Sexual behavior and condom use among seasonal Dalit migrant laborers to India from Far West, Nepal: a qualitative study.

PubMed

Bam, Kiran; Thapa, Rajshree; Newman, Marielle Sophia; Bhatt, Lokesh Prasad; Bhatta, Shree Krishna

2013-01-01

Around 41% of Human Immunodeficiency Virus (HIV) cases in Nepal occur in seasonal migrant laborers. Dalit migrant laborers represent the largest proportion of reported HIV cases in the Far Western Region (Sudur Pashchimanchal, or Far West), Nepal. The study's objectives were to assess sexual behavior, condom use status and HIV risk perception among Dalit migrant laborers to India from Far West Region, Nepal. The study was conducted among Dalit male migrant laborers aged 15 years and above who had migrated for at least six months of the last two years to India. For the sampling the village development committees (VDCs) from Achham, Doti and Kanchanpur districts of Nepal were purposively selected. The data were collected in March and April 2011 via ten in-depth interviews and four focus group discussions and analyzed using content analysis. Poor socio-economic status, caste-related discrimination, and lack of employment opportunities push large groups of young Dalits to migrate to India for employment, where they engage in sex with female sex workers (FSWs). The participants described unmarried status, peer influence, alcohol use, low-priced sex with FSWs and unwillingness to use condoms as common factors of their migration experience. Lack of awareness on HIV/AIDS was common among study participants. Awareness of HIV/AIDS and faithful, monogamous partnerships are reported as factors influencing safer sexual behavior. Dalits are an especially vulnerable population among migrant laborers and may be over-represented in new HIV infections in Nepal. Comprehensive surveying and health promotion programs targeted to this population are urgently needed and potent methods of stopping HIV spread.

Sexual Behavior and Condom Use among Seasonal Dalit Migrant Laborers to India from Far West, Nepal: A Qualitative Study

PubMed Central

Bam, Kiran; Thapa, Rajshree; Newman, Marielle Sophia; Bhatt, Lokesh Prasad; Bhatta, Shree Krishna

2013-01-01

Background Around 41% of Human Immunodeficiency Virus (HIV) cases in Nepal occur in seasonal migrant laborers. Dalit migrant laborers represent the largest proportion of reported HIV cases in the Far Western Region (Sudur Pashchimanchal, or Far West), Nepal. The study’s objectives were to assess sexual behavior, condom use status and HIV risk perception among Dalit migrant laborers to India from Far West Region, Nepal. Methods The study was conducted among Dalit male migrant laborers aged 15 years and above who had migrated for at least six months of the last two years to India. For the sampling the village development committees (VDCs) from Achham, Doti and Kanchanpur districts of Nepal were purposively selected. The data were collected in March and April 2011 via ten in-depth interviews and four focus group discussions and analyzed using content analysis. Results Poor socio-economic status, caste-related discrimination, and lack of employment opportunities push large groups of young Dalits to migrate to India for employment, where they engage in sex with female sex workers (FSWs). The participants described unmarried status, peer influence, alcohol use, low-priced sex with FSWs and unwillingness to use condoms as common factors of their migration experience. Lack of awareness on HIV/AIDS was common among study participants. Awareness of HIV/AIDS and faithful, monogamous partnerships are reported as factors influencing safer sexual behavior. Conclusions Dalits are an especially vulnerable population among migrant laborers and may be over-represented in new HIV infections in Nepal. Comprehensive surveying and health promotion programs targeted to this population are urgently needed and potent methods of stopping HIV spread. PMID:24040359

A hyperendemic focus of Taenia solium transmission in the Banke District of Nepal.

PubMed

Sah, Keshav; Poudel, Ishab; Subedi, Suyog; Singh, Dinesh Kumar; Cocker, Jo; Kushwaha, Peetambar; Colston, Angela; Donadeu, Meritxell; Lightowlers, Marshall W

2017-12-01

Neurocysticercosis is a major cause of epilepsy in countries where Taenia solium is endemic and the parasite is a major cause of food-borne disease globally. Pigs are the natural intermediate host involved in transmission of the parasite. T. solium is known to be endemic in Nepal, however there is limited reliable data about the prevalence of the disease in Nepal. The aim of this study was to determine accurately the prevalence of porcine cysticercosis in slaughter age pigs in an area of Nepal where pigs are known to be free-roaming. Pigs were obtained from the Udaypur Village Development Committee (VDC) and Hirminiya & Betahani VDC of the Banke district in Nepal. One hundred and ten animals of slaughter age (approximately 8-16 months old) were purchased, slaughtered and the heart, liver, brain and half the body skeletal musculature were sliced using hand knives and the number and viability of T. solium cysts determined. Thirty two of the 110 animals were found to harbour T. solium cysticerci (29%), of which 30 (27%) were found to have viable cysticerci (93% of the infected animals). This is one of the highest prevalences of porcine cysticercosis that has been reported to date from the results of necropsy on randomly selected animals. This study highlights a high rate of transmission of T. solium in the Banke District of Nepal. It encourages further investigation of human and porcine cysticercosis in Nepal, as well as implementation of efforts to reduce transmission of the parasite and the associated human disease. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Processes of Internal and International Migration from Chitwan, Nepal.

PubMed

Bohra, Pratikshya; Massey, Douglas S

2009-01-01

In this study we examine which factors predict internal and international migration from Chitwan, a flat valley located in the South-Central region of Nepal, seeking to measure the effect of theoretically specified variables such as human capital, social capital, physical capital, and neighborhood socioeconomic conditions while controlling for demographic variables. We use data from the Chitwan Valley Family Study (CVFS) to estimate a series of discrete time event history models of first and repeat migration to three competing destinations: other locations within Chitwan, other districts within Nepal, and places outside of Nepal. Results support hypotheses derived from neoclassical economics, the theory of new economics of migration, social capital theory, and cumulative causation theory. Our results underscore the need for a synthetic theoretical model that incorporates factors operating at the individual, household, and community levels. The use of multiple explanatory models yields a clearer picture of the forces driving internal and international migration from rural districts in developing nations such as Nepal.

Processes of Internal and International Migration from Chitwan, Nepal

PubMed Central

Bohra, Pratikshya; Massey, Douglas S.

2011-01-01

In this study we examine which factors predict internal and international migration from Chitwan, a flat valley located in the South-Central region of Nepal, seeking to measure the effect of theoretically specified variables such as human capital, social capital, physical capital, and neighborhood socioeconomic conditions while controlling for demographic variables. We use data from the Chitwan Valley Family Study (CVFS) to estimate a series of discrete time event history models of first and repeat migration to three competing destinations: other locations within Chitwan, other districts within Nepal, and places outside of Nepal. Results support hypotheses derived from neoclassical economics, the theory of new economics of migration, social capital theory, and cumulative causation theory. Our results underscore the need for a synthetic theoretical model that incorporates factors operating at the individual, household, and community levels. The use of multiple explanatory models yields a clearer picture of the forces driving internal and international migration from rural districts in developing nations such as Nepal. PMID:21423821

What Caused the Winter Drought in Western Nepal during Recent Years?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, S-Y; Yoon, Jin-Ho; Gillies, R.

Western Nepal has experienced consecutive and worsened winter drought conditions since 2000 culminating in a severe drought episode during 2008-2009. In this study, the meteorological conditons and a historical pespective of the winter droughts in western Nepal were analyzed using respectively instumental records and a paleoclimatic drought index. Althought decadal-scale drought conditions were found to be recurrent in the paleoclimate record, the severity of the recent decadal drought (since 2000) clearly stands out in the 700 years of record and, this is suggestive of potential anthropogenic influences in the recent decades. Meteorological diagnosis using atmospheric reanalysis in the recent decadesmore » revealed that (1) winter drought in western Nepal is linked to the Arctic Oscillation and its decadal variability, which initiates a tropospheric short-wave train across the Europe, Eurasia and South Asia, and that (2) the persistent warming of the Indian Ocean likely contributes to the suppression of rainfall through enhanced local Hadley circultion. It is therefore conceivable that the recent spells of decadal drought in Nepal drought are symptomatic of both natural variability and anthropogenic influences.« less

Developing an Index to Measure Health System Performance: Measurement for Districts of Nepal.

PubMed

Kandel, N; Fric, A; Lamichhane, J

2014-01-01

Various frameworks for measuring health system performance have been proposed and discussed. The scope of using performance indicators are broad, ranging from examining national health system to individual patients at various levels of health system. Development of innovative and easy index is essential to measure multidimensionality of health systems. We used indicators, which also serve as proxy to the set of activities, whose primary goal is to maintain and improve health. We used eleven indicators of MDGs, which represent all dimensions of health to develop index. These indicators are computed with similar methodology that of human development index. We used published data of Nepal for computation of the index for districts of Nepal as an illustration. To validate our finding, we compared the indices of these districts with other development indices of Nepal. An index for each district has been computed from eleven indicators. Then indices are compared with that of human development index, socio-economic and infrastructure development indices and findings has shown the similarity on distribution of districts. Categories of low and high performing districts on health system performance are also having low and high human development, socio-economic, and infrastructure indices respectively. This methodology of computing index from various indicators could assist policy makers and program managers to prioritize activities based on their performance. Validation of the findings with that of other development indicators show that this can be one of the tools, which can assist on assessing health system performance for policy makers, program managers and others.

Parent Decision-Making When Selecting Schools: The Case of Nepal

ERIC Educational Resources Information Center

Joshi, Priyadarshani

2014-01-01

This paper analyzes the parent decision-making processes underlying school selection in Nepal. The analysis is based on primary survey and focus group data collected from parent meetings in diverse local education markets in two districts of Nepal in 2011. It highlights three main arguments that are less frequently discussed in the context of…

Spousal migration and human papillomavirus infection among women in rural western Nepal.

PubMed

Johnson, Derek C; Lhaki, Pema; Bhatta, Madhav P; Kempf, Mirjam-Colette; Smith, Jennifer S; Bhattarai, Pankaj; Aryal, Shilu; Chamot, Eric; Regmi, Kiran; Vermund, Sten H; Shrestha, Sadeep

2016-07-01

In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal. Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husband's migration status with HR-HPV infection and cervical cytology status. In 265 women, the prevalence of HR-HPV was 7.5% (20/265), while the prevalence of abnormal cervical cytology, defined using the Bethesda system as atypical glandular cells of undetermined significance or worse, was 7.6% (19/251). Half of the study participants (50.8%, 130/256) had husbands who had reported migrating for work at least once. Women aged ≤34 years were significantly less likely to test positive for HR-HPV than women aged >34 years (OR 0.22, 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband's migration. Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husband's migration for work could be delaying HR-HPV infections in married women until an older age. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Role of Obstetric Knowledge in Utilization of Delivery Service in Nepal

ERIC Educational Resources Information Center

Karkee, Rajendra; Baral, Om Bahadur; Khanal, Vishnu; Lee, Andy H.

2014-01-01

Birth Preparedness and Complication Readiness (BP/CR) program has been promoted in Nepal to equip pregnant women with obstetric knowledge so as to motivate them to seek professional care. Using a prospective design of 701 pregnant women of more than 5 months gestation in a central hills district of Nepal, we evaluated if having obstetric knowledge…

Female community health volunteers service utilization for childhood illness- improving quality of health services only is not enough: a cross-sectional study in mid-western region, Nepal.

PubMed

Miyaguchi, Moe; Yasuoka, Junko; Poudyal, Amod Kumar; Silwal, Ram Chandra; Jimba, Masamine

2014-09-11

Female Community Health Volunteers (FCHVs) are considered service providers for major health problems at the community level in Nepal. However, few studies have been conducted about the roles of FCHVs from the users' perspective. This study sought to examine the current status of FCHV service utilization and identify the determinants of caregivers' utilization of FCHVs' health services in the mid-western region of Nepal. This cross-sectional study targeted 446 caregivers of children under five years of age and whose children had ever fallen ill in the study village development committees (VDCs) of three districts of Nepal. Caregivers were asked about their usual health practices for childhood illness, health service utilization for childhood illness, children's health condition, satisfaction with health services, and socio-demographic status. Descriptive statistics and multiple logistic regression were used for analysis. Among 446 caregivers, 66.8% had never sought care from FCHVs for their children's illnesses in their lifetime, and more than 50% of them were unaware of FCHVs' services for acute respiratory infection and diarrhea. Among 316 caregivers whose child had an illness during the last seven months, 92.3% of them (n = 293) did not take their child to FCHVs. The main reasons were the lack of medicine available from them and their incompetency in providing care. Among the 446 caregivers, those who participated in a mothers' group (n = 82) were more likely to use FCHVs' services in their lifetime (AOR = 3.23, 95% CI =1.81-5.76). Caregivers can gain benefit by using FCHV's health services, but a majority of the caregivers did not seek care from FCHVs due to its limited quality. Raising caregivers' awareness on FCHV is equally important at community level.

Using exhumation histories to constrain Main Himalayan Thrust geometry and seismic hazard in the western Nepal Himalaya

NASA Astrophysics Data System (ADS)

Harvey, J. E.; Burbank, D.

2016-12-01

The Himalaya of western Nepal present a challenge to conventional understanding of the geometry and behavior of the Main Himalayan Thrust (MHT), a major seismogenic structure which accommodates 2 cm/yr of Indo-Asian convergence. Slip along a steeper ramp in the MHT drives long-term uplift of the Greater Himalaya along >1000 km of the central range front, resulting in a conspicuous physiographic transition known as PT2. This physiographic break is seemingly absent in western Nepal, which suggests a structural geometry and/or kinematic history distinct from areas along strike. This anomaly must be investigated to clarify how seismic hazard may differ from better-understood areas along strike. The importance of this work is heightened by the recent and catastrophic Gorkha earthquake in 2015. We present a suite of 7 relief transects comprising a mix of apatite and zircon U-Th/He and muscovite Ar-Ar cooling ages. These transects were collected across the more gradual mountain front in western Nepal in an effort to clarify where uplift and exhumation have been focused over the past 10 Ma. We invert these cooling ages using the thermo-kinematic model Pecube in order to constrain exhumation histories that best fit the measured cooling ages. Results confirm that MHT geometry and kinematic history in western Nepal are far more complex than in better-studied areas along strike. Exhumation rates in the along-strike projection of PT2 are slow ( 0.1-0.2 km/Myr) compared with rates 50 km toward the hinterland ( 1.0-1.5 km/Myr), suggesting that exhumation has been more rapid in this more northerly position for the past several Ma. Although a range of kinematic scenarios could explain the anomalous cooling histories, it is likely that a recently active midcrustal ramp in the MHT sits beneath this more northerly position. If the 2015 Gorkha earthquake initiated near the up-dip end of the MHT ramp in central Nepal, it is conceivable that similarly hazardous earthquakes could trigger from an analogous structural position in western Nepal, which puts seismic hazard well north of where one would expect by simply projecting PT2 across western Nepal. In addition to clarifying the seismic hazard posed by the MHT to populations in the region, these results are especially relevant to the proposed large hydroelectric dam projects in the region.

Safe delivery care practices in western Nepal: Does women's autonomy influence the utilization of skilled care at birth?

PubMed

Bhandari, Tulsi Ram; Kutty, V Raman; Sarma, P Sankara; Dangal, Ganesh

2017-01-01

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives-women's autonomy-plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women's autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women's autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women's education had a strong positive association (odds ratio = 24.11, CI = 9.43-61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women's education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband's education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women's autonomy may be an important mediating factor in this pathway.

Safe delivery care practices in western Nepal: Does women’s autonomy influence the utilization of skilled care at birth?

PubMed Central

Kutty, V. Raman; Sarma, P. Sankara; Dangal, Ganesh

2017-01-01

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives—women’s autonomy—plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women’s autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women’s autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women’s education had a strong positive association (odds ratio = 24.11, CI = 9.43–61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women’s education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband’s education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women’s autonomy may be an important mediating factor in this pathway. PMID:28771579

Dengue Virus Serotypes 1 and 2 Responsible for Major Dengue Outbreaks in Nepal: Clinical, Laboratory, and Epidemiological Features

PubMed Central

Dumre, Shyam Prakash; Bhandari, Renu; Shakya, Geeta; Shrestha, Sanjaya Kumar; Cherif, Mahamoud Sama; Ghimire, Prakash; Klungthong, Chonticha; Yoon, In-Kyu; Hirayama, Kenji; Na-Bangchang, Kesara; Fernandez, Stefan

2017-01-01

Abstract. Dengue virus (DENV) is expanding toward previously nonendemic areas. DENV has recently been introduced in Nepal with limited information. We report the clinical features and serotype distribution of DENV in Nepal during the 2010 outbreaks. A total of 1,215 clinical dengue cases at two major hospitals of central and western Nepal were investigated. Demographic, clinical, and laboratory parameters were recorded. Serum specimens were tested for DENV by IgM/IgG enzyme-linked immunosorbent assays (ELISAs) and reverse transcription polymerase chain reaction (RT-PCR). We confirmed DENV infection in 403 (33%) patients from 12 districts with an estimated case fatality rate of 1.5%. DENV infection was more common in adults (87%) and urban settings (74%). We detected all four serotypes but DENV-1 and -2 were mainly responsible for major outbreaks (92%). Overall, 60% of all DENV infections were secondary and 17% were severe dengue; both being more frequent among the DENV-2 infections. Rash, bleeding, abdominal pain, hepatomegaly, elevated liver enzymes, and thrombocytopenia were significantly more common in severe dengue compared with nonsevere infections. We also confirmed the expansion of dengue to hill urban areas (DENV-1 and -2), including the capital Kathmandu (altitude, 1,300 m) though > 90% cases were from southern plains. Differential clinical and laboratory features probably help in clinical decisions. Multiple serotypes circulation and elevated secondary infections pose potential risk of severe outbreaks and deaths in the future. Therefore, a country with recent dengue introduction, like Nepal, urgently requires a systematic surveillance and appropriate control measures in place to respond to any disastrous outbreaks. PMID:29031282

Predisposing, enabling, and need factors associated with utilization of institutional delivery services: A community-based cross-sectional study in far-western Nepal.

PubMed

Freidoony, Leila; Ranabhat, Chhabi Lal; Kim, Chun-Bae; Kim, Chang-Soo; Ahn, Dong-Won; Doh, Young Ah

2018-01-01

Use of institutional delivery services can be effective in reducing maternal and infant mortality. In Nepal, however, the majority of women deliver at home. Using Andersen's behavioral model of use of health care services, this cross-sectional study aimed to identify factors associated with use of institutional delivery services in four villages and one municipality in Kailali district, Nepal. Mothers (N = 500) who had given birth in the 5 years preceding the survey (conducted between January and February 2015) were randomly selected by cluster sampling and interviewed using a semi-structured questionnaire. Bivariate analyses and multivariate hierarchical logistic regression analyses were performed. Among the women surveyed, 65.6% had used institutional delivery services for their last delivery, a higher proportion than the national average. Primiparity, having a secondary or higher education level, living in the Durgauli village, having husbands with occupations other than agriculture or professional/technical jobs, and having attended four or more antenatal care (ANC) visits had significantly increased use of institutional deliveries. Also, belonging to the richest 20% of the community and having experienced pregnancy complications were marginally significantly associated. These findings demonstrate the need for improving mother's education, encouraging them to attend ANC visits and addressing disparities between different regions.

Ethnomedicine in Himalaya: a case study from Dolpa, Humla, Jumla and Mustang districts of Nepal

PubMed Central

Kunwar, Ripu M; Nepal, Bal K; Kshhetri, Hari B; Rai, Sanjeev K; Bussmann, Rainer W

2006-01-01

Traditional plant use in Nepal has been documented for millennia. The importance of plants as medicine has not diminished in any way in recent times, and traditional medicines are still the most important health care source for the vast majority of the population. This paper examines the ethnobotany and traditional use of plants extracted from the vulnerable alpine zone in the Dolpa, Humla, Jumla and Mustang districts of Nepal. The results of this ethnobotanical study indicate that a very large number of plant species is used as traditional medicines. There were 107, 59, 44 and 166 species of ethnomedicinal importance in surveyed areas of Dolpa, Humla, Jumla and Mustang district respectively. Of these, 84 common species, used at least in two districts, were selected to enumerate their ethnomedicinal properties. The 84 species belonged to 75 genera and 39 families. The commonest species in this pharmacopoeia were: Allium wallichii, Cordyceps sinensis, Dactylorhiza hatagirea, and Rheum australe. A total of 21 species were most common in three districts and 59 in two districts. The genera Aconitum, Allium, Arisaema, Berberis, Corydalis, Gentiana, Hippophae, Juniperus and Rhododendron each possessed two species with ethnomedicinal use. Labiatae was the most medicinally important family with five species used, followed by Araceae, Compositae, Liliaceae, Polygonaceae, Ranunculaceae, Scrophulariaceae and Umbelliferae, each contributing four species. PMID:16749924

Applicability of citronella oil (Cymbopogon winteratus) for the prevention of mosquito-borne diseases in the rural area of Tikapur, far-western Nepal.

PubMed

Sajo, Ma Easter Joy; Song, Soon-Bong; Bajgai, Johny; Kim, Young-Je; Kim, Pan-Suk; Ahn, Dong-Won; Khanal, Narendra; Lee, Kyu-Jae

2015-01-01

Mosquito-borne diseases are a serious global problem, particularly in tropical and sub-tropical countries such as Nepal. Citronella oil is a natural mosquito repellent as well as a local fragrance in Nepal, which is accessible at very low cost because citronella plants are widely cultivated in rural areas of the Terai belt in Nepal. This study was conducted using a real-life randomized controlled pilot trial to confirm the effectiveness and applicability of locally-produced citronella oil as a mosquito repellent for the prevention of mosquito-borne diseases in Nepal. A repellency activity test was performed with 100% citronella oil (Cymbopogon winteratus) from April to May 2013 in the Tikapur Municipality of the Kailali district, Nepal. The test was divided into two trials: an indoor exposure (IE) test (N=101) and an outdoor exposure (OE) test (N=140) from 5.00 pm to 7.00 pm. Each trial contained an experimental citronella oil-applied group and a non-applied (control) group. The outcome measures were the protective effect of citronella oil against mosquitoes, the number of mosquito bites, the repellency percentage, the smell satisfaction and the irritation level. Experimental group had a significant protective effect against mosquito bites in IE (96.5%, n=57) and OE (95.7%, n=70) tests compared to the control group in IE (29.5%, n=44) and OE (28.6%, n=70) tests (experimental vs control groups, p<0.001). The repellency percentage for the OE test was 96.7%. In the smell satisfaction test (n=127), most of the participants responded with high satisfaction: 'good' (67.7%), 'very good' (16.5%), 'bad' (13.4%) and 'very bad' (2.4%). IE and OE tests showed similar satisfaction levels in each category. In the irritation level test (n=127), 87.4% and 12.6% responded with no irritation and slight irritation, respectively. There were no reports of moderate or severe irritation. The topical application of citronella oil can be employed as an easily-available, affordable and effective alternative mosquito repellent to prevent mosquito-borne diseases in rural areas such as Tikapur, Nepal.

The use of medicinal plants in the trans-himalayan arid zone of Mustang district, Nepal

PubMed Central

2010-01-01

Background This study documents the use of medicinal plants from the Mustang district of the north-central part of Nepal. Traditional botanical medicine is the primary mode of healthcare for most of the population of this district and traditional Tibetan doctors (Amchi) serve as the local medical experts. Methods Field research was conducted in 27 communities of the Mustang district in Nepal from 2005-2007. We sampled 202 interviewees, using random and snowball sampling techniques. After obtaining prior informed consent, we collected data through semi-structured interviews and participant-observation techniques. Voucher specimens of all cited botanic species were deposited at TUCH in Nepal. Results We recorded the traditional uses of 121 medicinal plant species, belonging to 49 vascular plant and 2 fungal families encompassing 92 genera. These 121 species are employed to treat a total of 116 ailments. We present data on 58 plant species previously unknown for their medicinal uses in the Mustang district. Of the medicinal plants reported, the most common growth form was herbs (73%) followed by shrubs, trees, and climbers. We document that several parts of individual plant species are used as medicine. Plant parts were generally prepared using hot or cold water as the 'solvent', but occasionally remedies were prepared with milk, honey, jaggery, ghee and oil. Amchis recommended different types of medicine including paste, powder, decoction, tablet, pills, infusion, and others through oral, topical, nasal and others routes of administration. Conclusions The traditional pharmacopoeia of the Mustang district incorporates a myriad of diverse botanical flora. Traditional knowledge of the remedies is passed down through oral traditions and dedicated apprenticeships under the tutelage of senior Amchi. Although medicinal plants still play a pivotal role in the primary healthcare of the local people of Mustang, efforts to ensure the conservation and sustainable use of medicinal species are necessary. PMID:20370901

Equity and Discrimination among Children: Schooling Decisions in Rural Nepal.

ERIC Educational Resources Information Center

Ashby, Jacqueline A.

1985-01-01

Interviews and survey questionnaires were used to collect--from 302 randomly selected farm households in the Kahvre Palanchowk District in eastern Nepal--information regarding how families make decisions about schooling for children. The findings suggest that sociocultural and economic factors cause parents to discriminate among children according…

Revisiting global body politics in Nepal: A reflexive analysis.

PubMed

Harcourt, Wendy

2016-01-01

Using the example of a human rights training in Nepal, the author looks at global body politics in a reflexive piece on her engagement in development practices that translate western feminist ideas on gender inequality and empowerment via UN human rights policies into non-western contexts. It firsts look at postcolonial and critical literature on feminist engagement in gender and development processes including a discussion on the concept of global body politics before examining briefly the framing of gender-based violence in Nepal. The core of the paper is a reflexive analysis and interrogation of the training in Nepal in order to bring out the tensions and contradictions around western developmental, feminist and human rights discourses. The discussion looks at how difficult it is for feminist, human rights and developmental discourses and practices to unmoor themselves from the notion of the 'expert' and those who do the rights/work/righting rights training and those who are perennially seen as requiring training. The conclusion reflects on possibilities of other epistemic practices found in intercultural dialogues.

Prioritizing and Funding Nepal's Multisector Nutrition Plan.

PubMed

Pomeroy-Stevens, Amanda; Shrestha, Madhukar B; Biradavolu, Monica; Hachhethu, Kusum; Houston, Robin; Sharma, Indu; Wun, Jolene

2016-12-01

Nepal has a long tradition of designing good multisectoral nutrition policy. However, success of policy implementation has varied. More evidence on how to successfully carry out multisector nutrition policy is needed. We tracked the influence of Nepal's multisectoral nutrition plan (MSNP) on the process of priority setting and budgeting from 2014 to 2016. This study used a mixed-method longitudinal design to track qualitative and budgetary changes related to MSNP processes nationally as well as in 3 districts. Qualitative changes in each study area were assessed through interviews, observation, news content, and meeting notes. Changes in allocations and expenditures were calculated based on budget documents, work plans, and validation interviews. Improved understanding of the MSNP was documented nationally and in study districts but not in VDCs. Human resources, ownership, bottom-up planning, coordination, advocacy, and sustainable structures all emerged as important factors within the enabling environment. Evidence suggests the MSNP influenced improvements in the last 3 factors. We also found notable increases in activities and financing for nutrition-allocations increased steadily between FY 2013-2014 and FY 2015-2016, and 28% of total nutrition allocations in the final year came from new or expanded MSNP-affiliated activities. Data from 3 districts highlight challenges linking local planning and budgeting to central-level structures. The MSNP appears to have strengthened the nutrition system in Nepal and increased priority and funding for nutrition. Next steps include strengthening linkages to the districts and below. Other countries can learn from the MSNP's success in increasing investment for nutrition. © The Author(s) 2016.

Design and implementation of a patient navigation system in rural Nepal: Improving patient experience in resource-constrained settings.

PubMed

Raut, Anant; Thapa, Poshan; Citrin, David; Schwarz, Ryan; Gauchan, Bikash; Bista, Deepak; Tamrakar, Bibhu; Halliday, Scott; Maru, Duncan; Schwarz, Dan

2015-12-01

Patient navigation programs have shown to be effective across multiple settings in guiding patients through the care delivery process. Limited experience and literature exist, however, for such programs in rural and resource-constrained environments. Patients living in such settings frequently have low health literacy and substantially lower social status than their providers. They typically have limited experiences interfacing with formalized healthcare systems, and, when they do, their experience can be unpleasant and confusing. At a district hospital in rural far-western Nepal, we designed and implemented a patient navigation system that aimed to improve patients' subjective care experience. First, we hired and trained a team of patient navigators who we recruited from the local area. Their responsibility is exclusively to demonstrate compassion and to guide patients through their care process. Second, we designed visual cues throughout our hospital complex to assist in navigating patients through the buildings. Third, we incorporated the patient navigators within the management and communications systems of the hospital care team, and established standard operating procedures. We describe here our experiences and challenges in designing and implementing a patient navigator program. Such patient-centered systems may be relevant at other facilities in Nepal and globally where patient health literacy is low, patients come from backgrounds of substantial marginalization and disempowerment, and patient experience with healthcare facilities is limited. Copyright © 2015 Elsevier Inc. All rights reserved.

Mobile Learning Practice in Higher Education in Nepal

ERIC Educational Resources Information Center

Parajuli, Krishna Prasad

2016-01-01

During the 15 years of this current century, mobile technology has become a leading technology in the support of educational outcomes. This study investigated the mobile learning practices among undergraduates in higher education in the semi-urban and rural areas of the Gorkha district of Nepal. The objectives were to explore the availability of…

Genetic diversity of plasmodium vivax merozoite surface protein-3alpha (Pvmsp-3alpha) gene in Jhapa District of Nepal.

PubMed

Adhikari, Madhav; Ranjitkar, Samir; Schousboe, Mette Leth; Alifrangis, Michael; Imwong, Mallika; Bhatta, Dwij Raj; Banjara, Megha Raj

2012-03-01

In Nepal, Plasmodium vivax accounts for approximately 80-90% of the malaria cases, but limited studies have been conducted on the genetic diversity of this parasite population. This study was carried out to determine the genetic diversity of P. vivax population sampled from subjects living in an endemic area of Jhapa District by analyzing the polymorphic merozoite surface protein-3alpha (Pvmsp-3alpha) gene by using PCR-restriction fragment length polymorphism. Three distinct genotypes were obtained from 96 samples; type A: 40 (71%), type B: 7 (13%), and type C: 9 (16%) which could be categorized into 13 allelic patterns: A1-A9, B1, B2, C1 and C2. These results indicated a high genetic diversity within the studied P. vivax population. As the transmission rate of malaria is low in Nepal, the diversity is most likely due to migration of people between the malaria endemic regions, either within the country or between Nepal and India. Similar prevalence of the three genotypes of Pvmsp-3alpha between the two countries likely supports the latter explanation.

Regional variation in pig farmer awareness and actions regarding Japanese encephalitis in Nepal: implications for public health education.

PubMed

Dhakal, Santosh; Joshi, Durga Datt; Ale, Anita; Sharma, Minu; Dahal, Meena; Shah, Yogendra; Pant, Dhan Kumar; Stephen, Craig

2014-01-01

Japanese encephalitis (JE) is a mosquito-borne zoonotic disease that has pigs as the major amplifying hosts. It is the most important cause of viral encephalitis in people in Nepal and is spreading in its geographic distribution in that country. Pig farming is increasing in Nepal due to reducing cultural biases against pigs and government programs to support pig farming for poverty alleviation. Major strategies for JE prevention and control include education, vector control, and immunization of people and pigs. This study used a survey of 400 pig farmers in 4 areas of Nepal with different JE and pig farming histories to explore regional variations in farmer awareness and actions towards JE, the association of awareness and actions with farm and farmer variables, and the implications of these associations for public health education. Exposure to JE risk factors was common across pig farms and pig farming districts but there were significant district level differences in knowledge and practices related to on-farm JE risk reduction. Social factors such as literacy, gender, and cultural practices were associated with farmer attitudes, knowledge and practices for JE control. JE vaccine uptake was almost non-existent and mosquito control steps were inconsistently applied across all 4 districts. Income was not a determining factor of the differences, but all farmers were very poor. The low uptake of vaccine and lack of infrastructure or financial capacity to house pigs indoors or away from people suggest that farmer personal protection should be a priority target for education in Nepal. This study re-enforces the need to attack root causes of people's personal disease prevention behaviours and take into account local variation in needs and capacities when designing health or agriculture education programs.

Knowledge of diabetes mellitus among pregnant women in three districts of Nepal.

PubMed

Shrestha, S; Thapa, P; Saleh, F; Thapa, N; Stray, B Pedersen; Khanom, K

2013-09-01

Diabetes mellitus is an emerging health problem in developing world with the consumption of energy dense diet and inactive lifestyle. The problem of diabetes is further expanded due to ignorance and lack of knowledge. The aim of the study was to assess the knowledge of diabetes among pregnant women in three districts of Nepal. A community based cross-sectional study was conducted in three districts in mountain, hilly and plain areas of Nepal. A total of 590 pregnant women were interviewed during the period of July 2009 to June 2010. A knowledge score system was applied. Poor score was <40%, average (40-60%) and good (>60%) of the total score. Statistical software SPSS 11.5 was used for data entry, data management and analysis. Out of 590 pregnant women, only 41% had heard about diabetes mellitus. Majority of the participants (75%) from age group >30 years had not heard about diabetes. Among the 241 with some knowledge, the knowledge score median percent(range) on the meaning, symptoms, risk factors, treatment, prevention, complications and overall knowledge were 50%(0-100), 25% (0-75), 20% (0-60), 20% (0-100), 25% (0-100), 20% (0-60) and 26% (0- 58) respectively. According to defined category, majority of those who ever heard about diabetes had poor knowledge (95%). Knowledge among literate women (p=.001), women residing in Kailali district (plain region) (p=.003) and those with positive family history of diabetes (p=.003) was found to be significant. As large proportions of Nepalese pregnant women do not have any knowledge or have poor knowledge regarding diabetes, extensive health education and health promotion programs are urgently recommended to prevent diabetes in Nepal.

On the relationship between cultural values and preferences and affective health in Nepal.

PubMed

Furr, L Allen

2005-03-01

The westernization of developing countries has improved physical health and life expectancy. Modernization, however, is believed to have injurious effects on mental health. Some research suggests that the effects of modernization vary, hurting some but benefiting others. Economic disparity is usually presumed to cause the mental health problems. The purpose of this study was to determine if aspects of westernization other than economic status predicted depression scores in a sample of adults occupying similar economic stations in Nepal. Survey data were collected from 276 teachers in Nepal. The questionnaire was administered in Nepali. Statistical tests sought to determine the relationship between scores on a measure of depression and having a western cultural orientation. Bivariate and multi-variate analyses indicate that a higher western orientation was associated with lower depression scores. Non-traditional attitudes towards the Nepalese caste system and gender political equality predicted lower depression scores. Attitudes regarding gender economic equality and a preference for western music and film and English language were not associated with depression scores. Findings suggest that the relationship between modernization and psychological well-being are contextual.

Livelihood Vulnerability Approach to Assess Climate Change Impacts to Mixed Agro-Livestock Smallholders Around the Gandaki River Basin of Nepal

NASA Astrophysics Data System (ADS)

Panthi, J., Sr.

2014-12-01

Climate change vulnerability depends upon various factors and differs between places, sectors and communities. People in developing countries whose subsistence livelihood depends upon agriculture and livestock are identified as particularly vulnerable. Nepal, where the majority of people are in a mixed agro-livestock system, is identified as the world's fourth most vulnerable country to climate change. However, there are few studies on how vulnerable mixed agro-livestock smallholders are and how their vulnerability differs across different ecological regions. This study aims to test two vulnerability assessment indices, livelihood vulnerability index (LVI) and IPCC vulnerability index (VI-IPCC), around the Gandaki river basin of Nepal. A total of 543 households practicing mixed agro-livestock were surveyed from three districts (Dhading, Syangja and Kapilvastu) representing the mountain, mid-hill and lowland altitudinal belts respectively. Data on socio-demographics, livelihoods, social networks, health, food and water security, natural disasters and climate variability were collected. Both indices differed across the three districts, with mixed agro-livestock smallholders of Dhading district found to be the most vulnerable and that of Syangja least vulnerable. This vulnerability index approach may be used to monitor rural vulnerability and/or evaluate potential program/policy effectiveness in poor countries like Nepal. The present findings are intended to help in designing intervention strategies to reduce vulnerability of mixed agro-livestock smallholders and other rural people in developing countries to climate change.

Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.

PubMed

Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H

2015-01-01

Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry of Health and Population (MoHP). Strategies to overcome these challenges included involvement of MoHP in the process, especially by providing psychotropic medicines and appointing a senior level officer to facilitate project activities, and collaboration with National Health Training Centers (NHTC) in training programs. This study describes many challenges facing mental health care in Nepal. Most of these challenges are not new, yet this study contributes to our understanding of these difficulties by outlining the national and district level factors that have a direct influence on the development of a district level mental health care plan.

The "Iron Gate": High-Stakes Assessment at Age 16 in Nepal and England

ERIC Educational Resources Information Center

Davies, Dan

2016-01-01

In Nepal, the School Leaving Certificate (SLC) assessment taken by 16-year-olds at the end of Grade 10 of formal schooling performs a similar function to the General Certificate of Secondary Education (GCSE) examination in England in that it summarises individual, school, district and national achievement and acts as a filtering mechanism to the…

The incidence of color blindness among some school children of Pokhara, Western Nepal.

PubMed

Niroula, D R; Saha, C G

2010-03-01

The incidence of color blindness varies from race to race and different in different geographical area. Since, there is no such report about the prevalence of color blindness in the western part of Nepal, the present study had been conducted to find out the incidence of color blindness among school children of Pokhara city, western Nepal. Participant's (n=964, 474 boys, 490 girls, age group 10 to 19 years) color vision was tested by using Ishihara chart (38 plates). Among 474 boys, 18 boys were color blind with the prevalence of 3.8%. None of girls were found to be color blind. Out of 18 color blind boys, nine, six and three boys were the victims of deuteranopia, deuteranomaly and protanomaly respectively. The incidence of color blindness were more amongst the Darji (14.3%) and Newar (9.1%) ethnic groups.

Serosurveillance and factors associated with the presence of antibodies against bluetongue virus in dairy cattle in two eco-zones of Nepal.

PubMed

Gaire, T N; Karki, S; Dhakal, I P; Khanal, D R; Bowen, R A

2016-12-01

Cattle play an important role in the epidemiology of bluetongue (BT) by acting as reservoir hosts. However, the status of BT virus (BTV) in dairy cattle in Nepal is unknown. The objective of this study was to estimate the prevalence of BTV antibodies in dairy cattle in two eco-zones of Nepal, and to identify the factors associated with virus exposure. The authors conducted a cross-sectional serosurvey from March 2012 through February 2013 by sampling 131 dairy cattle from seven clusters (villages) in the Chitwan district in the Terai region (southern lowlands) and the Lamjung district in the Hills region (the middle part of Nepal). Of the 131 serum samples tested, 29.3% (95% confidence interval [CI]: 21.5-37.2) were positive for BTV antibodies. Herd-level seroprevalence was 45.7% (95% CI: 30.9-61.0). Bivariate analysis indicated a positive association between seroconversion to BTV and age, and an association with breed of cattle after controlling for clustering of animals within herds. Based on this model, cattle were more likely to become seropositive as they aged. Crossbred cattle were more likely to be seropositive than those of exotic breeds (odds ratio [OR] = 4.6; 95% CI: 1.5-14.1). The results indicate widespread exposure of dairy cattle to BTV in Nepal. The authors suggest that dairy cattle should be included in the surveillance plan for BTV infection in Nepal and that it is important to educate farmers about the possible impacts of this disease. © OIE (World Organisation for Animal Health), 2016.

Innovation in Primary School Construction: Community Participation in Seti Zone, Nepal. Educational Building Report 20. A Case Study.

ERIC Educational Resources Information Center

Tamang, H. D.; Dharam, K. C.

Nepal is one of the poorest countries in the world. In 1981 the Education for Rural Development in Seti Zone Project--more commonly known as the "Seti Project"--was part of the Nepalese government's effort to develop a system of basic education in that far western region of Nepal. The early success of the project provided the impetus for…

The Differential Impact of User-Fee Exemption Compared to Conditional Cash Transfers on Safe Deliveries in Nepal.

PubMed

Pradhan, Elina; Fan, Victoria Y

2017-08-01

To assess the differential impact of a copayment exemption compared to a cash incentive on increasing skilled birth attendance (i.e., birth attended by a skilled health worker) in Nepal. This study used data on 8,785 children born between July 2005 and December 2008, obtained from the nationally representative Demographic and Health Surveys, 2006 and 2011. Twenty-five districts received both the policy interventions, and the remaining 50 control districts received only the cash incentive. We employed a difference-in-differences model to compare children born in districts with both interventions to those in districts with conditional cash transfers only. Average marginal effects of the difference-in-difference coefficient on skilled birth attendance measures are estimated. Skilled birth attendance in districts with both interventions was no higher on average than in districts with only the cash incentive. In areas with adequate road networks, however, significantly higher skilled birth attendance was observed in districts with both interventions compared to those with only the cash incentive. The added incentive of the user-fee exemption did not significantly increase skilled birth attendance relative to the presence of the cash incentive. User-fee exemptions may not be effective in areas with inadequate road infrastructure. © Health Research and Educational Trust.

Dengue virus infection in a French traveller to the hilly region of Nepal in 2015: a case report.

PubMed

Gupta, Birendra Prasad; Adhikari, Anurag; Rauniyar, Ramanuj; Kurmi, Roshan; Upadhya, Bishnu Prasad; Jha, Bimlesh Kumar; Pandey, Basudev; Das Manandhar, Krishna

2016-03-21

Dengue viral infections are known to pose a significant risk during travel to tropical regions, but it is surprising to find dengue transmission in the hilly region of Nepal, which is over 1800mtr above sea level. A 43-year-old Caucasian female traveler from France presented with fever and abdominal pain following a diarrheal illness while visiting the central hilly region of Nepal. Over the course of 9 days, she developed fever, body aches, and joint pain, with hemorrhagic manifestation. She was hospitalized in India and treated with supportive care, with daily monitoring of her platelets. An assessment by enzyme-linked immunosorbent assay showed that she was positive for dengue non-structural protein 1. Upon her return to France, dengue virus was confirmed by reverse transcriptase-polymerase chain reaction. The district where this dengue case was reported is in the hilly region of Nepal, neighboring the capital city Kathmandu. To the best of our knowledge, there has previously been no dengue cases reported from the district. This study is important because it aims to establish a potential region of dengue virus circulation not only in the tropics, but also in the subtropics as well, which in Nepal may exceed elevations of 1800mtr. This recent case report has raised alarm among concerned health personnel, researchers, and organizations that this infectious disease is now on the way to becoming established in a temperate climate.

Intestinal parasitosis in school children of Lalitpur district of Nepal.

PubMed

Tandukar, Sarmila; Ansari, Shamshul; Adhikari, Nabaraj; Shrestha, Anisha; Gautam, Jyotshana; Sharma, Binita; Rajbhandari, Deepak; Gautam, Shikshya; Nepal, Hari Prasad; Sherchand, Jeevan B

2013-11-09

Enteric parasites are the most common cause of parasitic diseases and cause significant morbidity and mortality, particularly in developing countries like Nepal. The objective of this study was to estimate the prevalence and risk factors of intestinal parasitic infections among school going children of Lalitpur district of Nepal. A total of 1392 stool samples were collected from school children of two government, two private and two community schools of the same district. The stool samples were examined for evidence of parasitic infections by direct microscopy and confirmed by concentration methods (formal ether sedimentation technique or floatation technique by using Sheather's sugar solution). Modified Ziehl-Neelsen (ZN) staining was performed for the detection of coccidian parasites. Prevalence of intestinal parasitosis was found to be 16.7%. The highest prevalence rate was seen with Giardia lamblia (7.4%) followed by Entamoeba histolytica (3.4%) and Cyclospora cayetanensis (1.6%). Children aged 11-15 years and the ones belonging to family of agriculture workers were most commonly affected. Hand washing practice and type of drinking water also showed significant difference. The burden of parasitic infections among the school children, coupled with the poor sanitary conditions in the schools, should be regarded as an issue of public health priority and demands for effective school health programs involving periodic health education and screening.

