American Journal of Public Health Research

Ascertaining Cause of Perinatal Deaths in A Tertiary Care Hospital

by J Shrestha, R Shrestha, R Tuladhar and S Basnet

Special Issue

Perinatal mortality rate of Nepal is high indicating poor obstetrics and neonatal care services in the country. Identifying the causes of perinatal deaths would help in identifying the avoidable deaths so that timely interventions can be implemented in future. This study was conducted with the aim of finding out the perinatal mortality rate and its causes at our centre, Manipal Teaching hospital. This is a prospective observational type of study. Perinatal deaths after 28 weeks of gestation and weighing more than 1 kg and neonatal deaths within one week of birth were included. Maternal and neonatal characteristics were studied. Perinatal deaths were classified according to Aberdeen classification of perinatal deaths. Results indicated perinatal mortality rate of 37.6 per 1000 births with more than 60% stillbirths. Mechanical factors during intrapartum period (21.5%) and neonatal factors like prematurity, meconium aspiration and sepsis (22.4%) were major causes of the perinatal mortality. Almost 24% of the perinatal deaths were unexplained and these occurred in macerated stillbirths. Therefore, focus should be on providing quality antenatal care and strict intrapartum surveillance as well as neonatal care to bring down the perinatal deaths. Autopsy should be considered when cause of death is unexplained.

American Journal of Public Health Research. 2015, 3(4A), 87-91. DOI: 10.12691/ajphr-3-4A-19
Pub. Date: July 03, 2015

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Benign Breast Diseases: Profile at a Teaching Hospital

by OB Karki, D Kunwar and Abhijit De

Special Issue

Benign breast diseases are the most common cause of breast problems. About a quarter of women during her lifetime will suffer from a benign breast disorder that requires some form of treatment. The most common symptoms are breast pain, lumpiness or a lump and nipple discharge. Triple assessment that includes clinical examination, imaging like ultrasonography (USG) or mammography and a pathological examination – FNAC or core needle biopsy has a very high accuracy rate in diagnosing, discrete benign breast diseases and this can be used for reassurance. This was a hospital based prospective study to determine the frequency of benign breast diseases and their pattern. Demographic data, investigations and histopathological diagnosis were collected and analyzed from patients who attended presenting to the department of surgery with breast complaints. The clinical diagnoses were compared with final diagnosis. After that they were appropriately managed. There were 160 patients in the cohort. Out of the patients presenting with benign breast diseases female (96%) were predominant. The majority of the patients (67%) were in the age group of 21 years to 40 years. The commonest presentation of benign breast diseases was pain (45%), followed by lump (26%). Fibroadenoma accounted for 46%. This study showed that among the benign breast diseases in females there were preponderance of mastalgia and fibroadenoma followed by fibrocystic diseases.

American Journal of Public Health Research. 2015, 3(4A), 83-86. DOI: 10.12691/ajphr-3-4A-18
Pub. Date: July 03, 2015

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Prevalence of Gingivitis and Periodontitis amongst School Children: A Cross Sectional Study

by R.B. Adhikari, A. Karmacharya, N. Malla and M.B Gurung

Special Issue

Gingivitis and periodontitis usually a common problem in school children in rural area especially from lower socioeconomic back ground. The aim of this study was to ascertain the prevalence of gingivitis and periodontitis among the school going children in a rural area of Nepal. This was a cross-sectional study done amongst 542 school going children of age 5 to 16 at Shree Nispakshya secondary school at Kaski district of Nepal. Out of 542 school going children, 117 children were in 5-7 years age group, 132 children were in 8- 10 years age group, 158 children were 11-13 years age group and 135 children were in the age group of 14-16 years, respectively. The gingival index, given by Loe & Silness was used for recording the severity of gingivitis and for periodontal disease, index given by Ramfjord was used for evaluation. The prevalence of gingivitis and periodontitis were 57.01% and 14.02%, respectively. The younger age group children had comparatively lesser percentage of gingivitis and periodontitis than older age group children.

