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This study explores perceptions of Continuing Professional Development (CPD) opportunities among stakeholders in the profession of nursing in Nepal.Qualitative study using focus group discussions (FGDs).Eight FGDs were conducted in three major cities of Nepal with nursing stakeholders including nurse managers, matrons and directors/managers of private and public nursing colleges, representatives of nursing organizations, government officials, nursing academics and practitioners from the government and private sectors. The data were analysed thematically using Creswell's six steps of analysis and the Standards for Reporting Qualitative Research (SRQR) guideline was followed.The study generated three major themes: (a) policy level including the national situation of CPD, political influence and training guided by the policy; (b) organizational level incorporating perceptions towards forms of CPD, staff shortage, poor staff retention, seniority for training, financial constraints and lack of continuity of training; and (c) individual level including motivation for training and lack of relevant training.

Applying for a research grant is one of the skills new researchers need to learn. Writing a grant application can be an intimidating process. Most research funders have either an online application system or a standard application form that can be emailed to the funder. Although the length and layout of a grant application can vary between funding bodies, most ask for similar details, including a research proposal, the nature of the research team, a budget, a timeline, and often a risk assessment. This paper summarises key funding agencies in the health research field. Furthermore, it briefly outlines the general process of applying for grants related to health and health services research in the UK. To highlight some of the issues that can occur in the grant application process, we provide two examples of applications for international research grants from UK-based funding bodies, each had to be resubmitted before of it was successful in receiving funding.

Getting a PhD is the highest possible education qualification which only a small proportion of all students achieve. As a consequence, examining PhD research in the form of a doctoral thesis is specialist work. This paper highlights the different options that are available for PhD examiners. There are four general options: (1) pass, (2) rewrite and resubmit; (3) lower degree, with or without resubmission; and (4) fail the PhD. However, from our experience, of both being examined for our own PhDs and examining others at a range of different universities, we have noted a considerable variety in detail within these common options. This paper outlines a variety of outcomes of a PhD examination, followed by four short case studies, each reflecting on a particular aspect /differences we experienced as examinees or as examiners. This paper further aims to alert PhD candidates and examiners to study the examination rules set by the awarding university, as the details of the PhD examination outcome, and hence the options available to both examiners and the students may differ more than one might expect.

This paper reviews the mixed-methods studies from the last 2 years (2021-2022) into androgen use to highlight the most relevant developments within the field.The literature review found seven papers from 2021 to 2022. These seven cover a range of important considerations, including interventions to reduce androgen use, educational tools to increase professionals' knowledge, explorations on the comorbidity of use with other substances, motivations for use, potential risks factors for androgens' initiation, or risks of using androgens. Key findings include a greater understanding of motivations for use, particularly in females and older males; identification of potential risks for starting use/using androgens; benefits of including practical strength exercises in preventive intervention programmes and the efficacy of e-learning tools to increase professionals' knowledge of androgens use, as well as an increase in their confidence to support androgen users.The key implications for clinical practice are that we still need to support healthcare professionals to overcome the barriers for increasing their skills and knowledge around androgen use. A recognition that people who have become dependent on androgen use are potentially at risk of considerable harm, with further research needed into sub-groups of androgen users., http://links.lww.com/COE/A35.

Background The Middle East and North Africa (MENA) region continues to have the lowest prevalence of HIV (human immunodeficiency virus) in the world, less than 0.1%, yet new transmissions are increasing. Consistent condom use can reduce the probability of transmission by 90–95%, and its use remains as the staple prevention method; however, this isn’t the case for the MENA region, where condom use, knowledge of proper use, and accessibility are limited. Aims To conduct a systematic review on condom use, its use across different population groups, and its barriers and facilitators in countries that fall under the UNAIDS regional classification of MENA. Methods This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The search included electronic databases: PubMed/MEDLINE, Academic Search Ultimate, COCHRANE, APA PsycINFO, ScienceDirect, CINAHL Complete, Scopus. There was no date restriction. Results Of the 471 records retrieved, 45 articles were appraised and included in the analysis. The reported barriers and facilitators are sub-divided into personal, social, and structural factors. Condom accessibility, partner objection, and their perceived ineffectiveness were key barriers, whereas availability, cost, and lack of awareness were rarely mentioned. Concerns of personal health and future financial security, as well as positive peer influence and delayed sexual experience, were identified as motivators. Conclusion Condom promotion in the region needs to incorporate gender-based power in relationships and the influence of religion, as well as the legal and structural factors. More investment and research are needed for women-initiated contraceptive and digital healthcare initiatives.

