Compliance and its Determinants Regarding Iron and Folic Acid Supplementation during Pregnancy in Kathmandu, Nepal.

Background Iron deficiency anemia is one of the major public health problems mostly affecting pregnant women of developing countries like Nepal. Kathmandu, the capital city of Nepal, has considerably high prevalence of anemia, which is attributed to inadequate dietary iron and problems of compliance to iron and folic acid supplementation. Objective This descriptive study aimed to identify the levels of and determinants associated with compliance regarding Iron and folic acid supplementation among pregnant women in Kathmandu, Nepal. Method The study was conducted in Paropakar Maternity and Women's Hospital in Kathmandu. Systematic random sampling was done to select a total of 406 samples that were either handed questionnaire for self-administration or interviewed. The χ2 test and multiple linear regressions were used for statistical analysis. Result The findings showed 73.2% of the respondents had high compliance, 12.8% moderate compliance, and 14% low compliance to iron and folic acid supplementation. More than half of the respondents had insufficient knowledge regarding anemia, iron deficiency and iron and folic acid supplementation. Multiple linear regression revealed that perceived severity, perceived barriers and social support were determinants of compliance to iron and folic acid supplementation (p<0.05). Conclusion This study infers that there is a lack of knowledge and awareness regarding anemia, iron deficiency, and iron and folic acid supplementation among pregnant women, and improvement in social support and perception of severity of the disease, and minimization of associated barriers may lead to better outcome in terms of compliance to iron and folic acid supplementation among pregnant women.

Prevalence of placental pathology in low birthweight infants.

OBJECTIVE: To determine the prevalence of placental pathology among low birthweight infants delivered at Srinagarind Hospital. MATERIAL AND METHOD: Descriptive study of 114 placentas from infants weighing between 500 and 2,499 grams delivered between June 2002 and June 2004 in the labour room, Srinagarind Hospital. Placentas from low birthweight infants were examined by a perinatal pathologist in the surgical pathology room, department of pathology, faculty of medicine, Khon Kaen University. The demographic data of the mothers, the gestational age of the infants by obstetric information and according to the Ballard score and placental examinations were collected and analyzed. The placental examinations included both macroscopic and microscopic studies. RESULTS: The prevalence of placental pathology in low birthweight infants was 80.7%. The four types of placental pathology were an increased placental to fetal weight ratio, infarction, vascular abnormalities of the decidua, and inflammation in 64.1, 30.4, 20.6 and 18.5 percent, respectively. CONCLUSION: All placentas of low birthweight infants should be studied for potential pathologies.

Simultaneous PCR detection of beta - thalassemia and alpha - thalassemia 1 (SEA type) in prenatal diagnosis of complex thalassemia syndrome.

OBJECTIVE: To establish a rapid PCR method for simultaneous detection of beta-thalassemia and alpha-thalassemia 1 genes for diagnosis of complex alphabeta-thalassemia syndrome. DESIGN AND METHODS: Using multiplex allele specific PCR approach, we evaluated a simultaneous detection of the SEA type alpha-thalassemia 1 and the common Southeast Asian beta-thalassemia and hemoglobin E genes. The system was tested on known cases of double heterozygote for alpha- and beta-thalassemias and in a prenatal diagnosis of complex alphabeta-thalassemia syndrome. RESULTS: Co-inheritance of alpha-thalassemia 1 (SEA type) with each of the common beta-thalassemia genes in Southeast Asian and with hemoglobin E could be identified in a single PCR reaction. A successful application of this simultaneous detection system in prenatal diagnosis of a complex thalassemia syndrome caused by an EFBart's disease was demonstrated in a Thai family. CONCLUSION: We have shown that correct diagnosis of double heterozygosity for alpha-thalassemia 1 and beta-thalassemia or hemoglobin E could be obtained using a simultaneous multiplex PCR. These rapid PCR assays would facilitate characterization and prenatal diagnosis of complex thalassemia syndromes in the regions where both alpha- and beta-thalassemias and hemoglobin E are common.

A simple non radioactive method for detecting beta-thalassemia/hbe disease: application to prenatal diagnosis.

We have developed allele specific polymerase chain reaction (ASPCR) that allows rapid screening of the beta E-globin and common beta-thalassemia genes in Thailand. These non-radioactive methods are based on the amplification by the polymerase chain reaction of the beta E and beta-thalassemia specific DNA fragments using specific primers. With this approach, both heterozygote and homozygote for the disease could readily be identified on agarose gel electrophoresis of the amplified DNA. We have applied the method for a prenatal diagnosis of beta-thalassemia/HbE disease in a Thai family at the second trimester of pregnancy. The result obtained was comparable to that of conventional dot blot hybridization using radioactive probes. The simplicity, accuracy and non isotopic of the approach make it a highly promising method for a carrier screening and a prenatal diagnosis of this common disorder.

Postterm pregnancy: computer analysis of the antepartum fetal heart rate patterns.

The purpose of this study was to establish reference ranges for numerical fetal heart rate (FHR) data in postterm pregnancy and to compare them with the patterns of fetuses under undisturbed condition at term. FHR was analysed on-line by Sonicaid Computer System 8000. A statistically significant decrease in the number of accelerations and decrease of variation in postterm pregnancy was observed. The duration of high variation (high episodes) in the 42nd week of gestation was statistically lower than in the pregnancy at term. These observations should be taken into account by clinicians in the interpretation of FHR records in postterm pregnancy.

Effect of the vibratory acoustic stimulation on fetal heart rate patterns of premature fetuses.

The purpose of this study was to examine the heart rate patterns before and after a standardized external vibratory acoustic stimulation in a group of 24 healthy premature fetuses at 32-35 weeks gestational age. FHR was analysed on line by Sonicaid Computer System 8000. A significant increase in the number of accelerations and an increase of variation after stimulus were observed. All other FHR patterns such as baseline, high and low episodes did not change significantly.

Computer analysis of the antepartum fetal heart rate patterns in the intrauterine growth-retarded human fetus using Sonicaid System 8000.

A total of 28 pregnant women with growth-retarded fetuses were studied to examine the antepartum fetal heart rate patterns between 30 and 39 weeks of gestation. Sonicaid Computer System 8000 was used to analyze on line 200 cardiotocograms. We found that there is an increase in the number of accelerations, an increase in variation assessed in beats per minute and in milliseconds, an increase in duration of high episode and a decrease in the number of decelerations.