Evaluation of the Rural-Telemedicine program in Nepal : study from the selected districts

Telemedicine is growing both in developed and developing countries and has remained as an integral part of health care delivery system. It includes different health activities and medical services that take place at distance. In the developing countries it supports to improve the accessibility, quality and efficiency of the healthcare services and also reduces the cost of service. It also supports to improve the administrative as well as technical aspect of healthcare system. Government of Nepal has also implemented the rural-telemedicine program in thirty rural-districts hospitals for providing specialist health care services and also to improve the accessibility of health services for the rural community peoples. Methods: This study explores the existing situation of the rural telemedicine program and the challenges and limitations related with its implementation. Similarly it has also highlighted the roles and responsibilities of the government to improve the program. The study data and information were collected from the selected rural-telemedicine sites and it includes various respondents who were involved in the program and were working at various levels under the government health system. This is a qualitative study with interpretative case study approach. This approach is used since it supports to explore and understand the study area and produce deep insights into the context. For collecting the study data, multiple data collection tools (Semi-structured interview, site observation and discussion) were used. The collected data and information were analyzed and interpreted based on the preconception of the researcher and by comparing them with the concept provided by the Information Infrastructure (II) Theory and Actor-Network Theory. Results: Study findings shows that the rural-telemedicine service is necessary and important to improve the accessibility and provide specialized healthcare services to the rural community peoples. It has connected the rural-district hospitals with the tertiary level hospital and also supported the health personnel working in the rural areas to get necessary medical support. However the program is facing various challenges due to the lack of sufficient infrastructure and technology that are needed to support the program. Similarly the study findings show that various other factors have also affected the rural-telemedicine program. Such factors are related with the weak policy of government on rural-telemedicine program, limited fund, lack of trained and motivated human resources, frequent and unplanned transfer of the health personnel, unsatisfactory incentives for those health personnel involved in the program and not having supportive environment. Conclusion: Government need to improve on the existing policy and provide sufficient attention to the program. It is necessary to strengthen the infrastructure and technology and make them user-friendly and culturally adjustable. Similarly it should be cost effective and affordable and supportive to the local technology. For the sustainability of the program, government should also focus on the promotional activities and conduct networking and partnering with the related private organizations and external development partners. Similarly regular training and attractive incentives should be provided to the health personnel to motivate them to work in the rural areas. Government also needs to focus on conducting regular supervision, monitoring and evaluation of the program so that it will provide opportunity to gradually develop the program and timely address the related limitations and challenges. Keywords: Rural-telemedicine, challenges and limitation, role of government, sustainability, Nepa

Trachoma Decline and Widespread Use of Antimicrobial Drugs

Widespread use of antimicrobial drugs may be contributing to trachoma decline

Comparison of Two Azithromycin Distribution Strategies for Controlling Trachoma in Nepal

OBJECTIVE: The study compares the effectiveness of two strategies for distributing azithromycin in an area with mild-to-moderate active trachoma in Nepal. METHODS: The two strategies investigated were the use of azithromycin for 1) mass treatment of all children, or 2) targeted treatment of only those children who were found to be clinically active, as well as all members of their household. FINDINGS: Mass treatment of children was slightly more effective in terms of decreasing the prevalence of clinically active trachoma (estimated by clinical examination) and of chlamydial infection (estimated by DNA amplification tests), although neither result was statistically significant. CONCLUSION: Both strategies appeared to be effective in reducing the prevalence of clinically active trachoma and infection six months after the treatment. Antibiotic treatment reduced the prevalence of chlamydial infection more than it did the level of clinically active trachoma

Eliminating Trachoma in Areas with Limited Disease

The common wisdom is that a trachoma program cannot eliminate ocular chlamydia from a community, just reduce infection to a level where there would be minimal blindness. We describe the success of multiple mass antibiotic treatments, demonstrating that complete elimination of infection may be an attainable goal in an area with modest disease

