Impacts of El Nino/Southern Oscillation (ENSO) on streamflows in Nepal

This thesis investigates the impact of the El Nino/Southern Oscillation (ENSO) on mean monthly streamflows in Nepal using the Mann Whitney U test, harmonic analysis and correlation analysis. El Nino causes below-normal streamflows between July to December in western Nepal and between June and December in eastern Nepal in the El Nino years. La Nina causes above-normal streamflows in western Nepal between June and January. The multivariate ENSO index (MEI) can be used for streamflow prediction with lags of 1-2 months. El Nino has a stronger impact on streamflows than La Nina. A stronger ENSO impact in western Nepal than in eastern Nepal suggests an inverse relationship between El Nino impact and monsoon strength and a direct relationship between La Nina impact and monsoon strength. This study is the first step in understanding the ENSO-streamflow relationship in Nepal and provides important information on streamflow variability during ENSO events

Feto-maternal outcome of second stage cesarean section in B. P. Koirala institute of health sciences: a retrospective study

Background: Cesarean section (CS) is a common surgical procedure performed in obstetrics. The rate of rise of CS can be attributed to the increase in safety of the procedure, enhanced surgical techniques, improved    antibiotics, increase in number of women requesting for CS. In general, caesarean delivery is associated with more severe maternal complications compared to vaginal deliveries. The stage of labour at which CS is undertaken has been shown to influence the rate/risk of complication. Methods: It was an observational and retrospective study that depended on some clinical records related to more than 37 weeks’ gestation. The study was conducted in BP Koirala institute of health sciences, Dharan Nepal from 2021 December to 2022 December. The neonatal as well as maternal outcomes have been evaluated for CS among those who were observing the second stage in their labor period. The test statistics used to analyse the data were descriptive statistics chi-square test. Results:  The total delivery was 16131 out of which there were 6748 cesarean deliveries. Out of 6748 CS 65 patients had cesarean in second stage of labour. The most common cause of CS in second stage of labor was arrest of descent and dilatation (40%), followed by meconium-stained liquor (15.38%), occipito-posterior position (12.30%), and obstructed labour (3.07%) Being the least cause. One patient had to undergo peri-partum hysterectomy and the most common complication of second stage CS was prolong foleys catheterization (15 patients), post-partum febrile illness (20 patients out of 65), followed by wound infection, PPH, blood transfusion. The neonatal admission for NICU were birth asphyxia and respiratory distress were 50% each. Conclusions: CS in the second stage of labor is correlated with considerably improved neonatal and maternal rate of morbidity along with expanded neonatal mortality. A proper judgment and skilled obstetrician are required to perform a second-stage CS. CS in the second stage of labor is a technically demanding procedure with an increased risk of maternal and neonatal morbidity compared to the CS in the first stage of labor

Effect of a female community health volunteer-delivered intervention to increase cervical cancer screening uptake in Nepal:a cluster randomized controlled trial

This study aimed to assess the effect of Female Community Health Volunteer (FCHV)-delivered intervention to increase cervical cancer screening uptake among Nepalese women. A community-based, open-label, 2-group, cluster randomized controlled trial (CRCT) was conducted in a semi-urban setting in Western Nepal. Fourteen clusters (1:1) were randomly assigned to the intervention group, which received a 12-month intervention delivered by FCHVs or the control group (usual care). Between April and June 2019, 690 women aged 30–60 years were recruited for CRCT during the baseline survey. A follow-up assessment was conducted after the completion of the 12 months intervention. The primary outcome was the change in cervical cancer screening from baseline to 12-month follow-up. Of 690 women, 646 women completed the trial. 254 women in the intervention group and 385 women in the control group were included in the primary outcome analysis. There was a significant increase in cervical cancer screening uptake in the intervention group [relative risk (RR), 1.48; 95 % confidence interval (CI) 1.32, 1.66; P < 0.01)], compared to the control group. The secondary outcome was the change in median knowledge score among women that increased from 2 [interquartile range (IQR) 1–4] (baseline) to 6 [IQR 3–9] (follow-up) in the intervention group. However, the median knowledge score remained almost the same among women in the control group 2 [IQR 1–5] to 3 [IQR 2–5]. Our study findings reported that an FCHV-delivered intervention significantly increased cervical cancer screening uptake among women living in a semi-urban setting in Nepal. Trial registration: ClinicalTrials.gov NCT03808064

PAP Smear versus Colposcopy in the Absence of HPV-DNA Testing for the Screening of Pre-malignant and Malignant Cervical Lesions

