Journal of Karnali Academy of Health Sciences <p>The official journal of the Karnali Academy of Health Sciences, Jumla, Nepal.</p> en-US <p><br><br></p> (Dr. Kapil Amgain) (Sioux Cumming) Wed, 23 Dec 2020 09:58:30 +0000 OJS 60 Gender Issue in COVID-19 Pandemic <p>Since the first outbreak, COVID-19 has manifested itself as a serious public health threat with severe social and economic implications. Gender is an essential component that requires special attention and action in such crisis. This review is aimed at finding the gender-related issues amid COVID-19 pandemic that need to be considered and help stimulate related stakeholders to devise effective policies and actions.</p> <p>Health, socio-economical and education, all domains of gender are viciously affected by this pandemic. Though men and women have the same prevalence, men with COVID-19 are more at risk of worse outcomes and death. Even though the direct impact of disease is observed significantly high in men, the secondary socio-economic impact is catastrophic in women and girls considering their status in society as they are systemically oppressed and vulnerable group of population. The pandemic will have a prolong effect on socioeconomic dynamics. Hardly achieved milestones on gender equality reached low, which will take long to bounce back. From this crisis, government and policy makers should take a lesson and formulate public health policies and measures to contain the epidemic that takes account of gender and its interactions with all areas of inequality. &nbsp;</p> Santoshi Giri, Sitaram Khadka, Sushma Ranabhat, Mariam Agha Copyright (c) 2020 Author(s) Mon, 21 Sep 2020 00:00:00 +0000 COVID-19 Pandemic in Nepal: A Threat to Low Resources Countries <p>At present, the global community is experiencing a pandemic caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that caused coronavirus disease 2019 (COVID-19), the third disease from a coronavirus to cause a global outbreak. Person-to-person transmission occurs through droplet or contact transmission and if there is a lack of rigorous infection control or if no proper personal protective equipment (PPE) is available, it may endanger the first-line healthcare workers. In Nepal most of the cases are those who traveled to China and India till date, the infection is transmitted to clusters of societies only. Health workers as well as the general public has to be protected from getting infection applying established and universal infection prevention strategies including social distancing, hand hygiene and application of personal protective devices as required. Person-to-person contact is one of the most predominant ways of transmission of the disease, hence general public as well as all the professional workers have to follow the infection prevention approaches.</p> Seshananda Sanjel, Tarun Paudel, Sangita Sanjel Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Perception of Nurses and Relatives on Family Needs of Critically Ill Patients: A Hospital Based Comparative Study <p><strong>Background</strong>: Critical ill patients are not able to decide about their treatment and their relatives usually asked for the treatment decisions on behalf of the patient. At the time of critical illness, all family members or relatives experience crises and may be exhausted. Recognizing and addressing the relative’s needs is a very important aspect of holistic health care to critically ill patients.</p> <p><strong>Methods</strong>: A descriptive cross-sectional study was conducted to make a comparison between the nurses’ and relatives’ perceptions regarding the needs of critically ill patients’ family members’ in the Nepalese context. A convenient sample of 50 nurses and 50 relatives who meet the inclusion criteria were selected and interviewed by using a structured questionnaire in the different intensive care units of Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal during the period of January to April 2018. The data were analyzed by using descriptive and inferential statistics in the statistical package for social sciences version 16.</p> <p><strong>Results</strong>: The majority, (86%) of the relatives ranked “to know specific facts concerning the patient’s progress and treatment” as the topmost very important need, and 80% of the nurses’ ranked this need as a very important need. The majority of nurses (86%) ranked “to receive explanations about the environment of critical care unit for the first time” as a topmost very important need, whereas, only 54% of the relatives had ranked this need as very important to them. There was a statically significant positive correlation among some need statements between the two groups.</p> <p><strong>Conclusion</strong>: There was a significant difference in the perception of some aspects of family needs by the nurses and relatives. Nurses’ mean score was lower than the relatives’ which can be a major source of disputes among nurses and relatives in the intensive care units.