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  • 1.
    Aryal, Umesh R.
    et al.
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Petzold, Max
    Akademistatistik - Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bondjers, Göran
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Krettek, Alexandra
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg, Sweden.
    Correlates of smoking susceptibility among adolescents in a peri-urban area of Nepal: a population-based cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site2014Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, nr 1, s. 1-14, artikkel-id 24488Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Susceptibility to smoking is defined as an absence of firm commitment not to smoke in the future or when offered a cigarette by best friends. Susceptibility begins in adolescence and is the first step in the transition to becoming an established smoker. Many scholars have hypothesized and studied whether psychosocial risk factors play a crucial role in preventing adolescent susceptibility to smoking or discourage susceptible adolescents from becoming established smokers. Our study examined sociodemographic and family and childhood environmental factors associated with smoking susceptibility among adolescents in a peri-urban area of Nepal.

    DESIGN: We conducted a population-based cross-sectional study during October-November 2011 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) located in a peri-urban area near Kathmandu, the capital city of Nepal, where tobacco products are easily available. Trained local enumerators conducted face-to-face interviews with 352 respondents aged 14-16. We used stepwise logistic regression to assess sociodemographic and family and childhood environmental factors associated with smoking susceptibility.

    RESULTS: The percentage of smoking susceptibility among respondents was 49.70% (95% CI: 44.49; 54.93). Multivariable analysis demonstrated that smoking susceptibility was associated with smoking by exposure of adolescents to pro-tobacco advertisements (AOR [adjusted odds ratio] =2.49; 95% CI: 1.46-4.24), the teacher (2.45; 1.28-4.68), adolescents attending concerts/picnics (2.14; 1.13-4.04), and smoking by other family members/relatives (1.76; 1.05-2.95).

    CONCLUSIONS: Smoking susceptible adolescents are prevalent in the JD-HDSS, a peri-urban community of Nepal. Several family and childhood environmental factors increased susceptibility to smoking among Nepalese non-smoking adolescents. Therefore, intervention efforts need to be focused on family and childhood environmental factors with emphasis on impact of role models smoking, refusal skills in social gatherings, and discussing harmful effects of smoking with family members and during gatherings with friends.

  • 2.
    Choulagai, Bishnu P.
    et al.
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Aryal, Umesh Raj
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
    Shrestha, Binjwala
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Vaidya, Abhinav
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
    Onta, Sharad
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
    Petzold, Max
    Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Krettek, Alexandra
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants2015Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, artikkel-id 29396Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Estimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted at the end of 2010. We also report on the use of skilled birth attendants (SBAs) and associated factors in the JD-HDSS at the follow-up point.

    DESIGN: We used a structured questionnaire to survey 3,505 households in the JD-HDSS, Bhaktapur, Nepal. To investigate the use of SBAs, we interviewed 434 women who had delivered a baby within the prior 2 years. We compared demographic and health indicators at baseline and follow-up and assessed the association of SBA services with background variables.

    RESULTS: Due to rising in-migration, the total population and number of households in the JD-HDSS increased (13,669 and 2,712 in 2010 vs. 16,918 and 3,505 in 2012). Self-reported morbidity decreased (11.1% vs. 7.1%, respectively), whereas accidents and injuries increased (2.9% vs. 6.5% of overall morbidity, respectively). At follow-up, the proportion of institutional delivery (93.1%) exceeded the national average (36%). Women who accessed antenatal care and used transport (e.g. bus, taxi, motorcycle) to reach a health facility were more likely to access institutional delivery.

    CONCLUSIONS: High in-migration increased the total population and number of households in the JD-HDSS, a peri-urban area where most health indicators exceed the national average. Major morbidity conditions (respiratory diseases, fever, gastrointestinal problems, and bone and joint problems) remain unchanged. Further investigation of reasons for increased proportion of accidents and injuries are recommended for their timely prevention. More than 90% of our respondents received adequate antenatal care and used institutional delivery, but only 13.2% accessed adequate postnatal care. Availability of transport and use of antenatal care was associated positively with institutional delivery.

