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The article explores how Nepalese public schools' traditional hierarchy-dominated educational culture shapes teachers' professional growth and sense of identity. Through the narrative inquiry approach, I explored teachers 'professional identity development using Gee's (2000) identity framework. The data revealed that hierarchy and power relations between the teachers and the social context fundamentally shaped teacher identity development. However, the study further showed that professional hierarchy was not uni-layered, the power was not one-directional, and the domination was not permanent but rather dynamic. Factors like academic qualifications, job status, technological skills, and social status made the hierarchy complex. More interestingly, hierarchical relationships did not always undermine teacher empowerment but confidence in some cases. For example, when a teacher in a marginalized position due to some factors such as poor health condition was viewed as a role model or capable of success despite challenges, they achieved high value from their colleagues.

This article examines the role of gender difference in a qualitative interview from the theoretical lenses of the sociocultural perspective of teachers' identity in a localized context of Ph.D. field research. The study blends the researcher's critical reflections during interviewing female teachers in exploring their teacher identity and existing literature on gender differences in a qualitative interview. In addition, a research diary is used as the data source to unpack the complexity of gender dynamics in a qualitative interview. To add to the discussion of gender difference in a qualitative interview, we argued that gender difference between the interviewer and the interviewee mediates and shapes the data collection in a qualitative interview. Thus, to understand the role of gender difference in a qualitative interview, it is necessary to do a comprehensive analysis of the complex dynamics of gender matching, the cultural background of the interviewee, and possible power relations between the researcher and participants. This study contributes to the dynamics in interviewing women by a man outside the Western cultural setting, particularly during a field research experience by a Ph.D. scholar.

Studies on Psychological Sense of School Membership (PSSM) have been widespread globally for three decades. However, it has not been discussed in the context of Nepali schools' education. A positive sense of belongingness to schools among the students is essential to foster their good academic achievement as well as their mental health. Furthermore, it also increases students' motivation and peer adjustment. This study uncovers the sense of school belongingness of grade eight students in community schools in Nepal employing a descriptive survey design under quantitative research. The five points PSSM scale, a valid and widely used measurement scale, has been used to examine the students' perceptions about their school membership. Four major concepts have emerged from the data analysis: sense of attachment with school, sense of acceptance, sense of school ownership, and sense of respect and honor. Results revealed that students lack a strong sense of membership towards their school although they have feelings of attachment with their school. While students have a strong perceived sense of school ownership, they feel of being a weaker relationship with their teachers. Therefore, the study has immediate application to create awareness about the psychological sense of school membership among students and PSSM into academic discourse so that the Ministry of Education can initiate the necessary measures for improved students' learning.

Aim/Purpose: This study explores how online writing groups facilitate the academic identity development of doctoral scholars. Background: Academic institutions around the world, and especially in developing societies, are demanding increasing amounts of research and publications from their doctoral scholars. The current study used an online writing group to facilitate writing skills development, which bolstered the academic identity development of participating scholars. Academic identity is defined as the becoming and being of an academic scholar, with writing skills as a means of acquiring and performing the status and skills of a scholar. It is reflected in the confidence, contribution, and relationship carried out in writing as a member of the academic community. Methodology: This study utilizes narrative inquiry as a research methodology to capture the experiences of six doctoral scholars from two universities in Nepal. We explore the academic identity of doctoral scholars from a sociocultural perspective, employing unstructured interviews, meeting notes, and entry and exit surveys of the online writing group. Contribution This article shows how online writing groups offer unique and impactful opportunities for networking, collaboration, and problem-solving, which can significantly enhance their writing abilities and prospects of publication, thereby fostering their intellectual agency and academic identity. Findings: This study reports three findings of the value of online writing groups: addressing gaps in formal education, community as a form of accountability, and virtual community as a platform for identity development. On the final finding of identity development, we identify and discuss four themes from data analysis: growth of self-image as scholars, strengthening of commitment to scholarship, identification of venues for expanding the scope of publication, and enhancement of digital skills. The informal and collaborative nature of online writing support facilitated socially constructivist learning, which was highly conducive to the development of academic identity among emerging scholars. Recommendations for Practitioners: It is recommended that institutions implement and encourage online writing support programs as an effective means of addressing gaps in doctoral education. While this program can fill gaps in the low-resource contexts of developing countries, it can bolster formal mentoring in any context. Recommendations for Researchers: Further research should use large-scale or longitudinal studies to explore how informal, especially online writing support and collaboration, accelerate research and writing skills, scholarly productivity, and overall academic identity formation of doctoral scholars. Impact on Society: As societies around the world accelerate their demand for doctoral degrees and also require research and publications for degree completion, new and creative approaches utilizing emerging technologies could help to fill gaps in curriculum and support systems for their doctoral scholars. Future Research: Future research could expand the scope and take a longitudinal approach for more fine-grained data and developing broader perspectives.

The COVID-19 pandemic has affected higher education institutions (HEIs) worldwide and reshaped the existing educational system. Due to travel constraints and physical separation, there has been a global shift toward distance learning, and Nepal is no exception. This research intends to assess the practicality of online education by evaluating learners' experiences amidst COVID-19. A cross-sectional study was directed among HEIs students in Nepal using self-structured questionnaires. Our study revealed that 64.6% of the respondents were unsatisfied with online classes. More than half of the respondents (53.4%) use cell phones for online studies. Online education was reported to be unappealing to 28.8% of respondents. Variables such as age group (p = 0.05), enjoying class (p < 0.001), hours spent for an online class in a day (p = 0.05), and period for educational work using an electronic device (p = 0.1) were found significant with satisfaction level using both bivariate test and inferential test of univariate binary logistics regression. The challenges and opportunities encountered among students and faculties are highlighted along with the recommendations for fortifying communication in online-based teaching/learning.

