Kumud Kafle | Tribhuvan University (original) (raw)

Papers by Kumud Kafle

The Lancet, 1995

prediction of disabling and non-disabling cerebral palsy at age two in a low birthweight populati... more prediction of disabling and non-disabling cerebral palsy at age two in a low birthweight population. Pediatrics 1995; 95: 249-54. 27 The Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia

The Lancet, 1993

32 McGuire WL, Clark GM. Prognostic factors and treatment decisions in axillary node-negative bre... more 32 McGuire WL, Clark GM. Prognostic factors and treatment decisions in axillary node-negative breast cancer patients. N Engl J Med 1992; 326: 1756-61. 33 Valagussa P, Bondonna F, Veronesi U. Patterns of relapse and survival following radical mastectomy. Analysis of 716 consecutive patients.

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2005

SETTING A western hill district in Nepal, where tuberculosis (TB) treatment under DOTS was offere... more SETTING A western hill district in Nepal, where tuberculosis (TB) treatment under DOTS was offered by the regional tuberculosis centre, two primary health centres, eight health posts, three sub-health posts and one ward of sub-metropolitan Pokhara. OBJECTIVE To analyse the contribution of socioeconomic status to non-adherence to DOTS. DESIGN Case-control study. Data were collected by questionnaire-based face-to-face interviews. The study sample consisted of 50 cases and 100 controls. The participation rate was 80% for cases (non-adherents) and 95% for controls. RESULTS Logistic regression analysis showed that the risk of non-adherence to TB treatment was significantly associated with unemployment (odds ratio [OR] 9.2), low status occupation (OR 4.4), low annual income (OR 5.4), and cost of travel to the TB treatment facility (OR 3.0). Factors significant in the bivariate analyses--living conditions, literacy and difficulty in financing treatment--were not found to be significantly a...

Journal of Nepal Medical Association

Pralidoxime are enzyme reactivator that are known to reactivate the phosphorylated acetylcholines... more Pralidoxime are enzyme reactivator that are known to reactivate the phosphorylated acetylcholinesterase by binding to the organophosphorus molecule. The use of oximes in acute organophosphorus poisoning has been a controversial subjects for over two decades. This study was conducted with the objective to find out the estimation of serum cholinesterase and use of pralidoxime in organophosphorus poisoning. A prospective analysis of all organophosphorus poisoning cases presented at the Emergency Department, Tribhuvan University Teaching Hospital for seven months was done. Out of 26 cases about 60% of poisoning cases were monitored for pseudocholinesterase level. About 50% of them had pseudocholinesterase level within normal limit and 20% had less than 10% of normal value. Only 33% cases with pseudocholinesterase level less than 10% were treated with pralidoxime. The initial dose of Pralidoxime used was 1 gm followed by maintenance dose of 500mg 6 hourly, the doses prescribed were less ...

Journal of Nepal Health Research Council, 2013

BACKGROUND In most Asian countries, 50 - 90% of pharmaceutical sales are made in private drug out... more BACKGROUND In most Asian countries, 50 - 90% of pharmaceutical sales are made in private drug outlets, by personnel with some training in drugs but not for the treatment of common health problems. The objective of the study was to determine effects of focused training for private drug sellers to improve practices in treating acute respiratory infections and diarrhoea in children, and anaemia in pregnancy in Nepal. METHODS Randomized controlled, four way nested design study incorporating four interventions for drug retailers in both hill and terai districts. One group received mailed printed educational materials followed by mailed feedback; a second received small group training followed by feedback; a third received small group training only; and a fourth, the control group, received no intervention. Surrogate customer method was used to assess practices. Outcomes were measured using multivariate linear regression. RESULTS A significant increase in the asking of key history questio...

Infectious diseases are major health problems in Nepal. Antimicrobial resistance (AMR) amongst va... more Infectious diseases are major health problems in Nepal. Antimicrobial resistance (AMR) amongst various pathogens have made it difficult to cure these diseases using economical and safe antimicrobial agents. AMR has been seen at various levels of health care delivery in Nepal. This paper briefly articulates the observations made by Alliance for Prudent Use of Antibiotics (APUA) Nepal.

Journal of Nepal Medical Association, 1989

Journal of Nepal Health Research Council, 2014

BACKGROUND Monitoring/supervision is an essential component for improving the quality of health s... more BACKGROUND Monitoring/supervision is an essential component for improving the quality of health services including rational use of medicines. A new bottom-up approach of monitoring/supervision consisting of self-assessment/ peer-group discussion was found to be effective in improving prescribing practices. The new strategy significantly improved the prescribing practices based on standard treatment guidelines. The government has implemented it as a Program in primary health care services of Nepal. This article aims to share the implementation status of the self-assessment/peer-group discussion Program for improving the prescribing practices of common health problems and availability of drugs in the district health system. METHODS Concurrent mixed research design was applied for data collection. The data were collected at different levels of health care system using in-depth interviews, participatory observations and documentary analysis. RESULTS The Management Division, Department o...

