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Agency: European Commission | Branch: FP7 | Program: CP-FP-SICA | Phase: HEALTH.2010.2.3.4-2 | Award Amount: 6.45M | Year: 2010

Neglected Infectious Diseases (NID) such as trypanosomiasis, leishmaniasis, schistosomiasis and soil-transmitted helminthiasis receive less than 5% of the global investment for tropical diseases research. Clinical praxis in disease-endemic countries (DEC) is rarely evidence based and does not make use of the latest innovations in diagnostic technology. NIDrelated research on diagnostics is particularly underfunded, and diagnostic tools are lacking for a number of NID. The aim of this proposal is to bridge the gap between existing technological innovation in diagnostics and clinical care practice for NID in resource-poor settings. The specific objectives are to develop simple, cost-effective diagnosis-treatment algorithms for three NID-related clinical syndromes: the persistent fever, the neurological and the digestive syndromes. Evidence-based algorithms for the primary care level will be designed with a patient-centred approach, following guidance from DEC stakeholders and making the best possible use of existing assays and treatments. Relevant diagnostic technology and diagnostic platforms will be introduced according to the specific epidemiological contexts in Africa and South-Asia. The research consortium brings together a network of clinical epidemiologists, a diagnostics development group, several partners from academia and SMEs. The consortium further includes workpackages on reference laboratory, economic evaluation, quality assurance and translation to policy. By developing accurate and affordable diagnostic platforms and by optimizing diagnostic-treatment algorithms, this project will rationalise treatment use, circumvent progression to severe presentations and thereby reduce NID morbidity/mortality and hinder the emergence of resistances. The project will result in two main deliverables: policy recommendation for health authorities in DEC, and a series of innovative diagnostic platforms.

Pandey A.K.,BP Koirala Institute of Health science
Nepal Medical College journal : NMCJ | Year: 2012

Persons with prolonged and heavy alcohol use generally suffer from alcohol dependence syndrome (ADS) and develop physical, sexual as well as psychiatric co-morbidity. Successful recovery to normalcy depends on multiple factors including patient's motivation. To study clinico-demographic profile, reasons for initiating alcohol use, sexual and psychiatric disorders and eagerness for treatment and quitting alcohol in ADS inpatients. Fifty consecutive ADS inpatients with matching controls were enrolled. Clinico-demographic profile, factors for initiating alcohol use, psychiatric and sexual co-morbidity and want for treatment and being abstinent was studied applying relevant scales. All subjects were males with a mean age of 37.5 years, 80% were married, majority were Hindu (88%) and from nuclear families (56%). Fifty two percent had an education level of Graduation or more and 68% of patients reported peer pressure to be the initiating factor for alcohol use. Seventy six percent had psychiatric co-morbidity including personality Problems and other Psychiatric disorders 19(38%), delirium tremens 14 (28.00%) and Mood disorders 12(24%).Depression being most common mood disorder (14%). Nicotine was the most common other substance of use 32 (64%). Sixty eight percent of the patient reported one or another sexual dysfunction. 68% of ADS inpatients acknowledged of having problems related to their drinking, expressed desire for change and were eager to avail treatment and to remain abstinent. ADS patients commonly suffer from psychiatric co-morbidity and sexual dysfunctions. They also wish to have effective treatment and to quit alcohol.

Karkee R.,BP Koirala Institute of Health science
Journal of the Nepal Medical Association | Year: 2012

Nepal reportedly reduced the maternal mortality ratio by 48% within one decade between 1996-2005 and received the Millennium development goal award for this. However, there is debate regarding the accuracy of this figure. On the basis of framework of determinants of maternal mortality proposed by McCarthy and Maine in 1992 and successive data from Nepal demographic health survey of 1996, 2001 and 2006, a literature analysis was done to identify the important factors behind this decline. Although facility delivery and skilled birth attendants are acclaimed as best strategy of reducing maternal mortality, a proportionate increase in these factors was not found to account the maternal mortality rate reduction in Nepal. Alternatively, intermediate factors particularly women awareness, family planning and safe abortion might have played a significant role. Hence, Nepal as well as similar other developing countries should pay equal attention to such intermediate factors while concentrating on biomedical care strategy.

