Search

Background: In rural Nepal, poor road and transport networks and few testing laboratories impede tuberculosis diagnosis. A drone transport system was established to transport sputum samples to laboratories with advanced molecular diagnostic machines – GeneXpert MTB/RIF. This study explored the perceptions of using drones for tuberculosis diagnosis among community stakeholders, female community health volunteers, and healthcare providers from communities with drones implemented and without drone programs. Methods: In December 2019, we conducted focus group discussions in two drone-implemented and three without drone programs. We purposively selected 40 participants: Female community health volunteers (n=16), community stakeholders (n=18), and healthcare providers (n=6). Focus group discussions employed semi-structured questions, which were audio-recorded, transcribed, and translated into English. Codebook thematic analysis was performed and charted using three levels of the socioecological model: individual, community, and health system. Results: We identified four themes (i) Trust in drones underpins successful use for tuberculosis diagnosis; (ii) Drone-based sample transport optimised connectivity and accessibility for people with tuberculosis and healthcare providers; (iii) Drones create opportunities to improve community and health system, and (iv) External factors impede the use of drones to facilitate tuberculosis diagnosis. The study reported, at an individual level, people's trust in drones mainly through community-based events. For local healthcare providers, drones reduce transport time, opportunity costs, and immediate cash costs of transport. At the community level, drone use creates opportunities to increase the skills of local people as drone pilots. At the health system level, drone transport increases efficient sputum sample delivery and provides opportunities to transport medicines and other biomedical samples. Perceived challenges of using drones were adverse weather, limitations in skilled human resources, and financial resources to operate drones sustainably. Conclusions: Healthcare providers, female community health volunteers, and community stakeholders reported high levels of trust in drones and perceived their use for tuberculosis diagnosis and care to substantially benefit people with tuberculosis and providers in rural Nepal. There was a high level of demand for application to other healthcare services and wider geographical coverage, demonstrating drones as a potential tool for enhancing access to healthcare in geographically remote communities. [ABSTRACT FROM AUTHOR]

The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in the study design (e.g. cross-sectional vs longitudinal) can generate different estimates making the design and impact evaluation of socio-economic protection strategies difficult. The objective of the study was to compare the socio-economic impacts of TB estimated by applying cross-sectional or longitudinal data collections in Nepal. We analysed the data from a longitudinal costing survey (patients interviewed at three time points) conducted between April 2018 and October 2019. We calculated both mean and median costs from patients interviewed during the intensive (cross-sectional 1) and continuation (cross-sectional 2) phases of treatment. We then compared costs, the prevalence of catastrophic costs and the socio-economic impact of TB generated by each approach. There were significant differences in the costs and social impacts calculated by each approach. The median total cost (intensive plus continuation phases) was significantly higher for the longitudinal compared with cross-sectional 2 (US$119.42 vs 91.63, P  < 0.001). The prevalence of food insecurity, social exclusion and patients feeling poorer or much poorer were all significantly higher by applying a longitudinal approach. In conclusion, the longitudinal design captured important aspects of costs and socio-economic impacts, which were missed by applying a cross-sectional approach. If a cross-sectional approach is applied due to resource constraints, our data suggest that the start of the continuation phase is the optimal timing for a single interview. Further research to optimize methodologies to report patient-incurred expenditure during TB diagnosis and treatment is needed. [ABSTRACT FROM AUTHOR]

