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Background:Rapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal.Methods:Semi-structured interviews were conducted among 32 health-care workers who were involved in clinical care of COVID-19 patients and four policy-makers who were responsible for COVID-19 control and management at central and provincial level. Interviews were conducted through telephone or Internet-based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches.Results:Both health-care workers and policy-makers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. The poor governance, and coordination between three tiers of government was compounded by the inadequate personal protective equipment for health-care workers, insufficient isolation beds for patients, and poor engagement of the private sector. Frontline health-care workers experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue serving patients.Conclusion:Preparedness for COVID-19 was affected by the poor coordination between three tiers of governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, health-care workers maintained their motivation. There is an urgent need for an effective coordination mechanism between various tiers of health structure (including private sector) in addition to incentivizing the health-care workers for the current and future pandemics.

Background: Elderly populations are the vulnerable population and yet still neglected one. The main aim of the research is to assess the nutritional status of elderly population at Gokarneshwor municipality, Kathmandu. Methods: Quantitative cross sectional study was conducted in the time frame of July 15-Jan 15, 2020 among 301 elderly population of Gokarneshwor municipality, Kathmandu. Proportionate systematic sampling was applied for elderly selection. Descriptive and inferential statistical analysis was performed by using the software Statistical Package for Social Sciences and Microsoft Excel. Results: Study reflected that most of the elderly (48.5%) had normal body mass index followed by overweight (24.6%), underweight (18.6%) and obese (8.3%) respectively. Currently 27.2% used to consume alcohol and 24.3% used to smoke. More than one third (39.1%) elderly reported psychological stress or disease. Most of the elderly (40.1%) had high pressure followed by Diabetes (27.1%), Chronic Obstructed Pulmonary Disease (23.6%), heart disease (7.1%) and heart stroke (1.9%) respectively. Elderly nutritional status was statistically significant among marital status (P=0.022), food intake in recent three month (P=0.024), weight loss (P=0.001), mobility (P=0.004), self-perception of health status (P=0.029), psychological stress (P

Prognostic markers are the biomarkers used to measure the disease progression and patient outcome regardless of treatment in coronavirus disease 2019 (COVID-19). This study aimed to analyze laboratory parameters as prognostic markers for the early identification of disease severity. In this study, 165 patients attending Sukraraj Tropical and Infectious Disease Hospital with COVID-19 were enrolled and divided into severe and non-severe groups. The demographic data, underlying co-morbidities, and laboratory findings were analyzed and compared between severe and non-severe cases. The correlation between the disease criticality and laboratory parameters was analyzed. Cut-off values of parameters for severe patients were speculated through the receiver operating characteristics (ROC) curve, and regression analysis was performed to determine the risk factors. Patients with severe COVID-19 infection had significantly higher absolute neutrophil count, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), ferritin, positive carbohydrate reactive protein (CRP), glucose, urea, creatinine, and aspartate aminotransferase, while lower absolute lymphocyte count, absolute eosinophil count (AEC), and red blood cell count in comparison to non-severe infection. ROC analysis gave a cut-off value (sensitivity, specificity) of age, AEC, NLR, PLR, and ferritin as 47.5 years (70.2, 64.7%), 335 cells/mm3 (74, 67%) 3.3 (68.4, 63.7%), 129 (77.2, 51%), and 241 ng/mL (74.0%, 65.0%) respectively. Risk factor analysis showed higher age, low AEC, high ferritin, and positive CRP as independent risk factors associated with severe COVID-19 infection. Hematological and inflammatory markers, including novel NLR and PLR, should be assessed to aid clinicians in the early identification of severe cases, prioritization of cases, and effective management to decrease the mortality of COVID-19 patients.

Aim: To access the knowledge, attitude, and practice (KAP) towards COVID-19 disease among chronic diseases patients visiting tertiary hospitals of Kathmandu. Methods: A cross-sectional study was conducted among chronic disease patients who visited Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu. Semi-structured questionnaire was used to collect patients’ socio-demographic data and perspectives on COVID-19. Results: Four hundred chronic disease patients participated in the study, with 53.2% female and 46.8% male, and 56.8% of age ≥50 years. Overall, 55.5% of the participants had good knowledge, 56.2% had good practice, and 30.7% had positive attitude towards COVID-19. Younger patients, 18-34 years, were found to have higher odds of having good knowledge compared to other age groups (aOR: 2.5; 95% CI: 1.3-6.0). The patients with less than average family income and those unable to read and write had lower odds of having positive attitude towards COVID-19 (aOR: 0.6; 95% CI: 0.4-0.9 and aOR: 0.4; 95%CI: 0.2-0.9, respectively). A statistically significant correlation was found between the patients’ knowledge and practice, knowledge and attitude, and attitude and practice (p Conclusion: Nearly half of the chronic disease patients in Nepal had poor knowledge and practice whereas more than two-third had negative attitude towards COVID-19 disease. Older age of the patient was significantly associated with poor knowledge and poor practice. These study findings could be helpful for the government and non-government stakeholders while planning COVID-19 awareness campaigns to the targeted patient groups.

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

Background - This study is to assess the effectiveness of Nepal’s COVID-19 disease response in the first wave and second wave (01/28/2020-06/28/21) by inspecting the trajectory of morbidity (cases) and mortality (deaths) peaks after the implementation of key COVID-19 interventions shown through constructing graphs utilizing Nepal’s COVID-19 daily situation reports. Objectives - This study aims to highlight the notable mistakes of Nepal's COVID-19 interventions and policies to provide possible recommendations through Covid-19 Nepal Preparedness and Response Plan in April 2021 to improve their disease response policies and interventions, preparing the country against future pandemics. Methods - A retrospective analysis was conducted to investigate contextual information using scholarly and grey literature in Google Scholar to help understand what occurred in Nepal within and before the peaks. Result - Although, Nepal's disease response was effective and swift in the beginning months shown from the daily cases and mortalities were as high as 24 and 0 per day, respectively. However, that soon changed a year later when problems from existing policies and interventions arose as the pandemic continued with cases reaching as high as 8,173 per day and 5,410 mortalities per day. Conclusion - The paper addresses the potential problems with existing policies and interventions by concluding with possible improvements to Nepal’s current COVID-19 2021 Disease Response Plan to mitigate mortality and morbidity in future endemics or pandemics Nepal may endure.

ObjectivesTo estimate the prevalence of anxiety and depression and identify the associated factors among people with type 2 diabetes mellitus (T2DM) visiting diabetes clinics of Pokhara Metropolitan, Nepal.DesignCross-sectional study.SettingThree diabetes clinics in Pokhara Metropolitan, Nepal, from May to July 2021.Participants283 people with T2DM visiting selected diabetes centres of Pokhara Metropolitan.Outcome measuresAnxiety and depression were the outcome measures. Face-to-face interviews were conducted using a structured questionnaire comprising information related to participants’ sociodemographic profile and several factors along with Hospital Anxiety and Depression-Anxiety subscale and Patient Health Questionnaire-9 to assess the levels of anxiety and depression, respectively. Pearson’s Χ2tests and binary logistic regression were performed to examine association between dependent and independent variables at 5% level of significance.ResultsThe prevalence of anxiety and depression was 31.4% (95% CI 26.2% to 37.5%) and 36.4% (95% CI 30.8% to 42.0%), respectively. Anxiety was found to be associated with a lower level of perceived social support (adjusted OR (AOR) 2.442, 95% CI 1.020 to 5.845), multiple complications (AOR 2.758, 95% CI 1.015 to 7.334) and comorbidities (AOR 2.110, 95% CI 1.004 to 4.436), severe COVID-19 fear (AOR 2.343, 95% CI 1.123 to 4.887) and sleep dissatisfaction (AOR 1.912, 95% CI 1.073 to 3.047). Economical dependency (AOR 1.890, 95% CI 1.026 to 3.482), no insurance (AOR 2.973, 95% CI 1.134 to 7.093), lower perceived social support (AOR 2.883, 95% CI 1.158 to 7.181), multiple complications (AOR 2.308, 95% CI 1.585 to 6.422) and comorbidities (AOR 2.575, 95% CI 1.180 to 5.617), severe COVID-19 fear (AOR 2.117, 95% CI 1.009 to 4.573), alcohol use (AOR 2.401, 95% CI 1.199 to 4.806) and sleep dissatisfaction (AOR 1.995, 95% CI 1.093 to 3.644) were found to be associated with depression.ConclusionThis study showed high prevalence levels of anxiety and depression among people with T2DM. Strengthening social support and focusing on people with diabetes suffering from comorbidity and complications could help to reduce their risk of mental health problems.

