Awareness, Enrollment and Utilization of Health Insurance among Adults of Pokhara

Introduction Procuring a health insurance is important because medical care is expensive, especially in private sector. Hospitalization nowadays is very expensive. Financial burden while being sick can be managed wisely by paying a small annual premium which would lessen stress in case of medical emergencies. The objective of study is to assess awareness, enrollment and utilization of health insurance and find out association between awareness and enrollment with demographic variables. Material and methods A descriptive cross sectional study was conducted to assess awareness, enrollment and utilization of health insurance among adult of Phulbari-11, Pokhara. The study was conducted during the period from June – August 2019 among 153 adult using purposive sampling. The data was analyzed using descriptive and inferential statistics using Statistical Package for Social Science(SPSS) version 18.0. Result: Nearly 61% were young adult. About 2/3rd (66%) were female. Majority (82.4%) had received some form of formal education. About 57% were aware about health insurance and 40% had enrolled in it. Among them, more than 2/3rd (69%) had procured service at least once. Respondent's awareness is statistically significant with ethnicity. Enrollment in health insurance is significantly associated with age, ethnicity, marital status, history of chronic illness, family history of chronic illness and awareness of health insurance. Conclusion: Awareness about health insurance is low. Enrollment and utilization of the scheme is not as expected. The enrollment in this scheme can further be enhanced through government effort to increase awareness among community people with the help of health care personnel and media.

Exclusive Breastfeeding and Complementary Feeding Practices among Children in Slum of Pokhara

Background: It is estimated that, on an average about 35% of infants 0 - 6 months old are exclusively breastfed around the world. Optimal breastfeeding and complementary feeding practices can save the lives of 1.5 million children under five every year. The condition is further worse in slum areas where vulnerable group of people resides. So, this study aims to assess prevalence on initiation of breastfeeding, exclusive breastfeeding and complementary feeding practices. Methods: A cross sectional study was conducted from November 2017 - February 2018 among 400 married women having child between 6 - 24 months. A pre-tested structured questionnaire comprising of socio-demographic characteristics, exclusive breastfeeding and complementary feeding practice were used. Data was analyzed using Statistical Package for Social Sciences (SPSS) 18.0 version. Results: About 55% of the mothers had initiated breastfeeding within an hour (<1 hour). About half (50.5%) had practiced exclusive breastfeeding to their children. More than fifty percentages (51.5%)of the mothers introduced complementary foods at 6 months. Age at pregnancy, mode of delivery, family size and colostrum feeding is associated with early initiation of breastfeeding at 95% CI i.e. p value <0.05. Whereas, age of mother, ethnicity, mode of delivery and initiation of breastfeeding were significantly associated with exclusive breastfeeding at 95% CI i.e. p value <0.05. Conclusions: The breastfeeding and complementary feeding practice in slum area is not optimal. Health awareness program focusing on early initiation of breastfeeding, exclusive breastfeeding practices and timely introduction of complementary foods in these vulnerable groups of population is needed o prevent its untoward effects. Keywords: complementary feeding; exclusive breastfeeding; initiation; malnutrition.  

Biomass Fuel Use and Cardiac Function in Nepali Women

Background

Exposure to household air pollution (HAP) from cooking with biomass fuel affects billions of people. We hypothesized that HAP from woodsmoke, compared to other household fuels, was associated with adverse cardiovascular outcomes, of which there have been few studies.

Methods

A cross-sectional study was completed in 299 females aged 40-70 years in Kaski District, Nepal, during 2017-18. All participants underwent a standard 12-lead ECG, ankle and brachial systolic blood pressure measurement, and 2D color and Doppler echocardiography. Current stove type was confirmed by inspection. Blood pressure, height, and weight were measured using a standardized protocol. Hypertension was defined as ≥140/90 mmHg or prior diagnosis. Hemoglobin A1c (HbA1c) was obtained, with diabetes mellitus defined as a prior diagnosis or HbA1C ≥ 6.5%. We used adjusted linear and logistic multivariable regressions to examine the relationship of stove type with cardiac structure and function.

