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.

[The relation between patient volume and quality of care. Results of a survey]. / Forholdet mellom pasientvolum og behandlingskvalitet. Resultat av høring.

A report on the relation between patient volume and quality of treatment has been evaluated by health administrators. The majority supports that adequate patient volume is important for quality of treatment and for quality assurance. The implementation of these concepts in the organizing of health services is advocated. There is a relation between every single administrator's attitude towards the volume-quality concept and the number of beds in their own hospital. Clinical audit by means of registers and more national control of the hospital service is supported.

Pharmacokinetics of phenytoin in acute adult and child intoxication.

The pharmacokinetics of phenytoin was studied in 4 acute intoxications. Two patients were identical twins aged 2 years 5 months being concomitantly poisoned, whereas one adult male was admitted twice. Their maximal phenytoin plasma concentrations were 246, 200, 168 and 164 mumol/l; the lowest values were in the twins. Despite this, consciousness in the children was more depressed whereas severe ataxia and involuntary movements dominated the course in the adult. All patients survived without any sequelae upon symptomatic treatment. Saturation kinetics of phenytoin could be demonstrated in all cases. For the twins, a Km in the range of 10.3-48.6 mumol/l was calculated, indicating saturation kinetics even within the therapeutic range of 40-80 mumol/l. In the twins, the Vmax was in the range of 47.3-79.4 mumol/l/day with a maximal elimination rate of 37.7-63.6 mumol/l/kg/day. We suggest that these kinetic parameters for phenytoin probably are independent of age.