Reinnervation and neuropeptides in mouse skin flaps

Degeneration and regeneration of nerves in skin flaps has so far been studied mainly by classical staining methods and there is little information on neuropeptide involvement. Therefore, we have investigated immunocytochemically the temporal course of reinnervation of neuropeptide appearance in skin flaps of mice. Fibres immunoreactive for a general neural marker protein gene product 9.5 (PGP 9.5), and for the neuropeptides substance P, calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) disappeared by 24 h in the flap and surrounding skin. By the 7th day, PGP 9.5-immunoreactive nerves were seen close to the pedicle. By 15 days, they were seen within the body of the flap, clustered focally without specific organisation in greater density than in control skin. Many were also immunoreactive for CGRP and substance P. Neural immunoreactivity for VIP and NPY appeared later (day 30). Thus, regrowing nerves appear initially to be denser than normal innervation. The early appearance of apparently hypertrophic sensory neuropeptide-containing (CGRP and substance P) fibres may have a role in trophic, regulatory and reparative processes.

Is economic dependence on the husband a risk factor for intimate partner violence against female factory workers in Nepal?

Background

Violence related injury is a serious public health issue all over the world. This study aims to assess the association between several socio-economic factors and intimate partner violence (IPV) in Nepal.

Methods

A cross-sectional study was conducted among 236 women working in carpet and garment factories in Kathmandu, Nepal. Interviews were conducted to collect quantitative data on three forms of IPV, namely physical violence, psychological violence and sexual violence, as well as on a number of potentially associated factors.

Results

Twenty-two percent of women experienced sexual IPV, 28% physical IPV and 35% psychological IPV at least once in the last 12 months. The variables independently associated with at least one form of IPV were: age of the woman >29 years [OR = 4.23, p = 0.025 for physical IPV; OR = 6.94, p = 0.008 for sexual IPV; OR = 3.42, p = 0.043 for psychological IPV], alcohol consumption of the husband [OR = 9.97, p < 0.001 for physical IPV; OR = 3.76, p = 0.004 for sexual IPV; OR = 4.85, p < 0.001 for psychological IPV], education of the husband above primary level [OR = 0.43, p = 0.013 for physical IPV; OR = 0.51, p = 0.033 for psychological IPV], and economic dependency of the woman on the husband [OR = 3.04, p = 0.021 for physical IPV; OR = 2.97, p = 0.008 for psychological IPV].

Conclusions

This study identified various factors associated with IPV and showed that economic dependence of wives on their husband was among the most important ones. Thus, for the prevention of IPV against women, long term strategies aiming at livelihood and economic empowerment as well as independence of women would be suggested.

Purification of innate immunostimulant from green tea using a silkworm muscle contraction assay

A polysaccharide was purified from a hot water extract of green tea leaves by measuring the immunostimulatory activity in silkworm larvae. Nuclear magnetic resonance and chemical analysis of acid hydrolysates revealed that the purified substance possessed a backbone containing polygalacturonic acids with methyl ester residues. Treatment with β-glucanase attenuated the muscle contraction activity of the purified sample, suggesting that the β-glucan structure, probably as a branched form, was required for its activity. The purified fraction stimulated the production of interleukin-6 by mouse peritoneal macrophages. These results suggest that measuring immunostimulation in silkworm larvae is useful for evaluating innate immunostimulants from various sources.

katG (SER 315 THR) gene mutation in isoniazid resistant Mycobacterium tuberculosis

BACKGROUND Isoniazid (INH) together with Rifampicin (RFP) forms the cornerstone of a short chemotherapy course for tuberculosis (TB) treatment. Mutation at codon 315 of katG gene is most prevalent in isoniazid resistant Mycobacterium tuberculosis (MTB) and is high in area with high TB incidence. Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) has been found to be a reliable and effective tool for the identification of the specific gene alteration.

OBJECTIVE

The objective of this study was to screen Ser315Thr mutation of KatG gene of INH resistant MTB strain by PCR-RFLP technique.

METHODS

Altogether 37 INHr MTB isolates obtained from German Nepal Tuberculosis Project (GENETUP) Kathmandu Nepal was included in the study. Deoxyribonucleic Acid (DNA) extraction was performed according to protocol of SORPOCLEAN from the culture isolates. Amplification of the fragment with katG codon 315 was performed in a Biometra Thermocycler using primers. The amplified fragment was cleaved with MspI. The restriction fragments obtained were electrophoresed in a 2% agarose gel and were visualized using transilluminator.

