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With the change in socio-political and educational contexts in global academia, the trend of writing academic papers has arisen among Nepali students and educators in higher education. However, many of them are still unfamiliar with the basic standard to be incorporated in an academic paper. In this context, this study examined the post-graduate students' errors in writing research proposals. A textual analysis method was employed, where quantitative phase of analysis was followed by qualitative, and the data were collected from 24 purposively selected research proposals and from the interview with 10 students. The quantitative data were gathered from content analysis of the research proposals and qualitative data were collected from the unstructured interview. The collected proposals were studied, erroneous expressions were listed and categorized in to four parameters like grammatical errors, lexical semantic errors, mechanic errors and syntactic errors. The information from the interview was recorded, noted and analyzed. The results exhibited that (1) article and preposition usages were more persistent grammatical errors; (2) run-ons and fragmentation were more reiterated syntactic errors; and (3) uses of single lexical items were more common lexical-semantic errors and punctuation was the more regular mechanical errors. These findings reveal that students have insufficient knowledge and skills for academic writing. Therefore, they need academic writing courses, training, or workshops from the early level of their schooling. The findings of this study are useful for curriculum designers, policymakers, instructors, and students because it provides significant information on the building blocks experienced by English language learners in writing research paper.

Online video games have become popular among teenage students and have drawn the attention of both parents and teachers in Nepal. We report an analysis of secondary students' experiences of playing online video games and parents' perception of their children's game behaviour. We employed online semi-structured interviews with students and parents, and observation of students' game activities. This paper reports on how online video games developed students' independent study skills and autonomous learning abilities. Video games can be an assistive tool to engage teenage learners in collaborative and autonomous learning activities. Parents, however, perceived that video games unless specifically designed for educational purposes, can negatively impact students' health. Findings suggest that the appropriate integration of video games into educational practices can strengthen students' self-learning habits and develop their capabilities.

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.

Academic performance is taken as the process of carrying out academic activities and discourses by faculty members to enhance their academic activities and discourses. The purpose of this research was to identify the faculty member's level of academic performance in higher educational institutions. To conduct this research, a quantitative methodology was employed. The tools to measure the academic performance of faculty members were developed using Delphi method. The data were collected with 445 sampled respondents from four universities. The factor analysis was used to explore the dimensions of academic performance. The factor analysis identified four factors of academic performance i.e., research and publication, innovation, interactive learning, and capacity building. To analyze the level of academic performance, mean and the standard deviation was used. It was found that individual differences and the organizational environment, culture, and technological infrastructure were crucial to influence the pace and level academic performance in academia.

Teaching and learning process in 21st century has been embedded with technology. Use of ICTs plays crucial role in ameliorating knowledge acquisition in general and enhancing English Language mastering in particular. The government of Nepal has made provision of integrating ICTs in school education with the aim of enhancing quality education and make both teachers and learners confidence and competitive in the present global world. In this context, this research intended to investigate roles and practices of ICTs at English as Foreign language classes (EFL) of Nepal. To achieve the objective, explanatory sequential mixed research design was adopted. Survey questionnaire, unstructured interview and non-participant observation were used to as the tools of data collection and forty secondary English teachers (20 from public schools & 20 from private schools) were the sample population. Two datasets; quantitative and qualitative were collected and analyzed sequentially. The findings of the research reveal that majority of the teachers were positive towards roles of ICTs in language teaching even they were doubt if ICTs could develop creative and critical abilities of the students. Though the teachers practiced ICTs in their classes, they felt discomfort in using new ICT tools and applications. The findings imply that teachers should be given training on ICT use for building up their skills; knowledge and confidence to achieve optimum advantages form it.

Purpose: The purpose of this paper is to discuss the formal workplace learning situation in Nepal and argue that workplace learning is not in priority in Nepali Technical and Vocational Education and Training (TVET) despite a regular policy emphasis. Design/methodology/approach: Data were gathered using both desk-based review of pre-diploma and diploma-level curricula and semi-structured interviews with eight employers and six technical school principals. Coded themes were interpreted in the meaning-making process. Findings: Workplace skills learning in Nepal has remained a neglected agenda. Despite some successful implementation practices and policy recognition, it is stagnated. Employers expect skills in graduates relevant to their demands. However, unfortunately, there needs to be more trust for a culture of shared responsibilities among employers and TVET providers for arranging the provisions so that the learners can acquire the skills that the employers need. There is a blaming game between them, which has ultimately resulted in the poor arrangement of workplace learning. Practical implications: TVET providers' and employers' engaged participation in recognizing and developing workplace learning for making the learning as per the needs of the world of work could benefit them and also support students to upgrade and acquire employability skills. Originality/value: This paper is based on empirical data and contributes new knowledge in academia which is still rare in the context of Nepal.

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Traditional and local knowledge (TLK) can be instrumental in mitigating the risks of disasters. There are calls to prioritize such knowledge to promote community resilience against disasters. This study examines the integration of TLK into disaster risk reduction (DRR) policies in Nepal, India and Bangladesh using a qualitative content analysis. We evaluated the level of integration in three components: policy priority, policy governance, and policy integration. Policy priority included five criteria and showed that India has better integrated TLK into national policies, followed by Nepal, and Bangladesh. None of the countries met our criteria for policy governance. Nepal and India emphasize community-based disaster management, combining traditional knowledge with modern technologies. However, policies are silent about the pathways of such integration, the governance mechanisms have no provision for community participation, nor are any integration tools proposed to promote such practices. Overall, the DRR policies have acknowledged the need to engage with TLK, but much more work is needed to prioritize TLK integration, which requires integration tools (e.g., legal, economic and institutional) and resources. • Integrating traditional/local knowledge (TLK) into DRR policies is poorly understood. • Policies of Nepal, India and Bangladesh acknowledge TLK but do not prioritize it. • India integrates DRR policies better than Nepal/Bangladesh do. • There are no legislative, economic, or communicative tools for TLK in DRR policies. • The involvement of local communities in formal mechanisms is a critical issue. [ABSTRACT FROM AUTHOR]

Online video games have become popular among teenage students and have drawn the attention of both parents and teachers in Nepal. We report an analysis of secondary students' experiences of playing online video games and parents' perception of their children's game behaviour. We employed online semi-structured interviews with students and parents, and observation of students' game activities. This paper reports on how online video games developed students' independent study skills and autonomous learning abilities. Video games can be an assistive tool to engage teenage learners in collaborative and autonomous learning activities. Parents, however, perceived that video games unless specifically designed for educational purposes, can negatively impact students' health. Findings suggest that the appropriate integration of video games into educational practices can strengthen students' self-learning habits and develop their capabilities. [ABSTRACT FROM AUTHOR]

We conducted a tuberculosis (TB) serosurveillance program of captive elephants in Nepal and compared hematology and biochemistry parameters between seropositive and seronegative elephants. A total of 153 elephants (male=20, female=133) from four national parks were tested for TB using the ElephantTB STAT-PAK® Assay (ChemBio Diagnostic Systems, Inc., Medford, NY, USA). The mean reported age for 138 elephants was 38.5 years (range 2-71 years). Seroprevalence for TB was 21.56% (33/153). The majority of seropositive elephants were female (n=30) and from Chitwan National Park (n=29). The occurrence of TB seropositive cases in other more remote national parks suggests TB may be widespread among the captive elephant population of Nepal. Hematology and biochemistry analyses were performed on 13 and 22 seropositive elephants, respectively and, nine elephants from a seronegative TB herd for comparison. Hematology parameters (hemoglobin, packed cell volume, platelet, white blood cells, and erythrocyte sedimentation rate) were comparable between the two groups. Total protein, globulin, and lactate dehydrogenase were significantly higher in seronegative elephants, and bilirubin was significantly higher in seropositive elephants whereas blood urea nitrogen, creatinine, glutamic oxaloacetic transaminase/aspartate aminotransferase (GOT/AST), glutamic pyruvic transaminase/alanine aminotransferase (GPT/ALT), gamma glutamyl transferase (GT), and albumin were not significantly different. The range of biochemical parameters that were significantly different between seropositive and seronegative elephants had narrow ranges. Thus, the potential of these parameters as a direct biomarker for TB diagnosis is limited based on the findings in this study. We recommend including blood parameters in future TB surveillance studies. [ABSTRACT FROM AUTHOR]

