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Background: Rapid industrialization, increasing traffic hazards, and the hectic pace of modern life have exposed people to a greater risk of accidental injuries. We aimed to document the incidence of injuries in the Bhagawanpur Rural Municipality of Siraha District of Nepal and their pattern and cost of treatment. Methods: This cross-sectional study involved 12,935 participants in Bhagawanpur Rural Municipality. A door-to-door survey was conducted from June to August 2018 by face-to-face interview using a preformed semi-structured questionnaire designed for this study. The households were selected by probability proportion to size method from each ward. The variables included the number of injuries, patterns, and costs of treatment. Results: The incidence of injury was 5.3%. The majority (36.2%) belonged to the age group of 16-30 years. The fall injury occurred in 54.2% and superficial bruises affected 70% of injury. Minor injury contributed to about 89.8% and major injury was seen among 10.2% of the study participants. More than half (56%) of the individuals spent less than NPR 1500.00 for the treatment. Conclusion: The incidence of injury was 5.3% among people living in Bhagawanpur Rural Municipality of Siraha District. Most of them were young, and had minor injuries. Treatment costs for most of the injuries were less than NPR 1500.00.

Background: Pediatricians provide multiple early childhood screenings and are in a privileged position to promote child oral health by enacting timely dental referrals. Our primary objective included assessing the pre- and post- educational intervention knowledge, attitude and practice of pediatricians on child oral health. The secondary objective included the assessment of prevalence of oral health problems in children attending Pediatrics out-patient department (OPD). Methods: This one-year hospital based longitudinal study involved conveniently selected 400 children (6 months to 14-years-old) from Pediatrics OPD and 12 pediatricians (complete enumeration) from a university hospital, BPKIHS, Dharan, Nepal. Screening for oral health problems in children was performed. Pre- and post-educational intervention knowledge and attitude towards child oral health of the pediatricians were assessed using a validated questionnaire. The practice component was assessed through pre- questionnaire and pre- and post-intervention dental referral paper practice. Data analysis included descriptive statistics, chi-square and paired t-tests. Results: Educational intervention significantly increased the knowledge score of the pediatricians but not their attitude (p = 0.72) or the paper dental referral practice. Oral health problems were observed in 59.3% of the children attending pediatrics OPD, dental caries being the most prevalent (49.9%). Conclusion: More than half of the children attending pediatrics OPD had oral health problems. Educational intervention was effective in improving pediatricians’ knowledge but not their attitude and the paper dental referral practice.

Introduction: Dental caries though preventable oral health problem is affecting school children worldwide and around 50% of Nepalese children are suffering from it. Baseline data with good understanding of dental caries and associated risk factors are necessary to form preventive strategies for setting and achieving oral health goals. Objective: This study was conducted to determine dental caries experience and associated risk factors among school-going children of 6-13 years old in Dharan sub-metropolitan city, Nepal. Methods: A cross-sectional study was conducted from 5th Jan 2018 to 4th Jan 2019 among 680 school children selected by multistage cluster sampling method. Pretested, standardized, closed-ended questionnaire answered by the parents was used to gather information regarding the associated risk factors. Dental caries experience was obtained from deft/DMFT (WHO modification 1997). Comparison of categorical data was done using Chi-square test. Multivariable binary logistic regressions were used for the statistical analysis. Results: The overall caries prevalence was 61.6%, in primary dentition it was 48.25% and in permanent dentition it was 34.4%. Dental caries experience was with mean deft 4.67 (±2.7) in primary dentition and mean DMFT 1.72 (±1.05).in permanent dentition. Multivariate analysis showed significant association between dental caries experience and grade three and grade four school children had experienced greater caries (p

Background: Regular physical exercise is linked to produce beneficial influence on cognitive functions. Cognition can be evaluated by Stroop test where a person's selective attention capacity, skills and processing speed are assessed. Limited work has been done to explore the acute effect of exercise on cognition. Objective: To assess whether acute exposure to submaximal aerobic exercise of three minutes can bring changes in the cognitive function (selective attention and cognitive processing ability). The secondary objective was to assess the physical fitness index of medical students. Methods: Twenty four apparently healthy third year male medical students of BPKIHS (B. P. Koirala Institute of Health Sciences) having mean age of 22.33 ± 1.09 years, body height and weight of 170.10 ± 5.85 cm of 65.38 ± 8.84 kg respectively were recruited. A computer based online version of Stroop Test was done to identify cognitive performance in resting sitting position. Then participants were asked to perform 3 min step test. A recovery time of 5 min was given post exercise and Stroop Test was assessed again. Statistical analysis was done using Paired T test. Data are expressed in mean and SD. Level of significance is considered at p

Background: Family planning allows individuals and couples to anticipate and attain their desired number of children, spacing and timing of their births. It is achieved through use of contraceptive methods. A man’s perspective on the family planning methods and services is essential on his family health. The study aimed to know about knowledge, attitude and practice of family planning methods in male (Rickshaw puller) of Eastern Nepal and to know their reasons for not using the family planning. Methods: A descriptive cross-sectional study was done in Inaruwa municipality. Total of 400 male rickshaw puller samples were taken. Knowledge, attitude and practice on contraceptives were evaluated with the help of a predesigned questionnaire. Descriptive analysis was done by using SPSS 11.5software to obtain frequencies and percentages. Results: Out of 400 interviewed, 366 were interviewed with 92% response rate, the mean age was 36.54 years, and 92.7% said they heard about Family planning method. Health worker was the main Source of family planning information. Regarding the attitude of the Male respondents, 83.1% supported the concept of family planning; only 33.9% said they had used a male contra­ceptive, 46.7% of the respondents said the males didn’t practice the family planning methods on themselves because of the work load. Conclusions: Majority of the respondents knew about family planning methods but only a few agreed to have used them. The main reason for men lagging behind could be that the burden of work due to which contraception in a family is taken up by females.