RESULTS

The katG Ser315Thr mutation was observed in 23 (62.2%) out of 37 INH resistant isolates. The drug susceptibility profile of INHr MTB isolates showed all isolates to be resistant to INH and RFP whereas 26 and 27 MTB isolates were resistant to Ethambutol (EMB) and Streptomycin (S) respectively. Seventeen (17) patients were harbouring katG gene mutated strain among Ethambutol and Streptomycin resistant cases.

CONCLUSION

The study identified high prevalence of Ser315Thr mutation in katG. The isolates harbouring this mutation were also simultaneously resistant to RFP. Ser315Th could be a potential genetic marker for predicting MDR-TB.

Post-operative drop in hemoglobin and need of blood transfusion in cesarean section at Dhulikhel Hospital, Kathmandu University Hospital

BACKGROUND

Cesarean section has been identified as one of the commonest indication for blood transfusion in obstetric practice because it involves risk of major intra-operative blood loss. Different figures varying from less than 500 ml to more than 1000 ml have been quoted as estimated blood loss associated with caesarean section. There is also a wide variation in blood ordering practices for this surgery.

OBJECTIVE

The objective of this study is to evaluate the blood ordering practice and transfusion for cesarean sections at our institute, to see post-operative drop in hemoglobin and hematocrit and to correlate those parameters with the duration between uterine incision and repair.

METHODS

In this prospective observational study, non-randomised purposive sample was taken from 121 ladies who underwent elective and emergency cesarean section at the department of obstetrics of Dhulikhel Hospital-Kathmandu University Hospital. Post-cesarean drop in hemoglobin and hematocrit and their relation with duration of uterine manipulation was calculated. Cross-match to transfusion (C/T ratio) ratio, transfusion probability (%T) and transfusion index (Ti) were also calculated.

RESULTS

Most frequent blood group was found to be O positive (38%) among those ladies. Average post-cesarean drop in hemoglobin was 1.52±1.27 gm/dl and drop in haematocrit was 5.49±4.1%. Post-operative drop in hemoglobin and haematocrit had weak and positive linear relation with duration between uterine incision and repair. Cross-match to transfusion ratio was 1, transfusion probability 100% and transfusion index was 2.

CONCLUSION

There is no need of routine cross-matching of blood for cesarean section. Only grouping with confirmation of availability should be done for emergency situation.

Analysis of health sector gender equality and social inclusion strategy 2009 of Nepal

The policy on gender equality and social inclusion (GESI) in health sector of Nepal is formulated in 2009 targeting toward poor, vulnerable, marginalized social and ethnic groups. Gender inequality and social discrimination are a social problem that affect on individual health finally. The main objective of this paper is to critically analysis and evaluates the Government's strategy on health sector gender equality and social inclusion in Nepal. We collected published and unpublished information assessing the public health, policy analysis and research needs from different sources. A different policy approaches for the analysis and evaluation of GESI strategies is applied in this paper. Universal education, community participation, individual, group and mass communication approaches, and social capital are the key aspects of effective implementation of policy at target levels.

Prevalence and Factors Associated with Tobacco Use among High School Students

BACKGROUND

Tobacco use is the leading cause of morbidity and mortality worldwide. Tobacco use among school-level students is a growing a public health problem in Nepal. A number of factors may be associated with tobacco use, but there is lack of literature showcasing an in-depth understanding of the growing prevalence of tobacco use in the Nepalese context. Therefore, our study aims to determine the prevalence of tobacco use and examine the factors associated with tobacco use among high school students at public schools in Budhanilkantha municipality, Kathmandu, Nepal.

METHODS

A cross-sectional survey was conducted, and 378 students were selected for this study. The schools were selected randomly. Data collection was carried out using the self-administered questionnaires adapted from the World Health Organization used Global Youth Tobacco Survey and the Center for Disease Control and Prevention used Youth Tobacco Survey.

RESULTS

Overall, 31.7% of the students ever consumed any tobacco products, and 20.1% were current tobacco users. One in five students started smoking when they were less than ten years of age. The proportion of students seeing at least one family member smoking and using smokeless tobacco was 52.1% and 47.1% respectively. Male and older students were significantly more likely to consume tobacco products than female and young students.

