It Takes More than a Village: Building a Network of Safety in Nepal's Mountain Communities.

Purpose This report from the field details the ways that one small maternal child health NGO, which began its work in Tibet and now works in the mountain communities of Nepal, has established a model for integrated healthcare delivery and support it calls the "network of safety." Description It discusses some of the challenges faced both by the NGO and by the rural mountain communities with whom it partners, as well as with the government of Nepal. Conclusion This report describes and analyzes successful efforts to reduce maternal and infant mortality in a culturally astute, durable, and integrated way, as well as examples of innovation and success experienced by enacting the network of safety model

Antibiotic Susceptibility Profile of respiratory pathogens obtained at tertiary care hospital from western Nepal

The prevalence and drug resistance of the respiratory pathogens is increasing gradually in Nepal. However, their detail study is rare in the western region of Nepal. Hence, this study was carried out to know the incidence and antibiotic susceptibility profile of the respiratory pathogens obtained at a tertiary care center located at Pokhara. 139 pathogens were isolated from 460 clinical samples included. Significant pathogens were Gram-negative bacteria 94 (67.62%), followed by 28 (20.15%) Candida, and Gram-positive isolates 17 (12.23%). The growth rate was significantly higher for sputum samples in comparison to throat swabs. Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter were significant Gram-negative isolates while Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes were Gram-positive pathogens. Sensitivity rate was higher for colistin and imipenem among Gram-negative isolates while lower sensitivity was for cefepime. Vancomycin was effective against all tested Gram-positive isolates while erythromycin and ciprofloxacin were less effective

Correlation of skeletal age by Greulich-Pyle atlas, physiological age by body development index, and dental age by London Atlas and modified Demirjian’s technique in children and adolescents of an Eastern Indian population

Abstract Background Forensic age estimation using multiple maturity indicators necessitates investigation of correlation between various techniques. This study intended to compare and evaluate the correlation between skeletal age using Greulich-Pyle atlas, dental age by Acharya’s modification of Demirjian’s technique and London Atlas method of Tooth Development, and age estimated by body developmental index with chronological age. Orthopantomograms and left hand-wrist radiographs of one hundred seventy-four subjects (64 males and 70 females) in the age group of 8–20 years were evaluated by age estimation methods. Physical parameters including height, weight, biacromial breadth, and biliospinale breadth were measured. The data were entered in the SPSS software (Version 27.0). Comparison between age estimation methods was done using Student’s t-test for paired samples. Unpaired t-test was utilized for gender-wise comparison of age. Pearson’s correlation coefficient was calculated to assess correlation between the various methods. Results Significant mean differences were noted between the chronological age and all the age estimation methods when Greulich-Pyle atlas method (− 0.43), modified Demirjian’s method (− 0.31), London Atlas Method (− 0.62), and body developmental index (− 0.51) were employed respectively. Inter-group comparison between all methods yielded no significant differences except for modified Demirjian’s method and London Atlas method (mean difference = 0.31). All the age estimation techniques showed strong correlation with chronological age; the best was provided by the Greulich-Pyle method (r = 0.92). Conclusion All the assessed age estimation techniques show strong correlation with chronological age. Acharya’s modified Demirjian’s method (dental age) and Greulich-Pyle atlas method (skeletal age) showed good accuracy and strong correlation with chronological age, suggesting that these methods can be used simultaneously and/or interchangeably for age assessment in children and adolescents of Eastern Indian population

Perceptions of service providers, service recipients and female community health volunteers on a rural obstetric ultrasound program in rural Nepal: a qualitative study

Abstract Background In rural Nepal, where women face financial and geographic barriers in accessing ultrasound scans, the government initiated a Rural Obstetric Ultrasound Program (ROUSG) to train skilled birth attendants (SBAs) in rural birthing centers and expand access to routine ultrasound scans for local pregnant women. This study explores the perceived benefits and limitations of the training and implementation of this program. Methods A qualitative study was conducted in 15 primary care facilities in Bhojpur and Dhading, two rural districts of Nepal. The research team conducted in-depth interviews with 15 trained SBAs and focus group discussions with 48 service recipients and 30 FCHVs to gain insight into their perceptions. All interviews and focus group discussions were recorded, reviewed, and manually coded into MS Excel. Results Overall, our findings indicated that the ROUSG program was very well received among all our study participants, though critical gaps were identified, mostly during the training of the SBAs. These included insufficient guidance or practice opportunities during training and the challenges of implementing the mobile obstetric ultrasound service. Most importantly, though, our results suggest that the implementation of the ROUSG program increased access to prenatal care, earlier identification and referrals for abnormal scans, as well as reduced pregnancy-related stress. There was also a notable anecdotal increase in antenatal care utilization and institutional deliveries, as well as high satisfaction in both service providers and recipients. Conclusion Our findings highlighted that while the training component could use some strengthening with increased opportunities for supervised practice sessions and periodic refresher training after the initial 21-days, the program itself had the potential to fill crucial gaps in maternal and newborn care in rural Nepal, by expanding access not only to ROUSG services but also to other MNH services such as ANC and institutional deliveries. Our findings also support the use of ultrasound in areas with limited resources as a solution to identify potential complications at earlier stages of pregnancy and improve timely referrals, indicating the potential for reducing maternal and neonatal morbidities. This initial study supports further research into the role ROUSG can play in expanding critical MNH services in underserved areas and improving broader health outcomes through earlier identification of potential obstetric complications

Non-surgical interventions for pelvic organ prolapse in rural Nepal: a prospective monitoring and evaluation study

Objectives: Pelvic organ prolapse (POP) is a major cause of morbidity in Nepal, particularly affecting women in the rural communities. Women with POP in Nepal may suffer from symptoms for decades. At present, the Government of Nepal advocates surgical intervention but access to surgical care is inadequate. This report evaluated the feasibility of a non-surgical public health programme in rural Nepal, and describes risk factors associated with POP in this setting. Design: Prospective monitoring and evaluation study of a new public health programme. Setting: Baglung district, rural Nepal. Participants: Women with gynaecological symptoms of POP. Main outcome measures Risk factors for disease progression were assessed using Fisher’s exact test, Pearson’s χ2-test and logistic regression analysis. Results: Of the 74 women included in this analysis, 70.8% were diagnosed with stage 2 POP or greater. The majority of women did not have any further children following the onset of POP symptoms (63.5%). Duration of symptoms ranged from 2 months to 60 years, with 73.4% of women suffering for over 5 years and 28.4% suffering for over 20 years. Univariate analyses identified age at screening, age at onset of symptoms, the duration of symptoms and an associated rectocele as factors associated with increasing POP severity (p < 0.05). Kegel exercises were taught to 25 (33.8%) women with POP and ring pessaries were offered to 47 (63.5%) women with POP. Conclusions: Non-surgical interventions may provide an opportunity to address the significant burden of POP in rural Nepal