Prevalence of Gingivitis in Second Trimester of Pregnancy

Background Gingivitis simply means the inflammation of gingiva. It is a reversible state but can lead to periodontitis. The final result could be the exfoliation of the tooth causing decreased masticatory function leading to a compromised quality of life. Gingivitis in the pregnant woman should be carefully assessed and treated and given special attention. There is rare documentation on the prevalence of gingivitis in pregnancy in the least developed countries. Objective To evaluate the prevalence of gingivitis in the second trimester of pregnancy and assess its relationship with age, parity, education, occupation, gravidity, oral hygiene habit and frequency of brushing. Method An observational descriptive study was conducted among 384 pregnant females in their second trimester in Kathmandu, Nepal. Demographic variables and general information including those related to oral hygiene practices and habits were collected during an interview. Plaque index and Gingival Index was recorded among the patients through full mouth examination at four sites. Result The prevalence of gingivitis in the second trimester of pregnancy was 76.3%. Statistically significant relationship was found between gingivitis and gravida and parity. A relation could not be established between gingivitis with age, education, occupation, oral hygiene habit and frequency of brushing. Conclusion The prevalence of gingivitis is found to be high in Nepalese pregnant women. Special strategies should be introduced targeting the pregnant women of least developed countries to uplift their periodontal health.

Teenage Pregnancy and Associated Risk Factors and Outcome in Nepal From 2000-2020: A Systematic Review and Meta-Analysis

Background Teenage pregnancy is considered a high-risk pregnancy in terms of reproductive outcome and the subsequent financial constraint. Objective To assess the prevalence of teenage pregnancy, associated risk factors, and outcomes in the context of Nepal. Method We searched electronic databases to search relevant articles published from January 2000 till October 2020 using the keywords with appropriate Boolean operators. All the data were extracted into a standardized form designed in Excel. We conducted a statistical analysis using Comprehensive Meta-Analysis Software (CMA) version 3. Data pooled for proportion with 95% confidence interval (CI). A Forest plot was used to visualize the degree of variation between studies. Result Fourteen studies were included in the analysis after the rigorous screening of 4425 studies. Prevalence of teenage pregnancy was 13.2% (Proportion, 0.132; CI, 0.077- 0.215). Among teenage pregnancies, 11.8% were already multigravida (Proportion, 0.118; CI, 0.029-0.374). Among teen pregnancies, 18.6% were illiterate; among the literate, only 25.9% were of education above grade 10,31.9% were unaware of contraceptive methods, and only 3.2% reported using any contraception methods. 75.4% of teenage pregnancies had a vaginal delivery with or without episiotomy, 6.5% by instrumental deliveries, and 21.5% by cesarean section. Preterm delivery was 12.0%, and post-term delivery was 8.2%. Abortion was reported in 11.1% of teenage pregnancies. Major tears were reported in 52.9%, obstructed labor was in 4%, and pre-labor rupture of the membrane was in 7.0% of teenage pregnancies. The low birth weight of newborns was 19.4%. Stillbirth and neonatal deaths were 1.7% and 1.4%, respectively. Conclusion The prevalence of teenage pregnancy in Nepal was 13.2%. The majority of them did not use any form of contraceptives; and had low education. Several maternal and neonatal complications were reported among teenage pregnancies.

Outbreak Investigation of Influenza in Pajaru VDC of Jajarkot District of Nepal

BACKGROUND

An outbreak investigation study was conducted in Pajaru, one of the initially affected Village Development Committees (VDCs) of the Jajarkot district in Nepal following an outbreak of respiratory illness in early 2015. The objectives of this study were to identify the cases and magnitude of the outbreak.

METHODS

A cross-sectional study was carried out in mid-April 2015 covering five most affected wards of Pajaru VDC to assess the patients using standard case definition for Influenza like Illness (ILI). Throat and nasal swabs were collected and sent to the National Influenza Center (NIC) in Kathmandu for laboratory confirmation.

RESULTS

The throat swab samples tested at NIC found Influenza A H1N1 pdm09. The attack rate was calculated to be 3% in ward number 9 and 41% in ward number 8. Wavelength of the infection was nearly two weeks in both the wards. Nearly 54% of the specimens were positive for Influenza A H1N1 pdm09. There was no ILI case fatality in the study area. Children aged 0-15 years were most affected. Majority of the patients presented with symptoms of fever, cough and sore throat.

CONCLUSIONS

There was gradual decline in the number of cases in all five wards suggestive of development of natural immunity in the community. True severity of the outbreak was not accurately reflected as compared to media reports.

