Browsing by Author "N, Jha"
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Publication A comparative study of coronary and contributory risk factors in rural and urban type 2 diabetics(Kathmandu University, 2004) N, JhaA prospective study of various coronary and contributory risk factors in urban and rural diabetic population is presented. For the coronary risk factors, smoking prevalence was high for urban diabetics (27%), also high TC levels (57%), and low levels of HDL cholesterol (17%) were comparatively greater in urban diabetics. Prevalence of hypertension was higher, (40%) in rural diabetics. High LDL levels were (>130mg/dl) were observed in 20% of rural subjects and 47% of urban diabetics. High TG levels (34%) were seen in rural diabetics. 54% of urban diabetics were centrally obese and 57% were obese from the rural study site. From this study, it was seen that, illiteracy percentage was found to be higher in rural subjects. Also, greater number of people (70%) were in inadequate status for the needed patient awareness. 77% of patients belonging to the rural study area were found to be unaware for the hypoglycaemia. Low patient compliance was seen in urban diabetics as compared to their rural counterparts, and 34% of patients belonging to both study sites were found to have no knowledge for diabetic complications. High total cholesterol was found to be the commonest lipid profile abnormality in this study. Second commonest lipid abnormality was high LDL levels. Low HDL cholesterol was found to be more commonly in patients of age > 60 years than <60 years (21.42% vs. 18.18%). More female patients were overweight and obese as compared to male (33.33% vs. 19.23%). A Large population of diabetics was found to have a sedentary lifestyle. Rural patients were progressing towards more coronary risk factors as compared to the urban ones, mainly with the lipid profile abnormalities. Although our type 2 diabetic patients share similar coronary risk factors as compared to diabetic patients from different countries, our type 2 patients have got high prevalence of hypertension. Male diabetics had high prevalence of smoking habits. Keywords: Coronary risk factors, Contributory risk factors, Lipid profile abnormalitiesPublication A study of sensitivity and resistance of pathogenic micro organisms causing UTI in Kathmandu valley(Kathmandu University, 2005) N, Jha; S K, BapatA retrospective study was conducted in five hospitals to observe the prevalence of organisms causing UTI and their sensitivity to antibiotics. Methodology: Altogether, data from five hundred samples of urine from five hospitals in Kathmandu was collected for this study from January 2005 to April 2005. Result: A total of 244 samples were found to be positive. Altogether six types of organisms were isolated as the causative factors. E. coli (49%), S. aureus, (coagulase positive) (23%), Proteus species (3.6%), Klebsiella (9.71%), Pseudomonas (0.8%) and Citrobacter (2.8%). Analysis of the samples showed that UTI was more common in females of younger age group as comp ared to males. The common age group for females was 21-30 years, whereas that for males was 31-40 years in all the hospitals except in hospital A, where the maximum number of females was from 31-40 years and males were between 71-80 years. The most common organism to cause UTI was found to be E. coli (49%), followed by S. aureus (23%) and Klebsiella (9.71%). All the organisms causing UTI were sensitive to nitrofurantoin and amoxycillin and ciprofloxacin was found to be least effective. Similarly, in three hospitals, B (88.2%), D (64.7%) and E (65.3%), amoxycillin was found to be most effective, amikacin and gentamycin (92.5%) was most effective in hospital C, and nitrofurantoin in hospital A (78%). The second commonest organism, i.e., S. aureus (23%) was most sensitive to cephalosporin (88.8%) of second generation, followed by nitrofurantoin (77.7%), amikacin (80.6%) and norfloxacin (65.5%). The third common organism, Klebsiella (9.71%) was most sensitive to norfloxacin (75%) and nitrofurantoin (75%). Lastly, Pseudomonas was resistant to all the antibiotics in hospital A, D and E, nil in hospital B and sensitive to amikacin (100%) in hospital C. Keywords: UTI, common pathogens, antibiotics sensitivity, resistance profilePublication Publication Impact of family health exercise program on health knowledge and practice of a rural population of eastern Nepal(Kathmandu University, 2006) N, Jha; S, Kumar; BK, Yadav; GCP, Singh; SR, NiraulaBackground: It is important to know the impact of health education on community. This may lead to improve the programs, commitment to students and staffs by taking feedback. These activities are aimed at producing changes in the community. Objective: To assess the impact of health education as intervention program during Family Health Exercise (FHE) about the knowledge and practice of people related to health in a village of eastern Nepal. Methods: During FHE, health education was given by the 3rd year medical students to the head of the 30 families. The neighbour 30 families were taken as control, where no health education was given. These two groups were compared after 6 months. Results: Sanitary practice (Hand washing) before meal was known to both groups. But the material used for washing hand (soap and ash) was 53% in intervention as compared to 30% in control group. People were aware about the importance of care of the mother during pregnancy and lactation, but more in intervention group. The knowledge and practice for starting semisolid food other than breast milk for infants during weaning were higher in intervention (89%) than control (31%) group. Conclusion: There was significant change in the knowledge and practice of woman (mainly host) who received health education. The community also benefited in terms of their health knowledge and practices. Such programs are useful for the community at large. Key words: Family Health Exercise, Impact of Health Education, Health education, Nepal.Publication Medical Education - Changing perspectives(Kathmandu University, 2005) S K, Bapat; N, JhaVarious aspects of medical education have been reviewed with special reference to medical institutions in Nepal. The newer trends in teaching methodology like audiovisual and computer aided methods are being followed in most of the institutions of Nepal. Similarly, attempts are being made to implement integrated teaching which, though not perfect, differs from institution to institution. The attempts seem to be more or less satisfactory with awareness amongst most of the teachers and planners. However, the methods of