The objective of this review is to provide a comprehensive outlook on existing evidence related t... more The objective of this review is to provide a comprehensive outlook on existing evidence related to breast cancer in Nepal and provide a way forward. Different key words were used to search the articles in MEDLINE, Google Scholar and Google. In addition, grey literatures were searched and experts on related fields were contacted. We also looked into the references of each searched articles. BC cases are on the rise since 1990. It is more common among urban women aged 41-50. Majority of women presented self-detected mass at an advanced stage. Most common type of cancer was Invasive ductal carcinoma. Quality of life among BC patients was above average. History of BC treatment goes back to 1992 where first radiation therapy was started. Treatment services are being provided in seven major hospitals along and some private hospitals. BP Koirala memorial hospital is the first specialized cancer hospital in Nepal catering all kind of cancer treatment in Nepal. Different NGOs, government and cancer hospitals are working on prevention of BC in Nepal. Nepal has invested much in detection, diagnosis and treatment of breast cancer. It is high time when the resources should be diverted to primary prevention and early detection along with awareness creation.
Two stage cluster sampling Respondent driven sampling Key population at higher risk Nepal Objecti... more Two stage cluster sampling Respondent driven sampling Key population at higher risk Nepal Objective: To discuss the basic standards for HIV related integrated biological and behavioural surveillance (IBBS) survey implementation, specific challenges of survey management, and to propose brief practical guidelines for management of IBBS surveys in resource limited setting. Methods: Two methods were used to address our study objectives: (a) a narrative review of the literature and (b) our experience as participant observer when working on IBBS survey management between July 2012 and January 2013 in Nepal. Results: In Nepal, IBBS surveys are conducted among key populations at higher risk of HIV such as people who inject drugs, men who have sex with men, female sex workers, seasonal male labour migrants and truckers (proxy for clients of female sex workers). The involvement of different institutions, people, and procedures makes IBBS survey management-including planning, implementation, sharing of findings and possible uses of survey findings-complicated to perform. In addition, basic survey methods and techniques including respondent driven sampling and two stage cluster sampling, are sometimes not properly performed in practice. Conclusions: This study showed that field implementation of some standards methods such as respondent driven sampling and cluster sampling for HIV related estimate or trends used for IBBS survey could be improved. This paper described lessons learnt and may be used as a guiding reference to improve and evaluate IBBS surveys in resource-poor settings also outside of Nepal.
BACKGROUND Equity has emerged as a cross-cutting theme in the health sector, and countries across... more BACKGROUND Equity has emerged as a cross-cutting theme in the health sector, and countries across the world are striving to ensure that all people have access to the health services they need without undue financial hardship and educational, social, cultural and geographical barriers. In this context, this analysis has attempted to analyse Nepal's progress in reducing inequalities in reproductive, maternal, newborn and child health services based on economic status and place of residence. METHODS In this analysis, we have used data available from the web version of the Health Equity Assessment Toolkit, a data visualisation tool developed by the World Health Organisation. We have analysed the inequalities in terms of a composite coverage index which combines eight reproductive, maternal, newborn and child health interventions along the continuum of care. RESULTS Composite coverage of reproductive, maternal, newborn and child health services was 43% in 2001 which increased to 65% ...
The objective of this review is to evaluate the potential of Abelmoschus esculentus as a dietary ... more The objective of this review is to evaluate the potential of Abelmoschus esculentus as a dietary agent in treatment of diabetes induced hyperglycemia. A comprehensive search of animal studies, human studies, and in-vitro assays published in scientific databases like Medline, Hub med, and printed manual scripts on herbal medicines in alternative medicine. Animal studies and in-vitro studies conducted have proved that Abelmoschus esculentus in form of Seeds, Peal, water soluble extracts and ethanol extracts demonstrated statistically and clinically significant results in lowering the blood glucose levels when compared to placebo, no treatment, and first line diabetic drugs like glibenclemide, metformin. Literature also confirmed the preventive effects of Abelmoschus esculentus on chronic diseases due to antioxidant effect exerted by high contents of natural flavonoids. Myricetin a commonly found flavonoid from Abelmoschus esculentus has shown protective effect in diabetes associated n...
