Publications by authors named "D M Upadhyaya"

29 Publications

Patient satisfaction and its socio-demographic correlates in a tertiary public hospital in Nepal: a cross-sectional study.

BMC Health Serv Res 2021 Feb 12;21(1):135. Epub 2021 Feb 12.

Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

Background: Patient satisfaction is one proxy indicator of the health care quality; however, enhancing patient satisfaction in low-income settings is very challenging due to the inadequacy of resources as well as low health literacy among patients. In this study, we assess patient satisfaction and its correlates in a tertiary public hospital in Nepal.

Methods: We conducted a cross sectional study at outpatient department of Bhaktapur Hospital of Nepal. To recruit participants for the study, we applied a systematic random sampling method. Our study used a validated Patient Satisfaction Questionnaire III (PSQ-III) developed by RAND Corporation including various contextual socio-demographic characteristics. We calculated mean score and percentages of satisfaction across seven dimensions of patient satisfaction. To determine the association between various dimensions of patient satisfaction and socio-demographic characteristics of the patient, we used a multi-ordinal logistic regression.

Results: Among 204 patients, we observed a wide variation in patient satisfaction across seven dimensions. About 39% of patients were satisfied in the dimension of general satisfaction, 92% in interpersonal manner, and 45% in accessibility and convenience. Sociodemographic factors such as age (AOR: 6.42; CI: 1.30-35.05), gender (AOR: 2.81; CI: 1.41-5.74), and ethnicity (AOR: 0.26; CI: 0.08-0.77) were associated with general satisfaction of the patients. Other sociodemographic variables such as education, occupation, and religion were associated with a majority of the dimensions of patient satisfaction (p < 0.05). Age was found to be the strongest predictor of patient satisfaction in five out of seven dimensions.

Conclusions: We concluded that patient satisfaction varies across different dimensions. Therefore, targeted interventions that direct to improve the dimensions of patient satisfaction where the proportion of satisfaction is low are needed. Similar studies should be conducted regularly at different levels of health facilities across the country to capture a wider picture of patient satisfaction at various levels.
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http://dx.doi.org/10.1186/s12913-021-06155-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881603PMC
February 2021

Frontline Healthcare Workers' Knowledge and Perception of COVID-19, and Willingness to Work during the Pandemic in Nepal.

Healthcare (Basel) 2020 Dec 11;8(4). Epub 2020 Dec 11.

Ministry of Health and Population, Kathmandu 44600, Nepal.

This study investigated the contextual factors associated with the knowledge, perceptions, and the willingness of frontline healthcare workers (FHWs) to work during the COVID-19 pandemic in Nepal among a total of 1051 FHWs. Multivariable logistic regression analysis was applied to identify independent associations between predictors and outcome variables. Of the total study subjects, 17.2% reported inadequate knowledge on COVID-19, 63.6% reported that they perceived the government response as unsatisfactory, and 35.9% showed an unwillingness to work during the pandemic. Our analyses demonstrated that FHWs at local public health facilities, pharmacists, Ayurvedic health workers (HWs), and those with chronic diseases were less likely, and male FHWs were more likely, to have adequate knowledge of COVID-19. Likewise, nurses/midwives, public health workers, FHWs from Karnali and Far-West provinces, and those who had adequate knowledge of COVID-19 were more likely to have satisfactory perceptions towards the government response. Further, FHWs-paramedics, nurse/midwives, public health workers, laboratory workers-FHWs from Karnali Province and Far-West Province, and those with satisfactory perceptions of government responses to COVID-19 were predictors of willingness to work during the COVID-19 pandemic. These results suggest that prompt actions are required to improve FHWs' knowledge of COVID-19, address negative perceptions of government responses, and motivate them through specific measures to provide healthcare services during the pandemic.
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http://dx.doi.org/10.3390/healthcare8040554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764814PMC
December 2020

Socio-demographic and Healthcare-seeking Predictors of Undernutrition among Children Under-five Years of Age in a Western District of Nepal.

J Nepal Health Res Counc 2020 Nov 14;18(3):488-494. Epub 2020 Nov 14.

Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

Background: Undernutrition is highly prevalent in Nepal, which interferes with physical and mental development among children. It is one of the severe health problems contributing to the significant portion of the disease burden. This study aimed to explore socio-demographic and healthcare-seeking related predictors of undernutrition among children under five years old in Dang, Nepal.

Methods: This was a descriptive cross-sectional study. A sample of 426 children was participated through stratified proportionate random sampling to identify socio-demographics and healthcare-seeking predictors of undernutrition. Multivariable regression was applied to identify the independent predictors of undernutrition.

