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1.
Lancet Glob Health ; 10(10): e1494-e1504, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36113533

RESUMO

BACKGROUND: In Nepal, Streptococcus pneumoniae (pneumococcus) is a common cause of bacterial pneumonia in children, and is a major health concern. There are few data on the effect of vaccination on the disease or colonisation with pneumococci in the nasopharynx of children in this setting. The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced into the routine infant immunisation schedule in Nepal in 2015. We aimed to investigate the effect of the introduction of PCV10 on pneumococcal carriage and disease in children in Nepal. METHODS: We did an observational cohort study in children in Nepal. The hospital surveillance study took place in Patan Hospital, Kathmandu, and community studies in healthy children took place in Kathmandu and Okhaldhunga district. For the surveillance study, all children admitted to Patan Hospital between March 20, 2014, and Dec 31, 2019, aged between 2 months and 14 years with clinician-suspected pneumonia, were eligible for enrolment. For the community study, healthy children aged 0-8 weeks, 6-23 months, and 24-59 months were recruited from Kathmandu, and healthy children aged 6-23 months were recruited from Okhaldhunga. We assessed the programmatic effect of PCV10 introduction using surveillance for nasopharyngeal colonisation, pneumonia, and invasive bacterial disease from 1·5 years before vaccine introduction and 4·5 years after vaccine introduction. For the surveillance study, nasopharyngeal swabs, blood cultures, and chest radiographs were obtained from children admitted to Patan Hospital with suspected pneumonia or invasive bacterial disease. For the community study, nasopharyngeal swabs were obtained from healthy children in the urban and rural settings. Pneumonia outcomes were analysed using log-binomial models and adjusted prevalence ratios (aPR) comparing each calendar year after the introduction of the vaccine into the national programme with the pre-vaccine period (2014-15), adjusted for calendar month, age, and sex. FINDINGS: Between March 20, 2014, and Dec 31, 2019, we enrolled 2051 children with suspected pneumonia, and 11 354 healthy children (8483 children aged 6-23 months, 761 aged 24-59 months, and 2110 aged 0-8 weeks) to assess nasopharyngeal colonisation. Among clinical pneumonia cases younger than 2 years, vaccine serotype carriage declined 82% (aPR 0·18 [95% CI 0·07-0·50]) by 2019. There was no decrease in vaccine serotype carriage in cases among older unvaccinated age groups. Carriage of the additional serotypes in PCV13 was 2·2 times higher by 2019 (aPR 2·17 [95% CI 1·16-4·05]), due to increases in serotypes 19A and 3. Vaccine serotype carriage in healthy children declined by 75% in those aged 6-23 months (aPR 0·25 [95% CI 0·19-0·33]) but not in those aged 24-59 months (aPR 0·59 [0·29-1·19]). A decrease in overall vaccine serotype carriage of 61% by 2019 (aPR 0·39 [95% CI 0·18-0·85]) was also observed in children younger than 8 weeks who were not yet immunised. Carriage of the additional PCV13 serotypes in children aged 6-23 months increased after PCV10 introduction for serotype 3 and 19A, but not for serotype 6A. The proportion of clinical pneumonia cases with endpoint consolidation on chest radiographs declined from 41% in the pre-vaccine period to 25% by 2018, but rose again in 2019 to 36%. INTERPRETATION: The introduction of the PCV10 vaccine into the routine immunisation programme in Nepal has reduced vaccine serotype carriage in both healthy children and children younger than 2 years with pneumonia. Increases in serotypes 19A and 3 highlight the importance of continued surveillance to monitor the effect of vaccine programmes. This analysis demonstrates a robust approach to assessing vaccine effect in situations in which pneumococcal disease endpoint effectiveness studies are not possible. FUNDING: Gavi, the Vaccine Alliance and the World Health Organization.


Assuntos
Infecções Pneumocócicas , Pneumonia , Portador Sadio/epidemiologia , Criança , Estudos de Coortes , Humanos , Lactente , Nepal/epidemiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Streptococcus pneumoniae
2.
PLoS One ; 17(9): e0273101, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36070314

