Tobacco use, exposure to second-hand smoke, and cessation training among the third-year medical and dental students in selected Member States of South-East Asia region: A trend analysis on data from the Global Health Professions Student Survey, 2005-2011.

Background: The Medical and Dental Global Health Professions Student Surveys (GHPSS) are surveys based in schools that collect self-administered data from students on the prevalence of tobacco use, exposure to second-hand smoke, and tobacco cessation training, among the third-year medical and dental students. Materials and Methods: Two rounds of medical and dental GHPSS have been conducted in Bangladesh, India, Myanmar, Nepal, Sri Lanka, and Thailand, among the third-year medical and dental students, between 2005 and 2006 and 2009 and 2011. Results: The prevalence of any tobacco use among third-year male and female medical students did not change in Bangladesh, India, and Nepal between 2005 and 2006 and 2009 and 2011; however, it reduced significantly among females in Myanmar (3.3% in 2006 to 1.8% in 2009) and in Sri Lanka (2.5% in 2006 to 0.6% in 2011). The prevalence of any tobacco use among third-year male dental students did not change in Bangladesh, India, Nepal, and Thailand between 2005 and 2006 and 2009 and 2011; however, in Myanmar, the prevalence increased significantly (35.6% in 2006 to 49.5% in 2009). Among the third-year female students, a significant increase in prevalence was noticed in Bangladesh (4.0% in 2005 to 22.2% in 2009) and Thailand (0.7% in 2006 to 2.1% in 2011). It remained unchanged in the other three countries. Prevalence of exposure to second-hand smoke (SHS) both at home and in public places, among medical students, decreased significantly in Myanmar and Sri Lanka between 2006 and 2009 and in 2011. Among dental students, the prevalence of SHS exposure at home reduced significantly in Bangladesh, India, and Myanmar, and in public places in India. However, there was an increase of SHS exposure among dental students in Nepal, both at home and in public places, between 2005 and 2011. Medical students in Myanmar, Nepal, and Sri Lanka reported a declining trend in schools, with a smoking ban policy in place, between 2005 and 2006 and 2009 and 2011, while proportions of dental students reported that schools with a smoking ban policy have increased significantly in Bangladesh and Myanmar. Ever receiving cessation training increased significantly among medical students in Sri Lanka only, whereas, among dental students, it increased in India, Nepal, and Thailand. Conclusion: Trends of tobacco use and exposure to SHS among medical and dental students in most countries of the South-East Asia Region had changed only relatively between the two rounds of GHPSS (2005-2006 and 2009-2011). No significant improvement was observed in the trend in schools with a policy banning smoking in school buildings and clinics. Almost all countries in the SEA Region that participated in GHPSS showed no significant change in ever having received formal training on tobacco cessation among medical and dental students.

Prevalence of smokeless tobacco use among adults in WHO South-East Asia.

Smokeless tobacco (SLT) use is an understudied problem in South-East Asia. Information on SLT use among the adult population was collected from various available sources. SLT use prevalence varies among countries in the region. The prevalence of SLT use is known for all countries at national level in the region with the exception of Bhutan and DPR Korea. For Bhutan, data pertains to Thimphu only. There is no available data on SLT use for DPR Korea. Using all available data from Bhutan, India, Myanmar, Nepal, and Sri Lanka, SLT use was found to be higher among males as compared to females; however, in Bangladesh, Indonesia, and Thailand, SLT use was higher among females as compared to males. Among males, prevalence of SLT use varied from 51.4% in Myanmar to 1.1% in Thailand. Among females, the prevalence of SLT use varied from 27.9% in Bangladesh to 1.9% in Timor-Leste. The prevalence also varies in different parts of countries. For instance, the prevalence of current use of SLT in India ranges from 48.7% in Bihar to 4.5% in Himachal Pradesh. In Thailand, prevalence of current use of tobacco use varies from 0.8% in Bangkok to over 4% in the northern (4.1%) and northeastern (4.7%) region. Among all SLT products, betel quid was the most commonly used product in most countries including Bangladesh (24.3%) and Thailand (1.8%). However, Khaini (11.6%) chewing was practiced most commonly in India. Nearly 5% of the adult population used tobacco as dentifrice in Bangladesh and India. SLT is more commonly used in rural areas and among disadvantaged groups. Questions from standard "Tobacco Questions for Surveys (TQS)" need to be integrated in routine health system surveys in respective countries to obtain standardized tobacco use data at regular intervals that will help in providing trends of SLT use in countries.

