Search

Cow is the national animal of Nepal, yet it is one of the most abused animal species here. Under realized utilities of cow that is nonlactating or pregnant is the reason for demonic cruelty. Since the Vedic period, gaushalas have been caring for cows. At present, most gaushalas have responsibility to rescue, offer refuge, and treat poorly treated or confiscated cattle from smuggling rackets in Nepal. It is no surprise that these abused animals suffer from many health issues and compromised reproductive ability. This study was conducted to know about husbandry practice and to determine prevalence of reproductive disorders in cows of Gaushala from Nepal. Altogether, 27 gaushalas were visited throughout the study period and cows (≥2 years) (n = 2959) were included for the study. From the study, respondents from 14.81% Gaushala admitted indigenous cattle only, 11.11% admitted any breed (indigenous and crossbreed), 44.44% admitted stray animals only, and 29.63% admitted all types (indigenous, crossbreed, and stray animals). The study revealed that among (n = 2959) animals examined, 5.54% (n = 164) were affected by either one or more reproductive problems. The major reproductive disorders identified in study area were repeat breeding 0.47%, cervico-vaginal and uterine prolapse 0.34%, retention of placenta 2.13%, dystocia 0.61%, and abortion 1.66%. Herd size of Gaushala had a significant difference (P < 0.05) on the overall prevalence of reproductive problems in cows of Gaushala. The main issues with gaushalas included a lack of resources like adequate fund, feeds, fodder, and water, shortage of grazing acreage, veterinary services, and difficulties in managing male cattle. To mitigate the issues and welfare related to gaushalas strict adherence to disease surveillance and biosecurity rules, avoidance of unlimited reproduction in cows, and separation of males and females, fund raising and resource management, collaboration with local government and NGOs, veterinary hospital, clinics, research, and innovation with veterinary institution and universities. [ABSTRACT FROM AUTHOR]

More than a third of women in Nepal have to carry water from source to home to satisfy their families' daily needs. A cross-sectional study was carried out in a hilly area in Nepal to assess water-carrying practices and their association with women's health. Quantitative interviews were conducted with 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water carrying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive physical stress due to water carrying during the dry season. Women suffered from a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk category of water carrying was significantly associated with uterine prolapse (OR = 1.44, 95%CI = 1.12–1.85, p = 0.031) and pain in the hips (OR = 1.69, 95%CI = 1.27–2.26, p<0.001). Receiving help with water carrying during pregnancy and during the first three months after delivery was associated with reduced odds ratios for uterine prolapse (OR = 0.10, 95% CI = 0.01–0.87, p = 0.037), and strong back pain (OR = 0.32, 95% CI = 0.12–0.87, p = 0.026). Improvements to water supply infrastructure and the promotion of social support for carrying water during pregnancy and after delivery are recommended to reduce water-carrying-related health risks. [ABSTRACT FROM AUTHOR]

Aims: Hysterectomy are being performed in regular basis and its aetiology and histopathological findings are watched and co-related in this study. Methods: This is an observational descriptive study carried out in the Department of Obstetrics and Gynaecology at Nobel Medical College Teaching Hospital Biratnagar for one year from 15 May 2021 to 15 may 2022. All the patients undergoing hysterectomies were analyzed for indication, type of procedure, complications and histopathological diagnosis. Results: A total of 456 hysterectomies were performed in a year. Preoperative diagnosis in most of the cases was fibroid uterus. The common surgical procedure was total abdominal hysterectomy. The most common histopathological diagnosis was fibroid uterus followed by uterine prolapse, ovarian mass, endometrial disease and adenomyosis. Conclusions: Fibroid uterus is the leading cause of hysterectomy as well as the commonest pathologic diagnosis followed by prolapsed uterus and ovarian tumor. [ABSTRACT FROM AUTHOR]

