Publications by authors named "Edwin van Teijlingen"

197 Publications

Slovenian midwifery professionalization: Perception of midwives and related health professions.

Eur J Midwifery 2021 20;5:30. Epub 2021 Jul 20.

Centre for Welfare Studies, Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia.

Introduction: This article presents research into the professionalization of midwifery in Slovenia. Since recognition by related occupations is important for professions, this comparative study asked doctors and nurses in Slovenia about their perceptions of the status of midwifery.

Methods: A questionnaire survey was conducted with 300 Slovenian midwives, 666 nurses and 416 obstetricians. The questionnaire included statements covering traditional sociological notions of the profession (ethics, theory, power), and three notions based on new elements of professionalism (reflective practice, interdisciplinary working, and partnership with clients).

Results: Findings suggest that nurses perceived themselves to be less autonomous than midwives, and this partly explains why most nurses thought that midwifery should be a specialized course of study, after the general nursing diploma. Obstetricians claimed to support midwives, however, they did not give midwives credit for basic midwifery competencies and did not feel midwifery to be equal to their profession. Midwives revealed not to feel autonomous; they felt that nursing and obstetrics is jeopardizing independent midwifery practice.

Conclusions: Slovenian midwifery was poorly evaluated in some attributes of professionalism, especially knowledge and autonomy. Even midwives themselves consider midwifery more occupation than profession. The autonomy of midwifery will be hard to achieve in the institutions of medical dominance. The study revealed that participants of all three groups are in a competitive relation and are poorly aware of the roles and competencies of the other two professions. Therefore, partially joined education might be beneficial in order to promote interprofessional collaboration in the future.
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http://dx.doi.org/10.18332/ejm/137664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8290859PMC
July 2021

Male involvement in promotion of safe motherhood in low- and middle-income countries: A scoping review.

Midwifery 2021 Jul 14;103:103089. Epub 2021 Jul 14.

Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, 10 St Paul's Ln, Boscombe BH8 8AJ, United Kingdom. Electronic address:

Background: Maternal health programmes that focus on the woman alone are limiting in LMICs as pregnant women often relate to maternity services through a complex social web that reflects power struggles within the kinship and the community.

Methods: A scoping review was conducted to explore the rationale for male involvement in maternal health in LMICs. This review was guided by the question: What is the current state of knowledge regarding the inclusion of men in maternal health services in LMICs? The literature search was conducted using mySearch, Bournemouth University`s iteration of the EBSCO Discovery Service (EDS) tool. The review process used the Preferred Reporting Items for Systematic Reviews to select papers for inclusion.

Findings: Thirty three studies met the inclusion criteria. Findings describe the rationale for involving men in maternity care, alongside the criticisms and challenges inherent in engaging with men in maternal health. Involving men in maternity services can improve health outcomes for women and infants. Health strategies aimed at educating men are relevant in equipping men with knowledge and skills that help men to be supportive of women`s wellbeing during pregnancy and childbirth.

Conclusion: Men can serve as advocates for women and reinforce their partner`s choices in accessing skilled care and infant feeding. Further research is required to examine the effect of male involvement on women`s autonomy and to assess health education interventions aimed at mitigating harmful outcomes of involving men in maternity services.
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http://dx.doi.org/10.1016/j.midw.2021.103089DOI Listing
July 2021

Cultural issues on accessing mental health services in Nepali and Iranian migrants communities in the UK.

Int J Ment Health Nurs 2021 Jul 21. Epub 2021 Jul 21.

Dorset Healthcare, University NHS Foundation Trust, Dorset, UK.

Mental health in Black Asian and Minority Ethnic (BAME) communities is a rising public health concern in the UK, with key challenges around accessing mental health services. Our understanding of mental health issues in the growing Nepali and Iranian communities in the UK is very limited. Therefore, this study aims to explore the major factors affecting access to, and engagement with NHS mental health services. This study used a qualitative approach comprising in-depth interviews with seven Nepali, eight Iranians and six community mental health workers in the south of England. The data were analysed using a thematic approach. Six themes were identified: (1) stigma and fear; (2) gender; (3) language; (4) tradition and culture; (5) family involvement; and (6) lack of cultural awareness in health workers, all appearing to be major issues. This study contributes to a shared understanding of mental illness within two given cultural contexts to promote early interventions in UK mental health services. Developing cross-cultural perspectives in health care should be a priority in practice.
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http://dx.doi.org/10.1111/inm.12913DOI Listing
July 2021

Caste Exclusion and Health Discrimination in South Asia: A Systematic Review.

Asia Pac J Public Health 2021 May 24:10105395211014648. Epub 2021 May 24.

Bournemouth University, Bournemouth, UK.

