Change in medical students' readiness for self-directed learning after a partially problem-based learning first year curriculum at the KIST medical college in Lalitpur, Nepal

INTRODUCTION

Modern medical education and the requirement for lifelong learning place increasing emphasis on self-directed learning. Studies have not been done on readiness for self-directed learning (SDL) among medical students in Nepal. The present study was carried out to (1) measure and compare readiness for SDL among medical students, and (2) note differences in readiness for SDL according to students' personal characteristics at the beginning and end of the first year of the MBBS course for medical students at the KIST Medical College in Nepal.

METHODS

The study was done using the Self-directed Learning Readiness Scale. Respondents' agreement with each of forty statements pertinent to self-directed learning readiness using a modified Likert-type scale was noted. The mean total and scores on the subcategories 'self-management', 'desire for learning' and 'self-control' were calculated and compared across subgroups of respondents and in January and August 2010 using appropriate parametric and non-parametric tests (p<0.05).

RESULTS

All 100 students participated in January while 90 participated in August. The mean scores varied with certain demographic and background characteristics. The mean total score increased from 152.7 to 157.3 while the self-management score increased significantly from 48.6 to 50.2 from January to August. There were small increases in the mean desire for learning scores from 46.9 to 47.7 and in the self-control scores from 58 to 59 from January to August, but not in other scores.

CONCLUSIONS

Self-directed learning scores were lower among these Nepalese students than reported elsewhere in the literature. Total scores and self-management scores improved at the end of the first year, but not scores on desire for learning and self-control.

Impact and Determinants of Gender Preference in Duhavi VDC of Eastern Nepal

Introduction: Gender equality has been a priority area of demographic research. One of the major reasons for high fertility and low acceptance of family planning is the prevalence of gender preference among couples. The objectives of this study were to identify the determinants and examine the extent of gender preference on fertility. Methods: This is a cross-sectional study carried from June 2008 to July 2009 in Duhavi VDC of Sunsari district of Nepal. Three hundred and fi ve randomly selected ever-married women of 15 - 49 years, who had at least one child were the subjects of the study. A questionnaire covering the areas on gender and fertility preference and methods and use of contraception was given and fi lled up. Results: The study showed that 42.6 % of the ever-married women belonged to the 25 - 29 years age group. Around 92 % of women whose last child was a male were using family planning methods whereas only 40 % of women whose last child was a female were using family planning methods. This difference was statistically signifi cant (P < 0.0001). Conclusions: The contraception use among the women having a female child was low, showing a desire for a male child which is one of the factors in the increase of family size in our society. Due to the patrilineal society, women are discouraged in the practice of contraception. Effective intervention programs need to be planned and conducted to rectify this situation.  Keywords: Determinants, Duhavi VDC, gender preference, impact, Nepal.

Academic detailing

There are a number of sources available to prescribers to stay up to date about medicines. Prescribers in rural areas in developing countries however, may not able to access some of them. Interventions to improve prescribing can be educational, managerial, and regulatory or use a mix of strategies. Detailing by the pharmaceutical industry is widespread. Academic detailing (AD) has been classically seen as a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits physicians in their offices to provide evidence-based information. Face-to-face sessions, preferably on an individual basis, clear educational and behavioural objectives, establishing credibility with respect to objectivity, stimulating physician interaction, use of concise graphic educational materials, highlighting key messages, and when possible, providing positive reinforcement of improved practices in follow-up visits can increase success of AD initiatives. AD is common in developed countries and certain examples have been cited in this review. In developing countries the authors have come across reports of AD in Pakistan, Sudan, Argentina and Uruguay, Bihar state in India, Zambia, Cuba, Indonesia and Mexico. AD had a consistent, small but potentially significant impact on prescribing practices. AD has much less resources at its command compared to the efforts by the industry. Steps have to be taken to formally start AD in Nepal and there may be specific hindering factors similar to those in other developing nations.

Impact and determinants of gender preference in Duhavi VDC of eastern Nepal

INTRODUCTION

Gender equality has been a priority area of demographic research. One of the major reasons for high fertility and low acceptance of family planning is the prevalence of gender preference among couples. The objectives of this study were to identify the determinants and examine the extent of gender preference on fertility.

METHODS

This is a cross-sectional study carried from June 2008 to July 2009 in Duhavi VDC of Sunsari district of Nepal. Three hundred and five randomly selected ever-married women of 15 - 49 years, who had at least one child were the subjects of the study. A questionnaire covering the areas on gender and fertility preference and methods and use of contraception was given and filled up.

