1
|
Kandel A, Arjyal A, Karmacharya B, Gajurel B. Pragmatic solutions for the global burden of stroke. Lancet Neurol 2024; 23:334. [PMID: 38508828 DOI: 10.1016/s1474-4422(24)00039-5] [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: 11/18/2023] [Accepted: 01/26/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Amit Kandel
- Department of Neurology, University at Buffalo, Buffalo, NY, USA; Buffalo General Medical Center, Buffalo, NY 14203, USA.
| | - Amit Arjyal
- School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Biraj Karmacharya
- Public Health and Community Programs, Dhulikhel Hospital, Kathmandu, Nepal; Department of Public Health, Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Bikram Gajurel
- Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| |
Collapse
|
2
|
Marasini S, Sharma S, Joshi A, Kunwar S, Mahato RK, Shrestha A, Karmacharya B. Exploring knowledge, perceptions, and practices of antimicrobials, and their resistance among medicine dispensers and community members in Kavrepalanchok District of Nepal. PLoS One 2024; 19:e0297282. [PMID: 38241275 PMCID: PMC10798439 DOI: 10.1371/journal.pone.0297282] [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: 07/03/2022] [Accepted: 01/02/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Inappropriate use of antimicrobials is a global public health issue, particularly in developing countries, including Nepal, where over-the-counter sales and self-medication of antimicrobials are common. OBJECTIVES To explore knowledge, perceptions, and practices of antimicrobials and their resistance among medicine dispensers and community members in Nepal. METHODS The study was conducted in three rural and five urban municipalities of the Kavrepalanchok district from May 2021 to August 2021. Data were collected using two qualitative approaches: In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). Data were analyzed using thematic analysis that combined deductive and inductive approaches to identify codes under pre-specified themes. RESULTS A total of 16 In-depth interviews with medicine dispensers and 3 focus group discussions with community members were conducted. Knowledge regarding antimicrobial resistance varied among dispensers. Those with a prior educational background in pharmacy often had good knowledge about the causes and consequences of antimicrobial resistance. Meanwhile, consumers were less aware of antimicrobial resistance. Community members perceived antimicrobials as effective medicines but not long-term solution for treating diseases. They reported that dispensing without a prescription was common and that both consumers and dispensers were responsible for the inappropriate use of antimicrobials. On the contrary, several dispensers said that self-medication was common among the consumers, especially among more educated groups. The medicine dispensers and consumers expressed concerns about the weak enforcement of policies regarding pharmacy drug use and dispensing practices. CONCLUSION Promoting and strengthening the appropriate use of antimicrobials among medicine dispensers and community members is crucial. Bold policies and collective implementation of regulations could help combat antimicrobial resistance.
Collapse
Affiliation(s)
- Sabina Marasini
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Sudim Sharma
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Anjali Joshi
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Surakshya Kunwar
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Roshan Kumar Mahato
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
- Institute for Implementation Science and Health, Kathmandu, Nepal
| | - Biraj Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| |
Collapse
|
3
|
Maharjan J, Pandit S, Arne Johansson K, Khanal P, Karmacharya B, Kaur G, Kumar Aryal K. Effectiveness of interventions for emergency care of hypoglycaemia and diabetic ketoacidosis: A systematic review. Diabetes Res Clin Pract 2024; 207:111078. [PMID: 38154537 DOI: 10.1016/j.diabres.2023.111078] [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: 11/02/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
AIM This systematic review aims to provide evidence on effectiveness of interventions used in emergency care of hypoglycaemia and diabetic ketoacidosis (DKA). METHODOLOGY This is a systematic review of randomized controlled trials and analytical studies. We selected studies based on eligibility criteria. The databases Medline, Cochrane library and Embase were searched from their inception till November 2, 2022, using search strategy. We used the term such as "diabetes mellitus", "treatment", "hypoglycaemia", "diabetic ketoacidosis", "low blood sugar", "high blood sugar" and Mesh terms like "disease management", "hypoglycaemia", "diabetic ketoacidosis", and "diabetes mellitus" to form search strategy. RESULTS Hypoglycemia: Both 10 % dextrose (D10) and 50 % dextrose (D50) are effective options with similar hospital mortality D10 (4.7 %) and D50 (6.2 %). DKA: Low dose insulin is non-inferior to standard dose with time till resolution of DKA 16.5 (7.2) hours and 17.2 (7.7) hours (p value = 0.73) respectively. In children, subcutaneous insulin was associated with reduced ICU admissions and hospital readmissions (67.8 % to 27.9 %). Plasmalyte (PL) is noninferior to sodium chloride (SC), with ICU length of stay 49 h (IQR 23-72) and 55 h (IQR 41-80) respectively, hyperchloremia was associated with longer in-hospital length of stay and longer time to resolution of DKA. And potassium replacement at < 10 mmol/L was associated with higher mortality (n = 72). CONCLUSION We conclude either of the 10 % or 50 % dextrose is effective for management of hypoglycaemia. For DKA subcutaneous insulin and intravenous insulin, chloride levels ≤ 109 mEq/L, potassium above 10 mmol/l, IV fluids like Plasmalyte and normal saline are effective.
Collapse
Affiliation(s)
- Jasmine Maharjan
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Norway.
| | - Sagar Pandit
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Kjell Arne Johansson
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Pratik Khanal
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Biraj Karmacharya
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway; Kathmandu University, School of Medical Sciences, Kathmandu University, Nepal
| | - Gunjeet Kaur
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway
| |
Collapse
|
4
|
Rawal L, Dahal P, Paudel G, Biswas T, Shrestha R, Makaju D, Shrestha A, Yadav U, Sahle BW, Iwashita H, Masuda G, Renzaho A, Shakya P, Shrestha A, Karmacharya B, Sakamoto H, Koju R, Sugishita T. Community-based lifestyle intervention for diabetes (Co-LID study) management rural Nepal: study protocol for a clustered randomized controlled trial. Trials 2023; 24:441. [PMID: 37403179 DOI: 10.1186/s13063-023-07451-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) has increased globally; with a disproportionate burden in South and Southeast Asian countries, including Nepal. There is an urgent need for clinically and cost-effective culturally adapted T2DM management programs. In this study, we aim to assess the effectiveness of community based culturally appropriate lifestyle intervention in improving the management and care of people with T2DM. METHODS We will conduct a cluster randomized control trial to evaluate the effectiveness of community based culturally appropriate lifestyle intervention in improving T2DM outcomes. The trial will be conducted in 30 randomly selected healthcare facilities from two purposively selected districts (Kavrepalanchowk and Nuwakot districts) of Bagmati province, Nepal. The selected healthcare facilities are being randomized into 15 interventions (n = 15) and usual care (n = 15) groups. Those in the intervention will receive group-based 12 an hour-long fortnightly session delivered over 6 months period. The intervention package includes 12 planned modules related to diabetes care, ongoing support, supervision and monitoring, follow-up from the trained community health workers, and educational materials on diabetes self-management. The participants in the usual care groups will receive pictorial brochure on diabetes management and they will continue receiving the usual care available from the local health facilities. The primary outcome is HbA1c level, and the secondary outcomes include quality of life, health care utilization, and practice of self-care behaviour, depression, oral health quality of life, and economic assessment of the intervention. Two points measurements will be collected by the trained research assistants at baseline and at the end of the intervention. DISCUSSION This study will provide tested approaches for culturally adapting T2DM interventions in the Nepalese context. The findings will also have practice and policy implications for T2DM prevention and management in Nepal. TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819). Registered on May 6, 2021.
Collapse
Affiliation(s)
- Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, 2000, Australia.
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Padam Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, 2000, Australia
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, 2000, Australia
| | - Tuhin Biswas
- Science and Math Program, Asian University for Women, Chattogram, Bangladesh
| | - Rabina Shrestha
- Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Deepa Makaju
- Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Abha Shrestha
- Department of public health and community programs, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Uday Yadav
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, The National Centre for Epidemiology and Population Health, ACT, The Australian National University, Canberra, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Berhe W Sahle
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Hanako Iwashita
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Gaku Masuda
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Andre Renzaho
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Prabin Shakya
- Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of public health and community programs, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Department of public health and community programs, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Haruka Sakamoto
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Rajendra Koju
- Department of Internal Medicine/Cardiology, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Tomohiko Sugishita
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
5
|
Mohan S, Chaudhry M, McCarthy O, Jarhyan P, Calvert C, Jindal D, Shakya R, Radovich E, Kondal D, Penn-Kekana L, Basany K, Roy A, Tandon N, Shrestha A, Shrestha A, Karmacharya B, Cairns J, Perel P, Campbell OMR, Prabhakaran D. A cluster randomized controlled trial of an electronic decision-support system to enhance antenatal care services in pregnancy at primary healthcare level in Telangana, India: trial protocol. BMC Pregnancy Childbirth 2023; 23:72. [PMID: 36703109 PMCID: PMC9878774 DOI: 10.1186/s12884-022-05249-y] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/24/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND India contributes 15% of the total global maternal mortality burden. An increasing proportion of these deaths are due to Pregnancy Induced Hypertension (PIH), Gestational Diabetes Mellitus (GDM), and anaemia. This study aims to evaluate the effectiveness of a tablet-based electronic decision-support system (EDSS) to enhance routine antenatal care (ANC) and improve the screening and management of PIH, GDM, and anaemia in pregnancy in primary healthcare facilities of Telangana, India. The EDSS will work at two levels of primary health facilities and is customized for three cadres of healthcare providers - Auxiliary Nurse Midwifes (ANMs), staff nurses, and physicians (Medical Officers). METHODS This will be a cluster randomized controlled trial involving 66 clusters with a total of 1320 women in both the intervention and control arms. Each cluster will include three health facilities-one Primary Health Centre (PHC) and two linked sub-centers (SC). In the facilities under the intervention arm, ANMs, staff nurses, and Medical Officers will use the EDSS while providing ANC for all pregnant women. Facilities in the control arm will continue to provide ANC services using the existing standard of care in Telangana. The primary outcome is ANC quality, measured as provision of a composite of four selected ANC components (measurement of blood pressure, blood glucose, hemoglobin levels, and conducting a urinary dipstick test) by the healthcare providers per visit, observed over two visits. Trained field research staff will collect outcome data via an observation checklist. DISCUSSION To our knowledge, this is the first trial in India to evaluate an EDSS, targeted to enhance the quality of ANC and improve the screening and management of PIH, GDM, and anaemia, for multiple levels of health facilities and several cadres of healthcare providers. If effective, insights from the trial on the feasibility and cost of implementing the EDSS can inform potential national scale-up. Lessons learned from this trial will also inform recommendations for designing and upscaling similar mHealth interventions in other low and middle-income countries. TRIAL REGISTRATION CLINICALTRIALS gov, NCT03700034, registered 9 Oct 2018, https://www. CLINICALTRIALS gov/ct2/show/NCT03700034 CTRI, CTRI/2019/01/016857, registered on 3 Mar 2019, http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=28627&EncHid=&modid=&compid=%27,%2728627det%27.
