Congratulations to PhD student Mrs Preeti Mahato who has a research methods paper published based on her PhD study in Nepal . In the areas of health promotion and health education, mixed-methods research approach has become widely used. In mixed-methods research, also referred to as multi-methods research, researchers combine quantitative and qualitative research designs in a single study. This paper introduces the mixed-methods approach for use in research in health education. To illustrate this pragmatic research approach the paper includes Preeti’s thesis as an example of mixed-methods research as applied in Nepal.
The paper, in the Journal of Health Promotion, is co-authored by Preeti’s PhD supervisors Dr. Catherine Angell and Prof. Edwin van Teijlingen (both in the Centre for midwifery, Maternal &Perinatal Health) and BU Visiting Faculty Prof. Padam Simkhada.
Mahato, P., Angell, C., van Teijlingen, E., Simkhada, P.P. (2018) Using Mixed-methods Research in Health & Education in Nepal, Journal of Health Promotion Official Publication of Health Education Association of Nepal (HEAN), 6: 45-48.
The Journal of Immigrant and Minority Health (Springer) just accepted the latest paper by former FHSS Ph.D. student Dr. Pratik Adhikary (photo).  His latest paper ‘Workplace accidents among Nepali male workers in the Middle East and Malaysia: A qualitative study’ is the fourth, and probably final, paper from his Bournemouth University Ph.D. thesis. This latest paper is based on the qualitative part of the mixed-methods thesis, his previous papers focused more on the quantitative data. [2-4]
Since this is a qualitative paper it also offers a more theoretical underpinning than the previous papers. The work uses the dual labour market theory which associates labour migration specifically to the host economy as it explains migration from the demand side. Labour migrants from less developed economies travel to fill the unskilled and low-skill jobs as guest workers in more developed economies to do the jobs better trained and paid local workers do not want to do. This theory also explains the active recruitment through labour agents in Nepal to help fulfil the demand for labour abroad, and it helps explain some of the exploitation highlighted in host countries. The theory also helps explain why lowly skilled migrant workers are often at a higher risk to their health than native workers . Similar to migrant workers from around the world, Nepali migrant workers also experience serious health and safety problems in the host countries including accidents and injuries.
The latest article will be Open Access in the Journal of Immigrant and Minority Health!
Adhikary P., Keen S., van Teijlingen, E. (2011) Health Issues among Nepalese migrant workers in Middle East. Health Science Journal 5: 169-175. www.hsj.gr/volume5/issue3/532.pdf
Adhikary, P., Sheppard, Z., Keen, S., van Teijlingen, E. (2017) Risky work: Accidents among Nepalese migrant workers in Malaysia, Qatar and Saudi, Health Prospect16(2): 3-10.
Adhikary P, Sheppard, Z., Keen S., van Teijlingen E. (2018) Health and well-being of Nepalese migrant workers abroad, International Journal of Migration, Health & Social Care 14(1): 96-105. https://doi.org/10.1108/IJMHSC-12-2015-0052
Congratulations to Faloshade Alloh (PhD student in Faculty of Health and Social Science), Dr. Pramod Regmi (Lecturer in International Health), Abe (Igoche) Onche (BU graduate MSc in Public Health) and Dr. Stephen Trenoweth (Principal Academic and Leaded for BU iWell Research Centre) on the timely publication of their paper on mental health in developing countries .
Despite being globally recognised as an important public health issue, mental health is still less prioritised as a disease burden in many Low-and Middle-Income Countries (LMICs). More than 70% of the global mental health burden occurs in poorer countries. The paper addresses mental health issues in LMICs under themes such as abuse and mental illness, cultural influence on mental health, need for dignity in care, meeting financial and workforce gaps and the need for national health policy for the mental health sector. This exciting paper has 51 references including several linking to BU publications on research in Africa [2-3] and several papers related to South Asia [4-6], particularly highlighting the recently completed THET project that was led by BU [4-5].