</p> <p><strong>Keywords</strong>: Intensive Care Unit, critically ill patient, family needs, nurses’ perception and relatives, perception</p> Sabita Pandey, Roshanee Shrestha, Narayani Paudel Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Awareness and Health Beliefs of Osteoporosis among Middle Aged Women in Selected Municipality of Kathmandu <p class="Default"><strong><span style="font-size: 11.0pt;">Introduction: </span></strong><span style="font-size: 11.0pt;">Osteoporosis is a bone disorder characterized by a reduction in bone density accompanied by increasing porosity and brittleness. It is one of the major public health problem globally and its prevalence is rapidly increasing particularly in women. Osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. Therefore the objectives of the study was to assess the existing awareness and health belief of osteoporosis among middle aged women. </span></p> <p class="Default"><strong><span style="font-size: 11.0pt;">Methods: </span></strong><span style="font-size: 11.0pt;">Descriptive cross-sectional research design was used on a sample of 328 middle aged women residing in Nagarjun Municipality, Kathmandu. Non probability purposive sampling technique was used to collect the data. Data was collected after informed consent through face to face interview schedule using Osteoporosis Knowledge Assessment Tool (OKAT) and Osteoporosis Health Beliefs Scale (OHBS). Descriptive statistics and inferential statistics (Chi-Square test) were used for data analysis at 5% level of significance. </span></p> <p class="Default"><strong><span style="font-size: 11.0pt;">Results: </span></strong><span style="font-size: 11.0pt;">The overall osteoporosis awareness and health beliefs mean scores were9.39 ± 2.93 and 146.18 ±11.58 respectively. Majority(60.0%) of the respondents were unaware of osteoporosis. Existing awareness of respondents was significantly associated with age (<strong><em>p</em></strong>&lt;0.001and level of education (<strong><em>p</em></strong>&lt;0.038). Based on the OHBS subscale score, the highest perception was on health motivation (22.73±2.81) and the lowest perception was on barriers to calcium intake (mean score 17.71±4.32). </span></p> <p class="Default"><strong><span style="font-size: 11.0pt;">Conclusion: </span></strong><span style="font-size: 11.0pt;">Based on the findings, it is concluded that the majority of middle aged women were unaware about osteoporosis. Education and age of women was significantly associated with level of awareness.</span></p> Sarita Panta, Sarita Adhikari, Anju Gurung, Bimala Pandey, Amuba K.C., Aruna Rai Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Prevalence of study related anxiety among medical students: a study from a medical college in central Nepal <p><strong>Introduction</strong>: Medical education can lead to anxiety and depression in medical students which may have negative academic and professional consequences on them. The objective of this study was to find out the prevalence of study related anxiety, its severity and frequency of different symptoms related to anxiety among medical students.</p> <p><strong>Results:</strong> Study-related anxiety was found in 73.33% of students. Anxiety was more common amongst final year medical students (83.33%) followed by 1<sup>st</sup>/2<sup>nd</sup> year students (76.67%). Prevalence of anxiety was found to be less among 4th-year&nbsp;medical students (63.33%). The majority of the students experienced a mild to moderate level of anxiety. i.e.44.31 % and 36.37 % respectively. The most common symptoms of study related anxiety were recurrent fearful thoughts about studies, constant tension about studies and panic feeling about exam in varying degree of severity.</p> <p><strong>Conclusion:</strong> There is a high prevalence of study related anxiety among medical students in the current study. Early identification and timely intervention of study related anxiety symptoms in medical students will prevent mental distress and negative effect on their academic pursuits.</p> <p>&nbsp;</p> Praveen Bhattarai, Devavrat Joshi, Bhupendra Singh Gurung Copyright (c) 2020 Author(s) Thu, 25 Jun 2020 00:00:00 +0000 Health Status of Elderly People Living in Old Aged Homes in Pokhara <p><strong>Background: </strong>Health is serious matter for the elderly people especially living in old aged homes. In this context, this study has tried to explore the health status of elderly people living in old aged homes.</p> <p><strong>Methods: </strong>Information were collected from fifty seven elderly people living in purposively selected three major old aged homes of Pokhara by using structured questionnaire through interview techniques. The elderly people, who were unable to speak, hear, complete the interview process, have severe psychiatric disorder, did not have verbal consent to participate were excluded from the study. Descriptive analysis was carried out for this research.</p> <p><strong>Results: </strong>Majority (87.7%) of the respondents had chronic physical health problem like back pain problem as major followed by other musculoskeletal problems, gastrointestinal disease, hypertension, respiratory problem, diabetes mellitus, heart disease, eyes and ears problem. The proportion of female was higher than male regarding their chronic physical health problem. Majority went to hospital when they were sick. Half of the respondents were worried about economic insecurity followed by lack of social relation, lack of treatment during illness, fear of future, lack of recreational activities, food management of old age homes, environment of elderly official, sitting and sleeping environment of elderly home and others respectively. All the respondents prayed god to cope with these stress followed by listening to religious hymns, go to religious places, solitary living, crying alone, and take cigarettes/alcohols.</p> <p><strong>Conclusions: </strong>Health status of elderly people living in old aged home was not good since most of the elderly were suffered from chronic physical health problem. Females are more vulnerable.</p> Ananta Raj Dhungana, Parbati Dhungana Copyright (c) 2020 Author(s) Tue, 22 Sep 2020 00:00:00 +0000 Health Problems of Nepalese Migrant Workers and Their Access to Healthcare Services in three countries of Middle East <p><strong>Background</strong>: Migrants’ health is a global public health issue. Middle East countries are the major destination for abroad job among Nepalese workers. This study carried out to identify the health problems among migrant workers and their access to health care in Saudi Arabia, United Arab Emirates (UAE) and Qatar of Middle East.