Alcohol Consumption during Pregnancy and Postpartum Period and its Predictors in Sindhupalchowk District, Nepal.

BACKGROUND: A substantial proportion of women in Nepal consume alcohol and homebrewed alcoholic beverages are the most common type of alcohol. Alcohol being a part of tradition and culture in Nepal and evidences suggesting even low to moderate dose of alcohol having impacts on the birth outcomes, we aimed at exploring the alcohol consumption pattern during pregnancy and postpartum period along with its predictors. METHODS: We studied all pregnant and recently delivered women using quantitative methods in selected wards within selected Village Development Committees of Sindhupalchowk district in Nepal after purposively choosing the district. We present the findings on pregnancy and postpartum period drinking and its predictors as proportion and adjusted odds ratio along with 95% CI. RESULTS: One-third of women drank alcohol during pregnancy and 43% during postpartum period. Nearly all drinking women mostly consumed homebrewed alcoholic beverages such as jaad/chhyang/localraksi. One-third consumed it daily during pregnancy, while three-quarters consumed daily during postpartum. One-fifth of currently drinking women drank ≥5 standard drinks on average per day in the last 30 days. Illiterate or women with low level of education were three times more likely to consume alcohol during pregnancy than women with secondary level education or higher. Similarly, women who didn't know that alcohol during pregnancy affects mother and child were four and half times more likely to consume alcohol during pregnancy than those who knew about it. Also, being dalits, disadvantaged and janajatis, husband's drinking and home brewing of alcohol were strongly associated with women's drinking during pregnancy and postpartum period. CONCLUSIONS: A substantial proportion of women consumed alcohol during pregnancy and postpartum period with high consumption frequency. Findings suggested, increasing awareness about consequences of drinking during pregnancy and postpartum period would be helpful probably as one of the components of routine antenatal care with a special focus to ethnic groups such as dalits, disadvantaged janajatis including relatively advantaged janajatis as well as the women with lower levels of education. Culture sensitive behavior change communication interventions aimed at reducing home brewing and husband's drinking would also be important Keywords: Alcohol consumption; home brewed; Nepal; postpartum period; pregnancy; predictor.

Alcohol Use by Nepalese Women: Evidence from Non Communicable Disease Risk Factors STEPS Survey Nepal 2013.

BACKGROUND: Over the centuries, the world has witnessed alcohol use as a common phenomenon among the male population. Owing to the vulnerability of women towards alcohol and its possible consequences on women as well as children when pregnant or lactating mothers drink alcohol, there is utmost need to know the alcohol use among this population. The study sought to assess alcohol use among the Nepalese women aged 15-69 years. METHODS: It was a sub-set analysis of 2807 women aged 15-69 years, extracted from a data of national cross-sectional study, NCD Risk Factors: STEPS Survey Nepal 2013 carried out among 4200 adults in 2013 using a multistage cluster sampling. Data collected in personal digital assistants using WHO NCD STEPS instrument version 2.2 were transferred to Microsoft Excel, cleaned in SPSS 16.0, and analyzed in STATA 13.0. RESULTS: We reported 11.7% (95% CI: 9.5-14.3) ever users of alcohol, 9.4% (95% CI: 7.4-11.7) last 12 months alcohol users, 7.1% (95% CI: 5.2-9.0) current drinkers, and 0.9% (95% CI: 0.5-1.6) with harmful use of alcohol. As compared to 15-29 years women, 30-44 and 45-69 years women were 1.61 (95% CI: 1.02-2.55) and 1.58 (95% CI: 1.03-2.43) times more likely to be drinkers in the last 12 months, respectively. Likewise, 45-69 years women were 2.84 (95% CI: 1.05-7.63) times more likely to indulge into harmful use of alcohol than their younger counterparts (15-29 years). Women from the Terai belt had lower odds of any drinking pattern than the women from hills: ever use (0.43, 95% CI: 0.27-0.70), alcohol use in the last 12 months (0.44, 95% CI: 0.26-0.75), current drinking (0.38, 95% CI: 0.22-0.65), and harmful use of alcohol (0.11, 95% CI: 0.03-0.37). Primary education holders were found to have 0.64 times (95% CI: 0.43-0.95) chances of current drinking than those without formal education. CONCLUSIONS: Women from upper age groups, hills, and with no formal education were found likely to be consuming alcohol. Contextual and culture friendly anti alcohol behaviour change communication interventions on community settings of hills and mountains, promoting active participation of relatively older women (45-69 years) and illiterate women are of great importance.

Socio-demographic Predictors of Tobacco Use among Women of Nepal: Evidence from Non Communicable Disease Risk Factors STEPS Survey Nepal 2013.

