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Peters S, Besse B, Marreaud S, Dafni U, Oselin K, Havel L, Esteban Gonzalez E, Isla D, Martinez-Marti A, Faehling M, Tsuboi M, Lee JS, Nakagawa K, Yang J, Keller S, Mauer M, Jha N, Stahel R, Paz-Ares L, O'Brien M. 930MO PD-L1 expression and outcomes of pembrolizumab and placebo in completely resected stage IB-IIIA NSCLC: Subgroup analysis of PEARLS/KEYNOTE-091. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1056] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kasaudhan SM, Ghimire A, Sharma SK, Baral D, Jha N, Singh SB. Undiagnosed and Uncontrolled Hypertension and Access to Health Care among Residents of an Urban Area of Eastern Nepal: a Cross-sectional Study. Kathmandu Univ Med J (KUMJ) 2022; 20:273-279. [PMID: 37042365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background The burden and complication of hypertension is increasing as most of the people living with hypertension are unaware of their condition and those who are already diagnosed with it do not have their blood pressure under control. Objective To assess the prevalence of undiagnosed and uncontrolled hypertension among residents of Itahari sub metropolitan city of eastern Nepal, along with its associated socio demographic and behavioral risk factors and access to health care services. Method Cross sectional study was conducted in five wards of Itahari, among 1161 participants, using population proportionate to sample size sampling technique. Face to face interview was conducted with participants for data collection applying semi- structured questionnaire and physical measurement like blood pressure, weight and height. Result Prevalence of hypertension was 26.5% includingundiagnosed 11.0% and previously diagnosed 15.5%. Among diagnosed, 76.6% had uncontrolled blood pressure and 56.70% were taking anti-hypertensive medicine, and 7.8% were under Ayurvedic medicine. More than 70% participants preferred private health facility for treatment and 22.7% had faced financial barrier to seek healthcare. About 64% of participants did not visit health services or had visited only once in past six months. Increasing age, Body Mass Index (BMI), smoking status and positive family history were found to be significantly associated with hypertension at < 0.05 level. Conclusion Prevalence of hypertension is high and awareness regarding available health services in local primary health center and its utilization is lacking among participants. Regular screening program for hypertension and awareness program to disseminate the knowledge of availability of primary health center should be conducted.
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Affiliation(s)
- S M Kasaudhan
- School of Public Health and Community Medicine, BP. Koirala Institute of Health Sciences, Dharan, Nepal
| | - A Ghimire
- School of Public Health and Community Medicine, BP. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S K Sharma
- Department of Internal Medicine, BP. Koirala Institute of Health Sciences, Dharan, Nepal
| | - D Baral
- School of Public Health and Community Medicine, BP. Koirala Institute of Health Sciences, Dharan, Nepal
| | - N Jha
- School of Public Health and Community Medicine, BP. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S B Singh
- School of Public Health and Community Medicine, BP. Koirala Institute of Health Sciences, Dharan, Nepal
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Jha N, Thapa B, Pathak SB, Pandey A, Pokhrel S, Shankar PR, Bhandary S, Mudvari A, Dangal G. A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:351-358. [PMID: 37042379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS.
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Affiliation(s)
- N Jha
- Department of Clinical Pharmacology and Therapeutics, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - B Thapa
- Department of Emergency Medicine, Kirtipur Hospital, Kirtipur, Nepal
| | - S B Pathak
- Department of Intensive Care Unit and Critical care, Nepal Mediciti Hospital, Sainbu, Bhaisepati, Nepal
| | - A Pandey
- Department of General Surgery, Madhyapur Hospital, Bhaktapur, Nepal
| | - S Pokhrel
- Department of Emergency Medicine, Nidan Hospital, Lalitpur, Pulchowk, Nepal
| | - P R Shankar
- IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia
| | - S Bhandary
- Department of Community Health Sciences and School of Public Health, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - A Mudvari
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | - G Dangal
- Kathmandu Model Hospital, Kathmandu, Nepal
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Thapa B, Sharma S, Shrestha A, Maharjan R, Jha N, Bajracharya S, Shrestha S, Neupane T, Sapkota BP, Koju RP, Oli N. Human Resources for Cardiovascular Disease Management in Nepal: A National Need Assessment. Kathmandu Univ Med J (KUMJ) 2022; 19:3-10. [PMID: 35526131] [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: 06/14/2023]
Abstract
Background Human resources are the mainstay of the healthcare system. Higher numbers of health workers have better healthcare coverage and outcomes. Availability of trained human resources to address the exponential rise in cardiovascular disease in Nepal is a national concern. Objective To assess the need of human resources for cardiovascular disease management in Nepal. Method We conducted an exploratory sequential mixed-method study. We developed a task force and organized a national workshop to engage stakeholders and collect feedback on the research process. We did a desk review and conducted 24 key informant interviews. We did thematic analysis from the codes generated. Result There is no clear definition and required estimation of health workers for cardiovascular disease management. There is a shortage of health workers with 8.9 doctors, 20.8 nurses, 0.05 cardiologist/cardiac surgeon, 4.2 pharmacist, 10.2 laboratory technicians per 10,000 population. There is a comprehensive human resource plan but it does not provide details of human resources for cardiovascular disease management. There is a lack of public private collaboration for human resource management. However, there is production of human resources for cardiovascular disease management through pre-service specialized courses and inservice training. Conclusion A clear definition and estimation of health workers with stringent human resource plan for cardiovascular disease management is essential. The government can still address these gaps by establishing a well-equipped central health workforce unit and expanding collaboration with private sectors.
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Affiliation(s)
- B Thapa
- Department of Nursing, Tribhuvan University, Institute of Medicine, Nepalgunj Nursing Campus, Banke, Nepal. and Fellow, TREIN Nepal, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Sharma
- Fellow, TREIN Nepal, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Nursing, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal. and Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - A Shrestha
- Department of Public Health and Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Fellow, TREIN Nepal, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. and Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Kathmandu, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - T Neupane
- Nepal Health Research Council, Kathmandu, Nepal
| | - B P Sapkota
- Health Coordination Division, Ministry of Health and Population, Kathmandu Nepal. and CIH-LMU Center for International Health, University Hospital, LMU Munich, Germany
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre. and Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - N Oli
- Department of Community Medicine, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
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Sapkota S, Shrestha S, Bista D, Shrestha A, Maharjan R, Bajracharya S, Jha N, Koju RP, Shrestha R. Medical Products for Cardiovascular Disease Management in Nepal: a needs assessment study. Kathmandu Univ Med J (KUMJ) 2022; 19:18-29. [PMID: 35526133] [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: 06/14/2023]
Abstract
Background Medical Products and Technologies is a key component of the health system. Quality medicines and efficient management of the medical products can secure effective cardiovascular diseases management. Objective To collate information and identify strengths, weaknesses, opportunities and threats (SWOT) associated with medical products and technology component for cardiovascular disease management in Nepal. Method This study is a part of a larger rapid assessment of Nepal's health system for cardiovascular disease management and based on The Health System Assessment Approach: A How-To Manual (USAID). The authors conducted a desk review of documents related to the WHO "medical product and technology" building block component and key informant interviews using a pre-tested interview protocol. The first eight interviews were transcribed verbatim and analysed inductively to generate a codebook; and the remaining, transcribed and deductively coded based on the codebook. Findings were categorised into relevant topical area and SWOT components. Result Nepal has laws and provisions for medicine regulation, pharmacovigilance, post marketing surveillance, registration and licensing provisions for pharmacy industries/ outlets, essential medicine lists and national formulary. These provisions also apply to medicines used for cardiovascular diseases. The challenge however, is the lack of effective implementation and monitoring, due to shortages of technical workforce and state of art information and technologies. Information on pharmaceutical expenditures for cardiovascular disease management is scarce; there are no standard national level guidelines that are consistently used to manage cardiovascular diseases in health facilities. Conclusion There are limited provisions and information on medical products for cardiovascular disease management in Nepal, and a need to strengthen existing provisions for medicine regulations and surveillance.
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Affiliation(s)
- S Sapkota
- Research Division, Manmohan Memorial Institute of Health Sciences, Soalteemod, Kathmandu, Nepal. Department of Pharmacy, Manmohan Memorial Institute of Health Sciences, Soalteemode, Kathmandu, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - D Bista
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Pharmacy, Kathmandu University, Dhulikhel, Kavrepalanchowk, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. and Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. and Department of Internal Medicine, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - R Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Pharmacovigilance Unit/Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Suwal PS, Prajapati D, Bajracharya S, Shrestha A, Maharjan R, Shrestha S, Jha N, Koju RP, Vaidya A. Assessment of Health Service Delivery to Address Cardiovascular Diseases in Nepal. Kathmandu Univ Med J (KUMJ) 2022; 19:40-50. [PMID: 35526135] [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: 06/14/2023]
Abstract
Background A health care delivery system is the organization of people, institutions, and resources designed to deliver health services. A comprehensive study to explore cardiovascular health service delivery in Nepal is lacking. Objective This study attempted to assess Nepal's health system gap on organization and delivery of cardiovascular disease prevention and management services. Method This mixed-method study used the six building blocks of the World Health Organization health system framework: organization; access; coverage, utilization and demand; equity; quality of services; and outcomes. We conducted the desk reviews of national and international documents, performed several key informant interviews, calculated the relevant indicators, and assessed the Strengths, Weaknesses, Opportunities, and Threats of the cardiovascular health service delivery. Result We found that most of the cardiovascular services are concentrated in urban areas, and suffer from poor access, quality, utilization, and coverage in most of the areas resulting in poor health outcomes. Though the services have recently improved due to increased primary care interventions, there is scope for the development of competent human resources, advancement of technologies, development of national protocols, and improved monitoring and supervision. Improved disease system including the medical recording and reporting mechanism to incorporate and reflect the true burden of CVD in Nepal is lacking. Conclusion Despite having health facilities from grassroots to the central level, availability, access, and quality of cardiovascular health services are poor. Further improvement and equitable expansion of promotive, preventive, diagnostic, referral, and rehabilitative cardiovascular services are needed to ensure universal health coverage.