RESUMO

BACKGROUND: Morbidity increases with age and enhances the burden of health problems that result in new challenges to meet additional demands. In the ageing population, health problems, and health care utilization should be assessed carefully and addressed. This study aimed to identify chronic morbidities, health problems, health care seeking behaviour and health care utilization among the elderly. METHODS: We conducted a community based, cross-sectional study in urban areas of the Sunsari district using face-to-face interviews. A total of 530 elderly participants were interviewed and selected by a simple proportionate random sampling technique. RESULTS: About half, 48.3%, elderly were suffering from pre-existing chronic morbidities, of which, 30.9% had single morbidity, and 17.4% had multi-morbidities. This study unfurled more than 50.0% prevalence of health ailments like circulatory, digestive, eye, musculoskeletal and psychological problems each representing the burden of 68.7%, 68.3%, 66.2%, 65.8% and 55.7% respectively. Our study also found that 58.7% preferred hospitals as their first contact facility. Despite the preferences, 46.0% reported visiting traditional healers for treatment of their ailments. About 68.1% reported having difficulty seeking health care and 51.1% reported visits to a health care facility within the last 6 months period. The participants with pre-existing morbidity, health insurance, and an economic status above the poverty line were more likely to visit health care facilities. CONCLUSION: Elderly people had a higher prevalence of health ailments, but unsatisfactory health care seeking and health care utilization behaviour. These need further investigation and attention by the public health system in order to provide appropriate curative and preventive health care to the elderly. There is an urgent need to promote geriatric health services and make them available at the primary health care level, the first level of contact with a national health system.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Idoso , Estudos Transversais , Humanos , Morbidade , Nepal/epidemiologia , Prevalência
3.
BMC Public Health ; 22(1): 1721, 2022 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-36088374

RESUMO

BACKGROUND: Nurturing care, including adequate nutrition, responsive caregiving and early learning, is critical to early childhood development. In Nepal, national surveys highlight inequity in feeding and caregiving practices for young children. Our objective was to describe infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under five in Dhanusha district, Nepal, and to explore socio-demographic and economic factors associated with these practices. METHODS: We did a cross-sectional analysis of a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N = 1360), sampled when children were median age 46 days and a follow-up survey of the same mother-child dyads (N = 1352) when children were median age 38 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators. RESULTS: The prevalence of feeding indicators varied. IYCF indicators, including ever breastfed (99%), exclusive breastfeeding (24-hour recall) (89%), and vegetable/fruit consumption (69%) were common. Problem areas were early initiation of breastfeeding (16%), colostrum feeding (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), minimum dietary diversity (49%) and animal-source food consumption (23%). Amongst caregiving indicators, access to 3+ children's books (7%), early stimulation and responsive caregiving (11%), and participation in early childhood education (27%) were of particular concern, while 64% had access to 2+ toys and 71% received adequate care. According to the Early Child Development Index score, only 38% of children were developmentally on track. Younger children from poor households, whose mothers were young, had not received antenatal visits and delivered at home were at higher risk of poor IYCF and caregiving practices. CONCLUSIONS: Suboptimal caregiving practices, inappropriate early breastfeeding practices, delayed introduction of complementary foods, inadequate dietary diversity and low animal-source food consumption are challenges in lowland Nepal. We call for urgent integrated nutrition and caregiving interventions, especially as interventions for child development are lacking in Nepal.


Assuntos
Aleitamento Materno , Fenômenos Fisiológicos da Nutrição do Lactente , Pré-Escolar , Estudos Transversais , Dieta , Feminino , Humanos , Lactente , Nepal/epidemiologia , Gravidez
4.
J Obes ; 2022: 2340809, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36061219

RESUMO

Background: Our eating practice is generally based on the food we choose to eat. The selection of unhealthy food, high cost of healthy food items, and easy availability of fast food may have negative impact on our health and eating behaviour. This study aims to access the gender difference in food choice and eating practice and their association with health among students in Kathmandu, Nepal. Methods: A cross-sectional descriptive study was conducted among 385 randomly selected undergraduate BBA (Bachelor in Business Administration) students of Tribhuvan University in Kathmandu by using semistructured self-administered questionnaire. The questionnaire included sociodemographic characters, health status, behaviour factors, eating practice, and food choice which were measured using Food Choice Questionnaire (FCQ). The data was analysed in SPSS. Frequency, percentage, mean, and standard deviation were calculated, and chi-square test and logistic regression were used to measure the association between two variables. Results: The study is comprised of 50.4% female and 49.6% male with mean ages of 20.04 and 20.75, respectively. A gender difference was observed in food choice but no gender difference was observed in eating practice. There was no significant association of food choice and eating practice with health. However, food choice and eating practice showed an association with the current living status of the respondents. Sensory appeal and health were the most important food choice motives among males and females, respectively. Conclusion: The study concluded that no gender difference was observed in food choice. However, gender difference was observed in eating practice. There was no association of food choice and eating practice with health.


