Journal of Microbiology, Immunology and Infection, 2015
Purpose:The outbreak attributed to pandemic influenza A H1N1(A(H1N1) pdm09) in the health care wo... more Purpose:The outbreak attributed to pandemic influenza A H1N1(A(H1N1) pdm09) in the health care workers(HCWs) was rarely reported in the literature. We conducted an outbreak investigation of A(H1N1)pdm09 among the HCWs in the emergency department (ED) and characterized the temporal and in-hospital progression of A(H1N1)pdm09 as it emerged in the ED. Methods: We included patients and HCWs with influenza like illness(ILI) enrolled during August 2014 eSeptember 2014. Respiratory specimens were tested by influenza rapid test, real-time reverse transcriptase polymerase chain reaction (RT-PCR) and viral cultures. Full-genome sequencing for HA and NA segments were done and phylogenetic trees were built to compare the differences among A(H1N1)pdm09 strains. Results: During this period, a total of 63 individuals suffered from ILI, including 20 patients and 43 HCW. A(H1N1)pdm09 was diagnosed in 41 individuals (20 patients and 21 HCWs). The most common presenting symptoms were fever (71.4%), cough (60.3%), sore throat (31.7%), and headache (22.2%). Three of the immune compromised patients had fatality related to A(H1N1)pdm09. The phylogenetic trees analysis for the HA and NA segments among 3 patients revealed strain similarity and no antiviral drugs resistance. The outbreak was halted by providing prophylactic zaramivir and adherence on infection control measurements. Conclusions: Influenza outbreak is a serious public and health concern. Early detection of index case as well as implementations of HCWs education, hand hygiene, cohorting care and aggressive cleaning of the environment surfaces was important in stop the outbreak.
This paper summarizes lessons learned from formative research conducted in Bangladesh, Ghana, Ind... more This paper summarizes lessons learned from formative research conducted in Bangladesh, Ghana, India, Mali and Nepal to inform the development of newborn health interventions, mostly in the context of field trials. Current practices, constraints to the adoption of optimal practices and implications for implementing inventions to improve newborn survival are discussed for: optimal care during pregnancy; skilled care at birth; optimal delivery and newborn care practices; special care of low birth weight babies; and timely and appropriate care seeking for newborn illness. General lessons concerning target audiences and intervention strategy are also drawn. In brief, interventions to reduce neonatal mortality need to start during pregnancy not only to promote birth preparedness and institutional delivery, but also to start the process of change concerning early newborn care practices. Their target audience should not only be pregnant or recently delivered women, but also include the main gatekeepers, particularly traditional birth attendants, grandmothers and other family members. Health providers' opinions also matter as care practices are less likely to change if families receive conflicting messages from different sources. Interventions are more likely to succeed if they are not simply message based, but include problem solving approaches, and a behavior change component to address community norms. Although antenatal care (ANC) is theoretically a good channel for newborn interventions, capitalising on its potential is not straightforward, and will require considerable investment and intervention development in its own right in order to improve ANC counselling, which will need to extend beyond training and tackle the many working day constraints encountered by ANC providers. Removing or subsidising the cost of deliveries may be a necessary action to increase institutional deliveries, but it is unlikely to be sufficient; measures will need to be put in place to ensure the basic quality of institutional deliveries and newborn care, and to change staff attitudes and practices. Post-natal visits should include observation of the baby, referral and counselling of the mother concerning danger signs in addition to promoting optimal care practices. The lessons learned should guide the development of interventions in other contexts, and ensure that key essential elements are not overlooked. They do not, however, mean that formative research will not be needed in other contexts, although the list of questions to address should be considerably reduced; successful intervention strategies require adaptation to make them local, context-specific if they are to be effective, and ongoing process monitoring to ensure the quality of intervention delivery, to check that it is having its intended effect, and to respond to any concerns from its implementers, recipients or the community. Finally, major gaps in evidence are highlighted. These include: establishing levels of recognition of asphyxiated babies and effectiveness of local solutions for resuscitation; clarifying the extent of the overlap between community perceptions of 'at risk' babies and low birthweight babies; developing and evaluating effective interventions to enable ANC services to deliver effective behaviour change counselling for pregnant and newborn health; evaluating effectiveness of delivering community-based newborn interventions at scale through routine services.
