Molecular typing of enteroviruses: comparing 5'UTR, VP1 and whole genome sequencing methods.

Enteroviruses (EV) commonly cause hand, foot and mouth disease (HFMD), and can also cause potentially fatal neurological and systemic complications. In our laboratory, sequencing 5' untranslated region (UTR) of the viral genome has been the routine method of genotyping EVs. During a recent localised outbreak of aseptic meningitis, sequencing the 5'UTR identified the causative virus as EV-A71, which did not fit with the clinical syndrome or illness severity. When genotyped using a different target gene, VP1, the result was different. This led us to evaluate the accuracy of the two different target genome regions and compare them against whole genome sequencing (WGS). We aimed to optimise the algorithm for detection and characterisation of EVs in the diagnostic laboratory. We hypothesised that VP1 and WGS genotyping would provide different results than 5'UTR in a subset of samples. Clinical samples from around New South Wales which were positive for EV by commercial polymerase chain reaction (PCR) assays were genotyped by targeting three different viral genome regions: the 5'UTR, VP1 and WGS. Sequencing was performed by Sanger and next generation sequencing. The subtyping results were compared. Of the 74/118 (63%) samples that were successfully typed using both the 5'UTR and the VP1 method, the EV typing result was identical for 46/74 (62%) samples compared to WGS as the gold standard. The same EV group but different EV types were found in 22/74 (30%) samples, and 6/74 (8%) samples belonged to different EV groups depending on typing method used. Genotyping with WGS and VP1 is more accurate than 5'UTR. Genotyping by the 5'UTR method is very sensitive, but less specific.

Detecting Cognitive Impairment Status Using Keystroke Patterns and Physical Activity Data among the Older Adults: A Machine Learning Approach.

Cognitive impairment has a significantly negative impact on global healthcare and the community. Holding a person's cognition and mental retention among older adults is improbable with aging. Early detection of cognitive impairment will decline the most significant impact of extended disease to permanent mental damage. This paper aims to develop a machine learning model to detect and differentiate cognitive impairment categories like severe, moderate, mild, and normal by analyzing neurophysical and physical data. Keystroke and smartwatch have been used to extract individuals' neurophysical and physical data, respectively. An advanced ensemble learning algorithm named Gradient Boosting Machine (GBM) is proposed to classify the cognitive severity level (absence, mild, moderate, and severe) based on the Standardised Mini-Mental State Examination (SMMSE) questionnaire scores. The statistical method "Pearson's correlation" and the wrapper feature selection technique have been used to analyze and select the best features. Then, we have conducted our proposed algorithm GBM on those features. And the result has shown an accuracy of more than 94%. This paper has added a new dimension to the state-of-the-art to predict cognitive impairment by implementing neurophysical data and physical data together.

Unobtrusive monitoring of behavior and movement patterns to detect clinical depression severity level via smartphone.

The number of individuals with mental disorders is increasing and they are commonly found among individuals who avoid social interaction and like to live alone. Amongst such mental health disorders is depression which is both common and serious. The present paper introduces a method to assess the depression level of an individual using a smartphone by monitoring their daily activities. The time domain characteristics from a smartphone acceleration sensor were used alongside a vector machine algorithm to classify physical activities. Additionally, the geographical location information was clustered using a smartphone GPS sensor to simplify movement patterns. A total of 12 features were extracted from individuals' physical activity and movement patterns and were analyzed alongside their weekly depression scores using the nine-item Patient Health Questionnaire. Using a wrapper feature selection method, a subset of features was selected and applied to a linear regression model to estimate the depression score. The support vector machine algorithm was then used to classify the depression severity level among individuals (absence, moderate, severe) and had an accuracy of 87.2% in severe depression cases which outperformed other classification models including the k-nearest neighbor and artificial neural network. This method of identifying depression is a cost-effective solution for long-term use and can monitor individuals for depression without invading their personal space or creating other day-to-day disturbances.

Prevalence of Extended Spectrum Beta-Lactamase Producing Klebsiella Pneumoniae Isolated From Urinary Tract Infected Patients.

