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Eriksen I, Rasmussen EH, Karmacharya B, Das S, Darj E, Odland ML. Challenges and possible improvements for healthcare teams at outreach clinics in Nepal - a qualitative study. Glob Health Action 2024; 17:2385177. [PMID: 39109605 PMCID: PMC11308952 DOI: 10.1080/16549716.2024.2385177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND All Nepalese citizens have the right to high-quality healthcare services free of charge. To achieve this, healthcare services for the rural population in Nepal need to be improved in terms of personnel, medicines, and medical equipment. OBJECTIVES To explore challenges and possible improvements healthcare personnel experience when travelling to rural parts of Nepal to provide healthcare. METHOD Data was collected from various health professionals using focus group discussions at Dhulikhel Hospital in Nepal. The data were transcribed and analysed using Systematic text condensation. RESULTS Twenty-two professional healthcare personnel participated in five group discussions. Four categories emerged from the collected material: Finding ORC services being underutilised, Wanting to fulfil tasks and do a good job, Facing inadequate resources, and Seeing the need for improved organisation and cooperation. There was consensus that rural clinics are important to maintaining health for the rural population of Nepal. However, there was frustration that the rural population was not benefitting from all available healthcare services due to underutilisation. CONCLUSION Rural healthcare clinics are not utilised appropriately, according to healthcare workers at the rural outreach clinics. Potential ways of overcoming the perceived challenges of underutilising available healthcare services include financial and human resources. The rural population´s health awareness needs to be increased, and the work environment for rural healthcare workers needs to be improved. These issues need to be prioritised by the government and policymakers.
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Affiliation(s)
- Ingrid Eriksen
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eirin Helene Rasmussen
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Biraj Karmacharya
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
| | - Seema Das
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Elisabeth Darj
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Maria Lisa Odland
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Dulal S, Saville NM, Merom D, Giri K, Prost A. Exploring the feasibility of integrating health, nutrition and stimulation interventions for children under three years in Nepal's health system: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001398. [PMID: 37115747 PMCID: PMC10146516 DOI: 10.1371/journal.pgph.0001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Community-based primary care settings are a potential entry point for delivering Early Childhood Development (ECD) interventions in Nepal. Past studies have suggested that integrating stimulation with nutrition interventions is an effective way to deliver multiple benefits for children, but there is limited knowledge of how to do this in Nepal. We conducted a qualitative study in Nepal's Dhanusha district to explore how stimulation interventions for early learning could be integrated into existing health and nutrition programmes within the public health system. Between March and April 2021, we completed semi-structured interviews with caregivers (n = 18), health service providers (n = 4), district (n = 1) and national stakeholders (n = 4), as well as policymakers (n = 3). We also carried out focus group discussions with Female Community Health Volunteers (FCHVs) (n = 2) and health facility operation and management committee members (n = 2). We analysed data using the framework method. Respondents were positive about introducing stimulation interventions into maternal and child health and nutrition services. They thought that using health system structures would help in the implementation of integrated interventions. Respondents also highlighted that local governments play a lead role in decision-making but must be supported by provincial and national governments and external agencies. Key factors impeding the integration of stimulation into national programmes included a lack of intersectoral collaboration, poor health worker competency, increased workload for FCHVs, financial constraints, a lack of prioritisation of ECD and inadequate capacity in local governments. Key barriers influencing the uptake of intervention by community members included lack of knowledge about stimulation, caregivers' limited time, lack of paternal engagement, poverty, religious or caste discrimination, and social restrictions for newlywed women and young mothers. There is an urgent need for an effective coordination mechanism between ministries and within all three tiers of government to support the integration and implementation of scalable ECD interventions in rural Nepal.
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Affiliation(s)
- Sophiya Dulal
- Western Sydney University, School of Health Sciences, Sydney, Australia
| | | | - Dafna Merom
- Western Sydney University, School of Health Sciences, Sydney, Australia
| | - Kalpana Giri
- Health Research and Development Forum, Kathmandu, Nepal
| | - Audrey Prost
- UCL Institute for Global Health, London, United Kingdom
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Quincey DJ, Kay P, Wilkinson J, Carter LJ, Brown LE. High concentrations of pharmaceuticals emerging as a threat to Himalayan water sustainability. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:16749-16757. [PMID: 34997518 PMCID: PMC8827227 DOI: 10.1007/s11356-021-18302-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/20/2021] [Indexed: 05/05/2023]
Abstract
The sixth UN Sustainable Development Goal, Clean Water and Sanitation, directly underpins other goals of Health, Life in Water and Sustainable Cities. We highlight that poor sanitation, exemplified through some of the highest concentrations of pharmaceuticals ever detected in rivers, will amplify societal and environmental stress where climate-induced reductions in flow are predicted. Rapidly growing urban centres with inadequate water treatment works will need to prioritise water quality improvement before supply reductions become a reality. For 23 river locations within Kathmandu City and the Annapurna region, Nepal, we show the presence of 28 of 35 monitored human-use pharmaceuticals. Concentrations of antibiotics measured in this sampling campaign in both Kathmandu City (sulfamethazine, metronidazole and ciprofloxacin) and rural locations (ciprofloxacin) are in excess of predicted no effect concentrations, suggesting these sites are at risk of proliferating antimicrobial resistance as well as affecting other ecotoxicological endpoints. It is anticipated that climate-induced reductions in flow combined with contaminated river systems will amplify future societal and environmental stress.