American Journal of Public Health Research. 2015, 3(4A), 80-82. DOI: 10.12691/ajphr-3-4A-17
Pub. Date: June 23, 2015

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Pediatric Head Injuries in a Neurosurgery Center of Nepal: An Epidemiological Perspective

by Bal Gopal Karmacharya and Bidur Acharya

Special Issue

Children aged 0-14 years constitute about 34.6% of the Nepalese population. Head injuries remain a significant factor among trauma related deaths. To carry out preventive measures for traumatic brain injuries we need epidemiological evidences so that preventive measures can be taken. The aim of this study was to explore the causes and outcome of traumatic brain injuries in children. This study was a descriptive study of all children who presented with head injuries to the Neurosurgery Unit of Manipal teaching Hospital in Pokhara. We studied demographic variables, causes of head injury, severity of head injuries, presenting features, operative procedures carried out and outcome of head injuries. Two hundred and eighty seven pediatric head injury patients aged 0 to 15 years were admitted from January 2013 to June 2014. The results indicated that fall from height accounted for 67.94% of head injury, majority of falls being from the windows and roofs. Mild head injuries were most common. Although majority of patients had a good recovery, mortality among severe, moderate and mild head injury was 44.44%, 3.33% and 0.91% respectively. Preventive measures should be taken to reduce these head injuries.

American Journal of Public Health Research. 2015, 3(4A), 76-79. DOI: 10.12691/ajphr-3-4A-16
Pub. Date: July 03, 2015

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Reasons for Early or Late Initiation of Complementary Feeding: A Study in Pokhara

by Sahisnuta Basnet, Brijesh Sathian, Kalpana Malla and Deepak Prasad Koirala

Special Issue

Complementary feeding is introduced into an infant’s diet at 6 months of age because at this age breast milk alone cannot adequately meet the child’s nutritional requirement for their optimal health. This study has been undertaken to assess mothers’ timely introduction of complementary feeding and to determine reasons for its early or delayed initiation. This was a cross sectional hospital based study conducted in Manipal Teaching Hospital, on 700 mothers from October 2013 to October 2014. Data was collected by face to face interview using a structured questionnaire. The mothers' understanding of the recommended time to start complementary feeding, and their actual practiced timing of complementary feeding was inquired. Where applicable, reason for early or late introduction to complementary feeding was determined. Out of the 700 mothers sampled, 544 (77.7%) knew that complementary feeding should be started at 6 months of age but only 359 (50%) were found to be practicing it. The most common cited reasons for early introduction of foods/liquids before the age of 6 months were as follows: “I did not have enough breast milk” (37.1%), “I had to return to my job” (15.1%), and “Relatives said that I should give my baby something other than breast milk” (8.3%). In order to improve infant feeding practices, there is a need for anticipatory guidance for the management of common breastfeeding difficulties. Also, considerations and strategies allowing more flexible working conditions such as improved maternity leave provisions may help mothers remain at home with their infants for longer, alleviating the need for early weaning.

American Journal of Public Health Research. 2015, 3(4A), 69-75. DOI: 10.12691/ajphr-3-4A-15
Pub. Date: July 03, 2015

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Outcome of Diaphyseal Fracture of Tibia Treated with Flexible Intramedullary Nailing in Pediatrics Age Group; A Prospective Study

