Journal Articles

Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915

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Start date: 2021Subject: search.filters.subject.Nepal

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    Healthcare performance of leprosy management in peripheral health facilities of Dhanusa and Mahottari, Nepal.
    (BioMed Central Ltd, 2025-12) Mahato RK; Ghimire U; Bajracharya B; K C B; Bam D; Ghimire D; Pyakurel UR; Hayman DTS; Pandey BD; Das CL; Paudel KP
    BACKGROUND: The global elimination of leprosy transmission by 2030 is a World Health Organization (WHO) target. Nepal's leprosy elimination program depends on early case diagnosis and the performance of health workers and facilities. The knowledge and skills of paramedical staff (Leprosy Focal Person, LFP) and case documentation and management by health facilities are therefore key to the performance of health care services. METHODS: The performance of health workers and facilities was evaluated through a combined cross-sectional and retrospective study approach of 31 health facilities and their LFPs in Dhanusa and Mahottari Districts in Madhesh Province, Nepal. An average of 6 patients (paucibacillary, PB, or multibacillary, MB) per health facility registered within the 2018/2019 fiscal year were also enrolled in the study. LFP knowledge (e.g., of the three cardinal signs) and skills (e.g., nerve palpation) and facility processes (e.g., record keeping) were scored (e.g., 0, 1) and then rescaled to a proportion, where 1 is perfect. Internal benchmarking was used to guide performance management. RESULTS: Overall LFP knowledge and skill scores of health workers ranged from 0.16 to 0.63 (median 0.53, 95% confidence interval (CI), 0.46-0.6). Case documentation scores ranged from 0.15 to 0.87 (median 0.37, 95% CI 0.36-0.38), case management scores from 0.38 to 0.79 (median 0.54, 95% CI 0.53-0.55) and overall healthcare scores from 0.36-0.62 (median 0.48, 95% CI 0.47-0.49). Leprosy-related training was significantly related to the knowledge and skills of the health workers. All identified cases (n = 187) adhered to the complete treatment and release after treatment (RFT) scheme, out of which 84.5% were satisfied with the service they were provided. Leprosy disability and ear hand and feet (EHF) scores were not significantly reduced in treated patients during the study period, but counseling by LFPs significantly improved cases' positive beliefs and practices regarding self-care. CONCLUSION: Overall leprosy care median performance was low (53%) and can be improved by evidenced-based training, onsite coaching, monitoring, and supervision to facilitate leprosy transmission elimination. The results highlight many of the challenges facing leprosy elimination programs.
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    Dietary practices, physical activity and social determinants of non-communicable diseases in Nepal: A systemic analysis.
    (PLOS, 2023-02-06) Sharma S; Matheson A; Lambrick D; Faulkner J; Lounsbury DW; Vaidya A; Page R; Kushitor SB
    Unhealthy dietary habits and physical inactivity are major risk factors of non-communicable diseases (NCDs) globally. The objective of this paper was to describe the role of dietary practices and physical activity in the interaction of the social determinants of NCDs in Nepal, a developing economy. The study was a qualitative study design involving two districts in Nepal, whereby data was collected via key informant interviews (n = 63) and focus group discussions (n = 12). Thematic analysis of the qualitative data was performed, and a causal loop diagram was built to illustrate the dynamic interactions of the social determinants of NCDs based on the themes. The study also involved sense-making sessions with policy level and local stakeholders. Four key interacting themes emerged from the study describing current dietary and physical activity practices, influence of junk food, role of health system and socio-economic factors as root causes. While the current dietary and physical activity-related practices within communities were unhealthy, the broader determinants such as socio-economic circumstances and gender further fuelled such practices. The health system has potential to play a more effective role in the prevention of the behavioural and social determinants of NCDs.
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    What Does Social Support Sound Like? Challenges and Opportunities for Using Passive Episodic Audio Collection to Assess the Social Environment.
    (Frontiers Media S.A., 2021-03-29) Poudyal A; van Heerden A; Hagaman A; Islam C; Thapa A; Maharjan SM; Byanjankar P; Kohrt BA; Kyriakopoulos M
    Background: The social environment, comprised of social support, social burden, and quality of interactions, influences a range of health outcomes, including mental health. Passive audio data collection on mobile phones (e.g., episodic recording of the auditory environment without requiring any active input from the phone user) enables new opportunities to understand the social environment. We evaluated the use of passive audio collection on mobile phones as a window into the social environment while conducting a study of mental health among adolescent and young mothers in Nepal. Methods: We enrolled 23 adolescent and young mothers who first participated in qualitative interviews to describe their social support and identify sounds potentially associated with that support. Then, episodic recordings were collected for 2 weeks from the mothers using an app to record 30 s of audio every 15 min from 4 A.M. to 9 P.M. Audio data were processed and classified using a pretrained model. Each classification category was accompanied by an estimated accuracy score. Manual validation of the machine-predicted speech and non-speech categories was done for accuracy. Results: In qualitative interviews, mothers described a range of positive and negative social interactions and the sounds that accompanied these. Potential positive sounds included adult speech and laughter, infant babbling and laughter, and sounds from baby toys. Sounds characterizing negative stimuli included yelling, crying, screaming by adults and crying by infants. Sounds associated with social isolation included silence and TV or radio noises. Speech comprised 43% of all passively recorded audio clips (n = 7,725). Manual validation showed a 23% false positive rate and 62% false-negative rate for speech, demonstrating potential underestimation of speech exposure. Other common sounds were music and vehicular noises. Conclusions: Passively capturing audio has the potential to improve understanding of the social environment. However, a pre-trained model had the limited accuracy for identifying speech and lacked categories allowing distinction between positive and negative social interactions. To improve the contribution of passive audio collection to understanding the social environment, future work should improve the accuracy of audio categorization, code for constellations of sounds, and combine audio with other smartphone data collection such as location and activity.
