Background:Child marriage defined by UNICEF as marriage before 18 years of age is a reality for more than 60 million women worldwide.1 The practice has become increasingly recognised as a human rights violation 2,3 and has decreased worldwide during the past 20 years.

ObjectivesThe study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal.MethodsWe conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health.ResultsOf 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71–282) and US$36 (19–61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector.ConclusionIndustrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered.

Inborn error of metabolism (IEM) was very rare hereditary disease. Newborn screening by Tandem mass spectrometry (MS/MS) program which can detect 17 diseases of inborn error of metabolism has been introduced in Japan since 2011. The objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of the MS/MS tests compared with Guthrie (GC) tests. Methods: A costutility analysis was conducted. We constructed a decision-tree and Markov model to compare life-time costs and quality-adjusted life-years (QALY). The comparisons were made between a current newborn screening program using MS/MS tests and a past screening program using GC tests. We conducted a systematic review to collect health benefits values. Treatment costs and disease progression rates were estimated using an administrative database in Japan. Disease prevalence and mortality rate were obtained from publications from government and Bulletin of the Japan Cooperative Project on Special Formula. Results: The ICER of MS/MS tests compared with GC tests was 2 million JPY per QALY (approximately $19,000 per QALY) which was lower than the willingness-to-pay threshold of 5 million JPY in Japan. Conclusions: Introduction of the new program with MS/MS tests has incurred additional costs to insurance payer; however, it has also yielded additional QALYs. Therefore, from the perspective of Japanese healthcare system, the MS/MS tests seemed to be cost-effective. However, the data of IEM such as incidence, transition probabilities, and utility, were limited, a long-term epidemiological study for the IEM patients is needed to reduce uncertainty of this analysis.

Aims:To find out the prevalence of domestic violence in pregnant women attending Antenatal clinics (ANC) of B. P. Koirala Institute of Health Sciences, a tertiary centre in eastern Nepal.Methods: It was a hospital based cross-sectional study done at antenatal clinics of BPKIHS from 14th March 2015 to 30th August 2015. The total number of recruited antenatal patients was 470. Data were collected by face to face interview via pretested semi-structured questionnaire. Descriptive and inferential statistics were used for data analysis. Results:The prevalence of domestic violence among pregnant women was 53.2% of which prevalence of physical domestic violence was 9.6%. The most common person inflicting the domestic violence was husband (23.6%). Emotional abuse was the most common form of domestic violence experienced by the pregnant women (26.8%) and threatening for remarriage was most common emotional violence faced (43.2%). As the age of the pregnant women increases, they tend to have more domestic violence. Conclusions:The prevalence of domestic violence among pregnant women seemed alarmingly high in our society. Awareness to the family members and strengthening the women empowerment at community level might play a major role for reducing such violence. Pregnancy-related violence is a serious public health issue.

Background: Antenatal care has proven to be an effective way to reduce maternal mortality and save the life of newborn. Nepal also follows the World Health Organization's recommendations of initiation of four antenatal care visits that has helped in decreasing the maternal mortality of the country. Still, the country has to do a lot in improving the antenatal care provision. Objective: The objective of this study was to fi nd out the antenatal care practices among the women with children less than fi ve years of age in a district of eastern Nepal. Methods: A descriptive cross-sectional study was conducted among residents of Aurabani village of Sunsari district. Non probability convenient sampling technique was used to collect data from 15th January to 30th January, 2015. Data of 100 women having children less than fi ve years of age were collected and analyzed in descriptive and inferential ways. Results: Women with nuclear family are more likely to have antenatal care visits (73.8%) compared to women with joint family (66.7%). The study showed that attendance of antenatal care visits among the educated women was higher (71.8%) than those illiterate (66.7%). In the study, 84.8% of women of primi-gravida completed antenatal care visit which was signifi cantly higher than women with multi gravida (59.3%) (p <0.05). Further, 83.1% of respondents who completed tetanus toxoid injections had not walked <30 meters distance for health services which was signifi cantly higher than those walking >30 meters distance (52.9%). An almost similar trend was found among pregnant women taking iron tablets and vitamin A. Furthermore, walking distance shows stronger association with women taking albendazole during pregnancy (p <0.001). Conclusion: A large percentage of women completed all four recommended antenatal visits. Women and their husbands who were educated placed high importance on antenatal visits. Gravida of the pregnancy was also related to the antenatal care visit. High number of primi-gravida women completed antenatal care visits than women with multigravida. Use of medicines like iron tablets, albendazole tablets, vitamin A and tetanus toxoid injection was directly related with the walking distance to the health center.