Background: Dengue fever is known as a break-bone fever and its common symptoms are headaches, high grade fever, muscular, bone pains and decrease of platelets count. Community participation involving local government and household participants in controlling breeding areas of dengue mosquitoes is the only cost-effective and sustainable activities of ensuring prevention and control of Dengue fever. This study aimed to assess the perception of the general population regarding community participation in the prevention of dengue and to verify its effectiveness with the control practices observed at the homes in Dharan sub-metropolitan city of Province No 1. Material and Methods: A cross-sectional study was conducted among 250 households at the Dharan sub-metropolitan city of Province no. 1 in Nepal from August to October 2019. The technique of sample collection was done using purposive sampling and data were collected using a pretested close-ended questionnaire and observational checklists. Results: Slightly over half of the respondents 129 (51.6%) reported a positive attitude regarding community practice and almost three out of five 157 (62.8%) houses were observed to have good dengue control practices. The univariate results revealed attitude of households regarding community participation were significantly associated with the control practices observed in their homes (p

Background: Sleep is important in maintenance of proper functioning of both mental and physical functions of human body. Studies have shown there is impact on the sleep parameters with the use of caffeine, cigarette and alcohol. As there is little availability of similar studies here in Nepal, we made an attempt to know the relation of consumption of such substances with the sleep quality and sleep parameters as per Pittsburgh Sleep Quality Index scale. Methods: A cross sectional study was conducted among the undergraduate students at BP Koirala Institute of Health Sciences, Dharan. Students were asked to complete a self- administered questionnaire to give information about demographic variables and habit of consumption of caffeinated beverages, cigarette and alcohol. The Pittsburgh Sleep Quality Index was utilized after the permission from authority to evaluate sleep quality. Results: Out of 350, almost half of the students (44.6%) had poor sleep quality. 40.8% students reported sleeping six hours or less per night and 10.1% used medications to sleep. 96% reported consuming caffeinated beverages, 20% consumed cigarettes and 38.3% consumed alcoholic beverages. There was significant association of poor sleep quality with the increased consumption caffeine, cigarette and alcohol (p

Introduction: With the evolution of cataract surgery over the past years and increasing patient demand for spectacle independence, today cataract surgery is moreover a refractive surgery. Surgically induced astigmatism (SIA) hinders post-operative refractive precision by changing the refractive power of cornea. Objectives: To calculate and compare SIA and postoperative spherical equivalent (SE) among eyes undergoing phacoemulsification performed via superior and temporal approach. Methodology: A longitudinal prospective observational study was conducted in a tertiary eye care center. 200 consecutive patients who underwent 2.8mm clear corneal phacoemulsification were allocated in Group A (Superior) and Group B (Temporal) in equal numbers by random lotiery method. Patients with any corneal pathology, glaucoma, retina or macular diseases, with previous history of trauma or ocular surgery were excluded. Preoperative astigmatism, postoperative astigmatism and postoperative SE were calculated at 6weeks follow-up. SIA was calculated using vector analysis software version 2.1 given by Dr Sawhney. Results Eighty patients of group A and 99 patients of Group B were included in the analysis. Preoperative keratometry and astigmatism was comparable between the two groups. Postopera tive astigmatism was significantly lower in temporal incision (0.75± 0.58) group than in superior incision group (1.2±0.71). SIA in-group A was 0.43D and in group B was 0.18D. SE was found to be significantly lower in temporal incision (p

Background: Family planning among people living with Human Immuno Deficiency Virus/Acquired Immune Deficiency Syndrome is proved to be effective in preventing Human Immuno Deficiency Virus transmission through sexual and mother to child transmission.We studied family planning practice among people living with Human Immuno Deficiency Virus/Acquired Immune Deficiency Syndrome at reproductive age and its associated factors.Methods: We conducted a cross-sectional study in four anti retro viral therapy centers in eastern Nepal from September 2015 to February 2016. Data was collected among 200 samples by face to face interview using pretested semi-structured questionnaire. Bivariate analysis and logistic regression was performed to analyze the associated factors.Results: Fifty one percent (51%) of participants in reproductive age were currently using family planning methods with male condom being the most common. On bivariate analysis, higher income, higher education, having living children, involvement in decision making, low fertility desire, longer duration in anti-retroviral therapy, family planning knowledge and past counseling were found to be statistically significant in having higher family planning practice. In multivariate analysis,participants with duration in anti-retroviral therapy for 1- 4 years(AOR: 9.2, 95% CI: 1.7-47.5), both spousal involvement in decision making (AOR:37.1, 95% CI: 6.5-211.9) and family planning counseling (AOR: 3.4, 95% CI: 1.0-11.3) were found to have higher odds of family planning practice.Conclusions: Male condom is the most common method of family planning practice among HIV patients. Higher income, education status of both partners and having living childrens are the encouraging factor for better practice. Involvement of both partners is associated with higher use of family planning practices. Duration of anti-retroviral therapy use has positive impact on use of family planning practices.Keywords: Family planning practice; people living; Human Immuno Deficiency Virus

