Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms- a longitudinal cohort study in Nepal.

BACKGROUND: The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal. METHODS: A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression. RESULT: In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45th postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant. CONCLUSION: Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.

Sepsis among Patients Admitted to the Intensive Care Unit of a Tertiary Care Centre.

Introduction: Sepsis is a life-threatening dysfunction and is one of the common causes of admission in intensive care units. Early diagnosis and management improves the outcome of patients. The aim of this study was to find out the prevalence of sepsis among patients admitted to the intensive care unit of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the intensive care unit of a tertiary care centre after obtaining ethical approval from the Institutional Review Committee. Data of patients admitted from 1 February 2022 to 31 January 2023 was collected between 6 April 2023 to 27 April 2023. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 1001 patients, the prevalence of sepsis was 278 (27.77%) (25-30.54, 95% Confidence Interval). Among them, 209 (75.17%) developed septic shock. The mean age was 56.6±19.34 years. Pneumonia 43 (15.46%) and genitourinary infection 43 (15.46%) were the most common sources of infection and the source was unknown in 124 (44.60%) of patients. Hypertension 75 (26.97%) was the most common comorbidity. Acute kidney injury 166 (59.71%) was the most common complication followed by thrombocytopenia 165 (59.35%) and transaminitis 79 (28.41%). Conclusions: The prevalence of sepsis among patients admitted to the intensive care unit was higher than other studies done in similar settings. Keywords: infection; intensive care unit; sepsis; tertiary care centre.