Journal Issue: Volume: 28, No. 3, December, 2006
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Volume
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Issue Date
2006
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Effectiveness of health insurance and its impact on rural health development
(Institute of Medicine, 2006) Rosyara, KP; Acharya, U; Khadka, PK
Abstract
Background: Providing health insurance or health security for poor people continues to be one of the most important unresolved policy issues for the world. Most rural and informal sector workers in the world do not have any form of health insurance. And in most developing countries, the rural and informal sectors constitute the bulk of the population. Emerging and reemerging new diseases Medical service are being expensive in the recent years because of the advancement of new technologies and increasing demand for quality of care, changing life styles and poor health accessibility in the rural areas.
Methods:Anon experimental descriptive exploratory research design was followed. The population of this study consisted of all those people who were involved in the Health Insurance Scheme launched by various organizations. 105 household was taken from Kirtipur Municipality.
Results: 96.2% of total 105 respondents have getting accessibility through existing Health Insurance scheme and most of them 42.9% have got free bed at the time of admission in the hospital, 43.8% free operation charge, 74.3% have got free health check up and 4.8% have got free lab tests.
Conclusion: Health Insurance Scheme is important indicators of quality services delivered by the scheme. Patient satisfaction is an important factor for willingness to pay. Quality of service is one of the determining factors for rural people to join the Health Insurance Scheme. On the basis of the study finding, it was concluded that awareness program on Health Insurance Scheme should be conducted for the community people, is necessary for the people and premium rate of existing HIS to be lowered, coverage area of the Scheme to be increased for making effective Health Insurance Scheme.
Keywords: Rural, Health Insurance
Vaginal and rectal misoprostol for first trimester termination of pregnancy
(Institute of Medicine, 2006) Pant, PR; Sharma, J; Shrestha, R
Abstract
Background: To compare the effectiveness of vaginal misoprostol with rectal misoprostol for termination of first trimester pregnancy. Prospective comparative study done on 138 women with unwanted pregnancy.
Methods: This study was conducted in Vinayak hospital Kathmandu, from April 2005 to March 2006(Baisakh 2062- Chaitra 2062) i.e. one year. Atotal of 138 women with unwanted pregnancy of 6- 12 weeks, and only those who agreed to participate were included in the study after written consent. Patients with scarred uterus following previous cesarean section, myomectomy or hysterotomy, known allergic to misoprostol, diarrhea, and fever, age below 16 and above 45 were excluded from the study. Abortion was induced with 8ooµgm of mesoprostol in alternative patients vaginally in posterior fornix (group A) and per rectally (group B)
Result: The age of the patients ranged from 16 -42 years and parity primi to sixth gravida. In group A54 patients out of 69( 78.2%) expelled products of conception after first dose of misoprostol within 24hours.15(21.7%) patients required repeat insertion of the drug .of these 8 expelled within the next 24 hours, whereas 7(10.1%) patients needed manual vacuum aspiration . In group B out of the 69 patients 59(85.5%) expelled product of conception within 24 hours of insertion of mesoprostol per rectally while the rest 10(14.4%) required re insertion of the drug. Out of these 10 cases 6 expelled within next 24 hours and four (5.8%) needed manual vacuum aspiration. Side effects of misoprostol: diarrhea, nausea, vomiting, headache and rigor were found to be more in rectal group than the vaginal.
Conclusion: For termination of first trimester pregnancy, rectal route of mesoprostol is more effective than the vaginal route , how ever the side effects like diarrhea pyrexia, headache were more in rectal group.
Keywords: misoprostol, termination of pregnancy, unwanted pregnancy
Prophylactic leg wrapping in elective cesarean section under bupivacain spinal anesthesia
(Institute of Medicine, 2006) Sharma, SA; Prasad, PN; Marhatha, MN; Gupta, MP
Abstract
Background: Hypotension is the most frequent and serious complication associated with spinal anesthesia in obstetrics. Over the years many interventions have been tried to prevent the hypotension. Preloading with fluid, prophylactic vasopressors and leg wrapping have been seen as effective interventions. Leg wrapping, a noninvasive and a nonpharmacologic method, has consistently been seen as an easy and effective intervention. Various studies using Esmarch bandage, graduated compression bandage and inflatable boots are found in the literature. Till now no study has been done using Elastic leukocrepe bandage, which is cheap and widely available. This study was thus carried out with the aim of finding out if wrapping with elastic leukocrepe would have a similar effect.
Methods: In a randomized controlled study, 30 patients (15 in each group) had either their legs wrapped or no wrapping prior to spinal anesthesia before cesarean section. Systolic blood pressure and rescue mephentermine use were recorded.
Result: The mean systolic blood pressure, SBP, at different time intervals was compared. The leg wrapped group had consistently higher SBP. Overall, 12 out of 15 patients in the leg wrapped group and all 15 patients in the control group experienced hypotensive episodes requiring rescue dose of mephentermine. The number of patients who had more than one hypotensive episodes during the surgery was also analyzed. 5 out of 15 cases compared to 14 out of 15 controls had more than one hypotensive episodes requiring supplemental mephentermine.
Conclusion: The findings of my study suggest that the wrapping of lower limbs with Leukocrepe elastic bandage (like other methods of wrapping) decreases the incidence of hypotensive episodes to a significant degree however it does not eliminate the incidence of hypotension in spinal anesthesia given to elective cesarean section patients.
Keywords: prophylactic leg wrapping, elective CS, spinal anesthesia
Multidrug resistance and extended spectrum betalactamase producing strains causing lower respiratory tract and urinary tract infection
(Institute of Medicine, 2006) Pokharel, BM; Koirala, J; Mishra, SK; Khadga, RK; Tuladhar, NR
Abstract
Background: Multidrug resistance (MDR) and Extended spectrum beta-lactamase (ESBL) producing strains are becoming world-wide problem. With a view to determine prevalence of MDR and ESBL strains causing lower respiratory tract infection (LRTI) and urinary tract infection (UTI), a pilot study was conducted in Microbiology Laboratory of TUTH from April-September 2004.
Material and Methods:Sputum and urine samples were collected, cultured and the bacterial isolates were identified with the use of standard method as described by American Society for Microbiology. These bacterial isolates were then subjected for antibiotics-sensitivity test with the use of disc diffusion method as described by Kirby Bauer. ESBL production was tested as described by National Committee for Clinical Laboratory Standards (NCCLS).
Results:Of the total bacterial isolates from sputum samples, 47.57% were MDR. The ESBL producing isolates were 24.27%. In case of urinary isolates, 60.40% and 16.00%. were found to be MDR and ESBL respectively.
Conclusion: These strains should be subjected for genetic study to acquire their detail genetic make-up to characterize the mechanism of drug resistance. This type of study should be continued throughout the year in order to acquire exact status of MDR and ESBL in Nepal.
Keywords: MDR, ESBL, LRTI, UTI