Factors influencing the utilization of health facilities for childbirth in a disadvantaged community of Lalitpur, Nepal

Background: In Nepal, half of deliveries take place at home (HMIS 2014), while institutional birth assisted by skilled birth attendants (SBAs) are still infrequent. Objectives: This study explores factors influencing the utilization of health facilities for childbirth in a disadvantaged community of rural Nepal. Method: A qualitative study with two focus groups: mothers-in-law and husbands, and female community health volunteers. 28 semi-structured in-depth interviews were conducted with selected participants 20 mothers and 8 grass-root and policy level stakeholders. Data were analysed by three delays model of conceptual framework. Results: The main reasons for giving birth at home included cultural tradition, lack of awareness about danger signs during pregnancy and childbirth, about importance of skilled birth attendants and lack of knowledge about availability of free 24-hours delivery sites/birthing centers, inability to afford two way transportation costs despite transport incentives provided by government for institutional delivery, fear of episiotomy/surgery/physical abuse and health service provider’s attitude for home delivery. Health facilities were mostly used by women who experienced complications during childbirth Policy Implications: Significant gaps from policy to grass root levels were identified which -suggests that dissemination of information about free delivery must be more effective. The health workers should convincingly inform families about benefits of institutional delivery, especially in marginalized/disadvantaged communities

Inclusion in the World Health Organization model list of essential medicines of non-vitamin K anticoagulants for treatment of non-valvular atrial fibrillation: a step towards reducing the burden of cardiovascular morbidity and mortality

Non-vitamin K antagonist oral anticoagulants (NOACs) represent a paradigm shift in the treatment of non-valvular atrial fibrillation (AF) with major practice guidelines around the world recommending NOACs over vitamin K antagonist oral anticoagulants for initial treatment of AF for stroke prevention. Here we describe the evidence collated and the process followed for the successful inclusion of NOACs into the 21st WHO Model List of Essential Medicines (EML). Individual NOACs have been reported to be non-inferior or superior to warfarin in preventing stroke and systemic embolism in eligible AF patients with a reduction in the risk of stroke and systemic embolism and a lower risk of major bleeding in patients with non-valvular AF compared with warfarin in both RCTs and real-world data. The successful inclusion of NOACs in the WHO EML is an important step forward in the global fight against cardiovascular morbidity and mortality, especially in low- and middle-income countries, where the burden of disease is high and limited access to diagnosis and treatment translates into a higher burden of morbidity, mortality, and economic costs

Antiviral Activity of Some Plants Used in Nepalese Traditional Medicine

Methanolic extracts of 41 plant species belonging to 27 families used in the traditional medicine in Nepal have been investigated for in vitro antiviral activity against Herpes simplex virus type 1 (HSV-1) and influenza virus A by dye uptake assay in the systems HSV-1/Vero cells and influenza virus A/MDCK cells. The extracts of Astilbe rivularis, Bergenia ciliata, Cassiope fastigiata and Thymus linearis showed potent anti-herpes viral activity. The extracts of Allium oreoprasum, Androsace strigilosa, Asparagus filicinus, Astilbe rivularis, Bergenia ciliata and Verbascum thapsus exhibited strong anti-influenza viral activity. Only the extracts of A. rivularis and B. ciliata demonstrated remarkable activity against both viruses

The Risk Factors of Seasonal Hyperacute Panuveitis

Background: Seasonal Hyperacute Panuveitis (SHAPU) is an eye disease of unclear aetiology occurring cyclically during the autumn in odd years in Nepal causing blindness within a week. This study is the first of its type to investigate the risk factors of SHAPU. Methods: A multicentric national level case–control study was performed during the 2017 SHAPU outbreak. Cases were matched to controls in a 1:3 ratio based on age, sex and geographic area. Questionnaire-based personal interview was used and risk factors were categorized as biological and behavioral. For univariate analysis, frequency, median and interquartile range was calculated. Chi-squared test with/without continuity correction and Fisher’s exact test were used. Multivariate conditional logistic regressions were used for all the independent variables for p <0.1 in the univariate analyses. Results: We identified 35 cases and 105 controls; 71.4% were children≤16 years (38-day infant to 50-year-old). All were immunocompetent individuals, males were 57.1% and females 42.9%. Potential risks such as visible moths/butterfly activity, contact with livestock, and attending mass gatherings of people were not reported more frequently in cases vs controls in univariate analyses. Differences in possibly protective factors such as self-reported mosquito net use, light off at night while sleeping, and habit of hands/face washing after physical contact/touch with any insects/butterflies/birds were not statistically significant between both groups. In multivariate model, SHAPU cases were significantly more likely than controls to report physical contact with butterflies/white moths (Adjusted OR:6.89; CI:2.79–17.01,p < .001). Conclusions: Direct physical contact with butterflies/moths was associated with significantly increased odds of SHAPU cases

