Nursing journal of bpkihs 2015

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NJBPKIHS Vol-1, No. -1, Issue-1, May 2015
NURSING JOURNAL
OF
BPKIHS
B.P. Koirala Institute of Health Sciences
College of Nursing
Dharan, Nepal
Vol-1, No. -1, Issue-1, May 2015

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Nursing Journal of BPKIHS
B.P. Koirala Institute of Health Sciences
College of Nursing
Dharan, Nepal
(A Peer-reviewed Nursing Journal of College of Nursing, BPKIHS)
ADVISORY COMMITTEE
Prof. Dr. B. P. Das, Vice Chancellor
Prof. Dr. B. P. Shrestha, Rector
Mr. Tul Bahadur Shrestha, Registrar
Prof. Dr. A. K. Sinha, Hospital Director
Prof. Pushpa Parajuli, Medical-Surgical Nursing Department
Prof. Mangala Shrestha, Maternal Health Nursing Department
Prof. Angur Badhu, Community Health Nursing Department
Prof. Sami Lama, Psychiatric Nursing Department
Prof. Dr. Tara Shah, Community Health Nursing Department
EDITORIAL BOARD
Chief Editor
Prof. Dr. Ram Sharan Mehta
Medical-Surgical Nursing Department
Editors
Mr. Ramanand Chaudhary, Child Health Nursing Department
Ms. Dev Kumari Shrestha, Maternal Health Nursing Department
Mr. Gayanand Mandal, Medical-Surgical Nursing Department
Mr. Shyam Lamsal, Community Health Nursing Department
Ms. Nirmala Pradhan, Psychartic Nursing Department
Ms. Sharmila Sharestha, Community Health Nursing Department
Managing Editor
Mr. Basant Kumar Karn, Child Health Nursing Department
Marketing Committee Members
Ms. Nirmala Pokhrel Ms. Gayatri Rai
Mr. Upendra Yadav Ms. Rambha Sigdel
Ms. Sunita Shah Ms. Dewa Adhakari
Ms. Kriti Thapa Ms. Rita Pokharel
Ms. Kriti Chaudhary

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ABOUT THE JOURNAL
The main aim of the Journal is t o provide opportunity to nurses in dissemination of their experiences,
ideas, views and knowledge generated through research. Thousands of nurses conduct research
everyday in Nepal and abroad. Conducting research is meaningless and wastage of resources if not
published. Getting research work published is ultimate need of research and desire of researcher.
The NJBPKIHS will provide the opportunity to publish research findings and also help in e asy access
to information to many nurses in Nepal. Finally it is going to change or rationalize old concepts,
bring about new concepts and practices in nursing which will contribute to improvement of quality
of nursing education and patient care.
NJBPKIHS is a peer-reviewed journal featuring research articles of exceptional significance in all areas
of nursing. The Journal seeks original manuscripts reporting scholarly work on the art and science of
nursing. Original articles may be empirical and qualitative studies, review articles, methodological
articles, brief reports, case studies and letters to the Editor. All research articles in NJBPKIHS will
undergone rigorous peer review, based on initial editor screening and anonymized refereeing by an
expert reviewer.
Editors and Editorial Board follow the international standards. The Editorial Board keep information
pertaining to all submitted manuscripts confidential. The Editorial Board is responsible for making
publication decisions for submitted manuscripts. The Editorial Board always strives tomeet the needs
of readers and authors. The Editorial Board evaluates manuscripts only for their intellectual content.
The Editorial Board strives to constantly improve their journals. The Editorial Board maintains the
integrity of the academic record. The Editorial Board discloses any conflicts of interest and precludes
business needs from compromising intellectual and ethical standards. The Editorial Board always be
willing to publish corrections, clarifications, retractions and apologies when needed.
Reviewers of NJBPKIHS are also expected to meet the international standards for reviewers when
they acceptreviewinvitations. Reviewers keepinformation pertaining to the manuscriptconfidential.
Reviewers bring to the attention of the Editorial Board any information that may be a reason to
reject publication of a manuscript. Reviewers must evaluate manuscripts only for their intellectual
content. Reviewers objectively evaluate the manuscripts based only on their originality, significance
and relevance to the domains of the journal. R eviewers notify NJBPKIHS management committee of
any conflicts of interest.
All material published by NJBPKIHS is protected by International copyright and intellectual property
laws. All the decisions wi ll be taken by Editorial board.
Contact Address: Chief-Editor, Nursing Journal of BPKIHS, College of Nursing, B. P. Koirala Institute
of Health Sciences, Dharan, Sunsari, Nepal
Email: njbpkihs@gmail.com
website: nj.bpkihs.edu

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Content
Editorial 5
Knowledge of Pulse Pulse oximetry among Health Care Providers Working at Pediatric Setup 6
RN Chaudhary, P Poudel , B K Karn, U Yadav
Telephone Health Service to improve the Quality of Life of the People Living with AIDS in Eastern Nepal 10
Prof. Dr. Ram Sharan Mehta, Dr. Naveen Kumar Pandey, Mr. Binod Kumar Deo
Knowledge and opinion on e ffects of television viewing on children among
mothers with under five children in Magudancha vadi village Salem Tamilnadu 14
N. Dhanasekaran, Lecturer
College of Medical Sciences TH, Bharatpur, Nepal
Psychosocial Problems Among Adolescents in a School of Urban Slum at Eastern Nepal 18
Rita Pokharel, S Lama, B Shrestha, M Shrestha, M Manandhar, M Chaudhary , P Poudel
Awareness on Kala-azar among the People Living in Selected Wards of Dharan Municipality 22
Bijaya Dawadi, Angur Badhu
Status of Breast-Feeding Practices Among Mothers of Hospitalized Neonates in BPKIHS 25
Binisha Sinha, B K Karn , U Yadav, B Thapa, R Bhurtel
Effectiveness of Mint Extract upon Dysmenorrhea among the Adolscen t girls in
selected School Acharapakkam Kanchipuram, Tamilnadu, India 28
Indumathi L, Lecturer, Nursing Programme
Knowledge Regarding Risk Factors of Cardiovascular Disease among Patients with
Cardiac Disease Attending Medical OPD of BPKIHS 31
Sangam Shrestha, Lecturer, Universal College of Nursing Sciences
Mr. Gayanand Mandal, BPKIHS
The Impact of Educational Intervention on Knowledge Regarding Care of
Child with Glomerular Disease among Nurses at BPKIHS Nepal 35
Shah Sunita, P Shrestha, R Chaudhary, BK Karn, U Yadav
Awareness of Postnatal Mothers Regarding Prevention of Neonatal Hypothermia 38
Sumitra Koirala, Lecturer
Sanjevani College of Medical Sciences

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Attitude Towards Nursing Profession Among Female Students of Higher Secondary School of Dharan Municipality 44
Aryal N, Instructor, Community Health Nursing
Pokhara Technical Health Multipurpose Institute
Shah T, Professor, BPKIHS
M.Sc. Nursing Programme in B. P. Koirala Institute of Health Sciences Nepal 49
Programme Coordinator, M.Sc. Nursing
Chief, College of Nursing, BPKIHS
Mr. Basant kumar Karn, HoD, Child Health Nursing Department, BPKIHS
Awareness on Preventive Measures of Cervical Cancer among Reproductive aged
Married Women of Simaria VDC Sunsari Nep al 53
Rambha Sigdel, T Shah, A Badhu
Lifestyle Pattern among the People Living with AIDS in Eastern Nepal 58
Prof. Dr. Prahlad Karki, HoD, Internal Medicine
Knowledge and Practice of Nurses in the Prevention of Vertical Transmission of HIV in
Selected Hospital of Eastern Region of Nepal 64
Pokharel Nirmala, Shah Tara, Chaudhary Ramanand, Rai Debkumari, Parajulee S.
Knowledge regarding Swine Flu among Pig Rearing Households of Select ed Ward of Dharan Municipality 66
Anita Subedi, Anuradha Timilsina, Sharmila Shrestha
Effects of an Educational Program on Nurses Knowledge and Practice Related to
Hepatitis-B: Pre-Experimental Design 70
Ram Sharan Mehta, Gayanand Mandal, Basant Kumar Karn
Observation: Overview 74
Upendra Yadav, Associate Professor
Overview of Surgical Unit one of B.P. Koirala Institute of Health Sciences 76
Shrestha Rukma, Gachhadar R, Chand P, Shrestha SB
Medical Surgical Nursing Specialty: An Overview 77
Angira Chaudhary, Bhawana Regmi, Erina Shrestha, Pushpa Koirala
Neelima shakya, Nirmala Rai, Rosy Chaudhary
M.Sc. Nursing Students, BPKIHS
CALL FOR PAPERS 79

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Editorial
Using Social Media for Continuous Professional Nursing Development
The Nursing Journal of BPKIHS is a peer-reviewed journal
that publishes scholarly workonnursingresearch, practice,
education and policy issues related to nursing in health
and illness. The mission of the journal is t o extend
understanding about the relationships between nursing,
health, illness, and health care with a goal of transforming
nursing practice with people.
Healthcare practice pertaining to nursing is constantly
changing as a result of new knowledge, research,
government policies and regulatory code of practice;
therefore, it is vital that nurses maintain currency with
practice guidelines, research and skills. Social media is
relatively new and its full potential in terms of educational
benefits is yet to be realized. In this editorial we discuss
how social media like Facebook, Twitter and other social
media can be used for continuous professional
development (CPD) in the nursing profession and explore
the different ways that nurses can use Facebook or Twitter
or other medias to keep up to date with practice.
Twitter is an online social ne tworking service that allows
users to send a message known as a tweet using 140
characters to each other or their followers i.e. those in a
person’s network.AreviewofpeopleonTwittershows that
there are a growing number of health professionals using
Twitter for professional conversation and pass along value.
In Facebook networking service allows users to send the
message, pictures and videos to each other followers i.e.
those in a network. Many nurses use Facebook to connect
and to share information and discuss ideas pertaining to
health and nursing.
Continuous professional development may use formal
approaches tolearning such as training sessions, classroom
events (e.g. lectures) or education workshops. Informal
learning may take the form of face to face conversations
with colleagues or verbal feedback on actions or
performance. As a result of the World Wide Web (www)
these approaches to knowledge sharing and transmission
can extend to online environments.One such environment
is social media using the platform Twitter or Facebook.
OtherPlatformssuchas YouTubeandblogscanalsoprovide
learning opportunities. In YouTube there are 100 hours of
YouTube videos being uploaded every minute. The use of
videos to aid CPD is becoming increasingly easier. Blogs
are open access personal web pages on which an individual
records opinions, thoughts, ideas and reflections and then
shares this with an audience. Blogs ar e not peer reviewed;
therefore, caution must be applied.
Blogs pages are extremely versatile and free and easy to
set up. Blogging is a digital way to bring all your
Continuous Professional Development into one place
and can be used. Some examples of reflective blogging
include: http://toystearsandtpn.wordpress.com/, http://
shesoffagaindiaryofastudentnurse.blogspot.co.uk/,http:/
/florencenursingtales.blogspot.co.uk/. Now, the Web
2.0 concept i.e. Social book marking (delicious, c onnote,
citeulike, livejournal etc), Wiki, Blogs, RSS, forum etc are
common in teaching learning practice.
The common web sites useful for nurses are:
www.google.com, www.msn.com, www.yahoo.com,
www.library.nams.org.np, www.4shared.com,
www.icn.ch, www.who.int, www.slideshare.net,
www.biomedcentral.com, www.easybib.com,
www.refworks.com, www.citationmachine.net,
www.sourceforge.net, www.screencast.com,
www.flicker.com, www.memplai.com,
www.youtube.com, www.tnaionline.org,
www.nnc.org.np, www.nhrc.org.np,
www.ugcnepal.edu.np, www.nursingassoc.org.np and
many more.
Hence, Nurses must be updatedwithcomputertechnology
and internet services and use the social media to update
them with professional development to contribute
professional nursing development.

