Browsing by Author "Vaidya, A"
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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 Acquaintance with the actuality: Community diagnosis programme of Kathmandu Medical College at Gundu village, Bhaktapur, Nepal(Kathmandu University, 2008) Vaidya, A; Pradhan, A; Joshi, SK; Gopalakrishnan, S; Dudani, IAbstract Introduction: In Nepal, various field programs such as community diagnosis programmes (CDP) have been initiated to make the education of doctors, nurses and dentists more community oriented and relevant and suited to the health care scenario. Community diagnosis refers to the identification and quantification of the health problems in a community and identification of their correlates for the purpose of defining those individuals or groups at risk or those in need of health care. The article presents the main activities of community diagnosis as a core component of community-based education for the medical students at Kathmandu Medical College, Kathmandu, Nepal. Methodology: A 4 weeks’ Community Diagnosis Programme was conducted by MBBS II students (9 th Batch) of the Kathmandu Medical College under the supervision of the Department of Community Medicine in November 2006 in the rural community of Gundu VDC (village development committee). The tools used included pre-tested questionnaires, weighing machines, measuring tapes, stethoscopes and sphygmomanometers. After the data collection and compilation, the students presented their findings in oral presentations, accompanied by a written report, including essential recommendations for improving the health status of these communities. Results: The students benefited from the necessary process of integrating clinical skills and a public health approach, so as to enhance their epidemiological thinking and be of greater use to the communities where they will practice. The community also benefited by achievement of behavioral changes leading to healthier lifestyles and increased awareness of health-related matters and their role in quality of life. Conclusions: CDP is a way to practically demonstrate that the link between a medical college and society is possible. That is, a medical college can serve the community and thus society, with specific activities to improve health and the skills of students who will serve as future health professionals.Publication Assessment of Health Service Delivery to Address Cardiovascular Diseases in Nepal(Kathmandu University, 2021) Suwal, PS; Prajapati, D; Bajracharya, S; Shrestha, A; Maharjan, R; Shrestha, S; Jha, N; Koju, RP; Vaidya, AABSTRACT Background A health care delivery system is the organization of people, institutions, and resources designed to deliver health services. A comprehensive study to explore cardiovascular health service delivery in Nepal is lacking. Objective This study attempted to assess Nepal’s health system gap on organization and delivery of cardiovascular disease prevention and management services. Method This mixed-method study used the six building blocks of the World Health Organization health system framework: organization; access; coverage, utilization and demand; equity; quality of services; and outcomes. We conducted the desk reviews of national and international documents, performed several key informant interviews, calculated the relevant indicators, and assessed the Strengths, Weaknesses, Opportunities, and Threats of the cardiovascular health service delivery. Result We found that most of the cardiovascular services are concentrated in urban areas, and suffer from poor access, quality, utilization, and coverage in most of the areas resulting in poor health outcomes. Though the services have recently improved due to increased primary care interventions, there is scope for the development of competent human resources, advancement of technologies, development of national protocols, and improved monitoring and supervision. Improved disease system including the medical recording and reporting mechanism to incorporate and reflect the true burden of CVD in Nepal is lacking. Conclusion Despite having health facilities from grassroots to the central level, availability, access, and quality of cardiovascular health services are poor. Further improvement and equitable expansion of promotive, preventive, diagnostic, referral, and rehabilitative cardiovascular services are needed to ensure universal health coverage. KEY WORDS CVDs, Health-service delivery, Infrastructure, Needs-assessment, NepalPublication 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 Community participation in health: A brief review and the experience of Kathmandu Medical College with the Duwakot community(Kathmandu University, 2008) Vaidya, A; Pradhan, BAbstract One of the principles of Primary Health Care (PHC), Community Participation is a process through which the stakeholders influence and share control over development initiatives and the decisions and resources which affect them. It is a complex issue that has been studied widely and continues to be of great interest among community health workers. This paper presents a brief review of various aspects of community participation. It then illustrates how it is practiced at Duwakot Community Hospital, Kathmandu Medical College, Duwakot, Bhaktapur, Nepal in collaboration with the local community. Key words: Primary Health Care, Community ParticipationPublication Comparison of PAP test among high and non-high risk female(Kathmandu University, 2003) Vaidya, Aprospective study of pap smear in 100 high risk and equal number of non high risk female among total 1022 female Gynecological patients within a period of two and half months {Beginning of Sept. to middle of Nov. 1995} in Maternity Hospital, Thapathali is presented. There were 9 cases positive for dyskaryosis among high risk and 3 cases among the comparison group. All positive cases were at the age of 35 years and above. In 9 positive cases, 5 cases were in CIN I (55.55%) while 4 were in CIN II (44.44%). Similarly out of 3 positive cases in comparison group 1 was in CIN I category (33.33%) and 2 cases were in CIN II (66.66%). Relation of positive cases with low social class revealed 80% CIN I and 50% CIN II among high risk group where as 66.6% CIN II in comparison group. Analysis of risk factor in development of various grades Dyskaryosis revealed 60% of CIN I had high parity while 50% had CIN II. There are about 40% of CIN I and 75% CIN II among child birth < 19yrs, 60% smoker had CIN I where as 100%. Smoker had CIN II. 80% of CIN I gave history of excessive vaginal discharge where as 50% of CIN II had excessive vaginal discharge. 