Methicillin-Resistant Staphylococcus Aureus Nasal Carriers among Laboratory Technical Staff of Tertiary Hospital in Eastern Nepal.

Background Methicillin-resistant Staphylococcus aureus (MRSA) has been the leading cause of nosocomial and community infections worldwide. In particular, healthcare workers are at constant risk to develop MRSA carriage. There is a paucity of data regarding the epidemiology of MRSA in laboratory workers who are constantly in contact with these pathogens in almost every hospital. Objective This study was undertaken to identify the burden of MRSA nasal carriers and the antibiotic susceptibility pattern of the isolates among laboratory technical staff. Method Sterile nasal swabs were taken from 50 laboratory technical staff working in the Central and Emergency laboratory of BP Koirala Institute of Health Sciences (BPKIHS). Standard procedures were followed for isolation, identification and antibiotic sensitivity testing. Antibiotic susceptibility tests were performed using disc diffusion and growth on Oxacillin screen agar based on Clinical and Laboratory Standards Institute (CLSI) guidelines. Result Out of 50 isolates of Staphylococcus aureus, 44 (88%) were Methicillin-sensitive (MSSA) while six (12%) were Methicillin-resistant (MRSA). All 50 isolates of S. aureus were found resistant to Penicillin while all were found sensitive to Teicoplanin, Linezolid, and Levofloxacin. Only five (10%) were sensitive to Erythromycin while 49 (98%) were sensitive to both Amikacin and Gentamicin. However, none of the MRSA isolates were found sensitive to all tested antimicrobial agents. Conclusion This repertoire portrays the emergence of MRSA in laboratory workers which clearly indicates the necessity of complying with the sanitary and antibacterial guidelines and adhering to the rational use of antibiotics to prevent nosocomial infections.

Understanding how women's groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study.

Women's groups, working through participatory learning and action, can improve maternal and newborn survival. We describe how they stimulated change in rural Nepal and the factors influencing their effectiveness. We collected data from 19 women's group members, 2 group facilitators, 16 health volunteers, 2 community leaders, 21 local men, and 23 women not attending the women's groups, through semi-structured interviews, group interviews, focus group discussions and unstructured observation of groups. Participants took photographs of their locality for discussion in focus groups using photoelicitation methods. Framework analysis procedures were used, and data fed back to respondents. When group members were compared with 11 184 women who had recently delivered, we found that they were of similar socioeconomic status, despite the context of poverty, and caste inequalities. Four mechanisms explain the women's group impact on health outcomes: the groups learned about health, developed confidence, disseminated information in their communities, and built community capacity to take action. Women's groups enable the development of a broader understanding of health problems, and build community capacity to bring health and development benefit.

Major Gene Controls of Field Resistance to Spot Blotch in Wheat Genotypes 'Milan/Shanghai #7' and 'Chirya.3'.

A number of exotic wheat (Triticum aestivum) genotypes resistant to spot blotch caused by Cochliobolus sativus are being used to improve the resistance of commercial cultivars in the warm regions of South Asia. The objective of the present study was to determine the inheritance of field resistance to spot blotch in two resistant (R) wheat genotypes, 'Chirya.3' and 'Milan/Shanghai #7' (MS#7), which were crossed to a susceptible (S) commercial cultivar, 'BL1473.' The two resistant genotypes also were crossed to determine allelic relationships for resistance between them. Spot blotch severity was recorded on the parents and on F1, F2, and F3 progenies. The F1 plants from the two crosses between susceptible and resistant genotypes had low disease severity like the resistant parents, indicating that resistance in Chirya.3 and MS#7 is conditioned by dominant gene action. The F2 plants segregated in 3R:1S ratios, and the F2:3 families showed the ratio of 1R:1S:2S, segregating for R and S, suggesting that resistance in the two resistant parents is conditioned by a single, dominant gene. The F1 plants from the cross between the two resistant genotypes were resistant, whereas their F2 progenies segregated in 15R:1S, suggesting that the resistance genes in MS#7 and Chirya.3 are nonallelic. These simply inherited sources of resistance could be useful for improving spot blotch resistance in the warm regions of South Asia and also may offer useful diversity to breeding programs for developing spot-blotch-resistant wheat cultivars in other regions.

