The reconstruction of a lost alveolar housing is important to achieve a harmonious balance between biology, function, and aesthetics for a prosthesis's successful outcome. Soft tissue ridge augmentation is a periodontal surgical procedure designed to correct mild to moderate horizontal alveolar ridge deformities alongside fixed partial prosthesis, mostly preferred for their aesthetic benefits and less invasive nature as compare to hard tissue augmentation. Moreover, the increase in keratinized tissue and the improved soft tissue profile reduces the risk of future complications and is essential for hygiene maintainance. The purpose of this case report was to present the successful periodontics-prosthodontics synergistic approach to treat a seibert class I moderate type ridge defect with additional vestibular depth and keratinized tissue insufficiency issues in an edentulous molar pontic site using a free gingival onlay graft.
Background Monitoring the antimicrobial use is one of the key strategies to address the growing global threat of antimicrobial resistance. Objective To find out antimicrobial usage at tertiary care hospital of Lalitpur, Nepal. Result An observational cross-sectional study was carried out at the Patan Academy of Health Sciences, Lalitpur, Nepal on September 25 and 26, 2023. World Health Organization point prevalence survey methodology was used with minor modification to meet hospital's context. The data on antimicrobial usage were collected from the medical records of patients admitted at or before 08:00 am on the day of the study in the acute care ward. Result The study involved 324 inpatients, with females comprising 176 (54.3%) and males 148(45.7%). The mean age was 37.89 years ± 24.87. Antibiotics usage was 78.1%. A total of 471 drug was prescribed of which 312 (66.2%) was used for therapeutic purpose and 159 (33.8%) for prophylaxis. Of 312 antibiotics, 283 (90.7%) were utilized empirically. Majority of prescribed medications belonged to watch group 16 (48.5%). Ceftriaxone was the most frequently prescribed antibiotic 142 (30.1%) and was the preferred choice for surgical prophylaxis 68 (94.4%). A total of 24 (72.7%) drugs were prescribed from the National List of Essential Medicines and 432 (91.7%) prescriptions were written using generic names. Conclusion The use of antibiotic was high, with good adherence to essential medicines and generic prescribing. Strengthening antimicrobial stewardship and evidence-based practices can further optimize prescribing, enhance patient safety and help combat antimicrobial resistance effectively.
Background Physical activity plays a crucial role in overall growth and development of adolescents. Physical inactivity (insufficient physical activity) has been identified as the fourth leading risk factor for global mortality (6% of death globally). Regular physical activity is recommended for the prevention of non-communicable disease and improvement of overall health. Worldwide, 81% of adolescents aged 11-17 years are physically inactive. Objective To assess physical activity and its association with selected variables among secondary level students of selected schools of Banepa municipality. Method A quantitative cross-sectional study was conducted using standard Global Physical Activity Questionnaire. Data were collected from 70 students using convenience sampling technique. Socio-demographic, environmental and lifestyle factor were also included in the questionnaire. Descriptive statistics (frequency, percentage, mean, median) and inferential statistics (Chi square test, Monte Carlo test) were applied using Statistical Package for Social Science Version 25 for data analysis. Result This study found that one sixth of the respondents reported low physical activity. Among males, the figure was 27.3% while in females it was 13.5%. Similarly, 72.7% of males met the World Health Organization recommendation for physical activity (≥ 600 Metabolic Equivalent for Task min/week) and 85.5% of females met the criteria. There was high contribution of recreational domain on physical activity. Conclusion This study concludes that most of the respondents had a high level of physical activity. Total physical activity score was largely contributed by recreational activity. This study did not find any association between levels of physical activity and selected socio-demographic, environmental and lifestyle related variables.