INTRODUCTION Promoting appropriate use of drugs is an essential element in achieving quality of h... more INTRODUCTION Promoting appropriate use of drugs is an essential element in achieving quality of health and medical cares for patients and the community, and also to minimize financial burden. OBJECTIVE The objective of this paper is to assess the successful intervention for sustainability and effects in post research phase. To address these problems, a variety of educational, managerial and regulatory strategies to improve prescribing have been tried in Nepal. When training is combined with a managerial intervention i.e. peer-group discussion, it results into improved changes in prescribing practices of paramedics in several practices. METHODOLOGY A prospective, three-way design study consisting of small group training, small group training followed by peer-group discussion and control was conducted in three regions of Nepal including one hill and two terai (plains) districts from each region. The study included all health post from the sampled districts, making 80 health posts the ...

Bulletin on narcotics, 1996

A rapid assessment of drug abuse in Nepal was conducted at different sites, including eight munic... more A rapid assessment of drug abuse in Nepal was conducted at different sites, including eight municipalities in the five development regions of the country. To interview various groups of key informants, such methods as semi-structured interviews, in-depth interviews and focus group discussions were used. A snowball sampling strategy for respondents who were drug abusers and a judgemental sampling strategy for the non-drug-using key informants were applied. About one fifth of the sample was recruited from the treatment centres and the rest from the community. Drug abusers in prison were interviewed, and secondary data from treatment centres and prisons analysed. The study revealed that the sample of drug abusers had a mean age of 23.8 years and was overwhelmingly male. Most respondents lived with their families and were either unemployed or students. About 30 per cent of the sample was married. A large majority of the sample had a family member or a close relative outside the immediat...

To improve the quality of health care in Nepal, supervision/ monitoring involving periodic visits... more To improve the quality of health care in Nepal, supervision/ monitoring involving periodic visits by the district supervisor to health facilities (top-down approach) is in practice. It is not objectively implemented because of time and financial constraints and terrain of the country. To assess the effectiveness of a pre-tested strategy i.e. peer-group discussion with self-assessment piloted through the district health system in improving quality of care. A pre-post pilot study was conducted in 41 PHC facilities of Chitwan district of Central Nepal. The intervention included small-group training to prescribers followed by peer-group discussion with self-assessment data. It involved visit of in-charges from health facilities to district level regular meeting with self-assessment data on the treatment of four targeted health problems and also the availability of drugs of their health facilities as well as from health facilities which were under their supervision (bottom-up approach). ...

Kathmandu University medical journal (KUMJ)

Promoting appropriate use of drugs is an essential element in achieving quality of health and med... more Promoting appropriate use of drugs is an essential element in achieving quality of health and medical cares for patients and the community, and also to minimize financial burden. The objective of this paper is to assess the successful intervention for sustainability and effects in post research phase. To address these problems, a variety of educational, managerial and regulatory strategies to improve prescribing have been tried in Nepal. When training is combined with a managerial intervention i.e. peer-group discussion, it results into improved changes in prescribing practices of paramedics in several practices. A prospective, three-way design study consisting of small group training, small group training followed by peer-group discussion and control was conducted in three regions of Nepal including one hill and two terai (plains) districts from each region. The study included all health post from the sampled districts, making 80 health posts the study population. The study reveale...

Key words: Drug use, INRUD, Nepal, Intervention, Sustainability, Peer-group discussion, Self-asse... more Key words: Drug use, INRUD, Nepal, Intervention, Sustainability, Peer-group discussion, Self-assessment ... When training is combined with a managerial intervention ie peer-group discussion, it results into improved changes in prescribing practices of paramedics in ...

MJSBH Vol 20 Issue 1 Jan-Jun 2021 !41 Pattern of Medicine Prescribing in PHC Facilities before ... more MJSBH Vol 20 Issue 1 Jan-Jun 2021 !41 Pattern of Medicine Prescribing in PHC Facilities before and after earthquake in Nepal Gajendra Bahadur Bhuju1,2, Kumud Kumar Kafle1,3, Radha Raman Prasad1,4, Vabha Rajbhandari1,5, Gorkha Bahadur DC1,6, Shiba Bahadur Karkee1,2, Bimal Man Shrestha1,7 and Praful Pradhananga1,8 1Pharmaceutical Horizon of Nepal 2Centre Institute of Science and Technology, New Baneshwor, Kathmandu, Nepal 3College of Medicine, Nepalese Army Institute of Health Sciences, Syanobharyang,Kathmandu, Nepal 4Association of Pharmaceutical Producers of Nepal, Nepal 5Sun Pharmaceuticals Limited 6Nepal Ausadhi Limited, Babarmahal, Kathmandu, Nepal 7Canadian Diabetes Association 8Agrata Health Education and Development (AHEAD)-Nepal, Kathmandu, Nepal