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Health literacy is crucial in maintaining good health and well-being, yet community-based studies on health literacy in Nepal are scarce. This study aimed to assess the level of health literacy and identify associated factors among adults in Rasuwa, Nepal. A community-based cross-sectional study was conducted among 253 adults aged above 18 years residing in Kalika Rural Municipality, Rasuwa. Data were collected through face-to-face interviews using the Psychometric Assessment of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). Multivariable logistic regression was used to evaluate independent correlates of health literacy levels. The mean ± SD age of participants was 46.3 ± 16 years. Only about a quarter (23.3%) of participants had adequate health literacy. The participants aged ≤ 45 years (aOR:1.9,95% CI: 1.0-3.6), people who perceived their health status as satisfactory (aOR: 3.1,95% CI: 1.5–6.3), had satisfactory self-rated financial status (aOR: 2.9,95% CI: 1.5–5.5), had satisfactory level of self- related esteem (aOR = 2.7,95% CI: 1.2–6.2), had a stable income (aOR = 1.9, 95% CI:1.0-3.5) were more likely to demonstrate adequate health literacy level. Conversely, illiterate participants (aOR: 0.1, 95% CI: 0.04–0.4) and those engaged in agriculture (aOR: 0.49, 95% CI: 0.2–0.9) had lower odds of having adequate health literacy. This study highlights inadequate health literacy status among approximately three-quarters of the participants. Factors such as age, self-rated health status, financial stability, self-esteem, and income were associated with health literacy levels. These findings underscore the importance of addressing socio-economic and individual factors in promoting health literacy initiatives, particularly targeting vulnerable populations, to improve overall health outcomes and healthcare utilization. [ABSTRACT FROM AUTHOR]

Background: The causative agents of Acute Encephalitis Syndrome remain unknown in 68–75% of the cases. In Nepal, the cases are tested only for Japanese encephalitis, which constitutes only about 15% of the cases. However, there could be several organisms, including vaccine-preventable etiologies that cause acute encephalitis, when identified could direct public health efforts for prevention, including addressing gaps in vaccine coverage. Objectives: This study employs metagenomic next-generation-sequencing in the investigation of underlying causative etiologies contributing to acute encephalitis syndrome in Nepal. Methods: In this study, we investigated 90, Japanese-encephalitis-negative, banked cerebrospinal fluid samples that were collected as part of a national surveillance network in 2016 and 2017. Randomization was done to include three age groups (< 5-years; 5-14-years; >15-years). Only some metadata (age and gender) were available. The investigation was performed in two batches which included total nucleic-acid extraction, followed by individual library preparation (DNA and RNA) and sequencing on Illumina iSeq100. The genomic data were interpreted using Chan Zuckerberg-ID and confirmed with polymerase-chain-reaction. Results: Human-alphaherpes-virus 2 and Enterovirus-B were seen in two samples. These hits were confirmed by qPCR and semi-nested PCR respectively. Most of the other samples were marred by low abundance of pathogen, possible freeze-thaw cycles, lack of process controls and associated clinical metadata. Conclusion: From this study, two documented causative agents were revealed through metagenomic next-generation-sequencing. Insufficiency of clinical metadata, process controls, low pathogen abundance and absence of standard procedures to collect and store samples in nucleic-acid protectants could have impeded the study and incorporated ambiguity while correlating the identified hits to infection. Therefore, there is need of standardized procedures for sample collection, inclusion of process controls and clinical metadata. Despite challenging conditions, this study highlights the usefulness of mNGS to investigate diseases with unknown etiologies and guide development of adequate clinical-management-algorithms and outbreak investigations in Nepal. [ABSTRACT FROM AUTHOR]

Rhododendron arboreum, belonging to the Ericaceae family, is primarily distinguished by its vivid red or light pink flowers. The flower is often known as "Lali Gurans" in Nepali and is recognized as the official flower of Nepal. Rhododendron flowers have traditionally been used to cure various human ailments including blood dysentery, headache, asthma, cough, stomachache, fever, inflammation and fungal infections. Moreover, it has medicinal and pharmacological importance. The present study aimed to investigate the beneficial effects of dietary laligurans flower as the growth promotor and immunostimulant in common carp (Cyprinus carpio) fingerlings. Rhododendron flowers taken from the Phulchowki hills of Kathmandu Valley were taxonomically identified by the National Herbarium Center, Govt. of Nepal following ethanol (70%) extract (LGE) and plain powder (LGP) were prepared. There was a total of 7 diets used in the study in which the control diet (T1) did not have any supplementation. The other diets 0.2% (T2), 0.4% (T3), 0.8% (T4) and 1.6% (T5) were supplemented with ethanol extract (LGE) while 0.2% (T6) and 0.4% (T7) were with dry powder (LGP). The experiment was specifically built as a recirculating aquaculture system and was carried out at the Central Fisheries Promotion and Conservation Center (CFPCC), Government of Nepal located in Balaju, Kathmandu. The aquaria were divided into 7 diets, with 3 replicates for each diet hence, fingerlings of common carp (Cyprinus carpio) weighing 2.43±0.21g allocated to 21 glass aquaria randomly. The fish were provided with food equivalent to 5% of their body weight and the sampling was conducted after a period of 90 days of feeding experiments. Statistically significant growth (p< 0.05) was seen in all the treated fish. However, carp fed with LGE performed better and the maximum amount of growth was obtained in carp fed with the 0.8% (T4) diet. The levels of total protein, albumin and globulin demonstrated an upward trend, but the levels of SGOT, SGPT and ALP showed a downward trend when compared to the control and LGP-treated diet. The haematological parameters of the fish given a T4 treated diet were within the normal range, however the levels of hemoglobin (Hb) and hematocrit (PCV) were elevated. Based on the evidence, it is advised that aqua culturists use the ethanol extract of laligurans flower to promote fish growth and improve the socioeconomic activities of farmers. [ABSTRACT FROM AUTHOR]

Background: Glycated hemoglobin is a well-known marker for evaluating long-term glycemic control. However, the accuracy of glycated hemoglobin measurement can be affected by the presence of hemoglobin variants, which makes the determination and interpretation of glycated hemoglobin values in terms of glycemic control not only difficult but also misleading. Here we present the first ever case of a patient with type 2 diabetes with hemoglobin E from Nepal, diagnosed incidentally because of spurious glycated hemoglobin levels. Case presentation: A 45-year-old Hindu Mongolian female with a history of type 2 diabetes for around 9 years but not very compliant with follow-ups was referred to our facility for plasma fasting and postprandial blood glucose levels and glycated hemoglobin. Fasting and postprandial blood sugars were found to be high. A consistent very low glycated hemoglobin by two different high-performance liquid chromatography (HPLC) methods compelled us to call the patient for a detailed clinical history and for the records of investigations done in the past. The patient has been a known case of type 2 diabetes for around 9 years and presented irregularly for follow-up visits. Around 4 years ago, she presented to a healthcare facility with fatigue, severe headaches, pain in the abdomen, discomfort, and dizziness for a couple of months, where she was shown to have high blood glucose. She was referred to a tertiary-level hospital in Kathmandu, where she was prescribed metformin 500 mg once daily (OD). Due to her abnormal hemoglobin A1c reports, she was then sent to the National Public Health Laboratory for repeat investigations. Her blood and urine investigations were sent. Complete blood count findings revealed high red blood cell and white blood cell counts, a low mean corpuscular volume, and a high red cell distribution width-coefficient of variation. Other parameters, including serum electrolytes, renal function tests, liver function tests, and urine routine examinations, were within normal limits. A peripheral blood smear revealed microcytic hypochromic red cells with some target cells. Hemoglobin electrophoresis showed a very high percentage of hemoglobin E, a very low percentage of hemoglobin A2, and normal proportions of hemoglobin A and hemoglobin F. A diagnosis of homozygous hemoglobin E was made, and family screening was advised. Conclusions: Clinicians should be aware of the limitations of glycated hemoglobin estimation by ion exchange high-performance liquid chromatography in patients with hemoglobin E and other hemoglobin variants. If the clinical impression and glycated hemoglobin test results do not match, glycated hemoglobin values should be determined with a second method based on a different principle, and glycemic status should be confirmed through alternative investigations, preferably those that are not influenced by the presence of hemoglobin variants (for example, boronate affinity chromatography, fructosamine test, glycated albumin test, the oral glucose tolerance test, continuous glucose monitoring, etc.). Consistent or even doubtful results should also raise the suspicion of a hemoglobin variant, which should be confirmed through further evaluation and investigations. [ABSTRACT FROM AUTHOR]

