Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis.

OBJECTIVE: To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal. STUDY DESIGN: Systematic literature review and meta-analysis. METHODS: PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion. RESULTS: The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening. CONCLUSION: Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.

Facile Synthesis of Bio-Templated Tubular Co3O4 Microstructure and Its Electrochemical Performance in Aqueous Electrolytes.

Template-assisted facile synthesis of tubular Co3O4 microstructures and its electrochemical performance was studied to understand its use as a potential electrode material for supercapacitors. Tubular porous Co3O4 microstructures were synthesized using cotton fibers as bio-template. The as-obtained templated Co3O4 structure inherits the morphology and microstructure of cotton fiber. The electrochemical performance of the electrode made up of tubular Co3O4 structure was evaluated in 3 M KOH, NaOH, and LiOH aqueous electrolytes. The large-surface-area of tubular Co3O4 microstructure has a noticeable pseudocapacitive performance with a capacitance of 401 F/g at 1 A/g and 828 F/g at 2 mV/s, a Coulombic efficiency averaging ~100%, and excellent cycling stability with capacitance retention of about 80% after 5,000 cycles. Overall, the tubular Co3O4 microstructure displayed superior electrochemical performance in 3 M KOH electrolyte with peak power density reaching 5,500 W/kg and energy density exceeding 22 Wh/kg. The superior performance of tubular Co3O4 microstructure electrode is attributed to its high surface area and adequate pore volume distribution, which allows effective redox reaction and diffusion of hydrated ions. The facile synthesis method can be adapted for preparing various metal oxide microstructures for possible applications in catalysis, electrochemical, sensors, and fuel cells applications.

Influence of Urea on the Synthesis of NiCo2O4 Nanostructure: Morphological and Electrochemical Studies.

The widespread use of miniature electronic devices calls for energy-dense storage strategies. The supercapacitor-based energy storage devices with high areal capacitance are desired energy storage alternative. It is still a challenge to fabricate supercapacitor-based energy devices with consistent performance. The porous metal oxides with large areal capacitance are desired materials for electrode, but there exists a limited understanding of the influence of synthesis parameters on microstructural properties, which largely govern their electrochemical performance. In the present work, hierarchal spinel nickel cobaltite (NiCo2O4) nanostructures were synthesized in the presence of the varying amount of hydrolyzing agent via a simple hydrothermal method coupled with a simple post-annealing process. This work focuses on understanding the influence of hydrolyzing agent in controlling the microstructure and hence ensuing electrochemical properties of the NiCo2O4 based electrode. Based on the urea hydrolyzing content, the as synthesized NiCo2O4 nanostructure varied from the rod, plate to nanoflower. The mesoporous nanostructures, with urea content 1.49 gm, exhibit a sizeable BJH surface area (79.2 m² g-1) and high mesopore volume (0.140 cm³ g-1). Remarkably, the NiCo2O4 nanoflower shows high specific capacitance of 3143.451 F/g at 2 mV/s scan rate, 1264.5 F/g at 1 A/g current density, energy density of 56 Wh/kg and power density of 8,400 W/kg in 3 M KOH electrolyte. The capacitance loss after 5000 cycles is 48% at the current density of 10 A/g, indicating their excellent cycling stability. The impressive electrocatalytic activity is largely ascribed to the high intrinsic electronic conductivity, superior mesoporous nanostructures and rich surface Ni active species of the NiCo2O4 materials, which can largely boost the interfacial electroactive sites and charge transfer rates indicating promising applications as electrodes in future supercapacitors.

Development and evaluation of an oral fast disintegrating anti-allergic film using hot-melt extrusion technology.

The main objective of this novel study was to develop chlorpheniramine maleate orally disintegrating films (ODF) using hot-melt extrusion technology and evaluate the characteristics of the formulation using in vitro and in vivo methods. Modified starch with glycerol was used as a polymer matrix for melt extrusion. Sweetening and saliva-simulating agents were incorporated to improve palatability and lower the disintegration time of film formulations. A standard screw configuration was applied, and the last zone of the barrel was opened to discharge water vapors, which helped to manufacture non-sticky, clear, and uniform films. The film formulations demonstrated rapid disintegration times (6-11s) and more than 95% dissolution in 5min. In addition, the films had characteristic mechanical properties that were helpful in handling and storage. An animal model was employed to determine the taste masking of melt-extruded films. The lead film formulation was subjected to a human panel for evaluation of extent of taste masking and disintegration.

