Dhulikhel Hospital

About: Dhulikhel Hospital is a healthcare organization based out in Kathmandu, Nepal. It is known for research contribution in the topics: Population & Epilepsy. The organization has 86 authors who have published 59 publications receiving 336 citations.

Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers

Abstract: Background Nepal has achieved a significant reduction of TB incidence over the past decades. Nevertheless, TB patients continue to experience barriers in access, diagnosis and completion of the treatment. The main objective of this study was to explore the factors affecting the access to the health services, diagnosis and the treatment completion for TB patients in central and western Nepal. Methods Data were collected using in-depth interviews (IDI) with the TB patients (n = 4); Focus Group Discussions (FGDs) with TB suspected patients (n = 16); Semi Strucutred Interviews (SSIs) with health workers (n = 24) and traditional healers (n = 2); and FGDs with community members (n = 8). All data were audio recorded, transcribed and translated to English. All transcriptions underwent thematic analysis using qualitative data analysis software: Atlas.ti. Results Barriers to access to the health centre were the long distance, poor road conditions, and costs associated with travelling. In addition, lack of awareness of TB and its consequences, and the belief, prompted many respondents to visit traditional healers. Early diagnosis of TB was hindered by lack of trained health personnel to use the equipment, lack of equipment and irregular presence of health workers. Additional barriers that impeded the adherence and treatment completion were the need to visit health centre daily for DOTS treatment and associated constraints, complex treatment regimen, and the stigma. Conclusions Barriers embedded in health services and care seekers’ characteristics can be dealt by strengthening the peripheral health services. A continuous availability of (trained) human resources and equipment for diagnosis is critical. As well as increasing the awareness and collaborating with the traditional healers, health services utilization can be enhanced by compensating the costs associated with it, including the modification in current DOTS strategy by providing medicine for a longer term under the supervision of a family member, peer or a community volunteer.

Telemedicine for epilepsy support in resource-poor settings.

Abstract: The Problem Epilepsy is a common disease worldwide causing significant physical and social. disability. It is one of the most treatable neurological diseases. Yet in rural, poorer countries like much of India and Nepal most people with epilepsy are not on any treatment often because they cannot access doctors. Conventional Approaches It is being appreciated that perhaps doctors are not the solution and that enabling health workers to treat epilepsy may be better. Few details however have been put forward about how that might be achieved. Thinking differently Untreated epilepsy should be considered a public health problem like HIV/AIDS, the various steps needed for treatment identified and solutions found. Telemedicine Approaches Telemedicine might contribute to two steps - diagnosis and review. A tool which enables non-doctors to diagnose episodes as epileptic has been developed as a mobile phone app and has good applicability, sensitivity and specificity for the diagnosis. There are a number of ways in which the use of phone review or SMS can improve management. Conclusions Telemedicine, as part of a public health program, can potentially help the millions of people in the resource-poor world with untreated epilepsy.

Validation of a phone app for epilepsy diagnosis in India and Nepal

Abstract: Purpose Untreated epilepsy is a major global public health problem with more than 20 million people not being treated for an easily treatable disease. In part this is due to a lack of trained doctors. There are many more non-medical health workers than doctors and they could have an important role in diagnosis and treatment of epilepsy if they had some tools. We have previously described such a tool to distinguish epileptic episodes from other causes of altered consciousness and here present its validation in three new populations. Methods The tool was presented as a phone app where the answers to 11 questions provided a probability score which indicated whether episodes might be due to epilepsy or not. It was applied either by non-medical volunteers, health workers, or inexperienced doctors to 132 patients in three separate populations in India and Nepal and compared with the "gold standard" diagnosis of a neurologist with expertise in epilepsy. Results There was good agreement between the app score and the neurologists' diagnoses (weighted kappa=75.3%). An app score of 90 or greater had a sensitivity of 88% and a specificity of 100% for diagnosing epilepsy. The app was easy to use with little training and took about 5min to administer. Conclusion A tool presented as a phone app can be used by non-medical health workers to identify episodes as epileptic or not with good accuracy. It needs to be evaluated more widely but has the potential to play a part in reducing the epilepsy treatment gap.

A Bayesian tool for epilepsy diagnosis in the resource-poor world: development and early validation.

Abstract: Purpose The epilepsy treatment gap in resource-poor countries is so large that existing numbers of doctors are unlikely to be able to close it. Other health workers are likely to be needed but they will need help. The diagnosis of an attack as epileptic or not is an essential step in the management of epilepsy. It should be possible to devise a tool to give the probability of episodes being epileptic based on a Bayesian analysis of the results of history taking. Method We asked about the nature of episodes in patients referred to epilepsy camps in Nepal. Answers were then compared to the final clinical diagnosis of epilepsy and the likelihood ratio (LR) of the episode being epileptic obtained for each answer. The most informative LRs, tested sequentially, formed the basis for a tool which was validated in a different Nepalese population. Results Data was obtained from 67 patients. The pre-test probability of having epilepsy was 0.76. Answers to 11 questions with the most informative LRs were then combined into a tool. This was tested on 14 different patients. Post-test probability scores in those with epilepsy ranged from 0.88 to 1 and for those with non-epilepsy from 0.07 to 0.42. Conclusion It is possible to devise a tool based on simple clinical information using Bayesian principles. Initial validation suggests that this has the potential to enable health workers to diagnose episodes as epileptic or not. This now needs to be tested in different populations. The tool is easily converted to a mobile phone app.

Cervical spine injuries in a teaching hospital of eastern region of Nepal: a clinico-epidemiological study.

Abstract: Cervical spine injuries with neural deficits carry significant impact economically, socially and psychologically to the individual and to the society. Risk factors involved, mode of injuries, constraints of management and rehabilitation are different in developing countries. Total 149 patients of cervical spine injuries presented in B.P. Koirala Institute of Health Sciences, Dharan, Nepal were evaluated prospectively for three years. Demographic details, etiology of injury, method and time taken for transportation and treatment method and progression of recovery were recorded. Most commonly involved age group was 30-49 years (44%) with male to female ratio of 4:1. Fall related injury especially from trees was the commonest mode of injury (60%). Patients were transported to hospital without neck immobilization (81%) in a vehicle unsuitable for spinal injuries patient with average delay of two days of injury. 79% had neural deficits among which 42% are with quadriparesis, 31% are with quadriplegia. Associated extra spinal injuries were found in 9% patients. Average hospital stay was 31 days. C5 vertebra was the most commonly injured vertebra. Cervical spine injuries, which has major impact over patient and society is still not adequately addressed by medical and public health system of developing countries like Nepal. Incidence of spinal injuries and its devastating consequences can be reduced by appropriate preventive measures and management along with rehabilitation.