Factors associated with smokeless tobacco use among pregnant women in rural areas of the Southern Terai, Nepal

Background: Tobacco use among women during pregnancy leading to poor maternal and child health outcomes has been well documented. However, factors influencing use of smokeless tobacco in Nepal has not yet been well established. This study aims at exploring the factors related to smokeless tobacco use among pregnant women in rural southern Terai of Nepal. Methods: A community-based cross-sectional study was performed at 52 wards within 6 Village Development Committee in Dhanusha district of Nepal. A total of 426 expectant mothers in their second trimester were selected using a multistage cluster sampling method. Descriptive and regression analyses were done to explore the factors that influence smokeless tobacco use. Results: In a total of 426 pregnant mothers, one in five used tobacco in any form. Among the users, 13.4% used smokeless tobacco. Pregnant mothers who were smoking tobacco (AOR 6.01; 95% CI (1.88-19.23), having alcohol consumption (AOR 3.86; 95% CI (1.23-12.08), stressed (AOR 5.04; 95% CI (1.81-14.03), non-vegetarian (AOR 3.31;(1.84-13.03), not attending regular mothers’ group meetings (AOR 4.63; (1.41-15.19), and not-exposed to mass media (AOR 5.02; (1.89-13.33) were significantly associated with smokeless tobacco use. Similarly, mothers of age group 20-34 years, dalit, aadibasi and janajati, hill origin, no education and primary education were more likely to use smokeless tobacco than their counterparts. Conclusions: Factors such as smoking tobacco, alcohol consumption, stress, and poor education were found to be significantly associated with smokeless tobacco use among pregnant women in southern Terai of Nepal. This requires an immediate attention develop an effective strategy to prevent and control smokeless tobacco use among pregnant women in southern Terai of Nepal

Beta-Lactamases in a Tertiary Care Hospital: "Biological Quake" Knocking at the Door

Background: Antimicrobial resistance due to the production of extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases, and metallo-β-lactamases (MBLs) have emerged as a major health catastrophe limiting antibiotic treatment options. Therefore, this study was conducted to assess the current level of ESBLs, AmpC β-lactamases, and MBLs- producing bacteria and their antibiotic susceptibility profile in a Nepalese hospital. Methods: This was a cross-sectional study carried out among the inpatients of Medicare National Hospital, Kathmandu from April to September 2015. During the study period, a total of 589 specimens (urine, sputum, blood, pus, body fluids, throat swab, central venous catheter - CVC tip) collected aseptically from the admitted patients were selected in the study. The collected specimens were processed, and the isolated organisms were identified following the standard microbiological methods. ESBL was detected by standard combination disc method and double-disc synergy test.  Results: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, and Candida albicans were the common microbial agents isolated from hospital-admitted patients. Among total 84 Gram-negative bacteria tested for ESBL-production, 23 (27.4%) isolates were ESBL-producers. ESBL production was seen in 32.3% of Escherichia coli and 28.6% of Klebsiella pneumoniae isolates. Similarly, MBL production was identified in 28.6% of Pseudomonas aeruginosa, and 6.5% of Escherichia coli. Likewise, 3.2% of Escherichia coli were AmpC β-lactamase-producers. The ESBL-producing bacteria showed less susceptibility to different antibiotics as compared to non-ESBL-producers. Consistent results were found with different methods like combination disk method, MASTDISKSTM ID AmpC and ESBL disk, Ezy MICTM Strip (MIX+/MIX) method, and triple ESBL detection Ezy MICTM strips employed for the detection of ESBL and AmpC. Conclusions: ESBL was commonly seen in Escherichia coli while MBL in Pseudomonas aeruginosa. Routine monitoring of these kinds of resistance phenotypes following appropriate methods is essential for the proper treatment of patients. Keywords: Antibiotic resistance, Beta-lactamases, ESBL, Hospital-admitted patients, MB

Prevalence of behavioral risk factors of cardiovascular diseases and associated socio-economic factors among pregnant women in a rural area in Southern Nepal

Background: Cardiovascular diseases (CVDs) have dramatically infiltrated populations living in abject poverty in Low- and Middle-income Countries (LMICs), and poor maternal and child health outcomes have been frequently reported for those with CVD risk factors. However, few studies have explored the behavioral risk factors of CVDs among pregnant women in rural settings. This study aimed at determining the prevalence and identifying the socio-economic predictors of behavioral risk factors of CVDs among pregnant women in rural area in Southern Nepal. Methods: A Community-based cross-sectional study was conducted in 52 clusters of Dhanusha District of Nepal in a total of 426 pregnant women in their second trimester using multistage cluster sampling method. Multivariable logistic regression model was used to assess independent associations between behavioral risk factors during pregnancy and maternal socio-economic characteristics. Results: Of the 426 study participants, 86.9, 53.9, 21.3 and 13.3%, respectively, reported insufficient fruits and vegetables consumption, insufficient physical activity, tobacco use, and harmful alcohol drinking. Socio-economic factors significantly associated with more than one behavioral risk factors in expectant mothers with a primary level education (adjusted odds ratio (AOR) 2.78; 95% Confidence Interval (CI) (1.35–5.72)), 20–34 years age group (Adjusted Odds Ratio (AOR) 0.27; 95% CI (0.13–0.56)), and those with the highest wealth index (AOR 0.36; 95% CI (0.16–0.84)). Conclusion: Higher prevalence of behavioral risk factors for CVDs and their socio-economic factors prevailing among pregnant women living in rural Nepal call for immediate health promotion interventions such as community awareness and appropriate antenatal counseling

Role of mass media on knowledge generation and countering misconceptions about tuberculosis transmission in Nepal

Objective: To explore the role of mass media on knowledge generation and counter the misconceptions about tuberculosis (TB) transmission in Nepal. Methods: A cross-sectional study was performed in the largest referral hospital in Nepal. The quota sampling technique was used to recruit 283 subjects into the sample. Results: A total of 235 (83.0%) respondents correctly replied that TB transmits through air by coughing or sneezing. A total of 29 (10.2%) respondents had correct knowledge about TB transmission without having misconceptions. Similarly, regarding the misconceptions about TB transmission, 157 (55.5%) replied that TB transmits through utensils, 163 (57.6%) respondents replied that TB transmits through sharing clothes/bed sheets/towel, 62 (21.9%) respondents replied that TB transmits through touching a person with TB, 142 (50.2%) respondents replied that TB transmits through food, 88 (31.1%) respondents replied that TB transmits through sexual contact. Respondents who read newspaper (ajusted odd ratio=3.004, cofidence interval=1.208–7.471) and listen to the radio daily (ajusted odd ratio=4.610, cofidence interval=1.738–12.234) were more likely to have correct knowledge on transmission of TB. Conclusions: National TB Control Program in Nepal should give priority in disseminating TB related message through newspapers, magazines and radio programs