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Nepal wellbeing Bournemouth Univerity Oct 2018

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Presentation on Bournemouth University research in Nepal, including THET-funded project on maternal mental health

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Nepal wellbeing Bournemouth Univerity Oct 2018

  1. 1. Prof. Edwin van Teijlingen @EvanTeijlingen Nepal team: Dr. Pramod Regmi, Dr. Nirmal Aryal, Dr. Bibha Simkhada & various FHSS Visiting Faculty BU Research & Wellbeing in Nepal 11 October 2018
  2. 2. BU Health Research in Nepal • Health staff capacity building • Reproductive & sexual health • Media & health • Mental health & well-being • Migration & health • PhD projects • Pratik Adhikary: Migrant workers’ health Malaysia & Middle East • Sheetal Sharma: Health promotion intervention study • Jib Acharya: Nutrition in children of the poor • Preeti Mahato: Evaluation of rural birth centres • Raksha Thapa: Discrimination & health of poor • Sulochana Dhakal: Rising Caesarean Section rates in Nepal
  3. 3. • Land-locked between India & China • Relatively high mortality & morbidity rates • GDP about $2,500 per person p/a* • GDP 197th country (out of 230)* * CIA (2017) World Fact book: Liechtenstein is first, UK 38th & Somalia is last. Background Nepal I
  4. 4. • Mount Everest • British Ghurkhas • Different climates • Largely Hindu population • 2015 earthquake Nepal II
  5. 5. • Independent state & republic since 2008. • Formerly the only Hindu kingdom in the world. • Never been a colony. • Census (2011) found literacy rate of men 75.1% but only 57.4 % in women with regional disparities in literacy. • Nepal only tried to increase literacy rate since inception of ‘democracy’ in 1951. Nepal III
  6. 6. 6 Mental Health Training for Community- Based Maternity Care Workers in Nepal Edwin van Teijlingen, Padam Simkhada, Bhimsen Devkota, Shyam K. Maharjan, Lokendra Sherchan, Ram Chandra Silwal, Krishna Acharya, Bishnu G.C., Ram K. Maharjan, Bibha Simkhada, Jillian Ireland, Jane Stephens, Colette Fanning, Geeta Sharma, Samridhi Pradhan, Seam MacKay, Ish Fawcett, Andrea Lawrie, Dave Havelock, Liz Murphy, Rose Pringle, Sapana Bista, Chrissy Reeves & Flora Douglas
  7. 7. 7 Mental Health in Maternity Care
  8. 8. 8 Mental Health in Nepal • Women of reproductive age have highest rates of suicide & mental health problems. 1 • Suicide rates within this group has increased from 22/100,000 in 1998 to 28/100,000 in 2008.2 Suicide is now one of leading causes of death for women of reproductive age.3 1) Subba SH, et al. Pattern and trend of deliberate self-harm in Western Nepal. J Forensic Sci. 2009; 54 (3): 704-707. 2) Pradhan A, et al. A review of the evidence: suicide among women in Nepal. Report by National Health Sector Support Program, DFID. Kathmandu, 2011. 3) Ho-Yen S, et al. Factors associated with depressive symptoms among postnatal women in Nepal. Acta Obstet Gynecol. 2007; 86: 291-297.
  9. 9. 9
  10. 10. 10 Mental health & maternity care in rural Nepal Two separate but related issues: • Rural population has poor access to skilled birth attendants, midwifery not recognised in Nepal as separate profession from nursing. • Mental illness is very stigmatised (not just in pregnancy & new mothers).
  11. 11. 11 Auxiliary Nurse Midwives • Key health care workers in for 90% of population who live in remote & rural areas. • Maternity care is poor: 58% women have access to ‘skilled providers’ (NDHS 2016). • Training of these maternity health workers falls short of international standard for midwifery (Bogren et al. 2013).
  12. 12. 12 Aims: • Build skills to recognise & discuss mental health issues in childbirth. • Introduce mental health promotion for women of childbearing age. • Design basic curriculum on maternal mental health. Project brought experienced UK health staff e.g. NHS midwives, midwifery lecturers, mental health nurses, etc. as volunteer trainers. THET-funded capacity building
  13. 13. 13 BU Fusion: Perfect fit NHS staff & BU staff volunteered to improve practice in Nepal
  14. 14. Participants selection & training • All ANMs working in all 23 Birthing Centres in Nawalparasi district were invited for training • All ANMs working in district participated (74 in total most are ANMs and few nurses).
  15. 15. 15 Training sessions • Six session over one year (Jan.2016-Jan 2017) • Different UK expert volunteers • ANMs divided into three groups (one third trained each day over three day period) • Started with need assessment • Regular feedback from ANMs • With Nepali translators & facilitators
