Disease In Nepal Research Articles

Engaging Community Members to Pinpoint Priorities around Zoonotic Disease in Nepal

Engaging Community Members to Pinpoint Priorities around Zoonotic Disease in Nepal

P213 UNDERSTANDING THE INFLUENCE OF SOCIAL SUPPORT ON ANTIHYPERTENSIVE MEDICATION ADHERENCE IN URBAN NEPAL: A QUALITATIVE STUDY

Background and objective: Hypertension is a critical public health challenge in Nepal, particularly in urban settings, contributing to the high morbidity and mortality from cardiovascular diseases. Despite the presence of effective treatment options, adherence to antihypertensive medication remains suboptimal. Emerging evidence suggests that social support plays a crucial role in improving medication adherence. This study aims to explore the influence of social support on antihypertensive medication adherence among hypertensive patients in urban Nepalese communities, specifically within the Community-based management of non-communicable disease in Nepal (COBIN cohort) located in the eastern part of Pokhara Metropolitan City, Nepal. Methods: A qualitative study was conducted involving in-depth interviews with 19 hypertensive patients. An individual was eligible if 318 years old, taking antihypertensive medications for 3 two months and living in Lekhnath area of Pokhara. Interviews were conducted by an English-speaking researcher, with support from translator speaking both English and Nepali, using the interview guide. The study utilized a thematic analysis to explore patients’ perceptions and experience related to social support while taking antihypertensive medicines regularly. Results: The findings revealed a complex interplay of positive and negative influences of social support on antihypertensive medication adherence. Positive influence, being reminders from family members and healthcare providers, appeared to improve participants’ self-esteem and self-efficacy on adhering to medications. In contrast, social interactions including suggestions of taking traditional remedies and misinformation about prescribed antihypertensive medications appeared to diminish medication adherence. The role of Female Community Health Volunteers (FCHVs) was overall positive, bridging the gap between healthcare services and community needs, however its sustainability needs to be addressed. Conclusion: Social support is perceived to be pivotal in enhancing medication adherence among hypertensive patients in urban Nepal. Strengthening such support through community-based interventions and enhancing the role of FCHVs could significantly improve health outcomes. This study underscored the need for comprehensive strategies that integrate social support into hypertension management programs in low-resource settings.

Prevalence of Fasciolosis in Commercial Cattle of Tulsipur Sub-Metropolitan, Dang, Nepal

Fasciolosis is a frequently occurring and economically significant parasitic disease of ruminants that is widely distributed. A cross-sectional study was conducted to find out the prevalence of fasciolosis in commercial cattle farms during the period from April 2023 to June 2023 in Tulsipur sub-metropolitan, Dang, Nepal. A total of 202 fresh fecal samples were collected purposively from the study area from cattle of different ages, breeds, sexes, and stages and examined using the direct method and the sedimentation method. The obtained data were coded and analyzed using the SPSS version 23 software. The overall prevalence of fasciolosis was 32.20%. Age-wise prevalence was found to be 52.83%, 23.46%, and 27.45% in groups less than two years, two to five years, and above five years, respectively. The prevalence of Fasciola was found to be 34.62% in cross-breed cattle and 10% in indigenous cattle, and 31.11% in females and 40.90% in male cattle. The stage-wise prevalence of Fasciola in calves, heifers and productive cattle were 50%, 39.21% and 22.52% respectively. Breed, age and stage-wise prevalence were found to be statistically significant (p<0.05) while sex-wise prevalence was found insignificant (p>0.05). Since fasciolosis is significantly prevalent among cattle in the Tulsipur sub-metropolitan area, periodic deworming is required to prevent the infections and maximize cattle production. Further study is required for the identification of the epidemiological risk factors and the preventive measures of the disease in Nepal.

Knowledge, attitude, and practice regarding dengue among non-health undergraduate students of Nepal.

