Browsing by Subject "Nepal"
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Item Country Report 2018: Nepal(2018) Uprety, UttamThe Constitution of Nepal 2015 (Article 17) ensures that every individual has the fundamental right to peaceful assembly and to freely associate. However, while individuals are mostly free to form organizations, the Association Registration Act – the umbrella act responsible for the registration and regulation of civil society organizations – clearly states that any attempt to act without registration is illegal, and those participating will be fined by the government. The Association Registration Act is, in most cases, the only piece of legislation governing the registration of civil society organizations (CSOs), unless otherwise stated in other statutes.Item Estimating the weight of children in Nepal by Broselow, PAWPER XL and Mercy method(Zhejiang University School of Medicine, 2018) Shrestha, Karun; Subedi, Prakriti; Pandey, Oshna; Shakya, Likhita; Chhetri, Kailash; House, Darlene R.; Emergency Medicine, School of MedicineBACKGROUND: Resuscitation of a critically-ill child requires an accurate weight for fluids and medication dosing; however, weighing children on a scale while critically ill is not always practical. The objective of this study is to determine the accuracy of three different weight estimation methods (Broselow, PAWPER XL and Mercy tape) of children presenting to Patan Hospital, Nepal. METHODS: This was a prospective, cross-sectional study that included children presenting to the emergency department and under-fourteen outpatient clinic at Patan Hospital. Measured weight was compared to estimated weight of Broselow, PAWPER XL, and Mercy tapes. The mean percentage error and percentage of estimated weights that were within 10% (PW10) and 20% (PW20) of actual weight were calculated. Acceptable accuracy was determined as a PW10>70% and PW20>95%. A Bland-Altman analysis was done to determine agreement between each weight estimation method and actual weight. RESULTS: The study included 813 children. The mean age was 4.2 years (ranging from 4 days to 14 years) with 60% male. The mean percentage error (MPE) for Broselow, PAWPER XL and Mercy were -1.0% (SD 11.8), 0.7% (10.5) and 4.2% (11.9) respectively. The predicted weight within 10% was highest for the PAWPER XL (71.5%) followed by Broselow (63.2%) and Mercy (58.1%). The predicted weight within 20% of actual weight was 95.2%, 91.5% and 91.3% for PAWPER XL, Broselow and Mercy respectively. CONCLUSION: The PAWPER XL tape was the only method found to be accurate in estimating the weight of Nepalese children.Item Impact of bedside lung ultrasound on physician clinical decision-making in an emergency department in Nepal(BMC, 2020) House, Darlene R.; Amatya, Yogendra; Nti, Benjamin; Russell, Frances M.; Emergency Medicine, School of MedicineBackground Lung ultrasound is an effective tool for the evaluation of undifferentiated dyspnea in the emergency department. Impact of lung ultrasound on clinical decisions for the evaluation of patients with dyspnea in resource-limited settings is not well-known. The objective of this study was to evaluate the impact of lung ultrasound on clinical decision-making for patients presenting with dyspnea to an emergency department in the resource-limited setting of Nepal. Methods A prospective, cross-sectional study of clinicians working in the Patan Hospital Emergency Department was performed. Clinicians performed lung ultrasounds on patients presenting with dyspnea and submitted ultrasounds with their pre-test diagnosis, lung ultrasound interpretation, post-test diagnosis, and any change in management. Results Twenty-two clinicians participated in the study, completing 280 lung ultrasounds. Diagnosis changed in 124 (44.3%) of patients with dyspnea. Clinicians reported a change in management based on the lung ultrasound in 150 cases (53.6%). Of the changes in management, the majority involved treatment (83.3%) followed by disposition (13.3%) and new consults (2.7%). Conclusions In an emergency department in Nepal, bedside lung ultrasound had a significant impact on physician clinical decision-making, especially on patient diagnosis and treatment.Item Incidence and risk factors for carbon monoxide poisoning in an emergency department in Nepal(Taylor & Francis, 2022) Acharya, Samita Pant; Purpura, Andrea; Kao, Louise; House, Darlene R.; Emergency Medicine, School of MedicineIncidence of carbon monoxide (CO) poisoning in Nepal has not been studied. The objective of this study was to evaluate baseline carboxyhemoglobin (COHb) concentrations, population risk factors, and incidence of CO poisoning at a single hospital in Nepal. This was a prospective, observational study of patients presenting to Patan Hospital Emergency Department from