Journal of Health and Allied Sciences

Dengue is spreading alarmingly in Nepal: Integrated efforts are required for Prevention and Control

Damaru Prasad Paneru — 2019-12-08

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Association of Television Watching on Physical Activity and Obesity among Children in Pokhara, Nepal

Sushma Chhetri — 2019-12-08

Sedentary behavior of children is increasing day by day due to use of modernized technologies like electronic medias and devices. Many studies are exploring the effects of prolonged television viewing on physical activity and obesity throughout the childhood. This study aims to assess the television viewing habits, leisure time physical activity and prevalence of obesity among children in Pokhara sub metropolitan, Nepal. A cross-sectional study was performed based upon six wards of Pokhara sub-metropolitan. Self developed questionnaire was used to evaluate the different parameters like socio-demographic, lifestyle characteristics and anthropometric characteristics. Anthropometric measurement was done using stadiometer and bathroom weighing machine. Data was entered in the Epi-Data software. Data were transferred into Statistical Package for Social Sciences (SPSS) software for analysis. Total 306 children aged 8-12 years included in the study, there was higher prevalence of television watching where 69.6 percent exceeded for more than 2 hours per day with mean TV viewing time to be 154.97±60.66 minutes per day. The daily time spent watching television was positively associated with obese children (p=0.005, OR=2.863, 95% CI= 1.343-6.103). More than 65 percent of children had low physical activity. Similarly, normal body mass category also showed positive association with physical activity level (p=0.04, OR=0.367, 95% CI=0.181-0.741) and leisure time physical activity level (p<0.001, OR=0.230, 95% CI=0.125-0.425). The current finding reveals that almost one third of children population exceeded the limit of 2 hours/day of TV viewing. Monitoring and limitation of children’s TV viewing time along with encouragement in alternative entertainments like reading, walking and athletics and healthy eating habits should be done in order to reduce epidemic of obesity.

Key words: Television watching, Obesity, Physical activity, Children

Level of Anxiety among the Elderly Adults at Western Regional Hospital, Pokhara, Nepal

Rasmita Poudel — 2019-12-08

Anxiety disorders are abnormal states in which most striking features are mental and physical symptoms of anxiety, whichare not caused by organic brain disease or any other psychiatric disorder. This study aimed at exploring the level of anxietyamong the elderly adults in inpatient and outpatient departments of western regional hospital, Pokhara, Nepal.This is a hospitalbased cross-sectional study conducted in the outpatient as well as inpatient departments, medical and geriatric ward of westernregional hospital, Pokhara. We interviewed 318 respondents purposively using structured interview schedule. Geriatric Anxiety Scale (GAS) – Version 2.0 was used to assess anxiety symptoms. It was found an overall 68% had anxiety. The highestfrequency 209 (65.7%) respondents had moderate anxiety whereas only 7(2.2%) had high anxiety. Sex, religion and monthlyfamily income were significantlyassociated with level of anxiety (p<0.05). The burden of anxiety among elderly patients visiting tertiary level health care suggestsfocusing on evidence-based interventions by health authority.

Key words : Anxiety, Elderly, Magnitude, Nepal

Knowledge Regarding Diabetic Care among Diabetic Patient

Sabina Lamichhane — 2019-12-08

Diabetic mellitus is the most common non-communicable disease as well as lifestyle disease which require a multipronged approach for its management, wherein patient has an important role to play in terms of self-care practices. So self-care of diabetes is essential for to control of disease and improvement of quality of patient’s life. This study aimed to assess the knowledge regarding on diabetes care among diabetes patient. This is a cross sectional descriptive study. It included sixty respondents who were diagnosed as diabetes mellitus attending in Medical ward, Medical OPD and Surgical OPD,Western Regional Hospital. Respondents were interviewed using a semi structured questionnaire. The data was collected using non probabilitypurposive sampling technique and analyzed using SPSS 16. The patients’ knowledge about the disease and their diabetes care were the main outcome measures. In this study, patients’ knowledge about diabetes care was satisfactory. More than half (56.7%) of respondents were between 40-60 years age group followed by more than half (51.7%) of female respondents. Majority (73.3%) of the respondents reside in urban area. Less than half (42.6%) of respondents have received primary education. More than half (53.3%) of the respondents had suffered from diabetes duration of 1-3 years. More than half (53.3%) of respondent had no family history of diabetes. Majority (76.7%) of respondents thought that diabetes is controllable disease less than half (35%) of respondents thought that diabetes may cause complication. Most (90%) of respondents received information about diabetes care from health worker/ institution. Knowledge regarding diabetic diet, exercise, oral health, eye care, foot care and blood sugar monitoring of respondents were 61.7%, 15%, 21.7%, 50%, 25%, and 31.7% respectively. The finding revealed that diabetic patent had a satisfactory knowledge on diabetes care. It indicates need of giving proper knowledge to diabetes patients by education.

