Identification of alcohol problem among long route bus drivers and staffs of Dharan, eastern Nepal: Assessing from the CAGE and DSM-IV tools.

BACKGROUND: Alcohol use remains a major cause of preventable death worldwide occurring prematurely. Despite its global burden, alcohol still is a legal drug. Various studies have also shown that factors like education, occupation, influence from films and family, for stress relief, pleasure during alcohol use, better self-esteem, and occupational boredom are associated with alcohol use. The consumption of alcohol, even in relatively small amounts, increases the risk of being involved in a crash for motorists and pedestrians. It is also associated with impaired judgments and so is often linked to road traffic accident. OBJECTIVES: To assess the prevalence, type of alcohol use, and the associated factors for the initiation of alcohol use among bus drivers and staffs of long route bus of Dharan. To assess the knowledge, attitude, and practice regarding alcohol use for their willingness to quit it with medical help. MATERIALS AND METHODS: The cross-sectional survey was conducted in 250 long route drivers and staffs in Dharan Bus Park in 2016 with the help of a self-designed questionnaire in Nepali language. The sample size was preliminarily estimated on the basis of the prevalence of alcohol use. The "Alcohol consumer" refers to drivers who used alcohol at least once in the previous year. RESULTS: Alcohol dependency among Hindu was found to be significantly more than other religious group. The prevalence of alcohol consumption was found to be 78%. About 51% drivers are likely to have alcohol problems, 39% are alcohol abuser, and 45% are alcohol dependent. CONCLUSION: Drinking and driving increase the vulnerability to injury and death on the road. The study creates awareness among drivers about the harmful use of alcohol and psychosocial consequences.

Clinico-epidemiological study of low birth weight newborns in the Eastern part of Nepal.

Low birth weight (LBW) remains an important cause of newborn morbidity and mortality. A hospital based prospective and descriptive study was conducted at Paediatric wards, Nursery, Neonatal intensive unit (NICU) and Post natal ward during period of June to October 2010 to note the clinico-epidemiological profile of Low Birth Weight (LBW) newborns. Incidence of the LBW babies in our hospital was 14.45%; more than four fifth (82.2%) baby's mothers were primigravida. Eighty two percent mothers had unbooked pregnancies. Twenty and half percent LBW babies were twins. The mean duration of hospital stay of the subject was 7.4 (± 5.5) days. The mean birth weight of LBW babies was 1648 (± 344) grams. Clinical sepsis, non physiological jaundice and hypoglycaemia were the three most common complications of LBW babies. Antibiotics, oxygen and phototherapy were the three commonest modes of therapy. Majority of children (82.0%) improved and were discharged. Birth weight and gestational age were significantly different between survivors and babies who expired. Primigravida and lesser antenatal visits were important risk factors for Low birth weight babies. Birth weight, gestational age, apnoea and mechanical ventilation were the predictors of outcome.

Smoking habit among male medical and dental students of B.P.Koirala Institute of Health Sciences, Nepal.

BACKGROUND: Smoking and health are intimately related and thus, smoking among future health care personnel is an important issue. As future physicians and dentists who will witness the continued burden of smoking-related diseases among their patients, represent a primary target for smoking prevention programs. OBJECTIVES: To explore the magnitude of smoking problem and assess the major causes aggravating the burden of smoking among medical and dental students. METHODS; A cross sectional study was conducted between June and July 2009 among 345 medical and dental students. Pre-tested self-administered questionnaire containing questions regarding smoking and its various correlates were used to collect the data. Chi square test was used for testing hypothesis. RESULTS: Prevalence of smoking was estimated as 38.4%, among whom majority started smoking during 15 to 19 years of life. Peer pressure was the major cause behind smoking (29.5%). Nearly one third of the participants used to consume alcohol along with smoking. Presence of parental smoking and use of other drugs were significantly associated with smoking among the students. CONCLUSION: Tobacco smoking is a significant health problem among the male medical and dental students. Medical and dental students were approached as they are the treatment providers for smoking and disease related to it in the future. The results in our study are discouraging and reveal that the medical knowledge regarding ill effects of smoking has not been able to check its use.