Non-adherence to anti-hypertensive medication in low- and middle-income countries: a systematic review and meta-analysis of 92443 subjects.

Hypertension is a rising global burden, and low- and middle-income countries account for 80% of deaths due to complications of hypertension. Hypertension can be controlled by adhering to anti-hypertensive medication. However, non-adherence is an increasing challenge. This review aims to systematically evaluate non-adherence to anti-hypertensive medication among adults in low- and middle-income countries and explore factors affecting non-adherence to anti-hypertensive medication. We performed a systematic search for studies published between 1 January 2000 and 31 August 2015. A selection process was performed for data extraction with a combination of Medical Subject Headings terms: 'hypertension' and 'adherence'. Further search criteria were: language ('english'), species ('humans'), and low- and middle-income countries. A total of 22 studies met the inclusion criteria. The pooled percentage of non-adherence when using the eight-item Morisky Medication Adherence Scale (MMAS) was 63.35% (confidence of interval (CI): 38.78-87.91) and 25.45% (CI:17.23-33.76) when using the 80 and 90% cut-off scales. The factors were classified into the five dimensions of adherence defined by the World Health Organization, and the majority of the studies reported factors from the dimension 'social and economic factors'. This systematic review demonstrated considerable variation of non-adherence to anti-hypertensive medication in low- and middle-income countries depending on the methods used to estimate non-adherence. The results showed a high non-adherence when the MMAS eight-item scale was used and low when the 80 and 90% cut-off scales were used. The majority of factors affecting non-adherence to anti-hypertensive medication fell within the World Health Organization defined dimension 'social and economic factors'.

Evaluation of temperature sum models and timing of Quassia amara (Simaroubaceae) wood-chip extract to control apple sawfly (Hoplocampa testudinea Klug) in Sweden.

Apple sawfly (Hoplocampa testudinea Klug) is a serious pest in European organic apple production. They hatch during a short period only, making correct timing of control measures crucial. Swedish organic growers have requested a strategy for optimal timing of the Quassia amara (Simaroubaceae) extract against the apple sawfly. The aim of this study was, therefore, to develop methods to predict the timing of Q. amara control in Sweden. A temperature sum model for timely placement of monitoring or mass-trapping sticky traps was validated for Swedish conditions. The average emergence of sawflies occurred at 169 degree days (SD = 20) counted from March 15 (threshold temperature 4 °C). The difference in emergence from existing first flight model of average and maximum 9 and 39 degree days (1 and 9 calendar days) was found acceptable. Accumulated oviposition of 85 % at full bloom (BBCH 65) suggests that mass trapping and monitoring could stop at this time. This is supported by a tendency of decreased trap catches during that period. Three application times for Q. amara were compared: (A) at petal fall (BBCH 67), (B) at a date calculated using female trap catch numbers and temperature sums, and (C) prior to peak egg hatch observed in the field. All treatments resulted in significantly lower percentage of damaged apples compared to the unsprayed control, with significantly less damage (1.3 %) in plots treated according to method (B). The results provide information on adult phenology and methods that could be used to determine timing of mass trapping and insecticide application against the apple sawfly.

Measurement of right atrial volume and diameters in healthy Nepalese with normal echocardiogram.

BACKGROUND: The size of right atrium is expected to be different in diverse healthy ethnic groups. It is important to know the normal size of right atrium in our healthy population. OBJECTIVE: The study aimed to find out the normal values of right atrial volume, right atrial short axis diameter and right atrial long axis diameter in healthy Nepalese population with normal echocardiographic findings. It also looked at correlations between right atrial dimensions and the right atrial volume. METHOD: Verbal consent was taken from all the participants. One hundred participants between the age of 18 and 60 years with normal echocardiographic findings and without any chronic disease were included in this study. Right atrial volume was measured by using area length method. Right atrial short axis diameter and Right atrial long axis diameter were measured in the four chamber view. RESULT: The mean right atrial volume was 23.64±5.36 ml (range 11.30-40.00 ml).The range of right atrial short axis diameter and right atrial long axis diameter were 1.34-3.80 cm and 2.4-4.7 cm respectively. CONCLUSION: The size of right atrium in the Nepalese population is smaller compared to western population. Male right atrial volume size is greater than female in Nepalese population similar to western population. The findings of normal value of right atrial volume and right atrial diameter in Nepalese population will help the physician to assess patients with various conditions affecting the right atrium.

Non-communicable diseases in Nepal: challenges and opportunities.