Vector control interventions for visceral leishmaniasis elimination initiative in South Asia, 2005-2010.

The Visceral Leishmaniasis (VL) Elimination Initiative in the Indian subcontinent was launched in 2005 as a joint effort between the governments in the Region (India, Nepal and Bangladesh) and the World Health Organization (WHO). The objective is to reduce the annual VL incidence below 1/10,000 inhabitants by 2015 based on detection and treatment of VL cases and vector control. We present here a review of studies published in the period 2005-2010 on the efficacy of different tools to control Phlebotomus argentipes. The review indicates that the current indoor residual spraying (IRS) and novel vector control methods mainly insecticide treated nets (ITN) have low effectiveness for several reasons. Efforts to improve quality of IRS operations and further research on alternative and integrated vector control methods need to be promoted to reach the VL elimination target by 2015.

How do health care providers deal with kala-azar in the Indian subcontinent.

Background & objectives: Three countries, Bangladesh, India and Nepal, set out to eliminate kala-azar by 2015. This study was aimed to document the knowledge and practices in kala-azar case management of public and private health providers in these three countries. Methods: A health care provider survey was conducted in 2007 at 4 study sites, viz., Muzaffarpur and Vaishali districts in India, Mahottari district in Nepal, and Rajshahi district in Bangladesh. Interviews were conducted with formal and informal health care providers at their home or practice. Results: About half of the providers in India and Nepal knew the rapid diagnostic test rK39 recommended by the elimination initiative, but this was not in Bangladesh. Knowledge of the recommended first-line drug, miltefosine, was good in India and Nepal but less so in Bangladesh. Interpretation & conclusions: Innovative tools for VL care have not yet been fully taken up by private for profit care providers in the three countries that launched a VL elimination initiative. The elimination initiative needs to address these gaps in private providers’ knowledge, given their substantial share in the care of VL patients.

An epidemiological study of organophosphorus poisoning at manipal teaching hospital, Pokhara, Nepal.

Organophosphorus compounds are chemical compounds containing carbon-phosphorus bonds (apart from phosphate and phosphite esters), primarily used in pest control and are often persistent organic pollutants. Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, with thousands of deaths occurring every year in Nepal. Most of these pesticide poisoning and subsequent deaths occur due to deliberate self ingestion of the poison. Sixty five patients with severe organophosphorus poisoning were admitted to the emergency ward of Manipal Teaching Hospital, Pokhara, Nepal from January 2008 to December 2008. History of ingestion, clinical signs & symptoms and survival time in case of death was also recorded to diagnose the OP poisoning. The mean age of patients was about 27 years. Most of the admitted cases were of suicidal in nature and women are the main victim. Suicidal deaths due to ingestion of organophosphorus compound are very common in Nepal especially in women. The reason may be the increasing stress in the family and economic constraints. Further study should be needed by government and NGO to evaluate it.

Effect of untreated bed nets on blood-fed Phlebotomus argentipes in kala-azar endemic foci in Nepal and India

Observational studies in the Indian subcontinent have shown that untreated nets may be protective against visceral leishmaniasis (VL). In this study, we evaluated the effect of untreated nets on the blood feeding rates of Phlebotomus argentipes as well as the human blood index (HBI) in VL endemic villages in India and Nepal. The study had a "before and after intervention" design in 58 households in six clusters. The use of untreated nets reduced the blood feeding rate by 85 percent (95 percent CI 76.5-91.1 percent) and the HBI by 42.2 percent (95 percent CI 11.1-62.5 percent). These results provide circumstantial evidence that untreated nets may provide some degree of personal protection against sand fly bites.

Clinical and etiological profile of acute febrile encephalopathy in eastern Nepal.

