Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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On Aug 2018

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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : February | Volume : 6 | Issue : 1 | Page : 51 - 56

Health Effects of Modern Temporary Female Hormonal Contraceptives among the Women in the Pokhara Sub-Metropolitan City of Western Nepal

Manu S.S. Rana, Madhav Thapaliya, Ram Prasad Aryal, Brijesh Sathian

1. MA, MPH, PhD, Asst. Prof, Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal. 2. MA, Senior Officer, Western Regional Health Directorate, Pokhara, Nepal. 3. MA, Professor, Population studies, Pokhara University, Pokhara, Nepal. 4. MD(AM), M.Sc, PGDCA, Ph.D (Biostatistics) Scholar, Assistant Professor & Chief Editor NJE, Department of Community Medicine, Manipal College of Medical Sciences.

Correspondence Address :
Dr. Manu S Rana, MA, MPH, PhD
Asst. Prof, Department of Community Medicine,
Manipal College of Medical Sciences, Pokhara, Nepal.
Phone: 00977-9846022623


Introduction: Prior studies in Nepal which observed the contraceptive behaviour of women have shown that most of the women who wanted to have either birth space or who limited their births primarily, do not use contraceptives because of health concerns, particularly from hormonal methods.
Objective: To study the use of modern female temporary hormonal contraceptives and their health effects.
Materials and Methods: This study was conducted in the institutionalized family planning centre of the government and non government organizations of Pokhara, Nepal. The data which were collected were the health effects of modern temporary female hormonal contraceptives and the socioeconomic and demographic characteristics from the interviews of 120 respondents.
Result: Depo clients were found to be more in number than others. The contraceptive acceptor age was highest among the 20 -34 year old females. The marriage and first child birth age was highest among 15-19 year old females and most of the temporary family planning contraceptive acceptors adopted the method after their first child birth. A majority of them had one boy and one girl as children. Though illiterate women were a majority, fifty percent knew all the four methods of female temporary contraceptives. Economically, most of the families annually earned Rs. 50001-100000, which was 43.3 percent. The side effects of the female temporary hormonal contraceptives were prevalent, but the warning effects were not indicated in this study. The warning effects such as lower abdominal or pelvic pain, severe headache, eye problems, vision loss or blurring, chest pain, cough, shortness of breath and severe leg pain (calf/ thigh) due to bone damage were not found.
Conclusion: This study revealed that during long term use, nearly hundred percent of the women didn’t feel any bad warning health effects due to use of hormonal contraceptives.


Family planning, Contraceptive, Health effects

Family planning is the key to the reduction of maternal mortality, not only in terms of the prevention of unwanted pregnancies and unsafe abortions, but also through its effect on the composition of childbearing (i.e., age and parity of the pregnant women, and the time between the pregnancies) (1). The main aims of Nepal’s family planning program are to assist individuals and couples to space their children, to prevent unintended pregnancies, and to improve their overall reproductive health. Several studies have revealed that misinformation about the methods and services existed on a variety of levels in Nepal. Both the acceptors and providers reported misconceptions about the methods in the community. These misconceptions included fears that some methods may cause severe health problems such as cancer. These could deter some couples from seeking family planning methods even though the methods were available and high quality services were provided. Another misconception was that the service providers believed that women did not go for follow up visits because the facility was too far or that women lacked the time. But few acceptors themselves listed these reasons; the acceptors mostly said that they didn’t think that the visit was necessary. A few urban studies in Kathmandu have shown that most of the women wanted to use a method, but not being able to find a suitable method which was comfortable and free of bad health effects was the main obstacle. Original Article Community Medicine Section If the women’s understanding of the importance of the followup visits was improved, the side effects or other problems could be addressed during these visits, which could, in turn, result in a greater probability of the continuation of these methods (2),(3),(4),(5),(6),(7).
Objectives of the Study
To study the use of modern female temporary hormonal contraceptives
and their health effects. However, the specific objectives were as follows:
i) To analyze the uses of the contraceptives (depo, pills and
norplant) among married women
ii) To identify the socioeconomic and the demographic status of
the married women who used contraceptives and
iii) To assess the health effects (side and warning effects)
of female modern temporary hormonal contraception on
women’s health

