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In the name of herbal medicine
(Institute of Medicine, 1998) Khakurel, B; Prasad, RR; Bhattarai, DD; Sheak, A
Abstract In the quest for safe and cost effective medicines, as much as 65-80% of the world's population have resorted to herbal remedies of one system or another, often led by a wrong notion that things originating from ancient practices cannot have detrimental effect on health. There are evidences of use of potentially toxic or ineffective plant substances in the form of crude powder or extracts contained in already marketed products. Herbal medicines even contaminated with ingredients of modern medicines, pests, microbes and heavy metals are marketed for which drug regulatory authorities often are not fully equipped to deal with. There is an increasing amount of cross-practice. Indiscriminate prescribing and illegal sale-distribution of drugs by health professionals belonging to different traditional systems including traditional healers and quacks, which is on the rise. In Nepal, there is no specific legislation to regulate the safety, efficacy, quality, sale-distribution, promotion and utilisation of herbal medicines belonging to traditional systems but quite a good amount of exercise has been done to formulate policies and guidelines on herbal medicines, especially in the line of integrating them with PHC services of the national health care system. There is an acute shortage of professional manpower on herbal medicines. There is also a great deficiency of evaluated information on their practical use. There is a need to look at the toxicity and efficacy of herbal remedies in the light of their past history, usefulness and extent of admixture with allopathic therapeutic agents and animal products. In this article, an attempt has been made to characterise the situation with a view to facilitate identification of issues and approaches towards rationalisation of the sector. Keywords: Medicinal plants, herbal medicine, Ayurveda, traditional medicine, regulation/legislation & policies, Nepal, work of WHO in areas of herbal medicine
Essential Drugs Concept : its application in Nepal
(Institute of Medicine, 1998) Thapa, BB; Prasad, RR; Shrestha, BM; Bhuju, GB; Rajbhandari, V
Abstract Essential drugs are those that satisfy the healthcare needs of the majority of the population; they should therefore be available at all times in adequate amount and in the appropriate dosage forms. Various factors need to be considered for the selection of such drugs, though the model list published by WHO serves as valuable guidelines. National List of Essential Drugs, Nepal (EDL) was published in 1986, which was first revised in 1992 and then in 1997. Implementation of it helps to provide health care to a large population in relatively less resources. We have made an effort in this paper to analyze the situation after implementing EDL in Nepal and suggest the ways and means for more effective implementation so that the goal of 'health for all' could be achieved. Keywords: Essential drugs, Nepal
Impact of a cost sharing drug supply scheme on the quality of service in public health facilities
(Institute of Medicine, 1998) Holloway, KA; Gautam, BR
Abstract Insufficient drug availability undermines primary health care in Nepal. This study investigated the impact of cost-sharing drug schemes (CSDS) in rural hilly E. Nepal, where the drug supply is supplemented and a nominal user fee charged, on the quality of service provided. A cross-sectional survey was conducted & WHO indicators used. It was found that the CSDS did improve drug availability and utilization rates. Further drug use was more rational in the CSDS in terms of prescribed drugs being dispensed and antibiotics being prescribed and dispensed in full course. In other respects the quality of care in CSDS was similar to non-CSDS facilities and was poor. Low staffing levels probably contributed to this. Of particular concern was the inadequate sterilization practices and sterile injection technique in most health facilities (CSDS & non-CSDS). Keywords: cost-sharing, prescribing habits, quality of care, drug use, facility utilization, user fees
How can motherhood be made safer in Nepal ? More than hospitals are needed
(Institute of Medicine, 1998) Carlough, Martha C; LeMaster, Joseph
Abstract The United Mission to Nepal (UMN) has been involved in health work in the Okhaldhunga District of eastern Nepal for more than 30 years. UMN's Okhaldhunga Hospital, which is the only hospital in the district has been providing emergency obstetric services (EOS) since 1979. The Community Health Section of the project has been involved in maternal and child health care, community health education, and nonformal education since 1977. During the last ten years, the absolute number of deliveries presenting to the hospital has increased almost three fold. Yet, the number of women presenting with complications has not increased proportionately, and still only represents a very small percentage of the women in the district who experience obstetric complications every year. The Community Health staff conducted focus group discussions among women attending antenatal clinics and literacy classes to ascertain local beliefs and practices concerning pregnancy and childbirth, and to improve our understanding of why women do or do not seek obstetric care at the hospital. These focus group discussions revealed that many women in the community know about high risk conditions in pregnancy (eg, prolonged labour, bleeding, breech position), but they still wait 2-3 days before seeking help. Going to the hospital is frequently delayed due to issues of finance, transport, family beliefs and decision making. Most women said that they did not make use of local health resources because they were unreliable and staff were often absent from their posts. Women in all groups said that the first person called for obstetric complications is still a traditional healer. The results of this experience in the Okhaldhunga District display that a limited focus on strengthening hospitals would not be enough to significantly change maternal mortality and morbidity. People need education about maternal health. Community-level health workers at health posts need training, support and supervision. Functional systems of transport and referral need to be established if motherhood, and the health of women, is to be made safer in places like the Okhaldhunga District of Nepal.