BACKGROUND: Klebsiella pneumoniae, one of the bacterial agents associated with urinary tract infection has been often implicated as a major extended spectrum beta-lactamase (ESBL) producer in last few decades. This study was designed to assess the prevalence of ESBL producing Klebsiella pneumoniae in urinary isolates at a tertiary care hospital in Kathmandu, Nepal, from July to December 2014. METHODS: One thousand nine hundred eighty six mid-stream urine specimens were collected aseptically from the clinically suspected patients of urinary tract infections attending Capital Hospital and Research Center, Kathmandu. The samples were processed following standard guidelines as recommended by American Society for Microbiology (ASM) and the isolates including Klebsiella spp. were identified using the specific biochemical and sugar fermentation tests recommended by ASM. Antibiotic sensitivity testing was done by modified Kirby-Bauer disk diffusion method and interpreted following Clinical and Laboratory Standards Institute (CLSI) guidelines. Klebsiella pneumoniae isolates showing resistance upon initial screening with ceftriaxone (30 µg) disc were then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) using ceftazidime (30 µg) and ceftazidime + clavulanic acid (30 µg + 10µg) and cefotaxime (30 µg) and cefotaxime + clavulanic acid (30 µg +10µg) disc as per CLSI guidelines. RESULTS: Out of a total 1986 specimens investigated, Escherichia coli was isolated in 309 (83.9%) and Klebsiella pneumoniae in 38 (10.3%) cases. Initial screening with ceftriaxone disc revealed 18 isolates of Klebsiella pneumoniae to be resistant. Further testing by PCDDT method confirmed 7 (18.4%) Klebsiella pneumoniae isolates to be ESBL producers. CONCLUSIONS: Compared to some earlier studies done in Nepal, higher prevalence of ESBL-producing Klebsiella pneumoniae was observed warranting a national surveillance for routine monitoring of ESBL producing Klebsiella pneumoniae isolates.

Indoor Staying During Winter Season Makes People More Susceptible to Flu.

An infectious diseases caused by RNA virus, the influenza is also commonly known as Flu. It mainly transmitted through air by coughs or sneezes of infected. The symptoms of flu like fever and headache are the result of the huge amounts of proinflammatory cytokines and chemokines (such as interferon or tumor necrosis factor) produced from influenza-infected cells. The activated vitamin has extreme effects on human immunity. Vitamin D prevents too much release of cytokines and chemokines. Staying much time indoor, away from contact of sunlight during winter season lowers the vitamin D level in human body. Thus, the chance of getting flu increases in winter season. Formulation of policy regarding vitamin D supplementation in diet for people such as elderly and with low sunlight exposure is hereby recommended. It will be beneficial to reduce influenza related morbidity and mortality during winter season.

Indications for Three Independent Domestication Events for the Tea Plant (Camellia sinensis (L.) O. Kuntze) and New Insights into the Origin of Tea Germplasm in China and India Revealed by Nuclear Microsatellites.

BACKGROUND: Tea is the world's most popular non-alcoholic beverage. China and India are known to be the largest tea producing countries and recognized as the centers for the domestication of the tea plant (Camellia sinensis (L.) O. Kuntze). However, molecular studies on the origin, domestication and relationships of the main teas, China type, Assam type and Cambod type are lacking. METHODOLOGY/PRINCIPAL FINDINGS: Twenty-three nuclear microsatellite markers were used to investigate the genetic diversity, relatedness, and domestication history of cultivated tea in both China and India. Based on a total of 392 samples, high levels of genetic diversity were observed for all tea types in both countries. The cultivars clustered into three distinct genetic groups (i.e. China tea, Chinese Assam tea and Indian Assam tea) based on STRUCTURE, PCoA and UPGMA analyses with significant pairwise genetic differentiation, corresponding well with their geographical distribution. A high proportion (30%) of the studied tea samples were shown to possess genetic admixtures of different tea types suggesting a hybrid origin for these samples, including the Cambod type. CONCLUSIONS: We demonstrate that Chinese Assam tea is a distinct genetic lineage from Indian Assam tea, and that China tea sampled from India was likely introduced from China directly. Our results further indicate that China type tea, Chinese Assam type tea and Indian Assam type tea are likely the result of three independent domestication events from three separate regions across China and India. Our findings have important implications for the conservation of genetic stocks, as well as future breeding programs.

Study of working experience in remote rural areas after medical graduation.

