Menopausal Health Status of Nepalese Women.

INTRODUCTION: Menopause is an unavoidable and sometimes problematic condition in which women may suffer from a number of health problems. Knowledge of the major symptoms associated with menopause helps reduce the burden and stress associated with the condition. In this context, a study was conducted to establish baseline data regarding menopausal health problems among Nepalese women. METHODS: A descriptive cross-sectional study was conducted among 2000 women aged over 40 years to identify their knowledge, attitude and practice related to menopausal health problems. Data was collected by interviewing the women and doing physical examination. Analysis was done using descriptive statistics and SPSS software was used for data analysis. RESULTS: A cohort of 2073 women (ages 40-60 years) participated in the research, among them 2000 yielded complete response. The study revealed that 820 (41%) women had reached menopause. The average age of menopause was 48.7 years. Majority of the women 1183 (59.2%) in the study did not know about menopausal health problems. Abnormal bleeding 353 (17.65%), sweating 315 (15.75%), hot flushes 299 (14.95%), joint/muscle pain 285 (14.25%) were the most common menopausal symptoms known by the women. Joint pain 736 (36.8%), hot flushes 584 (29.2%), irregular bleeding 582 (29.1%) were the most common experienced symptoms of menopause and only 586 (29.3%) consulted the health workers to alleviate menopausal symptoms. Moreover, most of the women 926 (46.3%) accepted menopause as a part of life. CONCLUSIONS: The research has tried to establish the baseline of menopausal health problems in the Nepalese women. The average age of menopause was 48.7 years. Majority did not know about menopausal health problems. Further researches with nationally representative sample are recommended to further explore the menopausal health problems of Nepalese women.

Urinary tract infection in vaginitis: a condition often overlooked.

Despite the differences between the organisms that cause vaginitis and urinary tract infections (UTI), it is possible that women with vaginitis develop UTI. The main objective of the study was to find the association of the common types of infectious vaginitis with UTI. Cross sectional study was conducted for six months in a referral hospital at Lalitpur, Nepal. Three hundred and sixmid-stream urine samples and high vaginal swabs (HVS) collected from non pregnant women were investigated by standard microbiological techniques. Among the women with bacterial vaginosis (BV), 75% also had UTI. Similarly, 46% and 13% of those with vaginal candidiasis and trichomoniasis respectively had concurrent UTI. Considering this strong association of UTI and vaginitis, women with either of these conditions should be tested for the other.

Prospective study of medical abortion in Nepal Medical College Teaching Hospital (NMCTH). A one year experience.

A combination of antiprogesterone mifepristone and prostaglandin analogue misoprostol provides an effective non surgical method for termination of pregnancy up to gestational age of 63 days. The objective of this study was to assess the efficacy of this medical regimen for termination of pregnancy up to 63 days of pregnancy. A hospital based prospective study was carried out in department of obstetrics and gynecology at Nepal Medical College Teaching Hospital (NMCTH) for a period of one year where 100 women requesting for medical abortion were enrolled. The medical regimen used was mifepristone 200 mg orally followed 24 hours later by misoprostol 800 micrograms administered buccally. Most of the women were in age group 20-29 years (50%), were nulliparous (81%) and were within 42 days of pregnancy (47%). The overall success rate of this regimen was 93.6%. Where success was defined as achieving complete abortion without needing surgical evacuation. Surgical evacuation was needed in 6 (6.4%) patients i.e. 5 for incomplete abortion and one for continued viable pregnancy. The combination of oral mifepristone 200mg followed 24 hours later by buccal misoprostol 800mcg is effective method of medical termination of pregnancy.

Level of awareness about legalization of abortion in Nepal: a study at Nepal Medical College Teaching Hospital.

World Health Organization (WHO) estimates that about 25.0% of all pregnancies worldwide end in induced abortion, approximately 50 million each year. More than half of these abortions are performed under unsafe conditions resulting in high maternal mortality ratio specially in developing countries like Nepal. Abortion was legalized under specified conditions in March 2002 in Nepal. But still a large proportion of population are unaware of the legalization and the conditions under which it is permitted. Legal reform alone cannot reduce abortion related deaths in our country. This study was undertaken with the main objective to study the level of awareness about legalization of abortion in women attending gyne out patients department of Nepal Medical College Teaching Hospital (NMCTH), which will give a baseline knowledge for further dissemination and advocacy about abortion law. Total 200 women participated in the study. Overall 133 (66.5%) women said they were aware of legalization of abortion in Nepal. Women of age group 20-34 years, urban residents, service holders, Brahmin/Chhetri caste and with higher education were more aware about it. Majority (92.0%) of the women received information from the media. Detail knowledge about legal conditions under which abortion can be performed specially in second trimester was found to be poor. Large proportion (71.0%) of the women were still unaware of the availability of comprehensive abortion care services at our hospital, which is being provided since last seven years. Public education and advocacy campaigns are crucial to create awareness about the new legislation and availability of services. Unless the advocacy and awareness campaign reaches women, they are not likely to benefit from the legal reform and services.