Cerebral palsy in Nepal: a descriptive study of 136 disabled children presenting to a cerebral palsy centre in Kathmandu
(Institute of Medicine, 1998) Ellis, Matthew; Bhattarai, Shobha; Pandey, Jamuna
Abstract There is little epidemiological data on the nature and causes of cerebral palsy (CP) in developing countries. This study reports 136 consecutive children presenting to a Cerebral Palsy centre in Kathmandu, Nepal. 108 had clinical evidence of nonprogressive disorders of movement or posture due to a defect of the developing brain (i.e. cerebral palsy) of which most (76%) were spastic in type. 90 of these children (82%) were additionally disabled by associated impairments of cognition, hearing or vision. There was a strong male bias in this series (male:female 74%:26%) reflecting in part the lower priority accorded to the girl child. Birth asphyxia of a severity sufficient to cause cerebral palsy always presents in the neonatal period with neonatal encephalopathy (NE). Of the 97 cases for which full historical details were available there was evidence of NE in 27 (28%). In only 19 cases (20%) was there good evidence of obstetric complications and birth asphyxia is the cause of the NE. The proportion of CP resulting from birth asphyxia in this series is similar to that found in industrialised countries. Even with improving maternity service provision in developing countries CP rates are unlikely to change dramatically. Provision of child disability services will remain a continuing priority for the foreseeable future. Keywords: cerebral palsy, birth asphyxia, Nepal
Sociocultural factors causing delay in hospitalization of children in Nepal
(Institute of Medicine, 1998) Thakur, Laxmi Shrestha
Abstract The present study conducted at Kanti Children's Hospital, Kathmandu revealed that 48 percent of parents of sick children admitted to hospital preferred to consult Traditional Faith Healers (TFM) or shamans initially. This was basically responsible for delays in the hospitalization of children. A further analysis of this data indicated that TFHs were unable to cure diseases like meningitis, diarrhoea, septicaemia, pneumonia, heart diseases, malnutrition, leukaemia. This study is both descriptive as well as exploratory in nature. A sample size of 300 parents (about 12% of total patients admitted in the medical wards of Kanti Children's Hospital from 1992-1993) were selected to participate in the study, and out of 300 parents, 25 parents were selected purposively from three districts (Kathmandu, Bhaktapur and Lalitpur) for the follow-up study. Five faith healers and ten doctors of Kanti Children's Hospital were also selected purposively for interview to record their views on causes of delays. This study showed that multiple factors played important roles for the delay of hospitalization of children such as technological factors, social factors and kinship, beliefs, economic factor, education and cure-seeking behaviour of people. The socio-cultural factors like literacy, ethnicity/caste, family structure, decision making process, and cultural and belief systems of people played a major role for the delay of hospitalization of children in Nepal. Keywords: children, hospitalization, sociocultural factors, Nepal
Epidemiology of reported human rabies cases in Nepal, 1992-1996
(Institute of Medicine, 1998) Gongal, GN
Abstract Human rabies is the most dreadful of all communicable diseases. Human rabid cases are reported from time to time in Nepal. An estimated 100 or more persons die of hydrophobia in Nepal annually. With an objective to study the epidemiology of human rabies in Nepal, all the human rabid cases were collected in a standard format from different hospitals during the period from 1992 to 1996. The analysis of reported human rabid cases indicates that rabid cases are reported from both rural and urban areas of Nepal due to negligence after animal bite. A total of 181 cases were reported in the kingdom of Nepal during the period from 1992 to 1996. All the hydrophobia cases except one were diagnosed on clinical background. Only 6 patients developed rabies despite complete or partial anti-rabies vaccination during the last 5 years. Sixty-one percent human rabid cases were reported from Central Development Region alone. Forty to eighty-one per cent hydrophobia patients were children. The male to female ratio was 3:1. Dog bite was the primary source of infection, 96 per cent hydrophobia patients were exposed to a rabid dog. Adult patients were bitten mostly in lower extremities whereas child patients were bitten in upper extremities and highly sensitive areas like head, neck and finger tips. Keywords: Human rabies, hydrophobia, dog, source of exposure, site of bite, incubation period