Background Between 1990 and 2017, Nepal experienced a shift in the burden of disease from communi... more Background Between 1990 and 2017, Nepal experienced a shift in the burden of disease from communicable, maternal, neonatal and nutritional (CMNN) diseases to non-communicable diseases (NCDs). With an increasing ageing population and life-style changes including tobacco use, harmful alcohol consumption, unhealthy diets, and insufficient physical activity, the proportion of total deaths from NCDs will continue to increase. An analysis of current diseases pattern and projections of the trends informs planning of health interventions. This analysis aims to project the mortality and risk factor of disease until 2040, based on past trends. Methods This study uses secondary data from the Global Burden of Disease (GBD) Study which analyses historic data from 1990 to 2016 to predict key variables such as, the mortality rates, life expectancy and Years of Life Lost for different causes of death from 2017 to 2040. ‘GBD Foresight Visualization’, a visualisation tool publicly available in the we...
Background: There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculo... more Background: There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculosis (TB) patients through Provider-Initiated HIV Testing and Counseling (PITC) under the national TB control program in Nepal. The degree and quality of program delivery were explored through determining whether the PITC program is currently implemented as intended. This study aimed to assess three major components of the program's implementation fidelity: adherence to PITC service, exposure, and quality of program delivery in order to optimize and standardize PITC implementation by exploring its barriers and enablers. Methods: This research used a sequential explanatory mixed method design. Retrospective cross-sectional study of TB patients enrolled in five TB treatment centers of the Kathmandu district from July 1, 2016, to June 30, 2017 was done to assess PITC adherence to Direct Observed Treatment-Short Course (DOTS) protocols. The centers' TB-DOTS readiness was assessed using the WHO Service Availability and Readiness Assessment checklist. A qualitative study was conducted to explore the barriers and enablers of PITC service implementation. Results: From a total of 643 TB patients registered, 591 (92.1%) patients were offered HIV test counseling. Amongst those, 571 (96.6%) accepted and 523 (91.5%) were tested. Service providers' HIV knowledge was found to be good although only 2/5 (40%) had participated in PITC training. The key barriers experienced by service providers were: patients feeling offended, stigmatization and lack of human resources in DOTS centers. The main enablers for PITC were national TB program commitment, health workers' motivation, collaboration between stakeholders and external development partners' promotion of program implementation. Conclusion: In the selected study sites, PITC services are well integrated into the routine TB control program with a high uptake of HIV testing among registered TB patients. This achievement should be sustained by addressing the identified barriers mainly in the quality of the PITC program delivery.
Background: There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculo... more Background: There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculosis (TB) patients through Provider-Initiated HIV Testing and Counseling (PITC) under the national TB control program in Nepal. The degree and quality of program delivery were explored through determining whether the PITC program is currently implemented as intended. This study aimed to assess three major components of the program's implementation fidelity: adherence to PITC service, exposure, and quality of program delivery in order to optimize and standardize PITC implementation by exploring its barriers and enablers. Methods: This research used a sequential explanatory mixed method design. Retrospective cross-sectional study of TB patients enrolled in five TB treatment centers of the Kathmandu district from July 1, 2016, to June 30, 2017 was done to assess PITC adherence to Direct Observed Treatment-Short Course (DOTS) protocols. The centers' TB-DOTS readiness was assessed using the WHO Service Availability and Readiness Assessment checklist. A qualitative study was conducted to explore the barriers and enablers of PITC service implementation. Results: From a total of 643 TB patients registered, 591 (92.1%) patients were offered HIV test counseling. Amongst those, 571 (96.6%) accepted and 523 (91.5%) were tested. Service providers' HIV knowledge was found to be good although only 2/5 (40%) had participated in PITC training. The key barriers experienced by service providers were: patients feeling offended, stigmatization and lack of human resources in DOTS centers. The main enablers for PITC were national TB program commitment, health workers' motivation, collaboration between stakeholders and external development partners' promotion of program implementation. Conclusion: In the selected study sites, PITC services are well integrated into the routine TB control program with a high uptake of HIV testing among registered TB patients. This achievement should be sustained by addressing the identified barriers mainly in the quality of the PITC program delivery.