Comparative study of post term and term pregnancy in Nepal Medical College Teaching Hospital (NMCTH).

Post term pregnancy (PTP) is one of the commonest obstetric conditions. Pregnancy is called term when it lies between 37 completed weeks to 42 completed weeks (259 to 294 days) from the last menstrual period. If the pregnancy exceeds this period (above 42 completed weeks) it is classified as post term pregnancy. The over all incidence of PTP is 10.0% of all pregnancies. The incidence of PTP varies depending on whether the calculation is based on the history and clinical examination alone, or whether early pregnancy ultrasound examination is used to estimate gestational age. Because of increased risk of maternal and perinatal morbidity and mortality, it is taken as high risk pregnancy. The published data on risk of unexplained intrauterine death associated with PTP vary. It is mostly due to decrease in amniotic fluid volume; meconium passed in utero, placental changes like calcification, abruption placentae and big baby. In present study the prevalence of PTP is 4.6% which is much less than those in different studies. Maternal and neonatal outcomes of pregnancy and related complications were compared with normal term pregnancy. This comparative study revealed increased risk to mother and fetus as pregnancy advances beyond term.

Complications of home delivery: our experience at Nepal Medical College Teaching Hospital.

A prospective study was conducted at Nepal Medical College Teaching Hospital to find out the complications of home delivery, maternal and fetal outcome and the main factors leading to home delivery. Among the 114 women who were brought to the hospital after home delivery, one was brought dead and one more died shortly after arrival. Sixty point five percent were housewives with no formal occupation, 68.4% were illiterate, 64.0% were multipara, Maximum no. of women belonged to the age group 20-24 years, 15.8% were adolescents, Lasheta (Lama, Sherpa , Tamang) was the most common ethnic group, Most of the women delivered at full term, whereas preterm delivery occurred in 4 (3.6%). Majority (73.7%) of the women had attended antenatal care at least once and half of the women had attended 4 and more visits. More than half had been fully immunized with tetanus toxoid and taken iron supplementation. As the reasons to deliver at home: 32.5% stated to be due to financial limitations, 30.7% due to ignorance and 16.7% due to transport limitations, and rest due to 'other reasons' which were most commonly stated as to be lack of attendant at home, long distance to hospital or delivery occurring too quickly or too late at night to attend the facility of choice. Ninety four point seven percent delivered at home with no trained assistance. Majority of the women (72.8%) were brought with retained placenta or excessive bleeding per vaginum. Twenty one point nine percent of the women were brought in shock needing active resuscitation. Twenty seven point two percent had postpartum hemorrhage. It was found that antenatal services were well utilized, but mothers were less likely to access good quality delivery/postnatal care. Despite the availability of services however, women still went on to deliver at home without any trained assistance, and this effect was greatest for the t less educated, poorer women. Financial and transport limitations appear to be some of the most important factors in women's inability to access skilled care. This important barrier to care will need to be addressed if we intend to improve delivery service to the most vulnerable of women.

Awareness and practice of family planning methods in women attending gyne OPD at Nepal Medical College Teaching Hospital.

A cross sectional descriptive study of awareness and practice of family planning methods among 200 women of reproductive age attending gynecology out patient department (GOPD) of Nepal Medical College Teaching Hospital from 14th May 2008 to 14th July, 2008 was carried out. Most of the respondents (93.0%) were aware of at least one of family planning methods out often methods, but only 65.0% had ever used it and contraceptive prevalence rate was 33.5% which was slightly higher than the national data as 28.5%. The best known method of temporary contraception was depo provera (78.0%) followed by oral contraceptive pills (74.0%) and condom (71.0%) and least known methods were vaginal foam tablets/jelly (34.0%) and natural methods (16.0%). Among permanent family planning methods, awareness about female sterilization (81.0%) was more than male sterilization (77.0%) which was in accordance with studies done in other countries. Knowledge about emergency coritraception was quite low (12.0%) as it was newly introduced in the country. Regarding current use of contraception depo provera (11.0%) was the most widely used followed by oral contraceptive pills (4.5%) and condom (4.5%). 5.5% had undergone female sterilization while only 2.5% of male partner had sterilization Knowledge of non contraceptive benefits of family planning methods was claimed by only 35.0% of the respondents, 27.0% reported awareness that condoms protect from HIV/AIDS and sexually transmitted diseases (STD) while knowledge about various adverse effects was widespread (52.5%). The most common source of information on contraception was media (55.5%), both printed and electronic. This study also observed that with increase in level of education, awareness also increased. Although most of the women were aware about the methods, they were ignorant about the details like duration of protection, return of fertility on discontinuation and non contraceptive benefits. The most common reason for discontinuation of FP methods was stated as side effects. A wide knowledge practice gap was evident in this study, which was similar to the findings of studies done in other developing countries. Improved female education strategies and better access to services are needed to solve these problems. The use of communication media suitable for the audience and adequate message is important in conducting effective family planning awareness activities. Efforts should be made to educate the public about the safety and convenience of modern, long-term, reversible methods of contraception among both healthcare professionals and the public.