Breast malignancy is the most frequent carcinoma among females across the world and third-most in Nepal. Early diagnosis of breast cancer through breast health awareness and self-examination, in addition to mammography screening, is a highly feasible and useful technique in poorly resourced settings. However, their intentions, whether to modify behaviors or actions, remain debatable and less explained in the literature. So, we aimed to assess how long an educational intervention affects women's intention to do a breast self-examination (BSE) and mammography screening. After assessing feasibility, one ward was assigned to the intervention (IG; ward number 30) and control group (CG; ward number 33), and then with inclusion criteria, a total of 360 females (180 each in IG and CG) aged 40–75 years enrolled in the study. After the baseline assessment, participants in the IG were delivered an hour-long breast cancer screening-related lecture-discussion- demonstration session that included BSE and mammography, aided with a silicone dummy. The session was carried out by the female trained nurses. Outcome data were obtained at the baseline, 4, 8, and 12 months following the intervention. Attitudes, perceived behavioral controls (PBCs) and behavioral intents (BIs) of both mammography and BSE at baseline were similar in both IG and CG except in case of subjective norms (SNs). Intents of BSE remained effective for 4 months, whereas for mammography, it was effective only at 4 and 12 months. Moreover, attitudes toward both tests remained intact for 4, 8, and 12 months (p = <.05) consistently. With regards to PBCs, women having good control remained only for 4 months in both screening tests. Further, regarding SN, significant mean changes were observed at 4 and 12 months in BSE, and only at 4 months in mammography screening. The session was effective in sustaining BSE and mammography intentions for at least 4 months. To retain the effects longer (up to 12 months), additional educational strategies focusing on subjective norms and perceived behavioral controls of both tests are highly warranted. [ABSTRACT FROM AUTHOR]

The 2015 Gorkha earthquake was one of the most devastating earthquakes in Nepal in this century. Postdisaster reconstruction is a complex and highly challenging process, especially concerning developing countries like Nepal, as it involves several well-coordinated plans and working activities. Due to the large scale of devastation, the Nepal government created a separate body, the National Reconstruction Authority (NRA), to manage and oversee recovery and reconstruction activities. This paper briefly discusses organizations typically involved in postdisaster reconstruction processes and the multifaceted roles they play. Document analysis on research papers, collected reports from the NRA, governmental departments, and many other organizations involved in the reconstruction was carried out. This study provides a comprehensive review of the reconstruction process after the 2015 Gorkha, Nepal, earthquake, whereas previous studies have covered a specific issue. The reconstruction works are presented structurally in detail. Similarly, the crucial steps and lesson learned for managing expectations and building back better are highlighted. This study may help to develop effective organization and policies in future postdisaster reconstruction. [ABSTRACT FROM AUTHOR]

An earthquake of moment magnitude (Mw) 7.8, the largest in the last 80 years, struck central Nepal on April 25, 2015. Named the Gorkha earthquake, it wreaked havoc on the country's central region, affecting 32 of 77 districts. The earthquake impacted nearly a million private houses, thousands of educational infrastructures, hundreds of health facilities, myriad cultural heritages and many other infrastructures. The National Reconstruction Authority (NRA) was established to lead the post-earthquake recovery and reconstruction and complete it within five years. This paper presents details of the earthquake's effects, the early response and the status of the post-earthquake reconstruction progress five years after the earthquake. Official reports from Nepalese government institutions, national and international authorities, government databases and research papers on the Gorkha earthquake were reviewed. The numbers of various infrastructures reconstructed and under construction each year after the earthquake and the reconstruction processes adopted are presented. The results show that 67% of private houses, 74% of educational institutions and 58% of health facilities were reconstructed in the five years. [ABSTRACT FROM AUTHOR]

