Prevalence and study of lipid abnormalities in nephrotic syndrome attending a tertiary hospital, Nepal

Background: The nephrotic syndrome is a common presentation of adult or pediatric kidney diseases characterized by proteinuria, dyslipidemia, edema and hypoalbuminemia. Mainly, two types of dyslipidemia are observed: elevated serum cholesterol alone (hypercholesterolemia) and elevation of serum cholesterol along with triglyceride (combined hyperlipidemia). Therefore, majority of patients could predispose for the development of coronary artery disease and other related complications.Methods: This was the prospective hospital-based study conducted in Tribhuvan University Teaching Hospital (TUTH), Nepal. Total sixty patients who meet the inclusive criteria were selected and enrolled from Nephrology outpatient department (OPD) and ward, attending from May 2009 till August 2010.Results: In this study, total sixty patients were enrolled who was diagnosis as primary nephrotic syndrome that was established by clinical parameters supported by renal biopsy. Minimal change glomerulonephritis was common diagnosis by renal biopsy followed by Focal segmental glomerulosclerosis (FSGS). The total serum cholesterol, TG and HDL was normal in 25%, 15%, 83.3% whereas, it is high among 75%,85% and 1.7% of the study populations. Similarly, 24hour urinary protein was >3.5gm/day in all patients. Total serum protein and albumin was normal in 18.3% and 8.3% respectively whereas, rest of the patients had low serum protein and albumin levels. TC/HDLc ratios were and among them, 70% had moderate to high risk value. Similarly, in this study, the serum cholesterol, TG and TC/HDL level was inversely correlated with low protein and albumin.Conclusions: Majority of patients have derangement of lipid profile among nephrotic syndrome patients, which could also predispose for the development of coronary artery disease

Effect of foliar spray of ethephon doses and pruning intensities on growth, sex expression, and yield of cucumber (var- Bhaktapur local) in Kaski, Nepal

A field experiment was conducted to study the effect of foliar spray of ethephon doses and pruning intensities on the performance of Bhaktapur local cultivar of cucumber in Kaski, Nepal from Feb- May 2021. The study was laid out in Randomized Complete Block design (RCBD) with 2G and 3G cutting, and four different doses of ethephon (@125ppm, @250ppm, @375ppm @500ppm) as six treatments against control and were replicated four times with 28 plots each of 20.8 m2 size having 4 rows with 4 plants per row. The data regarding plant height, leaf number, largest leaf area, days to 1st male and female flowering and fruit harvest, the total number of male and female flowers per plant, M: F flower ratio, fruit length, circumference, weight/fruit, fruit number per plant, fruit set % and yield were recorded and analyzed using MS-Excel and R-studio. The result revealed that growth and yield were significantly influenced by the levels of ethephon and pruning. Highest yield was recorded with ethephon @125ppm (83.54 t ha-1) which is as par with 3G (72.57 t ha-1) which was accompanied by a significantly higher number of fruits per plant {(125ppm=18.33), (3G=15.67)}, average fruit weight {(3G=674gm)}, (125ppm=608gm)}, and fruit set % {(3G=30.66 %)}, (125ppm=24.93 %)}. Significantly higher plant height (149.78 cm), and the highest number of leaves per plant (40) were recorded in control and Ethephon @125ppm at 50 DAT, respectively. The largest leaf area (626.84 cm2) was recorded in 2G which is at par with 3G (613.31 cm2) at 50 DAT. Higher dose of ethephon @500ppm (47.87 days) and 375 ppm (47.17 days) delayed days to 1st male flowering while all ethephon doses (T4=31.83 days, T5=32.5 days, T6=34.81 days, and T7=34.83 days) hastened female flowering than control and pruning. A significantly higher number of male flowers were obtained in the control (89.75), while the number of female flowers and M: F flower ratio increased with increasing ethephon level than in pruning (2G and 3G) and control. Hence, appropriate ethephon (125ppm) dose and pruning (3G) were highly conducive for better growth, sex expression, and yield of cucumber using Bhaktapur Local variety of cucumber in the hilly region of Nepal has a climatic condition similar to Kaski

Community participation for transformative action on women's, children's and adolescents' health.

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals

Community-based DOTS and family member DOTS for TB control in Nepal: costs and cost-effectiveness

