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Dhakal S, Sharma K, Adhikari K, Joshi A, Poudyal S. Osteoporosis and its associated factors among patients attending Manakamana Hospital, Chitwan, Nepal. PLoS One 2024; 19:e0289517. [PMID: 38381757 PMCID: PMC10881011 DOI: 10.1371/journal.pone.0289517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/29/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Osteoporosis is the most common skeletal disorder that weakens bones and increases their susceptibility to fractures. It is becoming an urgent and serious global epidemic. Early diagnosis and treatment are essential to reduce morbidity and mortality associated with it. This study aimed to find out the prevalence of osteoporosis among patients attending at Manakamana Hospital, Bharatpur, Chitwan, Nepal. METHODS A cross-sectional study was adopted and 623 patients attending at orthopaedic outpatients department (OPD) of Manakamana Hospital were selected using non-probability consecutive sampling technique. Data were collected from 15th October 2021 to 15th April, 2022, by using interview schedule, chart review and Bone Mineral Density (BMD) measurement through calcaneal ultrasonography. Ethical approval was obtained from Nepal Health Research Council Ethical Review Board prior to study procedures. Obtained data were analysed using descriptive statistics. Association between the variables were measured using chi-square test. RESULTS The mean age of the patients was 43.5 (±14.26) years. Nearly half (44%, n = 274) were middle aged adults, 59.7% were female and 56.0% were involved in agriculture and household chores. Nearly half of the patients (45.7%) were overweight/ obese, 7.9% were smokers and 13.5% had habit of alcohol use. Osteopenia or low bone density was detected in 58.9% patients and 19.4% had osteoporosis. The prevalence of osteoporosis was significantly associated with age group (p = <0.001) and educational status (p = 0.013) of the patients. CONCLUSIONS AND RECOMMENDATIONS Osteoporosis and osteopenia are prevalent in patients attending in the hospital. Hence, awareness, early screening, and treatment are necessary for the hospital attended patients to enhance their health and, minimize the risk of osteoporosis and the consequences associated with it.
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Affiliation(s)
| | - Kalpana Sharma
- Schools of Nursing, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Kishor Adhikari
- School of Public Health & Dept. of Community Medicine, Chitwan Medical College, Chitwan, Nepal
| | - Alisha Joshi
- Schools of Nursing, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Sunita Poudyal
- Schools of Nursing, Chitwan Medical College, Bharatpur, Chitwan, Nepal
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D'Souza R, Prakash B, Yadav NK, Ross O, Subedi K. Small vulnerable newborns in Nepal: the need for data. Lancet 2024; 403:614. [PMID: 38368006 DOI: 10.1016/s0140-6736(23)02024-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/18/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Rashmi D'Souza
- Royal College of Paediatrics and Child Health, London WC1X 8SH, UK. rashmi.d'
| | | | | | - Oliver Ross
- Royal College of Paediatrics and Child Health, London WC1X 8SH, UK
| | - Kalpana Subedi
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
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Gajurel BP, Yadav SK, Nepal G, Pant S, Yadav M, Shah R, Shah S. Neurological manifestations and complications of COVID-19 in patients admitted to a tertiary care center in Nepal during the second wave. Medicine (Baltimore) 2024; 103:e36017. [PMID: 38363915 PMCID: PMC10869060 DOI: 10.1097/md.0000000000036017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/18/2023] [Indexed: 02/18/2024] Open
Abstract
Neurological symptoms and signs of Coronavirus disease-19 (COVID-19) can accompany, follow, or precede respiratory symptoms and signs; hence, they are important in the diagnosis and management of COVID-19 patients. In this retrospective study conducted during the second wave of COVID-19, we included all patients diagnosed with COVID-19 using real-time polymerase chain reaction and admitted to the Tribhuvan University Teaching Hospital between June 2021 and October 2021. The patients were categorized into 2 groups: group A (with neurological manifestations or complications) and Group-B (without neurological manifestations or complications). The 2 groups were compared in terms of intensive care unit (ICU) admission, need for ventilatory support, length of hospital stay, and various outcomes. The study included 235 participants ranging in age from 13 to 102 years (mean age = 54 years, standard deviation = 18). Among the participants, 54.50% were male. The proportion of individuals in group A was higher (59.15%, N = 139) than that in Group-B (40.85%, N = 96). Notably, a significantly greater number of patients were admitted to the ICU in Group B than in Group A. However, there were no statistically significant differences in the need for ventilatory support or hospital stay between the 2 groups. Interestingly, group A showed a higher rate of improvement (Z = -3.1145, P = .00188, 95% CI), while Group-B had a higher rate of mortality (Z = 4.5562, P < .00001, 95% CI). Altered mental status and stroke have been specifically linked to poorer outcomes, whereas typical neurological manifestations, such as hyposmia, hypogeusia, dizziness, headache, and myalgia, are associated with better outcomes.
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Affiliation(s)
- Bikram Prasad Gajurel
- Department of Neurology Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sushil Kumar Yadav
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Gaurav Nepal
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Sobin Pant
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Manish Yadav
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Ravi Shah
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Sumit Shah
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
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Subedi K, Sigdel B, Khanal PP, Sharma D, Chaudhary G, Singh AK, Paneru S. Dental caries, tobacco usage and associated risk factor of dental caries in patients visiting a government hospital in Western, Nepal. BMC Oral Health 2024; 24:219. [PMID: 38342887 PMCID: PMC10859024 DOI: 10.1186/s12903-024-03997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/07/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND This study was conducted to assess the prevalence of dental caries, tobacco usage, and associated risk factors for dental caries in patients who visited a government hospital in Western, Nepal. METHODS This analytical cross-sectional study was conducted from January to April 2022. Patients above 18 years visiting the dental OPD of a government hospital, and who had provided informed consent were enrolled in the study using a convenience sampling technique. As the study also involved an illiterate population, in that case, informed consent was obtained from their respective legal guardian as well. A pretested standardized, close-ended questionnaire was administered by researchers to gather information regarding the associated risk factors and oral hygiene practices. Clinical examination was done for dental caries according to the criteria by the World Health Organization (WHO) using the "DMFT" index (WHO modification 1987). Bivariate and multivariable logistic regression was done and the odds ratio and p-value was calculated. For all tests, statistical significance was set at p < 0.05. RESULTS A total of 219 participants completed the study with a mean age of 31.73 ± 12.46. The prevalence of dental caries and tobacco was found to be 80.36% and 5.02% respectively. Participants without health insurance had 2.35 times higher odds of dental caries (95% CI: 1.03-5.36). Not rinsing the mouth after eating sweets was associated with 3.07 times higher odds of dental caries (95% CI: 1.31-7.18). Those who hadn't visited a dentist in the past 12 months had lower odds (0.42; 95% CI: 0.18-0.94). Eating fresh fruit daily showed statistically higher odds (2.70; 95% CI: 1.04-6.99) of dental caries. Non-tobacco users had higher odds (14.19; 2.55-78.99) of dental caries. CONCLUSION Dental caries is highly prevalent, while tobacco usage is relatively low. Factors associated with dental caries included lack of health insurance coverage, consumption of fruits once daily, recent dental visits within the past year, not rinsing the mouth with water after consuming sweets, and non-tobacco users.
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Affiliation(s)
- Krishna Subedi
- Department of Community Dentistry, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal.
| | - Bhawana Sigdel
- Department of Dentistry, Pokhara Academy of Health Sciences, Pokhara, Nepal
| | - Purna Prasad Khanal
- Orthodontic Unit, Dental Department, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Deepa Sharma
- Department of Oral Medicine and Radiology, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal
| | | | | | - Sunil Paneru
- Department of Dentistry, Pokhara Academy of Health Sciences, Pokhara, Nepal
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Bhattarai B, Thapa HB, Bashyal S, Thapa SK, Chaudhuri S, Agiwal V, Pant H, Singh S, Mahajan H. Structured Counselling and Regular Telephonic follow up to improve Referral flow and compliance in Nepal for Diabetic Retinopathy(SCREEN-D Study): a randomised controlled trial. BMC Health Serv Res 2024; 24:188. [PMID: 38336691 PMCID: PMC10858536 DOI: 10.1186/s12913-024-10647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Diabetic Retinopathy (DR) is an emerging public health issue, leading to severe visual impairment or blindness. Early identification and prompt treatment play a key role in achieving good visual outcomes. The objective of the study was to estimate the effectiveness of SCREEN package on improving referral compliance from peripheral centres to a tertiary eye centre in Nepal. METHODS In this facility-based cluster-randomized trial, ten out of 19 referring centres of the tertiary eye care centre in Lumbini zone, Nepal were randomized into intervention and control groups. A SCREEN packagewereprovided as intervention for DR patients who require advanced treatment in the tertiary centres and was compared with the current practice of the control arm, where structured counselling and follow-up mechanism are absent. Compliance was estimated by a weekly follow-up between the referring centre and the referred hospital. RESULTS We recruited 302 participantsof whom 153 were in the intervention arm. The mean age of the participants was 57.8 years (Standard deviation [SD]±11.7 years). With implementation of SCREEN package71.2% (n=109) in the intervention group and 42.9% (n=64) in the control group were compliant till three months of follow-up (Difference 28.3%, 95% CI: 17.6- 39.0, p<0.05). Compliance was 43% (n=66) with counselling alone, and 66% (n=103) with first telephonic follow-up in the intervention arm. The mean duration to reach the referral centre was 14.7 days (SD± 9.4 days) and 18.2 days (SD± 9.1 days) in the intervention and the control arm, respectively (Difference 3.5 days, 95% CI: 0.7 to 6.4 days). CONCLUSIONS Counselling& follow-up to patients is the key factor to improve the utilization of the health services by patients with DR. Health systems must be strengthened by optimizing the existing referral structure in Nepal. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration and Results System, ClinicalTrials.gov Identifier: NCT04834648 , 08/04/2021.
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Affiliation(s)
- Binita Bhattarai
- Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal.
- Lumbini Eye Institute and Research Centre, Bhairahawa, Nepal.
| | - Hari Bahadur Thapa
- Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal
| | - Sandip Bashyal
- Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal
| | | | | | - Varun Agiwal
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
| | - Hira Pant
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
| | - Samiksha Singh
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
| | - Hemant Mahajan
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
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Basnet A, Shrestha MR, Tamang B, Pokhrel N, Maharjan R, Rai JR, Bista S, Shrestha S, Rai SK. Assessment of Antibiotic Resistance among Clinical Isolates of Enterobacteriaceae in Nepal. Am J Trop Med Hyg 2024; 110:283-290. [PMID: 38167427 PMCID: PMC10859788 DOI: 10.4269/ajtmh.23-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/09/2023] [Indexed: 01/05/2024] Open
Abstract
Clinicians face a global challenge treating infections caused by Enterobacteriaceae because of the high rate of antibiotic resistance. This cross-sectional study from the Nepal Armed Police Force Hospital, Kathmandu, Nepal, characterized resistance patterns in Enterobacteriaceae across different antimicrobial classes and assessed incidences of multidrug-resistant (MDR) and extensively drug-resistant (XDR) infections. Enterobacteriaceae from clinical samples were isolated on blood and MacConkey agar, except for urine samples on cysteine lactose electrolyte-deficient agar. To determine antimicrobial susceptibility patterns, including MDR and XDR, the Kirby-Bauer disc diffusion method was used. Statistics were performed using SPSS, v. 17.0. Members of the family were identified in 14.5% (95% CI: 16.2-12.8%) of the total samples (N = 1,617), primarily in urine (54.7%, 128/234), blood (19.7%, 46/234), and sputum (15.0%, 35/234). Escherichia coli (n = 118, 44.2%) was the most predominant bacteria, followed by Citrobacter freundii (n = 81, 30.3%). As much as 95.6% (392/410) of the isolates were penicillin-resistant, whereas only 36.2% (290/801) were carbapenem-resistant. A total of 96 (36.0%) MDR and 98 (36.7%) XDR Enterobacteriaceae were identified. Proteus mirabilis (44.4%, 8/18) predominated MDR cultures, whereas C. freundii (53.1%, 43/81) predominated XDR cultures. Multidrug resistant (38.4%, 71/154) and XDR Enterobacteriaceae (22.7%, 35/154) were chiefly uropathogens. Fluoroquinolone resistance rates in non-MDR, MDR, and XDR isolates were 19.9%, 63.2%, and 96.2%, respectively, whereas cephalosporin resistance rates were 28.6%, 72.9%, and 95.4% and penicillin resistance rates were 67.0%, 97.4%, and 98.0%. One-seventh of patients visiting the hospital were found to be infected with Enterobacteriaceae, and of these patients, at least one-fourth were infected with MDR strains.