Assessment of Drought Scenario in Western Nepal

NASA Astrophysics Data System (ADS)

Pandey, V. P.; Khatiwada, K. R.

2017-12-01

Drought is a frequent phenomenon in relatively drier western Nepal. Lack of hydro-climatic information with wider spatial coverage is hindering effective assessment of the drought events. Furthermore, drought assessment is not getting adequate attention in Nepal. This study aims to develop drought scenario for Western Nepal by evaluating various types of drought indices in Karnali River Basin (area = 4,6150 km2) and recommend the most suited set of indices for data-poor regions. On the climatic data at ten stations, drought indices were calculated from following seven selected indices: Standardized Precipitation Index (SPI), Standardized Precipitation Evapotranspiration Index (SPEI), Palmer Drought Severity Index (PDSI), (self-calibrating) Palmer Drought Severity Index (scPDSI), Reconnaissance Drought Index (RDI), Standardized Streamflow Index (SSFI), and Palmer Hydrological Drought Index (PHDI). Initial results reflect that the basin is affected by severe meteorological drought. Most of the indices show the extreme dryness scenario during the years 1984-85, 1992-93, 1995, 2000, 20002, 2008-09, and 2012. The results from the stations with long-term temperature and precipitation data sets showed a higher (up to 0.9) correlation between SPI and RDI than for SPEI and other Palmer Drought Indices, which ranged from 0.6 to 0.8 only. This suggests ability of SPI to represent magnitude and duration of the drought events fairly well in the study basin, and therefore, has potential to represent drought dynamics in data-poor regions. Keywords: Drought; Karnali River Basin; Nepal Himalaya

Prevalence, associated factors, awareness, treatment, and control of hypertension: Findings from a cross sectional study conducted as a part of a community based intervention trial in Surkhet, Mid-western region of Nepal

PubMed Central

Dhungana, Raja Ram; Bhandari, Pratiksha; Gurung, Yadav; Paudel, K. N.

2017-01-01

Background Hypertension is one of the leading public health problems globally. About half of the deaths from cardiovascular diseases were attributed to hypertension in 2008. Reduction of blood pressure to normal range is one of the major challenges in preventing complications and future burden of cardiovascular diseases. Therefore, this study aims to determine prevalence, awareness, treatment and control of hypertension and its associated factors in Nepal. Methods This was a community based cross-sectional study conducted as a part of a community based intervention trial in Birendranagar Municipality of Surkhet district located at the Mid-western region of Nepal. We enrolled 1159 subjects aged 30 years and above. Out of 12 wards (administrative unit), four wards were selected randomly. Three hundred participants were recruited from each selected ward. Trained enumerator collected socio-demographic, anthropometric, and clinical data using standard STEPS questionnaires. Results Out of all participants, women were 71% and mean age was 47±12.6 years. The overall prevalence of hypertension was 38.9% (95% CI: 36–41.7) while age and sex adjusted prevalence was 40.6%. The hypertension was present in 48.1% (95% CI: 45.2–50.9) of men and 35.2% (95% CI: 32.4–37.9)] of women. Male gender (OR = 1.49), older age (OR = 1.04 per year), Dalit caste (OR = 1.71), past history of cigarettes smoking (OR = 2.78), current alcohol consumption (OR = 1.75), and raised body mass index (OR = 1.17 per unit) were identified as significant factors associated with hypertension. Of total hypertensive respondents, 53.4% (95% CI: 48.7–58) were aware, 29% (95% CI: 24.8–33.1) were receiving treatment for high blood pressure, and 8.2% (95% CI: 5.6–10.7) had controlled blood pressure. The awareness, treatment, and control status were worse in younger participants. Conclusions The study revealed high prevalence with low awareness, treatment, and control of hypertension in Nepal. Gender, age, ethnicity, smoking, drinking alcohol, and body mass index were associated with hypertension. Immediate public health and individual measures are warranted to reduce future burden of cardiovascular diseases. Trial registration ClinicalTrial.gov (NCT02981251) PMID:28982159

Support to the Safe Motherhood Programme in Nepal: an integrated approach.

PubMed

Barker, Carol E; Bird, Cherry E; Pradhan, Ajit; Shakya, Ganga

2007-11-01

Evidence gathered from 1997 to 2006 indicates progress in reducing maternal mortality in Nepal, but public health services are still constrained by resource and staff shortages, especially in rural areas. The five-year Support to the Safe Motherhood Programme builds on the experience of the Nepal Safer Motherhood Project (1997-2004). It is working with the Government of Nepal to build capacity to institute a minimum package of essential maternity services, linking evidence-based policy development with health system strengthening. It has supported long-term planning, working towards skilled attendance at every birth, safe blood supplies, staff training, building management capacity, improving monitoring systems and use of process indicators, promoting dialogue between women and providers on quality of care, and increasing equity and access at district level. An incentives scheme finances transport costs to a health facility for all pregnant women and incentives to health workers attending deliveries, with free services and subsidies to facilities in the poorest 25 districts. Despite bureaucracy, frequent transfer of key government staff and political instability, there has been progress in policy development, and public health sector expenditure has increased. For the future, a human resources strategy with career paths that encourage skilled staff to stay in the government service is key.

Glucose-6-phosphate dehydrogenase deficiency in people living in malaria endemic districts of Nepal.

PubMed

Ghimire, Prakash; Singh, Nihal; Ortega, Leonard; Rijal, Komal Raj; Adhikari, Bipin; Thakur, Garib Das; Marasini, Baburam

2017-05-23

Glucose-6-phosphate dehydrogenase (G6PD) is a rate limiting enzyme of the pentose phosphate pathway and is closely associated with the haemolytic disorders among patients receiving anti-malarial drugs, such as primaquine. G6PD deficiency (G6PDd) is an impending factor for radical treatment of malaria which affects the clearance of gametocytes from the blood and subsequent delay in the achievement of malaria elimination. The main objective of this study was to assess the prevalence of G6PD deficiency in six malaria endemic districts in Southern Nepal. A cross-sectional population based prevalence survey was conducted in six malaria endemic districts of Nepal, during April-Dec 2013. A total of 1341 blood samples were tested for G6PDd using two different rapid diagnostic test kits (Binax-Now ® and Care Start™). Equal proportions of participants from each district (n ≥ 200) were enrolled considering ethnic and demographic representation of the population groups. Out of total 1341 blood specimens collected from six districts, the overall prevalence of G6PDd was 97/1341; 7.23% on Binax Now and 81/1341; 6.0% on Care Start test. Higher prevalence was observed in male than females [Binax Now: male 10.2%; 53/521 versus female 5.4%; 44/820 (p = 0.003) and Care Start: male 8.4%; 44/521 versus female 4.5%; 37/820 (p = 0.003)]. G6PDd was higher in ethnic groups Rajbanshi (11.7%; 19/162) and Tharu (5.6%; 56/1005) (p = 0.006), major inhabitant of the endemic districts. Higher prevalence of G6PDd was found in Jhapa (22/224; 9.8%) and Morang districts (18/225; 8%) (p = 0.031). In a multivariate analysis, male were found at more risk for G6PDd than females, on Binax test (aOR = 1.97; CI 1.28-3.03; p = 0.002) and Care Start test (aOR = 1.86; CI 1.16-2.97; p = 0.009). The higher prevalence of G6PDd in certain ethnic group, gender and geographical region clearly demonstrates clustering of the cases and ascertained the risk groups within the population. This is the first study in Nepal which identified the vulnerable population groups for G6PDd in malaria endemic districts. The finding of this study warrants the need for G6PDd testing in vulnerable population groups in endemic districts, and also facilitates use of primaquine in mass supporting timely progress for malaria elimination.

The spatial heterogeneity between Japanese encephalitis incidence distribution and environmental variables in Nepal.

PubMed

Impoinvil, Daniel E; Solomon, Tom; Schluter, W William; Rayamajhi, Ajit; Bichha, Ram Padarath; Shakya, Geeta; Caminade, Cyril; Baylis, Matthew

2011-01-01

To identify potential environmental drivers of Japanese Encephalitis virus (JE) transmission in Nepal, we conducted an ecological study to determine the spatial association between 2005 Nepal JE incidence, and climate, agricultural, and land-cover variables at district level. District-level data on JE cases were examined using Local Indicators of Spatial Association (LISA) analysis to identify spatial clusters from 2004 to 2008 and 2005 data was used to fit a spatial lag regression model with climate, agriculture and land-cover variables. Prior to 2006, there was a single large cluster of JE cases located in the Far-West and Mid-West terai regions of Nepal. After 2005, the distribution of JE cases in Nepal shifted with clusters found in the central hill areas. JE incidence during the 2005 epidemic had a stronger association with May mean monthly temperature and April mean monthly total precipitation compared to mean annual temperature and precipitation. A parsimonious spatial lag regression model revealed, 1) a significant negative relationship between JE incidence and April precipitation, 2) a significant positive relationship between JE incidence and percentage of irrigated land 3) a non-significant negative relationship between JE incidence and percentage of grassland cover, and 4) a unimodal non-significant relationship between JE Incidence and pig-to-human ratio. JE cases clustered in the terai prior to 2006 where it seemed to shift to the Kathmandu region in subsequent years. The spatial pattern of JE cases during the 2005 epidemic in Nepal was significantly associated with low precipitation and the percentage of irrigated land. Despite the availability of an effective vaccine, it is still important to understand environmental drivers of JEV transmission since the enzootic cycle of JEV transmission is not likely to be totally interrupted. Understanding the spatial dynamics of JE risk factors may be useful in providing important information to the Nepal immunization program.

The Spatial Heterogeneity between Japanese Encephalitis Incidence Distribution and Environmental Variables in Nepal

PubMed Central

Impoinvil, Daniel E.; Solomon, Tom; Schluter, W. William; Rayamajhi, Ajit; Bichha, Ram Padarath; Shakya, Geeta; Caminade, Cyril; Baylis, Matthew

2011-01-01

Background To identify potential environmental drivers of Japanese Encephalitis virus (JE) transmission in Nepal, we conducted an ecological study to determine the spatial association between 2005 Nepal JE incidence, and climate, agricultural, and land-cover variables at district level. Methods District-level data on JE cases were examined using Local Indicators of Spatial Association (LISA) analysis to identify spatial clusters from 2004 to 2008 and 2005 data was used to fit a spatial lag regression model with climate, agriculture and land-cover variables. Results Prior to 2006, there was a single large cluster of JE cases located in the Far-West and Mid-West terai regions of Nepal. After 2005, the distribution of JE cases in Nepal shifted with clusters found in the central hill areas. JE incidence during the 2005 epidemic had a stronger association with May mean monthly temperature and April mean monthly total precipitation compared to mean annual temperature and precipitation. A parsimonious spatial lag regression model revealed, 1) a significant negative relationship between JE incidence and April precipitation, 2) a significant positive relationship between JE incidence and percentage of irrigated land 3) a non-significant negative relationship between JE incidence and percentage of grassland cover, and 4) a unimodal non-significant relationship between JE Incidence and pig-to-human ratio. Conclusion JE cases clustered in the terai prior to 2006 where it seemed to shift to the Kathmandu region in subsequent years. The spatial pattern of JE cases during the 2005 epidemic in Nepal was significantly associated with low precipitation and the percentage of irrigated land. Despite the availability of an effective vaccine, it is still important to understand environmental drivers of JEV transmission since the enzootic cycle of JEV transmission is not likely to be totally interrupted. Understanding the spatial dynamics of JE risk factors may be useful in providing important information to the Nepal immunization program. PMID:21811573

Characterization of rabies virus from a human case in Nepal.

PubMed

Pant, G R; Horton, D L; Dahal, M; Rai, J N; Ide, S; Leech, S; Marston, D A; McElhinney, L M; Fooks, A R

2011-04-01

Rabies is endemic throughout most of Asia, with the majority of human cases transmitted by domestic dogs (Canis familiaris). Here, we report a case of rabies in a 12-year-old girl in the Lalitpur district of Nepal that might have been prevented by better public awareness and timely post-exposure prophylaxis. Molecular characterization of the virus showed 100% identity over a partial nucleoprotein gene sequence to previous isolates from Nepal belonging to the 'arctic-like' lineage of rabies virus. Sequence analysis of both partial nucleoprotein and glycoprotein genes showed differences in consensus sequence after passage in vitro but not after passage in vivo.

Application of Vertical Electrical Sounding (VES) for the assessment of Ground Water Potential at Madi Phant, Palpa District, Western Nepal

NASA Astrophysics Data System (ADS)

Khatiwada, B.; Ghimire, H.; Bhusal, U. C.; Shrestha, S. R.; Upadhyay, K.; Khanal, A.; Pandey, D.

2017-12-01

Ground Water Resources Development Board (GWRDB), Government of Nepal, is the sole authority for systematize investigation, and management of ground water in the country. This study was conducted by GWRDB to create a data base of the groundwater potential in the hilly area. The main purpose of the study was to assess the groundwater potential at the Madi Phant Valley, Lesser Himalaya Region, Plapa District, Nepal. Data were acquired from WDJD-4 and analyzed using computer aided software called IPI2win, which yield an automatic interpretation of the apparent resistivity and data were correlated with lithologs of the vertical section. The simulated results of the ten VES points conducted using Schlumberger Configuration with AB/2 varying from 2 to 400 m and MN/2 varying from 0.5 to 50m reveal the presence of 4 to 8 geo-electric layers. Results obtained from software were rechecked by plotting the apparent resistivity value on Log-Log transparent graph sheet and manually interpreted using master curves and auxiliary curves. The resistivity values of the different layers' ranges from 3 Ωm to 3700 Ωm and were statistically analyzed from Golden Software Grapher. Representative resistivity sounding curves with modeled layer obtained after inversion was used to delineate the aquifer and 1D geoelectric sections. The geoelectrical sections for the study area consists of: the topsoil, sandy silt, sand and gravel, fractured rock and the fresh basement rock. The groundwater bearing layer of fractured rock varies between depth of 8-65 meters across foothill site (Eastern Corner) of the study area and groundwater bearing layer of sand and gravel/fractured rock varies between depth of 20-100 m in the central part of the Madi Phant valley. Contour map and 3D map of bedrock and water bearing layers for the conceptual model were prepared with the help of surfer shows that the gradient of the contour is high in the surrounding parts and flat in the center of Valley.

Multidisciplinary study on anthropogenic landslides in Nepal

NASA Astrophysics Data System (ADS)

Puglia, Christopher; Derron, Marc-Henri; Nicolet, Pierrick; Sudmeier-Rieux, Karen; Jaboyedoff, Michel; Devkota, Sanjay

2013-04-01

Nepal is a country in which shallow landslide is a frequent phenomenon. Monsoon is the main triggering factor but anthropogenic influence is often significant too. Indeed, many infrastructures, such as roads or water pipes, are not built in a rigorous way because of a lack of funds and knowledge. In the present study we examine the technical, social and economic issues of landslide management for two sites in Nepal. The first site is located in Sanusiruwari VDC (Sindhupalchock district, central Nepal) and the second one in Namadi VDC (Ramecchap district, central Nepal). Both sites are affected by landslides induced by the construction of hydropower plants. These landslides may threaten the viability of the hydropower plants. At both sites the problems are quite similar, but the first site project is a private one and the second one is a public one implemented by the United Nations Development Programme (UNDP). For both sites, bioengineering methods using Vetiver (Vetyveria zizanioides) plantations is the main stabilization measure. To follow the progression of both landslides, fieldwork observations were conducted before and after the 2012 rainy season, including photogrammetric and distancemeter acquisitions. Main issues were discussed with communities and stakeholders of the hydropower projects through interviews and participatory risk mapping. Main issues include: lack of communication between the project managers and communities leading to conflict and the lack of maintenance of the bio-engineering sites, leading to less effective Vetiver growth and slope stabilization. Comparing the landslide management (technical, social and economic) of the two projects allows to point out some specific issues within an integrated risk perspective.

A qualitative study about the gendered experiences of motherhood and perinatal mortality in mountain villages of Nepal: implications for improving perinatal survival.

PubMed

Paudel, Mohan; Javanparast, Sara; Dasvarma, Gouranga; Newman, Lareen

2018-05-15

We aim to examine the gendered contexts of poor perinatal survival in the remote mountain villages of Nepal. The study setting comprised two remote mountain villages from a mid-western mountain district of Nepal that ranks lowest on the Human Development Index (0.304), and is reported as having the lowest child survival rates in the country. The findings are taken from a larger study of perinatal survival in remote mountain villages of Nepal, conducted through a qualitative methodological approach within a framework of social constructionist and critical theoretical perspectives. Data were collected through in-depth interviews with 42 women and their families, plus a range of healthcare providers (nurses/auxiliary nurses, female health volunteers, support staff, Auxiliary Health Worker and a traditional healer) and other stakeholders from February to June, 2015. Data were analysed with a comprehensive coding process utilising the thematic analysis technique. The social construction of gender is one of the key factors influencing poor perinatal survival in the villages in this study. The key emerging themes from the qualitative data are: (1) Gendered social construct and vulnerability for poor perinatal survival: child marriages, son preference and repeated child bearing; (2) Pregnancy and childbirth in intra-familial dynamics of relationships and power; and (3) Perception of birth as a polluted event: birth in Gotha (cowshed) and giving birth alone. Motherhood among women of a low social position is central to women and their babies experiencing vulnerabilities related to perinatal survival in the mountain villages. Gendered constructions along the continuum from pre-pregnancy to postnatal (girl settlement, a daughter-in-law, ritual pollution about mother and child) create challenges to ensuring perinatal survival in these villages. It is imperative that policies and programmes consider such a context to develop effective working strategies for sustained reduction of future perinatal deaths.

Intestinal parasitosis in school children of Lalitpur district of Nepal

PubMed Central

2013-01-01

Background Enteric parasites are the most common cause of parasitic diseases and cause significant morbidity and mortality, particularly in developing countries like Nepal. The objective of this study was to estimate the prevalence and risk factors of intestinal parasitic infections among school going children of Lalitpur district of Nepal. Methods A total of 1392 stool samples were collected from school children of two government, two private and two community schools of the same district. The stool samples were examined for evidence of parasitic infections by direct microscopy and confirmed by concentration methods (formal ether sedimentation technique or floatation technique by using Sheather’s sugar solution). Modified Ziehl-Neelsen (ZN) staining was performed for the detection of coccidian parasites. Results Prevalence of intestinal parasitosis was found to be 16.7%. The highest prevalence rate was seen with Giardia lamblia (7.4%) followed by Entamoeba histolytica (3.4%) and Cyclospora cayetanensis (1.6%). Children aged 11–15 years and the ones belonging to family of agriculture workers were most commonly affected. Hand washing practice and type of drinking water also showed significant difference. Conclusions The burden of parasitic infections among the school children, coupled with the poor sanitary conditions in the schools, should be regarded as an issue of public health priority and demands for effective school health programs involving periodic health education and screening. PMID:24207086

Identifying Pathways for Improving Household Food Self-Sufficiency Outcomes in the Hills of Nepal

PubMed Central

Karki, Tika B.; Sah, Shrawan K.; Thapa, Resam B.; McDonald, Andrew J.; Davis, Adam S.

2015-01-01

Maintaining and improving household food self-sufficiency (FSS) in mountain regions is an ongoing challenge. There are many facets to the issue, including comparatively high levels of land fragmentation, challenging terrain and transportation bottlenecks, declining labor availability due to out-migration, and low technical knowledge, among others. Using a nonparametric multivariate approach, we quantified primary associations underlying current levels of FSS in the mid-hills of Nepal. A needs assessment survey was administered to 77 households in Lungaun (Baglung District), Pang (Parbat District), and Pathlekhet (Myagdi District), with a total of 80 variables covering five performance areas; resulting data were analyzed using Classification and Regression Trees. The most parsimonious statistical model for household FSS highlighted associations with agronomic management, including yields of maize and fingermillet within a relay cropping system and adoption of improved crop cultivars. Secondary analyses of the variables retained in the first model again focused primarily on crop and livestock management. It thus appears that continued emphasis on technical agricultural improvements is warranted, independent of factors such as land holding size that, in any case, are very difficult to change through development interventions. Initiatives to increase household FSS in the mid-hills of Nepal will benefit from placing a primary focus on methods of agricultural intensification to improve crop yields and effective technology transfer to increase adoption of these methods. PMID:26047508

Knowledge and Practice on Injection Safety among Primary Health Care Workers in Kaski District, Western Nepal

PubMed Central

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kc, Vikash Kumar; Jha, Nisha; Sharma, Damodar

2016-01-01

Background Unsafe injection practice can transmit various blood borne infections. The aim of this study was to assess the knowledge and practice of injection safety among injection providers, to obtain information about disposal of injectable devices, and to compare the knowledge and practices of urban and rural injection providers. Methods The study was conducted with injection providers working at primary health care facilities within Kaski district, Nepal. Ninety-six health care workers from 69 primary health care facilities were studied and 132 injection events observed. A semi-structured checklist was used for observing injection practice and a questionnaire for the survey. Respondents were interviewed to complete the questionnaire and obtain possible explanations for certain observed behaviors. Results All injection providers knew of at least one pathogen transmitted through use/re-use of unsterile syringes. Proportion of injection providers naming hepatitis/jaundice as one of the diseases transmitted by unsafe injection practice was significantly higher in urban (75.6%) than in rural (39.2%) area. However, compared to urban respondents (13.3%), a significantly higher proportion of rural respondents (37.3%) named Hepatitis B specifically as one of the diseases transmitted. Median (inter-quartile range) number of therapeutic injection and injectable vaccine administered per day by the injection providers were 2 (1) and 1 (1), respectively. Two handed recapping by injection providers was significantly higher in urban area (33.3%) than in rural areas (21.6%). Most providers were not aware of the post exposure prophylaxis guideline. Conclusion The knowledge of the injection providers about safe injection practice was acceptable. The use of safe injection practice by providers in urban and rural health care facilities was almost similar. The deficiencies noted in the practice must be addressed. PMID:27540325

Women's Autonomy and Its Correlates in Western Nepal: A Demographic Study.

PubMed

Bhandari, Tulsi Ram; Kutty, V Raman; Ravindran, T K Sundari

2016-01-01

Despite various efforts for enhancing women's autonomy in developing countries, many women are deprived of their capacity in decision-making on their household affairs as well as social issues. This paper aimed to examine women's autonomy and its associated factors in the Kapilvastu district of Nepal. We measured women's autonomy using a recently developed women's autonomy measurement scale from June to October 2014. Descriptive statistics, chi-square test and logistic multivariate modeling technique were applied for assessing the association of demographic and socio-economic characteristics of women and their autonomy. Mean score for women's autonomy was 23.34 ± 8.06 out of the possible maximum 48. It was found to be positively associated with higher age difference at marriage, advantaged caste/ethnicity, better employment for the husband, couple's education more than 10 years schooling, and higher economic status of the household. We found strong direct effect of women's education (OR = 8.14, CI = 3.77-17.57), husband's education (OR = 2.63, CI = 1.69-4.10) and economic status of household (OR = 1.42, CI = 1.01-2.03) on women's autonomy. When we adjusted women's education for husband's education, the odds ratio decreased by around 22% {from (OR = 8.14, CI = 3.77-17.57) to (OR = 6.32, CI = 2.77-14.46)} and was a mediator effect. The economic status of household also had mediator effect on women's autonomy through their education. Education status of women is a key predictor of women's autonomy in Kapilvastu district. Husband's education and economic status of the household are other important predictors of women's autonomy which have a mediator effect on women's autonomy. Improving educational status and economic conditions of both women and their husbands may be the best solution to promote women's autonomy.

Navigating Diagnoses: Understanding Mind–Body Relations, Mental Health, and Stigma in Nepal

PubMed Central

Harper, Ian

2013-01-01

Anthropologists and psychiatrists traditionally have used the salience of a mind–body dichotomy to distinguish Western from non-Western ethnopsychologies. However, despite claims of mind–body holism in non-Western cultures, mind–body divisions are prominent in non-Western groups. In this article, we discuss three issues: the ethnopsychology of mind–body dichotomies in Nepal, the relationship between mind–body dichotomies and the hierarchy of resort in a medical pluralistic context, and, lastly, the role of mind–body dichotomies in public health interventions (biomedical and psychosocial) aimed toward decreasing the stigmatization of mental illness. We assert that, by understanding mind–body relations in non-Western settings, their implications, and ways in which to reconstitute these relations in a less stigmatizing manner, medical anthropologists and mental health workers can contribute to the reduction of stigma in global mental healthcare. PMID:18784989

Using Inexpensive Technology and Multimedia to Improve Science Education in Rural Communities of Nepal

ERIC Educational Resources Information Center

Neupane, Sujaya

2014-01-01

This article explores an ongoing project that promotes science education in rural communities of western Nepal by using affordable technology. With the advent of inexpensive technology and multimedia resources, teaching materials for science education can be accessed with a much smaller budget than was previously possible. A preliminary survey…

Rural Agricultural Change and Fertility Transition in Nepal

ERIC Educational Resources Information Center

Bhandari, Prem; Ghimire, Dirgha

2013-01-01

Using longitudinal panel data from the Western Chitwan Valley of Nepal, this study examines the impact of the use of modern farm technologies on fertility transition--specifically, the number of births in a farm household. Previous explanations for the slow pace of fertility transition in rural agricultural settings often argued that the demand…

Malnutrition Status Among Under-5 Children in a Hill Community of Nepal.

PubMed

Gaurav, K; Poudel, I S; Bhattarai, S; Pradhan, P M S; Pokharel, P K

2014-01-01

Malnutrition, especially under nutrition puts children at increased risk of morbidity and mortality and remains a serious barrier in child growth, development and survival. This is a major public health problem among under- 5 children in Nepal particularly in rural areas. To assess the burden and contributing factors for malnutrition in hill community of Ilam district in eastern Nepal. A cross sectional study was conducted in rural hill communities of Ilam district, Nepal with a sample of 240 under- 5 children. Anthropometric measurements were used as per WHO guidelines to asses three nutritional status: Underweight, Stunting, and Wasting using descriptive statistics and chi square test was applied using SPSS 12.0 to assess social and predisposing factors. Seventeen percent of under- 5 children were moderately and 10.4 % were severely underweight. Similarly, 22.9%, and 17.5% were found to be moderately and severely stunted respectively. Less than 10% were found to be moderately and severely wasted. Older age group of children, education level of mother, not exclusive breast feeding practice had significant (p <0.05) effect on stunting. More than 50% children were affected with stunting, underweight and wasting at the same time. Significant proportion of under - 5 children were malnourished in the communities of the hilly areas. The study unveiled the importance of literacy and exclusive breast feeding for the prevention of malnutrition in under- 5 children.

Birth Spacing of Pregnant Women in Nepal: A Community-Based Study.

PubMed

Karkee, Rajendra; Lee, Andy H

2016-01-01

Optimal birth spacing has health advantages for both mother and child. In developing countries, shorter birth intervals are common and associated with social, cultural, and economic factors, as well as a lack of family planning. This study investigated the first birth interval after marriage and preceding interbirth interval in Nepal. A community-based prospective cohort study was conducted in the Kaski district of Nepal. Information on birth spacing, demographic, and obstetric characteristics was obtained from 701 pregnant women using a structured questionnaire. Logistic regression analyses were performed to ascertain factors associated with short birth spacing. About 39% of primiparous women gave their first child birth within 1 year of marriage and 23% of multiparous women had short preceding interbirth intervals (<24 months). The average birth spacing among the multiparous group was 44.9 (SD 21.8) months. Overall, short birth spacing appeared to be inversely associated with advancing maternal age. For the multiparous group, Janajati and lower caste women, and those whose newborn was female, were more likely to have short birth spacing. The preceding interbirth interval was relatively long in the Kaski district of Nepal and tended to be associated with maternal age, caste, and sex of newborn infant. Optimal birth spacing programs should target Janajati and lower caste women, along with promotion of gender equality in society.

Understanding three decades of land use changes and a cloudburst in Phewa Lake Watershed, Western Nepal

NASA Astrophysics Data System (ADS)

Sudmeier-Rieux, Karen; Tonini, Marj; Vulliez, Cindy; Sanjaya, Devkota; Derron, Marc-Henri; Jaboyedoff, Michel

2017-04-01

This paper details an extreme rainfall event, or cloudburst (315 mm/ 24 hours) which occurred on July 29-30, 2015 in the Phewa Lake Watershed, Western Nepal, three months after the April 25, 2015 Gorkha Earthquake. The event triggered over 170 landslides and debris flows, caused 8 deaths and considerable damage to livelihoods. The fatal debris flow started from one of the numerous rural roads, which have proliferated exponentially over the past decades. In addition to mapping landslides due to this extreme rainfall event, our study sought to document and analyze underlying natural and human land use factors that may have impacted the occurrence of landsliding (Vulliez et al submitted). To do so, our study analyzed land cover/ land use changes for the period 1979-2016 based on an interpretation of aerial photos and satellite images, combined with ground truthing. We studied how land use / land cover changes have resulted in a shift of active erosion zones from overgrazing around streams and forests to an exponential number of small failures along unplanned earthen rural roads, or "bulldozer roads". With several hundred small failures documented along roadsides (Leibundgut et al., 2016) as compared to only 14 landslides prior to 2015 extreme rainfall event - and none triggered by the 2015 earthquake - roads are thus a major driver of active erosion zones and small failures in the watershed. More effective management of the current unsustainable mode of rural road construction is required to reduce further environmental and economic impacts on vulnerable populations in Nepal. Leibundgut, G., Sudmeier-Rieux, K. Devkota, S., Jaboyedoff, M., Derron, M-H., Penna, I. Nguyen, L. (2016). Rural earthen roads impact assessment in Phewa watershed, Western region, Nepal. Geoenvironmental Disasters (2016) 3:13. DOI 10.1186/s40677-016-0047-8 Vulliez, C, Tonini, M., Sudmeier-Rieux, K. Devkota, S., Derron, M-H, Jaboyedoff, M. (submitted) Land use changes, landslides and roads in the Phewa Watershed, Western Nepal from 1979 to 2016. Applied Geography

Cumulative incidence, distribution, and determinants of catastrophic health expenditure in Nepal: results from the living standards survey.

PubMed

Ghimire, Mamata; Ayer, Rakesh; Kondo, Masahide

2018-02-14

Nepal has committed to the global community to achieve universal health coverage by 2030. Nevertheless, Nepal still has a high proportion of out-of-pocket health payment and a limited risk-pooling mechanism. Out-of-pocket payment for the healthcare services could result in catastrophic health expenditure (CHE). Evidence is required to effectively channel the efforts to lower those expenses in order to achieve universal health coverage. However, little is known about CHE and its determinants in a broad national context in Nepal. Therefore, this study was conducted to explore the cumulative incidence, distribution, and determinants of CHE in Nepal. Data were obtained from the nationally representative survey, the Nepal Living Standards Survey-third undertaken in 2010/11. Information from 5988 households was used for the analyses. Households were classified as having CHE when their out-of-pocket health payment was greater than or equal to 40% of their capacity to pay. Remaining households were classified as not having CHE. Logistic regression analyses were used to identify determinants of CHE. Based on household-weighted sample, the cumulative incidence of CHE was 10.3% per month in Nepal. This incidence was concentrated in the far-western region and households in the poorer expenditure quartiles. Multivariable logistic regression revealed that households were more likely to face CHE if they; consisted of chronically ill member(s), have a higher burden of acute illness and injuries, have elderly (≥60 years) member(s), belonged to the poor expenditure quartile, and were located in the far-western region. In contrast, households were less likely to incur CHE when their household head was educated. Having children (≤5 years) in households did not significantly affect catastrophic health expenditure. This study identified a high cumulative incidence of CHE. CHE was disproportionately concentrated in the poor households and households located in the far-western region. Policy-makers should focus on prioritizing households vulnerable to CHE. Interventions to reduce economic burden of out-of-pocket healthcare payment are imperative to lower incidences of CHE among those households. Improving literacy rate might also be useful in order to lower CHE and facilitate universal health coverage.

The role of Tamang mothers-in-law in promoting breast feeding in Makwanpur District, Nepal.

PubMed

Masvie, Hilde

2006-03-01

to systematically analyse the Nepalise grandmother's own perspective of breast feeding. a qualitative approach was used. Three focus-group discussions and eight semi-structured interviews formed the primary database. All interviews and discussions were tape recorded, and translated transcripts and field notes were analysed. Makwanpur District, rural Nepal. 31 Tamang mothers-in-law living in a household with their son's family, and taking part in child care. the data suggest that the mothers-in-law see themselves as key providers of, and decision-makers in, perinatal care practices. Traditional patterns of promotive and preventive care were identified. contrary to the widespread reports that early breast feeding is delayed in this setting, these grandmothers held colostrum in high regard, used no prelacteals and supported early initiation of breast feeding.

Using thermochonology to validate a balanced cross section along the Karnali River, far-western Nepal

NASA Astrophysics Data System (ADS)

Battistella, C.; Robinson, D.; McQuarrie, N.; Ghoshal, S.

2017-12-01

Multiple valid balanced cross sections can be produced from mapped surface and subsurface data. By integrating low temperature thermochronologic data, we are better able to predict subsurface geometries. Existing valid balanced cross section for far western Nepal are few (Robinson et al., 2006) and do not incorporate thermochronologic data because the data did not exist. The data published along the Simikot cross section along the Karnali River since then include muscovite Ar, zircon U-Th/He and apatite fission track. We present new mapping and a new valid balanced cross section that takes into account the new field data as well as the limitations that thermochronologic data places on the kinematics of the cross section. Additional constrains include some new geomorphology data acquired since 2006 that indicate areas of increased vertical uplift, which indicate locations of buried ramps in the Main Himalayan thrust and guide the locations of Lesser Himalayan ramps in the balanced cross section. Future work will include flexural modeling, new low temperature thermochronometic data, and 2-D thermokinematic models from a sequentially forward modeled balanced cross sections in far western Nepal.

Intestinal Parasitic Infestation in Combatants and Their Families: A Hospital-Based Study in Mid-Western Regional Police Hospital, Nepal

PubMed Central

Paudel, Damodar; Aung, Myo Nyein; Sharma, Bindhya; Aung, Thin Nyein Nyein; Moolphate, Saiyud

2014-01-01

Objective: To find out the scenario of intestinal parasitic infestation in combatants and their families in the setting of Mid-Western Regional Police Hospital (MWRPH), Nepal. Study Design: Cross-sectional study. Methods: All 2005 patients presented with the complaint of abdominal pain, diarrhoea, frequent defecation, blood in stool, or black stool from August 2007 to February 2011 were offered a stool examination. About 10g of fresh stool was collected in a clean, dry bottle. Two slides from each specimen were examined applying light microscope in 10 and 40 uvf at Banke, Nepalgunj hospital laboratory. Result: Among 2005 patients, 928 (46.28%) were infested with either helminths and/or protozoa. 96% were single infestation. The most common infestation was Ascaris lumbricoides (48.06%) and the second was hook worm (18.97%). Most common protozoal infestations were Entamoeba histolytica (12.92%) and Giardia lamblia (9.49%). Helminthic infestations peaked in cool months and protozoal infestations were rather steady throughout the year. Conclusion: Very high parasitic infestation in least developed mid- western Nepal may need urgent public health intervention. PMID:24762341

A Distance Blended Learning Program to Upgrade the Clinical Competence of District Non-doctor Anesthesia Providers in Nepal.

PubMed

Shah, Shristi; Knoble, Stephen; Ross, Oliver; Pickering, Stephen

2017-12-01

Across Nepal, anesthesia at a district level is provided mostly by non-doctor anesthesia providers (anesthesia assistants-AAs). Nepal's Government recognized the need to sustain competence with continuous professional development and to upgrade 6-month trained working AAs to professional equivalence with the new national standard of 12-month training. As they are essential district health workers and AA clinical training sites are full, an innovative distance blended learning, competency-based, upgrade 1-year course was developed and conducted in 2014-2017 for two batches. The course content was developed over 18 months by a team of Nepali and overseas AA training experts. The 1-year course started with a refresher course, continued with tablet-based 12-month self-learning modules and clinical case logs, regular educational mentor communication, midcourse 2-week contact time in an AA training site, regular text messaging and ended with clinical examination and multiple-choice questions. Tablet content included 168 new case studies, pre- and posttests, video lectures, matching exercises and a resource library. All module work and logged clinical cases were uploaded centrally, where clinical mentors were able to review work. Clinical skills were upgraded, as needed, through direct clinical contact midway through the course. Quantitative and qualitative course assessments were included. Fourteen working AAs in first batch and eight working AAs in second batch from district, zonal and mission hospitals across Nepal were enrolled. All remained working at their hospitals throughout the course, and there were no significant tablet problems inhibiting course completion. Twenty-one AAs completed all modules successfully with time required for module completion averaging 19.2 h (range 11.2-32). One AA left the course after 3 months with a personal problem. Subjectively, AAs felt that the obstetric and pediatric modules were more difficult; lowest marks were objectively seen in the airway module. Clinical mentors averaged 8.2 h mentoring review work per module with direct student communication of 2.9 h per module per month. Participants logged a total of 5473 clinical cases, ranging between 50 and 788 cases each. Complications were recorded; outcomes were good. Challenges were the national IT infrastructure making data synchronization difficult and the lack of clinical exposure at some AA's hospitals. Nineteen AAs attended the final examination, and all passed. Two AAs withdrew before the final examination period due to personal and logistic reasons. This is the first use of distance blended learning to upgrade district health workers in Nepal and perhaps for non-doctor anesthesia providers globally. Key success factors were motivated students, cultural and contextualized clinical content, good educational mentoring relationships with regular communication, central IT and motivational support, and face-to-face midcourse clinical contact time.

Alcohol Consumption during Pregnancy and Postpartum Period and its Predictors in Sindhupalchowk District, Nepal.

PubMed

Aryal, K K; Thapa, N; Mehata, S; Thapa, P; Alvik, A; Stray-Pedersen, B

2016-09-01

A substantial proportion of women in Nepal consume alcohol and homebrewed alcoholic beverages are the most common type of alcohol. Alcohol being a part of tradition and culture in Nepal and evidences suggesting even low to moderate dose of alcohol having impacts on the birth outcomes, we aimed at exploring the alcohol consumption pattern during pregnancy and postpartum period along with its predictors. We studied all pregnant and recently delivered women using quantitative methods in selected wards within selected Village Development Committees of Sindhupalchowk district in Nepal after purposively choosing the district. We present the findings on pregnancy and postpartum period drinking and its predictors as proportion and adjusted odds ratio along with 95% CI. One-third of women drank alcohol during pregnancy and 43% during postpartum period. Nearly all drinking women mostly consumed homebrewed alcoholic beverages such as jaad/chhyang/localraksi. One-third consumed it daily during pregnancy, while three-quarters consumed daily during postpartum. One-fifth of currently drinking women drank ≥5 standard drinks on average per day in the last 30 days. Illiterate or women with low level of education were three times more likely to consume alcohol during pregnancy than women with secondary level education or higher. Similarly, women who didn't know that alcohol during pregnancy affects mother and child were four and half times more likely to consume alcohol during pregnancy than those who knew about it. Also, being dalits, disadvantaged and janajatis, husband's drinking and home brewing of alcohol were strongly associated with women's drinking during pregnancy and postpartum period. A substantial proportion of women consumed alcohol during pregnancy and postpartum period with high consumption frequency. Findings suggested, increasing awareness about consequences of drinking during pregnancy and postpartum period would be helpful probably as one of the components of routine antenatal care with a special focus to ethnic groups such as dalits, disadvantaged janajatis including relatively advantaged janajatis as well as the women with lower levels of education. Culture sensitive behavior change communication interventions aimed at reducing home brewing and husband's drinking would also be important Keywords: Alcohol consumption; home brewed; Nepal; postpartum period; pregnancy; predictor.

Exploring health facilities' experiences in implementing the free health-care policy (FHCP) in Nepal: how did organizational factors influence the implementation of the user-fee abolition policy?

PubMed

Sato, Midori; Gilson, Lucy

2015-12-01

This article presents an Asian experience of abolishing health-care user fees: Nepal's universal free health-care policy, implemented in 2008. Based on doctoral fieldwork between August 2008 and April 2009, the paper analyses primary-care facilities' and central and district health systems' experiences with the policy. It makes a unique contribution to existing evidence because it explicitly applies organizational theory within a carefully designed, rigorous, multiple case-study analysis to deepen our understanding of the organizational and 'people' factors in the successful removal of user fees. The cases were two pairs of primary-care facilities in one district, paired for comparison of the facilities' experiences with the policy in relation to its effects on health care utilization. Data collection methods included document reviews; key informant interviews at district and central levels; in-depth, semi-structured interviews and group interviews at case facilities. (Data on indicators of utilization and quality changes over time were also collected and will be published separately). Using key elements of Nadler and Tushman's 'Organizational Congruence' model, a degree-of-fit analysis tested the study's initial propositions and yielded generalizations for contexts in and outside Nepal. The study found that Nepal's key implementation challenges were similar to Africa's: insufficient or delayed inputs of drugs and compensation; insufficient workforce and the resulting reduced quality of services that hampered facilities' relationships with their clients and health providers' attitudes. However, the Nepalese case facilities with (1) good intra- and inter-facility relationships, (2) adequate staffing, (3) well-oriented providers and (4) previously trained, better-informed and skilled health management committees experienced higher utilization and better-quality indicators over time. Through its detailed analysis of Nepal's experience in removing user fees, the study highlights the importance of addressing the 'people' and 'organizational' factors in health-policy development and implementation. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study.

PubMed

Poudel, Ak Narayan; Newlands, David; Simkhada, Padam

2017-01-24

There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs. This study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household's perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations. Average total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$ 30.2/month), which was 28.5% of the sample households' average monthly income. The average total direct costs for seeking HIV/AIDS treatment were NRs 1512 (US$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs. The study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households.

Children from the Dalit Community in Rural Nepal: A Challenge to Inclusive Education

ERIC Educational Resources Information Center

Khanal, Damodar

2015-01-01

Based on empirical research carried out in public secondary schools in the western part of Nepal, this article examines how Dalit children experience secondary-level education. Their experiences are explored using in-depth interviews with Dalit children, their parents and teachers. The findings reveal that Dalit children's inclusion is affected by…

Assessment of district health system within inter-sectoral context in Nepal.

PubMed

Bhusal, C L; Singh, S P; Aryal, K K; Jha, B K; Ghimire, N; Shah, N; Khatiwada, D; Magar, A

2013-05-01

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. 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. 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. 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.

Pesticide poisoning in Chitwan, Nepal: a descriptive epidemiological study.

PubMed

Gyenwali, Deepak; Vaidya, Abhinav; Tiwari, Sundar; Khatiwada, Prakash; Lamsal, Daya Ram; Giri, Shrikrishana

2017-07-03

Globally, there is a growing concern over pesticides use, which has been linked to self-harm and suicide. However, there is paucity of research on the epidemiology of pesticides poisoning in Nepal. This study is aimed at assessing epidemiological features of pesticides poisoning among hospital-admitted cases in selected hospitals of Chitwan District of Nepal. A hospital-based quantitative study was carried out in four major hospitals of Chitwan District. Information on all pesticides poisoning cases between April 1 and December 31, 2015, was recorded by using a Pesticides Exposure Record (PER) form. A total of 439 acute pesticides poisoning cases from 12 districts including Chitwan and adjoining districts attended the hospitals during the 9-month-long study period. A majority of the poisoned subjects deliberately used pesticides (89.5%) for attempted suicide. The total incidence rate was 62.67/100000 population per year. Higher annual incidence rates were found among young adults (111.66/100000 population), women (77.53/100000 population) and individuals from Dalit ethnic groups (98.22/100000 population). Pesticides responsible for poisoning were mostly insecticides (58.0%) and rodenticides (20.8%). The most used chemicals were organophosphates (37.3%) and pyrethroids (36.7%). Of the total cases, 98.6% were hospitalized, with intensive care required for 41.3%. The case fatality rate among admitted cases was 3.8%. This study has indicated that young adults, females and socially disadvantaged ethnic groups are at a higher risk of pesticides poisoning. Pesticides are mostly misused intentionally as an easy means for committing suicide. It is recommended that the supply of pesticides be properly regulated to prevent easy accessibility and misuse. A population-based study is warranted to reveal the actual problem of pesticides exposure and intoxication in the community.