by P R Onta, P Thapa, K Sapkota, N Ranjeet, A Kishore and M Gupta

Special Issue

Fracture of Tibia is the most common amongst pediatric fractures. Most tibial shaft fractures are treated conservatively with close reduction and above knee cast application. Surgery is indicated only when the fracture is unstable, open fracture and associated with multiple injuries. Flexible intramedullary nailing is commonly used for diaphyseal tibial fracture and is also well used in other long bone fracture. The advantages of flexible intramedullary nailing are minimal invasive surgery, short hospital stay and early weight bearing. The objective of this prospective study was to review the functional outcome of flexible intramedullary nailing in pediatric age group. In the study, the union time, weight bearing time and complications associated with flexible intramedullary nailing were observed. There were 18 children with fracture shaft of tibia treated at the Department of Orthopedics, Manipal Teaching Hospital, Pokhara, Nepal from April 2014 to March 2015. The protocol consisted in flexible intramedullary nailing of fracture shaft of tibia in children. Angulation, shortening and other complications were checked. In our study the average age of the patient was 8.2 years (range 6–12 years). Out of 18 children with fracture shaft of tibia 15 had close fracture and 3 had open fracture. All fracture cases treated with flexible intramedullary nailing had good alignment post operatively. The average age of the patient was 8.2 years (range 6-12 years). Sixteen children had an angulation of less than 5 degrees and 2 children had angulation of 5 to 10 degrees which was acceptable to the age group. The mean time of radiological union was 13.3 weeks with early callus formation of 4.3 weeks. The average time for full weight bearing was 8.8 weeks. The average hospital stay of the patient was 5.7 days (range from 3 to 16 days). Fixation with flexible intramedullary nails in diaphyseal fracture shaft of tibia in pediatric age group is simple, effective, minimally invasive procedure with short hospital stay and having good outcome.

American Journal of Public Health Research. 2015, 3(4A), 65-68. DOI: 10.12691/ajphr-3-4A-14
Pub. Date: June 22, 2015

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Anterior Traumatic Dental Injuries amongst Children and Adolescents in Western Region of Nepal

by RB Adhikari and MB Gurung

Special Issue

The facial profile of an individual depends a lot on his /her anterior permanent teeth. Injury to these teeth can impair the function and hamper the esthetic look of the individual. This study is to ascertain the prevalence and type of treatment received regarding traumatic dental injuries in Nepalese adolescents. The sample included 253 patients range from 7 -15 year old children and adolescent attending at Manipal Teaching Hospital, Pokhara, Nepal from 2012 to 2014. Dental injuries were clinically assessed as follows: uncomplicated crown fracture, complicated crown fracture, crown discoloration, intrusion, extrusion, avulsion and subluxation. The prevalence of dental injuries was 9.6%. Boys sustained more injuries than girls with a ratio of 4:1. The dental injuries were almost entirely restricted to the maxillary central incisors (48.40%). Single tooth injury was predominant in all age groups. The commonest type was uncomplicated crown fracture (48.41%). The commonest cause was road traffic accident (50.20%).

American Journal of Public Health Research. 2015, 3(4A), 62-64. DOI: 10.12691/ajphr-3-4A-13
Pub. Date: June 22, 2015

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Microcytic Hypochromic Anemia in Pediatric Age Group: A Hospital Based Study in Nepal

by Arnab Ghosh, Dilasma Ghartimagar, Sushma Thapa, Brijesh Sathian and Asis De

Special Issue

Iron deficiency is a major global health issue and it causes anemia as well as impaired cognitive and motor development and behavioral abnormalities. In developing countries, 39% children below 5 years and 48% children between 5–14 years suffer from anemia. Children with anemia may present in hospital with anemia related nonspecific or specific symptoms or with other associated diseases. In the current study, we have analyzed all pediatric cases with microcytic hypochromic anemia due to iron deficiency. The study was a hospital based retrospective study conducted over a period from September 2013 to December 2014. All cases with age between 1 month to 15 years who had microcytic hypochromic anemia were included in the study and were evaluated for definite diagnoses. All cases with iron deficiency were collated according to age, sex, social status, clinical features and presentation. A total of 422 cases of microcytic hypochromic anemia including 400 cases with iron deficiency were seen in the study period. Male to female ratio was 1.5:1 and the mean age was 4.9 years. The commonest age group was between 1-6 years (45%), followed by the group below 1 year of age (33.8%) and those above 6 years of age (21.2%). The majority of the patients were in the lower socio economic status (SES) (234 cases, 58.5%) followed by middle SES (118 cases, 29.5%) and higher SES (48 cases, 12%). Most of the cases presented with acute infections (234, 58.5%), followed by chronic infections (103, 25.8%) and chronic non-infectious diseases (43, 10.8%). The commonest clinical feature was pallor followed by nonspecific symptoms like generalized weakness and fever, vomiting, abdominal pain, cough. In the pediatric age group, IDA is the commonest type of anemia and is more common in infant and young children especially in lower SES which is similar to other developing countries. In this hospital based study, most cases presented with acute or chronic infections and very few cases presented with complaints related only to anemia. Community based programs might be carried out to increase the awareness of the society about proper nutrition and early detection of anemia.