Objective. To investigate the clinical and etiological profile of acute febrile encephalopathy in children presenting to a tertiary care referral center of Eastern Nepal. Methods. 107 children (aged 1 month to 14 yr) presenting to the emergency with fever (> 380 C) of less than 2 wk duration with altered sensorium with/ or without seizure were prospectively investigated for etiological cause. The investigations included blood and CSF counts, blood and CSF cultures, peripheral smear and serology for malarial parasite, and serology for Japanese encephalitis (JE) virus. Other investigations included EEG and CT or MRI wherever indicated. Results. The most common presenting complaints apart from fever and altered sensorium were headache and vomiting. Convulsions, neck rigidity, hypertonia, brisk deep tendon reflexes, extensor plantar response and focal neurological deficits were seen in 50%, 57%, 22.4%, 28%, 39.3% and 9.3% of the subjects, respectively. The diagnoses based on clinical presentation and laboratory findings were pyogenic meningitis in 45 (42%), non JE viral encephalitis in 26 (25%), JE in 19 (18%), cerebral malaria in 8 (7%), herpes encephalitis and tubercular meningitis in 4 (4%) each, and typhoid encephalopathy in 1 case. Conclusion. Pyogenic meningitis and viral encephalitis including JE are the most common causes of acute presentation with fever and encephalopathy. Preventive strategies must be directed keeping these causes in mind.

Chronic Suppurative Otitis Media in urban private school children of Nepal / Otite Média Crônica Supurativa em crianças de uma escola particular urbana do Nepal

Chronic suppurative otitis media is one of the common ear diseases of the ear, particularly in childhood. It is the commonest cause of persistent mild to moderate hearing impairment in children and young adults. AIM: To find out the prevalence of chronic suppurative otitis media among school children studying in urban private schools of Nepal. MATERIAL AND METHODS: This study was carried out among 500 school children aged between 5 -15 years. Students were selected from urban private schools of four districts of Nepal. In all students, history was taken and otoscopic examination done from May 2006 to October 2006. Data were described using frequency and percentage. Study design: Prospective cross sectional study. RESULTS: Results showed that the prevalence of chronic suppurative otitis media in children studying in urban private schools of Nepal is 5.0 percent. Unilateral disease was seen in 72.0 percent, 76.0 percent had a tubotympanic disease and 24.0 percent had atticoantral disease. CONCLUSION: The prevalence of chronic suppurative otitis media in urban private school children in Nepal is higher than other studies done in private school children. Health education, improvement of socioeconomic status and health facilities will be helpful in reducing the prevalence of chronic suppurative otitis media.

Otite média crônica supurativa é uma das mais comuns doenças do ouvido, principalmente em crianças. É a causa mais comum de perda auditiva persistente leve a moderada em crianças e adultos. OBJETIVO: encontrar a prevalência de otite média crônica supurativa em crianças de escolas particulares urbanas do Nepal. MATERIAIS E MÉTODOS: este estudo envolveu 500 crianças escolares com idades entre 5 e 15 anos. Os estudantes foram selecionados de escolas particulares urbanas de quatro distritos do Nepal. Todas as crianças passaram por anamnese e exame otoscópico entre Maio e Outubro de 2006. Os dados foram descritos por meio de freqüência e porcentagem. Formato do estudo: transversal e prospectivo. RESULTADOS: os resultados mostraram que a otite média crônica supurativa em crianças de escolas particulares do Nepal é de 5,0 por cento. Doença unilateral esteve presente em 72,0 por cento; 76,0 por cento tiveram doença tubo-timpânica e 24,0 por cento tiveram doença ático-coanal. CONCLUSÃO: a prevalência de otite média crônica supurativa em crianças de escolas particulares urbanas do Nepal é maior do que aquele encontrado em outros estudos envolvendo crianças de escolas particulares. Educação em saúde, estado sócio-econômico e instalações de atenção à saúde serão úteis na redução da prevalência de otite média crônica supurativa.

Oesophageal foreign bodies in children.

Foreign body ingestion is a common occurrence and carries significant morbidity and mortality. Failure to treat foreign bodies immediately can lead to various serious complications. This study was done to identify the types as well as site of foreign body ingested and its complication in children. A retrospective study of 122 cases of suspected foreign body ingestion in patients admitted in ENT and Head and Neck Surgery of TU Teaching Hospital, Kathmandu were done in between April 2004 to July 2008. Ages less than 12 years were included. In all cases x-ray soft tissue neck lateral and chest x-ray posterio-anterior views were done along with other preoperative investigations. Rigid oesophagoscopy or hypopharyngoscopy were done under general anesthesia to remove foreign bodies. There were 64.7% male and 35.3% female children. Foreign bodies were common in 0-4 year age group. Most common foreign body were coin (64.0%) followed by meat bone (14.0%). No foreign bodies were found in 2.4% patients as they were passed in stomach. No complications were noted during the entire period of this study. Most common foreign bodies in children are coin. Though complications with these foreign bodies are rare, these do occur due to delay in presentation and removal. No complications were noted in our series. Eventhough children who swallow foreign bodies are asymptomatic; we must maintain a high index of suspicion and undergo diagnostic procedure, if there is a positive history.

