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COVID-19 epidemic in Nepal is escalating with new cases/admissions at hospitals in recent weeks. The rise in cases is contributed by importation from India and has also led to an increase in the number of local/community transmission. While long-term lockdown can have devastating consequences in population, it is high time to consider the possibilities of exit strategies. The main objective of this piece is to explore the literature to lay out the possible measures for exit from the lockdown in Nepal. We used a descriptive review approach to compare and analyze the published academic and non-academic articles related to COVID-19 and lockdown until date. Post lifting plan should be in place as a roadmap to recovery. An exit strategy can be enacted effectively only when the community complies with new normal adjustments aided with effective public health measures and restrictions. Phase-wise measures should be employed while sudden loosening of restriction might result in detrimental effects.

The postnatal period (birth to 6 weeks of age) is a high-risk period for mothers and their newborns. Despite significant improvements in the Nepalese healthcare system over the last decade, there is still a high incidence of maternal and neonatal deaths during the postnatal period. These factors, in addition to existing socioeconomic barriers, discourage many women from returning to these facilities for postnatal care. This study therefore, aims to determine the extent of healthcare utilization among women with recent childbirth experience in the Mahalaxmi municipality in the Lalitpur district of Nepal. This study is descriptive cross-sectional needs assessment utilizing a pre-tested survey instrument administered to ninety-eight women who were randomly selected from the semi-urban Mahalaxmi municipality. All the respondents reported that they received ante-natal care during their pregnancy. A majority of the women reported that they received perinatal care from physicians. The results of the study showed that although there was a significantly high utilization of ante-natal and perinatal care among women with recent childbirth experience, most of the women were unaware of the availability or necessity of postnatal care, despite the accessibility of physicians and healthcare facilities.

Introduction: Unintentional injury is the biggest threat to the survival of the under-five children, which impact is immeasurable to families and often entire communities. The objectives of this study were to assess the prevalence of unintentional injuries among under-five children and the factors associated with it.Material and Methods: A facility-based quantitative cross-sectional study was conducted from August 2016 to January 2017. Multistage time frame convenient sampling method was applied to collect the data from 259 mothers of under-five children in the selected district of Mid-Western Development region of Nepal. The data was collected from 10 rural health facilities and two from urban setting using a semi-structured questionnaire. An analysis was performed using SPSS ver.15.Results: The prevalence of unintentional injuries was found to be 33.20 % among the under-five children. The present study showed that ecological belt, the age of mothers, education of mothers, education of fathers, the occupation of mothers, the occupation of fathers, family income quintiles, household type, numbers of a sibling, age and gender of children were significant factors associated with unintentional injuries among under-five children. More than 70% of the respondents were not aware of how to provide first aid care to the children with respect to unintentional injury.Conclusion: This study highlights the burden of unintentional injuries among under-five children in mid-western development region of Nepal. Intervention targeting multifactorial issues in line with all type of fall injuries, burns and injuries with the use of sharp objects might be helpful to tackle the problems.

Not available.Journal of Manmohan Memorial Institute of Health SciencesVol. 3, No. 1, 2017, page: 1-5

Many people and departments in higher education institutions and hospitals across the globe have objectives that include cross-national partnership working, internationalisation, capacity-building and sharing education and research. We find such commendable ideals at a global level in the Sustainable Development Goals (SDGs) to strategic plans of individual organisations from both low and high-income countries. Using a case-study approach this paper offers insights into some of the key practical issues around global partnership working. We use two case studies of a developing partnership between two separate higher education institutions from the United Kingdom (UK) and one from Nepal. To inform and guide others interested in developing global partnerships we highlight key the reasons for, considerations about, key procedures around the development of such Nepal-UK partnerships and key challenges. Journal of Manmohan Memorial Institute of Health SciencesVol. 3, No. 1, 2017, page: 94-100

