Journal of Nepal Health Research Council最新文献

The increase of the age of consent to 18, with the Muluki Penal Code that came into effect in 2017, created an unintended burden on the juvenile justice system in Nepal. The amendment, drafted to protect minors from sexual exploitation by adults, resulted in the criminalisation of consensual relationships between adolescents. The surge of inmates aged 16 to 18 years is leading Nepal into a crisis in its juvenile correction centres, with overcrowded facilities, decrepit conditions, and increased violence. This crisis was underlined by three deaths in juvenile correction centres at Bhaktapur, Parsa, and Banke up to September 2023. This article explores the legal, social, and ethical dilemmas generated by Nepal's reforms of rape law and advocates for a more nuanced approach in safeguarding vulnerable populations without moralising normal adolescent sexual conduct. This approach is based on the consideration of pending challenges for the juvenile justice system and the development of strategies to reconcile child protection goals with the realities of adolescents' relationships. Keywords: Informed consent; juvenile delinquency; Nepal; rape.

Backgrounds: Scrub Typhus is a re-emerging illness with considerable morbidity and mortality and affected children have nonspecific sign symptoms. This study was conducted to find out the risk factors, clinical characteristics and laboratory profile and treatment outcome of scrub typhus among the children admitted in tertiary level pediatric hospital for febrile illness.

Methods: A case control study was conducted among hospitalized children with acute febrile illness in a government pediatric referral hospital of central Nepal for two years (2021 to Sept 2023), who were tested using Scrub Typhus Antibody Rapid Test Kit.

Results: We recruited 137 participants, comprising 68 cases of scrub typhus and 69 controls who had fever as a presenting complain, tested negative for scrub typhus and are matched with case in terms of age, gender, place of residence, and most importantly devoid of chronic health issues like leukemia, solid tumor, tuberculosis or kala-azar. Almost all cases i.e. 98.5% (n=67) had fever which is followed by abdominal pain 19.1% (n=13), headache 11.8%(n=8), vomiting 10.3%(n=7) and abdominal distension 8.8%(n=6). Hepatomegaly was commonest finding among scrub typhus positive cases comprising 50% (n=34) followed by lymphadenopathy 29.4% (n=20), splenomegaly 27.9% (n=19), eschar 17.6% (n=12) and rashes 10.3% (n=7). Cases having thrombocytopenia and leukocytosis were 51.5% (n=35) and 32.3% (n=22) respectively. Among scrub typhus cases, 17.6% (n=12) needed pediatric intensive care, 20.6% (n=14) had some sort of complications (i.e., meningitis, acute kidney injury, septic shock, acute respiratory distress syndrome), 46.3% (n=31) became afebrile within 24 hours of therapy, 29.8% (n=20) needed 48 hours to become afebrile. There were about 80% cases with the habit of taking naps on the ground. Those who reside other than cemented houses were with an increased risk factor of about 72%. Those who were not having good beds were at an increased risk factor of almost 100%. There were 62% of cases with bushes near their home and about 100% cases where they store animal fodder in their home. There were 63% who have any sort of animal in their bedroom.

Conclusions: Engaging in agricultural work like working on fields, planting and livestock, working with bare hands/ feet, and having naps on the ground and living in houses made of mud dung and wood are the risk factors for the scrub factor. Fever, lymphadenopathy, hepatomegaly, splenomegaly are the common signs and symptoms and thrombocytopenia and increased levels of creatinine are the significant laboratory finding of scrub typhus in children.

Backgrounds: Problem-based learning (PBL) is a learner-centered pedagogical approach in which a person learns about a subject by working in groups to solve an open-ended problem. The objective of the present study was to assess students' perceptions and attitudes toward Problem-based learning and the role of tutors in Problem-based learning.

Methods: This quantitative study was conducted among second-year medical and dental undergraduate students from November 2022 to November 2023. The students were divided into eight groups, and each group was facilitated by tutors. A Problem-based learning tutor guide, with a case on the topic of diarrhea/dysentery, was designed as a module with six triggers and given to the groups. At the end of nine days of PBL sessions, feedback from students on the process of Problem-based learning and tutors was received using the 'Dolmans and Schmidt' and 'Dolmans and Ginns' questionnaires, respectively. The level of attitude of the students based on their feedback toward the Problem-based learning process and the tutors were also assessed. The data were entered into Microsoft Excel, and descriptive analysis was performed using the Statistical Package for Social Sciences (SPSS), version 21.

