Association between obesity and miscarriage among women of reproductive age in Nepal

Background: Obesity is a major health problem in low and middle income countries (LMICs) and is associated with miscarriage. This study aims to examine the association between obesity and miscarriage among reproductive age women (15–49 years) in Nepal. Methods: The combined 19160 cross-sectional pregnancy data from the Nepal Demographic and Health Survey (NDHS) for the years 2001, 2006, 2011 and 2016 was utilized. Miscarriage was defined as a spontaneous loss of pregnancy that occurred before the foetus reached 7 months of gestational age. Logistic regression analyses that adjusted for clustering, stratification and sampling weights were used to examine the association between obesity and miscarriage among women of reproductive age. Results: The odds of miscarriage were 1.45 times higher (Adjusted odds ratio (AOR) = 1.45; 95%Cl: 1.06, 1.98, P = 0.021) among women with obesity. Women who did not use contraception, younger (15–19 years), and older women (35 years or more) were significantly more likely to have miscarriage. Women who smoked tobacco reported higher odds of miscarriage than women who did not smoke tobacco (AOR = 1.27; 95%Cl: 1.07,1.50, P = 0.006). Stratification of maternal smoking status by maternal Body Mass Index (BMI), after adjusting for contraception, mother age and year of survey revealed that tobacco smoking and obesity are associated with miscarriage (AOR = 1.46; 95%Cl: 1.05,2.04, P = 0.025). Conclusions: Findings from this study show that obesity and tobacco smoking are associated with miscarriage. Smoking cessation, pregnancy planning and counselling on healthy weight for women of reproductive age in Nepal may help promote healthy behaviours and decrease the likelihood of miscarriage

Role of antenatal care and iron supplementation during pregnancy in preventing low birth weight in Nepal: Comparison of national surveys 2006 and 2011

Background: Low birth weight (LBW) is a major cause of neonatal deaths in developing countries including Nepal. Its social determinants in Nepal have rarely been identified. This study aimed to identify the factors associated with low birth weight among under-five children comparing data from the Nepal Demographic and Health Surveys (NDHS) of 2006 and 2011. Methods: Pooled data from the Nepal Demographic and Health Surveys (NDHS) of 2006 and 2011 were analysed initially and the two survey data were then compared separately. The association between LBW and socio-demographic and health related factors were analysed using multiple logistic regression analysis with a stepwise backward elimination procedure. Complex Sample Analysis method was used to account for study design and sampling.Results: A total of 2845 children, 923 children in 2006 and 1922 children in 2011, had their birth weight recorded. The mean birth weight was 3024 (SD = 654.5) grams. A total of 12.1% (95% Confidence interval (CI); 10.6%-13.7%) children had low birth weight (<2500 grams) at the time of birth. Attending antenatal care was found to be consistently associated with low birth weight for the pooled survey data, and both 2006 and 2011 survey data, respectively. Not attending antenatal care increased the odds of having a LBW infant by more than two times [OR 2.301; 95% CI (1.526-3.471)]. Iron supplementation, which is an integral part of antenatal care in Nepal, was also significantly associated with birth weight for combined and individual surveys. Mothers not consuming iron supplementation during their pregnancy were more likely to have LBW infants [OR 1.839; 95% CI (1.282-2.363)]. Residing in the Far-western and Eastern region were also significant risk factors for LBW in the pooled dataset and in 2011 survey. Conclusions: The current study indicated there was no significant decrease in the LBW prevalence and there is a need of targeted interventions aimed at decreasing the high rate of LBW through increasing antenatal care and consumption of iron supplementation during pregnancy

An Opportunity Not To Be Missed: Vaccination as an Entry Point for Hygiene Promotion and Diarrhoeal Disease Reduction in Nepal

This report aims to ascertain whether or not vaccination programmes offer a useful entry point for hygiene promotion and to define options for piloting and scaling up of a hygiene promotion intervention in Nepal

