Journal of Manmohan Memorial Institute of Health Sciences

Health Professional Education Alarming Crisis Knocking Our Doors

Dharma Prasad Khanal — 2023-11-06

The education of health professionals was creeping before multiparty political system in 1990 and substantially changed after this political event in Nepal. Free market economy opens the avenue of privatization of different sector of business and education sector only was not an exception. Several transformative developments have happened in education sector but all of them were donor driven that is becoming unfortunate for the country. In the period from 1990 to 2015 so many policy reformations occur for the implementation of free market economic concept that foster mushrooming of private educational institutions especially in class 12 level (we denote it as plus two in Nepal) followed by flooding affiliations of different universities for private colleges and they are likely to have a long-term effect on education system including health-professional education (HPE). The quality of HPE imparted directly affects the people’s health and it is thus very important to focus our attention towards it. But there was critical imbalance between the education and business. Moreover, the curricula of HPE of many universities is outdated and the topic stays within the confines of the four walls of the classroom and has no relevance in their daily lives although these are matters of routine healthcare.

Adolescent Mental Health: An Emerging Public Health Concern

Poojan Sharma — 2023-11-06

Adolescence is the phase of life between childhood and adulthood, from ages 10 to 19. They experience rapid physical, cognitive and psychosocial growth. Adolescent covers one sixth of the global population. An estimated 1.1 million adolescents die each year. The leading causes are road traffic injuries, suicide and interpersonal violence.

Individual And Environmental Factors Associated With Physical Activity Practices Among Adolescents Of Devchuli Municipality

Aashish Acharya — 2023-11-06

Background: Regular physical activity helps children and adolescents to remain healthy and fit, improve muscular and cardiorespiratory fitness, have psycho-social benefits The Global School Based Student Health Survey of Nepal 2015 shows that only 15.1% of adolescents of age 13-17 years were physically active daily. The risk factor of chronic diseases are traced back up to childhood hence promoting physical activity should start from childhood. Identification of these factors that affects level of physical activity among adolescents of Nepal and its better understanding will aid in promoting physically active lifestyle and designing effective interventions.

Assessment Of Most Common Infectious Diseases And Medicines Prescribed In The Health Posts Of Dhading District

Mijala Bajracharya — 2023-11-06

Background: Infectious diseases are the communicable or transmissible diseases which are mainly caused by presence of pathogenic agents like (bacteria, virus, fungi, protozoa) in the individual host. Globally the infectious diseases contribute for 32.3% of total death and in Nepal about 70% health related problems and death are caused by infectious disease. This study was aimed to find out most common infectious diseases and medicines prescribed in its management in the health posts of Dhading district.

Method: A Descriptive Cross-sectional study was conducted in three health posts of Dhading district namely Naubise health post, Bhumesthan health post and Mahadevbesi health post. 450 data were collected from record room of health posts from Shrawan 2077 to Asoj 2077. Patient related and drug related data and information were collected and analyzed.

Results: The most frequent cases were Respiratory Tract Infections (22.22%), Dermatitis (11.55%) and Urinary Tract Infections (11.11%). Majority of cases were in between the age group of 21-30 years (25.11%).The average number of drugs per prescription was 2.37. The percentage of drugs prescribed by generic name and from an essential drug list of Nepal was (73.38%) and (97.46%) respectively. Out of 1067 drugs prescribed, antimicrobials (39.9%) were most commonly prescribed followed by NSAIDs (25.7%), and antihistamine (15.8%). Among antimicrobial, most commonly prescribed was amoxycillin ( 35.21%) which was followed by ciprofloxacin (16.43%) and azithromycin (14.08%).

Conclusion: This study showed Respiratory Tract Infection was most common infectious disease and Amoxycillin was mostly prescribed drug.

Awareness On Foreign Body Aspiration Among Mothers Of Under-Five Children Of A Community

Jamuna Laxmi Maharjan — 2023-11-06

Background: Foreign Body Aspiration (FBA) is the fourth leading cause of accidental death for children under five years of age. FBA is a life-threatening emergency and needs urgent intervention. Mother is the primary caregiver for the child who can prevent, identify and get prompt treatment of FBA for their children. The objective of the study was to assess awareness on FBA among mothers of under five children.

Method: A descriptive cross-sectional study was conducted among 84 mothers of under-five children based on inclusion criteria using non-probability convenience sampling technique. A self-developed structured questionnaire was used using face to face interview technique to collect the data. Data was collected from 16th Jan.2022-14th Feb.2022. Data analysis and interpretation was done using descriptive and inferential statistics.

