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Occupational cancer in Nepal--an update.

This article is a discussion of occupational cancer in Nepal. The knowledge of specific problems of occupational cancer in Nepal is very scarce. Few researches on occupational cancer have been done in Nepal. A case-control study done recently has revealed a high risk (OR 4.2 95% CI: 1.4, 12) for lung cancer among the workers, who have worked in the exposed occupations. The incidence of cancer is thought to be rising every year. In this article an attempt has been made to establish the probable occurrence of carcinogens in the middle and large scale manufacturing industries in Nepal and the approximate number of workers exposed to different hazardous substances at the work places.

Carcinogens↗

Seroepidemiology of hepatitis B in Nepal.

To assess the prevalence of BHV infection in Nepal sera of 2,555 healthy individuals of different age groups from different parts of the country were examined for the markers of the infection. BHsAg and anti-HBs were assayed by R-PHA and PHA methods respectively and anti-HBc by ETA method. Anti-HBc was positive in 43.5 per cent of 2,555 sera of healthy individuals in Nepal. HBsAg was in 0.9 per cent (1.5 per cent in male and 0.5 per cent in female) and anti-HBs in 7.7 per cent (7 per cent in male and 8 per cent in female). The prevalence of HBsAg and anti-HBs was higher in urban than in rural areas, and the highest prevalence of these markers was noted in health care personnels (HBsAg 2.6 per cent and anti-HBs 17 per cent). HBsAg was not detectable in infants and young children, and the highest prevalence rate was observed in 6 to 15 years age group. The main mode of spread of HBV infection in Nepal was the horizontal transmission in pre-adolescent and adolescent children. HBV infection is common in Nepal but the BHsAg carrier rate is much lower than reported from other Asian countries.

Adolescent↗

Case study: perioperative nursing in Nepal.

The author presents a demographic and economic profile of Nepal, briefly describes its health care system, traces the development of nursing in Nepal, and uses a case study to describe perioperative nursing care in Nepal. The patient, who was diagnosed as having adenocarcinoma of the stomach, received care at the only teaching hospital in Nepal, and the author describes the patient's care from prediagnosis through discharge.

Adenocarcinoma↗

Status and future of clinical pathology in Nepal.

Clinical Pathology (CP) in Nepal is still in primitive stage. All most all CP tests are done manually. In many health institutions, even a basic CP test facilities are not available leading to an empirical treatment. Even the so-called big medical centers are lacking many important CP test facilities forcing the patients (those who can afford) to proceed to foreign countries for investigation and treatment of their health problem. With regard to the training of man power in the field of CP, Tribhuvan University Institute of Medicine began an academic training course called Proficiency Certificate Level in Health Laboratory Technology (PCL Health Lab.) in 1972. Presently, undergraduate and post-graduate courses, namely, Bachelor in Medical Laboratory Technology (BMLT) and MD Pathology are also being run since 1987 and 1996, respectively. Presently, CP services in Nepal are being rendered at both public and private sectors. CP services in private sector are provided by small so-called CP laboratories usually attached to a medical shops to a well set laboratories run by qualified man power. All most all private CP laboratories in Nepal function at morning and/or evening as they are run by the people working at the hospitals or other medical institutions during day time. Beside, newly emerged nursing homes are also providing CP services. However, quality control system in CP service in Nepal, is not effective yet. Thus, establishment of a national institution functioning as both referral CP center and quality monitoring body on CP services, and introduction of mandatory CP license examination appears to be an urgent need of the days to provide a qualitative CP service to the needy people.

Costs and Cost Analysis↗

Clinical Importance of Salmonella Paratyphi A Infection to Enteric Fever in Nepal.

Background: Enteric fever in Nepal is caused by infection with Salmonella typhi or Salmonella paratyphi A. The clinical presentation of these two illnesses has never been compared in a population of travelers and expatriates. If the illnesses are clinically comparable, and if S. paratyphi A infection is sufficiently common, the choice of typhoid vaccine for Nepal may have to take into account the vaccine's efficacy in preventing infection with S. paratyphi A. Methods: NonNepalese patients presenting to the CIWEC Clinic with a history of 3 days of fever or greater were considered eligible for the study. Patients with positive blood or stool cultures for S. typhi or S. paratyphi A were entered into the study (along with three patients who had positive Widal titers only). A questionnaire was administered by a physician to determine signs and symptoms. Treatment with oral chloramphenicol was openly compared to treatment with oral ciprofloxacin. Results: Forty-five cases of enteric fever were diagnosed during the 2 years of the study. Infection with S. typhi accounted for 20 cases, and S. paratyphi A was isolated in 22 cases. The illnesses were clinically indistinguishable. Treatment with chloramphenicol and ciprofloxacin was clinically comparable. Conclusions: Infection with S. paratyphi A accounts for a significant percentage of enteric fever presentations among tourists in Nepal, and the illness is comparable to infection with S. typhi. Therefore, the choice of typhoid vaccine for long-term travelers or expatriates in Nepal should take into account the vaccine's potential ability to also prevent S. paratyphi A infection. The only typhoid vaccine that can currently offer this type of cross protection is the whole-cell killed preparation.

