Women's empowerment for abortion and family planning decision making among marginalized women in Nepal: a mixed method study.

BACKGROUND: Women's empowerment is multidimensional. Women's education, employment, income, reproductive healthcare decision making, household level decision making and social status are vital for women's empowerment. Nepal is committed to achieving women empowerment and gender equality, which directly affects the reproductive health issues. This can be achieved by addressing the issues of the poor and marginalized communities. In this context, we aimed to find the association of women's empowerment with abortion and family planning decision making among marginalized women in Nepal. METHODS: A cross sectional study was conducted at selected municipalities of Morang district of Nepal from February 2017 to March 2018. A mixed method approach was used, where 316 married marginalized women of reproductive age (15-49 years) and 15 key informant interviews from representative healthcare providers and local leaders were taken. From key informants, data were analysed using the thematic framework method. Findings obtained from two separate analyses were drawn together and meta inferences were made. RESULTS: Women's empowerment was above average, at 50.6%. Current use of modern contraceptives were more among below average empowerment groups (p 0.041, OR 0.593 C.I. 0.36-0.98). We could not find any statistically significant differences among levels of women's empowerment, including those women with abortion knowledge (p 0.549); family planning knowledge (p 0.495) and women's decision for future use of modern contraceptives (p 0.977). Most key informants reported that unsafe abortion was practiced. CONCLUSIONS: Women's empowerment has no direct role for family planning and abortion decision making at marginalized communities of Morang district of Nepal. However, different governmental and non-governmental organizations influence woman for seeking health care services and family planning in rural community of Nepal irrespective of empowerment status.

Reliability and Validity of a Nepalese Version of the Oral Health Impact Profile for Edentulous Subjects.

PURPOSE: To assess the reliability and to validate the translated Nepalese version of the Oral Health Impact Profile (OHIP-EDENT-N) in Nepalese edentulous subjects. MATERIALS AND METHODS: The international guidelines for translation and cross-cultural adaption of OHIP-EDENT were followed, and a Nepalese version of the questionnaire was adapted for this study. Eighty-eight completely edentulous subjects were then selected for the study and completed their responses for the questionnaire. The reliability of the OHIP-EDENT-N was evaluated using internal consistency. Validity was assessed as construct and convergent validity. Construct validity was determined using exploratory factor analysis (EFA). The correlation between OHIP-EDENT-N subscale scores and the global question was investigated to test the convergent validity. RESULTS: Cronbach's alpha for the total score of OHIP-EDENT-N was 0.78. Construct validity was assessed by factor analysis: 70.196% of the variance was accountable to five factors extracted from the factor analysis. Factor loadings above 0.40 were noted for all items. In terms of convergent validity, significant correlations could be established between OHIP-EDENT-N and global questions. CONCLUSIONS: This study has been able to establish the reliability and validity of the OHIP-EDENT-N, and OHIP-EDENT-N can be a considered a reliable tool to assess the oral health related quality of life in the Nepalese edentulous population.

Effect of gender preference on fertility: cross-sectional study among women of Tharu community from rural area of eastern region of Nepal.

BACKGROUND: Son preference is predominant in developing countries especially South Asian countries and its effect is most visible when the fertility is on transition. Nepal is a country in South Asia where the fertility has declined and son is valued highly. This study examines the parent's gender preference for children and its effect on fertility and reproductive behaviors. METHODS: Study was conducted in Sonapur village development committee of Sunsari district among women of Tharu community of reproductive age (15-49) currently in union and having at least one child. Data was collected by house to house survey. Data was analyzed with IBM SPSS 20 version. Multinomial and binary logistic regression were used to analyze the relationship among variables. RESULTS: Three hundred women of reproductive age were included in the study. Current average age of the respondents was 31.97 years and mean age at marriage was 18.87 (SD +/-2.615). Child Sex ratio (male: female) of the respondents who didn't want any more children was 1.41. The birth spacing following male baby was 3.09 years whereas the average birth spacing following female baby was 2.71 years. Age of the respondents and education status of the respondents were also significantly associated with contraceptive practice. Presence of only female children in family significantly increased the desire of other children (AOR = 10.153, 95% CI = 2.357-43.732). CONCLUSION: This study finds that the gender preference affects the fertility and reproductive behavior of the respondents and it is necessary to reduce son preference for the health and well being of children and women.