BACKGROUND: Posting of doctors in remote rural areas has always been a priority for Government; however data are scarce in the country about experience of doctors of working in remote areas after medical graduation. OBJECTIVE: A questionnaire survey of doctors was planned to analyze their experience of working after graduation in remote rural areas in various parts of the country. METHOD: The cross-sectional survey was done by convenience sampling method. A one-page questionnaire with one partially closed-end and five open-end type questions was distributed to the doctors who had worked in remote rural areas after graduation under various governments' postings. RESULT: Two-third of participants had their home in urban areas and 89.8% had stayed for 1 to 5 years. About half of the participants had difficulty in getting the posting in the remote areas of their choice. Most participants indicated provision of opportunities for Residential (postgraduate) Training as their reasons of going to remote areas as well as their suggestions to encourage young graduates to go there. Similarly most also suggested appropriate career, salary and incentives to encourage doctors to go to work in remote areas. About 85% of participants pointed out the major problem faced while posted in remote areas as difficulty in handling varied situations with no guidance or seniors available around. CONCLUSION: The notable points indicated by the participants are centered on the opportunity for Residential Training and difficulties faced without such training. Residential Training is a priority to be considered while planning the health policy for optimum health care of people.

Pesticides in vegetable and food commodities: environment and public health concern.

Haphazard use of pesticides in the field and stored food commodities for the control of insect and pest has been a serious problem from view of environment and public health. The nutritional value of these is suppressed due to addition of toxins. The increased trend of Non communicable disease and communicable diseases may have close relation with the nutritious value and life styles associated with. The impacts on health should be considered as important issues from the view of public health. The article gives emphasis on organic farming & Integrated Pest Management (IPM) to minimize the harm of chemicals. It is deemed essential to think again about the current trend of malnutrition & obesity overweight among the Nepalese people and relationship with pesticides on the foods and vegetables.

Evaluation of nurse providers of comprehensive abortion care using MVA in Nepal.

BACKGROUND: Although Nepal's maternal mortality ratio has fallen over the past decade, unsafe abortion remains a leading cause of maternal morbidity and mortality. A key strategy for improving access to safe abortion services is to train mid-level providers such as nurses in comprehensive abortion care (CAC). The Family Health Division of the Nepal Ministry of Health trained an initial cohort of 96 nurses to provide first trimester CAC services using manual vacuum aspiration (MVA) between September 2006 and July 2009. This study evaluates the acceptability and quality of CAC services provided by trained nurses in Nepal. METHODS: Five assessments were used to evaluate post-training service provision on CAC: facility logbooks registry, nurse provider interviews, facility assessments, facility manager interviews and procedure observation checklists. Ninety-two nurses from 50 facilities participated in the evaluation. Descriptive statistics are reported. RESULTS: Overall, 5,600 women received CAC services from 42 facilities where nurses were providing services between June 2009 and April 2010. Complications were experienced by 68 surgical abortion clients (1.6%) and 12 medical abortion clients (1.2%). All nurses reported that clients were happy to receive care from them, and 67% of facility managers reported that clients preferred nurse providers over physicians or had no preference. Facility managers and nurses reported a need for additional support, including further training and improved drug and equipment supply. CONCLUSIONS: Trained nurses provide high quality CAC services in Nepal. Additional support in the form of facilitative supervision and training should be considered to strengthen CAC service provision.

State of maternal, newborn and child health programmes in Nepal: what may a continuum of care model mean for more effective and efficient service delivery?

The cost-effective interventions exist across the continuum of maternal to child survival at each level of the health system that can contribute to achieve the Millennium Development Goals 4 and 5. However, implementation inefficiency, low coverage and equity gaps along this continuum remain a serious challenge to Nepal's efforts to achieve these goals. This paper proposes a continuum of care model; discusses the readiness of policy and programs to provide high impact interventions across the continuum; identifies existing gaps in MNCHN programs; and recommends policy and program actions to improve coverage, equity, effectiveness and efficiency along the continuum of MNCHN service delivery in Nepal. The literature review includes systematic desk review, followed by discussions and deliberations amongst a group of professionals and MNCH experts in Nepal. Within the government health system in Nepal, a continuum of care approach is feasible, as policies and plans exist to ensure an integrated approach across the maternal to child care continuum. However, health programs largely remain vertically oriented. Achieving integration across the maternal to child continuum of care remains a challenge at each level of health system. An integrated system of program management for maternal, newborn and child health would be a feasible solution to enable an efficient and effective delivery of intervention packages. A collaborative and partnership approach to strengthen health systems, building managerial capacity, improving governance and engaging the private and civil sectors remains vital to achieve effective coverage and improve equity across the continuum of care.

