https://hdl.handle.net/20.500.14356/7 2026-07-08T11:26:52Z 2026-07-08T11:26:52Z Nagila, Amar, Assoc. Prof. Dr. Gautam, Sunil Raj, Dr. Baral, Yadunath, Dr. Dhakal, Roshan, Dr. https://hdl.handle.net/20.500.14356/3033 2026-06-16T06:45:14Z 2026-01-01T00:00:00Z

Title: Leveraging portable digital x-ray to strengthen tb case finding among people living with HIV in Gandaki province Authors: Nagila, Amar, Assoc. Prof. Dr.; Gautam, Sunil Raj, Dr.; Baral, Yadunath, Dr.; Dhakal, Roshan, Dr. Abstract: Abstract: Introduction: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain pressing global public health challenges, particularly in low- and middle-income countries like Nepal. TB is the leading cause of death among people living with HIV (PLHIV), accounting for a significant proportion of AIDS-related deaths. The co-infection of TB and HIV presents complex challenges, including delayed diagnosis, overlapping drug regimens and increased risk of mortality. Despite progress, Nepal continues to face a high burden of TB, including multidrug-resistant TB (MDR-TB), with limited early detection tools for high-risk groups such as PLHIV. This study aimed to strengthen TB case finding among PLHIV in Gandaki Province by leveraging portable digital X-ray technology integrated with CAD4TB (Computer-Aided Detection for Tuberculosis). Methods: A cross-sectional survey was conducted among HIV-positive patients attending (Antiretroviral Therapy) ART centers across diverse ecological regions (mountain, hill, and Terai districts). All participants were undergone digital chest X-ray screening and presumptive TB cases were confirmed through Gene-Xpert testing at the Provincial Tuberculosis Control Center. A total of 260 participants were enrolled. Ethical approval was obtained from the Institutional Review Committee (IRC), Pokhara University (105/2082/83) and relevant authorities. Findings: The study done among 260 people living with HIV registered in different ART center, demonstrated that study participants comprise of 58.5% (n=152) and 41.5% (n=108) female and males respectively. The majority were aged below 45 years (46.2%), followed Hindu religion (75.4%), from urban areas (75.0%), and living in nuclear families (84.6%). The Gene-Xpert test revealed that 81.1% (n=30) tested negative for MTB, while 16.2% (n=6) tested positive. Among positive cases, MTB was detected with high bacterial load (8.1%), medium bacterial load (5.4%), and very low bacterial load (2.7%). Majority of participants (60.8%) had normal body mass index. Also, digital chest X-ray screening was found to be normal among 85.8% of participants, while 14.2% of participants were suggestive of active or old tuberculosis (TB). The Gene-Xpert positivity rate was found to be 18.92%. This study found the TB prevalence as 2.69% (7/260) and 42.3% were having comorbidities. The bivariate analysis sex, ethnicity, alcoholic history, comorbidities, viral load, close contact with TB patient and symptoms of TB as predictors of TB infection among PLHIV. However, after adjustment in multivariate analysis ethnicity was identified as a main predictor for getting TB. Conclusion: This study determined the prevalence of TB infection and association with different relevant factors among people living with HIV in Nepal. The findings emphasize the importance of strengthening active TB screening and comprehensive assessment, of associated risk factors among PLHIV using the portable digital X-ray in order to design the targeted interventions for high-risk subgroups and ensure timely treatment. It is crucial for the achievement of national target of ending TB. These evidences suggest the early and efficient way of strengthening the active TB case findings by use of available resources such as digital chest X-ray. This insight should be incorporated into future HIV/TB control programs to reduce the financial burden of screening TB among PLHIV in Nepal by using portable digital Xray Description: Provincial Grant

2026-01-01T00:00:00Z Karki, Yagya Bahadur Karki, Khadaga B. https://hdl.handle.net/20.500.14356/730 2024-12-29T09:15:57Z 2014-01-01T00:00:00Z

Title: Evaluation of a calcium supplementation program for pregnant women in Dailekh district, Nepal Authors: Karki, Yagya Bahadur; Karki, Khadaga B. Abstract: Executive Summary: Introduction: This study was conducted to assess the coverage and compliance of the calcium pilot programme implemented by Family Health Division with the technical and financial support from the Maternal and Child Health Integrated Program (MCHIP), led by Jhpiego, to provide calcium supplements to pregnant women for prevention of Pre/ Eclampsia (PE/E) in Dailekh district for one year ending in August 2013. Dailekh district located in mid-western hills of Nepal has 55 Village Development Committees (VDCs) and one Municipality and according to the 2011 population census an estimated 63,073 women of reproductive age (15-49) have been living there. Methodology With the guidance from the Technical Working Group, FHD and MCHIP designed an evaluationstudy to assess the coverage and compliance of calcium supplementation programme. This includes a post-intervention household survey of recent mothers. The household survey used a cluster sampling method to identify respondents but the sampling units were recently delivered women (RDW) who had given birth in the last 6 months. In all, 62 clusters were chosen on the basis of probability proportional to population size and from each cluster 20 RDW were randomly chosen for interview. In order to interview a woman who had either a still birth or live birth in the last 6 months preceding the survey date over 10 households were visited. The total sample size was 1,240 RDW. In addition 109 health care providers (half of them were either staff nurse or auxiliary nurse midwives) and 112 FCHVs from the respective health facilities/wards from where RDWs were selected, were also administered separate questionnaires to assess their knowledge on calcium use and their experience of implementing the pilot calcium programme. The data processing was done in FoxPro software to generate a “cleaned” data set. The FoxPro data was transferred to SPSS system file for analysis. Data analysis was performed using simple frequency tables and two/three way cross tables. Basic statistical techniques have also been used in the analysis. The survey results have been compared with the national NDHS 2011 wherever appropriate. Characteristics of respondents or RDW The median age of mothers participating in the household survey was 23 years. About 18 percent of the RDW were under 20 years of age, 76 percent between 20-34 years of age and about 6 percent were 35-49 years of age. Thirty-nine percent of the respondents had no education, 14 percent had completed School Leaving Certificate (SLC) or more and 47 percent had completed primary or secondary education. In terms of caste/ethnicity, 43 percent of all respondents belonged to Chhetri/Thakuri group, followed by Dalit - 34 percent, Janjati 12 percent and Bahun/ Sanyasi 12 percent. Antenatal care (ANC) The survey showed 95% mothers giving birth in the last 6 months reported that they attended at least one ANC visit during their last pregnancy which is higher than the national average (85%) shown by NDHS, 2011. The median duration of pregnancy at the first antenatal care visit for those with ANC was 4 months regardless of residence. In Dailekh 71 percent of pregnant women made 4or more antenatal care visits during their entire pregnancy. More urban women (90%) have had four or more antenatal visits than rural women (69%). More mothers (75%) receiving calcium tablets had four or more antenatal visits during their pregnancy than those (71%) without calcium. Eightytwo percent of mothers received ANC from a skilled provider (a doctor, nurse, or midwife) for their most recent pregnancy. Among those mothers who did not go for ANC, over half (55%) of them said that the health facility was too far followed by the reason "it is not necessary" (45%), "not customary" (33%), "no good service" (19%), and 9 percent each said they "did not know" and "too expensive". Of the total respondents 95 percent received iron tablets and of them 99 percent got advice on iron tablets and 95 percent received iron tablets from a health worker or FCHVs. Most (95%) mothers receiving iron tablets at ANC visits also got resupply of iron tablets.

2014-01-01T00:00:00Z