This small scale ethnographic study is carried out in a public school of Kaski district in order to explore pedagogical practices from the perspectives of primary teachers as a course requirement of M Phil in Education Studies from Graduate School of Education, Tribhuvan University. Interview with three primary teachers was taken along with classroom observation. Data are analyzed qualitatively based on interview transcription, classroom observation record and researcher's field note. The study explored pedagogical practices in two broad global themes (1) shifting from traditional to constructivist teaching, (2) multiple school transition and curriculum. This article argue that primary teachers are in self-transition from traditional teaching to constructivist approach which is remarkable paradigm shifting on primary teachers' understanding of pedagogical practices. Similarly, multiple school transition and hangover of English as Medium of Instruction are major policy related challenges in order to renovate the existing teaching practices at primary level.

The purpose of this study was to explore how academic leaders of Nepali universities are experiencing entrepreneurship, changing contexts of higher education, and entrepreneurial activities to cope up with those changing contexts in order to lead universities. This inquiry is based on interpretive paradigm, which includes a multi-method approach. Five universities of Nepal were the researcher's living territories, where he interacted with nine participants in order to generate their narrative stories and experiences. The researcher explored and derived meanings from their stories and experiences, and in doing so, the researcher went through the process of coding, synthesizing, developing themes, analyzing, and interpreting meanings merging signature literature and theories of leadership and entrepreneurship. Through this enquiry, the researcher learned that entrepreneurship has multilayered meanings rooted in academic culture and society which could be understood being a part of the process. The researcher also learned that entrepreneurship is a process of dreaming and tracking a big picture, advocacy of change, elaboration of cognition, crossing the point of no return, a journey of togetherness, and tactful management of conflicts. The researcher also learned that changes in higher education in Nepal could be grouped under demand and supply market change. Within demand market, access, policy and awareness of parents and students are observed to have changed whereas within supply market, institutional providers, technology, pedagogy, curriculum and evaluation are found to have changed in higher education in Nepal. Apart from these, the researcher also learned that academic leaders of Nepali higher education have performed entrepreneurial activities like value added new programs, research and technological activities, fundraising activities, plan giving activities, retail sales and services, and real estate activities creating different values in order to cope up with those changing contexts in higher education. When the researcher examined the experiences and stories of the participants from leadership standpoint, he concludes that a vignette of entrepreneurship, changing context in higher education, and performance of entrepreneurial activities, have a nexus of dynamism in higher education.

This article aims to explore the policy provisions and practices of the local curriculum in primary level schools. Data are generated from teachers, head teachers, resource persons, and Assistant District Education Officer by using interview and focus group discussion. In addition, document analysis is done to locate the existing implementation status of local curriculum. The study revealed that the provision of local curriculum exists only on policy that lacks implementation in most primary schools. The popular trend of teaching English language is replacing the local curriculum. Teachers and head teachers are not well-informed and not acquainted with the developing guidelines of local curriculum. Similarly, they are perceived as lacking of technical knowledge in designing curricula. Therefore, there is a serious gap between the policy intention and its execution.This has created dilemma in practicing the local curriculum at primary level education in Nepal.

This study explores how young Bhutanese-Nepali refugee women experience racism within and outside of school settings. Using data collected from a 16-month community-based culturally responsive leadership project, we document how everyday racial othering impacts the youth's already fragile sense of identity and belonging. We explore how racial othering is produced through the denigration of language use, body image and community cultural practices. The research highlights the challenges of responding to anti-immigrant racism when negotiating spaces such as schools, workplaces, and peer culture. The findings illustrate how Bhutanese young women learned to walk away, resorted to talk-back and learned to cope with racism, and are negatively impacted by the verbal violence they encountered. Our research findings indicate how anti-Asian racial othering produces harm, leading the young women to have low self-esteem, self-doubt and anxiety. The young women's experiences reveal how racism impedes the desire and the ability to claim citizenship. The study calls for the need to recognize how immigrant/refugee experiences of being violated and aggrieved are often silenced or unrecognized and calls for the broader need for schools to engage with the struggles faced by young immigrant/refugee women.