American Journal of Public Health Research. 2015, 3(4A), 57-61. DOI: 10.12691/ajphr-3-4A-12
Pub. Date: July 03, 2015

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Intussusception in Children: A Short-Term Analysis in a Tertiary Care Hospital

by NK Hazra, OB Karki, M Verma, D Rijal, Abhijit De and B Nath

Special Issue

In children especially in infancy and early childhood intussusception is a common cause of bowel obstruction. The pattern of clinical presentations in children and outcomes of intussusception management in low resource setup and to tackle the challenging problems in the management of problem were analyzed. From January 2012 to December 2014 the records of all children below 15 years of age who experienced intussusception were reviewed. All these children were managed and treated at Manipal Teaching Hospital, Pokhara in the Western Region of Nepal. Clinical outcomes were correlated with age, sex, clinical symptoms, diagnostics and treatment protocol and length of hospital stay. Total 26 children of intussusception were managed during the three years period (2011-2014) with male to female ratio of 1.6:1. The common symptoms were abdominal pain (62%) and bleeding per rectum (31%) and irritability (25%). Ileocolic intussusceptions (76%) was the commonest type of intussusception in this study and mesenteric lymph nodes (46%) and appendix (23%) were the common lead points. The patients who had undergone operative reduction stayed in the hospital longer than those who had not undergone operative procedure. Surgical site infection (23%), postoperative ileus (15%), pneumonia (11%) were the commonest complications. Lack of specialized facilities and trained personnel were main reason for nonsurgical reduction. Intussusception cases usually reported late, therefore, operative procedure was the main treatment modality in the present hospital setup.

American Journal of Public Health Research. 2015, 3(4A), 53-56. DOI: 10.12691/ajphr-3-4A-11
Pub. Date: June 23, 2015

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An Assessment on Breastfeeding and Weaning Practices in Odisha, India

by Anindita Maiti, Lisa Sarangi, Saroj Kumar Sahu and Soumya Sucharita Mohanty

Special Issue

The World Health Organization recommends the practice of exclusive breastfeeding of infants for the first 6 months after birth. Breastfeeding, the simplest, healthiest and least expensive feeding method that fulfills the infant’s needs for nutrition and growth and it also reduces child morbidity and mortality. Although breastfeeding is a common practice in India, several factors like some cultural beliefs and misconceptions etc. affect poor breast feeding practices. Most of the people do not properly understand the importance of the knowledge about breastfeeding how it should be given, the timings, duration, correct techniques and appropriate time of weaning mother’s milk. The study was taken up to assess the knowledge, attitude and actual practices of breastfeeding in the mothers of children less than 2 years of age who attended the Immunization clinic. This was a Observational (Cross-sectional) study at Immunization clinic of Hi-Tech Medical College &Hospital, Bhubaneswar, Odisha for 3 months period. 286 mothers who visited the immunization clinic whose children were less than 2 years of age were part of the cohort. Predesigned and pretested questionnaire were used to interview the mothers. The data were analyzed in percentile. Knowledge of initiation of breastfeeding within half an hour to one hour of birth was there in 52.78% mothers And 40% had an idea about the importance of colostrum. The meaning of Exclusive breastfeeding was known to 34.97% while almost 48% mothers initiated breastfeeding within half an hour of birth, 75% fed colostrum to their newborns, 61% were practicing exclusive breastfeeding for first 6 months and 90% were practicing night feeds. Inappropriate attachment and positioning was observed in 55% of mothers. Only 15% started weaning (supplementary feeding) after 6 months of baby’s age. To give prelacteal feeds, non initiation of breastfeeding soon after birth, giving supplementary foods (Weaning) earlier and avoid exclusive breastfeeding are some of the cultural practices still prevalent in many areas and societies. The study showed that the mothers lacked knowledge regarding breastfeeding practices which could be imparted early during antenatal visits to the mothers and their spouses for support, sensitizing the health care givers and improving infrastructure for a successful breastfeeding initiation.

