User satisfaction with the National Health Insurance Program: A community-based survey from the Ilam district of Nepal.

BACKGROUND: The Government of Nepal initiated a family-based National Health Insurance Program (NHIP) in April 2016, aiming to ensure universal health coverage (UHC) by enhancing access to and utilization of quality health services. However, NHIP, in its initial years of implementation, encountered challenges such as low population coverage, a high dropout rate, and concerns among the insured regarding the quality of healthcare services. There is a dearth of information regarding user satisfaction with the NHIP in Nepal. This study aimed to assess user satisfaction with NHIP at the household level in Nepal. METHODS: We conducted a cross-sectional study among 347 households in the Ilam district using a multi-stage random sampling method. Face-to-face interviews were conducted with household heads enrolled in NHIP. A semi-structured questionnaire was used to collect the data. The multivariable logistic regression analysis was done to identify the predictors of satisfaction level. RESULTS: Overall, 53.6% of the insured were satisfied with the NHIP, while 31.1% had comprehensive knowledge about the NHIP. Factors such as gender (AOR: 1.80, 95% CI: 1.08-3.00), distance to the first point of contact (AOR: 2.15, 95% CI: 1.24-3.74), waiting time (AOR: 2.02, 95% CI: 1.20-3.42), availability of diagnostic services (AOR: 1.90, 95% CI: 1.05-3.45), availability of prescribed medicine (AOR: 3.90, 95% CI: 1.97-7.69), perceived service quality (AOR: 2.20, 95% CI: 1.15-4.20), and the behavior of service providers (AOR: 3.48, 95% CI: 1.04-11.63) were significantly associated with user satisfaction. CONCLUSION: The satisfaction level among NHIP users was deemed moderate. This study highlighted several factors, such as gender, distance to the first point of contact, waiting time, availability of diagnostic services and prescribed medicine, perceived service quality, and the behavior of service providers, as key determinants impacting user satisfaction. Recognizing the pivotal role of user satisfaction, health insurance stakeholders must prioritize it to ensure higher retention rates and coverage within NHIP.

Predictors to Intensive Care Unit admission among patient with coronavirus disease in Sukraraj Tropical and Infectious Disease Hospital, Nepal: A case-control study.

The clinical features of COVID-19 are vary widely, ranging from asymptomatic states or mild upper respiratory tract infections to severe pneumonia. Previous studies have shown that 20.0% of COVID-19 patients are hospitalized, out of which 10.0-20.0% are admitted to the Intensive Care Unit. The present study aims to assess predictors associated with COVID-19 leading to Intensive Care Unit admission among reverse transcriptase- polymerase chain reaction (RT-PCR) positive patients in Sukraraj Tropical and infectious disease hospital, Nepal. A case-control study was conducted from June 2022 to July 2022 among patients admitted to Sukraraj Tropical and Infectious Disease Hospital. A hospital-based age (± 2 years) and sex-matched case-control study design were adopted in which ICU admitted (case group, n = 33) and general ward admitted (control group, n = 66) were included. Data were collected using a structured questionnaire comprising of socio-demographic, clinical, and preventive predictors. Data were analyzed using the Statistical Package for Social Science version 11.5. The Chi-square test and conditional logistic regression to determine the predictors associated with ICU admission. High blood pressure, high C-reactive protein and poor application of preventive practices were found to be the predictors of ICU admission. Conditional logistics regression analyses revealed that independent risk factors associated with ICU admission were elevated blood pressure (AOR = 2.22; 95% CI 1.05-4.71, p = 0.015) and abnormal C-Reactive Protein (AOR = 2.92; 95% CI 1.24-6.84, p = 0.012) at the time of hospital admission were more likely to get admitted to ICU. Likewise, patients with poor preventive practice (AOR = 3.34; 95% CI 1.19-9.31, p = 0.02) more likely to get admitted to ICU than patient with good preventive practices.These research findings hold potential significance for facilitating early triage and risk assessment in COVID-19 patients.

Antibiotics use among residents in Eastern Nepal: a community-based mixed method study.

