Journal of Health Promotion

Reflections on health promotion fieldwork in Nepal: Trials and tribulations

Preeti Mahato — 2022-12-31

Fieldwork is often a crucial part of community-based public health studies. However, few researchers write about this, often challenging, process. This paper highlights various occasions where fieldwork in the area of public health, health promotion or community health was more difficult than expected or did not go as planned. Our reflections on working in the field will help less experienced health researchers, or those new to conducting research in Nepal, in their research development. Moreover, this paper is also calling upon health promotion researchers to share more details about the process of doing fieldwork and its trials and tribulations. Our key advice is to be inquisitive and openminded around fieldwork, followed by: be prepared for your fieldwork, conduct a risk assessment of what might go wrong and consider your options to overcome such trials and tribulations. Fieldwork is unpredictable; therefore, it is important to share practical lessons from the field which helps other to better understand these tribulations, and learn from them. Moreover, sharing such information may guide new researchers and help them identify strategies that can address those issues and challenges in their future health promotion studies.

Consequences of COVID-19 on children's learning and their responses

Shyam Krishna Maharjan — 2022-12-31

This article briefly highlights the effects of COVID-19 on schoolchildren's learning and their needs. The global COVID-19 pandemic has had a detrimental effect on the education system, among others. Lockdowns and school closures during COVID-19 reduced children's learning opportunities, leading to a long-term impact on their ability to learn. The learning loss is yet to be known as the world is still suffering from the virus and its variants. Teachers have struggled to complete the course and students were under pressure to study many lessons in a short window of time in order to make up for the school time lost during the pandemic. Because of vaccination including the booster dose against COVID-19, in addition to other preventive and control measures adopted by the public, the prevalence of COVID-19 has reduced. The government of Nepal and other stakeholders have made a decision to reopen schools and continue facilitating student learning face-to-face and through alternative teaching-learning approaches, ensuring health promoting school.

Multilevel factors appealing to junk food consumption among school children and adolescents: A systematic review

Yadu R. Upreti — 2022-12-31

Junk food consumption (JFC) is increasing and it is common mostly among schoolchildren and adolescents (SCA). The consequences of JFC have become a public health concern. The study aims to explore the factors associated with the JFC among SCA using the socioecological model (SEM). Electronic databases such as PubMed, Google Scholar, ResearchGate, and bibliographic references were used to obtain the related papers following the standard process of identification, screening, eligibility assessment, study quality assessment, and data extraction from the selected articles. Strengthening the reporting of observational studies in the epidemiological (STROBE) checklist was used to assess the quality standards of the papers. Out of the 785 papers, we synthesized the results from 22 quantitative articles based on merits. The findings of the study indicate that JFC behavior among the SCA is influenced by multilevel factors that extend from intrapersonal to public policy through interpersonal, organizational, and community levels. The results of the study suggest that more than two-thirds, more than one-third, near to one-third, and half of them supported with microsystem, mesosystem, exosystem, and macrosystem constructs of the SEM respectively. However, age, sex/gender, taste and pleasure of eating junk food, knowledge of junk food and attitude towards dietary choices of the microsystem (individual factors) and mass media exposure and marketing strategies of the macrosystem (public policy factors) remain the most influencing systems. The results indicate that individual and public policy level constructs are important to explaining JFC among the SCA. This implies that the researchers and policymakers need to consider multilevel factors while designing and implementing the school-based nutrition education programme to promote healthy dietary outcomes in the SCA.

Road traffic deaths and injuries in Kathmandu

Jyoti Kuikel — 2022-12-31

Road accidents account for the eighth leading cause of death for all ages in the world. The roads in Nepal are one of the most dangerous in the world, putting road users at greater risk, due to geographical and human causes. Pedestrians, motorbikes, and cyclists are the most vulnerable road users in the Kathmandu Valley. This paper aims to describe the trend of road traffic deaths and injuries in Kathmandu from the perspective of a safer road user policy. A descriptive retrospective study was done based on the information provided by the Metropolitan Traffic Police on road traffic crashes. In the study, the data on road traffic crashes, injuries, and deaths from all types of vehicles over five successive years were obtained from Traffic Police Office, Kathmandu in March-November, 2020 whereas, all the existing national road safety policies and strategies were collected from secondary data. The collected data were analyzed through MS Excel and represented in tables, bar diagrams, and pie charts. From the five successive years’ trend on road traffic injuries and deaths in Kathmandu, it was analyzed that the number of road traffic accidents in FY 2019/20 was 1.5 times higher than in 2018/19. The fatality rate increased to 0.4 per 100,000 population in FY 2019/20 where the fatality of the male population was higher than that of females and the majority of them were of the age group 16-35 years. The death and injury ratio was calculated which showed that the ratio was higher in FY 2019/20 indicating mild injuries and 2 severe injuries. The main causes of traffic accidents were road user negligence, speeding, and overtaking operations. In conclusion, the majority of the young population is prone to be at risk of road traffic accidents and deaths which are preventable.

