Implementation of cervical cancer prevention and screening across five tertiary hospitals in Nepal and its policy implications: A mixed-methods study.

In Nepal, cervical cancer is the most common cancer among women despite the existing policies. This study intends to assess the implementation of cervical cancer prevention and screening through service utilization by women, knowledge and attitude among health professionals, and the perceptions of stakeholders in Nepal. This mixed-methods study was conducted in 2022 across five tertiary hospitals in Kathmandu, Nepal. The quantitative study comprised the health professionals and women attending gynecology outpatient clinics from the selected hospitals. The qualitative study comprised stakeholders including service providers and experts on cervical cancer from selected hospitals, civil societies, and the Ministry of Health and Population. The utilization of screening through pap smear among 657 women across five hospitals was 22.2% and HPV vaccination was 1.5%. The utilization of cervical cancer screening was associated with older age [adjusted odds ratio (AOR) = 1.09, CI: 1.07, 8.19], married (AOR = 3.024, CI: 1.12, 8.19), higher education (AOR = 3.024, CI:1.12, 8.42), oral contraceptives use (AOR = 2.49, CI: 1.36, 4.39), and ever heard of cervical cancer screening (AOR = 13.28, CI: 6.85, 25.73). Among 254 health professionals, the knowledge score was positively associated with them ever having a training [Standardized Beta (ß) = 0.20, CI: 0.44, 2.43)] and having outreach activities in their hospital (ß = 0.19 CI: 0.89, 9.53) regarding cervical cancer screening. The female as compared to male health professionals (ß = 0.16, CI: 0.41, 8.16, P = 0.03) and having a cervical cancer screening guideline as compared to none (ß = 0.19 CI: 0.89, 9.53, P = 0.026) were more likely to have a better attitude for screening. The qualitative findings among 23 stakeholders reflected implementation challenges in policy, supply, service delivery, providers, and community. This study showed low utilization of prevention and services by women and implementation gaps on cervical cancer prevention and screening services across five tertiary hospitals in Kathmandu, Nepal. The findings could help designing more focused interventions.

Prelabour Rupture of Membranes among Pregnant Women Visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Prelabour rupture of membranes is a common obstetrics problem associated with maternal and perinatal morbidity and mortality. The exact cause is not known although various factors are found to be related to this condition. Hence, the objective of this study was to find out the prevalence of prelabour rupture of membranes among pregnant women in a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted from 1 November 2021 to 30 November 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/79/49). A structured proforma was filled out after taking a detailed history from each pregnant woman. Convenience sampling method was used. Point estimate and 99% Confidence Interval were calculated. Results: Among 700 pregnant women, the prevalence of prelabour rupture of membranes was 56 (8%) (5.36-10.64, 99% Confidence Interval). Among them, 40 (71.43%) occurred in the term, while preterm (before 37 weeks) occurred in 16 (28.57%) of all pregnancies. Previous miscarriage occurred in 15 (26.78%) followed by gestational diabetes mellitus 8 (14.28%). Conclusions: The prevalence of prelabour rupture of membranes was found to be lower than other studies done in similar settings. Keywords: miscarriage; oligohydramnios; prevalence.

Contraception Use among Women Visiting Outpatient Department of Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Family planning services can bring a wide range of benefits to women, their families and society as a whole. Many women of reproductive age have little or incorrect information about family planning methods. Even when they know some methods of contraceptives, they don't know the availability or how to use them properly. The aim of this study is to find out the prevalence of contraception use among women visiting the outpatient department of gynaecology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among women visiting the gynaecological outpatient department from 10 April 2021 to 10 April 2022 after taking ethical approval from the Institutional review committee (Reference number: 2079/80-03). Women aged 18 to 49 years visiting during the study period were included and pregnant, postmenopausal and unmarried women were excluded from the study. Data was collected from one-to-one interviews. A convenience sampling method was used. Point estimate and 95% confidence interval were calculated. Results: Out of 208 patients, 146 (70.19%) (63.97-76.41, 95% Confidence Interval) women were currently using contraceptives. Short-acting reversible contraception was used by 97 (66.44%) and long-acting reversible contraception was used by 23 (15.75%). A total of 21 (14.38%) women used permanent sterilisation. The most commonly used contraceptive device was Depo Provera, 43 (29.45%) followed by condoms, 29 (19.86%). Conclusions: The prevalence of contraception use is lower than the other studies done in similar settings. Therefore, contraception promotion programs have to be encouraged to promote the efficient use of contraception. Keywords: contraception; family planning; prevalence; women.

