Browsing by Author "Joshi, SK"
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Publication Acquaintance with the actuality: Community diagnosis programme of Kathmandu Medical College at Gundu village, Bhaktapur, Nepal(Kathmandu University, 2008) Vaidya, A; Pradhan, A; Joshi, SK; Gopalakrishnan, S; Dudani, IAbstract Introduction: In Nepal, various field programs such as community diagnosis programmes (CDP) have been initiated to make the education of doctors, nurses and dentists more community oriented and relevant and suited to the health care scenario. Community diagnosis refers to the identification and quantification of the health problems in a community and identification of their correlates for the purpose of defining those individuals or groups at risk or those in need of health care. The article presents the main activities of community diagnosis as a core component of community-based education for the medical students at Kathmandu Medical College, Kathmandu, Nepal. Methodology: A 4 weeks’ Community Diagnosis Programme was conducted by MBBS II students (9 th Batch) of the Kathmandu Medical College under the supervision of the Department of Community Medicine in November 2006 in the rural community of Gundu VDC (village development committee). The tools used included pre-tested questionnaires, weighing machines, measuring tapes, stethoscopes and sphygmomanometers. After the data collection and compilation, the students presented their findings in oral presentations, accompanied by a written report, including essential recommendations for improving the health status of these communities. Results: The students benefited from the necessary process of integrating clinical skills and a public health approach, so as to enhance their epidemiological thinking and be of greater use to the communities where they will practice. The community also benefited by achievement of behavioral changes leading to healthier lifestyles and increased awareness of health-related matters and their role in quality of life. Conclusions: CDP is a way to practically demonstrate that the link between a medical college and society is possible. That is, a medical college can serve the community and thus society, with specific activities to improve health and the skills of students who will serve as future health professionals.Publication Publication Asymptomatic throat carriage rate and antimicrobial resistance pattern of Streptococcus pyogenes in Nepalese school children(Kathmandu University, 2009) Dumre, SP; Sapkota, K; Adhikari, N; Acharya, D; Karki, M; Bista, S; Basnyat, SR; Joshi, SKAbstract Background: Streptococcus pyogenes or Group A streptococcus (GAS) causes several suppurative and non suppurative infections. In addition to pharyngitis and skin infections, GAS are also the causative agent of post-streptococcal infection syndromes such as acute rheumatic fever (ARF) and post-streptococcal glumerulonephritis (PSG). GAS frequently colonises in the throat of an asymptomatic person. Pharyngeal carriage rates of GAS among healthy school children vary with geographical location and seasons. Objectives: We carried out this preliminary study to determine the throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes or Group A streptococcus (GAS) among the Nepalese school children. Materials and methods: Four schools situated at different locations of Kathmandu valley were included in the study. Throat swabs from 350 students of age group 5-15 years were collected, immediately transported to the laboratory and were processed for S. pyogenes following standard microbiological procedures. Antimicrobial susceptibility testing of the isolates was performed by Kirby Bauer disc diffusion method following CLSI guidelines. Results: S. pyogenes was isolated from 10.9% (38/350) of the screened children. The GAS colonisation rate was statistically insignificant (P>0.05) with sex and age sub-groups, although the rate was slightly higher among girls and age sub-group 9-12 years. No significant difference in carrier rate was observed among different schools (P>0.05). All isolates were susceptible to azithromycin. No resistance was detected for penicillin and its derivative antibiotic ampicillin. Highest resistance rate was observed for cotrimoxazole (71.0%) followed by chloramphenicol (7.8%), ciprofloxacin (5.2%) and erythromycin (5.2%). Conclusion: Antibiotic resistant GAS isolated from asymptomatic Nepalese school children is a public health concern. When screened and appropriately treated with antibiotics, carriers can be prevented from spreading of streptococcal infections in the school environment and the community. Preventing cross infections would ultimately reduce the incidence of life-threatening sequelae which are debilitating and difficult to treat. It is recommended to conduct regular screening and GAS surveillance in schools, and maintain rational use of antibiotics to minimise GAS carriage/infections and resistance. Key words: Streptococcus pyogenes, Antibiotics Resistance, Throat carriage, Children, Nepal.Publication Publication Biomass combustion and potential health effects in the developing countries(Kathmandu University, 2010) Joshi, SK; Dahl, A; Kristensen, T; Roldin, PNAPublication Diabetes mellitus: A review of its associations with different environmental factors(Kathmandu University, 2010) Joshi, SK; Shrestha, SAbstract Diabetes Mellitus is a global health problem with a worldwide prevalence of 2.8% in 2000. Type 1 diabetes mellitus is an auto immune disorder genetically mediated, while type 2 is more of a life style induced disorder although the role of genetic susceptibility, infections are also equally strong. Many studies have backed up these statements. However, there have been very