Knowledge and Compliance of Oral Anticoagulation Therapy at Warfarin Clinic in Kathmandu: A Cross-sectional Study

Background: Warfarin is the most widely used anticoagulant drug worldwide due to its low cost and ease of use. Adequate knowledge and compliance to oral anticoagulation therapy are essential measures that decrease morbidity and mortality among cardiac patients. This study aimed to assess the level of knowledge and compliance regarding oral anticoagulation therapy among patients with a mechanical heart valve. Methods: A cross-sectional study was carried out among patients with mechanical heart valves on warfarin at Shahid Gangalal National Heart Centre of Kathmandu, Nepal. Participants were selected through a systematic random sampling technique, and a face-to-face interview was conducted. Knowledge was assessed using validated oral anticoagulation knowledge questionnaires composed of 20 multiple-choice questions. Compliance was assessed using 8 items Morisky Medication Adherence Scale. The descriptive and bivariate analysis were carried out using the Statistical Package for the Social Sciences version 16. Results: A total of 222 patients were included in this study. Only 35 (15.8%) had good knowledge, and 93 (41.9%) had high compliance to oral anticoagulation therapy. The mean adherence score was 1.81 ± 0.78. Age, literacy, and educational level of the patients were statistically significant with knowledge. The compliance was significantly related only with a duration of warfarin use (p=0.003). Conclusion: The patients had a moderate level of knowledge on warfarin therapy. However, they had good compliance with oral anticoagulation therapy. Based on the findings, education awareness program is recommended to improve the patient’s knowledge on oral anticoagulants

Integrated Diabetic Clinic in a Rural Hospital of Nepal

Diabetes is an important public health concern which is increasing rapidly in developing countries. It is challenging to prevent and manage diabetes in a rural setting. The Integrated Diabetic Clinic is comprehensive diabetes care under one roof. Its aim is to provide efficient accessible and affordable comprehensive care. It will make a huge difference in the management of diabetes. This clinic will play a major role in unifying different aspects of health care under one roof and offer the most comprehensive and cost-effective accessible health care to minimize mortality and morbidity associated with diabetes. Keywords: Integrated, Diabetes, Clinic, Nepal, Rural Hospital DOI: http://dx.doi.org/10.3126/jkahs.v2i1.2442

Knowledge Regarding Postnatal Care Among Postnatal Mother: A Hospital Based Study

Background: Becoming a mother is an important stage in every womanrsquos life. Most different period in womenrsquos life is their growth into parenthood and is precisely postpartum period. The postnatal period is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time. Yet, this is the most neglected period for the provision of quality care. Objective: To assess the level of knowledge among postnatal mothers about postnatal care. nbspMethods: A descriptive cross sectional study design was adopted for the study.Non probability purposive sampling technique was used to select the postnatal mothers. Fifty seven postnatal mothers were interviewed face to face using structured interview schedule in Gynecological/Obstetrical Ward of National Medical College Teaching Hospital, Birgunj. Data were collected using pre-tested structured interview schedule in Bhojpuri version. The obtained data were analyzed by descriptive statistics (frequency and percentage) and inferential statistics (chi-square). Findings: Among 57 postnatal mother half of the postnatal mothers, 30 (52.63%) had average level of knowledge regarding postnatal care. Highest knowledge was in the area of breastfeeding and lowest in the areas of family planning. There is still lack of knowledge among mothers regarding postnatal period, postnatal exercise, timing of first bath after birth of baby. There were statistically significant association between religion and knowledge of postnatal mothers (p-value 0.006). Similarly, there was no any statistical significant association of knowledge with others socio demographic variables. Conclusion: Different types of awareness program are required to improve maternal knowledge on postnatal care