Introduction: According to the WHO, more than two-thirds of all antibiotics are used in the community, of which about 30% are used inappropriately. The antimicrobial resistance (AMR) problem is a growing threat to Nepal because of indiscriminate and inappropriate use. However, exact data on the extent of inappropriate use of antibiotics in the community is scarce in Nepal. Objectives: To know the extent of inappropriate use of antibiotics among the community and their knowledge and practice towards the usage of antibiotics. Methods: A community-based cross-sectional study was conducted from 20 December 2017 to 20 March 2018 using a purposive sampling technique. A semi-structured questionnaire was used while conducting face-to-face interviews with 336 respondents to find out the knowledge and practice regarding antibiotic use. Investigators took different antibiotics (in all dosage forms) with them to show participants whether they knew and/or used the antibiotics in the last year. Results: The mean age of respondents with standard deviation was 39.87±13.67 years ranging from 18 to 84 years. Around 35.42% of respondents were farmers and 34.52% were homemakers. 28.87% of respondents were illiterate, 32.44% had primary education and 33.33% had secondary education. Almost half of them (48.51%) think that antibiotics are safe and can be commonly used. So, 43.15% of them preferred taking antibiotics when they had a common cold. The majority of the participants (81.84%) did not have any idea about antibiotic resistance. 94.6% of the respondents used antibiotics inappropriately. Conclusion: The results of the present study revealed that inappropriate use of antibiotics is high and associated with low earning wages in both males and females in the age group 18-39 years.

Medical students' attitude towards cultural diversity: a cross-sectional study at a health sciences university in eastern Nepal.

OBJECTIVES: To assess the attitude of medical students towards cultural diversity aiming to elucidate our current status in understanding cultural awareness and sensitivity. DESIGN, SETTING AND PARTICIPANTS: A web-based cross-sectional study was carried out among 601 undergraduate health science students (medical and dental courses) at a health sciences university in eastern Nepal via various modes of social-media platforms like WhatsApp, Messenger, Gmail, etc. OUTCOME MEASURES: Medical students' attitude towards cultural diversity and its association with the sociodemographic profile of the students. RESULTS: A total of 601 students participated in the study, out of which, 64.2% were men with a sex ratio of 1.8:1 and a mean age of 22.3±1.9 years. More than two-thirds (77.2%) of the students had an excellent to good attitude towards cultural diversity. The proportion of students reporting 'excellent' attitude towards cultural diversity was higher among male students compared with female students (37.8% vs 20.5%) and students aged >22 years compared with younger students (37.1% vs 26.7%). Gender (p<0.001) and age (p=0.009) were significantly associated with the attitude towards cultural diversity. CONCLUSIONS: Medical students, in general, are aware of the impacts of a cross-cultural society on the delivery of quality healthcare and also about the need to be aware of prejudices doctors may have towards certain cultures. Majority suggest the inclusion of concepts of multicultural awareness and sensitivity in the medical curriculum itself.

Utilization of social health security scheme among the households of Illam district, Nepal.

BACKGROUND: Nepal has implemented the social health security program in certain health facilities to improve access to quality health services. The aim of the study is to understand the utilization pattern of social health security schemes and community's perception of the social health security program. METHOD: A descriptive cross-sectional mixed-method study was conducted among 300 households of Illam district who had enrolled in the social health security scheme. A multi-stage random sampling method was used. A semi-structured questionnaire was used to collect quantitative data whereas focus group discussions (FGDs) were conducted for qualitative data. Descriptive analysis, bivariate and multivariate analysis was done. FGDs were transcribed and thematic analysis was done. FINDINGS: The utilization rate of social health security scheme was 88.7%. Factors associated with the utilization of program included: presence of under-five children and chronic illness in households, sex and age group. Focus group discussion revealed that people were aware of social health insurance and pleased with program implemented by government. However, the hospitals under the social health insurance were not able to meet their expectations. CONCLUSION: Although the utilization of social health security scheme was high, people were dissatisfied with the service provided by the hospital under the social health security scheme. Therefore, the social health insurance board should closely monitor the hospitals and develop a feedback mechanism from the users.

