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Background: Adolescent pregnancy is a multifactorial social and global health problem, es­pecially in remote, rural setting in low-middle-income countries. This study was conducted to determine the perinatal outcome of adolescent pregnancy of this region. Methods: A retrospective study was conducted in Karnali Academy of Health Sciences (KAHS), Jumla among nulliparous pregnant adolescent women aged 15 to 19 years (n=363) and those aged 20 to 24 years (n=445) who delivered in this hospital from April 2017 to April 2020 AD. Maternal and perinatal characteristics were compared between these groups. The categorical data between adolescent and adult women were compared. Chi-square test, Odds ratio and 95% confidence interval were examined using SPSS version 16. Results: During the study period, the incidence of adolescent pregnancy was 22%. The adolescent mothers had significantly higher incidence of anemia (p=0.005, OR:2.7; 95% CI:1.34-5.78), abnor­mal fetal presentation (p=0.006, OR:3.1; 95%CI:1.38-7.31) and preterm deliveries (p value

Introduction: COVID-19 has spread all around the world with huge toll of human lives and suffering since it evolved in China. Nepal had slow rise in morbidity due to COVID 19 in early days but has been gripped by the pandemic's exponential growth lately. This study was conducted with the aim to describe the clinical and epidemiological features of Nepali children in early phase of the pandemic. Methods: This was an observational study conducted at 11 COVID care centres designated by the Government of Nepal with availability of supervision by paediatricians between January and August 2020 in children under 18 years of age diagnosed with COVID 19. Data was collected based on definitions outlined in data collection resources available at WHO-ISARIC Global COVID-19 clinical resources platform and analysed. Results: One hundred and twenty one children diagnosed with COVID 19 who presented to the designated centres were enrolled. Majority of children (83.4%) were identified as a part of contact tracing, 28.1% had an identified contact to a person with COVID 19 prior to their diagnosis and 20.7% had another household member diagnosed with COVID 19. The mean age of admitted children was 8.8 years (SD 5.6 years) with the largest proportion being adolescents (40.5%). Male (58.7%) children were more commonly affected. There were 15 (12.4%) infants and 8 (6%) of them were under two months of age. Most children (87, 71.9%) were asymptomatic, 21 (22.3%) had mild symptoms and six (4.9%) had moderately severe symptoms. Fever (18.2%) was the most commonly reported symptom. All children were discharged after a median of 14 days of hospitalisation. Conclusions: Nepali children of all ages are affected by COVID 19 and present with asymptomatic or mildly symptomatic infection. Fever and respiratory symptoms are the most commonly reported symptoms. Most children do not develop complications. Continued surveillance in larger population of children as the pandemic unfolds will generate more stringent observations.

Foreign body ingestion should be considered as an important differential in a child with difficult asthma. We report an 11‐year‐old male child with foreign body aspiration who initially was diagnosed and treated as difficult asthma. Later on, he was diagnosed to have a foreign body in the right bronchus, which was successfully removed by flexible bronchoscopy.

Herpes zoster generally occurs after the exposure of VZV following varicella. This case report emphasizes a rare case of HZ in an infant without prior history of varicella or its exposure in the baby, other siblings, and mother during or after the pregnancy.

INTRODUCTION: In outpatient department (OPD) of hospital in low and middle income countries (LMICs), pediatric ear, nose and throat (ENT) disorders are common and huge variation in number is being reported in different seasons. This study aimed to study the prevalence and seasonal effect of ENT disorder in children. MATERIAL AND METHODS: One year (Jan-Dec, 2015) retrospective data of children (0 months-17 years) visiting ENT outpatient (ENT-OPD) department at Universal College of Medical Sciences-Teaching Hospital, Nepal was analysed. Descriptive statistics were calculated to report the prevalence of ENT disorders for various sub-groups including season. In addition to quantifying the prevalence of ENT disorders in children, the seasonal influence of each disorder was analysed. RESULTS: Out of 14,126 patients visiting the ENT-OPD, 3,423 (24.23%) were children. The mean age of children having ENT- disorders were 8.4±5.1, 10.6±4.6 and 10.7±4.7 years respectively with male-female ratio of 1.3:1. During all seasons 2,645 (77.3%) had ear problems, 328 (9.6%) nose disorders and 450 (13.14%) throat disorders. The percentage of children with ear disorders declined significantly with increase in age unlike those with nose and throat disorders (P < 0.001). Seasonal trend analysis showed that children had significantly higher number of ear disorders during summer and autumn seasons (P

