Visitor’s perspective of Patan Hospital, Patan Academy of Health Sciences, Nepal

A local man sits on the pavement in Patan Durbar Square at one am. A taxi driver calls a cell phone number I handed to him that belongs to the guesthouse I am staying at. Both of them are strangers to me, but go out of the way to make sure I reach home safe. It struck a chord, nice warm people and very hospitable. The next morning begins with meeting Mr. Shakya, the person in charge of visitors at Patan hospital, touring the hospital, including the outpatient department, emergency room, wards, auditorium, and medical school. I’m greeted with Namaste, and introduced as “tyo America ma doctor hoâ€. This is followed by a most important visit to the cafeteria. We go over the menu. I am told the most popular options and also advice to not order ‘jawanoko jhol†(for nursing females only, helps let down), I am told this will be explained soon in private. Curiosity grew. This hospital tour has surprised me because what I had in mind was a hospital with few rooms with barely any equipment. On the contrary, Patan hospital is fairly well equipped and organized with a CT scanner, multiple wards, and the medical school has an extensive public health department. Meanwhile I am offered a tea and biscuit everywhere. My first few hours of touring showed me that this is going to be a fun experience. This is followed by a stop at the Intensive Care Unit (ICU) where I will be on rotation for the next few weeks. Another cup of tea and biscuit follows, fourth of the day already

Prevalence and contributing factors of low birth weight babies in institutional delivery

Introductions: Low Birth Weight (LBW) is a sensitive indicator of socio-economic conditions and indirectly measures the health of mother and child. Though, the health situation of Nepal has improved substantially over the years, LBW rate is still high. The present study explores the prevalence and contributing factors of LBW babies delivered in Patan hospital. Methods: The data were collected retrospectively from patients’ record for babies born at Patan Hospital, Patan Academy of Health Sciences, Kathmandu, Nepal. Records were retrieved through systematic randomization and IBM SPSS 15.0 was used for analysis. Non-parametric tests were applied with correlation done between dependent and independent variables. Results: A total of 4395 birth occurred during the study period of which 527 met the study criteria and remaining were of normal birth weight. The prevalence of LBW was 11.99% and the average LBW was calculated as 2074.97 ± 344.425 grams. The factors associated with LBW included preterm babies (Pearson correlation coefficient= 0.554, p= 0.001 < 0.05) and oligohydamnious (Spearman’s correlation coefficient= 0.307, p= 0.019 < 0.05). Conclusions: This study suggests preterm babies and oligohydramnious to be contributing factors of LBW babies. Keywords: amniotic fluid index, intra uterine growth retardation, maternal risk factors, Patan Hospital, retrospective hospital based studyÂ

The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of Kathmandu

Enteric fever, caused by Salmonella enterica serovars Typhi and Paratyphi A (S. Typhi and S. Paratyphi A) remains a major public health problem in many settings. The disease is limited to locations with poor sanitation which facilitates the transmission of the infecting organisms. Efficacious and inexpensive vaccines are available for S. Typhi, yet are not commonly deployed to control the disease. Lack of vaccination is due partly to uncertainty of the disease burden arising from a paucity of epidemiological information in key locations. We have collected and analyzed data from 3,898 cases of blood culture-confirmed enteric fever from Patan Hospital in Lalitpur Sub-Metropolitan City (LSMC), between June 2005 and May 2009. Demographic data was available for a subset of these patients (n = 527) that were resident in LSMC and who were enrolled in trials. We show a considerable burden of enteric fever caused by S. Typhi (2,672; 68.5%) and S. Paratyphi A (1,226; 31.5%) at this Hospital over a four year period, which correlate with seasonal fluctuations in rainfall. We found that local population density was not related to incidence and we identified a focus of infections in the east of LSMC. With data from patients resident in LSMC we found that the median age of those with S. Typhi (16 years) was significantly less than S. Paratyphi A (20 years) and that males aged 15 to 25 were disproportionately infected. Our findings provide a snapshot into the epidemiological patterns of enteric fever in Kathmandu. The uneven distribution of enteric fever patients within the population suggests local variation in risk factors, such as contaminated drinking water. These findings are important for initiating a vaccination scheme and improvements in sanitation. We suggest any such intervention should be implemented throughout the LSMC area.This work was supported by The Wellcome Trust, Euston Road, London, United Kingdom. MFB is supported by the Medical Research Council (grant G0600718). SB is supported by an OAK foundation fellowship through Oxford University