Trend of tobacco use: Reviewing the STEPS surveys conducted in Nepal

Anil Kumar Mandal — 2022-12-31

The trend of tobacco use has changed over time in the world including Nepal. This study aimed to describe the trend of tobacco use in Nepal, is based on the review of the findings of three consecutive STEP wise approaches to non-communicable disease risk factor surveillance (STEPS) survey 2007, conducted by Society for Local Integrated Development Nepal (SOLID Nepal), and STEPS surveys 2013 and 2019, conducted by Nepal Health Research Council (NHRC). This study only compared the proportion of people who consumed tobacco during these surveys based on sex, age group, and age of initiation of tobacco use to describe the trend of tobacco use. The trend of any tobacco use, smoked tobacco use, and smokeless tobacco (SLT) use declined to 28.9% from 37.1%, to 17.1% from 26.2%, and to 18.3% from 18.6%, respectively during the period of 2007 to 2019. It shows that the prevalence of any tobacco use, smoked tobacco use and SLT use were in decreasing trend among men and women. In order to reduce it further, the government should conduct tobacco cessation programs considering SLT.

Forgotten health and social care needs of left-behind families of Nepali migrant workers

Yagya R. Adhikari — 2022-12-31

Not available.

Women’s autonomy and its effect on antenatal care visits among Tharu women of reproductive age (15-49) of Khairahani Municipality, Nepal

Anuska Adhikari — 2022-12-31

Women's autonomy in health care decision-making is enormously essential for improved maternal and child health outcomes and women's empowerment. This study examines women's autonomy and its effect on antenatal care (ANC) visits among the women of the Tharu community of Khairahani municipality, Chitwan. The probability proportional to size (PPS) sampling technique was adapted for sample estimation in each selected ward. A list of all the Tharu households in the community was prepared from which 294 women were selected using systematic random sampling techniques. Univariate, bivariate (Chisquare test), and multivariate analyses (binary logistic regression) were performed. One-fifth of women were youths aged 15-24 (mean 27.8 years). One out of ten women was illiterate, and about two-thirds (65%) were involved in agriculture. More than two in five women (42%) did not have autonomy. Women's autonomy, age group, educational status, occupational status, and husband's occupational status were significantly associated with antenatal care visits. A significantly high number of women (p<0.001) who had high autonomy (89%), compared with those who had no autonomy (65%), used ANC services for their last birth. Women with low autonomy and high autonomy were three times (OR=3.05; 95% CI=1.01-8.5) and 4.5 times (OR=4.5; 95% CI 2.3-8.6) more likely to utilize ANC visits than those who had no autonomy. Women's autonomy in healthcare decision-making, household purchases, and money expenditure were significantly associated with the use of antenatal care visits. Women's participation in the decision-making process regarding health care and household matters should be focused on and increased for better utilization of antenatal care services.

Food insufficiency among returnee migrants during COVID-19

Bidur Bastola — 2022-12-31

Remittance from the employed in the foreign countries has been contributing a lot to Nepal's economy, supporting the livelihoods of millions of families. The COVID-19 pandemic has been a catalyst for unprecedented social and economic change and exacerbated food insecurity levels in the short- and longer-term across the world. The study's objectives are to examine the status and determinants of food insufficiency due to COVID-19 among returnee migrants of the far western province of Nepal. Data for this survey were collected through telephone interviews with the respondent using cross-sectional research design selecting 1182 respondents as the sample. Among these returnee migrants 94.2% were males and one third of them were the youth of less than 25 years. The data were analyzed conducting univariate, bivariate and multivariate statistical tools. It was found that 18% of returnee migrants had food insufficiency in their households during the survey period. Multivariate analysis showed that the households with single women were about 1.9 times more likely to have food insufficiency (aOR=1.867, 95% CI=1.12- 3.11) than those households who did not have single women. Respondents with any healthrelated problem were two times more likely to have food insufficiency (aOR=2.443, 95% CI=1.48-4.03) than those who did not have any health-related problem. Similarly, migrants from poor households were two times more likely to have food insufficiency (aOR=2.620, 95% CI=1.52-4.52) than somehow well- to-do households. The female migrants who were physically disabled had lost their jobs in the host country and had been suffered more from food insufficiency.