Prehypertension and its predictors among older adolescents: A cross-sectional study from eastern Nepal.

Prehypertension is a state of transition between normal blood pressure and hypertension. Adolescent prehypertension is a strong predictor of hypertension in adults and is now considered for cardiovascular intervention or risk reduction. This study was conducted among adolescents to assess the burden of pre-hypertension and its predictors. A cross-sectional study was conducted among grade 11 and 12 students in three districts in eastern Nepal namely Jhapa, Morang and Sunsari. Sampling was done using a multistage stratified proportionate random method. A semi-structured questionnaire adapted from the WHO STEPwise approach to the non-communicable disease risk factor surveillance (STEPS) instrument was used as a study tool after modification and pre-testing in addition to the anthropometric and blood pressure measurements by the investigators. The prevalence of prehypertension was assessed along with the identification of its predictors through multivariable binary logistic regression modelling. A total of 806 participants aged 15 to 19 years, with 57.1% female, participated in the study. Prehypertension was found in 20.8% (24.6% in males and 18.0% in females) of the participants, while 7.1% of them were hypertensive (9.2% males and 5.4% females). Obesity and central obesity were seen among 6.3% and 17.7% of the respondents respectively. Age, sex, ethnicity and obesity were found to be significantly associated with prehypertension. A significant proportion of prehypertension was seen among the adolescent population along with a notable presence of risk factors such as smoking, alcohol consumption, obesity, and eating out. This warrants careful consideration and identification of relevant strategies to reduce the burden of prehypertension via school-based interventions to reduce the modifiable risk factors.

Catastrophic health expenditure on chronic non-communicable diseases among elder population: A cross-sectional study from a sub-metropolitan city of Eastern Nepal.

INTRODUCTION: This study was conducted with the objective to analyze the out-of-pocket (OOP) healthcare expenditure and catastrophic healthcare expenditure (CHE) on chronic non-communicable diseases (CNCD) among the elderly population, and the association of CHE on CNCD with associated factors among the same population. MATERIALS AND METHODS: We collected data from the elderly population of Dharan Sub-metropolitan city of the Eastern Nepal via door-to-door survey and face-to-face interview. The ten wards out of twenty were chosen by lottery method, and the equal proportion out of 280 samples was purposively chosen from each of ten wards (28 participants from each selected ward). The data were entered in Microsoft Excel 2019 v16.0 and statistical analysis was performed by using statistical package for social sciences, IBM SPSS® v21. The chi-square test was used to test the group differences. Multivariable logistic regression was used to determine independent factors associated with CHE (all variables with P < 0.20), and adjusted odds ratios (AOR) were calculated at 95% confidence interval (CI). RESULTS: The median household, food and health expenditures were 95325 (72112.50-126262.50), 45000 (33000-60000) and 2100 (885.00-6107.50) NPR respectively. The proportion of the participants with CHE was 14.6%. The single living participants had 3.4 times higher odds of catastrophic health expenditure (AOR = 3.4, 95% CI = 1.2-9.6, P-value = 0.022) than those who are married. Similarly, those who had cancer had 0.1 times lower odds of CHE (AOR = 0.1, 95% CI = 0.0-0.2, P-value = <0.001) than those without cancer. CONCLUSION: The elder population had significant financial health shocks due to chronic health ailments. There should be the provision of mandatory health insurance programmes for elderly to cut down the catastrophic healthcare expenditure. Similarly, there should be the provision of exemption scheme for vulnerable elderly who are more likely to face catastrophic expenditure from all available health facilities.

Prevalence and determinants of non-communicable disease risk factors among adult population of Kathmandu.

