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PubMed2005

Typhoid fever: a massive, single-point source, multidrug-resistant outbreak in Nepal.

BACKGROUND: In the summer of 2002, a total of 5963 cases of typhoid fever were recorded in Bharatpur, Nepal (population, 92,214) during a 7-week period. A team from the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand, and the CIWEC Travel Medicine Clinic (Kathmandu, Nepal) assisted the Nepal National Public Health Laboratory (Kathmandu, Nepal) in the further investigation of this large, explosive febrile disease outbreak. METHODS: Investigators conducted a thorough epidemiologic and laboratory investigation to assess the size and scope of the outbreak. In addition to subculturing of previously collected samples, blood samples were obtained from 100 febrile patients, and culture and susceptibility testing were done by standard laboratory methods. Pulsed field gel electrophoresis (PFGE) and plasmid analysis were done. RESULTS: The majority of the isolates, including 1 from the municipal water supply, were multidrug resistant. The minimum inhibitory concentrations (MICs) of ciprofloxacin ranged from 0.19 microg/mL to 0.125 microg/mL. With use of PFGE, all isolates, including isolates from the water supply, showed an analytical similarity of 96%-100%. Multidrug-resistant isolates had a plasmid encoding for resistance, and those with resistance to nalidixic acid had a single-point mutation. CONCLUSIONS: To the best of our knowledge, this outbreak is the largest single-point source outbreak of multidrug-resistant typhoid fever yet reported, and it was molecularly traced to the city's single municipal water supply. Isolates were uniformly resistant to nalidixic acid, there was a decrease in their susceptibility as measured by MIC of fluoroquinolones, and 90% of isolates obtained were resistant to >1 antibiotic.

Adult↗
PubMed2005

The impact of vitamin A supplementation on mortality inequalities among children in Nepal.

OBJECTIVE: This paper examines gender, caste and economic differentials in child mortality in the context of a cluster-randomized trial of vitamin A distribution, in order to determine whether or not the intervention narrowed these differentials. DESIGN: The study involved secondary analysis of data from a placebo-controlled randomized field trial of vitamin A supplements. The study took place between 1989-1991 in rural Sarlahi District of Nepal, with 30,059 children age 6 to 60 months. The main outcome measures were differences in mortality between boys and girls, between highest Hindu castes and others, and between the poorest quintile and the four other quintiles. RESULTS: Without vitamin A, girls in rural Nepal experience 26.1 deaths per 1000, which is 8.3 deaths more than the comparison population of boys. With vitamin A the mortality disadvantage of girls is nearly completely attenuated, at only 1.41 additional deaths per 1000 relative to boys. Vitamin A supplementation also narrowed mortality differentials among Hindu castes, but did not lower the concentration of mortality across quintiles of asset ownership. The vitamin A-related attenuation in mortality disadvantage from gender and caste is statistically significant. CONCLUSIONS: We conclude that universal supplementation with vitamin A narrowed differentials in child death across gender and caste in rural Nepal. Assuring high-coverage vitamin A distribution throughout Nepal could help reduce inequalities in child survival in this population.

Attitude to Health↗
PubMed2006

Genetically diverse group A streptococci from children in far-western Nepal share high genetic relatedness with isolates from other countries.