Introduction: Nasopharyngeal carcinoma (NPC) shows geographic and ethnic variation with specific etiopathogenesis. This study characterized the distribution of NPC patients stratified by ethnicity, geography, and histology in a tertiary-level cancer center in Nepal. Methods: A descriptive retrospective study was designed to analyze NPC cases from different regions among patients visiting the hospital from 2016 to 2021. Demographic and clinical information was obtained from medical records. Ethical approval was granted by the Nepal Health Research Council (NHRC). Data analyses and visualization were carried out with R software. Results: During the six-year period, a total of 65 individuals were diagnosed with NPC, comprising 42 males and 23 females. Patient median age was 43 years (range 11–85 years). A bimodal age distribution of cases was observed with peaks in patients aged 30–39 years and 50–59 years. Of the NPC patients studied, 29 were from Koshi Province, with 7 cases from Ilam district and 6 cases from Morang district. There were 18 patients in Bagmati Province, and Kathmandu district had the highest number of cases within this region, with 8 patients. The highest proportion of cases were observed among patients of Janajati ethnicity (60%), including Rai, Limbu, and Sherpa people. Histologically, undifferentiated non-keratinizing NPC was the most commonly observed subtype, accounting for 43.1% of cases, followed by 20% differentiated non-keratinizing NPC and 4.6% keratinizing NPC across the entire sample population. The majority of patients (75.3%) were diagnosed at an advanced stage (stage III or IV) with none diagnosed at stage I. Conclusions: In our study, most cases of NPC occurred in patients from provinces in eastern Nepal (Koshi province), and of the Janajati ethnic community. The most common histological subtype was undifferentiated non-keratinizing carcinoma. Further epidemiological studies could address differences in prevalence and the challenge of late presentation of NPC patients in Nepal. [ABSTRACT FROM AUTHOR]

Background: Nepal is one of the high prevalent countries for tobacco use in Southeast Asia regions. Tobacco related cancer share the major burden since a decade, however, population-based estimates is still lacking. This study provides results from population-based cancer registries on tobacco-related cancer (TRCs) burden in Nepal. Methods: The data were collected by population-based cancer registry conducted in nine districts by Nepal Health Research Council. The districts were categorized in urban, semi-urban and rural regions on the basis of geographical locations and facilities available in the regions. Analysis was done to identify tobacco-associated cancer incidence, mortality and patterns along with cumulative risk of having cancer before the age of 75 years. Results: Tobacco-related cancer was 35.3% in men and 17.3% in women. We found that every one in 36 men and one in 65 women developed tobacco-related cancer before age 75 in Nepal. Cancer of lung, mouth, esophagus and larynx were among the five most common tobacco-related cancers in both men and women. The incidence of tobacco-associated cancers was higher in urban region with age adjusted rate 33.6 and 17.0 per 100,000 population for men and women respectively compared to semi-urban and rural regions. Tobacco-associated cancer mortality was significantly higher compared to incidence. Conclusion: The prevalence of tobacco-related cancer found high in Nepal despite of enforcement of tobacco control policy and strategies including WHO framework convention on tobacco control. Concerned authorities should focus towards monitoring of implemented tobacco control policy and strategies. [ABSTRACT FROM AUTHOR]

Background: The Government of Nepal initiated a family-based National Health Insurance Program (NHIP) in April 2016, aiming to ensure universal health coverage (UHC) by enhancing access to and utilization of quality health services. However, NHIP, in its initial years of implementation, encountered challenges such as low population coverage, a high dropout rate, and concerns among the insured regarding the quality of healthcare services. There is a dearth of information regarding user satisfaction with the NHIP in Nepal. This study aimed to assess user satisfaction with NHIP at the household level in Nepal. Methods: We conducted a cross-sectional study among 347 households in the Ilam district using a multi-stage random sampling method. Face-to-face interviews were conducted with household heads enrolled in NHIP. A semi-structured questionnaire was used to collect the data. The multivariable logistic regression analysis was done to identify the predictors of satisfaction level. Results: Overall, 53.6% of the insured were satisfied with the NHIP, while 31.1% had comprehensive knowledge about the NHIP. Factors such as gender (AOR: 1.80, 95% CI: 1.08–3.00), distance to the first point of contact (AOR: 2.15, 95% CI: 1.24–3.74), waiting time (AOR: 2.02, 95% CI: 1.20–3.42), availability of diagnostic services (AOR: 1.90, 95% CI: 1.05–3.45), availability of prescribed medicine (AOR: 3.90, 95% CI: 1.97–7.69), perceived service quality (AOR: 2.20, 95% CI: 1.15–4.20), and the behavior of service providers (AOR: 3.48, 95% CI: 1.04–11.63) were significantly associated with user satisfaction. Conclusion: The satisfaction level among NHIP users was deemed moderate. This study highlighted several factors, such as gender, distance to the first point of contact, waiting time, availability of diagnostic services and prescribed medicine, perceived service quality, and the behavior of service providers, as key determinants impacting user satisfaction. Recognizing the pivotal role of user satisfaction, health insurance stakeholders must prioritize it to ensure higher retention rates and coverage within NHIP. [ABSTRACT FROM AUTHOR]

Few seroprevalence studies have been conducted on coronavirus disease (COVID‐19) in Nepal. Here, we aimed to estimate seroprevalence and assess risk factors for infection in the general population of Nepal by conducting two rounds of sampling. The first round was in October 2020, at the peak of the first generalized wave of COVID‐19, and the second round in July–August 2021, following the peak of the wave caused by the delta variant of SARS‐CoV‐2. We used cross‐sectional probability‐to‐size (PPS)‐based multistage cluster sampling to estimate the seroprevalence in the general population of Nepal at the national and provincial levels. We tested for anti‐SARS‐CoV‐2 total antibody using the WANTAI SARS‐CoV‐2 Ab ELISA kit. In Round 1, the overall national seroprevalence was 14.4%, with provincial estimates ranging from 5.3% in Sudurpaschim to 27.3% in Madhesh Province. In Round 2, the estimated national seroprevalence was 70.7%, with the highest in the Madhesh Province (84.8%) and the lowest in the Gandaki Province (62.9%). Seroprevalence was comparable between males and females (Round 1, 15.8% vs. 12.2% and Round 2, 72.3% vs. 68.7%). The seroprevalence in the ecozones—Terai, hills, and mountains—was 76.3%, 65.3%, and 60.5% in Round 2 and 17.7%, 11.7%, and 4.6% in Round 1, respectively. In Nepal, COVID‐19 vaccination was introduced in January 2021. At the peak of the first generalized wave of COVID‐19, most of the population of Nepal remained unexposed to SARS‐CoV‐2. Towards the end of the second generalized wave in April 2021, two thirds of the population was exposed. [ABSTRACT FROM AUTHOR]

In Nepal, over 1 million individuals have tested positive for SARS-CoV-2. We sought to describe the frequency of nonrecovery from this infection at 6 months and associated symptoms. We conducted a retrospective cohort study of 6142 women who had positive and negative PCR tests for this infection 6 months previously at 3 institutions in Kathmandu. In telephone interviews women provided information on 22 symptoms and their intensities, health status and history, and functional status. Of 3732 women who had tested PCR positive, 630 (16.9%) reported that they were unrecovered. These 630 unrecovered women were distinguished statistically from the 3102 recovered women by more frequent histories of allergies, rheumatoid disease, BCG immunization, Covid vaccination, strep throat and recent URIs, and both weight gain and weight losses of more than 5 kg in the 6 months following testing, and stressful events in the preceding year. Fatigue, pain, difficulty remembering, shortness of breath, heat and cold intolerance and unrefreshing sleep were reported in 41.9% to 10.5% of these 630 unrecovered women. Six months after confirmed SARS-CoV-2 infection 16.9% of Nepali women have long-COVID manifested as an immune, metabolic, and hormonal systems disruptive and dysfunction syndrome [ABSTRACT FROM AUTHOR]

