Journal of Nepal Health Research Council最新文献

Background: Acute Suppurative Otitis Media(ASOM) is a very common disease of childhood caused by various bacteria and viruses. Amoxicillin is used as first line antibiotics in the community setting as well as hospital setting.

Methods: This is a hospital based prospective observational cross-sectional study. All cases of ASOM of patients under 14 years presenting to the Patan Hospital with duration of less than 6weeks were included in the study. Ear discharge was collected using sterile cotton swab using aseptic precautions and sent to the Department of Microbiology for further processing. The children were treated with amoxicillin (80mg/kg/day) with maximum dose not exceeding 3g/day and follow up was done after 1 week of antibiotic therapy for clinical responsiveness.

Results: Out of 32 cases, 13 cases showed no growth of organism in the culture sensitivity reports. Among remaining 19 cases, 9 were sensitive and 10 were resistant to amoxicillin. Coagulase negative Staphylococcus (7) was the most common organism grown in the laboratory followed by Staphylococcus aureus (4) and Klebsiella pneumoniae (4). Chloramphenicol, linezolid, clindamycin and trimethoprim-sulphamethoxazole were the most common antibiotics sensitive to the organisms grown besides amoxicillin. Out of total 32 patients, 31 were responsive to high dose amoxicillin at the end of 1 week.

Conclusions: Oral amoxicillin in high doses is effective in the treatment of ASOM in children.

Background: Sickle cell disease (SCD) is a significant public health issue in Nepal, predominantly affecting the Tharu community in the Mid-Western and Sudurpaschim province. This study was design to understand the socio-demographic characteristics and symptoms of SCD patients attending the health camp conducted by Seti Provincial Hospital in Sudurpashchim Province, Nepal.

Methods: This study was cross-sectional study conducted at Sudurpashchim Province of Nepal visiting in Seti provincial Hospital during the period of free health camp organized by Hospital. After ethical clearance, patients were enrolled based on inclusion and exclusion criteria, and their demographic, epidemiological, and clinical profiles were recorded using a structured questionnaire.

Results: Among 119 patients with SCD, the mean age was 22.58 years, with a majority (58.8%) being female. Most patients (45.37%) belonged to the upper lower socioeconomic class. The most common symptom was musculoskeletal pain, weakness, and fever (30.5%), followed by jaundice, chest pain, and vertigo (21.84%). Additionally, 15.96% experienced weakness, nausea, breathing difficulties, and fever; 12.60% reported weight loss, low hemoglobin, and chest pain; 10.08% had backache, joint pain, fever, and headache; and 9.24% experienced knee pain, fever, anemia, and vertigo.

Conclusions: SCD is seen in younger patients in Sudurpashchim Province, especially Kailali and Kanchanpur Districts with Tharu communities are more affected. Major systemic manifestations of SCD include pain crisis, hemolytic crisis, acute chest syndrome, hepatopathy and AVN of hip. The government of Nepal should implement policies focus for treatment and pain management within the current health system, to minimize, control, and prevent the high burden of SCD in the Tharu communities.

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Background: This study aimed to assess the antimicrobial resistance rates of Acinetobacter species and Pseudomonas species isolated from clinical samples in an Antimicrobial Resistance (AMR) surveillance site in Gandaki Province, Nepal.

Methods: A retrospective analysis of data from an AMR surveillance site was extracted and analyzed, covering the time period from January 2020 to June 2024. A total of 575 Acinetobacter species and 687 Pseudomonas species were identified, with varying numbers tested for susceptibility against different antibiotics. Resistance rates were calculated for each pathogen-antibiotic combination.

Results: Resistance in Acinetobacter species was observed in 49.9% of isolates to amikacin and 42.7% to gentamicin, whereas Pseudomonas species showed resistance rates of 21.2% and 18.5%, respectively. Resistance to piperacillin-tazobactam was identified in 54.0% of Acinetobacter species and 24.6% of Pseudomonas species. Notably, 80.3% of Acinetobacter species and 62.6% of Pseudomonas species were resistant to ceftazidime, while carbapenem resistance was observed in 59.3% of Acinetobacter species and 14.8% of Pseudomonas species. Norfloxacin resistance was observed in 38.3% of Acinetobacter species and 43.5% of Pseudomonas species, whereas only 4.0% of Acinetobacter species and 11.4% of Pseudomonas species isolates were resistance to tigecycline. Resistance rates varied across sample types, with Acinetobacter species from respiratory samples and Pseudomonas species from urine samples exhibiting the highest resistance.