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Affiliation(s)
- P S Suwal
- Nepal Institute of Health Sciences, Jorpati Kathmandu, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Prajapati
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Shahid Gangalal National Heart Centre, and National Academy of Medical Sciences, Kathmandu, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal. and Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. and Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - A Vaidya
- Department of Community Medicine, Kathmandu Medical College Public Limited, Kathmandu, Nepal
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Pradhan PM, Bhatt RD, Pandit R, Shrestha A, Maharjan R, Jha N, Bajracharya S, Shrestha S, Koju RP, Karmacharya BM. Needs Assessment of Leadership and Governance in Cardiovascular Health in Nepal. Kathmandu Univ Med J (KUMJ) 2022; 19:30-39. [PMID: 35526134] [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: 06/14/2023]
Abstract
Background Good governance and leadership are essential to improve healthy life expectancy particularly in low and middle-income countries (LMICs). This study aimed to epitomize the challenges and opportunities for leadership and good governance for the health system to address non-communicable diseases particularly cardiovascular diseases (CVD) in Nepal. Objective The objective of this study was to understand and document CVD programs and policy formulation processes and to identify the government capacity to engage stakeholders for planning and implementation purposes. Method A national-level task force was formed to coordinate and steer the overall need assessment process. A qualitative study design was adopted using "The Health System Assessment Approach". Eighteen indicators under six topical areas in leadership and governance in cardiovascular health were assessed using desk review and key informant interviews. Result Voice and accountability exist in planning for health from the local level. The government has shown a strong willingness and has a strategy to work together with the private and non-government sectors in health however, the coordination has not been effective. There are strong rules in place for regulatory quality, control of corruption, and maintaining financial transparency. The government frequently relies on evidence generated from large-scale surveys for health policy formulation and planning but research in cardiovascular health has been minimum. There is a scarcity of cardiovascular disease-specific protocols. Conclusion Despite plenty of opportunities, much homework is needed to improve leadership and governance in cardiovascular health in Nepal. The government needs to designate a workforce for specific programs to help monitor the enforcement of health sector regulations, allocate enough funding to encourage CVD research, and work towards developing CVD-specific guidelines, protocols, and capacity building. KEY WORDS Cardiovascular diseases, Governance, Leadership, Needs assessment, Nepal.
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Affiliation(s)
- P Ms Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal. Nepalese Society of Community Medicine. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R D Bhatt
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Wuhan University, Faculty of Medical Sciences, School of Health Sciences, Wuhan, China. and Department of Biochemistry, Kathmandu University School of Medical Sciences, Nepal
| | - R Pandit
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Physiology, Nepal Medical College and Teaching Hospital, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. and Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre. and Department of Internal Medicine, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre
| | - B M Karmacharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. and Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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Shrestha A, Parajuli SB, Aryal A, Shrestha A, Maharjan R, Jha N, Bajracharya S, Shrestha S, Neupane T, Poudel U, Karmacharya BM, Koju RP, Dhimal M. National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study. Kathmandu Univ Med J (KUMJ) 2022; 19:58-67. [PMID: 35526137] [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: 06/14/2023]
Abstract
Background Health financing is a major domain of health system building blocks. With the epidemiological transition and increasing trend of Cardiovascular diseases (CVDs), it is crucial to assess the status of health financing to address the gap of prevention, control, and treatment of CVDs in Nepal. Objective This paper aims to assess the situation of healthcare financing on Cardiovascular diseases in Nepal. We framed three key functions of health system financing: (a) revenue collection, (b) pooling of resources, and (c) purchasing of services for this study. Method We used sequential explanatory mixed-method research design. We conducted desk reviews, analyzed secondary data on health financing followed by Key-Informant Interviews with five relevant policymakers and experts between February and September 2019. We obtained the Ethical clearance from the Nepal Health Research Council. Result Out of pocket (OOP) expenditure remains the highest source (52%) of total health care expenditure in Nepal, and two third of it is made for NCDs. Out of total current health expenditure on outpatient and inpatient services for fiscal year 2015/16, only 7% of total NCDs was spent on CVDs. Hypertension is the third-most utilized insurance service out of 36 CVD related services provided by the Health Insurance Board. The existing health related social service schemes covers the high costs associated with treatment, and streamlining these services including provider payment mechanisms with the health insurance program could open up opportunities to expand quality CVD services and make it accessible to the marginalized population. Conclusion Health Financing is the integral part of the health system. With the rising burden of cardiovascular diseases and its impact on impoverishment due to high OOP, integrated health care services, budget specification based on the evidence-based burden of disease such as CVD needs to be prioritized by the government.
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Affiliation(s)
- A Shrestha
- Department of Community Medicine, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S B Parajuli
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Community Medicine, Birat Medical College Teaching Hospital, Biratnagar, Nepal
| | - A Aryal
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Nyaya Health Nepal, Kathmandu, Nepal
| | - A Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. and Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - T Neupane
- Nepal Health Research Council, Kathmandu, Nepal
| | - U Poudel
- Nepal Health Research Council, Kathmandu, Nepal
| | - B M Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - M Dhimal
- Nepal Health Research Council, Kathmandu, Nepal
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Karmacharya RM, Shestha AP, Shrestha A, Bajracharya S, Maharjan R, Shrestha S, Jha N, Pyakurel P. National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study. Kathmandu Univ Med J (KUMJ) 2022; 19:51-57. [PMID: 35526136] [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: 06/14/2023]
Abstract
Background Health information system is an integral component of a country's capacity to integrate, process, report, and use information in improving health services. Objective This study aims to assess the infrastructure and capacity of the national Health information system to address cardiovascular diseases in Nepal. Method We adopted the United States Agency for International Development manual "The Health System Assessment Approach: A How-To Manual", Version 2.0. Three topical areas: input, process and output, were identified. Stepwise approach for Health information system assessment was done. A desk review and key informant interview was performed. Audio recordings were transcribed in Nepali language and intercoder reliability was checked. Result The upgraded District Health Information Software 2.3 provides a comprehensive online data management solution. Sustainable funding to upgrade the system exists. Annual report provides performance of all the components of the health care delivery system. Data were reviewed quarterly. However, no dedicated section for cardiovascular diseases in the Health information system is present. Private health facilities are poorly represented. Strategic planning, management, and evaluation of the Health information system are lacking. Inadequacy of timeliness, completeness, and periodicity of the reporting still exist. Conclusion A separate section of cardiovascular diseases in the Health information system is required. Better reporting of private sectors and its inclusion in databases is of utmost importance. Adaptation in the recently introduced federal structure is key for development of Health information system in the country.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular Surgery Unit), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A P Shestha
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - R Maharjan
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. Nepal. Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - P Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Paz-Ares L, O'Brien M, Mauer M, Dafni U, Oselin K, Havel L, Esteban Gonzalez E, Isla D, Martinez-Marti A, Faehling M, Tsuboi M, Lee JS, Nakagawa K, Yang J, Keller S, Jha N, Marreaud S, Stahel R, Peters S, Besse B. VP3-2022: Pembrolizumab (pembro) versus placebo for early-stage non-small cell lung cancer (NSCLC) following complete resection and adjuvant chemotherapy (chemo) when indicated: Randomized, triple-blind, phase III EORTC-1416-LCG/ETOP 8-15 – PEARLS/KEYNOTE-091 study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.224] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Dinakaran D, Jha N, Joseph K, Walker J. Response and Toxicity Patterns Seen in Patients Treated With Combination Immunotherapy and Radiotherapy in the UNSCARRed (UNresectable Squamous Cell Carcinoma treated With Avelumab and Radical Radiotherapy) Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.971] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Arinaminpathy N, Nandi A, Vijayan S, Jha N, Nair SA, Kumta S, Dewan P, Rade K, Vadera B, Rao R, Sachdeva KS. Engaging with the private healthcare sector for the control of tuberculosis in India: cost and cost-effectiveness. BMJ Glob Health 2021; 6:bmjgh-2021-006114. [PMID: 34610905 PMCID: PMC8493898 DOI: 10.1136/bmjgh-2021-006114] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background The control of tuberculosis (TB) in India is complicated by the presence of a large, disorganised private sector where most patients first seek care. Following pilots in Mumbai and Patna (two major cities in India), an initiative known as the ‘Public–Private Interface Agency’ (PPIA) is now being expanded across the country. We aimed to estimate the cost-effectiveness of scaling up PPIA operations, in line with India’s National Strategic Plan for TB control. Methods Focusing on Mumbai and Patna, we collected cost data from implementing organisations in both cities and combined this data with models of TB transmission dynamics. Estimating the cost per disability adjusted life years (DALY) averted between 2014 (the start of PPIA scale-up) and 2025, we assessed cost-effectiveness using two willingness-to-pay approaches: a WHO-CHOICE threshold based on per-capita economic productivity, and a more stringent threshold incorporating opportunity costs in the health system. Findings A PPIA scaled up to ultimately reach 50% of privately treated TB patients in Mumbai and Patna would cost, respectively, US$228 (95% uncertainty interval (UI): 159 to 320) per DALY averted and US$564 (95% uncertainty interval (UI): 409 to 775) per DALY averted. In Mumbai, the PPIA would be cost-effective relative to all thresholds considered. In Patna, if focusing on adherence support, rather than on improved diagnosis, the PPIA would be cost-effective relative to all thresholds considered. These differences between sites arise from variations in the burden of drug resistance: among the services of a PPIA, improved diagnosis (including rapid tests with genotypic drug sensitivity testing) has greatest value in settings such as Mumbai, with a high burden of drug-resistant TB. Conclusions To accelerate decline in TB incidence, it is critical first to engage effectively with the private sector in India. Mechanisms such as the PPIA offer cost-effective ways of doing so, particularly when tailored to local settings.
