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Background: Female Sex Workers (FSWs) are main drivers of the HIV epidemic in Nepal. The work environment of sex work in Nepal is differentiated into establishment based (e.g. massage parlors, dance restaurants, hotels and lodges) and street based (e.g. streets, parks and markets). The study compares HIV, syphilis and risk behaviours among establishment-based FSWs and street-based FSWs in Kathmandu Valley of Nepal. Materials and Methods: Cross-sectional bio-behavioral surveys in 2006, 2008, 2011 and 2015 aimed to sample 2093 FSWs using two stage cluster sampling in the Kathmandu valley. Statistical analysis used chi-squared tests and logistic regression models to assess differences of HIV, syphilis and risk behaviors among street-based FSWs and establishment-based FSWs. Results: The study included 39.7% street-based FSWs and 60.3% establishment-based FSWs. The street-based FSWs had lower education levels, older age groups, separated, longer duration of sex work and inconsistent condom used with clients than establishment-based FSWs (p<0.05). Establishment-based FSWs were lower exposure to HIV intervention programs and pervasive alcohol consumption and use of drugs (p<0.05). The multivariate analysis showed that street-based FSWs were more likely of HIV test (aOR=1.25, 95%CI=1.04, 1.49), HIV (aOR=4.72, 95%CI=2.19, 10.15) and syphilis (aOR=7.96, 95%CI=3.49, 18.15) than establishment-based FSWs. Conclusion: Street-based FSWs possessed higher risk behaviour and have higher HIV and syphilis prevalence. HIV prevention interventions targeting FSWs should consider risks and vulnerability of street-based FSWs. .

Introduction: Although Karnali is an old civilization of Nepal, this province has low human development indexes and the indicators of health are low. This study was carried out to comprehend the trend of public health indicators and disease pattern of Karnali Province. Methods: Descriptive study using provincial three years’ health data were reviewed from all the 10 districts of Karnali Province using per forma. Data entered in Microsoft Excel software were transferred into the statistical package for social sciences version 21 and descriptive analysis was carried out. Results: Previous three years’ data were analyzed. The last years’ results were BCG coverage was 106.0%, DPT/Hepa B was 93.0%, 95.0%, tetanus toxoid (TT) 2 & tetanus toxoid 2+ was 82.0%, 0-11 months' growth monitoring was 126.0%, 0-23 months' underweight children was 8.0%, pneumonia among new acute respiratory infection was 24.0% prevalence of acute respiratory infection was 949/1,000, prevalence of diarrhea was 709/1,000 and severe dehydration among diarrhea was 0.9%. Four Antenatal chick up was 55.0% institutional delivery was 67.0%, delivery by skill birth attendant was 56.0%, health examination within 24 hours of delivery was 65.0%, and contraceptive prevalence (CPR) rate was 35.0%. Likewise, treatment success rate of tuberculosis was 86.0%, new case detection for rate/100,000 tuberculosis was 0.5, HIV Incidence rate/10,000 was 5.3 and outpatient department attendance was 83.0%. Among top 10 diseases, respiratory infection was the first with 14.8%, followed by acute peptic disorders 10.4%, headache 7.9%, worm infestations 7.2% and fall injuries/ fractures found 5.9%. Conclusions: The indicators of health condition of Karnali Province are markedly low in comparison to the other provinces as well as the national figure. The utilization of public health services has to be reinforced in the province and districts.

Background: In context of Nepal, although pregnant women from city areas contribute to maternal mortality, evidence of the study of utilization of antenatal care services and factors affecting antenatal care visits (ANC) are focused in rural areas where health institutions are not easily available. The objective of this study was to identify ANC services utilization by eligible women in Pokhara sub-metropolitan city. Methods: This was a cross-sectional study conducted applying face to face interviews with 240 eligible women bearing at least one youngest child below the age of two years. A structured and semi-structured questionnaire was used after translating into the Nepali language and pretesting it in the field. Data entered in Microsoft excel were transferred in SPSS (Statistical package for social sciences) version 21 and analysis were carried out. Both descriptive and inferential statistics were computed. The significance was set at the 0.05 level. Results: Approximately 97.0% of women had visited ANC during their recent pregnancy and about 56.0% of women had ≥4 ANC visits. The majority (80.3%) of the women used to seek ANC checkups during their first trimester and nearly half (49.0%) of the respondents belonged to the younger age of 15-19 years. Women’s (99.0%) and her husbands’ (86.0%) educational level significantly impacted ANC visits. Women having fewer numbers of children (98.0%) and the nuclear family (99.0%) had significantly higher ANC visits. Husbands’and mother-in-laws’ encouragement to go for ANC visits was significantly higher. All of the above-mentioned parameters were statistically significant at p< 0.05 level. Conclusions: There was variation in ANC service taking as per the encouragement from the husband and mother-in-law of the woman. Hence, awareness programs targeting husband and mother-in-law regarding the importance of ANC services are suggested. Conduction of detailed study in the future to explore the quality of services is recommended.

BACKGROUND Most low-income settings experiencing concentrated HIV epidemic lack information about key populations (KPs), including people who inject drugs (PWID), men who have sex with men (MSM), male sex workers (MSW), transgender (TG) and female sex workers (FSW) because they are hidden and marginalised in society and frequently undocumented. Out of several approaches to size estimation, mapping and size estimation is particularly useful when local estimates are needed for planning and monitoring of prevention programmes. OBJECTIVE To locate hot spots related to sex work, cruising spots, and injecting drug use, and to estimate the number of sex workers, PWID, MSM, MSW and TG at the district level (adjusting for double-counting, frequency of visiting spots, and low visibility), and at the national level using extrapolation algorithms . METHODS The mapping exercise among MSM, MSW, TG, PWID and FSW was carried out in 44 districts of Nepal between July and November 2016 by collecting relevant information directly from hotspots where KPs members congregate. Districts to be mapped were selected purposively, to both provide data to local programmes in areas with high concentrations of KPs, and inform extrapolation to unmapped districts as part of national estimation procedures. RESULTS Altogether 11056 KPs and 10977 non- KPs informants were interviewed from across the 44 mapped districts to identify the hotspots. District level adjustment factors (mobility adjustment, frequency adjustment and invisibility adjustment) were sequentially applied. The final estimates used all three adjustment factors. We found that the national estimate of FSW in Nepal ranges between 43,829 to 54,207. The national estimate of MSM/TG lies between 88,009 and 112,150, of which a minimum of 18,704 and maximum 24,216 are TG, and a minimum 53,373 and maximum 67,292 are MSM. And finally the national estimate of PWID ranges between 27,248 to 34,487. Among them, a minimum 24,572 and a maximum 30,561 are men, and minimum 2,676 and maximum 3,926 are women. CONCLUSIONS The size of KPs provided through mapping exercise can be utilised for setting benchmarks and measuring program coverage. The major limitation is that mapping may count the majority of KPs who visit hotspots on a very regular basis, while missing the subset who are not “hotspot based” or who visit hotspots less frequently. However, the strength of mapping is that it reflects hands-on knowledge and experience of people who have access to communities that outside researchers may not have, thereby accounting for people who might otherwise be invisible.