The Seroepidemiology of Haemophilus influenzae Type B Prior to Introduction of an Immunization Programme in Kathmandu, Nepal.

Haemophilus influenzae type b (Hib) is now recognized as an important pathogen in Asia. To evaluate disease susceptibility, and as a marker of Hib transmission before routine immunization was introduced in Kathmandu, 71 participants aged 7 months-77 years were recruited and 15 cord blood samples were collected for analysis of anti-polyribosylribitol phosphate antibody levels by enzyme-linked immunosorbent assay. Only 20% of children under 5 years old had levels considered protective (>0.15 µg/ml), rising to 83% of 15-54 year-olds. Prior to introduction of Hib vaccine in Kathmandu, the majority of young children were susceptible to disease

A Poverty Analysis in Baitadi District, Rural Far Western Hills of Nepal: An Inequality Decomposition Analysis

Occupational caste is deprived in terms of education, and landholding. Due to this laboring and agriculture (specially small animals like goats and poultry) remain the prominent source of income for them. Average income from salaried job is the highest followed by remittance and that from laboring is the lowest. This led to the high concentration of Occupational caste under third and fourth income quartile (poorer). A share of income from agriculture in total income is the highest and the share from laboring is the lowest. Relative concentration coefficient (RCC-ci or gi) shows salaried job has both the highest income disequalizing effect (ci = 1.56 or gi = 1.49) as well as the highest factor inequality weight (wici) followed by agriculture. In case of Melauli, however, salaried job followed by remittance has the highest income disequalizing effect. Negative values of Relative Concentration Coefficient and factor inequality weight for laboring indicate that income from it has the income equalizing effect. Thus, agricultural promotion in rural areas based on labor demand increasing policies with proper market arrangement for the agricultural produce will be helpful to reduce the income inequality. In addition, regulation regarding working hour and minimal wage rate should be strictly enforced for the welfare of those involved in laboring, which is also the poorest.Coefficient of variation; gini-coefficient; relative concentration coefficient; factor inequality weight

Relationship between Income-poverty and Food insecurity in Rural Far-western Mid-hills of Nepal

For the purpose of this study, sample was selected through stratified random sampling from Baitadi district, which falls in rural Far-western Hills of Nepal. Both income and consumption measure of poverty revealed that problem of poverty is more severe in Melauli, which is relatively remote village devoid of transportation, communication, market, and other developmental services. Education, occupation, gender of household head, and family size are found to be the most important factors that affect income-poverty as well as consumption-poverty (food insecurity). Caste and landholding size has a significant effect on poverty when we consider food insecurity. Households with illiterate head, head engaged in laboring, female-head, larger family size, Occupational Caste household, and small holding are suffering from both income-poverty and consumption-poverty in greater extent. Income-poverty measure shows the higher incidence, gap, and severity of poverty compared to food insecurity for all the variables considered for the study. This could be due to inclusion of non-food expenses while constructing poverty line, and is also due nature of consumption itself, which is relatively continuous compared to income. However, in Melauli, incidence, depth, and severity of both poverty measures are closer. This may be due to shortcoming of income-poverty measure to take into account of spatial factor. Therefore, adoption of poverty line for whole region i.e., Rural Western Hills could mislead understanding of poverty. Thus, consumption-poverty is very relevant in the case where construction of location specific income-poverty line demands extra cost. This can further be justified by significantly higher chance of non-poor, in terms of income-poverty, being food insecure, and lower chance of income-poor being food secure in Melauli compared to Patan.Income-poverty; consumption-poverty; Baitadi; householdIncome-poverty, consumption-poverty, Baitadi district.

