Nepal Institute of Health Science

Kathmandu, Nepal

Nepal Institute of Health Science

Kathmandu, Nepal
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Singh U.,Nepal Institute of Health science | Singh U.,Prince of Songkla University | Ueranantasun A.,Prince of Songkla University | Kuning M.,Prince of Songkla University
BMC Pregnancy and Childbirth | Year: 2017

Background: Survey data from low income countries on birth weight usually pose a persistent problem. The studies conducted on birth weight have acknowledged missing data on birth weight, but they are not included in the analysis. Furthermore, other missing data presented on determinants of birth weight are not addressed. Thus, this study tries to identify determinants that are associated with low birth weight (LBW) using multiple imputation to handle missing data on birth weight and its determinants. Methods: The child dataset from Nepal Demographic and Health Survey (NDHS), 2011 was utilized in this study. A total of 5,240 children were born between 2006 and 2011, out of which 87% had at least one measured variable missing and 21% had no recorded birth weight. All the analyses were carried out in R version 3.1.3. Transform-then impute method was applied to check for interaction between explanatory variables and imputed missing data. Survey package was applied to each imputed dataset to account for survey design and sampling method. Survey logistic regression was applied to identify the determinants associated with LBW. Results: The prevalence of LBW was 15.4% after imputation. Women with the highest autonomy on their own health compared to those with health decisions involving husband or others (adjusted odds ratio (OR) 1.87, 95% confidence interval (95% CI) = 1.31, 2.67), and husband and women together (adjusted OR 1.57, 95% CI = 1.05, 2.35) were less likely to give birth to LBW infants. Mothers using highly polluting cooking fuels (adjusted OR 1.49, 95% CI = 1.03, 2.22) were more likely to give birth to LBW infants than mothers using non-polluting cooking fuels. Conclusion: The findings of this study suggested that obtaining the prevalence of LBW from only the sample of measured birth weight and ignoring missing data results in underestimation. © 2017 The Author(s).


Pandey S.,Khan Research Laboratories | Tiwari K.,Nepal Institute of Health Science | Senarath U.,University of Colombo | Agho K.E.,University of Western Sydney | And 11 more authors.
Food and Nutrition Bulletin | Year: 2010

Background. Childhood undernutrition and mortality are high in Nepal, and therefore interventions on infant and young child feeding practices deserve high priority. Objective. To estimate infant and young child feeding indicators and the determinants of selected feeding practices. Methods. The sample consisted of 1,906 children aged 0 to 23 months from the Demographic and Health Survey 2006. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results. Breastfeeding was initiated within the first hour after birth in 35.4% of children, 99.5% were ever breastfed, 98.1% were currently breastfed, and 3.5% were bottle-fed. The rate of exclusive breastfeeding among infants under 6 months of age was 53.1%, and the rate of timely complementary feeding among those 6 to 9 months of age was 74.7%. Mothers who made antenatal clinic visits were at a higher risk for no exclusive breastfeeding than those who made no visits. Mothers who lived in the mountains were more likely to initiate breastfeeding within 1 hour after birth and to introduce complementary feeding at 6 to 9 months of age, but less likely to exclusively breastfeed. Cesarean deliveries were associated with delay in timely initiation of breastfeeding. Higher rates of complementary feeding at 6 to 9 months were also associated with mothers with better education and those above 35 years of age. Risk factors for bottle-feeding included living in urban areas and births attended by trained health personnel. Conclusions. Most breastfeeding indicators in Nepal are below the expected levels to achieve a substantial reduction in child mortality. Breastfeeding promotion strategies should specifically target mothers who have more contact with the health care delivery system, while programs targeting the entire community should be continued. © 2010, The United Nations University.


Patel A.,Center for Clinical Epidemiology | Badhoniya N.,Center for Clinical Epidemiology | Khadse S.,BJ Medical College | Senarath U.,University of Colombo | And 11 more authors.
Food and Nutrition Bulletin | Year: 2010

Background. In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality. Objective. To estimate infant and young child feeding indicators and determinants of selected feeding practices in India. Methods. The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005-06. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results. Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for > 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for > 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR=1.29), higher maternal education level (OR=1.32), urban residence (OR=1.46), and absence of postnatal examination (OR=1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR=0.57), and for those who watched television (OR=0.75). Conclusions. Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households. © 2010, The United Nations University.


