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Background: Cooking with traditional fuels can lead to severe health issues caused by household air pollution, and can also affect gender equality and drive environmental degradation. In Nepal, despite government efforts to promote electric cooking, more than half of the population still uses traditional fuels, with electric cooking adoption remaining below 1%. Several of the barriers to and enablers of clean cooking vary geographically; however, few studies have considered spatial explicit information in planning national-scale transitions to clean cooking. In this study we provide a spatially explicit roadmap to estimate the required investments and benefits gained from the transition across Nepal., Methods: This study uses geospatial modelling methods to evaluate strategies to achieve the Government of Nepal's vision for a national-scale transition to clean cooking. We integrate the open-source clean cooking geospatial assessment tool OnStove and a spatial multicriteria analysis model. With OnStove, we evaluate which cooking technologies and fuels maximise the net benefits of a clean-cooking transition across each km 2 of the region. With the multicriteria analysis, we weigh stakeholder preferences and prioritise areas of action where policy should be implemented. We used the most up-to-date geospatial data to the year 2023, such as the High Resolution Settlement Layer, Open Street Maps' road networks, the Global Human Settlement Layer, NASA/USGS forest cover maps, and Facebook's Relative Wealth Index, among others. We also relied on data from the Nepal Oil Corporation, the Nepal Electricity Agency, the Central Bureau of Statistic's 2021 national census, and the Alternative Energy Promotion Center. We evaluate four scenarios capturing advances on clean cooking policy up to the year 2022, current market inefficiencies, and the potential effects of new policies for clean-cooking transition in Nepal., Findings: Our results show that transitional and clean cooking technologies provide higher net benefits than traditional options everywhere across Nepal in all scenarios. Our net-benefit analysis shows that around 9563 deaths could be averted yearly if benefits and externalities were perceived and valued correctly. Furthermore, substantial benefits could be achieved in regard to greenhouse gas emissions avoidance, time saved, and health-cost reductions. Our results also show that the current subsidy strategy from the Government of Nepal is well aligned with the benefits achieved under a cost-benefit analysis. In this context, electric cooking can bring the highest benefits to the largest part of the population. The analysis showed how high subsidies for liquefied petroleum gas in Nepal can present trade-offs with energy security and independence, and how this could be avoided by transferring part of the subsidy to cover differentiated electric cooking tariffs. Accounting for stakeholder preferences and sociodemographic and geographical differences to prioritise areas of focus can balance affordability constraints and target the most vulnerable people first, thus achieving integrated and inclusive planning., Interpretation: Using spatially explicit modelling approaches to evaluate strategies for a clean cooking transition can provide more nuanced results that have not been possible before. This approach can enable data-driven and integrated planning to help to understand which locations of a study area should be prioritised for policy application. Integrated planning can help to reduce affordability constraints on the population and design strategies for a sustainable and inclusive transition. These strategies allow financial institutions, donors, impact investors, development organisations, and government agencies to use their resources, funds, and assistance to create a large impact., Funding: Clean Cooking Alliance., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Along with many physical issues associated with the HIV/AIDS there are socio-psychological ill-effects including depression, anxiety and stress. The antiretroviral therapy has been successful in prolonging the life but not much information is available on the psychosocial issues and social support from Nepal., Methods: Sequential explanatory mixed method study design was followed. All the patients undergoing antiretroviral therapy in Bharatpur Hospital above 18 years of age and giving consent to participate were conveniently selected. Validated Nepalese version of Becks Depression Inventory and Becks Anxiety Inventory tool while translated and validated Multidimensional Scale of Perceived Social Support scale was used Purposive In-depth Interview was conducted with open ended questionnaire to obtain qualitative data. Chi-square and logistic regression were used for quantitative analysis while manual content analysis was used to analyze the qualitative data., Results: The totals of 288 participants were included in the study About 43% had some level of depression, 98% had very low level of anxiety and almost half of the people had high support. In binary logistic regression model, the significant variables were sex, marital status and occupation. Females had 2.622 times more odds of depression than males, the risk of having depression in occupation group- agriculture and household was 3.661 and 2.508 time more as compared to jobholder respectively. Similarly, single individuals had 2.815 higher odds of depression than couples. Emotional disturbances and fear of vulnerability, stigmatization, dealing with difficulties were the major problems in these groups with good familial and organization support., Conclusions: Clinicians, health and AIDS professionals should routinely screen for depression among other interventions to promote psychological health in HIV/AIDS-positive individuals.

Background: The increasing burden of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and its association with the stigma, disability, less productive life, diminished immune has overall affected the quality of well being. There are also many factors that directly or indirectly affect the quality of Life of People living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome. Thus, this study aims to assess Quality of Life among people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome., Methods: A cross-sectional analytical study among 100 individuals of age 18 years and above and diagnosed from 6 month and above attending the ART clinic of Bharatpur Hospital was carried out between using simple random sampling technique. Quality of life was evaluated using World Health Organization Quality of life questionnaire (WHO QOL-BREF instrument)., Results: This study reveals that the Quality of Life median scores were highest for the environmental domain (25±2.6) and lowest for the social domain (11±1.4). The overall Quality of Life median scores in the other two domains were physical domain (23±2.4), and psychological domain (19±3.1). The Quality of Life scores of all four domains were strongly co-related with the total measure of the quality of life. The strongest correlation was seen in psychological domain .Sex, Education, Marital status, Cause of HIV, Co-morbidities of illness, and Family support was statistically associated with overall Quality of Life., Conclusions: Higher education, Good family support and no co-morbidties to the illness has a greater impact in improving the quality of Life.