The genetic diversity of group A streptococci (GAS) throughout much of the world has not been adequately explored. To assess genetic variation among GAS in western Nepal, 120 noninvasive GAS, collected from eight different villages, were genetically characterized using emm typing, sof sequencing, and multilocus sequence typing (MLST). A high level of genetic diversity was observed among these isolates, with 51 genotypes based upon 51 multilocus sequence types (STs), 45 emm sequence types, and 28 sof sequence types. On the basis of shared ST-emm and sof-emm associations, 40 of the 51 genotypes were identical or highly related to genotypes characterized from locations outside of Nepal, even though most of the emm sequence and clonal types are rare among GAS within the United States. When analyzing all known STs highly related to Nepal STs, only one example of similar STs shared between a sof PCR-positive strain and a sof PCR-negative strain was observed. Since previous data indicate free exchange of MLST loci between sof-positive and sof-negative strains, there is possibly selection against the expansion of subclones resulting from horizontal transfers of sof or emm genes between sof-positive and sof-negative strains. All 45 emm types encountered in Nepal have also been documented from other countries. These data, together with data encompassing the past decade of emm type surveillance, support the possibility that most existing GAS emm types have been discovered. Similarly, since most (40/51) strain types were highly related to strains found elsewhere, it is likely that a major fraction of the existing GAS clonal complexes have been discovered.

Antigens, Bacterial↗
PubMed2005

Traditional healers' roles on eye care services in Nepal.

AIM: To evaluate the traditional healer (TH) training programme carried out by Nepal Netra Jyoti Sangh, a non-governmental organisation in Nepal, by measuring the changes in knowledge and practices of trained THs in providing primary eye care services. METHODS: 103 trained THs practising in six districts of Nepal were interviewed with a semistructured questionnaire. Their knowledge about various illnesses and eye care practices were compared before and after the training. RESULTS: A significant change in the number of THs with accurate perceived knowledge about trachoma (28.2% v 70.9%, p<0.0001) and cataract (54.4% v 94.2%, p<0.0001) was found after the training. In total, 98 (95%) THs stopped using traditional eye medicines after receiving the training (p<0.0001). The referral practices of THs improved significantly after the training (15% v 100%, p<0.0001). After the training, 95% of the THs used an eye care kit to treat patients with red eyes and simple ocular trauma. CONCLUSION: The findings show that a TH training programme on primary eye care services convinced traditional healers to stop the use of traditional eye medicines and improve referral practices in Nepal.

Adult↗
PubMed1990

High serum concentrations of aflatoxin in Nepal as measured by enzyme-linked immunosorbent serum assay.

1 Sera from 28 Nepalis, both patients and workers in a hospital in Banepa, Nepal were examined for AFB1 by enzyme-linked immunosorbent assay (ELISA). 2 This assay, previously validated using spiked sera, provides a sensitive rapid determination of serum aflatoxin (B1, G1 and Q1). 3 All 28 sera were positive with concentrations from 60 pg ml-1 to 10 ng ml-1. 4 These results suggest that consumption of aflatoxin in Nepal is high (greater than 50-800 ng kg-1 d-1). 5 No reports of the degree of contamination of food, human consumption or body fluid concentrations of aflatoxin in Nepal have been previously published. 6 Aflatoxin may contribute to the development of hepatocellular carcinoma, which is probably a common tumour in Nepal.

Aflatoxins↗
PubMed2006

Informing patients about cancer in Nepal: what do people prefer?

INTRODUCTION: Traditionally, doctors in Nepal do not discuss a diagnosis of malignancy with their patient. Instead, discussion is more likely to take place with family members, who then filter the information that the patient receives. This study aims to quantify the amount of actual disclosure of a cancer diagnosis that takes place, through a survey of patients admitted for hospice care, and to compare this with preferences regarding cancer disclosure from a survey of the general population. OBJECTIVES: (a) To determine what proportion of patients, referred for hospice care with advanced cancer, who were aware of their disease and prognosis. (b) To determine the attitude among the public toward disclosure of information of a diagnosis of malignancy, if they or a close relative were to develop the disease. (c) To observe if educational attainment impacts on issues related to disclosure of a cancer diagnosis. METHOD: (a) Prospective survey of patients with cancer admitted to 'Hospice Nepal' over a one-year period, recording details of how much patients knew of their diagnosis. (b) Survey of the general population in and around the Kathmandu valley, with a questionnaire asking the following two questions: If you were diagnosed with cancer would you like to be informed of your cancer? If a close relative was diagnosed with cancer would you like them to be informed of their cancer? RESULTS: A survey of the 96 patients admitted to 'Hospice Nepal' over the one-year study period showed that 19 (20%) of the patients had knowledge of both their disease and the stage of the disease; 16 (17%) knew that they had cancer but did not know about their disease progression or prognosis; 61 (63%) were unaware of the nature, seriousness or prognosis of their disease. A survey of the general population in Kathmandu showed 204 (80%) of the 256 respondents wanted to be informed if they were diagnosed with cancer, even if it was incurable; 44 (17%) wanted to be informed of such a diagnosis only if it was curable; and 8 (3%) did not want to be informed of such a diagnosis at all. CONCLUSION: In Nepal, there is a clear disparity between what patients would like to be told should they develop cancer, and what patients with cancer know about their disease. In the Asian context, it is not unusual to be advised that western practices of disclosure are inappropriate, yet this study, conducted in a very non-western culture, shows that the patient's wish to know about their illness is a desire which can transcend cultural and ethnic differences.