Cervical spondylosis in Nepalese porters.

Neck pain with or without radiculopathy and myelopathy is a very common problem in clinical practice. The incidence is believed to be higher in subgroups carrying load on their head. It has been reported in literature that radiographic spondylosis is appreciable in 25% to 50% of population by the age of 50 years and 75% to 85% by the age of 65 years. One hundred and nineteen lateral X-rays of cervical spine were analyzed as case-control study in patients between 40 and 50 years age with the objective of finding out proportion of cervical spondylosis in this age group and difference in the prevalence between porters and non-porters. Out of the 119 cases 54 (45.4.2%) were porters and 65 (54.6%) were non-porters. There were 98 (82.4%) males and 21 (17.6%) females. The overall prevalence of radiological cervical spondylosis was 69 (58%). The prevalence of cervical spondylosis was significantly lower (x2=14.795, p=0.0001) in porters in comparison to non-porters. The odds ratio was found to be 0.23 (0.10, 0.53) at 95% confidence interval indicating that portering significantly prohibited development of spondylosis. This study concludes that the overall prevalence of cervical spondylosis in the Nepalese population is slightly higher than in the Caucasian and contrary to other studies there is significantly lower prevalence of such degeneration among the Nepalese porters.

Traumatic posterior fossa extradural haematoma.

Posterior fossa extradural haematoma is known for the vague signs and symptoms and a notorious course that varies from recovery to sudden death. The incidence of posterior fossa epidural hematomas among intracranial epidural hematomas has been reported from 4% to 7%. Subsequently, PFEDH with low GCS or the haematoma of more than 10 ml were subjected to evacuation. Since the volume of the posterior fossa is limited, patients deteriorate early with the development of obstructive hydrocephalus, which is visible in the CT scan in only thirty percent of cases. A retrospective study of 43 cases was done in this Institute from May 1999 to December 2005. The males (98%) have a clear predominance over female patients (2%). Road traffic accidents accounted for the majority of the cases (80%), fall for the rest (17%) and one case due to a bullhorn injury. Vomiting was the most common symptom accounting for 67% of cases followed by transient loss of consciousness in 48% and headache in 34%. On arrival to the hospital 67% presented with a GCS more than 13, 28% with score of 9-12 and the rest 5% with GCS of less than 8. Out of the total 43 cases of PFEDH surgical evacuation was done in 33(76%) and conservative management in 10 cases (23%). A dichotomised Glasgow outcome score was used to measure the outcome. This was favorable in 27 of the 33 cases operated (81%), and 7 out of the 10 conservatively managed group (70%). Overall favorable outcome was found in 34 cases (79%) with overall mortality of the study being 7%.

A study of abdominal pain in children.

Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal. Knowledge about its etiology and frequency helps in its evaluation and management. The present study was undertaken to find out the causes and their frequency of pain abdomen in Nepali children. Children with pain abdomen presenting at the emergency room and pediatric outpatient department of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 were clinically evaluated and investigated to find out the causes and frequency of their pain abdomen. The outcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completed investigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only. 91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic (9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related to surgical conditions, which needed operative management. Secondary or extra-abdominal causes were found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic (11) were predominant causes. Our study showed that the causes of pain abdomen in children were predominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, including functional and emotional causes were infrequent. Small percentage needing surgical management formed a diagnostic challenge.

Screening of syphilis in abroad job seeking healthy males.

This study was carried out to find out the prevalence of syphilis is healthy male populations. Test for Syphilis is mandatory for those who apply for overseas employment, especially in Middle East countries. From randomly selected Nepalese male population (16-50 years) seeking jobs abroad, 2585 blood samples were collected and tested by nontreponemal test, the Rapid Plasma Reagin test and by treponemal test, the Treponema pallidum haemagglutination test. Confirmed cases of syphilis were 22 (0.85%). No association of syphilis with any age groups (X2 = 6.6465, P>0.05) and development regions were observed (X2 = 1.8782, P>0.05). Syphilis occurrence was almost equal in terai (0.94%) and hilly region (0.9%) and was none in mountainous region showing no association (X2 = 1.5334, P>0.05). In eastern development region, all the cases were from terai region showing significantly greater occurrence of syphilis in terai region (X2 = 4.334, P<0.05). In the contrary, all the cases of syphilis in mid-western development region were from hilly region, however this finding was not statistically significant (X2 = 0.5497, P>0.05). Asymptomatic stage of syphilis may lead to tertiary syphilis; hence, People should be educated about the disease; they should be screened and treated when required.