Gurung G.N.,BP Koirala Institute of Health science
Nepal Medical College journal : NMCJ | Year: 2012

Tuberculosis (TB) affects mostly economically active population in underdeveloped and developing countries, therefore TB can have far reaching economic and social consequences among infected people and their household members. The objectives of this study were to estimate the household expenditure before and during the course of disease, to explore the direct and indirect cost burden of tuberculosis in terms of annual family income and to compare the total cost burden in a family of case treated with directly observed treatment shortcourse (DOTS) and without DOTS. A total of 160 treatment completed, pulmonary tuberculosis (PTB) cases fulfilling the inclusion criteria were interviewed. The median patients income before and during illness was US$1.95 and US$0.9 respectively. Similarly, household expenditure before illness was US$3.24 and during illness was US$4.28. Direct cost burden in terms of annual family income was higher (15.2%) than indirect cost burden (8.2%). But, free distribution of anti tuberculosis therapy (ATT) through DOTS reduced the total cost burden of patient by more than 8%. In conclusion, overall cost burden of pulmonary tuberculosis is high even though the treatment is free of cost.

Karkee R.,BP Koirala Institute of Health science | Binns C.W.,Curtin University Australia | Lee A.H.,Curtin University Australia
BMC Pregnancy and Childbirth | Year: 2013

Background: There are several barriers for pregnant women to deliver in a health care facility. This prospective cohort study investigated factors affecting facility delivery and reasons for unplanned place of delivery after implementation of the safer mother programme in Nepal.Methods: Baseline interviews using a validated questionnaire were conducted on a sample of 700 pregnant women representative of the Kaski district in central Nepal. Follow-up interviews of the cohort were then conducted within 45 days postpartum. Stepwise logistic regression analysis was performed to determine factors associated with the facility delivery outcome.Results: Of the 644 pregnant women whose delivery location had been identified, 547 (85%) gave birth in a health care facility. Women were more likely to deliver in a health facility if they were educated especially with higher secondary or above qualification (adjusted odds ratio (OR) 12.39, 95% confidence interval (CI) 5.09 to 30.17), attended 4 or more antenatal care visits (OR 2.15, 95% CI 1.25 to 3.69), and lived within 30 minutes to the facility (OR 11.61, 95% CI 5.77 to 24.04). For the 97 women who delivered at home, 72 (74.2%) were unplanned, mainly due to quick precipitation of labour making it impossible to reach a health facility.Conclusions: It appeared that facility delivery occurs more frequent among educated women and those who live nearby, even though maternity services are now freely available in Nepal. Because of the difficult terrain and transportation problem in rural areas, interventions that make maternity service physically accessible during antenatal period are needed to increase the utilisation of health facility for child birth. © 2013 Karkee et al.; licensee BioMed Central Ltd.

Singh V.P.,Bp Koirala Institute Of Health Science | Singh R.,P.A. College
Journal of Orthodontics | Year: 2014

The aim of this study was to develop a reliable and valid Nepali version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ). Design: Cross-sectional descriptive validation study. Settings: B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Methods: A rigorous translation process including conceptual and semantic evaluation, translation, back translation and pre-testing was carried out. Two hundred and fifty-two undergraduates, including equal numbers of males and females with an age ranging from 18 to 29 years (mean age: 22.33±2.114 years), participated in this study. Reliability was assessed by Cronbach's alpha coefficient and the coefficient of correlation was used to assess correlation between items and test-retest reliability. The construct validity was tested by factorial analysis. Convergent construct validity was tested by comparison of PIDAQ scores with the aesthetic component of the index of orthodontic treatment needs (IOTN-AC) and perception of occlusion scale (POS), respectively. Discriminant construct validity was assessed by differences in score for those who demand treatment and those who did not. Results: The response rate was 100%. One hundred and twenty-three individuals had a demand for orthodontic treatment. The Nepali PIDAQ had excellent reliability with Cronbach's alpha of 0.945, corrected item correlation between 0.525 and 0.790 and overall test-retest reliability of 0.978. The construct validity was good with formation of a new sub-domain 'Dental self-consciousness'. The scale had good correlation with IOTN-AC and POS fulfilling convergent construct validity. The discriminant construct validity was proved by significant differences in scores for subjects with demand and without demand for treatment. Conclusion: To conclude, Nepali version of PIDAQ has good psychometric properties and can be used effectively in this population group for further research. © 2014 British Orthodontic Society.

Karkee R.,BP Koirala Institute of Health science
BMC pregnancy and childbirth | Year: 2014

In the context of maternity service, the mother's assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal. A cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression. Within the health facility sub-scale, birth centre was rated lowest on items 'adequacy of medical equipment', 'health staff suited to women's health' and 'adequacy of health staff', whereas public hospital was rated the lowest with respect to 'adequacy of room', 'adequacy of water', 'environment clean', 'privacy' and 'adequacy of information'. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001). Overall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality.