Background: All over the world nearly 860,000 people are injured every day and 2.3 million deaths occur annually due to occupational accidents and work-related diseases.There are limited studies that specifically determine the knowledge of waste handlers on occupational health problems and associated factors of occupational health problems and injuries in waste handlersin context of Nepal. Therefore, this studyaimed to assess the knowledge of waste handlers on occupational health and safety practices and its association with utilization of PPEs along with the condition of occupational health problems and injuries and factors associated with them among the waste handlers of Kathmandu Metropolitan City. Methods: A descriptive cross-sectional survey was conducted among selected 355 solid waste collectors by using semi-structured questionnaire and observation checklist, which was completed from March 2016 to May 2016. The data was entered into SPSS 20 version for analysis and a chi-square test was performed to see the presence of the association between the dependent and selected independent variables. Results: Among total respondents (355) surveyed 51.5% had got knowledge on occupational health hazard, 16.1 % had got the knowledge to prevent from work-related health risks, 29% had got knowledge about PPEs and 31.5% had got knowledge about PPEs utilization. About 45.8% of the study participants had practices of the utilization of PPEs. Majority of the respondents i.e. 63.7% reported that they were suffering from occupational health problems. The evidence of the occupational health injuries was found to be low i.e. 25.4%. Similarly, variables which had significant influence on the occupational health problems were knowledge on occupational health hazard ( p =0.016), work experience ( p =0.021), health checkup ( p =0.042) and for the occupational health injuries were monthly income( p =0.036), knowledge to prevent from health risk ( p =0.001), gender ( p =0.02), and knowledge of occupational health hazard ( p =0.011), work experience ( p = 0.025), work type ( p =0.001), knowledge on PPEs ( p =0.034) and knowledge on work-related health risks ( p = 0.027). Conclusion: Based on this study, its recommended to improve occupational health and safety practices. Awareness programs need to be focused to increase the knowledge on Occupational health hazards and safety practices to improve the utilization of PPEs.. Journal of Manmohan Memorial Institute of Health Sciences Vol. 3, No. 1, 2017, page: 56-72

Background: On April 25, 2015 at 11:56 local time, a great earthquake of massive magnitude-7.8 trembler was experienced in Nepal. Along with the physical and economical loss, such disasters can have devastating consequences in adolescent’s mental health. The purpose of this study is to determine the prevalence of Post-Traumatic Stress Disorder and associated factors among adolescents after 2015 Nepal Earthquake.Methods: A total of 140 adolescents from grade 8, 9 and 10 of two higher secondary schools were recruited in this study. Post-Traumatic Stress Disorder CheckList-5 (PCL-5) of DSM-V criteria was used for the diagnosis of Post-Traumatic Stress Disorder. Chi-square test was used to assess the association.Results: Among 140 adolescents, the age range was 12 to 19 years with a mean age of 14.8 (SD=1.1) where 27.1% of the participants had Post-Traumatic Stress Disorder. A statistically significant association was found between Post-Traumatic Stress Disorder and grade (χ² = 9.324, p

Not available.

Tuberculosis (TB) is a major public health concern for Nepal like many other developing countries around the world. Economic barrier is one of the major problems in poor and marginalized population. Poor people mostly remain unaware of the treatment facilities and some find it difficult in seeking T.B treatment as they don’t trust the program and most of them don’t possess enough knowledge about the disease itself. Population residing in the remote areas of the countries can’t access the treatment facilities due to far distance of health facilities from there residence due to lack of roads and lack of transport. Thus difficult geography primarily in rural areas in the country acts as a barrier to access the health facility. TB infection faces add-on challenge with the advent of co-infection and possibility of increase in drug resistant TB. This is why detecting TB in its early stage would pose a number of advantages to the patient that would in turn help for early treatment. However, the challenges and barriers in early diagnosis remain that is being contributed by multifaceted factors. The lack of knowledge coupled with poor financial capacity to pay for the diagnosis especially in rural population prevents them from being diagnosed properly as well. Factors for not completing the treatment are when patient starts feeling better, lack of drugs, major side effects of the drugs and inadequate knowledge about advantages of completion of the drug treatment. The attitude of the hospital staff also in many cases leads to discontinuation of the treatment. Patient who have limited income and got financial support from their relatives explained about treatment going above their obtainable resources leading to early withdrawal from the treatment completion. Geography is one of the important issues for treatment completion as routine drug administration follow up in patient (farther from particular distance) is difficult and leads to exhaustion and withdrawal from the treatment.Journal of Manmohan Memorial Institute of Health Sciences Vol. 2 2016 p.76-80

Background: Nepal introduced Tobacco Products (Control and Regulatory) Act in 2011. This act has mandatory provision of enlarged graphical health warning in Nepali language on at least 75% area on the package of all the tobacco products. This study examined the perception of cigarette graphic health warnings and smoking habits among current smokers.Methodology: This is a cross-sectional study conducted in Butwal sub-metropolitan city in Rupandehi district of Nepal. Among 19 wards of the sub-metropolitan city, four wards were selected randomly by computer-generated codes. Enumerators purposively selected 10 shops from each ward, then recruited every third cigarette buyer from each shop to make a total of five. Smoking status was ascertained by asking if they had ever smoked in last thirty days. We approached 200 people, of whom 40 (20.0%) didn’t agree to participate and 10 (5.0%) didn’t smoke currently. Thus, information from 150 current smokers was finally included in the analysis.Results: Nearly 71% of respondents said they would smoke even if the price of cigarette was doubled. Similarly, 55.3% reported that they had intention to quit smoking, followed by 62.0% agreeing on taxation of cigarette and tobacco products is essential. Nearly 81% said it is necessary to keep health warnings in the package of cigarette. About 87% knew that the Government of Nepal has introduced some regulations to control tobacco products. Nearly 80% of respondents had heard of new provision on enlarged graphic health warning on cigarette packages. More than one-fourth (26.7%) had reduced the frequency of smoking since they started using packages with enlarged graphic health warning.Conclusion: Majority had heard of graphic health warning on cigarette packages. Greater than a half of the respondents had intention to quit smoking, and nearly two-third identified taxation as important means to control smoking. A quarter of respondents reported that they forewent smoking after they started using new packages with enlarged graphic health warning. Further research on impact of graphic health warning on smoking levels through repeated cross sectional studies can be the future research priority.