Key words : diabetes, diabetes care, knowledge

Diurnal Variation of Serum 25 (OH) D3 , Calcium and Phosphorus in Type 2 Diabetes Mellitus

Rupendra Shakya — 2019-12-08

Diurnal variation, an outgrowth of chronobiology, is the inferential statistical mapping of structures in variables; in and around us, consisting of rhythms chaos and trends. Type-2 diabetes mellitus is a metabolic disorder with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. The diurnal time structure of serum 25(OH) D3 and calcium may relate to the prevention and chronotherapeutic efficacy and management of type 2 diabetes mellitus. To our knowledge, the diurnal variation of serum 25(OH) D3 has not yet been reported in type 2 diabetic patients. The present study was planned to evaluate the diurnal variation of serum 25(OH) D3 , calcium and phosphorus levels in type 2 diabetic patients. Ten clinically healthy volunteers and ten diagnosed patients of type 2 diabetes mellitus of similar age groups were synchronized for one month with diurnal activity from about 06:00 to about 22:00 and nocturnal rest. All subjects took their meals three times daily without any change in their usual fluid intake. Blood sample were collected into plain and sterile vials under quality control procedures from each participant at every 6 hour. Serum 25(OH) D3 , serum Ca++, serum PO4 , FBS and PPBS levels were estimated. A marked diurnal variation in serum 25(OH) D3 was recorded in healthy subjects (P=0.030). Similarly, a circadian rhythm of borderline statistical significance was also recorded for vitamin D in diabetic patients (P=0.083) and in healthy participants for serum calcium (P=0.070), phosphorus (P=0.102), and the calcium-phosphorus ratio (P=0.091) by the Two way ANOVA analysis. In addition, the amplitude and acrophase differed from healthy participants in diabetic patients for studied variables with a change of MESOR for calcium-phosphorus ratio. Mapping the broader time structure of different physiological variables investigated herein may be helpful in understanding the treatment and prevention of diabetic mellitus.

Key words: Serum 25(OH) D3 , Calcium, Phosphorous, Type 2 Diabetes mellitus

Factors Associated with Teenage Pregnancy: A Case Control Study

Nirmala Neupane — 2019-12-08

Teenage pregnancy is a major public health problem worldwide. Studies shows that teenage mothers are more likely to experience pregnancy-related complications compared to normal age mothers. This study was conducted to find the associated factors of teenage pregnancy. Hospital based case-control study was adopted among teenage mothers (15-19 years) and non-teenage (20-29 years) postnatal mothers admitted in two medical college teaching hospitals of Pokhara. Systematic random sampling was used to select the respondents. Study sample comprises 432 respondents with 216 cases and 216 controls. The data was collected by using structured interview schedule and collected data were entered in MS excel with validated command and analyzed with SPSS 16 version. The study resulted that teenage pregnancy was associated with disadvantaged ethnicity (AOR: 2.02, 95% CI: 1.14-3.56) agriculture (AOR: 5.37, 95% CI: 1.86-15.49) and labour (AOR: 6.22, 95% CI: 2.56-15.11) family occupation, lower education (AOR: 2.57, 95% CI: 1.39-4.76), nonworking status of women (AOR: 2.87, 95% CI: 1.60-5.14), unplanned pregnancy (AOR: 1.79, 95% CI: 1.101-3.21), incomplete immunization (AOR: 2.32, 95% CI: 1.11-4.84) and preterm gestational age (AOR: 3.23, 95% CI: 1.46-7.15).It is recommended to design and implement health education interventions especially for disadvantaged groups and people with low socio economic to reduce teenage pregnancy; to emphasize on providing opportunities for higher education, employment and empowerment and increasing utilization of family planning and maternal health services among teenagers.

