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"Physicians Nepal History."
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Impact of National health insurance on medication adherence among hypertensive patients: A hospital-based cross-sectional study from Kailali, Nepal
Noncompliance of medication among patients with chronic disease is a major challenge for the health system. Expanding of national health insurance among patients might increase their access to health care services, reduce out of pocket expenditures, and improve health outcomes. This study aimed to determine the association between enrollment in health insurance and medication adherence among hypertensive patients in Nepal.
A cross-sectional study was conducted among 402 patients visiting the outpatient department of Tikapur Hospital located in Kailali, Nepal. Data was collected by face-to-face interviews using a structured questionnaire. Adherence to hypertensive medication was assessed using the Hill Bone Medication Adherence Scale (HB-MAS). A multivariable logistic regression model was constructed to ascertain the association between enrollment in health insurance and medication adherence.
Overall, 52.7% (60.2% of uninsured and 45.3% of insured) of the patients was medication adherence. Enrollment in health insurance was not significantly associated with medication adherence. The participants among those who had reported more than secondary level education was higher odds of medication adherence (AOR = 3.30; 95% CI: 1.25-8.73); those who reported more than five minutes of interaction with doctors (AOR = 2.97; 95% CI: 1.56-5.65); those on medication for more than 10 years had higher odds of adherence (AOR:2.56; 95% CI:1.35-4.86); aged group 50-59 years was lower odds of medicatio n (AOR = 0.46; 95% CI: 0.23-0.91); compared to patients with no formal education;those who reported less than or equal to 5 minutes of interaction with doctors; those who had less than 5 years of medication; participants younger than 50 years respectively.
Our study showed that enrollment in health insurance was not associated with medication adherence among patients with hypertension. Health system interventions such as improving counseling, patient education, and follow-up, and ensuring availability of medicines might improve medication adherence among patients. Health professionals also should set up education, and interventions aimed at increased awareness of the consequences of non-adherence to antihypertensive medication.
Journal Article
Leprosy – eliminated and forgotten: a case report
Background
Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual.
Case presentation
In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication.
Conclusion
An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.
Journal Article
SILVER BIRD: HOW THE DC-3 CONTRIBUTED TO PUBLIC HEALTH IN 1950s NEPAL
Moore shares his experiences in 1950s Nepal. A US Public Health Service physician, Moore spent the early part of the decade in the mountains of Nepal, delivering a variety of personal and public health services to local populations living thousands of feet above sea level and in poor condition. In an area virtually devoid of services and where the average age at death was 35, he organized a system of personal health care, including cataract surgery, treatment for infections, and maternal and child health services. Traveling on elephants through tall weeds, Moore battled epidemics of malaria through the us of DDT and other insecticides.
Journal Article
Partners for Peace: An American Doctor and a Journalist in 1950's Nepal
Dr. George Moore's experiences in the US Public Health Service in Nepal in the early 1950s are presented. He reports on the work of Dr. G.C. Sood, an Indian eye surgeon who set up clinics to treat the many eye diseases and cataracts in the population. He also includes the activities of Nancy Dammann, an officer in the US Information Services, who served in Nepal at that time and accompanied Drs. Moore and Sood on a grueling trip across the mountains to document the opening of one of Dr. Sood's eye clinics.
Journal Article
Post-training quality of syndromic management of sexually transmitted infections by chemists and druggists in Pokhara, Nepal: is it satisfactory?
Objective. Using simulated client and provider interview methods, this study assessed chemists and druggists’ post-training management quality of syndromic sexually transmitted infections focusing on the areas of privacy maintaining, encouraging, history taking, counseling, referral practice, partner notification, and drug prescribing and then compared the findings of two methods. Design. Forty-five pharmacies from a list of 75 in Pokhara, who collected sexually transmitted infections data during 1999, were selected randomly. First simulated client successfully presented either urethral or vaginal discharge syndrome at 37 pharmacies and recorded the events of whole encounter into an observation form within 20 minutes. Later 39 chemists and druggists were interviewed by a pre-tested semi-structured questionnaire. Main measures. Results were reported mainly by numbers and corresponding percentages. For comparative purpose, P values were also shown. Results. Overall, interview method revealed satisfactory knowledge of chemists and druggists for management of sexually transmitted infections except drug prescribing but their actual behaviors, revealed by simulated client method, indicated lower quality and differed significantly in the areas of encouraging, history taking, counseling, referral practice, and partner notification. Both methods indicated very poor qualities of drug prescribing. Conclusion. Retained knowledge of chemists and druggists for syndromic management of sexually transmitted infections were not applied to simulated client in actual practice. They should not prescribe drugs for patients of sexually transmitted infections, except referring to the doctors/hospitals. Continuous monitoring and further motivations for them may improve syndromic management quality of sexually transmitted infections. Moreover, depending on the purpose of study, various methods should be applied simultaneously to reach a better conclusion.
Journal Article