International migration is in an increasing trend globally; internal migration is also very common, particularly in low- and middle- income countries (LMICs). Little attention has been paid to the impact of men’s migration on non-migrating women’s health. Therefore, we undertook a systematic review to examine the impact of men's migration on the health of women who remain behind in LMICs. We searched five databases, CINAHL, Google Scholar, PsychINFO, PubMed and Scopus, for publications from 2005 to 2022 using key search terms 'left-behind', 'women' and 'migration'. Thirty-three peer-reviewed publications were included in the review. Findings suggest that left-behind women had increased access to healthcare due to better financial positions (via remittances) and experienced more empowerment/autonomy in the absence of their husbands. This resulted in increased (a) decision-making regarding their health and (b) freedom of mobility to seek healthcare. Remittances led to improved food and housing security, a critical wider determinant of health. However, some studies reported that in the longer term, the physical health of women who remain behind was negatively impacted. Almost all studies on mental health reported higher depressive symptoms among migrant wives compared to women co-habiting with their spouses. Left-behind women feared contracting sexually transmitted infections from their migrant partners. National and local policies should include support groups and counselling services at the local health centre for women who remain behind. We recommend further studies on the areas presented above as well as unexplored areas such as vulnerability to violence and impact of remittance on health and nutrition.

Background: Anecdotal reports suggest an increasing prevalence of kidney problems in returnee Nepali migrant workers from the Gulf countries and Malaysia. Aims and Objectives: This study aims to (a) explore the magnitude of the kidney health-related problems in returnee Nepali migrant workers; and, (b) assess the need for further scientific investigations. Materials and Methods: This was a self-administered survey of practicing nephrologists in Nepal. All 51 nephrologists working in Nepal (at the time of this study) were approached by email for anonymous participation using an online survey platform. Data were collected between December 2019 and February 2020. Descriptive statistics were generated for data analysis. Results: A total of 38 nephrologists completed the survey. Almost all their migrant patients were: younger than 40 years, males, from rural areas of Nepal, and had worked in Gulf countries or Malaysia. Most (92.1%) of the respondents reported that the causes behind kidney-related problems of returnee migrant workers were of unknown etiology and less likely to be linked to traditional risk factors. Chronic kidney disease and glomerulonephritis were the most common kidney health-related problems. The vast majority of respondents (76.3%) thought that the returnee migrant workers are at a higher risk of kidney-related problems than the general Nepali population. Conclusion: Nepali labor migrants in the countries of the Gulf and Malaysia could be at a higher risk of kidney health-related problems than the general Nepali population. Further rigorous scientific investigation is warranted to examine the kidney-health-related risk of Nepali migrant workers.

This is an editorial only.

The number of scientific articles published each year is rapidly growing and so is the number of academic journals. This makes it impossible for an individual practitioner or researcher to keep track of all research published in their own field or sub-discipline. With the growing amount of publications, it is also becoming more difficult to distinguish between similar papers published on the same topic, in the same journal, or by the same researchers (or research team). This perspective paper could support students and novice researchers, outlines the difference between the unique identifier for: (1) you as the researcher, (2) a specific paper; and (3) a specific journal. This paper further outlines the various numerical identifiers associated with academic publishing to help demystify academic publishing.

Worldwide there is a growing interest in multidisciplinary and interdisciplinary research. This overview paper addresses some of the pitfalls and barriers to being an interdisciplinary researcher. Being involved in interdisciplinary research is not an easy option for an individual discipline expert. It requires individual skills, ability to see beyond one’s discipline and perhaps personality characteristics such as a great team player. Interdisciplinary research may involve a mixed-methods approach underpinned by conflicting, and according to some incommensurable, research philosophies. The paper uses some examples from our own experiences of working in interdisciplinary teams to illustrate its potential.

Complex Innovative Trial Design (CID) offers several potential benefits for clinical research, including the use of novel statistical techniques such as adaptive designs and Bayesian methods that require computer simulation to determine operating characteristics. By leveraging these techniques, CID has the potential to increase the probability of success for clinical trials while simultaneously reducing the time and cost required for drug development.