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Affiliation(s)
- Ajaya Basnet
- Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Tribhuvan University, Kathmandu, Nepal
- Department of Microbiology, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Mahendra Raj Shrestha
- Department of Clinical Laboratory, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Basanta Tamang
- Department of Microbiology, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Nayanum Pokhrel
- Research Section, Nepal Health Research Council, Kathmandu, Nepal
| | - Rajendra Maharjan
- Department of Clinical Laboratory, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Junu Richhinbung Rai
- Department of Microbiology, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Shrijana Bista
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Shila Shrestha
- Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Tribhuvan University, Kathmandu, Nepal
| | - Shiba Kumar Rai
- Department of Research and Microbiology, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal
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Bruffaerts R, Axinn WG, Ghimire DJ, Benjet C, Chardoul S, Scott KM, Kessler RC, Schulz P, Smoller JW. Community exposure to armed conflict and subsequent onset of alcohol use disorder. Addiction 2024; 119:248-258. [PMID: 37755324 PMCID: PMC10872606 DOI: 10.1111/add.16343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/17/2023] [Indexed: 09/28/2023]
Abstract
AIMS To measure the independent consequences of community-level armed conflict beatings on alcohol use disorders (AUD) among males in Nepal during and after the 2000-2006 conflict. DESIGN A population-representative panel study from Nepal, with precise measures of community-level violent events and subsequent individual-level AUD in males. Females were not included because of low AUD prevalence. SETTING Chitwan, Nepal. PARTICIPANTS Four thousand eight hundred seventy-six males from 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15-59 were eligible (response rate 93%). MEASUREMENTS Measures of beatings in the community during the conflict (2000-2006), including the date and distance away, were gathered through neighborhood reports, geo-location and official resources, then linked to respondents' life histories of AUD (collected in 2016-2018) using the Nepal-specific Composite International Diagnostic Interview with life history calendar. Beatings nearby predict the subsequent onset of AUD during and after the armed conflict. Data were analyzed in 2021-2022. FINDINGS Cohort-specific, discrete-time models revealed that within the youngest cohort (born 1992-2001), those living in neighborhoods where armed conflict beatings occurred were more likely to develop AUD compared with those in other neighborhoods (odds ratio = 1.66; 95% confidence interval = 1.02-2.71). In this cohort, a multilevel matching analysis designed to simulate a randomized trial showed the post-conflict incidence of AUD for those living in neighborhoods with any armed conflict beatings was 9.5% compared with 5.3% in the matched sample with no beatings. CONCLUSIONS Among male children living in Chitwan, Nepal during the 2000-2006 armed conflict, living in a neighborhood where armed conflict beatings occurred is associated with increased odds of developing subsequent alcohol use disorder. This association was independent of personal exposure to beatings and other mental disorders.
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Affiliation(s)
- Ronny Bruffaerts
- Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum KU Leuven, Leuven, Belgium
| | - William G Axinn
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Dirgha J Ghimire
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Corina Benjet
- Department of Epidemiology and Psychosocial Research, National Institute of Psychiatry Instituto Nacional de Psiquiatría Ramón de La Fuente Muñiz, Mexico City, Mexico
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Schulz
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Subedi K, Shrestha A, Bhagat T. Oral health status and barriers to utilization of dental services among pregnant women in Sunsari, Nepal: A cross-sectional study. Int J Dent Hyg 2024; 22:209-218. [PMID: 37635438 DOI: 10.1111/idh.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 06/17/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES This study was conducted to assess oral hygiene practices, oral health status and barriers to utilization of oral health care services among pregnant mothers attending two family health care clinics in Sunsari, Nepal. METHODS A cross-sectional study was conducted among 139 women using a purposive sampling technique. The data collection was done using a pretested standard semi-structured questionnaire. Face-to-face interviews of the participants were done by a single investigator in the local language (Nepali). The examination was done using a mouth mirror and CPI probe for periodontal status, loss of attachment and dentition status, and treatment needs. RESULTS The majority of pregnant mothers brushed their teeth once a day or less than once a day (n = 106, 76.3%) and self-reported perceived oral health status was poor/fair (n = 93, 66.9%). The prevalence of dental caries was found to be 69.8%. Bleeding on probing was present in all participants. DMFT, presence of bleeding on probing and increased periodontal pocket was significantly high among women who had self-reported their oral health problems in comparison to those who had not reported any problem. The most common barriers reported by the participants were a lack of knowledge of dental checkups and a lack of perceived need for dental care during pregnancy. CONCLUSIONS There was a high prevalence of dental caries and periodontal disease. Lack of knowledge and perceived need for dental care were the major barriers found in this study. Hence, this directs towards the utmost need for improvement in awareness level as well as oral hygiene practices.
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Affiliation(s)
- Krishna Subedi
- Dental Department, Pokhara Academy of Health Sciences, Pokhara, Nepal
| | - Ashish Shrestha
- Department of Public Health Dentistry, CODS, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Tarakant Bhagat
- Department of Public Health Dentistry, CODS, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Huang B, Hua J, Liu S, Wang X, Sun Z, Bai R, Dong W. Temporal trends in disease burden and attributable risk factors for tracheal, bronchus, and lung cancer in Nepal, 1990-2019. Cancer Epidemiol 2024; 88:102497. [PMID: 38007840 DOI: 10.1016/j.canep.2023.102497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Tracheal, bronchus, and lung (TBL) cancer is one of the most common cancers in Nepal. The aim of this study was to analyze the changing disease burden and risk factors for TBL cancer in Nepal from 1990 to 2019. METHODS TBL cancer burden data were obtained from the Global Burden of Disease Study 2019. A decomposition analysis was used to explore the impact of changes in population size, population age structure, age-specific prevalence, and disease severity on long-term trends of the TBL cancer burden in Nepal. RESULTS In 2019, TBL cancer resulted in the loss of 45.2 thousand (95% uncertainty interval [UI]: 32.3-59.2 thousand) disability-adjusted life years (DALYs) in Nepal, with the age-standardized incidence and prevalence rates increasing by 12.7% (95% UI: -21.0 to 63.9%) and 12.8% (95% UI: -21.1 to 62.0%), respectively, compared with 1990. The proportion of DALYs due to TBL cancer increased significantly among people aged 70 years and older from 1990 to 2019. However, the proportion of DALYs due to TBL cancer still dominated among males and females aged 50-69 years. Population growth, population aging, and increased age-specific prevalence led to an increased disease burden of TBL cancer, while disease severity led to a decreased burden. In 2019, smoking remained the major risk factor for TBL cancer in Nepal, while ambient particulate matter pollution exhibited the most significant rise. CONCLUSIONS The disease burden of TBL cancer in Nepal has continued to increase over the past three decades, and given the continuing population growth and aging process, TBL cancer is likely to have a considerable impact on health in Nepal in the future. There is a need to further establish effective TBL cancer prevention and control policies.
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Affiliation(s)
- Binfang Huang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Jinchao Hua
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Shanshan Liu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Xu Wang
- Department of Science and Technology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Zhonghe Sun
- Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
| | - Ruhai Bai
- School of Public Affairs, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Wanyue Dong
- School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, Nanjing 210023, China.
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Dielemans A, Mahat P, Dunn JA, Balcke E, Kumar Jha R, Ghimire S, Gaire H, Honikman S. Prevalence of maternal depression and anxiety symptoms and associations with child mental health outcomes in rural Nepal. Trop Med Int Health 2024; 29:128-136. [PMID: 38126274 DOI: 10.1111/tmi.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study describes the prevalence, associated factors and child mental health outcomes related to symptoms of maternal depression and anxiety within 5 years after childbirth in a rural district in Nepal. This association is not well-understood in rural, community-based settings in low- and middle-income countries (LMIC). METHODS A sample of 347 women with children under 5 years was recruited in September 2019 for a cross-sectional study in the rural Saptari district in Nepal. Multivariable logistic regression was used to investigate the association between maternal depressive or anxiety symptoms and children's experience and impact of emotional and behavioural difficulties. RESULTS In total, 144 women (41.5%) had moderate or severe depression symptoms and 118 (34%) had anxiety symptoms. Mothers with a lower income were more likely to have anxiety symptoms than the highest income group (OR: 1.8, 95% CI: 1.1-3.0). An association existed between maternal depressive symptoms and the impact of emotional or behavioural difficulties in children (OR: 2.44, 95% CI: 1.02-5.84). In contrast, there was no association between maternal anxiety and child outcomes. CONCLUSIONS Our findings suggest that the prevalence of probable maternal anxiety and depression symptoms was relatively high in this rural, low-resourced and community-based setting in Nepal. Maternal depressive symptoms were associated with the degree of impact on children's mental health post-infancy, emphasising the importance of improving maternal mental health in the early years of a child's life.
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Affiliation(s)
| | - Pashupati Mahat
- Centre for Mental Health and Counselling Nepal, Kathmandu, Nepal
| | - Julia Alexandra Dunn
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Emily Balcke
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Rajesh Kumar Jha
- Centre for Mental Health and Counselling Nepal, Kathmandu, Nepal
| | - Smriti Ghimire
- Centre for Mental Health and Counselling Nepal, Kathmandu, Nepal
| | - Himal Gaire
- Centre for Mental Health and Counselling Nepal, Kathmandu, Nepal
| | - Simone Honikman
- Perinatal Mental Health Project, Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Lacey H, Jain N, Sugimoto M, Shimato M, Zhou SJ, Pirags V, Shakya R, Karmacharya RM, Baral PP. Advancing diabetes primary care education and knowledge in Nepal: A scoping review and case study discussion. Prim Care Diabetes 2024; 18:25-36. [PMID: 38061968 DOI: 10.1016/j.pcd.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 02/12/2024]
Abstract
AIMS Diabetes mellitus (DM) is a chronic disorder of insulin and glucose metabolism. It affects more than 463 million people worldwide and is expected to reach 700 million by 2045. In the Southeast Asian region, the prevalence of DM has tripled to 115 million due to rapid urbanization, unhealthy diet, sedentary lifestyles, and genetic factors. In Nepal, a developing country, DM affects 8.5% of adults, with an alarming increase in recent years. Lack of diabetes education and limited populational adoption of behavioural changes further hamper care. METHODS In the present study, we performed a scoping review to determine the status of awareness, attitudes, and knowledge about diabetes in the Nepalese population with a focus on the educational initiatives that have been implemented. We also conducted a two-week international case study discussion among medical students to brainstorm viable intervention strategies. RESULTS Our findings indicate that limited data is available on the level of education or initiatives to improve knowledge and practice among healthcare professionals and community members. Targeted studies of people with diabetes also present heterogeneous results due to differences in the sample population, geographic location, education, age, and gender. Accordingly, we propose five interrelated education-based strategies that leverage existing networks to expand community outreach and engagement, improve system resilience, and improve health outcomes. CONCLUSIONS Effective education for healthcare professionals, community, and patients with diabetes is vital in improving diabetes outcomes in Nepal and South Asia. Collaboration, funding, and evaluation are key areas needing reform.
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Affiliation(s)
- Hester Lacey
- Faculty of Medicine, Brighton and Sussex Medical School, 94 N - S Rd, Falmer, Brighton BN1 9PX, United Kingdom.
| | - Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, 16 Dzirciema Street, Riga LV-1007, Latvia
| | - Mai Sugimoto
- Faculty of Medicine, Queen Mary University of London, Mile End Rd, Bethnal Green, London E1 4NS, United Kingdom
| | - Masako Shimato
- Faculty of Medicine, University College London, Gower St, London WC1E 6BT, United Kingdom
| | - Shi Jia Zhou
- Faculty of Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Valdis Pirags
- Faculty of Medicine, University of Latvia, 3 Jelgavas Street, Riga LV-1004, Latvia; Department of Endocrinology and Rheumatology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga LV-1002, Latvia
| | - Rajani Shakya
- Research & Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel 45200, Nepal
| | - Robin Man Karmacharya
- Department of Surgery, Kathmandu University School of Medical Sciences, B.P.Highway, Panauti 45209, Nepal
| | - Phanindra Prasad Baral
- Non-Communicable Disease and Mental Health Section, Epidemiology and Disease Control Division (EDCD), Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Government of Nepal, Kathmandu, Nepal
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Goyal A, Shinde SA, Purandare N. Oral health in Nepal: Challenges v/s Spiritual Belief. Int J Dent Hyg 2024; 22:118-119. [PMID: 37793068 DOI: 10.1111/idh.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Astha Goyal
- Department of Biochemistry, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidypeeth (DPU), Pimpri, Pune, India
| | - Sarita A Shinde
- Department of Biochemistry, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidypeeth (DPU), Pimpri, Pune, India
| | - Nidhi Purandare
- Department of Biochemistry, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidypeeth (DPU), Pimpri, Pune, India
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Adhikari S, Phuyal S, Acharya KP. Addressing zoonotic disease transmission from temple monkeys to humans in Nepal. J Travel Med 2024; 31:taad157. [PMID: 38102759 DOI: 10.1093/jtm/taad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
Evidence of infection with the zoonotic pathogens has been reported from temple monkeys in Nepal. In this paper, the possible spillover of zoonotic pathogens from monkeys to humans is discussed.
