A Status of Health-related Quality of Life of Renal Recipients at a Transplant Center in Kathmandu

Background: Renal transplant is considered as the best treatment available to restore renal function in patients with renal failure. Health-related quality of life (HrQoL) is an important indicator for evaluating therapeutic outcomes and mortality in patients with end-stage renal disease, including renal failure. This study aimed to assess the health-related quality of life (HrQoL) of renal transplant recipients. Methods: This observational cross-sectional study involved 165 post renal transplant patients (mean age ± SD, 37.5 ± 10.7 years) from Tribhuvan University Teaching Hospital. Health-related quality of life was assessed by face-to-face interviews, using Kidney Transplant Questionnaire (KTQ-25) and scored according to the scoring algorithm of KTQ-25. Results: The mean score of HrQoL was 5.44 ± 0.80, with the highest score for appearance (6.65 ± 0.53) and the lowest for uncertainty/ fear dimension (4.29 ± 1.10). Several factors, including age, occupation, loan, length of renal replacement therapy, and time since transplantation were significantly associated with different dimensions KTQ-25 questionnaire (all, p < 0.05). Conclusion: As uncertainty/fear affected the quality of life most, counseling programs for recipients are needed focusing on psychological wellbeing. Although funding is available for patients with end-stage renal failure from the government, that does not seem to be adequate for them

Accessing health services in India: Experiences of seasonal migrants returning to Nepal.

Background: Migration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India. Methods: Six focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. A further 12 stakeholders working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data were analysed thematically. Results: The interviewed returnee migrants worked in 15 of India’s 29 states, most as daily-wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services. Conclusions: Nepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to

Improving the implementation of health workforce policies through governance: a review of case studies

<p>Abstract</p> <p>Introduction</p> <p>Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC).</p> <p>Methods</p> <p>We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'.</p> <p>Results and discussion</p> <p>In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralization being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. Forms of partnership and participation described in the case studies are numerous and offer different lessons. Strikingly, in none of the articles was 'partnerships' a core focus. A common theme in the dimension of 'oversight' is local-level corruption, affecting, amongst other things, accountability and local-level trust in governance, and its cultural guises. Experiences with accountability mechanisms for HRH policy development and implementation were lacking.</p> <p>Conclusion</p> <p>This review shows that the term 'governance' is neither prominent nor frequent in recent HRH literature. It provides initial lessons regarding the influence of governance on HRH policy development and implementation. The review also shows that the evidence base needs to be improved in this field in order to better understand how governance influences HRH policy development and implementation. Tentative lessons are discussed, based on the case studies.</p

The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study.

BACKGROUND: In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai. METHODS: Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis. RESULTS: All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers' group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs. CONCLUSIONS: Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings

Landslide susceptibility mapping using support vector machine and GIS at the Golestan province, Iran

The main goal of this study is to produce landslide susceptibility map using GIS-based support vector machine (SVM) at Kalaleh Township area of the Golestan province, Iran. In this paper, six different types of kernel classifiers such as linear, polynomial degree of 2, polynomial degree of 3, polynomial degree of 4, radial basis function (RBF) and sigmoid were used for landslide susceptibility mapping. At the first stage of the study, landslide locations were identified by aerial photographs and field surveys, and a total of 82 landslide locations were extracted from various sources. Of this, 75% of the landslides (61 landslide locations) are used as training dataset and the rest was used as (21 landslide locations) the validation dataset. Fourteen input data layers were employed as landslide conditioning factors in the landslide susceptibility modelling. These factors are slope degree, slope aspect, altitude, plan curvature, profile curvature, tangential curvature, surface area ratio (SAR), lithology, land use, distance from faults, distance from rivers, distance from roads, topographic wetness index (TWI) and stream power index (SPI). Using these conditioning factors, landslide susceptibility indices were calculated using support vector machine by employing six types of kernel function classifiers. Subsequently, the results were plotted in ArcGIS and six landslide susceptibility maps were produced. Then, using the success rate and the prediction rate methods, the validation process was performed by comparing the existing landslide data with the six landslide susceptibility maps. The validation results showed that success rates for six types of kernel models varied from 79% to 87%. Similarly, results of prediction rates showed that RBF (85%) and polynomial degree of 3 (83%) models performed slightly better than other types of kernel (polynomial degree of 2 = 78%, sigmoid = 78%, polynomial degree of 4 = 78%, and linear = 77%) models. Based on our results, the differences in the rates (success and prediction) of the six models are not really significant. So, the produced susceptibility maps will be useful for general land-use planning

Opportunistic respiratory infections in HIV patients attending Sukraraj tropical and infectious diseases Hospital in Kathmandu, Nepal

Introduction: Opportunistic bacterial and fungal infections are the major cause of morbidity and mortality among immune suppressed HIV-positive patients. The main objective of this study was to determine bacterial and fungal organisms causing respiratory infections and their susceptibility to commonly prescribed antimicrobials among HIV patients attending a tertiary infectious disease hospital in Kathmandu. Methods: Sputum samples were collected from the HIV-positive patients attending Sukraraj Tropical and Infectious Disease Hospital (STIDH) from August 2017 to March 2018. A total of 100 sputum samples were cultured on conventional bacterial and fungal culture media. Bacterial and fungal isolates were identified based on their colony characteristics, microscopic morphology and various biochemical tests. Antibiotic susceptibility test (AST) of bacterial isolates was performed by modified Kirby Bauer disc diffusion method. Results: Out of 100 sputum samples cultured, 24% (n=24) showed bacterial growth, 42% (n=42) showed fungal growth and 10% (n=10) had both bacterial and fungal growth. Among bacteria, 91.6% (n=22) were monomicrobial and 8.4% (n=2) were polymicrobial in growth, of which, Klebsiella pneumoniae (37.5%) were predominant isolates, followed by Pseudomonas aeruginosa (29.2%), and Escherichia coli (16.7%). The antibiotic susceptibility test (AST) showed 68% (17/25) of bacterial isolates were multi-drug resistant (MDR) and among them 41.2% (7/17) were found to be extended spectrum β lactamase (ESBL) producers. Fungal growth was observed in 42% of samples (42/100). A total of six different species of Candida and four different genera of molds were identified. On species differentiation, Candida albicans (20%) were followed by Candida parapsilosis (4%), and Candida dubliniensis (3%); and various molds were Aspergillus fumigatus (4%), Aspergillus flavus (2%), and Penicillium species (5%). CD4 count was inversely associated with bacterial and fungal infections. Fifty percent of the patients with the fungal infections had a CD4 count below 200. No fungal organisms were isolated from HIV-positive patients under antifungal drug treatment. Conclusion: HIV-positive patients with a CD4 count less than 200 cells/µL are more vulnerable to opportunistic infections of bacterial and fungal origin. Early isolation, identification and appropriate treatment can reduce mortality due to co-infections. Routine screening of opportunistic pathogens is critical to contain the disease progression.</p