BackgroundGlobally, knowledge of health sector options to respond to domestic violence during pregnancy is increasing, but this topic is under-investigated in Nepal. This gap affects the provision of adequate antenatal care services and understanding of factors that influence women’s willingness and ability to use available services. It is critical to know more about the social norms in a community that promote and prevent women experiencing domestic violence from seeking antenatal care.ObjectiveTo explore community perceptions of domestic violence against pregnant women.MethodsA qualitative study was conducted in Dhulikhel municipality, involving 41 men and 76 women in 12 focus group discussions in different gender and family role separated groups. The interviews were recorded, transcribed in verbatim, and analyzed using content analysis. A socio-ecological model was used as a theoretical framework to illustrate linkages between individual, relationship, community, and societal influences on perceptions of domestic violence during pregnancy.ResultsThe community recognized different forms of violence during pregnancy threatening women’s physical and psychological health and presenting obstacles to seeking antenatal care. Some types of culturally specific violence were considered particularly harmful, such as pressure to give birth to sons, denial of food, and forcing pregnant women to do hard physical work during pregnancy, which may leave daughters-in-law vulnerable to domestic violence in extended families. A culture where violence is normalized and endurance and family reconciliation are promoted above individual health was perceived to cause women to tolerate and accept the situation. Participants suggested actions and strategies to address continuing violence, which indicated a societal transition toward increased awareness and changing attitudes and practices.ConclusionsDomestic violence during pregnancy needs to be addressed at different levels in Nepal, where women are often dependent on others for access to health care. Social norms were perceived to be shifting toward reduced acceptance of violence against women, but restrictions on women’s life options, movement, and decision-making authority were still considered impediments to pregnant women’s health.

Background: Peripheral intravenous catheter-related phlebitis is a common and signi¿ cant problem in clinical practice. This study was carried out to determine the occurrence of peripheral intravenous catheter related phlebitis and to de¿ ne the possible factors associated to its development. Materials and methods: Prospective observational study was carried out on 230 clients who were under ¿ rst time peripheral infusion therapy during two months period: September -October, 2007. Peripheral infusion site was examined for signs of phlebitis once a day. Jackson Standard visual phlebitis scale was used to measure the severity of the phlebitis. SPSS software was used to enter, edit and analyze the data and t-test, chi-square test, binary logistic regression and ROC curve were used to draw the statistical inferences. Results: Phlebitis developed in 136/230 clients (59.1%). It was very mild in most cases. Increased incidence rates of infusion related phlebitis were associated with male sex, small catheter size (20 gauge), insertion at the sites of forearm, IV drug administration and blood product transfusions. The incidence rate of phlebitis rose sharply after 36 hours of catheter insertion. Conclusion: Peripheral Intravenous therapy related phlebitis at KUTH, Dhulikhel Hospital is a signi¿ cant problem. Related risk factors as found in the present study were insertion site (forearm), size of catheter (20G) and dwell time (>= 36 hours). There were higher incident of phlebitis among the client with Intra venous drug administration and especially between ages 21 -40 years. Therefore more attention and care are needed in these areas by the care provider.Key words: Phlebitis, Intravenous Therapy, Catheter, Risk Factors, KUTH, Nepal. I ntravascular devices are common and play very important role in modern day medical practice. One of the devices most used is the peripheral intravenous catheter (PIC) for IV À uids, IV medications, blood product administration, or blood sampling 1 . About 50% of hospital patients require intravenous (IV) access 2 . Although such catheter provides necessary intravascular access, their use puts client at risk for associated complications which may be local and systemic.One of the most common complications of PIC is phlebitis that may occur in up to75% of hospitalized patients 3 . It remains a signi¿ cant problem in clinical practice and causes patient discomfort, catheter replacement, prolong hospital stay and health care cost. Many factors have been implicated in the genesis of phlebitis namely (1) chemical factors such as irritant drugs and À uids, (2) mechanical factors: such as catheter material, size of cannula, site of insertion, duration of cannulation (dwell time) 4 etc. Many cases of PICs related phlebitis has been noted at KUTH, Dhulikhel Hospital, Kathmandu University Teaching Hospital. A prospective observational study was conducted to assess the magnitude of the problem as well as to shed some light on possible contributing factors. Awareness of such factors may help to ...