The caste system is social stratification system that has been used over the last 3 millennia. This review aims to investigate caste-based inequity in health care utilization in South Asia, particularly focusing those at the bottom of the caste hierarchy, commonly known as Dalit communities. A systematic methodology was followed; key databases (including CINAHL, Medline, SocINDEX, PubMed, Nepjol, JSTOR, and ASSIA) were searched for relevant articles published before October 2019, using comprehensive search strategy in accordance with the PRISMA guidelines. In total 15,109 papers were found, and from these, 9 selected papers were included in the review. The papers focused on studies in both India (n = 7) and Nepal (n = 2) and utilized a range of methods including qualitative (n = 2), quantitative (n = 3), and mixed methods (n = 4) approaches. The review identified 4 main themes: stigma, poverty, cultures and beliefs, and health care. Caste-based inequity impacts upon all aspects of an individual's well-being including violence and everyday life risks. Caste also impacts upon individuals' opportunities to access education, employment, and health care. Dalits appear to experience this more significantly due to both poverty and their caste status, which increases their vulnerability to health risks.
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http://dx.doi.org/10.1177/10105395211014648DOI Listing
May 2021

Development and implementation of a potential coronavirus disease 2019 (COVID-19) vaccine: A systematic review and meta-analysis of vaccine clinical trials.

Nepal J Epidemiol 2021 Mar 31;11(1):959-982. Epub 2021 Mar 31.

Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar.

Background: To date, there is no comprehensive systematic review and meta-analysis to assess the suitability of COVID-19 vaccines for mass immunization. The current systematic review and meta-analysis was conducted to evaluate the safety and immunogenicity of novel COVID-19 vaccine candidates under clinical trial evaluation and present a contemporary update on the development and implementation of a potential vaccines.

Methods: For this study PubMed, MEDLINE, and Embase electronic databases were used to search for eligible studies on the interface between novel coronavirus and vaccine design until December 31, 2020.

Results: We have included fourteen non-randomized and randomized controlled phase I-III trials. Implementation of a universal vaccination program with proven safety and efficacy through robust clinical evaluation is the long-term goal for preventing COVID-19. The immunization program must be cost-effective for mass production and accessibility. Despite pioneering techniques for the fast-track development of the vaccine in the current global emergency, mass production and availability of an effective COVID-19 vaccine could take some more time.

Conclusion: Our findings suggest a revisiting of the reported solicited and unsolicited systemic adverse events for COVID-19 candidate vaccines. Hence, it is alarming to judiciously expose thousands of participants to COVID-19 candidate vaccines at Phase-3 trials that have adverse events and insufficient evidence on safety and effectiveness that necessitates further justification.
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http://dx.doi.org/10.3126/nje.v11i1.36163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033643PMC
March 2021

Midwives' views towards women using mHealth and eHealth to self-monitor their pregnancy: A systematic review of the literature.

Eur J Midwifery 2020 17;4:36. Epub 2020 Sep 17.

Florence Nightingale Foundation, London, United Kingdom.

Introduction: There are many mobile telephone apps to help women self-monitor aspects of pregnancy and maternal health. This literature review aims to understand midwives' perspectives on women self-monitoring their pregnancy using eHealth and mHealth, and establish gaps in research.

Methods: MEDLINE, PubMed, Scopus, CINAHL and PsycINFO were systematically searched on midwifery, eHealth/mHealth and perspectives. Qualitative, quantitative and mixed-methods studies published in English were considered for inclusion in the review, without geographical limitations. Relevant articles were critically appraised and narrative synthesis was conducted.

Results: Twelve relevant papers covering midwives' perspectives of the use of eHealth and mHealth by pregnant women were obtained for inclusion in this review. Seven of these publications focused on midwives' views of eHealth, and five on their perspectives of mHealth interventions. The studies included demonstrate that midwives generally hold ambivalent views towards the use of eHealth and mHealth technologies in antenatal care. Often, midwives acknowledged the potential benefits of such technologies, such as their ability to modernise antenatal care and to help women make more informed decisions about their pregnancy. However, midwives were quick to point out the risks and limitations of these, such as the accuracy of conveyed information, and negative impacts on the patient-professional relationship.

Conclusions: Post-COVID-19, where technology is continuously developing, there is a compelling need for studies that investigate the role of eHealth and mHealth in self-monitoring pregnancy, and the consequences this has for pregnant women, health professionals and organisations, as well as midwifery curricula.
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http://dx.doi.org/10.18332/ejm/126625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839093PMC
September 2020

COVID-19 in Qatar: Ways forward in public health and treatment.

Qatar Med J 2020 4;2020(3):38. Epub 2021 Jan 4.

Department of Pharmacology, Sir Seewoosagur Ramgoolam Medical College, Belle Rive, Vacoas-Phoenix, Mauritius.