The authors highlight that although mental health education and health care services in most LMICs are poorly resourced; there is an urgent need to address issues beyond funding that contribute to poor mental health. In order to meet the increasing challenge of mental health illness in LMICs, there is a need for effort to address cultural and professional challenges that contribute to poor mental health among individuals. The authors suggest that mental health should be integrated into primary health care in LMICs. Creating awareness on the impact of some cultural attitudes/practices will encourage better uptake of mental health services and increase the ease when discussing mental health issues in these countries which can contribute to reducing the poor mental health in LMICs.
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal and Perinatal Health (CMMPH)
Alloh, F.T., Regmi, P., Onche, I., van Teijlingen E., Trenoweth, S. (2018) Mental health in low- and middle income countries (LMICs): Going beyond the need for funding, Health Prospect 17 (1): 12-17.
Alloh F, Regmi P, Hemingway A, Turner-Wilson A. (2018) Increasing suicide rates in Nigeria. African Health Journal [In Press].
Alloh FT, Regmi PR. (2017) Effect of economic and security challenges on the Nigerian health sector. African Health Sciences. 17 (2):591-2.
Acharya DR, Bell JS, Simkhada P, van Teijlingen ER, Regmi PR. (2010) Women’s autonomy in household decision-making: a demographic study in Nepal. Reproductive Health. 7 (1):15.
Simkhada B, Sharma G, Pradhan S, Van Teijlingen E, Ireland J, Simkhada P, et al. (2016) Needs assessment of mental health training for Auxiliary Nurse Midwives: a cross-sectional survey. Journal of Manmohan Memorial Institute of Health Sciences. 2:20-6.
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 Education Today 66: 44-50. https://authors.elsevier.com/c/1Wu2axHa5G~S-
Regmi PR, Alloh F, Pant PR, Simkhada P, van Teijlingen E. (2017) Mental health in BME groups with diabetes: an overlooked issue? The Lancet. 389 (10072):904-5.
Last Saturday Festival of Learning highlighted BU’s research in the fields of health and migration in South Asia. BU Visiting Professor Padam Simkhada from Liverpool John Moores University (LJMU) presented selected studies with Dr. Pramod Regmi and Prof. Edwin van Teijlingen in the Create lecture theatre. Their work covers some of the recent research conducted in Nepal by staff from the Faculty of Health & Social Sciences. They highlighted two very interesting, but different, projects in particular.
The first one relates to Nepali migrant workers, since some 3.5 million Nepalese (14% of total population) are working abroad; primarily in Malaysia, the Middle East and India. One recent project is focusing on Nepali migrant workers in India. Working abroad is considered a livelihood strategy for many poor people and most Nepalese migrants are involved in semi/unskilled labour, mainly on building sites, in factories, and in domestic work.
The second project focuses on the health and social issue of transgender and the use of hormones. To date there is little literature on hormone use experiences in transgender populations in Nepal, focusing on a study of male-to-female transgender (MTF) populations and the experiences of people using hormone therapy (oral or injection or other replacement therapies).
Festival of Learning event 2018 with an international flavour: exploring recent research projects undertaken in Nepal by staff from the Faculty of Health and Social Sciences. The event focuses on Nepali migrant workers in India, women and migration and explores the health and social issues of transgender and the use of hormone therapy in male-to-female transitioning populations in Nepal.
Fusion Building: Create Lecture Theatre, Bournemouth University on Saturday 16 June 2018 from 5.00-6.00PM
A new multidisciplinary project in South Asia, run between two of Bournemouth University’s Faculties, has recently been funded. The cross-faculty project “Scoping Study to understand the maternal health, ageing and wellness in rural India to develop a grass-root centre addressing these issues” has Dr Shanti Shanker (Psychology) as its principal investigator in collaboration with Prof Edwin van Teijlingen (Human Sciences & Public Health). These BU lead researchers have been working in India and Nepal for more than a decade.
