Browsing by Author "Baral, Gehanath"
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Publication Adopting Logic Model to Predict Ovarian Cancer(Nepal Health Research Council, 2024) Baral, Gehanath; Marahatta, Sujanbabu; Singh, SumerBackground: The Logic model was primarily used in educational programs and then to evaluate tuberculosis control, cervical cancer prevention programs, and cardiovascular disease in health. Unlike cervical cancer, there is a gap in screening for ovarian cancer. However, clinical services exist. Thus, the Logic model has been used to evaluate the service standards for the secondary prevention of ovarian cancer. Methods: This is the multi-centric service evaluation research adopted from the Logic Model. There are four domains namely utility, feasibility, propriety, and accuracy standards in the Logic model that includes 53 question items altogether for each participant. For each item, the participants responded on a Likert scale to assess their satisfaction with the service provided to the patients. There are 5-point satisfaction levels from strongly disagree to agree strongly. The internal consistency of items was calculated and the factor analysis was performed. Software used were Microsoft Excel, SPSS, SPSS Amos, and R. Results: The agreement level of all specialist participants was satisfactory for the current prediction and management approach to ovarian cancer with a median value of 73.5% towards positive sentiment. Cronbach’s alfa was at an acceptable level of more than 0.8 for utility, feasibility, and accuracy domains. The propriety domain had poor yield. Chi-squared test-based model fit is good (Baseline and Factor Models <0.001) and Barlott’s test of sphericity is likely to work (X2=5460.242, df=1378, and p<0.001). Other confirmatory factors were not at an acceptable level. Conclusions: The logic model may work to predict ovarian cancer with an acceptable level of reliability, however for the perfect fit it requires a larger sample size. Keywords: Factor analysis; logic model; ovarian cancer; satisfaction.Publication Burden of Reproductive Organ Cancer of Females in the Population-based Cancer Registry in Nepal(Nepal Health Research Council, 2024) Baral, Gehanath; Marahatta, Sujanbabu; Singh, SumerBackground: There are sporadic facility-based reports but an information gap in the cancer burden in the community is apparent. To address this, the Nepal Health Research Council (NHRC) started a Population-based Cancer Registry (PBCR) in 2018 in the country. Thus, this study aims to identify the cancer burden in the female population, especially in the reproductive organs. Methods: A quantitative database analysis of the Population-based Cancer Registry for year 2018 and 2019 was performed. Data entered in the TSV (Tab-separated values) files were imported to MS Excel and SPSS data Window and variables regrouped before analysis. The national census, WHO standardized population, and registry data were used for the descriptive analysis of the registry variables. Ethical approval was taken from the Ethical Review Board of NHRC. Result: Out of 6854 cancer registries, the female population was 3590 with a male-to-female ratio of 10:11. This registry covers 10.75% of the country’s population. The crude and age-standardized cancer incidence rates were 1.24% and 66.2 per 100,000 for the female population respectively. Reproductive organs (21%) and breast (19.7%) cancers are the most common in females, and out of reproductive organs cervical (58%) and ovarian (25%) cancers are the commonest. Surgery was the main treatment modality (32.7%) with or without chemotherapy and radiotherapy. Conclusions: The burden of cancer is higher in females because of breast cancer. Reproductive organ cancers and breast cancers share an equal burden of around 20% each. The most common female genital cancer is of uterine cervix followed by the ovary. Keywords: Breast; burden of cancer; cancer registry; cervix; ovary.Publication Detection of Cervical Precancer Using Visual Inspection Method with Acetic Acid(Nepal Health Research Council, 2024) Baral, Gehanath; Oli, Lila; Verma, Sheela; Rai, Snigdha; Aryal, Parshuram; Tiwari, SumanBackground: Cervical cancer screening is the priority activity of the government. Visual inspection with Acetic acid (VIA), Pap smear Liquid-based cytology, and HPV DNA testing are different methods of screening. VIA-based screening is the cost-effective method of screening in a resource-constrained setting like in our country as this doesn’t require cyto-histological testing, can be performed by trained paramedics too, and is as accurate as a cytological test. The aim is to explore pre-cancer cervical lesions by screening women in the community by visual inspection using acetic-acid. Methods: Community-based cross-sectional study done at a health camp setting for three months from March to June 2023. The married non-pregnant women of 30-60 years were screened. Descriptive tests as well as sub-group analysis performed by Chi-Square tests. Results: From ten community health camps, 1255 cases were screened and screen positivity was 14.3%. Positive results were proportionately distributed to all parity by 13-19%. Half of the positive results (47.2%) were in the 34-40 age group. There were no significant differences in screen positivity by parity or vaginal discharge. Menopausal women had 7.7% screen positivity. Conclusions: The prevalence of VIA positivity in the community was found double the previous facility-based prevalence; and there was no significant difference by parity, menopausal status, and vaginal discharge. The positivity was more in 30-45 years of age. Keywords: Cervical pre-cancer; screening; VIA.Publication Diagnostic Dilemma in Intra-abdominal Cancers(Nepal Medical Association, 2025) Baral, GehanathAbstract Problem statement: A diagnostic dilemma exists in cancer care, especially in intraabdominal lesions. Despite the diagnostic means available so far, clinical decision-making is practically difficult due to diagnostic limitations. The inherent variation of any means influences decision-making. There is an iceberg-like diagnostic inaccuracy in revealing the specific condition or disease. This clinical decision-making gap is worrisome. Conclusion: Besides technological and bio-molecular advancements, the structured working framework would be protective and persuasive in mitigating dilemmas to some extent.