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.

Effect of COVID-19 Pandemic on Emergency Department Admissions and Outcome.

BACKGROUND: Emergency Department admissions have changed significantly during the COVID-19 pandemic. Understanding this variation may play a crucial role in rearranging hospital resources for better outcome. In this study, we aimed to assess the impact of COVID-19 pandemic on emergency department admission and outcome. METHODS: This is a cross-sectional retrospective study conducted at Bharatpur Hospital, Nepal comparing pre- pandemic data of the 4 months (March 24 to July 21, 2019) with the initial 4 months of the pandemic (March 24 to July 21, 2020). RESULTS: Admission in emergency ward decreased during covid period among female admission (47%vs43%), age-group(0-14)(18%vs12%), Dalit(17%vs11%) p<0.0001.Diagnosis increased during covid for acute abdomen(11%vs13%), animal and insect bite(10%vs13%), psychiatric illness(2%vs6%),poisoning and drug over dose(0.9%vs2.6%)(p<0.0001).The odds for referral(cOR 3.62,95% CI:2.70-4.84), Left against medical advice(cOR 6.03,95% CI:.06-8.94) and death(cOR 3.28,95% CI:1.64-6.68) increased during the covid respectively. CONCLUSIONS: There was decrease in rates of emergency department utilization during the Covid-19 pandemic. Admissions due to trauma, gastrointestinal, respiratory, neurological, musculoskeletal and coronary artery disease showed a decline whereas psychiatric disorders, diabetes and hypertension, animal and insect bites cases increased. Overall, mortality rate was increased.

Clinical Profile and Outcome of Corona Virus Disease-19 Infection in Pregnant Women.

BACKGROUND: The corona virus disease 19 pandemic has affected the whole world with pregnant ladies being more vulnerable population. This study aimed to evaluate characteristics of corona virus disease 19 infection in pregnancy and neonates and whether close proximity to the mother increases the incidence of corona virus disease infection in neonates.. METHODS: This is a hospital based prospective cross sectional observational study done among pregnant women presenting to Paropakar maternity and womens hospital from 1st September 2020 to 31st march 2021 with confirmed corona virus disease 19 infection. RESULTS: The total 160 cases were included in study. Most of the women (33.8%) were of 20- 25 years of age, 55 % were multigravida and 77.6 % were full term. Around 74 % of cases were symptomatic with predominant symptoms being cough, fever and sore throat present in 33.1 %, 18% and 14% respectively. Out of 125 deliveries 71 % of cases underwent cesarean section of which fetal distress was most common indication. Six newborns were positive for corona virus disease 19 infection within 48 hours of life. Mortality was seen in four mothers and three neonates. CONCLUSIONS: The clinical presentation of corona virus disease infection in pregnant ladies is similar to general population. There is no increased risk of vertical transmission to the baby.

Perinatal Outcome of Second Twin in Third Trimester of Pregnancy.

BACKGROUND: With increasing trend of twin pregnancy and along with increasing advancement in neonatal care, survival rate of twin pregnancy has increased. However there is worse perinatal outcome in second twin in comparison with the first twin. METHODS: Hospital based observational cross-sectional study of 42 pregnant women with twin pregnancy at Paropakar Maternity and Women's Hospital was conducted from November 2019 to October 2020. The outcome of second twin was assessed in relation to gestational age, chorionicity, mode of delivery, delivery interval. McNemar test was used for analysis with 0.05 as the level of significance. RESULTS: Among 42 pair of twins, Apgar score of the second twin was found to be lower than the first twin (p=0.00) in general and in preterm gestation (p=0.115). Among twin who had monochorionic placenta; higher number of twin 1 had Apgar score of ?7(p=0.004). Among twin who had inter-delivery interval of <30min; higher number of twin1 had Apgar score of ?7 at 5 minutes. (p=0.00). CONCLUSIONS: Second twin has lower Apgar score in relationship to period of gestation, mode of delivery, inter-delivery interval, and chorionicity.