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.

B-Lynch brace suture simple surgical technique for managing post-partum haemorrhage - report of three cases.

Post-partum haemorrhage is a major contributor to maternal morbidity and mortality. Numerous medical and surgical therapies have been used but none has been uniformly successful. Three cases which were managed successfully with brace suture following failure of medical management for post-partum haemorrhage are being presented. The ease and usefulness of this procedure as a life saving measure, its relative safety and its capacity for preserving the uterus and thus fertility is high lighted.

Study of young people attending an adolescent friendly centre.

Adolescents are the individuals between the ages of 10 and 19 years and the youth are those between the ages of 15 to 24 years. World Health Organisation has therefore defined young people as individuals between the age group of 10 to 24 years. In our country Adolescents comprise more than one fifth (22%) of the total population. Therefore Family Health Division, Ministry of Health, established an adolescent friendly centre at Bir Hospital on 5th January 2002. This paper has tried to study and analyse the young population attending this centre at a fixed period of time. This study was carried out to a. Find out the total number of adolescents. b. Estimate their male: female ratio. c. Find out their ethnicity, address, marital status, education, and occupation d. Learn what Health and Development problems these young people have. This is a cross sectional study done at Bir Hospital adolescent friendly centre for a period of one year. All young people (adolescents and youths) coming to this centre within the specified period are included in this study. OPD register was used to collect the data, which was obtained and analysed manually. Total of 956 young people were provided healthcare and counselling services from this centre. Out of them, only 9.21 % were males. 887 (92.78%) of this population are adolescents, 69 (7.22%) are from 19 to 24 years age group and 880 (92.05%) of them are youth. Majority (28.56%) were Brahmins. 313 (32.74%) of these people were from outside the valley. 9 (10.23%) out of 88 boys and 384 (79.34%) out of 484 girls were married. 1.14% of boys and 14.63% of girls were illiterate. 4.55% of boys and 14.17% of girls had not completed the studies of standard five. 17.05% of boys and 47% of girls had not completed their school. 81.82% of boys and 38.36% of girls had joined the college. It also showed that 521 (54.50%) of these young people are students but 35.94% of girls are housewives. 278 (32.03%) girls presented with menstrual problems and 22.12% (192) came with pregnancy related problems and 15.27 % of these young people presented with the symptoms of various infections Twenty six (3%) girls came with features of anaemia and 22 (2.53%) girls had dropped in for family planning services. 20 (2.09%) of these young people had some psychological problem (mainly anxiety) and 9.62% of them had various types of skin problems. Adolescent friendly centre can play a vital role to support and help a good number of adolescents of the society. Key words: Adolescents, youths, and young people.

Painless delivery--a short experience.

PURPOSE: To determine efficacy and safety a randomized comparison of continuous infusion versus intermittent injection of epidural bupivacaine for labor analgesia was performed in the Maternity Hospital, Thapathali Kathmandu. METHODS: Twenty healthy parturient received a loading dose of 10 ml of epidural 0.1% bupivacaine with 25 mg of pethidine. They were then randomized to receive continuous infusion of 0.1% bupivacaine 10 ml/hour with the help of infusion pump or intermittent injection of 0.1% bupivacaine 10 ml hourly. For breakthrough pain 10 ml of 0.1% bupivacaine top ups given in both groups. The two groups were compared for analgesic efficacy, mode of delivery, patient assessment of analgesia, motor block and other complications. Data analyzed in Pentium III version with SPSS and statistical significance test is done with independent samples t-test. RESULTS: The 10 patients in each group were comparable in age but not in parity. Analgesic efficacy was excellent in 10 cases and comfortable in another 10 cases [excellent/comfortable 6:4 with infusion and 4:6 with intermittent injection]. There were no statistically significant differences between groups in pain scores or duration of active first or second stage of labor. Fifteen women had spontaneous vaginal deliveries, one caesarian section (infusion group) and four instrumental deliveries (intermittent injection group). Four women in the infusion group had hypotension and motor block, but none in the intermittent injection group. APGAR scores in both groups were 7-8/10 at 1 minute and 9-10/10 at 5 minutes. CONCLUSION: Both continuous infusion and intermittent injection of low dose bupivacaine are very good methods of relieving labor pain in our context. Analgesic efficacy was similar in both groups and there was no prolongation of second stage of labor.

A profile of menstrual disorders in a private set up.

Menstruation and its disorders are still considered unholy and impure and are not yet recognised as significant reproductive health morbidity. Therefore a prospective study was carried out at a private clinic for a period of three months where total number of patients coming with current or past menstrual problems are 525. This number did not include pregnant women or those on any hormonal medications or having dysfunctional uterine bleeding. This study aimed to find out the incidence of Menstrual Morbidity and their mode of presentation. It has also tried to find out these women's age, parity, age of menarche and number, following discriminating traditional rituals during their 1st and regular menses, their family planning status and the districts from where they came to Kathmandu for their treatment. In this study, menstrual morbidity was found to be 43.75%. Approximately 60% of women having menstrual complaints had absolutely normal menstrual cycle; whereas 13% of them had irregular, 17% of them had prolonged and 6% had short menstrual cycle. A significant number (46%) of women although suffering from menstrual problems presented with other symptoms like vaginal discharge, pain lower abdomen, subfertility, urinary problems, abdominal lumps and for cuT check-ups. 3% of the women who presented with vague, non-specific complaints asking for a general check up had one or the other menstrual problem. Although approximately 69% of these women were from the age group of 20-39 years, 4% of them were adolescents and 27% above 40 years. It was observed that although approximately 78% of these women were primi- and multiparous ladies, 22% were unmarried and nulliparous suffering from various menstrual morbidities. More than 55% of these women had their menarche at the age of 12-14 years. It was not surprising to note that more than 90% of women had to follow the traditional unhealthy and unsociable rituals during their first menstruation. More than 75% of them had to follow the discriminating traditional rituals which consider a menstruating woman untouchable for 5 days of every month throughout their active reproductive lives. 20% of these women were using non-hormonal contraceptive methods, out of which more than 50% had undergone permanent sterilisation. It was a matter of pride to note that this clinic was providing the health care services to the adolescents and women of 13 zones and more than 52 districts of the country.