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Knowledge of Pulse Pulse oximetry among Health Care
Providers Working at Pediatric Setup
RN Chaudhary, P Poudel , B K Karn , U Yadav
Department of Child Health Nursing, BPKIHS
Email: ramanandachaudhary@yahoo.com
Abstract: Pulse pulse oximetry monitors have become so common in acute health care settings over
the last decade that blood oxygen is now considered a “fifth” vital sign. Pulse pulse oximetry provide3s
a noninvasive painless and reliable method to measure arterial oxygen saturation. This technology
adds valuable data to the assessment of the pediatric practitioner. Objective of the study was to assess
knowledge of pediatric nurses regarding pulse pulse oximetry and the ability to apply it in a given
clinical scenario. A descriptive cross sectional study was carried out on 50 nurses working in Pediatric
units of B. P. Koirala Institute of Health Sciences, Dharan. The participants were recruited through
census sampling technique from pediatric wards. Data were collected using semi-structured, self
administered questionnaires. Descriptive statistics were employed for analyzing data.
It was found that 90% of the nurses felt need of training; 84% correctly answered what a pulse oximeter
measures means, 40% correctly answered how a pulse oximeter works, but only 5% had a correct
understanding of the oxyhemoglobin dissociation curve. Nurses identified a wide range of normal
arterial oxygen saturation values and made numerous errors in evaluating saturation readings in
hypothetical clinical scenarios. The majority of nur ses felt need of training about pulse pulse oximetry,
there was a lack of knowledge of basic principles. The results of the study have implications for basic
professional education programs and the orientation and ongoing education of pediatric health care
providers.
Key Words: Nurse, Pulse oximetry, Knowledge
Introduction: Pulse pulse oximetry provides a noninvasive,
painless, and reliable method to measure arterial oxygen
saturation. This technology adds valuable data to the
assessment of the pediatric practitioner. Ten years ago
these devices were mainly limited to operating rooms and
some intensive care units. Since that time, they have
entered into routine use for both continuous and episodic
measurement of oxygen saturation of patients in clinics,
physician offices, emergency departments, various wards
and ambulances. This measurement is now considered by
many to be a component of routine vital signs.
Likeothervitalparameters, the data needtobeinterpreted
so that significance of the reading in relation to patient
condition may be assessed. This requires the practitioner
tobefamiliar with the monitoringequipment to determine
if accurate data were obtained as well as knowledge
regarding what is being measured and the potential
physiologic impact of the results. These data points are
integrated with other physical assessment to determine
clinical patient stability. Health care providers’ knowledge
may not always be sufficient. The lack of knowledge may
affect the patient care decisions and potentially adversely
affecting patient outcomes.
Objectives of the study: The objectives of the study were
to assess the knowledge of pediatric nurses about pulse
pulse oximetry technology and their abi lity to apply it in a
given clinical scenario.
ResearchMethodology: A descriptivecross sectional study
was carried out on nurses working in Pediatric units of B.
P. Koirala Institute of Health Sciences, Dharan. The study
participants were recruited through census sampling
technique from NICU, PICU, Nursery and pediatric Wards
of BPKIHS. Data were collected using semi-structured, self
administered questionnaires. Before collecting the
information, permission was taken from the institute
authority and verbal consent was obtained from the
respondents. Descriptive statistics were employed for
analyzing data.
Result: Majority (94%) of the nurses were between the
age group of 20 – 30 years. Majority (96%) of the nur ses
had qualification of PCL Nursing. More than half (54%) of
thenurseshadtheworkingexperiencefor1–5years.None
of the nurses received formal training of pulse pulse
oximetry. Details are in table 1.
Knowledge related to pulse pulse oximetry function and
measurement were quite variable among respondents.
Nurses had not received adequate training using pulse
pulse oximetry equipment and 90% of the nurses felt need
of training. However, when asked to describe how pulse
pulse oximetry works, 40% of the nurses responded
correctly. For an answer to be correct, the respondents
had to mention that light sensor, red/infrared light
absorption, and/or pulsatile blood flow in their response.
The fact that pulse pulse oximetry measures the oxygen

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saturation of hemoglobin as well as the pulse rate was
understood by 84% of nurses.
Knowledge of the oxyhemoglobin dissociation curve as it
relates to pulse pulse oximetry was one of the least
understood concepts by all respondents; only 5% of nurses
provided correct answer to the question. While 38% of
nurses correctly identified the unit of measure for pulse
pulse oximetry values as percentage, fewer i.e. 12% of
nurses identified the unit of measure for the partial
pressure of oxygen in blood as millimeters of mercury.
Details are in figure 2.
Factors influencing accuracy of pulse oximetry readings:
The pulse oximeter requires a pulsatile signal and alarms
when it cannot detect the peripheral pulse. A question
tested whether respondents knew that immediately after
a cardiac arrest or in the event of shock, the signal would
be lost and therewould be no reading. When this question
regarding cardiac arrest was posed in the 1994 Stoneham
study, two nurses (7%) answered it correctly. The current
studyrevealedsimilarresultswith16%ofnurses, answering
correctly. Seventypresentof nursescorrectlyidentifiedthat
the saturation would decrease, perhaps with the
understanding that saturations during respiratory arrest
falluntil hypoxiaresultsincardiacarrest. Respondentswere
asked to identify how common factors might affect the
accuracy of pulse pulse oximetry readings.
The factors were divided into life threatening, physiologic,
and environmental situations. The numbers of correct
responses by discipline are shown in Table 2. Overall, there
was a surprising lack of knowledge related to the impact
of these factors by nurses. Cardiac arrest, by definition,
wouldresult in no pulsatileflow neededfor this technology
to function; however, only 16% of nurses recognized this
fact. All respondents were able to recognize that
physiologic factors such as dark skin and jaundice did not
alter the readings. Of the physiologic factors, anemia was
the least correctly recognized factor by 10% nurses.
Environmental factors as a whole yielded fewer correct
responses. Only 18% of nurses recognized that bright light
or sunshine on the sensor probe would potentially falsely
increase the saturation reading. Additionally, there was a
lack of appreciation that nail polish or cold environment
could result in the probe failing to detect an adequate
signal.
Clinical Scenarios:
Four clinical scenarios were presented in the survey, and
respondents were asked to identify appropriate responses
orcourses of action. The scenarios weredesigned toassess
the clinical judgment and decision-making abi lity of
pediatric practitioners.
Scenario 1: This scenario involved a child with Respiratory
Syncytial Virus (RSV). Respondents were asked what the
implications of the pulse oximetry reading were.
Componentsofacorrectresponse wereheartratereadings
on the two monitors correlate indicating a true
desaturation. The PaO2
has decreased from approximately
90 mm Hg to 60 mm Hg. The practitioner should first check
the airway, breathing, and circulation; increase the oxygen
flowrate; and notify the physician if appropriate. Fifty four
present nurses responded correctly that the desaturation
was clinically important and identified an appropriate
course of action.
Scenario 2: This scenario involved a child with sickle cell
anemia with a Hgb of 5 gm/dL. R espondents were asked
what the implications of the pulse oximetry reading were
andwhatwouldbetheirimmediateresponse.Components
of a correct response were PaO2
has decreased from
approximately 94mmHgto 90 mm Hg. The pulse oximeter
does not reflect decreased oxygen carrying capacity
secondary to a low Hgb. Anemic patients may not have
adequateoxygen tomeetmetabolic demands even though
their Hgb is saturated with oxygen and they have an
acceptable SaO2
. Here patient is becoming hypoxic and
appropriate courses of action include checking the air way,
breathing, and circulation; increasing the oxygen flowrate;
and notifying the physician. Only 14% of nurses identified
the implication of the decreasing.
Scenario 3: This scenario involved a child with unrepaired
Tetrology of Fallot who has an oxygen saturation of 85%
when asleep and 80% when eating. Respondents were
askedtoprovidetheirassessments,immediate actions, and
any changes they would make to the plan of care.
Components of a correct response were the correct
assessment is to note an increased oxygen demand during
eating. Although the child’s baseline saturation is expected
to be low secondary to intracardiac right to left shunting,
the child needs intervention during eating to prevent
further hypoxia. Sixteen percentage nurses assessed the
situation correctly and answered that they would stop oral
feedings, increase the oxygen flow rate, and either feed
via Nasogastric tube or initiate small frequent feedings if
the child was not tachyponic.
Scenario 4: The final scenario involved a 4-month-old baby,
with a history of an acute life-threatening event, who is
admitted for evaluation of gastroesophageal reflux.
Respondents were askedfor their assessments, immediate
responses, and any changes in the plan of care that they
would initiate. Component of a correct response was
practitioners should assess the child. Although the
monitors do not correlate, this may be a real hypoxic event
that has corrected itself as opposed to an artifact that
caused the appearance of desaturation. Changes in plan
of care are based on the assessment. Of the nurses, 62%
correctly stated that they would check the child first and
adjust the pulse oximeter since the two heart rates
reported by the two monitors do not correlate. The

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appropriate change in the plan of care would be to change
the sensor site, which 44% of the nurses replied that they
would do.
Table 1. Socio-Demographic Profile of the Respondents
n=50
Characteristics Category Frequency Percentage
Age in Years 20 – 30 47 94
30 – 40 3 6
Educational
background
BN/B.Sc. Nursing 2 4
PCL 48 96
Working Area Pediatric Unit 1 10 20
Pediatric Unit 2 8 16
NICU 16 32
PICU 8 16
Nursery 8 16
Duration of work
experience in nursing
6 months–1 year 18 36
1 – 5 years 27 54
>5 years 5 10
Formal Training received
on pulse pulse oximetry
Yes 0 0
No 50 100
Figure1. Oxyhemoglobin Dissociation Curve
Table 2. Knowledge regarding Factors Affecting Accuracy
of Pulse Pulse oximetry Reading
n = 50
Factors Correct Answer Frequency Percentage
Life Threatening
Cardiac arrest Inadequate signal 8 16
Respiratory arrest Decrease 37 74
Shock Inadequate signal 5 10
Physiologic
Jaundice No change 28 56
Anemia No change 5 10
CO poisoning Increase 18 36
Dysarhythmia Inadequate signal 15 30
Dark skin No change 43 86
Peripheral vasoconstriction Inadequate signal 33 66
Environmental
Nail Polish Inadequate signal 18 36
Bright light or sunshine No change 9 18
Cold environment Inadequate signal 25 50
Discussion: Pediatric nurses included in this survey
expressed relatively high confidence in their knowledge
related to pulse pulse oximetry. However, the level of
understanding by these nurses was unacceptably low as
reflected in their responses to survey questions. Previous
studies demonstrated marked lack of understanding of the
oxyhemoglobin dissociation curve (OHDC), lack of
knowledge of other technology, and inadequate
interpretation of data leading to delayedinterventions and
changes in plans of care.
The current study results support the previous studies’
findings in understanding of the technology, its limitations,
and application in the clinical setting. This is somewhat
surprising considering the increased use of pulse oximetry
equipment in all health care settings since the time those
earlier studies were conducted. The results of this study
indicate that overall pediatric nurses surveyed were not
consistently able torecognize the significance of low pulse
oximetry readings and did not consistently indicate an
appropriate action. Nurses, however, were more likely to
take action in the clinic al scenarios and problem-solve to
correctorpreventrecurrence.Thismaybeduetothedirect
care-giving role of bedside nurses.
The clinical scenario of the chi ld with sickle cell anemia
would require integration of theoretical knowledge.
Although anemia does not interferewithoximeterreadings
perse,ityieldsreadings thatareprone tomisinterpretation
by practitioners. Marked anemia would shift the OHDC to
the left, resulting in smaller decr eases in saturation
corresponding to increasingly significant drops in PaO2
.
Cote et al. (1991) point out that appreciable clinical signs
and symptoms do not become evident until there is a
significant hypoxic event. Clinical evidence of hypoxia is
seen at mean SpO2
of 70 +/- 8%. Further, Cote and
colleagues define a major hypoxic event to have occurred
when the SpO2
is < 85% for more than 30 seconds.
Identification of major hypoxic episodes would require
pulse oximetry equipment and strong clinical judgment of
practitioners to correctly interpret the data. This study
showed that although there is wide exposure to the
equipment, practitioners did not consistently have the
knowledge neededto interpret data and make appropriate
alterations in plans of care. The danger in this situation
lies in the consequence of significant hypoxic episodes
being under-recognized and under-treated despite
sophisticated monitoring. As these findings and those of
previous studies indicate, there is a definite need for
increased and improved education about the proper use
of pulse pulse oximetry technology and interpretation of
pulse oximetry readings.
Conclusion: Despitenoneoftheparticipants hadgotformal
training on the use of pulse pulse o ximetry, 40% correctly
responded how it works. Similarly, majority of participants