Background. Nepal, currently facing a high burden of noncommunicable diseases (NCDs), including cardiovascular diseases (CVDs), which poses the highest mortality rate in the country, does not seem to have a proper referral strategy. This study explored the wide range of factors and challenges that affect the referral system of CVD cases in Nepal. Methods. In this qualitative study, we conducted face-to-face and telephone interviews with purposely selected 57 key participants which included 35 healthcare professionals from tertiary, secondary, and primary levels from Bagmati Province and 22 CVD patients (myocardial infarction and stroke) from Bagmati and Madhesh Provinces. We interviewed them using an interview guide with open-ended questions for in-depth information in a local language and in a private space. The interviews were audio-recorded, transcribed verbatim, coded, and analyzed using the thematic approach. Results. The findings indicated that the referral system for CVD cases from primary- to secondary- to tertiary-level care is inadequate and malfunctioning. The major factors affecting referral of CVD cases are centralization of CVD-specific services in few urban areas, inadequate systematic communication between the centers, self-referential, lack of human resources for CVD care, and obstacles to patient transfer due to geographical and financial reasons. Conclusion. A referral system for CVD patients is absent in the context of Nepal. Understanding and addressing key factors that affect the referral system of CVD patients may help to improve cardiac outcomes and ultimately save lives. [ABSTRACT FROM AUTHOR]

Violence against women (VAW), particularly intimate partner violence (IPV) or domestic violence, is a major public health issue, garnering more attention globally post-coronavirus disease 2019 (COVID-19) lockdown. Health providers often represent the first point of contact for IPV victims. Thus, health systems and health providers must be equipped to address survivors' physical, sexual and mental health care needs. However, there is a notable lack of evidence regarding such readiness in Nepal. This study, utilizing a concurrent triangulation design, evaluated the readiness of public health facilities in Nepal's Madhesh Province in managing VAW, focusing on providers' motivation to offer psychosocial counselling to survivors. A cross-sectional study was conducted across 11 hospitals and 17 primary health care centres, where 46 health care providers were interviewed in February–April 2022. The study employed the World Health Organization's tools for policy readiness and the Physician Readiness to Manage IPV Survey for data collection. Quantitative and qualitative data were collected via face-to-face interviews and analysed using descriptive and content analysis, respectively. Only around 28% of health facilities had trained their staff in the management of VAW. Two out of 11 hospitals had a psychiatrist, and a psychosocial counsellor was available in four hospitals and two out of 17 primary health care centres. Two-thirds of all health facilities had designated rooms for physical examinations, but only a minority had separate rooms for counselling. Though a few health facilities had guidelines for violence management, the implementation of these guidelines and the referral networks were notably weak. Hospitals with one-stop crisis management centres demonstrated readiness in VAW management. Health providers acknowledged the burden of IPV or domestic violence and expressed motivation to deliver psychosocial counselling, but many had limited knowledge. This barrier can only be resolved through appropriate training and investment in violence management skills at all tiers of the health system. [ABSTRACT FROM AUTHOR]

Objectives: This study describes the prevalence, associated factors and child mental health outcomes related to symptoms of maternal depression and anxiety within 5 years after childbirth in a rural district in Nepal. This association is not well‐understood in rural, community‐based settings in low‐ and middle‐income countries (LMIC). Methods: A sample of 347 women with children under 5 years was recruited in September 2019 for a cross‐sectional study in the rural Saptari district in Nepal. Multivariable logistic regression was used to investigate the association between maternal depressive or anxiety symptoms and children's experience and impact of emotional and behavioural difficulties. Results: In total, 144 women (41.5%) had moderate or severe depression symptoms and 118 (34%) had anxiety symptoms. Mothers with a lower income were more likely to have anxiety symptoms than the highest income group (OR: 1.8, 95% CI: 1.1–3.0). An association existed between maternal depressive symptoms and the impact of emotional or behavioural difficulties in children (OR: 2.44, 95% CI: 1.02–5.84). In contrast, there was no association between maternal anxiety and child outcomes. Conclusions: Our findings suggest that the prevalence of probable maternal anxiety and depression symptoms was relatively high in this rural, low‐resourced and community‐based setting in Nepal. Maternal depressive symptoms were associated with the degree of impact on children's mental health post‐infancy, emphasising the importance of improving maternal mental health in the early years of a child's life. [ABSTRACT FROM AUTHOR]

Freshwater fish are crucial components of aquatic ecosystems that are affected by a range of anthropogenic activities. Freshwater bodies in Nepal are under different threats affecting biodiversity. Inter-basin water transfer (IBWT) involving damming and diversion of water from one river basin to another is considered a major threat to aquatic biodiversity. Impact assessment of such projects include generation of baseline information on different biotic and abiotic variables. The aim of this study was to generate baseline information on fish diversity from the glacial-fed (Bheri) and the spring-fed (Babai) rivers and their selected tributaries from western Nepal in the wake of the first proposed inter-basin water transfer from the former to the latter. A total of 10 sampling sites, five each from Bheri and Babai River systems, were chosen strategically. Electrofishing was conducted encompassing different seasons in 2018 following the standard method. A total of 32 species with catch per unit effort (CPUE) of 47±24 from Bheri and 42 species with CPUE of 63±52 from Babai River were recorded. Cyprinidae, followed by Nemacheilidae, were the most dominant families in both river systems, and Barilius vagra and Schistura beavani were the most dominant species in both. Species richness and abundance showed a significant difference between rivers, and differences in fish assemblages reflects differences in ecological regimes. Failure to observe migratory species such as Anguilla bengalensis suggests that migratory routes may already have been affected. Of the total 52 species recorded, eight are in the threatened categories of the IUCN Red List and need active conservation measures. The findings provide a reference to assess the impacts of water transfers on fish assemblages in these river systems. [ABSTRACT FROM AUTHOR]

Data on antimicrobial resistance (AMR) from sites not participating in the National AMR surveillance network, conducted by National Public Health Laboratory (NPHL), remain largely unknown in Nepal. The "Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) assessed AMR data from previously untapped data sources in Nepal. A retrospective cross-sectional data review was carried out for the AMR data recorded between January 2017 and December 2019 to analyze AMR data from 26 hospital-based laboratories and 2 diagnostic laboratories in Nepal. Of the 56 health facilities initially contacted to participate in this project activity, 50.0% (28/56) signed a data-sharing agreement with CAPTURA. Eleven of the 28 hospitals were AMR surveillance sites, whereas the other 17, although not part of the National AMR surveillance network, recorded AMR-related data. Data for 663 602 isolates obtained from 580 038 patients were analyzed. A complete record of the 11 CAPTURA priority variables was obtained from 45.5% (5/11) of government hospitals, 63.6% (7/11) of private hospitals, and 54.6% (6/11) of public-private hospitals networked with NPHL for AMR surveillance. Similarly, 80% (8/10) of clinics and 54.6% (6/11) of laboratories outside the NPHL network recorded complete data for the 10 Global Antimicrobial Resistance and Use Surveillance System (GLASS) priority variables and 11/14 CAPTURA priority variables. Retrospective review of the data identified areas requiring additional resources and interventions to improve the quality of data on AMR in Nepal. Furthermore, we observed no difference in the priority variables reported by sites within or outside the NPHL network, thus suggesting that policies could be made to expand the surveillance system to include these sites without substantially affecting the government's budget. [ABSTRACT FROM AUTHOR]

Polymelia is an extremely rare congenital anomaly where an individual is born with an abnormally developed extra or supernumerary limb which is generally shrunken and functionless. A case of thoracomelia (a type of polymelia) was observed macroscopically and confirmed radiologically in 1.5 years old boy born in Nepal with an abnormal supernumerary upper limb attached to his back in the thoracic region. The limb was successfully amputated, and the boy had a favorable outcome after surgical treatment, without any adverse effects or impairment. Understanding the embryogenesis of thoracomelia is essential for unraveling the complex mechanisms underlying this condition and potentially aiding in early diagnosis and intervention. This case report and review aims to shed light on the intricate processes governing forelimb formation and their perturbations leading to thoracomelia. [ABSTRACT FROM AUTHOR]