There are significant changes in rural livelihoods as Nepali society passes through an agrarian transition. Understanding those changes is fundamental to guiding approaches to support communities to generate sustainable development pathways and to adapt to risk. The socio-ecological research examines how community forests are used by different household groups across the mid-hills of central Nepal. Results from a quantitative survey of community forest user group members suggest that households are increasingly reliant on off-farm/forest activities. While the forest remains important for subsistence activities, including providing fodder and mulch to support agroforestry, households are less actively managing or utilising community forests. As rural societies evolve and people become less immediately dependent on their local environments, policy will need to adjust to support complex agroforestry systems for multiple direct livelihood benefits. Socio-economic and demographic structural changes are important determinant factors in driving a divergence in the direct use values of the forest. Knowledge of complex local socio-ecological situations can guide multifunctional natural resource management outcomes that provide unique pathways for different types of households reliant on subsistence agroforestry and commercial harvesting activities. Without such knowledge of changing local environmental management needs, the evolving relationships between communities and their natural resources are likely to remain important, largely overlooked drivers of policy complexity within developing countries during agrarian transitions. • The roles of the forest are changing with development in the mid-hills of Nepal. • Activity within community forests are declining across all rural household groups. • The forest remains vitally important for supporting subsistence agroforestry. • Unique forest development pathways could be pursued to support all households. • Forest policy can meet subsistence and commercial needs as societies transition. [ABSTRACT FROM AUTHOR]

Knowledge management is taken as an integral component of any institution to enhance organizational effectiveness and productivity. Knowledge Management (KM) in academia is being prioritized these days to enhance academic activities and discourses. The knowledge management impacts to enhance the academic activities in academia, particularly for higher educational institutions (HEIs). Furthermore, the practices of KM enhance academic activities in higher educational institutions. Thus, the purpose of this research was to measure the level of KM among faculty members of HEIs. The quantitative method was used to conduct this research. The tools to measure knowledge management practices among faculty members of HEIs were developed by using Delphi methods. The 445 respondents were taken from the four universities of Nepal. Similarly, the data was taken from these universities as well. The factor analysis was used to identify the dimension of KM. The factor analysis identified seven dimensions of KM; knowledge utilization, acquisition, generation, dissemination, transfer, creation, and presentation. To analyze the level of the knowledge management, mean and standard deviation were used as the indicators or analysis tools for this research. The level of knowledge management was categorized into three groups viz. low, medium, and high. The study found that the overall pace of KM was high except for the knowledge generation process in the context of higher education. Due to individual differences and the organizational environment, culture, and technological infrastructure, it makes the level of knowledge generation differences comparing from other dimensions of knowledge management. [ABSTRACT FROM AUTHOR]

Nepal is going through a major socio-economic transition in rural areas and hence in forest management practices, leading to changes in and evolution of new forest-people relationships. Community forests are experiencing an ecological transition resulting a new pattern of growth, regeneration and diversity in forest composition. The ecological transition of forest corresponds to the shifting local collective actions in community forestry which are emerging from the new socio-economic dynamics in rural areas such as income-diversification, declining subsistence utilization of forest resources and outmigration of the rural population. However, these changes are highly differentiated and variable. The hilly areas are experiencing remarkable forest cover changes than in the lowlands of Terai. In this paper, we examine the evolving intersection between new forest transition and community collective action in Nepal. We draw our analysis on the comparative case study of four villages from three different ecological regions. Our findings show that the forest transition is not static, but a dynamic process shaped by diverse local and external factors. Further, declining utilization of forests for subsistence uses has led to a new dynamic in community collective action which has played a central role in driving forest transition. Community participation in forest management is also declining. Hence, we call for reconceptualizing local collective action in this changed context which can help revise forest policies and reimagine forest institutions that can better respond to the socio-economic changes of the mountain landscape and revitalize local collective actions. • Nepal's forests experiencing ecological changes. • Socio-economic changes in Nepal leading to shift in community collective action. • Interplay between forest transition and community collective action is discussed. • Community participation in forest management activities and utilization are declining. • Reimagining forest policies and institutions to respond these changes is urgent. [ABSTRACT FROM AUTHOR]

• Labor shortage due to out-migration adversely affected smallholder farmers in Nepal. • Adoption of scale-appropriate mechanization increased rice productivity by 1110 kg/ha. • Adoption of mechanization by non-adopters would increase rice productivity by 1250 kg/ha. • Very small rice cultivating farms (≤0.25 ha) benefited most from adoption of mechanization. • Rising on-farm rural wage due to labor shortage was the primary driver of mini-tiller adoption. Smallholder farmers in the mid-hills of Nepal are facing an acute labor shortage due to out-migration which, in general, has affected the capacity to achieve timely crop establishment, harvest, and inter-cultural operations. These effects are more visible in the case of labor-intensive crops such as rice and promoting higher levels of rural mechanization has emerged as the primary policy response option. Nevertheless, quantitative evidence for the ability of mechanization to offset the adverse effects of shortages increasing labor prices in these systems is largely absent. This study investigates the impacts associated with adoption of mini-tillers (5 to 9 horsepower) for land preparation on smallholder rice productivity in the mid-hills of Nepal. We use an endogenous switching regression that accounts for both observed and unobserved sources of heterogeneity between mini-tiller adopters and non-adopters. Findings demonstrate that rising on-farm rural wage rates and an emerging decline in draft animal availability are driving adoption of the mini-tiller. Among users, the mini-tiller increased rice productivity by 1,110 kg/ha (27%). Further, regression results suggest that mini-tiller non-adopters would be able to increase their rice productivity by 1,250 kg/ha (26%) if they adopt. Moreover, our analysis revealed that very small farms (≤0.25 ha) that adopt mini-tillers are benefited the most in terms of gains in rice productivity. These findings support policies that favor the expansion of small-scale mechanization in the hill production ecologies of South Asia and highlight the need to foster the emergence of an associated service economy that will permit smallholders access to capital-intensive machinery such as the mini-tiller. [ABSTRACT FROM AUTHOR]

By definition, public spaces are areas or locations that are open and accessible to all people, and in cities they are open space that is specifically concerned with public health, social cohesion, and the quality of urban life. This paper reports a review of literatures on urban public spaces attempting to gauge the research gaps on public spaces through a scoping-review analysis of relevant studies. The review of relevant literatures published from 1990 to 2023 led to an inference that there is a huge gap in defining the publicness (non-excludable and non-rival) of the public spaces in Nepal. Furthermore, knowledge about public spaces is found to be scattered. However, all Nepal-based research identified that open spaces in Kathmandu valley were severely encroached upon. Rapid urbanization, along with a lack of resilient urban planning and governance, appears to have a significant influence on urban public spaces and social cohesion, as well as diseconomies in emerging economies. Social inequalities, health disparities, environmental injustice, economic instability and stifled cultural expression are all intricately bound to urban public spaces, particularly green public space, which still remains a research priority for new evidence-based urban policymakers and urban planners in developing countries. Future research should therefore focus on a multilevel approach preferably using network model to cover and comprehend the societal-benefits of public space, extending large-scale quantitative assessments with field evaluations of each public space, community surveys, and other qualitative research in Nepal. Component-wise research gaps are also evidently explored in the course of separate domains. • This paper gauges the research gap on new and regenerated public spaces. • A substantial gap remains in locally redefining the public spaces, promoting diseconomies in the emerging economies. • Social, health, environmental, economic and cultural aspects of urban green public spaces are to be in research priority. • Future research should focus on grasping the societal value of public space at multilevel approach using network model. [ABSTRACT FROM AUTHOR]

