Job Satisfaction and Its Associated Factors among PHC Level Health Workers of Kaski District

Introduction: Job satisfaction has been identified as key factor of health worker retention and turnover in Low and middle income countries. In Nepal, only 55% of the health workers were satisfied with their current jobs. There is limited amount of literature in the areas related to factors affecting job satisfaction. This study aimed to assess the level of job satisfaction and its associated factors among PHC level health workers in Kaski district. Methodology: Health facility based cross sectional, quantitative study was conducted collecting quantitative data from all PHC level health facilities (3 Primary Health Care Center and 45 Health Posts) health workers of Kaski district, Nepal through face to face interview. The perceived 12 item job satisfaction scale was developed and used to identify job satisfaction. The association between the independent and outcome variable was analyzed by using chi square test. Results: The results showed two-third (66%) of PHC level health workers were satisfied with their current jobs in overall job satisfaction at Kaski district. The study showed that Health Assistant were more satisfied than Auxiliary Nurse Midwifery and Auxiliary Health Workers. Sex (OR=1.80, 95%CI=1.0-3.26), level of working post (OR= 2.62,95%CI=.1.44-4.77) salary (OR= 3.96,95%CI=2.07-7.57) ,pension (OR=3.96, 95%CI=2.07-7.57) training (OR=5.01, 95%CI=2.66-9.39) , opportunity for promotion (OR=2.80, 95%CI=1.54-5.09) , reward provision (OR=3.63,95% CI=1.94-6.77) and role in decision making OR=5.08,95% CI=2.34-11.04) were found to be significantly associated with overall job satisfaction. Conclusion: Two- third of the PHC level health workers of Kaski district were found to be satisfied with their job. Responsible bodies need to make provisions to improve the job satisfaction level of health professional so as to improve the healthcare services of PHCCS and HPs. Key words: Job satisfaction, Health workers, Primary health care level

“Depression, Anxiety and Stress among Nurses during Corona Lockdown in a Selected Teaching Hospital, Kaski, Nepal"

Introduction: Mental health is as important as physical health to respond to COVID-19 pandemic. This pandemic has increased social isolation and fear regarding health and well-being as well as a dilemma which can lead to mental health problems among general people and health workers.Thus the main objective of this study was to assess the prevalence and factors associated with depression, anxiety and stress among nurses working in a hospital of Nepal during the period of Corona lockdown. Methods: A cross-sectional study was carried out among 152 nurses working at Gandaki Medical College Teaching Hospital and Research Centre of Kaski district of Nepal. Data were collected using a structured self-administered questionnaire consisting of socio-demographic items and Depression, Anxiety and Stress Scale (DASS-42) scale from 11 April to 18 April, 2020. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 22 applying descriptive statistics and inferential statistical method. Results: Respondent's mean age and SD was 24.09 + 3.19 years. The sample mean score of DASS-42 was 29.46 (SD 25.37). Depression, anxiety and stress were prevalent among 39.5%, 50% and 25.7% of the respondents respectively. There was significant association of depression with education level (χ2 =6.597; p=0.01) and working unit (χ2 =8.187; p=0.004). Anxiety was significantly associated with working unit (χ2 =6.973; p=0.008) and children status (χ2 =4.199; p=0.040). Stress was significantly associated with age (χ2 =4.906; p=0.027), working unit (χ2 =4.984; p=0.026) and children status (χ2 =5.653; p=0.017). Conclusion: Based on findings, it can be concluded that some degree of depression, anxiety and stress were prevalent among nurses during COVID-19 pandemic. Further assessment should be made to confirm the respective diagnoses. Stress and anxiety relieving sessions and psychological support programs may help for the nurses with higher than cut-offs.

