors associated with human brucellosis among South Korean cattle slaughterhouse workers. We enrolled 922 subjects working in 71 slaughterhouses across the country in 2012. A structured questionnaire was used to obtain data from the subjects, following which blood samples were collected and tested using the microagglutination test; serum titers ≥ 1:20 were considered reactive. Independent risk factors were identified using multivariate logistic regression analysis with backward elimination. Overall, 62 of 922 participants (6.7%) exhibited seroreactivity for brucellosis, and 0.4% had a seroprevalence at a dilution of 1:160. Multivariate analysis revealed that the risk factors for human brucellosis seroreactivity included large-scale slaughtering (≥100 cattle per day; odds ratio (OR), 5.41; 95% confidence interval (CI), 2.95–9.91) and medium-scale slaughtering (50–99 cattle per day; OR, 2.53; 95% CI, 1.16–5.51). Moreover, the risk of brucellosis infection was significantly lower among slaughterhouse workers who always wear protective glasses (OR, 0.27; 95% CI, 0.11–0.69) than in those who sometimes or rarely wore such glasses. Regular and consistent use of personal protective equipment, especially protective glasses, should be encouraged among cattle slaughterhouse workers to reduce brucellosis infection.

Seroreactivity and Risk Factors Associated with Coxiella burnetii Infection among Cattle Slaughterhouse Workers in South Korea

Q fever, caused by Coxiella burnetii, is a zoonotic disease that is an occupational hazard to people who work in close contact with animals or their carcasses. A nationwide serologic study among cattle slaughterhouse workers who were presumed to be at risk of having C. burnetii infection in South Korea was performed to investigate the seroreactivity of C. burnetii infection and identify related risk factors. Out of 1017 cattle slaughterhouse workers in South Korea, 923 (90.8%) participated in this cross-sectional study. Samples were tested for immunoglobulin G (IgG) and M (IgM) antibodies against phase II C. burnetii via indirect immunofluorescence assay. The overall seroreactivity, defined as IgG or IgM antibody titer cutoffs ≥1:16, was 9.1% (84/923). Additionally, a significant association was found between the seroreactivity of C. burnetii infection and performing carcass evisceration work (odds ratio, 2.36; 95% confidence interval, 1.39–4.03) in multivariate analysis. To diminish C. burnetii infection, cattle slaughterhouse workers need to take precautions during the evisceration process.

Correlates of Selected Biochemical Markers of Bone turnover among Post-Menopausal Women

Introduction

Bone turnover leading to osteoporosis and poor quality of life is common during postmenopausal period. Study of bone turnover markers that contribute to non-invasive assessment of bone-metabolic disorders holds an important area of research in low income country like Nepal. This study aimed to examine the correlates of bone turnover markers in post-menopausal women in tertiary level of health care center of Nepal.

Methods

A hospital-based cross-sectional study conducted during the period of November 2016 to December 2017 among 354 women. Blood samples for calcium, inorganic phosphorus, alkaline phosphatase and vitamin D were collected and analyzed using a validated and calibrated tools. Data were analyzed using Statistical Package for the Social Sciences software version 20.

Results

Mean+Standard deviation of age of post-menopausal women was significantly higher compared to pre-menopausal women (post-menopausal women, (57.98±8.08) vs. pre-menopausal, (31.35±5.83), (P<0.001). Selected biochemical markers of bone-turnover such as alkaline phosphatase levels were significantly higher with year since menopause (P<0.001), whereas serum calcium, and vitamin D were decreasing with year since menopause among post-menopausal women. In addition, calcium and vitamin D were significantly negatively correlated with year since menopause (P<0.01) while body mass index, inorganic phosphorus and alkaline phosphatase were significantly positively correlated with year since menopause (P<0.01).

Conclusions

Our study revealed that body mass index, inorganic phosphorus and alkaline phosphatase positively correlated with year since menopause while calcium and vitamin D were negatively correlated suggesting for a medical supervision of hormonal changes and periodic dosing of calcium and vitamin D among post-menopausal women to reduce the problem of bone health.

