Incidence of intrapartum stillbirth and associated risk factors in tertiary care setting of Nepal: a case-control study

Background: Each year, 1.2 million intrapartum stillbirths occur globally. In Nepal, about 50% of the total number of stillbirths occur during the intrapartum period. An understanding of the risk factors associated with intrapartum stillbirth will facilitate the development of preventative strategies to reduce the burden of death. This study was conducted in a tertiary-care setting with the aim to identify the risk factors associated with intrapartum stillbirth. Methods: A case-control study was completed from July 2012 to September 2013. All women who had an intrapartum stillbirth during the study period were included as cases, and 20% of women with live births were randomly selected on admission to make up the referent population. Information from the clinical records of case and referent women was retrieved. In addition, interviews were completed with each woman on their demographic and obstetric history. Results: During the study period, 4,476 women with live births were enrolled as referents and 136 women with intrapartum stillbirths as cases.  The following factors were found to increase the risk for intrapartum stillbirth: poor familial wealth quintile (Adj OR 1.8, 95% CI-1.1-3.4); less maternal education (Adj OR, 3.2 95% CI-1.8-5.5); lack of antenatal care (Adj OR, 4.8 95% CI 3.2-7.2); antepartum hemorrhage (Adj OR 2.1, 95% CI 1.1-4.2); multiple births (Adj. OR-3.0, 95% CI- 1.9-5.4); obstetric complication during the labor period (Adj. OR 4.5, 95% CI-2.9-6.9); lack of fetal heart rate monitoring per protocol (Adj. OR-1.9, 95% CI 1.5-2.4); no partogram use (Adj. OR-2.1, 95% CI 1.1-4.1); small weight for gestational age (Adj. OR-1.8, 95% CI-1.2-1.7); premature birth (Adj. OR-5.4, 95% CI 3.5-8.2); and being born premature and with small weight for gestational age (Adj. OR-9.0, 95% CI 7.3-15.5). Conclusion: Inadequate Fetal heart rate monitoring and partogram use are risk factors associated with intrapartum stillbirth and increasing the adherence to the interventions that can reduce the risk of intrapartum stillbirth. Preterm birth and small weight for gestational age were the factors that had the highest risk for intrapartum stillbirth, which indicates that adequate antenatal care can improve the health and growth of the baby and prevent premature death

Influenza B virus: Need for heightened surveillance and epidemiologic case studies

Recent report of increased influenza B virus infection, particularly theclinical profiles and treatment challenges imposed like that of influenza A,underscores the importance of continuing influenza B virus surveillance.This is, especially in resource limited country, early detection of influenzavirus, its clinical presentation and complications would be vital in minimizingthe public heath burden imposed by this virus.Keywords: chronic obstructive pulmonary disease, influenza B, severe acutepulmonary infection

A network approach for managing ecosystem services and improving food and nutrition security on smallholder farms

1. Smallholder farmers are some of the poorest and most food insecure people on Earth. Their high nutritional and economic reliance on home--grown produce makes them particularly vulnerable to environmental stressors such as pollinator loss or climate change which threaten agricultural productivity. Improving smallholder agriculture in a way that is environmentally sustainable and resilient to climate change is a key challenge of the 21st century. 2. Ecological intensification, whereby ecosystem services are managed to increase agricultural productivity, is a promising solution for smallholders. However, smallholder farms are complex socio-ecological systems with a range of social, ecological and environmental factors interacting to influence ecosystem service provisioning. To truly understand the functioning of a smallholder farm and identify the most effective management options to support household food and nutrition security, a holistic, systems-based understanding is required. 3. In this paper, we propose a network approach to understand, visualise and model the complex interactions occurring among wild species, crops and people on smallholder farms. Specifically, we demonstrate how networks may be used to (a) identify wild species with a key role in supporting, delivering or increasing the resilience of an ecosystem service; (b) quantify the value of an ecosystem service in a way that is relevant to the food and nutrition security of smallholders; and (c) understand the social interactions that influence the management of shared ecosystem services. 4. Using a case study based on data from rural Nepal, we demonstrate how this framework can be used to connect wild plants, pollinators and crops to key nutrients consumed by humans. This allows us to quantify the nutritional value of an ecosystem service and identify the wild plants and pollinators involved in its provision, as well as providing a framework to predict the effects of environmental change on human nutrition. 5. Our framework identifies mechanistic links between ecosystem services and the nutrients consumed by smallholder farmers and highlights social factors that may influence the management of these services. Applying this framework to smallholder farms in a range of socio-ecological contexts may provide new, sustainable and equitable solutions to smallholder food and nutrition security.Peer reviewe

Factors that influence the plant use knowledge in the middle mountains of Nepal.

