Browsing by Author "Karmacharya, BM"
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Publication A Cross-Sectional Study of Medication Adherence Pattern and Factors Affecting the Adherence in Chronic Obstructive Pulmonary Disease(Kathmandu University, 2015) Shrestha, R; Pant, A; Shakya Shrestha, S; Shrestha, B; Gurung, RB; Karmacharya, BMABSTRACT Background Chronic obstructive pulmonary disease (COPD) is considered as a major health problem, associated with mortality and morbidities. Various disease management strategies have been established to optimize patient’s longevity and functional status where patient adherence to the prescribed treatment plays a key role. Poor adherence to medication is common among COPD patients and is affected by number of factors like number of medicines, delivery devices and patient-related factors. Objective This study aims to investigate the adherence pattern in the management of COPD and factors affecting patient adherence to the prescribed treatment. Method This study is a cross-sectional study which was conducted in a tertiary care hospital. Those patients suffering from COPD of all age were enrolled in this study and prior informed consent was obtained from patients. The structured questionnaire was used to interview those patients. Result Total 100 patients were enrolled in this study, among which most patients (45%) were of age groups 60-70 years. Unintentional non-adherence to medication attributed for 65% of patients and the major reason was forgetfulness (52.3%). Most patients had discontinued the medication due to experience of side effects (63.3%). The result showed significant association between adherence and polypharmacy (p=0.00). However, there was no significant association between adherence and age, sex, mode of administration of drugs, technics to use delivery devices etc. Conclusion Majority of COPD patients were elderly (mean age= 68.4 years). Forgetfulness was associated with medication non-adherence. Most of the patients had discontinued medication because of side effects. Polypharmacy is one of the major factors associated with non-adherence to medication in COPD. KEY WORDS Adherence, COPD, Dhulikhel Hospital, non-adherence, polypharmacyPublication Medication Adherence to Oral Hypoglycemic Agents Among Type II Diabetic Patients and Their Clinical Outcomes with Special Reference to Fasting Blood Glucose and Glycosylated Hemoglobin Levels(Kathmandu University, 2013) Shrestha, SS; Shakya, R; Karmacharya, BM; Thapa, PABSTRACT Background Oral hypoglycemic agents (OHAs) are the major treatment for people with type 2 diabetes mellitus (DM2). However, non-adherence to OHAs remains as one of the main reasons for poor glycemic control. Objectives To assess the adherence pattern to OHAs and clinical outcomes with special reference to fasting blood glucose (FBG) level and glycosylated hemoglobin (HbA1c) levels. Methods Informed consent was obtained from patients fulfilling the criteria and from the patient party in case of incapacitated patients. Information was obtained by interviewing them and filled in the appropriate questionnaire. All the medical information of the patients was obtained from the medical case records and laboratory reports. Results OHAs had been discontinued by 25% of patients. Overall 38% had ever discontinued and/ or often missed OHAs. Intentional discontinuation of OHAs attributed for 72% of the patients, followed by forgetfulness (42.9%), carelessness (30.6%), and hypoglycemia, (24%). There were 50.50% patients who had uncontrolled FBG (>130 mg/dl) level and 39% had uncontrolled HbA1c (≥ 7%) level. Taking reference age group 51-60 years, control of FBG level was found to be statistically associated with the decreasing age group (p = 0.006, OR = 4.8) as well as increasing age group (p = 0.008, OR = 4.034). There was significant association between controlled HbA1c level and patients’ knowledge about the precautions to be taken while using OHAs (p = 0.044, OR = 4). However, there was no significant association between glycemic control and OHAs adherence. Conclusion Majority of the patients who had missed OHAs attributed it to forgetfulness. Hypoglycemia may also be one of the contributing factors for poor adherence to OHAs. However no association was found between adherence and various other factors like age groups, treatment complexity, health literacy and social or family support. KEY WORDS Adherence, diabetes, HbA1c, hypoglycemia, non-adherencePublication Potential of Global Health Education in Low-Income Settings(Kathmandu University, 2013) Karmacharya, BMNAPublication Quit Intentions and Attempts among Smokers in Sub-urban Nepal: Findings from the Dhulikhel Heart Study(Kathmandu University, 2018) Karmacharya, BM; Fitzpatrick, AL; Koju, R; Sotodehnia, N; Xu, DR; Pradhan, PMS; Shrestha, AABSTRACT Background The most effective way for smokers to