Bardet‐Biedl Syndrome (BBS) is a rare autosomal recessive disorder with a wide spectrum of clinical manifestations like retinal dystrophy, obesity, polydactyly, mental retardation, hypogonadism, and renal dysfunction. We report a case of 14‐year‐old obese boy with poor scholastic performances, hypothyroidism, and poor vision diagnosed as BBS.

Introduction: Perinatal mortality rate is a sensitive indicator of the quality of obstetric and pediatric health services. It also helps us to evaluate the efficiency of health care provided by a particular hospital. The aim of this study was to evaluate the cause of perinatal death in a tertiary care medical centre, which may help to reduce the incidence of perinatal death and improve the quality of care. Methods: The two-year retrospective study of perinatal deaths was done at Karnali Academy of Health Sciences (KAHS), Jumla from March 2017 to April 2019. Data was collected from monthly perinatal audit and annual mortality reviews. Registers in the maternity ward, sick Neonate Care Unit, and files of dead newborns kept in the record section of the hospital were studied and reviewed. Results: A total of 1354 deliveries were conducted in the 24 months period at KAHS with a perinatal mortality rate of 36.08 per 1000 total birth and early neonatal death rate of 12.8 per 1000 live birth. The Perinatal mortality was higher in low birth weight and premature baby. The cause of stillbirth and early Neonatal death were identified. Most of the early neonatal death was due to Prematurity (41.17%) followed by Birth Asphyxia and Neonatal Sepsis. Conclusion: Prematurity and its related complication were the most common cause of early neonatal death followed by birth Asphyxia and Neonatal Sepsis. There is a need to improve antenatal, early identification of high-risk pregnancy as well as Neonatal Intensive Care Unit (NICU) to further reduce deaths due to prematurity and birth asphyxia. Keywords: Perinatal Mortality Rate; Early Neonatal Mortality Rate; Rural Areas; Jumla DOI: http://doi.org/10.3126/jkahs.v2i2.25178

Introduction: Nepal is a low socioeconomic country and adolescent pregnancy can have a deleterious effect on the mother, child and the community. The aim of this study was to know the incidence of teenage pregnancy and its outcomes in the mid-western region of Nepal Method: This was a retrospective study conducted in Karnali Academy of Health Science, Jumla, Nepal. Data were collected from the hospital records from October 2017 to September 2018. Result: The incidence of teenage pregnancy was 22.6% among total deliveries. Most of them were Primigravida (84.9%). Majority of them were 18 years of age (47.5%). Caesarean section accounted for 10.8%. In perinatal outcome, the incidence of preterm birth was 15.1%, and extremely low birth weight was 2.2%, very low birth weight was 1.4% and low birth weight was 12.2%. Maternal complication accounted for 33.09%. Conclusion: The study concluded that the incidence of teenage pregnancy is considerably high and it is associated with an increases risk of an adverse outcome to both mother and newborn. Therefore, education and awareness can be helpful in reducing adolescent pregnancy and its adverse outcomes. Keyword: Adolescent pregnancy, teenage pregnancy, Karnali Academy of Health Science, Jumla, Nepal, Intrauterine Fetal Death, World Health Organization (WHO) DOI: http://doi.org/10.3126/jkahs.v2i2.25169