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were aware of what pulse pulse oximetry measures and
itsimportance.Morethanone-thirdrespondentsidentified
its unit of measurement. Most significant finding of the
study is only 5% participants wereawareofoxyhemoglobin
Dissociation Curve. In given four clinical scenarios where
knowledge of clinical applications were assessed, were
poorlyunderstoodbymajorityofparticipants and thus 95%
respondents felt the need of training.
References:
1. Birnbaum S. Pulse pulse o ximetry: identifying its
applications, coding, and reimbursement. Chest
2009;135(3):838–841.
2. Baker AF, Habib HS. Normal values of pulse pulse
oximetry in newborns at high altitude. J Trop Pediatr
2005;51(3):170–173.
3. Clinical and Laboratory Standard Institute. Pulse Pulse
oximetry; Approved Guideline. 2nd ed. CLSI document
POCT11-A2. Wayne, PA: Clinical and Laboratory
Standards Institute; 2011.
4. Cote C J, Rolf N, Liu L M P, Goudsouzian N G, Ryan J F,
Zaslavsky A, et al. (1991). A single-blind s tudy of
combined pulse pulse oximetry and capnography in
children. Anesthesiology 1991; 74: 980-987.
5. Kruger P S, Longden PJ. A study of a hospital staff’s
knowledge of pulse pulse oximetry. Anesthesia and
Intensive Care 1997; 25: 38-41.
6. Miller P. Using pulse pulse oximetry to make clinical
nursing decisions. Orthopedic Nursing 1992; 11(4), 39-
42.
7. Murray,C.B.,&Loughlin,G.M.Makingthemos tofpulse
pulse oximetry. Contemporary Pediatrics 1995;
12(7):45-62.
8. Salas AA. Pulse pulse oximetry values in healthy term
newborns at high altitude. Ann Trop Paediatr
2008;28(4):275–278.
9. Rodriguez, L.R., Kotin, N., Lowenthal, D., & Kattan, M.
A study of pediatric house staff’s knowledge of pulse
pulse oximetry. Pediatrics 1994; 93, 810-813.
10.Stoneham MD, Saville GM, WilsonIH.Knowledge about
pulse pulse oximetry among medical and nursing staff.
Lancet 1994; 344:1339 - 42.

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Telephone Health Service to improve the Quality of Life of the People Living
with AIDS in Eastern Nepal
Dr. Naveen Kumar Pandey
Mr. Binod Kumar Deo
B. P. Koirala Institute of Health Sciences, Dharan, Nepal
Email: ramsharanmehta@gmail.com
Abstract: Quality of Life (QOL) is an important component in the evaluation of the well-being of People
Living with AIDS (PLWA). This study assessed the effectiveness of education intervention programme in
improving the QOL of PLWA on Anti Retroviral Therapy (ART) attaining the ART-clinics at B. P. Koirala
Institute of Health Sciences (BPKIHS), Nepal. A pre-experimental research design was used to conduct
the study among the PLWA on ART at BPKIHS from June to August 2013 involving 60 PLWA on pre-test
randomly. The mean age of the respondents was 36.70 ± 9.92, and majority of them (80%) w ere of age
group of 25-50 years and Male (56.7%). After education intervention programme there is significant
changeintheQOLinallthef ourdomainsi.e.Physical (p=0.008), Psychological (p=0.019), Social (p=0.046)
and Environmental (p=0.032) using student t-test at 0.05 level of significance. There is significant (p=
0.016) difference in the mean QOL scores of pre-test and post-test. High QOL scores in post-test after
educationinterventionprogrammemayreflectiveoftheeffectivenessofplannededucationinterventions
programme.
Key Words: Telephone, AIDS, Health Service, Nepal
Introduction: Low cost, effective interventions are needed
to deal with the major global bur den of HIV/AIDS.
Telephone consultation offers the potential to improve
health of people living with HIV /AIDS cost-effectively and
to reduce the burden on affected people and health
systems. Tele-health is defined as, the use of information
and communication technology to deliver health and
health care services and information over large and small
distances. Telephone nursing is a subset of nursing tele-
practice that involves giving telephone advice to callers.1
The demands of the people living with HIV /AIDS are
enormous and need to be addressed in terms of public
health policy, health economics and patient-care
perspectives. The care for HIV/AIDS patients is provided
through general and infectious disease hospitals in Nepal.
There has been a growing interest over the past 20 years
in exploring the care-giving experience. Nurses are in an
excellent position to minimize the burden of care
experienced by PLWA.
Developing countries in the global south which ha ve
already introduced innovative technologies such as mobile
banking need to drive the development of e-health, that
is, the harnessing of ICT, to improve healthcare delivery
systems in their countries. Researcher further stresses that
industrialized countries like the United States and Europe
have many years of experience in the use of IC T in
healthcaredelivery. These industrializedcountries have not
only learned lessons and made mistakes, but have also
achieved a lot of successes. Therefore, there is an
opportunity for developing countries to use ICT in a more
integrated way in the healthcare sector to improve the
quality, safety and efficiency in deliv ering healthcare
services to the people.2
Self-management interventions increasingly are used
among people with chr onic conditions to improve
symptom management3
and there is a growing evidence
base for their use. Self-management programmes have
shown positive outcomes in a variety of long-term
conditions; including arthritis, s troke, diabetes, and
hypertension4
these interventions may be designed
specifically to improve quality of life and to promote self-
management aspects of health care, such as medication
adherence. Telephone heath service continues to grow as
a valuable method for providing nursing care, especially in
home healthcare.
In B. P. Koirala Institute of Health Sciences ART clinic is one
of the best serving ART clinic in Nepal, where more than
one thousand PLWHA are enrolled. Out of that enrolled
PLWA more than 500 are enrolled in ART-clinic and about
400 PLWA are taking the ART drug regularly. This
intervention study helps to improve the quality of life of
PLWA and decrease the burden of the disease among the
PLWA and their family.
Objectives of the Study: To assess the effects of self-
management intervention for adults living with AIDS in
improving quality of life
Methodology: Pre-experimentalresearchdesignwas used
to conduct the study among the people living with AIDS
(PLWA) on anti-retroviral treatment (ART) for more than
three months enrolled in B. P. Koirala Institute of Health

- 12 -
Sciences (BPKIHS) ART-clinic. Adults (18 years and above)
diagnosed case of AIDS having telephone service access
were only included. No restrictions based on sex, race,
mode of transmission of HIV or location of participants was
made.
Sampling frame was prepared from the ART registers
available at BPKIHS ART-clinic and obtaining the history
from the clients attending at the clinic. Total 586 PLWA
was enrolled in the ART-clinic of BPKIHS, which w as the
population of the study. PLWHA visit the tropical ward
frequently not only for ART drugs but also for CD-4 count,
OI check-up and medication. This tropical unit is the focal
point for the PLWHA.
Firstpre-testwas takenfrom the 60 subjects (10% samples)
selected randomly and then education intervention was
carried out for all the PLWA attending the ART-clinic. The
education intervention was continued for three months in
ART-clinic days i.e. Monday, Wednesday and Friday from
9am-1pm regularly for 3 months from June to August 2013
by principle investigator, VCT-nurse and other trained
nurses along with ART clinic doctorusingprepared booklet,
which was distributed among all the participants free of
cost.
Telephone callsweremade toalltheparticipants who were
involved in pre-test, to find out the situation and support
relatedtoself-management.InthetelephonecallthePLWA
were given advice on self-care, information related to OI
symptoms management, side effects of ART drugs, CD-4
count and the answers of the PLWA. After the education
intervention the follow-up and telephone counseling was
provided to all the participants involved in Pre-test. The
participants were given the instruction that they can
contact the investigators when they need help and they
were also informed that investigators can contact for
needful information and support. They were also trained
how to contact and how to communicate their problems
to the investigators. The printed information with
telephone number and details of the contact persons were
given to each participant during the pre-test, with
explanation.
After Twelveweeksofeducationintervention post-testwas
taken among the participants who were involved in the
pre-test. Total 58 subjects were only interviewed at post-
test; as two subjects were transferred out in other ART-
centre during the study period. After the post-test follow-
up was also carried out to help and support and to clarify
their quarries. Four focus group discussions was also
arranged to find out the effectiveness of the programme
and find out the obstacles, so that can be solved on time.
Results: It was found that the majority of the PLWA (80%)
on ART included in the study in the pre-test was of age
group of 25-50 years with mean ± SD 36.70 ± 9.92. The
majority of the respondents was Male (56.7%), Hindu
(95%), illiterate (13.3%), belongs to rural areas (36.7%) and
from Sunsari district (56.7%). Itwasfound thatmajormode
of transmission of HIV-infections among the subjects was
by sexual route (80%). The majority of the PLWA (58.3%)
on ART therapy was one to three years. All the PLWA were
on ART. The PLWA on ART were suffering with Pulmonary
TB (36.7%), Gastritis (30%), Oral thrush (18.3%) and
Hepatitis-C (13.3%).
It was found that in pre-test 70% PLWA on ART reported
having fever within last six weeks. Similarly, they were also
suffering with Anorexia (51.7%), Diarrhoea (38.3%), Cough
(50%), and Insomnia (51.7%). In Post-test only 44.8%
reported having fever within last six weeks; similarly they
also reported having Anorexia (39.7%), Diarrhoea (31.0%),
Constipation (48.3%), Pain (32.8%) and Insomnia (24.1%).
In pre-test 31.7% respondents reported having the habits
of smoking, where as only 17.2% reported in post-test.
Similarly, the habit of taking alcohol in pre-test was
reported by 23.3% and 20.7% in post-test. The frequency
of performingexercise reported in pre-testwas never 55%,
rarely 10% but in post-test25.9%reportedneverand25.9%
rarely. The details of disease process and health status in
depicted in table 1.
It was found that the mean physical health status score in
pre-test was 19.74 and post-test 17.51, which has
significantlydifference(p=0.008).Similarly,inPsychological
health status the pre-test mean score was 36.47 and post-
test 32.36, which has significantly difference (p=0.019), in
social health status the pre-test mean score was 18.12 and
post-test16.66,whichhassignificantlydifference(p=0.046)
and the mean environmental status score in pre-test was
29.47andpost-test26.36,whichhassignificantlydifference
(p= 0.032). The overall mean quality of life in pre-test was
103.29 and post-test 92.94., which is significantly different
(p=0.016). The details of association calculated between
pre-test and post-test is depicted in table 2.
The telephone calls were done to support the people living
with ART involved in the pre-test. Each respondent was
calledfor one to twotimes. The telephone calls weremade
in the morning 9 am to 11am and in the afternoon 2pm to
4pm. During the telephone advice the respondents were
suggested about the self-care, complication management,
information related to CD-4 count, OI infection
management, ART side effects and schedules of tests and
availability of doctors. The quarries of the respondents
were also answered. During the phone call the information
of respondents were kept on hand. The phone calls were
done by the ART-nurse along with the principle in vestigator
on set schedule. The major concern of the respondents
were CD-4 count time, CD-4 report, side effects of ART and
their management,OIsymptomsandit’management. The
details are mentioned in table 1and 2.