Introduction: The incidence of cervical cancer is very high in developing countries. The extensive use of cervical screening with PAP smear and colposcopy has considerably increased the detection of premalignant and malignant cervical lesions.&nbsp;Methods: This was a hospital-based study conducted over a period of three months. All the patients underwent gynecological examination, PAP smear and colposcopy. In case of abnormal findings in colposcopy or follow-up cytology, patients were advised for cervical biopsy. With reference to the histopathological reports, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PAP smear and colposcopy were evaluated. Results: The most common cytological result was Negative for Intraepithelial Lesion or Malignancy (NILM, 60%) followed by Atypical Squamous Cells of Undetermined Significance (ASCUS, 10%), Atypical Squamous Cells- cannot exclude High grade lesion (ASC-H, 6%), Low grade Squamous Intraepithelial Lesion (LSIL,10%) and High grade Squamous Intraepithelial Lesion (HSIL, 11%). In colposcopy, 60% of the patients were normal and 40% showed atypical transition zone. Histo-pathological findings among 53 patients were NILM (13.2%), cervicitis (13.2%), Cervical Intraepithelial Neoplasia I (CIN I, 28.3%), CIN II and CIN III (39.6%) and invasive carcinoma (5.66%). The sensitivity, specificity, PPV and NPV of PAP smear were 63.6%, 66.6%, 33.3%, and 87.5% respectively. Similarly sensitivity, specificity, PPV, NPV of colposcopy for abnormal cervical lesions were 87.56%, 15.38%, 76.09% and 28.57% respectively. Conclusion: In the absence of HPV-DNA testing, the combined use of PAP smear and colposcopy to detect premalignant and malignant cervical lesions increases early detection and treatment

Spatial and Temporal Variation of Fish Assemblages in Seti Gandaki River, Tanahu, Nepal

The space and time variations of the fish community structure in hill streams of Nepal are poorly understood. This research aims at studying the space and time variation of fish community structure in the Seti Gandaki River, Tanahu, Nepal. The field survey was conducted from July 2017 to June 2018 and the fishes were sampled from six sites using a medium size cast net of mesh size ranging from 3 mm to 6 mm mesh size, 25-33 feet length and 3.5-5 feet width, with the help of local fisher man. A total of 1,440 individuals were caught representing 46 species belonging to three order, nine families and 23 genera. The analysis of similarity (ANOSIM) showed significant difference in space (R = 0.824, P = 0.001) but not in time (R = 0.135, P = 0.021). On the basis of similarity percentage (SIMPER) analysis, 85.43% similarity was found among the seasons and major contributing species were Barilius bendelisis (8.44%) followed by B. vagra (7.79%), Tor putitora (7.27%), Garra gotyla (7%), Acanthocobotis botia (6.7%), Neolissochilus hexagonolepis (6.64%), Barilius shacra (6%), B. barila (4.5%) and Opsarius barna (4.37%). On the other hand, 85.24% similarity was found among the sites and major contributing species were B. bendelisis (8.8%) followed by B. vagra (7.6%), G. gotyla (7.27%), T. putitora (7.17%), A. botia (6.97%), N. hexagonolepis (6.7%), B. shacra (6.34%), B. barila (4.7%) and O. barna (4.39%). Results from the Canonical Correspondence Analysis indicated that the environmental variables, such as pH, total hardness, alkalinity, dissolved oxygen and water temperature have shown to determine the fish community structure of Seti Gandaki River. Keywords: Fish diversity, freshwater, habitat, spatio-temporal, strea

Prevalence of prediabetes and associated factors of prediabetic stages: a cross-sectional study among adults in Nepal

Objectives To estimate the prevalence of prediabetes and to assess the association of prediabetic stages with sociodemographic, lifestyle and clinical factors Design Cross-sectional study at the screening and inclusion stage of a Diabetes Prevention Education Program (DiPEP) trial Setting The study was conducted in two urban communities in Nepal (October 2019–March 2020). Participants A total of 6222 residents of two study sites, aged 18–64 years and without a history of diabetes, were eligible for prediabetes screening. Exclusion criteria were pregnancy, history of diabetes and critical illness. A total of 291 participants with prediabetes were included in this study. Primary and secondary outcome measures Prevalence of prediabetes based on glycated haemoglobin (HbA1c) criteria (5.7%–6.4%) was the primary outcome of the study. Odds Ratio and 95% CI were estimated to assess the associations between the outcome prediabetic stages (5.7%–5.9% vs 6.0%–6.4%) and sociodemographic, lifestyle and clinical factors in both unadjusted and adjusted models. Results Out of 6222 screened participants, 308 (5%, 95% CI: 4.4% to 5.5%) individuals were detected with prediabetes based on HbA1c. The mean age of 291 responded participants was 50.3±7.6 years and 67% were females. Among them, 78% aged 45–64 years, 97% had central obesity, 90% had high waist–hip ratio, 63% were hypertensive and 66% had no family history of diabetes. Approximately, 54% and 46% of individuals with prediabetes had HbA1c of 5.7%–5.9% and 6.0%–6.4%, respectively. Female gender was associated with prediabetes with HbA1c 6.0%–6.4% (OR, 1.98, 95% CI: 1.07 to 3.67) in the adjusted model. Conclusion The estimated prevalence of prediabetes was 5% among screened participants, and female gender was associated with the prediabetic stage. As a large proportion of the population with prediabetes were not aware of their status, this study demonstrates a need for regular community screening programmes to detect individuals with prediabetes and provide them a comprehensive lifestyle intervention for diabetes prevention.publishedVersio