</p> <p><strong>Methods: </strong>This was a cross-sectional study; carried out among 480 returnee migrant workers who have given consent for the study. Data were collected at Tribhuvan International Airport (October 2018) using pretested structured interview schedule after taking approval from Institutional Review Committee of Pokhara University. Data were analyzed using SPSS 20 version. Percentage, mean/median, standard deviation, Chi square test and logistic regression performed.</p> <p><strong>Results</strong>: Majority of the returnee migrants workers were male (95.0%) and their mean age was 32.38±5.54 years. Almost ten percent of the participants suffered from at least one health problem during their stay in Middle East; among them, respiratory problems were common (35.6%). Almost all participants (99.6%) had health policy to take care of migrant workers and 93.5 percent participants had health insurance coverage. Female workers (AOR 4.34; CI: 1.54-12.19), and migrants who worked for additional benefits (AOR 2.17; CI: 1.11-4.25) had significantly higher prevalence of health problems than their counterparts (P&lt;0.05).</p> <p><strong>Conclusion: </strong>Almost ten percent migrant workers had at least one health problem during their stay in Saudi Arabia, UAE and Qatar. Almost all workers had the access to health care in Middle East countries. Female workers and the workers who performed additional work (over time) were at higher risk of the health problems. Universal coverage of quality health care for migrant workers in abroad and mainstreaming the route of permission for work is recommended.</p> Damaru Prasad Paneru, Chiranjivi Adhikari, Raju Pandey, Bimala Bhatt, Manisha Chalise, Nirdesh Baidhya, Arati Paudel Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Awareness and Implementation Status of Tobacco Policy Provisions among Students of Public Schools in Budhanilkantha Municipality, Nepal <p><strong>Background: </strong>The tobacco epidemic was responded globally with the enforcement of the WHO Framework Convention on Tobacco Control (WHO FCTC), a first public health treaty, on 27 February 2005. As a party and signatory country to FCTC, Nepal ratified the tobacco product (control and regulation) act in 2011. After endorsement of the act and other related tobacco policy documents, it is necessary to measure awareness level and the implementation status among different stakeholders including adolescent students. This study aimed to assess the awareness and implementation status of tobacco policy provisions in the students of Budhanilkantha Municipality of Kathmandu district, Nepal.</p> <p><strong>Methods: </strong>This study was a school-based cross-sectional survey. A total of 378 students were recruited from five schools of Budhanilkantha municipality of Kathmandu, Nepal. The self-administered questionnaires were adapted from the Global Youth Tobacco Survey (GYTS) tool of the World Health Organization and youth-tobacco survey tool of the Center for Disease Control and Prevention (CDC) to collect the data.</p> <p><strong>Results: </strong>The study showed that less than half of the participants (45.8%) knew that there is a tobacco product (control and regulatory) act in Nepal. Similarly, two-thirds (65.9%) of the participants responded that they were aware of the selling of tobacco products to a person below 18 years was legally prohibited in Nepal. In terms of tobacco laws enforcement, 66.2% of the participants were not prevented from buying tobacco products because of their age.</p> <p><strong>Conclusions: </strong>More than half of the students were found unaware of tobacco control policies of Nepal, despite the students are the key target stakeholders of tobacco control policies. Additionally, implementation of policy provisions related to protecting the students from tobacco in school or home is not effectively enforced although Nepal has comprehensive tobacco control policies.</p> Bhakta KC, Laxmi Kumari Oli, Nawa Dahal Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Experience of Mothers Having Preterm Newborns in Neonatal Care Units <p><strong>Background: </strong>Preterm births are vulnerable to morbidities and require hospitalization in the neonatal care unit (NCU). The situation is stressful for mothers influencing their attachment and care to the newborns. Therefore, this study was conducted to explore the experience of mothers having preterm newborns in NCU.</p> <p><strong>Methods: </strong>The qualitative study was conducted among purposively selected 13 mothers of NCU admitted preterm infants at Tribhuvan University, Teaching Hospital. Data was collected using in-depth interview. Colaizzi content analysis method was used for data analysis.