- 13 -
Table1. Disease Process and Health Status of the Respondents
n=60
SN Disease process and health status Number Percentage (%)
1 Mode of Transmission of HIV
a. Sexual 48 80.0
b. IVDU 12 20.0
2 Total Duration of HIV Positive (in months)
<12 5 8.3
12-24 16 26.7
25-36 8 11.6
37-48 11 18.4
49-60 3 5.0
>60 17 28.3
3 Total Duration on ART (in months)
<12 7 11.7
12-36 35 58.3
36-60 11 18.4
>60 7 11.7
4 CD-4 on Start of ART
<50 4 6.7
50-350 53 88.3
>350 3 5.0
5 Latest CD-4 Count
<350 34 56.7
350-500 11 18.3
>500 10 16.7
Not Tested 5 8.3
6 Current Therapies or Treatment (MR)
a. ART 60 100
b. Bactrim 49 81.0
c. Fluconazole (anti-fungal) 5 8.3
Table 2. DistributionofMeansandSDoftransformed Quality of Life Scoreobtained from WHOQOL SF-36 Questionnaire
Quality of Life Domains
Pre-Test Mean
Score
(full Score=5)
(n=60)
Post-Test Mean
Score
(full Score=5)
(n=58)
Difference
(Mean Score)
P-value
Physical (7 domains) 19.74 17.51 2.23 0.008
Psychological (13 domains) 36.47 32.36 4.11 0.019
Social (6 domains) 18.12 16.66 1.46 0.046
Environmental (10 domains) 29.47 26.36 3.11 0.032
Overall QoL 103.29 92.94 10.35
(t-value
=2.489)
0.016
Discussion: In the pre-test total 60 subjects were included
in the study. After the education intervention programme
in the post-test total 58 subjects was only included as two
subjects were transferred out to other ART centers. Out
of total 60 subjects 10% were of age group less than 25
years, 80% of age group 25-50 years and 10% more than
50 years. Most of the respondents were Male (56.7%),
Hindu (95%), and Mangolian (40%) bycaste.Regarding the
educational status 13.3% were illiterate, 17.2% can read
and write, 9.6% had primary education, 55.5% had
secondary education and 17.2% had higher education.
Study conducted by Njamnshi5
, on socio-demographic
status of PLWHA reported that the mean age of the PLWA
were 37.3 ± 8.9 years, Married 54.3%, farmer 10.2%, and
38% had primary education, 65.8% had multiple sex
partners,whichissimilarto this study.Thestudyconducted
by Ogbuji6
on, QOL among PLWA, reported that the mean
age of PLWA were 34.8 ± 8.2 years and 70% were from

- 14 -
poor economic status group, which is similar to this study.
Similar finding were reported by MatiN7
as well.
Itwasfoundthatinthepre-testthemean scoresonphysical
health status domain was 2.82, psychological health status
domain 2.80, social health status domain 3.02,
environmental health status domain 2.94 and the overall
QOL mean score was 2.89; similarly in the post-test the
physical health status domain mean score was 2.52,
psychological 2.51, social 2.78, environmental 2.66 and
overall QOL mean score was 2.61. Similar findings were
reported by Lechner8
in the study conducted on cognitive-
behavior interventions improves QoL in women with AIDS.
Similar findings were also reported by Ogbuji6
study
conducted on QoL among the PLWA. Similar findings were
reported by Imam9
.
Conclusion: High QOL scores after education intervention
programme in the Physical, Psychological, Social and
Environmental domains mayreflective of the effectiveness
of planned education interventions programme. The
people living with AIDS (PLWA); the users of telephone
heath service seems to be satisfied with the service and
vast majority followed the advice they were given.
Telephone health service should be the part of HIV/AIDS
service, must be available at each ART/VCT centers,
operated by a trained VCT/ART nurse for effective home
health care problems solution of the PLWA, in very cost
effective method.
References:
1. Goodwin S. Telephone Nursing: An emerging practice
area. Nursing Leadership. 2007; 20(4): 37-45.
2. Collins DL, Leibbrandt M. The financial imp act of HIV/
AIDS on poor households in South Afric a. AIDS. 2007;
21(7): 75-81.
3. Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH.
Self-management Education Programs in Chronic
Disease. Archives Internal Medicine. 2004; 164(9/
23):1641–9.
4. Lau-Walker M, Thompson DR. Self-management in
long-term health conditions - A complex concept
poorly understood and applied - Letter to the Editor.
Patient Education and Counselling.2009; 75:290–2.
5. Njamnshi DM, fonsah JY, Yepnjio FN, Kouanfac C,
Njamnshi AK. The social and ec onomic status of
patients attending an HIV/AIDS treatment centre in
Yaounde, Cameroon. Geneva Health Forum. 2012;
2012.11.12.
6. Ogbuji OC, Oke AE. Quality of life among persons living
with HIV infection in Ibadan, Nigeria. Afr. Med
Sci.2010; 39(2):127-35.
7. Matin N, Shahrin L, Pervez MH, Banu S, Ahmed D,
Khatun M, Pietroni M. Clinical profile of HIV/AIDS
infected patients admitted to a new specialist unit in
Dhaka, Bangladesh- a low prevalence country for HIV.
J Health Popul Nutr.2011; 29(1)14-9.
8. Lechner SC, Antoni MH, Lydston D, LaPrriere A, Ishil
M, Devieux J. etal. Cognitive interventions improve
quality of life in women with AIDS. Journal of
Psychosomatic Research. 2003; 54(3):253-261.
9. Imam MH, Flora MS, Moni MA, Shameem RK, Haque
MA, Mamuns A. Health related QOL with HIV/AIDS in
different states of HIV infection. Mymensingh Med J.
2012; 21(3): 509-15.
Acknowledgement: We express Heartfelt thanks to
University Grant Commission (UGC) Sanothimi, Bhaktpur
for providing the budget to conduct this study.

- 15 -
Knowledge and opinion on effects of television viewing on children among
mothers with under five children in Magudanchavadi village Salem Tamilnadu
N. Dhanasekaran, Lecturer
Email: nvdhana@gmail.com
Abstract: Children born into television families regard television as a permanent fixture in their lives.
Excessive watching of television Programmes has an unhealthy effect on children. Hence the mothers
are expected to be knowledgeable regarding the various effects of television on children. To assess the
knowledge and opinion on effects of television viewing on children, to compare the knowledge and
opinion on regarding effects of television viewing on children with their demographic variable and to
associate between the knowledge and opinion scores of mothers with under five children with their
demographic variables. A descriptive design with cross sectional survey approach was used to assess
the knowledge and opinion on effects of television viewing on children among mothers with under five
children in Mugudanchavadivillage, Salem, Tamilnadu. Datawas collectedfrom 100 mothers with under
five children by convenient sampling technique using structured interview schedule from 14/09/14 to
15/10/14.
Demographic characteristic reveals that 85% of mothers were in the age group of 21 - 30 years, 39 %
had higher secondary school education, 47% house wives. Majority i.e. 68 % had one child. Thirty one
percentage got information from television/ Radio and Neighbours/ Relatives. All the houses (100%)
had television, 46 % of the children watch television less than 1 hour/ day. Overall knowledge scores of
motherswithunderfivechildrenwere60.65%,depictinggoodknowledgeoneffectsoftelevisionviewing
onchildren.Sixtyonepercent hadgood knowledgeonphysiologicaleffects and 93% had positive opinion
on “Television should be watched according to a fixed time”. There was significant association between
knowledge scores and previous source of information. The Overall knowledge is good. However lowest
percentage in the areas of “Effects of television viewing” and “Psychological effects” were attention
seeking, implying the necessity to improve the knowledge in regard to prevent aggressive and violent
behavior .
Key words: Knowledge, Effects of television viewing, Mothers, Salem.
Introduction: Entertainment is something everybody looks
forward to. There are many ways to entertain those who
need leisure. Television is one of the mos t popular
entertainments, one of the greatestinventions of mankind.
It has found nearly 99 % of households in India tha t 2.24
number of television set in the average household.
Television has become quite popular among people of all
ages. It provides variety for all tastes. Excessive watching
of television programmes has an unhealthy effect on
children.1
The average child will watch 8000 murders on television
before finishing elementary school. The average Indian
child has seen 200,000 acts of violence on television,
including 40,000 murders. 20,000 numbers of television
commercials seen in a year by an average child and 73 %
of parents who wouldliketolimittheirchi ldren’s television
watching. 1
Watching television is more educative and instructive than
the lesson learnt at school, for the school may not have
sufficientfacilities for teaching in a systematic way.Various
programmes telecast our knowledge about historical
events, important personalities and current affairs. The
daily news network gives round up of the various
happenings in the national and international scenario.
Education programme instill a spirit of scientific enquiry
in the viewers. Listening to the television broadcast also
improves the vocabulary, accent, pronunciation and
language of the viewers.2
On the other hand television has an adverse effect on
children. They get addicted to it and problems are caused
due to the harmful effect of radiation from the television
and strain on the eyes. The possible negative health effects
of television viewing on children, such as violent or
aggressive behaviour, substance use, sexual activity,
obesity, poor body imag e and decreased school
performance.Inadditional to the television ratings system,
media education is an effective approach to mitigating
these potential problems. 3
The role of parents’ for television viewing of children is
that they have to set a limit, monitor type of programmes
are watched by their children. So the parents need more
information regarding the effects of television viewing on
children. 4

