Exosomes derived from adipose stem cells in combination with hyaluronic acid promote diabetic wound healing

Diabetic wound is one of the main challenges in dermatology. Although stem cell-based treatment has therapeutic benefits in wound repair, the clinical application is still limited. Herein we investigated whether adipose stem cells -derived exosomes (Exo) loaded on hyaluronic acid (HA) could promote healing in diabetic rats. Sixty diabetic rats were randomly planned into the control group, Exo group, HA group, and HA+Exo group. On days 7, 14, and 21, five rats from each group were sampled for stereological, molecular, and tensiometrical assessments. Our results indicated that the wound closure rate, the total volumes of new epidermis and dermis, the numerical densities of fibroblasts, the length density blood vessels, collagen density as well as tensiometrical parameters of the healed wounds were significantly higher in the treated groups than in the control group, and these changes were more obvious in the HA+Exo ones. Furthermore, the expression of TGF-β and VEGF genes were meaningfully upregulated in all treated groups compared to the control group and were greater in the HA+Exo group. This is while expression of TNF-α and IL-1β, as well as numerical densities of neutrophils decreased more considerably in the HA+Exo group in comparison to the other groups. Generally, it was found that using both HA injection and exosomes has more effect on diabetic wound healing.

Fluorescence Resonance Energy Transfer (FRET)-Based Sensor for Detection of Foodborne Pathogenic Bacteria: A Review

Sensitive and rapid determination of foodborne pathogenic bacteria is of practical importance for the control and prevention of foodborne illnesses. Nowadays, with the prosperous development of fluorescence assays, fluorescence resonance energy transfer (FRET)-derived diagnostic strategies are extensively employed in quantitative analysis of different pathogenic bacteria in food-related matrices, which displays a rapid, simple, stable, reliable, cost-effective, selective, sensitive, and real-time way. Considering the extensive efforts that have been made in this field so far, we here discuss the up-to-date developments of FRET-based diagnostic approaches for the determination of key foodborne pathogens like Staphylococcus aureus, Escherichia coli, Vibrio parahaemolyticus, Salmonella spp., Campylobacter spp., and Bacillus cereus in complex food-related matrices. Moreover, the principle of this technology, the choosing standards of acceptor-donor pairs, and the fluorescence properties are also profiled. Finally, the current prospects and challenges in this field are also put forward.

Clinical Correlates of Venetoclax-Based Combination Sensitivities to Augment Acute Myeloid Leukemia Therapy

The BCL2 inhibitor venetoclax combined with the hypomethylating agent azacytidine shows significant clinical benefit in a subset of patients with acute myeloid leukemia (AML); however, resistance limits response and durability. We prospectively profiled the ex vivo activity of 25 venetoclax-inclusive combinations on primary AML patient samples to identify those with improved potency and synergy compared with venetoclax + azacytidine (Ven + azacytidine). Combination sensitivities correlated with tumor cell state to discern three patterns: primitive selectivity resembling Ven + azacytidine, monocytic selectivity, and broad efficacy independent of cell state. Incorporation of immunophenotype, mutation, and cytogenetic features further stratified combination sensitivity for distinct patient subtypes. We dissect the biology underlying the broad, cell state-independent efficacy for the combination of venetoclax plus the JAK1/2 inhibitor ruxolitinib. Together, these findings support opportunities for expanding the impact of venetoclax-based drug combinations in AML by leveraging clinical and molecular biomarkers associated with ex vivo responses.

SIGNIFICANCE

By mapping drug sensitivity data to clinical features and tumor cell state, we identify novel venetoclax combinations targeting patient subtypes who lack sensitivity to Ven + azacytidine. This provides a framework for a taxonomy of AML informed by readily available sets of clinical and genetic features obtained as part of standard care. See related commentary by Becker, p. 437 . This article is featured in Selected Articles from This Issue, p. 419.

LncRNA-miRNA interaction is involved in colorectal cancer pathogenesis by modulating diverse signaling pathways

LncRNAs function as molecular sponges for miRNAs to control their availability for targeting mRNA molecules. This procedure indirectly regulates the expression of cancer-related genes. Some lncRNAs also directly interact with miRNAs, leading to their degradation or sequestration, which can negatively impact gene expression. miRNAs, on the other hand, play a critical role in controlling the expression of genes, including oncogenes and tumor suppressor genes. Multiple types of cancer have been linked to the onset and progression of miRNA dysregulation. Even though there is a lot of potential for treating CRC by targeting the LncRNA-miRNA axis, several challenges remain to be overcome. The specificity of the targeting approach, delivery methods, resistance, safety, and cost-effectiveness are critical research areas that must be addressed to advance this field and improve treatment outcomes for people with CRC.

Comparative evaluation of A1A2 and A2A2 cow milk-containing diets on biochemical and histological parameters of Wistar rats

This Research Communication aims to compare the effect of A1A2 and A2A2 cow milk diets on the biochemical and histological parameters of rats. The rats were divided into four groups and fed with a normal diet, A2 milk powder, A1A2 or A2A2 cow milk diets for 90 d. Blood glucose, kidney function, liver function and lipid profile were examined during the experimental period. The study showed an increase in the body weight of the A1A2 group whereas a slight decrease in the A2A2 group, and blood glucose levels increased from d 0 to day 90 in all experimental groups. However, none of these changes were found to be statistically insignificant (P > 0.05). Moreover, no significant changes were recorded in other parameters (serum glutamic pyruvic transferase and serum glutamic-oxaloacetic transaminase for liver function, bilirubin direct, cholesterol, triglycerides, creatinine and uric acid). The histology of the liver, kidney and pancreas also showed no changes in all groups. Overall, this study revealed no significant difference in the nutritional values of A1A2 and A2A2 milk types and hence equally beneficial for health. Although the present study showed no significant difference in the effect of both milk types in 90 d, further studies might be conducted to evaluate their longer term effects.

Epidemiology of unintentional childhood injuries in urban and rural areas of Nepal- A comparative study

Unintentional injuries are one of the leading causes of ill health, disability & death among the children and young adults worldwide. As these injuries are strongly related to social determinants, the burden falls mainly upon the Low- and Middle-Income Countries (LMICs) like Nepal. Thus, the main objective was to explore the epidemiology of unintentional childhood injuries in urban and rural areas of Kavrepalanchok district. A cross sectional analytical study was done in Bethanchok rural municipality and Dhulikhel municipality of Kavrepalanchok district. The respondents were interviewed using a pretested semi-structured questionnaire. The details of injuries sustained within the past 12 months were included. A total of 667 children aged 1-16 years were surveyed, among which 26% from rural and 17.2% from urban areas had unintentional injuries in the past 12 months. Falls were the most common mode of injury in both the areas. Similarly, the proportion of burn was more in rural area (16.1%) whereas, Road Traffic Injuries were more in urban area (12.5%). Majority of the injuries occurred at home (54.5%) while the child was playing (64.1%). Factors like child's gender and place of residence affected the occurrence of unintentional injuries (p<0.05). Out of total injured children, 18 of them had not recovered and 11 were left with some form of permanent disability. As the rate and pattern of unintentional childhood injuries in the rural and urban area differ, the prevention strategies should focus on risk factors that apply to both the areas and awareness should be created among the parents and primary caregivers about the fact that childhood injuries are predictable and preventable.

Addressing Domestic Violence in Antenatal Care Environments in Nepal (ADVANCE) - study protocol for a randomized controlled trial evaluating a video intervention on domestic violence among pregnant women

BACKGROUND

Domestic violence (DV) prior to, and during pregnancy is associated with increased risks for morbidity and mortality. As pregnant women routinely attend antenatal care this environment can be used to offer support to women experiencing DV. We have developed a video intervention that focuses on the use of behavioral coping strategies, particularly regarding disclosure of DV experiences. The effectiveness of this intervention will be evaluated through a randomized controlled trial (RCT) and a concurrent process evaluation.