</p> <p><strong>Results: </strong>Among 13 mothers, 8 were primipara, 25-30 years, homemakers; 6 had Bachelor or above education; 11 had ANC visit &gt; 4 times. Ten infants were very preterm (&lt; 32 weeks gestational age), 11 have very low birth weight (&lt; 1500 gram), 9 born by caesarian section and stayed NICU for 7-14 days. Study identified 5 themes and 18 subthemes: loss of control (fear and anxiety, distress towards pain and suffering, guilt feeling, hopelessness); sense of difference (newborn’s appearance, needs and problems, breastfeeding and parental roles); care of newborn (trust to nurses, confidence and emotional attachment with care involvement,), support for coping (support from family, nurses and other mothers); and difficulties faced (distance to NCU, inadequate guidance and information, and lack of supportive environment)</p> <p><strong>Conclusion: </strong>The hospitalization of preterm newborns in NCUs was usually stressful situation for mothers. Their positive experience and coping was related with provided guidance support and involvement in newborn care. Therefore, nurses working in NCU should consider these care components in their practice. &nbsp;</p> Tumla Shrestha, Ajanta Singh, Saraswoti Kumari Gautam Bhattarai, Kalpana Silwal Raut Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Family Caregivers’ Satisfaction towards the Communication of Health Service Providers in Tertiary Care Hospital of Nepal <p><strong>Introduction</strong>: Patient and family caregivers’ satisfaction is an essential measure of the quality of care and a determinant of health service utilization. Measuring family caregivers’ satisfaction with health service providers is important for understanding and improving the quality of care at health facilities. Therefore, the present study aimed to assess the satisfaction of family caregivers towards the communication of health service providers.</p> <p><strong>Methods</strong>: A descriptive cross-sectional study was conducted by the development of a questionnaire at one of the tertiary care hospitals. Self-administered questionnaires related to demography and different dimensions on the satisfaction of caregivers towards the communication of health service provider was designed. Sixty caregivers were provided questionnaire and data was collected. Descriptive analysis, frequency, and percentage were calculated using SPSS 23 (SPSS Inc., Chicago, IL, USA)</p> <p><strong>Results</strong>: The study showed that the majority of the caregivers (40%) were of the young age group (31-40 years). More than half (53%) of the caregivers were satisfied with different ways of communication about the patient's condition and treatment. In terms of communication mode, the majority of the caregivers were satisfied with related different ways of communication about the patient's condition and treatment (53.3%) followed by verbal (63.6 %) and non-verbal (50.6 %) respectively during their stay at the hospital.</p> <p><strong>Conclusion</strong>: The current study found that caregivers were satisfied with the communication provided by health service providers. This suggests that the treatment provided to patients might have better outcome measures. Additionally, it may help to reduce the anxiety among caregivers regarding the patients’ condition.</p> Sonam Shrestha, Basant Maharjan, Swosti Acharya, Manisha Dangol, Sunil Shrestha Copyright (c) 2020 Author(s) Mon, 21 Sep 2020 00:00:00 +0000 Immediate Effects of Yoga Based Relaxation Technique Yoga Nidra on Heart Rate Variability in Young and Healthy Volunteers <p><strong>Introduction</strong>: Cardiovascular autonomic functions are affected by the negative influences of stress which bring about alterations in heart rate variability (HRV). Yoga based relaxation techniques like Yoga Nidra have been found to relieve stress as shown by improved HRV. This study was conducted to assess the immediate effects of a yoga based guided relaxation technique, Yoga Nidra on HRV parameters in young and healthy volunteers.</p> <p><strong>Methods</strong>: This was an interventional study conducted in the Department of Clinical Physiology, Institute of Medicine, Maharajgunj. Fifty two male medical students were divided into supine rest group (n=26) and Yoga Nidra group (n=26). HRV indices were recorded before and after supine rest and Yoga Nidra. Intra-group and inter-group comparisons of the HRV parameters were done before and after the interventions.</p> <p><strong>Results</strong>: In comparison to the supine rest, Yoga Nidra produced significant increase in values of HF (1460.72 Vs 3272.99; p=0.03) and HFnu (50.32 Vs 62.68; p=0.004); and significant reduction in the values of LFnu (49.68 Vs 37.32; p=0.004) and LF:HF ratio (0.99 Vs 0.59; p=0.004), which suggested that the parasympathetic modulating response of Yoga Nidra was better than that of supine rest.</p> <p><strong>Conclusion</strong>: Yoga Nidra, a yoga based relaxation technique brings better relaxation response than supine rest as indicated by the significantly improved HRV indices.</p> Praghosh Chhetri, Lava Shrestha, Binaya SJB Rana, Dinesh Banstola, Narayan Bahadur Mahotra Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Depression among Chronic Kidney Diseases Patients Receiving Hemodialysis <p><strong>Background: </strong>Chronic Kidney Disease (CKD) is a progressive irreversible loss of renal function over a period of months or years. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintains life. Hemodialysis is used for patients who require short term dialysis (days to weeks) and for patients with advanced CKD and End Stage renal Disease (ESRD) who require long term or permanent renal replacement therapy. Hemodialysis significantly and adversely affects the lives of patients, both physically and psychologically. Depression is the most common psychological condition among patients with ESRD. Depression in dialysis patients not only effect mortality, but increased rate of hospitalizations and dialysis withdrawal is also very common.</p> <p><strong>Methods: </strong>A descriptive cross sectional research design was carried out to identify the depression level of chronic kidney disease patients receiving Hemodialysis in Western Regional Hospital, Pokhara using Beck Depression Inventory among forty six patients.</p> <p><strong>Results: </strong>The study findings revealed that majority of the patients (84.8%) has various degree of depression i.e. mild (21.7%), moderate (30.8%) and severe (32.6%). Only fifteen percent of patient has no depression. There was no statistical association between the level of depression and socio-demographic variables. It can be concluded that the prevalence of depression is high among patients receiving Hemodialysis.