BACKGROUND: According to WHO, the deaths due to NCDs in Nepal have soared from 60% of all deaths in 2014 to 66% in 2018. The study assessed the prevalence and determinants of non-communicable disease risk factors among adult population of Kathmandu. MATERIALS AND METHODS: A community based cross-sectional study was conducted from September 2019 to February 2020 among 18-69 years adults residing in municipalities of Kathmandu district. Multi-stage random sampling technique was used to select 245 subjects who were interviewed using WHO NCD STEPS instrument. Chi-square test and logistic regression analysis were done to explore the determinants of NCD risk factors. RESULTS: The prevalence of current smoking, alcohol consumption, low intake of fruits and vegetables and low physical activity was found to be 22%, 31%, 93.9% and 10.2% respectively. More than half (52.2%) of the participants were overweight or obese and the prevalence of raised blood pressure was 27.8%. Smoking was associated significantly with male gender (AOR = 2.37, CI: 1.20-5.13) and respondents with no formal schooling (AOR: 4.33, CI: 1.50-12.48). Similarly, the odds of alcohol consumption were higher among male gender (AOR: 2.78, CI: 1.47-5.26), people who were employed (AOR: 2.30, CI: 1.13-4.82), and those who belonged to Chhetri (AOR: 2.83, CI: 1.19-6.72), Janajati (AOR: 6.18, CI: 2.74-13.90), Dalit and Madhesi, (AOR: 7.51, CI: 2.13-26.35) ethnic groups. Furthermore, respondents who were aged 30-44 years (AOR: 5.15, CI: 1.91-13.85) and 45-59 years (AOR: 4.54 CI: 1.63-12.66), who were in marital union (AOR: 3.39, CI: 1.25-9.13), and who belonged to Janajati (AOR: 3.37, CI: 1.61-7.04), Dalit and Madhesi (AOR: 4.62, CI: 1.26-16.86) ethnic groups were more likely to be associated with overweight or obesity. Additionally, the odds of raised blood pressure were higher among people who were of older age (AOR: 6.91, CI: 1.67-28.63) and those who belonged to Janajati ethnic group (AOR: 3.60, CI: 1.46-8.87) after multivariate analysis. CONCLUSION: The findings of the study highlighted high prevalence of behavioral and metabolic risk factors, which varied on different socio-demographic grounds. Thus, population specific health promotion interventions centered on public health interests is recommended to reduce risk factors of NCDs.

Prevalence of Intimate Partner Violence and Associated Factors Among Married Nepalese Men in Kathmandu Metropolitan City.

BACKGROUND: Intimate Partner Violence is defined as the intentional use of physical force, or power, threatened or actual against on self/others or groups that results in injury, death, psychological harm. METHODS: A community-based cross-sectional study was conducted in Kathmandu Metropolitan city in 2018. An adequate sample of 210 married men was selected from randomly selected 10 wards of Kathmandu Municipality. A semi-structured questionnaire including standard scales was used for data collection. Multivariate analysis was performed to find out the association of Intimate Partner Violence with different variables. RESULTS: The mean age of male respondents was 40.19 years. More than half of the respondents were Janajatis. Overwhelming respondents were Hindu (religion). Intimate Partner Violence was estimated in forms of Physical violence, 31.9%, Sexual violence, 4.3%, and Psychological violence, 50.5%. Age, age at marriage, marriage type, marriage decision, spousal age gap, family income, education, smoking habit and depression were independently associated with violence. However, family income and education were found to be significant factors associated with violence even after adjusting the effects of other potential factors. CONCLUSIONS: Strong association of Intimate Partner Violence with family income, and education of male respondents was observed. More than half of the males had psychological violence and nearly one-third of the participants had Physical violence. The study concludes that Intimate Partner Violence among males could not be neglected.

Assessment of Gingival Biotypes in Patients Visiting a Tertiary Care Centre in Eastern Nepal.

BACKGROUND: Evaluation of gingival biotype has become a routine procedure in periodontal examination because the type of gingival biotype can positively or negatively affect the outcome of periodontal, restorative, orthodontic and implant therapy. The aim of the study was to assess the proportion of types of gingival biotypes in patients visiting a tertiary care center in eastern Nepal. METHODS: Two hundred and fifty patients between 25 to 45 years attending the Periodontology and Oral Implantology were assessed. Gingival biotype of the patents was determined with Probe Transparency technique Results: Out 250 patients assessed, 73 patients (approximately 29.2 %) had thin gingival biotype and remaining 177 patients (approximately 70.8 %) had thick gingival biotype. The number of the male with thin biotype was 31 whereas the number of the male with thick biotype was 82. Similarly, out of 137 female, 42 had thin biotype and remaining 95 female had thick biotype. The types of biotypes were not associated with gender (p=0.67). CONCLUSIONS: Thicker gingival biotype was the more common type of gingival biotype in patients attending the tertiary care center of Eastern Nepal. The occurrence of thick gingival biotype was more common in Adivasi Janajati ethnic community compared to Brahmin / Chhetri ethnic community.