METHODS

All pregnant women between 12-22 weeks of gestation attending routine antenatal care at two tertiary level hospitals in Nepal are invited to participate. DV is measured using the Nepalese version of the Abuse Assessment Screen (N-AAS). Additionally, we measure participants' mental health, use of coping strategies, physical activity, and food security through a Color-coded Audio Computer Assisted Self Interview (C-ACASI). Irrespective of DV status, women are randomized into the intervention or control arm using a computer-generated randomization program. The intervention arm views a short video providing information on DV, safety improving actions women can take with an emphasis on disclosing the violence to a trusted person along with utilizing helplines available in Nepal. The control group watches a video on maintaining a healthy pregnancy and when to seek healthcare. The primary outcome is the proportion of women disclosing their DV status to someone. Secondary outcomes are symptoms of anxiety and depression, coping strategies, the use of safety measures and attitudes towards acceptance of abuse. Follow-up is conducted after 32 weeks of gestation, where both the intervention and control group participants view the intervention video after completing the follow-up questionnaire. Additionally, a mixed methods process evaluation of the intervention will be carried out to explore factors influencing the acceptability of the intervention and the disclosure of DV, including a review of project documents, individual interviews, and focus group discussions with members of the research team, healthcare providers, and participants.

DISCUSSION

This study will provide evidence on whether pregnant women attending regular antenatal visits can enhance their safety by disclosing their experiences of violence to a trusted person after receiving a video intervention.

TRIAL REGISTRATION

The study is registered in ClinicalTrial.gov with identifier NCT05199935.

Improving Estimates of Injury Burden in Nepal: A Qualitative Study

BACKGROUND

Routinely collected injury data can help to identify populations at risk of injury, circumstances surrounding those injuries, and can be used to develop targeted interventions. However, routinely collected injury data in Nepal are at risk of being incomplete or poorly coded and are underutilised. Therefore, this study aimed to explore the strengths, and opportunities for improvement, of systems that routinely measure injury incidence in Nepal.

METHODS

This study employed a qualitative design where data were collected through interviews with personnel working in four routine data systems; the Health Management Information System, the Road Accident Reporting System, the Daily Incident Reporting System, and the Civil Registration System. Interviews were conducted with front-line data collectors as well as strategic decision makers working in these data systems. Interviews were audio-recorded, transcribed, translated into English and analysed using framework analysis.

RESULTS

A total of 32 interviews were completed, 19 interviews with front-line data collectors and 13 interviews with strategic decision makers. The data recording and reporting process of the four systems were identified and described. The analysis of data yielded 11 themes that described the strengths and limitations of the data collected through the four systems, challenges for effective data systems, and user recommendations for system improvement.

CONCLUSIONS

This study identified the strengths, limitations, system challenges, and opportunities to improve data quality of each of the four routine data collection systems. These findings may be useful in engaging stakeholders in strengthening existing routine injury data collection systems or implementing alternative systems.

A qualitative study on gender inequality and gender-based violence in Nepal

BACKGROUND

Gender inequality and violence are not mutually exclusive phenomena but complex loops affecting each other. Women in Nepal face several inequalities and violence. The causes are diverse, but most of these results are due to socially assigned lower positioning of women. The hierarchies based on power make women face subordination and violence in Nepal. The study aims to explore participants' understanding and experience to identify the status of inequality for women and how violence emerges as one of its consequences. Furthermore, it explores the causes of sex trafficking as an example of an outcome of inequality and violence.

METHOD

The study formulated separate male and female groups using a purposive sampling method. The study used a multistage focus group discussion, where the same groups met at different intervals. Six focus group discussions, three times each with male and female groups, were conducted in a year. Thirty-six individuals, including sixteen males and twenty females, were involved in the discussions. The study used constructivist grounded theory for the data analysis.

RESULTS

The study participants identify that a power play between men and women reinforce inequality and increases the likelihood of violence for women. The findings suggest that the subjugation of women occurs due to practices based on gender differences, constricted life opportunities, and internalization of constructed differences among women. The study identifies that interpersonal and socio-cultural violence can result due to established differences between men and women. Sex trafficking, as an example of the outcome of inequality and violence, occurs due to the disadvantageous position of women compounded by poverty and illiteracy. The study has developed a concept of power-play which is identified as a cause and consequence of women's subordination and violence. This power play is found operative at various levels with social approval for men to use violence and maintain/produce inequality.

CONCLUSION

The theoretical concept of power play shows that there are inequitable power relations between men and women. The male-centric socio-cultural norms and practices have endowed men with privilege, power, and an opportunity to exploit women. This lowers the status of women and the power-play help to produce and sustain inequality. The power-play exposes women to violence and manifests itself as one of the worst expressions used by men.

Does Forum Theater Help Reduce Gender Inequalities and Violence? Findings From Nepal

Gender inequality and violence against women are present in every society and culture around the world. The intensities vary, however, based on the local guiding norms and established belief systems. The society of Nepal is centered on traditional belief systems of gender roles and responsibilities, providing greater male supremacy and subordination for the females. This has led to the development and extensive practices of social gender hierarchal systems, producing several inequalities and violence toward women. This study has utilized Forum Theater interventions as a method of raising awareness in 10 villages in eastern Nepal. The study aimed to understand the perception and changes in the community and individuals from the interactive Forum Theater performances on pertinent local gender issues. We conducted 6 focus group discussions and 30 individual interviews with male and female participants exposed to the interventions. The data analysis utilized the constructivist grounded theory methodology. The study finds that exposure and interactive participation in the Forum Theater provide the audience with knowledge, develop empathy toward the victim, and motivate them to change the situation of inequality, abuse, and violence using dialogues and negotiations. The study describes how participation in Forum Theater has increased individual's ability for negotiating changes. The engagement by the audience in community discussions and replication of efforts in one of the intervention sites show the level of preparedness and ownership among the targeted communities. The study shows the methodological aspects of the planning and performance of the Forum Theater and recommends further exploration of the use of Forum Theater in raising awareness.

Identification of research priorities for suicide prevention in Nepal: a Delphi study

BACKGROUND

Suicide is a significant public health concern in Nepal and there is a need for an evidence-based suicide prevention programme to facilitate stakeholders working towards suicide prevention in Nepal. Collaborative research between stakeholders focussing on shared priorities can help to prevent and control suicide. Hence, we aimed to develop a consensus list of research priorities for suicide prevention in Nepal.

METHODS

The Delphi expert consensus method was used to elicit the prioritized research questions for suicide prevention in Nepal. Participants comprised suicide prevention experts (psychologists, psychiatrists, psychiatric nurses, researchers and advocates) and people with lived experience. Three rounds of Delphi were conducted; round 1: one to one interviews involving open ended questions used to generate research questions; round 2: ranking of the research questions using a 5-point Likert scale, and round 3: re-ranking of research questions in light of individual and group responses.

RESULTS

Forty-two participants participated in round 1 followed by 38 in round 2 and 39 in round 3 . 522 research questions were generated through round 1 which were grouped together and reduced to 33 research questions sent for ranking in round 2. Using a cut off of at least 70% of the panel ranking questions as 'very important' or 'important', 22 questions were retained. These research questions were sent for re-rating in round 3 resulting in a final list of prioritized questions.

CONCLUSIONS

This is the first expert consensus study to identify the top research priorities for suicide prevention in Nepal, and used experts in suicide prevention and those with lived experience. A consensus was reached regarding the studies needed to improve suicide data quality, assess the burden and identify factors associated with suicide. A priority driven approach to suicide prevention research may ensure that the research endeavour provides the most useful information for those whose day-to-day work involves trying to prevent suicide.

Recent Developments and Potential for Clinical Use of Casein as a Drug Carrier

BACKGROUND

The development of drug delivery carriers is the key area of research in the field of novel drug delivery systems. To date, a long list of carriers has been identified for this purpose but the deliveries of poorly water-soluble active substances are still facing challenges and hence, such substances are pharmacologically unsafe and economically incompetent.

OBJECTIVE

This article aims to review the applications of casein as a drug carrier and its potential for clinical use.

METHODS

The relevant literature on the casein protein was collected from authentic online scientific databases like PubMed, Scopus and Google Scholar using different keywords including "casein", "drug delivery system", "drug carrier" and "bioavailability". The articles and books accessed online have been thoroughly reviewed and the most relevant reports on casein as a drug carrier have only been included in the present study.

RESULTS

Casein is a milk protein that has many structural and physicochemical properties which facilitate its functionality in delivery systems. Moreover, its amphiphilic nature makes it the most suitable carrier for both hydrophobic and hydrophilic drugs without showing any toxic effects. The carriers obtained from natural sources are trustworthy over synthetic carriers and in the demand of the market due to their easy availability, low-cost factor, bio-friendly and nontoxic nature.

CONCLUSION

Casein was found to be an effective natural drug carrier in various delivery systems due to its unique applications in improving the bioavailability and efficacy of a drug.

Identifying research priorities for road safety in Nepal: a Delphi study

OBJECTIVE

To identify and prioritise the research needed to help Nepali agencies develop an improved road safety system.

DESIGN

Delphi study.

SETTING

Nepal.

PARTICIPANTS

Stakeholders from government institutions, academia, engineering, healthcare and civil society were interviewed to identify knowledge gaps and research questions. Participants then completed two rounds of ranking and a workshop.

RESULTS

A total of 93 participants took part in interviews and two rounds of ranking. Participants were grouped with others sharing expertise relating to each of the five WHO 'pillars' of road safety: (1) road safety management; (2) safer roads; (3) safer vehicles; (4) safer road users and (5) effective postcrash response. Interviews yielded 1019 research suggestions across the five pillars. Two rounds of ranking within expert groups yielded consensus on the important questions for each pillar. A workshop involving all participants then led to the selection of 6 questions considered the most urgent: (1) How can implementing agencies be made more accountable? (2) How should different types of roads, and roads in different geographical locations, be designed to make them safer for all road users? (3) What vehicle fitness factors lead to road traffic crashes? (4) How can the driver licensing system be improved to ensure safer drivers? (5) What factors lead to public vehicle crashes and how can they be addressed? and (6) What factors affect emergency response services getting to the patient and then getting them to the right hospital in the best possible time?

CONCLUSIONS

The application of the Delphi approach is useful to enable participants representing a range of institutions and expertise to contribute to the identification of road safety research priorities. Outcomes from this study provide Nepali researchers with a greater understanding of the necessary focus for future road safety research.

Modulation of gut microbiota with Ayurveda diet and lifestyle: A review on its possible way to treat type 2 diabetes

Background

The prevalence of type 2 diabetes (T2D) has increased substantially in the past few decades throughout the world. In India, the epidemic of diabetes continues to increase irrespective of area, status, and age. Despite various scientific societies involved in the treatment of diabetes, still, the burden of diabetes keeps growing.

Aims

The aim of this work is to explore the Ayurvedic concept of a personalized diet to modulate the gut microbiota for the treatment of T2D.

Material and methods

A thorough study of literature from online scientific databases including Web of Science, PubMed, Scopus, and Google Scholar as well as from classical texts of Ayurveda was done. A careful compilation was done to extract the valuable output of the personalized diet to modulate the gut microbiota.

Results

There are various diets used to control blood glucose levels, and their effects are also being studied on the transcriptome or epigenome despite 99.9% genomic similarity among human beings. However, microbiomes have only 10% similarity. Ayurvedic diet is given on the basis of Prakriti (body constitution), therefore, it is also called personalized diet.

Conclusion

The diets prescribed for T2D in Ayurveda are high in fibers, polyphenols, and complex carbohydrates which enrich butyrate-producing bacteria and decrease lipopolysaccharide-producing bacteria. Hence, there is a need to have a personalized diet to manage the glucose level by enriching beneficial gut microbiota. The approach of a personalized diet associated with gut microbiota can be helpful in maintaining blood sugar in T2D patients.

Lifestyle Behaviours among General Population During Lockdown Period during Corona Virus Disease-19 Pandemic

BACKGROUND

Healthy lifestyle behaviours have been consistently associated with reduced non-communicable disease related morbidity, mortality and wellbeing. Unhealthy behaviours are major contributors to the global burden of disease. The main aim of this study is to access lifestyle behaviours in adults during the corona virus disease-19 pandemic.

METHODS

Cross sectional study was conducted among general population residing in Nepal. Online questionnaire was developed using Google Forms. Questionnaire comprised of three validated tools regarding the following lifestyle behaviours: Physical activity, Nutrition, Sleep. The collected data was analysed using SPSS version 20. To test the differences between changes in dietary and physical activity behaviours in relation to changes in body weight a Chi-square test was used.

RESULTS

During Covid -19 lockdown, 124(42%) participants performed moderate level of physical activity. Of those participated, 127(43.1%) and 44(14.9%) reported an increase and decrease of weight, respectively. Among 110(37.3%) who reported snacking in lockdown led to weight gain in 68(61.8%). Availability of more time for meal preparation (24.1%) and feelings of boredom (17.4%) were the main reasons for changing dietary habits. The subjective sleep quality of participants was as follows: very good-40.3%; fairly good-45.4 %; fairly bad-11.2%; very bad 3.1%. There was significant positive correlation between sleep quality and sleep duration (R=0.261; P<0.001), sleep latency (R=0.362; P<0.001), sleeping medications (R=0.174; P<0.003) and daytime dysfunction (R=0.308; P<0.001).

CONCLUSIONS

Life style behaviours were affected during lockdown period. Higher amounts of food intake and snaking were increased. Physical activity was at a moderate level, increased sedentary behaviour was reported by most participants during lockdown. However, sleep quality was not negatively affected.

Experience of living near a highway in Nepal: Community perceptions of road dangers in Makwanpur district

INTRODUCTION

Road traffic injuries are a major but neglected global challenge. There are high and rising rates of road traffic injuries in Nepal. Most of the studies reporting these injuries in Nepal have used quantitative methods to describe the injury burden. Little qualitative research has been conducted to describe the contexts and social processes surrounding crashes, or public perceptions of risks and potential solutions. The aim of this study was to explore the perceptions of road dangers from communities living alongside a major highway in Nepal.

METHODS

In this qualitative study we recruited members of neighbourhood development committees and a mother's group to take part in focus groups exploring their views. Data were audio-recorded, transcribed, translated and analysed thematically.

RESULTS

Four focus groups were conducted involving 34 participants aged 24-65. Our study findings highlight the challenges faced by people living near a major highway and their fear of getting injured on the road. Five themes that emerged were: risky behaviours of road users, infrastructure for safer behaviour, poor condition and maintenance of roads and vehicles, limited adherence and enforcement of traffic laws, and the need for road safety awareness programmes.

CONCLUSION

The community groups expressed multiple concerns regarding the safety of members of their communities and lived-in fear of death and injury on the road where they lived. There is an urgent need for government agencies to understand these concerns and to take action in relating to infrastructure provision, regulation and behavioural change programmes.

An Overview of Biotechnology Applications in Ayurveda: An Amalgamation of Techniques and Science

Abstract:

Health trends are constantly evolving, and so are health systems. No health system is perfect, hence the needed complement. Therefore, Western medicine (WM) practitioners are looking for traditional medicine (TM) and vice versa, as WM has an edge in an emergency while TM has in chronic diseases. However, the purpose of both systems is similar, which is a relief, despite different philosophies and methodologies. Globally, acceptance of TM by the scientific community is limited due to the lack of scientific evidence of benefits and efficiency, despite its potential. Ayurveda is one kind of the oldest TM systems of the world, serving humankind without changing a little, despite changes in geography, environment, weather conditions, and soil composition, which result in new diseases. Hence, the challenge of good health is arising. Therefore, there is a need to carry out research that would apply in its own way and satisfy the tenets of biomedical research too. The best way of doing this is multidisciplinary research by involving technology and Ayurvedic experts. Biotechnology can offer techniques from diagnosis to treatment of disease through substances of natural origin, including plants, animals and minerals. The present review is merely an overview of the possibilities which may be applied in Ayurveda in the present scenario. Ayurveda is the “science of life, and biotechnology is like “the service provider.” Therefore, biotechnology has all those techniques to serve Ayurveda up to the maximum and humankind at large. Even it may give rise to a new approach by combining Ayurveda and biotechnology.

Completeness of police reporting of traffic crashes in Nepal: Evaluation using a community crash recording system

OBJECTIVE

Accurate road crash reporting is essential for evaluating road safety interventions and plans. Under-reporting of road traffic crashes, injuries, and fatalities in police records has been widely described. The aim of this study was to apply and evaluate a community crash recording system, and assess the quality of the data in comparison with traffic police data in Nepal.

METHODS

The crash data collection methodology involved recruiting Local Record Keepers working and living at locations known to be at a high risk of crashes. Six shopkeepers were recruited at three crash locations and trained to complete collision incident forms for crashes occurring over one year on the section of road visible from their premises. Manual traffic volume and pedestrian counts, and spot speed surveys were conducted. Data were compared with District police records for the same period and locations.

RESULTS

Over 12 months, 110 crashes were recorded by the Local Record Keepers. Of these, 70 resulted in 145 injuries (5 fatalities, 62 severe, and 78 minor injuries), while 40 resulted only in property damage. Comparable police data recorded 23 crashes, of which 18 crashes resulted in 27 injuries (8 fatalities, 13 serious, and 6 minor injuries), and 5 crashes in property damage only. The difference in recording of fatal and serious injuries was statistically significant (χ2(1) = 19.94, p < 0.001). The police reporting rate was highest for fatalities (62.5%) but only 11.6% and 7.1% for property damage cases and minor injuries respectively, and 3.8% for single-vehicle crashes. Compared to the Local Record Keeper data, the overall police crash reporting rate was 19.7%.

CONCLUSIONS

Local Record Keepers' recording of road traffic crashes and casualties is feasible and provides a more complete record than routinely collected police data. The low reporting rate in the police records of minor injury, property damage, and single-vehicle crashes suggest significant underestimation and bias in the reporting of the actual burden of road traffic crashes. Local Record Keeper recording is a viable method for validating police reports.

Injury amongst Medicolegal Cases in Department of Forensic Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction:

Victim of injuries presenting to a hospital is a medico-legal issue. So, with medical management, proper documentation of injuries should be done as a legal duty by all physicians attending such cases. The study aims to find the prevalence of injury amongst medicolegal cases in the Department of Forensic Medicine in a tertiary care centre.

Methods:

A descriptive cross-sectional study was done amongst 328 medicolegal cases presenting at a tertiary center, from January 2019 to February 2021. Ethical approval was obtained from the Institutional Review Committee (Reference number: 2603202101). Convenience sampling was used to select study samples. After detailed history regarding the incidence, injuries were examined and documented in a performa. The data were entered in Statistical Package for Social Sciences version 18. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data.

Results:

Among 328 cases presenting to hospital for medicolegal issues, 237 (72.25%) (67.40-77.09 at 95% Confidence Interval) had injuries, out of which 170 (71.73%) cases were due to physical assault and 64 (27%) cases due to accident; the rest two (1.26%) were undetermined. Majority of victims of injury were adult males, with a mean age of 32.41±13.96 years. In most accidental injuries internal organs were also injuries and were life-threatening.

Conclusions:

The prevalence of injuries amongst medicolegal cases was found to be higher in our study in comparison to other studies done in similar settings. Most of the injuries were due to physical assault; however, the majority of road traffic injuries were life-threatening. These road traffic injuries could have been prevented by following a safe system approach to road safety.

Road safety and heavy goods vehicle driving in LMICs: Qualitative evidence from Nepal

BACKGROUND

Heavy goods vehicle drivers are an influential driving population in Nepal, with over 90% of goods in the country are transported by road. Due to the time spent on the road, drivers have long periods of exposure to the risk of crash involvement. The study explores the perceptions and experiences of heavy goods vehicle drivers and representatives from their professional association regarding road danger.

METHODS

We conducted semi-structured interviews with fifteen heavy goods vehicle drivers regularly driving on the East-West highway of Makwanpur District, Nepal. A focus group was conducted with eleven members from a major transportation entrepreneur's association in Nepal. The focus group and interviews were audio-recorded, transcribed, translated, and analyzed using thematic analysis.

RESULTS

Four themes were developed- assumptions of blame; perceptions of safety culture in the trucking industry; influence of road infrastructure; and behaviours of road users. The road and traffic environment, enforcement, and the safety culture in the heavy vehicle industry not only influenced the attitudes of the road users towards traffic safety but also legitimized and encouraged behaviours that affect safety. General and industry-related road safety improvements suggested by participants included: making provision for heavy good vehicles parking areas, separating the highway with a median strip, improving crash investigation capacity, conducting road safety awareness and training programs, strictly enforcing the speed limit and laws about driving under the influence of alcohol/drugs, and formulating strategies to create a safe, supportive working environment in the heavy vehicle industry.

CONCLUSION

Heavy goods vehicle drivers and members of the professional association can provide rich information regarding the barriers and facilitators of road risk in Nepal. Their perceptions and opinions can contribute to devising interventions at individual, societal, organizational, and governmental levels, and inform efforts to develop a positive safety culture within the heavy vehicle transport industry.

Home-related and work-related injuries in Makwanpur district, Nepal: a household survey

OBJECTIVE

To describe the epidemiology of home-related and work-related injuries, their mechanisms, inequalities and costs associated with these injuries.

METHODS

A household survey was undertaken in three palikas of Makwanpur district between April and June 2019. Data were collected electronically on non-fatal injuries that occurred in the previous 3 months and fatal injuries that occurred in the previous 5 years.

FINDINGS

17 593 individuals were surveyed from 3327 households. Injury rates were 8.0 per 1000 population for home injuries and 6.4 per 1000 for work-related injuries; 61.0% of home injuries were among women and 69.9% of work-related injuries among men. Falls were the cause of 48% home injuries, affecting 50.9% of men and 46.5% of women. Burns/scalds were higher in women than men, affecting 17.4% of women reporting home injuries. Cuts and piercings accounted for 39.8% of all work-related injuries and 36.3% were falls. Injury incidence varied by ethnic group: home injuries were highest in Brahmin (12.0 per 1000) and work-related injuries highest in Rai groups (21.0 per 1000). The total mean costs (transport and treatment) of work-related injury was US$143.3 (SD 276.7), higher than for home injuries (US$130.4, SD 347.6). The number of home (n=74, 64.9%) and work-related (n=67, 77.9%) injuries were higher in families below the poverty line than families in the next income bracket (home: n=22, 19.3%; work: n=11, 12.8%).

CONCLUSIONS

Home-related and work-related fall injuries are common. The inequalities in injury identified in our study by rurality, age, sex, income level and ethnic group can help target injury prevention interventions for vulnerable groups.

Job Satisfaction among School Teachers in Duwakot, Bhaktapur District, Nepal

Introduction: Job satisfaction is one of the determinant factors for professionals. The job satisfaction concerning school teachers reflects their strong motivation towards their job. This study aimed to measure the job satisfaction among teachers of Government and Private schools of  Changu Narayan Municipality. Methods: A cross-sectional study was done at seven government and five private schools of wards no. 1 and 2 of Changu Narayan Municipality Bhaktapur District, Nepal over one month (20th April - 19th May 2021). Schools of Changu Narayan Municipality Ward No. 1 and 2 were purposively selected. The data was collected through validated questionnaire on Job Description Index (JDI)8 which consists of 17 domains. Data were entered in Excel and data analysis was done in SPSS version 20. Results: The overall job satisfaction was 65.77±11.52 which indicates that the majority of teachers were highly satisfied with their job. Conclusion:  The findings of this study indicate job satisfaction among  school level teachers was satisfied in their occupation especially in teaching profession. The domain sources of job satisfaction in school teachers appear to be work itself, coworker, relationship with students and sense of achievement. Whereas motivation in profession is most likely to be less job satisfaction among Government and Private schools.

