Journal of Nepal Health Research Council最新文献

Forensic medicine offers important medical evidence for the purpose of criminal justice through examinations of victims, accused, and deceased. However, Nepal faces severe deficiencies in forensic services due to lack of trained specialists, which hampers justice delivery. Most medico-legal autopsies are performed by untrained doctors without forensic pathology expertise, who fail to recognize evidence. Facilities lack basic autopsy equipment, cold storage, and hygiene. Shortage of experts causes heavy workloads, which further affects the quality. There are also no guidelines for clinical forensic examinations. The poor state of mortuaries and flawed autopsies allow perpetrators to escape sentences. Urgent reforms like recruiting specialists, upgrading infrastructure, implementing forensic protocols, monitoring standards, and budget allocations are needed to strengthen Nepal's medico-legal framework. The medico-legal system must leverage the expertise of local forensic experts by providing training, and career opportunities. Emphasis on forensics will be in the interests of justice, human rights and law. The time to act is now. Keywords: Autopsy; forensic medicine; medico-legal; Nepal.

Background: Institutional delivery services play a critical role in reducing maternal and neonatal mortality. Despite this, a significant proportion of deliveries still take place at home, especially within marginalized communities like the Chepang. This study seeks to examine the barriers that Chepang women in Chitwan, Nepal, encounter in accessing institutional delivery services.

Methods: A community-based cross-sectional study was conducted from June 20th to July 20th, 2024, involving 174 mothers who had given birth in the last two years. Data were collected via face-to-face interviews using a semi-structured questionnaire, followed by statistical analysis using SPSS.

Results: The study found that 73.6% of mothers delivered at home. Major barriers included long distances to health facilities (66.7% reported more than one hour of travel), low education levels (34.5% were illiterate), and economic factors. Analysis revealed significant associations between institutional delivery and factors such as income source, with agricultural workers having lower odds of utilizing institutional services. Additionally, literacy (OR: 2.308, p = 0.034) and complications during pregnancy (OR: 0.147, p < 0.001) were significant predictors of institutional delivery.

Conclusions: The findings indicate critical barriers to institutional delivery among Chepang mothers, highlighting the urgent need for targeted interventions to improve healthcare access. Enhancing education and addressing transportation challenges are essential for promoting safer childbirth practices and improving maternal health outcomes in this vulnerable population.

Background: Medical research publications in Nepal have remained relatively uncommon over the last decade. However, recent growing research interest among clinicians in Nepal has emphasised the need to identify and address key barriers to strengthen the research-publication process. This study aimed to identify these barriers and focus areas for improving publication practices among paediatricians in Nepal.

Methods: A cross-sectional study was conducted among Nepali paediatricians from 15 January to 15 May 2024 using a semi-structured questionnaire distributed via Google Forms. The survey included Likert-scale, open-ended, and closed-ended questions on research-publication barriers, research practices, motivation, and recommendations for improvement.

Results: A total of 293 participants (male: 60.1%) responded to the survey. Of these, 35.2% worked in government hospitals, 38.6% were subspecialists, and 54.9% had additional responsibilities beyond their paediatric work. Furthermore, 77.5% of paediatricians had publications, with 78% and 95.15% as principal authors and co-authors, respectively. Systematic reviews and meta-analyses were deemed to be the most challenging, whereas cross-sectional studies were the easiest to conduct. Academic recognition (73.7%) was the primary motivation for publishing, whereas the most significant barrier was being overwhelmed by clinical work (64.5%). Time management (96.1%) and clinical work responsibilities (93.2%) were the main challenges in the manuscript preparation. Ghost authorship (14%) and gift authorship (32.6%) were the most common issues related to authorship. Most participants (80.5%) believed that training in manuscript writing and research methodology could improve the quality and quantity of the research publications.

Conclusions: Paediatricians in Nepal face several publication barriers, which can be addressed through increased funding, improved resources, and enhanced research training.

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Background: The prevalence of gender discrimination and sexual harassment/ violence among children is alarmingly high in Nepal. This study aimed to measure aggregate changes in knowledge, attitude, and skills among school adolescents on gender discrimination; sexual harassment, mindfulness of breathing; and self-defense skills, with application of an integrative experiential learning modules.

Methods: A quasi-experimental study was carried out among 3661 students from 8-9 grades (1880 intervention and 1781 control) in 52 community schools across the seven provinces. Pre- and post-intervention self-reported surveys were conducted among the intervention and control groups before and after intervention of 24 learning hours. We used a mixed two-way effects model to measure the changes in composite indices between pretest and posttest among both the groups.

Results: We found statistically significant increment (P<0.0001) in knowledge, attitude and skills on gender norms, gender discrimination, sexual harassment, self-defense, reporting sexual harassment, legal measures and mindfulness of breathing technique among the intervention group compared to that in the control group.

Conclusions: These findings, though measured immediately after the intervention, offer initial evidence that school adolescents could be empowered to prevent the risks of gender discrimination and sexual harassment.

