A quality of care assessment for women of childbearing potential with epilepsy in Bhutan: An observational study.

BACKGROUND & OBJECTIVE: In lower-middle income countries such as Bhutan, the treatment gap for epilepsy is over 50% as compared to a treatment gap of less than 10% in high-income countries. We aim to analyze the quality of epilepsy care for women of childbearing potential in Bhutan using the Quality Indicators in Epilepsy Treatment (QUIET) tool, and to assess the usefulness of the tool's section for women with active epilepsy (WWE) in the Bhutanese setting. METHODS: A prospective convenience cohort was enrolled in Thimphu, Paro, Punakha, and Wangdue, Kingdom of Bhutan, in 2022. Bhutanese women of childbearing potential at the time of enrollment (18-44 years old) were evaluated for the diagnosis of active epilepsy and underwent a structured survey-based interview with Bhutanese staff. Participants were surveyed on their epilepsy, pregnancy, and antiseizure medicine (ASM) histories. The clinical history and quality of epilepsy care of adult WWE were assessed using a section of the QUIET tool for women, an instrument originally developed by the U.S. Department of Veterans Affairs to analyze the quality of epilepsy care for American adults. RESULTS: There were 82 Bhutanese WWE of childbearing potential, with mean age of 30.6 years at enrollment (range 18-44, standard deviation (SD) 6.6) and mean age of 20.3 years at epilepsy diagnosis (range 3-40, SD 8.0)). 39 % (n = 32) had a high school or above level of education, and 42 % (n = 34) were employed. 35 % (n = 29) reported a seizure within the prior week, and 88 % (n = 72) reported a seizure within the prior year. 49 % (n = 40) of participants experienced > 100 lifetime seizures. All but one participant took antiseizure medications (ASMs). At enrollment, participants presently took no (n = 1), one (n = 3), two (n = 37), three (n = 25), four (n = 11), or over five (n = 5) ASMs. The most common ASMs taken were levetiracetam (n = 40), phenytoin (n = 27), carbamazepine (n = 23), phenobarbital (n = 22), and sodium valproate (n = 20). 61 % of all WWE took folic acid. Of the 40 previously pregnant WWE, eight (20 %) took folic acid during any time of their pregnancy. 35 % (n = 29) used betel nut (doma, quid) and 53 % (n = 21) of pregnant WWE used betel nut during pregnancy. CONCLUSIONS: Based on data about WWE participants' ASM, supplement, and substance use, our study identified the high use of first generation ASMs (including valproate), frequently in polytherapy, and betel nut use as treatment gaps in women of childbearing potential age with active epilepsy in Bhutan. To address these gaps for locations such as Bhutan, we propose modifications to the QUIET tool's "Chronic Epilepsy Care for Women" section.

Effect of different levels of nitrogen and charcoal on growth and yield traits of chili (Capsicum annuum L.).

Nitrogen and carbon sources are important for the growth and yield of chili. A combination of nitrogen and charcoal shows the potential to increase the availability of nutrients and stimulate plant performance. Therefore, an experiment was conducted to investigate the influence of different levels of nitrogen and charcoal on the growth and yield of chili. A pot experiment was carried out at Lamjung Campus, Lamjung, Nepal from 2019 to 2020. The experiment was carried out using two-factor Completely Randomized Design (CRD) with five replications. Twelve treatments consisted of three levels of nitrogen (0, 50 and 100 kg N ha-1) and four levels of charcoal (0, 2.5, 5 and 7.5% by soil weight) were used in the experiment. Nitrogen and charcoal showed a significant effect on different growth and yield parameters. Nitrogen application at the rate of 100 kg N ha-1 showed significantly the maximum number of primary branches (8.25), plant height (52.62 cm), leaf area (54.33 cm2), number of fruits per plant (42.95), fruit length (6.97 cm), yield per pot (97.14 g) and root length (29.87 cm). The application of 2.5% charcoal by soil weight showed a significant effect on plant height (53.60 cm), fruit length (7.12 cm) and yield per pot (77.55 g), while the application of 5% charcoal by soil weight produced the maximum number of fruits per plant (31.93). The combined level of nitrogen @ 100 kg N ha-1 and charcoal @ 2.5% by soil weight produced the yield per plot (127.1 g). This study suggests that chili production can be maximized by applying such a combined level of nitrogen and charcoal in the Lamjung.