Development and validation of a photographic food atlas for portion size assessment in the southern plains of Nepal.

OBJECTIVE: To develop and validate a photographic food atlas of common foods for dietary assessment in southern Nepal. DESIGN: We created a life-sized photographic atlas of forty locally prepared foods. Between March and June 2014, data collectors weighed portion sizes that respondents consumed during one mealtime and then a different data collector revisited the household the next day to record respondents' estimations of their previous day's intakes using the atlas. Validity was assessed by percentage error, Cohen's weighted kappa (κ w) and Bland-Altman limits of agreement. SETTING: Dhanusha and Mahottari districts in southern Nepal. SUBJECTS: A random sample of ninety-five adults in forty-eight rural households with a pregnant woman. RESULTS: Overall, respondents underestimated their intakes (mean error =-4·5 %). Rice and dal (spiced lentil soup) intakes were underestimated (-14·1 % and -34·5 %, respectively), but vegetable curry intake was overestimated (+20·8 %). Rice and vegetable curry portion size images were significantly reliably selected (Cohen's κ w (se): rice=0·391 (0·105); vegetable curry=0·430 (0·139)), whereas dal images were not. Energy intake over one mealtime was under-reported by an average of 569 kJ (136 kcal; 4·5 % error) using recall compared with the weighing method. CONCLUSIONS: The photographic atlas is a useful tool for field estimation of dietary intake. Average errors were low, and there was 'modest' agreement between weighed and recalled portion size image selection of rice and vegetable curry food items. Error in energy estimation was low but with wide limits of agreement, suggesting that there is scope for future work to reduce error further

A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal.

BackgroundMaternal and neonatal mortality rates remain high in many economically underdeveloped countries, including Nepal, and good quality antenatal care can reduce adverse pregnancy outcomes. However, identifying how to best improve antenatal care can be challenging.ObjectiveTo identify the interventions that have been investigated in the antenatal period in Nepal for maternal or neonatal benefit. We wanted to understand their scale, location, cost, and effectiveness.Study designOnline bibliographic databases (Cochrane Central, MEDLINE, Embase, CINAHL Plus, British Nursing Index, PsycInfo, Allied and Complementary Medicine) and trial registries (ClinicalTrials.gov and the World Health Organization Clinical Trials Registry Platform) were searched from their inception till May 24, 2020. We included all studies reporting any maternal or neonatal outcome after an intervention in the antenatal period. We screened the studies and extracted the data in duplicate. A meta-analysis was not possible because of the heterogeneity of the interventions and outcomes, so we performed a narrative synthesis of the included studies.ResultsA total of 25 studies met our inclusion criteria. These studies showed a variety of approaches toward improving antenatal care (eg, educational programs, incentive schemes, micronutrient supplementation) in different settings (home, community, or hospital-based) and with a wide variety of outcomes. Less than a quarter of the studies were randomized controlled trials, and many were single-site or reported only short-term outcomes. All studies reported having made a positive impact on antenatal care in some way, but only 3 provided a cost-benefit analysis to support implementation. None of these studies focused on the most remote communities in Nepal.ConclusionOur systematic review found good quality evidence that micronutrient supplementation and educational interventions can bring important clinical benefits. Iron and folic acid supplementation significantly reduces neonatal mortality and maternal anemia, whereas birth preparedness classes increase the uptake of antenatal and postnatal care, compliance with micronutrient supplementation, and awareness of the danger signs in pregnancy

A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal.

Maternal and neonatal mortality rates remain high in many economically underdeveloped countries, including Nepal, and good quality antenatal care can reduce adverse pregnancy outcomes. However, identifying how to best improve antenatal care can be challenging. To identify the interventions that have been investigated in the antenatal period in Nepal for maternal or neonatal benefit. We wanted to understand their scale, location, cost, and effectiveness. Online bibliographic databases (Cochrane Central, MEDLINE, Embase, CINAHL Plus, British Nursing Index, PsycInfo, Allied and Complementary Medicine) and trial registries (ClinicalTrials.gov and the World Health Organization Clinical Trials Registry Platform) were searched from their inception till May 24, 2020. We included all studies reporting any maternal or neonatal outcome after an intervention in the antenatal period. We screened the studies and extracted the data in duplicate. A meta-analysis was not possible because of the heterogeneity of the interventions and outcomes, so we performed a narrative synthesis of the included studies. A total of 25 studies met our inclusion criteria. These studies showed a variety of approaches toward improving antenatal care (eg, educational programs, incentive schemes, micronutrient supplementation) in different settings (home, community, or hospital-based) and with a wide variety of outcomes. Less than a quarter of the studies were randomized controlled trials, and many were single-site or reported only short-term outcomes. All studies reported having made a positive impact on antenatal care in some way, but only 3 provided a cost-benefit analysis to support implementation. None of these studies focused on the most remote communities in Nepal. Our systematic review found good quality evidence that micronutrient supplementation and educational interventions can bring important clinical benefits. Iron and folic acid supplementation significantly reduces neonatal mortality and maternal anemia, whereas birth preparedness classes increase the uptake of antenatal and postnatal care, compliance with micronutrient supplementation, and awareness of the danger signs in pregnancy

