Perception and knowledge about HIV/AIDS among Nepalese adolescent

Background and Objectives: Nepal is confronted with increasing incidence of HIV among adolescents. There is need to ensure, these people have correct knowledge for HIV prevention. Hence, this study was carried out to assess the perception and knowledge of adolescents regarding HIV/AIDS and to identify the areas of misconception that might serve as an important target of educational intervention. Methodology: A self designed questionnaire regarding knowledge and perception about HIV/AIDS was distributed to the students of secondary school who attended the heath assessment program organized by Kist Medical College. Submitted questionnaires were analyzed and tabulated to find out the existing knowledge and attitude of the participants. Results: Knowledge regarding HIV/AIDS was satisfactory. Seventy-nine percentage of female and 64% male agreed to care for HIV/AIDS patients. However there were still misconceptions about transmission. Sixty-two percentages thought that contraceptive pills prevent HIV transmission. Thirty two percent thought that mosquito can transmit HIV, 21 % replied that sharing of utensils, and towels etc can transmit HIV. Forty five percentage of the participants thought that someone who looks healthy cannot transmit HIV. Conclusion: Perception regarding HIV/AIDS was satisfactory. Some areas of misconception was detected which can be overcome with proper educational interventions.

Enteric Fever in Children at Dhulikhel Hospital.

Introduction: Typhoid fever is one of the most common public health problems in Nepal. It occurs in all parts of the world where water supplies and sanitation are sub-standard. In Dhulikhel hospital, this is one of the top acute febrile illnesses in inpatient department. The objectives of this study were to evaluate the clinical and laboratory parameters including culture and sensitivity, the response to therapy, and complications of enteric fever among child cases at Dhulikhel Hospital. Materials and Methods: This retrospective study was conducted at Dhulikhel Hospital, Kathmandu University Teaching Hospital from January 2009 to June 2011. Statistical analysis was done with SPSS. Results: There were total of 138 cases of enteric fever admitted. There were 73 (53%) male and 65 (47%) female. Eighty-one percent were above five years of age. The most common clinical presentation was fever (100%) followed by headache and G I symptoms. Hepatomegaly was the most common sign seen among the cases and was seen in 110cases (79.71%). Most of the patients had normal WBC count 100 (72.46%) Widal test was positive in 70 (50.72%) cases and blood culture was positive in 52(37.68%) cases. Nalidixic acid was found to be resistant in 26 (50%) cases. Complications were seen in only 7 (5%) enteric fever cases. Conclusion: Typhoid fever is predominant in school going children in Nepal with slight male predominance. Fever lasting over 3 days followed by headache and GI symptoms are the major presenting symptoms. In making the diagnosis, the isolation of bacteria from blood is the “gold standard”. Nalidixic acid resistant Salmonella typhi is on the increasing trend. Pneumonia was found to be the most common complication among all other complications seen in enteric cases. In Dhulikhel Hospital this is one of the top acute febrile illnesses in inpatient department.

Clinical Profile and Outcome of Acute Encephalitis Syndrome in Dhulikhel Hospital of Nepal.

Introduction: Acute encephalitis syndrome (AES) is a constellation of clinical signs and or symptoms i.e. acute fever with acute change in mental status. AES may be present as encephalitis, meningoencephalitis or meningitis. It can be associated with severe complication, including impaired consciousness, seizure, limb paresis or death. Materials and Methods: Study consisted of retrospective analysis of hospital records of children up to 16 years of age admitted with diagnosis of AES in the department of Paediatrics Dhulikhel Hospital, Kathmandu University Teaching Hospital, Dhulikhel Kavre from January 2010 to December 2011. Results: During the two years (January 2010 to December 2011), 47 patients of AES were admitted. Among the admitted cases there were 34 male and 13 female patients. Meningitis cases were 29, encephalitis cases were 14 and 4 meningoencephalitis cases. Among the meningitis cases, viral meningitis accounted for 12, bacterial meningitis accounted for 15 and 1 tubercular meningitis.One was eosinopilic meningitis in which the causative organism was found to be fasciolosis by ELISA. Viral encephalitis was found to be the most common cause of encephalitis. Sensorineural hearing loss was seen in 3 cases, subdural effusion in 1 and hydrocephalus in 1. One patient had intracranial hemorrhage with hemiparesis as a complication of eosinophilic meningitis. Conclusion: Acute encephalitis syndrome is one of the most common causes of PICU admission in Dhulikhel hospital. Bacterial meningitis was common among the acute encephalitis syndrome followed by viral meningitis. One case of eosinophilic meningitis with intracranical hemorrhage and hemiparesis was found. Sensorineural hearing loss was found to be commonest complication.

