Purpose: Discharge against medical advice (DAMA), leave against medical advice (LAMA), and self discharge have been used in similar circumstances to mean abandoning the physician's advice and deciding to leave the hospital abruptly without caring about possible outcomes. It is a sensitive issue common in NICUs across the developing world. To decrease NMR and under-5 mortality further, it is important to explore the factors leading to DAMA. Hence, this study aims to find the prevalence of DAMA, its causes, and related socio-demographic factors. Patients and Methods: A cross-sectional descriptive study was conducted in the NICU of College of Medical Sciences Teaching Hospital located in central Nepal from June 2019 to May 2020. Out of 110 cases of DAMA during the study period, 105 cases gave consent to participate in the study. Medical data were recorded from patient records followed by filling out of a semi-structured questionnaire by parents of the patients. Results: Out of 611 cases admitted to the NICU during the study period, 110 neonates (18%) were self-discharged. The leading cause for parents to take such a decision was poor financial condition (58%), followed by lack of improvement (21%). Conclusion: The study showed that DAMA in the NICU was 18%. Poor financial condition followed by lack of improvement in patient's condition were the main reasons for selfdischarge.

Introduction: Acute respiratory infection is a major cause of mortality and morbidity among under-five children in developing countries. Children under five years of age are most vulnerable to various common but treatable conditions. The objective of this study is to find the prevalence of acute respiratory infections among under-five hospitalized children in a tertiary hospital of central Nepal. Methods: This was a descriptive cross-sectional study conducted in a tertiary hospital of Nepal from January 2018 to December 2019. Ethical approval was taken from the Institutional review committee (Reference No: 2020-073). Convenience sampling technique was used. Data was entered in the Microsoft excel sheet, then extracted and analyzed in the Statistical package of Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage and presented in tables and figures. Results: Among 660 children in our study, the prevalence of acute respiratory infection among hospitalized under-five children was 242 (36.67%) (32.99-40.34 at 95% Confidence Interval). Fever and cough were the most common presenting complaints among these children seen in 196 (81%) and 185 (76%) respectively. Stunting and wasting were seen in 37 (15%) and 26 (10.7%) of these children with acute respiratory infection while 6 (2.5%) of them were found overweight. Conclusions: Acute respiratory infection is the most common reason for hospital admission among children under five years of age and the prevalence was high as compared to the standard study. The chief complaints are fever and cough.

Introduction: Febrile seizure is the commonest cause of seizure in children and appears mostly between 6-60 months of life. The objective of this study is to find out the prevalence of febrile seizure among hospitalized children of a tertiary centre of Nepal. Methods: This is a descriptive cross-sectional study conducted in a teaching hospital of central Nepal, from 2014 January to 2019 December. After obtaining ethical clearance from Institutional Review Committee (Reference number: 2019-038), clinical and demographic data was retrieved from patient record retrospectively and reviewed for completeness and accuracy; those fulfilling the definition of febrile seizure were enrolled in the study. Convenience sampling technique was used. The data was analyzed using Statistical Packages for Social Sciences Version 25. Point estimate is done at 95% Confidence Interval and frequency and proportion was calculated. Results: Out of 4890 cases admitted during the study period, 214 (4.37%) (3.80%-4.94% at 95% Confidence Interval) children were diagnosed with febrile seizure. One hundred thirty one (62%) children had a simple febrile seizure. In majority of the cases, seizure lasted for less than 5 minutes; however, 10 (4.6%) of them presented with febrile status epilepticus, 111 (52%) children had generalised tonic seizure and upper respiratory tract infection was the commonest cause of fever. Conclusions: Prevalence of febrile seizure is significant among hospitalized children and simple febrile seizure is the commonest type. A substantial number of children present in febrile status epilepticus, even though the duration of febrile seizure is brief in most of the cases.

Background Advantages due to immunization are numerous and cannot be avoided but at the same time pain inflicted on babies needs to be addressed when possible. Pain associated with immunization injections has often been overlooked when remedies are available. Objective To find out the effect of breastfeeding on relieving pain during immunization injection in infants. Method An experimental study was conducted at Immunization clinic of B.P. Koirala Institute of Health Sciences (BPKIHS). Total 124 subjects were divided randomly into two groups. Experimental subjects were allowed to breastfeed for 5-10 minutes before immunization while control group was immunized without breastfeeding. Interview Questionnaire was used to obtain demographic variables and measurements were obtained. Measures of pain was recorded using duration of cry and Modified Behavior Pain Scale, by Taddio et al. Data was analyzed by using SPSS 20.0 where variables were assessed with frequency tables, Pearson’s Chi-Square test, independent t test and Mann Whitney U test. Result The mean pain score in experimental group was 7.10 and in control group 7.56 which was statistically significant (p=0.001). The median duration of cry was significantly shorter in experimental group i.e. 25 seconds (IQR: 20-30) than control group 42.5 seconds (IQR: 30-61.5) (p < 0.001). Conclusion Breastfeeding before immunization is effective in reducing pain in infants.