Modelling perinatal and child mortality in Nepal

South Asia has the second largest burden of perinatal and childhood mortality in the world and Nepal has been reported as a significant contributor to this burden within the region. The main aim of this thesis was to statistically model perinatal and childhood mortality in Nepal. Specifically, this thesis will first conduct a systematic review of factors associated with perinatal mortality in South Asia including Nepal. Second, socioeconomic predictors of stillbirths in Nepal will be examined. Third, Factors associated with perinatal mortality in Nepal will be identified. Finally, this thesis will examine factors associated with under-5 mortality in Nepal. Chapter 2 identifies the factors associated with perinatal and childhood mortality through literature review. The systematic literature review revealed the most common factors associated with perinatal mortality were: low socioeconomic status, lack of quality health care services, pregnancy/obstetric complications and lack of antenatal care. Similarly, poor socio economic status, rural residence, higher birth order and lower birth interval, use of contraceptives, polluted fuel for cooking at home, and antenatal care were found to be associated with under-5 mortality. Chapter 4 examined the socio-economic predictors of stillbirth in Nepal. Multivariable analysis and found maternal age (>25years), ecological zone (mountains or hills), religion (Hindu, Muslim, Christian and others), low maternal education, mother’s occupation (farming) and the use of open defecation system are associated with stillbirth. Chapter 5 presents the factors associated with Perinatal Mortality (PM) and Extended Perinatal Mortality (EPM) in Nepal. In this study, PM rate was 42 [95% Confidence Interval (CI): 39, 44] per 1000 births and the corresponding EPM rate was 49 [95% CI: 46, 51] for the five-year prior each survey (2001-2016). Multivariable analysis revealed that ecological zone, household wealth index, birth order and birth interval; maternal age, use of contraceptives, and types of cooking fuel were associated with PM and EPM. Chapter 6 assesses the common factors associated with neonatal, post-neonatal, infant, child, and under-5 mortality in Nepal, and the study found that the death of the previous child, non usage of contraceptives and non-receipt of TT vaccination during pregnancy were associated with inder-5 mortality. In summary, household with poor socio-economic status, and non-use of contraceptives among mothers were strongly associated with perinatal, and under-5 mortality in Nepal. Hence, future intervention to reduce perinatal and under-5 mortality should focus on family planning and these intervention should target mothers from socioeconomically disadvantaged groups

Low Compliance with Iron-Folate Supplementation Among Postpartum Mothers of Nepal: An Analysis of Nepal Demographic and Health Survey 2011

One in five maternal deaths are directly attributable to anaemia in the world. The World Health Organization recommends iron supplementation from the second trimester of pregnancy to 45 days after delivery. The aim of this study was to determine the compliance rate of iron-folate consumption and the factors associated with iron-folate consumption among post-natal mothers in Nepal. This study utilised the data of Nepal Demographic and Health Survey (NDHS) 2011. The NDHS 2011 is a cross sectional and nationally representative survey. Of the 4,148 respondents, only 20.7 % consumed iron throughout the post-natal period for 45 days. Mothers who had higher and secondary education [adjusted Odd ratio (aOR) 3.101; 95 % CI (2.268–4.240)]; had attended four or more antenatal care visits [aOR 9.406; 95 % CI (5.552–15.938)]; lived in Far-western development region [aOR 1.822; 95 % CI (1.387–2.395)]; delivered in health facility [aOR 1.335; 95 % CI (1.057–1.687)]; and attended postnatal care [aOR 2.348; 95 % CI (1.859–2.965)] were more likely to take iron for 45 days of postpartum. Intervention to increase the compliance with the postpartum iron-folate supplementation are required to avoid adverse pregnancy outcomes associated with poor iron status with especial focus on the mothers who delivered at homes and did not attend postnatal check up

