Admitting Deserving Medical Students from Rural and Disadvantaged: Patan Academy of Health Sciences' Approach.

BACKGROUND: Patan Academy of Health Sciences (PAHS) aims to produce physicians who would be able and willing to serve in the rural areas. Recognizing the critical importance of student selection strategy, among others, in achieving the program goals, it has adopted an innovative scheme for selecting medical students. This paper describes PAHS medical student selection scheme that favors enrollment of deserving applicants from rural and disadvantaged groups so as to help improve distribution of physicians in rural Nepal. METHODS: A student admission committee comprising a group of medical educators finalized a three-step student selection scheme linked with scholarships after reviewing relevant literatures and consultative meetings with experts within and outside Nepal. The committee did local validation of Personal Quality Assessment (PQA) that tested cognitive ability and personality traits, Admission OSPE (Objective Structured Performance Examination) that assessed non-cognitive attributes of applicants. It also provided preferential credits to applicants' socio-economic characteristics to favor the enrollment of deserving applicants from rural and disadvantaged groups through Social Inclusion Matrix (SIM). Three different categories of scholarship schemes namely Partial, Collaborative and Full were devised with Partial providing 50% and other two categories each providing 100% coverage of tuition fee. RESULTS: PAHS student selection scheme succeeded in enrolling more than half of its students from rural areas of Nepal, including about 10% of the students from that of the most backward region of the country. About one third of students were female and about the same were from public and community school. Sixty percent of students receive different categories of scholarships. CONCLUSIONS: Limited findings indicate the success of the selection scheme in enrolling high proportion of applicants from rural and disadvantageous groups and enable them to pursue study by providing scholarships.

Development of Community Based Learning and Education system within Undergraduate Medical Curriculum of Patan Academy of Health Sciences.

BACKGROUND: In response to continuing health disparities between rural and urban population, Patan Academy of Health Sciences (PAHS) was established in 2008. It aimed to produce physicians who would be able and willing to serve in the rural areas. In order to empower them with understanding and tools to address health issues of rural population, an innovative curriculum was developed. This paper aims to describe the community based learning and education (CBLE) system within the overall framework of PAHS undergraduate medical curriculum. METHODS: A Medical School Steering Committee (MSSC) comprising of a group of committed medical educators led the curriculum development process. The committee reviewed different medical curricula, relevant literatures, and held a series of consultative meetings with the stakeholders and experts within and outside Nepal. This process resulted in defining the desirable attributes, terminal competencies of the graduates, and then the actual development of the entire curriculum including CBLE. RESULTS: Given the critical importance of population health, 25% of the curricular weightage was allocated to the Community Health Sciences (CHS). CBLE system was developed as the primary means of delivering CHS curriculum. The details of CBLE system was finalized for implementation with the first cohort of medical students commencing their studies from June 2010. CONCLUSIONS: The CBLE, a key educational strategy of PAHS curriculum, is envisaged to improve retention and performance of PAHS graduates and, thereby, health status of rural population. However, whether or not that goal will be achieved needs to be verified after the graduates join the health system.

Outbreak Investigation of Influenza in Pajaru VDC of Jajarkot District of Nepal.

BACKGROUND: An outbreak investigation study was conducted in Pajaru, one of the initially affected Village Development Committees (VDCs) of the Jajarkot district in Nepal following an outbreak of respiratory illness in early 2015. The objectives of this study were to identify the cases and magnitude of the outbreak. METHODS: A cross-sectional study was carried out in mid-April 2015 covering five most affected wards of Pajaru VDC to assess the patients using standard case definition for Influenza like Illness (ILI). Throat and nasal swabs were collected and sent to the National Influenza Center (NIC) in Kathmandu for laboratory confirmation. RESULTS: The throat swab samples tested at NIC found Influenza A H1N1 pdm09. The attack rate was calculated to be 3% in ward number 9 and 41% in ward number 8. Wavelength of the infection was nearly two weeks in both the wards. Nearly 54% of the specimens were positive for Influenza A H1N1 pdm09. There was no ILI case fatality in the study area. Children aged 0-15 years were most affected. Majority of the patients presented with symptoms of fever, cough and sore throat. CONCLUSIONS: There was gradual decline in the number of cases in all five wards suggestive of development of natural immunity in the community. True severity of the outbreak was not accurately reflected as compared to media reports.

Confinement resonances in photoionization of Xe@C60+.

Experimental evidence is presented for confinement resonances associated with photoabsorption by a Xe atom in a C60 cage. The giant 4d resonance in photoionization of Xe is predicted to be redistributed into four components due to multipath interference of photoelectron waves reflected by the cage. The measurements were made in the photon energy range 60-150 eV by merging a beam of synchrotron radiation with a mass/charge selected Xe@C60+ ion beam. The phenomenon was observed in the Xe@C(58)(3+) product ion channel. [corrected]

Dyselectrolytemia in chronic obstructive pulmonary diseases with acute exacerbation.

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality and morbidity world wide. Due to lack of awareness about the precipitating factors and predictors of prognosis, cases of acute exacerbation of COPD often suffer the fatal outcomes. In our study we assessed the levels of serum sodium and potassium in subjects with acute episodes of COPD and their healthy controls. We found a significantly low level of serum sodium (133± 6.86 meq/lit) and potassium (3.39 ± 0.96 meq/L)) in subjects with acute exacerbation of COPD than their healthy counterparts [sodium-142 ± 2.28 meq/L and potassium- 4.52 ± 0.02 meq/L (p <0.05)]. Therefore, our study findings suggest that, serum sodium and potassium levels may get deranged in subjects with acute exacerbations of COPD which should be routinely checked for to avoid fatal outcomes.