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Affiliation(s)
- Nimalan Arinaminpathy
- Department of Infectious Disease Epidemiology, Imperial College London, London, London, UK
| | - Arindam Nandi
- Population Council, New York, New York, USA.,CDDEP, Washington, District of Columbia, USA
| | | | - Nita Jha
- World Health Partners, Patna, India
| | | | - Sameer Kumta
- Bill and Melinda Gates Foundation, India Country Office, New Delhi, India
| | - Puneet Dewan
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Kiran Rade
- World Health Organization Country Office for India, New Delhi, India
| | | | - Raghuram Rao
- National Tuberculosis Elimination Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Kuldeep S Sachdeva
- South-East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
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13
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Huddart S, Singh M, Jha N, Benedetti A, Pai M. Case fatality and recurrent tuberculosis among patients managed in the private sector: A cohort study in Patna, India. PLoS One 2021; 16:e0249225. [PMID: 33770134 PMCID: PMC7996982 DOI: 10.1371/journal.pone.0249225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/20/2020] [Accepted: 03/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A key component of the WHO End TB Strategy is quality of care, for which case fatality is a critical marker. Half of India's nearly 3 million TB patients are treated in the highly unregulated private sector, yet little is known about the outcomes of these patients. Using a retrospective cohort design, we estimated the case fatality ratio (CFR) and rate of recurrent TB among patients managed in the private healthcare sector in Patna, India. METHODS World Health Partners' Private Provider Interface Agencies (PPIA) pilot project in Patna has treated 89,906 private sector TB patients since 2013. A random sample of 4,000 patients treated from 2014 to 2016 were surveyed in 2018 for case fatality and recurrent TB. CFR is defined as the proportion of patients who die during the period of interest. Treatment CFRs, post-treatment CFRs and rates of recurrent TB were estimated. Predictors for fatality and recurrence were identified using Cox proportional hazards modelling. Survey non-response was adjusted for using inverse probability selection weighting. RESULTS The survey response rate was 56.0%. The weighted average follow-up times were 8.7 months in the treatment phase and 26.4 months in the post-treatment phase. Unobserved patients were more likely to have less than one month of treatment adherence (32.0% vs. 13.5%) and were more likely to live in rural Patna (21.9% vs. 15.0%). The adjusted treatment phase CFR was 7.27% (5.97%, 8.49%) and at 24 months post-treatment was 3.32% (2.36%, 4.42%). The adjusted 24 month post-treatment phase recurrent TB rate was 3.56% (2.54%, 4.79%). CONCLUSIONS Our cohort study provides critical estimates of TB patient outcomes in the Indian private sector, and accounts for selection bias. Patients in the private sector in Patna experienced a moderate treatment CFR but rates of recurrent TB and post-treatment fatality were low.
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Affiliation(s)
- Sophie Huddart
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
- Faculty of Medicine, University of California-San Francisco, San Francisco, CA, United States of America
| | | | - Nita Jha
- World Health Partners, Patna, India
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
- Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
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Ankaiah D, Mitra S, Srivastava D, Sivagnanavelmurugan M, Ayyanna R, Jha N, Venkatesan A. Probiotic characterization of bacterial strains from fermented South Indian tomato pickle and country chicken intestine having antioxidative and antiproliferative activities. J Appl Microbiol 2021; 131:949-963. [PMID: 33404172 DOI: 10.1111/jam.14991] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/07/2020] [Accepted: 12/28/2020] [Indexed: 12/31/2022]
Abstract
AIM The present study aims to evaluate the potential antioxidant and antiproliferative properties of probiotic bacterial isolates Weissella cibaria p3B, Bacillus subtilis CS, and Bacillus tequilensis CL, isolated from South Indian fermented tomato pickle (homemade) and gut content of indigenous country chicken. METHODS AND RESULTS The bacterial isolates exhibited antimicrobial activity against food-borne, human pathogenic bacteria, along with better survival under different bile and acidic conditions, hydrophobicity towards several hydrocarbons, and adherence to intestinal epithelial cells (INT-407 cells). Also, the intact cell (IC) mixture of the three species showed better DPPH, ABTS, and Fe2+ chelating activity as compared to the individual IC or cell extract (CE) activity. Among the three bacterial species, W. cibaria p3B revealed maximum antiproliferative activity against HeLa and Caco-2 cancer cells, all of which were nontoxic to INT-407 cells. Apart from being non-hemolytic, the bacterial isolates did not display any necrotic inhibition in HeLa and Caco-2 cells. The cell free supernatant (CFS) of the three bacterial isolates were tested for the production of antimicrobial peptides or bacteriocins. It found that the CFS of bacterial isolates was stable at various temperature, pH and sensitive to proteolytic enzymes confirms protenoius in nature of the antimicrobil peptides or bacteriocins. CONCLUSION The bacterial isolates showed promising antimicrobial, antioxidant as well as antiproliferative activities with better survival ability at different pH and bile concentrations. The three bacterial isolates were able to produce potential antimicrobial peptides or bacteriocins. SIGNIFICANCE AND IMPACT OF THE STUDY These results indicate better compatibility of our bacterial isolates against synthetic drugs to avoid adverse side effects and can be processed as dietary supplements against food and human pathogens. They can also provide antioxidative and antiproliferative benefits to humans and animals.
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Affiliation(s)
- D Ankaiah
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry, India
| | - S Mitra
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry, India
| | - D Srivastava
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry, India
| | - M Sivagnanavelmurugan
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry, India
| | - R Ayyanna
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry, India
| | - N Jha
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry, India
| | - A Venkatesan
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry, India
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Abstract
The purpose of this study was to develop a diagnostic tool to automatically detect temporomandibular joint osteoarthritis (TMJOA) from cone beam computed tomography (CBCT) images with artificial intelligence. CBCT images of patients diagnosed with temporomandibular disorder were included for image preparation. Single-shot detection, an object detection model, was trained with 3,514 sagittal CBCT images of the temporomandibular joint that showed signs of osseous changes in the mandibular condyle. The region of interest (condylar head) was defined and classified into 2 categories-indeterminate for TMJOA and TMJOA-according to image analysis criteria for the diagnosis of temporomandibular disorder. The model was tested with 2 sets of 300 images in total. The average accuracy, precision, recall, and F1 score over the 2 test sets were 0.86, 0.85, 0.84, and 0.84, respectively. Automated detection of TMJOA from sagittal CBCT images is possible by using a deep neural networks model. It may be used to support clinicians with diagnosis and decision making for treatments of TMJOA.
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Affiliation(s)
- K S Lee
- College of Medicine, Korea University, Seoul, Republic of Korea
| | - H J Kwak
- College of Medicine, Korea University, Seoul, Republic of Korea
| | - J M Oh
- College of Medicine, Korea University, Seoul, Republic of Korea
| | - N Jha
- Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Y J Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - W Kim
- Seoul National University, Seoul, Republic of Korea
| | - U B Baik
- Ewha Womans University, Seoul, Republic of Korea
| | - J J Ryu
- College of Medicine, Korea University, Seoul, Republic of Korea
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16
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Deo S, Jindal P, Gupta D, Khaparde S, Rade K, Sachdeva KS, Vadera B, Shah D, Patel K, Dave P, Chopra R, Jha N, Papineni S, Vijayan S, Dewan P. What would it cost to scale-up private sector engagement efforts for tuberculosis care? Evidence from three pilot programs in India. PLoS One 2019; 14:e0214928. [PMID: 31166942 PMCID: PMC6550378 DOI: 10.1371/journal.pone.0214928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/24/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Private providers dominate health care in India and provide most tuberculosis (TB) care. Yet efforts to engage private providers were viewed as unsustainably expensive. Three private provider engagement pilots were implemented in Patna, Mumbai and Mehsana in 2014 based on the recommendations in the National Strategic Plan for TB Control, 2012-17. These pilots sought to improve diagnosis and treatment of TB and increase case notifications by offering free drugs and diagnostics for patients who sought care among private providers, and monetary incentives for providers in one of the pilots. As these pilots demonstrated much higher levels of effectiveness than previously documented, we sought to understand program implementation costs and predict costs for their national scale-up. METHODS AND FINDINGS We developed a common cost structure across these three pilots comprising fixed and variable cost components. We conducted a retrospective, activity-based costing analysis using programmatic data and qualitative interviews with the respective program managers. We estimated the average recurring costs per TB case at different levels of program scale for the three pilots. We used these cost estimates to calculate the budget required for a national scale up of such pilots. The average cost per privately-notified TB case for Patna, Mumbai and Mehsana was estimated to be US$95, US$110 and US$50, respectively, in May 2016 when these pilots were estimated to cover 50%, 36% and 100% of the total private TB patients, respectively. For Patna and Mumbai pilots, the average cost per case at full scale, i.e. 100% coverage of private TB patients, was projected to be US$91 and US$101, respectively. In comparison, the national TB program's budget for 2015 averages out to $150 per notified TB case. The total annual additional budget for a national scale up of these pilots was estimated to be US$267 million. CONCLUSIONS As India seeks to eliminate TB, extensive national engagement of private providers will be required. The cost per privately-notified TB case from these pilots is comparable to that already being spent by the public sector and to the projected cost per privately-notified TB case required to achieve national scale-up of these pilots. With additional funds expected to execute against national TB elimination commitments, the scale-up costs of these operationally viable and effective private provider engagement pilots are likely to be financially viable.
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Affiliation(s)
- Sarang Deo
- Indian School of Business, Hyderabad, India
| | - Pankaj Jindal
- UCLA Anderson School of Management, Los Angeles, CA, United States of America
| | | | | | | | | | | | - Daksha Shah
- Mumbai Mission for TB Control, Mumbai, India
| | | | | | | | - Nita Jha
- World Health Partners, Patna, India
| | | | | | - Puneet Dewan
- Independent Consultant, Seattle, WA, United States of America
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17
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Daftary A, Satyanarayana S, Jha N, Singh M, Mondal S, Vadnais C, Pai M. Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India. BMJ Glob Health 2019; 4:e001417. [PMID: 31179037 PMCID: PMC6528751 DOI: 10.1136/bmjgh-2019-001417] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Received: 01/14/2019] [Revised: 03/13/2019] [Accepted: 04/06/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction India has the world’s highest burden of tuberculosis (TB). Private retail pharmacies are the preferred provider for 40% of patients with TB symptoms and up to 25% of diagnosed patients. Engaging pharmacies in TB screening services could improve case detection. Methods A novel TB screening and referral intervention was piloted over 18 months, under the pragmatic staggered recruitment of 105 pharmacies in Patna, India. The intervention was integrated into an ongoing public–private mix (PPM) programme, with five added components: pharmacy training in TB screening, referral of patients with TB symptoms for a chest radiograph (CXR) followed by a doctor consultation, incentives for referral completion and TB diagnosis, short message service (SMS) reminders and field support. The intervention was evaluated using mixed methods. Results 81% of pharmacies actively participated in the intervention. Over 132.49 pharmacy person-years of observation in the intervention group, 1674 referrals were made and 255 cases of TB were diagnosed. The rate of registration of symptomatic patients was 62 times higher in the intervention group compared with the control group (95% CI: 54 to 72). TB diagnosis was 25 times higher (95% CI: 20 to 32). Microbiological testing and test confirmation were also significantly higher among patients diagnosed in the intervention group (p<0.001). Perceived professional credibility, patient trust, symptom severity and providing access to a free screening test were seen to improve pharmacists’ engagement in the intervention. Workload, patient demand for over-the-counter medicines, doctor consultation fees and programme documentation impeded engagement. An additional 240 cases of TB were attributed to the intervention, and the approximate cost incurred per case detected due to the intervention was US$100. Conclusions It is feasible and impactful to engage pharmacies in TB screening and referral activities, especially if working within existing public-private mix (PPM) programmes, appealing to pharmacies’ business mindset and among pharmacies with strong community ties.
