Objective: Unhealthy menstrual practices and the contexts surrounding them should be explored and clearly understood; this information could be useful while developing and implementing interventions to increase hygienic practices during menstruation and consequently increase health and well-being of women. Therefore, this study was conducted to explore traditional menstrual practices and the contextual factors surrounding the practices in the rural communities of far-western Nepal. Methods: This was a qualitative case study conducted in the Achham district of Nepal. Semi-structured interviews were conducted among four women, three men and two female community health volunteers to collect data and thematic analysis was performed to analyze the data. Results: We found two commonly reported menstrual practices: seclusion practice (Chhaupadi) and separation practice. In the Chhaupadi practice, women are secluded to stay in a small shed away from the house and restricted to wash or take a bath in public water sources for 5-7 days of the periods, whereas in the separation practice, women can stay in the house, but they still have several restrictions. The contextual factors that were reported to influence the cultural practices are as follows: cultural beliefs that symbolize menstruation as impure, menstrual stigma, poverty, illiteracy, the influence of traditional healers and family members, and limited effect of Chhaupadi elimination interventions. We also found that some development in the reduction of cultural myths and practices is happening, but the rate of change is rather slow. Conclusion: Most of the Nepalese women, especially in the rural areas of far-western Nepal, are forced to follow the harmful menstrual practices because of the socio-cultural context surrounding their lives. We believe the findings of this study would be relevant in terms of developing and implementing further menstrual health-related, community-based interventions that will be responsive to the local cultural context, beliefs, and practices.

BackgroundHIV disclosure is an important step in delivering the right care to people. However, many people with an HIV positive status choose not to disclose. This considerably complicates the delivery of adequate health care.MethodsWe conducted a grounded theory study to develop a theoretical model explaining how local contexts impact on HIV disclosure and what the mechanisms are that determine whether people choose to disclose or not. We conducted in-depth interviews among 23 people living with HIV, 8 health workers and 5 family and community members, and 1 community development worker in Achham, Nepal. Data were analysed using constant-comparative method, performing three levels of open, axial, and selective coding.ResultsOur theoretical model illustrates how two dominant systems to control HIV, namely a community self-coping and a public health system, independently or jointly, shape contexts, mechanisms and outcomes for HIV disclosure.ConclusionThis theoretical model can be used in understanding processes of HIV disclosure in a community where HIV is concentrated in vulnerable populations and is highly stigmatized, and in determining how public health approaches would lead to reduced stigma levels and increased HIV disclosure rates.

Introduction: Urban firefighting is a challenge however very less is known about how the firefighters manage on addressing fire disasters when it occurs or what sort of health risks they generally face. The health risks in firefighting are abundant however very less is explored, in regard to the Nepalese context. This study thus aims to explore general characteristics and potential stress causing factors among urban firefighters of Kathmandu valley as Nepal lacks any such study. Methods: A qualitative study design with in-depth interview questions were used to interview 15 currently employed firefighters and the station in charge of Kathmandu valley and thematic analysis was done to derive results. The study was conducted in two phases, the first phase including the use of locally translated and validated DASS-21 (Depression Anxiety and Depression Scale) tool to identify potentially stress suffering firefighters while the second phase included use of in-depth interview (IDI) and key informant interview (KII) format to explore stress causing factors among firefighters. Results: The results showed that most firefighters were stressed due family separations, difficult PPEs, lack of human resource adequacies, income insufficiency, underwhelming response at active site and lack of health addressing programs in the station. The firefighters additionally mentioned stress due to recurring bluff calls and unmanaged traffic in the city. Conclusion: Despite the solvable problems, the station lacked standard operating guidelines, physical fitness and mental well-being programs, deemed essential for the occupation in general. Therefore, concerned authorities must prioritize the needs of urban fire station and firefighters.