Papers by Prof Padam Simkhada
Journal of Manmohan Memorial Institute of Health Sciences, 2015
Tourism, a global industry, brings with it a number of public health problems, one of which is th... more 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 travellers and hosts. Previous studies have largely focused on sex workers and sex tourists. This study assesses sexual behaviour, 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-martial 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.
Nepal Journal of Epidemiology, 2015
Nepal Journal of Epidemiology, 2015
... Sexual health knowledge and risky sexual behaviour among Trekkers' Guides in Nepal. ... ... more ... Sexual health knowledge and risky sexual behaviour among Trekkers' Guides in Nepal. ... van Teijlingen, E., Simkhada, P., Bhatta, P., Regmi, P. and Simkhada, B., 2006. Sexual health knowledge and risky sexual behaviour among Trekkers' Guides in Nepal. ...
BMC Pregnancy & Childbirth, 2015
Nepal has made significant progress with regard to reducing the maternal mortality ratio but a ma... more 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. 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. 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. 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.
PLOS ONE, 2015
Heart failure (HF) continues to be a challenging condition in terms of prevention and management ... more Heart failure (HF) continues to be a challenging condition in terms of prevention and management of the disease. Studies have demonstrated various cardio-protective effects of Ghrelin. The aim of the study is to determine the effect of Ghrelin on mortality and cardiac function in experimental rats/mice models of HF.
Kathmandu University medical journal (KUMJ)
This paper highlights some of the challenges facing maternal health in Nepal and to suggest possi... more This paper highlights some of the challenges facing maternal health in Nepal and to suggest possible solutions for improvements. Key literature from across the globe is reviewed and discussed in a Nepalese context. Maternal mortality remains one of the biggest public health problems in Nepal. Lack of access to basic maternal healthcare, difficult geographical terrain, poorly developed transportation and communication systems, poverty, illiteracy, women's low status in the society, political conflict, shortage of health care professional and under utilization of currently available services are major challenges to improving maternal health in Nepal. In order to effect real improvements in maternal health, attention needs to be focused both on biomedical and social interventions. Improving health facilities, mother's nutrition, women's position in the society such as freedom of movement, providing education to female children, integrating Traditional Birth Attendants into ...
Asian Journal of Epidemiology, 2009
... Statistical Yearbook of Nepal 2001. Government of Nepal, National Planning Commission Secreta... more ... Statistical Yearbook of Nepal 2001. Government of Nepal, National Planning Commission Secretariat, Kalhmand u, Nepal, Devkota, B. and E. van Teijlingen, 2007. Basic health as peace dividend in post-conflict Nepal. ... Health: Percept ion versus observation. Brit. Med. ...
Wilderness & Environmental Medicine, 2006
Over the past few years there has been a growing interest in the importance of pilot studies in h... more Over the past few years there has been a growing interest in the importance of pilot studies in health science research. 1 Pilot studies should provide insight into the research issues being studied and/or provide information about relevant field questions and about the logistics of the field inquiry. These 2 functions of the pilot study are not the same because the term pilot study has 2 distinct meanings: first, feasibility studies, that is,''small-scale version [s], or trial run [s], done in preparation for the major study''2; and second, pretesting one's ...
Nepal Journal of Epidemiology, 2014
Research in Higher Education (HE), particularly in health and medical sciences plays a crucial ro... more Research in Higher Education (HE), particularly in health and medical sciences plays a crucial role, not only in enhancing knowledge and skills of students and academics, but also in helping to develop managers and policy makers who rely on evidence-based planning and programming. This paper reports university teacher's knowledge and practices in Published online by NepJOL-INASP www.nepjol.info/index.php/NJE 406 accessing to electronic research-based evidences in health and medical sciences in Nepal.
Nepal Journal of Epidemiology, 2012
ABSTRACT It is clear that academic dissemination has a system of checks and balances which author... more ABSTRACT It is clear that academic dissemination has a system of checks and balances which authors may experience as barriers. We all want to be sure that scientific information disseminated in academic journals is based on solid data, ethically collected and correctly interpreted. The process of peer reviewing helps to prevent bad science and/or poor scientific papers being published. Many published scientific papers differ from the original submitted manuscript since papers go through a process of peer-review, editing and rewriting. However, there are other potential obstacles in the field of academic publishing. This paper is a case-study of one methods paper which stumbled upon a number of barriers related to the viability and continued existence of a number of academic journals in Nepal. Finally, we offer some advice to help health journals to survive when their editors leave.