Introduction: Fixed orthodontic treatment causes chronic low grade irritation on the oral mucosa. Tobacco smoking is considered to be a risk factor in the development of oral cancer. This study involves a cytomorphometric analysis on the buccal mucosal cells in patients undergoing fixed orthodontic treatment who are tobacco smokers. Methods: Exfoliated buccal mucosal cells were obtained from orthodontic patients (smokers & non-smokers) as well as smokers and non-smokers who are not undergoing any orthodontic treatment. Smears were stained with rapid PAP stain and digital images of 50 cells were analysed using the Image J software. Results: Statistical analysis revealed that there were significant increase in the values of nuclear and cell diameter between non-smokers undergoing orthodontic treatment and smokers (p

Background: Basic Life Support (BLS) aims to maintain respiration and circulation in the cardiac arrest victim and involves a major focus on cardiopulmonary resuscitation (CPR) with minimal use of ancillary equipment. The raised standards of care demand that knowledge about BLS/ CPR be updated and include the lay persons as well as medical experts who have the potential to become the teachers of the skill. The objective of the study was to describe the knowledge and attitude of medical personnel (nurses and doctors) towards BLS/ CPR. Methods: This cross sectional study was done among the doctors and nurses working in Department of General Practice and Emergency Medicine, BPKIHS, Nepal after ethical approval. A pre-validated questionnaire (Shrestha et al, WJEM, 2012) with pre-structured questions was used for assessing the knowledge and attitude. Attitude was measured using 5 point Likert. Designation, previous training and demographics were used as describing variables. For data recording and statistical analysis; Microsoft Excel, SPSS 11 and EPI Info were used. Results: Total number of sample size was 84 medical personnel working in emergency department (consultant 12, junior resident 16, house officer 18, and senior nurse 3 and staff nurse 35). Nine (11%) respondents answered more than 10 questions, 57 (68%) answered 6-10 question and 18 (21%) answered less than 5 question. Average mean score (total 15) was 7.40 (SD 2.32, 95% CI 6.90-7.90).Mean score of the positive attitude (total 15) to CPR was 11.1807 (2.43, 10.65-11.71). The mean score for reluctance (total 5) to perform CPR was 3.25 (consultants and those who were certified in BLS or taken BEC course in the department had maximum score in knowledge (p

Background: Rose Angina Questionnaire (RAQ) is a useful screening questionnaire for ischemic heart disease validated in different settings; however, its diagnostic ability to predict myocardial infarction (MI) in the emergency is less clear. Objectives: To find out the usefulness of RAQ to predict MI in patients presenting to the emergency. Methods: A cross-sectional study was conducted at the BP Koirala Institute of Health Sciences (BPKIHS), a teaching hospital in eastern Nepal from 1 January to 30 March 2017, after ethical clearance from the Institutional Review Committee. Informed consent was obtained from the patients for their anonymised information to be published in this study The samples were collected from 100 patients with chest pain aged 40 to 70 years presenting to the emergency. RAQ was applied and its performance to detect MI was compared with emergency and cardiologist diagnosis of MI. Sensitivity, specificity, positive predictive value and negative value were calculated along with descriptive analysis. Results: A total of 100 patients were analysed with the mean age of 63.78 years (SD 11.60) and male to female ratio of 1.94. RAQ detected 58 cases (63.8%) with emergency department (ED) diagnosis of MI (true positive) and identified 3 (33.3%) cases with non-MI (true negative). The true positive rate for RAQ to detect MI after cardiologist consultation was 71.6%. RAQ had a sensitivity of 84.91% (95% confidence interval (CI) 72.41% –93.25%) to detect positive troponin, 63.74% (52.99–73.56) to detect positive electrocardiogram (ECG) and 71.60% (95% CI 60.5% to 81.07%) to detect final diagnosis of MI. Conclusion: RAQ is a good screening tool to detect MI in the emergency that can be used in isolation or in combination with other diagnostic modalities to detect it early.

Background: In academic institutes, dental students are not only involved in academic activities, but also in the management of patients’ care. This calls for inculcation of adequate knowledge and positive attitude among them so that a good clinical practice is implemented in the dental setting, thereby creating a safe working environment for students as well as patients. Thus, the study was conducted to assess knowledge and attitude regarding infection control among undergraduate dental students of B.P.Koirala Institute of Health Sciences, Dharan, Nepal.Methods: An online descriptive cross-sectional study was conducted at BPKIHS from February till March 2021. Undergraduate students from third year, fourth year and internship were included in the study. A self-administered questionnaire comprised of demographic characteristics, knowledge and attitude regarding infection control was used to collect the data via a Google form. Descriptive and inferential statistics was used to analyze the data. The p value Results: A total of 136 undergraduate dental students participated out of which 65.0% were females and 35.0% were males. Out of the total participants, 78.7% were found to have adequate knowledge while 74.3% participants showed ‘positive’ attitude. Mean age of the participants with adequate knowledge was significantly higher than participants with inadequate knowledge (p=0.047). The difference in knowledge among participants was statistically significant (p=0.001) in academic years. The majority (90.4%) of interns showed adequate knowledge followed by fourth year (83.7%) and third year (58.7%) students. The difference in attitude, was also statistically significant (p= 0.011) in academic years, but it was mostly (90.4%) of positive attitude in fourth year participants followed by third year (68.3%) and Interns (65.4 %).Conclusion: The present study reports adequate knowledge and positive attitude regarding infection control among undergraduate dental students in BPKIHS. Further studies are encouraged to be conducted among students from different academic institutes all over the country to ascertain their level of attitude and knowledge regarding infection control in dental care services.

