COVID-19 Pandemic and Neonatal Health: What We Know so Far?

COVID-19 first time appeared in December 2019 in Wuhan, China. The number of cases increased rapidly in china and outside and the World Health Organization declared a pandemic on 11th March 2020. The pregnant and postpartum women, child, and neonatal populations are vulnerable to this disease due to immunological and physiological changes. This paper analyzed the published evidence for assessing the effect of COVID-19 on neonatal health and health care. Online published literature was searched from PubMed, Google Scholar, and other official webpages using keywords: "coronavirus/COVID-19/new coronavirus 2019"/SARS-CoV-2 and neonatal health/care/outcomes" and reviewed to prepare this article. COVID-19 is the potential to transmit either mother to fetus or mother/caregiver to neonates. However, neonates born from infected mothers did not show significant clinical features. Pharyngeal-swab, amniotic-fluid, cord-blood, and breast-milk test results were not found positive. Health facility-based vaginal/caesarian delivery was considered a low risk of transmission. However, recommended to separate neonates with infected mothers/caregivers and test immediately after birth to avoid the possible transmission. Mothers/caregivers should take routine preventive measures such as washing hands frequently and avoiding contact with infected people. If neonates suffered from the server acute respiratory distress requires intensive care urgently. Despite the possibility of the intrauterine transmission of COVID-19 direct evidence is still lacking so it needs more studies for further confirmation. The International Pediatric Association suggested preventive programs, curative care, vaccination, and telemedicine care as the minimum services and called on its members to address these cares during the pandemic.

Risk Factors for Complications in Acute Appendicitis among Paediatric Population

INTRODUCTION

Appendicitis is one of the most common causes of acute abdomen in children. Patients who are diagnosed early and undergo an appendectomy before perforation have a good outcome. However, it is difficult to diagnose in young children because its clinical manifestations may be atypical. The aim of this study was to determine the risk factors for complications in acute appendicitis in paediatric population.

METHODS

We performed a cross sectional study on children (age ≤18 years) who underwent appendectomy for suspected appendicitis from January 2014 to December 2015. Medical records of patients who met inclusion criteria were reviewed. Preoperative, operative and post-operative data were analyzed. The main outcome measure was intraoperative confirmation of gangrenous or perforated appendicitis. Multivariate logistic regression analysis was performed, and the main predictors of interest were patient's age, duration of pain and total leucocyte count.

RESULTS

Total 73 paediatric patients (46 males) with mean age 13±3.8 were studied. In multivariate logistic regression analysis, patients having pain duration more than 72 hours and patients with leucocyte count >15000/mm3 were more likely to have complicated appendicitis [(OR:14.6), (95% CI= 2.40 - 89.77), (P= 0.004)] and [(OR=16.38), (95% CI = 1.836-146), (P = 0.012)] respectively. However, the age of the patient is not independently associated with complicated appendicitis.

CONCLUSIONS

Increase in total leucocyte count and duration of the presentation can be a good marker of complicated appendicitis.

Choices, Shift and Continuation of Temporary Contraceptive Methods among Women of Reproductive age in Western Development Region of Nepal

Aims: Global family planning programs have been in existence in the developing world. Modern techniques of temporary contraceptives have been proved to be useful tool for limiting births. This study is intended to identify the use pattern, associated factors with the choice, shift and continuity of temporary methods of contraception.Methods: This is descriptive cross-sectional study, incorporating qualitative aspects. Out of sixteen districts six were selected proportionately by using simple random methods from each ecological zone of the Western Development Regions, Nepal. Focus group discussion was accomplished among the different level family planning service providers.Results: User of Depo-Provera and pills were seen more in comparison to other temporary contraceptive. There are different reasons behind choosing of temporary contraceptive method such as Pills make regularity in menstruation, Norplant is useful for prolonged period, Depo-Provera is useful for three months and confidently used for a long time without any risk, motivation by friends/relatives. Reasons in changing the contraceptives includes associated side effects, lack of availability, irregularity in menstruation, choosing the another best method, excessive bleeding, difficult to use, pressure from family and husband to give birth, misunderstanding and stress in the family, traditional belief and lack of education.Conclusions: For proper choice of modern contraceptive methods promotion, education and knowledge about associated factors related to use of these method is needed. Continuous information on contraceptives focusing particularly on the side effects and trained health care providers are essential. 

Abortion Practices in Nepal: What does Evidence Show?

Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative.  However, every year around 22 million women seek unsafe abortion in developing countries. Globally, the unsafe abortion accounts for 13% maternal deaths. Out of the total aborted women, around five million women were admitted to hospitals as a result of unsafe abortion. Similarly, more than three million women suffer from severe complications from unsafe abortion every year. In 2002, responding to the public voices and high attribution of unsafe abortion on maternal mortality, Nepal granted legal access to safe abortion introducing safe abortion act. Women can seek abortion up to 12 weeks of gestation for any indication. However, sex selective pregnancy termination is prohibited in Nepal. This study aimed to assess the results of various studies on abortion practices in Nepal. Literature published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2014 were used to prepare this paper. From 2004 to 2014, more than half a million women sought safe abortion care in Nepal. Despite the considerable progress, unsafe abortion is still a major issue in Nepal as it has been estimated that it constitutes half of all abortions undertaken every year. Published literature further showed that still an unmet need of safe abortion services exists in Nepal. However, the overall awareness of legal abortion was found to be high among Nepalese women. We found negative attitude of most people towards women who sought abortion care. Similarly, a large number of unmarried women were found at risk for seeking abortion care due to socio-cultural norms, values and stigmas in Nepal.