Salmonella is one of the pathogenic microbe responsible in food borne diseases. In developing countries like Nepal, Salmonellosis is one of the leading food-borne disease. The present study was conducted with an objective to enumerate coliform and to find the prevalence of Salmonella species in chicken meat along with their antimicrobial susceptible profile. A total of 30 chicken meat samples were collected and examined following the standard techniques and procedures at the Med Micro Lab from January 2020 to April 2020. The study was performed following the conventional methods for the detection of Salmonella spp. Biochemical methods were implied for the detection of isolates and Antibiotic Susceptibility Test were performed by modified Kirby Bauer disc diffusion test [1]. Out of the 30 samples, 12(40%) sample showed positive for Salmonella spp. Salmonella spp 2(16.67%) were found to be resistant to Ciprofloxacin, Chloramphenicol 1 (0.33%), Cotrimoxazole 2(16.66%), Nalidixic acid 7 (58.33%) Ampicillin 3 (25%) and Ceftriaxone (0%). Salmonella was found to be 100% sensitive towards Ceftriaxone. The highest resistance was observed towards Nalidixic acid (58.33%) followed by Ampicillin (25%) and Cotrimoxazole (16.67%). Finally, the result of the study recommended that the use of standardized procedures in slaughtering and handling of chicken meat, provision of training on best practice of handling of meat for handlers and raising the level of awareness of people about the healthy consumption of chicken meat should be increased. [ABSTRACT FROM AUTHOR]

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Introduction: The access, watch, and reserve (AWaRe) classification of antibiotics was developed in 2019 by the WHO Expert Committee on the Selection and Use of Essential Medicines as a tool to support antibiotic stewardship efforts at local, national, and global levels. The objectives of this study were to assess the availability of antibiotics as per WHO AWaRe classification at community pharmacies located around a tertiary care hospital in Lalitpur and to compare these antibiotics with the national essential medicine list of Nepal. Method: The cross-sectional study was conducted at community pharmacies located within a two-kilometer radius of a teaching hospital from August to November 2022. A total of 82 community pharmacies registered with the Nepal Chemist and Druggists Association and the Department of Drug Administration were studied. Data was collected using a standard proforma containing the names of the antibiotics classified as per the WHO's AWaRe classification. Results: Access group of antibiotics, Ampicillin, (82;100%), Amoxycillin, (82;100%), Flucloxacillin, (82;100%), and Metronidazole, (82;100%) were available in all community pharmacies. Results from the watch group showed that Azithromycin, (80; 97.6%) was available in all pharmacies followed by Cefixime, (80; 97.6%), Ciprofloxacin, (73; 89%), Levofloxacin, (74; 90.2%)and Ofloxacin, (74; 90.2%). Linezolid, (24; 29.3%) was the most common antibiotics available from the reserve group of antibiotics. Colistin was the second commonly available antibiotic. The most available antibiotic from the not recommended group were Ampicillin/Cloxacillin (82; 100%), followed by Piperacillin/Sulbactam, (39; 47.6%). There were differences in the classification of antibiotics between the WHO AWaRe list and the Essential Medicines list of Nepal in terms of numbers of antibiotics listed. Conclusion: Antibiotics from the not recommended and reserve groups were commonly available in community pharmacies. The implementation of antibiotic guidelines should be emphasized along with strict monitoring of the sale of antibiotics without a prescription in community pharmacy settings. [ABSTRACT FROM AUTHOR]

Equitable access to quality health services is a fundamental right of every citizen. As access to quality health services is an important domain of universal health coverage. Clinical audit is a crucial tool for maintaining a high standard of care in the hospital. This study aims to highlight the discrepancies between actual practice and standard in order to identify the changes needed to improve the quality of care and to implement the changes of Radiology department in central government hospital of Nepal. A descriptive, cross-sectional survey encompassing central government hospital was conducted. A structured online questionnaire comprising 41 questions was employed and classified into 2 sections, encompassing demographic data and clinical audit tool. Microsoft Excel and SPSS V.25 were used to analyze the data, and frequencies were computed. Of the 31 central government hospitals in Nepal, 19 (61.3%) are located in Bagmati province. Six of the thirty-one hospital radiography staff members have completed at least BLS or ACLS training. There is no biomedical engineering support at 8 Hospital. Hospitals that have adopted RIS or PACS are 41.9%. There are no personnel radiation dose monitoring devices in 22 out of 31 hospitals. Only six hospitals provide staff members with recurring radiation protection training. In the imaging sector, 74.2% of hospitals have an obvious radiation hazard warning for expectant moms. This study highlights the relatively medium level of clinical audit in central government hospital of Nepal. However, the identified lack of knowledge pertaining to the clinical audit emphasizes the need for further education and training in this area. To address this gap, we recommend the establishment of comprehensive orientation of clinical audit for radiology professionals. Encouraging equitable and high-quality healthcare will aid in achieving the Sustainable Development Goals (SDGs) through clinical audit. [ABSTRACT FROM AUTHOR]

Background: Teledermatology has become a popular alternative tool for providing dermatology services during the COVID-19 pandemic worldwide. Despite being a rising health care modality, it helped to deliver uninterrupted services. The study aimed to determine the implementation, utilization, and acceptance of teledermatology services during the pandemic. Objectives: The aim was to assess the satisfaction of patients utilizing teledermatology services and to obtain their clinical and epidemiological data. Methods: This was a retrospective, observational, single-center study on patients using teledermatology services. Demographic data was analyzed and a questionnaire survey was conducted through phone calls regarding their experience of the service. Results: The mean age of the patients was 33.48 ± 17.89 years. Out of 122 teleconsultations, 89 patients could be contacted again for feedback, among which 81 (91%) found the service easy to use, 75 (84.3%) were able to express their problems similarly to visits in person, 49 (55.05%) regarded teleconsultation as the same as an in-person visit, 80 (89.9%) were satisfied, and 85 (95.5%) agreed to use the service in the future. Superficial fungal infection was the most common diagnosis (24.6%). Newly registered patients were more satisfied in comparison to follow-up patients (96.36% of new cases vs. 79.41% of follow-up cases, p = 0.01). Conclusion: Teledermatology was well accepted by the patients in the current scenario. Telehealth services have a promising role in the future in fulfilling public health demands. [ABSTRACT FROM AUTHOR]

Background: With an increasing burden of stroke, it is essential to minimize the incidence of stroke and improve stroke care by emphasizing areas that bring out the maximum impact. The care situation remains unclear in the absence of a national stroke care registry and a lack of structured hospital-based data monitoring. We conducted this systematic review and meta-analysis to assess the status of stroke care in Nepal and identify areas that need dedicated improvement in stroke care. Methods: A systematic literature review was conducted to identify all studies on stroke epidemiology or stroke care published between 2000 and 2020 in Nepal. Data analysis was done with Statistical Package for Social Sciences (SPSS) and Comprehensive Meta-analysis (CMA-3). Results: We identified 2533 studies after database searching, and 55 were included in quantitative and narrative synthesis. All analyses were done in tertiary care settings in densely populated central parts of Nepal. Ischemic stroke was more frequent (70.87%) than hemorrhagic (26.79%), and the mean age of stroke patients was 62,9 years. Mortality occurred in 16.9% (13-21.7%), thrombolysis was performed in 2.39% of patients, and no studies described thrombectomy or stroke unit care. Conclusion: The provision of stroke care in Nepal needs to catch up to international standards, and our systematic review demonstrated the need to improve access to quality stroke care. Dedicated studies on establishing stroke care units, prevention, rehabilitation, and studies on lower levels of care or remote regions are required. [ABSTRACT FROM AUTHOR]

