Journal of Nepal Health Research Council最新文献

Background: Lack of a structured referral system is a challenging hurdle in developing countries like Nepal that delays in management. Identification causes of delays and their timely management is of immense importance. The study aimed to assess the maternal and fetal outcome of referred-in obstetric patients and to identify various maternal determinants of referrals inParopakar Maternity and Women's Hospital.

Methods: A prospective study was conducted during 3 months duration from May to June 2021 among undelivered obstetric cases who were referred to Paropakar Maternity and Women's Hospital. Study excluded self-referrals, without referral slips and postpartum patients. Maternal determinants, mode of management, maternal and fetal outcomes were noted.

Results: Out of 47 cases enrolled, most common diagnosis of referral was hypertensive disorder accounting for 19.14% followed by intrauterine growth restriction comprising 10.6%. Of total, 55.3% of referred patients were from the district hospitals. Ambulances rescued 78.7% of cases and 10.6% were rescued by helicopter. About 12.7% of the referred cases required intensive care management. Live birth were 86.3%, still birth 4.5% and 9.1% of Intrauterine Fetal Death.

Conclusions: Among the varied high risk cases, most common diagnosis at the time of referral was hypertensive disorders followed by cases requiring critical care and surgical management. This highlights need and scope of strengthening emergency obstetric care centres and early identification and treatment of high risk cases antenatally at every level of health centres.

Background: The World Health Organization (WHO) defines abortion as pregnancy termination before 20 weeks gestation or a fetus born weighing less than 500gm. Nearly half of all abortions worldwide are unsafe. Each year more than one lakh abortions are done in Nepal and the number of women seeking abortion services is in increasing trend. It has been identified as one of the major public health problems in Nepal Methods: A descriptive cross-sectional study design was conducted among 448 adolescent students of grade 10 in 7 different schools of different municipalities in Sarlahi district. Simple random sampling using 50% prevalence and structured-self-administered questionnaires were used. Data was entered and analysed by using SPSS version 16.0.

Results: Among all 448 respondents, it was found that 1.3% of them were married and only 41.3% of respondents had adequate knowledge of abortion, similarly only 46.2% know about its legalization in Nepal. Among them, the majority was male respondents but adequate knowledge of abortion was found high among females i.e. 51.14% and adequate knowledge of its legalization in Nepal was found high among males i.e. 58.75%.

Conclusions: This is to conclude that, there is no significant relationship between different variable of respondents and their knowledge on Abortion and its legalization in Nepal.

Background:  The burden of hypertension is increasing, especially in low- and middle-income countries like Nepal. Occupation is one of the risk factors correlated with hypertension, among others. There is limited evidence about its prevalence among school teachers in Nepal. Therefore, the study aims to identify the prevalence of hypertension and its associated factors among school teachers.

Methods: A school-based cross-sectional study was conducted from September 1st to October 12th, 2023, at Amargadhi Municipality among two hundred twenty-three (223) school teachers using a two-stage stratified random sampling technique. Data on socio-demographic profiles and behavioral factors, including a history of diabetes and hypertension, as well as blood pressure, were collected using a standardized method.

Results: The overall prevalence of hypertension was 14.7% and 8.9% were taking antihypertensive medication. After excluding medication (n=203), 41% of participants had pre-hypertension systolic, and 3.9% had Systolic hypertension. Diastolic blood pressure followed a similar pattern: 53.7% had pre-hypertension, and 6.4% had hypertension. About 96% of them had controlled systolic blood pressure, and nearly 90% had controlled diastolic blood pressure. The mean diastolic and systolic blood pressures were 76.98 (8.72) mmHg and 115 (11.93) mmHg, respectively. The Stepwise regression showed that both diastolic and systolic blood pressure were significantly associated with sex and body mass index.

Conclusions: There is a high prevalence of hypertension and pre-hypertension among study participants. To effectively prevent and control hypertension, it is essential to prioritize school teachers in public health initiatives. As respected role models within their communities, teachers can influence the adoption of healthy lifestyles and behaviors.

Acute pancreatitis is an uncommon complication in pregnancy. Here we present a case of 24-year-old gravda 2 para 1 woman with an acute abdominal pain in her 24-week period of gestation. Her laboratory reports suggested the diagnosis of acute pancreatitis. However, the root cause was unidentifiable through various investigations. She was accordingly managed. Acute pancreatitis during pregnancy is rare with incidence ranging from 1 in 1,000 to 10,000. Gall stones remains the main causative factor. The exact etiology in some cases cannot be identified and hence they are referred as idiopathic pancreatitis. Although computed tomography is the gold standard investigation of choice for acute pancreatitis, they are not done routinely and ultrasonography is the safe investigation of choice especially among the pregnant patients. This investigation along with assessment of serum amylase or lipase and other enzymes can be done to diagnose the disease. Treatment includes conservative management to surgical intervention. Here, we have discussed the diagnosis of an acute pancreatitis in pregnancy and the treatment of the condition. Keywords: Case Report; idiopathic; pancreatitis; pregnancy.