April 2019 to March 2020. Demographics, risk factors for CO poisoning, symptoms, and clinical pretest probability of CO poisoning was documented. COHb concentration was obtained using a noninvasive co-oximeter. Significant CO exposure was defined as COHb concentration > 10%. CO poisoning was defined as COHb > 10% coupled with symptoms. Of 1,040 patients, 745 patients had a recordable COHb concentration. Median age was 40 years (IQR 33) with 407 (55%) females. Average COHb was 7.2%. Warm months were associated with higher COHb concentrations (8.1% vs 6.0%, p < 0.05). Firewood use had higher COHb concentrations compared to gas heating (8.6% vs 7.0%, p < 0.05). Overall, 228 (31%) patients had a COHb concentration > 10% indicating significant CO exposure. Sixteen patients had CO poisoning. We found a significant baseline incidence of COHb > 10% (31%) in patients presenting to a hospital in Nepal. Risk factors for higher baseline COHb concentrations included warm months and cooking with firewood.Item Knowledge, Attitude and Practice of COVID-19 among radiography professionals in a kingdom of the Himalayas, Nepal(Elsevier, 2022) Raya, C. K.; Sah, S.; Dangal, A.; Shrestha, S.; Maharjan, S.; Radiology and Imaging Sciences, School of MedicineIntroduction: COVID-19 is a global health crisis for every health professional including radiographers. Adequate knowledge, a good attitude, and safe practice are very important in the present scenario. In this present study, we aim to determine the knowledge, attitude, and practice (KAP) of COVID-19 among radiographers in the kingdom of Himalayas, Nepal. Methods: An electronic questionnaire survey consisting of 15 questions, 5 questions for each knowledge, attitude, and practice including socio-demographic variables (gender, age, academic qualification, work experience, workplace, and work province) was conducted from January 5 to February 15, 2021. A score of 1 was given for each correct answer and a score of 0 was given for each incorrect answer. The score 0-60% was considered inadequate and above 60% was considered adequate. Data were analysed using SPSS version 27 (IBM Chicago, United States). A non-parametric test was used since the data did not follow a normal distribution. The p-value was set at a 5% level of significance. Results: Total 390 radiographers, 262 male, and 128 females, mean age 27.17±5.64 years, range 20 to 50 were included in this study. The mean knowledge, attitude, and practice were 4.46±0.54, 89.20%, 3.94±0.96, 78.80%, and 4.40±0.77, 88.00% respectively. There was not a statistically significant difference in knowledge and practice according to socio-demographic variables. However, there was a statistically significant difference in attitude according to gender and work province but was not statistically significant by age group, academic qualification, work experience, and workplace. Conclusion: The radiographers in Nepal had adequate knowledge, a good attitude, and safe practice during the COVID-19 crisis.Item Leprosy in Nepal(National Society for Histotechnology, 2020) Wood, Debra M.Item Rehabilitation in Nepal(Elsevier, 2019-11) Dhakal, Raju; Groves, Christine C.; Physical Medicine and Rehabilitation, School of MedicineAs a low-income country with a significant burden of disease and frequent natural disasters, the need for rehabilitation in Nepal is significant. Rehabilitation services currently available in Nepal are limited, but the government has recently adopted a 10-year action plan to address rehabilitation needs nationwide. Rehabilitation education and training is necessary to provide and retain adequate multidisciplinary rehabilitation providers for current and future needs in Nepal. The implementation of evidence-based recommendations to improve the quality of rehabilitation services and access to rehabilitation is critical to maximize individual and community well-being.Item Risk Factors, Clinical Features, and Outcomes among Stroke Patients Presenting to Spinal Injury Rehabilitation Centre(Nepal Health Research Council, 2021) Dhakal, Raju; Khadka, Anjita; Groves, Christine; Physical Medicine and Rehabilitation, School of MedicineBackground: Worldwide, stroke is the second leading cause of death and disability. The burden of stroke in countries like Nepal is increasing. The purpose of this study is to describe the epidemiology, clinical features, and functional outcomes of individuals with stroke in a rehabilitation hospital in Nepal. Methods: A prospective descriptive study was conducted among individuals with stroke presenting for inpatient rehabilitation to the Nepal’s first interdisciplinary inpatient stroke rehabilitation unit over a one-year period; from 1 April 2018 – 30 March 2019. Results: Twenty-four individuals were enrolled, with average age of 56.8 years (SD 11.9, range 