“Baba Has Come to Civilize Us”: Developmental Idealism and Framing the Strict Demands of the Brahma Kumaris

This article extends and complicates the theory that “strict churches are strong” based on the strict demands that were followed and not followed by the Brahma Kumaris in Nepal. To be successful, strict religious groups must not only be strict, but also frame their strictness in ways that resonate with the everyday experiences and commonly held beliefs of their members. Nepali women involved with the Brahma Kumaris tend to accept and follow the group's demands when those demands have been framed as modern, and that framing is resonant with the prevailing definitions of modernity offered by Western development agencies. When the modern framing is not resonant, as with the case of framing celibacy as “spiritual birth control,” the strict demand is not followed, and the frame itself is rejected in favor of the practice being defined in different terms.     

Indian Journey

What began as a trekking adventure becomes a search for spiritual “health” in the Buddhism of the Himalayan regions of India. The difficulties of Himalayan travel perhaps mirror the difficult ascent to the inner reaches of Buddhism. Freddy English is a free-lance writer and committed traveler. This journal is the first in what we hope will be a special series.     

Religion and mental health among Nepal earthquake survivors in temporary tent villages

The aim of this study was to explore the relationship between mental health and the perceived importance of religion and the frequency of prayer among 200 children ages 10–18 years who lived in temporary camps for earthquake survivors in Nepal. The participants were examined using the Child Behavior Checklist (CBCL) 6–18 and were asked about the importance of religion in their lives. In contrast to expectation that high perceived importance of religion and prayer frequency have positive impacts on mental health after earthquakes, the results indicated significantly higher levels of withdrawal/depression. The group that prayed less frequently after the earthquakes had significantly higher scores for somatic symptoms, withdrawal/depression, anxiety/depression, social immaturity, internalising problems, and total CBCL scores. However, the clinical risk group (T score of 65 or higher in the CBCL total score), no significant difference according to the importance of religion showed and frequency of daily prayer.     

The reliability and predictive ability of the Test of Infant Motor Performance (TIMP) in a community-based study in Bhaktapur,Nepal

AimIn a Nepalese setting, to measure the reliability of the Test of Infant Motor Performance (TIMP) and its ability to predict development scores at 6 months.MethodsNepalese infants (n = 705) were assessed by the TIMP when they were 8–12 weeks old and the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 6 months. Inter-rater agreement was expressed by intraclass correlation coefficients (ICCs), the internal consistency by Cronbach’s alphas and Pearson correlation coefficients. Predictive ability was estimated in linear regression models.ResultsInter-rater agreement was excellent (ICCs > 0.93). Alphas for the TIMP total scores were 0.76 for infants born to term and 0.72 in those born preterm. Correlation coefficients between TIMP total and Bayley-III subscale-scores ranged from 0.05 to 0.28 for term infants and from 0.15 to 0.43 for preterm infants. Using American norms, 56.3 % had TIMP scores within average and 43.7 % below average range. Bayley-III subscale scores were lower in children with TIMP scores below the average range, with the strongest estimates for Gross motor and Socio-emotional development.InterpretationThe reliability of the TIMP was acceptable, and the TIMP could be a feasible tool to monitor infant motor development in low-resource settings. Properties of the TIMP differed according to gestational age.     

A Cultural Adaptation of Dialectical Behavior Therapy in Nepal

Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia.     

Disparity of motorcycle helmet use in Nepal – Weak law enforcement or riders' reluctance?