Experiences of key populations in getting and sharing HIV and AIDS-related information: A descriptive phenomenological study

Toya Nath Pahadi — 2022-12-31

Despite the long-running targeted communication programs, the concentrated HIV epidemic in key populations has not declined as expectedin Nepal.In this context, the present descriptive phenomenological study was carried out in Nepalgunj Submetropolitan City to explore the experiences of key populations in getting and sharing HIV and AIDS-related information. In-depth interviews were carried out with nine participants selected through snowball sampling from sexual minority people, and female sex workers. Colaizzi’s descriptive phenomenological analysis method was adopted in data analysis. Participants were increasingly using digital means of communication. Peer approach was experienced as more confidential and training in drop-in-center a friendly mode of communication. Experiences of embarrassment, stigma, and discrimination were also prevalent. The findings of this study indicate HIV communication needs to be easily accessible, confidential, and friendly.

Nutritional practices of the preschool-aged children and associated factors: A cross-sectional study in Rupandehi district of Nepal

Prakash Sharma — 2022-12-31

Undernutrition is a common problem among Nepali preschool-aged children. Every parent’s feeding practice should be focused on preventing unhealthy eating behaviors of preschool-aged children as it is very difficult to change it in their later life. This study was carried out to assess the key nutritional practices and associated factors among the 3-5-year-old preschool-aged children from their primary caregivers/mothers by employing a quantitative research method. Data were collected through scheduled interviews and observations from mothers/primary caregivers of 394 preschool-aged children who were selected through a multi-stage random sampling procedure in Rupandehi District of Nepal. Binary logistic regression was done to determine the predictors of nutritional practices of preschool-aged children. A p-value less than 0.05 is considered statistical significance. Economic statuses including caste/ethnicity were the main socio-economic and demographic variables to determine the nutritional practices of the preschool-aged children. Findings of the study indicated that majority of preschool-aged children were found in low-level nutritional practices. The preschoolaged children from marginal economic status, including disadvantage-cohorts of the Terai and Dalit, were the victims of the poor nutritional practices. Hence, community-based nutrition education intervention and mothers/caregivers’ awareness programs on feeding practices may be an incredible effort to improve the nutritional status of preschool-aged children if the program is intervened by targeting the background characteristics of the community group.

Eye health knowledge among basic level science and health education teachers in Solukhumbu district of Nepal

Pushpa Babu Basnet — 2022-12-31

Prior studies showed that school teachers have an important role in controlling blindness at the community level. A school eye health promotion program is essential because it helps cover health services for children in the community. The study aimed to assess the factors of eye-health problems and eye-health knowledge at the basic level of school teachers at the primary level of eye health problems and care. A cross-sectional study design was implemented with a self-administered questionnaire. A total of 292 health and science basic-level school teachers have been selected from the Solukhumbu district. The sample size was determined by Slovin's formula. Data were analyzed using the IBM Statistical Package for the Social Sciences (SPSS) V20. The proportion of teachers knowing eye health problems and care of children is higher among teachers having qualifications at master level or above (mean rank = 179.99) than the bachelor level (mean rank =146.30), grade twelve (mean rank =149.06) and grade ten (mean rank =116.91) which was statistically significant (p<0.05. The study concluded that the level of qualification of the teacher was significantly associated with knowledge of the eye-health. Hence teachers who have low qualifications should be trained in the eye-health.

Risk perception and intent to take precautionary actions against COVID-19 among adult population during pandemic in Nepal

Shanti Prasad Khanal — 2022-12-31

This cross-sectional study sought whether there was an association between COVID-19 risk perception and the intention to take precautionary health measures among Nepalese adults aged 20 to 60 years. A multi-stage sampling technique was used to select study participants in this study. With the help of Kobo Toolbox application programs, field enumerators interviewed 1072 adults from 14 districts of Nepal in March and April of 2021. In the study, the average age of participants was 35.11 years. Over half (52%) of them were women, and 44% were the Brahmins and Chhetri caste. Apart from perceived susceptibility, the study showed that the largest group (41%) of respondents had the lowest level of perceived susceptibility. Only a few (14.8%) of respondents expressed a strong intention to take safe measures (M=1.14 ±0.35). The study results indicated that four constructs of the health belief model such as perceived severity, barriers, benefits, and self-efficacy were positively correlated (>0.05) with taking protective health measures. In contrast, perceived susceptibility was not associated (0.53) with the intention to take protective health measures. Overall, Nepalese people are reluctant to act against COVID-19 because of their low-risk perception, which makes it necessary to raise public awareness regarding COVID-19.