Results: This study found that children below 24 months of age were more likely to be undernourished than children aged 24-36 months. Female children (OR=2.32, 95% CI: 1.19-4.54), illiterate or non-formally educated women (OR=4.09, 95% CI: 1.84-9.08), mother's occupation other than a housewife (OR=13.05, 95% CI: 4.19-40.68), labor work of father (OR=2.40, 95% CI: 1.04-5.57) had increased risk of undernutrition among children. Similarly, food insufficiency from their land, antenatal care visit, postnatal care visit, and delivery place were significantly associated with childhood undernutrition among children.  Conclusions: The study showed that undernutrition among children is associated with age and gender of children, educational attainment of the mother, food sufficiency, health-seeking practices of the mother during pregnancy, delivery, and postnatal. Socio-demographics and health-seeking practices related predictors must be explicitly considered to address undernutrition among children under the age of five years.
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http://dx.doi.org/10.33314/jnhrc.v18i3.2875DOI Listing
November 2020

Genetic engineering of potato (Solanum tuberosum L.) for enhanced α-tocopherols and abiotic stress tolerance.

Physiol Plant 2020 Oct 24. Epub 2020 Oct 24.

Department of Biotechnology, Dr Harisingh Gour Central University, Sagar, Madhya Pradesh, India.

Vitamin E (α-tocopherol) is a lipid-soluble essential vitamin recognized for improvement in degenerative health conditions, abating cancer risk, and coronary heart diseases in humans. While in plants, it acts as a free radical scavenger that protects cells against oxidative and photooxidative damages. The daily consumption of potato makes it a key target for biofortification with vitamins for eliminating vitamin deficiency in large populations. Vitamin E biosynthetic pathway genes have been overexpressed in plants via genetic engineering to enhance the α-tocopherol content. Major genes involved in the vitamin E biosynthesis in plants viz. the homogentisate-phytyltransferase (At-HPT) and γ-tocopherol-methyltransferase (At-γ-TMT), isolated from Arabidopsis were constitutively overexpressed in potato (Solanum tuberosum L.). The molecular analyses of independent transgenic lines revealed a stable integration of both the genes in the plant genome. The transgenic potato exhibited significantly improved vitamin E contents up to 173-258% in comparison to the untransformed control plants. Transgenic tissues also exhibited increased cellular antioxidant enzymes, proline, osmolyte, and glutathione content that are directly correlated with the ability of the plant to withstand abiotic stresses imposed by salt (NaCl) and heavy metal (CdCl ). Therefore, the current strategy of increasing the vitamin E content in potato with enhanced tolerance to abiotic stresses might greatly aid efforts to engineer crops for human health benefits and greater yield under adverse environmental conditions.
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http://dx.doi.org/10.1111/ppl.13252DOI Listing
October 2020

Sociodemographic correlates of antenatal care visits in Nepal: results from Nepal Demographic and Health Survey 2016.

BMC Pregnancy Childbirth 2020 Sep 5;20(1):513. Epub 2020 Sep 5.

Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

Background: Good quality antenatal care visits are crucial to reduce maternal mortality and improve overall maternal and neonatal health outcomes. A previous study on antenatal care visits analyzed the nationally representative data of 2011; however, no studies have been conducted recently in Nepal. Therefore, we analyzed the sociodemographic correlates of the frequency and quality of antenatal care among Nepalese women from the nationally representative data of 2016.

Methods: We analyzed data obtained from the Nepal Demography Health Survey (2016) on antenatal care for 2761 women who had one or more births in the past three years. Our study defined 'good quality antenatal care' as at least a 75% score on a composite metric which was obtained by adding the weighted scores assigned to the twelve recommended components of antenatal care. We analyzed the factors associated with the frequency and quality of antenatal care by using multiple Poisson regression and multiple logistic regression.

Results: While 70% of the Nepalese women surveyed had at least four antenatal care visits, only 21% of these women received good-quality antenatal care. We found that the educated women (APR: 1.12; CI: 1.05-1.19) and the women of rich wealth index (APR: 1.27; CI: 1.18-1.37) were more likely to receive a higher number of antenatal visits. In contrast, women living in rural areas (APR: 0.92; CI: 0.87-0.98), and those who had more than two children (APR: 0.88; CI: 0.83-0.93) were less likely to receive a higher number of antenatal visits. Regarding the quality of antenatal care, educated women (AOR: 1.51; CI: 1.09-2.08), women who had educated husbands (AOR: 2.11; CI: 1.38-3.22), women of rich wealth index (AOR: 1.58; CI: 1.13-2.20) and women who had intended pregnancy (APR: 1.69; CI: 1.23-2.34), were more likely to receive good-quality antenatal care.

Conclusions: Observing a wide variation in the coverage of different components of antenatal care, concerned stakeholders could tailor the interventions by focusing on components with lower use. Because we found an association of myriad sociodemographic factors with the frequency and quality of antenatal care, targeted interventions are necessary.
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http://dx.doi.org/10.1186/s12884-020-03218-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487925PMC
September 2020