Exponentiated Odd Lomax Exponential distribution with application to COVID-19 death cases of Nepal.

This study suggested a new four-parameter Exponentiated Odd Lomax Exponential (EOLE) distribution by compounding an exponentiated odd function with Lomax distribution as a generator. The proposed model is unimodal and positively skewed whereas the hazard rate function is monotonically increasing and inverted bathtubs. Some important properties of the new distribution are derived such as quintile function and median; asymptotic properties and mode; moments; mean residual life, mean path time; mean deviation; order statistics; and Bonferroni & Lorenz curve. The value of the parameters is obtained from the maximum likelihood estimation, least-square estimation, and Cramér-Von-Mises methods. Here, a simulation study and two real data sets, "the number of deaths per day due to COVID-19 of the first wave in Nepal" and ''failure stresses (In Gpa) of single carbon fibers of lengths 50 mm", have been applied to validate the different theoretical findings. The finding of an order of COVID-19 deaths in 153 days in Nepal obey the proposed distribution, it has a significantly positive relationship between the predictive test positive rate and the predictive number of deaths per day. Therefore, the intended model is an alternative model for survival data and lifetime data analysis.

Depression and Anxiety among Patients with Type II Diabetes Mellitus in Chitwan Medical College Teaching Hospital, Nepal.

The prevalence of depression and anxiety disorders is common among people with diabetes mellitus. Coexistence of diabetes and depression/anxiety increases the risk of diabetes complications and reduces the overall quality of life. Hence, this study aimed to assess the depression and anxiety among patients with type 2 diabetes mellitus in Chitwan. Descriptive survey was carried out among 296 purposively selected clinically diagnosed type 2 diabetes patients admitted in the Chitwan Medical College Teaching Hospital from 15th June 2018 to 17th September 2019. Patients were interviewed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7). Data were analyzed using descriptive and inferential statistics. Of 296 diabetic patients, 48.6% were 60 years and above, 59.5% female and 61.5% literate; their common occupation was agriculture (38.2%) followed by household work (26.4%). Nearly two-thirds (62.8%) of diabetes patients had other chronic comorbid conditions. Depression and anxiety were observed among 57.8% and 49.7% of diabetes patients, respectively. While observing the severity, 27.4%, 19.6%, 8.4%, and 2.4% of patients had mild, moderate, moderately severe, and severe depression, respectively. Likewise, 24.7%, 20.3%, and 4.7% of patients had mild, moderate, and severe anxiety, respectively. Current living status, educational status, medicine adherence, satisfaction toward current treatment, and history of mental illness in the family were found to be significant factors associated with the anxiety of patients with diabetes. Further, educational status, smoking habit, satisfaction towards current treatment, and history of diabetes in family were the factors associated with depression. Prevalence of depression and anxiety is high among admitted patients with diabetes mellitus, and many factors are associated with it. Hence, regular screening services are essential along with diabetes management plan for timely identification and treatment of the vulnerable groups in the healthcare centers.

Utilization of Family Planning Methods Among Postpartum Mothers in Kailali District, Nepal.

BACKGROUND: Postpartum contraceptives use offers a distinctive opportunity to maintain appropriate birth spacing for health benefits to both mother and child. However, the concept of postpartum family planning (PPFP) is poorly understood and contraceptives use during the postpartum period remains low in Nepal. Therefore, this study aimed to assess the factors affecting the utilization of family planning (FP) methods among postpartum mothers in the Kailali district, Nepal. METHODS: A community-based cross-sectional study was conducted between September and October 2013 among postpartum mothers in Kailali district. Simple random sampling was applied to select a total of 427 study participants. A pre-tested standard semi-structured questionnaire was used for gathering data. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. RESULTS: Overall, 32.8% of the postpartum women used different types of contraceptives. Condoms (37.1%) followed by Depo-Provera 29.3% were the most used postpartum contraceptives. Half (50%) of the postpartum women had an unmet need for family planning. Multiple logistic regression model revealed that the occupation of husband [AOR=3.2 (95% CI: 2.0-6.00], past use of family planning methods [AOR=4.0 (95% CI:2.4-6.5)] and resumption of menstruation [AOR=2.5 (95% CI:1.6-4.1)] were significantly associated with the use of modern contraceptives during the first year of the postpartum period. CONCLUSION: Contraceptive uptake within the first year of postpartum was found to be low among women in the Kailali district, Nepal. Previous experience with the use of family planning methods, occupation of the husbands, and resumption of menstruation are important factors in the PPFP decisions of women in this population. Therefore, the family planning program should work on improving couples' knowledge of the risk of pregnancy, fertility returning time and modern contraceptives use during the postpartum period targeting women whose husbands are in migrant occupations, who are not menstruating and who have not used FP before.

