Journal of Karnali Academy of Health Sciences

Institutionalization of Minimum Service Standards (MSS) for Health Facilities in Nepal: Exemplary Plan-Do-Study-Act (PDSA) Cycle for Readiness and Service Availability

2023-08-05T07:19:55+00:00

Access to health facilities alone, without quality services, does more harm than the benefit to the people’s health.
Nepal has invested more than two decades in expansion of number of health facilities and the journey is still on to
balance level of health facilities based on the federal structure. Institutionalization of Minimum Service Standards
(MSS) for health facilities in Nepal implemented by Ministry of Health and Population is an exemplary Plan-DoStudy-Act (PDSA) cycle for health facilities readiness and service availability for quality improvement. Thus, it is important to document the process for guiding institutionalization of tools. From its design, development, stakeholders’ engagement, implementation to development of action plan makes MSS lively and outcome-oriented
tool. MSS for health facilities in Nepal is an effort of government to prepare foundation of readiness and service
availability to move ahead with effective quality service utilization. Digitalization of the all sets of MSS,
development of MSS to cover the existing type of the health facilities currently present in the country and access
of data set for researchers is the way forward. Developing standards for national accreditation system and
international collaboration is the next step to embrace. Furthermore, MSS gradually reported through selfassessment of the health facilities with occasional monitoring by the local, provincial and federal government and gap fulfillment through routine annual work plan and budgeting is the future direction. It is high time MoHP moves ahead with service specific quality improvement tools integrated with MSS assessment to prepare them for high
quality health systems that can adapt to changing health needs and health shocks.

Awareness and Practice of Family Planning Methods among Women in Jumla - A Cross-Sectional Study

2023-08-05T07:19:55+00:00

Background: The family planning method is used to help individuals and couples to avoid unwanted pregnancies, regulate intervals between pregnancies, and determine the number of children to be given birth. Family planning is an effective intervention for promoting maternal health, but its acceptability and utilization are affected by many factors. High level of maternal and infant mortality is related to unintended pregnancy. The main causes of unintended pregnancy were no use of family planning methods. One of the perceived barriers to family planning was a lack of knowledge about family planning use. Therefore, the objective of this study is to assess the awareness and practice of family planning methods among women in Chandannath Municipality Jumla. Methodology: A community-baseddescriptive cross-sectional study was conducted through face-to-face interviewsusing a semi-structuredinterview questionnaire among 64 women. The Multi-stage sampling technique was adopted. The Chandannath municipality of Jumla districtwas chosen purposively at first then the study site was selected by simple random sampling (lottery) and the sample was selected by systematic random sampling technique. This study was conducted after getting ethical approval from the Institutional ReviewCommittee of Karnali Academy of Health Sciences. Data were analyzed by using Statistical Package of Social Sciences version 16. Descriptive analysis (Frequency, percentage, mean, standard deviation) and inferential statistics (chi-square) was used.

Results: Out of 64 respondents,nearlyone-third (31.30%) of the respondents were 40 and above years. 96.90% of the respondents and 98.40% of their husbands were literate. The majority 60.90% had a family size below five and 89.10% had less than three children. 59.37% of the respondents know the meaning of family planning as a measure of birth control and 62.50% were aware that FP improves maternal and child health.79.6percentagehad information from health workers. 90.60%) of respondents were aware thatfamily planning methods are available from health posts. 51.60% of respondents had adequate awareness; 46.90% were current family planning users. Among them 36.65% used Depo-Provera. The level of awareness was not significantly associated with their practice of family planning methods (p=0.216).

Conclusion: This study demonstrates that more than half of the respondents had adequate awareness and nearly half of the respondents were current family planning users. There is no association between the level of awareness and practice of family planning. It provides baseline data of the respective area. Health personnel and responsible authorities will be sensitive to increase awareness and optimize the utilization of family planning. Further large-scale studies are needed to identify barriers to usingfamily planning methods.

Assessment of Food Intake and Nutritional Status of Children Attending Montessori School of Pokhara Valley

2023-08-05T07:19:55+00:00

Introduction: Childhood is a time of critical growth in which proper nutrition is necessary.Children afflicted by sustained poor nutrition are at greater risk for obesity, mental and emotional health problems and a failure to thrive academically. The objective of thisstudy was to assess the food intake and nutritional status of children attending the Montessori school.