Background COVID-19 (COrona VIrus Disease-19) outbreak is an alarming situation for all health care workers. Dental and oral health care workers (DOCHWs) are invariably at a higher risk of getting infected or transmitting disease due to the nature and duration of work. The objective is to determine the effect of the COVID-19 pandemic on Nepalese dental and oral health care workers and their practices. Methods A cross-sectional observational, online survey was designed and conducted via Google form from 24 June 2020 to 13 July 2020 among DOHCWs of Nepal. The study tool developed after reviewing pertinent literature and international guidelines. Results A total of 51.9% were aged 20 to 29 years, 61.7% were male, 52.6% were single; 92.5% had no morbidity. Of the respondents, majority 60.2% of DOCHWs were working in routine duties on the COVID-19 crisis. They reduced their current practice to before the pandemic; 48.2 % of them working less than 20 hours per week, while only 10.5 % of them working more than 40 hours per week. Moreover, 73.7% performed only selective or lesser procedure; 18% closed dental practices / stayed home; only 1.5% worked more; 6.8% shifted practice to online (teledentistry). The majority of the respondents restricted their activity to an emergency (21%) and urgent procedures (22.7%). A considerable proportion of participants reported symptoms of depression (21.9%), anxiety (24.2%), and distress (8.4%). Bivariate analysis showed a statistically significant level of satisfaction with logistic support provided by the administrative agency in the different workplace (oral health service centre) with relation to the availability of masks other than N95, N99 (p = 0.04), availability of PPEs (p = 0.06) and facility of cleaning area (p = 0.01). Conclusion The impact of the COVID-19 pandemic among DOHCWs is widespread and adversely affect the personal, professional and academic lives of DOHCWs of Nepal. The participants reported experiencing psychological burden, precipitated by financial burden and worries about an uncertain future.

Background Irrespective of the treatment method, union is the ultimate goal of any fracture treatment. However, nowadays, rather than the physician-based clinico-radiological methods, the patient-reported outcome measurements assessing their quality of life and function are gaining much popularity. This is specifically true in the part of the world where the patient needs almost complete degree of hip/knee flexion – for social, cultural, religious or occupational reason(s). The ability to squat can assess the mobility and stability of joints and thus the quality of squatting is a proxy reflection of the functional outcome after fixation of lower limb fracture. Thus, we studied to determine the inter-observer and intra-observer reliability of Radiographic Union Score for Tibia (RUST) and Squat and Smile (S & S) test in clinical photograph. We further calculated the sensitivity and specificity of S & S test in predicting healing of lower limb fracture fixed by intramedullary interlocking nail considering RUST as the gold standard. Methods This was a retrospective study of prospectively collected data of solid Surgical Implant Generation Network (SIGN) intramedullary interlocking nailing from a single, university-based, high volume tertiary center where 56 consecutive adults with either tibial or femoral shaft fractures fixed with a SIGN nail within one year and not requiring any surgery till minimum of eighteen-month follow-up were included. Cases without either Anterior-Posterior (AP) view and/or Lateral (Lat.) view follow-up x-ray(s) or proper S & S clinical photograph (at least 1.5-year post fixation) were excluded. The x-rays (RUST criteria) and clinical photograph (S & S grading) were scored by two independent and blinded observers each and repeated after 1 month. Results The overall intra-observer reliability was from 0.773 to 0.825 and inter-observer reliability from 0.635 to 0.757 for RUST scoring which was from 0.687 to 0.785 and from 0.301 to 0.650 respectively for S & S scoring. The sensitivity and specificity of S & S in predicting fracture healing were up to 82.22% and 63.64% respectively. Conclusion The S & S test is reliable to predict the healing of lower limb fracture fixed with an intramedullary nail. The test is more useful to determine healed fractures than to determine non-healed ones. (sensitivity being higher than specificity)

Background School-aged adolescents are in particular need of preventive program to ensure positive long-term oral health and hygiene. The objective of this study was to assess the effectiveness of an oral health education (OHE) intervention on oral hygiene knowledge, attitude and practices (KAP), plaque control and gingival health among 12–15 years old school children in Dharan sub-metropolitan city, Nepal. Methods A randomized controlled trial was conducted with parallel study groups, comprising 12–15-year-old school children, 120 in each group. OHE was given to the experimental group at baseline, third and sixth months and to the control group after completion of the study. Interview of the participants were done using a 23-item questionnaire for assessment of oral hygiene KAP. For each question, correct answer was scored as 1 and wrong answer was scored zero. An overall composite score was then created, by adding the individual scores. Oral examination was done using mouth mirror and WHO probe to record Turesky–Gilmore–Glickman modification of the Quigley-Hein plaque index, Gingival index and Dentition status and treatment needs. Analysis was done using chi-square test for categorical data and independent t test, Mann–Whitney U test, repeated measures ANOVA and post hoc Tukey’s test for quantitative data. The level of significance was set at P Results There was 54.58% improvement in overall oral hygiene KAP in experimental group (P = 0.001) whereas no improvement was seen in control group at the end of the study. The mean plaque score was improved by 57.67% (P = 0.001) in experimental group in comparison to 4.56% in control group. Gingival index was improved by 49.90% (P = 0.001) in experimental group in comparison to 0.7% in control group. Caries experience was increased in both groups but no significant difference was seen. Conclusions The study concluded that oral health education was effective in improving oral hygiene KAP, plaque control and gingival health. Trial registration The trial was retrospectively registered with Clinical Trial Registry India (CTRI) with identifier no. CTRI/2018/05/013985, registered on 05/21/2018. (http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=23651&EncHid=&modid=&compid=%27,%2723651det%27). Institutional Review Committee, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal provided the ethical approval (Ref. No.: 292/074/075-IRC).