Purpose: This study assesses the inclusion of disability in Nepal's policy and guidance relevant to water, sanitation and hygiene (WASH), and menstrual hygiene management (MHM) in comparison to gender. We investigated both policy formulation and implementation, using the Kavrepalanchok district as a case study. Materials and methods: We used the EquiFrame framework, adapted for disability and gender, and focusing on WASH and MHM. Ten Nepali policies and guidance documents were reviewed and scored for quality against the framework, which included 21 core concepts of human rights. We also interviewed key informants to consider the inclusion of disability in the implementation of MHM interventions. We applied stratified purpose sampling to 12 government officials and service providers working in Kathmandu and the Kavrepalanchock district; conducted in-depth interviews and analysed data thematically using Nvivo 11. Results: Disability was inadequately covered within the policy documents, and MHM policy commitments for disability were almost non-existent. Participation of people with disabilities in policy development was limited; within Kavrepalanchok, policy commitments were not implemented as intended and disability service providers were unable to allocate government resources. Inadequate data on disability and MHM resulted in limited professional understanding of the issues, as service providers had no training. A narrow WASH infrastructure approach to improving MHM for people with disabilities was prioritised. MHM interventions were delivered in schools; these failed to reach children with disabilities who are often out of school. Finally, there were indications that some caregivers seek sterilisation for people with disabilities who are unable to manage menstruation independently. Conclusion: Though the Constitution of Nepal enshrines gender equality and disability inclusion, there are consistent gaps in attention to disability and MHM in policies and practice. These omit and exclude people with disabilities from MHM interventions. Investment is required to generate evidence on the MHM barriers faced by people with disabilities, which would then be drawn on to develop training on these issues for professionals to improve understanding. Subsequently, policy makers could include more concepts of human rights against disability in relevant policies and service providers could implement policy commitments as intended. [ABSTRACT FROM AUTHOR]

Utilising data from Nepal Demographic and Health Survey from 1996-2016 and some landmark verdicts of the Supreme Court on reproductive rights since the early 1990s, this article evaluates the pace of continuity and change in women's health status, particularly of reproductive rights of women. Thus, this study aims to identify sociocultural factors that influence women's health, particularly their reproductive health. Although in the last few decades, Nepal has made substantial achievements in reproductive health service delivery and reduction of childhood mortality, however, performance is rather slow in achieving nutritional and health seeking behaviour. for family planning services, elimination of harmful and discriminatory practices that influences on girls and women's health adversely. The Supreme Court of Nepal through its series of verdicts has greatly contributed to safeguarding women's reproductive health progressively, although the full implementation of these landmark verdicts has yet to be materialised. Key findings of this analysis show that health remains gendered in Nepal, from childhood. A major breakthrough could be possible only by removing the social determinants of women's health. [ABSTRACT FROM AUTHOR]

An echocardiographic investigation is one of the key modalities of diagnosis in patients suffering from COVID 19, especially if they are elderly, have associated comorbid conditions, and pregnant. Hence, it is becoming extremely essential to look into the correct safety precautions, health-care professionals must take while conducting an echo investigation. At the same time, a focused echo examination aimed at correct imaging view acquisition in the shortest possible time is the need of the hour. The decision matrix formulated for conducting an echocardiographic evaluation is based on the presence or absence of cardiological comorbidity vis-a-vis positive or suspected for COVID- 19. The safety measures and image acquisition have been constructed keeping in mind the current safety precautions by the World Health Organization, the Centers for Disease Control and Prevention, and the Ministry of Health and Family Welfare, India. [ABSTRACT FROM AUTHOR]

Most of the rural people of Nepal use fuelwood for cooking and space heating in residential sector. Government of Nepal has announced to make Nepal as a smokeless country by replacing traditional cookstoves. Two pot mud improved cookstove is one of the most promoted cookstoves in the context of Nepal. There is a need to study the effects of different parameters on mud improved cookstove for its better performance. The objective of this work is to study the effect of variation of different parameters on two pot mud ICS and identify parameters for its better performance. Power test of cookstove, specially focusing on thermal efficiency, has been performed by changing different parameters. Effect of varying fuel feeding rate, chimney height, opening area of air fuel inlet, inlet area of interconnecting tunnel, combustion chamber height, grate height and insulating material on thermal efficiency have been studied individually. Then cookstove has been developed by different best combinations such as a) geometrical parameters b) use of grate and insulations in best geometrical parameters and formation of channel on the opening. Thermal efficiency of modified cookstove increased from 18% to 25.6%; i.e. the increment of 7.60%. Economic analysis of different thermal efficiencies cookstove has been performed. [ABSTRACT FROM AUTHOR]