Like many low- and middle-income countries, Nepal is experiencing a massive motorization, predominantly from increased use of motorcycles which is driving a surge in road-related injuries and fatalities. Motorcycles and their riders have been identified as a focal point for road traffic injury prevention measures. While helmet use is mandatory for both motorcycle drivers and passengers, fines for helmet non-use are only levied on drivers, not on passengers, and it is unclear how this unequal enforcement translates to helmet use rates in Nepal. Hence, a video-based observation on motorcyclists’ helmet use was conducted alongside a questionnaire survey on fatalism, perceived police enforcement, risk-taking personality, and perceived usefulness of helmets. For the observation and questionnaire survey, seven rural and urban sites were selected from all seven provinces of Nepal, representing varied populations, road environments, and elevations. The observation of the helmet use behavior of 2548 motorcycle riders revealed an alarming picture of helmet use in Nepal. While more than 98% of observed motorcycle drivers in Nepal used a motorcycle helmet, less than 1% of observed passengers did so. Interviews of 220 riders show that the absence of a fine for helmet non-use by passengers is accompanied by an unawareness of the traffic law, where only 11.8% of respondents knew about the mandatory helmet use law for passengers. Unhelmeted riders had a significantly higher attribution of road related crashes to fate, compared with riders that used a helmet. Results of this study can serve as an evidence base for revisions of Nepal’s Vehicle and Transportation Management Act in regard to traffic rule enforcement and fines. They further show the global importance of comprehensive regulation on safety related behaviors of road users. The feasibility of more comprehensive enforcement is discussed against the background of helmet availability for passengers.     

Impact of Peer Support on PTSD,Hope, and Functional Impairment: A Mixed-Methods Study of Child Soldiers in Nepal

The experience of child soldiers during postwar civilian reintegration is recognized as a major contributor to mental health. For some children, postwar social relations may be more important than war trauma in determining psychosocial well-being. Mixed methods incorporating epidemiology and qualitative case studies were employed to evaluate the effects of family, peer, and community relations after reintegration on psychosocial outcomes: hope, functional impairment, and post-traumatic stress disorder (PTSD). Participants were 142 child soldiers, including 9 qualitative case studies. Peer support predicted increased hope, decreased functional impairment, and decreased PTSD symptoms. Conversely, problems with peer relations predicted less hope and more PTSD symptoms. Maximizing peer support and minimizing stigma from peers should be prioritized within psychosocial reintegration programs, especially among former child soldiers with PTSD.     

Indian Journey

What began as a trekking adventure becomes a search for spiritual “health” in the Buddhism of the Himalyan regions of India. The difficulties of Himalyan travel perhaps mirror the difficult ascent to the inner reaches of Buddhism. Freddy English is a free-lance writer and committed traveler. This journal is the second in a series, of which the first part appeared in our 45:4 issue.     

Organizational citizenship behavior and organizational commitment in Nepal

The present study examines the structure of organizational citizenship behavior (OCB) and its relation to organizational commitment in Nepal. Four-hundred and fifty employees of five Nepalese organizations filled out standardized questionnaires. Exploratory and confirmatory factor analyses revealed two factors of OCB, altruism and compliance, replicating Western models of extra-role behavior. Structural equation analysis showed a positive relation between affective and normative commitment on the one hand and both citizenship factors on the other. Continuance commitment was negatively related to compliance and unrelated to altruism. The findings thus confirmed the structure and usefulness of the concepts in an under-researched geographical area. Findings of the research are discussed within the Nepalese sociocultural context.     

Depression and anxiety among war-widows of Nepal: a post-civil war cross-sectional study

Thousands of Nepalese women were widowed as a consequence of a decade (1996–2006) long civil war in Nepal. These women are at grave risk of mental health problems due to both traumatic experiences and violation of natural order of widowhood. The present study explores the depression and anxiety among war-widows. In 2012, a cross-sectional study was designed to interview 358 war-widows using validitated Beck Depression Inventory and Beck Anxiety Inventory in four districts of Nepal – Bardiya, Surkhet, Sindhupalchowk and Kavrepalanchowk with history of high conflict intensity. The prevalence of depression and anxiety was 53% and 63% respectively. Financial stress was significantly associated with depression (2.67, 95% CI: 1.40–5.07) and anxiety (2.37, 95% CI: 1.19–4.72). High autonomy of women as compared to low autonomy, high social support as compared to low social support and literacy as opposed to illiteracy was associated with less likelihood of depression and anxiety. Our results suggest high magnitude of depression and anxiety among war-widows in Nepal. Future policy efforts should be directed at providing mental health services to identify mental health issues among conflict affected individuals with focus on education, employment and activities to promote social support and autonomy at community.