Adult↗
PubMed2003

Impact and determinants of sex preference in Nepal.

CONTEXT: Gender discrimination and son preference are key demographic features of South Asia and are well documented for India. However, gender bias and sex preference in Nepal have received little attention. METHODS: 1996 Nepal Demographic and Health Survey data on ever-married women aged 15-49 who did not desire any more children were used to investigate levels of gender bias and sex preference. The level of contraceptive use and the total fertility rate in the absence of sex preference were estimated, and logistic regression was performed to analyze the association between socioeconomic and demographic variables and stopping childbearing after the birth of a son. RESULTS: Commonly used indicators of gender bias, such as sex ratio at birth and sex-specific immunization rates, do not suggest a high level of gender discrimination in Nepal. However, sex preference decreases contraceptive use by 24% and increases the total fertility rate by more than 6%. Women's contraceptive use, exposure to the media, parity, last birth interval, educational level and religion are linked to stopping childbearing after the birth of a boy, as is the ethnic makeup of the local area. CONCLUSIONS: The level of sex preference in Nepal is substantial. Sex preference is an important barrier to the increase of contraceptive use and decline of fertility in the country; its impact will be greater as desired family size declines.

Adolescent↗
PubMed1999

A ten year serological survey of hepatitis A, B and C viruses infections in Nepal.

BACKGROUND: In 1987, we reported that the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in Nepal was low, as compared to hepatitis A virus (HAV) infection, and that no human T-lymphotropic type-1 (HTLV-1) infection was found in Nepal. OBJECTIVES: To determine changes in the prevalence of HAV, HBV, and HCV infections between 1987 and 1996 in inhabitants of Bhadrakali (suburban) and Kotyang (rural) villages in Nepal. STUDY DESIGN: We did a cross-sectional survey of 458 inhabitants of two Nepalese villages, to assess the prevalence of antibody to HAV (anti-HAV), antibody to hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg), antibody to HCV (anti-HCV), and antibody to HTLV-I (anti-HTLV-I). RESULTS: Anti-HAV was detected in 454 (99.1%), HBsAg in 5 (1.1%), anti-HBc in 33 (7.2%) and anti-HCV in 8 (1.7%) of serum samples tested in 1996. Statistically significant differences by gender or age group were nil. The prevalence of HCV infection was significantly higher in 1996 than in 1987 after adjusting for age of subjects living in the two villages (p < 0.01). The prevalence of HBsAg was significantly higher in 1996 than 1987 in Bhadrakali after adjusting for the factor of age (p < 0.05). Between 1987 and 1996, evidence for HTLV-1 positive residents was nil. CONCLUSION: These results suggest that HAV has been endemic in Nepal for long time while not of HBV, and that HCV infection tends to be increased recently.

Adolescent↗
PubMed1996

Radiology in Nepal.

