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This paper analyses university teachers and students' experiences of online learning during the COVID-19 pandemic in Nepal and presents post-pandemic implications. Potential ramifications of the findings in a normal setting were suggested by the analysis of data gathered through semi-structured interviews with participants both during and after the pandemic, as well as through observation of online classes during the period. Findings demonstrate teachers' ability to create online learning, an alternative mode to a physical classroom, during the pandemic while having an inadequate level of ICT understanding. Despite limited access to digital technology and no administrative assistance, teachers and students created an online learning environment. Findings, however, show an increasing digital gap between rural and urban areas. The discontinuation of effective online learning techniques in the post-pandemic circumstances produced by the teachers during the pandemic pointed out the issues of reforming higher education in developing countries such as Nepal.

This study aims to explore university students' perception regarding an e-assessment system in terms of preference, assessment management, and the quality assurance process. A cross-sectional online survey was employed among 384 students of Nepal Open University (NOU). Structural equation modeling (SEM) was used in the research. Findings indicate that the perception of students regarding preference, e-assessment management, and the quality assurance process was found to be significantly high. In particular, the perception of preference regarding digital assessment was higher than assessment management and the quality assurance process. Gender, ethnicity, and place for taking classes, have an effect on implementation. This study concludes that three attributions of preference for digital assessment, management, and quality assurance are affected by one another.

The purpose of this study was to measure the effect of classroom practices of using communication tools, collaboration skills, digital skills, and software skills of teachers on the communication behaviors of students during mathematics instruction. A cross-sectional online survey was conducted among 466 mathematics teachers in Nepal. The primary statistical techniques applied in the data analysis were mean, standard deviation, one-sample t-test, and structural equation modeling (SEM). The results showed that the level of skill transformations of mathematics teachers in digital skills was found to be significantly low. Moreover, practices of using communication tools, collaborative skills of teachers, digital skills enhancement of teachers, and software skills enhancement of teachers were found to be significant predictors of the communication behavior of students. The results of this study suggested that teachers' technological empowerment is essential for developing digitally competent teachers who can transform the traditional mathematics classrooms into an online mode that is more constructive, collaborative, engaging, and supportive to the learners in a flexible and joyful learning environment. The study contributes to providing the knowledge of digital instructional skills of mathematics teachers to the communication behavior of the students. Moreover, the study gives an insight into using multi-group SEM in studying teachers' technological skills on students' learning of soft skills, such as communication behavior.

Purpose: The purpose of this paper is to explore and analyze the context and concept of higher education for sustainable development (HESD) in Nepalese higher educational institutions (HEIs). Design/methodology/approach: The research gathers facts and information both from primary and secondary sources. Five open-ended questions were developed to interview university high-ranking officials, such as VCs, registrars, deans and the chief of the planning division. Findings: The inclusion of 17 sustainable development goals in the country's Fifteenth Plan, national policy documents, and the University Grants Commission-led higher education reform programme provides sufficient context for HESD. In the absence of HESD literacy and a persuasive strategy, university leadership is less active in lobbying for SDG 4.7 with the government and funding agencies, university faculties and trade unions. In fact, both insights and initiatives to conceptualize HESD are lacking. Research limitations/implications: This study's setting is distinct and the interpretation of the HESD concept is based on a small sample size. Thus, the generalization of its findings is intrinsically limited in the context of a country in the geographic region. However, the findings of this research provide practical insights to implement HESD in Nepalese HEIs. Practical implications: This study is intended to inform and prepare the Nepalese academic community, urging HEIs to implement HESD with a well-defined plan of action. It contributes to the literature by considering how the current context and concept of HESD suites to promote sustainability in Nepalese HEIs, transforming the traditional academic structure and making academic leaders aware that HESD is only a means to an end. Originality/value: This research is Nepal's first study of its type with a broad understanding of the context and concept of HESD. It also provides information for HEI leaders on how to initiate the HESD acceleration process.

This qualitative study explored teachers' use of technology to manage teaching and learning activities during COVID-19 in Nepalese higher education institutions. To this end, 11 teachers from three universities located in five provinces of Nepal were purposefully selected. Their experiences of using technological tools were explored through semi-structured interviews and document analysis. The findings show that the implementations of online teaching and learning to manage students' learning loss during the COVID-19 were marred by paradoxical policy, insufficient resources, teachers' attitudes, socio-psychological issues, the lack of trained teachers and connection among technology, curriculum, pedagogy and assessment. Interestingly, the findings demonstrate that the teachers have taken the COVID-19 crisis as an opportunity for learning to use technologies in their teaching and learning activities. Based on these findings, we suggest that the government of Nepal needs to design an action plan to facilitate free mental health and wellbeing counseling programmes for students and teachers, provide sufficient devices with internet access to their students and train teachers and staff on how they can blend technologies, pedagogies and contents.

This paper presents the use of translanguaging in the assessment of content subjects in the context of Nepal's higher education. Since its proposition in the 1990s, translanguaging has been receiving much scholarly attention in multilingual educational contexts. In such contexts, individuals' language practices show a shift from the understanding of languages as separate autonomous systems to the recognition of integrated and heteroglossic practices. Drawing on the analysis of relevant policy documents and examinees' answer sheets of formative assessment, and interviews with eight purposively selected teacher educators teaching at the master's level at a university in Nepal, this paper reports that examinees' translanguaging practices in responding to assessment questions exhibit their translanguaging instinct resisting unplanned English-prioritised monolingual policies. It also reveals fluidity and simultaneity in examinees' use of diverse linguistic resources defying demarcated language boundaries as aspired by the institution's English-prioritised policies. The study further reports layered translanguaging exercised by examinees which educators acknowledged as an attempt to enhance efficacy in content communication. Examinees' translanguaging practices and educators' acknowledgment of translanguaged writing indicate collective resistance from the bottom-up countering monoglossic ideologies in assessment systems. This implies consideration of examinees' and educators' roles in promoting translanguaging for future language policy changes to facilitate effective assessment.

Learner-centered instruction is very important concept in virtual and face-to-face classes for enhancing academic performance of students. This research aims to study the status of learner-centered instructions followed by the teachers in online classes during the pandemic and its effectiveness on the mathematics achievement of the learners. The cross-sectional survey design was used by taking 2273 students by convenient sampling from basic to university level of Nepal. The t-test, ANOVA, correlation, and regression techniques were used to analyze the data. The finding of the study indicates that the learning-centered role of teachers was found to be high in mathematics teaching during the pandemic situation in Nepal however teachers are not habituated to give extra time in learning difficulties whereas the problem solving and creative role of teachers were found better as compared to other. Types of the institutions, teaching level, access to the internet, and having tablet are the determinants for the learner-centered instruction in teaching whereas availability of laptop and computer, types of institutions, and access to the internet have significant roles to determine the mathematics achievement. The findings of this research suggest that practice of learner-centered instruction would be useful and beneficial for the learners in online classes.

The global COVID-19 pandemic has severely hit the lives of the people of Nepal. The country witnessed two phases of lockdown over 10 months from March 2020 until August 2021. I completed my PhD data collection in Nepal through February to April 2021, when the pandemic's risk was naturally lowered. My research explores local value systems of communities involved in school governance in Lalitpur, Nepal. Accordingly, my participants included schools' stakeholders: parents, teachers, locals, Education Officers and elected representatives. The COVID-19 situation in Nepal requires social distancing and mask wearing while talking with others. In my experience these health protocols disrupted my aims to develop rapport and build close, trusting relationships with my research participants. In this article, I reflect on ways I sought to build relationships of trust with my participants before conducting interviews amid COVID-19 regulations. I narrate my experiences as a Nepalese citizen and researcher in uncertain times. This research might be useful to researchers in establishing a relationship with participants, applying face to face interviews in unfavourable situations such as a pandemic.

Online teaching became an alternative approach for the teacher to run the teachinglearning activities during the COVID-19 pandemic. In this context, this study aimed to identify the issues of mathematics teachers in teaching mathematics through online mode during the pandemic where issues represented the problems and challenges. Altogether 415 mathematics teachers from different levels participated in this crosssectional survey. A self-constructed tool consisting of six categories of problems as Skills and training related problems (STP), learner related problems (LRP), course management and evaluation related problems (CMERP), resource using skills and infrastructure related problems (RUSIP), teaching related problem (TRP), and support and collaboration related problem (SCP) was employed in the study. T-test, ANOVA, correlation, and multiple linear regression were the major statistical techniques used to analyze the data. The findings indicate that the technical skills and digital resources with the learners and teaching figures and curves were major challenges of mathematics teachers in online mode of instruction. Additionally, gender, number of available devices, institute types, teaching levels, ICT training, and types of job were explanatory factors to determine the challenges of mathematics teachers in online teaching during the pandemic.