Investigating aquifer contamination and groundwater quality in eastern Terai region of Nepal.

PubMed

Mahato, Sanjay; Mahato, Asmita; Karna, Pankaj Kumar; Balmiki, Nisha

2018-05-21

This study aims at assessing the groundwater quality of the three districts of Eastern Terai region of Nepal viz. Morang, Jhapa, Sunsari using physicochemical characteristics and statistical approach so that possible contamination of water reservoir can be understood. pH, temperature, conductivity, turbidity, color, total dissolved solids, fluorides, ammonia, nitrates, chloride, total hardness, calcium hardness, calcium, magnesium, total alkalinity, iron, manganese, arsenic have to be analyzed to know the present status of groundwater quality. Results revealed that the value of analyzed parameters were within the acceptable limits for drinking water recommended by World Health Organization except for pH, turbidity, ammonia and iron. As per Nepal Drinking Water Quality Standards, fluoride and manganese too were not complying with the permissible limit. Electrical conductivity, total dissolved solids, chloride, total hardness, calcium hardness, manganese, and total alkalinity show good positive correlation with major water quality parameters. Calcium, magnesium, total hardness, calcium hardness and total alkalinity greatly influences total dissolved solids and electrical conductivity. ANOVA, Tukey, and clustering highlight the significance of three districts. Groundwater can be considered safe, but there is always a chance of contamination through chemical wastes in the heavily industrialized area of Morang and Sunsari Industrial corridor.

Serological Assessment for Leishmania donovani Infection in Blood Donors of Sunsari District, Dharan, Nepal.

PubMed

Timilsina, Suraj; Raj Bhattarai, Narayan; Khanal, Basudha; Rijal, Suman

2016-03-01

Visceral leishmaniasis (VL) is a major vector-borne disease caused by Leishmania donovani, after replication of the parasites in macrophages, mononuclear phagocytic system. VL is endemic in 12 districts of central and eastern Terai lowlands of Nepal bordering North Bihar, India with an estimated 8 million population at risk. In addition, VL endemicity is also extending to new endemic regions like Dharan from its classical rural foci. Hence, we aimed to detect the evidence of Leishmania donovani infection in the blood samples received from blood donors of Sunsari district, Dharan, (eastern Nepal), a region endemic for human VL. Sera from 507 asymptomatic blood donors were subjected to serological screening for anti-Leishmania donovani antibodies. Direct agglutination test (DAT) was performed on the sera. Out of 507 donors, majority (78.50 %) were male. Among the donors, 472 (93.10 %) belonged to age group 18-45 years where as 35 (6.90 %) to age group >45 years. Circulating anti-Leishmania antibodies were detected in 5 (1 %) out of 507 healthy, Human Immunodeficiency Virus types 1 and 2 (HIV 1and 2), Hepatitis B Surface Antigen (HBsAg), anti- Hepatitis C Virus (anti-HCV)-negative, and Syphillis non-reactive donors. All the seropositive cases were male and belonged to the age group 18-45 years. The result suggests that there is an immediate need of screening asymptomatic blood donors for leishmania seropositivity especially in endemic areas.

Disabled women׳s maternal and newborn health care in rural Nepal: A qualitative study

PubMed Central

Morrison, Joanna; Basnet, Machhindra; Budhathoki, Bharat; Adhikari, Dhruba; Tumbahangphe, Kirti; Manandhar, Dharma; Costello, Anthony; Groce, Nora

2014-01-01

Objective there is little evidence about disabled women׳s access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women׳s experiences of maternal and newborn care in rural Nepal. Design we used a qualitative methodology, using semi-structured interviews. Setting rural Makwanpur District of central Nepal. Participants we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women. Findings married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women. Key conclusions and implications for practice integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care. PMID:24768318

Disabled women׳s maternal and newborn health care in rural Nepal: a qualitative study.

PubMed

Morrison, Joanna; Basnet, Machhindra; Budhathoki, Bharat; Adhikari, Dhruba; Tumbahangphe, Kirti; Manandhar, Dharma; Costello, Anthony; Groce, Nora

2014-11-01

there is little evidence about disabled women׳s access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women׳s experiences of maternal and newborn care in rural Nepal. we used a qualitative methodology, using semi-structured interviews. rural Makwanpur District of central Nepal. we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women. married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women. integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Community perceptions of unintentional child injuries in Makwanpur district of Nepal: a qualitative study

PubMed Central

2014-01-01

Background In Nepal, childhood unintentional injury is an emerging public health problem but it has not been prioritised on national health agenda. There is lack of literature on community perceptions about child injuries. This study has explored community perceptions about child injuries and how injuries can be prevented. Methods Focus group discussions were conducted with mothers, school students and community health volunteers from urban and rural parts of Makwanpur district in Nepal. FGDs were conducted in Nepali languages. These were recorded, transcribed and translated into English. A theoretical framework was identified and thematic analysis conducted. Results Three focus group discussions, with a total of 27 participants, took place. Participants were able to identify examples of child injuries which took place in their community but these generally related to fatal and severe injuries. Participants identified risk factors such as the child’s age, gender, behaviours and whether they had been supervised. Consequences of injuries such as physical and psychological effects, impact on household budgets and disturbance in household plans were identified. Suggestions were made about culturally appropriate prevention measures, and included; suitable supervision arrangements, separation of hazards and teaching about safety to the parents and children. Conclusion Community members in Nepal can provide useful information about childhood injuries and their prevention but this knowledge is not transferred into action. Understanding community perceptions about injuries and their prevention can contribute to the development of preventive interventions in low income settings. PMID:24886124

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study.

PubMed

Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P; Krettek, Alexandra

2014-01-01

Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

Integration of Remote Sensing Products with Ground-Based Measurements to Understand the Dynamics of Nepal's Forests and Plantation Sites

NASA Astrophysics Data System (ADS)

Gilani, H.; Jain, A. K.

2016-12-01

This study assembles information from three sources - remote sensing, terrestrial photography and ground-based inventory data, to understand the dynamics of Nepal's tropical and sub-tropical forests and plantation sites for the period 1990-2015. Our study focuses on following three specific district areas, which have conserved forests through social and agroforestry management practices: 1. Dolakha district: This site has been selected to study the impact of community-based forest management on land cover change using repeat photography and satellite imagery, in combination with interviews with community members. The study time period is during the period 1990-2010. We determined that satellite data with ground photographs can provide transparency for long term monitoring. The initial results also suggests that community-based forest management program in the mid-hills of Nepal was successful. 2. Chitwan district: Here we use high resolution remote sensing data and optimized community field inventories to evaluate potential application and operational feasibility of community level REDD+ measuring, reporting and verification (MRV) systems. The study uses temporal dynamics of land cover transitions, tree canopy size classes and biomass over a Kayar khola watershed REDD+ study area with community forest to evaluate satellite Image segmentation for land cover, linear regression model for above ground biomass (AGB), and estimation and monitoring field data for tree crowns and AGB. We study three specific years 2002, 2009, 2012. Using integration of WorldView-2 and airborne LiDAR data for tree species level. 3. Nuwakot district: This district was selected to study the impact of establishment of tree plantation on total barren/fallow. Over the last 40 year, this area has went through a drastic changes, from barren land to forest area with tree species consisting of Dalbergia sissoo, Leucaena leucocephala, Michelia champaca, etc. In 1994, this district area was registered and established to grow and process high quality trees shaded of Arabica coffee beans. Here we use temporal satellite images and repeat terrestrial and aerial photographs, along with plot level biomass to show impact of this positive transformation of the landscape on above and below ground carbon masses. The study time period is 1990-2015.

Injection practice in Kaski district, Western Nepal: a community perspective.

PubMed

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, Pathiyil Ravi; Kumar, Vikash K C; Maskey, Manisha; Jha, Nisha

2015-04-29

Previous studies have shown that unsafe injection practice is a major public health problem in Nepal but did not quantify the problem. The present community-based study was planned to: 1) quantify injection usage, 2) identify injection providers, 3) explore differences, if any, in injection usage and injection providers, and 4) study and compare people's knowledge and perception about injections between the urban and rural areas of Kaski district. A descriptive, cross-sectional mixed-methods study was conducted from July to November 2012, using a questionnaire based survey and focus group discussions (FGDs). A semi-structured questionnaire advocated by the World Health Organization was modified and administered to household heads and injection receivers in selected households and the FGDs were conducted using a topic guide. The district was divided into urban and rural areas and 300 households from each area were selected. Twenty FGDs were held. In 218 households (36.33%) [99 in urban and 119 in rural] one or more members received at least one injection. During the three month recall period, 258 subjects (10.44%) reported receiving injection(s) with a median of two injections. The average number of injections per person per year was calculated to be 2.37. Health care workers (34.8%), staff of medical dispensaries (37.7%), physicians (25.2%), and traditional healers (2.3%) were consulted by the respondents for their basic health care needs and for injections. Compared to urban respondents, more rural respondents preferred injections for fever (p < 0.001). People preferred injections due to injections being perceived by them as being powerful, fast-acting, and longer lasting than oral pills. More than 82% of respondents were aware of, and named, at least one disease transmitted by using unsterile syringes during injection administration or when syringes are shared between people. Less preference for injections and high awareness about the association between injections and injection-borne infections among the general population is encouraging for safe injection practice. However, respondents were not aware of the importance of having qualified injection providers for safe injections and were receiving injections from unqualified personnel.

Nutritional status of children in two districts of the mountain region of Nepal.

PubMed

Thapa, M; Neopane, A K; Singh, U K; Aryal, N; Agrawal, K; Shrestha, B

2013-09-01

Nutritional status is a prime indicator of health. Generally, three anthropometric indicators are often used to assess nutritional status during childhood and adolescence: underweight (weight-for-age), stunting (height- for-age) and thinness (BMI-for-age). Malnutrition in children is a major public health problem in many developing countries. This study was conducted to assess nutritional status among children attending health camps in two mountainous districts in Nepal. Five hundred and seventy five children below 15 years of age attending the medical camp in Humla and Mugu districts in October 2011 were assessed for nutritional status. For children less than five years, weight for age, weight for height and height for age as per WHO classification, and for children between five to 15 years age specific values of height, weight and Body Mass Index (BMI) were calculated. In Humla district, 28.2% children were undernourished, 8.8% wasted and 22.4% stunted in less than five years. In the same age group, 31.7% children were undernourished, 9.4% wasted and 29.4% stunted in Mugu district. In the age group five to 15 years, thinness was seen in 22.4% and 29.4% children in Humla and Mugu respectively. Malnutrition (underweight, stunting, wasting and thinness) still constitutes a major health problem among Nepalese children, particularly in mountainous regions.

An ethnobotanical analysis of parasitic plants (Parijibi) in the Nepal Himalaya.

PubMed

O'Neill, Alexander Robert; Rana, Santosh Kumar

2016-02-24

Indigenous biocultural knowledge is a vital part of Nepalese environmental management strategies; however, much of it may soon be lost given Nepal's rapidly changing socio-ecological climate. This is particularly true for knowledge surrounding parasitic and mycoheterotrophic plant species, which are well represented throughout the Central-Eastern Himalayas but lack a collated record. Our study addresses this disparity by analyzing parasitic and mycoheterotrophic plant species diversity in Nepal as well as the ethnobotanical knowledge that surrounds them. Botanical texts, online databases, and herbarium records were reviewed to create an authoritative compendium of parasitic and mycoheterotrophic plant species native or naturalized to the Nepal Central-Eastern Himalaya. Semi-structured interviews were then conducted with 141 informants to better understand the biocultural context of these species, emphasizing ethnobotanical uses, in 12 districts of Central-Eastern Nepal. Nepal is a hotspot of botanical diversity, housing 15 families and 29 genera of plants that exhibit parasitic or mycoheterotrophic habit. Over 150 of the known 4500 parasitic plant species (~3 %) and 28 of the 160 mycoheterotrophic species (~18 %) are native or naturalized to Nepal; 13 of our surveyed parasitic species are endemic. Of all species documented, approximately 17 % of parasitic and 7 % of mycoheterotrophic plants have ethnobotanical uses as medicine (41 %), fodder (23 %), food (17 %), ritual objects (11 %), or material (8 %). Parasitic and mycoheterotrophic plant species exhibit high diversity in the Nepal Central-Eastern Himalaya and are the fodder for biocultural relationships that may help inform future environmental management projects in the region.

Cholera outbreaks (2012) in three districts of Nepal reveal clonal transmission of multi-drug resistant Vibrio cholerae O1

PubMed Central

2014-01-01

Background Although endemic cholera causes significant morbidity and mortality each year in Nepal, lack of information about the causal bacterium often hinders cholera intervention and prevention. In 2012, diarrheal outbreaks affected three districts of Nepal with confirmed cases of mortality. This study was designed to understand the drug response patterns, source, and transmission of Vibrio cholerae associated with 2012 cholera outbreaks in Nepal. Methods V. cholerae (n = 28) isolated from 2012 diarrhea outbreaks {n = 22; Kathmandu (n = 12), Doti (n = 9), Bajhang (n = 1)}, and surface water (n = 6; Kathmandu) were tested for antimicrobial response. Virulence properties and DNA fingerprinting of the strains were determined by multi-locus genetic screening employing polymerase chain reaction, DNA sequencing, and pulsed-field gel electrophoresis (PFGE). Results All V. cholerae strains isolated from patients and surface water were confirmed to be toxigenic, belonging to serogroup O1, Ogawa serotype, biotype El Tor, and possessed classical biotype cholera toxin (CTX). Double-mismatch amplification mutation assay (DMAMA)-PCR revealed the V. cholerae strains to possess the B-7 allele of ctx subunit B. DNA sequencing of tcpA revealed a point mutation at amino acid position 64 (N → S) while the ctxAB promoter revealed four copies of the tandem heptamer repeat sequence 5'-TTTTGAT-3'. V. cholerae possessed all the ORFs of the Vibrio seventh pandemic island (VSP)-I but lacked the ORFs 498–511 of VSP-II. All strains were multidrug resistant with resistance to trimethoprim-sulfamethoxazole (SXT), nalidixic acid (NA), and streptomycin (S); all carried the SXT genetic element. DNA sequencing and deduced amino acid sequence of gyrA and parC of the NAR strains (n = 4) revealed point mutations at amino acid positions 83 (S → I), and 85 (S → L), respectively. Similar PFGE (NotI) pattern revealed the Nepalese V. cholerae to be clonal, and related closely with V. cholerae associated with cholera in Bangladesh and Haiti. Conclusions In 2012, diarrhea outbreaks in three districts of Nepal were due to transmission of multidrug resistant V. cholerae El Tor possessing cholera toxin (ctx) B-7 allele, which is clonal and related closely with V. cholerae associated with cholera in Bangladesh and Haiti. PMID:25022982

The Byanshi: an ethnographic note on a trading group in far western Nepal.

PubMed

Manzardo, A E; Dahal, D R; Rai, N K

1976-09-01

The Byanshi who live in the district of Darchula are among the lesser known trading groups of Nepal. The Byanshi, close to the borders of Nepal, India, and Tibet, make their living trading wool, yak tails, salt, grain, and other commodities across the Himalayas and over the border into Pithoragarh district and even down into the Terai. The Byanshi live their lives in 2 separate areas. In the summer they live in their traditional homeland in Byana panchayat in the northern section of Darchula, close to Nepal's border with China. The major settlements in the area are Tinkar and Chhangru. The entire panchayat has a population of about 2000. In the winter, when snow makes life difficult in the high mountains, the Byanshi migrate down to Khalanga panchayat. Of greater importance than agriculture is animal husbandry, which is the backbone of trade in the Himalayas. Most important is that husbandry supports trade. The Byanshi social organization is somewhat confusing. An attempt is made to explain the clan structure as simply as possible. Upon the birth of a child the women from the village bring local beer, meat, and other food to the mother. Up to the 11th day after childbirth, the new mother and child are considered to be polluted. On the 8th day after delivery a ceremony known as "malengkho kormo" is performed, where the mother and child are ritually bathed. From this point, both the mother and child may enter the hearth area of their house, but the house itself is considered polluted. On the 11th day, all villagers are invited to attend the ceremony known as "chhyosimo" which purifies the house and the people. The Byanshi practice 3 forms of marriage: marriage by capture; love marriage, a form of elopmement; and the arranged marriage. The latter is becoming most common. Death rituals have always been the most exaggerated and costly ceremonies for the Bayanshi. The religion of the Byanshi combines features of Tibetan Buddhism, hill animism, and Hinduism in a very complex pattern. The Byanshi are a progressive group of people who place a premium on education. The emphasis on education has created a talent pool, allowing some Byanshis to work as overseers, school teachers, officers in the Nepalese army, employees in travel agencies and hotels in Kathma. The Byanshi also stress entrepreneurship. Since the Chinese have come to Tibet, trade has slackened and the Byanshi claim it is difficult to make a living. They want to be resettled as a group but are unwilling to give up their "shrunken" trade upon resettlement.

Identifying acceptability and price points for purchasing micronutrient powders for children 2 to 5 years old in Nepal.

PubMed

Gunnala, Rajni; Perrine, Cria G; Subedi, Giriraj; Mebrahtu, Saba; Dahal, Pradiumna; Jefferds, Maria Elena

2017-01-01

Little is known about purchasing micronutrient powders (MNP) for children 2-5 years. We describe acceptability for purchasing and price points for MNP for children 2-5 years among caregivers living in districts where free MNP are distributed for children 6-23 months. Crosssectional surveys conducted 3 months after MNP program implementation in 2 districts; 15 months after implementation in 2 different districts. Chi square tests and logistic regression describe associations among sociodemographics and program exposure factors and acceptability of purchasing MNP among 1,261 mothers of children 6-23 months who had heard of MNP. Overall, 77.5% and 86.1% of mothers reported acceptability for purchasing MNP in the 3 and 15 month surveys, respectively. Positive pricing attitude (PPA) about paying 150 Nepali rupees for 60 sachets of MNP was reported by 66.3% and 73.4% of mothers. Acceptability for purchasing MNP in both time periods increased with higher wealth quintile and higher maternal education; PPA increased with higher maternal education. Controlling for socio-demographics, program exposure factors associated with acceptability for purchasing MNP included: lack of perceived barriers to MNP intake and health worker counselling (3 month surveys); knowledge of benefits of MNP intake and lack of perceived barriers to MNP intake (15 month surveys). Mothers reported acceptability for purchasing MNP and PPA for older children in Nepal. Differences in acceptability were found across socio-demographics and program exposures. Use of these results and further exploration into actual purchasing behaviour can inform future MNP distribution methods in Nepal.

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

PubMed Central

Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P.; Krettek, Alexandra

2014-01-01

Background Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps. PMID:25119066

Health system decentralisation in Nepal: identifying the issues.

PubMed

Collins, Charles; Omar, Mayeh; Adhikari, Damodar; Dhakal, Ramji; Emmel, Nick; Dhakal, Megha Raj; Chand, Padam; Thapa, Druba; Singh, Arjun B

2007-01-01

The purpose of this paper is to describe and discuss policy analysis in Nepal and review the wide range of choices feasible in decentralisation decision making. In this paper an iterative qualitative method was developed and used in the research, which consisted of focus group interviews, key informant interviews, document analysis, including descriptive statistics, and analysis of the policy context. Participants in the research reflected the urban/rural mix of districts and the geography of Nepal. Analysis combined transcribed interviews with findings from document searches and analysis of the policy context. Coding was pre-determined during the training workshop and further codes were generated during and after the fieldwork. The paper finds that Nepal is in the process of decentralising public services from the central level to the local level, particularly to local bodies: District Development Committees (DDCs), Village Development Committees (VDCs) and Municipalities. Key contextual factors referred to are the overall structure of decentralisation, the social context of poverty and the political instability leading to a fluid political situation characterised by political tension, armed conflict, controversies and agreements while carrying out the research. The key issues identified and discussed in the paper are the policy process leading to decentralisation, the organisational structure and tension in the proposed system, the systems of resource generation, allocation, planning and management and lastly the forms of accountability, participation, public-private relations and collaborative strategies. The paper discusses the challenges faced in conducting such a policy analysis, the broad ranging and unremitting nature of the decentralisation process, and the contextual setting of the process of change.

Geographical heterogeneity and inequality of access to improved drinking water supply and sanitation in Nepal.

PubMed

He, Wen-Jun; Lai, Ying-Si; Karmacharya, Biraj M; Dai, Bo-Feng; Hao, Yuan-Tao; Xu, Dong Roman

2018-04-02

Per United Nations' Sustainable Development Goals, Nepal is aspiring to achieve universal and equitable access to safe and affordable drinking water and provide access to adequate and equitable sanitation for all by 2030. For these goals to be accomplished, it is important to understand the country's geographical heterogeneity and inequality of access to its drinking-water supply and sanitation (WSS) so that resource allocation and disease control can be optimized. We aimed 1) to estimate spatial heterogeneity of access to improved WSS among the overall Nepalese population at a high resolution; 2) to explore inequality within and between relevant Nepalese administrative levels; and 3) to identify the specific administrative areas in greatest need of policy attention. We extracted cluster-sample data on the use of the water supply and sanitation that included 10,826 surveyed households from the 2011 Nepal Demographic and Health Survey, then used a Gaussian kernel density estimation with adaptive bandwidths to estimate the distribution of access to improved WSS conditions over a grid at 1 × 1 km. The Gini coefficient was calculated for the measurement of inequality in the distribution of improved WSS; the Theil L measure and Theil T index were applied to account for the decomposition of inequality. 57% of Nepalese had access to improved sanitation (range: 18.1% in Mahottari to 100% in Kathmandu) and 92% to drinking-water (range: 41.7% in Doti to 100% in Bara). The most unequal districts in Gini coefficient among improved sanitation were Saptari, Sindhuli, Banke, Bajura and Achham (range: 0.276 to 0.316); and Sankhuwasabha, Arghakhanchi, Gulmi, Bhojpur, Kathmandu (range: 0.110 to 0.137) among improved drinking-water. Both the Theil L and Theil T showed that within-province inequality was substantially greater than between-province inequality; while within-district inequality was less than between-district inequality. The inequality of several districts was higher than what is calculated by regression of the Gini coefficient and our estimates. This study showed considerable geographical heterogeneity and inequality not evidenced in previous national statistics. Our findings may be useful in prioritizing resources to reduce inequality and expand the coverage of improved water supply and sanitation in Nepal.

Health resources and Internet with reference to HealthNet Nepal.

PubMed

Pradhan, Mohan Raj

2003-01-01

Technologies with the ability to send information in a fast, efficient and cheap fashion, such as the Internet--can provide dramatic improvements in access to information, advice and care. This article discusses importance of Internet, applications of Internet in providing information services in the health field. The Internet was developed in western countries and the information flow is from North to South. But for decision making within a country, information generated within a country is needed. For this, an organization like HealthNet Nepal is developed. The article discusses the various services of HealthNet Nepal and discusses about its unique features as compared to commercial ISPs.

Isolation and characterization of aerobic culturable arsenic-resistant bacteria from surfacewater and groundwater of Rautahat District, Nepal.

PubMed

Shakya, S; Pradhan, B; Smith, L; Shrestha, J; Tuladhar, S

2012-03-01

Arsenic (As) contamination of groundwater is a serious Environmental Health Management issue of drinking water sources especially in Terai region of Nepal. Many studies have reported that due to natural abundance of arsenic in the environment, various bacteria have developed different resistance mechanisms for arsenic compound. In this study, the culturable arsenic-resistant bacteria indigenous to surfacewater as well as groundwater from Rautahat District of Nepal were randomly isolated by standard plate count method on the basis of viable growth on plate count agar amended with arsenate ranging from 0, 0.5, 10, 40, 80 to 160 milligram per liter (mg/l). With respect to the morphological and biochemical tests, nine morphologically distinct potent arsenate tolerant bacteria showed relatedness with Micrococcus varians, Micrococcus roseus, Micrococcus luteus, Pseudomonas maltophilia, Pseudomonas sp., Vibrio parahaemolyticus, Bacillus cereus, Bacillus smithii 1 and Bacillus smithii 2. The isolates were capable of tolerating more than 1000 mg/l of arsenate and 749 mg/l of arsenite. Likewise, bioaccumulation capability was highest with M. roseus (85.61%) and the least with B. smithii (47.88%) indicating the potential of the organisms in arsenic resistance and most probably in bioremediation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Measuring impacts of community forestry program through repeat photography and satellite remote sensing in the Dolakha district of Nepal.

PubMed

Niraula, Rabin Raj; Gilani, Hammad; Pokharel, Bharat Kumar; Qamer, Faisal Mueen

2013-09-15

During the 1990's community-based forest management gained momentum in Nepal. This study systematically evaluates the impacts that this had on land cover change and other associated aspects during the period 1990-2010 using repeat photography and satellite imagery in combination with interviews with community members. The results of the study clearly reflect the success of community-based forest management in the Dolakha district of the mid-hills of Nepal: during the study period, the rate of conversion of sparse forest into dense forest under community-based management was found to be between 1.13% and 3.39% per year. Similarly, the rate of conversion of non-forest area into forest was found to be between 1.11% and 1.96% per year. Community-based forest management has resulted in more efficient use of forest resources, contributed to a decline in the use of slash-and-burn agricultural practices, reduced the incidence of forest fires, spurred tree plantation, and encouraged the conservation and protection of trees on both public and private land. The resulting reclamation of forest in landside areas and river banks and the overall improvement in forest cover in the area has reduced flash floods and associated landslides. Copyright © 2013 Elsevier Ltd. All rights reserved.

Determinants of farmers' choice for veterinary service providers in Nepal Mountains.

PubMed

Lamichhane, Dirga Kumar; Shrestha, Sabina

2012-08-01

This study was aimed to analyze factors that affect farmers' choice for major actors of veterinary service providers in village areas of Kaski district of Nepal, with the objective of identifying choice-specific attributes which could be addressed for improving the penetration of professional veterinary services in village areas. The information was obtained from 125 farmers using a structured questionnaire. A proportional hazard model was used for data analysis because of its ability to accommodate the attributes of both the chooser and the choice simultaneously. The results showed that village animal health workers (VAHWs) were the most preferred service providers followed by veterinarians and mid-level technicians. The farmers' age and education level had a significant but inverse relationship with the probability of choosing any of the three service providers. From our study, we found that the main choice-specific attributes with a significant impact on the choice probability was the distance to the preferred service provider. Since there was a high preference for VAHW, this suggests the possibility of poorly trained service providers dominating veterinary service market in village areas of Kaski district. Hence, the efforts put forward in the legalization of VAHW system in Nepal should first address the constraints that obstruct the accessibility of professional veterinary service providers in village areas.

Newborn survival in Nepal: a decade of change and future implications.

PubMed

Pradhan, Y V; Upreti, Shyam Raj; Pratap K C, Naresh; K C, Ashish; Khadka, Neena; Syed, Uzma; Kinney, Mary V; Adhikari, Ramesh Kant; Shrestha, Parashu Ram; Thapa, Kusum; Bhandari, Amit; Grear, Kristina; Guenther, Tanya; Wall, Stephen N

2012-07-01

Nepal is on target to meet the Millennium Development Goals for maternal and child health despite high levels of poverty, poor infrastructure, difficult terrain and recent conflict. Each year, nearly 35,000 Nepali children die before their fifth birthday, with almost two-thirds of these deaths occurring in the first month of life, the neonatal period. As part of a multi-country analysis, we examined changes for newborn survival between 2000 and 2010 in terms of mortality, coverage and health system indicators as well as national and donor funding. Over the decade, Nepal's neonatal mortality rate reduced by 3.6% per year, which is faster than the regional average (2.0%) but slower than national annual progress for mortality of children aged 1-59 months (7.7%) and maternal mortality (7.5%). A dramatic reduction in the total fertility rate, improvements in female education and increasing change in skilled birth attendance, as well as increased coverage of community-based child health interventions, are likely to have contributed to these mortality declines. Political commitment and support for newborn survival has been generated through strategic use of global and national data and effective partnerships using primarily a selective newborn-focused approach for advocacy and planning. Nepal was the first low-income country to have a national newborn strategy, influencing similar strategies in other countries. The Community-Based Newborn Care Package is delivered through the nationally available Female Community Health Volunteers and was piloted in 10 of 75 districts, with plans to increase to 35 districts in mid-2013. Innovation and scale up, especially of community-based packages, and public health interventions and commodities appear to move relatively rapidly in Nepal compared with some other countries. Much remains to be done to achieve high rates of effective coverage of community care, and especially to improve the quality of facility-based care given the rapid shift to births in facilities.

Scrub Typhus: An Emerging Neglected Tropical Disease in Nepal.

PubMed

Upadhyaya, B P; Shakya, G; Adhikari, S; Rijal, N; Acharya, J; Maharjan, L; Marasini, B R

2016-05-01

Scrub typhus is a neglected tropical disease and is under reported from Nepal. The objective of this study was to investigate the sero-epidemiology of scrub typhus in patients suffering from acute febrile illness. A total of 434 specimens collected from July to November 2015 at National Public Health Laboratory (NPHL) were investigated for detection of immunoglobulin M (IgM) antibody to Orientiatsutsugamushi.The Scrub Typhus Detect TM kit (InBios, USA) was used to detect the antibodies to O.tsutsugamushi in human serum. Randomly selected 10% positive specimens were used for confirmation by dot- enzyme-linked immunosorbent assay and indirect immunofluorescence assay. Of the total, 175 (40.3%) were positive for IgM antibodies to O. tsutsugamushi. Positive results of scrub typhus were highest among female in 11-20 year followed by males in 41-50 years age group. The IgM antibodies to O. tsutusugamushi were positive in specimens of various geographical regions including 30 districts of Nepal. Positive cases were found in various ecological regions of Nepal. Scrub typhus is one of the neglected tropical diseases in Nepal. Patients with acute febrile illness should be investigated for scrub typhus with high priority. There is an urgent need of reliable and affordable diagnostic tests at all level of health facilities of Nepal. Surveillance and public health awareness about the disease transmission and preventive measures needs to be initiated.

The experiences of districts in implementing a national incentive programme to promote safe delivery in Nepal

PubMed Central

Powell-Jackson, Timothy; Morrison, Joanna; Tiwari, Suresh; Neupane, Basu Dev; Costello, Anthony M

2009-01-01

Background Nepal's Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the intention of increasing utilisation of professional care at childbirth. It provided cash to women giving birth in a health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We explored early implementation of the programme at the district-level to understand the factors that have contributed to its low uptake. Methods We conducted in ten study districts a series of key informant interviews and focus group discussions with staff from health facilities and the district health office and other stakeholders involved in implementation. Manual content analysis was used to categorise data under emerging themes. Results Problems at the central level imposed severe constraints on the ability of district-level actors to implement the programme. These included bureaucratic delays in the disbursement of funds, difficulties in communicating the policy, both to implementers and the wider public and the complexity of the programme's design. However, some district implementers were able to cope with these problems, providing reasons for why uptake of the programme varied considerably between districts. Actions appeared to be influenced by the pressure to meet local needs, as well individual perceptions and acceptance of the programme. The experience also sheds light on some of the adverse effects of the programme on the wider health system. Conclusion The success of conditional cash transfer programmes in Latin America has led to a wave of enthusiasm for their adoption in other parts of the world. However, context matters and proponents of similar programmes in south Asia should give due attention to the challenges to implementation when capacity is weak and health services inadequate. PMID:19508710

Prevalence of diabetic retinopathy among self-reported adult diabetics in districts of Eastern Nepal in a community based study.

PubMed

Agarwal, Lalit T; Agarwal, Nisha

2017-07-01

Diabetic retinopathy (DR) is the leading cause of blindness among working age adults around the world. Each year more and more people live with this condition, which can result in life-changing complications. To determine the prevalence and risk factors of diabetic retinopathy (DR) in a large community based screening programme, in order to estimate the future burden of the disease. A cross sectional community based study was conducted between 1st January and 31st December 2014 in a purposive sample of adults with selfreported diabetes mellitus (DM) from Morang and Sunsari district of Nepal. A structured questionnaire was used to collect patient data. Ophthalmological evaluation was done and fundus was examined for grading DR using direct and indirect ophthalmoscope. Among the 698 diabetic patients, mean age was 55.02±11.8 years (ranging from 24 to 91 years). 12.3% of diabetic were not under any treatment. Only 69.3% of patients had visited eye specialist for diabetic retinopathy screening. Prevalence of DR was found to be 15.3%; 13.9% had non-proliferative DR and 1.4% had proliferative DR. Prevalence of diabetic macular edema was 2.1%. In Morang district prevalence of DR was 14.2% and in Sunsari district it was 16.2%. In the binary-logistic regression analysis, duration of diabetes was associated with significantly increased risk of DR (OR: 1.13; 95% confidence interval (CI), 1.09 to 1.17; p<0.001). History of absence of arterial hypertension decreased the risk of DR (OR: 0.56; 95% CI, 0.36 to 0.87; p=0.01). One sixth of the patients with diabetes in the Eastern region of Nepal have retinopathy. Diabetic retinopathy risk increased with duration of diabetes and decreased with history of no co-existing arterial hypertension. © NEPjOPH.

Impact of mass media on the utilization of antenatal care services among women of rural community in Nepal.

PubMed

Acharya, Dilaram; Khanal, Vishnu; Singh, Jitendra Kumar; Adhikari, Mandira; Gautam, Salila

2015-08-12

Antenatal care has several benefits for expecting mothers and birth outcomes; yet many mothers do not utilise this service in Nepal. Mass media may play an important role in increasing the use of antenatal care and other maternal health services. However, the effect of mass media on increasing health service utilisation has remained an under studied area in Nepal. The aim of this study was to investigate the impact of mass media on the utilisation of antenatal care services in rural Nepal. A community-based cross-sectional study was conducted in Sinurjoda Village Development Committee of Dhanusha District, Nepal. A total of 205 mothers of children aged under 1 year were selected using systematic random sampling. Logistic regression was employed to examine the association between selected antenatal care services and mass media exposure after adjusting for other independent variables. A majority of mothers were exposed to mass media. Radio was accessible to most (60.0%) of the participants followed by television (43.41%). Mothers exposed to mass media were more likely to attending antenatal visits [Odds ratio (OR) 6.28; 95% CI (1.01-38.99)], taking rest and sleep during pregnancy [OR 2.65; 95% CI (1.13-6.26)], and receiving TT immunization [OR 5.12; 95% CI (1.23-21.24)] than their non-exposed counterparts. The study reported a positive influence of mass media on the utilisation of antenatal care services in Nepal. Therefore, further emphasis should be given to increase awareness of women of rural Nepal through mass media to improve utilisation of antenatal care services in Nepal.

Economic uses of forest plant resources in western Chitwan, Nepal

PubMed Central

Dangol, Dharma R.

2012-01-01

This paper discusses economic uses of forest plant resources documented from 117 forest plots and neighboring areas of western Chitwan, Nepal. The paper lists information on the plant species (1) that provide valuable food, vegetable and medicinal products that maintain human health and general well-being of the households; (2) that are economically valuable to farmers such as high-grade fodder, useful plants for crop management (e.g., pesticide, compost, green manure); (3) that are used as piscicide (harvest fish from rivers and streams), (4) that provide materials for use in household construction (e.g. building materials, thatch) and tool making; and (5) that have aesthetic value. The access to forest resources is important for many households, especially those living in remote and poor agricultural areas such as Western Chitwan. This paper also highlights the availability of the species wherever possible based upon the field data. PMID:23066332

Women’s Autonomy and Its Correlates in Western Nepal: A Demographic Study

PubMed Central

Bhandari, Tulsi Ram; Kutty, V. Raman; Ravindran, T. K. Sundari

2016-01-01

Despite various efforts for enhancing women’s autonomy in developing countries, many women are deprived of their capacity in decision-making on their household affairs as well as social issues. This paper aimed to examine women’s autonomy and its associated factors in the Kapilvastu district of Nepal. We measured women’s autonomy using a recently developed women’s autonomy measurement scale from June to October 2014. Descriptive statistics, chi-square test and logistic multivariate modeling technique were applied for assessing the association of demographic and socio-economic characteristics of women and their autonomy. Mean score for women’s autonomy was 23.34± 8.06 out of the possible maximum 48. It was found to be positively associated with higher age difference at marriage, advantaged caste/ethnicity, better employment for the husband, couple’s education more than 10 years schooling, and higher economic status of the household. We found strong direct effect of women’s education (OR = 8.14, CI = 3.77–17.57), husband’s education (OR = 2.63, CI = 1.69–4.10) and economic status of household (OR = 1.42, CI = 1.01–2.03) on women’s autonomy. When we adjusted women’s education for husband’s education, the odds ratio decreased by around 22% {from (OR = 8.14, CI = 3.77–17.57) to (OR = 6.32, CI = 2.77–14.46)} and was a mediator effect. The economic status of household also had mediator effect on women’s autonomy through their education. Education status of women is a key predictor of women’s autonomy in Kapilvastu district. Husband’s education and economic status of the household are other important predictors of women’s autonomy which have a mediator effect on women’s autonomy. Improving educational status and economic conditions of both women and their husbands may be the best solution to promote women’s autonomy. PMID:26799217

Phenotypic and genetic characterization of Vibrio cholerae O1 clinical isolates collected through national antimicrobial resistance surveillance network in Nepal.

PubMed

Shakya, Geeta; Kim, Dong Wook; Clemens, John D; Malla, Sarala; Upadhyaya, Bishnu Prasad; Dumre, Shyam Prakash; Shrestha, Sirjana Devi; Adhikari, Shailaja; Sharma, Supriya; Rijal, Nisha; Shrestha, Sanjaya K; Mason, Carl; Kansakar, Palpasa

2012-08-01

Cholera occurs in sporadic cases and outbreaks in Nepal each year. Vibrio cholerae O1 (n = 522) isolated during 2007-2010 from diarrheal patients at 10 different hospital laboratories in Nepal were characterized. Biochemical and serologic identifications showed that all the isolates belonged to serogroup O1, El Tor biotype. Except 72 isolates of Inaba serotype isolated in the year 2007, all the remaining isolates were of Ogawa serotype. All isolates were resistant to nalidixic acid and furazolidone. Resistance to tetracycline, ciprofloxacin, erythromycin and co-trimoxazole were 21, 4, 16 and 90 % respectively. Seventy-seven of these isolates were selected for further characterization for ctxB gene and MLVA typing. Two different variants of classical type cholera toxin were observed. Ogawa strains from 2007 and 2010-Western Nepal outbreak harbored CTX-3 type cholera toxin, whereas Inaba serotypes in 2007 and the remaining Ogawa serotypes in 2008-2010 harbored CTX 3b-type toxin. MLVA analysis showed circulation of four different groups of altered V. cholerae O1 El Tor strains. Two different profiles were seen among 2007 Inaba (9, 3, 6, x, x) and Ogawa (10, 7, 6, x, x) isolates. The MLVA profile of 2008 and 2009 Ogawa isolates were similar to those of Inaba strains of 2007. Isolates from 2010 also showed three different MLVA profiles; profile 9, 3, 6, x, x in 3 isolates, 11, 7, 6, x, x among 2010 Western Nepal outbreak strains and profile 8, 3, 6, x, x among isolates from Butwal and Kathmandu.

Linking Attitudes, Policy, and Forest Cover Change in Buffer Zone Communities of Chitwan National Park, Nepal

NASA Astrophysics Data System (ADS)

Stapp, Jared R.; Lilieholm, Robert J.; Leahy, Jessica; Upadhaya, Suraj

2016-06-01

Deforestation in Nepal threatens the functioning of complex social-ecological systems, including rural populations that depend on forests for subsistence, as well as Nepal's biodiversity and other ecosystem services. Nepal's forests are particularly important to the nation's poorest inhabitants, as many depend upon them for daily survival. Two-thirds of Nepal's population relies on forests for sustenance, and these pressures are likely to increase in the future. This, coupled with high population densities and growth rates, highlights the importance of studying the relationship between human communities, forest cover trends through time, and forest management institutions. Here, we used surveys to explore how household attitudes associated with conservation-related behaviors in two rural communities—one that has experienced significant forest loss, and the other forest gain—compare with forest cover trends as indicated by satellite-derived forest-loss and -regeneration estimates between 2005 and 2013. Results found a significant difference in attitudes in the two areas, perhaps contributing to and reacting from current forest conditions. In both study sites, participation in community forestry strengthened support for conservation, forest conservation-related attitudes aligned with forest cover trends, and a negative relationship was found between economic status and having supportive forest conservation-related attitudes. In addition, on average, respondents were not satisfied with their district forest officers and did not feel that the current political climate in Nepal supported sustainable forestry. These findings are important as Nepal's Master Plan for the Forestry Sector has expired and the country is in the process of structuring a new Forestry Sector Strategy.

Linking Attitudes, Policy, and Forest Cover Change in Buffer Zone Communities of Chitwan National Park, Nepal.

PubMed

Stapp, Jared R; Lilieholm, Robert J; Leahy, Jessica; Upadhaya, Suraj

2016-06-01

Deforestation in Nepal threatens the functioning of complex social-ecological systems, including rural populations that depend on forests for subsistence, as well as Nepal's biodiversity and other ecosystem services. Nepal's forests are particularly important to the nation's poorest inhabitants, as many depend upon them for daily survival. Two-thirds of Nepal's population relies on forests for sustenance, and these pressures are likely to increase in the future. This, coupled with high population densities and growth rates, highlights the importance of studying the relationship between human communities, forest cover trends through time, and forest management institutions. Here, we used surveys to explore how household attitudes associated with conservation-related behaviors in two rural communities-one that has experienced significant forest loss, and the other forest gain-compare with forest cover trends as indicated by satellite-derived forest-loss and -regeneration estimates between 2005 and 2013. Results found a significant difference in attitudes in the two areas, perhaps contributing to and reacting from current forest conditions. In both study sites, participation in community forestry strengthened support for conservation, forest conservation-related attitudes aligned with forest cover trends, and a negative relationship was found between economic status and having supportive forest conservation-related attitudes. In addition, on average, respondents were not satisfied with their district forest officers and did not feel that the current political climate in Nepal supported sustainable forestry. These findings are important as Nepal's Master Plan for the Forestry Sector has expired and the country is in the process of structuring a new Forestry Sector Strategy.

Genotypic Characterization of Human Immunodeficiency Virus Type 1 Derived from Antiretroviral Drug-Treated Individuals Residing in Earthquake-Affected Areas in Nepal.

PubMed

Negi, Bharat Singh; Kotaki, Tomohiro; Joshi, Sunil Kumar; Bastola, Anup; Nakazawa, Minato; Kameoka, Masanori

2017-09-01

Molecular epidemiological data on human immunodeficiency virus type 1 (HIV-1) are limited in Nepal and have not been available in areas affected by the April 2015 earthquake. Therefore, we conducted a genotypic study on HIV-1 genes derived from individuals on antiretroviral therapy residing in 14 districts in Nepal highly affected by the earthquake. HIV-1 genomic fragments were amplified from 40 blood samples of HIV treatment-failure individuals, and a sequencing analysis was performed on these genes. In the 40 samples, 29 protease, 32 reverse transcriptase, 25 gag, and 21 env genes were sequenced. HIV-1 subtyping revealed that subtype C (84.2%, 32/38) was the major subtype prevalent in the region, while CRF01_AE (7.9%, 3/38) and other recombinant forms (7.9%, 3/38) were also detected. In addition, major drug resistance mutations were identified in 21.9% (7/32) of samples, indicating the possible emergence of HIV-1 drug resistance in earthquake-affected areas in Nepal.