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Affiliation(s)
- Amrita Daftary
- McGill International TB Centre and Department of Epidemiology & Biostatistics, McGill University, Montreal, Québec, Canada.,Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Srinath Satyanarayana
- The International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Nita Jha
- World Health Partners, Patna, Bihar, India
| | | | - Shinjini Mondal
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Caroline Vadnais
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Madhukar Pai
- McGill International TB Centre and Department of Epidemiology & Biostatistics, McGill University, Montreal, Québec, Canada.,Manipal McGill Centre for Infectious Diseases, Manipal, Karnataka, India
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Shim JS, Han SH, Jha N, Hwang ST, Ahn W, Lee JY, Ryu JJ. Effect of Irradiance and Exposure Duration on Temperature and Degree of Conversion of Dual-Cure Resin Cement for Ceramic Restorations. Oper Dent 2018; 43:E280-E287. [PMID: 30106334 DOI: 10.2341/17-283-l] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study investigated the effects of irradiance and exposure duration on dual-cured resin cements irradiated through ceramic restorative materials. A single light-curing unit was calibrated to three different irradiances (500, 1000, and 1500 mW/cm2) and irradiated to three different attenuating materials (transparent acryl, lithium disilicate, zirconia) with 1-mm thicknesses for 20 or 60 seconds. The changes in irradiance and temperature were measured with a radiometer (or digital thermometer) under the attenuating materials. The degree of conversion (DC) of dual-cure resin cement after irradiation at different irradiances and exposure durations was measured with Fourier transform near infrared spectroscopy. Two-way analysis of variance revealed that irradiance ( p<0.001) and exposure duration ( p<0.001) significantly affected temperature and DC. All groups showed higher DCs with increased exposure times ( p<0.05), but there were no statistically significant differences between the groups irradiated with 1000 mW/cm2 and 1500 mW/cm2 ( p>0.05). Higher-intensity irradiances yielded higher temperatures ( p<0.05), but exposure time did not affect temperature when materials were irradiated at 500 mW/cm2 ( p>0.05).
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Jha N, Rathore DS, Shankar PR, Bhandary S, Alshakka M, Gyawali S. Knowledge, Attitude and Practice Regarding Pharmacovigilance and Consumer Pharmacovigilance among Consumers at Lalitpur District, Nepal. J Nepal Health Res Counc 2017; 15:31-37. [PMID: 28714489 DOI: 10.3126/jnhrc.v15i1.18011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adverse drug reactions (ADRs) can be a big threat to the health of people in Nepal as a variety of medicines are consumed in the country. Involving consumers in pharmacovigilance can strengthen ADR reporting. The study aims to find out knowledge, attitude and practice regarding pharmacovigilance and consumer pharmacovigilance among consumers at Lalitpur district, Nepal Methods: It was carried out in outpatients visiting in KIST Medical College and Teaching Hospital, Lalitpur, Nepal. Participant's knowledge, attitude and practice were measured by noting their agreement with a set of 21 statements along with multiple choice and open ended questions. RESULTS A total of 157 outpatients were surveyed. The knowledge scores for males (12) was better compared to the females (11), but the scores for attitude and practice were same for both groups. The maximum score for knowledge was 29, attitude was 6 and practice was 10. The overall KAP scores was 45. The total scores for knowledge, attitude and practice for males (24) were better compared to female (22) respondents. Seventy-one patients (68%) who participated in this study favoured establishing a consumer centre for obtaining information about ADRs. CONCLUSIONS Knowledge scores among consumers regarding pharmacovigilance is low and require advocacy and improvement.
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Affiliation(s)
- N Jha
- Department of Clinical Pharmacology, KIST Medical College, Lalitpur, Nepal
| | - D S Rathore
- Department of Pharmacy, NIMS University, Rajasthan, India
| | - P R Shankar
- Department of Pharmacology, American International Medical University, St. Lucia, caribbean
| | - S Bhandary
- Department of Community Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - M Alshakka
- Department of Pharmaceutics and Clinical Pharmacy, Aden University, Yemen
| | - S Gyawali
- Department of Clinical Pharmacology, Manipal College of Medical Sciences, Kaski, Nepal
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Sah RB, Pradhan B, Subedi L, Karki P, Jha N. Epidemiological Study of Tobacco Smoking Behaviour amongst Residents of the Hill Region of Nepal. Kathmandu Univ Med J (KUMJ) 2016; 14:215-220. [PMID: 28814681] [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: 06/07/2023]
Abstract
Background Tobacco use is still a serious public health problem in the world and represents a major cause of morbidity and mortality in most parts of the world. Objective To measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of Dhankuta Municipality. Method The cross-sectional study was conducted among the residents of the Dhankuta Municipality where 205 households were taken as subjects. Pretested semistructured questionnaire was used for data collection and face to face interview was conducted. Univariate and multivariate logistic regression was used to see the association between various factors and tobacco use and identify the predictor variables. Result Overall prevalence of tobacco consumption in Dhankuta Municipality was found to be 57.1%. Prevalence of tobacco consumption among the male was significantly higher (67%) than female (47.1%) (p<0.05). Most of the respondents (56.4%) started consuming tobacco due to peer pressure and for recreation (24.8%). The multivariate logistic regression showed that the people with illiterate have higher chances of consuming tobacco than above School Leaving Certificate (OR 38.395, 95% CI=3.209- 459.417). The respondents below poverty line (<1.25 US$) was consuming tobacco more than above poverty line (> 1.25 US $) (OR 6.814, 95% CI= 1.255-36.986). Conclusion The aims of this study was to measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of the Dhankuta Municipality. We conclude that the prevalence rate of tobacco consumption in the Dhankuta Municipality was found to be moderately high. Factors like male in gender, Brahmin/Chhetri in ethnicity, lack of education, poor occupation like farmer and housewife, poor economic status were associated with tobacco use.
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Affiliation(s)
- R B Sah
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - B Pradhan
- Department of Internal Medicine, Koirala Institute of Health Sciences, Dharan, Nepal
| | - L Subedi
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - P Karki
- Department of Internal Medicine, Koirala Institute of Health Sciences, Dharan, Nepal
| | - N Jha
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Abstract
This is a retrospective case series of 233 spinal injury patients admitted to the orthopaedic ward of BPKIHS from May 1997 to April 2001. The inpatient records were analysed. In all, 40.3% of spinal injuries resulted from falls from trees while cutting leaves for fodder, and 27.9% resulted from falls from first/second floors. More than 75% of total spinal injuries are largely preventable. Overall, 46.8% of our spinal injury patients had complete cord transection at the level of injury. All adolescents and adults, irrespective of age or sex, should be the target groups for community education and intervention programmes for prevention of spinal injury.
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Affiliation(s)
- S Lakhey
- Department of Orthopaedics, BP Koirala Institute of Health Sciences, Dharan, Nepal.
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Mishra SK, Jha N, Shankar PR, Dahal PK, Khatiwada B, Sapkota YD. An Assessment of Diabetic Retinopathy and Diabetes Management System in Nepal. J Nepal Health Res Counc 2016; 14:104-110. [PMID: 27885292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Visual damage due to diabetic retinopathy is a major concern which can be reduced through appropriate coordination and cooperation between the diabetes management services and diabetic retinopathy services. The study assessed the existence, availability and accessibility of health care services for diabetes mellitus and diabetic retinopathy in Nepal. METHODS The study was carried out from 1 April to 24 June 2015. The tool for assessment of diabetic retinopathy and diabetes management systems developed by the World Health Organization was used for the assessment of major stakeholders like endocrinologists, ophthalmologists, ophthalmic assistants, nurses involved in diabetes care, patients and human resources from Ministry of Health and Population and international non-governmental organizations dealing with eye care services in Nepal. RESULTS Thirty-seven key stakeholders were selected for the study. Six out of fifteen ophthalmologists were unaware about the prioritization of diabetes as national health concern. The main function of diabetes association included patient education and awareness 18(48.6%), clinician education and awareness 16(43.2%). Thirteen professionals (35.1%) said that the patients were not found to be aware about diabetic patients' organizations. The information to community is provided occasionally and only through national-level media. All forms of diabetes care were funded out-of-pocket by the patients themselves. CONCLUSIONS Coordination should be strengthened for an effective and holistic management of diabetes mellitus making diabetes care and diabetic retinopathy services more accessible. Diabetes mellitus and its complications are becoming a public health threat in Nepal.
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Affiliation(s)
- S K Mishra
- Nepal Netra Jyoti Sangh, Tripureshwor, Kathmandu, Nepal
| | - N Jha
- Department of Clinical Pharmacology, KIST Medical College, Lalitpur, Nepal
| | - P R Shankar
- Department of Pharmacology, Xavier University of School of Medicine, Aruba, Kingdom of Netherlands
| | - P K Dahal
- Department of Community Medicine, KIST Medical College, Lalitpur, Nepal
| | - B Khatiwada
- Nepal Technical Assistance Group, Maitighar, Kathmandu, Nepal
| | - Y D Sapkota
- International Agency for of Prevention of Blindness, India
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Yadav D, Karki P, Yadav S, Jha N. Adherence to antiretroviral drug treatment ARV among people living with HIV/AIDS: A study from Eastern Nepal. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.309] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kulosa AP, Fim D, Zipfel KH, Rühmann S, Sauer S, Jha N, Gibble K, Ertmer W, Rasel EM, Safronova MS, Safronova UI, Porsev SG. Towards a Mg Lattice Clock: Observation of the ^{1}S_{0}-^{3}P_{0} Transition and Determination of the Magic Wavelength. Phys Rev Lett 2015; 115:240801. [PMID: 26705620 DOI: 10.1103/physrevlett.115.240801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Indexed: 06/05/2023]
Abstract
We optically excite the electronic state 3s3p ^{3}P_{0} in ^{24}Mg atoms, laser cooled and trapped in a magic-wavelength lattice. An applied magnetic field enhances the coupling of the light to the otherwise strictly forbidden transition. We determine the magic wavelength, the quadratic magnetic Zeeman shift, and the transition frequency to be 468.46(21) nm, -206.6(2.0) MHz/T^{2}, and 655 058 646 691(101) kHz, respectively. These are compared with theoretical predictions and results from complementary experiments. We also develop a high-precision relativistic structure model for magnesium, give an improved theoretical value for the blackbody radiation shift, and discuss a clock based on bosonic magnesium.