Methods: A cross sectional study was carried out among 235 children of 3-5 years from twenty Montessori schools. Data were collected using simple random sampling. A weighed food was recorded from the consumption of children during a day of their stay in the Montessori school along with the observation of food consumption.

Results: More than every nine out of ten children (92.8%) didn’t meet calorie requirement. The mean food intake during their stay in Montessori was 368.81±111.89 grams. Mean calorie, fat, protein, retinol and beta carotene intake were 540±150.5 Kcal, 10.04±5.6 grams, 13.25±5.49 grams, 49.76±32.6 grams, 135.75±274.67 grams respectively. Dietary fat (OR=3.7, 95% CI; 1.8-7.5) and protein consumption (OR=2.2, 95% CI; 1.1-4.4) were significantly associated with overweight status of children.

Conclusion: The numberof nutritive foods should be increased so that the children meet adequate amount of nutrient required for the proper growth and development of their body. Since the association between dietary fat and protein intake with overweight condition was observed the excess use of fat providing foods should be limited and protein rich foodsshould be provided as per the Recommended Dietary Allowance (RDA) of Montessori children.

Clinical Characteristics, Maternal and Fetal Outcomes of Pregnant Women with COVID-19

2023-08-05T07:19:55+00:00

Background: Pregnant woman are more vulnerable to COVID infection due to physiological changes in the immune and cardiopulmonary system. The aim of the study is to assess the clinical characteristics, maternal and fetal outcomes of pregnant patients with COVID-19 in Patan hospital.

Methods: This was a descriptive cross-sectionalstudy conducted in Patan hospital from 1 August 2020 to30July 2021 following approval from ethical committee. The study population comprised of all pregnant women with COVID-19 diagnosed by reverse transcriptase polymerase chain reaction test. There were total of 171 cases. The data were obtained from medical records and hospital database system. The statistical analysis was done by using SPSS version 16.

Results: In Patan hospital, there were a total of 171 patients who were COVID-19positive by PCR test. There were total deliveries of 4,277 during one year period and hence the incidence was 3.99%. There were101 (59.06%) caesarean section and 70 (40.93%)vaginal deliveries among which one was vacuum assisted delivery. There were two peripartum hysterectomies. Majority of the patients were asymptomatic, common symptoms were cough 29 (16.95%), fever 27 (15.78%) and shortness of breath 13 (7.6%). Prematurity was the common fetal complicationseen in 28 (16.37%) of the cases. Maternal mortality was seen in 7(4.09%) patients. Conclusions: COVID-19 is associated with increase maternal morbidity and mortality. Symptoms can be from mild form to muchmore severe course of illness. Proper treatment and timely referral of severe cases to higher center can improve both maternal and fetal outcomes in COVID-19 in pregnancy

Determinants of Toilet Training Awareness among Mothers in Siddharthnagar Municipality of Rupandehi District, Nepal

2023-08-05T07:19:55+00:00

Introduction: If children are not trained in toilet training, they may have psychological issues. Mother’s alertness plays a very important role in toilet training which is vital for the better growth and development of a child. Thus the objective of the study was to assess thedeterminants of awareness regardingtoilet training among mothers.

Methods: Descriptive cross-sectional study design was carried out among 100 mothers of children aged 1-3 years using non-probability purposive sampling technique. The study was done in Siddharthnagar Municipality, ward number 3, RupandehiNepal from 19thSeptember to 3rd October 2021. Semi-structured questionnairewas used to collect the data. The collected data was checked, reviewed, coded, edited, entered in Microsoft excel and was analyzed by using Statistical Package for Social Science version 20. In descriptive analysis frequencies, percentages, means, and standard deviation were calculated. Inferential statistics was used to find the determinants of awareness level.

Results: The study findings revealed 49% of mothers had high level of awareness regarding toilet training. Mothers having age group 31 to 40 years (AOR=12.27; CI: 2.87-52.49), who cannot read and write (AOR=0.09; CI: 0.02-0.52), and number of living children (AOR=36.58; CI: 6.26-213.55) were significantly associated with level of toilet training awareness.

Conclusion: Almost half of the mothers had high level of awareness regarding toilet training. Age of mother, education status of mother and number of children were determinants of toilet training awareness of mother. Thus, local government, policy makers and health personnel are recommended to conduct informal educational program especially for early age mothers and mothers having only one child for promoting andupgrading the mother’s awareness regarding toilet training.