Key words: Teenage pregnancy, associated factors, case control study, outcomes, adolescents

Prevalence and Factors Associated with Food Security from Rural Community of Parbat District

Bijaya Parajuli — 2019-12-08

Food security exists when all people at all times have physical and economic access to sufficient, safe and nutritious food that meet their dietary needs and food preferences for an active and healthy life. Similarly food insecurity at household level refers to the inability of the household to secure adequate food for meeting the dietary needs of its members. The study aimed to assess the prevalence and factors associated with food security from rural community of Parbat district. A community based cross-sectional study was conducted among 385 participants of 21 wards from seven different Village Development Committee of Parbat district. A systematic random sampling technique was used to select the participants. Data were collected through face to face interview using the Nepalese version of Household Food Insecurity Access Scale. Ethical approval was taken from Nepal Health Research Council. Bivariate analysis was done to identify the associated factors of food security. The study revealed that more than half of the households were food insecure. There for ecommunity based food security program is recommended to improve the food security condition of the rural communities of Parbat district. The key factors associated with food security were: availability and accessibility factors as: land availability, amount of land,irrigation unavailability and allocation of money not enough for food. Sustainable agriculture production through the promotion of technologies to enhance crop by proper water management in the land and alternative solutions as provision of livestock farming to those who have less land are recommended.

Key words: Food insecurity, availability, accessibility, rural areas

Role of Education in Health Care Decision Making in Nepal: Evidences from a Cross-Sectional Survey

Deepak Raj Paudel — 2019-12-08

Education is increasingly put forth as a means of empowering women in developing countries, such as Nepal. Grounded on intra-household gender dynamics literature, empowerment in this paper is conceptualized as the decision-making ability of a woman regarding health care. The purpose of this study is to examine the role of education level as a means of improving women’s intra-household bargaining power in the spheres of health care. A cross-sectional survey was conducted from June to July 2013 among 300 married women of three districts in Gandaki Province of Nepal. The sample was selected in three stages, first stage being the selection of districts, second, being the village development committees and third being women. Logistic regression was applied to analyze the effect of women’s education on decision making on health care. The study reveals education level has a positive and significant effect on women’s decision making on health care. Overall, this study highlights the need for efforts to educate Nepalese girls in terms of higher schooling and associated beneficial welfare effects.

Key words: Health care, women’s education, decision making, Gandaki Province, Nepal.

Effect of Coping and Threat Intervention on Physical Activity Intention among Government Employees of Baglung Municipality

Janaki Pathak — 2019-12-08

Physical inactivity is one of the major risk factors for non-communicable diseases. Physical activity related to work was categorized into vigorous, moderate and low levels. Dissatisfaction with body image proportionally increases with increasing BMI and engagement in some form of physical activity. The main objective of this study was to determine the effectiveness of coping and threat intervention to increase the physical activity intention among employees of governmental offices in Baglung Municipality. This study was done among 15-69 age group which are at risk of developing obesity and its related diseases. Since obesity and physical activity are associated it is essential to explore obesity related information session for change physical activity intention, which provides the rationale for the current study. One group pre-test, post-test design was used in this study. Physical activity intention was measured applying protection motivation theory based on self-administered questionnaire, and anthropometric assessment was used to measure the body mass index. Formative research was done to develop educational intervention. Forty eight samples from different governmental organization of Baglung Municipality selected from simple random sampling without replacement technique. Frequency, percentage, mean and standard deviation for univariate, chi-square and paired t-test for bivariate analysis was done. Most of the participants were male (81.3%) with mean age of (40.19 ± 10.61) years and plurality of the participants were in 45-69 age groups (41.7%). There was significant increase in self efficacy towards physical activity (p<0.049) and severity towards obesity (p<0.001) after the intervention. Both intention towards physical activity (p<0.001) and health literacy (p<0.001) were significantly increased after intervention. Interactive lecture was effective to bring about changes in self efficacy, severity, intention and health literacy. Interactive lecture method based on coping and threat strategies of protection motivation theory is recommended to increase physical activity intention and health literacy among governmental employees.

