Saval Khanal

Oncology pharmacy practice in a teaching hospital in Nepal.

Objective. To highlight the patient care activities performed by pharmacists during their ward rounds in medical oncology ward of a tertiary care hospital in western region of Nepal. Methods. The study was conducted for 3 months. Two pharmacists joined the clinicians and nurses in the ward rounds every morning as a member of healthcare team. The data used in this study was obtained from different documented files in hospital and were analyzed as per study objectives. Results. During 3 months (May 20, 2008 to August 20, 2008), pharmacists provided answers to eight queries asked by clinicians and nurses for the patient care purpose. During the same period pharmacists detected four cases of medication errors and provided suggestions on them. A total of 30 adverse drug reaction (ADR) reports were reported to the regional pharmacovigilance center during the study time. Altogether there were 84 types of adverse drug reaction seen on those patients. Most of them were related to hematological system. Conclusion. The study evaluated the drug information provided by pharmacists, spontaneous reporting of ADRs by the pharmacists, and their intervention on treatment plan of patients during ward round. This suggests pharmacists can play a significant role on patient care when he or she joins round with other healthcare personnel in the oncology ward. J Oncol Pharm Practice (2010) 16: 75—79.

Use of Healthcare Services by Patients with Non-Communicable Diseases in Nepal: A Qualitative Study with Healthcare Providers

INTRODUCTION The healthcare systems in many Low-and Middle-Income Countries (LMICs) like Nepal have long focused on preventing and treating infectious diseases. Little is known about their preparedness to address the increasing prevalence of Non-Communicable Diseases (NCDs). AIM This study aimed to investigate the use of healthcare services by patients with NCDs in Nepal. MATERIALS AND METHODS Nine healthcare providers (including health assistants, pharmacy assistants, nurse, specialised nurse, practicing pharmacists, chief hospital pharmacist, doctors and specialised doctor) from Pokhara, Nepal, were recruited using purposive sampling. In depth interviews about the magnitude of NCDs, first point of care, screening and diagnosis, prevention and management, follow-up, and healthcare system responses to NCD burden were conducted. Data were thematically analysed with a deductive approach. RESULTS Although the healthcare system in Nepal is still primarily focused on communicable infectious diseases, healthcare providers are aware of the increasing burden of NCDs and NCD risk factors. The first points of care for patients with NCDs are government primary healthcare facilities and private pharmacies. NCDs are often diagnosed late and opportunistically. NCD prevention and treatment is unaffordable for many people. There are no government sponsored NCD screening programs. CONCLUSION There are problems associated with screening, diagnosis, treatment and follow-up of patients with NCDs in Nepal. Healthcare providers believe that the current healthcare system in Nepal is inadequate to address the growing problem of NCDs. The health system of Nepal will face challenges to incorporate programs to prevent and treat NCDs in addition to the pre-existing communicable diseases.

Pharmacy workforce to prevent and manage non-communicable diseases in developing nations: The case of Nepal.

Non-communicable diseases (NCDs, e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) are the main causes of mortality and morbidity in developing countries, including Nepal. Nearly half of the deaths in Nepal are caused by NCDs. Nepal lacks adequate human resources to prevent and manage NCDs, but the skills and expertise of pharmacists in Nepal are underused. There is evidence from many countries that pharmacists can contribute substantially to the prevention and management NCD. We aim to describe the opportunities and challenges for pharmacists to prevent and manage NCDs in Nepal. Pharmacists can contribute by screening and monitoring NCDs; counseling on lifestyle; providing medication therapy management services; promoting public health; and providing other pharmaceutical services. Challenges to the implementation of some of these activities in the current context include inadequate training of pharmacists in NCD prevention and management, the cost of pharmaceutical services to patients and government, and the existing health care service delivery model. There is a need for health services research to determine how pharmacists can be best used to prevent and manage NCDs in Nepal.

