Find Papers by Expertise
Search by Name or Keyword
Professor Padam Simkhada, Andrew Lee, Edwin van Teijlingen, K Karki, CH Neupane
Nepal Journal of Epidemiology, Vol 5 (No 1), 441-43, 2015.
Abstract: By investing in health protection, the health of the nation can be safeguarded from future threats of uncontrolled infectious disease epidemics and disasters.
Journal of Manmohan Memorial Institute of Health Sciences, 1 (4), 43-49, 2015.
Abstract: For decades the maternal mortality in Nepal was the lead cause of death among women, with serious improvements in the maternal mortality ratio in the twentieth century the second most common cause has become more prominent. Suicide is now one of the leading causes of death for women of a reproductive age in Nepal. This scoping review brings together the key available literature to identify the causes of suicide among women in Nepal. Published and unpublished studies and the grey literature published on women and suicide related to Nepal between 2000 and 2014 were searched and included in this review.This review suggested a number of explanations for high rate of suicide among women including: partner violence, alcoholism and polygamy, the culture of silence, early age marriage and prolonged child bearing and dependency on men for financial security. This paper highlights some challenges and suggests ways forward in the improvement of mental health in Nepal.
Going into the groin: Injection into the femoral vein among people who inject drugs in three urban areas of England
Professor Vivian Hope, Jennifer Scott, Katelyn Cullen, John V. Parry, Fortune Ncube, Matthew Hickman
Drug Alcohol Depend. 2015 Jul 1;152:239-45, 2015.
Abstract: BACKGROUND: There have been increasing concerns about injection into the femoral vein - groin injecting - among people who inject drugs in a number of countries, though most studies have been small. The extent, reasons and harms associated with groin injecting are examined. METHOD: Participants were recruited using respondent driven sampling (2006-2009). Weighted data was examined using bivariate analyses and logistic regression. RESULTS: The mean age was 32 years; 25% were women (N=855). During the preceding 28 days, 94% had injected heroin and 13% shared needles/syringes. Overall, 53% reported ever groin injecting, with 9.8% first doing so at the same age as starting to inject. Common reasons given for groin injecting included: "Can't get a vein elsewhere" (68%); "It is discreet" (18%); and "It is quicker" (14%). During the preceding 28 days, 41% had groin injected, for 77% this was the only body area used (for these "It is discreet" was more frequently given as a reason). In the multivariable analysis, groin injection was associated with: swabbing injection sites; saving filters for reuse; and receiving opiate substitution therapy. It was less common among those injecting into two body areas, and when other people (rather than services) were the main source of needles. Groin injection was more common among those with hepatitis C and reporting ever having deep vein thrombosis or septicaemia. CONCLUSIONS: Groin injection was common, often due to poor vascular access, but for some it was out of choice. Interventions are required to reduce injecting risk and this practice.
NOFAS-UK Research Publication, Issue 13, June, 2015.
Aditi Sharma, Gangalal Tuladhar, Amit Dhungel, Padmadharini, Edwin van Teijlingen, Professor Padam Simkhada
Public Health Perspective, 5 (2), 2015.
Introduction: Green Tara Nepal, a leading NGO working on Health Promotion, recently disseminated the findings of the evaluation of key health promotion initiatives in the country. The evaluation was conducted in collaboration with the Government of Nepal, Green Tara Trust, a UK-based charity, several NGOs and INGOs and three UK universities, namely Liverpool John Moores University, Bournemouth University and the University of Sheffield. The evaluation identified key government, bilateral, UN agencies and I/NGOs working in health promotion in Nepal. Their health promotion activities and approaches were documented and gaps were identified. This editorial focuses on the position of health promotion in the different health policies in Nepal.
Lesley Milne, Edwin van Teijlingen, Vanora Hundley, Professor Padam Simkhada, Jillian Ireland
BMC Pregnancy & Childbirth, 15:142, 2015.