Reproductive health rights ensure that people are able to have satisfying and safe sex life and that they have the capacity to reproduce with freedom to decide, when and how often to do so. This study aimed to assess the knowledge and practices on reproductive health rights among madhesi married women. A descriptive cross-sectional study was conducted among 384 madhesi married women of reproductive age in Sarlahi district conducted from July 2014 to December 2014. Data were entry in Epidata software and analyzed by SPSS 20 version. Of the total 384 respondents most of them (39.3%) were of age group 25-35 years from different ethnic groups. Most were simple illiterate (65.6%) and housewife (60.9%) very few of respondents were knowledge about reproductive health rights (37%) and not statistical significant relationship with level of knowledge and level of practice (χ 1 2 =2.036, p=0.154). Level of knowledge was statistically significant relationship with educational level (χ 4 2 = 43.983 p

IntroductionOver-the-counter (OTC) use of antibiotics contributes to the burgeoning rise in antimicrobial resistance (AMR). Drawing on qualitative research methods, this article explores the characteristics of OTC sales of antibiotic in Nepal, its drivers and implications for policy.MethodsData were collected in and around three tertiary hospitals in eastern, western and central Nepal. Using pre-defined guides, a mix of semi-structured interviews and focus group discussions were conducted with dispensers at drug stores, patients attending a hospital and clinicians. Interviews were audio-recorded, translated and transcribed into English and coded using a combination of an inductive and deductive approach.ResultsDrug shops were the primary location where patients engaged with health services. Interactions were brief and transactional: symptoms were described or explicit requests for specific medicine made, and money was exchanged. There were economic incentives for clients and drug stores: patients were able to save money by bypassing the formal healthcare services. Clinicians described antibiotics as easily available OTC at drug shops. Dispensing included the empirical use of broad-spectrum antibiotics, often combining multiple antibiotics, without laboratory diagnostic and drug susceptibility testing. Inappropriately short regimens (2–3 days) were also offered without follow-up. Respondents viewed OTC antibiotic as a convenient alternative to formal healthcare, the access to which was influenced by distance, time and money. Respondents also described the complexities of navigating various departments in hospitals and little confidence in the quality of formal healthcare. Clinicians and a few dispensers expressed concerns about AMR and referred to evadable policies around antibiotics use and poor enforcement of regulation.ConclusionsThe findings point to the need for clear policy guidance and rigorous implementation of prescription-only antibiotics.

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

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

Background More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions. Methods The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings. Results The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care – all within LMICs. Conclusions Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities.

BackgroundRapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the characteristics and drivers of the health system preparedness towards COVID-19 and its impacts on frontline health care workers (HCWs) in Nepal.MethodsSemi-structured interviews (SSIs) were conducted among 32 HCWs who were involved in clinical care of COVID-19 patients and four policymakers who were responsible for COVID-19 control and management at central and provincial level. Participants were included from all seven provinces of Nepal. All SSIs were conducted through telephone or internet based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches.ResultsBoth HCWs and policymakers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. Specifically, there was inadequate personal protective equipment for HCWs, insufficient isolation beds for patients, poor coordination between the three tiers of governance, and poor engagement of the private sector. Additionally, HCWs experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue working in the forefront.ConclusionThis study identified poor preparedness of the health system in the course of Nepal's COVID-19 response embedded in the governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, HCWs maintained their motivation. Urgent efforts are required to reform the governance and coordination mechanism in addition to incentivizing the HCWs for the current and future pandemics.