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.

The 2015 constitution of Nepal declared Nepal to be a Federal, Democratic, and Republic nation. The constitution has provided local governments the right to manage school education, and the 2017 Local Government Operation Act of Nepal has outlined the roles and responsibilities of local governments in taking guardianship of school education. Since 2017, Nepal has been in the process of institutionalising decentralised governance practices, but this is proceeding at a slow pace. Unprecedently, from early 2020, the COVID-pandemic hit hard the lives of Nepali people, and Nepali education suffered greatly. The pandemic has brought several opportunities for the government to devolve the management system of school education to local levels. This article is based upon the analysis of the six newly introduced plans, regulations, and guidelines in Nepali education, that aim to continue school education amid the COVID-pandemic. These newly introduced polices have significantly acknowledged and mobilised the local strengths in educational management. This research supports a new academic discussion on governance ideas of the Nepalese education system, induced by the COVID-19 pandemic.

The official announcement of COVID-19 as a global pandemic on 11 March 2020 by World Health Organization (WHO), the world economy has abruptly declined, billions of people are in lockdown, maintaining self-isolation. In this survey, 150 respondents were selected randomly and this survey intends to highlight the impact of lockdown in agriculture Students on their education along with their response towards pros and cons. This survey shows that maximum respondent, around 52% of them found lockdown beneficial in the sense that it has helped to neutralize the gravity of viral infection and 48% of them doesn't found it beneficial as their educational schedule has been halted. The practical education of a student is disturbed due to lockdown and now they are utilizing this period involving in online courses, training, and webinars. Many of them couldn't have access to the internet to catch the session, thus the government should initiate policy in education through a long term perspective so that no pandemic could interfere with the educational institution in digital world.

Background: Health literacy is an important public health concern and can be defined as 'the degree or extent to which the individuals have the capacity to obtain, process and understand basic health information and services to make appropriate health decisions'. Research on health literacy among recent immigrants to Canada is not that extensive. Objective: The purpose of this paper was to describe health literacy status among Nepalese immigrants residing in Calgary, Alberta, Canada. Methods: In 2019, a cross-sectional study, using a self-administered questionnaire, was conducted among Nepalese immigrants in Calgary. The questionnaire comprised 38 questions including sociodemographic information, self-rated health status, having a chronic disease or not, health literacy, sources of health information and preference to gain health information. Results: We received 401 responses: 49.63% were from women, 51.37% were aged 36-55 years, 37.00% had graduate-level education, 44.96% had immigrated to Canada less than 5 years ago and 81.05% were employed full-time/part-time or self-employed. Findings revealed that 17.21% of survey participants had limited health literacy, followed by 40.15% who had marginal health literacy. The majority of the survey participants (71.82%) either always or often got health information from healthcare professionals, followed by online resources (56.61%). Conclusion: Noteworthy levels of limited health literacy and marginal health literacy were observed among the Nepalese immigrant population. Multidirectional, culturally tailored, community-led, collaborative initiatives are needed to improve health literacy among the immigrant population, to lessen health disparities and to promote better health outcomes.

This study aimed to examine the teachers' humanistic role in terms of integrity, dignity, and freedom in online classes, and its effect on mathematics learning achievement. The cross-sectional survey design was carried out by taking 2260 students from school to tertiary levels in Nepal during the COVID-19 pandemic. T-test, ANOVA, and hierarchical regressions were the major statistical techniques used to yield the results in the research. The results showed that access to the internet, grades/levels, and availability of digital devices are significant in the practice of the humanistic role of teachers and students' learning achievement. Additionally, many factors such as teachers' equality and fair treatment, expression of negative emotions, and displaying energy and enthusiasm in teaching-learning activities, interest in students' well-being, extended moral support, positive attitude, and understanding of pressures and limitations of students are significant predictors in the achievement of mathematics.

Technological tools such as computers and the internet were used to continue education and student assessment in mathematics during the COVID-19 pandemic in Nepal. This study examined integrating digital resources in teaching, learning, and assessment practices among 456 digitally literate mathematics teachers in secondary schools in Nepal, administering an online questionnaire in Google Forms. The structural equation modeling and mean decrease in accuracy plots were the primary statistical tools used in the data analysis. Findings indicated that the use of digital resources in mathematics teaching in online classes was high during the pandemic in Nepal. The results showed that sharing and integrating digital resources in mathematics instruction significantly affects student assessment, whereas developing and sharing digital resources impacted the integration of such resources in student assessment.

Context: This article explores the lived experiences of learners with disabilities who were attending short-term skills-based training programs in Nepal. The research questions addressed were how the learners with disabilities had been experiencing learning with their peers without disabilities and whether the vocational training was inclusive from the perspectives of learners with disabilities. Approach: Based on a phenomenological design, eight learners with disabilities were purposively selected. In-depth interviews were held with the participants. Data were collected in the forms of audiotaped recordings, field notes, and institutional records. The thematic analysis technique was employed to explicate the transcribed data. Results: The results showed that learners with disabilities faced difficulty in commuting to and from the training center. The physical learning environment was insufficiently accessible, and this affected the learning of students with disabilities. Although the learners with physical disabilities had no problem in understanding the subject matter taught in the mainstream classrooms, the learners with visual impairments and those who were with hard of hearing had, at times, difficulty in following their instructors. The learners with disabilities had trouble with socialization and with forming friendships though they had supportive instructors. The participants' statements revealed that the existing inclusion practices were not enough to address the needs of persons with disabilities. However, they viewed inclusion as a much better option to cater to the needs of differently abled people.

Limited health literacy is linked to unhealthy behaviors, adverse health outcomes, poor quality of life and financial burdens on society. However, little is known about the level of health literacy, especially among school-going children. This cross-sectional study assesses health literacy levels and their determinants in 354 school children from Kathmandu Metropolitan City, utilizing a multi-stage cluster sampling method. The 10-item Health Literacy for School-Aged Children was used to measure the student's literacy levels. Bivariate analysis and multivariable logistic regression at the significance level of 0.05 were performed to determine factors associated with limited health literacy. The majority of participants (76.6%) had moderate health literacy, while 13.8% had a high level and 9.6% had a low level of health literacy. Students from nuclear families had lower odds [adjusted odds ratio (aOR): 0.4; 95% CI: 0.2–0.8] of having limited health literacy. Students whose mother education was up to secondary school (aOR: 10.1; 95% CI: 1.3–78.9), students with pre-existing mental health conditions (aOR: 3.7; 95% CI: 1.4–9.6) and students with unsatisfactory health status (aOR: 3.9; 95% CI: 1.5–10.5) had higher odds to have limited health literacy. These results suggest the importance of prioritizing school health promotion and education activities for students with pre-existing mental health conditions and mothers with low educational attainment. Implementing peer support group programs for children with mental illnesses, mobilizing school health professionals and introducing interventions such as vocational training of mothers can collectively improve health literacy among school-going children. [ABSTRACT FROM AUTHOR]