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http://dx.doi.org/10.5339/qmj.2020.38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780299PMC
January 2021

Multidisciplinary approach to COVID-19 risk communication: a framework and tool for individual and regional risk assessment.

Sci Rep 2020 12 10;10(1):21650. Epub 2020 Dec 10.

Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.

The COVID-19 pandemic has exceeded over sixty-five million cases globally. Different approaches are followed to mitigate its impact and reduce its spreading in different countries, but limiting mobility and exposure have been de-facto precautions to reduce transmission. However, a full lockdown cannot be sustained for a prolonged period. An evidence-based, multidisciplinary approach on risk zoning, personal and transmission risk assessment in near real-time, and risk communication would support the optimized decisions to minimize the impact of coronavirus on our lives. This paper presents a framework to assess the individual and regional risk of COVID-19 along with risk communication tools and mechanisms. Relative risk scores on a scale of 100 represent the integrated risk of influential factors. The personal risk model incorporates age, exposure history, symptoms, local risk and existing health condition, whereas regional risk is computed through the actual cases of COVID-19, public health risk factors, socioeconomic condition of the region, and immigration statistics. A web application tool ( http://www.covira.info ) has been developed, where anyone can assess their risk and find the guided information links primarily for Nepal. This study provides regional risk for Nepal, but the framework is scalable across the world. However, personal risk can be assessed immediately from anywhere.
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http://dx.doi.org/10.1038/s41598-020-78779-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729931PMC
December 2020

Importance of involving patients and public in health research in Bangladesh and Nepal.

Int J Technol Assess Health Care 2020 Nov 5;37:e10. Epub 2020 Nov 5.

Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.

Patient and public involvement/engagement (PPI/E) in public health research and health technology assessment (HTA) in high-income countries (HICs) have significantly increased over the past decade. PPI/E helps to improve research and HTA, ultimately benefitting patients and service users. PPI/E is a very new concept in many low- and middle-income countries (LMICs). This paper considers the importance of PPI in public health research and HTA in the development and implementation of technology in the health sector in South Asia. Currently, in this region, health technology is frequently adopted from HICs without local research and HTA. It also discusses the importance of local co-creation of technology to reflect the needs of users within a culturally appropriate setting. It is important for LMIC-based researchers to understand the potential of PPI/E and how it can contribute to it to improve health care and research, especially perhaps in the era of COVID-19.
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http://dx.doi.org/10.1017/S0266462320000811DOI Listing
November 2020

Accessing health services in India: experiences of seasonal migrants returning to Nepal.

BMC Health Serv Res 2020 Oct 29;20(1):992. Epub 2020 Oct 29.

Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.

Background: Migration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India.

Methods: Six focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. A further 12 stakeholders working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data were analysed thematically.

Results: The interviewed returnee migrants worked in 15 of India's 29 states, most as daily-wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services.

Conclusions: Nepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to.
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http://dx.doi.org/10.1186/s12913-020-05846-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597057PMC
October 2020

Artificial Intelligence and Health in Nepal.

Nepal J Epidemiol 2020 Sep 30;10(3):915-918. Epub 2020 Sep 30.

Department of Computing & Informatics, Bournemouth University, Bournemouth, UK.

The growth in information technology and computer capacity has opened up opportunities to deal with much and much larger data sets than even a decade ago. There has been a technological revolution of big data and Artificial Intelligence (AI). Perhaps many readers would immediately think about robotic surgery or self-driving cars, but there is much more to AI. This Short Communication starts with an overview of the key terms, including AI, machine learning, deep learning and Big Data. This Short Communication highlights so developments of AI in health that could benefit a low-income country like Nepal and stresses the need for Nepal's health and education systems to track such developments and apply them locally. Moreover, Nepal needs to start growing its own AI expertise to help develop national or South Asian solutions. This would require investing in local resources such as access to computer power/capacity as well as training young Nepali to work in AI.
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http://dx.doi.org/10.3126/nje.v10i3.31649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538016PMC
September 2020

Impact of COVID-19 on clinical trials and clinical research: A systematic review.

Nepal J Epidemiol 2020 Sep 30;10(3):878-887. Epub 2020 Sep 30.

Geriatrics and long term care Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar.

