Kunta Devi Pun - Academia.edu (original) (raw)

Papers by Kunta Devi Pun

BMC Public Health, Sep 14, 2023

Background Domestic violence (DV) prior to, and during pregnancy is associated with increased ris... more Background Domestic violence (DV) prior to, and during pregnancy is associated with increased risks for morbidity and mortality. As pregnant women routinely attend antenatal care this environment can be used to offer support to women experiencing DV. We have developed a video intervention that focuses on the use of behavioral coping strategies, particularly regarding disclosure of DV experiences. The effectiveness of this intervention will be evaluated through a randomized controlled trial (RCT) and a concurrent process evaluation. Methods All pregnant women between 12-22 weeks of gestation attending routine antenatal care at two tertiary level hospitals in Nepal are invited to participate. DV is measured using the Nepalese version of the Abuse Assessment Screen (N-AAS). Additionally, we measure participants' mental health, use of coping strategies, physical activity, and food security through a Color-coded Audio Computer Assisted Self Interview (C-ACASI). Irrespective of DV status, women are randomized into the intervention or control arm using a computer-generated randomization program. The intervention arm views a short video providing information on DV, safety improving actions women can take with an emphasis on disclosing the violence to a trusted person along with utilizing helplines available in Nepal. The control group watches a video on maintaining a healthy pregnancy and when to seek healthcare. The primary outcome is the proportion of women disclosing their DV status to someone. Secondary outcomes are symptoms of anxiety and depression, coping strategies, the use of safety measures and attitudes towards acceptance of abuse. Follow-up is conducted after 32 weeks of gestation, where both the intervention and control group participants view the intervention video after completing the follow-up questionnaire. Additionally, a mixed methods process evaluation of the intervention will be carried out to explore factors influencing the acceptability of the intervention and the disclosure of DV, including a review of project documents, individual interviews, and focus group discussions with members of the research team, healthcare providers, and participants.

Violence Exposed Nepalese Pregnant Women have an Accepting Attitude to Domestic Violence and Suffer from Emotional Distress

PubMed, Apr 17, 2024

Background Violence against women and girls is frequent, a third of all women is estimated to exp... more Background Violence against women and girls is frequent, a third of all women is estimated to experience violence in their lifetime and mostly by an intimate partner. Women in Southeast Asia are most affected, and previous studies in Nepal found that one in five women had experiences of domestic violence, including being afraid of someone in the family. Objective To investigate women's attitudes to domestic violence and their emotional distress, in a specific group of pregnant women. Method Validated questions from the WHO multi-country study on women's health and experiences of domestic violence, and questions from the Hopkins Symptom Checklist (HSCL-5), measuring depression and anxiety, were used. Women could answer anonymously by hearing questions in a headset and touching a tablet screen, for 'yes' or 'no'. Result In total 1011 pregnant women participated in the research and 240 women admitted being exposed to domestic violence (23.7%). These women had a more accepting attitude to violence compared to non-violence exposed women. They agreed more that the husband had good reasons to hit his wife, if she does not complete the household work to his satisfaction, she disobeys or refuses to have sex with him. Violence exposed women also reported more emotional distress and subsequently reduced wellbeing. They admitted worrying too much, feelings of hopelessness, feeling blue, fearful, or nervous. Conclusion The present study found that the pregnant Nepali women having an accepting attitude to violence suffer from emotional distress.

Scandinavian Journal of Public Health, Aug 10, 2017

on behalf of ADVANCE study group 1 .

PLOS ONE, Jul 26, 2018

This study aimed to evaluate if domestic violence affected women's ability to prepare for childbi... more This study aimed to evaluate if domestic violence affected women's ability to prepare for childbirth. Birth preparedness and complication readiness (BP/CR) includes saving money, arranging transportation, identifying a skilled birth attendant, a health facility, and a blood donor before childbirth. During data collection, Nepal experienced two earthquakes and therefore it was possible to examine associations between domestic violence, women's BP/ CR and effects of the earthquakes. Methods Women who were between 12 and 28 weeks of gestation participated in a descriptive crosssectional study at a hospital antenatal clinic in Nepal, where they completed a structured questionnaire on sociodemographic characteristics, obstetric history, experiences of domestic violence, and BP/CR. The 5-item Abuse Assessment Screen was used to assess prevalence of domestic violence, and a questionnaire on safe motherhood obtained from Jhpiego was used to assess BP/CR status. The participants self-completed the questionnaire on a tablet computer. Those who reported at least three out of five BP/CR activities were considered prepared for childbirth. Results A total of 1011 women participated in the study: 433 pre-earthquakes and 578 post-earthquakes. With respect to BP/CR, 78% had identified a health facility for childbirth and 65% had saved money prior to childbirth. Less than 50% had identified a birth attendant to assist

