Una investigación etnográfica sobre la violencia médica en los centros de salud de Nepal / Ethnographic Investigation into Medical Violence in Nepali Healthcare Facilities / Uma investigação etnográfica da violência médica em centros de saúde no Nepal

Introducción: la violencia no es un subproducto inherente de las relaciones humanas, pero los con-flictos sí lo son. En este artículo se examinan los factores y circunstancias que conducen a la tensión y los conflictos entre las personas que buscan atención médica y los establecimientos médicos nepalíes y los miembros del personal que trabajan allí. Desarrollo: embebido con una revisión de la literatura relevante, a través del análisis de datos etnográficos generada a partir de la investigación de campo y el análisis de contenido de la representación de noticias seleccionada, el artículo se desarrolla en cuatro secciones diferentes. La primera parte trata sobre el contexto de las consultas médicas que resultan en el desarrollo de una relación problemática. A esto le sigue el examen de los diferentes tipos de violencia, enfrentamientos y protestas que surgen a través de tales relaciones. En la tercera parte se analizan las implicaciones de las crecientes promesas médicas y el consiguiente aumento de las expectativas, mien-tras que la última parte destaca cómo las prácticas médicas típicas que existen en los propios hospitales nepaleses aumentan la posibilidad de enfrentamientos y violencia. Conclusión: la frecuente ocurrencia de peleas y violencia médica tanto en hospitales públicos como privados en Nepal sugiere que hay una bre-cha de comunicación entre los proveedores de servicios y el paciente debido a la naturaleza esotérica de la medicina. El conflicto y la violencia hacia los proveedores de servicios también pueden prosperar en el contexto de un modelo explicativo diferencial de las dos partes. La creciente animosidad también indica una disminución de la confianza entre los proveedores de atención médica y los solicitantes en Nepal

Introduction: Violence is not an inherent by-product of human relationships, but conflicts are. This arti-cle examines the factors and circumstances that lead to tension and conflicts between health seekers, and their counterpart Nepali medical establishments, and their staff members. Development: The article is divided into four sections by embedding a relevant literature review, analyzing ethnographic data generated from field research, and analyzing the content analysis of selected news portrayals. The first section discusses the context of the medical consultations that lead to the development of a problematic relationship. This is followed by examining the various types of violence, confrontations, and protests that arise from such relationships. The implications of rising medical promises and resulting height-ened expectations are discussed in the third section. The last section focuses on how common medical practices in Nepali hospitals increase the possibility of confrontations and violence. Conclusions: The prevalence of tussles and medical violence in Nepal's public and private hospitals suggests that they can occur in any hospital, regardless of ownership. Because of the esoteric nature of medicine, there is always a communication gap between service providers and patients. Conflict and violence against service providers can thrive in the context of a two-sided differential explanatory model. The growing hostility also indicates a decline in trust between healthcare providers and patients in Nepal

Introdução: a violência não é um subproduto inerente às relações humanas, mas o conflito é. Este artigo examina os fatores e circunstâncias que levam à tensão e ao conflito entre as pessoas que pro-curam cuidados médicos e os estabelecimentos médicos nepaleses e os funcionários que aí trabalham. Desenvolvimento: incorporada a uma revisão da literatura relevante, através da análise de dados etno-gráficos gerados a partir da pesquisa de campo e da análise de conteúdo da representação noticiosa selecionada, o artigo desenvolve-se em quatro seções distintas. A primeira parte trata do contexto das consultas médicas que resultam no desenvolvimento de uma relação problemática. Em seguida, exa-minamos os diferentes tipos de violência, confrontos e protestos que surgem através de tais relações. A parte três discute as implicações das crescentes promessas médicas e o consequente aumento das expectativas, enquanto a última parte destaca como as práticas médicas típicas que existem nos próprios hospitais nepaleses aumentam o potencial de confrontos e violência. Conclusão: a frequente ocorrência de brigas e violência médica em hospitais públicos e privados no Nepal sugere-nos que podem ocorrer em qualquer hospital, independentemente do proprietário. Sempre existe uma lacuna de comunicação entre os prestadores de serviços e o paciente devido à natureza esotérica da medicina. O conflito e a vio-lência contra os prestadores de serviços também podem florescer no contexto de um modelo explicativo diferencial das duas partes. A crescente animosidade também indica um declínio na confiança entre os prestadores de cuidados de saúde e os requerentes no Nepal

