13 research outputs found
The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal
Background The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed
the effect of the pandemic on the disruption of institutional
delivery care in Nepal.
Methods We conducted a prospective cohort study among
52356 women in nine hospitals to assess the disruption of
institutional delivery care during the pandemic (comparing
March to August in 2019 with the same months in 2020).
We also conducted a nested follow up cohort study with
2022 women during the pandemic to assess their provision
and experience of respectful care. We used linear regression
models to assess the association between provision and experience of care with volume of hospital births and women’s
residence in a COVID-19 hotspot area.
Results The mean institutional births during the pandemic across the nine hospitals was 24563, an average decrease
of 11.6% (P<0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume
hospitals declined on average by 20.8% (P<0.0001) during
the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% (P=0.001). Maternity
services halted for a mean of 4.3 days during the pandemic
and there was a redeployment staff to COVID-19 dedicated
care. Respectful provision of care was better in hospitals with
low-volume birth (β=0.446, P<0.0001) in comparison to
high-medium-volume hospitals. There was a positive association between women’s residence in a COVID-19 hotspot
area and respectful experience of care (β=0.076, P=0.001).
Conclusions The COVID-19 pandemic has had differential
effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects
of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform
a “building-back-better” approach in post-pandemic period
Tuberculosis in HIV Patient
Introduction: Strict monitoring of anti tuberculosis therapy (ATT) and antiretroviral therapy (ART) is crucial for proper management of TB/HIV co-infected patients.
Methods: Between December 2006 and December 2008 a prospective observational study was conducted among 135 TB/HIV co-infected patients visiting antiretroviral therapy in Seti Zonal Hospital, Dhangadi. The diagnosed TB patients were subjected to ATT through directly observed treatment short-course (DOTS) and its response was evaluated as per WHO guidelines.
Results: Â Among 135 studied subjects, 71.9% were males and over 88 % of the patients were in the age group 21 to 50. Of the Total TB cases 68.1% presented pulmonary TB (PTB) and 37.20% of the Extra-pulmonary Tuberculosis (EPTB) cases were lymph node TB. 75.5% of them had completed ATT, 8.2% transfer out and 12.6% were default.
Conclusions: Majority of the patients presented PTB, and lymph node TB was found to be the most common EPTB. Comparatively, high efficacy of ATT was found in HIV patients visiting this resource poor setting.
Key words:Â antiretroviral therapy; anti TB therapy; Dhangadi; lymph node T; treatment response
Tuberculosis in HIV Patient
Introduction: Strict monitoring of anti tuberculosis therapy (ATT) and antiretroviral therapy (ART) is crucial for proper management of TB/HIV co-infected patients.
Methods: Between December 2006 and December 2008 a prospective observational study was conducted among 135 TB/HIV co-infected patients visiting antiretroviral therapy in Seti Zonal Hospital, Dhangadi. The diagnosed TB patients were subjected to ATT through directly observed treatment short-course (DOTS) and its response was evaluated as per WHO guidelines.
Results: Among 135 studied subjects, 71.9% were males and over 88 % of the patients were in the age group 21 to 50. Of the Total TB cases 68.1% presented pulmonary TB (PTB) and 37.20% of the Extra-pulmonary Tuberculosis (EPTB) cases were lymph node TB. 75.5% of them had completed ATT, 8.2% transfer out and 12.6% were default.
Conclusions: Majority of the patients presented PTB, and lymph node TB was found to be the most common EPTB. Comparatively, high efficacy of ATT was found in HIV patients visiting this resource poor setting.
Key words: antiretroviral therapy; anti TB therapy; Dhangadi; lymph node T; treatment response
Pattern of Abortion Care in a Tertiary Level Maternity Hospital in Nepal
Introduction: Complications from unsafe abortion are believed to account for the largest proportion
of hospital admissions for gynaecological services in developing countries and not to mention the
cost it imparts to the health system of a country. Therefore, it is equally important to find out the
prevalence and the pattern of abortion among the women who utilize the safe abortion care services
and provide a framework to target various health promotion programs including safe-motherhood
and reproductive health; such that the future interventions to avoid the unintended pregnancy and
unsafe abortion can be implemented accordingly.
Methods: A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal.
Social and demographic information of all the women seeking induced abortions from January 2011
to December 2012 were included and the result was analyzed.
Result: Abortion contributed to about 1.68% of the total patient served in the hospital that provides
both obstetrical and gynecological services. Of the total 4830 patients who underwent induced
abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than
one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two
parity and belonged to higher caste.
Conclusion: The socio-demographic profile of the abortion clients in Nepal has remained similar
over the years. We need to address the accessibility and availability to the safe abortion care services
along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion
care to all group of women and also, women education regarding contraception to avoid repeated
abortions or unwanted pregnancy in the future.
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Keywords: abortion; pattern; socio-demographic