In Nepal, pelvic floor disorders affect about 24% of the women in reproductive age whereof 10% suffer from pelvic organ prolapse (POP). Still, many do not seek health care. Strengthening exercises for the pelvic floor muscles for prevention and treatment of POP has shown strong evidence internationally, but for women in Nepal surgery is primarily offered. To amend this, a novel pelvic floor muscle training (PFMT) program for pregnant women was introduced. To learn about how the PFMT-program was received by the participating women, their understanding of the importance of doing the exercises, and the constraints of daily life for performing the program. A qualitative study design based on a sub-sample (N = 10) from a strategic sample (N = 235) who participated in the PFMT-program. Ten semi-structured in-depth interviews were interpreted according to a phenomenological analytical tradition. The 10 women were representative for the women who had participated in the PFMT-program with regard to urban residence, socioeconomic, and educational standing. The program was well received and compliance satisfactory. In line with the PFMT's learning outcomes, the women described risk factors, showed knowledge about the pelvic floor muscles, and understood the importance of doing the exercises. They had managed to fit the exercises into their busy daily routines. Meeting peers in exercise groups and understanding from family were positive factors for compliance. The Nepalese women appear interested in self-care and are making an effort to fit the exercises into their busy schedule. Although the communicative validity was satisfactory, the pragmatic validity cannot be generalized to women in rural areas and under less fortunate socioeconomic and educational circumstances. [ABSTRACT FROM AUTHOR]

Aims: To audit and evaluate the surgical indications, routes of surgery and types of hysterectomies performed along with histopathological analysis of those hysterectomies in respect to disease of endometrium, myometrium, cervix and fallopian tubes and ovaries for benign conditions. Methods: This is retrospective cross sectional study of all hysterectomy specimens received in the department of Pathology, B and C teaching hospital and research center, Jhapa, Birtamode, Nepal from May 2017 to May 2019. Clinical details were received from the data provided by gynecologists in histopathological requisition forms. Only specimens received for the benign indication for hysterectomy were taken. Results: : Out of 115 specimens, the number was equal on both abdominal and vaginal route. The common indications were leiomyoma (60%, n=69), abnormal uterine bleeding (24%, n=28) and uterine prolapsed in 11% (n=l 3). Uterovaginal prolapse was seen commonest indication for hysterectomy in age group of 5th and 6th decade of life. Myometrial pathology was seen in 74% (n=75) comprising mostly of leiomyoma. Endometrial pathology was present in 14% (n=16) and chronic non-specific cervicitis in 24% (n=28). Abnormal tubo- ovarian pathology was found in 40% (n=51). Conclusions: Leiomyoma, abnormal uterine bleding and uterovaginal prolapsed are the common benign conditions undergoing hysterectomy. [ABSTRACT FROM AUTHOR]

Background: Uterine prolapse (UP), which affects about 10% of women of reproductive age in Nepal, is the most frequently reported cause of poor health in women of reproductive age and postmenopausal women. Currently, women's awareness of UP is unknown, and attempts to unravel the UP problem are inadequate. This study aims to assess UP knowledge among married reproductive women, and determine the association between UP knowledge and socioeconomic characteristics. Methods: Our cross-sectional descriptive study investigated 25 districts representing all five administrative regions, three ecological zones, and urban and rural settings. We used structured questionnaires to interview 4,693 married women aged 15-49 years. We assessed UP knowledge by asking women whether they had ever heard about UP, followed by specific questions about symptoms and preventive measures. Descriptive statistics characterized the study population regarding socioeconomic status, assessed how many participants had ever heard about UP, and determined UP knowledge level among participants who had heard about the condition. Simple regression analysis identified a possible association between socioeconomic characteristics, ever heard about UP, and level of UP knowledge. Results: Mean age of participants was 30 years (SD [standard deviation] 7.4), 67.5% were educated, 48% belonged to the advantaged Brahmin and Chhetri groups, and 22.2% were Janajati from the hill and terai zones. Fifty-three percent had never heard about UP. Among women who had heard about UP, 37.5% had satisfactory knowledge. Any knowledge about UP was associated with both urban and rural settings, age group, and education level. However, satisfactory knowledge about UP was associated with administrative region, ecological zones, caste/ethnic group, and age group of women. Conclusion: Fifty-three percent of participants had never heard about UP, and UP knowledge level was satisfactory in 37.% of those who had ever heard about UP. Any knowledge was associated with urban/rural setting, age group, and education level, whereas satisfactory knowledge was associated with geography, caste/ethnic group, and age group. UP-related health promotion programs should target women from all caste/ethnic groups, age groups, and education levels, including urban and rural communities. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the prevalence and associated risk factors of pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS) among women seeking healthcare services in 3 discrete rural areas in Nepal. Methods: A cross-sectional study was conducted using a Nepalese-specific questionnaire to obtain demographic and personal information. Urinary symptoms were examined using the Urogenital Distress Inventory Short form questionnaire, while POP severity was staged according to the POP-Q system. The χ2 test and multivariate logistic regression analysis were used to determine POP risk factors. Results: Of the 174 women included in the analysis, 106 (60.9%) had stage II POP or greater. In all, 93 women (53.4%) had cystocele, 63 (36.2%) had rectocele, and 37 (21.3%) had uterine prolapse. Univariate analysis identified high parity; young age at first delivery; menopause; squatting or standing position during delivery; and early return to work after delivery as risk factors for POP. Multivariate logistic regression revealed that delivery in a lying position presented a lower risk for cystocele than squatting or standing (odds ratio 0.34; P <0.01). Conclusion: Both LUTS and POP are common among women in rural Nepal. Cystocele is the most frequent, advanced, and symptomatic form of POP observed in this population. [Copyright &y& Elsevier]