Background: School aged adolescents are in particular need of preventive program to ensure positive long-term oral health and hygiene. However, due to lack of health education and insufficient preventive measures, the oral health status of these students is not always good resulting in high morbidity. The objective of this study was to assess the effectiveness of an oral health education intervention on oral hygiene knowledge, attitude and practices (KAP), plaque control and gingival health among 12-15 years old school children in Dharan sub-metropolitan city, Nepal.Methods: A randomized controlled trial was conducted with parallel study groups, comprising 12-15-year-old school children, 120 in each group (experimental and control group). Interview of the participants were done using a 23-item questionnaire for assessment of oral hygiene knowledge, attitude and practices (KAP). Oral examination was done using mouth mirror and WHO probe to record Turesky-Gilmore-Glickman modification of the Quigley-Hein plaque index (1970), Gingival index (Loe H and Silness J 1963) and Dentition status and treatment needs at baseline and third and sixth months of the study period. Analysis was done using chi-square test for categorical data and Independent t test, repeated ANOVA, Kruskal-Wallis test, Friedman test, Mann-Whitney U test for quantitative data. The level of significance was set at pResults: There was 54.58% improvement in overall oral hygiene KAP in experimental group (p=0.001) whereas no improvement was seen in control group after 6 months of intervention. The mean plaque score was improved by 57.67% (p=0.001) in experimental group in comparison to 4.56% in control group. Gingival index was improved by 49.90% (p=0.001) in experimental group in comparison to 0.7% (p=0.05) in control group. Caries experience was increased in both groups but no significant difference was seen.Conclusions: The study concluded that oral health education was effective in improving oral hygiene KAP, plaque control and gingival health.Trial registration: The trial was retrospectively registered with Clinical Trial Registry India (CTRI) with identifier no. CTRI/2018/05/013985, registered on 05/21/2018. (http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=23651&EncHid=&modid=&compid=%27,%2723651det%27). Institutional Review Committee, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal provided the ethical approval (Ref. No.: 292/074/075-IRC).

Background Severe acute malnutrition (SAM) is the most extreme and visible form of undernutrition plagued by chronic poverty, household food insecurity, lack of education. One of the indigenous and marginalized community of Nepal, Satar/Santhal has often been neglected and is devoid of good education and are economically deprived. This predisposes under 5 children of Satar into malnutrition. The study aims to assess determinants of SAM among children under 5 years of age in Satar community of Jhapa district, Nepal. Material & methods A community based matched case control study was carried from September 2019 to February 2020 among under five children of Satar community residing in Jhapa district. Multistage random sampling technique was used to select 50 cases and 100 controls in the ratio of 1:2. Information was collected through personal interview with the parents and anthropometric measurement of the children was measured. Bivariate and multivariate conditional logistic regression analysis was used to explore the determinants of severe acute malnutrition. Results A total of 664 children between the age group of 6–59 months were screened for SAM. The prevalence of SAM was found 7.53%. Factors like, low economic status, birth interval less than 2 years, frequency of breast feeding Conclusion Low economic status and frequency of breast feeding less than 8times/day were major determinants of SAM among children under 5yrs of age. Ending malnutrition will require greater efforts and integrated approaches to eradicate extreme poverty. Multi-sector approaches have been conducting for SAM in Nepal but there are no specific approaches for marginalized community.

PurposeThe purpose of this paper is to assess the health status and risky behaviours of inmates in Nepal.Design/methodology/approachThis cross-sectional study was conducted in Jhumka Regional Prison, the largest male prison in eastern Nepal from September 2014 to August 2015. Data were collected through face-to-face interviews from 434 randomly selected incarcerated participants using semi-structured questionnaires.FindingsThe mean age of 434 participants was 35.7 years (SD 13.3). The majority (84 per cent) had at least one current health problem, of which the commonest were respiratory (50 per cent), skin (38 per cent) and digestive (26 per cent). Alcohol (73 per cent) and cigarettes (71 per cent) were the most commonly used substances prior to imprisonment. Approximately, 27 and 11 per cent reported illicit drug use and injectable drug use prior to incarceration, respectively. A total of 204 inmates reported having intercourse with sex workers. Of these, 49 per cent did not use a condom in their last intercourse with a sex worker.Research limitations/implicationsThis paper illustrates that a wide range of physical and mental health problems exist among incarcerated people in Nepal. The study may lack generalisability, however, as it was conducted in a single male prison.Practical implicationsThe paper suggests a need for medical, psychiatric and substance abuse care in correctional settings to improve the health status of the prison population. It is also important to develop screening policies for blood-borne viral and other infectious diseases in the prison.Originality/valueThis is the first study of its kind drawn from prisons in Nepal.