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Affiliation(s)
- A P Kulosa
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - D Fim
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - K H Zipfel
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - S Rühmann
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - S Sauer
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - N Jha
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - K Gibble
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
- Department of Physics, The Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - W Ertmer
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - E M Rasel
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - M S Safronova
- Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
- Joint Quantum Institute, NIST and the University of Maryland, College Park, Maryland 20899, USA
| | - U I Safronova
- Department of Physics, University of Nevada, Reno, Nevada 89557, USA
| | - S G Porsev
- Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
- Petersburg Nuclear Physics Institute, Gatchina 188300, Russia
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Banerjee R, Debenham B, Martell K, Scrimger R, Jha N, Lau H, Parliament M. A Comparison of Primary Chemoradiation Therapy Versus Primary Surgery for Stage III-IV Squamous Cell Carcinoma of the Oropharynx. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.187] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sah RB, Subedi L, Shah U, Jha N, Pokharel PK. Nutritional supplementation practices during pregnancy in Village Development Committees of Morang District, Nepal. J Coll Med Sci-Nepal 2015. [DOI: 10.3126/jcmsn.v10i2.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pregnancy is a critical period for both woman and baby from a nutritional perspective. Poor nutrition, during pregnancy is associated with adverse maternal and fetal outcomes. However, due to various factors, pregnant women do not increase the quality or quantity of diet during pregnancy. OBJECTIVE To find out the prevalence of nutritional supplementations taken during pregnancy and to find out the association between sociodemographic characteristics and nutritional supplementations taken during pregnancy. MATERIALS AND METHODS The cross-sectional study was conducted from 1st March to 14th March, 2014 among the residents of Rangeli VDC of Morang District in Eastern Nepal where 300 households were taken as subjects. Semistructured questionnaire was used and face to face interview was conducted. Chi-square test was applied to find out the association between sociodemographic characteristics and nutritional supplementations taken during pregnancy. RESULT The problem of not taking extra nutritional supplementations during pregnancy is common and has become a key public health concern. Lack of education of wife and husband led some of the respondents not taking more nutritional supplementations during pregnancy. CONCLUSION The problem of not taking extra nutritional supplementations during pregnancy is common and has become a key public health concern. Lack of education of wife and husband led some of the respondents not taking more nutritional supplementations during pregnancy.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12948 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 10-17
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Khanal VK, Jha N, Karki P, Paudel IS. Opportunistic infections and clinical profile of HIV/AIDS patients: A study from eastern region of Nepal. Nepal Med Coll J 2014; 16:194-197. [PMID: 26930745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There is a wide spread availability of highly active antiretroviral treatment but opportunistic illnesses still occur and result in an increased risk of mortality among persons with HIV/AIDS. The spectrum of illness that one observes, changes as the CD4+ cell count declines. The close relationship between clinical manifestation and CD4+ cell count has made measurement of the latter a routine part of evaluation of the progress of HIV infection in individuals: The objective of this study was to reveal the clinical spectrum and explore the different types of opportunistic infections in HIV/AIDS patients. A total of 234 patients with HIV/AIDS from three ART centers of Eastern Nepal were purposively selected for this cross sectional study conducted from May 2009 to April 2010. Statistical analysis was done using SPSS version 11.5. Chi-squared test and Student's t test were applied to find the association between the variables. A p-value less than 0.05 was considered to be significant. Out of the 234 patient, 85% were found to be symptomatic. Most common presenting symptoms were weight loss (74.4%) followed by fever (59.4%). Around 64% of HIV/AIDS patients had a CD4+ cell count below 200 cells/mm3. Most common opportunistic infections were tuberculosis (51.1%) followed by oral candidiasis (21.7%). A significant relationship (p < 0.001) between decrease in CD4+ cell count and occurrence of opportunistic infections in HIV/AIDS patients was seen.
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Abstract
Background Anemia in pregnancy is responsible for many adverse effects on maternal and fetal outcome. It is the commonest hematological disorder accompanying pregnancy. Prevalence of anemia among pregnant women is fairly high worldwide, especially in developing countries. A research finding published by World Health organization revels that the prevalence of anemia among pregnant women in developing countries averages 56% (ranging between 35 to 100%). Though Nepal has decreasing trend of prevalence of anemia, it is still high (42% in 2006). Identifying the associated factors which are responsible for the development of anemia during pregnancy would be of great help in mitigating the burden to some extent. Ojective of the study was to find out the pattern of anemia and associated risk factors for anemia during pregnancy. Materials and Methods A cross-sectional study was conducted in VDC named Hansposa. Door to door survey was carried out to collect data using pre-designed questionnaires. Ante-natal check-ups were provided with analysis of hemoglobin levels, in every individual of study population, using conventional Shali's method. Chi-square test was applied, where applicable. Results Altogether 249 pregnant women were included in the study. The proportion of anemia was found to be 46.6%, the cases of mild anemia, and moderate anemia were 51.0% and 49.0% respectively. Risk factors includes: history of complications during previous pregnancy (P<0.001), education (P<0.05), age at marriage (P=0.028), low socio-economic status (P<0.001), gravidity and parity (P<0.01), poor knowledge about anemia (P<0.001), abnormal body mass index (P<0.001) and smoking (P=0.05). Conclusion This study indicates that the prevalence of anemia during pregnancy bears a resemblance to national value. Major associated risk factors include: history of complications during previous pregnancy, low knowledge about anemia in pregnant women, women with low body mass index, age at marriage, socio-economic status, gravidity and parity, and smoking. Most importantly, the lack of commitment in female education plays vital role in its existence.DOI: http://dx.doi.org/10.3126/nje.v4i4.11358 Nepal Journal of Epidemiology 2014; 4(4):386-92
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Sah RB, Gaurav K, Baral DD, Subedi L, Jha N, Pokharel PK. Factors affecting Early Age Marriage in Dhankuta Municipality, Nepal. ACTA ACUST UNITED AC 2014. [DOI: 10.3126/njms.v3i1.10354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Child marriage is a substantial barrier to social and economic development in Nepal, and a primary concern for women’s health. Little evidence from Nepal is available regarding the ways in which early marriage may compromise young women’s lives and their reproductive health and choices. The objectives of this study was to find out the factors associated with early age marriages in Dhankuta Municipality. Methods: The cross-sectional study was conducted among the residents of Dhankuta municipality, Nepal; where 246 households were taken as subjects. Pretested semi-structured questionnaire was administered to the study subjects and face to face interview was conducted. Chi-square test was applied to find out the association between factors and age of marriages. Results: Almost 53.3% of women were married before age 18 years. Education of wife and husband, and economic status are found to be the important variables in explaining early age marriage. Prevalence of child marriage was higher in Hindu than in Buddhist and Christian women but the difference was not significant. Age of marriage was not significantly associated with contraceptive use. Unwanted pregnancies were higher in early age marriage. It was also seen that unwanted pregnancies was higher (59.3%) than wanted pregnancies (48.6%). Conclusion: The findings of the study indicate that early age marriage was associated with low education and being poor. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 26-30 DOI: http://dx.doi.org/10.3126/njms.v3i1.10354
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Jha N. Social Marketing in Health: Developing Country’s Perspective. Nepal j obstet gynaecol 2014. [DOI: 10.3126/njog.v8i2.9758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
No abstract available.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 1-4 DOI: http://dx.doi.org/10.3126/njog.v8i2.9758
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Saggar S, Jha N, Deslippe J, Bolan NS, Luo J, Giltrap DL, Kim DG, Zaman M, Tillman RW. Denitrification and N2O:N2 production in temperate grasslands: processes, measurements, modelling and mitigating negative impacts. Sci Total Environ 2013; 465:173-95. [PMID: 23260378 DOI: 10.1016/j.scitotenv.2012.11.050] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [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: 09/11/2012] [Revised: 11/11/2012] [Accepted: 11/12/2012] [Indexed: 05/02/2023]
Abstract
In this review we explore the biotic transformations of nitrogenous compounds that occur during denitrification, and the factors that influence denitrifier populations and enzyme activities, and hence, affect the production of nitrous oxide (N2O) and dinitrogen (N2) in soils. Characteristics of the genes related to denitrification are also presented. Denitrification is discussed with particular emphasis on nitrogen (N) inputs and dynamics within grasslands, and their impacts on the key soil variables and processes regulating denitrification and related gaseous N2O and N2 emissions. Factors affecting denitrification include soil N, carbon (C), pH, temperature, oxygen supply and water content. We understand that the N2O:N2 production ratio responds to the changes in these factors. Increased soil N supply, decreased soil pH, C availability and water content generally increase N2O:N2 ratio. The review also covers approaches to identify and quantify denitrification, including acetylene inhibition, (15)N tracer and direct N2 quantification techniques. We also outline the importance of emerging molecular techniques to assess gene diversity and reveal enzymes that consume N2O during denitrification and the factors affecting their activities and consider a process-based approach that can be used to quantify the N2O:N2 product ratio and N2O emissions with known levels of uncertainty in soils. Finally, we explore strategies to reduce the N2O:N2 product ratio during denitrification to mitigate N2O emissions. Future research needs to focus on evaluating the N2O-reducing ability of the denitrifiers to accelerate the conversion of N2O to N2 and the reduction of N2O:N2 ratio during denitrification.
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Affiliation(s)
- Surinder Saggar
- Ecosystems & Global Change Team, Landcare Research, Private Bag 11052, Palmerston North 4442, New Zealand.
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Sah RB, Pokharel PK, Paudel IS, Acharya A, Jha N, Bhattarai S. A study of prevalence of Taenia infestation and associated risk factors among the school children of Dharan. Kathmandu Univ Med J (KUMJ) 2013; 10:14-7. [PMID: 23434955 DOI: 10.3126/kumj.v10i3.8011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Taenia prevalence has remained high among certain ethnic groups and occupational diseases in Nepal. Taenia saginata and Taenia solium species are worldwide in distribution. Infection is found most often in rural areas of developing countries with poor hygiene and living in close contact with pigs and eating undercooked pork meats. This allows the tapeworm infection to be completed and its cycle to continue. OBJECTIVES To measure the prevalence of taenia infestation and to identify risk factors associated with taenia infestation among the school children of Dharan. METHODS A cross sectional study was conducted among 935 Government and private school going children of Grade VI, VII, and VIII of Dharan during 2007 to 2008. Stratified random sampling method was applied to choose the schools and the study subjects. The prevalence was calculated, Chi-square test was used to measure the association of risk factors and taenia infestation. RESULTS Taenia species was found to be high (5.5%) among the school children of Dharan. Infection rate of taenia among the male children (6.0%) was slightly higher than female (4.8%). There were no cases of taenia infestation found among children washing hands with soap. Regarding meat consumption in the non-vegetarian group, taenia infestation was found higher (6.5%) among pork eating than nonpork eating (4.7%). No significant relationship was traced among the factors in the causation of taenia infestation although slight indications present. CONCLUSION Taenia species was found very high among the school children of Dharan. No such association was found with the risk factors.