Caesarean section (CS) rate is rising dramatically worldwide. WHO recommended CS rate of 10-15% at populational level would not be the ideal rate at the hospitals level due to the differences on population they have been serving. At the hospital level, a perfectly effective system is necessary to understand the trends and causes of rising trends of CS as well as to implement effective measures where necessary to control the same. Hence, WHO recommended the Robson classification, which is also called the 10-group classification of CS (TGCS) as a global standard tool to assess, monitor and compare CS rates within healthcare facilities over time, and between health facilities. The Robson classification, proposed by Dr Michael Robson in 2001, is a system that classifies all women at admission at a specific health facility for childbirth into 10 groups based on five basic obstetric characteristics (parity, gestational age, onset of labour, foetal presentation and number of foetuses). This classification is easy and simple and mutually exclusive, highly reproducible, easily applicable, and useful to change clinical practice. It has many strengths such as simplicity, flexibility (further subdivisions can be made to increase homogeneity within groups). This classification helps to identify and analyse the contribution of each group to overall CS rates. It also allows distinguishing the main group of women who contributes most and least to the overall CS rates; so that the CS rates can be monitored in a meaningful, reliable, and action-oriented manner in each health facilities for optimal use of CS.

Background The COVID-19 virus is still with us, and in resource-limited countries, like Nepal, resurgence of a new variant is still a threat. In this pandemic, low-income countries struggle to provide essential public health services, including family planning. This study was conducted to explore what sorts of barriers are faced by women needing family planning services in Nepal during the pandemic. Methods This qualitative study was conducted in five districts of Nepal. Telephonic in-depth interviews were conducted with 18 women of reproductive age (18–49 years) who were the regular clients of family planning services. Data were coded deductively using the preexisting themes based on a socio-ecological model (e.g., individual, family, community, and health-facility levels). Results Individual level barriers included low self-confidence, inadequate knowledge on COVID-19, myths and misconception related to COVID-19, limited access to FP services low priority to SRH services, low autonomy in family and limited financial ability. Family level barriers comprised of partner’s support, social stigma, increased time at home with husbands or parents, un-acceptance of family planning services as essential health services, financial hardship due to loss of jobs, and communication with in-laws. Movement restrictions and transportation hindering access, unsecured feeling, violation of privacy, and obstacles from security personnel were the community level barriers and unavailability of preferred choice of contraception, increased waiting time, limited outreach services by community health workers, limited physical infrastructures, the behavior of health workers, stock out of commodities, and absence of health workers were health facility level barriers. Conclusion This study highlighted key barriers faced by women in seeking family planning services during the COVID-19 lockdown in Nepal. Policymakers and program managers should consider strategies to ensure continued availability of the full method mix during emergency, particularly since disruptions may go unnoticed and strengthen the provision of services through alternative service delivery channels to ensure sustained uptake of such services in this sort of pandemic.

Introduction: To date, there is no comprehensive systematic review and meta-analysis to assess the suitability of COVID-19 vaccines for mass immunization. The current systematic review and meta-analysis was conducted to evaluate the safety and immunogenicity of novel COVID-19 vaccine candidates under clinical trial evaluation and present a contemporary update on the development and implementation of a potential vaccines. Methods: For this study PubMed, MEDLINE, and Embase electronic databases were used to search for eligible studies on the interface between novel coronavirus and vaccine design until December 31, 2020. Results: We have included fourteen non-randomized and randomized controlled phase I-III trials. Implementation of a universal vaccination program with proven safety and efficacy through robust clinical evaluation is the long-term goal for preventing COVID-19. The immunization program must be cost-effective for mass production and accessibility. Despite pioneering techniques for the fast-track development of the vaccine in the current global emergency, mass production and availability of an effective COVID-19 vaccine could take some more time. Conclusions: Our findings invited a revisit to the reported solicited and unsolicited SAE for COVID-19 candidate vaccines. Hence, it is alarming to judiciously expose thousands of participants to COVID-19 candidate vaccines at Phase-3 trials that have adverse events and insufficient evidence on safety and effectiveness that necessitates further justification.

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Not applicable as this is an editorial.

Background: This study explores food beliefs among poor mothers related to feeding their offspring. Mothers’ misconception of a healthy diet is one of the major causes of nutritional problems in preschool-aged children in Nepal and these beliefs and attitudes can result in the inappropriate feeding of young children. Objectives: The main objectives of this study were:• identify major barriers for recommending healthy food that are associated with existing cultures, religions and ethnic divisions;• assess the knowledge, attitudes, and beliefs about nutritious food amongst mothers;• assess health-seeking behaviour for children of low socio-economic status. Methods: Study used a qualitative focus group discussion. Fifty participants took part in seven focus groups to explore their food beliefs. The qualitative focus groups aimed to collect in-depth information around food beliefs and data were thematically analysed. Results: The study identified six key themes: (a) poverty; (b) knowledge; (c) policy; (d) beliefs about breastfeeding; (e) food beliefs: and (f) health-seeking behaviours/cultural influences. Many participants thought that illiterate and underserved populations are generally exposed due to financial scarcity, poor knowledge and strongly rooted in cultural practices, and beliefs. This study found ‘diversified views’ as a major barrier to food and health-seeking behaviours. Some groups recognised the negative effects of existing beliefs and taboos. However, the spiritual healers highlighted the importance of linking beliefs with cultural and religious norms and values. They showed the complex relationships between food and health-seeking behaviours and food recommendations with financial status and the perceived cultural practices of society. Conclusions: This study suggests that a public health approach is needed to address nutrition problems associated with behaviour and revealed major barriers which were associated with poverty, resources, and mothers’ education level.