Collapse
Affiliation(s)
- Sailesh Mohan
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India ,grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control (CCDC), Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016 India
| | - Monica Chaudhry
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India
| | - Ona McCarthy
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Prashant Jarhyan
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India
| | - Clara Calvert
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK ,grid.4305.20000 0004 1936 7988Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Devraj Jindal
- grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control (CCDC), Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016 India
| | - Rajani Shakya
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - Emma Radovich
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Dimple Kondal
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India
| | - Loveday Penn-Kekana
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Kalpana Basany
- grid.501907.a0000 0004 1792 1113SHARE (Sci Health Allied Res Education), MediCiti Institute of Medical Sciences Campus, Medchal-Malkajgiri, Hyderabad, Telangana 501401 India
| | - Ambuj Roy
- grid.413618.90000 0004 1767 6103All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, Delhi, 110029 India
| | - Nikhil Tandon
- grid.413618.90000 0004 1767 6103All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, Delhi, 110029 India
| | - Abha Shrestha
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - Abha Shrestha
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - Biraj Karmacharya
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - John Cairns
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Pablo Perel
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Oona M. R. Campbell
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Dorairaj Prabhakaran
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India ,grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control (CCDC), Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016 India ,grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| |
Collapse
|
6
|
Matthews S, Coates MM, Bukhman A, Trujillo C, Ferrari G, Dagnaw WW, Fénelon DL, Getachew T, Karmacharya B, Larco NC, Lulebo AM, Mayige MT, Mbaye MN, Tarekegn G, Gupta N, Adler A, Bukhman G. Health system capacity to manage diabetic ketoacidosis in nine low-income and lower-middle income countries: A cross-sectional analysis of nationally representative survey data. EClinicalMedicine 2023; 55:101759. [PMID: 36471690 PMCID: PMC9718963 DOI: 10.1016/j.eclinm.2022.101759] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There has been increasing awareness about the importance of type 1 diabetes (T1D) globally. Diabetic ketoacidosis (DKA) is a life-threatening complication of T1D in low-income settings. Little is known about health system capacity to manage DKA in low- and lower-middle income countries (LLMICs). As such, we describe health system capacity to diagnose and manage DKA across nine LLMICs using data from Service Provision Assessments. METHODS In this cross-sectional study, we used data from Service Provision Assessment (SPA) surveys, which are part of the Demographic and Health Survey (DHS) Program. We defined an item set to diagnose and manage DKA in higher-level (tertiary or secondary) facilities, and a set to assess and refer patients presenting to lower-level (primary) facilities. We quantified each item's availability by service level in Bangladesh (Survey 1: May 22 2014-Jul 20 2014; Survey 2: Jul 2017-Oct 2017), the Democratic Republic of the Congo (DRC) (Oct 16 2017-Nov 24 2017 in Kinshasha; Aug 08 2018-Apr 20 2018 in rest of country), Haiti (Survey 1: Mar 05 2013-Jul 2013; Survey 2: Dec 16 2017-May 09 2018), Ethiopia (Feb 06 2014-Mar 09 2014), Malawi (Phase 1: Jun 11 2013-Aug 20 2013; Phase 2: Nov 13 2013-Feb 7 2014), Nepal (Phase 1: Apr 20 2015-Apr 25 2015; Phase 2: Jun 04 2015-Nov 05 2015), Senegal (Survey 1: Jan 2014-Oct 2014; Survey 2: Feb 09 2015-Nov 10 2015; Survey 3: Feb 2016-Nov 2016; Survey 4: Mar 13 2017-Dec 15 2017; Survey 5: Apr 15 2018-Dec 31 2018; Survey 6: Apr 15 2019-Feb 28 2020), Tanzania (Oct 20 2014-Feb 21 2015), and Afghanistan (Nov 1 2018-Jan 20 2019). Variation in secondary facilities' capacity and trends over time were also explored. FINDINGS We examined data from 2028 higher-level and 7534 lower-level facilities. Of these, 1874 higher-level and 6636 lower-level facilities' data were eligible for analysis. Availability of all item sets were low at higher-level facilities, where less than 50% had the minimal set of supplies, less than 20% had the full minimal set, and less than 15% had the ideal set needed to diagnose and manage DKA. Across countries in lower-level facilities, less than 14% had the minimal set of supplies and less than 9% the full set of supplies for diagnosis and transfer of DKA patients. No country had more than 20% of facilities with the minimal set of items needed to assess or manage DKA. Where data were available for more than one survey (Bangladesh, Senegal, and Haiti), changes in availability of the minimal set and ideal set of items did not exceed 15%. Tertiary facilities performed best in Haiti, Ethiopia, Malawi, Nepal, Senegal, Tanzania, and Afghanistan. Secondary facilities that were rural, public, and had fewer staff had lower capacity. INTERPRETATION Health system capacity to manage DKA was low across these nine LLMICs. Although efforts are underway to strengthen health systems, a specific focus on DKA management is still needed. FUNDING Leona M. and Harry B. Helmsley Charitable Trust, and Juvenile Diabetes Research Foundation Ltd.
Collapse
Affiliation(s)
- Sarah Matthews
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew M. Coates
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alice Bukhman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Celina Trujillo
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- NCD Synergies Project, Partners In Health, Boston, MA, USA
| | - Gina Ferrari
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- NCD Synergies Project, Partners In Health, Boston, MA, USA
| | - Wubaye Walelgne Dagnaw
- NCD Synergies Project, Partners In Health, Boston, MA, USA
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Biraj Karmacharya
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Nancy Charles Larco
- Haitian Foundation for Diabetes and Cardiovascular Diseases (FHADIMAC), Port-au-Prince, Haiti
| | - Aimée M. Lulebo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | - Getahun Tarekegn
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Neil Gupta
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Alma Adler
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gene Bukhman
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- NCD Synergies Project, Partners In Health, Boston, MA, USA
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Corresponding author. Center for Integration Science, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| |
Collapse
|
7
|
Harada Y, Prajapati D, Poudel P, Karmacharya B, Sugishita T, Rawal L. Effectiveness of oral health promotion interventions for people with type 2 diabetes delivered by non-dental health care professionals: a systematic review. Glob Health Action 2022; 15:2075576. [PMID: 35946304 PMCID: PMC9373766 DOI: 10.1080/16549716.2022.2075576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Oral health problems among people with diabetes mellitus are an emerging public health problem. Despite the rising concerns of oral health and diabetes mellitus comorbidity, there is a lack of dental health care professionals such as dentists, to address this problem, especially at the primary care level in low- and middle-income countries. OBJECTIVE This review systematically synthesizes the current evidence in terms of the involvement of non-dental health care professionals in promoting oral health among people with type 2 diabetes mellitus and assessed the effectiveness of such programs. METHODS Six electronic databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, and Scopus) and Google Scholar were systematically searched. The inclusion criteria were: 1) had an intervention promoting oral health; 2) targeted but not limited to people with type 2 diabetes mellitus; 3) intervention led but not limited to by non-dental health care professionals; 4) published in English language between January 2000 and July 2021. This review was registered in PROSPERO (#CRD42021248213). RESULTS A total of five studies from four countries (Finland, Thailand, Iran, and the Netherlands) met the inclusion criteria. The interventions included oral health education, a dental care reminder system, and the implementation of oral health care protocols in general practices, all of which were mainly implemented by nurses. All interventions improved clinical outcomes, including decreased probing depth, attachment loss, and plaque index scores, and non-clinical outcomes such as enhanced knowledge, attitudes, and behaviors. Three studies also reported an improvement in diabetes mellitus outcomes. CONCLUSION This review suggests that non-dental health care professionals play a promising role in promoting oral health among people with type 2 diabetes mellitus. Our findings support the potential for integrating oral health promotion programs in primary health care, as such programs could bring better oral health and diabetes mellitus outcomes.
Collapse
Affiliation(s)
- Yuriko Harada
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Dilip Prajapati
- Department of Community and Public Health Dentistry, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Nepal
| | - Prakash Poudel
- School of Nursing and Midwifery, Western Sydney University, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Drug Health Services, South Western Sydney Local Health District (SWSLHD), Cabramatta, NSW, Australia
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Nepal
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Australia.,Physical Activity Research Group, Appleton Institute, Central Queensland University, Australia.,Translational Health Research Institute, Western Sydney University, NSW, Australia
| |
Collapse
|
8
|
Rao AM, Popper SJ, Gupta S, Davong V, Vaidya K, Chanthongthip A, Dittrich S, Robinson MT, Vongsouvath M, Mayxay M, Nawtaisong P, Karmacharya B, Thair SA, Bogoch I, Sweeney TE, Newton PN, Andrews JR, Relman DA, Khatri P. A robust host-response-based signature distinguishes bacterial and viral infections across diverse global populations. Cell Rep Med 2022; 3:100842. [PMID: 36543117 PMCID: PMC9797950 DOI: 10.1016/j.xcrm.2022.100842] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/12/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
Limited sensitivity and specificity of current diagnostics lead to the erroneous prescription of antibiotics. Host-response-based diagnostics could address these challenges. However, using 4,200 samples across 69 blood transcriptome datasets from 20 countries from patients with bacterial or viral infections representing a broad spectrum of biological, clinical, and technical heterogeneity, we show current host-response-based gene signatures have lower accuracy to distinguish intracellular bacterial infections from viral infections than extracellular bacterial infections. Using these 69 datasets, we identify an 8-gene signature to distinguish intracellular or extracellular bacterial infections from viral infections with an area under the receiver operating characteristic curve (AUROC) > 0.91 (85.9% specificity and 90.2% sensitivity). In prospective cohorts from Nepal and Laos, the 8-gene classifier distinguished bacterial infections from viral infections with an AUROC of 0.94 (87.9% specificity and 91% sensitivity). The 8-gene signature meets the target product profile proposed by the World Health Organization and others for distinguishing bacterial and viral infections.