Perceived risk and associated factors of healthcare waste in selected hospitals of Kathmandu, Nepal.

BACKGROUND: Healthcare waste management is the subject of a neglected issue in many developing countries. Health care facilities are facing a major challenge in handling healthcare wastes and reducing their potential risks to human health and the environment. Insufficient understanding of the risk associated with healthcare waste by health workforce can contribute to poor waste management practices. The main aim of this study is to assess risk perception towards healthcare waste among hospital attendants and to identify associated factors. METHODOLOGY: We carried out a cross-sectional hospital-based study among 120 attendants of a private and public hospital in Kathmandu, Nepal. We used two-stage random sampling for the selection of hospital and participants. We conducted a face-to-face interview with the participants using semi-structured questionnaires. Based on the mean score, we classified risk perception as good and poor. Bivariate and multivariate analysis was carried out to determine associates of risk perception towards healthcare waste. RESULTS: Approximately 51.0% of hospital attendants had poor risk perception of healthcare waste. Nearly half of the participants (49.2%) had inadequate knowledge and 43.0% had a negative attitude. Factors such as healthcare waste management training (p = 0.028), housekeeping department (p = 0.036) and attitude (p = 0.001) were associated with risk perception of healthcare waste. CONCLUSION: Hospital attendants had a poor understanding of risk perception of healthcare waste. Periodic training on healthcare waste management and edification on the risk associated with healthcare waste is essential to boost awareness among all healthcare workers. Communication on behavioral improvements for appropriate waste management must be prioritized to change the perception of health workers.

Risk perception towards healthcare waste among community people in Kathmandu, Nepal.

BACKGROUND: Healthcare waste management is a serious issue in context of developing countries. Better assessment of both risks and effects of exposure would permit improvements in the management of healthcare waste. However, there is not yet clear understanding of risks, and as consequences, inadequate management practices are often implemented. OBJECTIVES: This study primarily aims to assess risk perception towards healthcare waste and secondly to assess knowledge, attitude and identify the factors associated with risk perception. RESULTS: A cross-sectional community based study was carried out among 270 respondents selected through multistage sampling technique. Face-to-face interview was conducted using semi-structured questionnaires. Risk perception was classified as good and poor based on mean score. Bivariate and multivariate analyses were carried out to determine the associates of risk perception. More than half, 52% of the sampled population had a poor risk perception towards healthcare waste. More than a quarter 26.3% had inadequate knowledge and forty percent (40%) had a negative attitude towards health care waste management. Having knowledge (OR = 3.31; CI = 1.67-6.58) was a strong predictor of risk perception towards healthcare waste. The perception of risk towards healthcare waste among community people was poor. This highlights the need for extensive awareness programs. Promoting knowledge on healthcare waste is a way to change the perception in Nepal. Community engaged research approach is needed to address environmental health concerns among public residents.

Occlusal Characteristics of Primary Dentition among School Going Children.

BACKGROUND: Certain characteristics of the primary dentition have been described that may be required in the smooth transition from primary to permanent dentition and therefore development of ideal occlusion in permanent dentition. The objectives of this study were to assess different occlusal characteristics of primary dentition among school going children of Dharan, Nepal and to compare these occlusal characteristics based on gender and race. METHODS: A community based cross-sectional study was conducted among 625 school children of Mongolian and Caucasian race, aged 3 to 7 years, and having complete set of primary dentition. A close-ended questionnaire was developed to gather demographic information followed by the examination of occlusal and soft tissue parameters. RESULTS: The result showed 77.2% of the children had developmental spaces and 83.1% had primate spaces. Flush terminal plane molar and class I canine relationships were present in 68.8% and 81.6%, respectively with normal overjet (53.5%), normal overbite (41.1%), straight facial profile (86.7%) and competent lips (98.6%). Crowding was present in 35.4%, midline discrepancy in 11.3%, crossbite in 7.2%, scissor bite in 0.6% and open bite in 2.1% of the children examined. CONCLUSIONS: Most of the occlusal characteristics were desirable but with the existence of some malocclusion traits, necessitating timely recognition and correction through early screening. Gender and racial influences were also observed and it emphasizes the need for treatment plan based on them.