Domesticating cleaner cookstoves for improved respiratory health: Using approaches from the sanitation sector to explore the adoption and sustained use of improved cooking technologies in Nepal

Drawing on village-based data from Nepal, this paper explores the transferability of the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to the clean cooking sector and its potential to elucidate how barriers to improved cookstove adoption and sustained use intersect at different scales. The paper also explores the potential of IBM-WASH, behaviour settings theory and domestication analysis to collectively inform effective behaviour change techniques and interventions that promote both adoption and sustained use of health-promoting technologies. Information on cookstove use in the community since 2012 enables valuable insights to be gained on how kitchen settings and associated cooking behaviour were re-configured as homes and stoves were re-built following the April 2015 earthquake. The methodological approach comprised of semi-structured interviews, focus group discussions, direct observation and household surveys. The findings indicated that the IBM-WASH framework translated well to the improved cookstove sector, capturing key influences on clean cooking transitions across the model's three dimensions (context, psychosocial and technology) at all five levels. Understandings gained from utilising IBM-WASH were enhanced – especially at the individual and habitual levels – by domestication analysis and settings theory which elucidated how different cooking technologies were incorporated (or not) within physical structures, everyday lives and routine behaviour. The paper concludes that this combination of approaches has potential applicability for initiatives seeking to promote improved environmental health at community-wide scales

NUrse-led COntinuum of care for people with Diabetes and prediabetes (NUCOD) in Nepal: study protocol for a cluster randomized controlled trial

Background The purpose of this study will be to improve diabetes prevention, access to care and advocacy through a novel cost-effective nurse-led continuum of care approach that incorporates diabetes prevention, awareness, screening and management for low-income settings, and furthermore utilizes the endeavor to advocate for establishing a standard diabetes program in Nepal. Methods We will conduct a two-arm, parallel group, stratified cluster randomized controlled trial of the NUrse-led COntinuum of care for people with Diabetes (N1 = 200) and prediabetes (N2 = 1036) (NUCOD) program, with primary care centers (9 outreach centers and 17 government health posts) as a unit of randomization. The NUCOD program will be delivered through the trained diabetes nurses in the community to the intervention group and the outcomes will be compared with the usual treatment group at 6 and 12 months of the intervention. The primary outcome will be the change in glycated hemoglobin (HbA1c) level among diabetes individuals and progression to type 2 diabetes among prediabetes individuals, and implementation outcomes measured using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. Outcomes will be analyzed on an intention-to-treat basis. Discussion The results of this trial will provide information about the effectiveness of the NUCOD program in improving clinical outcomes for diabetes and prediabetes individuals, and implementation outcomes for the organization. The continuum of care model can be used for the prevention and management of diabetes and other noncommunicable diseases within and beyond Nepal with similar context. Trial registration ClinicalTrials.gov, NCT04131257. Registered on 18 October 2019.This study will be conducted under the umbrella of a large implementation project and will be supported by a World Diabetes Foundation (WDF17-1483) grant, a China Medical Board (CMB16–260) grant and Dhulikhel Hospital Kathmandu University. However, the funding organizations will have no role in the design of the study, data collection, data analysis, data interpretation or writing of the report

Triggers of acute attacks of gout, does age of gout onset matter?: a primary care based cross-sectional study

Objectives To determine the proportion of people with gout who self-report triggers of acute attacks; identify the commonly reported triggers, and examine the disease and demographic features associated with self-reporting any trigger(s) of acute attacks of gout. Methods Individuals with gout were asked to fill a questionnaire enquiring about triggers that precipitated their acute gout attacks. Binary logistic regression was used to compute odds ratio (OR) and 95% confidence intervals (CI) to examine the association between having ≥1 self-reported trigger of acute gout and disease and demographic risk factors and to adjust for covariates. All statistical analyses were performed using STATA. Results 550 participants returned completed questionnaires. 206 (37.5%) reported at least one trigger of acute attacks, and less than 5% reported >2 triggers. Only 28.73% participants reported that their most recent gout attack was triggered by dietary or lifestyle risk factors. The most frequently self-reported triggers were alcohol intake (14.18%), red-meat or sea-food consumption (6%), dehydration (4.91%), injury or excess activity (4.91%), and excessively warm or cold weather (4.36% and 5.45%). Patients who had onset of gout before the age of 50 years were significantly more likely to identify a trigger for precipitating their acute gout attacks (aOR (95%CI) 1.73 (1.12–2.68) after adjusting for covariates. Conclusion Most people with gout do not identify any triggers for acute attacks, and identifiable triggers are more common in those with young onset gout. Less than 20% people self-reported acute gout attacks from conventionally accepted triggers of gout e.g. alcohol, red-meat intake, while c.5% reported novel triggers such as dehydration, injury or physical activity, and weather extremes