Morbidity profile and prescribing patterns among outpatients in a teaching hospital in Western Nepal

PubMed Central

Lamichhane, DC; Giri, BR; Pathak, OK; Panta, OB; Shankar, PR

2006-01-01

Background Recent studies on prescribing among outpatients in hospitals in Western Nepal are lacking. The main objectives of the study were to obtain information on the morbidity pattern among outpatients and to analyze prescribing using drug use indicators. Methods A retrospective hospital record based study from 01.01.2004 to 31.12.2004 was carried out among individuals attending the outpatient department (OPD) of the Manipal Teaching hospital, Pokhara, Western Nepal. A total of 32,017 new patients attended the OPD during the study period. Systematic random sampling (1 in every 20 patients) was done and 1600 patients selected. After excluding patients visiting the emergency department, those who got admitted and whose records were not available, 1261 cases were analyzed. The demographic details, morbidity pattern, average number of drugs prescribed, percentage of drugs prescribed by generic names and from the Essential drug list of Nepal (Essential drugs are those which satisfy the priority healthcare needs of the population), percentage of encounters with an antibiotic and an injection prescribed were noted. Results 1261 patients made 1772 visits. Upper respiratory tract infection and acid peptic disease were the most common diagnoses. The mean number of drugs was 1.99. Only 19.5% and 39.6% of drugs were prescribed by generic name and from the Essential drug list. Antibiotics and injections were prescribed in 26.4% and 0.96% of encounters. Cetrizine, vitamins, amoxicillin, the combination of paracetamol and ibuprofen and ranitidine were most commonly prescribed. Conclusions Upper respiratory tract infections and acid peptic disease were the common illnesses. Generic prescribing and use of essential drugs were low. Some of the drug combinations being used were irrational. Prescriber education may be helpful in encouraging rational prescribing. PMID:18523618

Fitting Community Based Newborn Care Package into the health systems of Nepal.

PubMed

Pradhan, Y V; Upreti, S R; Kc, N P; Thapa, K; Shrestha, P R; Shedain, P R; Dhakwa, J R; Aryal, D R; Aryal, S; Paudel, D C; Paudel, D; Khanal, S; Bhandari, A; Kc, A

2011-10-01

Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.

Factors associated with childhood ocular morbidity and blindness in three ecological regions of Nepal: Nepal pediatric ocular disease study.

PubMed

Adhikari, Srijana; Shrestha, Mohan Krishna; Adhikari, Kamala; Maharjan, Nhukesh; Shrestha, Ujjowala Devi

2014-10-23

Nepal Pediatric Ocular Diseases Study is a three year longitudinal population based study. Here we present the baseline survey report which aims to investigate various risk factors associated with childhood ocular morbidity and blindness in three ecological regions of Nepal. This baseline survey is a population based cross sectional study. The investigation was conducted in a district from each of the following regions: Terai, Hill and Mountain. The Village Development Committees (VDCs) from each district were selected by random sampling. Three Community health workers were given training on vision screening and identification of abnormal ocular signs in children. They conducted a house to house survey in their respected districts examining the children and gathering a standardized set of data variables. Children with abnormal vision or ocular signs were then further examined by pediatric ophthalmologists. A total of 10950 children aged 0-10 years (5403 from Terai, 3204 from the hills, 2343 from the mountains) were enrolled in the study. However 681 (6.2%) were non responders. The male to female ratio was 1.03. The overall prevalence of ocular morbidity was 3.7% (95% CI of 3.4%-4%) and blindness was 0.07% (95% CI of 0.02%-0.12%). Ocular morbidity was more prevalent in the mountain region whereas blindness was more prevalent in the Terai region.Children from the Terai region were more likely to suffer from congenital ocular anomalies compared to the other regions. Children whose mother smoked, drank alcohol, or was illiterate were significantly afflicted with ocular diseases (p < 0.05). In addition,a higher prevalence of ocular disease was related to children with past medical history of systemic illnesses, abnormal postnatal period or missing childhood vaccinations. Blindness was more prevalent in children who suffered from a systemic illness. Females and under-nourished children were more likely to have ocular morbidity and blindness. It was found that childhood blindness was more prevalent in the Terai region, the undernourished, females and in those with co-morbid systemic illnesses. This study strongly suggests that prevention of childhood blindness requires additional resources to address these disparity.

Identifying acceptability and price points for purchasing micronutrient powders for children 2 to 5 years old in Nepal

PubMed Central

Gunnala, Rajni; Perrine, Cria G; Subedi, Giriraj; Mebrahtu, Saba; Dahal, Pradiumna; Jefferds, Maria Elena

2017-01-01

Background and Objective Little is known about purchasing micronutrient powders (MNP) for children 2–5 years. We describe acceptability for purchasing and price points for MNP for children 2–5 years among caregivers living in districts where free MNP are distributed for children 6–23 months. Methods and Study Design Cross-sectional surveys conducted 3 months after MNP program implementation in 2 districts; 15 months after implementation in 2 different districts. Chi square tests and logistic regression describe associations among socio-demographics and program exposure factors and acceptability of purchasing MNP among 1,261 mothers of children 6–23 months who had heard of MNP. Results Overall, 77.5% and 86.1% of mothers reported acceptability for purchasing MNP in the 3 and 15 month surveys, respectively. Positive pricing attitude (PPA) about paying 150 Nepali rupees for 60 sachets of MNP was reported by 66.3% and 73.4% of mothers. Acceptability for purchasing MNP in both time periods increased with higher wealth quintile and higher maternal education; PPA increased with higher maternal education. Controlling for socio-demographics, program exposure factors associated with acceptability for purchasing MNP included: lack of perceived barriers to MNP intake and health worker counselling (3 month surveys); knowledge of benefits of MNP intake and lack of perceived barriers to MNP intake (15 month surveys). Conclusions Mothers reported acceptability for purchasing MNP and PPA for older children in Nepal. Differences in acceptability were found across socio-demographics and program exposures. Use of these results and further exploration into actual purchasing behaviour can inform future MNP distribution methods in Nepal. PMID:28049270

Pharmacotherapy of Bipolar Affective Disorder: A Hospital based Study from Sub Himalayan Valley of Nepal

PubMed Central

Sathian, Brijesh; Chakraborty, Prasanta Kumar; Banerjee, Indraneel; Roy, Bedanta; Jauhari, Akhilesh Chandra; Saha, Archana

2014-01-01

Introduction: In Bipolar disorder the mood of the patients fluctuates between depression and mania. The main objective of the study was to find out the commonest mood stabilizers used for the treatment of Bipolar affective disorders in Western Nepal in hospitalized patients in an actual clinical set up. Methods: This was a cross-sectional study which was conducted between October 2009 and September 2010 at Psychiatric ward at Manipal teaching hospital, Pokhara, Nepal, a tertiary care hospital situated in Western Nepal. The diagnosis of the disease was based on ICD-10 (Tenth revision) Classification of mental and Behavioural disorders, Diagnostic Criteria for Research. We calculated odds ratio and their 95% confidence intervals (95% CI). p< 0.05 was considered as statistically significant. Results: 62.1% of the patients were less than 40 yrs, 56.3% were male, 72.4% were unemployed and 75.9% of the patients were having monthly income <10,000/month. As far as ethnicity is concerned 37.9% of the cases were Brahmin and by occupation 29.9% of the patients were students followed by housewife 25.3%, labour 17.2%, retired 13.8% respectively. Drugs and Psychotherapy [OR 1.4, 95% (CI 0.575, 3.4017)] was prescribed in age <40 years as compared to age>40 yrs. Male patients [OR 7.22, 95% (CI 0.862, 60.499)] and [OR 2.353, 95% (CI 0.857, 6.455)] received drugs by trade names and drugs not from the national drug list of Nepal as compared to females. Monthly income <10,000/month and [OR 2.8, 95% (CI 0.742, 10.56)] tendency of receiving drugs by trade names. Among the mood elevators Sodium valproate was the commonest drug to be prescribed in 51/87(58.6%) patients followed by Lithium in 30/87 (34.5%) cases and Carbamazepine in 6/87 (6.9%) cases. Sodium valproate was prescribed at 1,000 mg/day, Lithium was prescribed at 900 mg/day in and Carbamazepine was prescribed at 800 mg/day. Conclusion: Among all the mood elevators Sodium valproate is the commonest drug prescribed for the treatment of bipolar affective disorder, recommended that there is a trend of using newer drugs like sodium valproate rather than the conventional mood stabilizers like Lithium for bipolar affective disorder in Western Development region of Nepal. PMID:25121003

Feminization and marginalization? Women Ayurvedic doctors and modernizing health care in Nepal.

PubMed

Cameron, Mary

2010-03-01

The important diversity of indigenous medical systems around the world suggests that gender issues, well understood for Western science, may differ in significant ways for non-Western science practices and are an important component in understanding how social dimensions of women's health care are being transformed by global biomedicine. Based on ethnographic research conducted with formally trained women Ayurvedic doctors in Nepal, I identify important features of medical knowledge and practice beneficial to women patients, and I discuss these features as potentially transformed by modernizing health care development. The article explores the indirect link between Ayurveda's feminization and its marginalization, in relation to modern biomedicine, which may evolve to become more direct and consequential for women's health in the country.

First isolation of dengue virus from the 2010 epidemic in Nepal.

PubMed

Pandey, Basu D; Nabeshima, Takeshi; Pandey, Kishor; Rajendra, Saroj P; Shah, Yogendra; Adhikari, Bal R; Gupta, Govinda; Gautam, Ishan; Tun, Mya M N; Uchida, Reo; Shrestha, Mahendra; Kurane, Ichiro; Morita, Kouichi

2013-09-01

Dengue is an emerging disease in Nepal and was first observed as an outbreak in nine lowland districts in 2006. In 2010, however, a large epidemic of dengue occurred with 4,529 suspected and 917 serologically-confirmed cases and five deaths reported in government hospitals in Nepal. The collection of demographic information was performed along with an entomological survey and clinical evaluation of the patients. A total of 280 serum samples were collected from suspected dengue patients. These samples were subjected to routine laboratory investigations and IgM-capture ELISA for dengue serological identification, and 160 acute serum samples were used for virus isolation, RT-PCR, sequencing and phylogenetic analysis. The results showed that affected patients were predominately adults, and that 10% of the cases were classified as dengue haemorrhagic fever/ dengue shock syndrome. The genetic characterization of dengue viruses isolated from patients in four major outbreak areas of Nepal suggests that the DENV-1 strain was responsible for the 2010 epidemic. Entomological studies identified Aedes aegypti in all epidemic areas. All viruses belonged to a monophyletic single clade which is phylogenetically close to Indian viruses. The dengue epidemic started in the lowlands and expanded to the highland areas. To our knowledge, this is the first dengue isolation and genetic characterization reported from Nepal.

Need of The Ministry of Health in Federal Democratic Republic of Nepal.

PubMed

Regmi, K; Upadhyay, M; Tarin, E; Chand, P B; Uprety, S R; Lekhak, S C

2017-01-01

The constitution of Nepal provides appointing a council of ministers both at federal and provincial levels without defining portfolios. There is a political agreement that MOH will be retained at the federal level. This article draws evidences around the world to meet health needs of Nepalese, the role of provincial ministry of health and coordinating structure at district/local level. The constitution emphasises on health and pronounced in 46 articles which provides guidance for the creation of federalized governance levels at federal, provincial and local levels. Retaining ministry of health at federal level without creating devolved structure at province and local levels in health sector will create difficulty in translating the spirit of the constitution and may not be effective in addressing health issues nationally and meeting global achievements like SDGs. It is suggested to establish an elaborate health system accordingly in Nepal to ensure constitutional mandate of health as a basic human right.

Using formative research to design a context-specific behaviour change strategy to improve infant and young child feeding practices and nutrition in Nepal.

PubMed

Locks, Lindsey M; Pandey, Pooja R; Osei, Akoto K; Spiro, David S; Adhikari, Debendra P; Haselow, Nancy J; Quinn, Victoria J; Nielsen, Jennifer N

2015-10-01

Global recommendations on strategies to improve infant feeding, care and nutrition are clear; however, there is limited literature that explains methods for tailoring these recommendations to the local context where programmes are implemented. This paper aims to: (1) highlight the individual, cultural and environmental factors revealed by formative research to affect infant and young child feeding and care practices in Baitadi district of Far Western Nepal; and (2) outline how both quantitative and qualitative research methods were used to design a context-specific behaviour change strategy to improve child nutrition. Quantitative data on 750 children aged 12-23 months and their families were collected via surveys administered to mothers. The participants were selected using a multistage cluster sampling technique. The survey asked about knowledge, attitude and behaviours relating to infant and young child feeding. Qualitative data on breastfeeding and complementary feeding beliefs and practices were also collected from a separate sample via focus group discussions with mothers, and key informant interviews with mothers-in-law and husbands. Key findings revealed gaps in knowledge among many informants resulting in suboptimal infant and young child feeding practices - particularly with relation to duration of exclusive breastfeeding and dietary diversity of complementary foods. The findings from this research were then incorporated into a context-specific nutrition behaviour change communication strategy. © 2013 Helen Keller International © 2013 John Wiley & Sons, Ltd.

Determinants of institutional birth among women in rural Nepal: a mixed-methods cross-sectional study.

PubMed

Maru, Sheela; Rajeev, Sindhya; Pokhrel, Richa; Poudyal, Agya; Mehta, Pooja; Bista, Deepak; Borgatta, Lynn; Maru, Duncan

2016-08-27

Encouraging institutional birth is an important component of reducing maternal mortality in low-resource settings. This study aims to identify and understand the determinants of persistently low institutional birth in rural Nepal, with the goal of informing future interventions to reduce high rates of maternal mortality. Postpartum women giving birth in the catchment area population of a district-level hospital in the Far-Western Development Region of Nepal were invited to complete a cross-sectional survey in 2012 about their recent birth experience. Quantitative and qualitative methods were used to determine the institutional birth rate, social and demographic predictors of institutional birth, and barriers to institutional birth. The institutional birth rate for the hospital's catchment area population was calculated to be 0.30 (54 home births, 23 facility births). Institutional birth was more likely as age decreased (ORs in the range of 0.20-0.28) and as income increased (ORs in the range of 1.38-1.45). Institutional birth among women who owned land was less likely (OR = 0.82 [0.71, 0.92]). Ninety percent of participants in the institutional birth group identified safety and good care as the most important factors determining location of birth, whereas 60 % of participants in the home birth group reported distance from hospital as a key determinant of location of birth. Qualitative analysis elucidated the importance of social support, financial resources, birth planning, awareness of services, perception of safety, and referral capacity in achieving an institutional birth. Age, income, and land ownership, but not patient preference, were key predictors of institutional birth. Most women believed that birth at the hospital was safer regardless of where they gave birth. Future interventions to increase rates of institutional birth should address structural barriers including differences in socioeconomic status, social support, transportation resources, and birth preparedness.

A Review of Tectonic Models and Analytical Data from Almora-Dadeldhura Klippe, Northwest India and Far Western Nepal.

NASA Astrophysics Data System (ADS)

Bosu, S.; Robinson, D.; Saha, A.

2017-12-01

Tectonic models developed from the Himalayan thrust belt constitute three models- critical taper, channel flow and wedge extrusion. Their differences are manifested in predicted minimum shortening, deformation propagation style and tectonic architecture across the thrust belt. Recent studies from isolated synformal klippen composed of Greater and Tethyan Himalayan rock within the Himalayan thrust belt disagree over the tectonic history, especially in the Almora-Dadeldhura klippe, which is the largest klippe in the thrust belt. These recent studies are limited to one transect each, and two or fewer types of analytical data to justify their models. Due to the limited spatial coverage, these studies often reflect a narrow perspective in their tectonic models; thus, combining the data from these studies provides a holistic view of the regional tectonic history. This study compiled the available data across the 350 km wide Almora-Dadeldhura klippe, using petrology, stratigraphy, metamorphic history, microstructure, U-Pb ages of intrusive granite, monazite and muscovite ages of the shear zones, and exhumation ages from apatite fission track, along with original field observations, microstructure and microtexture data from 5 different transects in northwest India and far western Nepal. The review of the compiled data suggests that the Himalayan thrust belt in northwest India and far western Nepal is a forward propagating thrust system, and that the analytical data support the critical taper model.

Molecular and phylogenetic analyses of the liver amphistome Explanatum explanatum (Creplin, 1847) Fukui, 1929 in ruminants from Bangladesh and Nepal based on nuclear ribosomal ITS2 and mitochondrial nad1 sequences.

PubMed

Mohanta, U K; Rana, H B; Devkota, B; Itagaki, T

2017-07-01

Explanatum explanatum flukes, liver amphistomes of ruminants, cause significant economic loss in the livestock industry by inducing severe liver damage. A total of 66 flukes from 26 buffaloes and 7 cattle in four different geographic areas of Bangladesh and 20 flukes from 10 buffaloes in the Chitwan district of Nepal were subjected for analysis. The sequences (442 bp) of the second internal transcribed spacer (ITS2) of ribosomal DNA and the variable fragments (657 bp) of mitochondrial nicotinamide dehydrogenase subunit 1 (nad1) of E. explanatum flukes from Bangladesh and Nepal were analysed. The aim of this study was molecular characterization of the flukes and to elucidate their origin and biogeography. In the ITS2 region, two genotypes were detected among the flukes from Bangladesh, while flukes from Nepal were of only one genotype. Phylogenetic analyses inferred from the nad1 gene revealed that at least four divergent populations (groups I-IV) are distributed in Bangladesh, whereas two divergent populations were found to be distributed in Nepal. Fst values (pairwise fixation index) suggest that Bangladeshi and Nepalese populations of group I to IV are significantly different from each other; but within groups III and IV, the populations from Bangladesh and Nepal were genetically close. This divergence in the nad1 gene indicates that each lineage of E. explanatum from diverse geography was co-adapted during the multiple domestication events of ruminants. This study, for the first time, provides molecular characterization of E. explanatum in Bangladesh and Nepal, and may provide useful information for elucidating its origin and dispersal route in Asia.

Community-based early warning systems for flood risk mitigation in Nepal

NASA Astrophysics Data System (ADS)

Smith, Paul J.; Brown, Sarah; Dugar, Sumit

2017-03-01

This paper focuses on the use of community-based early warning systems for flood resilience in Nepal. The first part of the work outlines the evolution and current status of these community-based systems, highlighting the limited lead times currently available for early warning. The second part of the paper focuses on the development of a robust operational flood forecasting methodology for use by the Nepal Department of Hydrology and Meteorology (DHM) to enhance early warning lead times. The methodology uses data-based physically interpretable time series models and data assimilation to generate probabilistic forecasts, which are presented in a simple visual tool. The approach is designed to work in situations of limited data availability with an emphasis on sustainability and appropriate technology. The successful application of the forecast methodology to the flood-prone Karnali River basin in western Nepal is outlined, increasing lead times from 2-3 to 7-8 h. The challenges faced in communicating probabilistic forecasts to the last mile of the existing community-based early warning systems across Nepal is discussed. The paper concludes with an assessment of the applicability of this approach in basins and countries beyond Karnali and Nepal and an overview of key lessons learnt from this initiative.

Universal institutional delivery among mothers in a remote mountain district of Nepal: what are the challenges?

PubMed

Joshi, D; Baral, S C; Giri, S; Kumar, A M V

2016-12-21

Setting: Eight village development committees of Mugu District, a remote mountainous district of Nepal that has poor maternal health indicators. Objectives: 1) To assess the proportion of mothers who delivered in health facilities (institutional delivery); 2) among mothers who delivered at home, to understand their reasons for doing so; and 3) among mothers who delivered in health facilities, to understand their challenges. Design: Cross-sectional study involving semi-structured interviews with mothers conducted in 2015. Results: Of 275 mothers, 97 (35%) had an institutional delivery. Multivariate logistic regression analysis showed that women who resided within 1 h distance from the birthing centre, had adequate mass media exposure or had only one child were more likely to deliver in hospital. Reasons for non-institutional delivery ( n = 178) were related to geographical access (49%), personal preferences (18%) and perceived poor quality care (4%). Mothers who accessed institutional delivery ( n = 97) also reported difficulties related to travel (60%), costs (28%), dysfunctional health system (18%) and unfriendly attitudes of the health-care providers (7%). Conclusion: To improve access to institutional delivery, the government should establish a 24/7 emergency ambulance network, including air ambulance. Health system issues, including unfriendly staff attitudes, urgently need to be addressed to gain the trust of the mothers.

Marital status and abortion among young women in Rupandehi, Nepal.

PubMed

Andersen, Kathryn L; Khanal, Ram Chandra; Teixeira, Alexandra; Neupane, Shailes; Sharma, Sharad; Acre, Valerie N; Gallo, Maria F

2015-01-01

Despite liberalization of the Nepal abortion law, young women continue to experience barriers to safe abortion services. We hypothesize that marital status may differentially impact such barriers, given the societal context of Nepal. We evaluated differences in reproductive knowledge and attitudes by marital status with a probability-based, cross-sectional survey of young women in Rupandehi district, Nepal. Participants (N = 600) were surveyed in 2012 on demographics, romantic experiences, media habits, reproductive information, and abortion knowledge and attitudes. We used logistic regression to assess differences by marital status, controlling for age. Participants, who comprised never-married (54%) and ever-married women (45%), reported good access to basic reproductive health and abortion information. Social desirability bias might have prevented reporting of premarital romantic and sexual activity given that participants reported more premarital activities for their friends than for themselves. Only 45% knew that abortion was legal, and fewer ever-married women were aware of abortion legality. Never-married women expected more negative responses from having an abortion than ever-married women. Findings highlight the need for providing sexual and reproductive health care information and services to young women regardless of marital status.

Profile of skin biopsies and patterns of skin cancer in a tertiary care center of Western Nepal.

PubMed

Kumar, Ajay; Shrestha, Prashanna Raj; Pun, Jenny; Thapa, Pratichya; Manandhar, Merina; Sathian, Brijesh

2015-01-01

Skin biopsy is the method to assist clinicians to make definite dermatological diagnosis which further helps in holistic management. Skin cancers are relatively rare clinical diagnosis in developing countries like Nepal, but the prevalence is on rise. To investigate the profile of skin biopsies and frequencies and pattern of skin cancers in a tertiary care centre of Western Nepal. The materials consisted of 434 biopsies (1.37%) out of 31,450 OPD visits performed in the Department of Dermatology, Manipal Teaching Hospital, Pokhara, Nepal, during the period of Dec 2011-Nov 2014. Data were collected and analyzed using SPSS-16 with reference to incidence, age, sex, race and clinical and histopathological features. The commonest disorders observed in biopsies were papulosquamous lesions, skin tuberculosis of different types, benign skin tumors, leprosy, collagen and fungal diseases. Viral diseases were rarely seen, probably due to straight forward clinical diagnosis. Dermatological malignancies accounted for 55/434 (12.67%) of biopsies. Skin disorders in general were commoner in females 280/434 (64%), including malignancies 32/55(58.2%). Mean age of patients with skin cancer was 54.5 years. Facilities for proper laboratory investigation of dermatological disorders will improve the quality of life. The most prevalent lesion in skin biopsies was papulosquamous disorders followed by skin tuberculosis of different types. Dermatological malignancy constituted 55/434 (12.67%) cases. The prevalence of skin malignancy is on rise in Nepalese society probably due to increase in life expectancy and better diagnostic services.

Climate change and adverse health events: community perceptions from the Tanahu district of Nepal

NASA Astrophysics Data System (ADS)

Mishra, Shiva Raj; Mani Bhandari, Parash; Issa, Rita; Neupane, Dinesh; Gurung, Swadesh; Khanal, Vishnu

2015-03-01

Nepal is a country economically dependent on climate-sensitive industries. It is highly vulnerable to the environmental, social, economic and health impacts of climate change. The objective of this study is to explore community perceptions of climate variability and human health risks. In this letter, we present a cross sectional study conducted between August 2013 and July 2014 in the Tanahu district of Nepal. Our analysis is based on 258 face-to-face interviews with household heads utilizing structured questionnaires. Over half of the respondents (54.7%) had perceived a change in climate, 53.9% had perceived an increase in temperature in the summer and 49.2% had perceived an increase in rainfall during the rainy season. Half of the respondents perceived an increase in the number of diseases during the summer, 46.5% perceived an increase during the rainy season and 48.8% during winter. Only 8.9% of the respondents felt that the government was doing enough to prevent climate change and its impact on their community. Belonging to the Janajati (indigenous) ethnic group, living in a pakki, super-pakki house and belonging to poor or mid-level income were related to higher odds of perceiving climate variability. Illiterates were less likely to perceive climate variability. Respondents living in a pakki house, super-pakki, or those who were poor were more likely to perceive health risks. Illiterates were less likely to perceive health risks.

Medical students’ characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal’s first medical college

PubMed Central

Shakya, Rabina; Pokhrel, Bharat M; Eyal, Nir; Rijal, Basista P; Shrestha, Ratindra N; Sayami, Arun

2012-01-01

Objective To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas. Design Observational cohort study. Setting Medical college registry, with internet, phone, and personal follow-up of graduates. Participants 710 graduate doctors from the first 22 classes (1983-2004) of Nepal’s first medical college, the Institute of Medicine. Main outcome measures Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student. Results 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal. Conclusions A cluster of medical students’ characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school. PMID:22893566

Fault- and Area-Based PSHA in Nepal using OpenQuake: New Insights from the 2015 M7.8 Gorkha-Nepal Earthquake

NASA Astrophysics Data System (ADS)

Stevens, Victoria

2017-04-01

The 2015 Gorkha-Nepal M7.8 earthquake (hereafter known simply as the Gorkha earthquake) highlights the seismic risk in Nepal, allows better characterization of the geometry of the Main Himalayan Thrust (MHT), and enables comparison of recorded ground-motions with predicted ground-motions. These new data, together with recent paleoseismic studies and geodetic-based coupling models, allow for good parameterization of the fault characteristics. Other faults in Nepal remain less well studied. Unlike previous PSHA studies in Nepal that are exclusively area-based, we use a mix of faults and areas to describe six seismic sources in Nepal. For each source, the Gutenberg-Richter a and b values are found, and the maximum magnitude earthquake estimated, using a combination of earthquake catalogs, moment conservation principals and similarities to other tectonic regions. The MHT and Karakoram fault are described as fault sources, whereas four other sources - normal faulting in N-S trending grabens of northern Nepal, strike-slip faulting in both eastern and western Nepal, and background seismicity - are described as area sources. We use OpenQuake (http://openquake.org/) to carry out the analysis, and peak ground acceleration (PGA) at 2 and 10% chance in 50 years is found for Nepal, along with hazard curves at various locations. We compare this PSHA model with previous area-based models of Nepal. The Main Himalayan Thrust is the principal seismic hazard in Nepal so we study the effects of changing several parameters associated with this fault. We compare ground shaking predicted from various fault geometries suggested from the Gorkha earthquake with each other, and with a simple model of a flat fault. We also show the results from incorporating a coupling model based on geodetic data and microseismicity, which limits the down-dip extent of rupture. There have been no ground-motion prediction equations (GMPEs) developed specifically for Nepal, so we compare the results of standard GMPEs used together with an earthquake-scenario representing that of the Gorkha earthquake, with actual data from the Gorkha earthquake itself. The Gorkha earthquake also highlighted the importance of basin-, topographic- and directivity-effects, and the location of high-frequency sources, on influencing ground motion. Future study aims at incorporating the above, together with consideration of the fault-rupture history and its influence on the location and timing of future earthquakes.

Progress Toward Measles Elimination - Nepal, 2007-2014.

PubMed

Khanal, Sudhir; Sedai, Tika Ram; Choudary, Ganga Ram; Giri, Jagat Narain; Bohara, Rajendra; Pant, Rajendra; Gautam, Mukunda; Sharapov, Umid M; Goodson, James L; Alexander, James; Dabbagh, Alya; Strebel, Peter; Perry, Robert T; Bah, Sunil; Abeysinghe, Nihal; Thapa, Arun

2016-03-04

In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR) established a goal to eliminate measles and to control rubella and congenital rubella syndrome (CRS) in SEAR by 2020. Current recommended measles elimination strategies in the region include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets minimum recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. In 2013, Nepal, one of the 11 SEAR member states, adopted a goal for national measles elimination by 2019. This report updates a previous report and summarizes progress toward measles elimination in Nepal during 2007-2014. During 2007-2014, estimated coverage with the first MCV dose (MCV1) increased from 81% to 88%. Approximately 3.9 and 9.7 million children were vaccinated in SIAs conducted in 2008 and 2014, respectively. Reported suspected measles incidence declined by 13% during 2007-2014, from 54 to 47 cases per 1 million population. However, in 2014, 81% of districts did not meet the measles case-based surveillance performance indicator target of ≥2 discarded non-measles cases per 100,000 population per year. To achieve and maintain measles elimination, additional measures are needed to strengthen routine immunization services to increase coverage with MCV1 and a recently introduced second dose of MCV (MCV2) to ≥95% in all districts, and to enhance sensitivity of measles case-based surveillance by adopting a more sensitive case definition, expanding case-based surveillance sites nationwide, and ensuring timely transport of specimens to the accredited national laboratory.

Establishing a health demographic surveillance site in Bhaktapur district, Nepal: initial experiences and findings

PubMed Central

2012-01-01

Background A health demographic surveillance system (HDSS) provides longitudinal data regarding health and demography in countries with coverage error and poor quality data on vital registration systems due to lack of public awareness, inadequate legal basis and limited use of data in health planning. The health system in Nepal, a low-income country, does not focus primarily on health registration, and does not conduct regular health data collection. This study aimed to initiate and establish the first HDSS in Nepal. Results We conducted a baseline survey in Jhaukhel and Duwakot, two villages in Bhaktapur district. The study surveyed 2,712 households comprising a total population of 13,669. The sex ratio in the study area was 101 males per 100 females and the average household size was 5. The crude birth and death rates were 9.7 and 3.9/1,000 population/year, respectively. About 11% of births occurred at home, and we found no mortality in infants and children less than 5 years of age. Various health problems were found commonly and some of them include respiratory problems (41.9%); headache, vertigo and dizziness (16.7%); bone and joint pain (14.4%); gastrointestinal problems (13.9%); heart disease, including hypertension (8.8%); accidents and injuries (2.9%); and diabetes mellitus (2.6%). The prevalence of non-communicable disease (NCD) was 4.3% (95% CI: 3.83; 4.86) among individuals older than 30 years. Age-adjusted odds ratios showed that risk factors, such as sex, ethnic group, occupation and education, associated with NCD. Conclusion Our baseline survey demonstrated that it is possible to collect accurate and reliable data in a village setting in Nepal, and this study successfully established an HDSS site. We determined that both maternal and child health are better in the surveillance site compared to the entire country. Risk factors associated with NCDs dominated morbidity and mortality patterns. PMID:22950751

Literacy and motivation for the prevention and control of hypertension among female community health volunteers: a qualitative study from Nepal.

PubMed

Neupane, Dinesh; Mclachlan, Craig S; Gautam, Rupesh; Mishra, Shiva Raj; Thorlund, Michael; Schlütter, Mette; Kallestrup, Per

2015-01-01

The prevalence of hypertension is increasing in Nepal. Thus, there is a need for a programme to improve primary healthcare. One possibility is to assign prevention, diagnosis, and treatment of hypertension to female community health volunteers (FCHVs). To assess literacy and motivation to be involved in a hypertension prevention and control programme in Nepal among FCHVs. Five focus group discussions (FGDs) were conducted with a total of 69 FCHVs in Lekhnath municipality, Kaski district, Nepal. Seven themes were developed on the basis of data collection: 1) knowledge about hypertension; 2) risk factors of hypertension; 3) prevention and control of hypertension; 4) access to treatment for hypertension in the community; 5) learning about blood pressure measurement; 6) ability to raise blood pressure awareness in the community; 7) possible challenges for their future involvement. Data were analysed using the thematic analysis approach. FCHVs have some knowledge about diagnosis, risk factors, and complications of hypertension. General unanimity was observed in the understanding that hypertension and risk factors needed to be addressed. The willingness of FCHVs to contribute to prevention, control, and management was strong, and they were confident that with some basic training they could obtain skills in hypertension management. Despite limited knowledge about hypertension, FCHVs expressed willingness and readiness to be trained in hypertension management. This study supports the possibility of involving FCHVs in prevention and control of hypertension in Nepal.

Factors Associated with Smokeless Tobacco Use among Pregnant Women in Rural Areas of the Southern Terai, Nepal.

PubMed

Singh, J K; Acharya, D; Kadel, R; Adhikari, S; Lombard, D; Koirala, S; Paudel, R

2017-01-01

Tobacco use among women during pregnancy leading to poor maternal and child health outcomes has been well documented. However, factors influencing use of smokeless tobacco in Nepal has not yet been well established. This study aims at exploring the factors related to smokeless tobacco use among pregnant women in rural southern Terai of Nepal. A community-based cross-sectional study was performed at 52 wards within 6 Village Development Committee in Dhanusha district of Nepal. A total of 426 expectant mothers in their second trimester were selected using a multistage cluster sampling method. Descriptive and regression analyses were done to explore the factors that influence smokeless tobacco use. In a total of 426 pregnant mothers, one in five used tobacco in any form. Among the users, 13.4% used smokeless tobacco. Pregnant mothers who were smoking tobacco (AOR 6.01; 95% CI (1.88-19.23), having alcohol consumption (AOR 3.86; 95% CI (1.23-12.08), stressed (AOR 5.04; 95% CI (1.81-14.03), non-vegetarian (AOR 3.31;(1.84-13.03), not attending regular mothers' group meetings (AOR 4.63; (1.41-15.19), and not-exposed to mass media (AOR 5.02; (1.89-13.33) were significantly associated with smokeless tobacco use. Similarly, mothers of age group 20-34 years, dalit, aadibasi and janajati, hill origin, no education and primary education were more likely to use smokeless tobacco than their counterparts. Factors such as smoking tobacco, alcohol consumption, stress, and poor education were found to be significantly associated with smokeless tobacco use among pregnant women in southern Terai of Nepal. This requires an immediate attention develop an effective strategy to prevent and control smokeless tobacco use among pregnant women in southern Terai of Nepal.

Molecular phylogenetic identification of Fasciola flukes in Nepal.

PubMed

Shoriki, Takuya; Ichikawa-Seki, Madoka; Devkota, Bhuminand; Rana, Hari B; Devkota, Shiva P; Humagain, Sudeep K; Itagaki, Tadashi

2014-12-01

Eighty-one Fasciola flukes collected from 8 districts in Nepal were analyzed for their species identification on the basis of their spermatogenic status and nuclear ribosomal internal transcribed spacer 1 (ITS1) and for their phylogenetic relation with Fasciola flukes from other Asian countries on the basis of the mitochondrial NADH dehydrogenase subunit 1 (nad1) gene. Sixty-one flukes (75.3%) were aspermic Fasciola sp., and 20 flukes (24.7%) were identified as Fasciola gigantica. All of the aspermic flukes displayed the Fh/Fg type in ITS1, which was predominant in aspermic Fasciola sp. from China, and most (60 flukes) displayed the Fsp-ND1-N1 haplotype in the nad1, which had an identical nucleotide sequence to the major haplotype (Fg-C2) of the aspermic flukes from China. These results suggest that aspermic Fasciola sp. was introduced into Nepal from China. Furthermore, the results of the diversity indices, neutrality indices, and median-joining network analysis with reference haplotypes from Asian countries suggest that aspermic Fasciola sp. rapidly expanded its distribution. In contrasts, F. gigantica displayed 10 nad1 haplotypes, which showed higher population diversity indices than the haplotypes of aspermic flukes, indicating that the F. gigantica population was clearly distributed in Nepal earlier than the aspermic Fasciola population. Although the F. gigantica haplotypes from Nepal formed a star-like phylogeny consisting of a main founder haplotype (Fg-ND1-N1), together with some F. gigantica haplotypes from Myanmar and Thailand, the Nepal population differed genetically from F. gigantica populations of neighboring countries as each country had distinct founder haplotype(s). Copyright © 2014 Elsevier Inc. All rights reserved.

Impact of livestock hygiene education programs on mastitis in smallholder water buffalo (Bubalus bubalis) in Chitwan, Nepal.

PubMed

Ng, Linda; Jost, Christine; Robyn, Misha; Dhakal, I P; Bett, Bernard; Dhakal, Pramod; Khadka, Rupak

2010-09-01

A project implemented from 2003 to 2005 trained women in Chitwan District, Nepal, in hygienic dairy production using a process of social mobilization. The aim of this research was to assess if the prevalence of mastitis in water buffalo in the households of women who were trained was lower one year after training than in untrained households, if the training influenced knowledge and practices for the prevention or control of mastitis, and if these practices and knowledge were associated with a lower prevalence of mastitis. A total of 202 households from Eastern and Western Chitwan District were included in the study. Of these, 60 households had participated in the project and 142 had not. Milk samples were collected from 129 households (33 project households and 96 non-project households). Clinical mastitis was determined using visual inspection of udders and detection of macroscopic clots and flakes in milk. The California Mastitis Test was used to diagnose sub-clinical mastitis from milk samples, and the IDEXX SNAP test to identify the presence of tetracycline residues. The prevalence of mastitis in trained households (39.4%) was 43.78% of that in untrained households (60.4%), lower but not significantly so (p=0.08, 95% CI 0.17-1.12). Thirteen indicators of knowledge or practice for the control or prevention of mastitis were more likely to occur in trained households, four significantly so (not consuming milk from sick buffalo (p=0.001), using soap to wash hands before milking (p=0.001), discarding milk after antibiotic usage (p=0.01), and choosing appropriate flooring for their livestock (p=0.03)). Trained households that discarded milk from sick buffalo were 2.96 times more likely to have at least one animal with mastitis in the household (p=0.03, 95% CI 1.15-7.65). Trained households that knew to wash buffalos' teats after milking were less likely (OR 0.25) to have mastitis in their herd (p=0.02, 95% CI 0.08-0.80). Of the 138 buffalos tested, only one tested positive for tetracycline residues. 2010 Elsevier B.V. All rights reserved.

Student feedback on the use of paintings in Sparshanam, the Medical Humanities module at KIST Medical College, Nepal

PubMed Central

2011-01-01

Background Paintings have been used in Medical Humanities modules in Nepal at Manipal College of Medical Sciences and KIST Medical College. Detailed participant feedback about the paintings used, the activities carried out, problems with using paintings and the role of paintings in future modules has not been previously done. Hence the present study was carried out. Methods The present module for first year medical students was conducted from February to August 2010 at KIST Medical College, Nepal. Paintings used were by Western artists and obtained from the Literature, Arts and Medicine database. The activities undertaken by the students include answering the questions 'What do you see' and 'What do you feel' about the painting, creating a story of 100 words about the scene depicted, and interpreting the painting using role plays and poems/songs. Feedback was not obtained about the last two activities. In August 2010 we obtained detailed feedback about the paintings used. Results Seventy-eight of the 100 students (78%) participated. Thirty-four students (43.6%) were male. The most common overall comments about the use of paintings were "they helped me feel what I saw" (12 respondents), "enjoyed the sessions" (12 respondents), "some paintings were hard to interpret" (10 respondents) and "were in tune with module objectives" (10 respondents). Forty-eight (61.5%) felt the use of western paintings was appropriate. Suggestions to make annotations about paintings more useful were to make them shorter and more precise, simplify the language and properly introduce the artist. Forty-one students (52.6%) had difficulty with the exercise 'what do you feel'. Seventy-four students (94.9%) wanted paintings from Nepal to be included. Conclusions Participant response was positive and they were satisfied with use of paintings in the module. Use of more paintings from Nepal and South Asia can be considered. Further studies may be required to understand whether use of paintings succeeded in fulfilling module objectives. PMID:21385427

Spatial and Temporal Dynamics of Flora in Forest, Grassland and Common Land Ecosystems of Western Chitwan, Nepal

PubMed Central

DANGOL, Dharma Raj; MAHARJAN, Keshav Lall

2013-01-01

This paper describes changes of species composition and population of flora in space and time in western Chitwan, Nepal. This paper also discusses on the changes in flora due to flood and human activities. To illustrate these changes, we used survey data collected from January to April of 1996, 2000, and 2007 from the Barandabhar forest, National Park forest and the forests along the Narayani River banks, grasslands of National Park and common lands of western Chitwan as a part of longitudinal study on “reciprocal relation of population and the environment”. From these data, density values were calculated to analyze spatial and temporal changes in flora species composition and population. We also noted the changes of top species in time and space in due course of time. If the species and its rank not changed, their densities (population) values of flora species changed. We found that changes in species composition, population, appearance or disappearance of flora from a particular space (research plot) were noted as a result of natural forces or human activities. PMID:25061414

Spatial and Temporal Dynamics of Flora in Forest, Grassland and Common Land Ecosystems of Western Chitwan, Nepal.

PubMed

Dangol, Dharma Raj; Maharjan, Keshav Lall

2012-06-30

This paper describes changes of species composition and population of flora in space and time in western Chitwan, Nepal. This paper also discusses on the changes in flora due to flood and human activities. To illustrate these changes, we used survey data collected from January to April of 1996, 2000, and 2007 from the Barandabhar forest, National Park forest and the forests along the Narayani River banks, grasslands of National Park and common lands of western Chitwan as a part of longitudinal study on "reciprocal relation of population and the environment". From these data, density values were calculated to analyze spatial and temporal changes in flora species composition and population. We also noted the changes of top species in time and space in due course of time. If the species and its rank not changed, their densities (population) values of flora species changed. We found that changes in species composition, population, appearance or disappearance of flora from a particular space (research plot) were noted as a result of natural forces or human activities.

Depression and anxiety among war-widows of Nepal: a post-civil war cross-sectional study.

PubMed

Basnet, Syaron; Kandel, Pragya; Lamichhane, Prabhat

2018-02-01

Thousands of Nepalese women were widowed as a consequence of a decade (1996-2006) long civil war in Nepal. These women are at grave risk of mental health problems due to both traumatic experiences and violation of natural order of widowhood. The present study explores the depression and anxiety among war-widows. In 2012, a cross-sectional study was designed to interview 358 war-widows using validitated Beck Depression Inventory and Beck Anxiety Inventory in four districts of Nepal - Bardiya, Surkhet, Sindhupalchowk and Kavrepalanchowk with history of high conflict intensity. The prevalence of depression and anxiety was 53% and 63% respectively. Financial stress was significantly associated with depression (2.67, 95% CI: 1.40-5.07) and anxiety (2.37, 95% CI: 1.19-4.72). High autonomy of women as compared to low autonomy, high social support as compared to low social support and literacy as opposed to illiteracy was associated with less likelihood of depression and anxiety. Our results suggest high magnitude of depression and anxiety among war-widows in Nepal. Future policy efforts should be directed at providing mental health services to identify mental health issues among conflict affected individuals with focus on education, employment and activities to promote social support and autonomy at community.

Risk Factors for the Presence of Chikungunya and Dengue Vectors (Aedes aegypti and Aedes albopictus), Their Altitudinal Distribution and Climatic Determinants of Their Abundance in Central Nepal

PubMed Central

Dhimal, Meghnath; Gautam, Ishan; Joshi, Hari Datt; O’Hara, Robert B.; Ahrens, Bodo; Kuch, Ulrich

2015-01-01

Background The presence of the recently introduced primary dengue virus vector mosquito Aedes aegypti in Nepal, in association with the likely indigenous secondary vector Aedes albopictus, raises public health concerns. Chikungunya fever cases have also been reported in Nepal, and the virus causing this disease is also transmitted by these mosquito species. Here we report the results of a study on the risk factors for the presence of chikungunya and dengue virus vectors, their elevational ceiling of distribution, and climatic determinants of their abundance in central Nepal. Methodology/Principal Findings We collected immature stages of mosquitoes during six monthly cross-sectional surveys covering six administrative districts along an altitudinal transect in central Nepal that extended from Birgunj (80 m above sea level [asl]) to Dhunche (highest altitude sampled: 2,100 m asl). The dengue vectors Ae. aegypti and Ae. albopictus were commonly found up to 1,350 m asl in Kathmandu valley and were present but rarely found from 1,750 to 2,100 m asl in Dhunche. The lymphatic filariasis vector Culex quinquefasciatus was commonly found throughout the study transect. Physiographic region, month of collection, collection station and container type were significant predictors of the occurrence and co-occurrence of Ae. aegypti and Ae. albopictus. The climatic variables rainfall, temperature, and relative humidity were significant predictors of chikungunya and dengue virus vectors abundance. Conclusions/Significance We conclude that chikungunya and dengue virus vectors have already established their populations up to the High Mountain region of Nepal and that this may be attributed to the environmental and climate change that has been observed over the decades in Nepal. The rapid expansion of the distribution of these important disease vectors in the High Mountain region, previously considered to be non-endemic for dengue and chikungunya fever, calls for urgent actions to protect the health of local people and tourists travelling in the central Himalayas. PMID:25774518

Population Mobility and Spread of HIV Across the Indo-Nepal Border

PubMed Central

Nepal, Binod

2007-01-01

The article reviews information on the epidemiology of HIV/AIDS and behavioural networking to examine the role of population mobility in spreading HIV across the Indo-Nepal border. Documents were collected through a systematic search of electronic databases and web-based information resources, and the review focuses on studies about types of the virus, prevalence of HIV, and sexual and injecting networking. HIV-1 (subtype C) and HIV-2 were identified in Nepal. The prevalence of HIV was higher among male labour migrants and female sex workers (FSWs) who returned from India, especially from Mumbai, than in similar non-migrant groups. In the early 2000s, about 6–10% of Mumbai returnee men, compared to up to 4% of India returnee men and up to 3% of non-migrant men in the far-west Nepal, were identified with HIV. Likewise, when the prevalence of HIV among sex workers in Kathmandu was found to be 17% in 1999–2000, up to 44% of India returnee and 73% of Mumbai returnee FSWs were identified with the virus. These data are, however, based on small samples with questionable representativeness of the target populations and need to be interpreted cautiously. They also generate a biased impression that HIV was coming into Nepal from India. Recently, the possibility of a two-way flow of HIV across the Indo-Nepal border through injecting and sexual networking have been indicated by serological and behavioural data from a south-eastern cluster of Nepal and a north-eastern district of India. Although similar behavioural networks exist along other segments of the border, serological data are unavailable to assess whether and how extensively this phenomenon has caused the spread of HIV. Collaborative research and interventions covering both sides of the border are desirable to fully understand and address the prospect of HIV epidemics associated with cross-border population mixing. PMID:18330059

Lower Genital Tract Trauma in A Tertiary Care Centre in Mid-Western Nepal.

