Journal Issue: Volume: 22, No. 1 & 2 (2000)
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2000
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Iron Supplementation for Controlling Anaemia in Pregnancy by Involving FCHVs in Saralahi
(Institute of Medicine, 2000) Shah, H; Sherchand, JB
Abstract
Anaemia in pregnancy, mainly iron deficiency, is a public health problem. The present study aimed to determine the effect of iron supplementation in pregnant women in Saralahi District for reducing the prevalence of anaemia. For this purpose 80 pregnant women, with haemoglobin >7.0g/dl in 12-34 weeks of pregnancy, were selected in the study by using participation of FCHVs. Giving 120 mg of iron supplementation per day for 1 month, their haemoglobins were reassessed to determine the effects of iron.
The prevalence of anaemia in the current study found was 52.5%. The mean haemoglobin (n=80) was 10.585 g/dl with confidence limits of 10.31-10.86 (5% significance level).
After iron supplementation, the prevalence of anaemia was reduced to 2.5% (P=0.001 at 99.73 confidence level). The mean haemoglobin was increased to 13.14 g/dl. (P=0.001). The per day increase of haemoglobin was 0.09 g/dl. The increase in haemoglobin was inversely related to the severity of anaemia (r = - 0.93, P < 0.001). The increase in haemoglobin after Fe supplementation was more in the group of pregnant women of the third trimester than in the group of pregnant women of the second trimester. The increase was highly significant (P < 0.01).
Keywords: Iron deficiency, anaemia, pregnancy, FCHV, iron supplementation, Sarlahi
Surgeon's role in the management of lymphomas
(Institute of Medicine, 2000) Singh, Yogendra; Sayami, Geeta; Khakurel, Mahesh
Abstract
A retrospective analysis of the lymphomas treated at the Department of Surgery, T.U. Teaching Hospital, Kathmandu between 1995 to 1999 was carried out in an attempt to clarify the role of surgeons in the management of such cases. Sixty patients with the diagnosis of lymphoma mainly NHL (52 cases), were admitted during the past 5 years. The average age was 41�17 years ranging from 7 to 70 years. The female to male ratio was 1:1.5. The majority of NHL patients (80%) presented with superficial lymphadenopathy, most commonly in the cervical lymph nodes, where almost 50% of cases were diagnosed by FNAC. The rest - 20% (9 cases) presented with abdominal lump where laparotomy was performed in 7 cases and USG guided FNAC was done in 2 cases to confirm the diagnosis of lymphoma. Six cases (11.5%) of NHL were of extra-nodal origin (4 stomach and 2 colon). All 6 cases were subjected to radical surgery for carcinoma. According to the Ann Arbor staging system, most of the lymphoma cases were in stage III or IV and 25% of the cases presented with B symptoms. Serum LDH correlated with therapeutic response in 80% of nodal lymphomas (8 out of 10 cases). Almost all the patients received chemotherapy with most commonly used regimens - CHOP, BACOP or MOPP. However, 20% of the patients failed to complete the course of chemotherapy. There was 3 mortality (5%) during therapeutic course because of the progressive recurrent disease. Although the follow-up records were available for half of the cases, major morbidity included recurrence of the disease in two cases, CNS involvement in two cases and second malignancy in one case following the treatment of lymphomas. Therefore, in our set up, a surgeon has a sole responsibility for putting tissue diagnosis, relieving the complication of the disease or treatment, chemotherapy of the lymphomas, especially NHL.
Keywords: Lymphomas, biopsy, extra-nodal disease, surgical excision, chemotherapy
HIV/AIDS: Knowledge and extra marital sexual behaviour of boatmen in Fewa Lake
(Institute of Medicine, 2000) Sharma, Mahesh; Poudel, Krishna; Poudel, Kalpana
Abstract
The participants of the Training Workshop on HIV/AIDS and development, which was held in Pokhara under the project "Participatory Planning and Management of HIV/AIDS", decided to conduct a rapid assessment study on HIV/AIDS among the boatmen of Fewa Lake. This descriptive study conducted by using structured questionnaire attempts to explain the knowledge and extra marital sexual behaviour of selected boatmen of the Fewa Lake in Pokhara.
Almost all the boatmen (98%) had heard about HIV/AIDS and the majority of them have had fairly accurate knowledge about its route of transmission except a few, who had some misconceptions about the route of transmission. About 50% of the respondents practice sex outside their marriage and the majority (71%) of them are between 15-35 years of age. Condom use during such sex activities is not known.
In spite of good knowledge about HIV/AIDS, sex practices of boatmen are not free from risk particularly the young boatmen who are most vulnerable.
Keywords: Boatmen, HIV/AIDS, Extra marital sex, Transmission
Epidemiological Profile of Japanese Encephalitis in Nepal 1996 - 1997
(Institute of Medicine, 2000) Joshi, DD
Abstract
In Nepal, during the past two decades, Japanese Encephalitis (JE) is known to occur mainly in southern terai districts of Nepal, but recently during 1996 and 1997, the Kathmandu valley particularly, the southern part of Lalitpur district first reported outbreak of JE, which was confirmed both serologically and virologically. Epidemiological surveillance study was carried out in all 18 JE endemic terai districts of Nepal during the months of November & December of 1996 and 1997 respectively. Results of epidemiological, entomological and serological investigation are presented, tabulated, analyzed and discussed. There was a total of 1687 cases with 353 deaths (21% Case fatality rate) in 1996 and a total of 1740 cases with 126 deaths (7% CFR) in 1997. All age & sex groups are infected with the disease, but below 15 years children were more prevalent with 21% & 7% CFR in male and 16% and 6% CFR in female children during 1996 and 1997 respectively. Whereas in adults, both male and female showed 23% and 25% CFR respectively. There is a seasonal difference in occuring diseases; the maximum number of cases appeared from June to October, and August was observed as a peak period during both years.
