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Tandukar S, Thakali O, Baral R, Tiwari A, Haramoto E, Tuladhar R, Joshi DR, Sherchan SP. Application of wastewater-based epidemiology for monitoring COVID-19 in hospital and housing wastewaters. Sci Total Environ 2024; 931:171877. [PMID: 38531458 DOI: 10.1016/j.scitotenv.2024.171877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/04/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
An alternative and complementary diagnostic method of surveillance is provided by wastewater-based surveillance (WBS), particularly in low-income nations like Nepal with scant wastewater treatment facilities and clinical testing infrastructure. In this study, a total of 146 water samples collected from two hospitals (n = 63) and three housing wastewaters (n = 83) from the Kathmandu Valley over the period of March 2021-Febraury 2022 were investigated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using quantitative reverse transcription TaqMan PCR assays targeting the N and E genes. Of the total, 67 % (98/146) samples were positive for SARS-CoV-2 RNA either by using N- or E-gene assay, with concentrations ranging from 3.6 to 9.1 log10 copies/L. There was a significant difference found between positive ratio (Chi-square test, p < 0.05) and concentration (t-test, p = 0.009) of SARS-CoV-2 RNA detected from hospital wastewater and housing waters. Wastewater data are correlated with COVID-19 active cases, indicating significance in specific areas like the Hospital (APFH) (p < 0.05). According to the application of a bivariate linear regression model (p < 0.05), the concentrations of N gene may be used to predict the COVID-19 cases in the APFH. Remarkably, SARS-CoV-2 RNA was detected prior to, during, and following clinical case surges, implying that wastewater surveillance could serve as an early warning system for public health decisions. The significance of WBS in tracking and managing pandemics is emphasized by this study, especially in resource-constrained settings.
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Affiliation(s)
- Sarmila Tandukar
- Organization for Public Health and Environment Management, Lalitpur, Nepal
| | - Ocean Thakali
- Organization for Public Health and Environment Management, Lalitpur, Nepal
| | - Rakshya Baral
- Center of Research Excellence in Wastewater based Epidemiology, Morgan State University, Baltimore, MD 21251, United States of America
| | - Ananda Tiwari
- Expert Microbiology Research Unit, Finnish Institute for Health and Welfare, Kuopio 70701, Finland
| | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Reshma Tuladhar
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Dev Raj Joshi
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Samendra P Sherchan
- Organization for Public Health and Environment Management, Lalitpur, Nepal; Center of Research Excellence in Wastewater based Epidemiology, Morgan State University, Baltimore, MD 21251, United States of America; Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan; Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal; Department of Environmental Health Sciences, Tulane University, New Orleans, LA 70112, United States of America.
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Hossain S, Mihrshahi S. Effect of exclusive breastfeeding and other infant and young child feeding practices on childhood morbidity outcomes: associations for infants 0-6 months in 5 South Asian countries using Demographic and Health Survey data. Int Breastfeed J 2024; 19:35. [PMID: 38755734 PMCID: PMC11097433 DOI: 10.1186/s13006-024-00644-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/12/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Despite growing evidence of the impacts of exclusively breastfeeding infants during the first 6 months of life on preventing childhood infections and ensuring optimal health, only a small number of studies have quantified this association in South Asia. METHODS We analyzed data from the Demographic and Health Surveys in Afghanistan (2015; n = 3462), Bangladesh (2017-2018; n = 1084), India (2019-2021; n = 26,101), Nepal (2022; n = 581), and Pakistan (2017-2018; n = 1,306), including babies aged 0-6 months. Multivariate logistic regression models were used to determine the association between exclusive breastfeeding in the last 24 h and diarrhoea, acute respiratory infections, and fever in the two weeks before the survey. We also examined the association between other infant and young feeding indicators and these outcomes. RESULTS Infants who were exclusive breastfed had decreased odds of diarrhoea in Afghanistan (AOR: 0.49, 95% CI 0.35, 0.70), India (AOR: 0.80, 95% CI 0.70, 0.91), and Nepal (AOR: 0.42, 95% CI 0.20, 0.89). Compared with infants who were not exclusive breastfed, infants who were exclusively breastfed were less likely to have fever in Afghanistan (AOR: 0.36, 95% CI 0.26, 0.50) and India (AOR: 0.75, 95% CI 0.67, 0.84). Exclusive breastfeeding was associated with lower odds of acute respiratory infections in Afghanistan (AOR: 0.57, 95% CI 0.39, 0.83). Early initiation of breastfeeding was protective against diarrhoea in India. Bottle feeding was a risk factor for diarrhoea in India and for fever in Afghanistan and India. Bottle feeding was also a risk factor for acute respiratory infection in Afghanistan and India. CONCLUSIONS Not exclusive breastfeeding is a risk factor for diarrhoea, acute respiratory infections, and fever in some South Asian countries. These findings could have substantial implications for global and national efforts to increase exclusive breastfeeding rates. More support, advocacy, and action are required to boost breastfeeding rates as a crucial public health measure.
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Affiliation(s)
- Saldana Hossain
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
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Luitel NP, Lamichhane B, Pokhrel P, Upadhyay R, Taylor Salisbury T, Akerke M, Gautam K, Jordans MJD, Thornicroft G, Kohrt BA. Prevalence of depression and associated symptoms among patients attending primary healthcare facilities: a cross-sectional study in Nepal. BMC Psychiatry 2024; 24:356. [PMID: 38745133 PMCID: PMC11092057 DOI: 10.1186/s12888-024-05794-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Depression is a prevalent mental health condition worldwide but there is limited data on its presentation and associated symptoms in primary care settings in low- and middle-income countries like Nepal. This study aims to assess the prevalence of depression, its hallmark and other associated symptoms that meet the Diagnostic and Statistical Manual (DSM-5) criteria in primary healthcare facilities in Nepal. The collected information will be used to determine the content of a mobile app-based clinical guidelines for better detection and management of depression in primary care. METHODS A total of 1,897 adult patients aged 18-91 (63.1% women) attending ten primary healthcare facilities in Jhapa, a district in eastern Nepal, were recruited for the study between August 2, 2021, and March 25, 2022. Trained research assistants conducted face-to-face interviews in private spaces before the consultation with healthcare providers. Depression symptoms, including hallmark symptoms, was assessed using the validated Nepali version of the Patient Health Questionnaire (PHQ-9). RESULTS One in seven (14.5%) individuals attending primary health care facilities in Jhapa met the threshold for depression based on a validated cut-off score ( > = 10) on the PHQ-9. The most commonly reported depressive symptoms were loss of energy and sleep difficulties. Approximately 25.4% of women and 18.9% of men endorsed at least one of the two hallmark symptoms on the PHQ-9. Using a DSM-5 algorithm (at least one hallmark symptom and five or more total symptoms) to score the PHQ-9, 6.3% of women and 4.3% of men met the criteria for depression. The intra-class correlation coefficient for PHQ-9 total scores by health facility as the unit of clustering was 0.01 (95% confidence interval, 0.00-0.04). CONCLUSION Depression symptoms are common among people attending primary healthcare facilities in Nepal. However, the most common symptoms are not the two hallmark criteria. Use of total scores on a screening tool such as the PHQ-9 risks overestimating the prevalence and generating false positive diagnoses. Compared to using cut off scores on screening tools, training health workers to first screen for hallmark criteria may increase the accuracy of identification and lead to better allocation of treatment resources.
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Affiliation(s)
- Nagendra P Luitel
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal.
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, George Washington University, Washington, D.C, USA.
| | - Bishnu Lamichhane
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Pooja Pokhrel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Rudrayani Upadhyay
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Makhmud Akerke
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Kamal Gautam
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, George Washington University, Washington, D.C, USA
| | - Mark J D Jordans
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Brandon A Kohrt
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, George Washington University, Washington, D.C, USA
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Jasuja JK, Bub F, Veit J, Fofana HKM, Sacko M, Saye R, Chatigre JK, N'Goran EK, Yao JA, Khanal B, Koirala K, Bhattarai NR, Rijal S, von Müller L, Bottieau E, Boelaert M, Chappuis F, Polman K, Utzinger J, Becker SL. Multiplex PCR for bacterial, viral and protozoal pathogens in persistent diarrhoea or persistent abdominal pain in Côte d'Ivoire, Mali and Nepal. Sci Rep 2024; 14:10926. [PMID: 38740833 DOI: 10.1038/s41598-024-60491-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
In contrast to acute diarrhoea, the aetiology of persistent digestive disorders (≥ 14 days) is poorly understood in low-resource settings and conventional diagnostic approaches lack accuracy. In this multi-country study, we compared multiplex real-time PCR for enteric bacterial, parasitic and viral pathogens in stool samples from symptomatic patients and matched asymptomatic controls in Côte d'Ivoire, Mali and Nepal. Among 1826 stool samples, the prevalence of most pathogens was highest in Mali, being up to threefold higher than in Côte d'Ivoire and up to tenfold higher than in Nepal. In all settings, the most prevalent bacteria were EAEC (13.0-39.9%) and Campylobacter spp. (3.9-35.3%). Giardia intestinalis was the predominant intestinal protozoon (2.9-20.5%), and adenovirus 40/41 was the most frequently observed viral pathogen (6.3-25.1%). Significantly different prevalences between symptomatic and asymptomatic individuals were observed for Campylobacter, EIEC and ETEC in the two African sites, and for norovirus in Nepal. Multiple species pathogen infection was common in Côte d'Ivoire and Mali, but rarely found in Nepal. We observed that molecular testing detected multiple enteric pathogens and showed low discriminatory accuracy to distinguish between symptomatic and asymptomatic individuals. Yet, multiplex PCR allowed for direct comparison between different countries and revealed considerable setting-specificity.
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Affiliation(s)
- Jasmin K Jasuja
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany
- Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Bub
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany
| | - Jonas Veit
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany
| | | | - Moussa Sacko
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Rénion Saye
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | | | - Eliézer K N'Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Joel A Yao
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Basudha Khanal
- Department of Microbiology, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kanika Koirala
- Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narayan R Bhattarai
- Department of Microbiology, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suman Rijal
- Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Lutz von Müller
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany
- Institute for Laboratory Medicine, Microbiology and Hygiene, Christophorus Kliniken, Coesfeld, Germany
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany.
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
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Mehta R, Jha BK, Awal B, Sah R, Shrestha L, Sherpa C, Shrestha S, Jha R. Molecular characterization of influenza virus circulating in Nepal in the year 2019. Sci Rep 2024; 14:10436. [PMID: 38714669 PMCID: PMC11076455 DOI: 10.1038/s41598-024-58676-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/02/2024] [Indexed: 05/10/2024] Open
Abstract
Influenza (sometimes referred to as "flu") is a contagious viral infection of the airways in the lungs that affects a significant portion of the world's population. Clinical symptoms of influenza virus infections can range widely, from severe pneumonia to moderate or even asymptomatic sickness. If left untreated, influenza can have more severe effects on the heart, brain, and lungs than on the respiratory tract and can necessitate hospitalization. This study was aimed to investigate and characterize all types of influenza cases prevailing in Nepal and to analyze seasonal occurrence of Influenza in Nepal in the year 2019. A cross sectional, retrospective and descriptive study was carried out at National Influenza Center (NIC), National Public Health Laboratory Kathmandu Nepal for the period of one year (Jan-Dec 2019). A total of 3606 throat swab samples from various age groups and sexes were processed at the NIC. The specimens were primarily stored at 4 °C and processed using ABI 7500 RT PCR system for the identification of Influenza virus types and subtypes. Data accessed for research purpose were retrieved from National Influenza Centre (NIC) on 1st Jan 2020. Of the total 3606 patients suspected of having influenza infection, influenza viruses were isolated from 1213 (33.6%) patients with male predominance. The highest number of infection was caused by Influenza A/Pdm09 strain 739 (60.9%) followed by Influenza B 304 (25.1%) and Influenza A/H3 169 (13.9%) and most remarkable finding of this study was the detection of H5N1 in human which is the first ever case of such infection in human from Nepal. Similar to other tropical nations, influenza viruses were detected year-round in various geographical locations of Nepal. The influenza virus type and subtypes that were in circulation in Nepal were comparable to vaccine candidate viruses, which the currently available influenza vaccine may prevent.
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Affiliation(s)
- Rachana Mehta
- National Public Health Laboratory Teku, Kathmandu, Nepal.
| | | | | | - Ranjit Sah
- National Public Health Laboratory Teku, Kathmandu, Nepal
| | - Lilee Shrestha
- National Public Health Laboratory Teku, Kathmandu, Nepal
| | | | | | - Runa Jha
- National Public Health Laboratory Teku, Kathmandu, Nepal
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Chand AB, Basnet A, Maharjan B, Rai G, Joshi YP, Bhatt LR, Sen B, Rai SK. Drug-resistant Mycobacterium tuberculosis among Nepalese patients at a tuberculosis referral center. PLoS One 2024; 19:e0301210. [PMID: 38709710 PMCID: PMC11073693 DOI: 10.1371/journal.pone.0301210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/12/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB), characterized by isoniazid and rifampicin resistance, is caused by chromosomal mutations that restrict treatment options and complicate tuberculosis management. This study sought to investigate the prevalence of pre-extensively drug-resistant (pre-XDR) and extensively drug-resistant (XDR) tuberculosis, as well as mutation pattern, in Nepalese patients with MDR/rifampicin-resistant (RR)-TB strains. METHODS A cross-sectional study was conducted on MDR/RR-TB patients at the German Nepal Tuberculosis Project from June 2017 to June 2018. The MTBDRsl line probe assay identified pre-XDR-TB and XDR-TB. Pre-XDR-TB included MDR/RR-TB with resistance to any fluoroquinolone (FLQ), while XDR-TB included MDR/RR-TB with resistance to any FLQ and at least one additional group A drug. Mutation status was determined by comparing bands on reaction zones [gyrA and gyrB for FLQ resistance, rrs for SILD resistance, and eis for low-level kanamycin resistance, according to the GenoType MTBDRsl VER 2.0, Hain Lifescience GmbH, Nehren, Germany definition of pre-XDR and XDR] to the evaluation sheet. SPSS version 17.0 was used for data analysis. RESULTS Out of a total of 171 patients with MDR/RR-TB, 160 had (93.57%) had MTBC, of whom 57 (35.63%) had pre-XDR-TB and 10 (6.25%) had XDR-TB. Among the pre-XDR-TB strains, 56 (98.25%) were FLQ resistant, while 1 (1.75%) was SLID resistant. The most frequent mutations were found at codons MUT3C (57.14%, 32/56) and MUT1 (23.21%, 13/56) of the gyrA gene. One patient had SLID resistant genotype at the MUT1 codon of the rrs gene (100%, 1/1). XDR-TB mutation bands were mostly detected on MUT1 (30%, 3/10) of the gyrA and rrs, MUT3C (30%, 3/10) of the gyrA, and MUT1 (30%, 3/10) of the rrs. CONCLUSIONS Pre-XDR-TB had a significantly higher likelihood than XDR-TB, with different specific mutation bands present in gyrA and rrs genes.