avoid or minimize the harmful effects is to quit smoking. Smoking cessation has been attributed to multiple factors operating at physiological, psychological, environmental and social level. There is common consensus that smoking cessation programs should be tailored for specific populations. However, there has been lack of data regarding factors that influence smoking cessation in Nepal, which has hindered the development of effective smoking-cessation interventions. Objective To assess the prevalence of quit attempts, successful quitting and the factors associated with them in a randomly selected, population-based adult participants in sub-urban Nepal. Method This cross-sectional study utilized data from the first wave of the baseline survey of the Dhulikhel Heart Study (DHS). A total of 2225 households of Dhulikhel city were enumerated and a third of the households (n=735) were randomly selected. Questions on tobacco use were ascertained using the questions based on the WHO STEPS survey questionnaire and questions on past quit attempts. Result Out of 1073 participants, 248 (23.1%) were current smokers and 99 (9.2%) were former smokers. Only 58% of the current smokers mentioned that they had attempted to quit smoking. When asked if they were interested in quitting if helped, almost 90.5% mentioned they were willing. Brahmins were less likely to have quit smoking (former smoker) compared to Newars (OR: 0.41, 95% CI: 0.18-0.90). We also observed that those who had high alcohol consumption were less likely to have quit smoking (OR: 0.36, 95% CI: 0.17-0.76). We didn’t find any meaningful significant association between socio-demographic factors or other CVD risk factors and the quit attempts. Conclusion As the country braces to address the burden of non-communicable diseases in Nepal, it is crucial to incorporate tobacco cessation programs in the national health system to meet the global target of bringing tobacco consumption to less than 5% by 2040. We recommend future studies to get a broader understanding of quit effort and factors associated with thereby supporting the development of evidence-based strategies to address tobacco cessation. KEY WORDS Dhulikhel, Tobacco cessation, Sub-urbanPublication Study of Pre-disposing Factors of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Antibiotic Prescribing Pattern with Reference to Antibiotic Sensitivity Test(Kathmandu University, 2015) Shrestha, R; Shrestha, B; Shakya Shrestha, S; Pant, A; Prajapati, B; Karmacharya, BMABSTRACT Background Chronic Obstructive Pulmonary Disease (COPD) affects about 329 million people worldwide, which is nearly 5% of the entire global population. In the context of Nepal, COPD accounts for 43% of the non-communicable disease burden and 2.56% of hospitalizations. Various pre-disposing factors like bacterial, viral, fungal, smoking, occupational exposures and genetic factors have been proposed to precipitate COPD and its exacerbation though, the definitive pre-disposing factors and factors related to acute exacerbation have not been determined in the context of Nepal. Objective To find out the pre-disposing factors and the related causative agents for COPD. Method A cross sectional study was conducted in a tertiary care hospital. Patients of all age group who were diagnosed as COPD and admitted in the hospital were included in this study. Patients were interviewed using structured questionnaire. The socio- demographic data including personal and medical history were recorded from those participants. In addition, sputum from those patients was sent for culture to investigate the possible responsible pathogens as well as its antibiotic sensitivity pattern. Result A total of 150 patients having Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) who have admitted from either emergency or out-patient department of the hospital were included in this study. Among the total number of patients, more than half of them were female (n=82). In addition, analysis of occupations shows that most of them were either farmer (36.0%) or housewife (30.7%). In total studied patients (n=150), most of them were using traditional firewood (83%) for cooking purpose and majority of patients (91%) were smokers. Most of the sputum samples show growth of gram-positive cocci (26.7%) and gram negative bacilli (27.5%). Considering the overall sensitivity pattern, the higher sensitivity was recorded for Co-trimoxazole and Ciprofloxacin while higher rate of resistance was noted for Penicillin group of drugs. The most widely used antibiotics were found to be Cephalosporin group of drugs (68%). Conclusion The present study revealed that the case of COPD is more in female and the commonest pre-disposing factor is found to be smoke/firewood. Cephalosporin group of drugs is the most commonly prescribed drug. KEY WORDS AECOPD, firewood, pre-disposing factor and therapy of COPD