In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and fo... more In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community-based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12-fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level.
Thisstldy araminedse~prcqernandirons~ofpeopleagedlOto?2yearslivingm~e Itaharidistrict(an~district... more Thisstldy araminedse~prcqernandirons~ofpeopleagedlOto?2yearslivingm~e Itaharidistrict(an~district,40malaand32femalesjanlmthe~district(an agicultural district, 89 males and 82 females) in the Terai region of soutbem Nepal. The relaticnship between the results and food and nutrient intakes was also invest&ted. 'Ihe mean values of weigbt were very low in bc& groups, which led to a low bcxly mas index, 18-X). The mean values of serum total protein (TPj for the residents in the CXm district were higher ttran~oftheItahar~(p<D.o5)aniinthe~:.thoseforfanaleswere~~~tnales (p&OS). Serum albumin (Albj level did not differ significantly between the two groups and sexes. The mean values of serum iron (SQ were mostly within normal mngeq however those for cxwarl females were low. Uma&akdircnbindingcapcity(UIBC)andtotalircn bii cap&y (1~) levels were much bi&er in the chitwrn than in the Itabati, therefore, theSyTlBcratiowaslowerinthefclrmer~in~el~andfemalesin~~~also showed lower SkTlBC ratio. These finding qgest that iron (Fe) itdake for the Chitwan residents seems to be insutlicient. The average amount of Fe intake in the Chitwan was lower, and about cne-thkl of the residarts, especially about half of the young women showed SIRIBC ratios equal to or below 16%, offering support for the existence of iron deficiency. SI correlated negptively with UIBC Semm TP and Alb a3scciated with nutritnul status correlated strcngly with enxgy and protein rich f& while Fe intake showed cxxrelaticn with ceTe81s, fish meat and nutriets, exq calcium. These finding indicate that the sdicient intake of foai cc&king @in and energy can &ease the level of Fe intake. Among legumes,blackgram~~abcut15mg/l00gofFe,~~~itccluldserveasagood foodsaurceofFebecaueofitseasyavailability.
Background Nutrition asserts to be a fundamental for child growth and development. Undernutrition... more Background Nutrition asserts to be a fundamental for child growth and development. Undernutrition increases the risk of child morbidity and mortality becomes a major public health challenges in developing countries. The aim of study was to assess prevalence of stunting, wasting and underweight among children aged 6-23 months in Dalit and Non-Dalit and associated factors.Method A cross sectional comparative study was conducted among mothers with their children aged 6-23months in Dhanusha district. Overall, 599 respondents were taken through multistage simple random sampling of which 300 from Non-Dalit and 299 from Dalit. Anthropometry measurement and interview were used for data collection technique and structure questionnaire was applied as a tool. Using Statistical Package for the Social Science, descriptive and inferential analysis were done.Results Prevalence of stunting, underweight and wasting were 49.9%, 34.8% and 13.4% in Dalit and 39.0%, 25.0% and 8.7% in Non-Dalit respectiv...
Background: The prevalence of hepatitis B infection is heterogeneous and ubiquitous. This study a... more Background: The prevalence of hepatitis B infection is heterogeneous and ubiquitous. This study aimed to identify the prevalence of the infection among the pregnant women who attended in a tertiary care hospital, transmission of the infection in their newborn and associated risk factors.Methods: A one year prospective study was conducted. Mother’s venous blood was collected for the hepatitis B serological test during the antenatal care or before delivery; the newborn’s cord blood was also collected for the HBsAg. Results: A total 16400 pregnant women were tested; of them 53 were HBsAg positive. The total prevalence of the infection was 0.32% among the pregnant: 0.5% among the indigenous and 0.2% in other than indigenous. The infection was significantly high in the indigenous group compare to other than indigenous [2.596 (1.475-4.569), p=.001]. Thirty-two out of 53 hepatitis B positive pregnant were delivered in the hospital, of them 75% (n=24) were indigenous and 25% (n=8) were othe...
