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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 616-619

Health problems and challenges for optimal health-care delivery in Humla District, Nepal


1 Department for Management of Science and Technology Development; Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
2 Department of General Medicine, District Hospital, Simikot, Humla, Karnali, Nepal
3 District Hospital Support Program, Nick Simons Institute, Sanepa, Lalitpur, Nepal
4 Department of General Medicine, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal
5 Department of Community Dentistry, Faculty of Dentistry, Western University, Pathum Thani, Thailand

Date of Submission12-Dec-2018
Date of Decision20-Jul-2021
Date of Acceptance19-Dec-2021
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. Dinesh Rokaya
Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City
Vietnam
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_85_18

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  Abstract 


Background: Humla is one of the remote districts located in the north-west of Nepal and located at an altitude between 1500 and 7300 meters. Poor health-care services, less health-care professional, seasonal outbreak of diseases, food deficit in winter, and traditional beliefs in the curative service have caused health-care problems, hindrance, and challenges in the proper health-care delivery in Humla. Objectives: This study aims to provide information on the health problems and describes the difficulties and challenges to the health-care system in Humla district. Materials and Methods: A retrospective cross-sectional survey was conducted at the District Hospital Humla regarding medical treatment and disease prevalent from June 2017 to April 2018. Microsoft and SPSS version 18 were used to analyze the data. Results: It showed that the majority of the patients visiting at hospital show gastritis (30%), followed by pelvic inflammatory disease (20%), chronic obstructive pulmonary disease (12%), trauma (from landslide injury and fall injury) (8%), and alcoholic liver disease (10%). In addition, 35% of Humli people follow the traditional belief of witch doctor, 15% do home remedy, and 50% of people go to see a medical doctor and do modern treatment. Conclusions: Humli people face several difficulties in the health care, such as less number of hospitals, less number of doctors and health-care personals, few specialists, and less medical equipment. Among medical problems, gastritis and pelvic inflammatory disease were the most common medical problems in Humla.

Keywords: Health, health care, Humla, Nepal, Simikot


How to cite this article:
Rokaya D, Rokaya N, Patel JN, Sah A, Yadav RK, Suttagul K. Health problems and challenges for optimal health-care delivery in Humla District, Nepal. J Datta Meghe Inst Med Sci Univ 2022;17:616-9

How to cite this URL:
Rokaya D, Rokaya N, Patel JN, Sah A, Yadav RK, Suttagul K. Health problems and challenges for optimal health-care delivery in Humla District, Nepal. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 1];17:616-9. Available from: http://www.journaldmims.com/text.asp?2022/17/3/616/360237




  Introduction Top


Humla, the second largest district, is one of the most remote districts located in the north-west corner of Mid-West Nepal and located at altitude between 1500 and 7300 meters.[1],[2] It is an isolated place in Karnali Zone and is connected to Nepalgunj and Surkhet by airways. The current population of Humla is about 50,000 and consists of two major ethnic groups, Hindu and Buddhist. The literacy rates are also among the lowest in the country. The overall literacy rate was found to be 47.6% (33% females and 62% males). Some pictures on Humla and Humli people are shown in [Figure 1].
Figure 1: Humli people

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Poor health-care services, less health-care professional, seasonal outbreak of diseases, food deficit in winter, and traditional beliefs in cure have caused health-care problems, hindrance, and challenges in the proper health-care delivery in Humla. In a developmental composite index, Humla district ranked the fourth from worst off. Indicators of development in health care are also very low, although the presence of only 1 hospital in Simikot and 26 health posts in some villages. The fact is that only one hospital serving as a referral center located in Simikot is under-equipped.[3] This study aims to provide information on the health problems and describes the difficulties and challenges to the health-care system in Humla district.


  Materials and Methods Top


A descriptive retrospective survey was conducted in District Hospital Humla regarding disease prevalence and treatment done by Humli people from June 2017 to April 2018. After obtaining approval from the district hospital and obtaining consent from each patient, they were interviewed visiting the hospital of the age of 20–80 years [Table 1]. A total number of 5500 patients were studied (male: 2090 and females: 3410). Diagnosis of the disease was made from the sound clinical examinations, X-ray reports, and/or laboratory investigations. The disease prevalence in Humla was studied from July 2017 to April 2018. The different methods of medical treatment utilized in Humla were also studied.
Table 1: Details of the participants

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Microsoft and SPSS version 18 (SPSS for Windows, NY, USA) were used to analyze the data. The level of significant difference was set at P = 0.05. Chi-square test was used to compare the number between males and females. One-way ANOVA was done to compare the different methods of medical treatments utilized in Humla.


