Introduction: Childhood malnutrition is a leading cause of mortality and morbidity in children under five years in Nepal. There is evidence to show that childhood malnutrition varies from region to region, within Nepal.

IntroductionSerious neonatal infections including pneumonia, sepsis and meningitis account for a third of neonatal deaths around the world. However data on neuro-cognitive impairment after neonatal infection, particularly following clinical diagnosis of possible serious bacterial infection (pSBI) used to guide empiric treatment are lacking.MethodologyThis prospective study included 102/196 children born in a rural hospital in Kenya who survived neonatal pSBI (excluding those with confirmed meningitis) and 94/196 well neonates born in the same hospital. Children had neurodevelopmental assessments (incl. vision, hearing, motor) at between 18 to 36 months. A culturally appropriate neurodevelopmental assessment tool, Kilifi developmental inventory (KDI) was utilised in this study. Risks and differences in impairment were assessed using multivariable logistic and linear regressions respectively, adjusting for age, birth weight, gestational age, clinical diagnosis of HIE and bacteraemia.ResultsThe children who had neonatal pSBI had a higher risk of developing neurodevelopmental impairment (18/102(17.6%) vs 5/94 (5.3%); Odds Ratio (OR) 1.78, 95%confidence interval (CI) 1.60–1.99) compared to those without pSBI. Speech and language (13/102 (12.7%) vs 3/94 (3.2%); OR 1.41, 95% CI 1.29–1.56) and neuro-motor domains (11/102 (10.8%) vs 4/94 (4.3%); OR 1.38, 95% CI 1.22–1.58) were most commonly affected domains. Psychomotor scores from KDI tool were also significantly higher for those unexposed to pSBI for total scores compared to those exposed.ConclusionNeonatal pSBI (excluding cases of confirmed meningitis) caused significant neurodevelopmental impairment in children after adjusting for confirmed bacteraemia. This has important implications for improving prevention, supporting effective neonatal care and managing the long-term consequences of neonatal infection in resource-poor settings.

AimsIn Nepal, 1.94% of the population is reported to have disability. A lower standard of living is reported in households with a person with disability in both rural and urban Nepal.1 Little is known about the impact of neurodisability among children in Nepal. Our aim was to understand the impact of childhood neurodisability in Eastern Nepal.MethodsQualitative research was carried out among care-givers of 24 children (18 boys, 6 girls; mean age 8.3 y). Focus group discussions and interviews guided by structured questionnaire were employed. Thematic analysis of the data was carried out to identify the challenges of children with neurodisability.ResultsStudy participants had conditions ranging from cerebral palsy to rare neuro-degenerative conditions. They raised several issues, which were previously reported.2 The main challenges identified were difficulty in accessing appropriate and timely medical advice, financial and educational challenges, cultural beliefs and taboos that affect the child and the family, and the psychological impact of the illness on the children and caregivers. There is often delay in seeking medical advice and accessing care. Limited facility for medical treatment and therapy made it inaccessible at regular interval. Among the study group, 18 caregivers reported significant anxiety and fear about children’s future. Alcohol addiction, domestic abuse abandonment of a parent was reported in 4 families. Most families reported their children being treated differently by the community (19/23). Three families reported that the community positively supported their children.ConclusionOur data identified inadequate service provisions to support children with neurodisability and their families in Nepal. This is compounded by other factors- cultural and religious beliefs and financial constraints. A few families have identified culturally acceptable solutions to deal with some of the long-term challenges in their lives. These included alternative educational arrangements, home modifications and making separate financial provisions for the child.References. Eide AH, et al. Living conditions among people with disability in Nepal. Study Report2016.. Kuper, et al. The impact of disability on the lives of children; cross-sectional data including 8,900children with disabilities and 898,834 children without disabilities across 30 countries. PLoS One2014September 9;9(9).