For decades the maternal mortality in Nepal was the lead cause of death among women, with serious improvements in the maternal mortality ratio in the twentieth century the second most common cause has become more prominent. Suicide is now one of the leading causes of death for women of a reproductive age in Nepal. This scoping review brings together the key available literature to identify the causes of suicide among women in Nepal. Published and unpublished studies and the grey literature published on women and suicide related to Nepal between 2000 and 2014 were searched and included in this review. This review suggested a number of explanations for high rate of suicide among women including: partner violence, alcoholism and polygamy, the culture of silence, early age marriage and prolonged child bearing and dependency on men for financial security. This paper highlights some challenges and suggests ways forward in the improvement of mental health in Nepal.DOI: http://dx.doi.org/10.3126/jmmihs.v1i4.12001Journal of Manmohan Memorial Institute of Health Sciences Vol. 1, Issue 4, 2015Page: 43-49

DOI: http://dx.doi.org/10.3126/jmmihs.v1i2.9902 Journal of Manmohan Memorial Institute of Health Sciences Vol.1(2) 2013; 3-11

The aftermath of the Nepal earthquake brought substantial population displacements and change in environmental situation exposing the vulnerability to the existing pathogens for the transmission. There was huge panic at the individual level and media towards the possible epidemic aftermath the recent disaster. Meanwhile, Nepal has faced this sort of problem after eighty two years (1ast biggest earthquake in 1990 BS) and the lack of the knowledge transfer was evident to cope up with the situation. There are documented evidences that injuries and deaths during shortly after natural disaster are associated with injuries and high risk of infectious disease transmission with possible outbreak shortly after the disaster. In Nepal, the aftermath of earthquake resulted complete destruction of 392 health facilities and 531 were partially damaged. The functioning of these facilities was severely compromised. The disruption of the health programs (diseases prevention and control activities, immunization, vector control) further pose the threats towards increase risk of infectious diseases transmission and outbreaks following the earthquake. The risk of the disease outbreak was associated with the prolonged after effect of the disaster. These after effect included displaced populations, environmental changes, increasing the breeding sites of the vectors, high exposure to and proliferations of disease vectors (rodents, mosquitoes and flies), unplanned and overcrowded temporary shelters, polluted water and poor sanitation, poor nutritional status and poor personal hygiene, low level of immunity to vaccine preventable diseases. There was prediction of possible disease outbreak aftermath the present earthquake in Nepal however prompt health action accompanied with sound disease surveillance measures carried out by Epidemiology and Disease Control Division (EDCD) with the technical guidance of Chinese Medical Team took the situation under control. The collaboration between the national health system, international experts and academic institutions played vital to prevent the outbreak of disease after the recent disaster. The main causes of communicable diseases aftermath the disaster include: presence of pathogens, displacement of population, change in environment, disruption of basic public utilities, lack of basic health services and food shortage etc. The following protocol was devised to prevent the outbreak of disease after the recent earthquake: Assessment of the diseases in the disaster area Collection and analysis of the health and disease burden in the disaster area Communication of information about disease Early investigation Reporting of disease Report analysis and evaluation Monitoring of disease The following preventive and control measures were taken on an immediate basis to avoid the spread of communicable diseases following the recent earthquake: water safety, medical services, early warning system, vector control and health promotion measures. Under the leadership of EDCD and National Health Research Council the Chinese Medical Team supported the epidemic investigation and rapid response activities. The team conducted the rapid assessment of the temporary settlements in the affected areas and collected the necessary health and disease related information. Meanwhile the hospital based disease surveillance was carried out to monitor the disease situation. There was high risk of the water contamination aftermath the epidemic hence the water surveillance was done. The water purification and health promotion activities were simultaneously carried out in the hard hit areas. Environmental disinfection was carried out in the areas were human corpse, chicken and cattle decayed and polluted the environment. The multidisciplinary teams incorporating the medical doctors, epidemiologists, public health workers, environmentalist, heath educators, medical laboratory professionals and social workers were deputed. The epidemic investigation and rapid response activities were continued soon after the earthquake till the end of the May 2015. The activities were carried out considering the post-impact phase (4 days to 4 weeks) when the first waves of infectious diseases (water-borne infections, food-borne or air-borne) epidemic might occur. Infectious disease transmission or outbreaks may be seen days, weeks or even months after the onset of the disaster. Hence the disease outbreak control activities need to be carried out continually to prevent the future epidemic. It’s hard to predict the disaster. Not only in Nepal, natural disasters can result at any time in any part of the world causing heavy loss of human life and damage infrastructure and human assets. Usually natural disasters cannot be stopped. The magnitude of disasters can be reduced if preventive measures be taken in due time for which pragmatic government policies with immediate response and public awareness are of utmost importance. The speed of action is vital in responding to emergencies. It is very important that immediate action is taken to control outbreaks, treat the people who are affected as well as raise awareness about the disease.