Dengue poses a significant public health concern worldwide. It is identified as a recent emerging infectious disease in Nepal. Understanding the situation and dynamics between knowledge, attitudes, and practices (KAP) related to dengue among students is crucial for effective prevention and control strategies. This study aimed to assess the KAP and their associated factors of dengue among non-health undergraduate students of Nepal to identify gaps and suggest appropriate interventions. A web-based cross-sectional study was conducted among 429 non-health undergraduate students at eleven Nepalese Universities, with 80% of participants from the four most prominent ones in the country. Self-administered online forms were administered via Google Forms platform predominantly through social media for data collection. Data was cleaned and then exported to IBM SPSS Statistics 20.0 for analysis. Demographic characteristics of respondents were described using descriptive statistics. Multivariate logistic regression was conducted to determine the association between individual characteristics and KAP. Pearson's correlation coefficient was used to determine the association between knowledge-attitude, attitude-practice, and knowledge-practice. Statistical significance was determined at the p-value < 0.05. Around half of the participants were female (50.3%). The majority of participants were between 22 to 37 years, unmarried, and belonged to the Brahmin/Chhetri ethnic group. This study demonstrated a significant gap in KAP. Only 15.2% of participants had good knowledge while 25.9% and 68.3% of participants exhibited good attitudes and practices respectively. Marital status (AOR = 3.32, CI: 1.32-8.34), third-year educational level (AOR = 3.59, CI:1.34-9.57), and fourth-year educational level (AOR = 4.93, CI:1.88-12.94) were significantly associated with knowledge regarding dengue. Age (AOR = 1.73, CI: 1.10-3.01) was significantly associated with preventive practice regarding dengue. None of the demographic or socio-economic characteristics of respondents was associated with attitude on dengue. The knowledge-attitude (rka = 0.01), knowledge-practice (rkp = 0.22), and attitude-practice (rap = 0.01) were positively correlated in this study.

Awareness and Practice on Prevention and Control of Dengue among Community People of Lalitpur Metropolitan City

Background: Dengue is a mosquito-borne viral disease that has rapidly spread in many countries worldwide in recent years. Dengue is a major public health problem in many countries. Dengue is a rapidly emerging disease in Nepal that is endemic across most provinces. The incidence of dengue has increased in recent years due to the expansion of the Aedes aegypti vector. The increasing outbreak of dengue in Nepal is becoming a major concern for the public health. Objective: The objective of the study was to assess awareness level and practice on prevention and control of dengue among community people in Lalitpur metropolitan city. Method: A community-based cross-sectional study was conducted from January to June 2023 at ten different wards in Lalitpur metropolitan city. Sample populations of 368 residents of Lalitpur metropolitan city above the age of 18 years were selected for the study. Simple random probability sampling technique used for the sample selection. Statistical Package for the Social Sciences (SPSS) 16 version used to analyze the data. Result: Majority (98.1%) of respondents knew about dengue fever. Most of the respondents (47.1%) answered that dengue is caused by aedes mosquito. Majority (71.4%) of respondents stated that dirty water was breeding sites of dengue mosquito. Primary preventive measures used were cleanliness 34.1 percent followed by use of mosquito net/coil 31.4 percent. The community people had good awareness (79.3%) of dengue, but poor practice (56.79%) in prevention and control of dengue. According to this study, socio-demographic factors such as age, sex, and education level were significantly linked to the knowledge level of the participants. Conclusion: According to this study, the community people had a good awareness level of dengue (79.3%). However, their practice of prevention and control of dengue was found to be poor (56.79%).

Abnormal High Body Mass Index among Adolescents of Secondary Schools.

The rapid increase in the cases of childhood obesity and overweight and its potential to pose other non-communicable diseases has made it a global public health issue. Urbanisation and changing lifestyles also pose a threat to disease in Nepal, but the prevalence of such diseases in Nepal is still not known according to the method recommended by World Health Organization for children's obesity and overweight. This study aimed to find out the prevalence of abnormal high body mass index among adolescents of secondary schools. A descriptive cross-sectional study was conducted among children aged 5-19 years at two secondary schools from 7 June to 14 June 2023 after getting ethical approval from the Institutional Review Committee. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Out of 157 children, 29 (18.47%) (12.40-24.54, 95% Confidence Interval) had abnormal high body mass index. Out of 29 children, 19 (65.51%) were male. The prevalence of abnormal high body mass index among adolescents was found to be higher than other studies done in similar settings. children; obesity; overweight; prevalence; schools.

