Knowledge, Attitude and Practice towards COVID-19 among Private School Teachers of Chitwan, Nepal.

Background The coronavirus disease (COVID-19) pandemic has brought life to a standstill across the world, with nearly 178 countries reporting school closures. As the schools have started reopening slowly, precautions are utmost necessary to prevent the potential spread of COVID-19 in school and community settings. Objective To assess knowledge, attitude and practice towards COVID-19 among private school teachers. Method A web based cross-sectional analytical study design was undertaken. Currently working private school teachers of Chitwan District were included as a unit of analysis. The snowball sampling technique was employed to identify the eligible participant. Collected data was entered in SPSS version 20 and analyzed using the Chi-square test, Pearson correlation, and binary logistic regression. Result Of 344 participants, the majority were male (52.9%), most of the participants were from age group 26-30 years (38.4%). Regarding knowledge, attitude and practice, 57% had good knowledge, 53.2% had favorable attitude and 51.7% had good practice towards COVID-19. Logistic regression analysis demonstrated gender (OR 0.475, 95% CI: 0.256-0.818) and COVID-19 training (OR 25.687, 95% CI 5.354-123.226) were significant with good knowledge. Conclusion Knowledge about COVID-19 among private schools teacher was good, attitudes have been mostly favorable, and the practices were mostly adequate. However, good knowledge is not the only factor for better attitude and good practices. It is necessary to implement massive education campaigns, trainings and information via school authorities and health authorities by developing and adopting appropriate guidelines on COVID-19.

Analysis of Prognostic Factors of Bell's Palsy in a Tertiary Care Centre of Eastern Nepal.

Background Bell's palsy is the most common cause of acute facial peripheral neuropathy commonly encountered in otolaryngology clinics. Studies regarding epidemiology, risk factors, treatment and prognosis of Bell's palsy are sparse in our settings. Objective To analyze the prognostic factors of Bell's palsy in tertiary care Centre of eastern Nepal. Method A retrospective chart review of patients diagnosed with Bell's palsy from 1st January 2005 to 31st December 2018 was done. Records of the patients were obtained from medical record section of BP Koirala Institute of Health Sciences. Result A Total of 208 patients were included for analysis. After six months 72.6% patients had complete recovery. Patients who presented with lower House Brackmann (HB) grade had significantly better complete recovery than those with high grade (89.1% vs 45.6%). The complete recovery was 80.3%, 73.8%, 63.5% and 50% for the patients of more than 30 yrs, 31-45 years, 46-60 years and more than 60 years respectively and the difference was significant (p= 0.012). Alcohol significantly reduced the complete recovery (p= 0.043). Multivariate analysis showed high HB grade score at presentation to be significant predictor of poor prognosis. (p= 0.001 odds ratio 11.262). Conclusion Old age, use of alcohol and the severity of facial nerve palsy at the time of presentation were the bad prognostic factors, severity of the palsy was found to be most significant predictor.

Dermatophytic Infections among the Patients Attending Di Skin Hospital and Research Center at Maharajgunj Kathmandu.

BACKGROUND: Dermatophytosis is the common and most significant superficial fungal infections because of their widespread involvement among the people all over the world. The clinical presentation, though very typical of ringworm infection, is often confused with other skin disorders, making laboratory diagnosis and confirmation necessary. The aim of this research is to study different clinical variants of dermatophytosis and its associated risk factor among the patients attending Di Skin Hospital and Research Center. METHODS: A descriptive cross-sectional study design was used. Total of 110 samples collected from suspected cases of dermatophytosis were studied among the patients attending DI Skin Hospital and Research Center at Maharajgunj, Kathmandu, Nepal. Skin, hair and nail specimens taken from the patients were processed by direct microscopy and culture using a standard protocol. Macroscopic appearance and microscopic morphology of micro and macroconidia were studied for proper identification of dermatophytes. Data were analyzed using the statistical package for the social sciences (SPSS) version 20 for windows. RESULTS: Dermatophytosis was more common in the age group of 21-30 (29.1%) years and was more predominant among male population with male to female ratio being 1.39:1. Among the total number of dermatophytosis cases only 52.72% showed fungal elements in KOH preparation and only 43.63% were culture positive. Most common clinical type was tinea corporis (29.1%) followed by tinea cruris (18.2%). Among the total isolates T. rubrum was most common (58.33%) followed by T. mentagrophytes (20.83%), other Trichophyton spp (12.5%) and Microsporum gypseum (8.33%). Most of the positive cases used to take bath, change their dresses and innerwear only once a week. Similarly, Sweating nature could be the possible cause for dermatophytic infection (P=0.006 at CI=95%) and also there was a significant relation between the sharing habit of dress materials and positive cases (P=0.033 at CI=95%). Among the total cases, most of the positive cases did not have any knowledge about fungal infection.Study concluded that more the knowledge of fungal infection less the chance of fungal infection (P=0.003 at CI=95%). CONCLUSIONS: Tinea corporis was the commonest clinical pattern and overall predominance in the study was male with 21-30 being most affected age group. T. rubrum forms the commonest aetiological agent of dermatophytosis. Possible cause of dermatophytic infection was due to poor hygienic status and lack of knowledge on fungal infection and its preventive measures.

