Journal Issue: Volume: 29, No. 2, (2009)
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Issue Date
2009
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Are we Practicing Evidenced Based Medicine for Common Paediatric Problems?
(Nepal Paediatric Society (JNPS), 2009) Sharma, Pushpa Raj
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Maternal Risk Factors and Morbidity Pattern of Very Low Birth Weight Infants: A NICU Based Study at Eastern Nepal
(Nepal Paediatric Society (JNPS), 2009) Poudel, Prakash; Budhathoki, Sunil; Shrivastava, Manoj Kumar
Abstract:
Background: Preterm deliveries of babies weighing less than 1500 grams (VLBW, very low birth weight) are of major concern because of maximum perinatal morbidity and mortality found in this group. VLBW babies overload the neonatal intensive care unit (NICU) and their mortality contributes significantly to neonatal and infant mortality.
Objectives: To study the common maternal risk factors associated with VLBW births. To study the morbidity and mortality patterns of VLBW babies.
Methods: This was a hospital based retrospective study done in NICU of BP Koirala Institute of Health Sciences. Data were collected from medical records of VLBW babies admitted in NICU over a period of three years (13 April 2005 to 12 April 2008). Data were analyzed with SPSS 10.0 software.
Results: Data of 140 VLBW babies were analyzed. Mean birth weight was 1188.9 (±212.78), 10.7% were home deliveries, 24.3% were twins, 31.4% required active resuscitation at birth and 46.4% were exposed to antenatal steroid. Common maternal risk factors associated with premature deliveries were inadequate antenatal check up (ANC) visits (95.7%), twin pregnancy (24.3%), antepartum hemorrhage (APH, 28.6%), premature rupture of membrane (23.6%), pregnancy induced hypertension (12.9%), bad obstetric history (12.9%) and maternal age less than 20 years (8.6%). Common morbidities among VLBW babies were clinical sepsis (77.1%), non physiological hyperbilirubinemia (73.6%), apnea (48.6%), shock (42.9%), hypoglycemia(39.3%), anemia (29.3%), hyaline membrane disease (HMD, 21.4%), patent ductus arteriosus (15.0%), severe hypothermia (12.1%), culture proven sepsis (15.7%), retinopathy of prematurity (5.7%), and bronchopulmonary dysplasia (3.6%). Overall survival was 54.3% and major causes of death were HMD (51.0%) and sepsis (34.7%). Median durations of hospital stay were 17.5 days for survivors and five days for expired cases.
Conclusion: Increasing the coverage of ANC visits, early diagnosis and treatment of APH and pregnancy induced hypertension, discouraging the childbirth at too young age, early diagnosis and treatment of acute infections and chronic medical diseases in mothers are important measures to decrease the burden of VLBW births. Common morbidities in VLBW babies are sepsis, HMD, apnea, hyperbilirubinemia, patent ductus arteriosus, shock, anemia, hypoglycemia, hypothermia and hypocalcemia. Common causes death of VLBW babies are HMD and sepsis. Overall survival of VLBW babies in our settings is less. More numbers of well equipped NICUs and services like surfactant therapy are needed to improve survival of VLBW infants in our set up.
Study of Visceral Leishmaniasis (Kala-azar) in Children of Nepal
(Nepal Paediatric Society (JNPS), 2009) Joshi, Durga Datt
Abstract:
Introduction: Visceral leishmaniasis (VL) or Kala-azar is a potentially fatal vector-borne (sand fly phlebotomies spp) zoonotic disease caused by a protozoan parasite, Leishmania donovani. In Nepal, the disease is restricted to the Eastern Terai region which lies adjacent to the Bihar state of India. Although leishmaniasis is regarded as a significant health problem in Nepal by the Ministry of Health, there is no active case detection programme in the country.
Objective: Objectives of this study were to determine the up-to-date morbidity and mortality trend for VL in children of Nepal.
Method: The epidemiological surveillance team from the NZFHRC visited to eight zonal hospitals in Terai region during the month from September to December of each year 2003 to 2007. The morbidity and mortality data up to the year 2007 were collected every year. The team has also collected 66 blood serum samples of which 18 samples from children were collected for the diagnosis.