RESULTS

The study showed that 42.6% of the ever-married women belonged to the 25 - 29 years age group. Around 92% of women whose last child was a male were using family planning methods whereas only 40% of women whose last child was a female were using family planning methods. This difference was statistically significant (P < 0.0001).

CONCLUSIONS

The contraception use among the women having a female child was low, showing a desire for a male child which is one of the factors in the increase of family size in our society. Due to the patrilineal society, women are discouraged in the practice of contraception. Effective intervention programs need to be planned and conducted to rectify this situation.

Hyperglycemia, glucose intolerance, hypertension and socioeconomic position in eastern Nepal

Abstract. The present study was undertaken to evaluate differences between urban and rural Nepali populations in terms of hyperglycemia, socioeconomic position (SEP) and hypertension, through a community based survey in Sunsari District, eastern Nepal. Blood glucose levels were measured in participants (N = 2,006) S30 years old from urban and rural communities and were classified according to WHO criteria (1998) into normoglycemia (NGY), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and hyperglycemia (HGY). SEP was assessed by structured health interview along with anthropometric measurements and behavioral variables. Hypertension was classified per Joint National Committee (JNC-VII) criteria. Ten point three percent and 11.9% of subjects in this survey (13.3% urban and 11.0% rural) gave a family history and personal history of diabetes mellitus, respectively. Of urban participants (n = 736) with no history of diabetes 70 (9.5%) had HGY and 143 (19.4%) had glucose intolerance (IFG and IGT). Of rural participants (n = 1,270) 114 (9.0%) had HGY and 176 (13.9%) had glucose intolerance. There was an increasing trend in numbers of cases of hyperglycemia and intolerance with increasing age (chi2 198.2, p < 0.001), body mass index (BMI) (chi2 35.1, p < 0.001), SEP (chi2 48.5, p < 0.001) and hypertension (chi2 130.6, p < 0.001). Rural participants had a lower odds ratio [0.706; 95% confidence interval (CI) 0.455-1.096] of having hyperglycemia than urban participants. Individuals with medium and higher SEP had a lower odds ratio (0.878; CI 0.543-1.868) and higher odds ratio (1.405; CI 0.798-2.474), respectively, compared to individuals with lower SEP of having HGY. Both urban and rural populations are at risk for hyperglycemia and glucose intolerance. Individuals having a medium SEP had lower risk of diabetes mellitus than individuals from lower and higher SEP.

Small group effectiveness during pharmacology learning sessions in a Nepalese medical school

BACKGROUND

Small group learning sessions are used in pharmacology at the KIST Medical College, Lalitpur, Nepal. Feedback about student behaviours that enhance and hinder small group effectiveness was obtained. This will help us improve the small group sessions and will also be useful to educators using small groups in other medical schools.

METHOD

The small groups were self-managing with a group leader, time-keeper, recorder and presenter. Small group effectiveness was measured using the Tutorial Group Effectiveness Instrument (TGEI) developed by Singaram and co-authors. The instrument was administered in June 2010 and key findings obtained were shared with students and facilitators. The instrument was administered again in August. The mean cognitive, motivational, demotivational and overall scores were compared among different categories of respondents in June and August. Scores were also compared between June and August 2010.

RESULTS

A total of 89 students participated in the study in June and 88 in August 2010. In June, females rated overall group productivity higher compared to males. The cognitive and motivational scores were higher in August 2010 while the demotivational score was lower.

CONCLUSION

The small group effectiveness was higher in August after the educational intervention which utilised feedback about problems observed, theoretical considerations of effective small groups and how this information can be applied in practice.

An epidemiological study of injury among urban population

BACKGROUND

Injuries are a focus of public health practice because they pose a serious health threat, occur frequently and are preventable. Injuries affect people of all ages and range from minor cuts and bruises to major catastrophes that take thousands of lives.

OBJECTIVES

This paper aims to fi nd out the prevalence of injuries and to study the various epidemiological factors related to the injuries in Dharan.

MATERIALS AND METHODS

A sample of 1398 households was taken as study sample. A systematic random sampling technique was used to select the 10% households from each 19 wards. A pre-tested questionnaire was used to collect demographic information and information related to injuries to the persons suffered from injuries.

RESULT

The prevalence of minor injury in Dharan was 3.5% per month. The injury was common in the age group, 40-49 years (4.6%) and majority of injured persons were farmers (6.9%). Home was the common place (55.6%) for the minor injury. Cut/stab (32.8%) was the most common types of minor injury. The prevalence of major injury was 0.7% per year and occurred more among 50-59 years age group (1.7%). The commonest place for major injury was at road (53.1%) and service holders were at more risk (1.4%). Falls from the height (46.9%) were the most common types of major injury.