Findings: The findings showed that majority of the respondents 52.4% had poor level of awareness on FBA. The findings of the study showed low level of awareness on causes, signs and symptoms, preventive measures, management, complications. Majority of the respondents (91.7%) replied male child as risk gender & 89.3% respondents answered 1-5 years children having maximum chances of FBA. There is no significant association between level of awareness and Socio-demographic variables.

Conclusion: More than half of the respondents had poor level of awareness on FBA. Therefore, study emphasizes on need to create more awareness about causes, signs and symptoms, prevention, management and complications among mothers of under-five children.

Study Of Thyroid Profile In Different Trimesters Of Pregnancy

Anit Lamichhane — 2023-11-06

Background: Thyroid disorders and dyslipidemia are frequent during pregnancy, which are associated with complications for both the mother and the fetus. Hence, this study aims to evaluate thyroid function test and its association with dyslipidemia in pregnancy.

Method: This laboratory-based cross-sectional study was carried out in Manmohan Memorial Teaching Hospital, Kathmandu, Nepal. A total of 200 participants; where 100 pregnant and 100 non pregnant women were included in the study. Pregnant women were further subdivided into 1st, 2nd and 3rd trimester groups. Thyroid Profile and Lipid profile were estimated. Student t-test, one way ANOVA, and Pearson’s correlation were applied.

Findings: The findings of the study revealed that the level of TSH was significantly (p<0.001) lower, TG, TC and VLDL were significantly (p<0.001) higher and HDL was significantly (p<0.001) lower in pregnant women as compared to non-pregnant women. In different trimester of pregnancy TG (p<0.001), TC (p<0.05) and VLDL (p<0.001) were found to be significantly increased with increasing trimester of pregnancy.

Conclusion: In medical interventions, screening of thyroid hormones, lipid profile and adjustment of TSH level according to trimester specific range in different trimesters should be implemented to improve lipid indices to decrease pregnancy complications outcomes.

Awareness On Minor Disorders Of Pregnancy Among Pregnant Women Of A Hospital

Mamata Maharjan — 2023-11-06

Background: Minor disorders of pregnancy are the common discomforts experienced during pregnancy. These disorders can be unbearable and stressful which may later affect outcomes of pregnancy. The objective of the study was to find out awareness on minor disorders of pregnancy among pregnant women attending antenatal OPD. Methods: A descriptive cross-sectional study was conducted among 91 pregnant women in Bhaktapur hospital by using non - probability convenience sampling technique. Face to face interview technique was used to collect data by using self-developed structured questionnaire. The study was conducted between 27 April 2022 to 27 May,2022. Data management, analysis and interpretation was done using descriptive and inferential statistics and represented in tabulated form.

Results: The findings of this study showed that the majority (70.3%) of the respondents had an inadequate level of awareness of minor disorders of pregnancy. Inadequate awareness was present in causes of hemorrhoid, causes of varicose vein 25.3%, and causes of insomnia 44.0% during pregnancy. There was a significant association between levels of awareness on minor disorders of pregnancy with type of family (p=0.017).

Conclusion: Awareness on minor disorders of pregnancy among pregnant women is still inadequate, which suggests the need for effective health education program on minor disorders of pregnancy to prevent form complications arise from these disorders.

Morphological Patterns Of Anemia In Patients With Chronic Kidney Disease In A Tertiary Care Hospital, Nepal

Prajwal Khanal — 2023-11-06

Introduction: Anemia is the major health issue that is causing the most disability worldwide amongst the patients with chronic kidney disease (CKD). Anemia in CKD is defined as an Hemoglobin level <13.5 g/dl and 12.0 g/dl in men and women respectively as demarcated by National Kidney Foundation. This study provides insights about the subtypes of anemia in patients with chronic kidney disease patients. We aim to determine the morphological Patterns of anemia in a patient with chronic kidney disease, the differential diagnosis of renal anemia.

Methods: A descriptive cross-sectional study was conducted among diagnosed CKD patients presented to the Nephrology Out patient department of a tertiary level hospital in Kathmandu over a six months period, from September 15, 2022 to March 15, 2023. Etiology of anemia were worked out. All adults (>18 years of age) with chronic kidney disease patients with an estimated glomerular filtration rate (eGFR) below 60 ml/min, and who were not started on dialysis were recruited. The study proposal was approved by Institutional review committee (IRC) of Nepalese army institute of health sciences (NAIHS) prior of conducting the study. Convenience Sampling was done.

