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.

Strengthening clinical microbiology skill acquisition; a nationwide survey of faculty perceptions & practices on teaching & assessment of practical skills to undergraduate students.

PURPOSE: New Competency-Based Medical Education (CBME) curriculum has emphasized on the acquisition of core competencies by an Indian Medical Graduate (IMG). Likewise ability to perform basic microbiological investigations, and diagnose infectious disease is deemed critical for a doctor of first contact. In order to prepare students to achieve these competencies, effective skill training and assessment is paramount. However, microbiology skill training is known to vary across Indian medical schools. This survey has explored faculty perceptions and current practices across the country, to suggest measures for strengthening skill acquisition. METHODS: Online survey was conducted through Google form questionnaire. Faculty shared their perceptions and practices on the Likert scale about teaching, learning and assessment of microbiology skills. RESULTS: Sixty faculty members from 58 medical colleges from 17 states of India participated. Majority of the faculty considered interpretational skills as more important than technical skills. Faculty perceptions and practices varied. Although most of the skills are being taught and assessed on one or more occasions, some important clinical microbiology skills were not assessed. Feasibility was an issue for new set of CBME competencies. Blue print and skill laboratory was adopted by 10% and 31.66% colleges respectively. CONCLUSIONS: Variation in perceptions and practices in teaching and assessment of microbiology skills in Indian context is now documented. Skill training requires a standardised and robust program with ample opportunities for practice and feedback. Faculty orientation and use of innovative strategies are overriding to augment skill acquisition and thus, successful implementation of new CBME curriculum.

Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study.

OBJECTIVES: The study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal. METHODS: We conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health. RESULTS: Of 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71-282) and US$36 (19-61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector. CONCLUSION: Industrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered.

Emerging biosensor platforms for the assessment of water-borne pathogens.

Pathogens are key contaminants in water that are responsible for the generation of various water-borne diseases, and include viruses, fungi, bacteria, and protozoan parasites. The pathogenic effects of these species in water depend on their shape, size, composition, and structure. The resulting water-borne diseases are a serious threat to the environment, including to humans and animals, and are directly responsible for environmental deterioration and pollution. The potential presence of these pathogens requires sensitive, powerful, efficient, and ideally real-time monitoring methods for their reproducible quantification. Conventional methods for pathogen detection mainly rely on time-consuming enrichment steps followed by biochemical identification strategies, which require assay times ranging from 24 h to up to a week. However, in recent years, significant efforts have been made towards the development of biosensing technologies enabling rapid and close-to-real-time detection of water-borne pathogens. This review summarizes recent developments in biosensors and sensing systems based on a variety of transducer technologies for water-quality monitoring, with specific focus on rapid pathogen detection.

Latrine coverage and its utilisation in a rural village of Eastern Nepal: a community-based cross-sectional study.

BACKGROUND: A little more than 1/3rd of the rural households in Nepal have improved latrine facility. The government of Nepal is working towards making an open defecation free area all over Nepal. There is no data found in literature searches regarding the status of latrines and its utilisation in Nepal. This study aims to estimate the coverage and utilisation of latrine and its associated factors in a rural community of Nepal. METHODS: We conducted a cross sectional study in March 2015-September 2015 among 625 households in Hattimuda Village, Morang district in Eastern Nepal using semi-structured pre-tested questionnaire with observational checklists. RESULTS: Out of 623 households, 473 (76.9%) have latrine facilities. There is an increase in latrine coverage in Hattimuda by 37% (38.9% in 2011 to 75.9% in 2016). Majority of the latrines (89.9%) were functional, however 32.3% needs maintenance. The extent of latrine utilisation among those households with a toilet at home was satisfactory (94.3%). Presence of child below 5 years of age at home (OR 2.37, 95% CI 0.05-0.46), functional latrine (OR 27.37, 95% CI 6.84-109.45), frequency of cleaning (OR 3.66, 95% CI 1.09-12.29) and latrine constructed with self-initiation (OR 4.21, 95% CI 1.06-16.66) are factors significantly associated with the utilisation of the latrine. CONCLUSIONS: While the coverage needs to be increased, appropriate interventions to increase the utilisation of latrine needs to be in place so that the village moves closer to open defecation free (ODF) status. As other studies are not found from Nepal, the findings from this study can be used a reference for other rural areas of Nepal.

Assessment of hypertension control and clinical course of patients excluded from the SYMPLICITY HTN-3 trial.