This project was recently awarded £76k from the HEFCE GCRF (Higher Education Funding Council for England, Global Challenge Research Funds) Call, at Bournemouth University. The project will be running from 2017 to 2021 between Maharashtra, India, Nepal and the UK. This important research initiative aligns closely with Bournemouth University’s strategic plan around South Asia through Connect India. Connect India is BU’s hub of practice which focuses on the world’s most populated areas and a global region which is developing rapidly in many ways.
Congratulations to FHSS PhD students Preeti Mahato and Elizabeth Waithaka, FHSS academics Drs. Catherine Angell and Pramod Regmi and BU Visiting Faculty Prof. Padam Simkhada (Based at Liverpool John Moores University) on the publication of their latest paper: ‘ Health Promotion opportunities for Auxiliary Nurse Midwives in Nepal’ . The paper appeared in Health Prospect: Journal of Public Health.
Mahato, P.K., Regmi, P.R., Waithaka, E., van Teijlingen, E., Simkhada, P., Angell, C. . Health Promotion opportunities for Auxiliary Nurse Midwives in Nepal. Health Prospect, 16 (2): pp. 13-17, May. 2018.
This week’s inaugural meeting of the Dorset Global Health Network was a great success. It was sold out on ‘Eventbrite’ long before day of the event (25th of April). The inaugural meeting held at Bournemouth University (BU) focused on Nepal. The evening was opened by Dr. Emer Forde who is GP Programme Director, Health Education Wessex (Dorset) and member of BU’s Centre for General Practice. She spoke of her and her son’s recent experience in her presentation ‘Voluntourism in Nepal : A lesson in the grey areas of global health.’
The second short presentation was by Prof. Edwin van Teijlingen for BU’s Centre for Midwifery, Maternal & Perintal Health (CMMPH). His presentation with the title ‘The challenge of perinatal mental health in Nepal’ covered issues around maternal mental health, auxiliary nurse-midwives and stigma and culture in southern Nepal. The project brought together academics, midwives, nurses, and other health workers in Nepal and the UK to help in the training of auxiliary nurse midwives in Nawalparasi on key aspects of mental health and mental health promotion. The project led by Bournemouth University was funded under the Health Partnership Scheme (HPS) which is managed by a London-based organisation called THET (Tropical Health & Education Trust).
The third speaker and final speaker Dr Ollie Ross, Consultant Anaesthetist at Southampton General Hospital, introduced the film ‘Hospital’. The film provides a portrait of a state-run hospital in one of the most remote and poor districts of Nepal and how individuals can make a difference to people’s lives. Dr Ross is also a consultant to the Nick Simons Foundation working in Nepal. According to The Nepali Times Nepal’s most accomplished documentary maker, Kesang Tseten, has a knack of bringing out in his films the best in people. He looks for the flower that grows amidst the squalour, and tries to spread a message of hope. His film, Hospital, returns to rural Nepal to portray a hospital in Kalikot where ordinary health workers accomplish extraordinary things.
The event was organised by the Dorset Primary Care Workforce Centre in collaboration with Bournemouth University and the Wessex Global Health Network.
This week saw the pre-publication of ‘Qualitative evaluation of mental health training of auxiliary nurse midwives in rural Nepal’ in the international journal Nurse Education Today (published by Elsevier). The paper is a report of an evaluation of a THET-funded projectwhich run from 2015 to 2017. Bournemouth University led a team comprising Liverpool John Moores University and Tribhuvan University (the oldest university in Nepal). These three universities worked together on a training project of Auxiliary Nurse Midwives in Nawalparasi focusing on key aspects of mental health and mental health promotion. The project was funded under the Health Partnership Scheme (HPS) which is managed by a London-based organisation called THET (Tropical Health & Education Trust).
Mental illness is increasingly recognized as a global health problem. However, in many countries, including Nepal, it is difficult to talk about mental health problems due to the stigma associated with it. Hence a training programme was developed to train auxiliary nurse midwives, who otherwise are not trained in mental health as part of their pre-registration training in rural Nepal, on issues related to maternal mental health. After the training programme a selection of auxiliary nurse midwives were interviewed to establish their views on the training, its usefulness and ways to improve it.