Result: Anemia was seen in 96.8% of patients among which 58.9% of the patients presented with severe anemia. Among all patients, mean hemoglobin value was 9.45±1.60 g/dl. Moderate anemia was the commonest (50.50%) degree of anemia. Microcytic hypochromic was the commonest (44.7%) finding in peripheral blood film study followed by normocytic normochromic type (43.7%) and plasmacytoma (5.3%).

Conclusion: We found a high prevalence of anemia among chronic kidney disease as compared to other studies conducted in similar settings. The higher percentage of anemia found in the study may be attributed to NKF criteria for anemia diagnosis, the cutoff of which is higher than that for general population. Also, the patients not having received renal replacement therapy in the past were taken in the study, causing higher incidence of anemia in CKD. Treatment of anemia may somewhat improves quality of life. Thus, early recognition and effective treatment in patients with CKD is highly recommended.

Assertiveness Among Nursing Students Of A Nursing Institute In Kathmandu

Shristi Rana — 2023-11-06

Background: Assertiveness is a key attribute for successful nursing practice. A professional nurse must be assertive for improving nursing care so it should be emphasized during their academic period. The objective of the study was to find out the assertiveness among nursing students in Kathmandu.

Method: A descriptive cross-sectional study design with 71 nursing students of Proficiency Certificate Level (PCL) in Manmohan Memorial Institute of Health Sciences was conducted between 27th April, 2022 to 27th May 2022. Non-probability sampling technique was used to select the sample. Assertiveness Scale of Begley and Glacken, a self-administered questionnaire was used for data collection which was distributed to the respondents by mail. Data analysis and interpretation was done using descriptive and inferential statistics.

Result: The result showed that majority of the respondents (87.3%) had moderate level of assertiveness and very least respondents (4.2%) had high level of assertiveness. Respondents were found to be more assertive who enjoy to start conversations with strangers (3.75±0.61), who are always frank about their feelings (3.57±0.92) and never find difficult to compliment and praise friends (2.97±1.01). However, they were less assertive in trying to avoid conflict (1.45±1.41), never disagree when a friends’ opinion is wrong (1.63±1.00) and are more careful to avoid hurting other people’s feelings (1.24±0.68). There is no significant association between level of assertiveness with sociodemographic variables.

Conclusion: The findings of the study conclude that the majority of respondents were less assertive in avoiding conflict, disagreeing to friends’ opinion and careful to avoid hurting other people’s feeling. So, the concerned academic organization should emphasis more on encouraging assertiveness among the nursing students.

Effect Of Breastfeeding Among Under 2 Years Children In Kaski District, Nepal

Srijana Paudel — 2023-11-06

Background: Breastfeeding is one of the most important determinants of child survival, birth spacing, and the prevention of childhood infections. The beneficial effects of breastfeeding depend on its initiation, duration, and the age at which the breastfed child is weaned. Breastfeeding positively influences cognitive development.

Methods: A descriptive cross-sectional study design was used to study impacts of breastfeeding among under 2 year’s children in Kaski district. Interview schedule as a structured questionnaire was used as data collection tool. Data was entered in Epi-data and analysis was performed with the help of the Statistical Package for Social Science.

Results: The result showed nearly one-third (30.9%) of the respondents had fed bottle milk to their children. Majority (85.7%) of respondents had knowledge about effect of breastfeeding. Majority (78.9%) of the children were stunted and 27.8% of children are underweight. Very few (5.3%) of children were found wasted. Sex (p 0.044), suffering from disease (p 0.046), duration of breastfeeding (p 0.001), breastfeeding interval (p 0.001), breastfeeding time in day (p 0.001) were statistically associated with effect of breastfeeding. Height and weight, age and weight was found positively correlated (p<0.05).

Conclusion: The study showed child who were breastfed frequently were normal in weight; their physical development is found good. There is positive co-relation between height and weight as well as age and weight. BCC programme should be conducted for breastfeeding mothers on time, interval, duration of breastfeeding

Knowledge On Management Of Side Effects Of Chemotherapy Among Cancer Patients In A Hospital Of Bhaktapur

Sunita Shrestha — 2023-11-06

Background: Cancer is the second leading cause of death worldwide. The increase in incidence of cancer is directly related to the increase in number of patients receiving chemotherapy. The objective of the study was to assess the knowledge on management of side effects of chemotherapy among cancer patients in a hospital of Bhaktapur.

Method: Descriptive cross-sectional study was conducted among 104 cancer patients in a hospital of Bhaktapur, Nepal using non-probability purposive sampling technique. Data was collected through face-face interview technique by using self-developed structured questionnaire. The study was conducted between 2079-10-01 to 2079-10-30. Data management, analysis and interpretation was done using descriptive and inferential statistics and represented in tabulated form.