38-79). Seventeen patients (71%) presented with ischemic stroke. Hypertension was the most common modifiable stroke risk factor observed, present in 21 (88%) of individuals. Median rehabilitation length of stay was 32.5 days (IQR 15.3 – 68.8). Median Modified Barthel Index at admission was 25.0 (IQR 8.5-57.0) and at discharge was 67.0 (IQR 46.0-88.0), a statistically significant improvement (Z = -3.408, p = 0.001). Median Modified Rankin Scale on admission was 5.0 (IQR 4.0-5.0) and at discharge was 4.0 (IQR 3.6-4.8; Z = -3.276, p = 0.001). Conclusions: Most individuals with stroke admitted for interdisciplinary stroke rehabilitation demonstrated “severe” levels of disability and dependency on admission, and “moderate” levels of disability and dependency at the time of discharge. Hypertension represents a strategic target for primary and secondary prevention of stroke. With the burden of stroke increasing in Nepal, it is imperative to improve long-term availability and access to comprehensive stroke care for all affected individuals.Item Stable isotopes of river water and groundwater along altitudinal gradients in the High Himalayas and the Eastern Nyainqentanghla Mountains(Elsevier, 2017-12-01) Florea, Lee; Bird, Broxton W.; Lau, Jamie K.; Wang, Lixin; Lei, Yanbin; Yao, Tandong; Thompson, Lonnie G.; Earth Science, School of ScienceStudy Region This study considers river water and groundwater in seeps and springs collected from the non-monsoon season in the valleys of the Dudh Koshi River in eastern Nepal and the Niyang River of eastern Tibet, both in the Himalaya Mountains. Study Focus Data from this study comprise water samples that provide a single season snapshot of δ18O and δD values that give additional information into the sources of moisture and the altitude lapse rates for the southern flank of the High Himalaya of Nepal and the Eastern Nyainqentanghla Mountains of the Tibetan Plateau. New Hydrological Insights The local water line for Nepal samples, δD=(7.8±0.3) · δ18O + (4.0‰±4.6‰), was moderately lower in slope than for Tibetan Plateau samples, δD=(8.7±0.1) · δ18O + (24.3‰±2.0‰); evaporation has a greater influence on the Nepal samples—consistent with warmer temperatures in Nepal versus Tibet within the same altitude range. Mean d-excess values for Tibet samples (13.1‰±2.0‰) implies that recycled continental moisture has more influence than marine moisture observed for the Nepal samples (7.4‰±4.4‰). Altitude lapse rates of δ18O and δD for Nepal samples (-2.8‰‰km−1 and −24.0‰km−1) do not significantly differ from Tibet samples (−3.1‰‰km−1 and −27.0‰km−1) and regional measurements; the lapse rates are reduced above 4500m and are not influenced by exceptionally high elevations in the Dudh Koshi River watershed.Item Student Competition (Knowledge Generation) ID 1986472: Experience of patients with spinal cord injury regarding the quality of care during acute hospital stay in Nepal(Allen Press, 2023) Gautam, Srijana; Mushahwar, Vivian; Baniya, Mandira; Manhas, Kiran Pohar; Dhakal, Raju; Groves, Christine Cain; Ho, Chester; Physical Medicine and Rehabilitation, School of MedicineBackground: Spinal cord injury (SCI) results in physical impairments and psychosocial issues that generate challenges to individuals, families, and society. Understanding the acute care hospital experience after SCI is important as it may have an impact on persons with spinal cord injuries’ (PWSCI) subsequent journey to the rehabilitation center and community. This experience has not been studied in Nepal, especially from the perspective of PWSCI. Objectives: To understand how PWSCI (1) are involved in decision-making for their care; (2) are educated about secondary complications and, (3) perceive overall positive and negative experiences regarding their care during their acute care hospital stay in Nepal. Methods: Qualitative study based on Van Manen’s phenomenology using purposive sampling at the Spinal Injury Rehabilitation Center, the only dedicated SCI center in Nepal. We interviewed participants (n=24) who were referred from nine different acute hospitals using a semi-structured interview guide co-developed with SCI experts and PWSCI. Using thematic analysis, we extracted the findings with Manen’s approach. Results: We identified three preliminary themes: (1) Families, but not PWSCI, are often included in the decision-making process; (2) For education on secondary complications, only pressure injury prevention was recalled; (3) Timeliness of spinal surgery was a concern. Conclusion: There are opportunities to improve the acute care experience for PWSCI in Nepal. PWSCI desired to be more engaged in the decision-making process and more involved in their own care. Concerns regarding the timeliness of surgery correlated with the findings of previous Nepali studies.