Browsing by Author "Pokharel, PK"
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Publication A Study of Prevalence of Taenia Infestation and Associated Risk Factors Among the School Children of Dharan(Kathmandu University, 2012) Sah, RB; Pokharel, PK; Paudel, IS; Acharya, A; Jha, N; Bhattarai, SABSTRACT Background Taenia prevalence has remained high among certain ethnic groups and occupational diseases in Nepal. Taenia saginata and Taenia solium species are worldwide in distribution. Infection is found most often in rural areas of developing countries with poor hygiene and living in close contact with pigs and eating undercooked pork meats. This allows the tapeworm infection to be completed and its cycle to continue. Objectives To measure the prevalence of taenia infestation and to identify risk factors associated with taenia infestation among the school children of Dharan. Methods A cross sectional study was conducted among 935 Government and private school going children of Grade VI, VII, and VIII of Dharan during 2007 to 2008. Stratified random sampling method was applied to choose the schools and the study subjects. The prevalence was calculated, Chi-square test was used to measure the association of risk factors and taenia infestation. Results Taenia species was found to be high (5.5%) among the school children of Dharan. Infection rate of taenia among the male children (6.0%) was slightly higher than female (4.8%). There were no cases of taenia infestation found among children washing hands with soap. Regarding meat consumption in the non-vegetarian group, taenia infestation was found higher (6.5%) among pork eating than non- pork eating (4.7%). No significant relationship was traced among the factors in the causation of taenia infestation although slight indications present. Conclusion Taenia species was found very high among the school children of Dharan. No such association was found with the risk factors. KEY WORDS Prevalence, risk factors, taenia infestation, school children, DharanPublication Association of obesity and physical activity in adult males of Dharan, Nepal(kathmandu University, 2006) Vaidya, A; Pokharel, PK; Nagesh, S; Karki, P; Kumar, S; Majhi, SObjectives: Obesity is one of the most apparent-yet most neglected public health problems. Physical activity is a crucial element in the development of obesity but still its importance in the occurrence of obesity varies in different populations. This paper aims to study the burden of obesity and its association with physical activity was carried out in a rapidly urbanizing town. Methods: A cross-sectional study to investigate the prevalence of obesity and its association with physical activity was carried out in one thousand adult males of Dharan municipality. Tools of data collection included interview and physical measurements such as blood pressure, height and weight measurements, and waist and hip circumferences. Odds ratios (ORs) and their 95% confidence intervals for obesity were computed across various demographic and other variables without adjusting and then adjusting for physical activity. Results: The prevalence of overweight and obesity in the population was 32.9% and 7.2% respectively. The study showed that physical inactivity is more importantly associated with obesity in the older population. The trend of young being more obese is reversed after adjusting for physical activity so that those in the older age were more obese than the younger ones. Similarly, those in to the business, vocational and clerical works, those who were more literate and those in the higher socio-economic status were significantly associated with obesity even after correcting for physical activity. Conclusion: The prevalence of overweight and obesity is high in the males of Dharan. The value and effect of physical activity seem to vary across different age-groups and socio-economic status and occupations. The young, the technical persons or businessmen and the more prosperous ones probably need to bring down their calorie intake along with emphasis on physical activity in order to bring down their weight and cardiovascular risk.Publication Asthma symptomatics school children of Sonapur(Kathmandu University, 2007) Pokharel, PK; Pokharel, P; Bhatta, NK; Pandey, RM; Erkki, KAbstract Background: Bronchial asthma is one of the most common illnesses in children. Factors influencing development of asthma have not been studied in rural population. Materials and methods: Two thousand school-going children from three schools of Sonapur VDC, Sunsari in the surrounding of industries were screened for the presence of symptoms of asthma using a questionnaire suggested by International Study of Asthma and Allergy in Children (ISSAC). Results: One hundred twenty children were identified with symptoms of bronchial asthma. For each child with asthma two age and sex matched non-asthmatic control were selected from the study population. History, clinical examination and in-depth interview were carried out for all cases and controls. Factors associated with presence of symptoms of asthma on multivariate analysis were: passive smoking (OR 3.33, 95% CI 1.85-7.65), pets at home (OR 5.5, 95% CI 1.04-29.15), and absence of windows in living rooms (OR 4.03, 95% CI 1.17- 13.79). Factors such as family history of asthma, history of worm infestation, fuel used for cooking, location of kitchen and food