Journal Article↗

Modelling the effectiveness of financing policies to address underutilization of children's health services in Nepal.

OBJECTIVE: To estimate the price responsiveness of utilization of formal children's health-care services in Nepal and to use this information to model the impact on utilization of subsidies or increases in user fees. METHODS: A total of 8112 individual observations (of children aged < 15 years) from 2847 households in 274 communities were obtained from the 1996 Nepal Living Standards Survey. A logit model was applied to determine the net impact of price on a parent or caregiver's decision to seek care for a given instance of illness. The model's coefficients were used to calculate the price responsiveness of utilization decisions. FINDINGS: Parents or caregivers reported that 9.7% of children (788/8112) had been ill or injured in the previous month. Parents reported that they had sought care in 566 (71.8%) of these cases; care was most frequently sought from public providers. The price elasticity of demand for children's health-care services in the formal sector was estimated at -0.16. As prices rise, the demand curve exhibits continuous and declining price elasticity. Overall, a 100% subsidy of user fees would increase current utilization rates by 56%, while a 100% increase in fees would lead to a drop in utilization of only 12%. The differential in utilization across income groups was substantial after changes in fees were implemented. CONCLUSION: While the effect of price on the utilization of children's health-care services in Nepal is statistically significant, the size of the impact is modest. Policies to subsidize fees could increase utilization substantially, while fee increases would lead to modest declines in utilization and generate increased revenue.

Adolescent↗

Nutritional status and mortality of highland children in Nepal: impact of sociocultural factors.

This study investigates the nutritional status of native children in the highlands of Nepal (1,700-3,000 m) and explores the relationship between child mortality and surviving children's nutritional status. A random sample of 145 households from 11 villages in the Koshi Hill Zone in east Nepal was surveyed, and the nutritional status of the 438 children < 14 years of age living in these households was assessed by means of anthropometry. We found a severe growth retardation in the Nepalese children compared to lowland reference groups as well as to highland children from the Andes. Child mortality and altitude are not significantly different between higher (Brahman and Chetri) and lower (Baisya and Sudra) caste households. A lower caste status and higher altitude of the household is associated with a significantly better nutritional status in offspring. In multiple regression analyses, improved nutritional status in children is significantly associated with lower caste (P = 0.001), higher altitude (P = 0.009), and less crowding (P = 0.001) but not with sibling mortality (P = 0.11). We thus conclude that nutritional status of children in households in the highlands of Nepal is associated with the household's socioeconomic status and altitude but not with mortality among siblings.

Adolescent↗

Infection with GB virus C and hepatitis C virus in drug addicts, patients on maintenance hemodialysis, or with chronic liver disease in Nepal.

Infection with GB virus C (GBV-C) and hepatitis C virus (HCV) was surveyed in various populations in Kathmandu, Nepal. GBV-C RNA and HCV RNA were detected in four (2%) and none, respectively, of 181 normal controls. Viral RNAs were detected significantly more frequently (P < 0.001) in 32 (44%) and 43 (60%), respectively, of 72 users of illicit intravenous drug, and in three (14%) and one (5%) of 22 patients on maintenance hemodialysis. The three hemodialysis patients with GBV-C RNA had been transfused with more blood units than the 19 without GBV-C RNA (51 +/- 21 vs. 5 +/- 3 units, P < 0.01), and one was co-infected with HCV. Of 145 patients with chronic liver disease, GBV-C RNA was detected in four (3%) and HCV RNA in 12 (8%); only one patient with GBV-C RNA was without markers of HCV or hepatitis B virus infection. In the 32 drug addicts infected with GBV-C, genotypes were G1 in two (6%), G2 in 26 (81%), G3 in three (9%), and the remaining one (3%) was coinfected with G2 and G3. GBV-C genotypes in the 13 individuals in the populations other than drug addicts were G2 in 11 (85%) and G3 in two (15%). HCV genotypes in the 43 drug addicts with viremia were l/1a in 21 (49%), V/3a in 19 (44%) and l/1a plus V/3a in two (5%); these genotypes were not prevalent in normal controls and patients with chronic liver disease in Nepal. These results indicate that GBV-C infection is prevalent in healthy subjects in Nepal at a frequency (2%) comparable with those in the other countries and that GBV-C transmits efficiently by intravenous drug abuse among drug addicts and by transfusion in hemodialysis patients.