  • 3.
    Do, Loan Minh
    et al.
    Outpatient Department, National Hospital of Paediatrics, Hanoi, Vietnam / Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Viveca
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande.
    Tran, Toan Khanh
    Family Medicine Department, Hanoi Medical University, Hanoi, Vietnam.
    Nguyen, Huong Thanh
    Faculty of Social Sciences, Behaviour and Health Education, Hanoi School of Public Health, Hanoi, Vietnam.
    Eriksson, Bo
    Health Metrics, Department of Public Health and Community Medicine, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ascher, Henry
    Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Angered Hospital, Gothenburg, Sweden.
    Vietnamese mother's conceptions of childhood overweight: Findings from a qualitative study2016Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, artikkel-id 30215Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Childhood overweight and obesity is a new and emerging problem in Vietnam. The so far observed prevalence increases have pointed to the need for public health intervention strategies with parents as crucial resources for change. Objective: The aim of this study was to understand mothers' conceptions of childhood overweight. Design: Four focus group discussions were conducted with a total of 33 mothers of preschool children, 4-6 years old, living in urban and rural districts of Hanoi, Vietnam. The discussions were audio taped and transcribed verbatim. The obtained data were analyzed using the principles of phenomenography. Results: Four main categories with 13 subcategories emerged in the process of analysis. The first category, called 'Concept of overweight', contained mothers' views on childhood overweight. A major concern was the negative aspects of overweight such as impaired social interaction and health problems. The second category, 'Identification of overweight', described the ways mothers use to recognize overweight in children: own experience, growth chart, and public or health care system's information. The third category, 'Causes of overweight', showed mothers' understanding of factors possibly contributing to overweight development: unhealthy food and lifestyle, genetic susceptibility, parent's lack of knowledge, and limited time to take care of children as well as economic improvement. The fourth category, 'Management of overweight', described the ways mothers use to manage a child's weight problem: control of their food intake, increasing their physical activity, and encouraging their child self-control. However, they find such strategies difficult to implement and their intentions are sometimes challenged by the child's grandparents. Conclusions: The study gives an understanding of the mothers' conceptions of four important and practically useful aspects of overweight in children. The findings highlight the roles of media and the health care system in enhancing a social awareness of the problem and the need for prevention. Growth charts need to be used more regularly and consciously in child health care for early detection of children at risk and as a tool for information to parents. When designing intervention programs, the entire extended families, especially grandparents and their roles, need to be considered.

  • 4.
    Oli, Natalia
    et al.
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Department of Community Medicine, Kathmandu Medical College, Nepal.
    Vaidya, Abhinav
    Department of Community Medicine, Kathmandu Medical College, Nepal.
    Eiben, Gabriele
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande.
    Krettek, Alexandra
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial2019Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, s. 1-12, artikkel-id 1670033Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Nepal, like many low- and middle-income countries, exhibits rising burden of cardiovascular diseases. Misconceptions, poor behavior, and a high prevalence of risk factors contribute to this development. Health promotion efforts along with primary prevention strategies, including risk factor reduction in both adults and children, are therefore critical. Objectives: This study assessed the effectiveness of a health promotion intervention on mothers' knowledge, attitude and practice (KAP) and their children's behavior regarding diet and physical activity. Methods: The Heart-health Associated Research, Dissemination and Intervention in the Community (HARDIC), a community-based trial, used peer education to target mothers with 1-9-year-old children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal, during August-November 2016. In the intervention area, 47 peer mothers were trained to conduct four education classes for about 10 fellow mothers (N = 391). After 3 months, all eligible mothers in the intervention and control areas were interviewed and the results were compared with the KAP of all eligible mothers at baseline. Results: Post-intervention, mothers' KAP median scores had improved regarding heart-healthy diet and physical activity. More mothers had 'good' KAP (>75% of maximum possible scores), and mothers with 'good' knowledge increased from 50% to 81%. Corresponding control values increased only from 58% to 63%. Mothers' attitude and practice improved. Additionally, mothers in the intervention area reported improvement in their children's diet and physical activity behavior. Moreover, Difference in Differences analysis showed that the HARDIC intervention significantly increased mothers' KAP scores and children's behavior scores in the intervention area compared to the control area. Conclusions: Our intervention improves KAP scores regarding diet and physical activity and shows potential for expansion via community health workers, volunteers, and/or local women. Moreover, HARDIC can contribute to Nepal's Package of Essential Noncommunicable Diseases Initiative, which currently lacks a specific package for health promotion.

  • 5.
    Oli, Natalia
    et al.
    Kathmandu Medical College, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Vaidya, Abhinav
    Kathmandu Medical College, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Subedi, Madhusudan
    Patan Academy of Health Sciences, Lalitpur, Nepal.
    Krettek, Alexandra
    Sahlgrenska Academy at University of Gothenburg / Nordic School of Public Health NHV, Gothenburg.
    Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community.2014Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, artikkel-id 24023Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice.

    OBJECTIVE: This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients' viewpoint.

    DESIGN: We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories.

    RESULTS: Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness.

    CONCLUSIONS: This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community's cardiovascular health literacy and preventive practices.

