Journal of Nepal Health Research Council最新文献

Background: The most vulnerable time for child's survival is the neonatal period with the highest risk of dying at an average global rate of 17 deaths per 1,000 live births in 2022. Sepsis, prematurity and perinatal asphyxia are the common causes of neonatal morbidity and mortality. This study was aimed to assess the morbidities of newborns admitted in tertiary care neonatal intensive care unit of Nepal and their outcome.

Methods: A prospective cross sectional study was carried out for 4 years (2076 Shrawan - 2080 Asar) in NICU of Bharatpur Hospital, Chitwan. All patients admitted in NICU within study period were included in the study. Data were entered onto a spreadsheet and then analyzed using SPSS version 16.

Results: The total number of neonates admitted in NICU in last four years (Shrawan 2076 to Asar 2080) was 2810 with male: female ratio being 1.5:1. Sepsis (64.9%) was the commonest diagnosis in NICU admitted babies, followed by neonatal jaundice (26.1%), prematurity (26.0%) and PND (22.2%) respectively. Total discharged neonates after successful management were 2433 (86.5%) while 96 (3.4%) neonates expired. Forty eight (1.8%) neonates were referred to other center and 233 (8.3%) left the hospital against medical advice (LAMA). Among neonates with birth weight less than 2500 gm, 66(6%) expired and 149(13.5%) went on LAMA.

Conclusions: Sepsis, neonatal jaundice and birth asphyxia were the common diagnosis in NICU admitted babies. Similarly, preterm/low birth weight babies had higher mortality and major portion of them leave against medical advice.

Background: The evolving population demographics, healthcare system, and epidemiological transition have highlighted the need for interdisciplinary teamwork to deliver cost-effective and quality care. Despite its importance, research shows it is not consistently practiced in healthcare settings. This study aims to determine nurses' perceptions of interdisciplinary teamwork in clinical settings.

Methods: A descriptive cross-sectional study was conducted in selected tertiary hospitals, Kathmandu. Sample size was calculated using Cochrane formula and convenient sampling was used to enroll 216 nurses. Data were collected using a self-administered modified version of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ). Frequnecy, percentage and mean were calculated as well as chi-square test was done for analysis.

Results: Among 216 nurses, 56.9% had negative perception of teamwork. The overall item mean score and standard deviation for NP-PCOCQ was 2.66 and 0.383, respectively. Perception regarding nurse-physician relations have the highest mean score and nurse-administrative relations have lowest. The majority of nurses in emergency and medical care had positive perception while those in surgical and critical care had negative perceptions of teamwork. The overall moderate perceptions of teamwork were reflected in the NP-PCOCQ score, highlighting the influence of clinical work environment on nurses' collaborative experiences.

Conclusions: Majority of nurses have negative perception of teamwork with nurse-administrative relations scoring the lowest among subscales. Organizations should create a supportive work environment through strategic planning, effective communication, and regular collaboration to ensure teamwork.

Background: Hypertension is an emerging public health problem in Nepal due to epidemiological and nutritional transition in the last two decades. In this study, we aimed to characterize the distribution of risk factors for hypertension in Nepalese police officer of far western province of Nepal.

Methods: This cross-sectional study was conducted in police stations in three districts of the far western Province of Nepal. Physical examination including blood pressure, height, weight, waist circumference, and random blood sugar and urine reaction were recorded during the annual medical check after obtaining verbal approval to research the findings. Hypertension, defined as systolic BP (SBP) ? 140 mmHg and/or diastolic BP (DBP) ? 90 mmHg (classified as 1) was the outcome variable of interest. Covariates of hypertension were elicited through the multivariable logistic regression. These covariates were age, gender, body mass index (BMI), residence location, diabetes status and waist circumference.

Results: Among the 1055 police personnel, 14% (146) were hypertensive, 4.8% (51) were diabetic, and 33% (339) were pre-obese (BMI 25.0-29.0). In the multivariable logistic regression, age groups 25-29 (adjusted odds ratio [AOR] = 2.03, 95% CI 1.11, 3.75), 35-39 (AOR = 2.36, 95% CI 1.22, 4.62), and 40-44 years (AOR = 2.50, 95% CI 1.20, 5.16) were twice at odds of being hypertension compared to 19-24 year. At the same time, those with pre-obese were 78% (AOR = 1.78, 95% CI 1.21, 2.62) more likely to report hypertension compared to normal BMI. A unit increase in waist circumference was likely to be associated with a 6% (AOR = 1.06, 95% CI 1.01, 1.11) increase in hypertension.

Conclusions: The prevalence of hypertension in the Nepalese police personnel in the western region of Nepal was lower than in the general population. The risk factors for hypertension were age, being overweight, and increased waist circumference.