few researches that show association of diabetes with environmental factors like pollution, exposure to chemicals e.g. mercury, arsenic, psychological condition e.g. depression, stress, and socio-economic conditions e.g. occupation, earnings etc. Recently, the role of these factors in causation and progression of diabetes have received much attention. Thus, this review has been designed to explore more on association of diabetes with physical, socio-economic and psychological environment. Key words: arsenic, diabetes, environment, mercury, occupation, POPs, sleep, socio-economic status, stressPublication Publication Economic and social burden due to injuries and violence in Nepal: A cross-sectional study(Kathmandu University, 2009) Joshi, SK; Shrestha, SAbstract Background: Injury and violence cause five million deaths annually in the world which is around 9% of the global mortality. Eight out of fifteen leading causes of deaths in the age group 15-25 years are injury related. Objective: The objective of this study was to assess the incidence, severity and socio-economic burden of injuries and violence in two cities of Nepal. Materials and methods: Relevant data was collected from 17th August 2008 to 16th September 2008 from injured patients attending emergency departments at six health centres in two cities. Results: In total, 505 injury cases were reported. 42.5% of the injuries occurred in roads and 34.1% at home. 65% of road traffic injuries involved motorcycles. The majority (60%) of the injured subjects were economically active. A single injury case cost 126.2 US$ including all the expenses and the loss due to inability to work. Conclusion: The high incidence of injuries, especially road traffic injuries, adds a huge economic burden to nation. Key words: disabilities, economic burden, injuries, violencePublication Environmental health effects of brick kilns in Kathmandu valley(Kathmandu University, 2008) Joshi, SK; Dudani, IAbstract Introduction: Brick kilns operating in Kathmandu valley are known to be a leading cause of air pollution. The main objective of this study was to assess the effect of brick kilns on environment and human health. This study has been done at Duwakot VDC in Bhaktapur. Methods: This study was conducted during brick kilns operating and not operating periods. Different methods were used for data collection, such as household environmental health survey, school health examination, and air quality measurement for total suspend particles, particulate matter of size less than 10 microns, Sulphur Dioxide, Oxides of Nitrogen, and Carbon Monoxide. Results: A total of 330 individuals were interviewed during household environmental survey and majority of them expressed about smoke related respiratory discomfort at home and surrounding. Out of 141 school children who underwent thorough physical health examination, 79 students were from Ganesh Public School (located near to brick kilns) and 62 were from Nabin English School (far away from brick kilns). Statistically significant high odds ratios for respiratory problems like tonsillitis (4.17 95% CI 2.05, 8.45) and acute pharyngitis (4.08 95% CI 2.01, 8.33) were observed among the students from Ganesh Public School. Average value of particulate matter of size less than 10 microns and total suspend particles for the pre operation time was 0.029 mg/m³ and 0.033 mg/m³ respectively whereas, it reached 0.050 mg/m³ and 0.056 mg/m³ respectively during the brick kiln operation time. Conclusion: The concentration of various air pollutants was higher during the operation of brick kilns at Duwakot. Similarly, the health status of the school children attending the school close to the vicinity of the brick kilns was worse compared to the students attending the school away from the brick kilns. Key words: Environmental Health, Air Pollution, total suspend particles (TSP), particulate matter of size less than 10 microns (PM10), Sulphur Dioxide (SO2), Oxides of Nitrogen (NOx ), Carbon Monoxide (CO), Brick Kilns, Duwakot, NepalPublication Environmental noise induced hearing loss in Nepal(Kathmandu University, 2003) Joshi, SK; Devkota, S; Chamling, S; Shrestha, SIntroduction: Noise pollution in urban cities is a serious problem and steadily increasing over the years. This has direct and indirect affect to the people that can lead to the health hazard. Objectives: To find out environmental noise induced health effect on people residing in an urban community and to predict the risk of the environmental noise induced hearing loss Material and methods: One hundred fifty questionnaires were filled up for the environmental noise pollution survey. For the case control study, 36 exposed and 25 non-exposed residents of Kupondole were included. Based on the place of residence (main road and 20 min. walking distance from the main road), subjects were divided into exposed and non-exposed group concerning environmental noise. Demographic data and information about health problems was obtained by a structured interview. Audiometric test was performed using manual audiometer. Odds ratios (OR) and their 95% confidence intervals (95% CI) for noise induced hearing loss were estimated using logistic regression. Adjustment for occupational noise was done Results: The major health effect induced by the environmental noise was observed as lack of concentration followed by irritation, fatigue and headache. The crude OR and 95% CI for the exposed subjects was 4.2 (1.4, 12). After adjustment for occupational noise, the OR (95% CI) was 4.0 (1.2, 13). Conclusion: This study shows that exposure to noise causes wide range of health effects. For the exposed subjects there was an increased risk of noise induced hearing loss. The risk was significantly increased