Epidemiological profile of Kala-azar in a tertiary care center of Mid Western Nepal

BACKGROUND Kala-azar has been endemic in the central and eastern Terai region of Nepal neighbouring North Bihar, India. Data of Kala-azar in Mid and Far Western Nepal is scarce. We conducted this study to highlight the burden of Kala-azar in this region.&#x0D; METHODS This study was a cross sectional study conducted from July 2019 to May 2023 in the Department of Internal Medicine of Bheri Hospital. A total of 112 patients diagnosed with Kala-azar were enrolled in study. Data about socio-demographic profile and outcome were entered in MS EXCEL and analyzed by SPSS 20.&#x0D; RESULTS A total of 112 patients were enrolled in study with female predominance 86 (76.79%). Majority of the patients 37(33.03%) were of less than 15 years of age. Kala-azar cases were distributed not only to Terai districts but also in hilly and mountainous districts of Karnali and Sudur paschim provinces. 95(84.82%) cases were new and 17 cases were relapsed cases. 98(87.50%) cases improved with treatment, 5(4.46%) cases expired while one case was referred.&#x0D; CONCLUSIONS Kala-azar is a neglected tropical disease in Nepal. Once confined to the tropical Terai region, it has now been moving towards hills and mountains of Mid and Far Western Nepal. Public awareness campaign and strengthening the Kala-azar treatment centers would help to attain the goal of Kala-azar elimination program of Nepal.

Experience of clinicians with dual bronchodilator therapy in COPD (EXPAND) in Nepal

Introduction: Combination of bronchodilators, particularly long-acting muscarinic antagonists (LAMAs) and long-acting β2 agonists (LABAs) have become the mainstay of pharmacological therapy for COPD. COPD is now a common non communicable disease in Nepal. Objective: The study evaluated the current perception and experience of the clinicians in Nepal on diagnosis and management of COPD with focus on use of dual bronchodilator therapy. Method: This cross-sectional, observational survey evaluated experiences of clinicians (n=96; pulmonologist-13, physician-57, general practitioner-26) in Nepal on diagnosis, management trends, and current perceptions on the use of dual bronchodilator therapy in COPD management. Result: 93% of clinicians were practising in an urban setting for an average of 10 years and an average of 35% of their patients are of COPD. 61% of clinicians use mMRC with (34%) or without (27%) CAT score. 92% of clinicians perceived that most of their patients had 1 (32%) or &gt;1 (59%) exacerbation/year. 54% of clinicians performed spirometry on all their patients with suspected COPD. 49% of clinicians measured blood EOS in their patients with severe COPD before adding ICS. 93% of clinicians preferred dual therapy (separate inhalers or a combination) for their COPD patients, but 83% of clinicians preferred LABA + LAMA in a single inhaler over inhalers given separately. 57% of clinicians preferred LABA + LAMA and 82% preferred the Tiotropium + Formoterol combination. 81% of clinicians stepped up or stepped down their treatment. 56% of patients were taking LABA + LAMA + ICS and 55% of clinicians co-prescribed ICS + LABA with LABA + LAMA. 80% of clinicians checked the inhalation technique at every visit and an average of 54% of their COPD patients were adherent (&gt;80%) to the prescribed inhalation therapy. 78% of clinicians felt that dryness of mouth was the most common side effect of LABA + LAMA. 94% of clinicians believed that managing COPD better could improve cardiovascular outcomes in their patients with coexistent COPD. Conclusion: In the EXPAND survey, Formoterol + Tiotropium was preferred by most clinicians in Nepal amongst the LABA + LAMA combination. There is a good scope for improvement in the utilization of tools like spirometry, mMRC, CAT, and blood EOS in the daily practice of clinicians in Nepal.

Spatiotemporal distribution of foot-and-mouth disease in Nepal between 2019 and 2021

Foot-and-mouth disease (FMD) is a highly contagious viral disease affecting cloven-hoofed livestock. It is caused by the FMD virus (FMDV), which has seven distinct serotypes (O, A, C, SAT I, SAT II, SAT III, and Asia 1). In Nepal, FMD is a prevalent and economically important livestock disease, with hundreds of outbreaks yearly across different regions. However, there is limited understanding of the recent epidemiological trends of FMD in the past few years in Nepal. This study aims to analyze the spatial and temporal distribution of FMD in Nepal from 2019 to 2021. The FMD and TADs Investigation Laboratory, under the Government of Nepal, conducts annual risk-based surveillance of FMD in the country. The nonstructural protein (NSP) serosurveillance and serotyping (for outbreak confirmation) data from this laboratory were used for the study. The samples were collected either by the laboratory staff or were sent to the laboratory. Data analysis and mapping were performed using Epi info version 7.2.5.0 and QGIS version 3.22.5, respectively. Our findings revealed that 37.65% of samples (n = 417) tested positive for serotyping. The highest number of positive cases occurred in March–April, followed by December. Geographically, the Terai region had the most positive cases, followed by hills and mountains. The positivity rate for serotyping did not significantly vary by animal species (p > 0.05). Serotype O was the dominant serotype in all years, accounting for 98% of cases, while serotype A was found in only 2% of serotype-positive samples. In NSP serosurveillance, out of 3216 samples tested, 15.07% (474/3146; 95% CI, 13.86–16.36) tested positive. NSP seropositivity varied significantly by year (p < 0.001) but not by eco-zone (p > 0.05). In conclusion, FMD remains endemic in Nepal, with a consistent epidemiological pattern except that the Asia 1 serotype was not detected in the past years. We recommend expanding FMD surveillance activities to high-risk areas and collecting data on potential risk factors driving FMD infection in the country. This will enable the implementation of suitable control measures.

