Factors affecting retention of child health card in a rural area.

BACKGROUND: The child health card is a tool used by Health Management Information System in Nepal. It contains records on immunization, vitamin A and a weight-for-age growth chart. The objective of this study was to identify the magnitude of and the factors affecting retention of child health card. METHODS: A cross sectional descriptive design using quantitative methodology was applied. Divyapuri VDC was selected purposively and simple random sampling was applied to obtain a sample of 282 households with children between one to 36 months. Information was collected by interview with mothers of one to 36 months children and by observation of child health cards. Descriptive analysis was performed to assess the magnitude of retention of child health card. Then, bivariate analysis was performed; odds ratio and corresponding 95% confidence interval were used to test the significance of association. Logistic regression model was used for control of confounding. RESULTS: Only 41% of the mothers produced child health card at the time of survey. For about 7% respondents, child health card was not issued and only 45% of the respondents who were issued child health card have retained it. Younger age group of the child, mothers living nearer to health facility, mothers with knowledge on use of child health card for recording immunization and recording growth monitoring; and mothers who were explained child health card by health worker were found significantly higher odds of retaining it. CONCLUSIONS: The retention of child health card was low in the study area. Health workers should be trained to educate mothers on retention and use of child health cards.

Iodine supplementation in pregnancy and its effects on perinatal outcome.

Iodine is an important micronutrient for mental growth and development. Limited information is available on the role of iodine supplementation in pregnancy and its effect on perinatal outcome. We designed intervention study to assess the effect of iodine supplementation during second half pregnancy and its effect on perinatal outcomes (maternal and neonatal health). Among 60 intervened with oral iodine tablet in pregnancy and 60 control pregnant women in Sindhupalchowk District Hospital Chautara, we assessed maternal and neonatal health after the delivery. The significant differences were found among duration of pregnancy, weight of pregnant mother before and after intervention of at least three months duration (56.1 kg vs. 59.6 kg, p < 0.001), weight of neonate (3.3 kg in intervention vs. 3.0 kg in control, p < 0.001), and thyroxin hormone (1.1 ng in intervention vs. 1.2 ng in control, p < 0.001) of women between intervened and control subjects. Therefore, regular supplementation of iodine in oral form for more than three months during pregnancy preferably during early stage will bring significant positive changes in perinatal outcomes.

Biochemical nutritional indicators in children with protein energy malnutrition attending Kanti Children Hospital, Kathmandu, Nepal.

BACKGROUND: Nutrition is the science of food and its relationship to health. Nutritional status is one of the key indicators of health Nutritional status of Nepal is not satisfactory. Especially Protein Energy Malnutrition (PEM) in Nepal is a very common problem in children under fi ve years of age. There are number biochemical parameters which become altered during protein energy malnutrition. OBJECTIVES: The objectives of the study are to determine biochemical nutritional indicators among children suffering from PEM and to compare all biochemical parameters with well nourished children and also to determine the factors affecting PEM among children under five years. MATERIALS AND METHODS: The study design was cross sectional, descriptive study with control. Children between ages 6 to 59 months attending outpatient department (OPD) and wards of Kanti Children's Hospital (KCH), Maharajgunj, Kathmandu, Nepal were purposively selected. The sample size was calculated by using prevalence of malnutrition in Nepalese context and allowable error of 10 %, a total of 120 cases which include 60 PEM cases and 60 controls were selected. They were grouped into two groups based on whether they are above or below the 80% of 50th percentile of weight for height based on growth chart of National Centre of Health Statistics (NCHS), USA. RESULTS: The educational status of parents of children with PEM was found to be significantly less (p<0.05) as compared to their non-PEM counterparts. Occupations of parents whose children were in PEM group include mainly housewives and labourers. Larger proportions of children in our study were born at home and exact birth weights of children were not known. Most of the children are colostrum fed. Most of the children in our study were immunized. Almost equal proportion of children belonged to nuclear family type and joint family type. The mean serum glucose, sodium, potassium, cholesterol, haemoglobin was not significantly different in both groups while mean total protein, albumin, and calcium were significantly (p<0.05) low in PEM group when compared to well nourished children (control). There was significantly (p<0.05) higher incidence of hypoproteinemia, hypoalbuminaemia, and hypocalcaemia, in PEM group when compared to control group. CONCLUSION: A significant proportion of children with protein energy malnutrition had altered biochemical parameters which were related to food intake and biochemical metabolism mandatory during growth and development of children less than five years of age. There was significantly higher proportion of hypoglycaemia, hypoproteinemia, hypoalbuminaemia, anaemia, hypocholesterolemia and hypocalcaemia in children with PEM when compared to normally nourished children.