Background: The burden of musculoskeletal (MSK) pain and disabilities is high in health facilities but remains unknown in the community due to a lack of community‐level studies. The community‐oriented program for control of rheumatic diseases (COPCORD) is focused on determining MSK pain and disabilities through epidemiological surveys. This study adopted the COPCORD stage I protocol to determine the prevalence of rheumatic MSK pain and disability and its associated factors in the Pyuthan district of Nepal. Methodology: A cross‐sectional community‐based study using the quantitative method was conducted in Pyuthan municipality as per COPCORD stage I protocol. COPCORD stage I (phase I and phase II) questionnaires were used to collect data through the interview technique. Populations aged 18 years and above were included in the study. A multistage sampling technique was used, and the total sample size was 2145. The collected data from phase I and phase II were entered in Epidata version 3.1. Descriptive and analytical analysis was done in SPSS. The Chi‐square test was used to find the association between dependent and independent variables. Findings: The overall prevalence (past and current MSK pain/swelling) was 26.81% (95% CI 24.9–28.7). Current MSK pain/swelling was found in 19.53% of the participants, and past MSK pain/swelling was found in 25.87%. Among self‐reported chronic diseases, joint pain was reported by the majority of the participants (17.86%). Age, sex, education, nature of work, current smoking, tobacco use, and alcohol use were found to be associated with past and current MSK pain/swelling. Conclusions: More than one‐fourth of the participants had MSK pain/swelling. The prevalence of MSK pain/swelling was higher in elderly participants, females, illiterates, heavy workers, smokers, tobacco users, and alcohol users. Similar studies should be conducted in other regions of the country, and this study should also be expanded to COPCORD Stages II and III to identify the risk factors and to improve the management of MSK pain and disorders. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to assess the state of the art of quality of education, research and governance to incorporate sustainable development goal 4 (SDG 4) in Nepalese higher education institutions (HEIs). In particular, it raises questions to initiate a discourse on HEIs to achieve SDG 4. Design/methodology/approach: The idea of undertaking this research is heavily borrowed from scientific literature and policy documents. It is an exploratory study that assesses the current status of quality of education, research and governance and suggests policy measures to inculcate SDGs culture in Nepalese HEIs. This study follows a qualitative approach. The analysis is based on the opinions of 113 HEIs stakeholders and high-ranked university officials. Discussions among stakeholders have been organized using online facilities such as Zoom and Team. Findings: Nepalese universities had not incorporated SDGs in their policy, planning, budget and curriculum. The research finds that even after the government's commitment to SDGs, HEIs are not honestly involved in academic discourse on these goals. From the conversation with university officials, it appears that Universities have understood it as a government policy for development, rather than incorporating it as their sectoral responsibility to ensure the quality of education for future generations. Practical implications: This paper prescribes policies to inculcate SDGs culture practically throughout the university structure and operations and opens the floor to discourse on the sectoral role to reach SDG 4. Second, this research suggests activities and policies integrated toward the common good agenda. Originality/value: The paper is the first of its type in the context of a least developed country, Nepal, to raise the issue of HEIs for SDGs. This paper also represents the situation of HEIs for SDGs of similar countries.

Health literacy is crucial in maintaining good health and well-being, yet community-based studies on health literacy in Nepal are scarce. This study aimed to assess the level of health literacy and identify associated factors among adults in Rasuwa, Nepal. A community-based cross-sectional study was conducted among 253 adults aged above 18 years residing in Kalika Rural Municipality, Rasuwa. Data were collected through face-to-face interviews using the Psychometric Assessment of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). Multivariable logistic regression was used to evaluate independent correlates of health literacy levels. The mean ± SD age of participants was 46.3 ± 16 years. Only about a quarter (23.3%) of participants had adequate health literacy. The participants aged ≤ 45 years (aOR:1.9,95% CI: 1.0-3.6), people who perceived their health status as satisfactory (aOR: 3.1,95% CI: 1.5–6.3), had satisfactory self-rated financial status (aOR: 2.9,95% CI: 1.5–5.5), had satisfactory level of self- related esteem (aOR = 2.7,95% CI: 1.2–6.2), had a stable income (aOR = 1.9, 95% CI:1.0-3.5) were more likely to demonstrate adequate health literacy level. Conversely, illiterate participants (aOR: 0.1, 95% CI: 0.04–0.4) and those engaged in agriculture (aOR: 0.49, 95% CI: 0.2–0.9) had lower odds of having adequate health literacy. This study highlights inadequate health literacy status among approximately three-quarters of the participants. Factors such as age, self-rated health status, financial stability, self-esteem, and income were associated with health literacy levels. These findings underscore the importance of addressing socio-economic and individual factors in promoting health literacy initiatives, particularly targeting vulnerable populations, to improve overall health outcomes and healthcare utilization. [ABSTRACT FROM AUTHOR]

Flood occurred in the Melamchi River on June 15 and recurred on July 31, 2021 have led notorious impacts in Nepal. This study has investigated these extreme flood events and their nexus with climate i.e. precipitation and temperature. The available daily and hourly hydro-meteorological data were analyzed. The regional flow during both flood events were estimated using 1-D hydraulic HEC-HMS model and the correlation among rainfall -runoff, temperature with snow water equivalent were examined. Result show that the Melamchi region found an average annual rainfall of 2610 mm during 1992–2021. Specifically, the middle section i.e. Shermathang and Tarkeghang has observed the highest daily average rainfall of 26.8 mm and 39.2 mm during the first and 61.4 mm and 66.6 mm during the second flood event, respectively. The discharge found at the Melamchi town segment was at 2893 m3/s and 1105 m3/s in the first and second events respectively in which regional contribution into discharge were found significant. The Bhemathang, which is landslide damming area where The daily average discharge observed 357 m3/s and 76 m3/s on both events, respectively. At the Nakote, the rainfall and runoff are poorly correlated while snow water equivalent and temperature showed positive correlation during summer. The snowmelt contribution to discharge was found 9.68 m3/s in the Melamchi River during the Summer season. The regional contribution to discharge and spatial variations of precipitation during flooding events showed that precipitation is the main climatic driver while temporary damming and increasing temperature also contributes to the magnitude of the Melamchi flood. [ABSTRACT FROM AUTHOR]

Human-wildlife conflict (HWC) is a pressing issue worldwide but varies by species over time and place. One of the most prevalent forms of HWC in the mid-hills of Nepal is human-common-leopard conflict (HLC). Leopard attacks, especially in forested areas, can severely impact villagers and their livestock. Information on HLC in the Gorkha district was scarce, thus making it an ideal location to identify high-risk zones and landscape variables associated with such events. Registered cases were collected and reviewed from the Division Forest Office (DFO) during 2019-2021. Claims from DFO records were confirmed with herders and villagers via eight focus group discussions. To enhance modeling success, researchers identified a total of 163 leopard attack locations on livestock, ensuring a minimum distance of at least 100 meters between locations. Using maximum entropy (MaxEnt) and considering 13 environmental variables, we mapped common leopard attack risk zones. True Skill Statistics (TSS) and area under receiver-operator curve (AUC) were used to evaluate and validate the Output. Furthermore, 10 replications, 1,000 maximum iterations, and 1000 background points were employed during modeling. The average AUC value for the model, which was 0.726 ± 0.021, revealed good accuracy. The model performed well, as indicated by a TSS value of 0.61 ± 0.03. Of the total research area (27.92 km2), about 74% was designated as a low-risk area, 19% as a medium-risk area, and 7% as a high-risk area. Of the 13 environmental variables, distance to water (25.2%) was the most significant predictor of risk, followed by distance to road (16.2%) and elevation (10.7%). According to response curves, the risk of common leopard is highest in the areas between 1.5 to 2 km distances from the water sources, followed by the closest distance from a road and an elevation of 700 to 800 m. Results suggest that managers and local governments should employ intervention strategies immediately to safeguard rural livelihoods in high-risk areas. Improvements include better design of livestock corrals, insurance, and total compensation of livestock losses. Settlements near roads and water sources should improve the design and construction of pens and cages to prevent livestock loss. More studies on the characteristics of victims are suggested to enhance understanding of common leopard attacks, in addition to landscape variables. Such information can be helpful in formulating the best management practices. [ABSTRACT FROM AUTHOR]

Despite the availability of successful vaccines, measles outbreaks have occurred frequently in recent years, presumably due to the lack of proper vaccination implementation. Moreover, measles cases in adult groups, albeit small in number, indicate that the previously neglected adult group may need to be brought into vaccine coverage to achieve WHO's goal of measles eradication from the globe. In this study, we develop a novel transmission dynamics model to describe measles cases in adults and children to evaluate the role of adult infection in persistent measles cases and vaccination programs for eradication. Analysis of our model, validated by measles cases from outbreaks in Nepal, provides the vaccination reproduction number (conditions for measles eradication or persistence) and the role of contact network size. Our results highlight that while children are primary targets for measles outbreaks, a small number of infections in adults may act as a reservoir for measles, causing obstacles to eradication. Furthermore, our model analysis shows that while impactful controls can be achieved by children-focused vaccines, a combined adult-child vaccination program may help assert eradication of the disease. [ABSTRACT FROM AUTHOR]

