Clinical Outcome of Infants Younger than Two Months in Children Ward of a Tertiary Care Hospital, Nepal

Introductions: Newborn and young infants are most vulnerable for preventable deaths, particularly in developing countries. This study was conducted to see the clinical profile and outcome of infants less than two months of age admitted in children ward of Patan Hospital.Methods: This descriptive retrospective study was conducted at Patan Hospital, over 12 months from April 2014 to March 2015. Hospital records of all admitted infant less than two were reviewed. The demographic characteristics, clinical profile and clinical outcome were descriptively analyzed.Results: Out of 2062 admissions in children ward, 614 (29.8%) were infants less than two months,out of which 482were neonate less than 28 days. Among these neonates. 114 were inborn. Out of 436 infection, blood culture was positive in 37 (8.9%). There were 4 (0.04%) deaths, 4 (0.04%) referral and 22 (0.25%) left against medical advice. Infection 436 (436) was the commonest cause of illness, of which neonatal sepsis 163 (37.4%), pneumonia 130 (30%) staphylococcal skin infection 39 (8.7%) and UTI 34 (7.8%). There were 71(11.6%) cases of neonatal hyperbilirubinemia. Blood culture was positive in 55(9%) with CONS being the commonest organism isolated; 19  (51.3%).Conclusions: Children ward contributes significantly to the care of sick infants less than two months of age, especially out born ones, requiring neonatal care facility in tertiary level hospital of Nepal. As most admissions are for infection, followed by hyperbilirubinemia, pediatrics wards need to be equipped and staffed accordingly to meet the need of sick young infants.Keywords: children ward, clinical profile, neonatal sepsi

Rates and Determinants of Mother\u27s Own Milk Feeding in Infants Born Very Preterm

Objectives: To examine rates and determinants of mother\u27s own milk (MOM) feeding at hospital discharge in a cohort of infants born very preterm within the Canadian Neonatal Network (CNN). Study design: This was a population-based cohort study of infants born at (NICUs) participating in the CNN between January 1, 2015, and December 31, 2018. We examined the rates and determinants of MOM use at discharge home among the participating NICUs. We used multivariable logistic regression analysis to identify independent determinants of MOM feeding. Results: Among the 6404 infants born very preterm and discharged home during the study period, 4457 (70%) received MOM or MOM supplemented with formula. Rates of MOM feeding at discharge varied from 49% to 87% across NICUs. Determinants associated with MOM feeding at discharge were gestational age 29-32 weeks compared with (aOR 1.56, 95% CI 1.25-1.93), primipara mothers (aOR 2.12, 95% CI 1.86-2.42), maternal diabetes (aOR 0.79, 95% CI 0.66-0.93), and maternal smoking (aOR 0.27, 95% CI 0.19-0.38). Receipt of MOM by day 3 of age was the major predictor of breast milk feeding at discharge (aOR 3.61, 95% CI 3.17-4.12). Conclusions: Approximately two-thirds of infants born very preterm received MOM at hospital discharge, and rates varied across NICUs. Supporting mothers to provide breast milk in the first 3 days after birth may be associated with improved MOM feeding rates at discharge

ESTIMATING THE INDIRECT IMPACT OF THE COVID-19 PANDEMIC ON NEONATAL MORTALITY IN NEPAL

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The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: analysis from four recent demographic and health surveys in Nepal

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in health care resource use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016. Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens: Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12–23 months. We presented trends and correlates of full vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities. Results Full vaccination coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from − 32.3 [− 45.5,-19.1] in 2001 to an SII of-8.4 [− 18.6,-1.7] in 2016. Similarly, the SII for education decreased from − 61.8 [− 73.5,-50.1] in 2001 to an SII of − 30.5 [− 40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full vaccination coverage by wealth quintiles dropped from 0.21 (0.12–0.28) in 2001 to 0.054 (− 0.01–0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period. Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2

Breastfeeding Knowledge and Behavior Among Women Visiting a Tertiary Care Center in India: A Cross-Sectional Survey

