Journal Issue: Volume 20, No. 1 & 2 (1998)
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Volume
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Issue Date
1998
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
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
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
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.
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
Cardiac pacing at TU Teaching Hospital - Changing perspective
(Institute of Medicine, 1998) Jha, Sunil; Acharya, SM; Pahari, Anil
Abstract
Life-saving procedures like cardiac pacing have been restarted in the TU Teaching Hospital. In this study, various aspects of cardiac pacing are described. In a period of 27 months, 36 permanent pacemaker implantation and 60 temporary pacemaker implantation procedures were performed by this group. All the procedures were successful and no serious complications were observed. Pacing parameters, and complications are discussed and compared with the earlier studies which clearly demonstrates betterment of the pacemaker situation. The first pediatric pacemaker implantation in Nepal is described. Problems and improvement aspects are highlighted.
Keywords: Permanent pacemaker, Temporary pacemaker, Pacemaker implantation, fluoroscopy, syncopal attacks, CHB, SSS