Background Small for gestational age (SGA) is common among newborns in low‐income countries like Nepal and has higher immediate mortality and morbidities. Objectives To study the prevalence and prognostic factors of SGA babies in Western Nepal. Methods A cross‐sectional study (November 2016‐October 2017) was conducted in a tertiary care hospital in Western Nepal. Socio‐demographic, lifestyle factors including diet, and exposures including smoking and household air pollution in mothers who delivered newborns appropriate for gestational age (AGA), SGA and large for gestational age (LGA) were recorded. Logistic regression was carried out to find the odds ratio of prognostic factors after adjusting for potential confounders. Results Out of 4000 delivered babies, 77% (n = 3078) were AGA, 20.3% (n = 813) were SGA and 2.7% (n = 109) were LGA. The proportion of female‐SGA was greater in comparison to male‐SGA (n = 427, 52.5% vs n = 386, 47.5%). SGA babies were born to mothers who had term, preterm, and postterm delivery in the following proportions 70.1%, 19.3%, and 10.6%, respectively. The average weight gain (mean ± SD) by mothers in AGA pregnancies was 10.3 ± 2.4 kg, whereas in SGA were 9.3 ± 2.4 kg. In addition to low socioeconomic status (OR 1.9, 95% CI 1.1, 3.2), other prognostic factors associated with SGA were lifestyle factors such as low maternal sleep duration (OR 5.1, CI 3.6, 7.4) and monthly or less frequent meat intake (OR 5.0, CI 3.2, 7.8). Besides smoking (OR 8.8, CI 2.1, 36.3), the other major environmental factor associated with SGA was exposure to household air pollution (OR 5.4, 4.1, 6.9) during pregnancy. Similarly, some of the adverse health conditions associated with a significantly higher risk of SGA were anemia, oligohydramnios, and gestational diabetes. Conclusions SGA is common in Western Nepal and associated with several modifiable prognostic factors.

BackgroundDespite readily availability of vaccines against both Hemophilus influenzae and Pneumococcus, pneumonia remains the most common cause of morbidity and mortality in children under the age of five years in Nepal. With growing antibiotic resistance and a general move towards more rational antibiotic use, early identification of clinical signs for the prediction of radiological pneumonia would help practitioners to start the treatment of patients. The main aim of this study was to reassess the clinical predictors of pneumonia in Nepal.MethodsThis cross-sectional study was conducted between June 2015 and November 2015 at Tribhuvan University Teaching Hospital, a tertiary hospital in Kathmandu, Nepal. Children aged 3-60 months with a clinical diagnosis of pneumonia by a physician were enrolled in the study. Radiological pneumonia was identified and categorized as per World Health Organization guidelines by an experienced radiologist blinded to patient characteristics. We calculated sensitivity and specificity of clinical signs and symptoms for radiological pneumonia.ResultsOut of 1021 children with fever, 160 cases were clinically diagnosed as pneumonia and were enrolled for this study. Among the enrolled patients, 61% had radiological pneumonia. Tachypnea had the highest sensitivity of 99%, while bronchial breathing had the highest specificity of 100%. During univariate analysis, grunting, wheezing, nasal discharge, decreased breath sounds, noisy breathing and hypoxemia were associated with radiological pneumonia. Only hypoxemia remained an independent predictor when adjusted for all the factors.ConclusionTachypnea was the most sensitive sign, whereas bronchial breathing was most specific sign for radiological pneumonia.

DOI: https://doi.org/10.3126/jucms.v6i2.22467 Introduction: Healthy, full term, exclusively breastfed infants are expected to lose weight in the first days following birth. There are conflicting opinions about what constitutes a normal neonatal weight loss. This study was conducted to establish the reference weight loss pattern in exclusively breastfed neonates. Materials and methods: A cross sectional observational study was conducted at a tertiary care hospital of western Nepal for a period of 12 months. All babies delivered were recruited. Newborns with birthweight of > 2500 grams without any congenital anomalies and Apgar score >7/10 were finally included for analysis. Breast feeding was started as soon as possible and all newborns were fed within 6 hours of life. If breast feeding was not possible within first 2 hours of life, expressed breast milk (EBM) or formula feeding was initiated as recommended. Data was analyzed showing distribution and frequency of various parameters like initiation of breastfeeding, weight of babies at different time intervals and weight loss patterns. Results: Out of 1000 babies subjected to analysis, majority were males (n= 517, 51.7%). The average time of initiation of breast feeding was less than 6 hours. The weight loss pattern in babies was 7.1% at 72 hours of life. Conclusion: Breast feeding was initiated as soon as possible in all healthy term neonates. The average weight loss pattern in all term healthy newborns were almost similar. Keywords: Breast feeding, weight loss pattern, initiation of breast feeding