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Affiliation(s)
- Arun Bahadur Chand
- Department of Microbiology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
- Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal
- German Nepal Tuberculosis Project, Kathmandu, Nepal
| | - Ajaya Basnet
- Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal
| | | | - Ganesh Rai
- Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal
| | - Yadav Prasad Joshi
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Lok Raj Bhatt
- Department of Microbiology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Bindu Sen
- Department of Dentistry, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Shiba Kumar Rai
- Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Kathmandu, Nepal
- Department of Microbiology, Nepal Medical College Teaching Hospital, Kathmandu, Nepal
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Song KR, Chapagain RH, Tamrakar D, Shrestha R, Kanodia P, Chaudhary S, Wartel TA, Yang JS, Kim DR, Lee J, Park EL, Cho H, Lee J, Thaisrivichai P, Vemula S, Kim BM, Gupta B, Saluja T, Pansuriya RK, Ganapathy R, Baik YO, Lee YJ, Jeon S, Park Y, Her HL, Park Y, Lynch JA. Safety and immunogenicity of the Euvichol-S oral cholera vaccine for prevention of Vibrio cholerae O1 infection in Nepal: an observer-blind, active-controlled, randomised, non-inferiority, phase 3 trial. Lancet Glob Health 2024; 12:e826-e837. [PMID: 38614631 PMCID: PMC11027156 DOI: 10.1016/s2214-109x(24)00059-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND In October, 2017, WHO launched a strategy to eliminate cholera by 2030. A primary challenge in meeting this goal is the limited global supply capacity of oral cholera vaccine and the worsening of cholera outbreaks since 2021. To help address the current shortage of oral cholera vaccine, a WHO prequalified oral cholera vaccine, Euvichol-Plus was reformulated by reducing the number of components and inactivation methods. We aimed to evaluate the immunogenicity and safety of Euvichol-S (EuBiologics, Seoul, South Korea) compared with an active control vaccine, Shanchol (Sanofi Healthcare India, Telangana, India) in participants of various ages in Nepal. METHODS We did an observer-blind, active-controlled, randomised, non-inferiority, phase 3 trial at four hospitals in Nepal. Eligible participants were healthy individuals aged 1-40 years without a history of cholera vaccination. Individuals with a history of hypersensitivity reactions to other preventive vaccines, severe chronic disease, previous cholera vaccination, receipt of blood or blood-derived products in the past 3 months or other vaccine within 4 weeks before enrolment, and pregnant or lactating women were excluded. Participants were randomly assigned (1:1:1:1) by block randomisation (block sizes of two, four, six, or eight) to one of four groups (groups A-D); groups C and D were stratified by age (1-5, 6-17, and 18-40 years). Participants in groups A-C were assigned to receive two 1·5 mL doses of Euvichol-S (three different lots) and participants in group D were assigned to receive the active control vaccine, Shanchol. All participants and site staff (with the exception of those who prepared and administered the study vaccines) were masked to group assignment. The primary immunogenicity endpoint was non-inferiority of immunogenicity of Euvichol-S (group C) versus Shanchol (group D) at 2 weeks after the second vaccine dose, measured by the seroconversion rate, defined as the proportion of participants who had achieved seroconversion (defined as ≥four-fold increase in V cholerae O1 Inaba and Ogawa titres compared with baseline). The primary immunogenicity endpoint was assessed in the per-protocol analysis set, which included all participants who received all their planned vaccine administrations, had no important protocol deviations, and who provided blood samples for all immunogenicity assessments. The primary safety endpoint was the number of solicited adverse events, unsolicited adverse events, and serious adverse events after each vaccine dose in all ages and each age stratum, assessed in all participants who received at least one dose of the Euvichol-S or Shanchol. Non-inferiority of Euvichol-S compared with Shanchol was shown if the lower limit of the 95% CI for the difference between the seroconversion rates in Euvichol-S group C versus Shanchol group D was above the predefined non-inferiority margin of -10%. The trial was registered at ClinicalTrials.gov, NCT04760236. FINDINGS Between Oct 6, 2021, and Jan 19, 2022, 2529 healthy participants (1261 [49·9%] males; 1268 [50·1%] females), were randomly assigned to group A (n=330; Euvichol-S lot number ES-2002), group B (n=331; Euvichol-S ES-2003), group C (n=934; Euvichol-S ES-2004]), or group D (n=934; Shanchol). Non-inferiority of Euvichol-S versus Shanchol in seroconversion rate for both serotypes at 2 weeks after the second dose was confirmed in all ages (difference in seroconversion rate for V cholerae O1 Inaba -0·00 [95% CI -1·86 to 1·86]; for V cholerae O1 Ogawa -1·62 [-4·80 to 1·56]). Treatment-emergent adverse events were reported in 244 (9·7%) of 2529 participants in the safety analysis set, with a total of 403 events; 247 events were reported among 151 (9·5%) of 1595 Euvichol-S recipients and 156 events among 93 (10·0%) of 934 Shanchol recipients. Pyrexia was the most common adverse event in both groups (57 events among 56 [3·5%] of 1595 Euvichol-S recipients and 37 events among 35 [3·7%] of 934 Shanchol recipients). No serious adverse events were deemed to be vaccine-related. INTERPRETATION A two-dose regimen of Euvichol-S vaccine was non-inferior to the active control vaccine, Shanchol, in terms of seroconversion rates 2 weeks after the second dose. The simplified formulation and production requirements of the Euvichol-S vaccine have the potential to increase the supply of oral cholera vaccine and reduce the gap between the current oral cholera vaccine supply and demand. FUNDING The Bill & Melinda Gates Foundation. TRANSLATION For the Nepali translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Katerina Rok Song
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea.
| | - Ram Hari Chapagain
- Department of Pediatric Medicine, Kanti Children's Hospital, Kathmandu, Nepal
| | - Dipesh Tamrakar
- Center for Clinical Trial Studies, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rajeev Shrestha
- Center for Clinical Trial Studies, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Piush Kanodia
- Department of Pediatrics and Neonatology, Nepalgunj Medical College, Nepalgunj, Nepal
| | - Shipra Chaudhary
- Department of Pediatrics and Adolescent Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - T Anh Wartel
- International Vaccine Institute, Stockholm, Sweden
| | - Jae Seung Yang
- Science Unit, International Vaccine Institute, Seoul, South Korea
| | - Deok Ryun Kim
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Jinae Lee
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Eun Lyeong Park
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Haeun Cho
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Jiyoung Lee
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | | | - Sridhar Vemula
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Bo Mi Kim
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Birendra Gupta
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Tarun Saluja
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Ruchir Kumar Pansuriya
- Vaccine Process Development Unit, International Vaccine Institute, Seoul, South Korea; Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Ravi Ganapathy
- Research and Development, Hilleman Laboratories, Singapore
| | - Yeong Ok Baik
- Research and Development Division, EuBiologics, Seoul, South Korea
| | - Young Jin Lee
- Research and Development Division, EuBiologics, Seoul, South Korea
| | - Suhi Jeon
- Production Division, EuBiologics, Seoul, South Korea
| | | | - Howard L Her
- Research and Development Division, EuBiologics, Seoul, South Korea
| | | | - Julia A Lynch
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
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8
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Sherpa K, Sherpa PP, Sherpa T, Rothenbühler M, Ryffel C, Sherpa D, Sherpa DR, Sherchand O, Galuszka O, Dernektsi C, Reichlin T, Pilgrim T. Risk of Cardiac Arrhythmias Among Climbers on Mount Everest. JAMA Cardiol 2024; 9:480-485. [PMID: 38568602 PMCID: PMC10993151 DOI: 10.1001/jamacardio.2024.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024]
Abstract
Importance Arterial hypoxemia, electrolyte imbalances, and periodic breathing increase the vulnerability to cardiac arrhythmia at altitude. Objective To explore the incidence of tachyarrhythmias and bradyarrhythmias in healthy individuals at high altitudes. Design, Setting, and Participants This prospective cohort study involved healthy individuals at altitude (8849 m) on Mount Everest, Nepal. Recruitment occurred from January 25 to May 9, 2023, and data analysis took place from June to July 2023. Exposure All study participants underwent 12-lead electrocardiogram, transthoracic echocardiography, and exercise stress testing before and ambulatory rhythm recording both before and during the expedition. Main Outcome The incidence of a composite of supraventricular (>30 seconds) and ventricular (>3 beats) tachyarrhythmia and bradyarrhythmia (sinoatrial arrest, second- or third-degree atrioventricular block). Results Of the 41 individuals recruited, 100% were male, and the mean (SD) age was 33.6 (8.9) years. On baseline investigations, there were no signs of exertional ischemia, wall motion abnormality, or cardiac arrhythmia in any of the participants. Among 34 individuals reaching basecamp at 5300 m, 32 participants climbed to 7900 m or higher, and 14 reached the summit of Mount Everest. A total of 45 primary end point-relevant events were recorded in 13 individuals (38.2%). Forty-three bradyarrhythmic events were documented in 13 individuals (38.2%) and 2 ventricular tachycardias in 2 individuals (5.9%). Nine arrhythmias (20%) in 5 participants occurred when climbers were using supplemental bottled oxygen, whereas 36 events (80%) in 11 participants occurred at lower altitudes when no supplemental bottled oxygen was used. The proportion of individuals with arrhythmia remained stable across levels of increasing altitude, while event rates per 24 hours numerically increased between 5300 m (0.16 per 24 hours) and 7300 m (0.37 per 24 hours) before decreasing again at higher altitudes, where supplemental oxygen was used. None of the study participants reported dizziness or syncope. Conclusion and Relevance In this study, more than 1 in 3 healthy individuals experienced cardiac arrhythmia during the climb of Mount Everest, thereby confirming the association between exposure to high altitude and incidence of cardiac arrhythmia. Future studies should explore the potential implications of these rhythm disturbances.
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Affiliation(s)
- Kunjang Sherpa
- Department of Cardiology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | | | | | - Martina Rothenbühler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Diabetes Center Bern, Bern, Switzerland
| | - Christoph Ryffel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Chrisoula Dernektsi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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9
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Sharma BB, Pennell C, Sharma B, Smith R. Reducing maternal mortality in low- and middle-income countries: the Nepalese approach of helicopter retrieval. Am J Obstet Gynecol 2024; 230:473-475. [PMID: 38431464 DOI: 10.1016/j.ajog.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 03/05/2024]
Abstract
Ninety-four percent of global maternal deaths occur in low- and middle-income countries (LMICs). The UN has a goal of reducing maternal deaths to <70 per 100,000 live births by 2030, but progress is minimal. Maternal deaths in LMICs are associated with 3 delays in the care of women with obstetrical emergencies: 1) in the family of the woman realizing that her life is at risk, 2) in the transport of the woman to a hospital, and 3) in providing care after arrival at the hospital. These 3 delays function like links in a chain, and failure of any link leads to maternal death. LMICs have characteristics that make it likely that the chain will break. Women in LMICs frequently have low standing, and cultural beliefs often lead to delay in the recognition of obstetrical emergencies. LMICs are characterized by poor roads and long distances to hospitals leading to transport delays. Cultural and other factors also lead to treatment delays when a woman reaches a suitably-equipped and staffed hospital. Nepal has addressed these delays and reduced maternal mortality. Firstly, we have reported in the Journal the use of culturally acceptable approaches to improving the knowledge about antenatal care in remote villages. In the case of Nepal, singing songs related to maternal care proved to be a highly effective strategy. We now report that the government of Nepal has repurposed military helicopters to overcome the tyranny of poor roads to allow rapid transport of women with obstetrical emergencies to a small number of fully-equipped and staffed hospitals. As of June 2023, this service has successfully retrieved 625 women in four and half years. The Nepalese government has included questions on maternal mortality in the 2021 national census, followed by a verbal autopsy. These data indicate a fall in the maternal mortality ratio from 239 in 2016 to 151 in 2021. The efficiency of the triage service continues to improve, suggesting that maternal mortality will continue to fall. This may provide a model that can be implemented in other LMICs and highlights factors that may be responsible for recent increases in the US maternal mortality ratio.
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Affiliation(s)
| | - Craig Pennell
- The University of Newcastle Hunter Medical Research Institute, New South Wales, Australia
| | - Biraj Sharma
- The University of Newcastle Hunter Medical Research Institute, New South Wales, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, The University of Newcastle Hunter Medical Research Institute, Hunter Medical Research Institute, New South Wales, Australia.
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10
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Raut S, Kagotho N. Examining Women's HIV Protective Behaviors in Nepal. Health Soc Work 2024; 49:115-123. [PMID: 38569530 DOI: 10.1093/hsw/hlae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/10/2023] [Accepted: 07/26/2023] [Indexed: 04/05/2024]
Abstract
Women's autonomy in decision making has important sexual and reproductive health implications. This study uses a nationwide analysis in Nepal to examine women's autonomy, attitude toward intimate partner violence (IPV) behaviors, and HIV-related knowledge in the execution of HIV protective behaviors such as having one sexual partner or getting an HIV test to prevent HIV transmission. Secondary data analysis was conducted using the nationally represented Nepal Demographic and Health Survey (2016-2021) dataset. The sample included 9,904 women ages 15 to 49 who self-identified as ever married. Factor analysis for women's autonomy, attitude toward IPV behaviors, and HIV-related knowledge were conducted based on social dominance theory. Structural equation modeling was conducted, and the results indicated that higher autonomy decreased the risk of HIV infection through having one sexual partner. Factors related to multiple sex partners included unemployment, religious affiliation, and age. Similarly, higher autonomy, HIV-related knowledge, having a formal job, and urban residence increased women's likelihood of taking an HIV test. Women's higher education, greater wealth, religious affiliation, and youth also correlate with HIV testing. Future HIV prevention interventions should include strategies that support women's social and economic empowerment and enhance women's ability to make informed choices about their health and risks.
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Affiliation(s)
- Shambika Raut
- MA, is a doctoral student, College of Social Work, The Ohio State University, 1947 College Road North, Columbus, OH 43210, USA
| | - Njeri Kagotho
- PhD, is associate professor, College of Social Work, The Ohio State University, Columbus, OH, USA
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11
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Hamal S, Gurung YB, Shrestha B, Shrestha P, Sapkota NL, Shrestha VL. Factors associated with miscarriage in Nepal: Evidence from Nepal Demographic and Health Surveys, 2001-2016. PLoS One 2024; 19:e0302001. [PMID: 38683811 PMCID: PMC11057729 DOI: 10.1371/journal.pone.0302001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Miscarriage is a major public health concern in low and middle-income countries (LMICs) like Nepal. This study aims to examine the factors associated with miscarriage among pregnant women of reproductive age (15-49 years) in the past 15 years. METHODS There were a total of weighted sample of 26,376 cross-sectional pregnancy data from Nepal Demographic and Health Surveys (NDHS) 2001, 2006, 2011, and 2016 combined together, which was used in the study. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify factors associated with miscarriage among pregnant women of reproductive age in Nepal. RESULTS The results showed that maternal age, contraception, tobacco smoking, wealth index, respondents' educational status, and, caste/ethnicity were found to be strong factors of miscarriage in Nepal. The likelihood of having a miscarriage among older women (≥40 years) was more than 100% (aOR = 2.12, 95% CI [1.73, 2.59]), among non-users of contraception was 88.9% (aOR = 1.88, 95% CI [1.68, 2.11]) (p<005) and non-smoking women had a 19% lower odds of miscarriage (aOR = 0.81, 95% CI [0.69, 0.95]). Respondents from the richest wealth index had 50% (aOR = 1.50, 95% CI [1.22, 1.85]) higher likelihood of miscarriage. Mothers with only primary education had a 25% higher chance of miscarriage (aOR = 1.25, 95% CI [1.09, 1.44]) compared to those with secondary and higher secondary education. In relation to caste/ethnicity, Dalits had 13% lesser likelihood (aOR = 0.87, 95% CI [0.74, 1.02]) and Janajatis had 26% lower chances of a miscarriage than Brahmin/Chettri (aOR = 0.74, 95% CI [0.64, 0.85]). CONCLUSION Findings from this study show that miscarriages are associated with maternal age, use of contraception, smoking, wealth index, caste, and ethnicity. Interventions aimed to improve use of contraceptives, avoiding smoking and pregnancy planning on the basis of maternal age, are needed to prevent miscarriage. Also, women from Brahmin ethinicity and those with the highest income index require greater attention when it comes to miscarriage prevention strategies in Nepal.