Preeti Mahato is a PhD student in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) who undertook an in-depth evaluation of our project as part of her PhD research. This qualitative study has three themes emerging: (1) issues related to training; (2) societal attitudes; and (3) support for women. The ‘training’ theme describes the benefits and limitations of training sessions. ‘Societal attitudes’ describes society’s attitude towards mental health which is largely negative. ‘Support’ describes the positive behaviour and attitude towards pregnant women and new mothers.
The paper concludes that there is a need for continued training for auxiliary nurse midwives who are based in the community. This gives them the opportunity to reach the whole community group and potentially have influence over reduction of stigma; offer support and diagnosis of mental ill-health. There is still stigma around giving birth to a female child which can lead to mental health problems. It is imperative to increase awareness and educate the general public regarding mental health illnesses especially involving family members of those who are affected.
Dr. Pramod Regmi, FHSS Lecturer in International Health has been appointed as an Editorial Board Member for the Journal of Global Health Reports. This journal is affiliated with the Journal of Global Health (www.jogh.org). The Journal of Global Health Reports focuses on “Promoting local research to improve global health” It is open to all local, small-scale, context-specific studies in global health, both qualitative and quantitative, as long as they are conducted in a rigorous and replicable way and report their results properly.
Next week the Dorset Global Health Network will have its inaugural meeting on April 25th. The meeting will focus on Nepal starting at 18.30 with a Nepalese buffet.
There will be three short presentations followed by the film ‘Hospital’.
Voluntourism in Nepal : A lesson in the grey areas of global health (Dr Emer Forde, Bournemouth University)
The challenge of perinatal mental health in Nepal (Prof. Edwin van Teijlingen, Bournemouth University)
Supporting Training and innovative solutions to the provision of rural health care in Nepal (Dr Ollie Ross, Consultant Anaesthetist, Southampton General Hospital)
The Film “Hospital” provides a portrait of a state-run hospital in one of the most remote and poor districts of Nepal and how individuals can make a difference to people’s lives. It will be introduced by Dr Ollie Ross, who is a consultant to the Nick Simons Institute working in Nepal.
This will be followed by a discussion about the development of Dorset Global Health Network.
Today on the second day of the 2018 BNAC (Britain-Nepal Academic Council) conference there was a very good representation of Bournemouth University (BU) research at Durham University. BU’s Professor Michael Wilmore presented his paper: Construction of ‘Community’ in Research on Nepalese Commons. In the morning FHSS’s PhD student Jib Acharya had an oral presentation on Impact of Healthy Snacks on Children’s Health: An Overview of a Pilot Study.
Prof. Edwin van Teijlingen presented joint work between BU, Liverpool John Moors University (LJMU) and the University of Oxford on the topic Skills transfer, employability & entrepreneurship of returnee labour migrants in Nepal. Bournemouth University was involved in this project through Dr. Pramod Regmi, Dr. Nirmal Aryal and Prof. Edwin van Teijlingen.
The final talk of the day (and of the conference) was by Prof. Padam Simkhada from LJMU. Prof. Simkhada is also Visiting Professor at the Centre for Midwifery, Maternal & Perinatal Health at Bournemouth University. He was presenting Debate on Educational Reform in Nepal: Outcomes of the International Conference on Quality of Higher Education in Federal Nepal on behalf of LJMU, Bournemouth University and Manmohan Memorial Institute of Health Sciences (MMIHS) in Nepal. Earlier this year BU signed a Memorandum of Agreement with MMIHS in Kathmandu.
As part of the new plan BU2025, “we want to continue to develop our global partnerships and links with other institutions and organisations”. This is an admirable aim, and it is, of course, the best way forward for a truly global Higher Education Institution like Bournemouth University (BU). But to translate this general aim into a particular global partnership we need to consider the underlying processes of initiating and developing such partnerships. We published a paper  on the issues one needs to consider in developing a partnership, based on the example of BU’s partnership with Manmohan Memorial Institute of Health Sciences (MMIHS) in Nepal.