Correlates of the Timely Initiation of Complementary Feeding among Children Aged 6⁻23 Months in Rupandehi District, Nepal

Although the predictors of the timely initiation of complementary feeding are well-known elsewhere, there is less awareness of the topic in Nepal. The current study was undertaken to identify the correlates of timely initiation of complementary feeding among children aged 6–23 months. A community-based cross-sectional study was conducted in the Rupandehi district, Nepal. A total of 155 mother-child pairs were selected using a simple random sampling technique. Logistic regression with adjustment for potential confounders was employed to examine the independent association between risk factors and the timely initiation of complementary feeding. Fewer than 3 in 5 children aged 6–23 months received complementary feeding at the recommended time. Literate mothers and a maternal occupation in the service or business sectors were found to be associated with complementary feeding at 6 months. In addition, child characteristics such as birth order, male children, and those fed micronutrients were also more likely to have been received complementary feeding at 6 months than their counterparts. Maternal education and occupation, and child characteristics such as, birth order, male gender, and micronutrient consumption, which are correlates of the timely initiation of complementary feeding, suggest that the Nepalese Infant and Young Child Feeding (IYCF) programme should target these predictors while designing preventive strategies.

'MATRI-SUMAN' a capacity building and text messaging intervention to enhance maternal and child health service utilization among pregnant women from rural Nepal: study protocol for a cluster randomised controlled trial

BACKGROUND

Capacity development of health volunteers and text messaging to pregnant women through mobile phones have shown improved maternal and child health (MCH) outcomes and is associated with increased utilisation of MCH services. However, such interventions are uncommon in Nepal. We aim to carry out an intervention with the hypothesis that capacity building and text messaging intervention will increase the MCH service utilisation.

METHOD/DESIGN

MATRI-SUMAN is a 12-month cluster randomized controlled trial (RCT). The trial involves pregnant women from 52 clusters of six village development committees (VDCs) covering 66,000 populations of Dhanusha district of Nepal. In the intervention clusters, Female Community Health Volunteers (FCHVs) will receive capacity development skills through reinforcement training, supervision and monitoring skills for the promotion of health seeking behaviour among pregnant women and study participants will receive periodic promotional text messaging service about MCH components through mobile phones. A sample of 354with equal numbers in each study arm is estimated using power calculation formula. The primary outcomes of this study are the rate of utilization of skilled birth attendants and consumption of a specified diversified meal. The secondary outcomes are: four antenatal (ANC) visits, weight gain of women during pregnancy, delivery of a baby at the health facility, postnatal care (PNC) visits, positive changes in child feeding practices among mothers, performance of FCHVs in MCH service utilization.

DISCUSSION

The intervention is designed to enhance the capacity of health volunteers for the promotion of health seeking behaviour among pregnant women and text messaging through a mobile phone to expecting mothers to increase MCH service utilization. The trial if proven effective will have policy implications in poor resource settings.

TRIAL REGISTRATION

ISRCTN60684155, ( https://doi.org/10.1186/ISRCTN60684155 ). The trial was registered retrospectively.

Awareness and Work-Related Factors Associated with Scrub Typhus: A Case-Control Study from South Korea

This study aimed to examine the awareness and the work-related factors associated with scrub typhus to provide data essential for evidence-based preventive strategies. A community-based case control study was carried out in the rural areas of Gyeongsangbuk-do, South Korea. Confirmed cases of scrub typhus (n = 57) were based on laboratory tests performed by the Korean Centers for Disease Control and Prevention (KCDC), 114 matched neighborhood controls, age (±6 years), gender and area of residence in the Gyeongsangbuk-do of South Korea. These cases were contracted over the 12-month period of January to December 2015. Overall, 61.4% cases and 79.8% of the control group had heard about scrub typhus. Cases were less aware about the fact that mites are mainly found in the bushes and that long sleeves and full-length pants and boots helped prevent scrub typhus. However, more were aware of the eschar lesion as a characteristic sign of scrub typhus. Work related risk factors such as having a wetland or puddles of water surrounding the house, dry field farming and working in the livestock industry were significantly associated with the scrub typhus. Health promotion strategies, such as creating general awareness, personal protection methods and improving personal hygiene and environmental sanitation in collaboration with relevant sectors, are recommended to reduce the burden of scrub typhus. Further intervention studies on awareness and behavioral and environmental modifications are required to investigate the effectiveness of such interventions.