also after adjusting for occupational noise. Keywords: Environmental Noise, Noise Induced Hearing Loss (NIHL), Audiometric Test, Noise Pollution Survey, NepalPublication Publication Publication Occupational health in small scale and household industries in Nepal: A situation analysis(Kathmandu University, 2008) Joshi, SK; Dahal, PAbstract Introduction: Making working conditions safe and healthy is the interest of workers, employers and the Government. Although it seems simple and obvious, this idea has not yet gained meaningful recognition in Nepal. Materials and methods: The study was conducted in ten small scale industries of Kathmandu valley. Altogether 545 questionnaires on socioeconomic and occupational history were filled up. Similarly, Workplace Occupational Health Assessment was done in all ten industries. A thorough medical examination of 135 child workers was done using a structured questionnaire to find out the health effects due to occupational hazards. Results: Out of the total 545 workers present in the industries under study, 135 (24.8%) were child workers. Higher proportion of child workers (97%) was illiterate compared to 3% of children with primary level education. Among the child workers, 23 (17%) were girls. The majority of the child labourers were suffering from conditions like otitis externa, otitis media, scabies, anaemia, upper respiratory diseases, nasal problems, abdominal pain etc. Conclusion: The occupational health and safety practices in small scale industries in Kathmandu have been found to be unsatisfactory. Child labour is a serious problem. Out of ten industries, six have employed child workers and the working conditions range from bad to terrible. Health and welfare of the child workers was also not satisfactory. Key words: Situation Analysis, Occupational Hazards, Occupational Health and Safety, Small Scale and Household Industries, Child Labour, Kathmandu, NepalPublication Serological Prevalence of Antibodies to Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) among Healthy Nepalese Males – A Retrospective Study(Kathmandu University, 2003) Joshi, SK; Ghimire, GRA retrospective data analysis for sero-prevalence of antibodies to HIV, HBV and syphilis was carried out during the period 3 rd September 2003 to 3 rd June 2004 in 627 apparently healthy Nepalese males aged 17 to 48 years and association of the diseases with age group and blood group were analyzed. The study showed the prevalence of HIV, HBV and syphilis being 1.6%, 2.7% and 0.6% respectively. Analysis of blood group showed that 97.76% of total male population having Rhesus positive blood. Among them, O “positive” was the most common blood group with 31.9% followed by A “positive”, B “positive” and AB “positive” respectively. The analysis of relationship showed a tendency of high affinity of those diseases in the subjects with O “positive” blood group. However, no real association of those infections was found with the blood group (HIV: X2 = 0.902, P = 0.99; HBsAg: X 2 = 1.212, P = 0.99; RPR: X 2 = 3.975, P = 0.789). Key Words: HIV, AIDS, HBV, HBsAg, STD, RPR, NepalPublication Solid biomass fuel: Indoor air pollution and health effects(Kathmandu University, 2006) Joshi, SKNAPublication Throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes among the asymptomatic Nepalese school children(Kathmandu University, 2009) Dumre, SP; Sapkota, K; Adhikari, N; Acharya, D; Karki, M; Basnyat, SR; Joshi, SKAbstract Background: Streptococcus pyogenes or Group A streptococcus (GAS) causes several suppurative and non suppurative infections. Since the 1980s there has been re-emergence in the incidence of invasive S. pyogenes infections and rheumatic heart disease all over the world and hence throat carriage has assumed of great importance. Objectives: We carried out this preliminary study to determine the throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes or Group A streptococcus (GAS) among the Nepalese school children. Materials and methods: Four schools situated at different locations of Kathmandu valley were included in the study. Throat swabs from 350 students of age group 5-15 years were collected, immediately transported to the laboratory and were processed for S. pyogenes following standard microbiological procedures. Antimicrobial susceptibility testing of the isolates was performed by Kirby Bauer disc diffusion method following CLSI guidelines. Results: S. pyogenes was isolated from 10.9% (38/350) of the screened children. The GAS colonisation rate was statistically insignificant (P>0.05) with sex and age subgroups, although the rate was slightly higher among girls and age subgroup 9-12 years. No significant difference in carrier rate was observed among different schools (P>0.05). Highest resistance rate was observed for Cotrimoxazole (71.05%) followed by Chloramphenicol (7.8%), Ciprofloxacin (5.2%) and Erythromycin (5.2%). All isolates were susceptible to Azithromycin. No resistance was detected for penicillin and its derivative and Azithromycin. Conclusion: Antibiotic resistant GAS isolated from asymptomatic Nepalese children is a concern. When screened and appropriately treated with antibiotics, carriers can be prevented from spreading of streptococcal infections in the community. This would ultimately reduce the incidence of life-threatening sequelae which are debilitating and difficult to treat. It is recommended to conduct regular screening programs and GAS surveillance, and maintain rational use of antibiotics to keep GAS carriage/ infections and resistance in check. Key words: Streptococcus pyogenes, Antibiotics Resistance, Children, Throat carriage, NepalPublication Violence against women in Nepal: Role of health care workers(Kathmandu University, 2009) Joshi, SKNA