Environmental Impact Assessment (EIA) is a planning tool which enables decision makers to accept environmentally friendly projects and reject environment damaging projects or their certain components. EIA has been mandatory in Nepal since the enactment of Environment Protection Act in 1997. Usually in Nepal, EIA is done for a project late in the project cycle after many important decisions on design and locations have already been made. While in case of government sponsored projects, EIA has remained as 'pro forma' compliance with government's legal requirements. This paper analyses outputs of approved EIA of a mega infrastructure project "Second International Airport Project" which government wants to implement despite of protests by conservationists, and environmental and social activists. There are technocratic problems in EIA Report such as informational weaknesses, insufficient analysis of impacts, and inadequately proposed mitigations measures. It indicates political influence on EIA. This paper suggests making policy decision on size and nature of an international airport and its facilities, alternative locations avoiding ecologically sensitive area, and source of funding. It proposes to conduct a comprehensive Environmental and Social Impact Assessment (ESIA) complying with national and international environmental and social safeguards, before making any decision to fell trees. [ABSTRACT FROM AUTHOR]

With fewer than 200 tigers (Panthera tigris tigris) left in Nepal, that are generally confined to five protected areas across the Terai Arc Landscape, genetic studies are needed to provide crucial information on diversity and connectivity for devising an effective country-wide tiger conservation strategy. As part of the Nepal Tiger Genome Project, we studied landscape change, genetic variation, population structure, and gene flow of tigers across the Terai Arc Landscape by conducting Nepal’s first comprehensive and systematic scat-based, non-invasive genetic survey. Of the 770 scat samples collected opportunistically from five protected areas and six presumed corridors, 412 were tiger (57%). Out of ten microsatellite loci, we retain eight markers that were used in identifying 78 individual tigers. We used this dataset to examine population structure, genetic variation, contemporary gene flow, and potential population bottlenecks of tigers in Nepal. We detected three genetic clusters consistent with three demographic sub-populations and found moderate levels of genetic variation (He = 0.61, AR = 3.51) and genetic differentiation (FST = 0.14) across the landscape. We detected 3–7 migrants, confirming the potential for dispersal-mediated gene flow across the landscape. We found evidence of a bottleneck signature likely caused by large-scale land-use change documented in the last two centuries in the Terai forest. Securing tiger habitat including functional forest corridors is essential to enhance gene flow across the landscape and ensure long-term tiger survival. This requires cooperation among multiple stakeholders and careful conservation planning to prevent detrimental effects of anthropogenic activities on tigers. [ABSTRACT FROM AUTHOR]

Nepal is heavily dependent on the traditional energy sources and imported fossil fuel, which has an adverse impact on the environment and economy. Renewable energy technologies promoted in the country are regarded as a means of satisfying rural energy needs of the country for operating different rural end-uses. In this context, this article is prepared to investigate energy alternatives to pump drinking water in one of the remote rural village of Nepal, which has no means of running water source. Analyses in this article are based on the formulation of three technical scenarios of water pumping using petro-diesel, jatropha-based biodiesel and solar photovoltaic pumps. The technical system design consists of system sizing of prime mover (engine, solar panel and pumps) and estimation of reservoir capacity, which are based on the annual aggregate water demand modelling. With these investigations, detailed financial modelling is carried out in a spreadsheet to compare the alternatives on the basis of the economic parameters; net present value, equivalent annualised cost and levelised cost of water pumping. Analysis is carried out considering different influential parameters; water head, discharge, incentives on the investments, which have effects on the cost of pumped water. Likewise, in case of biodiesel-based system, different yield rate of jatropha plants is also considered in estimating the cost of producing biodiesel. It is found that for operating a biodiesel-based pumping system for the study area, the levelised cost of pumping 1 L of water is higher than that of a solar pump and even higher when compared with diesel, if the seed yield per plant is less than 2 kg and without subsidy on the investment cost of cultivation and processing. With the productivity of 2.5 kg/plant, a biodiesel-based system is more attractive than that of the diesel-based pump, but still remains more expensive than that of solar pump. From the technical perspective (reliability and easiness in operation) and economic evaluation of the technical alternatives, solar pumping system is found to be the most viable solution to pump drinking water in the project area. [ABSTRACT FROM PUBLISHER]