Results: A total 25890 cases with 599 deaths were reported during the year 1980-2006. The case fatality rate (CFR) varied from 0.23% to 13.2%. Districtwise analysis showed that, during 2003, highest incidence was in Mahottari district (184/100,000), followed by Sarlahi (100/100,000) and Sunsari (96/100,000). The highest CFR was in Dhanusha (2.9%) followed by Bara (2.4%) and Saptari (2.0%). Majority (70.9%) of persons affected by VL were aged 15 years and above, followed by 10-14 years (13.9%), 5-9 years (11.9%) and 1-4 years (3.3%). VL cases recorded from different district of Nepal for the year 2004, 2005, 2006 and 2007 are recorded. CFR for the year 2004, 2005, 2006 and 2007 were 3.2%, 3.7%, 16.67% and 11.42% respectively.
Conclusions: There should be regular surveillance research work to be carried out in endemic area. Mass public health education, to make the people aware about preventive aspects of the disease is important. The possibility of the existence of animal reservoirs as zoonotic disease should also be considered. This disease is very much serious in children below 15 years of age both in male and female, therefore it is essential to have paediatrician post at least in all VL six endemic districts.
Determinant of Early Initiation of Breastfeeding in a Tertiary Neonatal Unit
(Nepal Paediatric Society (JNPS), 2009) Nepal, Deepeshwara; Jeeva, Sankar M; Misra, Satish M; Paul, Vinod K
Abstract:
Introduction: Initiation of breastfeeding within one hour of birth is an important determinant of successful breastfeeding. National Family and Health Survey -3(NFHS-3) reported that only 23.4% of children < 3 years were breastfed within one hour of birth.
Objectives: the purpose of this study is to study the determinant of initiation of breastfeeding within one hour of birth.
Setting: Tertiary -level neonatal unit.
Material and Methods: All mothers admitted in the postnatal ward were eligible for inclusion; mothers of sick and /or preterm infants were excluded. Enrolled mothers were interviewed between 24 and 72 hours after delivery.
Results: The proportion of mothers who initiated breast feeding within one hour of delivery was 32%, between 1-6 hrs were 47% and between 6 to 48 hrs were 21%. Maternal age, education, socioeconomic status, occupation and antenatal or labor room counseling did not influence the initiation of breast feeding within one hour of delivery in univariate analysis. On multivariate analysis, admission in the general ward and delivery by caesarean section were found to be significantly associated with not initiating breastfeeding within one hour (adjusted ORs: 8.79, 2.48 to 31.08, p=0.001 and 6.79, 4.07 to 22.02 p=0.001 respectively). Only about 13% of the infants received prelacteal feeds.
Conclusion: Mothers delivering by caesarean section or admitted in the general ward were at high risk of not initiating breastfeeding within one hour. Innovative strategies are required to ensure timely ignition of breastfeeding.
Child Health Status of Nepal: Social Exclusion Perspective
(Nepal Paediatric Society (JNPS), 2009) Gurung, Gagan
Abstract:
Introduction: Nepal has achieved a spectacular success in child health over the last decades but the achievement is not uniform across different social groups. Therefore, there is urgent need to identify the groups who are excluded from access of child health services which would give us population at risk to prioritize and utilize the scarce resources available in health sector more effectively and efficiently.
Methods: The study was descriptive type and was based on review of secondary data of different studies done in past. The study used World Bank framework of dimension of exclusion to analyze social exclusion in child health in Nepal. The health differentials in child health across different social groups were analyzed using simple descriptive analysis like percentage and ratios. The trends of the child health disparities over the ten years were done comparing the data of NFHS1996 and NDHS 2006.
Results: The study showed there were disparities in child health status by ethnicity, location, wealth status. In most of the cases, the trends of disparities are increasing for mortality indicators and malnutrition status. Interestingly, the gaps in accessibility indicators of child health services are becoming narrowed down.
Conclusion: This study showed the discrepancies in child health status in different social groups. The inequality in childhood mortality and malnutrition are increasing over the period for different groups where as it is decreasing for accessibility indicators of childhood health services.