Forecasting the quantity and cost of medicines to treat non-communicable diseases in low- and middle-income countries: Applying knowledge on medicine use from developed countries

Forecasting the quantity and cost of medicines to treat non-communicable diseases in lowand middle-income countries: Applying knowledge on medicine use from developed countries Saval Khanal, B.Pharm., M.Sc.(S.A.P.), Lennert Veerman, Ph.D., Lisa Nissen, Ph.D., Samantha Hollingworth, Ph.D. School of Pharmacy, Pharmacy Australia Centre for Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD 4102, Australia School of Public Health, The University of Queensland, Australia School of Clinical Sciences, Queensland University of Technology, Australia School of Pharmacy, The University of Queensland, Australia

Shift in disease burden from communicable to non-communicable diseases: Aiming to achieve Universal Health Coverage in Nepal

A major barrier to accessing healthcare services is spending, and the extended time that non-communicable diseases require treatment for means that many people around the world do not have proper access to care. Saval Khanal from Sankalpa Foundation, Nepal, Lennert Veerman and Samantha Hollingworth from the University of Queensland and Lisa Nissen from Queensland University of Technology lay out the results of their study and establish a method to forecast medicine use in Nepal.

Female community health volunteers to reduce blood pressure: feasible and sustainable?

Dinesh Neupane and colleagues (January, 2018) 1 report the effectiveness of a lifestyle intervention to reduce blood pressure led by Nepalese female community health volunteers (FCHVs). Although we agree with the authors that the FCHV-led lifestyle intervention, alongside blood pressure monitoring, can be a good initiative for blood pressure reduction, we have concerns about its feasibility and sustainability.

Academic Detailing in Low- and Middle-Income Countries: Principles, Use, Impact, and Lessons Learned

Abstract Academic detailing is a structured educational outreach program in which a trained health professional visits healthcare professionals in their practice settings to deliver tailored evidence-based information. Principally, it is very similar to pharmaceutical detailing, which is provided by pharmaceutical representatives. It has been mostly used for providing information to healthcare professionals, improving their knowledge attitude and practice, influencing prescribing, and promoting evidence-based practice. It was first practiced in the early 1980s in the United States and has been gradually practiced in many high-income countries. Academic detailing in low- and middle-income countries (LMICs), mostly, is at pilot level or at the research level. Academic detailing, if implemented in LMICs, can equally be effective as high-income countries. Major challenges to implementing academic detailing in LMICs include funding, lack of human resources, lack of health information, and influence of pharmaceutical detailing. This chapter aims to provide information on basic concepts of academic detailing, its practice, current status, challenges, and some recommendations in LMICs.

Forecasting the amount and cost of medicine to treat type 2 diabetes mellitus in Nepal using knowledge on medicine usage from a developed country

This research was aimed to forecast the amount and cost of medicines required to treat people with type 2 diabetes mellitus (T2DM) in Nepal over 30 years.

‘MATRI-SUMAN’ a capacity building and text messaging intervention to enhance maternal and child health service utilization among pregnant women from rural Nepal: study protocol for a cluster randomised controlled trial

BackgroundCapacity development of health volunteers and text messaging to pregnant women through mobile phones have shown improved maternal and child health (MCH) outcomes and is associated with increased utilisation of MCH services. However, such interventions are uncommon in Nepal. We aim to carry out an intervention with the hypothesis that capacity building and text messaging intervention will increase the MCH service utilisation.Method/designMATRI-SUMAN is a 12-month cluster randomized controlled trial (RCT). The trial involves pregnant women from 52 clusters of six village development committees (VDCs) covering 66,000 populations of Dhanusha district of Nepal. In the intervention clusters, Female Community Health Volunteers (FCHVs) will receive capacity development skills through reinforcement training, supervision and monitoring skills for the promotion of health seeking behaviour among pregnant women and study participants will receive periodic promotional text messaging service about MCH components through mobile phones. A sample of 354with equal numbers in each study arm is estimated using power calculation formula. The primary outcomes of this study are the rate of utilization of skilled birth attendants and consumption of a specified diversified meal. The secondary outcomes are: four antenatal (ANC) visits, weight gain of women during pregnancy, delivery of a baby at the health facility, postnatal care (PNC) visits, positive changes in child feeding practices among mothers, performance of FCHVs in MCH service utilization.DiscussionThe intervention is designed to enhance the capacity of health volunteers for the promotion of health seeking behaviour among pregnant women and text messaging through a mobile phone to expecting mothers to increase MCH service utilization. The trial if proven effective will have policy implications in poor resource settings.Trial registrationISRCTN60684155, (https://doi.org/10.1186/ISRCTN60684155). The trial was registered retrospectively.

Possible Metformin-Induced Otorrhoea: A Rare Case

Ear problems attributed to metformin use are not documented in the literature.