Objectives: Neonatal morbidity and mortality rates reflect efficiency of health services of a country. This study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to neonatology unit. Methods: The study was conducted in Neonatal Unit of Karnali Academy of Health Sciences, Jumla for a period of one year from 1st May 2017 to 30th April 2018. Data of all admitted patients were reviewed and analyzed in terms of gender, gestational age, age at presentation, weight, cause of admission and their outcome. Diagnosis was made on clinical examination, radiological findings and laboratory investigations. Data were analyzed using SPSS version 20. Results: Out of 153 neonates admitted during the study period, 2 were excluded because of deficient record. Full-term neonates were 122(80.7%) while preterm were 29 (19.3%). Low birth weight (LBW) babies were 32 (21.18%).Neonatal sepsis 91 (60.26%) was the most common cause of hospital admissions followed by meconium aspiration syndrome 21(13.9%) and prematurity 10(6.62%). Out of 151 newborns, 112 babies (74.1%) were discharged after improvement, 15(9.93%) left against medical advice, 13(8.6%) babies were referred to higher centers for intensive care and there were 9 (5.9%) mortalities and 2(1.3%) got absconded. Conclusion: The majority of neonatal morbidity is due to sepsis, prematurity and respiratory causes. All these causes are preventable to some extent and, can be effectively treated in order to reduce morbidity and mortality. Keywords: New Born, Mortality, Admission, Sepsis

Background Earthquakes impact child health in many ways. Diseases occurring immediately following an earthquake have been studied in field based hospitals but studies on the inpatient disease pattern among children without trauma in a permanent hospital setup is lacking. Methods We examined the diagnoses of all children without trauma, admitted to Kanti Children’s Hospital, Kathmandu for fifteen-week duration (from 4th week to end of the 18th week) following the 7.8 magnitude Nepal earthquake on 25th April 2015. The admitted children were grouped based on direct effect of earthquake on their family (house damaged or family member injured or dead) and on whether their place of residence was located in an earthquake affected district. Most common diagnoses were identified and their distribution between the aforementioned groups analyzed to examine differences, if any, in disease occurrence or presentation. The fifteen weeks study duration was divided into three parts of five weeks each, to study trends in illness presentation. Variables were compared among various groups using appropriate statistical tests (p

Background. Low birth weight (LBW) is defined as the birth weight of live born infants below 2500 g, regardless of gestational age. It is a public health problem caused by factors that are potentially modifiable. The purpose of this study was to determine the socioeconomic, obstetric, and maternal factors associated with LBW in Lumbini Provincial Hospital, Nepal. Methods. The study was conducted using case control study design with 1 : 2 case control ratio. A total of 105 cases and 210 controls were taken in this study. Data were entered on Epi data software version 3.1 and exported to Statistical Package for Social Science (SPSS) software version 25 for analysis. Characteristics of the sample were described using mean and standard deviation. Bivariate analysis was done to assess the association between dependent and independent variables. The ultimate measure of association was odds ratio. Variables found to be associated with bivariate analysis were entered into a multivariable logistic regression model to identify predictors of LBW. Results. The mean age of the participants was 25.98 years with ±4.40 standard deviation. Mothers with literate educational background (AOR 0.32, 95% CI 0.13–0.81), housewife (AOR 2.63, 95% CI 1.11–6.20), vaginal mode of delivery (AOR 0.45, 95% CI 0.25–0.82), gestational age Conclusion. Educational and occupational status, mode of delivery, gestational age, maternal weight, and history of LBW were found to be independent predictors of LBW. There is need of developing coordination with education sector for increasing educational status of mothers and adolescent girls. Social determinants of health need to be considered while developing interventional programs. Similarly, interventional programs need to be developed considering identified predictors of low birth weight.

BackgroundScrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children.MethodsA prospective observational study was carried out in children aged 1-16 years, admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA.ResultsAll cases of scrub typhus (n = 76) presented with fever and commonly had other symptoms such as headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). About 12% (n = 9) had necrotic eschar. Similarly, thrombocytopenia, raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), severe thrombocytopenia (22.4%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%). Over two-thirds (69.70%) of the cases were treated with doxycycline followed by combination with azithromycin in the remaining 18.4%. Overall, mortality rate in this group was 3.9%.ConclusionsScrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Myocarditis and acute kidney injury are important complications which when addressed early can prevent mortality. Use of doxycycline showed a favorable outcome.

Background. Neurocysticercosis (NCC), a common cause of seizures in children from low and middle income countries (LMICs), if not diagnosed and treated early enough may lead to considerable morbidity and mortality. There is a lack of data on the prevalence of NCC and its clinical characteristics among those with seizure in South-Western Nepal. Aims and Objectives. To study the prevalence and clinical characteristics of NCC in children with seizures. Material and Methods. All children admitted to Universal College of Medical Sciences, a tertiary hospital in South-Western Nepal with seizures during 2014–16, were tested for NCC. NCC was diagnosed by neuroimaging [computerized tomography (CT) scan or magnetic resonance imaging (MRI)]. We used logistic regression to test the association between NCC with participants’ characteristics and clinical symptoms. Results. Among 4962 in-patient children, 168 (104 boys and 64 girls) had seizures (138 with generalized tonic clonic seizures (GTCS) and 30 with focal seizures). 43% of children with seizures had CT scan confirmed NCC. The prevalence of NCC in the oldest children (13–16 years) was significantly greater (57.1% versus 15.6%) compared to the youngest (0–4 years) one (p<0.001). Among 72 children with NCC, the proportions of children with vesicular, calcified, and colloidal stages were 76% (n=35), 18% (n=13), and 6% (n=2), respectively. Children with focal seizures had 13% more NCC compared to those with GTCS but the result was statistically not significant. The adjusted odds of having NCC among 5–8 years, 9–12 years, and 13–16 years children were 6.6 (1.78–24.60), 11.06 (2.74–44.60), and 14.47 (3.13–66.96), respectively, compared to 0–4-year-old children. Reoccurrence of seizures within the first 3 months of taking antiepileptic drug in those with NCC was approximately 3 times higher compared to those without NCC (11% versus 4%, p=0.084). Conclusions. This study shows that NCC contributes significantly to higher prevalence of seizures in children in South-Western region of Nepal.

Introduction: Measurement of birth weight (BW), crown heel length (CHL), head circumference (HC) and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socio economic status, maternal size, and maternal diseases. The study aimed to construct centile charts for BW, CHL and HC for new born at different gestational ages in western Nepal. Methods: This was a descriptive cross sectional study done over a period of 15 months in a tertiary care hospital of western Nepal. BW, length, HC and CC were measured within 12-24 hours of birth. Gestational age was estimated from first day of last menstrual period, maternal ultrasonology and New Ballard’s scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole’s Lambda Mu Sigma method was used for constructing centile curves. Results: Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of BW, CHL, and HC from 33-42 weeks of gestation. 57.35% (1147) were male, mean gestational age was 38.13 ±2.44 weeks, where 21.5% were preterm and 1.7% post term. The means of BW, CHL, HC and CC were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. These data vary as compared to the Kathmandu data, in case of birth weight for 10th and 90th centiles, and at 90th centile in case of length. Conclusions: This necessitates the update in the existing growth charts and develop in different geographical regions of a country.

Not present

Sclerema neonatorum is a form of panniculitides characterized by diffuse hardening of subcutaneous tissue with minimal inflammation. It usually affects ill and preterm neonates. Prognosis is usually poor in many cases despite aggressive management. Various treatment modalities (antibiotics, intravenous immunoglobulin, steroids, and exchange transfusion) have been explained in literature. Steroids due to its easy availability and low cost can prove to be lifesaving in such cases, especially in resource poor countries. Here, we report a case of sclerema neonatorum in a one-week preterm baby treated successfully with parenteral steroids and antibiotics.