Key words : Physical exercise, Protection motivation theory, Body image, Health literacy, body mass index.

Expenditure for Hemodialysis: A Study among Patient Attending at Hospitals of Pokhara Metropolitan City, Nepal

Nirmala Thapa — 2019-12-08

Incidence and prevalence of chronic kidney disease (CKD) is increasing worldwide. It is contributing significantly to deaths and disability. Every year, numbers of cases of renal failure requiring hemodialysis are also increasing. Government of Nepal has made a provision to support the patients undergoing hemodialysis; nevertheless, the patient has to bear the huge financial and psychological burden for dialysis. This study was carried out to study the expenditure made by the patients for dialysis in the Pokhara Metropolitan City Nepal. This was an institution based cross sectional descriptive study. A total of 157 patients who had dialysis or undergoing dialysis at different hospitals of Pokhara Metropolitan City were interviewed using structured interview guideline. Expenditure records of patients were also reviewed. The study was carried out during August to October, 2018. Results are presented in table and diagrams aided by statistical tests like mean, median, standard deviations and ranges. Majority of the patients were male (61.8%). Mean age of the patients under hemodialysis was 49.75±14.91 years. Majorities were Janajati (53.5) and most of them were unemployed (78.3%). Total expenditure made for hemodialysis was NRs. 32,810 (US$ 289.87). The median monthly out of pocket expenditure for haemodialysis per patients was Nepalese Rupees (NRs) 32,810 (US$ 289.87) in which median monthly indirect cost of hemodialysis was NRs 9,200 (US$ 81.28) and median direct cost of hemodialysis per month was NRs 23610 (US$ 208.59). A great majority (78%) of the respondents faced catastrophic health expenditure for dialysis. Patients with renal failure requiring dialysis faced catastrophic health expenditure. The government should focus on programs supporting for dialysis and pay attention on the preventive measures for occurrence of kidney diseases.

Key words : Hemodialysis, Expenditure, Patient

Application and Validation of the Beck Anxiety Inventory among Nepalese School Adolescents

Chiranjivi Adhikari — 2019-12-08

Anxiety is a common mental disorder (CMD) and it affects all the age groups including children and adolescents. Various scales and tools are available to screen and diagnose anxieties. Beck Anxiety Inventory (BAI) is a reliable tool recommended for 12- 80 years to screen panic to geriatric anxiety. It is also applied and validated among Nepalese adults for Generalised Anxiety Disorder (GAD). This study was aimed to apply and validate the Beck Anxiety Inventory (BAI) against school adolescents in Nepal. BAI is a 21-item self-reported scale having four-point Likert scale from “0” (Not at all) through “3” (Severely-I could barely stand it). The tool was translated into Nepali and back-translated into English and several iterations were done till the original meaning was obtained. The tool was concurrently validated against seven-item Generalized Anxiety Disorder scale (GAD-7) as a gold standard, which possesses only seven items and similar Likert scale. Descriptive, inferential including sensitivity, specificity and principal component analysis were performed for 2007 sample adolescents from 13 public and ten private schools of five development regions of the country. The prevalence of generalized anxiety was 34.78% and descriptive data revealed that the BAI and GAD-7 scores were positively skewed. The concurrent validity was moderate (ρ=0.58, p<0.001) and the BAI showed a good internal consistency (a=0.86). The cut-off of 13/14 showed acceptable sensitivity (70.9% ), specificity (73.1% ), and AUC (80.0% (95%CI; 77.4-82.5)) (p<0.001). The principal component analysis showed six-factor explaining 52.04 percent variance, instead of four-factor in most of the literatures. The Nepalese BAI-Adolescent is a valid tool for age group 13-19 years; if applied cautiously regarding the items three, six and thirteen. It can screen 80.0% of the generalized anxiety cases with 70.9 percent sensitivity and 73.1 percent specificity among students and hence recommended to use in schools.