Climate change and infectious disease surveillance in Nepal: qualitative study exploring social, cultural, political and institutional factors influencing disease surveillance.

To explore the impacts of contextual issues encompassing social, cultural, political and institutional elements, on the operation of public health surveillance systems in Nepal concerning the monitoring of infectious diseases in the face of a changing climate. Semi-structured interviews (n=16) were conducted amongst key informants from the Department of Health Services, Health Information Management System, Department of Hydrology and Meteorology, World Health Organization, and experts working on infectious disease and climate change in Nepal, and data were analysed using thematic analysis technique. Analysis explicates how climate change is constructed as a contingent risk for infectious diseases transmission and public health systems, and treated less seriously than other 'salient' public health risks, having implications for how resources are allocated. Further, analysis suggests a weak alliance among different stakeholders, particularly policy makers and evidence generators, resulting in the continuation of traditional practices of infectious diseases surveillance without consideration of the impacts of climate change. We argue that along with strengthening systemic issues (epidemiological capacity, data quality and inter-sectoral collaboration), it is necessary to build a stronger political commitment to urgently address the influence of climate change as a present and exponential risk factor in the spread of infectious disease in Nepal.

Clinico-epidemiological profile of cerebrovascular accident in eastern Nepal: A descriptive cross-sectional study.

cerebrovascular accident (CVA) has contributed to a significant increase in the morbidity and mortality rates in lower middle-income counties like Nepal. Despite being a common noncommunicable disease in Nepal, little attention has been paid to it, in terms of formulating national health plans and policies by the concerned authorities. This was a descriptive cross-sectional study in patients diagnosed with cerebrovascular accidents at a tertiary care hospital in Eastern Nepal. We analyzed 128 diagnosed cases of cerebrovascular accidents from February 26, 2023 to June 26, 2023 after taking ethical clearance from the Institutional Review Committee (Reference no. IRC-PA-283/2078-79). Data were analyzed by Statistical Package for the Social Sciences version 23. The objective of this study was to explore the age and sex distribution of CVA, its association with medical co-morbidities, and known risk factors like Type-2-Diabetes Mellitus, hypertension, thyroid disorders, smoking and alcohol. Together with calculating the distribution of ischemic CVA and hemorrhagic CVA we had also staged the disease based on the National Institute of Health Stroke Scale.

Prescription audit and drug interactions of anti-diabetic drugs at Outpatient Department at a tertiary care teaching hospital in Eastern Nepal

Type 2 diabetes mellitus (T2DM) is the third major non-communicable disease in Nepal. Drug utilization studies help in reducing the patient’s expenditure, adverse drug reactions and drug-drug interactions. It would help in understanding of consumption of drugs including newer ones. Objective was to analyze the prescribing pattern and drug interactions of anti-diabetic drugs. A prospective cross-sectional study was conducted among patients having T2DM at Birat Medical College and Teaching Hospital (BMCTH), Biratnagar, Nepal from May 2019- August 2019. WHO core drug use indicators were used to analyze the obtained data. Descriptive statistics like mean, standard deviation, frequency and percentage were calculated using Microsoft Excel 2013. Out of 200 patients, 104 (52.0%) were females and 49.5% were from the age group of 41-60 years. Average number of drugs per patient was 5.74. Biguanides (40.7%) were the most common prescribed oral antidiabetic drugs followed by Sulfonylureas (23.3%). The percentage of drugs prescribed by generic name and from WHO essential drug list was 0.6% and 15.4% respectively. A total of 95 (47.5%) patients has potential drug-drug interaction (DDI) and it was most common in the age group of 41-60 years (43.2%). Among 95 DDI, Metformin+Amlodipine ranked in 1st position (16 encounters). Polypharmacy was prevalent in the present study. Metformin was the most commonly prescribed anti-diabetic drug. The percentage of drugs from the WHO essential medicine list and prescribed by generic names was low. Prevalence of potential DDI was high.