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Affiliation(s)
- Sharadha Hamal
- Gandaki Medical College, Tribhuvan University, Kirtipur, Pokhara
| | - Yogendra B. Gurung
- Central Department of Population Studies, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bidhya Shrestha
- Central Department of Population Studies, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Prabin Shrestha
- Tri-Chandra Multiple Campus, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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12
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Parajuli A, Kakchapati S, Arjyal A, Joshi D, Kharel C, Otmani Del Barrio M, Baral SC. Assessing intersectional gender analysis in Nepal's health management information system: a case study on tuberculosis for inclusive health systems. Infect Dis Poverty 2024; 13:31. [PMID: 38659012 PMCID: PMC11044533 DOI: 10.1186/s40249-024-01194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a major public health problem in Nepal, high in settings marked by prevalent gender and social inequities. Various social stratifiers intersect, either privileging or oppressing individuals based on their characteristics and contexts, thereby increasing risks, vulnerabilities and marganilisation associated with TB. This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System (HMIS) of National Tuberculosis Programme (NTP) by conducting an intersectional analysis of TB cases recorded via HMIS. METHODS A desk review of key policies and the NTP's HMIS was conducted. Retrospective intersectional analysis utilized two secondary data sources: annual NTP report (2017-2021) and records of 628 TB cases via HMIS 6.5 from two TB centres (2017/18-2018/19). Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB, registration category and treatment outcome. RESULTS Gender, social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation. NTP has initiated the collection of age, sex, ethnicity and location data since 2014/15 through the HMIS. However, only age and sex disaggregated data are routinely reported, leaving recorded social stratifiers of TB patients static without analysis and dissemination. Furthermore, findings from the intersectional analysis using TB secondary data, showed that male more than 25 years exhibited higher odds [adjusted odds ratio (aOR) = 4.95, 95% confidence interval (CI): 1.60-19.06, P = 0.01)] of successful outcome compared to male TB patients less than 25 years. Similarly, sex was significantly associated with types of TB (P < 0.05) whereas both age (P < 0.05) and sex (P < 0.05) were significantly associated with patient registration category (old/new cases). CONCLUSIONS The results highlight inadequacy in the availability of social stratifiers in the routine HMIS. This limitation hampers the NTP's ability to conduct intersectional analyses, crucial for unveiling the roles of other social determinants of TB. Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.
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Affiliation(s)
- Ayuska Parajuli
- HERD International, Saibu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | | | - Abriti Arjyal
- HERD International, Saibu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Deepak Joshi
- HERD International, Saibu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Chandani Kharel
- HERD International, Saibu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Mariam Otmani Del Barrio
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Sushil C Baral
- HERD International, Saibu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal.
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Baral R, Tuladhar R, Manandhar S, Singh A, Sherchan S. Detection of bla KPC gene among carbapenemase producing Klebsiella pneumoniae isolated from different clinical specimens at tertiary care hospital of Nepal. BMC Microbiol 2024; 24:144. [PMID: 38664608 PMCID: PMC11044503 DOI: 10.1186/s12866-024-03301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Klebsiella pneumoniae infections have become a major cause of hospital acquired infection worldwide with the increased rate of acquisition of resistance to antibiotics. Carbapenem resistance mainly among Gram negative is an ongoing problem which causes serious outbreaks dramatically limiting treatment options. This prospective cross-sectional study was designed to detect blaKPC gene from carbapenem resistant K. pneumoniae. MATERIALS AND METHODS A totally of 1118 different clinical specimens were screened and confirmed for KPC producing K. pneumoniae phenotypically using Meropenem (10 μg) disc. The blaKPC gene was amplified from the isolates of K. pneumoniae to detect the presence of this gene. RESULT Of the total samples processed, 18.6% (n = 36) were K. pneumoniae and among 36 K. pneumoniae, 61.1% (n = 22/36) were meropenem resistant. This study demonstrated the higher level of MDR 91.7% (n = 33) and KPC production 47.2% (n = 17) among K. pneumoniae isolates. The blaKPC gene was detected in 8.3% (n = 3) of meropenem resistant isolates. CONCLUSION Since the study demonstrates the higher level of MDR and KPC producing K. pneumoniae isolates that has challenged the use of antimicrobial agents, continuous microbiology, and molecular surveillance to assist early detection and minimize the further dissemination of blaKPC should be initiated. We anticipate that the findings of this study will be useful in understanding the prevalence of KPC-producing K. pneumoniae in Nepal.
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Affiliation(s)
- Rakshya Baral
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal.
- Department of Biology, Morgan State University, Baltimore, USA.
| | - Reshma Tuladhar
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Sarita Manandhar
- Department of Microbiology, Tri-Chandra Multiple Campus, Tribhuvan University, Kathmandu, Nepal
| | - Anjana Singh
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Samendra Sherchan
- Department of Biology, Morgan State University, Baltimore, USA
- Department of Environmental Health Sciences, Tulane University, New Orleans, USA
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14
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Uranw S, Bhattarai NR, Cloots K, Roy L, Rai K, Kiran U, Pyakurel UR, Lal BK, Burza S, Rijal S, Karki P, Khanal B, Hasker E. Visceral leishmaniasis in the hills of western Nepal: A transmission assessment. PLoS One 2024; 19:e0289578. [PMID: 38630746 PMCID: PMC11023194 DOI: 10.1371/journal.pone.0289578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/12/2024] [Indexed: 04/19/2024] Open
Abstract
In Nepal, visceral leishmaniasis (VL) has been targeted for elimination as a public health problem by 2026. Recently, increasing numbers of VL cases have been reported from districts of doubtful endemicity including hills and mountains, threatening the ongoing VL elimination program in Nepal. We conducted a multi-disciplinary, descriptive cross-sectional survey to assess the local transmission of Leishmania donovani in seven such districts situated at altitudes of up to 1,764 meters in western Nepal from March to December 2019. House-to-house surveys were performed for socio-demographic data and data on past and current VL cases. Venous blood was collected from all consenting individuals aged ≥2 years and tested with the rK39 RDT. Blood samples were also tested with direct agglutination test, and a titer of ≥1:1600 was taken as a marker of infection. A Leishmania donovani species-specific PCR (SSU-rDNA) was performed for parasite species confirmation. We also captured sand flies using CDC light traps and mouth aspirators. The house-to-house surveys documented 28 past and six new VL cases of which 82% (28/34) were without travel exposure. Overall, 4.1% (54/1320) of healthy participants tested positive for L. donovani on at least one serological or molecular test. Among asymptomatic individuals, 17% (9/54) were household contacts of past VL cases, compared to 0.5% (6/1266) among non-infected individuals. Phlebotomus argentipes, the vector of L. donovani, was found in all districts except in Bajura. L. donovani was confirmed in two asymptomatic individuals and one pool of sand flies of Phlebotomus (Adlerius) sp. We found epidemiological and entomological evidence for local transmission of L. donovani in areas previously considered as non-endemic for VL. The national VL elimination program should revise the endemicity status of these districts and extend surveillance and control activities to curb further transmission of the disease.
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Affiliation(s)
- Surendra Uranw
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narayan Raj Bhattarai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kristien Cloots
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lalita Roy
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Tropical & Infectious Diseases Center, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Keshav Rai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Usha Kiran
- World Health Organization, Country Office for Nepal, Kathmandu, Nepal
| | - Uttam Raj Pyakurel
- Epidemiology and Disease Control Division, Department of Health Services, Government of Nepal, Kathmandu, Nepal
| | - Bibek Kumar Lal
- Epidemiology and Disease Control Division, Department of Health Services, Government of Nepal, Kathmandu, Nepal
| | - Sakib Burza
- Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suman Rijal
- Drugs for Neglected Diseases Initiative, India Office, New Delhi, India
| | - Prahlad Karki
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Basudha Khanal
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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15
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Rimal S, Shrestha S, Paudel SW, Shah Y, Bhandari G, Pandey K, Kharbuja A, Kapandji M, Gautam I, Bhujel R, Takamatsu Y, Bhandari R, Klungthong C, Shrestha SK, Fernandez S, Malavige GN, Pandey BD, Urano T, Morita K, Ngwe Tun MM, Dumre SP. Molecular and Entomological Characterization of 2023 Dengue Outbreak in Dhading District, Central Nepal. Viruses 2024; 16:594. [PMID: 38675935 PMCID: PMC11053854 DOI: 10.3390/v16040594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
In 2023, Nepal faced its second largest dengue outbreak ever, following a record-breaking number of dengue cases in 2022, characterized by the expansion of infections into areas of higher altitudes. However, the characteristics of the 2023 circulating dengue virus (DENV) and the vector density remain poorly understood. Therefore, we performed DENV serotyping, clinical and laboratory assessment, and entomological analysis of the 2023 outbreak in central Nepal. A total of 396 fever cases in Dhading hospital suspected of being DENV positive were enrolled, and blood samples were collected and tested by different techniques including PCR. Of these, 278 (70.2%) had confirmed DENV infection. Multiple serotypes (DENV-1, -2, and -3) were detected. DENV-2 (97.5%) re-emerged after six years in Dhading while DENV-3 was identified for the first time. Dengue inpatients had significantly higher frequency of anorexia, myalgia, rash, diarrhea, nausea, vomiting, abdominal pain, and thrombocytopenia (p < 0.05). In this area, Aedes mosquitoes largely predominated (90.7%) with the majority being A. aegypti (60.7%). We also found high levels of Aedes index (20.0%) and container index (16.7%). We confirmed multiple DENV serotype circulation with serotype re-emergence and new serotype introduction, and high vector density in 2023. These findings call for the urgent initiation and scaling up of DENV molecular surveillance in human and mosquito populations for dengue control and prevention in Nepal.
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Affiliation(s)
- Sandesh Rimal
- Central Department of Microbiology, Tribhuvan University, Kathmandu 44601, Nepal; (S.R.); (S.S.); (A.K.); (R.B.)
| | - Sabin Shrestha
- Central Department of Microbiology, Tribhuvan University, Kathmandu 44601, Nepal; (S.R.); (S.S.); (A.K.); (R.B.)
| | | | | | - Govinda Bhandari
- Dhading Hospital, Dhading Besi 45100, Nepal; (S.W.P.); (G.B.); (R.B.)
| | - Kishor Pandey
- Central Department of Zoology, Tribhuvan University, Kathmandu 44601, Nepal;
| | - Anjana Kharbuja
- Central Department of Microbiology, Tribhuvan University, Kathmandu 44601, Nepal; (S.R.); (S.S.); (A.K.); (R.B.)
| | - Merveille Kapandji
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.K.); (Y.T.); (K.M.)
| | - Ishan Gautam
- Natural History Museum, Tribhuvan University, Swayambhu, Kathmandu 44620, Nepal;
| | - Rajshree Bhujel
- Central Department of Microbiology, Tribhuvan University, Kathmandu 44601, Nepal; (S.R.); (S.S.); (A.K.); (R.B.)
| | - Yuki Takamatsu
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.K.); (Y.T.); (K.M.)
| | | | - Chonticha Klungthong
- Armed Forces Research Institute of Medical Sciences, Bangkok 10400, Thailand; (C.K.); (S.F.)
| | | | - Stefan Fernandez
- Armed Forces Research Institute of Medical Sciences, Bangkok 10400, Thailand; (C.K.); (S.F.)
| | | | - Basu Dev Pandey
- DEJIMA Infectious Disease Research Alliance, Nagasaki University, Nagasaki 852-8523, Japan; (B.D.P.); (T.U.)
| | - Takeshi Urano
- DEJIMA Infectious Disease Research Alliance, Nagasaki University, Nagasaki 852-8523, Japan; (B.D.P.); (T.U.)
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.K.); (Y.T.); (K.M.)
- DEJIMA Infectious Disease Research Alliance, Nagasaki University, Nagasaki 852-8523, Japan; (B.D.P.); (T.U.)
- Center for Vaccines and Therapeutic Antibodies for Emerging Infectious Diseases, Shimane University, Izumo 690-8504, Japan
- Department of Tropical Viral Vaccine Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.K.); (Y.T.); (K.M.)
- DEJIMA Infectious Disease Research Alliance, Nagasaki University, Nagasaki 852-8523, Japan; (B.D.P.); (T.U.)
- Center for Vaccines and Therapeutic Antibodies for Emerging Infectious Diseases, Shimane University, Izumo 690-8504, Japan
- Department of Tropical Viral Vaccine Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Shyam Prakash Dumre
- Central Department of Microbiology, Tribhuvan University, Kathmandu 44601, Nepal; (S.R.); (S.S.); (A.K.); (R.B.)
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Raya S, Malla B, Shrestha S, Sthapit N, Kattel H, Sharma ST, Tuladhar R, Maharjan R, Takeda T, Kitajima M, Tandukar S, Haramoto E. Quantification of multiple respiratory viruses in wastewater in the Kathmandu Valley, Nepal: Potential implications of wastewater-based epidemiology for community disease surveillance in developing countries. Sci Total Environ 2024; 920:170845. [PMID: 38340866 DOI: 10.1016/j.scitotenv.2024.170845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
Despite being the major cause of death, clinical surveillance of respiratory viruses at the community level is very passive, especially in developing countries. This study focused on the surveillance of three respiratory viruses [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A virus (IFV-A), and respiratory syncytial virus (RSV)] in the Kathmandu Valley, Nepal, by implication of wastewater-based epidemiology (WBE). Fifty-one untreated wastewater samples were from two wastewater treatment plants (WWTPs) between April and October 2022. Among eight combinations of the pre-evaluated methods, the combination of concentration by simple centrifugation, pretreatment by DNA/RNA Shield (Zymo Research), and extraction by the QIAamp Viral RNA Mini Kit (QIAGEN) showed the best performance for detecting respiratory viruses. Using this method with a one-step reverse transcription-quantitative polymerase chain reaction (RT-qPCR), SARS-CoV-2 RNA was successfully detected from both WWTPs (positive ratio, 100 % and 81 %) at concentrations of 5.6 ± 0.6 log10 copies/L from each WWTP. Forty-six SARS-CoV-2 RNA-positive samples were further tested for three mutation site-specific one-step RT-qPCR (L452R, T478K, and E484A/G339D), where G339D/E484A mutations were frequently detected in both WWTPs (96 %). IFV-A RNA was more frequently detected in WWTP A (84 %) compared to WWTP B (38 %). RSV RNA was also detected in both WWTPs (28 % and 8 %, respectively). This is the first study on detecting IFV-A and RSV in wastewater in Nepal, showing the applicability and importance of WBE for respiratory viruses in developing countries where clinical data are lacking.
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Affiliation(s)
- Sunayana Raya
- Department of Engineering, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Bikash Malla
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Sadhana Shrestha
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Niva Sthapit
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Hari Kattel
- Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sangita Tara Sharma
- Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Reshma Tuladhar
- Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Rabin Maharjan
- Department of Civil Engineering, Institute of Engineering, Tribhuvan University, Lalitpur, Nepal
| | - Tomoko Takeda
- Department of Earth and Planetary Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Masaaki Kitajima
- Division of Environmental Engineering, Hokkaido University, North 13 West 8, Kita-ku, Sapporo, Hokkaido 060-8628, Japan.
| | | | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan.