Key words: Adolescent, application, anxiety, Beck, Nepalese, school, validation.

Assessment of Nonsteroidal Anti-inflammatory Drugs Prescription Pattern and Gastrointestinal Risk Factors in a Tertiary Care Hospital of Western Nepal

Parbati Dulal — 2019-12-08

NSAIDs are commonly prescribed group of drugs with changing frequency of prescription pattern over a period of time and has wide range of adverse effect, mainly on alteration in GI, renal functions and CVS system, which can be life-threatening. Thus, the aim of study was to evaluate the current prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of NSAID-induced gastrointestinal (GI) risk factors in a Tertiary Care Hospital of Western Nepal. A prospective observational NSAIDs induced gastrointestinal risk related study was conducted over a period of two months by clinical pharmacist on which study cohort include 370 patients who are taking or/and prescribed with NSAIDs. A self-administered questionnaire was completed by each patient for knowledge over prescribed NSAID and simplified risk scoring scale (the Standardized Calculator of Risk for Events; SCORE) was used to evaluate patients risk for GI complications with the used of NSAIDs. Data were analyzed by using Statistical Package for Social Science (SPSS) software version 17.0. The study groups were stratified into four risk groups according to GI SCORE tool, 18.4% of the patients belonged to high risk to very high risk groups for gastrointestinal complications. Analysis of prescription pattern revealed that overall frequency of prescription pattern of plain NSAIDs was found to be 60%, among which naproxen 500mg (21.3%) was found to be the most commonly prescribed non-selective NSAIDs (92%). Out of 370 at 105 prescription FDCs were prescribed. The finding conclude that although about more than 70% of patients receiving gastroprotective agents and had knowledge over NSAIDs still patients were at high to very high risk for NSAID-induced gastrointestinal complications and still there is a need of effective education/ knowledge towards NSAIDs and their pros and cons on use to the respective healthcare workers and patients in order to promote effective drug utilization.

Key words : Fixed Dose Combination (FDCs), Gastro-protective Agents (GPAs), Gastrointestinal complications, Non- Steroidal Anti-inflammatory Drugs (NSAIDs),

Respiratory Health Problem among the Taxi Drivers of Pokhara Metropolitan City, Nepal

Sudarshan Gautam — 2019-12-08

Respiratory health problems affect the respiratory tract and lungs. WHO states that four major potentially fatal respiratory problems will account for about one in five deaths worldwide by 2030. Taxi drivers are among the major sub-population at the risk of respiratory problems because of their exposure to polluted environment. Therefore, the present study aimed to find out the respiratory health problems among the taxi drivers of Pokhara metropolitan city of Nepal. A cross sectional study was conducted among 203 taxi drivers of the Pokhara Metropolitan city. Multistage sampling method was used to select the desired number of taxi drivers. Data were entered into EPI-DATA 3.1 and then analyzed in SPSS 20. Percentage, mean, and standard deviation were assessed to describe, and chi square test was used to infer the findings. Ethical approval for this study was obtained from Nepal Health Research Council. All samples were male with mean age of 38.46 ± 7.8 years. Majority of the taxi drivers were educated up to secondary level (54.2%), married (91.6%), were married and 78.8 percent had income of NRs 1000-1500/day. A large proportion of the drivers (96.6%) had to work for more than 10 hours/day and three-quarters (74.4%) of them did not take rest even in weekends. Nearly a quarter (24.1%) of them complained at least one respiratory health problem or symptom. Prevalence of respiratory health problems among the taxi drivers was 24.1 percent. Job duration was significantly associated with the respiratory symptoms.