Collapse
Affiliation(s)
- Aditya M. Rao
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, 240 Pasteur Dr., Biomedical Innovation Building, Room 1553, Stanford, CA, USA,Immunology Graduate Program, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Stephen J. Popper
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Sanjana Gupta
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, 240 Pasteur Dr., Biomedical Innovation Building, Room 1553, Stanford, CA, USA,Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Viengmon Davong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Anisone Chanthongthip
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sabine Dittrich
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew T. Robinson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Pruksa Nawtaisong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Biraj Karmacharya
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Simone A. Thair
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, 240 Pasteur Dr., Biomedical Innovation Building, Room 1553, Stanford, CA, USA,Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Isaac Bogoch
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - David A. Relman
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, 240 Pasteur Dr., Biomedical Innovation Building, Room 1553, Stanford, CA, USA,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA,Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA,Infectious Diseases Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Purvesh Khatri
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, 240 Pasteur Dr., Biomedical Innovation Building, Room 1553, Stanford, CA, USA,Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA,Corresponding author
| |
Collapse
|
9
|
Poudel P, Rawal LB, Kong A, Yadav UN, Sousa MS, Karmacharya B, Pradhan S, George A. Oral Health Knowledge, Attitudes and Practices of People Living with Diabetes in South Asia: A Scoping Review. Int J Environ Res Public Health 2022; 19:13851. [PMID: 36360731 PMCID: PMC9654734 DOI: 10.3390/ijerph192113851] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Diabetes increases the risk of oral health complications. This review aimed to synthesise the current evidence on the oral health knowledge, attitudes and practices of people living with diabetes in South Asian countries and provide recommendations on possible strategies for addressing the gaps in oral health care in this population, including the role of non-dental professionals. Using a scoping review framework, six electronic databases (Ovid Medline, CINAHL, ProQuest Central, Scopus, Web of Science and Embase) were searched to identify the relevant literature published between January 2000 and December 2021. The data were extracted into three main categories based on the review's aims, and further refined into sub-categories. A total of 23 studies were included. The review identified that while people with diabetes living in South Asian countries had some level of awareness about oral health and limited care practices to maintain good oral health, there were gaps in knowledge, and there were areas where their oral health practices and attitudes could be improved. The findings suggest a need for developing targeted oral health policies as well as implementing integrated oral health care interventions involving non-dental professionals to improve the oral health outcomes of people with diabetes.
Collapse
Affiliation(s)
- Prakash Poudel
- eHealth, NSW Government, St Leonards, NSW 2065, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW 2000, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Norman Gardens, QLD 4710, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Ariana Kong
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Uday N. Yadav
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2601, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mariana S. Sousa
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Biraj Karmacharya
- Department of Community and Public Health Dentistry, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Panauti 45209, Nepal
| | - Shaili Pradhan
- Department of Dental Surgery, National Academy of Medical Sciences, Bir Hospital, Mahabouddha, Kathmandu 44600, Nepal
| | - Ajesh George
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, NSW 2010, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3552, Australia
| |
Collapse
|
10
|
Bhattarai S, Nerhus Larsen R, Shrestha A, Karmacharya B, Sen A. Association between socioeconomic positions and overweight/obesity in rural Nepal. Front Nutr 2022; 9:952665. [PMID: 36159479 PMCID: PMC9501994 DOI: 10.3389/fnut.2022.952665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionObesity and its association with socioeconomic factors are well-established. However, the gradient of this relationship among rural populations in low- and middle-income countries such as Nepal is not fully understood. We sought to assess the association of socioeconomic factors (education, income, and employment status) with overweight/obesity.MethodsThis cross-sectional study analyzed data from 260 participants aged ≥18 years and attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors was collected, and weight and height were measured for all the study participants. Those with a body mass index of <25 kg/m2 were regarded as non-overweight/obese and those with ≥25 kg/m2 were regarded as overweight/obese. Poisson regression models were used to estimate prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and overweight/obesity. In addition, we assessed the effect of modification by age and gender to study the effect of socioeconomic factors on overweight/obesity.ResultsThe age-standardized prevalence of overweight/obesity was higher for individuals with higher education (23%) and high-income (32%) and those who were unemployed (42%). Compared to the low-income and no formal education groups, the prevalence ratio of overweight/ obesity was 1.69 and 2.27 times more for those belonging to the high-income and high school and above groups, respectively. No evidence of effect modification by gender and age was observed.ConclusionsSocioeconomic factors, education, and income were positively associated with overweight/obesity prevalence in rural Nepal. Further large studies using longitudinal settings are necessary to replicate our findings.
Collapse
Affiliation(s)
- Sanju Bhattarai
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Implementation Science and Health, Kathmandu, Nepal
- *Correspondence: Sanju Bhattarai ;
| | | | - Archana Shrestha
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, United States
| | - Biraj Karmacharya
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Oral Health Services and Research Center, TkMidt, Trondheim, Norway
- Abhijit Sen
| |
Collapse
|
11
|
Bhattarai P, Shrestha A, Xiong S, Peoples N, Ramakrishnan C, Shrestha S, Yin R, Karmacharya B, Yan LL, Jafar TH. Strengthening urban primary healthcare service delivery using electronic health technologies: A qualitative study in urban Nepal. Digit Health 2022; 8:20552076221114182. [PMID: 35898291 PMCID: PMC9309786 DOI: 10.1177/20552076221114182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Nepal is a South Asian country with a high burden of non-communicable diseases. Electronic health technologies are a promising strategy to mitigate the rising burden of non-communicable diseases by strengthening primary healthcare center service delivery. However, electronic health implementation in Nepal is limited. Furthermore, electronic health use at the primary healthcare center level is chronically understudied. This qualitative study seeks to understand the perceived awareness, benefits, and determinants of electronic health uptake in Nepal, focusing on primary healthcare center-level non-communicable disease management. Methods We conducted in-depth interviews with 27 participants including policymakers, health experts, facility administrators, providers, and non-communicable diseases patients in 2019. We selected six urban primary healthcare center facilities via cluster convenience sampling for recruiting facility administrators, providers, and patients, and used convenience sampling to recruit policymakers and experts. We conducted thematic data analysis inductively and deductively using the electronic health readiness assessment framework to understand perceived barriers and facilitators of electronic health implementation. Results While there was general awareness and acceptance of electronic health, multiple barriers impede readiness for implementation. These include policy making gaps, language barriers, low user technical literacy, concerns of overreliance on technology, and inadequate training for administrators and providers. Stakeholder suggestions include creating electronic health interfaces that meet the needs of end users (providers and patients), providing training to enable end users to effectively use electronic health technologies, and strong policy support at the national level. Conclusion We identify several determinants for effectively promoting the use of electronic health for non-communicable diseases service delivery at the primary healthcare center level in Nepal.
Collapse
Affiliation(s)
- Prayog Bhattarai
- Yale-NUS College, Singapore,Biraj Karmacharya, Department of Community
Programs, Kathmandu University School of Medical Sciences (KUSMS), Nepal.
Lijing L. Yan, Global Health Research
Center, Duke Kunshan University, China.
| | - Abha Shrestha
- Kathmandu University School of Medical
Sciences (KUSMS), Nepal
| | - Shangzhi Xiong
- Duke Kunshan University, ChinaThe George Institute for Global Health, University
of New South Wales, Australia
| | | | | | | | - Ruoyu Yin
- Department of Family Medicine and Primary Care, Nanyang Technological
University, Singapore
| | - Biraj Karmacharya
- Department of Community Programs, Kathmandu University School of
Medical Sciences (KUSMS), Nepal
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, China
| | | |
Collapse
|
12
|
Shrestha R, Yadav UN, Shrestha A, Paudel G, Makaju D, Poudel P, Iwashita H, Harada Y, Shrestha A, Karmacharya B, Koju R, Sugishita T, Rawal L. Analyzing the Implementation of Policies and Guidelines for the Prevention and Management of Type 2 Diabetes at Primary Health Care Level in Nepal. Front Public Health 2022; 10:763784. [PMID: 35223722 PMCID: PMC8864089 DOI: 10.3389/fpubh.2022.763784] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Nepal, in recent years, is witnessing an increasing problem of type 2 diabetes that has resulted significant premature deaths and disability. Prevention and management of non-communicable diseases (NCDs) including diabetes have been prioritized in the national policies and guidelines of the Nepal Government. However, research looking at the overview of the implementation of the existing policies and guidelines for diabetes prevention and control is scarce. Hence, this study reviewed diabetes related existing policies and its implementation process at the primary health care level in Nepal. Methods This study involved two phases: Phase I: situation analyses through review of documents and Phase II: qualitative exploratory study. In phase I, four databases (Medline, Web of Science, Embase and PubMed) were systematically searched using key search terms related to diabetes care and policies between January 2000 and June 2021. Also, relevant gray literature was reviewed to understand the trajectory of policy development and its translation with regards to diabetes prevention and management at primary health care level in Nepal. Following the phase I, we conducted in-depth interviews (IDI) and key informant interviews (KII) with health care providers, policy makers, and managers (IDI = 13, and KII = 7) at peripheral and central levels in Kavrepalanchowk and Nuwakot districts of Nepal. The in-depth interviews were audio recorded, transcribed, and coded. The triangulation of data from document review and interviews was done and presented in themes. Results Four key themes were identified through triangulating findings from the document review and interviews including (i) limited implementation of policies into practices; (ii) lack of coordination among the different levels of service providers; (iii) lack of trained human resources for health and inadequate quality services at the primary health care level, and (iv) inadequate access and utilization of diabetes care services at primary health care level. Specifically, this study identified some key pertinent challenges to the implementation of policies and programs including inadequate resources, limited engagement of stakeholders in service design and delivery, lack of trained health care providers, lack of financial resources to strengthen peripheral health services, fragmented health governance, and weak reporting and monitoring systems. Conclusion This study revealed that the policies, plans, and strategies for prevention and management of NCDs in Nepal recognized the importance of diabetes prevention and control. However, a major gap remains with adequate and lack of clarity in terms of implementation of available policies, plans, strategies, and programs to address the problem of diabetes. We suggest the need for multisectoral approach (engaging both health and non-health sectors) at central as well as peripheral levels to strengthen the policies implementation process, building capacity of health care providers, ensuring adequate financial and non-financial resources, and improving quality of services at primary health care levels.