Background: Blastocystis sp. is a common intestinal parasite found in faecal sample surveys. Several studies have implicated human-to-human, zoonotic and waterborne transmissions by Blastocystis sp. However, there has been no study providing evidence interlinking these three transmissions in a community. We have previously shown a high prevalence of Blastocystis sp. subtype 4 amongst village dwellers in Bahunipati, Nepal, and the present study extends the observation to assess if the same subtype of Blastocystis sp. occurs in animals they rear and rivers they frequent. Methods: Faecal samples were collected from 65 animals. Four river water samples were collected from two rivers. Faecal samples were examined using in vitro cultivation. Blastocystis sp. from animal faecal and river samples were genotyped using seven subtype-specific sequence tagged site (STS) primer-polymerase chain reaction (PCR). Results: Blastocystis sp. infected 15.4% animals with subtype 4 being the predominant genotype (40.0%). Both rivers were contaminated with Blastocystis sp. subtype 1 and subtype 4, which were also detected in humans living in the same village in our previous study. Blastocystis sp. subtype 4 that was detected in buffalo and pigs was also found in the respective family members that reared these animals. Conclusions: This unusually high prevalence of Blastocystis subtype 4 found in village dwellers was also found to be pervasive in the animals they reared and the rivers they frequented implying a strong possibility of waterborne zoonosis for Blastocystis sp [ABSTRACT FROM AUTHOR]

Trafficking in girls and women for sexual exploitation has a long history in Nepal. Its magnitude, processes and factors leading to trafficking have changed with the growing phenomena of urbanization, Nepal's entry in the world labour market for carpet industry, armed conflict and the emergence of foreign labour market opportunities for Nepali youth especially after 2000. Utilising secondary data from different sources and narratives of the trafficking survivors, this article aims to critically review the contemporary trafficking situation in Nepal and Government's and civil society's efforts to combat trafficking and identify the new areas of concerns and gaps to combat trafficking in girls and women. [ABSTRACT FROM AUTHOR]

In rural and low-income urban households, energy is 'women's business': women are responsible for providing energy, and use it for domestic chores and productive activities. However, the poor quality fuels many women use contribute to their time poverty, ill health, and level of drudgery. Despite these negative impacts, energy policy remains gender-blind. This can be attributed to the invisibility of women's needs to energy planners, stemming from a lack of appropriate gender-analysis tools to meet the particular data requirements of the energy sector. This article analyses why standard gender tools do not provide appropriate gender-disaggregated energy data, and describes a set of tools that have been developed for that purpose. The paper concludes with an evaluation of recent experiences testing the tools in Pakistan, India, and Nepal. [ABSTRACT FROM AUTHOR]

