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Introduction: Under nutrition is an underlying cause of more than one third of global deaths in children below the age of 5 years. Nutrition education is a critical strategy of intervention to improve child complementary feeding practices which will subsequently decrease mortality and morbidity of under-5 children. Objective: To determine the knowledge of nurses on complementary feeding practices and also provide appropriate training and verify its effectiveness. Method: It is a hospital based educational interventional study. The time-series was from October 2021 to march 2022 included 24 nursing staff. The nurses underwent one-day training on complementary feeding practices in infant. They were evaluated periodically on their knowledge at four different time points. The effectiveness of training was calculated based on the change in scores, as per mean numeric scores, immediately, 1 and 6 months after the training. Result: The nurses showed high competence by obtaining above average scores (100%) by all participant immediately after training and remained so after 1 month. The mean test score obtained before training was 15.3 which increased to 23 after training, 21.9 after 1 month and 17.8 after 6 months of training. The differences in mean were statistically significant (p value 0.000). Conclusion: This training intervention improved knowledge of nurses regarding complementary feeding practices, but improvements need to be strengthened and sustained.

Background: The coronavirus disease-2019 (COVID -19) outbreak and lockdown measures have given challenges related to food production, food supply chain, indulgence in low healthy processed food, lack of public transportation, difficulties in accessing emergency and regular health services. Nepal already has high burden of child mortality (39 deaths per 1000 live births) and this pandemic situation has put children at greater risk of facing hunger, malnutrition, lack of routine immunisation, communicable disease outbreak, and many more psychological as well as physical health issues. Objectives: This study identifies nutritional status and gap in routine vaccination in children during COVID-19 pandemic thereby help in modelling action plan to prevent an outpouring in malnutrition and vaccine preventable infections in children. Methods: This is a hospital-based analytical cross-sectional study done among 138 children of ages one to 59 months old from 1st January 2021 to 1st August 2021 attending paediatric clinic of KMCTH. Results: In this study, 20 (14.4%) of the children were stunted, 23 (16.6%) were wasted and 15 (10.8%) were categorised under undernutrition, three (2.2%) were overweight and three (2.2%) were obese. There were significantly more male children stunted than female (p-value = 0.005). Thirty-five (33.3%) of less than 15 months children were reported to have delay of more than two weeks in routine immunisation of children. A significant delay of more than four weeks was observed in 29 (27.6%). Conclusion: Indirect impact of COVID-19 pandemic in children like malnutrition and gap in routine vaccination needs to be addressed seriously in Nepal.

BackgroundGlobally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5–24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited.MethodsA new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations.ResultsThe total number of children ConclusionInjuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.

Background: Umbilical cord infection (omphalitis) is a major cause of neonatal mortality and morbidity in a developing country like Nepal. Detached umbilical stump is an important colonizing site for different types of bacteria and it also provides direct access to bloodstream. Hence, inadequate cord care may lead to omphalitis as well as neonatal sepsis. Objectives: This study aims to compare two different cord care regimens (dry cord care versus chlorhexidine cord care) on their cord separation time and the incidence of omphalitis. Methodology: This is a comparative observational study conducted at the Neonatal unit of Kathmandu Medical College over a three months period (August 2019 to October 2019). All newborn babies born between 37 to 42 weeks of gestation were enrolled. Randomization for dry cord care and chlorhexidine cord care group was done via computer generated numbers. Statistical package for social sciences 19 version was used for statistical analysis. Results: Among 514 term babies, 256 babies were included in the dry cord care group while 258 babies were enrolled in the chlorhexidine cord care group. The two groups had similar baseline characteristics. The mean cord separation time in the dry cord care group was 7.70±1.2 days (range 3-15 days), whereas in the chlorhexidine group, it was 7.77±1.4 days (range 4-18 days). Conclusion: There was no significant difference between the cord separation times in dry and chlorhexidine cord care regimens. Both dry cord care and chlorhexidine cord care regimens were found to be safe and effective.