Developing community-based intervention strategies and package to save newborns in Nepal.

In Nepal, the proportion of under 5 deaths that are neonatal (0-28 days) has been increasing in the last decade, due to faster declines in infant and child mortality than in neonatal mortality. This trend is likely due to a focus on maternal and child survival programs that did not adequately address newborn health needs. Policy and actions to save newborn lives resulted from increased attention to newborn deaths in 2001, culminating in the endorsement of the National Neonatal Health Strategy in 2004, a milestone that established newborn health and survival as a national priority. Operationalization of the National Neonatal Health Strategy took place in 2007 with the development of the Community-Based Newborn Care Package (CB-NCP). This paper describes how national stakeholders used global, regional and in-country research and policies to develop the CB-NCP, thus outlining key ingredients to make newborn health programming a reality in Nepal. A technical working group was constituted to review existing evidence on interventions to improve newborn survival, develop a tool to prioritize neonatal interventions, and conduct program learning visits to identify key components appropriate to the Nepal context that should be included in the Community Based Integrated Newborn Care Package. The group identified interventions based on the evidence of impact on newborn survival, potential mechanisms within the existing health system to deliver the interventions, and linkages with existing programs and different tiers of the health system. Not only was Nepal one of the first countries in south-east Asia where government adopted a national strategy to reduce neonatal deaths, but it was also one of the first to endorse a package of neonatal interventions for pilot testing and scaling up through existing community-based health systems that provide basic health services throughout the country. CB-NCP was designed to be gradually scaled up throughout the country by integration with Safe Motherhood and Child survival programs that are currently operating at scale. Under Ministry of health and Population leadership, a network of academia, professional bodies and partners developed a common vision for improving newborn health and survival, and launched district-level pilot programs to demonstrate and learn how newborn health interventions could be effectively and efficiently delivered and scaled up in Nepal.

Fitting Community Based Newborn Care Package into the health systems of Nepal.

Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.

Trend of complete hydatidiform mole.

INTRODUCTION: Complete Hydatidiform mole is one of the most frequent abnormal pregnancies. This review studies the trend of complete mole in Paropakar Maternity and Women's hospital and clinical ability to detect it. METHODS: This is a retrospective study of 504 cases of complete hydatidiform mole recorded at Paropakar maternity and women's hospital, Kathmandu, during 2058-2065 B.S. Medical records were reviewed and incidence, clinical presentation and method of diagnosis were studied. RESULTS: During the study period, there were 13,9117 births and 504 complete moles, 12 partial moles, 48 persistent gestational tumours, six choriocarcinoma and four invasive moles recorded in the hospital. The incidence of complete mole was one per 276 births. It was prevalent among women younger than 29 years (80%) and among the primigravidae (36.7%). More than 90% women presented in the first half of their pregnancy and vaginal bleeding was the main complaint (68.3%). Suction evacuation, dilation and evacuation followed by sharp curettage and abdominal hysterectomy were performed in 80.6%, 17.6% and 1.2% of the women respectively. Persistent mole and choriocarcinoma developed in 9.5% and 0.4% respectively. CONCLUSIONS: Complete mole has the highest incidence. It affects mostly younger women and presents with vaginal bleeding most of the time, usually in the first half of their pregnancy.

Intrauterine condom tamponade in management of post partum haemorrhage.

BACKGROUND: Uterine tamponade is often used to control post partum hemorrhage. Among various methods, condom Foley's catheter tamponade is simple, easy to use and is believed to be effective. The study evaluates outcome of condom Foley's catheter tamponade. METHODS: In this prespective observational study, condom tamponade was applied to fourteen cases with varying degrees of PPH, not controlled with pharmacologic measures. The efficacy on control of bleeding was assessed along with the total amount of blood loss and any complications. RESULTS: The condom tamponade stopped bleeding in all the cases. Average amount of blood loss was 1221 ml. No complications were noted. CONCLUSIONS: Thus, condom tamponade is an effective method to control intractable PPH. It's simple and does not require expertise to use, so, it can have a wide application even in resource poor settings.

Psychiatric morbidity among physically ill persons in eastern Nepal.