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Affiliation(s)
- Sonu Adhikari
- Department of Animal Breeding and Biotechnology, Agriculture and Forestry University (AFU), PO Box 13712, Rampur, Chitwan, Nepal
| | - Sarita Phuyal
- Central Referral Veterinary Hospital, Tripureshwar, Kathmandu 45104, Nepal
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Aslam M, Baudin T, Farvaque E, Marakbi R. Measuring the presence and incidence of cholera in Hindustan: New data from primary sources for the colonial era. Sci Data 2024; 11:49. [PMID: 38191626 PMCID: PMC10774304 DOI: 10.1038/s41597-023-02796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024] Open
Abstract
We build a new dataset covering 90 years of Cholera spreading in Hindustan from 1814 to 1904. We gather data from a collection of primary sources issued from medical reports. We propose a harmonization procedure to make these data comparable and corresponding to the current borders of India, Pakistan, Nepal, and Bangladesh. Our methodology is corroborated when comparing our newly produced data with other accounts, in particular Roger (1926)'s estimations. It opens the door to research aiming at estimating the effect of the successive waves of Cholera on the economic, social and epidemiological dynamics of the region.
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Affiliation(s)
- Maqsood Aslam
- LÉP (Laboratoire d'Économie de Poitiers), Université de Poitiers, France, and School of Economics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Thomas Baudin
- Univ. Lille, CNRS, IESEG School of Management, UMR 9221 - LEM - Lille Économie Management, F-59000, Lille, France
| | - Etienne Farvaque
- Univ. Lille, CNRS, IESEG School of Management, UMR 9221 - LEM - Lille Économie Management, F-59000, Lille, France.
- CIRANO, Montréal, Québec, Canada.
| | - Reda Marakbi
- Univ. Lille, CNRS, IESEG School of Management, UMR 9221 - LEM - Lille Économie Management, F-59000, Lille, France
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65
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Thapa P, Lama S, Rai G, Sapkota N, Pradhan N, Thapa R, Uprety P, Basnet M. Family caregiver experience of caring COVID-19 patients admitted in COVID-19 hospital of a tertiary care hospital in Nepal. PLoS One 2024; 19:e0295395. [PMID: 38181040 PMCID: PMC10769026 DOI: 10.1371/journal.pone.0295395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/19/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Informal caregivers played a significant role in caring for COVID-19 patients during hospitalization in Nepal. This study aimed to understand the experiences of family caregivers attending to their relatives in a COVID-19 hospital in Nepal. METHODS A descriptive phenomenological approach was adopted to understand the caregiver's experience in supporting their relatives admitted to the COVID-19 hospital of the BP Koirala Institute of Health Sciences (BPKIHS). Thirteen caregivers of COVID-19 positive patients were purposively selected from April to June, 2022. Face-to-face interviews were conducted at a caregiver residential facility using the interview schedule developed by the department for the purpose of data collection after obtaining ethical clearance from the Institutional review committee of BPKIHS. Data were audio recorded and manually analyzed. RESULTS Among the 13 caregivers, six were male and seven were female. The findings were categorized into five domains: challenges encountered, changes in physical and mental health, changes in roles and responsibilities, positive experiences, and strategies to ease caregiving tasks. Major challenges included financial burdens, communication problems, stigmatization, Insecurity, substandard accommodation, and visitor restrictions. Caregivers reported negative emotions, unmet physical health needs, and shifts in family and occupational roles. Despite these challenges, caregivers attempted to cope positively and acknowledged the efforts of healthcare personnel and other family members. Suggestions for improving caregiving included providing essential medical and basic services within the hospital, enhancing accommodation facilities, establishing proper communication channels, and allowing visitations. CONCLUSIONS Caregivers of COVID-19 patients face significant challenges during the caregiving process. Enhancing hospital services, promoting effective communication, fostering positive attitudes, and ensuring a safe environment can facilitate caregiving tasks.
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Affiliation(s)
- Prekshya Thapa
- Department of Psychiatric Nursing, College of Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sami Lama
- Department of Psychiatric Nursing, College of Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Gayatri Rai
- Hospital Matron, Nursing Service Administration, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nidesh Sapkota
- Department of Psychiatry, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Nirmala Pradhan
- Department of Psychiatric Nursing, College of Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Roshni Thapa
- Department of Community Health Nursing, College of Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Pratik Uprety
- Medical Doctor, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Madhur Basnet
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Shrestha A, Ghimire S, Kinney J, Mehta R, Mistry SK, Saito S, Rayamajhee B, Sharma D, Mehta S, Yadav UN. The role of family support in the self-rated health of older adults in eastern Nepal: findings from a cross-sectional study. BMC Geriatr 2024; 24:20. [PMID: 38178009 PMCID: PMC10768249 DOI: 10.1186/s12877-023-04619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Nepal's low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults. METHODS A community-based cross-sectional survey in eastern Nepal's two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health. RESULTS Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support. CONCLUSIONS Given the important role of family support in Nepali older adults' health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults' care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies.
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Affiliation(s)
- Aman Shrestha
- Department of Sociology & Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Saruna Ghimire
- Department of Sociology & Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Jennifer Kinney
- Department of Sociology & Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Ranju Mehta
- Little Buddha College of Health Sciences, Kathmandu, Bagmati, Nepal
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Shoko Saito
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Binod Rayamajhee
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Deepak Sharma
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Suresh Mehta
- Koshi Province Ministry of Health, Biratnagar, Koshi, Nepal
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia.
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Joshi AB, Banjara MR, Das ML, Ghale P, Pant KR, Pyakurel UR, Dahal G, Paudel KP, Das CL, Kroeger A, Aseffa A. Epidemiological, Serological, and Entomological Investigation of New Visceral Leishmaniasis Foci in Nepal. Am J Trop Med Hyg 2024; 110:44-51. [PMID: 38011729 DOI: 10.4269/ajtmh.23-0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/15/2023] [Indexed: 11/29/2023] Open
Abstract
The aim of this study was to explore epidemiological, serological, entomological, and social aspects of visceral leishmaniasis (VL) in new foci in Nepal. The study was conducted in 11 villages of five districts that had been previously free of VL but that reported new cases between 2019 and 2021. We screened 1,288 inhabitants using rK39 tests and investigated the epidemiological and clinical characteristics of 12 recent VL cases. A total of 182 community members were interviewed about knowledge, attitude, and practices regarding VL. They then underwent an awareness training; 40 of them had a second interview at 6 months to assess the training impact. Vector surveys were conducted in six houses per village to assess sandfly density and infection rates. The prevalence of VL infection was 0.5% and 3.2% among screened populations in Dolpa and Kavre districts, respectively, while the other districts had no rK39-positive cases. No association between travel history and VL infection was found. Phlebotomus argentipes sandflies were collected in three districts at high altitudes (from 1,084 to 4,450 m). None of the sandflies captured had Leishmania donovani DNA. People in new foci were not aware of VL symptoms, vectors, or preventive measures. The training significantly improved their knowledge and practice in seeking medical care in case of illness. The epidemiological, serological, and entomological investigations suggest indigenous focal transmission of VL. An integrated package of strategic interventions should be implemented by the national VL elimination program in districts with new VL foci.
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Affiliation(s)
- Anand Ballabh Joshi
- Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
| | - Murari Lal Das
- Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal
| | - Pragyan Ghale
- Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal
| | - Krishna Raj Pant
- Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal
| | - Uttam Raj Pyakurel
- Epidemiology and Disease Control Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Gokarna Dahal
- Epidemiology and Disease Control Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Krishna Prasad Paudel
- Epidemiology and Disease Control Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Chuman Lal Das
- Epidemiology and Disease Control Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Axel Kroeger
- Centre for Medicine and Society, Albert-Ludwigs-University, Freiburg, Germany
| | - Abraham Aseffa
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
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Paudel K, Bhandari P, Gautam K, Wickersham JA, Ha T, Banik S, Shrestha R. Mediating role of food insecurity in the relationship between perceived MSM related stigma and depressive symptoms among men who have sex with men in Nepal. PLoS One 2024; 19:e0296097. [PMID: 38166131 PMCID: PMC10760890 DOI: 10.1371/journal.pone.0296097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Previous studies have indicated the association between stigma and depressive symptoms among frequently stigmatized groups, such as men who have sex with men (MSM). While this association has been suggested in the literature, there is a dearth of evidence that examines whether food insecurity statistically mediates the relationship between stigma and depressive symptoms. METHODS This cross-sectional study conducted between October and December 2022 among a sample of 250 MSM in Kathmandu, Nepal, recruited through respondent-driven sampling. An unadjusted model including the exposure (stigma), mediator (food insecurity), and outcome variables (depressive symptoms) and an adjusted model that controlled for sociodemographic, behavioral, and health-related confounders were used. Bootstrapping was utilized to estimate the coefficients of these effects and the corresponding 95% confidence intervals. Via bootstrap approach, we find out the mediating role of food insecurity in the association between stigma and depressive symptoms. RESULTS Depressive symptoms, stigma, and food insecurity were 19.6%, 24.4%, and 29.2%, respectively, among MSM. Food insecurity was associated with higher age (b = 0.094; 95% CI = 0.039, 0.150) and monthly income (b = -1.806; 95% CI = -2.622, -0.985). Depressive symptoms were associated with condom-less sex in past six months (b = -1.638; 95% CI = -3.041, -0.092). Stigma was associated with higher age (b = 0.196; 95% CI = 0.084, 0.323) and PrEP uptake (b = 2.905; 95% CI = 0.659. 5.248). Food insecurity statistically mediated 20.6% of the indirect effect of stigma in depressive symptoms. CONCLUSION Our findings show that food insecurity affects the relationship between stigma and depressive symptoms in this population. Reducing food insecurity and addressing the stigma surrounding sexual orientation should be a priority when addressing mental health concerns among MSM in Nepal and other resource-limited countries with similar socio-cultural settings.
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Affiliation(s)
- Kiran Paudel
- Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States of America
| | | | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States of America
| | - Jeffrey A. Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States of America
| | - Toan Ha
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Swagata Banik
- Baldwin Wallace University, Berea, OH, United States of America
| | - Roman Shrestha
- Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States of America
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States of America
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Gogate P, Saravanan S, Borah RR, Gurung R, Mishra SK, Sapkota YD, Adhikari S, Bachracharya K, Joshi P. Paediatric ophthalmology in Nepal. Eye (Lond) 2024; 38:10-12. [PMID: 37400567 PMCID: PMC10764343 DOI: 10.1038/s41433-023-02632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/09/2023] [Accepted: 06/07/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
- Parikshit Gogate
- Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune, India.
- Department of Ophthalmology, D.Y.Patil Medical College, Pimpri, Pune, India.
- School of Health Sciences, Queens University, Belfast, United Kingdom.
| | | | | | | | | | - Yuddha Dhoj Sapkota
- International Agency for the Prevention of Blindness, South East Asia, Kathmandu, Nepal
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Nevin WD, Jones J, Tupper D, Dunbar JAT, Wilson D, Ross D, Woolley S, Dodd J, Biswas J, Lamb L, Beeching NJ, O’Shea MK, Fletcher TE. Gastrointestinal parasite infections in Nepalese Gurkha recruits arriving in the United Kingdom from 2012-2020. PLoS Negl Trop Dis 2024; 18:e0011931. [PMID: 38277403 PMCID: PMC10849272 DOI: 10.1371/journal.pntd.0011931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/07/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Gastrointestinal parasite (GIP) infections are a major cause of global morbidity, infecting hundreds of millions of people each year and potentially leading to lifelong infection and serious complications. Few data exist on screening for GIP infections in migrants entering the UK or on the current performance of different traditional diagnostic approaches. This study aimed to describe the prevalence of GIP infections in Nepalese Gurkha recruits screened on arrival in the UK. METHODOLOGY/PRINCIPAL FINDINGS We present a retrospective analysis of data from screening male adults (18-21 years) who arrived in the UK from Nepal between 2012 and 2020. Three separate faecal samples were obtained from participants at weekly intervals and processed for formalin-ethyl acetate (FEA) concentration/light microscopy and charcoal culture. Serum samples were analysed for IgG antibodies to Strongyloides stercoralis by ELISA. Results were available from 2,263 participants, of whom 463 (20.5%, 95% CI 18.8%-22.2%) had a positive diagnostic test for at least one GIP infection. A total of 525 potential infections were identified. Giardia duodenalis was most common (231/2263, 10.2%), followed by S. stercoralis (102/2263, 4.5%), and hookworm species (86/2263, 3.8%). Analysis (microscopy and culture) of the initial stool sample diagnosed only 244/427 (57.1%) faecally identified pathogens, including 41/86 (47.7%) hookworm infections. The proportion of participants infected with any GIP showed a downward trend over the study period. Log-binomial regression showed risk of infection decreasing by 6.1% year-on-year (95% CI 3.2% - 9.0%). This was driven predominantly by a fall in hookworm, S. stercoralis and Trichuris trichiura prevalence. CONCLUSIONS/SIGNIFICANCE The level of potentially pathogenic GIP infection in young Nepalese men migrating to the UK is high (20.5%) and requires a combined diagnostic approach including serology and analysis of multiple stool samples incorporating specialised parasitological methods. Advances in molecular approaches may optimise and simplify the intensive screening strategy required.