Collapse
Affiliation(s)
- Rabina Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Uday Narayan Yadav
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Abha Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, QLD, Australia
| | - Deepa Makaju
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Prakash Poudel
- Centre for Oral Health Outcomes & Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Hanako Iwashita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuriko Harada
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Archana Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Rajendra Koju
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, QLD, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- *Correspondence: Lal Rawal ;
| |
Collapse
|
13
|
Bukhman G, Mocumbi AO, Gupta N, Amuyunzu-Nyamongo M, Echodu M, Gomanju A, Jain Y, Karmacharya B, Kapambwe S, Lulebo A, Makani J, Masiye JK, Mategeko PK, Owino E. From a Lancet Commission to the NCDI Poverty Network: reaching the poorest billion through integration science. Lancet 2021; 398:2217-2220. [PMID: 34687660 DOI: 10.1016/s0140-6736(21)02321-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 01/15/2023]
Affiliation(s)
- Gene Bukhman
- Center for Integration Science in Global Health Delivery, Brigham and Women's Hospital Boston, MA 02130, USA; Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Partners In Health, Boston, MA, USA.
| | - Ana Olga Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Neil Gupta
- Center for Integration Science in Global Health Delivery, Brigham and Women's Hospital Boston, MA 02130, USA; Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Partners In Health, Boston, MA, USA
| | | | | | - Anu Gomanju
- Kathmandu Institute of Child Health, Kathmandu, Nepal
| | | | | | | | - Aimée Lulebo
- University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | | |
Collapse
|
14
|
Cao WR, Shakya P, Karmacharya B, Xu DR, Hao YT, Lai YS. Equity of geographical access to public health facilities in Nepal. BMJ Glob Health 2021; 6:bmjgh-2021-006786. [PMID: 34706879 PMCID: PMC8552161 DOI: 10.1136/bmjgh-2021-006786] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/03/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Geographical accessibility is important against health equity, particularly for less developed countries as Nepal. It is important to identify the disparities in geographical accessibility to the three levels of public health facilities across Nepal, which has not been available. Methods Based on the up-to-date dataset of Nepal formal public health facilities in 2021, we measured the geographical accessibility by calculating the travel time to the nearest public health facility of three levels (ie, primary, secondary and tertiary) across Nepal at 1×1 km2 resolution under two travel modes: walking and motorised. Gini and Theil L index were used to assess the inequality. Potential locations of new facilities were identified for best improvement of geographical efficiency or equality. Results Both geographical accessibility and its equality were better under the motorised mode compared with the walking mode. If motorised transportation is available to everyone, the population coverage within 5 min to any public health facilities would be improved by 62.13%. The population-weighted average travel time was 17.91 min, 39.88 min and 69.23 min and the Gini coefficients 0.03, 0.18 and 0.42 to the nearest primary, secondary and tertiary facilities, respectively, under motorised mode. For primary facilities, low accessibility was found in the northern mountain belt; for secondary facilities, the accessibility decreased with increased distance from the district centres; and for tertiary facilities, low accessibility was found in most areas except the developed areas like zonal centres. The potential locations of new facilities differed for the three levels of facilities. Besides, the majority of inequalities of geographical accessibility were from within-province. Conclusion The high-resolution geographical accessibility maps and the assessment of inequality provide valuable information for health resource allocation and health-related planning in Nepal.
Collapse
Affiliation(s)
- Wen-Rui Cao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Prabin Shakya
- Departments of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Departments of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Dong Roman Xu
- ACACIA Labs, SMU Institute for Global Health (SIGHT) and Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China.,Center for WHO Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, Guangdong, China
| | - Yuan-Tao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ying-Si Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China .,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, Guangdong, China
| |
Collapse
|
15
|
Gupta N, Mocumbi A, Arwal SH, Jain Y, Haileamlak AM, Memirie ST, Larco NC, Kwan GF, Amuyunzu-Nyamongo M, Gathecha G, Amegashie F, Rakotoarison V, Masiye J, Wroe E, Koirala B, Karmacharya B, Condo J, Nyemazi JP, Sesay S, Maogenzi S, Mayige M, Mutungi G, Ssinabulya I, Akiteng AR, Mudavanhu J, Kapambwe S, Watkins D, Norheim O, Makani J, Bukhman G. Prioritizing Health-Sector Interventions for Noncommunicable Diseases and Injuries in Low- and Lower-Middle Income Countries: National NCDI Poverty Commissions. Glob Health Sci Pract 2021; 9:626-639. [PMID: 34593586 PMCID: PMC8514044 DOI: 10.9745/ghsp-d-21-00035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022]
Abstract
Noncommunicable Disease and Injury (NCDI) Poverty Commissions in 16 low- and middle-income countries provided evidence-based recommendations on a local, expanded set of priority NCDIs and health-sector interventions needed in national initiatives to attain universal health coverage. These commissions provide a collective platform for policy, research, and advocacy efforts to improve coverage of cost-effective and equitable health-sector interventions for populations living in extreme poverty. Health sector priorities and interventions to prevent and manage noncommunicable diseases and injuries (NCDIs) in low- and lower-middle-income countries (LLMICs) have primarily adopted elements of the World Health Organization Global Action Plan for NCDs 2013–2020. However, there have been limited efforts in LLMICs to prioritize among conditions and health-sector interventions for NCDIs based on local epidemiology and contextually relevant risk factors or that incorporate the equitable distribution of health outcomes. The Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion supported national NCDI Poverty Commissions to define local NCDI epidemiology, determine an expanded set of priority NCDI conditions, and recommend cost-effective, equitable health-sector interventions. Fifteen national commissions and 1 state-level commission were established from 2016–2019. Six commissions completed the prioritization exercise and selected an average of 25 NCDI conditions; 15 conditions were selected by all commissions, including asthma, breast cancer, cervical cancer, diabetes mellitus type 1 and 2, epilepsy, hypertensive heart disease, intracerebral hemorrhage, ischemic heart disease, ischemic stroke, major depressive disorder, motor vehicle road injuries, rheumatic heart disease, sickle cell disorders, and subarachnoid hemorrhage. The commissions prioritized an average of 35 health-sector interventions based on cost-effectiveness, financial risk protection, and equity-enhancing rankings. The prioritized interventions were estimated to cost an additional US$4.70–US$13.70 per capita or approximately 9.7%–35.6% of current total health expenditure (0.6%–4.0% of current gross domestic product). Semistructured surveys and qualitative interviews of commission representatives demonstrated positive outcomes in several thematic areas, including understanding NCDIs of poverty, informing national planning and implementation of NCDI health-sector interventions, and improving governance and coordination for NCDIs. Overall, national NCDI Poverty Commissions provided a platform for evidence-based, locally driven determination of priorities within NCDIs.
Collapse
Affiliation(s)
- Neil Gupta
- Partners In Health NCD Synergies, Boston, MA, USA. .,Division of Global Health Equity, Brigham & Women's Hospital, Boston MA, USA.,Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Ana Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Said H Arwal
- Afghan Ministry of Public Health, Kabul, Afghanistan
| | | | | | | | - Nancy C Larco
- Fondation Haïtienne de Diabète et de Maladies Cardio-Vasculaires, Port-au-Prince, Haiti
| | - Gene F Kwan
- Partners In Health NCD Synergies, Boston, MA, USA.,Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | | | | | | | | | - Emily Wroe
- Partners In Health NCD Synergies, Boston, MA, USA.,Division of Global Health Equity, Brigham & Women's Hospital, Boston MA, USA.,Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Bhagawan Koirala
- Manmohan Cardiothoracic Vascular and Transplant Center Institute of Medicine, Kathmandu, Nepal
| | - Biraj Karmacharya
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Jeanine Condo
- School of Public Health, University of Rwanda, Kigali, Rwanda
| | | | - Santigie Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Sarah Maogenzi
- Tanzania Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda.,Makerere University College of Health Sciences, Kampala, Uganda
| | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | | | | | - David Watkins
- Division of General Internal Medicine, Department of Medicine and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ole Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gene Bukhman
- Partners In Health NCD Synergies, Boston, MA, USA.,Division of Global Health Equity, Brigham & Women's Hospital, Boston MA, USA.,Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | | |
Collapse
|
16
|
Bhattarai S, Tandstad B, Shrestha A, Karmacharya B, Sen A. Socioeconomic Status and Its Relation to Hypertension in Rural Nepal. Int J Hypertens 2021; 2021:5542438. [PMID: 34497724 PMCID: PMC8419497 DOI: 10.1155/2021/5542438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/16/2021] [Accepted: 08/18/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Hypertension and its association with socioeconomic positions are well established. However, the gradient of these relationships and the mediating role of lifestyle factors among rural population in low- and middle-income countries such as Nepal are not fully understood. We sought to assess the association between socioeconomic factors (education, income, and employment status) and hypertension. Also, we assessed whether the effect of education and income level on hypertension was mediated by lifestyle factors. METHODS This cross-sectional study was conducted among 260 participants aged ≥18 years attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors were collected, and blood pressure, weight, and height were measured for all study participants. Those with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or administrating high blood pressure-lowering medicines were regarded as hypertensives. Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and hypertension. We explored mediation, using the medeff command in Stata for causal mediation analysis of nonlinear models. RESULTS Of the 50 hypertensive participants, sixty percent were aware of their status. The age-standardized prevalence of hypertension was two times higher for those with higher education or high-income category. Compared to low-income and unemployed groups, the prevalence ratio of hypertension was 1.33 and 2.26 times more for those belonging to the high-income and employed groups, respectively. No evidence of mediation by lifestyle factors was observed between socioeconomic status and hypertension. CONCLUSIONS Socioeconomic positions were positively associated with hypertension prevalence in rural Nepal. Further studies using longitudinal settings are necessary to validate our findings especially in low- and middle-income countries such as Nepal.