Background Diabetic retinopathy is one of the leading causes of blindness worldwide. The relationship between glucose level and development of diabetic retinopathy has always been an area of interest and constantly evolving. Objective To determine the association of glycosylated hemoglobin and plasma glucose levels with different grades of diabetic retinopathy. Method A hospital based cross sectional study was conducted among 504 patients with type II diabetes mellitus attending the Department of Ophthalmology in a University Hospital for one year duration. Relevant history regarding diabetes mellitus was recorded for all patients. The status of diabetic retinopathy in each patient was diagnosed by detailed ophthalmological examination and classified according to International Classification of Diabetic Retinopathy Scale. All the patients were evaluated for their glycosylated hemoglobin, fasting and post prandial blood glucose levels. Bivariate analysis using t-tests and chi-square tests was used to measure the strength of association between the different variables. An Analysis of Variance (ANOVA) test was used to evaluate the association between the means of different variables. Result Total 504 patients constituted of 254 males (50.39%) and 250 (49.60 %) females. Almost half of the study population had poor glycemic control and deranged fasting and post prandial blood sugar levels. Diabetic retinopathy was observed in 124 (24.60%) patients and diabetic macular edema was observed in 42 (8.33%) patients. Poor control of glycosylated hemoglobin (> 7.6) was seen in 88 (70.96%) cases of diabetic retinopathy and 34 (80.95%) cases of diabetic macular edema. Uncontrolled fasting and postprandial blood sugar levels were associated with a significant number of cases of diabetic retinopathy and of diabetic macular edema respectively. A statistically significant association was observed between increasing grades of diabetic retinopathy and higher glycosylated hemoglobin and plasma glucose levels. Conclusion Higher the level of glycosylated hemoglobin and plasma glucose levels, more severe is the grade of diabetic retinopathy.
Background Individuals affected by β-thalassemia experience complications such as hepatic hemosiderosis and fibrosis due to frequent blood transfusions, which can lead to iron overload. Multiple blood transfusion burdens in thalassemia, particularly in lowincome countries, impact health-related quality of life. Objective Liver function parameters and health-related quality of life were assessed using Nepali version 36 short-form survey instruments to reveal the vitality, physical, mental, emotional, pain, general health, and social functioning of β-thalassemia cases. Method In this cross-sectional study, forty β-thalassemia cases who had visited the Universal College of Medical Sciences tertiary care teaching hospital of Lumbini Province, Nepal were enrolled. The hemoglobin variant band percentage was estimated by D-10 BioRad high performance liquid chromatography (HPLC), Mentzer Index (Mean Cell Volume by Red Blood Cell count) by Beckman hematological analyzer, and serum liver parameters (Bilirubin, Total protein, Albumin, Alanine aminotransferase, Aspartate aminotransferase, Alkaline phosphatase) were estimated by using Diatron fully automated analyzer. The internal consistency of the Nepali version of 36 shortform survey instruments was checked by Cronbach`s alpha was found to be > 0.70 from the recoded value. Data are analyzed using the STATA/MP14, and ANOVA and t-test are applied to test the significance considering p-value < 0.05. Result The frequency of the β-thalassemia Trait (60%) was higher than β-thalassemia Major (30%) and 7.5% β-thalassemia Intermedia co-morbidities with Sickle cell (2.5%) and β/δ variants (2.5%). Higher frequency was found in ethnic groups Muslim (32.5%) followed by Terai indigenous-Tharu (30%) and Madheshi (27.5%). The transfusiondependent cases have significantly higher Total, Direct, Indirect Bilirubin, and Alkaline phosphatase levels than non-transfusion dependent cases (p < 0.001). The physical functioning, general health, emotional health, and vitality were significantly decreased in β-thalassemia Major as compared to β-thalassemia Trait (p < 0.001), and significantly correlated with Mentzer index and HPLC patterns (HBA2/HBF) (p < 0.05). Conclusion Transfusion dependent β-thalassemia Major and Intermedia had elevated Bilirubin and Alkaline phosphatase levels as compared to non-transfusion dependent β-thalassemia Trait, exacerbating health-related quality of life, emphasizing the preventable disparities for optimized transfusion protocols and psychosocial support.
Angiosarcoma is an uncommon malignant vascular tumor of endothelial origin and commonly described in soft tissue. Thyroid is an uncommon site for angiosarcoma and is a very aggressive tumor commonly occurring in elderly female, characterized by its prevalence in Alpine regions of central Europe. The main aim of this case report is to provide an insight on thyroid angiosarcoma (TAS) occurring in nonAlpine region, to know the major diagnostic features of thyroid angiosarcoma and distinguish it from anaplastic thyroid carcinoma with angiomatoid features. Due to its overlapping microscopic features diagnosis of primary thyroid angiosarcoma (TAS) was challenging. However, the combination of thorough microscopic findings and immunohistochemical studies (CD 31, Vimentin, Thyroglobulin and Thyroid Transcription Factor-1) are vitally important in differentiating these two tumors to achieve at a final diagnosis. This significantly helps to decide the best treatment option and predict the behaviour.