The 2022 Monkeypox Disease (MPOX) outbreak was declared a pandemic after detecting multiple human-to-human monkeypox cases in ‘non-endemic’ nations. The index case of MPOX has been reported in Nepal. Also, the disease burden in neighboring countries and international travel and tourism could increase the MPOX burden in Nepal. This study recruited 443 study participants between August 25 and September 10, 2022, using the snowball technique and using descriptive statistics to assess the awareness and knowledge of MPOX. Approximately 82% (n=361) of the study participants were young adults aged between 18-29 years and were undergoing or holders of tertiary education degrees (72.2%, n=320). Our findings showed that 76.5% (n=339/443) of the respondents were aware of the 2022 MPOX outbreak and obtained information about the disease from their local radio and television stations (20.6%, n = 70), as well as from other sources such as social media platforms (70.5%, n=239), and other internet sources (61.6%, n=209). The mean knowledge score of the respondents was 3.95±1.26, with a range of 0.5 to 7. Approximately three-quarters (72.3%, n=245) of the study participants were graded to have a good knowledge of the MPOX. Of the listed symptoms, study participants correctly identified high fever (62.2%, n=339), rashes (51.0%, n=173), swollen lymph nodes (34.5%, n=117), and sores around the mouth, vagina, and anus (26.8%, n=91). A higher number of participants were aware that vaccination could confer protection against the disease (70.8%, n=240). However, less than one third of the participants (30%, n=102) were aware that safe sex practices can be a preventive strategy against the disease. Finally, none of the sociodemographic variables were associated with increased knowledge of MPOX among the study participants. The knowledge of MPOX among the study population was above average. We advocate that public enlightenment campaigns in Nepal should address wrong perceptions of MPOX.

Escherichia coli in untreated milk leads to economic losses from subclinical mastitis and reduced milk production, while also posing a public health risk due to the emergence of antimicrobial resistant strains, particularly associated with consuming unpasteurized milk and dairy products. This study aimed to determine the prevalence and antimicrobial resistance (AMR) of E. coli isolated from buffalo milk in Siddarthanagar Municipality of Rupandehi district, Nepal. A total of 102 milk samples were collected from lactating buffaloes. The isolation and identification of E. coli were carried out using enrichment media, selective media, and biochemical tests. Antimicrobial susceptibility testing was carried out using the Kirby–Bauer disk diffusion method on Mueller–Hinton agar (Merck), according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Resistance was tested against gentamicin, amikacin, ciprofloxacin, enrofloxacin, ceftriaxone, ceftazidime, cotrimoxazole, and chloramphenicol. In addition to this, farmers were administered a questionnaire consisting of both open- and close-ended questions to identify various animal-related and management-related risk factors associated with the prevalence of E. coli. The prevalence of E. coli in our study was 29.4% (n = 30/102). Ceftriaxone and ceftazidime showed 100% resistance, while cotrimoxazole and amikacin showed 86.7% and 80% resistance, respectively. Furthermore, 86.7% of E. coli isolates were multidrug resistant (MDR). Despite suggestive trends, associations between E. coli prevalence and risk factors lacked statistical significance, necessitating further research. While some antibiotics exhibited effectiveness, many faced resistance, highlighting the need for prudent antimicrobial usage and increased awareness among farmers. Raising awareness about milk pasteurization and implementing food safety practices is essential for ensuring farmers and public health.

Introduction: Gastrointestinal (GI) parasites are major health concerns in both humans and domestic animals. Livestock farming is one of the common livelihood practices in rural Nepal. The proximity at human and domestic animal interface increases the chances of dissemination of enteric parasites, especially those of zoonotic importance. This study was aimed at finding the parasite prevalence and risk factors in both humans and their domestic animals in Jirel community. Materials and Methods: A field survey was conducted on the Jirel ethnic people and their domestic animals in Dolakha district, where a total of 152 fresh fecal samples from humans and domestic animals (cow, pigs, goats, chickens, ducks, and pigeons) were collected. The feces were examined by wet mounts and concentration techniques. A structured questionnaire survey was carried out among the local people and owners of the domestic animals to gather sociodemographic information, awareness, and hygienic practices in relation to parasite transmission Results: The enteric parasite prevalence was found to be highest in goats (80.0%;12/15), followed by pigs (55.55%;5/9), cows (45.45%;6/11), chickens (11.7%;4/34), and humans (1.41%;1/71), while the fecal samples of ducks and pigeons did not contain any parasites. The only parasite identified in humans was Ascaris lumbricoides. Similarly, three genera of GI parasites (Eimeria sp., Strongyloides sp, and Trichuris sp.) from goats, two genera each from cow (Eimeria sp. and Strongyloides sp.), pigs (Entamoeba sp. and A. suum), and chickens (Eimeria sp. and Ascaridia galli), were detected Conclusions: Based on the direct field observation, questionnaire survey and laboratory analysis, it is concluded that the Jirel community people are aware of health and hygiene; however, intervention measures are necessary to prevent parasitic infection in their domestic animals.

Medical pluralism is a global norm rather than an exception. However, the kind of medical pluralism that exists in many settings is exclusionary and undemocratic. In many nations, medical pluralism has official acceptance, allowing both biomedicine and traditional systems of medicine a legitimate space into the formal healthcare system. However, traditional systems of medicine fall far behind biomedicine in terms of structural superiority and institutional strengths. Moreover, various forms of traditional medicine, particularly of popular variants, remain excluded from formal healthcare system, and a variety of traditional healers lack official legitimacy. Though conceptually medical pluralism sounds more or less equal standing of co-existing systems of medicine, the reality is that biomedicine enjoys a dominant status over heterodox medical systems. Upon examining the amount of budgetary allocation, number of health facilities, size of health human resources, educational institutions and research output, this paper reveals an overemphasis on biomedicine, overshadowing both scholarly and popular traditional medicine. This arrangement underscores the undemocratic and exclusionary nature of medical pluralism in the country. In light of the published data sources this paper examines the structure of medical pluralism and proposes measures that can contribute to advancing inclusive and democratic medical pluralism in Nepal.

