Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization.

This study aims to evaluate factors associated with health care utilization (HCU) and to assess vertical and horizontal equity in utilization among Nepali older adults. Data are from an existing cross-sectional study involving systematic random sampling of 260 older adults in Far-Western (Sudurpaschim) Province of Nepal. Andersen's theoretical framework was used to assess predisposing, enabling, and need factors that have the potential to influence health care utilization. Multivariable logistic regression analyses were conducted to examine potential correlates of HCU. Horizontal and vertical equity were assessed using concentration curve and index. More than one-third of participants had not visited a health facility in the prior 12 months. Nine in 10 participants did not know about the government's free health service for older adults. Joint/extended family type, Ayurvedic/Homeopathic health care preference, higher-income tertile, and presence of chronic conditions were associated with higher odds of health care utilization in adjusted analyses. The concentration curve for HCU lies below the line of equity, and the subsequent index is positive, indicating that HCU was concentrated among richer individuals. If the government of Nepal is to achieve its goal of universal health care, the existing pro-rich inequity in HCU needs to be addressed.

The frontier of modern Western medicine in Nepal.

Using the concepts frontier and interface the introduction and spreading of modern Western medicine in Nepal and its relations to other medical systems are described and analyzed. Medical systems do not prevail in the same degree in all places; we may call the geographic areas of concentration the core areas or center(s) of medical systems and the remaining areas their periphery. The frontier of a medical system is defined as that part of the periphery where the presence of the system is increasing. The place of the frontier, its width and the forms in which a medical system appears at its frontier are determined by both internal dynamics and contextual factors. In non-socialist countries like Nepal the dynamics of modern Western medicine are characterized by three tendencies: centralization, expansiveness and a commercial and capitalist character. Some important contextual factors which have been shaping the frontier in Nepal are: migration, including tourism, labor-migration and trade; the role of foreign aid and geographical conditions. The situation at the frontier has an important influence on the nature of the interface between modern Western medicine and other medical systems. In the article Faith-healing, Ayurvedic medicine, Homeopathy and Tibetan medicine are described briefly and the interface between them and modern Western medicine is looked into.

Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal.

OBJECTIVE: To investigate whether the finding in a previous study that homeopathic medicines decrease the duration of acute diarrhea in children could be replicated in a different study population. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Private, charitable health clinic in Kathmandu, Nepal. SUBJECTS: A consecutive sample of 126 children, 6 months to 5 years of age, who presented during April through June, 1994, with more than three unformed stools in the previous 24 hours. INTERVENTION: Children received either an individualized homeopathic medicine or placebo, to be taken one dose after each unformed stool for 5 days. Parents recorded daily stools on diary cards, and health workers made home visits daily to monitor children. OUTCOME MEASURES: Predefined measures were based on the previous study: (1) duration of diarrhea, defined as the time until there were fewer than three unformed stools per day, for two consecutive days, and (2) Average number of stools per day for each group. RESULTS: Of the 126 children initially enrolled, 116 completed treatment. The mean number of stools per day over the entire 5-day treatment period was 3.2 for the treatment group and 4.5 for the placebo group (P = 0.023). A Kaplan-Meier survival analysis of the duration of diarrhea, which included data from all patient visits, showed an 18.4% greater probability that a child would be free of diarrhea by day 5 under homeopathic treatment (P = 0.036). CONCLUSIONS: These results are consistent with the finding from the previous study that individualized homeopathic treatment decreases the duration of diarrhea and number of stools in children with acute childhood diarrhea.

Quality and effectiveness of service provision of traditional medicine based health service centres in Kathmandu, Nepal.

BACKGROUND: Health services based on traditional systems of medicine has been expanding, flourishing and getting popularity, however, quality and effectiveness of service provision, has always been questioned probably due to the lack of research activities, poor or nil implementation of national policies and regularity systems and poor or nil monitoring and evaluation by any state agencies. Objective of this study was to explore the present situation of privately run traditional medicine based health service providing centres in the Kathmandu valley and service users' perception. METHODS: Data were gathered through interview, observation, and review of relevant documents. Registered health service centres were selected (5 each from Ayurveda, Naturopathy, Homeopathy, Acupuncture and Amchi system of medicine) by simple random method and 132 patients (5-7 from each centre) were selected using convenient sampling. RESULTS: Three of the five systems of traditional medicine (Homeopathy, Amchi and Acupuncture) considered for this study were providing services through clinic level (only OPD services) facilities, while Ayurveda and Naturopathy had hospital (in patient services) level services with number of beds ranging from 10 -25. Nearly all of the centres were found following almost all of the guidelines as stipulated by the Ministry of Health and Population. Nearly, two third of the patients visited these centres as there was no improvement in their condition at the modern medicine hospitals. More than two third of the patients interviewed perceived the quality of services being satisfactory, while three in ten patients perceived it as very much satisfactory. CONCLUSIONS: Perception of patients visiting the traditional medicine based centres and the hunger towards more effective service provision by the providers seems to be taking these systems of medicine towards the path of further development. Well recognition and further motivation by the state will help capacitate and strengthen these systems of medicine and garner their proper development in the Nepalese context.

Availability and acceptability of medical abortion in Nepal: health care providers' perspectives.

Abortion was legalised in Nepal in September 2002 and manual vacuum aspiration is the main procedure used for safe abortion. Although medical abortion has not yet officially been introduced in Nepal, with the highly porous Indo-Nepal border and the easy availability of mifepristone and misoprostrol in Indian chemists' shops, it is possible the drugs are entering from Indian markets illegally. This study aimed to gauge current awareness of the availability of medical abortion drugs in Nepal and explore what health professionals and paramedics felt about the use of medical abortion to expand access to safe abortion in the country. Data were drawn from interviews with private obstetrician-gynaecologists, general physicians, paramedics, ayurvedic and homeopathic practitioners and chemists in 24 urban municipalities and peri-urban areas in Nepal. Various types of allopathic and indigenous forms of medicine for menstrual regulation in the Nepalese market were widely known whereas knowledge of the availability of mifepristone and misoprostrol was low. Almost all respondents had a positive view of the potential for providing mifepristone and misoprostol in Nepal and most thought that obstetrician-gynaecologists, general physicians and other certified abortion care providers should be able to provide the drugs. Many respondents were interested in doing so themselves. Registration of mifepristone and misoprostrol is the key to introducing medical abortion in Nepal and should happen as soon as possible.

Suxamethonium myalgia: an ethnic comparison with and without pancuronium pretreatment.

The incidence of myalgia after suxamethonium was determined in 200 fit military male dental patients of European, Chinese and Nepalese descent. Half received pancuronium 1 mg and the other half received saline pretreatment on a randomised double-blind basis. The percentage incidence of postsuxamethonium myalgia after saline or pancuronium was found to be: Europeans 26%, 13%; Chinese 13%, 7%; Nepalese 20%, 14%. Although pancuronium reduced the incidence of myalgia by about 50% overall, these values were not significantly different from each other. The recovery of spontaneous ventilation following suxamethonium was quicker in the Europeans than in the Asians (p < 0.05). Pancuronium pretreatment also delayed the recovery of spontaneous ventilation and recovery from neuromuscular block (p < 0.05) but this was independent of ethnicity. The Europeans recovered from anaesthesia more quickly than the Asians. It was concluded that ethnicity affected recovery from suxamethonium and from anaesthesia but was not of clinical relevance to the incidence of myalgia in male Asians and Europeans.