Objective: Although there are a number of studies on trekkers' knowledge of acute mountain sickness (AMS), there is little current literature on other groups at altitude, for example, marathon runners. Increased knowledge of AMS is associated with a lower incidence of AMS. The purpose of this study was to determine AMS knowledge of marathon runners with an aim to improve AMS information distribution. Incidence of AMS was also determined.Methods: Participants completed a self-assessment AMS knowledge questionnaire in Kathmandu before starting the acclimatization trek for the Tenzing Hillary Everest Marathon in Nepal. Lake Louise Scoring questionnaires were completed every day of the 12-day acclimatization trek.Results: The majority (86%; 43 of 50) of participants obtained information about AMS before the marathon, with the Internet providing the most common source (50%; 25 of 50). Ninety-two percent (46 of 50) of participants rated their knowledge as average or above, and self-assessment correlated with knowledge questionnaire scores (r = .479, P < .001). However, 48% (24 of 50) did not know it was unsafe to ascend with mild AMS symptoms, and 66% (33 of 50) thought it was safe to go higher with symptoms relieved by medication. Only 50% (25 of 50) knew AMS could occur from 2500 m. Thirty-eight percent (19 of 50) of participants had AMS during the acclimatization trek, and 6% (3 of 50) experienced it during the race.Conclusions: This study adds to previous literature regarding knowledge and incidence of AMS. It further highlights that more needs to be done to improve knowledge through better information dissemination, with inclusion of scenario-based information to aid application of this knowledge to practical situations. [ABSTRACT FROM AUTHOR]

The World Conservation Union (IUCN) publishes the Red List of Threatened Species, the most authoritative information available globally on the conservation status of species. However, the status of globally threatened species remains controversial at local levels because many of them are not protected as part of national statutory law. Such anomalies are examples of controversies in implementing the much-hyped environmental slogan “think globally, act locally”. Here we provide a comparative review between globally threatened species as listed by the IUCN Red List found in Nepal and those of nationally protected species under Nepalese law. We discovered a significantly higher diversity of globally threatened mammals and birds in Nepal than would be expected relative to their global ratios. We established remarkable disparities in species conservation in Nepal: (1) a large number (an average of 85% of species of five taxonomic groups: mammals, birds, amphibians, fishes and reptiles) of IUCN-listed globally threatened species found in Nepal are not protected by national law; (2) most protected species listed are mammals (70%), but more than half of globally-threatened mammals found in Nepal are not protected; and (3) amphibians and fish are not protected, although they represent 12% of the total number of globally-threatened species found in the country. Such large gaps in Nepalese conservation law are an indication of unresponsive and inefficient conservation planning. The Government of Nepal and international conservation partners should: (1) emphasize knowledge-based conservation strategies for all taxonomic groups; and (2) prioritize updating the lists of protected species. [ABSTRACT FROM AUTHOR]

Conservation agriculture (CA) systems composed of intercropping and strip tillage practices were evaluated on marginalized maize-based farming system in hill region of Nepal. On-farm experimental trials were conducted on the field of 25 smallholder farmers in three villages of central mid-hill region. Results indicated that although CA systems did not increase crop yields; higher return and revenue were generated due to increased number of crop harvests and higher price of the cash crops used in intercropping. Therefore, it was concluded that smallholder farmers should adopt CA system for increasing return and improving sustainability of the farming system. [ABSTRACT FROM AUTHOR]

Tourism is a growing industry in Nepal. Pokhara is one of the major tourist destinations in Nepal. To foster the tourism industry in Nepal then government of Nepal decided on 2008 to launch a national tourism campaign ''Nepal Tourism Year 2011'' targeting to bring one million international tourists into Nepal in the year 2011. This paper focuses on analyzing the impact of Nepal Tourism Year 2011's advertisement campaign on tourist arrival in Pokhara city. Also it attempts to highlight the impact of network and information access on tourism arrival. A sincere attempt has also been made to investigate the impact of NTY in bringing international tourist in Nepal particularly in Pokhara. [ABSTRACT FROM AUTHOR]

Forest landscapes in the midhills of western Nepal are not adequately conserved within a protected area network. The species and ecosystems in these human-dominated landscapes are highly endangered. Understanding the effects of human activities on wildlife is therefore important for devising an appropriate conservation strategy in this region. Here, we show, using data on spatial structure of three endangered mountain ungulates, that presence of these species is determined by the level of human disturbance and habitat requirements. We show that species preferring flat areas covered by dense forest are exposed to more intensive human disturbances, and even an adaptation to rugged areas does not imply less human disturbance. Abundance of all species studied declined with the number of villages in the vicinity and increased with distance to nearest village. Therefore, increasing human population may contribute to a decrease of wildlife population in the region. To prevent this, community forestry program enabling local people to protect forest near villages and land-use strategy aimed at reducing further encroachment of forest in higher altitudes should be immediately launched in the region. [ABSTRACT FROM AUTHOR]

Abstract: Almost nothing is known about the distribution and status of the Himalayan serow, an IUCN category “near threatened” ungulate, formerly widely distributed from subtropical to subalpine regions, in the Nepalese Himalaya. Heavy hunting, together with habitat loss and fragmentation are believed to have caused local extinctions in many sites within its geographical range. Distribution pattern of this dense forest dwelling threatened ungulate thus indicates conservation status of the whole unique ecosystems of this region. The objective of this study was therefore to assess distribution and status of serow in the Nepalese midhills. We conducted surveys, based on sightings and indirect presence signs, in western Nepal, between the subtropical Bardia National Park in the south and mountainous Shey Phoksundo National Park in the north, during 2008–2010. We recorded serow in the Bardia National Park. Further to the north, we recorded it only in highly rugged and inaccessible areas in the high altitudes, which suggests their possible extinction in the midhill region. The serow presence was strongly positively correlated with hunting intensity and forest intactness index. The populations of serow, scattered in the region, are small and therefore likely to be sensitive to demographic stochasticity. This all may consequently lead to future extinction of serow in the entire region. This information can be used to aid further research and decision-making processes for conservation planning along altitudinal gradient of Nepal''s Himalaya. [Copyright &y& Elsevier]

This paper examines the relationship between self esteem of housewives with respect to some selected socioeconomic variables, namely; marital status, husband's income, husband's occupation, husband's physical attraction, women's own intelligence and women's physical attraction with a sample of 240 Pokherli married women. The study compares whether the self-esteem of women and other different factors is different among the various caste groups. A comparison is also made between professional women and housewives. Self-esteem of women is significantly different among the various caste groups with the highest in Magar and Gurung women. Professional women are more conscious than housewives in all aspects of husband's success. This study tests the common assertion that women, having reasonably higher income housewives experience their husbands' success. Husbands' success does positively affect a housewife's self esteem, but only indirectly, through its effect on perceived marital success. Only husband's income has a direct positive effect on self esteem, while other successes of the husband actually lower her self esteem. Since marriage is traditionally a basis for a woman's identity, successful marriega increases her feelings of worth. However, the specific role arrangments may reduce her feelings of personal competence. [ABSTRACT FROM AUTHOR]

Objectives: To test the use of Moyers prediction method and Tanaka and Johnston's equations for use in a Nepalese population and to construct new probability tables and prediction formulae based on the actual tooth sizes in a sample of the Nepalese population. Design: Cross-sectional. Source and setting: Dental, medical and nursing science students at the B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Subjects and methods: The sample consisted of 100 Nepalese males and 100 females aged between 17 and 23 years. Subjects without any previous orthodontic treatment, fully erupted permanent teeth and with no dental anomalies were recruited. Dental study models were taken and measurements of the mesio-distal widths of teeth were carried out using digital caliper. The measured values were compared with predicted values derived from Moyers method and Tanaka and Johnston equations. Independent (tests were used to examine differences between genders. Correlation coefficients and linear regression equations were used to compare the actual Nepalese tooth widths with predicted values Results: Moyers method at 50% tends to underestimate the actual width of the canine and premolars in males by 0.3 mm and overestimate the width in females by 0.2 mm. The Tanaka and Johnston method tends to overestimate the actual width of the canine and premolars in both males (0.7 mm) and females 1.0 mm. Conclusion: The newly developed regression equations are more accurate for prediction of width of unerupted permanent teeth in a Nepalese population. Further studies are required based on larger sample size, to confirm the applicability of the new regression equations proposed. [ABSTRACT FROM AUTHOR]

