Exploring determinants of hydrocele surgery coverage related to Lymphatic Filariasis in Nepal: An implementation research study

Background Hydrocele is a chronic condition in males in which there is an excessive collection of straw-colored fluid, which leads to enlargement of the scrotum. It is a common manifestation of lymphatic filariasis (LF) affecting nearly 25 million men worldwide. Surgery is the recommended treatment for hydrocele and is available free of cost in all government hospitals in Nepal. This research explored patient, provider, and community factors related to accessing hydrocele surgery services by the patients. Methods This study employed a qualitative method. The research was conducted in two LF endemic districts, namely Kanchanpur and Dhading, which are reported to have the highest number of hydrocele cases during morbidity mapping conducted in 2016. In addition to five key informant interviews with the LF focal persons (one national and 4 district-level), nine in-depth interviews were conducted with hydrocele patients (5 of whom had undergone surgery and 4 who had not undergone surgery) and with 3 family members, and two focus group discussions with the female community health volunteers. Results Most of the respondents did not have knowledge of hydrocele as one of the clinical manifestations of LF nor that it is transmitted through a mosquito bite. Although perceived as treatable with surgery, most of the patients interviewed believed in as well as practiced home remedies. Meanwhile, fear of surgery, embarrassment, lack of money, along with no knowledge of the free hydrocele surgery acted as barriers for accessing the surgery. On the other hand, financial support, flexible guidelines enabling the hospital to conduct surgery, decentralization and scaling up of morbidity mapping along with free hydrocele surgery camps in any remaining endemic districts were identified as enablers for accessing surgery. Conclusion Hydrocele surgery coverage could be improved if the program further addresses community awareness. There is a need for more focus on information dissemination about hydrocele and hydrocele surgery.

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Multilevel factors influencing contraceptive use and childbearing among adolescent girls in Bara district of Nepal: a qualitative study using the socioecological model

BMJ Open ◽

10.1136/bmjopen-2020-046156 ◽

2021 ◽

Vol 11 (10) ◽

pp. e046156

Author(s):

Kazutaka Sekine ◽

Nirajan Khadka ◽

Rogie Royce Carandang ◽

Ken Ing Cherng Ong ◽

Anand Tamang ◽

...

Keyword(s):

Family Planning ◽

Adolescent Girls ◽

Contraceptive Use ◽

Healthcare Providers ◽

Married Couples ◽

Rural Municipality ◽

Community Health Volunteers ◽

Female Community ◽

Female Community Health Volunteers ◽

Depth Interviews

ObjectivesThis study aimed to identify the multilevel factors that influence contraceptive use and childbearing decisions in Nepal and examine relationships among these factors.DesignThe study drew on qualitative data collected through in-depth interviews (IDIs) and key informant interviews (KIIs) and triangulated results.SettingAn urban municipality and a rural municipality in Bara district, Nepal.ParticipantsWe recruited a total of 60 participants (e.g., 20 married adolescent girls aged 15–19, 20 husbands, 20 mothers-in-law) for IDIs and 10 (e.g., four healthcare providers, three health coordinators, three female community health volunteers) for KIIs.ResultsMarried adolescent girls faced a range of barriers that are inter-related across different levels. Patriarchal norms and power imbalances between spouses limited their decision-making power regarding contraception. Social pressures to give birth soon after marriage drove the fear of infertility, abandonment and the stigmatisation of childless married couples, which leads to lack of women’s autonomy in making decisions about family planning. Mothers-in-law and religion exerted considerable influence over couples’ decisions regarding contraception. Limited access to information about the benefits and methods of family planning contributed to fear of the side effects of contraceptives and low awareness about the risks involved in adolescent pregnancy.ConclusionsThe convergent results from triangulation confirm that the decision to postpone childbearing is not merely the personal choice of an individual or a couple, highlighting the importance of targeting families and communities. The study underscores the need to challenge restrictive sociocultural norms so that adolescent girls become empowered to exercise greater control over contraceptive use.

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Effect of an Educational Intervention on Knowledge and Perception Regarding Rational Medicine Use and Self-medication

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i3.1495 ◽

2018 ◽

Vol 16 (3) ◽

pp. 313-320

Author(s):

Nisha Jha ◽

Pathiyil Ravi Shankar ◽

Anurag Marasini

Keyword(s):

