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Background and Aims: Medication adherence among Post myocardial infarction (MI) patient is suboptimal all over the world. Although significant advances have been made in the diagnosis and management of Acute Myocardial Infraction, it is still a major cause of morbidity and mortality worldwide and significant therapeutic challenges to the society. The purpose of the study was to study the medication adherence and to identify the effect of adverse drug reaction (ADR) on medication adherence. Methods: The study was a single center, prospective study carried out in Shahid Gangalal National Heart Centre (SGNHC) in Nepal. The enrolled patients were followed up at 6th weeks after discharge in outpatient department (OPD) visit. Patients were interviewed with Morisky Green Levine (MGL) adherence scale questionnaire to identify medication adherence. The ADR was assessed. Data were analyzed in SPSS version 20. Results: A total of 134 patients were included in the study. The study showed post MI patient were highly adherent to medication (92.5%). ADR was not significantly associated with medication adherence. Conclusion: Patients were highly adherent to medication and the effect of ADR on medication adherence was not significant.

Background: Approximately 287,000 women died globally from causes related to pregnancy and childbirth in 2010. Nepal is among the countries with high maternal mortality rates in South Asia region with estimated Maternal Mortality Rate 239/100,000 live births. Underutilization of health services is one factor contributing to high maternal mortality rate. In Nepal, 81% of births take place at home without skilled health providers. Many complications related to childbirth can be prevented by utilization of maternal health services. Methods: A descriptive cross-sectional study was carried out among 71 respondents from May 15, 2019 to November 16, 2019 and it took by using total enumeration sampling technique. Structured self developed questionnaire was used to collect data using interview technique. Data was analyzed via SPSS software version 16 by using descriptive and inferential statistics. Results: Utilization of free maternity services was extremely low among Chepang women of Western Region of Nepal. With regards to antenatal utilization during their latest pregnancy was 73.2%. Only22.5% of the respondents had given birth of their baby in health institution rest of them delivered at home. Majority of the respondents did not utilized postnatal services (95.8%) whereas only 4.2% respondents utilized postnatal services. There was statistically significant association between utilization of ANC services and age (p=0.000), income (p= .006), education of the respondent (p=0.001) and religion of the respondents (p= 0.044). Similarly there was statistically significant association between utilization of delivery services and age (p=0.29), education of the respondent (p=0.007) but there is no significant association between utilization of postnatal services and selected demographic variables. Conclusion: The study concluded that maternity services utilization is extremely low among Chepang women of Nepal. There was significant association between age, educational status and religion. Therefore the government and non government organizations effort on health awareness programme are essential to maximize the utilization of maternity services. Key words: Antenatal, Delivery, Chepang, Postnatal, Utilization.

Introduction: Non-adherence is a common problem that directly affects the outcome. Therefore, to achieve the desired treatment outcomes, it is necessary to consider the factors affecting non-adherence to medication. Furthermore, there seems to be a dearth of information regarding non-adherence to psychotropic drug therapy. Thus, this study was designed to assess non-adherence to psychotropic drug therapy. Data and Methods: For three months, 384 patients visited the outpatient department (O.P.D.) of the mental hospital in Lagankhel, Nepal. Two sets of questionnaires were used, and the Statistical Package for Social Sciences (S.P.S.S) was used for data analysis. Results: 31.5% of the 384 patients adhered strongly to their drug therapy, and the non-adherence rate was 68.4%. Patients without a family history of mental illness and those with family involvement had higher adherence rates. Low adherence was seen in people who had a low income, a perception of good and bad health, were diagnosed with depression along with another disorder, or had a history of attempted suicide. Conclusion: Nonadherence to psychotropic medications was found to be widespread. Additionally, it was associated with multiple factors. Therefore, comprehensivestrategies should be developed to address the factors associated with non-adherence to psychotropic medication.

