Cause of Death in Women of Reproductive Age in Rural Nepal Obtained Through Community-Based Surveillance: Is Reducing Maternal Mortality the Right Priority for Women's Health Programs?

Pyakurel, Ram Sharan; Sharma, Neeraj; Paudel, Deepak; Coghill, Anna E.; Sinden, Laura L; L, Bost; Larkin, Melissa; Burrus, Carla J.; Roy, Khrist

doi:10.1080/07399332.2014.908193

Cited by 14 publications

(6 citation statements)

References 10 publications

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“…However, studies have also indicated that suicidal ideation may be higher in camps prior to migration where one study reported that, among women who screened positive for a common mental disorder, 91 % reported having had thoughts of suicide in the previous month [14]. Recent reports in Nepal identified suicide as the leading cause of death amongst women of reproductive age [21, 40]. Further investigation found mixed relationships between caste and suicide where more deaths occurred among higher castes, but more suicidal thoughts were endorsed in lower castes [20, 21].…”

Section: Discussionmentioning

confidence: 99%

An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011

Hagaman

Sivilli²,

Ao³

et al. 2016

J Immigrant Minority Health

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An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled populations.

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Section: Discussionmentioning

confidence: 99%

An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011

Hagaman

Sivilli²,

Ao³

et al. 2016

J Immigrant Minority Health

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“…Additionally, a recent five-country study found that Nepal community and clinical populations had high rates of suicide ideation, but the lowest amounts of ideation disclosure and help-seeking following an attempt (Jordans, et al, 2017). This underscores the importance of further research on why suicidal thoughts are not disclosed, as well as a better understanding of perceived drivers and meanings of suicidal deaths in Nepal (Jordans, et al, 2017; Jordans, et al, 2014; Pyakurel, et al, 2015; Marahatta, et al, 2016; Pradhan, et al, 2011). …”

Section: Introductionmentioning

confidence: 99%

Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths

Hagaman

Khadka²,

Wutich

et al. 2018

Cult Med Psychiatry

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South Asia accounts for the majority of the world's suicide deaths, but typical psychiatric or surveillance-based research approaches are limited due to incomplete vital surveillance. Despite rich anthropological scholarship in the region, such work has not been used to address public health gaps in surveillance and nor inform prevention programs designed based on surveillance data. Our goal was to leverage useful strategies from both public health and anthropological approaches to provide rich narrative reconstructions of suicide events, told by family members or loved ones of the deceased, to further contextualize the circumstances of suicide. Specifically, we sought to untangle socio-cultural and structural patterns in suicide cases to better inform systems-level surveillance strategies and salient community-level suicide prevention opportunities. Using a mixed-methods psychological autopsy approach for cross-cultural research (MPAC) in both urban and rural Nepal, 39 suicide deaths were examined. MPAC was used to document antecedent events, characteristics of persons completing suicide, and perceived drivers of each suicide. Patterns across suicide cases include (1) lack of education (72% of cases); (2) life stressors such as poverty (54%), violence (61.1%), migrant labor (33% of men), and family disputes often resulting in isolation or shame (56.4%); (3) family histories of suicidal behavior (62%), with the majority involving an immediate family member; (4) gender differences: female suicides were attributed to hopeless situations, such as spousal abuse, with high degrees of social stigma. In contrast, male suicides were most commonly associated with drinking and resulted from internalized stigma, such as financial failure or an inability to provide for their family; (5) justifications for suicide were attributions to 'fate' and personality characteristics such as 'stubbornness' and 'egoism'; (5) power dynamics and available agency precluded some families from disputing the death as a suicide and also had implications for the condemnation or justification of particular suicides. Importantly, only 1 out of 3 men and 1 out of 6 women had any communication to family members about suicidal ideation prior to completion. Findings illustrate the importance of MPAC methods for capturing cultural narratives evoked after completed suicides, recognizing culturally salient warning signs, and identifying potential barriers to disclosure and justice seeking by families. These findings elucidate how suicide narratives are structured by family members and reveal public health opportunities for creating or supplementing mortality surveillance, intervening in higher risk populations such as survivors of suicide, and encouraging disclosure.

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“…In Nepal, snakebite is an important public health problem [ 18 – 20 ] with peak annual incidence and mortality rates of up to 1162/100 000 and 162/100 000, respectively, reported in eastern regions [ 19 ]. Snakebite is a disease of poverty.…”

Section: Introductionmentioning

confidence: 99%

Dose of antivenom for the treatment of snakebite with neurotoxic envenoming: Evidence from a randomised controlled trial in Nepal

et al. 2017

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BackgroundCurrently, there is inadequate evidence on which to base clinical management of neurotoxic snakebite envenoming, especially in the choice of initial antivenom dosage. This randomised controlled trial compared the effectiveness and safety of high versus low initial antivenom dosage in victims of neurotoxic envenoming.Methodology/ Principal findingsThis was a balanced, randomised, double-blind trial that was conducted in three health care centers located in the Terai plains of Nepal. Participants received either low (two vials) or high (10 vials) initial dosage of Indian polyvalent antivenom. The primary composite outcome consisted of death, the need for assisted ventilation and worsening/recurrence of neurotoxicity. Hourly evaluations followed antivenom treatment. Between April 2011 and October 2012, 157 snakebite victims were enrolled, of which 154 were analysed (76 in the low and 78 in the high initial dose group). Sixty-seven (43·5%) participants met the primary outcome definition. The proportions were similar in the low (37 or 48.7%) vs. high (30 or 38.5%) initial dose group (difference = 10·2%, 95%CI [-6·7 to 27·1], p = 0·264). The mean number of vials used was similar between treatment groups. Overall, patients bitten by kraits did worse than those bitten by cobras. The occurrence of treatment-related adverse events did not differ among treatment groups. A total of 19 serious adverse events occurred, including seven attributed to antivenom.ConclusionsThis first robust trial investigating antivenom dosage for neurotoxic snakebite envenoming shows that the antivenom currently used in Nepal performs poorly. Although the high initial dose regimen is not more effective than the low initial dose, it offers the practical advantage of being a single dose, while not incurring higher consumption or enhanced risk of adverse reaction. The development of new and more effective antivenoms that better target the species responsible for bites in the region will help improve future patients’ outcomes.Trial registrationThe study was registered on clinicaltrials.gov (NCT01284855) (GJ 5/1)

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Cause of Death in Women of Reproductive Age in Rural Nepal Obtained Through Community-Based Surveillance: Is Reducing Maternal Mortality the Right Priority for Women's Health Programs?

Cited by 14 publications

References 10 publications

An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011

An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011

Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths

Dose of antivenom for the treatment of snakebite with neurotoxic envenoming: Evidence from a randomised controlled trial in Nepal

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