Opportunities and Challenges of a Rural-telemedicine Program in Nepal

Background:Telemedicine services are considered essential for improving the accessibility, quality and efficiency of the healthcare services in developing countries. With these expectations, government of Nepal has implemented a rural-telemedicine program in thirty peripheral district hospitals to improve the accessibility of specialist health services. Telemedicine can be appropriate to the nation like Nepal with low physician/patient ratio. However the acceptability of telemedicine can be a delayed process, where the healthcare modalities are not well internalized. Similarly, the peoples who are involved in the program play a key role for making it efficient and effective. Hence, assessing the opportunities and challenges is important to address needs and better implement the program. Methods:This study has used an interpretive case study approach to explore the opportunities and challenges of the program. Fifteen stakeholders were interviewed from central level and program sites namely Darchula, Sindhupalchowk and from Patan hospital. Discussions at peripheral sites with stakeholders were recorded and intensive notes were taken. Results:The findings suggested that the rural-telemedicine programme does offer some benefits, however there are still many challenges associated with the implementation of program. These challenges include infrastructure problems, lack of human resources, competence and financing. Conclusions: Overall attitude of the stakeholders involved in delivering telemedicine services was favorable however several loopholes were reported in the existing system. Hence it shows sufficient potentialities of ruraltelemedicine to improve the health care delivery in rural and inaccessible areas

Assessment of Forest Fire and Its Impact on Plant Biodiversity of Buffer Zone, Langtang National Park, Nepal

The research work was focused on the study of forest fire and its impact assessment on plant biodiversity by vegetation assessment in the fire-affected and adjoining non-affected areas to identify the signals of severity and probable causes of fire. Data were collected by quadrate method, site survey, consultation and group discussion, mapping of the studied area, and questionnaire survey. The results show that there was a notable difference in tree and shrub diversity. The Shannon Wienner index (H) = 0.70 and 0.49, and Simpson’s Divesity (D) = 0.64 and 0.51, for trees in adjoining and fire-affected areas respectively. Similarly, Shannon Wienner index (H) = 0.91 and 0.72, and Simpson’s Divesity (D) = 0.84 and 0.68 for shrubs in adjoining and fire-affected areas respectively. Likewise, herb diversity did not differ significantly (H = 1.02 and 0.97; D = 0.87 and 0.88 in the adjacent to burned area and fire-affected area). Gleichenia gigantea, Artemisia dubia, Rubus spp., Oxalis chodata, and some medicinal plants such as Butea minor were found to be most affected by the fire. Mainly dried thickets of Drepanostachyum intermedium and Saccharum spontaneum act as fuel for the fire, which easily ignites and regenerates soon after a fire. Drought before monsoon was found to be the leading cause of forest fires, followed by electricity shooting (17%), ignorance and carelessness (38%), slash and burn practice (15%), other (7%), and unknown causes (23%). Hence the need to better address the drivers of resource extraction from the national park to mitigate this degradation

Do face-to-face training and telephonic reminder improve dry powder inhaler technique in patients with COPD?

Introduction. Current modes of instruction on inhaler technique are inadequate. We aimed to evaluate the value of face-to-face training and telephonic reminder (FFTTR) for improving Rotahaler technique in experienced patients with COPD. Materials and Methods. A single group pre-/postinterventional study was conducted at Chitwan Medical College Teaching Hospital, Nepal. We assessed the Rotahaler technique of thirty consecutive patients using Rotahaler device for more than one year. Patients with incorrect technique (n=20) were instructed and trained by a pharmacist. Telephonic reminder was used to reinstruct patients on the correct technique on weekly basis for two weeks and technique was reassessed after 4 weeks of their first training. Descriptive statistics including Wilcoxon Signed Rank test were applied. Results. The mean age was 66.06±10.6. Of 30 patients, 10 (33.3%) performed Rotahaler technique correctly at baseline and were excluded from FFTTR intervention. FFTTR corrected the technique in 18 (90%) patients and the median (IQR) score increased from 6 (5-6) to 8 (8-8) (