Authors’ conflicts of interest in Nepalese healthcare journals

Most biomedical journals now require authors to declare their conflicts of interest (COI), especially financial ones, before they accept the manuscript for submission. This study aims to examine the COI policies of Nepalese healthcare journals. The sample constituted journals indexed in Nepal Journals Online (NepJOL) as of June 2021. Of the 68 that met our inclusion criteria, 38(55.9%) journals endorsed the COI policy of the International Committee of Medical Journal Editors. Thirty-six (52.9%) journals had a policy for reporting the COI. Financial COI was the only type of COI mentioned. All journals in Nepal are encouraged to request the authors to declare the COI for better transparency.

Knowledge, Attitude and Practice about Hypertension among adult Population of Letang Municipality, Morang District, Eastern Nepal

Introduction:Hypertension has been identified as one of the major public health and medical challenges with 1/4 adults worldwide estimated to have high blood pressure (BP).Objectives: To assess knowledge, attitude and practices regarding hypertension and to measure the association between socio-demographic characteristics with knowledge, attitude and practice regarding hypertension among adult population.Methods:The cross-sectional study was conducted among the 335 adult populationsin Letang Municipality of Nepal. Semi-structured questionnaire wasused for data collection. Chi-square test was applied to measure the association between socio-demographic characteristics with knowledge, attitude and practice regarding hypertension.Results:Majority of the respondents (67.2) have knowledge about the meaning of hypertension and symptoms of hypertension (52.2%). Mostof the respondents think that regular physical activity (83.9%) and reduce salt intake (84.2%) can be prevent hypertension.Almost 73.4% of respondents didn’t know their blood pressure and never checked their BP regularly(66.6%). Almost 12.8% of the study population sufferingfrom hypertension. The adult Population with age group of 41-60years (62.6%) was seen significantly good knowledge in comparison to other age groups. The study population having educational level SLC and above was seen significantly good knowledge,attitude and practice regarding prevention of hypertension in comparison to below SLC and illiterate. The study population belong to above poverty line had significantly good knowledge,attitude and practice regarding prevention of hypertensionin comparison to below poverty line.Conclusions:We conclude that majority of the study population of Letang Municipality had higher knowledge and positive attitude toward prevention of hypertension but the level of practices was poor.

Response to Tyrosine Kinase Inhibitors in Patients with BCR-ABL1 Positive Chronic Myeloid Leukemia; 13.5 Years’ Experience at Patan Hospital, Nepal

Background:Since the advent of Tyrosine Kinase Inhibitor (TKI), well controlled studies in developed world have shown that the life expectancy of patients with CML is comparable to normal people without the disease. But long-term follow up studies are lacking in resource poor setting. Methods:This is a retrospective follow up study looking at the molecular response and resistance to Tyrosine Kinase Inhibitors (TKI) in patients enrolled in the Max Access Program since February 2003 till March 2017. Patients with twoor more BCR-ABL1 levels by Karyotyping/ fluorescent in situ hybridization (FISH) / reverse transcriptase polymerase chain reaction (RT-PCR) were included. At baseline, complete blood count (CBC), renal function test (RFT), and liver function test (LFT) were evaluated. Bone marrow aspiration and biopsy for morphology, cytogenetic analysis by Karyotyping/FISH and/or molecular analysis by RT-PCR were also done if these tests were not performed earlier. FISH or RT-PCR was done on peripheral blood every 3–12 months as necessary if the patient could afford. Patients with warning response/failure underwent BCR-ABL1 Resistance Mutation Analysis (IRMA).Results:Three hundred and forty six (346) patients had two or more BCR-ABL1 monitoring tests done. Optimal response was seen in 49.42%. Similarly, suboptimal response and failure were seen in 16.5% and 34% respectively. Overall Survival is 89.6% (at 1.8 -165 months, mean 62 months) . If only CML related events is considered survival is 95.9%. Seventy seven (77) patients with a total of 80 BCR-ABL1 domain Imatinib Resistance Mutation Analyses (IRMA) showed 19 different types of mutations with the most common being T315I mutation (8 and 19.5%). About 22.25% of the total patients showed resistance to Glivec out of which 10.98% showed mutations. Nine patients underwent trial for treatment free response (TFR) and 5 of them relapsed between 2-8 months.Conclusions:Despite all the odds of having financial problem, accessibility problem due to distances, transportation, etc. and difficulty monitoring with routine BCR-ABL1 and IRMA, our findings show that the outcome of TKI therapy in our CML patients is comparable to well controlled studies done elsewhere. Overall survival, molecular and cytogenetic responses and mutations in our patients who developed resistance as well as TFR are also similar to other studies. The resistance rate of 22.25% is slightly higher compared to other studies in developed world. This is mainly because of poor monitoring due to unavailability of the test including IRMA in our country and affordability until 2012. It proves that TKI is very effective in CML even in a resource-poor, developing country