Epidemiology and Demographic Profile of Inflammatory Bowel Disease in Nepal

Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract. Once thought to be a disease of the developed nations, the burden of IBD has been rising in Asian countries. Inflammatory bowel disease leads to severe impairment in the quality of life of the patients. There have been numerous studies across the globe which have provided new insight into different aspects of this disease. Not only IBD is being diagnosed more but patients are also becoming more aware of this debilitating condition. It is encouraging to see a few studies from Nepal in the recent past. However, the epidemiological and demographic features of IBD remain largely unknown. Through this review, we aim to gain insight into the epidemiology and demographic features of patients with IBD in Nepal.

Prevalence of Diabetes and Diabetic Retinopathy in Far-western Province of Nepal.

Although diabetes is emerging as growing public health problem, there is limited population based data about the prevalence of the disease in Nepal. This cross-sectional population-based survey, conducted in the Far-western province of Nepal from April 2020 to April 2021, used standardized RAAB + DR methodology. Diabetes was diagnosed on the basis of treatment history and random blood sugar test results of greater than 200 mg/dl. Diabetic retinopathy screening was done by ophthalmologists. All relevant data were imported into the RAAB software package (RAAB V.6) for analysis. Among 4615 study population, 2.8 % (n=129) had diabetes, and 35.7% (n=46) of the diabetics were newly identified cases. Of the known diabetics, 61.4% (n=51) never had an eye examination, and only 27.7% (n=23) of cases had their eye checked for DR in the last year. Fundus examination showed 13.2 % (n=17) of the diabetic patients to have some form of diabetic retinopathy and 6.2% (n=8) had diabetic maculopathy. Only 0.8% (n=1) of the cases were categorized as sight-threatening DR but a greater number of diabetes patients had severe visual impairment or blindness (3.9%) as compared to non-diabetic patients (1.8%). Prevalence of diabetes and DR were relatively lower in Far-western Nepal. However poor coverage of screening examinations have left many of these cases undetected in the communities. Effective community-based diabetes and DR screening and referral programs can help to detect and treat diabetes and DR early on to prevent vision loss and other diabetic complications.

Visual outcome of standard treatment of sarcoid uveitis at a tertiary eye center in Nepal

Introduction: Sarcoidosis is a less-studied disease in Nepal, both as a systemic as well as ocular disease. We aimed to describe the visual outcome of standard therapy of sarcoid uveitis in Nepal. Methods: Observational study through Electronic Medical recording system of Tilganga Institute of Ophthalmology from December 2017 to March 2020. Patients diagnosed by IWOS criteria, treated with standard protocol and with minimum six-month follow up were included. The clinical parameters evaluated were type of uveitis, anatomical location and IWOS category. Treatment related factors evaluated were need for immunosuppressants, anti-glaucoma medication and cataract surgery. Visual outcome at six months was the major outcome evaluated, considering two lines of improvement or worsening as significant. Vision limiting complications assessed were cystoid macular edema, complicated cataract and secondary glaucoma. Visual outcome was stratified based on demography, anatomical involvement, uveitis subtype, IWOS category and need for immunomodulators. Results: Forty-six eyes of 25 patients were included. Based on IWOS criteria, presumed ocular sarcoidosis had best visual outcome with 93.33% improvement. Males had better post-treatment vision (90% vs.76.9%). 20-40 years age group had best improvement (96.5%) and anterior uveitis had best visual outcome (100%). A single immunomodulator could not be recommended based on this study. 18(39%) eyes had raised IOP, 4(8.6%) had secondary angle closure glaucoma, 4(8.6%) had hypotony, 1(2.1%) eye underwent cataract surgery and 1(2.1%) eye had cystoid macular edema. Conclusions: Sarcoid uveitis has good visual outcome. High degree of suspicion, early diagnosis and prompt treatment aids in diagnosis and limits vision-limiting complications.