Examination of relationship of scores obtained in grades 10 and 12 with the entry and success in undergraduate medical education.

BACKGROUND: Entrance examination (admission test) is the most important and widely accepted method of student selection for admission into medical schools in Nepal. For many schools it is the only criterion of student selection. OBJECTIVES: To examine relationships of scores obtained in schooling (grade 10 and 12), medical entrance and MBBS professional examinations in a cohort to identify predictive strength for entry into medical school and success in medical education. METHODS: Exam scores from grade 10 to medical entrance and professional exams of undergraduate medical education of a total of 118 medical students who entered medical school between 1994 and 1998 only through the merit of open competitive medical entrance examination at the BP Koirala Institute of Health Sciences (BPKIHS) were assessed. RESULTS: Student selection for admission in MBBS course at BPKIHS and their subsequent success were not determined by difference in outcomes of public and private management of schools at grade 10 (selection p= 0.80 and success p= 0.32 ) and grade 12 (selection p= 0.59 and success p= 0.55). Grade 12 averaged scores had no relationship in getting these students selected for admission into medical course (r= 0.08, p= 0.37), but did show correlation with the overall success in medical education (r= 0.32, p= 0.00). Scores in physics at grade 12 retained predictive strength in success in medical education (r= 0.19, p= 0.04). CONCLUSION: The present student selection criteria for medical education are not appropriate and need to incorporate other attributes of candidates along with cognitive aspects.

Prevalence of tuberculosis in household contacts of sputum smears positive cases and associated demographic risk factors.

Pulmonary tuberculosis (PTB) is transmitted by aerosolized droplets nuclei. Home is the vulnerable place for transmission of this disease to its contacts. Risk factors associated with this contact transmission may differ according to locality. This study aims to determine the prevalence of household contact (HC) PTB and examine the risk factors contributing to it. A cross-sectional study was conducted to determine the prevalence of HC TB among HCs aged > 5 years in Dharan. During the study period (June 2009 - May 2010), 184 index cases with sputum smear positive for AFB and their 802 HCs were included. Three sputum specimens were collected from each HCs and examined microscopically for AFB detection. The prevalence of HC TB was found to be 1.6%. The result was statistically associated (P < 0.05) with illiterate HCs (OR= 5.77, 95%CI =1.52-21.81), close proximity with ICs (OR=3.07, 95%CI = 1.02-9.25), primary relatives to ICs (OR= 4.85, 95%CI = 1.07-22.05) and slum dweller (OR = 4.56, 95%CI = 1.25-16.71). Similarly, AFB positivity was associated (P<0.05) with household crowding (OR = 7.46, 95%CI = 2.36-23.49), room size < or = 10 x 10 feet (OR=4.05, 95%CI = 1.23-13.25), firewood user while cooking (OR = 5.96, 95%CI = 1.92-18.45). The prevalence of HCs tuberculosis is found to be 1.6%. Poverty, illiteracy, overcrowding, close proximity, close relation with ICs, firewood while cooking, slum dweller, are major factors highlighted by this study as risk factors of contact TB. Our results recommend a much better contact tracing and treatment program.

Impact and determinants of gender preference in Duhavi VDC of eastern Nepal.

INTRODUCTION: Gender equality has been a priority area of demographic research. One of the major reasons for high fertility and low acceptance of family planning is the prevalence of gender preference among couples. The objectives of this study were to identify the determinants and examine the extent of gender preference on fertility. METHODS: This is a cross-sectional study carried from June 2008 to July 2009 in Duhavi VDC of Sunsari district of Nepal. Three hundred and five randomly selected ever-married women of 15 - 49 years, who had at least one child were the subjects of the study. A questionnaire covering the areas on gender and fertility preference and methods and use of contraception was given and filled up. RESULTS: The study showed that 42.6% of the ever-married women belonged to the 25 - 29 years age group. Around 92% of women whose last child was a male were using family planning methods whereas only 40% of women whose last child was a female were using family planning methods. This difference was statistically significant (P < 0.0001). CONCLUSIONS: The contraception use among the women having a female child was low, showing a desire for a male child which is one of the factors in the increase of family size in our society. Due to the patrilineal society, women are discouraged in the practice of contraception. Effective intervention programs need to be planned and conducted to rectify this situation.