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Affiliation(s)
- William D. Nevin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Jayne Jones
- Clinical Diagnostic Parasitology Laboratory, Liverpool School of Tropical Medicine, United Kingdom
| | - Donna Tupper
- Medical Centre, Infantry Training Centre, Catterick, United Kingdom
| | - James A. T. Dunbar
- Friarage Hospital, Northallerton, United Kingdom
- 212 Field Hospital, Royal Army Medical Corps, Defence Medical Services, United Kingdom
| | - Duncan Wilson
- Headquarters Defence Medical Services Group, Defence Medical Directorate, ICT Building, Edgbaston, Birmingham, United Kingdom
| | - David Ross
- Defence Public Health Unit, Defence Medical Services, United Kingdom
| | - Stephen Woolley
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - James Dodd
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Jason Biswas
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Lucy Lamb
- Department of Infectious Diseases, Imperial College London, United Kingdom
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, United Kingdom
- Department of Infectious Diseases, Royal Free Hospital, London, United Kingdom
| | - Nicholas J. Beeching
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Matthew K. O’Shea
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Thomas E. Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Mehta PK, Maharjan M. Assessment of microfilaremia in 'hotspots' of four lymphatic filariasis endemic districts of Nepal during post-MDA surveillance. PLoS Negl Trop Dis 2024; 18:e0011932. [PMID: 38295107 PMCID: PMC10861036 DOI: 10.1371/journal.pntd.0011932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 02/12/2024] [Accepted: 01/22/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The lymphatic filariasis (LF) elimination program in all sixty-three endemic districts of Nepal was based on annual mass drug administration (MDA) using a combination of diethylcarbamazine (DEC) and albendazole for at least 5 years. The MDA program was started in the Parsa district of the Terai region and at least six rounds of MDA were completed between 2003 and 2017 in all filariasis endemic districts of Central Nepal. Transmission Assessment Survey (TAS) report indicated that circulating filarial antigen (CFA) prevalence was below the critical value i.e., ≤ 2% in selected LF endemic districts of Central Nepal. Based on the TAS report, antigen-positive cases were found clustered in the foci of those districts which were considered as "hotspots". Hence the present study was designed to assess microfilaremia in hotspots of four endemic districts of Central Nepal after the MDA program. METHODOLOGY AND PRINCIPAL FINDINGS The present study assessed microfilaremia in hotspots of four endemic districts i.e. Lalitpur and Dhading from the hilly region and Bara and Mahottari from the Terai region of Central Nepal. Night blood samples (n = 1722) were collected by finger prick method from the eligible sample population irrespective of age and sex. Community people's participation in the MDA program was ensured using a structured questionnaire and chronic clinical manifestation of LF was assessed using standard case definition. Two districts one each from the hilly region (Lalitpur district) and Terai region (Bara district) showed improved microfilaria (MF) prevalence i.e. below the critical level (<1%) while the other two districts are still over the critical level. There was a significantly high prevalence of MF in male (p = <0.05) and ≥41 years of age group (p = <0.05) community people in the hotspots of four endemic districts. People who participated in the previous rounds of the MDA program have significantly low MF prevalence. The upper confidence limit of MF prevalence in all hotspots of four districts was above the critical level (>1%). Chronic clinical manifestation of LF showed significant association with the older age group (≥41 years) but not with sex. CONCLUSIONS The study revealed LF transmission improved in hotspots of two districts while continued in others but the risk of LF resurgence cannot be ignored since the upper confidence level of MF prevalence is over 1% in all the hotspots studied districts. High MF prevalence is well correlated with the number of MDA rounds but not with the MDA coverage. Community people involved in MDA drug uptake in any previous and last rounds have significantly less MF infection. Hence it is recommended that before deciding to stop the MDA rounds it is essential to conduct the MF survey at the hotspots of the sentinel sites.
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Affiliation(s)
- Pramod Kumar Mehta
- Central Department of Zoology, Institute of Science and Technology, Tribhuvan University, Kirtipur, Nepal
| | - Mahendra Maharjan
- Central Department of Zoology, Institute of Science and Technology, Tribhuvan University, Kirtipur, Nepal
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Mehta PK, Maharjan M. Entomological assessment in 'hotspots' of four lymphatic filariasis endemic districts, Central Nepal during post-MDA surveillance. J Vector Borne Dis 2024; 61:136-142. [PMID: 38648416 DOI: 10.4103/0972-9062.392252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/22/2023] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND OBJECTIVES Annual mass drug administration (MDA) is the main strategy to interrupt the transmission of lymphatic filariasis (LF) in the community. The main aim of monitoring the MDA program, for its effectiveness and interruption of LF is the post-MDA surveillance using antigen survey in children born after MDA. The latest technique of new research suggests that xenomonitoring is an effective tool for monitoring LF intervention. The objective of this study was to assess the W. bancrofti infection/or infectivity in vector mosquitoes by xenomonitoring during post-MDA surveillance. METHODS A descriptive cross-sectional study was conducted in the hotspots of selected four districts of Central Nepal. A gravid trap technique was used for sampling mosquitoes. Infection/or infectivity was determined via the dissection of vector mosquitoes. Anopheles, Aedes, Armigerus and Culex species were collected from hotspots of four endemic districts, two from the hilly region (Lalitpur and Dhading) and two from Terai region (Bara and Mahottari) of Central Nepal. RESULTS A total of 4450 mosquitoes belonging to four genera, Anopheles, Culex, Armigeres, and Aedes were collected from four hotspots. The distribution of Culex quinquefasciatus was found to be the highest, 88.9% (n=3955/4450) followed by Cx. vishnui (4.5%), Armigeres sp (5.8%), An. culicifascies (0.2%), Aedes spp (0.8%). The proportion of female mosquitoes trapped is significantly higher. A total of 3344 parous Cx. quinquefasciatus mosquitoes were dissected for any larval stage of W. bancrofti. We could not find any filarial infection in dissected mosquito samples. INTERPRETATION CONCLUSION We conclude that the gravid trap is an efficient tool for the collection of gravid Cx. quinquefasciatus mosquitoes for xenomonitoring studies of filariasis endemic regions. Vector composition indicated a maximum number of vector mosquitoes of lymphatic filariasis were trapped compared with the other three species. Distribution and density of Cx. quinquefasciatus was found highest in four hotspots of endemic districts. None of the Cx. quinquefasciatus dissected were found to be infected by larval forms of filaria. Since the low levels of infection persistence in the human population in these hot spots, vector infection and infectivity can't be ignored. Microscopic xenomonitoring at a low level of infection persistent is less likely to be efficient so molecular xenomonitoring along with a large sample should be required in each of the hot spots of the districts. Additionally, area is receptive so further vector control intervention should be required to reduce the risk of resurgence of infection.
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Affiliation(s)
- Pramod Kumar Mehta
- Central Department of Zoology, Institute of Science and Technology, Tribhuvan University, Kirtipur, Nepal
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Sabin L, Saville N, Dixit Devkota M, Haghparast-Bidgoli H. Factors affecting antenatal screening for HIV in Nepal: results from Nepal Demographic and Health Surveys 2016 and 2022. BMJ Open 2023; 13:e076733. [PMID: 38135312 DOI: 10.1136/bmjopen-2023-076733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Antenatal screening for HIV remains low in Nepal. Identifying factors associated with the uptake of antenatal screening is essential to increase uptake and prevent mother-to-child transmission (MTCT). This study investigated the effects of individual-level and district-level characteristics on the utilisation of antenatal screening for HIV in Nepal and how these effects changed between 2016 and 2022. DESIGN We used publicly available cross-sectional data from 2016 to 2022 Nepal Demographic and Health Surveys. SETTING Stratified, multistage, random sampling was used to collect nationally representative data. PARTICIPANTS 1978 and 2007 women aged 15-49 years who gave birth in the 2 years preceding the surveys. PRIMARY AND SECONDARY OUTCOME MEASURES We used multilevel models to estimate associations between antenatal screening and potential factors influencing it in 2016 and 2022. We used districts as a random effect and looked at the intraclass correlation coefficients to disentangle the geographical effects. To distinguish barriers to HIV screening from barriers to accessing antenatal care (ANC) services, we performed similar analyses with whether the woman attended at least one ANC visit as the dependent variable. RESULTS Factors associated with antenatal screening have not changed significantly between 2016 and 2022. Higher uptake of HIV screening was found among women with higher education, the pregnancy being desired later and women who had four or more ANC visits. Being from a poorer family and having low knowledge of MTCT and the medicines to prevent transmission were associated with lower uptake. From the supply side, no factors had a significant effect on antenatal screening. Factors associated with antenatal screening and those associated with any ANC were different. Our results also showed a partial importance of geographical factors on screening uptake. CONCLUSIONS Our results supported that antenatal screening could be improved by enhancing access to information and improving the availability of free screening.
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Affiliation(s)
- Lucie Sabin
- Institute for Global Health, University College London (UCL), London, UK
| | - Naomi Saville
- Institute for Global Health, University College London (UCL), London, UK
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Maharjan S, Gallagher P, Gautam M, Joh HS, Sujan MJ, Aboushady AT, Kwon SY, Gautam S, Upadhyaya MK, Jha R, Acharya J, MacWright WR, Marks F, Stelling J, Poudyal N. Recording and Reporting of Antimicrobial Resistance (AMR) Priority Variables and Its Implication on Expanding Surveillance Sites in Nepal: A CAPTURA Experience. Clin Infect Dis 2023; 77:S560-S568. [PMID: 38118014 PMCID: PMC10732557 DOI: 10.1093/cid/ciad581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Data on antimicrobial resistance (AMR) from sites not participating in the National AMR surveillance network, conducted by National Public Health Laboratory (NPHL), remain largely unknown in Nepal. The "Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) assessed AMR data from previously untapped data sources in Nepal. A retrospective cross-sectional data review was carried out for the AMR data recorded between January 2017 and December 2019 to analyze AMR data from 26 hospital-based laboratories and 2 diagnostic laboratories in Nepal. Of the 56 health facilities initially contacted to participate in this project activity, 50.0% (28/56) signed a data-sharing agreement with CAPTURA. Eleven of the 28 hospitals were AMR surveillance sites, whereas the other 17, although not part of the National AMR surveillance network, recorded AMR-related data. Data for 663 602 isolates obtained from 580 038 patients were analyzed. A complete record of the 11 CAPTURA priority variables was obtained from 45.5% (5/11) of government hospitals, 63.6% (7/11) of private hospitals, and 54.6% (6/11) of public-private hospitals networked with NPHL for AMR surveillance. Similarly, 80% (8/10) of clinics and 54.6% (6/11) of laboratories outside the NPHL network recorded complete data for the 10 Global Antimicrobial Resistance and Use Surveillance System (GLASS) priority variables and 11/14 CAPTURA priority variables. Retrospective review of the data identified areas requiring additional resources and interventions to improve the quality of data on AMR in Nepal. Furthermore, we observed no difference in the priority variables reported by sites within or outside the NPHL network, thus suggesting that policies could be made to expand the surveillance system to include these sites without substantially affecting the government's budget.