CONCLUSION

The injuries related to lifestyle profession and road traffic accidents (RTA) is the commonest burden revealed in the study sample. Promotion of safety and education for protection at work and safe driving can prevent the major socio-economic loss to the family and community at large.

Primary Heealth Care Development: Where is Nepal after 30 years of Alma Ata Declaration??

The year 2008 has witnessed the global conversation to return to tenets of Alma-Ata and to review its 30 years of journey. We reviewed Nepal's journey on Primary Health Care development: policy formulation, structure development, progress and constraints. Though Nepal has institutionalised the PHC approach in health policy, strategy and health care delivery system, this has not been effectively translated into actions, and the results are mixed. Nepal has gained impressive achievements in selective primary health care markers: 45.43% maternal mortality and 62.34% child mortality reduction during 1990-2005. But gain in comprehensive health care markers is not impressive: 18.7% Skilled Birth Attendant (4% in poorest quintile and 45% in richest quintile), 39% having access to improved sanitation and 55.7% of females are literate as compared to males. Socio-political environment until recently was not favourable for comprehensive primary health care, allowing limited health sector decentralisation and community empowerment. Health activities were focussed more on selective health care strategy in the form of disease control, immunisation, vitamin A supplementation, oral rehydration solution use and contraceptive use. Nepal's rural hilly geography posed great challenge on logistic supply, communication and retention of health workers rendering public health centres of low quality with negative perceptions of consumers. Nepal is on the pathway to build equitable comprehensive primary health care.

Swine-origin influenza A (H1N1) in Indian children

BACKGROUND

Swine-origin influenza A H1N1 (S-OIV) has not been systematically studied in Indian children.

OBJECTIVES

To study the clinical characteristics, morbidity and mortality pattern in children with S-OIV infection.

METHODS

This prospective study was conducted during the 'containment phase' of the pandemic in New Delhi from 10 June to 5 August 2009. All children suspected of being infected by S-OIV were admitted to the isolation wards and clinically evaluated according to WHO guidelines. Nasal and throat swabs were collected immediately for real-time reverse transcriptase polymerase chain reaction (RT-PCR). Haemoglobin, total leucocyte and platelet counts and chest radiography were undertaken in all patients. Those who tested positive for S-OIV infection were treated with oseltamivir for 5 days in isolation wards.

RESULTS

Thirty-seven children fulfilled the inclusion criteria. Twenty-one tested positive for S-OIV by RT-PCR and 16 tested negative. Comparison of the clinical characteristics of the two groups showed that duration of cough was longer in children with S-OIV (p<0.03). Total leucocyte and lymphocyte counts were significantly less in the S-OIV group (p<0.001 and , 0.02, respectively). Oseltamivir-related gastritis was seen in 38% of children. All improved and were discharged.

CONCLUSION

S-OIV infection in Indian children had features similar to those of seasonal influenza. Lymphopenia is an important feature of S-OIV.

Primary health care development: where is Nepal after 30 years of Alma Ata Declaration?

The year 2008 has witnessed the global conversation to return to tenets of Alma-Ata and to review its 30 years of journey. We reviewed Nepal's journey on Primary Health Care development: policy formulation, structure development, progress and constraints. Though Nepal has institutionalised the PHC approach in health policy, strategy and health care delivery system, this has not been effectively translated into actions, and the results are mixed. Nepal has gained impressive achievements in selective primary health care markers: 45.43% maternal mortality and 62.34% child mortality reduction during 1990-2005. But gain in comprehensive health care markers is not impressive: 18.7% Skilled Birth Attendant (4% in poorest quintile and 45% in richest quintile), 39% having access to improved sanitation and 55.7% of females are literate as compared to males. Socio-political environment until recently was not favourable for comprehensive primary health care, allowing limited health sector decentralisation and community empowerment. Health activities were focussed more on selective health care strategy in the form of disease control, immunisation, vitamin A supplementation, oral rehydration solution use and contraceptive use. Nepal's rural hilly geography posed great challenge on logistic supply, communication and retention of health workers rendering public health centres of low quality with negative perceptions of consumers. Nepal is on the pathway to build equitable comprehensive primary health care.