Stimulating policy debate on blood transfusion services through the work of an emergency obstetric care project in Nepal.

PURPOSE: To improve the quality and accessibility of emergency obstetric care (EmOC) at district level. METHODS: As the availability of safe and reliable blood transfusion services is a critical component of EmOC, financial and management support was provided to the blood transfusion service centers in the 3 project's Phase 1 districts. EVALUATION: An evaluation after 3 years showed that, with modest financial outlays and the development of supportive district level partnerships, substantial improvements in quality and management of services had been achieved. The evaluation also identified limitations imposed by lack of legal frameworks and central support; although the Nepal Red Cross Society has a government mandate to supply the national blood needs, the operating procedures and guidelines have no legal base. The evaluation report was widely circulated, and the findings used in national policy discussions. RESULTS: Following this a task force was commissioned to develop a legal policy framework to ensure standardized quality blood services with defined management and monitoring roles and responsibilities.

Impact of a pilot acute respiratory infection (ARI) control programme in a rural community of the hill region of Nepal.

A prospective study was conducted to determine the magnitude of morbidity and mortality caused by acute respiratory infections (ARI) among children under 5 years of age and to assess the feasibility of reducing mortality owing to ARI by the use of community health workers. Villages selected for this study were situated on the south-west edge of Kathmandu Valley, about 24 km from the city centre. The study group consisted of 1019 children under the age of 5 years at the beginning of the study and followed for 3 years. During the 1st year, baseline information was collected. During the 2nd and 3rd years, intervention measures (health education, immunization and antibiotics for children with signs suggesting pneumonia) were taken and their effect assessed. There was a 59% reduction in the ARI-specific death rate among study children between surveillance year and intervention year I and a further 25% reduction in the ARI-specific death rate between intervention years I and II. Despite a substantial reduction in ARI mortality with the interventions, there was still an unacceptably high mortality from chronic diarrhoea, malnutrition and other factors. This implies that the programme to control ARI, diarrhoea, malnutrition and immunizable diseases should be integrated into one, within the framework of a primary health care strategy.

Epidemiological study of tobacco smoking behaviour among adults in a rural community of the hill region of Nepal with special reference to attitude and beliefs.

This study, designed to examine adult smoking behaviour, attitudes and norms was carried out in the hill villages of Alapot and Bhadrabas, Nepal, using the WHO standardized survey questionnaire. Some 1506 adults were interviewed. The overall prevalence of daily smokers is 73.7%. The majority of people, though aware of hazards of smoking, are not concerned with its possible effects on their own or other people's health. More males than females endorse public action against smoking. Both the endorsement of public action against smoking and awareness of social norms discouraging smoking increase with educational attainment. The motives for not smoking and endorsement of public actions against smoking have been ranked. Based on these findings strategies for a national smoking control programme have been recommended.

Domestic smoke pollution and respiratory function in rural Nepal.

A study was conducted to see the effect of domestic smoke pollution on respiratory function by using vitalograph Model 20.400 S-type dry portable spirometer in 150 randomly selected female subjects aged 30-44 years from a rural area situated in the outskirts of Kathmandu valley at an altitude of 4,800 ft. above sea level. The area is totally free from industrial and atmospheric pollution. Women spend considerable time near the fireplace, which serves both cooking and heating purposes and emits smoke from wood and other biomass fuel. Domestic smoke pollution is considerable because dwellings are ill-ventilated and without chimnies. The selected sample comprised of 6 groups-25 subjects each of 3 exposure levels to domestic smoke pollution amongst smokers and non-smokers. All the spirometric tests (FVO, FEV1 and FMEF 25-75) were performed in a standard way as recommended by American Thoracic Society in Snowbird Meeting in 1979. Variation of age, height, arm-span and weight between the three different levels of exposure to domestic smoke in both the smokers and non-smokers were compared and results revealed no significant variation in all the variables mentioned above. There was a fall of mean FVC, FEV1 and FMEF 25-75 as duration of exposure increased. This decline was found to be statistically significant amongst the smokers but not amongst the non-smokers. Similar results was found even after adjusting for age & height.