Collapse
Affiliation(s)
- Sanju Bhattarai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Birgit Tandstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Chronic Disease Epidemiology Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, USA
| | - Biraj Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute of Implementation Science and Health, Kathmandu, Nepal
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Oral Health Services and Research Center, (TkMidt), Trondheim, Norway
| |
Collapse
|
17
|
Krishna MT, Vedanthan PK, Vedanthan R, El Shabrawy RM, Madhan R, Nguyen HL, Kudagammana T, Williams I, Karmacharya B, Hariharan S, Krishnamurthy K, Sumantri S, Elliott R, Mahesh PA, Marriott JF. Is spurious penicillin allergy a major public health concern only in high-income countries? BMJ Glob Health 2021; 6:bmjgh-2021-005437. [PMID: 34016579 PMCID: PMC8141433 DOI: 10.1136/bmjgh-2021-005437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mamidipudi Thirumala Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK .,Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Campus, Birmingham, UK
| | | | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Ramesh Madhan
- Department of Phamacy Practice, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Hoa L Nguyen
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Thushara Kudagammana
- Department of Paediatrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Central, Sri Lanka
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, West Midlands, UK
| | - Biraj Karmacharya
- Departments of Public Health and Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu, Nepal
| | - Seetharaman Hariharan
- Department of Clinical Surgical Sciences, The University of the West Indies St Augustine Campus, St Augustine, Tunapuna-Piarco, Trinidad and Tobago
| | | | - Stevent Sumantri
- Department of Internal Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia
| | - Rachel Elliott
- Division of Population Health, Health Services Research and Primary care, The University of Manchester, Manchester, UK
| | - Padukudru Anand Mahesh
- Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore, Karnataka, India
| | - John F Marriott
- The School of Pharmacy, University of Birmingham, Birmingham, UK
| |
Collapse
|
18
|
Rahman MM, Chowdhury SR, K. Bohara A, Karmacharya B. A Case of Negative Externality: Use of Pesticide and Its Impact on Health Among Farmers in Salumbhu Village, Nepal. Journal of Health Management 2021. [DOI: 10.1177/09720634211011568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The widespread and uncontrolled use of harmful pesticide to facilitate mass-level agricultural production creates negative externalities ranging from environmental degradation to having adverse health implications to the users. This article explores a primary village-level data of farmers in the Salumbhu village of Nepal to investigate the health effects associated with pesticide use. A total of six health symptoms grouped into two categories such as serious health-related issues and irritants are analysed separately using ordered logit model. For the robustness of the results, Poisson and negative binomial models are also used. We found that farmers as compared to the non-farmers are significantly more prone to facing serious health issues. Furthermore, as farmers are the applicators of pesticide, the odds of them facing all the health symptoms increases significantly. The results are uniform across different measures of health and over multiple models, which advocates the need of appropiate regulations in the usage of pesticide in Nepal.
Collapse
Affiliation(s)
| | | | - Alok K. Bohara
- Department of Economics, University of New Mexico, Albuquerque, NM, USA
| | - Biraj Karmacharya
- Department of Community Programs, Kathmandu University School of Medical Sciences, Panauti, Nepal
| |
Collapse
|
19
|
Neupane G, Acharya S, Thapa A, Sharma S, Pokharel S, Bhattarai M, Upadhyay A, Sotoodehnia N, Karmacharya B, Timsina L, Pokharel Y. COMMUNITY-CENTRIC STUDY TO MITIGATE CARDIOVASCULAR DISEASE IN RURAL NEPAL: THE NON-COMMUNICABLE DISEASE IN NEPAL STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Ni Z, Atluri N, Shaw RJ, Tan J, Khan K, Merk H, Ge Y, Shrestha S, Shrestha A, Vasudevan L, Karmacharya B, Yan LL. Correction: Evaluating the Feasibility and Acceptability of a Mobile Health–Based Female Community Health Volunteer Program for Hypertension Control in Rural Nepal: Cross-Sectional Study. JMIR Mhealth Uhealth 2020; 8:e19048. [PMID: 32525811 PMCID: PMC7317624 DOI: 10.2196/19048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zhao Ni
- Duke UniversityDurham, NCUnited States
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Neupane G, Acharya S, Bhattarai M, Upadhyay A, Belbase B, Bhandari M, Pandeya D, Pokharel S, Ghimire S, Thapa G, Karmacharya B, Bhatt MR, Spertus JA, Neupane D, Timsina L, Pokharel Y. Study, Design, and Rationale of Noncommunicable Diseases in Nepal (NCD Nepal) Study: A Community-Based Prospective Epidemiological and Implementation Study in Rural Nepal. Glob Adv Health Med 2020; 9:2164956120917379. [PMID: 32284911 PMCID: PMC7139172 DOI: 10.1177/2164956120917379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/24/2020] [Accepted: 03/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs) are the leading causes of deaths globally. Currently, there are limited high-quality data on the epidemiology and usefulness of community-based screening and treatment of NCDs in low-to-middle-income countries (LMIC), like Nepal. We describe the protocol of a community-based, longitudinal epidemiological study of screening and management of NCDs in rural Nepal. METHODS We organize monthly mobile health clinics to screen NCDs among 40- to 75-year-old residents from municipal subdivision wards 3, 4, 6, and 7 of Ghorahi submetropolitan city, Dang, Nepal (approximately 406 km west of the capital, Kathmandu). We estimate a total of 7052 eligible participants. After obtaining informed consent, trained personnel will collect sociodemographic and lifestyle data, medical, medication, and family history using validated questionnaires, plus anthropometric measures and capillary glucose levels. We will screen for hypertension, diabetes, obesity, dyslipidemia, tobacco and alcohol use, self-reported physical activity, dietary habits, cardiovascular disease, stroke, chronic lung disease, cancer, and chronic kidney disease. We will also check hemoglobin A1C, lipid panel, serum creatinine, sodium, potassium, urine dipstick, and urine albumin-to-creatinine ratio in high-risk participants. We will offer lifestyle counseling, pharmacotherapy or refer to higher level care, where appropriate; routinely follow participants with NCDs for continuity of care; and follow individuals without NCDs but with elevated glucose, prehypertension or other risk factors every year, and those without risk factors every 2 years. We will monitor participants in the community to reduce attrition and to track all-cause and disease-specific mortality. DISCUSSION Understanding the community burden of NCDs in resource-limited setting and testing effectiveness of community-based screening and management of NCDs will provide insights to develop national policy to address NCD burden in LMIC like Nepal.
Collapse
Affiliation(s)
- Gagan Neupane
- Health Foundation Nepal, Lalitpur, Nepal
- Shreegaun Primary Health Care Center, Dang, Nepal
| | - Sameer Acharya
- Health Foundation Nepal, Lalitpur, Nepal
- Shreegaun Primary Health Care Center, Dang, Nepal
| | - Manoj Bhattarai
- Health Foundation Nepal, Lalitpur, Nepal
- Department of Medicine/Nephrology, Kidney Specialists of the
Palm Beach, Palm Beach, Florida
| | - Ashish Upadhyay
- Health Foundation Nepal, Lalitpur, Nepal
- Section of Nephrology, Department of Medicine, Boston University
School of Medicine, Boston, Massachusetts
| | | | - Manoj Bhandari
- Health Foundation Nepal, Lalitpur, Nepal
- Department of Cardiology, Bronx Care Health System, New York,
New York
| | - Drona Pandeya
- Health Foundation Nepal, Lalitpur, Nepal
- Chemistry Department, Sonic Healthcare, Clinical Pathology
Laboratories, Austin, Texas
| | | | | | | | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu
University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel,
Nepal
- Sun Yat-sen Global Health Institute, Sun Yat-sen University,
Guangzhou, China
| | | | - John A Spertus
- Saint Luke’s Mid America Heart Institute, University of
Missouri, Kansas City, Missouri
| | - Dinesh Neupane
- Nepal Development Society, Chitwan, Nepal
- Welch Center for Prevention, Epidemiology and Clinical
Research, Johns Hopkins University, Baltimore, Maryland
| | - Lava Timsina
- Health Foundation Nepal, Lalitpur, Nepal
- Centers of Outcomes Research in Surgery, Department of Surgery,
Indiana University, Indianapolis, Indiana
| | - Yashashwi Pokharel
- Health Foundation Nepal, Lalitpur, Nepal
- America Nepal Medical Foundation, New York, USA
- Saint Luke’s Mid America Heart Institute, University of
Missouri Kansas City, Missouri
| |
Collapse
|
22
|
Ni Z, Atluri N, Shaw RJ, Tan J, Khan K, Merk H, Ge Y, Shrestha S, Shrestha A, Vasudevan L, Karmacharya B, Yan LL. Evaluating the Feasibility and Acceptability of a Mobile Health-Based Female Community Health Volunteer Program for Hypertension Control in Rural Nepal: Cross-Sectional Study. JMIR Mhealth Uhealth 2020; 8:e15419. [PMID: 32149712 PMCID: PMC7091025 DOI: 10.2196/15419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/29/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hypertension is a major modifiable risk factor for cardiovascular disease, the world's leading cause of death. The prevalence of hypertension is disproportionately higher in South Asian countries than in other regions of the world. Screening for hypertension in primary care settings remains a challenge in many South Asian countries, including Nepal. Nepal is located in the Himalayan Mountains region, posing significant geographical challenges for its rural citizens to access primary health care and service delivery. This barrier increases the costs and inconvenience for rural Nepalis to access hypertension screening and treatment. As a result, the prevalence of hypertension in Nepal tripled in the last 25 years to 22.4%-38.6%. Nepal's Ministry of Health and Population relies on female community health volunteers to link health centers and communities to provide basic health services. Over 50,000 of these volunteers in Nepal have received basic health care training and are assigned to take care of maternal and child health. Due to limited health care resources, adopting new methods to control hypertension is an urgent need in Nepal. Several recent studies in Nepal have recommended extending the role of female community health volunteers to include hypertension management through blood pressure monitoring and home-based education. OBJECTIVE The goal of this study was to assess if a mobile health-based female community health volunteer approach of combining the traditional community health volunteer program with digital technologies would be feasible and acceptable in rural Nepal. METHODS In this study, we recruited 17 female community health volunteers and extended their role from maternal and child health to hypertension management through screening blood pressures. RESULTS All 17 female community health volunteers successfully measured 1113 rural Nepalis' blood pressures, identified 169 hypertensive patients, and collected health behaviors data of the 169 hypertensive patients. Among the 169 patients, 70% of them had a mobile phone, and 92% were interested in receiving health-related information via a mobile phone. Among those who were interested in receiving information via a mobile phone, 84% preferred voice calls, and 7% and 1% preferred texting and apps, respectively. CONCLUSIONS Results from this study indicate that a digital health intervention that leverages feature-phones combined with female community health volunteers may be an acceptable and pragmatic way to implement an evidence-based program to reduce hypertension in rural Nepal.