A cross sectional study to evaluate antenatal care service provision in three hospitals in Nepal

Background Globally too many mothers and their babies die during pregnancy and childbirth, a key element of optimizing outcomes is high-quality antenatal care (ANC). The Government of Nepal have significantly improved ANC and health outcomes through high-level commitment and investment, but still only 69% attend four recommended antenatal appointments. Objective To evaluate the quality and perceptions of ANC in Nepal to understand the compliance with Nepalese standards. Study Design This cross-sectional study took place at a tertiary referral and private hospital in Kathmandu, and a secondary hospital in Makwanpur. It recruited 538 female inpatients on postnatal wards during the two-week data collection period in May/June 2019. A case note review and verbal survey of women to understand the pregnancy information they received and their satisfaction with ANC was performed. We created a summary score of the completeness of ANC services received ranging 0-50 (50 indicating complete accordance with standards) and investigated the determinants of attending 4 ANC visits and patient satisfaction. Results The median ANC attendance was 4 visits at the secondary and referral hospitals and 8 at the private hospital. 24% attended less than 4 visits. 22% (117/538) attended a first trimester visit and 12% (65/538) attended visits at all points recommended in the standards. Over 90% of women had blood pressure monitoring, hemoglobin estimation, blood grouping and Rhesus typing, HIV and syphilis screening. 50% of women had urinalysis at every visit (IQR 20 to 100). 95% (509/538) reported receiving pregnancy information, but retention was variable: 93% (509/538) received some information about danger signs, 58% (290/502) remembered headaches whereas 98% (491/502) remembered fluid leaking. The ANC completeness score revealed the private hospital offered the most complete clinical services (mean 28.7, SD=7.1) with the secondary hospital performing worst (mean 19.1, SD=7.1). The factors influencing attendance at 4 ANC visits in the multivariable model were beginning ANC in the first trimester (OR 2.74 (95% CI 1.36, 5.52) and having a lower level of education (no-school OR 0.46 (95% CI 0.23, 0.91), Grades 1-5 OR 0.49 (95%CI 0.26, 0.92)). Overall 56% (303/538) of women were satisfied with ANC. The multivariable analysis revealed satisfaction was more likely in women attending the private hospital compared to the referral hospital (OR 3.63 95% CI 1.68 to 7.82) and lower in women who felt the ANC facilities were not adequate (OR 0.35 95% CI 0.21 to 0.63) and who wanted longer antenatal appointments (OR 0.5 95% CI 0.33 to 0.75). Conclusions Few women achieved full compliance with the Nepali ANC standards, however, some services were delivered well. To improve, each antenatal contact needs to meet its clinical aims and be respectful. To achieve this communication and counselling training for staff, investment in health promotion and delivery of core services is needed. It is important that these interventions address key issues, such as attendance in the first trimester, improving privacy and optimizing communication around danger signs. However, they must be designed alongside staff and service users and their efficacy tested prior to widespread investment or implementation

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Facilitators and barriers to healthy eating in a worksite cafeteria: a qualitative study from Nepal

Objective: Worksite interventions can serve as a potential platform for translating existing knowledge of diabetes prevention and facilitate healthy food choices. The study explored perceptions about healthy eating as well as potential facilitators and barriers to healthy eating among employees in a wire manufacturing factory in Nepal. Methods and materials We conducted a cross-sectional exploratory qualitative study in a wire manufacturing industry in eastern Nepal. We conducted three focus group discussions (FGDs) with a total of 26 employees and four in-depth interviews (IDIs) with cafeteria operators/managers from a wire manufacturing factory in eastern Nepal. FGDs and IDIs were audio-recorded, transcribed verbatim and analysed using the thematic method. Results: Most employees defined healthy eating as the consumption of food prepared and maintained using hygienic practices and fresh foods in general. Major barriers to healthy eating included unavailability of healthy foods, difficulty in changing eating habits, the preference for fried foods in Nepali culture and the high costs of some healthy foods. The most commonly reported facilitator of healthy eating was the availability of affordable healthy food options in worksite cafeterias. Conclusion: Availability of healthy food options at an affordable price could lead to healthier food choices in the worksite