ABSTRACT This case report documents the first confirmed outbreak of African swine fever (ASF) in a wild boar (Sus scrofa) in Nepal. The case was identified in a wild boar carcass found in Shuklaphanta National Park in February 2023. Post‐mortem findings, including splenomegaly, haemorrhagic lymph nodes and congested organs, were suggestive of ASF, which was confirmed by real‐time PCR. Epidemiological evidence indicates potential transmission from nearby ASF‐infected domestic pigs. This case underscores the critical need for rigorous biosecurity protocols, comprehensive surveillance and targeted wildlife management strategies to prevent further transmission between domestic pig and wild boar populations.

Introduction: Hip and knee arthroplasty surgeries are essential for treating end-stage osteoarthritis, providing significant functional improvements. Despite a global rise in these procedures, Nepal lacks a National Joint Registry, resulting in a gap in tracking the exact number of surgeries, outcomes, and complications. This study aims to address this gap regarding the demographics of hip and knee arthroplasties in Nepal. Methods: An observational study was conducted after obtaining the ethical approval from the Nepal Health Research Council (Reference number: 2024/136) with data collected from prosthesis supplier. The study included all primary hip and knee arthroplasties performed in 2022 and 2023, excluding revision cases and those requiring mega prostheses. Data analysis was performed using Microsoft Excel for descriptive statistics. Results: There were a total of 1259 surgeries, 916 (72.77%) total knee replacements were performed, with a female predominance of 741 (81.42%) and a median age of 67 years(IQR: 62-71). There were 343 (27.23%) total hip replacements surgeries of which 200 (58.31%) were done in males. Most surgeries 1148 (91.18%) occurred within the Kathmandu Valley. Conclusions: Total knee arthroplasty accounted for the majority of cases, showing a predominance of female patients with the majority of surgeries in the capital city.

We investigated the extent to which methodological concerns explicitly addressed by the designers of the World Mental Health Surveys persist in the results that were obtained using the WMH-CIDI instrument. We compared rates of endorsement of mental illness symptoms in the United States (very high) and Nepal (very low) as they were affected by respondent understanding of the survey, social desirability bias, interview social context and translation-related sources of misunderstanding. The results showed that, although levels of misunderstanding and social desirability were higher in Nepal than in the U.S., these potential methodological concerns had less effect on symptom endorsement in Nepal than in the U.S. In Nepal non-methodological factors related to the socio-cultural context probably had a more substantial impact on observed symptom rates than did the methodological factors. The larger issue is the effect that methodological factors have on the validity of reported rates of disorder.

The topic of how reflexivity ought to be utilized in the global aspect of research is yet to be fully theorized in educational research. Through the use of rigorous reflexivity, this paper examines a "halfie" researcher's negotiation of insider and outsider identities within his transnational home/field site of Nepal. By examining how identities are reconfigured within transnational spaces, the paper analyzes the intricacies of negotiating legitimacy and reciprocity with participants. Although the literature on reflexivity asks researchers to be "open" about their identities, the author explores how one can be open yet also be complicit in the research process. The article proposes that (halfie) researchers be accountable for their contradictory identities in transnational sites and recognize the sociocultural contexts in which they do fieldwork. (Contains 9 notes.)

Objectives: The Chepang people, an indigenous ethnic group in Nepal, experience substantial marginalization and socioeconomic disadvantages, making their communities among the most vulnerable in the region. This study aimed to determine the prevalence and factors associated with adolescent pregnancy in the Chepang communities of Raksirang Rural Municipality, Makwanpur District, Bagmati Province, Nepal. Methods: A cross-sectional study was conducted from October 2022 to April 2023 among 231 Chepang women selected using simple random sampling from Raksirang Rural Municipality. A semi-structured questionnaire was used for interviewing the mothers. Bivariate and multivariate logistic regression analyses were performed, using odds ratios with 95% confidence intervals (CIs). Variables with a variation inflation factor of more than 2 and a p-value of more than 0.25 were excluded from the final model. Results: The study revealed that the prevalence rate of adolescent pregnancy among Chepang women was 71.4% (95% CI, 65.14 to 77.16). A large percentage of participants (72.7%) were married before the age of 18 years. Poor knowledge of adolescent pregnancy (adjusted odds ratio [aOR], 10.3; 95% CI, 8.42 to 14.87), unplanned pregnancy (aOR, 13.3; 95% CI, 10.76 to 19.2), and lack of sex education (aOR, 6.57; 95% CI, 3.85 to 11.27) were significantly associated with adolescent pregnancy. Conclusions: The prevalence of adolescent pregnancy among the Chepang community was high. These findings highlighted the importance of raising awareness about the potential consequences of adolescent pregnancy and implementing comprehensive sexuality education programs for preventing adolescent pregnancies within this community.

Abstract Background and objective Monkeypox virus (MPXV) is the causative agent of monkeypox’s zoonotic infection and was declared a global emergency by the World Health Organization (WHO). Studies from different countries have shown insufficient knowledge among the general public on MPXV. This study aimed to assess the knowledge of the general public of Nepal on MPXV. Methods Three hundred people were interviewed in person in October 2022, and 282 complete responses were recorded. The questionnaire related to the knowledge of MPXV was derived from a previous study conducted among the general population of Saudi Arabia. Twenty-two questions were included that assessed the knowledge and attitude of Nepalese toward monkeypox. Statistical comparison between high and low knowledge was performed using Pearson’s Chi-square test. Logistic regression models were deployed to establish the relationship between participants’ knowledge and socio-demographic characteristics. Results Among the total respondents, 53.8% demonstrated high knowledge of monkeypox. People aged 18–25 years, unmarried people, and those living in urban areas had significantly higher levels of knowledge. Most respondents believed that MPXV is not a conspiracy or bioterrorism (63.1%) and agreed that it is likely to affect people’s social and economic life as COVID-19 did (67.0%). The history of COVID-19 vaccination (aOR: 2.980; 95%CI: 1.227, 7.236) and the younger age (aOR: 2.975; 95%CI: 1.097, 8.069) were found to be significant determinants of the knowledge of the participants on monkeypox. Conclusion We observed that most Nepalese populations had a high knowledge of monkeypox and that social media was the most valuable source of information.

Avian pathogenic Escherichia coli (APEC) is a major bacterial pathogen responsible for the most widespread form of colibacillosis, resulting in substantial economic losses within the poultry sector and posing a potential public health risk. From July to September 2021, our study investigated the antibiotic resistance pattern of Escherichia coli (E. coli) and the presence of virulence-associated genes (iucD, iutA, iss, and ompT) linked to APEC using 105 broiler meat samples comprising liver, thigh, and breast muscle, in Chitwan, Nepal. E. coli was isolated and identified by culturing samples on MacConkey's agar, Eosin-methylene blue (EMB) agar and performing different biochemical tests. Antibiotic resistance patterns of E. coli were determined by the Kirby-Bauer disc diffusion method. Following the isolation of E. coli, the molecular detection of APEC was performed using conventional polymerase chain reaction (PCR). Out of the 105 samples analyzed, 61 (58.1 %) tested positive for E. coli. In antibiotic susceptibility test (AST), gentamicin and tetracycline exhibited the highest resistance rates, with 90.2 % and 67.2 %, respectively and 29.5 % of the E. coli isolates displayed multidrug-drug resistance. Out of 61 confirmed E. coli isolates, iutA was detected in 47 (77.0 %) samples, iucD in 46 (75.4 %), iss in 53 (86.8 %), and ompT in 39 (63.9 %) samples. This study reports the occurrence of MDR E. coli in meat samples, together with virulence genes associated with APEC which poses a public health threat. Continuous surveillance is vital for monitoring APEC transmission within poultry farms, coupled with efforts to raise awareness of food safety among consumers of broiler meat.

Mumps is a highly contagious viral infection caused by paramyxovirus. It usually presents with fever and parotid gland swelling. It may be associated with complications like aseptic meningitis, encephalitis, oophoritis, orchitis, pancreatitis. The incidence of mumps infection is increasing in Nepal. This paper aims to advocate for the introduction of vaccination against mumps in the national immunization schedule.

Introduction Children below the age of 15 years account for the majority of acquired immunodeficiency syndrome (AIDS)-related deaths in Nepal. Antiretroviral therapy (ART) improves health and prolongs lives of people with human immunodeficiency virus (HIV). Poor adherence to ART provides clue to a sub-therapeutic level of antiretroviral drug, which can facilitate multi-drug resistance of similar regimen, leading to treatment failure and death. The objective of this study was to determine the level of adherence to ART and its associated factors among HIV-infected children aged 0-14 years in Pokhara Academy of Health Sciences (PoAHS), Pokhara, Nepal. Material and methods This cross-sectional study was conducted between September 15th, 2020 and February 15th, 2021, and included 57 HIV-infected children. Caregivers of the children were questioned with a pre-tested, semi-structured questionnaire, which was later translated verbally to Nepali. Trained doctors took the interviews. Acquired data was entered using SPSS version 17 software for analysis. Level of significance was set at p

Abstract Background Health system-delivered evidence-based interventions (EBIs) are important to reducing amenable under-5 mortality (U5M). Implementation research (IR) can reduce knowledge gaps and decrease lags between new knowledge and its implementation in real world settings. IR can also help understand contextual factors and strategies useful to adapting EBIs and their implementation to local settings. Nepal has been a leader in dropping U5M including through adopting EBIs such as integrated management of childhood illness (IMCI). We use IR to identify strategies used in Nepal’s adaptation and implementation of IMCI. Methods We conducted a mixed methods case study using an implementation research framework developed to understand how Nepal outperformed its peers between 2000–2015 in implementing health system-delivered EBIs known to reduce amenable U5M. We combined review of existing literature and data supplemented by 21 key informant interviews with policymakers and implementers, to understand implementation strategies and contextual factors that affected implementation outcomes. We extracted relevant results from the case study and used explanatory mixed methods to understand how and why Nepal had successes and challenges in adapting and implementing one EBI, IMCI. Results Strategies chosen and adapted to meet Nepal’s specific context included leveraging local research to inform national decision-makers, pilot testing, partner engagement, and building on and integrating with the existing community health system. These cross-cutting strategies benefited from facilitating factors included community health system and structure, culture of data use, and local research capacity. Geography was a critical barrier and while substantial drops in U5M were seen in both the highest and lowest wealth quintiles, with the wealth equity gap decreasing from 73 to 39 per 1,000 live births from 2001 to 2016, substantial geographic inequities remained. Conclusions Nepal’s story shows that implementation strategies that are available across contexts were key to adopting and adapting IMCI and achieving outcomes including acceptability, effectiveness, and reach. The value of choosing strategies that leverage facilitating factors such as investments in community-based and facility-based approaches as well as addressing barriers such as geography are useful lessons for countries working to accelerate adaptation and implementation of strategies to implement EBIs to continue achieving child health targets.

