Category: Statistics

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):506-511.

ABSTRACT

Background Rehabilitation services are vital in improving the quality of life for people with disabilities in Nepal, where there is a prolonged effect of civil conflict and frequent natural disasters. To refer patients to rehabilitation specialists, health professionals should be equipped with knowledge and should have a positive attitude towards multidisciplinary rehabilitation. However, information on the knowledge, attitude, and practice (KAP) of health professionals in Nepal regarding multidisciplinary rehabilitation is limited. Objective To determine the level of knowledge, attitude, and practice of multidisciplinary rehabilitation among health professionals. Method A cross-sectional study was conducted across three hospitals in the Kavre district involving 118 various health professionals. A self-administered questionnaire was used to measure knowledge, attitude, and practice. Knowledge scores ranged from 0 to 24 (≤ 8: low, 9-16: moderate, > 16: high) and attitude scores from 0 to 20 (≤ 6: low, 7-14: moderate, > 14: high). Data were analyzed using SPSS version 26, employing descriptive statistics and non-parametric tests. Result The mean knowledge score was 17.77 ± 4.91, with 72% of participants demonstrating a high level of knowledge in multidisciplinary rehabilitation. The mean attitude score was 16.22 ± 3.23, with 74% rating high positive attitudes. Regarding practice, 50% of participants referred more than five patients to physiotherapists monthly, while 79.4% did not refer any patients to physiatrists monthly. Conclusion Health professionals in the Kavre district exhibit generally high knowledge and positive attitudes towards multidisciplinary rehabilitation. Nonetheless, referral patterns indicate underutilization of physiatrists and speech therapists, suggesting areas for targeted interventions to improve multidisciplinary rehabilitation services accessibility in Nepal.

PMID:42318729

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):493-498.

ABSTRACT

Background Laparoscopic Cholecystectomy is, a frequently performed surgery for symptomatic cholelithiasis. On various studies, in a significant proportion of patients developing gallstones, biliary infection has been noted. Objective To assess the bacteriological profile of bile and to determine antibiotic sensitivity pattern for preoperative prophylaxis in laparoscopic cholecystectomy patients. Method A prospective observational study was carried out from November 2021 to April 2022 at the Department of Surgery, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal after obtaining ethical approval from the Institutional Review Committee of Nepalese Army Institute of Health Sciences (Reg. No: 478) and informed written consent from each patient. A total of 123 patients undergoing for laparoscopic cholecystectomy were studied. About 5 ml of bile aspirated from gall bladder was collected in a sterile syringe and transported to laboratory for culture and sensitivity. Demographic characteristics, culture outcomes and postoperative parameters were collected using predesigned Performa. Statistical analysis was performed using Statistical Package for the Social Sciences software (SPSS). Result Bile culture was positive in 25 (20.33%) patients. The most predominant organisms were Gram negative bacteria. The most commonly isolated organisms were Escherichia coli, Pseudomonas spp and Klebsiella spp. On sensitivity profile, the isolates were most sensitive to antibiotics like: amikacin, gentamicin, clindamycin, meropenem, imipenem, linezolid and piperacillin plus tazobactum with resistance encountered against ampicillin. Conclusion Most common organisms isolated from bile culture were Gram negative. Aminoglycoside group of drugs was found to be most sensitive and can be used as first line drug for preoperative prophylaxis in patients undergoing laparoscopic cholecystectomy. It also highlights on the importance of understanding demographical and clinical aspects of patient’s profile along with bactibilia.

PMID:42318727

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):487-492.