Results

The majority of women primarily used liquified petroleum gas (LPG) stoves (65%), while 12% used biogas, and 23% used wood-burning cook-stoves. Prevalence of major cardiovascular risk factors was 35% with hypertension, 19% with diabetes mellitus, and 15% current smokers. After adjustment, compared to LPG, wood stove use was associated with increased indexed left atrial volume (β = 3.15, 95% CI 1.22 to 5.09) and increased indexed left ventricular end diastolic volume (β = 7.97, 95% CI 3.11 to 12.83). There was no association between stove type and systemic hypertension, left ventricular mass, systolic dysfunction, diastolic dysfunction, pulmonary hypertension, abnormal ankle-brachial index, or clinically significant ECG abnormalities.

Conclusion

Biomass fuel use was associated with increased indexed left atrial volume and increased indexed left ventricular diastolic volume in Nepali women, suggesting subclinical adverse cardiac remodeling from HAP in this cross-sectional study. We did not find evidence of an association with hypertension or typical cardiac sequelae of hypertension. Future studies to confirm these results are needed.

Profile of Acute Coronary Syndrome In Young People: A Hospital Based Observational Study in Western Nepal

Introduction: Acute coronary syndrome is associated with high mortality and morbidity. The incidence of acute coronary events in young is increasing.Objectives: This study aimed at evaluating the profile of acute coronary syndrome in young people in the western part of Nepal.Methodology: A retrospective study was designed. All patients admitted for acute coronary syndromes were taken and data of acute coronary syndrome involving patients aged less than 45 years from April 2015 through December 2017 were collected in a pre-structured proforma and analyzed.Results: There were 712 (489 males and 223 females with M:F=2.19:1) acute coronary syndrome patients admitted during the study period. Only 79 (12.9%) patients were patients <45 years of age. Commonest risk factor of acute coronary syndrome was smoking (69%) followed by dyslipidemia (46.8%), hypertension (45.5%) and diabetes (14%). Out of 79 patients of young acute coronary syndrome, 37 (46.8%) presented with ST elevated myocardial infarction, 16 (20.2%) with non-ST elevated myocardial infarction and 26 (32.9%) with unstable angina. Most common finding in coronary angiography was single vessel disease (35%) –left anterior descending artery being the commonest (53% of single vessel disease), double vessel disease (17.7%), non-critical coronary artery disease (16.4%), triple vessel disease (7.6%) and left main (1.2%). Myocardial bridging was seen in 1.2% and 20% had normal coronaries. Comparison of males and females in different categories of acute coronary showed that males predominate significantly in ST elevated myocardial infarction (odds ratio: 2.99; p=0.03) but there was no significant difference between the males and females presenting either with Non ST elevated myocardial infarction or unstable angina.Conclusion: Acute coronary syndrome in young people was common (12.9%) particularly males with Non ST elevated myocardial infarction. Smoking was the commonest risk factor. Public awareness regarding stoppage of cigarette smoking should be focused to prevent such events especially in the young population. BJHS 2018;3(1)5 : 361-365

Association of serum magnesium level with poor glycemic control and renal functions in Nepalese patients with type 2 diabetes mellitus

BACKGROUND

Hypomagnesaemia has been shown to be associated with type 2 diabetes mellitus (T2DM) and its complications. The present study investigated the association of hypomagnesaemia with T2DM and its complications in patients hailed mostly from the western hilly region of Nepal.

METHODS

This study was conducted among 150 type 2 diabetic patients and 150 of non-diabetic controls between May to September 2016. Relevant demographic, anthropometric, physiological and biochemical variables were measured using standard protocols. Statistical analyses were performed by SPSS version 17.0.

RESULTS

Hypomagnesaemia (1.7±0.2mg/dl) was present in 50% of diabetic patients and none in the healthy controls (2.0±0.2mg/dl). It was inversely correlated with levels of glycated hemoglobin (HbA1c) (r=-0.299), total cholesterol (r=-0.219), low density lipoprotein-cholesterol (r=-0.168) and creatinine (r=-0.215) and directly correlated with serum creatinine based glomerular filtration rate (eGFRcr) (r=0.196). Subjects with hypomagnesaemia were significantly older (57.4±11.5years) and had higher levels of HbA1c (8.4±1.2%) and serum total cholesterol (248.3±72.0mg/dl). The methods of diabetes control did not have a significant influence on serum magnesium level. Patient's age (OR: 1.05 (95% CI-1.01-1.09)), poor glycemic control (OR: 6.78 (95% CI-2.56-17.95)) and low eGFR_cr (OR: 4.89 (95% CI-1.78-13.40)) were the significant predictors of hypomagnesaemia.