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Kc S, Gooden TE, Aryal D, Koirala K, Luitel S, Haniffa R, Beane A. The burden of anxiety, depression, and stress, along with the prevalence of symptoms of PTSD, and perceptions of the drivers of psychological harms, as perceived by doctors and nurses working in ICUs in Nepal during the COVID-19 pandemic; a mixed method evaluation. BMC Health Serv Res 2024; 24:450. [PMID: 38600462 PMCID: PMC11007980 DOI: 10.1186/s12913-024-10724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/14/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in significant physical and psychological impacts for survivors, and for the healthcare professionals caring for patients. Nurses and doctors in critical care faced longer working hours, increased burden of patients, and limited resources, all in the context of personal social isolation and uncertainties regarding cross-infection. We evaluated the burden of anxiety, depression, stress, post-traumatic stress disorder (PTSD), and alcohol dependence among doctors and nurses working in intensive care units (ICUs) in Nepal and explored the individual and social drivers for these impacts. METHODS We conducted a mixed-methods study in Nepal, using an online survey to assess psychological well-being and semi-structured interviews to explore perceptions as to the drivers of anxiety, stress, and depression. Participants were recruited from existing national critical care professional organisations in Nepal and using a snowball technique. The online survey comprised of validated assessment tools for anxiety, depression, stress, PTSD, and alcohol dependence; all tools were analysed using published guidelines. Interviews were analysed using rapid appraisal techniques, and themes regarding the drivers for psychological distress were explored. RESULTS 134 respondents (113 nurses, 21 doctors) completed the online survey. Twenty-eight (21%) participants experienced moderate to severe symptoms of depression; 67 (50%) experienced moderate or severe symptoms of anxiety; 114 (85%) had scores indicative of moderate to high levels of stress; 46 out of 100 reported symptoms of PTSD. Compared to doctors, nurses experienced more severe symptoms of depression, anxiety, and PTSD, whereas doctors experienced higher levels of stress than nurses. Most (95%) participants had scores indicative of low risk of alcohol dependence. Twenty participants were followed up in interviews. Social stigmatism, physical and emotional safety, enforced role change and the absence of organisational support were perceived drivers for poor psychological well-being. CONCLUSION Nurses and doctors working in ICU during the COVID-19 pandemic sustained psychological impacts, manifesting as stress, anxiety, and for some, symptoms of PTSD. Nurses were more vulnerable. Individual characteristics and professional inequalities in healthcare may be potential modifiable factors for policy makers seeking to mitigate risks for healthcare providers.
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Affiliation(s)
- Shirish Kc
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Diptesh Aryal
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal.
| | | | | | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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Poudel B, Paudel K, Adhikari B, Paudel R, Bhusal S, Adhikari N, Adhikari TB, Sapkota VP, Shrestha R. Prevalence of common risk factors of major noncommunicable diseases among sexual and gender minorities in Kathmandu valley, Nepal. Medicine (Baltimore) 2024; 103:e37746. [PMID: 38579035 PMCID: PMC10994461 DOI: 10.1097/md.0000000000037746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/07/2024] [Indexed: 04/07/2024] Open
Abstract
Four noncommunicable diseases (NCDs): cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, account for 71% of global deaths. However, little is known about the NCDs risk profile of sexual and gender minorities (SGMs). This study aimed to determine the prevalence of NCDs risk factors among the SGMs of Kathmandu valley, Nepal. A cross-sectional study was conducted among SGMs in the Kathmandu valley, Nepal. We recruited 140 participants using the snowball sampling method. A face-to-face interview was done using a structured questionnaire adapted from World Health Organization Step Wise Approach to Surveillance (STEPS instruments V2.2 2019) along with blood pressure and anthropometric measurements. Data were analyzed using Statistical Package for Social Science (SPSS.v20). More than two-thirds of the participants, 96 (68.6%), had co-occurrence of NCDs risk factors. The prevalence of insufficient fruits and vegetables consumption, current smoking, harmful alcohol consumption, overweight/obesity, and hypertension were 95.7%, 40.0%, 32.9%, 28.5%, and 28.6%, respectively. There was a significant association between hypertension, harmful alcohol consumption, and overweight/obesity with the participants' age, employment status, and marital status, respectively. Study findings indicated a higher prevalence of NCDs risk factors among SGMs. National-level NCDs surveillance, policy planning, prevention, and targeted health interventions should prioritize the SGMs.
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Affiliation(s)
- Bikram Poudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Kiran Paudel
- Nepal Health Frontiers, Kathmandu, Nepal
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - Bikram Adhikari
- Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rajan Paudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sandesh Bhusal
- Nepal Health Frontiers, Kathmandu, Nepal
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - Nabin Adhikari
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Tara Ballav Adhikari
- Nepal Health Frontiers, Kathmandu, Nepal
- Community-Based Management of Non-communicable Diseases in Nepal Project, Nepal Development Society, Bharatpur, Nepal
- Section for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
- Section of Infectious, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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Regmi S, Bertone MP, Shrestha P, Sapkota S, Arjyal A, Martineau T, Raven J, Witter S, Baral S. Understanding health system resilience in responding to COVID-19 pandemic: experiences and lessons from an evolving context of federalization in Nepal. BMC Health Serv Res 2024; 24:428. [PMID: 38575933 PMCID: PMC10996157 DOI: 10.1186/s12913-024-10755-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has tested the resilience capacities of health systems worldwide and highlighted the need to understand the concept, pathways, and elements of resilience in different country contexts. In this study, we assessed the health system response to COVID-19 in Nepal and examined the processes of policy formulation, communication, and implementation at the three tiers of government, including the dynamic interactions between tiers. Nepal was experiencing the early stages of federalization reform when COVID-19 pandemic hit the country, and clarity in roles and capacity to implement functions were the prevailing challenges, especially among the subnational governments. METHODS We adopted a cross-sectional exploratory design, using mixed methods. We conducted a desk-based review of all policy documents introduced in response to COVID-19 from January to December 2020, and collected qualitative data through 22 key informant interviews at three tiers of government, during January-March 2021. Two municipalities were purposively selected for data collection in Lumbini province. Our analysis is based on a resilience framework that has been developed by our research project, ReBUILD for Resilience, which helps to understand pathways to health system resilience through absorption, adaptation and transformation. RESULTS In the newly established federal structure, the existing emergency response structure and plans were utilized, which were yet to be tested in the decentralized system. The federal government effectively led the policy formulation process, but with minimal engagement of sub-national governments. Local governments could not demonstrate resilience capacities due to the novelty of the federal system and their consequent lack of experience, confusion on roles, insufficient management capacity and governance structures at local level, which was further aggravated by the limited availability of human, technical and financial resources. CONCLUSIONS The study findings emphasize the importance of strong and flexible governance structures and strengthened capacity of subnational governments to effectively manage pandemics. The study elaborates on the key areas and pathways that contribute to the resilience capacities of health systems from the experience of Nepal. We draw out lessons that can be applied to other fragile and shock-prone settings.
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Affiliation(s)
| | - Maria Paola Bertone
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | | | | | | | - Tim Martineau
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Kain VJ, Dhungana R, Basnet B, Basnet LB, Budhathoki SS, Fatth W, Sherpa AJ. Stakeholders' Perspectives on the "Helping Babies Breathe" Program Situation in Nepal Following the COVID-19 Pandemic. J Perinat Neonatal Nurs 2024; 38:221-220. [PMID: 38758276 DOI: 10.1097/jpn.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND The COVID-19 pandemic impacted healthcare systems, including resuscitation training programs such as Helping Babies Breathe (HBB). Nepal, a country with limited healthcare resources, faces challenges in delivering effective HBB training, managing deliveries, and providing neonatal care, particularly in remote areas. AIMS This study assessed HBB skills and knowledge postpandemic through interviews with key stakeholders in Nepal. It aimed to identify strategies, adaptations, and innovations to address training gaps and scale-up HBB. METHODS A qualitative approach was used, employing semistructured interviews about HBB program effectiveness, pandemic challenges, stakeholder engagement, and suggestions for improvement. RESULTS The study encompassed interviews with 23 participants, including HBB trainers, birth attendants, officials, and providers. Thematic analysis employed a systematic approach by deducing themes from study aims and theory. Data underwent iterative coding and refinement to synthesize content yielding following 5 themes: (1) pandemic's impact on HBB training; (2) resource accessibility for training postpandemic; (3) reviving HBB training; (4) impacts on the neonatal workforce; and (5) elements influencing HBB training progress. CONCLUSION Postpandemic, healthcare workers in Nepal encounter challenges accessing essential resources and delivering HBB training, especially in remote areas. Adequate budgeting and strong commitment from healthcare policy levels are essential to reduce neonatal mortality in the future.
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Affiliation(s)
- Victoria J Kain
- Author Affiliations: School of Nursing and Midwifery, Griffith University, Brisbane, Australia (Dr Kain); Safa Sunaulo, Nepal (Mr Dhungana); KIST Medical College and Teaching Hospital, Nepal (Ms Basnet); Curative Service Division, Department of Health Services, Nepal (Dr Basnet); Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom (Dr Budhathoki); Global Engagement Institute, Berlin, Germany (Mr Fatth); and Human Rights Peace and Development Forum, Nepal (Ms Sherpa)
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21
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Sthapit N, Malla B, Tandukar S, Thakali O, Sherchand JB, Haramoto E. Evaluating acute gastroenteritis-causing pathogen reduction in wastewater and the applicability of river water for wastewater-based epidemiology in the Kathmandu Valley, Nepal. Sci Total Environ 2024; 919:170764. [PMID: 38331291 DOI: 10.1016/j.scitotenv.2024.170764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 02/10/2024]
Abstract
Rapid urbanization and population growth without the implementation of proper waste management are capable of contaminating water sources, which can lead to acute gastroenteritis. This study examined the detection and reduction of five gastroenteritis-causing enteropathogens, Salmonella, Campylobacter coli, Campylobacter jejuni, Clostridium perfringens, and genogroup IV norovirus, and one respiratory pathogen, influenza A virus, in two municipal wastewater treatment plants (WWTP) using an oxidation ditch system (WWTP A; n = 20) and a stabilization pond system (WWTP B; n = 18) in the Kathmandu Valley, Nepal, collected between August 2017 and August 2019. All enteropathogens were detected in wastewater via quantitative PCR. The concentrations of the pathogens ranged from 5.7 to 7.9 log10 copies/L in WWTP A and from 4.9 to 8.1 log10 copies/L in WWTP B. The log10 reduction values of the pathogens ranged from 0.3 to 1.0 in WWTP A and from -0.1 to 0.2 in WWTP B. The association between the pathogen concentrations and the number of clinical cases in the corresponding week could not be evaluated; however, the consistent detection of pathogens in the wastewater despite low number of case reports suggested the use of wastewater-based epidemiology (WBE) for early warning of acute gastroenteritis (AGE) in the Kathmandu Valley. The pathogens were also detected in river water at approximately 7.0 log10 copies/L and exhibited no significant difference in concentration compared to wastewater, suggesting the applicability of river water for WBE of AGE. Insufficient treatment of all pathogens in the wastewater was observed, suggesting the need for full rehabilitation of the treatment plants. However, the influent may be utilized for early detection of AGE-causing pathogens in the city, whereas the river water may serve as an alternative in areas without connection to the WWTPs.
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Affiliation(s)
- Niva Sthapit
- Department of Engineering, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Bikash Malla
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Sarmila Tandukar
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Ocean Thakali
- Department of Engineering, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Jeevan B Sherchand
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu 1524, Nepal
| | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan.
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Uprety S, Ngo I, Maggos M, Dangol B, Sherchan SP, Shisler JL, Amarasiri M, Sano D, Nguyen TH. Multiple pathogen contamination of water, hands, and fomites in rural Nepal and the effect of WaSH interventions. Int J Hyg Environ Health 2024; 257:114341. [PMID: 38442666 DOI: 10.1016/j.ijheh.2024.114341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/23/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
Water, Sanitation, and Hygiene (WaSH) interventions are the most effective in reducing diarrheal disease severity and prevalence. However, very few studies have investigated the effectiveness of WaSH intervention in reducing pathogen presence and concentration. In this study, we employed a microfluidic PCR approach to quantify twenty bacterial pathogens in water (n = 360), hands (n = 180), and fomite (n = 540) samples collected in rural households of Nepal to assess the pathogen exposures and the effect of WaSH intervention on contamination and exposure rates. The pathogen load and the exposure pathways for each pathogen in intervention and control villages were compared to understand the effects of WaSH intervention. Pathogens were detected in higher frequency and concentration from fomites samples, toilet handle (21.42%; 5.4,0 95%CI: mean log10 of 4.69, 5.96), utensils (23.5%; 5.47, 95%CI: mean log10 of 4.77, 6.77), and water vessels (22.42%; 5.53, 95%CI: mean log10 of 4.79, 6.60) as compared to cleaning water (14.36%; 5.05, 95%CI: mean log10 of 4.36, 5.89), drinking water (14.26%; 4.37, 85%CI: mean log10 of 4.37, 5.87), and hand rinse samples (16.92%; 5.49, 95%CI: mean log10 of 4.77, 6.39). There was no clear evidence that WaSH intervention reduced overall pathogen contamination in any tested pathway. However, we observed a significant reduction (p < 0.05) in the prevalence, but not concentration, of some target pathogens, including Enterococcus spp. in the intervention village compared to the control village for water and hands rinse samples. Conversely, no significant reduction in target pathogen concentration was observed for water and hand rinse samples. In swab samples, there was a reduction mostly in pathogen concentration rather than pathogen prevalence, highlighting that a reduction in pathogen prevalence was not always accompanied by a reduction in pathogen concentration. This study provides an understanding of WaSH intervention on microbe concentrations. Such data could help with better planning of intervention activities in the future.
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Affiliation(s)
- Sital Uprety
- Department of Civil and Environmental Engineering, University of Illinois at Urbana Champaign, Urbana, IL, USA; Department of Sanitation, Water and Solid Waste for Development (Sandec), Swiss Federal Institute of Aquatic Science and Technology (Eawag), Dübendorf, Zurich, Switzerland; Department of Civil and Environmental Engineering, Tohoku University Sendai, Japan.
| | - Isaac Ngo
- Department of Microbiology, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Marika Maggos
- Department of Microbiology, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Bipin Dangol
- Environment and Public Health Organization (ENPHO), Kathmandu, Nepal
| | - Samendra P Sherchan
- Environment and Public Health Organization (ENPHO), Kathmandu, Nepal; Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA; BioEnvironmental Science Program Morgan State University, Baltimore, MD, 21251, USA
| | - Joanna L Shisler
- Department of Microbiology, University of Illinois at Urbana Champaign, Urbana, IL, USA; Institute of Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Mohan Amarasiri
- School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Daisuke Sano
- Department of Frontier Sciences for Advanced Environment, Tohoku University, Sendai, Japan; Department of Civil and Environmental Engineering, Tohoku University Sendai, Japan
| | - Thanh H Nguyen
- Department of Civil and Environmental Engineering, University of Illinois at Urbana Champaign, Urbana, IL, USA; Institute of Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA
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Adhikari CM, Prajapati D, Timalsena B, Bogati A, Khan B, Safi S, Adhikari J, Ghimire V. Use of Statin and Target Low-density lipoprotein cholesterol attainment among post-ST elevation myocardial infarction patients in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. J Nepal Health Res Counc 2024; 21:564-572. [PMID: 38616584 DOI: 10.33314/jnhrc.v21i4.4754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND and objective: Lipid-lowering is an important intervention to reduce cardiovascular morbidity and mortality in the secondary prevention of STEMI. There is no study to analyze the use of statin and LDL-C treatment target attainment among STEMI patients in Nepal. This study aims to assess the use of statin and LDL-C treatment target attainment among STEMI patients. METHODS It was a prospective observational single-center study conducted at the Shahid Gangalal National Heart Centre, Kathmandu, Nepal outpatient department. An outpatient department-based survey was conducted among STEMI patients who have lipid profile levels at the time of admission for STEMI and after 4-13 weeks of the index event. Lipid profile levels, diagnosis, and risk factors were collected during the outpatient follow-up. RESULTS Our study included 280 post-STEMI patients; the mean age was 57.5±11.7 years with the majority being male. The mean duration of follow-up was 6.7 ± 0.1 weeks. Rosuvastatin was the preferred statin with 82.1%. The most common dose of statin used was Rosuvastatin 20mg (70%), followed by Atorvastatin 40mg (12.5%). LDL-C levels of <1.4mmol/l were achieved in 44.6% of cases and LDL levels of <1.8mmol/l in 71.8% of cases. In 36.8% of the study population, there was a greater than 50% decline in LDL-C levels. Diabetic patients (55.1% and 83.1%) only have the significant achievement of LDL goal of both <1.4mmol/l and <1.8mmol/l respectively, when compared to those without diabetes (44.9% and 16.9%). CONCLUSIONS Most of the post-STEMI patients were treated with high doses of statins and achieved the target LDL-C levels.