Objectives. Gastric cancer (GC) is one of the most prevalent neoplasms and a leading cause of mor... more Objectives. Gastric cancer (GC) is one of the most prevalent neoplasms and a leading cause of mortality globally. To our knowledge, its relationship with dietary factors is not adequately studied and understood in the Nepalese context. This study is aimed at exploring the relationship between the possible dietary risk factors responsible for gastric cancer in Nepal. Methods. A hospital-based matched case-control study was conducted in two specialized cancer hospitals in Nepal. A total of 237 participants (79 cases and 158 controls) were included in the study. Patients diagnosed within one year (incidence case) with histologically confirmed gastric cancer were taken as cases, and healthy visitors of gastric and nongastric cancer patients without past and present history or not a suspected information of gastric cancer were included as controls. A face-to-face interview was conducted using a semi-structured food frequency questionnaire. Backward stepwise conditional logistic regressio...
ABSTRACTSince its establishment, Institute of Medicine (IOM) has been pursuing Community Oriented... more ABSTRACTSince its establishment, Institute of Medicine (IOM) has been pursuing Community Oriented MedicalEducation (COME) in training medical graduates in the country. The community orientation of the MBBSprogram of IOM is achieved through community based learning divided into different experiences like fieldbased community diagnosis, concurrent field with families with sick members, district hospital managementthrough posting in the district hospitals. The aim of this article is to review the organization of the COMEat IOM, identify the strengths and weaknesses of this approach and suggest measures for improvement. Areview of the educational activities related to community based learning experiences was done, and focusgroup discussions were carried out among the current and the past students. Besides these two activities,literature was searched and concerned authorities were informally interviewed to find out if there has beenany consensus regarding the effectiveness and desirabili...
South Asian countries experience some of the highest levels of child undernutrition in the world,... more South Asian countries experience some of the highest levels of child undernutrition in the world, strongly linked to poor infant and young child feeding (IYCF) practices. Strong and responsive policy support is essential for effective interventions to improve IYCF. This study aimed to identify opportunities for strengthening the policy environment in the region to better support appropriate infant and young child feeding. We mapped policies relevant to infant and young child feeding in India, Pakistan, Bangladesh, Sri Lanka and Nepal, based on a common matrix. The matrix described potentially relevant policies ranging from high-level strategic policy documents to implementation-level guidelines. We analyzed the data based on themes focused on caregiver interactions with IYCF interventions: provision of correct information to mothers, training of frontline workers, enabling mothers to engage with service providers and strategic support for IYCF. Policy support for IYCF was present in...
The aim of the current study was to examine the impact of antenatal iron-folic acid (IFA) supplem... more The aim of the current study was to examine the impact of antenatal iron-folic acid (IFA) supplementation on perceived birth size and birthweight in Pakistan over a 5-year period from 2002 to 2006. The data source was the Pakistan Demographic and Health Survey (PDHS) 2006-2007. Information from 5692 most recent live-born infants within 5 years prior to the survey was examined. The primary outcomes were maternal perception of birth size and birthweight, and the main exposure was any use of antenatal IFA supplements. Birthweight was reported for only 10% of the live births in the PDHS 2006-2007. Multivariate logistic regression analysis was adjusted for the cluster sampling design and for 13 potential confounders. The risk of having smaller than average birth size newborn was significantly reduced by 18% (adjusted odds ratio 0.82, 95% confidence interval 0.71, 0.96) for mothers who used any IFA supplements compared with those who did not. A similar (18%), but non-significant reduction...