A study of malaria in bordering countries of India: Nepal, Pakistan, and Thailand

Background: Malaria still occurs in Nepal, Pakistan and Thailand which are countries of the South-east Asia region. Material and Methods: For the present study, three countries’ (Nepal, Thailand, and Pakistan) Malaria Prevalence and their strategic elimination programs of were taken into consideration based on all the available online data. These countries were compared by their preventive strategies and stipulated eradication time according to their geographical areas. They were further classified as endemic, non-endemic areas of their country maps and tabulated respectively. Results: During 2021, there were 623 reported confirmed cases of Malaria in Nepal. Of these, 94% were caused by Plasmodium vivax while 5% were due to P. falciparum. During 2021, there were 350,467 reported confirmed cases of Malaria in Pakistan. Of these, 78% were caused by Plasmodium vivax while 21% were due to P. falciparum. During 2021, there were 7420 cases of Malaria in Thailand of which 61% were due to Plasmodium vivax and 23% were due to P. falciparum. Conclusion: The number of imported cases of Malaria from India to Nepal and vice versa would decrease if anti-Malaria measures are stepped up in the respective countries’ border districts. The main species causing Malaria in Pakistan is Plasmodium vivax. This will prove a challenge to eliminate because of the hypnozoites that are difficult to treat which remain latent in the liver and cause recurrent attacks of the disease even if the initial phase is apparently cured. Thailand aims to eliminate Malaria by 2024 using the methods of timely surveillance and quick response.

Health status of tribes of Uttar Pradesh with special reference to health-seeking behaviour of uncharted Tharu tribe: A mappingreview

Background & objectives: The tribal population in India is considered as one of the vulnerable groups with respect to their achievements in health and other developmental issues. In this context, this mapping review attempted to understand the health profile of the Tharu tribal community residing in the northern State of Uttar Pradesh, India through literature mining. Tharu tribe is one of the indigenous groups living in the Terai plain on the Indo-Nepal border. In 1967, this tribe was documented as a Scheduled Tribe by the Government of India. The present review aimed to map the health-seeking behaviour of the Tharu population and review other factors pertaining to their health such as socioeconomic, developmental, employment, education, etc. Methods: Online data search was carried out on PubMed and Google Scholar using search terms ‘Tharu’ AND ‘India’. In addition, official reports avaibale in public domain and grey literature was also searched. Results: Twenty seven studies including reviews, articles, books/book chapters were evaluated along with 13 reports (including reports from government organizations and grey literature) were retrieved and analyzed. Of the 27 published reports, 16 were found relevant to Tharu tribe in India. A total of 29 (16 articles + 13 reports ) were included in this review. Interpretation & Conclusions: This mapping review highights the health seeking behaviour of the Tharu tribe in India that can help inform future interventions to improve the health status of the Tharu tribe as well as other aspects of their development.

Associations between nutritional status among school children and social determinants of health of their parents in Kaski district, Nepal / 国際保健医療

Background  This study explored the association of residence, caste, social determinants of health (SDH) of parents, and daily junk food intake with the nutritional status of school children living in different residential areas of a district in Nepal. Methods  A survey was conducted from December 2017 to March 2019, including 331 school children aged 6 to 12 years as well as their parents, in the primary village for Japan International Cooperation Agency (JICA) support and the surrounding area in the Machapuchare Administrative Region of Kaski District, Gandagi Province, Nepal. In this study, the body mass index for age z-score (BMIZ), a criterion used by the WHO for assessing malnutrition, was used for determining underweight; BMIZ <−2 SD was defined as underweight.  The children’s anthropometric data were measured to assess their nutritional status, and a survey on children’s daily junk food intake and parents' SDH was conducted among parents. The responses were analyzed by logistic regression analysis.Results  Of the children who participated in the survey, 31 (9.4%) were underweight.   An association between parents’ SDH and children’s underweight was found after adjusting for mothers’ age at marriage, number of siblings, and daily junk food intake, and the results showed that lower caste (OR＝0.241, p＝0.001), lower education of mothers (OR＝3.879, p＝0.011) and non-literacy of fathers (OR＝2.790, p＝0.023) had statistically significant effects on BMIZ.Conclusions  In this study, BMIZ, indicating underweight in Nepalese school children, was associated with higher caste and a mother’s level of educational attainment and father’s of non-literacy. To understand the factors influencing children’s health, it is necessary to evaluate sociodemographic parameters of parents as childcare providers, including culture, education, employment, living conditions, and diet, and to conduct surveys that capture data on the SDH of parents from various perspectives.