Prevalence and Factors Associated with Microalbuminuria among Type 2 Diabetic Patients : A Hospital Based Study

Introduction: Microalbuminuria is the earliest clinical evidence of diabetic nephropathy. However, prevalence and associated factors with microalbuminuria among type 2 diabetic patients has been understudied area of research in Nepalese context. This study aimed to determine the prevalence and factors associated with microalbuminuria among type 2 diabetic patients. Methods: This study was a hospital-based cross-sectional study. Blood samples for serum creatinine, Hemoglobin A1C, Fasting blood sugar and urine sample for microalbumin and urine creatinine were collected and analyzed using validated and standardized tools from a total of 400 Type 2 diabetic patients in Devdaha Medical College and Teaching Hospital, Rupandehi, Nepal from August 2014 to September 2017. Microalbuminuria was defined as urinary albumin-to-creatinine ratio greater than 30 and less than300 μg /mg of creatinine Results: Of 400 type 2 diabetic patients, 186 (46.5%) had microalbuminuria. The mean values of FBS, HbA1C, serum creatinine, microalbumin, microalbumin/urine creatinine ratio were higher in microalbuminuria group. Microalbuminuria was significantly positively correlated with duration of diabetes, FBS, HbA1C, serum creatinine, microalbumin, microalbumin/ urine creatinine, systolic blood pressure and diastolic blood pressure (P< 0.01). Conclusions: Our study demonstrated that nearly half of the type 2 diabetic patients had microalbuminuria. Our results emphasize to increase to accessibility to microalbuminuria testing for all the type 2 diabetic patients and bring them under medical supervision to reduce the unwanted complications of diabetes mellitus.

Prevalence and Factors Associated with Microalbuminuria among Type 2 Diabetic Patients : A Hospital Based Study

INTRODUCTION

Microalbuminuria is the earliest clinical evidence of diabetic nephropathy. However, prevalence and associated factors with microalbuminuria among type 2 diabetic patients has been understudied area of research in Nepalese context. This study aimed to determine the prevalence and factors associated with microalbuminuria among type 2 diabetic patients.

METHODS

This study was a hospital-based cross-sectional study. Blood samples for serum creatinine, Hemoglobin A1C, Fasting blood sugar and urine sample for microalbumin and urine creatinine were collected and analyzed using validated and standardized tools from a total of 400 Type 2 diabetic patients in Devdaha Medical College and Teaching Hospital, Rupandehi, Nepal from August 2014 to September 2017. Microalbuminuria was defined as urinary albumin-to-creatinine ratio greater than 30 and less than300 μg /mg of creatinine Results: Of 400 type 2 diabetic patients, 186 (46.5%) had microalbuminuria. The mean values of FBS, HbA1C, serum creatinine, microalbumin, microalbumin/urine creatinine ratio were higher in microalbuminuria group. Microalbuminuria was significantly positively correlated with duration of diabetes, FBS, HbA1C, serum creatinine, microalbumin, microalbumin/ urine creatinine, systolic blood pressure and diastolic blood pressure (P< 0.01).

CONCLUSIONS

Our study demonstrated that nearly half of the type 2 diabetic patients had microalbuminuria. Our results emphasize to increase to accessibility to microalbuminuria testing for all the type 2 diabetic patients and bring them under medical supervision to reduce the unwanted complications of diabetes mellitus.

Assessment of Critical Knowledge on Maternal and Newborn care Services among Primary Level Nurse Mid-wives in Kapilvastu District of Nepal

Background Despite greater emphasis on maternal and neonatal health through policy and programming in Nepal, maternal and neonatal health is still not impressive. Health care providers' knowledge assessment on maternal and neonatal care has been well documented elsewhere, but it is very little understood in Nepal. Objective The primary objective of this study was to assess the critical knowledge of primary level nurse- midwives on maternal and newborn care in Kapilvastu District of Nepal. Method This was an Institution based cross-sectional study, conducted in Kapilvastu district, Nepal among sixty eight nurse-midwives. The participants were selected using simple random sampling technique. For collecting the data, health institutions were visited by enumerators for a month from 1st October to 1st November 2012. Data were entered into Microsoft Excel, cleaned and analyzed using SPSS version 17.0. Result More than 3/4th of the nurse-midwives had 10-20 years of experience. Majority of them (89.7%) had poor knowledge in taking action to prevent mother to child transmission for HIV positive women. More than half of them (54.4%) had some knowledge in performing the active management of third stage of labor whereas almost half (51.5%) had poor knowledge to actions needed on post-partum haemorrhage (PPH). Similarly, more than two third (69.1%) had poor knowledge in newborn care. Conclusion Majority of the nurse-midwives were found to have either poor or some level of knowledge in most of the components of maternal and newborn care services. So, greater emphasis should be given to upgrade the knowledge of nurse mid-wives.