assessment of the students at every level, call for changes and improvement, in the light of modern trends. Similarly, the process of selection in medical colleges needs change. The replies to the questionnaire given to the students of two batches were very interesting and it is worthwhile to undertake such studies in other institutions as well. Valid suggestions opined by them should be implemented. Keywords: Medical education, medical institutions in Nepal, teaching methodology,Publication Prevalence and determinants of unmet need for family planning in a district of eastern region of Nepal(Kathmandu University, 2006) GP, Bhandari; Premarajan, KC; N, Jha; BK,Yadav; IS, Paudel; S, NageshObjectives: The unmet need for family planning is defined as the discrepancy between individual’s contraceptive behaviors and their stated fertility preferences – The extent of which is very high in developing countries like Nepal. This study explores the unmet need and its determinants. Methods: Among the teaching district of B.P. Koirala institute of Health Sciences, in the Eastern Region of Nepal, a district was selected randomly to conduct a cross-sectional study. A total of 1079 women were selected using systematic random sampling. We compared different demographic variables and sex-ration to unmet need by using means, percentage and applied chi-squared test where applicable. Result: The extent of unmet need is 25 percent with 9.5 percent for spacing and 15.5 percent for limiting. The mean age at marriage is 16(±3.2) years. A strong association of gender preferences towards male child and unmet need exist, which is highly significant. Conclusion: Unmet need is high despite extensive family planning program in Nepal. Mean age at marriage below legal age, low female education and gender discrimination are the factors responsible for unmet need.Publication Prevalence of adverse drug reactions with commonly prescribed drugs in different hospitals of Kathmandu valley(Kathmandu University, 2007) N, Jha; O, Bajracharya; T, NamgyalAbstract Objectives: To study the prevalence of adverse drug reactions (ADRs) in five different hospitals of Kathmandu Valley. Materials and Methods: An analytical cross sectional study was designed from May 2007 to September 2007 in which prevalence of ADR was calculated. A total of 37 cases of ADRs were taken from 4287 patients and 10% of the remaining population without ADRs i.e. 425 out of 4250 patients was selected randomly. ADRs were analyzed as per the structured questionnaires designed by Canadian adverse drug reaction monitoring program. Data thus obtained were analyzed by using SPSS and Excel 2003 software and relevant statistical tools were applied. Results: Prevalence of ADR in this study was 0.86% and male to female ratio was 0.85. 54.1% were female and 45.9% were male (P = 0.65). The highest percentage of ADRs were seen in adult patients, however the difference was statistically not significant. Maximum numbers of ADRs were reported from skin, 35.13% followed by GIT, 29.72% and then from CNS, 18.91%. Anti-infectives were associated with maximum number of ADRs followed by IV urograffin. Rashes, 35.13% were the most common type of ADRs reported followed by vomiting, 13.51% and then dizziness which was 10.81%. Regarding the outcomes attributed to ADRs, one patient died due to ADR caused by dapsone and 15 cases got hospitalized due to ADRs. The incidence of ADRs in different age groups was not significant. Similarly, there was no significant association between ADRs and sex. No significant difference was seen in case of age group less than one year as compared to two or more years of age (P = 0.78). For causality of ADRs, according to Naranjo algorhythm scale, 35% of reactions were assessed to be probable, 32% as possible and 19% were definite. Similarly, for severity assessment, 54% reports were mild, 35% were moderate and 10.81% were severe. Conclusion: Prevalence of ADR in this study was 0.8% which is similar to other studies in other countries. All the ADRs were not toxic reactions and they were unpredictable. Key words: Prevalence, ADRs, DrugsPublication Social health insurance: A knowledge-do gap in eastern Nepal(Kathmandu University, 2007) N, Jha; P, Karki; BP, Das; N, ChapagainHealth care costs, and those for inpatient care in particular, pose a barrier to seeking health care, and cost be a major cause of indebtedness and impoverishment, particularly among the poor. The Ministry of Health in Nepal intends to initiate alternative financing schemes such as community and social health insurance schemes as a means to supplement the government health sector financing source. Social Health Insurance (SHI) is a mechanism for financing and purchasing / delivering health care to workers in the formal sector regulated by the government. Considering all these facts BP Koirala Institute of Health Sciences (BPKIHS) has introduced SHI scheme in 2000 as an alternative health care financing mechanism to the community people of Sunsari and Morang districts. In the beginning small area was elected as a pilot project to launch the scheme. A major objective of SHI is to reduce poverty caused by paying for health care and to prevent already vulnerable families from falling into deeper poverty when facing health problems. A total of 26 organizations with 19799 populations are at present in SHI scheme. Sixteen rural based organizations with 14,047 populations and 10 urban based organizations with 5752 people are the beneficiaries in this scheme. BPKIHS SHI Scheme is the outcome of the visionary thinking on social solidarity and as an alternative health care financing mechanism to the community. BPKIHS is mobilizing people's organizations and is offering health services through its health insurance scheme at subsidized expenses. This has helped people to avail with health facilities who otherwise would have been left vulnerable because of their penetrating health needs. There is huge gap between premium collection and expenditures. The expenditures are more and this may be due to knowledge – do gap in the program. If conditions are unsuitable, SHI can lead to higher costs of care, inefficient allocation of health care resources, inequitable provision and dissatisfied patients. It can also be more difficult to realize the potential advantages of SHI in future. The future challenges confronting the scheme are to give the continuity and sustainability of the program to its catchments areas. This might entail a shift in its program operation mechanism. People's active involvement is required, which will further provide a sense of ownership in the scheme amongst the people.