Bacteriological Profile of Neonatal Sepsis: A Hospital Based Study.

Introduction: Neonatal sepsis is a major cause of mortality and morbidity in newborn. There are many factors that contribute to neonatal sepsis. The organisms responsible for early onset and late onset sepsis are different. Objective: This study was conducted to analyze the organisms responsible for early onset and late onset neonatal sepsis. Materials and Methods: A prospective hospital based study over the period of one year was conducted at neonatal intermediate care unit of Kanti Children’s Hospital, Maharajgunj, Kathmandu, Nepal. Results: Organisms were isolated in 6.1% of the collected blood samples. The male female ratio of culture proven sepsis was 1.9:1. Escherichia coli were found to be the most common organism in both early onset and late onset sepsis. Staphylococcus aureus was more common in late onset sepsis than early onset sepsis. Conclusion: Escherichia coli were the most common organism in both early onset and late onset sepsis. Staphylococcal aureus was significantly more common in late onset sepsis than early onset sepsis.

Need of expansion of special adolescent clinic.

A cross sectional study has been done over a period of one year to find out the total number of young people, adolescents and youth attending at general gynaecological OPD and special adolescent clinic and to analyse them in terms of their sex, ethnicity, address, marital status, education, occupation and their health problems in a teaching hospital at Kathmandu. Of the total 2480 patients 31.29% were young people, 18.34% of them were adolescents and 30.52% of them were youth. Male attendance was insignificant. Majority (91%) of the young people were Brahmins, Newars and Chhetriyas. Most (91%) of them were from Kathmandu valley, 73% were already married and 60% had experienced pregnancy. Approximately 12% of these people were illiterate, 24.85% of them had not completed the primary level education. Only 19%of them had completed the SLC examination Lack of education, trend of early marriage has been reflected on to their occupation. 64% of them are engaged in routine household work as housewives. Few (4.3%) of these young people were not doing anything at all. Majority (59%) of them presented with pregnancy related problems and rest of them came for problems like Pelvic infection, urinary tract infection, sub fertility, breast problems and others. This study conclude that good number of young people from different parts of the country attend special adolescent clinic with different needs. Therefore adolescent friendly services in the hospital need to be strengthened to provide special care for them.

Patients choice for method of early abortion among comprehensive abortion care (CAC) clients at Kathmandu Medical College Teaching Hospital (KMCTH).

OBJECTIVE: The over all objective of the study was to determine different methods of abortion opted by CAC clients at KMCTH. The specific objective of the study was to know the reasons for pregnancy termination and to know the reasons opted for either medical or surgical method of abortion. METHODOLOGY: A hospital based prospective study was carried out for a period of six months at KMCTH from 1st January 2006 to 31st June 2006. All the patient undergoing CAC services were included for the study. Clients were provided with written and verbal information regarding the methods of terminating early abortion and its associated complications. After that they were asked to give their informed choice and decision. All the pertinent information was entered on pre-structured questionnaire. RESULTS: During the study period a total of 100 patients underwent CAC services. The commonest reason for termination pregnancy was no desire for additional children (60%) followed by youngest child too small or short spacing (21%). 74% of the patients opted for surgical abortion, 23% patient opted for medical abortion and 3% of the patient remain undecided. Reasons for favouring surgical method of abortion was that surgical abortion is complete (35), repeated visits are avoided (18), quick (10) would be with service provider and feel safe (5), lack of expectancy (2) side effect of medical treatment (1), twin pregnancy (1), easy (1), fear of pain (1). Medical method of abortion was favoured due to fear of surgery (9), easy and less painful (8) and maintains privacy (6). CONCLUSION: Factors affecting the choice of abortion method appear to be numerous and complex. Providers need to be sensitive to differences in women's values and life circumstances when counselling them about an abortion method. In particular, providers should incorporate into their counselling sessions what women need to know about the characteristics of abortion methods and help women to identify what is the best option for them. Key words: Early abortion medical methods, surgical methods, choice.

Nuchal cord and perinatal outcome.