Effect of Maternal Socio-demographic Factors and Child Feeding Practice on Wasting Among Under Five Years Children in Slum Area of Rupandehi District in Nepal

Introduction: Childhood wasting although well studied elsewhere, it has not been well understood about in slum area of Nepal. This study aimed to assess effect of socio-demographic factors and child feeding practice in the determination of wasting among the children under five years of age in slum area of Nepal.Methods: A community based cross-sectional study was performed among 150 children under five years of age from the slum area of Nepal between 1st January and  28th February 2013 using simple random sampling techniques. Multivariate analyses were performed to determine factors associated with wasting controlling the potential confounders.Results: In a total of 150 under five years children, the prevalence of wasting was 56 (37.33%). The current study demonstrated that children of mothers from dalit (Adjusted Odds Ratio (OR) 11.5; 95% CI: 03.1 – 41.3), aadibasi/janajati (AOR 4.6; 95% CI: 1.2 – 17.0), illiterate mothers (AOR 3.6; 95% CI: 1.1 – 13.6), laborer mothers (AOR 2.1; 95% CI: 1.1-9.4), child age group 25-36 months (AOR 2.8; 95% CI: 1.5-5.3), multiple child birth order (AOR 10.0; 95% CI: 2.5-25.0), children who were not fed colostrums (AOR 15.0; 95% CI: 1.25-10.0)) were more likely to develop wasting compared to their counterparts.Conclusions: As incremental childhood wasting is associated with maternal socio-demographic factors and child feeding practice, health promotion strategies should focus maternal socio-demographic factors, age of children and early initiation of breast feeding for the improved child nutrition in slum area of Nepal.Keywords: socio-demographic factors; urban slum; under five children; wasting. [PubMed]

Association of water handling and child feeding practice with childhood diarrhoea in rural community of Southern Nepal

Diarrhoea is a major cause of childhood morbidity and mortality globally. While the childhood diarrhoea and its association with child feeding, and hygiene, hand washing and water treatment are studied elsewhere, the association of water handling and child feeding with childhood diarrhoea is an understudied area in Nepal. This study aimed to investigate the association of water handling and child feeding practice with childhood diarrhoea among children of one to five years of age in Southern, Nepal. A cross-sectional study was conducted in the Dhanusha district of Southern Nepal in 2013. A total of 284 mother-child pairs were selected using systemic random sampling. A four-week prevalence of childhood diarrhoea was reported using frequency distribution. The association of childhood diarrhoea with water handling and child feeding practices was ascertained using multiple logistic regressions after adjusting for potential confounders. The result of the study demonstrated that the four-week prevalence of childhood diarrhoea was 36.6%. Our finding showed that unsafe water handling practices were associated independently with childhood diarrhoea: untreated water (aOR 3.55; 95% CI: 1.13-11.10), uncovered water (aOR 2.14; 95% CI: 1.09-4.19). Similarly, partial breast feeding (aOR 4.35; 95% CI: 1.87-10.12) was also associated with higher odds of childhood diarrhoea. One third of children in Southern Nepal still had diarrhoea within the four weeks preceding the survey. As poor water handling and sub optimal infant feeding practice were major risk factors contributing to such a high burden of the disease, health promotion strategies such as promotion of safe water handling, improved hygiene and child feeding practices are recommended for the prevention of childhood diarrhoea in Southern Terai of Nepal.

Effect of Maternal Socio-demographic Factors and Child Feeding Practice on Wasting Among Under Five Years Children in Slum Area of Rupandehi District in Nepal

INTRODUCTION

Childhood wasting although well studied elsewhere, it has not been well understood about in slum area of Nepal. This study aimed to assess effect of socio-demographic factors and child feeding practice in the determination of wasting among the children under five years of age in slum area of Nepal.