Introduction: Anti-thrombotic, statins and antihypertensive drugs are commonly used for the management of acute ischemic stroke in Nepal but there is no evidence regarding their efficacy in our context. This study aims to explore the efficacy of these combined medications (anti-thrombotic, statins and antihypertensive drugs) in acute ischemic stroke patients for the first time and to assess the risk factors present in those patients., Methods: The study was conducted on 37 acute ischemic stroke patients admitted and treated at the Neurology Department of College of Medical Sciences-Teaching Hospital, Chitwan, Nepal and they were followed at three months (90±10 days). The initial stroke severity and functional disability were evaluated at admission and at 3 months using National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) respectively. The outcome parameters were functional independence (mRS≤2) and mortality at three months (mRS=6). Frequency distribution, Mann-Whitney U-test and χ2 test were performed for statistical analysis., Results: Out of 37 patients, 27 (73%) were Smoker, 22 (59.5%) had hypertension and 19 (51.4%) were alcohol consumer. The stroke severity on admission was statistically significant with functional independence (P=0.003) and mortality (P=0.015) at three month. Similarly, Rankin grade on admission was statistically significant with functional independence (P=0.001) and mortality (P=0.048) at three month. At three months, 20 (69%) survived patients were independent while mortality was seen in eight (21.6%) patients., Conclusions: The management of acute ischemic stroke with combined anti-thrombotic, statins and antihypertensive drugs seems promising and efficacious in mild to moderately severe ischemic stroke.

Introduction: Primarily, health sector connects two segments - medicine and public health, where medicine deals with individual patients and public health with the population health. Budget enables both the disciplines to function effectively. The Interim Constitution of Nepal, 2007 has adapted the inspiration of federalism and declared the provision of basic health care services free of cost as a fundamental right, which needs strengthening under foreseen federalism., Methods: An observational retrospective cohort study, aiming at examining the health sector budget allocation and outcome, was done. Authors gathered health budget figures (2001 to 2013) and facts published from authentic sources. Googling was done for further information. The keywords for search used were: fiscal federalism, health care, public health, health budget, health financing, external development partner, bilateral and multilateral partners and healthcare accessibility. The search was limited to English and Nepali-language report, articles and news published., Results: Budget required to meet the population's need is still limited in Nepal. The health sector budget could not achieve even gainful results due to mismatch in policy and policy implementation despite of political commitment., Conclusions: Since Nepal is transforming towards federalism, an increased complexity under federated system is foreseeable, particularly in the face of changed political scenario and its players. It should have clear goals, financing policy and strict implementation plans for budget execution, task performance and achieving results as per planning. Additionally, collection of revenue, risk pooling and purchasing of services should be better integrated between central government and federated states to horn effectiveness and efficiency.

Introduction: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries and not to mention the cost it imparts to the health system of a country. Therefore, it is equally important to find out the prevalence and the pattern of abortion among the women who utilize the safe abortion care services and provide a framework to target various health promotion programs including safe-motherhood and reproductive health; such that the future interventions to avoid the unintended pregnancy and unsafe abortion can be implemented accordingly., Methods: A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal. Social and demographic information of all the women seeking induced abortions from January 2011 to December 2012 were included and the result was analyzed., Result: Abortion contributed to about 1.68% of the total patient served in the hospital that provides both obstetrical and gynecological services. Of the total 4830 patients who underwent induced abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two parity and belonged to higher caste., Conclusion: The socio-demographic profile of the abortion clients in Nepal has remained similar over the years. We need to address the accessibility and availability to the safe abortion care services along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion care to all group of women and also, women education regarding contraception to avoid repeated abortions or unwanted pregnancy in the future.

Background: Inter-sectoral coordination has been one of the different factors in the district health system that produces efficient output which has been identified by the Alma Ata declaration as an essential component to achieve notion of 'Health for All'. This study was therefore aimed to describe the major four key functions of the health systems and to find out the situation of inter-sectoral coordination in Nepal., Methods: A mixed method with Focus Group Discussion (FGD) and In-Depth Interview with relevant personnel to collect the majority of the data was carried out from June 2012 to November 2012 from six districts selected purposively based on the health performance indicators., Results: The major findings in relation to the key functions of district health systems showed that the overall management of the district health system happens under the leadership of chief of District Health Office of Public health office with the cooperation of all the personnel in different sections in a predetermined pattern and inter-sectoral coordination and collaboration exist only to a very limited extent., Conclusions: The major constraints for inter-sectoral coordination to be effective is lack of its planning and enforcement where inter-sectoral coordination could be important for both preventive and promotive health care, waste management, water supply and sanitation, health service utilization, pesticides and human health, agriculture and nutrition, air pollution. The main components in the district health system needs an immediate attention and inter-sectoral effort should be initiated from the central level and implemented in all the levels.