BACKGROUND: Globally, tobacco use is most common public health problem. Similar is the situation of Nepal where thousands of lives are lost annually. Both sexes are affected by tobacco use but women share different and unique problems. Hence, in this paper we made an attempt to understand socio-demographic predictors of tobacco use among women of Nepal. METHODS: A cross-sectional study was carried out with a sample of 2797 women (15-69 years) recruited through multistage cluster sampling technique. This study used sub-set of data of non-Communicable diseases risk factors survey 2013 of Nepal. Bivariate and multivariable regression analyses were carried out to determine predictors of tobacco use among women of Nepal. RESULTS: Among total women, 14% were having at least one form and pattern of tobacco use. Furthermore, 10 % were smoker and 4 percent were using any form of chewing tobacco user. As compared to 15-29 years women, 45-69 years age group were 5 times (OR=4.7, 95% CI =2.7-8.0) more likely to be tobacco user. Similarly, urban women were 40% (OR=0.6, 95% CI=0.38-0.95) less vulnerable than rural women. In addition, higher educated women were found to be at 1% (OR=0.01, 95% CI=0.01-0.01) less risk of being tobacco user. CONCLUSIONS: Age, area of residence, and education level were found to be significant socio-demographic predictors for tobacco use among women in Nepal. Therefore, tobacco control programme should target these groups for interventions.

Prevalence and Determinants of Comorbid Diabetes and Hypertension in Nepal: Evidence from Non Communicable Disease Risk Factors STEPS Survey Nepal 2013.

BACKGROUND: Despite being preventable disease, diabetes and hypertension fall among top 10 leading causes of death globally. Diabetes and hypertension are independent risk factor for cardiovascular disease, and the risk is markedly increased by their co-occurrence.This study attempted to find out the prevalence of comorbid diabetes and hypertension in Nepal. METHODS: A cross-sectional survey was conducted among 4,200 Nepalese adults selected through multistage cluster sampling.Out of 4,200 respondents of larger study, this article includes the analysis of 3,772respondents who granted permission for physical and biochemical measurement. Nepali version of WHO NCD STEPS instrument version 2.2 was used for data collection. In order to obtain national estimates sample weight was used. Chi-square test and multivariable binary logistic regression were used to assess the association of socio-economic predictors with comorbid conditions after adjusting effect of clusters and strata. RESULTS: The overall prevalence of comorbid diabetes and hypertension was found to be 2% in Nepal.Considering age group 15 to 29 years as reference, people in age group 45-69 and 30 to 44 years were found to have 33 folds (AOR=33.06, 95%CI=5.90-185.35) and 6 folds(AOR=6.36, 95%CI=1.08-37.43) higher odds of developing comorbid condition of diabetes and hypertension. CONCLUSIONS: Prevalence of comorbid diabetes and hypertension seem to be high in people of 45-69 years of age. Age and level of education seem to be associated with comorbid diabetes and hypertension.

Oral Health Condition of School Children in Nawalparasi District, Nepal.

BACKGROUND: Oral diseases and feeding habits are inextricably linked. Significance of assessing oral health conditions among the school children therefore exists. The current study investigated the oral health condition among 5-6 years and 12-13 years children in Nawalparasi district, Nepal. METHODS: Recruiting 1,000 school children aged (5-6) and (12-13) years in Nawalparasi district, a cross-sectional study was carried out from November to December, 2014. Data assembled from standard instrument was entered in Epi-Data 3.1, cleaned in SPSS version 16.0, and analyzed in Epi Info 3.5.4. RESULTS: Of 12-13 years children, three out of ten (32.0%, 95% CI: 27.8-36.4) suffered from occasional dental discomfort and pain, and 8.1% (95% CI: 5.9-11.0) often experienced dental discomfort and pain during the last 12 months. It was 73.6% (95% CI: 69.3-77.4) who brushed teeth at least once a day, while another 20.7% (95% CI: 17.2-24.7) brushed twice a day. Among all children, 86.1% (95% CI: 82.6-89.1) used toothpaste to brush the teeth. A three-fourth (73.8%, 95% CI: 69.5-77.7) drank tea with sugar daily. Dental caries was visible on 42.2% (95% CI: 37.7-46.8) (mean DMFT score 2.3 ± 1.5). Likewise, a quarter (24.1%, 95% CI: 20.3-28.3) had gingival bleeding, 10.9% (95% CI: 8.3-14.1) questionable enamel fluorosis, 4.5% (95% CI: 2.9-6.9) dental trauma, and 1.7% (95% CI: 0.8-3.5) oral mucosal lesion. Referral for preventive/routine treatment was observed in 40.5% (95% CI: 36.145.1). Among 5-6 years old children, a remarkable proportion of dental caries (64.4%, 95% CI: 59.2-69.4 and mean DMFT score 4.4 ± 3.0) was noted. Statistics of enamel fluorosis, dental trauma, and oral mucosal lesions in this age group were: 3.1% (95% CI: 1.6-5.6), 1.7% (95% CI: 0.7-3.8), and 1.1% (95% CI: 0.4-3.0) respectively. About 40.1% (95% CI: 35.0-45.4) were referred for preventive treatment, and the rest for prompt treatment. CONCLUSIONS: Oral health of the children was poor, chiefly dental carries remained widespread. Dental hygiene awareness should be promoted in schools in active coordination and collaboration with education authorities.