The sudden outbreak of Coronavirus-19 disease (COVID-19) is transforming the psychology and interpersonal relationships of millions across the globe. In Nepal, there is a need for national mental health surveys post COVID-19. This pandemic can cause traumatic experiences to the patients, caregivers, those quarantined and frontline healthcare providers which may lead to PTSD. Special attention should be focused on high-risk individuals, including policies to implement regular screening of PTSD symptoms.

Many traditional scientific journals carry an editorial at the start of each issue or perhaps in most issues. The more recently established online journals seemed to have discontinued this tradition, for example there is no editorial in Sociological Research Online or many of the online journals in the BMC stable, such as BMC Pregnancy & Childbirth or BMC Public Health. Over the past two decades we have published close to fifty editorials between us. We would like to highlight some of their specific features to offer advice and encouragement to would-be editorial writers, and, more generally, promote the writing and publishing of editorials. This paper includes an overview of the eight most recent editorials, all focusing on the hot topic of COVID-19, published in this scientific journal.

Burgeoning morbidity and mortality due to COVID-19 pandemic including the peaks in outbreaks due to different variants have attracted global attention. Although the development and rolling out of vaccines have been impressive, low- and middle-income countries suffer from a double burden: (1) lack of adequate vaccines; and (2) low vaccine uptake (vaccine hesitancy). The main objective of this study was to explore perceptions around COVID-19 and vaccine hesitancy among urban and rural population in Western Nepal. A qualitative study was conducted in six urban wards of Pokhara municipality and four rural municipalities in Kaski district of Nepal. A semi-structured interview guide was used to interview participants who were selected purposively to explore the perceived burden of COVID-19 pandemic, roles, and contributions of vaccine. Nineteen interviews were conducted by telephone following a government recommendation to avoid face-to-face meetings. Audio-recorded interviews were thematically analysed after transcription and translation into English. COVID-19 is a major (public) health concern and affects people at an individual, societal and national level. People dreaded its health hazards and consequences and seemed to be compliant with public health measures such as maintaining social distance, wearing masks and maintaining hygiene. Vaccine was considered to be a major intervention to fight the pandemic, nonetheless, the rationale and benefits of vaccines were blemished by the perceived lack of the vaccine’s effectiveness, duration of protection, and its potential side-events. Expedited development of vaccine was embraced with suspicion that vaccine may have incurred compromise in quality. Science and rationale behind vaccine were smeared by misinformation and clearly counteracting the misinformation were deemed critical. Providing information about vaccines through government entities (who are trusted) and respected individuals may engender trust and uptake of vaccine. Fighting off misinformation of COVID-19 is critical to curb the course of pandemic. Increased attention towards monitoring and investing in legitimacy of information and offering information through trusted sources can help improve the vaccine coverage.

Online communication tools are increasingly being used by qualitative researchers; hence it is timely to reflect on the differences when using a broad range of data collection methods. Using a case study with a potentially hard-to-reach substance-using population who are often distrustful of researchers, this article explores the use of a variety of different platforms for interviews. It highlights both the advantages and disadvantages of each method. Face-to-face interviews and online videos offer more opportunity to build rapport, but lack anonymity. Live Webchat and audio-only interviews offer a high level of anonymity, but both may incur a loss of non-verbal communication, and in the Webchat a potential loss of personal narrative. This article is intended for sociologists who wish to broaden their methods for conducting research interviews.

Female labour migration from the global south to the Middle East has increased in recent times. The rights and health of these women are often severely affected during and post migration. The aim of this study was to provide a clearer understanding of the process and context of female labour migration from Nepal. This included reasons for female labour migration, the risks, benefits, health impacts and measures to better support and protect women before, during and post migration.Data in this paper is based on semi-structured interviews conducted with ten key stakeholders (staff working with support organisations, policy-makers and researchers in the field) all with a professional interest in female labour migration from Nepal.It was found that government restrictions on female labour migrants working in the domestic sector increased undocumented migration through India, increasing the risk of trafficking and exploitation. Despite these risks, migration is attractive to many Nepalese women as it offers an opportunity to improve livelihood for them and their family. In addition, it can provide a ‘window to empowerment’. The study concludes that restricted migration, implemented in the name of protection, has undermined the rights, security and health of many Nepalese women.