This article aims to explore the phenomenon of women experiencing gender-based violence (GBV) at home, strategies adopted by women to manage GBV, knowledge, attitude and practice (KAP) among health service providers (HSPs) and law enforcers to support GBV victims and to recommend appropriate policy and program initiatives for combating GBV in Nepal. GBV is an attitudinal problem of men towards women in Nepal. Men always feel superior to women and try to keep them subservient and commit violence if women are not able to understand their sentiments and act accordingly for pleasing them and performing their reproductive and productive roles, including household chores. One-third (35 percent) of women in Nepal experience GBV at home, although most violence is unreported and unrecorded in informal or formal institutions. Psychological violence was found to be high, followed by physical, economic and sexual violence. The main reasons for perpetuating violence against women are the low educational status of women, bringing less dowry at the time of marriage, no control over resources by women and low educational status of the perpetuators. Promulgating a law to criminalize GBV perpetrators and the formulation and implementation of educational and training programs to reduce GBV are immediate needs of the country. [ABSTRACT FROM AUTHOR]

Abstract: The Lesser Himalayan low- to medium-grade metamorphic rocks in central Nepal are rich in K-white micas occurring as porphyroclasts and in matrix defining S1 and S2. Porphyroclasts are usually zoned with celadonite-poor cores and celadonite-rich rims. The cores are the relics of igneous or high grade metamorphic muscovites, and the rims were re-equilibrated or overgrown under lower T metamorphic conditions. The matrix K-white micas defining S1, pre-dating the Main Central Thrust activity, are generally celadonite-rich. They show heterogeneous compositional zoning with celadonite-rich cores and celadonite-poor rims. They were recrystallized at lower T condition prior to the Main Central Thrust activity, most probably prior to the India–Asia collision (pre-Himalayan metamorphism). The matrix K-white micas along S2, synchronous to the Main Central Thrust activity (Neohimalayan metamorphism), are relatively celadonite-poor and were recrystallized under relatively higher T condition. K-white micas defining S1 also were partially re-equilibrated during the Neohimalayan metamorphism. The average compositions of recrystallized K-white micas defining both S1 and S2 become gradually poor in (Fe+Mg)- and Si-contents and rich in Al- and Ti-contents from south to north showing an increase of metamorphic grade from structurally lower to higher parts in the Lesser Himalaya. This shows that the metamorphism is inverted throughout the inner Lesser Himalaya. The tectono-metamorphic significance of the published K–Ar and 40Ar/ 39Ar K-white micas ages from the Lesser Himalaya need re-evaluation in the context of observed intrasample compositional variation and zoning, and possible higher closure temperature (∼500°C) for K–Ar system. [Copyright &y& Elsevier]

Abstract: Objective: Maternal folate deficiency is associated with neural tube defects (NTDs), the most common congenital birth defect at Maternity Hospital, Kathmandu, Nepal. NTDs can be prevented with periconceptional folic acid supplementation (FAS). This study was performed to assess the awareness of FAS among women of reproductive age in Kathmandu. Methods: A semi-structured questionnaire was administered to 400 randomly selected patients aged 15 to 45years visiting Kathmandu Model Hospital from May to July 2011, seeking any awareness of FAS, knowledge of its impact on fetal development and knowledge of the appropriate time of supplementation. Results: Forty percent (95% CI 35.1–45.0) of women had heard about FAS, 16.3% (95% CI 12.8–20.2) knew that folate affects fetal health and 5.0% (95% CI 3.1–7.6) knew that it should be taken pre-pregnancy. Level of education was strongly associated with awareness (multivariate Odds Ratio for lowest vs. highest level of education: 0.29, 95% CI 0.15–0.56). Conclusions: Knowledge of FAS is very low among women of childbearing age in Kathmandu. Inclusion of FAS information in health awareness programs is recommended. [Copyright &y& Elsevier]

Farm mechanization among smallholder farming systems in developing countries is emerging as a viable option to off-set the effects of labor out-migration and shortages that undermine agricultural productivity. However, there is limited empirical literature on gender and farm mechanization. This study assesses the impacts of the gender of household heads on mini-tiller adoption in the hills of Nepal, using an exogenous switching treatment regression model. Our findings reveal that there is a significant gender gap in mini-tiller adoption between male-headed households (MH-HHs) and female-headed households (FH-HHs). Compared to MH-HHs, the mini-tiller adoption rate is significantly lower among the FH-HHs, and a large amount of unobserved heterogeneity is deriving this difference. Moreover, when MH-HHs and FH-HHs have similar observed attributes, the mini-tiller adoption rate among the food insecure FH-HHs is higher than in the food secure group. The gender-differentiated mini-tiller adoption rate can be minimized primarily by enhancing market access. Findings suggest that farm mechanization policies and programs targeted to the FH-HHs can reduce the gender-differentiated adoption gap in Nepal and similar hill production agro-ecologies in South Asia, which will enhance the farm yield and profitability. • Farm mechanization is significantly different between MH-HHs and FH-HHs. • Mini-tiller adoption rate is significantly lower among the FH-HHs. • Substantial amount of unobserved heterogeneity is affecting the adoption difference. • Food insecure FH-HHs would benefit most from mechanization intervention. • Mini-tiller adoption difference between MH-HHs and FH-HHs can be minimized by enhancing market access. [ABSTRACT FROM AUTHOR]

This paper analyzes smallholder farmers' willingness to pay (WTP) for the purchase of scale-appropriate farm mechanization in the hill ecologies of Nepal using the case of mini-tiller technology: a small, 5–7 horsepower two-wheel tractor primarily used for agricultural land preparation. Using primary survey data from 628 randomly-selected households, we find that farm size, local wage rates, out-migration, access to credit services, and associations with agricultural cooperatives positively influence the WTP for mini-tillers while the number of draft animals owned negatively influence the WTP for mini-tillers. On average, farmers were willing to pay 31% less than the actual price of a mini-tiller. Results also exhibited a heterogeneous demand in which the lowest quartile farm size households, typically the poorest farm households, were willing to pay 26% less for the mini-tiller than the top quartile of farms. In the context of labor scarcity and rising rural wages, agricultural policy on farm mechanization in Nepal should aim to prioritize small farms through robust service provision models in order to increase the level of farm mechanization in the country. • Scale-appropriate mechanization has the potential to mitigate the problem of labor scarcity. • Farm size, on-farm labor wages, and access to credit are positively associated with WTP for the mini-tiller. • Number of draft animals owned is negatively associated with WTP for the mini-tiller. • Farmers' average WTP was 31% lower than the actual mini-tiller price. • Compared to the richest quartile farms, the WTP of the poorest quartile was 26% lower for mini-tillers. [ABSTRACT FROM AUTHOR]