Assuntos
Comportamento Alimentar , Preferências Alimentares , Estudos Transversais , Feminino , Humanos , Masculino , Nepal/epidemiologia , Estudantes , Inquéritos e Questionários
5.
Glob Health Sci Pract ; 10(4)2022 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-36041839

RESUMO

INTRODUCTION: We conducted an assessment in Malawi, Nepal, Niger, and Uganda to document access-related reasons for not using contraceptive methods during the COVID-19 pandemic that led to unintended pregnancies, describe use of modern contraception among women in potential need of contraception compared to before the pandemic, examine method choice, and describe barriers to contraceptive access and use. METHODS: Between December 2020 and May 2021, we conducted an opt-in phone survey with 21,692 women, followed by an outbound survey with 5,124 women who used modern nonpermanent contraceptive methods or who did not want to get pregnant within 2 years but were not using a modern contraceptive method. The surveys examined current behaviors and documented behaviors before the pandemic retrospectively. We used multivariable logistic regression models to examine factors associated with contraceptive use dynamics during COVID-19. RESULTS: Pregnant women surveyed reported that the pandemic had affected their ability to delay or avoid getting pregnant, ranging from 27% in Nepal to 44% in Uganda. The percentage of respondents to the outbound survey using modern contraception decreased during the pandemic in all countries except Niger. Fear of COVID-19 infection was associated with discontinuing modern contraception in Malawi and with not adopting a modern method among nonusers in Niger. Over 79% of surveyed users were using their preferred method. Among nonusers who tried obtaining a method, reasons for nonuse included unavailability of the preferred method or of providers and lack of money; nonusers who wanted a method but did not try to obtain one cited fear of COVID-19 infection. CONCLUSION: We found evidence of surveyed women attributing unintended pregnancies to the pandemic and examples of constraints to contraceptive access and use on the supply and demand side. The effects of the pandemic must be interpreted within the local contraceptive, health system, and epidemiological context.


Assuntos
COVID-19 , Serviços de Planejamento Familiar , COVID-19/epidemiologia , Anticoncepção/métodos , Comportamento Contraceptivo , Anticoncepcionais , Estudos Transversais , Feminino , Humanos , Malaui/epidemiologia , Nepal/epidemiologia , Níger , Pandemias , Gravidez , Estudos Retrospectivos , Uganda/epidemiologia
6.
Matern Child Health J ; 26(10): 1976-1982, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36002697

RESUMO

INTRODUCTION: Despite significant improvements in recent years, maternal and neonatal health outcomes remain poor in many regions of the world. One such area is in the remote mountainous regions of Nepal. The purpose of this study is to describe the current antenatal care practices and delivery support in a mountainous district of Nepal. METHODS: This study took place in Solukhumbu District between December 2015 and February 2018. A household survey was created using evidence-based maternal and neonatal care indicators. Women who had delivered within the previous two years were surveyed regarding antenatal and delivery care they received. A standardized health facility survey was used to evaluate the operational status of health facilities. The study was approved by the Nepal Ministry of Health and the University of Utah IRB. RESULTS: A total of 487 households and 19 facilities were surveyed. 35.7% (174/487) of deliveries occurred in a health facility (hospital, primary health care center or birthing center). 35.2% (171/486) of deliveries were attended by a skilled birth attendant. 52.8% (47/89) of women who did not deliver in a facility noted that transportation issues and not having sufficient time to travel during labor prevented them from delivering in a facility. No health posts had staff trained in obstetric and neonatal emergencies. DISCUSSION: The majority of women in Solukhumbu District do not receive high quality antenatal and delivery care. An intervention that would make antenatal care and delivery support more accessible could improve maternal and infant outcomes in this district and other similar regions.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Serviços de Saúde Materna , Criança , Parto Obstétrico , Feminino , Instalações de Saúde , Acesso aos Serviços de Saúde , Humanos , Recém-Nascido , Nepal/epidemiologia , Assistência Perinatal , Gravidez , Cuidado Pré-Natal
7.
J Nepal Health Res Counc ; 20(1): 59-64, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35945854

RESUMO

BACKGROUND: The COVID-19 pandemic has challenged the entire globe and the need for a vaccine is supreme. Since many vaccines along with Covishield have been granted emergency use authorization, the evaluation and monitoring of safety are crucial. Covishield was rolled out in Nepal on January 27, 2021. So through this study, we aim to identify the prevalence of Adverse Events Following Immunization in general with the first dose of Covishield vaccine, compare Adverse Events Following Immunization in prior COVID-19 positive cases and Adverse Events Following Immunization in co-morbid individuals. METHODS: This was a descriptive cross-sectional study conducted in 440 sample from May 2021 till July 2021 in a provincial government hospital of western Nepal. Ethical approval was received from Ethical Review Board, Nepal Health Research Council (Registration no: 279/2021 P). Simple random sampling was used. Point estimate was done at 95% confidence interval and descriptive analysis was done to identify the prevalence of Adverse Events Following Immunization within one week after Covishield vaccination in the studied population. RESULTS: 79.77% of the study population complaint at least one or more Adverse Events Following Immunization. Fever, myalgia, headache, pain at the injection site, arthralgia, chills, and fever are the most common Adverse Events Following Immunization. 42.73% of the study population self-medicated to manage Adverse Events Following Immunization, 7.89% took leave from work while 0.28% needed medical attention. No major Adverse Events Following Immunization relevance with prior-COVID history or co-morbidity was seen. CONCLUSIONS: Majority of the vaccinated participants had minor adverse effects on the first-day post-vaccination while most of the Adverse Events Following Immunization subsided within seven days.