Purpose Mental health disparities exist among Black, Asian and Minority Ethnics (BAME) populations. This paper aims to provide an overview of mental health services designed for the BAME population in the UK, both established BAME communities and refugee/asylum-seekers. Design/methodology/approach A range of electronic databases were searched for peer-reviewed studies conducted within the past decade in the UK. Using the Arksey and O’Malley methodology, data were extracted, analysed and summarised. Findings A total of 13 papers were identified, mostly non-randomised community-based. Studies were very heterogeneous in terms of their sample and service provided. After the initial appraisal, the authors presented a narrative synthesis. Overall, all studies reported positive mental health outcomes and beneficial effects. Research limitations/implications Because of the time limitations and quality of the papers, the authors only included peer-reviewed journal papers. Practical implications Mental health services provided for BAME people, both established and refugee/asylum-seekers are feasible and improve engagement with the services and mental health outcomes. Initiatives are required to facilitate the integration of these targeted services within mental health and community services for BAME in the UK. Originality/value This scoping review is a snapshot of the mental health services designed for BAME people in the UK, either established or refugee/asylum-seekers in the past 10 years and adds to the evidence-based knowledge from these studies.

Background/Aims: Uncertainty in illness is a well-known concept in health care literature. A considerable volume of research has investigated how people adapt to different health conditions and how the concept of uncertainty in illness relates to those populations. The aim of this article is to explore the concept of uncertainty in illness among mental health nurses and to provide an understanding of its relevance to people living with mental ill health. Method: A focus group was conducted with mental health nurses at an international psychiatric nursing conference. The focus group discussion was recorded and then transcribed and thematically analysed. Results: Uncertainty in illness among people living with mental ill health exists and manifests itself in various ways: uncertainty in the context of loss, uncertainty as a stimulus for change, and uncertainty as an integral part of the human experience and existence. Conclusions: Even though contemporary approaches in mental health nursing do not directly address uncertainty, the concept and its implications need to be considered and raised further among mental health professionals in order to improve support for people living with mental ill health in their process of personal recovery.

Background Despite breastfeeding providing maximum health benefits to mother and baby, many women in the United Kingdom do not breastfeed, or do so briefly. Purpose Using tenets of ethnography, this study aimed to explore the everyday experiences of first time breastfeeding mothers in the early weeks following birth. Methods Using a camcorder, five mothers in the United Kingdom captured their real-time experiences in a video diary, until they perceived their infant feeding was established. Using a multidimensional approach to analysis, we examined how five mothers interacted with the camcorder as they shared their emotions, feelings, thoughts and actions in real-time. Findings Mothers recorded 294 video clips, total recording time exceeded 43 h. This paper focuses on one theme, the therapeutic role of the camcorder in qualitative research. Four subthemes are discussed highlighting the therapeutic impact of talking to the camcorder: personifying the camcorder; using the camcorder as a confidante; a sounding board; and a mirror and motivator. Conclusion Frequent opportunities to relieve tension by talking to “someone” without interruption, judgement or advice can be therapeutic. Further research needs to explore how the video diary method can be integrated into standard postnatal care to provide benefits for a wider population.

Globally, frequent flooding causes higher magnitude of disaster among the developing and developed nations. Particularly, the Indian subcontinent is considered as highly vulnerable area for natural disaster and is affected most because of limited resources and coping strategies for post-disaster rehabilitation. Apart from the great impact on human health, floods have considerable impact on mental health. The most frequently diagnosed psychological illness in flood affected population is post-traumatic stress disorder (PTSD). In India, the incidence of PTSD in major natural disasters varies considerably depending upon the magnitude of event, with the highest rates reported of around 70%. Studies conducted during initial few months post-disaster, showed a higher occurrence of psychiatric manifestations. On the other hand, some reports suggested contrary results under similar circumstances. Notably, extreme age (children and elderly), female gender, socioeconomic status, pre-existing mental health issues and financial crisis post-disaster are the potential predisposing factors influencing the vulnerability of PTSD. In Indian context, the variability in the magnitude of psychiatric illness is mainly attributed to the ethnic diversity (vulnerable population), severity and type of flood event and social support. Still there is more to explore regarding the long-term sequelae of catastrophic floods on physical and mental trauma on disaster-affected populations.