Abstract: Background: Nepal has made significant progress with regard to reducing the maternal mortality ratio but a major challenge remains the under-utilisation of skilled birth attendants who are predominantly facility based. Studies have explored women’s views of the barriers to facility birth; however the voices of staff who offer services have not been studied in detail. This research explores the views of staff as to the key reasons why pregnant women do not give birth in a maternity-care facility. Methods: This mixed methods study comprised qualitative interviews and non-participant observation. The study was conducted in two small non-governmental hospitals, one semi-rural and one urban, in Kathmandu Valley. Twenty interviews were conducted with health care providers and other staff in these hospitals. The interviews were undertaken with the aid of a Nepali translator, with some interviews being held in English. Twenty-five hours of non-participant observation was conducted in both maternity hospitals . Both observation and interview data were analysed thematically. Ethical approval was granted by the Nepal Research Health Council and Bournemouth University’s Ethics Committee. Results: Key themes that emerged from the analysis reflected barriers that women experience in accessing services at different conceptual levels and resembled the three phases of delay model by Thaddeus and Maine. This framework is used to present the barriers. First Phase Delays are: 1) lack of awareness that the facility/services exist; 2) women being too busy to attend; 3) poor services; 4) embarrassment; and 5) financial issues. Themes for the second Phase of Delay are: 1) birthing on the way; and 2) by-passing the facility in favour of one further away. The final Phase involved: 1) absence of an enabling environment; and 2) disrespectful care. Conclusion: This study highlights a multitude of barriers, not all of the same importance or occuring at the same time in the pregnancy journey. It is clear that staff are aware of many of the barriers for women in reaching the facility to give birth, and these fit with previous literature of women’s views. However, staff had limited insight into barriers occuring within the facility itself and were more likely to suggest that this was a problem for other institutions and not theirs.
Connecting local support: A qualitative study exploring the role of voluntary organisations in long-term condition management
Rebecca Morris, Sue Kirk, Anne Kennedy, Ivaylo Vassilev, Amy Mathieson, Mark Jeffries, Dr Christian Blickem, Helen Brooks, Caroline Sanders, Anne Rogers
Chronic Illness, 11(2), 140-155, 2015.
Abstract: Objectives: To examine the role of community groups to support people living with long-term conditions and the organisational factors that influence this role. Methods: Thirty-three semi-structured interviews were conducted with voluntary group organisers purposefully sampled in Greater Manchester from a local database of community groups. Interviews explored the organisations role in supporting people living with a long-term condition, their social networks and the origins of the groups. Results: Respondents’ construed their role in supporting individual capacity for management either explicitly (e.g. providing exercise) or implicitly (e.g. emotional support). This role was influenced by a combination of group ideology, funding and social networks. Analysis highlights the role of the non-clinical setting, the social support provided within the group, as well as organisational processes that influenced their capacity to support people living with long-term conditions. Conclusion: By examining the organisation of voluntary groups, this study highlights the way in which they may support or constrain access to an extended range of support for people with long-term conditions. This paper has implications for commissioning of services by the health service from the third sector because of the differing ideological perspectives and limited operational capacity.
‘I’m managing my diabetes between two worlds’: Beliefs and experiences of diabetes management in British South Asians on holiday in the East: a qualitative study
Neesha Patel, Anne Kennedy, Dr Christian Blickem, David Reeves, Carolyn Chew-Graham
Journal of Diabetes Research, 2015.
Abstract: Background. Diabetes is disproportionately high among British South Asians compared to the general UK population. Whilst the migrant British South Asians group has received most attention on research related to diabetes management, little consideration has been given to impact of travel back to the East. This study aimed to explore the role of social networks and beliefs about diabetes in British South Asians, to better understand their management behaviours whilst holidaying in the East. Methods. Semistructured interviews were conducted in Greater Manchester. Forty-four participants were recruited using random and purposive sampling techniques. Interviews were analysed thematically using a constant comparison approach. Results. Migrant British South Asians expressed a strong preference to be in a hot climate; they felt they had a healthier lifestyle in the East and often altered or abandoned their diabetes medication. Information acquisition on diabetes and availability of social networks in the East was valued. Conclusion. Social networks in the East are a valued source of information and support for diabetes. The lack of adherence to medication whilst abroad suggests that some migrant British South Asians have a poor understanding of diabetes. Future research needs to explore whether patients are seeking professional advice on diabetes management prior to their extended holiday.