allergy were not significant in statistical analysis. Conclusion: Thus, passive smoking, inadequate ventilation and domestic animals and pets (dogs and cats) at home are significant risk factors associated with presence of symptoms of asthma in these children. Key words: asthma; risk factors; passive smoking; domestic animals and pets; cross ventilation; childhood asthmaPublication Comparative study of community medicine practice in MBBS curriculum of health institutions of Nepal(Kathmandu University, 2009) Marahatta, SB; Sinha, NP; Dixit, H; Shrestha, IB; Pokharel, PKAbstract Background: A revolution in health care is occurring as a result of changes in the practice of medicine and in society. Medical education, if it is to keep up with the times, needs to adapt to society's changing attitudes. Presently medical education has been criticised for its orientation and insensitivity to people’s need. The MBBS curriculum of medical institutions of Nepal has been focusing on community-based approaches and is still guided by the same notion. The question put forward is whether it has been appropriate to nurture the present health needs and aspiration of people. Objective: The objective of the present study is to review the existing community based medical education in health institutions of Nepal to strengthen the components of community care. Materials and methods: Qualitative study was done by reviewing the curricula and existing community medicine courses/activities in MBBS curriculum of Institute of Medicine (IoM)/Tribhuvan University, BP Koirala Institute of Health Sciences (BPKHIS) and Kathmandu University School of Medical Sciences (KUSMS). Findings and Discussion: The curriculum of all the health institutions have addressed significantly on community medicine practice. As per Institute of Medicine, the community medicine practice is achieved through community based learning experiences like community diagnosis, concurrent field with families of sick members and district health system management practice. In BP Koirala Institute of Health Sciences, community medicine practice is undertaken through exposure to community diagnosis program, health care delivery system, family health exercise, applied epidemiology and educational research methodology, management skills for health services and Community Oriented Compulsory Residential Rotatory Internship Program (COCRRIP). In KUSMS, community medicine module is carried out as- community diagnosis program, community health intervention project, school health project, occupational health project, health delivery system functioning, family health care activities and Compulsory Residential Rotatory Internship Program in outreach clinics. In the practice the practical aspects are largely unstructured that waste too much time in non-educational activities and rely on learning and doing. Meanwhile, expectation of the community is increasing and the challenge of nurturing their demands has come in forefront. Community has perceived that the medical schools are concentrating on fulfilling the demand of their curriculum rather directing on their health care need. Conclusion: Health institutions need to be accountable to take the responsibility of strengthening the health status of the community of their catchments areas. The practice of community medicine need to be done in an innovative way and these schools should execute continual intervention activities and complement other institutions working in their areas. Key words: Community medicine, curriculum, field practicePublication Exploring the iceberg of hypertension: A community based study in an eastern Nepal town(Kathmandu University, 2007) Vaidya, A; Pokharel, PK; Karki, P; Nagesh, SObjectives: Hypertension is an important public health challenge in the developing and the developed world alike. However, community-based studies on cardiovascular diseases including hypertension in a developing country like Nepal have been limited. The primary aim of this study is to measure the prevalence of hypertension in the Dharan town of Eastern Nepal and to explore the ‘iceberg phenomenon’ of hypertension in the study population. Methods: A population-based cross-sectional analytical study was undertaken in the Dharan municipality in 2004-5 with one thousand males aged 35 years and above as participants. The subjects were recruited by simple random sampling of the households in each ward. Results: The overall prevalence of hypertension in the study population was 22.7% which was comparable to the studies from Northern and Western India. The comparison between the population with normal and high blood pressure at time of study shows significant differences in terms of age, religion, current job status, occupation, socio- economic status, physical activity and tobacco use. Conclusion: The study shows that while a vast majority of the hypertensive population was not aware of their high blood pressure status, at the same time, a large fraction of the population with increased blood pressure did not have their blood pressure under control. A surveillance system to detect population with high blood pressure, follow up the detected cases of hypertension, as well as motivate and/or counsel the ‘hard-to-treat’ cases for regular follow-up should be valuable. Key words: hypertension, community-based, iceberg, Eastern NepalPublication Factors Contributing to Antenatal Care