Results: Among the 79 responses received, 72 (92.4%) students gave a good rating of the process of Problem-based learning, indicating a favorable attitude. The participants agreed with the themes based on the influence of discussion, content tested, course objectives, lectures, tutors, and reference literature. Similarly, 63 (81%) students gave a good rating of the tutorials’ performance, suggesting a favorable attitude. They agreed that tutors facilitated active, self-directed, contextual, and collaborative learning.

Conclusions: This study revealed the positive perceptions and attitudes of medical and dental undergraduate students regarding the PBL process and the role of tutors in Problem-based learning. The outcomes of this study have provided a foundation for implementing Problem-based learning in Nepal's medical and dental undergraduate curricula.

Background: The Coronavirus (SARS-CoV-2) infection termed as COVID-19 was first detected in Wuhan, Hubei Province of China, in December 2019 and has been declared as a pandemic by the World Health Organization on January 30, 2020. The study aims to understand the time, place and person distribution of covid-19 morbidity, mortality of COVID-19 in Nepal.

Methods: The analysis produces the descriptive epidemiological features of COVID-19 pandemic in Nepal. The data was analysed to produce disaggregated case rate and case fatality rate across various time, place and personal characteristics aggregated at national and subnational level Results: The study found that the observed case rate was significantly higher among males compared to females. Similarly, case rate was the highest among males of 31-40 years and females of 51- 60 years. Case fatality rate increased with age group. Above the age of 41-50 years, case fatality rate was higher among males compared to females. We observed that case fatality rate was disproportionately concentrated among the poor districts in terms of GDP Conclusions: The observed case rate is significantly higher among males compared to females, however case fatality rate increased with age group. Case rate was found the highest in the Bagmati province followed by the Gandaki Province. However, case fatality rate was found the highest in hilly and mountain districts of Province 1, Gandaki and Karnali. Case fatality rate was disproportionately concentrated among the poor districts in terms of GDP.

Rupture of sinus of Valsalva is a rare cardiac condition which is associated with severe left to right shunting. Symptoms may include breathlessness, chest pain and fatigue or even cardiogenic shock and when untreated, this condition carries a grave prognosis. We report a case of a 57-year-old gentleman without any past comorbidities who presented to our hospital with features of acute heart failure due to rupture of sinus of Valsalva which was diagnosed by echocardiogram and further confirmed by cardiac computed tomography scan. Patient underwent successful patch closure of the defect and made a good recovery. His hospital stay was uneventful and is under regular follow up. This highlights the importance of multimodality imaging and timely treatment for cases of rupture of sinus of Valsalva. Keywords: Echocardiogram; ruptured sinus of Valsalva; sinus of Valsalva aneurysm.

Background: The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) is a questionnaire for evaluating the frequency, severity, and impact on quality of life of persons with. Urinary incontinence is a stigma, and a Nepali version of the change women to persons will help to screen for incontinence, and be valuable for clinicians, researchers, and for persons with urinary incontinence.

Methods: After receiving ethical clearance and permission from ICIQ, the translation and cross-cultural adaptation was conducted using the ICIQ module protocol. This incorporated initial translation of the questionnaire, backward translation with involvement of ICIQ. The necessary adjustments were made during a meeting with the reconciliation expert team. After the approval from the ICIQ, interviews were conducted with eight women with urinary incontinence for conceptual equivalence. After cognitive debriefing, the comments were checked and proofreading of the questionnaires for comprehensibility, readability and accuracy of the grammar were done. Final typesetting and formatting were checked to match the original ICIQ-UI SF.

Results: The IICIQ-UI SF was successfully translated and cross-culturally adapted while maintaining the characteristics of the original source.

Conclusions: Through translation, review from the experts and interviews conducted with Nepalese women experiencing urinary incontinence, a relevant and comprehensive ICIQ-UI SF was developed to use in Nepal. The questionnaire will be of great value for clinical use and future studies involving Nepalese women.

Background: Personal hygiene is crucial for a healthy life, especially for school children who are more susceptible to diseases due to poor hygiene. This study was design to determine the existing knowledge, attitude and practice of personal hygiene among secondary students of grade nine and ten of a government school of Jumla.

Methods: A school-based cross-sectional study was conducted in a Government Secondary school situated in a rural area of Jumla. A total of 368 adolescent girls and boys from classes nine and ten were included. Data were collected using pre-tested, self-administered questionnaires and analyzed with SPSS version 16. The Chi-square test was applied to compare the proportions of quantitative variables.