OBJECTIVE: to find out the incidence of nuchal cord at delivery, intrapartum complication and perinatal outcomes in the cases with nuchal cord. MATERIALS AND METHODS: A prospective, cross-sectional, comparative study done at Kathmandu Medical College Teaching Hospital (KMCTH) between March 2006 to September 2006. Total 512 deliveries occurred during this period that were enrolled in the study and were analyzed for presence of nuchal cord at the time of delivery, number of coils whether loose or tight, intrapartum complications and perinatal outcome. The cases with nuchal cord at the time of delivery were taken as study group and the cases without nuchal cord served as control group. Outcome variables between the two groups were compared. Outcome variables used were meconium staining of liquor, rate of instrumental and caesarean delivery, intrapartum fetal heart rate (FHR) irregularities. As a measure of perinatal outcome Apgar score<7 at 1 minute and 5 minutes and incidence of neonatal unit admission was taken. RESULTS: Incidence of nuchal cord at the time of delivery was 22.85%. Incidence of single nuchal cord was highest (18.95%). Intrapartum complications like FHR irregularities and meconium staining of liquor were increased in nuchal cord group but statistically not significant. Instrumental delivery rate was high in nuchal cord group but statistically not significant (0.108). However, caesarean section rate was high in the group without nuchal cord (p=0.029). Apgar score<7 at 1 minute was significantly low in nuchal cord group (p=0.010) but apgar score at 5 minutes and admission to neonatal unit was not more common. CONCLUSION: Nuchal cord is not associated with adverse perinatal outcome.

High risk nonmetastatic persistent gestational trophoblastic tumour following an abortion.

Locally invasive non-metastatic persistent gestational trophoblastic tumours (PGTT) following a non-molar pregnancy occur very rarely. Non-metastatic tumours usually falls in low risk group in WHO scoring system based on prognostic factors. We report a case of high risk non-metastatic PGTT which followed a spontaneous first trimester abortion. Complete remission of the tumour was achieved by chemotherapy EMA-CO regimen.

Evaluation of a successful intervention for sustainability and effects in post research phase.

INTRODUCTION: Promoting appropriate use of drugs is an essential element in achieving quality of health and medical cares for patients and the community, and also to minimize financial burden. OBJECTIVE: The objective of this paper is to assess the successful intervention for sustainability and effects in post research phase. To address these problems, a variety of educational, managerial and regulatory strategies to improve prescribing have been tried in Nepal. When training is combined with a managerial intervention i.e. peer-group discussion, it results into improved changes in prescribing practices of paramedics in several practices. METHODOLOGY: A prospective, three-way design study consisting of small group training, small group training followed by peer-group discussion and control was conducted in three regions of Nepal including one hill and two terai (plains) districts from each region. The study included all health post from the sampled districts, making 80 health posts the study population. RESULTS: The study revealed the effectiveness of the peer-group discussion approach in improving the prescribing practices. An assessment to identify the sustainability of the strategy and its effect within the district healthcare system after the completion of the research phase was undertaken. The study found that peer-group discussion was discontinued in all targeted districts and the improved practices were not sustained after the completion of the research. Various reasons have been found for not continuing the effective intervention.

Comprehensive abortion care service at Kathmandu Medical College--an experience.

INTRODUCTION: His Majesty's Government amended the Nepal Criminal Code (Muluki Ain)--for Liberalising abortion law in the month of Chaitra 2058 (March 2002) and Royal Assent was given on 10th Asoj 2059 (27th September 2002). Accordingly Comprehensive Abortion Care (CAC) Services was initiated in the country. Kathmandu Medical College after enlisting with Ministry of Health started this service from June 2004. OBJECTIVE: This study was carried out to know--1. Reasons for undergoing CAC service. 2. The complications after the CAC services. 3. The various contraceptive methods adopted by the client following CAC. METHODOLOGY: Hospital based prospective study was carried out in Department of Obstetrics & Gynaecology at KMCTH from the period July 2004 to April 2005. Total 160 patients who asked for CAC were enrolled in the study. Counselling, history taking and general examination and per vaginal examination was carried out at the visit. CAC was performed with premedication with Doxycycline 100 mg and Ibuprofen 400 mg half an hour before the procedure. Paracervical block was also given with 1% xylocaine. MVA was performed as described in standard techniques. Patient was discharged after 1-2 hours of observation and with contraception opted by the clients. RESULTS: Main reason for performing CAC was unwanted pregnancy in 66.75%. Complication following CAC was 1.25%. Post CAC contraception was adopted by 93%. Most preferred method was Inj. Depoprovera CONCLUSION: The reason for CAC service asked by the patients was unwanted pregnancy. CAC service performed had minimal complication and also gave the opportunity for contraception.