Point of Sale Display: A Call to Action on Prohibition of Tobacco Products in Nepal

https://blogs.bmj.com/tc/2015/08/05/point-of-sale-display-a-call-to-action-on-prohibition-of-tobacco-products-in-nepal

The Epidemiology of Hospitalization for Pneumonia in Children under Five in the Rural Western Region of Nepal: A Descriptive Study

© 2013 Banstola, Banstola. Pneumonia is one of the major public health problems in children under five years of age. The aim of this study was to analyze the time, place, and characteristics of the distribution of pneumonia in hospitalized children under five years of age at the Dhaulagiri Zonal Hospital (DZH) in Nepal. A descriptive cross-sectional study was carried out at DZH from July 16, 2008 to August 17, 2011 for hospitalized children under five years of age and diagnosed with pneumonia. The main bacterial cause of pneumonia was Streptococcus pneumoniae and the main viral cause was Respiratory Syntical Virus (RSV). The majority of children admitted for treatment of pneumonia were males (60%), from upper class ethnic groups, and common among those aged 29 days to one year (49.1% of overall pneumonia cases). Data from this study show that pneumonia episodes in DZH occurred throughout the year with a sharp increase in the occurrence at the end of August to September. More cases were recorded during the rainy seasons and winter months in all three study years. The cases were from households most concentrated in Baglung municipality where the hospital is located. Pneumonia was found in higher proportions among hospitalized male children, those aged 29 days to one year, and in upper ethnic groups, during the rainy seasons and in winter months, and among local populations near the hospital in the rural western region of Nepal. Strengthening community-based case management, prevention strategies, and health care delivery system would help reduce pneumonia cases and the overall burden associated with it. © 2013 Banstola, Banstola

The economic burden of multimorbidity: Protocol for a systematic review

Data Availability: No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.Supporting information is available online at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0301485#sec019 .Multimorbidity, also known as multiple long-term conditions, leads to higher healthcare utilisation, including hospitalisation, readmission, and polypharmacy, as well as a financial burden to families, society, and nations. Despite some progress, the economic burden of multimorbidity remains poorly understood. This paper outlines a protocol for a systematic review that aims to identify and synthesise comprehensive evidence on the economic burden of multimorbidity, considering various definitions and measurements of multimorbidity, including their implications for future cost-of-illness analyses. The review will include studies involving people of all ages with multimorbidity without any restriction on location and setting. Cost-of-illness studies or studies that examined economic burden including model-based studies will be included, and economic evaluation studies will be excluded. Databases including Scopus (that includes PubMed/MEDLINE), Web of Science, CINAHL Plus, PsycINFO, NHS EED (including the HTA database), and the Cost-Effectiveness Analysis Registry, will be searched until March 2024. The risk of bias within included studies will be independently assessed by two authors using appropriate checklists. A narrative synthesis of the main characteristics and results, by definitions and measurements of multimorbidity, will be conducted. The total economic burden of multimorbidity will be reported as mean annual costs per patient and disaggregated based on counts of diseases, disease clusters, and weighted indices. The results of this review will provide valuable insights for researchers into the key cost components and areas that require further investigation in order to improve the rigour of future studies on the economic burden of multimorbidity. Additionally, these findings will broaden our understanding of the economic impact of multimorbidity, inform us about the costs of inaction, and guide decision-making regarding resource allocation and cost-effective interventions. The systematic review’s results will be submitted to a peer-reviewed journal, presented at conferences, and shared via an online webinar for discussion.The author(s) received no specific funding for this work. This study is part of the first author's PhD project and that the first author is sponsored by the Department of Health Sciences at Brunel University London

The Availability of Emergency Obstetric Care in Birthing Centres in Rural Nepal: A Cross-sectional Survey.

OBJECTIVE: The purpose of this health system's study is to assess the availability of Emergency Obstetric Care (EmOC) services in birthing centres in Taplejung District of eastern Nepal. METHODS: A cross-sectional survey was conducted in 2018 in all 16 public health facilities providing delivery services in the district. Data collection comprised: (1) quantitative data collected from health workers; (2) observation of key items; and (3) record data extracted from the health facility register. Descriptive statistics were used to calculate readiness scores using unweighted averages. RESULTS: Although key health personnel were available, EmOC services at the health facilities assessed were below the minimum coverage level recommended by the World Health Organisation. Only the district hospital provided the nine signal functions of Comprehensive EmOC. The other fifteen had only partially functioning Basic EmOC facilities, as they did not provide all of the seven signal functions. The essential equipment for performing certain EmOC functions was either missing or not functional in these health facilities. CONCLUSIONS FOR PRACTICE: The Ministry of Health and Population and the federal government need to ensure that the full range of signal functions are available for safe deliveries in partially functioning EmOC health facilities by addressing the issues related to training, equipment, medicine, commodities and policy