Assuntos
Vacinas contra COVID-19 , COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , ChAdOx1 nCoV-19 , Estudos Transversais , Humanos , Imunização , Nepal/epidemiologia , Pandemias/prevenção & controle , Vacinação/efeitos adversos , Vacinas/efeitos adversos
8.
PLoS One ; 17(8): e0270186, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36044457

RESUMO

BACKGROUND: The burden of non-communicable diseases like diabetes and hypertension is increasing worldwide including low-and middle-income countries. Good knowledge of such diseases among young people will make them adopt a healthy lifestyle from an early age, which will, in turn, prevent them from developing such non-communicable diseases. This study aimed to assess the knowledge, attitude, and practice of rural and urban school students regarding diabetes and hypertension. We also aimed to see the differences in the knowledge, attitude, and practice of students from rural vs. urban communities. METHODS: A school-based cross-sectional study was conducted from May 1 2021 to June 30, 2021, in four schools in Nepal (1 from a metropolitan city, 2 from an urban municipality, and 1 from a rural municipality). The study was conducted among the secondary-level students of classes 9 and 10 in each school. The data were collected from the participants via pre-tested questionnaires and analyzed in the Statistical Packages for Social Sciences (SPSS) version 20.0. Logistic regression analysis was carried out to determine the determinants of knowledge and attitude regarding diabetes and hypertension. RESULTS: Of 380 respondents, 35.5% were residents of metropolitan city, 37.4% were from the urban municipality and 27.1% were from the rural municipality. The mean age of respondents was 15.61±0.99 years and 51.1% were male. Respondents having a family history of diabetes and hypertension were 21.1% and 37.9% respectively. Respondents from the metropolitan city had significantly higher mean knowledge scores than the respondents from the urban and rural municipality (p<0.001) while there was no significant difference in mean attitude scores. There was significantly higher daily consumption of fruits and vegetables among the participants from rural municipality (p<0.01) while no significant difference was seen in salt consumption and time spent on physical activity. In univariate regression analysis, place of residence, family occupation, parental education, and family history of diabetes and hypertension were significantly associated with good knowledge level. In multivariate analysis, only a higher grade of study (grade 10 in comparison to grade 9) was an independent predictor of a student's good attitude level. CONCLUSION: In general, there was a good attitude towards diabetes and hypertension despite poor knowledge. The mean knowledge scores were lower in urban municipality and rural municipality compared to metropolitan city. Low knowledge scores on diabetes and hypertension among the students show an urgent need for school-based interventional programs focusing on non-communicable diseases and lifestyle modification with more emphasis on rural communities.


Assuntos
Diabetes Mellitus , Hipertensão , Doenças não Transmissíveis , Adolescente , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipertensão/epidemiologia , Masculino , Nepal/epidemiologia , População Rural , Estudantes , Inquéritos e Questionários
9.
BMC Public Health ; 22(1): 1567, 2022 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-35978424