Material and Methods

Research Site and Population
Kaski, among the 75 districts of Nepal, lies in the western development region, almost in the centre of the western region. It is a hilly district and the Pokhara sub-metropolis is a valley which is situated at the south of the district. It is also the headquarters of the Kaski District, the Gandaki Zone and the Western Region. The governmental institutionalized family planning and MCH clinic (Marry stops) which was under the district public health office and the Family Planning Association of Nepal, Kaski Branch Office, Kaski, was the study place. Women who visited the clinic and were taking hormonal contraceptives at present, since more than one year regularly, was the population which was targeted. The researcher collected data of a qualitative and quantitative nature. Structured and semi- structured questionnaires were developed. For the data collection, women who were using temporary hormonal contraception were taken as the population. Prior approval for the study was obtained from the institutional research ethical committee.
Nature and Sources of the Data
The primary data were collected from questionnaires. The researcher himself collected the data. One hundred and twenty samples were considered as the sample size. The researcher visited the site, filled the questionnaires and continued it until 120 samples were obtained. For the secondary data, the daily records which were registered in the clinic were used.
Data Collection Technique
A check list was prepared to collect the qualitative and quantitative data from married women of 15 to 49 years of age, who were using hormonal contraceptives. Women who visited the clinic to employ contraceptive methods and for the continuation of the same, were interviewed from the survey site and this process was continued until the sample size reached 120 samples. A client exit interview method with purposive sampling was used.
Sample Size Calculation
The sample size was calculated by using the formula N= Z2PQ/ D2 .Where N= sample size, The national rate of family planning methods, P=44 % (Annual report), Q= 1-P, D= allowable error= 22% and Z= 1.96. The total sample size which was needed for this study was 119 (8).
Data Management and Analysis
The data was analyzed by using Excel 2003, R 2.8.0, Statistical Package for the Social Sciences (SPSS) for Windows version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 windows version. The Chi-square test was used to examine the association between the different variables. A p-value of < 0.05 (two-tailed) was considered to establish the statistical significance.
Conceptual Framework
All the contraceptives, besides their contraceptive action, whatever the type of the method, whether permanent or temporary, hormonal or non hormonal, have mild to sometimes severe unwanted effects. Those unwanted effects were divided into two categories. The side effects and the warning effects were collectively named as the health effects as per the protocol of reproductive health which was published by the Government of Nepal.