This cross-sectional hospital-based study investigated the prevalence and pattern of psychiatric morbidity among 151 physically ill psychiatric-referred cases admitted various departments in BPKIHS. Consecutive referral cases were initially worked up by junior residents and diagnosis/differential diagnosis was made by consultant according to ICD-10 diagnostic guidelines. Of total 151; M: 77 (50.9%) and F: 74 (49.1); Majority 38 (25.1%) of subjects were young with age 15-24 yrs and 95 (62.9%) were from plains. About 21.8% referrals came from internal medicine followed by emergency department, 9 (5.9%). The highest number of cases 48 (31.7%) had neuropsychiatric illnesses and 17.0% had some medical complications resulted from suicide act. Among psychiatric co morbidity, dissociative/conversion disorders were the commonest 26 (17.2%) followed by alcohol use-related disorders 25 (16.5%) and depressive disorder 20 (13.2%). To conclude, the co-occurrence of medical and psychological/psychiatric conditions is common, which demands timely identification and early interventions in order to reduce morbidity and mortality.

Using FBRM to investigate the sewage sludge flocculation efficiency of cationic polyelectrolytes.

Polyelectrolyte flocculation is a commonly used method for sewage sludge conditioning. The rate and extent of water removal from the flocculated sludge depends on the properties of the polyelectrolytes. This study investigates the flocculation performance of four different cationic polyelectrolytes using an in-situ laser probe which uses focused beam reflectance measurements (FBRM). It is used to characterise the floc number and size distribution of the flocculated sludge at various polyelectrolyte doses. Results show that the FBRM technique is very successful in tracking the change in particle population and chord lengths during the sludge flocculation process. The FBRM offers an alternative method for optimising the flocculation system in both selecting the flocculant and determining its optimum dose. Both the reduction in particle count for particles of less than 10 mum and the flocculation efficiency defined from the amount of the original sludge distribution remaining after flocculation correlate well with dewatering performance.

Health problems among the street children of Dharan municipality.

BACKGROUND: The street children, a marginalised and vulnerable population to poor health, have grown all over the world and also in our country. The continuous exposure to harsh environment and nature of their life style threatens their mental, physical, social and spiritual well being. With the increasing number the problem is also growing at an alarming proportion. It is therefore important to have baseline data on their health problems. OBJECTIVES: This study was conducted to identify the physical health problems among the street children of Dharan Municipality, Nepal. MATERIALS AND METHODS: This is a cross sectional descriptive study. Forty eight subjects were included in the study. Research instruments included an interview schedule, physical health examination performa and lab investigations (i.e. blood for haemoglobin, urine routine examination/microscopic examination, stool routine examination/ microscopic examination). RESULTS: Study results showed that 68.8% of the street children were between 11-15 years of age, 95.8% were males. Out of the total subjects 81.2% were found to be rag pickers. Research findings reveal that 100% of the subjects had at least one or more health problems. The study revealed that majority 87.5% had the habit of cigarette smoking, 50% had habit of consuming alcohol and 72.9% had the habit of taking drug. Dendrite (glue sniffing) was the only drug used by the respondents in this study. The most common health problems were head lice infestation (81.2%), headache (66.7%), cut injury (60.4%), common cold (52.1%), dental caries (52%), burning micturation (47.9%), cough (47.9%), underweight (43.8%), abdominal pain (39.6%), tinnitus (37.55%), gum bleeding (33.3%), joint pain (31.2%), eye inflammation (25%), leg cramps (25%), palpable lymph nodes (25%), chest pain (18.8%), skin lesions (16.7%), abnormal vision (8.3%). CONCLUSION: Most of the diseases were due to poor health habits. It was found that the nature of work, their life styles and the different types of behaviour they adapt finally lead them to many health problems. The health problem can be prevented, if an integrated program that involves all the issues are developed and implemented.

Lignite aided dewatering of digested sewage sludge.