Senarath U.,University of Colombo | Dibley M.J.,University of Sydney | Godakandage S.S.R.,Family Health Bureau | Jayawickrama H.,Family Health Bureau | And 12 more authors.
Food and Nutrition Bulletin | Year: 2010

Background. Poor feeding practices in early childhood contribute to the burden of childhood malnutrition and morbidity. Objective. To estimate the key indicators of breastfeeding and complementary feeding and the determinants of selected feeding practices in Sri Lanka. Methods. The sample consisted of 1,127 children aged 0 to 23 months from the Sri Lanka Demographic and Health Survey 2000. The key infant feeding indicators were estimated and selected indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Results. Breastfeeding was initiated within the first hour after birth in 56.3% of infants, 99.7% had ever been breastfed, 85.0% were currently being breastfed, and 27.2% were being bottle-fed. Of infants under 6 months of age, 60.6% were fully breastfed, and of those aged 6 to 9 months, 93.4% received complementary foods. The likelihood of not initiating breastfeeding within the first hour after birth was higher for mothers who underwent cesarean delivery (OR = 3.23) and those who were not visited by a Public Health Midwife at home during pregnancy (OR = 1.81). The rate of full breastfeeding was significantly lower among mothers who did not receive postnatal home visits by a Public Health Midwife. Bottlefeeding rates were higher among infants whose mothers had ever been employed (OR = 1.86), lived in a metropolitan area (OR = 3.99), or lived in the South-Central Hill country (OR = 3.11) and were lower among infants of mothers with secondary education (OR = 0.27). Infants from the urban (OR = 8.06) and tea estate (OR = 12.63) sectors were less likely to receive timely complementary feeding than rural infants. Conclusions. Antenatal and postnatal contacts with Public Health Midwives were associated with improved breastfeeding practices. Breastfeeding promotion strategies should specifically focus on the estate and urban or metropolitan communities. © 2010, The United Nations University.


Dibley M.J.,University of Sydney | Roy S.K.,International Center for Diarrhoeal Disease Research | Senarath U.,University of Colombo | Patel A.,Indira Gandhi Government Medical College | And 11 more authors.
Food and Nutrition Bulletin | Year: 2010

Background. Information on infant and young child feeding is widely available in Demographic and Health Surveys and National Family Health Surveys for countries in South Asia; however, infant and young child feeding indicators from these surveys have not been compared between countries in the region. Objective. To compare the key indicators of breastfeeding and complementary feeding and their determinants in children under 24 months of age between four South Asian countries. Methods. We selected data sets from the Bangladesh Demographic and Health Survey 2004, the India National Family Health Survey (NFHS-03) 2005-06, the Nepal Demographic and Health Survey 2006, and the Sri Lanka 2000 Demographic and Health Survey. Infant feeding indicators were estimated according to the key World Health Organization indicators. Results. Exclusive breastfeeding rates were 42.5% in Bangladesh, 46.4% in India, and 53.1% in Nepal. The rate of full breastfeeding ranged between 60.6% and 73.9%. There were no factors consistently associated with the rate of no exclusive breastfeeding across countries. Utilization of health services (more antenatal clinic visits) was associated with higher rates of exclusive breastfeeding in India but lower rates in Nepal. Delivery at a health facility was a negative determinant of exclusive breastfeeding in India. Postnatal contacts by Public Health Midwives were a positive factor in Sri Lanka. A considerable proportion of infants under 6 months of age had been given plain water, juices, or other nonmilk liquids. The rate of timely first suckling ranged from 23.5% in India to 56.3% in Sri Lanka. Delivery by cesarean section was found to be a consistent negative factor that delayed initiation of breastfeeding. Nepal reported the lowest bottle-feeding rate of 3.5%. Socioeconomically privileged mothers were found to have higher bottlefeeding rates in most countries. Conclusions. Infant and young child feeding practices in the South Asia region have not reached the expected levels that are required to achieve a substantial reduction in child mortality. The countries with lower rates of exclusive breastfeeding have a great potential to improve the rates by preventing infants from receiving water and water-based or other nonmilk liquids during the first 6 months of life. © 2010, The United Nations University.


Mihrshahi S.,Queensland University of Technology | Kabir I.,International Center for Diarrhoeal Disease Research | Roy S.K.,International Center for Diarrhoeal Disease Research | Agho K.E.,University of Western Sydney | And 11 more authors.
Food and Nutrition Bulletin | Year: 2010

