Impact of COVID-19 on health services utilization in Province-2 of Nepal: A qualitative study among community members and stakeholders

Background The COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aimed to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal. Methods The semi-structured qualitative interviews were conducted among purposively selected participants (n=41) from a mix of rural and urban settings in all districts (n =8) of the Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro. Results The findings of this research are categorized into four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and anxious about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions in health services were mostly due to the closure of health services at local health care facilities, limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health care workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from the government at all levels towards health services continuation/management during the COVID-19 pandemic. Conclusions This study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is critical to expand and continue the service coverage, and its quality (even more during pandemics), as well as increase public-private sector engagement to ensure the essential health services are available for the population

The role of maternal echocardiography and uterine artery Doppler at 11-14 weeks in the prediction of pre-eclampsia in nulliparous women

Background: Pre-eclampsia (PE) complicates 2% of pregnancies and may have serious effects on mother and child, which makes it an important threat to public health in both developed and developing countries. Once high-risk women are identified, they can be targeted for more intense prenatal surveillance and preventative measures. Predicting PE in the first trimester requires the use of maternal echocardiography and the uterine artery pulsatility index (UAPI). Objective of the study was to see whether maternal echocardiography and uterine artery Doppler at 11-14 weeks can predict subsequent development of PE in nulliparous women.Methods: This prospective observational cohort study was carried out in outdoor patients of obstetrics and gynecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), with collaboration with department of cardiology, National Institute of Nuclear Medicine and Allied Sciences (NINMAS), BSMMU, Dhaka, during 01 December 2013 to July 2015. A total of 135 healthy nulliparous women at 11-14 weeks of gestation were included in this study. Data was processed and analyzed by statistical package for the social sciences (SPSS) version 24.0.Results: Among 135 patients, two (1.5%) patients developed preeclampsia during 1st follow-up (20-28 weeks) and four (2.9%) patients developed preeclampsia during (29-36 weeks). Mean total peripheral resistance was found to be 1332.0±75.2 dynes/sec/cm5 in preeclampsia and 1157.0±139.2 dynes/sec/cm5 in non preeclamptic pregnancy. The difference between two groups was statistically significant. MAP and total peripheral resistance were statistically significant (p<0.05) between two groups.Conclusions: In first trimester of pregnancy UAPI is the best predictor for detection of PE

Monitoring of organochlorine pesticide residues from bovine milk in Patna (Bihar), INDIA

&nbsp;The milk has high nutritional properties and is widely used as baby food in different forms. The present study was undertaken to evaluate pesticide contamination in bovine milk samples from Patna district of Bihar. Out of 24 samples analyzed during 2012, 18 samples (75 %) were found to be contaminated with HCH residues varying from ND-0.178 mg kg-1 (mean value 0.135 mg kg-1). Seven samples (29.2 %) had HCH exceeding MRL of 0.01 mg kg-1. DDT residues were detected in 20 samples (83.3 %) and ranged from ND-0.132 mg kg-1 (mean value 0.122 mg kg-1). Five samples (20.8 %) contained DDT residues above the prescribed MRL of 0.05 mg kg-1. Out of 24 samples of bovine milk analyzed during 2013, 16 samples (66.7 %) were found to be contaminated with HCH and 15 samples (62.5%) with DDT residues. The residues of HCH varied from ND-0.154 mg kg-1 (mean value 0.053 mg kg-1) and DDT from ND-0.120 mg kg-1 (mean value 0.122 mg kg-1). The residues of HCH and DDT were above MRL in four samples (16.7 %) and three samples (12.5 %) respectively. The management practices of animals and legal punishment on using banned pesticides are the alternatives to reduce pesticide contamination incidences in milk

Health and Wellbeing of the Nepalese population: Access and experiences of health and social care services in the UK

To date there has been very little research on the health and well-being of Nepali citizens living int the UK. This mixed-methods study is crucial as the NHS and social services have minimal awareness of the specific health and related social care needs of the UK Nepali community compared to other larger Black and Minority Ethnic (BME) communities. Therefore, this study aims to identify health and social care needs to promote positive health and wellbeing for the Nepali population in the UK. It also assesses health inequalities amongst the Nepali population focusing on the need for national level prioritisation to reduce these inequalities experienced by the broader UK Nepali population using NHS services