PubMed

Adhikari, A K; Dutta, M; Das, C R

2017-01-01

The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. Appropriate surgical intervention can avert morbidity and mortality.

Ambiguous Loss in a Non-Western Context: Families of the Disappeared in Postconflict Nepal

ERIC Educational Resources Information Center

Robins, Simon

2010-01-01

Ambiguous loss has become a standard theory for understanding the impact of situations where the presence of a family member is subject to ambiguity. A number of studies of ambiguous loss have been made in a range of situations of ambiguity, but almost all have been firmly located within a Western cultural context. Here, ambiguous loss is explored…

Identifying and Investigating the "Best" Schools: A Network-Based Analysis

ERIC Educational Resources Information Center

Joshi, Priyadarshani

2018-01-01

This paper aims to provide a fresh perspective on the predominantly negative discourse on schooling quality in low-income countries by focusing on the research questions: "How can one identify great schools and what makes them special?" Using a network-based perspective, I measure peer evaluations of quality in two districts in Nepal.…

Experiencing and Responding to Private Competition: The Importance of Subjectivity and Intermediate Outcomes

ERIC Educational Resources Information Center

Joshi, Priyadarshani

2016-01-01

Despite substantial growth in private schooling in developing countries, there has been little attention paid to the question of how public schools are experiencing and responding to competition in these contexts. To address this research gap, I collected primary survey data from two districts in Nepal and used descriptive and logistic regression…

Nutritional assessment of community-dwelling older adults in rural Nepal.

PubMed

Ghimire, Saruna; Baral, Binaya Kumar; Callahan, Karen

2017-01-01

Demographic transition in Nepal, like in many developing countries, has resulted in a burgeoning elderly population whose health status is not currently monitored. One pillar of health is adequate nutrition. Yet, little is known about the nutritional health status of the elderly in Nepal. The financial, material, and personnel limitations in Nepal's health delivery services necessitate health screening instruments that require minimal clinical staff and resources. To our knowledge, no such nutritional assessment tool has been validated in Nepal. Therefore, our aims are two-fold: To assess the nutritional status of the elderly population in one typical Nepali village, Okharpauwa, in Nuwakot District, Nepal; and concurrently, to validate the Mini Nutritional Assessment (MNA) tool. A cross-sectional field study was conducted with a sample of 242 elderly people in Okharpauwa, Nepal to obtain prevalence of malnutrition. Differences in demographic and lifestyle factors between these who were malnourished, those at risk of malnourishment, and those who had adequate nutritional status were analyzed. The MNA tool was evaluated using receiver operating characteristic (ROC) curve analysis; sensitivity, specificity, and diagnostic accuracy were calculated. 111 males and 131 females, with a mean age of 69.8±7.4 years, participated in this study. The mean BMI of the participants was 21.4±3.9 kg/m2; the mean MNA score was 19.3±4.2. BMI was significantly correlated with the total MNA score (r = 0.58; p<0.001). The diagnostic accuracy, sensitivity and specificity of MNA were 81%, 86% and 67% respectively. Of the 242 elderly sampled, 24% were malnourished and 65% were at risk of malnutrition. Malnutrition was more prevalent among females (29%) than males (18%), and most prevalent among the marginalized Dalit ethnic group (40%). Elderly persons who were married and literate had better nutritional health than their counterparts. The MNA appears to be a valid and sensitive tool for rapid nutritional screening of the elderly in Nepal. The prevalence of malnutrition was high among Nepalese elderly in the Okharpauwa VDC, which requires urgent health monitoring and management attention.

Assessment of Nutritional Status of Children Under Five years of age in rural Nepal.

PubMed

Chataut, J; Khanal, K

2016-01-01

Background Nutritional status of children is one of the major predictors of child survival. However, malnutrition is a major public health problem in most of the developing countries and occurs prominently among under-five children. In context of Nepal, nearly 37% children are suffering from underweight, 41% from stunting and 11% are suffering from wasting. These children are at a substantially greater risk of severe acute malnutrition and death. Objective The objective of the study was to assess the nutritional status of children under five years of age and to find the factors associated with malnutrition. Method A cross-sectional study was conducted in Dolakha and Kavre districts of Nepal for assessing the nutritional status of under-five children and associated factors. A total of 243 under five children were included from two purposively selected village development committees (VDCs) i.e. one from each district. Statistical Package for the Social Sciences (SPSS) 22 Version and ENA Software Version 2011 were used for analyzing the data. Result Out of 243 children, according to WHO based on weight for height assessment, 17 (7.0%) were wasted, in height for age analysis, 97 (39.9%) were stunted and in weight for age assessment, 46 (18.9%) were underweight. Conclusion In the study population, there is high prevalence of malnutrition, especially stunting among under-five. Taking into account weight, height, age, and mid upper arm circumference (MUAC) measurements of malnourished children more than threefifths of them were found below -2SD and nearly one-fourths below -3SD which needs intervention.

Adolescents' knowledge and opinions about smoking: a qualitative study from the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal.

PubMed

Povlsen, Lene; Aryal, Umesh Raj; Petzold, Max; Krettek, Alexandra

2016-04-09

The use of tobacco products among adolescents in Southeast Asia represents a major public health burden. Two out of ten adolescents attending school are tobacco users and several factors influence them to initiate tobacco use. Most studies related to tobacco use are quantitative, whereas qualitative studies exploring adolescents' smoking behavior and their views, knowledge and experiences are scarce. To gain a deep understanding of Nepalese adolescents' knowledge and opinions about smoking and reasons for smoking initiation. Adolescents from four secondary schools in the Bhaktapur district, Nepal. Eight focus-group discussions were conducted with 71 adolescents aged 13-16 years and from grades 8-10. Data were analyzed using manifest qualitative content analysis. The participants knew that smoking represents health risks as well as socio-economic risks, but few described the addictive nature of tobacco and health risks related to passive smoking. Most participants related smoking initiation to the smoking behavior of peers and family members, but easy accessibility to cigarettes, ineffective rules and regulations, and exposure to passive smoking also created environments for smoking. Some expressed confidence to resist peer pressure and refuse to start smoking, but also expressed the need for prevention strategies in schools and for governmental initiatives, such as more strict implementation of tobacco control and regulations to prevent and reduce smoking. Curbing the tobacco epidemic in Nepal requires healthy public policies and multifaceted interventions to address the knowledge gap on health consequences associated with smoking among adolescents, teachers and parents/adults.

Nutrition-sensitive agricultural interventions and gender dynamics: A qualitative study in Nepal.

PubMed

Kjeldsberg, Cecilie; Shrestha, Niva; Patel, Miti; Davis, Dale; Mundy, Gary; Cunningham, Kenda

2018-03-24

Undernutrition and low women's status persist as major development obstacles in South Asia and specifically, Nepal. Multi-sectoral approaches, including nutrition-sensitive agriculture, are potential avenues for further reductions in undernutrition. Although evidence is growing, many questions remain regarding how gender mediates the translation of agricultural production activities into nutritional benefit. In this study, we examined how gender influences the pathway from agricultural production to improved income and control of income, with a focus on five domains of empowerment: decision-making power, freedom of mobility, social support, workload and time, and self-efficacy. For this, we conducted a qualitative retrospective assessment (N = 10 FGDs) among 73 beneficiary women of a nutrition-sensitive agriculture programme implemented from 2008 to 2012 in two districts of Nepal-Baitadi and Kailali. We found that women reported increased decision-making power, new knowledge and skills, increased recognition by their family members of their new knowledge and contributions, and self-efficacy as farmers and sellers, whereas workload and time were the most consistent constraints noted. We also found that each empowerment domain operated differently at different stages of the pathway, sometimes representing barriers and at other times, opportunities and that the interconnectedness of the domains made them difficult to disentangle in practice. Finally, there were major contextual differences for some domains (e.g., freedom of mobility) between the two districts. Future policies and programmes need to include in-depth formative research to ensure that interventions address context-specific gender and social norms to maximise programmatic opportunities to achieve desired results. © 2018 John Wiley & Sons Ltd.

Determinants of severe acute malnutrition among children under 5 years of age in Nepal: a community-based case-control study.

PubMed

Pravana, Nilesh Kumar; Piryani, Suneel; Chaurasiya, Surendra Prasad; Kawan, Rasmila; Thapa, Ram Krishna; Shrestha, Sumina

2017-08-28

Malnutrition is one of the leading causes of morbidity and mortality among children under the age of 5 years in low and middle income countries like Nepal. Children with severe acute malnutrition (SAM) are nine times more likely to die than children without malnutrition. The prevalence of SAM has increased in Nepal over the past 15 years; however, the determinants of SAM have not been clearly assessed in the country. To assess the determinants of SAM among children aged 6-59 months in the Bara district of Nepal. A community-based case-control study was conducted in 12 randomly selected Village Development Committees (VDCs) of the Bara district of Nepal. A random sample of 292 children aged 6-59 months (146 as cases and 146 as controls) from 12 VDCs were included in this study. The prevalence of SAM among children under the age of 5 years was 4.14%. The following factors were significantly associated with SAM: low socioeconomic status (adjusted odds ratio (AOR) 17.13, 95% CI 5.85 to 50.13); mother's age at birth <20 or >35 years (AOR 3.21, 95% CI 1.30 to 7.94); birth interval <24 months (AOR 4.09, 95% CI 1.87 to 8.97); illiterate father (AOR 3.65, 95% CI 1.62 to 8.20); bottle feeding (AOR 2.19, 95% CI 1.73 to 12.03); and not initiating complementary feeding at the age of 6 months (AOR 2.91, 95% CI 1.73 to 12.03). Mother's educational level, initiation of breastfeeding, colostrum feeding, and exclusive breastfeeding were not significantly associated with SAM. The mother's age at birth, birth interval, socioeconomic status, father's educational level and initiation of complementary feeding at the age of 6 months were important determinants of SAM among children. A multi-sector approach is essential to address SAM. There is a need for further studies not only focusing on SAM but also moderate acute malnutrition. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

iss054e006869

NASA Image and Video Library

2017-12-27

iss054e006869 (Dec. 27, 2017) --- This photograph taken by Expedition 54 crew members aboard the International Space Station reveals striking climate differences of Nepal and the Himalayan mountain range, including Mount Everest (left) and the Tibetan highlands of western China (right).

Response of the Laprak Landslide to the 2015 Nepal Earthquake and Implications for the Utility of Simple Infinite Slope Models in Regional Landslide Hazard Assessment

NASA Astrophysics Data System (ADS)

Haneberg, W. C.; Gurung, N.

2016-12-01

The village of Laprak, located in the Gorkha District of western Nepal, was built on a large colluvium landslide about 10 km from the epicenter of the 25 April 2015 M 7.8 Nepal earthquake. Recent episodic movement began during a wet period in 1999 and continued in at least 2002, 2006, and 2007, destroying 24 homes, removing 23 hectares of land from agricultural production, and claiming 1 life. Reconnaissance mapping, soil sampling and testing, and slope stability analyses undertaken before the 2015 earthquake suggested that the hillside should be stable under dry conditions, unstable to marginally stable under static wet conditions, and wholly unstable under wet seismic conditions. Most of the buildings in Laprak, which were predominantly of dry fitted stone masonry, were destroyed by Intensity IX shaking during the 2015 earthquake. Interpretation of remotely sensed imagery and published photographs shows new landslide features; hence, some downslope movement occurred but the landslide did not mobilize into a long run-out flow. Monte Carlo simulations based upon a pseudostatic infinite slope model and constrained by reasonable distributions of soil shear strength, pore pressure, and slope angle from earlier work and seismic coefficients based upon the observed Intensity IX shaking (and inferred PGA) yield high probabilities of failure for steep portions of the slope above and below the village but moderate probabilities of failure for the more gentle portion of the slope upon which most of the village was constructed. In retrospect, the seismic coefficient selected for the pre-earthquake analysis proved to be remarkably prescient. Similar results were obtained using a first-order, second-moment (FOSM) approach that is convenient for GIS based regional analyses. Predictions of permanent displacement made using a variety of published empirical formulae based upon sliding block analyses range from about 10 cm to about 200 cm, also broadly consistent with the observed earthquake effects. Thus, at least in the case of Laprak, the conceptually simple infinite slope models used in many GIS based regional analyses appear to provide robust results if reasonable ranges of soil strength, pore pressure, slope geometry, and seismic loading are used.

Birth outcomes across ethnic groups of women in Nepal.

PubMed

Acharya, Pratima Poudel; Alpass, Fiona

2004-01-01

This study was conducted at the Western Regional Hospital (WRH), Pokhara, Nepal. We investigated the relationship between selected socioeconomic variables, pregnancy indices, birth weight, and maternal health in women of different ethnic origins. In our cross-sectional data set, 29.8% of infants were born with a low birth weight. Our data analysis showed Indo-Aryan and lower caste ethnic groups had significantly lower weight babies than Tibeto-Burman and Newar groups. Further analysis showed that the Tibeto-Burman group received better care during pregnancy. Similarly, the Newar groups had significantly better nutritional intake than the Indo-Aryan and lower caste groups. The outcome of food restriction and antenatal care during pregnancy in specific ethnic groups has important implications for the health care delivery system. Health policymakers should target those ethnic groups and develop culturally based policies to reduce the incidence of low birth weight in Nepal.

Selection and Characterization of Potential Baker's Yeast from Indigenous Resources of Nepal

PubMed Central

Timilsina, Parash Mani; Yadav, Archana; Joshi, Yogesh; Bhujel, Sahansila; Adhikari, Rojina; Neupane, Katyayanee

2017-01-01

The study aims to isolate the yeast strains that could be used effectively as baker's yeast and compare them with the commercial baker's yeast available in the market of Nepal. A total of 10 samples including locally available sources like fruits, Murcha, and a local tree “Dar” were collected from different localities of Bhaktapur, Kavre, and Syangja districts of Nepal, respectively. Following enrichment and fermentation of the samples, 26 yeast strains were isolated using selective medium Wallerstein Laboratory Nutrient Agar. From the differential tests which included morphological and microscopic observation and physiological and biochemical characterization such as nitrate reduction and lactose utilization tests, 8 strains were selected as possible Saccharomyces strain. The selected strains were further assessed for their efficient leavening ability by tests such as ethanol tolerance, osmotolerance, invertase test, and stress exclusion test. The three most potent strains ENG, MUR3B, and SUG1 isolated from grape, Murcha, and sugarcane, respectively, were used in the fermentation and baking of dough. These strains also carried a possibility of being used as industrial baker's yeast. PMID:29387490

Selection and Characterization of Potential Baker's Yeast from Indigenous Resources of Nepal.

PubMed

Karki, Tika B; Timilsina, Parash Mani; Yadav, Archana; Pandey, Gyanu Raj; Joshi, Yogesh; Bhujel, Sahansila; Adhikari, Rojina; Neupane, Katyayanee

2017-01-01

The study aims to isolate the yeast strains that could be used effectively as baker's yeast and compare them with the commercial baker's yeast available in the market of Nepal. A total of 10 samples including locally available sources like fruits, Murcha, and a local tree "Dar" were collected from different localities of Bhaktapur, Kavre, and Syangja districts of Nepal, respectively. Following enrichment and fermentation of the samples, 26 yeast strains were isolated using selective medium Wallerstein Laboratory Nutrient Agar. From the differential tests which included morphological and microscopic observation and physiological and biochemical characterization such as nitrate reduction and lactose utilization tests, 8 strains were selected as possible Saccharomyces strain. The selected strains were further assessed for their efficient leavening ability by tests such as ethanol tolerance, osmotolerance, invertase test, and stress exclusion test. The three most potent strains ENG, MUR3B, and SUG1 isolated from grape, Murcha, and sugarcane, respectively, were used in the fermentation and baking of dough. These strains also carried a possibility of being used as industrial baker's yeast.

Seasonal Dietary Intakes and Socioeconomic Status among Women in the Terai of Nepal

PubMed Central

Campbell, Rebecca K.; Talegawkar, Sameera A.; Christian, Parul; LeClerq, Steven C.; Khatry, Subarna K.; Wu, Lee S.F.

2014-01-01

ABSTRACT Despite widespread nutritional deficiencies, investigations of usual diet in rural South Asia remain sparse. The present study characterizes year-round and seasonal dietary patterns of women in the Terai of Nepal by sociodemographic status, using a novel, weekly single-visit and usual food frequency questionnaire that links recall to the agricultural season. The study was conducted across seasons in 2006-2008 among 15,899 women of reproductive age in Sarlahi district. Intakes were tabulated for all foods, overall and by socioeconomic status (SES), and in and out of season, as appropriate. Foods consumed regularly [median (interquartile range) weekly frequency] were rice [13 (7-13)], potatoes [10 (5-13)], legumes [6 (2-9)], and vegetable oil [13 (13-13)]. Animal products were infrequently consumed [1 (0-2) time per week] as were fruits and vegetables, most with a median weekly intake frequency of 0. Higher SES was associated with more frequent consumption of most food-groups, including in-season fruits and vegetables. Diets of women in the Terai of Nepal lack diversity and, likely, nutrient adequacy, which may pose health risks. PMID:25076658

Environmental management plan (EMP) for Melamchi water supply project, Nepal.

PubMed

Khadka, Ram B; Khanal, Anil B

2008-11-01

More than 1.5 million people live in the Kathmandu valley. The valley is facing an extreme shortage of water supply. At the same time the demand is escalating rapidly. To address this issue of scarcity of water, the government of Nepal has proposed a project of inter-basin transfer of water from Melamchi River located 40 km north-east of the Kathmandu valley. The project will cover two districts and three municipalities and will potentially have significant impacts on the environment. In accordance with the Environmental Protection Regulation of Nepal (1997), the Melamchi Water Supply Project (MWSP) has undergone an EIA during the feasibility study stage of the proposed project. The recommendations contained in the EIA were integrated into the project design for implementation in 2006. This paper summarizes the background of MWSP, the environmental concerns described in the EIA and the status of Environmental Management Plan (EMP) developed to address environmental compliance and other issues involving participation and support of the local people. This paper also provides some lessons to learn on the modalities of addressing the demands and grievances of the local people concerning environmental management.

The supplemental use of infant formula in the context of universal breastfeeding practices in Western Nepal.

PubMed

Khanal, Vishnu; Scott, Jane A; Lee, Andy H; Karkee, Rajendra; Binns, Colin W

2016-05-21

While the initiation of breastfeeding is universal in Nepal, little has been reported on formula feeding practices. This study aimed to report the prevalence of, and factors associated with, the use of infant formula as supplementary feeds in the Western region of Nepal. A community-based cohort study was conducted to collect infant feeding information among 735 postpartum mothers using structured questionnaires. Complete formula feeding data were collected from 711 women in the first, fourth and sixth month postpartum. Factors independently associated with formula feeding were investigated using multiple logistic regression. All mothers were breastfeeding their infants at the time of recruitment. The prevalence of formula feeding was 7.5 % in the first month and 17 % in the sixth month. About a quarter of mothers (23.8 %) reported providing infant formula at least once during the first six months of life. Infant formula was used commonly as top-up food. Stepwise logistic regression showed that infants born to families residing in urban areas (adjusted odds ratio (aOR): 2.14; 95 % confidence interval (CI): 1.37 to 3.33), mothers with higher education (aOR: 2.08; 95 % CI: 1.14 to 3.80), and infants born by caesarean section (aOR: 1.96; 95 % CI: 1.21 to 3.18) were at greater risk of formula feeding. The current findings indicate that health workers should support mothers to initiate and continue exclusive breastfeeding particularly after caesarean deliveries. Furthermore, urban health programs in Nepal should incorporate breastfeeding programs which discourage the unnecessary use of formula feeding. The marketing of formula milk should be monitored more vigilantly especially in the aftermath of the April 2015 earthquakes or other natural disasters.

Factor Structure of Scores from the Conners' Rating Scales-Revised among Nepali Children

ERIC Educational Resources Information Center

Pendergast, Laura L.; Vandiver, Beverly J.; Schaefer, Barbara A.; Cole, Pamela M.; Murray-Kolb, Laura E.; Christian, Parul

2014-01-01

This study used exploratory and confirmatory factor analyses to examine the structures of scores from the Conners' Teacher and Parent Rating Scales-Revised (CTRS-R and CPRS-R, respectively; Conners, 1997). The scales were administered to 1,835 parents and 1,387 teachers of children in Nepal's Sarlahi district, a region where no other measures of…

Tablet e-Logbooks: Four Thousand Clinical Cases and Complications e-Logged by 14 Nondoctor Anesthesia Providers in Nepal.

PubMed

Shah, Shristi; Ross, Oliver; Pickering, Stephen; Knoble, Stephen; Rai, Indra

2017-10-01

To meet the need for essential surgery across rural Nepal, anesthesia at district level is delivered by nondoctor anesthetists. They require support to maintain confidence and competence, and upgraded professional registration to secure their status. To meet these needs, a distance-blended learning course was pioneered and delivered. A core course requirement was to log all clinical cases; these were logged on a new e-logbook. Fourteen nondoctor anesthesia providers working in 12 different districts across Nepal were enrolled in the 1-year course. The course is based on self-completion on a tablet loaded with new learning modules, a resource library, and a case logbook. Continuous educational mentoring was provided by anesthesiologists by phone and email. The logbook included preanesthesia assessment and interventions, American Society of Anesthesiologists (ASA) grading, types of cases and anesthesia given, monitors used, complications, outcomes and free text remarks. Cases were uploaded monthly to a database, and mentors reviewed all logbook entries. The 14 nondoctor anesthesia providers were widely distributed across the country in district, zonal, community, and mission hospitals, and had different levels of clinical experience and caseloads. Logbooks and uploads were regularly completed without difficulty; 1% cases were entered incompletely with no case details provided. A total of 4143 cases were recorded. Annual caseload per nondoctor anesthesia provider ranged from 50 to 788, the majority of which were under spinal anesthesia; 34% of the total cases were cesarean deliveries, of which 99% received spinal anesthesia. Fifty gastrointestinal laparotomies (1% total) were recorded. Ninety-one percent of cases were ASA I, 0.8% ASA III/IV. Pulse oximetry was used in 98% of cases. Complications were recorded in 6% of cases; the most common were circulation problems (69%) including hypotension and occasional bradycardia after spinal anesthesia. Airway complications were usually under ketamine anesthesia requiring basic airway maneuvers; 4 difficult intubations were recorded under general anesthesia. Anesthesia outcomes were good with overall mortality of 0.1% (total 4 cases). Causes of death included severe preeclampsia, sepsis postlaparotomy, and patients with multiorgan failure for minor procedure. The tablet-based electronic anesthesia logbook was successfully used to record cases, complications, and outcomes across rural Nepal. The nondoctor anesthesia providers had trust and confidence in recording outcomes. It remains to be tested whether an e-logbook would be routinely completed outside of a specific training course. Such a logbook could be incorporated into all continuous professional development programs for rural nondoctor anesthetists.

Persistent Complex Bereavement Disorder and Culture: Early and Prolonged Grief in Nepali Widows.

PubMed

Kim, Jane; Tol, Wietse A; Shrestha, Abina; Kafle, Hari Maya; Rayamajhi, Rajin; Luitel, Nagendra P; Thapa, Lily; Surkan, Pamela J

2017-01-01

Persistent complex bereavement disorder (PCBD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has not been well studied in socioculturally diverse populations. Thus, this qualitative study examined (a) how widows in Nepal understand grief, (b) whether a local construct of PCBD exists, and (c) its comparability with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), terminology. Using an adapted Explanatory Model Interview Catalogue (EMIC) framework, semistructured interviews with 25 widows and 12 key informants, as well as three focus-group discussions (n = 20), were conducted between October 2014 and April 2015. Through an inductive grounded theory-based approach, we used the constant comparative method, iteratively coding transcripts to identify themes and patterns in the data. Also, we created two lists of grief responses, one of early reactions and another all reactions to grief, based on the frequency of mention. No single term for grief was reported. Widows reported a local construct of PCBD, which was broadly compatible with DSM-5 terminology but with important variation reflecting societal influence. Surviving torture during conflict, economic and family stressors, and discrimination were mentioned as important determinants that prolong and complicate grief. Suicidal ideation was common, with about 31% and 62% of widows reporting past-year and lifetime suicidality, respectively. Findings may not be generalizable to all Nepali widows; participants were recruited from a non-governmental organization, from Kathmandu and its neighboring districts, and were primarily of reproductive age. While PCBD symptoms proposed in DSM-5 were mentioned as relevant by study participants, some components may need adaptation for use in non-Western settings, such as Nepal.

Rectal bleeding and implications for surgical care in Nepal.

PubMed

Tessler, Robert; Gupta, Shailvi; Pathak, John; Ghimire, Pranita; Kingham, Thomas P; Kushner, Adam L; Amatya, Kapendra Shekhar; Nwomeh, Benedict C

2015-07-01

Because rectal bleeding is a cardinal symptom of many colorectal diseases including colorectal cancers, its presence alone could give insight into the prevalence of these conditions where direct population screening is lacking. In South Asia, which is home to over one fifth of the world's population, there is paucity of epidemiologic data on colorectal diseases, particularly in the lower-income countries such as Nepal. The aim of this study was to enumerate the prevalence of rectal bleeding in Nepal and increase understanding of colorectal diseases as a health problem in the South Asian region. A countrywide survey using the Surgeons OverSeas Assessment of Surgical Need tool was administered from May 25-June 12, 2014 in 15 of the 75 districts of Nepal, randomly selected proportional to population. In each district, three Village Development Committees were selected randomly, two rural and one urban based on the Demographic Health Survey methodology. Individuals were interviewed to determine the period and point prevalence of rectal bleeding and patterns of health-seeking behavior related to surgical care for this problem. Individuals aged >18 y were included in this analysis. A total of 1350 households and 2695 individuals were surveyed with a 97% response rate. Thirty-eight individuals (55% male) of the 1941 individuals ≥ 18 y stated they had experienced rectal bleeding (2.0%, 95% confidence interval 1.4%-2.7%), with a mean age of 45.5 (standard deviation 2.2). Of these 38 individuals, 30 stated they currently experience rectal bleeding. Health Care was sought in 18 participants with current rectal bleeding, with two major procedures performed, one an operation for an anal fistula. For those who sought health care but did not receive surgical care, reasons included no need (4), not available (6), fear and/or no trust (5), and no money for health care (1). For those with current rectal bleeding who did not seek health care, reasons included no need (1), not available (2), fear and/or no trust (6), and no money for health care (3). Twenty-three individuals had an unmet surgical need secondary to rectal bleeding (1.2%, 95% confidence interval 0.8%-1.8%). The Nepal health care system at present does not emphasize the importance of surveillance colonoscopies or initial diagnostics by a primary care physician for rectal bleeding. Our data demonstrate limited access for patients to undergo evaluation of rectal bleeding by a health care professional and that potentially there are people in Nepal with rectal bleeding that may have undiagnosed colorectal cancer. Further advocacy for preventative medicine and easier access to surgical care in lower-income countries is crucial to avoid emergency surgeries, advanced stage malignancies, or fatalities from treatable conditions. Copyright © 2015 Elsevier Inc. All rights reserved.

Operationalizing crop monitoring system for informed decision making related to food security in Nepal

NASA Astrophysics Data System (ADS)

Qamer, F. M.; Shah, S. N. Pd.; Murthy, M. S. R.; Baidar, T.; Dhonju, K.; Hari, B. G.

2014-11-01

In Nepal, two thirds of the total population depend on agriculture for their livelihoods and more than one third of Gross Domestic Product (GDP) comes from the agriculture sector. However, effective agriculture production across the country remains a serious challenge due to various factors, such as a high degree of spatial and temporal climate variability, irrigated and rain-fed agriculture systems, farmers' fragile social and economic fabric, and unique mountain practices. ICIMOD through SERVIR-Himalaya initiative with collaboration of Ministry of Agricultural Development (MoAD) is working on developing a comprehensive crop monitoring system which aims to provide timely information on crop growth and drought development conditions. This system analyzes historical climate and crop conditions patterns and compares this data with the current growing season to provide timely assessment of crop growth. Using remote sensing data for vegetation indices, temperature and rainfall, the system generated anomaly maps are inferred to predict the increase or shortfall in production. Comparisons can be made both spatially and in graphs and figures at district and Village Developmental Committee (VDC) levels. Timely information on possible anomaly in crop production is later used by the institutions like Ministry of Agricultural Development, Nepal and World Food Programme, Nepal to trigger appropriate management response. Future potential includes integrating data on agricultural inputs, socioeconomics, demographics, and transportation to holistically assess food security in the region served by SERVIR-Himalaya.

Prevalence and Associated Factors of Hypertension: A Community-Based Cross-Sectional Study in Municipalities of Kathmandu, Nepal

PubMed Central

Pandey, Achyut Raj; Devkota, Surya

2016-01-01

Objective. This study aimed to assess the prevalence and associated factors of hypertension in newly declared municipalities of Kathmandu, Nepal. Design, Settings, and Participants. This was a community-based cross-sectional study conducted in the municipalities of Kathmandu District, Nepal, between January and July 2015. Study participants were aged 18 to 70 years, residing permanently in the study sites. Municipalities, Wards, households, and respondents were selected randomly. Results. Of the 587 participants, 58.8% were females, mean (SD) age was 42.3 (13.5) years, 29.3% had no formal education, 35.1% were Brahmins, and 41.2% were homemakers. Prevalence of hypertension was 32.5% (95% CI: 28.7–36.3). Age, gender, education, ethnicity, occupation, smoking, alcohol consumption, physical activity, diabetes, menopausal history, and family history of cardiovascular disease (CVD) and hypertension were significantly associated with hypertension. In multivariable analysis, smoking, alcohol consumption, physical activity, body mass index, and diabetes were identified as significant explanatory variables for hypertension. Conclusion. This study demonstrated that the people living in newly established municipalities of Kathmandu, Nepal, have a high burden of hypertension as well as its associated factors. Therefore, community-based preventive approaches like lifestyle modification and early detection and treatment of hypertension might bring a substantial change in tackling the burden effectively. PMID:27293880

Seasonal fuel consumption, stoves, and end-uses in rural households of the far-western development region of Nepal

NASA Astrophysics Data System (ADS)

Lam, Nicholas L.; Upadhyay, Basudev; Maharjan, Shovana; Jagoe, Kirstie; Weyant, Cheryl L.; Thompson, Ryan; Uprety, Sital; Johnson, Michael A.; Bond, Tami C.

2017-12-01

Understanding how fuels and stoves are used to meet a diversity of household needs is an important step in addressing the factors leading to continued reliance on polluting devices, and thereby improving household energy programs. In Nepal and many other countries dependent on solid fuel, efforts to mitigate the impacts of residential solid fuel use have emphasized cooking while focusing less on other solid fuel dependent end-uses. We employed a four-season fuel assessment in a cohort of 110 households residing in two elevation regions of the Far-Western Development Region (Province 7) of Nepal. Household interviews and direct fuel weights were used to assess seasonality in fuel consumption and its association with stoves that met cooking and non-cooking needs. Per-capita fuel consumption in winter was twice that of other measured seasons, on average. This winter increase was attributed to greater prevalence of use and fuel consumption by supplemental stoves, not the main cooking stove. End-use profiles showed that fuel was used in supplemental stoves to meet the majority of non-meal needs in the home, notably water heating and preparation of animal food. This emphasis on fuels, stoves, and the satisfaction of energy needs—rather than just stoves or fuels—leads to a better understanding of the factors leading to device and fuel choice within households.

Design and implementation of an affordable, public sector electronic medical record in rural Nepal.

PubMed

Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha Bangura, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

2017-06-23

Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.

Design and implementation of an affordable, public sector electronic medical record in rural Nepal

PubMed Central

Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

2018-01-01

Introduction Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility. Development The electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. Application For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal. Discussion Over the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty. PMID:28749321

Distribution and habitat use of red panda in the Chitwan-Annapurna Landscape of Nepal

PubMed Central

Sherpa, Peema; Thapa, Gokarna Jung; Kokh, Manish; Lama, Sonam Tashi; Khanal, Kapil; Thapa, Arjun; Jnawali, Shant Raj

2017-01-01

In Nepal, the red panda (Ailurus fulgens) has been sparsely studied, although its range covers a wide area. The present study was carried out in the previously untapped Chitwan-Annapurna Landscape (CHAL) situated in central Nepal with an aim to explore current distributional status and identify key habitat use. Extensive field surveys conducted in 10 red panda range districts were used to estimate species distribution by presence-absence occupancy modeling and to predict distribution by presence-only modeling. The presence of red pandas was recorded in five districts: Rasuwa, Nuwakot, Myagdi, Baglung and Dhading. The predictive distribution model indicated that 1,904.44 km2 of potential red panda habitat is available in CHAL with the protected area covering nearly 41% of the total habitat. The habitat suitability analysis based on the probability of occurrence showed only 16.58% (A = 315.81 km2) of the total potential habitat is highly suitable. Red Panda occupancy was estimated to be around 0.0667, indicating nearly 7% (218 km2) of the total habitat is occupied with an average detection probability of 0.4482±0.377. Based on the habitat use analysis, altogether eight variables including elevation, slope, aspect, proximity to water sources, bamboo abundance, height, cover, and seasonal precipitation were observed to have significant roles in the distribution of red pandas. In addition, 25 tree species were documented from red panda sign plots out of 165 species recorded in the survey area. Most common was Betula utilis followed by Rhododendron spp. and Abies spectabilis. The extirpation of red pandas in previously reported areas indicates a need for immediate action for the long-term conservation of this species in CHAL. PMID:29020020

Distribution and habitat use of red panda in the Chitwan-Annapurna Landscape of Nepal.

PubMed

Bista, Damber; Shrestha, Saroj; Sherpa, Peema; Thapa, Gokarna Jung; Kokh, Manish; Lama, Sonam Tashi; Khanal, Kapil; Thapa, Arjun; Jnawali, Shant Raj

2017-01-01

In Nepal, the red panda (Ailurus fulgens) has been sparsely studied, although its range covers a wide area. The present study was carried out in the previously untapped Chitwan-Annapurna Landscape (CHAL) situated in central Nepal with an aim to explore current distributional status and identify key habitat use. Extensive field surveys conducted in 10 red panda range districts were used to estimate species distribution by presence-absence occupancy modeling and to predict distribution by presence-only modeling. The presence of red pandas was recorded in five districts: Rasuwa, Nuwakot, Myagdi, Baglung and Dhading. The predictive distribution model indicated that 1,904.44 km2 of potential red panda habitat is available in CHAL with the protected area covering nearly 41% of the total habitat. The habitat suitability analysis based on the probability of occurrence showed only 16.58% (A = 315.81 km2) of the total potential habitat is highly suitable. Red Panda occupancy was estimated to be around 0.0667, indicating nearly 7% (218 km2) of the total habitat is occupied with an average detection probability of 0.4482±0.377. Based on the habitat use analysis, altogether eight variables including elevation, slope, aspect, proximity to water sources, bamboo abundance, height, cover, and seasonal precipitation were observed to have significant roles in the distribution of red pandas. In addition, 25 tree species were documented from red panda sign plots out of 165 species recorded in the survey area. Most common was Betula utilis followed by Rhododendron spp. and Abies spectabilis. The extirpation of red pandas in previously reported areas indicates a need for immediate action for the long-term conservation of this species in CHAL.

Rapid field-based landslide hazard assessment in response to post-earthquake emergency

NASA Astrophysics Data System (ADS)

Frattini, Paolo; Gambini, Stefano; Cancelliere, Giorgio

2016-04-01

On April 25, 2015 a Mw 7.8 earthquake occurred 80 km to the northwest of Kathmandu (Nepal). The largest aftershock, occurred on May 12, 2015, was the Mw 7.3 Nepal earthquake (SE of Zham, China), 80 km to the east of Kathmandu. . The earthquakes killed ~9000 people and severely damaged a 10,000 sqkm region in Nepal and neighboring countries. Several thousands of landslides have been triggered during the event, causing widespread damages to mountain villages and the evacuation of thousands of people. Rasuwa was one of the most damaged districts. This contribution describes landslide hazard analysis of the Saramthali, Yarsa and Bhorle VDCs (122 km2, Rasuwa district). Hazard is expressed in terms of qualitative classes (low, medium, high), through a simple matrix approach that combines frequency classes and magnitude classes. The hazard analysis is based primarily on the experience gained during a field survey conducted in September 2014. During the survey, local knowledge has been systematically exploited through interviews with local people that have experienced the earthquake and the coseismic landslides. People helped us to recognize fractures and active deformations, and allowed to reconstruct a correct chronicle of landslide events, in order to assign the landslide events to the first shock, the second shock, or the post-earthquake 2015 monsoon. The field experience was complemented with a standard analysis of the relationship between potential controlling factors and the distribution of landslides reported in Kargel et al (2016). This analysis allowed recognizing the most important controlling factor. This information was integrated with the field observations to verify the mapped units and to complete the mapping in area not accessible for field activity. Finally, the work was completed with the analysis and the use of a detailed landslide inventory produced by the University of Milano Bicocca that covers most of the area affected by coseismic landslides in Nepal (Valagussa et al, 2016). As a result, a 1:10.000 hazard map was produced. About 47% of the area is classified at high hazard, almost 19 % at medium level and 34% at low risk. In addition, the hazard map reports 262 polygons of active coseismic or postseismic landslides.

Impact of Spiritual Behavior on Self-Reported Illness: A Cross-Sectional Study among Women in the Kailali District of Nepal.

PubMed

Ranabhat, Chhabi Lal; Kim, Chun-Bae; Park, Myung-Bae; Bajgai, Johny

2018-01-01

Different health behaviors influence health and illness. Spiritual well-being is one of the most important aspects of health promotion. The aim of this study was to identify the association between spiritual behavior in relation to meditation, worship, and physical exercise during yoga with self-reported disease/illness among women of the Kailali district of Nepal. This was a cross-sectional study with 453 randomly selected women in the Kailali district of Nepal within 1 municipality and 4 village development committees (VDC) using cluster sampling. We used a semi-structured interview to collect the data for selected respondents. Socioeconomics, lifestyle, self-care, and spiritual behavior variables were independent variables, and self-reported illness in the past year was a dependent variable. Descriptive statistics, chi square, hierarchical logistic regression for odds ratio, and 95% CI were used when appropriate. Study results showed that 89% of participants were from the rural area, 29.3% were housewives, 51.4% had no formal education, 43.2% used tobacco, 42.1% did yoga, and 16.9% engaged in regular worship. Self-reported illness was associated with safe toilet-using behavior, tobacco use, junk food consumption, yoga and regular exercise, worship, and regular sleeping habits. Comparing odds ratios and 95% CIs, the women who had safe toilet behavior and did not use tobacco were 2.48 (1.98-7.98) and 2.86 (1.74-7.34) times less likely to be ill, respectively. Likewise, women who consumed junk food; did not regularly exercise, meditate, or worship; and had irregular sleeping habits were 1.65 (1.32-4.61), 2.81(1.91-5.62), 2.56 (2.01-4.88), 4.56 (3.91-8.26), and 2.45 (2.12-5.03) times more likely to become ill, respectively. Our study concludes that spiritual behavior is effective for better health and low risk for disease occurrence. A spiritual health policy and separate curriculum for basic education and medical education should be promoted globally, and further research is recommended.

Nutritional assessment of community-dwelling older adults in rural Nepal

PubMed Central

Ghimire, Saruna; Baral, Binaya Kumar; Callahan, Karen

2017-01-01

Background Demographic transition in Nepal, like in many developing countries, has resulted in a burgeoning elderly population whose health status is not currently monitored. One pillar of health is adequate nutrition. Yet, little is known about the nutritional health status of the elderly in Nepal. The financial, material, and personnel limitations in Nepal’s health delivery services necessitate health screening instruments that require minimal clinical staff and resources. To our knowledge, no such nutritional assessment tool has been validated in Nepal. Therefore, our aims are two-fold: To assess the nutritional status of the elderly population in one typical Nepali village, Okharpauwa, in Nuwakot District, Nepal; and concurrently, to validate the Mini Nutritional Assessment (MNA) tool. Methods A cross-sectional field study was conducted with a sample of 242 elderly people in Okharpauwa, Nepal to obtain prevalence of malnutrition. Differences in demographic and lifestyle factors between these who were malnourished, those at risk of malnourishment, and those who had adequate nutritional status were analyzed. The MNA tool was evaluated using receiver operating characteristic (ROC) curve analysis; sensitivity, specificity, and diagnostic accuracy were calculated. Results 111 males and 131 females, with a mean age of 69.8±7.4 years, participated in this study. The mean BMI of the participants was 21.4±3.9 kg/m2; the mean MNA score was 19.3±4.2. BMI was significantly correlated with the total MNA score (r = 0.58; p<0.001). The diagnostic accuracy, sensitivity and specificity of MNA were 81%, 86% and 67% respectively. Of the 242 elderly sampled, 24% were malnourished and 65% were at risk of malnutrition. Malnutrition was more prevalent among females (29%) than males (18%), and most prevalent among the marginalized Dalit ethnic group (40%). Elderly persons who were married and literate had better nutritional health than their counterparts. Conclusions The MNA appears to be a valid and sensitive tool for rapid nutritional screening of the elderly in Nepal. The prevalence of malnutrition was high among Nepalese elderly in the Okharpauwa VDC, which requires urgent health monitoring and management attention. PMID:28196115

Association of water handling and child feeding practice with childhood diarrhoea in rural community of Southern Nepal.

PubMed

Acharya, Dilaram; Singh, Jitendra K; Adhikari, Mandira; Gautam, Salila; Pandey, Pragya; Dayal, Vinita

Diarrhoea is a major cause of childhood morbidity and mortality globally. While the childhood diarrhoea and its association with child feeding, and hygiene, hand washing and water treatment are studied elsewhere, the association of water handling and child feeding with childhood diarrhoea is an understudied area in Nepal. This study aimed to investigate the association of water handling and child feeding practice with childhood diarrhoea among children of one to five years of age in Southern, Nepal. A cross-sectional study was conducted in the Dhanusha district of Southern Nepal in 2013. A total of 284 mother-child pairs were selected using systemic random sampling. A four-week prevalence of childhood diarrhoea was reported using frequency distribution. The association of childhood diarrhoea with water handling and child feeding practices was ascertained using multiple logistic regressions after adjusting for potential confounders. The result of the study demonstrated that the four-week prevalence of childhood diarrhoea was 36.6%. Our finding showed that unsafe water handling practices were associated independently with childhood diarrhoea: untreated water (aOR 3.55; 95% CI: 1.13-11.10), uncovered water (aOR 2.14; 95% CI: 1.09-4.19). Similarly, partial breast feeding (aOR 4.35; 95% CI: 1.87-10.12) was also associated with higher odds of childhood diarrhoea. One third of children in Southern Nepal still had diarrhoea within the four weeks preceding the survey. As poor water handling and sub optimal infant feeding practice were major risk factors contributing to such a high burden of the disease, health promotion strategies such as promotion of safe water handling, improved hygiene and child feeding practices are recommended for the prevention of childhood diarrhoea in Southern Terai of Nepal. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Knowledge, attitude and practice regarding dengue fever among the healthy population of highland and lowland communities in central Nepal.