  • 6.
    Onta, Sharad
    et al.
    Tribhuvan University, Kathmandu, Nepal .
    Choulagai, Bishnu
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy, University of Gothenburg, Sweden.
    Shrestha, Binjwala
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy, University of Gothenburg, Sweden.
    Subedi, Narayan
    Nepal Public Health Foundation, Kathmandu, Nepal .
    Bhandari, Gajananda P
    Nepal Public Health Foundation, Kathmandu, Nepal .
    Krettek, Alexandra
    Sahlgrenska Academy, University of Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg, Sweden.
    Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study2014Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, s. 1-9, artikkel-id 24580Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care.

    DESIGN: We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers.

    RESULTS: Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities.

    CONCLUSIONS: Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

  • 7.
    Shakya-Vaidya, Suraj
    et al.
    Nepal Medical College Teaching Hospital, Kathmandu, Nepal / Nordic School of Public Health NHV, Gothenburg, Sweden.
    Aryal, Umesh Raj
    Nordic School of Public Health NHV, Gothenburg, Sweden / Kathmandu Medical College, Kathmandu, Nepal.
    Upadhyay, Madan
    B.P. Eye Foundation, Kathmandu, Nepal.
    Krettek, Alexandra
    Nordic School of Public Health NHV, Gothenburg, Sweden / Sahlgrenska Academy at University of Gothenburg, Sweden.
    Do non-communicable diseases such as hypertension and diabetes associate with primary open-angle glaucoma?: Insights from a case-control study in Nepal2013Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, s. 22636-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Non-communicable diseases (NCDs) such as hypertension and diabetes are rapidly emerging public health problems worldwide, and they associate with primary open-angle glaucoma (POAG). POAG is the most common cause of irreversible blindness. The most effective ways to prevent glaucoma blindness involve identifying high-risk populations and conducting routine screening for early case detection. This study investigated whether POAG associates with hypertension and diabetes in a Nepalese population.

    METHODS: To explore the history of systemic illness, our hospital-based case-control study used non-random consecutive sampling in the general eye clinics in three hospitals across Nepal to enroll patients newly diagnosed with POAG and controls without POAG. The study protocol included history taking, ocular examination, and interviews with 173 POAG cases and 510 controls. Data analysis comprised descriptive and inferential statistics. Descriptive statistics computed the percentage, mean, and standard deviation (SD); inferential statistics used McNemar's test to measure associations between diseases.

    RESULTS: POAG affected males more frequently than females. The odds of members of the Gurung ethnic group having POAG were 2.05 times higher than for other ethnic groups. Hypertension and diabetes were strongly associated with POAG. The overall odds of POAG increased 2.72-fold among hypertensive and 3.50-fold among diabetic patients.

    CONCLUSION: POAG associates significantly with hypertension and diabetes in Nepal. Thus, periodic glaucoma screening for hypertension and diabetes patients in addition to opportunistic screening at eye clinics may aid in detecting more POAG cases at an early stage and hence in reducing avoidable blindness.

  • 8.
    Shakya-Vaidya, Suraj
    et al.
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Povlsen, Lene
    Nordic School of Public Health NHV, Gothenburg, Sweden .
    Shrestha, Binjwala
    Sahlgrenska Academy University of, Gothenburg, Sweden / Tribhuvan University, Maharajgunj, Kathmandu, Nepal .
    Grjibovski, Andrej M
    Norweigan Institute of Public Health, Oslo, Norway .
    Krettek, Alexandra
    Sahlgrenska Academy, University of Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg Sweden.
    Understanding and living with glaucoma and non-communicable diseases like hypertension and diabetes in the Jhaukhel-Duwakot Health Demographic Surveillance Site:: a qualitative study from Nepal2014Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, s. 25358-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Primary open-angle glaucoma (POAG) is one of the most common causes of irreversible blindness. A possible association between POAG and non-communicable diseases such as hypertension and diabetes suggests that the incidence of POAG may increase. People with POAG in Nepal usually present late to hospital and have poor knowledge of glaucoma.

    OBJECTIVES: Anticipating a knowledge gap regarding these diseases, this study aimed to explore the knowledge of POAG, hypertension, and diabetes in the community and barriers to health care.

    DESIGN: We conducted this qualitative study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), a peri-urban community near Kathmandu, a capital city of Nepal. To study how disease influences knowledge, we conducted focus group discussions separately for men and women with and without pre-existing POAG, hypertension, and diabetes. Data were analyzed using the framework analysis approach.

    RESULTS: Although people suffering from POAG, hypertension, and/or diabetes exhibited adequate knowledge of hypertension and diabetes, they lacked in-depth knowledge of POAG. People believed mostly in internal health locus of control. Perception of disease consequences and impact of disease on daily life was influenced by pre-existing POAG, hypertension, and/or diabetes but only in men. Gender disparity was observed regarding health literacy, health perception, and health barriers, which put women in a more difficult situation to tackle their health. We also revealed a gap between knowledge, attitude, and practice of health among women and healthy men.