- 16 -
The above mentioned studies show that television has
certain effects on children. Some parents encourage the
television watching habits of their children where as some
others discourage. The parents have an important role to
play in selecting programmes for their children. The
investigator enquired with several mothers to know
whether the mothers were aware regarding the various
effects of television on children. Many mothers conveyed
that TV has bad effects. TV takes much of their time. Some
were not denying the fact that television is educative and
informative. Some mothers didn’t care and they watched
television along with their chi ldren. After consulting a few
mothers the investigator felt it was necessary to find out
the mothers knowledgeregarding the effects of television.
Objectives: Objective of the study was to assess the
knowledgeandopinionofmotherswithunderfivechildren
on effects of television viewing on children, compare the
knowledge and opinion with their demogr aphic variables
and to find out the association between the knowledge
and opinion scores.
Design and Methodology: A descriptive design with cross
sectional survey approach was used. The study was
conducted in Mugudanchavadi village, Salem, Tamilnadu,
India which is 20 km away from Salem city. The mothers
with under-five children were the population of the study.
Convenient sampling technique was used to select 100
samples.
The knowledge section tool consists of 20 items. Each item
has four options with one correct option. Each correct
option carries ‘one score’ and wrong option ‘zero score’.
The opinion section tool consists of 12 statements.
Maximum score for each positive and negative statement
was five. Each statement will have five scales. Such as
Strongly Agree (SA), Agree (A), Undecided (UD), Disagree
(DA), and StronglyDisagree(SDA).Eachnegative statement
were also included in the tool.
Split - half method (Spearman’s co-relation co- efficient
formula) was used to find out the reliability of the
structuredinterviewscheduleandtheco-relationvaluewas
r = 0.8.
Prior to data collection written permission was obtained
from the village leader, Mugudanchavadi village, Salem.
Further, before collection of data informed consent was
obtained from the mothers with under five children. The
data was collected from 14/09/09 to 15/10/14. During this
period investigator collected the data by using Structured
Interview Schedule. All data collectedwere entered in data
sheet and analyzed using the statistical software SPSS
version 16.0. The chi- square test was used to test the
association between demographic variables with
knowledge scores.
Result: Demographic characteristic reveals that highest
percentage i.e. 85% were in the age group of 21 - 30 years,
39% had higher secondary school education, 47% house
wives. Thirty six percent were in the incomegroup Rs.2000
and less per month, 48 % and 46% were from joint family
and nuclear family respectively. Majority (68%) had one
child and most of them were Hindus (98%). More or less
similar percentage (31% and 29%) of the mother s got
information from television/ Radio and Neighbours/
Relatives. All the houses had television, and highest
percentage (46%) of the children watchtelevision less than
1 hour/ day. Details are in table 1.
Area wise distribution of mean, SD and mean percentage
of knowledge scores shows that highest mean score
(4.79±1.18) which is 68% of the ma ximumscore is obtained
in the area “Physiological effects” revealing good
knowledge and lowest mean score (0.42 ± 0.57) which is
21% of the maximum score is obtained for the area
“Psychological effects”. Further good knowledge is also
found in the areas “Scholastic performance” where the
mean scorewas 2.01 ± 0.87 which is 67 % of the total score,
and in the area “Role of parents” where the mean score is
3.77 ± 0.86 which is 63 % of the total score. Further, the
overall mean, SD, and mean percentage of knowledge
scores show that the mean score was 12.13 ± 2.51 which is
60.65% of the total score, revealing good knowledge of
mothers with under five children. Details are in table 2.
Percentage wise distribution regarding positive statements
on effects of television viewing on children reveals highest
percentage (93%) had positive opinion related “Television
should be watched according to a fixed time” and lowest
percentage (4%) had negative opinion for the same
statement. It seems majority of the mother s have
knowledge in this aspect.
Percentagewisedistributionregardingnegativestatements
on effects of television viewing on children reveals (67%)
had positive opinion related“Itisbettertowatch television
out of the house.” and 14% had negative opinion for the
same statement. It seems majority of the mother s did not
have knowledge of this aspect. Details are in table 4.
There was no significant association between knowledge
scores of mothers when compared to age, educational
status, occupational status, income of the family per
month, type of family, and number of children below 5
years of age, religion, and hours of television viewed by
children, but significantassociationwas observed between
opinion scores of mothers and number of chi ldren below
5 years of age.

- 17 -
Table: 1 Demographicdistributionoftherespondentsand
comparison of the kno wledge scores of mothers with
under five children with their demographic variables
(n =100)
Parameters / Interval No. Mean SD Percentage
Age
< 21 years 1 6 0 30
21 – 30 years 85 12.25 2.38 61.25
31 - 40 years 14 11.78 2.86 58.9
Educational Status
No formal education 7 11.85 1.67 59.25
Primary school education 18 12 2.16 60
Secondary school education 19 11.42 3.64 57.1
Higher secondary school
education
39 12.35 2.25 61.75
Graduates 17 12.64 2.23 63.2
Occupational status
House wife 47 12.10 2.42 60.5
Daily wages 9 12 1.93 60
Govt employee 2 13.5 0.70 67.5
Private employee 1 17 0 85
Self employed 41 12 2.68 60
Family income /month (Rs)
< 2000 36 12.25 2.74 61.25
2001 – 4000 28 12.10 2.29 60.5
4001 – 6000 22 11.45 2.53 57.25
6001 – 8000 9 13.44 2.50 67.2
> 8000 5 12 1.22 60
Type of family
Nuclear 46 12.15 2.23 60.75
Joint 48 12.27 2.65 61.35
Extended 6 10.83 3.18 54.15
No of children below 5 years of age
One 68 12.16 2.33 60.8
Two 32 12.06 2.86 60.3
Religion
Hindu 98 12.07 2.5 60.35
Christian 2 15 0 75
Previous source of Information
No information 19 11.26 2.86 56.3
Neighbours / Relatives 29 12.37 2.21 61.85
Health personnel 4 10.5 4.04 52.5
Television / Radio 31 11.90 2.42 59.5
Newspaper / Magazines 17 13.47 1.87 67.35
Hours of television viewed by children
< 1 hours 46 12.73 1.68 61.85
1 to 2 hours 34 12.11 2.74 60.55
3 to 4 hours 13 10.15 3.43 50.75
> 4 hours 5 11.8 2.04 59
Any time free irrespective of
particular hours
2 12 4.24 60
Overall 100 12.13 2.51 60.65
Table 2: Area wise distribution of Mean, SD and mean
percentage of knowledge of mothers regarding effects of
television viewing on children. (n=100)
Area
Max score Knowledge score
Mean SD Mean %
Effects of television viewing 2 1.14 0.76 57
Physiological effects 7 4.79 1.18 68
Psychological effects 2 0.42 0.57 21
Scholastic performance 3 2.01 0.87 67
Role of parents 6 3.77 0.86 63
Overall 20 12.13 2.51 60.65
Table : 3 Item wise distribution of percentage of mothers
with under five children according to their correct
responsestotheknowledge items on effectsoftelevision
viewing on children.
Effects of television viewing Percentage
1 Television provides new knowledge to children 68
2
Television viewing decreases family interaction of
children
46
Physiological effects of television viewing
3
Physiological effects of viewing television is
obesity , sleeplessness, vision problem, decreased
motor development
77
4
Associated snack eating and inactivity is the
reason for obesity in children viewing television
62
5
Strain on eyes is the ill effect of radiation from
television
92
6
Vision defect is the long term eye problem of
viewing television
66
7
Television viewing causes sleeplessness
18
8
Effect of violent programmes on children is sleep
disturbance due to nightmares
81
9
Ideal duration for watching television is 1 – 2
hours / day
83
Psychological effects of television viewing
10
Violent programme is most dangerous for child
behavior
19
11
Behavioural ill effects of viewing television is
increasing aggressive behavior
23
Scholastic performance
12
Violent movies in television affects the scholastic
performance of the children
73
13
Decreased attention span and lower academic
performance is affects of prolonged television
viewing
68
14
Educational Programme is help in improving
intellectual level of children
60
Role of parents on effects of television viewing on children
15
Age appropriate programmes are suitable for the
children
93
16
Television has to be kept in the hall
84
17 Parents should watch television with children to
prevent the harmful effects.
22
18 More than 6 feet to be maintained between the
child and television while watching television
83

- 18 -
Table 4: Percentage distribution of opinion sc ores of mothers with under five children on effects of television viewing
on children. n=100
Discussion: Television being a part of the present
environment attracts children who spend hours watching
both suitable and unsuitable programmes. Television has
an adverse effect on children. They get addicted to it and
problems are caused due to the harmful effect of radiation
from the television and strain on the eyes. The possible
negative health effects of television viewing on children,
such as violent or aggressive behaviour, substance use,
sexual activity, obesity, poor body image and decreased
school performance. Hence parents are having important
role to monitor their children. 5
In this present study the overall mean was 12.13 ± 2.51
which is 60.65% of the maximum score, revealing good
knowledge. This study is similar to the study of Cinobi john
(2005)(6)
who revealed that 52.25% of mothers with under
five children have good knowledge of effects of television
viewing on children. The lowest mean score (0.42 ± 0.57)
which is 21 % of the maximum score is obtained for the
area “Psychological effects”. This is supported by
Zimmerman FJ, et al., (2005)whose findings said that 18%
of respondents had some knowledge about psychological
effects of television viewing on children. 7
Percentage wise distribution according to their level of
positive statements shows that majority of the mother s
(85%) had positive opinion. Further, 15% had undecided
opinion. It shows that majority of the mothers had positive
opinion. It might be because most of the mothers had
average knowledge level.
Percentage wise distribution according to their level of
negative statements shows that majority of the mother s
(87%) had undecided opinion. Further, 13% of the mothers
hadnegativeopinion.Itshows thatmajorityofthemothers
had undecided opinion.
Significant association was found between knowledge
scores of mothers and previous source of information and
the significant association was found between opinion
scores of mothers and number of chi ldren below 5 years
of age.
Conclusion: The overall knowledge is good. However
lowest percentage in the areas of “Effects of television
viewing” and “Psychological effects” were attention
seeking, implying the necessity to improve the knowledge
in regard to prevent aggressive and violent behavior.
Reference:
1. Nielson.A.C. Report on Television. North-brook,
IL:A.C.Nielsen company;2012
2. Landhuis CE. Does Childhood television viewing lead
to attention Problems in Adolescence?. Results from a
Prospective Longitudinal Study, Journal of Pediatrics
Sep; 120(3): 2013 ; 532-537.
3. AmericanAcademyofPaediatrics.Children,Adolescents
and Television. Paediatrics 2007; 107:423-6.
4. Tamizharasi, Television – A Master or A Monster for
Children, The Sparkle. 2009
5. Van Evra, Television and child development. Hillsdale:
N J: Erlbaum 62 (5), 2012: 452 - 453.
6. Cinobi john, Early Television Exposure and Subsequent
Attentional Problems in children, Archives of Pediatrics
Adolescence Medline, 113(1), 2013; 708- 713.
7. Zimmerman FJ, (2005), Early cognitive stimulation,
emotionalsupportandtelevisionwatchingaspredictors
of subsequent bullying among grade school children,
ArchivesofPediatricsAdolescence Medline,Apr;159(4)
2005: 384- 388.
Opinion statement
Positive Undecided Negative
No& % No. & % No. & %
Positive
Television viewing children should be supervised by parents. 91 3 6
Television should be watched according to a fixed time. 93 3 4
Parents must not encourage the child to watch late night television. 74 7 19
Children should be allowed to watch particular channels only. 72 12 16
Parents always need to discourage viewing television as it distracts
the concentration towards study. 81 0 19
Children learn good and bad behaviours through television. 86 0 14
Negative
Television viewing should be allowed for children. 20 7 73
Parents must allow children to watch television when they want. 38 17 45
When children watch television, parents are free 50 6 44
Television is no way good for children. 29 26 45
It is better to watch television out of the house. 67 19 14
No programme in the television is harmful for the children. 46 11 43