Acute tuberculous mastoiditis
(Institute of Medicine, 1998) Baskota, DK; Sinha, BK
Abstract Tuberculosis is one of the commonest infectious diseases of developing countries including Nepal, affecting almost all the vital organs of human body. Here an unusual case of tuberculosis of temporal bone has been presented. A 26-year old lady presenting with features of acute mastoiditis was managed surgically. All the investigations including histopathological examination were negative for tuberculosis, but in the end she responded only to anti tuberculous therapy (ATT) with complete resolution of her symptoms. Keywords: Tuberculosis (TB), mastoiditis, granulations, antituberculous therapy, sequestra, mastoidectomy
Typhoid perforation in adults
(Institute of Medicine, 1998) Rijal, Basista; Shrestha, Mitra Lal; Shrestha, Bala Ram; Singh, Yogendra; Khakurel, Mahesh
Abstract This study was conducted to establish the nature of clinical presentation, management and prognosis of typhoid perforation at the TU Teaching Hospital. A retrospective study was conducted from July 1988 to June 1993. During this five-year period, 632 patients with enteric fever were admitted. Of the 632 cases, 30 (4.8%) had enteric perforation, in which 25 (83%) and 5 (17%) were males and females respectively. Perforation was most common in 30 to 39 years age group and occurred mostly during the second week of fever. Fever, abdominal pain and vomiting were common symptoms. Diagnosis was mainly clinical, supplemented by the presence of pneumoperitoneum and confirmed at laparotomy. Operative management was the common modality of treatment with only 6% of mortality, which is much lower than that reported in the literature. Keywords: Typhoid, perforation, incidence, management
Psychological and behavioural problems in school students of Morang district
(Institute of Medicine, 1998) Sharma, VD
Abstract Results of structured and semi-structured interviews of 37 school teachers from 9 different schools of Morang has been presented in relation to existence of psychological/behavioural problems in their students. Data on 3911 students have been analyzed. The study shows that 1442 (36.89%) of students had some kind of problem. The list of conditions in decreasing order of incidence are: very slow to learn, irregular school attendance, suddenly degrading school performance, not able to concentrate and running away from school. The female/male ratio of students was 1:1.47. Keywords: slow learner, behavioural problem in school, psychological problem in school, Nepal
Are women more resistant to cataract ?
(Institute of Medicine, 1998) Chaudhuri, Joydeep Dutta
Abstract Cataract, already a major cause of visual impairment and blindness, is likely to become an increasing problem as the world population ages. It has already been shown that transforming growth factor B (TGF-B) induces changes in rat ocular lenses which are similar to the feature of human anterior subcapsular cataracts. The protective role of oestrogen in such cases has also been shown. This adds to an increasing importance of hormone replacement therapy in post menopausal women.
Prevalence of PSA in suspected cases at TUTH
(Institute of Medicine, 1998) Jha, Bharat; Gurung, Chitra Kumar; Mishra, Parashuram; Bist, Pushpa
Abstract Blood samples of suspected cases of prostate carcinoma were analysed by Enzyme Immunoassay. The objective of this study was to find out the percentage of PSA positivity in under or above 50 years of age. We found that positivity percentage was higher in under or 50 years age group. Keywords: PSA, BHP, Carcinoma prostate, TNM staging
Epithelioid hemangioendothelioma
(Institute of Medicine, 1998) Pahari, Anil; Acharya, Subarna; Jha, Sunil C
Abstract Epithelioid Hemangioendothelioma (EH) is a rare, vasoformative vascular tumour, which displays intermediate clinical behaviour between that of hemangioma and angiosarcoma. We report a case of EH in a 30-year old female, with recurrent pericardial effusion, cough, shortness of breath, haemoptysis, and a negative malignancy workup of pericardial fluid aspiration cytology, and pericardial biopsy. The diagnosis of EH was established after open lung biopsy. Our patient had a malignant form of the disease, who had evidence of alveolar haemorrhage terminally. This is the first case being reported from Nepal. Chemotherapy was advised which she refused, and she died within five months of onset of symptoms.
