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Sanju Bhattarai,1,2 Dikshya Wagle,2 Archana Shrestha,2– 4 Bjørn Olav Åsvold,1,5 Eva Skovlund,1 Abhijit Sen1,6 1Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 2Institute of Implementation Science and Health, Kathmandu, Nepal; 3Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; 4Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, 06510, USA; 5Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 6Center for Oral Health Services and Research (Tkmidt), Trondheim, NorwayCorrespondence: Sanju Bhattarai, Email sanju.bhattarai@ntnu.noIntroduction: Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management.Methods: We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale − 8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals.Results: We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives.Discussion: Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.Keywords: hypertension control, adherence, social support, Nepal

Introduction: Nepal's move to a federal system was a major constitutional and political change, with significant devolution of power and resources from the central government to seven newly created provinces and 753 local governments. Nepal's health system is in the process of adapting to federalism, which is a challenging, yet potentially rewarding, task. This research is a part of broader study that aims to explore the opportunities and challenges facing Nepal's health system as it adapts to federalisation. Methods: This exploratory qualitative study was conducted across the three tiers of government (federal, provincial, and local) in Nepal. We employed two methods: key informant interviews and participatory policy analysis workshops, to offer an in-depth understanding of stakeholders' practical learnings, experiences, and opinions. Participants included policymakers, health service providers, local elected members, and other local stakeholders. All interviews were audio-recorded, transcribed, translated into English, and analysed thematically using the six WHO (World Health Organization) health system building blocks as a theoretical framework. Results: Participants noted both opportunities and challenges around each building block. Identified opportunities were: (a) tailored local health policies and plans, (b) improved health governance at the municipality level, (c) improved health infrastructure and service capacity, (d) improved outreach services, (e) increased resources (health budgets, staffing, and supplies), and (f) improved real-time data reporting from health facilities. At the same time, several challenges were identified including: (a) poor coordination between the tiers of government, (b) delayed release of funds, (c) maldistribution of staff, (d) problems over procurement, and (e) limited monitoring and supervision of the quality of service delivery and data reporting. Conclusion: Our findings suggest that since federalisation, Nepal's health system performance is improving, although much remains to be accomplished. For Nepal to succeed in its federalisation process, understanding the challenges and opportunities is vital to improving each level of the health system in terms of (a) leadership and governance, (b) service delivery, (c) health financing, (d) health workforce, (e) access to essential medicines and technologies and (f) health information system. [ABSTRACT FROM AUTHOR]

The study was conducted among 50 mothers of Jhangad community to assess the knowledge regarding weaning practice on infant. Although the findings showed that most of the mothers had heard about weaning practice, only 76% mothers knew about ideal weaning time. There was a difference between the time for the initiation of weaning and selection of the food items. 92% used foods for weaning from local sources like rice and pulses (34%) because of its easy availability. A considerable number had a concept that proper weaning helps in overall growth and development of the child. 8% replied that it helps to prevent malnutrition. Health problems like diarrhoea were the most frequent problem complained by the mothers after weaning. [ABSTRACT FROM AUTHOR]

An abstract of the article "Tobacco Use Among Adults in Rural VDCs of Dhankuta, Eastern Nepal: a community based cross sectional survey," by D. K. Yadav and colleagues is presented.