  Results Top


The participants' detail, as shown in [Table 1], showed that there was a significant difference between number of males and females (P < 0.01). The results of the study conducted in District Hospital Humla are shown in [Figure 2] and [Figure 3]. [Figure 2] shows the prevalence of various diseases in Humla [Figure 3]. It showed that the majority of the people had gastritis (30%), followed by pelvic inflammatory disease (20%). Chronic obstructive pulmonary disease (COPD) presented a moderate amount (12%). Trauma cases (landslide injury and fall from height) were often encountered at health post. Alcoholic liver disease also presented in considerable number (8%–10%).
Figure 2: Diseases prevalent in Humla (June 2017–April 2018)

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Figure 3: Different methods of medical services utilized in Humla in 2017/2018. Significant difference at P < 0.05. *P < 0.001

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The results of different methods of medical services utilized in Humla from July 2017 to April 2018 are shown in [Figure 3]. Due to traditional beliefs, a high number of Humli people (35%) do treatments with witch doctors and 15% do home remedy. Half (50%) of the Humla people went to see a medical doctor and do modern treatment and receive modern treatment. There was a significant difference between three types of medical services (P < 0.001).


  Discussion Top


Humla is considered as one of the isolated places in Nepal in terms of the geographically, politically, and developmentally. It scores lowest in terms of women's empowerment.[4] At 240 per 100,000 live births, the infant mortality rate in Humla is triple that of the rest of Nepal.[5] Humla has low fertility rates. The average total fertility rate (total births per woman) for the district was estimated at 4.5 in both 1986 and 1991, while the rate for the rest of Nepal was 6 in 1985 and 5.6 in 1990.[6] Relatively low total fertility rate in northern Humla is as a result of polyandrous Lama (mongoloid) residents. Gender issues are a major concern in a ranking of the 75 districts of Nepal. Polyandry, a marriage system practiced by many ethnics of Lama in this area, allows a single woman to have multiple husbands (man and his brothers) simultaneously. Normally, unmarried women do not have children and are excluded from the pool of reproductive women. This practice lowers the fertility rate and population density relative to other areas of Nepal.[7]

In this study, gastritis (30%) may be due to the food habit such as intake of spicy food and long gap between meals due to workload, pelvic inflammatory disease (20%) may be due to poor hygiene and health education, and alcoholic liver disease (8%–10%) may be due to the traditional intake of beverages encountered. Most of the people in Humla cook food from smoke due to unavailability of electricity and cooking gas. The majority of the females also smoke tobacco. These are the leading causes of respiratory diseases such as COPD. In addition, there is a strong belief of this practice among local people and they visit the traditional doctors called witch doctors at the time of illness. When they are not cured, some people may go to do modern treatment, but in some cases, it might be late unfortunately leading to death.

This study also shows that numerous cases were referred to the higher centers (in cities) due to unavailability of the services and specialists. Various referral cases to higher centers were orthopedic cases, especially fractures, surgical cases (cholelithiasis, renal calculi, and appendicitis), alcoholic liver diseases, and complicated delivery. Serious cases were transferred to higher centers by the air ambulance which has been provided by the government at free of cost. Others have to go to referral centers at their own cost, and the poor people cannot afford this option.

In Humla, currently, a total of five nongovernment organizations, four community health units, and two Ayurveda medical centers have been actively working in the health sector.[5] Health-care improvement approaches in Humla are child health and immunization, nutrition, family health and planning, safe motherhood, female community health volunteers, primary health-care outreach clinics, Primary Health Care Revitalization Division, and health education and trainings [Figure 4]. The district immunization coverage of all antigens in the regular program has decreased in recent years. Community-based integrated management of newborn and childhood illness program has been implemented up to the community level, and it has shown positive results in the management of childhood illnesses.[5]
Figure 4: Health-care improvement approaches in Humla