Premenstrual Syndrome among Medical Students of a Medical College: A Descriptive Cross-sectional Study.

Introduction: Premenstrual syndrome is the premenstrual disorder with wide range of prevalence world-wide leading to higher rates of work absences, higher medical expenses, and lower health-related quality of life. The aim of this study was to find out the prevalence of premenstrual syndrome among medical students of a medical college. Methods: A descriptive cross sectional study was conducted in a medical college among medical students using self-reported questionnaires based on American College of Obstetricians and Gynaecologists criteria for premenstrual syndrome, and 12-Item Short Form Health Survey for quality of life, from 1 January 2022 to 31 March 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 207807955). Convenience sampling was used among students who met the inclusion criteria. Point estimate and 95% Confidence Interval were calculated. Results: Among 113 patients, premenstrual syndrome according was seen in 83 (73.45%) (82.93-83.06, 95% Confidence Interval) out of which, 56 (67.46%) showed mild premenstrual syndrome, and 27 (32.53%) had moderate premenstrual syndrome. The most commonly reported affective symptoms of premenstrual syndrome was irritability 82 (98.79%), while the somatic symptoms was abdominal bloating 63 (75.90%). Conclusions: The prevalence of premenstrual syndrome among medical students was similar to in the other studies done in similar settings. Keywords: premenstrual syndrome; prevalence; quality of life.

Clinical Profile, Disease Severity and Perinatal Outcomes of Laboratory-confirmed COVID-19 among Pregnant Women Delivering in a Tertiary Care Centre.

BACKGROUND: Pregnant women and their fetuses represent a high-risk population during coronavirus disease 2019 (COVID-19) pandemic. During pregnancy, body undergoes significant physiologic, mechanical, and immunologic alterations which increases susceptibility to infections. Thus pregnant women are at an increased risk for severe illness from COVID-19. This study explored the clinical profile, disease severity, and perinatal outcomes of pregnant women with COVID-19. METHODS: A retro-prospective cross-sectional study was conducted at KIST Medical College after ethical approval. All women (1227) who delivered from 15 April 2020 to 15 October 2021 and underwent the COVID-19 screening by Reverse Transcriptase Polymerase Chain Reaction were studied. COVID-19 positive women (44) were further analyzed and classified as asymptomatic, mild, moderate, severe, and critical diseases. Data was collected in proforma by reviewing patients' records. The data analysis were done in SPSS version 26. A descriptive statistical test and chi-square test were done. RESULTS: The prevalence of COVID-19 among delivering pregnant women was 3.6% (44/1227). Majority were asymptomatic 79.5% (35). About 16% (7) had mild illness and 4.5% (2) had moderate illness. The caesarean rate was 34.1% (15/44) among COVID-19 positive women. Stillbirth and preterm birth was observed in 2.3% (1) and 4.5% (2) respectively. The COVID-19 infection rate in a neonate was 4.5%. CONCLUSIONS: The severity of COVID-19 among delivering pregnant women was less. The perinatal outcome was also favourable. The overall prognosis of COVID-19 among mothers and newborns was good. Further research is needed to understand the true magnitude of risks and management, more so with the emergence of new variants.

Thyroid Dysfunction in Patients with Abnormal Uterine Bleeding in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Abnormal uterine bleeding is a common gynecological presentation, accounting for at least 20% of all new outpatient visits. It has been recognized that thyroid dysfunction may have profound effects on the female reproductive system. Both hypothyroidism and hyperthyroidism are associated with a variety of changes, including delayed onset of puberty, anovulatory cycles, and abnormally high fetal wastage. Hence, this study was conducted to know the thyroid status of the patient with abnormal uterine bleeding. METHODS: A descriptive cross-sectional study was conducted in all the patients with abnormal uterine bleeding in a tertiary care hospital from 2 August 2019 to 2 February 2020. Ethical clearance was received from the institutional review committee of KIST Medical College. Convenient sampling was done. Data was collected using a questionnaire which includes patients profile, the pattern of abnormal uterine bleeding, and thyroid profile. Statistical analysis was done using Statistical Package for the Social Sciences version 23. RESULTS: Out of 79 patients, it was found that 67 (84.8%) were euthyroid, 11 (13.9%) were hypothyroid,and 1 (1.2%) was hyperthyroidism. The most common type of abnormal uterine bleeding wasmenorrhagia 34 (43%), followed by polymenorrhoea 23 (29%), oligomenorrhoea 13 (16.5%), menometrorrhagia 6 (7.6%), metrorrhagia 2 (2.5%), and hypomenorrhea 1 (1.3%). The maximum number of patients was between 20-25 years with the mean age of 31 years. Among hypothyroid, 7(8.8%) had subclinical hypothyroidism and 4 (5%) had frank hypothyroidism. CONCLUSIONS: Most females with abnormal uterine bleeding were euthyroid. Menorrhagia was the most common pattern of abnormal uterine bleeding.