The population of females who used modern temporary female hormonal contractives, of all ages, either married or unmarried and who visited the static clinic of family planning were interviewed. Age was one of the most important demographic characteristics which played an important role in the marriage status, the sexual activity and the adaptation of the contraceptive method. The population of the study was divided on the basis of caste and ethinicity, as more than fifty percent of the population was Janajatis, followed by Brahmins, schedule castes and lastly Terians. (Table/Fig 1) depicts that out of the 120 women, a majority of them got married between the ages of 15-19, which was 71.7 percent of the population. The below 14 years girls also were found to get married, who formed 2.5 percent of the population. Around 26 percent of the girls preferred to get married after the age of 20 years. As most of the marriages occurred in the age group of 15- 19 years, the first child was born in the same age group. Most of the women gave birth in the next year of marriage. This means that early age pregnancy was also prevalent. Among the 15-19 years age group, 55 percent of the girls gave birth to their first child in the same period orin the next year of their marriages. (Table/Fig 2) depicts, that housewives and those in and labour formed the highest percentage of the population who used contraceptives (32.5 and 30.8 percent respectively). Business women mostly held shop, who formed 17.5 percent of the population. Among them, two and a half percent were students. A Hindu woman who was doing business, who had secondary education, started with oral contraceptives immediately after marriage and gave child birth after four years of her marriage. The distribution of the respondents on the basis of religion demonstrated that 76 percent were Hindus, followed by 22 percent Buddhists and nearly 2 percent. The women were categorized into 6 groups based on their income. The lowest annual income of the Nepal government is Rs.55200 annually. The first category had an income of less than Rs.55200, in which there were 8.3 percentage respondents fall. A majority of the respondents e (43.3 percentage) had an income of Rs. 55201 to 100000. It meant that the poorest women were taking hormonal contraceptives from those organization may be, as they were free of cost. Most of the respondents (39.2 percent) used temporary female hormonal contraceptives after the birth of their first child. More than 31 percent used hormonal contraceptives after their third child. Women who had two children used the contraceptives more (31.7 percent) and it was remarkable that women who had one child also followed close behind (30 percent). Overall, 90 percent of the pregnancies resulted in live births. In the survey areas, all the women had live births. Illiterate women formed 35 percent and literate women formed 65 percent of the population. Among the literate ones, most were primary education holders (59 percent). Those with intermediate education and above were only 6 percent among the literate women. A majority of the women answered the questions on and understood family planning; that it was about giving birth to less number of children. A few answered that they did not know about it. Those who managed their family size according to their economic status formed a remarkable percentage of the population (17.5%). Depo was the fist method which was used by 76 percent of the women and the pill was used initially by 19 percent of the women only. Among eleven women who had used Depo before, 91 percent said that they experienced severe pain and heavy vaginal bleeding. One of them or nine percent among them also complained of amenorrhoea. One client also reported about the failure of Depo, in which case pregnancy occurred. Most of the clients said that they felt uneasy in using it daily. The side effects of Depo were reported only by a minimum number of women (twenty percent). Similarly, its warning effects were reported by only 7 percent women. Here, most of the pill users discontinued it because of the difficulty using it daily and due to side effects (20 percent). (Table/Fig 3) shows that thirty seven percent women who took Depo, seventy nine percent who took pills and ninety three percent of the Norplant users said that they did not know any bad health effects of those methods. Twenty nine percent of Depo users said that they had heard that lower abdominal pain or pelvic pain and heavy vaginal bleeding occured as its side effects. Some of the respondents had a misconception that the pills acted on the stomach and not on the uterus. Failure of the method was also reported, which was supported by the literature, as 1.6 percent in the case of Depo. Some of the women also answered questions about paralysis and sterilization, which were not proved by the literature and was also not the scope of this study. (Table/Fig 4) depicts that forty one percent Depo users answered that they had no bad health effects at all within 3 months of its use. But fifty seven percent said that they had side effects like mild and moderate bleeding, nausea, vomiting, weight gain, mild backache and amenorrhoea. In case of the warning effects in Depo, only severe bleeding/ severe weight loss was observed in two percent of the women. Fifty percent of the pill users didn’t report any side effects and another fifty percent said that they had mild side effects. No warning effects were reported by the pill users. The Norplant users also didn’t report any kind of warning effects. Eighty three percent said that they knew about its side effects and 17 percent did’nt know about its side effects. In a three month period of use of those methods, a majority of the respondents had no side effects and some had side effects. In case of Depo, only 2 percent suffered from the warning effects (severe vaginal bleeding and severe weight loss). (Table/Fig 5) shows that fifty three percent said that they had side effects and forty six percent said they didn’t have any health effects after one year’s use of Depo. 0ne percent claimed that they experienced warning effects even after one year’s use of Depo. Fifty eight percent of the pill users reported side effects and fourty two percent said that they had no health effects. No warning effects were reported by the pill users. In case of the Norplant users, 37.5 percent had side effects, where as 62.5 percent had no side effects after one year of use. (Table/Fig 6) depicts that among the Depo users, 40 percent didn’t report any bad health effects, whereas 59 percent reported side effects and only 1 percent reported warning effects. The maximum number of side effects was found among up to one year users (18 percent women), followed by those who used it for 1-2 years of duration who had a high percentage of side effects (18 and 12 percent), respectively. Among the Depo users who used it for 10 years and more, only 5 percent had side effects. Those who used it for 3 years and above had no warning effects. (Table/Fig 7) describes the summary of the health effects of all the three female hormonal contraceptives (Depo, pill, Norplant) which were studied in this research. Among the 120 women who were interviewed, 46.67 percent said that they had no bad health effects, which meant that they had no warning and side effects, 52.50 percent women said that they had side effects, and only 0.83 percent of the women said that they were suffering from lower abdominal pain or pelvic pain, which was the warning effect. The women who are using these hormonal contraceptives at present are not experiencing any warning effects. Even the ones who have been using them from a long time to ten years also have no complaints. One of the women said that the pill had failed and that conception had resulted, but that no defects were observed in the child’s health. The child is now twenty months of age and no abnormal signs or symptoms have been observed in its health as yet.


