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Introduction: Neonatal sepsis, a significant contributor to global neonatal mortality, poses substantial risks to infant health, particularly in low-resource countries like Nepal. Despite its high prevalence, there is a lack of clarity in defining and understanding neonatal sepsis, leading to challenges in diagnosing and managing the condition effectively. The probable impact of neonatal sepsis on long-term neurodevelopmental outcomes, including motor and cognitive delays, remains under-explored in Nepal. The primary objective of this study is to report the prevalence of neurodevelopmental delay in neonates with documented sepsis. The secondary objective is to report significant associations of the same with selected probable risk factors., Methods and Analysis: This is a dual-centric prospective cohort study that is ongoing at two hospitals-Paropakar Maternity and Women's Hospital and Siddhi Memorial Hospital in Nepal, over a 2-year period. Neonates diagnosed with sepsis will be assessed using the Developmental Assessment Scale for Indian Infants at 6 months and 1 year, postdiagnosis. Statistical analyses will include prevalence estimation and logistic regression., Competing Interests: Competing interests: The authors declare no competing interests regarding the publication of this study protocol exploring the neurodevelopmental outcomes following documented neonatal sepsis in Nepal. There are no financial or non-financial interests that could be perceived as potentially influencing the objectivity, integrity or validity of the research conducted or the conclusions drawn from it. All authors involved in the development of this protocol have no affiliations or involvement with any organisations or entities that have a direct or indirect interest in the subject matter discussed in this study. The research is conducted with the sole purpose of advancing knowledge and understanding neonatal sepsis and its impact on neurodevelopmental outcomes, without any external influences or conflicts of interest., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Strategic action plans around newborn health evaluation are needed, to address the high neonatal mortality rate in Nepal. Surveillance systems, like Newborn Metabolic Screening (NBS), could reveal unrecognized drivers of neonatal death. NBS is not routinely performed in Nepal. Our objective was to determine the feasibility of establishing NBS, and its acceptability among healthcare providers and parents, in Nepal., Methods: This prospective cohort study was conducted between November 2021 and May 2022 in term/late preterm infants born at Paropakar Maternity Hospital, Kathmandu, screening for 6 disorders that can be confirmed and managed locally. Staff were trained on dried-blood spot collection and transport protocols, performance metrics were established, and assays were performed at an accredited laboratory in Bangalore, India. Surveys were developed to determine acceptability among health-care providers and parents., Results: Of 835 parents approached for the study, 825 (98.8%) consented. Parental surveys showed that 92% considered "no cost" option most important in choosing to participate in the study. Samples were transported to laboratories in Kathmandu and Bangalore in 36 ± 24 h, and 4.75 ± 1 days, which exceeded expected metrics of 24 and 48 h, respectively. Results were communicated to parents by 9.5 ± 2 days, which was within the expected metric window of 14 days. Abnormalities were reported in 13 infants and included 5 hemoglobinopathy traits (4 Hb E and 1 Hb D), 3 congenital hypothyroidism, 2 glucose-6-phosphate dehydrogenase deficiency, 1 congenital adrenal hyperplasia, 1 elevated acylcarnitine, and 1 biotinidase deficiency. Healthcare providers surveyed (n = 116) showed that 67% reported a moderate understanding of NBS; all indicated that screening would be beneficial. Most cited early diagnosis and treatment, as well as, providing risk to future pregnancies as significant benefits. 90% thought screening should be routinely performed., Conclusions: We demonstrate that it is feasible to introduce NBS in Nepal. Transport metrics were longer than expected due to COVID pandemic travel restrictions; however, it was possible to deliver results to families within 2 weeks of birth. Parents overwhelmingly considered "no cost" option as the most important in choosing to screen. A government-sponsored program will be a key factor in establishing NBS in Nepal., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval for the study was obtained from the Paropakar Maternity and Women’s Hospital Institutional Review Committee (Ref No. 6712014), Nepal Health Research Council (Ref No. 385), and Ann & Robert H. Lurie Children’s Hospital Institutional Review Board (IRB 2021–4591). Written informed consent was obtained for all study participants. The research conformed to the principles of the Helsinki Declaration. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: The postpartum period is a high-risk time for unintended pregnancies. A short inter-pregnancy interval leads to a series of complications for both the mother and the fetus. Postpartum contraceptive knowledge helps women decide the time frame for future pregnancy and prepare. The study aimed to find out the prevalence of postpartum family planning among women undergoing deliveries in a tertiary care hospital., Methods: A descriptive cross-sectional study was conducted from hospital records of all postpartum women delivering in a tertiary care hospital from Jan 2017 to Jan 2019. Ethical approval was taken from the Institutional Review Committee (IRC) of Kathmandu University School of Medical Sciences/Dhulikhel Hospital (reference number: 62/19). Convenience sampling was done. Data was entered and analyzed using Statistical Package of the Social Sciences version 26. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data., Results: Out of 4205 deliveries, 1211 (28.7%) (27.33-30.06 at 95% Confidence Interval) women utilized postpartum family planning. Depot-medroxyprogesterone acetate was adopted by a majority of the participants 802 (19.1%)., Conclusions: The use of postpartum contraception in this study was similar to the findings from studies done in national data and studies.

Dry matter production and nutrient dynamics were quantified in the reproductive components of 14- and 30-year-old teak (Tectona grandis L.) stands growing in a dry tropical region. Flower production per tree was positively related to tree size. Despite massive flower production (33 x 10(6) and 171 x 10(6) ha(-1) year(-1) in 14- and 30-year-old trees, respectively), only about 0.5-0.7% flowers developed into fruits. Immature fruit abscission totalled 34 and 58% of the total number of fruits initiated in the 14- and 30-year-old stands, respectively. The production of reproductive components (flowers, peduncles and fruits) was 245 kg ha(-1) year(-1) in the 14-year-old stand and 1122 kg ha(-1) year(-1) in the 30-year-old stand. In both stands, relatively greater amounts of dry matter and nutrients were allocated to reproductive parts in September than in other months. Toward the end of the fruit maturation period, considerable nutrient resorption occurred. More than 90% of the nutrients accumulated in the peduncle were resorbed. Smaller amounts, ranging from 21% for K to 58% for N, were resorbed from mature, winged indehiscent fruits.