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Affiliation(s)
| | - Dipanker Prajapati
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Birat Timalsena
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Amrit Bogati
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Barkadin Khan
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Sajjad Safi
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Jagat Adhikari
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Vijay Ghimire
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
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Gautam P, Puri MC, Karki S, Foster DG. Deaths among Women of Reproductive Age: an Explorative Case Study among Abortion Seekers. J Nepal Health Res Counc 2024; 21:692-696. [PMID: 38616604 DOI: 10.33314/jnhrc.v21i4.4871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
In Nepal, abortion was legalized in 2002. Yet many women are denied abortion services. Women denied abortion services may either continue their pregnancies or find abortion care elsewhere. However, what is not known is the consequences on women, and their children after accessing abortion services or after being denied abortion services. This comment aims to understand the cause of death of women who sought abortion services between 2019 and 2020 and were enrolled in a longitudinal nationwide study of the consequences of legal abortion access in Nepal. Women were interviewed 6 weeks and every 6 months for 3 years after seeking abortion. During the follow-up interviews, the field research assistants were informed about the death of the clients. Once the death was reported, a trained senior research staff visited the deceased persons house and interviewed family members including husbands, maternal parents or in-laws to explore the cause of death. A total of nine deaths were reported between April 2019 and December 2022. Out of nine deceased women, four received abortions while five of them were initially denial abortion services. The majority of the deaths were due to suicide followed by tuberculosis. None of the deaths were caused by abortion or birth. Keywords: Death; Nepal; reproductive ages; womens health.
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Affiliation(s)
- Preeti Gautam
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
| | - Mahesh C Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), Kusunti, Lalitpur, P.O. Box 9626, Kathmandu, Nepal
| | - Sunita Karki
- Center for Research on Environment, Health and Population Activities (CREHPA), Kusunti, Lalitpur, P.O. Box 9626, Kathmandu, Nepal
| | - Diana Greene Foster
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standard in Reproductive Health, University of California, San Francisco, USA
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Kathayat TS, Rokaya PK, Rawal M, Marasini P, Karki PD, Nath M. Epidemiology of Spinal Trauma and Related Complication. J Nepal Health Res Counc 2024; 21:642-645. [PMID: 38616596 DOI: 10.33314/jnhrc.v21i4.4911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Traumatic spinal injury is leading cause of mortality and morbidity among the people of productive age group. This study aim to find the cause of spinal injury, site ,and mode of injury, treatment option given so that a preventive measures and create awareness among people of this region. METHODS This is a prospective observation study done in Karnali Academy of Health Sciences from December 2021 to January 2023. Performa was filled to collect data. Data were entered in excel sheet and transported to SPSS 16.0 and statistical analysis was done . RESULTS Out of 117 patients male population had higher incidence of spinal trauma (69.2%) with average age 43.9 years . Fall injury was the commonest mode of injury. 65.8% had injury at the thoracolumbar junction followed by lumbar, thoracic and cervical respectively. Cervical injury patients had higher incidence of neurological deficit. The average duration of trauma to hospital presentation was 10.9±11.2 hours. 19.7 % were operated and 6.8 % of patients were referred to other center. CONCLUSIONS Fall injury being the commonest mode of injury in this art of world, prevention and awareness should be raised about the spinal trauma and its consequences. Adequate equipment with health facilities to the distant hospital may reduce the referral rate and duration of presentation to the hospital which ultimately prevent the further damage to the cord.
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Affiliation(s)
- Tufan Singh Kathayat
- Department of Orthopaedics and Trauma surgery , Karnali Academy of Health Sciences
| | - Poojan Kumar Rokaya
- Department of Orthopaedics and Trauma surgery , Karnali Academy of Health Sciences
| | - Mangal Rawal
- Department of Orthopaedics and Trauma surgery , Karnali Academy of Health Sciences
| | - Pawan Marasini
- Department of Orthopaedics and Trauma surgery , Karnali Academy of Health Sciences
| | | | - Mohan Nath
- Department of Orthopaedics and Trauma surgery, Seti Provincial Hospital
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Adhikari S, Maharjan J, Bhattarai S, Kunwar K, Agrawal S, Dangal RK, Chapagain RH, Bista TB, Bhattarai S. Adverse Events Following COVISHIELD and VERO CELL Vaccination Campaigns Against COVID-19. J Nepal Health Res Counc 2024; 21:651-658. [PMID: 38616598 DOI: 10.33314/jnhrc.v21i4.4926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Vaccination against COVID-19 for Nepalese was initiated in January 2021 for various age groups. People were anxious about receiving the vaccines and were concerned about the safety profile of the vaccine they received. In this study, we have tried to observe the Adverse Events Following Immunization of two different vaccines namely COVISHIELD (ChAdOx1 nCOV-19) and VERO CELL (CZ02 strain), used in different phases of vaccination by the government of Nepal. METHODS We conducted a cross-sectional study among people who received COVID-19 vaccines in this study using a self-administered questionnaire. Data was cleaned and then exported to IBM SPSS v.20 for analysis, Chi-square test was used to see the association between different variables and a p-value<0.05 was considered statistically significant. RESULTS Out of 303 respondents, all had received the first and 270 participants had received the second dose of the COVID-19 vaccine, among which, 133 (43.89%) reported at least one side effect after the first dose of vaccination while 58 (21.48%) had self-reported side effects after the second dose of vaccination. Seventeen percent of the respondents had COVID-19 infection within the past 3 months before receiving COVID-19 vaccine. Three percent of participants had re-infection with COVID-19 after receiving the first or the second dose of the COVID-19 vaccine. Among participants who experienced adverse events, 42% and 62.1% of participants experienced mild adverse events following the first dose and second dose of the vaccine, respectively. Conclusions: The adverse events following immunization for both vaccines after both doses of vaccination were quite low, with 43.89% of participants reporting side effects after the first dose and 21.48% of participants reporting side effects after the second dose. Adverse events were most frequently reported within 24 hours of vaccination and were mostly mild. There was no statistical significance of adverse events between both vaccines.
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Affiliation(s)
| | | | | | | | | | - Raj Kumar Dangal
- Kathmandu University School of Medical Sciences, Dhulikhel hospital, Dhulikhel, Nepal
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Sharma A, Sharma Y, Thapa A, Kar N. Mental Health of Mothers with Malnourished Children in Nepal: A Prospective Observational Study. J Nepal Health Res Counc 2024; 21:659-666. [PMID: 38616599 DOI: 10.33314/jnhrc.v21i4.4965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/31/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Maternal mental health may influence the nutritional status of their children. It was intended to assess the mental health status of the mothers of children admitted to a nutrition rehabilitation center. We specifically explored the relationship between maternal mental health and malnutrition of the child; to observe any change of maternal depressive/anxiety symptoms and weight gain in the child following admission. METHODS In a prospective observational study, malnutrition of children was assessed based on weight for height z scores using the WHO Anthro-Survey-Analyser. We evaluated anxiety using the Generalized Anxiety Disorder Scale (GAD-7) and depression by Patient Health Questionnaire (PHQ-9). Demographic and clinical variables were collected. RESULTS The degree of malnutrition of the children at admission and discharge was: mild (3.6% v 31.7%), moderate (37.7% v 26.3%), severe (58.7% v 8.4%), and no malnutrition (0.0% v 33.5%) (p<0.001). At admission, 12% of mothers had anxiety, depression, or both, which decreased to 3.0% at the time of discharge. There was no difference in malnutrition scores among children of mothers with or without anxiety/depression at admission or discharge, except that children of depressed mothers continued to have significantly greater levels of malnutrition at discharge compared with the mothers without depression. Maternal anxiety or depression was not associated with the severity of malnutrition. CONCLUSIONS A proportion of mothers of children with malnutrition had clinical anxiety and depression; and maternal mental health concerns, especially depression may influence the nutrition of children. It is imperative to explore maternal mental health routinely for malnourished children.
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Affiliation(s)
- Asmita Sharma
- Department of Pediatric Nursing, Bharatpur Hospital Nursing College, Bharatpur, Nepal
| | - Yograj Sharma
- Department of Pediatrics, Bharatpur Hospital, Bharatpur, Nepal
| | - Asha Thapa
- Department of Pediatric Nursing, Bharatpur Hospital Nursing College, Bharatpur, Nepal
| | - Nilamadhab Kar
- Department of Psychiatry, Black Country Healthcare NHS Foundation Trust, Wolverhampton, UK
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Pokhrel N, Neupane A, Thapa N, Yadav RK, Hamal PK, Malla P. Respiratory Morbidity and Mortality of Traumatic Cervical Spinal Injury. J Nepal Health Res Counc 2024; 21:680-683. [PMID: 38616602 DOI: 10.33314/jnhrc.v21i4.5068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Traumatic cervical spinal injuries can severely affect respiratory function and cause significant morbidity and mortality. The typical respiratory morbidity in cervical spine injury is Atelectasis, Ventilator-associated pneumonia, acute respiratory distress syndrome and delayed weaning, etc. The study aims to see the prevalence of respiratory morbidity as well as mortality associated with cervical spine injury. METHODS Cross sectional study based on retrospective data was conducted on the X Sciences with the existing hospital record during the period of 3 years to find out the prevalence respiratory morbidity like Ventilatory Associated Pneumonia, delayed weaning, ARDS, atelectasis of traumatic cervical spine injury, determine the prevalence, type, and impact of respiratory morbidity and mortality in this population. RESULTS Total no 76 patients data meeting the inclusion criteria included in study. Male patients were more prone to develop traumatic cervical spinal injuries (SCI). The prevalence of respiratory morbidity in term of VAP(57.89), delayed weaning(46.05) and Atelectasis(22.36) was high. Patients with Asia A Neurology has higher association for VAP and delayed weaning, while Asia E Neurology patients had no respiratory morbidity. The study found a significant positive association between respiratory morbidity with hospital stay, and ventilator days (p-value: 0.019 and 0.048). A total of 15 patients died, 28.95% were discharged on request and 40.8% leaving the hospital against medical advice. CONCLUSIONS The prevalence of respiratory morbidity higher in cervical spine injury. Furthermore, it has associated with prolonged ICU and ventilator days and increase in mortality.
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Affiliation(s)
- Nabin Pokhrel
- National Academy of Medical Science, Kathmandu, Nepal
| | | | - Nabin Thapa
- Karnali Academy of Health Science, Karnali, Nepal
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Lamichhane N, Dumre AP, Thakur GK. Epidemiology of Stress Fracture in Police Trainees. J Nepal Health Res Counc 2024; 21:573-577. [PMID: 38616585 DOI: 10.33314/jnhrc.v21i4.4791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Military recruits and athletes have high occurrence of stress fractures, with very high incidence among military recruits. Symptomatic stress fractures can be disabling in some people. This study aims at identifying pattern and distribution of such fractures in Nepal Police trainee and assess the risk factors and demographics that may help to develop the local guidelines. METHODS This study analysed 65 police trainees who presented to the orthopaedic Out Patient Department at Nepal Police and Province Police Hospital diagnosed as a case of stress fracture from 29 December, 2020 to 29 December, 2021. Ethical approval was obtained and different variables analysed were age, sex, Body Mass Index, location of fracture, duration of pain, method of treatment, time to heal the fracture and time to pain free mobilisation of patient. RESULTS There were 65 trainees with 86 sites of fracture at different bones with 50.8% (33) of male population. The majority of fracture was located at tibia (58.1%) followed by pubic rami (33.7%) with potentially debilitating fracture neck of femur seen in 4.6% subjects. Mean duration of pain was 20.7±14.2 days with mean time for pain free mobilisation 42.2±17.7 days after presentation. 96.5% of those recovered with conservative treatment (activity restriction or cast). CONCLUSIONS The location of stress fracture depends upon the type of training or activities. Modification of activities in early phase of training with early visit for medical care in case of trainees with increasing pain may decrease morbidities and complications requiring operative treatment.
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Joshi A, Rijal N, Gurung S, Basukala B, Sharma R, Bista R, Singh N, Pradhan I. Is Venous Thromboembolism Prophylaxis Needed in Patients Undergoing Knee Arthroscopy? A Prospective Observational Study. J Nepal Health Res Counc 2024; 21:587-592. [PMID: 38616587 DOI: 10.33314/jnhrc.v21i4.4802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Although rare, deep vein thrombosis is a potentially life-threatening complication of knee arthroscopy. There are scanty literature analysing deep vein thrombosis after arthroscopy in Nepal. This study aimed to identify the prevalence of deep vein thrombosis in patients undergoing knee arthroscopy without chemoprophylaxis postoperatively at 2 weeks and 6 weeks, respectively. The study also aimed to estimate the risk of deep vein thrombosis in these patients by using Caprini Risk Assessment Model. METHODS This prospective observational study was conducted at AKB center, B and B Hospital, Gwarko, Lalitpur, over a period of 16 months. All patients who underwent arthroscopy knee surgeries fulfilling the inclusion criteria were included in the study. The primary outcome measure was the prevalence of deep vein thrombosis as diagnosed by compression color-coded ultrasonography of the popliteal vein and calf vein at 2 weeks and 6 weeks postoperatively. The secondary outcome measure was the prevalence of deep vein thrombosis in the risk groups according to Caprini Risk Assessment Model. RESULTS Out of 612 patients who underwent arthroscopic knee surgeries during the study period, 2 patients (0.33%) developed deep vein thrombosis at 6 weeks follow-up as diagnosed with ultrasonography of the popliteal and calf veins. The prevalence rate in high-risk group was 0.33% (1 in 307) and in very high-risk group was 5.88% (1 in 17). CONCLUSIONS There was a low prevalence of deep vein thrombosis without chemoprophylaxis following knee arthroscopy in our study. There was higher prevalence of deep vein thrombosis in very high-risk group patients, so close monitoring of such patients during follow-up is recommended.
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Affiliation(s)
- Amit Joshi
- Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal
| | - Nishchal Rijal
- Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal
| | - Subash Gurung
- Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal
| | - Bibek Basukala
- Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal
| | - Rajiv Sharma
- Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal
| | - Rohit Bista
- Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal
| | - Nagmani Singh
- Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal
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Gautam K, Aguilar C, Paudel K, Dhakal M, Wickersham JA, Acharya B, Sapkota S, Deuba K, Shrestha R. Preferences for mHealth Intervention to Address Mental Health Challenges Among Men Who Have Sex With Men in Nepal: Qualitative Study. JMIR Hum Factors 2024; 11:e56002. [PMID: 38551632 PMCID: PMC11015371 DOI: 10.2196/56002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/01/2024] [Accepted: 02/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately burdened by poor mental health. Despite the increasing burden, evidence-based interventions for MSM are largely nonexistent in Nepal. OBJECTIVE This study explored mental health concerns, contributing factors, barriers to mental health care and support, and preferred interventions to improve access to and use of mental health support services among MSM in Nepal. METHODS We conducted focus groups with MSM in Kathmandu, Nepal, in January 2023. In total, 28 participants took part in 5 focus group sessions. Participants discussed several topics related to the mental health issues they experienced, factors contributing to these issues, and their suggestions for potential interventions to address existing barriers. The discussions were recorded, transcribed, and analyzed using Dedoose (version 9.0.54; SocioCultural Research Consultants, LLC) software for thematic analysis. RESULTS Participants reported substantial mental health problems, including anxiety, depression, suicidal ideation, and behaviors. Contributing factors included family rejection, isolation, bullying, stigma, discrimination, and fear of HIV and other sexually transmitted infections. Barriers to accessing services included cost, lack of lesbian, gay, bisexual, transgender, intersex, queer, and asexual (LGBTIQA+)-friendly providers, and the stigma associated with mental health and sexuality. Participants suggested a smartphone app with features such as a mental health screening tool, digital consultation, helpline number, directory of LGBTIQA+-friendly providers, mental health resources, and a discussion forum for peer support as potential solutions. Participants emphasized the importance of privacy and confidentiality to ensure mobile apps are safe and accessible. CONCLUSIONS The findings of this study have potential transferability to other low-resource settings facing similar challenges. Intervention developers can use these findings to design tailored mobile apps to facilitate mental health care delivery and support for MSM and other marginalized groups.