RESUMO

BACKGROUND: As the global burden of disease evolves, lower-resource countries like Nepal face a double burden of non-communicable and infectious disease. Rapid adaptation is required for Nepal's health system to provide life-long, person-centred care while simultaneously improving quality of infectious disease services. Social determinants of health be key in addressing health disparities and could direct policy decisions to promote health and manage the disease burden. Thus, we explore the association of social determinants with the double burden of disease in Nepal. METHODS: This is a retrospective, ecological, cross-sectional analysis of infectious and non-communicable disease outcome data (2017 to 2019) and data on social determinants of health (2011 to 2013) for 753 municipalities in Nepal. Multinomial logistic regression was conducted to evaluate the associations between social determinants and disease burden. RESULTS: The 'high-burden' combined double burden (non-communicable and infectious disease) outcome was associated with more accessible municipalities, (adjOR3.94[95%CI2.94-5.28]), municipalities with higher proportions of vaccine coverage (adjOR12.49[95%CI3.05-51.09]) and malnutrition (adjOR9.19E103[95%CI19.68E42-8.72E164]), lower average number of people per household (adjOR0.32[95%CI0.22-0.47]) and lower indigenous population (adjOR0.20[95%CI0.06-0.65]) compared to the 'low-burden' category on multivariable analysis. 'High-burden' of non-communicable disease was associated with more accessible municipalities (adjOR1.93[95%CI1.45-2.57]), higher female proportion within the municipality (adjOR1.69E8[95%CI3227.74-8.82E12]), nutritional deficiency (adjOR1.39E17[95%CI11799.83-1.64E30]) and malnutrition (adjOR2.17E131[95%CI4.41E79-1.07E183]) and lower proportions of population under five years (adjOR1.05E-10[95%CI9.95E-18-0.001]), indigenous population (adjOR0.32[95%CI0.11-0.91]), average people per household (adjOR0.44[95%CI0.26-0.73]) and households with no piped water (adjOR0.21[95%CI0.09-0.49]), compared to the 'low-burden' category on adjusted analysis. 'High burden' of infectious disease was also associated with more accessible municipalities (adjOR4.29[95%CI3.05-6.05]), higher proportions of population under five years (adjOR3.78E9[95%CI9418.25-1.51E15]), vaccine coverage (adjOR25.42[95%CI7.85-82.29]) and malnutrition (adjOR4.29E41[95%CI12408.29-1.48E79]) and lower proportions of households using firewood as fuel (adjOR0.39[95%CI0.20-0.79]) ('moderate-burden' category only) compared to 'low-burden'. CONCLUSIONS: While this study produced imprecise estimates and cannot be interpreted for individual risk, more accessible municipalities were consistently associated with higher disease burden than remote areas. Female sex, lower average number per household, non-indigenous population and poor nutrition were also associated with higher burden of disease and offer targets to direct interventions to reduce the burden of infectious and non-communicable disease and manage the double burden of disease in Nepal.


Assuntos
Desnutrição , Doenças não Transmissíveis , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Promoção da Saúde , Humanos , Desnutrição/epidemiologia , Nepal/epidemiologia , Estudos Retrospectivos , Determinantes Sociais da Saúde
11.
Nepal J Ophthalmol ; 14(27): 31-38, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35996901

RESUMO

INTRODUCTION: Retinitis Pigmentosa (RP) is a group of diffuse retinal degenerative diseases predominantly affecting the rod and cone photoreceptors. The prevalence of retinitis pigmentosa seen in literature is approximately 1:4000. Retinitis Pigmentosa is one of the the most common causes of blindness in the age group of 20 to 40 years. The objective of this study was to determine the profile of retinitis pigmentosa in Terai and Nepal-India border region considering patients seeking care at a Tertiary level Eye Hospital in the terai region (southern part) of Nepal. MATERIALS AND METHODS: A hospital-based, retrospective study was carried out at R. M. Kedia Eye Hospital. A total of 385 (83 males and 107 females from Nepal and 109 males and 86 females from India) diagnosed patients of Retinitis Pigmentosa were included in the study. Data was collected over a period of eleven years from 2008-2018. RESULTS: Out of 385 diagnosed Retinitis Pigmentosa patients, 192 (49.87%) were male and 193 (50.13%) were female with slightly female predominance. The prevalence of RP seen in our study was 0.03%. About 51% of the patients visited here were from India and nearby border areas/ villages which cover most of the rural areas of India. In this study it was found that 49.34% of the RP cases were from Nepal, of which 43.63% of cases were from Hindu community and 5.71% from Muslim community and about 50.66% cases of RP were from India, of which 37.67% from Hindu and 12.98% from Muslim community. The peak age of presentation of RP was at 30-39 years (29.09%), followed by 20-29 years (26.75%). The common marriage pattern of consanguinity was found in Muslim community in between the first cousins. In this study the hospital record did not show any evaluation for the syndromic disease in the hospital record, though RP is usually non syndromic and there are literatures where many syndromic forms have been identified. CONCLUSION: The prevalence of RP seen in the study was 0.03% (A total of 1101299 sample population of which 385 patients had RP). Since RP is an inherited disease and is one of the non-treatable causes of blindness which runs in the families, a role of counseling to reduce consanguineous marriages should be brought forward to reduce the disease process.