Adrenal gland tumors, including both benign and malignant forms, are increasingly detected due to advancements in imaging techniques. This prospective study, conducted at Nepal Mediciti Hospital evaluated thirteen patients diagnosed with adrenal masses, all confirmed benign via contrast-enhanced computed tomography. Functional assessment, preoperative endocrinological and anesthesiological evaluations and pharmacological preparations were conducted as needed. All patients underwent successful lateral transperitoneal laparoscopic adrenalectomy, performed by a single surgeon. The study population had a female predominance (9 females, 4 males), with tumor sizes ranging from 2 to 9 cm. No surgeries required conversion to open procedures, and postoperative outcomes were favorable, with no mortality or re-operations. Complications were minimal, including transient blood pressure elevation in one pheochromocytoma case and one postoperative chest infection. Histopathological findings included aldosterone-producing adenomas, cortisol-producing adenomas, and pheochromocytomas. The study supports the continued use of laparoscopic adrenalectomy as the preferred surgical method for adrenal tumors.
We report a rare case of posterior microphthalmos with prominent papillomacular folds, pseudo disc edema and high hyperopia in a 12 year old child with no systemic anomalies. The patient was diagnosed as high hyperopia two years ago but the posterior findings were missed. The anterior segment of the eye was normal on slit lamp examination but the appropriate diagnosis was missed. Hence detailed evaluation of every hyperopic child should be done for the timely management. This case report highlights the importance of detailed fundus and biometric evaluation to avoid missing the diagnosis of posterior microphthalmos in a high hyperopic child with no systemic anomalies.
Background Renal involvement is the most common form of systemic complication in neonates with perinatal asphyxia. Acute Kidney Injury (AKI) can be oliguric or non oliguric. There is no consensus on the definition of acute kidney injury in neonates, which makes early diagnosis and management difficult. Acute kidney injury leads to significant morbidity and mortality in neonates. Objective Current study aims to explore the prevalence of Acute Kidney Injury in Neonates with perinatal asphyxia and its relation to the severity of Hypoxic Ischemic Encephalopathy (HIE). Method A single-center, retrospective, cross-sectional study was carried out to analyze the cases of perinatal asphyxia in the Neonatal Intensive Care Unit (NICU) and Neonatal Ward (NNW) for a period of three years (September 2020 to August 2023) in a tertiary care center. The study analyzed 195 neonates with perinatal asphyxia and Hypoxic Ischemic Encephalopathy (HIE). Data analysis was done using Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics(mean ± SD for continuous variables; percentages for categorical variables) and chi-square test (to compare categorical associations) were applied. The prevalence of acute kidney injury and its relation to grades of HIE were determined using a chi-square test. Result The prevalence of acute kidney injury among cases of perinatal asphyxia was 17.4%. The prevalence of acute kidney injury increased with an increase in the grading of hypoxic ischemic encephalopathy. Acute kidney injury was predominant among males with a male-to-female ratio being 3.2:1. Oliguric acute kidney injury was more common than non-oliguric acute kidney injury. 8.8% of cases had mortality, with the majority of cases being hypoxic ischemic encephalopathy grade II. The Chisquare test found a statistically significant association between hypoxic ischemic encephalopathy grades and acute kidney injury (p value=0.0113, i.e., p < 0.05) Conclusion Acute kidney injury remains one of the common complications of Perinatal Asphyxia (PA). There was a significant association between acute kidney injury cases and grades of Hypoxic Ischemic Encephalopathy (HIE), with HIE II being the most common type. Screening for acute kidney injury in case of hypoxic ischemic encephalopathy should be prioritized.
Structured scientific writing in medicine is seldom a part of curricula especially in non-native English-speaking countries. However, with the right tools and strategies, young researchers and academicians can be assured of artful dissemination of their research. The aim of this study is to propose a checklist that can help authors in structuring a polished scholarly manuscript. In order to achieve this, the authors carried out a literature search across prominent databases like PubMed, MEDLINE and Global Index Medicus to investigate the common reasons for retraction or rejection of manuscripts between 2020 to 2023. The inclusion criteria were as follows: reviews, observational studies, commentaries and editorials published in English since 2020 in the field of healthcare. A total of 32 results were identified, eight of which met the inclusion criteria. The eight included studies were from the field of dentistry, cardiology, neurology, spine surgery, anaesthesiology, nursing, and medically assisted reproduction. The most common reasons for article rejection or retraction were academic misconduct, designing errors, unintentional errors and data fraud. In order to overcome these flaws, the G.R.A.P.E. (Grammar, Reference Management, Archiving, Plagiarism, Equator-Network) checklist is proposed. Satisfying this checklist can result in a well-knit manuscript. The common reasons for article rejection/retraction can be avoided should students and academicians use the recommended strategies and tools as per the proposed checklist.