Determinants of Physical Activity and Dietary Habits among Adults in Ghana: A Cross-Sectional Study

Acknowledgments: We acknowledge support from the Ghana Statistical Service, Brunel Global Health Academy, and the Office of the President of Ghana. Data availability statement: The data presented in this study are available upon request from the corresponding author.Copyright: © 2022 by the authors. A critical understanding of the interrelationship between two behavioral decisions—participating in physical activity, and eating healthily—is lacking in Ghana. This study aimed to determine which factors affect each of the two behavioral decisions, jointly and separately, among adults aged 18 years or older in three metropolises (Kumasi, Accra, and Tamale) of Ghana. The data from the Ghana Obesity Survey 2021 were used. A bivariate probit model was fitted to estimate nonlinear models that indicate an individual’s joint decision to participate in physical activity and consume a healthy diet. A positive correlation (r = 0.085; p < 0.05) was found between these two decisions, indicating a relationship between these two behavioral decisions. The common correlates between these decisions were self-reported good health status, high income, and attitudes toward being overweight. Men were more likely to be physically active but less likely to eat well. Both religion and culture determined participation in physical activity, but not the consumption of a healthy diet. Marital status determined diet, but not physical activity. The new knowledge gained from this analysis around the nature and the extent of the interconnectedness between physical activity and diet is critical to devising targeted interventions for obesity prevention in Ghana.This research received no external funding

Diabetes prevention and management in South Asia: A call for action

Background: Globally, the number of people living with Diabetes Mellitus (DM) has increased by four-folds since 1980. South Asia houses one-fifth of the world’s population living with diabetes and it was the 8th leading cause of deaths in 2013 for South Asians. Aim: To review and discuss the context of diabetes in South Asia with a particular focus on a) contributing factors and impact; b) national health policies around non-communicable diseases in the region and; c) to offer recommendations for prevention and management of diabetes. Method: We assessed relevant publications using PubMed, Scopus and OvidSP. Similarly, the World health Organization (WHO) and relevant ministries of each South Asian country were searched for reports and policy documents. Results: Emerging evidence supports that the prevalence of diabetes (ranges from 3.3% in Nepal up to 8.7% in India) in South Asia follows the global trend over the past decades. Urban populations in the region demonstrate a higher prevalence of diabetes although is also a public health concern for rural areas. Changes in the pattern and types of diet along with increasingly sedentary lifestyles are major causes for diabetes. Overall agenda of health promotion to prevent diabetes has not yet been established in the region and majority of the countries in the region are inadequately prepared for the therapeutic services for diabetes. Conclusion: The early onset of the diabetes, longevity of morbidity and early mortality may have a significant impact on people's health expenditure and health system as well as on the region's demographic composition. There is an urgent need to reduce the diabetes prevalence in the region through evidence-based interventions ranging from prevention and early detection to appropriate treatment and care. We suggest that a multi-sectorial collaboration across all stakeholders is necessary to raise awareness about diabetes, its prevention, treatment and care in the region

Achieving universal health coverage in Nepal

https://blogs.bmj.com/bmj/2019/02/15/amrit-banstola-et-al-achieving-universal-health-coverage-in-nepal

Prehospital emergency care for trauma victims in Nepal: a mixed-methods study

Data-sharing statement: All data requests should be submitted to the corresponding author for consideration. Access to anonymised data may be granted following review.Background: The prehospital care system in Nepal is poorly developed, with multiple providers, limited co-ordination of services and no national coverage. There is little published evidence reporting the prehospital care of patients with trauma, data which are important to inform the development of the prehospital care system. Objectives: In order to understand the challenges of providing prehospital care to trauma patients, the study aimed to explore the burden of trauma presenting to prehospital care providers and the experience of providing care to these patients. Design: We used a mixed-method study that included secondary data analysis and qualitative semistructured interviews. Setting: Nepal (Kathmandu Valley, Chitwan, Pokhara and Butwal). Participants: Staff employed by the Nepal Ambulance Service including ambulance drivers, emergency medical technicians, dispatch officers and service managers. Data sources: Data describing callouts by the Nepal Ambulance Service over 1 year. Callout data were anonymised and analysed descriptively. Semistructured interviews were audio-recorded, transcribed, translated and analysed using inductive thematic analysis. Results: Of 1408 trauma calls received, 48.4% (n = 682) resulted in prehospital care being provided. The most common mechanism of injury was falls (35.8%), followed by road traffic crashes (19.1%) and the commonest types of injuries were fractures (33.1%) and spinal injuries (10.1%). Mean time from call to arrival at hospital was 48 minutes (range 20 minutes–6 hours). Seventeen staff described factors facilitating effective prehospital care, including having adequate resources, systems and training. Barriers to delivering prehospital care included the expectations and behaviour of patients’ relatives and bystanders, a lack of public awareness of the role and provision of prehospital care, and poor road and traffic conditions. Limitations: For some data fields, data were missing, limiting the ability to precisely determine patient needs and response times. The qualitative data may have been subject to responder bias if participants felt uncomfortable reporting something that may have reflected badly on their employer. Conclusions: Trauma is a major reason for requesting prehospital care, which can be delivered in less than an hour from receiving a call to arrival at the hospital. Multiple factors impede the effective delivery of care which could be addressed through further development across the prehospital care system. Future work: Qualitative research to explore the perceptions and experiences of trauma victims, road users, emergency department staff, police officers, members of organisations involved in prehospital care, firefighters, and policy-makers would complement the findings from this study. Specific issues raised, such as the difficulties experienced when handing over patients between prehospital and hospital care providers, warrant further exploration.This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/49 using UK aid from the UK Government to support global health research

