Knowledge, Attitude and Practice Regarding Environmental Tobacco Smoke among Pregnant Women of Sunsari.

Background Second hand tobacco smoke or Environmental Tobacco Smoke (ETS), contains toxic substances and carcinogens that cause serious health effects in humans. Studies show that ETS exposure during pregnancy is injurious to the mother-infant pair with long term consequences. Limited studies are found in context of ETS in pregnancy in Nepal. Objective To explore the knowledge about harmful effect of ETS exposure in pregnant women and to know the behavior of avoidance from exposure to ETS during pregnancy. Method A cross sectional study was conducted among 303 pregnant women attending antenatal clinics at the District Hospital Inaruwa and BPKIHS Dharan. A pre-tested semi-structured questionnaire was used to collect data regarding socio-demographic characteristics, knowledge, attitude and practice regarding Environmental tobacco smoke. Data was entered in Excel and analyzed in SPSS 11.5. Result The mean age of the respondents was 23.86±4.68 years. The proportion of primigravida was 53.5% and multi-gravida was 46.5%. Among the respondents, 14% were illiterate and 91% were unemployed. A similar proportion of the husbands (12%) were illiterate. Three-fourth (75%) of the respondents lived in joint family. It was found that 86% of their husbands were smokers. There were 61% of pregnant women who had heard about ETS, mainly through television (35%) and radio (30%). There was 86% of the households who had initiated some measures to prevent smoking inside the house. Conclusion The pregnant women in this study are aware about ETS. However a significant number of them believe that ETS is not harmful compared to active smoking. There is a need for further studies to identify interventions to avoid ETS exposure among the pregnant women.

Antenatal Health Care Service Utilization in Slum Areas of Pokhara Sub-Metropolitan City, Nepal.

BACKGROUND: Half a million women die every year due to pregnancy and childbirth in the world. Among these death, 99% occur in the low and middle income countries. Antenatal care (ANC) provides an opportunity to deliver different services which are important in improving maternal survival. METHODS: A descriptive cross sectional study was conducted from September 2012 - February 2013 among 400 married women of reproductive age group. A pre-tested structured questionnaire were used and data were analyzed using Statistical Package for Social Science(SPSS) for windows version 18.0. Frequency, crude and adjusted odds ratios and confidence intervals were performed. RESULTS: Nearly 27% had four or more antenatal health care utilization(ANC) visits on appropriate time according to schedule of World Health Organization(WHO). In logistic regression, ANC users were found to be more/less likely to be in age group 20 - 35 years (AOR =2.825, 95% CI: 1.166-6.843), education of spouse (AOR 0.361, 95% CI : 0.130-1.000), occupation of spouse (AOR = 0.261, 95% CI: 0.093 -0.739), monthly income of family > 20,000Nrs (AOR = 2.190, 95% CI: 1.041-4.606), planned pregnancy (AOR = 2.417, 95% CI: 1.047 -5.609), death of child (AOR = 3.153, 95% CI: 1.112 -8.944). CONCLUSIONS: This study demonstrated low antenatal care service utilization. Hence, there is a need to increase the availability and accessibility of antenatal care to all women.

Electronic Health Literacy Skills among Medical and Dental Interns at B P Koirala Institute of Health Sciences.

BACKGROUND: Appropriate use of the available electronic resources is important for decision making in health. The use of electronic resources in health care is universal. The study measures the eHealth literacy skills among the medical and dental interns of the B P Koirala Institute of Health Sciences (BPKIHS), Nepal. METHODS: Self administered electronic Health Literacy Scale (eHEALS) was used to collect data from 125 medical and dental interns at BPKIHS. The interns represent immediate past medical student and soon to be professional doctor. RESULTS: A quarter of interns are not sure about the usefulness of internet resources for health. The interns have limited knowledge about right resources in the internet. They are not equipped to tell useful resources from the not-useful ones in the internet. CONCLUSIONS: There is a need to pay attention to the eHealth Literacy needs of the interns. Further research may be needed to generate evidence on what interventions may be specific to meet the ehealth literacy needs of the medical and dental interns.