International Journal Of Community Medicine And Public Health
Background: Objective of this study was to assess the prevalence of self-reported and undiagnosed... more Background: Objective of this study was to assess the prevalence of self-reported and undiagnosed diabetes and prediabetes cases in rural south Indian population.Methods: The study was carried as secondary analysis of the data collected in our Health management information system (HMIS) as a part of our health systems initiative in Alakkudi gram panchayat, Thanjavur district, Tamil Nadu, India. We analysed the fasting glucose and post prandial glucose values of 1307 individuals form our database to assess the prevalence of undiagnosed diabetes and prediabetes as per the cut off recommended by Indian Council of Medical Research 2018 diabetes diagnostic criteria. We also presented the descriptive analysis of demographic features, risk behaviour, anthropometric data along with personal and family history of all the individuals analysed in this study. The secondary data retrieved from the HMIS system was free of any personal identifiers.Results: The self-reported prevalence of diabetes ...
Background: Men having sex with men (MSM) and transgender (TG) people are of higher risk of HIV s... more Background: Men having sex with men (MSM) and transgender (TG) people are of higher risk of HIV subpopulations in Nepal with estimated size of about 450 thousands in 2012. HIV prevention interventions among MSM/TG started since early 2000 and continued with key focus on HIV testing and counseling, behaviour change interventions (peer-education, community outreach, drop in centre (DIC) and reduction of stigma and discrimination), diagnosis and treatment of sexually transmitted infections (STIs). However the effect of prevention efforts in reducing HIV and STIs among MSM/TG has not evaluated yet. This study assessed the trends of HIV and selected STIs among MSM in Nepal. Methods: We collected data from four rounds of integrated biological and behavioural surveillance (IBBS) surveys conducted among MSM/TG in Kathmandu valley from 2004 to 2012. We analyzed the trends and explored the association of HIV with the key interventions such as community outreach, DIC, peer-education, condoms/l...
ABSTRACT To discuss the basic standards for HIV related integrated biological and behavioural sur... more ABSTRACT To discuss the basic standards for HIV related integrated biological and behavioural surveillance (IBBS) survey implementation, specific challenges of survey management, and to propose brief practical guidelines for management of IBBS surveys in resource limited setting.
The objective of this review is to provide a comprehensive outlook on existing evidence related t... more The objective of this review is to provide a comprehensive outlook on existing evidence related to breast cancer in Nepal and provide a way forward. Different key words were used to search the articles in MEDLINE, Google Scholar and Google. In addition, grey literatures were searched and experts on related fields were contacted. We also looked into the references of each searched articles. BC cases are on the rise since 1990. It is more common among urban women aged 41-50. Majority of women presented self-detected mass at an advanced stage. Most common type of cancer was Invasive ductal carcinoma. Quality of life among BC patients was above average. History of BC treatment goes back to 1992 where first radiation therapy was started. Treatment services are being provided in seven major hospitals along and some private hospitals. BP Koirala memorial hospital is the first specialized cancer hospital in Nepal catering all kind of cancer treatment in Nepal. Different NGOs, government and cancer hospitals are working on prevention of BC in Nepal. Nepal has invested much in detection, diagnosis and treatment of breast cancer. It is high time when the resources should be diverted to primary prevention and early detection along with awareness creation.
Two stage cluster sampling Respondent driven sampling Key population at higher risk Nepal Objecti... more Two stage cluster sampling Respondent driven sampling Key population at higher risk Nepal Objective: To discuss the basic standards for HIV related integrated biological and behavioural surveillance (IBBS) survey implementation, specific challenges of survey management, and to propose brief practical guidelines for management of IBBS surveys in resource limited setting. Methods: Two methods were used to address our study objectives: (a) a narrative review of the literature and (b) our experience as participant observer when working on IBBS survey management between July 2012 and January 2013 in Nepal. Results: In Nepal, IBBS surveys are conducted among key populations at higher risk of HIV such as people who inject drugs, men who have sex with men, female sex workers, seasonal male labour migrants and truckers (proxy for clients of female sex workers). The involvement of different institutions, people, and procedures makes IBBS survey management-including planning, implementation, sharing of findings and possible uses of survey findings-complicated to perform. In addition, basic survey methods and techniques including respondent driven sampling and two stage cluster sampling, are sometimes not properly performed in practice. Conclusions: This study showed that field implementation of some standards methods such as respondent driven sampling and cluster sampling for HIV related estimate or trends used for IBBS survey could be improved. This paper described lessons learnt and may be used as a guiding reference to improve and evaluate IBBS surveys in resource-poor settings also outside of Nepal.