In late February this year MMIHS signed a Memorandum of Agreement (MoA) with BU at a ceremony in the Nepalese capital Kathmandu, where Prof. Stephen Tee represented BU. This MOA is an agreement between us that provides a basis on which the parties will consider potential future collaboration. The UoA formalises a long-standing collaboration between the two institutions, and indicates a desire to collaborate further in the future. MMIHS and BU academics have jointly applied for research grants, conducted collaborative research and published together and it is exactly this personal link between people that allows this, and many other, global partnerships to flourish.
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health
van Teijlingen, E., Marahatta, S.B., Simkhada, P., McIver, M., Sharma, J.P. (2017) Developing an international higher education partnerships between high & low-income countries: two case studies J Manmohan Memorial Inst Health Sci, 3(1): 94-100.
Congratulations to two Faculty of Health & Social Sciences PhD students, Preeti Mahato and Elizabeth Waikhaka, who co-authored a paper published in the WHO South-East Asia Journal of Public Health. Their paper is called ‘Social autopsy: a potential health-promotion tool for preventing maternal mortality in low-income countries’. Co-authors include Dr. Puspa Pant from the Centre for Child and Adolescent Health, University of the West of England (Bristol) and Dr. Animesh Biswas based at the Reproductive & Child Health Department, Centre for Injury Prevention & Research, Bangladesh (CIPRB) in the capital of Bangladesh, Dhaka.
The authors argue that verbal autopsy is used to attribute a clinical cause to a maternal death. The aim of social autopsy is to determine the non-clinical contributing factors. A social autopsy of a maternal death is a group interaction with the family of the deceased woman and her wider local community, where facilitators explore the social causes of the death and identify improvements needed. Although still relatively new, the process has proved useful to capture data for policy-makers on the social determinants of maternal deaths. This article highlights the potential role of social autopsy in health promotion.
Mahato, P.K, Waithaka, E., van Teijlingen, E., Pant, P.R., Biswas, A. (2018) Social autopsy: a potential health-promotion tool for preventing maternal mortality in low-income countries. WHO South-East Asia Journal of Public Health7(1): 24–28.
Last week I attended and presented e-poster at the RCOG (Royal College of Obstetrics & Gynaecology) World Congress 2018 in Singapore. The main congress programme run 22 to 24 March. RCOG president Professor Lesley Regan told in her opening speech that this Congress had more than 2,800 delegates and 150 speakers from 82 countries. Prof Regan also said that the Congress focused on the need for all to work in the field of obstetrics and gynaecology and to act as advocates for women’s health. Furthermore, she stressed that it is necessary to look beyond clinical aspects and provide safe, high-quality care to speak for the needs of the women, many of whom have no choice of their own.
The e-poster I presented ‘Study of rural maternity and childbirth care in a southern district of Nepal’ is part of my PhD study on maternity care in Nepal.
My poster was displayed on the morning of 22nd March (8:08– 8:16 AM) under the topic ‘early pregnancy and acute gynaecology’. Over the three days programme schedule, I also attended several plenary sessions, oral presentations and viewed many e-posters. Although there were many topics specific to clinical aspects of obstetrics and gynaecology, I was mostly interested in presentations related to contraception and fertility control, abortion, gender equality, reproductive and sexual health of marginalised communities, female genital mutilation, breastfeeding and so on. Overall, it was a great experience to learn about research in women’s health and maternity care and an opportunity to do networking with researchers with similar interests.
Finally, I would like to thank Santander Awards to provide me fund to cover my expenses to attend this congress and my supervisors for motivating me to apply for this conference.
Congratulations to Mrs. Preeti Mahato on the acceptance of her paper ‘Qualitative evaluation of mental health training of Auxiliary Nurse Midwives in rural Nepal’ by Nurse Education Today, an academic journal published by Elsevier. Preeti is currently registered as PhD student in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH). The paper is co-authored by CMMPH’s Catherine Angell and Edwin van Teijlingen as well as BU Visiting Faculty Padam Simkhada and Jillian Ireland. The paper is a result of the evaluation part of the ‘Mental Health Training for Community-based Maternity Providers in Nepal’ project and written on behalf of this THET team.