</p> <p><strong>Conclusion: </strong>The prevalence of depression is high among patients receiving Hemodialysis. It is effective to provide mental health services to the CKD patients receiving Hemodialysis which help them better psychologically adaptation to their disease and improve their quality of life. &nbsp;</p> Shanti Khadka, Rita Adhikari, Tarun Paudel Copyright (c) 2020 Author(s) Mon, 21 Sep 2020 00:00:00 +0000 Effectiveness of Sexual Harassment Risk Reduction Education based on Health Belief Model: A Quasi Experimental Study <p><strong>Background: </strong>Sexual harassment is a public health problem which has serious effects to girls’ psychosomatic health. Due to social stigma and lack of skills, even the girls can’t refuse sexual harassment. This study was done to evaluate the effectiveness of sexual harassment risk reduction education based on Health Belief Model.</p> <p><strong>Methods: </strong>A quasi experimental study was conducted in secondary level public schools of Tokha Municipality, Kathmandu. The study was done from 5th February 2016 to 5th May 2016. The sample size was 117 for each group which was calculated with input of 95% CI, power of test=80%, assuming 38 % change based on baseline study and 10% nonresponse rate. The ratio of participants in intervention and control group was 1:1 and the total numbers of participants were 128 in pretest and 121 in posttest at the intervention group and 131 in pretest and 122 in posttest in the control group. Data was collected by using self-administered questionnaire for knowledge and likert’s scale was used for attitude and behavioural intention. Lecture, group discussion, role play and brainstorming were methods used for intervention. After two weeks of intervention, a post-test was done.</p> <p><strong>Results: </strong>Testing of hypothesis revealed that the knowledge about sexual harassment, anti-sexual harassment attitude and behavioural intention of using refusal skills in sexual harassment in the intervention group were significantly higher than that of control groups i.e. p&lt;0.001, p&lt;0.001 and p&lt;0.05 respectively.</p> <p><strong>Conclusion: </strong>Sexual harassment risk reduction education intervention based on health belief model is effective to increase the knowledge, attitude and behavioural intention of participants. The findings of the study encourage further exploring creative approaches to programming in other violence prevention areas. &nbsp;</p> Radhika Thapaliya, Samir Kumar Adhikari Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Morbidity and Mortality Pattern of Appendicitis in Rural Teaching Hospital of Nepal <p><strong>Background</strong>: Acute appendicitis is the most common cause of surgical acute abdomen. It contributes for 40 % of all emergency performed abdominal surgeries in western world and 26 % it accounts for in Nepal. The treatment of acute appendicitis remains a health problem and considerable morbidity and mortality are still associated with it. Perforation, abscess formation, appendicular lump and surgical site of infection are well reported morbidities. Late arrival in hospital and use of inadequate dose of antibiotics in local might have association in increasing morbidities. The aim of the study is to observe the morbidity and mortality in appendicitis patients belonging to this Midwestern region of Nepal.</p> <p><strong>Methods</strong>: This retrospective cross sectional study was carried out in the Karnali academy of health sciences, Jumla Nepal. The data includes the 5 years period from Jan 2014 to March 2020. The parameters included admission of acute appendicitis, age, gender, post-operative findings and complication.</p> <p><strong>Results</strong>: There were 186 cases collectively. 175 cases of appendicitis were recorded. The mean age was 31±15.16. Ninety two (52.6%) were female; 83(47.4%) were male. 119(68%) had appendectomies. 56(32%) were treated conservatively. 29(51.78%) were appendicular lump and 27(48.2%) were suspected appendicitis. Five were found to have perforation of appendix. Two had abscess in 29 cases of appendicular mass. 2 had surgical site infection.</p> <p><strong>Conclusion</strong>: Among patients who were admitted in the hospital with diagnosis of acute appendicitis, the commonest complication is the appendicular lump, which might be due to late hospital arrival or early antibiotics use impulsively at local level, followed by perforation appendix. The result supports both appendectomy and conservative treatment are equally feasible for acute appendicitis accordingly the cases presented in the hospital.</p> Suryaman Menyangbo, Gakul Bhatta, Kripa Subedi, Bibek Pun Magar, Harihar Devkota, Prem Prasad Panta Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Partial edentulism and its correlation with educational status: a hospitalbased study <p><strong>Background: </strong>Maintenance of oral hygiene is one of the most important factors to prevent tooth loss. Education plays a significant role to maintain good oral hygiene. The objective of the study was to determine partial edentulism based on Kennedy’s classification and to find out correlation between partial edentulism and educational status.</p> <p><strong>Methods: </strong>A cross-sectional study was carried out among 189 partially edentulous patients visiting dental OPD of three government hospitals. Patients above 18 years of age were selected using non-probability convenience sampling, 63 from each center. History taking and visual examination were done after getting informed consent from the participants. Descriptive (mean, median, standard deviation, range, ratio and percentage) and inferential (Man-Whitney test) statistics were applied.