The inclusion of young people in conducting research leads to the creation of shared knowledge, honest communication, and increases the legitimacy of the research, allowing it to be an effective base for policy creation. This paper looks at the role of horizontal co-production with young people, as we reflect together on the process of collaboration in peace-building research. [ABSTRACT FROM AUTHOR]

Background and Aims: Access to safe and sufficient drinking Water, Sanitation, and good Hygiene (WASH) facilities in schools play a crucial role in preventing students from numerous Neglected Tropical Diseases, improving the learning environment in schools, and creating resilient communities living in a healthy environment. This study aims to explore the impact of combining WASH facilities on students' health status, school attendance, and educational achievements. Methods: Four schools, two with improved and two without improved WASH facilities, were selected purposively from Dhanusha and Chitwan districts of Nepal. A total of 24 participants, 16 students, and eight teachers were also purposively selected based on the Theory of Data Saturation. The participants were interviewed face‐to‐face using study guidelines; Key Informants Interview for teachers and In‐depth Interview for students. The data were audio recorded and analyzed thematically using Dedoose 9.0.17 qualitative data management and analysis software. Results: School WASH facilities have a significant impact on students' health and well‐being. Poor school‐WASH facilities hindered students' school attendance, particularly for menstruating girls. School without separate toilets for girls, including menstruation hygiene facilities, lack of water and soap, sanitary pad, and secure toilet's door often have higher rates of absenteeism among girls. Poor teacher and students' relationships, students' low interest in education, household chores, and participation in social customs also contribute to students' absence from school and low educational performance. It is important to note that inadequate WASH facilities affect not only students, but also teachers in the same school. Conclusion: The lack of safe and sufficient drinking water, unimproved sanitation, and poor hygiene facilities were seen by students and teachers as reducing their health and well‐being, school attendance, and academic performance. Thus, schools need prioritize and promote the provision of improved WASH facilities for the betterment of students' health, attendance, and educational proficiency. [ABSTRACT FROM AUTHOR]

Background: Improvements in standard precaution related to infection prevention and control (IPC) at the national and local-level health facilities (HFs) are critical to ensuring patient's safety, preventing healthcare-associated infections (HAIs), mitigating Antimicrobial Resistance (AMR), protecting health workers, and improving trust in HFs. This study aimed to assess HF's readiness to implement standard precautions for IPC in Nepal. Methods: This study conducted a secondary analysis of the nationally-representative Nepal Health Facility Survey (NHFS) 2021 data and used the Service Availability and Readiness Assessment (SARA) Manual from the World Health Organization (WHO) to examine the HF's readiness to implement standard precautions for IPC. The readiness score for IPC was calculated for eight service delivery domains based on the availability of eight tracer items: guidelines for standard precautions, latex gloves, soap and running water or alcohol-based hand rub, single use of standard disposal or auto-disable syringes, disinfectant, safe final disposal of sharps, safe final disposal of infectious wastes, and appropriate storage of infectious waste. We used simple and multiple linear regression and quantile regression models to examine the association of HF's readiness with their characteristics. Results were presented as beta (β) coefficients and 95% confidence interval (95% CI). Results: The overall readiness scores of all HFs, federal/provincial hospitals, local HFs, and private hospitals were 59.9±15.6, 67.1±14.4, 59.6±15.6, and 62.6±15.5, respectively. Across all eight health service delivery domains, the HFs' readiness for tuberculosis services was the lowest (57.8±20.0) and highest for delivery and newborn care services (67.1±15.6). The HFs performing quality assurance activities (β = 3.68; 95%CI: 1.84, 5.51), reviewing clients' opinions (β = 6.66; 95%CI: 2.54, 10.77), and HFs with a monthly meeting (β = 3.28; 95%CI: 1.08, 5.49) had higher readiness scores. The HFs from Bagmati, Gandaki, Lumbini, Karnali and Sudurpaschim had readiness scores higher by 7.80 (95%CI: 5.24, 10.36), 7.73 (95%CI: 4.83, 10.62), 4.76 (95%CI: 2.00, 7.52), 9.40 (95%CI: 6.11, 12.68), and 3.77 (95%CI: 0.81, 6.74) compared to Koshi. Conclusion: The readiness of HFs to implement standard precautions was higher in HFs with quality assurance activities, monthly HF meetings, and mechanisms for reviewing clients' opinions. Emphasizing quality assurance activities, implementing client feedback mechanisms, and promoting effective management practices in HFs with poor readiness can help to enhance IPC efforts. [ABSTRACT FROM AUTHOR]

Nepal holds a high ichthyofaunal diversity, nevertheless, the molecular study of Nepalese fish is still in its early stages. The first record of a cyprinid fish species the Garra kempi Hora, 1921 for Nepal was reported from eastern Nepal's Lohandra River. Both morphology and molecular data affirmed the existence of G. kempi in Nepal's aquatic system. This species was previously reported from China (Tibet) and northern India. The maximum likelihood phylogenetic analysis and pairwise genetic distance based on Kimura 2 parameters using cytochrome oxidase subunit 1 (COI) segment sequences (665 bp) also confirmed the identity of the species as G. kempi. The COI sequences of specimens from Nepal formed a monophyletic clade with the sequence of G. kempi from northeastern India and the two contained a pairwise genetic distance of 1.8% only. The new record of G. kempi from Nepal warrants a detailed ichthyofaunal survey for documenting the fish diversity in Nepal. [ABSTRACT FROM AUTHOR]

A comprehensive understanding of the intricate relationship between precipitation threshold and extreme river discharge, especially in mountainous regions, is challenging yet crucial for effective mountain risk management. This study, conducted in the Himalayan region of Nepal, employs an innovative approach using Intensity-Duration-Frequency (IDF) curves to identify potential precipitation extremes relevant to extreme river discharges. Detailed analysis of historical hydrometeorological events and their impacts in Nepal was carried out to select a specific event for thorough examination. Additionally, the research evaluates satellite-based precipitation data and utilizes frequency analysis techniques such as Gumbel and Log Pearson Type III distributions, customized to the region’s unique conditions. Furthermore, the study evaluates Probable Maximum Precipitation (PMP) and Depth-Area-Duration (DAD) curves at various sub-basin levels. The findings underscore the significant role of 3-day consecutive precipitation over 1-day events in generating extreme river discharge within the basin. Notably, the study reveals discrepancies between PMP values derived from gauge-based and satellite-based data, emphasizing the necessity for proper bias correction of the satellite data. Despite its limitations, the research highlights the potential of high-resolution satellite data for disaggregating gauge observed daily precipitation and underscores its applicability to other Himalayan basins, offering valuable insights into precipitation-related extreme events and their implications for water resource management and disaster risk reduction. [ABSTRACT FROM AUTHOR]

Factors associated with the habitat suitability of northern red muntjac (Muntiacus vaginalis) especially outside protected areas in the human-dominated landscape are still lacking. Fine-scale environmental variables can influence the habitat suitability of the animals. This study aimed to explore the different eco-geographic fine-scale variables for the distribution of the northern red muntjac; and predict suitable habitats using the maximum entropy (Maxent) model in the Chitwan Annapurna landscape (CHAL). The presence points of the northern red muntjac (n = 265) were collected between 2018 to 2021 using 150 transects of various lengths in four blocks. Density-based occurrence points rarify and performance-based variable selection were applied to improve the output of the model. The model was evaluated based on the area under the curve (AUC) value of operator characteristic (ROC) and analyzed on the basis of the response curve, the relative importance of variables, Jackknife test and suitability map. Results indicated the model was statistically satisfactory (mean AUC > 0.75). The distance to the nearest cropland was the most contributed variable followed by Normalized Difference Built-up Index (NDBI), distance to developed/settlement area and distance to grassland that explained suitability of Northern red muntjac. The species distribution model predicted 6.52% highly suitable and 23.77% suitable area for northern red muntjac. Therefore, this area is important for the muntjac and provides a possible alternative habitat for other wild animals outside the protected areas. Our research suggests that human dominated landscape should be prioritized in management plans for the conservation of muntjac. [ABSTRACT FROM AUTHOR]

