An Assessment of Diabetic Retinopathy and Diabetes Management System in Nepal

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.

Choices, Shift and Continuation of Temporary Contraceptive Methods among Women of Reproductive age in Western Development Region of Nepal

Aims: Global family planning programs have been in existence in the developing world. Modern techniques of temporary contraceptives have been proved to be useful tool for limiting births. This study is intended to identify the use pattern, associated factors with the choice, shift and continuity of temporary methods of contraception.Methods: This is descriptive cross-sectional study, incorporating qualitative aspects. Out of sixteen districts six were selected proportionately by using simple random methods from each ecological zone of the Western Development Regions, Nepal. Focus group discussion was accomplished among the different level family planning service providers.Results: User of Depo-Provera and pills were seen more in comparison to other temporary contraceptive. There are different reasons behind choosing of temporary contraceptive method such as Pills make regularity in menstruation, Norplant is useful for prolonged period, Depo-Provera is useful for three months and confidently used for a long time without any risk, motivation by friends/relatives. Reasons in changing the contraceptives includes associated side effects, lack of availability, irregularity in menstruation, choosing the another best method, excessive bleeding, difficult to use, pressure from family and husband to give birth, misunderstanding and stress in the family, traditional belief and lack of education.Conclusions: For proper choice of modern contraceptive methods promotion, education and knowledge about associated factors related to use of these method is needed. Continuous information on contraceptives focusing particularly on the side effects and trained health care providers are essential.