An account of total of 58 plant species including 57 genera and 43 families was reported as useful in ethnomedicine from semi-structured questionnaire survey to the 76 participants of Kaski and Baitadi districts, Nepal. Fieldwork and participatory meetings were carried out between September 2017 and January 2018. A total of 419 emic use reports including 150 from Kaski and 269 from Baitadi were reported from 58 ethnomedicinal plant species. Each species was reported for 2-43 use reports and each participant recorded 1-12 use reports. About 25% (n = 104) use reports were associated with the treatment of digestive system disorders followed by 83 for general complaints. Of the species assessed, 53 species had IASc value 0.25. Species Swertia chirayita, Paris polyphylla, Bergenia ciliata, Valeriana jatamansi and Centella asiatica with > 0.25 IASc were found to be highly consented; however they were incongruent between the sample groups and sites. Divergent plant use knowledge specific to each sample district and group was corresponding to the heterogeneity of socio-economy and culture of the sites. Gender, ethnicity, household economy and food availability of the respondents were leading factors affecting the plant use knowledge. Despite the sites were relatively homogenous in eco-physiography, they possessed the distinct plant use knowledge, hinted that the socio-economic factors are more explanatory in plant use knowledge

Prey selection by leopards (Panthera pardus fusca) in the mid‐hill region of Nepal

Abstract Information on prey selection and the diet of the leopard (Panthera pardus fusca) is essential for leopard conservation. We conducted an investigation into the prey species and the proportion of each species in the leopard's diet in a human‐dominated mid‐hill region of Nepal. The analysis of 96 leopard scats collected between August 2020 and March 2021 revealed that leopards consumed 15 prey species, including small‐ and medium‐sized mammals and livestock. In addition to these prey species, we also found plastic materials, bird feathers, and some unidentified items in the leopard scats. Wild ungulates (such as barking deer, Muntiacus muntjak and wild boar, Sus scrofa) constituted only 10% of the biomass in the scats, while livestock contributed 27%, and other wild prey contributed 50%. Among all species, domestic goats had the highest relative biomass in the scats, followed by the jungle cat (Felis chaus), domestic dog (Canis familiaris), and large Indian civet (Viverra zibetha). Similarly, the Indian hare (Lepus nigricollis) had the highest proportion of relative individuals present in the scat samples, followed by the jungle cat and the large Indian civet. A lower proportion of biomass from wild ungulates in the leopard's diet and a higher dependency of the leopard on domestic prey and other wild prey indicate a shortage of medium‐sized wild prey, such as barking deer and wild boar, in leopard habitats. Therefore, the conservation of wild prey species, especially medium‐sized prey, is crucial for reducing the leopard's dependence on livestock and mitigating human‐leopard conflicts in the future

Implementing a simplified neonatal resuscitation protocol-helping babies breathe at birth (HBB) : at a tertiary level hospital in Nepal for an increased perinatal survival

BACKGROUND: Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. The development of the low cost interventions and their effective delivery are needed to reduce deaths from birth asphyxia. This study will assess the impact of a simplified neonatal resuscitation protocol provided by Helping Babies Breathe (HBB) at a tertiary hospital in Nepal. Perinatal outcomes and performance of skilled birth attendants on management of intrapartum-related neonatal hypoxia will be the main measurements. METHODS: The study will be carried out at a tertiary level maternity hospital in Nepal. A prospective cohort-study will include a six-month baseline a six month intervention period and a three-month post intervention period. A quality improvement process cycle will introduce the neonatal resuscitation protocol. A surveillance system, including CCD cameras and pulse oximeters, will be set up to evaluate the intervention. DISCUSSION: Along with a technique to improve health workers performance on the protocol, the study will generate evidence on the research gap on the effectiveness of the simplified neonatal resuscitation protocol on intrapartum outcome and early neonatal survival. This will generate a global interest and inform policymaking in relation to delivery care in all income settings.Trial registrationISRCTN97846009

Implementing a simplified neonatal resuscitation protocol-helping babies breathe at birth (HBB) : at a tertiary level hospital in Nepal for an increased perinatal survival

BACKGROUND: Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. The development of the low cost interventions and their effective delivery are needed to reduce deaths from birth asphyxia. This study will assess the impact of a simplified neonatal resuscitation protocol provided by Helping Babies Breathe (HBB) at a tertiary hospital in Nepal. Perinatal outcomes and performance of skilled birth attendants on management of intrapartum-related neonatal hypoxia will be the main measurements. METHODS: The study will be carried out at a tertiary level maternity hospital in Nepal. A prospective cohort-study will include a six-month baseline a six month intervention period and a three-month post intervention period. A quality improvement process cycle will introduce the neonatal resuscitation protocol. A surveillance system, including CCD cameras and pulse oximeters, will be set up to evaluate the intervention. DISCUSSION: Along with a technique to improve health workers performance on the protocol, the study will generate evidence on the research gap on the effectiveness of the simplified neonatal resuscitation protocol on intrapartum outcome and early neonatal survival. This will generate a global interest and inform policymaking in relation to delivery care in all income settings.Trial registrationISRCTN97846009