This study aimed to develop and evaluate a model of hospital-based injury surveillance and describe the epidemiology of injuries in adults. One-year prospective surveillance was conducted in two hospitals in Hetauda, Nepal. Data were collected electronically for patients presenting to emergency departments (EDs) with injuries between April 2019 and March 2020. To evaluate the model’s sustainability, clinical leaders, senior managers, data collectors, and study coordinators were interviewed. The total number of patients with injuries over one year was 10,154, representing 30.7% of all patients visiting the EDs. Of patients with injuries, 7458 (73.4%) were adults aged 18 years and over. Most injuries (6434, 86%) were unintentional, with smaller proportions due to assault (616, 8.2%) and self-harm (408, 5.5%). The median age of adult patients was 33 years (IQR 25–47). Males had twice the rate of ED presentation compared with females (40.4 vs. 20.9/1000). The most common causes were road traffic accidents (32.8%), falls (25.4%), and animal/insect related injuries (20.1%). Most injured patients were discharged after treatment (80%) with 9.1% admitted to hospital, 8.1% transferred to other hospitals, and 2.1% died. In Nepal, hospital-based injury surveillance is feasible, and rich injury data can be obtained by embedding data collectors in EDs.

Introduction: Low birth weight is directly related to both immediate and long term development and wellbeing of a person. There are numerous maternal and foetal factors contributing to low birth weight. The mortality and morbidity of low birth weight can be reduced if the maternal risk factors are detected early and managed by simple techniques. Methods: 207 low birth weight live newborn babies regardless of gestational age born in a tertiary level teaching institute from September 2015 to September 2016 were enrolled as cases and same number of normal birth weight babies (i.e. 2.5 to 4 kgs) as control. Information was obtained directly from mothers using pretested structured questionnaire and was analysed using SPSS version 20. Results: The incidence of low birth weight was found to be 9.8%. Mean weight of low birth weight babies was 1.98 kg and mean gestational age was 37.34 weeks. Among low birth weight babies, 47.8% were preterm and 52.2% were term. Out of 119 small for gestational age babies, the frequency of symmetrical small for gestational age was 45.3% and asymmetrical small for gestational age was 54.6%. There was significant association of low birth weight with multiple maternal factors like maternal age, education, weight, height, weight gain during pregnancy, ANC visits, parity, antepartum haemorrhage, previous abortion/low birth weight, birth spacing, tobacco/alcohol intake and haemoglobin. Conclusions: Prevalence of low birth weight is likely to be far higher than figure in isolated rural settings of our country. Contribution of SGA is higher than Appropriate for Gestational Age which brings us to a larger burden of long term morbidity and mortality. Various maternal factors are responsible for birth of low birth weight babies.

Background: Malnutrition among young children is becoming a major public health concern in low income countries like Nepal where under nutrition remains one of the primary causes of ill health. Acute lower respiratory tract infection (ALRTI) and malnutrition in children are associated with morbidity and mortality in developing countries.Objective of this study was to assess ALRTI as a risk factor for malnutrition in children at Kathmandu Medical College Teaching Hospital. Methods: This was a cross-sectional study con-ducted at Kathmandu Medical College Teaching Hospital over 5 months duration (August - December 2017). Under 5 yrs children diagnosed as ALRTI were taken and healthy children from same age group attending the immunization clinic were the controls. Anthropometric measurements were measured and stunting and wasting were described according to the WHO classification of malnutrition. Data were analyzed using SPSS version 18. Statistical analyses were done in the form of frequency, mean and cross tabulation. Chi-Square test was used to assess the association of ALRTI with malnutrition. P value

Almost 10% of global deaths are secondary to injuries, yet in the absence of routine injury surveillance and with few studies of injury mortality, the number and cause of injury deaths in many countries are not well understood. This study aimed to develop and evaluate the feasibility of a method to identify injury deaths in rural Nepal. Working with local government authorities, health post staff and female community health volunteers (FCHVs), we developed a two-stage community fatal injury surveillance approach. In stage one, all deaths from any cause were identified. In stage two, an interview with a relative or friend gathered information about the deceased and the injury event. The feasibility of the method was evaluated prospectively between February 2019 and January 2020 in two rural communities in Makwanpur district. The data collection tools were developed and evaluated with 108 FCHVs, 23 health post staff and two data collectors. Of 457 deaths notified over one year, 67 (14.7%) fatal injury events were identified, and interviews completed. Our method suggests that it is feasible to collect data on trauma-related deaths from rural areas in Nepal. These data may allow the development of injury prevention interventions and policy.