Uterine prolapse is a major reproductive health issue in Nepal. There is a wide range of literature available on the causes and risk factors of uterine prolapse and on the ways to prevent and treat it. There is still a lack of published evidence on what prevention and treatment services are working well or the attitudes toward them. This paper presents the findings of a qualitative study on primary and secondary prevention of uterine prolapse in Eastern Nepal. Method: The study involved eight focus group discussions with 71 women in six villages of the eastern districts of Siraha and Saptari and 14 qualitative interviews with health professionals from the local to central level. The group discussions and interviews covered the awareness levels of uterine prolapse and its prevention and treatment, as well as participants' opinions on and experiences with the services offered. Results: It was found that patriarchy, gender discrimination, and cultural traditions such as early marriage and pregnancy make it difficult for people to discontinue uterine prolapse risk behaviors. Women are aware of risk factors, prevention, and treatment, but are powerless to change their situations. Health professionals and women are fond of surgery as treatment, but opinions on the use of ring pessaries and pelvic floor muscle training are split. Conclusion: The main recommendation that can be drawn from this study is that research on the effectiveness of early treatments, such as ring pessaries and exercise, should be conducted. Furthermore, the involvement of other target groups (husbands, adolescents, and mothers-in-law) needs to be increased in order to make it easier for women to adapt low-risk behaviors. Finally, uterine prolapse prevention should be better integrated in national reproductive health services. Enforcing transparency, monitoring systems, and collaborations are important factors that should be considered as well. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse is common in rural women in Nepal. Pregnancy in a woman with pelvic organ prolapse is uncommon and rarely continues beyond the second trimester. If it proceeds after that, the uterus usually ascends with progression of pregnancy and becomes abdominal, leaving little trace of prolapse. Pregnancy continuing to term with uterine prolapse is very rare. The case reported here is of a pregnant woman from a remote district in Nepal who had nine pregnancies and at 38 weeks of pregnancy presented at the district hospital with severe uterine prolapse, a large cervical ulcer and the baby's foot protruding from the cervix. Air transport was the only means of reaching the nearest hospital with emergency obstetric care, 200km away. The baby was delivered stillborn at the airport by the auxiliary nurse-midwife who accompanied her. Her husband was counselled for and had a vasectomy. The woman was fitted with a ring pessary but could not afford to go to the nearest town for surgery for the prolapse. People in remote areas of Nepal often seek medical advice very late. This and the lack of education, low utilisation of family planning services, and lack of skilled birth attendance and safe delivery centres at local level contribute to high maternal morbidity and mortality. Le prolapsus est fréquent chez les Népalaises rurales. La grossesse chez une femme avec prolapsus est inhabituelle et se poursuit rarement après le deuxième trimestre. Si elle continue au-delà, l'utérus s'élève avec la progression de la grossesse et devient abdominal, laissant peu de traces du prolapsus. Il est très rare qu'une grossesse arrive à terme en cas de prolapsus génital. Le cas décrit ici concerne une femme enceinte dans un district isolé qui a eu neuf grossesses et s'est présentée à 38 semaines à l'hôpital du district avec un prolapsus génital sévère, un large ulcère génital et le pied du bébé dépassant du col de l'utérus. Un transport aérien était le seul moyen d'atteindre l'hôpital le plus proche dispensant des soins obstétricaux d'urgence, à 200 kilomètres de là. La sage-femme infirmière auxiliaire qui accompagnait la mère a accouché le bébé mort-né à l'aéroport. Le mari a été vu en consultation et a subi une vasectomie. On a posé un pessaire à la femme, mais elle n'avait pas les moyens de se rendre à la ville la plus proche pour s'y faire opérer du prolapsus. Les habitants des zones isolées du Népal consultent souvent très tard les médecins. Ce phénomène ainsi que le manque d'instruction, le faible recours aux services de planification familiale, le manque d'assistance qualifiée à l'accouchement et l'absence de centres de maternité sans risque au niveau local contribuent à un taux élevé de morbidité et mortalité maternelles. En Nepal, el prolapso del órgano pélvico es común en mujeres rurales. El embarazo en una mujer con prolapso del órgano pélvico no es común y rara vez continúa más allá del segundo trimestre. Si continúa, el útero generalmente asciende con la evolución del embarazo y se vuelve abdominal, dejando poco rastro del prolapso. Muy rara vez el embarazo continúa a término cuando hay prolapso uterino. Aquí se presenta el caso de una mujer embarazada, de un distrito remoto, quien tuvo nueve embarazos y a las 38 semanas del embarazo acudió al hospital distrital con prolapso uterino severo, una úlcera cervical grande y el pie del bebé salido del cérvix. Transporte aéreo fue el único medio de llegar al hospital más cercano, a 200 km de distancia, para recibir cuidados obstétricos de emergencia. La enfermera auxiliar-partera profesional que la acompañaba la ayudó en un parto de mortinato en el aeropuerto. El esposo de la mujer tuvo una vasectomía tras recibir consejería al respecto. A la mujer le colocaron un pesario vaginal, pero ella no tenía los recursos financieros para ir al pueblo más cercano y someterse a una cirugía para el prolapso. Las personas en zonas remotas de Nepal a menudo buscan asesoría médica muy tarde. Esto aunado a la falta de educación, el uso infrecuente de servicios de planificación familiar y la falta de asistencia de parto calificada y centros de parto seguros a nivel local, contribuyen a las altas tasas de morbilidad y mortalidad maternas. [ABSTRACT FROM AUTHOR]