Mental health in Black Asian and Minority Ethnic (BAME) communities is a rising public health concern in the UK, with key challenges around accessing mental health services. Our understanding of mental health issues in the growing Nepali and Iranian communities in the UK is very limited. Therefore, this study aims to explore the major factors affecting access to, and engagement with NHS mental health services. This study used a qualitative approach comprising in-depth interviews with seven Nepali, eight Iranians and six community mental health workers in the south of England. The data were analysed using a thematic approach. Six themes were identified: (1) stigma and fear; (2) gender; (3) language; (4) tradition and culture; (5) family involvement; and (6) lack of cultural awareness in health workers, all appearing to be major issues. This study contributes to a shared understanding of mental illness within two given cultural contexts to promote early interventions in UK mental health services. Developing cross-cultural perspectives in health care should be a priority in practice.

Traditionally the role of the external examiners in UK universities or more formally Higher Education Institutions (HEIs) is that of quality assurance (QA). Typically, an experienced academic who is not affiliated with the HEI (i.e., someone from another university) is invited to act as an external examiner for a particular course or a module. The external examiner’s primary role is to provide impartial and independent advice to ensure academic standards are upheld for a degree program; and that the degree is comparable with similar programs across the country and that the achievements of students are also comparable with students on courses at other universities. This primary role makes external examiners highly valued people in UK universities, and as a result, their views are nearly always taken seriously. Over and above this recognized primary role of QA, external examiners can also be engaged by the host university in other ways. These additional roles or tasks of the external examiner can help enhance teaching and learning in higher education. This chapter will reflect on the range of roles, including the ones that go beyond QA.

The novel coronavirus or COVID-19 is a new highly infectious virus affecting a large population across the globe. There is no specific therapeutic drug available against covid-19 hence the most effective public health measures need to strictly be adhered to without delay. Range of issues were reported to fight against COVID-19 in the current health system of Nepal which should be addressed and strengthened the full spectrum of the health system for its effective and sustainable response. It is crucial to understand the current health system at the local and provincial level and strictly adhere the federal government policies and plan as per the protocol for maintaining minimum infection prevention and control measures with having preventive and safety measures to both service providers and community people. To tackle those daily increasing number of COVID-19 cases, it provides an opportunity for the three tires of governments to reprioritize the health service in the national agenda for the effective prevention and response it. Although National health policy 2019 clearly articulated the need for equitable access and quality of health care services to all. Evidence shows that Nepal is in risk zone because of comparably weak health system that should be aware of all three tires of governments of Nepal and strengthen and control the present threat posed the daily increasing cases of pandemic.

Vaccination saves lives and can be an effective strategy for preventing the spread of the COVID-19, but negative attitudes towards vaccines lead to vaccine hesitancy. This study aimed to explore the factors influencing the uptake of the COVID-19 vaccine in the Nepali community in the United Kingdom (UK). This qualitative study included in-depth interviews with 20 people from Nepal living in the UK. Interviews were conducted by a native-Nepali speaker and all interviews were audio-recorded, transcribed, and translated into English before being analysed thematically. Our study found that attitudes towards COVID-19 are generally positive. Nine overlapping themes around barriers to COVID-19 vaccination were identified: (a) rumours and mis/disinformation; (b) prefer home remedies and yoga; (c) religion restriction; (d) concern towards vaccine eligibility; (e) difficulty with online vaccine booking system; (f) doubts of vaccine effectiveness after changing the second dose timeline; (g) lack of confidence in the vaccine; (h) past bad experience with the influenza vaccine; and (i) worried about side-effects. Understanding barriers to the uptake of the COVID-19 vaccine can help in the design of better targeted interventions. Public health messages including favourable policy should be tailored to address those barriers and make this vaccination programme more viable and acceptable to the ethnic minority communities in the UK.

Patient and public involvement/engagement (PPI/E) in public health research and health technology assessment (HTA) in high-income countries (HICs) have significantly increased over the past decade. PPI/E helps to improve research and HTA, ultimately benefitting patients and service users. PPI/E is a very new concept in many low- and middle-income countries (LMICs). This paper considers the importance of PPI in public health research and HTA in the development and implementation of technology in the health sector in South Asia. Currently, in this region, health technology is frequently adopted from HICs without local research and HTA. It also discusses the importance of local co-creation of technology to reflect the needs of users within a culturally appropriate setting. It is important for LMIC-based researchers to understand the potential of PPI/E and how it can contribute to it to improve health care and research, especially perhaps in the era of COVID-19.