Advanced secondary abdominal pregnancy
(Institute of Medicine, 1998) Rana, Ashma; Singh, Meeta
Abstract In secondary abdominal pregnancy, due to poor placentation and poor decidual reaction, the placenta may invade and erode maternal vessels. Pregnancy may terminate at any time resulting in massive intraperitoneal bleeding. Clinical findings were bulky uterus at 6 months of gestation with enlarged abdomen and haemoperitoneum; possible diagnosis of secondary abdominal pregnancy was confirmed by ultrasound. We were able to prevent maternal loss by prompt diagnosis and management. Keywords: haemoperitoneum, Secondary abdominal pregnancy
Neurocysticercosis presenting with hypersexuality
(Institute of Medicine, 1998) Sharma, Vidya Dev; Khalid, Abdul
Abstract Neurological disorders can produce paraphilic behaviour and alterations in sexual drive. Lesions of the temporal lobe have been classically associated with sexual disorders. We are reporting a 20-year old girl who presented with marked hypersexuality for five years and had history of generalized tonic-clonic seizures about seven years back. EEG record showed localised spike discharges with phase reversal in the leads corresponding to left parietal lobe. MRI scan revealed calsifications with no perifocal oedema in both parietal lobes and right occipital lobe, suggestive of healed neurocysticercosis. The patient showed significant improvement with carbamazepine. Keywords: Hypersexuality, neurocysticercosis, epilepsy
Successful hymenectomy in a young girl in imperforate hymen
(Institute of Medicine, 1998) Singh, Meeta; Rana, Asma; Jha, Rajshree; Gurung, Geeta; Thapa, Bimal
Abstract An imperforate hymen may exist at the lower end of the vagina. This is due to failure in breakdown of the partition between the mullerian and sinovaginal bulb, contributing to the formation of vagina. We are presenting a case of a fourteen-year girl who was diagnosed as haematocolpus with imperforate hymen from history and clinical examination. Diagnosis was reconfirmed with abdominal ultrasonogram after evacuation of bladder, who had urgent surgical treatment (incision and excision) and relief of symptoms of lower abdominal pain and inability to pass urine. Keywords: Imperforate hymen, haematocolpus, surgical treatment
Chloroquine induced depression
(Institute of Medicine, 1998) Chakrabarti, Kajal
Abstract Certain drugs are known to induce depressive states; chloroquine - an antimalaria, in therapeutic doses administered for treatment of malaria, may produce symptoms rather indistinguishable from depression. Depression is the commonest psychiatric illness seen by general practitioners; in fact, it is one of the commonest clinical problems that general practitioners have to deal with. Prevalence rates for depressions, based on standardized interview, vary considerably between studies (Casey et al, 1984, Robins et al, 1984) probably due to differences in research method rather than true inter practice variation. A number of studies suggest that about 5% of the consulting patients show major depression, another 5% milder episodes, and a further 10% depressive symptoms (Blacker and clase, 1987). Depression is so common that point prevalence rate varies between 13 and 20 percent of the population (Michael Gelder Dennis Gath, Richard Mayan and Philipcowen, 1996). Commonly used drugs for depression include barbiturates, contraceptives, anti-hypertensive, digitalis, ethanol, steroids, phenytoin and analgesics agents (Jr., Ayd, J, Frank, 1995) and depression maybe due to chronic medical illness and other endocrine disorders. The present article describes two cases of depression related to the administration of chloroquine as antimalarial drug. Keywords: Chloroquine induced depression, depression, antimalarial drug
Headache: a prospective study
(Institute of Medicine, 1998) Sharma, Vidya Dev
Abstract A prospective study was done to find out the epidemiology, presentation, type and cause of headache, its relationship with life events and the effects of drugs and relaxation therapy on tension type headache. It was noticed that headache was more common in the second decade of life (47.5%), and more in unmarried (65%) females (62%) and in the education level between matriculation and intermediate level (62.5%). Mostly, the headache was insidious in onset (55%) and generalized throughout the scalp (62.5). It was described as a general sense of heaviness which started around mid-afternoon and progressed up to late evening. It was of moderate severity and aggravated by mental tension (42.5%) and relieved by rest (45%). There was no significant relation of headache with head position or movement. Most of these cases (87%) had no Eye or ENT problems. In life events screening, a large bulk of the patients fell in moderate adjustment needed group with marriage, failure in exams, and change in town being the most frequently encountered event in the last 1 yr. With the help of low-dose tricyclic antidepressants and supportive counseling, noticeable reduction in symptom started in the third week and by the end of sixth week complete symptom removal occurred in 53% of the patients and 33% were better. Keywords: tension-type headache, relaxation therapy, headache, tricyclic antidepressants
Information needs of the academic staff of B.P. Koirala Institute of Health Sciences
(Institute of Medicine, 1998) Pradhan, Mohan Raj
Abstract A survey was done to investigate the information needs of the academic staff of B.P. Koirala Institute of Health Sciences (BPKIHS). The tool used for data collection was questionnaire. The results shows that user should be aware of the various tools of library for making efficient use of the existing resources of the library. Keywords: Information needs, Survey method, Planning
Suvedi, BK
(Institute of Medicine, 1998) Presentation of AIDS in Nepal
Abstract This article presents symptomatic HIV infection/AIDS and mortality due to AIDS in Nepal. The frequently affected age group is 20-29 years and the number of males predominates over females. The pattern of presentation of AIDS in the Nepali context is also discussed. Tuberculosis of lungs is the important opportunistic infection in HIV positive persons, contributing to 67.8% of the total AIDS cases. Non-specific symptoms like weight loss (98.4%), fever (95.4%) and diarrhoea (78.7%) contribute to majority of the presentations. Symptoms like vaginal discharge in women (52.2%), persistent lymphadenopathy (24.6%) and oral thrush (28.4%) are also important contributors. The mean age at death is 28.8 years. Keywords: AIDS, Nepal, Tuberculosis, Lymphadenopathy, Oral thrush

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