Mechanical dewatering is commonly used to increase the solids content of municipal sludge prior to its disposal. However, if the rate of filtration is slow, mechanical dewatering can be expensive. In this study, the use of lignite to improve the sludge dewatering is investigated. The effectiveness of lignite conditioning of polyelectrolyte-flocculated sludge is examined using mechanical compression tests. Results show that lignite conditioning in conjunction with polyelectrolyte flocculation gives much better dewatering than the polyelectrolyte flocculation alone. Using Darcy's filtration theory, the specific cake resistance and permeability of the compressed cakes are obtained. Both of these parameters are significantly improved after lignite conditioning. Mercury porosimetry tests on compressed cakes show that the porosity of the lignite-conditioned sludge cake is much higher than that of the polyelectrolyte-flocculated sludge and it increases with increasing doses of lignite. The mercury porosimetry results show that the lignite pore volume of pores greater than 0.5 microm are reduced with increasing sludge ratio indicating that sludge is trapped within these pores, whereas smaller pores are unaffected. The yield stress curves for sludge, lignite and sludge-lignite mixtures show that the sludge filter cake is very compressible, but the lignite-conditioned cake has a range of compressibility which although more than lignite indicate that the cake is relatively incompressible at low pressures. Thus, lignite conditioning acts to maintain the permeability of the filter cake during compression dewatering by resisting cake compression. This leads to a trade-off between the rate of dewatering and the solids content of the compressed cake. With lignite conditioning, the dewatering rate can be increased by a factor of five for the same degree of water removal.

Myths and misconceptions about abortion among marginalized underserved community.

INTRODUCTION: Unsafe abortion remains a huge problem in Nepal even after legalization of abortion. Various myths and misconceptions persist which prompt women towards unsafe abortive practices. METHODS: A qualitative study was conducted among different groups of women using focus group discussions and in depth interviews. Perception and understanding of the participants on abortion, methods and place of abortion were evaluated. RESULTS: A number of misconceptions were prevalent like drinking vegetable and herbal juices, and applying hot pot over the abdomen could abort pregnancy. However, many participants also believed that health care providers should be consulted for abortion. CONCLUSIONS: Although majority of the women knew that they should seek medical aid for abortion, they were still possessed with various misconceptions. Merely legalizing abortion services is not enough to reduce the burden of unsafe abortion. Focus has to be given on creating awareness and proper advocacy in this issue.

Magnesium sulphate: a life saving drug.

A retrospective study of 68 eclamptic women who received Magnesium sulphate at Koshi Zonal Hospital were analyzed during a one year period (2006-2007 AD). Maternal conditions at admission, associated complications in mothers and babies, delivery outcomes and cause of death were also studied in each case. There were 5240 deliveries during the period of analysis. Of which 4976 were live births, pregnancy induced hypertension was 0.89% (47), 0.74% (39) presented with pre-eclampsia, 0.30 (16) cases with severe pre-eclampsia and 0.43 (23) cases with mild pre-eclampsia. During this period 1.3% (68) of eclampsia presented to the hospital. Of which 67.7% presented with ante-partum eclampsia, 22.1% with intrapartum eclampsia and 10.3% with post partum eclampsia. Majority of women (63.2%) were between 20-25 years of age, while teenage pregnancy contributed 30.88% of eclamptic cases. The diastolic blood pressure was >110 mm of Hg in 45.6% of cases, 90-110 mmHg in 50% of cases and in 4.4% the it was <90 mmHg. 94.1% presented to the hospital in an unconscious state, 79.4% of eclamptic women received the full dose of magnesium sulphate (initial loading plus maintenance dose), while rest failed to receive the full dose. Nine women with severe pre-eclampsia received magnesium sulphate as a prophylactic measure. 17.7% women had home delivery, one patient left against medical advice and one was referred to a tertiary care center. Caesarian Section (Lower Segment) was performed in 35.2% of cases, 30.8% had normal vaginal deliveries and 5.8% had pre term delivery. About 69.6% babies were born alive, 8.7% were still births, 11.6% were neonatal deaths and 4.4% of babies had to be admitted to the neonatal intensive care. Eclamptic women stayed less than one week in the hospital in majority of cases (64.7%), between 1-2 weeks in 32.4% and more than two weeks in 2.9%. Maternal complications included decreased urinary output, pulmonary edema in three cases; chest and wound infection two cases each; post partum psychosis, vulval haematoma, severe headache one case each. There were seven maternal deaths during this period and eclampsia contributed to one of the deaths. Eclampsia is a major cause of maternal and perinatal morbidity and mortality in our setup. Magnesium sulphate is an excellent drug of choice in management of eclampsia and pre-eclampsia. Wider coverage of pre-natal care, timely referral and optimal management of cases of eclampsia with magnesium sulphate in hospitals are key issues to prevent mortality/morbidity associated with it.