Conclusions: The study underscores alarming levels of antimicrobial resistance in Acinetobacter species and Pseudomonas species. Acinetobacter species demonstrated higher resistance to most antibiotics compared to Pseudomonas species. The variation in resistance patterns across sample types highlights the need of infection site and pathogen-specific antibiotic stewardship strategies.

Background: The first case of dengue in Nepal was recorded in Chitwan in 2005. Since 2006, Nepal has had annual outbreakss with previous largest outbreak in 2019 with 18,000 recorded cases, 42,504 reported cases in 2022 and 51 confirmed deaths. Dengue imposes significant economic and societal burdens on countries where the disease is endemic. The objectives of this study were to explore the perceived social impact of dengue experienced by health service providers and receiver from previous dengue outbreak.

Methods: A cross-sectional exploratory qualitative design was used to conduct the study in Kathmandu and Lalitpur Metropolitan City with the sample size of 16. Primary data were collected from two categories of respondents; Key informant interviews with health service providers and In-depth interviews with health service consumers using purposive sampling technique.

Results: The findings from the healthcare consumer's perspective showed how dengue had affected them physically, socially, and financially. Likewise, healthcare providers discussed their methods for dealing with dengue outbreaks and stressed the importance of having a well-prepared plan, protocols, and effective government responses in place.

Conclusions: The research provides insight into the need for coordinated efforts from all three tiers of government to implement preventive strategies for vector control so that its negative impact on physical health of affected people, financial and social burden could be minimized effectively. In addition, various challenges like inadequacy of human resources, logistics, increasing workload, and mental stress among health workers were highlighted.

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 original Mini Cog was modified to make it applicable to non-literates as well. However the reliability and validity of the modified mini cog (MMC) has not been examined. Therefore, we aimed to investigate the intra- and inter-rater reliability, criterion validity, sensitivity and specificity of the MMC.

Methods: In this methodological and repeated measures design, elderly individuals (>60 years) with no neurological diagnosis or adults (>18 years) with neurological diagnosis were recruited from a tertiary hospital and the local community using purposive and snowball sampling. One of the raters administered the MMC twice (one week apart). Another rater administered the MMC and the Rowland Universal Dementia Assessment Scale (RUDAS) once during the first assessment session.

Results: The ICC for consistency of a rater across the tests and absolute agreement between two raters ranged from 0.97-0.99. The MMC scores of two raters were not significantly different. The MMC was able to differentiate between elderly participants with no neurological diagnosis and adult participants with neurological diagnosis. A significant correlation (Coefficients: 0.52-0.68) was found between the MMC and RUDAS. The sensitivity and specificity of the MMC were 86% and 70% respectively. The cutoff score of the MMC was found ? 3.

Conclusions: We demonstrated an excellent intra- and inter-rater reliability, and adequate criterion validity, sensitivity and specificity of the MMC. The MMC was also able to discriminate various groups having varied level of cognitive dysfunction. However, further studies are warranted to get more insight into the value of this instrument.

Background: Health promoting lifestyle refers to the healthy practices that improves health. The objective of the study was to assess health promoting lifestyle and health related quality of life among hypertensive patients attending a tertiary level hospital.

Methods: Cross sectional study design was used among 255 hypertensive patients, selected purposively from those attending cardiology OPD. Data were collected by using Health Promoting Lifestyle Profile tool and Short Form-36 Health Survey tool through face to face interview. Data were analyzed by using descriptive, inferential statistics with SPSS version 16.

Results: Health promoting lifestyle among hypertensive patients was at intermediate level (median score=130) with the highest score in spiritual growth (29.48) and the lowest score in physical activity (12.33) subscale. Health related quality of life among hypertensive patients was good (median score=64.45) with the highest score in mental health (80.61) and the lowest score in role physical (49.90) subscale. Health promoting lifestyle and health related quality of life were found positively correlated (r=0.757) and statistically significant (p <0.001). This study found that increasing age, longer duration of hypertension and presence of comorbidities were associated with lower HRQOL whereas being married and being literate were associated with higher HRQOL (p<0.005). Hierarchical regression analysis revealed that being married, education level, presence of comorbidities and six subscales of health promoting lifestyle (spiritual growth, interpersonal relationship, nutrition, health responsibility, stress management and physical activity) were influencing factors of health related quality of life among hypertensive patients (p<0.005).

Conclusions: Health promoting lifestyle is an important factor that influences health related quality of life among hypertensive patients.

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: 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.