Background: Breastfeeding is commonly practiced by a majority of mothers in developing countries, though there are widespread misconceptions about optimal breastfeeding traditions. In addition to culturally prominent rituals and social norms, incorrect and inadequate breastfeeding knowledge is major factors for this high-risk behavior. Objectives: To assess knowledge, attitude and practices of breastfeeding among girls and women visiting a tertiary care center in India and to find out the factors, which influence the breastfeeding behaviors. Design/Methods: It is a cross-sectional, questionnaire-based study done among women attending outpatient and inpatient Department of Obstetrics & Gynecology of S.S. Hospital, Banaras Hindu University, India. A face-to-face interview using a pre-designed, self-administered, standardized questionnaire regarding knowledge, attitude, and practices of breastfeeding was conducted. The information was collected and analyzed using SPSS statistical software. Findings: Among 1000 women enrolled in the study, 89% were married, 25% were primiparous, and 52% were multiparous. More than 50% were illiterate, 91% unemployed, and 90% had hospital delivery. Of the total 770 mothers, only 55% received proper antenatal care during pregnancy, of which only 40% were counseled about breastfeeding. Regarding knowledge and attitude about breastfeeding, majority females (71.4%) considered breast milk as best food for a newborn, which was better in younger women <20 years (86%). Regarding breastfeeding behavior, only 45% mothers initiated breastfeeding within one hour of delivery, which was worse in home delivered mothers (25%). Most (82%) mothers fed colostrum to their babies but 27% of mothers gave pre-lacteal feeds. Illiterate mothers (56.3%), mothers with only primary education (70%), and unemployed mothers (53.85%) continued to do exclusive breastfeeding without initiating complementary feeds even after six months. Conclusion(s): Although breastfeeding is practiced by a majority of mothers in a developing country like India, there is a significant gap in knowledge and optimal breastfeeding behaviors. Healthy breastfeeding behavior can be encouraged among mothers by proper counseling by health care workers and organizing educational programs focusing women especially with low education and limited resources.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Breastfeeding practices within the first six months of age in mid-western and eastern regions of Nepal: a health facility-based cross-sectional study

Abstract Background The World Health Organization recommends initiation of breastfeeding within 1 hour of birth and exclusive breastfeeding up to 6 months of age. Infant feeding practices, including suboptimal breastfeeding practices, are associated with stunting. Rate of stunting was highest in the Mid-western region and lowest in the Eastern region of Nepal. This study aimed to assess the breastfeeding practices in these two regions, as well as to identify factors associated with partial breastfeeding. Methods We conducted a health facility-based cross-sectional study in the Mid-western and Eastern regions of Nepal from December 2017 to May 2018. Investigators administered a pre-tested questionnaire among consecutive 574 mother-infant dyads at different levels of health facilities. We dichotomized the breastfeeding pattern to partial breastfeeding and full (exclusive or predominant) breastfeeding. We conducted multivariable logistic regression to identify factors associated with partial breastfeeding within 6 months of age. Results There were 574 infants included in the study, all of which received at least some breastfeeding. Only 23.2% of infants were exclusively breastfed until 6 months, with 28.2% predominantly breastfed and 48.6% partially breastfed. Partial breastfeeding rate was 52.3% in the Mid-western region and 44.4% in the Eastern region. Breastfeeding was initiated within an hour from birth in 67.2% of infants. One-quarter of infants were given pre-lacteal feed, honey being the commonest. Knowledge of the recommended duration of exclusive breastfeeding was inadequate in 16, and 65% of mothers reported breastfeeding problems in the first 6 months. Firstborn and low birth weight infants had a significantly higher rate of partial breastfeeding. Partial breastfeeding was also higher when infants were not breastfed within 1 hour from birth, mothers reported having breastfeeding-related problems or had inadequate knowledge of the duration of exclusive breastfeeding. Conclusion Nearly half of the infants were fully breastfed at 6 months of age in Nepal. The rate of partial breastfeeding was higher with inadequate knowledge on duration of exclusive breastfeeding or late initiation of breastfeeding or perceived breastfeeding problems. Hence, programs should address knowledge and practice gaps in breastfeeding practices, particularly among mothers of low birth weight and firstborn infants