Spousal migration and human papillomavirus infection among women in rural western Nepal

Johnson, Derek C.; Lhaki, Pema; Bhatta, Madhav P.; Kempf, Mirjam Colette; Smith, Jennifer S.; Bhattarai, Pankaj; Aryal, Shilu; Chamot, Eric; Regmi, Krishna; Vermund, Sten H.; Shrestha, Sadeep

doi:10.1093/inthealth/ihw015

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…The details of the development and the pilot testing of the questionnaire have been previously described [3, 11, 12]. The survey questionnaire included questions related to socioeconomic indicators, behavioral risk, reproductive health, and migration related factors.…”

Section: Methodsmentioning

confidence: 99%

High-risk human papillomavirus infection and abnormal cervical cytology among Nepali and Bhutanese refugee women living in eastern Nepal

Bhatta

Johnson

Lama³

et al. 2017

BMC Infect Dis

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BackgroundCervical cancer is the leading cause of cancer morbidity and mortality among women in Nepal and Bhutan. Data on high-risk human papillomavirus (HR-HPV) infection and cervical abnormalities among Nepali and Bhutanese women are sparse. The objectives of this study were to assess and compare the prevalence of HR-HPV infection and cervical abnormalities among Nepali and Bhutanese women living in Jhapa District in eastern Nepal; and examine the risk factors for HR-HPV infection and cervical abnormalities in those women.MethodsStudy participants were recruited from a women’s health camp organized by NFCC-International, a Nepal-based non-governmental organization, in 2014. Consenting participants were administered a demographic and health questionnaire and cervico-vaginal specimens collected. Both self-collected and clinician-collected cervico-vaginal specimens were tested for HR-HPV infection. Cytologic exam was performed on clinician-collected samples and cervical cytology results were categorized according to the Bethesda classification. A participant was classified as a Bhutanese if they were either born in Bhutan or currently lived in one of the United Nations administered Bhutanese refugee camps in Jhapa; otherwise, the participant was classified as a Nepali.ResultsOf the 647 study participants, 15.9% were Bhutanese women living in refugee camps and the overall age (± standard deviation) was 38.8 ± 8.2 years. The prevalence of HR-HPV infection was 8.9% and abnormal cervical cytology was 7.1% respectively, with no significant difference in HR-HPV positivity (p = 0.399) or abnormal cervical cytology (p = 0.698) between Nepali and Bhutanese women. Compared to women whose husbands had not migrated for employment, women whose husbands had migrated outside of the district had 3.30 times (95% Confidence Interval [CI]: 1.13–9.64) the odds of being HR-HPV positive and women whose husbands had migrated outside the country had 2.92 times (95% CI: 1.32–6.49) the odds of having abnormal cervical cytology.ConclusionsHR-HPV positivity and abnormal cervical cytology were similar among Nepali and Bhutanese women. Husbands migrating for employment within or outside the country was a significant risk factor for high-risk HPV infection and cervical cytology, indicating the important role spousal behavior may play in HR-HPV acquisition and cervical abnormalities among these women.

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Section: Methodsmentioning

confidence: 99%

High-risk human papillomavirus infection and abnormal cervical cytology among Nepali and Bhutanese refugee women living in eastern Nepal

Bhatta

Johnson

Lama³

et al. 2017

BMC Infect Dis

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“…Cervical cytology was assessed for research purposes using clinician-collected ThinPrep ® PreservCyt ® medium (Hologic/Gen-Probe, San Diego, CA), with results classified according to the Bethesda criteria. In Accham, three women had high-grade squamous intraepithelial lesion (HSIL) and one had squamous cell cancer (SCC) [18, 19]. In Jhapa, only one individual had HSIL.…”

Section: Methodsmentioning

confidence: 99%

Genomic diversity and phylogenetic relationships of human papillomavirus 16 (HPV16) in Nepal

Makowsky

Lhaki²,

Wiener

et al. 2016

Infection, Genetics and Evolution

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Objectives/Background Sequence variants in HPV16 confer differences in oncogenic potential; however, to date there have not been any HPV sequence studies performed in Nepal. The objective of this study was to characterize HPV16 viral genome sequences from Nepal compared to a reference sequence in order to determine their lineages. Additionally, we sought to determine if five High-grade Squamous Intraepithelial Lesion (HSIL) subjects were genetically distinct from the non-HSIL subjects Methods DNA was isolated from exfoliated cervical cells from 17 individuals in Nepal who were previously identified to be HPV16-positive. A custom HPV16 Ion Ampliseq panel of multiplexed degenerate primers was designed that generated 47 overlapping amplicons and covered 99% of the viral genome for all known HPV16 variant lineages. All sequence data were processed through a custom quality control and analysis pipeline of sequence comparisons and phylogenetic analysis. Results While there were high similarities across the genomes, with two major indels observed in the non-coding region between E5 and L2. Compared to the PAVE reference HPV16 genome, there were up to 9, 4, 38, 27, 8, 7, 52, and 32 nucleotide variants in the E6, E7, E1, E2, E4, E5, L2, and L1 genes in the Nepalese samples, respectively. Based on sequence variation, HPV16 from Nepal falls across the A, C, and D lineages in this study. We found no evidence of genetic distinctness between HSIL and non-HSIL subjects. Conclusions The evolutionary and pathological characteristics of the representative HPV16 genomes from Nepal seem similar to results from other parts of the world and provide the basis for further studies.

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“…11 Because of the weak local economy, an estimated 50% of families have at least one member working abroad. 12 Since 2008, Nyaya Health Nepal (NHN), a non-profit healthcare organisation has managed the hospital through a public–private partnership with the Ministry of Health and Population of Nepal, with support from a US-based non-profit Possible . The hospital sees over 100 000 outpatient visits annually and is staffed by 15–20 PCPs, including physicians and health assistants (healthcare workers with 3 years of medical training).…”

Section: Methodsmentioning

confidence: 99%

Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study

Rimal¹,

Choudhury

Agrawal³

et al. 2021

BMJ Open

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IntroductionDespite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings.MethodsWe conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers’ behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period.ResultsProviders experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:−9, Q3:−2) decrease in PHQ-9 scores (p<0.0001).ConclusionUsing the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers’ positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare.

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Spousal migration and human papillomavirus infection among women in rural western Nepal

Cited by 6 publications

References 24 publications

High-risk human papillomavirus infection and abnormal cervical cytology among Nepali and Bhutanese refugee women living in eastern Nepal

High-risk human papillomavirus infection and abnormal cervical cytology among Nepali and Bhutanese refugee women living in eastern Nepal

Genomic diversity and phylogenetic relationships of human papillomavirus 16 (HPV16) in Nepal

Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study

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