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Introduction: The insurgence of COVID-19 has affected many aspects of human life and its repercussions on the life of children cannot be undermined. In addition to the serious impact on health and food insecurity, lack of recreational activities, school closure and switch to online learning have pushed children to excessive screen exposure. This study aimed to assess the duration of screen time and parental perspective towards screen viewing in children during the pandemic. Methods: A community-based descriptive cross-sectional study was carried out in Bharatpur Metropolitan City. A total of 384 parents were included purposively. A semi-structured questionnaire was used to interview the parents during the pandemic for one month. During the data collection, appropriate universal precautions for COVID-19 were taken. Results: The median duration of screen exposure was two hours (30 minutes to 9 hours). Most (65%) of the parents stated that their children spent more time on screen compared to pre-COVID-19 times. The majority (82%) of the parents were worried about the possible consequences of excessive screen time. More than two-thirds (72%) of parents thought that screen exposure also has various benefits for children. Conclusion: Most of the children exceeded the duration of screen time recommended by the World Health Organization. Most of the parents were worried about the harmful effects on the health and behavior of children.

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

Introduction: Smoking and use of other tobacco products are a global public health threat. The objective of the study was to predict the initiation and sustenance of smoking cessation (SC) by applying the multi-the- ory model (MTM) of health behavior change. Methods: In a cross-sectional study, the face-to-face interview was conducted by visiting different public places and coffee shops in Kathmandu Metropolitan, Nepal. A 30-item valid and reliable MTM-based survey instrument was administered to the participants who smoked cigarettes. Stepwise multiple regres- sions were conducted to explain SC behavior. The entire value of the Cronbach alpha coefficient (α) of the subscales and the scale was 0.91 which is excellent internal consistency. Results: A total of 132 participants completed the study (93.6%). The median age of participants was 35.53 years and 75% of them were males. The median number of cigarettes smoked per day was 7. Behavioral con- fidence (β = 0.06, P = 0.02) and changes in the physical environment (β = 0.11, P = 0.01) were significant predictors for the initiation of SC. Next, emotional transformation (β = 0.25, P < 0.001) was a significant predictor for sustenance for SC. Conclusion: MTM has the usefulness to assess both the initiation and sustenance behavior of SC. Poten- tial solutions using MTM constructs should be developed in future interventions to change behavior of SC.

Introduction In Nepal, approximately 31% of adult industrial employees have diabetes. While the prevention of type 2 diabetes through behavioural intervention has been disseminated, worksite could be an effective platform for the translation of this knowledge into action as employed adults spend most of their workday waking hours at workplaces.Methods and analysis We will conduct a randomised controlled trial to assess the effectiveness of a behavioural and a canteen intervention on diabetes risk reduction among those who are prediabetic at two worksites in eastern Nepal. We will recruit 162 adult full-time factory workers with haemoglobin A1c (HbA1c) of 5.7%–6.4% at baseline or fasting blood sugar of 100–125 mg/dL. The 8–14 months’ control period will be followed by the behavioural intervention where half of the participants will be randomised to receive the behavioural intervention and half will act as a control and will not receive any intervention. Then, all participants will receive the canteen intervention. The analysis will be intent-to-treat, comparing the difference in the change in HbA1c% between the behavioural intervention group and the control group using a two-sample t-test. The within-participant changes in HbA1c after 6 or more months on the canteen intervention among those not randomised to the behavioural intervention in the previous period will be assessed using the paired t-test.Ethics and dissemination Ethical approval was obtained from the Institutional Review Board at Yale School of Public Health, New Havens, USA and the Nepal Health Research Council.Trial registration number NCT04161937.