Background: The non-communicable diseases (NCDs) are one of the leading causes of death globally which accounts for 68% out of world’s 56 million deaths in 2012. Around 82% of the premature deaths due to NCDs occur in the low-and middle-income countries and 40% of global NCD-related deaths take place before the age of 70. The study aimed to assess knowledge of dietary habits and behaviour-related determinants of NCD in urban Nepalese women of Eastern Nepal. Materials and Methods: A cross-sectional study was designed by using interviewer-administered questionnaire regarding knowledge on NCD. The definitions used for the study adopted the WHO STEP wise approach to chronic disease risk factor surveillance (STEPS) survey. A total 706 women aged 20–59 years were selected randomly from Inaruwa Municipality of Eastern Nepal. Results: The overall knowledge scores was found to be 62.14% with standard deviation 14.93% and it build up that the diet- and behaviour-related causes (mean score 75.25%), diet quality (mean score 45.27%) fruit and vegetable link (mean score 30.02%), health consequences of obesity (mean score 76.82%), causes of cardiovascular disease (mean score 77.08%) and causes of certain cancers (mean score 36.10%) were calculated. The total score of knowledge regarding NCD was found to be significant with caste/ethnicity, education level, occupation, socioeconomic status, physical activity and fruit intake. Conclusions: Findings revealed the population had good overall knowledge concerning diet and nutrition related to NCD in the relatively new context of the obesity epidemic in urban set up of Nepal. However, there was poor knowledge of the benefit of eating fruit and vegetables and other preventable causes of certain cancers. Nutrition education messages need to be communicated within the general population of women. Education targeting the benefits of vegetables and fruit may have the positive impact on NCD prevention.

Introduction: Worldwide, the morbidity of psychiatric illnesses is on the rise. Quality in-patient services are a part of quality mental health services provision. Knowledge about the pattern of illness among patients admitted to the ward could help the service providers to plan better and provide better services. This study was undertaken to explore the clinico-demographic profile of patients admitted to psychiatric ward at BPKIHS..Material And Method: This is a hospital based retrospective and cross-sectional study. After ethical approval from the Institutional Review Committee, the data of all patients admitted to Psychiatry Ward from 1st January 2007 to 31st December 2016 were collected from the data-base of Medical Records Section. The diagnoses were made according to the ICD-10 criteria. 3687 admissions were processed for the analysis.Results: Of the 3687 admissions, 2183(59.2%) were male and 1504 (40.8%) were female. The age range was 4-92 years with mean age of 32.4(±12.6) years. The majority of the admissions (62.5%) were from Sunsari (1159,31.4%) and surrounding districts (1147,31.1%). Mood disorders were the commonest diagnoses 1788(48.5%) followed by schizophrenia, schizotypal and delusional disorders 829(22.5%) and psychoactive substance use disorders 813(22.1). 92% of patients admitted were improved on discharge and three cases expired in the ward. Out of 3687 admissions, 957(26%) were readmissions.Conclusion: Mood disorders were the commonest diagnosis among the admitted patients. Outcome of hospital stay was good with 92% discharged in improved condition and only three mortalities in 10 years duration. Address seems to significantly affect the service utilization. J Psychiatrists’ Association of Nepal Vol. 6, No. 2, 2017, Page: 15-21

Background: Nepal is witnessing rise in non-communicable chronic diseases. Costs of the medicine, availability of the medicine for free in public health sectors and variation of price of medicines may play an important role in the management of chronic disease. The study was undertaken to find out the variation in price of drugs used for treating non communicable diseases among private pharmacies and availability of free essential medicines in public facilities.Methods: Randomly selected 33 public health centers and 13 pharmacies were included for the study. Availability of free essential medicines for treating selected chronic diseases was assessed in public health centers and percentage price variation in various branded drugs used for treating these diseases was assessed at the consumer level.Results: Out of 89 different formulations, variations between maximum and minimum priced brands of more than 100% were observed in 37 formulations and that of > 200% in 22 formulations. Thirty-seven formulations had more than 100% inter-pharmacy variation. The most commonly available free essential medicines was 4 mg salbutamol (88.57%) while the least available free essential drug was levothyroxine 5 mg (9.0%).Conclusions: Considerable variation in prices is seen among similar drugs and in prices of same drug in different pharmacies. These factors may have implications in the management of chronic disease in Nepal offsetting the government’s effort to control chronic diseases.

Introduction: School experience has remarkable effect on emotional and personal development of children. Intended developments can be achieved through qualified education. It is quite a challenging fact that corporal punishment is still being used in the schools of Nepal as reported in the news papers and other literature. However, there is littlie information about the knowledge and atitude of teachers towards corporal punishment.Objecive: To assess knowledge and atitude and to identify the association between the selected variables and knowledge and attitude towards corporal punishment among primary school teachers of Biratnagar Sub-Metropolitan City.Methodology Descriptive cross-sectional study was conducted in Biratnagar Sub-metropolitan City, Nepal. A total of 160 primary school teachers were included using total enumeration sampling technique. Data were collected by using self-administered, semi-structured questionnaire and Likert Scale. Written consent was taken from each participant and ethical approval was taken from Institutional Review Board of B.P Koirala Institute of Health Sciences. Statistical analysis was done using SPSS.Results All respondents had heard about corporal punishment but most of them were not clear about the rules against corporal punishment in schools. The mean percentage score of knowledge was 58.81 ± 19.34 and for attitude 56.30 ± 6.98. There was a positive correlation (r=0.455, p

