Unsafe abortion after legalisation in Nepal: a cross-sectional study of women presenting to hospitals

OBJECTIVE

To investigate abortion practices of Nepali women requiring postabortion care.

DESIGN

Cross-sectional study.

SETTING

Four tertiary-care hospitals in urban and rural Nepal.

SAMPLE

A total of 527 women presenting with complications from induced abortion in 2010.

METHODS

Women completed questionnaires on their awareness of the legal status of abortion and their abortion-seeking experiences. The method of induction and whether the abortion was obtained from an uncertified source was documented. Multivariable logistic regression was used to identify associated factors.

MAIN OUTCOME MEASURES

Induction method; uncertified abortion source.

RESULTS

In all, 234 (44%) women were aware that abortion was legal in Nepal. Medically induced abortion was used by 359 (68%) women and, of these, 343 (89%) took unsafe, ineffective or unknown substances. Compared with women undergoing surgical abortion, women who had medical abortion were more likely to have obtained information from pharmacists (161/359, 45% versus 11/168, 7%, adjusted odds ratio [aOR] 8.1, 95% confidence interval 4.1-16.0) and to have informed no one about the abortion (28/359, 8% versus 3/168, 2%, aOR 5.5, 95% CI 1.1-26.9). Overall, 291 (81%) medical abortions and 50 (30%) surgical abortions were obtained from uncertified sources; these women were less likely to know that abortion was legal (122/341, 36% versus 112/186, 60%, aOR 0.4, 95% CI 0.2-0.7) and more likely to choose a method because it was available nearby (209/341, 61% versus 62/186, 33%, aOR 2.5, 95% CI 1.5-4.3), compared with women accessing certified sources.

CONCLUSIONS

Among women presenting to hospitals in Nepal with complications following induced abortion of pregnancy, the majority had undergone medically induced abortions using unknown substances acquired from uncertified sources. Women using medications and those accessing uncertified providers were less aware that abortion is now legal in Nepal. These findings highlight the need for continued improvements in the provision and awareness of abortion services in Nepal.

A case of nocardia keratitis treated successfully with topical amikacin

BACKGROUND

Keratitis caused by the nocardia species is rare in clinical practice and can cause confusion during treatment because it often mimics fungal keratitis.

CASE

This is a case of nocardia keratitis occurring in a forty-year-old lady without any predisposing factors. It was initially treated as fungal keratitis, then as herpes simplex viral keratitis, but once the organism was known, it was successfully treated with topical fortified amikacin 14 mg/ml (1.4 %).

CONCLUSION

Delay in diagnosis can occur in nocardia keratitis due to its rarity in occurrence. It responds well if proper therapy is instituted on time.

Endogenous Aspergillus endophthalmitis in a healthy individual

BACKGROUND

Fungal endogenous endophthalmitis in a healthy individual without any predisposing factors is very uncommon. It can occur in intravenous drug abusers, where Aspergillus is more frequently isolated as the causative organism.

CASE

We treated an unusual case of culture-proven endogenous Aspergillus endophthalmitis who was immunocompetent and was not an intravenous drug user. The affected eye was successfully treated with repeated intravitreal, intracameral and intrastromal injections of amphotericin B and anterior chamber wash.

CONCLUSION

Endogenous fungal endophthalmitis can occur in healthy individuals.

Surgical abortion in second trimester: initial experiences in Nepal

INTRODUCTION

In spite of legalising abortion and making safe abortion available at affordable price at accessible distance to almost everyone, unsafe abortion especially second trimester abortion is still a big health problem in Nepal.

OBJECTIVE

The objective of the study is to fi nd the demographic profile, reasons for seeking abortion and to see the effectiveness of Misoprostol in preparing the cervix.

MATERIALS AND METHODS

A prospective study was done in the two second trimester abortion trainings conducted in Maternity hospital, Kathmandu. Total 57 clients had second trimester abortion performed. Information was collected from structured questionnaire and then data was analysed.

RESULTS

Commonest reason for seeking abortion was, multiparity (61.4%). Common reasons for second trimester abortion were, completed family size with unwanted pregnancy (61.4%), unwanted pregnancy in married (10.52%) unwanted pregnancy in unmarried (5.26%).