Background The World Health Organization Surgical Safety Checklist (WHO-SSC) reduces surgical complications and morbidity; however, its utilization remains low in low- and middleincome countries. Objective To assess the utilization and completeness of a modified WHO Surgical Safety Checklist at a tertiary hospital in Nepal. Method A descriptive, observational cross-sectional study was conducted in 300 surgeries at Kathmandu Medical College Teaching Hospital (February to May 2024) following ethical clearance. Utilization and completeness of the modified WHO Surgical Safety Checklist (Pre-procedure check, Sign-in, Time-out, Sign-out) were observed passively. Data were analyzed using Microsoft Excel and SPSS v 20. Data were presented in numbers and percentages and Chi-square/ Fisher's exact test used for categorical variables. A p-value of < 0.05 was considered significant. Result WHO Surgical Safety Checklist was utilized in 48.7% of cases, with full compliance in only 8.7%. Utilization rate was seen to be 63% in the Pre-procedure check, while Sign-out was the least performed (29.3%). Highest utilization was seen in the General Surgery department, while the highest completion rate was seen in Neurosurgery (100%). Verbal confirmation (70.2%) was done more than written documentation. Conclusion Despite proven benefits, adherence to WHO Surgical Safety Checklist remains suboptimal. Targeted training and regular audits are essential to improve compliance and patient safety in resource-limited settings.
Background The butterfly effect is an optical phenomenon with endodontic and a restorative significance that can be seen in cross-sections of some of the tooth roots. Objective To investigate occurrence of butterfly effect in roots of extracted human mandibular first premolars and to determine differences in tubule density in mesio-distal and bucco-lingual direction of sections of root having buttery effect. Method It was an prospective experimental study comprised of twenty single rooted extracted mandibular first premolars. Each tooth was divided into three sections: coronal, middle and apical third. Then, nine sections of each sample were taken, three from each section i.e., coronal, middle and apical third, hence making sample size of total 180. All the selected samples were ground into 1 mm thickness and examined under 20X magnification microscope. Five samples presenting with the butterfly effect were selected and prepared for Scanning Electron Microscope to evaluate the difference in density of dentinal tubules among mesio-distal and buccolingual direction. Mann Whitney U test was applied to find out the significance of butterfly effect among different sections. The data was entered in Microsoft excel sheet and transferred to Statistical Package for Social Sciences (SPSS) version 20 for statistical analysis. Ethical approval was obtained from Kathmandu University School of Medical Sciences institutional review committee (IRC No.:127/16). Result Butterfly effect was seen in 19.4% of sample. Apical sections had more occurrence rate (30%) followed by middle (23.3%), and coronal sections (5%). Female predilection (30%) for occurrence was seen. Under SEM, the samples with butterfly effect presented with higher median density (2349.32 number/mm2 ) of dentinal tubules in bucco-lingual section as compared to mesio-distal section (1208.23 number/mm2 ). Conclusion Butterfly effect was present in 19% of the samples. Butterfly effect is more seen on aplical section of tooth. Female have more chance of having butterfly effect than male.
Palliative care is a vital component of healthcare that aims to alleviate the suffering of patients with life-threatening conditions. This specialized medical care focuses on managing symptoms, addressing social, emotional, and physical needs, and enhancing the quality of life for patients and their families. Palliative care addresses the patient's medical, psychological, and spiritual requirements, and can be used as the primary focus of care or in conjunction with curative therapies. Pain management is a crucial aspect of palliative care, involving the control or reduction of pain through medication, therapy, and other treatments. However, pain is a subjective sensation, making quantification and effective relief challenging. This review highlights the complex issues associated with pain management in palliative care, emphasizing the need for improved training and accessible pain management techniques, such as the widely recognized "Wong-Baker Face Pain Scale", particularly in resource-constrained environments like Nepal. The complex nature of pain management in palliative care compromises patients' quality of life, influenced by factors like chemotherapy and terminal illness. Addressing this issue is imperative, especially in areas like Nepal where there is a shortage of appropriate training among medical personnel. Encouragingly, initiatives like mobile health teams, smartphone apps, and the establishment of a Palliative Care Training Center demonstrate progress in improving end-of-life care.