Prevalence of Self Induced Abortion by Self-Administration of Abortive Pills among Abortion-related Admissions in a Tertiary Care Centre.

INTRODUCTION: Each year, unsafe medical abortion costs the lives of thousands worldwide. Despite the legalization of abortion in Nepal in 2002, many still seek services from unauthorized sources. This has led to grave consequences including death. Our objective is to find out the prevalence of self-induced abortion by self-administration of abortive pills and related complications. METHODS: It is a descriptive cross-sectional study carried out among abortion-related admissions in a tertiary care center from June 15 2018 to March 15, 2020. Ethical approval was taken from the institutional review committee (076/077/51). Data was collected using pre-designed proforma and analyzed in Statistical Package for the Social Sciences version 26. Point estimate at 95% Confidence Interval (CI) was calculated along with frequency and proportion for binary data. RESULTS: Out of 223 cases enrolled, 37 (16.6%) (9.6-23.6 at 95% Confidence Interval) were self-induced abortion cases by self-administration of abortion pills. The mean gestational age at the time of intake of pills was 7+6±3+1 week of gestation. The majority were diagnosed with incomplete abortion 14 (37.8%) followed by septic abortion 8 (21.6%). A surgical evacuation was performed in 25 (67.6%). Anemia was observed in 19 (51.3%) with severe anemia in 4 (10.8%). Blood transfusion was carried out in 14 (37.8%). Post abortive contraception was accepted by only 16 (42.3%). CONCLUSIONS: Medical abortion is safe if done under supervision but self-induced abortion by self-administration of abortion pills has a high complication rate. Therefore, further studies exploring a different dimension of the serious issue is the need of time.

Prevalence of Perinatal Deaths in a Tertiary Care Hospital of Nepal.

INTRODUCTION: Perinatal mortality indicates quality of maternal and neonatal care and is high in Nepal. This study was conducted to find out the prevalence of perinatal deaths in a tertiary care center. METHODS: This descriptive cross-sectional study was conducted from July 2017 to June 2018 at KIST Medical College and Teaching Hospital. Details of each perinatal death were filled in predesigned proforma from hospital in-patient records within 24 hours of perinatal death. The total of 1088 cases were selected for the study and convenience sampling was done. Statistical analysis was done with Statistical Package for Social Sciences version 17.0. RESULTS: Prevalence of perinatal death is 16 (1.46%) out of 1095 births. In the same way, perinatal mortality rate, stillbirth rate and early neonatal mortality rate were calculated and found to be 14.61 per 1000 births, 8.21 per 1000 births and 6.44 per 1000 live births respectively. Preterm neonates constituted of 71.4% of early neonatal deaths. CONCLUSIONS: Perinatal mortality rate was 50% lower than that of national survey, however comparable with study at another tertiary care center at Kathmandu. Stillbirth and prematurity contributed significantly to perinatal mortality. Provision of good antenatal surveillance, identification of high risk pregnancies and good neonatal care to preterm neonates would be required to reduce perinatal mortality.

Predisposing Factors and Outcome of Malpresentations in an Institute.

INTRODUCTION: This study was done to find out the incidence of malpresentation among all deliveries with various types of Malpresentations, its mode of delivery , maternal and fetal predisposing factors with outcome. METHODS: This was a cross sectional descriptive study done at KIST Medical College and Teaching Hospital. Review cases of women admitted in labor after 22 weeks with malpresentation was done. Maternal/fetal predisposing factors were recorded. RESULTS: Total delivery in study period was 4009 where 101 (2.5%) were of malpresentation. Breech was the commonest malpresentation 83 (82.1%). Assisted vaginal delivery occurred in 16 (15.8%) and 953 (84.2%) caesarian section. Malpresentations was common in primigravida 62 (61.3%). Half (47.2%) cases had one/more predisposing factors, commonest being oligohydramnious 7 (6.9%). Out of 108 babies with malpresentation, 10 had perinatal deaths and 10 had NICU admissions. Congenital anomaly was found in 4 babies. CONCLUSIONS: The most common type of malpresentation was breech common in primigravida with oligohydramnios as contributing factor.