Qualitative research and its place in health research in Nepal.

There has been a steady growth in recent decades in Nepal in health and health services research, much of it based on quantitative research methods. Over the same period international medical journals such as The Lancet, the British Medical Journal (BMJ), The Journal of the American Medical Association (JAMA) and the Journal of Family Planning and Reproductive Health Care and many more have published methods papers outlining and promoting qualitative methods. This paper argues in favour of more high-quality qualitative research in Nepal, either on its own or as part of a mixed-methods approach, to help strengthen the country's research capacity. After outlining the reasons for using qualitative methods, we discuss the strengths and weaknesses of the three main approaches: (a) observation; (b) in-depth interviews; and (c) focus groups. We also discuss issues around sampling, analysis, presentation of findings, reflexivity of the qualitative researcher and theory building, and highlight some misconceptions about qualitative research and mistakes commonly made.

External validation of prognostic model of one-year mortality in patients requiring prolonged mechanical ventilation.

BACKGROUND: External validation of prognostic model for one-year mortality in patients ventilated for 21 days or more. A measure that identifies patients who are at high risk of mortality after prolonged ventilation will help physicians communicate prognoses to patients or surrogate decision makers. Our objective was to validate a prognostic model developed by Carson et al in a different setting. METHODS: An observational study was conducted from September 2002 to September 2007 in 30 beds Medical/Surgical Intensive Care Unit (ICU) at Mercy Fitzgerald Hospital (MFH) and 20 beds Medical/Surgical ICU at Mercy Philadelphia Hospital (MPH). One hundred and fifty medical and surgical patients requiring mechanical ventilation after acute illness for at least 21 days after initial intubation were enrolled. RESULTS: One year mortality was 45.4%. Area under the receiver operating characteristic curve for three month mortality was 0.90 and for one year mortality was 0.92. For identifying patients who had ≥90% risk of death at 3 month had sensitivity of 40% and specificity of 95% and risk of death at 1 year had sensitivity of 70% and specificity of 99%. Four predictive variables, requirement of vasopressors, hemodalysis, platelet count ≤ 150 x 10 9/L and age ≥50 yrs can be used as a simple prognostic score that clearly identifies low-risk patients and high-risk patients. CONCLUSIONS: Simple clinical variables measured on day 21 of mechanical ventilation can identify patients at highest and lowest risk of death from prolonged mechanical ventilation.

Commercial sex workers in Kathmandu Valley: profile and prevalence of sexually transmitted diseases.

This paper presents a socioeconomic profile and the prevalence of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), among 341 female commercial sex workers (CSWs) in Kathmandu Valley. Most of the CSWs are from outside the valley, but from within Nepal. Over 50% of the CSWs have a secondary or higher level of education. The average age of the CSWs is 21 years. The average age of first sexual intercourse was 16 years; and, at entering the sex trade, 18 years. The most frequently reported type of sexual activity is vaginal intercourse followed by anal intercourse. Although a large proportion of CSWs are aware of condoms, only one-fifth of them reported using condoms most of the time they had intercourse. The majority of the CSWs are aware of general types of STDs. Slightly over 60% are aware of AIDS, and the majority of them know of at least one mode of AIDS transmission. Gynecological examination based on symptoms revealed that 72% of the CSWs were infected with some type of STD. About 47% had vaginal discharges, 36% had pelvic inflammatory disease, 24% had ulcerative disease, and 4% had urethritis. Blood tests of the CSWs revealed that 28% had VDRL (a test for syphilis), hepatitis B, or HIV. The prevalence of VDRL was the most common, followed by hepatitis B. Of the 341 CSWs, 3 (0.9%) were HIV-positive.