Background: Migration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India. Methods: Six focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. A further nother 12 key persons working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data w ere as analysed thematically. Results: The interviewed returnee migrants worked in 15 of India’s 29 states, most as daily wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services. Conclusions: Nepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to. Keywords: Migrants, Returnees, Healthcare access, Qualitative research, Nepal, South Asia

Background: The World Health Organization has reported more than 31,186,000 confirmed cases of coronavirus disease-19 (COVID-19), including 962,343 deaths, worldwide as on September 21, 2020. The current COVID-19 pandemic is affecting clinical research activities in most parts of the world. The focus on developing a vaccine for SARS-CoV-2 and the treatment of COVID-19 is, in fact, disrupting many upcoming and/or ongoing clinical trials on other diseases around the globe. On March 18, 2020, the United States Food and Drug Administration (FDA) issued an updated guideline for the conduct of clinical trials during the current health emergency situation. The potential challenges, such as social distancing and quarantines, result in study participants’ inaccessibility and trial personnel for in-person scheduled study visits and/or follow-up. Due to the sudden onset and wide-spread impact of COVID-19, its influence on the management of clinical trials and research necessitates urgent attention. Therefore, our systematic review of the literature aims to assess the impact of the COVID-19 pandemic on the conduction of clinical trials and research. The search for the relevant articles for review included the keywords "COVID-19” AND "clinical trial" in PubMed, MEDLINE, Embase, Google scholar and Google electronic databases. Key findings include: delaying subject enrollment and operational gaps in most ongoing clinical trials, which in turn has a negative impact on trial programmes and data integrity. Globally, most sites conducting clinical trials other than COVID-19 are experiencing a delay in timelines and a complete halt of operations in lieu of this pandemic, thus affecting clinical research outcomes.

This editorial outlines the underlying nature of COVID-19 in Qatar; key public health measures and some of the lessons learnt from elsewhere across the world.

Background Migration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India. Methods Six focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. Another 12 key persons working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data was analysed thematically. Results The interviewed returnee migrants worked in 15 of India’s 29 states, most as daily wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services. Conclusions Nepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to.

Nepal started its full lockdown on March 24, 2020 and has been extended until 14 June 2020 as a precaution for prevention of COVID-19 infection. However, the strict lockdown has been criticised by many as not all the deaths are caused by COVID-19. The long and strict lockdown have had some negative effects in many aspects of health of an individual in the community. Many women are facing barriers to access maternity health care during the lockdown period and there has been rise in the suicidal behaviour such as sucidal attempt and actual suicide itself among the general population. As the lockdown began in Nepal, all the school and colleges were suspended, and children were forced to spend their time indoors and exams has been postponed leaving the students stressed about the uncertainty of their future. Social distancing, isolation and quarantine at home can result in isolated in an abusive home where there could be even more increase in abuse during such crisis. Millions of babies are missing the routine vaccinations which is a threat to global achievement in immunization. Apart from the rise in negative impact on health of Nepali people, there are other impacts related to health such as serious impacts on logistics and supply management including shortage of medicine and food supply; and impacts on farming including both production and sale. Nepal took several precautionary measures as a response towards COVID-19 such as First, limiting international air travel, sealing the land border-crossings with India and introduction of social distancing measures. However, with rise in deaths due to non COVID related causes and negative impacts on economic and financial condition of the country, there is a need for the country to ease its lockdown. Contact tracing, making face mask mandatory along with social distancing measure can be an alternative to lockdown for Nepal while the country is preparing to ease its lockdown. Social distancing, hygiene, lifestyle factors and PPE measures need to continue for long term, whilst we need to keep working on the big public health issues such as poverty reduction, improving access to health service to achieve universal health coverage.

Over the past few decades, we have seen several outbreaks of zoonotic coronavirus infections. These viruses have the potential of interspecies transmission leading to pathogenesis in humans. This particular respiratory coronavirus initially named 2019-nCOV, is known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In the current situation, abiding to the general health guidelines is utmost important to maintain stronger immunity for fighting infections and protection from other environmental hazards.

