A prospective international cooperative information technology platform built using open-source tools for improving the access to and safety of bone marrow transplantation in low- and middle-income countries

Jagriti Innovations developed a collaboration tool in partnership with the Cure2Children Foundation that has been used by health professionals in Italy, Pakistan, and India for the collaborative management of patients undergoing bone marrow transplantation (BMT) for thalassemia major since August 2008. This online open-access database covers data recording, analyzing, and reporting besides enabling knowledge exchange, telemedicine, capacity building, and quality assurance. As of February 2014, over 2400 patients have been registered and 112 BMTs have been performed with outcomes comparable to international standards, but at a fraction of the cost. This approach avoids medical emigration and contributes to local healthcare strengthening and competitiveness. This paper presents the experience and clinical outcomes associated with the use of this platform built using open-source tools and focusing on a locally pertinent tertiary care procedure—BMT.     

Type 2 Diabetes and Its correlates: A Cross Sectional Study in a Tertiary Hospital of Nepal

Type 2 diabetes mellitus (T2DM) is an emerging global health problem in Nepal. However, there is still a paucity of information on its burden and its risk factors among service users from a hospital based setting. This is a cross sectional study conducted among the service users of diabetes clinic in Tribhuvan University Teaching Hospital of Nepal. A sample size of 154 was selected systematically from the patient registration from 30th July to 16th August, 2013. Of the 154 participants, 42.85?% had T2DM. Higher mean body mass index (26.50?±?5.05 kg/m²) and waist circumference (92.47?±?11.30 cm) was found among the individuals with T2DM and, compared to those without diabetes (Body mass index 25.13?±?4.28 kg/m²: waist circumference 88.91?±?12.30 cm) (P?=?0.013). In further analysis, the sedentary occupation (aOR 3.088; 95?% CI 1.427–6.682), measure of high waist circumference (aOR 2.758; 95?% CI 1.238–6.265) individuals from lower socioeconomic status (aOR 3.989; 95?% CI 1.636–9.729) right knowledge on symptoms of diabetes (aOR 3.670; 95?% CI 1.571–8.577) and right knowledge on prevention of diabetes (aOR 3.397; 95?% CI 1.377–8.383) were significantly associated with T2DM status. The current findings suggest that health programs targeting T2DM should focus increasing awareness on harmful health effects of sedentary occupation, symptoms of T2DM and its prevention among the urban population.     

Stakeholder Engagement in Planning the Design of a National Needs Assessment for Cardiovascular Disease Prevention and Management in Nepal

BackgroundThere is growing support for stakeholder engagement in health research, but the actual impact of such engagement has not been well established.ObjectivesThis paper describes the stakeholder engagement process and evaluation during the planning of the national needs assessment for cardiovascular disease in Nepal.MethodsWe used personal and professional networks to identify relevant stakeholders within the 7Ps framework (Patients and the Public, Providers, Purchasers, Payers, Public Policy Makers and Policy Advocates, Product Makers and the Principal Investigators) to develop a plan for assessing cardiovascular health needs in Nepal. We consulted 40 stakeholders through 2 meetings in small groups and a workshop in a large group to develop the study methods, conceptual framework, and stakeholder engagement process. We interviewed 33 stakeholders to receive feedback on the stakeholder engagement process.ResultsWe engaged 80% of the targeted stakeholders through small group discussions and a workshop. Three of 5 recommendations from the small group discussion were aimed at improving the stakeholder engagement process and 2 were aimed to improve the research methods. Eleven of 27 recommendations from the workshop aimed to improve the research methods, 4 aimed to improve stakeholder engagement, and 2 helped to expand the scope of dissemination. Ten were irrelevant or could not be incorporated due to resource limitation. Most stakeholders noted that the workshop provided an open platform for a multisectoral group to colearn from one another and share ideas. Others highlighted that the discussion generated insights to enhance research by incorporating expertise and ideas from different perspectives. The major challenges discussed were about committing the time for engagement.ConclusionsThe stakeholder engagement process positively affected the design of our research. This study provides important insights for future researchers that aim to engage stakeholders in national-level assessment programs in the health care system in the context of Nepal.     

The Association of Childhood Pneumonia with Household Air Pollution in Nepal: Evidence from Nepal Demographic Health Surveys

Introduction

Childhood pneumonia is a major cause of mortality worldwide while household air pollution (HAP) is a major contributor to childhood pneumonia in low and middle-income countries. This paper presents the prevalence trend of childhood pneumonia in Nepal and assesses its association with household air pollution.

Methods

The study analysed data from the 2006, 2011 and 2016 Nepal Demographic Health Surveys (NDHS). It calculated the prevalence of childhood pneumonia and the factors that cause household air pollution. The association of childhood pneumonia and HAP was assessed using univariate and multi-variate analysis. The population attributable fraction (PAF) of indoor pollution for causing pneumonia was calculated using 2016 NDHS data to assess the burden of pneumonia attributable to HAP factors.

Results

The prevalence of childhood pneumonia decreased in Nepal between 2006 and 2016 and was higher among households using polluting cooking fuels. There was a higher risk of childhood pneumonia among children who lived in households with no separate kitchens in 2011 [Adjusted risk ratio (ARR) 1.40, 95% CI 1.01–1.97] and in 2016 (ARR 1.93, 95% CI 1.14–3.28). In 2016, the risk of children contracting pneumonia in households using polluting fuels was double (ARR 1.98, 95% CI 1.01–3.92) that of children from households using clean fuels. Based on the 2016 data, the PAF for pneumonia was calculated as 30.9% for not having a separate kitchen room and 39.8% for using polluting cooking fuel.

Discussion for Practice

Although the occurrence of childhood pneumonia in Nepal has decreased, the level of its association with HAP remained high.