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Affiliation(s)
- Duncan J Quincey
- School of Geography & Water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
| | - Paul Kay
- School of Geography & Water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
| | - John Wilkinson
- Environment and Geography Department, University of York, Heslington, YO10 5NG, York, UK
| | - Laura J Carter
- School of Geography & Water@Leeds, University of Leeds, Leeds, LS2 9JT, UK.
| | - Lee E Brown
- School of Geography & Water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
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Neupane P, Bhandari D, Tsubokura M, Shimazu Y, Zhao T, Kono K. The Nepalese health care system and challenges during COVID-19. J Glob Health 2021; 11:03030. [PMID: 33692885 PMCID: PMC7914404 DOI: 10.7189/jogh.11.03030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Prajwal Neupane
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Dilip Bhandari
- Department of Neurosurgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Yuzo Shimazu
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
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Bhandari AKC, Dhungel B, Rahman M. Trends and correlates of cesarean section rates over two decades in Nepal. BMC Pregnancy Childbirth 2020; 20:763. [PMID: 33298004 PMCID: PMC7724849 DOI: 10.1186/s12884-020-03453-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cesarean section (CS) is a major component of emergency obstetric care. There has been a substantial rise in the rate of CS in private institutions in Nepal which might reflect the successful implementation of delivery schemes introduced by the government extended to the private organizations alternatively, it may also reflect the need for more public health care facilities to provide maternal and child health care services. Hence, the objective of this study was to examine the trends in institutional-based CS rates in Nepal along with its correlates over time. METHODS We used the National Demographic and Health Survey (NDHS) data collected every 5 years, from 1996 to 2016. The trend in CS rates based on five waves of NDHS data along with its correlates were examined using multivariable logistic regression models after adjusting for socio-demographics and pregnancy-related variables. RESULTS We included 20,824 reproductive-aged women who had a history of delivery within the past 5 years. The population-based CS rate increased from 0.9% in 1996 [95% CI: (0.6-1.2) %] to 10.2% in 2016 [95% CI: (8.9-11.6) %, p < 0.01] whereas the institutional-based CS rate increased from 10.4% in 1996 [95% CI: (8.3-12.9) %] to 16.4% in 2016 [95% CI: (14.5-18.5) %, p < 0.01]. Private institutions had a nearly 3-fold increase in CS rate (8.9% in 1996 [95% CI: (4.8-16.0) %] vs. 26.3% in 2016[95% CI: (21.9-31.3) %]. This was also evident in the trend analysis where the odds of having CS was 3.58 times higher [95% CI: (1.83-7.00), p < 0.01] in 2016 than in 1996 in the private sectors, while there was no evidence of an increase in public hospitals (10.9% in 1996 to 12.9% in 2016; p for trend > 0.05). Education of women, residence, wealth index, parity and place of delivery were significantly associated with the CS rate. CONCLUSION Nepal has observed a substantial increase in cesarean delivery over the 20 years, which might indicate a successful implementation of the safe motherhood program in addressing the Millennium Development Goals and Universal Health Care agenda on maternal and child health. However, the Nepal government should examine existing disparities in accessibility of emergency obstetric care services, such as differences in CS between public and private sectors, and promote equity in maternal and child health care services accessibility and utilization.
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Affiliation(s)
- Aliza K. C. Bhandari
- St. Luke’s International University Graduate School of Public Health, Tokyo, Japan
| | - Bibha Dhungel
- St. Luke’s International University Graduate School of Public Health, Tokyo, Japan
| | - Mahbubur Rahman
- St. Luke’s International University Graduate School of Public Health, Tokyo, Japan
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Sürmeli A, Tolunay T, Yasin Y, Kusoglu H, Arcan A, Jaiswal A, Gökmen B, Acharya B, Arslan B, Baka BE, Imamoglu GS, Ökke L, Sahiner M, Yildiz P, Altinayak R, Pokharel S, Yaylaci S, Arikan S, Yolcu YU, Kurt Ö. Child health, parasites and lower socioeconomic status: Outcomes of a long-term screening, intervention and training study by health volunteers in rural Nepal. Acta Trop 2020; 202:105263. [PMID: 31711749 DOI: 10.1016/j.actatropica.2019.105263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/19/2019] [Accepted: 11/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Nepal is a developing country with limited resources for health provision due to its geographic difficulties and frequent natural disasters, such as floods and earthquakes. Children are at risk of growth retardation due to inadequate food intake and unhealthy environment. Lower back pain is common among the adults and causes limitations in daily activities. MATERIAL/METHODS A group of voluntary Turkish medical students, doctors and civil members conducted a field study, together with Nepalese doctors (MDs) and local volunteers, concerned with health-screening, intervention practices and on-site training in rural Nepal between 2013 and 2015. Physical examination of participants, together with stool examinations for parasites were done and those for whom treatment was indicated were referred to MDs who also ran a field pharmacy containing donated medications. RESULTS Totally, 1148 individuals-725 children and 423 adults-were screened between 2013 and 2015. Musculoskeletal problems and upper respiratory tract infections were primary complaints among adults and sick children, respectively. Three-quarters of 203 collected stools had ≥ 1 parasite(s). CONCLUSIONS Growth retardation in children observed during the study, the burden of intestinal parasites on Nepalese children and unavailability of effective health services for citizens in rural areas should direct local authorities to allocate greater resources for country's health infrastructure improvement and to provide a higher standard of childhood nutrition.