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Affiliation(s)
- Sanju Maharjan
- Public Health Research, Anweshan Private Limited, Lalitpur, Nepal
| | | | - Manish Gautam
- Public Health Research, Anweshan Private Limited, Lalitpur, Nepal
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Ahmed Taha Aboushady
- International Vaccine Institute, Seoul, Republic of Korea
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sanjay Gautam
- International Vaccine Institute, Seoul, Republic of Korea
- Research & Collaboration, Anka Analytica, Melbourne, Australia
| | | | - Runa Jha
- National Public Health Laboratory, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Jyoti Acharya
- National Public Health Laboratory, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Madagascar
| | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
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Nai S, Ranjitkar UD, Pandey A. Perceived Burden of Care among Parents of Children with Sickle Cell Disease. J Nepal Health Res Counc 2023; 21:197-202. [PMID: 38196207 DOI: 10.33314/jnhrc.v21i02.4575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Children affected with Sickle Cell Disease mostly depend on their parents for assistance which creates physical, emotional, social, and financial burdens among the parents. The objective of this study was to find out the level of perceived burden of care among parents of children with sickle cell disease in a hospital. METHODS A descriptive cross-sectional research design was used with a quantitative approach. The data were collected using a structured interview schedule using the Zarit Burden Interview scale among 152 parents attending the social service unit of Bheri Hospital, Nepalgunj. A nonprobability purposive sampling technique was used. Data were analyzed using Statistical Package for Social Science (SPSS), version 20. The Chi-square test was used to measure the association between the level of burden of care and selected variables. RESULTS One hundred and fifty-two parents were included in the study, among which more than half (58.6%) were fathers. More than half (52.0%) of parents perceived mild to moderate burden with a Mean±SD score of level of burden is 1.26±0.44. A significant statistical association was found between the level of burden of care and the relationship to the child (p=0.002), and the type of family (p=0.04). CONCLUSIONS The study showed that the majority of the parents' perceived a mild to moderate burden.
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Affiliation(s)
- Saraswoti Nai
- Department of Pediatric Nursing, Nepalgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Nepal
| | - Uma Devi Ranjitkar
- Department of Pediatric Nursing, Maharajgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Nepal
| | - Apsara Pandey
- Department of Pediatric Nursing, Maharajgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Nepal
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Banstola H, Shrestha TM, Bhattarai D, Ghimire M, Chhetri SB. Clinical and Laboratory Characteristics of Patients with Mono and Coinfection of Dengue and Scrub typhus. J Nepal Health Res Counc 2023; 21:254-258. [PMID: 38196217 DOI: 10.33314/jnhrc.v21i02.4078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Dengue is a neglected tropical disease, and Scrub typhus is an emerging tropical illness in Nepal. Coinfection between them is found in literature and clinical practice. The objective of this study is to describe and compare the demographic, clinical, and laboratory characteristics of patients with mono and coinfection of Dengue and Scrub typhus. METHODS This was a single-center hospital-based retrospective study, performed at Beni District Hospital, Nepal. The patient who was diagnosed with mono and coinfection of Dengue and Scrub typhus from 1st January 2020 to 16th September 2020 were included. Data regarding demographic characteristics, symptoms, signs, and laboratory parameters were collected and analyzed. RESULTS In 53 patients who fall under the inclusion criteria of our study, 12 patients had coinfection with dengue and Scrub typhus with headache being the most common symptom regardless of mono or coinfection followed by myalgia and arthralgia. Total platelet counts at the time of admission were lower in the coinfection group with increasing thrombocytopenia during the disease course in comparison to mono-infection. The maximum temperature recorded, elevation in hepatic enzymes, and duration of defervescence were more in the coinfection group in comparison to dengue and scrub mono-infection. CONCLUSIONS Mono and coinfection of Dengue, Scrub typhus present with common clinical symptoms, laboratory findings. With limited resources for screening and diagnosis, clinical prediction based on symptoms alone or together with lab parameters is difficult which is further difficult in the presence of Co-infection.
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Affiliation(s)
| | | | - Dipesh Bhattarai
- Department of Psychiatry and Mental Health, Maharajgunj Medical Campus, Institute of Medicine
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Rauniyar LP, Rouniyar M, Jha R, Yadav AK, Sah MK. Outcome of Malnourished Children Admitted in the Nutritional Rehabilitation Home. J Nepal Health Res Counc 2023; 21:243-248. [PMID: 38196215 DOI: 10.33314/jnhrc.v21i02.4642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Globally, the burden of malnutrition, especially undernutrition, as well as the consequences of malnutrition is of the rise which is especially of significant concern for underdeveloped countries. Countries like Nepal are also facing a similar problem of malnutrition. In Madhesh province, among the under 5 children the incidence of chronic malnutrition is 29.3%. Our aim is to assess the malnourishment in the children of Madhesh province in Nepal. METHODS This cross-sectional quantitative study was carried out among 409 malnourished children who were admitted from July 17, 2018 to July 16, 2022 at NRH in Gajendra Narayan Singh Hospital. Collected data were fed into Microsoft-excel and analyzed using SPSS software, version-2016. As data were normally distributed, frequency, percentage, mean and standard deviation were calculated for descriptive analysis. To find out the association of categorical variables, the Chi-square test or Fisher's Exact test was used where appropriate. P-value <0.05 was significant. RESULTS Out of 409 malnourished cases, 145 cases were SAM (SD<-3) and 264 cases were MAM (-2 to -3SD) at the time of admission. The mean increment in the weight was 1.14±0.44 kg. The average length of stay was 19.82±8.73 days. There is a significant difference (p<0.001) in the length of stay among the SAM and MAM cases of our study and a difference in the increment of weight in comparison to mean weight gain (1.14±0.44 kg) with respect to the length of stay of the malnourished child who stayed for more than 28 days and less. CONCLUSIONS There is significant weight gain in malnourished children after management at the Nutritional Rehabilitation Center.
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Affiliation(s)
- Lalan Prasad Rauniyar
- Department of Pediatrics, BP Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Maya Rouniyar
- Department of EM and GP, BP Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Rashmi Jha
- Nutritional Rehabilitation Center, GNS Hospital, Saptari, Madhesh Province, Nepal
| | | | - Mukesh Kumar Sah
- General Practitioner and Emergency Medicine Physician, Department of Emergency Medicine and General Practice; Sunsari District Hospital, for Patan Academy of Health Sciences, Lalitpur, Nepal
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Bastola R, Shrestha SK, Sigdel B, Poudel D, Ghimire S, Ghimire A, Khadka KB, Basnet A. Demographic Profile and Outcome of Pediatric Intensive Care Unit. J Nepal Health Res Counc 2023; 21:214-218. [PMID: 38196210 DOI: 10.33314/jnhrc.v21i02.4495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Pediatric intensive care provides better observation as well as an intensive treatment, which helps to cure, support, and provide better outcomes for sick children. This study aimed to describe the demographic profile and the outcome of PICU patients, and evaluate the relationship of diagnostic categories with treatment and outcome. METHODS This retrospective cross-sectional study was conducted in a six-bedded PICU from 1 March 2021 to 1 March 2022. Bivariate analysis was used to identify the association between dependent and independent variables. RESULTS The infants admitted below 6 months of age were 63 (22.3%) and had male predominance accounting for 64%. The main portal of entry of the admitted cases was emergency ward 214(75.6%). Most of the patients 153(54.1%) were admitted for intensive monitoring of their abnormal vitals along with critical care according to our PICU protocol. Respiratory illness 122(43.1%), neurosurgical illness 59(20.8%), and primary infectious disease 52(18.3%) were the common reason for PICU admission. Post-major surgery 2(66.7%), hematological illness 3(37.5%), and cardiac disorders 1(20%) had high mortality rates. Among the portal of admission, the majority of the children (80.0 %) who were admitted to the PICU through the emergency ward died before exiting from the PICU (p<0.0001). CONCLUSIONS Respiratory illness was the most common cause of admission and post-major surgery had the highest mortality rate. Portal of entry was statistically associated with patient characteristics and had a significant relationship with the outcome. Similar studies in other health institutions are required to further analyze the demographic profile and outcome of pediatric critical care in Nepal.
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Affiliation(s)
- Ramchandra Bastola
- Department of Pediatrics, Pokhara Academy of Health Sciences (PoAHS), Pokhara, Nepal
| | | | - Bhawana Sigdel
- Department of Pediatrics, Pokhara Academy of Health Sciences (PoAHS), Pokhara, Nepal
| | - Drishti Poudel
- Department of Pediatrics, Pokhara Academy of Health Sciences (PoAHS), Pokhara, Nepal
| | - Sunita Ghimire
- Department of Pediatrics, Pokhara Academy of Health Sciences (PoAHS), Pokhara, Nepal
| | - Amrita Ghimire
- Department of Pediatrics, Pokhara Academy of Health Sciences (PoAHS), Pokhara, Nepal
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Mahato S, Devkota N, Kafle BR, Singh M, Dahal HR. Prevalence of Depression and its Associated Factors among Inmates. J Nepal Health Res Counc 2023; 21:232-237. [PMID: 38196213 DOI: 10.33314/jnhrc.v21i02.4617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Depression can cause suicidal attempts among prisoners and it is intimidating to speculate the deteriorating mental status of them. Since, there is very limited research on the depression of prisoners in Nepal and as prisoners have rights to health care without any discrimination, this cross-sectional study aimed to assess the prevalence of depression and its associated factors among inmates. METHODS An institute-based cross-sectional study was employed on 352 inmates selected by a systematic random sampling method from July 15 to August 15 2022. Face-to-face interview was conducted using the Centre for Epidemiological Studies Depression Scale (CESD). Data were entered into Epi - data version 3.1 and analysed using SPSS version 17. RESULTS The prevalence of depression among the inmates was 54.3%. About 4.3% reported suicidal ideation during imprisonment. Depression was significantly associated with previous occupation, drug use, duration of incarceration, number of prisoners per cell, family support, social support and suicidal thought during imprisonment. CONCLUSIONS More than half of the prisoners have depressive symptoms & thus recommended for the confirmatory diagnosis and treatment of mental issues drawing the attention of concerned authorities toward prisoner's mental health.
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Affiliation(s)
| | | | | | - Matrika Singh
- Aannapurna Neurological Institute and Allied Sciences
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Khadka S, Dhungana S, Prajapati D, Dhungana M, Dangol PB, Shakya R, Tamrakar B, Kandel U, Adhikari CM. Prevalence and Comparision of Conventional Risk Factors of Cardiovascular Disease Between Clinical and Nonclinical Staff. J Nepal Health Res Counc 2023; 21:207-213. [PMID: 38196209 DOI: 10.33314/jnhrc.v21i02.4453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death around the globe. A number of studies have shown that hospital staff are vulnerable to cardiovascular disease due to a certain risk of shift duty. It is important to identify cardiovascular risk factors among hospital staff. The aim of this study is, to assess the prevalence of conventional risk factors of cardiovascular disease among hospital staff. METHODS A quantitative cross-sectional study was conducted among staff working at a Shahid Gangalal National Heart Center, a tertiary cardiac center in Nepal. Simple and multiple linear regression analyses were used to examine the association between independent variables and cardiovascular diseases. Statistical analysis was done using SPSS software version 20. RESULTS A total of 250 hospital staff participated in this study. Among them, 137 were clinical staff and 113 were non-clinical staff. The mean age of clinical staff and the non-clinical staff was 33.69 ± 7.02 years and 38.7 ± 10.58 years respectively with a total of 66.8% females. Prevalence of hypertension, diabetes mellitus, and dyslipidaemia was less in clinical staff compared to non-clinical staff. The mean systolic, diastolic BP was high in non-clinical staff ( P-value 0.001), moreover mean HDL-C was low (1.2 ± 0.2 mmol). BMI was significantly low in clinical staff. [standardized β= -0.24; 95% CI: -2.90, -0.88]. CONCLUSIONS The prevalence of cardiovascular risk factors were high in non-clinical staff compared to clinical staff.
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Affiliation(s)
- Sunita Khadka
- Department of Preventive Cardiology and Cardiac Rehabilitation, Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
| | - Suraksha Dhungana
- Department of Nursing, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Dipanker Prajapati
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Murari Dhungana
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Prati Badan Dangol
- Department of Nursing, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Roji Shakya
- Department of Nursing, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Binita Tamrakar
- Department of Nursing, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Unnati Kandel
- Department of Pathology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
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Budha Magar E, Gupta M, Parajuli A, Chaudhary R, Pandey A, Bhattarai S. Child Marriage: Knowledge, Factors, Consequences and Utilization of Maternal Services among Early Married Women. J Nepal Health Res Counc 2023; 21:259-264. [PMID: 38196218 DOI: 10.33314/jnhrc.v21i02.4307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In 2020, UNFPA estimated additional 13 million child marriage cases in Nepal after a decade of lockdown due to COVID-19 wherein 2020, the data of child marriage before the age of 18 reached 5 million where marriage done before the age of 15 years was 1.3 million as per UNICEF. In Nepal, the legal age for marriage is 20 years. As per the National Criminal Code 2074, article 173 (1,2 and 3), one is imprisoned for three years with a penalty of Rs. 30,000, if found to violate the law: marrying before reaching the legal age. METHODS An analytical cross-sectional study was conducted. The sampling design used for the study was simple random sampling. Out of 9 municipalities in Sindhuli district, Dudhauli municipality was selected by using lottery method. 8 wards out of 14 wards in Dudhauli municipality were selected by using purposive sampling. 160 participants were early married women within the age of 15 to 24 years. Three key stakeholders were selected for Key Informant Interview from the local government level worker, non-Governmental organizations working within the municipality, and Dudhauli Health Post. One focused group discussion was conducted with 6 early married women. All the collected data were analyzed through simple descriptive statistics such as frequency, percentage, mean and inferential statics by using chi-square. For a qualitative study, the information collected from the key stakeholders was documented in narrative form. RESULTS Seven out of 126 women suffered from miscarriage during their second delivery. There is a significant association between the age of marriage and the number of children (P-value 0.0520) and birth time after marriage (P-value 0.019). The majority, 32.6 percent believes that child marriage can be prevented by children's counseling Conclusions: Only 1.6 percent of early married women faced complications during delivery. Majority of physically active women engaged in agriculture sector (97.5%) did not face any difficulty during delivery. None of the early married women have ever suffered from obstetric fistula despite of early delivery.