Streamflow alteration is one of the most noticeable effects of changes in rainfall patterns (both intensity and amount) in the Himalayan region. Additionally, the impact of climate change on the localized rainfall patterns is particularly significant, which is more crucial in the Himalayas. This study carries out a comprehensive analysis on temporal variability of the rainfall and its relation to streamflow in a typical mountain river basin, located in the southern aspect of central Himalayas. The primary objective of this study is to analyze seasonal and annual rainfall trends across rain gauge stations within the selected Kali Gandaki (KG) River Basin. Monthly rainfall data were used to examine the rainfall and streamflow trends. Mann-Kendall (MK) trend test, Sen's slope, and sequential MK (SQMK) analysis were employed to evaluate monotonic trends on homogenized time series data. Our findings revealed the formation of an anticlockwise hysteresis loop between streamflow and rainfall within the catchment. Understanding the relationship between streamflow and rainfall would provide a foundation for effective water resources management. [ABSTRACT FROM AUTHOR]

Aims: Pelvic floor disorders negatively affect the quality of life of women worldwide. Lack of adequate knowledge among women as well as health workers and limited access to health care has deprived women of proper management. This study aimed to assess the knowledge and common practice regarding PFDs among mid-level health providers. Methods: A descriptive cross-sectional survey was conducted among mid-level health providers attending training on reproductive health morbidity screening at the health training centers of two hilly districts of eastern Nepal after ethical clearance from Institutional Review Committee, BPKIHS. The data were collected using a structured questionnaire, pretested before the use. The participants were requested to complete questionnaire before the training session was started. The data obtained were analyzed using descriptive statistics. Results: Out of 72 participants, 71 completed the questionnaires. Mean age of participants was 30.56±8.27 years. Among them, 63.4% were nurses and 36.6% ANMs; 81.7% were aware of pelvic floor disorders (PFD), 90.2% identified pelvic organ prolapse (POP) as the commonest PFDs in Nepal, 91.4% were aware of risk factors and 32.4% knew about Urogynecology subspeciality. Majority (53.4%) were not screening for PFDs routinely. Nearly 40% participants would reassure and refer the patients with POP, 53% do so for urinary incontinence and 70% would refer patients with obstetric fistula and fecal incontinence. Only 35% would start treatment for pelvic organ prolapse. Those with experience > 5 years were more likely to screen PFDs (p=0.007) and start treatment for pelvic organ prolapse (p=0.034). Conclusion: Mid-level health providers are aware of common pelvic floor disorders but are not routinely screening these disorders or practicing simple conservative management strategies. Training these health workers with proper screening guidelines on pelvic floor disorders is imperative. [ABSTRACT FROM AUTHOR]

Inter Basin Water Transfer (IBWT) is a water resource stressor globally with negative environmental impacts. This study describes the major ions and hydrochemistry of the first ever ongoing IBWT from snow-fed Bheri River to rain-fed Babai River in Western Nepal. Water samples from 10 sites, five from each river system, were collected in HDPE bottles for major ions (Ca2+, Mg2+, Na+, K+, HCO3-, Cl-, SO42-, NO3-, CO32-) along with the estimation of pH, temperature and conductivity encompassing winter, spring, summer, and autumn in 2018. Ca2+ and HCO3- were the most dominant cation and anion, respectively, with Ca - Mg - HCO3 water type in both the river systems. Mann Whitney test revealed significant variation (p<0.05) between the two river systems with regard to Ca2+, Mg2+, HCO3-, and SO42- Kruskall Wallis test revealed significant variations between seasons in pH, temperature, Na+, K+, and Cl- in Bheri River system, and in pH, TDS, temperature, Na+, K+, Cl- and SO42- in Babai River system. Carbonate weathering was the main mechanism of ionic sources with insignificant contribution from silicate weathering. Relatively higher concentrations of the major ions during the dry seasons probably indicate the dilution effect of monsoon. Higher concentrations of the ions in the Babai River system reflect the latter's bedrock geology with susceptibility to erosion. With Nepal's future plans of IBWTs and their environmental implications, this finding could be helpful in mitigating the negative consequences of IBWTs in the impact assessment and management of IBWT projects because of their implications on management of aquatic resources. [ABSTRACT FROM AUTHOR]

Background: Most hospitalized patients experience Drug Therapy-Related Problems (DTRPs) resulting in morbidity, mortality, and an increase in the cost of treatment. DTRPs are an important issue and a serious yet preventable problem. Objective: To identify DTRPs in the department of critical care medicine of a tertiary care center in Nepal. Methods: This was a cross-sectional study carried out at the department of critical care medicine in a tertiary care hospital in Kathmandu, Nepal from August to November 2021. All the patients admitted to ICU/ high care unit (HCU) for more than 48 hours during the study period were recruited in this study. Two clinical pharmacists visited the ICU/ HCU daily to identify any drug therapy-related problems. The Pharmaceutical Care Network Europe (PCNE) Classification system version 9.1 was referred for the classification of identified DTRPs. Descriptive statistics were applied for demographic variables. The Chi-square test was used for categorical variables. Pearson correlation was used to study the relationship between patient variables and the number and types of DTRPs. Results: DTRPs were identified in 74.2% (n=89) of patients. More than one DTRP was identified in 38.5% of patients. The identified DTRPs were primarily classified into two sections: Problems and Causes. A total of 106 problems were identified among which unnecessary drug treatment (40.5%, n=43) was the most common problem. For the causes: total of 137 were identified, out of which the drug and dose selection accounted for 44.5 and 16.8%, respectively. The average DTRP per patient was 1.5± 0.7. Antibiotics 30 (22%) and multivitamins, 10 (7%) were the maximal involved in DTRPs. More DTRPs were observed in male patients (n=60, 80%). The association between dose selection and gender was significant. Drug selection issues were observed more in patients prescribed multiple drugs and with a shorter hospital stay. Conclusion: Most DTRPs identified in the study were those that could be prevented. More focus is needed on antibiotic usage in the ICU and special monitoring measures are needed for vulnerable patient groups such as the elderly. Inclusion of more clinical pharmacists can help to identify and mitigate DTRPs. [ABSTRACT FROM AUTHOR]

Background: Cauliflower production during the late winter season has major problems including the requirement of long duration for its maturity, lower yield and poor postharvest quality, especially in the mid-hill region of Nepal. A field experiment was conducted to access the growth, crop maturity and yield of late-season cauliflower varieties at Puranchaur, Kaski in the mid-hill region of Nepal. Methods: The experiment was arranged in a randomized complete block design (RCBD) with toal eleven late-season cauliflower varieties in which nine were hybrid varieties viz. Freedom, Titan, Ravella, Artica, Bishop, Casper, Indam 9803, NS 106 and Snow Mystique while two were open pollinated varieties viz. Amazing and Snowball 16. The experiment was conducted from November 2016 to March 2017 with four replications. Result: Significantly shorter period for final curd initiation of 76 days was recorded in NS 106 and Indam 9803 which was statistically similar with Amazing. Significantly shorter period for final curd maturation of 90 days was recorded in Amazing which was statistically similar to Bishop and NS 106. Similarly, the highest curd yield of 50 mt/ha was produced by Bishop at 91 days after transplanting (DAT) while the lowest crud yield of 19 mt/ha was recorded in Snowball 16 at 113 DAT. Finally, it was concluded that Bishop found the best hybrid variety for higher curd yield and short duration for maturation while Amazing performed higher yield than Snowball 16 and early maturing variety in the mid-hill region of Nepal. [ABSTRACT FROM AUTHOR]

Understanding the local communities' attitudes toward protected areas (PAs) is critical to PA management planning. However, what socio‐economic and demographic factors drive their attitude remains poorly studied. We interviewed 135 residents in three villages in the buffer zone of Bardia National Park, Nepal, to assess their perceived benefits and costs of the PA. We found that perceived benefits are skewed toward wealthy and influential people, whereas costs associated with wildlife‐caused damage (i.e., crop raiding) are borne disproportionately by poor people. The Tobit regression model showed that wealthy and educated residents who obtained direct tourism benefits from the park were significantly more likely to hold positive attitudes toward the PA. On the flip side, residents who had experienced conflict with park administration (park staff and military guards) and incurred a higher amount of crop loss in the recent past were likely to have negative attitudes. Our results showed that negative attitudes largely stemmed from park staff and military guards' behavior and inefficient service delivery from the national park office. In light of these findings, we suggest the park administration develop mechanisms to ensure efficient service delivery and pragmatic handling of community grievances concerning law enforcement and wildlife damage compensation. We also recommend directing park benefits to less educated and poor households and those suffering property losses from wildlife to improve park‐people relationships. [ABSTRACT FROM AUTHOR]