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Affiliation(s)
- Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Camille Aguilar
- School of Nursing and Health Studies, University of Miami, Miami, FL, United States
| | - Kiran Paudel
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal
| | - Manisha Dhakal
- Blue Diamond Society, Dhumbarahi Height, Kathmandu, Nepal
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States
| | - Bibhav Acharya
- Department of Psychiatry and Behavioral Sciences, School of Medicine, UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
- Possible, Kathmandu, Nepal
| | | | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States
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Hussain MA, Singh SK, Naz S, Haque M, Shah HK, Singh A. Predictors of apical periodontitis in root canal treated teeth from an adult Nepalese subpopulation: a cross-sectional study. BMC Oral Health 2024; 24:400. [PMID: 38553672 PMCID: PMC10979567 DOI: 10.1186/s12903-024-04139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Endodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP. METHODS Digital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models. RESULTS Prevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96-15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28-0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09-0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08-0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP. CONCLUSIONS Within the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards.
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Affiliation(s)
- Md Asdaq Hussain
- Department of Conservative Dentistry & Endodontics, National Medical College, Birgunj, Nepal.
| | - Shailendra Kumar Singh
- Department of Prosthodontics & Maxillofacial Prosthesis, National Medical College, Birgunj, Nepal
| | - Shazia Naz
- Department of Operative Dentistry, de'Montmorency College of Dentistry, Lahore, Pakistan
| | - Merazul Haque
- Department of Prosthodontics & Maxillofacial Prosthesis, National Medical College, Birgunj, Nepal
| | - Harish Kumar Shah
- Department of Periodontology & Oral Implantology, National Medical College, Birgunj, Nepal
| | - Abanish Singh
- Department of Community Dentistry, National Medical College, Birgunj, Nepal
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Kamar SB, Pandey H, Shahi R, Puri S, Yadav GK, Amgain K. Evaluation of SARS-CoV-2 Humoral Response Following Vaccination with ChAdOx1 nCoV-19 (Covishield™) and/or Sinopharm, BBIBP-CorV (Vero cell™). J Nepal Health Res Counc 2024; 21:523-529. [PMID: 38615227 DOI: 10.33314/jnhrc.v21i3.4634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Billions of doses of COVID-19 vaccine have been introducing in the world to prevent pandemic COVID-19. Higher efficacy but limited data are available for its longevity. We aimed to find out the IgG Anti-SARS Cov-2 antibody level among frontline healthcare workers after two doses of vaccines. METHODS A cross-sectional study was carried among 170 HCPs of Seti Provincial Hospital of western Nepal, who were more than 18 years, and had taken two doses of either one of COVID 19 vaccine. All those participants, who were on leave during the data collection tenure (1st February 2022 to 28th February 2022) and/or did not consent to participate were excluded. Mindray SARS-CoV-2 S-RBD IgG assay kit based on CLIA method, was used whose target antigen is S-RBD (spike protein of receptor binding domain) antigen. The IgG immunoglobulin is detected and cut off value ≥10 AU/ml is considered positive. RESULTS Based on the recommended cut off, the antibody was present in more than 90% across both groups of vaccinee i.e. the positive antibody titer at a mean duration of 7.31 months was 93.53% overall (93.75% and 93.44% in Vero cell™ and Covishield™ vaccinees respectively). There were 3.92 times high odds of high antibody titer (≥250 AU/ml) in Covishield™ group (OR: 3.92, 95% CI: 1.86-8.26, P-value: <0.001) than in Vero cell™ group of vaccinee. Similarly, there were significant difference of high titer of antibody across groups with more than six months of elapse of vaccination (OR: 2.18, 95% CI: 1.06-4.49, P-value: <0.001) than with less than six months of elapse of vaccination. CONCLUSIONS The humoral response was higher among HCPs who received two-doses vaccination with ChAdOx1 nCoV-19 (Covishield™) and/or Sinopharm, BBIBP-CorV (Vero cell™) vaccine, and among those with six or more months of elapse of vaccination. The seroprevalence of SARS-CoV-2 following two-doses vaccination among HCPs was more than nine-tenths.
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Affiliation(s)
- Sher Bahadur Kamar
- Department of Internal Medicine, Seti Provincial Hospital, Kailali, Nepal
| | - Hemraj Pandey
- Department of Paediatrics, Seti Provincial Hospital, Kailali, Nepal
| | - Ramesh Shahi
- Department of Pathology, Seti Provincial Hospital, Kailali, Nepal
| | - Shurehraman Puri
- Department of Emergency Medicine, Seti Provincial Hospital, Kailali, Nepal
| | - Gopal Kumar Yadav
- Department of Internal Medicine, Narayani Hospital, Ministry of Health and Population, Birgunj, Nepal
| | - Kapil Amgain
- Department of Anatomy and Cell Biology, Karnali Academy of Health Science, Jumla, Nepal
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Thapa S, Sharma S, Gautam N, Shrestha S, Raj Ghimire B, Dahal S, Adhikari B, Maharjan R, Thapa S, Kattel R, Koirala R. Performance of Distress Thermometer: A Study among Cancer Patients. J Nepal Health Res Counc 2024; 21:472-478. [PMID: 38615220 DOI: 10.33314/jnhrc.v21i3.4719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The Distress Thermometer accompanied with Problems List is a commonly used screening tool for psychosocial distress. However, it's cut-off score, performance and risk factors for psychosocial distress varies among studies. This is the first study conducted in Nepal to investigate the Distress Thermometer's screening properties, its optimal cut-off score and evaluating the prevalence of psychosocial distress and its risk factors. METHODS This cross-sectional study enrolled 162 heterogeneous cancer patients. The English form of the Distress Thermometer was translated to Nepali using a forward and backward translation method. Questionnaires including socio-demographic, clinical characteristics, the Hospital Anxiety and Depression Scale and Distress Thermometer accompanied with Problems List were filled. Receiver Operating Characteristic analysis of distress thermometer scores was evaluated against Hospital Anxiety and Depression Scale-Total (≥15). An Area Under the Curve, sensitivity, specificity, positive predictive value and negative predictive value were calculated at each Distress Thermometer cut-off score. RESULTS Receiver Operating Characteristic analysis showed an excellent discriminating performance (Area Under the Curve =87.4%). A cut-off score of 4 on Distress Thermometer was established and it yielded sensitivity (88.9%), specificity (71.1%), positive predictive value (75.4%) and negative predictive value (86.5%) respectively. Furthermore, 55.6% of participants were distressed and emotional problems (odd ratio = 28.00), practical problems (odd ratio = 12.152) and physical problems (odd ratio = 2.397) were found to be significant risk factors for PD. CONCLUSIONS PD is a global burden in cancer patients. The DT with a cut-off score of 4 accompanied with PL is valid instrument for screening PD in Nepali cancer patients. PL identified the problems that causes of PD.
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Affiliation(s)
| | - Susmita Sharma
- Nepal Cancer Hospital and Research Center Pvt. Ltd, Department Medical Oncology, Harisiddhi, Lalitpur, Nepal
| | - Nishim Gautam
- Nepal Cancer Hospital and Research Center Pvt. Ltd, Department Medical Oncology, Harisiddhi, Lalitpur, Nepal
| | - Sudip Shrestha
- Nepal Cancer Hospital and Research Center Pvt. Ltd, Department Medical Oncology, Harisiddhi, Lalitpur, Nepal
| | - Bijesh Raj Ghimire
- Nepal Cancer Hospital and Research Center Pvt. Ltd, Department Medical Oncology, Harisiddhi, Lalitpur, Nepal
| | - Sanuja Dahal
- Vinayak College of Health Science, Battisputali-9, Kathmandu, Nepal
| | - Bibhav Adhikari
- College of Management, Little Angels' College of Higher Studies, Hattiban, Lalitpur, Nepal
| | - Rubina Maharjan
- PGY-1, Pediatrics, New York Health And Hospitals, Woodhull Medical Center, United State
| | - Sadiksha Thapa
- Nepal Cancer Hospital and Research Center Pvt. Ltd, Department Medical Oncology, Harisiddhi, Lalitpur, Nepal
| | - Regina Kattel
- Nepal Cancer Hospital and Research Center Pvt. Ltd, Department of Psycho-oncology, Harisiddhi, Lalitpur, Nepal
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Chhetri BR, Thapa R, Banjara MR. Decadal Analysis of ESBL-Escherichia coli Antibiotic Resistance Patterns in Urine Samples from Nepal: A Systematic Review and Meta-Analysis. J Nepal Health Res Counc 2024; 21:353-365. [PMID: 38615204 DOI: 10.33314/jnhrc.v21i3.4723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND This systematic review aimed to determine the antimicrobial resistance pattern of the extended-spectrum β-lactamases producing Escherichia coli (ESBL-EC) in urine samples in Nepal. METHODS Systematic literature review was conducted to locate all articles reporting ESBL-EC in urine samples published between January 2012 to December 2022. The Egger's weighted regression analysis was done to assess the publication bias. A random-effects model was used to calculate the pooled prevalence and corresponding 95% confidence interval due to significant between-study heterogeneity. The strength of correlation between multidrug resistance and ESBL production in E.coli strains was determined using Pearson's correlation coefficient. The data were analyzed using R-language 4.2.2. software. RESULTS The combined prevalence of E.coli in urine samples was found to be 14 % (95% CI, 11-18), while the overall pooled prevalence of ESBL E.coli and MDR E.coli were 30% (95% CI, 20-42) and 70% (95% CI, 38-90) respectively. A strong positive correlation of 0.99 (95% CI, 0.89-1.0) was found between ESBL production and MDR among E.coli isolates. Imipenem was the drug of choice against ESBL-E.coli in urine specimens. CONCLUSIONS Our analyses showed the overall ESBL-EC and MDR-EC burden in Nepal is considerably high. Likewise, the study also infers an increasing trend of antibiotic resistance pattern of ESBL-EC in urine samples.
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Affiliation(s)
- Bibek Rana Chhetri
- Faculty of Medicine and Life Sciences, Chester Medical School, University of Chester, UK
| | - Rajat Thapa
- Faculty of Medicine and Life Sciences, Chester Medical School, University of Chester, UK
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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Parajuli S, Khadka A, Sharma Regmi S, Sthapit S, Singh Rathaur E. Belief and Risk Factors Associated with Suicidal and Self-harm Behaviour among Young Adults of Kathmandu District. J Nepal Health Res Counc 2024; 21:445-449. [PMID: 38615215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Suicide is an emerging public health problem accounting for over 700,000 annual deaths globally. It is also the fourth leading cause of death among the age group 15-29 years in the world. In Nepal, on average 14 people commit suicide every day. Our study explores the factors associated with suicidal and self-harm behaviours among young adults in the Kathmandu district, Nepal. METHODS A descriptive cross-sectional study was conducted among a total of 242 young adults of the Kathmandu district. Data were collected through interview using a developed semi-structured questionnaire. Descriptive statistics and odds ratios were used for data analysis. RESULTS The mean age for initial suicidal and self-harm behaviour was found to be 14 and 15 years respectively, with 28.51% reporting suicidal behaviours including making a plan or suicidal ideation or attempts, and 18.5% with self-harm behaviours. Avoidance and emotional discharge were found as common coping strategies adopted by participants. Belief, family functioning, depression status and self-harm behaviour were found statistically associated with suicidal behaviour. CONCLUSIONS Various factors including belief, family functioning, and depression were found to influence individual suicidal behaviour. Hence, an integrated approach addressing these factors is crucial for the prevention and control of suicide among young adults at risk.
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Affiliation(s)
- Sagar Parajuli
- Department of Public Health, Nobel College, Pokhara University
| | - Anil Khadka
- Department of Public Health, Nobel College, Pokhara University
| | | | - Supriya Sthapit
- Department of Public Health, Nobel College, Pokhara University
| | - Ela Singh Rathaur
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
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Paudel PK, Bhandari P, Kc N, Devkota B. Morbidity and Mortality Profile of Neonates Admitted in Neonatal Intensive Care Unit. J Nepal Health Res Counc 2024; 21:373-379. [PMID: 38615206 DOI: 10.33314/jnhrc.v21i3.4168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The neonatal period faces the greatest risk of death as they are vulnerable to sepsis, birth asphyxia, hypoxic injuries etc. A substantial disparity exists in NMR between Nepal and other developed countries and among different provinces of Nepal as well. This study was conducted to describe the pattern of neonatal admission, and immediate hospital outcomes from NICU located in a remote part of Nepal. METHODS This prospective study was conducted in The Province Hospital, Karnali, Nepal over a period of six months (June 2021 to Dec 2021 AD). The variables used were neonatal age, sex, gestation, birth weight, maternal age, mode and place of delivery. Neonatal morbidities and final outcomes at discharge were recorded in a predesigned proforma. RESULTS A total of 396 neonates included, the majority were inborn 283(71%), male 241(61%), term 301(76%) and had normal birth weight 279 (70.4%). Neonatal sepsis 188(37.2%), prematurity 95(24%), and birth asphyxia 55(15.2%) were main indications for hospitalization. The majority 337(85%) improved after treatment, while 33(8.3%) died, 12 (3%) left against medical advice and 14(3.5%) cases were referred. Preterm neonates had thrice the risk of mortality than term neonates (OR =3.27). Low birth weight (< 2500 grams) had higher odds of poor outcomes (OR =3.5). Low maternal age (<20 years), prematurity, LBW, mechanical ventilation and inotrope use were predictors of poor outcomes. CONCLUSIONS Neonatal sepsis, prematurity and perinatal asphyxia were the most common causes of NICU admissions. Mechanical ventilation, inotropes use, extreme prematurity, low birth weight and younger age of the mother were predictors of poor outcome.