The Upper end of Tibia of Nepalese adults: A Morphometric study

Introduction: The tibia bone forms the main skeleton of the leg. It plays an important role in weight bearing and takes part in the formation of knee joint. The knowledge of different dimensions of upper end of tibia will help the orthopaedic surgeons for diagnosis, planning and treatment of disease related to knee. Inappropriate design of knee replacement could affect the outcome of surgery with reported complications. The objective of the study is to find out the morphometric measurements of upper end of tibia in Nepalese Population. Methods: After ethical approval (MEMG/IRC/211/GA) the study was done on 60 dry tibia bones of Nepalese citizens irrespective of sex and race in the Department of Anatomy, Manipal College of Medical Sciences, Pokhara. The morphometric measurements of medial condyle, lateral condyle, intercondylar area and circumference of upper end of tibia of both sides were measured manually by thread, scale and Vernier calliper. Data were reported as mean ± SD and analyzed with MS Excel 2007 software. Results: Average anteroposterior measurements were found to be 46.38 mm and 39.14 mm and average transverse measurements were 28.79 mm and 27.86 mm respectively for medial and lateral condyles of both sides. The anteroposterior and transverse measurements of intercondylar area of tibia were 47.75 mm and 7.11 mm on the right side and 49.81 mm and 7.25 mm respectively on the left side (p<0.05). Similarly mediolateral length and circumference of upper end of tibia of left limb were significantly greater than the right limb (p<0.05). Conclusion: The knowledge of different dimensions of upper end of tibia may be important in anthropological practice. Morp hometric parameters of upper end of tibia will be important to orthopaedic surgeons for diagnosis, planning and treatment of disease related to knee in Nepalese population.

Morphometric Measurement of Sacral Hiatus in Dry Human Sacrum

Introduction: Sacral hiatus is the chief location for caudal epidural anesthesia during surgery of perineal region and also for a pain free parturition. Thus, this study was conducted to examine, measure and record the morphometry of sacral hiatus and to analyze it for any anatomical variations with clinical implications. Methods: The cross-sectional study was carried in the Department of Anatomy, Sikkim Manipal Institute of Medical Science, Gangtok, Sikkim. For the study seventy dry human sacral bone with entire sacral hiatus were measured. The shape of the sacral hiatus was observed. Level of the apex, base, length, width and anterior posterior diameter of sacral hiatus was measured with Digital Vernier Caliper. The study was approved by Institutional Ethical Committee (IEC No:SMIMS/IEC/2017-01). Data were analysed by one-way analysis of variance (ANOVA) and the difference was considered significant when P<0.05. SPSS 20 was used for data analysis. Results: The study revealed inverted “U” shaped sacral hiatus as the common shape in 35(50%) followed by inverted “V” shaped sacra in 18 (25.71 %) followed by irregular shaped sacral hiatus in 8 (11.42 %) cases. A Dumbbell shaped sacral hiatus was observed in 4 (5.71%) cases with a bony protuberance protruding medially from both edges. Absence or complete agenesis of sacral hiatus, a rare phenomenon, was observed in 3 (4.28%) and bifid in 2(2.85%) specimens only. Conclusion: The prevalence of inverted “U” shaped sacral hiatus and constriction of the sacral canal at apex of sacral hiatus was found high. This knowledge of variation in shape of sacral hiatus could be clinically important while providing caudal anesthesia and doing epidural block.

Perception and Factors Influencing Junk Food Consumption among School Children of Pokhara

Introduction: The main problem with junk foods is that they're low in satiation, that is, people don't feel as full when they eat them, which can lead to overeating. Another problem is that junk food tends to replace other more nutritious foods. In our diet over the time, urbanization and recent development in the foods industries have led to the notable increase in junk food production making them readily available, accessible and affordable. The main objective of this study was to understand the perception and identify factors influencing junk food consumption among school level children of Pokhara. Methods: A cross sectional analytical study was conducted among 220 students of 12 different private schools of Pokhara of grade 4-9. Systematic random sampling was done to select the required samples and the data was collected using self-administered questionnaire and personal interviews. Results: Majority (81%) of the students considered junk food consumption to be unhealthy. About half of the students were unaware of the nutritive value, quality of the food, ingredients, preservatives used and negative consequences of junk foods. There is a significant difference between the grade of the students and the average frequency of junk food use per week. The average consumption of junk food increases as the grades of students increases.(Chi square =53.025, p ≤0.01). Conclusion: Consumption of junk food was notably high due to various enabling factors such as addictive taste, changing lifestyle, propagandist advertising and instant availability. Grade and sex of the students were found to be significant predictors in over consuming junk foods.