CONCLUSIONS

This study showed that a significant proportion of school students had experienced tobacco use. Age and sex of the students were significantly associated with the status of current smoking and the use of smokeless tobacco.

Multi-level factors associated with utilization of water, sanitation and hygiene services by mothers in Nepal

BACKGROUND

Providing improved water, sanitation, and hygiene (WASH) at a household level remains one of the major public health challenges in Nepal. Household mothers are likely to have limited access to combined WASH services, this is influenced by individual, and community factors. Individual components of an improved water source, sanitary toilet, fixed place for handwashing, and availability of soap and water were merged into one and called combined WASH. This paper aimed to identify the individual and community factors associated with combined WASH facilities and practices among mothers with children under five years in Nepal.

METHODS

A cross-sectional study was conducted using data from the Nepal Demographic and Health Survey (NDHS), 2016. The weighted sample size of this study was 4887 mothers with children under five years. The independent variables within the mothers included age, education, occupation, and caste/ethnicity in addition to education of the husband, wealth index, exposure to the newspaper, radio and television, residence, ecological zones, provinces, distance and participation in health mother groups were analyzed with the outcome variable of combined WASH. A multi-level mixed effects logistic regression model was used to assess the relationship of explanatory variables with WASH.

RESULTS

At an individual level, a rich wealth index was positively associated with combined WASH (AOR = 6.29; 95%CI: 4.63-8.54). Higher education levels and exposure to television had higher odds of having combined WASH. At the community level, the hill zone, urban residence, and Sudurpashim Provinces were positively associated with combined WASH while Madesh and Karnali Provinces and distance to water source greater than 31 minutes were associated with lower access to combined WASH.

CONCLUSION

Educated and rich household have positive association with combined WASH. It is recommended that both the health and other sectors may be instrumental in improving the combined WASH service for mothers at households.

Health impacts and research ethics in female trafficking

Female trafficking is a social and public health problem, associated with physical and sexual abuse, psychological trauma, injuries from violence, sexually transmitted infections, adverse reproductive outcomes and substance misuse. It faces several challenges ranging from the hidden nature of the problem to ethical and human rights issues. The objectives of this paper are to analyze health impact of trafficking; ethical and research issues and anti-trafficking strategies in the Nepalese context. We collected published and unpublished data assessing the public health, ethical burden and research needs from different sources. Trafficked female involved in sex-industry that face grave situation as depicted and it might a reservoir of sexually transmitted diseases. Ethical issues related to survey of assessing the burden are difficult to carry out. The best ways to prevent and control these problems are to enhance anti- trafficking laws and raise awareness, empower and mobilize females and establish organizational capacity.

Effectiveness of Social Media-Based Intervention in Intention Change of Adolescents for Promoting Sexual Health Behavior in Western Terai of Nepal

BACKGROUND

Sexually transmitted infections (STIs) in adolescents are among the major public health challenges that have to be prevented in time. Traditional education falls short of reach; social media offers accessible ways. However, there is no research on such an issue in Nepal. Accordingly, this study was conducted to assess the effectiveness of a social media-based health education intervention in changing the intention of promoting sexual health among adolescents in Nepal. Study Design: A quasi-experimental study.

METHODS

A total of 160 adolescent students aged 14-19 years old from four purposively selected schools were evenly divided into intervention and non-intervention groups. Sampling and data collection were performed between May and June 2023. Data were collected through self-administered questionnaires for pretest and posttest evaluation. The intervention was delivered and followed up through a Facebook Messenger group. The obtained data were managed and analyzed using SPSS 21, with a significance level of 5%.

RESULTS

Social media-based health education interventions played a significant role in promoting the sexual health behavior of adolescents. The adolescents' knowledge and attitude scores on STIs increased from 2.33 to 4.62 and from 21.87 to 26.30. In addition, their scores on subjective norms, perceived behavioral control, and intentions in promoting sexual behavior increased from 13.93 to 17.59, from 19.96 to 25.40, and from 13.07 to 18.06, respectively, which were statistically significant.

CONCLUSION

The utilization of social media platforms such as Facebook Messenger groups is an effective medium for delivering health educational messages. Hence, increasing social media-based health education is a cost-effective intervention for promoting the health and sexual behaviors of adolescents.