METHODS

A community based cross-sectional study was performed among 150 children under five years of age from the slum area of Nepal between 1st January and 28th February 2013 using simple random sampling techniques. Multivariate analyses were performed to determine factors associated with wasting controlling the potential confounders.

RESULTS

In a total of 150 under five years children, the prevalence of wasting was 56 (37.33%). The current study demonstrated that children of mothers from dalit Adjusted Odds Ratio (OR) 11.5; 95% CI: 03.1 - 41.3), aadibasi/janajati (AOR 4.6; 95% CI: 1.2 - 17.0), illiterate mothers (AOR 3.6; 95% CI: 1.1 - 13.6), laborer mothers (AOR 2.1; 95% CI: 1.1-9.4), child age group 25-36 months (AOR 2.8; 95% CI: 1.5-5.3), multiple child birth order (AOR 10.0; 95% CI: 2.5-25.0), children who were not fed colostrums (AOR 15.0; 95% CI: 1.25-10.0) were more likely to develop wasting compared to their counterparts.

CONCLUSIONS

As incremental childhood wasting is associated with maternal socio-demographic factors and child feeding practice, health promotion strategies should focus maternal socio-demographic factors, age of children and early initiation of breast feeding for the improved child nutrition in slum area of Nepal.

Factors Associated with Smokeless Tobacco Use among Pregnant Women in Rural Areas of the Southern Terai, Nepal

BACKGROUND

Tobacco use among women during pregnancy leading to poor maternal and child health outcomes has been well documented. However, factors influencing use of smokeless tobacco in Nepal has not yet been well established. This study aims at exploring the factors related to smokeless tobacco use among pregnant women in rural southern Terai of Nepal.

METHODS

A community-based cross-sectional study was performed at 52 wards within 6 Village Development Committee in Dhanusha district of Nepal. A total of 426 expectant mothers in their second trimester were selected using a multistage cluster sampling method. Descriptive and regression analyses were done to explore the factors that influence smokeless tobacco use.

RESULTS

In a total of 426 pregnant mothers, one in five used tobacco in any form. Among the users, 13.4% used smokeless tobacco. Pregnant mothers who were smoking tobacco (AOR 6.01; 95% CI (1.88-19.23), having alcohol consumption (AOR 3.86; 95% CI (1.23-12.08), stressed (AOR 5.04; 95% CI (1.81-14.03), non-vegetarian (AOR 3.31;(1.84-13.03), not attending regular mothers' group meetings (AOR 4.63; (1.41-15.19), and not-exposed to mass media (AOR 5.02; (1.89-13.33) were significantly associated with smokeless tobacco use. Similarly, mothers of age group 20-34 years, dalit, aadibasi and janajati, hill origin, no education and primary education were more likely to use smokeless tobacco than their counterparts.

CONCLUSIONS

Factors such as smoking tobacco, alcohol consumption, stress, and poor education were found to be significantly associated with smokeless tobacco use among pregnant women in southern Terai of Nepal. This requires an immediate attention develop an effective strategy to prevent and control smokeless tobacco use among pregnant women in southern Terai of Nepal.

Knowledge of Maternal and Newborn Care Among Primary Level Health Workers in Kapilvastu District of Nepal

BACKGROUND

Higher maternal and neonatal deaths are common in low- and middle-income countries; due to less access to skilled help. Adequate knowledge and skills on maternal and newborn care (MNC) of community health workers can improve maternal and newborn health.

AIMS

To identify the knowledge of primary level health workers on some components of MNC.

SUBJECTS AND METHODS

Respondents were selected using simple random sampling method. For collecting the data, enumerators visited health institutions for 2 months from 1(st) October to 31(st) November 2012, and structured interview schedule was used to gather the information. A cross-sectional study was conducted in a total of one hundred and thirty-seven primary level health workers in Kapilvastu district, Nepal. The Chi-square test was employed to examine the association between the knowledge of health workers on MNC and designation and work experience. Data were analyzed using SPSS version 17.