Mental health has historically been neglected both in the developed and developing world. It was not included in the Millennium Development Goals, the global targets for the developing world's fight towards better health and development. However, over the past couple of years, it is increasingly recognised as an important public health concern and calls have been made for its inclusion in the post-2015 sustainable development goals. The 66th World Health Assembly, consisting of Ministers of Health of 194 Member States including Nepal, adopted the WHO's Comprehensive Mental Health Action Plan 2013-2020 in May 2013. Policies surrounding healthcare have often focused on the physical wellbeing of people without considering their psychological health. This is despite studies showing that mental health problems account for 14% of the global burden of disease. Though this is a global phenomenon there are disparities between Nepal's provision of medical resources towards this area of healthcare. Language: en

Introduction: Post dural puncture headache occurs as the cerebrospinal fluid leaks out from the breach that the needle has made in the dura. The incidence of Post Dural Puncture Headache (PDPH) is a common complication after spinal anesthesia. The objective of our study is to find out incidence of PDPH in patients undergoing surgery under spinal anesthesia in Dhulikhel Hospital. Methods: 120 patients who underwent spinal anesthesia were selected for the study. Questionnaire was used to assess the post dural puncture headache 24 hours after surgery. Headache, if present in frontal or occipital areas which increased when sitting or situational movement and relieves by lying in flat position were considered as PDPH. Results: PDPH was observed in 25% of the patients. The incidence of PDPH is 30% and 70% in male and female respectively. It was 2.33 times more in age group 18-30- years than 31-45 years. Conclusions: The incidence of PDPH was high in female and age group 18-30 years. The incidence of PDPH is high when the bevel is transverse to the dural fibers. Keywords : Bevel direction; incidence; post-dural puncture headache; spinal anesthesia DOI: http://dx.doi.org/10.3126/joim.v32i2.4942 Journal of Institute of Medicine , August, 2010; 32: 30-32

Introduction: WHO defines low birth weight (LBW) as a birth weight less than 2500 grams. Almost a third of the newborn in South East Asia Region is a low birth weight baby. Many risk factors contributing to LBW have been recognized, which in order of importance are low maternal weight, low maternal hemoglobin, low maternal height, primi-parity, adolescent mother and poor or inadequate maternal nutrition during pregnancy. Low birth weight babies have a higher risk of morbidity and mortality than an infant of normal birth weight. The present study was carried out to explore the associated risk factors of low birth weight which will be beneficial to undertake effective measures to reduce the burden of the low birth weight. Methods: This was a hospital based case control study conducted in Dhulikhel hospital, Kavre, Nepal from Jan 1st 2008 to 30th May 2010. A total of 401 cases and an equal number of age matched controls were taken to assess the different risk factors of the mother for LBW babies. Ethical approval for the study was taken from KUSMS-Institutional research committee. Data analysis was done using SPSS version 10.0. Results: Data of 401 LBW and equal number of normal birth weight babies were analyzed. The incidence of LBW in this study was 11.07%. LBW was more common in female (n=236) than in male (n=165) babies. However this difference was statistically insignificant. Among the case and the control group, maternal hemoglobin (p

The corrected PDF for this article was loaded on 07/02/2011. Background: Children contribute a significant proportion of the tuberculosis (TB) burden in Nepal and suffer severe TB related morbidity and mortality, particularly in endemic areas. Diagnosis and management of pediatric TB especially Extra pulmonary TB (EPTB) is challenging. Objectives: The present study was designed to study clinical, laboratory characteristics and outcome of childhood tuberculosis. Methods: A prospective analysis of 60 cases of TB children within three years period was conducted at Pediatric Department, Dhulikhel Hospital and followed up till child completely recovered. Results: In the present study 60 children had clinical and lab evidence of tuberculosis and received anti tubercular therapy. Extra pulmonary tuberculosis was common (78.3%) than pulmonary tuberculosis (21.6%). BCG scar was absent in eight (13.33%) and absent BCG vaccination was significantly associated with disseminated TB (p

DOI: 10.3126/kumj.v7i3.2722 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 194-195