Fertility Desire and Its Determinants Among People Living with HIV in Antiretroviral Therapy Clinic of Teku Hospital, Nepal.

BACKGROUND: Pregnancy in people Living with HIV/AIDS (PLHIV) involves significant public health risks, including the risk of HIV transmission to uninfected partners and the fetus. Despite the growing importance of fertility issues for HIV-infected people, little is known about their fertility desires in Nepal. This study, therefore, aimed to determine the magnitude of and factors associated with the fertility desire of PLHIV. PATIENTS AND METHODS: A cross-sectional study was conducted among 280 PLHIV attending the antiretroviral therapy (ART) clinic in Teku Hospital, Nepal. A standard semi-structured questionnaire was administered to participants using systematic random sampling. Data were entered using Epi-data 3.1 and analyzed using SPSS software version 20. RESULTS: Out of the total participants, 12.1% desired to have a child. Among those having this desire, 44.1% had not decided when to have a child. Reasons for desiring a child were having no children (44.1%), wanting to have a child of different sex than the previous one (29.4%), followed by wanting to have another child (26.5%). Factors such as being male (COR: 3.1, 95% CI: 1.3-7.0), being ≤40 years of age (COR: 3.8, 95% CI: 1.5-9.4), higher age at marriage (COR: 7.7, 95% CI: 1.5-39.6), middle socio-economic status (COR: 3.5, 95% CI: 1.7-7.3), having no children (COR: 22.9, 95% CI: 8.6-60.8) or fewer children (COR: 74.8, 95% CI: 9.7-575.1), greater CD4 count (COR: 2.8, 95% CI: 1.3-5.9) and having moderate knowledge of prevention of mother-to-child transmission (COR: 5.4, 95% CI: 2.3-12.7) had higher odds of having fertility desire. CONCLUSION: Around one in every ten participants had a desire for fertility despite their HIV status. This calls for special attention in promoting integrated services for HIV and reproductive health. It will be important to include counseling and other services for those with fertility desire alongside providing ART.

Burden of injuries in Nepal, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: Nepal is a low-income country undergoing rapid political, economic and social development. To date, there has been little evidence published on the burden of injuries during this period of transition. METHODS: The Global Burden of Disease Study (GBD) is a comprehensive measurement of population health outcomes in terms of morbidity and mortality. We analysed the GBD 2017 estimates for deaths, years of life lost, years lived with disability, incidence and disability-adjusted life years (DALYs) from injuries to ascertain the burden of injuries in Nepal from 1990 to 2017. RESULTS: There were 16 831 (95% uncertainty interval 13 323 to 20 579) deaths caused by injuries (9.21% of all-cause deaths (7.45% to 11.25%)) in 2017 while the proportion of deaths from injuries was 6.31% in 1990. Overall, the injury-specific age-standardised mortality rate declined from 88.91 (71.54 to 105.31) per 100 000 in 1990 to 70.25 (56.75 to 85.11) per 100 000 in 2017. In 2017, 4.11% (2.47% to 6.10%) of all deaths in Nepal were attributed to transport injuries, 3.54% (2.86% to 4.08%) were attributed to unintentional injuries and 1.55% (1.16% to 1.85%) were attributed to self-harm and interpersonal violence. From 1990 to 2017, road injuries, falls and self-harm all rose in rank for all causes of death. CONCLUSIONS: The increase in injury-related deaths and DALYs in Nepal between 1990 and 2017 indicates the need for further research and prevention interventions. Injuries remain an important public health burden in Nepal with the magnitude and trend of burden varying over time by cause-specific, sex and age group. Findings from this study may be used by the federal, provincial and local governments in Nepal to prioritise injury prevention as a public health agenda and as evidence for country-specific interventions.

Psychiatric Morbidities in Patients with Non-communicable Diseases among Inpatients of Medicine Department in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Psychiatric morbidities are common among patients with chronic non-communicable diseases. These diseases have high morbidity, mortality, and higher health costs. However, psychiatric conditions are often underdiagnosed and undertreated in our country. This study aimed to find out the psychiatric morbidities among patients with non-communicable diseases admitted in inpatients units of the medicine department. METHODS: A descriptive cross-sectional study was conducted in the inpatients of the medicine department of a tertiary care hospital among 926 patients with chronic non-communicable diseases. Ethical approval was obtained from the Chitwan Medical College Institutional Review Committee (Ref.No.IRC:2074/75:38). A convenient sampling technique was used. Patients were interviewed using the Patients Health Questionnaire. Data analysis was performed using Statistical Package for Social Sciences version 16. RESULTS: Among 926 non-communicable disease patients, psychiatric morbidities observed were somatization 612 (66.1%) anxiety 319 (34.4%), and depression 379 (40.9%). Patients with multiple non-communicable diseases had higher psychiatric morbidities compared to patients with a single disease. CONCLUSIONS: Psychiatric morbidities are common among admitted patients suffering from non-communicable diseases in Nepal. Hence, regular screening services are needed in all levels of health care centers to identify and treat the risk groups on time.