Introduction: Maternal mortality in Nepal dropped from 553 to 186 per 100 000 live births during 2000-2017 (66% decline). Neonatal mortality dropped from 40 to 21 per 1000 live births during 2000-2018 (48% decline). Stillbirths dropped from 28 to 18 per 1000 births during 2000-2019 (34% decline). Nepal outperformed other countries in these mortality improvements when adjusted for economic growth, making Nepal a 'success'. Our study describes mechanisms which contributed to these achievements., Methods: A mixed-method case study was used to identify drivers of mortality decline. Methods used included a literature review, key-informant interviews, focus-group discussions, secondary analysis of datasets, and validation workshops., Results: Despite geographical challenges and periods of political instability, Nepal massively increased the percentage of women delivering in health facilities with skilled birth attendance between 2000 and 2019. Although challenges remain, there was also evidence in improved quality and equity-of-access to antenatal care and childbirth services. The study found policymaking and implementation processes were adaptive, evidence-informed, made use of data and research, and involved participants inside and outside government. There was a consistent focus on reducing inequalities., Conclusion: Policies and programmes Nepal implemented between 2000 and 2020 to improve maternal and newborn health outcomes were not unique. In this paper, we argue that Nepal was able to move rapidly from stage 2 to stage 3 in the mortality transition framework not because of what they did, but how they did it. Despite its achievements, Nepal still faces many challenges in ensuring equal access to quality-care for all women and newborns., Competing Interests: Competing interests: Dr Punya and Dr Bibek are currently employed by the Government of Nepal. Dr Sharma was previously employed there. Their participation and insights have been invaluable to this report., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objectives: To evaluate the feasibility of using the NeuroMotion smartphone application for remote General Movements Assessment for screening infants for cerebral palsy in Kathmandu, Nepal., Method: Thirty-one term-born infants at risk of cerebral palsy due to birth asphyxia or neonatal seizures were recruited for the follow-up at Paropakar Maternity and Women's Hospital, 1 October 2021 to 7 January 2022. Parents filmed their children at home using the application at 3 months' age and the videos were assessed for technical quality using a standardised form and for fidgety movements by Prechtl's General Movements Assessment. The usability of the application was evaluated through a parental survey., Results: Twenty families sent in altogether 46 videos out of which 35 had approved technical quality. Sixteen children had at least one video with approved technical quality. Three infants lacked fidgety movements. The level of agreement between assessors was acceptable (Krippendorf alpha 0.781). Parental answers to the usability survey were in general positive., Interpretation: Engaging parents in screening of cerebral palsy with the help of a smartphone-aided remote General Movements Assessment is possible in the urban area of a South Asian lower middle-income country., Competing Interests: Competing interests: KS and HEKS developed the application NeuroMotion with financial support from a private donation through Knut och Alice Wallenbergs Stiftelse. For the purpose of further research and later implementation of NeuroMotion, the company NeuroMotion AB was founded and is the owner of the application. NeuroMotion AB is owned by KS and HEKS and has the purpose of research and to be non-profitable., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Stigma and poor mental health are important factors influencing the quality of life (QOL) of people with neglected tropical diseases (NTDs). This study examines the relationship between stigma, depression and QOL among people affected by leprosy and lymphatic filariasis (LF) in Nepal., Methods: A cross-sectional community-based survey was conducted among 102 NTD-affected persons (70 leprosy and 32 LF) using interview-administered questionnaires measuring the level of stigma (5-QSI-AP), symptoms of depression (PHQ-9) and QOL (WHOQOL-8). Three different regression models were developed, each using the ordinary least squares and Poisson regression to evaluate the association between stigma and QOL, depression and QOL, and stigma and depression., Results: The mean scores were 21.8±4.4 for QOL, 6.6±5.6 for depression and 3.0±2.8 for stigma. Almost 17% reported the prevalence of depression symptoms. Both stigma (β=-0.65, p<0.001) and depression (β=-0.32, p<0.001) were associated with lower scores for QOL, while there was a significant positive relationship between stigma and depression (β=0.92, p<0.001). Similar results were obtained from the Poisson regression models., Conclusions: The study showed a considerable burden of depression, stigma and poor QOL among study participants with leprosy and LF in Nepal. A holistic package of care that addresses the physical, mental and psychological well-being of people with NTD is required., Contexte: La stigmatisation et la mauvaise santé mentale sont des facteurs importants qui influencent la qualité de vie des personnes atteintes de maladies tropicales négligées (MTN). Cette étude examine la relation entre la stigmatisation, la dépression et la qualité de vie chez les personnes atteintes de lèpre et de filariose lymphatique au Népal., Méthodes Utilisées: Une enquête communautaire transversale a été menée auprès de 102 personnes atteintes de MTN (70 de la lèpre et 32 de la filariose lymphatique) à l'aide de questionnaires administrés par entretien mesurant le niveau de stigmatisation (5-QSI-AP), les symptômes de dépression (PHQ-9) et la qualité de vie (WHOQOL-8). Trois modèles de régression différents ont été développés, chacun utilisant les moindres carrés ordinaires et la régression de Poisson pour évaluer l'association entre : (i) la stigmatisation et la QV; (ii) la dépression et la QV; et (iii) la stigmatisation et la dépression., Résultats: Les scores moyens étaient de 21,8±4,4 pour la QV, 6,6±5,6 pour la dépression, et 3,0±2,8 pour la stigmatisation. Près de 17% des personnes interrogées ont signalé la prévalence de symptômes dépressifs. La stigmatisation (β = -0,65, p<0 001) et la dépression (β = -0,32, p<0 001) ont été associées à des scores plus faibles pour la qualité de vie, tandis qu'il existait une relation positive significative entre la stigmatisation et la dépression (β = 0,92, p<0 001). Des résultats similaires ont été obtenus à partir des modèles de régression de Poisson., Conclusions: L'étude a montré une incidence importante de dépression, de stigmatisation et d'une mauvaise qualité de vie parmi les participants atteints de lèpre et de FL au Népal. Il convient donc de mettre en place un ensemble de soins holistiques pour ces patients qui prendrait en compte le bien-être physique, mental et psychologique des personnes atteintes de MTN., Antecedentes: La estigmatización y la mala salud mental son factores importantes que influyen en la calidad de vida de las personas con enfermedades tropicales desatendidas. las personas con enfermedades tropicales desatendidas (ETD). Este estudio examina la relación entre el estigma, la depresión y la CdV entre las personas afectadas por lepra y lepra y la filariasis linfática en Nepal., Métodos: Se realizó una encuesta comunitaria transversal entre 102 personas afectadas por ETD (70 de lepra y 32 de filariasis linfática) utilizando cuestionarios entrevistas para medir el nivel de estigma (5-QSI-AP), los síntomas de depresión (PHQ- 9) y la CdV (OMS- 9). 9) y la calidad de vida (WHOQOL-8). Se desarrollaron tres modelos de regresión diferentes regresión de Poisson para evaluar la asociación entre: (i) el estigma y (ii) la depresión. entre: (i) estigma y CdV; (ii) depresión y CdV; y (iii) estigma y depresión., Resultados: Las puntuaciones medias fueron 21,8±4,4 para la CdV, 6,6±5,6 para la depresión y 3,0±2,8 para el estigma. Casi el 17% informó de la prevalencia de síntomas de depresión. Tanto el estigma (β = -0,65, p<0 001), como la depresión (β = -0,32, p<0 001) se asociaron con puntuaciones más bajas para la CdV, mientras que hubo una relación positiva significativa entre el estigma y la depresión (β = 0,92, p<0 001). Se obtuvieron resultados similares en los modelos de regresión de Poisson., Conclusiones: El estudio mostró una carga considerable de depresión, estigma y mala CdV entre los participantes del estudio con lepra y FL en Nepal. Se requiere un paquete holístico de atención que aborde el bienestar físico, mental y psicológico de las personas con ETD., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in the study design (e.g. cross-sectional vs longitudinal) can generate different estimates making the design and impact evaluation of socio-economic protection strategies difficult. The objective of the study was to compare the socio-economic impacts of TB estimated by applying cross-sectional or longitudinal data collections in Nepal. We analysed the data from a longitudinal costing survey (patients interviewed at three time points) conducted between April 2018 and October 2019. We calculated both mean and median costs from patients interviewed during the intensive (cross-sectional 1) and continuation (cross-sectional 2) phases of treatment. We then compared costs, the prevalence of catastrophic costs and the socio-economic impact of TB generated by each approach. There were significant differences in the costs and social impacts calculated by each approach. The median total cost (intensive plus continuation phases) was significantly higher for the longitudinal compared with cross-sectional 2 (US$119.42 vs 91.63, P < 0.001). The prevalence of food insecurity, social exclusion and patients feeling poorer or much poorer were all significantly higher by applying a longitudinal approach. In conclusion, the longitudinal design captured important aspects of costs and socio-economic impacts, which were missed by applying a cross-sectional approach. If a cross-sectional approach is applied due to resource constraints, our data suggest that the start of the continuation phase is the optimal timing for a single interview. Further research to optimize methodologies to report patient-incurred expenditure during TB diagnosis and treatment is needed., (© The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: Emergency Department admissions have changed significantly during the COVID-19 pandemic. Understanding this variation may play a crucial role in rearranging hospital resources for better outcome. In this study, we aimed to assess the impact of COVID-19 pandemic on emergency department admission and outcome., Methods: This is a cross-sectional retrospective study conducted at Bharatpur Hospital, Nepal comparing pre- pandemic data of the 4 months (March 24 to July 21, 2019) with the initial 4 months of the pandemic (March 24 to July 21, 2020)., Results: Admission in emergency ward decreased during covid period among female admission (47%vs43%), age-group(0-14)(18%vs12%), Dalit(17%vs11%) p<0.0001.Diagnosis increased during covid for acute abdomen(11%vs13%), animal and insect bite(10%vs13%), psychiatric illness(2%vs6%),poisoning and drug over dose(0.9%vs2.6%)(p<0.0001).The odds for referral(cOR 3.62,95% CI:2.70-4.84), Left against medical advice(cOR 6.03,95% CI:.06-8.94) and death(cOR 3.28,95% CI:1.64-6.68) increased during the covid respectively., Conclusions: There was decrease in rates of emergency department utilization during the Covid-19 pandemic. Admissions due to trauma, gastrointestinal, respiratory, neurological, musculoskeletal and coronary artery disease showed a decline whereas psychiatric disorders, diabetes and hypertension, animal and insect bites cases increased. Overall, mortality rate was increased.