The joys of doing an international visiting professorship are the challenging environment and the enthusiasm of the indigenous students and physicians. Having previously taught radiology at the University of Nairobi, Kenya, for 4 months in 1992, I felt prepared for the advanced diseases, limited supplies, broken equipment, and challenging environment that I would encounter in Nepal. The Radiology Outreach Foundation sponsored me (W. E. Brant) for 3 months to teach radiology at Tribhuvan University Teaching Hospital (TUTH) in Kathmandu in the spring of 1995. I was concerned about how effective my teaching would be, how well I could relate to the local conditions of practice, and whether my English-only language skills would be sufficient. My hosts in Nepal proved as eager to teach me as to learn from me. I was captivated by the ability of the TUTH faculty to innovate. Nephrostomy drainage could be accomplished with a feeding tube or refashioned angiography catheter (Fig. 1). Complete aspiration of a hepatic abscess could and should be performed with a single needle at the time of diagnosis because the patient may never be able to return for follow up. One day's film review revealed every manifestation of pulmonary tuberculosis (TB), as well as worms in the bile ducts and hydatid cysts in the liver. Without CT scanning, sonography was the prime diagnostic tool. Although my prepared lectures were well received, teaching is best accomplished while the daily film stack and with sonography transducer in hand. English is understood and well spoken by almost all physicians and medical students in Nepal. In this article, we discuss the current practice of radiology in Nepal.

Delivery of Health Care↗
PubMed2002

Prevalence of antibody to Chlamydia pneumoniae in residents of Japan, the Solomon Islands, and Nepal.

Sera of 4,050 residents from Japan, 276 from the Solomon Islands, and 602 from Nepal were tested by an enzyme-linked immunosorbent assay to determine the prevalence of antibody to Chlamydia pneumoniae. The prevalence of IgG and IgA antibodies was significantly higher in the Solomon Islands (64.9% and 82.2%) and Nepal (73.1%, and 69.8%) than in Japan (53.6% and 41.1%). These prevalence rates increased throughout the teenage years in the Solomon Islands and Japan and leveled off with age, whereas in Nepal the prevalence rates gradually increased with age. The prevalence of a high (> 3.0) IgA antibody index, which is suggestive of acute infection, was significantly higher in the Solomon Islands (34.8%) than in Japan (3.2%) and Nepal (10.5%). The prevalence of IgG antibody ranged from 46.4% to 67.7%, and the prevalence of IgA antibody ranged from 33.7% to 61.8% in the four difference areas of Japan. These findings indicate considerable differences in the prevalence of antibodies to C. pneumoniae by age in these nations and between the regions of Japan tested.

Adolescent↗
PubMed1999

Awareness about a national immunization day programme in the Sunsari district of Nepal.

The initiative to eradicate poliomyelitis globally by the year 2000 was launched at the Forty-first World Health Assembly in May 1988, when all WHO Member States were challenged to help eradicate poliomyelitis from the world, a gift to the children of the twenty-first century. In Nepal, 100-250 children per year become disabled due to poliomyelitis. The government of Nepal is determined to eradicate the disease from the country by the year 2000 through the National Immunization Day (NID) Programme. Since 1996, about 3.3 million children under 5 years of age have been immunized each year in Nepal. In the present study, we analysed the impact of the campaign in the Sunsari district of Nepal. The study was carried out during the first NID (6 December 1996) to evaluate the local population's awareness of the programme and the impact of the media on such awareness. A total of 843 respondents were interviewed, 39% of whom were illiterate. Two important aspects of the mass campaign (whether a child previously immunized should be immunized again in the NID, and whether children should be brought to the next NID) were clearly understood by the majority of the people (93.1% and 98.8% of the respondents, respectively), although only a small proportion (24.4%) of individuals understood the purpose of the programme. Radio was the single most effective means of providing information, education, and communication about NIDs. The encouraging response, especially from a poor, illiterate rural population, augurs well for the goal of eradicating poliomyelitis from the world.