Results: Among the 368 students, 43.3% were male and 52.7% were female, with a mean age of 14.98 ± 1.34 years. The study found that 94.8% had good knowledge, 82.3% had a positive attitude towards personal hygiene, and 63.6% practiced good personal hygiene. Participants with a positive attitude towards personal hygiene demonstrated a higher percentage of good hygiene practices. However, there was no statistically significant association between knowledge and attitude on personal hygiene.

Conclusions: The study revealed that the majority of the students had a good level of personal hygiene knowledge. Boys appeared to be more knowledgeable than the girls; though these knowledge and attitude were not reflected in their practices. The study proposed that health education should focus on enhancing the attitude and practice to improve hygiene among rural youth.

Background: There are sporadic facility-based reports but an information gap in the cancer burden in the community is apparent. To address this, the Nepal Health Research Council (NHRC) started a Population-based Cancer Registry (PBCR) in 2018 in the country. Thus, this study aims to identify the cancer burden in the female population, especially in the reproductive organs.   Methods: A quantitative database analysis of the Population-based Cancer Registry for year 2018 and 2019 was performed. Data entered in the TSV (Tab-separated values) files were imported to MS Excel and SPSS data Window and variables regrouped before analysis. The national census, WHO standardized population, and registry data were used for the descriptive analysis of the registry variables. Ethical approval was taken from the Ethical Review Board of NHRC.

Result: Out of 6854 cancer registries, the female population was 3590 with a male-to-female ratio of 10:11. This registry covers 10.75% of the country’s population. The crude and age-standardized cancer incidence rates were 1.24% and 66.2 per 100,000 for the female population respectively. Reproductive organs (21%) and breast (19.7%) cancers are the most common in females, and out of reproductive organs cervical (58%) and ovarian (25%) cancers are the commonest. Surgery was the main treatment modality (32.7%) with or without chemotherapy and radiotherapy.

Conclusions: The burden of cancer is higher in females because of breast cancer. Reproductive organ cancers and breast cancers share an equal burden of around 20% each. The most common female genital cancer is of uterine cervix followed by the ovary.

Background: Patient satisfaction is an integral component of patient care. This concept has been already integrated in the developed nations and the topic is getting interest in developing nations. Hence attempt has been made to address the satisfaction of the patients in different settings and hospitals. The objective of this study was to assess the satisfaction and likely sociodemographic factors affecting the satisfaction among the outpatients.

Methods: A cross-sectional study was conducted among 207 outpatients visiting different departments of the hospital by systematic random sampling method. The satisfaction was assessed by the abbreviated form of Patient Satisfaction Questionnaire-18 and the mean scores of seven domains were obtained.

Results: Mean satisfaction level was 3.53(0.40) out of 5. Highest level of satisfaction was in interpersonal manner domain and the lowest in accessibility and convenience domain. None of the sociodemographic variables was significantly associated with the overall satisfaction (p>0.05). Enrollment into the national health insurance, occupation and educational status of the patients were found to significantly affect one or more domains.

Conclusions: This study showed that the overall satisfaction was fair; hence there is room for improvement for better patient satisfaction. Hospital needs to focus on easy accessibility and convenience of the healthcare facilities and resources to the patients.

Background: Otomycosis is a fungal infection of external auditory canal with worldwide prevalence of 9% to 30%. Treatment includes elimination of predisposing factor, thorough canal cleaning and topical or systemic antifungal agents. Clotrimazole is a specific topical antifungal agent with effectiveness varying from 95% to 100%. Gentian violet is an aniline dye and its use as antifungal has been mentioned in literature with effectiveness up to 80%. This study was aimed at comparing the effectiveness of these two commonly used treatments in otomycosis.This is a conducted in Department of ENT-HNS, Patan Academy of Health Sciences, Lalitpur, Nepal over one-year period after approval from institutional review committee. Patients with otomycosis were randomized into arm A and arm B group. Arm A patients were treated with one percent clotrimazole topical drops. Patients in Arm B were treated with application of one percent Gentian Violet paint. Effectiveness was measured on the basis of clinical response and recovery at end of second week. Data analysis was done with Epi Info application. Chi-square test was used and p-value less than 0.05 was considered significant.

Results: Total 90 patients were treated for otomycosis over one year. Recovery was better in clotrimazole group at second week i.e., 86.84% vs 71.43%.

Conclusions: Clotrimazole was more effective in treatment of otomycosis compared to Gentian Violet paint, though the result was not statistically significant.