</p> <p><strong>Results: </strong>In 189 partially edentulous patients 61% were females and 39% were males, and 48.1% people had no formal education. Kennedy’s Class III was most common (59% in maxillary, 61% in mandibular arches) and Kennedy’s class IV was least common (1% in maxillary, 6% in mandibular arches). From the study, we found that the number of teeth missing was higher in people with no formal education and there was statistically significant difference in the number of missing teeth in people with formal education and people who didn’t have any formal education (p&lt;0.05).</p> <p><strong>Conclusion: </strong>The study showed that education plays a vital role in generating awareness about maintenance of oral hygiene and people who are educated have a tendency of retaining more of their natural dentition. Preventive educational programs should be focused in the low education group so that more effective outcomes can be achieved. &nbsp;</p> Bhumesh Kaphle, Ashish Shrestha, Tarakant Bhagat, Daniel Shrestha, Suresh Bhandari, Umesh Jha Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Antibiotic Profile of Extended Spectrum Beta Lactamase Escherichia coli from Clinical Samples <p><strong>Background: </strong>Extended spectrum β-lactamases have addressed the serious challenges worldwide due to the emergence of ESBL producing genes which possess a serious threat for the treatment of infections both in community and hospitals since it is found to be increasing trends of multidrug resistance. This study was focused to find out the antibiotic profile of multidrug resistant Escherichia .coli and status of ESBLs producing E.coli.</p> <p><strong>Methods: </strong>This was a cross-sectional study conducted over a period of 2 years (September 2017 to April 2019) at microbiology laboratory of Nepal Mediciti Hospital. A total of 16542 samples were processed. Various clinical samples were collected from both inpatients and outpatients aseptically and without contaminating skin commensals. Standard microbiological techniques were used for isolation and identification of pathogens. Extended spectrum beta-lactamases were phenotypically confirmed by combined disc method.</p> <p><strong>Results: </strong>Out of 1449 E.coli isolates, 323(22.29%) were found to be MDR E.coli. Isolation rate of ESBL producing E.coli (66.56%) were found to be high among MDR E.coli isolates.</p> <p><strong>Conclusion: </strong>There was increasing prevalence of ESBL producing E.coli and was essential to monitor antibiotic susceptibility pattern and formulate antibiotic policy to prevent the spread of MDR and ESBL producers. &nbsp;</p> Mahesh Kumar Chaudhary, Indrani Jadhav, Indrani Jadhav, Megha Raj Banjara Copyright (c) 2020 Author(s) Mon, 21 Sep 2020 00:00:00 +0000 Comparison Between Supraclavicular and Infraclavicular Approach in Subclavian Vein Catheterization in Tertiary Center of Nepal <p><strong>Introduction: </strong>Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique. Due to anatomical advantage and lesser risk of infection subclavian vein is preferred. Either supraclavicular (SC) or infraclavicular (IC) approach could be used for subclavian vein catheterization. The aim of the study was to compare SC and IC approach in ease of catheterization of SCV and record the complications present if any.</p> <p><strong>Methods and materials: </strong>This was a hospital based comparative, interventional study conducted from November 2016 to October 2017 in Operation Theater in Bir Hospital. In this study, 70 patients for elective surgical cases meeting the inclusion criteria were randomly enrolled. Then samples were equally divided by lottery into either supraclavicular or infraclavicular approach groups. The Access time, cannulation success rate, attempts made for successful cannulation of vein, easy insertion of catheter and guide wire, approximate inserted length of catheter and associated complications in both groups were recorded. Data was entered in statistical software SPSS 16. Chi-square test was used. P value &lt; 0.05 was considered significant.</p> <p><strong>Results: </strong>The mean access time in group SC for SCV catheterization was 2.12 ± 0.81 min compared to 2.83 ± 0.99 min in group IC (p-value= 0.002). The overall success rate in catheterization of the right SCV using SC approach (34 / 35) was better as compared with group IC (33 / 35) using IC approach. First successful attempt in the SC group was 74.28% as compared with 57.14% in the IC group.</p> <p><strong>Conclusion: </strong>The SC approach of SCV catheterization can be considered alternative to IC approach in terms of landmark accessibility, success rate and rate of complications.</p> Robin Khapung, Jeju Nath Pokharel, Kiran Kumar KC, Kripa Pradhan, Uma Gurung, Subi Basnyat, Praveen Kumar Giri Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Essential Emergency Surgical Care in Remote Hilly Districts of Karnali - A Cross-Sectional Survey <p><strong>Background: </strong>Remote hilly areas of Karnali Province has one in all the very best burdens of surgically treatable conditions within the world and therefore, the highest unmet need. The first objective of our study was to gauge the capacity of first-referral health facilities in remote districts of Karnali Province to perform basic surgical procedures. The aim is to assess the status of Essential Emergency Surgical Care in remote hilly districts of Karnali region of Nepal.