Clinical Relevance: Country-specific estimates of the prevalence of refractive errors are important to formulate national eye health policies for refractive care services., Background: The purpose of this study was to systematically synthesise available literature and estimate the prevalence of refractive errors in the Nepalese population., Methods: PubMed, Scopus, and Web of Science databases were systematically searched for articles on refractive errors and presbyopia published in English language until 27 September 2022. Population and school-based quantitative, cross-sectional prevalence studies and Rapid Assessment of Avoidable Blindness survey repository data were included. The quality of the included studies was assessed using the Newcastle Ottawa scale adapted for cross-sectional studies. Data extraction was performed with consensus among the reviewers. Meta-analysis of the prevalence was performed using the Random effects model to estimate the pooled proportions., Results: A total of 38 studies with 101 701 participants were included: 18 studies in children (n = 31 596) and 20 in adults (n = 70 105). In children, the estimated pooled prevalence of overall refractive errors was 8.4% (95% CI: 4.8 to 12.9) with myopia, hypermetropia and astigmatism prevalent in 7.1% (95% CI: 3.7 to 11.4), 1.0% (95% CI: 0.7 to 1.3) and 2.2% (95% CI: 0.9 to 3.9), respectively. In adults, the prevalence of refractive errors, uncorrected refractive errors, and uncorrected presbyopia were 11.2% (95% CI: 8.0 to 14.9), 7.3% (95% CI: 5.4 to 9.5) and 78.9% (95% CI: 69.1 to 87.3), respectively., Conclusions: The pooled prevalence of refractive errors is relatively low while uncorrected refractive errors and presbyopia are high in Nepalese population suggesting a need for better access to refractive care services in the country. The paucity of quality evidence on prevalence of refractive errors, particularly in children, indicates a need for a well-designed population-based study to accurately estimate the current prevalence of refractive errors.

Entrapment abdominal neuropathy is not a common diagnosis in our context. Chronic Abdominal wall pain is often mistaken for gastritis, gynecological issue, thoracic spinal radiculopathy, rectus sheath hematoma, abdominal muscle injury or psychiatric disorder. Anterior cutaneous nerve entrapment syndrome is one of the frequent causes of abdominal wall pain occurring due to trapped thoracic intercostal nerves between abdominal muscles. History and bedside Carnett's sign can elicit the diagnosis. Injection of the local anesthetics with steroids in the junction between the rectus sheath and abdominal muscle under ultrasound guidance can provide sustained pain relief. We should consider Anterior cutaneous nerve entrapment syndrome as a differential diagnosis while evaluating the abdominal wall pain. Keywords: ACENE; carnett's test; chronic abdominal pain; entrapment neuropathy; hydrodissection.

Introduction: There is limited data on clinical course and outcomes of hospitalized adults with COVID-19 in Nepal. Thus, it is imperative to characterize the features of this disease in the domestic context., Methodology: We identified all adult patients with laboratory-confirmed COVID-19 admitted to five different hospitals in Nepal from June 15 to July 15, 2020. We collected epidemiological, socio-cultural and clinicopathologic data, and stratified the patients based on their symptom status., Results: The study included 220 patients with an overall median age of 31.5 (25-37) years, and 181 (82.3%) were males. 159 (72.3%) were asymptomatic, and 163 (74.1%) were imported cases. Of 217 patients with the available data, 110 (50.7%) reported their annual household income less than 2000 US dollars, and 122 (56.2%) practiced Pranayama (yogic rhythmic breathing techniques) regularly. Eight patients (3.6%) required supplemental oxygen and two patients (0.9%) died. None of the patients who practiced Pranayama regularly required supplemental oxygen. Compared to asymptomatic patients, symptomatic patients had greater proportion of females (31.1% vs. 12.6%, p = 0.001), imported cases (85.2% vs. 69.8%, p = 0.02), illiterates (26.8% vs. 12.1%, p = 0.01), alcohol users (43.3% vs. 24.5%, p = 0.01), and had higher platelet count (253×109/L vs. 185×109/L, p = 0.02)., Conclusions: Most cases were imported, asymptomatic young males, with very few deaths. Pranayama practice was associated with protection against severe COVID-19, but more data is needed to substantiate this. The association of platelets count with symptom status in the Nepalese population needs further exploration., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Ashok Chaudhary, Uday Narayan Singh, Pramod Paudel, Niresh Thapa, Kamal Khadka, Prameshwar Kumar Sah, Sher Bahadur Kamar, Jagadish Joshi, Kamar Hasan Ansari, Shree Ram Tiwari, Sarbesh Sharma, Sanjay Kumar Jaiswal, Ramesh Joshi, Samikchya Baskota, Arjun Prasad Tiwari, Hem Raj Pandey.)

Background: The corona virus disease 19 pandemic has affected the whole world with pregnant ladies being more vulnerable population. This study aimed to evaluate characteristics of corona virus disease 19 infection in pregnancy and neonates and whether close proximity to the mother increases the incidence of corona virus disease infection in neonates.., Methods: This is a hospital based prospective cross sectional observational study done among pregnant women presenting to Paropakar maternity and womens hospital from 1st September 2020 to 31st march 2021 with confirmed corona virus disease 19 infection., Results: The total 160 cases were included in study. Most of the women (33.8%) were of 20- 25 years of age, 55 % were multigravida and 77.6 % were full term. Around 74 % of cases were symptomatic with predominant symptoms being cough, fever and sore throat present in 33.1 %, 18% and 14% respectively. Out of 125 deliveries 71 % of cases underwent cesarean section of which fetal distress was most common indication. Six newborns were positive for corona virus disease 19 infection within 48 hours of life. Mortality was seen in four mothers and three neonates., Conclusions: The clinical presentation of corona virus disease infection in pregnant ladies is similar to general population. There is no increased risk of vertical transmission to the baby.

