and Bruce L. InnisTo determine hepatitis E virus (HEV) infection and disease rates in the Kathmandu Valley of Nepal, serum was collected from 757 healthy Nepalese (ages 12 -48 years) during March and September 1992 and September 1993. At each visit, reports of interval illness were obtained. Sera were examined for IgG to HEV, using a commercially available kit. Seroconversion was used as a marker for HEV infection, and an episode of hepatitis E was defined as a history of jaundice with seroconversion. Seroprevalence ranged from 16% to 31% and increased with age, whereas both infection and disease rates decreased with age. Infection and disease rates were as high as 99/1000 and 45/1000 person-years, respectively. These results highlight the importance of sporadic hepatitis E as a public health problem among adolescents and young adults in this region. Hepatitis E virus (HEV) is believed to be the primary agentStudies to characterize the prevalence of IgG to HEV began as a result of the recent development of serologic assays for responsible for enterically transmitted non-A, non-B hepatitis. The most commonly reported signs and symptoms of this dis-HEV. Generally, the prevalence of antibody against HEV is low (0% -3%) in areas where no outbreaks have been reported ease include malaise, jaundice, dark urine, nausea, abdominal pain, fever, hepatomegaly, and vomiting [1]. The mortality rate and sporadic cases are rare (e.g., in the United States, Europe, Australia, Japan, New Zealand, South Africa, and Thailand) for hepatitis E is higher than for hepatitis A and ranges from 1% -3% among men and nonpregnant women to 12% -42% [5 -8]. By contrast, the prevalence of antibody against HEV is higher (10% -40%) in regions where outbreaks have been among pregnant women [2]. High rates of perinatal death are also associated with this disease [3,4]. Hepatitis E is an imreported and sporadic transmission occurs regularly, such as India, Nepal, and Tajikistan [6,7,9, 10]. Age-specific antibody portant health concern in nearly all under-developed regions of the world. No vaccines for hepatitis E have been developed, prevalence has been examined in India and Nepal [9, 10]. In both studies, antibody prevalence was found to increase with and prophylaxis with immune serum globulin appears to have little or no protective effect [2]. age until about age 30 years. No increase in antibody prevalence was apparent after age 30. No sex-dependent differences in antibody prevalence were observed; on the other hand, in older age groups, the numbers of women were too small to NOTE. Serum and medical histories were collected from 757 persons during March and September 1992 and September 1993. Case of hepatitis E was defined as episode of jaundice (self-reported during interview) along with acquisition of IgG to HEV during period examined. Infection was based on acquisition of HEV antibody during period examined. IgG to HEV was detected using ELISA developed by Diagnostic Biotechnology (Singapore). All 3 serum specimens from each individual were ...

BackgroundDeath certificates (DC) are one of the most important medico-legal documents that physicians work through. DCs are extensively used in health statistics for epidemiological studies, and in health policy planning as a public health resource tool. Cause-of-death (COD) statement, which is vulnerable to various errors, is the vital part of a DC that has the potential to mislead the policy makers and statisticians. Hence, we evaluated and analyzed the errors prevalent in COD statement of DC.MethodsA retrospective observational study was conducted at medical Intensive Care Unit (ICU) of Blue Cross Hospital, Kathmandu, Nepal within two years of study period. A total of 204 medical records of the deceased patients were reviewed. Three sub-headings of COD statement of DC- Part I Immediate COD (ICOD), Part I Underlying COD (UCOD), and Part II Other significant conditions (OSC) were extensively evaluated for the major medical errors.ResultsThe study found errors in 78.4 % of DCs. The highest number of errors was in UCOD (83 %). Most common errors were “Mechanism of Death- terminal event” in ICOD, “More than one competing causes” in UCOD, and “OSC present but not listed” in OSC. The error in DC was found to be statistically significant with the severity of sepsis (p = 0.003), and presence of chronic organ failures (p = 0.034). Age, time of death, source of admission, and duration of ICU stay were not found to be statistically associated with the errors in DC.ConclusionPrevalence of errors in DC was quite high. Most errors were committed in underlying cause of death, which is the most important part of DC. Complexity of the cases was the key factor that increased the risks of committing errors. Specific education should supersede general educational interventions to minimize the errors considerably in writing DC in complex cases.

Hepatitis E Vaccine Trial in the Royal Nepal Army

Hepatitis E in the Royal Nepal Army and the Kathmandu Valley

Study on Health and Socioeconomic Status of Mothers and Children Living in Bijeswari Army Family Quarter