Background: Due to its perception as a disease of development, road traffic accident and related injuries tend to be under recognized as a major health problem in developing countries. However, majority of the world's fatalities on the roads occur in low income and middle income countries. Since the main cause of road traffic accident is attributed to human risky behaviors, it is important to identify significant factors for risky behaviors of drivers. Objective: To know the risk taking behavior among drivers and practices of driving. Methods: This population based cross-sectional study. The study was conducted in Dharan, a township in Eastern Nepal. The study population includes of all long route drivers who are registered in membership of vehicle organization. Modified semi structured questionnaire was used for data collection. SPSS version 11.5 computer software was used for data entry and analysis. Results: Majority of study population belong to 25-29 years group. Majority of the drivers had valid license (98%) and about 68.9% drivers didn’t had any formal driving training school prior starting driving vehicle Most of them drive in high speed at highways but majority ignored that they take alcohol while driving. with growing age, years of driving had correlation of accidents among drivers population Conclusion: Study population comprises of youth drivers and most they had valid lenience. With the growing age drivers are neglecting traffic rules and sings and young driver are driving vehicles with overconfidently Health Renaissance 2015;13 (3): 1-6

Background: Knowledge, attitudes and practices (KAP) surveys are possibly the most frequently used studies in health-seeking behaviour research. Health care workers serve as key players in the prevention and management of diseases. Their perceptions, attitudes and practices have implications for the management of diseases in both health centers and communities. Objective: To assess knowledge, attitude and practice towards STDs among health attendant staffs (health aids and health attendants) of BPKIHS. Methods: This is a descriptive cross sectional study. The study population was Health attendants and Health aids workers working in different departments of BPKIHS. Modified structured questionnaire was used for data collection. SPSS version 11.5 was used for data entry and analysis. Results: 180 Health attendants and Health aids working in different departments of BPKIHS participated in the study. 29% belonged to 30-34 age groups. 86% of study population had heard about STD/HIV/AIDS. 29% expressed that having intercourse without using condoms is known as unprotected sex. Unprotected sexual habits (40.6%), using mask, gloves while working (30%) were methods listed for prevention of transmission of STDs/HIV/AIDS. Conclusion: Majority were from 30-39 years group.86% had heard about STDs/HIV/AIDS. The commonest method to protect from STDs/HIV/AIDS were listed as avoiding multiple sex partners and use gloves and mask while working. Health Renaissance 2015;13 (3): 95-106

Background: The prevalence of anemia in adolescence girls are said to be 42 to 60% in Nepal. Iron deficiency results from prolonged deficit of iron in diet or increased need for iron during a period of intense growth like adolescence. However, the terms anemia, iron deficiency, and iron deficiency anemia are used interchangeably. Aims and Objective: We aimed to find out the prevalence of anemia and iron deficiency in adolescent school girls of Dharan, Nepal by measuring hemoglobin and serum ferritin levels. Materials and Methods: This cross-sectional study was done in higher secondary schools, including government and private schools, of Dharan conducted by the Department of Basic and Clinical Physiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. A total of 150 adolescent school girls of Dharan was selected by systemic random sampling method. Hemoglobin and ferritin levels were analyzed by cyanmethemoglobin method and immunoturbidimetric assay respectively. Descriptive statistics, paired t-test and chi-square test were used. Results: Anemic girls were 33.33% (n=50/150). Anemia with iron deficiency was identified in 17.33% girls (n=26/50) and anemia with normal iron level was in 16 % girls (n=24/50). Normal hemoglobin level with iron deficiency was identified in 9% (n= 14/100) girls and normal hemoglobin with normal ferritin level was in 57% (n=86/100) girls. Conclusions: Prevalence of anemia was less in the adolescent school girls of Dharan, Nepal, than the earlier documented reports in which only half the anemic adolescent girls were iron deficient; suggesting that the remaining other anemic girls had other causes of anemia. Asian Journal of Medical Sciences Vol.8(5) 2017 22-26

Contraceptive use and fertility rates vary substantially among developing countries. An important factor, which affects the fertility of any population, is Contraceptive. Contraceptive use varies by age. Nepal over the past 15 years show an impressive increase in the use of modern contraceptive methods from 26 percent in 1996 to 43 percent in 2011. Objectives of the is to assess the knowledge, attitude regarding family planning and the practice of contraceptives among the married women of Dhabi VDC of Eastern Nepal. A descriptive cross-sectional observational study was done in Dhabi VDC. Total of 300 married women age 15-49 sample were taken from family planning center situated in Dhabi. Knowledge, attitude and practice on contraceptives were evaluated with the help of a predesigned questionnaire. Descriptive analysis was done by using SPSS 11.5 software to obtain frequencies and percentages. Out of 300 interviewed women, the mean age was 27.94 years, 98% had heard about Family planning method. Radio was the main Source of family planning information. Regarding the usage of contraceptive methods, about 79.3% had ever used and 63.3 had current using some sort of contraception, among the method used Injectables were the commonly used methods About 71% of married women other child in the further. Despite the knowledge of all family planning methods majority of the women used Injectables. Easily accessible and easily to use were the main reasons for choosing Injectables methods.