Background Low birth weight is a common problem in neonates.The ponderal index (PI) is a simple anthropometric measurement that is used to diagnose impaired fetal growth. PI = Weight (GM)/Length (CM) 3 × 100. The value of ponderal index Objectives To determine the ponderal index of the low birth weight babies and to classify them accordingly. Methods A descriptive cross sectional study which was carried out in Paediatrics Department of Kathmandu Medical College Teaching Hospital from July 2020 to September 2020. Ethical clearance was taken from the Institutional Review Committee. The study population consisted of low birth weight neonates on any period of gestation. Informed written consent was taken from the parents. Babies with congenital malformations were excluded. The sample size was 212 neonates. The eligible babies were examined after birth. Birth weight and the length were taken by standard weighing machine and infantometer. For perinatal factors, interview of parents were taken using the designed proforma. Results A total of 210 low birth weight babies fulfilling the inclusion criteria were enrolled in this study.105 (49.5%) mothers were primiparous. 116 (54.7%) babies were born vaginally. 111 (52.4%) babies were males. A total of 111 (52.3%) babies were premature. The mean birth weight of the babies was 2052±352 gms (1050–2490 gms) and the mean gestational age was 35±2 weeks (28–42 weeks). Out of 212 babies, ninety-nine babies (46.7%) had a low ponderal index ( 170 babies (80.2%) had no postnatal complications, 15 babies had neonatal sepsis, 10 babies had respiratory distress syndrome, 6 babies had hypoxic-ischemic encephalopathy (4 babies stage I HIE, 2 babies Stage II HIE), 8 babies had transient tachypnea of newborn, 3 babies had hypoglycemia and 2 babies had polycythemia. Conclusions Ponderal index is a simple and effective tool to identify wasting. In this study, nearly 46.7% of the low birth weight babies were disproportionate at birth.

Background Availability of injury related mortality data can play a vital role in planning health services for injury prevention and monitoring progress towards Sustainable Development Goal 3.4. In the absence of a robust death registration system, this study explored the feasibility of a model to identify injury deaths occurring outside hospital in rural Nepal. Methods Data were collected prospectively between February 2019 and January 2020, in two rural municipalities in Makwanpur district. Female Community Health Volunteers notified all deaths in their area to the local Health-Post. Trained data collectors identified the injury-related deaths and invited relatives of the deceased to take part in a structured face-to-face interview. Results Over one year, 67/451 (14.9%) deaths were identified as secondary to an injury in the two study areas (injury mortality rate 104/100,000 population). The rate of community injury deaths was higher in males (128/100,000) than females (80/100,000) with a median age at death of 40 years (SD=20.8, range 2 to 93). Community injury deaths were most commonly secondary to suicide (65/100,000), followed by unintentional injury (36/100,000) and assault/violence (3/100,000). Conclusion Large numbers of injury deaths occur outside hospital, and these appear more likely to be due to intentional than unintentional harm. These findings are a valuable additional source of information for engaging stakeholders, developing targeted injury prevention interventions and informing policies. Learning Outcomes Community deaths secondary to injuries are common and will be missed in hospital-based data collection systems. The mechanism of injury may be different for community compared to hospital cases.

Background Injury surveillance is important for national injury control and prevention initiatives and enables monitoring of progress towards Sustainable Development Goals 3.4 and 3.6. In the absence of a national injury surveillance system in Nepal, we evaluated the feasibility of a model of hospital-based surveillance. Methods An injury surveillance system was introduced in the emergency departments of two hospitals in Makwanpur district. Anonymous data on patients presenting with an injury were collected 24 hours a day between April 2019 and February 2020. A process evaluation involved 14 interviews to explore sustainability of the model. Results Over 11 months, a total 6942 adult patients with injuries attended the study hospitals. More than half attendees (64.3%) were male and most (55.7%) were young adults (18–35 years). Most injuries were unintentional (86.3%, n=5988); predominantly road traffic injuries (32.2%), falls (25.6%) and animal related harm (20.1%). The hospital management and clinical staff valued the availability and usefulness of injury data that had been collected from the hospital-based surveillance. Conclusion A large proportion of the work presenting to these two hospitals is injury related, and potentially preventable. Road traffic injuries are a significant component of the adult injuries. The lack of capacity of hospital staff for collecting injury data is a major barrier for sustaining the injury surveillance system in the longer term. Learning Outcomes Rich injury data can be obtained by embedding data collectors in emergency departments. Such data can enable monitoring of epidemiological trends. Effective surveillance systems require investment and capacity.