RESULTS

In a total of 137 primary level health workers, more than half 53.2% (73/137) were senior auxiliary health workers/health assistant. Health workers having correct knowledge on contents of MNC were-registration 32.1% (44/137), major components of antenatal care 57.7% (79/137), danger signs of pregnancy 39.4% (54/137), five cleans 59.1% (81/137), postnatal health problems 54.0% (74/137), majority to health action to newborn care, newborn bath and meaning of exclusive breastfeeding. There was a statistical association between designation of health workers and above-mentioned components of MNC (P < 0.05).

CONCLUSIONS

The differentials in the knowledge of MNC among primary level health suggest improving knowledge of the grass root level health workers with appropriate training and development programs.

Association between sociodemographic characteristics of female community health volunteers and their knowledge and performance on maternal and child health services in rural Nepal

Background

Engaging community health volunteers and community health workers to provide maternal and child health (MCH) care services in resource-poor settings is one of the global and widely used concepts. Despite a great role of female community health volunteers (FCHVs) in MCH services in Nepal, few research studies have been performed in this area. Our research aimed to assess the knowledge and performance of FCHVs on MCH services associated with their sociodemographic characteristics.

Methods

A cross-sectional survey was conducted to assess the knowledge and performance on selected MCH services of FCHVs using structured questionnaire in 16 village development committees of Dhanusha district, Southern Terai, Nepal, from the first of January to the end of February of 2014. A total of 138 FCHVs were selected by using multistage random sampling technique. Logistic regression was employed to examine the association between selected sociodemographic characteristics and knowledge and performance on MCH services of FCHVs after adjusting for significant variables associated with knowledge and performance and within-cluster effect.

Results

Our findings demonstrated that sociodemographic characteristics were associated independently with good knowledge of FCHVs on MCH services: education level secondary and above (adjusted odds ratio [aOR] 5.2; 95% confidence interval [CI] 2.2–12.2); residing in Mother and Infant Research Activities, nongovernmental organization working area (aOR 3.7; 95% CI 1.5–8.8); and middle caste (aOR 3.3; 95% CI 1.0–10.3). Similarly, satisfactory performance of FCHVs significantly associated with MCH services were education level secondary and above (aOR 8.9; 95% CI 3.2–24.3) and residing in Mother and Infant Research Activities working areas (aOR 9.0; 95% CI 3.5–22.6).

Conclusion

The study recommends considering education level while recruiting rural FCHVs and capacity enhancement through additional training and development programs in collaboration with developmental partner.

Perceived Usefulness of a Microfinance Intervention on Health Awareness and Practices in Nepal

Background

Economic constraints may lead to poor health among people from the developing world. Microfinance has proven to be useful in improving health outcomes elsewhere, but it still remains a neglected issue in Nepal. This study aims to assess perceived usefulness of the microfinance on health awareness and practices among different ethnic groups of Nepal.

Method

A community-based cross-sectional study was conducted in four districts of western Nepal. A total of 500 microfinance clients representing different ethnic groups (upper caste, aadibasi and janajati, and dalit) were selected by using systemic random sampling. Health awareness and practices among different ethnic groups were compared by logistic regression after adjustment for age, level of education, sex of household heads, occupation, and place of residence. Since participants were asked about their health awareness and practices, before and after microfinance intervention, during a single interview, there was a strong possibility of recall bias with respect to their preintervention awareness and other measures.

Results

Microfinance intervention positively influenced self-reported health awareness and practices among different ethnic groups in Nepal, which was highest among the upper caste group (77–92%, rate ratios around 1.7–2.6), followed by the aadibasi/janajati (60–76%, rate ratios around 1.4–1.8) and dalit group (33–52%, reference group). Self-reported awareness about environment and sanitation, family planning methods, and available health services at local level improved from 11.2 to 69.2, 9.2 to 65.0, and 3.8 to 59.8%, respectively, among the clients after microfinance intervention (p < 0.001). Similarly, the practices of eating nutritious food/balanced diet, drinking safe water, using toilet, immunizing the children, and regularly visiting the healthcare facility were improved from 4.2 to 63.8, 12.6 to 66.8, 15.2 to 70.4, 15.8 to 73.8, and 3.6 to 61.4%, respectively (p < 0.001).

Conclusion

Despite lack of control group and potential recall bias, this study reports positive effect of microfinance on self-reported health awareness and practices among different ethnic groups of Nepal. This finding supports further implementation and evaluation of equity-based microfinance to improve health and economic conditions of Nepalese people.