Adolescent↗
PubMed2000

Family practice training in Nepal.

BACKGROUND: This article describes the health care system in Nepal and the only existing family practice (general practice) training program in that country. The majority of doctors in Nepal still have no residency training, and a specialist focus pervades. The efforts of some leading educators in Nepal led to establishment of a family practice training program in 1982, and the program now enrolls 12 residents per year, half of whom are from India. Major obstacles in education, financing, and policy must be addressed before family practice can have a meaningful presence or effect on the health care in Nepal.

Family Practice↗
PubMed2002

Dosages of anti-tuberculosis medications in the national tuberculosis programs of Kenya, Nepal, and Senegal.

SETTING: National tuberculosis programs in Kenya, Nepal, and Senegal. OBJECTIVES: To ascertain adequacy of initial prescriptions of dosages of anti-tuberculosis medications in the three national tuberculosis programs. METHODS: Collection of patient treatment cards in a representative sample of treatment centers in Kenya, Nepal, and Senegal. Calculation of drug dosages in milligram per kilogram body weight of isoniazid, rifampicin, and pyrazinamide and comparison with international recommendations for dosage of these medications. RESULTS: A total of 12,346 patient treatment cards were available. Yet of these only 8640 were analyzed: 5575 (65% of total) from Kenya, 612 (53% of total) from Nepal, and 2453 (95% of total) from Senegal had the patient's weight recorded and were given a nationally recommended treatment regimen. The proportions of patients receiving an internationally recommended isoniazid dosage were 34%, 15%, and 15%, respectively in Kenya, Nepal and Senegal; the corresponding figures for rifampicin were 77%, 77%, and 93% and for pyrazinamide 25%, 3% and 75%, respectively, in the three countries. The majority of errors were over-dosage, but some cases of under-dosage were also identified. CONCLUSIONS: This study shows that over-dosage was a frequent event in all three countries. Two major reasons for this error are inadequate drug combinations in Kenya and Senegal, and in all three countries recommendations for weight brackets that did not ideally fit internationally recommended dosages. It is vital to address these problems to reduce both the risk of unnecessary drug toxicity on one end of the spectrum, and suboptimal drug levels on the other.

Adolescent↗
PubMed2001

Health promotion approach for the control of food-borne parasitic zoonoses in Nepal: emphasis on an environmental assessment.

Green and Kreuter define health promotion as the use of both education and ecology to encourage and support living conditions conducive to good health. Their PRECEDE-PROCEED model delineates a practical way to cope with health problems using this definition. Applying PRECEDE to Nepal helps identify the steps needed to control the ever-increasing incidence of food-borne parasitic zoonoses (FBPZ) there and in other South Asian countries. In executing the first five steps of the model, we focused on behavioral and environmental assessments to find a method for controlling FBPZ. Through these two assessments, we identified the following behavioral and environmental objectives: establish a meat inspection system by 2003, establish training programs on safe meat production and selling practices by 2003, improve slaughterhouses and slaughtering practices by 2003. The educational and ecological assessments revealed that the necessary predisposing, reinforcing and enabling factors for appropriate control of FBPZ are present in Nepal, while an administration and policy assessment shows Nepal meets PRECEDE requirements through its recent meat inspection legislation. Although the data for each element of the PRECEDE-PROCEED model are limited in Nepal, they clearly tell us to move forward to the PROCEED stage to control FBPZ there as well as in all of South Asia.

Abattoirs↗
PubMed2002

Evidence of torture in the mid west region of Nepal.