Breastfeeding and infant/young child feeding in Nepal

Background: Under nutrition being a major problem in Nepal, it is necessary to meet the minimum dietary standard which is essential for growth and development of young children, so promotion of infant and young child feeding practices among children is important intervention. Methods: A descriptive, cross sectional study was conducted among mothers of children of Bardia and Kailali districts of under 2 years and data was collected using the pre-tested questionnaire. Results: The study shows 30.3 percent of the mothers initiated breastfeeding within an hour of birth, 47.9 percent gave colostrums, 25.5 percent were practicing exclusive breastfeeding at 6 or more months,60 percent mothers fed anything else as prelacteal feed before breast feeding, 60 percent of mothers started complementary feeding between 3-6 months, 47.9 percent of mothers used anything from a bottle with a nipple yesterday or last night, 74.8 percent of mothers were currently breast feeding their children, 58 percent used iodized salt and 70.05 percent revealed that their child received Vit A within last six months. Conclusions: The present study showed that late initiation of breast feeding and practice of prelacteal feeds among home delivered mothers being high. The frequency of complementary feeding ranged was less and early/late weaning are still widely prevalent, use of bottle feeding is high, use of iodized salt is still low. There is a need to educate the mothers regarding proper infant/child feeding practices.info:eu-repo/semantics/publishedVersio

Adverse obstetric symptoms and rural-urban difference in cesarean delivery in Rupandehi district, Western Nepal: a cohort study.

BACKGROUND: The burden of maternal morbidity is high in developing countries including Nepal. This study investigated obstetric complications and rural-urban difference in cesarean delivery rate in Western Nepal. METHODS: A community-based cohort study was conducted in the Rupandehi district of Western Nepal during January-October, 2014, by interviewing 735 mothers within one month postpartum. The prevalence of obstetric complications was reported via frequency distribution, while factors associated with cesarean delivery were assessed using logistic regression analysis. RESULTS: The prevalence of adverse obstetric symptoms during antenatal, intranatal and postnatal periods were 19.7 %, 27.8 % and 21.6 %, respectively. In total, 81 (11.0 %) mothers reported having stillbirths. The cesarean delivery rate was 14.1 % overall but was four times higher in the urban (23.0 %) than in the rural areas (5.8 %). Prolonged labor (19.0 %) and heavy bleeding (16.7 %) were common among rural women. Logistic regression analysis confirmed that cesarean section was more likely for mothers residing in urban areas than in rural areas (adjusted odds ratio 3.41; 95 % confidence interval 2.01 to 5.78). CONCLUSIONS: About one in five mothers reported some adverse obstetric symptoms. Obstetric problems were more common in the rural areas, whereas cesarean delivery rate was much higher in the urban areas. Further investigations are required to determine whether these cesarean sections are medically warranted or provider induced

Maternal Mortality and Associated Factors in a Tertiary Care Center of Western Nepal

Introduction: Identifying the cause of maternal death is important. The aim of this study was to determine the causes of maternal deaths and the factors associated with it. Methods: This was an observational, cross-sectional, analytical study conducted at Department of Obstetrics and Gynecology, Manipal Teaching Hospital from July 2013 to June 2017. Women who died during pregnancy, delivery, or puerperium were included in the study. Demographic factors, clinical profile, cause and type of maternal deaths were noted by taking history and by inquiring with the medical personnel involved in managing patients.&nbsp; Data analysis was done using SPSS version 16. Results: There were 15 maternal deaths and 9923 livebirths. The maternal mortality ratio was 151 per 100,000 live births. Mean age of mothers was 28 years (SD = 7.5). Most of them were from rural areas, had low educational status. The mean gestational age at time of death was 33 weeks (SD = 7.5). Most of deaths (73%, n = 11) occurred in the postnatal period and 60% (n = 9) were critical at presentation. Direct obstetric causes like eclampsia was the most common (26.7%, n = 4) direct obstetric cause and cardiac disease was one of the important indirect cause (13.3%, n = 2). Delay in seeking health care and delay in reaching health center was the major reason for maternal deaths. Conclusion: Maternal mortality were mostly associated with direct obstetric causes, eclampsia being the most common. Most of the deaths were associated with delay in seeking health care and reaching health care centers