Occupational exposure and pulmonary function of jute mill workers in Sunsari, Nepal

Most workers of building, pottery, timber, food and mine industries suffer from non-specific lung diseases and ventilatory disorders. There are many such industries operative in Sunsari, Nepal and so far no study has been reported on pulmonary function of jute mill workers of this region, who are also exposed to dust as other workers in similar types of industries. A brief clinical sheet regarding age, occupational particulars, smoking habits and presence or absence of respiratory symptoms was recorded for each worker. Spirometric parameters were recorded using an electronic spirometer. The group consisted of 95 male workers with mean age 28.43 +/- 7.58 yrs, weight 53.77 +/- 8.70 kg and height 164.83 +/- 6.82 cm. The study indicated an overall reduction in FVC, FEV1, PEFR, FEF25-75% and MVV. FEV1/FVC was within the normal range. Further division of workers into smokers and non-smokers, showed comparatively more decline in PEFR, FEF 25.0-75.0% and FEV1/ FVC in smokers. From this study, it can be concluded that exposure of jute dust leads to combined types of spirometric deficit revealing restrictive or obstructive diseases.

Cranio facial anthropometric measurements among Rai and Limbu community of Sunsari District, Nepal

Anthropometry is applied to obtain measurements of living subjects for identifying age, stature, and various dimensions related to particular race or an individual. Population based cross sectional study was carried out in Dharan and its neighbouring areas with the help of departments of Anatomy and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan. This study included 444 healthy people aged 25-50 years belonging to pure race of Rai and Limbu communities. Head length, nasal ergonomics and total stature were measured for each selected individual. Student't' test was applied to identify significance of the variables. Except nasal breadth of Limbu, the results showed a significant variation (p < 0.001) in all parameters between male and female of both the communities. It was also revealed that Limnbu males and females were taller with larger head length, longer nasal length and nasal height. Similarly nasal breadths of Limbu females were broader where as in males, Rai had broader nose than that of the Limnbu. Therefore it was concluded that anthropometric measurements can play significant role in determining the sex and ethnicity of characteristic pure races of national importance.

Halfway up the highway: Can Nepal meet its Health Millennium Development Goals?

The Millennium Development Goals (MDGs) are international objectives on poverty reduction adopted by the world community and provide the broad context for this revolution in thinking and practice. The MDGs place a central focus on public health, in recognition of the fact that improvements in public health are vital not only in their own right but also to break the poverty trap of the world's poorest economies. Nepal has been committed to achieving the MDGs since it endorsed the Millennium Declaration. As we have at present just passed the midway through the 15 years to MDGs deadline of 2015, this article reviews the status of Nepal in achieving the MDGs, the challenges it faces and whether it can achieve the MDGs by 2015.Key words: development, goals, health, millennium, Nepal

Halfway up the highway: can Nepal meet its Health Millennium Development Goals?

The Millennium Development Goals (MDGs) are international objectives on poverty reduction adopted by the world community and provide the broad context for this revolution in thinking and practice. The MDGs place a central focus on public health, in recognition of the fact that improvements in public health are vital not only in their own right but also to break the poverty trap of the world's poorest economies. Nepal has been committed to achieving the MDGs since it endorsed the Millennium Declaration. As we have at present just passed the midway through the 15 years to MDGs deadline of 2015, this article reviews the status of Nepal in achieving the MDGs, the challenges it faces and whether it can achieve the MDGs by 2015.

Rain, temperature, and child-adolescent height among Native Amazonians in Bolivia

BACKGROUND

Global climate change and recent studies on early-life origins of well-being suggest that climate events early in life might affect health later in life.

AIM

The study tested hypotheses about the association between the level and variability of rain and temperature early in life on the height of children and adolescents in a foraging-farming society of native Amazonians in Bolivia (Tsimane').

SUBJECT AND METHODS

Measurements were taken for 525 children aged 2-12 and 218 adolescents aged 13-23 in 13 villages in 2005. Log of standing height was regressed on mean annual level and mean intra-annual monthly coefficient of variation (CV) of rain and mean annual level of temperature during gestation, birth year, and ages 2-4. Controls include age, quinquennium and season of birth, parent's attributes, and dummy variables for surveyors and villages.

RESULTS

Climate variables were only related with the height of boys age 2-12. The level and CV of rain during birth year and the CV of rain and level of temperature during ages 2-4 were associated with taller stature. There were no secular changes in temperature (1973-2005) or rain (1943-2005).

CONCLUSION

The height of young females and males is well protected from climate events, but protection works less well for boys ages 2-12.

Prevalence of adverse drug reactions with commonly prescribed drugs in different hospitals of Kathmandu valley

OBJECTIVES

To study the prevalence of adverse drug reactions (ADRs) in five different hospitals of Kathmandu Valley.