Study of the magnitude of diabetes and its associated risk factors among the tuberculosis patients of Morang, Eastern Nepal.

BACKGROUND: WHO addresses the infectious disease like Tuberculosis, and non- communicable disease like Diabetes among the top 10 causes of death worldwide, which collectively leads to increasing mortality and premature death especially in developing countries. Hence, the present study aims to assess the prevalence of diabetes and its associated risk factors among the tuberculosis patient of Morang, Eastern Nepal. METHODS: A cross-sectional study was carried out among the 320 respondents undergoing tuberculosis treatment of Morang district. Respondents from eight randomly selected DOTS centers were selected purposively. The Fasting Blood Sugar and 2-h Post-Prandial Blood Sugar were assessed in the laboratory of respective DOTS center by the glucose oxidase method. An interview for socio-demographic and other variables was conducted using a pretested semi-structured questionnaire based on WHO-STEP Instrument for chronic disease and excerpt from DASS-21 was used for the variable stress. RESULTS: The prevalence of diabetes, pre-diabetic and glucose intolerance among tuberculosis patient was 11.9, 17.2, and 17.8% respectively. Additionally, the univariate analysis reported, user of tobacco products, current alcohol consumers, family history of diabetes and stress level, to have positive association with diabetes, while the multivariate analysis reported, the current alcohol consumer as the significant predictor of diabetes among the tuberculosis patient. CONCLUSION: A significant portion of the respondents were diabetic, impaired glucose tolerance and pre-diabetic, which supports the fact of diabetes being comorbid with tuberculosis. Hence, it shifts the focus on the bidirectional screening of tuberculosis and diabetes.

Health Literacy and Knowledge of Chronic Diseases in Nepal.

BACKGROUND: Understanding of risk factors and developing healthy lifestyles is a way of tackling the surging burden of chronic diseases in low-to-middle income countries such as Nepal. Health literacy (HL) has a pivotal role in prevention, adherence to treatment, self-care, and better use of health care; therefore, factors associated with HL need to be studied in the context of Nepal. OBJECTIVE: This study was conducted to assess the level of HL and explore disease-specific knowledge among patients with chronic diseases. METHODS: A cross-sectional study was conducted among 426 respondents with hypertension, diabetes mellitus, or chronic obstructive pulmonary disease from a tertiary care hospital and primary care clinics using face-to-face interviews. HL was measured using a translated and pretested HL questionnaire (the Europe-Asia Health Literacy Survey Questionnaire). Disease-related knowledge was assessed using a validated questionnaire. KEY RESULTS: The study found that 27% of the respondents had sufficient HL, 19% had marginal HL, and 54% had inadequate HL. Factors associated with inadequate HL included being older and female, and having lower or no education, unemployment or retired status, poverty, and having a history of smoking or a history of consuming alcohol. HL was a strong predictor of knowledge regarding hypertension (ß = 0.32; p < .05), diabetes mellitus (ß = 0.41; p < .05), and chronic obstructive pulmonary disease (ß = 0.37; p < .05) in multiple regression analyses after adjusting for age, gender, education, marriage, family history of disease, attendance at follow-up clinics at recommended intervals, information received regarding disease at clinics, smoking, and alcohol intake. CONCLUSIONS: A sufficient level of HL was uncommon among participants in our study. People with sufficient HL knew significantly more about their diseases or conditions than those with inadequate HL. [HLRP: Health Literacy Research and Practice. 2018;2(4):e221-e230.]. PLAIN LANGUAGE SUMMARY: Very little is known about health literacy in Nepal. We conducted a study to learn how much people in Nepal with hypertension, diabetes, or chronic obstructive pulmonary disease knew about their condition and sought to check its association with health literacy. We found that more than one-half of the participants did not have adequate health literacy levels. Participants who were older, female, uneducated, retired from work, or poor had lower levels of health literacy. We also found that those with high levels of health literacy had better knowledge of their disease. Therefore, we recommend that in Nepal health literacy should be measured for each patient and support regarding management of his or her condition should be provided if necessary.