</p> <p><strong>Method: </strong>The screening Tool was Situational Analysis to Assess Emergency and Essential Surgical Care, to spot the health facility’s capacity to perform basic surgical (including obstetrics and trauma) and anesthetic procedures by investigating four categories of data: human resources, infrastructure, equipment and interventions available. The tool interrogated the supply of eight sorts of care providers, 35 surgical interventions and 67 items of apparatus.</p> <p><strong>Results: </strong>on the average, 72.83% of all admissions required either minor or major surgical interventions. Oxygen supplies, electrical power backup, running water, blood bank, hospital guidelines were inconsistent. Only 1 Hospital have trained Surgeons, Anesthesiologist and Obstetrician/Gynecologist. Only 1 hospital can perform around 97.1% of procedures.</p> <p><strong>Conclusion: </strong>The capacity for essential surgery is severely limited in Karnali region of Nepal. Limitations was seen in basic equipment, human resources, infrastructure, and supplies. &nbsp;</p> Praveen Kumar Giri, Prem Prasad Panta, Niresh Thapa Copyright (c) 2020 Author(s) Tue, 22 Sep 2020 00:00:00 +0000 Clinical Profile of Enteric Fever in Children of a Tertiary Care Centre in Kathmandu, Nepal <p><strong>Background: </strong>Enteric fever, commonly known as typhoid fever is a global public health problem. It is one of the common infectious diseases of humans, fever lasting for more than 7 days. It is transmitted by faecooral route and common in the areas with poor sanitation. Globally, majority of the Typhoid fever is caused by Salmonella enterica var typhi, one fifth of the infection is caused by Salmonella enterica var paratyphi. This study was conducted to describe clinical and laboratory parameters among children with enteric fever.</p> <p><strong>Methods: </strong>It was a descriptive cross-sectional study conducted in the Pediatric ward and Pediatric Intensive Care Unit (PICU) of Nepal Medical College Teaching Hospital (NMCTH), Atterkhel, Kathmandu, Nepal from 2015 January to 2015 December. Inclusion criteria: clinical details and laboratory parameters of children aged 13 months to 15 years old with diagnosis of enteric fever was obtained in the proforma and descriptive statistics were calculated.</p> <p><strong>Result: </strong>A total of 1,020 children with the sign and symptom suggestive of enteric fever were admitted in the inpatient department (Pediatrics) during the study period. All the enteric fever suspected children were tested for blood culture, Widal test and complete blood count, out of them 80 children were diagnosed as enteric fever. Male female ratio is 1.6:1. Fever was the most common clinical feature observed in 95% cases and other common features were loose motion (37.5%), vomiting (33.8%) and abdominal pain (27.5%). Hepato-splenomegaly is common finding of Enteric fever reported in 85.0% and 43.7%. Majority of the patients had normal leucocyte count (71.0%) and leucopenia reported in 20.0%.</p> <p><strong>Conclusion: </strong>Fever and hepato-splenomegaly were the major clinical presentation of typhoid fever in our study. Other less common features were loose motion, vomiting and abdominal pain. This finding may be useful for the pediatrician and other health professionals for the early diagnosis of enteric fever. &nbsp;</p> Sunil Budhathoki, Satyam Rimal, Lopsang Lama, Sabina Shrestha, Seshananda Sanjel, Kapil Amgain Copyright (c) 2020 Author(s) Mon, 21 Sep 2020 00:00:00 +0000 Seroprevalence of Hepatitis B Virus Surface Antigen (HBsAg) in Patients Visiting Teaching Hospital of Jumla, Nepal <p><strong>Background</strong>: Hepatitis B Virus (HBV) infection is a foremost global health problem. In the context of Nepal, the prevalence of HBV infection is found to be low, 0.9% (1.1% in males and 0.5% in females), though a high prevalence of ≥8% is shown among the population in the mountainous region by several studies. The epidemiology of HBV infection in the population of Jumla is not well-known. This study aimed to find out the seroprevalence of HBV surface antigen (HBsAg) in patients visiting Karnali Academy of Health Sciences Teaching Hospital (KAHS-TH), Jumla, Nepal.</p> <p><strong>Methods</strong>: The cross-sectional study was conducted in people visiting KAHS-TH, Jumla for testing HBsAg from 1st April 2018 to 31st March 2019. The samples collected were tested for HBsAg by using the Rapid HBsAg test kit. All positive cases were further tested by the Chemiluminescence (CLIA) method for HBsAg. The data entry was done in Microsoft Excel. After transferring the data into SPSS version 16, data analysis was done.Results: In this study, 1704 individuals were screened during the period. Overall 53 (3.11%) were HBsAg positive. Among the total of 506 males and 1198 females, 22 (4.34%) males and 31 (2.58%) females were positive for HBsAg. The highest prevalence (8.1%) was observed in the age group of 40– 45 years. But the prevalence rate is zero in 0-5 years age group and above 65 years of age.</p> <p><strong>Conclusion</strong>: The HBV infection was higher in Jumla as compared to that of the overall prevalence of Nepal. Males were highly infected than females and the middle age group was at the high-risk of HBV infection.&nbsp;</p> Bibek Pun Magar, Niresh Thapa, Elisha Rana, Keshav Raj Joshi, Arjun Prasad Tiwari Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000 Accuracy of Ultrasound Scanning in Diagnosing Acute Appendicitis in Patients Admitted at Vicente Sotto Memorial Medical Center <p><strong>Introduction: </strong>Acute appendicitis is the most common abdominal surgical emergency. Both abdominal ultrasonography and computed tomography are common diagnostic tools in its diagnosis with each having its own advantages and disadvantages.