Association of serum LDL cholesterol level with periodontitis among patients visiting a tertiary-care hospital.

INTRODUCTION: High low-density lipoproteins (LDL) cholesterol is one of the major risk factors for cardiovascular disease. In recent years, some evidence has been presented that periodontitis, an infectious inflammatory condition of the periodontium, is associated with an increased risk of cardiovascular disease. To further elucidate this association, we have studied the levels of LDL cholesterol, a known risk marker for cardiovascular disease, in a periodontally-diseased group. METHODS: The levels of serum LDL cholesterol in 47 subjects with mild to severe (clinical attachment loss equal to or greater than 1 mm) chronic generalized (at least 30% of teeth affected) periodontitis with the mean age of 42.21 ± 1.46 years were measured and compared with those obtained from 42 age (39.83 ± 0.94) and sex matched controls. Both groups were free from systemic illnesses. RESULTS: The mean serum LDL cholesterol in periodontitis patients was found to be significantly higher (P < 0.001) as compared to that of the controls. The mean clinical attachment loss was positively correlated with serum LDL cholesterol (P < 0.01) and gingival index (P<0.05). The frequency of persons with pathologic values of LDL cholesterol was significantly higher in periodontitis patients compared with that of the controls. CONCLUSIONS: These results showed that high serum LDL cholesterol may be associated with periodontitis in healthy people. However, it is unclear whether periodontitis causes an increase in the levels of serum LDL or an increased LDL is a risk factor for both periodontitis and cardiovascular disease.

The burden of injury in terms of economics loss and disability days: a community based study form eastern Nepal.

BACKGROUND: Injuries are already a substantial public Health problem all over the world and are expected to increase in the 211st Century. They are major causes of deaths and disability in the population and also involve high societal costs. OBJECTIVES: This study was designed to assess the economic loss due to the injury and the disability days due to different types of injuries. METHODS: A systematic random sampling technique was used to select 1388 households from 19 wards. A detailed questionnaire was used to collect information related to injuries to the persons suffered from injuries including treatment obtained, cost of treatment (direct/indirect cost) and length of disability. RESULTS: Among the minor injured persons, majority (93.2%) did not spend any indirect cost. 36.7% of the major inured persons spent Nepalese rupees 10,001 to NRs 100,000 as direct treatment costs. But 50% spent less than 5000 NRs as indirect cost for major injury treatment. Maximum number (67.4%) of major injured persons had disability days of 31 to 90 days. CONCLUSION: The high incidence of injuries, especially road traffic injuries, adds a huge economic burden to nation.

Comparative attitude and plans of the medical students and young Nepalese doctors.

INTRODUCTION: Many doctors are leaving Nepal to work abroad. To understand this problem better, we decided to study the attitude and plans of young doctors and medical students. MATERIALS AND METHODS: This cross-sectional study was conducted at Kathmandu Medical College involving 65 first year medical students, 100 interns and 100 house officers. The data collected was entered in Microsoft excel and analysed by SPSS (Statistical Package for Social Sciences) programme. Chi-square test was used to compare two proportions. Significance level was set at 5%. RESULTS: Only 2% house officers said that their job prospects were excellent as compared to 22.4% of students, whereas 20% house officers as compared to 9% students thought job prospects in Nepal were poor (p= 0.003). Eighty two percent of students thought that a doctor's service to his country was very important as compared to 51% of interns (p= 0.001) and 58% of house officers. Forty percent of students, 58% of interns and 48% of house officers (no statistical significance between the three groups) planned to migrate to a developed country after graduation. Eighty eight percent of students, 89% interns and 74% of house officers (no statistical significant differences between the three groups) were of the opinion that improving career opportunities or working environment of the doctor could make the profession more attractive. CONCLUSION: Although majority of students, interns and house officers were of the opinion that a doctor's service to his community/country was very important, almost half of them still planned to migrate to a developed country after graduation. Improving the chances of professional advancement and professional working environment can make the profession more attractive, and therefore, may decrease this tendency for brain drain from our country.