It has long been recognised that the feeding behaviour of Culicin mosquitoes is of paramount importance in the epidemiology of mosquito-borne JE pathogens. Host feeding pattern of vector mosquitoes is crucial for the maintenance of the complex natural cycle of JE virus, which includes pigs and birds and sometimes large animals like buffaloes and cattle. The virus is transmitted from pig to pig and bird to pig by Culex species of mosquito. The human beings are only incidental hosts of JE. The role of pigs and ducks as amplifier hosts is well established in Nepal as well as in other southeast Asian countries. Except dog Cx. vishnui was found to feed on man, cattle, buffalo, pig, bird and goat, showing its wide range of feeding. Among them bovids were found to be preferred hosts after pigs and ducks. Pigs and ducks possess a high body temprerature and attract a large number of mosquitoes, thus maintaining the pig-mosquito-pig cycle, duck-mosquito-duck-mosquito-pig cycle. In Nepal, in recent outbreaks of 1996 and 1997, the feeding behaviour of mosquito on bovid in the endemic areas, where there are no pigs and ducks population, has been observed. This means the epidemiological pattern of the disease transmission could be buffalo-mosquito-buffalo and cattle-mosquito-cattle cycle with more contact with humans infection through vectors. JE virus isulation studies in the endemic areas from mosquitoes, animals and diseases human beings are needed to confirm this hypothesis.
The prevention and control of JE has been a challenging problem in view of non-availability of effective chaemoprophylaxis against the virus and limitations of immuno-prophylaxis. There have been attempts for effective prevention and control of JE by malathion spraying, directing the control measures against the vectors-Culicine mosquitoes. However, this approach too has its own limitation because the known vectors of JE in Nepal namely Culex species mainly breed in large paddy fields and ponds limiting the effectiveness and feasibility of the larval control. JE virus transmission is from domestic animals and birds as reservoirs because the JE virus in nature is found in pigs, birds and large animals like water buffaloes and cattle. In Nepal pigs and ducks have been found as the main reservoirs of JE virus. In the present senario, the epidemiology of JE has undergone considerable changes over the last two decades. There are no reports of antibodies in 'sentinel' pigs from terai districts of the country. Therefore, seroconversion profile of sentinel pigs and birds with its relation to endemicity pattern of JE in Nepal must be carried out urgently. The human cases of JE have been known to occur between mid June to mid October with peaks in August and September. Therefore, the JE transmission period epidemiologically can be considered as July to October with a peak on September.
The present study has revealed that the JE situation in Nepal from 1978 onward showed increasing trend in the incidence of JE from the human population point of view, coverage of geographical area, seasonal occurance, vector bionomics, animal reservoir hosts and environmental and climatic changing effects. Since it is a vector-borne viral zoonotic disease, so far Culicine mosquitoes species viz. Culex tritaeniorhynchus, Cx. vishnui, Cx. pseudovishnui, Cx. gelidus and Cx. fuscocephalus have been incriminated and identified as vectors of JE. The female mosquitoes are known to feed on a wide range of vertebrates including man. Whereas some Culicine species have a restricted host range and distinct feeding preferences. JE is a viral zoonotic disease transmitted by mosquito vector bite and caused by arbovirus (flavivirus) which affects the central nervous system. The virus is maintained in nature in animals reservoirs like pigs, cattle and birds. This disease was first recognised in Japan in 1924 and in the Indian adjoining border of southern terai districts of Nepal, Gorkhpur district of Uttar Pradesh in 1978. Since then the JE has become a major public health problem in all Terai districts of Nepal since 1978. The current epidemiological survey study has revealed that both the ricefields and the ponds situated in every endemic villages are chiefly contributing towards the population density of Culicine mosquitoes. In view of recurrent outbreaks in Terai districts and widespread breeding places of mosquitoes, there is an urgent need to asses the feasibility of suitable vector control measures including antilarval operations and ultra-low volume application of insecticides in all the affected endemic districts.
Keywords: amplifier host, chemoprophylaxis, immuno-prophylaxis
Cost-sharing Drug Scheme (CSDS): an experience from Chyangthapu Health Post
(Institute of Medicine, 2000) Karkee, Shiba B; Tamang, AL; Gurung, YB; Dahal, S; Saunders, Philippa
Abstract
This paper describes a community-organised Cost-Sharing Drug Scheme (CSDS) in a remote Health Post (HP) of eastern Nepal. The inadequate annual supply of drugs from the government was supplemented by an additional supply from Britain Nepal Medical Trust (BNMTa) in 80% of the cost price. The prescribed drugs were dispensed at 40% of the cost price. The local Village Development Committees (VDCs) also made financial contribution. Thus, the government supply, BNMT subsidy, the local VDC contribution and the patient fee helped to generate a revolving fund which was managed by the Local Health Support Committee (LHSC). The District Health Office (DHO) carried out the supervision/monitoring and BNMT staff facilitated the process of Drug Scheme Programme (DSP) implementation. The result showed that single item fee improves the quality of care and the local community can be involved in drug schemes management.
Keywords: Cost-Sharing Drug Scheme, Local Health Support Committee, Essential drugs, Drug prescribing practice, User fees, Revolving fund, Health Post, Nepal