Prehospital emergency care for trauma victims in Nepal: a mixed-methods study

Meeting abstract. Presented at the 15th World Conference on Injury Prevention and Safety Promotion (Safety 2024) abstracts.Background: The prehospital care system in Nepal is underdeveloped, with multiple providers, limited co-ordination of services and no national coverage. With no national ambulance service or emergency services phone number, people often call local hospitals during emergencies. Local hospital ambulances often only convey victims without providing care from trained Emergency Medical Technicians (EMT). Objective: To explore the burden of trauma presenting to prehospital care providers and the experience of providing care to people with injuries in Nepal. Methods: A mixed-methods study was conducted in collaboration with the Nepal Ambulance Service (the largest prehospital care provider in Nepal) in the Kathmandu Valley, Chitwan, Pokhara, and Butwal. The study involved the analysis of one year of de-identified callout data (May 2019 to May 2020) and semi-structured interviews with ambulance drivers, EMTs, dispatch officers and service managers. Interviews were transcribed, translated, and analysed using inductive thematic analysis. Results: Of 1,408 trauma calls, 48.4% (n=682) received prehospital care, either at the scene, during transport, or both. Falls (35.8%) and road traffic crashes (19.1%) were the most common mechanisms of injury. The commonest types of injuries were fractures (33.1%) and suspected spinal injuries (10.1%). The cause of injury was not recorded in a third of records. The average time from call to arrival at hospital was 48 minutes (range: 20 minutes - 6 hours). Qualitative analysis identified factors facilitating effective prehospital care including adequate resources, systems and training. Heavy traffic, lack of prioritisation of emergency vehicles on the road and poor road quality often impeded arrival at the scene and delayed transport to hospital. At the scene, bystanders sometimes insisted on immediate hospital transfer without allowing EMTs to provided care and EMTs reported fear of legal repercussions if the patient died or had a poor outcome. Conclusions: Trauma is a common reason for requesting prehospital care, which, on average, can be delivered in less than an hour. However, multiple factors hinder effective care delivery, requiring policy changes and professional development within the prehospital care system. Promulgation of a ‘Good Samaritan’ law could support prehospital care providers in offering on-site and en-route treatment

Implementation approaches for leprosy prevention with single-dose rifampicin: a support tool for decision making

BACKGROUND: In the past 15 years, the decline in annually detected leprosy patients has stagnated. To reduce the transmission of Mycobacterium leprae, the World Health Organization recommends single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients. Various approaches to administer SDR-PEP have been piloted. However, requirements and criteria to select the most suitable approach were missing. The aims of this study were to develop an evidence-informed decision tool to support leprosy programme managers in selecting an SDR-PEP implementation approach, and to assess its user-friendliness among stakeholders without SDR-PEP experience. METHODOLOGY: The development process comprised two phases. First, a draft tool was developed based on a literature review and semi-structured interviews with experts from various countries, organisations and institutes. This led to: an overview of existing SDR-PEP approaches and their characteristics; understanding the requirements and best circumstances for these approaches; and, identification of relevant criteria to select an approach. In the second phase the tool's usability and applicability was assessed, through interviews and a focus group discussion with intended, inexperienced users; leprosy programme managers and non-governmental organization (NGO) staff. PRINCIPAL FINDINGS: Five SDR-PEP implementation approaches were identified. The levels of endemicity and stigma, and the accessibility of an area were identified as most relevant criteria to select an approach. There was an information gap on cost-effectiveness, while successful implementation depends on availability of resources. Five basic requirements, irrespective of the approach, were identified: stakeholder support; availability of medication; compliant health system; trained health staff; and health education. Two added benefits of the tool were identified: its potential value for advocacy and for training. CONCLUSION: An evidence-informed SDR-PEP decision tool to support the selection of implementation approaches for leprosy prevention was developed. While the tool was evaluated by potential users, more research is needed to further improve the tool, especially health-economic studies, to ensure efficient and cost-effective implementation of SDR-PEP