40% of CIN I was having injection Depo provera. Cases were also analyzed according to risk factor. Out of 9 positive cases among high-risk females 5 positive had parity more than 4 and 4 cases had less than 4. 5 positive cases were among less than 19 years of first childbirth, 4 among more than 19 years. 7 positive cases were smoker and 2 positive cases were non-smoker. 6 positive cases gave history of abnormal vaginal discharge and 3 positive cases had no abnormal vaginal discharge. Out of 9 positive cases 2 had history of injection Depo provera continuously for >5 years where as 7 were non users. Key words: PAP Smear, High risk, Dyskaryosis, CINPublication Determination and Evaluation of Sense of Coherence in Women in Semi-urban Nepal: A part of the Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) Trial(Kathmandu University, 2021) Thapa, DR; Oli, N; Vaidya, A; Suominen, S; Ekström-Bergström, A; Areskoug Josefsson, K; Krettek, AABSTRACT Background Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals’ overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal. Objective To determine and evaluate women’s SOC before and after a health education intervention. Method This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban Jhaukhel- Duwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1-7 years. Eight hundred and fifty-seven women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests and one-way uni-variate ANOVA. Result Women’s total SOC mean values at baseline were 51.1-57.4 and at follow up 54.4-54.9 in the intervention and control area, respectively. At baseline, SOC was significantly weaker in the intervention area compared to the control area (p < 0.001). At follow- up three months later, SOC was significantly stronger in the intervention area than in the control area (p < 0.001). Conclusion Nepalese women had weaker SOC than women in high-income countries, but comparable to neighboring country India with similar cultural features. Empowerment of women through community participation and health education strengthened SOC. The SOC-13-questionnaire in its Nepali version is recommended to be further evaluated. KEY WORDS Health education, Health promotion, Non-communicable disease, Quality of life, Sense of coherencePublication 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 Is Ethnicity an Important Determinant of High Blood Pres- sure in Nepalese Population? A community-Based Cross- Sectional Study in Duwakot, Nepal(Kathmandu University, 2012) Vaidya, AABSTRACT Background Hypertension is a rising public health problem in Nepal. Most of the upsurge is attributed to the behavioural and lifestyle transitions. However, the hereditary component such as ethnicity, which may also be an important determinant, has not been studied. Objective This study aims to investigate if ethnicity is a key determinant of having a high blood pressure in the Nepalese population. Methods A population-based cross sectional study was conducted in the Duwakot village of Bhaktapur District, Nepal. Systematic random sampling of the adults was done in all the nine wards. A total of 641 adults of both sexes, of age 35 years or more were included in the analysis. Results Most of the life-style related risk factors were comparable in the broad two ethnic groups- Tibeto-Burmans and Indo-Aryans. The prevalence of hypertension was 25.3% in the Tibeto-Burmans compared to the 14.0% in the Indo-Aryans. Crude odds ratio (95% CI) of being hypertensive for the Tibeto-Burmans compared to the Indo-Aryans was 2.07 (1.36-3.15) (p=0.01). After adjusting for the different factors the adjusted odds ratio (95% CI) for the same was found to be 1.78 (1.12-2.81) (p=0.014). Conclusion There is an ethnic variation in the blood pressure distribution in the Nepalese population, which might be acting independent of the different life-style factors. More elaborate studies, including longitudinal and migration studies, and probably genetic analyses, can provide a more definite answer. KEY WORDS blood pressure, ethnicity, NepalPublication Measurement of Right Atrial Volume and Diameters in Healthy Nepalese with Normal Echocardiogram(Kathmandu University, 2014) Karki, DB; Pant, S; Yadava, SK; Vaidya, A; Neupane, DK; Joshi, SABSTRACT Background The size of right atrium is expected to be different in diverse healthy ethnic groups. It is important to know the normal size of right atrium in our healthy population. Objective The study aimed to find out the normal values of right atrial volume, right atrial short axis diameter and right atrial long axis diameter in healthy Nepalese population with normal echocardiographic findings. It also looked at correlations between right atrial dimensions and the right atrial volume. Method Verbal consent was taken from all the participants. One hundred participants between the age of 18 and 60 years with normal echocardiographic findings and without any chronic disease were included in this study. Right atrial volume was measured by using area length method. Right atrial short axis diameter and Right atrial long axis diameter were measured in the four chamber view. Result The mean right atrial volume was 23.64±5.36 ml (range 11.30 - 40.00 ml).The range of right atrial short axis diameter and right atrial long axis diameter were 1.34-3.80 cm and 2.4-4.7 cm respectively. Conclusion The size of right atrium in the Nepalese population is smaller compared to western population. Male right atrial volume size is greater than female in Nepalese population similar to