Diabetes Prevention Education Program in a population with pre-diabetes in Nepal: a study protocol of a cluster randomised controlled trial (DiPEP)

Introduction Evidence suggests that diabetes burden can be reduced by implementing early lifestyle intervention programmes in population with pre-diabetes in high-income countries. However, little is known in developing nations like Nepal. This study aims to assess effectiveness of community-based Diabetes Prevention Education Program (DiPEP) on haemoglobin A1c (HbA1c) level, proportion of pre-diabetes reverting to normoglycaemia, diet, physical activity, weight reduction, diabetes knowledge and health literacy after 6 months of follow-up. Furthermore, we will also conduct qualitative studies to explore experiences of participants of intervention sessions and perception of healthcare workers/volunteers about DiPEP. Methods and analyses This is a community-based two-arm, open-label, cluster randomised controlled trial. We will randomise 14 clusters into intervention arm and control arm. Estimated total sample size is 448. We will screen individuals without diabetes, aged 18–64 years, and permanent residents of study sites. HbA1c test will be only performed if both Indian Diabetes Risk Score and random blood sugar value are ≥60 and 140–250 mg/dL, respectively. At baseline, participants in intervention arm will receive DiPEP package (including intensive intervention classes, diabetes prevention brochure, exercise calendar and food record booklet), and participants in control arm will be provided only with diabetes prevention brochure. The change in outcome measures will be compared between intervention to control arm after 6 months of follow-up by linear mixed models. Also, we will conduct individual interviews among participants and healthcare workers as part of a qualitative study. We will use thematic analysis to analyse qualitative data. Ethics and dissemination Regional Committee for Medical and Health Research Ethics, Norway; Nepal Health Research Council, Nepal and Institutional Review Committee, Kathmandu University School of Medical Sciences have approved the study. The DiPEP package can be implemented in other communities of Nepal if it is effective in preventing diabetes. Trial registration number NCT04074148, 2019/783.publishedVersio

Effectiveness of a group-based Diabetes Prevention Education Program (DiPEP) in a population with pre-diabetes: a cluster randomised controlled trial in Nepal

Background Although several lifestyle intervention studies have been conducted in low/middle-income countries, there were no such studies in Nepal. Therefore, a group-based culturally tailored Diabetes Prevention Education Program (DiPEP) was conducted recently. The study aimed to evaluate the effect of DiPEP in glycated haemoglobin (HbA1c), weight, waist circumference, physical activity and diet among population with pre-diabetes. Method A two-arm cluster randomised controlled trial was conducted in 12 clusters of two urban areas in Nepal. The DiPEP was a 6 month intervention (four 1-hour weekly educational sessions and 5 months of follow-up by community health workers/volunteers (CHW/Vs)). A postintervention assessment was done after 6 months. Linear mixed model was used to estimate the mean difference in primary outcome (HbA1c) and secondary outcomes (weight, waist circumference, physical activity and diet) between intervention and control arms, adjusted for baseline measure. Results In intention-to-treat analysis with a total of 291 participants, the estimated mean difference in HbA1c was found to be 0.015 percentage point (95% CI −0.074 to 0.104) between the intervention arm and the control arm, while it was −0.077 (95% CI −0.152 to −0.002) among those who attended at least 3 out of 4 educational sessions. The estimated mean difference in weight (in participants who attended ≥1 educational session) was −1.6 kg (95% CI −3.1 to −0.1). A significantly lower grain consumption was found in intervention arm (−39 g/day, 95% CI −65 to −14) compared with the control arm at postintervention assessment. Conclusion Although compliance was affected by COVID-19, individuals who participated in ≥3 educational sessions had significant reduction in HbA1c and those who attended ≥1 educational session had significant weight reduction. Grain intake was significantly reduced among the intervention arm than the control arm. Hence, group-based lifestyle intervention programmes involving CHW/vs is recommended for diabetes preventionEffectiveness of a group-based Diabetes Prevention Education Program (DiPEP) in a population with pre-diabetes: a cluster randomised controlled trial in NepalpublishedVersio

Prevalence of Abnormal PAP Smear in Pregnancy: A Hospital-Based Study in Western Nepal

Introduction: Cervical carcinoma is the third most common malignancy worldwide. The World Health Organization in 2014 reported the crude incidence rate of cervical cancer in Nepal as 24.2 per 100,000 women per year. This study was carried out with the aim of finding out the prevalence of cervical smear abnormality in pregnancy. Methods: An observational study was conducted in the department of Obstetrics and Gynecology of a tertiary center for a period of one year from May 2021 to April 2022. All pregnant women up to 28 weeks of gestation who had National Health Insurance coming for antenatal check-ups underwent PAP smear test. The cytological results were reported based on the Bethesda classification system 2001. Results: Of 200 pregnant women enrolled in the study, the Pap smear report revealed that 32% of the study subjects had inflammatory smear showing candidiasis and bacterial vaginosis with reactive inflammatory changes. However, 66.5% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.5% of subjects had signs related to carcinoma cervix in which the subject had a low-grade squamous intraepithelial lesion.  No satisfactory sample was reported in 1% of the subjects. Conclusion: Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness