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This study is a comprehensive assessment of the waste management system in Besisahar municipality. Information and some data have been collected from the municipality of Besisahar, followed by interviews with municipal officials responsible for waste management, stakeholders, waste workers, and residents. A total of 230 households, 20 schools, 10 government and private offices, 10 financial institutions, 60 commercial hotels, restaurants, and shops, and 20 medical shops and healthcare institutions, were selected in this study by random sampling. An extensive field study was conducted within all municipal wards and at dump sites. The results indicated that 42.14% of solid waste was collected through door-to-door collection services, 5.87% was mismanaged in open public places, 11.21% was used as compost manure, and the rest was discarded on riverbanks, dug up, and burned. A large component of the characterization of household waste consisted of organic waste (68.03%), followed by paper/paper products (8.13%), agricultural waste (5.5%), plastic (5.21%), construction (3.81%), textile (2.72%), metals (0.54%), glass (1.01%), rubber (0.10%), electronic (0.05%), pharmaceutical (0.1%) and others (4.78%) in the Besishahar municipality. Solid waste generation was found to be at 197.604 g/capita/day, as revealed by cluster sampling in 230 households. Around 4.285 tons-solid waste/day were generated in urban areas, while 16.13 tons-solid waste/day was estimated for the whole municipality. An important correlation between the parameters of solid waste was found by statistical analysis. Currently, solid waste is dumped on riverbanks, open fields, and springs, creating environmental and health hazards. The findings of this study will be useful to Besisahar municipality and its stakeholders in forming policies that facilitate waste management practices in this region and promote sustainable waste management systems. [ABSTRACT FROM AUTHOR]

Food security and dietary diversity, defined as providing either physical (availability) or economic (accessibility) access to food, are linked with access to and control over productive resources and is a highly-gendered phenomenon. In Nepal, labor out-migration has increased household income and may have increased people's ability to access diverse food either by increasing investment in agriculture or purchasing various food items from the market. However, the relationship between household dietary improvement and labor out-migration is complex. Drawing on a survey of 1,053 migrant households in three agroecological regions of Nepal, this paper disentangles this complex phenomenon by showing how household dietary diversity and women's dietary diversity are influenced by biophysical, social, economic, and cultural factors. The influence of the amount of remittances, land abandonment, and women confined to the house by household chores are some factors that policy makers should consider seriously in designing gender-sensitive nutrition policies. The expansion of women's agency contributes to enhancing dietary diversity and specifically women's dietary diversity at the household level; however, how these factors determine an individual's dietary diversity depends on intrahousehold dynamics and relations. [ABSTRACT FROM AUTHOR]

Background: Providing improved water, sanitation, and hygiene (WASH) at a household level remains one of the major public health challenges in Nepal. Household mothers are likely to have limited access to combined WASH services, this is influenced by individual, and community factors. Individual components of an improved water source, sanitary toilet, fixed place for handwashing, and availability of soap and water were merged into one and called combined WASH. This paper aimed to identify the individual and community factors associated with combined WASH facilities and practices among mothers with children under five years in Nepal. Methods: A cross-sectional study was conducted using data from the Nepal Demographic and Health Survey (NDHS), 2016. The weighted sample size of this study was 4887 mothers with children under five years. The independent variables within the mothers included age, education, occupation, and caste/ethnicity in addition to education of the husband, wealth index, exposure to the newspaper, radio and television, residence, ecological zones, provinces, distance and participation in health mother groups were analyzed with the outcome variable of combined WASH. A multi-level mixed effects logistic regression model was used to assess the relationship of explanatory variables with WASH. Results: At an individual level, a rich wealth index was positively associated with combined WASH (AOR = 6.29; 95%CI: 4.63–8.54). Higher education levels and exposure to television had higher odds of having combined WASH. At the community level, the hill zone, urban residence, and Sudurpashim Provinces were positively associated with combined WASH while Madesh and Karnali Provinces and distance to water source greater than 31 minutes were associated with lower access to combined WASH. Conclusion: Educated and rich household have positive association with combined WASH. It is recommended that both the health and other sectors may be instrumental in improving the combined WASH service for mothers at households. [ABSTRACT FROM AUTHOR]