Various studies show that more than 600,000 women in Nepal are suffering from prolapsed uterus and that 200,000 of those needed immediate surgery. Many of the women with prolapse could recall the exact moment they first felt the prolapse and found difficulty to share the problems due to fear of stigma. Stories ranged from seven days immediately after the first delivery to after the birth of the fifth or sixth child; during cooking rice to sneezing and long coughing; fetching water in a big bucket to working in the field. If detected at an early stage, uterine prolapse (UP) can be controlled by pelvic exercises. For severe cases, the remedy is to insert a ring pessary to stop it from descending which has to be changed every four months. In extreme cases, uterine tissue protrudes from the vagina causing extreme discomfort. The only remedy is hysterectomy in which the uterus is surgically removed. The operation costs are about NRs 20,000. The Government of Nepal and other donor organizations have allocated funds to provide services to about 10,000 to 12,000 women suffering from uterine prolapse as humanitarian support each year and services are likely to be expanded in future. Women suffering from UP have not been able to get benefit from such assistance due to deep rooted socio-cultural perceptions and practices. The number of suffering women, on the other hand, would not decrease from existing curative management policy without hammering the root causes of UP. Moreover, a clear vision and strategy is needed to shift from humanitarian aid to a more sustainable public health intervention. [ABSTRACT FROM AUTHOR]