Gender preference among pregnant women in Nepal

Background:Nepalese society is traditionally patriarchal and son-preferred with increasing numbers of sex-selective abortions. In this context, this study aims to assess the gender preference and associated factors among pregnant women visiting the antenatal care ward of a large public maternity hospital in Kathmandu, Nepal.Methods:A hospital-based cross-sectional study was carried out among 821 antenatal women. Data was collected via face to face interview with structured questionnaire, and gender preference was assessed using Coombs’ scale.Results:At the first instance, more than half 56.2% respondents wished to have two sons and one daughter if they were to have only three children. On asking further questions as per the Coombs’ scale, about 40% of the respondents had son preference falling in IS scale 7-5, 33% had balanced IS-4, and 27% had daughter preference (IS 3-1). The respondent characteristics significantly associated with gender preference were ecological region (p=0.007), education (p=0.009), marital duration (p=0.044) and parity 0.32.Conclusions:The wish to have son is prevalent among the respondents followed by a mixed gender of children. Educational status, ecological region, and parity explain this differential wish. Women’s education and autonomy are the areas to tackle with sex biasof offspring

An evaluation of fixed dose combinations and it’s practices at medicine department of tertiary care hospital, Nepal

Background:A large proportion of fixed dose combinations (FDCs) are manufactured and used widely in Nepal. This study aimed to evaluate the FDCs and its utilization in medicine department of tertiary care hospital. Methods:A cross-sectional study was conducted for 50 days among admitted patients in the medicine department of tertiary care hospital, Nepal. A predesigned form was used to collect the data at the time of patient discharge. Only the oral FDCs were selected for study.Microsoft Excel 2007 was used for statistical analysis and data were presented as number and percentage in tabulated and figure forms.Results:Oral FDCs were used in 27.08% of admitted patients. A total of 295 FDCs were prescribed in 208 patients with 44 FDC items in 58 different brand names. Categorically, the most commonly used FDCs were of analgesics (34.24%) followed by antibiotics (25.76%) and vitamin supplements (22.71%). The 27.27% of FDCs prescribed contain more than two active pharmaceutical ingredients (APIs) up to nine and the highest number of APIs were found in vitamin supplements. All FDCs were prescribed in the brand names. The very few 2.27% and 4.55% of FDCs were prescribed from the essential medicine list of Nepal and world health organization, respectively.Conclusions:The use of FDCs listed in essential medicine list was very poor. Similarly, generic prescribing was also zero. The regulatory body must study the rationality of FDC before production, marketing, importing, and utilization in hospital.

Mapping the high burden areas of cholera in Nepal for potential use of oral cholera vaccine: An analysis of data from publications and routine surveillance systems

Objective: To assess the extent of existing published evidence on cholera and to characterize the epidemiologic data of cholera in Nepal. Methods: We conducted a literature scoping review by summarizing published literature reporting on cholera in Nepal from January 1946 to March 2019 in online databases: MEDLINE, Embase, Cochrane, and Global Health. Additionally, we reviewed national surveillance data on clinically diagnosed and laboratory confirmed cholera reported by the Ministry of Health and Population. Results: Most of the published studies were conducted predominantly in Kathmandu Valley during the rainy season; however, outbreaks have been reported in other parts of Nepal including Terai, Hilly and Mountain regions. Our literature review exhibited that all age groups were affected by cholera, but particularly children and young adults were at-risk age groups in Nepal. Vibrio cholerae serogroup O1, biotype El Tor, serotype Ogawa has been predominantly isolated with an emergence of resistant strains since 1996. Two mass vaccination campaigns using oral cholera vaccines were conducted: Rautahat district in 2014 and Banke district in 2017. Conclusions: Capacity building for a nation wide systematic cholera surveillance with rapid and reliable diagnosis is needed to better estimate the burden of cholera and identify geographically at-risk areas associated with the disease in Nepal. It is essential for developing an adequate policy on oral cholera vaccine introduction and effective water, sanitation and hygiene interventions.