BACKGROUND Equity has emerged as a cross-cutting theme in the health sector, and countries across... more BACKGROUND Equity has emerged as a cross-cutting theme in the health sector, and countries across the world are striving to ensure that all people have access to the health services they need without undue financial hardship and educational, social, cultural and geographical barriers. In this context, this analysis has attempted to analyse Nepal's progress in reducing inequalities in reproductive, maternal, newborn and child health services based on economic status and place of residence. METHODS In this analysis, we have used data available from the web version of the Health Equity Assessment Toolkit, a data visualisation tool developed by the World Health Organisation. We have analysed the inequalities in terms of a composite coverage index which combines eight reproductive, maternal, newborn and child health interventions along the continuum of care. RESULTS Composite coverage of reproductive, maternal, newborn and child health services was 43% in 2001 which increased to 65% ...
The objective of this review is to evaluate the potential of Abelmoschus esculentus as a dietary ... more The objective of this review is to evaluate the potential of Abelmoschus esculentus as a dietary agent in treatment of diabetes induced hyperglycemia. A comprehensive search of animal studies, human studies, and in-vitro assays published in scientific databases like Medline, Hub med, and printed manual scripts on herbal medicines in alternative medicine. Animal studies and in-vitro studies conducted have proved that Abelmoschus esculentus in form of Seeds, Peal, water soluble extracts and ethanol extracts demonstrated statistically and clinically significant results in lowering the blood glucose levels when compared to placebo, no treatment, and first line diabetic drugs like glibenclemide, metformin. Literature also confirmed the preventive effects of Abelmoschus esculentus on chronic diseases due to antioxidant effect exerted by high contents of natural flavonoids. Myricetin a commonly found flavonoid from Abelmoschus esculentus has shown protective effect in diabetes associated n...
Background Between 1990 and 2017, Nepal experienced a shift in the burden of disease from communi... more Background Between 1990 and 2017, Nepal experienced a shift in the burden of disease from communicable, maternal, neonatal and nutritional (CMNN) diseases to non-communicable diseases (NCDs). With an increasing ageing population and life-style changes including tobacco use, harmful alcohol consumption, unhealthy diets, and insufficient physical activity, the proportion of total deaths from NCDs will continue to increase. An analysis of current diseases pattern and projections of the trends informs planning of health interventions. This analysis aims to project the mortality and risk factor of disease until 2040, based on past trends. Methods This study uses secondary data from the Global Burden of Disease (GBD) Study which analyses historic data from 1990 to 2016 to predict key variables such as, the mortality rates, life expectancy and Years of Life Lost for different causes of death from 2017 to 2040. ‘GBD Foresight Visualization’, a visualisation tool publicly available in the we...
Background: There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculo... more Background: There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculosis (TB) patients through Provider-Initiated HIV Testing and Counseling (PITC) under the national TB control program in Nepal. The degree and quality of program delivery were explored through determining whether the PITC program is currently implemented as intended. This study aimed to assess three major components of the program's implementation fidelity: adherence to PITC service, exposure, and quality of program delivery in order to optimize and standardize PITC implementation by exploring its barriers and enablers. Methods: This research used a sequential explanatory mixed method design. Retrospective cross-sectional study of TB patients enrolled in five TB treatment centers of the Kathmandu district from July 1, 2016, to June 30, 2017 was done to assess PITC adherence to Direct Observed Treatment-Short Course (DOTS) protocols. The centers' TB-DOTS readiness was assessed using the WHO Service Availability and Readiness Assessment checklist. A qualitative study was conducted to explore the barriers and enablers of PITC service implementation. Results: From a total of 643 TB patients registered, 591 (92.1%) patients were offered HIV test counseling. Amongst those, 571 (96.6%) accepted and 523 (91.5%) were tested. Service providers' HIV knowledge was found to be good although only 2/5 (40%) had participated in PITC training. The key barriers experienced by service providers were: patients feeling offended, stigmatization and lack of human resources in DOTS centers. The main enablers for PITC were national TB program commitment, health workers' motivation, collaboration between stakeholders and external development partners' promotion of program implementation. Conclusion: In the selected study sites, PITC services are well integrated into the routine TB control program with a high uptake of HIV testing among registered TB patients. This achievement should be sustained by addressing the identified barriers mainly in the quality of the PITC program delivery.