PREPARATION AND EVALUATION OF CYCLODEXTRIN COMPLEXES OF ANTI-TUBERCULAR DRUG RIFAMPICIN FOR IMPROVED BIOAVAILABILITY

The aim of the study was to increase the aqueous solubility, dissolution rate, stability, in vitro anti-tubercular activity and bioavailability of rifampicin by the way of inclusion complexation. Methyl B-cyclodextrin in case of rifampicin were used. Based on phase solubility studies that stoichiometry of complex of with respect to B-cyclodextrin for rifampicin was found to be 1:1 molar ratio. Different methods of preparation such as kneading and common solvent were employed to prepare the complexes. Formation of complexes In case of rifampicin, interaction of 4-methyl piperazin-1-ylimino-methyl (side chain) of rifampicin with the cyclodextrin molecule was confirmed by FTIR and 1H-NMR. The complexes prepared by different methods were subjected to solubility and in vitro dissolution studies. In case of rifampicin, in vitro anti-tubercular activity was found to be enhanced for the complexes of rifampicin indicated by a reduction in MIC of rifampicin. The oral bioavailability of rifampicin-MB-CD complex prepared by common solvent method was improved significantly. The results of stability studies revealed that stability of the drugs in solution and solid state were improved significantly due to complexation. Photostability of rifampicin is enhanced significantly by the way of complexation. Thus inclusion complexation of rifampicin with B-cyclodextrin, B-cyclodextrin derivatives and y-cyclodextrin improved its physical properties, bioavailability and in vitro activity

PROTECTIVE EFFECT OF SAPONIN OF MOMORDICA CYMBALARIA FENZL ON HIGH-GLUCOSE INDUCED NEUROPATHY IN NB-41A3 MOUSE NEUROBLASTOMA CELLS

Objective: The natural product Momordica cymbalaria Fenzl has been in use considerably because of its antidiabetic activity. In this work, we have investigated the protective action of one of its phytoconstituent, a saponin, in peripheral neuropathy–a diabetic complication.Methods: The saponin was isolated and identified by preparative high-performance liquid chromatography (preparative HPLC) and thin layer chromatography TLC). High glucose (56 mM)-mediated neuropathy was induced in NB-41A3 mouse neuroblastoma cells and the neuroprotective activity of the saponin was assessed by evaluating its effect on the two polyol pathway enzymes–aldose reductase (AR) and sorbitol dehydrogenase (SDH). The accumulation of intracellular sorbitol, activity of Na+K+-ATPase and production of pro-inflammatory cytokines IL-6, IL-1β and TNF-α were also investigated.Results: The results showed a significant reduction in AR activity and intracellular accumulation of sorbitol on saponin treatment. Improvement in Na+K+-ATPase activity was evident with a noteworthy reduction in IL-6, IL-1β and TNF-α production.Conclusion: These results suggest that the saponin possesses neuroprotective activity in diabetic peripheral neuropathy.Keywords: Diabetic peripheral neuropathy (DPN), Saponin of Momordica cymbalaria (SMC), Neuroblastoma cells, Aldose reductase, Sorbitol dehydrogenase, Na+K+-ATPas

Seasonal and Altitudinal Prevalence of Fascioliasis in Buffalo in Eastern Nepal

Buffalo is the most important livestock commodities for milk, meat production and several other multipurpose uses distributed densely from southern tarai to northern mid-hills in Nepal. Among several internal parasitic diseases fascioliasis is highly economic one caused by Fasciola in buffaloes. However, there are only few studies carried on prevalence of fascioliasis emphasizing buffaloes in relation to seasonal (summer and rainy, and winter) and altitudinal variations. Therefore, we examined prevalence of fascioliasis seasonally and vertically. For the purpose, we selected two districts of eastern Nepal and sampled from low altitude area known as Madhesha ranging from 175-200, Dhankuta from 800-1200 m, and Murtidhunga from 1800-2200 m elevation from the sea level, representing tarai, mid hills and high hills, respectively. Altogether from February 2013 to January 2014 at every two months interval we collected 798 fecal samples from buffaloes; 282 from Murtidhunga, 239 from Dhankuta and 277 from Madhesha. The samples were examined microscopically for the presence of Fasciola eggs using sedimentation technique. Results showed that overall prevalence of fascioliasis in buffaloes was 39.9% (319/798), ranging highest 42.6%in Madhesha followed by 39.7% in Murtidhunga and 37.2% in Dhankuta, respectively. The prevalence of fascioliasis was found to be significantly (p &lt;0.05) high in winter (44.9%) comparing to rainy season (34.4%). The prevalence of fascioliasis in buffaloes was relatively higher in low altitude than high altitude, although it was not statistically significant (p &lt;0.05). In our findings the female buffaloes showed higher prevalence for fascioliasis than in male. Since the fascioliasis in buffaloes is highly endemic, thus strategic deworming in high risk period is recommended along with measure to prevent pasture contamination with buffalo feces