American Journal of Public Health Research. 2015, 3(4A), 49-52. DOI: 10.12691/ajphr-3-4A-10
Pub. Date: June 23, 2015

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A Prospective Study on Impact of Non Stress Test in Prediction of Pregnancy Outcome

by Pravin Shrestha, Mehak Misha and Smita Shrestha

Special Issue

This prospective study was done at Department of Obstetrics and Gynecology, Manipal College of Medical Sciences, Pokhara, Nepal to identify effectiveness of NST in detecting high risk fetus thus preventing perinatal morbidity and mortality. The cohort of 125 pregnant mothers from 37 completed weeks to 42 weeks irrespective of risk factors, were subjected to NST for 20 minutes and extended to 40 minutes to avoid fetal sleep cycle. NST was categorized into Cat I, II and III according to NICHD. Fetal distress, meconium stained liquor was higher in Cat III group. There was more intervention in Cat II and Cat III group. Total number of patients who underwent LSCS was 51. Most common indication for LSCS (53%) was for fetal distress out of which 85% had NST of Cat II (37%) and Cat III (48%). For detecting high risk fetus, NST is a simple screening procedure and is helpful in decreasing perinatal morbidity and mortality.

American Journal of Public Health Research. 2015, 3(4A), 45-48. DOI: 10.12691/ajphr-3-4A-9
Pub. Date: July 03, 2015

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Implication of Ultrasonography in Detection of Retained Soft Tissue Foreign Bodies in Children: a Hospital Based Study from Western Nepal

by Prakash Sharma, Prasanna Ghimire and Subita Lalchan

Special Issue

The purpose of this study was to evaluate the sensitivity of sonography for detection of soft tissue foreign body and the common locations of foreign bodies in children. Children up to 14 years presenting to Radio diagnosis and Imaging department between August 2013 and May 2015 with diagnosis of retained foreign bodies embedded in soft tissue at various locations were included. All patients had both radiographs and ultrasound done. Location, size, depth, orientation and the relation to the adjacent structures were noted. Foreign bodies were then removed either by ultrasound guidance or by surgical exploration. Mean age of the patient was 10±3.7 years. Time of presentation ranged from 1 day to 35 days. Mean duration was 10 days. Pain and swelling were the presenting symptoms in all the patients. Sensitivity of ultrasound in detecting foreign body was 100%. There was no statistical difference between the length of the foreign bodies as measured by ultrasound and scale, after removal. Ultrasound is a cheap, readily available and effective modality for evaluation of retained foreign body in children.

American Journal of Public Health Research. 2015, 3(4A), 41-44. DOI: 10.12691/ajphr-3-4A-8
Pub. Date: June 23, 2015

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Neonatal Outcome of Expectant Mothers at Risk: A Community Level Study in Nepal

by Asis De, Abhijit De, Ninel Aruni Wijesekera, Bikas Pandey, Brijesh Sathian, Rebecca Finnegan and K. Seshagiri Rao

Special Issue

Neonatal mortality is still high in Nepal with U5MR 54 and IMR 46 per 1000 live births. 1 out of 22 Nepali child dies before age 1 year and 1 in 19 dies before he or she turns 5 years. In a low resource country like Nepal if expectant mothers are screened for risk factors and extra care given within existing resources for those who need more, there will be an impact on their risk status and on the outcome of pregnancy. In this study 187 expectant mothers were grouped into low and high risk categories using simple scoring system and their neonatal outcome was observed. Neonatal Death and Low Birth Weight (LBW) were undesirable outcome. At risk mothers can be identified with a simple risk scoring system at community level and timely intervention has definite impact on neonatal outcome.