Water Connection: Everyday Religion and Environments in Kathmandu Valley

This case study aims to explore the relationship between ‘everyday religion’ and prospects for urban sustainability in the context of on-going changes -in Kathmandu. It argues that everyday religion plays a role in furnishing the incentive for urban residents to sustainably manage ‘culturalized nature’ in the city. In particular, I examine water, the practices surrounding its use, and how these practices connect various social realms. I suggest that water in Kathmandu valley plays an important role as a connector encompassing life and death, religion and environment, as well as politics and development

Multi-serotype pneumococcal nasopharyngeal carriage prevalence in vaccine naïve Nepalese children, assessed using molecular serotyping.

Invasive pneumococcal disease is one of the major causes of death in young children in resource poor countries. Nasopharyngeal carriage studies provide insight into the local prevalence of circulating pneumococcal serotypes. There are very few data on the concurrent carriage of multiple pneumococcal serotypes. This study aimed to identify the prevalence and serotype distribution of pneumococci carried in the nasopharynx of young healthy Nepalese children prior to the introduction of a pneumococcal conjugate vaccine using a microarray-based molecular serotyping method capable of detecting multi-serotype carriage. We conducted a cross-sectional study of healthy children aged 6 weeks to 24 months from the Kathmandu Valley, Nepal between May and October 2012. Nasopharyngeal swabs were frozen and subsequently plated on selective culture media. DNA extracts of plate sweeps of pneumococcal colonies from these cultures were analysed using a molecular serotyping microarray capable of detecting relative abundance of multiple pneumococcal serotypes. 600 children were enrolled into the study: 199 aged 6 weeks to <6 months, 202 aged 6 months to < 12 months, and 199 aged 12 month to 24 months. Typeable pneumococci were identified in 297/600 (49.5%) of samples with more than one serotype being found in 67/297 (20.2%) of these samples. The serotypes covered by the thirteen-valent pneumococcal conjugate vaccine were identified in 44.4% of samples containing typeable pneumococci. Application of a molecular serotyping approach to identification of multiple pneumococcal carriage demonstrates a substantial prevalence of co-colonisation. Continued surveillance utilising this approach following the introduction of routine use of pneumococcal conjugate vaccinates in infants will provide a more accurate understanding of vaccine efficacy against carriage and a better understanding of the dynamics of subsequent serotype and genotype replacement

Two nonrecombining sympatric forms of the human malaria parasite Plasmodium ovale occur globally.

BACKGROUND: Malaria in humans is caused by apicomplexan parasites belonging to 5 species of the genus Plasmodium. Infections with Plasmodium ovale are widely distributed but rarely investigated, and the resulting burden of disease is not known. Dimorphism in defined genes has led to P. ovale parasites being divided into classic and variant types. We hypothesized that these dimorphs represent distinct parasite species. METHODS: Multilocus sequence analysis of 6 genetic characters was carried out among 55 isolates from 12 African and 3 Asia-Pacific countries. RESULTS: Each genetic character displayed complete dimorphism and segregated perfectly between the 2 types. Both types were identified in samples from Ghana, Nigeria, São Tomé, Sierra Leone, and Uganda and have been described previously in Myanmar. Splitting of the 2 lineages is estimated to have occurred between 1.0 and 3.5 million years ago in hominid hosts. CONCLUSIONS: We propose that P. ovale comprises 2 nonrecombining species that are sympatric in Africa and Asia. We speculate on possible scenarios that could have led to this speciation. Furthermore, the relatively high frequency of imported cases of symptomatic P. ovale infection in the United Kingdom suggests that the morbidity caused by ovale malaria has been underestimated

Sounds of Music and Worship in Uku Baha, Patan

Sounds of music and worship played in the courtyard of Uku Baha