Background: Breastfeeding is the ideal food for infants, with social support and self-efficacy being essential for the continuation of exclusive breastfeeding. This study aimed to assess the levels of social support and self-efficacy towards exclusive breastfeeding among mothers attending the MCH clinic in Bheri Hospital, Nepalgunj, Lumbini Province, Nepal.

Methods: A descriptive cross-sectional study, based on a quantitative approach, was conducted among 153 exclusively breastfeeding mothers using non probability purposive sampling technique. Data were collected through face-to-face interviews using the Exclusive Breastfeeding Social Support Scale (EBSSS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) tools. Data analysis involved descriptive and inferential statistics using SPSS version 21.

Results: The study found that more than half (56.2%) of respondents experienced low social support for exclusive breastfeeding Median 45 (IQR 26-49), and half (50.3%) had low self-efficacy Median 60 (IQR 15-70). A majority (63.4%) initiated breastfeeding within the first hour of birth. The level of social support was significantly associated with breastfeeding frequency (p=0.01). Similarly, self-efficacy had a significant association with breastfeeding frequency (p=0.01) and prelacteal feeding (p=0.04). A significant statistical association also existed between the level of social support and the level of self-efficacy (p<0.001).

Conclusions: Respondents demonstrated low social support and low self-efficacy for exclusive breastfeeding. The findings highlighted a significant statistical association between these two crucial factors. This study suggests that there is higher need for increasing social support and self-efficacy to promote exclusive breastfeeding.

Background: Numerous studies show a strong link between oral and systemic health. Oral pathogens and periodontal inflammation may contribute to systemic inflammation, increasing the risk of chronic diseases such as COPD. This study aims to provide evidence that supports integrated prevention and treatment approaches, emphasizing bidirectional relationship between oral health and COPD.

Methods: A comparative cross-sectional study was conducted at Outpatient Department of Pulmonary Medicine and Critical Care, Chitwan Medical College, from October 2023 to March 2025. Ninety-seven COPD patients and 97 age-matched non-COPD caregivers fulfilling inclusion criterias were evaluated for periodontal status using various indices including oral hygiene index-simplified (OHI-S), gingival bleeding index (GBI), and periodontal index for risk of infectiousness (PIRI). Periodontal parameters, including probing pocket depth (PPD) and clinical attachment loss (CAL), were also assessed. A non-probability consecutive sampling technique was applied. Data were analysed in SPSS version 27.0.

Results: The mean scores of OHI-S (1.9 ± 0.7 vs. 2.8 ± 0.89), GBI (20.03 ± 10.19 vs. 33.1 ± 16.2), PIRI (2.1 ± 1.9 vs. 6.2 ± 2.7), PPD (4.4 ± 2.6 vs. 7.6 ± 1.3), and CAL (2.3 ± 1.0 vs. 4.5 ± 1.1) for non-COPD and COPD groups, respectively, demonstrate that non-COPD participants had significantly better periodontal health compared to those with COPD (P value<0.001).

Conclusions: Patients with COPD showed poorer oral hygiene status, more gingival bleeding, and weaker periodontal health than those without COPD. Thus, it is crucial to emphasize on proper oral hygiene practices to prevent oral and periodontal diseases in these patients.

Background: Pruritus is a common and distressing symptom in patients with psoriasis, yet it is often overlooked and inadequately treated. This can lead to substantial physical, emotional, and social difficulties, negatively impacting patients' quality of life (QoL). The study's objectives were to evaluate the clinical and demographic profile of patients with psoriatic pruritus, assess its severity, and determine its impact on the QoL.

Methods: A prospective study was conducted among 112 patients presenting with psoriatic pruritus to the dermatology department of a tertiary care teaching hospital over a one-year period. Pruritus intensity was measured using a horizontal 10-point Visual Analog Scale (VAS). The impact of pruritus on the QoL was assessed using the validated 5-D Itch Scale (range 5 to 25). Descriptive statistical tools were employed to summarize and interpret the data.

Results: The mean age of the enrolled patients was 36±13 years. The cohort represented patients from 19 districts of Nepal. The mean duration of psoriasis was 8.9±7.3 years. The mean VAS score was 4.1±1.64 (categorized as "moderate" intensity), with the highest recorded score of 8. The mean 5-D Itch Scale score was 13.01±3.86 (categorized as "moderate" impact on the QoL), with individual scores ranging from 5 to 23.

Conclusions: Pruritus in patients with psoriasis was of moderate intensity, with a moderate impact on the quality of life. Dermatologists should be aware of the clinical burden of psoriatic pruritus and prioritize its evaluation and management as part of comprehensive psoriasis care.