The primary aim of this study was to assess the prevalence of domestic violence (DV) and its associated factors among pregnant women in Nepal. The secondary aims were to investigate disclosure of DV by women to healthcare personnel and to assess whether healthcare personnel had asked women about their experience of DV. Method:This cross-sectional study included 2004 pregnant women between 12 and 28 weeks gestation, attending routine antenatal care at two hospitals in Nepal from August 2014to November 2015. In our study, DV was defined as fear of a family member and/or an experience of physical, emotional, or sexual violence. Associated risk factors were analyzed using logistic regression analyses. Results:Twenty-one percent of the women had experienced DV; 12.5% experienced fear only, 3.6% violence only, and 4.9% experienced both violence and fear. Less than 2% percent reported physical violence during pregnancy. This study found that just 17.7% had ever been asked by healthcare personnel about DV, and of the women who had reported DV, only 9.5% had disclosed their experience to healthcare personnel. Women of young age and low socioeconomic status were more likely to have experienced DV. Women who 5 reported having their own income and the autonomy to use it were at significantly lower risk of DV compared to women with no income. Conclusion:A substantial proportion of women reported having experienced DV. Victims had rarely disclosed their experience of DV to healthcare personnel. Our study underlines the importance of integrating systematic assessment of DV in antenatal care.

Background Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal. Methods In this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen (modified) was used to assess fear and violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 (69%) women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500 g was defined as low birthweight and preterm birth as birth before completion of 37 weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations. Results Twenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 (95% CI;1.10–4.73)]. Conclusions Domestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not. Electronic supplementary material The online version of this article (10.1186/s12889-019-6967-y) contains supplementary material, which is available to authorized users.

Background Adolescence Pregnancy is a social problem worldwide with serious implication of maternal and child health. This study purposed to compare the maternal and neonatal outcome of the teenage mothers (15- 19 years) with that of the young mothers (20-24 years) to determine if adolescent pregnancies have increased risk of adverse outcomes. Objectives This st udy aims to find out the outcomes of adolescent pregnancy at Kathmandu Univeristy Hospital, Dhulikhel Hospital, KAvre. Methods Descriptive cross sectional study was done. The study included all primiparous mothers of age 15-19 (n=168) and 20-24 (n=401) recorded in the delivery record book of Dhulikhel Hospital from June 2007 to May 2008. Chi-square test and relative risk (RR) for subgroups of study population was examined using the SPSS version 10.0. Results The low birth weight baby among teenage mothers and young mothers were 28% and 26.7% respectively (p=0.572). The Relative risk of low birth weight among adolescent is 1.1 (0.75-1.684) times to that of young mothers at 95% confidence interval. Preterm birth was not associated with adolescence pregnancy (7% Vs. 11.5%, p=0.141). Normal delivery was the common mode of delivery among both groups (77.4% Vs. 74.6%). Among the neonatal complication, newborns of adolescents had greater neonatal complications than newborns of the young mothers (17.2% Vs 16.7%). Maternal complication like antepartum hemorrhage (2.4% Vs. 1.7%) and postpartum hemorrhage (0.6% Vs. 0.2%) was higher among adolescents. ConclusionsLow birth weight, common neonatal complication, antepartum hemorrhage and postpartum hemorrhage are found more in adolescent group, however statistically insignificant.http://dx.doi.org/10.3126/kumj.v9i1.6263 Kathmandu Univ Med J 2011;9(1):50-3

Background Antenatal care is provided during pregnancy to save lives of mother and foetus. World Health Organization recommends four focused visits as sufficient for normal pregnancy. Objective The objective of the study was to find out antenatal care practices in Tamang community of hilly areas of central Nepal. Methods Descriptive cross-sectional study was conducted in Tamang community of Lalitpur district. Systematic random sampling method was used to collect data from April to May 2011. Data of 194 women having ?3 years of children was collected and analyzed in descriptive and inferential ways. Results Antenatal visits were made by 78.9% (153) of women but only 46.4% (71) completed four antenatal visits. Mean visit was of 3.5 ± 1.13 times. Ninety four (61.4%) of first antenatal visits attainders completed the fourth visit. Age of women and antenatal visits, taking tetanus toxoid injection and knowledge on work of iron tablets exhibited significant association at 95% level of confidence (p <0.05). There was also significant association between numbers of childbirth and antenatal visits at 95% level of confidence (p <0.05). ConclusionsThere was a high rate of early marriage and early pregnancy in the Tamang communities. Women did not place high importance on antenatal visits. A large percentage did not complete all four recommended antenatal visits. Use of necessary medicine like iron, albendazole tablets and tetanus toxoid injection was often incomplete. DOI: http://dx.doi.org/10.3126/kumj.v9i2.6290 Kathmandu Univ Med J 2011;9(2):57-61

Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for both the mother and newborn, and sometimes death. In a low-income country like Nepal, women have few options to leave abusive situations. Therefore, there is a need for interventions to improve their safety. The aim of our study was to explore the use of safety measures before and after an educational intervention among women who have reported DV during pregnancy. Materials and methods: Of 1010 pregnant women screened consecutively for DV using the Abuse Assessment Screen (AAS) during routine antenatal care, 181 women reported domestic violence. All 1010 participating pregnant women were taught 15 safety measures using a locally developed flipchart. We obtained contact with 80 of the 181 eligible women postpartum, of whom 62 completed the follow-up assessment. We explored and described the use of safety measures at baseline and follow-up, using a standardized instrument called the Safety Behavior Checklist. Results: At follow-up, less than half of the women (n = 30, or 48.3%) reported any form of DV. Of the women who reported DV at follow-up, significantly more reported the experience of both violence and fear at baseline (21.9%, p = 0.01) compared with the women who did not report DV at follow-up (3.3%, p = 0.01). Women reporting DV at baseline and follow-up used more safety measures at baseline (56) and follow-up (80) compared with women reporting DV at baseline only (36 and 46). Women reporting DV at baseline and follow-up used more safety measures for the first time at follow-up, 57 new measures compared with the 28 new measures used by women reporting DV at baseline only. Conclusions: The use of a flipchart teaching session on safety measures within antenatal care may increase the number of safety measures women use to protect themselves during pregnancy and decrease the risks of adverse health effects of DV.

ObjectiveThis study aimed to evaluate if domestic violence affected women’s ability to prepare for childbirth. Birth preparedness and complication readiness (BP/CR) includes saving money, arranging transportation, identifying a skilled birth attendant, a health facility, and a blood donor before childbirth. During data collection, Nepal experienced two earthquakes and therefore it was possible to examine associations between domestic violence, women’s BP/CR and effects of the earthquakes.MethodsWomen who were between 12 and 28 weeks of gestation participated in a descriptive cross-sectional study at a hospital antenatal clinic in Nepal, where they completed a structured questionnaire on sociodemographic characteristics, obstetric history, experiences of domestic violence, and BP/CR. The 5-item Abuse Assessment Screen was used to assess prevalence of domestic violence, and a questionnaire on safe motherhood obtained from Jhpiego was used to assess BP/CR status. The participants self-completed the questionnaire on a tablet computer. Those who reported at least three out of five BP/CR activities were considered prepared for childbirth.ResultsA total of 1011 women participated in the study: 433 pre-earthquakes and 578 post-earthquakes. With respect to BP/CR, 78% had identified a health facility for childbirth and 65% had saved money prior to childbirth. Less than 50% had identified a birth attendant to assist with the delivery, transportation to a health facility, or arranged for a potential blood donor. Prior to the earthquakes, 38% were unprepared; by contrast, almost 62% were not prepared after the earthquakes. A significant association was found between exposure to violence and not being prepared for childbirth (AOR = 2.3, 95% CI: 1.4–3.9). The women with increased odds of not being prepared for childbirth were illiterate (AOR = 9.9, 95% CI:5.7–17), young (AOR = 3.4, 95% CI:1.6–7.2), from the most oppressed social classes (AOR = 3.0, 95% CI:1.2–7.6), were married to illiterate husbands (AOR = 2.5, 95% CI:1.2–5.2), had attended fewer than four antenatal visits (AOR = 2.0, 95% CI: 1.4–2.6), had low incomes (AOR = 1.7, 95% CI:1.1–2.9) or lived in rural settings (AOR = 1.5, 95% confidence interval CI:1.2–2.1).ConclusionThe paper identifies vulnerable women who require extra care from the health system, and draws attention to the need for interventions to reduce the harmful effects of domestic violence on women’s preparations for childbirth.