The anatomy of nose and paranasal sinuses is highly complicated and is most often characterised by considerable anatomical variations. These variations have often been linked to the aetiopathogenesis of inflammatory sinonasal pathology. Also apart from diagnostic value, these variations also predispose the surrounding critical structures to iatrogenic trauma during functional endoscopic sinus surgery (FESS). Some of these variations also have a role in recurrence of disease. Computed tomography (CT) is the mainstay of diagnosis and surgical planning for sinonasal diseases, and a structured checklist to assess possible anatomic variants helps to reduce the risk of surgical complications. Hence, we developed a checklist at our centre with the mnemonic "SNOT RACE".
Background Job satisfaction is a critical factor influencing healthcare quality, patient's outcomes and overall wellbeing in medical profession. Job satisfaction is an important component of improving job performance and maintaining overall quality of work in any organization. The result of job satisfaction will have an impact not only at the individual level but also in the institutional, societal, and national level. Objective To explore overall job satisfaction among the workforce of four different medical colleges in Nepal, as well as the factors associated with it. Method A cross-sectional study was conducted from August to December 2024 among medical, nursing, and administrative staff who had at least one year of teaching or working experience in their respective institutions. A 36-items job satisfaction questionnaire with 6-point Likert type responses was administered in-person. Data analysis was carried out with STATA version 18 software. Categorical variables were presented as frequencies and percentages, whereas continuous variables were described using means, standard deviations, medians, and ranges. Inferential statistical analyses comprised independent t-tests for comparisons between two groups and analysis of variance (ANOVA) for comparisons among multiple groups. A multivariable linear regression model was used to identify the significant factors associated with health workforce job satisfaction. Statistical significance was defined as p < 0.05, with results reported at a 95% confidence interval. Result This study analyzed job satisfaction among 533 health workers in four medical colleges. The average overall job satisfaction score was 122.24 (±15.17). Multivariable linear regression identified several significant determinants of overall job satisfaction among health workers in Nepal's teaching hospitals. Employees in Nursing (adjusted mean difference [AMD]: 5.35, 95% CI: 2.46 to 8.26) and Administration (AMD: 5.45, 95% CI: 2.20 to 8.71) departments reported higher OJS compared to those in the medical department. Contract staff had significantly lower job satisfaction (AMD: -4.23, 95% CI: -7.19 to -1.28), while differences for daily wage and other positions were not significant. Unexpectedly, employees without chronic diseases reported lower OJS (AMD: -2.66, 95% CI: -5.86 to -0.55). Higher organizational input factors were significantly associated with lower OJS (AMD: -0.37, 95% CI: -0.55 to -0.19). Conclusion This study revealed that health workforces had positive attitude towards their job however are dissatisfied with the benefits offered to them and the operating condition of their institutions. Expanding the teaching learning resources, continuing career opportunities through participation in professional development and regular promotion and increment of salary would be helpful in improving job satisfaction among health workforce in Nepal.
Background Nasal irrigation with normal saline and topical steroid spray forms the mainstay of treatment in post endoscopic sinus surgery patients. However nasal sprays may not deliver optimum dosage of drug to the paranasal sinus mucosa. Budesonide nasal irrigation solves this problem by delivering drugs in a high-volume high-pressure system. Objective The main objectiveof this study will provide insight into the efficacy of budesonide nasal irrigation following functional endoscopic sinus surgery (FESS) surgery and will help to establish new protocols in future. Method Forty-four patients were included and divided into 2 groups of 22 each. One arm received normal saline nasal irrigation and the other arm received budesonide nasal irrigation (1 mg in 500 ml) twice daily. Patients were followed up at 1st post-operative week and 10th post-operative week and on each visit Sino-Nasal Outcome Test (SNOT) 22 and Lund Kennedy Endoscopic scores (LKES) were assessed. Result The mean scores in the first visit was SNOT 22 : 15.73 + 8.897 vs 12.73 + 16.110 (p < 0.05) and LKES : 2.82 + 1.097 vs 1.77 + 1.52 (p > 0.05) in the saline and budesonide groups respectively. The mean scores in the second visit was SNOT 22 : 7.09+3.87 vs 3.73 + 8.70 (p < 0.05) and LKES : 1.64 + 0.790 vs 0.18 + 0.501 (p < 0.05) in the saline and budesonide groups respectively. Thus the budesonide arm had statistically significantly better scores when compared to the normal saline group. Conclusion Budesonide nasal irrigation with a positive pressure high volume device was found to have better efficacy when compared to normal saline irrigation. Budesonide nasal irrigation may be used in the post-operative management of endoscopic sinus surgery patients.