Despite the global nature of the aquatic biodiversity crisis, drivers of extirpation vary among regions, making local‐level data collection crucial for adaptive management in understudied regions like the Himalaya Biodiversity Hotspot (HBH). As human population growth, economic development and environment change accelerate across the HBH it is important to identify imperilled species and determine any ecological traits that predispose them to extirpation.In the present study, Monte Carlo analysis was used to determine fish species with significant range reductions ('significantly declining species') from the 1980s to the 1990s, and from the 1990s to the 2010s, at 38 sites on Nepal's Kaligandaki–Narayani River (KNR). Relative to a null model under which all species were equally likely to lose individuals between time periods, distributions of 16 of 83 species declined significantly across at least one of the two time periods, and two species, Hamilton's baril (Opsarius bendelisis) and the trout barb (Raiamas bola), declined across both.Mid‐water fishes native to both lowlands and hills were most likely to experience range reduction. International Union for the Conservation of Nature Red List status was not representative of actual population trends, highlighting the critical role of local, long‐term data collection and management strategies for effective conservation.Opsarius bendelisis and R. bola urgently need protection in the KNR to stem current population declines. Conservation efforts here should focus on speciose lower‐elevation sites, where many of the 14 other significantly declining species also occur. Overfishing is likely to have contributed to species declines, suggesting that the network of terrestrial protected areas already in place across the HBH can aid aquatic biodiversity conservation efforts owing to their status as fish sanctuaries. Rivers such as the KNR represent a unique opportunity to conserve an intact, albeit threatened, fish species, before human pressures lead to widespread extirpations of the type documented in many areas of the world. [ABSTRACT FROM AUTHOR]

Owing to the elevated radiation exposure of patients and personnel, the catheterization laboratory is particularly in need of optimal levels of radiation protection and safety protocols. Developing safe radiation procedures improves the safety of patients and personnel. This study aims to determine the necessary modifications to enhance the quality of care and implement safety and radiation protection measures for catheterization laboratories throughout Nepal. An online descriptive cross-sectional survey was emailed to all catheterization laboratory of Nepal. The questionnaire consisted of 32 questions focusing on radiation protection and safety in the catheterization laboratory. Results were analyzed using Microsoft Excel, and frequencies and percentages were calculated and summarized. Survey findings demonstrated a 70.42% adopted radiation protection and safety among 28 catheterization laboratory across Nepal. 32.1% respondents were unaware of the Radio-absorbent patient drapes, and 50% reported systematically using real-time radiation dose monitoring. Most of the survey respondents (92.9%) had updated emergency crash cart and 21.4% don't have clearly apparent radiation hazard indicator. 78.6% catheterization laboratory segregated waste according to National HealthCare Waste Management Standard Operating Procedure. 56.4% lacked personnel radiation dose monitoring devices. All participants are oriented for six steps of handwashing, wearing gloves, donning and doffing of Personal Protective Equipment; despite 78.6% only received at least Basic Life Support training. Physicians, Radiographers, Physicists, Nurses and hospital administration should work together to establish a radiation protection and safety program for the catheterization laboratory. The findings will be utilized to pinpoint shortcomings and create strategies for enhancing radiation protection and safety in catheterization labs across Nepal. Key stakeholders, including the Nepal Radiological Society, will need to continue collaborating with other organizations in order to enhance patient care and better promote, integrate, and drive resourcing of radiation protection and safety at all catheterization laboratories. [ABSTRACT FROM AUTHOR]

Background: Since 2006, Nepal has experienced frequent Dengue fever (DF) outbreaks. Up to now, there have been no knowledge, attitude and practice (KAP) studies carried out on DF in Nepal that have included qualitative in-depth and quantitative data. Thus, we aimed to explore and compare the KAP of people residing in the lowland (< 1500 m) and highland (> 1500 m) areas of Nepal.Methods: A cross-sectional mixed-method study was conducted in six districts of central Nepal in September-October 2018 including both quantitative (660 household surveys) and qualitative data (12 focus group discussions and 27 in-depth interviews). The KAP assessment was executed using a scoring system and defined as high or low based on 80% cut-off point. Logistic regression was used to investigate the associated factors, in quantitative analysis. The deductive followed by inductive approach was adopted to identify the themes in the qualitative data.Results: The study revealed that both the awareness about DF and prevention measures were low. Among the surveyed participants, 40.6% had previously heard about DF with a significantly higher number in the lowland areas. Similarly, IDI and FGD participants from the lowland areas were aware about DF, and it's associated symptoms, hence they were adopting better preventive practices against DF. The findings of both the qualitative and quantitative data indicate that people residing in the lowland areas had better knowledge on DF compared to people in highland areas. All IDI participants perceived a higher chance of increasing future dengue outbreaks due to increasing temperature and the mobility of infected people from endemic to non-endemic areas. The most quoted sources of information were the television (71.8%) and radio (51.5%). Overall, only 2.3% of the HHS participants obtained high knowledge scores, 74.1% obtained high attitude scores and 21.2% obtained high preventive practice scores on DF. Among the socio-demographic variables, the area of residence, educational level, age, monthly income, SES and occupation were independent predictors of knowledge level, while the education level of the participants was an independent predictor of the attitude level.Conclusions: Our study found a very low level of knowledge and insufficient preventive practices. This highlights an urgent need for extensive dengue prevention programs in both highland and lowland communities of Nepal. [ABSTRACT FROM AUTHOR]

Aquaponics has the potential to contribute to food security in urban Nepal, where agricultural land near cities is rapidly being converted for other uses. This technology's use is expanding in Nepal, but the relatively high cost of commercial fish food is a hindrance. As a result, some aquaponics operators are resorting to alternative, less expensive fish foods. Since the primary input of nutrients to the plants grown in aquaponics comes from the fish food, an evaluation of the impact of fish foods on plant and fish growth is needed to help operators evaluate the costs and benefits of commercial compared to alternative fish diets. This study evaluated the growth of lettuce and common carp, the most common species of plant and fish used in aquaponics in Nepal, with three fish diets (commercial fish food, commercial chicken food, and a homemade diet with mustard oil cake and rice bran) at a commercial aquaponics farm with nine identical systems allowing for three replicates of the three fish food treatments. There were no significant differences in the measurements of lettuce growth (stem length, root length, and stem mass) and few differences in nutrient concentrations in leaf tissue. The specific growth rate of the carp fingerlings was lowest for the fish in the systems fed with the homemade diet (0.21) compared to those fed commercial fish food or commercial chicken food (0.31 and 0.28, respectively). These findings suggest that aquaponics operators who have been buying the more expensive commercial fish food with fish meal as its protein source can save 50–95% of the related costs by using commercial chicken food or the homemade diet defined in this study. This could potentially encourage the expansion of aquaponics systems in Nepal. [ABSTRACT FROM AUTHOR]

There is increasing appreciation that group memberships can have both beneficial and damaging impacts on health. In collaboration with Nepal Leprosy Trust (NLT), this longitudinal study explores a group‐based approach to stigma reduction among people affected by leprosy in rural Nepal (N = 71)—a hard to reach and underrepresented non‐WEIRD population. Informed by the 'social cure' literature, and the progressive model of self‐stigma, we use a longitudinal design. We found that a sense of belonging to a self‐help group can facilitate education in terms of health literacy, and over time these two factors also have impacts on participants stigma. Specifically, self‐help group belonging predicted improvements in health literacy, leading to reduced endorsement of negative stereotypes and thus less stigma‐related harm among people affected by leprosy. The study offers promising evidence that group‐based interventions, which support health education, can reduce the harmful impact of stigma in very challenging contexts. [ABSTRACT FROM AUTHOR]