ABSTRACT

Background Video-assisted teaching in the nursing field serves as a valuable and innovative tool to enhance the learning experience for students. When there is a demonstration technique available, video-based education can be a good replacement. As future nurses, nursing students need a comprehensive understanding of insulin therapy to effectively educate and empower patients in managing their condition. Objective To assess the effectiveness of a video-assisted teaching program in improving nursing students’ knowledge and skills in insulin therapy. Method A quasi-experimental study was conducted among B.Sc. Nursing students from two Kathmandu University-affiliated colleges from 22nd March to 25th May 2024. Eligible students were allocated into the intervention group (n1=62) received both traditional demonstration and 10-minute video instruction, while the control group (n2=55) received only traditional demonstration. Baseline demographic data, knowledge, and skills were collected using self-administered questionnaires and a checklist. After four weeks, post-intervention assessments were conducted. Ethical approval and written informed consent was obtained. Data were analyzed using SPSS version 20 with descriptive statistics and inferential tests including t-test, Mann-Whitney U-test and Wilcoxon signed-rank test. Result Knowledge and skill scores significantly increased in both groups (p value < 0.001). However, the intervention group demonstrated a significantly higher increase in knowledge and skill scores compared to the control group, with p-values of 0.026 and <0.001, respectively. Conclusion The study indicates that video-assisted teaching effectively enhances nursing students’ knowledge and skills in insulin administration. Nursing education programs in Nepal can integrate such tools to produce more competent and confident nurses.

PMID:42318726

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):471-476.

ABSTRACT

Background Internal jugular venous cannulation is required in many aspects for patients in intensive care, major surgeries, hemodialysis etc. Superficial cervical plexus block allows field of anesthesia to operate and secure the cannula in awake patient. Objective To study pain relief caused by superficial cervical plexus block of local anesthesia during the procedure of cannulation of internal jugular vein in patients requiring central venous cannulation. Method This prospective observational study was conducted from December 2023 to August 2024 at Dhulikhel Hospital, Kathmandu University Hospital. Sixty four awake patients with American Society of Anesthesia (ASA) I-III requiring central venous cannulation received ultrasound-guided Superficial cervical plexus block with 10 ml of 0.25% ropivacaine prior to internal jugular venous cannulation. Pain score (Verbal Pain Rating Scale) and hemodynamic changes (Heart rate, Mean Arterial Pressure, Spo2) were assessed at key procedural steps: during block, needle puncture, subcutaneous tunneling, catheter insertion, securing and suturing and five minutes post-procedure with any adverse effect and complication. Data were analysed using SPSS 22, student’s unpaired t-test was applied to the continue statistical data and chi square test to the categorical test considering significance p value <0.05. Result All cannulations were successful on the first attempt. Only 1 patient (1.56)% required additional analgesia due to moderate pain during tunneling. Mean pain scores were minimal at all other stages (≤ 1). Hemodynamic parameters remained stable throughout the procedure, with no significant complications observed. Conclusion Ultrasound guided superficial cervical plexus block provides effective analgesia at various stages of procedure avoiding the complications. This study recommends Superficial block as one of the analgesic technique during awake internal jugular venous cannulation to improve patient comfort and procedural safety.

PMID:42318723

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):449-457.

ABSTRACT

Background Nepal’s National Immunization Programme (NIP) has made significant strides in safeguarding public health, notably through the integration of the Inactivated Polio Vaccine (IPV) in national immunization schedule, in 2014, to combat wild poliovirus serotypes. However, a global IPV shortage between 2016 and 2018 left approximately 1.46 million children unvaccinated, creating an immunity gap against Type-2 poliovirus. Objective To evaluate the coverage and equity of Nepal’s national inactivated polio vaccine catch-up campaign (May 26 to June 8, 2024) and identify key areas needing improvement. Method Administrative data from all 77 districts were reviewed and analysed by province, district, and ecological zone. To address this, Nepal launched a nationwide IPV vaccination campaign from May 26 to June 8, 2024, targeting children aged between five years and eight months to eight years and months. Result The campaign achieved national coverage of 95.9%. However, disparities were noted: district-level coverage ranged from 45.2% in Bagmati to 124.7% in Koshi. Province-level performance varied, with Madhesh (111.6%) and Karnali (110.7%) exceeding targets, while Bagmati (88.2%) and Gandaki (75.8%) underperformed. These differences were influenced by terrain, cold chain capacity, population mobility, and urban-rural inequities. Conclusion Nepal’s inactivated polio vaccine campaign largely succeeded in bridging the post-shortage immunity gap, but subnational disparities highlight systemic challenges. Strengthening cold chain infrastructure, improving microplanning through quality data, and tailoring outreach to underserved areas are essential to enhance equity and sustain Nepal’s polio-free status.