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Affiliation(s)
| | | | - Nawaraj Kc
- Department of Pediatrics, Province Hospital, Karnali
| | - Bibek Devkota
- Department of Anesthesia, Province Hospital, Karnali
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Rawal P, Shrestha SM, Gurung A, Poudel D. Pneumothorax, pneumomediastinum and subcutaneous emphysema as respiratory complications of COVID-19. J Nepal Health Res Counc 2024; 21:428-438. [PMID: 38615213 DOI: 10.33314/jnhrc.v21i3.4550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Pneumothorax, pneumomediastinum and subcutaneous emphysema are respiratory complications of Coronavirus disease 2019 occurring with noteworthy frequency in patients especially with severe disease. They can be life-threatening and often complicate patient managment. METHODS This was a retrospective, observational study of patients admitted in Nepal Armed Police Force hospital from 13/05/2020 to 28/12/2021 diagnosed with pneumothorax, pneumomediastinum or subcutaneous emphysema singly or in combination. Data were collected from clinical charts, imaging records and electronic medical records of Severe Acute Respiratory Syndrome Coronavirus-type 2 positive patients 18 years and older. The frequency and type of the defined complications, the inflammatory markers and ventilatory parameters just prior to their diagnosis, the duration of hospitalization and ICU admission and in-hospital mortality rate were studied. RESULTS Out of 4013 COVID-19 patients admitted in the hospital during the period, a total of 28 patients were observed to develop the complications, the overall incidence being 0.7% among hospitalized patients and 5.6% among ICU patients. The proportion of subcutaneous emphysema (64.3%) was highest followed by pneumomediastinum (46.4%) and then pneumothorax (39.3%) existing singly or in combination among the 28 patients, where four patients developed the complications spontaneously. Mean Positive End Expiratory Pressure of 12.1±2.6 cmH2O and Peak Inspiratory Pressure or Pressure Support of 30.9±10.3 cmH2O were observed for patients under positive pressure ventilation. Most of the patients who developed the complications (78.6%) died during treatment. CONCLUSIONS Pulmonary air leak complications occur frequently in COVID-19 patients treated with or without positive pressure ventilation signifying increased disease severity, risk of ICU admission and high mortality rate. Hence, clinicians should be vigilant of these complications in all patients affected with COVID-19 and institute timely management.
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Affiliation(s)
- Prabhat Rawal
- Department of Anesthesiology and Critical Care, Nepal A.P.F. Hospital
| | | | - Anju Gurung
- Department of Anesthesiology and Critical Care, Nepal A.P.F. Hospital
| | - Dipesh Poudel
- Department of Anesthesiology and Critical Care, Nepal A.P.F. Hospital
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Dangol S, Poudel D, Shrestha SM, Rawal P, Shrestha K. Awake Prone Positioning In COVID Positive Patients: A Retrospective Study. J Nepal Health Res Counc 2024; 21:366-372. [PMID: 38615205 DOI: 10.33314/jnhrc.v21i3.4073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND While the advanced health care settings are struggling hard to handle the sudden surge of COVID-19 cases, resource poor settings in developing countries like Nepal can barely stand to fight the increasing number of severe cases. Easily available cost effective interventions would be great blessing for such settings. This study aimed to study if awake prone positioning can be used as such intervention in COVID 19. METHODS The retrospective study involved 150 patients admitted between November 2020 and January 2021 at Nepal Armed Police Force Hospital and met specific inclusion criteria. Data was obtained at four different time points in relation to prone position and was analysed using International Business Machines Statistical Package for the Social Sciences (SPSS) version 23. RESULTS It was found that among 150 patients, majority (109; 72.7%) were males and 60(40%) had some comorbidities. The mean oxygen saturation was found to increase significantly from 87.18 %(SD 3.531) to 91.08(SD 2.206) after fifteen minutes of prone positioning. One way ANOVA test showed that there was significant difference in oxygen saturation between at least two time points. (F (3,596) = [180.005], p=0.000). Games Howell Post Hoc test for multiple comparisons showed that the mean value of SPO-2 was significantly different across all four time points, at significance level 0.05. CONCLUSIONS This study found Awake Prone positioning as a promising cost effective and feasible intervention for improving oxygenation in COVID 19 and thus could be a blessing to the resource poor health care settings.
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Affiliation(s)
- Shova Dangol
- Department of Anaethesia and Critical Care, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Dipesh Poudel
- Department of Anaethesia and Critical Care, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Surendra Man Shrestha
- Department of Anaethesia and Critical Care, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Prabhat Rawal
- Department of Anaethesia and Critical Care, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Kundu Shrestha
- Department of Anaethesia and Critical Care, Nepal Armed Police Force Hospital, Kathmandu, Nepal
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Gyamtsho S, Tenzin K, Choeda T. Maternal Risk Factors Associated with Preterm Birth: A Case Control Study. J Nepal Health Res Counc 2024; 21:505-513. [PMID: 38615225 DOI: 10.33314/jnhrc.v21i3.4933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Preterm birth is the child birth before 37 completed weeks .Prematurity is one of the leading causes of neonatal morbidity and mortality due to the complications associated with it. The objective of the study was to determine the maternal risk factors associated with all preterm birth in singleton pregnancy at National hospital. METHODS Hospital based unmatched case control study was conducted between March 2021 to December 2021 at National hospital, Thimphu, Bhutan. Case to control ratio was 1:2.Data were collected using interviewer -administered structured questionnaires. The collected data were entered into Epi-data and exported into SPSS for analysis. Independent variables with p-valves<0.05 in the univariate analysis were entered to multi variable logistic model to estimate the strength of association .P-valve <0.05 was considered significant. RESULTS Total of 107 cases and 201 controls participated with a response rate of 95.95%.Multiple logistic regression showed that mothers with ANC follow ≤ four[aOR 9.58(7.36-28.86) ], previous history of preterm delivery [aOR 2.99(1.5-15.77) ], previous caesarean section [aOR 5.72(2.19-14.92)], prelabour rupture of membrane [aOR 8.67(3.78-19.73)], fetal growth restriction [aOR 7.28(2.11-25.11)] , and pre-eclampsia [aOR 10.99(6.75-85.29) were the risk factors positively associated with preterm birth . CONCLUSIONS This study highlights that preeclampsia, number of antenatal care visits ≤ four, prelabour rupture of membrane, fetal growth restriction, previous caesarean section and previous preterm delivery were the risk factors for preterm birth. This show the need of early screening and prevention of preeclampsia, strengthening of antenatal care follow-up, and treatment of infection to prevent prelabour rupture of membrane, reducing primary caesarean section and more attention and care with previous preterm birth .
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Affiliation(s)
- Sonam Gyamtsho
- Department of Obstetrics and Gynecology. Jigme Dorji Wangchuck National Referral Hospital, Thimphu
| | - Karma Tenzin
- Faculty of Postgraduate medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu
| | - Tshering Choeda
- Faculty of Postgraduate medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu
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Karki KB, Shah BK, Shrestha SM. Sexual Dysfunctions among Diabetic and Non-diabetic People Attending in Tribhuvan University Teaching Hospital, Kathmandu Nepal. J Nepal Health Res Counc 2024; 21:514-522. [PMID: 38615226 DOI: 10.33314/jnhrc.v21i3.4991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Sexual dysfunctions including erectile dysfunction among men, a widespread sexual health issue, pose challenges to sexual satisfaction. This cross-sectional study aimed to assess the prevalence and determinants of sexual dysfunctions in both diabetic and non-diabetic individuals aged 30-70. METHODS A study at Tribhuvan University Teaching Hospital in Kathmandu, Nepal, surveyed 350 participants (176 men, 174 women), aged 30-70, with 52.6% having diabetes. The structured interviews and validated questionnaires like IIEF-5 for men and FSFI-6 for women to assess the prevalence and factors associated with erectile dysfunction were used. Statistical tools were employed to measure the associations of different variables with Sexual dysfunctions. RESULTS Overall, the prevalence of sexual dysfunction was 73.7% (95% CI: 72.4- 73.7) with higher rates in men 83.9% (95% CI: 83.1- 84.7) than women 63.6% (95% CI: 62.0 - 65.2). Individuals with diabetes experienced an 81.5% prevalence of sexual dysfunction (95% CI: 80.6-82.4), whereas non-diabetic individuals exhibited a 65.1% prevalence (95% CI: 63.5-66.7). In the diabetic male population, the prevalence of sexual dysfunction was 97.5% (95% CI: 97.4-97.6), while diabetic females had a prevalence of 68.9% (95% CI: 67.5-70.3). Among non-diabetic men, the percentage of erectile dysfunction was 72% (95% CI: 70.7-73.3), and among non-diabetic women, sexual dysfunction remained 56.2% (95% CI: 54.4-58.0). Among individuals with diabetes, those who used tobacco exhibited a sexual dysfunction prevalence of 93.8% (95% CI: 93.5-94.1), while non-tobacco users had a prevalence of 74.8% (95% CI: 73.6-76.0). In non-diabetic individuals, obesity was associated with a higher prevalence of sexual dysfunctions, reaching 84.6% (95% CI: 83.8-84.6). High blood pressure showed a strong association with sexual dysfunctions in both diabetic (83% with 95% CI: 81.9-83.4) and non-diabetic (70% with 95% CI: 67.7-70.1) groups. Individuals with diabetes for more than five years had a higher rate of sexual dysfunction as 87.8% (95% CI: 86.6-89.0) with 100% in men and 79% in women. However, there was no significant difference in the prevalence of sexual dysfunctions related to obesity and alcohol consumption between diabetics and non-diabetics. CONCLUSIONS The research highlights a noteworthy association of sexual dysfunctions with individuals with diabetes, male sex, tobacco use, and hypertension. The observed high prevalence of sexual dysfunctions in both diabetic and non diabetic people is a public health concern, emphasizing the need for culturally tailored approaches to address the sexual health of the affected individuals.
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Sharma R, Shrestha DP. Patch Testing in Allergic Contact Dermatitis. J Nepal Health Res Counc 2024; 21:467-471. [PMID: 38615219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Allergic contact dermatitis is one of the most common forms of skin diseases that require medical intervention. Appropriate detection of allergens by patch test and accurate avoidance of them is the key to management. The objective of this study is to determine the types and frequency of allergens responsible for Allergic contact dermatitis in a tertiary hospital of Nepal. METHODS Altogether 120 patients with Allergic contact dermatitis were enrolled in the study. Patch test was performed to find out the most common inciting allergen, utilizing the Indian Standard Series of allergens approved by The Contact and Occupational Dermatoses Forum of India. Results were read at 48 and 96 hours. Grading of the reactions was done based on the criteria of the International Contact Dermatitis Research Group. Pattern of reactivity of different allergens was assessed. RESULTS Of all the patients, 63 (53%) showed positivity to at least one allergen. Nickel sulfate was the most frequent sensitizing agent in 22 (18%) cases, followed by Fragrance mix in 11(9%) and Paraphenylenediamine in 7 (6%) cases. Out of all positive results, Grade 1 positivity was seen in 44 (51%), Grade 2 positivity in 41(47%) and only 2 (2%) cases showed Grade 3 positivity. Mercaptobenzothiazole, Balsam of Peru, Nitrofurazone and Wool Alcohol did not show positive results in any of our patients. CONCLUSIONS Patch testing helps in the treatment, long term remission, and patient counseling for prevention. Larger scale studies are required to know the sensitivity to allergens in Nepalese population.
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Affiliation(s)
- Rashmi Sharma
- National Academy of Medical Sciences, Bir Hospital, Kathmandu
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Joshi P, Agrawal S, Ghimire JJ, Shrestha PN, Khatun N, Banjara MR. Application of Pediatric Risk of Mortality (PRISM) III Score in Predicting Mortality Outcomes. J Nepal Health Res Counc 2024; 21:450-457. [PMID: 38615216 DOI: 10.33314/jnhrc.v21i3.4662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Children admitted in a pediatric intensive care unit have a high risk of mortality. Pediatric risk of mortality III score in first 24 hours of admission has increasingly been used to predict mortality. The objective of this study was to evaluate the validity of Pediatric risk of mortality score in prediction of mortality among the patient admitted in pediatric intensive care unit. METHODS This prospective observational study was conducted at pediatric intensive care unit of a government pediatric hospital from January to June 2021. Patients between 1 month to 14 years of age and meeting the inclusion criteria were enrolled. Pediatric risk of mortality III score was calculated within 24 hours of admission. Patients were followed up for outcome measure as survivors and non survivors. Chi square test and logistic regression analysis were used to find the association of predictors and the score. RESULTS The mean Pediatric risk of mortality III score was lower in survivors than in non-survivors (4.67 ± 3.8 versus 14.10 ± 6.07; p<0.001). Those requiring inotropic and ventilator support have significantly higher mortality [49.4 versus 0.6 (p<0.001) and 81.8 versus 1.5 (p<0.001) respectively]. Minimum systolic blood pressure, abnormal pupillary reflex, increased blood urea nitrogen and decreased platelet were the significant (p<0.001) risk factors. The area under the Receiver Operating Characteristic curve was 0.916±0.024 (p<0.001) and goodness-of-fit test showed no significant difference between observed and expected mortalities (p=0.186). CONCLUSIONS The Pediatric risk of mortality score constitutes a useful prognostic tool in predicting the mortality. KEY WORDS Mortality; pediatrics; pediatric intensive care unit; risk score.
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Affiliation(s)
- Prakash Joshi
- Department of Pediatric Medicine, Kanti Childrens Hospital, Maharajgunj, Kathmandu, Nepal
| | - Sumit Agrawal
- Department of Pediatric Medicine, Kanti Childrens Hospital, Maharajgunj, Kathmandu, Nepal
| | - Jagat Jeevan Ghimire
- Department of Pediatric Medicine, Kanti Childrens Hospital, Maharajgunj, Kathmandu, Nepal
| | - Pun Narayan Shrestha
- Department of Pediatric Medicine, Kanti Childrens Hospital, Maharajgunj, Kathmandu, Nepal
| | - Najala Khatun
- Department of Pediatric Medicine, Kanti Childrens Hospital, Maharajgunj, Kathmandu, Nepal
| | - Megha Raj Banjara
- Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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Chapagain Koirala P, Sah RK, Sherpa K, Poudyal S, Gautam B, Koirala R. Acute Myocardial Infarction in Women, a Study on Risk Factors, Angiographic Features and Outcomes. J Nepal Health Res Counc 2024; 21:491-497. [PMID: 38615223 DOI: 10.33314/jnhrc.v21i3.4762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Women with acute coronary syndrome are more likely to have cardiovascular disease risk factors and atypical symptoms as compared to men. In Nepal, there is a rising trend of Coronary Artery Disease and myocardial infarction in women. However, research on acute myocardial infarction in women is lacking. The aim of this study was to study the cardiac risk factors, clinical features, angiographic features, and outcome of acute myocardial infarction in Nepalese women admitted to Hospital. METHODS This was a cross sectional study done at Shahid Gangalal National Heart Center Kathmandu from September 2016 to March 2017. Female patients admitted with a diagnosis of acute ST-segment elevation myocardial infarction or non-ST segment elevation myocardial infarction, who fulfilled the inclusion criteria were included in the study. The details of the patients, demographic profile, major clinical symptoms, major coronary artery disease risk factors, angiographic features and outcomes were recorded and assessed during the study period. Coronary angiography was done in 112 patients out of 178 patients. RESULTS Out of 178 patients, 85.95 % had ST-segment elevation myocardial infarction and 14.05% had non-ST segment elevation myocardial infarction. The mean patient age was 62.53 ± 12.1. 26.4% patients were of age less than 55 years. Major risk factors were central obesity (94.61%), dyslipidemia due to low HDL (78.65%). hypertension (54.49%), smoking (54.49%) and type 2 diabetes (34.83%). The most common atypical symptoms were shortness of breath (35.39 %,) , nausea and vomiting (23. 6%) and epigastric pain (6.74%), Single vessel disease was found in 36%; double vessel disease in 26.3% and triple vessel disease in 28.9% of patients. The primary outcome of in- hospital mortality was 3.37 %. CONCLUSIONS Our study showed that significant number of females had Coronary Artery Disease at early age. Among women with myocardial infarction in Nepal, obesity due to high waist to hip ratio was the most common risk factor followed by dyslipidemia due to low high density lipoproteins, smoking, hypertension, and diabetes. Atypical symptoms were also common findings. Single vessel disease was the most common lesion and left anterior descending artery was the most commonly involved vessel. Mortality was seen in ST-segment elevation myocardial infarction patients only.