INTRODUCTION: The aim of this study was to find evidence of torture in the Mid West Region of Nepal. METHODOLOGY: Interview and clinical examination of self-reported torture-survivors in the Mid West Region of Nepal in the area of Nepalganj, which is on of the most important city in that region. Thirty-four persons (group A) were examined according to a programme performed by Physicians for Human Rights, Denmark. Furthermore, twenty-nine persons (group B) were interviewed according to an abbreviated programme performed by a local group of doctors. RESULTS: Testimonies of exposure to physical and psychological violence were validated, assessing the consistency between the reported exposure, reported ensuing symptoms and the results of clinical examinations. CONCLUSION: Torture has probably existed in Nepal for decades. The main reason given for torture is suspicion of political activity. Most of the torture takes place in District Police Offices, by the police. Episodes of torture performed by the Communist Party of Nepal, known widely as "the Maoists", have been reported. This investigation substantiates that torture is severely traumatizing for the survivor.

Adolescent↗
PubMed1993

Nepal launches new projects.

The CEDPA Nepal Country Office (NCO), directed by Mana Rana (WIM 5 and S&E 13), has launched an expanded leadership training program for women's NGOs and new service delivery projects under a 5-year grant extension from USAID. With additional support from the UNFPA, the NCO will undertake a new project with the Mothers' Club, a national women's NGO. The project will mobilize women and women's organizations to address grassroots needs. The CEDPA ACCESS Project recently funded the Nepal Red Cross and Family Planning Association of Nepal to begin community-based family planning projects. Trained volunteers will distribute nonclinical contraceptives from their homes, provide services through home visits, and refer clients to clinics. Nancy Russell, a nonprofit manager with 20 years of experience, has been appointed CEDPA resident coordinator for Nepal.

Asia↗
PubMed2004

Epidemiological survey of intestinal parasitic infections of diarrhoeal patients in Nepal and Lao PDR.

Intestinal parasitological survey was conducted to clarify the distribution of intestinal parasites in Nepal and Lao Peoples' Democratic Republic (Lao PDR) from 2001 to 2003. A total of 401 diarrheal fecal specimens were collected from patients aged one to 75 years (250 from Nepal and 151 from Lao PDR). The specimens were examined using the formalin-ether sedimentation (FES) and sucrose centrifugal flotation (SCF) techniques. Nine species (3 Nematoda, 1 Cestoda, and 5 Protozoa) of parasites were recovered from Nepal, whereas seven species (3 Nematoda, 1 Trematoda, and 3 Protozoa) from Lao PDR. Of the parasites detected, (14.4%) was the most common in Nepal, and was Opisthorchis viverrini (29.8%) in Lao PDR. Infection rates were markedly different among age groups in both countries; higher rates were observed in age groups of 10-29 years than in 0-9 years group. Scanning electron microscopic observation revealed that trematoda eggs recovered from Lao PDR were identified as O. viverrini, which could not be done by a light microscope.

Adolescent↗
PubMed2004

Evaluation of rapid diagnostic methods for pediatric viral diarrhea using samples collected in Nepal and Japan.

We evaluated real time PCR, ELISA and immunochromatography (ICG) test systems for detection of diarrheagenic viruses (Rotavirus, Adenovirus and Norovirus) in pediatric diarrheal fecal samples collected in Kathmandu, Nepal (n = 23) and in Kobe, Japan (n = 25) in summer of 2004. Of the 23 samples collected in Nepal, one (4.3%) was positive for Rotavirus and two (8.7%) for Adenovirus whereas six out of 25 samples (24.0%) collected in Japan were positive for Norovirus. Of the Japanese samples, 11 (44.0%) showed diarrheagenic bacteria (Campylobacter jejuni, Salmolella enteritidis) while six (26.1%) samples from Nepal showed parasites like Ascaris lumbricoides, Giardia intestinalis, Trichuris trchiura and Vampirolepis nana. Viral pathogens were not common during summer season in both Nepal and Japan. Real time RT-PCR was found to be relatively more sensitive compared with ELISA for Norovirus. However, immunological methods are simple and less time consuming (three hours for ELISA, 15 minutes for ICG) and appeared to be useful for rapid diagnosis of viral gastroenteritis especially in developing countries.

Adenoviridae↗