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Affiliation(s)
- R B Sah
- School of Public Health and Community Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal.
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Jejeebhoy SJ, Kalyanwala S, Mundle S, Tank J, Zavier AJF, Kumar R, Acharya R, Jha N. Feasibility of expanding the medication abortion provider base in India to include ayurvedic physicians and nurses. Int Perspect Sex Reprod Health 2013; 38:133-42. [PMID: 23018135 DOI: 10.1363/3813312] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT The availability of trained abortion providers is limited in India. Allowing ayurvedic physicians and nurses to perform medication abortions may improve women's access to the procedure, but it is unclear whether these clinicians can provide these services safely and effectively. METHODS Allopathic physicians, ayurvedic physicians and nurses (10 of each), none of whom had experience in abortion provision, were trained to perform medication abortions. In 2008-2010, these providers performed medication abortions in five clinics in Bihar and Jharkhand for 1,225 women with a pregnancy of up to eight weeks' gestation. A two-sided equivalence design was used to test whether providers' assessments of client eligibility and completeness of abortion matched those of an experienced physician "verifier," and whether medication abortions performed by nurses and ayurvedic physicians were as safe and effective as those done by allopathic physicians. RESULTS Failure rates were low (5-6%), and those for nurses and ayurvedic physicians were statistically equivalent to those for allopathic physicians. Provider assessments of client eligibility and completeness of abortion differed from those of the verifier in only a small proportion of cases (3-4% for eligibility and 4-5% for completeness); these proportions, and rates of loss to follow-up, were statistically equivalent among provider types. No serious complications were observed, and services by all three groups of providers were acceptable to women. CONCLUSION Findings support amending existing laws to improve women's access to medication abortion by expanding the provider base to include ayurvedic physicians and nurses.
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Gurung GN, Chhetri PSG, Jha N. Economic impact of pulmonary tuberculosis on patients and their families of Dharan municipality, Nepal. Nepal Med Coll J 2012; 14:196-198. [PMID: 24047014] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Tuberculosis (TB) affects mostly economically active population in underdeveloped and developing countries, therefore TB can have far reaching economic and social consequences among infected people and their household members. The objectives of this study were to estimate the household expenditure before and during the course of disease, to explore the direct and indirect cost burden of tuberculosis in terms of annual family income and to compare the total cost burden in a family of case treated with directly observed treatment shortcourse (DOTS) and without DOTS. A total of 160 treatment completed, pulmonary tuberculosis (PTB) cases fulfilling the inclusion criteria were interviewed. The median patients income before and during illness was US$1.95 and US$0.9 respectively. Similarly, household expenditure before illness was US$3.24 and during illness was US$4.28. Direct cost burden in terms of annual family income was higher (15.2%) than indirect cost burden (8.2%). But, free distribution of anti tuberculosis therapy (ATT) through DOTS reduced the total cost burden of patient by more than 8%. In conclusion, overall cost burden of pulmonary tuberculosis is high even though the treatment is free of cost.
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Affiliation(s)
- G N Gurung
- School of Public Health and Community Medicine, BP Koirala Institute of Health sciences, Dharan, Nepal.
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Choudhari M, Jha N, Yadav DK, Chaudhary D. Factors associated with patient delay in diagnosis of pulmonary tuberculosis in a district. J Nepal Health Res Counc 2012; 10:234-238. [PMID: 23281458] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Tuberculosis one of the major public health problems that is affecting large number of people each year including Nepal. METHODS A descriptive cross sectional study was conducted in Sunsari district of Nepal. The patients with pulmonary tuberculosis patients from 14 DOTS centers in the District were interviewed. Face to face interview by using structured questionnaire was used for data collection. Extra pulmonary tuberculosis and patients under Category II were excluded from the study.Data entry and analysis was carried out in SPSS version 16. Pearson Chi square test was used to test the association between outcome variable with different categorical independent variables. RESULTS Out of the total 215 patients, 91 (65.6%) were male, 109 (50.7%) were from rural residence, 69 (32.1%) were illiterate, 147 (68.4%) were married and 141 (66%) were sputum positive. The overall median patient delay was 42 days. About 145 (67.4%) of the patients had delayed their first consultation for more than 30 days. The patient delays were 56 out of 68 (82.4%) in age above 50 years patients, 121 out of 161 (75.2%) in married patients, 37 out of 45 (82.2%) in Kirats, 55 out of 69 (72.7%) in illiterates and 95 out of 124 (76.6%) in those who travel the distance of 2 or more km from the place of residence to health facility. CONCLUSIONS Since the time duration before the treatment and diagnosis in TB patients is long, this study emphasizes the need of awareness about symptoms of tuberculosis among general population.
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Affiliation(s)
- M Choudhari
- Koshi Science and Health Campus, Biratnagar, Nepal.
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Abstract
BACKGROUND Pharmacovigilance is the "science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems". Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored. AIMS To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal. METHOD A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability. RESULTS A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs. CONCLUSION Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.
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Affiliation(s)
- N Jha
- Department of Pharmacology, KIST Medical College, Lalitpur, Nepal.
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Abstract
BACKGROUND Pharmacovigilance is the "science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems". Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored. AIMS To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal. METHOD A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability. RESULTS A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs. CONCLUSION Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.
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Affiliation(s)
- N Jha
- Department of Pharmacology, KIST Medical College, Lalitpur, Nepal.
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Khanna L, Rohatgi A, Jha N. Chylothorax after esophagectomy. J Assoc Physicians India 2012; 60:46. [PMID: 23405540] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- L Khanna
- Department of Neurology, Sir Gangaram Hospital, N Delhi
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Ghimire A, Nagesh S, Jha N, Niraula SR, Devkota S. The Burden of Injury in terms of Economic Loss and Disability Days: A Community Based Study from Eastern Nepal. ACTA ACUST UNITED AC 2012; 9:27-30. [DOI: 10.3126/kumj.v9i2.6283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Injuries are already a substantial public Health problem all over the world and are expected to increase in the 211st Century. They are major causes of deaths and disability in the population and also involve high societal costs. Objectives This study was designed to assess the economic loss due to the injury and the disability days due to different types of injuries. Methods A systematic random sampling technique was used to select 1388 households from 19 wards. A detailed questionnaire was used to collect information related to injuries to the persons suffered from injuries including treatment obtained, cost of treatment (direct/indirect cost) and length of disability. Results Among the minor injured persons, majority (93.2%) did not spend any indirect cost. 36.7% of the major inured persons spent Nepalese rupees 10,001 to NRs 100,000 as direct treatment costs. But 50% spent less than 5000 NRs as indirect cost for major injury treatment. Maximum number (67.4%) of major injured persons had disability days of 31 to 90 days. Conclusion The high incidence of injuries, especially road traffic injuries, adds a huge economic burden to nation.DOI: http://dx.doi.org/10.3126/kumj.v9i2.6283Kathmandu Univ Med J 2011;9(2):27-30
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Pokhrel BR, Sharma P, Bhatta B, Bhandari B, Jha N. Health seeking behavior during pregnancy and child birth among Muslim women of Biratnagar, Nepal. Nepal Med Coll J 2012; 14:125-128. [PMID: 23671962] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Maternal mortality remains one of the biggest public health challenges in Nepal. This paper explores the health seeking behavior, during pregnancy and child birth in certain ethnic group. The poverty, illiteracy, women's low status in the society, lack of access and difficult geographical terrain are major reasons for poor maternal health status in Nepal. Cross-sectional study was conducted among 200 Muslim women of ward # 7 of Biratnagar municipality. They were interviewed to understand their health seeking behavior during pregnancy and childbirth, factors associated with use of health services and their role in the family. Information's on usages of health services, education level, family stricture, and occupational status, information were collected using a pretested and structured questionnaire. The overall institutional delivery in study population was found 24.5%. Low socio-economic status, Illiteracy and poverty in women are the major challenging features of pregnancy and child birth.
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Affiliation(s)
- B R Pokhrel
- Department of Community Medicine, Nobel Medical College Teaching Hospital and Research Center Biratnagar Morang Nepal.
