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Biomedical subjects

D S Malla

Publications and source records attributed to D S Malla.

6 recordsLinked to original sources
PubMed2000

Process indicators for safe motherhood programmes: their application and implications as derived from hospital data in Nepal.

Measuring maternal mortality ratios is fraught with problems and underestimates. Therefore process indicators have been proposed for monitoring the availability and use of obstetrics services. We report the results of process indicators for measuring the availability, use and quality of obstetric care in five districts in Nepal between 1997 and 1998. The number of comprehensive essential obstetric care (EOC) facilities was adequate for four of the five districts, but none had a minimum acceptable level of basic EOC facilities as set by UNICEF et al. The proportion of expected births in hospital was 21.5% in Rupandehi and < 5% in Baglung, Kailali, Okhaldunga and Surkhet. The minimum acceptable level is 15%. The 'met need' for obstetric care which pertains to the proportion of all women with direct obstetric complications that are treated in hospital was 14.9% in Rupandehi and < 5% in the other four districts, against the required minimum of 15%. The caesarean section rate calculated of all expected births in the population varied between 0.2% and 1.4%. The case fatality rate was 4.0% in Rupandehi Zonal Hospital. Analysis of these indicators clearly identified tremendous underuse of maternity services which has stimulated national policy discussions in Nepal with ensuing safe motherhood interventions and monitoring strategies.

Adult↗
PubMed1997

Thermal control of the newborn: knowledge and practice of health professional in seven countries.

Hypothermia is a common problem in neonates, particularly in developing countries where it is an important contributory factor to neonatal mortality and morbidity. An evaluation of the knowledge and practices of health professionals on the thermal control of newborns was carried out in seven countries: Brazil, India, Indonesia, Kazakhstan, Mozambique, Nepal and Zimbabwe. The evaluation, conceived as a preliminary phase for a one-day training course on thermal control, involved 28 health facilities and 260 health professionals (61 doctors and 199 nurses and midwives). It included an assessment of thermal control practices carried out in each health facility by external investigators and a questionnaire on knowledge about thermoregulation administered to health professionals involved in newborn care. The findings of the evaluation were consistent across countries and showed that thermal control practices were frequently inadequate in the following areas: ensuring a warm environment at the time of delivery; initiation of breastfeeding and contact with mother, bathing; checking the baby's temperature; thermal protection of low birth weight babies, and care during transport. Knowledge on thermal control was also insufficient, especially concerning the physiology of thermoregulation and criteria for defining hypothermia. During the one-day course that followed the evaluation, participants were able to recognize the existing gaps and to identify appropriate interventions. Knowledge and practice on the thermal control of the newborn are currently insufficient. However, awareness of the importance of thermal control and basic knowledge on thermal regulation and thermal protection can be easily acquired and on this basis motivation for improving thermal control practices can be developed.

Body Temperature Regulation↗
PubMed1993

A survey of technology and temperature control on a neonatal unit in Kathmandu, Nepal.

An assessment of the incubators in use at the Kathmandu Maternity Hospital neonatal unit was undertaken; this was followed by a prospective survey of neonatal temperatures on the unit. In the incubator assessment 11 studies were carried out in five incubators. Three of the thermostats in the five incubators did not work at all and those in the other two incubators were more than 3 degrees C inaccurate. All the incubator thermometers gave recordings less than the actual temperature (with a range of error: 1.3-4.4 degrees C). Six out of the 11 babies studied were hypothermic (defined as rectal temperature < 36 degrees C). In the prospective survey of temperatures a high incidence of hypothermia was found on the neonatal unit at the time of first temperature measurement (64 per cent had a rectal temperature of < 36 degrees C). A significant association between admission hypothermia and mortality was noted. Sixteen per cent (10/64) of babies admitted with temperatures < 36 degrees C died within the first week, compared to 0 (0/36) of those admitted with temperatures > or = 36 degrees C.

Body Temperature↗
PubMed1992

Effect of post-delivery care on neonatal body temperature.

A prospective observational study of post-delivery care and neonatal body temperature, carried out at Kathmandu Maternity Hospital, was followed by a randomized controlled intervention study using three simple methods for maintaining body temperature. There were 500 infants in the initial observation study and 300 in the intervention study. In the observation study, 85% (420/495) of infants had temperatures < 36 degrees C at 2 h and nearly 50% (198/405) had temperatures < 36 degrees C at 24 h (14% were < 35 degrees C). Most of the infants who were cold at 24 h had initially become cold at the time of delivery (only seven infants had been both well dried and wrapped). In the intervention study, all infants were dried and wrapped before random assignment to one of the three methods: the "kangaroo" method, the traditional "oil massage" or a "plastic swaddler". All three were found to be equally effective. Overall, 38% (114/298) of the infants had temperatures < 36 degrees C at 2 h and 18% (41/231) at 24 h (when none was < 35 degrees C).

Body Temperature↗
PubMed1986

Open drop ether anaesthesia for caesarean section: a review of 420 cases in Nepal.

Anaesthesia for Caesarean sections performed during 1982-83 at the Women's Hospital in Kathmandu, Nepal is reviewed. In a twelve-month period 535 Caesarean sections were performed, representing 7.36 per cent of 7,263 deliveries. Many pregnant women in Nepal do not have antenatal care and the mean haemoglobin of these mothers was 86 g X L-1. In the absence of an on-call anaesthetist for obstetrics, more than 90 per cent of the anaesthetics were given by junior obstetric residents, using open drop diethyl ether without endotracheal intubation. Eleven patients developed postoperative chest infection; in none of these was there any suggestion of inhalation of gastric contents and all recovered uneventfully. Of the 18 maternal deaths in the 7,263 deliveries during this period, one occurred during Caesarean section. This was due to uncontrollable haemorrhage and was not attributable to the anaesthetic. For poor risk patients, and in unskilled hands, diethyl ether remains a remarkably safe anaesthetic.

Adolescent↗