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A study done by malnutrition continues to be one of the major causes of morbidity and mortality among under-five children in developing countries. Hence, socioeconomic development along with counseling on breastfeeding practices and nutrition education among the urban slum masses needs to be ensured, which is an important factor to combat malnutrition.[8] A woman should be given health education regarding nutrition, personal hygiene, sanitation, immunization, birth preparedness, complication readiness, and family planning at the local level through different programs.[9] In addition, nongovernment/international organizations should support health-care programs to improve the health-care delivery system since the government's sole contribution is not sufficient enough to lead the Humli people to better health-care service delivery. The district health office has been conducting basic, refresher training along with clinical, nonclinical, and other management training. It has achieved 100% result against given target.[5] The health education and communication units in the district health offices implement information, education, and communication activities utilizing various media and methods according to the needs of the local people in the district. Local media and languages are used in the district for dissemination of health messages. The main activities include health education programs in the schools and community; print material production and distribution; production and dissemination of regular, weekly and periodic from FM radio programs; and publication and dissemination of health messages through newspapers, social mobilization, advocacy, workshop/seminar, folk events, observation on special days, and exhibitions.

Although Humla and Humli people face many difficulties, many organizations (government, nongovernment, and international organizations) including district hospital have played a great role in the improvement of the health system in Humla. Further recommendations for optimal health care includes education on health education and hygiene care to Humli people, government health policies for improving health system in Humla, improving additional of hospital services (physiotherapy and dental), and increasing number of health posts and health-care personals.


  Conclusions Top


Poor health-care services, difficult geographical belt, less health-care professional, seasonal outbreak of diseases, occasional food deficit, and traditional beliefs in treatment have caused health-care problems, hindrance, and challenges in the proper health-care delivery in Humla. Humli people face several difficulties in the health care, such as less number hospitals, less number of doctors and health-care personals, few specialists, and less medical equipment. The government should plan and make policies for remote places, such as Humla to improve the health care of the people. Most of the people are illiterate, and the gender discrimination in villages has abandoned females from getting a better education.

Acknowledgment

We thank all the participants who participated in this study. We acknowledge Mr. Jaya Bahadur Rokaya and District Health Office, Simikot, Humla, for their support and contribution for this article. The authors are grateful to the District Hospital, Humla District, Simikot, Humla, Nepal, for the technical assistance in conducting this research.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This research is supported by the District Hospital, Humla District, Simikot, Humla, Nepal.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Topographic Survey Branch, Survey Department, HMG Nepal. Glaciers Cover Parts of the High Himalaya; 1987. Available from: https://catalogue.nla.gov.au/Record/6160184. [Last accessed on 2018 May 13].  Back to cited text no. 1
    
2.
McKay KH. Health needs in two ethnic communities of Himalaya district, Nepal 242. CNAS J 2002;29:241-73.  Back to cited text no. 2
    
3.
District Health Report, Government of Nepal. Department of Health Services, District Health Office, Himalaya; 2016-2017. Available from: https://dohs.gov.np/wp-content/uploads/2014/04/Annual_Report_2069_70.pdf. [Last accessed on 2018 May 13].  Back to cited text no. 3
    
4.
Unitarian Services Committee. Self-Help Initiative Promotion Program, The he and Bargaun Village Development Committees, Himalaya District. USCCN, Baluwatar, Kathmandu. Canada, Nepal: Unitarian Services Committee; 1991. Available from: https://www.adaragroup.org/wp-content/uploads/2012/11/Report-on-Baseline-Primary-Health-Survey-Humla-District-Nepal.-Haddix-McKay-K.-December-1999..pdf. [Last accessed on 2018 May 13].  Back to cited text no. 4
    
5.
Dixit K. Building a New Nepal. UNDP Approaches to Sustainability Series; 2001. p. 27-36.  Back to cited text no. 5
    
6.
His Majesty's Government, Nepal Population Report 2002. Ministry of Population and Environment, Nepal; 2002. Available from: http://www.mope.gov.np. [Last accessed on 2018 May 13].  Back to cited text no. 6
    
7.
Haddix KA. Leaving your wife and your brothers: When polyandrous marriages fall apart. Evol Hum Behav 2001;22:47-60.  Back to cited text no. 7
    
8.
Sahoo DP, Dehmubed A, Jajulwar MB. An epidemiological study of acute malnutrition in children of age 6 months to 5 years in an urban slum of Mumbai, Maharashtra. J Datta Meghe Inst Med Sci Univ 2017;12:181-6.  Back to cited text no. 8
  [Full text]  
9.
Gurung J, Chandrasekaran V, Phadnis S, Binu VS. Birth preparedness and complication readiness among rural pregnant women: A cross-sectional study in Udupi, Southern India. J Datta Meghe Inst Med Sci Univ 2017;12:70-4.  Back to cited text no. 9
  [Full text]  


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