Adult↗

Genetic characterization of rhesus macaques (Macaca mulatta) in Nepal.

Indian-origin rhesus macaques (Macaca mulatta) have long served as an animal model for the study of human disease and behavior. Given the current shortage of Indian-origin rhesus, many researchers have turned to rhesus macaques from China as a substitute. However, a number of studies have identified marked genetic differences between the Chinese and Indian animals. We investigated the genetic characteristics of a third rhesus population, the rhesus macaques of Nepal. Twenty-one rhesus macaques at the Swoyambhu Temple in Kathmandu, Nepal, were compared with more than 300 Indian- and Chinese-origin rhesus macaques. The sequence analyses of two mitochondrial DNA (mtDNA) loci, from the HVS I and 12 S rRNA regions, showed that the Nepali animals were more similar to Indian-origin than to Chinese-origin animals. The distribution of alleles at 24 short tandem repeat (STR) loci distributed across 17 chromosomes also showed greater similarity between the Nepali and Indian-origin animals. Finally, an analysis of seven major histocompatibility complex (MHC) alleles showed that the Nepali animals expressed Class I alleles that are common to Indian-origin animals, including Mamu-A*01. All of these analyses also revealed a low level of genetic diversity within this Nepali rhesus sample. We conclude that the rhesus macaques of Nepal more closely resemble rhesus macaques of Indian origin than those of Chinese origin. As such, the Nepali rhesus may offer an additional resource option for researchers who wish to maintain research protocols with animals that possess key genetic features characteristic of Indian-origin rhesus macaques.

Animals↗

A study of drug use during pregnancy in a teaching hospital in western Nepal.

Information on the use of drugs during pregnancy is scarce and rather anecdotal. Careful consideration of the benefit to the mother and the risk to the fetus is required when prescribing drugs during pregnancy. The aim of this study was to gain knowledge on this issue in western Nepal. 2156 prescriptions of pregnant women were collected at random from the antenatal care (ANC) in obstetrics out-patient department (OPD) at Manipal Teaching Hospital (MTH), Nepal and analyzed for this study. The mean maternal age and hemoglobin concentration were 25 years and 12.21 g/dl, respectively. Twenty-three percent women attended obstetric OPD due to maternal disorders other than routine ANC (77%). Problem oriented drug use was due to nausea/vomiting (4.7%), dyspepsia (3.1%), and per vaginal spotting/bleeding (3.4%), mainly. Most of the women got 2-3 drugs and commonly included nutritional supplementation and tetanus toxoid. The average number of drugs/prescription was 2.00, 15.37% and 64.8% drugs were prescribed by generic name and as fixed dose combinations, respectively. The most commonly prescribed drugs were nutritional supplements like iron, folate, calcium, vitamins (72.8%), followed by tetanus toxoid (12.4%), gastrointestinals (5%), antimicrobials (4.6%), etc. Though, the selection of drugs was rational in most of the cases, some anomalies were observed and discussed with the clinicians. Our data reflect the general extent and prescribing pattern for those Nepalese pregnant women attending hospital in western Nepal.

Adolescent↗

Self-care in rural areas of India and Nepal.

Self-care during illness and pregnancies by individuals and their families is a ubiquitous and integral part of societies throughout the world. This paper reports findings about self-care practices identified during four studies carried out over a ten-year period involving about 14,000 interviews in 7,400 households comprising over 48,000 people in three Indian states and three districts of Nepal. The proportion of ill individuals using self-care over a two-week period in the different study areas ranged from 19 to 42 percent. This involved 5 to 9 percent of the total population in self-care activities during these two weeks. Much larger differences were found between India and Nepal in the use of self-care during pregnancies. Self-care or care by relatives and friends was the predominant source of maternity care in Nepal, including deliveries, while Indian maternal care was dominated by traditional birth attendants. Comparisons also were made between self-care and the use of professional healers or health care services during the same time period. Differences in the use of self-care by age, sex, caste, access to government or special project services, type of illness, and duration and severity of illness have also been shown. The need for similar, better standardized surveys in combination with intensive studies examining the details and rationale behind self-care practices in different societies has been stressed as an essential step in developing programs to expand or modify self-care practices of individuals and their families.

Activities of Daily Living↗

Anaesthesia training and development in Nepal 1985-1990.