The World Health Organization has reported more than 31,186,000 confirmed cases of coronavirus disease-19 (COVID-19), including 962,343 deaths, worldwide as on September 21, 2020. The current COVID-19 pandemic is affecting clinical research activities in most parts of the world. The focus on developing a vaccine for SARS-CoV-2 and the treatment of COVID-19 is, in fact, disrupting many upcoming and/or ongoing clinical trials on other diseases around the globe. On March 18, 2020, the United States Food and Drug Administration (FDA) issued an updated guideline for the conduct of clinical trials during the current health emergency situation. The potential challenges, such as social distancing and quarantines, result in study participants' inaccessibility and trial personnel for in-person scheduled study visits and/or follow-up. Due to the sudden onset and wide-spread impact of COVID-19, its influence on the management of clinical trials and research necessitates urgent attention. Therefore, our systematic review of the literature aims to assess the impact of the COVID-19 pandemic on the conduction of clinical trials and research. The search for the relevant articles for review included the keywords "COVID-19" AND "clinical trial" in PubMed, MEDLINE, Embase, Google scholar and Google electronic databases. Key findings include: delaying subject enrollment and operational gaps in most ongoing clinical trials, which in turn has a negative impact on trial programmes and data integrity. Globally, most sites conducting clinical trials other than COVID-19 are experiencing a delay in timelines and a complete halt of operations in lieu of this pandemic, thus affecting clinical research outcomes.
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http://dx.doi.org/10.3126/nje.v10i3.31622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538012PMC
September 2020

South Africa and its COVID-19 prohibition predilection.

Nepal J Epidemiol 2020 Sep 30;10(3):874-877. Epub 2020 Sep 30.

Centre for Midwifery, Maternal and Perinatal Health, Bournemouth University, Bournemouth, United Kingdom.

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http://dx.doi.org/10.3126/nje.v10i3.31543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538013PMC
September 2020

Coronavirus Disease (COVID-19) and the risk of Post-Traumatic Stress Disorder: A mental health concern in Nepal.

Nepal J Epidemiol 2020 Jun 30;10(2):841-844. Epub 2020 Jun 30.

Centre for Midwifery, Maternal and Perinatal Health, Bournemouth University, Bournemouth, UK.

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http://dx.doi.org/10.3126/nje.v10i2.29761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423405PMC
June 2020

Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal.

Glob Health Action 2020 12;13(1):1788262

Global Health Section, Department of Public Health, University of Copenhagen , Copenhagen, Denmark.

Nepal is currently facing a double burden of non-communicable diseases (NCDs) and communicable diseases, with rising trends of NCDs. This situation will add great pressure to already fragile health systems and pose a major challenge to the country's development unless urgent action is taken. While the primary health care approach offers a common platform to effectively address NCDs through preventive and curative interventions, yet its potential is not fully tapped in Nepal. In line with the Alma Ata and Astana Declarations, we propose an integrated approach for Nepal, and other low-and middle-income countries, including six key reforms to enhance the primary care response to the increasing burdens of NCDs.
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http://dx.doi.org/10.1080/16549716.2020.1788262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480568PMC
December 2020

Evaluation of a health promotion intervention associated with birthing centres in rural Nepal.

PLoS One 2020 22;15(5):e0233607. Epub 2020 May 22.

Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, United Kingdom.

Introduction: Birthing centres (BC) in Nepal are mostly situated in rural areas and provide care for women without complications. However, they are often bypassed by women and their role in providing good quality maternity services is overlooked. This study evaluated an intervention to increase access and utilisation of perinatal care facilities in community settings.

Methods: This longitudinal cross-sectional study was conducted over five years in four villages in Nepal and included two BCs. An intervention was conducted in 2014-2016 that involved supporting the BCs and conducting a health promotion programme with local women. Population-based multi-stage sampling of women of reproductive age with a child below 24 months of age was undertaken. Household surveys were conducted (2012 and 2017) employing trained enumerators and using a structured validated questionnaire. The collected data were entered into SPSS and analysed comparing pre- and post-intervention surveys.

Results: The intervention was associated with an increase in uptake in facility birth, with an increase in utilisation of perinatal services available from BCs. The post-intervention survey provided evidence that women were more likely to give birth at primary care facilities (OR 5.60, p-value <0.001) than prior to the intervention. Similarly, the likelihood of giving birth at a health facility increased if decision for birthplace was made jointly by women and family members for primary care facilities (OR 1.76, p-value 0.023) and hospitals/tertiary care facilities (OR 1.78, p-value 0.020. If women had less than four ANC visits, then they were less likely to give birth at primary care facilities (OR 0.39, p-value <0.001) or hospitals/tertiary care facilities (OR 0.63, p-value 0.014). Finally, women were less likely to give birth at primary care facilities if they had only primary level of education (OR 0.49, p-value 0.014).

Conclusion: BCs have the potential to increase the births at health facilities and decrease home births if their services are promoted by the local health promoters. In addition, socio-economic factors including women's education, the level of women's autonomy and having four or more ANC visits affect the utilisation of perinatal services at the health facility.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233607PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244127PMC
September 2020

Commercialisation and commodification of breastfeeding: video diaries by first-time mothers.