Background Unintentional Injuries comprise the fifth leading cause of death in Nepal in 2017, an increase of 23% compared to 1990. In Nepal, there is minimal community-derived evidence of home or occupational injuries. Our aim was to describe the epidemiology of injuries in the Makwanpur district, including the causes and risk factors associated with those injuries. Methods A cross-sectional, household survey was undertaken in three administrative areas of Nepal between April-June, 2019. Data were collected electronically about non-fatal and fatal injuries in the previous three months and five years, respectively. Results 17,593 individuals from 3,327 households were surveyed; 394 people were injured. 136/394 (34.5%) injuries occurred in homes, 109 (27.7%) were work-related. 225 (55.8%) were males, the age range was 0–87 years, 123 (30.7%) were child injuries, (0–17 yrs). The most commonly reported injury was falls (n=173, 43.9%), stumbling and tripping were the most common reasons and 73 (42.2%) occurred at home. More injuries occurred in rural administrative areas than urban areas, especially occupational injuries (occupational: chi-square=22.05, p=0.000; home: chi-square=13.89, p Conclusions Home and occupational fall injuries are common, especially in rural areas. Understanding the context of falls, especially identifying and working with particular occupational groups where they are prevalent, may identify risk factors and help target messages about primary falls prevention and interventions. Learning Outcomes Using hand-held computers and local enumerators for data collection in sample areas resulted in minimal missing data and monitoring of data quality during the collection period.

ObjectiveInjuries are a global health problem. To develop context-specific injury prevention interventions, one needs to understand population perceptions of home and workplace injuries. This study explored a range of views and perceptions about injuries in a variety of settings and identified barriers and facilitators to injury prevention.DesignQualitative study: interviews and focus groups.SettingThree administrative areas: Hetauda submetropolitan city, Thaha municipality and Bakaiya rural municipality in Makwanpur, Nepal.ParticipantsNine focus groups (74 participants) and nine one-to-one interviews were completed; workers from diverse occupations, residents (slum, traditional or modern homes) and local government decision-makers participated in the study between May and August 2019. The interviews and discussions were audio-recorded, transcribed verbatim, translated to English and analysed thematically.ResultsSix themes were developed: unsafe home and workplace environment; inadequate supervision and monitoring; perceptions that injuries are inevitable; safety takes low priority: financial and behavioural considerations; safety education and training; and government-led safety programmes and enforcement. Key barriers to injury prevention were perceived to be lack of knowledge about injury risk and preventive measures both at the community level and at the workplace. Facilitators were community-level educational programmes and health and safety training to employees and employers. Participants stressed the importance of the role of the government in planning future injury prevention programmes in different environments.ConclusionsThis study highlighted that both home and workplace injuries are complex and multifactorial. Lack of knowledge about injury risks and preventive measures, both at the community level and at the workplace, was found to be a common barrier to injury prevention, perceived to be mitigated by educational programmes. Together with previously published epidemiological evidence, the barriers and facilitators identified in this study offer useful basis to inform policy and practice.

