Browsing by Author "Wagle, RR"
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Publication De-worming during pregnancy in Nepal: an effect on neonatal mortality(Institute of Medicine, 2018) Shedain, PR; Dixit, Devkota M; Paudel, R; Wagle, RR; Karki, S; Shrestha, R; Sharma, YAbstract Background: The Ministry of Health and Population, Nepal has been administering the de-worming medication (with tablet albendazole) to pregnant women aiming at reducing maternal anemia and neonatal death since 2001. The neonatal mortality has remained stagnant for the past decade. The effect of de-worming during pregnancy on neonatal mortality is not known yet. Methods: This study is based on the database of Nepal Demographic and Health Surveys (NDHS) 2006 and 2011. This study includes the recent singleton live births within five years preceding the survey as the de-worming medication during the pregnancy was collected only in the recent live births (the last live birth) in the five years preceding the surveys. The newborn death of the pregnant women administered with de-worming medication was compared with those pregnant women who were not administered with de-worming medication during the pregnancy. An association has been established with the logistic regression model adjusting several potential confounding factors. Results: In the pooled data, the recent singleton live births were 8,147. A total of 813 and 2,274 mothers were found to have taken de-worming medication during pregnancy in the NDHS 2006 and 2011, respectively. The use of de-worming during pregnancy increased from 20% to 56% between the surveys, but the newborn deaths in de-worming group rose from 1.2% to 1.4%. The adjusted OR of the neonatal death with the de-worming was {aOR 1.129 (95% CI 0.696-1.829), P = 0.623}. Conclusion: The de-worming during pregnancy in Nepal was not found significantly associated with reduction on neonatal deaths, which suggests timely review of the program. Keywords: De-worming, neonatal mortality, pregnancy, NepalPublication 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