Older people's satisfaction with and utilisation patterns of the Old Age Allowance in Nepal.

OBJECTIVE: The Old Age Allowance in Nepal aims to support the welfare of older people, to improve their social and economic status and to encourage independence. The aim of this study was to assess satisfaction with and utilisation patterns of the Old Age Allowance among older people in Nepal. METHODS: A cross-sectional, quantitative study was conducted in Chitwan, Nepal. Face-to-face interviews were carried out with 232 older people asking about demographics, and satisfaction and utilisation of Old Age Allowance. RESULTS: Seventy-two per cent of older people expressed satisfaction with the Old Age Allowance. The highest satisfaction level (81.9%) was associated with the satisfaction scale construct of contribution to religious practices. Satisfaction with the allowance was associated with family relationships and dissatisfaction with higher expectations of allowance. The allowance was predominantly utilised for personal expenditure (91.4%), followed by health and medicine (75.0%). CONCLUSION: The Old Age Allowance is a necessary and important contribution to keeping older people connected with family and community.

Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal: a retrospective cohort study.

OBJECTIVES: Isoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has been no systematic assessment of IPT initiation and completion rates among PLHIV. We aimed to assess IPT initiation and completion rates in the Far-Western Region (FWR) of Nepal. DESIGN: We conducted a retrospective cohort study using secondary data extracted from registers maintained at ART centres. SETTING: All 11 ART centres in the FWR of Nepal. PARTICIPANTS: All PLHIV registered for care between January 2016 and December 2017 in 11 ART centres. PRIMARY OUTCOME MEASURES: IPT initiation and completion rates were summarised as percentages with 95% CI. Independent association between patient characteristics and non-initiation of IPT was assessed using cluster-adjusted generalised linear model (log binomial regression) and adjusted relative risk (RR) with 95% CI was calculated. RESULT: Of the 492 PLHIV included, 477 (97.0%) did not have active TB at registration. Among 477 without active TB, 141 (29.8%, 95% CI 25.7% to 34.1%) had been initiated on IPT and 85 (17.8%) were initiated within 3 months of registration. Of 141 initiated on IPT, 133 (94.3%, 95% CI 89.1% to 97.5%) had completed 6 months of IPT. Being more than 60 years of age (RR-1.3, 95% CI 1.1 to 1.7), migrant worker (RR-1.3, 95% CI 1.1 to 1.4) and not being initiated on ART (RR-1.4, 95% CI 1.1 to 1.8) were significantly associated with IPT initiation. CONCLUSIONS: In FWR of Nepal, three out of 10 eligible PLHIV had received IPT. Among those who have received IPT, the completion rate was good. The HIV care programme needs to explore the potential reasons for this low coverage and take context specific corrective action to fix this gap.

Adherence to antiretroviral treatment and associated factors among people living with HIV and AIDS in CHITWAN, Nepal.

BACKGROUND: Adherence to ART is the primary determinant of viral suppression and the risk of transmission, disease progression and death. Adherence of at least 95% is needed for optimal suppression. This study aimed at determining the adherence to Anti-Retroviral Therapy (ART) and its associated factors among People Living with HIV and AIDS in ART Center of Chitwan, Nepal. METHODS: A descriptive cross-sectional study was conducted among 231 clients aged 18 years to 49 years taking ART from Bharatpur Hospital of Chitwan and those who have been enrolled in ART for at least 6 months, were interviewed. Systematic Sampling technique was used. Semi-structured questionnaire was prepared by taking reference from the AIDS Clinical Trial group questionnaire (ACTG). Adherence was measured by patient self report. Data was entered Epi Data 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) software where the P value of < 0.05 was accepted as being statistically significant. The independent variables which were found significant at p-value 0.10 in bivariate analysis were fitted in multivariable logistic regression model. Multivariable logistic regression model was performed to know the net effect of the independent variables on Adherence to ART medication. RESULTS: The overall adherence in the last month was found to be 87.4%. Wrist watch and mobiles were seen as a facilitating factor for taking ART on time as clients taking ART used to set alarm to get informed of the medication time. Adherence was associated with female sex (AOR = 10.550 CI: 1.854-60.046), family consisting only parents and their children (AOR = 4.877, CI: 1.246-19.079), having no habit of taking alcohol (AOR = 5.842 CI: 1.294-26.383), HIV duration of more than 3 years (AOR = 10.055 CI: 2.383-42.430), picking up ART medications on their own (AOR = 7.861, CI: 1.670-36.998) and not having side effects of ART (AOR = 8.832, CI: 2.059-37.890). CONCLUSION: Identifying and evaluating the problems faced by ARV drug users can foster the achievement of ART related goals and addressing ART related problems in a rational way. Effective and appropriate monitoring of non adherence behaviors can help patients increase adherence level fostering improvement in treatment outcome.