Uterine prolapse (UP) is common in Nepal, with reported prevalence varying from 9 percent to 42 percent of women. Women with serious UP report deep shame and social, health, or economic hardship. This article reports on field research into knowledge and awareness of UP, effects on women and families, outcomes of a hysterectomy, knowledge of UP avoidance, and the potential for hysterectomy recipients to contribute to community education. [ABSTRACT FROM AUTHOR]

This paper describes the contribution of gender beliefs and gender-skewed cultural practices to the high prevalence of uterine prolapse among rural women in Nepal. In conditions of difficult geography, inadequate health services and underdevelopment, the pre-natal period is marked by a heavy workload, a low rate of pre-natal care, and restrictions on a woman's own health decision-making. Delivery is often facilitated by untrained assistants using push and pull methods that may cause pelvic damage. The recovery period after delivery is defined by ethnic prescriptions and household needs that disregard the woman's physical readiness to resume work. The Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW), the most central and comprehensive of the United Nations documents for the advancement of women, mandates that cultural beliefs and practices that are injurious to women must be modified. Reproductive health interventions can legitimately challenge the social causation of uterine prolapse as part of a broad prevention strategy. [ABSTRACT FROM AUTHOR]

Heavy load carrying of water, firewood, and sand/stones is a ubiquitous activity for women living in developing countries. Although the intra-abdominal pressure associated with heavy load carrying is hypothesized to increase the risk of pelvic organ prolapse (POP) among women, relevant epidemiologic data are lacking. We conducted a comparative study involving two exploratory cross-sectional studies among convenience samples of women carrying heavy loads, with different characteristics: (1) as part of their activities for daily living, in Shinyanga region, Tanzania; and (2) working as sand miners in Pokhara, Nepal. Women were categorized has having "low" or "high" load-carrying exposures based on the measured weights of the loads being carried at the time of the survey, as well as on self-reported duration and frequency of load carrying. A summary score for lower abdominal discomfort suggestive of POP was generated using questions from the Pelvic Organ Prolapse Distress Inventory (POPDI-6). Women with higher load carrying exposures had on average higher discomfort scores in both Tanzania (adjusted prevalence difference (PD a ) = 3.7; 95% CI: -3.8-11.3; p = 0.33) and Nepal (PD a = 9.3; 95% CI: -4.9-23.6; p = 0.18). We identified trends suggestive of an association between increasing heavy load carrying exposures and symptoms of lower abdominal discomfort. Our findings underscore the need for larger epidemiologic studies of the potential adverse reproductive health effects of heavy load carrying activities on women in developing countries.

Objective: To investigate whether heavy load carrying, wearing a patuka, and body position at work are risk factors for uterine prolapse among Nepali women., Methods: Community-based case-control study of 448 women (170 cases of uterine prolapse; 278 controls) aged 18-60 years in Kaski district, Nepal was conducted. Women diagnosed with uterine prolapse were cases. Two controls were recruited for each case, frequency-matched by residential area and age. Multivariate logistic regression was used to investigate associations between outcome and exposures., Results: No association of heavy load carrying with uterine prolapse was observed; women who never used a patuka had lower odds of uterine prolapse (odds ratio = 0.18, 95% confidence interval = 0.05-0.71). Women working in a sitting position had higher odds than those working in a standing position (odds ratio = 2.94, 95% confidence interval = 1.74-4.96), as did women who mainly worked in a bending position (odds ratio = 2.45, 95% confidence interval = 1.12-5.34). Housewives were more prone to uterine prolapse than women engaged in farming (odds ratio = 2.13, 95% confidence interval = 1.31-3.47)., Conclusion: Using a patuka, occupation, and body position during work were all associated with uterine prolapse. No association was found with heavy load carrying, although that might be attributable to the cross-sectional nature of study recruitment.

Uterine Prolapse (UP) is a major cause of mortality and morbidity among women in low-income countries like Nepal. More than 1 million women in Nepal suffer from this condition and most of them belong to the reproductive age. The cause and consequence for UP in Nepalese women is mainly gender discrimination. Early marriage, multiple births, lack of skilled birth attendants during delivery, continuous work throughout their pregnancies and soon after giving birth are the risk factors and causes of UP. It affects many aspects of a woman's quality of life, which ranges from physical discomfort, psychological, social and sexual lifestyle restrictions. Lack of knowledge of casual and preventative measures and perception of UP as normal phenomenon is the important barriers to access to treatment. Strong, effective and comprehensive strategies should address this underlying discrimination including socio-cultural discrimination, which could empower women to control their exposure to UP.