American Journal of Public Health Research. 2015, 3(4A), 35-40. DOI: 10.12691/ajphr-3-4A-7
Pub. Date: June 23, 2015

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Gender Differences in Ocular Biometry among Cataract Patients of Western Nepal

by Shristi Shrestha, Khem Raj Kaini and Binamra Basnet

Special Issue

Cataract blindness presents an enormous problem in terms of public health burden, economic loss and social burden. A hospital based retrospective study reviewed the medical data of 520 patients (mean age 68.42±11.77 years) to detect gender based comparison of axial length, corneal curvature and power of intraocular lens that was implanted in patients undergoing cataract surgery in Western Nepal. A significant inter-gender differences was seen in age, axial length, keratometric values and intraocular lens power between the two groups (p<0.05). Females had shorter axial length (22.85±0.86 mm) and steeper corneal curvature (K1: 43.79±1.51 D, K2: 44.46±1.54 D) compared to males (23.04±1.01 mm, K1: 43.51±1.40 D, K2: 44.16±1.40 D). The axial length had a decreasing trend with increasing age in both the sexes. The average power of the intraocular lens was 21.28±1.91 D. In conclusion, the axial length of Nepalese population was comparable to Indian and Pakistani population. However, it was slightly shorter than Whites, Middle-Eastern and some Asian population. The keratometric value ranges from 38.75-50.00 D. Maximum number of patients required intraocular lens of power between 20.00-22.99 D

American Journal of Public Health Research. 2015, 3(4A), 31-34. DOI: 10.12691/ajphr-3-4A-6
Pub. Date: June 22, 2015

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Time Trend of Pneumonia in under Five Children of Nepal

by Brijesh Sathian, Asis De, Padam Simkhada, Kalpana Malla, Arnab Ghosh, Sahisnuta Basnet, Bedanta Roy, Indrajit Banerjee, H S Supram and Suresh Devkota

Special Issue

Globally, Pneumonia is the leading communicable disease which is the reason of fatality in children. In 2013, there was approximately 935 000 child death in less than 5 years old because of Pneumonia, which was 15% of all the deaths in children. The scenario is more or less same in sub-Saharan Africa and South Asia. The objective of the study was to collate information from existing data and chart out the trends of the incidence of Pneumonia (mild + severe) per 1,000 children under five years (new visits) in the future. A secondary data analysis of the incidence of Pneumonia (mild + severe) per 1,000 children under five years (new visits) in Nepal was done between 2005 to 2014. The survey was conducted under the administrative supervision of the population division of the Ministry of Health and Population (MOHP). Curve fitting method was used to find out the convenient model. The data was analysed using Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA). A p-value of < 0.05 (two-tailed) was used to establish statistical significance. Excluding the constant term in the equation, the best fitted model was cubic, for the prediction of incidence of Pneumonia (mild + severe) per 1,000 children under five years (new visits). It is estimated that there will be 331 with 95% CI (0,1000) cases of Pneumonia (mild + severe) per 1,000 children under five years during 2020 in Nepal. The year wise incidence of Pneumonia (mild + severe) per 1,000 children under five years (new visits) in Nepal is having an increasing trend. The result provides reference data for organizing, planning, and evaluation of childhood pneumonia control program. Strengthening the health care delivery system and community-based prevention strategies and case management will facilitate to trim down pneumonia cases and the overall burden of this public health threat.