Efficacy of Combined Antithrombotic, Statins and Anti-Hypertensive Drugs in Acute Ischemic Stroke

INTRODUCTION

Anti-thrombotic, statins and antihypertensive drugs are commonly used for the management of acute ischemic stroke in Nepal but there is no evidence regarding their efficacy in our context. This study aims to explore the efficacy of these combined medications (anti-thrombotic, statins and antihypertensive drugs) in acute ischemic stroke patients for the first time and to assess the risk factors present in those patients.

METHODS

The study was conducted on 37 acute ischemic stroke patients admitted and treated at the Neurology Department of College of Medical Sciences-Teaching Hospital, Chitwan, Nepal and they were followed at three months (90±10 days). The initial stroke severity and functional disability were evaluated at admission and at 3 months using National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) respectively. The outcome parameters were functional independence (mRS≤2) and mortality at three months (mRS=6). Frequency distribution, Mann-Whitney U-test and χ2 test were performed for statistical analysis.

RESULTS

Out of 37 patients, 27 (73%) were Smoker, 22 (59.5%) had hypertension and 19 (51.4%) were alcohol consumer. The stroke severity on admission was statistically significant with functional independence (P=0.003) and mortality (P=0.015) at three month. Similarly, Rankin grade on admission was statistically significant with functional independence (P=0.001) and mortality (P=0.048) at three month. At three months, 20 (69%) survived patients were independent while mortality was seen in eight (21.6%) patients.

CONCLUSIONS

The management of acute ischemic stroke with combined anti-thrombotic, statins and antihypertensive drugs seems promising and efficacious in mild to moderately severe ischemic stroke.

Emergency Obstetric Care: Strategy for Reducing Maternal Mortality in Developing Countries

Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year nearly three million women die due to pregnancy related causes. This tragedy is avoidable if women have timely access to required emergency obstetric care. Emergency obstetric care refers to life-saving services for maternal and neonatal complications provided by skilled health workers. Since the beginning of the 1980’s, several efforts have been intensified to improve maternal and child health status and reducing the high morbidity and mortality. There was built on a worldwide consensus to provide improved maternal and child health care for addressing the high morbidity and mortality. All participant countries agreed to integrate emergency obstetric care services in their national health care system. Emergency obstetric care is one of the strategies for reducing the maternal mortality as pregnancy related complications are unpredictable. However, many women in developing countries do not have access to essential health care services including emergency obstetric care. Basic emergency obstetric care by skilled birth attendants or timely referral for further comprehensive emergency obstetric care can reduce maternal deaths and disabilities significantly. This paper is based on the results published in PubMed, Medline, Lancet, WHO and Google Scholar web pages from 1990 to 2013. DOI: http://dx.doi.org/10.3126/njog.v9i1.11179 NJOG 2014 Jan-Jun; 2(1):8-16

Status of Vitamin D and its Association with Stroke Risk Factors in Patients with Acute Ischemic Stroke in a Tertiary Care Hospital

INTRODUCTION

Vitamin D deficiency has been associated with many neurological illnesses. The status of Vitamin D in Nepalese ischemic stroke patients is still unknown. This study aims to assess the status of vitamin D and its association with stroke risk factors in patients with acute ischemic stroke from Central Nepal.

METHODS

A total of 60 patients with ischemic stroke were included in the study. Their clinical profile and Vitamin D status were assessed. Frequency distribution, Pearson χ2test and Kruskal-Wallis test were performed for statistical analysis using SPSS-IBM 20.

RESULTS

The median (IQR) age of the patient was 65 (53.25, 70.75) years, ranging from 18-87 years. Thirty-four (56.7%) were males. Fourty-eight (80%) patients had hypertension and 34 (56.7%) were smoker. Previous stroke was present in six (10%) cases. Thirty-seven (61.6%) patients had low levels of Vitamin D out of which 26 (43.3%) had vitamin D insufficiency and 11 (18.3%) had vitamin D deficiency. Vitamin D level was significantly associated with previous history of stroke (P=0.043).

CONCLUSIONS

Vitamin D deficiency occurs in patients with ischemic stroke. Previous episodes of stroke with low vitamin D levels could be a cause of recurrent strokes. Further studies are necessary to establish the role of vitamin D in acute ischemic stroke in Nepalese population.

Construction and Validation of a Women's Autonomy Measurement Scale with Reference to Utilization of Maternal Health Care Services in Nepal

INTRODUCTION

Women's autonomy is one of the predictors of maternal health care service utilization. This study aimed to construct and validate a scale for measuring women's autonomy with relevance to developing countries.

METHODS

We conducted a study for construction and validation of a scale in Rupandehi and further validated in Kapilvastu districts of Nepal. Initially, we administered a 24-item preliminary scale and finalized a 23-item scale using psychometric tests. After defining the construct of women's autonomy, we pooled 194 items and selected 24 items to develop a preliminary scale. The scale development process followed different steps i.e. definition of construct, generation of items pool, pretesting, analysis of psychometric test and further validation.

RESULTS

The new scale was strongly supported by Cronbach's Alpha value (0.84), test-retest Pearson correlation (0.87), average content validity ratio (0.8) and overall agreement- Kappa value of the items (0.83) whereas all values were found satisfactory. From factor analysis, we selected 23 items for the final scale which show good convergent and discriminant validity. From preliminary draft, we removed one item; the remaining 23 items were loaded in five factors. All five factors had single loading items by suppressing absolute coefficient value less than 0.45 and average coefficient was more than 0.60 of each factor. Similarly, the factors and loaded items had good convergent and discriminant validity which further showed strong measurement capacity of the scale.

CONCLUSIONS

The new scale is a reliable tool for assessing women's autonomy in developing countries. We recommend for further use and validation of the scale for ensuring the measurement capacity.