Abstract Background This study was conducted to assess the prevalence of dental caries, tobacco usage, and associated risk factors for dental caries in patients who visited a government hospital in Western, Nepal. Methods This analytical cross-sectional study was conducted from January to April 2022. Patients above 18 years visiting the dental OPD of a government hospital, and who had provided informed consent were enrolled in the study using a convenience sampling technique. As the study also involved an illiterate population, in that case, informed consent was obtained from their respective legal guardian as well. A pretested standardized, close-ended questionnaire was administered by researchers to gather information regarding the associated risk factors and oral hygiene practices. Clinical examination was done for dental caries according to the criteria by the World Health Organization (WHO) using the “DMFT” index (WHO modification 1987). Bivariate and multivariable logistic regression was done and the odds ratio and p-value was calculated. For all tests, statistical significance was set at p

Abstract Background Strategic action plans around newborn health evaluation are needed, to address the high neonatal mortality rate in Nepal. Surveillance systems, like Newborn Metabolic Screening (NBS), could reveal unrecognized drivers of neonatal death. NBS is not routinely performed in Nepal. Our objective was to determine the feasibility of establishing NBS, and its acceptability among healthcare providers and parents, in Nepal. Methods This prospective cohort study was conducted between November 2021 and May 2022 in term/late preterm infants born at Paropakar Maternity Hospital, Kathmandu, screening for 6 disorders that can be confirmed and managed locally. Staff were trained on dried-blood spot collection and transport protocols, performance metrics were established, and assays were performed at an accredited laboratory in Bangalore, India. Surveys were developed to determine acceptability among health-care providers and parents. Results Of 835 parents approached for the study, 825 (98.8%) consented. Parental surveys showed that 92% considered “no cost” option most important in choosing to participate in the study. Samples were transported to laboratories in Kathmandu and Bangalore in 36 ± 24 h, and 4.75 ± 1 days, which exceeded expected metrics of 24 and 48 h, respectively. Results were communicated to parents by 9.5 ± 2 days, which was within the expected metric window of 14 days. Abnormalities were reported in 13 infants and included 5 hemoglobinopathy traits (4 Hb E and 1 Hb D), 3 congenital hypothyroidism, 2 glucose-6-phosphate dehydrogenase deficiency, 1 congenital adrenal hyperplasia, 1 elevated acylcarnitine, and 1 biotinidase deficiency. Healthcare providers surveyed (n = 116) showed that 67% reported a moderate understanding of NBS; all indicated that screening would be beneficial. Most cited early diagnosis and treatment, as well as, providing risk to future pregnancies as significant benefits. 90% thought screening should be routinely performed. Conclusions We demonstrate that it is feasible to introduce NBS in Nepal. Transport metrics were longer than expected due to COVID pandemic travel restrictions; however, it was possible to deliver results to families within 2 weeks of birth. Parents overwhelmingly considered “no cost” option as the most important in choosing to screen. A government-sponsored program will be a key factor in establishing NBS in Nepal.

Abstract Background Participatory policy analysis (PPA) as a method in health policy and system research remains underexplored. Using our experiences of conducting PPA workshops in Nepal to explore the impact of the country’s move to federalism on its health system, we reflect on the method’s strengths and challenges. We provide an account of the study context, the design and implementation of the workshops, and our reflections on the approach’s strengths and challenges. Findings on the impact of federalism on the health system are beyond the scope of this manuscript. Main body We conducted PPA workshops with a wide range of health system stakeholders (political, administrative and service-level workforce) at the local and provincial levels in Nepal. The workshops consisted of three activities: river of life, brainstorming and prioritization, and problem-tree analysis. Our experiences show that PPA workshops can be a valuable approach to explore health policy and system issues – especially in a context of widespread systemic change which impacts all stakeholders within the health system. Effective engagement of stakeholders and activities that encourage both individual- and system-level reflections and discussions not only help in generating rich qualitative data, but can also address gaps in participants’ understanding of practical, technical and political aspects of the health system, aid policy dissemination of research findings, and assist in identifying short- and long-term practice and policy issues that need to be addressed for better health system performance and outcomes. Conducting PPA workshops is, however, challenging for a number of reasons, including the influence of gatekeepers and power dynamics between stakeholders/participants. The role and skills of researchers/facilitators in navigating such challenges are vital for success. Although the long-term impact of such workshops needs further research, our study shows the usefulness of PPA workshops for researchers, for participants and for the wider health system. Conclusions PPA workshops can effectively generate and synthesize health policy and system evidence through collaborative engagement of health system stakeholders with varied roles. When designed with careful consideration for context and stakeholders’ needs, it has great potential as a method in health policy and systems research.