Drug Use ◽

Community Health ◽

Healthcare Professionals ◽

Medicine Use ◽

Self Medication ◽

Community Health Volunteers ◽

Female Community ◽

Pharmaceutical Promotion ◽

Female Community Health Volunteers ◽

The Mean

Background: Rational use of medicines is important for safe and cost-effective pharmacotherapy. However, nearly half of the medicines available in the market may be used irrationally. The present study assessed the perceptions and knowledge about rational medicine use and responsible self-medication among participants before and after an educational intervention at KIST Medical College, Lalitpur. Methods: An educational module was conducted among healthcare professionals, media personnel and female community health volunteers. The questionnaire was administered before and immediately after the module. The areas addressed were rational medicine use, ethical prescribing, rational drug use situation in Nepal, pharmaceutical promotion, rational self-medication, safe use of antibiotics, and drug use problems in Nepal. Results: Among healthcare professionals, the rational drug use situation in Nepal and the total score significantly increased post-intervention (p<0.05). Among media personnel the mean scores increased significantly in pharmaceutical promotion and drug use problems in Nepal areas but there was a significant decrease in safe use of antibiotics. The pre-intervention pharmaceutical promotion score was significantly higher among healthcare professionals compared to media personnel while the rational self-medication scores were highest among female community health volunteers, safe use of antibiotics scores were highest among the media personnel. Post-intervention the mean pharmaceutical promotion scores was highest among healthcare professionals, rational self-medication scores among female community health volunteers, safe use of antibiotics, drug use problems in Nepal and total scores were highest among the media personnel. Conclusions: There were differences in the mean pre-intervention scores among different subgroups. A single session may not be enough to bring about significant changes in knowledge and perception. The retention of knowledge could be measured in future studies. Keywords: Female community health volunteers; health care professionals; media; rational medicine use; self medication.

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Unlocking Trust in Community Health Systems: Lessons from the Lymphatic Filariasis Morbidity Management and Disability Prevention Pilot Project in Luangwa District, Zambia

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.133 ◽

2021 ◽

Author(s):

Joseph M. Zulu ◽

Patricia Maritim ◽

Adam Silumbwe ◽

Hikabasa Halwiindi ◽

Patricia Mubita ◽

...

Keyword(s):

Focus Group ◽

Health Services ◽

Lymphatic Filariasis ◽

Health Systems ◽

Disability Prevention ◽

Focus Group Discussions ◽

Group Discussions ◽

Community Health Systems ◽

Referral Systems ◽

Depth Interviews

Background: Surgery for hydrocele is commonly promoted as part of morbidity management and disability prevention (MMDP) services for lymphatic filariasis (LF). However, uptake of these surgeries has been suboptimal owing to several community level barriers that have triggered mistrust in such services. This study aimed at documenting mechanisms of unlocking trust in community health systems (CHS) in the context of a LF hydrocele management project that was implemented in Luangwa District, Zambia. Methods: Qualitative data was collected through in-depth interviews and focus group discussions (n=45) in February 2020 in Luangwa District. Thirty-one in-depth interviews were conducted with hydrocele patients, CHWs, health workers, traditional leaders and traditional healers. Two focus group discussions were also conducted with CHWs who had been involved in project implementation with seven participants per group. Data was analyzed using a thematic analysis approach. Results: The use of locally appropriate communication strategies, development of community driven referral systems, working with credible community intermediaries as well as strengthening health systems capacity through providing technical and logistical support enhanced trust in surgery for hydrocele and uptake of the surgeries. Conclusion: Implementation of community led communication and referral systems as well as strengthening health services are vital in unlocking trust in health systems as such mechanisms trigger authentic partnerships, including mutual respect and recognition in the CHS. The mechanisms also enhance confidence in health services among community members.

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Effect of an Educational Intervention on Knowledge and Perception Regarding Rational Medicine Use and Self-medication

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i3.21430 ◽

2018 ◽

Vol 16 (3) ◽

pp. 313-320

Author(s):

Nisha Jha ◽

Shankar Pathiyil Ravi ◽

Marasini Anurag

Keyword(s):

Drug Use ◽

Community Health ◽

Healthcare Professionals ◽

Medicine Use ◽

Self Medication ◽

Community Health Volunteers ◽

Female Community ◽

Pharmaceutical Promotion ◽

Female Community Health Volunteers ◽

The Mean

Background: Rational use of medicines is important for safe and cost-effective pharmacotherapy. However, nearly half of the medicines available in the market may be used irrationally. The present study assessed the perceptions and knowledge about rational medicine use and responsible self -medication among participants before and after an educational intervention at KIST Medical College, Lalitpur.Methods: An educational module was conducted among healthcare professionals, media personnel and female community health volunteers. The questionnaire was administered before and immediately after the module. The areas addressed were rational medicine use, ethical prescribing, rational drug use situation in Nepal, pharmaceutical promotion, rational self-medication, safe use of antibiotics, and drug use problems in Nepal.Results: Among healthcare professionals, the rational drug use situation in Nepal and the total score significantly increased post-intervention (p<0.05). Among media personnel the mean scores increased significantly in pharmaceutical promotion and drug use problems in Nepal areas but there was a significant decrease in safe use of antibiotics. The pre-intervention pharmaceutical promotion score was significantly higher among healthcare professionals compared to media personnel while the rational self-medication scores were highest among female community health volunteers, safe use of antibiotics scores were highest among the media personnel. Post-intervention the mean pharmaceutical promotion scores was highest among healthcare professionals, rational self-medication scores among female community health volunteers, safe use of antibiotics, drug use problems in Nepal and total scores were highest among the media personnel. Conclusions: There were differences in the mean pre-intervention scores among different subgroups. A single session may not be enough to bring about significant changes in knowledge and perception. The retention of knowledge could be measured in future studies.

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