A primary means of conserving a species or a habitat in a human‐dominated landscape is through promoting coexistence with humans while minimizing conflict. For this, we should understand how wildlife is impacted by direct and indirect human activities. Such information is rare in areas with high human densities. To investigate how animals respond to altered ecological conditions in human‐dominated landscapes, we focused on a wild herbivore of conservation concern in the Krishnasaar Conservation Area (KrCA) in Nepal. Here, blackbuck Antilope cervicapra, a generalist grazer, lives in refugia located with a growing human population. We studied the impacts of humans on habitat use and behavior of blackbuck. We laid 250 × 250 m grid cells in the entire KrCA and carried out indirect sign surveys with three replications for habitat use assessment. We observed herds of blackbuck for 89 h in different habitat types using scan sampling methods. Our habitat‐use survey showed that habitats under intensive human use were hardly used by blackbuck, even when high‐quality forage was available. Habitat openness was the major predictor of habitat use inside the core area, where levels of human activities were low. We also found a positive correlation between habitat use by blackbuck and livestock. Blackbuck were substantially more vigilant when they were in forest than in grassland, again indicating an influence of risk. Overall, blackbuck appear to be sensitive to the risk associated with both natural and anthropogenic factors. Our findings have direct implications for managing human–wildlife interactions in this landscape, specifically regarding strategies for livestock grazing in habitats highly used by blackbuck and concerning predictions of how changing land use will impact the long‐term persistence of blackbuck. Our work suggests that wild herbivores may be able to persist in landscapes with high human densities so long as there are refuges where human activities are relatively low. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal's health systems gaps to prevent and manage CVDs.Methods: We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts' codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system.Results: National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible.Conclusion: Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services. [ABSTRACT FROM AUTHOR]

Background: Unused medicines can be stored by many people at their places of residence and houses for later use. This study evaluated knowledge, and attitudes regarding unused and expired medicines and explored medicine storage and disposal practices among selected households in the Kathmandu valley, Nepal. Method: A cross-sectional study with a two-stage cluster survey design was done using a semi-structured questionnaire from April to October 2021. The sample size (total number of households) after adjusting for design effect and non-response rate was 210 and the study population was the household heads. Simple random sampling was done to select clusters during the first stage and systematic random sampling to select households during the second stage. Descriptive statistics and t-test/one-way ANOVA were used to compare the respondents' average knowledge scores. Practice variables were presented using frequency distribution. Results: Around half the respondents were from the Kathmandu district, nearly 20% were from Bhaktapur and 30% were from Lalitpur. Nearly two-thirds were male and about 25% had a bachelor's degree. Nearly 90% of respondents agreed that storage of excess medicines at home may promote self-medication. Similarly, 97.6% of respondents agreed there is a lack of adequate information on the safe disposal of unused medicines. The majority [125 (59.5%)] of participants always checked the expiry date of medicines. The safe methods of medicine disposal were not known by 137 (65.2%) participants. Throwing in a dustbin was the preferred method of expired medicine disposal. Conclusion: The level of knowledge and practice of disposing of unused and expired medicines requires improvement. Educational interventions may help improve awareness further. Creating a chart summarizing disposal procedures of common medicines is important. Similar studies in other regions are required. [ABSTRACT FROM AUTHOR]

BACKGROUND: Community pharmacists are among the most accessible health care providers. OBJECTIVE: This study evaluates the knowledge of community pharmacists about the risks associated with medication use during pregnancy. METHODS: A cross-sectional study was carried out in March 2021 among the 344 community pharmacies in the Kathmandu Valley, Nepal. Convenience sampling was used for data collection using a structured and validated questionnaire. RESULTS: The majority of participants were male: 264 (76.7%), 94.2% were between the age of 21 to 30 years, and 53.1% had work experience of less than one year. Over half had completed diploma in pharmacy. Less than 10 medicines were dispensed to pregnant women daily in 61.6% of the pharmacies. Only 28.8% of the community pharmacists always inquired about pregnancy status from women in the reproductive age group. The median knowledge score was significantly different among individuals with different work experience and qualifications (p < 0.001). There was also difference in median scores according to average number of medicines dispensed daily (p = 0.006). The knowledge score also differed according to average number of medicines dispensed to pregnant woman and inquiry by the pharmacist about pregnancy status (p < 0.001). CONCLUSION: Our study revealed that the median knowledge scores need improvement. [ABSTRACT FROM AUTHOR]

Monosex tilapia (Oreochromis niloticus L.) was evaluated in a freshwater pond for 100 days at Gokuleshwor, Baitadi, Nepal during the summer and rainy seasons of 2019. Fingerlings were supplied at stocking densities of 5, 10, 15, and 20 fish per m³. At the time of stocking, the average fingerling weight was 8.5 grams. Each treatment had four replicates. Each of the treatments involved feeding the fish twice a day. The results revealed that the specific growth rate and survival rates decreased with increasing levels of stocking density. As stocking density increased, the growth performance of tilapia dropped. Fish growth was the highest at a stocking density of 5 fish per m³, but the production was the highest at a stocking density of 20 fish per m³. According to the findings of this study, farmers should use higher stocking densities to maximize production. [ABSTRACT FROM AUTHOR]

Background: Stereotactic surgery or stereotaxy is a minimally invasive form of surgical intervention which makes use of a three-dimensional coordinate system to locate small targets inside the body and to perform on them some procedures such as ablation, biopsy, lesion, injection, stimulation, implantation, radiosurgery (SRS), etc. Though it was developed a long time ago as a useful adjunct to brain lesions evaluation, it's use at our centre is quite recent. Methodology: The study included eight patients who underwent frame based stereotactic biopsy and pathological evaluation of specimen at National Academy of Medical Sciences (NAMS). Results: Out of eight patients the results were positive in seven patient and negative in one patient. Conclusions: The basic advantages of stereotaxy were realized in our cases with minimal morbidity and no mortality. Craniotomy for biopsy could be avoided. [ABSTRACT FROM AUTHOR]

Suicide is increasingly being recognized as a global public health concern, but it is still treated as a neglected burden in Nepal. Case-control study on suicide from Nepal is very rare. Thus, a community-based matched case-control study was conducted at Ilam District to identify different stressors associated with Nepalese suicidal victims with appropriate samples of 64 cases which were matched for age group (± 2 years) and area of residence with 128 controls (1:2 ratio). Data was collected through suicide survivors and close neighbors of suicide victims. Intimate partner violence was an independent risk factor for committing suicide (OR (95% CI) = 5.33 (1.41–20.10), P = 0.013). A conditional logistic regression identified two strong stressors of suicide: depression (OR (95% CI) = 10.53 (3.11–35.66), P < 0.001) and substance dependence (OR (95% CI) = 16.38 (4.23–63.35), P < 0.001). This is the first community-based case-control study to report stressors of suicide from eastern Nepal. An integrated counseling and public awareness center needs to be established by the Nepal Government at Ilam District addressing those significant stressors. Furthermore, the findings also have implications for formulating national health policy to be implemented in vulnerable districts in order to decrease risks of suicide in Nepal. [ABSTRACT FROM AUTHOR]

Background: Nepal has implemented the social health security program in certain health facilities to improve access to quality health services. The aim of the study is to understand the utilization pattern of social health security schemes and community's perception of the social health security program. Method: A descriptive cross-sectional mixed-method study was conducted among 300 households of Illam district who had enrolled in the social health security scheme. A multi-stage random sampling method was used. A semi-structured questionnaire was used to collect quantitative data whereas focus group discussions (FGDs) were conducted for qualitative data. Descriptive analysis, bivariate and multivariate analysis was done. FGDs were transcribed and thematic analysis was done. Findings: The utilization rate of social health security scheme was 88.7%. Factors associated with the utilization of program included: presence of under-five children and chronic illness in households, sex and age group. Focus group discussion revealed that people were aware of social health insurance and pleased with program implemented by government. However, the hospitals under the social health insurance were not able to meet their expectations. Conclusion: Although the utilization of social health security scheme was high, people were dissatisfied with the service provided by the hospital under the social health security scheme. Therefore, the social health insurance board should closely monitor the hospitals and develop a feedback mechanism from the users. [ABSTRACT FROM AUTHOR]