Kathmandu University Medical Journal, Jun 10, 2012

Background Antenatal care is provided during pregnancy to save lives of mother and foetus. World ... more Background Antenatal care is provided during pregnancy to save lives of mother and foetus. World Health Organization recommends four focused visits as sufficient for normal pregnancy. Objective The objective of the study was to find out antenatal care practices in Tamang community of hilly areas of central Nepal. Methods Descriptive cross-sectional study was conducted in Tamang community of Lalitpur district. Systematic random sampling method was used to collect data from April to May 2011. Data of 194 women having ≥3 years of children was collected and analyzed in descriptive and inferential ways. Results Antenatal visits were made by 78.9% (153) of women but only 46.4% (71) completed four antenatal visits. Mean visit was of 3.5 ± 1.13 times. Ninety four (61.4%) of first antenatal visits attainders completed the fourth visit. Age of women and antenatal visits, taking tetanus toxoid injection and knowledge on work of iron tablets exhibited significant association at 95% level of confidence (p <0.05). There was also significant association between numbers of childbirth and antenatal visits at 95% level of confidence (p <0.05). Conclusions There was a high rate of early marriage and early pregnancy in the Tamang communities. Women did not place high importance on antenatal visits. A large percentage did not complete all four recommended antenatal visits. Use of necessary medicine like iron, albendazole tablets and tetanus toxoid injection was often incomplete.

Kathmandu University Medical Journal, Jun 7, 2012

Background Adolescence Pregnancy is a social problem worldwide with serious implication of matern... more Background Adolescence Pregnancy is a social problem worldwide with serious implication of maternal and child health. This study purposed to compare the maternal and neonatal outcome of the teenage mothers (15-19 years) with that of the young mothers (20-24 years) to determine if adolescent pregnancies have increased risk of adverse outcomes.

Domestic Violence and Pregnancy in Nepal - Perceptions, Prevalence, Birth Preparedness and Perinatal Outcomes

Global Health Action, Jul 20, 2020

b,c,d on behalf of the ADVANCE study group †

Kathmandu University Medical Journal, Dec 31, 2022

Background The Cesarean Section (CS) is a major obstetric life-saving procedure used to avoid pre... more Background The Cesarean Section (CS) is a major obstetric life-saving procedure used to avoid pregnancy and childbirth complications. Cesarean sections are becoming more popular across the world, as well as in Nepal. Objective To assess the prevalence of cesarean section and its associated factors among women in Dhulikhel, Nepal. Method A cross-sectional study was conducted where 1246 pregnant women of age 15-45 years, admitted and delivered in hospital, were selected through purposive sampling technique and interviewed using structured questionnaires in Dhulikhel Hospital,

Kathmandu University Medical Journal, 2009

Background: Peripheral intravenous catheter-related phlebitis is a common and significant problem... more Background: Peripheral intravenous catheter-related phlebitis is a common and significant problem in clinical practice. This study was carried out to determine the occurrence of peripheral intravenous catheter related phlebitis and to define the possible factors associated to its development. Materials and methods: Prospective observational study was carried out on 230 clients who were under first time peripheral infusion therapy during two months period: September - October, 2007. Peripheral infusion site was examined for signs of phlebitis once a day. Jackson Standard visual phlebitis scale was used to measure the severity of the phlebitis. SPSS software was used to enter, edit and analyze the data and t-test, chi-square test, binary logistic regression and ROC curve were used to draw the statistical inferences. Results: Phlebitis developed in 136/230 clients (59.1%). It was very mild in most cases. Increased incidence rates of infusion related phlebitis were associated with male ...