Int Breastfeed J 2020 05 1;15(1):33. Epub 2020 May 1.

School of Pharmacy, University of Reading, Whiteknights Campus, Po Box 226, Reading, UK.

Background: Many of aspects of our lives became increasingly commercialised in post-modern society. Although breastfeeding is perhaps a late comer to this process in recent years, it too has seen significant commercialisation facilitated by social media and our obsession with celebrity culture. This paper explores how the commercialisation and commodification of breastfeeding impacts mothers' experiences of breastfeeding.

Methods: In a qualitative study, five mothers in the United Kingdom recorded their real-time breastfeeding experiences in video diaries. Using a multi-modal method of analysis, incorporating both visual and audio data, a thematic approach was applied.

Findings: Women preparing for breastfeeding are exposed to increasing commercialisation. When things do not go to plan, women are even more exposed to commercial solutions. The impact of online marketing strategies fuelled their need for paraphernalia so that their dependence on such items became important aspects of their parenting and breastfeeding experiences.

Conclusions: The audio-visual data demonstrated the extent to which "essential" paraphernalia was used, offering new insights into how advertising influenced mothers' need for specialist equipment and services. Observing mothers in their video diaries, provided valuable insights into their parenting styles and how this affected their breastfeeding experience.
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http://dx.doi.org/10.1186/s13006-020-00264-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193407PMC
May 2020

Commercialisation and commodification of breastfeeding: video diaries by first-time mothers.

Int Breastfeed J 2020 05 1;15(1):33. Epub 2020 May 1.

School of Pharmacy, University of Reading, Whiteknights Campus, Po Box 226, Reading, UK.

Background: Many of aspects of our lives became increasingly commercialised in post-modern society. Although breastfeeding is perhaps a late comer to this process in recent years, it too has seen significant commercialisation facilitated by social media and our obsession with celebrity culture. This paper explores how the commercialisation and commodification of breastfeeding impacts mothers' experiences of breastfeeding.

Methods: In a qualitative study, five mothers in the United Kingdom recorded their real-time breastfeeding experiences in video diaries. Using a multi-modal method of analysis, incorporating both visual and audio data, a thematic approach was applied.

Findings: Women preparing for breastfeeding are exposed to increasing commercialisation. When things do not go to plan, women are even more exposed to commercial solutions. The impact of online marketing strategies fuelled their need for paraphernalia so that their dependence on such items became important aspects of their parenting and breastfeeding experiences.

Conclusions: The audio-visual data demonstrated the extent to which "essential" paraphernalia was used, offering new insights into how advertising influenced mothers' need for specialist equipment and services. Observing mothers in their video diaries, provided valuable insights into their parenting styles and how this affected their breastfeeding experience.
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http://dx.doi.org/10.1186/s13006-020-00264-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193407PMC
May 2020

Factors associated with contraceptive use in rural Nepal: Gender and decision-making.

Sex Reprod Healthc 2020 Jun 12;24:100507. Epub 2020 Mar 12.

Singapore Clinical Research Institute, Singapore; Duke-NUS Graduate Medical School, Singapore. Electronic address:

Introduction: Gender norms and roles influence many decisions related to reproductive health behaviours including contraceptive use. There are very few studies related to gender norms and decision-making in contraceptive use in Nepal, hence this paper addresses these issues in a quantitative study.

Methods: A secondary data analysis of a primary study conducted in 2012 as a quantitative cross-sectional study in four villages of a hilly district in Nepal. This study included data that were collected from either the woman or the man in 440 couples of childbearing age with at least one child. The secondary analysis included (adjusted) regression analysis to investigate factors associated with contraception use with the variables of interest being gender roles and decision-making, whilst considering demographic and socio-economic controls.

Results: The secondary data analysis found gender roles were associated with current/ever use of contraceptives as reported by the respondents. Socio-economic factors such as husband's and wife's education and gender roles such as indicators showing sharing of childcare responsibilities affected contraceptive use positively. However, decision making regarding contraceptive use was not found to be associated with current/ever use of contraceptives.

Conclusion: Gender has a role in the use of contraceptive, however decision-making may not be associated with contraceptive use. Educational, health promotional and family planning programmes are recommended to promote use of contraceptives. It is important that husbands get involved in these programmes to encourage discussions related to contraceptive use.
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http://dx.doi.org/10.1016/j.srhc.2020.100507DOI Listing
June 2020

The Impact of Spousal Migration on the Mental Health of Nepali Women: A Cross-Sectional Study.

Int J Environ Res Public Health 2020 02 17;17(4). Epub 2020 Feb 17.

Manmohan Memorial Institute of Health Sciences, Tribhuvan University, Kathmandu P.O. Box No. 15201, Nepal.

