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Background Tuberculosis (TB) remains a major public health problem in low- and middle-income countries. As of 2021, Nepal is one of the high TB burden countries, with an increasing prevalence of cases. Literature suggests disparities in access to and utilization of health services and health status of people based on gender and other social stratifiers, leading to inequities in Nepal. TB is a disease, which is high among settings with common practice of gender and social inequities. This study aimed to a) explore inclusiveness of gender and other social stratifiers in the key health related national policies and health management information system (HMIS) b) to conduct disaggregated and intersectional analysis of the tuberculosis cases enrolled in the National Tuberculosis Programme (NTP). Methods Desk review of key policies and HMIS was conducted. Secondary data analysis was carried out from two data sources i.e. annual report data of NTP (2017–2021) and 628 recorded tuberculosis cases from two Directly-Observed Therapy, Short-course (DOTS) centres (2017/18-2018/19). Bivariate and multivariate analysis was carried out to measure association between social stratifers and types of TB, patient registration category and treatment outcome. Results While the NTP has initiated collecting data on age, sex, ethnicity and location since 2014/15 through the HMIS, limited data was available to unmask the role of other social determinants of TB. Similarly, various TB data have remained static as they were not analyzed and disseminated in annual report. National data showed sex and age wise variation among reported TB patients. Association between sex of the patient and types of tuberculosis (p

Background: Lymphatic Filariasis (LF), is a debilitating and painful neglected tropical disease and is one of the leading causes of permanent disability. Division of work within and outside the household and everyday practices influenced by sex and gender intersect with other demographics and social stratifiers that influence exposure to LF, which ultimately impact on disease burden. Hence, this study aimed to explore the influence of gender and its intersection with other social stratifiers for the prevention and care seeking behavior of LF in Nepal. Methods: This qualitative study was conducted using in-depth interviews (IDIs) and focus group discussions (FGDs) as methods for data collection in Bardiya district. Total 22 IDIs and 2 FGDs were conducted with purposively selected adult male and female aged ≥18 years, residing in the selected area for over a year. The data collection was conducted between January and March 2020. The study received ethical approval from Nepal Health Research Council (Reg. no. 656/2019) and Ethics Review Committee of WHO, Geneva. Results: Men spend more time outside their household compared to women while fulfilling their roles and responsibilities which was largely determined by what is socially acceptable. Thus, limited men’s access to preventive health services as they often missed mass drug administration (MDA) programme held every year in their community and had limited resources to adopt preventive measures to protect themselves from mosquito bites while travelling. The ability to prevent exposure varied when some did not have adequate bed nets for all family members. Although, women in most cases made decision on the selection, purchase and use of protective methods, it was influenced by the patriarchal and gender norms as they felt their responsibility to take care of the family members and thus prioritized male, children and elderly members of the household in case of limited availability. Gender, marital status, ethnicity and geographical areas intersected and influenced individual’s ability to access source of information. There existed sex and religion wise differences on preference of health facilities. Conclusion: Access to resources, division of work, norms and values and decision-making power alone and its interaction with various social stratifiers shaped peoples’ vulnerability to disease, ability to prevent exposure and response to illness. Trial registration: Not Applicable

IntroductionDespite evidence that iron and folic acid (IFA) supplements can improve anaemia in pregnant women, uptake in Nepal is suboptimal. We hypothesised that providing virtual counselling twice in mid-pregnancy, would increase compliance to IFA tablets during the COVID-19 pandemic compared with antenatal care (ANC alone.Methods and analysisThis non-blinded individually randomised controlled trial in the plains of Nepal has two study arms: (1) control: routine ANC; and (2) ‘Virtual’ antenatal counselling plus routine ANC. Pregnant women are eligible to enrol if they are married, aged 13–49 years, able to respond to questions, 12–28 weeks’ gestation, and plan to reside in Nepal for the next 5 weeks. The intervention comprises two virtual counselling sessions facilitated by auxiliary nurse midwives at least 2 weeks apart in mid-pregnancy. Virtual counselling uses a dialogical problem-solving approach with pregnant women and their families. We randomised 150 pregnant women to each arm, stratifying by primigravida/multigravida and IFA consumption at baseline, providing 80% power to detect a 15% absolute difference in primary outcome assuming 67% prevalence in control arm and 10% loss-to-follow-up. Outcomes are measured 49–70 days after enrolment, or up to delivery otherwise. Primary outcome: consumption of IFA on at least 80% of the previous 14 days. Secondary outcomes: dietary diversity, consumption of intervention-promoted foods, practicing ways to enhance bioavailability and knowledge of iron-rich foods. Our mixed-methods process evaluation explores acceptability, fidelity, feasibility, coverage (equity and reach), sustainability and pathways to impact. We estimate costs and cost-effectiveness of the intervention from a provider perspective. Primary analysis is by intention-to-treat, using logistic regression.Ethics and disseminationWe obtained ethical approval from Nepal Health Research Council (570/2021) and UCL ethics committee (14301/001). We will disseminate findings in peer-reviewed journal articles and by engaging policymakers in Nepal.Trial registration numberISRCTN17842200.