Awareness of Cardiovascular Health among Adults Residing in a Municipality in Kathmandu District, Nepal

2023-08-05T07:19:55+00:00

Background: Cardiovascular diseases are the leading cause of high disability adjusted life years and premature death,accounting disability among 43% of cases. If there is public awareness, most of the cardiovascular diseases can be prevented with modification of behavioral risk factors.Therefore, this study was conducted to find out the peoples’ awareness oncardiovascular health.

Methods: A cross-sectional design was used. Data was collected using an in-personinterview techniqueamong randomly selected236 adults residing in Budhanilkantha Municipality of Kathmandu District. Semi-structured interview schedule based on WHO Stepwise approach and literature review was used to collect data. Data analyzed usingdescriptive statistics (frequency, percentage, median, Inter Quartile Range)and inferences were drawn with an application of the chi-square test, and Fisher’s exact test.

Results: Among 236 participants,most (85.6%) of the adults had an adequate level of awareness regarding cardiovascular health. However, around 80% of them were unaware of radiating pain as a symptom of heart attack and around 40% of adults did not recognize high blood sugar and dyslipidemia as risk factors of cardiovascular disease. Awareness of cardiovascularhealth was significantly associated with educational level (p<0.001), ethnicity (p=0.021), self-reported morbidities (p=0.044) and family history of morbidities (p<0.001).

Conclusion: Although adults were aware of cardiovascular health, most of them did not know that control of blood sugar and blood cholesterol are necessary to maintain cardiovascular health. Hence, awareness programs targeting these aspects would be beneficial.

Knowledge and Attitude on Substance Abuse among Higher Secondary Schools Adolescents in Kathmandu District

2023-08-05T07:19:55+00:00

Background: Substance abuse creates a great threat to the health, social and economic condition of individual, family, community and to the nation. In the past two decades’ abuse of substances is an important public health concern especially among adolescent which creates tremendous burden on society. So, researchers were interested to assess the knowledge and attitude of adolescents on substance abuse in higher secondary schools of Kathmandu district.

Methods: A cross-sectional descriptive study design was used to assess the knowledge and attitude of adolescence on substance abuse. At first seven school and colleges was selected by the probability simple random sampling technique with 630 sample studying management and humanities. Data collection was done through self-administered questionnaire.

Results: More than half (59.2%) respondents have poor knowledge whereas only 8.6% have good level of knowledge on substance abuse, as only few have good level of knowledge on substance abuse. There is significant association between the levelof knowledge with age group (p value 0.011), Sex (p value 0.001), Ethnicity (p value 0.001), type of family (p value 0.001) and father’s education (p value 0.027) mother’s education (p value 0.009), father occupation (p value 0.036), and relationship between parents (p value 0.01).

Conclusion: More than half respondents have poor knowledge whereas only 8.6% have good level of knowledge on substance abuse. Though awareness campaigns exist in the country, but findings of this study suggest that still these activities need to be made more strengthen in order to make aware to the youth.

Ultrasonographic Assessment of Submandibular Salivary Gland at a Tertiary Care Centre in Nepal

2023-08-05T07:19:55+00:00

Background: Various disease conditionscan lead to the increased size of the submandibular gland. Normal dimensions of the salivary gland areuseful for the identification and diagnosis of various associated pathology. The study objective was to assess the normal dimension of the submandibular gland using an ultrasonograph at a tertiary care centre inNepal.

Methods: The descriptive cross-sectional study was conducted in the Department of Radiology and Imaging College of Medical Sciences, Bharatpur, Nepal among 126 patients. Ultrasound of the submandibular gland was done of all patients with Toshiba Aplio 500 superficial probe. The data werecollected and entered into Statistical Package for the Social Sciences version 16 and analyzed using descriptive statistics. Later the data was presented in form of tables.

Results: There were in total 126 patients who participated in the study. Among them 78 (61.9%) were females and the rest were males. The mediolateral width of the right submandibular salivary gland (2.70±0.40 cms) was slightly greater than the left side. The volume of the left salivary gland (6.91±2.32 cm3) was slightly larger than the right side in males. However, there was no statistically significant difference between male and female

Conclusion: This study concluded that the volume of the left salivary gland was slightly larger than the right side. The volume of the salivary gland of femaleswas more than males.

Morbidity Pattern and Health Seeking Behavior of Elderly People in Surnaya Rural Municipality, Baitadi, Nepal

2023-08-05T07:19:55+00:00

Background: The number of older persons in the world has increased substantially in recent years and the growth is projected to accelerate in the coming decades. With an increase in the proportion of the aged population, the elderly with ailments is also on the rise. The aged population has special health problems that are different from those of adults or young. This study aims to assess the morbidity patterns and health seeking behavior of elderly people.

