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.

Virology, Clinical Features and Diagnosis of COVID 19: Review Analysis

COVID-19 requires unprecedented mobilization of the health systems to prevent the rapid spread of this unique virus, which spreads via respiratory droplet and causes respiratory disease. There is an urgent need for an accurate and rapid test method to quickly identify many infected patients and asymptomatic carriers to prevent virus transmission and assure timely treatment of the patients. This article aims as an outcome of review of the evidence on viral load and its virulence of SARS-CoV2,so that it will help in further understanding the fact useful for investigating and managing the COVID-19 cases. A search of available evidence was conducted in pub-med "COVID-19 viral load and virulence" and its associated characters world-wide and Google Scholar to capture the most recently published articles. The WHO and Centre for Disease Control and Prevention (CDC) database of publications on novel coronavirus were also screened for relevant publications. Abstracts of 55 articles were screened by two authors and 15 were included in this study based on the inclusion criteria. SARS-coV2, the causative agent of COVID-19 falls under the coronavirus family but it has higher infectivity compared to SARS and MERS with higher reproduction numbers(Ro). Virulence has been found to be different throughout the world,however lower compared to SARS and MERS,till date. The most common clinical features have been found to be cough and fever. RT - PCR remains the most sensitive and specific method for the diagnosis of COVID-19 although it is time consuming, costly and requires highly skilled human resources. Hence, newer modalities like RT- LAMP can be alternative for point of care diagnosis as this is both cost effective and requires less skilled human resources. Despite recent advances in disease diagnosis and treatment outcomes using latest technological advances in molecular biology, the global pandemic COVID-19 remains a major headache for governments across the world due to limited testing capacity and lack of appropriate treatment and vaccine.

Prevalence of Hepatitis B and C among HIV Infected Patients in Nepal over 1990-2020

Background Hepatitis B and C (HBV and HCV) are viral infections caused by corresponding viruses. Here in this study we planned to conduct this meta-analysis to pool data on the prevalence and risk factors of HBV and/or HCV among HIV patients in Nepal. Method We used MOOSE guideline for the systemic review of available literature. We searched online databases using appropriate keywords. We used CMA-3 for data synthesis. Odds ratio, and proportion were used to estimate the outcome with a 95% confidence interval where appropriate. We assessed the heterogeneity using the I-squared (I2 ) test. Result We included nine studies for our synthesis. Pooling of data showed HBV in 4.6% (CI: 3.7-5.6), HCV in 19.7% (CI: 10.8-33.0), both HBV and HCV in 1.3% (CI: 0.5-3.7) in HIV affected individuals. Among HBV co-infected HIV positive patients, 59.5% (CI: 25.5-86.3) were male; 76.1% (CI: 30.1-96.0) were married and 43.6% (CI: 3.8-93.8) had a history of intravenous drug use (IVDU). Among HCV co-infected HIV positive individuals 88.3% (CI: 73.6-95.4) were male; 63.6% (CI: 55.4-71.1) were married; 91.5% (CI: 68.6-98.1) were literate; 59.2% (CI: 49.9-67.9) were on ART; and 92.2% (95%CI: 84.9-96.1) had a history of IVDU. Conclusion The pooled prevalence of co-infection with HBV, HCV, and combined HBV and HCV were 4.6%, 19.7% and 1.3% respectively among HIV positive patients. Thus, it is necessary to appropriately screen for HBV and HCV in individuals diagnosed with HIV and high-risk populations. IVDU remains the most common risk factor found in co-infected individuals.