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Affiliation(s)
- Aral Sürmeli
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey; Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | - Tuana Tolunay
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey; Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | - Yesim Yasin
- ACUFoM, Department of Public Health, Istanbul, Turkey
| | - Hülya Kusoglu
- ACUFoM, Department of Infectious Diseases, Istanbul, Turkey
| | - Abdullah Arcan
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey; Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | | | - Beril Gökmen
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey
| | | | - Burcu Arslan
- Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | - Büsra Ecem Baka
- ACU Faculty of Health Sciences, Physical Therapy and Rehabilitation, Istanbul, Turkey
| | - Gizem Söylemez Imamoglu
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey
| | - Larissa Ökke
- Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey; ACU Faculty of Health Sciences, Physical Therapy and Rehabilitation, Istanbul, Turkey
| | - Melike Sahiner
- ACUFoM, Department of Medical Education, Istanbul, Turkey
| | - Piril Yildiz
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey; Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | | | | | - Serpil Yaylaci
- ACUFoM, Department of Emergency Medicine, Istanbul, Turkey
| | - Silasu Arikan
- Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | - Yagiz Ugur Yolcu
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey
| | - Özgür Kurt
- Acibadem LABMED Clinical Laboratories, Istanbul, Turkey; ACUFoM, Department of Medical Microbiology, Istanbul, Turkey; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Clinical Parasitology Study Group, Switzerland.
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Sondaal AEC, Tumbahangphe KM, Neupane R, Manandhar DS, Costello A, Morrison J. Sustainability of community-based women's groups: reflections from a participatory intervention for newborn and maternal health in Nepal. COMMUNITY DEVELOPMENT JOURNAL 2019; 54:731-749. [PMID: 31885401 PMCID: PMC6924535 DOI: 10.1093/cdj/bsy017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 03/19/2018] [Indexed: 05/25/2023]
Abstract
Participatory community-based women's group interventions have been successful in improving maternal and newborn survival. In rural Makwanpur, Nepal, exposure to these Participatory Learning and Action groups resulted in a thirty-percent reduction in neonatal mortality rate and significantly fewer maternal deaths. It is often theorised that participatory approaches are more likely to be sustained than top-down approaches, but this is rarely evaluated after the withdrawal of external support. We sought to understand how participatory learning and action (PLA) groups in Makwanpur fared after the supporting non-governmental organisation withdrew their support as well as factors affecting their sustainability. We used mixed methods, conducting a cross-sectional survey of 239 groups, thirty focus group discussions with group members and thirty key informant interviews within twelve-seventeen months after support was withdrawn. Eighty percent of groups were still active which suggests that PLA groups have a high chance of being sustained over time. Groups were more likely to be sustained if the group had local importance and members continued to acquire new knowledge. However, the participatory nature of the group and local embeddedness were not enough to sustain all groups. They also needed leadership capacity, a unifying activity such as a fund, and a strong belief in the value of their meeting to sustain. These key factors should be considered when seeking to enable sustainability of participatory interventions.
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Affiliation(s)
- Annemijn E C Sondaal
- Address for correspondence: Annemijn E.C. Sondaal, Institute for Global Health, University College London, London WC1N 1EH, UK;
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Thakur A, Adhikari S, Anderson D, Feinn R. Health Care Access and Utilization by Nepalese Adults in Connecticut. Cureus 2019; 11:e4543. [PMID: 31263650 PMCID: PMC6592465 DOI: 10.7759/cureus.4543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Access to healthcare and the utilization of health services at both the state and national levels are frequent areas of study, specifically in major ethnic populations such as White, Black, and Hispanic/Latino. However, there are few studies assessing healthcare access and utilization in the Nepalese communities in the United States (U.S.), despite the rapidly growing population of Nepalese immigrants. Methods To explore this issue, we conducted a questionnaire-based survey of Nepalese adults in Connecticut (CT). Results When compared to the reporting of the general CT population, a greater percentage of this survey’s respondents report having trouble accessing necessary care (21.1% vs 11.0% in CT). Despite this, more Nepalese adults report satisfaction with the provider in terms of time spent during the visit (81.8% vs 76.0% in CT) and a consideration of values and beliefs during treatment (86.2% vs 70.0% in CT). In comparison with previous national reporting of the general U.S. population, Nepalese adults in the survey tend to have fewer total health care visits annually (87.1% reporting between zero and three visits vs. 64.7% in the U.S.). They also reported fewer dental visits (60.6% vs 71.0% in the U.S.). Conclusion While this novel study is one of the few examining health in the Nepalese population in the U.S., it serves as a foundation for future research in this area. Additionally, the results of the study highlight important disparities that local Nepalese organizations can use to design initiatives to improve this population’s health.