  16. 16. Needs Assessment Jan 2016 Questionnaire in Nepali covered knowledge, training, community perspectives on mental health/illness. Received ethical approval from NHRC One-page questionnaire: ‘yes/no’ answers
  17. 17. Needs Assessment Jan 2016
  18. 18. 18 Example of exercises In groups of 3 discuss (max 5 mins): • What do mental health & mental illness mean to you? • How are these words/ terms related? • Be prepared to give feedback to group. • Facilitator to note key issues on flip chart.
  19. 19. 19 Example of exercise ‘What is Mental Health?’
  20. 20. 20 We asked ANMs about their expectations from training
  21. 21. 21
  22. 22. 22 Pre-post training comparison In the sixth and final session we asked the same questions as in the initial needs assessment and we added seven follow- up questions.
  23. 23. 23 Pre-post training comparison Question: Correct answer Pre-test correctly N=74 Post-test correctly N=69 Change = improve Mental illness is common - about one in five adults experience a mental disorder at some stage in their life. Yes 46 (62%) 58 (84%) +22% Mental illness cannot affect children or young people. No 60 (81%) 65 (94%) +13%
  24. 24. 24 Pre-post training comparison Mental illness can be caused by: Correct answer Pre-test correctly N=74 Post- test correctly N=69 Change + = improve stressful life events. Yes 74 (100% 62 (90%) -10% abuse Yes 73 (99%) 63 (91%) -6% pregnancy & childbirth Yes 37 (50%) 60 (87%) +37%
  25. 25. 25 Post training evaluation Questions: Post-test N (%) If there was an opportunity I would advise other ANMs to attend training on mental health issues 62 (90%) My mental training (attending session with UK volunteers) has helped me be better communicate with pregnant women about mental health issues 67 (97%) My mental training (attending session with UK volunteers) has helped me be better communicate with pregnant women about other issues (not mental health) 62 (90%) My mental training with UK volunteers was waste of time & money. 21 (30%) If necessary when you are stressed or worried can you get support from other ANMs or health post staff? 57 (83%)
  26. 26. 26 Post training evaluation BUT, despite all this positive learning 30% answered ‘yes’ to the question: “My mental training with UK volunteers was a waste of time & money.”
  27. 27. 27 ANMs said they had learnt:…  about mental health in community & be able to raise awareness on mental health  best ways to do mental health counselling  mental problems prenatal & postnatal period  to be able to identify mental health complications around childbirth  new things on taking care of new-born  to practise things learnt in training
  28. 28. 2018 PhD student publication
  29. 29. Well-being in Nepal: A more personal view • Doing research in low-income countries: dealing with expectations of: – Being rich (with loads of money) – Bringing solutions – Representing govt./authority • Making a difference as a researcher • The well-being of the researchers
  30. 30. Ethics & Politics in Nepal
  31. 31. • How do you run FGs when privacy /confidentiality are not high priorities on poor people’s agendas? • How to keep outsiders away in open-air FGs? • How do you manage community expectations? Non-personal (non-research) issues
  32. 32. Personal well-being issues: Non-research Out of 13 UK THET volunteers only one hospital visit and one stolen passport (and some money).
  33. 33. Making a difference
  34. 34. BU run BNAC conference 2017 Making a difference
  35. 35. Media coverage
  36. 36. 38 References THET project • Mahato PK, Regmi PR, et al. (2015) Birthing centre infrastructure in Nepal post 2015 earthquake. Nepal J Epidemiology 5(4): 518-519. • Simkhada B. et al. (2016) Needs assessment of mental health training for Auxiliary Nurse Midwives: a cross-sectional survey, J Manmohan Memorial Inst Health Sci 2(1): 20-26. • Simkhada P, van Teijlingen E, et al. (2015) Why are so many Nepali women killing themselves? A review of key issues J Manmohan Memorial Inst Health Sci 1(4): 43-49. • van Teijlingen E et al. (2015) Mental health issues in pregnant women in Nepal. Nepal J Epidemiol 5(3): 499-501. • Mahato P, van Teijlingen E, Simkhada P, Angell C, Ireland J on behalf of THET team (2018) Qualitative evaluation of mental health training of Auxiliary Nurse Midwives in rural Nepal. Nurse Educ Today 66: 44-50
  37. 37. 39 Any Questions? Twitter: @EvanTeijlingen #Nepal #GlobalBU Email evteijlingen@bournemouth.ac.uk

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