Spousal separation, lack of companionship, and increased household responsibilities may trigger mental health problems in left-behind female spouses of migrant workers. This study aimed to examine mental ill-health risk in the left-behind female spouses of international migrant workers in Nepal. A cross-sectional survey was carried out in the Nawalparasi district. Study areas were purposively chosen; however, participants were randomly selected. Nepali versions of the 12-item General Health Questionnaire (GHQ), Beck Depression Inventory (BDI), and Connor-Davidson Resilience Scale (CD-RISC) were used. Mental ill-health risk was prevalent in 3.1% of the participants as determined by GHQ. BDI identified mild or moderate depression in 6.5% of the participants with no one having severe depression. In bivariate analysis, a high frequency of communication with the husband was associated with lower mental ill-health risk and depression, as well as increasing resilience. Reduced return intervals of husbands and a high frequency of remittance were also associated with a low GHQ score. In a multiple regression model, adjusting for potential confounding variables, participants who communicated with their husbands at least once a day had a greater mean CD-RISC score (i.e., high resilience against mental ill-health risk) compared to those who did so at least once a week; a mean difference of 3.6 (95% CI 0.4 to 6.9), = 0.03. To conclude, a low mental ill-health risk was found in the female spouses of migrants.
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http://dx.doi.org/10.3390/ijerph17041292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068335PMC
February 2020

Perceptions and Experiences of Health and Social Care Utilisation of the UK-Nepali Population.

J Immigr Minor Health 2021 Apr;23(2):298-307

Department of Nursing Science, Bournemouth University, Poole, UK.

With the growing UK Nepali community, understanding their health and social care needs is an essential to reduce health and social care inequalities. However, very little is known about the health, wellbeing and utilisation of health and social care services among the Nepali population in the UK. Therefore, this study set out to identify health and social care needs of Nepali community. The mixed-methods study was conducted with the Nepali population living in London. It consists of a semi-structured survey (N = 345); three focus group discussions and three key informant interviews. The mean age of the participants was 40.6 (± 17.6). About 28% of our sample reported having chronic health problems. About 60% currently consume alcohol and 21% were smokers. Male participants (35%) more likely to be physically active than females (21%). Registration with a family doctor/general practitioner (GP) was high (96%). However, uptake of disease screening was very low (28%). In the preceding year, 17% had experienced poor mental or emotional health. The findings also suggest language is a key barrier to utilise health and social care among UK Nepali. We suggest removing the language barrier is essential step to improve access to available health and social care services. A culturally sensitive educational initiative creating awareness about the structure of UK health and social care services is required to offer to this community.
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http://dx.doi.org/10.1007/s10903-020-00976-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914234PMC
April 2021

The Availability of Emergency Obstetric Care in Birthing Centres in Rural Nepal: A Cross-sectional Survey.

Matern Child Health J 2020 Jun;24(6):806-816

Department of Research and Training, Public Health Perspective Nepal, Kaski, Pokhara-25, Nepal.

Objective: The purpose of this health system's study is to assess the availability of Emergency Obstetric Care (EmOC) services in birthing centres in Taplejung District of eastern Nepal.

Methods: A cross-sectional survey was conducted in 2018 in all 16 public health facilities providing delivery services in the district. Data collection comprised: (1) quantitative data collected from health workers; (2) observation of key items; and (3) record data extracted from the health facility register. Descriptive statistics were used to calculate readiness scores using unweighted averages.

Results: Although key health personnel were available, EmOC services at the health facilities assessed were below the minimum coverage level recommended by the World Health Organisation. Only the district hospital provided the nine signal functions of Comprehensive EmOC. The other fifteen had only partially functioning Basic EmOC facilities, as they did not provide all of the seven signal functions. The essential equipment for performing certain EmOC functions was either missing or not functional in these health facilities.

Conclusions For Practice: The Ministry of Health and Population and the federal government need to ensure that the full range of signal functions are available for safe deliveries in partially functioning EmOC health facilities by addressing the issues related to training, equipment, medicine, commodities and policy.
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http://dx.doi.org/10.1007/s10995-019-02832-2DOI Listing
June 2020

The Availability of Emergency Obstetric Care in Birthing Centres in Rural Nepal: A Cross-sectional Survey.

Matern Child Health J 2020 Jun;24(6):806-816

Department of Research and Training, Public Health Perspective Nepal, Kaski, Pokhara-25, Nepal.

Objective: The purpose of this health system's study is to assess the availability of Emergency Obstetric Care (EmOC) services in birthing centres in Taplejung District of eastern Nepal.

