https://hdl.handle.net/20.500.14356/6 2026-06-10T09:11:24Z https://hdl.handle.net/20.500.14356/3031 Title: Screening of high-risk pregnancies for down syndrome using quadruple test at a tertiary care center of Nepal Authors: Niraula, Apeksha Abstract: Background: Down syndrome (DS) is the most common cause of developmental delay and accounts for 15-30 percent of individuals with intellectual disabilities. No finite published data suggests the prevalence of DS in Nepalese children. There is no definitive protocol from the government or professional bodies regarding screening, though the practice for screening DS is increasing both in the public and private sectors. Objectives: To screen high-risk pregnant women (Age ≥ 30 years) by quadruple biochemical test in the second trimester for Down syndrome and other chromosomal abnormalities. To evaluate the sensitivity and accuracy of the second-trimester screening (quadruple test with genetic sonogram) for trisomy 21 as compared to biochemical testing. Methods: This prospective observational study was conducted in the Department of Clinical Biochemistry in collaboration with the Department of Obstetrics and Gynecology, Institute of Medicine, TUTH, Maharajgunj, Kathmandu, Nepal. Pregnant women at 15-21 weeks of gestation were enrolled. Quadruple test (Alpha-fetoprotein (AFP), beta-human gonadotrophin (hCG), unconjugated estriol (UE3), and Inhibin-A in the laboratory using the technology of Chemiluminescence micro particle two-step immunoassay. Risk estimation using values of hormone levels and the resulting MoM was done using PRISCA 5.0.2.37. Results: 256 high-risk pregnancies were screened for trisomy 21, trisomy 18, and neural tube defects. The mean age of the patient was 33.65 ± 3.71 years. Out of 256 patients, 24 (8%) patients were identified as high risk for trisomy 21, 6 (1.96%) patients for Trisomy 18, and 6 (1.96%) patients for neural tube defects. Multiples of Median (MOM) for AFP in high-risk pregnancy were (1.06 ± 0.57; Sensitivity: 43.8% and specificity: 47.2 %), B-HCG (1.27 ± 0.59; Sensitivity: 87.5% and specificity 71.9%), UE3 (0.86 ± 0.45; Sensitivity: 31.3% and specificity 30.2%) and Inhibin (2.67 ± 1.16; Sensitivity: 81.3% and Specificity: 85.4%) respectively. Conclusion: Second-trimester quadruple test provides an effective screening tool for Down syndrome in the Nepalese population. Quadruple tests combined with sonograms can lower the rates of unnecessary amniocentesis in high-risk populations. Description: Provincial Grant 2024-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/2836 Title: Nutritional assessment and factors influencing nutritional status of under 5 years of children of dalit community of khatyad rural municipality, Mugu Authors: Baniya, Prem Laxmi Abstract: Background: Nutritional status is a primary public health concern in the global scenario mainly in low-income countries. Malnutrition consists of under nutrition, overweight, obesity, and micro-nutrient deficiencies among children or lactate mothers mainly in developing countries like Nepal. Evidence suggests that multiple micro-nutrient supplementation reduces the risk of stillbirths and low-birth weight. In Nepal Karnali province Dalit community are most deprived ethnic groups due to underline poverty, unemployment, illiteracy, and lack of health services. Methods A descriptive cross-sectional study was conducted among 199 children and mothers of Khatyad Rural Municipality using the survey questionnaire, and anthropometric measurement. Results: . Overall, there were 25.1%, 15.1%, 24.6%, and 9.5% cases of (severe) stunting, wasting, underweight, and malnutrition, respectively. The mean number the children of the family was 2.43, the number of children below 5 years of age was found 1.29. Similarly, the majority of mother give birth before 20 years (89.4 %) as compared to after 20 years (19.1 Almost every child had colostrum feed, Ante-natal check visit and 83.4 % had post-natal check visit too. Among the respondents 87.9 % of mothers delivered their child at a health facility. Almost all the households (92 %) had a toilet facility.According to MUAC, 11.1 % of the sample children were moderately malnourished and 9.5 % of them were severely malnourished. Conclusion: Dalit community children of Khatyad Rural Municipality were found with low nutritional status and it is being directly affected by maternal education level, socio-economic status of family, types of family, access to health service, and occupation. Key Words: Nutritional status, factors influencing, Dalit community, Khatyad rural municipality. Description: Provincial Grant 2023-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/2835 Title: Psycho-Social problems among elderly residing in Chitwan Authors: Poudyal, Sunita Abstract: Older people are vulnerable to various diseases that have profound impact on overall health and their quality of life and higher use of health services. Ageing is a period when person is withdrawn from daily activities especially their work, and feel unwanted and burden to their family. As a result, they suffer from different psycho-social problems such as depression, anxiety, insomnia, dementia, and loneliness etc. These psychosocial problems can also have an impact on physical health and disability. There is dearth of information in our country regarding the psychosocial problems of elderly so there is need to address the issues based on evidence. Hence, this study aimed to find out the psycho-social problems among elderly people residing in Bharatpur, Chitwan A cross-sectional study was adopted and 388 elderly residing in different wards of Bharatpur Metropolitan city were selected using probability simple random sampling technique. Elderly aged 65 years and above were included in the study. Data were collected using interview schedule containing geriatric depression scale-15, Geriatric anxiety scale-10, University of California Loss Angels Loneliness Scale (UCLA-20), and Mini-Cog Test. Obtained data were analysed in SPSS version 20 for windows using descriptive and inferential statistics. Chi-square test was applied to measure the association between psychosocial problems and selected variables. Findings of the study revealed that the mean age (± SD) of the elderly was 72.92 (±7.12) years. Almost all (93.6%) elderly had full functioning of activity of daily living and two third (66.5%) had other co-morbid conditions. More than two third (67.0%) of the elderly had depression, 60.3% had anxiety, 53.6% had moderate to high level loneliness, 47.2% had insomnia, and 33.3% had dementia. Age, functional dependency, sex, co-morbidity, financial dependence, education, and occupation are significantly associated with the psychosocial problems in the elderly. In conclusion, psychosocial problems are common among elderly residing in Bharatpur, Chitwan. Hence, there is need to develop and implement health care strategy by local health care planner to prevent, treat and manage the psychosocial problems among this risk groups. Further, health care providers working in geriatric problems or psychosocial health need to conduct regular screening programs for the early diagnosis and treatment of these problems. Description: Provincial Grant. 2023-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/2834 Title: Factors affecting correct technique and compliance of intranasal corticosteroid spray usage in patients with allergic rhinitis Authors: Gurung, Urmila, Dr. Abstract: Objective: To identify factors affecting correct technique and compliance of intranasal corticosteroid (INCS) spray usage in patients with allergic rhinitis. Methods: It was a cross-sectional study conducted in the Dept of ENT-Head and Neck surgery, Tribhuvan University Teaching Hospital from April to September 2023. Patients aged 18 or more with allergic rhinitis on INCS or used INCS in the past three months were assessed for INCS administration technique based on EPOS 2020 protocol and their compliance asked. Factors that could hinder the correct techniques and compliance were assessed. Results: A total of 138 patients, 71 males and 67 females, aged 18 to 72 years were included. Most of them (60/138; 43.5%) had completed secondary level education. 97.1% (134/138) had been prescribed INCS spray by an ENT doctor and 89.13% (124/ 138) patients had received verbal instructions mostly by ENT doctor (91.1%). 7.2% (10/138) patients completed all the steps of INCS administration technique as per EPOS 2020 protocol whilst 25/138 (18.1%) completed five essential steps. The correctness of the INCS administration technique however did not differ with age, gender, academic qualification, prescriber or whether instructions were given or not. Compliance was seen in 119/138 (86.2%). Amongst the 19 (13.7%) non-compliant patients, improvement in nasal symptoms in 13, no symptom improvement in two, cost factor in two and side effects like nasal irritation in two were observed. These factors were statistically different between compliant and non-compliant patients. The correctness of the technique did not affect the compliance. Conclusion. INCS spray was scarcely administered in the correct technique however the compliance was good. There were no identifiable factors associated with correctness of the INCS spray technique however, the compliance depended on the cost, side effect to INCS. As for symptoms, both improvement or no improvement could deter compliance. Keywords: Intranasal corticosteroid, allergic rhinitis, compliance, spray technique Description: Provincial Grant 2023-01-01T00:00:00Z