Mapping the high burden areas of cholera in Nepal for potential use of oral cholera vaccine: An analysis of data from publications and routine surveillance systems

Objective: To assess the extent of existing published evidence on cholera and to characterize the epidemiologic data of cholera in Nepal. Methods: We conducted a literature scoping review by summarizing published literature reporting on cholera in Nepal from January 1946 to March 2019 in online databases: MEDLINE, Embase, Cochrane, and Global Health. Additionally, we reviewed national surveillance data on clinically diagnosed and laboratory confirmed cholera reported by the Ministry of Health and Population. Results: Most of the published studies were conducted predominantly in Kathmandu Valley during the rainy season; however, outbreaks have been reported in other parts of Nepal including Terai, Hilly and Mountain regions. Our literature review exhibited that all age groups were affected by cholera, but particularly children and young adults were at-risk age groups in Nepal. Vibrio cholerae serogroup O1, biotype El Tor, serotype Ogawa has been predominantly isolated with an emergence of resistant strains since 1996. Two mass vaccination campaigns using oral cholera vaccines were conducted: Rautahat district in 2014 and Banke district in 2017. Conclusions: Capacity building for a nation wide systematic cholera surveillance with rapid and reliable diagnosis is needed to better estimate the burden of cholera and identify geographically at-risk areas associated with the disease in Nepal. It is essential for developing an adequate policy on oral cholera vaccine introduction and effective water, sanitation and hygiene interventions.

Lesbian, Gay, Bisexual, Transgender, Intersex People Residing on Blue Diamond Society of Dhumbarahi, Kathmandu, Nepal: A Social Life Perspective

Background:Sex refers to biological and physical characteristics that are linked with labeled male or female. Transgender refers to a person whose sense of personal identity and gender does not correspond with their birth sex. Objectives:The objective of the study was to determine the social life of LGBTI living at blue diamond society.Methodology:A descriptive cross-sectional study design was adopted among 188 respondents living at Blue diamond society Dhumbarahi, Kathmandu. Non-probability, purposive sampling technique and structured interview were used for data collection. Data was analyzed by using SPSS version 16 and percentage was calculated and presented in tables.Results:Among 188 respondents, 28.2% were transgender male, 28.7% were transgender female, 22.9%were gay and 20.2% were lesbian,all (100%) of the respondents have difficulty walking outside the society, all(100%) of the respondent have difficult to adjust beside their own society and all(100%) of the respondents do not have job opportunity in the society.Conclusion:The above results concluded that further studies on various topics related to LGBTI are needed to conduct for improvement of social life of LGBTI

Knowledge and practice regarding the use of emergency contraception among the higher secondary students of Nepal

Background: Emergency contraception or post coital contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. Among the adolescents, premarital and unplanned sexual intercourse mostly result unintended pregnancy. In such conditions, emergency contraception is effective, safe and relatively inexpensive and can prevent pregnancies up to 95% if taken immediately or within 5 days after the sexual intercourse. Emergency contraception is available in pill form and IUD. Objective of this study was to assess the knowledge and practice of emergency contraception use among the higher secondary level students.Methods: Study includes descriptive cross-sectional method with total 190 respondents who were selected though census method of sampling. Study data were collected through semi structured questionnaire and the data was analyzed by using the SPSS version 20.Results: Mean age of the respondent was 17.8 years and 98.4% of them were unmarried. Among the total respondents only 63.7% of them have heard about the emergency contraception. About 14.2% of the respondents had experience sexual intercourse, out of those 51.8% have used emergency contraceptive method to prevent them from unintended pregnancies. Among those who had experience sexual intercourse, 22% of them got unintended pregnancies, which were managed through surgical abortion (83.3%) and medical abortion (16.7%).Conclusions: Knowledge on proper use of emergency contraceptives can prevent unintended pregnancies that may occur among the adolescents due to premarital and unplanned sexual intercourse. However, only two third of respondents have heard about the emergency contraceptives. So it is important to raise awareness on emergency contraception and its rational use among the adolescents.