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Sharma B, Shrestha N, Sah SK. Depression and its Associated Factors among Faculties of Academic Institutions. J Nepal Health Res Counc 2023; 21:277-283. [PMID: 38196221 DOI: 10.33314/jnhrc.v21i02.4632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Depression is one of the common mental disorders occurring frequently in the community. The study aimed to find out the prevalence and correlates of depression among faculties of academic institutions in Pokhara Metropolitan, Kaski, Nepal. METHODS A cross-sectional study was conducted among 416 faculties selected from six academic institutions of Pokhara Metropolitan. A self-administered structured questionnaire method was applied to assess depression and explanatory variables among respondents. Beck Depression Inventory (BDI) was used to measure depression. The BDI score was classified into normal, mild, moderate and severe depression using the standard classification; and the depression levels were dichotomized into "absent" and "present". Descriptive statistics, bivariate analysis and multivariate logistic regression analysis were computed. Level of significance was set at 5%. RESULTS Of the total, 21.6% of respondents had depression including 6.7% moderate and 2.9% severe type depression. The likelihood of reporting depression was significantly higher among those who had physical health problems (AOR, 2.88; 95% CI, 1.16-7.13), consumed vegetables less than 2 times a day (AOR, 2.34; 95% CI, 1.07-5.08), had limited access to teaching aids in workplace (AOR, 2.00; 95% CI 1.19-3.33), had higher job stress and higher COVID-19 fear. Depression did not differ by the socio-demographic characteristics of the respondents and type of institution. CONCLUSIONS Improving physical health conditions, promoting vegetable consumption, ensuring access to basic facilities, and creating an enabling environment at workplace may help to address depression among faculties. Regular screening programs may help for timely identification and management of the cases.
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Affiliation(s)
- Bimala Sharma
- Department of Community Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara-27, Kaski, Nepal
| | - Nirmala Shrestha
- Department of Community Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara-27, Kaski, Nepal
| | - Saurabh Kishor Sah
- Department of Community Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara-27, Kaski, Nepal
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Shrestha S, Roka T. Insomnia among Elderly People in a selected urban Community. J Nepal Health Res Counc 2023; 21:324-329. [PMID: 38196229 DOI: 10.33314/jnhrc.v21i02.4819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Insomnia affects both physical and mental well-being of elderly people, also increasing risks of psychological problems such as depression and decreases quality of life. We assessed the proportion of elderly people with insomnia and associated factors in a selected community. METHODS We carried out a cross sectional study interviewing 110 elderly people residing in Shankarapur-7, Sankhu, Kathmandu using convenient sampling technique. We used a structured questionnaire and included Insomnia Severity Index to identify level of insomnia. We analysed insomnia as clinically significant and non-significant and present the results as proportion and further bivariate analysis. RESULTS About one third (29.1%) of the elderly had clinically significant insomnia. About half (53%) of the participants suffered from co-morbid disease conditions, mainly hypertension and diabetes mellitus. About 2 in 5 (38%) participants performed regular exercise for more than 15 minutes. Similarly, the proportion of clinically significant insomnia was higher among older age groups (50% among 70+ years & 21% among below 70 years), females 40% (males 19%), widowed 56% (currently married 21%), illiterate 42% (literate 13%). These were found to be significant during bivariate analysis. CONCLUSIONS We found a substantial proportion of participants with clinically significant insomnia. Promoting the physical and mental health of elderly people is important for them to lead a quality life. Health promotion approaches with targeted interventions for elderly are important to cater the need of elderly population and this might help improve the quality of life of the elderly people.
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Affiliation(s)
- Shristika Shrestha
- College of Nursing, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Tara Roka
- College of Nursing, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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84
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Xie X, Munos MK, Lama TP, Bryce E, Khatry SK, LeClerq SC, Katz J. Validation of maternal recall of number of antenatal care visits attended in rural Southern Nepal: a longitudinal cohort study. BMJ Open 2023; 13:e079029. [PMID: 38072474 PMCID: PMC10729047 DOI: 10.1136/bmjopen-2023-079029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to examine the validity of maternal recall of total number of antenatal care (ANC) visits during pregnancy and factors associated with the accuracy of maternal recall. DESIGN This was a longitudinal cohort study conducted from December 2018 through November 2020. SETTING Five government health posts in the Sarlahi district of Southern Nepal. PARTICIPANTS 402 pregnant women between ages 15 and 49 who presented for their first ANC visit at the study health posts. MAIN OUTCOMES The observed number of ANC visits (gold standard) and the reported number of ANC visits at the postpartum interview (maternal recall). RESULTS On average, women in the study who had a live birth attended 4.7 ANC visits. About 65% of them attended four or more ANC visits during pregnancy as recommended by the Nepal government, and 38.3% of maternal report matched the categorical ANC visits as observed by the gold standard. The individual validity was poor to moderate, with the highest area under the receiver operating characteristic curve (AUC) being 0.69 (95% CI: 0.65 to 0.74) in the 1-3 visits group. Population-level bias (as distinct from individual-level bias) was observed in the 1-3 visits and 4 visits groups, where 1-3 visits were under-reported (inflation factor (IF): 0.69) and 4 ANC visits were highly over-reported (IF: 2.12). The binary indicator ANC4+ (1-3 visits vs 4+ visits) showed better population-level validity (AUC: 0.69; IF: 1.17) compared with the categorical indicators (1-3 visits, 4 visits, 5-6 visits and more than 6 visits). Report accuracy was not associated with maternal characteristics but was related to ANC frequency. Women who attended more ANC visits were less likely to correctly report their total number of visits. CONCLUSION Maternal report of number of ANC visits during pregnancy may not be a valid indicator for measuring ANC coverage. Improvements are needed to measure the frequency of ANC visits.
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Affiliation(s)
- Xinyu Xie
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda K Munos
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tsering P Lama
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily Bryce
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Subarna K Khatry
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project Sarlahi, Lalitpur, Nepal
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project Sarlahi, Lalitpur, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Erchick DJ, Lama TP, Subedi S, Verhulst A, Guillot M, Khatry SK, LeClerq SC, Tielsch JM, Mullany LC, Katz J. Comparison of pregnancy and neonatal outcomes in a retrospective full pregnancy history survey versus population-based prospective records: a validation study in rural Sarlahi District, Nepal. J Health Popul Nutr 2023; 42:139. [PMID: 38066542 PMCID: PMC10709973 DOI: 10.1186/s41043-023-00472-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Countries without complete civil registration and vital statistics systems rely on retrospective full pregnancy history surveys (FPH) to estimate incidence of pregnancy and mortality outcomes, including stillbirth and neonatal death. Yet surveys are subject to biases that impact demographic estimates, and few studies have quantified these effects. We compare data from an FPH vs. prospective records from a population-based cohort to estimate validity for maternal recall of live births, stillbirths, and neonatal deaths in a rural population in Sarlahi District, Nepal. METHODS We used prospective data, collected through frequent visits of women from early pregnancy through the neonatal period, from a population-based randomized trial spanning 2010-2017. We randomly selected 76 trial participants from three pregnancy outcome groups: live birth (n = 26), stillbirth (n = 25), or neonatal death (n = 25). Data collectors administered the Nepal 2016 Demographic and Health Surveys (DHS)-VII pregnancy history survey between October 22, 2021, and November 18, 2021. We compared total pregnancy outcomes and numbers of pregnancy and neonatal outcomes between the two data sources. We matched pregnancy outcomes dates in the two sources within ± 30 days and calculated measures of validity for adverse outcomes. RESULTS Among 76 participants, we recorded 122 pregnancy outcomes in the prospective data and 104 outcomes in the FPH within ± 30 days of each woman's total observation period in the trial. Among 226 outcomes, we observed 65 live births that survived to 28 days, 25 stillbirths, and 32 live births followed by neonatal death in the prospective data and participants reported 63 live births that survived to 28 days, 15 stillbirths, and 26 live births followed by neonatal death in the pregnancy history survey. Sixty-two FPH outcomes were matched by date within ± 30 days to an outcome in prospective data. Stillbirth, neonatal death, higher parity, and delivery at a health facility were associated with likelihood of a non-matched pregnancy outcome. CONCLUSIONS Stillbirth and neonatal deaths were underestimated overall by the FPH, potentially underestimating the burden of mortality in this population. There is a need to develop tools to reduce or adjust for biases and errors in retrospective surveys to improve reporting of pregnancy and mortality outcomes.
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Affiliation(s)
- Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Tsering P Lama
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Seema Subedi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Michel Guillot
- University of Pennsylvania, Philadelphia, PA, USA
- French Institute for Demographic Studies (INED), Aubervilliers, France
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Luke C Mullany
- Applied Physics Laboratory, Johns Hopkins University, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Mahato RK, Ghimire U, Lamsal M, Bajracharya B, Poudel M, Napit P, Lama K, Dahal G, Hayman DTS, Karna AK, Pandey BD, Das CL, Paudel KP. Evaluating active leprosy case identification methods in six districts of Nepal. Infect Dis Poverty 2023; 12:111. [PMID: 38053215 DOI: 10.1186/s40249-023-01153-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal's population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment. METHODS Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated. RESULTS New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24-5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26-2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07-0.94%) and PB cases (0.13%, 95% CI 0.03-0.73) (χ2 = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1-0.46) and PB cases (0.48%, 0.19-0.98) (χ2 = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22-0.81). CONCLUSIONS The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection.
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Affiliation(s)
- Ram Kumar Mahato
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal.
| | - Uttam Ghimire
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Madhav Lamsal
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Bijay Bajracharya
- Epidemiology and Disease Control Division-Malaria Program Management Unit- SCI-GF, Kathmandu, Nepal
| | - Mukesh Poudel
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Prashnna Napit
- Leprosy Control & Disability Management Section, EPidemiology and Disease Control Division, DoHS, Kathmandu, Nepal
| | - Krishna Lama
- Lalgadh Leprosy Hospital & Service Center, Nepal Leprosy Trust, Lalgadh, Nepal
| | - Gokarna Dahal
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - David T S Hayman
- Molecular Epidemiology and Public Health Laboratory, Infectious Disease Research Centre, Hopkirk Research Institute, Massey University, Palmerston North, New Zealand
| | | | - Basu Dev Pandey
- DEJIMA Infectious Disease Research Alliance, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, Japan
| | - Chuman Lal Das
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Krishna Prasad Paudel
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal.
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Deuba K, Panta G, Rajbhandari RM, Kunwar R, Pokhrel TN, Pandey LR, Changsom D, Saeng-Aroon S, Thakur SK. Prevalence of viral load suppression and acquired drug resistance among people living with HIV in Nepal: a nationally representative surveillance study. J Glob Antimicrob Resist 2023; 35:122-127. [PMID: 37709138 DOI: 10.1016/j.jgar.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES This is the first nationally representative study to estimate the prevalence of viral load (VL) suppression and acquired HIV drug resistance (ADR) among people living with HIV (PLHIV) in Nepal. METHODS A cross-sectional study recruited 1418 PLHIV from 20 ART centres in Nepal, using a two-stage cluster design. Participants were eligible if they were HIV-positive individuals on ART for 9-15 months or at least 48 months. Plasma specimens were collected and tested for the quantification of HIV-1 RNA. Specimens with a VL ≥1000 copies/mL were further processed for sequencing of PR and RT genes of HIV-1. The sequences were then analysed to detect mutations causing HIV drug resistance. RESULTS The prevalence of ADR was 3.7% (95% confidence interval [CI]: 1.8-7.6) and 3.0% (95% CI: 1.8-5.2) among PLHIV who received ART for 9-15 months and 48 months or more, respectively. The prevalence of VL suppression was 95.3% (95% CI: 91.7-97.4) among those on ART for 9-15 months, and 96.5% (95% CI: 94.7-97.7) among those on ART for at least 48 months. The prevalence of any detectable acquired resistance to antiretroviral drugs was 80.7% (95% CI: 58.6-92.5) among those on ART for 9-15 months with VL ≥1000 copies/mL and 81.6% (95% CI: 55.4-94.0) among those on ART for at least 48 months with VL ≥1000 copies/mL. CONCLUSION This study suggests that improved accessibility to VL monitoring and timely assessment of drug resistance in routine HIV programs are crucial in Nepal to ensure access to HIV treatment for all in need.