Role of female community health volunteers in the prevention and early detection of chronic kidney disease in Nepal

Role of female community health volunteers in the prevention and early detection of chronic kidney disease in Nepal

Climate Change Impact on Floods and Water Borne Disease in Nepal

Introduction:Nepal’s reported risk to Climate Change adaptation reported by Notre Dame Global Adaptation Initiative Index (ND-GAIN Index) 2020 is 5.2 and ranked 71% high in country vulnerability, 126th of the total 180 countries. According to the report of the Ministry of Forest and Environment in 2018, flood is one of the principal climatic hazards in Nepal. According to the Department of Health Services Nepal, 3,500 children die each year due to water-borne diseases (WBD). The objective of this study is to analyze the climate change impact focusing on floods and WBD for the past two decades.Method:A secondary data analysis method was used to analyze the impact of floods and WBD attributed to climate change. Data was obtained from Nepal Risk Reduction Portal (http://drrportal.gov.np), Nepal Annual Health Reports (2000-2021), Nepal Government Vulnerability and Risk Assessment reports, and reputable journals.Results:Climate-related disasters have increased by six-fold in 2021, as compared to 2000 in Nepal. Among the people affected by disasters 71% of them are due to floods. Flood events during the last 21 years have a fluctuating trend with highest and lowest events observed in 2017(388) and 2015(15) respectively. Heavy and unusual rainfall patterns as a major indicator of climate change is likely to cause riverine floods and flash flooding by melting the glaciers. The incidence of diarrhea disease rose by 4.39% for 1°C increase in ambient temperature in data analysis collected on temperature and diarrhea from July 2002-June 2014.Conclusion:The findings suggested that increased temperatures in Nepal might have induced a change in flood events and the incidence of WBD (such as diarrhea), thus emphasizing the importance of climate change adaptation plans, flood risk management, and WBD surveillance to be prioritized and put in place to mitigate the effects of climate change.

Dengue serotype characterization during the 2022 dengue epidemic in Kathmandu, Nepal.

Nepal, particularly Kathmandu, witnessed a large outbreak of dengue in 2022. This study aimed to characterize the dengue serotypes prevailing in Kathmandu during this epidemic. Serotypes DEN-1, DEN-3, and DEN-2 were identified. The existence of multiple serotypes in a region portends the emergence of more severe dengue disease in Nepal.

Spectrum of congenital heart disease in Nepal from 2002-2022: A systematic review and meta-analysis.

Congenital heart diseases are recognized as public health concerns worldwide and Nepal is no exception. This study aims to study congenital heart disease in Nepal on grounds of burden, commonest type, common presentations, and associated noncardiac anomalies so that its spectrum can be known for prompt diagnosis and adoption of screening protocols. Relevant articles were searched in electronic databases using appropriate search terms and Boolean operators. Data were extracted in Excel and analyzed in Comprehensive Meta-Analysis Software. The proportion was used as an effect measure and a fixed or random-effect model was used as per the heterogeneity. Forest plots were used to give visual feedback. A total of nine studies were included in the qualitative and quantitative synthesis after a rigorous screening of imported studies. The prevalence of congenital heart disease was 0.7% (Proportion: 0.007; CI: 0.001-0.035; I2: 99.263%). The burden of atrial septal defect was 32.1%, ventricular septal defect was 31.1%, patent ductus arteriosus was 12.6% and Tetralogy of Fallot was 7.3%. The most common presentations were respiratory tract infection (54.7%), developmental delay (49.8%), difficulty in breathing (44.5%), failure to thrive (17.1%), and cyanosis (15.9%). The prevalence of congenital heart disease in Nepal was 0.7% and the frequency of male patients was higher. The atrial septal defect was the commonest on the whole, while, Tetralogy of Fallot was the commonest among cyanotic variety. Respiratory tract infection was frequently seen at presentation and the most commonly associated noncardiac anomaly was the cleft palate.

Consensus Statement of Cardiac Society of Nepal on Diagnosis, Management and Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Nepal

The prevalence of rheumatic heart disease is still significant in Nepal, especially in rural areas. It is an important preventable cause of morbidity and mortality in children and young adults. Diagnosis of rheumatic heart disease and acute rheumatic fever is based on clinical, laboratory, and echocardiographic criteria. Diagnosis and management criteria need to be locally relevant and practical to our context for implementation at the national level. The Cardiac Society of Nepal initiated the development of consensus document with aim of providing a reasonable and practical format of diagnostic and management. We hope this document will be helpful for physicians, pediatricians and cardiologists of the country to diagnose and treat acute rheumatic fever and RHD.