Environmental burden of acute respiratory infection and pneumonia due to indoor smoke in Dhading.

BACKGROUND: ARI and pneumonia is one of the major public health problems in Nepal which always ranks highest position among the top ten diseases. One of the risk factor of ARI and pneumonia is indoor smoke from kitchen where primary source of cooking is solid biomass fuel. This study was carried out in order to estimate the burden of ARI and pneumonia due to indoor smoke. ARI and pneumonia was chosen as it is one of the significant public health problem among under five children in Nepal and responsible for high number of premature deaths. METHODS: A cross-sectional study was conducted in Dhading district. Multistage cluster sampling technique was used for data collection considering ward as a cluster. The environmental burden of ARI and pneumonia due to indoor smoke was calculated using the WHO Environmental Burden of Disease Series. RESULTS: About 87 percent of households were using solid biomass fuel as a primary source of fuel. The under five children exposed to solid fuel use was 41313. The total 1284 Disability Adjusted Life Years were lost due to ARI and pneumonia and about 50 percent of it was attributed by Indoor smoke in household. CONCLUSIONS: The solid biomass fuel was primary source of energy for cooking in Dhading district which is attributing about 50 percent of burden of ARI and pneumonia among under five children.

Prevalence of anemia amongst adolescents in Nepal: a community based study in rural and urban areas of Morang District.

Adolescence covers 10-19 years of human age and is the transition period of life. In Nepal around 23 percent population are in this age group. A cross sectional community based study was carried out in Morang district to determine prevalence and distribution of anemia in terms of age, sex and locations (urban and rural) among adolescent population. Sahli method was used to determine the hemoglobin level. Three hundred and eight adolescents (127 urban, 181 rural in terms of location and 151 male, 157 female in terms of sex) participated in the study. The overall prevalence of iron deficiency anemia among adolescent population was 65.6% with the distribution of rural 62.4%, urban 70.0%, male 52.3% and female 78.3%. Sufficiency or deficiency of iron makes the living of adolescents different as it affects their growth requirement and cognitive performance. Iron reserve in female result better reproductive outcome. In Nepal, iron deficiency anemia among male adolescent has not been documented yet and this study reports more than half of them are found anemic which warrant further study.

Community ear care delivery by community ear assistants and volunteers: a pilot programme.

Hearing impairment is a major public health problem in Nepal. The present service delivery, however, is mainly hospital based and is limited to large towns. Those people residing in rural areas lack many basic needs including ear care services. The collaborative community volunteer-based ear care pilot programme implemented in Banke, Nepal aims to reach out to those rural areas by establishing sustainable primary ear care services, empowering and utilizing local resources. The focus of the programme is to promote multi-sector improvement in sanitation, nutrition, immunization, breast-feeding and timely care and support to ear patients to help prevent hearing impairment mainly from the sequelae of otitis media.

Reliability of clinical diagnosis in identifying infectious trachoma in a low-prevalence area of Nepal.

The WHO Alliance for Global Elimination of Trachoma by 2020 has increased the need to identify ocular chlamydial infections by clinical examination in areas of both high and low prevalence. The relationship between clinically active trachoma (as defined by clinical examination) and chlamydial infection is known for areas with hyperendemic trachoma, but not for areas with a low prevalence of the clinical disease. In the present study, we examined, photographed, and DNA tested the conjunctivae of children in the Surkhet district of mid-western Nepal, an area known to have a low prevalence of clinically active trachoma. Although 6% of the children aged 10 years and under were found to have clinically active trachoma, none were found to have chlamydia infection by the most sensitive DNA amplification tests available. A very low prevalence of clinically active trachoma is not necessarily evidence of the presence of chlamydial infection. Therefore, the WHO policy of not recommending an intensive trachoma control effort when the prevalence of clinically active trachoma is less than 10% in children is appropriate for this area of Nepal.

PIP: This article assesses the reliability of clinical diagnosis in identifying trachoma in a low prevalence area in Nepal. WHO¿s Alliance for Global Elimination of Trachoma by the year 2020 depends on the identification of communities in which blinding trachoma is present and of individuals in these communities who are seeking treatment. All children aged 1-10 from 6 villages in the Surkhet district of the Bheri zone underwent clinical tests, which were administered between November 17 and December 1, 1997. 726 out of 765 children were examined. 125 among these were further evaluated by photography and DNA testing on their right conjunctivae. Clinically active disease was found in 46 out of 726 children seen by the first examiner. Photographic evaluation showed that 32 of these 46 children had clinically active disease, while 14 of 79 children were found negative of the disease on examination. The results revealed that there was a low prevalence of active conjunctival disease in this area: only 6% of the children were clinically active on examination, and none were found to have chlamydia infection as assessed by the most sensitive DNA amplification test available. The WHO policy of not recommending an intensive trachoma control effort when the prevalence of clinically active trachoma is less than 10% in children is therefore appropriate for this area in Nepal. Clinical examination is the only feasible way of estimating the prevalence of infection; however, very low prevalence of active trachoma is not evidence for the presence of chlamydial infection.