In 1985 a diploma program in anaesthesia was established in Kathmandu, Nepal, as a joint venture between the Institute of Medicine in Kathmandu and the University of Calgary. Development of the program and of the specialty in the capital city of Kathmandu was continuously documented during the next five years by local and visiting faculty. In 1990 teams of two Nepali and one Canadian anaesthetist also conducted a survey of each of the seven 50-100 bed zonal hospitals which did not previously have a trained anaesthetist and which are now staffed by graduates of the diploma program. In 1985 Nepal, with a population of 16 million, had seven trained Nepali anaesthetists all of whom worked in two hospitals in Kathmandu. By the end of 1989, 19 physicians had graduated. Seven of these continue to work in Kathmandu hospitals, nine work in zonal hospitals throughout the country and two are taking higher anaesthesia training in the United Kingdom. Additional Nepali anaesthetists have returned from training abroad, and the Society of Anaesthesiologists of Nepal, which joined the World Federation of Societies of Anaesthesiologists in 1988, now has 34 members. An annual anaesthesiology symposium is held, and weekly clinical meetings are organized in the major hospitals in Kathmandu. Anaesthetists who work in the zonal hospitals have limited supplies of drugs and equipment and opportunities for continuing medical education are virtually nonexistent.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Department, Hospital↗

Psychological distress among displaced persons during an armed conflict in Nepal.

OBJECTIVE: Most internally displaced persons (IDPs) live in low-income countries experiencing a war; their psychosocial health has not been well addressed. We carried out a comprehensive assessment of traumatic experiences, distress symptomatology, and factors independently associated with distress among IDPs in Nepal. METHODS: A cross-sectional survey was conducted among 290 IDPs in Nepal during June-July 2003. We used the Hopkins Symptom Checklist-25 (HSCL-25) to assess depression and anxiety symptoms, and the Posttraumatic Stress Disorder (PTSD) Checklist--Civilian Version (PCL-C) to assess PTSD symptoms. All these instruments were validated against local corresponding syndromes and diagnoses of Composite International Diagnostic Interviews (CIDIs) as well. RESULTS: Almost everyone reported trauma and 53.4% had PTSD symptomatology. The rates of anxiety and depression symptomatology were 80.7 and 80.3%, respectively. Factors independently associated with anxiety symptomatology were illiteracy and feeling miserable on arrival at a new place. Female gender, age 41-50, and feeling miserable on arrival at a new place were associated with depression symptomatology. On the other hand, experiencing greater than three traumatic events and feeling miserable on arrival at a new place were associated with PTSD symptomatology, whereas evacuation after a weeklong preparation and lower caste appeared as protective factors. CONCLUSIONS: High rates of psychological distress and associated factors were identified among highly traumatized IDPs in Nepal, thereby underlining the need for collective assistance, not only for refugees, but also for IDPs. Risk and protective factors that we have identified can thus be utilized for any kind of psychosocial interventions among these IDPs.

Adolescent↗

Does community-based conservation shape favorable attitudes among locals? an empirical study from nepal.

Like many developing countries, Nepal has adopted a community-based conservation (CBC) approach in recent years to manage its protected areas mainly in response to poor park-people relations. Among other things, under this approach the government has created new "people-oriented" conservation areas, formed and devolved legal authority to grassroots-level institutions to manage local resources, fostered infrastructure development, promoted tourism, and provided income-generating trainings to local people. Of interest to policy-makers and resource managers in Nepal and worldwide is whether this approach to conservation leads to improved attitudes on the part of local people. It is also important to know if personal costs and benefits associated with various intervention programs, and socioeconomic and demographic characteristics influence these attitudes. We explore these questions by looking at the experiences in Annapurna and Makalu-Barun Conservation Areas, Nepal, which have largely adopted a CBC approach in policy formulation, planning, and management. The research was conducted during 1996 and 1997; the data collection methods included random household questionnaire surveys, informal interviews, and review of official records and published literature. The results indicated that the majority of local people held favorable attitudes toward these conservation areas. Logistic regression results revealed that participation in training, benefit from tourism, wildlife depredation issue, ethnicity, gender, and education level were the significant predictors of local attitudes in one or the other conservation area. We conclude that the CBC approach has potential to shape favorable local attitudes and that these attitudes will be mediated by some personal attributes.

Adolescent↗

Pediatric neurotrauma in Kathmandu, Nepal: implications for injury management and control.