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Affiliation(s)
- Abhishek Thakur
- Internal Medicine, Frank H. Netter MD School of Medicine, North Haven, USA
| | - Srijan Adhikari
- Neurosurgery, Frank H. Netter MD School of Medicine, North Haven, USA
| | - Daren Anderson
- Epidemiology and Public Health, Community Health Center, Weitzman Institute, Middletown, USA
| | - Richard Feinn
- Statistics, Frank H. Netter MD School of Medicine, North Haven, USA
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Adhikari R, Thapa S. Changing Trend of Infectious Diseases in Nepal. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1052:19-38. [PMID: 29785478 PMCID: PMC7122567 DOI: 10.1007/978-981-10-7572-8_3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Many infectious/communicable diseases (IDs) are endemic in Nepal. Until a decade and half ago, IDs were the major cause of both morbidity and mortality accounting 70% for both. However, as a result of various preventive measures implemented by both the state and non-state actors, the overall IDs have shown a changing (declining) trend. The most impressive decline has been seen in the intestinal helminth infection. Though the overall burden of IDs is decreasing, several newer infectious diseases (emerging infections) namely, dengue fever, scrub typhus, influenza (H5N1 and H1N1), and others are posing a great public health problem. On the other hand, though sporadic, outbreaks of endemic diseases together with HIV-TB coinfection and infection with drug resistance microbes during recent years have constituted a serious public health as well as medical problem. On the contrary, with the decline of IDs, noninfectious diseases (noncommunicable disease, NCD) namely, diabetes, cancer (and cancer therapy), and others are on the rise particularly in urban areas. Hence, currently Nepal is trapped in "double burden" of diseases. Risk of opportunistic infection has increased in immunocompromised person with NCD. To address the present situation, the multi-sectoral plan and strategies developed must be implemented effectively.
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Affiliation(s)
- Rameshwar Adhikari
- Research Center for Applied Science and Technology (RECAST), Tribhuvan University, Kathmandu, Nepal
| | - Santosh Thapa
- Department of Microbiology, Immunology and Genetics, Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, Texas USA
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Hagaman AK, Maharjan U, Kohrt BA. Suicide surveillance and health systems in Nepal: a qualitative and social network analysis. Int J Ment Health Syst 2016; 10:46. [PMID: 27274355 PMCID: PMC4895957 DOI: 10.1186/s13033-016-0073-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/10/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite increasing recognition of the high burden of suicide deaths in low- and middle-income countries, there is wide variability in the type and quality of data collected and reported for suspected suicide deaths. Suicide data are filtered through reporting systems shaped by social, cultural, legal, and medical institutions. Lack of systematic reporting may underestimate public health needs or contribute to misallocation of resources to groups most at risk. METHODS The goal of this study was to explore how institutional structures, cultural perspectives on suicide, and perceived criminality of self-harm influence the type and quality of suicide statistics, using Nepal as an example because of its purported high rate of suicide in the public health literature. Official documentation and reporting networks drawn by police, policy makers, and health officials were analyzed. Thirty-six stakeholders involved in various levels of the death reporting systems in Nepal participated in in-depth interviews and an innovative drawn surveillance system elicitation task. RESULTS Content analysis and social network analysis revealed large variation across the participants perceived networks, where some networks were linear pathways dominated by a single institution (police or community) with few nodes involved in data transmission, while others were complex and communicative. Network analysis demonstrated that police institutions controlled the majority of suicide information collection and reporting, whereas health and community institutions were only peripherally involved. Both health workers and policy makers reported that legal codes criminalizing suicide impaired documentation, reporting, and care provision. However, legal professionals and law review revealed that attempting suicide is not a crime punishable by incarceration. Another limitation of current reporting was the lack of attention to male suicide. CONCLUSIONS Establishment and implementation of national suicide prevention strategies will not be possible without reliable statistics and comprehensive standardized reporting practices. The case of Nepal points to the need for collaborative reporting and accountability shared between law enforcement, administrative, and health sectors. Awareness of legal codes among health workers, in particular dispelling myths of suicide's illegality, is crucial to improve mental health services and reporting practices.
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Affiliation(s)
- Ashley K. Hagaman
- />School of Human Evolution and Social Change, Arizona State University, Tempe, USA
| | - Uden Maharjan
- />Health Research and Social Development Forum, Kathmandu, Nepal
| | - Brandon A. Kohrt
- />Duke Global Health Institute and Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
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Assessing access to surgical care in Nepal via a cross-sectional, countrywide survey. Surgery 2016; 160:501-8. [PMID: 27158120 DOI: 10.1016/j.surg.2016.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/23/2016] [Accepted: 03/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Adequate surgical care is lacking in many low- and middle-income countries because of diverse barriers preventing patients from reaching providers. We sought to assess perceived difficulties to accessing surgical care in Nepal using the Surgeons OverSeas Assessment of Surgical Need tool. METHODS Fifteen of 75 Nepali districts were selected proportionate to the population, with 1,350 households surveyed. Household heads answered questions regarding access to health facilities, and 2 household members were interviewed for medical history. Continuous and categorical variables were analyzed via Wilcoxon rank sum test and Pearson χ(2) test. Multivariable logistic regressions for independent predictors of care access were performed controlling for age, sex, location, and literacy. RESULTS Of respondents with a surgical condition (n = 1,342), 650 (48.4%) accessed care and 237 (17.7%) did not. Unadjusted analyses showed greater median travel times to all facilities (P < .001) and median transport costs to secondary and tertiary centers (P < .001) for those who did not access care versus those who did. Literate respondents were more likely to access care across all facilities and access variables in adjusted models (odds ratio 1.66-1.80, P < .01). Those without transport money were less likely to access care at any facility in all analyses (P < .01). CONCLUSION The data project that at least 2.4 million individuals lack access to needed surgical care in Nepal during their lifetimes, with those not accessing health facilities having lower literacy rates and fewer transport resources. Promoting education, outreach programs, and transportation access could lessen barriers but will require further exploration.