The novel coronavirus disease 2019 (COVID-19) outbreak, caused by the pathogenic severe acute respiratory syndrome-2 (SARS-CoV-2) virus, is exponentially spreading across the globe. As there is paucity of published literature, the influence of COVID-19 on community health remains unclear. Therefore, we aimed to conduct a systematic review of the literature on the impact of COVID-19 on community health. The current systematic review was performed utilizing electronic databases, i.e., PubMed, MEDLINE, and EMBASE. We searched for the keywords "COVID-19" AND "community health" between January 1, 2020, until May 10, 2020. Although, limited evidence is available regarding quarantine to prevent COVID‐19, most studies considered quarantine as an essential public health measure to minimize rate of infection and mortality. Under these circumstances, people should focus on maintaining personal hygiene, proper nutrition, and extreme social distancing to reduce the risk of COVID-19. Besides, that there is a need to provide professional psychological support to reduce mental ill-health. We have highlighted two different public health approaches in South Asian countries, namely Nepal and India.

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the pandemic. Since its first report in late December from Wuhan, China, it has spread in 211 countries and has infected more than a million population claiming more than 81,000 lives until 7th April 2020. Although heterogeneous between countries, the recent trend shows that almost 10% of the infected persons are at the risk of death. The case-fatality has been reported to be at 2.3% in China, 7.2% in Italy, 1.73% in South Korea. One of the dreadful characteristics of the COVID-19 is that it is highly efficient at transmission from human to human. SARS-CoV-2 transmits from one human to another through respiratory droplets and close physical contact. Droplet transmission may also occur through fomites in the immediate environment around the infected person. Although there have been multiple studies and trials, no effective vaccines or anti-viral treatments have been effective to prevent or treat SARS-CoV-2 infection and can take another 12-18 months for the evidence to be generated. In this context, the only remained options would be to explore the epidemiological trend and learn from countries who have controlled the infection successfully. The early detection of cases and community containment have been some of the successful strategies. South Korea was able to lower the COVID-19 cases by an extensive and concerted community testing. The traditional strategies of isolation, quarantine, social distancing and community containment helped China to hold its level of infection after the second half of March 2020. With the increasing number of cases, Italy, the United State and the United Kingdom have increased their testing facilities. Germany, for instance, started mass testing and community surveillance quite early on (proactive community testing) reflected on its low fatality rate. In Nepal by 5 April 2020, only 1,521 tests have been performed only among the suspected cases (a reactive testing method) who attend the hospital and so far 9 has been confirmed cases. Though the case was identified in January, the country-wide lockdown came into effect only on 24 March 2020. Based on the report provided by the Ministry of Health and Population, Nepal is trying its best to increase the number of isolation and quarantine facilities along with the provision of essential PPE. Nepal is at stage II (evidence of local transmission as opposed to imported cases only) of a pandemic but it is difficult to say how the disease is circulating in our population due to poor testing coverage and no proactive community testing. Current public health measures that are cost-effective, although not ideal would be to stringently follow social distancing. Social distance alone would be futile unless, other measures are in place that includes proactive community testing, providing essential medical equipment such as personal protective equipment (PPE), isolation and quarantine spaces, medical logistics such as infection control gears, and ICU facilities with adequate ventilators. While social distancing is the best measure, for now, community outreach for proactive testing with mobilization of community health workers and the use of technologies to inform the preventive measures and to dispel the fears, and rumors can be promising. Including the general public, health workers and policymakers require a strong collaborative platform to work together to consolidate the measures ahead to prevent the COVID-19 disaster in Nepal. Keywords: COVID-19, SARS-CoV-2 pandemic, surveillance, social distancing

Background: Infectious disease outbreaks following natural disasters are reported in literature. Outbreaks were documented following natural disasters in many countries including Haiti. Such possibility following 2015 Nepal earthquake was a public health concern. Risk factors needed evaluation by post-disaster outbreak investigation. Hence, present study was undertaken to investigate potentials for such outbreak and to generate evidence for public health intervention.Methods: The study was conducted between April – May, 2015, with the cooperation of National Public Health Laboratory, Epidemiology and Disease Control Division, Nepal Health Research Council and the Chinese team. Rapid Response Teams visited earthquake affected districts and collected samples for analysis. Syndromic surveillance approach was followed. Samples were collected from syndromic patients under supervision. Those sick prior to earthquake or receiving treatment were excluded. Blood, stool and throat swab samples, as indicated, were collected. Drinking water and food samples including captured live mosquitoes from inhabited areas were obtained for study with the help of EDCD. Laboratory analysis was performed at the NPHL.Results: Total samples were 360 (114 biological, 246 environmental). Salmonella spp. was detected in two and Varicella zoster in one blood sample. Influenza B virus was detected in one throat swab. Rota virus was detected in two, Shigella dysenteriae in one and Salmonella spp. in one stool sample. No pathogen detected in water or food samples. Mosquitoes tested negative for dengue virus.Conclusions: Post-earthquake outbreak investigated in disaster phase-2. Diarrheal, enteric fever pathogens and Influenza B virus were detected. Environmental samples tested negative for pathogens. Vigilance is necessary for other risk factors.