Despite concerted effort from government and partners, Nepal continues to have a high burden of u... more Despite concerted effort from government and partners, Nepal continues to have a high burden of under nutrition among children. Identifying opportunities to strengthen policy support for infant and young child feeding (IYCF) is a key component to improve child survival, growth and development. This study aims to explore policy support for IYCF and to identify the influential stakeholders for IYCF for effective future policy development and programmatic action. Policies relevant to IYCF were identified through web searches and direct approaches to relevant government ministries. Policy content was analysed based on four key domains focussed on mothers, using a qualitative synthesis approach. Three group interviews were conducted using the participatory tool "Net-Map", to identify the influential stakeholders in IYCF policy and programming processes. Twenty-six relevant policy documents were analysed for content relating to IYCF. General support for IYCF was found in most of...
Background: Undernutrition is a major problem in Nepal and meeting the minimum dietary standard i... more Background: Undernutrition is a major problem in Nepal and meeting the minimum dietary standard is essential for growth and development of young children. Continuous monitoring of such practices is important to inform policy and program formulation. This study aimed to assess complementary feeding practices, and associated factors in Western Nepal. Methods: This was a cross-sectional study conducted in Rupandehi district of Western Nepal. Face-to-face interviews were conducted among 178 mothers of young children aged 6–23 months using a structured questionnaire and data on complementary feeding practices. These practices were reported as frequency distribution and the factors associated were ascertained using multiple logistic regression. Results: Only 57 % of mothers initiated complementary feeding at the age of 6 months. While the proportion of young children receiving minimum meal frequency was reasonably high (84 %), meal diversity (35 %) and minimum acceptable diet (33 %) remained low. Maternal education and having had their children's growth monitored were independently associated with receiving minimum acceptable diet. Conclusion: Few infants and young children received the recommended infant and young children feeding practices. Implementing health promotion programs that educate and enhance the skills of mothers should be a priority for future nutrition interventions.
Journal of Microbiology, Immunology and Infection, 2015
Purpose:The outbreak attributed to pandemic influenza A H1N1(A(H1N1) pdm09) in the health care wo... more Purpose:The outbreak attributed to pandemic influenza A H1N1(A(H1N1) pdm09) in the health care workers(HCWs) was rarely reported in the literature. We conducted an outbreak investigation of A(H1N1)pdm09 among the HCWs in the emergency department (ED) and characterized the temporal and in-hospital progression of A(H1N1)pdm09 as it emerged in the ED. Methods: We included patients and HCWs with influenza like illness(ILI) enrolled during August 2014 eSeptember 2014. Respiratory specimens were tested by influenza rapid test, real-time reverse transcriptase polymerase chain reaction (RT-PCR) and viral cultures. Full-genome sequencing for HA and NA segments were done and phylogenetic trees were built to compare the differences among A(H1N1)pdm09 strains. Results: During this period, a total of 63 individuals suffered from ILI, including 20 patients and 43 HCW. A(H1N1)pdm09 was diagnosed in 41 individuals (20 patients and 21 HCWs). The most common presenting symptoms were fever (71.4%), cough (60.3%), sore throat (31.7%), and headache (22.2%). Three of the immune compromised patients had fatality related to A(H1N1)pdm09. The phylogenetic trees analysis for the HA and NA segments among 3 patients revealed strain similarity and no antiviral drugs resistance. The outbreak was halted by providing prophylactic zaramivir and adherence on infection control measurements. Conclusions: Influenza outbreak is a serious public and health concern. Early detection of index case as well as implementations of HCWs education, hand hygiene, cohorting care and aggressive cleaning of the environment surfaces was important in stop the outbreak.