- 19 -
PSYCHOSOCIAL PROBLEMS AMONG ADOLESCENTS IN A SCHOOL OF
URBAN SLUM AT EASTERN NEPAL
Rita Pokharel, S Lama, B Shrestha,
M Shrestha, M Manandhar, M Chaudhary , P Poudel
Department of Psychiatric Nursing
Email.rpokharel35@gmail.com
Abstract: Adolescents face many psychosocial problems. Visiting health facility for psychological
problems is considered a stigmainNepal. Objective of the study was to screen forpsychosocial problems
amongadolescents, investigate the underlying causes forthese problems and to find out the relationship
of these problems with different variables. It was a cross sectional study. Students of grades eight, nine
and ten of a government school located in a slum area were screened. Paediatric Symptoms Checklist -
Youth Report (PSC-Y) was used and a cut off score of more than 28 was used to detect psychosocial
problems. Studentsfoundtohaveproblemswereinterviewedtofindouttheunderlyingc auses.Multiple
linear regression analysis was done to investigate the relationship between psychosocial problems and
selected variables.
Study was done in 275 students. Female to male ratio was 2:1. Most of the students were from
disadvantaged Janajati caste group (56.0%), Hindu religion (70.5%), and from families below poverty
line (67.6%). Family dispute was witnessed by 72.7% and 84.4% students were punished at home.
Nearly one third of the students’ fathers were working as daily wages labourer. Psychosocial problems
were found in 63 (22.9%) students. Most prevalent problems were loneliness, hopelessness and suicidal
ideationin25, 17and5studentsrespectively.Incounsellingsession, fearofteachers(17), studyproblems
(10) and domestic violence (4) were reported the underlying causes. Religion, punishments at home
and fathers’ occupation were found to have significant relationship with psychosocial problems.
Psychosocial problems like loneliness, hopelessness and suicidal ideation are common in school
adolescents and these problems have identifiable and remediable underlying causes.
Keywords: Psychosocial Problems, Adolescent, PSC-Y score
Introduction: Adolescence is the period from 10 to 19
years of age as defined by World Health Organization
(WHO).1
Adolescence is a transitional stage of physical and
mental development that occurs between childhood and
adulthood. This transition involves biological, social, and
psychological changes. The biological or physiological
changes are the easier tomeasure objectively as compared
to psychological changes. Adolescents are often thought
of as a healthy group. Nevertheless, many of them do die
prematurely due to accidents, suicide, violence and other
illnesses that are either preventable or treatable. 1
Many
chronic diseases and mental health conditions arise during
childhood. In Nepal, where psychological problems and
visittothehealthfacilityforthoseproblemsareconsidered
as stigma, it becomes even more necessary to create
awareness amongst parents and health care providers
about the extent of the psychological problems in children
and adolescents. These ensuing psychosocial problems are
known toleadtovarious learningandemotionaldifficulties
which then have an impact on psychological wellbeing of
children. Though efforts have been made to increase
awareness of the psychosocial morbidity pr esent in
children and adolescents in paediatricaswell as psychiatric
services, there is a dearth in Nepalese literature on the
detection of psychological problems and the benefits of
early detection and treatment of psychological problems
in children and adolescents.
Objectives: Objective of the study was to screen for
psychosocial problems among adolescents, investigate the
underlying causes for psychosocial problems and to find
out the relationship of these problems with different
variables.
DesignandMethodology: Descriptivecross-sectionalstudy
design was used to collect data from students of grades
eight, nine and ten of a government secondary school of
Dharanmunicipality.DharanisasmallcityinE asternregion
of Nepal. Diverse people from various ethnicities live in
this city. Almost all of the students attending this school
are from slum area and socioeconomically disadvantaged
families.
Paediatric symptoms checklist Youth Report (PSC-Y) in
Nepalilanguagewas usedtoscreenpsychosocialproblems.
PSC-Y consists of 35 items. Each item carries score from 1
to 3. A score of less than or equals to 28 was considered
not having psychosocial problems and score more than 28
was considered as having psychosocial problem. On the
basis of study done byMariaE.2
maximumobtainable score
of the scale is 105.

- 20 -
Study was conducted in two phases from 9th June 2013 to
15th July 2013. In phase one, data were collected from
adolescents by using self reporting questionnaire. In the
second phase, students found to have psychosocial
problems were interviewed, causes were investigated,
scores were verified by asking the students, provided
counsellingandreferred themtopsychiatristfortreatment
as required.
Data were entered in Microsoft excel 2007 sheet for
preparing master chart, then converted into SPSS 16
version for analysis. Descriptive statistics was used to
describe socio-demographic data and psychosocial
problems. Multiple linear regression analysis was used to
find out the factors related to psychosocial problems.
Various socio-demographic factors and potential risk
factors for the psychosocial problems were entered into
linear regression model and factors with significance level
< 0.2 were re-intered into multiple regression model.
Permission was obtained from related school. Informed
verbal consent obtained from parents and students. All
students who scored above cut off in PSC-Y were taught
relaxation and anger management techniques. Name of
students were concealed. Only researchers and counselee
were present during counselling session. Results were
reported to parents and teachers. Trainings were
conducted on adolescent suicide and corporal punishment
for teachers. Follow up was also done to find out whether
the needy students visited psychiatrist or not.
Results: Total number of students enrolled in study was
300. Because of incomplete response, failure to provide
consent and age factors, 25 students were excluded and
analysis was done in remaining 275 students. There were
96 males and 179 females, with female to male ratio of
2:1.Mean + SDageofthestudentswas (15.09 + 1.16)years.
Table 1 shows baseline characteristics of the students.
Total 63 students scored more than 28 in PSC-Y scale.
Among them, 63.5% were female and 36.5% were male.
Psychosocial problems and gender wise distribution of
those problems are presented in Table 2.
In counselling session causes of the problems were
explored by detailed history.Fear of teachers was the most
prevalent problem that wasreportedby 17 students. Study
problem was present in 10 students. Rest of the students
were found to have problems like experience of domestic
violence, other family problems, physical weakness, anger
management problem, death of parents, separation with
parents, unfulfilled desires. Some of the students did not
have any obvious reason for their psychosocial problems.
Religion other than Hindu, beaten or scolded at home and
father’s occupation as daily wages labourerwere the three
factors that were found to have statistically significant
relation. Result of multiple linear regression ana.lysis is
presented in Table 3.
Table 1 Baseline Characteristics of the Studen ts
n=275
Characteristics Category Frequency Percentage
Caste group a
Dalit 55 20.0
Disadvantaged Janajati 154 56.0
Relatively advantaged
Janajati
22 8.0
Upper caste 44 16.0
Religion Hindu 194 70.5
Christian 43 15.6
Buddhist 30 10.9
Others 8 3.0
Grade Eight 90 32.7
Nine 115 41.8
Ten 70 25.5
Presence of
Family Dispute
Never 66 24.0
Sometimes 200 72.7
Always 9 3.3
Punished at
home
Never 33 12
Sometimes 232 84.4
Always 10 3.6
Family income Below Poverty lineb
186 67.6
Above poverty line 89 32.4
Fathers'
occupation
Daily wages laborer 97 35.3
Farmer 61 22.2
Abroad migrant worker 40 14.5
Others 51 18.0
Father not present
c
26 9.5
Mothers'
occupation
Housewife 177 64.4
Others 96 35.6
a: caste groups were categorized according to standard of
Nepal Government
b: below poverty line is income less than $1.25 per capita
per day.
c: father separated ,or deceased
Table 2 Gender-wise distribution of problems reported
by students n=6 3
Problems of students Frequency Male number (%) Female number (%)
Loneliness 25 6 (24.0) 19 (76.0)
Hopelessness 17 5 (17.9) 12 (70.5)
Suicidal Ideation 5 1 (20.0) 4 (80.0)
Others 16 6 (37.5) 10 (62.5)

- 21 -
Table 3: Multiple Linear Regression Analysis of Psychosocial Problems Adjusted for Variables
Risk Variables B
Std.
Error
Beta T P
95% CI for B
Lower Upper
(Constant) -4.611 6.993 -.659 .510 -18.380 9.157
Janajati caste group .113 .491 .014 .230 .818 -.855 1.080
Other than Hindu religion
2.098 .986 .124 2.127 .034 .156 4.040
Age .834 .440 .125 1.895 .059 -.033 1.701
Class 1.184 .679 .116 1.745 .082 -.152 2.520
Family Dispute .393 .971 .024 .405 .686 -1.518 2.305
Punished at home 4.517 1.211 .226 3.729 <.001 2.132 6.903
Fathers' occupation of daily
wage laborer -2.646 .944 -.164 -2.804 .005 -4.504 -.788
Discussion: The term ‘psychosocial’ refers to the interplay
betweenthebiological,physiological, emotional, cognitive,
social, environmental and maturational factors. World
Health Organization statistics reveals that the prevalence
of disabling men tal illnesses among children and
adolescents attending healthcare centres range between
20-30% in urban areas and13-18% in rural areas.3
Various
studies from developing countries including Nepal and
India show that a significant percentage (7-35%) of the
paediatric population suffers from mental illness.4-7
Youth is the time where a person’s life is in between
childhood and adulthood. The majority (almos t 85%) of
the world’s youths live in developing countries, with
approximately 60% in Asia alone. A remaining 23 percent
live in the developing regions of Africa, and Latin America
and the Caribbean. By 2025, the number of youth living in
developing countries is projected to be 89.5%. In Nepal,
23.62 percent of the total population nearly a quarter of
the population is adolescent group.8
Government schools provide free education till grade 10.
Many people in remote and slum areas of Nepal send their
male children to private school and female children to
government school due to reasons like better education
in private schools and preference of males in society. This
can be the reason that present study found female is to
male ratio is 2:1.
Present study found that 23% students had psychosocial
problems. This figure is comparable to the finding 20.2%
of another study done in Indian subcontinent.9
Another
study in Chandigarh city of India found psychological
problems in 45.8% students.10
One school based study in
India also found that prevalence of psychosocial problems
was 17.9%. 11
These results show that psychosocial
problems are very common among adolescents and there
is urgent need to take preventive and curative actions.
Psychosocial problems are more common in females and
compared to males.12
Common problems detected in
students in this study were suicidal ideation, loneliness and
hopelessness.Inhigherproportionoffemalestudentswere
found to have psychosocial problems as compared to male
students. Among total students expressing each of
loneliness, hopelessness and suicidal ideation, proportions
of female students were 76.0%, 70.0% and 80.0%
respectively. Other hospital based studies done in Nepal
have also found psychiatric problems in higher proportion
of female children.6,13
In Nepal female children are likely
to face more psychosocial stressors because of male
preference in society. That could be the reason for higher
proportion of female students having psychosocial
problems.
Inthestudy, the commoncausesforpsychosocial problems
were fear of teachers, study problems, family dispute and
having punished at home. These are the stressors that can
be easily prevented and removed by educating and
counselling students, parents and teachers. Authors feel
the need of such school and family based counselling
sessions to reduce the burden of psychosocial problems in
students.
Children from other than Hindu religion, who were
punishedat home and whose fathers wereworking as daily
wages labourers were found to have significantly higher
PSY-C scores. Majority of Nepalese people follow Hindu
religion. Now a day the trend of religion change has been
increased. Children may get religious and spiritual
confusions and conflict that might be the reason for higher
score is PSC-Y in students other than Hindu Religion.
Though psychosocial problems found to be unrelated to
per capita income, scores in PSC-Y were significantly higher
in students whose fathers’ occupation was daily wages
labourer. This shows the relationship of psychosocial
problems with socioeconomic status. Ahmad et al. in India

- 22 -
found that the difference in prevalence of psychosocial
problems with socioeconomic status was significant.11
Conclusion: Psychosocial problems are common among
adolescents. Loneliness, hopelessness and suicidal ideation
are the common problems and these problems are more
common in female adolescents. Common underlying
stressors are fear of teachers, study problems and family
problems. Socioeconomicstatus and punishments athome
are important predictors of psychosocial problems in
resource poor settings. The rising trend of psychosocial
problems in adolescents, who are the future of a nation, is
alarming and ther efore, early detection and timely
intervention is crucial.
References:
1. World Health Organization. Adolescent health.
Available from http://www.who.int/topics/
adolescent_health/en/ (accessed on 09.04.2014)
2. Maria EP., linden JC, Michelle , J. Michael M. Michael
SJ. Identifying psychosocial dysfunction in school-age
Children: the pediatric symptom checklist as a self
report Measure.Psychol Sch. 2000 March 1; 37(2): 91–
106
3. Hassan ZK. Children mental health problems and
prospectsusingprimaryhealthcare.Pak J ChildMental
Health 1991;2:90-101.
4. Risal A, Sharma PP. Psychiatric Illness in the Paediatric
Population Presenting to a Psychiatry Clinic in a
Tertiary Care Centre. Kathmandu Univ Med J.
2010;9(32):375-81
5. Shrestha DM. Neuropsychiatric problems in children
attending a general psychiatric clinic in Nepal. J Nepal
Paediatr Soc. 1986;5:97-10.
6. Chadda RK and Saurabh. Pattern of Psychiatric
Morbidity in Children Attending a General Psychiatric
Unit. Indian J Pediatr. 1994;61:281-85.
7. Regmi SK, Nepal MK, Khalid A, Sinha UK, et al. A study
of children and adolescents attending the chi ld
guidance clinic of a g eneral hospital. Nepalese Journal
of Psychiatry 2000;1:90-7.
8. Government of Nepal Ministry of Health and
population. Nepal Population Report. 2011.
9. Bansal PD, Barman R.Psychopathology of school going
children in the age of 10-15 years. Int J. App Basic Med
Res. 2011;1(1):43-7
10. Arun P., Chavan BS. Stress and suicidal ideas in
adolescent students in Chandigarh. Indian J Med Sci.
2009;63:281-287
11. Ahmad A, Khalique N, Khan Z, Amir A . Prevalence of
psychosocial problems among school g oing male
adolescents. Indian J Community Med. 2007;32:219-
21
12. Sadock BJ, Sadock VA. Synopsis of psychiatry. 10th
edition. New Delhi, Lippincott Wiliam & Wikins; 2007.
13. Shakya DR. Psychiatric Morbidity Profiles of Child and
Adolescent Psychiatry Out-Patients in a Tertiary-Care
Hospital. J. Nepal Paediatr. Soc. 2010;30(2):79-84.