Non-communicable diseases constitute a major public health problem in Nepal. They are already killing more people than communicable diseases. However, addressing non-communicable diseases is not getting much attention from the government, academicians and development partners.Simple measures at population and individual level have not been implemented in an effective way. The vision on how to address non-communicable diseases at primary health care level is unclear. However, there is a unique possibility of integrating non-communicable diseases into the existing communicable diseases interventions which need to be tested and potential positive lessons have to be scaled up as soon as possible. The best buy approach as proposed by WHO could be implemented for non-communicable diseases prevention and management through primary health care approach.

Perceived discrimination among people living with HIV in Nepal.

BACKGROUND: HIV is one of the major public health problems in Nepal, fuelled by several socio-economic factors. The objective of this study was to explore perceived discrimination among people living with HIV in their own family, society and health facilities. METHODS: A qualitative descriptive cross-sectional study was conducted with semi-structured face-to-face in-depth interview of 18 people (10 men, 8 women) living with HIV in four districts of Nepal. RESULTS: Perceived discriminations among people living with HIV were found among family, society and health facilities. In families, the major forms of perceived discrimination were restriction to go outside, exposure to media and use of different utensils for eating purpose. Female HIV positive perceived more violence at household level than males. Financial restriction was also found imposed upon some respondents by the family for being HIV positive. Similarly, restriction to participate in social work, restriction to buy from shops, social harassment and insult were the main forms of discrimination. Perceived discrimination experienced in the health facility yielded very bitter experiences to some respondents, while many had refused treatment because of their HIV status. CONCLUSIONS: People living with HIV faced different forms of perceived discrimination within family, society and health facility which are thought to be crucial in supporting a person at the time of crisis. Intensive programs that can reduce social stigma and discrimination faced by people living with HIV are a most.

Feasibility and acceptability of gentamicin in the Uniject prefilled injection system for community-based treatment of possible neonatal sepsis: the experience of female community health volunteers in Nepal.

OBJECTIVE: Explore feasibility and acceptability of gentamicin in the Uniject prefilled injection system, in combination with oral cotrimoxazole-p and an appropriate newborn weighing scale, for treatment of possible neonatal sepsis when administered in the community by female community health volunteers. STUDY DESIGN: In a community-based program in Nepal, 45 volunteers recorded 422 live births. Among these, 82 infants were identified as having possible severe bacterial infection. In all, 67 of these infants were treated with gentamicin in Uniject and 15 were referred to the health facility. Mixed methods were used to collect data about Uniject performance, acceptability and safety. RESULT: Volunteers successfully treated 67 infants with gentamicin in Uniject. Gentamicin in Uniject performed well and was acceptable. CONCLUSION: Gentamicin in Uniject, in combination with cotrimoxazole-p and an appropriate newborn weighing scale, is a feasible and acceptable option for treatment of possible neonatal sepsis in the community by female community health volunteers.

Practices and perceptions on contraception acceptance among clients availing safe abortion services in Nepal.

BACKGROUND: The Government of Nepal has implemented safe abortion policy since 2002. There are 245 approved sites providing safe abortion services to women across the country. Family planning counselling is one of the components of the safe abortion policy, which is important to reduce unwanted pregnancy, maternal morbidity and mortality due to the consequences of unsafe abortion and the service burden. OBJECTIVES: This study explains the perceptions, practices and factors affecting the use of family planning among abortion clients attending safe abortion services in Nepal. METHODS: A cross sectional study was carried out on September, 2008 enrolling 58 women who were waiting in the dressing room for safe abortion services in Paropkar Maternity Hospital, Nepal. All women attending hospital clinic for receiving safe abortion services were approached for interview till the targeted number was fulfilled. A convenience sampling was applied to reach the sample size. RESULTS: Of the 58 respondents, majority of the respondents were Hindus (83%), residing in Kathmandu district (76%); of the age group 20-29 years (69%); and 98% were married. One fifth (20.68 %) of the respondents had previous history of spontaneous or induced abortion. The main reason for abortion did not want any more babies/ complete family (45%). The knowledge of modern contraception was high (98.27%). The knowledge of emergency contraception was low (25.9%). Side effects was the main reason (48%, n=31) for discontinuation of contraceptives. Intention to use some modern family planning methods after the abortion was expressed by 83% clients. The major enabling factor for continued contraceptive use was the absence of side effects. The family planning counselling was acceptable for 91% clients. CONCLUSION: Knowledge, acceptance of counselling service and intention to use family planning measure was high in the study participants. There is need to provide skills on adapting with the adverse effect of family planning measure through continuous education and reinforcement.