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Poudel BK, Ishii I, Khakurel B. Assessment of regulatory compliance in selected pharmacy outlets of Nepal. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2016. [DOI: 10.1111/jphs.12127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Bhupendra Kumar Poudel
- Graduate School of Pharmaceutical Sciences; Chiba University; Chiba Japan
- Department of Drug Administration; Kathmandu Nepal
| | - Itsuko Ishii
- Graduate School of Pharmaceutical Sciences; Chiba University; Chiba Japan
- Division of Pharmacy; Chiba University Hospital; Chiba Japan
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Shah MT, Bhattarai S, Lamichhane N, Joshi A, LaBarre P, Joshipura M, Mock C. Assessment of the availability of technology for trauma care in Nepal. Injury 2015; 46:1712-9. [PMID: 26140742 DOI: 10.1016/j.injury.2015.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/03/2015] [Accepted: 06/05/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND We sought to assess the availability of technology-related equipment for trauma care in Nepal and to identify factors leading to optimal availability as well as deficiencies. We also sought to identify potential solutions addressing the deficits in terms of health systems management and product development. METHODS Thirty-two items for large hospitals and sixteen items for small hospitals related to the technological aspect of trauma care were selected from the World Health Organization's Guidelines for Essential Trauma Care for the current study. Fifty-six small and 29 large hospitals were assessed for availability of these items in the study area. Site visits included direct inspection and interviews with administrative, clinical, and bioengineering staff. RESULTS Deficiencies of many specific items were noted, including many that were inexpensive and which could have been easily supplied. Shortage of electricity was identified as a major infrastructural deficiency present in all parts of the country. Deficiencies of pulse oximetry and ventilators were observed in most hospitals, attributed in most part to frequent breakdowns and long downtimes because of lack of vendor-based service contracts or in-house maintenance staff. Sub-optimal oxygen supply was identified as a major and frequent deficiency contributing to disruption of services. All equipment was imported except for a small percent of suction machines and haemoglobinometers. CONCLUSIONS The study identified a range of items which were deficient and whose availability could be improved cost-effectively and sustainably by better planning and organisation. The electricity deficit has been dealt with successfully in a few hospitals via direct feeder lines and installation of solar panels; wider implementation of these methods would help solve a large portion of the technological deficiencies. From a health systems management view-point, strengthening procurement and stocking of low cost items especially in remote parts of the country is needed. From a product development view-point, there is a need for robust pulse-oximeters and ventilators that are lower cost and which have longer durability and less need for repairs. Increasing capabilities for local manufacture is another potential method to increase availability of a range of equipment and spare parts.
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Affiliation(s)
- Mihir Tejanshu Shah
- Academy of Traumatology (India), Ahmedabad, India; Smt NHL Municipal Medical College, Ahmedabad, India.
| | | | | | - Arpita Joshi
- Smt NHL Municipal Medical College, Ahmedabad, India
| | | | | | - Charles Mock
- Department of Surgery, University of Washington, Seattle, USA
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K C B, Heydon S, Norris P. Access to and quality use of non-communicable diseases medicines in Nepal. J Pharm Policy Pract 2015; 8:21. [PMID: 26328058 PMCID: PMC4553926 DOI: 10.1186/s40545-015-0041-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
Noncommunicable diseases are a major healthcare problem in Nepal and their burden is increasingevery year. Noncommunicable diseases (NCDs) bring additional challenges to the Nepalese healthcaresystem which is already experiencing infrastructure shortages, poor service delivery, inadequate essential medicines coverage and shortages of healthcare workers. The Nepal government provides a limited number of free essential medicines through the free essential healthcare services program. This consists of a basic healthcare package provided through primary healthcare (PHC) facilities and district hospitals. Though around 40 essential medicines are provided without charge, studies have reported problems with access especially in all rural areas. There is a need to improve access to, coverage and quality use of medicines. The government has decided to provide some free medicines for NCDs alongside free essential medicines to be distributed via current healthcare structures. Though well intended, this decision will put extra strain on the essential medicines program. It should be supplemented by a comprehensive NCDs policy that takes account of the issues of sustainability and quality use of medicines. Complex cases of NCDs will be managed by tertiary hospitals but most of the cases of NCDs especially for rural people and the poor will end up in secondary level public hospitals (district and zonal hospitals). Therefore, the government needs to strengthen these public hospitals. Meanwhile, given the severity of the NCDs problem in Nepal, the Ministry of Health and Population (MoHP) should liaise with nongovernmental and missionary hospitals especially in rural areas to run NCDs management services. The Ministry should encourage these hospitals to run hospital pharmacies to improve people's access to and quality use of NCDs medicines. At the primary healthcare level, the Ministry could run NCDs prevention and control programs but existing PHC workers need training to perform proper dispensing of NCDs medicines. PHC facilities need a medical record system so that they can address the needs of NCDs patients requiring long term medication supply via a proximate PHC facility.