An epidemiological study of injury among urban population.

BACKGROUND: Injuries are a focus of public health practice because they pose a serious health threat, occur frequently and are preventable. Injuries affect people of all ages and range from minor cuts and bruises to major catastrophes that take thousands of lives. OBJECTIVES: This paper aims to fi nd out the prevalence of injuries and to study the various epidemiological factors related to the injuries in Dharan. MATERIALS AND METHODS: A sample of 1398 households was taken as study sample. A systematic random sampling technique was used to select the 10% households from each 19 wards. A pre-tested questionnaire was used to collect demographic information and information related to injuries to the persons suffered from injuries. RESULT: The prevalence of minor injury in Dharan was 3.5% per month. The injury was common in the age group, 40-49 years (4.6%) and majority of injured persons were farmers (6.9%). Home was the common place (55.6%) for the minor injury. Cut/stab (32.8%) was the most common types of minor injury. The prevalence of major injury was 0.7% per year and occurred more among 50-59 years age group (1.7%). The commonest place for major injury was at road (53.1%) and service holders were at more risk (1.4%). Falls from the height (46.9%) were the most common types of major injury. CONCLUSION: The injuries related to lifestyle profession and road traffic accidents (RTA) is the commonest burden revealed in the study sample. Promotion of safety and education for protection at work and safe driving can prevent the major socio-economic loss to the family and community at large.

Work related complaints among dentists.

The objective of this study was to describe the occurrence of neck pain, shoulder pain and back pain among dentists and to assess the risk factors affecting them. Sixty-eight dentists from Dharan and Biratnagar were interviewed using pretested questionnaires in January 2006. Back pain was the most common complaint affecting almost 80% of the study population, followed by neck pain (58.8%) and shoulder pain (47%). The frequency of shoulder pain among female dentists was nearly double that of males (P=0.009). The mean days of neck pain among males was significantly higher as compared to females (P=0.048). The study suggests that musculoskeletal complaints are common among dentists, though they are not of severe nature. There is a scope for further decreasing the prevalence and severity of these disorders by performing regular specific exercises.

Knowledge about human genetics among school students of eastern Nepal.

School students from 10 to 19 years of age are adolescents. Adolescent girls are usually exposed to consequences of early marriage, pregnancy and increased responsibility. Genetic disorders are important issues to persons of the reproductive age group. History-taking and screening-tests could uncover risk factors that require diagnostic testing during pregnancy. Therefore, the present survey was conducted among 707 school students (55.6% males, 44.4% females) to find out their knowledge about human genetics. Data were collected as written responses to a close-ended questionnaire. The knowledge of students about human genetic was found to be poor. The majority of students was not aware of the prevalence of genetic disorders in the community. Many students (75%) felt that genetic laboratory facilities and counseling services are necessary in this country. More than half of the students did not know the name of a hospital where genetic laboratory services are available. The study indicates that there is a need to introduce the basics of human genetics in the school curriculum and to implement strategies for awareness programs about genetic disorders and their early detection for possible intervention.

Prevalence of complications of simple tooth extractions and its comparison between a tertiary center and peripheral centers: a study conducted over 8,455 tooth extractions.