American Journal of Public Health Research. 2015, 3(4A), 27-30. DOI: 10.12691/ajphr-3-4A-5
Pub. Date: July 05, 2015

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Surviving the First Day in Nigeria: Risk Factors and Protectors

by Tukur Dahiru

Special Issue

Background: Deaths occurring within the first twenty-four hours of life constitutes a large proportion of child mortality; about 36% of all neonatal deaths took place within the first twenty-fours of delivery globally. Nigeria contributes around 9% of the global first-day mortality. Objectives: To determine the levels and determinants of first-day mortality using the 2013 Nigeria DHS data. Methods: This study utilized the 2013 Nigeria DHS which is a cross-sectional involving a nationally representative sample of 38, 948 women aged 15-49 years. First-day mortality rates were estimated for all births within the past five year prior to the survey and disaggregated by background characteristics and Cox proportional hazard models were generated to assess the relationship between some background characteristics and first-day mortality. Analysis was conducted using Stata v13. Results: The first-day mortality rate was found to be 19 per 1000 live births which was found to be higher among younger aged women, overweight women, babies in Southern part of Nigeria, rural residents, male babies and those babies delivered in health facilities among others. Factors that significantly predict first-day mortality are maternal age of more than 35 years (HR=1.12, 95%CI: 1.01-1.24), residing in Northern Nigeria (HR=1.18, 95%CI: 1.10-1.26), living in rural areas (HR=1.30, 95%CI: 1.22-1.40) and increasing maternal education (HR=1.20, 95%CI: 1.10-1.32). Utilization of at least four ANC visits (HR=0.87, 95%CI: 0.80-0.93) and having postnatal care within 24 hours (HR=094, 95%CI: 0.89-0.99) are all associated with decreased hazard of first-day mortality. Conclusion: First-day mortality rate in Nigeria is high; provision and expansion of both antenatal and postnatal care services particularly in rural areas and northern part of Nigeria will potential contribute in the reduction of first-day mortality.

American Journal of Public Health Research. 2015, 3(4A), 19-26. DOI: 10.12691/ajphr-3-4A-4
Pub. Date: July 03, 2015

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Oral Zinc as Adjuvant Therapy for Pediatric Recurrent Pneumonia: A Prospective Study in a Tertiary Care Hospital

by Tejesh Malla, Kalpana K Malla, Brijesh Sathian, Prithuja poudyal, Eva Gauchan and Sahisnuta Basnet

Special Issue

Zinc is an essential element required for the cell metabolism, including immunity. Therefore Zinc deficiency leads to susceptibility to infections and may affect pulmonary epithelial cell integrity. Many investigators have used zinc supplementation to see it’s effect on various diseases mainly diarrheal diseases and severe pneumonia. This study aims to evaluate the effect of oral Zinc supplementation in treatment and prevention of recurrent pneumonia. 506 Children aged 2 months to 60 months admitted during September 2011 to August 2014 for recurrent pneumonia with no other underlying illness in the Pediatric department of Manipal Teaching Hospital, Pokhara, Nepal were observed. Along with standard antibiotic treatment one group [Group I] received zinc (10 mg for < 6 months and 20 mg for ≥ 6 months for 10 days) and another group [Group II] did not receive Zinc. The primary outcome like resolution of tachypnea, chest in drawing, hypoxia, starting of oral feeds and hospital stay was noted. All cases were followed up every three monthly for one year to see the recurrence of pneumonia. Data was analyzed using SPSS version 16 and p < 0.01 was considered statistically significant. 20.24% of recurrent pneumonia meeting the inclusion criteria was evaluated. Maximum children (65.4%) were of age 2-12 months. Primary as well as secondary outcome was statistically significant (p<0.001) in Group I. The mean ± SD for primary outcome in Group I vs. Group II were –tachypnea (2.96±1.12 vs. 4.67 ± 1.61 days), chest in drawings (1.63 ±0.95 vs. 3.35 ±1.55 days), hypoxia (24.61 ±1.77 vs. 41.67 ± 2.11 hours), starting of oral feed (1.22 ±0.95 vs. 2.55 ± 1.23 days) and hospital stay (4.82 ±1.22 vs. 6.45 ± 1.99 days). In Group I 20/253 (7.9%) children lost follow up and 2/253(0.79%) patient died and in group II 1 (0.39%) died and 30 (11.85%) lost follow up. Recurrence of pneumonia was also significantly less (p<0.001) in zinc recipients. Determinants in two groups by logistic regression showed earlier resolution in zinc recipients with OR at 99% CI 9.654 (5.605, 16.625) for tachypnea, 14.506 (8.064, 26.095) for chest in drawings, 5.860 (3.415, 10.057) for hypoxia, 13.725 (7.270, 25.912) for starting oral feed and 0.075 (0.040, 0.140) for hospital stay. The recurrence of pneumonia was also less in group I with OR 3.348 at 99% CI (2.009, 5.581). Zinc as an adjuvant therapy is effective in treatment and prevention of recurrent pneumonia in children.