Assessment of Knowledge regarding Vitamin D among Medical Undergraduate Students

Introduction: It is estimated that one billion people in the world have vitamin D deficiency and observed as a  public health problem. The main objective of this study is to assess and compare the Vitamin D knowledge among MBBS, BDS and BSc. Nursing students of Kathmandu Medical College, Duwakot (before and after educational training). Methods: This is a cross sectional study carried out at Kathmandu Medical College, Duwakot among 1st year MBBS, BDS and B.Sc Nursing students. Data was collected from 2nd -15th February 2020. A structured self designed multiple choice questionnaire was used. A written  pretest assessment regarding vitamin D knowledge followed by a written posttest assessment  was taken after a lecture class on vitamin D. Ethical approval was obtained from Institutional Review Committee of Kathmandu Medical College (Ref. 2812201809). The census data of students were taken. The data was analyzed using SPSS software version 20.0 Results: Mean differences between the pretest and posttest scores showed an increment of vitamin D knowledge among MBBS students (t = 22.155, p = 0.000), BDS students (t = 16.46, p = 0.000) and B.Sc. Nursing students (t = 18.615, p = 0.000). Conclusions: Interactive lecture class showed moderate gain on knowledge regarding vitamin D among the under graduate students. Health education interventions can improve the knowledge and increases self-efficacy of future doctors and nurses about vitamin D.

Views of professional stakeholders on readiness for a safe road system in Nepal; an exploratory qualitative study

Road traffic injuries in Nepal are increasing despite being largely preventable. Little evidence exists regarding the barriers and facilitators to a safer road system. This study aimed to explore the perspectives of professionals whose jobs had the potential to influence road safety in Nepal regarding challenges and potential solutions. Semi-structured interviews with eight informants from diverse roles were analysed thematically. Three themes were identified: Modifying behaviours of road users; Road planning, construction and maintenance; and the Governance of roads and traffic. All participants considered the primary cause of crashes to be the negligent behavior of the road users, suggesting that improved knowledge would influence their decisions. Poor road design, building and maintenance, together with poor vehicle standards, and lack of investment and enforcement of existing road safety legislation, needed to be addressed through greater coordination of the agencies. The study identified a range of areas for future inquiry and action.

Women's Experience of Disrespect and Abuse during Institutional Delivery in Biratnagar, Nepal

Worldwide, a large number of women experience disrespectful and abusive behavior from care providers during childbirth. This violates the rights of women to attain respectful care. This study aimed to find out the women’s experience of disrespect and abuse during institutional delivery. A cross-sectional study was conducted in two hospitals of Morang district situated in eastern Nepal. Two hundred eighteen women from a public hospital and 109 women from a private hospital (N = 327) with normal vaginal delivery were selected purposively for this study. Data were collected through face-to-face interviews using a structured questionnaire based on the Disrespectful and Abusive Scale by Bowser and Hill. All women had experienced at least one type of disrespect and/or abuse during labor and delivery, most common being non-consented care (100%), non-dignified care (72%), and non-confidential care (66.6%), respectively. Discriminatory care and physical abuse were experienced by 32.33% and 13.23%, respectively. Ethnicity, religion, place of delivery, and numbers of living children were the main predictors of reporting disrespect and abuse. Overall, the occurrence of disrespect and abuse during institutional delivery was found to be very high.

Knowledge of Physiotherapy Practice among Medical Interns in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction:

Medical doctors have profound influence on other health professions including physiotherapist as they are at the top of the pyramid of healthcare profession. There is a lack of knowledge of physiotherapy among medical doctors. They may not be knowing of all physiotherapy services and practice. The objective of this study was to find adequate knowledge of physiotherapy practice among medical interns in a tertiary care hospital.

Methods:

A descriptive cross-sectional study was conducted on medical interns of a tertiary hospital of Kathmandu between 21^st March - 20^th May 2021, after taking ethical approval from the Institutional Review Committee. A convenient sampling method was used and sample size was calculated to be 94. A structured questionnaire was used to collect the demographic details and knowledge of Physiotherapy. Data was analyzed using statistical package for the social sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data.

Results:

The knowledge of physiotherapy practice was seen adequate among 16 (17%) (95% Confidence Interval = 9.41-24.59) medical interns. Physiotherapy is effective in reducing pain was acknowledged by 89 (97.4 %), 61 (64.9 %) had knowledge about conditions treated by physiotherapy, 55 (58.5 %) had knowledge that physiotherapy treatment follows definite treatment protocol and 26 (27.7 %) had knowledge that exercise prescription is done in physiotherapy.

Conclusions:

The prevalence of adequate knowledge is less in our study which is similar to other studies done in similar settings. Therefore, there is a need of educating the future medical doctors about physiotherapy, thereby reaching a better patient care.

Medical Students’ Perception Regarding E- Learning during Covid-19 Lockdown Period

Background and Objectives: Due to Covid-19 lockdown period undergraduate medical institutions across the country are moving towards e-learning for continuity of education. The purpose of this study is to determine the perceptions of students towards e-learning and to analyze medical students’ perception on e-learning vs. conventional learning. Materials and Method: This was a descriptive cross sectional study conducted by distributing an online semi-structured questionnaire consisting Likert scale to undergraduate medical students of Kathmandu Medical College. Data assembled from the survey were analyzed and Statistical package for social sciences (SPSS) 24 version software was used for data analysis. Result: A total of 273 students were enrolled in this study. Most of the students, 83.9% (229) had the perception that conventional teaching method was the best method for learning as compared to e-learning method 16.1% (44). The students mentioned that conventional method of learning is more effective to increase knowledge than e -learning (M= 3.87, M= 2.80) which was statistically significant (p=0.000). Conclusion: E-learning was the only option for students to study during lockdown period. But students preferred conventional method of learning as compared to e-learning. It might be due to some disadvantages of e-learning, eg. Technical difficulties, lack of interaction with teacher  and patients, etc. So, these measures have to be addressed for improving e-learning for betterment of teaching-learning activity during these types of circumstances in future.

Burnout among healthcare professionals in Nepal: An analytical study

Introduction: The greater risk of burnout among healthcare professionals is likely to develop an adverse effect on their personal life and the patients’ care. The main aim of this study was to assess the levels of burnout experienced by healthcare workers. Methods: A cross-sectional study was conducted from November 2020 to March 2021 among healthcare professionals working in different institutions. A convenient sampling technique was applied. An online questionnaire was developed using Google Forms. Results: The total burnout score among health professionals ranged from low (9.5%), moderate (89.5%) to high (1%). The burnout scores reported were of moderate level among doctors (89%) and nurses (92.2%). There was a negative correlation between burnout and compassion satisfaction (r = - 0.207: p<0.003). Healthcare professionals perceived burnout from time pressure (22.2%), followed by administrative work (20.1%) and dealing with patient’s relatives (13.5%). The identified effective way to minimize burnout was family support (29.1%), friends (21.2%), and their interest/hobbies (15.4%). Conclusion: Healthcare professionals in Nepal bear a moderate level of burnout. The main sources of burnout experienced by health workers were time pressure, administrative work, and dealing with patients’ relatives.

