RESUMO
Background: Children contribute a significant proportion of the tuberculosis (TB) burden in Nepal and suffer severe TB related morbidity and mortality, particularly in endemic areas. Diagnosis and management of pediatric TB especially Extra pulmonary TB (EPTB) is challenging. Objectives: The present study was designed to study clinical, laboratory characteristics and outcome of childhood tuberculosis. Methods: A prospective analysis of 60 cases of TB children within three years period was conducted at Pediatric Department, Dhulikhel Hospital and followed up till child completely recovered. Results: In the present study 60 children had clinical and lab evidence of tuberculosis and received anti tubercular therapy. Extra pulmonary tuberculosis was common (78.3%) than pulmonary tuberculosis (21.6%). BCG scar was absent in eight (13.33%) and absent BCG vaccination was significantly associated with disseminated TB (p<0.05). The most frequently seen symptoms were fever (65 %), cough (46.67 %) and abdominal distension (36.67%). Hepatomegaly (45%), ascites (33.33%), lymphadenopathy (23.33 %) and splenomegaly (11.67 %), and are common signs. Malnutrition seen in (33.3%) with more malnourished children with disseminated TB than in other diagnosis (p<0.001). Mantoux test was positive in (48.3%). Isolation of AFB was possible only in (8.33%). Among 60 cases (60%) were recovered completely with the primary regimen, (5%) recovered with extending the duration of primary regimen to three more months. (25%) failed to follow up, while (6.67%) died. Conclusion: EPTB is common than pulmonary TB. Among 60 cases 36 (60%) recovered completely with the primary regimen, three cases (5%) recovered with extending the duration with primary regimen. Fifteen cases (25%) failed to follow up, while four cases (6.67%) died.
RESUMO
BACKGROUND: Medical schools and medical education look different as we advance into the 21st century. Nepal has seen a dramatic increase in the number of medical schools/colleges in the last decade. Most schools practice traditional teaching method while others are implementing problem based learning (PBL). It is important to explore the current advances and practices in medical education to meet the needs of the health services of the country. OBJECTIVE: The objective of the present study is to explore the students' perception regarding present status of medical education in Nepal and provide recommendations to address future needs. MATERIAL AND METHODS: The study design of the present research was descriptive and exploratory type. Structured Questionnaire was used to assess the students' perception relating to different aspects of medical education. A total of 24 students studying in the final year of MBBS from six medical colleges were selected randomly. RESULTS: The traditional teaching/learning methodologies have been prevailing in the medical schools of the country. PBL suits many objectives of self directed learning (SDL) because students learn to reason and deduce facts and figures rather than rote learning. For the success of PBL and SDL students require learning resources and as per our findings although 71% of the students were satisfied with library facilities 54% were dissatisfied with computer resources. Community based approaches have been focused in the curriculum of all the medical schools of Nepal. About public health and community medicine teaching 86% of the students reported to be appropriate, of which 18% actually thought it was excessive. About the teaching of evidence based medicine (EBM), 50% students felt it was adequate and other half thought it was inadequate. Majority of the students i.e. 62% of the students also felt that the care of ambulatory patients was as well covered as the care of hospitalized patients. The areas of clinical practice which the students felt were inadequate included: nutrition (71%), geriatrics (70%), end of life care (71%), palliative care (67%), long term health care (70%), continuity of care (70%), ethical decision making (56%) and patient follow up (50%). In spite of completing their training, 25% felt they were not confident that they had acquired the clinical skills required to begin the residency program. As much as 60% felt they did not receive information about specialties and alternative medical careers. About 75% of the students had the feeling that medical profession will not be financially rewarding; 80% felt it would not be as respectable; 99% felt it would be more scientifically challenging. CONCLUSION: The medical education of Nepal is still guided by the notion of the traditional approaches. The teaching methods should come up as per the advancement in contemporary medical education. The training needs to be more structured and focused in practical reality than only feeding students with theoretical knowledge.