American Journal of Public Health Research. 2015, 3(4A), 12-18. DOI: 10.12691/ajphr-3-4A-3
Pub. Date: July 03, 2015

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Gender Preference among Married Women in Kolkata Metropolitan Slum of India

by Sanjay kr Saha, Medhatithi Barman, Avishek Gupta, Piyali Dutta Chowdhury, Gautam Sarker and Ranabir Pal

Special Issue

Preference for Male baby reflects underlying socioeconomic and cultural patterns and prevailing inequity between genders in many societies in India. A cross-sectional population based study was conducted in the urban slum of Kolkata in eastern India on socio-demographic variables of gender preference among 122 married women using a predesigned, pretested, semi-structured data collection tool. Maximum participants were less than 35 years - 25-34 years (50%) and 15-24 years (45.08%); Female children were predominant; one-third (33.16%) were born between 25-34 age of mothers followed by 10.56 percent from 15-24 age. Among respondents, majority were Hindu (78.68%); from Joint family (54.10%); Unreserved caste (56.57%); Primary school literates (60.65%). Female children were more among Hindus (54.55%), in nuclear families (53.88%), among middle and secondary level of literate mothers (58.23%). Gender had no significant role in treatment seeking behavior though male children had significantly more completion of immunization. In the continuation of education male children received significant advantages. Majority (58.20%) responded with two as the ideal family size; yet all the participants with single living daughter desired another child, preferably a son though 10 percent desired a daughter. Among the participants having one living son and no daughter, looked-for another child (16%), another son (36%) and rest (48%) a daughter. The study identified male gender baby preference among married women related with socio-demographic variables.

American Journal of Public Health Research. 2015, 3(4A), 6-11. DOI: 10.12691/ajphr-3-4A-2
Pub. Date: July 03, 2015

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Nutritional Deficiencies: Major Public Health Problem in Nepal

by Suresh Chandra Devkota, Asis De and Brijesh Sathian

Special Issue

Nutritional deficiency is a major public health challenge in Nepal. Nutritional deficiencies are occurring varying degree of manifestations and have tremendous impact not only on the health of vulnerable population but to the national economy too. Even though quite adequate government policies and guidelines have been prepared, over the years, basic nutrition promotion strategies haven’t been applied seriously at the community level. The major causes of nutritional deficiency in developing country like Nepal is poverty, lack of food security and nutrition education. Combating the deficiency seems a big challenge hence Government should develop more integrated and practical approaches to combat the deficiency. Nutrition promotion and support efforts should be ensured to reach specially to the needy, marginalized populations. Mere policy and strategy cannot yield foreseeable results. There is a strong need to improve the health service delivery systems which can ensure the desired change. This review study is an attempt to the draw attention of concerned authorities and public health researcher, to explore more information which can be helpful in revising the current approaches and in turn helps in achieving government’s desired goal: eradication of hunger and malnutrition from the country.

American Journal of Public Health Research. 2015, 3(4A), 1-5. DOI: 10.12691/ajphr-3-4A-1
Pub. Date: July 03, 2015

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Maternal and Child Health: A Current Perspective

by Dr Asis De

Special Issue

American Journal of Public Health Research. 2015, 3(4A), 0-0. DOI: 10.12691/ajphr-3-4A-0
Pub. Date: July 03, 2015

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Volume 3, Issue 4A