Prevalence of Agenesis of Mandibular Third Molars in A Tertiary Healthcare Centre of Nepal.

INTRODUCTION: Racial variation, genetic inheritance and various other factors can affect the jaw size and ultimately the tooth size and number. Studies for agenesis of mandibular third molars have been carried out in various populations but the data relating to these are not evident from most of the parts of Nepal. Hence, the objective of the present study is to determine the prevalence of agenesis of mandibular third molars among the population of patients visiting the Department of Oral Medicine and Radiology of B. P. Koirala Institute of Health Sciences. METHODS: This descriptive cross-sectional study was conducted at Department of Oral Medicine And Radiology, College of Dental Surgery, B. P. Koirala Institute of Health Sciences from September 2015 to September 2016 after taking ethical approval from Institutional Review Committee. Two hundred and eighty four patients (568 sites of third molar bilaterally), visiting the Department of Oral Medicine and Radiology were studied with Panoramic Radiograph to assess for agenesis of mandibular third molars bilaterally. Data was entered in Microsoft Excel sheet and transferred to Statistical Package for the Social Sciences version 11.5. RESULTS: Out of 284 participants, 568 sites of mandibular third molars were evaluated and agenesis was seen among 163 (28.7%) participants at the confidence interval of 95% (28.643 to 28.757). Total numbers of patient with single missing mandibular third molar were 35 (6.2%). Twenty one had agenesis only on the right side and 14 had agenesis only on the left. The total number of patients with agenesis of both the mandibular third molars was 64 (22.5%). CONCLUSIONS: Agenesis was highly prevalent in this study group. The likelihood of third molar being absent on one side, when there was concurrent missing third molar on the other side of mandible was also high.

Knowledge and perception about dental implants among undergraduate dental students.

INTRODUCTION: Awareness about dental implants is increasing among dental patients, which demands a higher level of competence for dental students. So, the objective of this study was to assess the knowledge and perception of undergraduate dental students about dental implants. MATERIALS AND METHODS: This cross-sectional questionnaire-based survey was conducted after taking ethical clearance and approval from the Institutional Review Committee of B.P. Koirala Institute of Health Sciences and informed consent from each dental college of Nepal. The sample included all those students who were present at the time of survey. Data collection were carried out during the academic schedules of the colleges, supervised, and monitored by the investigators themselves. Collected data were coded, entered in Microsoft excel 2013 and descriptive analysis was carried out. RESULTS: A majority of the total (54.6%) and 59.2% of 5th year respondents perceived to be moderately well-informed about dental implants. The main advantage of dental implants was thought to be longevity by 53.1% of total and 48.4% of 5th year students; only 27.6% of the total and 42.2% of 5th year students said the main advantage of dental implants is they are more conservative than other tooth-replacement modalities. Highest percentage of the total respondents (31.9%) said most important factor for implant success to be implant type and material, whereas 59.8% of 5th year students said case selection. Those who felt dental implants require additional oral hygiene maintenance and care by the patient and dentist were 58.4% of total and 75.1% of 5th year students. Over two-thirds (67.5%) of total thought that economic feasibility will limit use of dental implants in Nepal. The difficulty encountered to place implants was perceived to be average by 56.8% of total and 58.1% of 5th year. There were differences in the perception and knowledge at different academic levels, but not as expected. CONCLUSIONS: It could not be concluded that knowledge about dental implants increased with increase in academic level. Even at the late-clinical year a majority of students gave unsatisfactory responses.

Work Related Injury among Welders Working in Metal Workshops of Dharan Municipality, Nepal.