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Affiliation(s)
| | - Ram Kishor Sah
- Department of Cardiology, National Academy of Medical Sciences, Bir Hospital
| | - Kunjang Sherpa
- Department of Cardiology, National Academy of Medical Sciences, Bir Hospital
| | - Samir Poudyal
- Department of Cardiology, National Academy of Medical Sciences, Bir Hospital
| | - Binayak Gautam
- Department of Cardiology, National Academy of Medical Sciences, Bir Hospital
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Adhikary P, Devkota HR, Reingold AL, Ghimire DJ. Factors associated with depressive symptoms among returnee migrants and non-migrants working adults in Madi municipality in Nepal: a community-based cross-sectional study. BMC Public Health 2024; 24:861. [PMID: 38509521 PMCID: PMC10953170 DOI: 10.1186/s12889-024-18313-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Mental health is a growing concern worldwide. It is not well understood whether international labour migrants from Nepal who return to Nepal are at higher risk of developing mental health problems. The purpose of our study was to determine the prevalence of and examine the associated factors for depressive symptoms among returnee migrants and non-migrant working male adults in Nepal. METHODS A cross-sectional survey of a probability-based sample of 725 participants was conducted in February 2020. The sample was comprised of two groups based on migration status: returning migrants and non-migrants. The 21-item Beck Depression Inventory (BDI-21) questionnaire was used to assess depressive symptoms. Logistic regression was applied to investigate factors associated with symptoms of depression. RESULTS The overall prevalence of depressive symptoms was 10.1%. However, the prevalence of depressive symptoms was lower (7%) among returnee migrants compared to non-migrants (13.7%). Men in the lower income group had a higher chance of having depressive (AOR = 5.88, 95% CI: 2.17-15.96) than those in the higher income group. Similarly, Buddhists and Christians were more likely to be depressed (AOR = 2.20, 95% CI: 1.03-4.68) than Hindus. Participants with more than two children had a higher chance of having of depressive symptoms (AOR = 4.80, 95% CI: 1.15-20.05) compared with those without children. Unmarried men were more likely to be depressed (AOR = 4.07, 95%, CI:1.11-14.92) than those who were married. CONCLUSION The working Nepali adult male population in Nepal, including returning migrants, is at risk of depressive symptoms, but this association was lower in those in the higher income group, returnee migrants, those who were married, Hindus and those with no children. Our results highlight the need to monitor and develop national policies to ensure the mental health of the Nepali male adult population, including returnee migrants.
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Affiliation(s)
- Pratik Adhikary
- School of Public Health, UC Berkeley, Berkeley, USA.
- Institute for Social and Environmental Research (ISER-N), Bharatpur, Nepal.
| | - Hridaya Raj Devkota
- Institute for Social and Environmental Research (ISER-N), Bharatpur, Nepal
- Community Support Association of Nepal (COSAN), Kathmandu, Nepal
| | | | - Dirgha J Ghimire
- Institute for Social and Environmental Research (ISER-N), Bharatpur, Nepal
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Huda MD, Rahman M, Mostofa MG, Sarkar P, Islam MJ, Adam IF, Duc NHC, Al-Sobaihi S. Health Facilities Readiness and Determinants to Manage Cardiovascular Disease in Afghanistan, Bangladesh, and Nepal: Evidence from the National Service Provision Assessment Survey. Glob Heart 2024; 19:31. [PMID: 38524910 PMCID: PMC10959132 DOI: 10.5334/gh.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Background In South Asia, cardiovascular diseases (CVDs) are an increasing public health concern. One strategy for dealing with the growing CVDs epidemic is to make health facilities more ready to provide CVDs services. The study's objectives were to: (1) assess healthcare facilities' readiness to offer CVDs services; and (2) identify the variables that influence such readiness. Methods This study employed data from the Afghanistan Service Provision Assessment Survey 2018-2019, Bangladesh Health Facility Survey 2017, and Nepal Health Facility Survey 2021 that were cross-sectional and nationally representative. In Afghanistan, Bangladesh, and Nepal, 117, 368, and 1,381 health facilities, respectively, were examined. A total of 10 items/indicators were used to measure a health facility's readiness to provide CVDs services across three domains. Results The mean readiness scores of managing CVDs were 6.7, 5.6, and 4.6 in Afghanistan, Bangladesh, and Nepal, respectively. Availability of trained staff for CVD services are not commonly accessible in Afghanistan (21.5%), Bangladesh (15.3%), or Nepal (12.9%), except from supplies and equipment. Afghanistan has the highest levels of medicine and other commodity availability. Among the common factors linked with readiness scores, we ought to expect a 0.02 unit rise in readiness scores for three nations for every unit increase in number of CVDs care providers. In Afghanistan, Bangladesh, and Nepal, availability of both diagnosis and treatment facilities was associated with increases in readiness scores of 27%, 9%, and 17%, respectively. Additionally, an association was observed between nation-specific facility types and the readiness scores. Conclusions Country-specific factors as well as universal factors present in all three nations must be addressed to improve a health facility's readiness to provide CVDs care. To create focused and efficient country-specific plans to raise the standard of CVD care in South Asia, more investigation is necessary to ascertain the reasons behind country-level variations in the availability of tracer items.
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Affiliation(s)
- Md. Durrul Huda
- Diabetic Hospital, Chapai Nawabganj, Bangladesh
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Mosiur Rahman
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Md. Golam Mostofa
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Prosannajid Sarkar
- Dr. Wazed Research and Training Institute, Begum Rokeya University, Rangpur, Bangladesh
| | - Md. Jahirul Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD 4122, Australia
| | | | | | - Saber Al-Sobaihi
- Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe) at Osaka University, Osaka, Japan
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Bijukchhe SM, Gurung M, Pokhrel B, Shakya M, Pant D, Maskey P, Maskey H, Dhakal B, Rajkarkinar S, Bista S, Voysey M, Mujadidi YF, Kim YC, Atherton R, Jones E, Mclean F, Shrestha S, Hill M, Nyland KT, Kelly S, O'reilly P, Sah GP, Basnyat B, Pollard AJ, Shrestha S. Immune responses to typhoid conjugate vaccine in a two dose schedule among Nepalese children <2 years of age. Vaccine 2024; 42:2018-2025. [PMID: 38395723 DOI: 10.1016/j.vaccine.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Previously, the Vi-typhoid conjugate vaccine (Vi-TT) was found to be highly efficacious in Nepalese children under 16 years of age. We assessed the immunogenicity of Vi-TT at 9 and 12 months of age and response to a booster dose at 15 months of age. METHODS Infants were recruited at Patan Hospital, Kathmandu and received an initial dose of Vi-TT at 9 or 12 months of age with a booster dose at 15 months of age. Blood was taken at four timepoints, and antibody titres were measured using a commercial ELISA kit. The primary study outcome was seroconversion (4-fold rise in antibody titre) of IgG one month after both the doses. FINDINGS Fifty children were recruited to each study group.Some visits were disrupted by the COVID19 pandemic and occurred out of protocol windows.Both the study groups attained 100 % IgG seroconversion after the initial dose. IgG seroconversion in the 9-month group was significantly higher than in the 12-month group (68.42 % vs 25.8 %, p < 0.001). Among individuals who attended visits per protocol, IgG seroconversion after the first dose occurred in 100 % of individuals (n = 27/27 in 9-month and n = 32/32 in 12-month group). However, seroconversion rates after the second dose were 80 % in the 9-month and 0 % in the shorter dose-interval 12-month group (p < 0.001) (n = 16/20 and n = 0/8, respectively). INTERPRETATION Vi-TT is highly immunogenic at both 9 and 12 months of age. Stronger response to a booster in the 9-month group is likely due to the longer interval between doses.
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Affiliation(s)
- Sanjeev M Bijukchhe
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal; Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
| | - Meeru Gurung
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Bhishma Pokhrel
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Mila Shakya
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Dikshya Pant
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Pratistha Maskey
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Himang Maskey
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Babita Dhakal
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Shristy Rajkarkinar
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Sabitri Bista
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Merryn Voysey
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Yama F Mujadidi
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Young Chan Kim
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Rachel Atherton
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Elizabeth Jones
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Florence Mclean
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Sonu Shrestha
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Matilda Hill
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Sarah Kelly
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Peter O'reilly
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ganesh Prasad Sah
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Shrijana Shrestha
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
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Das SK, Bhattarai A, Paudel K, Bhusal S, Shah S, Timsina S, Subedi A, Niroula S, Alshahrani NZ, Sah S, Padhi BK, Barboza JJ, Rodriguez-Morales AJ, Salas-Matta LA, Bonilla-Aldana DK, Sah R. Socio-demographic determinants of the knowledge of Monkeypox Virus among the general public: a cross-sectional study in a Tertiary Care Center in Nepal. BMC Infect Dis 2024; 24:295. [PMID: 38448821 PMCID: PMC10916306 DOI: 10.1186/s12879-024-09184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Monkeypox virus (MPXV) is the causative agent of monkeypox's zoonotic infection and was declared a global emergency by the World Health Organization (WHO). Studies from different countries have shown insufficient knowledge among the general public on MPXV. This study aimed to assess the knowledge of the general public of Nepal on MPXV. METHODS Three hundred people were interviewed in person in October 2022, and 282 complete responses were recorded. The questionnaire related to the knowledge of MPXV was derived from a previous study conducted among the general population of Saudi Arabia. Twenty-two questions were included that assessed the knowledge and attitude of Nepalese toward monkeypox. Statistical comparison between high and low knowledge was performed using Pearson's Chi-square test. Logistic regression models were deployed to establish the relationship between participants' knowledge and socio-demographic characteristics. RESULTS Among the total respondents, 53.8% demonstrated high knowledge of monkeypox. People aged 18-25 years, unmarried people, and those living in urban areas had significantly higher levels of knowledge. Most respondents believed that MPXV is not a conspiracy or bioterrorism (63.1%) and agreed that it is likely to affect people's social and economic life as COVID-19 did (67.0%). The history of COVID-19 vaccination (aOR: 2.980; 95%CI: 1.227, 7.236) and the younger age (aOR: 2.975; 95%CI: 1.097, 8.069) were found to be significant determinants of the knowledge of the participants on monkeypox. CONCLUSION We observed that most Nepalese populations had a high knowledge of monkeypox and that social media was the most valuable source of information.
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Affiliation(s)
- Santa Kumar Das
- Department of Pulmonology and Critical Care, Tribhuvan University, Institute of Medicine, 44600, Maharajgunj, Nepal
| | | | - Kiran Paudel
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal
| | - Sandesh Bhusal
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sangam Shah
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Aastha Subedi
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sandhya Niroula
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Najim Z Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, 21589, Jeddah, Saudi Arabia
| | - Sanjit Sah
- Research Scientist, Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, 442001, Wardha, India
- SR Sanjeevani Hospital, Kalyanpur-10, Siraha, Nepal
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Alfonso J Rodriguez-Morales
- Faculties of Health Sciences and Environmental Sciences, Universidad Científica del Sur, 4861, Lima, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, P.O. Box 36, Lebanon
- Grupo de Investigación Biomedicina, Faculty of Msedicine, Fundacion Universitaria Autónoma de las Américas-Institucion Universitaria Vision de las Americas, Pereira, Risaralda, Colombia
| | - Luis A Salas-Matta
- Faculties of Health Sciences and Environmental Sciences, Universidad Científica del Sur, 4861, Lima, Peru
| | | | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, 44600, Kathmandu, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, 411018, Pune, Maharashtra, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, 411018, Pune, Maharashtra, India
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Gurung TB, Paudel R, K. C. A, Acharya A, Khanal PK. Appropriate complementary feeding practice and associated factors among mothers of children aged 6-23 months in Bhimphedi rural municipality of Nepal. PLoS One 2024; 19:e0299969. [PMID: 38446802 PMCID: PMC10917259 DOI: 10.1371/journal.pone.0299969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Appropriate complementary feeding plays a crucial role in the enhancement of child survival; and promotes healthy growth and development. Evidence has shown that appropriate complementary feeding is effective in preventing malnutrition and child mortality. Thus, the main objective of this study is to assess the prevalence of appropriate complementary feeding practice and associated factors among mothers of children aged 6-23 months. METHODOLOGY A community-based cross-sectional study was conducted from August to December 2018. A total of 259 mothers who had children aged 6-23 months were selected randomly from the 714 eligible mothers. A structured questionnaire was used to collect the data from the respondents. The data were collected in a tablet phone-based questionnaire using the Open Data Kit mobile application by face-to-face interview. Data analysis was done in SPSS version 21. Multivariable logistic regression was used to identify the factor associated with appropriate complementary feeding practice. RESULT The prevalence of appropriate complementary feeding practice was 25%. Mother and father with formal education (AOR 6.1, CI: 1.7-22.4 and AOR 5.6 CI: 1.5-21.2 respectively), counseling on IYCF (AOR 4.2, CI: 1.5-12.3), having kitchen garden (AOR 2.4, CI: 1.1-5.2) and food secured family (AOR 3.0, CI: 1.0-8.9) had higher odds of appropriate complementary feeding practice. CONCLUSION This study revealed that a significant proportion of mothers had inappropriate complementary feeding practice for their children aged 6-23 months. This study highlights the need for behavior change communication and promotion of kitchen garden to address the associated factors and promote appropriate complementary feeding practice.
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Affiliation(s)
- Thag Bahadur Gurung
- Environment Health and Health Care Waste Management Section, Management Division, Department of Health Service, Kathmandu, Nepal
| | - Rajan Paudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Aashish Acharya
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
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Kunwar S, Sharma S, Marasini S, Joshi A, Adhikari A, Ranjit A, Byanju Shrestha I, Shrestha A, Shrestha AK, Karmacharya BM. Cyberbullying and cyber-victimisation among higher secondary school adolescents in an urban city of Nepal: a cross-sectional study. BMJ Open 2024; 14:e081016. [PMID: 38448066 PMCID: PMC10916119 DOI: 10.1136/bmjopen-2023-081016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/16/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE To assess the prevalence and factors associated with cyberbullying and cyber-victimisation among high school adolescents of Pokhara Metropolitan City, Nepal. DESIGN A cross-sectional study. SETTING Pokhara Metropolitan City, Nepal. PARTICIPANTS We used convenient sampling to enrol 450 adolescents aged 16-19 years from four distinct higher secondary schools in Pokhara Metropolitan City. OUTCOME MEASURES We administered the Cyberbullying and an Online Aggression Survey to determine the prevalence of cyberbullying and cyber-victimisation. Univariate and multivariate logistic regression analyses were performed to estimate the ORs and 95% CIs. Data were analysed using STATA V.13. RESULTS The 30-day prevalence of cyberbullying and cyber-victimisation was 14.4% and 19.8%, and the over-the-lifetime prevalence was 24.2% and 42.2%, respectively. Posting mean or hurtful comments online was the most common form of both cyberbullying and cyber-victimisation. Compared with females, males were more likely to be involved in cyberbullying (adjusted OR (AOR)=13.52; 95% CI: 6.04 to 30.25; p value <0.001) and cyber-victimised (AOR=2.22; 95% CI: 1.33 to 3.73; p value <0.05). Using the internet almost every day was associated with cyberbullying (AOR=9.44; 95% CI: 1.17 to 75.79; p value <0.05) and cyber-victimisation (AOR=4.96; 95% CI: 1.06 to 23.18; p value <0.05). Students from urban place of residence were associated with both cyberbullying (AOR=2.45; 95% CI: 1.23 to 4.88; p value <0.05) and cyber-victimisation (AOR=1.77; 95% CI: 1.02 to 3.05; p value <0.05). CONCLUSION The study recommends the implementation of cyber-safety educational programmes, and counselling services including the rational use of internet and periodic screening for cyberbullying in educational institutions. The enforcement of strong anti-bullying policies and regulations could be helpful to combat the health-related consequences of cyberbullying.
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Affiliation(s)
- Surakshya Kunwar
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | - Sabina Marasini
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Anjali Joshi
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | | | - Ishwori Byanju Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Akina Koju Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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