Prevalence of domestic violence and birth preparedness and complication readiness among pregnant women in Nepal (N = 1011)

<p>Prevalence of domestic violence and birth preparedness and complication readiness among ... more <p>Prevalence of domestic violence and birth preparedness and complication readiness among pregnant women in Nepal (N = 1011).</p

Distribution of domestic violence, earthquake status, sociodemographic and obstetric characteristics in relation to birth preparedness and complication readiness among pregnant women in Nepal (N = 1011)

<p>Distribution of domestic violence, earthquake status, sociodemographic and obstetric cha... more <p>Distribution of domestic violence, earthquake status, sociodemographic and obstetric characteristics in relation to birth preparedness and complication readiness among pregnant women in Nepal (N = 1011).</p

Flow chart of inclusion in the study population

<p>Flow chart of inclusion in the study population.</p

Associated risk factors for birth preparedness and complication readiness among pregnant women with complete case information (N = 954) in Nepal

<p>Associated risk factors for birth preparedness and complication readiness among pregnant... more <p>Associated risk factors for birth preparedness and complication readiness among pregnant women with complete case information (N = 954) in Nepal.</p

Additional file 3: of Domestic violence and perinatal outcomes â a prospective cohort study from Nepal

Prevalence of domestic violence and low birthweight, preterm birth or cesarean section of Nepal, ... more Prevalence of domestic violence and low birthweight, preterm birth or cesarean section of Nepal, 2016 (DOCX 16 kb)

Additional file 2: of Domestic violence and perinatal outcomes â a prospective cohort study from Nepal

Distribution of obstetric characteristics among women of Nepal, 2016. (DOCX 21 kb)

Additional file 1: of Domestic violence and perinatal outcomes â a prospective cohort study from Nepal

Characteristics of women with and without delivery records in Nepal, 2016. (DOCX 25 kb)

Domestic Violence and Pregnancy in Nepal - Perceptions, Prevalence, Birth Preparedness and Perinatal Outcomes

Global Health Action

b,c,d on behalf of the ADVANCE study group †

International Journal of Environmental Research and Public Health

Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for... more Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for both the mother and newborn, and sometimes death. In a low-income country like Nepal, women have few options to leave abusive situations. Therefore, there is a need for interventions to improve their safety. The aim of our study was to explore the use of safety measures before and after an educational intervention among women who have reported DV during pregnancy. Materials and methods: Of 1010 pregnant women screened consecutively for DV using the Abuse Assessment Screen (AAS) during routine antenatal care, 181 women reported domestic violence. All 1010 participating pregnant women were taught 15 safety measures using a locally developed flipchart. We obtained contact with 80 of the 181 eligible women postpartum, of whom 62 completed the follow-up assessment. We explored and described the use of safety measures at baseline and follow-up, using a standardized instrument called the Safet...

BMC Public Health, Sep 14, 2023

Background Domestic violence (DV) prior to, and during pregnancy is associated with increased ris... more Background Domestic violence (DV) prior to, and during pregnancy is associated with increased risks for morbidity and mortality. As pregnant women routinely attend antenatal care this environment can be used to offer support to women experiencing DV. We have developed a video intervention that focuses on the use of behavioral coping strategies, particularly regarding disclosure of DV experiences. The effectiveness of this intervention will be evaluated through a randomized controlled trial (RCT) and a concurrent process evaluation. Methods All pregnant women between 12-22 weeks of gestation attending routine antenatal care at two tertiary level hospitals in Nepal are invited to participate. DV is measured using the Nepalese version of the Abuse Assessment Screen (N-AAS). Additionally, we measure participants' mental health, use of coping strategies, physical activity, and food security through a Color-coded Audio Computer Assisted Self Interview (C-ACASI). Irrespective of DV status, women are randomized into the intervention or control arm using a computer-generated randomization program. The intervention arm views a short video providing information on DV, safety improving actions women can take with an emphasis on disclosing the violence to a trusted person along with utilizing helplines available in Nepal. The control group watches a video on maintaining a healthy pregnancy and when to seek healthcare. The primary outcome is the proportion of women disclosing their DV status to someone. Secondary outcomes are symptoms of anxiety and depression, coping strategies, the use of safety measures and attitudes towards acceptance of abuse. Follow-up is conducted after 32 weeks of gestation, where both the intervention and control group participants view the intervention video after completing the follow-up questionnaire. Additionally, a mixed methods process evaluation of the intervention will be carried out to explore factors influencing the acceptability of the intervention and the disclosure of DV, including a review of project documents, individual interviews, and focus group discussions with members of the research team, healthcare providers, and participants.