This paper summarizes lessons learned from formative research conducted in Bangladesh, Ghana, Ind... more This paper summarizes lessons learned from formative research conducted in Bangladesh, Ghana, India, Mali and Nepal to inform the development of newborn health interventions, mostly in the context of field trials. Current practices, constraints to the adoption of optimal practices and implications for implementing inventions to improve newborn survival are discussed for: optimal care during pregnancy; skilled care at birth; optimal delivery and newborn care practices; special care of low birth weight babies; and timely and appropriate care seeking for newborn illness. General lessons concerning target audiences and intervention strategy are also drawn. In brief, interventions to reduce neonatal mortality need to start during pregnancy not only to promote birth preparedness and institutional delivery, but also to start the process of change concerning early newborn care practices. Their target audience should not only be pregnant or recently delivered women, but also include the main gatekeepers, particularly traditional birth attendants, grandmothers and other family members. Health providers' opinions also matter as care practices are less likely to change if families receive conflicting messages from different sources. Interventions are more likely to succeed if they are not simply message based, but include problem solving approaches, and a behavior change component to address community norms. Although antenatal care (ANC) is theoretically a good channel for newborn interventions, capitalising on its potential is not straightforward, and will require considerable investment and intervention development in its own right in order to improve ANC counselling, which will need to extend beyond training and tackle the many working day constraints encountered by ANC providers. Removing or subsidising the cost of deliveries may be a necessary action to increase institutional deliveries, but it is unlikely to be sufficient; measures will need to be put in place to ensure the basic quality of institutional deliveries and newborn care, and to change staff attitudes and practices. Post-natal visits should include observation of the baby, referral and counselling of the mother concerning danger signs in addition to promoting optimal care practices. The lessons learned should guide the development of interventions in other contexts, and ensure that key essential elements are not overlooked. They do not, however, mean that formative research will not be needed in other contexts, although the list of questions to address should be considerably reduced; successful intervention strategies require adaptation to make them local, context-specific if they are to be effective, and ongoing process monitoring to ensure the quality of intervention delivery, to check that it is having its intended effect, and to respond to any concerns from its implementers, recipients or the community. Finally, major gaps in evidence are highlighted. These include: establishing levels of recognition of asphyxiated babies and effectiveness of local solutions for resuscitation; clarifying the extent of the overlap between community perceptions of 'at risk' babies and low birthweight babies; developing and evaluating effective interventions to enable ANC services to deliver effective behaviour change counselling for pregnant and newborn health; evaluating effectiveness of delivering community-based newborn interventions at scale through routine services.
In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and fo... more In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community-based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12-fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level.
Thisstldy araminedse~prcqernandirons~ofpeopleagedlOto?2yearslivingm~e Itaharidistrict(an~district... more Thisstldy araminedse~prcqernandirons~ofpeopleagedlOto?2yearslivingm~e Itaharidistrict(an~district,40malaand32femalesjanlmthe~district(an agicultural district, 89 males and 82 females) in the Terai region of soutbem Nepal. The relaticnship between the results and food and nutrient intakes was also invest&ted. 'Ihe mean values of weigbt were very low in bc& groups, which led to a low bcxly mas index, 18-X). The mean values of serum total protein (TPj for the residents in the CXm district were higher ttran~oftheItahar~(p<D.o5)aniinthe~:.thoseforfanaleswere~~~tnales (p&OS). Serum albumin (Albj level did not differ significantly between the two groups and sexes. The mean values of serum iron (SQ were mostly within normal mngeq however those for cxwarl females were low. Uma&akdircnbindingcapcity(UIBC)andtotalircn bii cap&y (1~) levels were much bi&er in the chitwrn than in the Itabati, therefore, theSyTlBcratiowaslowerinthefclrmer~in~el~andfemalesin~~~also showed lower SkTlBC ratio. These finding qgest that iron (Fe) itdake for the Chitwan residents seems to be insutlicient. The average amount of Fe intake in the Chitwan was lower, and about cne-thkl of the residarts, especially about half of the young women showed SIRIBC ratios equal to or below 16%, offering support for the existence of iron deficiency. SI correlated negptively with UIBC Semm TP and Alb a3scciated with nutritnul status correlated strcngly with enxgy and protein rich f& while Fe intake showed cxxrelaticn with ceTe81s, fish meat and nutriets, exq calcium. These finding indicate that the sdicient intake of foai cc&king @in and energy can &ease the level of Fe intake. Among legumes,blackgram~~abcut15mg/l00gofFe,~~~itccluldserveasagood foodsaurceofFebecaueofitseasyavailability.