Background. In Bangladesh, poor infant and young child feeding practices are contributing to the burden of infectious diseases and malnutrition. Objective. To estimate the determinants of selected feeding practices and key indicators of breastfeeding and complementary feeding in Bangladesh. Methods. The sample included 2,482 children aged O to 23 months from the Bangladesh Demographic and Health Survey of 2004. The World Health Organization (WHO)-recommended infant and young child feeding indicators were estimated, and selected feeding indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Results. Only 27.5% of mothers initiated breastfeeding within the first hour after birth, 99.9% had ever breastfed their infants, 97.3% were currently breastfeeding, and 22.4% were currently bottle-feeding. Among infants under 6 months of age, 42.5% were exclusively breastfed, and among those aged 6 to 9 months, 62.3% received complementary foods in addition to breastmilk. Among the risk factors for an infant not being exclusively breastfed were higher socioeconomic status, higher maternal education, and living in the Dhaka region. Higher birth order and female sex were associated with increased rates of exclusive breastfeeding of infants under 6 months of age. The risk factors for bottle-feeding were similar and included having a partner with a higher educational level (OR = 2.17), older maternal age (OR for age > 35 years = 2.32), and being in the upper wealth quintiles (OR for the richest = 3.43). Urban mothers were at higher risk for not initiating breastfeeding within the first hour after birth (OR = 1.61). Those who made three to six visits to the antenatal clinic were at lower risk for not initiating breastfeeding within the first hour (OR = 0.61). The rate of initiating breastfeeding within the first hour was higher in mothers from richer households (OR = 0.37). Conclusions. Most breastfeeding indicators in Bangladesh were below acceptable levels. Breastfeeding promotion programs in Bangladesh need nationwide application because of the low rates of appropriate infant feeding indicators, but they should also target women who have the main risk factors, i.e., working mothers living in urban areas (particularly in Dhaka). © 2010, The United Nations University.


Thapa S.,Nepal Institute of Health science | Thapa S.,Catholic University of Leuven | Angdembe M.,B P Koirala Institute Of Health Science | Chauhan D.,Nepal Institute of Health science | Joshi R.,Nepal Institute of Health science
Journal of Obstetrics and Gynaecology Research | Year: 2014

Aim: This study was carried out in order to identify the determinants of pelvic organ prolapse (POP) among the women of the western part of Nepal. Methods: This was a matched case-control study. Cases were defined as women diagnosed with third and fourth degree POP, and the control group consisted of women who were screened and confirmed of not having any degree of POP. Cases (n = 183) and controls (n = 183) were randomly selected and for each case, one control was selected, matched by age and place of residence. A semistructured interview was carried out to obtain the information for both groups. Bivariate analysis along with conditional logistic regression analysis was carried out to identify the association between selected variables with POP. Results: The results showed the significant association between number of vaginal deliveries, tear of vagina in the last childbirth, sphincter damage in the last childbirth and duration of labor in the last childbirth with POP, after adjusting for educational status of the women, carrying heavy loads, type of usual work and incidence of diarrhea. Conclusion: The results suggest that prolonged labor along with vaginal delivery having sphincter and vaginal tear are the determinants of POP and program managers should strongly consider these factors to develop interventions targeting the prevention of POP. © 2014 Japan Society of Obstetrics and Gynecology.


Thapa S.,Nepal Institute of Health science | Paudel I.S.,BP Koirala Institute of Health science | Bhattarai S.,BP Koirala Institute of Health science | Joshi R.,Nepal Institute of Health science | Thapa K.,National Academy of Medical science
Asia-Pacific Journal of Public Health | Year: 2015

Information related to contraception discontinuation, especially in the context of Nepal is very limited. A nested case-control study was carried out to determine the factors affecting discontinuation of intrauterine contraceptive devices (IUCDs). A total of 115 cases (IUCD discontinuers) and 115 controls (IUCD continuers) were randomly selected based on the data obtained from the user's record of a family planning center in Kathmandu. Matching criteria were age during insertion and date of insertion of IUCD. Logistic regression was used to analyze the data. When cases were compared with controls, the results showed that place of residence, sex of last child, reproductive intention, experience of side effects, and follow-up practice were associated with discontinuation of the IUCD. Experience of side effects has been seen as the major reason for discontinuation. The results suggest that side effects after IUCD insertion should be properly discussed and promptly treated to reduce the discontinuation rate. © 2012 APJPH.


PubMed | National Academy of Medical science, Nepal Institute of Health science and BP Koirala Institute of Health science
Type: Journal Article | Journal: Asia-Pacific journal of public health | Year: 2015

Information related to contraception discontinuation, especially in the context of Nepal is very limited. A nested case-control study was carried out to determine the factors affecting discontinuation of intrauterine contraceptive devices (IUCDs). A total of 115 cases (IUCD discontinuers) and 115 controls (IUCD continuers) were randomly selected based on the data obtained from the users record of a family planning center in Kathmandu. Matching criteria were age during insertion and date of insertion of IUCD. Logistic regression was used to analyze the data. When cases were compared with controls, the results showed that place of residence, sex of last child, reproductive intention, experience of side effects, and follow-up practice were associated with discontinuation of the IUCD. Experience of side effects has been seen as the major reason for discontinuation. The results suggest that side effects after IUCD insertion should be properly discussed and promptly treated to reduce the discontinuation rate.

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