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    Evaluating active leprosy case identification methods in six districts of Nepal.
    (BioMed Central Ltd., 2023-12-06) Mahato RK; Ghimire U; Lamsal M; Bajracharya B; Poudel M; Napit P; Lama K; Dahal G; Hayman DTS; Karna AK; Pandey BD; Das CL; Paudel KP
    BACKGROUND: Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal's population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment. METHODS: Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated. RESULTS: New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24-5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26-2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07-0.94%) and PB cases (0.13%, 95% CI 0.03-0.73) (χ2 = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1-0.46) and PB cases (0.48%, 0.19-0.98) (χ2 = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22-0.81). CONCLUSIONS: The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection.
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    Characterization and management of human-wildlife conflicts in mid-hills outside protected areas of Gandaki province, Nepal
    (PLOS, 2021-11-19) Baral K; Sharma HP; Rimal B; Thapa-Magar K; Bhattarai R; Kunwar RM; Aryal A; Ji W; Sharma LK
    With the intent to better management human wildlife conflict (HWC) and wildlife conservation in mid-hills outside protected areas of Gandaki province, Nepal, we analyzed the patterns and drivers of HWC. Using data collected from literature, government records and questionnaire survey, we investigated temporal, seasonal and spatial distribution of human casualties caused by wildlife attacks. We also appraised the perception of local people towards wildlife conservation. We have recorded 77 cases (69 human injuries and 8 mortalities) during the period of nine year between 2011 and 2019. The number of wildlife attacks increased over this period. Wildlife attacks were more frequent in winter with 50% (42) of attacks occurred between September and December. Common leopard (Panthera pardus) and Himalayan black bear (Ursus thibetanus laniger) were the major species involved in these conflicts. Common leopard was the most feared species that causes highest number of human mortalities (87%, n = 67); the most severe type of HWC outcome. Forty-eight percent (n = 37) attacks were reported at human settlement areas followed by 27% attacks in agriculture land (n = 21) and 24% (n = 19) in forest. Generalized linear model analysis on spatial variables showed that the probability of human attacks increases with decreasing elevation (β = -0.0021, Z = -1.762, p = 0.078) and distance from the forest (β = -0.608, Z = -0.789, p = 0.429). We recommend to decrease habitat degradation / fragmentation, carry out habitat management program within forest to increase prey availability to decrease the wildlife invasion into human settlement area, and decrease dependency of people on forest resources by providing alternative livelihood opportunities. Simplified relief fund distribution mechanism at local level also helps alleviate the impact of HWC. The knowledge obtained by this study and management measures are important for better human-wildlife co-existence.
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    Human wildlife conflict and impacts on livelihood: A study in community forestry system in mid-hills of Nepal
    (MDPI (Basel, Switzerland), 2021-12-01) Baral K; Sharma HP; Kunwar R; Morley C; Aryal A; Rimal B; Ji W; Yosef R
    Human wildlife conflict (HWC) impacts the livelihood of many rural communities world-wide. This study investigated the impact of HWC on people living near community forests (CF) in Nepal. Using databases provided by the Division of Forest Offices and data obtained from surveys between October 2019–March 2020, we quantified the financial loss of HWC to the local people. Between 2015 and 2019, 3315, or 27%, of the livestock owned by the survey respondents were killed by wild predators in the Kaski and Tanahun Districts. Chicken (Gallus spp.) was the most common prey taken (80%), followed by sheep (Ovis spp.) and goats (Capra spp.) (15%), cows (Bos spp.) (2%), pigs (Sus spp.) (2%), and buffalo (Bubalus spp.) (1%). Leopards (Panthera pardus) were the primary predators, followed by golden jackals (Canis aureus), jungle cats (Felis chaus), yellow-throated mar-tens (Martes flavigula), and Himalayan black bears (Ursus thibetanus). The financial loss of livestock during this period was USD $115,656.00, equivalent to USD $142.61 per household. Crops were also damaged and eaten by wildlife, and 2165 crop-raiding events were recorded between 2015 and 2019. Rice (Oryza sativa), followed by maize (Zea mays), millet (Panicum miliaceum), and potatoes (Solanum tuberosum) were the main crops lost. Rhesus monkeys (Macaca mulatta) were the most common crop raiders, causing 74% of the damage, followed by Indian field mice (Mus booduga) (12%). From 2015 to 2019, crop losses equated to USD $83,424.00. Forest regeneration on abandoned agricultural land expanded wildlife habitats, enabling wild animals to come within reach of human settlements, which increased the likelihood of HWC events. Although the success of the community forest res-toration program resulted in increased forest-cover, marginally increasing biodiversity, the reduced distance between human settlements and wildlife habitat, compounded by a lack of natural prey, may have unwittingly exacerbated HWC in this region. We recommend surveying predator and prey populations in the forest habitat, and implementing a habitat management program to improve prey populations within the community forests. Meantime, we propose establishing a financial relief and insurance program for crop and livestock losses at the local community level to alle-viate any financial difficulties to the local communities caused by HWC.