Climate change can have significant impacts on crop yields and food security. This study assessed the linkages between climate change and crop yields to obtain a better understanding on the drivers of food security. The study was conducted in Pasagaun village of Lamjung District in Nepal, where household surveys and focus group discussions (FGDs) were used to collect data including crop cultivation, irrigation facilities, and adaptation strategies. Moreover, climate data (temperature and precipitation) from 1992 to 2020 were collected from the Khudi Bazar meteorological station and crop yield data were obtained from the Agri-Business Promotion and Statistics Division. Trend analysis of temperature and precipitation was conducted using Mann-Kendall trend test and Sen's Slope method, and the results showed an increase in the average temperature of approximately 0.02 ​°C/a and a decrease in the annual precipitation of 9.84 mm/a. The cultivation of traditional varieties of rice and foxtail millet (Kaguno) has vanished. Although, there was no significant impact of the maximum temperature on the yield of rice and maize, the regression analysis revealed that there are negative relationships between rice yield and annual minimum temperature (r ​= ​−0.44), between millet yield and annual precipitation (r ​= ​−0.30), and between maize yield and annual minimum temperature (r ​= ​−0.31) as well as positive relationship between rice yield and annual precipitation (r ​= ​0.16). Moreover, average rice yield and millet yield have decreased by 27.0% and 57.0% in 2000–2020, respectively. Despite other reasons for the decrease in crop yield such as the lack of irrigation facilities, out-migration of farmer, and increased pest infestation, respondents have adopted adaptation strategies (for example, shifts in cultivation time and changes in crop types) to minimize the impacts of climate change. More investigation and community-based farming education are needed to understand and alleviate the harmful impacts of climate change on crop yield, as effective adaptation coping strategies are still insufficient. This study provides insights into the adaptation strategies that are necessary to keep food security in the face of climate change.

Aflatoxins (AFs), secondary metabolites produced by fungi, pose significant health risks, especially to children and elderly individuals. In developing countries such as Nepal, the tropical climate promotes fungal growth, leading to elevated levels of AF in animal feed and milk. In this study, we aimed to investigate the occurrence of aflatoxin M1 (AFM1) in dairy milk from the Kathmandu District and to assess husbandry practices contributing to contamination. We collected 84 milk samples, including raw milk from farms, retailers’ milk, and packet milk, and analyzed them using the competitive enzyme-linked immunosorbent assay (c-ELISA) technique. We also interviewed farmers to gather information on feeding and storage practices. All the collected milk samples were contaminated with AFM1, with 97.6% of the samples exceeding the European Union (EU) maximum permissible limit of 50 ppt (0.05 μg/kg). The majority (98.5%) of the farms included paddy straw, and all farms (100%) included concentrate in their feed regimens. Only half (52%) of the farms had proper storage facilities. Straw was mostly stored in sacks outdoors or left open in a shed, while concentrates were stored in a closed room or shed. This study reveals very high levels of AFM1 contamination in the milk samples, presenting a serious public health issue, and recommends comprehensive surveillance and further investigations across the country, especially given the limited research and literature available.

BackgroundCorneal ulcers are a common cause of blindness in low-income and middle-income countries, usually resulting from traumatic corneal abrasions during agricultural work. Antimicrobial prophylaxis of corneal abrasions can help prevent corneal ulcers, but delays in the initiation of therapy are frequent. We aimed to assess whether a community-based programme for corneal ulcer prevention would reduce the incidence of corneal ulceration.MethodsA cluster-randomised trial was performed in village development committees (VDCs) in Nepal. VDCs in the catchment area of Bharatpur Eye Hospital, Nepal with less than 15 000 people were eligible for inclusion. We randomly assigned (1:1) VDCs to either an intervention group or a control group. In the intervention VDCs, existing female community health volunteers (FCHVs) were trained to diagnose corneal abrasions and provide a 3-day course of ophthalmic antimicrobials to their patients. In the control VDCs, FCHVs did not provide this intervention. Participants were not masked given the nature of the intervention. Both groups were followed up for 3 years for photographic evidence of corneal ulceration. The primary outcome was the incidence of corneal ulceration, determined by masked assessment of corneal photographs. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT01969786.FindingsWe assessed 112 VDCs, of which 24 were enrolled. The study was performed between Feb 4, 2014, and Oct 20, 2017. 12 VDCs were randomly assigned to the intervention group and 12 to the control group. 252 539 individuals were included in the study (130 579 in the intervention group and 121 960 in the control group). FCHVs diagnosed and provided antimicrobials for 4777 corneal abrasions. The census identified 289 corneal ulcers among 246 893 person-years in the intervention group (incidence 1·21 cases [95% CI 0·85-1·74] per 1000 person-years) and 262 corneal ulcers among 239 170 person-years in the control group (incidence 1·18 cases [0·82-1·70] per 1000 person-years; incidence rate ratio 1·03 [95% CI 0·63-1·67]; p=0·93). Medication allergy was self-reported in 0·2% of participants.InterpretationWe did not detect a reduction in the incidence of corneal ulceration during the first 3 years of a community-based corneal ulcer prevention programme. Further study might be warranted in more rural areas where basic eye care facilities are not available.FundingNational Eye Institute.