<p>Abstract</p> <p>Background</p> <p>Two TB control strategies appropriate for South Asia (a community-based DOTS [CBD] strategy and a family-based DOTS [FBD] strategy) have been shown to be effective in Nepal in meeting the global target for the proportion of registered patients successfully treated. Here we estimate the costs and cost-effectiveness of the two strategies. This information is essential to allow meaningful comparisons between these and other strategies and will contribute to the small but growing body of knowledge on the costs and cost-effectiveness of different approaches to TB control.</p> <p>Methods</p> <p>In 2001–2, costs relating to TB diagnosis and care were collected for each strategy. Structured and semi-structured questionnaires were used to collect costs from health facility records and a sample of 10 patients in each of 10 districts, 3 using CBD and 2 using FBD. The data collected included costs to the health care system and social costs (including opportunity costs) incurred by patients and their supervisors. The cost-effectiveness of each strategy was estimated.</p> <p>Results</p> <p>Total recurrent costs per patient using the CBD and FBD strategies were US$76.2 and US$84.1 respectively. The social costs incurred by patients and their supervisors represent more than a third of total recurrent costs under each strategy (37% and 35% respectively). The CBD strategy was more cost-effective than the FBD strategy: recurrent costs per successful treatment were US$91.8 and US$102.2 respectively.</p> <p>Discussion</p> <p>Although the CBD strategy was more cost-effective than the FBD strategy in the study context, the estimates of cost-effectiveness were sensitive to relatively small changes in underlying costs and treatment outcomes. Even using these relatively patient-friendly approaches to DOTS, social costs can represent a significant financial burden for TB patients.</p

Using qualitative evaluation components to help understand context: case study of a family planning intervention with female community health volunteers (FCHVs) in Nepal.

BACKGROUND: Evaluations of health interventions are increasingly concerned with measuring or accounting for 'context'. How to do this is still subject to debate and testing, and is particularly important in the case of family planning where outcomes will inevitably be influenced by contextual factors as well as any intervention effects. We conducted an evaluation of an intervention where female community health volunteers (FCHVs) in Nepal were trained to provide better interpersonal communication on family planning. We included a context-orientated qualitative component to the evaluation. Here, we discuss the evaluation findings, specifically focusing on what was added by attending to the context. We explore and illustrate important dimensions of context that may also be relevant in future evaluation work. METHODS: The evaluation used a mixed methods approach, with a qualitative component which included in-depth interviews with women of reproductive age, FCHVs, and family planning service providers. We conducted iterative, thematic analysis. RESULTS: The life-history fertility and contraception narratives generated from the in-depth interviews contextualised the intervention, yielding nuanced data on contraceptive choices, needs, and areas for future action. For instance, it highlighted how women generally knew about effective contraceptive methods and were willing to use them: information was not a major barrier. Barriers instead included reports of providers refusing service when women were not in the fifth day of their menstrual cycle when this was unnecessary. Privacy and secrecy were important to some women, and risked being undermined by information sharing between FCHVs and health services. The qualitative component also revealed unanticipated positive effects of our own evaluation strategies: using referral slips seemed to make it easier for women to access contraception. CONCLUSIONS: Life history narratives collected via in-depth interviews helped us understand pathways from intervention to effect from the user point of view without narrowly focusing only on the intervention, highlighting possible areas for action that would otherwise have been missed. By attending to context in a nuanced way in evaluations, we can build a body of evidence that not only informs future interventions within that context, but also builds better knowledge of contextual factors likely to be important elsewhere

"Who Will Marry a Diseased Girl?" Marriage, Gender, and Tuberculosis Stigma in Asia

In a qualitative study on the stigma associated with tuberculosis (TB), involving 73 interviews and eight focus groups conducted in five sites across three countries (Bangladesh, Nepal, and Pakistan), participants spoke of TB’s negative impact on the marriage prospects of women in particular. Combining the approach to discovering grounded theory with a conceptualization of causality based on a realist ontology, we developed a theory to explain the relationships between TB, gender, and marriage. The mechanism at the heart of the theory is TB’s disruptiveness to the gendered roles of wife (or daughter-in-law) and mother. It is this disruptiveness that gives legitimacy to the rejection of marriage to a woman with TB. Whether or not this mechanism results in a negative impact of TB on marriage prospects depends on a range of contextual factors, providing opportunities for interventions and policies

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

The COVID-19 pandemic affected access to antenatal care in low and middle-income countries where anaemia in pregnancy is prevalent. We analyse how health workers provided antenatal care and the factors affecting access to antenatal care during the COVID-19 pandemic in Kapilvastu district in the western plains of Nepal. We used qualitative and quantitative methodologies, conducting eight semi-structured interviews with health workers who provided antenatal care during the pandemic, and a questionnaire containing open and closed questions with 52 female community health volunteers. Antenatal care was severely disrupted during the pandemic. Health workers had to find ways to provide care with insufficient personal protective equipment and guidance whilst facing extreme levels of stigmatisation which prevented them from providing outreach services. Pregnant women were fearful or unable to visit health institutions during the pandemic because of COVID-19 control measures. Pre-pandemic and during the pandemic health workers tried to contact pregnant and postpartum women and families over the phone, but this was challenging because of limited access to phones, and required pregnant women to make at least one antenatal care visit to give their phone number. The pandemic prevented new pregnancies from being registered, and therefore the possibilities to provide services over the phone for these pregnancies were limited. To reach the most marginalised during a pandemic or other health emergency, health volunteers and households need to exchange phone numbers, enabling proactive monitoring and care-seeking. Strengthening procurement and coordination between the municipal, provincial, and federal levels of government is needed to ensure adequacy of antenatal supplies, such as iron folic acid tablets, in health emergencies. Community engagement is important to ensure women and families are aware of the need to access antenatal care and iron folic acid, and to address stigmatisation of health workers