Archana Amatya

Maternal mortality over the last decade: A changing pattern of death due to alarming rise in hepatitis in the latter five‐year period

Aims:  To study the causes of maternal mortality in two consecutive five year periods over a decade (1997–2001/2002–2006) in a university hospital.

What factors influence the choice of urban or rural location for future practice of Nepalese medical students? A cross-sectional descriptive study

BackgroundNepal is experiencing a public health issue similar to the rest of the world, i.e., the geographical maldistribution of physicians. Although there is some documentation about the reasons physicians elect to leave Nepal to work abroad, very little is known about the salient factors that influence the choice of an urban versus rural practice setting for those physicians who do not migrate. In recent years, around 1000 medical students became doctors within Nepal, but their distribution in rural locations is not adequate. The purpose of this study was to explore what factors influence the choice of urban or rural location for the future clinical practice of Nepalese medical students in the final year of their programMethodsA cross-sectional descriptive study design was used for this study involving Nepalese medical students in their final year of study and currently doing an internship in a medical college. The sample consisted of 393 medical students from four medical colleges in Nepal that were selected randomly. An anonymous self-administered questionnaire was used for data collection. To determine the association with rural location choice for their future practice setting, a comparison was done that involved demographic, socio-economic, and educational factors. Data were entered in EpiData and analyzed by using SPSS version 16.ResultsAmong the 393 respondents, two thirds were male (66.9%) and more than half were below 25 years of age. Almost all (93%) respondents were single and about two thirds (63.4%) were of Brahmin and Chhetri ethnic origin. About two thirds (64.1%) of the respondents were born in a rural setting, and 58.8% and 53.3% had a place of rearing and permanent address in a rural location, respectively. The predictors of future rural location choice for their clinical practice (based on the bivariate analysis) included:(a)Rural (versus urban) place of birth, place of rearing, and permanent address(b)Source of family income (service, business, and agriculture)(c)Occupation of father (service, business and agriculture)(d)Wealth ranking (higher, middle, and lower wealth rank)(e)Educational factors: location, type of secondary education, and type of higher secondary educationConclusionFor medical students who were soon to complete their studies, demographic and educational factors were found to be significant predictors for a rural location choice, as opposed to socio-economic factors. Our findings indicate that to ensure the rural retention of physicians, the government of Nepal should attract potential medical students from those who were reared and educated in a rural setting.

UTERINE PERFORATION AS A SEQUEL TO REPEATED CURETTAGE FOR MOLAR

An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingooophorectomy for uterine perforation because of repeated dilatation and curettage for persisting vaginal bleeding following molar evacuation. As significant proportion of molar do progress into Gestational trophoblastic Neoplasia which in this case was choriocarcinoma; directs our attention to the fact that proper follow up of post molar cases using at least urinary beta HCG and instituting chemotherapy whenever necessary should be advocated in order to avoid such a drastic management. CASE REPORT Journal of Nepal Medical Association, 2002:41:401-403