CONCLUSIONS

Second trimester abortion is one of the most common procedures performed in reproductive-aged women and when performed by a skilled provider in the appropriate setting, it is one of the safest surgeries, if it is well supported by change in policy of the country and acceptability of the people.

Ocular evaluation in patients with chronic renal failure--a hospital based study

Chronic renal failure affects every organ system including eye. The aim of this study is to conduct thorough ocular examination in the patients of chronic renal failure and to analyze the findings. 119 cases were collected from Nephrology unit of Tribhuvan University Teaching Hospital between 1st June 2002 to 15th December 2003. This was a cross sectional, descriptive type of study. Sampling technique was consecutive and stratified. Severity of renal disease was classified as mild, moderate, severe and end stage renal disease. Twenty-three percent of total 238 eyes had vision < 6/18. The causes for visual impairment were maculopathy 23 eyes, cataract 14 eyes followed by proliferative diabetic retinopathy, 9 eyes. Twelve percent of total eyes had vision < 6/60. Lid edema was present in 63.0%, conjunctival pallor in 75.6% and corneal calcification in 1.6%. Retinopathy was the most important finding. Hypertensive retinopathy was present in 56 out of total 119 cases (47.1%). It was more prevalent and tended to be more severe as renal disease progressed. This was statistically significant. Diabetic retinopathy was present in 38 out of 43 diabetic cases (88.3%). Although statistically not proven, more severe grades of diabetic retinopathy were detected with increasing severity of the renal disease. There was one case of bilateral serous detachment of the retina relating to chronic renal failure. In this study, 47 out of 56 cases of hypertensive retinopathy and 19 out of 38 cases of diabetic retinopathy were detected for the first time, thus showing the importance of ocular evaluation of the patients of renal insufficiency.

Intestinal parasitosis among subjects undergoing cataract surgery at the eye camps in rural hilly areas of Nepal

Present study investigated the intestinal parasitosis among 221 subjects undergoing cataract surgery (M: 129 and F: 92; aged 13-86 years) at the eye camps in three rural hilly districts (Ramechhap, Sindhupalchok and Dhading) in 2006. Stool samples collected in clean, dry, screw capped plastic containers were examined locally by direct smear technique and anti-parasitic drugs were distributed to parasite positive subjects. The remaining stool samples were fixed with 10% formal-saline, transported to Shi-Gan Health Foundation/Nat'l Inst of Trop Med and Public Health Research, Kathmandu and re-examined by formal-ether sedimentation technique. A total of 148 samples (66.9%) were positive for some kind of intestinal parasites (F: 68.5% and M: 65.9%; P > 0.05). Ramechhap (Manthali) and Sindhupalchok (Chautara) had higher positive rate (71.8% and 70.7%, respectively) than in Dhading (Salyantar) (60.0%) (P > 0.05). Tibeto-Burman (indigenous nationalities) ethnic group had highest positive rate (70.1%) compared with Indo-Aryan (64.7%) and Dalits (57.7%). Subjects without toilet (latrine) had marginally higher positive rate (69.7%) than those having toilet at their home (65.5) (P> 0 .05). Age was independent of positive rate. Vegetarians had marginally higher parasitic infection rate compared to their non-vegetarian counterparts. Helminths were more common than protozoa. Overall, hookworm was the commonest parasite detected. However, Ascaris was common in Dhading District. Entamoeba histolytica was most common among protozoa and was followed by Cyclospora and others.

Keratoprosthesis, Dohlman Type I device for a patient with repeated corneal graft failure

Background: Keratoprosthesis (Kpro) surgery is performed in patients in whom traditional penetrating keratoplasty (PK) surgery has no hope for graft survival. The burden of corneal blindness is high in a developing country like Nepal. Case: A thirty-year-old man, with multiple graft failure in his only eye, underwent Kpro surgery. He had ambulatory vision and a stable Kpro 29 months after the surgery. Conclusion: Kpro surgery has been introduced in the country with this as the first case. Patients with poor prognosis for PK can benefit from this type of surgery. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5869 NEPJOPH 2012; 4(1): 165-169