PubMed

Dhimal, Meghnath; Aryal, Krishna Kumar; Dhimal, Mandira Lamichhane; Gautam, Ishan; Singh, Shanker Pratap; Bhusal, Chop Lal; Kuch, Ulrich

2014-01-01

Dengue fever (DF) is the most rapidly spreading mosquito-borne viral disease in the world. In this decade it has expanded to new countries and from urban to rural areas. Nepal was regarded DF free until 2004. Since then dengue virus (DENV) has rapidly expanded its range even in mountain regions of Nepal, and major outbreaks occurred in 2006 and 2010. However, no data on the local knowledge, attitude and practice (KAP) of DF in Nepal exist although such information is required for prevention and control measures. We conducted a community based cross-sectional survey in five districts of central Nepal between September 2011 and February 2012. We collected information on the socio-demographic characteristics of the participants and their knowledge, attitude and practice regarding DF using a structured questionnaire. We then statistically compared highland and lowland communities to identify possible causes of observed differences. Out of 589 individuals interviewed, 77% had heard of DF. Only 12% of the sample had good knowledge of DF. Those living in the lowlands were five times more likely to possess good knowledge than highlanders (P<0.001). Despite low knowledge levels, 83% of the people had good attitude and 37% reported good practice. We found a significantly positive correlation among knowledge, attitude and practice (P<0.001). Among the socio-demographic variables, the education level of the participants was an independent predictor of practice level (P<0.05), and education level and interaction between the sex and age group of the participants were independent predictors of attitude level (P<0.05). Despite the rapid expansion of DENV in Nepal, the knowledge of people about DF was very low. Therefore, massive awareness programmes are urgently required to protect the health of people from DF and to limit its further spread in this country.

Knowledge, Attitude and Practice Regarding Dengue Fever among the Healthy Population of Highland and Lowland Communities in Central Nepal

PubMed Central

Dhimal, Meghnath; Aryal, Krishna Kumar; Dhimal, Mandira Lamichhane; Gautam, Ishan; Singh, Shanker Pratap; Bhusal, Chop Lal; Kuch, Ulrich

2014-01-01

Background Dengue fever (DF) is the most rapidly spreading mosquito-borne viral disease in the world. In this decade it has expanded to new countries and from urban to rural areas. Nepal was regarded DF free until 2004. Since then dengue virus (DENV) has rapidly expanded its range even in mountain regions of Nepal, and major outbreaks occurred in 2006 and 2010. However, no data on the local knowledge, attitude and practice (KAP) of DF in Nepal exist although such information is required for prevention and control measures. Methods We conducted a community based cross-sectional survey in five districts of central Nepal between September 2011 and February 2012. We collected information on the socio-demographic characteristics of the participants and their knowledge, attitude and practice regarding DF using a structured questionnaire. We then statistically compared highland and lowland communities to identify possible causes of observed differences. Principal Findings Out of 589 individuals interviewed, 77% had heard of DF. Only 12% of the sample had good knowledge of DF. Those living in the lowlands were five times more likely to possess good knowledge than highlanders (P<0.001). Despite low knowledge levels, 83% of the people had good attitude and 37% reported good practice. We found a significantly positive correlation among knowledge, attitude and practice (P<0.001). Among the socio-demographic variables, the education level of the participants was an independent predictor of practice level (P<0.05), and education level and interaction between the sex and age group of the participants were independent predictors of attitude level (P<0.05). Conclusion Despite the rapid expansion of DENV in Nepal, the knowledge of people about DF was very low. Therefore, massive awareness programmes are urgently required to protect the health of people from DF and to limit its further spread in this country. PMID:25007284

Intimate partner violence during pregnancy and use of antenatal care among rural women in southern Terai of Nepal.

PubMed

Singh, Jitendra Kumar; Evans-Lacko, Sara; Acharya, Dilaram; Kadel, Rajendra; Gautam, Salila

2018-04-01

Underutilisation of antenatal care services due to intimate partner violence during pregnancy has been well documented elsewhere, but it is understudied in Nepal. Our study aimed at exploring the impact of intimate partner violence on antenatal care service utilisation in southern Terai of Nepal. A community-based cross-sectional study was performed in 6 village development committees in Dhanusha district, Nepal. A total of 426 pregnant women in their second trimester were selected using a multistage cluster sampling method. Multivariable regression analyses were used to examine the association between exposure to intimate partner violence and selected antenatal care services, adjusting for covariates. Among 426 pregnant women, almost three out of ten women (28.9%) were exposed to intimate partner violence at some point during their pregnancy. Pregnant women who were exposed to intimate partner violence were less likely to: register for antenatal care (OR 0.31; 95% CI (0.08-0.50)), take iron and folic acid (OR 0.55; 95% CI (0.12-0.90)), report dietary diversity (middle vs low: OR 0.34; 95% CI (0.11-0.58) and high vs low: OR 0.18; 95% CI (0.08-0.37)), have rest and sleep during day time (OR 0.47; 95% CI (0.61-0.58)), and attend mother's group meetings (OR 0.29; 95% CI (0.10-0.83)). Intimate partner violence during pregnancy is associated with low utilisation of antenatal care services. Therefore, effective strategies to prevent or reduce intimate partner violence during pregnancy is needed, which may lead to improved antenatal care service utilization in Nepal with healthier mothers and children's outcome. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Chronic pain experience and pain management in persons with spinal cord injury in Nepal.

PubMed

Thapa, Sagun; Kitrungrote, Luppana; Damkliang, Jintana

2018-04-25

Chronic pain is the frequent and significantly challenging complications in persons with spinal cord injury (SCI). Socio-cultural background may lead people perceive and manage pain differently. The study aims to describe the chronic pain experience and pain management of SCI persons in Nepal. A descriptive cross sectional study was conducted among purposively selected sample of 120 SCI persons with chronic pain living in the eight districts of Bagmati Zone of Nepal. The data were collected using the International Spinal Cord Injury Pain Basic Data Set Version 2 (ISCIPBDS-2) and Open-ended Pain Management Questionnaire. The data were analyzed using descriptive statistics and content analysis method. The back (n=84), lower legs/feet (n=63) and buttocks/hips (n=51) was found as the common pain locations. In common, the onset of pain was found within the first 6 month of the injury. Overall pain intensity and pain interference were found to be at the moderate level. The SCI persons used pain medications and non-pharmacological pain management. Ibuprofen was the commonly used pain medication and commonly used non-pharmacological pain management methods included physical support (e.g. massage, exercise), relaxation (e.g. distraction, substance abuse), coping (e.g. acceptance, praying), and traditional herbs. SCI persons had chronic pain experience which interfered with their daily living. They used pain medications and non-pharmacological pain management methods based on their beliefs, knowledge, and community resources in Nepal. This study provides some evidence to help the team of rehabilitation professional to plan and help SCI persons with chronic pain. Based on these findings, chronic pain management intervention for SCI persons should be developed and supported continuously from hospital to home based community context of Nepal.

Re-emergence of dengue virus serotype 2 strains in the 2013 outbreak in Nepal

PubMed Central

Gupta, Birendra Prasad; Singh, Sneha; Kurmi, Roshan; Malla, Rajani; Sreekumar, Easwaran; Manandhar, Krishna Das

2015-01-01

Background & objectives: Epidemiological interventions and mosquito control are the available measures for dengue control. The former approach uses serotype and genetic information on the circulating virus strains. Dengue has been frequently reported from Nepal, but this information is mostly lacking. The present study was done to generate a comprehensive clinical and virological picture of a dengue outbreak in Nepal during 2013. Methods: A hospital-based study involving patients from five districts of Nepal was carried out. Demographic information, clinical details and dengue serological status were obtained. Viral RNA was characterized at the molecular level by reverse-transcription polymerase chain reaction (RT-PCR), nucleotide sequencing and phylogenetic analysis. Results: From among the 2340 laboratory-confirmed dengue cases during the study period, 198 patients consented for the study. Clinically they had fever (100%), headache (59.1%), rashes (18.2%), retro-orbital pain (30.3%), vomiting (15.1%), joint pain (28.8%) and thrombocytopenia (74.3%). Fifteen (7.5%) of them had mucosal bleeding manifestations, and the rest were uncomplicated dengue fever. The patients were mostly adults with a mean age of 45.75 ± 38.61 yr. Of the 52 acute serum samples tested, 15 were positive in RT-PCR. The causative virus was identified as DENV serotype 2 belonging to the Cosmopolitan genotype. Interpretations & conclusions: We report here the involvement of DENV serotype 2 in an outbreak in Nepal in 2013. Earlier outbreaks in the region in 2010 were attributed to serotype 1 virus. As serotype shifts are frequently associated with secondary infections and severe disease, there is a need for enhancing surveillance especially in the monsoon and post-monsoon periods to prevent large-scale, severe dengue outbreaks in the region. PMID:26905233

Diet and physical activity for children's health: a qualitative study of Nepalese mothers’ perceptions

PubMed Central

Oli, Natalia; Vaidya, Abhinav; Subedi, Madhusudan; Eiben, Gabriele; Krettek, Alexandra

2015-01-01

Objectives Non-communicable diseases account for 50% of all deaths in Nepal and 25% result from cardiovascular diseases. Previous studies in Nepal indicate a high burden of behavioural cardiovascular risk factors, suggesting a low level of knowledge, attitude and practice/behaviour regarding cardiovascular health. The behavioural foundation for a healthy lifestyle begins in early childhood, when mothers play a key role in their children's lives. This qualitative study, conducted in a Nepalese peri-urban community, aimed to explore mothers’ perception of their children's diet and physical activity. Design We notated, tape-recorded and transcribed all data collected from six focus group discussions, and used qualitative content analysis for evaluation and interpretation. Setting The study was conducted in the Jhaukhel-Duwakot Health Demographic Surveillance Site in the Bhaktapur district of Nepal. Participants Local health workers helped recruit 61 women with children aged 5–10 years. We distributed participants among six different groups according to educational status. Results Although participants understood the importance of healthy food, they misunderstood its composition, perceiving it as unappetising and appropriate only for sick people. Furthermore, participants did not prioritise their children's physical activities. Moreover, mothers believed they had limited control over their children's dietary habits and physical activity. Finally, they opined that health educational programmes would help mothers and recommended various intervention strategies to increase knowledge regarding a healthy lifestyle. Conclusions Our data reveal that mothers of young children in a peri-urban community of Nepal lack adequate and accurate understanding about the impact of a healthy diet and physical activity. Therefore, to prevent future cardiovascular disease and other non-communicable diseases among children, Nepal needs health education programmes to improve mothers’ cardiovascular health knowledge, attitude and behaviour. PMID:26351183

The impact of ocular trauma during the Nepal earthquake in 2015.

PubMed

Pradhan, E; Limbu, B; Thakali, S; Jain, N S; Gurung, R; Ruit, S

2017-03-28

Nepal was struck by a massive earthquake on the 25th April 2015 and major aftershock on the 12th of May 2015, resulting in widespread devastation with a death toll in the thousands. The burden of ocular trauma resulting from the recent earthquakes in Nepal has not been described thus far. The aim of this study was to determine the types of ocular injuries sustained in the earthquake in Nepal and its management in Tilganga Institute of Ophthalmology (TIO) in Gaushala, Kathmandu. This is a hospital-based retrospective study of patients presenting to TIO following repeated earthquake. Variables that were recorded included patients' presenting symptoms and time to presentation, visual acuities at presentation and at follow-up, diagnosis of ocular injury and surgery performed. There were 59 cases of earthquake victims visiting TIO, Gaushala, Kathmandu from April 2015 to July 2015, with 64 affected eyes due to 5 cases of bilateral involvement. The majority of patients were from the district Sindhupalchowk (14 cases, 23.7%), which was the epicenter of the main earthquake. The average duration between the earthquake and presentation was 13 · 9 days (range 1-120 days). Closed globe injury was most frequent (23 cases), followed by open globe injuries (8 cases). While 24 patients (38%) initially presented with a visual acuity <3/60 in their affected eye, 15 patients (23%) had a visual acuity of <3/60 on follow-up. A variety of surgical treatments were required including anterior and posterior segment repair. Immediate management of ocular trauma is critical in order to prevent blindness. Characterizing the burden of earthquake-related ocular trauma will facilitate planning for service provision in the event of a future earthquake in Nepal, or in countries, which are similarly at risk of having natural disasters.

TRADITIONAL USES OF PLANTS OF COMMONLAND HABITATS IN WESTERN CHITWAN, NEPAL

PubMed Central

Dangol, D.R.

2012-01-01

This paper is based on the flora data gathered from 138 common land plots as part of a multi-method longitudinal study of the reciprocal relations between population and environment in western Chitwan, Nepal. The paper also describes the uses and availability of different species drawing upon both field data and knowledge of indigenous and local residents in the study area. Land use in western Chitwan is changing rapidly and common land areas have been under much stress due to population increase, whereas the common land areas are valuable to local residents. Both indigenous and new migrant residents in this area use the available plant resources for different purposes which bring economic benefit to the households. Plant species provide valuable food, vegetable and medicinal products that maintain human health and general wellbeing of the household. These plants are also economically valuable to farmers with high quality forage value as well as useful for crop management (e.g., pesticide, compost, green manure). Moreover, some plant species are used as fish poison to harvest fish from rivers and streams. Likewise, the common land areas provide materials for use in house construction (e.g., thatch) and making tools with the potential and viable sites as communal grazing land. It is evident that access and utilization of common land resources are important for many households, especially those in remote and poor agricultural areas such as western Chitwan. PMID:22945971

Factor Structure of Scores from the Conners’ Rating Scales–Revised Among Nepali Children

PubMed Central

Pendergast, Laura L.; Vandiver, Beverly J.; Schaefer, Barbara A.; Cole, Pamela M.; Murray-Kolb, Laura M.; Christian, Parul

2014-01-01

This study used exploratory and confirmatory factor analyses to examine the structures of scores from the Conners’ Teacher and Parent Rating Scales–Revised (CTRS-R and CPRS-R, respectively; Conners, 1997). The scales were administered to 1,835 parents and 1,387 teachers of children in Nepal's Sarlahi district – a region where no other measures of child psychopathology have been studied. With a Nepali sample, the findings indicate that reduced two factor models for the Conners’ scales are superior to the models identified in the scale development research. The hyperactivity and inattention factors were comparable to what has been identified in prior research, while other factors (e.g., social problems) differed substantially. Implications for use of the Conners’ scales in Nepal and cross cultural issues in the assessment of ADHD symptoms are discussed. PMID:25574454

Status of intestinal parasitosis among hospital visiting patients in Deukhury Valley, Dang, Nepal.

PubMed

Khanal, L K; Rai, S K; Khanal, P R; Ghimire, G

2011-06-01

Intestinal parasitosis is highly prevalent among the general population in Nepal. This study aimed to assess the status of intestinal parasitosis among patients attending Deukhury Community Hospital, Lamahi, Dang, situated in the mid western region of Nepal. A total of 210 stool samples examined by direct smear technique were reported. The overall prevalence of intestinal parasitic infection was found to be 21.4% (M = 23.5% vs F = 19.3%). Children < 15 yrs age were infected more often as compared to > 60 yrs and 15-60 yrs aged people. Among adults, Entamoeba histolytica infection was found to be very high compared to high helminthic infection found among children. Finding showed that, the prevalence was significantly high (68.8%) among people having low socio-economic status compared to others (31.1%) (p < 0.05). Among various parasites detected, E. histolytica was the most common parasite (48.8%) followed by helminths, mainly Ascaris lumbricoides (31.1%), hookworm (13.3%), Trichuris trichiura (4.4%) and Taenia species (2.2%) respectively in the locality.

Indirect exposure to a family planning mass media campaign in Nepal.

PubMed

Boulay, Marc; Storey, J Douglas; Sood, Suruchi

2002-01-01

It is often noted that some individuals become aware of a mass media program's messages through discussions with other individuals. However, the extent to which indirect exposure occurs, and its influence on behavior, are somewhat unclear. This study examines the role of indirect exposure in extending the reach of a family planning mass media campaign in Nepal. Sociometric data, gathered from nearly all women between the ages of 15 and 49 years living in six villages in Dang District, Nepal (N = 667), assessed indirect exposure to the radio program. Indirect exposure was extensive; half of all respondents were indirectly exposed to the program's messages and the overall reach of the program increased from 50% to 75% when indirect exposure was considered. Members of community groups had higher levels of direct exposure to the radio program and more extensive and diverse social networks, allowing them to serve as a conduit for these messages into the wider community. While direct exposure to the radio program appeared to influence family planning knowledge, indirect exposure was more strongly associated with contraceptive use. These findings suggest that program evaluations that ignore indirect exposure underestimate the impact of a mass media program on behavior.

Self-reported health problems, health care utilisation and unmet health care needs of elderly men and women in an urban municipality and a rural area of Bhaktapur District of Nepal.

PubMed

Kshetri, Dan B B; Smith, William C S

2011-06-01

The study aimed to identify the felt common health problems, utilisation of health services and unmet needs of urban and rural elderly people of Bhaktapur district, Nepal. It was a cross sectional population study of people aged 60 years or more where 204 respondents were interviewed in 2009. The common felt problems were pain and swelling of joints (65.7%), indigestion (63.7%), excessive tiredness (38.2%) and hypertension (35.8%). Pain and swelling of joints (72.5%) and back pain (40.4%) were higher in rural elderly population whereas indigestion (67.6%) and hypertension (37.85%) were higher in urban population. Pain and swelling of joints (66.7%) and indigestion (69.6%) were higher in males, and hypertension (50.0%), back pain (38.2%) and chronic bronchitis/asthma (39.2%) were higher in females. The unmet needs varied between different health problems. In general women had more unmet needs than men, where 80 unmet needs were identified for the 102 men compared with 105 for the 102 women, and these unmet needs increased dramatically with age. This approach yields new insights into the health care needs of the elderly and will be helpful to health care planners.

Strategic rehabilitation of the earthquake affected microhydropower plants in Nepal

NASA Astrophysics Data System (ADS)

Baidar, B.; Koirala, R.; Neopane, H. P.; Shrestha, M. V.; Thapa, B.

2016-11-01

Most people in the rural areas of Nepal rely on Micro-hydro Power Plants (MHPs) for their energy sources. With around four decade experiences in design and development of MHPs, Nepalese techno-entrepreneurs have gained wider reputation in the South Asian region and the beyond. However with the lack of competences in developing Francis turbines, majority of the MHPs are equipped with either Pelton of Cross Flow turbine, even though Francis units are suitable. With the devastating earthquake of a 7.6 magnitude that struck in the Gorkha district on Saturday, 25 April 2015, about 76 km northwest of the capital city Kathmandu, and the aftershocks followed claimed more than 8000 lives. It did not leave hydropower plants either. Many big plants have been affected and hundreds of MHPs were damaged, needing short to long term rehabilitation. The preliminary assessment of the 61 affected MHPs in the 6 earthquake affected districts shows more than 50% sites are suitable for Francis turbine. Hence the strategic rehabilitation plan has been developed in the present paper for the affected plants considering issues like geographical shift, dislocation of people and also with the focus on replacing the old turbine with Francis turbine in the suitable sites. The similar strategy can also be implemented in other developing countries with such situations.

Medicinal plants used by the Tamang community in the Makawanpur district of central Nepal

PubMed Central

2014-01-01

Background We can conserve cultural heritage and gain extensive knowledge of plant species with pharmacological potential to cure simple to life-threatening diseases by studying the use of plants in indigenous communities. Therefore, it is important to conduct ethnobotanical studies in indigenous communities and to validate the reported uses of plants by comparing ethnobotanical studies with phytochemical and pharmacological studies. Materials and methods This study was conducted in a Tamang community dwelling in the Makawanpur district of central Nepal. We used semi-structured and structured questionnaires during interviews to collect information. We compared use reports with available phytochemical and pharmacological studies for validation. Results A total of 161 plant species belonging to 86 families and 144 genera to cure 89 human ailments were documented. Although 68 plant species were cited as medicinal in previous studies, 55 different uses described by the Tamang people were not found in any of the compared studies. Traditional uses for 60 plant species were consistent with pharmacological and phytochemical studies. Conclusions The Tamang people in Makawanpur are rich in ethnopharmacological understanding. The present study highlights important medicinal plant species by validating their traditional uses. Different plant species can improve local economies through proper harvesting, adequate management and development of modern techniques to maximize their use. PMID:24410808

Association between socioeconomic status of mothers, food security, food safety practices and the double burden of malnutrition in the Lalitpur district, Nepal.

PubMed

Sarki, Mahesh; Robertson, Aileen; Parlesak, Alexandr

2016-01-01

The prevalence of childhood overweight and obesity is increasing in low-and middle income countries such as Nepal. At the same time, high prevalence of chronic undernutrition persists leading to a double burden of malnutrition. To identify associations between the socioeconomic status of mothers, food security, the food safety environment within the household, and prevalence of stunting and overweight of the children. Statistical analysis of socioeconomic, food safety-related and anthropometric data from 289 mother-child dyads in an urban area of the Kathmandu Valley, Nepal. According to WHO standards, 26 % of the children, aged 0-59 months, were stunted, 10 % were underweight, and 6.6 % were either overweight or obese. Significantly more boys than girls were underweight (p = 0.004) and stunted (p < 0.001). The higher education level of mothers was associated with a higher height-for-age (HAZ) score in girls, but not with HAZ in boys. Irrespective of sex, children of mothers with highest education level had significantly lower BMI-for-age scores (BAZ) than those of mothers with low education levels. None of the food safety indicators were associated with either HAZ or the BAZ. The education level of mothers seems to be relevant to help reduce the double burden of malnutrition at least in some regions of Nepal. This should be taken into consideration when designing programmes to prevent both chronic undernutrition and non-communicable diseases.

Blue sheep in the Annapurna Conservation Area, Nepal: habitat use, population biomass and their contribution to the carrying capacity of snow leopards.

PubMed

Aryal, Achyut; Brunton, Dianne; Ji, Weihong; Raubenheimer, David

2014-01-01

The Himalaya region of Nepal provides a habitat for the endangered snow leopard (Panthera uncia) and its principal prey species, the blue sheep (Pseudois nayaur). The aim of this study was to describe the habitat, the distribution and the population structure of blue sheep, and to estimate their contribution to the carrying capacity of snow leopard in the upper Mustang region of Nepal. Blue sheep were recorded at altitudes from 3209-5498 m on slopes with gradients of 16-60° and aspects of 40°NE to 140°SE. A total of 939 blue sheep were counted in the upper Mustang region, and 98 were counted in the Yak Kharka region of Manang district; however, upper Mustang had the lowest population density of blue sheep recorded within their distribution range in Nepal (0.86 blue sheep/km(2)). The results of the study show that a higher density of blue sheep is associated with greater plant species diversity. The most important species present in the blue sheep habitat were Kobresia pygmaea, Artemesia spp., Lonicera spp., Lancea tibetica, Poa spp., Astragalus spp. and Ephedra gerardiana. It is estimated that the existing blue sheep population biomass of approximately 38 925 kg in the upper Mustang region could support approximately 19 snow leopards (1.6 snow leopards/100 km(2)). © 2012 Wiley Publishing Asia Pty Ltd, ISZS and IOZ/CAS.

Age at first marriage in Nepal: differentials and determinants.

PubMed

Aryal, Tika Ram

2007-09-01

The aim of this paper is to investigate the differentials and determinants of female age at first marriage in rural Nepal. The life table technique was employed to calculate median age at marriage. The proportional hazard model was used to study the effect of various socioeconomic variables, and to identify the magnitude and significance of their effects on the timing of first marriage. The data were taken from a sample survey of Palpa and Rupandehi districts in rural Nepal. Both married and unmarried females of marriageable age were included in the survey. Median age at marriage was about 17 years for data from only married females, whereas it was about 18 years for data from married as well as unmarried females of marriageable age. Median age at marriage was about 16 years for uneducated females and 19 years for females educated up to intermediate or higher level. The analysis underestimates the median age at marriage for married females, probably due to right censoring. The risk of getting married early decreased gradually with increasing year-of-birth cohort. The risk of early marriage was higher among females of high socioeconomic status compared with those of low socioeconomic status. Females engaged in service married earlier than those engaged in household work. High socioeconomic status families are motivated, for religious and prestige reasons, to get their daughters married at an early age, preferably before menarche. Thus, education, occupation and age at menarche are the most powerful factors in deciding the timing of first marriage in Nepal.

12 CFR 4.5 - District and field offices.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., northeast and southeast Iowa, central Kentucky, Michigan, Minnesota, eastern Missouri, North Dakota, Ohio..., Mississippi, Oklahoma, Tennessee, and Texas. Western District Office of the Comptroller of the Currency, 1225... and western Iowa, Kansas, western Missouri, Montana, Nebraska, Nevada, New Mexico, Oregon, South...

Different hematologic responses to hypoxia in Sherpas and Quechua Indians.

PubMed

Winslow, R M; Chapman, K W; Gibson, C C; Samaja, M; Monge, C C; Goldwasser, E; Sherpa, M; Blume, F D; Santolaya, R

1989-04-01

Previous studies of the erythropoietic response to hypoxia in high-altitude natives suggest that the hematocrit and hemoglobin values in Himalayan natives (Sherpas) are lower than expected for the altitude, perhaps because of a genetic adaptation. However, differences in sampling techniques and experimental methods make comparisons difficult. Our studies were carried out to compare the erythropoietic response with the same altitude in age-matched natives of the Himalayas and Andes by the same experimental techniques. Healthy male subjects were selected in Ollagüe, Chile (n = 29, 27.3 +/- 5.9 yr) and in Khunde, Nepal (n = 30, 24.7 +/- 3.8 yr). Both of these villages are located at 3,700 m above sea level. Hematologic measurements confirmed lower hematocrit values in Nepal (48.4 +/- 4.5%) than in Chile (52.2 +/- 4.6%) (P less than 0.003). When subjects were matched for hematocrit, erythropoietin concentrations in Chile were higher than in Nepal (P less than 0.01). Detailed measurements of blood O2 affinity in Nepal showed no differences in shape or position of the O2 equilibrium curve between Sherpas and Western sojourners. Our results indicate that although Quechua Indians have higher hematocrits than Sherpas living at the same altitude, nevertheless they may be functionally anemic.

An ethnobotanical survey of medicinal plants used in Terai forest of western Nepal

PubMed Central

2012-01-01

Background Nepal Himalayas have been known as a rich source for valuable medicinal plants since Vedic periods. Present work is the documentation of indigenous knowledge on plant utilization as natural remedy by the inhabitants of terai forest in Western Nepal. Methods Study was conducted during 2010–2011 following standard ethnobotanical methods. Data about medicinal uses of plants were collected by questionnaire, personal interview and group discussion with pre identified informants. Voucher specimens were collected with the help of informants, processed into herbarium following standard methods, identified with the help of pertinent floras and taxonomic experts, and submitted in Department of Botany, Butwal Multiple Campus, Tribhuvan University, Nepal for future references. Results During the present study 66 medicinal plant species belonging to 37 families and 60 genera has been documented. These plants were used to treat various diseases and ailments grouped under 11 disease categories, with the highest number of species (41) being used for gastro-intestinal disorders, followed by dermatological disorders (34). In the study area the informants’ consensus about usages of medicinal plants ranges from 0.93 to 0.97 with an average value of 0.94. Herbs (53%) were the primary source of medicine, followed by trees (23%). Curcuma longa (84%) and Azadirachta indica (76%) are the most frequently and popularly used medicinal plant species in the study area. Acacia catechu, Bacopa monnieri, Bombax ceiba, Drymaria diandra, Rauvolfia serpentina, and Tribulus terrestris are threatened species which needs to be conserved for future use. Conclusions The high degree of consensus among the informants suggests that current use and knowledge are still strong, and thus the preservation of today's knowledge shows good foresight in acting before much has been lost. The connections between plant use and conservation are also important ones, especially as the authors note that neither the local inhabitants nor the government is addressing the potential loss of valuable species in this region. PMID:22591592

Survival on antiretroviral treatment among adult HIV-infected patients in Nepal: a retrospective cohort study in far-western Region, 2006–2011

PubMed Central

2013-01-01

Background Though financial and policy level efforts are made to expand antiretroviral treatment (ART) service free of cost, survival outcome of ART program has not been systematically evaluated in Nepal. This study assesses the mortality rates and determinants among adult HIV-infected patients on ART in Far-western region of Nepal. Methods This retrospective cohort study included 1024 (51.2% men) HIV-infected patients aged ≥15 years, who started ART between May 15th 2006 and May 15th 2011 in five ART sites in the Far-western region, Nepal. Follow-up time was calculated from the date of ART initiation to date of death or censoring (loss to follow-up, transferred out, or 15 November 2011). Mortality rates (per 100 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore determinants of mortality. Results The median follow-up time was 19.1 months. The crude mortality rate was 6.3 (95% confidence interval (CI) 5.3-7.6) but more than three-times higher in first 3 months after ART initiation (21.9 (95% CI 16.6- 28.8)). About 12% (83% men) of those newly initiated on ART died during follow-up. The independent determinants of mortality were male sex (hazard ratio (HR) 4.55, 95% CI 2.43-8.51), poor baseline performance scale (bedridden <50% of the day during the past month, HR 2.05, 95% CI 1.19-3.52; bedridden >50% of the day during the past month, HR 3.41, 95% CI 1.67-6.98 compared to normal activity), one standard deviation decrease in baseline bodyweight (HR 1.04, 95% CI 1.01-1.07), and poor WHO clinical stage (stage III, HR 2.96, 95% CI 1.31-6.69; stage IV, HR 3.28, 95% CI 1.30-8.29 compared to WHO clinical stage I or II). Conclusions High mortality was observed within the first 3 months of ART initiation. Patients with poor baseline clinical characteristics had higher mortality, especially men. Earlier initiation of ART through expanded testing and counselling should be encouraged in HIV-infected patients. PMID:24369908

Social care and support for elderly men and women in an urban and a rural area of Nepal.

PubMed

Kshetri, Dan Bahadur Baidwar; Smith, Cairns S; Khadka, Mira

2012-09-01

This study has aimed to describe the care and support for urban and rural elderly people of Bhaktapur district, Nepal. Efforts were made to identify the feeling of some features of general well-beings associated to mental health, person responsible for care and support, capability to perform daily routine activities, sources of finance and ownership to the property. More than half of the respondents were found having single or multiple features of loneliness, anxiety, depression and insomnia. The rate of point prevalence loneliness was found higher in the above 80 years of age, urban respondents. Almost 9 in 10 respondents were capable themselves to dress, walk and maintain personal hygiene and majority of them were assisted by spouse, son/daughter-in-laws. Family support was common sources of income and ownership to the property was absolutely high.

Student perception about working in rural Nepal after graduation: a study among first- and second-year medical students.

PubMed

Shankar, P Ravi; Thapa, Trilok P

2012-08-31

The Federal Democratic Republic of Nepal is a developing country in South Asia with a population of 29.8 million. In September 2011, there were 18 medical schools with 14 being in the private sector. KIST Medical College is a private school in Lalitpur district. The present study was conducted to obtain information on student perceptions about working in rural Nepal after graduation. The study was conducted among first- and second-year undergraduate medical students using a semi-structured questionnaire developed by the authors using inputs from the literature and their experiences of teaching medical students. Year of study, gender, method of financing of medical education, place of family residence and occupation of parents were noted. Participant responses were analysed, grouped together and the number of respondents stating a particular response was noted. Of the 200 students, 185 (92.5%) participated with 95 being from the first year and 90 from the second. Most students were self-financing and from urban areas. Regarding the question of working in rural Nepal after graduation, 134 (72.4%) said they will work after their undergraduate course. Students preferred to work in the government or nongovernmental sector. Student felt doctors are reluctant to serve in rural Nepal due to inadequate facilities, low salary, less security, problems with their professional development, less equipment in health centres, decreased contact with family and difficulties in communicating with an illiterate, rural population. About 43% of respondents felt medical education does not adequately prepare them for rural service. Repeated rural exposure, postings in rural hospitals and health centres, and training students to diagnose and treat illness with less technology were suggested. The median monthly salary expected was 60 000 Nepalese rupees (US$ 820) and was significantly higher among first-year students. The majority of respondents were in favour of working in rural Nepal after graduation. They wanted facilities in rural areas and health centres to be improved. Changes in the education system were suggested. Providing relatively better facilities for rural doctors compared with urban doctors and reorienting medical education for producing doctors for rural Nepal can be considered. Further studies are required in other private medical schools.

Linking Science of Flood Forecasts to Humanitarian Actions for Improved Preparedness and Effective Response

NASA Astrophysics Data System (ADS)

Uprety, M.; Dugar, S.; Gautam, D.; Kanel, D.; Kshetri, M.; Kharbuja, R. G.; Acharya, S. H.

2017-12-01

Advances in flood forecasting have provided opportunities for humanitarian responders to employ a range of preparedness activities at different forecast time horizons. Yet, the science of prediction is less understood and realized across the humanitarian landscape, and often preparedness plans are based upon average level of flood risk. Working under the remit of Forecast Based Financing (FbF), we present a pilot from Nepal on how available flood and weather forecast products are informing specific pre-emptive actions in the local preparedness and response plans, thereby supporting government stakeholders and humanitarian agencies to take early actions before an impending flood event. In Nepal, forecasting capabilities are limited but in a state of positive flux. Whilst local flood forecasts based upon rainfall-runoff models are yet to be operationalized, streamflow predictions from Global Flood Awareness System (GLoFAS) can be utilized to plan and implement preparedness activities several days in advance. Likewise, 3-day rainfall forecasts from Nepal Department of Hydrology and Meteorology (DHM) can further inform specific set of early actions for potential flash floods due to heavy precipitation. Existing community based early warning systems in the major river basins of Nepal are utilizing real time monitoring of water levels and rainfall together with localised probabilistic flood forecasts which has increased warning lead time from 2-3 hours to 7-8 hours. Based on these available forecast products, thresholds and trigger levels have been determined for different flood scenarios. Matching these trigger levels and assigning responsibilities to relevant actors for early actions, a set of standard operating procedures (SOPs) are being developed, broadly covering general preparedness activities and science informed anticipatory actions for different forecast lead times followed by the immediate response activities. These SOPs are currently being rolled out and tested by the Ministry of Home Affairs (MoHA) through its district emergency operation centres in West Nepal. Potential scale up and successful implementation of this science based approach would be instrumental to take forward global commitments on disaster risk reduction, climate change adaptation and sustainable goals in Nepal.

Hidden voices: prevalence and risk factors for violence against women with disabilities in Nepal.

PubMed

Puri, Mahesh; Misra, Geetanjali; Hawkes, Sarah

2015-03-18

There is an increasing body of evidence on the extent and predictors of violence against women in Nepal. However, much of the published research does not yet take into account additional features of marginalization and vulnerability suffered by some women - for example, women socially excluded on account of their disability. Critical gaps exist in empirical data on the extent, risk factors, access to care, socio-economic and health consequences of violence among women with disabilities in Nepal. This paper addresses some these gaps and aims to promote evidence-informed policy and programme responses in Nepal. We conducted a cross-sectional survey of 475 women with disability aged 16 years and above in three districts in Nepal. In-depth interviews with 12 women who reported violence in the survey were also carried out. Using multivariate statistical methods we estimated the prevalence and risk factors for violence experienced both over the past 12 months and lifetime. Over the lifetime, 57.7% of women reported they had ever experienced violence, including emotional violence (55.2%); physical violence (34%); and sexual violence (21.5%). Over the preceding 12 months, 42% of women reported that they had experienced violence. Multivariate analysis showed that women with disabilities who were young, working in paid employment, and those who required permission from husbands/family to go to health centres or participate in community organizations were at increased risk of violence. Women experienced a range of negative outcomes from violence - including physical and emotional trauma. However, a majority of women did not seek care or redress from the health, justice or other sectors. Women in Nepal are at high risk of violence, often from members of their immediate family or local community. Rates of violence are higher in women with disability than among women in the general population. Tackling violence requires a comprehensive approach that addresses the root causes of women's unequal position in society, and builds upon principles of equity and justice to ensure that all women are able to realize their rights to a life free from violence.

Alcohol Consumption Practices among Married Women of Reproductive Age in Nepal: A Population Based Household Survey

PubMed Central

Thapa, Narbada; Aryal, Krishna Kumar; Puri, Rupendra; Shrestha, Saraswoti; Shrestha, Sheela; Thapa, Pukar; Mehata, Suresh; Thapa, Pushpa; Banjara, Megha Raj; Stray-Pedersen, Babill

2016-01-01

Background Alcohol chemically known as ethanol, causes several health, economic and social consequences across the world. Literatures suggest potential harm of alcohol drinking by pregnant women especially to the fetus and the mother. Despite anumber of significant public health problems related to alcohol consumption, this area has been ignored in Nepal and information at the national level is limited. Thus this study aimed at finding the prevalence of alcohol consumption among married women of reproductive age. Methods A nationally representative household survey was carried out from April to August 2013 by taking 16 districts across all 15 eco administrative regions. From the selected districts, 86 village development committees and 14 municipalities were selected as primary sampling units using probability proportionate to size, followed by random selection of 3 wards from each primary sampling unit. Finally, 30 households within each ward were selected using systematic random sampling, and one married women of reproductive age from each household. A total of 9000 married women of reproductive age were interviewed using a semi-structured questionnaire, on alcohol consumption practices including environmental factors and socio demographic characteristics and were included in the analysis. Results National prevalence of alcohol consumption ever among married women of reproductive age was 24.7% (95% CI:21.7–28.0), last 12 months 17.9% (95% CI:15.3–20.7) and last 30 days (current drinking) 11.8% (95% CI:9.8–14.1). There was substantial variation among the districts ranging from 2% to 60%. Multivariable analysis suggests women with no education or within formal education, dalit and janajatis ethnicity, whose husbands drink alcohol, who brew alcohol at home and women from mountains were significantly at higher risk of consuming alcohol. Among the women who drank alcohol in last 12 months, a substantial proportion of them drank home brewed alcoholic beverages (95.9%, 95% CI:94.3–97.4). Conclusion Alcohol consumption was common practice among married women of reproductive age in Nepal with variation among the subgroups of population. Thus, further investigation and behavior change communication interventions to reduce alcohol consumption especially among the women with higher risk of drinking is essential. PMID:27035722

Smartphone tool to collect repeated 24 h dietary recall data in Nepal.

PubMed

Harris-Fry, Helen; Beard, B James; Harrisson, Tom; Paudel, Puskar; Shrestha, Niva; Jha, Sonali; Shrestha, Bhim P; Manandhar, Dharma S; Costello, Anthony; Saville, Naomi M

2018-02-01

To outline the development of a smartphone-based tool to collect thrice-repeated 24 h dietary recall data in rural Nepal, and to describe energy intakes, common errors and researchers' experiences using the tool. We designed a novel tool to collect multi-pass 24 h dietary recalls in rural Nepal by combining the use of a CommCare questionnaire on smartphones, a paper form, a QR (quick response)-coded list of foods and a photographic atlas of portion sizes. Twenty interviewers collected dietary data on three non-consecutive days per respondent, with three respondents per household. Intakes were converted into nutrients using databases on nutritional composition of foods, recipes and portion sizes. Dhanusha and Mahottari districts, Nepal. Pregnant women, their mothers-in-law and male household heads. Energy intakes assessed in 150 households; data corrections and our experiences reported from 805 households and 6765 individual recalls. Dietary intake estimates gave plausible values, with male household heads appearing to have higher energy intakes (median (25th-75th centile): 12 079 (9293-14 108) kJ/d) than female members (8979 (7234-11 042) kJ/d for pregnant women). Manual editing of data was required when interviewers mistook portions for food codes and for coding items not on the food list. Smartphones enabled quick monitoring of data and interviewer performance, but we initially faced technical challenges with CommCare forms crashing. With sufficient time dedicated to development and pre-testing, this novel smartphone-based tool provides a useful method to collect data. Future work is needed to further validate this tool and adapt it for other contexts.

The Household Costs of Visceral Leishmaniasis Care in South-eastern Nepal

PubMed Central

Baltussen, Rob; Rijal, Suman; Boelaert, Marleen

2013-01-01

Background and objectives Visceral leishmaniasis (VL) is an important public health problem in south-eastern Nepal affecting very poor rural communities. Since 2005, Nepal is involved in a regional initiative to eliminate VL. This study assessed the economic impact of VL on households and examined whether the intensified VL control efforts induced by the government resulted in a decrease in household costs. Methods Between August and September 2010, a household survey was conducted among 168 patients that had been treated for VL within 12 months prior to the survey in five districts in south-eastern Nepal. We collected data on health-seeking behaviour, direct and indirect costs and coping strategies. Results The median total cost of one episode of VL was US$ 165 or 11% of annual household income. The median delay between the onset of symptoms and presentation to a qualified provider was 25 days. Once the patient presented to a qualified provider, the delay to correct diagnosis was minimal (median 3 days). Direct and indirect costs (income losses) represented 47% and 53% of total costs respectively. Households used multiple strategies to cope with the cost of illness, mainly mobilizing cash/savings (71%) or taking a loan (56%). Conclusions The provision of free VL diagnosis and drugs by the Nepalese control programme has been an important policy measure to reduce the cost of VL to households. But despite the free VL drugs, the economic burden is still important for households. More effort should be put into reducing indirect costs, in particular the length of treatment, and preventing the transmission of VL through vector control. PMID:23469298

The household costs of visceral leishmaniasis care in south-eastern Nepal.

PubMed

Uranw, Surendra; Meheus, Filip; Baltussen, Rob; Rijal, Suman; Boelaert, Marleen

2013-01-01

Visceral leishmaniasis (VL) is an important public health problem in south-eastern Nepal affecting very poor rural communities. Since 2005, Nepal is involved in a regional initiative to eliminate VL. This study assessed the economic impact of VL on households and examined whether the intensified VL control efforts induced by the government resulted in a decrease in household costs. Between August and September 2010, a household survey was conducted among 168 patients that had been treated for VL within 12 months prior to the survey in five districts in south-eastern Nepal. We collected data on health-seeking behaviour, direct and indirect costs and coping strategies. The median total cost of one episode of VL was US$ 165 or 11% of annual household income. The median delay between the onset of symptoms and presentation to a qualified provider was 25 days. Once the patient presented to a qualified provider, the delay to correct diagnosis was minimal (median 3 days). Direct and indirect costs (income losses) represented 47% and 53% of total costs respectively. Households used multiple strategies to cope with the cost of illness, mainly mobilizing cash/savings (71%) or taking a loan (56%). The provision of free VL diagnosis and drugs by the Nepalese control programme has been an important policy measure to reduce the cost of VL to households. But despite the free VL drugs, the economic burden is still important for households. More effort should be put into reducing indirect costs, in particular the length of treatment, and preventing the transmission of VL through vector control.

Pre-earthquake national patterns of preschool child undernutrition and household food insecurity in Nepal in 2013 and 2014.