Background: In mid-2023, Nepal experienced a significant outbreak of conjunctivitis, affecting over 60% of outpatients in eye hospitals and prompting school closures. The outbreak, peaking in August, predominantly impacted children and individuals with compromised immunity. Clinical manifestations included sudden-onset redness, foreign body sensation, watery discharge, and occasional lid swelling. Most cases exhibited acute haemorrhagic conjunctivitis, with management involving ocular lubricants, personal hygiene, and topical antibiotics. This case series from Himalaya Eye Hospital in Pokhara details the genomic epidemiology and clinical characteristics of conjunctivitis cases during the outbreak.

Methods: To understand the causative agents, conjunctival swabs from patients were subjected to unbiased metagenomic next-generation sequencing (mNGS) in Illumina iSeq100 at Dhulikhel Hospital Kathmandu University Hospital Results: This case series revealed the presence of Enterovirus C (coxsackievirus strain A24) as the major pathogen responsible for the outbreak.

Conclusions: This case series contributes valuable insights into the genomic diversity of conjunctivitis-associated viruses, highlighting the potential of mNGS in enhancing diagnostic capabilities and guiding public health responses.

Background: Leave against medical advice is a more prevalent challenge in Intensive Care units of developing countries compared to developed ones.

Methods: This prospective observational study was done included 466 patients aged ?18 years who underwent leave against medical advice in a level three intensive care unit of a medical college. The patient admitted to the intensive care unit who chose to leave against the clinicians' advice was referred to as leaving against medical advice. All data were first entered into an Excel sheet and then transferred to a statistical package for the social sciences-16 for analysis. The descriptive data are presented as the number and percentage for categorical data and mean ± standard deviation for continuous data according to their distribution.

Results: A total of 466 patients were included in the study, and among them,273(58.58%) were male and 193(41.41%) were female. Middle- aged patients account for 234(50.21%) cases. Most patients, 460(98.71%) were admitted from the emergency department. LAMA occurred most frequently during morning shift, 258(55.56%) and in the month of Chaitra 19.4%.The mean ICU stay was 2.53±1.92 days. Internal Medicine accounted for 221(47.2%) who underwent leave against medical advice. 59(12.6%) were mechanically ventilated. Poor prognosis was the primary reason in 278(59.64%) patients who underwent leave against medical advice.

Conclusions: Poor prognosis and financial problems were the most common reasons for patients to leave against medical advice. Therefore, government and other institutions should address this as a critical issue in patient management.

Background: This study aims to determine the prevalence of refractive error among undergraduate students in Far Western Nepal and association with ethnicity, parental history of myopia and environmental factors.

Methods: Non-interventional, cross-sectional study was done with random sampling involving 768 undergraduate students aged 18 to 26 years were included. Comprehensive ocular examinations were performed using non-cycloplegic refraction by single examiner. A structured, pre-validated questionnaire was used to gather personal demographics, outdoor activity levels, screen time, parental history of myopia, and ethnicity.

Results: The refractive error was found in 16.63% with myopia prevalent in 16.40% of the students. The findings revealed a significant association between myopia and several risk factors, including parental myopia (?=-0.86±0.05; p<0.001), extended near work (?=-0.60±0.08; p<0.001), and high screen time (?=-0.81±0.05; p<0.001). This significant association revealed higher incidences of myopia within academic departments that require intensive near visual tasks, especially in engineering department. Furthermore, ethnic variations indicated that Aryan students, particularly in the Brahmin and Chhetri communities has higher prevalence of myopia than other groups.

Conclusions: The higher prevalence of myopia among the undergraduate students in Far West Nepal was seen at the age of 19. This study suggests the critical risk factors associated with myopia, including age, outdoor activities, screen time, parental history, and ethnic variations which need early health initiatives with preventive strategies for the growing incidence of myopia.

Background: To determine the prevalence of inducible clindamycin resistance among methicillin-resistance Staphylococcus aureus (MRSA), and to detect the presence of mecA and ermC genes among MRSA recovered from hospital patients in central Nepal.

Methods: Staphylococcus aureus isolated from a total of 289 clinical specimens consisting of pus and wound swabs were analyzed and identified. The MRSA strains were screened using a cefoxitin (30 µg) disc following the CLSI procedure and a double-disc test (D-test) was applied to investigate iMLSB-resistant phenotypes among the MRSA isolates. The bacterial genomic DNA was extracted and mecA and ermC genes were detected using specific primer pairs.

Results: Among the 64 S. aureus strains, 39.1% of the isolates were MRSA. The prevalence of inducible clindamycin resistance among MRSA was observed to be 48%. All MRSA (100%) isolates were resistant to penicillin and amoxicillin, whereas all strains were susceptible to linezolid, vancomycin, teicoplanin, and tigecycline. Among MRSA isolates, 8% carried the mecA gene and 13.3% of iMLSB isolates were positive for the ermC gene.

Conclusions: A high rate of inducible clindamycin resistance among MRSA was observed. To identify the status of antibiotic resistance among S. aureus, further genomic-based studies are required.