Background: The pathophysiology underlying acute mountain sickness (AMS) and excessive hypoxemia at high altitudes is not fully understood. Previous work by our group has demonstrated a significant association between urinary measures of dehydration and bicarbonate retention in subjects developing excessive hypoxemia and AMS at high altitudes. To further characterize these findings, we returned to our original testing site to examine the hypothesis that subjects with lower levels of oxygen saturation and/or AMS would possess higher levels of venous bicarbonate. Methods: Medical history inquiry, clinical examination. Lake Louise scoring, and the collection of venous levels of bicarbonate concentration and base excess were performed on 52 lowland-dwelling persons after they completed a religious pilgrimage in the Nepal Himalayas to approximately 4,250 m. Results: Oxygen saturation levels were strongly and inversely correlated with serum levels of venous bicarbonate and base excess, whereas AMS and Lake Louise scores were not associated with these measures of alkalosis. Conclusions: Our data suggest an association between measures of serum bicarbonate anion retention and decreasing oxygen saturation. Our data do not demonstrate an association between AMS or Lake Louise scores and measures of serum bicarbonate level. We propose that excessive hypoxemia at high altitudes may be associated with a compromised ability of the kidney to metabolically compensate for an altitude-induced hypocapnic alkalosis. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex (MTBC) in humans and animals. Numbers of multi drug resistance TB (MDR-TB), extrapulmonary TB (EPTB) and zoonotic TB cases are increasingly being reported every year in Nepal posing a major public health problem. Therefore, the Government of Nepal should act immediately to strengthen the screening facilities across the country to be able to identify and treat the TB infected patients as well as detect zoonotic TB in animal species. Endorsement of One Health Act by the Government of Nepal is an opportunity to initiate the joint programs for TB surveillance among human and animal species using one health approach to reduce the TB burden in Nepal. [ABSTRACT FROM AUTHOR]

Background Hepatitis E causes a significant burden of disease in developing countries and has recently been increasingly recognized in developed countries. Comparing population anti-hepatitis E virus (HEV) seroprevalence across populations has been difficult. Objectives The aim of this study was to compare the anti-HEV IgG seroprevalence in both adults and children in three hyper-endemic areas (Nepal, Bangladesh and southwest France) using a sensitive, commercial anti-HEV IgG assay. Study Design Serum or plasma from adults and children in Nepal (n=498), Bangladesh ( n = 1,009) and Southwest France ( n = 1031) were tested for anti-HEV IgG using the Wantai assay. Results After age-standardization, anti-HEV IgG seroprevalence was 47.1%, 49.8% and 34.0% in Nepal, Bangladesh and southwest France, respectively. There was no difference in seroprevalence by gender in any of the countries. A paucity of infections in children 1–10 years-old was consistently observed (less than 15%) at all 3 locations. Conclusions Surprisingly similar high rates of anti-HEV antibodies were detected using a common, sensitive assay. Despite differences in the epidemiology and circulating genotype of HEV in Nepal, Bangladesh and southwest France, this study found more similarities in population seroprevalence than expected. [ABSTRACT FROM AUTHOR]

Abstract: In energy dependent economies, energy consumption is often linked with the growth in Gross Domestic Product (GDP). Energy intensity, defined herewith, as the ratio of the total primary energy consumption (TPE) to the GDP, is a useful concept for understanding the relation between energy demand and economic development. The scope of this article is to assess the future primary energy consumption of Nepal, and the projection is carried out along with the formulation of simple linear logarithmic energy consumption models. This initiates with a hypothesis that energy consumption is dependent with the national macro-economic parameters. To test the hypothesis, nexus between energy consumption and possible determinant variables are examined. Status of energy consumption between the period of 1996 and 2009, and for the same period, growth of economic parameters are assessed. Three scenarios are developed differing from each other on the basis of growth rates of economic indicators: total GDP, GDP-agriculture, GDP-trade, GDP-industry, and other variables including growth in private consumptions, population, transport vehicles numbers, prices of fossil fuels etc. Scenarios are: Business as Usual (BAU), Medium Growth Scenario (MGS) and High Growth Scenario (HGS). Energy consumption in all the sectors and for all fuel types are not statistically correlated with every economic parameters tested in the assessment. Hence, the statistically correlated models are included in the prognosis of energy consumption. For example, the TPE consumption and electricity consumption, both are significantly dependent with the total GDP and population growth. Likewise, fuel wood consumption is significantly dependent with the growth in rural population and private consumptions. In BAU the estimated electricity consumption in 2030 would be 7.97 TWh, which is 3.47 times higher than that of 2009. In MGS, the total electricity consumption in 2030 is estimated to increase by a factor of 5.71 compared to 2009. Likewise, in HGS, electricity consumption would increase by 10-fold until 2030 compared to 2009, demanding installed capacity of power plant at 6600 MW, which is only from hydro power and other centralised system. [Copyright &y& Elsevier]