One of the major management problems in and around protected areas is the intensifying conflict between local people and wildlife, especially large carnivores. Livestock depredation and human fatalities caused by attacks of carnivores are found to be serious obstacles in conflict management. This study aims to explore the patterns, costs, causes and perceptions of human large carnivore conflict in the Nawalpur area of Chitwan National Park. The patterns of livestock loss and human casualties due to large carnivores (Panthera tigris and Panthera pardus) were analysed using the secondary data reported to Chitwan National Park from 2001 to 2019. To understand the people's perception towards carnivores and wildlife conservation, 150 victim respondents were asked, with one household selected from each grid. During 19-year study period, a total of 521 incidents caused by large carnivores were reported, which included 33 human casualties and 488 livestock depredations. Tiger was responsible for the maximum conflict incidents in Nawalpur. The total relief provided for human deaths and injuries was US$17524.41, whereas US$13702.18 was used to compensate for livestock depredation in the Nawalpur area by authorities of the Chitwan National Park. More than 64% of the respondents liked the presence of carnivores in their area and had a positive attitude toward the conservation of large carnivores, even though the carnivores were responsible for livestock depredation and human injury and death. People's satisfaction with the relief scheme provided by the government depended on ethnicity, gender, age class, occupation, education, insurance, and livestock ownership, but they believed the scheme was not effective. Hence, an effective relief scheme and awareness about the process of relief funding should be conducted in conflict areas. Conducting awareness programs for local communities about large carnivores, their behavior, and preparing predator-proof corrals would be helpful in minimizing conflict in the study area. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine the current quality of work-life (QWL) situation and the effectiveness of labor laws for promoting QWL in the context of Nepalese workplaces. Design/methodology/approach: It uses a descriptive-interpretative-qualitative approach to analyze the responses. Information is gathered through discussions with 85 higher- and middle-level managers of large and medium-sized organizations. Findings: The majority of Nepalese organizations accept safe and healthy working conditions, social relevance of work-life, social integration in the work organization, and work and total life space as the key aspects of QWL. They have become even more critical as a result of the COVID-19 pandemic. However, they face challenges in providing employees with opportunities for continued growth and security, immediate opportunity to use and develop human capacities, adequate and fair compensation and constitutionalism in the work organization. QWL-related provisions in Labour Act, 2017, play a vital role in promoting the QWL situation. The QWL programs offer many benefits to employees' private and working lives. The lack of such programs would undoubtedly have negative consequences for Nepalese companies. Compliance with labor laws will promote a better QWL situation at Nepalese workplaces. Research limitations/implications: Only managerial perspectives are considered for examining the current situation of QWL and the effectiveness of QWL-related provisions of the Labour Act, 2017. It excludes the views of union leaders. Practical implications: This paper indicates that labor laws' QWL-related provisions are effective. It also provides several policy measures for promoting a better QWL in Nepalese workplaces. Originality/value: This study presents QWL-related legal provisions and the actual situation at the workplaces of Nepal. It also presents the key aspects of QWL in the context of Nepal. [ABSTRACT FROM AUTHOR]

The current study investigated whether hope and its two components (agency and pathways) weakened the relations between perceived burdensomeness, thwarted belongingness, and fearlessness about death and suicidal ideation among older adults living in rural Nepal. A community sample of 300 people aged from 60 to 90 years (Mage = 67.07, SDage = 6.23) who resided in the rural mid-hills of Nepal completed standardized measures. Hope and agency moderated the relationship between perceived burdensomeness and suicidal ideation and pathways moderated the relationship between thwarted belongingness and suicidal ideation. Hope, and particularly agency, may play a protective role in reducing suicidal ideation among older Nepali adults living in rural areas who experience perceived burdensomeness. In contrast, pathways may be an additional risk factor for older adults experiencing unmet belongingness needs. Research is required to understand fearlessness about death and suicidality among older Nepali adults. Increasing hope and particularly agency may be associated with a reduction in suicidal ideation among older Nepali adults who experience feelings of being a burden. However, increasing pathways may be associated with an increase in suicidal ideation among those who experience unmet belongingness needs. Research is needed to understand how to accurately assess suicide risk among Nepali older adults. [ABSTRACT FROM AUTHOR]

Nepal holds a high ichthyofaunal diversity, nevertheless, the molecular study of Nepalese fish is still in its early stages. The first record of a cyprinid fish species the Garra kempi Hora, 1921 for Nepal was reported from eastern Nepal's Lohandra River. Both morphology and molecular data affirmed the existence of G. kempi in Nepal's aquatic system. This species was previously reported from China (Tibet) and northern India. The maximum likelihood phylogenetic analysis and pairwise genetic distance based on Kimura 2 parameters using cytochrome oxidase subunit 1 (COI) segment sequences (665 bp) also confirmed the identity of the species as G. kempi. The COI sequences of specimens from Nepal formed a monophyletic clade with the sequence of G. kempi from northeastern India and the two contained a pairwise genetic distance of 1.8% only. The new record of G. kempi from Nepal warrants a detailed ichthyofaunal survey for documenting the fish diversity in Nepal. [ABSTRACT FROM AUTHOR]

Background: Salivary gland tumors consist of a group of heterogeneous lesion with complex clinicopathological characteristics. Fine needle aspiration (FNA) cytology has been used as a quick, non-invasive diagnostic tool for the diagnosis of neoplastic and non-neoplastic lesion of salivary gland. Aims and Objectives: The aims and objectives of the study are to perform the cytopathological evaluation of minor and major salivary gland lesions (neoplastic and non-neoplastic) in terms of its various types, frequency, site, demographic distribution and to correlate with histopathology findings whenever available. Materials and Methods: This is a hospital-based 3-year study in which 155 cases of patient underwent FNA cytology for salivary gland swelling (non-neoplastic and neoplastic) of which seven cases were excluded due to scant and inadequate aspirate, and thus, only 148 cases were included in this study and histopathological correlation was available in 42 cases. Any metastatic lesion, repeat samples from same patient were excluded from the study. Results: Out of 148 cases, male patients were 72 (49%) and female patients were 76 (51%) with M: F ratio of 0.9:1. Benign lesion was commonly seen in 31-40 years, non-neoplastic lesion at 41-60 years (n=18, 37.6%), and malignant lesions at 61-90 years (n=9, 37.5%). Parotid was the most common salivary gland involved by neoplastic and non-neoplastic lesion accounting 65.5% (n=97) followed by submandibular gland 29.7% (n=34). Pleomorphic adenoma was most frequently diagnosed among all salivary gland lesions (60%). Mucoepidermoid carcinoma outnumbered the category (14%) of malignant salivary gland lesion. On histopathology correlation, 33 cases were correctly diagnosed in cytopathology whereas 9 cases showed discordant result. FNA cytology sensitivity was 66.6%, specificity was 93.3%, positive predictive value was 80.0%, and negative predictive value was 87.5%, respectively. Diagnostic accuracy was found to be 85.7%. Conclusion: Cytopathology examination of salivary gland can be used as safe and reliable method in primary diagnosis of lesions of salivary gland. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure associated with pregnancy without any other known cause. With a prognosis that can vary from the complete recovery of left ventricular function to maternal mortality as well as recurrence with subsequent pregnancies, early diagnosis and treatment of PPCM is important in management. Bromocriptine treatment is beneficial effects on LVEF and mortality in women with severe acute PPCM in addition to standard heart failure therapy. However, further study is required to establish its effect in PPCM. Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure associated with pregnancy without any other known cause. Most of the clinical presentation is similar to symptoms of advanced pregnancy making the diagnosis difficult. Reported are three patients who developed dyspnea, orthopnea, and dry cough during the first week of puerperium. On examination, bilateral lower limb edema and bilateral basal lung crepitation were present in all patients. Chest radiograph showed pulmonary edema in cases two and three, and pleural effusion in case one. All patients had reduced left ventricular ejection fraction and raised N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) levels. Case two developed PPCM in the background of left pyelonephritis. Case three was complicated by acute kidney injury. All patients were managed with bromocriptine, diuretics, beta‐blockers, ACE inhibitors, and fluid restriction. Hence, PPCM though rare should be considered as a differential in women presenting with features of heart failure in later months of pregnancy or within 5 months of delivery. [ABSTRACT FROM AUTHOR]