Study of low birth weight babies in Nepal Medical College.

This was a retrospective study conducted to study the newborns weigth less than 2500gm delivered in Nepal medical college in the year 2005 and 2006. The cases were studied to find out the incidence and relation of maternal age, parity, gestational age, sex, etiological factors, mode of deliveries with Low Birth Weight (LBW) babies. There were 172 patients with LBW babies out of 1517 patient. Including the 9 twin babies, there were total 181 babies with LBW. Thus the incidence of LBW babies was 11.9%. There were only 26 (15.0%) under 20 years of age. As for parity, 92 (53.0%) were primigravida and 80 (46.0%) were multigravida. There were 6 (3.5%) of the babies less than 28 weeks, 22 (13.0%) between 29 to 32 weeks, 61 (33.7%) between 33 to36 weeks, 78 (43.1%) between 37 to 40 weeks and 14 (7.7%) 41 weeks or above. The babies under 1000gm or 1000 gms were 7 (4.1%),1001-1500 gms were 15 (8.7%), 1501-2000 gms were 40 (23.0%) and 2001-2500 gins were 119 (69.2%). Male babies were 94 (52.0%) and female babies were 87 (48.0%). Caesarian section was 15.7% remaining babies were delivered vaginally. Among the risk factor for LBW babies, spontaeneous preterm labour were 61 (35.5%), intra-uterine growth restriction were 51 (29.0%), antepartum haemorrhage 10 (5.8%), twin 9 (5.2%), pregnancy induced hypertension 12 (7.0%), preterm premature rupture of labour 8 (4.7%), anomalies were 4 (2.3%) and urinary tract infection were 20 (11.6%). Other infection were Typhoid 4 (2.3%) and chest infection 2 (1.2%). Thus the incidence of LBW babies in our hospital is quite high in comparision to the Western world and primigravida has more chance of delivering LBW babies. Spontaeneous preterm labour and intra uterine growth restriction are major risk factor leading to LBW babies. Urinary tract infection also plays important role in spontaeneous preterm labour. So to reduce the prevalence of LBW babies, we should identify in early the high risk pregnancy, taking more care to primigravida, treating clinical and subclinical infection in time to prevent spontaeneous preterm labour, diagonosing and managing the intra uterine growth restricted babies in time.

Complications of home delivery: a retrospective analysis.

This study was conducted to analyze the cases who had attended Nepal Medical College Teaching Hospital (NMCTH) after home delivery in order to broadly review the complications. This is a retrospective descriptive study. The number of total deliveries during the study period of two years (April, 2002- April, 2004) was 1619, among which 88 (5.4%) were cases who attended after home delivery. Majority of women (35.2%) were primi, 57.9% belonged to 20-25 year age group, 17% were young primi, and 85.2% were full term deliveries whereas 9.1% were preterm. More than half of them (57.9%) had regular antenatal check up. Most of them came from within 1-2 km distance of NMCTH. 51.1% were brought only after 2 hrs of delivery. The most common reason for attending hospital was retained placenta (84.1%-74 cases) among whom 51 (68.9%) needed controlled cord traction, 8 cases (10.8%) needed manual removal, rest of the cases had placenta lying in the vagina. Fifteen (17%) cases had post partum hemorrhage, 9 cases (10.2%) were brought in a state of shock. 71.6% were anemic, 11 (12.5%) had Hb <7 gm%. Other complications included cervical, third degree perineal tear. Blood transfusion was needed in 19 (21.6%) cases. All cases improved with proper resuscitation, use of antibiotics and definitive management of complications. Most of them were discharged within 4 days of admission. Perinatal mortality rate was 65.9/1000 births. This study showed that home deliveries were associated with increased maternal morbidity especially the third stage complications. Studies done in developed countries have shown that home birth is safe for normal, low risk women, with adequate infrastructure and support i.e. given a well trained midwife and facilities to transfer to hospital if necessary. In our context, a community based obstetric service must be developed with emphasis on regular and quality antenatal care, health education to women and proper training of birth attendants.