Background Nutrition asserts to be a fundamental for child growth and development. Undernutrition... more Background Nutrition asserts to be a fundamental for child growth and development. Undernutrition increases the risk of child morbidity and mortality becomes a major public health challenges in developing countries. The aim of study was to assess prevalence of stunting, wasting and underweight among children aged 6-23 months in Dalit and Non-Dalit and associated factors.Method A cross sectional comparative study was conducted among mothers with their children aged 6-23months in Dhanusha district. Overall, 599 respondents were taken through multistage simple random sampling of which 300 from Non-Dalit and 299 from Dalit. Anthropometry measurement and interview were used for data collection technique and structure questionnaire was applied as a tool. Using Statistical Package for the Social Science, descriptive and inferential analysis were done.Results Prevalence of stunting, underweight and wasting were 49.9%, 34.8% and 13.4% in Dalit and 39.0%, 25.0% and 8.7% in Non-Dalit respectiv...
Background: The prevalence of hepatitis B infection is heterogeneous and ubiquitous. This study a... more Background: The prevalence of hepatitis B infection is heterogeneous and ubiquitous. This study aimed to identify the prevalence of the infection among the pregnant women who attended in a tertiary care hospital, transmission of the infection in their newborn and associated risk factors.Methods: A one year prospective study was conducted. Mother’s venous blood was collected for the hepatitis B serological test during the antenatal care or before delivery; the newborn’s cord blood was also collected for the HBsAg. Results: A total 16400 pregnant women were tested; of them 53 were HBsAg positive. The total prevalence of the infection was 0.32% among the pregnant: 0.5% among the indigenous and 0.2% in other than indigenous. The infection was significantly high in the indigenous group compare to other than indigenous [2.596 (1.475-4.569), p=.001]. Thirty-two out of 53 hepatitis B positive pregnant were delivered in the hospital, of them 75% (n=24) were indigenous and 25% (n=8) were othe...
Objectives. Gastric cancer (GC) is one of the most prevalent neoplasms and a leading cause of mor... more Objectives. Gastric cancer (GC) is one of the most prevalent neoplasms and a leading cause of mortality globally. To our knowledge, its relationship with dietary factors is not adequately studied and understood in the Nepalese context. This study is aimed at exploring the relationship between the possible dietary risk factors responsible for gastric cancer in Nepal. Methods. A hospital-based matched case-control study was conducted in two specialized cancer hospitals in Nepal. A total of 237 participants (79 cases and 158 controls) were included in the study. Patients diagnosed within one year (incidence case) with histologically confirmed gastric cancer were taken as cases, and healthy visitors of gastric and nongastric cancer patients without past and present history or not a suspected information of gastric cancer were included as controls. A face-to-face interview was conducted using a semi-structured food frequency questionnaire. Backward stepwise conditional logistic regressio...
ABSTRACTSince its establishment, Institute of Medicine (IOM) has been pursuing Community Oriented... more ABSTRACTSince its establishment, Institute of Medicine (IOM) has been pursuing Community Oriented MedicalEducation (COME) in training medical graduates in the country. The community orientation of the MBBSprogram of IOM is achieved through community based learning divided into different experiences like fieldbased community diagnosis, concurrent field with families with sick members, district hospital managementthrough posting in the district hospitals. The aim of this article is to review the organization of the COMEat IOM, identify the strengths and weaknesses of this approach and suggest measures for improvement. Areview of the educational activities related to community based learning experiences was done, and focusgroup discussions were carried out among the current and the past students. Besides these two activities,literature was searched and concerned authorities were informally interviewed to find out if there has beenany consensus regarding the effectiveness and desirabili...