Recently, many individuals of greater one-horned rhino (GOHR) were died with unknown reason in Chitwan National Park (CNP), Nepal. This has arisen chaos and confusion in the rhino conservation program of the country. This study was designed to determine the prevalence of gastrointestinal parasites among GOHR in the CNP. A total of 100 dung samples were collected opportunistically by the random sampling method. Dung samples were preserved in 2.5% potassium dichromate solution and analysed in the laboratory by the direct smear and concentration method (floatation and sedimentation). Eggs and larvae of gastrointestinal parasite were found in 91% examined samples. Altogether 13 different genera of parasites were identified with one protozoan i.e. Eimeria sp. (9%), nine nematodes i.e. Strongyloides sp. (65%), Ascaris sp. (16%), Haemonchus sp. (15%), Dromeostrongylus sp. (9%), Oxyuris sp. (8%), Bunostomum sp. (8%), Chabertia sp. (5%), Trichostrongylus sp. (4%) and Nematodirus sp. (2%), one cestode i.e. Anoplocephala sp. (16%) and two trematodes i.e. Paramphistomum sp. (31%) and Fasciola sp. (14%). Nematode parasites were found to be most prevalent (87% of samples) followed by trematodes (45%), cestodes (16%) and protozoans (9%). The study indicates a high prevalence of gastrointestinal parasites in the GOHR of CNP and identifies that there is need of strategic control measures to protect this endangered species from parasitic infection.

Introduction: Intentional pesticide poisoning is a major clinical and public health problem in agricultural communities in low and middle income countries like Nepal. Bans of highly hazardous pesticides (HHP) reduce the number of suicides. We aimed to identify these pesticides by reviewing data from major hospitals across the country and from forensic toxicology laboratories., Methods: We retrospectively reviewed medical records of 10 hospitals for pesticide poisoned patients and two forensic laboratories of Nepal from April 2017 to February 2020. The poison was identified from the history, referral note, and clinical toxidrome in the hospitals and from gas chromatography analysis in the laboratories. Data on demographics, poison, and patient outcome were recorded on a data collection sheet. Simple descriptive analysis was performed., Results: Among hospital cases ( n  = 4148), the commonest form of poisoning was self-poisoning (95.8%) while occupation poisoning was rare (0.03%). Case fatality was 5.3% ( n  = 62). Aluminum phosphide ( n  = 38/62, 61.3%) was the most commonly identified lethal pesticide for deaths. Forensic toxicology laboratories reported 2535 deaths positive for pesticides, with the compounds most commonly identified being organophosphorus (OP) insecticides ( n  = 1463/2535; 57.7%), phosphine gas ( n  = 653/2535; 25.7%; both aluminum [11.8%] and zinc [0.4%] phosphide) and organochlorine insecticides ( n  = 241/2535; 9.5%). The OP insecticide most commonly identified was dichlorvos ( n  = 273/450, 60.6%)., Conclusion: The data held in the routine hospital medical records were incomplete but suggested that case fatality in hospitals was relatively low. The pesticides identified as causing most deaths were dichlorvos and aluminum phosphide. Since this study was completed, dichlorvos has been banned and the most toxic formulation of aluminum phosphide removed from sale. Improving the medical record system and working with forensic toxicology laboratories will allow problematic HHPs to be identified and the effects of the bans in reducing deaths monitored.

Background: Timely initiation of breastfeeding can reduce neonatal morbidities and mortality. We aimed to study predictors for timely initiation of breastfeeding (within 1 h of birth) among neonates born in hospitals of Nepal., Method: A prospective observational study was conducted in four public hospitals between July and October 2018. All women admitted in the hospital for childbirth and who consented were included in the study. An independent researchers observed whether the neonates were placed in skin-to-skin contact, delay cord clamping and timely initiation of breastfeeding. Sociodemographic variables, obstetric and neonate information were extracted from the maternity register. We analysed predictors for timely initiation of breastfeeding with Pearson chi-square test and multivariate logistic regression., Results: Among the 6488 woman-infant pair observed, breastfeeding was timely initiated in 49.5% neonates. The timely initiation of breastfeeding was found to be higher among neonates who were placed skin-to-skin contact (34.9% vs 19.9%, p - value < 0.001). The timely initiation of breastfeeding was higher if the cord clamping was delayed than early cord clamped neonates (44.5% vs 35.3%, p - value < 0.001). In multivariate analysis, a mother with no obstetric complication during admission had 57% higher odds of timely initiation of breastfeeding (aOR 1.57; 95% CI 1.33, 1.86). Multiparity was associated with less timely initiation of breastfeeding (aOR 1.56; 95% CI 1.35, 1.82). Similarly, there was more common practice of timely initiation of breastfeeding among low birthweight neonates (aOR 1.46; 95% CI 1.21, 1.76). Neonates who were placed skin-to-skin contact with mother had more than two-fold higher odds of timely breastfeeding (aOR 2.52; 95% CI 2.19, 2.89). Likewise, neonates who had their cord intact for 3 min had 37% higher odds of timely breastfeeding (aOR 1.37; 95% CI 1.21, 1.55)., Conclusions: The rate of timely initiation of breastfeeding practice is low in the health facilities of Nepal. Multiparity, no obstetric complication at admission, neonates placed in skin-to-skin contact and delay cord clamping were strong predictors for timely initiation of breastfeeding. Quality improvement intervention can improve skin-to-skin contact, delayed cord clamping and timely initiation of breastfeeding., (© 2021. The Author(s).)

Background: Perinatal events which result in compromised oxygen delivery to the fetus can lead to Birth Asphyxia (BA). While the incidence, risk factors and outcomes of BA have been characterized, less is known in low resource settings., Aim: To determine the incidence of Birth Asphyxia (BA) in Nepal and to evaluate associated risk factors and outcomes of this condition., Methods: A nested observational study was conducted in 12 hospitals of Nepal for a period of 14 months. Babies diagnosed as BA at ≥37 weeks of gestation were identified and demographics were reviewed. Data were analyzed using binary logistic regression followed by multiple logistic regression analysis., Results: The incidence of BA in this study was 6 per 1000 term livebirths and was higher among women 35 years and above. Predictors for BA were instrumented vaginal delivery (aOR:4.4, 95% CI, 3.1-6.1), fetal distress in labour (aOR:1.9, 95% CI, 1.0-3.6), malposition (aOR:1.8, 95% CI, 1.0-3.0), birth weight less than 2500 g (aOR:2.0, 95% CI, 1.3-2.9), gestational age ≥ 42 weeks (aOR:2.0, 95% CI, 1.3-3.3) and male gender (aOR:1.6, 95% CI, 1.2-2.0). The risk of pre-discharge mortality was 43 times higher in babies with BA (aOR:42.6, 95% CI, 32.2-56.3)., Conclusion: The incidence of Birth asphyxia in Nepal higher than in more resourced setting. A range of obstetric and neonatal risk factors are associated with BA with an associated high risk of pre-discharge mortality. Interventions to improve management and decrease rates of BA could have marked impact on outcomes in low resource settings., (© 2021. The Author(s).)