and Delivery Prac- tices in Village Development Committees of Ilam District, Nepal(Kathmandu University, 2013) Pradhan, PMS; Bhattarai, S; Paudel, IS; Gaurav, K; Pokharel, PKABSTRACT Background Proper antenatal care and good delivery practice helps to prevent the complications of childbirth and ensures a wholesome maternal and child health in the future. Almost half of the births in the developing countries take place without a skilled birth attendant. Objectives To assess the antenatal care (ANC) and delivery practices in the Village Development Committees (VDC) of Ilam district, Nepal and to identify the relationship with the socio-demographic factors. Method Cross sectional study of 262 mothers of reproductive age group having at least one child of less than five years of age, selected by simple random sampling, was carried out over different VDCs of Ilam by face to face interview using semi-structured questionnaire. Results Among 262 mothers, 34.7% were married before the age of 18 years. 69.5% of the mothers had attended four antenatal care visits. Nearly 47% of the deliveries were conducted at home out of which only 33.6% were conducted by skilled birth attendant. Number of children and maternal education were found to significantly affect the ANC visit and place of delivery. Age at marriage and age at first pregnancy were significantly associated with the place of delivery. Conclusion Large proportion of mothers still do not have adequate antenatal visits and this is supported by the fact that nearly half of the deliveries were conducted at home. Motivation and incentives are required for pregnant mothers especially in rural areas regarding importance of adequate antenatal visits and delivery in health institutions. Population policies should be aimed at reducing proportion of women marrying and giving birth in their teens. KEY WORDS Antenatal care, delivery practices, home delivery, pregnancy, NepalPublication Malnutrition Status Among Under - 5 Children in a Hill Community of Nepal(Kathmandu University, 2014) Gaurav, K; Poudel, I S; Bhattarai, S; Pradhan, PMS; Pokharel, PKABSTRACT Background Malnutrition, especially under nutrition puts children at increased risk of morbidity and mortality and remains a serious barrier in child growth, development and survival. This is a major public health problem among under- 5 children in Nepal particularly in rural areas. Objective To assess the burden and contributing factors for malnutrition in hill community of Ilam district in eastern Nepal. Method A cross sectional study was conducted in rural hill communities of Ilam district, Nepal with a sample of 240 under- 5 children. Anthropometric measurements were used as per WHO guidelines to asses three nutritional status: Underweight, Stunting, and Wasting using descriptive statistics and chi square test was applied using SPSS 12.0 to assess social and predisposing factors. Result Seventeen percent of under- 5 children were moderately and 10.4 % were severely underweight. Similarly, 22.9%, and 17.5% were found to be moderately and severely stunted respectively. Less than 10% were found to be moderately and severely wasted. Older age group of children, education level of mother, not exclusive breast feeding practice had significant (p <0.05) effect on stunting. More than 50% children were affected with stunting, underweight and wasting at the same time. Conclusion Significant proportion of under - 5 children were malnourished in the communities of the hilly areas. The study unveiled the importance of literacy and exclusive breast feeding for the prevention of malnutrition in under- 5 children. KEY WORDS Contributing factors, malnutrition, Nepal, under- 5 children.Publication Maternal and Perinatal outcome among the booked and unbooked pregnancies from catchments area of BP Koirala Institute of Health Sciences, Nepal(Kathmandu University, 2007) Pokharel, HP; Lama, GJ; Banerjee, B; Paudel, LS; Pokharel, PKObjectives: To examine the differences in maternal and perinatal outcome among booked and unbooked pregnant women and their perception for underutilization of services targeted for them. Methods: Two thousand two hundred and twenty eight pregnant women, booked and unbooked, attending emergency obstetrics care during Jan.-Dec. 2005, were included in the study; Investigators followed cases till discharge. Results: Tendency for mothers to be booked was found to be significantly associated with age. Booked and unbooked mothers differed by distance to the hospital and parity. There was difference between the periods of gestation at which they presented to the hospital among both the groups (p<0.0001). Nearly eighty percent (81.4%) of unbooked mothers did not know the period of gestation. Most of these women conceived during lactational or depo provera-induced amenorrhea. The maternal mortality rate for unbooked mothers was 16 out of 1056 and none among the booked. Perinatal mortality is 3 times less in booked mothers. Higher perinatal mortalities are associated with unbooked mothers and had a higher proportion of maternal intensive care unit admissions and perinatal deaths compared with the booked group. Focus group discussion revealed that the reasons for underutilizations of services are; Distance, cost, disempowerment of women and attitudes of hospital personnel. Conclusion: The opportunities to enhance utilizations are based on distance, cost