Browsing by Author "Mishra, SR"
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Publication A National Equity Initiative to Address Noncommunicable Diseases and Injuries: Findings and Recommendation from the Nepal NCDI Poverty Commission(Kathmandu University, 2022) Koirala, B; Adhikari, SR; Shrestha, A; Vaidya, A; Aryal, KK; Kalaunee, SP; Shrestha, A; Mishra, SR; Sharma SK; Karki, A; Maharjan, B; Singh, S; Schwarz, D; Gupta, N; Bukhman, G; Karmacharya, BMABSTRACT We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission’s conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally. KEY WORDS NCDI Poverty Commission, Noncommunicable diseases and injuriesPublication Genetic variability of the human filarial parasite, Wuchereria bancrofti in Southern parts of Nepal(Institute of Medicine, 2015) Adhikari, RK; Sherchand, JB; Hoti, SL; Vishal, LA; Mishra, SR; Weber, EJW; Khanal, PR; Joshi, G; Dumre, SP; Adhikari, R; Nazeer, S; Ranabhat, K; Wagle, RRAbstract Introduction: Lymphatic filariasis (LF) is a neglected tropical disease, caused by Wuchereria bancrofti parasite and pose potential risk to about 1.4 billion people in 73 countries. In Nepal, 60 out of 75 districts are endemic and nearly 90% of the population is at risk and mass drug administration (MDA) has beenin place since 2003. Yet, information about the genetic diversity of W. bancrofti is largely lacking. Methods: The genetic variability of the parasites in two localities Kailali and Kapilbastu from south- western parts of Nepal were studied. Blood samples were collected at night and stained with Giemsa stain and positive archived slides were taken for the study. W. Bancrofti was individually picked under microscope and gDNA was isolated from the pooled (100 mf) samples. Short Tandem 29bp Repeats (STR) from the intronic region of Abundant Larval Transcript-2 (ALT-2) gene and haplotype mapping of the Internal Transcribed Spacer (ITS-1) region were studied. The phylogenetic trees were constructed and analyzed. Results: The analyses of STR, haplotypes and the phylogenetic trees indicated the presence of at least two genetically distinct clusters among the W. Bancrofti parasite populations in two areas. Conclusion: The study identified two genetically distinct clusters of mf in the populations. The finding of two genetic “variants” of W. bancrofti in the present study has important implications for filariasis epidemiology and control/elimination program. Keywords: Genetic variability, Lymphatic filariasis, Nepal, Wuchereria bancroftiPublication Quality of life of people living with lymphoedema: A cross sectional community based study in selected districts of Nepal(Institute of Medicine, 2014) Adhikari, RK; Sherchand, JB; Mishra, SR; Ranabhat, K; Wagle, RRAbstract Introduction: Lymphatic Filariasis (LF) is the second most common cause of physical disability worldwide with 40 million people chronically disabled by the disease and about twice that number suffering from covert lymphatic changes or kidney diseases. The most common chronic manifestations of the disease are lymphoedema and hydrocele. The objective of this study is to evaluate the quality of life (QOL) of lymphoedema patients in Nepal. Methods: We sought the help of female community health volunteers, health workers working in peripheral health centers in selected sentinel surveillance sites in listing out the names of patients with lymphoedema. The researcher obtained details of 205 cases of lymphoedema (49 cases of Elephantiasis and 156 cases of hydrocele) in three districts (Dhading 74, Kapilbastu 78, Kailali 53). A total of 205 healthy individuals were selected from the same locality (Dhading 68, Kapilbastu 66, Kailali 71) for comparison. World Health Organization Quality of Life questionnaire brief version (WHO QOL-BREF) was used for data collection. Results: The mean age of the respondents was 45.95 years with a standard deviation of 17.96 years. In four domains, the physical domain scored highest (14.28±2.52) and the environmental domain scored lowest (12.19±1.69). Patients with lymphoedema had significantly low QOL scores in physical (p<0.001), psychological (p<0.001), social relationship (p<0.001), and environmental (p<0.001) compared to their healthy counterparts. Similarly, the overall QOL score was lower in patients with lymphoedema than in healthy control, and it was statistically significant (p<0.001). Conclusion: This study reports significantly low QOL scores in all four domains in patient with lymphoedema denoting low quality of life compared to their healthy counterparts. It is recommended that the current Lymphatic Filariasis elimination program of Nepal should focus to initiate morbidity management program specifically to patients with lymphoedema and hydrocele. Keywords: Lymphoedema, filariasis, quality of life, cross sectional studies, Nepal