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Shamji M, Moon ES, Glennie R, Soroceanu A, Lin C, Bailey C, Simmonds A, Fehlings M, Dodwell E, Dold A, El-Hawary R, Hashem M, Dold A, Dold A, Jones S, Bailey C, Karadimas S, Whitehurst D, Norton J, Norton J, Manson N, Kesani A, Bednar D, Lundine K, Hartig D, Fichadi A, Fehlings M, Kim S, Harris S, Lin C, Gill J, Abraham E, Shamji M, Choi S, Goldstein C, Wang Z, McCabe M, Noonan V, Nadeau M, Ferrara S, Kelly A, Melnyk A, Arora D, Quateen A, Dea N, Ranganathan A, Zhang Y, Casha S, Rajamanickam K, Santos A, Santos A, Wilson J, Wilson J, Street J, Wilson J, Lewis R, Noonan V, Street J, El-Hawary R, Egge N, Lin C, Schouten R, Lin C, Kim A, Kwon B, Huang E, Hwang P, Allen K, Jing L, Mata B, Gabr M, Richardson W, Setton L, Karadimas S, Fehlings M, Fleming J, Bailey C, Gurr K, Bailey S, Siddiqi F, Lawendy A, Sanders D, Staudt M, Canacari E, Brown E, Robinson A, McGuire K, Chrysostoum C, Rampersaud YR, Dvorak M, Thomas K, Boyd M, Gurr K, Bailey S, Nadeau M, Fisher C, Batke J, Street J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Vaccaro A, Chapman J, Arnold P, Shaffrey C, Kopjar B, Snyder B, Wright J, Lewis S, Zeller R, El-Hawary R, Moroz P, Bacon S, Jarzem P, Hedden D, Howard J, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Parent E, Hill D, Hedden D, Moreau M, Mahood J, Lewis S, Bodrogi A, Abbas H, Goldstein S, Bronstein Y, Bacon S, Chua S, Magana S, Van Houwelingen A, Halpern E, Jhaveri S, Lewis S, Lim A, Leelapattana P, Fleming J, Siddiqqi F, Bailey S, Gurr K, Moon ES, Satkunendrarajah K, Fehlings M, Noonan V, Dvorak M, Bryan S, Aronyk K, Fox R, Nataraj A, Pugh J, Elliott R, McKeon M, Abraham E, Fleming J, Gurr K, Bailey S, Siddiqi F, Bailey C, Davis G, Rogers M, Staples M, Quan G, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Shamji M, Hurlbert R, Jacobs W, Duplessis S, Casha S, Jha N, Hewson S, Massicotte E, Kopjar B, Mortaz S, Coyte P, Rampersaud Y, Rampersaud Y, Goldstein S, Andrew B, Modi H, Magana S, Lewis S, Roffey D, Miles I, Wai E, Manson N, Eastwood D, Elliot R, McKeon M, Bains I, Yong E, Sutherland G, Hurlbert R, Rampersaud Y, Chan V, Persaud O, Koshkin A, Brull R, Hassan N, Petis S, Kowalczuk M, Petrisor B, Drew B, Bhandari M, DiPaola C, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, McLachlin S, Bailey S, Gurr K, Bailey C, Dunning C, Fehlings M, Vaccaro A, Wing P, Itshayek E, Biering-Sorensen F, Dvorak M, McLachlin S, Bailey S, Gurr K, Dunning C, Bailey C, Bradi A, Pokrupa R, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Kelly A, Wen T, Kingwell S, Chak J, Singh V, Cripton P, Fisher C, Dvorak M, Oxland T, Wali Z, Yen D, Alfllouse A, Alzahrani A, Jiang H, Mahood J, Kortbeek F, Fox R, Nataraj A, Street J, Boyd M, Paquette S, Kwon B, Batke J, Dvorak M, Fisher C, Reddy R, Rampersaud R, Hurlbert J, Yong W, Casha S, Zygun D, McGowan D, Bains I, Yong V, Hurlbert R, Mendis B, Chakraborty S, Nguyen T, Tsai E, Chen A, Atkins D, Noonan V, Drew B, Tsui D, Townson A, Dvorak M, Chen A, Atkins D, Noonan V, Drew B, Dvorak M, Craven C, Ford M, Ahn H, Drew B, Fehlings M, Kiss A, Vaccaro A, Harrop J, Grossman R, Frankowski R, Guest J, Dvorak M, Aarabi B, Fehlings M, Noonan V, Cheung A, Sun B, Dvorak M, Vaccaro A, Harrop J, Massicotte E, Dvorak M, Fisher C, Rampersaud R, Lewis S, Fehlings M, Marais L, Noonan V, Queyranne M, Fehlings M, Dvorak M, Atkins D, Hurlbert R, Fox R, Fourney D, Johnson M, Fehlings M, Ahn H, Ford M, Yee A, Finkelstein J, Tsai E, Bailey C, Drew B, Paquet J, Parent S, Christie S, Dvorak M, Noonan V, Cheung A, Sun B, Dvorak M, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Lange J, DiPaola C, Lapinsky A, Connolly P, Eck J, Rabin D, Zeller R, Lewis S, Lee R, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, DiPaola C, Street J, Bodrogi A, Goldstein S, Sofia M, Lewis S, Shin J, Tung K, Ahn H, Lee R, Batke J, Ghag R, Noonan V, Dvorak M, Goyal T, Littlewood J, Bains I, Cho R, Thomas K, Swamy G. Canadian Spine Society abstracts1.1.01 Supraspinal modulation of gait abnormalities associated with noncompressive radiculopathy may be mediated by altered neurotransmitter sensitivity1.1.02 Neuroprotective effects of the sodium-glutamate blocker riluzole in the setting of experimental chronic spondylotic myelopathy1.1.03 The effect of timing to decompression in cauda equina syndrome using a rat model1.2.04 Intraoperative waste in spine surgery: incidence, cost and effectiveness of an educational program1.2.05 Looking beyond the clinical box: the health services impact of surgical adverse events1.2.06 Brace versus no brace for the treatment of thoracolumbar burst fractures without neurologic injury: a multicentre prospective randomized controlled trial1.2.07 Adverse event rates in surgically treated spine injuries without neurologic deficit1.2.08 Functional and quality of life outcomes in geriatric patients with type II odontoid fracture: 1-year results from the AOSpine North America Multi-Center Prospective GOF Study1.3.09 National US practices in pediatric spinal fusion: in-hospital complications, length of stay, mortality, costs and BMP utilization1.3.10 Current trends in the surgical treatment of adolescent idiopathic scoliosis in Canada1.3.11 Sagittal spinopelvic parameters help predict the risk of proximal junctional kyphosis for children treated with posterior distraction-based implants1.4.12 Correlations between changes in surface topography and changes in radiograph measurements from before to 6 months after surgery in adolescents with idiopathic scoliosis1.4.13 High upper instrumented vertebra (UIV) sagittal angle is associated with UIV fracture in adult deformity corrections1.4.14 Correction of adult idiopathic scoliosis using intraoperative skeletal traction1.5.01 Cauda equina: using management protocols to reduce delays in diagnosis1.5.02 Predicting the need for tracheostomy in patients with acute traumatic spinal cord injury1.5.03 A novel animal model of cervical spondylotic myelopathy: an opportunity to identify new therapeutic targets1.5.04 A review of preference-based measures of health-related quality of life in spinal cord injury research1.5.05 Predicting postoperative neuropathic pain following surgery involving nerve root manipulation based on intraoperative electromyographic activity1.5.06 Detecting positional injuries in prone spinal surgery1.5.07 Percutaneous thoracolumbar stabilization for trauma: surgical morbidity, clinical outcomes and revision surgery1.5.08 Systemic inflammatory response syndrome in spinal cord injury patients: Does its presence at admission affect patient outcomes?2.1.15 One hundred years of spine surgery — a review of the evolution of our craft and practice in the spine surgical century [presentation]2.1.16 Prevalence of preoperative MRI findings of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion2.1.17 Adverse event rates of surgically treated cervical spondylopathic myelopathy2.1.18 Morphometricand dynamic changes in the cervical spine following anterior cervical discectomy and fusion and cervical disc arthroplasty2.1.19 Is surgery for cervical spondylotic myelopathy cost-effective? A cost–utility analysis based on data from the AO Spine North American Prospective Multicentre CSM Study2.2.20 Cost–utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis (DLS)2.2.21 Minimally invasive surgery lumbar fusion for low-grade isthmic and degenerative spondylolisthesis: 2- to 5-year follow-up2.2.22 Results and complications of posterior-only reduction and fusion for high-grade spondylolisthesis2.3.23 Fusion versus no fusion in patients with central lumbar spinal stenosis and foraminal stenosis undergoing decompression surgery: comparison of outcomes at baseline and follow-up2.3.24 Two-year results of interspinous spacers (DIAM) as an alternative to arthrodesis for lumbar degenerative disorders2.3.25 Treatment of herniated lumbar disc by sequestrectomy or conventional discectomy2.4.26 No sustained benefit of continuous epidural analgesia for minimally invasive lumbar fusion: a randomized double-blinded placebo controlled study2.4.27 Evidence and current practice in the radiologic assessment of lumbar spine fusion2.4.28 Wiltse versus midline approach for decompression and fusion of the lumbar spine2.5.09 The effect of soft tissue restraints following type II odontoid fractures in the elderly — a biomechanical study2.5.10 Development of an international spinal cord injury (SCI) spinal column injury basic data set2.5.11 Evaluation of instrumentation techniques for a unilateral facet perch and fracture using a validated soft tissue injury model2.5.12 Decreasing neurologic consequences in patients with spinal infection: the testing of a novel diagnostic guideline2.5.13 Prospective analysis of adverse events in surgical treatment of degenerative spondylolisthesis2.5.14 Load transfer characteristics between posterior fusion devices and the lumbar spine under anterior shear loading: an in vitro investigation2.5.15 Preoperative predictive clinical and radiographic factors influencing functional outcome after lumbar discectomy2.5.16 A Thoracolumbar Injury Classification and Severity Score (TLICS) of 4: What should we really do?3.1.29 Adverse events in emergent oncologic spine surgery: a prospective analysis3.1.30 En-bloc resection of primary spinal and paraspinal tumours with critical vascular involvement3.1.31 The treatment impact of minocycline on quantitative MRI in acute spinal cord injury3.1.32 Benefit of minocycline in spinal cord injury — results of a double-blind randomized placebo-controlled study3.2.33 Improvement of magnetic resonance imaging correlation with unilateral motor or sensory deficits using diffusion tensor imaging3.2.34 Comparing care delivery for acute traumatic spinal cord injury in 2 Canadian centres: How do the processes of care differ?3.2.35 Improving access to early surgery: a comparison of 2 centres3.3.36 The effects of early surgical decompression on motor recovery after traumatic spinal cord injury: results of a Canadian multicentre study3.3.37 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors3.3.38 Effect of motor score on adverse events and quality of life in patients with traumatic spinal cord injury3.4.39 The impact of facet dislocation on neurologic recovery after cervical spinal cord injury: an analysis of data on 325 patients from the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS)3.4.40 Toward a more precise understanding of the epidemiology of traumatic spinal cord injury in Canada3.4.41 Access to care (ACT) for traumatic SCI: a survey of acute Canadian spine centres3.4.42 Use of the Spine Adverse Events Severity (SAVES) instrument for traumatic spinal cord injury3.5.17 Does the type of distraction-based growing system for early onset scoliosis affect postoperative sagittal alignment?3.5.18 Comparison of radiation exposure during thoracolumbar fusion using fluoroscopic guidance versus anatomic placement of pedicle screws3.5.19 Skeletal traction for intraoperative reduction in adolescent idiopathic scoliosis3.5.20 Utility of intraoperative cone-beam computed tomography (O-ARM) and stereotactic navigation in acute spinal trauma surgery3.5.21 Use of a central compression rod to reduce thoracic level spinal osteotomies3.5.22 ICD-10 coding accuracy for spinal cord injured patients3.5.23 Feasibility of patient recruitment in acute SCI trials3.5.24 Treatment of adult degenerative scoliosis with DLIF approaches. Can J Surg 2012. [DOI: 10.1503/cjs.012212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Scrimger R, Seikaly H, Jha N, Parliament M, Harris J, Williams D, Zhu G. PO-0722 SURGICAL TRANSFER OF THE SUBMANDIBULAR GLAND WITH IMRT RESULTS IN EXCELLENT LONG-TERM SALIVA PRODUCTION. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71055-1] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jha N, Harvey PD. Profile of female sterilisation clients at eight clinics in Eastern India. J Fam Plann Reprod Health Care 2012; 38:143-4. [PMID: 22454029 DOI: 10.1136/jfprhc-2011-100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jejeebhoy SJ, Kalyanwala S, Zavier AF, Kumar R, Mundle S, Tank J, Acharya R, Jha N. Can nurses perform manual vacuum aspiration (MVA) as safely and effectively as physicians? Evidence from India. Contraception 2011; 84:615-21. [DOI: 10.1016/j.contraception.2011.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/10/2011] [Accepted: 08/17/2011] [Indexed: 11/30/2022]
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Shankar R, Bajracharya O, Jha N, Gurung SB, Ansari SR, Thapa HS. Change in medical students' readiness for self-directed learning after a partially problem-based learning first year curriculum at the KIST medical college in Lalitpur, Nepal. Educ Health (Abingdon) 2011; 24:552. [PMID: 22081659] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Modern medical education and the requirement for lifelong learning place increasing emphasis on self-directed learning. Studies have not been done on readiness for self-directed learning (SDL) among medical students in Nepal. The present study was carried out to (1) measure and compare readiness for SDL among medical students, and (2) note differences in readiness for SDL according to students' personal characteristics at the beginning and end of the first year of the MBBS course for medical students at the KIST Medical College in Nepal. METHODS The study was done using the Self-directed Learning Readiness Scale. Respondents' agreement with each of forty statements pertinent to self-directed learning readiness using a modified Likert-type scale was noted. The mean total and scores on the subcategories 'self-management', 'desire for learning' and 'self-control' were calculated and compared across subgroups of respondents and in January and August 2010 using appropriate parametric and non-parametric tests (p<0.05). RESULTS All 100 students participated in January while 90 participated in August. The mean scores varied with certain demographic and background characteristics. The mean total score increased from 152.7 to 157.3 while the self-management score increased significantly from 48.6 to 50.2 from January to August. There were small increases in the mean desire for learning scores from 46.9 to 47.7 and in the self-control scores from 58 to 59 from January to August, but not in other scores. CONCLUSIONS Self-directed learning scores were lower among these Nepalese students than reported elsewhere in the literature. Total scores and self-management scores improved at the end of the first year, but not scores on desire for learning and self-control.