Background: The postoperative analgesic efficacy of trans-muscular quadratus lumborum block in abdominal surgeries is well established; however, its intraoperative safety and efficacy as an anesthetic is still being explored. This retrospective case review was conducted to investigate the efficacy and safety of combined quadaratus lumburoum block and low-dose subarachnoid block for anesthesia in complex abdominal operations., Methods: Perioperative data of 29 patients, who underwent abdominal operations during the period of June/2019 to October/2019 under the combined technique, was analyzed. The primary outcome was intra and postoperative pain scores with the conox as qnox and numeric rating scale respectively at different time points. The secondary outcomes were intraoperative sedation scores with conox as qcon and perioperative dosage of fentanyl, changes in mean arterial pressure and the incidence of adverse events., Results: The mean qnox scores at incision, viscera dissection, closure and before transport to the post anesthesia care unit were between 44.66 and 55.79. The mean numeric rating scale scores before bed on the operation day, at 8 am on the first postoperative day, before bed on the first postoperative day and at 8 am on the second postoperative day were between 3.41 and 3.86. The mean qcon scores during the operations were between 61.31 and 65.82 while it was 85.66 following the stoppage of all sedations. The mean total perioperative consumption of fentanyl was 38.7mcg. The proportion of patients having MAP changes of less than 20% from baseline was 85.72%. The incidence of peri-operative adverse events was low., Conclusions: For complex abdominal operations, a combination of ultrasound-guided QLB-TM and low dose spinal anesthesia achieves adequate analgesia and is a safe technique.

Background: The high burden of chronic conditions, coupled with various physical, mental, and psychosocial changes that accompany the phenomenon of aging, may limit the functional ability of older adults. This study aims to assess the prevalence of poor functional status and investigate factors associated with poor functional status among community-dwelling older adults in rural communities of eastern Nepal., Methods: Data on 794 older adults aged ≥ 60 years from a previous community-based cross-sectional study was used. Participants were recruited from rural municipalities of Morang and Sunsari districts of eastern Nepal using multi-stage cluster sampling. Functional status was assessed in terms of participants' ability to perform activities of daily living using the Barthel Index. Covariates included sociodemographic characteristics, lifestyle factors, and self-reported chronic conditions. A binary logistic regression model was used to investigate factors associated with poor functional status., Results: The overall prevalence of poor functional status was 8.3 % (male: 7.0 % and female: 9.6 %), with most dependence noted for using stairs (17.3 %), followed by dressing (21.9 %) on Barthel Index. In the adjusted model, oldest age group (odds ratio [OR] = 2.83, 95 %CI: 1.46, 5.50), those unemployed (OR = 2.41, 95 %CI: 1.26, 4.65), having memory/concentration problems (OR = 2.32, 95 %CI: 1.30, 4.13), depressive symptoms (OR = 2.52, 95 %CI: 1.28, 4.95), and hypertension (OR = 1.78, 95 %CI: 1.03, 3.06) had almost or more than two times poor functioning., Conclusions: One in 12 older adults had poor functional status as indicated by their dependency on the items of the Barthel Index; those in the oldest age bracket were more likely to exhibit poor functional status. We suggest future studies from other geographies of the country to supplement our study from the rural setting for comprehensive identification of the problem, which could guide the development of prevention strategies and comprehensive interventions for addressing the unmet needs of the older adults for improving functional status.

Background: The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal., Methods: We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women's residence in a COVID-19 hotspot area., Results: The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% ( P  < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals declined on average by 20.8% ( P  < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% ( P  = 0.001). Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care. Respectful provision of care was better in hospitals with low-volume birth (β = 0.446, P  < 0.0001) in comparison to high-medium-volume hospitals. There was a positive association between women's residence in a COVID-19 hotspot area and respectful experience of care (β = 0.076, P  = 0.001)., Conclusions: The COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a "building-back-better" approach in post-pandemic period., Competing Interests: Conflicts of interest: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author) and declare no conflicts of interest., (Copyright © 2021 by the Journal of Global Health. All rights reserved.)

Background: Cooled Radiofrequency ablation is a newer technique for management of chronic knee pain in osteoarthritis. The aim of the study is to evaluate the clinical outcomes in patients with chronic osteoarthritis in terms of pain scores for first six months of cooled radiofrequency ablation using ultrasound guidance., Methods: A cross-sectional study with retrospective review of database was evaluated to analyze the change in the Numerical Rating Scale from baseline scores at 1 day, 1 month and 6 months after the Cooled Radiofrequency ablation of genicular nerves around knee in patients with chronic knee osteoarthritis., Results: Median age was 71 years [ 61-73 years (IQR: 25-75)] with more female preponderance. Numerical Rating Scale (Mean ± S.D.) was significantly less at 1 day (1.87 ± 1.22), 1 month (3.03 ± 0.99) and 6 months (3.37 ± 1.098) from baseline values (6.77 ± 1.00). No soreness and numbness were noted., Conclusions: Cooled Radiofrequency using Ultrasound guidance for management of knee pain in chronic osteoarthritis is promising and reduces Numerical Rating Score significantly from baseline at 1 month and 6 months respectively.

Background: Global emergence of carbapenem-resistant Klebsiella pneumoniae is a major public health concern. Phage therapy - application of lytic phage to kill pathogenic bacteria - is considered as one of the promising alternatives to tackle this antibiotic crisis in recent days. This study aimed to isolate, characterize and evaluate therapeutic efficacy of a novel K. pneumoniae phage in mouse model., Methods: A novel lytic bacteriophage (phage) Kp&#95;Pokalde&#95;002 was isolated against carbapenem-resistant K. pneumoniae (Kp56) and characterized. Safety parameters of the phage were evaluated by bioinformatic analysis of its genome. A lethal dose (~1×107 CFU/mouse) of Kp56 was determined and administrated in the mice. The infected mice were treated with phage Kp&#95;Pokalde&#95;002 at a multiplicity of infection (MOI) 1.0 (~1×107 PFU/mouse) via both oral and intraperitoneal (IP) routes., Results: Isolated phage comprised an icosahedral capsid with a short tail. Based on genome analysis, the phage was strictly lytic belonging the Podoviridae family (T7-like viruses) and free from any virulent and antibiotic-resistant genes. The phage was stable up to 60 °C for 30 minutes and effective between pH 4 to 11 (optimum pH 9). The phage exhibited a short latent period (20 minutes) with burst size of 121 phage particles per infected cell. The infected mice were rescued with the phage therapy via both oral and IP route. Significant reduction of bacterial load (3-7 log10 CFU/ml) in the blood and lung was observed in the treatment group., Conclusions: We provide an evidence of successful phage therapy against carbapenem-resistant K. pneumoniae infected mouse model using locally isolated lytic phage.

Background: Meningioma is the most common primary brain tumor, constituting more than half of all benign central nervous system tumors. This study aims to analyze the clinical outcome and recurrence after surgery of intracranial meningioma in Nepal., Methods: This is a retrospective study of newly diagnosed intracranial meningioma patients operated at Nepal Mediciti Hospital between 2007 and 2019. Demographics; clinical, radiologic, and perioperative details; histopathology; and clinical outcome variables were reviewed. Association of independent variables with primary outcome variables: modified Rankin Scale (favorable [≤ 3] vs. unfavorable [>3]) and recurrence was analyzed. Logistic regression model was designed to calculate adjusted odds ratio with 95% confidence interval (CI)., Results: Of 233 patients, mean age was 47 years, female individuals were affected twice as much as male individuals. Location was supratentorial in 83.3%, 83.7% had tumor greater than 5 cm in size. Gross total resection (SM 0-III) was achieved in 85.4%. A total of 98.7% had grade I meningioma. Favorable outcome was found in 94.8%. Recurrence rate was 6.9%. Tumor size less than 3 cm (adjusted odds ratio [AOR] 0.024 95% CI 0.001-0.416, P = 0.010), gross total resection (AOR 19.737, 95% CI 4.69-83.063, P < 0.001), and comorbidity (AOR 0.202, 95% CI 0.052-0.785, P = 0.021) were significantly associated with favorable outcome whereas age (AOR 3.491, 95% CI 1.029-11.850, P = 0.045) and WHO grade (AOR 0.024, 95% CI 0.002-0.344, P = 0.006) were independently associated with recurrence. The complication and surgical mortality rates were 30% and 1.72%, respectively., Conclusions: Tumor size, extent of resection, age, tumor grade, and medical comorbidities were significantly associated with postoperative outcome. We recommend a prospective study with standardized follow up protocol to assess the long-term outcome., (Copyright © 2020 Elsevier Inc. All rights reserved.)