PMID:42318720

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):441-448.

ABSTRACT

Background Despite persons affected by disability are expected to increase, limited support services and disparities in resource allocation exist in Myanmar which hinder persons with disabilities in accessing essential needs. This highlights the urgent need for spatial analysis through Geographic Information System (GIS) to better understand distribution of disability, socioeconomic correlations, and inform targeted policy interventions. Objective To provide hotspot clusters of disability prevalence across all districts of Myanmar and examine their distribution based on socioeconomic status along with the spatial autocorrelation patterns using Geographic Information System. Method District Level Report of 2019 of Myanmar Intercensal Survey was used. The data were processed and analysed using Quantum Geographic Information System and GeoDa programmes. Univariate and bivariate spatial analysis were performed using Global and Local Moran’s I statistics along with Local Indicators of Spatial Association to identify spatial clusters of disability rates. Result The overall prevalence of disability was 12.9 per 100 population in Myanmar. Seven hotspots were identified along the Western Region of Myanmar (Moran’s I value of 0.318). In bivariate Local Indicators of Spatial Association analysis, the literacy rate (Moran’s I: 0.216), child dependency ratio (Moran’s I: 0.137) and old dependency ratio (Moran’s I: 0.259) exhibited significant association with disability prevalence. Conclusion This study demonstrated the demographic disparities in distribution of disability prevalence. Moreover, the spatial relationships between socioeconomic factors and disability were identified, offering a foundational understanding for necessary interventions and demonstrating the value of spatial analysis in shaping healthcare strategies.

PMID:42318719

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):433-440.

ABSTRACT

Background Cervical cancer is the most common cancer among women in Nepal. Traditionally, healthcare professionals collect cervical specimens for Human Papillomavirus testing. Still, many women prefer self-collection, allowing them to sample in the comfort of their homes. Self-sampling has shown promise in other countries, but its acceptability in Nepal remains unexplored. Objective To assess the acceptability of Human papillomavirus self-sampling among women in Nepal. Method This community based single arm implementation study was conducted from 5 February 2021 to 17 July 2022 using mixed methods approach. For Cervical Cancer Screening, 1625 women aged 30-60 years were recruited and vaginal samples were collected using self-sampling technique. Quantitative data were collected by assessing sociodemographic, sexual and reproductive characteristics, awareness on cervical cancer and human papillomavirus vaccination, and acceptability. Qualitative data were obtained through in-depth interviews among 31 participants. Descriptive data were reported using frequencies and percentages. In-depth interviews were transcribed and coded using inductive and deductive methods. Result Among 1625 participants, 74% agreed to self-sample for screening. Among them, 98% found it easy to understand the directions to collect vaginal swabs, 96% reported ease in using a brush for sample collection, 89.6% found it painless and comfortable, 19.2% were afraid of hurting themselves while using the brush. Only 5.3% women felt embarrassed while self-collecting the sample. Qualitative results support these findings. Conclusion Increase cervical cancer screening participation rate with positive response towards self-screening indicates that Human papillomavirus self-sampling methods have potential to increase screening uptake, and achieve the national target of 70% screening coverage.

PMID:42318718

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):423-428.

ABSTRACT

Background Periodontal disease can impact several functional elements, such as chewing, swallowing, speech, and appearance, which in turn can affect self-confidence. People suffering from periodontitis typically report a diminished quality of life in comparison to those with healthy gums. Objective To evaluate the impact of chronic periodontal disease on the oral health-related quality of life of a patient visiting the tertiary hospital. Method The descriptive cross-sectional study was conducted among patients visiting the Department of Periodontology and Oral Implantology, Kathmandu University Hospital, using a predesigned/prevalidated self-administered questionnaire for a duration of 3 months from June 2024 to August 2024 after obtaining ethical approval. Data was collected and entered into Microsoft Excel, and further analysis was done using SPSS v21. Result A total of 380 participants were included in the study, comprising 197 (51.80%) males and 183 (48.20%) females. The mean age of the participants was 35.62 ± 13.56 years. The highest mean score was for physical disability (2.81 ± 1.99), indicating that this was the most frequently experienced impact. This was followed by physical pain (2.65 ± 1.96) and psychological disability (2.14 ± 2.22). The least affected domains were social disability (0.62 ± 1.33) and handicap (0.76 ± 1.50), suggesting that participants’ social lives and overall life roles were less impacted by their periodontal condition. Conclusion There was negative impact of periodontal diseases on various aspects of patients’ oral health-related quality of life, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap.

