Krishna Prasad Sapkota

Objective To examine the cumulative and synergistic association of vulnerable conditions: depression, tobacco use, unrecorded alcohol consumption and peer influence on alcohol use disorder (AUD) among adults of urban squatter settlements in Nepal. Design Cross-sectional. Setting Urban squatter settlements of Pokhara Metropolitan City, Gandaki Province, Nepal. Participants 309 adults aged 18–69 years who used to consume alcohol. Main outcome measure The Alcohol Use Disorders Identification Test (AUDIT) tool was used to assess the AUD and was defined as an AUDIT Score of ≥8. Cumulative and synergistic association of vulnerable conditions on AUD were explored in the multivariable logistic regression models using the interaction (product) term. Results The prevalence of AUD among adults who used to drink alcohol in the urban slum was 54.0% (95% CI 48.4% to 59.6%). The majority (81.9%) reported at least two vulnerable conditions, while 10.0% had all four conditions. The odds of AUD were higher for participants with one or more vulnerable conditions. More specifically, compared with adults with no or one syndemic factor, those who had at least three syndemic conditions had 16-fold higher odds of AUD (aOR: 16.068, 95% CI 6.002 to 43.020). These four vulnerable conditions can increase the risk of AUD by interacting synergistically with one another. Conclusion The synergistic effect of vulnerable conditions on AUD suggests that addressing vulnerable conditions simultaneously is required for the prevention and control of AUD.

Background: Access to and use of mental health services remain limited in low- and middle-income countries. This insufficient utilization presents a significant challenge to the proper management and treatment of mental illness. Identifying the reason behind the low utilization of mental health services at primary health facilities is very important for strengthening mental health services and their utilization at the primary health care level. Thus, this study aims to explore the barriers and facilitators of mental health services utilization at PHC facilities in the Syangja District of Nepal. Methodology: A cross-sectional qualitative study was conducted in Syangja district, Nepal between February and March 2025. A total of 22 interviews were conducted including 7 in-depth interviews with patients and 15 key informant interviews with health service providers. These interviews were carried out across five primary health care facilities and four local government units via validated interview guidelines. The participants were selected via purposive sampling. The interviews were conducted in the Nepali language, transcribed and then translated into English. Thematic analysis was carried out via NVivo software following the framework of Braun and Clarke. Results: The present study identified various facilitators that enable mental health service utilization such as sympathetic behavior of health workers, positive treatment experiences, support from family and the community, the close proximity of PHC facilities and the availability of free psychotropic medication. However, significant barriers persist such as stigma, lack of mental health awareness, traditional practices, lack of trained manpower, limited private space, frequent stockout of medicines and insufficient budget allocation. The strategies proposed by participants included increasing awareness through mass media, training multiple staff in mental health, ensuring consistent medicine availability and appointing mental health focal persons. Conclusion: There are various interwoven factors like facilitators and barriers that influence mental health services utilization in PHC facilities. This study highlights the urgent need for increased awareness, reduced stigma, trained manpower and consistent medicine supplies to improve mental health service utilization at primary health care facilities.

Menstrual restriction has persisted in Nepalese society for centuries, driven by ignorance and myth. This practice is imposed on women through various Hindu mythologies and leads to significant limitations in their daily activities. The most severe form of menstrual restriction, known as Chaupadi, has resulted in numerous deaths of women and young children due to suffocation, snakebite, rape, and other serious forms of harm. Despite its criminalization by law, there has been no visible impact on the practice of menstrual restriction. This discriminatory practice not only causes hormonal imbalance and physical pain but also has significant mental health implications for adolescent girls, which have yet to be fully explored. Therefore, this study aims to investigate the prevalence and perceived stress associated with menstrual restriction among adolescent girls attending lower secondary school in Far-Western Region, Kailali District, Nepal The study utilized a descriptive, cross-sectional design and recruited 370 respondents using a proportionate random sampling technique. The study was conducted at the secondary school of Godawari Municipality in Kailali, Nepal. Prior to the study, a structured questionnaire and a Likert scale were pretested among 10% of the population in Kathmandu. Data Analysis was done using Univariate Analysis, Bivariate Analysis (Chi-square) and Multi-variate Analysis (Logistic Regression). The findings revealed that perceived stress was comparatively higher among upper-caste groups and Dalits who followed menstrual restrictions religiously, as compared to disadvantaged Janajati from the hills. Moreover, the level of perceived stress was moderately high among households with larger family sizes. Significant associations were observed between menstrual restriction and perceived stress for each type of menstrual restriction studied, with more than 80% of the different measured levels of restrictions showing a significant association. Menstrual restriction-related practices, such as being restricted from entering inside the house, being sent to Chau-Goth, being restricted from touching male members, being restricted from touching livestock or animals, being restricted from eating together with the family, being restricted from consuming dairy products, being restricted from participating in cultural rituals, being restricted from sleeping in any bed, and being restricted from using heavy blankets and mattresses, were associated with perceived stress. The relationship between menstrual restrictions and perceived stress level was examined. Results showed that respondents with restrictions to enter or reside inside the house had 3.78 times higher odds of perceived stress (OR=3.78; CI=1.96-7.33), while those sent to Chhau Goth had 2.98 times higher odds (OR=2.98; CI=1.94-4.57). Respondents with restrictions on touching food, cooking food, plants with holy belief, livestock or animals, dairy products, eating together with family, participating in cultural rituals, having Prasad, sleeping in any bed, using packed pads, common toilet, or common taps during menstruation also had higher odds of perceived stress. Given the findings, further research is necessary to measure the level of perceived stress among adolescent girls in the population. This research has significant implications for the physical, social, and psychological well-being of adolescent girls and the community at large.

Background: To identify the association between different factors associated with knowledge, attitude and practice among the health care workers of Bhaktapur, Nepal. Materials and Methods: A descriptive cross-sectional study was carried out among 354 Health Care workers of Bhaktapur. The major objective of the study was to evaluate knowledge, attitude and practice of COVID-19 among the health care workers of Bhaktapur, Nepal and direct face to face interview method was carried out for this study. Chi-square test was applied to find the association between various demographic variables and knowledge attitude and practice. Results: Nearly, three fourth (74.4%) of the male had good knowledge and the female with good knowledge were 47.5%. But the percentage of female with positive attitude (80%) and good practice (67.5) were higher as compared to that of male. There were significant association between gender, years of schooling job description, and family type with the knowledge of the respondents. Conclusion: The study concluded that female, individuals with the basic and the secondary level of schooling and cleaners/others have a very less good knowledge percentage. Positive attitude among Pharmacists was low as compared to other profession. Similarly, percentage of female with good practice was higher than male and the respondents with years of experience. Among the different measures taken to prevent COVID-19, most of the health care workers said, not touching eyes, nose or mouth without washing hands can prevent COVID-19.Besides this, majority of the respondents said, use of PPE while handling the patients, avoiding close contact with the sick and washing and sanitizing hands also play the crucial role in prevention of spread of the virus.