Health system gaps in cardiovascular disease prevention and management in Nepal.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal's health systems gaps to prevent and manage CVDs. METHODS: We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts' codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. RESULTS: National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. CONCLUSION: Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

High Burden of Vitamin B12 Deficiency among Adults and Elderly.

BACKGROUND: Deficiency of vitamin-B12 is widespread. Adults and the elderly are particularly susceptible to vitamin-B12 deficiency. This study investigated the burden of vitamin-B12 deficiency and insufficiency among adults and the elderly attending a tertiary care hospital in Nepal. METHODS: This is a retrospective chart review conducted at Dhulikhel hospital. We reviewed records of 1615 patients investigating Vitamin-B12 level (pmol/L) at the clinical biochemistry laboratory from laboratory management database MIDAS between June 2020 and December 2021. Vitamin-B12 level was measured using enzyme immunoassay in Abbott Architect i1000SR analyzer. The categorical variables are presented as frequency and percentage; and numerical variables as  means and standard deviations, or median and Interquartile range.  Pearson Chi-square test was used to determine association between categorical variables.  Mann Whitney test and Kruskal Wallis H test were used to compare Vitamin-B12 level by categories. RESULTS: There were 1454 participants of which 33.5% of the patients were deficient, 27.9% were borderline deficient, while 38.7% had adequate vitamin B12 levels. Young adults(170.4 pmol/L) had a lower median vitamin B12 level than middle-aged adults (183.7pmol/L) and the elderly population (247.9pmol/L) (P<0.001). Compared to females (186.7 pmol/L), males(171.9 pmol/L) had lower vitamin B12 level (P <0.05). CONCLUSIONS: The study revealed that a significant proportion of young adults, middle aged adults and elderly population visiting a tertiary care hospital of Nepal are having vitamin B12 deficiency and borderline deficiency of public health concern.  Keywords: Adults; deficiency; elderly, vitamin B12.

Factors Affecting Turnaround Time in the Clinical Laboratory of the Kathmandu University Hospital, Nepal.

BACKGROUND: The turnaround time (TAT) as defined by most of the laboratories is the time interval between the specimens received in the laboratory to the time of reports dispatched with verification. Nearly 80% of hospital-attached clinical laboratories receive complaints about delayed TAT. Reporting in time is a crucial indicator of quality services along with accurate, precise and reliable reports, thus each clinical laboratory should identify affecting factors to eliminate them for the enhancement of quality services. METHODOLOGY: Dhulikhel Hospital-Kathmandu University Hospital is a tertiary care hospital, where this observational descriptive study was conducted in 2017. Requested tests received on database in the Department of Clinical Biochemistry Laboratory along with test requisition form (TRF) were carefully screened for any possible error. When analysis of individual patient's tests was completed, results of individual parameters were entered in the database manually. TAT was calculated as a time period between specimens received to analysis completed. Once test analysis has completed it was immediately followed by verification. RESULTS: A total of 36,108 patients' reports generated from the Department of Clinical Biochemistry Laboratory during study period were analyzed. Nearly 36% of reports exceeded the predefined TAT in case of stat tests, while around 7% of reports were out of predefined TAT in case of routine tests. Among prolonged TAT, around 75% of reports were delayed due to various extra analytical reasons and approximately 48% of total delayed reports were found only due to error by cash unit. CONCLUSION: The major reasons of delayed laboratory reports were due to time consumed to fix the pre-analytical errors created by other departments rather than laboratory itself. Cash unit alone has the highest degree of error in total testing process and it is the most significant factor for prolonged TAT. However reasons for prolonged TAT may vary with hospital to hospital depending upon different factors.