The economy of South Asia is experiencing growth, yet it faces constraints due to heavy reliance on fossil fuels and frequent power outages. Access to diverse energy sources, particularly electricity, is crucial for sustaining this growth. One feasible solution involves neighbouring countries engaging in the trade of renewable electrical energy. Hydropower stands as one of the many energy sources available in South Asia. However, sectorial constraints pose significant challenges to energy trade initiatives. This study utilises the Analytic Hierarchy Process (AHP) to evaluate Nepal's readiness and identify obstacles to its cross-border energy trade with India and Bangladesh. A comprehensive analysis of these obstacles is imperative for formulating effective strategies and policies. Additionally, this study offers recommendations for enhancing preparedness and resolving issues related to energy trading, which may apply to similar cross-border situations. This study ranks energy trading obstacles with neighbouring nations using the AHP, offering key insights for stakeholders and policymakers. Using a non-probabilistic purposeful sampling technique, 25 expert respondents from the energy sector and prominent academicians were selected as part of the data collection procedure. At every level of the interview process, their perspectives were invaluable in guaranteeing a thorough and rigorous investigation. [ABSTRACT FROM AUTHOR]

In remote communities, diagnosis of G6PD deficiency is challenging. We assessed the impact of modified test procedures and delayed testing for the point-of-care diagnostic STANDARD G6PD (SDBiosensor, RoK), and evaluated recommended cut-offs. We tested capillary blood from fingerpricks (Standard Method) and a microtainer (BD, USA; Method 1), venous blood from a vacutainer (BD, USA; Method 2), varied sample application methods (Methods 3), and used micropipettes rather than the test's single-use pipette (Method 4). Repeatability was assessed by comparing median differences between paired measurements. All methods were tested 20 times under laboratory conditions on three volunteers. The Standard Method and the method with best repeatability were tested in Indonesia and Nepal. In Indonesia 60 participants were tested in duplicate by both methods, in Nepal 120 participants were tested in duplicate by either method. The adjusted male median (AMM) of the Biosensor Standard Method readings was defined as 100% activity. In Indonesia, the difference between paired readings of the Standard and modified methods was compared to assess the impact of delayed testing. In the pilot study repeatability didn't differ significantly (p = 0.381); Method 3 showed lowest variability. One Nepalese participant had <30% activity, one Indonesian and 10 Nepalese participants had intermediate activity (≥30% to <70% activity). Repeatability didn't differ significantly in Indonesia (Standard: 0.2U/gHb [IQR: 0.1–0.4]; Method 3: 0.3U/gHb [IQR: 0.1–0.5]; p = 0.425) or Nepal (Standard: 0.4U/gHb [IQR: 0.2–0.6]; Method 3: 0.3U/gHb [IQR: 0.1–0.6]; p = 0.330). Median G6PD measurements by Method 3 were 0.4U/gHb (IQR: -0.2 to 0.7, p = 0.005) higher after a 5-hour delay compared to the Standard Method. The definition of 100% activity by the Standard Method matched the manufacturer-recommended cut-off for 70% activity. We couldn't improve repeatability. Delays of up to 5 hours didn't result in a clinically relevant difference in measured G6PD activity. The manufacturer's recommended cut-off for intermediate deficiency is conservative. [ABSTRACT FROM AUTHOR]

In the past few decades, the Nepali government has endorsed several nutritional policies, strategies, and guidelines. Given the lack of a comprehensive review of such policy documents, this review aims to describe the nutrition and food security policies and understand the existing policy gaps in Nepal. Findings from this study can be used to develop policies and programs to address Nepal's current and future nutritional needs. Policies relevant to nutrition and food security were identified by searching government websites and directly approaching relevant government ministries. Thematic analysis was conducted using framework methods under 8 predetermined themes: nutrition intervention, food security, food system, capacity building of human resources, nutrition education, nutrition governance, research, and monitoring and evaluation. The contents of each document reviewed were manually extracted in a spreadsheet stratified by the themes, and the findings were summarized for the respective themes. A total of 30 policy documents were reviewed. Most policies have focused on undernutrition; only a few have addressed overnutrition and diet-related noncommunicable diseases. Food security through a sustainable food system has been considered a key policy area in Nepal. Other areas in the food and nutrition policy landscape are capacity building for human resources, behavior change practices, nutrition governance, monitoring, and evaluation. Policy gaps have been identified in the quality and sustainability of nutrition programs; access to health care services; competent human resources for nutrition; intersectoral coordination and commitment; and support for monitoring, evaluation, and research activities. Most policies have tried to address a wide range of components of food and nutrition security; however, strategies focused on overnutrition and diet-related noncommunicable diseases are lacking. Several gaps are identified in this policy review; the findings can guide the policymakers to address these gaps via further policy development. [ABSTRACT FROM AUTHOR]

Livestock depredation by leopards is a pervasive issue across many Asian and African range countries, particularly in and around protected areas. Developing effective conflict mitigation strategies requires understanding the landscape features influencing livestock depredation. In this study, we investigated predictors associated with livestock depredation by leopards using 274 cases of leopard attacks on livestock that occurred between 2017 and 2020 in the Annapurna Conservation Area, Nepal. We also examined how livestock predation by leopards varied depending on the species, season, and time. A generalized linear model with binary logistic regression was used to test the statistical significance of variables associated with the presence and absence of conflict sites. The results revealed that the area of forest, agricultural land, length of rivers, slope, proximity to settlements and protected areas, and elevation significantly predicted the probability of leopard attacks on livestock. We also observed a significant increase in the incidence of leopard predation on livestock with decreasing slopes and rising elevations. The areas near human settlements and the protected areas faced a higher risk of leopard predation. The incidence of leopard predation on livestock varied significantly depending on the livestock species, season, and time. Goats were the most highly predated livestock, followed by sheep, cow/ox, and buffalo. A total of 289.11 km² (or around 5% of the research area) was deemed to be at high risk for leopard predation on livestock. This study's comprehensive understanding of human-leopard conflicts provides valuable insights for planning and implementing measures to reduce damage caused by leopard populations throughout their range. [ABSTRACT FROM AUTHOR]

Public lands including forests and community pastures are still crucial means of local livelihood, social security, and environmental conservation in many developing countries including Nepal. However, these resources are increasingly managed primarily to offset greenhouse gas emissions of developed countries. The new management has exacerbated many local problems: livelihood constriction, social crises, human casualties (deaths and serious injuries), biodiversity degradation, and water scarcity including cryosphere retreating. Drawing data from multiple sources, this study attempted to explain the international political objectives and processes that dispossessed developing societies of public land resources for the benefit of developed countries. It shows that representatives of the developed countries were proactively and strategically involved in agenda formation, solutions negotiations, and decision-making while developing international environmental policies, and succeeded to structure the policies for managing the resources of developing countries for the best benefit of their own countries. The developed countries provided funds and experts, as strategic tools, through international aid agencies to implement the policies of their interest in institutionally weak countries. In Nepal, the aid agencies influenced the thinking of the public and the decisions of the government and other stakeholders through a series of strategic measures. They propagandized false crises, worked with a coalition of powerful international agencies, offered free technical support, and changed national policies proactively to manage the land resources for achieving their missions. Active involvement in policy implementation also helped the agencies to monitor implementation hurdles and apply other tactics to resolve them. Lucrative flash incentives were provided to motivate and get the support of communities, powerful stakeholders, and politicians to implement the policies. Psychosocial pressures were also applied to persuade local communities and their leaders for getting local cooperation in making and practicing new legal institutions (government authority rules or orders, user group rules, and forest management plans) that bind and control local communities for forest protection. The institutions obliged local communities to contribute free labor or cash for developing, modifying, and protecting the forests. These two levels of interventions led to the further development of reinforcing institutions, resource conditions, and social-ecological systems that secured benefits for developed countries and deprived local communities of power to control, produce and access the public land resources in their own backyard for years. This study also showed that international environmental policies and aid agencies have respectively served as institutional weapons and vehicles for materially and institutionally powerful countries to colonize the land resources of weaker countries, without using of physical coercion or deplyment of military forces. [ABSTRACT FROM AUTHOR]