Introduction and Hypothesis: Limited existing evidence suggests that there is a high prevalence of female pelvic organ prolapse (POP) amongst Nepali women. However, to date, no comprehensive assessment of pelvic floor functional anatomy has been undertaken in this population. Our study aimed to determine functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic., Methods: One hundred and twenty-nine consecutive women attending the clinic were offered an interview, clinical examination [International Continence Society Pelvic Organ Prolapse Quantification system (ICS/POP-Q)] and 4D translabial ultrasound (TLUS). Most presented with general gynaecological complaints. Five were excluded due to previous pelvic surgery, leaving 124., Results: A POP-Q exam was possible in 123 women, of whom 29 (24%) were diagnosed with a significant cystocele, 50 (41%) significant uterine prolapse and seven (6%) significant posterior compartment prolapse. Evaluation of 4D TLUS data sets was possible in 120 women, of whom 25 (21%) had a significant cystocele, 45 (38%) significant uterine prolapse and ten (8%) significant descent of the rectal ampulla. In 13 cases, there was a rectocele with a mean depth of 14 (10-28) mm. Of 114 women in whom uterine position could be determined, 68 (60%) had a retroverted uterus associated with significant uterine prolapse (P 0.038)., Conclusions: POP is common in Nepali women attending a general gynaecology clinic, with a high prevalence of uterine prolapse (40%). Uterine retroversion was seen in 60% and was associated with uterine prolapse. Patterns of POP in Nepal seem to be different from patterns observed in Western populations.

Uterine prolapse (UP) is a reproductive health problem and public health issue in low-income countries including Nepal. We aimed to identify the contributing factors and stages of UP and its impact on quality of life in the Jhaukhel–Duwakot Health Demographic Surveillance Site of Bhaktapur, Nepal. Our three-phase study used descriptive cross-sectional analysis to assess quality of life and stages of UP and case–control analysis to identify contributing factors. First, a household survey explored the prevalence of self-reported UP (Phase 1). Second, we used a standardized tool in a 5-day screening camp to determine quality of life among UP-affected women (Phase 2). Finally, a 1-month community survey traced self-reported cases from Phase 1 (Phase 3). To validate UP diagnoses, we reviewed participants' clinical records, and we used screening camp records to trace women without UP. Among 48 affected women in Phase 1, 32 had Stage II UP and 16 had either Stage I or Stage III UP. Compared with Stage I women (4.62%), almost all women with Stage III UP reported reduced quality of life. Decreased quality of life correlated significantly with Stages I–III. Self-reported UP prevalence (8.7%) included all treated and non-treated cases. In Phase 3, 277 of 402 respondents reported being affected by UP and 125 were unaffected. The odds of having UP were threefold higher among illiterate women compared with literate women (OR=3.02, 95% CI 1.76–5.17), 50% lower among women from nuclear families compared with extended families (OR=0.56, 95% CI 0.35–0.90) and lower among women with 1–2 parity compared to >5 parity (OR=0.33, 95% CI 0.14–0.75). The stages of UP correlated with quality of life resulting from varied perceptions regarding physical health, emotional stress, and social limitation. Parity, education, age, and family type associated with UP. Our results suggest the importance of developing policies and programs that are focused on early health care for UP. Through family planning and health education programs targeting women, as well as women empowerment programs for prevention of UP, it will be possible to restore quality of life related to UP. [ABSTRACT FROM AUTHOR]

This article examines maternal medical services in Nepal and says although the overall maternal mortality rate has dropped, there are parts of the country where there has been no improvement. An estimated 600,000 Napalese women have suffered a uterine prolapse due to too many pregnancies, lack of care, hard work and poor nutrition and they need surgery that is not available to them. 81 percent of births in Nepal happen at home and some are questioning the claims of a mortality rate reduction. There are some who believe the decrease is the result of better access to contraceptives than to better health care for pregnant women.