Background: Hospitals play a crucial role in disaster response, but they often face resource challenges. Hospital disaster preparedness, involving plans and procedures, is vital to ensure they can handle emergencies effectively. Nepal has identified 25 Hub Hospitals to coordinate disaster response, highlighting the importance of organized disaster management planning in saving lives. This study assesses disaster preparedness in these designated hospitals.

Methods: This observational study conducted in December 2023 is a secondary analysis of data from a workshop held in 25 designated hub hospitals in Nepal. The workshop aimed to develop disaster preparedness plans. The study evaluates physical facilities, triage, planning, and available resources in these hospitals, categorizing variables related to beds, human resources, disaster plans, and more. Ethical approval was obtained.

Results: Average hospital bed occupancy in ward was 80% and that of emergency was 92%. The average bed per province was 1272, nurses were 833, doctors were 521, paramedics were 181. Disaster plan was available in 21(84%) of the hospital. Out of 21 hospitals that had disaster plan, surge capacity activation plan was included in 18(86%), infectious disease outbreak plan in 14(67%) and fire safety plan in 7(33%) of the disaster plan. Blood bank was available in 16(64%) of the hospitals. One stop crisis management Centre was available in in 24(96%) hub hospitals, birthing and facility for caesarean section was available in all hospitals.

Conclusions: The study findings reveal varying levels of hospital preparedness in Nepal, including bed occupancy, staff, disaster plans, structural assessments, and available services.

Background: Accurate mortality data is vital for public health planning and policy. In Nepal, non-standardized death certificates, often missing structured causal sequences and critical details, compromise data quality in the Civil Registration and Vital Statistics (CRVS) systems. Implementing the World Health Organization's (WHO) Medical Certificate of Cause of Death (MCCoD) could enhance accuracy, strengthen mortality statistics, and facilitate evidence-based public health interventions.

Methods: This retrospective study analyzed inpatient deaths occurring between 13 April 2024 to 15 December 2024. Demographic and clinical data were extracted from medical records. The leading causes of death were identified by analyzing International Classification of Diseases Eleventh Revision (ICD-11) coded data using the Digital Open Rule Integrated cause of death Selection (DORIS) tool. Additionally, the study assessed documentation errors, predominant causes of in-hospital mortality, and evaluated the accuracy of cause-of-death reporting in the Health Management Information System (HMIS).

Results: The study analyzed 564 death certificates and corresponding medical records. Chronic liver disease was the leading underlying cause of death (UCOD) accounting 11.17% of total deaths. No certificate was entirely error-free, with nearly all (99.9%) failing to document the time interval between symptom onset and death. Approximately 59% contained unclear abbreviations, while 99.7% listed multiple causes in a single line without proper sequencing. Only 2% followed a causal sequence as: immediate, antecedent, and UCOD. Additionally, inaccurately reported cardiopulmonary arrest as the UCOD in HMIS.

Conclusions: Hospital death certification remains critically substandard, undermining mortality data quality. Prioritizing WHO's MCCoD implementation and clinician training would significantly improve accuracy, supporting SDG targets for reliable cause of death reporting.

Background: Complicated parapneumonic effusion (PPE) and empyema require intercostal drainage (ICD), failure of which usually leads to surgery. Intrapleural instillation of fibrinolytic agents (IFT) enhance pleural drainage and reduce the need for surgery. This study aimed to evaluate the role of medical interventions (ICD and IFT) in complicated PPE and empyema.

Methods: In a prospective, cohort study conducted at National Academy of Medical Sciences, Bir Hospital. Patients aged >18 years with complicated PPE and empyema were included. ICD was placed in all. In those with significant residual effusion and loculations after ICD, intrapleural Streptokinase was instilled and daily drain output recorded. Outcomes were measured as complete, partial response and treatment failure. The duration of ICD tube in situ, length of hospital stay and need for surgical interventions was evaluated at three-month follow up.

Results: A total of 51 patients were enrolled into the study. Commonest symptoms were dyspnea, cough, chest pain and fever with a median duration of 14 days (IQR = 7-28). The etiologies of effusions were presumed or proven bacterial infection in 36 (70.5%), tuberculosis in 8 (15.7%) and parasitic infection in 2 (3.9%). ICD was successful in achieving a complete drainage in 22 (43.1%) patients. In the remaining 29 (56.9%), intrapleural Streptokinase was instilled which led to increase in drain output by 760.34 ± 283.90 ml. Post Streptokinase instillation; 18 (62.1%), 4 (15.8%) and 7 (24.2%) patients met the predefined criteria of "complete" response, "partial" response and treatment failure respectively. The mean duration of ICD tube in situ and hospital stay was 10.98 ± 3.56 and 13.51 ± 3.92 days respectively.