Every year, an estimated 210 million women have life-threatening complications of pregnancy which often lead to serious disability and a further half a million women die during pregnancy, childbirth, and the puerperium (more than 99% of these deaths occur in the developing countries) (9). Three million babies die in their first week of life and about 3·3 million infants are stillborn every year (10),(11). More than 120 million couples have an unmet need for contraception and 80 million women each year have unwanted or unintended pregnancies, 45 million of which are terminated (12),(13). Of these 45 million abortions, 19 million are unsafe, 40% of them are done on women who are aged below 25 years, and about 68,000 women die every year from the complications of unsafe abortions (14). Most of the studies on the family planning method acceptors and providers in Nepal have revealed that the overall quality of the services which were provided was acceptable and that the clients were likely to be satisfied with the services that they received at the health facilities centres. Although many dimensions of the quality were adequate, there were some areas that could be improved. A substantial minority of acceptors, especially those who adopted the pill or Depo-Provera, were not informed about the alternative methods or the possible side effects. In addition, according to the reports of the acceptors, the service providers did not strictly adhere to the established clinical protocols for screening clients. All of the recommended screening and medical history questions were asked to only a small proportion of the acceptors (2),(3),(4),(6),(7). Other studies in Nepal revealed that a large proportion of acceptors of all the four methods experienced side effects and that these side effects were strongly related to the women’s perception of the quality of the service delivery and the discontinuation of the methods. Especially, the acceptors of Depo-Provera were were likely to report that they had experienced side effects. Changes which were related to menstruation and heavy bleeding were the most frequently reported side effects among the acceptors of Norplant and Depo-Provera. Abdominal or pelvic pain was the most common side effect which was reported by the IUCD users, but a large proportion of women also said that they experienced menstrual or bleeding changes. Headache and dizziness or vertigo were the most commonly experienced side effects among the pill acceptors (2),(3),(4),(6),(7). But in our study, the respondents who used Depo previously discontinued it because of its warning effects. 91 percent discontinued it due to lower abdominal pain, heavy vaginal bleeding and method failure. Later, most of them used pills. One of them or nine percent among them also complained of amenorrhoea. One client also reported the failure of Depo and pregnancy occurred in that case. Similarly, women who used pills previously and later discontinued reported that they did so due to the uneasiness of the need to use the pill daily (66%) and due to method failure (7 percent). The warning effects were found only in 7 percent of the women as chest pain, cough and shortness of breath. Thirty seven percent women who took Depo, seventy nine percent who took pills and ninety three percent Norplant users said they did not know about any bad health effects of those methods. Twenty nine percent of the women among the Depo users said that they had heard that lower abdominal pain or pelvic pain and heavy vaginal bleeding could occur due to its use. The rumour of the collection of the tablets in the stomach or uterus was also spread among the women. Forty one percent Depo users answered that they had no bad health effects at all within 3 months of its use. But fifty seven percent said that they had side effects such as moderate bleeding, nausea, vomiting, weight gain and mild backache. In case of the warning effects of Depo only severe vaginal bleeding and severe weight loss were observed, which was two percent. Within three months of using Depo, severe bleeding occurred only in one woman and severe weight loss occurred in another woman. No warning effects were reported by the pill users. The respondents answered that they had no effects by 46 and 42 percent in Depo and pills respectively after one year and after whatever long period it was used. Fifty three percent women who used Depo and 56 percent who used pills only had side effects. Among the total women, fifty six percent claimed they have no health effects at present, 63 percent said they had side effects and 0.83 percent women ( one women) is suffering from lower abdominal pain at present.


Couples of the fertile age group are in search of family planning contraceptives these days. This need increases as the rate of literacy goes up. Males have only one temporary method of contraception. They have no other options, but women have choices among the modern temporary contraceptive methods. In Nepal, four female modern contraceptive methods are in practice and they are included in the regular health services. They are provided free of cost in government organizations. It has already been mentioned that these methods are not free of health effects. They provide protection against conception and at the same time, they also produce some kind of other unwanted health effects, which are categorized as the side effects and the warning effects. Many women have used these contraceptives in Nepal. Among them, most of the women (more than 50 percent) have been using Depo. The remaining 50 percent are using other methods. So, this study was mainly concentrated on Depo and its other effects besides its contraceptive effects. Hence, this study intended to find out the side effects (minor effects or temporary effects) and the warning effects (bad heath effects or long term effects) in the women who used Depo and other hormonal contraceptives. In the observations, it was attempted to find out about the knowledge of the respondents with regards to family planning and the effects that they faced after using those contraceptive methods. So, it was concluded by this research that in the long term use of hormonal contraceptives, nearly hundred percent of the women didn’t have any bad warning health effects.


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DOI and Others

ID: JCDR/2012/3006.3493:1881.1


Date of Submission: Aug 01, 2011
Date of Peer Review: Sep 10, 2011
Date of Acceptance: Dec 22, 2011
Date of Publishing: Feb 15, 2012

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