Knowledge of dental interns towards emergency management of avulsed tooth in dental colleges in Nepal.

BACKGROUND: Avulsion is most common traumatic injury of tooth. Adequate knowledge about management of this situation can save a tooth. This study was conducted to investigate the knowledge and attitude of dental interns of Nepal in the management of tooth avulsion and also evaluate the need for further education on managing avulsed teeth. METHODS: A cross-sectional survey consisting of 18 items were filled, collected and mailed back by 121 interns of Nepal from five dental colleges. The study period was from July to September 2013. All returned questionnaires were analyzed using SPSS 17.0. RESULTS: Dental interns with more efficient in answering questions regarding- ideal time for replantation of an avulsed tooth (p=0.024), splinting period (p=0.008), the critical factor in the outcome of replanted tooth (p=0.010) and the better prognosis with open apex (p=0.001). Prior knowledge about management of avulsed tooth had a role in correctly answering questions on type of splint used (p=0.022) and better prognosis with open apex (p=0.018). Attending educational program on trauma management helped them in correctly answering questions on avulsed permanent tooth to be replanted (p=0.043) and the type of splint used (p=0.014). CONCLUSIONS: Dental interns experience, prior knowledge and educational programs with dental management regarding traumatic injuries scored significantly higher than without such training or acquired information. However further knowledge needs to be enhanced by continued educational programs to ensure appropriate treatment.

Clinical characteristics of children with febrile seizure.

BACKGROUND: Febrile seizure is common in children below five years of age. This study was conducted to evaluate the clinical profile of children presenting with febrile seizure in a teaching hospital. METHODS: This was a descriptive retrospective study among children presenting with febrile seizure in a teaching hospital from July 2009 to June 2013. Children between six months to six years were included in the study while patients with prior episodes of afebrile seizures, abnormal neurodevelopment and not meeting the age criteria were excluded. Patient's demographic and clinical data were collected from the in-patients records and analyzed. RESULTS: This study included 103 children with febrile seizure. Out of which 67% were male. Simple febrile seizure and complex febrile seizure were observed in 76.7% and 23.3% of patients respectively. Majority of children (71.8%)had generalized tonic clonic seizure followed by tonic seizures. Most of children (72.8%) who developed first episode of seizure were below 24 months of age with the mean age of 20.7 (±12.1) months. Overall 33% of patients developed recurrence of febrile seizure and first episode of febrile seizure at age one year or below was associated with the seizure recurrence. Upper respiratory tract infections were the commonest cause of fever in these children. CONCLUSIONS: Febrile seizure was observed predominantly in children below age of two years and simple febrile seizure was the ommonest variety. Recurrence of febrile seizure was common and significantly associated with the first episode of febrile seizure at the age of one year or below.

Molecular mechanism of multi-drug resistance in Shigella isolates from rural China.

Diarrhoeal diseases and enteric infections are major causes of morbidity and mortality in the developing countries. Shigellosis was sixth in the rank of death caused by infectious disease in China. Present study assess the patterns of antimicrobial susceptibility and mutations in marA genes of Shigella isolates and its association. One hundred isolates of Shigella spp were tested to evaluate the antimicrobial susceptibility and mutation of marA through PCR-SSCP. The antimicrobial resistance profiles were: Amoxicilline-clavum (85%), Nalidixic acid (100%), Piperacilline (100%), Ciprofloxacin (25%) and Polymixin B (1.1%). S. flexneri isolates were more resistant than those ofS. sonnei to Amoxicilline-clavum (96.6% versus 0.0%, P<0.001) and Ciprofloxacin (27.3% versus 8.3%, P=0.141). S. flexneri isolates were more resistant than those of S. sonnei to three or more antimicrobial agents (96.6% versus 8.3%, P<0.001). Overall mutation rate in marA was 19%. Nucleotide sequencing showed mutations in three positionsÿcodon 6 ( Delation of C), 319 (Ala Gly) and 374 (Addition of C). The mutation of marA may play a minor role and other mechanisms may contribute to the drug resistance of Shigella spp.