Diversity of Hepatitis B genotypes in Nepal and updated Phylogenetic Tree: a Pilot Survey in 2012.

INTRODUCTION: Hepatitis B virus (HBV) is a current global health problem. HBV genotypes influence the treatment and long term outcome of HBV infected patients. Moreover, HBV genotypes differ in various region of the world. Such data was reported haphazardly but yet to be comprehensive for Nepal. This study attempted to find out the diverse hepatitis B genotypes in Nepal. METHODS: A convenient serum sample of 58 HBsAg positive patients from different parts of the country mainly from Nepalgunj, Palpa and Kathmandu were screened for hepatitis B genotype. Sequencing was done and Phylogenetic tree was created. RESULTS: Among 58 samples, 23 were genotype D, 17were genotype A and B wereC/D recombinant. Phylogenetic trees were created by distance-matrix and neighbor-joining analyses after bootstrapping to 1000 replicates. DISCUSSION: HBV genotypes A and D are the most common genotype in Nepal. Horizontal transmission is common in these genotypes. C/D recombinant genotype may be transmitted from Tibetan people living in Kathmandu. Prophylactic major controlling, horizontal and cross border transmission could be effective. CONCLUSIONS: Three major genotypes of HBV in Nepal were found to be A, C and D. Despite being a low prevalence area, Nepal has a diversity of hepatitis B genotypes Keywords: genotypes; HBV; phylogenetic.

Developing, piloting and scaling-up of Nepal's neonatal care program.

The Community-based Newborn Care Package is a set of neonatal care interventions to be delivered through the existing government system of facility-based health workers and community based volunteers in Nepal. The package was developed by the government of Nepal in 2007 based on the evidence from Nepal and neighboring countries and designed to be implemented as a comprehensive package to improve newborn survival. This paper reviews the process, progress, and lessons learned from the program design, early-implementation and monitoring and provides future directives to improve upon this integrated package that uses a continuum of care approach from the pre-pregnancy to neonatal periods by involving the communities, health workers and the private sector.

Clinicopathological evaluation of thyroglossal cyst.

INTRODUCTION: Thyroglossal cyst is a common congenital anomaly of the thyroid gland. Though malignant transformation is rare one case was a papillary carcinoma in my series. METHODS: Retrospectively thyroglossal cyst who underwent surgery during the period of January 2004 to March 2009 were evaluated. RESULTS: Age incidence of the cysts in the present series varied between 4 and 41 years. 12 (63%) patients were male and 7 (37%) patients were female. The sites of the lesion were as:thyrohyoid in 13 (68%),suprasternal in 1 (5%) and suprahyoid in 5 (27%) cases. Twelve patients had painless swelling on the neck and 7 had discharging sinus.Pre-operative cytological evaluation showed non-malignancy in all cases.Postoperative histological result turned out to be papillary carcinoma in 1 female patient of 33 years old and the remaining 18 had non-malignancy. This patient with papillary carcinoma had her thyroid gland in its normal position. CONCLUSIONS: Malignant transformation should be ruled out in all cases of thyroglossal cyst and fistula. Post-operatively specimen should be sent for histological examination.

Developing community-based intervention strategies and package to save newborns in Nepal.

In Nepal, the proportion of under 5 deaths that are neonatal (0-28 days) has been increasing in the last decade, due to faster declines in infant and child mortality than in neonatal mortality. This trend is likely due to a focus on maternal and child survival programs that did not adequately address newborn health needs. Policy and actions to save newborn lives resulted from increased attention to newborn deaths in 2001, culminating in the endorsement of the National Neonatal Health Strategy in 2004, a milestone that established newborn health and survival as a national priority. Operationalization of the National Neonatal Health Strategy took place in 2007 with the development of the Community-Based Newborn Care Package (CB-NCP). This paper describes how national stakeholders used global, regional and in-country research and policies to develop the CB-NCP, thus outlining key ingredients to make newborn health programming a reality in Nepal. A technical working group was constituted to review existing evidence on interventions to improve newborn survival, develop a tool to prioritize neonatal interventions, and conduct program learning visits to identify key components appropriate to the Nepal context that should be included in the Community Based Integrated Newborn Care Package. The group identified interventions based on the evidence of impact on newborn survival, potential mechanisms within the existing health system to deliver the interventions, and linkages with existing programs and different tiers of the health system. Not only was Nepal one of the first countries in south-east Asia where government adopted a national strategy to reduce neonatal deaths, but it was also one of the first to endorse a package of neonatal interventions for pilot testing and scaling up through existing community-based health systems that provide basic health services throughout the country. CB-NCP was designed to be gradually scaled up throughout the country by integration with Safe Motherhood and Child survival programs that are currently operating at scale. Under Ministry of health and Population leadership, a network of academia, professional bodies and partners developed a common vision for improving newborn health and survival, and launched district-level pilot programs to demonstrate and learn how newborn health interventions could be effectively and efficiently delivered and scaled up in Nepal.

Fitting Community Based Newborn Care Package into the health systems of Nepal.

Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.