Meditation, an inward journey to explore profound levels of consciousness rooted in Buddhism, has significant physical and psychological benefits, including enhanced well-being, improved concentration, emotional stability, and positive cognitive shifts. This narrative review consolidates past two decades of research on the neurophysiological effects of Buddhist mindfulness meditation based on neuroimaging findings, and aims to examine the Buddhist view of mindfulness meditation in relation to the structural and functional changes in the brain areas in health and diseases. Meditation practices, such as Vipassana in Buddhism, emphasize mindfulness and non-judgmental awareness of oneself and surrounding. Neuroimaging studies have revealed its significant impact on brain regions including structural changes involving anterior cingulate cortex (ACC), temporal lobe, insula, hippocampus, amygdala, thalamus and other areas. Four fundamental mechanisms summarize the mindfulness meditation: attention regulation, body awareness, emotion regulation, and a transformed selfperspective. The scientific explanation of effects of meditation is challenging, and we are only beginning to understand in neurophysiological terms. Previous research on mindfulness meditation has employed diverse methodological approaches, including self-reported measures, behavioral tasks and neuroimaging techniques; but there lacks a standardization, making it difficult to compare the findings. However, the cognitive processes are thought to underlie the potential benefits of mindfulness meditation in promoting mental well-being on an individual and societal level. This review highlights the mechanisms of mindfulness meditation to improve cognitive flexibility and promote mental well-being, in relation to Buddhist philosophy, with implications for individual and societal benefits.
Background Femoroacetabular impingement is regarded as precursor of osteoarthritis. Various studies have discussed the prevalence of femoroacetabular morphology but only few studies have been done on asymptomatic population using cross-sectional imaging. Objective To determine the prevalence of femoroacetabular impingement morphology in young asymptomatic population on computed tomography. Method This cross-sectional study was done in 200 individuals who underwent computed tomography for abdominal pathologies without any symptoms of hip pain, hip pathology or osteoarthritis. Multiplanar images were reformatted and assessed for the presence of parameters associated with femoroacetabular impingement; alpha angle greater than 55°, femoral head-neck offset less than 8 mm, angle of acetabular version less than 15°, lateral center edge angle greater than 40°. Result At least one of the femoroacetabular impingement morphology was detected in 162 hips. The prevalence of abnormal hip joint was higher in male patients than in female patients (47.3% vs 31.8%). Prevalence of cam morphology was 14.5%, pincher was 17.5% and mixed morphology was 8.5%. Prevalence of cam and mixed morphology were common in male hips however there was no statistically significant difference in prevalence of pincher morphology between male and female hips. Conclusion Femoroacetabular morphology was noted with high frequency in asymptomatic young population on computed tomography. Diagnosis of femoroacetabular impingement syndrome should be based on combination of clinical and radiological findings.
Background Dengue hemorrhagic fever (DHF) has re-emerged across the global South, particularly in tropical and subtropical urban areas, driven by environmental changes alongside local demographic and socioeconomic factors. Objective To investigate the spatial patterns and socioeconomic determinants of dengue fever in Nepal from 2020 to 2023. Method Using Geographic Information Systems (GIS), Gi* cluster analysis, and Local Moran's I statistics, the study examined the relationship between socio-economic variables and dengue incidence across districts. Key factors analyzed included population density, urbanization, and night-time light (NTL) intensity. Result Bivariate Local Indicators of Spatial Association (LISA) analysis showed fluctuating correlations between dengue hemorrhagic fever incidence and factors such as population density, urbanization, and night-time light intensity. Moran's I value for population density were -0.083 in 2020, -0.082 in 2021, 0.526 in 2022, and -0.020 in 2023. Similarly, for urbanization, Moran's I values shifted from -0.103 in 2020 to -0.090 in 2021, 0.458 in 2022, and 0.007 in 2023. Night-time light intensity also demonstrated changing correlations, with Moran's I values of -0.091 in 2020, -0.102 in 2021, 0.415 in 2022, and -0.068 in 2023. A notable shift from negative to positive correlations occurred between 2020 and 2022. In 2022, high-incidence dengue hemorrhagic fever clusters emerged in densely populated areas, while distinct spatial patterns were observed in 2020 and 2021. Conclusion Dengue hemorrhagic fever risk spatial models are useful tools for detecting high-risk locations and driving proactive public health initiatives. The study emphasized the importance of dynamic, targeted public health interventions based on spatial and socio-economic factors to effectively manage evolving dengue outbreak patterns.