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Affiliation(s)
- Bhuvan K C
- School of Pharmacy University of Otago, 18 Frederick Street, Dunedin, 9054 New Zealand
| | - Susan Heydon
- School of Pharmacy University of Otago, 18 Frederick Street, Dunedin, 9054 New Zealand
| | - Pauline Norris
- School of Pharmacy University of Otago, 18 Frederick Street, Dunedin, 9054 New Zealand
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Mishra SR, Khanal P, Karki DK, Kallestrup P, Enemark U. National health insurance policy in Nepal: challenges for implementation. Glob Health Action 2015; 8:28763. [PMID: 26300556 PMCID: PMC4546934 DOI: 10.3402/gha.v8.28763] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/14/2022] Open
Abstract
The health system in Nepal is characterized by a wide network of health facilities and community workers and volunteers. Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. But the reality is a far cry. Only 61.8% of the Nepalese households have access to health facilities within 30 min, with significant urban (85.9%) and rural (59%) discrepancy. Addressing barriers to health services needs urgent interventions at the population level. Recently (February 2015), the Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme (SHS) after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Mechanisms should be built for monitoring unfair pricing and unaffordable copayments, and an overall benefit package be crafted to include coverage of major health services including non-communicable diseases. Regulations should include such issues as accreditation mechanisms for private providers. Health system strengthening should move along with the roll-out of SHS. Improving the efficiency of hospital, motivating the health workers, and using appropriate technology can improve the quality of health services. Also, as currently a constitution drafting is being finalized, careful planning and deliberation is necessary about what insurance structure may suit the proposed future federal structure in Nepal.
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Affiliation(s)
- Shiva Raj Mishra
- Nepal Development Society, Chitwan, Nepal
- School of Population Health, University of Western Australia, Perth, Australia;
| | - Pratik Khanal
- Department of Community Medicine and Public Health, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | | | - Per Kallestrup
- Department of Public Health, Centre for Global Health, Aarhus University, Aarhus, Denmark
| | - Ulrika Enemark
- Department of Public Health, Centre for Global Health, Aarhus University, Aarhus, Denmark
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Singh VP, Moss TP. Psychological impact of visible differences in patients with congenital craniofacial anomalies. Prog Orthod 2015; 16:5. [PMID: 26061983 PMCID: PMC4402677 DOI: 10.1186/s40510-015-0078-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/28/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with craniofacial anomalies often have appearance concerns and related social anxiety which can affect their quality of life. This study assessed the psychological impact of facial and dental appearance in patients with craniofacial anomalies in comparison to a general population control group. METHODS The study involved 102 adult patients (51% male) with congenital craniofacial anomalies and 102 controls (49% male). Both groups completed the Nepali version of Derriford Appearance Scale (DAS) and the Psychological Impact of Dental Aesthetic Questionnaire (PIDAQ) in a clinical setting to assess appearance-related distress, avoidance, and anxiety. RESULTS There was a significant difference between patients and controls on both PIDAQ (mean score for patients 33.25 ± 9.45 while for controls 27.52 ± 5.67, p < 0.001) and DAS59 scores (mean score for patients 159.16 ± 31.54 while for controls 77.64 ± 6.57, p < 0.001), indicating that patients experienced greater negative psychological impact of living with their appearance (PIDAQ) and more appearance-related distress (DAS) than controls. DAS scores were not associated with gender. There was no association of the place of residence (rural vs. urban) with PIDAQ or DAS59 scores. CONCLUSIONS There is a significant psychological impact of altered facial and dental appearance in patients with craniofacial anomalies compared to controls. There was no effect of locality (rural/urban) on the psychological impact of facial and dental appearance in patients.
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Affiliation(s)
- Varun Pratap Singh
- />Department of Orthodontics and Dentofacial Orthopedics, Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar 56700 Nepal
| | - Timothy P Moss
- />Department of Health Psychology, University of the West of England, Frenchary Campus, cold Harbour Lane, Bristol, BS161QY UK
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Khanal V, Adhikari M, Karkee R, Gavidia T. Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal demographic and health survey 2011. BMC WOMENS HEALTH 2014; 14:19. [PMID: 24484933 PMCID: PMC3911793 DOI: 10.1186/1472-6874-14-19] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 01/29/2014] [Indexed: 11/24/2022]
Abstract
Background Postnatal care is essential to save the life of the mother and newborn. Knowledge on the determinants of postnatal care assists the policy makers to design, justify and implement appropriate interventions. The current study aimed to analyse the factors associated with utilisation of postnatal care services by mothers in Nepal based on the data from Nepal Demographic and Health Survey (NDHS) 2011. Methods This study utilised the data from NDHS 2011. The association between utilisation of at least one postnatal care visit (within 6 weeks of delivery) and immediate postnatal care (within 24 hours of delivery) with selected factors was examined by using Chi-square test (χ2), followed by multiple logistic regression. Result Of the 4079 mothers, 43.2% reported attending postnatal care within the first six weeks of birth, while 40.9% reported attending immediate postnatal care. Mothers who were from urban areas, from rich families, who were educated, whose partners were educated, who delivered in a health facility, who had attended a four or more antenatal visits, and whose delivery was attended by a skilled attendant were more likely to report attending at least one postnatal care visit. On the other hand, mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to have attended at least one postnatal care visit. Similarly, mothers who were from the urban areas, from rich families, who were educated, whose partners were educated, who had attended four or more antenatal visits, who delivered in a health facility and had delivered in the presence of a skilled birth attendant were more likely to report attending immediate postnatal care. Mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to attend immediate postnatal care. Conclusion The majority of postnatal mothers in Nepal did not seek postnatal care. Increasing utilisation of the recommended four or more antenatal visits, delivery at health facility and increasing awareness and access to services through community-based programs especially for the rural, poor, and less educated mothers may increase postnatal care attendance in Nepal.
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Affiliation(s)
- Vishnu Khanal
- Independent consultant, Maternal and Child Health, Sauraha Pharsatikar Village Development Committee, Ward 1, Rupandehi, Kathmandu, Nepal.
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Mahat A, Bezruchka SA, Gonzales V, Connell FA. Assessment of graduate public health education in Nepal and perceived needs of faculty and students. HUMAN RESOURCES FOR HEALTH 2013; 11:16. [PMID: 23621945 PMCID: PMC3640966 DOI: 10.1186/1478-4491-11-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 04/06/2013] [Indexed: 05/30/2023]
Abstract
BACKGROUND Despite the large body of evidence suggesting that effective public health infrastructure is vital to improving the health status of populations, many universities in developing countries offer minimal opportunities for graduate training in public health. In Nepal, for example, only two institutions currently offer a graduate public health degree. Both institutions confer only a general Masters in Public Health (MPH), and together produce 30 graduates per year. The objective of this assessment was to identify challenges in graduate public health education in Nepal, and explore ways to address these challenges. METHODS The assessment included in-person school visits and data collection through semi-structured in-depth interviews with primary stakeholders of Nepal's public health academic sector. The 72 participants included faculty, students, alumni, and leaders of institutions that offered MPH programs, and the leadership of one government-funded institution that is currently developing an MPH program. Data were analyzed through content analysis to identify major themes. RESULTS Six themes characterizing the challenges of expanding and improving graduate public health training were identified: 1) a shortage of trained public health faculty, with consequent reliance on the internet to compensate for inadequate teaching resources; 2) teaching/learning cultures and bureaucratic traditions that are not optimal for graduate education; 3) within-institution dominance of clinical medicine over public health; 4) a desire for practice-oriented, contextually relevant training opportunities; 5) a demand for degree options in public health specialties (for example, epidemiology); and 6) a strong interest in international academic collaboration. CONCLUSION Despite an enormous need for trained public health professionals, Nepal's educational institutions face barriers to developing effective graduate programs. Overcoming these barriers will require: 1) increasing the investment in public health education and 2) improving the academic environment of educational institutions. Long term, committed academic collaborations with international universities may be a realistic way to: 1) redress immediate inadequacies in resources, including teachers; 2) encourage learning environments that promote inquiry, creativity, problem-solving, and critical thinking; and 3) support development of the in-country capacity of local institutions to produce a cadre of competent, well-trained public health practitioners, researchers, teachers, and leaders.
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Affiliation(s)
- Agya Mahat
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Stephen A Bezruchka
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Virginia Gonzales
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Frederick A Connell
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Pambos M, Ng J, Loukes J, Matheson J, Aryal B, Adhikari S, Kerry S, Reid F, Oakeshott P. Demographics and diagnoses at rural health camps in Nepal: cross-sectional study. Fam Pract 2012; 29:528-33. [PMID: 22357578 DOI: 10.1093/fampra/cms010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The charity 'Health Partnership Nepal' is committed to both improving global health care and providing medical training links between Nepal and the UK. This paper analyses data gathered at rural health camps. AIM To describe the demographics, diagnoses and treatments offered to people attending three rural health camps in Nepal during 2009. Design Cross-sectional study. Setting Three free health care camps established within the Nuwakot district of Nepal during April-May 2009. Camps were staffed by doctors including GPs, nurses and medical students from London and Kathmandu. METHODS Attendees had treatment sheets completed which recorded their demographics, diagnoses and dispensed medications. RESULTS The mean age of the 1903 consecutive patients attending was 42.8 years (range one month to 98 years) of whom 68.6% were female and 13.7% were children. The majority, 82.3%, were agricultural workers. For adults (n = 1574), the most frequent complaints were stomach pain 20.1%, musculoskeletal pain 19.3% and visual acuity problems 6.1%. Stomach pain was significantly more common in women than men [21.2% (236/1064) versus 14.5% (65/449) P < 0.01]. For children (n = 249), the most common diagnoses were helminthiasis 10.4%, conjunctivitis 7.6% and upper respiratory tract infection 7.2%. Overall, opthalmological, gastroenterological and rheumatological diagnoses were significantly more common in Nepalese than UK general practice patients. Of 1109 recorded prescriptions, the most common were multivitamins 23%, oral analgesics 15% and oral antibiotics 14%. CONCLUSIONS There is a considerable unmet disease burden within rural districts of Nepal particularly for stomach pain, musculoskeletal pain and visual acuity problems. When planning similar rurally based health camps, we recommend recruiting GPs and ophthalmologists.