Malignant Tumors of the Female Genital Tract – a Hospital Based Analysis

Aims: The incidence of cancer and the cancer related deaths are increasing worldwide. There is limited data regarding  gynecological cancers in Nepal. This study is conducted to analyze the trends of female genital tract malignancies in Paropakar Maternity and Women’s Hospital (PMWH) and compare it with the national/international data.Methods: This was a retrospective study conducted in Department of Obstetrics/Gynecology and Pathology in PMWH.  All female diagnosed with the genital tract malignancies from July 2013 to July 2015 were included in the study.Results: Among 62 cases, cervical cancer was the commonest (71%) followed by ovarian cancer (14%), endometrial cancer (8%) and choriocarcinoma (3%). Majority of women belonged to 50-59 years for each type of tumors. Four-fifth of endometrial, half of the cervical and one-third of ovarian cancers were among grand-multipara. Sixty nine percent of women received treatment with 22 (9 cervical, 9 ovarian, 3 endometrial and one of corpus uteri)  surgical and 21 primary chemo/radiotherapy but 19 (31%) were lost for follow-up. Squamous type of cervical cancer was the commonest (93%).Conclusions: Cervical cancer was the commonest genital tract malignancy followed by ovarian cancer, endometrial cancer and choriocarcinoma. For each type of tumors, 50-59 years was the common age group and grand multiparity was seen in half of the women with the cervical cancer. Squamous type of cervical cancer was the commonest variety.  

Zika Virus: Yet Another Emerging Threat to Nepal

Zika virus (ZIKV) is a flavivirus with single stranded RNA related to yellow fever, dengue, West Nile, and Japanese encephalitis viruses and is transmitted by Aedes mosquitoes primarily by Aedes aegipti which is widely distributed in Nepal. ZIKV was first identified incidentally in Rhesus monkey in Uganda in 1947 and human infection in 1952; and by now outbreaks of ZIKV disease have been recorded in Africa, the Americas, Asia and the Pacific. The World Health Organization (WHO) has recently declared the ZIKV an international public health emergency. The aim of this paper is to briefly summarize origin, signs, symptoms, transmission, diagnosis, preventions and management of ZIKV and possible threat to Nepal in light of endemicity of other arbovirus infections and common mosquito vector species in Nepal. Keyword: Aedes aegypti; aedes albopictus; zika virus; microcephaly; birth defect; Nepal.

Perinatal Outcome of the Second Twin

Aims: The purpose of this study was to determine the perinatal outcome of the second twin compared to the first one. Methods: This is a hospital based comparative study of 60 pregnant women with twin pregnancy at Paropakar Maternity and Women’s Hospital, Kathmandu from 14 January 2013 to13 April 2013. Apgar score and admission to neonatal intensive care unit of the first and the second twins were studied in relation to the gestational age, chorionicity, mode of delivery, inter-delivery interval and birth weight. Mc Nemars test was used with 0.05 as the level of significance. Results: Among 60 sets of twins, Apgar score of the second twin was found to be lower than the first one (p=0.02) in general and in preterm gestation (p=0.049), dichorionic diamniotic chorionicity (p=0.012), vaginal delivery (p<0.001), inter-delivery interval of <30 minutes (p=0.007) and birth weight discordance of <30 % (p=0.014). Admission to neonatal intensive care unit was not significant (p=0.5). Conclusions: Second twin had low Apgar score and the neonatal admission rate was similar for both twins. 

Cornual Ectopic Pregnancy: Case Series

Three cases of cornual pregnancies encountered within three weeks at Paropakar Maternity and Women’s Hospital had diverse presentations. Fortunately, in all three case series, cornual resection was performed successfully. Cornual pregnancy is difficult to diagnose preoperatively with low ultrasonographic sensitivity and is easily confused with tubal ectopic pregnancy or a normal intrauterine pregnancy. Diagnosis before rupture is essential to prevent mortality and potential loss of fertility. The surgical management of diagnosed cornual pregnancy consists of hemostasis, resection, repair and reconstruction. 

An assessment of the safe delivery incentive program at a tertiary level hospital in Nepal

BACKGROUND

Maternity incentive program of Nepal known as Safe Delivery Incentive Program (SDIP) was introduced nationwide in 2005 with the intention of increasing utilization of professional care at childbirth. The program provided both childbirth service as well as 'cash' to women giving birth in a health facility in addition to incentives to health provider for each delivery attended, either at home or the facility. Due to a lack of uniformity in its implementation and administrative delays, the program was reformed and even extended to many not-for-profit health institutions in early 2007, and implemented as a 'Safer Mother Program' popularly known as "Aama-Suraksha-Karyakram" since January 2009.

METHODS

This is a system research with observational and analytical components. Plausibility design is selected to evaluate the performance-based funding (PBF) as a system level intervention of maternity care using two instruments: Pay-For-Performance and Conditional-Cash-Transfer. It uses interrupted time-series to control for the natural trend. Research tools used are interviews, the focus group discussions and literature review. Numerical data are presented in simple graphs. While online random number generator was used partly, the purposive sampling was used for qualitative data.

RESULTS

There is a gross discrepancy in non-targeted service delivery at the tertiary level health facility. Overflooding of maternity cases has hampered gynecological admission and surgical management delaying subspecialty care and junior physicians' training. With the same number and quality of physical facility and human resource, the additional program has put more strains to service providers and administrators.

CONCLUSIONS

There should be adequate planning and preparation at all levels of health facilities; implementing a new program should not adversely affect another existing service delivery system. For the optional implementation, hospital organogram should be revised; and physical facilities and the low-risk birthing-centers with referral linkages should be expanded.