Prevalence and factors associated with depression and anxiety among patients recovered from COVID-19: a cross-sectional study in a tertiary care hospital in Nepal

Introduction

COVID-19 has immensely affected the mental health of all people with prominent effects among the COVID-19 survivors who underwent hospitalisation. The evidence of the long-term mental health implications among the recovered COVID-19 patients remains unknown in Nepal. The study aimed to determine the prevalence of depression and anxiety and the associated factors among COVID-19 recovered patients.

Methods

An analytical cross-sectional study was conducted from May to August 2021 among 269 COVID-19 recovered patients admitted to Dhulikhel Hospital during the first wave (July 2020 to January 2021), and second wave (April 2021 to July 2021) of the COVID-19 pandemic. Anxiety and depression of the participants were assessed using the Hospital Anxiety and Depression Scale. Multivariate logistic regression analysis was performed to determine the factors associated with anxiety and depression.

Results

The prevalence of anxiety and depression were 38.66% (95% CI 32.99 to 44.65), and 30.48% (95% CI 25.24 to 36.28), respectively. Participants who received COVID-19 related information from the radio reported higher levels of anxiety and depression symptoms. Similarly, stigma, and being a health worker were significantly associated with a higher level of anxiety and depression symptoms, respectively. However, social support and long recovery duration were protective factors against anxiety and depression symptoms. Participants receiving a higher level of social support and having a recovery duration of 3-6 months, 7 months and more reported lower odds of anxiety and depression symptoms, respectively.

Conclusions

The greater prevalence of anxiety and depression symptoms among recovered COVID-19 patients highlights the need to design and implement appropriate mental health interventions. This could be done through psychosocial support and counselling services in health facilities, mental health service in emergency situation and post-discharge rehabilitation programmes.

Effects of health education intervention on menstrual hygiene knowledge and practices among the adolescent girls of Pokhara Metropolitan, Nepal

BACKGROUND

Poor menstrual hygiene practices are one of the major public health problems in Nepal. Due to persistent taboos and socio-cultural constraints, adolescent girls are often unaware of scientific facts, knowledge, and practices related to menstrual hygiene. This paper aims to assess the effects of health education intervention on menstrual hygiene knowledge and practices among adolescent girls in Pokhara Metropolitan, Nepal.

MATERIALS AND METHODS

A true experimental study was conducted in two government basic schools in Pokhara Metropolitan, Nepal. The study population was adolescent girls who had attended the menarche. Firstly, a pretest with the help of a self-administered questionnaire was done to find out the socio-demographic information, knowledge and practices of menstrual hygiene. Next, health education sessions were conducted among the intervention group. Finally, after one month of intervention, a post-test was conducted among the intervention and non-intervention group. Data analysis was done through descriptive and inferential statistics.

RESULTS

The findings showed significant improvement in the knowledge and practice level of adolescent girls on menstrual hygiene after health education intervention. Participants in the intervention group showed a significant increase in knowledge scores from 10.0% to 67.0%, while the non-intervention group remained unchanged at 7.5%. Good menstrual hygiene practices scores in the intervention group increased significantly from 22.5% to 67.0%, whereas the non-intervention group saw a slight rise from 20.0% to 22.5%. Regarding observed practice scores in menstrual hygiene, significant improvement was observed in the intervention group (45.0% to 100.0%) in contrast to the non-intervention group (25.0% to 27.5%).

CONCLUSIONS

This study highlights the crucial role of school health education interventions in promoting menstrual hygiene among adolescent girls. It emphasizes the importance of comprehensive educational programs tailored to early teenage girls, addressing timing, content, and delivery methods alongside ensuring the availability of Water, Sanitation and Hygiene (WASH) facilities.

Successful health promotion, its challenges and the way forward in Nepal

Health promotion is the most favorable approach and process to achieve a positive health outcome of the population. Several countries across the world are committed to achieving positive health for their people with the best health promotion strategies. Health promotion, in fact, shares a large portion of health care economy and resources in many countries. A low-income country like Nepal, however, lacks the implementation of rigorous health care strategies on a large scale and is deficient in evidence of the potential scope of health promotion. Nepal has adopted the global health promotion declaration on paper; however, health care providers and authorities are still working in a traditional way using existing health policies and strategies. This paper aims to explore some of the global best practices of health promotion, including the challenges and opportunities by adopting such practices in Nepal, and provides some recommendations as a way forward.