western population. The findings of normal value of right atrial volume and right atrial diameter in Nepalese population will help the physician to assess patients with various conditions affecting the right atrium. KEY WORDS Nepalese population, right atrial short axis diameter, right atrial long axis diameter, right atrial volume.Publication Need for community-based primary prevention of coronary heart disease in Nepal(Kathmandu University, 2008) Vaidya, ANAPublication Publication Prevalence of different types of gallstone in the patients with cholelithiasis at Kathmandu Medical College, Nepal(Kathmandu University, 2009) Pradhan, SB; Joshi, MR; Vaidya, AAbstract Background: Gallstone disease known as cholelithiasis is the most common digestive surgical disorder and account for an important part of health care expenditure. Attempt was made to analyse the gallstone for typing depending upon the composition. Aims & objectives: The main objective of this study was to see the prevalence of different types of gallstone in Nepal and to correlate them with the clinical findings. Materials & methods: Gallstones of 80 different patients who underwent cholecystectomy for cholelithiasis were collected from 20th January 2005 to 16th May 2006 in Department of Pathology, Kathmandu Medical College Teaching Hospital. Detailed history was taken. Stones were analyzed with chemical and enzymatic methods using clinical spectrophotometer. Results & conclusion: The most commonly involved age group for cholelithiasis (32.5%) is found to be 30-39 years with a female predominance (M: F=1:3.2). Cholelithiasis was found more commonly among non-vegetarian with the vegetarian: non-vegetarian ratio 1:9. Mixed type stone was found to be the most common type of stone comprising 78.75%, followed by cholesterol stone 12.5%, Brown pigment stone 7.5% and Black pigment stone 1.25%. Key words: Gallbladder, cholelithiasis, GallstonePublication Research Capacity for Prevention and Control of Non-communicable Diseases and their Risk Factors in Nepal: Findings of a Needs Assessment Study(Kathmandu University, 2022) Oli, N; Pradhan, PMS; Sagtani, RA; Shrestha, A; Jaacks, LM; Karmacharya, BM; Danaei, G; Vaidya, AABSTRACT Background Despite a high burden, there are limited trainings in non-communicable disease research in Nepal. Objective We conducted a needs assessment to assess existing research training capacity in academic health institutions of Nepal for the prevention and control of non- communicable diseases, identify gaps in research, and explore the feasibility of developing research training program in Nepal targeting non-communicable diseases. Method We did mixed-method research and reviewed academic institution curricula and scientific articles authored by Nepali researchers. We conducted 14 Focus Group Discussions with bachelor and masters level students of public health and community medicine; 25 In-depth Interviews with department heads and faculties, and government stakeholders. We surveyed medical and public health students on their research knowledge and skills development. Result Research methodology component was addressed differently across academic programs. One-third (33.7%) of students expressed lack of skills for analysis and interpretation of data. They felt that there is a wide scope and career-interest in non-communicable diseases research in Nepal. However, specific objectives in the curriculum and practical aspects regarding non-communicable diseases were lacking. Most of the non-communicable diseases research in Nepal are prevalence studies. Lack of funding, conflicting priorities with curative services, and inadequate training for advanced research tools were reported as major barriers. Conclusion Nepal must strengthen the whole spectrum of research capacity: epidemiological skills, research management, and fund development. Generation of a critical mass of non-communicable disease researchers must go together with improved funding from the government, non-governmental, and external funding organizations. KEY WORDS Curriculum, Need assessment, Public health, Research methodologyPublication The Heart-health Associated Research, Dissemination and Intervention in the Community (HARDIC) Trial for Nepalese Mothers regarding Diet and Physical Activity: A Process Evaluation(Kathmandu University, 2017) Vaidya, A; Oli, N; Eiben, G; Krettek, AABSTRACT Background Mothers with young children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance site of Bhaktapur district have misconceptions and poor behavioural practice regarding diet and physical activity. We developed the Heart- health Associated Research, Dissemination and Intervention in the Community trial - a health promotion intervention for mothers. Objective The objective of this study was to evaluate the intervention’s feasibility, acceptability, potential for transferability and scaling up, and to determine its immediate outcome. Method Duwakot and Jhaukhel were randomly selected as the intervention and control communities, respectively. We trained 47 peer mothers from Duwakot, each of whom gave classes with 10 fellow mothers of their neighbourhood. The process evaluation was carried out on a continuous basis at different points of the intervention held from August to November 2016. Result In round one, the participation and completion rates were both > 90% for peer mothers; and 85% and 70%, respectively, for the fellow mothers. However, the participation rates fell in the round two of the intervention. On the whole, the mothers expressed satisfaction and acceptance of the course content and training modality. Immediate evaluation of the intervention showed improvement of knowledge, attitude and practice of diet and physical activity among both groups of mothers. Conclusion The successful implementation of the intervention targeting diet and physical activity clearly demonstrates the feasibility of health promotional activities in the Nepalese community for improvement of cardiovascular health. KEY WORDS Diet, health promotion, mothers, physical activity, process evaluation