Brijesh Sathian, Asis De, Professor Padam Simkhada, Kalpana Malla, Arnab Ghosh, Sahisnuta Basnet, Bedanta Roy, Indrajit Banerjee, HS Supram, Suresh Devkota
American Journal of Public Health Research, Vol. 3, No. 4A, pp 27-30, 2015.
Abstract: Globally, Pneumonia is the leading communicable disease which is the reason of fatality in children. In 2013, there was approximately 935 000 child death in less than 5 years old because of Pneumonia, which was 15% of all the deaths in children. The scenario is more or less same in sub-Saharan Africa and South Asia. The objective of the study was to collate information from existing data and chart out the trends of the incidence of Pneumonia (mild + severe) per 1,000 children under five years (new visits) in the future. A secondary data analysis of the incidence of Pneumonia (mild + severe) per 1,000 children under five years (new visits) in Nepal was done between 2005 to 2014. The survey was conducted under the administrative supervision of the population division of the Ministry of Health and Population (MOHP). Curve fitting method was used to find out the convenient model. The data was analysed using Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA). A p-value of < 0.05 (two-tailed) was used to establish statistical significance. Excluding the constant term in the equation, the best fitted model was cubic, for the prediction of incidence of Pneumonia (mild + severe) per 1,000 children under five years (new visits). It is estimated that there will be 331 with 95% CI (0,1000) cases of Pneumonia (mild + severe) per 1,000 children under five years during 2020 in Nepal. The year wise incidence of Pneumonia (mild + severe) per 1,000 children under five years (new visits) in Nepal is having an increasing trend. The result provides reference data for organizing, planning, and evaluation of childhood pneumonia control program. Strengthening the health care delivery system and community-based prevention strategies and case management will facilitate to trim down pneumonia cases and the overall burden of this public health threat.
Professor Padam Simkhada, Edwin van Teijlingen, Pramod Regmi, Prakash Bhatta, Roger Ingham, Nicole Stone
Journal of Manmohan Memorial Institute of Health Sciences Vol. 1, Issue 4, Page: 35-42, 2015.
Abstract: Tourism, a global industry, brings with it a number of public health problems, one of which is the spread of sexually transmitted infections transmitted between travelers and hosts. Previous studies have largely focused on sex workers and sex tourists. This study assesses sexual behavior, knowledge and condom use among male trekking guides in Nepal. A self-administered questionnaire survey (n=324) was conducted using snowball sampling amongst men working as mountain trekking guides in Nepal. Most respondents (59%) had initiated sex before the age of 18. Most (84 %) reported sexual relations with a woman other than their partner, 46% reported foreign partners, 43% had Nepalese partners, and 28% had concurrent foreign and Nepalese partners. Most (70 %) reported ever having sex with a foreign woman and two-thirds had had sexual intercourse with foreign women in the previous 12 months. Participants’ age, education status, age of first sex, smoking and drinking habits and English proficiency were significant predictors of having sex with foreign women. About 60% reported condom use during their most recent occasion of extra-marital sex. A similar proportion had used a condom during last sexual intercourse with a foreign woman. The likelihood of condom use was associated with a guide’s age, educational level, ethnicity, age of first sex and work experience. Most trekking guides reported sexual relations with foreign women as well as irregular use of condoms. Although sexual health knowledge about among trekking guides is high, some misconceptions still result in unsafe sex. Hence there is an urgent need to revise the existing training for trekking guides and implement appropriate health promotion programmes.