Environmental Health, 2014
Background: Half of the world's population is exposed to household air pollution from biomass bur... more Background: Half of the world's population is exposed to household air pollution from biomass burning. This study aimed to assess the relationship between respiratory symptoms and biomass smoke exposure in rural and urban Nepal. Methods: A cross-sectional study of adults (16+ years) in a rural population (n = 846) exposed to biomass smoke and a non-exposed urban population (n = 802) in Nepal. A validated questionnaire was used along with measures of indoor air quality (PM 2.5 and CO) and outdoor PM 2.5 . Results: Both men and women exposed to biomass smoke reported more respiratory symptoms compared to those exposed to clean fuel. Women exposed to biomass were more likely to complain of ever wheeze (32.0 % vs. 23.5%; p = 0.004) and breathlessness (17.8% vs. 12.0%, p = 0.017) compared to males with tobacco smoking being a major risk factor. Chronic cough was similar in both the biomass and non-biomass smoke exposed groups whereas chronic phlegm was reported less frequently by participants exposed to biomass smoke. Higher PM 2.5 levels (≥2 SDs of the 24-hour mean) were associated with breathlessness (OR = 2.10, 95% CI 1.47, 2.99) and wheeze (1.76, 1.37, 2.26).
Thorax, 2010
Over half the world is exposed daily to the smoke from combustion of solid fuels. Chronic obstruc... more Over half the world is exposed daily to the smoke from combustion of solid fuels. Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease and can be caused by biomass smoke exposure. However, studies of biomass exposure and COPD show a wide range of effect sizes. The aim of this systematic review was to quantify the impact of biomass smoke on the development of COPD and define reasons for differences in the reported effect sizes. A systematic review was conducted of studies with sufficient statistical power to calculate the health risk of COPD from the use of solid fuel, which followed standardised criteria for the diagnosis of COPD and which dealt with confounding factors. The results were pooled by fuel type and country to produce summary estimates using a random effects model. Publication bias was also estimated. There were positive associations between the use of solid fuels and COPD (OR=2.80, 95% CI 1.85 to 4.0) and chronic bronchitis (OR=2.32, 95% CI 1.92 to 2.80). Pooled estimates for different types of fuel show that exposure to wood smoke while performing domestic work presents a greater risk of development of COPD and chronic bronchitis than other fuels. Despite heterogeneity across the selected studies, exposure to solid fuel smoke is consistently associated with COPD and chronic bronchitis. Efforts should be made to reduce exposure to solid fuel by using either cleaner fuel or relatively cleaner technology while performing domestic work.
Kathmandu University Medical Journal, 2010
This article identifi es and addresses opportunities for and challenges to current school-based s... more This article identifi es and addresses opportunities for and challenges to current school-based sex and sexual health education in Nepal. Key literature searches were conducted of electronic databases and relevant web-sites, furthermore personal contact with experts and the hand searching of key journals was included. The review of this literature generated the following challenges: Limitations to teaching including lack of life skill-based and human right-based approach, inappropriate teaching aid and reliance on conventional methods, existing policy and practice, parental/community support, and lack of research into and evaluation of sex education. Diverse methodology in teaching, implementation of peer education programme, partnership with parents, involvement of external agencies and health professionals, capacity building of teachers, access to support and service organisation, and research and evaluation in sex education have been suggested for improving the current practice of sex and sexual health education in Nepalese schools.
Kathmandu University Medical Journal, 2010
Sexual and reproductive health of young people has become a major health problem in recent decade... more Sexual and reproductive health of young people has become a major health problem in recent decades. Recent and rapidly increasing Human Immune Deficiency Virus (HIV) rates show an urgent need for Sexually Transmitted Infections (STIs) and HIV prevention interventions in Nepal. This paper attempts to assess knowledge, attitude and behaviour on STIs/HIV/AIDS in the context of young peoples of Nepal. A systematic review based on the available literature was carried out including both qualitative and quantitative studies. Our findings indicate that the overall knowledge regarding STIs and HIV/AIDS is high although the level of knowledge seems to differ according to education, gender, and area of residence. Knowledge about condoms was also very high but practice of correct and consistent use in premarital and extramarital sexual relations with non-regular partners seems to be lower. The overall sexual behaviour among young people is unsafe. This suggests that young people's sexual and reproductive health issues need to be further addressed and explored in order to promote safer and responsible sexual behaviour.
Kathmandu University Medical Journal, 2010
Background: Antiretroviral (ARV) drugs have become the cornerstone of HIV (Human Immunodefi cienc... more Background: Antiretroviral (ARV) drugs have become the cornerstone of HIV (Human Immunodefi ciency Virus) care and treatment. Its use has led to a marked reduction in AIDS (Acquired Immune Defi ciency Syndrome) related morbidity and mortality. However, more than fi ve years after their introduction few HIV infected people in Nepal are receiving ARVs. Objective: The main aim of this study is to identify barriers and obstacles to providing and expanding ARV programmes in Nepal.