Findings: More than half (56.7%) of the cancer patients had adequate knowledge on management of side effects of chemotherapy. Adequate knowledge was present on management of diarrhoea (82.7%), infection (65.4%) and nausea and vomiting (63.5%). However, inadequate knowledge was present on management of constipation (31.8%), extravasation (33.7%) gums bleeding (35.6%) and hair fall (38.5%). The study shows significant association between level of knowledge on management of side effects of chemotherapy with age (p=0.037) and educational status (p=0.029) of the cancer patients.

Conclusion: More than half of the cancer patients had adequate knowledge on management of side effects of chemotherapy. Despite of this, respondents had still gap in knowledge on management of side effects of chemotherapy which shows need for, health education and counselling should be done among cancer patients.

Quality Evaluation Of Different Commercial Shampoo Brands Made In Nepal

Deepti Piya Baniya — 2023-11-06

Background: Shampoo is one of the most popular cosmetic items for washing the hair and scalp. It is necessary to evaluate shampoo in order to understand its performance, quality, and effectiveness, as well as to ensure compliance with the standards of many journal articles.

Objective: The purpose of the research study was to evaluate the quality of four commercial and two medicinal shampoo brands made in Nepal.

Method: A cross-sectional, descriptive study was carried out in order to evaluate label information, microbiological quality, and physiochemical parameters such as (pH, density, viscosity, surface tension, foaming ability & stability, detergency power, wetting time etc. Furthermore, a UV-visible spectrophotometer was used to measure the percentage of assay of medicated sample.

Result: When compared to secondary data from journals, the study found that not all shampoos met specifications. It was found that only S5 of the six samples tested positive for microbial growth and exceeded the limit. Except for S5, the pH ranged between 5-7.The surface tension of all samples meets the specifications. S1-S4 had normal detergency power, however the medicated sample had low detergency power. All demonstrated good wetting time and dirt dispersion. The percentage of solid content in S1-S2 was very low. The assay percentage was within the prescribed range for medicated sample.

Conclusion: When compared to a standard journal, the study found that certain parameters were within range while some were out of range.

Virulence And Drug Resistance Pattern Of Escherichia Coli Isolates From Various Clinical Sample

Soma Kanta Baral — 2023-11-06

Introduction: E. coli is one of the most common pathogens, and its infection has resulted in a global burden due to its increased medication resistance and virulence factors. The goal of this study was to examine the drug resistance pattern and pathogenicity properties of Escherichia coli isolates.

Methods: Over the course of six months (March 2019-August 2019), a laboratory-based cross-sectional study was done among patients visiting Manmohan Memorial Teaching Hospital in Kathmandu, Nepal. Standard microbiological procedures were used to identify bacterial isolates from clinical specimens. The modified Kirby Bauer disk diffusion method was used to determine antibiotic susceptibilities. The combined disk test method was used to confirm the ESBL and MBL. To determine their virulence, serum bactericidal activity and biofilm productions were determined.

Results: 59.60 percent (n=81) of the 136 Escherichia coli isolates were multidrug resistant, 25.70 percent (n=35) were ESBL producers, and 11.80 percent (n=16) were MBL producers. Serum resistance was discovered in 22.8 percent (n=31) of the total isolates, while biofilm formation was found in 19.11 percent (n=26). Amoxycillin had the highest level of resistance (87.5%), whereas Chloramphenicol (93.4%) and Imipenem (80.9%) were the most susceptible antibiotics. Polymyxin B and Colistin sulphate were absolutely sensitive. In our investigation, 61.5 percent of biofilm producers were MDR, with non-beta lactamase types being the most common. MBL producers were discovered to be more serum resistant. Amikacin and Imipenem were found to be more sensitive to biofilm makers.

Conclusions: The expression of Escherichia coli virulence factors varied depending on the kind of infection. Escherichia coli has a high rate of multidrug resistance. To minimize the emergence and spread of antibiotic resistance in bacteria, proper identification of drug-resistant bacteria, careful use of antibiotics, and effective antibiotic policy are required.

To Assess The Knowledge And Perceptions Regarding Novel Coronavirus (Covid-19) During The First Surge Among Healthcare Workers Of Banke District, Nepal

Eliza Koirala — 2023-11-06

Background: Human Coronaviruses (HCoVs), a large family of single-stranded RNA viruses in humans causes mainly respiratory tract infections. The current outbreak of coronavirus disease 2019 has emerged as pandemic causing severe public health issue of international concern. This study aims to assess the knowledge and perception regarding novel coronavirus (COVID-19) during first wave of pandemic among healthcare workers working at various Health care institutions.