Violence Exposed Nepalese Pregnant Women have an Accepting Attitude to Domestic Violence and Suffer from Emotional Distress

PubMed, Apr 17, 2024

Background Violence against women and girls is frequent, a third of all women is estimated to exp... more Background Violence against women and girls is frequent, a third of all women is estimated to experience violence in their lifetime and mostly by an intimate partner. Women in Southeast Asia are most affected, and previous studies in Nepal found that one in five women had experiences of domestic violence, including being afraid of someone in the family. Objective To investigate women's attitudes to domestic violence and their emotional distress, in a specific group of pregnant women. Method Validated questions from the WHO multi-country study on women's health and experiences of domestic violence, and questions from the Hopkins Symptom Checklist (HSCL-5), measuring depression and anxiety, were used. Women could answer anonymously by hearing questions in a headset and touching a tablet screen, for 'yes' or 'no'. Result In total 1011 pregnant women participated in the research and 240 women admitted being exposed to domestic violence (23.7%). These women had a more accepting attitude to violence compared to non-violence exposed women. They agreed more that the husband had good reasons to hit his wife, if she does not complete the household work to his satisfaction, she disobeys or refuses to have sex with him. Violence exposed women also reported more emotional distress and subsequently reduced wellbeing. They admitted worrying too much, feelings of hopelessness, feeling blue, fearful, or nervous. Conclusion The present study found that the pregnant Nepali women having an accepting attitude to violence suffer from emotional distress.

Scandinavian Journal of Public Health, Aug 10, 2017

on behalf of ADVANCE study group 1 .

PLOS ONE, Jul 26, 2018

This study aimed to evaluate if domestic violence affected women's ability to prepare for childbi... more This study aimed to evaluate if domestic violence affected women's ability to prepare for childbirth. Birth preparedness and complication readiness (BP/CR) includes saving money, arranging transportation, identifying a skilled birth attendant, a health facility, and a blood donor before childbirth. During data collection, Nepal experienced two earthquakes and therefore it was possible to examine associations between domestic violence, women's BP/ CR and effects of the earthquakes. Methods Women who were between 12 and 28 weeks of gestation participated in a descriptive crosssectional study at a hospital antenatal clinic in Nepal, where they completed a structured questionnaire on sociodemographic characteristics, obstetric history, experiences of domestic violence, and BP/CR. The 5-item Abuse Assessment Screen was used to assess prevalence of domestic violence, and a questionnaire on safe motherhood obtained from Jhpiego was used to assess BP/CR status. The participants self-completed the questionnaire on a tablet computer. Those who reported at least three out of five BP/CR activities were considered prepared for childbirth. Results A total of 1011 women participated in the study: 433 pre-earthquakes and 578 post-earthquakes. With respect to BP/CR, 78% had identified a health facility for childbirth and 65% had saved money prior to childbirth. Less than 50% had identified a birth attendant to assist

Kathmandu University Medical Journal, Jun 10, 2012

Background Antenatal care is provided during pregnancy to save lives of mother and foetus. World ... more Background Antenatal care is provided during pregnancy to save lives of mother and foetus. World Health Organization recommends four focused visits as sufficient for normal pregnancy. Objective The objective of the study was to find out antenatal care practices in Tamang community of hilly areas of central Nepal. Methods Descriptive cross-sectional study was conducted in Tamang community of Lalitpur district. Systematic random sampling method was used to collect data from April to May 2011. Data of 194 women having ≥3 years of children was collected and analyzed in descriptive and inferential ways. Results Antenatal visits were made by 78.9% (153) of women but only 46.4% (71) completed four antenatal visits. Mean visit was of 3.5 ± 1.13 times. Ninety four (61.4%) of first antenatal visits attainders completed the fourth visit. Age of women and antenatal visits, taking tetanus toxoid injection and knowledge on work of iron tablets exhibited significant association at 95% level of confidence (p <0.05). There was also significant association between numbers of childbirth and antenatal visits at 95% level of confidence (p <0.05). Conclusions There was a high rate of early marriage and early pregnancy in the Tamang communities. Women did not place high importance on antenatal visits. A large percentage did not complete all four recommended antenatal visits. Use of necessary medicine like iron, albendazole tablets and tetanus toxoid injection was often incomplete.

Kathmandu University Medical Journal, Jun 7, 2012

Background Adolescence Pregnancy is a social problem worldwide with serious implication of matern... more Background Adolescence Pregnancy is a social problem worldwide with serious implication of maternal and child health. This study purposed to compare the maternal and neonatal outcome of the teenage mothers (15-19 years) with that of the young mothers (20-24 years) to determine if adolescent pregnancies have increased risk of adverse outcomes.