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Background: The tobacco epidemic is one of the major threats to public health, causing nearly 8 million deaths annually worldwide. In Nepal, every year, several Nepalese people die from tobacco-related diseases illnesses. Despite the implementation of several policies and strategies, tobacco use remains prevalent. This study, thus, aims to assess compliance with the legal provisions regulating tobacco products in Kathmandu Valley.

Methods: A multimethod study design was adopted to explore compliance with the legal provision of tobacco products in the Kathmandu Valley. Three hundred and five public places within the Kathmandu Valley were observed using the observation checklist, and fourteen key informant interviews were conducted. The ethical approval was obtained from the Ethical Review Board of the Nepal Health Research Council.

Results: Our findings show that the average adherence to the Tobacco Product Control Act in the Kathmandu Valley was merely 33.1%. Public transportation exhibited highest compliance 53.2%, whereas eateries demonstrated the lowest compliance at 15.9%. Health organizations demonstrated the highest adherence to prohibiting indoor smoking (94.7%), although the presence of "No Smoking" signage was inadequate, varying from 1.9% to 22.7% across various locations.

Conclusions: In conclusion, compliance with the legal provision of tobacco products was observed owing to limited knowledge of stakeholders, inadequate multi-sectoral coordination, and lack of monitoring mechanisms in public areas. Whereas awareness initiatives through diverse communication channels are found effective in improving compliance.

Background: Blood transfusions are lifesaving, but resource limitations and inadequate utilization patterns pose challenges in low- and middle-income countries. In Nepal, detailed analyses of blood use practices, are needed to inform resource allocation and policy decisions. The objective of this study was to study the overall and component-specific use, explore temporal trends in utilization of blood and blood products.

Methods: We conducted an observational study analyzing data from Blood Bank of Tribhuvan University Teaching Hospital (TUTH), a tertiary hospital (January 1st - December 31st, 2019). Data included patient demographics, blood groups, blood products requested and transfused, and facility type. Data analysis was conducted with SPSS v20.

Results: Patients from TUTH had substantially higher blood product requests, requesting 25,716 units compared to only 1855 units across other centers combined. Blood groups A positive (8089, 31.4%) and and O positive (7851, 30.6%) were the most requested blood groups. Whole blood (11358, 44.2%) and packed red blood cells (9565, 37.2%) were most frequently requested. We observed monthly fluctuations in demand with peak of 2742 requests in December with a trough in June (1947 units). Notably, only approximately 46% of blood products requested from patients admitted to TUTH were ultimately transfused.

Conclusions: Whole blood and packed red blood cells were the most frequently requested blood products. Eventhough whole blood was the most frequently requested blood product, the most transfused one was packed red cells. Peak demand was observed in December. Our study provides valuable insights into blood utilization patterns, underscoring the need for specific strategies to improve blood transfusion management practices.

This case report highlights the severity of dowry-related intimate partner violence in Terai, Nepal. A 24-year-old married female presented with multiple stab injuries to the abdomen and a cut-throat injury inflicted by her husband under the influence of alcohol due to dissatisfaction with dowry demands. Successful management involved exploratory laparotomy, anterior abdominal wall repair, cholecystectomy, and neck injury repair. However, on the third postoperative day, due to persistent pain and feeding difficulties, the patient was referred to a tertiary care center, where a re-exploratory laparotomy revealed missed diaphragmatic injury and bowel herniation requiring further repair. This case underscores the need for high clinical suspicion and early specialist referral in complex trauma scenarios. It also highlights the role of cultural and societal factors in intimate partner violence and the need for a multidimensional approach involving healthcare, legal, and social services. Keywords: Abdominal trauma; dowry; intimate partner violence; Nepal; stab injury.

Background: Olfactory fossa is a depression in anterior cranial cavity whose floor is formed by cribriform plate of ethmoid bone and is susceptible to injury during functional endoscopic sinus surgery (FESS), especially when fossa is deep. Understanding of patient's ethmoid roof anatomy and its possible variations is crucial for countering possible complications during functional endoscopic sinus surgery. So, objective of this study was to evaluate olfactory fossa depth.

Methods: In this descriptive cross sectional study, olfactory fossa depth was measured on Computed Tomographic images of 280 patients in the Department of Radiology, Tribhuvan University Teaching Hospital. The data were grouped according to Keros classification and their distributions were analyzed according to side and gender. Association between olfactory fossa depth with different parameters were evaluated with descriptive statistics, independent t-test, ANOVA and Chi-square test.

Results: Among 280 participants, 144 were male and 136 female. The mean depth of right and left olfactory fossa was found 5.10 ± 1.58 mm and 5.28 ± 1.62 mm respectively. Keros type II was the most common, found in 209 cases (74.60%) on left side and 194 (69.30%) on right side while type III was the least common. The difference between left and right olfactory fossa depth was significant though it was insignificant between male and female. No significant association was found between Keros type with sides and with gender.

Conclusions: Variation in olfactory fossa depth was common. Thus, preoperative assessment of ethmoid roof and Keros type is cruicial for warning the surgeon to minimize the critical complications.

Key words: Computed Tomography; olfactory fossa depth; para nasal sinus.