Browsing by Author "Pokharel, PK"
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Publication 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 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