    CONCLUSION: Although people in JD-HDSS exhibited adequate knowledge regarding hypertension and diabetes, they lacked in-depth knowledge about POAG. This study demonstrated gender difference in health literacy and access to health care, making women more vulnerable towards disease. We also demonstrated a gap between knowledge, attitude, and practice of health. However, tailored health literacy programs may bring changes in the health status in the community.

  • 9.
    Shrestha, Binjwala
    et al.
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Onta, Sharad
    Tribhuvan University, Kathmandu, Nepal.
    Choulagai, Bishnu
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Paudel, Rajan
    Tribhuvan University, Kathmandu, Nepal.
    Petzold, Max
    University of Gothenburg / University of the Witwatersrand, Johannesburg, South Africa.
    Krettek, Alexandra
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande. Sahlgrenska Academy at University of Gothenburg / UiT The Arctic University of Norway.
    Uterine prolapse and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal2015Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, s. 1-9, artikkel-id 28771Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Uterine prolapse (UP) is a reproductive health problem and public health issue in low-income countries including Nepal.

    OBJECTIVE: We aimed to identify the contributing factors and stages of UP and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site of Bhaktapur, Nepal.

    DESIGN: Our three-phase study used descriptive cross-sectional analysis to assess quality of life and stages of UP and case-control analysis to identify contributing factors. First, a household survey explored the prevalence of self-reported UP (Phase 1). Second, we used a standardized tool in a 5-day screening camp to determine quality of life among UP-affected women (Phase 2). Finally, a 1-month community survey traced self-reported cases from Phase 1 (Phase 3). To validate UP diagnoses, we reviewed participants' clinical records, and we used screening camp records to trace women without UP.

    RESULTS: Among 48 affected women in Phase 1, 32 had Stage II UP and 16 had either Stage I or Stage III UP. Compared with Stage I women (4.62%), almost all women with Stage III UP reported reduced quality of life. Decreased quality of life correlated significantly with Stages I-III. Self-reported UP prevalence (8.7%) included all treated and non-treated cases. In Phase 3, 277 of 402 respondents reported being affected by UP and 125 were unaffected. The odds of having UP were threefold higher among illiterate women compared with literate women (OR=3.02, 95% CI 1.76-5.17), 50% lower among women from nuclear families compared with extended families (OR=0.56, 95% CI 0.35-0.90) and lower among women with 1-2 parity compared to >5 parity (OR=0.33, 95% CI 0.14-0.75).

    CONCLUSIONS: The stages of UP correlated with quality of life resulting from varied perceptions regarding physical health, emotional stress, and social limitation. Parity, education, age, and family type associated with UP. Our results suggest the importance of developing policies and programs that are focused on early health care for UP. Through family planning and health education programs targeting women, as well as women empowerment programs for prevention of UP, it will be possible to restore quality of life related to UP.

  • 10.
    Usynina, Anna A.
    et al.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Grjibovski, Andrej M.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia / Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan / Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway / Department of Public Health, Hygiene and Bioethics, Institute of Medicine, North-Eastern Federal University, Yakutsk, Russia.
    Krettek, Alexandra
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Odland, Jon Øyvind
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / Department of Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
    Kudryavtsev, Alexander V.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Anda, Erik Eik
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Risk factors for perinatal mortality in Murmansk County, Russia: a registry-based study2017Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, nr 1, s. 1-10, artikkel-id 1270536Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Factors contributing to perinatal mortality (PM) in Northwest Russia remain unclear. This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry.

    OBJECTIVE: This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry.

    METHODS: The study population consisted of all live- and stillbirths registered in the Murmansk County Birth Registry during 2006-2011 (n = 52,806). We excluded multiple births, births prior to 22 and after 45 completed weeks of gestation, infants with congenital malformations, and births with missing information regarding gestational age (a total of n = 3,666) and/or the studied characteristics (n = 2,356). Possible associations between maternal socio-demographic and lifestyle characteristics, maternal pre-pregnancy characteristics, pregnancy characteristics, and PM were studied by multivariable logistic regression. Crude and adjusted odds ratios with 95% confidence intervals were calculated.

    RESULTS: Of the 49,140 births eligible for prevalence analysis, 338 were identified as perinatal deaths (6.9 per 1,000 births). After adjustment for other factors, maternal low education level, prior preterm delivery, spontaneous or induced abortions, antepartum hemorrhage, antenatally detected or suspected fetal growth retardation, and alcohol abuse during pregnancy all significantly increased the risk of PM. We observed a higher risk of PM in unmarried women, as well as overweight or obese mothers. Maternal underweight reduced the risk of PM.

    CONCLUSIONS: Our results suggest that both social and medical factors are important correlates of perinatal mortality in Northwest Russia.

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