Background: Worldwide, 36.7 million people were infected with Acquired Immunodeficiency Syndrome (AIDS) by the end of 2015. Over the period 2007 to 2015, there was a declining trend in the prevalence of adult Human Immunodeficiency Virus (HIV) in the state of Kerala, India. The current study aims to find a suitable statistical modelling technique for the distribution of HIV incubation time and predict the cumulative number of AIDS cases. Materials and Methods: The requisite data were obtained from the Kerala State AIDS Control Society (KSACS) for the years 2007 to 2015. To assess the distribution of HIV incubation time, the data of 22 HIV-infected Keralite patients were retrieved from the medical records of a teaching hospital. Data included age, gender, and incubation time. The back-calculation method was utilized to predict the cumulative HIV/AIDS cases. Results: The estimated total cumulative AIDS cases in Kerala for the years 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014 and 2015 were found to be 35,777, 48,944, 62,039, 45,669, 45,668, and 43,605, 42,377, 39,362, 37,617, 39,583, 25,414 respectively using back-calculation method with Weibull (2) incubation time distribution. The mean incubation time of the total HIV cases (male and female) was 4.4 years which indicates a rapid progression of the disease in the state of Kerala. Conclusion: The back-calculation method is a powerful tool to estimate the cumulative frequency of AIDS cases; which predicted a declining HIV trend among Keralites. Moreover, the Weibull distribution is the best fitted distribution for HIV incubation time in our population.

In the areas of health promotion and health education, mixed-methods research approach has become widely used. In mixed-methods research, also called multi-methods research, the researchers combine quantitative and qualitative research designs in a single study. This paper introduces the mixed-methods approach for use in research in health education. To illustrate this pragmatic research approach we are including an example of mixed-methods research as applied in Nepalese research.Journal of Health Promotion Vol.6 2008, p.45-48

Aspirations of quality, equitable and respectful care for all women in childbirth have, so far, been unrealised. Sub-optimal care remains the norm in many settings despite decades of substantial investment, the introduction of evidence-based policies, procedures and training programmes. Improving the standard of institutional care for childbearing women in Afghanistan is an example. \ud \ud This ethnography of a large public Afghan maternity hospital explored the experiences, motivations and constraints of healthcare providers. The aim was to identify barriers and facilitators in the delivery of care. Participant observation, semi-structured interviews, and focus group discussions were used to gather diverse perspectives on childbirth and care between 2010 and 2012. The influences of the sociocultural setting and political economy on facility-based care are discussed in this paper.\ud \ud Under the surface of this maternity hospital, social norms were in conflict with the principles of biomedicine. Contested areas included the control of knowledge, equity and the primary goal of work. The institutional culture was further complicated by pressure from powerful elites. These unseen values and pressures explain much of the disconnection between policy and implementation, education and the everyday behaviours of healthcare providers. Improving the quality of care and equity in Afghan public maternity hospitals will require political will from all stakeholders to acknowledge these issues and find culturally attuned ways to address them. Furthermore, the notion of competing world-views on healthcare has relevance beyond Afghanistan.

There are many Nepali men working in the Middle East and Malaysia and media reports and anecdotal evidence suggest a high risk of workplace-related accidents and injuries for male Nepali workers. Therefore, this study aims to explore the personal experiences of male Nepali migrants of unintentional injuries at their place of work. In-depth, face-to-face interviews (n = 20) were conducted with male Nepali migrant workers. Study participants were approached at Kathmandu International Airport, hotels and lodges around the airport. Interviews were transcribed and analysed using thematic analysis. Almost half of study participants experienced work-related accident abroad. The participants suggested that the reasons behind this are not only health and safety at work but also poor communication, taking risks by workers themselves, and perceived work pressure. Some participants experienced serious incidents causing life-long disability, extreme and harrowing accounts of injury but received no support from their employer or host countries. Nepali migrant workers would appear to be at a high risk of workplace unintentional injuries owing to a number of interrelated factors poor health and safety at work, pressure of work, risk taking practices, language barriers, and their general work environment. Both the Government of Nepal and host countries need to be better policing existing policies, introduce better legislation where necessary, ensure universal health (insurance) coverage for labour migrants, and improve preventive measures to minimize the number and severity of accidents and injuries among migrant workers.

Despite being globally recognised as an important public health issue, mental health is still less prioritised as a disease burden in many Low-and Middle-Income Countries (LMICs). More than 70% of the global mental health burden occurs in these countries. We discussed mental health issues in LMICs under themes such as abuse and mental illness, cultural influence on mental health, need for dignity in care, meeting financial and workforce gaps and the need for national health policy for the mental health sector. We highlighted that although mental health education and health care services in most LMICs are poorly resourced; there is an urgent need to address issues beyond funding that contribute to poor mental health. In order to meet the increasing challenge of mental health illness in LMICs, there is a need for effort to address cultural and professional challenges that contribute to poor mental health among individuals. We have a notion that mental health should be integrated into primary health care in LMICs. Creating awareness on the impact of some cultural attitudes/practices will encourage better uptake of mental health services and increase the ease when discussing mental health issues in these countries which can contribute to reducing the poor mental health in LMICs.

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