PMID:42318716

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):418-422.

ABSTRACT

Background Pancreatobiliary malignancies (PBM) are often diagnosed at an advanced stage, leading to poor outcomes. Studies on the clinical profile and diagnostic efficacy in research limited settings like Nepal are scarce. Objective To describe the clinico-demographic profile characteristic and evaluate the diagnostic yield of endoscopic techniques in-patient with suspected pancreatobiliary malignancy undergoing Endoscopic Retrograde Cholangiopancreatography. Method A retrospective, cross-sectional study was conducted at the endoscopy unit of a tertiary care center of Nepal from January 2017 to January 2023. We included 597 Patients over 18 years of age with suspected pancreatobiliary malignancy who underwent endoscopic retrograde cholangiopancreatography. Data on demographics, clinical presentation and diagnostic results (brush cytology and intraductal biopsy) were analyzed using descriptive statistics. Result Among 597 patients, the majority of patients (70.1%, n=419) were aged 50 years or older, with the highest proportion found in the 60-69 year age group. Significant cases were from the hilly region (52.9%) and Brahmin/Chhetri ethnic group (35.51%). In this study 52.4% were male and the most common presenting symptoms were obstructive jaundice (42.4%), abdominal pain (37.7%), and pruritus (22.8%). Endoscopic retrograde cholangiopancreatography was technically successful for biliary drainage in 93.6% (559/597), primarily using plastic stent (77.4%). Endoscopic retrograde cholangiopancreatography guided tissue diagnosis was done in 57.1% of patients (n=341) to establish histological diagnosis. The most frequent Endoscopic retrograde cholangiopancreatography finding was a distal common bile duct stricture (52.8%). Conclusion The diagnostic yield of Endoscopic retrograde cholangiopancreatography -guided tissue sampling remains suboptimal with biopsy proving superior to cytology. In a resource-constrained setting like Nepal, while considering the cost-effective and most sensitive diagnostic tool for pancreatobiliary malignancy, the preferred sequence for diagnostic tools is sonography, followed by CT scan for initial triage, and then Endoscopic retrograde cholangiopancreatography with brush and/or biopsy with drainage.

PMID:42318715

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):413-417.

ABSTRACT

Background Breast-conserving surgery with radiation therapy is the standard approach for early breast cancer. It provides much better cosmetic effects as well as the same level of overall survival as compared to a mastectomy. Despite strong global evidence supporting breast-conserving surgery, it is less preferred in Nepal, and its outcome in the Nepali context is poorly documented. Objective To assess the oncological outcomes of breast-conserving surgery at a tertiary cancer centre in Nepal. Method This hospital-based retrospective cohort study was done in Bhaktapur Cancer Hospital, Nepal, from 2012 to 2018. All the breast cancer patients who underwent breast-conserving surgery were included in the study and were followed up for at least 5 years postoperatively till 2024 with clinical examination and radiological investigations. The statistical analysis was done using SPSS version 22. The measurement data with a normal distribution were expressed as the mean ± standard deviation. Result The study included 100 patients, with a median age of 43 years (range 25-73 years), and a mean tumor size of 26.34 ± 8.6 mm. The mean hospital stay was 3.9 ± 1.08 days, and 94% patients had no complications. Histologically, invasive carcinoma of no special type was the most common. Five-year disease-free survival and five-year overall survival rate were 96% and 97% respectively. Conclusion Our study concluded that Breast Conserving Surgery has a shorter hospital stay, fewer complications, and good oncological outcomes, so it is a simple and feasible technique for patients with early breast cancer.

PMID:42318714