State of Post-injury First Response Systems in Nepal-A Nationwide Survey

Injuries account for 9.2% of all deaths and 9.9% of the total disability-adjusted life years in Nepal. To date, there has not been a systematic assessment of the status of first response systems in Nepal. An online survey was cascaded through government, non-governmental organisations and academic networks to identify first response providers across Nepal. Identified organisations were invited to complete a questionnaire to explore the services, personnel, equipment, and resources in these organisations, their first aid training activities and whether the organisation evaluated their first response services and training. Of 28 organisations identified, 17 (61%) completed the questionnaire. The range of services offered varied considerably; 15 (88.2%) provided first aid training, 9 (52.9%) provided treatment at the scene and 5 (29.4%) provided full emergency medical services with assessment, treatment and transport to a health facility. Only 8 (47.1%) of providers had an ambulance, with 6 (35.3%) offering transportation without an ambulance. Of 13 first aid training providers, 7 (53.8%) evaluated skill retention and 6 (46.2%) assessed health outcomes of patients. The length of a training course varied from 1 to 16 days and costs from US$4.0 to 430.0 per participant. There was a variation among training providers in who they train, how they train, and whether they evaluate that training. No standardisation existed for either first aid training or provision of care at the scene of an injury. This survey suggests that coordination and leadership will be required to develop an effective first response system across the country.

Occupational health hazard among Security Guards in Kathmandu District, Nepal

Introduction: The job of security guard is to protect the property and the people who reside or work on the premises where they guard. The occupational safety requires the maintenance and the promotion of workers’ health and working capacity by improving the working environment and the development of working organizations. The aim of study was to assess the occupational health hazards among the security guards and to find association between occupational health hazards with demographic variables. Methods: A cross-sectional study was conducted among the security guards across Kathmandu district from 20th December 2020 to 8th January 2021 using convenient sampling technique. The data was collected by direct interview method using the structured questionnaire. Results: The mean age of the respondents was 36.5 years with standard deviation 9.54. Males were 88.5 %. Most of the respondents (74%) were married. Majority of the respondents (78%) were Hindu by religion. The prevalence of Muscle pain was 70%, one fifth of the respondents (20%) had lower back pain. The Neck pain, elbow-hand- wrist pain and upper back pain each was present in 10% of the respondents. Conclusion: The muscular pain was not significant difference with demographic variables age, sex, marital status, ethnicity, religion and education status. The muscle pain was found higher in low worked experience of the security guards and not statistically significant.

The prevention of - and first response to - injuries in Nepal: a review of policies and legislation

BACKGROUND

Injuries, the cause of an estimated 4.5 million deaths annually and many more disabilities worldwide each year, are the predictable outcome of particular circumstances. One of the most effective ways to prevent injuries is through policy and legislation. The aim of this research study was to identify and critically review all policy and legislation in Nepal that had the potential to prevent injuries.

METHODS

We identified legislation and policy that met inclusion criteria through a stakeholder meeting, networks and contacts, and websites and electronic resources. Each included document was critically reviewed to identify areas of strength and opportunities for improvement. We compared the included documents against WHO's recommendations of known effective interventions.

RESULTS

Sixty-two documents met the inclusion criteria for this review. Of these, 24 (38.7%) were exclusively related to road injuries, 11 (17.7%) to occupational injuries, 6 (9.7%) to injuries in the home and 5 (8.1%) to injuries at school; 30 (48.4%) documents included text related to the first response to injuries. Of 127 strategic recommendations by WHO that provided an area for policy or legislative focus, 21 (16.5%) were considered adequately met by Nepali policy and legislation, 43 (33.9%) were considered partially met and 63 (49.6%) were not met.

CONCLUSION

We drew five conclusions from this critical policy review, which we have related to recommendations as follows: widening the scope of legislation and policy for injury prevention to emphasize injuries occurring at home or school; addressing the causes of injuries and promoting proven preventive measures; greater clarity on both individual and institutional roles and responsibilities; trustworthy data and quality evidence to inform decision-making; and financial investment and capacity-strengthening for injury prevention and first response. The current system of federal governance in Nepal has potential for strengthening injury prevention and first response at the central, provincial and local levels.

Knowledge of Vitamin D among First-year Medical Undergraduate Students of a Medical College: A Descriptive Cross-sectional Study

Introduction:

Vitamin D also known as the sunshine vitamin, helps in bone metabolism and calcium homeostasis. It is estimated that one billion people in the world have vitamin D deficiency making it a public health problem. The objective of this study is to find out the knowledge regarding vitamin D among first-year medical undergraduate students of a medical college.

Methods:

This is a descriptive cross-sectional study carried out from 2nd February 2020 to 15th February 2020 at Kathmandu Medical College Teaching Hospital, Duwakot among medical undergraduate students of a medical college. Ethical clearance was received from the Institutional Review Committee of Kathmandu Medical College Teaching Hospital (Reference Number: 2812201809). A structured self-designed multiple-choice questionnaire on vitamin D knowledge was used. Convenient sampling method was applied and statistical analysis was done with Statistical Package for the Social Sciences 20 version.

Results:

Out of total 157 undergraduate medical students, 21 (13.3%) exhibited good knowledge, 116 (73.9.8%) had average, and 20 (12.8%) had poor knowledge. There were 83 (52.9%) Bachelor of Medicine and Bachelor of Surgery students, 39 (24.8%) were Bachelor of Dental Surgery and 35 (22.3%) were Nursing students.

Conclusions:

We found a satisfactory level of knowledge of vitamin D among first-year undergraduate medical students of a medical college when compared to similar studies. The majority of students from all three disciplines had average knowledge of vitamin D.

Perceptions of injury risk in the home and workplace in Nepal: a qualitative study

OBJECTIVE

Injuries are a global health problem. To develop context-specific injury prevention interventions, one needs to understand population perceptions of home and workplace injuries. This study explored a range of views and perceptions about injuries in a variety of settings and identified barriers and facilitators to injury prevention.

DESIGN

Qualitative study: interviews and focus groups.

SETTING

Three administrative areas: Hetauda submetropolitan city, Thaha municipality and Bakaiya rural municipality in Makwanpur, Nepal.

PARTICIPANTS

Nine focus groups (74 participants) and nine one-to-one interviews were completed; workers from diverse occupations, residents (slum, traditional or modern homes) and local government decision-makers participated in the study between May and August 2019. The interviews and discussions were audio-recorded, transcribed verbatim, translated to English and analysed thematically.

RESULTS

Six themes were developed: unsafe home and workplace environment; inadequate supervision and monitoring; perceptions that injuries are inevitable; safety takes low priority: financial and behavioural considerations; safety education and training; and government-led safety programmes and enforcement. Key barriers to injury prevention were perceived to be lack of knowledge about injury risk and preventive measures both at the community level and at the workplace. Facilitators were community-level educational programmes and health and safety training to employees and employers. Participants stressed the importance of the role of the government in planning future injury prevention programmes in different environments.

CONCLUSIONS

This study highlighted that both home and workplace injuries are complex and multifactorial. Lack of knowledge about injury risks and preventive measures, both at the community level and at the workplace, was found to be a common barrier to injury prevention, perceived to be mitigated by educational programmes. Together with previously published epidemiological evidence, the barriers and facilitators identified in this study offer useful basis to inform policy and practice.

Occupational health and safety of the frontline healthcare workers in Nepal in COVID-19 pandemic

Occupational health and safety (OHS) is essential for every professional especially healthcare workers who work day and night serving patients. According to the WHO, health workers should not face any kind of workplace violence during their professional activities. Attention should also be paid to the mental and psychological health of healthcare workers and their protection should be of paramount importance. OHS related policies, rules and regulations have been formulated in Nepal. According to the law, the responsibility of the OHS of the employees has to be taken by the concerned organization. In Nepal, during the COVID-19 pandemic, health workers have to take the risk of infecting themselves while providing care for the patients. This has led to the infection of thousands of health workers and we have also lost quite a few healthcare workers in the line of duty in Nepal. On one hand, there is a psychological fear of acquiring COVID-19 infection in healthcare workers despite adopting health and safety measures, while on the other hand, in case of infection they will have to pay for the treatment from their own pockets. Sometimes ICU and ventilator services are not available not only in their working hospital but also in government referral health institutions which have given rise to incidences that healthcare workers themselves have to be admitted to other hospitals for the treatment. In such a situation, not just mental but also a financial burden has been added to the healthcare workers.

Adolescent's perception of road risk on their routes to school in Makwanpur, Nepal; a qualitative study

BACKGROUND

Busy and poor road infrastructure along routes to school poses high risk of traffic injury for children and adolescents. Ensuring every young person's safe journey to and from school is fundamental to achieving reductions in road injuries and Sustainable Development Goal 3.6. However, there is little evidence reporting adolescent's views about their school travel from low and middle income countries. This study aims to understand adolescent's perceptions of injury risks on their journey to school in Nepal.

METHODS

We used Photo-Elicitation Interview (PEI) methods to collect data from fourteen purposively identified adolescents (12-16 years) who walk to Tribhuwan Secondary School along the East-West Highway which is known to be at high risk of crashes in Makwanpur, Nepal. The participants used a camera to record parts of their journey, which they perceived as dangerous or safe. Photographs were used as prompts during an interview afterwards. Interviews were audio-recorded, transcribed, translated and analysed thematically.

RESULTS

The identified themes were categorised as either environmental or behavioural factors. The adolescents were scared to walk on narrow roadsides because of speeding vehicles. They also found crossing the road dangerous because of the lack of designated pedestrian crossings and disregard shown by drivers. Poor visibility caused by random roadside parking and trees also increased the sense of road danger.

CONCLUSION

Adolescents expressed multiple concerns which made their journeys difficult and dangerous. They illustrated issues such as poor road condition, inadequate pedestrian crossings and traffic signs, narrow roadsides, vehicle speeding and overtaking, failing to obey traffic rules and regulation -providing evidence that could be shared with the authorities to improve road safety near schools.

Gaming Disorder among Medical College Students during COVID-19 Pandemic Lockdown

Background The frequent lockdown in Nepal during COVID-19 pandemic had brought various kinds of complexities such as stress among college students. This situation had created uncertainty of future academic career of undergraduate students in medical colleges. Some previously published literature showed gaming as a coping mechanism against stress. Objective To assess the gaming behavior of Medical college students during lockdown in COVID-19 pandemic. Method A cross-sectional study was conducted during lockdown period of July to August 2020. A total of 412 college students were enrolled. Online Google forms were shared to all the eligible students through email, viber and messenger with the help of class representative. Collected data were analyzed in SPSS version 20.0. Result The prevalence of gaming disorder was 8.5% among 260 internet gaming users. About 69.2% of the participants reported that their gaming behavior had increased due to stress of COVID-19 pandemic. Gender and spending more time online per day showed significant associations with greater scores on the internet gaming disorder. Conclusion During lockdown period of COVID-19 pandemic, the gaming behavior of medical college students has increased.

Knowledge, Attitude and Practice about Vitamin D among Pregnant Women at a Municipality of Bhaktapur

Introduction:

Almost a billion people in the world are affected by Vitamin D deficiency. During pregnancy, the deficiency of Vitamin D can manifest as gestational diabetes, pre-eclampsia, preterm birth, or miscarriage in the early stages of pregnancy. The objective of this study was to assess the knowledge, attitude and practice and importance of Vitamin D among pregnant women via focus group.

Methods:

A qualitative study was carried out at Changu Narayan Municipality, Duwakot ward no. two, Bhaktapur district from November to December 2019 after approval from Institutional Review Committee of Kathmandu Medical College (Ref. 181020192). Participants were selected via the Female Community Health Volunteer's pregnant women list by purposive sampling method. Focus group discussion was conducted among pregnant women. The interview questions were open-ended and the data were analyzed using thematic analysis.

Results:

Study participants showed limited knowledge on vitamin D. Few participants had information regarding sun exposure for vitamin D. But many participants had negative attitudes towards sun exposure and lack of knowledge on sun exposure requirements. The participants have a huge knowledge gap between Vitamin D and its importance in pregnancy.

Conclusions:

Increasing awareness of the importance of Vitamin D among pregnant women is required.

Antidiabetic effect of aqueous-ethanol extract from the aerial parts of Artemisia roxburghiana

Artemisia roxburghiana is used for the management of diabetes mellitus in the Indian subcontinent. The present work aimed to validate the traditional claim of the plant in diabetes mellitus. In vitro studies were conducted using α-glucosidase and α-amylase assays whereas streptozotocin-nicotinamide-induced diabetic Wistar rats were used for in vivo study. The aqueous-ethanol extract from the aerial parts was found to exhibit α-glucosidase and α-amylase inhibitory activities with the IC₅₀ values of 31.0 and 17.2 mg/mL, respectively when compared with acarbose (IC₅₀ = 8.6 and 16.25 mg/mL, respectively). The extract showed a significant glucose-lowering effect in diabetic rats at the doses of 200 and 400 mg/kg in a dose-dependent manner, while acarbose (10 mg/kg) was used as a standard. The results revealed that A. roxburghiana aerial parts showed antidiabetic activity via inhibiting α-glucosidase and α-amylase enzymes. The present study also validated the ethnomedicinal claim of the plant in diabetes mellitus.

Status of Migration and Its Perceived Effects in Khopasi, Kavrepalanchowk District: A Descriptive Cross-Sectional Study

Introduction: Labor migration has become a means to make ends meet for low-income countries. It plays a key role to provide employment opportunities and has helped in the improvement of the standard of living. With the alarming rise of migrating workers, it becomes important to acknowledge the effects of migration on both the migrant workers in the destination country as well as families left behind at the place of origin. The objective of this study was to find out the status of migration of population in Khopasi village and their attitude towards the effects of migration on families left behind.  Methods: A descriptive cross-sectional study was conducted among 256 residents of Khopasi, Kavrepalanchowk district from 10-15th November 2019. Participants were interviewed using a semi-structured questionnaire to assess the status of migration of immediate family members as well as the attitude towards migration and its effects. Results: The prevalence of migrant workers was 39.8%. The process of migration was assisted by their migrated relatives 59 (19.1%) and by foreign employment agencies 30 (12.92 %). The expenses for migration were managed by bank loan 34 (33.34%). Among102 migrant workers, 54(52.9%) are still working abroad whereas 48 (47.1%) have returned to Nepal. The main reason for migrant workers to go abroad was unemployment 59 (57.8%) in Nepal. Out of 102 who migrated, most of them 39 (38.23%) have spent 1-3 years abroad while 76 (68.6%) send remittance regularly to their family members at home around 1-3 lakhs/year. Among all the migrant worker  37(36.27%) reported some form of disease and disability. There was a positive attitude toward family and the country’s economy but the overall attitude towards migration was negative. Conclusion: In this study, remittance sent by migrant workers to their families was not adequate as there were no visible financial benefits and negative health consequences were also present. There are other impacts of migration like broken families, separation, difficulty in the rearing of children, mental health of elderly were seen on the families left behind. Various studies are required to further analyze the impact of migration other than remittance.

Knowledge of occupational health hazards and practice of personal protective equipment among fabrication workers in Kathmandu district, Nepal

Background: Fabrication work is one of the hazardous occupations in which workers are exposed to different occupational hazards and injuries. But the workers lack proper knowledge about protecting themselves from those hazards. This study was conducted, to assess knowledge about occupational health hazards among fabrication workers and to find out the practice of Personal Protective Equipment (PPE) in fabrication works. Methods: A cross-sectional study was conducted among 394 fabricator workers of Kathmandu District by using a multi-stage sampling technique. Participants were interviewed with a pre-tested semi-structured questionnaire. Results: All the participants were male, and their age ranged from 19-60 years with the mean age of 32.3 years. 71.3% of participants had work-related health complains, among which arc eye (85.76%) was the most common. Among them, 87.1% had at least used one PPE. There was a significant association between awareness about occupational hazards and work experience of fabrication workers (p=0.001), and the practice of PPE with religion (p<0.01). Conclusions: This study found that fabrication workers were aware of occupational hazards and the use of PPE during the fabrication work. But the practice of PPE was not enough to protect them from the occupational hazards.

Importance of consent in the research

Research involving human participants needs to be scientifically valid and should be conducted according to accepted ethical standards. Research ethics provides guidelines for responsible conduct of research on human participants. It primarily protects the human participants of research and also educates and monitors researchers conducting health research to ensure a high quality of ethical standard. Consent is a research process of information exchange between the researcher and the human participants of research. Information provided to the human participants of research should be adequate, clearly understood by the participant of research with decision-making capacity and the research participant should voluntarily decide to participate. Respect for persons requires that the participants of research should be allowed to make choices about whether to participate or not in the research.

Awareness on Social Health Insurance Scheme among Locals in Bhaktapur Municipality

BACKGROUND

Illnesses impose a huge economic burden on individuals and families. Costly health care also discourages people from using health services thereby generating prolonged or worsened health problems. The recently endorsed National Health Insurance Policy forecasts the integration of all social health protection schemes thereby ultimately achieving universal coverage. The aim of this study was to find out the awareness of health insurance and evaluate source of information about health insurance.

METHODS

A cross sectional study was conducted on 385 participants from 5 randomly selected wards of Bhaktapur Municipality on July 2019. Households with health insurance were selected. The interview was taken either from the head of the family or the family member who takes financial decisions in the house. Face to face interview was taken in local language (Newari). Good and poor categories on awareness were developed. Descriptive statistics was applied.

RESULTS

Good awareness of social health Insurance scheme was found among 335(87.2%) participants. 99% of the participants showed the importance of social health insurance. The main source of information was insurance agents (47.3%) and female community health volunteers (28.6%). Regarding benefits of opting health insurance, 66.5 % of the participants stated that it would reduce out-of-pocket expenditure. 65.5% opined that it would help in case of emergency medical situations. About 91.9% of respondents wanted to renew their health insurance in future also.

CONCLUSIONS

Awareness regarding health insurance was found good, which shows the positive acceptance of social health Insurance scheme by community. Insurance agent and hemale community health volunteers (FCHV) seemed to have played an important role in dissemination of information.

Health Co-morbidities and Early Marriage in Women of a Rural Area of Nepal: A Descriptive Cross-Sectional Study

Introduction:

Early marriage is defined as the marriage of a young person less than 18 years. Early marriage is more prevalent in South Asia as more than half of all child marriage occurs here. Thirty-seven percent of girls in Nepal marry before age 18 years. This study was done to find out the health consequences of early marriage in women of a rural area of Nepal.

Methods:

A descriptive cross-sectional study was conducted from 10^th to 15^th Feb 2020 February in 358 women from Panauti, Kavrepalchowk. The convenient sampling method was used. Ethical approval was taken from the Institutional Review Committee. Economic status was assessed by using Kuppuswamy's socioeconomic scale. The collected data were analyzed using the Statistical Package for Social Science version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

Results:

The prevalence of early marriage was 187 (52.2%) (47.03 to 57.37 at 95% confidence interval). One hundred sixteen (62%) early marriage women had gynecological problems followed by depression problem 85 (45.5%) and miscarriage 32 (17.1%). The mean age of marriage was 17.2 years. The majority, i.e. 167 (89.3%) of respondents who married earlier were Hindu by religion. Early marriage was observed in 104 (55.6%) of illiterate women.

Conclusions:

The prevalence of early marriage was high. Early married women had a lower level of socio-economic status, lower level of education, which harmed the participants' health status.

Morbidity of School Children in Panauti Municipality of Kavrepalanchowk: A Descriptive Cross-sectional Study

INTRODUCTION

School health has been considered as a high priority intervention in developing countries but it has not been prioritized in Nepal. The objectives of the study are to find out the prevalence of morbidity and nutritional status in school children.

METHODS

A descriptive cross-sectional study was conducted in a private school located at Panauti Municipality of Kavrepalanchowk district for one week of November 2019. A convenient sampling technique was used. From a selected school, a total number of 356 students studying from Grade I to X were included in the study using. Confidence Interval at 95% was calculated along with frequency and proportion for binary data using Statistical Package for Social Science (SPSS) software.

RESULTS

Among 356 students, the most common three morbidities were dental caries 43 (18.1%), tonsillitis 26 (6.2 %), and headache 18 (7.1 %). Based on weight for age, 43 (23.9%) boys and 22 (12.5%)girls were underweight and 12 (6.7%) boys and 4 (2.7%) girls were overweight and 6 (2%) were obese. Thus school health programs should give more emphasis on oral health, nutrition, personal hygiene, etc.

CONCLUSIONS

The health and nutritional status of school children in this study were found to be satisfactory compared to other studies. The present study emphasized oral health. The school health program is important in the school for the prevention of diseases like a parasitic infestation, improving personal hygiene, and nutritional status.

Improving Safety Among Pregnant Women Reporting Domestic Violence in Nepal-A Pilot Study

Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for both the mother and newborn, and sometimes death. In a low-income country like Nepal, women have few options to leave abusive situations. Therefore, there is a need for interventions to improve their safety. The aim of our study was to explore the use of safety measures before and after an educational intervention among women who have reported DV during pregnancy. Materials and methods: Of 1010 pregnant women screened consecutively for DV using the Abuse Assessment Screen (AAS) during routine antenatal care, 181 women reported domestic violence. All 1010 participating pregnant women were taught 15 safety measures using a locally developed flipchart. We obtained contact with 80 of the 181 eligible women postpartum, of whom 62 completed the follow-up assessment. We explored and described the use of safety measures at baseline and follow-up, using a standardized instrument called the Safety Behavior Checklist. Results: At follow-up, less than half of the women (n = 30, or 48.3%) reported any form of DV. Of the women who reported DV at follow-up, significantly more reported the experience of both violence and fear at baseline (21.9%, p = 0.01) compared with the women who did not report DV at follow-up (3.3%, p = 0.01). Women reporting DV at baseline and follow-up used more safety measures at baseline (56) and follow-up (80) compared with women reporting DV at baseline only (36 and 46). Women reporting DV at baseline and follow-up used more safety measures for the first time at follow-up, 57 new measures compared with the 28 new measures used by women reporting DV at baseline only. Conclusions: The use of a flipchart teaching session on safety measures within antenatal care may increase the number of safety measures women use to protect themselves during pregnancy and decrease the risks of adverse health effects of DV.

Morbidity Pattern among Elderly Population of Changu Narayan Municipality, Bhaktapur

BACKGROUND

The Senior Citizens Acts 2063, Nepal defines the senior citizens (elderly population) as "people who are 60 years and above". Health is the most important determinant of the quality of life of people. Ill-health becomes a major obstacle for the well-being of the elderly population. This study was conducted to assess the morbidity pattern in elderly population.

METHODS

A community based cross-sectional study was carried out in field practice area of the Department of Community Medicine. 124 elderly population were selected by convenient sampling technique. A structured questionnaire was used to collect the data. Data was analyzed using SPSS version 20. Chi-square was used to test the association and p<0.05 was considered as significant.

RESULTS

The mean age of elderly population was 69.85 years. Majority (47.6%) of them were in the age group of 60-69 years. Males (50.8%) were more than females (49.2%). Twelve respondents (9.7%) were not suffering from any form of morbidity. Most common morbidity was muscular skeleton problem (40.8%), followed by hypertension (36.3%), diabetes (29.8.8%), psychological (23.4%) and respiratory (18.6%). Other morbidities gastrointestinal, dental, ENT, eye and genitourinary system were found in around ten percentage of elderly population Conclusions: Majority of the elderly population were suffering from non-communicable diseases. There is a need for health care services at all level with special focus on disease prevention, early detection and treatment for elderly population. This study found high prevalence of musculoskeletal, hypertension, diabetes and psychological problem and low prevalence of respiratory, gastrointestinal, dental, ENT, genitourinary and eye problem.