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Affiliation(s)
- Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Gopal Panta
- Save the Children International, Kathmandu, Nepal
| | - Rajesh Man Rajbhandari
- Center for Molecular Dynamics Nepal, Kathmandu, Nepal; CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado - BIOPOLIS Program in Genomics, Biodiversity, and Land Planning, Campus de Vairão, Universidade do Porto, Vairão, Portugal; SaBio, Instituto de Investigación en Recursos Cinegéticos, IREC (UCLM & CSIC), Ronda de Toledo s/n, Ciudad Real, Spain
| | | | | | - Lok Raj Pandey
- National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Don Changsom
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Siriphan Saeng-Aroon
- Bureau of Laboratory Quality Standards, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Sanjay Kumar Thakur
- National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
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Rai A, Chan MT, Nambiar S. Social and ecological disparities in anaemia among adolescent girls 15-19 years old in Nepal. Public Health Nutr 2023; 26:2973-2981. [PMID: 37905578 PMCID: PMC10755426 DOI: 10.1017/s1368980023002379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 09/30/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Adolescent girls are at risk of anaemia due to increased nutrient demands because of growth, menstrual blood loss and possible pregnancies. Sociocultural and household conditions influence their anaemia risk. We aimed to identify the sociocultural and economic factors associated with anaemia among adolescent girls in Nepal. DESIGN The Nepal Demographic and Health Surveys (NDHS) conducted in 2006, 2011 and 2016 were pooled for secondary analysis. We used data on haemoglobin measurements for anaemia and conducted bivariate and multivariable logistic regression analyses to identify factors associated with anaemia. SETTING Nationally representative NDHS households with adolescent girls 15-19 years of age. PARTICIPANTS Non-pregnant adolescent girls 15-19 years, with a haemoglobin measurement (n = 3731). RESULTS The overall prevalence of anaemia among adolescent girls was 39·6 %. Adolescents from socially disadvantaged caste/ethnicity groups were 1·42 times (95 % CI: 1·13, 1·78) more likely to have anaemia compared with those from Brahmin/Chhetri households. We found a counter-intuitive association between socio-economic status and anaemia where adolescents from the middle (adjusted OR (aOR) 1·37, 95 % CI: 1·01, 1·85) and highest (aOR 1·74, 95 % CI: 1·18, 2·56) quintiles were at increased odds of anaemia. Relative geographical inequality was observed where adolescents from the Terai region had 3·5 times (95 % CI: 2·32, 5·33) higher odds of anaemia. CONCLUSIONS The disparities in the distribution of anaemia among adolescents by caste/ethnicity groups, wealth quintiles and geographical regions are evident. Reducing the anaemia burden will require addressing the social determinants of anaemia by allocating resources and expanding anaemia prevention programmes to target adolescents at higher risk.
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Affiliation(s)
- Anjana Rai
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD4059, Australia
| | - Mei Ting Chan
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD4059, Australia
| | - Smita Nambiar
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD4059, Australia
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89
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Pokharel A, Philip S, Pokharel A, Acharya N, Dahal S, Ransing R. Perinatal depression among teenage mothers in a tertiary care teaching hospital of Nepal: A cross-sectional study. Asian J Psychiatr 2023; 90:103810. [PMID: 37913650 DOI: 10.1016/j.ajp.2023.103810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
The teenage pregnancy has serious adverse effect on physical and mental health of mothers and infants. This cross-sectional study was aimed to assess proportion of perinatal depression and well-being of teenage mothers in Nepal. Perinatal women were evaluated using Mental Health Continuum Short Form, and Edinburgh Postnatal Depression Scale. Of 239 perinatal women, 12 (5%) were teenage with a mean age of 18.17 ± 0.93 years. 33.3% (n = 4) of teenage mothers had depressive symptoms, and 25% (n = 3) had moderate/languishing mental health. A high proportion of depression and poor mental health suggests that screening and supportive care should be provided for teenage mothers.
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Affiliation(s)
- Arpana Pokharel
- Department of Psychiatry, Clinical Neurosciences, and Addiction Medicine, All India Institute of Medical Sciences, Guwahati 781101, India; Department of Psychiatry, Devdaha Medical College, 32907, Nepal
| | - Sharad Philip
- Department of Psychiatry, Clinical Neurosciences, and Addiction Medicine, All India Institute of Medical Sciences, Guwahati 781101, India
| | - Aruna Pokharel
- Department of Obstetrics and Gynecology, Devdaha Medical College, 32907, Nepal
| | - Nisha Acharya
- Medical Department, Rapti Academy of Health Sciences, Dang, Ghorahi 22400, Nepal
| | - Salina Dahal
- Medical Department, Rapti Academy of Health Sciences, Dang, Ghorahi 22400, Nepal
| | - Ramdas Ransing
- Department of Psychiatry, Clinical Neurosciences, and Addiction Medicine, All India Institute of Medical Sciences, Guwahati 781101, India; Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Thailand.
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90
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Poudel SS, Vaughan JA. POPULATION STRUCTURE AND BARTONELLA QUINTANA IN HEAD AND BODY LICE IN POKHARA, NEPAL (ANOPLURA: PEDICULIDAE). J Parasitol 2023; 109:559-564. [PMID: 38018745 DOI: 10.1645/23-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
This study examined the population structure of head and body lice infesting a random sample of people in Pokhara, Nepal during 2003, 2004, and 2005. A total of 106 participants (6 to 72 yr old, median = 12) volunteered to have lice collected from their heads and clothing. Most participants (70%) harbored only head lice, some (15%) had only body lice, and some (15%) had concurrent infestations of head and body lice (dual infestations). A total of 1,472 lice was collected. Significantly more nymphs were collected than adult lice. Louse populations were generally small (geometric mean = 8.8 lice per person) but a few participants harbored larger louse populations (maximum = 65 lice). People with dual infestations harbored significantly more lice than people with single infestations; however, there was no difference in the infestation intensities between people infested with head lice only vs. those infested with body lice only. Male participants harbored significantly more lice than did females. There were no significant differences in infestation intensity due to participant age or their socioeconomic level. The sex ratio of adult lice was increasingly female biased with increasing adult louse density. Infection of lice with Bartonella quintana was low (ca. 1.5%). Pediculosis is a common problem in urban Nepal.
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Affiliation(s)
- Shreekanta S Poudel
- Biology Department, University of North Dakota, Grand Forks, North Dakota 58202
| | - Jefferson A Vaughan
- Biology Department, University of North Dakota, Grand Forks, North Dakota 58202
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91
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Das M. Cancer care in Nepal after earthquake. Lancet Oncol 2023; 24:1314. [PMID: 37952543 DOI: 10.1016/s1470-2045(23)00582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
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92
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Paudel KP, Samuel R, Jha R, Pandey BD, Edirisuriya C, Shrestha NL, Gyawali P, Pokhrel A, Shrestha L, Mahato RK, Hossain SS, Arunkumar G, Bose AS, Dhimal M, Gautam D, Neupane S, Thakur N, Shrestha S, Bhusal N, Jha P, Gupta BP, Rayamajhi RB, Subedi KC, Kandel S, Poudel M, Thapa LB, Sharma GN, Gocotano AE, Sunny AK, Gautam R, Bhatta DR, Awale BK, Roka B, Ojha HC, Baral P, Adhikari MD, Lohani GR, Shrestha M, Singh DR, Aryal L, Pandav RS, Pokhrel R. Seroprevalence of SARS-CoV-2 infection in the general population of Nepal during the first and second generalized waves of the COVID-19 pandemic-2020-2021. Influenza Other Respir Viruses 2023; 17:e13234. [PMID: 38149926 PMCID: PMC10752246 DOI: 10.1111/irv.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Few seroprevalence studies have been conducted on coronavirus disease (COVID-19) in Nepal. Here, we aimed to estimate seroprevalence and assess risk factors for infection in the general population of Nepal by conducting two rounds of sampling. The first round was in October 2020, at the peak of the first generalized wave of COVID-19, and the second round in July-August 2021, following the peak of the wave caused by the delta variant of SARS-CoV-2. We used cross-sectional probability-to-size (PPS)-based multistage cluster sampling to estimate the seroprevalence in the general population of Nepal at the national and provincial levels. We tested for anti-SARS-CoV-2 total antibody using the WANTAI SARS-CoV-2 Ab ELISA kit. In Round 1, the overall national seroprevalence was 14.4%, with provincial estimates ranging from 5.3% in Sudurpaschim to 27.3% in Madhesh Province. In Round 2, the estimated national seroprevalence was 70.7%, with the highest in the Madhesh Province (84.8%) and the lowest in the Gandaki Province (62.9%). Seroprevalence was comparable between males and females (Round 1, 15.8% vs. 12.2% and Round 2, 72.3% vs. 68.7%). The seroprevalence in the ecozones-Terai, hills, and mountains-was 76.3%, 65.3%, and 60.5% in Round 2 and 17.7%, 11.7%, and 4.6% in Round 1, respectively. In Nepal, COVID-19 vaccination was introduced in January 2021. At the peak of the first generalized wave of COVID-19, most of the population of Nepal remained unexposed to SARS-CoV-2. Towards the end of the second generalized wave in April 2021, two thirds of the population was exposed.
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Affiliation(s)
- Krishna Prasad Paudel
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | | | - Runa Jha
- National Public Health LaboratoryMinistry of Health and PopulationKathmanduNepal
| | - Basu Dev Pandey
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
- DEJIMA Infectious Disease Research Alliance (DIDA)Nagasaki UniversityNagasakiJapan
| | | | | | | | - Amrit Pokhrel
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Lilee Shrestha
- National Public Health LaboratoryMinistry of Health and PopulationKathmanduNepal
| | - Ram Kumar Mahato
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | | | | | | | | | | | | | - Nishant Thakur
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | | | | | - Priya Jha
- WHO Country Office for NepalKathmanduNepal
| | | | | | - Koshal Chandra Subedi
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Shashi Kandel
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Mukesh Poudel
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Lila Bikram Thapa
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | | | | | | | | | | | - Bal Krishna Awale
- National Public Health LaboratoryMinistry of Health and PopulationKathmanduNepal
| | - Bhola Roka
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Hemant Chandra Ojha
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Phanindra Baral
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Mahendra Dhose Adhikari
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
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93
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Shrestha G, Gautam DK, Siwakoti B, Pradhananga KK, Mulmi R. Community-based Screening of Oral Cancer in Selected Districts of Nepal: A Cross-Sectional Study. Asian Pac J Cancer Prev 2023; 24:4111-4115. [PMID: 38156845 PMCID: PMC10909109 DOI: 10.31557/apjcp.2023.24.12.4111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Oral cancer screening plays a vital role in the prevention and control of oral cancer. This study aimed to determine the prevalence of oral potentially malignant disorders (OPMDs) in the Nepalese community. METHODS A cross-sectional study was conducted in six purposively selected districts in Nepal from May to December 2019. It utilized a camp-based approach, where a standardized questionnaire was administered through face-to-face interviews. Screening of oral cancer was performed by direct visualization and palpation. The study included adults aged 18 years and above, while those already diagnosed with oral cancer were excluded. Logistic regression was used to find out the association between OPMDs and the related variables. RESULTS A total of 1930 participants with a mean age of 44.3 years (SD=15.1) underwent oral cancer screening. Among them, 32% were current tobacco users, 2% were ex-users, and 11% were alcohol consumers. OPMDs, including suspected cancer, were identified in 139 (7.2%, 95% CI=6.1-8.4) participants. The most common lesion detected was leukoplakia (4.2%), followed by submucous fibrosis (1.5%), erythroplakia (0.9%), and palatal changes due to reverse smoking (0.1%). Additionally, 10 participants were suspected of having oral cancer. Older age group (AOR=7.00; 95% CI=2.76-17.77), male gender (AOR=2.52; 95% CI=1.58-4.02), tobacco chewers (AOR = 14.30; 95% CI=8.82-23.19), and smokers (AOR=4.67; 95% CI=2.88-7.57)) were identified as predictors of OPMDs. CONCLUSION This study revealed a high prevalence of OPMDs in Nepal, highlighting the need for oral cancer screening. The findings emphasize the importance of developing strategies to reduce tobacco use and implementing tobacco cessation intervention programs in Nepal to alleviate the burden of oral cancer.