CONCLUSION

Half of type 2 diabetic population under study had hypomagnesaemia without regard to the method of diabetes control. Old age, poor glycemic control, and low eGFRcr were the significant predictors of low serum magnesium in these patients. Besides their regular anti-diabetic treatment, clinicians should also consider dietary supplementation of magnesium to prevent further complications of diabetes in these patients.

Prevalence and pattern of dyslipidemia in Nepalese individuals with type 2 diabetes

Background

Atherogenic dyslipidemia is an important modifiable risk factor for cardiovascular disease among patients of type 2 diabetes mellitus. Timely detection and characterization of this condition help clinicians estimate future risk of cardiovascular disease and take appropriate preventive measures. The aim of this study was to determine the prevalence, pattern and predictors of dyslipidemia in a cohort of Nepalese patients with type 2 diabetes.

Results

We found mixed dyslipidemia as the most prevalent (88.1%) and isolated dyslipidemia (10.1%) as the least prevalent forms of dyslipidemia in our patients. The most prevalent form of single dyslipidemia was high LDL-C (73.8%) and combined dyslipidemia was high TG, high LDL-C and low HDL-C (44.7%). Prevalence of all single and mixed dyslipidemia was higher in patients with poor glycemic control and hypertension. The glycemic status of patients correlated with their fasting serum lipid profile. Dyslipidemia was associated mainly with male gender, poor glycemic control and hypertension.

Conclusions

Atherogenic dyslipidemia is associated mainly with male gender, poor glycemic control and hypertension. It is highly prevalent in Nepalese patients with type 2 diabetes. Urgent lifestyle modification, sustained glycemic control and aggressive lipid lowering treatment plans are necessary to minimize the future risk of cardiovascular disease in this population.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2465-4) contains supplementary material, which is available to authorized users.

Estimation of 10-Year Risk of Coronary Heart Disease in Nepalese Patients with Type 2 Diabetes: Framingham Versus United Kingdom Prospective Diabetes Study

BACKGROUND

Predicting future coronary heart disease (CHD) risk with the help of a validated risk prediction function helps clinicians identify diabetic patients at high risk and provide them with appropriate preventive medicine.

AIM

The aim of this study is to estimate and compare 10-year CHD risks of Nepalese diabetic patients using two most common risk prediction functions: The Framingham risk equation and United Kingdom Prospective Diabetes Study (UKPDS) risk engine that are yet to be validated for Nepalese population.

PATIENTS AND METHODS

We conducted a hospital-based, cross-sectional study on 524 patients with type 2 diabetes. Baseline and biochemical variables of individual patients were recorded and CHD risks were estimated by the Framingham and UKPDS risk prediction functions. Estimated risks were categorized as low, medium, and high. The estimated CHD risks were compared using kappa statistics, Pearson's bivariate correlation, Bland-Altman plots, and multiple regression analysis.

RESULTS

The mean 10-year CHD risks estimated by the Framingham and UKPDS risk functions were 17.7 ± 12.1 and 16.8 ± 15 (bias: 0.88, P > 0.05), respectively, and were always higher in males and older age groups (P < 0.001). The two risk functions showed moderate convergent validity in predicting CHD risks, but differed in stratifying them and explaining the patients' risk profile. The Framingham equation predicted higher risk for patients usually below 70 years and showed better association with their current risk profile than the UKPDS risk engine.

CONCLUSIONS

Based on the predicted risk, Nepalese diabetic patients, particularly those associated with increased numbers of risk factors, bear higher risk of future CHDs. Since this study is a cross-sectional one and uses externally validated risk functions, Nepalese clinicians should use them with caution, and preferably in combination with other guidelines, while making important medical decisions in preventive therapy of CHD.