Sexual behaviour of people living with HIV attending a tertiary care government hospital in Kathmandu, Nepal: a cross sectional study.

BACKGROUND: Clinical improvements that follow antiretroviral therapy (ART) may lead to increase or resumption of high risk activities that could unintentionally result in HIV transmission. The objective was to investigate whether treatment status is a significant predictor of sexual risk behaviour (unprotected sex). METHODS: A cross sectional study was conducted among 160 people living with HIV (PLHIV) (89 ART experienced and 71 ART naïve) attending Sukraraj Tropical and Infectious Disease Hospital in Kathmandu, Nepal. A structured questionnaire was used for data collection. Logistic regression with stepwise modeling was used to obtain adjusted odds ratios (OR) with 95 % CI. RESULTS: In this study, 92 % of sexually active respondents reported sex with a regular partner. ART experienced PLHIV were significantly more likely to report consistent condom use with their regular partners compared to ART naïve PLHIV (83 vs. 53 %; P = 0.006) during the past six months. In multivariate analysis, sex (OR = 4.59, 95 % CI: 1.15-18.39), treatment status (OR = 4.76, 95 % CI: 1.29-17.52) and alcohol consumption during last sex with regular partners (OR = 14.75, 95 % CI: 2.75-79.29) were significantly associated with unprotected sex. CONCLUSION: ART naïve PLHIV were five times more likely to exhibit sexual risk behaviour (have unprotected sex) than ART experienced PLHIV. Thus the study provided no evidence to suggest that ART experienced PLHIV exhibit greater sexual risk behaviour compared to ART naïve PLHIV. Prevention programmes need to emphasize on counselling to PLHIV and their regular partners with focused interventions such as couple counselling and education programmes.

Cost of diabetes mellitus care among patients attending selected outpatient clinics.

INTRODUCTION: In developing countries diabetes mellitus affects economically productive age group; more often affecting the productive member of the family. The objective of the study was to estimate the direct and indirect cost of illness of patients with DM attending the selected outpatient clinics in Kathmandu Valley. METHODS: A cross-sectional study was carried out in four outpatient clinics in Kathmandu Valley among 227 diabetic patients selected purposively. It was conducted from July to September, 2010. An adapted and pretested semi structured questionnaire was administered to diabetic patients aged 20 to 60 years with a minimum of a year of illness. RESULTS: The mean total cost per visit by a diabetic patient to an outpatient clinic was US$13.3 (95% CI: 11.70-14.92). Likewise the total cost incurred in the treatment and care of DM per month was US$ 40.41 (95% CI: 36.38-44.45) and per annum was US$ 445 (95% CI: 396.11- 495.61). In addition, the study results also showed that with increase in total direct cost per annum the duration of illness also increases. CONCLUSIONS: There is a high cost burden on the patient with DM visiting the selected private sector outpatient clinics.

Parenteral organophosphorus poisoning in a rural emergency department: a case report.

BACKGROUND: Poisoning is a common presentation in the emergency department. Oral exposures to organophosphorus compounds are especially frequent in rural and agricultural regions of South Asia and throughout the developing world. CASE PRESENTATION: Here we report a case of deliberate self-harm with an organophosphorus pesticide via the relatively uncommon parenteral route. A young woman injected herself with chlorpyriphos. Although the cholinergic effects were mild, cellulitis and abscess development were noted as a result. CONCLUSION: Resource limited agricultural countries like Nepal present health care workers with numerous challenges in poisoning management. This case represents a rare but potentially morbid method of agrochemical poison exposure.