Domestic Violence and Pregnancy in Nepal - Perceptions, Prevalence, Birth Preparedness and Perinatal Outcomes

Global Health Action, Jul 20, 2020

b,c,d on behalf of the ADVANCE study group †

Kathmandu University Medical Journal, Dec 31, 2022

Background The Cesarean Section (CS) is a major obstetric life-saving procedure used to avoid pre... more Background The Cesarean Section (CS) is a major obstetric life-saving procedure used to avoid pregnancy and childbirth complications. Cesarean sections are becoming more popular across the world, as well as in Nepal. Objective To assess the prevalence of cesarean section and its associated factors among women in Dhulikhel, Nepal. Method A cross-sectional study was conducted where 1246 pregnant women of age 15-45 years, admitted and delivered in hospital, were selected through purposive sampling technique and interviewed using structured questionnaires in Dhulikhel Hospital,

Kathmandu University Medical Journal, 2009

Background: Peripheral intravenous catheter-related phlebitis is a common and significant problem... more Background: Peripheral intravenous catheter-related phlebitis is a common and significant problem in clinical practice. This study was carried out to determine the occurrence of peripheral intravenous catheter related phlebitis and to define the possible factors associated to its development. Materials and methods: Prospective observational study was carried out on 230 clients who were under first time peripheral infusion therapy during two months period: September - October, 2007. Peripheral infusion site was examined for signs of phlebitis once a day. Jackson Standard visual phlebitis scale was used to measure the severity of the phlebitis. SPSS software was used to enter, edit and analyze the data and t-test, chi-square test, binary logistic regression and ROC curve were used to draw the statistical inferences. Results: Phlebitis developed in 136/230 clients (59.1%). It was very mild in most cases. Increased incidence rates of infusion related phlebitis were associated with male ...

Prevalence of domestic violence and birth preparedness and complication readiness among pregnant women in Nepal (N = 1011)

<p>Prevalence of domestic violence and birth preparedness and complication readiness among ... more <p>Prevalence of domestic violence and birth preparedness and complication readiness among pregnant women in Nepal (N = 1011).</p

Distribution of domestic violence, earthquake status, sociodemographic and obstetric characteristics in relation to birth preparedness and complication readiness among pregnant women in Nepal (N = 1011)

<p>Distribution of domestic violence, earthquake status, sociodemographic and obstetric cha... more <p>Distribution of domestic violence, earthquake status, sociodemographic and obstetric characteristics in relation to birth preparedness and complication readiness among pregnant women in Nepal (N = 1011).</p

Flow chart of inclusion in the study population

<p>Flow chart of inclusion in the study population.</p

Associated risk factors for birth preparedness and complication readiness among pregnant women with complete case information (N = 954) in Nepal

<p>Associated risk factors for birth preparedness and complication readiness among pregnant... more <p>Associated risk factors for birth preparedness and complication readiness among pregnant women with complete case information (N = 954) in Nepal.</p

Additional file 3: of Domestic violence and perinatal outcomes â a prospective cohort study from Nepal

Prevalence of domestic violence and low birthweight, preterm birth or cesarean section of Nepal, ... more Prevalence of domestic violence and low birthweight, preterm birth or cesarean section of Nepal, 2016 (DOCX 16 kb)

Additional file 2: of Domestic violence and perinatal outcomes â a prospective cohort study from Nepal

Distribution of obstetric characteristics among women of Nepal, 2016. (DOCX 21 kb)

Additional file 1: of Domestic violence and perinatal outcomes â a prospective cohort study from Nepal

Characteristics of women with and without delivery records in Nepal, 2016. (DOCX 25 kb)

Domestic Violence and Pregnancy in Nepal - Perceptions, Prevalence, Birth Preparedness and Perinatal Outcomes

Global Health Action

b,c,d on behalf of the ADVANCE study group †

International Journal of Environmental Research and Public Health

Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for... more Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for both the mother and newborn, and sometimes death. In a low-income country like Nepal, women have few options to leave abusive situations. Therefore, there is a need for interventions to improve their safety. The aim of our study was to explore the use of safety measures before and after an educational intervention among women who have reported DV during pregnancy. Materials and methods: Of 1010 pregnant women screened consecutively for DV using the Abuse Assessment Screen (AAS) during routine antenatal care, 181 women reported domestic violence. All 1010 participating pregnant women were taught 15 safety measures using a locally developed flipchart. We obtained contact with 80 of the 181 eligible women postpartum, of whom 62 completed the follow-up assessment. We explored and described the use of safety measures at baseline and follow-up, using a standardized instrument called the Safet...