Analysis of Health Facility Based Perinatal Verbal Autopsy of Electoral Constituency 2 of Arghakhanchi District, Nepal

BACKGROUND

Verbal autopsy is a method to diagnose possible cause of death by analyzing factors associated with death through detailed questioning. This study is a part of the operational research program in electoral constituency no. 2 (EC 2) of Arghakhanchi district by MIRA and HealthRight International.

METHODS

Two day essential newborn care training followed by one day perinatal verbal autopsy training and later one day refresher verbal autopsy training was given for health staff of EC 2 of Arghakhanchi district in two groups. Stillbirths of >22wks or > 500 gms and Early neonatal deaths (newborns died within7 days of life) were included in this study. The Nepal Government approved verbal autopsy forms were used for performing autopsies. Perinatal deaths were classified according to Wigglesworth's Classification. Causes of Perinatal deaths were analyzed. Data were analyzed in the form of frequencies and tabulation in SPSS 16 .

RESULTS

There were 41 cases of perinatal deaths (PND) were identified. Among them, 37 PNDs were from Arghakhanchi district hospital, 2 PNDs from Thada PHC, and one PND each from Subarnakhal and Pokharathok HPs. Among the 41 PNDs, 26 were stillbirths (SB) and 15 were early neonatal deaths (ENND). The perinatal mortality rate (PMR) of Arghakhanchi district hospital was 32.2 per 1,000 births and neonatal mortality rate (NMR) was 9.8 per 1,000 live births. Out of 26 stillbirths, 54% (14) were fresh SBs and 46% (12) were macerated stillbirths. The most common cause of stillbirth was obstetric complications (47%) where as birth asphyxia (53%) was the commonest cause of ENND. According to Wigglesworth's classification of perinatal deaths, Group IV (40%) was the commonest cause in the health facilities.

CONCLUSIONS

Obstetric complication was the commonest cause of stillbirth and birth asphyxia was the commonest cause of early neonatal death. This study highlighted the need for regular antenatal check-ups and proper intrapartum fetal monitoring with timely and appropriate intervention to reduce the incidence of stillbirths and intrauterine asphyxia.

Maternal and Neonatal Health Knowledge, Service Quality and Utilization: Findings from a Community Based Quasi-experimental Trial in Arghakhanchi District of Nepal

BACKGROUND

As part of the Partnership for Maternal and Newborn Health Project (PMNH), HealthRight International collaborated with Mother and Infant Research Activities (MIRA) to conduct operations research in Arghakhanchi district of Nepal to explore the intervention impact of strengthening health facility, improving community facility linkages along with Community Based Newborn Care Program (CB-NCP) on Maternal Neonatal Care (MNC) service quality, utilization, knowledge and care seeking behavior.

METHODS

This was a quasi-experimental study. Siddahara, Pokharathok, Subarnakhal,Narpani Health Posts (HPs) and Thada Primary Health Care Center(PHCC)in Electoral Constituency-2 were selected as intervention sites and Arghatosh, ,Argha, Khana, Hansapur HPs and Balkot PHCC in Electoral Constituency-1 were chosen as controls. The intervention started in February 2011 and was evaluated in August 2013. To compare MNC knowledge and practice in the community, mothers of children aged 0-23 months were selected from the corresponding Village Development Committees(VDCs) by a two stage cluster sampling design during both baseline (July 2010) and endline (August, 2013) assessments. The difference in difference analysis was used to understand the intervention impact.

RESULTS

Local resource mobilization for MNC, knowledge about MNC and service utilization increased in intervention sites. Though there were improvements, many effects were not significant.

CONCLUSIONS

Extensive trainings followed by reviews and quality monitoring visits increased the knowledge, improved skills and fostered motivation of health facility workers for better MNC service delivery. MNC indicators showed an upsurge in numbers due to the synergistic effects of many interventions.

Analysis of Obstetric Near Miss Cases of Different Health Facilities of Electoral Constituency Two of Arghakhanchi District

Aims: This study was done to identify and analyze obstetric near miss cases at health facilities of electoral constituency number 2 (EC 2) of Arghakhanchi district, Nepal. Methods: After receiving one day training on identifying obstetric near miss cases, health facility staff of EC 2 of Arghakhanchi district filled up WHO derived obstetric near miss forms for eight months duration. Causes of obstetric near miss cases were identified and analyzed in SPSS 16. Results: There were 31 obstetric near miss cases reported from different health facilities of EC 2 of Arghakhanchi. The commonest cause of obstetric near miss was Post-partum Hemorrhage (85%, n=26) followed by obstructed labor and ante partum hemorrhage (6%, n= 2) each. The leading cause of PPH was retained placenta/placental tissue in 55% cases (14) followed by atonic uterus (27%, n= 7). Two fifth of the mothers (39%, n=12) developed complication during labor. The most common complication developed after labor was hemorrhage. Conclusions: This study highlighted PPH as the most common serious obstetric problem in the health facilities and indicates the need for provision of blood transfusion at the health facility at least at Arghakhanchi. DOI: http://dx.doi.org/10.3126/njog.v9i2.11760

Microbial Desulfurization of Coals in a Slurry Pipeline Reactor Using. Thiobacillus ferrooxidans

Microbial desulfurization of Illinois #6 and Indiana #3 bituminous coal having a total sulfur content of 2 to 8% has been investigated using acidophilic microorganism, Thiobacillus ferrooxidans, in laboratory shake flash experiments and in a two-inch pipeline loop. The results indicate that about 80 to 85% pyritic sulfur removal was achieved with 10 to 25% coal/water slurry recirculated at 6-7 ft/sec at room temperature in 7 to 14 days. The experimental conditions have been optimized for maximum desulfurization. Results from this study show that the rates of bacterial desulfurization from coal samples are higher in the pipeline loop under turbulent flow conditions as compared to the shake-flask experiments for particle sizes ranging from 43 to 200 mum. It is visualized that the proposed coal slurry pipelines could be used as biological plug flow reactors under aerobic conditions. The laboratory corrosion studies under dynamic test conditions show that use of a corrosion inhibitor will limit the pipeline corrosion rate to acceptable levels.

Conditions in rural Nepal for which depot-medroxyprogesterone acetate initiation is not recommended: implications for community-based service delivery

The presence of medical conditions that might affect the use of depot-medroxyprogesterone acetate (DMPA) as a contraceptive method was assessed in a rural district in Nepal. A general health survey was conducted in nonpregnant and noncontracepting women aged 15-44 years to determine the presence of any health problems. The survey included a general assessment interview by nonphysicians, followed by formal medical histories and physical exams by female gynecologists. Possible pregnancy (nine cases) and abnormal uterine bleeding (one case) were the only conditions identified in which DMPA should not be used, based on the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use. Five additional cases of cardiovascular problems, in which DMPA initiation is not usually recommended, were also detected. Recently developed checklists based on the WHO criteria for DMPA use would have identified all of these health conditions. This checklist would allow the safe delivery of DMPA at the community health worker level, and increase the availability and accessibility of DMPA in rural Nepal.