Lavaju P.,BP Koirala Institute of Health science
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH | Year: 2013

The management of Mooren's ulcer can be a challenge for clinicians. To report a case of Mooren's ulcer treated with amniotic membrane transplantation supplemented with autologous serum eye drops. A 22-year-old male presented with history of pain, redness, watering and diminution of vision of the right eye for one year. Examination of his eyes revealed the best corrected visual acuity ( BCVA) of 6\60 and 6\6 in his right and left eyes respectively. Slit -lamp examination of the right eye showed a peripheral ulcer extending from 2'0 to 11'0 clock positions with peripheral thinning and the features suggestive of Mooren's ulcer. The condition did not improve with topical steroids and cyclosporine A eye drops. Therefore, 360 degree conjunctival peritomy with cauterization of the base was performed. Since there was no obvious improvement, the amniotic membrane transplantation was done with supplementation of autologous serum eye drops 20% four times a day. The patient showed symptomatic improvement in a week. There was cessation of the progression of the ulcer and decreased vascularization. One month later, a small corneal perforation was noted and was managed well with cyanoacrylate glue and bandage contact lens application. At nine months of follow up, the patient was symptomatically better, the ulcer had healed, the vascularization had decreased and the anterior chamber was well formed. Amniotic membrane transplantation showed to be promising in treatment of Mooren's ulcer refractory to immunosuppressive therapy. Addition of autologous serum eye drops seems to be an effective supplementary therapy. © NEPjOPH.

Agrawal S.,Bp Koirala Institute Of Health Science
Kathmandu University Medical Journal | Year: 2014

Background Vitiligo is a well-recognized pigmentary disorder of the skin and /or mucous membrane characterized by circumscribed ivory or chalky white macules devoid of identifiable melanocytes. The pathogenesis of vitiligo is complex and still not well understood. According to autocytotoxic hypothesis, oxidative stress has been suggested to be the initial pathogenic event in melanocyte degeneration. The role of free radicals and oxidative damage in the pathophysiology of vitiligo has been documented in recent studies.Objective To evaluate the role of oxidative stress in patients with vitiligo and of healthy controls by measuring levels of the oxidant malondialdehyde (MDA) and antioxidants vitamin C and vitamin E in serum and catalase (CAT) in erythrocytes.Method A total of 80 clinically diagnosed cases of vitiligo and 80 control subjects were included in the study to assess the activity of MDA, vitamin C and vitamin E in serum and CAT in erythrocytes of patients and controls by using the spectrophotometric assay.Result There was statistically significant increase in the levels of MDA in patients with vitiligo compared to the control group (p<0.001). No significant difference was found in the levels of vitamin C (p=0.411) and vitamin E (p=0.771) between the patients with vitiligo and control group. The levels of CAT in the vitiligo patients were found to be significantly lower than those of controls (p<0.001).Conclusion Increased oxidative stress and decreased catalase have been observed in vitiligo patients and the data suggesting that the free radicals may be involved in the destruction of melanocytes or dysregulation of melanogenesis. © 2014 Kathmandu University. All rights reserved.

Agency: European Commission | Branch: FP7 | Program: CP-SICA | Phase: HEALTH-2007-2.3.4-1 | Award Amount: 3.97M | Year: 2008

Visceral leishmaniasis (VL), one of the most-neglected infectious diseases, has an annual incidence of 500,000 cases. Early treatment is a major pillar of the current program for VL elimination on the Indian sub-continent. However, the arsenal of available drugs is very limited, and their use is jeopardized by drug resistance. Combination regimens for VL are under clinical development, but it will take several more years to change the drug policy. Meanwhile, the effectiveness of current drugs needs to be safeguarded in order to cure patients and ensure unremitting sustainment of VL control. For this, the uninterrupted supply of quality drugs, the promotion of treatment compliance and, the monitoring of treatment effectiveness and of drug resistance will be pivotal. The latter demands improved knowledge and know-how, hence clinical and laboratory research are urgently needed to support the drug policy of the VL elimination program. The present multi-disciplinary proposal addresses these needs: we aim to develop, evaluate and disseminate new tools for the assessment of drug resistance in L. donovani as well as innovative methodologies for monitoring Kala-Azar treatment effectiveness under routine conditions.

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