title: Trends in the workload of the two high altitude aid posts in the Nepal Himalayas.
abstract: BACKGROUND
  Acute mountain sickness (AMS), High altitude pulmonary edema (HAPE) and High Altitude Cerebral Edema (HACE) are well known problems in the high altitude region of the Nepal Himalayas. To assess the proportion of AMS, HAPE, and HACE from 1983 to 1995 in the Himalaya Rescue Association (HRA) aid posts' patients at the Everest (Pheriche 4,243 m) and Annapurna (Manang 3,499 m) regions, the two most popular trekking areas in the Himalayas. A retrospective study was conducted at the HRA medical aid posts in Manang (3,499 m) and Pheriche (4,243 m) in the Himalayas, where 4,655 trekkers (tourists, mostly Caucasians) and 4,792 Nepalis (mostly porters and villagers) were seen at the two high-altitude clinics from 1983 to 1995, for a variety of medical problems, including AMS.
  
  
  METHODS
  The number of trekking permits issued for entering the two most popular regions in the Himalayas was calculated and referenced to the proportion of trekkers with medical conditions. Well established guidelines like the Lake Louise Diagnostic Criteria were used in the assessment of AMS, HAPE and HACE. Linear regression analyses were performed on data collected from the two aid posts to determine the effect of time on each variable. For comparison between the aid posts, angular transformation (arcsine) and analysis of variance (ANOVA) were performed on all proportional (incidence) data.
  
  
  RESULTS
  Approximately 20% of all visitors (Nepali plus trekkers) who visited the higher Pheriche aid post were diagnosed with AMS compared to around 6% at the lower Manang aid post. There was a linear increase over time in the number of trekkers entering the Everest (r=0.904, p<.001) and the Annapurna (r=0.887, p<.001) regions. The proportion of trekker patients with any medical condition visiting the two HRA aid posts at Manang and Pheriche, expressed as a function of the total number of trekkers entering the Everest and Annapurna regions, was not significantly different between Pheriche (average 4%) and Manang (average 1%). However, the proportion of AMS, HAPE and HACE in patients (Nepali plus trekkers) to the aid posts was greater in those visiting the higher Pheriche aid post compared to the lower Manang aid post (f=56.74, n=13; p<. 001). Importantly, only the proportion of AMS (r=0.568; p<.05) and not HAPE or HACE increased over time in Pheriche, alongside an unchanged proportion of trekker patients, amongst all Pheriche aid post patients. There was no increase of AMS, HAPE or HACE in Manang.
  
  
  CONCLUSIONS
  HAPE and HACE are the life-threatening forms of AMS and although there is a linear increase of trekkers entering the Himalayas in Nepal, the findings revealed that HAPE and HACE have not increased over time. One possible explanation may be that awareness drives by organizations like the Himalayan Rescue Association may be effective in preventing the severe forms of AMS.
authors.affiliation: Medical Director, Himalayan Rescue Association and Medical Attending, Patan Hospital, Kathmandu, Nepal.
authors.forename: B
authors.initials: B
authors.lastname: Basnyat
authors.forename: G K
authors.initials: GK
authors.lastname: Savard
authors.forename: K
authors.initials: K
authors.lastname: Zafren
mesh_terms: D000532:Altitude Sickness / Q000453:epidemiology*; D001929:Brain Edema / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D009051:Mountaineering; D009390:Nepal / Q000453:epidemiology; D011654:Pulmonary Edema / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies