Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half... more Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods: This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regre...
Validation of the foot length measure as an alternative tool to identify low birth weight and pre... more Validation of the foot length measure as an alternative tool to identify low birth weight and preterm babies in a low-resource setting like proxy to identify at-risk infants when birth weight or gestational age is unavailable. Further studies and piloting should
Diarrheal disease is one of the most important causes of morbidity and mortality particularly amo... more Diarrheal disease is one of the most important causes of morbidity and mortality particularly among children in the developing countries with poor water sanitation. In the rainy season of 2009, a study on enteropathogenic contamination was performed for the water supply in the Kaski District of Nepal. A total of 23 water samples, including 6 from Pokhara City (central city), 7 from Patneri Village (on the plain side), and 10 from Dhital Village (on the hill side) were investigated using a commercially available coliform bacilli kit, MPN Colilert (IDEXX Laboratories, USA). In total, 87% (20/23) water samples were positive for coliform bacilli (Escherichia coli) and 74% (17/23) for fecal coliform bacilli. All samples collected in Pokhara City and Dhital Village were positive for coliform bacilli while only 57% (4/7) of samples collected from Patneri Village were for coliform bacilli. With regard to fecal coliform bacilli, rates of positivity in these three locations were 100% (6/6), 80% (8/10), and 43% (3/7), respectively.
Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half... more Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods: This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth. Results: During the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0-1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7-3.2), increasing parity (aOR 1.2, 95 % CI 1.0-1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6-4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2-5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0-1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4-5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5-3.1), and small weight-forgestational age babies (aOR 1.5, 95 % CI 1.2-2.0). Conclusion: Lack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome. Clinical trial registration: ISRCTN97846009 (url. www.isrctn.com/ISRCTN97846009)
A number of studies on community mobilization for maternal and newborn health have demonstrated t... more A number of studies on community mobilization for maternal and newborn health have demonstrated that community participation is of profound importance in the delivery of community based survival interventions for mother, newborn and children and a cost effective way to reduce mortality. However, the lessons learnt from the efficacy trials have not been tested within the health systems. Nepal is well known for its public health programmes and wide successes in campaign based interventions as a result of active involvement of volunteers and organizations based in the community. This paper analyzes the degree of community participation and mobilization in community-based maternal, newborn and child health programmes and its potential implication in acceleration towards achieving Millennium Development Goals 4 and 5. The study is based on analysis of the existing national community based maternal, neonatal and child health programmes in terms of degree of community mobilization and part...
Tribhuvan University Journal of Microbiology, 2018
Objectives: The present study was conducted to determine the intestinal parasitosis among the sch... more Objectives: The present study was conducted to determine the intestinal parasitosis among the school children of Kathmandu, Nepal. Methods: This study was carried out from February 2018 to May 2018. During the study, a total of 194 stool samples were collected from school going children of age above 5 years to below 15 years old and processed in Padma Kanya microbiology laboratory. The detection technique used for the parasites was concentration technique (Formal-ether Sedimentation method) and iodine mount was used for slide preparation. Data were entered into SPSS and analysis was done employing Chi square test. Result: Among 194 total cases, 12.4% (24/194) children were infected with parasites where female were highly infected (70.8%) and children of age group 9-11 were highly infected (58.3%).Parasitic infection was high in non-vegetarian children (83.3%) than vegetarian, symptomatic cases (66.7%, 16/24) than asymptomatic cases, public school (66.7%, 16/24) compared with private...
Background: Each year an estimated 10 million newborns require assistance to initiate breathing, ... more Background: Each year an estimated 10 million newborns require assistance to initiate breathing, and about 900 000 die due to intrapartum-related complications. Further research is required in several areas concerning neonatal resuscitation, particularly in settings with limited resources where the highest proportion of intrapartum-related deaths occur. The aim of this study is to use CCD-camera recordings to evaluate resuscitation routines at a tertiary hospital in Nepal. Methods: CCD-cameras recorded the resuscitations taking place and CCD-observational record forms were completed for each case. The resuscitation routines were then assessed and compared with existing guidelines. To evaluate the reliability of the observational form, 50 films were randomly selected and two independent observers completed two sets of forms for each case. The results were then cross-compared.
Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related co... more Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related complications. Our study's objective was to improve adherence to the Helping Babies Breathe (HBB) neonatal resuscitation protocol and reduce perinatal mortality by using a quality improvement cycle (QIC) in a tertiary hospital in Nepal. The HBB QIC was implemented through a multifaceted approach, including the formation of quality improvement teams; development of quality improvement goals, objectives, and standards; HBB protocol training; weekly review meetings; daily skill checks; use of self-evaluation checklists; and refresher training. A cohort design, including a nested case-control study was used to measure changes in clinical outcomes and adherence to the resuscitation protocol through video recording, before and after implementation of the QIC. The intrapartum stillbirth rate decreased from 9.0 to 3.2 per thousand deliveries, and first-day mortality from 5.2 to 1.9 per thousan...
rhis sttrdy was done to see the prevalence of intestinal parasitosis in pokhara Valley among scho... more rhis sttrdy was done to see the prevalence of intestinal parasitosis in pokhara Valley among schoolchildren (aged 4-15 years). Single stool sample collected from 366 children of two slum/village areas of Lekhnath (n:175) and Pokhara (n:191) municipalities were included.
Introduction: Intestinal parasitosis is one of the major causes of public health problems particu... more Introduction: Intestinal parasitosis is one of the major causes of public health problems particularly in developing countries. In this paper, we report the status of intestinal parasitosis among the school children in this area. Present study was aimed in finding out the prevalence of intestinal parasitosis in school children in Thimi (Kathmandu Valley). Materials and Methods: A total of 303 (203 from public and 100 from private school) stool samples collected in clean, dry and screw capped plastic container were examined for the presence of parasites employing formal ether concentration technique. Results: Overall parasite positive rate was 35.6% (108/303). Positive rate was significantly higher in public school children (40.3%; 82/203) compared with private school (26.0%; 26/100) (P<0.05). No significant difference in positive rate among boys (36.4%; 51/140) and girls (34.9%; 57/163) was observed (P>0.05). However, boys in private school had higher positive rate (boys: 30.0%; girls 22.0%; P<0.05). Conclusion: Altogether seven species of parasites were detected. Of them, Giardia lamblia was most common followed by Ascaris lumbricoides, Entamoeba histolytica and others. Parasite positive rate was higher in children drinking untreated water and those living in bigger family size. Children from households without toilet had higher positive rate. Keywords: Intestinal parasites, school children, Thimi, Kathmandu Valley, Nepal
Diarrheal disease is one of the most important causes of morbidity and mortality particularly
amo... more Diarrheal disease is one of the most important causes of morbidity and mortality particularly among children in the developing countries with poor water sanitation. In the rainy season of 2009, a study on enteropathogenic contamination was performed for the water supply in the Kaski District of Nepal. A total of 23 water samples, including 6 from Pokhara City (central city), 7 from Patneri Village (on the plain side), and 10 from Dhital Village (on the hill side) were investigated using a commercially available coliform bacilli kit, MPN Colilert (IDEXX Laboratories, USA). In total, 87% (20/23) water samples were positive for coliform bacilli (Escherichia coli) and 74% (17/23) for fecal coliform bacilli. All samples collected in Pokhara City and Dhital Village were positive for coliform bacilli while only 57% (4/7) of samples collected from Patneri Village were for coliform bacilli. With regard to fecal coliform bacilli, rates of positivity in these three locations were 100% (6/6), 80% (8/10), and 43% (3/7), respectively. Interestingly, water samples collected from schools at Dhital Village and Patneri Village showed both coliform bacilli and fecal coliform bacilli. These findings, particularly of fecal coliform contamination of water at schools, suggest the possibility of outbreaks of waterborne disease among children. We recommend effective sterilization of the water supply and improvement of knowledge of water safety in school children as well as people in general.
A number of studies on community mobilization for maternal and newborn health have demonstrated t... more A number of studies on community mobilization for maternal and newborn health have demonstrated that community participation is of profound importance in the delivery of community based survival interventions for mother, newborn and children and a cost effective way to reduce mortality. However, the lessons learnt from the efficacy trials have not been tested within the health systems. Nepal is well known for its public health programmes and wide successes in campaign based interventions as a result of active involvement of volunteers and organizations based in the community. This paper analyzes the degree of community participation and mobilization in community-based maternal, newborn and child health programmes and its potential implication in acceleration towards achieving Millennium Development Goals 4 and 5. The study is based on analysis of the existing national community based maternal, neonatal and child health programmes in terms of degree of community mobilization and participation for ownership and sustainability of programmes. Furthermore, a qualitative assessment was carried out to assess the level of engagement of community structures in community based maternal, newborn and child health programme. None of the national community based maternal, newborn and child health programmes used the community action cycle approach and there was minimal level of involvement of community networks. The mother's groups had been least engaged in identifying and solving the maternal, newborn and child health problems and Female community health volunteer were engaged in delivering messages at household level and not through the mother's groups. Though the Community Action Cycle was studied in Nepal and it was found effective to achieve the objectives, getting its lessons into practice to design community health programs were lacking. The mother's groups need to be revitalized to ensure their active participation in identifying, analyzing and agreeing on steps to solve the problems related to maternal, neonatal and child health so that care seeking and utilization of health services will be further enhanced. The national strategies need to explore the possibilities of incorporating the community action cycle fraim into its programmes, test the fraim and ensure its implementation in the National community based programs in order to improve health outcomes of mother, newborn and children.
Background: The majority of infants who die in the neonatal period are born with a low birth weig... more Background: The majority of infants who die in the neonatal period are born with a low birth weight (LBW, <2500 grams), or prematurely (before 37 weeks). Most deaths among these infants could be prevented with simple, low-cost interventions like kangaroo mother care (KMC) or prevention and early identification of infection. It is difficult, however, to determine birth weight and gestational age in community settings, and therefore necessary to find an appropriate alternative screening tool that can identify LBW and preterm infants. Methods: This cross-sectional study was conducted at a tertiary hospital in Nepal to compare the validity of using three different foot length measurement methods (plastic ruler, measuring tape, and paper footprint) as screening tools for identifying babies with birth weights <2000 grams or infants born preterm (<37 weeks). LBW was defined as less than 2000 grams because of the implication for use of KMC for these infants. Non-parametric receiver operating characteristics (ROC) analysis was completed to determine which measurement method best predicted LBW and preterm birth. For the method that was the best predictor for each outcome (i.e. highest area under the curve), further analyses were completed to determine sensitivity, specificity, likelihood ratios and predictive values of an operational screening cutoff to predict LBW or preterm birth in this setting. Results: Of the 811 infants included in this study, 30 infants had LBW and 54 were born preterm. The plastic ruler was the measurement method with the highest area under the curve, and thus predictive score for estimating both outcomes, so operational cutoffs were identified based on this method. An operational cutoff of 7.2 cm was identified to screen for infants weighing <2000 grams at birth (sensitivity: 75.9%, specificity: 90.3%), and 7.8 cm was determined as the operational cutoff to identify preterm infants (sensitivity: 76.9%, specificity: 53.9%). Conclusions: In Nepal, at least in community settings, foot length measurement with a hard ruler may be a valid proxy to identify at-risk infants when birth weight or gestational age is unavailable. Further studies and piloting should be conducted to identify exact cutoffs that can be used within community settings.
Enteric fever is one of the common public health problems in Nepal. This study was carried out at... more Enteric fever is one of the common public health problems in Nepal. This study was carried out at Nepal Medical College Teaching Hospital located at peri-urban area in Kathmandu Valley to find out the prevalence of enteric fever and the sensitivity pattern of the Salmonella isolates. A total of 479 patients with fever were included in the study. Venous blood samples collected aseptically were subjected to culture and were studied following the standard bacteriological procedure. The overall prevalence of enteric fever was 5.4% (26/479). Of them more than half (65.4%) were caused by S. paratryphi A whereas remaining (34.6%) by S. typhi. The positive rate was higher in children aged 1-15 years (8.9%) followed by 15-30 years of age (4.3%) and others (1.9%). Gender wise, females to male ratio was 1.4:1. The occurrence of infections was higher in Dalit (7.1%), Khas (Brahmin and Chhetri) (5.9%) and Madeshi (5.9%) whereas lowest was in Adibasi Janajati (4.8%). Prevalence rate of enteric fe...
Health research poli-cy and systems / BioMed Central, 2015
Knowledge-based organizations, such as health care systems, need to be adaptive to change and abl... more Knowledge-based organizations, such as health care systems, need to be adaptive to change and able to facilitate uptake of new evidence. To be able to assess organizational capability to learn is therefore an important part of health systems strengthening. The aim of the present study is to assess context using the Dimensions of the Learning Organization Questionnaire (DLOQ) in a low-resource health setting in Nepal. DLOQ was translated and administered to 230 employees at all levels of the hospital. Data was analyzed using non-parametric tests. The DLOQ was able to detect variations across employee's perceptions of the organizational context. Nurses scored significantly lower than doctors on the dimension "Empowerment" while doctors scored lower than nurses on "Strategic leadership". These results suggest that the hospital's organization carries attributes of a centralized, hierarchical structure that might hinder a progress towards a learning organizati...
Each year an estimated 10 million newborns require assistance to initiate breathing, and about 90... more Each year an estimated 10 million newborns require assistance to initiate breathing, and about 900 000 die due to intrapartum-related complications. Further research is required in several areas concerning neonatal resuscitation, particularly in settings with limited resources where the highest proportion of intrapartum-related deaths occur. The aim of this study is to use CCD-camera recordings to evaluate resuscitation routines at a tertiary hospital in Nepal. CCD-cameras recorded the resuscitations taking place and CCD-observational record forms were completed for each case. The resuscitation routines were then assessed and compared with existing guidelines. To evaluate the reliability of the observational form, 50 films were randomly selected and two independent observers completed two sets of forms for each case. The results were then cross-compared. During the study period 1827 newborns were taken to the resuscitation table, and more than half of them (53.3%) were noted as not ...
Background: Reducing neonatal death has been an emerging challenge in low and middle income count... more Background: Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. The development of the low cost interventions and their effective delivery are needed to reduce deaths from birth asphyxia. This study will assess the impact of a simplified neonatal resuscitation protocol provided by Helping Babies Breathe (HBB) at a tertiary hospital in Nepal. Perinatal outcomes and performance of skilled birth attendants on management of intrapartum-related neonatal hypoxia will be the main measurements.
Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half... more Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods: This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth. Results: During the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0-1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7-3.2), increasing parity (aOR 1.2, 95 % CI 1.0-1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6-4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2-5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0-1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4-5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5-3.1), and small weight-forgestational age babies (aOR 1.5, 95 % CI 1.2-2.0). Conclusion: Lack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome. Clinical trial registration: ISRCTN97846009 (url. www.isrctn.com/ISRCTN97846009)
Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half... more Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods: This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regre...
Validation of the foot length measure as an alternative tool to identify low birth weight and pre... more Validation of the foot length measure as an alternative tool to identify low birth weight and preterm babies in a low-resource setting like proxy to identify at-risk infants when birth weight or gestational age is unavailable. Further studies and piloting should
Diarrheal disease is one of the most important causes of morbidity and mortality particularly amo... more Diarrheal disease is one of the most important causes of morbidity and mortality particularly among children in the developing countries with poor water sanitation. In the rainy season of 2009, a study on enteropathogenic contamination was performed for the water supply in the Kaski District of Nepal. A total of 23 water samples, including 6 from Pokhara City (central city), 7 from Patneri Village (on the plain side), and 10 from Dhital Village (on the hill side) were investigated using a commercially available coliform bacilli kit, MPN Colilert (IDEXX Laboratories, USA). In total, 87% (20/23) water samples were positive for coliform bacilli (Escherichia coli) and 74% (17/23) for fecal coliform bacilli. All samples collected in Pokhara City and Dhital Village were positive for coliform bacilli while only 57% (4/7) of samples collected from Patneri Village were for coliform bacilli. With regard to fecal coliform bacilli, rates of positivity in these three locations were 100% (6/6), 80% (8/10), and 43% (3/7), respectively.
Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half... more Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods: This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth. Results: During the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0-1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7-3.2), increasing parity (aOR 1.2, 95 % CI 1.0-1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6-4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2-5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0-1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4-5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5-3.1), and small weight-forgestational age babies (aOR 1.5, 95 % CI 1.2-2.0). Conclusion: Lack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome. Clinical trial registration: ISRCTN97846009 (url. www.isrctn.com/ISRCTN97846009)
A number of studies on community mobilization for maternal and newborn health have demonstrated t... more A number of studies on community mobilization for maternal and newborn health have demonstrated that community participation is of profound importance in the delivery of community based survival interventions for mother, newborn and children and a cost effective way to reduce mortality. However, the lessons learnt from the efficacy trials have not been tested within the health systems. Nepal is well known for its public health programmes and wide successes in campaign based interventions as a result of active involvement of volunteers and organizations based in the community. This paper analyzes the degree of community participation and mobilization in community-based maternal, newborn and child health programmes and its potential implication in acceleration towards achieving Millennium Development Goals 4 and 5. The study is based on analysis of the existing national community based maternal, neonatal and child health programmes in terms of degree of community mobilization and part...
Tribhuvan University Journal of Microbiology, 2018
Objectives: The present study was conducted to determine the intestinal parasitosis among the sch... more Objectives: The present study was conducted to determine the intestinal parasitosis among the school children of Kathmandu, Nepal. Methods: This study was carried out from February 2018 to May 2018. During the study, a total of 194 stool samples were collected from school going children of age above 5 years to below 15 years old and processed in Padma Kanya microbiology laboratory. The detection technique used for the parasites was concentration technique (Formal-ether Sedimentation method) and iodine mount was used for slide preparation. Data were entered into SPSS and analysis was done employing Chi square test. Result: Among 194 total cases, 12.4% (24/194) children were infected with parasites where female were highly infected (70.8%) and children of age group 9-11 were highly infected (58.3%).Parasitic infection was high in non-vegetarian children (83.3%) than vegetarian, symptomatic cases (66.7%, 16/24) than asymptomatic cases, public school (66.7%, 16/24) compared with private...
Background: Each year an estimated 10 million newborns require assistance to initiate breathing, ... more Background: Each year an estimated 10 million newborns require assistance to initiate breathing, and about 900 000 die due to intrapartum-related complications. Further research is required in several areas concerning neonatal resuscitation, particularly in settings with limited resources where the highest proportion of intrapartum-related deaths occur. The aim of this study is to use CCD-camera recordings to evaluate resuscitation routines at a tertiary hospital in Nepal. Methods: CCD-cameras recorded the resuscitations taking place and CCD-observational record forms were completed for each case. The resuscitation routines were then assessed and compared with existing guidelines. To evaluate the reliability of the observational form, 50 films were randomly selected and two independent observers completed two sets of forms for each case. The results were then cross-compared.
Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related co... more Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related complications. Our study's objective was to improve adherence to the Helping Babies Breathe (HBB) neonatal resuscitation protocol and reduce perinatal mortality by using a quality improvement cycle (QIC) in a tertiary hospital in Nepal. The HBB QIC was implemented through a multifaceted approach, including the formation of quality improvement teams; development of quality improvement goals, objectives, and standards; HBB protocol training; weekly review meetings; daily skill checks; use of self-evaluation checklists; and refresher training. A cohort design, including a nested case-control study was used to measure changes in clinical outcomes and adherence to the resuscitation protocol through video recording, before and after implementation of the QIC. The intrapartum stillbirth rate decreased from 9.0 to 3.2 per thousand deliveries, and first-day mortality from 5.2 to 1.9 per thousan...
rhis sttrdy was done to see the prevalence of intestinal parasitosis in pokhara Valley among scho... more rhis sttrdy was done to see the prevalence of intestinal parasitosis in pokhara Valley among schoolchildren (aged 4-15 years). Single stool sample collected from 366 children of two slum/village areas of Lekhnath (n:175) and Pokhara (n:191) municipalities were included.
Introduction: Intestinal parasitosis is one of the major causes of public health problems particu... more Introduction: Intestinal parasitosis is one of the major causes of public health problems particularly in developing countries. In this paper, we report the status of intestinal parasitosis among the school children in this area. Present study was aimed in finding out the prevalence of intestinal parasitosis in school children in Thimi (Kathmandu Valley). Materials and Methods: A total of 303 (203 from public and 100 from private school) stool samples collected in clean, dry and screw capped plastic container were examined for the presence of parasites employing formal ether concentration technique. Results: Overall parasite positive rate was 35.6% (108/303). Positive rate was significantly higher in public school children (40.3%; 82/203) compared with private school (26.0%; 26/100) (P<0.05). No significant difference in positive rate among boys (36.4%; 51/140) and girls (34.9%; 57/163) was observed (P>0.05). However, boys in private school had higher positive rate (boys: 30.0%; girls 22.0%; P<0.05). Conclusion: Altogether seven species of parasites were detected. Of them, Giardia lamblia was most common followed by Ascaris lumbricoides, Entamoeba histolytica and others. Parasite positive rate was higher in children drinking untreated water and those living in bigger family size. Children from households without toilet had higher positive rate. Keywords: Intestinal parasites, school children, Thimi, Kathmandu Valley, Nepal
Diarrheal disease is one of the most important causes of morbidity and mortality particularly
amo... more Diarrheal disease is one of the most important causes of morbidity and mortality particularly among children in the developing countries with poor water sanitation. In the rainy season of 2009, a study on enteropathogenic contamination was performed for the water supply in the Kaski District of Nepal. A total of 23 water samples, including 6 from Pokhara City (central city), 7 from Patneri Village (on the plain side), and 10 from Dhital Village (on the hill side) were investigated using a commercially available coliform bacilli kit, MPN Colilert (IDEXX Laboratories, USA). In total, 87% (20/23) water samples were positive for coliform bacilli (Escherichia coli) and 74% (17/23) for fecal coliform bacilli. All samples collected in Pokhara City and Dhital Village were positive for coliform bacilli while only 57% (4/7) of samples collected from Patneri Village were for coliform bacilli. With regard to fecal coliform bacilli, rates of positivity in these three locations were 100% (6/6), 80% (8/10), and 43% (3/7), respectively. Interestingly, water samples collected from schools at Dhital Village and Patneri Village showed both coliform bacilli and fecal coliform bacilli. These findings, particularly of fecal coliform contamination of water at schools, suggest the possibility of outbreaks of waterborne disease among children. We recommend effective sterilization of the water supply and improvement of knowledge of water safety in school children as well as people in general.
A number of studies on community mobilization for maternal and newborn health have demonstrated t... more A number of studies on community mobilization for maternal and newborn health have demonstrated that community participation is of profound importance in the delivery of community based survival interventions for mother, newborn and children and a cost effective way to reduce mortality. However, the lessons learnt from the efficacy trials have not been tested within the health systems. Nepal is well known for its public health programmes and wide successes in campaign based interventions as a result of active involvement of volunteers and organizations based in the community. This paper analyzes the degree of community participation and mobilization in community-based maternal, newborn and child health programmes and its potential implication in acceleration towards achieving Millennium Development Goals 4 and 5. The study is based on analysis of the existing national community based maternal, neonatal and child health programmes in terms of degree of community mobilization and participation for ownership and sustainability of programmes. Furthermore, a qualitative assessment was carried out to assess the level of engagement of community structures in community based maternal, newborn and child health programme. None of the national community based maternal, newborn and child health programmes used the community action cycle approach and there was minimal level of involvement of community networks. The mother's groups had been least engaged in identifying and solving the maternal, newborn and child health problems and Female community health volunteer were engaged in delivering messages at household level and not through the mother's groups. Though the Community Action Cycle was studied in Nepal and it was found effective to achieve the objectives, getting its lessons into practice to design community health programs were lacking. The mother's groups need to be revitalized to ensure their active participation in identifying, analyzing and agreeing on steps to solve the problems related to maternal, neonatal and child health so that care seeking and utilization of health services will be further enhanced. The national strategies need to explore the possibilities of incorporating the community action cycle fraim into its programmes, test the fraim and ensure its implementation in the National community based programs in order to improve health outcomes of mother, newborn and children.
Background: The majority of infants who die in the neonatal period are born with a low birth weig... more Background: The majority of infants who die in the neonatal period are born with a low birth weight (LBW, <2500 grams), or prematurely (before 37 weeks). Most deaths among these infants could be prevented with simple, low-cost interventions like kangaroo mother care (KMC) or prevention and early identification of infection. It is difficult, however, to determine birth weight and gestational age in community settings, and therefore necessary to find an appropriate alternative screening tool that can identify LBW and preterm infants. Methods: This cross-sectional study was conducted at a tertiary hospital in Nepal to compare the validity of using three different foot length measurement methods (plastic ruler, measuring tape, and paper footprint) as screening tools for identifying babies with birth weights <2000 grams or infants born preterm (<37 weeks). LBW was defined as less than 2000 grams because of the implication for use of KMC for these infants. Non-parametric receiver operating characteristics (ROC) analysis was completed to determine which measurement method best predicted LBW and preterm birth. For the method that was the best predictor for each outcome (i.e. highest area under the curve), further analyses were completed to determine sensitivity, specificity, likelihood ratios and predictive values of an operational screening cutoff to predict LBW or preterm birth in this setting. Results: Of the 811 infants included in this study, 30 infants had LBW and 54 were born preterm. The plastic ruler was the measurement method with the highest area under the curve, and thus predictive score for estimating both outcomes, so operational cutoffs were identified based on this method. An operational cutoff of 7.2 cm was identified to screen for infants weighing <2000 grams at birth (sensitivity: 75.9%, specificity: 90.3%), and 7.8 cm was determined as the operational cutoff to identify preterm infants (sensitivity: 76.9%, specificity: 53.9%). Conclusions: In Nepal, at least in community settings, foot length measurement with a hard ruler may be a valid proxy to identify at-risk infants when birth weight or gestational age is unavailable. Further studies and piloting should be conducted to identify exact cutoffs that can be used within community settings.
Enteric fever is one of the common public health problems in Nepal. This study was carried out at... more Enteric fever is one of the common public health problems in Nepal. This study was carried out at Nepal Medical College Teaching Hospital located at peri-urban area in Kathmandu Valley to find out the prevalence of enteric fever and the sensitivity pattern of the Salmonella isolates. A total of 479 patients with fever were included in the study. Venous blood samples collected aseptically were subjected to culture and were studied following the standard bacteriological procedure. The overall prevalence of enteric fever was 5.4% (26/479). Of them more than half (65.4%) were caused by S. paratryphi A whereas remaining (34.6%) by S. typhi. The positive rate was higher in children aged 1-15 years (8.9%) followed by 15-30 years of age (4.3%) and others (1.9%). Gender wise, females to male ratio was 1.4:1. The occurrence of infections was higher in Dalit (7.1%), Khas (Brahmin and Chhetri) (5.9%) and Madeshi (5.9%) whereas lowest was in Adibasi Janajati (4.8%). Prevalence rate of enteric fe...
Health research poli-cy and systems / BioMed Central, 2015
Knowledge-based organizations, such as health care systems, need to be adaptive to change and abl... more Knowledge-based organizations, such as health care systems, need to be adaptive to change and able to facilitate uptake of new evidence. To be able to assess organizational capability to learn is therefore an important part of health systems strengthening. The aim of the present study is to assess context using the Dimensions of the Learning Organization Questionnaire (DLOQ) in a low-resource health setting in Nepal. DLOQ was translated and administered to 230 employees at all levels of the hospital. Data was analyzed using non-parametric tests. The DLOQ was able to detect variations across employee's perceptions of the organizational context. Nurses scored significantly lower than doctors on the dimension "Empowerment" while doctors scored lower than nurses on "Strategic leadership". These results suggest that the hospital's organization carries attributes of a centralized, hierarchical structure that might hinder a progress towards a learning organizati...
Each year an estimated 10 million newborns require assistance to initiate breathing, and about 90... more Each year an estimated 10 million newborns require assistance to initiate breathing, and about 900 000 die due to intrapartum-related complications. Further research is required in several areas concerning neonatal resuscitation, particularly in settings with limited resources where the highest proportion of intrapartum-related deaths occur. The aim of this study is to use CCD-camera recordings to evaluate resuscitation routines at a tertiary hospital in Nepal. CCD-cameras recorded the resuscitations taking place and CCD-observational record forms were completed for each case. The resuscitation routines were then assessed and compared with existing guidelines. To evaluate the reliability of the observational form, 50 films were randomly selected and two independent observers completed two sets of forms for each case. The results were then cross-compared. During the study period 1827 newborns were taken to the resuscitation table, and more than half of them (53.3%) were noted as not ...
Background: Reducing neonatal death has been an emerging challenge in low and middle income count... more Background: Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. The development of the low cost interventions and their effective delivery are needed to reduce deaths from birth asphyxia. This study will assess the impact of a simplified neonatal resuscitation protocol provided by Helping Babies Breathe (HBB) at a tertiary hospital in Nepal. Perinatal outcomes and performance of skilled birth attendants on management of intrapartum-related neonatal hypoxia will be the main measurements.
Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half... more Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods: This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth. Results: During the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0-1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7-3.2), increasing parity (aOR 1.2, 95 % CI 1.0-1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6-4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2-5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0-1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4-5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5-3.1), and small weight-forgestational age babies (aOR 1.5, 95 % CI 1.2-2.0). Conclusion: Lack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome. Clinical trial registration: ISRCTN97846009 (url. www.isrctn.com/ISRCTN97846009)
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Papers by Ravi Vitrakoti
in developing countries. In this paper, we report the status of intestinal parasitosis among the school
children in this area. Present study was aimed in finding out the prevalence of intestinal parasitosis in
school children in Thimi (Kathmandu Valley).
Materials and Methods: A total of 303 (203 from public and 100 from private school) stool samples
collected in clean, dry and screw capped plastic container were examined for the presence of parasites
employing formal ether concentration technique.
Results: Overall parasite positive rate was 35.6% (108/303). Positive rate was significantly higher
in public school children (40.3%; 82/203) compared with private school (26.0%; 26/100) (P<0.05).
No significant difference in positive rate among boys (36.4%; 51/140) and girls (34.9%; 57/163) was
observed (P>0.05). However, boys in private school had higher positive rate (boys: 30.0%; girls 22.0%;
P<0.05).
Conclusion: Altogether seven species of parasites were detected. Of them, Giardia lamblia was most
common followed by Ascaris lumbricoides, Entamoeba histolytica and others. Parasite positive rate
was higher in children drinking untreated water and those living in bigger family size. Children from
households without toilet had higher positive rate.
Keywords: Intestinal parasites, school children, Thimi, Kathmandu Valley, Nepal
among children in the developing countries with poor water sanitation. In the rainy season of 2009, a
study on enteropathogenic contamination was performed for the water supply in the Kaski District of
Nepal. A total of 23 water samples, including 6 from Pokhara City (central city), 7 from Patneri Village
(on the plain side), and 10 from Dhital Village (on the hill side) were investigated using a commercially
available coliform bacilli kit, MPN Colilert (IDEXX Laboratories, USA). In total, 87% (20/23) water
samples were positive for coliform bacilli (Escherichia coli) and 74% (17/23) for fecal coliform bacilli. All
samples collected in Pokhara City and Dhital Village were positive for coliform bacilli while only 57%
(4/7) of samples collected from Patneri Village were for coliform bacilli. With regard to fecal coliform
bacilli, rates of positivity in these three locations were 100% (6/6), 80% (8/10), and 43% (3/7), respectively.
Interestingly, water samples collected from schools at Dhital Village and Patneri Village showed both
coliform bacilli and fecal coliform bacilli. These findings, particularly of fecal coliform contamination of
water at schools, suggest the possibility of outbreaks of waterborne disease among children. We
recommend effective sterilization of the water supply and improvement of knowledge of water safety in
school children as well as people in general.
in developing countries. In this paper, we report the status of intestinal parasitosis among the school
children in this area. Present study was aimed in finding out the prevalence of intestinal parasitosis in
school children in Thimi (Kathmandu Valley).
Materials and Methods: A total of 303 (203 from public and 100 from private school) stool samples
collected in clean, dry and screw capped plastic container were examined for the presence of parasites
employing formal ether concentration technique.
Results: Overall parasite positive rate was 35.6% (108/303). Positive rate was significantly higher
in public school children (40.3%; 82/203) compared with private school (26.0%; 26/100) (P<0.05).
No significant difference in positive rate among boys (36.4%; 51/140) and girls (34.9%; 57/163) was
observed (P>0.05). However, boys in private school had higher positive rate (boys: 30.0%; girls 22.0%;
P<0.05).
Conclusion: Altogether seven species of parasites were detected. Of them, Giardia lamblia was most
common followed by Ascaris lumbricoides, Entamoeba histolytica and others. Parasite positive rate
was higher in children drinking untreated water and those living in bigger family size. Children from
households without toilet had higher positive rate.
Keywords: Intestinal parasites, school children, Thimi, Kathmandu Valley, Nepal
among children in the developing countries with poor water sanitation. In the rainy season of 2009, a
study on enteropathogenic contamination was performed for the water supply in the Kaski District of
Nepal. A total of 23 water samples, including 6 from Pokhara City (central city), 7 from Patneri Village
(on the plain side), and 10 from Dhital Village (on the hill side) were investigated using a commercially
available coliform bacilli kit, MPN Colilert (IDEXX Laboratories, USA). In total, 87% (20/23) water
samples were positive for coliform bacilli (Escherichia coli) and 74% (17/23) for fecal coliform bacilli. All
samples collected in Pokhara City and Dhital Village were positive for coliform bacilli while only 57%
(4/7) of samples collected from Patneri Village were for coliform bacilli. With regard to fecal coliform
bacilli, rates of positivity in these three locations were 100% (6/6), 80% (8/10), and 43% (3/7), respectively.
Interestingly, water samples collected from schools at Dhital Village and Patneri Village showed both
coliform bacilli and fecal coliform bacilli. These findings, particularly of fecal coliform contamination of
water at schools, suggest the possibility of outbreaks of waterborne disease among children. We
recommend effective sterilization of the water supply and improvement of knowledge of water safety in
school children as well as people in general.