Purpose: To describe the first pediatric cataract surgery case series report from Nepal.Setting: Tilganga Eye Center, Kathmandu, Nepal.Methods: This study comprised a consecutive series of 112 eyes of 85 children having cataract surgery with intraocular lens (IOL) implantation. General anesthesia of ketamine combined with peribulbar block was used in all patients. Patients'' demographics, cataract type and presenting symptoms, surgical intervention, preoperative and postoperative visual acuities, and follow-up clinical examinations were recorded.Results: Seventy-three eyes (65.2%) of 53 patients had extracapsular cataract extraction with posterior capsulotomy, anterior vitrectomy, and posterior chamber IOL implantation (ECCE+PCAP+AV+PCIOL), and 39 eyes (34.8%) of 32 patients had cataract extraction and IOL implantation with an intact posterior capsule (ECCE+PCIOL). Of all patients, the mean age at surgery was 6.2 years ± 4.3 (SD). The median age in the ECCE+PCAP+AV+PCIOL group was 4.7 years and in the ECCE+PCIOL group, 11.0 years. The mean follow-up was 5.4 ± 5.3 months. The most common postoperative complication in the ECCE+PCIOL group was visual axis/posterior capsule opacification, which was seen in 18 eyes (46.2%) compared to 4 eyes (5.5%) in the ECCE+PCAP+AV+PCIOL group. Visual acuity improved with surgery in both groups. The leading cause of poor outcomes was deprivation amblyopia. There were no anesthesia-related complications.Conclusions: Implantation of an IOL at the time of cataract extraction under combined systemic ketamine and peribulbar lidocaine anesthesia appeared to be well tolerated and produced significant visual improvement in pediatric patients in Nepal. Primary posterior capsulotomy and AV helped prevent visual axis opacification without a significant increase in complications. [Copyright &y& Elsevier]

In this study, the policy provisions, including legislative and institutional arrangements, made for agricultural development in Nepal are evaluated. The gaps and constraints are identified and mechanisms to reduce the gaps and address constraints are proposed. This study is primarily based on the review of literatures accompanied with the Key Informant Interviews (KIIs). Information on the key achievements and the challenges for achieving the goals of Agriculture Development Strategy (ADS) were obtained through KIIs. Altogether 10 key informants consisting of policy makers, government administrators and experts were selected. Despite government efforts to develop agriculture since the 1960s, the growth rate has remained very low. Some of the gaps and constraints limiting agricultural growth include: inappropriate approaches in designing agricultural policies, plans, and programs; inadequate and in some cases contradictory legislative provisions; low institutional capacity; and weak coordination between key stakeholders in formulating and implementing the sectoral policies. Also limited monitoring, evaluation, and analysis of activities and timely revision of the policies, programs, and acts using feedback have limited the outcome in terms of agricultural growth. Agriculture Development Strategy (ADS), 2015–2035, is hoped to be a milestone in transforming the agriculture sector from subsistence to commercialization. However, pragmatic implementation of the ADS is a major challenge. Strong political commitment and the active and positive involvement of stakeholders are needed to redesign programs and activities as per the restructuring the governance systems – federal, provincial and local levels. ADS should be mainstreamed into national and sectoral development frameworks, which would ensure effective coordination between agencies at different levels of governance. • Despite government policy provisions for accelerated growth rate, it remained slow. • Holistic approach with adequate legal and institutional provisions are necessary. • Policy should avoid contradictory and overlapping provisions with strong coordination. • Timely revision in policy with feedbacks from monitoring and evaluation is necessary. • Political stability and commitments are necessary for achieving accelerated growth. [ABSTRACT FROM AUTHOR]