Methods: A cross-sectional survey was conducted in 2018 in all 16 public health facilities providing delivery services in the district. Data collection comprised: (1) quantitative data collected from health workers; (2) observation of key items; and (3) record data extracted from the health facility register. Descriptive statistics were used to calculate readiness scores using unweighted averages.

Results: Although key health personnel were available, EmOC services at the health facilities assessed were below the minimum coverage level recommended by the World Health Organisation. Only the district hospital provided the nine signal functions of Comprehensive EmOC. The other fifteen had only partially functioning Basic EmOC facilities, as they did not provide all of the seven signal functions. The essential equipment for performing certain EmOC functions was either missing or not functional in these health facilities.

Conclusions For Practice: The Ministry of Health and Population and the federal government need to ensure that the full range of signal functions are available for safe deliveries in partially functioning EmOC health facilities by addressing the issues related to training, equipment, medicine, commodities and policy.
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http://dx.doi.org/10.1007/s10995-019-02832-2DOI Listing
June 2020

Psychological morbidity in Nepali cross-border migrants in India: a community based cross-sectional study.

BMC Public Health 2019 Nov 15;19(1):1534. Epub 2019 Nov 15.

Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.

Background: Since Nepali cross-border migrants can freely enter, work and stay in India, they are largely undocumented. The majority is involved in semi-skilled or unskilled jobs with limited labour rights and social security, a fact which predisposes them to psychological distress. We aimed to assess the prevalence of and factors associated with psychological morbidity among Nepali migrants upon their return from India.

Methods: A community based cross-sectional study was conducted in six districts of Nepal between September 2017 and February 2018. A total of 751 participants who had worked at least six months in India and returned to Nepal were interviewed from 24 randomly selected clusters. The General Health Questionnaire (GHQ)-12 was used to measure the psychological morbidity. Data were analysed using Poisson regression analysis.

Results: The majority was younger than 35 years (64.1%), male (96.7%), married (81.8%), had at least a primary education (66.6%), and belonged to Dalit, Janajati and religious minorities (53.7%). The prevalence of psychological morbidity was 13.5% (CI: 11.2-16.1%). Participants aged 45 years and above (adjusted prevalence ratio (aPR) = 2.74), from the Terai (aPR = 3.29), a religious minority (aPR = 3.64), who received no sick leave (aPR = 2.4), with existing health problems (aPR = 2.0) and having difficulty in accessing health care (aPR = 1.88) were more likely than others to exhibit a psychological morbidity.

Conclusion: This study demonstrated that psychological morbidity was prevalent in the study participants and varied significantly with individual characteristics, work conditions and health. Multifaceted approaches including psychological counselling for returnees and protection of labour and health rights in the workplace are recommended to help reduce psychological morbidity.
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http://dx.doi.org/10.1186/s12889-019-7881-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858657PMC
November 2019

Sudden cardiac death and kidney health related problems among Nepali migrant workers in Malaysia.

Nepal J Epidemiol 2019 Sep 30;9(3):788-791. Epub 2019 Sep 30.

Visiting Professor, Nobel College, Pokhara University, Nepal.

This paper reports on a consultation meeting that discussed two emerging health issues of Nepali migrant workers in Malaysia and the ways they can be addressed. Primarily, it focused on the issue of sudden cardiac deaths of Nepali migrant workers in Malaysia. This issue has been raised internationally by both scientific and media in the recent years. Secondly, it discussed kidney health related problem among Nepali migrant workers which has caught the attention of Nepali media recently. The meeting was organized in Kuala Lumpur, Malaysia on 19th April, 2019 where twenty people including health researchers, representatives of migrant related national and international organizations, and Nepali migrant workers participated. The meeting concluded that three types of data collection are needed: (1) good record of deaths, if at possible proper post-mortems; (2) a verbal autopsy tool to help identify underlying causes ; and qualitative research into kidney related problems.
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http://dx.doi.org/10.3126/nje.v9i3.25805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824844PMC
September 2019

Hormone use among Nepali transgender women: a qualitative study.

BMJ Open 2019 10 22;9(10):e030464. Epub 2019 Oct 22.

Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.

Objectives: There is a dearth of information on transgender individuals in Nepal, particularly studies exploring their use of hormone therapies. The objectives of this study therefore were to explore (1) how hormones are used, (2) types of hormones used and (3) side effects experienced by transgender women after hormone use. This is the first study of its kind in Nepal addressing this important public health issue.

Setting: The study was conducted in four districts of Nepal: Kathmandu, Sunsai, Banke and Kaski.

Design And Participants: This qualitative study comprises eight focus group discussions (FGDs) and nine interviews. FGDs and three face-to-face interviews were held with transgender women aged 18 years and older and six interviews with stakeholders working with and advocating on behalf of this population. The study was conducted between September 2016 and March 2017.