Burn patients are at high risk for nosocomial infection. Antibiotics are the key drugs for the treatment of infections. Overuse and inappropriate use of antibiotics increase both bacterial resistance and the cost of treatment. The introduction of correct and rational use of antibiotics appears to be impossible without having the knowledge of the current situation of antibiotic consumption. So, the study was conducted to know the current situation of antibiotic utilization pattern in burn patients.MethodsA Retrospective review of medical records was done to analyze the utilization pattern of antibiotics. The data were collected from Kirtipur hospital from June 2018 to May 2019. All the admitted patients irrespective of age, gender who were prescribed antibiotics and presented within three days of burn were included in the study. Patients admitted for less than 24hrs of a time were excluded from the study.ResultsA total of 249 reviewed case records came under inclusion criteria. Among them 51.8% were female and 48.2% were male. Mostly affected age group was 15-29 years (34.5%). Flame burn (51.8%) was the main cause of the burn. The majority had second-degree burn and 36.90% had 0-10% burn. Third-generation cephalosporin, ceftriaxone had the highest DDD/100BD (19.05). The most frequently used antibiotics were ceftriaxone, cefazolin, and piperacillin+tazobactam. DU90% comprises 12 antibiotics out of 30 antibiotics. The average number of antibiotics prescribed was 2.12 with a range of 1 to 7.ConclusionsThis study revealed the trend of antibiotic utilization pattern in burn patients. Third-generation cephalosporin, ceftriaxone was the most prescribed antibiotic. Regular antibiotic consumption using DDD methodology is needed for regular monitoring of antibiotic consumption so that timely intervention can be made and this study can be used as a baseline study.

Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

Limited data are available on atrial fibrillation (AF) and its clinical management and outcomes from an Australian perspective. This study was designed to examine the patient characteristics and antithrombotic treatment patterns among patients with AF in Tasmania, Australia. This retrospective observational study reviewed and followed patients with AF admitted to Tasmania’s 3 major hospitals between January 2011 and June 2012. Patients were excluded if they had only 1 episode of AF that reverted spontaneously or upon cardioversion without any documented recurrences. We reviewed the records of 2502 patients (≥18 years), and1469 were subsequently included in the study. The mean (±standard deviation [SD]) age of the patients was 76 (±12.3) years. The mean (± SD) CHADS2 score was 2.1 (±1.3), and 65.7% had a score ≥2. In total, only 55.6% of patients with CHADS2 score ≥2 were receiving anticoagulation and 9.9% were not receiving any antithrombotic treatment, whereas 85.4% of those at low risk (score 0) were on antithrombotic therapy. Hospitalization was associated with a significant increase in the rate of combination (antiplatelet plus anticoagulant) therapy ( P < .001). Suboptimal use of antithrombotic therapy highlights the need to improve AF management in our jurisdiction.

Although vitamin K antagonists (VKAs) are effective for long-term thromboprophylaxis in atrial fibrillation (AF), their limitations have led to widespread underutilisation, especially in the developing world. Novel oral anticoagulants (NOACs) have emerged as promising alternatives to VKAs, although there are some particular considerations and challenges to their introduction in developing countries. This review summarises the current state of antithrombotic management of AF in the developing world, explores the early evidence for the NOACs and describes some of the special considerations that must be taken into account when considering the role of the NOACs within developing countries' health care systems.A literature search was conducted via PubMed and Google Scholar to find articles published in English between the years 2000 to 2014. Search terms used were "atrial fibrillation", "oral anticoagulants", "warfarin", "NOACs", "dabigatran", "rivaroxaban", "apixaban", "edoxaban", "time in therapeutic range", "International Normalized Ratio" "cost-effectiveness", "stroke", "adverse-drug reactions" and "drug-drug interactions", together with the individual names of developing countries as listed by the World Bank. We reviewed the results of randomized clinical trials, relevant retrospective and prospective studies, case-studies and review articles.Many developing countries lack or have sporadic data on the quality of AF management, making it difficult to anticipate the potential impact of NOACs in these settings. The utilisation of anticoagulants for AF appears highly variable in developing countries. Given the issues associated with VKA therapy in many developing countries, NOACs offer some potential advantages; however, there is insufficient evidence to advocate the widespread replacement of warfarin at present. VKAs may continue to have a role in selected patients or countries, especially if alternative monitoring strategies can be utilised.The evaluation of the introduction of NOACs should consider safety, budget concerns and the quality of oral anticoagulation care achieved by each country. Prospective registries will be important in developing countries to better elucidate the comparative safety, efficacy and cost-effectiveness of NOACs and VKAs as NOACs are introduced into practice.