Background: There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculo... more Background: There exists low uptake of Human Immunodeficiency Virus (HIV) testing among Tuberculosis (TB) patients through Provider-Initiated HIV Testing and Counseling (PITC) under the national TB control program in Nepal. The degree and quality of program delivery were explored through determining whether the PITC program is currently implemented as intended. This study aimed to assess three major components of the program's implementation fidelity: adherence to PITC service, exposure, and quality of program delivery in order to optimize and standardize PITC implementation by exploring its barriers and enablers. Methods: This research used a sequential explanatory mixed method design. Retrospective cross-sectional study of TB patients enrolled in five TB treatment centers of the Kathmandu district from July 1, 2016, to June 30, 2017 was done to assess PITC adherence to Direct Observed Treatment-Short Course (DOTS) protocols. The centers' TB-DOTS readiness was assessed using the WHO Service Availability and Readiness Assessment checklist. A qualitative study was conducted to explore the barriers and enablers of PITC service implementation. Results: From a total of 643 TB patients registered, 591 (92.1%) patients were offered HIV test counseling. Amongst those, 571 (96.6%) accepted and 523 (91.5%) were tested. Service providers' HIV knowledge was found to be good although only 2/5 (40%) had participated in PITC training. The key barriers experienced by service providers were: patients feeling offended, stigmatization and lack of human resources in DOTS centers. The main enablers for PITC were national TB program commitment, health workers' motivation, collaboration between stakeholders and external development partners' promotion of program implementation. Conclusion: In the selected study sites, PITC services are well integrated into the routine TB control program with a high uptake of HIV testing among registered TB patients. This achievement should be sustained by addressing the identified barriers mainly in the quality of the PITC program delivery.
International Journal Of Community Medicine And Public Health
Background: Objective of this study was to assess the prevalence of self-reported and undiagnosed... more Background: Objective of this study was to assess the prevalence of self-reported and undiagnosed diabetes and prediabetes cases in rural south Indian population.Methods: The study was carried as secondary analysis of the data collected in our Health management information system (HMIS) as a part of our health systems initiative in Alakkudi gram panchayat, Thanjavur district, Tamil Nadu, India. We analysed the fasting glucose and post prandial glucose values of 1307 individuals form our database to assess the prevalence of undiagnosed diabetes and prediabetes as per the cut off recommended by Indian Council of Medical Research 2018 diabetes diagnostic criteria. We also presented the descriptive analysis of demographic features, risk behaviour, anthropometric data along with personal and family history of all the individuals analysed in this study. The secondary data retrieved from the HMIS system was free of any personal identifiers.Results: The self-reported prevalence of diabetes ...
Background: Men having sex with men (MSM) and transgender (TG) people are of higher risk of HIV s... more Background: Men having sex with men (MSM) and transgender (TG) people are of higher risk of HIV subpopulations in Nepal with estimated size of about 450 thousands in 2012. HIV prevention interventions among MSM/TG started since early 2000 and continued with key focus on HIV testing and counseling, behaviour change interventions (peer-education, community outreach, drop in centre (DIC) and reduction of stigma and discrimination), diagnosis and treatment of sexually transmitted infections (STIs). However the effect of prevention efforts in reducing HIV and STIs among MSM/TG has not evaluated yet. This study assessed the trends of HIV and selected STIs among MSM in Nepal. Methods: We collected data from four rounds of integrated biological and behavioural surveillance (IBBS) surveys conducted among MSM/TG in Kathmandu valley from 2004 to 2012. We analyzed the trends and explored the association of HIV with the key interventions such as community outreach, DIC, peer-education, condoms/l...
ABSTRACT To discuss the basic standards for HIV related integrated biological and behavioural sur... more ABSTRACT To discuss the basic standards for HIV related integrated biological and behavioural surveillance (IBBS) survey implementation, specific challenges of survey management, and to propose brief practical guidelines for management of IBBS surveys in resource limited setting.
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