Method: This web-based cross-sectional study was conducted among 174 health care workers of Banke district, Nepal between May-July 2020 during first wave of COVID-19 pandemic using an online self-administered questionnaire. A 35-item self-administered survey instrument was developed using WHO course materials on emerging respiratory viruses, including COVID-19, and covered the domains of HCWs characteristics, knowledge, and perceptions of HCWs related to COVID-19. Descriptive statistics were reported as proportion and frequencies. Bivariate analysis was performed using chi-square test to assess the association of level of knowledge, and perception about COVID-19 with participants’ characteristics. A p-value of less than 0.05 was considered statistically significant. All the statistical analysis was performed using IBM SPSS software, version 23.

Findings: Most of the participants (94.8%) had known about the virus from news (70.1%) and social media (68.4%). Among them only 36.2% participants had the opportunities to attend lectures, discussions, and training about the virus COVID-19. Overall, 55.7%, and 52.9% of the HCWs had adequate knowledge, and positive perception about COVID-19, respectively. Bivariate analysis showed no significant association of knowledge regarding COVID-19 among health care worker with participants characteristics whereas, the variables such as gender, occupation, working department showed significant association of perception regarding COVID-19 among health care worker.

Conclusion: This study revealed lower level of knowledge and positive perception regarding COVID-19 and infection control measures among HCWs. There is a need of adequate training to enhance the knowledge and perception about covid-19 and safety measures to the HCWs.

Perceptions And Practices Of Self-Medication Among The Residents Of Western, Nepal

Pharsuram Adhikari — 2023-11-06

Correction: On 27/11/2023 the PDF was replaced because of a mismatch in the introduction and methodology inside the article and the error is human error (copy / paste).

Background: Self-medication is defined as the “The taking of drugs, herbs or some remedies on personal initiative, or on the advice of another person without consulting a physician for the aliment of self-diagnosed physical illness”. Self-medication is practiced throughout the world, including both developing and developed countries. Self-medication includes both risks and benefits.

Objectives: To assess the perceptions and practices of self-medication among the residents of Western, Nepal.

Methods: A cross-sectional study was conducted among 378 respondents aged above 18. Closed ended questionnaire was used as data collection tool. Non-probability purposive sampling method was used for the collection of data.

Results: The prevalence of self-medication practices was found to be 76.8%. Friends/Family members/Relatives 34.20%), Past-own experience (23.9%) and Pharmacist (23.5%) were the major source of information for self-medication practices. The most common type of illness for self-medication were Headache (19.7%), Cough and Cold (19.1%) and fever (18.10%). NSAIDs (32.9%), Cough Syrups (15.0%) and Antibiotics (14.8%) were the mostly used drugs in self-medication practices. The most common reasons for self-medication were previous experience (23.59%), minor illness (19.77%) and quick reliefs (19.1%). More than half of respondents (57.0%) were found to have positive perception towards the self-medication practices. This study showed education status (p=0.033) had significant association with the self-medication practices.

Conclusion: The study focused to assess the perception and practices of self-medication. The prevalence of self-medication was found to be 78.6%. More than half of the residents were found to possess positive perception towards the self-medication practices.

Knowledge Of School Health Programmes Among Teachers In Schools, Gulmi

Rhinu Shrestha — 2023-11-06

Background: School teachers should have basic knowledge regarding school health programs to provide promotive and preventive healthcare through the implementation of the program. Thus, the main objective of the study was to assess the knowledge of school health programs among school teachers in the schools of Gulmi.

Method: A cross-sectional descriptive study was designed using a probability proportionate sampling technique and data from 73 respondents were collected using a self-developed structured questionnaire. The study was conducted between 2079/10/01 to 2079/10/30. Data management analysis and interpretation were done using descriptive and inferential statistics and presented in tabulated form.

Result: In total, 49.3 % of the respondents had an adequate level of knowledge. Most (86.3 %) of respondents had a clear concept of the meaning. 90.4% of respondents had adequate knowledge of school health education. 58.9 % and 54.8% of respondents had adequate knowledge of Nutrition and health services, and school health nurses respectively. Only 46.9% of respondents had adequate knowledge of School health education. The study showed an association between the level of knowledge and the level of teaching area of the teachers (P=0.039).

Conclusion: There was Less than half of the teachers had adequate knowledge on school health program. However, there are still gaps in knowledge on school health environment, Nutrition, and health services. Thus the training program should be provided by authorized level regarding this kind of components to enhance knowledge among teachers.