The screening of patients referred for the Symplicity Renal-Denervation Catheter Therapy on Resistant Hypertension (SYMPLICITY HTN-3) trial was rigorous, with many found not eligible to participate. We investigate patients who were not included in the trial and evaluate their current hypertensive (HTN) therapy, control and clinical status. A retrospective review and telephone interview was performed 8-10 months postscreening on 45 patients and their referring providers who were ultimately not included. Patients were grouped into 4 categories: (1) noninterest; (2) excluded (not meeting inclusion criteria); (3) screen failure (excluded during screening visits due to adequate blood pressure control guided by HTN specialist); or (4) referred after enrollment closure. Primary outcomes evaluated included current anti-HTN management and clinical outcomes. This population consisted of 42% males, mean age 65 ± 5 years, 78% African American, 64% diabetic, and 21% chronic kidney disease. Primary referral basis included cardiology (44%), nephrology (30%), and primary care (26%). At time of follow-up, 20% had continued resistant HTN while most of the patients had controlled HTN (60%); with highest success rates among the screen failure group (88%) who also had the lowest average systolic blood pressure (137 ± 11 mm of Hg) when compared to other groups (P = .04). Average number of medications was lowest in the screen failure group (2.8 ± 1.6, P = .07). Resistant and/or uncontrolled HTN was most prevalent in the noninterest or excluded groups, as were hospitalization for cardiovascular and HTN urgency/emergency. This study highlights the disparity of HTN control and treatment in daily practice compared with clinical trials, and confirms a need for vigilant screening of those considered candidates for renal denervation.

Rapid assessment of trachoma in underserved population of Car-Nicobar Island, India.

PURPOSE: To determine the burden of trachoma and its related risk factors amongst the native population of Car-Nicobar Island in India. METHODS: Rapid assessment for trachoma was conducted in ten villages of Car-Nicobar Island according to standard WHO guidelines. An average of 50 children aged 1-9 years were assessed clinically for signs of active trachoma and facial cleanliness in each village. Additionally, all adults above 15 years of age in these households were examined for evidence of trachomatous trichiasis and corneal opacity. Environmental risk factors contributing to trachoma like limited access to potable water & functional latrine, presence of animal pen and garbage within the Nicobari hut were also noted in all villages. RESULTS: Out of a total of fifteen villages in Car-Nicobar Island, ten villages were selected for trachoma survey depending on evidence of socio-developmental indicators like poverty and decreased access to water, sanitation and healthcare facilities. The total population of the selected clusters was 7277 in the ten villages. Overall, 251 of 516 children (48.6%;CI: 46.5-55.1) had evidence of follicular stage of trachoma and 11 children (2.1%;CI:1.0-3.4) had evidence of inflammatory stage of trachoma. Nearly 15%(CI:12.1-18.3) children were noted to have unclean faces in the ten villages. Trachomatous trichiasis was noted in 73 adults (1.0%;CI:0.8-1.2). The environmental sanitation was not found to be satisfactory in the surveyed villages mainly due to the co-habitance of Nicobari people with domestic animals like pigs, hens, goats, dogs, cats etc in most (96.4%) of the households. CONCLUSION: Active trachoma and trachomatous trichiasis was observed in all the ten villages surveyed, wherein trachoma control measures are needed.

Assessment of energy balance of Indian farm women in relation to their nutritional profile in lean and peak agricultural seasons.

In India, the farm women are not only involved in household activities but also contribute in various farm operations, animal husbandry. The objective was to assess nutritional profile of the farmwomen and their occupational health problems, to compare the physiological workload in lean and peak seasons and to find out relationship between physiological workload and nutritional intake. The study was conducted on a sample of 90 farmwomen. Energy Intake was calculated using physiological fuel values of carbohydrate, fat and protein. Energy Expenditure Rate (EER), Total Energy Expenditure (TEE) and Energy Balance were calculated. The physiological workload was assessed using sub-maximal workload technique. The results revealed that all the respondents of all categories were, more or less, performing all the agriculture, allied and household activities. In all the agriculture activities physiological hazards such as body pain and fatigue were dominant. Dietary, nutritional and energy intake was lower for heavy workers, from all landholding and BMI categories. HR and OCR were in linear relationship in all BMI categories. Physical work capacity increased with good nutritional status and decreased with age. Regression equations were suggested for calculating oxygen consumption (y) at their known heart rate (x) during various agriculture operations.