Introduction: Family planning (FP) is crucial for improving maternal and newborn health outcomes, promoting gender equality, and reducing poverty. Unmet FP needs persist globally, especially in South Asia and Sub-Saharan Africa leading to unintended pregnancies, unsafe abortions, and maternal fatalities. This study aims to identify the determinants of unmet needs for FP from a nationally representative survey. Methods: We analyzed the data of 11,180 currently married women from nationally representative Nepal Health Demographic Survey 2022. We conducted weighted analysis in R statistical software to account complex survey design and non-response rate. We conducted univariate and multivariable binary and multinomial logistic regression to assess association of unmet need for FP with independent variables including place of residence, province, ecological belt, ethnicity, religion, current age, participant's and husband's education, occupation, wealth quintile, parity, desire for child, and media exposure. Results: The total unmet FP need was 20.8% (95%CI: 19.7, 21.9) accounting 13.4% (95%CI: 12.5, 14.4) for unmet need for limiting and 7.4% (95%CI: 6.8, 8.0) for unmet for spacing. Lower odds of total unmet need for FP were present in 20–34 years and 35–49 years compared to <20 years, women belonging to Madhesi ethnic group (AOR: 0.78; 95%CI: 0.64, 0.95) compared to Brahmin/Chhetri, women from richest (AOR: 0.69; 95%CI: 0.56, 0.84), richer (AOR: 0.82; 95%CI: 0.68, 0.97) and middle wealth quintile (AOR: 0.82; 95%CI:0.70, 0.98) groups compared poorest wealth quintile group and women belonging to rural area (AOR: 0.89; 95%CI: 0.80, 0.99) compared to urban area. Higher odds of unmet need for FP were present among women with basic (AOR: 1.34; 95%CI: 1.17, 1.54), and secondary level (AOR: 1.32; 95%CI: 1.12, 1.56) education compared to women without education, among women from Madhesh (AOR: 1.56; 95%CI: 1.22, 1.98), Gandaki (AOR: 2.11; 95%CI: 1.66, 2.68), Lumbini (AOR: 1.97; 95%CI: 1.61, 2.42) and Sudurpashchim province (AOR: 1.64; 95%CI: 1.27, 2.10) compared to Koshi province and among women whose husband education was basic level (AOR:1.37; 95%CI: 1.15, 1.63), or secondary level (AOR: 1.32; 95%CI: 1.09, 1.60) education. Conclusion: Nepal faces relatively high unmet FP needs across various socio-demographic strata. Addressing these needs requires targeted interventions focusing on age, ethnicity, religion, education, and socio-economic factors to ensure universal access to FP services. [ABSTRACT FROM AUTHOR]

Introduction: Nasopharyngeal carcinoma (NPC) shows geographic and ethnic variation with specific etiopathogenesis. This study characterized the distribution of NPC patients stratified by ethnicity, geography, and histology in a tertiary-level cancer center in Nepal. Methods: A descriptive retrospective study was designed to analyze NPC cases from different regions among patients visiting the hospital from 2016 to 2021. Demographic and clinical information was obtained from medical records. Ethical approval was granted by the Nepal Health Research Council (NHRC). Data analyses and visualization were carried out with R software. Results: During the six-year period, a total of 65 individuals were diagnosed with NPC, comprising 42 males and 23 females. Patient median age was 43 years (range 11–85 years). A bimodal age distribution of cases was observed with peaks in patients aged 30–39 years and 50–59 years. Of the NPC patients studied, 29 were from Koshi Province, with 7 cases from Ilam district and 6 cases from Morang district. There were 18 patients in Bagmati Province, and Kathmandu district had the highest number of cases within this region, with 8 patients. The highest proportion of cases were observed among patients of Janajati ethnicity (60%), including Rai, Limbu, and Sherpa people. Histologically, undifferentiated non-keratinizing NPC was the most commonly observed subtype, accounting for 43.1% of cases, followed by 20% differentiated non-keratinizing NPC and 4.6% keratinizing NPC across the entire sample population. The majority of patients (75.3%) were diagnosed at an advanced stage (stage III or IV) with none diagnosed at stage I. Conclusions: In our study, most cases of NPC occurred in patients from provinces in eastern Nepal (Koshi province), and of the Janajati ethnic community. The most common histological subtype was undifferentiated non-keratinizing carcinoma. Further epidemiological studies could address differences in prevalence and the challenge of late presentation of NPC patients in Nepal. [ABSTRACT FROM AUTHOR]

Dengue poses a significant public health concern worldwide. It is identified as a recent emerging infectious disease in Nepal. Understanding the situation and dynamics between knowledge, attitudes, and practices (KAP) related to dengue among students is crucial for effective prevention and control strategies. This study aimed to assess the KAP and their associated factors of dengue among non-health undergraduate students of Nepal to identify gaps and suggest appropriate interventions. A web-based cross-sectional study was conducted among 429 non-health undergraduate students at eleven Nepalese Universities, with 80% of participants from the four most prominent ones in the country. Self-administered online forms were administered via Google Forms platform predominantly through social media for data collection. Data was cleaned and then exported to IBM SPSS Statistics 20.0 for analysis. Demographic characteristics of respondents were described using descriptive statistics. Multivariate logistic regression was conducted to determine the association between individual characteristics and KAP. Pearson's correlation coefficient was used to determine the association between knowledge-attitude, attitude-practice, and knowledge-practice. Statistical significance was determined at the p-value < 0.05. Around half of the participants were female (50.3%). The majority of participants were between 22 to 37 years, unmarried, and belonged to the Brahmin/Chhetri ethnic group. This study demonstrated a significant gap in KAP. Only 15.2% of participants had good knowledge while 25.9% and 68.3% of participants exhibited good attitudes and practices respectively. Marital status (AOR = 3.32, CI: 1.32–8.34), third-year educational level (AOR = 3.59, CI:1.34–9.57), and fourth-year educational level (AOR = 4.93, CI:1.88–12.94) were significantly associated with knowledge regarding dengue. Age (AOR = 1.73, CI: 1.10–3.01) was significantly associated with preventive practice regarding dengue. None of the demographic or socio-economic characteristics of respondents was associated with attitude on dengue. The knowledge-attitude (rka = 0.01), knowledge-practice (rkp = 0.22), and attitude-practice (rap = 0.01) were positively correlated in this study. Author summary: Dengue has been identified as one of Nepal's youngest emerging infectious diseases. Nepal had its first dengue outbreak in 2006 followed by major cyclic outbreaks in 2010, 2013, 2016, 2019, and 2022. This study particularly tried to capture the situation of the knowledge, attitude, and practice of non-health undergraduate students and to possibly help identify the gaps and to support interventions planning to improving the endemic condition of dengue. This study found that 15.2% of participants had good knowledge, 25.9% and 68.3% of the participants had good attitudes and preventive practices regarding dengue respectively. To bridge the gap between knowledge and practice on dengue and promote KAP on dengue, television, and social media can be effective tools as these are major sources of information about dengue. Tailored interventions addressing demographic-specific factors are imperative for enhancing KAP on dengue prevention and control. [ABSTRACT FROM AUTHOR]

Background: Studies on cross-informant agreement on adolescents' emotional and behavioral problems (EBPs) are sparse in low- and middle-income countries. This study aimed to assess parent-adolescent and teacher-adolescent agreement on EBPs and associated factors in Nepal. Methods: This cross-sectional survey included 1904 school-going adolescents aged 11–18, enrolled in government and private schools located in sixteen districts of Nepal. The Nepali versions of the Youth Self Report, Child Behavior Checklist, and Teacher's Report Form were administered to assess EBPs reported by adolescents, their parents, and teachers, respectively. Repeated measures analysis of variance (ANOVA) was done to assess mean differences in problem scores. Pearson's correlation was used to assess cross-informant agreement. Linear regression analysis was used to explore factors associated with cross-informant discrepancies in EBPs. Results: Adolescents reported significantly more problems than their parents and teachers. Mean Total Problem scores for the 90 common items in the adolescents' self-reports, parent reports, and teacher reports were 34.5 (standard deviation [SD]: 21.4), 24.1 (SD = 19.2), and 20.2 (SD = 17.5) respectively. Parent-adolescent agreement on Total Problems was moderate, whereas teacher-adolescent agreement was low. The parent-adolescent agreement was moderate to low for the two broadband scales and all syndrome scales, whereas the teacher-adolescent agreement was low for all scales. Female gender and ethnic minority status impacted both parent-adolescent and teacher-adolescent discrepancies. Family stress/conflicts impacted parent-adolescent discrepancies, while academic performance impacted teacher-adolescent discrepancies. Conclusions: Nepali adolescents reported more EBPs than their parents and teachers. The agreement between adolescents' self-reports and reports by their parents and teachers was moderate to low. Gender, caste/ethnicity, family stress/conflicts, and academic performance were associated with cross-informant discrepancies. It is crucial to collect information from different sources, consider context-specific needs, and discern factors influencing cross-informant discrepancies to accurately assess adolescents' EBPs and develop personalized approaches to treatment planning. [ABSTRACT FROM AUTHOR]