The Status of Serum Amylase among type 2 Diabetes Patients in Pokhara

Introduction: Diabetes Mellitus has become one of the common metabolic disorders characterized by hyperglycemia, associated with deficiency or resistance to insulin and shows abnormality in exocrine activity of pancreas. Pancreas is mixed gland that is both an endocrine and an exocrine gland with clusters of endocrinal, islet cell dispersed among exocrine acinar cells. Defects in islets cells in diabetes effect the exocrine secretion of the pancreas. Methods: Hospital based case-control study was conducted. Total sample size was 388. Out of which 194 were known cases of type 2 diabetic patients attending Manipal Teaching Hospital for medical checkup whereas 194 were Non Diabetic individuals with age and sex matched. Self-administer question was used to collected data from case and control. Three ml fasting blood samples were collected and centrifuged. Serum amylase was analyzed by using a semi automated analyzer. All estimates data were analysis statistically by using SPSS 22.0 full version. Results: Serum amylase levels were found significantly low in diabetic patients as compared to the Non-Diabetic (r = -0.313, p-value <0.001). Similarly, present study also showed negative correlation between serum amylase levels and duration of diabetes with Non-Diabetic (r = -0.388, p <0.001). Status of serum amylase and fasting sugar level was found to different among age groups, sex and ethnic groups. Conclusions: The increasing in duration of diabetes decreases the level of serum amylase which suggests a possible exocrine-endocrine relationship in this disease. Similarly, the level of serum amylase and fasting blood sugar vary among age group, sex and ethnicity. Thus, measurement of serum amylase can be an additional informative parameter for the assessment of chronicity and progress of the illness as well as the response to therapy.

Therapeutic Adherence among Chronic Kidney Disease Patients under Hemodialysis in Selected Hospitals of Kathmandu Valley

Introduction: Chronic Kidney Disease (CKD) is an emergent public health problem in Nepal. Hemodialysis is the best treatment for this disease to reduce morbidity and mortality. Therapeutic adherence is crucial factor that influences morbidity and mortality among patients under hemodialysis. The objective of the study was to find out the therapeutic adherence among CKD patients under hemodialysis in selected hospitals of Kathmandu valley. Methods: Descriptive cross-sectional study design was adopted. Altogether 164 patients with CKD under hemodialysis were selected by using non-probability purposive sampling technique. Data were collected through face to face interview using structured interview schedule. Frequency, percent, mean and standard deviations were used for data analysis. Nonparametric Kruskal Wallis test and Mann Whitney U test were applied to measure the mean difference in therapeutic adherence among CKD patients under hemodialysis according to selected variables. Results: Therapeutic adherence levels were 33.5%, 62.8% and 3.7% for good, satisfactory and unsatisfactory respectively. Concerning about hemodialysis, 92.7% respondents had good, 6.1% had satisfactory and 1.2% had unsatisfactory level of adherence to hemodialysis. Furthermore, it was found that 29.9%, 1.8 % and 87.8% respondents had good; and 59.1%, 42.1% and 9.1% had satisfactory level of adherence to diet, fluid and medicine respectively. The results showed that therapeutic adherence was statistically significant with mean difference according to sex (p=0.009), duration of hemodialysis (p=0.001), total session of hemodialysis (p=0.001) and providing health information by dietician and other hemodialysis patients (p=0.001). Conclusion: Therapeutic adherence was found to be satisfactory but adherence to fluid intake is still unsatisfactory. It is recommended that regular education and counseling should be provided in order to increase level of therapeutic adherence.