ObjectiveThis paper describes the epidemiology of home- and work-related injuries, their mechanisms, inequalities and costs associated with these injuries.MethodsA household survey was undertaken in three palikas (administrative areas) of Makwanpur district between April-June, 2019. Data were collected electronically on non-fatal injuries that occurred in the previous three months and fatal injuries that occurred in the previous five years.Findings17,593 individuals were surveyed from 3,327 households. The injury rate was 8.0/1000 population for home injuries and 6.4/1000 for work-related injuries; 61.0% of home injuries were among females and 69.9% of work-related injuries among males. Forty-eight percent of all home injuries were due to falls (28 males (50.9%) and 40 females (46.5%)); burn/scalds were higher among females 15 (10.5%). Cuts and piercings accounted for 40% of all work-related injuries and 36.3% were falls. Injury incidence varied by ethnic group: home injuries were highest in Brahmin (12/1000) and work-related injuries highest in Rai groups (21.0 per 1000). The total mean cost of work-related injury was US$143.3 (SD 276.7), higher than for home injuries (US$130.4, SD 347.6). The number of home (n = 74, 64.9%) and work-related (n = 67, 77.9%) injuries were higher in families below the poverty line (ConclusionsHome and occupational fall injuries are common. The inequalities in injury identified in our study by rurality, age, sex, income level and ethnic group can help target injury prevention interventions for vulnerable groups.What is already known on the subjectLimited epidemiological data are available in Nepal about the location of injury, activity taking place when injury occurred and the costs of injuryThere is limited information about the distribution of injuries by ethnicity and income groups.What this study addsPeople from rural areas experience more injuries than people living in urban or city areasManual workers sustain more work-related injuries than those in other occupationsCertain ethnic groups have higher rates of injuries than other ethnic groupsPeople with lower income experience more injuries than people with higher incomesInjury costs are high in relation to average per capita income.

ObjectiveTo describe the epidemiology of home-related and work-related injuries, their mechanisms, inequalities and costs associated with these injuries.MethodsA household survey was undertaken in three palikas of Makwanpur district between April and June 2019. Data were collected electronically on non-fatal injuries that occurred in the previous 3 months and fatal injuries that occurred in the previous 5 years.Findings17 593 individuals were surveyed from 3327 households. Injury rates were 8.0 per 1000 population for home injuries and 6.4 per 1000 for work-related injuries; 61.0% of home injuries were among women and 69.9% of work-related injuries among men. Falls were the cause of 48% home injuries, affecting 50.9% of men and 46.5% of women. Burns/scalds were higher in women than men, affecting 17.4% of women reporting home injuries. Cuts and piercings accounted for 39.8% of all work-related injuries and 36.3% were falls. Injury incidence varied by ethnic group: home injuries were highest in Brahmin (12.0 per 1000) and work-related injuries highest in Rai groups (21.0 per 1000). The total mean costs (transport and treatment) of work-related injury was US$143.3 (SD 276.7), higher than for home injuries (US$130.4, SD 347.6). The number of home (n=74, 64.9%) and work-related (n=67, 77.9%) injuries were higher in families below the poverty line than families in the next income bracket (home: n=22, 19.3%; work: n=11, 12.8%).ConclusionsHome-related and work-related fall injuries are common. The inequalities in injury identified in our study by rurality, age, sex, income level and ethnic group can help target injury prevention interventions for vulnerable groups.

Introduction: Hyaline membrane disease (HMD) is an acute lung disease of preterm babies caused by surfactant insufficiency. Decreased surfactant results in insufficient surface tension in the alveolus during expiration leading to alveolar collapse, atelectasis, impaired gas exchange, severe hypoxia and acidosis, leading to respiratory failure. Surfactant replacement therapy (SRT) is now accepted as the standard treatment of preterm babies with HMD. Objective: The objective of this study was to analyze the outcome of surfactant replacement therapy in preterm babies with hyaline membrane disease. Methodology: This is a prospective observational study conducted at 10 bedded neonatal unit of Pediatrics Department, Kathmandu Medical College Teaching Hospital, Sinamangal. Study duration was of one year period (15 May 2017 – 14 May 2018). Preterm babies from 26 wks–35 wks of gestation with Hyaline Membrane Disease were included in this study whereas babies with lethal congenital malformations eg: Meningomyelocele, Anencephaly, Gastrochisis, Diaphragmatic Hernia were excluded. All preterm babies who had clinical and radiological features of HMD were considered for Surfactant Replacement Therapy (SRT). The surfactant (Survanta; Abboti Laboratories, USA; Dose: 4 ml/kg) was administered intra-tracheally according to standard procedures in four divided aliquot applying INSURE (intubation, surfactant administration and extubation to Bubble CPAP) Technique. Ethical clearance was received from Institutional Review Committee (IRC) of Kathmandu Medical College and Statistical analysis was done with SPSS 19 version with frequency and cross tabulation. Results: In this study of 30 preterm babies with HMD received SRT, 47% (14) were male and 53% (16) were female. The mean birth weight of preterm babies with HMD was 1372.17 ± 395 gms and mean gestational age was 30.1±2.6 weeks. Among 30 preterm babies with HMD receiving SRT, 73.3% (22 babies) discharged from the hospital and 6.3% (8 babies) expired. Among eight expired babies, five died due to pulmonary hemorrhage and three died due to septicemia with DIC. Maximum survival was seen in the gestational age of 30-35 wks and birth weight 1200-2100gms. Conclusion: The use of SRT has improved the survival outcome and decreased the associated morbidities in babies with HMD. The maximum impact of survival was seen among the preterm babies of 30- 35 weeks with birth weight of 1200 -2100 grams.

