Journal Issue: Volume: 36, No. 1 (2014) April
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Volume
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Issue Date
2014
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Policy Making Challenges on Dual Burden of Environment Related Diseases
(Institute of Medicine, 2014) Sherchand. Jeevan B.
NA.
Availability and Use of Oxytocin in Health Facilities in Nepal
(Institute of Medicine, 2014) Poudyal, AK; Shrestha, B; Onta, SR
Abstract
Introduction: Although maternal mortality is declining over the past 15 years, it is still high in Nepal. Postpartum haemorrhage is the leading cause of maternal deaths in Nepal. Oxytocin is one of the emergency drugs, which prevent and manage postpartum haemeorrhage, listed in essential drug list, and supplied to hospitals and Primary Health Care centers in Nepal. The study aimed to assess availability, storage condition, prescriber’s knowledge and practice of Oxytocin in Nepal.
Methods: A descriptive cross-sectional explorative study was conducted in 40 health facilities of 10districts. Multiple methods–observation, interviews, store records and delivery charts analysis-were used to collect data. The respondents of the study (health facility in-charges, service providers and storekeepers) were interviewed with semi-structured questionnaire. The collected data was entered into MS-Excel and analyzed using SPSS version 17.
Results: Oxytocin was available throughout the year in 35.5% of health facilities among them only 8.3% of health facilities stored Oxytocin in refrigerator. In-charges, service providers, were not aware of recommended temperature for Oxytocin storage. Similarly, 40.7% of the service providers used Oxytocin for prevention and management of postpartum haemorrhage, 31.9% and 27.4% of service providers used Oxytocin for augmentation and induction respectively.
Conclusion: In some districts, the medicine was not available throughout the year. Majority of service providers were not aware of recommended indications to induction and augmentation. There should be a serious effort to orient the service providers about rational use of Oxytocin and store to maintain the efficacy of the drug.
Keywords: Oxytocin, post-partum hemorrhage
Assessment of Quality of Life of People Living with HIV and AIDS Receiving Anti-Retroviral Therapy in Kathmandu Valley
(Institute of Medicine, 2014) Acharya, DK
Abstract
Introduction: Quality of Life (QOL) of people living with HIV and AIDS is a great concern. The impact of HIV on QOL falls under four major domains referred to as physical, psychological, social and environment domain. The objective of this study was to assess the quality of life of people living with HIV and AIDS taking antiretroviral therapy and its association with socio demographic and disease related variables.
Methods: Descriptive cross sectional study design was used. 128 randomly selected participants enrolled at Tribhuwan University Teaching Hospital (TUTH) ART center above 15 years were interviewed. QOL was evaluated using the World Health Organization Quality of Life (WHOQOL) Bref instrument. Data was entered in Epi Data and analyzed using SPSS version 16.
Results: The median scores with interquartile range (IQR) in four domains of QOL was highest in social domain i.e. 69 (56 to 75) and lowest in psychological domain i.e. 56 (50 to 69). All the domains were positively correlated with the overall QOL with Spearman’s rho ranging from .31 to .63. Strongest correlation was observed between psychological domain and overall QOL. Age, sex and marital status were significantly associated with the overall QOL whereas level of education and disease related variables i.e. CD4 counts and WHO clinical stage have no significant association with overall QOL.
Conclusion: The study concludes the need for psychological support and community based interventions for PLHIV and AIDS to enhance their QOL. Social support to women living with HIV and AIDs is also required to help them better cope with the disease.
Keywords: HIV and AIDS, QOL, WHOQOL, CD4
Maternal Mortality in Pregnancy with Heart Disease
(Institute of Medicine, 2014) Dali, B; Baral, J
Abstract
Introduction: The incidence of heart disease complicating pregnancy is approximately 1–3% of pregnancies and is responsible for 10 to 15% of maternal mortality. While rheumatic heart disease is on real decline in western world, it is adamantly remaining unchanged here in Nepal and persistently contributing to maternal mortality in cardiac complication in pregnancy.
Methods: From the ongoing maternal mortality study since BS 2050 (13th April 1993), data from last 15 years (April 1998 - 2013) were extracted. The data were tabulated and analyzed.
Results: There were 14 12.5% deaths accountable to heart disease in a total 112 maternal mortality during the period of 15 years and they were mostly from rheumatic heart disease. Most of them were multivalvular heart disease except for a solitary case of aortic stenosis. MTP (2) Caesarian (3) breech vaginal delivery (1) were performed and spontaneous expulsion was managed along with supportive care delivered in mothers who died shortly after admission.
Conclusion: Poor health seeking behavior and careless attitude is a part of blame game played often played whereas mortality from rheumatic heart disease which is obsolete in global scenario is of utmost concern as cardiac conditions pertaining to this etiology can be minimized certainly and the mortality attributed thus can be reduced. Termination of pregnancy should only be allowed for reason more than valvular lesion like coarctation of aorta.
Keywords: Heart Disease, maternal mortality