BACKGROUND: Injuries are a problem worldwide in all occupations. Welders are exposed to many hazards at work resulting in a variety of health problems including injuries at work. This study was conducted to find out the prevalence and factors associated with injuries among welders in Dharan city of eastern Nepal. METHODS: A cross sectional study was conducted among 86 welders in Dharan city. Occurrence of injury in past 2 weeks and past 12 months were recorded. Data regarding sociodemographic along with occupational characteristics was collected using semi structured questionnaire. Data analysis was done using SPSS version 17. RESULTS: All the welders in this study were male with almost half of the welders under the age of 25 years and about a fifth (21.1%) of the welders having received some form of welding training. In the past 12 months, 21.1% of the welders suffered from work related injuries. More than 95% welders used at least one personal protective equipment in this study. More injuries were seen among welders with age ?35 years, working experience ? 5 years, not received training and not using of PPE at work. However, these factors were not found to be statistically significant. CONCLUSIONS: Work related injuries are high among welders of Dharan. Further research is required to explore the relationship between age, literacy, training and use of personal protective equipment with the occurrence of injuries among the welders.

Preferred Source and Perceived Need of More Information about Dental Implants by the Undergraduate Dental Students of Nepal: All Nepal Survey.

OBJECTIVES: This study was conducted to know the preferred source and perceived need of more information about dental implants by the undergraduate students of Nepal and their association with academic levels and gender. MATERIALS AND METHODS: It was conducted in all the dental colleges of Nepal from June 2016 to June 2017 after taking ethical clearance and approval from the research committee of BPKIHS. It included all those who were present at the time of survey. Data collection was done through a cross-sectional questionnaire survey during the academic schedule of the colleges, supervised and monitored by the investigators themselves. The collected data were coded and entered in Microsoft excel 2013, and statistical analysis was done by SPSS 20 version. RESULT: A majority of the respondents agreed that they were not provided with sufficient information about implant treatment procedures during their BDS program (65.3%), would like more to be provided in the curriculum (95.1%), and would like to get additional reliable information from dental consultants and specialists (40.7%) and training on it from fellowship programs conducted by universities (39.2%). Significant association was seen between the responses and academic levels. CONCLUSION: Undergraduate dental students of Nepal want more information about dental implants through various means.

Utility of Ischemia Modified Albumin as an Early Marker for Diagnosis of Acute Coronary Syndrome.

BACKGROUND: The diagnosis of acute coronary syndrome remains challenging, as cardiac troponins and creatine kinase-MB do not detect myocardial ischemia. Ischemia modified albumin is biomarker positive within 6-10 minutes following ischemic onset, where oxygen free radicals leads to reduction in binding capacity of human serum albumin to transitional metal-cobalt. The objective of this study was to compare ischemia modified albumin between acute coronary syndrome patients and healthy controls, and evaluate diagnostic performance of ischemia modified albumin compared to cardiac troponins, creatine kinase-MB and electrocardiogram in acute coronary syndrome patients. METHODS: Fifty ACS patients and 50 healthy controls were enrolled in this cross-sectional study. Ischemia modified albumin was measured after addition of known amount of cobalt to human serum albumin, followed by spectrophotometric determination of unbound cobalt fraction at 470 nm using dithiothreitol as coloring agent. Independent student t-test and One-way ANOVA to compare differences of mean between groups; diagnostic sensitivity and specificity of ischemia modified albumin was determined by receiver operating characteristic curve; McNemar-test was used to assess diagnostic performance of entire test parameters, when used alone and in combinations. RESULTS: Ischemia modified albumin was significantly higher in acute coronary syndrome patients compared to controls (0.823±0.191 vs 0.410±0.081)(p<0.001). Receiver operating characteristic curve derived optimal cut-off of 0.475 Absorbance unit had sensitivity and specificity of 92% and 82% respectively (area under curve- 0.96). However, no significant differences in mean ischemia modified albumin values between three categories of acute coronary syndrome were seen. Sensitivity of ischemia modified albumin assay (92%) was significantly higher compared to electrocardiogram (72%), cardiac troponin I (18%), and creatine kinase-MB(42%). CONCLUSIONS: Ischemia modified albumin is elevated in acute coronary syndrome patients with better diagnostic performance compared to electrocardiogram, cardiac troponin I, and creatine kinase-MB for early diagnosis, however, with limited ability to discriminate between ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina.

Morbidity patterns among the welders of eastern Nepal: a cross-sectional study.