Collapse
Affiliation(s)
- Zhao Ni
- Duke University, Durham, NC, United States
| | | | | | | | - Kinza Khan
- Duke University, Durham, NC, United States
| | | | - Yunfan Ge
- Duke Kunshan University, Kunshan, China
| | | | | | | | | | | |
Collapse
|
23
|
Schwarz D, Dhungana S, Kumar A, Acharya B, Agrawal P, Aryal A, Baum A, Choudhury N, Citrin D, Dangal B, Dhimal M, Gauchan B, Gupta T, Halliday S, Karmacharya B, Kishore S, Koirala B, Kshatriya U, Levine E, Maru S, Rimal P, Sapkota S, Schwarz R, Shrestha A, Thapa A, Maru D. An integrated intervention for chronic care management in rural Nepal: protocol of a type 2 hybrid effectiveness-implementation study. Trials 2020; 21:119. [PMID: 31996250 PMCID: PMC6990567 DOI: 10.1186/s13063-020-4063-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/09/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Nepal, the burden of noncommunicable, chronic diseases is rapidly rising, and disproportionately affecting low and middle-income countries. Integrated interventions are essential in strengthening primary care systems and addressing the burden of multiple comorbidities. A growing body of literature supports the involvement of frontline providers, namely mid-level practitioners and community health workers, in chronic care management. Important operational questions remain, however, around the digital, training, and supervisory structures to support the implementation of effective, affordable, and equitable chronic care management programs. METHODS A 12-month, population-level, type 2 hybrid effectiveness-implementation study will be conducted in rural Nepal to evaluate an integrated noncommunicable disease care management intervention within Nepal's new municipal governance structure. The intervention will leverage the government's planned roll-out of the World Health Organization's Package of Essential Noncommunicable Disease Interventions (WHO-PEN) program in four municipalities in Nepal, with a study population of 80,000. The intervention will leverage both the WHO-PEN and its cardiovascular disease-specific technical guidelines (HEARTS), and will include three evidence-based components: noncommunicable disease care provision using mid-level practitioners and community health workers; digital clinical decision support tools to ensure delivery of evidence-based care; and training and digitally supported supervision of mid-level practitioners to provide motivational interviewing for modifiable risk factor optimization, with a focus on medication adherence, and tobacco and alcohol use. The study will evaluate effectiveness using a pre-post design with stepped implementation. The primary outcomes will be disease-specific, "at-goal" metrics of chronic care management; secondary outcomes will include alcohol and tobacco consumption levels. DISCUSSION This is the first population-level, hybrid effectiveness-implementation study of an integrated chronic care management intervention in Nepal. As low and middle-income countries plan for the Sustainable Development Goals and universal health coverage, the results of this pragmatic study will offer insights into policy and programmatic design for noncommunicable disease care management in the future. TRIAL REGISTRATION ClinicalTrials.gov, NCT04087369. Registered on 12 September 2019.
Collapse
Affiliation(s)
- Dan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- Ariadne Labs, Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA USA
| | - Santosh Dhungana
- Department of Internal Medicine, Hurley Medical Center, Flint, MI USA
| | - Anirudh Kumar
- Department of Medicine, NYU Langone Health, New York, NY USA
| | - Bibhav Acharya
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | | | - Anu Aryal
- Nyaya Health Nepal, Kathmandu, Nepal
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
| | - Aaron Baum
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Nandini Choudhury
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - David Citrin
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Anthropology, University of Washington, Seattle, WA USA
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | | | - Meghnath Dhimal
- Nepal Health Research Council, Ministry of Health and Population, Kathmandu, Nepal
| | | | - Tula Gupta
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Scott Halliday
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Biraj Karmacharya
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
- Nepal Technology Innovation Center, Kathmandu University, Dhulikhel, Nepal
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Sandeep Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Young Professionals Chronic Disease Network, New York, NY USA
| | - Bhagawan Koirala
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Erica Levine
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sheela Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | | | - Sabitri Sapkota
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Ryan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Archana Shrestha
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
- Yale School of Public Health, Center for Methods in Implementation and Prevention Science, New Haven, CT USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT USA
| | | | - Duncan Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| |
Collapse
|
24
|
McMahon D, Shrestha R, Karmacharya B, Shrestha S, Koju R. The international medical elective in Nepal: perspectives from local patients, host physicians and visiting students. Int J Med Educ 2019; 10:216-222. [PMID: 31760382 PMCID: PMC7246114 DOI: 10.5116/ijme.5dc3.1e92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 11/06/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To understand the impact of the international medical elective (IME) on Nepali patients and physicians alongside visiting European and American medical students. METHODS At a hospital in Nepal, semi-structured interviews were conducted with 15 patients and 15 physicians about positive and negative experiences with visiting medical students. Likert scale surveys about knowledge of Nepal, clinical competencies, and post-elective feedback were administered to 56 visiting medical students before and after their elective. Interviews were coded using conventional content analysis and surveys were analyzed using descriptive statistics and paired t-tests. RESULTS Emergent positive themes from interviews were that visiting students enhanced the reputation of the hospital, afforded financial benefits, improved international collaboration, and increased knowledge, culture and language exchange. However, negative themes were the language barrier and time expended to orient students. Before vs. after the elective, visiting students had increased knowledge of Nepal's healthcare system (M=1.9, SD=0.6 vs. M=3.2, SD=0.6, t(55)=-10.22, p<.001), ability to communicate with health professionals from different backgrounds (M=3.3, SD=0.7 vs. M=3.6, SD=0.7, t(55)=-3.11, p=0.003) and practice in resource constrained environments (M=2.4, SD=0.9 vs. M=2.8, SD=0.9, t(55)=-2.42, p=0.02). However, students had no change in history (M=4.0, SD=0.7 vs. M=3.9, SD=0.7, t(55)=0.84, p=0.40), physical exam (M=3.9, SD=0.6 vs. M=3.9, SD= 0.7, t(55)=0.22, p=0.82) or diagnostic (M=3.5, SD=0.7 vs. M=3.4, SD=0.8, t(55)=1.52, p=0.14) abilities. CONCLUSIONS This study demonstrated a variety of benefits and harms of the IME. To improve the IME experience, medical educators should emphasize pre-departure orientation and fostering equitable partnerships between sending and receiving institutions.
Collapse
Affiliation(s)
| | - Rajeev Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - Shrinkhala Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rajendra Koju
- Department of Cardiology, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| |
Collapse
|
25
|
Yan LL, Vedanthan R, Mensah GA, Karmacharya B, Shrestha A, Fitzpatrick A, Duc HA, Tandon N, Davila-Roman VG, Huffman MD, Miranda JJ, Irazola V, Koju R, Newsome B, Yusuf S. Developing the Core Pillars of Training Global Cardiovascular Health Researchers: Companionship, Light, and Fuel. Glob Heart 2019; 14:387-389. [PMID: 31727269 DOI: 10.1016/j.gheart.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China.
| | - Rajesh Vedanthan
- Section for Global Health, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Biraj Karmacharya
- Department of Community Programs, Kathmandu University, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of Community Programs, Kathmandu University, Dhulikhel, Nepal
| | | | | | | | - Victor G Davila-Roman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA; Department of Medicine, Northwestern University, Chicago, IL, USA; The George Institute for Global Health, Sydney, New South Wales, Australia
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Vilma Irazola
- South American Center of Excellence for Cardiovascular Health CESCAS (Centro de Excelencia en Salud Cardiovascular para América del Sur), Institute for Clinical Effectiveness and Health Policy IECS (Instituto de Efectividad Clínica y Sanitaria), Buenos Aires, Argentina
| | - Rajendra Koju
- Department of Community Programs, Kathmandu University, Dhulikhel, Nepal
| | - Brad Newsome
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
| |
Collapse
|
26
|
Andrews JR, Vaidya K, Bern C, Tamrakar D, Wen S, Madhup S, Shrestha R, Karmacharya B, Amatya B, Koju R, Adhikari SR, Hohmann E, Ryan ET, Bogoch II. High Rates of Enteric Fever Diagnosis and Lower Burden of Culture-Confirmed Disease in Peri-urban and Rural Nepal. J Infect Dis 2019; 218:S214-S221. [PMID: 28961918 PMCID: PMC6226739 DOI: 10.1093/infdis/jix221] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In South Asia, data on enteric fever are sparse outside of urban areas. We characterized enteric fever diagnosis patterns and the burden of culture-confirmed cases in peri-urban and rural Nepal. Methods We used national reports to estimate enteric fever diagnosis rates over 20 years (1994-2014) and conducted a prospective study of patients presenting with a >72-hour history of fever to 4 peri-urban and rural healthcare facilities (during August 2013-June 2016). We compared clinical characteristics of patients with culture-confirmed Salmonella Typhi or Paratyphi infection to those of patients without enteric fever. We used generalized additive models with logistic link functions to evaluate associations of age and population density with culture positivity. Results National rates of enteric fever diagnosis were high, reaching 18.8 cases per 1000 during 2009-2014. We enrolled 4309 participants with acute febrile illness. Among those with a provisional clinical diagnosis, 55% (1334 of 2412) received a diagnosis of enteric fever; however, only 4.1% of these had culture-confirmed typhoidal Salmonella infection. Culture positivity was highest among young adults and was strongly associated with higher population density (P < .001). Conclusions Enteric fever diagnosis rates were very high throughout Nepal, but in rural settings, few patients had culture-confirmed disease. Expanded surveillance may inform local enteric fever treatment and prevention strategies.