Abstract 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 Since the M w 7.9 Gorkha earthquake of April 25, 2015, the seismicity of central and western Nepalese Himalaya has been monitored by an increasing number of permanent seismic stations. These instruments contribute to the location of thousands of aftershocks that occur at the western margin of the segment of the Main Himalayan Thrust (MHT) that ruptured in 2015. They also help to constrain the location of seismic clusters that originated at the periphery of the fault ruptured by the Gorkha earthquake, which may indicate a migration of seismicity along the fault system. We report here a seismic crisis that followed the Lamjung earthquake, a moderate M w 4.7 event (M L 5.8, M Lv 5.3) that occurred on May 18, 2021, about 30 km west of the Gorkha earthquake epicenter at the down-dip end of the locked fault zone. The study of the hypocentral location of the mainshock and its first 117 aftershocks confirms mid-crustal depths and supports the activation of a 30–40° dipping fault plane, possibly associated with the rupture of the updip end of the MHT mid-crustal ramp. The cluster of aftershocks occurs near the upper decollement of the thrust system, probably in its hanging wall, and falls on the immediate northern margin of a region of the fault that has not been ruptured since the 1344 or 1505 CE earthquake. The spatio-temporal distribution of the first 117 aftershocks shows a typical decrease in the associated seismicity rate and possible migration of seismic activity. Since then, the local seismicity has returned to the pre-earthquake rate and careful monitoring has not revealed any large-scale migration of seismicity towards the locked fault segments. Graphical Abstract

Abstract Background Minimally Invasive Tissue Sampling (MITS) has been successfully used to establish the cause of death in low- and middle-income countries, mostly in stillbirths and neonates. The objective of this study was to determine the causes of death among adults using MITS in the Gandaki province of Nepal and to find out the contribution of MITS to identify the causes of death. Methods A multicentric hospital-based pilot study was conducted to enroll 100 cases of adult deaths. The specimens of cerebrospinal fluid, blood, brain, lungs, and liver tissue were collected utilizing MITS. These specimens underwent standard histopathological, serological, and microbiological analyses. The findings from MITS, and if available, clinical records and forensic autopsy findings were compiled and the cause of death panel identified the causes of death. The final cause of death allocated to each case was based on the WHO International Medical Certificate of Death. Results Among a total of 100 cases enrolled during the study period, infectious cause attributed to the immediate cause of death in 77 (77%), cardiovascular in 10 (10%), neurological in 8 (8%), malignancy in two (2%), and gastrointestinal and hepatobiliary cause in one (1%) case. The mean age of the cases was 50.8 ± 15.9 years and 76 (76%) were males. MITS established the cause of death in the causal chain of events in 81(81%) cases and identified the cause of death significantly more with infectious than non-infectious causes (p

Quantifying the spatiotemporal dynamic of potential evapotranspiration (PET) in topographically complex country are often limited by the scarcity and difficulty in obtaining ground-based measured climate data. Remote sensing products have multiple advantage, which allows rapid acquisition of information and status over large areas and long time series. This study compared and explored the spatiotemporal variation of PET across Nepal using three widely-used remote sensing and reanalysis data PET products (CRU_PET, MODIS_PET and PML_PET), and PET estimation using Hargreaves-Samani method based on CHIRTS datasets. On the basis of this, the spatiotemporal dynamic at seasonal and annual level and the periodical change of PET and meteorological aridity index AI (precipitation P/PET) were identified using Mann-Kendall test and Morlet Wavelet method. These PET products showed general spatial consistency over most areas in Nepal with higher PET in the south and less in the north. However, great differences were also found in PET values for four different products. Compared with the three remote sensing and reanalysis data products, CHIRTS_PET performs better in Nepal. The AI based on CHIRTS_PET showed an insignificant increasing (wetting) trend in the western and southern regions, while an insignificant decreasing (drying) trend in the central and northeastern region, which is generally consistent with the spatial pattern of precipitation. In the western and southern regions, the positive impact of increasing precipitation on AI masked the negative effect of increasing PET, and thus making this region getting humid. However, in the central and northeastern region, the increase in PET aggravates the impact of reduced precipitation on the drying trend. Our investigation have broad implications for sustainable water resources management under climate change in a topographically complex country like Nepal.

IntroductionThe majority of blindness worldwide could be prevented or reversed with early diagnosis and treatment, yet identifying at-risk and prevalent cases of eye disease and linking them with care remain important obstacles to addressing this burden. Leading causes of blindness like glaucoma, diabetic retinopathy and age-related macular degeneration have detectable early asymptomatic phases and can cause irreversible vision loss. Mass screening for such diseases could reduce visual impairment at the population level.Methods and analysisThis protocol describes a parallel-group cluster-randomised trial designed to determine whether community-based screening for glaucoma, diabetic retinopathy and age-related macular degeneration reduces population-level visual impairment in Nepal. A door-to-door population census is conducted in all study communities. All adults aged ≥60 years have visual acuity tested at the census visit, and those meeting referral criteria are referred to a local eye care facility for further diagnosis and management. Communities are subsequently randomised to a community-based screening programme or to no additional intervention. The intervention consists of a single round of screening including intraocular pressure and optical coherence tomography assessment of all adults ≥60 years old with enhanced linkage to care for participants meeting referral criteria. Four years after implementation of the intervention, masked outcome assessors conduct a repeat census to collect data on the primary outcome, visual acuity. Individuals with incident visual impairment receive a comprehensive ophthalmological examination to determine the cause of visual impairment. Outcomes are compared by treatment arm according to the originally assigned intervention.Ethics and disseminationThe trial has received ethical approval from the University of California San Francisco Institutional Review Board, Nepal Netra Jyoti Sangh and the Nepal Health Research Council. Results of this trial will be disseminated through publication in peer-reviewed journals and presentation at local and international meetings.Trial registration numberNCT03752840.