MATERIALS AND METHODS

An analytical cross sectional study was designed from May 2007 to September 2007 in which prevalence of ADR was calculated. A total of 37 cases of ADRs were taken from 4287 patients and 10% of the remaining population without ADRs i.e. 425 out of 4250 patients was selected randomly. ADRs were analyzed as per the structured questionnaires designed by Canadian adverse drug reaction monitoring program. Data thus obtained were analyzed by using SPSS and Excel 2003 software and relevant statistical tools were applied.

RESULTS

Prevalence of ADR in this study was 0.86% and male to female ratio was 0.85. 54.1% were female and 45.9% were male (P = 0.65). The highest percentage of ADRs were seen in adult patients, however the difference was statistically not significant. Maximum numbers of ADRs were reported from skin, 35.13% followed by GIT, 29.72% and then from CNS, 18.91%. Anti-infectives were associated with maximum number of ADRs followed by IV urograffin. Rashes, 35.13% were the most common type of ADRs reported followed by vomiting, 13.51% and then dizziness which was 10.81%. Regarding the outcomes attributed to ADRs, one patient died due to ADR caused by dapsone and 15 cases got hospitalized due to ADRs. The incidence of ADRs in different age groups was not significant. Similarly, there was no significant association between ADRs and sex. No significant difference was seen in case of age group less than one year as compared to two or more years of age (P = 0.78). For causality of ADRs, according to Naranjo algorhythm scale, 35% of reactions were assessed to be probable, 32% as possible and 19% were definite. Similarly, for severity assessment, 54% reports were mild, 35% were moderate and 10.81% were severe.

CONCLUSION

Prevalence of ADR in this study was 0.8% which is similar to other studies in other countries. All the ADRs were not toxic reactions and they were unpredictable.

Social health insurance: a knowledge-do gap in eastern Nepal

Health care costs, and those for inpatient care in particular, pose a barrier to seeking health care, and cost be a major cause of indebtedness and impoverishment, particularly among the poor. The Ministry of Health in Nepal intends to initiate alternative financing schemes such as community and social health insurance schemes as a means to supplement the government health sector financing source. Social Health Insurance (SHI) is a mechanism for financing and purchasing / delivering health care to workers in the formal sector regulated by the government. Considering all these facts BP Koirala Institute of Health Sciences (BPKIHS) has introduced SHI scheme in 2000 as an alternative health care financing mechanism to the community people of Sunsari and Morang districts. In the beginning small area was elected as a pilot project to launch the scheme. A major objective of SHI is to reduce poverty caused by paying for health care and to prevent already vulnerable families from falling into deeper poverty when facing health problems. A total of 26 organizations with 19799 populations are at present in SHI scheme. Sixteen rural based organizations with 14,047 populations and 10 urban based organizations with 5752 people are the beneficiaries in this scheme. BPKIHS SHI Scheme is the outcome of the visionary thinking on social solidarity and as an alternative health care financing mechanism to the community. BPKIHS is mobilizing people's organizations and is offering health services through its health insurance scheme at subsidized expenses. This has helped people to avail with health facilities who otherwise would have been left vulnerable because of their penetrating health needs. There is huge gap between premium collection and expenditures. The expenditures are more and this may be due to knowledge - do gap in the program. If conditions are unsuitable, SHI can lead to higher costs of care, inefficient allocation of health care resources, inequitable provision and dissatisfied patients. It can also be more difficult to realize the potential advantages of SHI in future. The future challenges confronting the scheme are to give the continuity and sustainability of the program to its catchments areas. This might entail a shift in its program operation mechanism. People's active involvement is required, which will further provide a sense of ownership in the scheme amongst the people.

Knowledge about human genetics among school students of eastern Nepal

School students from 10 to 19 years of age are adolescents. Adolescent girls are usually exposed to consequences of early marriage, pregnancy and increased responsibility. Genetic disorders are important issues to persons of the reproductive age group. History-taking and screening-tests could uncover risk factors that require diagnostic testing during pregnancy. Therefore, the present survey was conducted among 707 school students (55.6% males, 44.4% females) to find out their knowledge about human genetics. Data were collected as written responses to a close-ended questionnaire. The knowledge of students about human genetic was found to be poor. The majority of students was not aware of the prevalence of genetic disorders in the community. Many students (75%) felt that genetic laboratory facilities and counseling services are necessary in this country. More than half of the students did not know the name of a hospital where genetic laboratory services are available. The study indicates that there is a need to introduce the basics of human genetics in the school curriculum and to implement strategies for awareness programs about genetic disorders and their early detection for possible intervention.