Discordance between international guideline recommendations and anticoagulant prescribing patterns among patients with nonvalvular atrial fibrillation (NVAF) has been frequently reported. This study was designed to compare the anticoagulant utilization pattern to earlier data in the same population and identify predictors of anticoagulant prescribing among patients with NVAF. We reviewed patients with NVAF admitted to Tasmania’s 3 major hospitals between January 2011 and June 2012 and compared the anticoagulant utilization pattern to earlier data. Patients were excluded if they had only 1 episode of NVAF that reverted spontaneously or upon cardioversion. Multivariate logistic regression analysis was used to identify predictors of anticoagulant prescribing. Overall, 53.8% of patients received anticoagulant treatment compared to 40.4% 15 years ago. Among eligible patients at high-risk of stroke, 52.5% were receiving anticoagulant therapy (vs 42.1% 15 years ago). Approximately 10% of patients with a CHADS2 score ≥2 were not receiving any antithrombotic treatment, reduced from 18.2% in the earlier cohort, whereas anticoagulant use increased among those at low risk (score 0) to 48.5% from 14.2%. Younger age (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.97-1.0; P = .04); CHADS2 = 1, relative to 0 (OR 1.68, 95% CI 1.07-2.63; P = .02); CHF (OR 1.56, 95% CI 1.12-2.15; P = .008); and embolic disease history (OR 1.77, 95% CI 1.09-2.86; P = .02) were significant predictors of anticoagulant prescribing. While there has been improvement over the past 15 years, suboptimal use of anticoagulant therapy among high-risk patients with NVAF remains common. There is significant potential for improvement in the quality of stroke prophylaxis in patients with NVAF.

The Pharmacovigilance program in Nepal is at very preliminary stage. Present study analyzed the pattern, causality, severity and preventability of the reported adverse drug reactions (ADRs) to the Pharmacovigilance center at Nepal Medical College and Teaching Hospital (NMCTH), from June 2007 to July 2011. A total of 40 ADR cases were reported, among which 23 (57.5%) were in males and 17 (42.5%) in females. Nineteen (47.5%) ADRs were reported in the age group between 21-40 years. Department of Medicine reported 12(30%) ADRs. Among the total ADRs, antibiotics [n=17, (42.5%)] were responsible for most of the reactions followed by non steroidal anti-inflammatory drugs [n=5, (12.5%)]. Most of the drugs were found to affect dermatological system [n=14, (35%)]. Carbamazepine accounted for 5 (12.5%) ADRs. The causality assessment showed 34 (85%) of the ADRs to have a ‘probable’ relationship with the suspected reaction.DOI: http://dx.doi.org/10.3126/jnpa.v26i1.6633JNPA. XXVI(1) 2012 54-61

Background Accreditation of curriculum by students may be useful in further modification of teaching and learning methods in medical colleges of any country specially Nepal. Course curriculum of medical sciences is made by learned professors of Universities, politicians and the government officers without consulting the students for whom it is made. In Nepal, Medical education is an experimental integrated teaching of four and half years for MBBS degree. Until now it has not been assessed as to what type of Doctors we are producing. This paper aims on the objective to find out whether integrated teaching or classical medical studies produce better doctors. Methods The present study was done to assess the teaching, learning and evaluation procedures adopted in Nepal Medical College, Kathmandu by getting feedback from students of 4 th (Basic Sciences), 5 th -7 th semesters and feedback was also taken from a few final year students (Clinical Sciences). A total of nearly two hundred students from this institution participated in this study. A multi-graded questionnaire was prepared and a pilot study of 20 students was done and the results were discussed among the authors to modify the questionnaire. This modified questionnaire was used in the main study. The same questionnaire was used for eliciting feedback from clinical students. The present study was undertaken from August 2008-January 2009. Results Out of 200 medical students, the mean age was found to be 19.4 ± 3 years SD. In gender distribution, male students (61%) were higher than female students (39%). Most of the medical students (70%) wanted to become doctor, to become rich and famous, 90% wanted to go to US (Massive brain drain). 90% of the students perceived that Anatomy is the most interesting and most relevant basic science subject for clinical studies and in Anatomy theory hours of teaching is to be increased (60%). Community Medicine was the most uninteresting subject of Basic sciences and if they are assured of attendance which subject they would not like to attend community medicine classes. 85% wanted that Pharmacology should be reduced in first four semesters and should be extended to seventh semester like Community Medicine. The best teaching method is Chalk and Board Method (60%) and followed by LCD slides (20%). Conclusion: Overall the results were alarming and may be taken up seriously by the policy makers. They can bring about amendments in course curriculum of universities in future . Keywords: Medical Education; Under-graduate; Post- Graduate; Nepal Medical College. DOI: http://dx.doi.org/10.3126/nje.v1i3.5575 Nepal Journal of Epidemiology 2011;1(3) 95-100