PubMed

Shrestha, Sudeep; Thorne-Lyman, Andrew L; Manohar, Swetha; Shrestha, Binod; Neupane, Sumanta; Rajbhandary, Ruchita; Shrestha, Raman; Klemm, Rolf Dw; Nonyane, Bareng As; Adhikari, Ramesh K; Webb, Patrick; West, Keith P

2018-01-01

Preschool undernutrition remains a burden in Nepal. This paper reports results of surveys in 2013 and 2014, examining patterns of child nutritional status across the country, associations with household food insecurity and antecedent comparative national data for subsequent evaluations of nutritional status following the earthquake in Nepal in 2015. A multi-stage sample was drawn comprising 21 sites in 75 districts of the country, representing the mountains, hills and Terai zones, providing proportionate to zonal samples of 4286 and 4947 households and 5401 and 5474 preschool children in each year, respectively. Children 6 to 59 months of age were measured for weight and height, expressed as standardized z-scores for height-for-age (HAZ), weight-for-height (WHZ), and stunting and wasting (<-2 z for each). The household food insecurity access scale (HFIAS) was used to measure food security. Between 2013 and 2014, HAZ decreased from a mean (SD) of -1.46 (1.39) to -1.54 (1.33) z-scores, while the prevalence of stunting increased from 35.5% to 37.4% (p<0.05 for both), evident in the mountains and Terai but not hills. In both years, wasting was highest (~22%) in the Terai versus mountains or hills (~8%). More households were classified food secure in 2014 (73%) than 2013 (59%), evident in all zones. Two midyear surveys in Nepal revealed a stable nutritional situation among preschool children, reflecting a pause in the long-term decline in stunting noted in previous years. The same period saw a slight reduction in wasting and improved household food security.

Reading habits and attitude toward medical humanities of basic science students in a medical college in Western Nepal.

PubMed

Shankar, P Ravi; Dubey, Arun K; Mishra, P; Upadhyay, Dinesh K

2008-01-01

The Manipal College of Medical Sciences, Pokhara, Nepal, admits students from Nepal, India, Sri Lanka, and other countries to the undergraduate medical course. The present study sought to describe and explore reading habits of medical students during the first three semesters and obtain their views regarding inclusion of medical humanities in the course. The authors introduced a voluntary module in medical humanities to the fifth- and sixth-semester students. Gender, semester, and nationality of respondents were noted. Commonly read noncourse books (fiction and nonfiction) were noted. Student attitudes toward medical humanities were studied using a set of nine statements. A total of 165 of the 220 students (75%) participated. Indians followed by Nepalese were the most common nationalities. Romantic fiction and biography were most commonly read. The Alchemist and The Da Vinci Code were commonly read books. Students were in favor of inclusion of medical humanities in the curriculum. The median total score was 30 (maximum possible score = 45). Students read widely beyond their course. The possibility of introducing medical humanities in the curriculum should be explored.

A new experimental community pharmacy internship module for undergraduate pharmacy students in western Nepal: overview and reflections.

PubMed

Timsina, Sangita; K C, Bhuvan; Adhikari, Dristi; Alrasheedy, Alian A; Mohamed Ibrahim, Mohamed Izham; Kaundinnyayana, Atisammodavardhana

2017-01-01

Community pharmacies in Nepal and other South Asian countries are in a mediocre state due to poor regulation and the fact that many pharmacies are run by people with insufficient training in dispensing. This has led to the inappropriate use of medicines. The problems due to poor regulation and the mediocre state of community pharmacies in South Asia encompass both academia and clinical practice. In this paper, a 2-week community pharmacy internship programme completed by 2 graduating pharmacy students of Pokhara University (a Nepalese public university) at Sankalpa Pharmacy, Pokhara, Nepal is illustrated. During the internship, they were systematically trained on store management, pharmaceutical care, counselling skills, the use of medical devices, pharmaceutical business plans, medicine information sources, and adverse drug reaction reporting. An orientation, observations and hands-on training, case presentation, discussion, and feedback from 2 senior pharmacists were used as the training method. A proper community pharmacy internship format, good pharmacy practice standards, and a better work environment for pharmacists may improve the quality of community pharmacies.

A new experimental community pharmacy internship module for undergraduate pharmacy students in western Nepal: overview and reflections

PubMed Central

2017-01-01

Community pharmacies in Nepal and other South Asian countries are in a mediocre state due to poor regulation and the fact that many pharmacies are run by people with insufficient training in dispensing. This has led to the inappropriate use of medicines. The problems due to poor regulation and the mediocre state of community pharmacies in South Asia encompass both academia and clinical practice. In this paper, a 2-week community pharmacy internship programme completed by 2 graduating pharmacy students of Pokhara University (a Nepalese public university) at Sankalpa Pharmacy, Pokhara, Nepal is illustrated. During the internship, they were systematically trained on store management, pharmaceutical care, counselling skills, the use of medical devices, pharmaceutical business plans, medicine information sources, and adverse drug reaction reporting. An orientation, observations and hands-on training, case presentation, discussion, and feedback from 2 senior pharmacists were used as the training method. A proper community pharmacy internship format, good pharmacy practice standards, and a better work environment for pharmacists may improve the quality of community pharmacies. PMID:28811395

Public Health Responses to a Dengue Outbreak in a Fragile State: A Case Study of Nepal

PubMed Central

Griffiths, Karolina; Banjara, Megha Raj; O'Dempsey, T.; Munslow, B.; Kroeger, Axel

2013-01-01

Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak. Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants. Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control. Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks. PMID:23690789

Nepal project moves ahead as grass-roots force.

PubMed

1995-06-01

A JOICFP mission to Nepal (April 2-14, 1995) performed several tasks, including the following: 1) collection of materials from nongovernmental organizations, the government, and international agencies in preparation for a National IEC Workshop (November 14-16, 1995) and a National Workshop (November 19-21, 1995) on family planning promotions; 2) arrangements for an external evaluation of the Community-based Sustainable Family Planning/Maternal and Child Health (MCH) Project with Special Focus on Women, which is supported by the United Nations Population Fund (UNFPA); 3) discussions regarding the production of the Nepali version of the videotape, "Rakhee and Mousse," and plans for utilization of US$11,122 of the JOICFP Voluntary Fund (JVF); 4) observation of refresher training for 135 women volunteers from 15 villages in Panchkhal, Kavre District, that was conducted by Sabatri Basnet; and 5) a meeting with the village health committee and women volunteers of the community-based, primary health care unit of Anaikiot. Coordination with the other activities of the Family Planning Association of Nepal and women volunteers to diffuse FP/MCH services and project activities has been a positive development in the project. The mission decided, based on its visits, to formulate technical support in the form of training, provision of quality service, and a referral institute for patients for the project areas of Panchkhal and Sunsari.

Publications - NL 2006-1 | Alaska Division of Geological & Geophysical

Science.gov Websites

Liberty Bell, western Bonnifield mining district geophysical tract Authors: DGGS Staff, and Athey, J.E inventory Liberty Bell, western Bonnifield mining district geophysical tract: Alaska Division of Geological

Outbreak Investigation of Influenza in Pajaru VDC of Jajarkot District of Nepal.

PubMed

Upadhyay, S K; Singh Pradhan, P M; Mahato, R K; Marasini, B; Upadhyaya, B; Shakya, G; Baral, G; Baral, K P

2016-09-01

An outbreak investigation study was conducted in Pajaru, one of the initially affected Village Development Committees (VDCs) of the Jajarkot district in Nepal following an outbreak of respiratory illness in early 2015. The objectives of this study were to identify the cases and magnitude of the outbreak. A cross-sectional study was carried out in mid-April 2015 covering five most affected wards of Pajaru VDC to assess the patients using standard case definition for Influenza like Illness (ILI). Throat and nasal swabs were collected and sent to the National Influenza Center (NIC) in Kathmandu for laboratory confirmation. The throat swab samples tested at NIC found Influenza A H1N1 pdm09. The attack rate was calculated to be 3% in ward number 9 and 41% in ward number 8. Wavelength of the infection was nearly two weeks in both the wards. Nearly 54% of the specimens were positive for Influenza A H1N1 pdm09. There was no ILI case fatality in the study area. Children aged 0-15 years were most affected. Majority of the patients presented with symptoms of fever, cough and sore throat. There was gradual decline in the number of cases in all five wards suggestive of development of natural immunity in the community. True severity of the outbreak was not accurately reflected as compared to media reports.

Measuring Nutrition Governance: An Analysis of Commitment, Capability, and Collaboration in Nepal.

PubMed

Webb, Patrick; Ghosh, Shibani; Shrestha, Robin; Namirembe, Grace; Gurung, Sabi; Sapkota, Diplav; Bell, Winnie Fay; Davis, Dale; Kennedy, Eileen; Neupane, Shailes; Manohar, Swetha; Baral, Kedar

2016-12-01

Global commitments to nutrition have supported calls for better evidence to support effective investments at national level. However, too little attention has so far been paid to the role of governance in achieving impacts. This article explores the ways by which the commitment and capabilities of policy implementers affect collaborative efforts for achieving nutrition goals. Over 1370 structured interviews were held with government and nongovernment officials over 3 years in 21 districts. Coded responses supported quantitative analysis of stakeholders' knowledge, attitudes, and practices regarding policy implementation. Stakeholder commitment was already high in 2013 when a new national policy was adopted, but capabilities were weak. Only one-third of interviewed respondents had any nutrition training. Rollout of training focusing on districts targeted for early implementation of multisector programming. This raised levels of nutrition training among interviewed respondents to 57% in 2015, which raised demand for technical information to support actions. Better understanding of the complexity of cross-sector work led to calls for higher budgets and more effective cross-sectoral collaboration. Nepal offers an example of effective efforts to improve nutrition governance across sectors at all levels of administration. The promotion of awareness, capacity, and new ways of working shows promise. Trainings, information sharing, and management support led to growing willingness among civil servants to engage across sectors. Structured surveys offer a viable way to track change across institutions and sectors. © The Author(s) 2016.

Epidemiology of Unintentional Child Injuries in the Makwanpur District of Nepal: A Household Survey

PubMed Central

Pant, Puspa Raj; Towner, Elizabeth; Ellis, Matthew; Manandhar, Dharma; Pilkington, Paul; Mytton, Julie

2015-01-01

Secondary sources of information indicate that the proportion of child deaths due to injuries is increasing in Nepal. This study aimed to describe the epidemiology of unintentional injuries in children, explore risk factors and estimate the burden faced by families and the community in the Makwanpur district. We conducted a household survey in Makwanpur, covering 3441 households. Injuries that occurred during the 12 months before the survey and required treatment or caused the child to be unable to take part in usual activities for three or more days were included. We identified 193 cases of non-fatal unintentional child injuries from 181 households and estimated an annual rate of non-fatal injuries of 24.6/1000 children; rates for boys were double (32.7/1000) that for girls (16.8/1000). The rates were higher among the children of age groups 1–4 years and 5–9 years. Falls were the most common cause of non-fatal child injuries followed by burns in preschool children and road traffic injuries were the most likely cause in adolescence. Mean period of disability following injury was 25 days. The rates and the mechanisms of injury vary by age and gender. Falls and burns are currently the most common mechanisms of injury amongst young children around rural homes. PMID:26633439

Aflatoxin exposure during the first 1000 days of life in rural South Asia assessed by aflatoxin B1-lysine albumin biomarkers

PubMed Central

Groopman, John D.; Egner, Patricia A.; Schulze, Kerry J.; Wu, Lee S-F; Merrill, Rebecca; Mehra, Sucheta; Shamim, Abu A.; Ali, Hasmot; Shaikh, Saijuddin; Gernand, Alison; Khatry, Subarna K.; LeClerq, Steven C.; West, Keith P.; Christian, Parul

2015-01-01

Aflatoxin B1 is a potent carcinogen, occurring from mold growth that contaminates staple grains in hot, humid environments. In this investigation, aflatoxin B1-lysine albumin biomarkers were measured by mass spectrometry in rural South Asian women, during the first and third trimester of pregnancy, and their children at birth and at two years of age. These subjects participated in randomized community trials of antenatal micronutrient supplementation in Sarlahi District, southern Nepal and Gaibandha District in northwestern Bangladesh. Findings from the Nepal samples demonstrated exposure to aflatoxin, with 94% detectable samples ranging from 0.45 to 2939.30 pg aflatoxin B1-lysine/mg albumin during pregnancy. In the Bangladesh samples the range was 1.56 to 63.22 pg aflatoxin B1-lysine/mg albumin in the first trimester, 3.37 to 72.8 pg aflatoxin B1-lysine/mg albumin in the third trimester, 4.62 to 76.69 pg aflatoxin B1-lysine/mg albumin at birth and 3.88 to 81.44 pg aflatoxin B1-lysine/mg albumin at age two years. Aflatoxin B1-lysine adducts in cord blood samples demonstrated that the fetus had the capacity to convert aflatoxin into toxicologically active compounds and the detection in the same 2-year-old children illus trates exposure over the first 1000 days of life. PMID:25308602

Medicinal plant diversity and traditional healing practices in eastern Nepal.

PubMed

Shrestha, Nawal; Shrestha, Saugat; Koju, Laxmi; Shrestha, Krishna Kumar; Wang, Zhiheng

2016-11-04

The rich floral and ethnic composition of eastern Nepal and the widespread utilization of locally available medicinal plants offer remarkable opportunity for ethnomedicinal research. The present paper aims to explore medicinal plant diversity and use in the remote villages of eastern Nepal. It also aims to evaluate ethnopharmacological significance of the documented use reports and identify species of high indigenous priority. The study was undertaken in four villages located in the Sankhuwasabha district in eastern Nepal. Ethnomedicinal information was collected through structured interviews. The homogeneity of informant's knowledge and the relative importance of documented medicinal plants were validated by informant consensus factor and use value, respectively. Species preference for treatment of particular diseases was evaluated through fidelity level. We reported medicinal properties of 48 species belonging to 33 families and 40 genera, for the treatment of 37 human ailments. The uses of 10 medicinal plants were previously undocumented. The informant consensus factor (F IC ) ranged between 0.38 and 1 with about 50% of values greater than 0.80 and over 75% of values greater than 0.70, indicating moderate to high consensus among the informants on the use of medicinal plants in the region. Swertia chirayita was the most preferred species with significantly high use values, followed by Paris polyphylla and Neopicrorhiza scrophulariiflora. The remote villages in eastern Nepal possess rich floral and cultural diversity with strong consensus among informants on utilization of plants for local healthcare. The direct pharmacological evidence for medicinal properties of most species indicates high reliability of documented information. Careful and systematic screening of compounds isolated from these plants could possibly provide good opportunity for the discovery of novel medicines to treat life-threatening human diseases. We recommend prioritization of medicinal plants and reinforcement of existing cultivation practices for sustainable management of high-priority species. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

HIV decline associated with changes in risk behaviours among young key populations in Nepal: analysis of population-based HIV prevalence surveys between 2001 and 2012.

PubMed

Deuba, Keshab; Ekström, Anna Mia; Tomson, Göran; Shrestha, Rachana; Marrone, Gaetano

2017-08-01

We assessed changes in HIV prevalence and risk behaviours among young key populations in Nepal. A total of 7505 participants (aged 16-24 years) from key populations who were at increased risk of HIV infection (2767 people who inject drugs (PWID); 852 men who have sex with men/transgender (MSM/TG); 2851 female sex workers (FSW) and 1035 male labour migrants) were recruited randomly over a 12-year period, 2001-2012. Local epidemic zones of Nepal (Kathmandu valley, Pokhara valley, Terai Highway and West to Far West hills) were analysed separately. We found a very strong and consistent decline in HIV prevalence over the past decade in different epidemic zones among PWID and MSM/TG in Kathmandu, the capital city, most likely due to a parallel increase in safe needle and syringe use and increased condom use. A decrease in HIV prevalence in 22 Terai highway districts, sharing an open border with India, was also consistent with increased condom use among FSW. Among male labour migrants, HIV prevalence was low throughout the period in the West to Far West hilly regions. Condom use by migrant workers involved with FSW abroad increased while their condom use with Nepalese FSW declined. Other risk determinants such as mean age at starting first injection, injection frequency, place of commercial sex solicitation, their mean age when leaving to work abroad did not change consistently across epidemic zones among the young key populations under study. In Nepal, the decline in HIV prevalence over the past decade was remarkably significant and consistent with an increase in condom use and safer use of clean needles and syringes. However, diverging trends in risk behaviours across local epidemic zones of Nepal suggest a varying degree of implementation of national HIV prevention policies. This calls for continued preventive efforts as well as surveillance to sustain the observed downward trend.

Urban air quality of kathmandu valley "Kingdom of Nepal"

NASA Astrophysics Data System (ADS)

Sharma, C. K.

The oval shaped tectonic basin of Kathmandu valley, occupying about 656 sq.km is situated in the middle sector of Himalayan range. There are three districts in the valley, i.e. Kathmandu, Lalitpur and Bhaktapur. Out of the three, the most populated is Kathmandu city (the capital of Kingdom of Nepal) which has a population of 668,00 in an area of approximately 50 km 2. The energy consumption of the city population is about 1/3 of the total import to Nepal of gasoline, diesel, kerosene, furnace oil and cooking gas. This has resulted heavy pollution of air in the city leading to bronchitis, and throat and chest diseases. Vehicles have increased several fold in recent months and there are 100,000 in number on the road and they have 900 km of road, out of which only 25% is metalled. Most of the two and three wheelers are polluting the air by emission of gases as well as dust particulate. SO 2 has been found to go as high as 202 μg cm -3 and NO 2 to 126 μg cm -3 particularly in winter months when a thick layer of fog covers the valley up to 10 am in the morning. All the gases are mixed within the limited air below the fog and the ground. This creates the problem. Furthermore, municipal waste of 500 m 3 a day and also liquid waste dumped directly into the Bagmati river at the rate of 500,000 ℓ d -1 makes the city ugly and filthy. Unless pollution of air, water and lard are controlled in time, Nepal will lose much of its foreign exchange earnings from the tourist industry. It is found that tourist arrivals have considerably reduced in recent years and most of hotels occupancy is 50-60% in peak time. Nepal is trying to introduce a legal framework for pollution control but it will take time to become effective.

Environmental burden of diarrhoeal diseases due to unsafe water supply and poor sanitation coverage in Nepal.

PubMed

Aryal, K K; Joshi, H D; Dhimal, M; Singh, S P; Dhakal, P; Dhimal, B; Bhusal, C L

2012-05-01

Unsafe water and poor sanitation are major contributing factors of diarrhoea. Most of the water supply systems in urban and rural area of Nepal do not have basic water treatment facilities. This has resulted in frequent reports of fecal contamination in drinking water and outbreaks of waterborne diseases. The purpose of this study was to find out the burden of diarrhoeal diseases at different scenario of water supply system and sanitation status in Nepalese context. A cross-sectional study was conducted in four different districts of Nepal analyzing six different scenarios based on availability of water supply and sanitation status. Village Development Committees (VDCs) and community selection was made purposively and 360 households, 60 from each scenario were selected conveniently to achieve the required number. Within the selected household, the head of the household or any member above 18 years of age was interviewed using a structured questionnaire. Observation was done for toilet and water sources besides questionnaire method. Incidence of diarrhoea per 1000 population was found to be the highest in scenario-IV (Spring without toilet) with 204.89 followed by scenario-VI (Tube well without toilet) with 145.30, while it was less in scenario-I (Tap water with toilet) with 46.05. Accordingly, the burden of disease (YLD) was also found to be the highest in scenario-IV and the lowest in scenario-I. Most of the households didn't treat water before drinking. Hand washing practice was found to be more than 90% regardless of toilet availability. The greater risk of acquiring diarrhoeal disease and higher burden of disease in situation of unprotected water source and absence of toilet shows that these are still important contributing factors for diarrhoeal disease in Nepal. Use of sanitary toilets and protected water source are the important measures for diarrhoeal disease prevention in Nepal.

Awareness of occupational hazards and use of safety measures among welders: a cross-sectional study from eastern Nepal

PubMed Central

Budhathoki, Shyam Sundar; Singh, Suman Bahadur; Sagtani, Reshu Agrawal; Niraula, Surya Raj; Pokharel, Paras Kumar

2014-01-01

Objective The proper use of safety measures by welders is an important way of preventing and/or reducing a variety of health hazards that they are exposed to during welding. There is a lack of knowledge about hazards and personal protective equipments (PPEs) and the use of PPE among the welders in Nepal is limited. We designed a study to assess welders’ awareness of hazards and PPE, and the use of PPE among the welders of eastern Nepal and to find a possible correlation between awareness and use of PPE among them. Materials and methods A cross-sectional study of 300 welders selected by simple random sampling from three districts of eastern Nepal was conducted using a semistructured questionnaire. Data regarding age, education level, duration of employment, awareness of hazards, safety measures and the actual use of safety measures were recorded. Results Overall, 272 (90.7%) welders were aware of at least one hazard of welding and a similar proportion of welders were aware of at least one PPE. However, only 47.7% used one or more types of PPE. Education and duration of employment were significantly associated with the awareness of hazards and of PPE and its use. The welders who reported using PPE during welding were two times more likely to have been aware of hazards (OR=2.52, 95% CI 1.09 to 5.81) and five times more likely to have been aware of PPE compared with the welders who did not report the use of PPE (OR=5.13, 95% CI 2.34 to 11.26). Conclusions The welders using PPE were those who were aware of hazards and PPE. There is a gap between being aware of hazards and PPE (90%) and use of PPE (47%) at work. Further research is needed to identify the underlying factors leading to low utilisation of PPE despite the welders of eastern Nepal being knowledgeable of it. PMID:24889850

Diet and physical activity for children's health: a qualitative study of Nepalese mothers' perceptions.

PubMed

Oli, Natalia; Vaidya, Abhinav; Subedi, Madhusudan; Eiben, Gabriele; Krettek, Alexandra

2015-09-08

Non-communicable diseases account for 50% of all deaths in Nepal and 25% result from cardiovascular diseases. Previous studies in Nepal indicate a high burden of behavioural cardiovascular risk factors, suggesting a low level of knowledge, attitude and practice/behaviour regarding cardiovascular health. The behavioural foundation for a healthy lifestyle begins in early childhood, when mothers play a key role in their children's lives. This qualitative study, conducted in a Nepalese peri-urban community, aimed to explore mothers' perception of their children's diet and physical activity. We notated, tape-recorded and transcribed all data collected from six focus group discussions, and used qualitative content analysis for evaluation and interpretation. The study was conducted in the Jhaukhel-Duwakot Health Demographic Surveillance Site in the Bhaktapur district of Nepal. Local health workers helped recruit 61 women with children aged 5-10 years. We distributed participants among six different groups according to educational status. Although participants understood the importance of healthy food, they misunderstood its composition, perceiving it as unappetising and appropriate only for sick people. Furthermore, participants did not prioritise their children's physical activities. Moreover, mothers believed they had limited control over their children's dietary habits and physical activity. Finally, they opined that health educational programmes would help mothers and recommended various intervention strategies to increase knowledge regarding a healthy lifestyle. Our data reveal that mothers of young children in a peri-urban community of Nepal lack adequate and accurate understanding about the impact of a healthy diet and physical activity. Therefore, to prevent future cardiovascular disease and other non-communicable diseases among children, Nepal needs health education programmes to improve mothers' cardiovascular health knowledge, attitude and behaviour. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Demand and access to mental health services: a qualitative formative study in Nepal

PubMed Central

2014-01-01

Background Nepal is experiencing a significant ‘treatment gap’ in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. Methods This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. Results As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. Conclusions This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME’s integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting. PMID:25084826

Demand and access to mental health services: a qualitative formative study in Nepal.

PubMed

Brenman, Natassia F; Luitel, Nagendra P; Mall, Sumaya; Jordans, Mark J D

2014-08-02

Nepal is experiencing a significant 'treatment gap' in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME's integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting.

Study of Annual Mass Balance (2011-2013) of Rikha Samba Glacier, Hidden Valley, Mustang, Nepal

NASA Astrophysics Data System (ADS)

Gurung, S.; Bhattrai, B. C.; Kayastha, R. B.; Stumm, D.; Joshi, S.; Mool, P. K.

2016-12-01

lthough Himalayan glaciers are of particular interest interms of future water supplies, regional climate changes, and sea-level rises, little is known about them due to lack of reliable and consistent data. There is a need for monitoring these glaciers to bridge this knowledge gap and to provide field measurements necessary to calibrate and validate the results from different remote sensing operations. Therefore, glaciological observations have been carried out by the Cryosphere Monitoring Project (CMP) since September 2011 on Rikha Samba Glacier in Hidden valley, Mustang district in western Nepal in order to study its annual mass balance. This paper presents the first results of that study. There are 10 glaciers in Hidden Valley, named G1, G2, G3, up to G10. Of these, G5 is the Rikha Samba Glacier, which has the largest area (5.37 km2) in this valley and the highest and lowest altitudes (6,476 and 5,392 m a.s.l., respectively). The glacier mass balance discussed in this paper was calculated using the glaciological method and the equilibrium line altitude (ELA).The glacier showed a negative annual point mass balance along the longitudinal profile of its lower part from September 10, 2011 to October 3, 2012. Stake measurements from October 4, 2012 to September 30, 2013 indicated a negative areal average of annual mass balance -0.088±0.019 m w.e. for the whole glacier. Based on these observations, the ELA of the Rikha Samba Glacier is estimated at 5,800 m a.s.l. in 2013. This negative balance may be due to rising air temperatures in the region, which have been incrementally rising since 1980 accompanied by little or no significant increase in precipitation in that period. The negative mass balance confirms the general shrinking trend of the glacier.

Challenges to improving maternal health in rural Nepal.

PubMed

Thapa, S

1996-05-04

In the remote village of Martadi, in Bajura district of western Nepal, the total fertility rate is 7. 20% of newborns die before they reach age 1. Temporary migration, mainly to India, is common due to the inability of the rugged and rocky terrain to supply enough food. The existence of temporary migration and a high frequency of remarriage suggest a high rate of sexually transmitted diseases. The relatively new hospital is very much under used (e.g., only 35 patients in 1995). The office in Kolti that supplies vaccines to Martadi has gone at least six months without receiving any new child immunization drugs, despite the presence of an air service. During and after delivery, no one, not even family members or traditional birth attendants, can touch a woman, who is confined to a cow-shed to deliver and care for her child and herself alone. Yet sick animals receive care. A new mother also is required to bathe herself, often requiring a walk of many hours. Women often identify access to water as their top priority. Pregnant or postpartum women are forbidden from eating green vegetables because of the belief that they cause diarrhea. Sanitation is better now in Martadi than in the past. Diarrhea and vomiting were once very prevalent. The international organization, CARE, along with the Ministry of Local Development operate the Remote Area Basic Needs Project, which revolves around community organization, agroforestry, rural infrastructure, and primary health care. The project has helped villagers construct low-cost toilets. It provides training in basic hygiene. Households have kitchen-gardens. Many families are now eating green vegetables regularly. Fruit trees are being introduced. Villagers recognize the value of child immunization. Some small-scale drinking water systems are operating. Villagers are trained in repair and management of these systems. About 33% of women aged 15-49 want no more children. A first-ever outreach program for female sterilization services is planned for Martadi and Kolti.

75 FR 45602 - Kern and Tulare Counties Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

..., Western Divide Ranger District, 32588 Highway 190, Springville, California 93265. Comments may also be... copying. The public may inspect comments received at Western Divide Ranger District, 32588 Highway 190... comment. Persons who wish to bring [[Page 45603

Working Together, Staying Vital. Proceedings of the Joint Conference of the Western Australian District High Schools Administrators' Association and the National Society for the Provision of Education in Rural Australia (20th, Fremantle, Western Australia, June 2004)

ERIC Educational Resources Information Center

Boylan, Colin, Ed.; Hemmings, Brian, Ed.

2004-01-01

The 20th National Society for the Provision of Education in Rural Australia (SPERA) and Western Australia District High School Administrators' Association (WADHSAA) joint conference proceedings, based on the theme "Working Together, Staying Vital," was held in Fremantle, Perth, Western Australia, in June 2004. The proceedings contain 13…

Women's empowerment in agriculture and child nutritional status in rural Nepal.

PubMed

Cunningham, Kenda; Ploubidis, George B; Menon, Purnima; Ruel, Marie; Kadiyala, Suneetha; Uauy, Ricardo; Ferguson, Elaine

2015-12-01

To examine the association between women's empowerment in agriculture and nutritional status among children under 2 years of age in rural Nepal. Cross-sectional survey of 4080 households conducted in 2012. Data collected included: child and maternal anthropometric measurements; child age and sex; maternal age, education, occupation and empowerment in agriculture; and household size, number of children, religion, caste and agro-ecological zone. Associations between the Women's Empowerment in Agriculture Index (WEAI)'s Five Domains of Empowerment (5DE) sub-index and its ten component indicators and child length-for-age Z-scores (LAZ) and weight-for-length Z-scores (WLZ) were estimated, using ordinary least-squares regression models, with and without adjustments for key child, maternal and household level covariates. Two hundred and forty rural communities across sixteen districts of Nepal. Children under 24 months of age and their mothers (n 1787). The overall WEAI 5DE was positively associated with LAZ (β=0·20, P=0·04). Three component indicators were also positively associated with LAZ: satisfaction with leisure time (β=0·27, P<0·01), access to and decisions regarding credit (β=0·20, P=0·02) and autonomy in production (β=0·10, P=0·04). No indicator of women's empowerment in agriculture was associated with WLZ. Women's empowerment in agriculture, as measured by the WEAI 5DE and three of its ten component indicators, was significantly associated with LAZ, highlighting the potential role of women's empowerment in improving child nutrition in Nepal. Additional studies are needed to determine whether interventions to improve women's empowerment will improve child nutrition.

Do mobile family planning clinics facilitate vasectomy use in Nepal?

PubMed

Padmadas, Sabu S; Amoako Johnson, Fiifi; Leone, Tiziana; Dahal, Govinda P

2014-06-01

Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy. A three-level random intercept logistic regression analysis was applied on data from the 2011 Nepal Demographic and Health Survey to investigate the extent of influence of mobile family planning clinics on the odds of a male or a female sterilization, adjusting for relevant characteristics including ecological differences and random effects. The analyses included a sample of 2014 sterilization users, considering responses from currently married women of reproductive ages. The odds of a male sterilization were significantly higher in a mobile clinic than those in a government hospital (odds ratio, 1.65; 95% confidence interval, 1.21-2.25). The effects remained unaltered and statistically significant after adjusting for sociodemographic and clustering effects. Random effects were highly significant, which suggest the extent of heterogeneity in vasectomy use at the community and district levels. The odds of vasectomy use in mobile clinics were significantly higher among couples residing in hill and mountain regions and among those with three or more sons or those with only daughters. Mobile clinics significantly increase the uptake of vasectomy in hard-to-reach areas of Nepal. Reproductive health interventions should consider mobile clinics as an effective strategy to improve access to male-based modern methods and enhance gender equity in family planning. Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition. Copyright © 2014 Elsevier Inc. All rights reserved.

Community development and livestock promotion in rural Nepal: effects on child growth and health.

PubMed

Miller, Laurie C; Joshi, Neena; Lohani, Mahendra; Rogers, Beatrice; Loraditch, Meghan; Houser, Robert; Singh, Padma; Mahato, Shubh

2014-09-01

More than 50% of children in Nepal are malnourished. Economic growth and poverty reduction are not always sufficient to improve the health and nutritional status of children. Heifer Nepal uses livestock training as a tool for community development and poverty alleviation but does not directly address child health and nutrition. To systematically assess the effects of Heifer activities on child health and nutrition. The study was a 2-year, longitudinal, randomized, controlled trial in six communities in Nepal (both Terai and hills), pair-matched for specific characteristics, randomly assigned to receive Heifer community development activities at baseline (intervention) or 1 year (control). At 6-month intervals over a period of 2 years, child anthropometric and comprehensive household surveys were performed. Four hundred fifteen households were enrolled containing 607 children 6 months to 5 years of age. The intervention and control communities were equivalent for baseline socioeconomic status, household size, ownership of land and animals, and child nutrition and health. At 12 months (prior to animal donations), the Terai intervention group had improved child weight (p = .04), improved child height (p = .05), and reduced sick days (p = .03), as well as increased household income (p = .004), increased ownership of animals (p = .04) and land (p = .04), and improved sanitation practices (p < .01). In all districts, longer participation in Heifer activities corresponded to more improvement in child height-for-age z-scores. Heifer interventions resulted in improved socioeconomic status and household income per family member. Children under 60 months of age in the intervention group had greater incremental improvement in height-for-age and weight-for-age z-scores than children in the control group, and longer participation in Heifer activities was associated with better growth. Poverty alleviation programs, such as Heifer, may indirectly benefit child growth.

Bypassing birthing centres for child birth: a community-based study in rural Chitwan Nepal.

PubMed

Shah, Rajani

2016-10-21

Child delivery in a health facility is important to reduce maternal mortality. Bypassing nearby birthing facility to deliver at a hospital is common in developing countries including Nepal. Very little is known about the extent and determinants of bypassing the birthing centres in Nepal. This study measures the status of bypassing, characteristics of bypassers and their reasons for bypassing. A community-based cross-sectional study was carried out in six rural village development committees of Chitwan district of Nepal. Structured interviews were conducted with 263 mothers who had given birth at a health facility and whose nearest facility was a birthing centre. Descriptive statistics, univariate and multivariable logistic regression analysis were performed. More than half of the mothers had bypassed the nearer birthing centres to deliver at hospital. Living in plain area [aOR: 2.467; 95 % CI: 1.005-6.058], higher wealth index [aOR: 4.981; 95 % CI: 2.482-9.999], advantaged caste/ethnicity [aOR: 2.172; 95 % CI: 1.153-4.089], older age [aOR: 2.222; 95 % CI: 1.050-4.703] and first birth [aOR: 2.032; 95 % CI: 1.060-3.894] were associated with higher likelihood of bypassing. Among the reasons of bypassing as reported by the bypassers, lack of operation, video x-ray, and blood test facilities were the most common ones, followed by the lack of medicines/drugs and equipment, lack of skilled service provider, and inadequate physical facilities, among others. Quality of service at the birthing centres needs to be given a high consideration to increase their use as well as to ensure an equitable access to the quality care by all.

A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal.

PubMed

Choulagai, Bishnu P; Onta, Sharad; Subedi, Narayan; Bhatta, Dharma N; Shrestha, Binjwala; Petzold, Max; Krettek, Alexandra

2017-10-01

Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. The eligible participants for the survey were women that had delivered a baby within the past 12 months preceding the survey. Implementation was administered by trained health volunteers, youth groups, mothers' groups and health facility management committee members. Post-intervention, we used difference-in-differences and mixed-effects regression models to assess and analyse any increase in the utilization of skilled birth care and antenatal care (ANC) services. All analyses were done by intention to treat. Our trial registration number was ISRCTN78892490 (http://www.isrctn.com/ISRCTN78892490). Interviewees included 1746 and 2098 eligible women in the intervention and control groups, respectively. The 1-year intervention was effective in increasing the use of skilled birth care services (OR = 1.57; CI 1.19-2.08); however, the intervention had no effect on the utilization of ANC services. Expanding the intervention with modifications, e.g. mobilizing more active and stable community groups, ensuring adequate human resources and improving quality of services as well as longer or repeated interventions will help achieve greater effect in increasing the utilization of SBA. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Low compliance with iron-folate supplementation among postpartum mothers of Nepal: an analysis of Nepal Demographic and Health Survey 2011.

PubMed

Khanal, Vishnu; Adhikari, Mandira; Karkee, Rajendra

2014-06-01

One in five maternal deaths are directly attributable to anaemia in the world. The World Health Organization recommends iron supplementation from the second trimester of pregnancy to 45 days after delivery. The aim of this study was to determine the compliance rate of iron-folate consumption and the factors associated with iron-folate consumption among post-natal mothers in Nepal. This study utilised the data of Nepal Demographic and Health Survey (NDHS) 2011. The NDHS 2011 is a cross sectional and nationally representative survey. Of the 4,148 respondents, only 20.7% consumed iron throughout the post-natal period for 45 days. Mothers who had higher and secondary education [adjusted Odd ratio (aOR) 3.101; 95% CI (2.268-4.240)]; had attended four or more antenatal care visits [aOR 9.406; 95% CI (5.552-15.938)]; lived in Far-western development region [aOR 1.822; 95% CI (1.387-2.395)]; delivered in health facility [aOR 1.335; 95% CI (1.057-1.687)]; and attended postnatal care [aOR 2.348; 95% CI (1.859-2.965)] were more likely to take iron for 45 days of postpartum. Intervention to increase the compliance with the postpartum iron-folate supplementation are required to avoid adverse pregnancy outcomes associated with poor iron status with especial focus on the mothers who delivered at homes and did not attend post-natal check up.

Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study.

PubMed

Sreeramareddy, Chandrashekhar T; Panduru, Kishore V; Verma, Sharat C; Joshi, Hari S; Bates, Michael N

2008-01-24

Studies from developed countries have reported on host-related risk factors for extra-pulmonary tuberculosis (EPTB). However, similar studies from high-burden countries like Nepal are lacking. Therefore, we carried out this study to compare demographic, life-style and clinical characteristics between EPTB and PTB patients. A retrospective analysis was carried out on 474 Tuberculosis (TB) patients diagnosed in a tertiary care hospital in western Nepal. Characteristics of demography, life-style and clinical features were obtained from medical case records. Risk factors for being an EPTB patient relative to a PTB patient were identified using logistic regression analysis. The age distribution of the TB patients had a bimodal distribution. The male to female ratio for PTB was 2.29. EPTB was more common at younger ages (< 25 years) and in females. Common sites for EPTB were lymph nodes (42.6%) and peritoneum and/or intestines (14.8%). By logistic regression analysis, age less than 25 years (OR 2.11 95% CI 1.12-3.68) and female gender (OR 1.69, 95% CI 1.12-2.56) were associated with EPTB. Smoking, use of immunosuppressive drugs/steroids, diabetes and past history of TB were more likely to be associated with PTB. Results suggest that younger age and female gender may be independent risk factors for EPTB in a high-burden country like Nepal. TB control programmes may target young and female populations for EPTB case-finding. Further studies are necessary in other high-burden countries to confirm our findings.

Paleoseismic evidence of the CE 1505 (?) and CE 1803 earthquakes from the foothill zone of the Kumaon Himalaya along the Himalayan Frontal Thrust (HFT), India

NASA Astrophysics Data System (ADS)

Malik, Javed N.; Naik, Sambit P.; Sahoo, Santiswarup; Okumura, Koji; Mohanty, Asmita

2017-09-01

The importance of understanding earthquake sources in India and Nepal was underscored by the disastrous 2015 earthquakes of 25 April Gorkha (Mw 7.8) and 12 May Kodari (Mw 7.3, aftershock) in Nepal. The Kumaon-Garhwal segment experienced strong earthquakes in CE 1505 and CE 1803, probably along the Himalayan Frontal Thrust (HFT). Of these, the CE 1505 was the greatest earthquake reported from the region in historical chronicles. However, no surface ruptures related to either of 1505 or 1803 have been identified from the Kumaon-Garhwal segment, and an ambiguity remained about their ruptures dispite recent reports of CE 1505 surface rupture in Western Nepal. We used high-resolution satellite (CARTOSAT-1) data for mapping active fault traces and carried out paleoseismic studies to identify paleo-earthquakes along the HFT. A trench excavated across the Kaladungi Fault (KF), a branching fault of HFT, revealed evidence of at least three earthquakes. Event I (the oldest) occurred between BCE 467 and CE 570; Event II occurred between CE 1294-1587. We infer that the Event II was the most likely historically-reported, great Himalayan earthquake of CE 1505. Event III occurred between CE 1750-1932, and may represent the large magnitude CE 1803 (7.5 > Mw < 8.0) earthquake. Our findings not only help in understanding the frontal fault dynamics, but also may aid seismic hazard evaluation in India and Nepal.

Differentiated Typology of Sex Work and Implication for HIV Prevention Programs among Female Sex Workers in Nepal.

PubMed

Mishra, Shiva Raj; Neupane, Sanjeev Raj

2015-01-01

Sex work in exchange for kind and cash has long been practiced in Nepal. The HIV prevention program in Nepal is focused mainly on these two typologies of sex work. There might be more typologies of sex work beyond streets and establishments seeking research and programmatic attention. The objective of the study is to explore the differentiated typologies of sex work. This is a cross-sectional study conducted using a qualitative technique. Researchers carried out eight Focus Group Discussions with female sex workers (FSWs) (n = 50) in different places of Tanahu district. Data were analyzed using a deductive thematic analysis approach. We identified a more differentiated typology of sex work. Private contact-based sex work and the covert sex work on the cruising areas along the major highways were common. Sex work has become easier to operate with the advent of new technologies such as cell phone. With limited role of facilitation by brokers and pimps, now FSWs are better off and have longer duration of relationship with clients. Soft prostitution was common, as FSWs complemented their income through sex work. The conventional mode of peer and outreach educational approach needs to be further strengthened and modified according to the changing typology of sex work. HIV testing sites need to be further expanded to cruising areas along the highways.

Differentiated Typology of Sex Work and Implication for HIV Prevention Programs among Female Sex Workers in Nepal

PubMed Central

Mishra, Shiva Raj; Neupane, Sanjeev Raj

2015-01-01

Background: Sex work in exchange for kind and cash has long been practiced in Nepal. The HIV prevention program in Nepal is focused mainly on these two typologies of sex work. There might be more typologies of sex work beyond streets and establishments seeking research and programmatic attention. The objective of the study is to explore the differentiated typologies of sex work. Methods: This is a cross-sectional study conducted using a qualitative technique. Researchers carried out eight Focus Group Discussions with female sex workers (FSWs) (n = 50) in different places of Tanahu district. Data were analyzed using a deductive thematic analysis approach. Results: We identified a more differentiated typology of sex work. Private contact-based sex work and the covert sex work on the cruising areas along the major highways were common. Sex work has become easier to operate with the advent of new technologies such as cell phone. With limited role of facilitation by brokers and pimps, now FSWs are better off and have longer duration of relationship with clients. Soft prostitution was common, as FSWs complemented their income through sex work. Conclusion: The conventional mode of peer and outreach educational approach needs to be further strengthened and modified according to the changing typology of sex work. HIV testing sites need to be further expanded to cruising areas along the highways. PMID:25785259

Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study.

PubMed

Khatri, Resham Bahadur; Dangi, Tara Prasad; Gautam, Rupesh; Shrestha, Khadka Narayan; Homer, Caroline S E

2017-01-01

Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers. We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis. Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center. The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.

Complementary school garden, nutrition, water, sanitation and hygiene interventions to improve children's nutrition and health status in Burkina Faso and Nepal: a study protocol.

PubMed

Erismann, Séverine; Shrestha, Akina; Diagbouga, Serge; Knoblauch, Astrid; Gerold, Jana; Herz, Ramona; Sharma, Subodh; Schindler, Christian; Odermatt, Peter; Drescher, Axel; Yang, Ray-Yu; Utzinger, Jürg; Cissé, Guéladio

2016-03-09

Malnutrition and intestinal parasitic infections are common among children in Burkina Faso and Nepal. However, specific health-related data in school-aged children in these two countries are scarce. In the frame of a larger multi-stakeholder project entitled "Vegetables go to School: Improving Nutrition through Agricultural Diversification" (VgtS), a study has been designed with the objectives to: (i) describe schoolchildren's health status in Burkina Faso and Nepal; and to (ii) provide an evidence-base for programme decisions on the relevance of complementary school garden, nutrition, water, sanitation and hygiene (WASH) interventions. The studies will be conducted in the Centre Ouest and the Plateau Central regions of Burkina Faso and the Dolakha and Ramechhap districts of Nepal. Data will be collected and combined at the level of schools, children and their households. A range of indicators will be used to examine nutritional status, intestinal parasitic infections and WASH conditions in 24 schools among 1144 children aged 8-14 years at baseline and a 1-year follow-up. The studies are designed as cluster randomised trials and the schools will be assigned to two core study arms: (i) the 'complementary school garden, nutrition and WASH intervention' arm; and the (ii) 'control' arm with no interventions. Children will be subjected to parasitological examinations using stool and urine samples and to quality-controlled anthropometric and haemoglobin measurements. Drinking water will be assessed for contamination with coliform bacteria and faecal streptococci. A questionnaire survey on nutritional and health knowledge, attitudes and practices (KAP) will be administered to children and their caregivers, also assessing socioeconomic, food-security and WASH conditions at household level. Focus group and key-informant interviews on children's nutrition and hygiene perceptions and behaviours will be conducted with their caregivers and school personnel. The studies will contribute to fill a data gap on school-aged children in Burkina Faso and Nepal. The data collected will also serve to inform the design of school-based interventions and will contribute to deepen the understanding of potential effects of these interventions to improve schoolchildren's health in resource-constrained settings. Key findings will be used to provide guidance for the implementation of health policies at the school level in Burkina Faso and Nepal. ISRCTN30840 (date assigned: 17 July 2015).