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Affiliation(s)
- R Shankar
- KIST Medical College, Imadol VDC, Lalitpur, Nepal.
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Uprety S, Jha N, Poudel IS, Pokharel P, Poudel M, Niraula SR. Impact and Determinants of Gender Preference in Duhavi VDC of Eastern Nepal. JNMA J Nepal Med Assoc 2011. [DOI: 10.31729/jnma.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction: Gender equality has been a priority area of demographic research. One of the major reasons for high fertility and low acceptance of family planning is the prevalence of gender preference among couples. The objectives of this study were to identify the determinants and examine the extent of gender preference on fertility.
Methods: This is a cross-sectional study carried from June 2008 to July 2009 in Duhavi VDC of Sunsari district of Nepal. Three hundred and fi ve randomly selected ever-married women of 15 - 49 years, who had at least one child were the subjects of the study. A questionnaire covering the areas on gender and fertility preference and methods and use of contraception was given and fi lled up.
Results: The study showed that 42.6 % of the ever-married women belonged to the 25 - 29 years age group. Around 92 % of women whose last child was a male were using family planning methods whereas only 40 % of women whose last child was a female were using family planning methods. This difference was statistically signifi cant (P < 0.0001).
Conclusions: The contraception use among the women having a female child was low, showing a desire for a male child which is one of the factors in the increase of family size in our society. Due to the patrilineal society, women are discouraged in the practice of contraception. Effective intervention programs need to be planned and conducted to rectify this situation.
Keywords: Determinants, Duhavi VDC, gender preference, impact, Nepal.
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Abstract
There are a number of sources available to prescribers to stay up to date about medicines. Prescribers in rural areas in developing countries however, may not able to access some of them. Interventions to improve prescribing can be educational, managerial, and regulatory or use a mix of strategies. Detailing by the pharmaceutical industry is widespread. Academic detailing (AD) has been classically seen as a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits physicians in their offices to provide evidence-based information. Face-to-face sessions, preferably on an individual basis, clear educational and behavioural objectives, establishing credibility with respect to objectivity, stimulating physician interaction, use of concise graphic educational materials, highlighting key messages, and when possible, providing positive reinforcement of improved practices in follow-up visits can increase success of AD initiatives. AD is common in developed countries and certain examples have been cited in this review. In developing countries the authors have come across reports of AD in Pakistan, Sudan, Argentina and Uruguay, Bihar state in India, Zambia, Cuba, Indonesia and Mexico. AD had a consistent, small but potentially significant impact on prescribing practices. AD has much less resources at its command compared to the efforts by the industry. Steps have to be taken to formally start AD in Nepal and there may be specific hindering factors similar to those in other developing nations.
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Affiliation(s)
- P R Shankar
- Department of Clinical Pharmacology, KIST Medical College, Gwarko, Nepal.
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Uprety S, Jha N, Poudel IS, Pokharel PK, Poudel M, Niraula SR. Impact and determinants of gender preference in Duhavi VDC of eastern Nepal. JNMA J Nepal Med Assoc 2011; 51:28-33. [PMID: 22335092] [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: 05/31/2023] Open
Abstract
INTRODUCTION Gender equality has been a priority area of demographic research. One of the major reasons for high fertility and low acceptance of family planning is the prevalence of gender preference among couples. The objectives of this study were to identify the determinants and examine the extent of gender preference on fertility. METHODS This is a cross-sectional study carried from June 2008 to July 2009 in Duhavi VDC of Sunsari district of Nepal. Three hundred and five randomly selected ever-married women of 15 - 49 years, who had at least one child were the subjects of the study. A questionnaire covering the areas on gender and fertility preference and methods and use of contraception was given and filled up. RESULTS The study showed that 42.6% of the ever-married women belonged to the 25 - 29 years age group. Around 92% of women whose last child was a male were using family planning methods whereas only 40% of women whose last child was a female were using family planning methods. This difference was statistically significant (P < 0.0001). CONCLUSIONS The contraception use among the women having a female child was low, showing a desire for a male child which is one of the factors in the increase of family size in our society. Due to the patrilineal society, women are discouraged in the practice of contraception. Effective intervention programs need to be planned and conducted to rectify this situation.
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Affiliation(s)
- S Uprety
- School of Public Health and Community Medicine, BP Koirala Institute of Health Science, Ghopa, Dharan, Nepal.
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Mehta KD, Karki P, Lamsal M, Paudel IS, Majhi S, Das BKL, Sharma S, Jha N, Baral N. Hyperglycemia, glucose intolerance, hypertension and socioeconomic position in eastern Nepal. Southeast Asian J Trop Med Public Health 2011; 42:197-207. [PMID: 21323183] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Abstract. The present study was undertaken to evaluate differences between urban and rural Nepali populations in terms of hyperglycemia, socioeconomic position (SEP) and hypertension, through a community based survey in Sunsari District, eastern Nepal. Blood glucose levels were measured in participants (N = 2,006) S30 years old from urban and rural communities and were classified according to WHO criteria (1998) into normoglycemia (NGY), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and hyperglycemia (HGY). SEP was assessed by structured health interview along with anthropometric measurements and behavioral variables. Hypertension was classified per Joint National Committee (JNC-VII) criteria. Ten point three percent and 11.9% of subjects in this survey (13.3% urban and 11.0% rural) gave a family history and personal history of diabetes mellitus, respectively. Of urban participants (n = 736) with no history of diabetes 70 (9.5%) had HGY and 143 (19.4%) had glucose intolerance (IFG and IGT). Of rural participants (n = 1,270) 114 (9.0%) had HGY and 176 (13.9%) had glucose intolerance. There was an increasing trend in numbers of cases of hyperglycemia and intolerance with increasing age (chi2 198.2, p < 0.001), body mass index (BMI) (chi2 35.1, p < 0.001), SEP (chi2 48.5, p < 0.001) and hypertension (chi2 130.6, p < 0.001). Rural participants had a lower odds ratio [0.706; 95% confidence interval (CI) 0.455-1.096] of having hyperglycemia than urban participants. Individuals with medium and higher SEP had a lower odds ratio (0.878; CI 0.543-1.868) and higher odds ratio (1.405; CI 0.798-2.474), respectively, compared to individuals with lower SEP of having HGY. Both urban and rural populations are at risk for hyperglycemia and glucose intolerance. Individuals having a medium SEP had lower risk of diabetes mellitus than individuals from lower and higher SEP.
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Affiliation(s)
- K D Mehta
- Department of Biochemistry, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Shankar P, Gurung S, Jha N, Bajracharya O, Karki B, Thapa T. Small group effectiveness during pharmacology learning sessions in a Nepalese medical school. Australas Med J 2011; 4:327-31. [PMID: 23386895 DOI: 10.4066/amj.2011.662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Small group learning sessions are used in pharmacology at the KIST Medical College, Lalitpur, Nepal. Feedback about student behaviours that enhance and hinder small group effectiveness was obtained. This will help us improve the small group sessions and will also be useful to educators using small groups in other medical schools. METHOD The small groups were self-managing with a group leader, time-keeper, recorder and presenter. Small group effectiveness was measured using the Tutorial Group Effectiveness Instrument (TGEI) developed by Singaram and co-authors. The instrument was administered in June 2010 and key findings obtained were shared with students and facilitators. The instrument was administered again in August. The mean cognitive, motivational, demotivational and overall scores were compared among different categories of respondents in June and August. Scores were also compared between June and August 2010. RESULTS A total of 89 students participated in the study in June and 88 in August 2010. In June, females rated overall group productivity higher compared to males. The cognitive and motivational scores were higher in August 2010 while the demotivational score was lower. CONCLUSION The small group effectiveness was higher in August after the educational intervention which utilised feedback about problems observed, theoretical considerations of effective small groups and how this information can be applied in practice.
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Affiliation(s)
- Pr Shankar
- KIST Medical College, Imadol, Lalitpur, Nepal
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