Key words : Respiratory problem, preventive practice, taxi driver

Clients Satisfaction on Perinatal Health Service among Postnatal Mother in Bharatpur Hospital

Saran Kharel — 2019-12-08

Perinatal and maternal health are interlinked.World Health Organization defined perinatal period as period commences at 28 completed weeks of gestation and ends seven completed days after birth. The health care services that a woman receives during this period are very important for the survival and wellbeing of both the mother and a child.The study aimed to assessthe client satisfaction on perinatal health services among postnatal mothers in Government Hospital of Bharatpur, Nepal. Cross-sectional descriptive study design was used to determine the level of patient satisfaction through purposive sampling technique. The client satisfaction is measured by using 5 point likert scale with different items on ANC, intranatal, PNC and general.The study population comprised of married women of reproductive age who had taken service from maternity ward of Bharatpur Hospital. The data was collected through semi-structure interview schedule and collected data were entered in Epi-data 3.1 and exported data was analyzed using SPSS. Frequency tabulation, mean, percentage and chisquare test were done for statistical analysis The total sample size was 140, among them most of 100 (71.4%) respondent were 20-29 years. The level of satisfaction were found more on postnatal services (64.3%) than antenatal services (60.7%) and intranatal services (55.7%). In terms of association between perinatal satisfaction with the selected demographic variables only two variables i.e. parity and number of child shows association with Chi-square 0.591 and 4.078 and p-value 0.018 and 0.043 respectively.

Key words: Hospital, clientsatisfaction, Perinatal period

Awareness and Practice of Cervical Cancer and it's Screening Among Married Women of Syangja, Nepal

Mamata Chhetri — 2019-12-08

Cervical cancer is the second most common cancer in women worldwide. Close to half a million new cases are diagnosed each year and over 2.5 lakhs of women die due to cervical cancer annually. Current estimates indicate that every year 2332 women are diagnosed with cervical cancer and 1367 die from the disease. It is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide. A cross-sectional descriptive design was used to assess the awareness and practice of cervical cancer screening among the married women of Syangja district. Proportionate stratified sampling was used to select the total 207 representative sample. Data was collected by using semi structured interview schedules and collected data were entered in Ms-Exel and analyzed using SPSS. The study result showed that majority 96% of the respondents had poor awareness and whereas none of the respondents had good awareness regarding the cervical cancer and its screening tests. The highest awareness was in the area of cervical cancer screening with mean percentage 61.11% whereas the least awareness was in the area of general aspects of cervical cancer with mean percentage 41.55%. Regarding practice of cervical cancer screening test 25.6% had performed it within 5 years, among them 50.93% of the respondents had undergone pap smear test. There was no association exists between the selected demographic variables and the level of awareness. Similarly there was no correlation exists between the level of awareness on cervical cancer and practice of cervical cancer screening. Majority of the women had poor awareness regarding the cervical cancer screening tests and significantly low practice of cervical cancer screening test.

Key words: Awareness, Practice, Cervical cancer, cervical cancer screening

Factors Influencing Exclusive Breast Feeding Practice among the Mothers of Infants in Pokhara

Bijita Joshi — 2019-12-08

Exclusive breastfeeding means infant receives only breast milk and nothing else except for oral rehydration solution (ORS), medicines, vitamins and minerals for first six months of age. The prevalence of exclusive breastfeeding in our society is low and various underlying factors are responsible. The main aim of this study was to identify the factors influencing exclusive breastfeeding practice among the mothers of infant in Pokhara. A descriptive cross sectional study was conducted among 101 breastfeeding mothers having infant up to six months in the immunization clinics held in ward no. 12, 13, 14, 15 and 16 of Pokhara-Lekhnath metropolitan. Non probability purposive sampling technique was used. Researcher developed questionnaire were administered to the mothers and data collected. The data were analyzed with Chi square test using SPSS 20 software. The findings revealed that the prevalence of exclusive breastfeeding practice among the mothers of infant below six months old was 49.5 percent. The factors such as mode of delivery (p<0.001), pre lacteal feeding (p<0.001), time of initiation of breastfeeding (p<0.001) and breast problems experience (p= 0.004) were found associated with the exclusive breastfeeding. It concludes that factors such as mode of delivery, pre lacteal feeding, time of initiation of breastfeeding and breast problems experience were found associated with EBF practice. Low birth weight of infants and higher education status of mothers did not influence on EBF. There is a need to provide information on prevention of breast related problems among the breastfeeding mothers for the promotion of EBF practice.

Key words: Exclusive breastfeeding, Infant, Mothers