Current status of breast cancer in Nepal

Breast carcinoma is one of the most common and dreaded diseases of women, and in Nepal, it is second most common cancer. The situation is more alarming in the rural areas where the majority of women are illiterate and ignorant about the hazards of breast cancer. Different screening strategies such as rural cancer registries and camp approach for cancer detection have been found useful in minimizing the problem of breast cancer in the villages. Advanced presentation of breast cancer and the problem of late diagnosis is well documented in Nepal. Moreover, diagnostic workup, treatment and palliative services are inadequate in most parts of Nepal. A better understanding current situation of breast cancer can help government to formulate breast cancer prevention strategy in Nepal. In this review, authors present an overview of the burden of breast cancer, risk factors, screening, and cancer care among Nepalese women.

Knowledge on pulmonary tuberculosis among Dalit community of Bharatpokhari VDC of Kaski district, Nepal

Background: Tuberculosis still remains public health problems in Nepal. Previous studies among marginalized ethnic groups suggest that being poor increases the risk of tuberculosis. Dalit communities are those communities in Nepal, backward in social, economic and educational fields and are not excluded from the risk of tuberculosis. The objective of the study was to determine the level of knowledge on pulmonary tuberculosis among Dalit community of Bharatpokhari VDC of Kaski.Methods: Community based cross-sectional study was conducted to determine the level of knowledge on pulmonary tuberculosis among Dalit community of Bharatpokhari VDC, Kaski from January 2010 to July 2010. Samples were taken randomly from different wards of the VDC. Data was collected by using pretested structured questionnaire by home to home visit of age 15-49 years. Data was collected from 15th January 2010 to 15th May 2010.Results: Study revealed that 29% respondents had adequate level of knowledge on pulmonary tuberculosis. The factor, education status was associated with level of knowledge on pulmonary tuberculosis on bivariate analysis (p=0.005).Conclusions: More than two third of the respondents had inadequate level of knowledge on pulmonary tuberculosis. Thus, recommends for the awareness programme on pulmonary tuberculosis. The education status and level of knowledge on pulmonary tuberculosis was significantly associated on bivariate analysis, and recommends for improvement in the education status of dalit community would be beneficial.

An Autochthonous Human Case of Fasciolopsiasis in Nepal

Fasciolopsiasis is rarely known as the parasitic disease in Nepal. Herein, we report a case of fasciolopsiasis in a 22-year-old man who was admitted in the hospital with abdominal pain, distension and loss of appetite for a month. He had previously diagnosed with acute viral hepatitis but, his abdominal pain was not resolving despite improvement in his liver function and general condition. During endoscopy an adult digenean worm was seen in the first part of the duodenum. After isolation, the worm was identified morphologically as Fasciolopsis buski. Microscogic examination of the patient’s stool revealed eggs with a morphology consistent with F. buski. Eggs were yellow-brown, ellipsoidal, unembmbryonated, operculated, filled with yolk cells, with thin shell and ranging 118–130 μm in length and 60–69 μm in width. The abdominal pain of the patient was resolved after treatment with praziquantel. By the present study, it was confirmed for the first time that fasciolopsiasis is indigenously transmitted in Nepal. Accordingly, the epidemiological studies in humans and reservoir host animals should be performed intensively in near future.

Non-related contact lens coinfection with Acanthamoeba and Fusarium

Rationale: Microbial keratitis caused by coinfection with more than one species of pathogens is a severe condition with an unfavorable prognosis. Patient concerns: An immunocompetent Nepali woman complained of pain in the left eye, redness, watering and decreased vision for 5 months. Interventions: The patient was discarded and accurately diagnosed with coinfection with Fusarium sp. and Acanthamoeba sp. The habit of washing the eyes with tap water from a domestic storage tank was the most likely source of infection since it was found to be contaminated with cysts of Acanthamoeba sp. The woman received eye drops of fluconazole and natamycin (5%), cefazoline (50 mg/mL), atropine, and tablets of itraconazole (100 mg), which were later switched to eye drops of clotrimazole (1%), natamycin (5%) and voriconazole (1%), and tablets of itraconazole. A full thickness penetrating keratoplasty was performed followed by treatment with eye drops of voriconazole (1%), natamet (5%), ofloxacin, atropine and carboxymethylcellulose for one week. Outcomes: After treatment, the condition of the patient significantly improved and was discharged one week after keratoplasty. Lessons: This is the first report of Acanthamoeba keratitis in Nepal and the first report of coinfection with Fusarium in this country and highlights the importance of early diagnosis of microbial keratitis both in single microorganism infections and coinfections, even in no contact lens wearers.