Maternal and Fetal Outcomes Following Cesarean Deliveries: A Retrospective Study

Introduction: Cesarean section (CS) was introduced in clinical practice as a life-saving procedure for both the mother and baby. The World Health Organization (WHO) has set a 15 percent minimum threshold for cesarean delivery to save the life of the mother and fetus. The rates of cesarean delivery have been increasing worldwide, leading to emerging public health issues affecting both developed and developing countries. This study examined the maternal and fetal outcomes of cesarean section at a tertiary-level hospital. Methods: This study was based on secondary data retrieved from the record information of the registry of Maternity, Gynecological, Operation Theater, and Neonatal Intensive Care Unit (NICU) ward of the regional hospital in western Nepal. A total of 5802 women delivered by cesarean section, those record had complete information of year 2013 to 2016 were analyzed. Data were collected through review guidelines developed by the researcher. Frequency and percentage were used to analyze the socio-demographic and obstetric information, indication of cesarean section, maternal and neonatal outcomes, and the obtained results presented in tables, graphs, and narratives. The Chi-square test was used to find out the association of cesarean section and its outcomes with demographic and obstetrics variables. Results: The mean age of mothers was 25.25 ± 4.7 years,with the minimum and maximum age being 14 and 48 years respectively. Of the 5802 mothers, 17.1 percent of mothers had poor outcomes having some maternal complications. Regarding neonatal outcomes of 5872 neonates, 11.8 percent of new born had poor outcomes having some complications like low birth weight, asphyxia, etc. There was statistically significant association of age, ethnicity, and type of cesarean section with maternal outcomes. Similarly, weeks of gestation and mode of cesarean section were significantly associated with neonatal outcomes. Conclusion: A large number of cesarean sections were emergency. Of the mothers who delivered by cesarean section majority of them and newborns had good outcomes. Mothers and neonates actual needs, contributory factors and outcomes following cesarean section need to be extensive evaluation before performing it.

Predictors of Oral Anticoagulants Utilization in Patients with Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance, increasing in prevalence with age. It is often associated with structural heart disease, although a substantial proportion of patients with AF have no detectable heart disease. Hemodynamic impairment and thromboembolic events related to AF result in significant morbidity, mortality, and cost. Several factors are associated with the prescription of oral anticoagulants. This review predicts the overall factors that are associated with oral anticoagulant utilization in patients with AF. Methods: Literatures that analyze the predictors of oral anticoagulant utilization in atrial fibrillation were searched using PubMed and Google Scholar published in journals from 2003 to 2019. Eligibility, data extraction and quality assessment were followed by a narrative synthesis of data. An extensive search of recent literature was performed. Results: Older age, comorbidities like hypertension, diabetes, heart failure, coronary artery disease, peripheral artery disease, moderate to severe kidney disease, polypharmacy, higher stroke and bleeding risk, history of smoking and alcohol or substance abuse, and lower cost are predictors of warfarin utilization. Similarly, younger age, better kidney function with creatinine clearance at least 30 mL/min, no or lower risk of stroke and hemorrhage, no polypharmacy, less comorbidities, prescriptions by neurologists and cardiologist, people residing in countries with lower poverty rates, and high cost are potential predictors of non-vitamin K antagonist oral anticoagulants utilization. Conclusion: Our study suggests that knowing the predictors for anticoagulation utilization can improve medication appropriateness in arterial fibrillation patients.

Distribution Pattern of Serum Uric Acid Level Before and After National Festival Dashain among Patients Visiting Tertiary Hospital, Kathmandu, Nepal

Introduction: Dashain, one of the national festivals in Nepal, celebrated with excessive consumption of high purine content foods, alcoholic and soft beverages. These foods have been associated with higher Serum Uric Acid (SUA) levels leading to hyperuricemia. This study was intended to evaluate the distribution pattern of SUA level a month before and after this festival for two consecutive years. Methods and Materials: The data of 5818 patients visiting Clinical Biochemistry Laboratory, Tribhuvan University Teaching Hospital for SUA test (a month before and after Dashain festival for two consecutive years; 2017 - 2018 A.D.) were collected and analyzed. The statistical analysis was done using SPSS version 21. Continuous variables were expressed as mean ± SD taking 95% confidence interval and p values of <0.05 was considered to be statistically significant. Mann-Whitney U test was used to compare the variables. Results: The mean SUA levels before and after Dashain in two consecutive years were 333.5 ± 112.1 μmol/L and 334.2±114.7 μmol/L in 2017 A.D. and 322.6 ± 103.9μmol/L and 343.2± 111.4 μmol/L in 2018 A.D. There was a significantly elevated level of the mean SUA level after Dashain festival in 2018 among both sexes (p-value <0.05). The age-wise distribution of mean SUA after the Dashain festival was consistent with increasing age among the study population. Conclusion: The study concluded that the Dashain festival has an impact on increasing the SUA level.