and client friendly environment of hospital personnel. It has been observed, building teaching hospitals alone, will not have much impact to maternal and perinatal outcome, unless peripheral health institutions are equipped with facilities and service provisions. Keywords: Booked mothers, Unbooked mothers, maternal complication, perinatal outcome.Publication Nutritional status and morbidity pattern among governmental primary school children in the Eastern Nepal(Kathmandu University, 2004) Shakya, SR; Bhandary, S; Pokharel, PKObjective: To assess the nutritional status and morbidity pattern of primary school children. Methods: Descriptive, cross-sectional study was administered in the five governmental schools located in Dhankuta town (Dhankuta district) and Ineruwa town (Sunsari district). The schools were selected using simple random sampling technique. From these selected schools, a total number of 818 students studying from Grade I to V were enumerated in the study using census survey method. Results: Among 818 students, 61% of the students were found to be malnourished. The students were more stunted (21.5%) than wasted (10.4%). Only 5.4 % of the students were found to be both wasted and stunted. The collected blood and stool samples from the students revealed parasitic infestation of 65.8% and anaemia of 58%. The most common diseases in those schools were: skin diseases (20%), dental caries (19.8%), and lymphodenopathy (10.5%). Among skin diseases, pediculosis was more common among girls while ringworms and scabies were common among boys. Conclusion: The study revealed that high percentage of primary school students was malnourished. It was found that there was a high prevalence of parasitic infestation and anaemia. The study result revealed the urgent need for initiation of school health program with specific emphasis on prevention of diseases, improvement of personal hygiene and nutritional status with the collaboration of governmental and non-governmental institutions. Key Words: Nepal, school health, nutritional status, malnutrition, anaemia, pediculosis.Publication Outbreak of Cholera in Tilathi VDC Saptari Nepal(Kathmandu University, 2012) Yadav, DK; Tamrakar, D; Baral, R; Jha, P; Gautam, S; Pokharel, PKABSTRACT Background On 2011, Cluster of cholera cases was reported in the Tilathi VDC of Saptari, Nepal. Objective The outbreak was investigated to identify the etiological agent and possible source of infection and guiding the prevention and control measures. Methods Demographic and clinical details were collected from the suspected case-patients, and the outbreak was described by time, place, and person. Focus group discussion and Key informant interview were conducted to assess the practice of sanitation, source of drinking water and probable cause of diarrheal disease. Five stool samples and 10 water samples of tube well and ponds were collected and microbiological study was done in BPKIHS Dharan. Results A total of 111 persons suffered with diarrhea and 02 died of it (attack rate 3.05%, case fatality rate 1.8%). All age groups were affected with disease (median age 26 yrs) and males were affected more than females. Descriptive epidemiology suggested the clustering of cases were around the pond where they clean utensils, take bath and wash clothes. The Vibrio cholerae 01 El Tor, Ogawa serotype was isolated in 03 out of 05 suspected stool samples and in all three of the pond water samples. They reported that most of the houses do not have the toilet and people do not wash their hands regularly with soap and water after defecation. Conclusion Vibrio cholerae was the causative agent behind the outbreak and probable source of infection was the problematic pond water which they used for different purpose. Immediate chlorination of the pond was recommended to halt further spread of the epidemics. KEY WORDS Cholera, outbreak, tilathi, saptariPublication Prevalence of glaucoma in Sunsari district of eastern Nepal(Kathmandu University, 2007) Sah, RP; Badhu, BP; Pokharel, PK; Thakur, SKD; Das, H; Panda, AAims: To determine prevalence of glaucoma and glaucoma suspect in subjects 40 years and above in Sunsari district of eastern Nepal. Methods: A community based cross sectional study examining 1600 selected subjects was carried out. In all subjects best corrected visual acuity was determined. Oblique torch light test was used for anterior chamber depth evaluation. Intraocular pressure (IOP) measurements with Perkins tonometer and fundus examination were carried out in the community. Subjects diagnosed as glaucoma suspect were further evaluated in the hospital using slit lamp examination, gonioscopy and Goldmann perimetry. Glaucoma was defined by characteristic disc and visual field changes irrespective of the level of IOP. Results: Of 1600 subjects examined, the prevalence of glaucoma was found to be 0.938%. The prevalences of primary open angle glaucoma, primary angle closure glaucoma, secondary glaucoma and ocular hypertension were 0.562%, 0.125%, 0.250% and 0.500% respectively. Lens induced glaucoma accounted for all the cases of secondary glaucoma. Conclusion: The prevalence of glaucoma in the Sunsari District of Nepal is 0.938%, which is lower than that reported in the neighboring regions. Lens induced glaucoma is highly prevalent as a cause of secondary glaucoma. Key words: Glaucoma, prevalence, Eastern Nepal, secondary glaucoma