We model interseismic plate coupling distribution on the Main Himalayan Thrust (MHT) in Nepal through the inversion of secular GNSS velocity data. To complement previously published data, we compile velocity data from ten additional continuous stations to improve spatial resolution in central and mid-western Nepal. A regional non-planar structural model is adopted to reproduce the MHT fault plane. In general, the coupling pattern seems nearly binary, indicating that transition from full coupling to decoupling is occurring sharply in very narrow zones. In eastern Nepal (> 84.5ºE), plate coupling is very strong from the surface to intermediate depths, including the source region of the 2015 Mw 7.8 Gorkha earthquake. Geodetically estimated slip deficit rates are consistent with the rupture history of great earthquakes in the east revealed by geomorphological observations. In the west (< 83.0ºE), a weakly coupled zone extends laterally at intermediate depths, whereas the coupling in the shallower part remains very strong. Although the slip deficit rate in the west is significantly smaller than that in the east, seismic moment accumulated, since the last complete rupture in 1505 may be capable of generating a future great event. In central Nepal, estimated slip deficit rates are comparable with those in the east, and no great event has been documented over the past several centuries. Thus, the seismic risk may be most urgent in central Nepal. The development of local seismicity and crustal deformation should be carefully monitored. [ABSTRACT FROM AUTHOR]

This study aims to explore university students’ perception regarding an e-assessment system in terms of preference, assessment management, and the quality assurance process. A cross-sectional online survey was employed among 384 students of Nepal Open University (NOU). Structural equation modeling (SEM) was used in the research. Findings indicate that the perception of students regarding preference, e-assessment management, and the quality assurance process was found to be significantly high. In particular, the perception of preference regarding digital assessment was higher than assessment management and the quality assurance process. Gender, ethnicity, and place for taking classes, have an effect on implementation. This study concludes that three attributions of preference for digital assessment, management, and quality assurance are affected by one another. [ABSTRACT FROM AUTHOR]

Introduction: Autologous blood products like Platelet Rich Plasma (PRP) and Leukocyte and Platelets Rich Fibrin (L-PRF) have been used for many years across many types of skin ulcers. However, the effectiveness of autologous blood products on wound healing is not well established. Methods: We evaluated the 'second generation' autologous product- Leukocyte and Platelet- Rich Fibrin (L-PRF). Our trial was undertaken on patients suffering from neuropathic leprosy ulcers at the Anandaban hospital which serves the entire country of Nepal. We conducted a 1:1 (n = 130) individually randomised trial of L-PRF (intervention) vs. normal saline dressing (control) to compare rate of healing and time to complete healing. Rate of healing was estimated using blind assessments of ulcer areas based on three different measurement methods. Time to complete healing was measured by the local unblinded clinicians and by blind assessment of ulcer images. Results: The point estimates for both outcomes were favourable to L-PRF but the effect sizes were small. Unadjusted mean differences (intervention vs control) in mean daily healing rates (cm2) were respectively 0.012 (95% confidence interval 0.001 to 0.023, p = 0.027); 0.016 (0.004 to 0.027, p = 0.008) and 0.005 (-0.005 to 0.016, p = 0.313) across the three measurement methods. Time to complete healing at 42 days yielded Hazard Ratios (unadjusted) of 1.3 (0.8 to 2.1, p = 0.300) assessed by unblinded local clinicians and 1.2 (0.7 to 2.0, p = 0.462) on blind assessment. Conclusion: Any benefit from L-PRF appears insufficient to justify routine use in care of neuropathic ulcers in leprosy. Trial registration: ISRCTN14933421. Date of trial registration: 16 June 2020. Author summary: Autologous Blood Products such as Leucocyte and Platelets Rich Fibrin (L-PRF) gel have been widely used in the treatment of skin ulcers, including Leprosy ulcers. L-PRF gel contains a high concentration of platelets and leucocytes rich in growth factors that might promote wound healing. However, our systematic review showed that there is a lack of high-quality trial evidence for the effectiveness of L-PRF. To evaluate the efficacy of L-PRF we conducted an individual randomised controlled trial (n = 130) of L-PRF gel vs conventional normal saline dressings. Photographs were taken during twice weekly dressing changes in both intervention and control groups. The ulcer photographs were assessed by blinded assessors using three different ulcer area measurement methods. Outcomes were rate of healing and time to complete epithelialisation. Point estimates for intervention effects across outcomes and measurement methods, intervention vs control was favorable to L-PRF but the effect sizes were small and mostly not statistically significant. [ABSTRACT FROM AUTHOR]

Background: Worksite-based health programs have shown positive impacts on employee health and have led to significant improvements in cardiovascular risk factor profiles. We aimed to determine the effect of cafeteria intervention on cardio-metabolic risk factors diet in a worksite setting (Dhulikhel Hospital) in Nepal. Methods: In this one-arm pre-post intervention study, we recruited 277 non-pregnant hospital employees aged 18–60 with prediabetes or pre-hypertension. The study was registered in clinicaltrials.gov (NCT03447340; 2018/02/27). All four cafeterias in the hospital premises received cafeteria intervention encouraging healthy foods and discouraging unhealthy foods for six months. We measured blood pressure, fasting glucose level, glycated hemoglobin, cholesterol in the laboratory, and diet intake (in servings per week) using 24-hour recall before and six months after the intervention. The before and after measures were compared using paired-t tests. Results: After six months of cafeteria intervention, the median consumption of whole grains, mono/polyunsaturated fat, fruits, vegetable and nuts servings per week increased by 2.24(p<0.001), 2.88(p<0.001), 0.84(p<0.001) 2.25(p<0.001) and nuts 0.55 (p<0.001) servings per week respectively. The median consumption of refined grains decreased by 5.07 servings per week (p<0.001). Mean systolic and diastolic blood pressure decreased by 2 mmHg (SE = 0.6; p = 0.003) and 0.1 mmHg (SE = 0.6; p = 0.008), respectively. The low-density lipoprotein (LDL) was significantly reduced by 6 mg/dL (SE = 1.4; p<0.001). Conclusion: Overall, we found a decrease in consumption of refined grains and an increase in consumption of whole grains, unsaturated fats, fruits, and nuts observed a modest reduction in blood pressure and LDL cholesterol following a 6-month cafeteria-based worksite intervention incorporating access to healthy foods. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is widely regarded as an increasing threat to global public health. Antibiotic treatment guidelines have been increasingly recognized as an effective tool to guide appropriate prescriptions and help curtail antibiotic resistance. The present study aimed to assess physician's adherence to hospital antibiotic treatment guideline recommendations in Nepal and determine predictive variables with a significant association. This was a retrospective, monocentric observational review to investigate the adherence to endorsed guidelines using the medical records of adults admitted to the hospital with a diagnosis of urinary tract infection (UTI), pneumonia, or skin and soft tissue infection (SSTI) from January 2018 to December 2019. Of the 2,077 medical records that were reviewed (954 UTI, 754 pneumonia, and 369 SSTI), 354 (17%) met the study inclusion criteria, which included 87 UTI, 180 pneumonia, and 87 SSTI patients. Among eligible patients with antibiotic prescriptions, the following were adherent to guideline recommendations: 33 (37.9%) UTI, 78 (43.3%) pneumonia, and 23 (26.4%) SSTI. The overall extent of adherence to hospital antibiotic treatment guidelines for the use of antibiotics among adult inpatients diagnosed with these common infections was 37.9%. Patients who received ceftriaxone (OR = 2.09, 95% CI = 1.18–3.71, p = 0.012) and levofloxacin (OR = 4.63, 95% CI = 1.30–16.53, p = 0.018) had significantly higher adherence to treatment guidelines. This study revealed a low adherence rate despite the availability of updated guidelines for antibiotic prescriptions. The findings confer an urgent need to confront antibiotic prescription patterns in such tertiary care centers for tailored interventions to improve adherence to antibiotic guidelines. [ABSTRACT FROM AUTHOR]