Ingestion of Bell Clappers by a Shaman in Jumla, Nepal: A Case Report

Accidental foreign body ingestion is a common problem encountered in Emergency. Deliberate FB ingestion may result due to an act of insanity or an act of daring. A shaman locally known as Dhami was brought to Emergency with the history of ingestion of bell clappers. He denied the history of psychiatric illness or substance abuse. On physical examination, there were signs of peritonitis. Laparotomy was done to remove the FBs. Post-operative period was uneventful. Apart from the surgical intervention, psychological counselling was given to him. This is a rare interesting case due to the fact that the 15 cm long FBs passing all the way through without significant injury and finally causing obstruction in ileocecal junction and perforation in the distal ileum

Anxiety and depression among patients with chronic obstructive pulmonary disease and general population in rural Nepal

Abstract Background Anxiety and depression are usually under diagnosed among the patients with Chronic Obstructive Pulmonary Disease (COPD), which has a negative impact on patient quality of life through restriction of activities, loss of independence, and decreased social functioning. The purpose of this study was to describe the levels and characteristics of anxiety and depression in patients with COPD in Nepal as compared to the general population. Methods A hospital-based observational comparative analytical study was conducted in the United Mission Hospital, Tansen and the Okhaldhunga Community Hospital, Okhaldhunga, Nepal from June 1st 2015 to April 15th 2016. A convenience sample of two groups of participants were recruited: patients with COPD (study group) and visitors to the facility (comparison group). Anxiety and depression were measured with the Beck Anxiety and Depression Inventory Scale. Results A total of 198 individuals participated in the study; 93 with COPD and 105 from the general population. The mean age of the respondents was 58.24 ± 12.04 (40-82) years. The mean scores for anxiety and depression in COPD group were 23.76± 9.51 and 27.72± 9.37 respectively, while in comparison group, the mean score for anxiety was 8.01± 6.83 and depression was 11.60 ± 8.42. Both anxiety and depression scores were statistically significant between the groups with p value <0.001. Conclusions Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Early assessment and multi-model treatment of anxiety and depression should be part of management in COPD

Prevalence and type-specific distribution of human papillomavirus infection among women in mid-western rural, Nepal- A population-based study

Abstract Background Cervical cancer is the most common cancer among women in Nepal. The prevalence of human papillomavirus (HPV) 16 and or HPV 18 among women with cervical pre-cancer and cancer is higher than the incidence of HPV in the world population. The population-based epidemiological data of HPV in the general population in most parts of the country remains unknown. The objective of this study was to assess the prevalence and type distribution of HPV infection and association of abnormal cytology with high risk HPV infection among women in mid-western rural, Nepal. Methods A population-based cross sectional study was conducted in Jumla, one of the most remote districts in Nepal. A total of 1050 cervical samples were collected from married and non- pregnant women aged 20–65 years during mobile Cervical Cancer Screening Clinics conducted from May 2016 to January 2017. The presence of HPV DNA was firstly confirmed by HPV consensus PCR using PGMY09/PGMY11 designed primers, then HPV positive samples were further genotyped by the membrane hybridization method to detect the 21 high-risk HPV (HR-HPV) and low-risk HPV types. The prevalence of HR-HPV among women with normal and abnormal cytology was calculated. Data were analyzed using SPSS software for Windows. P < 0.05 was considered statistically significant. Results A total of 998 women were eligible for this study with the mean age 32.6 ± 8.6 years, and the mean marital age was 16.7 ± 3.8 years. The overall prevalence of HPV infections was 19.7%. HR-HPV and low-risk HPV were 11.7 and 8.7% respectively. The six most common HR-HPV types were HPV16, 39, 58, 33, 51 and 18. HR-HPV infection among the women with abnormal and normal cytology was of 27.3 and 10.8% respectively. Conclusions There was a higher prevalence of HR-HPV infection among women living in Jumla than other parts of Nepal. This study provides preliminary information on overall HPV and type-specific HR-HPV prevalence, HR-HPV 16, 39, 58, 33, 51, and 18 are the most prevalent genotypes in this region. The data contribute to the epidemiological knowledge about HPV and type-specific HR-HPV genotypes prevalence in mid-Western Nepal