Educational association with zoonotic related knowledge and practices of livestock farmers in selective districts of Nepal

Kosh Bilash Bagale — 2022-12-31

This study aims to assess the educational association with knowledge and preventive practices of livestock farmers toward the common zoonoses. A descriptive cross- sectional quantitative research design was followed in the study. The total sample size was 380 livestock farmers from randomly selected three districts of Nepal. Systematic sampling technique was applied for data collection. The data were calculated using descriptive statistics. Univariate, bivariate, and multivariate analyses were performed. The majority of the respondents (52.4%) had basic level education. Similarly, more than two-thirds (67.6%) adopted agro-farming and less than one in ten (7.9%) had livestock as a major occupation in their households. In this study bird flu (95.8%) and rabies (90.7%) are highly known zoonoses and swine flu is average (54.2%) in terms of respondents' knowledge. The finding shows that a large number of respondents with higher education had good knowledge about zoonoses and followed better zoonoses preventive practices. Among the higher educated respondents; practice to avoid sick animal consumption was 86.7 percent, practice to children avoiding livestock contact was 45.5 percent, pregnant women avoiding livestock exposure was 49 percent and pre-exposure vaccination practices was 55.8 percent which showed significant statistical association with their level of education. However, a significant number of respondents with higher education still were unaware about many common zoonoses and poor preventive practices. Therefore; education should be accessible in every community whereas; health education with specific zoonoses in the school curriculum and zoonoses related training for livestock farmers should be warranted.

Assessing the effectiveness of a menstrual hygiene management and sexual and reproductive health education program in post-earthquake Nepal

Sara E. Baumann — 2022-12-31

This study assesses the effectiveness of a menstrual hygiene management (MHM) and sexual and reproductive health (SRH), school-based education program conducted in Dhading, Nepal after the 2015 mega-earthquake. The intervention aimed to improve MHM/SRH knowledge among adolescent girls on a range of topics including adolescence, female anatomy, menstruation, and more. Quantitative data were collected via cross-sectional, self-administered, community-based surveys after the 2015 earthquake with 3,319 adolescent girls in grades 7-9 in Dhading district. Data were collected using the same survey tool before and after the intervention and responses were compared using SAS 9.4. Before the intervention, the median MHM/SRH knowledge score was 50% of the pre-test questions answered correctly. After the intervention, the median MHM/SRH knowledge score improved to 73% of the post-test questions answered correctly. Topics with the greatest percentage improvements between pre- and post-tests included age of menarche (from 20.5% to 60.0%), timing of taking emergency contraceptive pills after unsafe sexual contact (from 14.8% to 54.1%), and approaches for managing menstrual pain (from 42.2% to 77.1%). The school-based MHM/SRH educational intervention led to significant improvements in participant MHM/SRH knowledge. Equipping girls with accurate information about MHM/SRH long before a disaster occurs by embedding the information into the national school curriculum is one way to ensure they are prepared with key information required to manage MHM/SRH needs if another disaster occurs.

Role of social media for sexual communication and sexual behaviors: A focus group study among young people in Nepal

Pramod R. Regmi — 2022-12-31

Over the past decade, young people’s use of the social media has increased steadily in many countries including Nepal. Studies in other countries suggest that social media platforms can play an important role in facilitating sexual communication and relationships. This qualitative study comprising focus group discussions (FGDs), intends to explore: (a) perceptions of and motives toward social media re. sexual communication in educated unmarried young people in Nepal; and (b) their views of the link between social media and risky sexual behavior. We carried out eight FGD, four with young men and four with young women. FDGs were audio recorded, transcribed and thematically analyzed. All FGD participants were students (age range 15-22) from Kathmandu. Five themes emerged from the thematic analysis: a) use of and motives for using social media; b) sex education in general; c) sexual information through social media; d) social media’s role in forming romantic and sexual relationships; and e) negative experience of social media. Social media are popular among young people in Nepal and is considered as an important platform to access sexual health information. Young people also use these to establish romantic and sexual relationships, however, it doesn’t necessarily mean that social media are directly leading to unsafe sexual behaviors in young people. It is the lack of awareness and inadequate education about sex that is resulting in unsafe sexual practices. Overall, suggesting the need for more appropriate health promotion activities in the field sex and relationship education.