Assuntos
Doenças Retinianas , Retinite Pigmentosa , Adulto , Cegueira/epidemiologia , Cegueira/etiologia , Feminino , Hospitais , Humanos , Masculino , Nepal/epidemiologia , Prevalência , Retinite Pigmentosa/diagnóstico , Retinite Pigmentosa/epidemiologia , Estudos Retrospectivos , Adulto Jovem
12.
Nepal J Ophthalmol ; 14(27): 49-58, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35996903

RESUMO

INTRODUCTION: Hypertensive retinopathy is a common complication in patients with hypertension. This study aims to assess the prevalence, associated factors and awareness of hypertensive retinopathy among an elderly population with hypertension in Bhaktapur, Nepal. MATERIALS AND METHODS: This is a population-based, cross-sectional study conducted from 2013 to 2015 in Bhaktapur district, Nepal. The sample size was 2100 subjects aged 60 years and above. From this sample, all diagnosed patients with hypertension were analyzed. A detailed history was obtained, and an ocular examination was performed. RESULTS: Information was complete for 1860 (88.57%) subjects. The age of the study population ranged from 60 to 95 years with the mean age of 69.64±7.31 years. Hypertension was found in 643 subjects (34.61%), of which 224 (12.04%) were newly diagnosed cases. Among the subjects with hypertension, hypertensive retinopathy was found in 81 cases (12.6%). Hypertensive retinopathy was more frequent in the age group 70-79 years (15.23%), males (13.25%), illiterates (13.56%), diabetics (16.49%), and body mass index (BMI) ≥25 kg/m2 (14%). None of the factors was found to be statistically significant. Among the study participants, awareness regarding the effect of hypertension on eye, retina and vision was found to be 13.84%, 8.4%, and 11.98% respectively. CONCLUSION: Prevalence of hypertension and hypertensive retinopathy among an elderly population of 60 years and above in Bhaktapur district, Nepal were similar to other countries. Hypertensive retinopathy was higher among males, illiterates, diabetes and BMI> 25kg/m2. Awareness of hypertensive retinopathy was 8.4% among hypertensive subjects. Emphasis should be directed toward improving awareness campaigns.


Assuntos
Hipertensão , Retinopatia Hipertensiva , Idoso , Estudos Transversais , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Retinopatia Hipertensiva/diagnóstico , Retinopatia Hipertensiva/epidemiologia , Retinopatia Hipertensiva/etiologia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Prevalência , Retina , Fatores de Risco
13.
Nepal J Ophthalmol ; 14(27): 59-64, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35996904

RESUMO

INTRODUCTION: Corneal foreign bodies are one of the commonest forms of ocular trauma, the majority of which occur due to occupational exposure. The aim of this study was to study the profile of patients with corneal foreign bodies. MATERIALS AND METHODS: A hospital based prospective study was conducted among 60 patients presenting to the ophthalmology outpatient department in Dhulikhel Hospital-Kathmandu University Hospital (DH-KUH) over a time span of 6 months. Demographic data of patients, clinical characteristics of foreign bodies and associated complications were noted. RESULTS: Most of the patients were males (n=55) belonging to the 21-30 age group (n=24). Majority of them were workers in metal industries (n=26). Welding and cutting metal were implicated as the most common mode of injury (n=53). CONCLUSION: By virtue of this study, we identified the high risks associated with sustaining this form of ocular trauma. The incidence and hence the prevalence of corneal foreign body can be gradually levelled down if we aware the people about the associated complications and advise them to use protective eye wears (PEW).


Assuntos
Corpos Estranhos no Olho , Corpos Estranhos , Estudos Transversais , Corpos Estranhos no Olho/diagnóstico , Corpos Estranhos no Olho/epidemiologia , Corpos Estranhos no Olho/cirurgia , Feminino , Corpos Estranhos/complicações , Humanos , Masculino , Nepal/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Centros de Atenção Terciária
14.
Nepal J Ophthalmol ; 14(27): 82-92, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35996907

RESUMO

INTRODUCTION: As the number of people with diabetes mellitus is increasing because of urbanization and change in dietary habits and sedentary lifestyle, the number of diabetic retinopathy is also expected to increase in future. [1] [sa2] We aimed to find out the prevalence of diabetic retinopathy and associated risk factors among diabetic patients in the tertiary eye hospital. MATERIALS AND METHODS: This is the observational cross-sectional study enrolling 420 diabetic patients visiting the multispecialty tertiary eye hospital between March 2020 and February 2021. Anthropometry measurement, laboratory risk profiles and blood pressure were recorded Results: The prevalence of any diabetic retinopathy, proliferative diabetic retinopathy, and diabetic macular edema were 30.96 %, 6.19 %, and 5.95 % respectively. The duration of DM (p=0.001), hypertension (p=0.04), high SBP (p=0.023), abdominal obesity (p=0.015), high LDL(p=0.011) cholesterol, low HDL cholesterol(p=0.012), and creatinine (p=0.001) were associated with DR in our study. CONCLUSION: A holistic approach should target to control the modifiable risk factors like blood sugar, blood pressure, lipid profile, kidney function, and obesity to prevent DR. Anthropometric assessment of waist to height and waist circumference should be included in the holistic health promotion strategy in Nepal as BMI may not be risk factors for DR in Nepalese people.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Edema Macular , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Humanos , Edema Macular/epidemiologia , Nepal/epidemiologia , Prevalência , Fatores de Risco , Centros de Atenção Terciária
15.
Nepal J Ophthalmol ; 14(27): 93-102, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35996908