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Affiliation(s)
- Gambhir Shrestha
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Dej Kumar Gautam
- Department of Surgical Oncology, B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal.
| | - Bhola Siwakoti
- Department of Cancer Prevention, Control and Research, B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal.
| | | | - Rashmi Mulmi
- Department of Cancer Prevention, Control and Research, B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal.
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94
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Chapagain R, Giri B, Bhattarai T, Dhungana J, Walters M, Damasco E, Blanco J, Ladas KD, Antoniades A, Ladas E. A cross-sectional study evaluating the prevalence and predictors of malnutrition among children and adolescents visiting an urban academic hospital in Nepal. Public Health Nutr 2023; 26:2738-2747. [PMID: 37811557 PMCID: PMC10755450 DOI: 10.1017/s136898002300188x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To examine the prevalence of malnutrition among children and adolescents visiting Kanti Children’s Hospital (KCH) and identify predictors associated with malnutrition. Results will guide the development of a newly established nutrition programme at KCH. DESIGN This cross-sectional pilot study recruited children and adolescents over a 1-month period. Nutritional anthropometrics (height, weight and mid-upper arm circumference (MUAC)) and socio-demographic questionnaires were administered. Clinical data were abstracted from the medical chart. SETTING KCH in Kathmandu, Nepal. PARTICIPANTS 370 children and adolescents. RESULTS Most participants were male (65·1 %); mean age was 3·9 years (±3·4 years). The prevalence of stunting was 25·9 %, wasting was 17·3 % and 24·0 % when classified by BMI-for-age Z-score or MUAC, respectively. Two percent of participants were overweight. Notably, 32·1 % of children ≥5 years were classified with wasting based on MUAC-for-age Z-score, which is higher than that observed in children <5 (20·2 %). Food insecurity was reported among 58·2 % of children with stunting and 34·0 % with wasting. Chronic medical conditions predicted stunting and wasting. The lowest level of wealth predicted stunting, while ethnicity predicted wasting. Ethnicity and education level predicted food insecurity. CONCLUSIONS We found that the prevalence of stunting and wasting at KCH are higher than previously published studies in Nepal. Malnutrition persists beyond 5 years, and we identified several predictors of malnutrition. Increased provision of and access to clinical nutrition programmes is an essential need for KCH. Twinning programs that provide local clinicians with increased opportunities for education and mentorship of local staff remains a pressing need in Nepal.
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Affiliation(s)
- Ram Chapagain
- Department of Paediatrics, Kanti Children’s Hospital, National Academy of Medical Sciences (NAMS), Kathmandu, Nepal
| | - Bishnu Giri
- Oncology Unit, Kanti Children’s Hospital, Kathmandu, Nepal
| | - Tribhuwan Bhattarai
- Department of Paediatrics, Kanti Children’s Hospital, National Academy of Medical Sciences (NAMS), Kathmandu, Nepal
| | - Juna Dhungana
- Oncology Unit, Kanti Children’s Hospital, Kathmandu, Nepal
| | - Michelle Walters
- Division of Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University, Irving Medical Centre, 3959 Broadway, CHN 10-06A, New York, NY10032, USA
| | - Erika Damasco
- Division of Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University, Irving Medical Centre, 3959 Broadway, CHN 10-06A, New York, NY10032, USA
| | - Jessica Blanco
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Kyriaki D Ladas
- Aristotle University School of Medicine, Thessaloniki, Greece
| | | | - Elena Ladas
- Division of Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University, Irving Medical Centre, 3959 Broadway, CHN 10-06A, New York, NY10032, USA
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95
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Zuckerman NS, Schwartz E, Pandey P, Erster O, Halpern O, Bucris E, Morad-Eliyahu H, Wax M, Lustig Y. Dengue Types 1 and 3 Identified in Travelers Returning from Kathmandu, Nepal, during the October 2022 Outbreak Are Related to Strains Recently Identified in India. Viruses 2023; 15:2334. [PMID: 38140575 PMCID: PMC10921925 DOI: 10.3390/v15122334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Phylogenetic analysis of dengue serotypes 1 and 3, which were diagnosed in travelers and Nepalese infected in Kathmandu during the October 2022 outbreak, revealed that both serotypes were clustered closest to the sequences sampled in India. This suggests both serotypes may have originated in India.
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Affiliation(s)
- Neta S. Zuckerman
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Eli Schwartz
- The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer 52621, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Prativa Pandey
- CIWEC Hospital and Travel Medicine Center, Kathmandu 44600, Nepal;
| | - Oran Erster
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Osnat Halpern
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Efrat Bucris
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Hagar Morad-Eliyahu
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Marina Wax
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
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96
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Byanju R, Kandel RP, Poudyal B, Bhandari S, Ligal A, Pradhan S, Gautam M, Shrestha P, Sah RK, Gonzales JA, Porco TC, Whitcher JP, Srinivasan M, Upadhyay MP, Lietman TM, Keenan JD, O'Brien KS. Risk factors for corneal ulcers: a population-based matched case-control study in Nepal. Br J Ophthalmol 2023; 107:1771-1775. [PMID: 36202599 PMCID: PMC10076439 DOI: 10.1136/bjo-2022-322141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS We aimed to examine risk factors for corneal ulcer in a rural and peri-urban setting in Nepal. METHODS This population-based matched case-control study was nested in a cluster randomised trial in 24 village development committees in Nepal. Incidence density sampling was used to match incident corneal opacity cases to controls, matching on time of opacity, age, sex and location. Cases and controls were invited to participate in a survey of risk factors for corneal ulcer. Risk factors were evaluated using conditional logistic regression to account for matching. RESULTS Of the 540 participants with incident opacities identified in the trial, 433 were willing to participate in this substudy and matched to a control. Compared with controls, cases had lower odds of having any education vs no education (adjusted OR, aOR 0.60, 95% CI 0.39 to 0.94), working in non-manual labour occupations vs manual labour occupations (aOR 0.64, 95% CI 0.42 to 0.95) and preferring medical shops for ocular trauma versus eye care system centres (aOR 0.58, 95% CI 0.37 to 0.92). Cases had higher odds of protective goggle use versus no protection (aOR 3.8, 95% CI 1.3 to 11.0) and having an ocular injury vs none (aOR 7.7, 95% CI 4.3 to 13.6) compared with controls. CONCLUSION We found ocular injury, manual labour and lower education to be strongly associated with the development of corneal ulcer. Given the persistent burden of corneal blindness in this area, prevention efforts could target efforts to increase access to care in areas where these factors are common.
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Affiliation(s)
| | - Ram Prasad Kandel
- Bharatpur Eye Hospital, Bharatpur, Nepal
- Seva Foundation, Berkeley, California, USA
| | | | | | - Anju Ligal
- Bharatpur Eye Hospital, Bharatpur, Nepal
| | | | | | | | | | - John A Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - John P Whitcher
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | | | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Jeremy David Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
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97
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Amatya B, Schwartz E, Biber A, Erster O, Lustig Y, Pradhan R, Khadka B, Pandey P. Dengue serotype characterization during the 2022 dengue epidemic in Kathmandu, Nepal. J Travel Med 2023; 30:taad034. [PMID: 36971480 DOI: 10.1093/jtm/taad034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/02/2023] [Accepted: 03/24/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
| | - Eli Schwartz
- The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Biber
- The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oran Erster
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Bhawani Khadka
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
| | - Prativa Pandey
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
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98
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Bijukchhe SM, Hill M, Adhikari B, Shrestha A, Shrestha S. Nepal's worst dengue outbreak is a wake-up call for action. J Travel Med 2023; 30:taad112. [PMID: 37584474 PMCID: PMC10658652 DOI: 10.1093/jtm/taad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
Nepal had its worst dengue outbreak in 2022. Climate change, urbanization and increased transportation networks have favoured dengue mosquito vectors. As the monsoon season approaches, dengue outbreak seems inevitable. Strengthening the national dengue preventive strategy, healthcare planning and resource allocation is essential to avoid future outbreaks.
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Affiliation(s)
- Sanjeev M Bijukchhe
- Department of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Matilda Hill
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ashis Shrestha
- Department of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Shrijana Shrestha
- Department of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
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99
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Sharma A, Adhikari R, Parajuli E, Buda M, Raut J, Gautam E, Adhikari B. Psychological morbidities among Nepalese migrant workers to Gulf and Malaysia. PLoS One 2023; 18:e0267784. [PMID: 37939081 PMCID: PMC10631658 DOI: 10.1371/journal.pone.0267784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/29/2022] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND One of the important aftereffects of rapid global development is international mobility, which has placed the health of migrant workers as a key public health issue. A less-developed country, Nepal, with political instability and a significant lack of employment, could not remain untouched by this phenomenon of migration. Our goal was to identify and determine the predictors of anxiety, depression, and psychological wellbeing among Nepalese migrant workers in Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia. METHODS A descriptive cross-sectional study was used to collect information from 502 Nepalese migrant workers in the arrival section of Tribhuvan International Airport from May to June 2019 using purposive sampling. Workers with a minimum work experience of 6 months and above were included in the study. A structured questionnaire with socio-demographic items was used along with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and WHO (five) wellbeing scale for measuring the subjective psychological wellbeing and screening for depression. RESULTS The mean age of the respondents was 32.97 years. Majority (41.8%) of the respondents had work experience in Qatar and 63.7% had work experience of 1-5 years. The results suggested that 14.4% had mild to severe depression while 4.4% had a moderate level of anxiety. The WHO5 wellbeing index score suggested that 14.1% of the respondents had a score below 13, which is suggestive of poor psychological wellbeing. Further, the country of work (p = 0.043), sleeping hours (p = 0.001), occupation (p = 0.044), working hours (p = 0.000), water intake (p = 0.010) and anxiety level (p = 0.000) were found to be significantly associated with depression score. Similarly, sleeping hours (p = 0.022), occupation (p = 0.016), working hours (p = 0.000), water intake (p = 0.010), and anxiety level (0.000) were significantly associated with the WHO5 wellbeing score. CONCLUSIONS Nepalese migrant workers in the Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia bear an important burden of psychological morbidities. This highlights the need to prioritize the migrant worker's mental health by Nepal as well as Gulf countries and Malaysia.
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Affiliation(s)
- Abha Sharma
- Faculty of Nursing, Mahidol University, Salaya, Thailand
- Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Renuka Adhikari
- Central Department of Home Science, Tribhuvan University, Kirtipur, Nepal
| | - Enjila Parajuli
- Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Manisha Buda
- Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Jyotika Raut
- Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Ena Gautam
- Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Bibhav Adhikari
- Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
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100
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Baral S, Rajbhandari S. Diabetic foot problem in Nepal. Front Endocrinol (Lausanne) 2023; 14:1277940. [PMID: 38027189 PMCID: PMC10661256 DOI: 10.3389/fendo.2023.1277940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Nepal is a developing country where diabetes is becoming a major health challenge due to its high prevalence of 8.5% affecting around 2 million people. Due to limited resources, there are many barriers to providing affordable and convenient diabetes care or regular screening for complications. There is no reliable data on incidence, prevalence, and complications of diabetic foot problems in Nepal. Methods We conducted an online survey amongst senior physicians, who were members of 'Diabetes & Endocrine Association of Nepal' to assess their perception of diabetic foot problems in Nepal. Results Thirty-Eight physicians responded to the survey who saw a total of 17597 patients in the preceding month. They recalled seeing 647 with 'Diabetic Foot Ulcers', giving a crude Diabetic Foot Ulcer prevalence rate of 3.7%. They recalled seeing 2522 patients with painful neuropathy that required medical treatment, giving a crude painful neuropathy prevalence rate of 14.3%. A history of foot ulcer was present in an additional 578 patients. Previous minor amputation had been performed in 215 patients (1.2%) and major amputation in 135 patients (0.8%). Discussion Despite having expertise in various fields there is no dedicated multi-disciplinary diabetic foot clinic in Nepal. This survey shows that diabetic foot problems are abundant in Nepal and there is a need for structured multi-disciplinary approach for screening and treatment.
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Affiliation(s)
- Suman Baral
- Department of Diabetes & Endocrinology Mediciti Hospital, Lalitpur, Nepal
| | - Satyan Rajbhandari
- Department of Diabetes & Endocrinology Lancashire Teaching Hospital, Chorley, United Kingdom
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