BACKGROUND: Welding process has many hazards that the welders are exposed to resulting in numbers of health effects and diseases. Safety measures and practices among welders are important ways of preventing or reducing the health hazards associated with this occupation. We conducted this study to find out the morbidity patterns among the welders working in eastern Nepal. METHODS: A cross sectional study was conducted among 300 welders using semi structured questionnaire. Morbidity categories were classified based on symptoms experienced in past 6 months. RESULTS: All the welders learned welding by apprenticeship, without any formal health and safety training. Injury was the most common problem at work followed by skin problems and eye symptoms. Age of the welders, duration of employment & welding hours per day were associated with the morbidities among the welders. CONCLUSIONS: There is a need for occupational health services for welders in Nepal. While further research may be required to make policy recommendations, the current study provides a baseline morbidity burden among these welders to look for interventions to promote health and safety at work for this neglected group of workers in Nepal.

Tobacco use among women in Dharan, eastern Nepal.

The study was undertaken to assess the prevalence and patterns of tobacco use and also assess the factors affecting tobacco use among the female population of Dharan. A cross-sectional survey of a representative sample of 2,340 female participants aged 15 years and above was conducted in Dharan municipality in 2001. Cluster sampling with probability proportionate to size technique was used. Of the 2,340 subjects, 12.9% were cigarette smokers and 14.1% were smokeless tobacco users. The smoking habit had a significant relationship with the habit of tobacco chewing. About 50% of the smokers had been continuously smoking for more than 20 years. Smokers aged 50 years and above were more likely to smoke more than 10 cigarettes per day than those at the reproductive age (15-49 years). Health problems among females did not have any significant relationship with tobacco-chewing, but smokers were nearly twice as likely to suffer from any health problem than non-smokers. Gastrointestinal problems were the most common complaint among the tobacco users. An effective awareness programme is required to discourage the use of tobacco and encourage women to take regular health check-ups.

Acute appendicitis: a quality assurance study.

The parameters that indicate the quality of patient care in acute appendicits (AA) were evaluated. One hundred sixty-four patients, who underwent emergency appendectomy (EA) at the B.P. Koirala Institute of Health Sciences, Dharan, Nepal were studied prospectively. The mean duration of the symptoms was 42.2 +/- 69.5 hours (range 2-720 hours, median 24 hours). The mean waiting period in the hospital was as 12.7 +/- 21.8 hours (range 1-188 hours, median 7 hours). Special investigations' such ultrasonography, computed tomography or laparoscopy, were not used for diagnosis. The perforation rate was 39%. The histopathology report of 79% of the patients was available. Diagnostic accuracy in histologically evaluated patients was 91.5%. One patient (0.6%) died. The mean hospital stay was 3.2 +/- 2.0 days (range 1-17 days). Patients who had to wait in hospital for < 24 hours before surgery had a longer duration of symptoms, underwent exploratory laparotomy through a mid-line incision more frequently, had a higher incidence of perforated/gangrenous appendix and longer hospital stay. The mean medical expenditure for patients treated in the general ward was Nepali Rupees (NR) 2485 +/- 504 (range NR 1372-4500). The majority of patients/guardians (88%-97%) were satisfied with the medical expenditure incurred, promptness of service, behaviour of the hospital staff and the facilities available in the hospital. The diagnostic accuracy and cost of treatment were favourable. The longer duration of symptoms, non-utilization of special investigations for diagnosis, high perforation rate and less than cent-per cent biopsy rate are the aspects that require attention to improve the quality of surgical care.

The relationship of dental extrinsic stains with the concentration of trace elements in water sources in a district of Nepal.

PURPOSE: To assess the relationship of dental extrinsic stains (DES) with levels of trace elements in drinking water sources. MATERIALS AND METHODS: A cross-sectional study among the population of Madesha VDC. A sample of 551 residents aged between 4 years and above was examined. A questionnaire was prepared to assess the dietary habits, oral hygiene practices, age, period of residency (POR), followed by clinical examination regarding the presence or absence of DES. Water samples were collected and sent for analysis by AAS method for trace elements. RESULTS: The prevalence of DES was 39%. Twenty-eight water samples had Fe levels that exceeded permissible levels and all samples were negative for other trace elements. Stains were associated with POR and levels of Fe in water (P value < 0.001). There was a positive correlation by ward of Fe levels and stain distribution. CONCLUSION: The results revealed an association between DES with age, POR, and Fe levels in water. The positive correlation between stain distribution by ward and levels of Fe in water indicated the causative role of Fe in stains.