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.

A multicenter study of incidence, risk factors and outcomes of babies with birth asphyxia in Nepal.

BACKGROUND: Perinatal events which result in compromised oxygen delivery to the fetus can lead to Birth Asphyxia (BA). While the incidence, risk factors and outcomes of BA have been characterized, less is known in low resource settings. AIM: To determine the incidence of Birth Asphyxia (BA) in Nepal and to evaluate associated risk factors and outcomes of this condition. METHODS: A nested observational study was conducted in 12 hospitals of Nepal for a period of 14 months. Babies diagnosed as BA at ≥37 weeks of gestation were identified and demographics were reviewed. Data were analyzed using binary logistic regression followed by multiple logistic regression analysis. RESULTS: The incidence of BA in this study was 6 per 1000 term livebirths and was higher among women 35 years and above. Predictors for BA were instrumented vaginal delivery (aOR:4.4, 95% CI, 3.1-6.1), fetal distress in labour (aOR:1.9, 95% CI, 1.0-3.6), malposition (aOR:1.8, 95% CI, 1.0-3.0), birth weight less than 2500 g (aOR:2.0, 95% CI, 1.3-2.9), gestational age ≥ 42 weeks (aOR:2.0, 95% CI, 1.3-3.3) and male gender (aOR:1.6, 95% CI, 1.2-2.0). The risk of pre-discharge mortality was 43 times higher in babies with BA (aOR:42.6, 95% CI, 32.2-56.3). CONCLUSION: The incidence of Birth asphyxia in Nepal higher than in more resourced setting. A range of obstetric and neonatal risk factors are associated with BA with an associated high risk of pre-discharge mortality. Interventions to improve management and decrease rates of BA could have marked impact on outcomes in low resource settings.