</p> <p><strong>Methods: </strong>Patients of suspected acute appendicitis were evaluated with an ultrasound to see the sensitivity, specificity, positive and negative predictive value of ultrasound for intraoperative appendicitis diagnosis. The study included 113 patients of suspected acute appendicitis presenting in the emergency during a one year duration. Sensitivity, specificity, positive predictive value and negative predictive value was calculated from their respective formulae.</p> <p><strong>Results: </strong>The majority of the patients were male patients between the age group of 18 to 30. The sensitivity of ultrasound for diagnosis of acute appendicitis was 96% and specificity was 33%. The positive predictive value was 98% and the negative predictive value was 20%</p> <p><strong>Conclusion: </strong>Ultrasound has good sensitivity and the low cost along with no radiation exposure makes this an acceptable screening investigative modality though due to low specificity, it would be recommended to go for a computed tomography scan if ultrasound shows negative result for appendicitis. &nbsp;</p> Uma Gurung, Dhiraj Gurung Copyright (c) 2020 Author(s) Mon, 21 Sep 2020 00:00:00 +0000 COVID-19 Pandemic in Yemen <p>COVID-19, a global pandemic, has threatened the whole world with its devastating nature. Though, initially it has affected the developed countries, the countries in low- and middle-income category also are not spared. Yemen is a country with low-income economy and has been in an ongoing civil war. The first case of COVID-19 was reported on 10th April 2020 and there have been a total of 1619 cases along with 447 total deaths as of 21st July 2020. The preventive measures such as lockdown, social distancing, and personal hygiene are practiced, however there is still lack of adequate resources for efficient healthcare facilities. No drugs and vaccines are approved to fully rely on for the treatment of COVID-19, therefore the concept of “do not take the virus and do not give the virus” with different approaches of preventive aspects through hand-washing, social distancing, wearing masks and gloves, and making people aware in mass utilizing audio-visual media are helpful. Aids from different agencies and collaborative efforts of all the stakeholders are in need for the containment of COVID-19 cases in Yemen. By strengthening and increasing healthcare set-ups and resources, preparation of management guidelines by the government and mobilizing such resources to different parts for awareness, adequate reverse transcription-polymerase chain reaction (RT-PCR) tests, contact tracing, and safe quarantine and isolation services are essential. &nbsp;</p> Saleh Musaed Mohammed Al-Subari, Mohammad Saleem, Sitaram Khadka, Nagd Mohammed Ahmed Mahmood, Talal M. Ziad Alhouzani, Dhan Bahadur Shrestha Copyright (c) 2020 Author(s) Tue, 22 Sep 2020 00:00:00 +0000 Get Well Soon Card: Self Help Program to Overcome Hospital Based Financial Barrier <p><strong>Background: </strong>The health care cost is increasing not only in developed countries but also in developing countries. Although the modality of treatment has made significant progresses over the years, delivery of treatment is sometimes beyond the expectation of patient as well as inaccessible financially. Citizen from developing countries like Nepal have to pay out of their own pocket for even minor health issues. We initiated a new concept to bridge this gap between treatments and necessity of funds through crowd funding scheme.</p> <p><strong>Methods: </strong>This was a cross sectional prospective and observational study conducted at Annapurna Neurological Institute and Allied Sciences from July 2017 to April 2020. This study was conducted on “Get Well Soon “card which was a friendly gesture with monetary value provided by visitors to patients. This card was made available in hospital pharmacy without any hidden cost. A convenient sample survey on 100 participant including admitted patients as well as visitors in the hospital was conducted on their perception about Get well soon card before initiating this program.</p> <p><strong>Results: </strong>This innovative self-help scheme has been proven to be quiet successful in a short period of time with many supporters advocating in its favor. Total number of 1012 patients have been benefited from the card which was provided to them by their visitors and relatives during their hospitalization with purchase of card worth NRs. 1144500 (~$11445) during the study period.</p> <p>&nbsp;<strong>Conclusion: </strong>Get Well Soon Card can be beneficial to those populations who are financially constrained and lack insurance for the treatment. This Cultural Revolution of crowd funding can be duplicated not only in Nepal, but also in different developing countries where out of pocket system is still prevailing. &nbsp;</p> Sharad Hari Gajuryal, Narayan Satyal, Sangita Bidari, Shristi Panta, Basant Pant Copyright (c) 2020 Author(s) Mon, 21 Sep 2020 00:00:00 +0000 An Attempted Homicidal Cut Throat Injury: A Case Study <p>Homicidal cut throat is an injury over the front of neck by sharp instruments with an intent of murder. The neck contains vital structures (nerves, blood vessels, airway and pharyngeal conduit) in a compact fashion that may be difficult to access for physical examination or surgical exploration in a limited time. That is why these cases create panic and pose great challenges in the management. Here is a case of an attempted homicidal cut throat injury that highlights some of the challenges encountered in the management along with discussion on the evolving knowledge of the optimal management practice.</p> Mukesh Kumar Sah, Madhu Thakur Copyright (c) 2020 Author(s) Sat, 29 Aug 2020 00:00:00 +0000