RESUMO

INTRODUCTION: Cortical visual impairment (CVI) in children is a retro chiasmal visual tract disorder where there is with an impairment in the visual acuity and/or functionality of vision-guided task, including motor planning in the presence of normal ocular findings or minimal ocular morbidity. The study was conducted to assess the knowledge about CVI among ophthalmologists practicing in Nepal. MATERIALS AND METHODS: This was a cross sectional study. Data collection was done by administering a preformed, validated questionnaire that was sent via email to all the ophthalmologists registered under the Nepal Ophthalmic Society. The email mentioned the aim of the study along with the questionnaire. RESULTS: A total of 146 (37.82%) ophthalmologists responded to the questionnaire. Forty four percent of the participants were general ophthalmologists, 28% were pediatric ophthalmologists and 67% were ophthalmologists from other subspecialty. The median age of participants was 37.6 years. Most of the ophthalmologist had a good knowledge about the cause, common risk factors, clinical risk factors, management and prognosis of CVI. However only 29.5% of participants were aware of the investigation of choice for diagnosing CVI and 31.7% were aware of the leading causes of visual impairment in the developed countries. The study also established that the knowledge score was higher in pediatric ophthalmologists than the general ophthalmologist and ophthalmologists from other specialties. CONCLUSION: Most of the ophthalmologists had a good knowledge about the cause, common risk factors, clinical features, management and prognosis of CVI. However only a limited number of participants were aware of the investigation of choice for diagnosing CVI and the leading causes of visual impairment in the developed countries. Majority of the participants rarely examined patients with CVI which does not correlate with the high prevalence of perinatal hypoxia, the commonest cause of CVI, in our country.


Assuntos
Cegueira Cortical , Encefalopatias , Oftalmologistas , Baixa Visão , Adulto , Cegueira Cortical/diagnóstico , Cegueira Cortical/epidemiologia , Cegueira Cortical/etiologia , Encefalopatias/complicações , Criança , Estudos Transversais , Humanos , Nepal/epidemiologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Baixa Visão/diagnóstico , Baixa Visão/epidemiologia , Baixa Visão/etiologia
16.
Nepal J Ophthalmol ; 14(27): 122-129, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35996911

RESUMO

INTRODUCTION: Major cause of irreversible blindness is glaucoma which is increasing as a significant global health problem. Knowledge of glaucoma burden and its clinical characteristics in this region is essential. MATERIALS AND METHODS: This was a cross-sectional hospital -based study conducted at Glaucoma unit in CHEERS Hospital, Bhaktapur from August 2015 to July 2019. Patients' demographic profile, along with comprehensive eye examination findings were reviewed from the records. Data analysis was done with IBM SPSS version 24 and was presented in mean (±SD), frequency and proportions and a chi- square test was applied. P value < 0.05 was considered statistically significant. RESULTS: Total of 310 glaucoma cases were included in this study. The mean age presentation was 61.89±14.4 years, and the majority of patients (52.9%) were in the age group 60-79 years. Most patients had primary open angle glaucoma (171, 55.2%) followed by primary angle closure glaucoma (92, 29.7%). CONCLUSION: Primary open angle glaucoma is the most common form of glaucoma. The proportion of glaucoma increased with increasing age (> 40 years). Provision of screening programs targeting persons with risk factors and opportunistic eye examinations would be beneficial in detection of glaucoma.


Assuntos
Glaucoma de Ângulo Fechado , Glaucoma de Ângulo Aberto , Glaucoma , Adulto , Idoso , Estudos Transversais , Estudos Epidemiológicos , Glaucoma/diagnóstico , Glaucoma/epidemiologia , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/epidemiologia , Humanos , Pessoa de Meia-Idade , Nepal/epidemiologia , Prevalência
18.
J Nepal Health Res Counc ; 20(1): 12-20, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35945847