Journal of Travel Medicine, 2009
Every year several hundred Voluntary Service Overseas (VSO) volunteers are placed in developing c... more Every year several hundred Voluntary Service Overseas (VSO) volunteers are placed in developing countries where they live and work among the local population. This study analyzes the risk and problems encountered by VSO volunteers overseas. Methods. Information was collected from 219 returned VSO volunteers (out of 609; response rate 36%) recruited in the United Kingdom, using a self-administered questionnaire. During the period April 2006 to March 2007 volunteers were given a questionnaire by the VSO medical unit in London with a return envelope. Results. Diarrhea was the most prevalent problem (79.9%), especially for the younger volunteers. Skin and dental problems were next most prevalent. More than one in six had experienced accidents and nearly one-fourth acts of aggression (including verbal) or violence. Most (87.5%) lived in regions with mosquito-borne diseases, 11.6% of these had smear positive malaria. Of all volunteers, 11.0% had placed themselves at risk of HIV and sexually transmitted infections (STIs). Unprotected sexual intercourse (45.0%) and split condoms (30.0%) were the main sexual health risk factors. Just over one-fourth of volunteers reported ongoing medical/psychological problems on return, the most common being diarrhea (25.0%), skin disease (15.4%), gynecological problems (13.5%), and injuries (9.6%). Conclusion. Volunteers experience a range of health problems during and after their placement in the developing world. Our study shows the importance of (1) predeparture health preparation of volunteers and (2) medical care and advice for volunteers. This advice is also important for travelers in similar conditions such as those visiting relatives, long-term backpackers, and students working in or traveling to developing countries. Further research is needed to help explain some of the findings and study ways of preventing accidents and illness.
Journal of Public Health, 2005
Background Reducing the worldwide mortality ratio by 75 per cent between 1990 and 2015 is a key M... more Background Reducing the worldwide mortality ratio by 75 per cent between 1990 and 2015 is a key Millennium Development Goal. Randomized controlled trials (RCTs) are the accepted 'gold standard' to assess the effectiveness of interventions but they are not always appropriate for practical, ethical or economic reasons in developing countries. This study examines the use of cluster randomized trials and quasi-experimental (nonrandomized) study designs to evaluate complex interventions implemented to reduce maternal mortality.
Journal of Adolescent Research, 2011
Social and cultural changes in Nepal, including better communication facilities and transport, mo... more Social and cultural changes in Nepal, including better communication facilities and transport, more urbanization and a rising age at which people marry, have created more opportunities for young people for "dating." Our qualitative study explores whether the existence of dating cultures influences young people's sexual behavior in Nepal. Focus group discussions with a total of 75 participants and 31 in-depth individual interviews were conducted among young people in Nepal. Most urban and rural young people liked the dating culture. Although it is a new kind of culture in Nepalese society, it is gaining popularity. The mass media were regarded as encouraging and creating an environment for dating. Most participants believed that dating culture encourages premarital and extramarital sexual behavior. He has an interest in global health particularly in public health problems in developing countries. His research focuses on sexual health, migration, sex trafficking, and health promotion in middle-and low-income countries.
Culture, Health & Sexuality, 2010
People in Nepal generally hold fairly traditional views about sex and sexual health, whilst Weste... more People in Nepal generally hold fairly traditional views about sex and sexual health, whilst Western tourists often have a more liberal approach towards sex and relationships. There is evidence that significant sexual interaction occurs between male trekking guides and female travellers and/or local female sex workers in Nepal. This qualitative study explored trekking guides' sexual health knowledge, sexual relationships and condom use with female trekkers and local female sex workers. A total of 21 in-depth interviews were conducted with male trekking guides. Most reported having had sexual relationships with female trekkers and local female sex workers. Explanations for intercourse with female trekkers included: financial support; getting future trekkers through word-of-mouth advertising from the women they have had sex with; and opportunities for emigration. Interestingly, sexual intercourse is reported as more likely to be initiated by female trekkers than by guides, and more so by older women. In contrast, the main reasons for having sex with local female sex workers included: romantic love or sexual excitement and novelty. Awareness regarding sexual health was high among guides, but several factors discouraged the regular use of condoms. Further research with female tourists would help understand the motivations and reasons for their sexual behaviour.
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Papers by Prof Padam Simkhada