Original Article

Abstract Introduction: Traditionally grandmultiparity has been considered to be an obstetric hazard both to the mother and foetus. Compounding factors are low socioeconomic status, poor female literacy and social deprivation. In developed populations with improved and optimal obstetric services, parity per se is no longer considered a significant risk for adverse obstetric and perinatal outcome. Objectives: To compare the obstetric and perinatal outcome between grandmultiparas and second gravidas with previous one delivery as well as analyse certain socio demographic features in the two groups. Methodology: Case records from Maternity Hospital, Kathmandu, an inner city tertiary care centre were retrospectively studied. 106 cases of grandmultiparous patients were compared with 110 cases of second gravidas who had previously delivered once which was taken as the control group. Biosocial features as well as obstetric and perinatal outcome were analyzed. Results: Rural residents comprised 60.4% of the grandmultiparous group versus 27.7% of the control group. A predominance of early marriage as well as an older age profile was noted in the grandmultipara. ANC attendance was documented to be much lower among grandmultipara with 26.4% having absolutely no antenatal care. A higher frequency of hypertensive disorders in pregnancy, preterm birth, anaemia, malpresentations, multiple pregnancy and premature rupture of membranes, postpartum haemorrhage and retained placenta was noted in the grandmultipara which also had a slightly higher caesarean delivery rate. The salient adverse perinatal outcome was found to be intrauterine foetal death, preterm birth and neonatal sepsis. Conclusion: In our set up grandmultiparity continues to challenge our obstetric practice with its associated increased likelihood of maternal and perinatal complications. Concerted effort should be directed to reducing high parity in the community through effective family planning initiatives and specialized antepartum and intrapartum supervision of this group should be available

Does Nepal’s Climate Change Adaptation Policy and Practices Address Poor and Vulnerable Communities?

Climate change (CC) impact, adaptation practices and policies are an emerging area of research and development in Nepal. Many households were deeply affected by, climatic variability and natural disasters coupled with a decade-long conflict, leaving them with few options to cope with CC in Nepal. The study was done through reviewed CC related policies and programs initiated at the national to local level.  Additionally, study was conducted to analyze different CC adaptation programs and practices in different eco-region from Himalaya to Inner Terai region of center and western Nepal through shared learning dialogue, field observation, key informant interview, regional and district level consultative workshop and focus group discussion. To address the issues of CC, different government and nongovernment institutions have initiated its adaptation programs in Nepal. NAPA and LAPA- Nepal highlighted the adaptation practices and adaptation framework from national to local level. These national programs initiatives have been endorsed by the GoN (Government of Nepal) through the promulgation of CC Policy Nepal 2011.  The policy has focused on interdisciplinary approach with 80% funds allocated at the local level particularly for poor and vulnerable groups. Some district level offices have initiated CC adaptation activities such as construction of water harvesting pond for irrigation, water source protection, agroforestry practices and training on CC adaptation and mitigation. Similarly, in some project supported districts, community level and VDC level five year local adaptation plans have been prepared. However, it is observed that there is a big gap in institutional arrangement, capacity to implement and mechanisms for adaptation programs at local level and poor communities. It was also observed that different GOs programs and NGOs were involved to improve the livelihood of the poor and vulnerable communities through pro-poor programs at local level which resulted improve CC adaptation capacity. It is suggested that CC policy in Nepal be formulated with holistic approach, institutionalized implementing mechanism and focus on livelihood improvement of the poor and vulnerable communities that have joint environmental, social or economic benefits. Keywords:  Community, Institutions, NAPA, no-regret approach, LAPA, Livelihood, Vulnerabilit

Village Baseline Study: Site Analysis Report for Haryana - Karnal, India

This is the report of the village baseline study of Pakhana in the CCAFS benchmark site of Karnal, India conducted from March 15-17, 2013 to complement an earlier household baseline survey done in the same village. Pakhana is located in the fertile flat land of the Indo-Gangetic plains and has good access to roads, markets, electricity and communication. The community has not experienced a food crisis and 90% of the population enjoys year-round food security. Pakhana benefited from the Green Revolution and has adopted improved varieties and the use of chemical fertilizers and pesticides. However, Pakhana now faces challenges resulting from population growth, deforestation, reduced and variable rainfall, declining soil fertility and organic matter, monocropping, over application of chemical inputs, and depletion of the water table. As a result, access to water resources is more difficult, profits have decreased and production is constrained. Without adjustments, Pakhana’s food security, livelihoods and natural resources will be further strained and threatened

Emergence or improved detection of Japanese encephalitis virus in the Himalayan highlands?