Study on determination of errors in prescription writing: A semi-electronic perspective.

BACKGROUND: Prescription writing is one of the most important and basic skills that a doctor needs. Prescribing errors may have various detrimental consequences. Hence, the components of a prescription should be clearly written, free of drug related omission (incomplete prescription), commission (incorrect information) and integration errors, without nonofficial abbreviations, and fulfil the legal requirements of a prescription. Since errors of prescribing are the commonest form of avoidable medication errors, it is the most important target for improvement. OBJECTIVES: To estimate the types and prevalence of medication errors during transcription. MATERIALS AND METHODS: A cross sectional descriptive retrospective study was conducted at Nobel Medical Teaching Hospital, Biratnagar, Nepal during a time period from 15th November 2008 to 14th February 2009. A random sample of 268 prescriptions of patients written during a period of one year (18/06/2007 to 17/06/2008) for ten different medical out patient departments of the Hospital were reviewed and the analysis was carried out for determining the different types of errors in writing a prescription. RESULTS: No error was found regarding the name, age, sex and address of the patients. The error in prescriptions regarding the prescriber's name, qualification, NMC registration number and signature were 85.4%, 99.6%, 99.6% and 15.7% respectively. Similarly, the symbol Rx was missing in 66.8%. Dosage form, quantity, dose, frequency and route of administration were not mentioned in 12%, 60%, 19%, 10% and 63% of the prescriptions respectively. Likewise, strength of the prescribed medicines was not stated in 40% of the cases. CONCLUSION: There is a need to critically address the legibility of prescription, correct spelling of drugs, authorised abbreviations and all other informations of a prescription concerned with patient, prescriber and drugs to minimise the occurrence of medication errors.

Erythrocyte glutathione status in human visceral leishmaniasis.

A glutathione redox cycle is a major antioxidant defense system for the detoxification of reactive oxygen species within erythrocytes. Reactive oxygen species such as superoxide anions, hydrogen peroxide and hydroxyl radicals are generated as a host defense mechanism for killing of engulfed Leishmania donovani, a causative agent of visceral leishmaniasis, are capable of damaging lipids and other biomolecules when produced in excess. Erythrocytes are most vulnerable to Reactive oxygen species. In present study we aimed to evaluate erythrocyte reduced glutathione (GSH) levels as an antioxidant and erythrocyte malondialdehyde (MDA) as a marker of lipid peroxidation. The study included twenty-five Visceral leishmaniasis patients and they were followed up after their complete chemotherapy with antileishmanial drugs (sodium stibogluconate) for 30 days. Forty six age and sex matched healthy individuals were taken as controls. GSH levels in erythrocytes of visceral leishmaniasis patients were increased in spite of significant increased erythrocyte MDA as compared to controls. Whereas erythrocyte GSH and MDA levels of follow up patients were decreased as compared to patients before treatment groups. We concluded that visceral leishmaniasis patients are in oxidative stress which most likely induces the endogenous antioxidant such as GSH or its poor utilization by cells.

Partitioning of naphthalene to gemini surfactant-treated alumina.

Partitioning of naphthalene to anionic surfactants adsorbed on alumina in the aqueous phase was studied for immobilization of the contaminant in the subsurface. Three anionic surfactants with different molecular structures were used: a conventional (sodium dodecylbenzene sulfonate, SDDBS), a gemini (dialkylated disulfonated diphenyl oxide with alkyl chain length of 12, DADS-C12), and a dianionic (monoalkylated disulfonated diphenyl oxide with alkyl chain length of 12, MADS-C12). Sorption of the surfactants onto alumina was studied in a series of batch experiments and the effectiveness of the adsorbed surfactants onto aluminum oxide as a sorptive phase for naphthalene was compared.

Binding of dialkylated disulfonated diphenyl oxide surfactant onto alumina in the aqueous phase

Adsorption of a gemini surfactant that has two monomers and a spacer in a molecule (dialkylated disulfonated diphenyl oxide with alkyl chain lengths of twelve, DADS-C12) onto positively-charged aluminum oxide in water was studied and compared with a single-monomer anionic surfactant (sodium dodecylbenzene sulfonate, SDDBS). More mass of the gemini surfactant was adsorbed than the conventional single-monomer SDDBS. Fewer moles of the first were bound to the substrate than the second indicating that larger molecular structure of the gemini surfactant does not hinder the sorption. Both surfactants followed similar sorption mechanisms, however, stronger hydrophobic interactions were shown in the bilayer formation of the adsorbed gemini surfactant.