RESUMO

BACKGROUND: Gestational diabetes mellitus is a condition of glucose intolerance during pregnancy. The burden of Gestational diabetes mellitus is ever increasing including a lower middle-income country like Nepal. METHODS: This meta-analysis was conducted in accordance to the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases of "Embase", "Google Scholar", "Scopus", "Web of Science" were searched for observational studies in Nepal from 2000 to July 2021. Random effect model was used to estimate the pooled prevalence subgroup analysis. RESULTS: This systematic review and meta-analysis analyzed 9 studies with a total of 20865 participants. Pooled prevalence of gestational diabetes mellitus was 2.61% (95% CI: 1.25- 5.37). From subgroup analysis, the prevalence of Gestational diabetes mellitus according to the diagnostic criteria were: International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria 6.56% (95% CI: 4.79-8.92), World Health Organization (WHO) criteria 4.81% (95% CI: 3.79-6.08), Diabetes in Pregnancy Study Group of India (DIPSI) criteria 4.71% (95% CI: 3.06-7.18), Carpenter and Coustan criteria (CC) 1.08% (95% CI: 0.43-2.71); prevalence according to the publication time: before 2015 1.20% (95% CI: 3.64-6.41), in and after 2015 4.84% (95% CI: 0.42-3.39); prevalence according to the place: within Kathmandu valley 2.70% (95% CI: 1.17-6.08), outside Kathmandu valley 2.28% (95% CI: 0.26-17.15). CONCLUSION: Our study revealed the increasing prevalence of GDM in Nepal. Further large observational studies at local levels are essential to measure the actual burden, risk factors and potential preventive measures for Gestational diabetes mellitus.


Assuntos
Diabetes Gestacional , Intolerância à Glucose , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Nepal/epidemiologia , Gravidez , Prevalência , Fatores de Risco
19.
J Nepal Health Res Counc ; 20(1): 26-32, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35945849

RESUMO

BACKGROUND: Orbital tumors have rare incidence, still they play a significant role in terms of morbidity and mortality. Orbital tumors may be primary, secondary or metastatic. These consist of benign and malignant lesions with extreme variations in pediatric and adult groups. These lesions can have acute or chronic onset, slow to rapid progression with or without bony destructions leading to vision loss, deformity and sometimes death. METHODS: This retrospective cross-sectional study was carried out in the Department of Ophthalmic Pathology and Laboratory Medicine in Biratnagar Eye Hospital. Fifty-one patients who underwent histopathological evaluation for their orbital lesions from June 2018 to December 2019 were included in the study. RESULTS: Orbital tumor and tumor like lesions comprised 27 cases (52.94%) in adults and 24 (47.06%) in paediatrics. Histopathologically, the most common pediatric benign tumor was dermoid cyst and malignant was secondary to orbital extension of retinoblastoma. Also, the most common adult benign orbital tumor was cavernous hemangioma and malignant was non Hodgkins lymphoma. The clinico-pathological accuracy for diagnosis was 68.63%. Association between age groups and nature of orbital lesions and between clinical and histopathological diagnosis was found to be statistically significant (p<0.05). CONCLUSIONS: Orbital tumors and tumor like lesions are uncommonly encountered. These masses showed significant variation in incidence in children versus adults. Combined efforts by different specialties help in early and prompt management of the orbital tumors.


Assuntos
Neoplasias Orbitárias , Adulto , Criança , Estudos Transversais , Hospitais , Humanos , Nepal/epidemiologia , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/epidemiologia , Neoplasias Orbitárias/patologia , Estudos Retrospectivos
20.
J Nepal Health Res Counc ; 20(1): 33-40, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35945850

RESUMO

BACKGROUND: The utilization of institutional delivery services is pivotal to improve maternal health and reducing maternal mortality amid childbirth. But COVID-19 pandemic is posturing considerable challenges to maintain essential maternal and newborn health services. So study aims to assess the factors associated with the utilization of institutional delivery during the COVID -19 pandemic. METHODS: Data was collected from the 116 mothers of Kalika Municipality, Chitwan. The total enumerative sampling technique was used to include mothers who delivered a baby during lockdown (March 21 to August 21, 2020). Collected data were analysed by using descriptive and inferential statistics like chi-square test, logistic regression analysis. RESULTS: Out of 116 mothers, 76.6% had their delivery in the health facilities. Logistic regression analysis showed several factors associated with utilization of institutional delivery such as ethnicity, respondents education status, distance to the nearest health facility, fear of traveling, fear to visit health facility (AOR= 4.923; 95% CI =1.475-16.432, p=0.001),perception on the risk of covid-19 to mother, and intrauterine transmission of COVID-19 (AOR= 19 5.472;95% CI 1.35-22.175;p= 0.017) was found to be statistically significant with the utilization of institutional delivery during COVID-19 pandemic. CONCLUSIONS: Several factors have been associated with the utilization of institutional delivery during pandemic. Women preferred not to seek healthcare due to the fear of being infected, lack of awareness, and misperception about COVID-19 and pregnancy. Therefore, the concerned authority should need to deliver a separate message to the pregnant women for a regular check-up and deliver a baby at a hospital.


Assuntos
COVID-19 , Serviços de Saúde Materna , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Parto Obstétrico , Feminino , Instalações de Saúde , Humanos , Recém-Nascido , Modelos Logísticos , Nepal/epidemiologia , Pandemias , Gravidez , Cuidado Pré-Natal
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