Non-related contact lens coinfection with Acanthamoeba and Fusarium

Rationale: Microbial keratitis caused by coinfection with more than one species of pathogens is a severe condition with an unfavorable prognosis. Patient concerns: An immunocompetent Nepali woman complained of pain in the left eye, redness, watering and decreased vision for 5 months. Interventions: The patient was discarded and accurately diagnosed with coinfection with Fusarium sp. and Acanthamoeba sp. The habit of washing the eyes with tap water from a domestic storage tank was the most likely source of infection since it was found to be contaminated with cysts of Acanthamoeba sp. The woman received eye drops of fluconazole and natamycin (5%), cefazoline (50 mg/mL), atropine, and tablets of itraconazole (100 mg), which were later switched to eye drops of clotrimazole (1%), natamycin (5%) and voriconazole (1%), and tablets of itraconazole. A full thickness penetrating keratoplasty was performed followed by treatment with eye drops of voriconazole (1%), natamet (5%), ofloxacin, atropine and carboxymethylcellulose for one week. Outcomes: After treatment, the condition of the patient significantly improved and was discharged one week after keratoplasty. Lessons: This is the first report of Acanthamoeba keratitis in Nepal and the first report of coinfection with Fusarium in this country and highlights the importance of early diagnosis of microbial keratitis both in single microorganism infections and coinfections, even in no contact lens wearers.

Factors Associated With Stillbirth Among Pregnant Women in Nepal / 예방의학회지

OBJECTIVES: Stillbirth is a common adverse pregnancy outcome that represents a distressing and traumatic event for women and their partners. The aim of this study was to identify factors associated with stillbirth in ever-pregnant women in Nepal. METHODS: This study utilized the individual women's dataset from the Nepal Demographic and Health Survey, conducted in 2016. The dependent variable of interest was whether women had at least 1 stillbirth during their lifetime. The associations between independent variables and the dependent variable of the study were analyzed using a multiple logistic regression model. RESULTS: Among 8918 ever-pregnant women aged 15-49 years, 488 had experienced at least 1 stillbirth during their lifetime, representing 5.5% of the total. After adjusting each factor for the confounding effects of other factors, maternal age, maternal education, place of residence, and sub-region remained significantly associated with having experienced stillbirth. CONCLUSIONS: Stillbirth continues to be a major problem among women, especially those with higher maternal age, those who are illiterate, and residents of certain geographical regions. To minimize stillbirth in Nepal, plans and policies should be focused on women with low education levels and residents of rural areas, especially in the western mountain and far-western hill regions.

Prevalence and Associated Factors of Hypertension Subtypes Among the Adult Population in Nepal: Evidence from Demographic and Health Survey Data

OBJECTIVES: This study aims to determine the prevalence, and associated factors of undiagnosed hypertension [Systolic Diastolic Hypertension (SDH), Isolated Systolic Hypertension (ISH) and Isolated Diastolic Hypertension (IDH)] in the Nepalese adult population.METHODS: Nepal Demographic and Health Survey 2016 data from adults (≥ 18 years) was used in this study. The final weighted sample size was 13,393. Blood pressure (BP) was measured 3 times and the average of the second and third measurement was reported. SDH (systolic BP (SBP) ≥ 140 mmHg and diastolic BP (DBP) ≥ 90 mmHg), ISH (SBP ≥ 140 mmHg and DBP < 90 mmHg), and IDH (SBP < 140 mmHg and DBP ≥ 90 mmHg) were measured. Multilevel logistic regression analyses were conducted to find the association between the independent variables and the covariates.RESULTS: The prevalence of SDH, IDH and ISH were 8.1%, 7.5%, and 3.3% respectively. The odds of having SDH and ISH increased with old age. However, the odds of having IDH decreased with increasing age. Females has lower odds of having SDH and IDH compared with male participants. Individuals that had been married, resided in Province 4 (p < 0.05) or 5 (p < 0.01) were statistically significantly associated with having IDH. Being overweight or obese was statistically significantly associated with all 3 HTN subtypes (p < 0.001).CONCLUSION: The necessary steps should be taken so that public health promotion programs in Nepal may prevent and control undiagnosed hypertension.