Evaluation of teachers training workshop at Kirkpatrick level 1 using retro-pre questionnaire.

BACKGROUND: Teacher training focusing on teaching learning methodologies, assessment tools, and approaches that motivate the teachers and enhance their confidence is one of the fundamental programs of faculty development. The objective of this study was to assess the self-reported perceived confidence of faculty members after participating in a basic teachers training workshop. METHODOLOGY: The retrospective post-then-pre design questionnaire was used for evaluating the faculty members' self-reported perceived confidence at Kirkpatrick level 1 (evaluation of reaction) after completing basic teachers training workshops. The self-reported perceived confidence on 30 statements were analyzed by 3 categories (not confident, confident, and highly confident) on a Likert scale. RESULTS: Out of 60 participants (18 in the 3rd and 21 each in the 4th and 5th teachers training workshops), 58 (96.67%) responded to all statements. The mean age of the participants was 34.14±5.15 years; 70.7% were male and 29.3% female. Overall, the self-reported perceived confidence level of the participants of the 3rd (pre-training median 57, post-training median 70, p<0.001), 4th (pre-training median 51, post-training median 67, p<0.001) and 5th (pre-training median 51, post-training median 68, p<0.001) training workshops was significantly increased after training. There was a noticeable change in the level of confidence of the participants after training. The observed percentage change in self-reported perceived confidence was 29.63% in those who received no training prior to joining college (n=51, 87.9%); this was 2 times more than those who received some sort of training prior to teachers training (n=7, 12.1%). CONCLUSION: Overall, the self-reported perceived confidence level of the participants was significantly increased after teachers training workshop.

Association of knowledge, attitude and demographic variables with cervical Pap smear practice in Nepal.

BACKGROUND: Coverage of cervical pap smear test in Nepal is below general global values. One of the reasons may be that cervical cancer prevention policy of Nepal has 'Visual Inspection of Cervix with Acetic Acid' as the only screening tool. The focus of present study was to find out association of demographic factors, knowledge and attitude regarding cervical Pap smear test with its practice by women in Nepal. MATERIALS AND METHODS: This cross sectional analytical observational study was conducted between February 1, 2013 and April 30, 2013. Participants were interviewed with the help of a structured questionnaire. Chi square and multivariate logistic regression tests were used to detect associations of variables with pap smear practice. RESULTS: Chi square test showed that practice was significantly associated with knowledge about pap smear test and cervical cancer, having favourable attitude towards the test, urban residency and 36-50 years age-group. Pap smear utilization was not associated with age-at-marriage, parity and age-at-first-child-birth. Multivariate logistic regression showed favorable attitude towards pap smear test as the only variable which significantly influenced pap smear practice (p=0.006, OR: 2.4). CONCLUSIONS: Pap smear coverage has been found to be 15.7% which is lower than global average and that for developing countries. Health education programs which are effective not only in increasing knowledge about cervical cancer and pap smear test but also effective in positively changing attitude towards the test should be organized to increase pap smear coverage.

Tuberculosis in HIV patient.

INTRODUCTION: Strict monitoring ofanti tuberculosis therapy and antiretroviral therapyis crucial for proper management of TB/HIV co-infected patients. METHODS: Between December 2006 and December 2008 a prospective observational study was conducted among 135 TB/HIV co-infected patients visiting antiretroviral therapy in Seti Zonal Hospital, Dhangadi. The diagnosed TB patients were subjected to ATT through directly observed treatment short-course (DOTS) and its response was evaluated as per WHO guidelines. RESULTS: Among 135 studied subjects, 97 (71.9%) were males and over 119 (88 %) of the patients were in the age group 21 to 50. Of the total TB cases 92 (68.1%) presented pulmonary TB and 37.20% of the Extra-pulmonary Tuberculosis cases were lymph node TB. 72 (53.33%) of them had completed ATT, 11 (8.2%) transfer out and 17 (12.6%) were default. CONCLUSIONS: Majority of the patients presented PTB, and lymph node TB was found to be the most common EPTB. Comparatively, high efficacy of ATT was found in HIV patients visiting this resource poor setting.