Methods: A community-based, cross-sectional study was conducted among 197 elderly people in Surnaya Rural Municipality, Baitadi. Data was collected through face-to-face interview using a pre-tested structured questionnaire. Ethical approval was received, and ethical issues were addressed. Data were processed using IBS SPSS v.25.0. Descriptive statistics and chi-square test was used.

Results: The prevalence of morbidity was 71.6%. Respiratory condition was most reported, followed by digestive, musculoskeletal, and cardiovascular diseases. Further, 17.0% sustained injury. Healthcare seeking by 77.3% and 76.1% had treatment compliance. The morbidity condition was significantly associated with economic status (p=0.041), spiritual activity (p=0.032), and difficulty falling asleep (p=0.003). Distance to reach the nearest health facility (p=0.022) and presence of chronic health problems (p<0.001) was significantly associated with healthcare seeking behavior of the elderly.

Conclusion: The high prevalence of multiple morbidities in elderly was reported, among which the respiratory condition was leading. Still, large numbers of elderly do not seek healthcare and have low treatment compliance. Elderly-friendly health services, an extension of health insurance, and health screening services are recommended to enhance health seeking behavior of the elderly.

Changes in Occurrence of Diarrheal and Respiratory Diseases before and during COVID-19 Pandemic among Nepalese Population: A cross-sectional Study

2023-08-05T07:19:55+00:00

Background: The government of Nepal has adopted a number of preventative and control measures to halt the spread of coronavirus disease (COVID-19). In this study, we aimed to determine whether the use of preventive and control measures such as hand washing, social distancing, lockdown implementation, and mask-wearing has significantly slowed down the spread of infectious diseases like diarrhoea and respiratory illnesses during the pandemic period.

Methods: A descriptive and cross-sectional study was conducted among 3086 participants across Nepal via electronic media from July 28 to August 30, 2020. The participants were asked to provide information about their experiences with diarrhoea and respiratory symptoms in the three months before and during the COVID-19 pandemic. The Mc-Nemar test was used to compare the incidence of respiratory and diarrheal diseases before and during the pandemic period.

Results: Compared to before and during the COVID-19 pandemic, vomiting (3.3%), diarrhoea (7.3%) and abdominal pain (12.1%) decreased to 2.8%, 6.9%, and 6.1%, respectively. Between two concurrent periods, such as before the onset and during the COVID-19 pandemic lockdown, the prevalence of dysentery and stomach pain was statistically different (p-value< 0.001).As the prevalence of the common cold decreased from 30.2% to 20.3%, so did that of sore throats (15.1% to 10.6%), coughs/chest pain (8.3% to 5.6%), dyspnoea (2.8% to 1.9%), and pneumonia (2.6% to 1.5%). This difference in the prevalence of respiratory diseases such as the common cold, sore throat, laryngitis/pharyngitis, cough/chest pain, dyspnoea, and pneumonia were statistically significant.

Conclusion: Upon comparing the COVID-19 period to the pre-pandemic period, it appeared that the symptoms of diseases like diarrhoea and respiratory illnesses were on the decline. Therefore, we can conclude that the Government of Nepal's preventive measures for COVID-19 have helped to reduce the prevalence of such diseases

Examining the Impact of Emotional Intelligence on Employee Well-Being and Employee Engagement in the Digital Era

2023-08-05T07:19:55+00:00

Introduction: Employee Well-Being (EWB) and Employee Engagement (EE) are crucial for a healthy workplace, but concern about Well-Being (WB) and EE are still prevalent. Emotional intelligence (EI) can help regulate and recognize emotions, and this study examines its impact on EWB and EE in the Digital Era (DE), considering socio-demographic factors.

Methods: This study used a self-administered survey to gather the data and combined a quantitative method with a descriptive cross-sectional research design. The study made use of a variety of tools, including the employee engagement scale (EES), which was used to assess EE, the emotional intelligence scale (EIS), which was used to measure EI, and the functional well-being score from the World Health Organization (WHO), which was used to measure EWB. All the tools used in the study have been validated and are reliable, as determined by Cronbach’s alpha and other statistical analyses

Results: The findings demonstrated that emotional intelligence (EI) significantly impacts employee well-being (EWB) and employee engagement (EE). H1 was accepted through Pearson correlation (P > 0.005, R = 0.065, R² = 0.004, and adjusted R² = 0.001), while H2 was supported by regression analysis (P >0.005, R = 0.717, R² = 0.514, and adjusted R² = 0.512). These findings highlight that EI is a predictor of EWB and EE, as well as a factor associated with years of work experience.