Collapse
Affiliation(s)
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Shawn Wen
- D-Lab, Massachusetts Institute of Technology, Cambridge
| | - Surendra Madhup
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | | | - Bibush Amatya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Rajendra Koju
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | | | - Elizabeth Hohmann
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | | |
Collapse
|
27
|
Kumar A, Schwarz D, Acharya B, Agrawal P, Aryal A, Choudhury N, Citrin D, Dangal B, Deukmedjian G, Dhimal M, Dhungana S, Gauchan B, Gupta T, Halliday S, Jha D, Kalaunee SP, Karmacharya B, Kishore S, Koirala B, Kunwar L, Mahar R, Maru S, Mehanni S, Nirola I, Pandey S, Pant B, Pathak M, Poudel S, Rajbhandari I, Raut A, Rimal P, Schwarz R, Shrestha A, Thapa A, Thapa P, Thapa R, Wong L, Maru D. Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal. BMJ Glob Health 2019; 4:e001343. [PMID: 31139453 PMCID: PMC6509610 DOI: 10.1136/bmjgh-2018-001343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/02/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022] Open
Abstract
Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care-first-contact access, care coordination, comprehensiveness and continuity-offer practical, high-quality design options for non-communicable disease care in low-income and middle-income countries. We describe an integrated non-communicable disease intervention in rural Nepal using the 4C principles. We present 18 months of retrospective assessment of implementation for patients with type II diabetes, hypertension and chronic obstructive pulmonary disease. We assessed feasibility using facility and community follow-up as proxy measures, and assessed effectiveness using singular 'at-goal' metrics for each condition. The median follow-up for diabetes, hypertension and chronic obstructive pulmonary disease was 6, 6 and 7 facility visits, and 10, 10 and 11 community visits, respectively (0.9 monthly patient touch-points). Loss-to-follow-up rates were 16%, 19% and 22%, respectively. The median time between visits was approximately 2 months for facility visits and 1 month for community visits. 'At-goal' status for patients with chronic obstructive pulmonary disease improved from baseline to endline (p=0.01), but not for diabetes or hypertension. This is the first integrated non-communicable disease intervention, based on the 4C principles, in Nepal. Our experience demonstrates high rates of facility and community follow-up, with comparatively low lost-to-follow-up rates. The mixed effectiveness results suggest that while this intervention may be valuable, it may not be sufficient to impact outcomes. To achieve the Sustainable Development Goals, further implementation research is urgently needed to determine how to optimise non-communicable disease interventions.
Collapse
Affiliation(s)
- Anirudh Kumar
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Ariadne Labs, Harvard T H Chan Schoo of Public Health and Brigham and Women's Hospital, Boston, MA, United States
| | - Bibhav Acharya
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Anu Aryal
- Nyaya Health Nepal, Kathmandu, Nepal
| | | | - David Citrin
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Anthropology, University of Washington, Seattle, WA, United States
- Henry M Jackson School of International Studies, University of Washington, Seattle, WA, United States
| | | | - Grace Deukmedjian
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, Natividad Medical Center, Salinas, CA, United States
| | | | | | - Bikash Gauchan
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Scott Halliday
- Nyaya Health Nepal, Kathmandu, Nepal
- Henry M Jackson School of International Studies, University of Washington, Seattle, WA, United States
| | - Dhiraj Jha
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - SP Kalaunee
- Nyaya Health Nepal, Kathmandu, Nepal
- College of Business and Leadership, Eastern University, St Davids, PA, USA
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
- Nepal Technology Innovation Center, Kathmandu University, Dhulikhel, Nepal
- Sun Yat-sen Global Health Insititute, Sun Yat-sen University, Guangzhou, China
| | - Sandeep Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Young Professionals Chronic Disease Network, New York, NY, United States
| | - Bhagawan Koirala
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Lal Kunwar
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Sheela Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stephen Mehanni
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Gallup Indian Medical Center, Gallup, NM, United States
| | - Isha Nirola
- Harvard University T H Chan School of Public Health, Boston, MA, USA
| | | | - Bhaskar Pant
- Department of Orthopedic and Trauma, Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal
| | | | | | | | | | - Pragya Rimal
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ryan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Archana Shrestha
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, MA, USA
- Division of Research and Development, Dhulikhel Hospital, Dhulikhel, Nepal
| | | | - Poshan Thapa
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Lena Wong
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Tuba City Regional Health Care, Tuba City, AZ, United States
| | - Duncan Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
28
|
Fitzpatrick AL, Shrestha R, Shrestha A, Koju R, Shrestha Karmacharya R, Pant B, Karmacharya B. Abstract WP570: Associations Between Stroke Symptoms and Cognition in Nepal. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Low and middle income countries have the largest burden of stroke, accounting for more than 85% of stroke deaths globally. As many low- and middle-income countries, including Nepal, transition from communicable to non-communicable diseases (NCDs), the impact of stroke on cognition becomes increasingly important.
Methods:
Data on cardiovascular risk factors and cognition were collected as part of the Dhulikhel Heart Study, a longitudinal study to evaluate risk factors for heart disease and stroke in Dhulikhel, a community outside of Kathmandu, Nepal. In Phase 1 of the baseline exam, 252 randomly-selected adults age 50 and older completed the Mini-Mental Exam (MMSE) and Digit Spans ( DST) forward and backward as part of a home interview. Mild stroke symptoms were collected by self-report the Questionnaire for Verifying Stroke-Free Status (QVSFS). Multiple linear regression evaluated associations between stroke symptoms and cognition adjusted for demographics (age, sex, education, religion, and ethnicity) and CVD risk factors (smoking, exercise, BMI, blood pressure, hypertension, and diabetes).
Results:
Mean age of study participants was 62.4 years (SD 9.2) and 57.5% were women. The mean MMSE score (weighted for illiteracy) was 18.7 (SD 6.4) and 19% reported to have had at least one of five stroke symptoms (sudden one-sided numbness or weakness, sudden vision-loss, inability to express oneself or inability to understand). An increased risk of lower memory score was found with report of a previous episode of numbness (DST backward: B=-1.17, SE=0.34, p=0.001). Borderline associations (.05 < p<.10) were found between any stroke symptoms and Digit Span forward, numbness and MMSE, and numbness and DST forward. When adjusted for demographic and cardiovascular risk factors, significant associations were found between having experienced any stroke symptom and Digit Span backward (B=-1.46, SE=0.66, p=.03) as well as numbness (B=-1.75, SE=0.72, p=0.02).
Conclusions:
Associations between previous stroke symptoms and reduced cognition emphasize the need to screen and treat persons with undiagnosed stroke or TIAs in low-resource settings. A reduction in modifiable vascular risk factors is also needed to reduce CVD and associated dementia.
Collapse
Affiliation(s)
| | - Rajeev Shrestha
- Community Programs, Dhulikhel Hosp, Kathmandu Univ Sch of Med Sciences, Dhulikhel, Nepal
| | - Archana Shrestha
- Community Programs, Dhulikhel Hosp, Kathmandu Univ Sch of Med Sciences, Dhulikhel, Nepal
| | - Rajendra Koju
- Cardiology, Dhulikhel Hosp, Kathmandu Univ Sch of Med Sciences, Dhulikhel, Nepal
| | | | - Basant Pant
- Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal
| | - Biraj Karmacharya
- Community Programs, Dhulikhel Hosp, Kathmandu Univ Sch of Med Sciences, Dhulikhel, Nepal
| |
Collapse
|
29
|
Ide N, LoGerfo JP, Karmacharya B. Barriers and facilitators of diabetes services in Nepal: a qualitative evaluation. Health Policy Plan 2018; 33:474-482. [DOI: 10.1093/heapol/czy011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nicole Ide
- Department of Family Medicine, University of Washington, Box 354696, Seattle, WA 98195, USA
| | - James P LoGerfo
- Department of Global Health, University of Washington, Box 357965, Seattle, WA 98195, USA
- Department of Medicine, University of Washington, Box 356420, Seattle, WA 98195, USA
| | - Biraj Karmacharya
- Department of Medicine, University of Washington, Box 356420, Seattle, WA 98195, USA
- Division of Cardiology, University of Washington, Seattle, WA 98195, USA
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| |
Collapse
|
30
|
Thapa B, Powell J, Yi J, McGee J, Landis J, Rein L, Kim S, Shrestha S, Karmacharya B. Adolescent Health Risk and Behavior Survey: A School Based Survey in Central Nepal. Kathmandu Univ Med J (KUMJ) 2017; 15:301-307. [PMID: 30580346] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background A comprehensive study of adolescent health risk specific to the Dhulikhel catchment area has not been performed. Objective This survey assesses trends in demographics, nutrition, hygiene and related infrastructure, causes of injury, violence, mental health, substance abuse, and menstrual hygiene. Method A 40 question survey was adapted from the Center for Disease Control (CDC) Youth Risk Behavior Surveillance System, translated into the Nepali language, and administered to 1200 students in eight different schools in central Nepal. Descriptive statistics were used to summarize the data. Result The data has identified nutrition, infrastructure, mental health, and menstrual hygiene as areas for improvement. The number of adolescents who reported going hungry some, most, or all of the time (30.5%, 25.8%, 13.9%) reveals a need for better food access. Approximately 44.5 % of students had no access to soap and water at school. Students who endorse dissatisfaction with themselves was 6.5% and those with suicidal ideation or attempt was 11.8% of the surveyed population. A significantly greater percentage of students who reported suicidal ideation also reported engaging in behaviors related to physical violence, substance abuse, being dissatisfaction with themselves, insomnia due to anxiety, and loneliness. Of the female students, 40.1% reported missing school at least once in the last three months due to their period. Conclusion This data shows a need for better food access, improved infrastructure in schools in central Nepal, and the need to address the prevalence of mental health issues through program interventions.
Collapse
Affiliation(s)
- B Thapa
- Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226
| | - J Powell
- Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226
| | - J Yi
- Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226
| | - J McGee
- Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226
| | - J Landis
- Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226
| | - L Rein
- Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226
| | - S Kim
- Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - B Karmacharya
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| |
Collapse
|
31
|
Karmacharya B, Shrestha A, Fitzpatrick AL, Koju R, Sotodehnia N, Xu DR. Prevalence and Correlates of Tobacco Use in a Suburban community of Nepal: Findings from the Dhulikhel Heart Study. Kathmandu Univ Med J (KUMJ) 2017; 15:336-342. [PMID: 30580353] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Smoking and oral tobacco use are important risk factors for cancer and other chronic diseases. The distribution of tobacco consumption in Nepal varies across the population subgroups. There is little information on the correlates of tobacco use among suburban population in Nepal. Objective To estimate the prevalence of smoking and oral tobacco use; and determine the socio-demographic and other CVD risk factors associated with them in a suburban population of Dhulikhel, Nepal. Method This cross sectional study utilized data from the first wave of the baseline survey of the Dhulikhel Heart Study (DHS). A total of 2225 households of Dhulikhel city were enumerated and a third of the households (n=735) were randomly selected. Questions on tobacco use were ascertained from 1073 adults age 18 years and older using the questions based on the WHO STEPS survey questionnaire. Result More than a third (36%) of the men were current smokers and 12% reported regular use of oral tobacco. About 14% of the women were current smokers and only 0.5% reported to use oral tobacco regularly.In the multivariate analysis, sex, ethnicity, education, alcohol consumption and body mass index were significantly associated with tobacco use. Males were 2.6 times as likely as females to smoke (95%: 1.53-4.59; p<0.001). Brahmin/Chhetri were 2.8 times more likely to smoke compared to Newars (95% Ci: 1.53-5.18; p=0.001). Education reduced the odds of smoking; compared to those with no formal education, those with up to high school and those with a high school degree or higher were 0.50 (95% CI: 0.27-0.92; p=0.02 ) and 0.38 (95% CI: 0.16-0.91; p=0.03) percent less likely to smoke, respectively. Moderate drinkers were 8 times more likely (95% CI: .54 - 18.40; p<0.001) and high drinkers were 13 times (95% CI: 6.63 - 24.26; p<0.001) compared to non-drinkers. Regarding oral tobacco use males were 15 times as likely as females to use oral tobacco (95% CI: 4.1-58.8; p<0.001). Compared to Newars, Brahmin/Chhetri were 2.7 times as likely to use oral tobacco (95% CI: 1.08 - 6.66; p=0.03). Conclusion Although Nepal has made some progress in passing progressive laws for tobacco control, and national surveys have shown slight reduction on tobacco use, this is far from satisfactory to meet the global target of bringing tobacco consumption to less than 5% by 2040. We recommend future studies to focus on socio-cultural, gender and behavioral aspects of tobacco use in addition to the epidemiological aspects.