Pseudoexfoliation syndrome in various ethnic population of Nepal.

Pseudoexfoliation syndrome is an ocular condition characterized by a distinctive deposition of fibrillar material in the anterior segment of the eye. Pseudoexfoliation syndrome is frequently associated with glaucoma. Though it is seen in all the population, prevalence varies considerably in different races. A hospital based study done in Nepal by our group showed that Gurung population is frequently affected by this disease than any others. To determine the fact a larger population based study was necessary. Thus a research was designed to survey the various populations in the community. Different population from Kathmandu valley, Kavrepalanchowk, Pokhara, and Ghandruk were evaluated in two different phases to include major ethnic population living in Nepal. Household surveys done to bring all the targeted population to base hospital and detail examination including anterior segment evaluation after dilatation of pupil, optic disc evaluation, intraocular pressure measurement, gonioscopy, visual field recording and photographic documentation was done. Total of4430 population surveyed while only 2135 fulfilled the criteria for inclusion. Gurungs irrespective of their place of residence showed higher prevalence of Pseudoexfoliation syndrome accounting for 7.8% in Kathmandu valley while 12.0% in Ghandruk. Tamangs were affected very rarely by this disease accounting only for 0.3%. Gurungs are at higher risk of developing Pseudoexfoliation syndrome than any others in Nepal.

Prevalence of diabetic retinopathy following a community screening for diabetes.

Diabetic retinopathy is a public health challenge in developing countries including Nepal and is not like other preventable or treatable causes of blindness. The aim of study was to estimate the prevalence of diabetic retinopathy following a community screening for diabetes. A community-based, cross sectional study was designed to screen for diabetes in people age > or =40 years in a semi-urban community of Kathmandu, Nepal. In those individuals with detected diabetes, a comprehensive eye examination was performed by an ophthalmologist and diabetic retinopathy was graded using a standard protocol. 1475 persons were screened for diabetes with a mean age of 54.7 +/- 12 years with sex ratio of 0.69 male per female. Thirty-four subjects were found to have impaired fasting glucose and sixty subjects had diabetes. The prevalence of diabetes mellitus was 4.1% (60) but 6.4% (94) had an abnormal blood sugar level. Fifty-seven diabetic patients visited at-Tilganga Eye Centre for ocular examination. Among examined patients, the prevalence of diabetic retinopathy was 19.3% (11). Only one person had clinically significant macular edema requiring laser therapy. The prevalence of hypertension and cataracts were the same among patients with and without diabetic retinopathy. The prevalence of diabetic retinopathy was low but one of sixteen newly diagnosed diabetics did have evidence of diabetic retinopathy. Eighty-four percent of known diabetics had never had their eyes examined for ocular complications. Community awareness and physician coordination should be emphasized to increase the eye examination rate.

Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) in a Tertiary-Care Hospital in Eastern Nepal.

Nosocomial infection is a major problem in the world today. Methicillin-resistant Staphylococcus aureus (MRSA) strains, usually resistant to several antibiotics, shows a particular ability to spread in hospitals and is now present in most of the countries. The aim of the present study was to determine the prevalence of MRSA infections and their antimicrobial susceptibility pattern in our hospital located in eastern Nepal. Identification of Staphylococcus aureus was confirmed by standard methods and the antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. Interpretation criteria were those of the national committee for clinical laboratory standards. During a period of one year, out of a total of 750 Staphylococcus aureus strains isolated from various clinical samples, 196 (26.14%) were found to be Methicillin-resistant. Seventy percent isolates of MRSA were from inpatient departments and amongst them only 10% of the isolates were from intensive care units (ICU). More than 65% of MRSA were found to be resistant to Penicillin, Cephalosporins, Ciprofloxacin, Gentamicin Erythromycin and Tetracycline, while 47.96% of them were resistant to Amikacin. Many MRSA strains were multidrug-resistant. However, no strains were resistant to Vancomycin. To reduce the prevalence of MRSA, the regular surveillance of hospital acquired infection, isolation nursing of patients who carry MRSA, monitoring of antimicrobial susceptibility pattern and formulation of a definite antibiotic policy may be helpful.