Conclusion: The findings suggest that EI plays a crucial role in determining EWB and EE. The study also highlighted the association between EI and years of work experience. These results imply that developing and enhancing EI competencies could positively impact EWB and EE, thereby improving job satisfaction and organizational outcomes. However, the study's limitations include a small sample size and a cross-sectional design, which limits the generalizability of the findings. Further research could explore the causal relationship between EI, EWB, and EE and identify potential interventions to enhance EI in the workplace.

Knowledge and Practice of Injection Safety among Nurses Working in Tertiary Health Science Institute of Eastern Nepal

2023-08-05T07:19:55+00:00

Background: Injections are among the nursing procedures which are commonly performed worldwide. Unsafe injections occur routinely in most developing world regions, implying a significant potential for the transmission of blood borne pathogen. Unsafe injections currently account for a significant proportion of all new hepatitis B and C infections. This study was done to explore the factors affecting knowledge and practices and to carry out observation in selected sample.

Material and Methods: A descriptive cross-sectional study design was used to conduct the study among 143 nurses working at selected wards of BPKIHS using self-administered questionnaire. The Medical, Surgical, Emergency, Orthopedic, ICU, SICU, Gynecology, Antenatal and Postnatal wards were selected purposively and the nurses were selected using population proportionate stratified random sampling. Observation of the 30 injection procedure was carried out .Collected data was analyzed using various descriptive and inferential statistics.

Results: The mean age of the respondents was 25.48±3.66 years. Poor knowledge was seen among 33.6% and good knowledge was seen among 66.4% of the respondents. Similarly, good practice was observed among 11.2% and excellent practice was observed among 88.6% of the respondents. Significant association was found between knowledge and socio-demographic variables i.e. total work experience (p 0.023), vaccination against hepatitis B (p<0.001)

Conclusion: The study concluded that one third of the nurses had good knowledge regardinginjection safety and majority of the nurses had excellent practice. The major lacking was seen related to the steps to be taken immediate after needle stick injury, practices of recapping of the syringes and coverage of the Hepatitis B vaccination. We recommend the authority of the study setting to prioritize these components. Further participatory observation studies are required to explore factors related to the knowledge and practices of safe injection practices.

Basic Concept of Healthy Aging

2023-08-05T07:19:55+00:00

Population aging is a characteristic of the 21stcentury, regardless of a nation’s level of development. An aging global population results in a burden in medical and social demographic problems. Addressing this problem is the highest priority for the careof the older population worldwide. Healthy aging is an individual lived experience that is influenced by healthy behaviors over the course of a lifetime.This includes a person’s ability to: meet their basic needs; learn, grow and make decisions; be mobile; build and maintain relationships, and contribute to society. For the promotion of healthy aging, a healthy lifestyle is important. A healthy lifestyle for older adults includes healthy eating, regular physical activity, staying at a healthy weight, improving mental health, social participation, regular health checkups and health screening, no smoking, and taking steps to prevent falls

Tele-stroke Services in Areas of Rural Nepal: A Dire Need

2023-08-05T07:19:55+00:00

With the increasing burden of non-communicable diseases in South Asian countries, Nepal also holdsa pertinent position with the rapidly increasing prevalence of non-communicable diseases. Among the South Asian countries with the least developed health infrastructure in Nepal, the hurdles of providing equal health services to all demographic and geographic groupsof people had always been a matter of serious concern. Moreover,the citizens of rural Nepal had always been kept at a distance from even minor to several major healthcare services fordecades and stroke-related illness falls under one of thosemajor diseases with spiking rates of hypertension and diabetes mellitus. Traditional risk factors, lifestyle and feeding practices of those regions combined with arduous transportation facilitiesbarring the rural citizens from getting health care services from tertiary care centers have increased morbidity rates as well. Along with it the numbers of neurologistsand stroke centers providing specialist services are not in par with the burden of stroke-related illness. Adding to it such stroke care servicesare below scarce level and completely devoid in most of the areas of rural Nepal whichis a matter of global health concern. Telestroke service if properly implemented can act a modern solution to provide access to such special health care services preventing rural citizens from lifelong disability and dependence.