Ecosystem-based adaptation (EbA) is an ecologically sensitive, cost-effective, and locally adaptive climate adaptation strategy to strengthen the climate resilience of vulnerable communities. While many studies on EbA have been conducted in rural and mountainous regions or within the natural sciences realm, there is a lack of comprehensive research that assesses how urban EbA measures have been incorporated into existing policies and plans in Global South, including in Nepal. Ecosystem-based adaptation is in the early stages of its establishment as a fundamental component to address climate adaptation and sustainable development in urban environments. Accordingly, effective integration strategies, challenges, potential focal areas, and entry points have yet to be extensively studied. To address the literature gap, this paper analyses the types of EbA interventions and the extent of urban EbA integration within Nepal's climate, urban, and sectoral policies and plans. Direct content analysis and a qualitative scoring system were used to evaluate the plan components and assess the level of EbA integration. The findings indicate that the policies and plans recognise the importance of conserving, enhancing, and managing ecosystems for climate change adaptation, and EbA measures are mainly included in action-oriented sections. However, the results also reveal inadequate EbA integration, particularly in the information base, vision and objectives, and implementation aspects. The implementation component notably lacks comprehensive provisions for budget allocation, responsible authorities, definite timelines, and clear roadmaps. The breakdown of EbA integration in the policies and plans suggests that climate and urban plans substantially integrate urban EbA measures, but discrepancies exist with climate and urban policies and sectoral policies and plans. These findings collectively emphasise a pressing need to enhance the recognition and integration of urban EbA measures within policy frameworks with a view towards strengthening climate resilience and mitigating climate-related hazards in urban environments. [ABSTRACT FROM AUTHOR]

In this paper, the stochastic frontier gravity model is applied to analyze the trade potential between China and Nepal and the prospects of Lanzhou-Kathmandu South Asian rail-road freight trains (LKSARFT). Based on the statistical data, we test the Exports Efficiency (EE), Bilateral Trade Efficiency (BTE), Exports Trade Potential (ETP), Bilateral Trade Potential (BTP), Extended Exports Trade Potential (EETP), Extended Bilateral Trade Potential (EBTP), Improved Exports Trade Potential (IETP) and Improved Bilateral Trade Potential (IBTP) between China and Nepal, the following analysis results can be found: for the bilateral trade model, the bilateral non-efficiency factor decreasing at a rate of 0.057 with time increasing, bilateral trade increasing at a rate of 0.057 with time increasing. For the exports model, the exports non-efficiency factor increasing at a rate of 0.004 with time increasing, exports trade decreasing at a rate of 0.057 with time increasing. The BTE between China and Nepal increases when time changes, the EE from China to Nepal remains constant changing during the 18 years. The changing range of BTE is 0.002–0.05; the changing range of EE from China to Nepal is over 0.1, larger than the BTE. The BTE and EE ranking among the eight South Asian countries are ranking fifth and fourth during the 18 years. exports trade resistance from China to Nepal is larger than bilateral trade resistance; The import trade potential from Nepal to China is huge, the focus of bilateral trade between China and Nepal may be changed, there are more goods may be exported from Nepal to China, and China may become trade deficit when trading with Nepal. Then, the development bottlenecks of the LKSARFT are analyzed. Finally, we give policy directions to boost bilateral trade efficiency and tap the potential of bilateral trade between China and Nepal. [ABSTRACT FROM AUTHOR]

Introduction: Health-facility data serves as a primary source for monitoring service provision and guiding the attainment of health targets. District Health Information Software (DHIS2) is a free open software predominantly used in low and middle-income countries to manage the facility-based data and monitor program wise service delivery. Evidence suggests the lack of quality in the routine maternal and child health information, however there is no robust analysis to evaluate the extent of its inaccuracy. We aim to bridge this gap by accessing the quality of DHIS2 data reported by health facilities to monitor priority maternal, newborn and child health indicators in Lumbini Province, Nepal. Methods: A facility-based descriptive study design involving desk review of Maternal, Neonatal and Child Health (MNCH) data was used. In 2021/22, DHIS2 contained a total of 12873 reports in safe motherhood, 12182 reports in immunization, 12673 reports in nutrition and 12568 reports in IMNCI program in Lumbini Province. Of those, monthly aggregated DHIS2 data were downloaded at one time and included 23 priority maternal and child health related data items. Of these 23 items, nine were chosen to assess consistency over time and identify outliers in reference years. Twelve items were selected to examine consistency between related data, while five items were chosen to assess the external consistency of coverage rates. We reviewed the completeness, timeliness and consistency of these data items and considered the prospects for improvement. Results: The overall completeness of facility reporting was found within 98% to 100% while timeliness of facility reporting ranged from 94% to 96% in each Maternal, Newborn and Child Health (MNCH) datasets. DHIS2 reported data for all 9 MNCH data items are consistent over time in 4 of 12 districts as all the selected data items are within ±33% difference from the provincial ratio. Of the eight MNCH data items assessed, four districts reported ≥5% monthly values that were moderate outliers in a reference year with no extreme outliers in any districts. Consistency between six-pairs of data items that are expected to show similar patterns are compared and found that three pairs are within ±10% of each other in all 12 districts. Comparison between the coverage rates of selected tracer indicators fall within ±33% of the DHS survey result. Conclusion: Given the WHO data quality guidance and national benchmark, facilities in the Lumbini province well maintained the completeness and timeliness of MNCH datasets. Nevertheless, there is room for improvement in maintaining consistency over time, plausibility and predicted relationship of reported data. Encouraging the promotion of data review through the data management committee, strengthening the system inbuilt data validation mechanism in DHIS2, and promoting routine data quality assessment systems should be greatly encouraged. [ABSTRACT FROM AUTHOR]

Introduction: The outbreak of a global pandemic like COVID-19 has highlighted significant distress around mental health. The burden of mental health issues like anxiety and depression requires evidence-based intervention, especially in low-income settings like Nepal. The study aims to determine the prevalence of anxiety and depression and the factors associated with it among hypertensive patients. Materials and methods: The quantitative cross-sectional study design was used for this study. The study was conducted among 374 samples from selected wards of Kathmandu Metropolitan using a convenience sampling technique. Face-to-face interviews were conducted using a structured interview schedule. A Chi-square test was used to identify the statistical significance between dependent and independent variables. Binary logistic regression analysis was performed to determine the factors associated with anxiety and depression. Results: The prevalence of anxiety and depression among hypertensive patients during the COVID-19 pandemic was 27.8% and 24.3% respectively. According to the results of bivariate logistic regression analysis, smoking/tobacco consumption, staying in quarantine, positive COVID-19 test result, history of COVID-19 positive in the family, History of death due to COVID-19 in the family, visiting a hospital during the COVID-19 pandemic appeared as influencing factors of both anxiety and depression. Conclusion: Our findings suggest that COVID-19 has a substantial effect on the mental health of hypertensive patients. This study highlights the need to develop early intervention and coping strategies among this population to minimize the negative impact of COVID-19 on their mental health and well-being. [ABSTRACT FROM AUTHOR]

This study investigates the role of corporate governance structures as mediators between external supervision, credit appraisal measurement, capital adequacy, and the performance of commercial banks in Nepal. This research sheds light on the significance of effective corporate governance practices within Nepali commercial banks and how certain governance mechanisms may impact bank performance. A quantitative research design was employed, using data from commercial banks in Nepal for this study. Surveys were utilized to collect quantitative data. Structural equation modeling was used as a primary tool to assess the data. The findings add to existing literature about corporate governance and its effects on bank performance in emerging economies such as Nepal. The study's findings offer valuable insights into the significance of corporate governance structures, external supervision, credit appraisal measurement systems, and capital adequacy for commercial banks' performance in Nepal. The research methodology adds value to the existing literature using quantitative data collection methods. Its results may have practical ramifications for banks, regulators, and policymakers, suggesting effective governance practices as essential measures for increasing stability and performance at commercial banks. [ABSTRACT FROM AUTHOR]

Health literacy (HL) is crucial in achieving the Sustainable Development Goal of reducing one-third of premature mortality by 2030 from Non-Communicable Diseases (NCDs) and improving Universal Health Coverage. Low health literacy is linked to poor health outcomes, and evidence shows that levels of limited HL are high, even among highly educated individuals. This study aims to assess HL levels and related factors among patients with NCDs at Tribhuvan University Teaching Hospital (TUTH) in Nepal. A cross-sectional survey was conducted at TUTH among 303 patients with NCDs with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, Hypertension, Epilepsy, Asthma and Cancer who came for follow-up from December 2022 to February 2023. Data was collected via face-to-face interviews by the trained enumerators using a structured Health Literacy Questionnaire (HLQ) containing 44 items (divided into nine domains). Multivariate logistic regression analysis was performed using SPSS version 26, with statistical significance at 0.05, to determine the associated factors of HL. The mean ±SD age of the respondents was 47.4±16.18 years. More than half of the respondents were female (56.1%). The patients had higher HL in all HL domains except 'Navigating the healthcare system'. Educational status was significantly associated with six out of nine HL domains. Co-morbidity, attendance at health-related seminars, regular physical activity, and social connectedness were associated with at least one of the domains of HL. This study identified the important factors of HL, such as socio-demographic and medical factors among patients with NCDs. This highlights the need for a comprehensive approach to address identified gaps in HL, considering its multifaceted and composite nature and promoting interventions to improve HL in high-risk populations. [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]

Introduction: Sexual and Reproductive Health and Rights (SRHR) have been promoted globally, yet sexual and reproductive health (SRH) interventions are seldom evaluated from the perspective of service users and service providers. Very little is known about whether and why various target groups including general women are (or are not) practicing SRH -related self-care practices. This study explored SRH self-care practices and facilitators and barriers to the adoption of SRH self-care among reproductive-age women of Nepal. Methods: In this descriptive qualitative study, we conducted in-depth interviews in June 2022 with ten married women of reproductive age (service users) and four SRHR service providers (program managers and health service providers) in Nepal. Thematic analysis was conducted for data analysis. Results: We found that commonly practiced self-care practices were self-administration of contraceptives, self-management of pain, self-monitoring of pregnancy, self-awareness and seeking medical abortions (tele-abortion), self-medication for pre-exposure prophylaxis for HIV, and self-testing for HIV and pregnancy. The multi-level barriers to SRH self-care were poor knowledge and perceived lack of need for SRH self-care, limited access, and negative behaviors from the service providers. The program-related barriers included lack of evidence, limited financial resources, lack of accountability, and limited knowledge and skills among service providers on SRH self-care measures. Peer support, an increasing number of service sites, and access to and use of digital (health) tools emerged as the facilitators of SRH self-care. Conclusions: The findings of this study suggest that addressing barriers such as poor knowledge, limited access, and negative attitudes while leveraging facilitators such as peer support and digital tools is essential for promoting and enabling effective SRH self-care among women. Population-wide awareness programs supplemented by increasing service sites are essential for increasing SRH self-care practices. [ABSTRACT FROM AUTHOR]

Background: Studies on cross-informant agreement on adolescents' emotional and behavioral problems (EBPs) are sparse in low- and middle-income countries. This study aimed to assess parent-adolescent and teacher-adolescent agreement on EBPs and associated factors in Nepal. Methods: This cross-sectional survey included 1904 school-going adolescents aged 11–18, enrolled in government and private schools located in sixteen districts of Nepal. The Nepali versions of the Youth Self Report, Child Behavior Checklist, and Teacher's Report Form were administered to assess EBPs reported by adolescents, their parents, and teachers, respectively. Repeated measures analysis of variance (ANOVA) was done to assess mean differences in problem scores. Pearson's correlation was used to assess cross-informant agreement. Linear regression analysis was used to explore factors associated with cross-informant discrepancies in EBPs. Results: Adolescents reported significantly more problems than their parents and teachers. Mean Total Problem scores for the 90 common items in the adolescents' self-reports, parent reports, and teacher reports were 34.5 (standard deviation [SD]: 21.4), 24.1 (SD = 19.2), and 20.2 (SD = 17.5) respectively. Parent-adolescent agreement on Total Problems was moderate, whereas teacher-adolescent agreement was low. The parent-adolescent agreement was moderate to low for the two broadband scales and all syndrome scales, whereas the teacher-adolescent agreement was low for all scales. Female gender and ethnic minority status impacted both parent-adolescent and teacher-adolescent discrepancies. Family stress/conflicts impacted parent-adolescent discrepancies, while academic performance impacted teacher-adolescent discrepancies. Conclusions: Nepali adolescents reported more EBPs than their parents and teachers. The agreement between adolescents' self-reports and reports by their parents and teachers was moderate to low. Gender, caste/ethnicity, family stress/conflicts, and academic performance were associated with cross-informant discrepancies. It is crucial to collect information from different sources, consider context-specific needs, and discern factors influencing cross-informant discrepancies to accurately assess adolescents' EBPs and develop personalized approaches to treatment planning. [ABSTRACT FROM AUTHOR]

Background: Miscarriage is a major public health concern in low and middle-income countries (LMICs) like Nepal. This study aims to examine the factors associated with miscarriage among pregnant women of reproductive age (15–49 years) in the past 15 years. Methods: There were a total of weighted sample of 26,376 cross-sectional pregnancy data from Nepal Demographic and Health Surveys (NDHS) 2001, 2006, 2011, and 2016 combined together, which was used in the study. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify factors associated with miscarriage among pregnant women of reproductive age in Nepal. Results: The results showed that maternal age, contraception, tobacco smoking, wealth index, respondents' educational status, and, caste/ethnicity were found to be strong factors of miscarriage in Nepal. The likelihood of having a miscarriage among older women (≥40 years) was more than 100% (aOR = 2.12, 95% CI [1.73, 2.59]), among non-users of contraception was 88.9% (aOR = 1.88, 95% CI [1.68, 2.11]) (p<005) and non-smoking women had a 19% lower odds of miscarriage (aOR = 0.81, 95% CI [0.69, 0.95]). Respondents from the richest wealth index had 50% (aOR = 1.50, 95% CI [1.22, 1.85]) higher likelihood of miscarriage. Mothers with only primary education had a 25% higher chance of miscarriage (aOR = 1.25, 95% CI [1.09, 1.44]) compared to those with secondary and higher secondary education. In relation to caste/ethnicity, Dalits had 13% lesser likelihood (aOR = 0.87, 95% CI [0.74, 1.02]) and Janajatis had 26% lower chances of a miscarriage than Brahmin/Chettri (aOR = 0.74, 95% CI [0.64, 0.85]). Conclusion: Findings from this study show that miscarriages are associated with maternal age, use of contraception, smoking, wealth index, caste, and ethnicity. Interventions aimed to improve use of contraceptives, avoiding smoking and pregnancy planning on the basis of maternal age, are needed to prevent miscarriage. Also, women from Brahmin ethinicity and those with the highest income index require greater attention when it comes to miscarriage prevention strategies in Nepal. [ABSTRACT FROM AUTHOR]

Background: Worksite-based health programs have shown positive impacts on employee health and have led to significant improvements in cardiovascular risk factor profiles. We aimed to determine the effect of cafeteria intervention on cardio-metabolic risk factors diet in a worksite setting (Dhulikhel Hospital) in Nepal. Methods: In this one-arm pre-post intervention study, we recruited 277 non-pregnant hospital employees aged 18–60 with prediabetes or pre-hypertension. The study was registered in clinicaltrials.gov (NCT03447340; 2018/02/27). All four cafeterias in the hospital premises received cafeteria intervention encouraging healthy foods and discouraging unhealthy foods for six months. We measured blood pressure, fasting glucose level, glycated hemoglobin, cholesterol in the laboratory, and diet intake (in servings per week) using 24-hour recall before and six months after the intervention. The before and after measures were compared using paired-t tests. Results: After six months of cafeteria intervention, the median consumption of whole grains, mono/polyunsaturated fat, fruits, vegetable and nuts servings per week increased by 2.24(p<0.001), 2.88(p<0.001), 0.84(p<0.001) 2.25(p<0.001) and nuts 0.55 (p<0.001) servings per week respectively. The median consumption of refined grains decreased by 5.07 servings per week (p<0.001). Mean systolic and diastolic blood pressure decreased by 2 mmHg (SE = 0.6; p = 0.003) and 0.1 mmHg (SE = 0.6; p = 0.008), respectively. The low-density lipoprotein (LDL) was significantly reduced by 6 mg/dL (SE = 1.4; p<0.001). Conclusion: Overall, we found a decrease in consumption of refined grains and an increase in consumption of whole grains, unsaturated fats, fruits, and nuts observed a modest reduction in blood pressure and LDL cholesterol following a 6-month cafeteria-based worksite intervention incorporating access to healthy foods. [ABSTRACT FROM AUTHOR]

In Nepal, visceral leishmaniasis (VL) has been targeted for elimination as a public health problem by 2026. Recently, increasing numbers of VL cases have been reported from districts of doubtful endemicity including hills and mountains, threatening the ongoing VL elimination program in Nepal. We conducted a multi-disciplinary, descriptive cross-sectional survey to assess the local transmission of Leishmania donovani in seven such districts situated at altitudes of up to 1,764 meters in western Nepal from March to December 2019. House-to-house surveys were performed for socio-demographic data and data on past and current VL cases. Venous blood was collected from all consenting individuals aged ≥2 years and tested with the rK39 RDT. Blood samples were also tested with direct agglutination test, and a titer of ≥1:1600 was taken as a marker of infection. A Leishmania donovani species-specific PCR (SSU-rDNA) was performed for parasite species confirmation. We also captured sand flies using CDC light traps and mouth aspirators. The house-to-house surveys documented 28 past and six new VL cases of which 82% (28/34) were without travel exposure. Overall, 4.1% (54/1320) of healthy participants tested positive for L. donovani on at least one serological or molecular test. Among asymptomatic individuals, 17% (9/54) were household contacts of past VL cases, compared to 0.5% (6/1266) among non-infected individuals. Phlebotomus argentipes, the vector of L. donovani, was found in all districts except in Bajura. L. donovani was confirmed in two asymptomatic individuals and one pool of sand flies of Phlebotomus (Adlerius) sp. We found epidemiological and entomological evidence for local transmission of L. donovani in areas previously considered as non-endemic for VL. The national VL elimination program should revise the endemicity status of these districts and extend surveillance and control activities to curb further transmission of the disease. [ABSTRACT FROM AUTHOR]

Background: Appropriate complementary feeding plays a crucial role in the enhancement of child survival; and promotes healthy growth and development. Evidence has shown that appropriate complementary feeding is effective in preventing malnutrition and child mortality. Thus, the main objective of this study is to assess the prevalence of appropriate complementary feeding practice and associated factors among mothers of children aged 6–23 months. Methodology: A community-based cross-sectional study was conducted from August to December 2018. A total of 259 mothers who had children aged 6–23 months were selected randomly from the 714 eligible mothers. A structured questionnaire was used to collect the data from the respondents. The data were collected in a tablet phone-based questionnaire using the Open Data Kit mobile application by face-to-face interview. Data analysis was done in SPSS version 21. Multivariable logistic regression was used to identify the factor associated with appropriate complementary feeding practice. Result: The prevalence of appropriate complementary feeding practice was 25%. Mother and father with formal education (AOR 6.1, CI: 1.7–22.4 and AOR 5.6 CI: 1.5–21.2 respectively), counseling on IYCF (AOR 4.2, CI: 1.5–12.3), having kitchen garden (AOR 2.4, CI: 1.1–5.2) and food secured family (AOR 3.0, CI: 1.0–8.9) had higher odds of appropriate complementary feeding practice. Conclusion: This study revealed that a significant proportion of mothers had inappropriate complementary feeding practice for their children aged 6–23 months. This study highlights the need for behavior change communication and promotion of kitchen garden to address the associated factors and promote appropriate complementary feeding practice. [ABSTRACT FROM AUTHOR]

Nepal's poultry industry has experienced remarkable growth in the last decade, but farm biosafety and biosecurity measures are often overlooked by farmers. As a result, farms often suffer from sporadic and regular outbreaks of many diseases, impacting production and creating public health challenges. Poor management practices, including overuse of antibiotics for prophylaxis and therapeutics, can enhance the spread of poultry diseases by propagating antimicrobial resistance (AMR) that is threatening poultry and human health. We assessed biosafety, biosecurity risks and AMR stewardship in sixteen poultry farms located in four districts: Ramechhap, Nuwakot, Sindhupalchowk, and Kavre. Risk assessment and AMR stewardship evaluation questionnaires were administered to formulate biosafety and biosecurity compliance matrix (BBCM). Risk assessment checklist assessed facility operations, personnel and standard operating procedures, water supply, cleaning and maintenance, rodent/pest control and record keeping. Oral and cloacal samples from the poultry were collected, pooled, and screened for eight poultry pathogens using Polymerase Chain Reaction (PCR) tests. Based on BBCM, we identified the highest BBCM score of 67% obtained by Sindhupalchowk farm 4 and the lowest of 12% by Kavre farm 3. Most of the farms (61.6%) followed general poultry farming practices, only half had clean and well-maintained farms. Lowest scores were obtained for personnel safety standard (42.4%) and rodent control (3.1%). At least one of the screened pathogens were detected in all farms. Mycoplasma gallisepticum was the most common pathogen detected in all but three farms, followed by Mycoplasma synoviae. More than half of the farmers considered AMR a threat, over 26% of them used antibiotics as a preventive measure and 81% did not consider withdrawal period for antibiotics prior to processing of their meat products. Additionally, antibiotics classified as "Watch" and "Restrict" by the WHO were frequently used by the farmers to treat bacterial infections in their farms. [ABSTRACT FROM AUTHOR]

Soil fertility maps are crucial for sustainable soil and land use management system for predicting soil health status. However, many regions of Nepal lack updated or reliable soil fertility maps. This study aimed to develop the soil fertility map of agricultural areas in Resunga Municipality, Gulmi district of Nepal using the geographical information system (GIS) technique. A total of 57 composite geo-referenced soil samples from the depth (0–20 cm) were taken from the agricultural land of an area of 52 km2. Soil samples were analyzed for their texture, pH, organic matter, total nitrogen, available phosphorous, available potassium, available boron, and available zinc. These parameters were modelled to develop a soil quality index (SQI). Using the kriging tool, obtained parameters were interpolated and digital maps were produced along with soil quality and nutrient indices. The result showed that the study area lies within the fair (0.4 to 0.6) and good (0.6 to 0.8) range of SQI representing 96% and 3% respectively. Soil organic matter and nitrogen showed moderate variability exhibiting a low status in 95% and 86% of the total study area. Phosphorous and potassium showed medium status in 88% and 75% of the study area, respectively. Zinc was low and boron status was medium in most of the area. To maintain soil fertility is by improving the rate of exogenous application of fertilizers and manures. The application of micronutrients like boron and zinc is highly recommended in the study area along with organic manures. The soil fertility map can be used as a baseline for soil and land use management in Resunga Municipality. We recommend further studies to validate the map and assess the factors affecting soil fertility in this region. Soil fertility maps provide researchers, farmers, students, and land use planners with easier decision-making tools for sustainable crop production systems and land use management systems. [ABSTRACT FROM AUTHOR]

Bamboo are the fastest growing perennial woody grasses that have versatile applications. Most of the local people inhabiting the riverine area of the Siwalik region of Nepal rely on bamboo products for economic benefits and medicinal uses. Our objective was to identify the diversity of bamboo species, their ethnomedicinal practices, and economic and ecological importance. Data were collected by direct observation, key informant interviews, participatory rural appraisal, inventory technique, focus group discussions, and a household survey using semi-structured and structured questionnaires. We recorded four genera and nine species of bamboo, of which eight species have been used for agriculture, five for medicine, four for construction, food, fodder, artifacts and religious purpose, three for river embankment, and two for ornamental purpose. As the local people in the study area were deprived of medical facilities, using traditional herbal medicine to cure various diseases was a common practice. The inhabitants responded that they use bamboo-based primary ethnomedicinal care even against snake and scorpion bites. Similarly, they use bamboo young culm for reducing body weight and control diabetes. The value of the informant consensus factor was found to be maximum for the bamboo against snake and scorpion bites (1.0) and minimum for weight loss (0.81). This study concludes that the traditional utilization of all kinds of bamboo in the region is vast despite their less diversity. The recorded bamboo species are used not only for food and fodder but also in preparing artifacts, soil nutrients restoration in the fallow land, construction materials for the rural people, river embankments, and religious and spiritual purposes. Therefore, if grown on a large scale, bamboo can provide sustainable benefits for the local users and ecological aspects. Bambusa tulda and Dendrocalamus strictus have a broad spectrum of pharmacological agents. Considering the multifaceted application of bamboo in the Siwalik area, it is worthwhile to encourage the local people to bamboo plantation, which would contribute to supplement their household requirements and be one of the alternative livelihood options. [ABSTRACT FROM AUTHOR]

Background: Inappropriate use of antimicrobials is a global public health issue, particularly in developing countries, including Nepal, where over-the-counter sales and self-medication of antimicrobials are common. Objectives: To explore knowledge, perceptions, and practices of antimicrobials and their resistance among medicine dispensers and community members in Nepal. Methods: The study was conducted in three rural and five urban municipalities of the Kavrepalanchok district from May 2021 to August 2021. Data were collected using two qualitative approaches: In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). Data were analyzed using thematic analysis that combined deductive and inductive approaches to identify codes under pre-specified themes. Results: A total of 16 In-depth interviews with medicine dispensers and 3 focus group discussions with community members were conducted. Knowledge regarding antimicrobial resistance varied among dispensers. Those with a prior educational background in pharmacy often had good knowledge about the causes and consequences of antimicrobial resistance. Meanwhile, consumers were less aware of antimicrobial resistance. Community members perceived antimicrobials as effective medicines but not long-term solution for treating diseases. They reported that dispensing without a prescription was common and that both consumers and dispensers were responsible for the inappropriate use of antimicrobials. On the contrary, several dispensers said that self-medication was common among the consumers, especially among more educated groups. The medicine dispensers and consumers expressed concerns about the weak enforcement of policies regarding pharmacy drug use and dispensing practices. Conclusion: Promoting and strengthening the appropriate use of antimicrobials among medicine dispensers and community members is crucial. Bold policies and collective implementation of regulations could help combat antimicrobial resistance. [ABSTRACT FROM AUTHOR]

In remote communities, diagnosis of G6PD deficiency is challenging. We assessed the impact of modified test procedures and delayed testing for the point-of-care diagnostic STANDARD G6PD (SDBiosensor, RoK), and evaluated recommended cut-offs. We tested capillary blood from fingerpricks (Standard Method) and a microtainer (BD, USA; Method 1), venous blood from a vacutainer (BD, USA; Method 2), varied sample application methods (Methods 3), and used micropipettes rather than the test's single-use pipette (Method 4). Repeatability was assessed by comparing median differences between paired measurements. All methods were tested 20 times under laboratory conditions on three volunteers. The Standard Method and the method with best repeatability were tested in Indonesia and Nepal. In Indonesia 60 participants were tested in duplicate by both methods, in Nepal 120 participants were tested in duplicate by either method. The adjusted male median (AMM) of the Biosensor Standard Method readings was defined as 100% activity. In Indonesia, the difference between paired readings of the Standard and modified methods was compared to assess the impact of delayed testing. In the pilot study repeatability didn't differ significantly (p = 0.381); Method 3 showed lowest variability. One Nepalese participant had <30% activity, one Indonesian and 10 Nepalese participants had intermediate activity (≥30% to <70% activity). Repeatability didn't differ significantly in Indonesia (Standard: 0.2U/gHb [IQR: 0.1–0.4]; Method 3: 0.3U/gHb [IQR: 0.1–0.5]; p = 0.425) or Nepal (Standard: 0.4U/gHb [IQR: 0.2–0.6]; Method 3: 0.3U/gHb [IQR: 0.1–0.6]; p = 0.330). Median G6PD measurements by Method 3 were 0.4U/gHb (IQR: -0.2 to 0.7, p = 0.005) higher after a 5-hour delay compared to the Standard Method. The definition of 100% activity by the Standard Method matched the manufacturer-recommended cut-off for 70% activity. We couldn't improve repeatability. Delays of up to 5 hours didn't result in a clinically relevant difference in measured G6PD activity. The manufacturer's recommended cut-off for intermediate deficiency is conservative. [ABSTRACT FROM AUTHOR]

Background: Informal caregivers played a significant role in caring for COVID-19 patients during hospitalization in Nepal. This study aimed to understand the experiences of family caregivers attending to their relatives in a COVID-19 hospital in Nepal. Methods: A descriptive phenomenological approach was adopted to understand the caregiver's experience in supporting their relatives admitted to the COVID-19 hospital of the BP Koirala Institute of Health Sciences (BPKIHS). Thirteen caregivers of COVID-19 positive patients were purposively selected from April to June, 2022. Face-to-face interviews were conducted at a caregiver residential facility using the interview schedule developed by the department for the purpose of data collection after obtaining ethical clearance from the Institutional review committee of BPKIHS. Data were audio recorded and manually analyzed. Results: Among the 13 caregivers, six were male and seven were female. The findings were categorized into five domains: challenges encountered, changes in physical and mental health, changes in roles and responsibilities, positive experiences, and strategies to ease caregiving tasks. Major challenges included financial burdens, communication problems, stigmatization, Insecurity, substandard accommodation, and visitor restrictions. Caregivers reported negative emotions, unmet physical health needs, and shifts in family and occupational roles. Despite these challenges, caregivers attempted to cope positively and acknowledged the efforts of healthcare personnel and other family members. Suggestions for improving caregiving included providing essential medical and basic services within the hospital, enhancing accommodation facilities, establishing proper communication channels, and allowing visitations. Conclusions: Caregivers of COVID-19 patients face significant challenges during the caregiving process. Enhancing hospital services, promoting effective communication, fostering positive attitudes, and ensuring a safe environment can facilitate caregiving tasks. [ABSTRACT FROM AUTHOR]

Background: Previous studies have indicated the association between stigma and depressive symptoms among frequently stigmatized groups, such as men who have sex with men (MSM). While this association has been suggested in the literature, there is a dearth of evidence that examines whether food insecurity statistically mediates the relationship between stigma and depressive symptoms. Methods: This cross-sectional study conducted between October and December 2022 among a sample of 250 MSM in Kathmandu, Nepal, recruited through respondent-driven sampling. An unadjusted model including the exposure (stigma), mediator (food insecurity), and outcome variables (depressive symptoms) and an adjusted model that controlled for sociodemographic, behavioral, and health-related confounders were used. Bootstrapping was utilized to estimate the coefficients of these effects and the corresponding 95% confidence intervals. Via bootstrap approach, we find out the mediating role of food insecurity in the association between stigma and depressive symptoms. Results: Depressive symptoms, stigma, and food insecurity were 19.6%, 24.4%, and 29.2%, respectively, among MSM. Food insecurity was associated with higher age (b = 0.094; 95% CI = 0.039, 0.150) and monthly income (b = -1.806; 95% CI = -2.622, -0.985). Depressive symptoms were associated with condom-less sex in past six months (b = -1.638; 95% CI = -3.041, -0.092). Stigma was associated with higher age (b = 0.196; 95% CI = 0.084, 0.323) and PrEP uptake (b = 2.905; 95% CI = 0.659. 5.248). Food insecurity statistically mediated 20.6% of the indirect effect of stigma in depressive symptoms. Conclusion: Our findings show that food insecurity affects the relationship between stigma and depressive symptoms in this population. Reducing food insecurity and addressing the stigma surrounding sexual orientation should be a priority when addressing mental health concerns among MSM in Nepal and other resource-limited countries with similar socio-cultural settings. [ABSTRACT FROM AUTHOR]