Background : It is a great challenge for a doctor to give proper care and discharge because of overcrowding in emergency units like ours. The clinical records in emergency are an essential document that reflects the quality of care which is given to the patient. Objectives: To find out the time taken for discharge from emergency and to find out the current trend of problems presenting to emergency and their prescription pattern. Methods : A retrospective descriptive hospital based study was carried out using all emergency discharged patients’ case sheet records from 14th April to 14th May 2013. A number of 1022 files were analyzed. Results: Out of 1022 discharge files, majority (72%) of the patients included Australian Triage Score (ATS) 3. Patients with ATS 5 had a mean duration of stay of 24 hours whereas ATS 2, 3, 4 patients had mean duration of stay of 10.10 hours, 8.75 hours and 5.48 hours respectively. Most common clinical presentation was trauma (31.3%). Out of 1022 patients, 504 (49%) were treated with antibiotics. Cefixime was the most frequently administered antibiotics (24.7%). Of all 506 patients received analgesic, mostly diclofenac (30.8%), 79 received antispasmodic drugs, mostly hyoscine butyl bromide (6.2%), and antipyretics mostly paracetamol. Proton pump inhibitors (PPI) were used in 594 (58.1%) patients mostly pantoprazole (47.2%). Conclusion: Sicker patients had longer duration of stay in the emergency unit. Trauma is the most common presentation, analysis, antibiotics and PPL are the most commonly prescribed which show in the emergency unit. Health Renaissance 2014;12(3): 209-214

Background: Being a mother is considered by many women as their most important role in life. Women’s perceptions of their abilities to manage the demands of parenting and the parenting skills they posses are reflected by perceived maternal role competence. The present study was carried out to assess the perceived maternal role competence and its associated factors among mothers. Methods: A descriptive cross-sectional research study was carried out on 290 mothers of infant in four immunization clinics of Dharan, Nepal. Data were collected using a standardized predesigned, pretested questionnaire (Parent sense of competence scale, Rosenberg’s self esteem scale, Maternity social support scale). The data were analyzed using descriptive and inferential statistics and multiple regression analysis at 0.05 level of significance. Results: The mean score of the perceived maternal role competence obtained by mothers was 64.34±7.90 and those of knowledge/skill and valuing/comfort subscale were 31±6.01 and 33±3.75, respectively. There was a significant association between perceived maternal role competence and factors as the age of the mother (P

Introduction. The prevalence of Pulmonary Tuberculosis (PTB) is much higher in the prison population than in the general population. This study aims to find out the prevalence of PTB and its associated factors among inmates in eastern Nepal. Methods. This cross-sectional study was conducted in Jhumka Regional Prison, the largest male prison of Eastern Nepal from September 2014 to August 2015. Semi-structured questionnaires were used to identify individuals with a cough more than one-week duration among 434 randomly selected inmates. Screening of PTB was done by sputum smear test and/or GeneXpert test. Prevalence of TB was defined as the number of cases detected during the study period divided by the total number of inmates screened during that period. Fisher’s exact test was used to find out the association of PTB with related variables. Results. A total of 434 inmates were screened for PTB with mean age 35.7 years and body mass index 22.7 kg/m2. A total of 68 inmates had a productive cough of more than a week and two patients were already on anti-tuberculosis therapy at the time of screening. Sixty sputum samples were considered for sputum smear/GeneXpert test and 6 of them (10%) had positive results. The prevalence of TB in the Prison was 1843/100,000 population. Chest pain and abnormal chest auscultation findings were found to be significantly associated with PTB. Conclusions. This study showed that there was a high rate of PTB among inmates in Nepal. The results suggest a need for effective screening of PTB and strategies to improve management including reduction of PTB transmission in the prison.

Nepal is witnessing rise in non-communicable chronic diseases. Costs of the medicine, availability of the medicine for free in public health sectors and variation of price of medicines may play an important role in the management of chronic disease. The study was undertaken to find out the variation in price of drugs used for treating non communicable diseases among private pharmacies and availability of free essential medicines in public facilities.Randomly selected 33 public health centers and 13 pharmacies were included for the study. Availability of free essential medicines for treating selected chronic diseases was assessed in public health centers and percentage price variation in various branded drugs used for treating these diseases was assessed at the consumer level.Out of 89 different formulations, variations between maximum and minimum priced brands of more than 100% were observed in 37 formulations and that of200% in 22 formulations. Thirty-seven formulations had more than 100% inter-pharmacy variation. The most commonly available free essential medicines was 4 mg salbutamol (88.57%) while the least available free essential drug was levothyroxine 5 mg (9.0%).Considerable variation in prices is seen among similar drugs and in prices of same drug in different pharmacies. These factors may have implications in the management of chronic disease in Nepal offsetting the government's effort to control chronic diseases.

Background Emergence of multi-drug-resistant tuberculosis is a serious challenge for successful global tuberculosis control. Early diagnosis of drug-resistant tuberculosis by direct nitrate reductase assay (NRA) aids in appropriate treatment and reduction in disease transmission, particularly in countries with high tuberculosis burden. The aim of this study was to evaluate the performance of NRA for direct detection of resistance to rifampicin and isoniazid in Mycobacterium tuberculosis in laboratories with limited resources. Methods Fifty-eight new smear-positive sputum samples were processed as per the guidelines of revised national tuberculosis control program, India. The performance of NRA on middlebrook 7H11 agar was evaluated for detection of rifampicin and isoniazid resistance directly on smear-positive sputum specimens, and the results were compared with conventional proportion method. Sensitivity and specificity of the test were compared with the gold standard proportion method. Mc Nemar chi-square test was used to find out the significant difference between two methods. Results Direct NRA for detection of rifampicin resistance was 85.7% sensitive and 100% specific, whereas sensitivity and specificity of isoniazid resistance were 87.5% and 100%, respectively. Agreement between NRA and proportion method was 98% for both the drugs. The mean days of drug susceptibility testing results were 19.3 days for NRA and 72 days for conventional proportion method. The results of NRA were available in 21 days for 83% of the samples. Conclusions Direct NRA on middlebrook 7H11 medium is a highly sensitive, reliable, and significantly faster method to perform drug susceptibility testing. It has the potential to be implemented for rapid detection of multi-drug-resistant tuberculosis against insufficient resources.