Our THET project in Nepal is a collaboration between the Centre for Midwifery, Maternal & Perinatal Health (CMMPH), Tribhuvan University (Nepal’s oldest university) and Liverpool John Moores University (LJMU). The project receives funding from DFID, and is managed through THET and supported locally in Nepal by a charity Green Tara Nepal.
Edwin van Teijlingen, Padam Simkhada, Shyam K Maharjan Preeti Mahato, Bhimsen Devkota, Padmadharini Fanning, Jillian Ireland, Bibha Simkhada, Lokendra Sherchan, Ram Chandra Silwal, Shyam K Maharjan, Ram K Maharjan, Catherine Angell, Flora Douglas.
Huge numbers of pregnant women and new mothers are taking their own lives in Nepal as they deal with extreme poverty, natural disasters, domestic violence and oppression. Research shows suicide represents 16% of all deaths in women of reproductive age. The rate is higher than previously recorded and there has been a considerable increase over the past few years. But a new project which trained midwives about mental health issues might hold the key to turning this around.
Suicide is primarily associated with unwanted pregnancy or the feeling of being trapped in poverty or situations of sexual and physical abuse. A study of 202 pregnant women (carried out between September and December 2014) found that 91% of them experienced some kind of physical, emotional or sexual abuse – mostly at the hands of their husbands and/or mother-in-laws.
Pregnancy is a known trigger for mental health problems. But gender discrimination and domestic violence are making matters worse. In addition to these issues, natural disasters are also a huge contributing factor to the spiralling mental health problems of young mothers.
Lack of control
In Nepal, making decisions about seeking maternity care is not in the hands of the pregnant woman but usually lies with her mother-in-law or husband. When young women marry they move in with their husbands’ family and their lives are ruled by their in-laws. These women often have little say in seeking health care during pregnancy, childbirth and the postnatal period.
In many poor families, husbands migrate for work leaving their young wives with family. Nepal has a real migrant workers economy with close to 50% of Nepalis relying on financial help from relatives abroad. Mental health problems can worsen for women who have been taken away from their own families. In other cases, young women face domestic violence due to their husbands’ drinking leading to mental health issues and suicide.
There is also a lack of understanding of pregnancy and childbirth-related mental health issues and husbands and mothers-in-law often fail to support these vulnerable young women. They in turn are reluctant to seek help due to the stigma associated with mental illness.
Cultural and social norms
Cultural practices and social norms, like gender inequalities and early marriage, hinder women who have a lack of choice when it comes to their role as mothers. There is also a preference for sons rather than daughters, who are seen as an “economic burden” in many families. If a woman is expecting a daughter, especially for the second or third time, this can also trigger mental health issues.
Depression and anxiety are common and affect ten to 15 out of every 100 pregnant women in the country. Postnatal depression is often reported, but less attention is given to more common and less obvious mental health issues.
Natural disasters and midwives
Recurrent earthquakes and floods exacerbate issues of depression and helplessness as women are forced to live in temporary shelters and have the burden of increased poverty.
For many rural Nepali women, the most qualified birth attendant they can expect to look after them is the Nepali Auxiliary Nurse Midwives (ANMs). But a study found that they received little or no formal training on perinatal mental health issues. Although there have been gradual improvements in health care for women during pregnancy, mental health support is leaving many women feeling that suicide is their only option.
As part of a Tropical Health and Education Trust project, funded by DFID, around 80 ANMs were trained on perinatal mental health issues. The project used UK-based volunteers in Nepal over two years.
The training helped raise awareness of mental health well-being and improved access to mental health care for pregnant women and new mothers. This is a vital first step towards improving community-based services for pregnant women in rural Nepal. But to offer hope to more young women there needs to be a significant increase in this type of training and awareness raising.