Cesarean section without urethral catheterization: a randomized control trial.

BACKGROUND: Urethral catheterization is done as a routine procedure in cesarean section. It is associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay. OBJECTIVE: To determine the feasibility and safety of cesarean section without urethral catheterization. METHODS: A prospective, randomized controlled trial was carried out from April 2008 to March 2009, in the Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences. Among 150 patients who had undergone cesarean section 75 were catheterized and 75 were uncatheterized. RESULTS: First void discomfort was significantly associated with the use of indwelling catheter (OR 6.95, CI 95 %, 3.74 to 12.95; P less than 0.001).Significant number of patients with indwelling catheter had signs and symptoms of urinary tract infection (OR 6,CI 95%, 2.59 to 13. 86; P less than 0.001). Positive urinalysis for urinary tract infection was high in catheterized group (P less than 0.001). Hospital stay was shorter in patients without catheter (p less than 0.05). None of the patients had bladder injury. There were no significant differences in duration of surgery and ambulation time between two groups of patients. CONCLUSIONS: Cesarean section can be done safely without urethral catheterization with reduced morbidities.

Maternal and perinatal outcome among the booked and unbooked pregnancies from catchments area of BP Koirala Institute of Health Sciences, Nepal.

OBJECTIVES: To examine the differences in maternal and perinatal outcome among booked and unbooked pregnant women and their perception for underutilization of services targeted for them. METHODS: Two thousand two hundred and twenty eight pregnant women, booked and unbooked, attending emergency obstetrics care during Jan.-Dec. 2005, were included in the study; Investigators followed cases till discharge. RESULTS: Tendency for mothers to be booked was found to be significantly associated with age. Booked and unbooked mothers differed by distance to the hospital and parity. There was difference between the periods of gestation at which they presented to the hospital among both the groups (p<0.0001). Nearly eighty percent (81.4%) of unbooked mothers did not know the period of gestation. Most of these women conceived during lactational or depo provera-induced amenorrhea. The maternal mortality rate for unbooked mothers was 16 out of 1056 and none among the booked. Perinatal mortality is 3 times less in booked mothers. Higher perinatal mortalities are associated with unbooked mothers and had a higher proportion of maternal intensive care unit admissions and perinatal deaths compared with the booked group. Focus group discussion revealed that the reasons for underutilizations of services are; Distance, cost, disempowerment of women and attitudes of hospital personnel. CONCLUSION: The opportunities to enhance utilizations are based on distance, cost and client friendly environment of hospital personnel. It has been observed, building teaching hospitals alone, will not have much impact to maternal and perinatal outcome, unless peripheral health institutions are equipped with facilities and service provisions.

Evaluation of endometrial changes and p53 expression in tamoxifen treated women: comparison of various methods.

OBJECTIVE: To compare transvaginal sonography (TVS), sonohysterography (SHG), hysteroscopy and endometrial aspiration (EA) and p53 expression in assessing endometrial abnormalities in women on tamoxifen. METHODS: In a cross sectional study of 50 pre- and post-menopausal women receiving tamoxifen for > 2 years, all participants underwent TVS and EA. Those with endometrial thickness > 4 mm on TVS underwent hysteroscopy and SHG. Serum p53 antibody and p53 immunohistochemistry were tested in all women. RESULTS: The sensitivity and specificity when compared with histopathology as the reference standard were as follows: TVS 100% and 33.3%, SHG 85.7% and 50%, hysteroscopy 92.8% and 80.8%, serum p53 50% and 83.3%, and p53 immunohistochemistry 57.1% and 61.1%. Prevalence of endometrial abnormalities was not significantly different in asymptomatic and symptomatic women. CONCLUSION: Tamoxifen-users require routine testing for endometrial evaluation. TVS followed by hysteroscopy and biopsy is an effective option. p53 expression correlates with histological abnormalities.