OBJECTS: There is a scarcity of data regarding childhood neurological injuries in developing countries such as Nepal. The epidemiology of acute pediatric neurotrauma in Kathmandu was studied to assess the implications of these data for injury prevention programs. METHODS: The clinical records of patients <or=18 years who presented to Tribhuvan University Teaching Hospital between April 1, 2001 and April 1, 2004 with acute neurological trauma and were subsequently admitted to hospital were retrospectively reviewed. A standard proforma was used to collect information on patient demographics, the nature and etiology of the injuries, their acute management, and outcomes. CONCLUSIONS: Four hundred sixteen injured children were admitted to hospital, and the charts for 352 (85%) were available for review. Spinal injuries were relatively rare (4%) compared to head injuries (96%). Falls were the most common cause of injuries (61%). It took significantly longer (p<0.001) for children injured in rural Nepal (62%) to obtain neurosurgical care (30.1 h) than those injured within Kathmandu (7.1 h). A Glasgow Outcome Score of 5 was obtained for 96%, 76%, and 22% of patients with mild, moderate, or severe head injuries, respectively. Besides efforts to improve prehospital transport and acute management of these injuries, preventive measures that are applicable to the Nepalese scenario are urgently needed. Interventions should focus on health education programs directed at parents and children and upgrading of road safety measures. Neurological injuries must also be viewed in the context of the broader social issues in Nepal that contribute to injury.

Accident Prevention↗

Large-scale general collection of wild-plant DNA in Mustang, Nepal.

The deposit of DNA samples of wild plants that correspond to voucher specimens is highly informative and greatly enhances the value of the herbarium specimens. The Society of Himalayan Botany (SHB), Tokyo, has assembled general collections of flowering plants of the Sino-Himalayan region for more than 40 years. In a trial of the collection of these types of bioresources for use in basic research, we adopted FTA cards, which have recently been used for large-scale collection of DNA of humans, microorganisms and viruses, for the general collection of DNA samples of wild plants during a botanical expedition in Mustang, Nepal, in 2003. Three hundred and fifty-five plant specimens from Mustang, Nepal, were collected along with the corresponding DNA samples. Examination of the quality of the DNA samples by PCR demonstrated the utility of the collection system. The identification of all of the specimens collected, as well as data from the specimens, will be presented on the Flora of Nepal Database website (http://ti.um.u-tokyo.ac.jp/default.htm), which is open to the public. The DNA resources will be identified on the website and distributed openly by the SHB to researchers worldwide for basic research.

Botany↗

Attitude towards family planning in Dharan, east Nepal: implications for the family planning programme.

A survey of the knowledge, attitude and practice of family planning was conducted in Dharan, Nepal. The town offers a full range of family planning services free of charge. There was a strong desire to limit family size; 52.5% of couples were currently using some modern method of family planning. Of the current users, 62.3% had been sterilized, including 92.3% of those in the lowest socioeconomic group. Health risks and incompleteness of the family were the most common reasons for non-use of contraception, the latter reason reflecting ignorance of the temporary nature of some methods. There was a strong preference for male children and couples rarely used contraception until at least one so had been born. Even in this prosperous town where couples were highly motivated towards family planning and all methods were readily available, there was heavy reliance on sterilization. This is typical of Nepal and has largely been responsible for the failure of the family planning programme--as most couples choosing sterilization are in the older age group and have completed a relatively large family. If Nepal is to succeed in meeting its target of reducing the total fertility rate (i.e., births per woman) from the current 5.8 to 4 by the year 2000 it will need not only to expand services but actively to promote temporary methods of contraception, particularly the more reliable longer acting reversible methods such as Depo-Provera, Norplant and intrauterine contraceptive devices.

Adolescent↗

The frontier of modern Western medicine in Nepal.

Using the concepts frontier and interface the introduction and spreading of modern Western medicine in Nepal and its relations to other medical systems are described and analyzed. Medical systems do not prevail in the same degree in all places; we may call the geographic areas of concentration the core areas or center(s) of medical systems and the remaining areas their periphery. The frontier of a medical system is defined as that part of the periphery where the presence of the system is increasing. The place of the frontier, its width and the forms in which a medical system appears at its frontier are determined by both internal dynamics and contextual factors. In non-socialist countries like Nepal the dynamics of modern Western medicine are characterized by three tendencies: centralization, expansiveness and a commercial and capitalist character. Some important contextual factors which have been shaping the frontier in Nepal are: migration, including tourism, labor-migration and trade; the role of foreign aid and geographical conditions. The situation at the frontier has an important influence on the nature of the interface between modern Western medicine and other medical systems. In the article Faith-healing, Ayurvedic medicine, Homeopathy and Tibetan medicine are described briefly and the interface between them and modern Western medicine is looked into.

China↗