- 23 -
Awareness on Kala-azar among the People Living in
Selected Wards of Dharan Municipality
Bijaya Dawadi, Angur Badhu
Email: bijayadawadi1@gmail.com
Abstract: Objective of the study was to study the awareness on Kala-azar among the community people
living in ward number 14 of Dharan municipality, eastern Nepal. A descriptive cross-sectional study
design was used; purposive sampleing was done to enroll the study participants from people living in
ward no. 14 of Dharan Municipality. A total of 100 participants were enrolled in the study. Almost half
of the study subjects (52%) were aware about kala-azar and median percentage of awareness was
77.77%. History of previous exposure to kala-azar and related activity was statistically significant with
awareness (p-value 0.01).There was no statistically significant association between awareness of kala-
azar and age, education, occupation, monthly income of the head of the households ( p-value 0.15,
0.25 , 0.32 and 0.75) respectively. Awareness on kala-azar was associated with past exposure to kala-
azar and related activities. The moderate awareness level of community people suggest the need of
strengthening and improving the existing health services and community based NGOs for awareness
raising activities in affected areas of Dharan municipality.
Key words: Awareness, Community people, Dharan
Introduction: Kala-azar (V isceral leishmaniasis) is a
zoonotic infection caused by protozoa (parasite) that
belongtothegenus Leishmania. The diseaseisnamedafter
Leishman, who first described it in London in May 1903. It
is transmittedby the biteofinfectedfemale sandfly(vector)
Phlebotamusargentipes. Geographical distribution of
Leishmaniasis is restricted to tropical and temperate
region,which are the natural habitat of sand fly. Poverty
and malnutrition pla y a major role in increased
susceptibility to the disease.Migration of the susceptible
population to the endemic areas is also another cause of
acquiring of disease. Worldwide, 200 million people are at
risk and an estimated 5,00,000 new cases occur annually.
More than 90% of Kala-azar cases reported worldwide
occurs in Bangladesh, North East India, Nepal, Sudan and
NorthEast Brazil. More than 60% of the world’s Visceral
Leishmaniasis cases are reported from India, Nepal, and
Bangladesh alone. The Kala-azar incidence has decreased
to 1.71 per 10,000 populations during the fiscal year 2064/
2065 compared to 2.7 in the fiscal year 2063/2064. The
target of Kala-azar elimination programme is toreduce the
incidence of Kala-azar 1 per 10,000 at risk population by
the year 2015.The prevalence of Kala-azar in Dharan is 4%
and the incidence is 1.6 3/10,000 population.
Objectives: With objective of assessing the awareness
regarding Kala-azar among the people living in w ard no.14
of Dharan municipality and to find out the association
between the awareness and selected sociodemographic
variables, study was carried out.
Methodology: An ethical approval was taken from College
of nursing BPKIHS Dharan, Municipality ooffice of ward
number 14 to conduct the study. Informed consent was
obtained from each respondent. A ddescriptive cross
sectional study was carried out to conduct the study.
Purposive sampling was done to select the ward.
Systematicrandom sampling was done to select the house.
The ward was chosen due to outbreak of visceral
leishmaniasis in 2005.There were 663 households
altogether and the total sample were 100. Pretesting was
done with 10% of the sample siz e (n=100) in similarsetting.
Itwas done in Dharan 17 Railway.People were approached
at their homes for an interview and information on
knowledge, attitude and practices were collected using
semi-structured questionnaire based on objective of
research the questions contained: sociodemographic
informationoftherespondent, kknowledgeregardingKala-
azar, aattitude regardingKala-azar, practice regardingKala-
azar. The data collection time was two weeks from 2011
Februray 8 to 21. Data was entered in Excel and analyzed
by using SPSS 16.0. Descriptive statistics such as median,
percentage and frequency used for describing the
demographic data and awareness regarding kala-azar.
Inferential statistic such as Chi-square test, Fisher’s Exact
test and Mann Whitney U test were used for finding out
the associations between the awareness and selected
variable.
Results: Majority of the responders (77%) were the head
of the house.Most of the respondents (30%) were from
the age group 18"27years. Their median age was found
to be 39 years and IQR 26-51.75 years.The standard
deviation was found to be 14.24. More than one third of
the family (35%) were Hill disadvantaged janajati and
another one third were Upper caste groups (34%). More
than half of the respondents (56%) belonged to nuclear
family. Majority of the families (77%) hadfamily members
less than or equal to six in the family. The median no. of
family member is 5 and IQR (4"6). F ourty percent of the
head of the house were labour, followed by involvement
in the business 18%. Nearly half of the head of the house

- 24 -
(49%) had studied up to primary to high schooll and about
one third (32%) of the people w ere illiterate.
The economic status of the majority of the f amily (80%)
were below poverty line whereas one fifth (20%) were
above poverty. Out of 100 families taken,18 families had
the members with the previous exposure to Kala-azar.
Regarding the assessment of knowledge of mode of
transmission of Kalazar, majority of the respondents (56%)
replied the commonest mode of transmission of Kala-azar
is from the bite of infected mosquito and 35% correctly
responded the mode of transmission is from the bite of
infected sand fly and few replied through the air and by
drinking dirty water. While assessing knowledge regarding
theriskfactorsofkala-azarthemajorityofthepeople(96%)
consideredwatercollectedditchorpondaround the house
andthrowingwastageseverywhereasthemajorriskfactors
followed by shed near the house (94%) and more than half
(54%) considered crevices in the house as also the risk
factor.the knowledgeregarding sign and symptomsofKala-
azar.
While assessing knowledge about the signs and symptoms
of Kalazar, majority of people (88%) considered fever for
two or more than two weeks as the major sign and
symptom. Almost half (49%) respondents denied the
increase in the weight. More than half (53%) of the
respondent didnot have any knowledge about the
abdominal pain. Half (50%) of the respondent didnot know
about abdominal enlargement, however, (42%) knew
about it. Majority of the r espondents (84%) knew about
darkening of skin and more than three fourth (77%) of
the people knew about anemia. W ith regards to the
knowledgeregarding diagnosis of Kala-azar majority (96%)
of the respondents considered check up with doctor can
diagnose the disease,similarly (94%) respondents believed
it can be diagnosed by blood check,nearly half (45%) of
the respondents said by bone marrow aspiration.More
than half of the respondents (60%) considered Kala-azar
as a non-communicable disease. Similarly, majority of the
respondents (65%) had knowledge regarding free
treatment of Kala-azar.
While asking about the practice of making shed near the
house majority(85%) of the families did not have shed near
the house. Majority (75%) of the respondent responded
that kala-azar spreads as epidemic during summer and
almost one fifth(19%) of the r espondent correctly
responded it as rainy season.While asking about the
participation of the respondents in Kalazar awareness
programmajority (93%) of the r espondents did not
participateinany awareness programmeandonlyfew(7%)
participated on awareness programme.
Table 1. Respondent’s Knowledge Regarding the
Preventive Measures of Kala-azar
n=100
SN Categories
Response in percentage
Yes No Do not know
1. Use of mosquito net 95 1 4
2. Use of DDT spray 85 4 11
3. Environmental cleanliness 98 0 2
4. Burning of a coil 85 11 4
5. Avoid the case of kala-azar 24 58 18
6. Use of medicated bed net
given by NGO'S,INGO'S
84 4 12
Table 2. Respondents’ Attitude Regarding Kala-azar
n=100
SN Categories SA A C D SD
1. Kala-azar caused to the
people of lowest
socioeconomic group.
43 21 8 8 20
2. Kala-azar caused to people
irrespective of caste, sex,
age, population.
68 9 4 3 16
3. After exposure to Kala-azar
one cannot live a normal
life.*
14 9 8 10 59
4. Isolation of kala-azar case
should be done.*
14 7 16 8 55
5. Kala-azar can be cured by
faith healers.*
0 1 0 1 98
6. Kala-azar can be controlled
by community participation.
72 16 10 0 2
* = negative statements
SA=strongly agree D=Disagree
A=Agree SD=stronglydisagree C=Con fused
Table 3. Practice Regarding Kala-azar of the Family
n=100
Variables Categories Percentage
Floor stay Upper 4
Lower 96
Sleeping place Inside room 90
Outside room in verendah 10
Place inside the room Bed
Floor
85
5
Use of net Yes 88
No 12
Causes of not using
(N=12)
No net 5 (41.66%)
Others
• Unwillingness
• No mosquitos
• Sleep in fan
• Suffocation
7 (58.33%)
2 (28.57%)
1 (14.29%)
1 (14.29%)
3(42.90%)

- 25 -
Conclusions: Kala-azar(Visceralleishmaniasis)isazoonotic
infection caused by protozoa(parasite) that belong to the
genus Leishmania. The disease is named after
Leishman,who first described it in London in May 1903. It
is transmittedby the biteofinfectedfemale sandfly(vector)
Phlebotamusargentipes.Visceral Leishmaniasisis
predominantlyruraldisease, commoninlowlandsofNepal.
Since 1997, VL has been reported from the Dharan with
peak in 2005 at ward no. 14 & 15 of Dharan . There is no
data available about knowledge, attitude and practices of
the community people about VL , which is vital for the
success of disease control program. The disease can be
controlled through raising awareness of the people and
bridging the gap between knowledge and practice.The
awareness program may be in the form of broadcasting
the information in the air from FM, publishing pamplets
and booklet or organizing health teching in the area by
nurses.
References:
1. Guerin P,OlliaroP,Sundar S. et al. Drugs for the
treatment of V isceral
Leishmaniasis,currentstatus,needs and proposed R
and D Agenda. Lancet Inf Dis.2002;2(8):594-501
2. NA Siddique et.al. Awareness about Kalazar disease
and related preventive attitude and practices in highly
endemic rural area of India. Southeast Asian J Trop.
Med public Health.2010;41(1):1-12
3. Sunder S, More DK, Singh MK, et al. Failure of
pentavalent antimonyinvisceralleishmaniasisinIndia:
report from the center of the Indian epidemic. Clin
Infect Dis .2000;2(2):151-58
4. Alvar J, Yactayo S, Bern C. Leishmania sis and
poverty. Trends Parasito .2006;22(12):552-57
5. Mondal D, Singh SP, Kumar N, et al. V isceral
leishmaniasis elimination programme in India,
Bangladesh, and Nepal: reshaping the case finding/
case management strategy. PLoSNegl Trop
Dis .2009;3(1):355
6. Boelaert M, Meheus F, Sanchez A et al. The poorest of
the poor: a poverty appraisal of households affected
by visceral leishmaniasis in Bihar, India. . Tropical
MedicineandInternational Health .2009;14(6):639-44
7. Adongo P B, Kirkwood B & Kendall C . How local
community knowledge about malaria a ffects
insecticide-treatednetuseinnorthernGhana. Tropical
Medicine and InternationalHealth .2005;10(3):366-78
8. Guerin P J, Olliaro P, Sundar S et al. V isceral
leishmaniasis: current status of control, diagnosis, and
treatment, and a proposedresearch and development
agenda. LancetInfectious Diseases .2002;2(8):494-501
9. Adhikari SR and Maskay NM. Economic Cost and
Consequences of Kala-Azar in Danusha and Mahottari
Districts of Nepal. Indian Journal of Community .