This study was conducted to investigate and compare the prevalence of complications of simple tooth extractions in a tertiary centre (BP Koirala Institute of Health Sciences, Dharan) and the peripheral centers (Mechi and Koshi zonal hospitals). This is a prospective descriptive study. Tooth extractions were carried out under local anesthesia in the tertiary and the peripheral centers during one year period (March 15"th 2004 to March H"111 2005). Intraoperative and postoperative complications were recorded and analyzed. Out of 8,455 tooth extractions in 6,639 [male-2,465 (37.12%) and females - 4,174 (62.88%)] patients aged between 5yrs- 65 yrs, 7,152 extractions were done in tertiary center and 1,393 extractions were done in peripheral centers.90 complications (1.06%) were observed. 53(58.89%) complications were intraoperative and 37(41.12%) complications were postoperative. 60(0.84%) complications were observed in the tertiary center and 30 (2.3%) complications were observed in the peripheral centers and the difference was highly significant (P<0.000001). The most frequent complication in the tertiary centre was fracture of tuberosity (0.15%) and in the peripheral centers it was 'roots left' (0.77%). Prevalence of 'roots left', injury to adjacent tooth and postoperative hemorrhage was significantly high (P<0.05) in peripheral centers. The higher prevalence rate of complications of tooth extractions in the peripheral centers should not be overlooked and well equipped and organized extraction procedure with qualified dental practitioner is strongly suggested to minimize the complications.

Factors influencing mortality in perforated duodenal ulcer following emergency surgical repair.

Duodenal perforation is a common abdominal catastrophe with excellent outcome if prompt resuscitation and surgical repair of perforation are done. The aim of this study was to identify factors associated with death after surgery in patients with duodenal perforation. One hundred and forty-five patients who underwent Graham's patch repair for perforated duodenal ulcer between 14 April 2002 and 31 December 2004 were studied. The mean age was 45.99 years and 61 patients (42.07 %) were referrals. There were 124 (85.52 %) males and 21 (14.48 %) females. There were 10 deaths (6.9 %). The mean time delay was 2.46 days. It was 2.37 days in survivors, 3.7 days in non-survivors. The time delay was 3.25 days for females and 3.13 days for patients referred from another hospital. The mortality was significantly associated with time delay between perforation and operation (p<0.01), presence of co-morbid conditions (P<0.04), respiratory rate (p<0.02), raised blood urea (p<0.01) and serum creatinine (p<0.001), size of perforation (p<0.005), amount of peritoneal fluid (p=0.003) and requirement of postoperative intensive care unit support (p=0.003). Time delay between perforation and operation, preoperative blood urea and serum creatinine, size of perforation and amount of peritoneal fluid, presence of co-morbid conditions and need for post operative ICU support are the important predictors of outcome after emergency surgery for duodenal perforation.

Emergence of primary teeth in children of Sunsari district of Eastern Nepal.

UNLABELLED: This study assessed the timing and eruption sequence of primary teeth in children of Sunsari district of Eastern Nepal and compared the eruption pattern of males & females between various, ethnic groups. METHOD: This cross-sectional study, included 501 subjects, aged 3 months to 60 months selected by simple random sampling method. The determinant variables such as age, gender, ethnicity, and eruption of teeth were recorded. RESULTS: This study provides a model data on emergence of primary teeth and number of deciduous teeth in these children. This is a first study of its kind in Nepal. The findings of this study will help as a reference data for optimal use in clinical, academic, and research activities, especially for children of Eastern Nepal.

Impact of family health exercise program on health knowledge and practice of a rural population of eastern Nepal.

BACKGROUND: It is important to know the impact of health education on community. This may lead to improve the programs, commitment to students and staffs by taking feedback. These activities are aimed at producing changes in the community. OBJECTIVE: To assess the impact of health education as intervention program during Family Health Exercise (FHE) about the knowledge and practice of people related to health in a village of eastern Nepal. METHODS: During FHE, health education was given by the 3rd year medical students to the head of the 30 families. The neighbour 30 families were taken as control, where no health education was given. These two groups were compared after 6 months. RESULTS: Sanitary practice (Hand washing) before meal was known to both groups. But the material used for washing hand (soap and ash) was 53% in intervention as compared to 30% in control group. People were aware about the importance of care of the mother during pregnancy and lactation, but more in intervention group. The knowledge and practice for starting semisolid food other than breast milk for infants during weaning were higher in intervention (89%) than control (31%) group. CONCLUSION: There was significant change in the knowledge and practice of woman (mainly host) who received health education. The community also benefited in terms of their health knowledge and practices. Such programs are useful for the community at large.