South Asian countries experience some of the highest levels of child undernutrition in the world,... more South Asian countries experience some of the highest levels of child undernutrition in the world, strongly linked to poor infant and young child feeding (IYCF) practices. Strong and responsive policy support is essential for effective interventions to improve IYCF. This study aimed to identify opportunities for strengthening the policy environment in the region to better support appropriate infant and young child feeding. We mapped policies relevant to infant and young child feeding in India, Pakistan, Bangladesh, Sri Lanka and Nepal, based on a common matrix. The matrix described potentially relevant policies ranging from high-level strategic policy documents to implementation-level guidelines. We analyzed the data based on themes focused on caregiver interactions with IYCF interventions: provision of correct information to mothers, training of frontline workers, enabling mothers to engage with service providers and strategic support for IYCF. Policy support for IYCF was present in...
The aim of the current study was to examine the impact of antenatal iron-folic acid (IFA) supplem... more The aim of the current study was to examine the impact of antenatal iron-folic acid (IFA) supplementation on perceived birth size and birthweight in Pakistan over a 5-year period from 2002 to 2006. The data source was the Pakistan Demographic and Health Survey (PDHS) 2006-2007. Information from 5692 most recent live-born infants within 5 years prior to the survey was examined. The primary outcomes were maternal perception of birth size and birthweight, and the main exposure was any use of antenatal IFA supplements. Birthweight was reported for only 10% of the live births in the PDHS 2006-2007. Multivariate logistic regression analysis was adjusted for the cluster sampling design and for 13 potential confounders. The risk of having smaller than average birth size newborn was significantly reduced by 18% (adjusted odds ratio 0.82, 95% confidence interval 0.71, 0.96) for mothers who used any IFA supplements compared with those who did not. A similar (18%), but non-significant reduction...
Despite concerted effort from government and partners, Nepal continues to have a high burden of u... more Despite concerted effort from government and partners, Nepal continues to have a high burden of under nutrition among children. Identifying opportunities to strengthen policy support for infant and young child feeding (IYCF) is a key component to improve child survival, growth and development. This study aims to explore policy support for IYCF and to identify the influential stakeholders for IYCF for effective future policy development and programmatic action. Policies relevant to IYCF were identified through web searches and direct approaches to relevant government ministries. Policy content was analysed based on four key domains focussed on mothers, using a qualitative synthesis approach. Three group interviews were conducted using the participatory tool "Net-Map", to identify the influential stakeholders in IYCF policy and programming processes. Twenty-six relevant policy documents were analysed for content relating to IYCF. General support for IYCF was found in most of...
Background: Undernutrition is a major problem in Nepal and meeting the minimum dietary standard i... more Background: Undernutrition is a major problem in Nepal and meeting the minimum dietary standard is essential for growth and development of young children. Continuous monitoring of such practices is important to inform policy and program formulation. This study aimed to assess complementary feeding practices, and associated factors in Western Nepal. Methods: This was a cross-sectional study conducted in Rupandehi district of Western Nepal. Face-to-face interviews were conducted among 178 mothers of young children aged 6–23 months using a structured questionnaire and data on complementary feeding practices. These practices were reported as frequency distribution and the factors associated were ascertained using multiple logistic regression. Results: Only 57 % of mothers initiated complementary feeding at the age of 6 months. While the proportion of young children receiving minimum meal frequency was reasonably high (84 %), meal diversity (35 %) and minimum acceptable diet (33 %) remained low. Maternal education and having had their children's growth monitored were independently associated with receiving minimum acceptable diet. Conclusion: Few infants and young children received the recommended infant and young children feeding practices. Implementing health promotion programs that educate and enhance the skills of mothers should be a priority for future nutrition interventions.
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