Perinatal asphyxia is one of the major causes of neonatal morbidity and mortality. It mainly causes neurodevelopmental delay leading to hypoxic-ischemic encephalopathy. We present here the case of a preterm male baby of 1670 grams born at 31+3 weeks of gestation delivered by 25-year-old primi mother through vaginal delivery with history of umbilical cord prolapse. At birth, the baby had no heart rate and cyanosed following which he was resuscitated according to the Neonatal Advanced Life Support 2015 guidelines protocol. After 5 minutes of neonatal resuscitation, the baby's heart rate reappeared, but was only upto 20 beats/min and resuscitation thus continued. But heart rate did not improve despite of using all form of resuscitation procedure including intubation and drugs. After 2 hours, baby cried spontaneously and later baby was managed in Neonatal Intensive Care Unit according to the neonatal unit protocol of the hospital. Keywords: birth asphyxia; cord prolapse; hypoxic ischemic encephalopathy.

Introduction: Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. This study was done to determine the bacterial profile causing neonatal sepsis and to assess their susceptibility pattern to various antimicrobial agents. Materials and Methods: A cross-sectional prospective study was conducted in Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal among 340 neonates suspected of neonatal sepsis. Blood culture was performed and organisms were identified with Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI). Results: The prevalence rate of neonatal sepsis was 20.3%. Among 340 neonates, 52.17% were males and 47.82% were females. Gram positive cocci were the most predominant isolates (88.40%). Among Gram positive cocci Staphylococcus epidermidis was the most common isolates (72.46%) followed by Staphylococcus aureus (7.24%), Staphylococcus saprophyticus (4.34%) and Enterococcus fecalis (4.34%). Gram negative bacilli were found in 11.60% of the growth positive samples of which E.coli and Klebsiella spp were found in 10.14% and 1.44% respectively. Sensitivity to Amikacin was highest among all types of organisms isolated. Vancomycin and Gentamycin sensitivity was highest for Gram positive and Gram negative organisms respectively. Ampicillin resistance was highest among isolates. Among the 69 isolates 48 were Multiple drug resistant. Conclusion: The predominance of Gram positive cocci particularly Coagulase negative Staphylococci is shown. Empirical antibiotic therapy should be reviewed for Multiple drug resistant strains. DOI: http://dx.doi.org/10.3126/jnps.v34i3.9183 J Nepal Paediatr Soc 2014;34(3):175-180

Background: A gestational age specific c birth weight, length and head circumference centile chart will help to identify intrauterine growth of a baby. Since the first published gestational age specific anthropometric study done in Nepal by Manandhar DS et al in 1993-94, there have been significant changes in socioeconomic conditions with improved health indicators. This study was done for identifying any changes in anthropometric measurements of the newborns born at Kathmandu Medical College Teaching Hospital (KMCTH). Objectives: To produce gestational age specific c birth weight, length and head circumference centile charts of the New born babies born at KMCTH and to calculate incidence of low birth weight (LBW) babies at KMCTH. Methods: This is a cross sectional observational study. Study was done at labour room, operation theatre, special care baby unit and postnatal wards of KMCTH. Study period was from 18th Aug 2011 to 28th Nov 2012 (15 months duration). Within 24 hours of birth, baby’s weight, length and head circumference were measured by medical officers and post graduate Residents of the Paediatrics Department. Mother’s weight, height and ethnicity were also recorded. Maturity of the baby was assessed by maternal history and corroborated by using modified Ballard score and Obstetric USG (Ultra sonogram) findings. Data were entered in excel database programme and later transferred into SPSS (Statistical package of social science) 16. Mean, standard deviation, range and percentiles values at different gestational age specific c groups were calculated. Results: A total of 2029 live babies without gross congenital malformations were included in this study, among which 57% (1154) were male. While analyzing maturity assessment, 89.1% (1808) were term, 8.7% (176) were preterm and 2.2 % (45) babies were post term. Mean birth weight at 40 weeks of gestation was 3.10 kg with Standard Deviation (SD) of 0.4 kg, mean head circumference was 34.0 cm (SD 1.2 cm) and mean length was 49.2 cm (SD 2.2 cm). Out of 2029 babies, 16.2% (328) babies were low birth weight (LBW) and 1.4% (28) babies weighed >4 kg. Conclusion: Percentile charts of newborns will help to assess the intrauterine growth of babies. Further more studies of these percentile charts will help to produce national level percentile charts of newborns of Nepal.DOI: http://dx.doi.org/10.3126/jkmc.v3i3.12244Journal of Kathmandu Medical CollegeVol. 3, No. 3, Issue 9, Jul.-Sep., 2014,Page: 97-101

Aims: This study was done to identify and analyze obstetric near miss cases at health facilities of electoral constituency number 2 (EC 2) of Arghakhanchi district, Nepal. Methods: After receiving one day training on identifying obstetric near miss cases, health facility staff of EC 2 of Arghakhanchi district filled up WHO derived obstetric near miss forms for eight months duration. Causes of obstetric near miss cases were identified and analyzed in SPSS 16. Results : There were 31 obstetric near miss cases reported from different health facilities of EC 2 of Arghakhanchi. The commonest cause of obstetric near miss was Post-partum Hemorrhage (85%, n=26) followed by obstructed labor and ante partum hemorrhage (6%, n= 2) each. The leading cause of PPH was retained placenta/placental tissue in 55% cases (14) followed by atonic uterus (27%, n= 7). Two fifth of the mothers (39%, n=12) developed complication during labor. The most common complication developed after labor was hemorrhage. Conclusions : This study highlighted PPH as the most common serious obstetric problem in the health facilities and indicates the need for provision of blood transfusion at the health facility at least at Arghakhanchi. DOI: http://dx.doi.org/10.3126/njog.v9i2.11760

Introduction: The near miss concept and the criterion-based clinical audit are proposed as useful approaches for obtaining such information in newborn health care. There is currently no Standard definition and criteria for neonatal near miss especially for the community level intervention. Thus, lifesaving interventions could be an entry point to initiate the development of the neonatal near-miss definition. Mother and Infants Research Activities and Health Right International (HRI) developed a new tool for assessing neonatal near miss cases based on the Community based newborn care package programme. This is a part of operational research programme on strengthening the health facilities of Electoral constituency No; 2 of Arghakhanchi district of Nepal. The objective of this study was to identify and analyze neonatal near miss cases at different health facilities of Electoral constituency No; 2 of Arghakhanchi district, Nepal. Materials and Methods: One day of training on identifying neonatal near miss cases was given by an expert at Arghakhanchi district hospital to the health facilities staff in two groups. Health facility staffs were trained on identifying neonatal near miss cases and completing the modified neonatal near miss case forms. Neonatal near miss cases were documented for nine months period. Results: There were a total of 28 cases of neonatal near miss reported from different health facilities. Among them, 90% babies were delivered at health facility and 72% babies were of normal birth weight. Low birth weight incidence is 21% among near miss cases. Neonatal near miss contributed possible severe bacterial infection/ severe infection 47%, birth asphyxia in 43% cases and very low birth weight 7%. Conclusions: Birth asphyxia and PSBI were the two most common causes of neonatal near miss in the health facilities of Arghakhanchi district. There is a need to improve the quality of neonatal care in health facilities to properly manage these neonatal near miss cases which were referred to higher centre. DOI: http://dx.doi.org/10.3126/jnps.v34i2.9880 J Nepal Paediatr Soc 2014;34(2):115-118