Role of rehabilitation centres in reducing drug abuse problem in a town of Eastern Nepal.

OBJECTIVES: This paper focuses to describe the role and activities of Drug Rehabilitation Centres (DRCs) in reducing the drug-abuse problem in Dharan. It also offers suggestions for increasing the effectiveness of prevention programs. MATERIALS AND METHODS: Records of three DRCs working in Dharan for the past 9 years were analyzed using appropriate statistical tools. RESULTS: The yearly clean rate is significantly higher in these centres. Harm reduction program was currently available only in one centre. Pharmacotherapy along with short-term rehabilitation was available at de-addiction unit of B. P. Koirala Institute of Health Sciences whereas long-term rehabilitation was at others centres. CONCLUSION: Thus, there should be a strong coordination and network with each other to increase the effectiveness of the treatment program for drug abuse. The treatment centres should be increased in number as well as in quality. BPKIHS should take initiation to start long-term management with repeated booster programs.

Aetioepidemiological profile of spinal injury patients in Eastern Nepal.

This is a retrospective case series of 233 spinal injury patients admitted to the orthopaedic ward of BPKIHS from May 1997 to April 2001. The inpatient records were analysed. In all, 40.3% of spinal injuries resulted from falls from trees while cutting leaves for fodder, and 27.9% resulted from falls from first/second floors. More than 75% of total spinal injuries are largely preventable. Overall, 46.8% of our spinal injury patients had complete cord transection at the level of injury. All adolescents and adults, irrespective of age or sex, should be the target groups for community education and intervention programmes for prevention of spinal injury.

EPI vaccination in Nepal.

A number of surveys, small or large, have been undertaken by various agencies for coverage evaluation of immunization programs. The most commonly used design is the WHO-30 cluster sampling method. Other new methods are the Institute for Refresh Medical Statistics (IRMS) New Delhi method and the lot quality assurance sampling method. This paper describes the National Immunization Day (NID) method to evaluate the immunization coverage of the Expanded Program on Immunization (EPI) vaccines in the Sunsari district of Nepal. A total number of 3,332 respondents (69.4% females and 30.6% males) were interviewed regarding the immunization status of their children during NID. The children with complete immunization (BCG, measles and three doses of DPT and OPV) were 65.7%. The individual coverage by EPI vaccines (except OPV III and measles) was more than 80%. The result shows that there is positive relationship between immunization coverage and educational level of the respondents.

Teachers awareness and opinion about AIDS--a study from eastern Nepal.

The potential for spread of HIV in Nepal is considered large because of the presence of extensive commercial sex workers, high rate of sexually transmitted disease, low condom use and many pockets of intravenous drug users. To prevent this disease from producing any public health problem in Nepal, strategies have been formulated by Government and non-government agencies in Nepal. School teachers' views and knowledge regarding HIV/AIDS are very important so that they can impart correct acknowledge about this dreaded disease AIDS to the school children who ultimately serve as catalytic agent to spread correct acknowledge in the community in long run. Teachers' awareness about HIV/AIDS in this study was fairly good. Majority of them were aware about established routes of HIV/AIDS transmission and various ways of preventing it. Various misconceptions regarding HIV transmission and its causes are the matter of concern. To impart education to the teachers and the community, more than 60% of the teachers expressed the radio to be the most effective medium. This can be suggested to the government to deliver more simple and attractive programmes about HIV/AIDS education through radio in suitable time for the community. The special AIDS education programme, for school teachers long term objective and with the support of government, non-government and social organizations will go a long way in dissemination of health knowledge to the school children.