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Permanent URI for this collectionhttps://hdl.handle.net/10361/7396

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Sexual behavior and condom use among seasonal dalit migrant laborers to India from far west, Nepal: a qualitative study
(© 2013 PLoS ONE, 2013) Bam, Kiran; Thapa, Rajshree; Newman, Marielle Sophia; Bhatt, Lokesh Prasad; Bhatta, Shree Krishna; BRAC James P Grant School of Public Health
Background:Around 41% of Human Immunodeficiency Virus (HIV) cases in Nepal occur in seasonal migrant laborers. Dalit migrant laborers represent the largest proportion of reported HIV cases in the Far Western Region (Sudur Pashchimanchal, or Far West), Nepal. The study's objectives were to assess sexual behavior, condom use status and HIV risk perception among Dalit migrant laborers to India from Far West Region, Nepal.Methods:The study was conducted among Dalit male migrant laborers aged 15 years and above who had migrated for at least six months of the last two years to India. For the sampling the village development committees (VDCs) from Achham, Doti and Kanchanpur districts of Nepal were purposively selected. The data were collected in March and April 2011 via ten in-depth interviews and four focus group discussions and analyzed using content analysis.Results:Poor socio-economic status, caste-related discrimination, and lack of employment opportunities push large groups of young Dalits to migrate to India for employment, where they engage in sex with female sex workers (FSWs). The participants described unmarried status, peer influence, alcohol use, low-priced sex with FSWs and unwillingness to use condoms as common factors of their migration experience. Lack of awareness on HIV/AIDS was common among study participants. Awareness of HIV/AIDS and faithful, monogamous partnerships are reported as factors influencing safer sexual behavior.Conclusions:Dalits are an especially vulnerable population among migrant laborers and may be over-represented in new HIV infections in Nepal. Comprehensive surveying and health promotion programs targeted to this population are urgently needed and potent methods of stopping HIV spread.
Illness perception of tuberculosis (TB) and health seeking practice among urban slum residents of Bangladesh: a qualitative study
(© 2014 BioMed Central Ltd., 2014) Bam, Kiran; Prasad Bhatt, Lokesh; Thapa, Rajshree; Karimjee Dossajee, Hussein; Raj Angdembe, Mirak; BRAC James P Grant School of Public Health
Background: Combating tuberculosis (TB) in urban slums is more complex than in rural areas due to reasons such as over-crowding, unhygienic living conditions and poverty. This study aimed to assess illness perception of TB and identify barriers and facilitators for health seeking practice among the residents of Badda slum, Dhaka, Bangladesh. Methods. The Badda slum was purposively selected. Convenience sampling was carried out to select participants aged 18 years and above. Twenty two in-depth interviews, two key informants' interviews and participatory rapid appraisal (PRA) were conducted. Data were analyzed manually by using defined a priori codes and color coding of the quotes in data matrix table. Results: TB was commonly recognized as Jokkha (pulmonary TB), Sas rog (disease associated to breathing) followed by TB. More females than males had knowledge about TB related illness. Very few perceived of being at risk of TB despite the high risk behavior and environment. Prime barriers for health seeking practice of TB were cost along with other barriers like prevailing stigma on TB, lack of information on service sites and unavailability of accompanying person. Training and orientation to community organizations and people, awareness on TB and free treatment through advertisements/media, community level diagnostic and home based care were identified as the facilitators for the health seeking practice of TB. Conclusions: Perceptions of TB and knowledge associated with the disease shape the health seeking practice, therefore promotion of media awareness campaign, targeting the people of urban slums for reducing misconceptions and promotion of home based service is needed to encourage health seeking practice in the future.
Scenario of adolescent sexual and reproductive health with opportunities for information communication and technology use in selected South Asian countries
(© 2015 Technological Educational Institute of Athens, 2015) Bam, Kiran; Arvind Girase, Bhushan; BRAC James P Grant School of Public Health
Introduction: Regardless of being involved in early sexual activity, significant number of South Asian adolescents gets restricted in making informed decisions on sexual and reproductive practices due to diverse seclusion norms. Since adolescents have been identified as the earliest users of new technologies like mobile phones, computers and the Internet, these tools can be harnessed to deliver sexuality education to overcome the trajectory of engaging in risky sexual behavior. Regardless of numerous efforts, Information and communication technology (ICTs) in response to the health concerns still a challenge. Aim: A systematic review was conducted to ascertain and describe the scenario and ICT use opportunities in Adolescent Sexual and Reproductive Health program information. Methodology: Peer-reviewed published studies, government and non-government documents, and survey reports between 1990 and 2013 on adolescent sexual and reproductive health in the selected South Asian countries were systematically reviewed right from their formation till latest amendment. Eligibility criteria were literature published in English, targeting male and female adolescents, aged 10-19 years irrespective of their marital status. Results: In depth review of 86 publicly available documents comprising policy papers and guidelines of selected countries along with journal articles, survey reports found 27 documents matching our selection criteria. All such documents were assessed and relevant information was extracted by research team. In contrast to the general population, data on adolescent access to and use of ICT in practicing sexual and reproductive health services are minimal, and criteria and definitions that would aid data analysis and comparison across countries are lacking. Conclusion: ICT platforms should be applied to scale-up policies and programmes that promote the sexual and reproductive health of adolescents due to their low cost, increased access to remote populations, better efficiency and improved flexibility for programming.
Nutritional status and its association with quality of life among people living with HIV attending public anti-retroviral therapy sites of Kathmandu Valley, Nepal
(© 2015 BioMed Central Ltd., 2015) Thapa, Rajshree; Amatya, Archana; Prasad Pahari, Durga; Bam, Kiran; Newman, M Sophia; BRAC James P Grant School of Public Health
Background: Little evidence exists on the connections between nutrition, diet intake, and quality of life (QoL) among people living with HIV (PLHIV). The study aimed to estimate the prevalence of under-nutrition among PLHIV in Nepal, and identify risk factors and assess correlations with PLHIVs' QoL and nutritional status. Methods: This quantitative cross-sectional study used Body Mass Index (BMI) as an indicator for nutritional status, and additional information on opportunistic infections (OIs), CD4 count, and World Health Organization (WHO) clinical staging was collected from medical records. Participants were asked to complete surveys on food security and QoL. Descriptive analysis was used to estimate the prevalence of under nutrition. To assess associations between nutrition status and independent variables, bivariate and multivariate analysis was completed. Spearman's rank correlation test was used to assess the association between nutritional status and QoL. Results: One in five PLHIVs was found to be under nourished (BMI <18.5 kg/m2). Illiteracy, residence in care homes, CD4 cells count <350 cells/mm3, OIs, and illness at WHO clinical stages III and IV were found to be significant predictors of under nutrition. BMI was significantly correlated with three domains of QoL (psychological, social and environmental). Conclusion: Nutrition interventions should form an integral part of HIV care programs. Understanding the presence of OI, decline in CD4 count, and advancing WHO clinical stages as risk factors can be helpful in preventing under nutrition from developing. Longitudinal research is necessary to further explicate associations between nutritional status and QoL.

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