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

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

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

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

Not available.

Background: Tuberculosis is one of the significant public health problems of Nepal. Adherence to medication is very important for improving quality of life and preventing complication. Adherence to tuberculosis medications has significant economic and therapeutic consequences as non-adherence patients are at greater risk of developing complications which affect their health status and overall quality of life. The study aims to determine the factors associated with medication adherence and its effect on health related quality of life among tuberculosis patients in selected districts of Gandaki Province. Methods: A health facility based cross-sectional study was carried out among 180 tuberculosis patients registered under DOTS and receiving treatment more than or equal to 60 days. WHOQOL-BREF tools to assess quality of life and Morisky medication adherence scale (MMAS-8) was adopt to assess medication adherence. Data was entered in Epi-data and analysis was performed with the help of the Statistical Package for Social Science (SPSS). The odds ratio with a 95% CI was calculated and p-value of

ObjectivesThere is a dearth of information on transgender individuals in Nepal, particularly studies exploring their use of hormone therapies. The objectives of this study therefore were to explore (1) how hormones are used, (2) types of hormones used and (3) side effects experienced by transgender women after hormone use. This is the first study of its kind in Nepal addressing this important public health issue.SettingThe study was conducted in four districts of Nepal: Kathmandu, Sunsai, Banke and Kaski.Design and participantsThis qualitative study comprises eight focus group discussions (FGDs) and nine interviews. FGDs and three face-to-face interviews were held with transgender women aged 18 years and older and six interviews with stakeholders working with and advocating on behalf of this population. The study was conducted between September 2016 and March 2017.ResultsOur participants were young. The majority of FGD participants had completed school-level education and 40% had been using hormones for 1 to 3 years. Five overlapping themes were identified: (1) reasons and motivations for hormone use; (2) accessibility and use of hormones; (3) side effects; (4) utilisation of healthcare services and (5) discontinuation of hormone use.ConclusionHormone use was common in our sample. Most received information on hormone therapy online and through their peer networks. A few study participants sought doctors’ prescriptions for hormone therapy, but hormones were more likely to be bought from local private pharmacies or abroad through friends. This kind of self-medication is associated with a range of risks to the physical and mental health of transgender individuals. Incorporating information, education and communication about hormone therapy into existing health promotion interventions targeted to this population may help transgender people to make better informed choices.

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

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

The health system in Nepal is currently undergoing some very interesting radical reforms. The new Constitution in 2015 brought a complete restructuring of the country’s political system, creating a Federal Republic with seven Provinces. This change involves a significant devolution of power and resources from central to local level in many sectors including the health sector. This editorial warns of the risk of moving away the political focus from Public Health in a centralised political system

Background Non-alcoholic fatty liver disease (NAFLD) is mutually and bidirectionally linked with metabolic syndrome (MetS) of which it is both the cause and the consequences. Worldwide, 6.3 to 33% of the general populations are estimated to suffer from the disease with even higher prevalence in the group sharing metabolic co-morbidities. Hence, this study aims to recognize various risk factors including metabolic components and blood parameters to predict the possible incidence of the disease. Methods Total of 429 (219 NAFLD and 210 control) subjects were conveniently selected for study during the period of 9 months. Diagnosis of non-alcoholic fatty liver disease was done by liver imaging and based on liver enzymes. Assessment of metabolic syndrome was done by International Diabetic Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. All biochemical and hematological parameters and liver enzymes were estimated by using standard guideline. Mean comparison of quantitative data in different groups were performed using analysis of variance (one-way ANOVA). Risk estimation of NAFLD associated with each character was verified by Chi-square test. Results There was significant high levels of body mass index (BMI), waist circumference (WC) and lipid profiles in NAFLD patients in comparison to control population (p