Collapse
Affiliation(s)
- B Karmacharya
- Department of Community Medicine, Dhulikhel Hospital, Kathmandu University Hopsital, And Sun Yat-sen University Global Health Institute, Sun Yat-sen University
| | - A Shrestha
- Department of Epidemiology, Harvard TH Chan School of Public Health
| | - A L Fitzpatrick
- Departments of Epidemiology, Family Medicine and Global Health, University of Washington
| | - R Koju
- Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital
| | - N Sotodehnia
- Division of Cardiology, University of Washington
| | - D R Xu
- Sun Yat-sen University Global Health Institute, Sun Yat-sen University
| |
Collapse
|
32
|
McCleery R, Oli MK, Hostetler JA, Karmacharya B, Greene D, Winchester C, Gore J, Sneckenberger S, Castleberry SB, Mengak MT. Are declines of an endangered mammal predation‐driven, and can a captive‐breeding and release program aid their recovery? J Zool (1987) 2013. [DOI: 10.1111/jzo.12046] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. McCleery
- Department of Wildlife Ecology and Conservation University of Florida Gainesville FL USA
| | - M. K. Oli
- Department of Wildlife Ecology and Conservation University of Florida Gainesville FL USA
| | | | - B. Karmacharya
- Department of Biology University of Louisiana at Lafayette Lafayette LA USA
| | - D. Greene
- Department of Wildlife Ecology and Conservation University of Florida Gainesville FL USA
| | - C. Winchester
- Florida Fish and Wildlife Conservation Commission Panama City FL USA
| | - J. Gore
- Florida Fish and Wildlife Conservation Commission Panama City FL USA
| | - S. Sneckenberger
- South Florida Ecological Services Office United States Fish and Wildlife Service Vero Beach FL USA
| | - S. B. Castleberry
- Warnell School of Forestry and Natural Resources University of Georgia Athens GA USA
| | - M. T. Mengak
- Warnell School of Forestry and Natural Resources University of Georgia Athens GA USA
| |
Collapse
|
33
|
Abstract
We describe a young woman from a rural village in Nepal who suffered multiple wasp and hornet stings. She collapsed and was managed by a telephone consultation between a village health worker and a hospital specialist. The patient recovered fully. Not only was the telephone consultation efficient in terms of cost savings from avoided hospital treatment, but it was also effective since, with conventional care, there was a strong possibility that the patient would have died on her way to hospital. This case illustrates the potential for telephone-delivered rural care and management in emergency situations.
Collapse
Affiliation(s)
- Tshering Lama
- Room H005, School of Health, Community and Education Studies, Northumbria University, Coach Lane Campus East, Newcastle-upon-Tyne NE7 7XA, UK.
| | | | | | | |
Collapse
|
34
|
Joshi S, Agarwal B, Malla G, Karmacharya B. Complete elimination of tetanus is still elusive in developing countries: a review of adult tetanus cases from referral hospital in Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2007; 5:378-381. [PMID: 18604058] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM To analyse demography, clinical presentation, treatment, complications and outcome of patients with tetanus over a 2-year period. MATERIALS AND METHODS A retrospective analysis of medical records of all patients with tetanus admitted to the intensive care unit of B.P Koirala Institute of Health Sciences, Dharan, Nepal between July 2004 and June 2006. RESULTS Tetanus accounted for 1.1 % of our ICU admission. Eight tetanus patients (mean age 52 years; M: F ratio 7:1) were admitted. The tetanus prone wounds of seven patients were managed at home. The most common presenting complaints were trismus and stiffness of neck and back (87.5%). Elective intubation was followed by tracheostomy in all the patients. Overall mean duration of ventilatory support was 12.5 days. Treatments given in ICU were diazepam, magnesium sulphate, tetanus immunoglobulin, metronidazole, wound management and supportive measures. Five patients (62.5%) developed autonomic instability and three patients had ventilatory associated pneumonia (37.5%). Average ICU stay was 15.1 days while hospital stay was 20.1 days. Five patients (62.5%) survived the course of disease. Two patients (25%) left the hospital against medical advice while the other (12.5%) died in ICU. CONCLUSION Tetanus is a vaccine preventable disease. Tetanus prone wounds should be managed appropriately. Respiratory compromise and autonomic instability are the main causes of morbidity and mortality. Early recognition, intense support and prompt treatment improves morbidity and mortality of patients diagnosed with tetanus.
Collapse
Affiliation(s)
- S Joshi
- Department of Anaesthesiology and Critical Care, B.P Koirala Institute of Health Sciences, Dharan, Nepal.
| | | | | | | |
Collapse
|
35
|
Dematteis A, Menzano A, Tizzani P, Karmacharya B, Meneguz PG, Lovari S. IMMOBILIZATION OF HIMALAYAN TAHR WITH A XYLAZINE–KETAMINE MIXTURE AND REVERSAL WITH ATIPAMEZOLE UNDER FIELD CONDITIONS. J Wildl Dis 2006; 42:633-9. [PMID: 17092894 DOI: 10.7589/0090-3558-42.3.633] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Twenty-nine free-ranging Himalayan tahr (Hemitragus jemlahicus) were darted in the Sagarmatha National Park (Nepal) using different combinations of xylazine and ketamine. Animals in Group 1 (n = 4) received a mean xylazine-ketamine dose of 2.77 +/- 0.99 mg/kg xylazine plus 3.32 +/- 0.19 mg/kg ketamine in males and 2.39 +/- 0.10 mg/kg xylazine plus 4.29 +/- 0.17 mg/kg ketamine in females. Animals in Group 2 (n = 25) received a mean xylazine-ketamine dose of 1.70 +/- 0.41 mg/kg xylazine plus 3.06 +/- 0.74 mg/kg ketamine in males and 1.82 +/- 0.29 mg/kg xylazine plus 3.29 +/- 0.52 mg/kg ketamine in females. No anesthetic-related mortality was recorded. Anesthesia was reversed by a standard dose of 11 mg/animal of atipamezole administered by intramuscular injection. Although all anesthetic dosages immobilized free-ranging tahr successfully, a quick and smooth recovery was obtained (11.1 +/- 5.6 min) only with the dosages of Group 2.
Collapse
Affiliation(s)
- A Dematteis
- CERIGEFAS (Research Centre on Wildlife Management), Università degli Studi di Torino, Fraz.ne Rore, 17, 12020 Sampeyre (CN), Italy.
| | | | | | | | | | | |
Collapse
|
36
|
Karmacharya B, Sharma VK. Results of typhoid perforation management: our experience in Bir Hospital, Nepal. Kathmandu Univ Med J (KUMJ) 2006; 4:22-24. [PMID: 18603862] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine the demographic characteristics, clinical features, operative findings and postoperative complications in patients operated for typhoid enteric perforation. METHODS A retrospective study was carried out in the Department of General Surgery, Bir Hospital since 2002 to April 2004. Among 189 patients who underwent laparotomy for hollow viscus perforation in two years, ileal perforation was found in 102 patients. RESULTS The sex ratio of the patients was 4.66:1, in favor of male, with age range of 14-78 years and mean age 28.35 years. Most of the patients (80.39 %) presented with history of fever for two weeks. Half of the patients presented within 24 hours of onset of generalized abdominal pain. Majority (65.67%) had a solitary perforation on the antimesenteric border of terminal ileum. Eighty one percent of patients had trimming of the ulcer margins and primary closure. Complications included wound infection (35.3%), wound dehiscence (17.6%), fecal fistula (7.84%) and hospital mortality (6.86%). CONCLUSION Typhoid ulcer perforation is common among developing nations, including Nepal. Postoperative complications following surgical management of perforation are high and increases mortality.
Collapse
Affiliation(s)
- B Karmacharya
- Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal.
| | | |
Collapse
|
37
|
Sharma N, Koju R, Karmacharya B, Tamang MD, Makaju R, Nepali N, Shrestha P, Adhikari D. Typhoid fever in Dhulikhel hospital, Nepal. Kathmandu Univ Med J (KUMJ) 2004; 2:188-92. [PMID: 16400212] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
One hundred and twelve cases of typhoid fever presenting in outpatient and emergency department of Dhulikhel Hospital in Nepal were studied. In this study, it was found that 71% typhoid fever cases were less than 30 years of age group with male to female ratio of 3:1. Fever over 5 days followed by headache and chills were major presenting symptoms. Widal test and blood culture for Salmonella typhi were positive in 59% and 49% cases respectively. Two third of our study population had total leucocyte count of normal range. The fever clearance time was significantly better with ofloxacin compared to ciprofloxacin (p < 0.05) and ceftriaxone compared to chloramphenicol (p < 0.05). The release from treatment was significantly shorter with ceftriaxone compared to ofloxacin, ciprofloxacin and chloramphenicol (p < 0.01). Ceftriaxone was found to be 100% sensitive to salmonella typhi. Amoxicillin was only 52.1% sensitive to Salmonella typhi. Early diagnosis and institution of appropriate antibiotic therapy is of paramount importance in the management of typhoid patients.
Collapse
Affiliation(s)
- N Sharma
- Kathmandu University Teaching Hospital, Dhulikhel.
| | | | | | | | | | | | | | | |
Collapse
|