Background High dietary salt intake is recognized as a risk factor for several non-communicable diseases (NCDs), in particular cardiovascular diseases (CVDs), including heart attack and stroke. Accurate measurement of population level salt intake is essential for setting targeted goals and plans for salt reduction strategies. We used a spot urine sample to estimate the mean population salt intake in Nepal and evaluated the association of salt intake with excess weight, hypertension, raised blood sugar and hypercholesterolemia, and a number of sociodemographic characteristics. Methods A population-based cross-sectional study was carried out from February to May 2019 using a WHO STEPwise approach to surveillance. Spot urine was collected from 4361 participants aged 15-69 years for the analysis of salt intake. We then used the INTERSALT equation to calculate population salt intake. Student's 't' test, one-way ANOVA and multivariable linear regression were used to assess the association between salt intake and a number of factors. Statistical significance was accepted at P < .05. Results The average (±SD) age of participants was 40 (14.1) years. Mean salt intake, derived from spot urine samples, was estimated to be 9.1g/d. A total of 70.8% of the population consumed more than the WHO's recommended amount of 5g salt per day, with almost one third of the population (29%) consuming more than 10g of salt per day. Higher salt intake was significantly associated with male gender (ß for male = 0.98g; 95%CI:0.87,1.1) and younger age groups (ß25-39 years = 0.08; 95%CI:-0.08,0.23) and higher BMI (ß = 0.19; 95% CI:0.18,0.21). Participants who were hypertensive and had raised blood cholesterol consumed less salt than people who had normal blood pressure and cholesterol levels (P<0.001). Conclusions Salt consumption in Nepal is high, with a total of 70.8% of the population having a mean salt intake >5g/d, well above the World Health Organization recommendation. High salt intake was found to be associated with sex, age group, education, province, BMI, and raised cholesterol level of participants These findings build a strong case for action to reduce salt consumption in Nepal in order to achieve the global target of 30% reduction in population salt intake by 2025. [ABSTRACT FROM AUTHOR]

Background: Owing to the advancement in organ transplantation, treating an individual with organ failure in today's world has become possible. However, organ transplantation is lagging in the absence of adequate organ donations. Shortage of organs for transplantation is a challenge to developing countries like Nepal and developed countries like the USA and UK. Despite various efforts to increase the rate of organ donation, the problem persists. The primary reason for the failure to accomplish adequacy in organ donation is the immediate dependency on an available donor. On top of that, reluctance to decide on organ donation after death, regarded as an onerous moment, at least by the general public, has another impact on the subject. Some countries have shifted while some are planning to change from an informed consent system to a presumed consent system, in which if an individual does not make any decision during lifetime, it is presumed that his/her organ can be removed for organ transplantation after death. Objective: To perceive the perception of healthcare professionals of the tertiary care centre of eastern Nepal regarding the presumed consent system. Methods: Purposive sampling of 221 health care professionals (Faculties, Nursing In-charges, Lab-technicians, and Radiology technicians) participated in the study. Results: Most healthcare professionals (90.5%) support using a presumed consent system in Nepal and agree on considering the family's opinion in the decision-making for cadaveric organ donation. Conclusion: Most healthcare professionals have shown their perception in favors of presumed consent to support the increasing organ donation rate. [ABSTRACT FROM AUTHOR]

Understanding damages caused by wildlife is critical in developing strategies to mitigate human-wildlife conflict. We conducted 135 household surveys and group discussions in three villages around Bardia National Park, Nepal. Of the 222 total wildlife damage incidents in 2017, crop damage was the most frequent conflict (72%) followed by livestock depredation (24%). While elephants (Elephas maximus) and deer (Axis axis) were the main species implicated in crop loss, leopards (Panthera pardus) and tigers (Panthera tigris) were responsible for livestock depredation. Livestock depredation resulted in an average annual monetary loss of US$32.27 ($19.23-$442.30) per household. On average, each household lost 11% of their total annual potential crop production to wildlife damage. Poor households experienced noticeably disproportionate losses. Only 32% of respondents experiencing wildlife damage received compensation from the park. We recommend simplifying the compensation process and focusing on elephant and leopard damages while working to improve mitigation measures. [ABSTRACT FROM AUTHOR]

Background: Zanthoxylum armatum is one of the 30 prioritized medicinal plants for economic development of Nepal with a high trade value. Understanding the ecology of individual species is important for conservation and cultivation purposes. However, relation of ecological factors on the distribution and populations of Z. armatum in Nepal remain unknown. To address this knowledge gap, an attempt has been made to study the population structure, distribution, and regeneration potentiality of Z. armatum. Vegetation sampling was conducted at six different localities of Salyan district along the elevation range of 1,000 m to 2,000 m. Results: Altogether 50 plant species belonging to 44 genera under 34 families were found to be associated with Z. armatum. Significantly higher species richness was found at Rim (1,400-1,700 m) and Chhatreshwori (1,800-2,000 m) and lower at Kupinde (1,600-1,800 m). The highest population density of Z. armatum was at Kupinde (1,600-1,800 m) with a total of 1,100 individuals/ha. and the lowest at Chhatreshwori (1,800-2,000 m) with 740 individuals/ha. Based on the A/F value (Whitford index), it can be said that Z. armatum has random distribution in the study area. The plants were categorized into seedlings, saplings and adults based on plant height and the status of natural regeneration category determined. The regeneration potentiality of Z. armatum in the study area was fair with the average seedlings and saplings densities of 150 and 100 individuals/ha. Respectively. A Shannon-Weinner index mean value of 2.8 was obtained suggesting high species diversity in the study area. Conclusions: The natural distribution and regeneration of Z. armatum is being affected in the recent years due to anthropogenic disturbances. Increasing market demand and unsustainable harvesting procedures are posing serious threat to Z. armatum. Thus, effective conservation and management initiatives are most important for conserving the natural population of Z. armatum in the study area. [ABSTRACT FROM AUTHOR]

Background: Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. Methods: This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. Results: Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. Conclusions: Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to assess the national and regional pharmacovigilance centres in Nepal in terms of their policy frameworks, structure and functioning. Methods A descriptive cross-sectional study was conducted during January 2021 among regional pharmacovigilance centres, and the national pharmacovigilance centre and the Ministry of Health and Population. The indicator-based pharmacovigilance assessment tool (IPAT) consisting of 43 indicators (26 core and 17 supplementary) assessing different aspects of pharmacovigilance was used. Key findings Of a total of 14 candidates representing regional pharmacovigilance centres, 12 agreed to participate. The national pharmacovigilance centre located at the Department of Drug Administration had an acceptable level of infrastructure and manpower but poor functioning and weak collaboration with regional centres. There are no policies and procedures specifically related to pharmacovigilance and no requirement for pharmaceutical companies to report adverse drug reactions (ADRs). The national centre received only 42 ADR reports during the evaluation period. The regional centres are mostly located (10 out of 14) in the Kathmandu Valley and had qualified manpower and basic resources. There were poor process indicators suggesting problems with functioning in terms of ADR reporting, signal generation and drug safety communication. Conclusions Underreporting of ADRs, weak processes and poor coordination among centres limit functioning of the system. Creating more awareness, involving consumers and pharmaceutical companies in the reporting process, and conducting more training programmes are needed for the proper functioning of pharmacovigilance services in Nepal. [ABSTRACT FROM AUTHOR]

Program managers routinely design and implement specialised maternal and newborn health trainings for health workers in low- and middle-income countries to provide better-coordinated care across the continuum of care. However, in these countries details on the availability of different training packages, skills covered in those training packages and the gaps in their implementation are patchy. This paper presents an assessment of maternal and newborn health training packages to describe differences in training contents and implementation approaches used for a range of training packages in Ethiopia and Nepal. We conducted a mixed-methods study. The quantitative assessment was conducted using a comprehensive assessment questionnaire based on validated WHO guidelines and developed jointly with global maternal and newborn health experts. The qualitative assessment was conducted through key informant interviews with national stakeholders involved in implementing these training packages and working with the Ministries of Health in both countries. Our quantitative analysis revealed several key gaps in the technical content of maternal and newborn health training packages in both countries. Our qualitative results from key informant interviews provided additional insights by highlighting several issues with trainings related to quality, skill retention, logistics, and management. Taken together, our findings suggest four key areas of improvement: first, training materials should be updated based on the content gaps identified and should be aligned with each other. Second, trainings should address actual health worker performance gaps using a variety of innovative approaches such as blended and self-directed learning. Third, post-training supervision and ongoing mentoring need to be strengthened. Lastly, functional training information systems are required to support planning efforts in both countries. [ABSTRACT FROM AUTHOR]