Results: Our participants were young. The majority of FGD participants had completed school-level education and 40% had been using hormones for 1 to 3 years. Five overlapping themes were identified: (1) reasons and motivations for hormone use; (2) accessibility and use of hormones; (3) side effects; (4) utilisation of healthcare services and (5) discontinuation of hormone use.

Conclusion: Hormone use was common in our sample. Most received information on hormone therapy online and through their peer networks. A few study participants sought doctors' prescriptions for hormone therapy, but hormones were more likely to be bought from local private pharmacies or abroad through friends. This kind of self-medication is associated with a range of risks to the physical and mental health of transgender individuals. Incorporating information, education and communication about hormone therapy into existing health promotion interventions targeted to this population may help transgender people to make better informed choices.
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http://dx.doi.org/10.1136/bmjopen-2019-030464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830677PMC
October 2019

The Health of Nepali Migrants in India: A Qualitative Study of Lifestyles and Risks.

Int J Environ Res Public Health 2019 09 28;16(19). Epub 2019 Sep 28.

Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Wardha 442001, India.

Most health research on Nepali migrant workers in India is on sexual health, whilst work, lifestyle and health care access issues are under-researched. The qualitative study was carried out in two cities of Maharashtra State in 2017. Twelve focus group discussions (FGDs) and five in-depth interviews were conducted with Nepali male and female migrant workers. Similarly, eight interviews were conducted with stakeholders, mostly representatives of organisations working for Nepali migrants in India using social capital as a theoretical foundation. Five main themes emerged from the analysis: (i) accommodation; (ii) lifestyle, networking and risk-taking behaviours; (iii) work environment; (iv) support from local organisations; and (v) health service utilisation. Lack of basic amenities in accommodation, work-related hazards such as lack of safety measures at work or safety training, reluctance of employers to organise treatment for work-related accidents, occupational health issues such as long working hours, high workload, no/limited free time, discrimination by co-workers were identified as key problems. Nepali migrants have limited access to health care facilities due to their inability to prove their identity. Health system of India also discriminates as some treatment is restricted to Indian nationals. The strength of this study is the depth it offers, its limitations includes a lack of generalizability, the latter is a generic issue in such qualitative research. This study suggests risks to Nepali migrant workers' health in India range from accommodation to workplace and from their own precarious lifestyle habit to limited access to health care facilities. We must conduct a quantitative study on a larger population to establish the prevalence of the above mentioned issues and risks. Furthermore, the effectiveness of Nepali migrant support organisations in mitigating these risks needs to be researched.
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http://dx.doi.org/10.3390/ijerph16193655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801478PMC
September 2019

Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care.

BMC Pregnancy Childbirth 2019 Aug 22;19(1):307. Epub 2019 Aug 22.

Bournemouth University, Centre for Qualitative Research, 19 Christchurch Road, Bournemouth, BH1 3LH, UK.

Background: Healthcare providers are the vital link between evidence-based policies and women receiving high quality maternity care. Explanations for suboptimal care often include poor working conditions for staff and a lack of essential supplies. Other explanations suggest that doctors, midwives and care assistants might lack essential skills or be unaware of the rights of the women for whom they care. This ethnography examined the everyday lives of maternal healthcare providers working in a tertiary maternity hospital in Kabul, Afghanistan between 2010 and 2012. The aim was to understand their notions of care, varying levels of commitment, and the obstacles and dilemmas that affected standards.

Methods: The culture of care was explored through six weeks of observation, 41 background interviews, 23 semi-structured interviews with doctors, midwives and care assistants. Focus groups were held with two diverse groups of women in community settings to understand their experiences and desires regarding care in maternity hospitals. Data were analysed thematically.

Results: Women related many instances of neglect, verbal abuse and demands for bribes from staff. Doctors and midwives concurred that they did not provide care as they had been taught and blamed the workload, lack of a shift system, insufficient supplies and inadequate support from management. Closer inspection revealed a complex reality where care was impeded by low levels of supplies and medicines but theft reduced them further; where staff were unfairly blamed by management but others flouted rules with impunity; and where motivated staff tried hard to work well but, when overwhelmed with the workload, admitted that they lost patience and shouted at women in childbirth. In addition there were extreme examples of both abusive and vulnerable staff.

Conclusions: Providing respectful quality maternity care for women in Afghanistan requires multifaceted initiatives because the factors leading to suboptimal care or mistreatment are complex and interrelated. Standards need enforcing and abusive practices confronting to provide a supportive, facilitating environment for both staff and childbearing women. Polarized perspectives such as 'villain' or 'victim' are unhelpful as they exclude the complex realities of human behaviour and consequently limit the scope of problem solving.
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http://dx.doi.org/10.1186/s12884-019-2420-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708168PMC
August 2019
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