Conclusions: In patients with complicated parapneumonic effusion and empyema, intercostal drainage and intrapleural fibrinolytic have high success rates and a potential to significantly reduce the need for surgical interventions. These results are relevant to us as thoracic surgery and VATS services are limited and only available at few centers in Nepal.

Background: Research Ethics Committees (RECs) play a critical role in safeguarding ethical integrity in health research by reviewing protocols for scientific validity, social value, and ethical compliance. FERCAP, a regional initiative under WHO-TDR, has supported harmonization and capacity building in research ethics across the Asia-Pacific region for the past 25 years. The 24th FERCAP International Conference, hosted by the Nepal Health Research Council in 2024, provided a platform to examine ethical challenges and innovations under the theme "Maximizing Benefits through Responsible Conduct of Research."

Methods: A cross-sectional qualitative study was conducted using secondary data sources from the conference, including video recordings, agendas, presentations, transcripts, and reports. Descriptive analysis was performed on participant demographics, while thematic analysis was applied to content from plenary and parallel sessions. Three researchers independently coded the data and identified major themes through consensus.

Results: The conference was attended by over 500 participants from 23 countries and featured presentations across 18 thematic sessions. Three primary themes emerged: strengthening ethical oversight through post-approval monitoring and capacity building; promoting inclusivity and contextual relevance in ethics review, especially in social science and community-based research; and addressing emerging ethical issues posed by new technologies and decentralized trials. Discussions also emphasized integrating open science principles, harmonizing international guidelines, and recognizing institutional contributions to ethics governance.

Conclusion: The findings from the 24th FERCAP Conference highlight the region's progress and challenges in upholding ethical standards amidst rapidly evolving research contexts. The conference reinforced the need for collaborative frameworks, continued ethics training, and responsive policies that address both biomedical and social research landscapes. These outcomes will inform future directions as FERCAP prepares for its 25th anniversary and continues to strengthen ethical research environments across the region.

Background: Neonatal mortality refers to the risk of death within the first month of life. This study investigates the key factors influencing neonatal mortality in Nepal between 2011 and 2016, focusing on changes over this period.

Methods: Data for this research were sourced from the Nepal Demographic and Health Survey (NDHS) for the years 2011 and 2016. Neonatal mortality was the primary outcome variable. Key determinants examined included community-level factors (residence), socio-economic factors (maternal and paternal education, wealth index), maternal characteristics (age, pregnancy duration, antenatal care visits), infant characteristics (sex, birth order, birth interval, birth weight), delivery factors (assistance and location of delivery), and post-delivery factors (breastfeeding status, postnatal check-ups).

Results: Statistical analysis utilized the Chi-squared test to identify significant relationships between determinants and outcomes, alongside a full logistic model based on treatment contrasts. Findings indicated that in 2011, the significant factors included pregnancy duration, postnatal checks, antenatal visits, and having twins. By 2016, important determinants shifted to the mother's age, breastfeeding status, pregnancy duration, postnatal checks, and antenatal visits.

Conclusions: The study highlights that pregnancy duration, postnatal check-ups, and antenatal visits consistently influenced neonatal mortality across both surveys. Given the rarity of studies addressing program impacts on neonatal mortality, this research suggests conducting panel studies to better understand the slow decline of neonatal mortality in Nepal.

Background: Typhoid fever remains a major concern in tropical countries. The availability of an effective vaccine could be an important inclusion to currently available interventions. We reported on our evaluation of the immunogenicity and safety of the typhoid conjugate vaccine (Vi-DT) among Nepali children.

Methods: The study was an observer blinded, active controlled, randomized phase III clinical trial in children above 6 months and less than 18 years old. Three different lots of Vi-DT(Vi- Diptheria Toxoid); test vaccine and Vi-TT ( Vi-Tetanus Toxoid); comparator vaccines were administered to eligible children. Seroconversion was assessed with blood samples collected at baseline and 4 weeks after the vaccination. A rise of at least 4-fold vi-antibody titer from the baseline was used to indicate positive seroconversion. Data on solicited and unsolicited adverse events were collected.

Results: Four hundred and eighty-eight children participated in the study. Seroconversion rate was 98.61% and 98.36% among participants who received Vi-DT and Vi-TT vaccines respectively. One immediate adverse event was observed only for Vi-DT group. One hundred forty-two and 66 solicited AEs within 7 days were observed with test and comparator vaccine respectively. Unsolicited AEs within 28 days were 125 for test vaccine compared and 77 for the comparator vaccine. Two SAEs were reported which were Not- related to study vaccine.

Conclusions: The overall seroconversion in Vi DT vaccine was non inferior to the comparator vaccine and the safety profile of the vaccine was good without any life-threatening events.