The emergence of Japanese encephalitis virus (JEV) in the Himalayan highlands is of significant veterinary and public health concern and may be related to climate warming and anthropogenic landscape change, or simply improved surveillance. To investigate this phenomenon, a One Health approach focusing on the phylogeography of JEV, the distribution and abundance of the mosquito vectors, and seroprevalence in humans and animal reservoirs would be useful to understand the epidemiology of Japanese encephalitis in highland areas

The functional, social and economic impact of acute encephalitis syndrome in Nepal--a longitudinal follow-up study.

notes: PMCID: PMC3772013Open Access JournalOver 133,000 children present to hospitals with Acute Encephalitis Syndrome (AES) annually in Asia. Japanese encephalitis (JE) accounts for approximately one-quarter of cases; in most cases no pathogen is identified and management is supportive. Although JE is known to result in neurological impairment, few studies have examined the wider impact of JE and AES on patients and their families.Wellcome TrustUniversity of Liverpool Clinical Fellowshi

A preliminary randomized double blind placebo-controlled trial of intravenous immunoglobulin for Japanese encephalitis in Nepal

BACKGROUND: Japanese encephalitis (JE) virus (JEV) is a mosquito-borne flavivirus found across Asia that is closely related to West Nile virus. There is no known antiviral treatment for any flavivirus. Results from in vitro studies and animal models suggest intravenous immunoglobulin (IVIG) containing virus-specific neutralizing antibody may be effective in improving outcome in viral encephalitis. IVIG's anti-inflammatory properties may also be beneficial. METHODOLOGY/PRINCIPAL FINDINGS: We performed a pilot feasibility randomized double-blind placebo-controlled trial of IVIG containing anti-JEV neutralizing antibody (ImmunoRel, 400mg/kg/day for 5 days) in children with suspected JE at two sites in Nepal; we also examined the effect on serum neutralizing antibody titre and cytokine profiles. 22 children were recruited, 13 of whom had confirmed JE; 11 received IVIG and 11 placebo, with no protocol violations. One child (IVIG group) died during treatment and two (placebo) subsequently following hospital discharge. Overall, there was no difference in outcome between treatment groups at discharge or follow up. Passive transfer of anti-JEV antibody was seen in JEV negative children. JEV positive children treated with IVIG had JEV-specific neutralizing antibody titres approximately 16 times higher than those treated with placebo (p=0.2), which was more than could be explained by passive transfer alone. IL-4 and IL-6 were higher in the IVIG group. CONCLUSIONS/SIGNIFICANCE: A trial of IVIG for JE in Nepal is feasible. IVIG may augment the development of neutralizing antibodies in JEV positive patients. IVIG appears an appealing option for JE treatment that warrants further study. TRIAL REGISTRATION: ClinicalTrials.gov NCT01856205

Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever

<p>Abstract</p> <p>Background</p> <p>More than 15 million people worldwide have rheumatic fever (RF) and rheumatic heart disease due to RF. Secondary prophylaxis is a critical cost-effective intervention for preventing morbidity and mortality related to RF. Ensuring adequate adherence to secondary prophylaxis for RF is a challenging task. This study aimed to describe the rates of recurrent episodes of RF, quantify adherence to secondary prophylaxis, and examine the effects of medication adherence to the rates of RF in a cohort of Brazilian children and adolescents with RF.</p> <p>Methods</p> <p>This retrospective study took place in the Pediatric Rheumatology outpatient clinic at a tertiary care hospital (Instituto de Puericultura e Pediatria Martagão Gesteira) in Rio de Janeiro, Brazil, and included patients with a diagnosis of RF from 1985 to 2005.</p> <p>Results</p> <p>536 patients with RF comprised the study sample. Recurrent episodes of RF occurred in 88 of 536 patients (16.5%). Patients with a recurrent episode of RF were younger (p < 0.0001), more frequently males (p = 0.003), and less adherent (p < 0.0001) to secondary prophylaxis than patients without RF recurrence. Non-adherence to medication at any time during follow-up was detected in 35% of patients. Rates of non-adherence were higher in the group of patients that were lost to follow-up (42%) than in the group of patients still in follow-up (32%) (p = 0.027). Appointment frequency was inadequate in 10% of patients. Higher rates of inadequate appointment frequency were observed among patients who were eventually lost to follow-up (14.5%) than in patients who were successfully followed-up (8%) (p = 0.022). 180 patients (33.5%) were lost to follow up at some point in time.</p> <p>Conclusions</p> <p>We recommend implementation of a registry, and a system of active search of missing patients in every service responsible for the follow-up of RF patients. Measures to increase adherence to secondary prophylaxis need to be implemented formally, once non-adherence to secondary prophylaxis is the main cause of RF recurrence. Detection of irregularity in secondary prophylaxis or in appointments should be an alert about the possibility of loss of follow-up and closer observation should be instituted.</p