- 26 -
STATUS OF BREAST-FEEDING PRACTICES AMONG MOTHERS OF
HOSPITALIZED NEONATES IN BPKIHS
Binisha Sinha, B K Karn , U Yadav,
B Thapa, R Bhurtel
College of Nursing, BPKIHS
Email: me_binisha@yahoo.com
Abstract: Breastfeeding is the ideal form of infant feeding and is crucial for lifelong health and well-
being. Although, majority of mother s in Nepal have been breastfeeding their children, but still there
are a number of problems related to breastfeeding practices. To assess the status of breastfeeding
practices among mothers of hospitalized neonates. A descriptive study was carried out at Neonatal
Ward at BPKIHS, Dharan. The study was carried out on 45 hospitalized neonates. All the mothers present
in the ward for the care of admitted neonates were the sample of the study. The consecutive sampling
technique was used to select the study subjects using structured and semi-structured questionnaire.
Collected data were analyzed using descriptive statistics.
The median age of the hospitalized neonates was 9 days with IQR (4-16) days. More than 82% of the
hospitalized neonates were currently breastfed.Only about 4% of the mothers had practiced pre-lacteal
feeds. About 42% of the mothers initiated breast feeding within one hour of deliv ery and 86% of the
mothers fed colostrum to their hospitalized neonates. The mean frequency of night time breastfeeding
practices reported was 2 times. More than 86% of the mothers had practiced exclusive breastfeeding.
Nearly 8% of the mothers practiced partial breastfeeding practices. Lactogen and cow’s milk were the
most common type. Only 4% had practiced predominant breastfeeding practice. More than 91% of the
mothers breastfed their neonates during illness period. The most common reason being the doctor/
nurse advice (75.6%). Almost 83% of the mothers had received some type of information regarding
breastfeeding practices and Health Institution (83%), being the most common source. Breastfeeding
counseling during antenatal clinics, immunization clinics, postnatal follow up and peer support for
exclusive breastfeeding should be included as part of breastfeeding promotion programs in BPKIHS as
well.
Key Words: Breastfeeding Practices, Mothers, Hospitalized neonates.
Introduction: Breastfeeding is the ideal form of infant
feeding and is crucial for lifelong health and well-being.1
Although majority of mother s in Nepal have been
breastfeeding their children, but still there are a number
of problems related to breastfeeding practices.
Objectives: The study was conducted to assess the status
of breastfeeding practices among mothers of hospitalized
neonates.
Materials & methods: A cross-sectional descriptive study
design was used to conduct the study. The setting of the
study was Neonatal Ward of BPKIHS, Dharan. Total 45
samples were selected using consecutive Sampling
Technique. A semi structured interview questionnaire was
used to assess the breastfeeding practices. Collected data
were analyzed using descriptive statistics such as
percentage, frequency, mean, median, mode and Inter
Quartile Range, Standard Deviation.
Results: The median age of the mother was found to be 24
years with mean parity ± S.D being (1.7 5 ± 1.00). About
62% of the neonates were normally delivered and nearly
50% of the mother ’s were educated up to secondary level.
Majority (82%) were housewives. Seventeen out of forty
five mothers belonged to disadvantaged janajatis and
majority (80%) of the mother s belonged to joint family.
Regarding mode of delivery of the index child, 30 neonates
were institutional inborn, 7 were institutional outside born
and only 6 neonates were delivered at home. About 62%
of the neonates were male.
The median age of the neonates were 9 days IQR being (4-
16)days.Themostcommondiagnosiswereneonatalsepsis
(46.7%), Hyperbilirubinemia (20%) followedby pneumonia
(17%). About 82% of the hospitalized neonates were
currently on breastfeeding. Only 2% of the mothers had
practicedprelactealfeedingandabout42%oftheneonates
wereinitiatedwithinonehourofdelivery.Themediantime
of initiation of breastfeeding was 2 hours. The most
common reasons for delay in initiation were ‘baby was
admitted in NICU, BPKIHS’, ‘baby was referred to BPKIHS
soon after delivery’, ‘due to hospital procedure’ and ‘baby
didn’t cried and was admitted after delivery’. Nearly 87%
of the mothers fed colostrum to their babies. About 93%
of the mothers practiced night time breastfeeding and the

- 27 -
mean frequency of night time breastfeeding practices ±
S.D was (2±1.02) times.
About 9% of the mother s had practiced partial
breastfeeding practices; lactogen being the common type
whereas only 4% of the mother s had practiced
predominantbreastfeeding;waterbeingthecommontype.
Nearly 87% of the mothers had practiced exclusive
breastfeeding to their hospitalized neonates. Ninety-one
percent of the mother breast fed their neonates during
illness period of the neonates. The most common reason
being ‘doctor/ nurses advise’ and ‘baby feels hungry’. The
most common reason for not feeding during illness were
‘as per doctor/ nurse advise’ and ‘baby can’t suck breast
milk’. About 82% of the mothers received information
regarding breastfeeding practices and the most common
reason being doctor/ nurses (86%), health institution (83%)
and television/ radio (78%).
Discussion: The median age of the hospitalized neonates
was 9 days. More than 82% of the hospitalized neonates
were currently breastfed. The main reason for currently
not breastfeeding was ‘as per doctor’s advice’.
Only about 4% of the mother s had practiced prelacteal
feeds, which was found in spontaneous vaginal and home
delivery; and honey and cow’s milk being the most
common prelacteal feeds. The most frequent reason for
giving prelacteal feeds were traditional practices and
mother/ mother’s in law advice. A study done by V Khanal
in Nepal found that 21.3% of mothers introduced some
type of prelacteal feeds to the neonates as plain water,
sugar/gucose, infantformula, any other milk beside breast
milk, honey etc..2
A study in Ethiopia found that about 38%
had practiced prelacteal feeds and home delivery was a
risk factor for practicing prelacteal feeding. Late initiation
was also associated with prelacteal feeding in his study 3
.
According to NDHS 2011, 28 % of infants are given a pre-
lacteal feed (ghee, honey, sugar)6
.
Only 4% had initiated breastfeeding within half an hour of
birth and about 20% within 1 hour of birth. The me dian
duration of initiation was 2 hours. About 57% of the cases
had delay in initiation of breastfeeding and the most
common reasons for delay in initiation were ‘baby was
admitted’, ‘due to Caesarean procedure’, and ‘ due to
hospitalprocedure’.Delayininitiationofbreastfeedingwas
found in spontaneous vaginal delivery and institutional
inborn neonates. As per third National Family Health
Survey (NHFS-3, India); only 23.4% chi ldren received
breastfeeding within one hour of birth 4
whereas a study
done in Bhaktapur, Nepal found that 91% of the mothers
gave colostrum and 57% initiated breastfeeding within 1
hour of delivery5
whereas nearly 86% had fed colostrum
to the neonates and the most common reason for not
feeding colostrum were ‘baby was sick and admitted, not
able to suck’ and ‘ doctor’s advice not to breastfeed now’
in our study.
Colostrum feeding practices was found to be satisfactory
in institutional inborn babies. The probable reason might
be the doctor’s/ nurses advice. According to NDHS 2011,
nearly 45 % of children are breastfed within an hour of
birth. 85 % of children are breastfed within a day of birth.
Breastfeeding within one hour of birth is mor e common in
urban areas (51 %) than in rural areas (44 %). Children born
in a health facility were more likely to start breastfeeding
within one hour of birth (5 6 %) than children delivered at
home (36 %)6
.
About 6% of the cases didn’t practice night time
breastfeeding. The mean frequency of nigh t time
breastfeedingpracticewas2times. About 8% hadpractised
partial breastfeeding practices. The most common type
being cow’s milk and lactogen. Spoon feeding and bottle
feeding were the common ways of partial breastfeeding
practices and the reasons being ‘baby’s feels hungry’ and
‘less breast milk secreted’. Only 4% had practiced
predominant breastfeeding practices. The common type
ofpredominantbreastfeedingpracticebeingwaterandthe
most common reason being ‘baby feels thirsty’. More than
86% of the mothers had practiced exclusive breastfeeding
whereas the prevalence of exclusive breastfeeding at 1
month is 74% and 15% of the neonates had initiated partial
breastfeeding practices within 1 month in the study done
by K Ulak in Nepal5
. According to NDHS 2011, nearly, 88 %
percentofinfants age 0-1 months receivebreastmilk only6
.
Morethan82%ofthecases hadreceivedinformationabout
breastfeeding practices during antenatal period or
postnatal period and nurses being the main sources of
information.
The mean parity of mothers in the present study was found
to be 1.75 ± 1.00 whereas the mean parity of mothers was
2.10 ± 1.08 in the study done by Kumar Dinesh et al in
India7
.A study done by Tuladhar JM in 1990 on Breast
feeding: Patterns and Correlates in Nepal found that the
younger women and women who have higher parity had
a slightly shorter length of breastfeeding8
.
Conclusion: Overall outcome of this study suggests that
although breastfeeding is natural and physiological, the
current breastfeeding practices are far from optimum. The
harmfulbreastfeedingpracticessuchasintroductionofpre-
lacteal feeds, discarding colostrums and delay in initiation
of breastfeeding is prevalent in our setting. So,
breastfeeding counseling during an tenatal clinics,
immunization clinics, postnatal period and peer support
for exclusive breastfeeding should be included as part of
breastfeeding promotion programs in every health
institution and BPKIHS as well.

- 28 -
References:
1. GhaiOP.EssentialsofPediatrics.6thed.CBSPublishers,
New Delhi.2004.
2. Khanal V, Adhikari M, Sauer K, Zhao Y.Factors
associated with the introduction of prelacteal feeds
in Nepal: Findings from the Nepal Demographic and
Health Survey 2011.Int Breastfeed J. 2013. 8; 8(1):9.
3. Legesse M, Demena M, Mesfin F, Haile D. Prelacteal
feeding practices and associated factors among
mothers of children aged less than 24 months in Raya
Kobo district, North EasternEthiopia: a cross-sectional
study.Int Breastfeed J. 2014. 14;9(1):189.
4. GuptaP.TextbookofPediatrics.1st
ed.NewDelhi.2013.
CBS Publishers and Distributors.
5. Ulak M, Chandyo RK, Mellander L, Shrestha PS, Strand
TA. Infant feeding practices in Bhaktapur, Nepal: a
cross-sectional, health facility based survey. Int.
Breastfeed J. 2012. 10;7(1):1.
6. Nepal Demography and Health Survey (NDHS-20011):
Nutrition for Children and Women. Ministry of Health
and population/New Era/Macro Int’l Inc, Calverton
Maryland, USA. 2012.
7. Kumar D, Agrawal N, Swami HM. Socio-demographic
Correlates of breastfeeding in urban slums of
Chandigarh. Indian J of Med Sci. 60:461-466.
8. Tuladhar JM. Breast feeding: Patterns and Correlates
in Nepal. Asia-pacific population Journal, 1990;
5(1):157-63.

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