Prevalence and risk factors of soil-transmitted helminth infection in Nepal.

BACKGROUND: The purpose of this study is to evaluate the prevalence and intensity and examine the risk factors of soil transmitted helminth (STH; i.e., roundworm [Ascaris lumbricoides], hookworms [Ancylostoma duodenale and Necator americanus], and whipworm [Trichuris trichiura]) infections in Nepal. METHODS: Five hundred and ninety-four adults (256 men and 338 women) were selected via convenience sampling from five communities in Nepal. The Kato-Katz method was used to assess the prevalence and intensity of STH infection in this population. RESULTS: Prevalence of STH infection ranged from 3.3% in Birendranagar in Chitwan, 3.5% in Kuleshor in Kathmandu, 11.7% in Kanyam in Ilam, 17.0% in Dhikurpokhari in Kaski and 51.4% in Khokana in Lalitpur District [corrected]. Multivariable regression analysis revealed that not using soap for hand-washing was significantly associated with the prevalence and infection intensity of roundworm, hookworms and whipworm. Similarly, not wearing sandals or shoes outside was significantly associated with the prevalence and infection intensity of roundworm and hookworms, but not with infection intensity of whipworm. Literacy, being underweight or overweight, anemia and occupation were not associated with prevalence and intensity of roundworm and hookworms infection, but there was an association between occupation and the prevalence of whipworm infection. CONCLUSION: STH infection was associated with individual hygiene behavior, but not with nutritional status or socio-demographic characteristics. Health policy focusing on changing individual hygiene behaviors might be useful in addressing STH infection in Nepal.

Health status of married women residing five communities in Nepal: unexpectedly high prevalence of anemia in a well-off community of Kathmandu.

The high prevalence of anemia and underweight among reproductive age women is a serious health concern in Nepal. The objective of the present study was to describe anemia prevalence and nutritional status of married women in Nepal. Total of 278 women were included in the present analysis. The five communities included an urban commercial area (W) in Kathmandu, an agricultural village (K) in Lalitpur District, an agricultural village in Chitwan District (C) and one in Ilam District (I) with intensive cash cropping, and another rural village in Kaski District (P) with high number of international out-migration of males. The study procedure included anthropometric measurements, blood collection for hemoglobin measurement, and stool collection for examination of hookworm infection, and a structured interview on their reproductive history including contraceptive use. The altitude adjusted prevalence of anemia was 65%, 23%, 16%, 49% and 58% in communities C, I, K, P and W respectively. The hookworm prevalence of each community was not associated with the anemia prevalence. In the urban well-off community W, although 38% of the women had BMI > or = 25 and only 2% of women had BMI<18.5, 58% of the women were anemic. A logistic regression analysis on the anemia risk at the individual level showed no effect of helminth infection, but a significant negative effect of Depo-Provera (depot-medroxyprogesterone acetate) use. Causes of high anemia prevalence among the women resided in the urban well-off area should be investigated in future studies.

Primary carcinoma of fallopian tube after prolonged retention of Lippes loop.

PIP: Although a small number of uterine malignancies have been reported in long-term IUD users, a cause-effect relationship is difficult to establish. This article presents a case of primary carcinoma of the fallopian tubes with a coexisting Lippes loop. The 50-year-old patient presented to Seth Sukhlal Karnani Memorial Hospital (Calcutta, India) 5 years after menopause with complaints of occasional vaginal bleeding for the past 2 months. A Lippes loop had been inserted 20 years earlier, with no follow-up after the first year of use. Total hysterectomy was performed. Gross cut-section revealed the Lippes loop inside the uterine cavity. The distal parts of both fallopian tubes showed multiple small cystic spaces filled with fluid, with features of papillary adenocarcinoma arising from mucosa infiltrating the wall and projecting into the lumen. The distorted tubes also showed features of hydrosalpinx follicularis. Although the ovaries were adherent to the tubes, they were not malignant. The atrophic endometritis present in this case suggests that carcinoma was preceded by salpingitis, in turn possibly initiated by prolonged IUD retention.^ieng

Study of pregnancy outcome over a period of five years in a postgraduate institute of west Bengal.

This study is a retrospective analysis of the pregnancy outcome over a period of 5 years at IPGME&R and SSKM Hospital, Calcutta. Of the total 13,211 obstetrical admissions during the period from 1st January, 1990 to 31st December, 1994, 32.6% cases were admitted for antenatal complications, 27.3% for antenatal observations, 0.5% for postpartum complications and 39.4% for medical termination of pregnancy. Vaginal delivery was carried out in 50% of cases of which 78.7% were of normal vaginal delivery and 21.2% were of instrumental delivery. In the remaining cases caesarean section was done of which again 58.1% was elective and 41.8% was emergency caesarean sections. Maternal mortality was 4.6/1,000 live births. Perinatal mortality rate was 3.9%. The analysed data reflect the fact that the maternal mortality and perinatal mortality were well controlled over this period in spite of a large number of complicated cases being referred to this hospital with minimum facilities.

PIP: A retrospective study of the 13,211 obstetrical admissions in 1990-94 to a teaching hospital in Calcutta, India, revealed generally adequate pregnancy outcomes, despite the referral of a large number of complicated cases to this facility. 4312 cases (32.6%) involved antenatal complications, primarily abortion, anemia, and hypertensive disorders, and 3617 (27.3%) were referred for observation after a reduction in fetal movement; another 5217 (39.4%) were for medical termination of pregnancy. Of the 6633 deliveries in the study, 3315 (50%) were by cesarean section. There were 30 maternal deaths, for a maternal mortality rate of 4.6/1000 live births. The main causes of maternal death were eclampsia, septic abortion, cardiac arrest, and respiratory failure after cesarean section. Of the 6703 newborns delivered, 2.6% were stillborn and 33.9% were low birth weight. The perinatal mortality rate was 3.9/1000 live births.