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Affiliation(s)
- Michael Pambos
- Population Health Sciences and Education, St. George's, University of London, London, UK.
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Developing an understanding between people: The key to global health. Travel Med Infect Dis 2010; 8:180-3. [DOI: 10.1016/j.tmaid.2010.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 02/18/2010] [Accepted: 02/23/2010] [Indexed: 11/20/2022]
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Hirai K, Ohno Y, Jindai M, Aoki Y, Hayashi E, Higuchi H, Mizuno S, Nagata K, Tamura T, Rai SK, Shrestha MP. Serum nutritional status of tocopherol and retinol normalized to lipids of persons living in the southern rural Terai region in Nepal. Environ Health Prev Med 2004; 9:13-21. [PMID: 21432333 DOI: 10.1265/ehpm.9.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 11/20/2003] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The present study examined the levels of serum α-Tocopherol (Toc), retinol (Ret), cholesterol (Chol) and triglycerides (TG), and their correlations in the sera of people in Nepal. METHODS The survey was conducted on the general populace in the agricultural Terai region in southern Nepal. The study population consisted of 93 males and 83 females aged 10-68 years. Serum Toc and Ret were measured by high-performance liquid chromatography. RESULTS No significant differences were observed between the genders for the average of total Chol (T-Chol) (140 and 145 mg/100 ml, respectively), HDL-C (45 and 47 mg/100 ml), LDL-C (94 and 97 mg/100 ml), and TG (106 and 110 mg/100 ml), and the ratio of LDL/HDL (2.16). The levels of mean Toc (4.32 and 4.27 μg/ml) were about the same for both genders, while the mean Ret levels were significantly higher for males (624 ng/ml) than for females (535 ng/ml) (p<0.001). A direct relationship was found between the levels of Toc and Ret (r=0.46, p<0.001 and r=0.28, p<0.05 for males and females, respectively). Serum levels of Toc and Ret were positively related to the levels of Chol (r=0.48 and r=0.58, p<0.001 for males and r=0.49, p<0.01 and r-0.28, p<0.05 for females, respectively). The ratio of Toc/TG normalized to serum TG was directly correlated to the ratio of Ret/TG (r=0.79 for males, and r=0.72 for females, p<0.001, respectively) and the ratios of Toc/TG and Ret/TG were negatively related to the LDL/HDL levels (r=-0.49 and r=-0.43, for males, and r=-0.46 and r=-0.57 for females, p<0.001, respectively). CONCLUSION The levels of Toc and Ret were low in the sera of people living in the southern rural Terai region in Nepal, and it was found that lower levels of Toc and Ret normalized to TG increased the ratio of LDL/HDL. These results suggest that greater intake of foods rich in Toc and Ret should be encouraged to reduce the erisk of coronary heart disease.
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Affiliation(s)
- Kazuko Hirai
- Department of Health and Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, 558-8585, Osaka, Japan
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Ohno Y, Hirai K, Nakanishi M, Nagata K, Tamura T, Shrestha MP. Serum protein and immunoglobulin levels among nepalese living in southern Nepal. Environ Health Prev Med 2002; 7:119-22. [PMID: 21432293 DOI: 10.1265/ehpm.2002.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2001] [Accepted: 02/27/2002] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study examined the levels of serum protein fractionation, immunoglobulin (Ig) and antistreptolysin O (ASO) of people (91 males and 84 females aged 10-68 years) living in the Terai region of southern Nepal, as there has previously been no information available about them. METHODS Blood samples were collected early in the morning after overnight fasting. Serum protein fractionation was carried out by cellulose-acetate electrophoresis. IgG, IgA, IgM and ASO were measured by immuno-turbidimetry with clinical kits. RESULTS The mean proportion of albumin (Alb) was rather low due to increased globulin (Glb). The Alb level of males was significantly higher than that of females, while the male γ-Glb level was significantly lower than that of females. The mean values of IgG, IgM and ASO for males were lower than those values for females, although the difference was significant only for the IgM value. The mean values of IgM for female age groups of 30-39 years or less were significantly higher than those for the corresponding male age groups. Age correlated positively with IgA, and negatively with ASO in both sexes. γ-Glb and IgG correlated significantly with TP, AlB, α(1)-Glb and IgA in both sexes. ASO correlated with β-Glb and IgA in males, and with γ-Glb and IgG in females. CONCLUSIONS The fact that the level of γ-Glb, a major component of serum globulin, was high suggested exposure to a highly bacterial and viral environment. These results point to the need to prevent infectious diseases as well as improve their nutritional status, especially for children and young adults.
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Affiliation(s)
- Yoshimi Ohno
- Department of Food Science and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, 663-8558, Nishinomiya, Hyogo, Japan
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