Effect of the 2015 earthquake on pediatric inpatient pattern at a tertiary care hospital in Nepal.

PubMed

Giri, Bishnu Rath; Chapagain, Ram Hari; Sharma, Samana; Shrestha, Sandeep; Ghimire, Sunita; Shankar, P Ravi

2018-02-05

Earthquakes impact child health in many ways. Diseases occurring immediately following an earthquake have been studied in field based hospitals but studies on the inpatient disease pattern among children without trauma in a permanent hospital setup is lacking. We examined the diagnoses of all children without trauma, admitted to Kanti Children's Hospital, Kathmandu for fifteen-week duration (from 4th week to end of the 18th week) following the 7.8 magnitude Nepal earthquake on 25th April 2015. The admitted children were grouped based on direct effect of earthquake on their family (house damaged or family member injured or dead) and on whether their place of residence was located in an earthquake affected district. Most common diagnoses were identified and their distribution between the aforementioned groups analyzed to examine differences, if any, in disease occurrence or presentation. The fifteen weeks study duration was divided into three parts of five weeks each, to study trends in illness presentation. Variables were compared among various groups using appropriate statistical tests (p < 0.05). A total of 1057 patients were admitted. The proportion of patients requiring admission for pneumonia, acute gastroenteritis and acute or poststreptococcal glomerulonephritis (AGN/PSGN) was significantly higher among children belonging to earthquake affected districts. Proportion of patients with any infective condition was also significantly higher in this group. Acute gastroenteritis and any infective condition were significantly higher among children from substantially affected families. The proportion of AGN/PSGN among admitted patients increased in successive time categories among patients from affected districts and from substantially affected families. Urinary Tract Infection, bronchiolitis, tuberculosis, pleural effusion, protein energy malnutrition/failure to thrive, nephrotic syndrome, meningitis/meningoencephalitis, epilepsy or seizure disorders, leukemia/malignancies, enteric fever, infective hepatitis and congenital heart disease were not significantly different among children from affected and not affected districts or between substantially affected and not affected families. Patients from substantially affected families were admitted to semi-intensive care ward or ICU in significantly higher proportions (12.6% vs 7.8%, p = 0.014). Children seeking care for certain diseases were more likely to be from earthquake affected families and districts. Those from affected families required critical care more often.

Evaluation of community pharmacies regarding dispensing practices of antibiotics in two districts of central Nepal.

PubMed

Ansari, Mukhtar

2017-01-01

To evaluate the status of community pharmacies, their staff, and practices toward dispensing antibiotics. Cross-sectional, prospective. Community pharmacies in two districts of central Nepal, from March 2016 to May 2016. A systematic random sampling approach was adopted to sample 161 community pharmacies. Data on the registration status of pharmacies, qualification or training of dispensing staff, and the practice of dispensing antibiotics were collected using a pre-tested questionnaire. Face to face interviews were carried out by a previously trained interviewer. Data were analyzed for descriptive and inferential statistics using IBM SPSS Statistics 21. Among 161 community pharmacies, 25% were not registered and most of them were located in rural areas. It was typical (66.5%) to dispense antibiotics without prescription and most (91.4%) of the staffs involved in dispensing were non-pharmacists. Furthermore, the study revealed common practices of replacing one brand of antibiotic with other brands (66%), dispensing incomplete courses of antibiotics (73%), and not giving any advice regarding antibiotic use (39%) or completion of a full course of therapy (80%). There were significant (p < 0.001) relationships between the location of pharmacies (rural vs urban) and the qualifications of the pharmacy staff. Dispensing antibiotics without prescription and by non-pharmacists are common in this region. The study also found several issues regarding the irrational use of antibiotics. Thus, there is an urgent need to address these issues and promote the informed use of antibiotics.

Water Quality, Sanitation, and Hygiene Conditions in Schools and Households in Dolakha and Ramechhap Districts, Nepal: Results from A Cross-Sectional Survey.

PubMed

Shrestha, Akina; Sharma, Subodh; Gerold, Jana; Erismann, Séverine; Sagar, Sanjay; Koju, Rajendra; Schindler, Christian; Odermatt, Peter; Utzinger, Jürg; Cissé, Guéladio

2017-01-18

This study assessed drinking water quality, sanitation, and hygiene (WASH) conditions among 708 schoolchildren and 562 households in Dolakha and Ramechhap districts of Nepal. Cross-sectional surveys were carried out in March and June 2015. A Delagua water quality testing kit was employed on 634 water samples obtained from 16 purposively selected schools, 40 community water sources, and 562 households to examine water quality. A flame atomic absorption spectrophotometer was used to test lead and arsenic content of the same samples. Additionally, a questionnaire survey was conducted to obtain WASH predictors. A total of 75% of school drinking water source samples and 76.9% point-of-use samples (water bottles) at schools, 39.5% water source samples in the community, and 27.4% point-of-use samples at household levels were contaminated with thermo-tolerant coliforms. The values of water samples for pH (6.8-7.6), free and total residual chlorine (0.1-0.5 mg/L), mean lead concentration (0.01 mg/L), and mean arsenic concentration (0.05 mg/L) were within national drinking water quality standards. The presence of domestic animals roaming inside schoolchildren's homes was significantly associated with drinking water contamination (adjusted odds ratio: 1.64; 95% confidence interval: 1.08-2.50; p = 0.02). Our findings call for an improvement of WASH conditions at the unit of school, households, and communities.

Water Quality, Sanitation, and Hygiene Conditions in Schools and Households in Dolakha and Ramechhap Districts, Nepal: Results from A Cross-Sectional Survey

PubMed Central

Shrestha, Akina; Sharma, Subodh; Gerold, Jana; Erismann, Séverine; Sagar, Sanjay; Koju, Rajendra; Schindler, Christian; Odermatt, Peter; Utzinger, Jürg; Cissé, Guéladio

2017-01-01

This study assessed drinking water quality, sanitation, and hygiene (WASH) conditions among 708 schoolchildren and 562 households in Dolakha and Ramechhap districts of Nepal. Cross-sectional surveys were carried out in March and June 2015. A Delagua water quality testing kit was employed on 634 water samples obtained from 16 purposively selected schools, 40 community water sources, and 562 households to examine water quality. A flame atomic absorption spectrophotometer was used to test lead and arsenic content of the same samples. Additionally, a questionnaire survey was conducted to obtain WASH predictors. A total of 75% of school drinking water source samples and 76.9% point-of-use samples (water bottles) at schools, 39.5% water source samples in the community, and 27.4% point-of-use samples at household levels were contaminated with thermo-tolerant coliforms. The values of water samples for pH (6.8–7.6), free and total residual chlorine (0.1–0.5 mg/L), mean lead concentration (0.01 mg/L), and mean arsenic concentration (0.05 mg/L) were within national drinking water quality standards. The presence of domestic animals roaming inside schoolchildren’s homes was significantly associated with drinking water contamination (adjusted odds ratio: 1.64; 95% confidence interval: 1.08–2.50; p = 0.02). Our findings call for an improvement of WASH conditions at the unit of school, households, and communities. PMID:28106779

Aflatoxin exposure during the first 1000 days of life in rural South Asia assessed by aflatoxin B₁-lysine albumin biomarkers.

PubMed

Groopman, John D; Egner, Patricia A; Schulze, Kerry J; Wu, Lee S-F; Merrill, Rebecca; Mehra, Sucheta; Shamim, Abu A; Ali, Hasmot; Shaikh, Saijuddin; Gernand, Alison; Khatry, Subarna K; LeClerq, Steven C; West, Keith P; Christian, Parul

2014-12-01

Aflatoxin B1 is a potent carcinogen, occurring from mold growth that contaminates staple grains in hot, humid environments. In this investigation, aflatoxin B1-lysine albumin biomarkers were measured by mass spectrometry in rural South Asian women, during the first and third trimester of pregnancy, and their children at birth and at two years of age. These subjects participated in randomized community trials of antenatal micronutrient supplementation in Sarlahi District, southern Nepal and Gaibandha District in northwestern Bangladesh. Findings from the Nepal samples demonstrated exposure to aflatoxin, with 94% detectable samples ranging from 0.45 to 2939.30 pg aflatoxin B1-lysine/mg albumin during pregnancy. In the Bangladesh samples the range was 1.56 to 63.22 pg aflatoxin B1-lysine/mg albumin in the first trimester, 3.37 to 72.8 pg aflatoxin B1-lysine/mg albumin in the third trimester, 4.62 to 76.69 pg aflatoxin B1-lysine/mg albumin at birth and 3.88 to 81.44 pg aflatoxin B1-lysine/mg albumin at age two years. Aflatoxin B1-lysine adducts in cord blood samples demonstrated that the fetus had the capacity to convert aflatoxin into toxicologically active compounds and the detection in the same 2-year-old children illustrates exposure over the first 1000 days of life. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mental health and psychosocial problems in the aftermath of the Nepal earthquakes: findings from a representative cluster sample survey.

PubMed

Kane, J C; Luitel, N P; Jordans, M J D; Kohrt, B A; Weissbecker, I; Tol, W A

2018-06-01

Two large earthquakes in 2015 caused widespread destruction in Nepal. This study aimed to examine frequency of common mental health and psychosocial problems and their correlates following the earthquakes. A stratified multi-stage cluster sampling design was employed to randomly select 513 participants (aged 16 and above) from three earthquake-affected districts in Nepal: Kathmandu, Gorkha and Sindhupalchowk, 4 months after the second earthquake. Outcomes were selected based on qualitative preparatory research and included symptoms of depression and anxiety (Hopkins Symptom Checklist-25); post-traumatic stress disorder (PTSD Checklist-Civilian); hazardous alcohol use (AUDIT-C); symptoms indicating severe psychological distress (WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS)); suicidal ideation (Composite International Diagnostic Interview); perceived needs (Humanitarian Emergency Settings Perceived Needs Scale (HESPER)); and functional impairment (locally developed scale). A substantial percentage of participants scored above validated cut-off scores for depression (34.3%, 95% CI 28.4-40.4) and anxiety (33.8%, 95% CI 27.6-40.6). Hazardous alcohol use was reported by 20.4% (95% CI 17.1-24.3) and 10.9% (95% CI 8.8-13.5) reported suicidal ideation. Forty-two percent reported that 'distress' was a serious problem in their community. Anger that was out of control (symptom from the WASSS) was reported by 33.7% (95% CI 29.5-38.2). Fewer people had elevated rates of PTSD symptoms above a validated cut-off score (5.2%, 95% CI 3.9-6.8), and levels of functional impairment were also relatively low. Correlates of elevated symptom scores were female gender, lower caste and greater number of perceived needs. Residing in Gorkha and Sindhupalchowk districts and lower caste were also associated with greater perceived needs. Higher levels of impaired functioning were associated with greater odds of depression and anxiety symptoms; impaired functioning was less strongly associated with PTSD symptoms. Four months after the earthquakes in Nepal, one out of three adults experienced symptoms of depression and distressing levels of anger, one out of five engaged in hazardous drinking, and one out of ten had suicidal thoughts. However, posttraumatic stress symptoms and functional impairment were comparatively less frequent. Taken together, the findings suggest that there were significant levels of psychological distress but likely low levels of disorder. The findings highlight the importance of indicated prevention strategies to reduce the risk of distress progressing to disorder within post-disaster mental health systems of care.

Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda

PubMed Central

Mendenhall, Emily; De Silva, Mary J.; Hanlon, Charlotte; Petersen, Inge; Shidhaye, Rahul; Jordans, Mark; Luitel, Nagendra; Ssebunnya, Joshua; Fekadu, Abebaw; Patel, Vikram; Tomlinson, Mark; Lund, Crick

2014-01-01

Three-quarters of the global mental health burden exists in low- and middle-income countries (LMICs), yet the lack of mental health services in resource-poor settings is striking. Task-sharing (also, task-shifting), where mental health care is provided by non-specialists, has been proposed to improve access to mental health care in LMICs. This multi-site qualitative study investigates the acceptability and feasibility of task-sharing mental health care in LMICs by examining perceptions of primary care service providers (physicians, nurses, and community health workers), community members, and service users in one district in each of the five countries participating in the PRogramme for Improving Mental health carE (PRIME): Ethiopia, India, Nepal, South Africa, and Uganda. Thirty-six focus group discussions and 164 in-depth interviews were conducted at the pre-implementation stage between February and October 2012 with the objective of developing district level plans to integrate mental health care into primary care. Perceptions of the acceptability and feasibility of task-sharing were evaluated first at the district level in each country through open-coding and then at the cross-country level through a secondary analysis of emergent themes. We found that task-sharing mental health services is perceived to be acceptable and feasible in these LMICs as long as key conditions are met: 1) increased numbers of human resources and better access to medications; 2) ongoing structured supportive supervision at the community and primary care-levels; and 3) adequate training and compensation for health workers involved in task-sharing. Taking into account the socio-cultural context is fundamental for identifying local personnel who can assist in detection of mental illness and facilitate treatment and care as well as training, supervision, and service delivery. By recognizing the systemic challenges and sociocultural nuances that may influence task-sharing mental health care, locally-situated interventions could be more easily planned to provide appropriate and acceptable mental health care in LMICs. PMID:25089962

Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda.

PubMed

Mendenhall, Emily; De Silva, Mary J; Hanlon, Charlotte; Petersen, Inge; Shidhaye, Rahul; Jordans, Mark; Luitel, Nagendra; Ssebunnya, Joshua; Fekadu, Abebaw; Patel, Vikram; Tomlinson, Mark; Lund, Crick

2014-10-01

Three-quarters of the global mental health burden exists in low- and middle-income countries (LMICs), yet the lack of mental health services in resource-poor settings is striking. Task-sharing (also, task-shifting), where mental health care is provided by non-specialists, has been proposed to improve access to mental health care in LMICs. This multi-site qualitative study investigates the acceptability and feasibility of task-sharing mental health care in LMICs by examining perceptions of primary care service providers (physicians, nurses, and community health workers), community members, and service users in one district in each of the five countries participating in the PRogramme for Improving Mental health carE (PRIME): Ethiopia, India, Nepal, South Africa, and Uganda. Thirty-six focus group discussions and 164 in-depth interviews were conducted at the pre-implementation stage between February and October 2012 with the objective of developing district level plans to integrate mental health care into primary care. Perceptions of the acceptability and feasibility of task-sharing were evaluated first at the district level in each country through open-coding and then at the cross-country level through a secondary analysis of emergent themes. We found that task-sharing mental health services is perceived to be acceptable and feasible in these LMICs as long as key conditions are met: 1) increased numbers of human resources and better access to medications; 2) ongoing structured supportive supervision at the community and primary care-levels; and 3) adequate training and compensation for health workers involved in task-sharing. Taking into account the socio-cultural context is fundamental for identifying local personnel who can assist in detection of mental illness and facilitate treatment and care as well as training, supervision, and service delivery. By recognizing the systemic challenges and sociocultural nuances that may influence task-sharing mental health care, locally-situated interventions could be more easily planned to provide appropriate and acceptable mental health care in LMICs. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Whole World Handbook. A Student Guide to Work, Study and Travel Abroad. 1978-79 Edition.

ERIC Educational Resources Information Center

Cohen, Marjorie Adoff

This 1978-79 student guide to work, study, and travel abroad contains chapters on the following areas: Western Europe; the U.S.S.R. and Eastern Europe; the Middle East and North Africa; Africa south of the Sahara; South Asia (India, Nepal, Sri Lanka, Bangladesh, and Pakistan); East Asia; Southeast Asia; Australia and New Zealand; Latin America and…

Geomorphic impacts, age and significance of two giant landslide dams in the Nepal Himalayas: Ringmo-Phoksundo (Dolpo District) and Dhampu-Chhoya (Mustang District).

NASA Astrophysics Data System (ADS)

Fort, Monique; Braucher, Regis; Bourlès, Didier; Guillou, Valery; Nath Rimal, Lila; Gribenski, Natacha; Cossart, Etienne

2014-05-01

Large catastrophic slope failures have recently retained much attention in the northern dry Himalayas (1). They play a prominent role in the denudation history of active orogens at a wide range of spatial and time scales (2), and they impact durably landforms and process evolution in upstream catchments. Their occurrence mostly results from three different potential triggers: earthquakes, post-glacial debuttressing, and permafrost melting. We focus on two examples of giant rock slope failures that occurred across and north of the Higher Himalaya of Nepal and assess their respective influence on the regional, geomorphic evolution. The Ringmo rockslide (4.5 km3) results from the collapse of a mountain wall (5148 m) cut into palaeozoic dolomites of the Tethysian Himalayas. It caused the damming of the Suli Gad River at the origin of the Phoksumdo Lake (3600 m asl). The presence of glacial till at the very base of the sequence suggests the rockslide event is post-glacial, a field assumption confirmed by cosmogenic dating. Two consistent 36Cl ages of 20,885 ±1675 argue for a single, massive event of paraglacial origin that fits well with the last chronologies available on the Last Glacial Maximum in the Nepal Himalaya. The persistence of the Phoksumdo Lake is due to its dam stability (i.e. high lime content of landslide components) and to low sediment flux from the arid, upper Suli Gad catchment. The Dhampu-Chhoya rock avalanche (about 1 km3, area extent 10 km2) was derived from the northward failure of the Kaiku ridge, uphold by north-dipping, upper crystallines of the Higher Himalaya. It dammed the Kali Gandaki River, with complex interactions with the Late Pleistocene ice tongues derived from the Dhaulagiri (8167 m) and Nilgiris (7061 m) peaks. Both the rock avalanche and glaciers controlled the existence and level of the "Marpha Lake" (lacustrine deposits up to Kagbeni). Again, consistent 10Be ages of 29,680 ± 1015 ka obtained from two large blocks (>1000 m3) suggest a single event, in full agreement with other 10Be dates obtained by a different team from the same site (3). This latter event occurred during glaciation, and was likely triggered in connection with the North Himalayan Fault and/or Thakkhola fault activity. Post-landslide dam evolution includes rapid dissection of lacustrine deposits (4), yet the braided pattern of the Kali Gandaki evidence the delay in headward erosion caused by landslide dam persistence. References: (1) Hewitt K., 2009. Catastrophic rock slope failures and late Quaternary developments in the Nanga Parbat-Haramosh Massif, Upper Indus basin, northern Pakistan. Quaternary Science Reviews, 28, 1055-1069; (2) Korup, O., Clague, J.J., 2009. Natural hazards, extreme events, and mountain topography. Quaternary Science Reviews 28, 977-990; (3) Zech R., Zech M, Kubik P.W., Kharki K., Zech W. (2009). Deglaciation and landscape history around Annapurna, Nepal, based on 10Be surface exposure dating, Quaternary Science Reviews, v. 28(11-12), pp.1106-1118; (4) Fort M., Cossart E. (2013) Erosion assessment in the middle Kali Gandaki (Nepal): A sediment budget approach. Journal of Nepal Geological Society, Vol. 46, pp. 25-40.

Improving Curriculum and Assessment through a School-University Partnership.

ERIC Educational Resources Information Center

Fielding, Glen D.

1989-01-01

This article describes the Valley Education Consortium, a long-term, ongoing school-university partnership to achieve concurrent improvements in secondary school curriculum and assessment. The partnership consists of 10 school districts in western Oregon, three county education service districts, the Oregon State University-Western Oregon State…

Factors affecting institutional delivery in rural Chitwan district of Nepal: a community-based cross-sectional study.

PubMed

Shah, Rajani; Rehfuess, Eva A; Maskey, Mahesh K; Fischer, Rainald; Bhandari, Prem B; Delius, Maria

2015-02-13

Health facility delivery is considered a critical strategy to improve maternal health. The Government of Nepal is promoting institutional delivery through different incentive programmes and the establishment of birthing centres. This study aimed to identify the socio-demographic, socio-cultural, and health service-related factors influencing institutional delivery uptake in rural areas of Chitwan district, where high rates of institutional deliveries co-exist with a significant proportion of home deliveries. This community-based cross-sectional study was conducted in six rural Village Development Committees of Chitwan district, which are characterised by relatively low institutional delivery rates and the availability of birthing centres. The study area represents both hilly and plain areas of Chitwan. A total of 673 mothers who had given birth during a one-year-period were interviewed using a structured questionnaire. Univariate and multivariable logistic regression analysis using stepwise backward elimination was performed to identify key factors affecting institutional delivery. Adjusting for all other factors in the final model, advantaged caste/ethnicity [aOR: 1.98; 95% CI: 1.15-3.42], support for institutional delivery by the husband [aOR: 19.85; 95% CI: 8.53-46.21], the decision on place of delivery taken jointly by women and family members [aOR: 5.43; 95% CI: 2.91-10.16] or by family members alone [aOR: 4.61; 95% CI: 2.56-8.28], birth preparations [aOR: 1.75; 95% CI: 1.04-2.92], complications during the most recent pregnancy/delivery [aOR: 2.88; 95% CI: 1.67-4.98], a perception that skilled health workers are always available [aOR: 2.70; 95% CI: 1.20-6.07] and a birthing facility located within one hour's travelling distance [aOR: 2.15; 95% CI: 1.26-3.69] significantly increased the likelihood of institutional delivery. On the other hand, not knowing about the adequacy of physical facilities significantly decreased the likelihood of institutional delivery [aOR: 0.14; 95% CI: 0.05-0.41]. With multiple incentives present, the decision to deliver in a health facility is affected by a complex interplay of socio-demographic, socio-cultural, and health service-related factors. Family decision-making roles and a husband's support for institutional delivery exert a particularly strong influence on the place of delivery, and this should be emphasized in the health policy as well as development and implementation of maternal health programmes in Nepal.

75 FR 54846 - Kern and Tulare Counties Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-09

.... Applications or written comments should be sent to Priscilla Summers, Western Divide Ranger District, 32588... inspect comments received at Western Divide Ranger District, 32588 Highway 190, Springville, CA 93265...) receive public comment. Persons who wish to bring related matters to the attention of the Committee may...

75 FR 32359 - Kern and Tulare Counties Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-08

.... Written comments should be sent to Priscilla Summers, Western Divide Ranger District, 32588 Highway 190... Western Divide Ranger District, 32588 Highway 190, Springville, CA 93265. Visitors are encouraged to call... related matters to the attention of the Committee may file written statements with the Committee staff...

Estimates of delays in diagnosis of cervical cancer in Nepal

PubMed Central

2014-01-01

Background Cervical cancer is the leading cause of cancer related deaths among women in Nepal. The long symptom to diagnosis interval means that women have advanced disease at presentation. The aim of this study was to identify, estimate and describe the extent of different delays in diagnosis of cervical cancer in Nepal. Methods A cross-sectional descriptive study was conducted in two tertiary cancer hospitals of Nepal. Face to face interview and medical records review were carried out among 110 cervical cancer patients. Total diagnostic delay was categorized into component delays: patient delay, health care providers delay, referral delay and diagnostic waiting time. Results Total 110 patients recruited in the study represented 40 districts from all three ecological regions of the country. Median total diagnostic delay was 157 days with more than three fourth (77.3%) of the patients having longer total diagnostic delay of >90 days. Out of the total diagnostic delay, median patient delay, median health care provider delay, median referral delay and median diagnostic waiting time were 68.5 days, 40 days, 5 days and 9 days respectively. Majority of the patients had experienced longer delay of each type except referral delay. Fifty seven percent of the patients had experienced longer patient delay of >60 days, 90% had suffered longer health care provider delay of >1 week, 31.8% had longer referral delay of >1 week and 66.2% had waited >1 week at diagnostic center for final diagnosis. Variation in each type of delay was observed among women with different attributes and in context of health care service delivery. Conclusions Longer delays were observed in all the diagnostic pathways except for referral delay and diagnostic waiting time. Among the delays, patient delay is of crucial importance because of its longer span, although health care provider delay is equally important. In the context of limited screening services in Nepal, the efforts should be to reduce the diagnostic delay especially patient and health care provider delay for early detection and reduction of mortality rate of cervical cancer. PMID:24533670

Communicating Climate Change - Weather Forecast Need Assessment and Information Dissemination Mechanism to Farmers in Nepal

NASA Astrophysics Data System (ADS)

Panthi, J., Sr.

2014-12-01

Climate Change is becoming one of the major threats to the fragile Himalayan ecosystem. It is affecting all sectors mainly fresh water, agriculture, forest, biodiversity and species. The subsistence agriculture system of Nepal is mainly rain-fed; therefore, climate change and climate extremes do have direct impacts on it. Weather extremes like droughts, floods and landslides long-lasting fog, hot and cold waves are affecting the agriculture sectors of Nepal. As human-induced climate change has already showing its impacts and it is going to be there for a long time to come, it is paramount importance to move towards the adaptation. Early warning system is an effective way for reducing the impacts of disasters. Forecasting of weather parameters (temperature, precipitation, and wind) helps farmers for their preparedness activities. With consultation with farmers and other relevant institutions, a research project was carried out, for the first time in Nepal, to identify the forecast information need to farmers and their dissemination mechanism. Community consultation workshops, key informant survey, and field observations were the techniques used for this research. Two ecological locations: Bageshwori VDC in Banke (plain) and Dhaibung VDC in Rasuwa (mountain) were taken as the pilot sites for this assessment. People in both the districts are dependent highly on agriculture and the weather extremes like hailstone, untimely rainfall; droughts are affecting their agriculture practices. They do not have confidence in the weather forecast information disseminated by the government of Nepal currently being done because it is a general forecast not done for a smaller domain and the forecast is valid only for 24 hours. The weather forecast need to the farmers in both the sites are: rainfall (intensity, duration and time), drought, and hailstone but in Banke, people wished to have the information of heat and cold waves too as they are affecting their wheat and tomato crops respectively the most. The mechanism of dissemination of the forecast information has been identified and agreed as local radio/FM, mobile telephoning to community leader and displaying and daily updating the forecast information in community hoarding boards.

On the identity of Deliphrum nepalicum Coiffait, 1977 (Coleoptera: Staphylinidae: Omaliinae: Anthophagini).

PubMed

Shavrin, Alexey V

2018-01-25

Deliphrum nepalicum was described without comparisons by Coiffait (1977) based on a female from "Environs de Maharigaan (Jumla District, eastern Nepal). A study of the holotype and additional material revealed that D. nepalicum undoubtedly belongs to the genus Olophrum Erichson, 1839 (see generic characters in Scheerpeltz (1929), Newton et al. (2000), Zanetti (2012) etc.). Thus, a new combination is proposed: Olophrum nepalicum (Coiffait 1977) comb.n. The species is redescribed, distributional map and ecological data are provided. The aedeagus of O. nepalicum is illustrated for the first time.

What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal.

PubMed

Raven, Joanna; Baral, Sushil; Wurie, Haja; Witter, Sophie; Samai, Mohamed; Paudel, Pravin; Subedi, Hom Nath; Martineau, Tim; Elsey, Helen; Theobald, Sally

2018-02-07

Health workers are critical to the performance of health systems; yet, evidence about their coping strategies and support needs during and post crisis is lacking. There is very limited discussion about how research teams should respond when unexpected crises occur during on-going research. This paper critically presents the approaches and findings of two health systems research projects that explored and evaluated health worker performance and were adapted during crises, and provides lessons learnt on re-orientating research when the unexpected occurs. Health systems research was adapted post crisis to assess health workers' experiences and coping strategies. Qualitative in-depth interviews were conducted with 14 health workers in a heavily affected earthquake district in Nepal and 25 frontline health workers in four districts in Ebola-affected Sierra Leone. All data were transcribed and analysed using the framework approach, which included developing coding frameworks for each study, applying the frameworks, developing charts and describing the themes. A second layer of analysis included analysis across the two contexts, whereas a third layer involved the research teams reflecting on the approaches used to adapt the research during these crises and what was learned as individuals and research teams. In Sierra Leone, health workers were heavily stigmatised by the epidemic, leading to a breakdown of trust. Coping strategies included finding renewed purpose in continuing to serve their community, peer and family support (in some cases), and religion. In Nepal, individual determination, a sense of responsibility to the community and professional duty compelled staff to stay or return to their workplace. The research teams had trusting relationships with policy-makers and practitioners, which brought credibility and legitimacy to the change of research direction as well as the relationships to maximise the opportunity for findings to inform practice. In both contexts, health workers demonstrated considerable resilience in continuing to provide services despite limited support. Embedded researchers and institutions are arguably best placed to navigate emerging ethical and social justice challenges and are strategically positioned to support the co-production of knowledge and ensure research findings have impact.

Knowledge, attitude and practice towards medicines among school teachers in Lalitpur district, Nepal before and after an educational intervention

PubMed Central

2013-01-01

Background Few studies regarding Knowledge, Attitude and Practice (KAP) towards medicines among school teachers have been carried out in Nepal. Obtaining baseline KAP is important to note deficiencies and plan appropriate interventions. School teachers have to know about medicines as they can be an important source of information about rational and safe use of medicines. The department of Clinical Pharmacology, KIST Medical College, Lalitpur, conducted a study regarding KAP of school teachers about medicines before and after an educational intervention from April 2011 to December 2011. Methods The study was done in selected schools of Lalitpur district. Teachers were selected on a voluntary basis after obtaining written informed consent. Gender, ethnic or caste group, native place, age, educational qualifications, subject taught were noted. An educational intervention using a combination of methods like presentations, brainstorming sessions, interactive discussions using posters and distribution of information leaflets about the use of medicines was conducted. The KAP and overall scores among subgroups according to gender, age, level of education, subject, ethnicity, type of school (primary vs. secondary and government vs. private school) were studied. KAP and overall scores before and after the intervention was compared using Wilcoxon signed ranks test as the scores were not normally distributed. Results A total of 393 teachers participated before and after the intervention. The median (interquartile range) knowledge, attitude and practice scores before the intervention were 63 (10), 23 (5) and 270 (48) respectively while the overall score was 356. The median knowledge, attitude and practice scores after the intervention were 71 (10), 28 (5) and 270 (48) respectively while the overall score increased to 369. Maximum possible score of knowledge, attitude and practice were 100, 40 and 320 respectively. Scores improved significantly for knowledge (p<0.001), attitude (p<0.001) and total scores (p<0.001) but not for practice (p=0.528). Conclusion The intervention was effective in improving knowledge and attitude of the teachers. More studies among school teachers about their knowledge, attitude and practice about medicines are required in Nepal. PMID:23849402

Mapping Geohazards in the Churia Region of Nepal: An Application of Remote Sensing and Geographic Information Systems

NASA Astrophysics Data System (ADS)

Bannister, Terri

The Churia region of Nepal is experiencing serious environmental degradation due to landslides, monsoon flooding, land use changes, and gravel excavation. The objectives of this study were to quantify the temporal change of landslides as related to changes in land use/deforestation/urbanization, to quantify the temporal change and extent of river inundation in the Terai, to quantify the extent to which stone quarrying exacerbates the degradation process, and to generate a landslide hazard risk map. Gravel extraction and precipitation data, along with field work and geospatial methods, were used to map degradation by focusing on the centrally located districts of Bara, Rautahat, and Makwanpur. Landsat land use classifications were conducted on imagery from 1976, 1988, 1999, and 2015. A modified Normalized Difference Mid-Infrared (NDMIDIR) algorithm was created by incorporating slope, elevation, and land use types to identify landslide scars. A GIS model using weighted landslide variables derived from remote sensing and GIS methods to predict landslide susceptibility was created. These variables include hydrology, settlement, lithology, geology, precipitation, infrastructure, elevation, slope, aspect, land use, and previous landslides. Gravel excavation in 2007/2008 was nearly 700% higher than in 2001/2002. The Normalized Difference Vegetation Index (NDVI) results showed that the study area is losing 1.03% forest cover annually; in 1977, there was 70% forest cover, but only 32% forest cover remained in 2016. The accuracy assessment of the 2015 Landsat 8 land use classification was 79%. NDMIDIR results showed that from 1988 to 2016, the total area representing landslide scars increased from 7.26km2 to 8.73 km2. The weighted variable GIS model output map indicated that 70% of the Siwalik zone and southern Lesser Himalayan zone in the three study districts have significant risk of landslides. Landslides and flooding from heavy monsoon rain, deforestation to develop agriculture and urbanization, and gravel extraction have caused rapid and ongoing environmental degradation in the Churia region of Nepal. Results provide information for disaster management and assist policy planners in landslide prone areas decrease loss of lives and property.

Climatic conditions and child height: Sex-specific vulnerability and the protective effects of sanitation and food markets in Nepal.

PubMed

Mulmi, Prajula; Block, Steven A; Shively, Gerald E; Masters, William A

2016-12-01

Environmental conditions in early life are known to have impacts on later health outcomes, but causal mechanisms and potential remedies have been difficult to discern. This paper uses the Nepal Demographic and Health Surveys of 2006 and 2011, combined with earlier NASA satellite observations of variation in the Normalized Difference Vegetation Index (NDVI) at each child's location and time of birth to identify the trimesters of gestation and periods of infancy when climate variation is linked to attained height later in life. We find significant differences by sex: males are most affected by conditions in their second trimester of gestation, and females in the first three months after birth. Each 100-point difference in NDVI at those times is associated with a difference in height-for-age z-score (HAZ) measured at age 12-59 months of 0.088 for boys and 0.054 for girls, an effect size similar to that of moving within the distribution of household wealth by close to one quintile for boys and one decile for girls. The entire seasonal change in NDVI from peak to trough is approximately 200-300 points during the 2000-2011 study period, implying a seasonal effect on HAZ similar to one to three quintiles of household wealth. This effect is observed only in households without toilets; in households with toilets, there is no seasonal fluctuation, implying protection against climatic conditions that facilitate disease transmission. We also use data from the Nepal Living Standards Surveys on district-level agricultural production and marketing, and find a climate effect on child growth only in districts where households' food consumption derives primarily from their own production. Robustness tests find no evidence of selection effects, and placebo regression results reveal no significant artefactual correlations. The timing and sex-specificity of climatic effects are consistent with previous studies, while the protective effects of household sanitation and food markets are novel indications of mechanisms by which households can gain resilience against adverse climatic conditions. Copyright © 2016 The Author(s). Published by Elsevier B.V. All rights reserved.

Teaching Field Geology in the Nepal Himalaya with a Geohazards and Intercultural Emphasis

NASA Astrophysics Data System (ADS)

Pratt-Sitaula, B. A.; Upreti, B. N.; Gajurel, A.

2017-12-01

SIT Study Abroad (School of International Training), in collaboration with Nepal's national university - Tribhuvan University, runs a seven-week summer field education called "Nepal: Geoscience in the Himalaya". The program is designed to teach core geoscience field skills as well as geohazard analysis and intercultural science collaboration. Approximately 70% of the students come from colleges across the USA and 30% come from Tribhuvan University. A key element of the learning is how to work effectively with colleagues from a different educational system and culture. The program starts with a four-day orientation in Kathmandu and then travels to the Kali Gandaki Valley of western Nepal. Everyone treks on foot while completing a geologic transect map from south to north across the main Himalayan range. More traditional field skills are learned during a detailed stratigraphic exercise. On the way back down the valley, the emphasis changes to surface processes and students complete an air photo analysis and small research project on human-earth system interactions. Once back on the road system, the students conduct both a landslide hazard analyses and an earthquake damage assessment. Throughout this time, students maintain a research ideas journal from which they develop an independent study project, which they carry out during the last two weeks of the program. The program particularly emphasizes affordable, sustainable solutions to geohazards that are appropriate for a developing country such as Nepal—a very eye-opening approach for students from the USA. The overall program mission is to promote geoscience field skill development in a societal context and more globally informed scientists, citizens, and leaders.

Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study

PubMed Central

Sreeramareddy, Chandrashekhar T; Panduru, Kishore V; Verma, Sharat C; Joshi, Hari S; Bates, Michael N

2008-01-01

Background Studies from developed countries have reported on host-related risk factors for extra-pulmonary tuberculosis (EPTB). However, similar studies from high-burden countries like Nepal are lacking. Therefore, we carried out this study to compare demographic, life-style and clinical characteristics between EPTB and PTB patients. Methods A retrospective analysis was carried out on 474 Tuberculosis (TB) patients diagnosed in a tertiary care hospital in western Nepal. Characteristics of demography, life-style and clinical features were obtained from medical case records. Risk factors for being an EPTB patient relative to a PTB patient were identified using logistic regression analysis. Results The age distribution of the TB patients had a bimodal distribution. The male to female ratio for PTB was 2.29. EPTB was more common at younger ages (< 25 years) and in females. Common sites for EPTB were lymph nodes (42.6%) and peritoneum and/or intestines (14.8%). By logistic regression analysis, age less than 25 years (OR 2.11 95% CI 1.12–3.68) and female gender (OR 1.69, 95% CI 1.12–2.56) were associated with EPTB. Smoking, use of immunosuppressive drugs/steroids, diabetes and past history of TB were more likely to be associated with PTB. Conclusion Results suggest that younger age and female gender may be independent risk factors for EPTB in a high-burden country like Nepal. TB control programmes may target young and female populations for EPTB case-finding. Further studies are necessary in other high-burden countries to confirm our findings. PMID:18218115

Prevalence and patterns of hazardous and harmful alcohol consumption assessed using the AUDIT among Bhutanese refugees in Nepal.

PubMed

Luitel, Nagendra P; Jordans, Mark; Murphy, Adrianna; Roberts, Bayard; McCambridge, Jim

2013-01-01

This study sought to ascertain the prevalence of hazardous and harmful alcohol consumption among Bhutanese refugees in Nepal and to identify predictors of elevated risk in order to better understand intervention need. Hazardous and harmful alcohol consumption was assessed using the Alcohol Use Disorder Identification Test (AUDIT) administered in a face-to-face interview in a census of two camps comprising ∼8000 refugees. Approximately 1/5 men and 1/14 women drank alcohol and prevalence of hazardous drinking among current drinkers was high and comparable to that seen in Western countries with longstanding alcohol cultures. Harmful drinking was particularly associated with the use of other substances including tobacco. Assessment of the alcohol-related needs of Bhutanese refugees has permitted the design of interventions. This study adds to the small international literature on substance use in forced migration populations, about which there is growing concern.

Convergence rate across the Nepal Himalaya and interseismic coupling on the Main Himalayan Thrust, implications for seismic hazard

NASA Astrophysics Data System (ADS)

Ader, T. J.; Avouac, J.; Bollinger, L.; Lyon-Caen, H.; Chanard, K. D.; Galetzka, J. E.; Genrich, J. F.; Sapkota, S. N.

2011-12-01

We use 24 continuous GPS stations installed by Caltech throughout Nepal, in addition to previously published campaign GPS points and leveling data collected along the road Birganj-Katmandu-Kodari to propose a detailed pattern of coupling on the MHT. The continuous GPS time series are processed modeling the noise on the daily positions by a combination of white and flicker noise, in order to infer secular velocities at the stations with consistent error bars. We then locate the pole of rotation of the Indian plate in the ITRF 2005 reference frame at longitude = 3.6o ± 2.6o, latitude = 51.52o ± 0.26o with an angular velocity of Ω = 0.518 ± 0.008o/Myr. The pattern of coupling on the MHT is computed with a backslip model on a fault dipping 10o to the North and whose strike roughly follows the foothills of the Himalayan chain. The model indicates that the MHT is locked from the surface to a distance of approximately 100 km along dip, corresponding to a depth of 15 to 20 km where the temperature reaches 350oC. In map view, the transition locked/creeping seems to be at the most a few tens of kilometers wide and overlaps with the belt of midcrustal microseismicity underneath the Himalayas. The convergence of the Indian plate underneath the Tibetan plateau proceeds at a rate of 18.1 ± 0.5~mm/yr in central and eastern Nepal and 19.9 ± 0.7~mm/yr in western Nepal. The moment deficit accrues at a rate of 6.7 ± 1019 Nm/yr on the MHT. This rate exceeds by far the moment released by the seismicity in the past 500 years, indicating that the risk for a large M > 8 earthquake to happen in Nepal is real.

A first telecoupling analysis of multi-species poaching trade in Nepal: When outside demands seek and distribute a local resource in times of globalization

NASA Astrophysics Data System (ADS)

Regmi, G. R.; Lama, R. P.; Puri, G.; Huettmann, F.

2016-12-01

Asia remains one of the last wilderness resources in the world. It's widely praised for those resources and they are in a global appreciation and demand. Considering open borders, many of them virtually uncontrollable in Asia, and globalization in full swing, precious local resources become available to a global audience without much constraint though. Nepal and its unique biodiversity presents us with one of such cases while hard data remain elusive. Here we present a first telecoupling analysis based on poaching and crime statistics presented in the public print national daily newspapers (Kantipur and Gorkhapatra) in Nepal. This review highlights a few high-profile species (timber: Sal Shorea robusta , Sissoo Dalbergia sissoo, Pine Pinus species; aromatic and medicinal plants: Red Sandal Wood Santalum album, Orchid Orchid species, Paris Paris polyphylla, Jatamashi Nardostachys grandiflora, Kutki Picrorhyza scrophulariiflora and wildlife: Royal Bengal Tiger Panthera tigris tigris, Rhino Rhinoceros unicornis, Pangolin Manis species, Common Leopard Panthera pardus, Red Panda Ailurus fulgens, Snow Leopard Panthera uncia) in Nepal, traded out directly and illegally to India and China. We provide a wider perspective regarding sending, receiving and spill-over agents. Arguably, the western world as the spill-over agent set up a globalization framework that allows for items, virtually any items, to be shipped across borders, e.g. done on foot, by car or plane. It further allows to create and satisfy a demand by the receiver (=nations in wider Asia), and a system that circumvents the legal structure in the sending location (=Nepal and its biodiversity hotspots and wilderness). We extend the traditional telecoupling analysis with a flow analysis of money, remittance payments and banking networks. This research describes for the first time such a system which is by now essentially found worldwide, how it operates, what devastating impacts it leaves behind on landscapes, and how to resolve it for betterment.

Drivers of sustained hygiene behaviour change: A case study from mid-western Nepal.

PubMed

McMichael, Celia; Robinson, Priscilla

2016-08-01

Behaviour change is central to the prevention of many population health problems, yet it is typically difficult to initiate and sustain. This paper reports on an evaluation of a water, sanitation and hygiene (WASH) intervention in mid-western Nepal, with particular focus on the drivers and barriers for handwashing with soap/ash and elimination of open defecation. The research was conducted during October-November 2014, two and half years following the intervention's end-point. Qualitative data were collected from the target community (n = 112) via group discussions, interviews and drawings/stories of 'most significant change'. Households' handwashing/water facilities and toilets were observed. Analysis was informed by a model that highlights environmental, psychosocial and technological factors that shape hygiene behaviours across multiple levels, from the habitual to the structural (Dreibelbis et al. 2013). Findings indicate the intervention has supported development of new norms around hygiene behaviours. Key drivers of sustained hygiene behaviour were habit formation, emotional drivers (e.g. disgust, affiliation), and collective action and civic pride; key constraints included water scarcity and socio-economic disadvantage. Identifying and responding to the drivers and constraints of hygiene behaviour change in specific contexts is critical to sustained behaviour change and population health impact. Copyright © 2016 Elsevier Ltd. All rights reserved.

Phlebotomus argentipes seasonal patterns in India and Nepal.

PubMed

Picado, Albert; Das, Murari Lal; Kumar, Vijay; Dinesh, Diwakar S; Rijal, Suman; Singh, Shri P; Das, Pradeep; Coosemans, Marc; Boelaert, Marleen; Davies, Clive

2010-03-01

The current control of Phebotomus argentipes (Annandale and Brunetti), the vector of Leishmania donovani (Laveran and Mesnil), on the Indian subcontinent is base on indoor residual spraying. The efficacy of this method depends, among other factors, on the timing and number of spraying rounds, which depend on the P. argentipes seasonality. To describe P. argentipes' seasonal patterns, six visceral leishmaniasis (VL) endemic villages, three in Muzaffarpur and three in Sunsari districts in India and Nepal, respectively, were selected based on accessibility and VL incidence. Ten houses per cluster with the highest P. argentipes density were monitored monthly for 15-16 mo using Center for Disease Control and Prevention light traps. Minimum and maximum temperature and rainfall data for the months January 2006 through December 2007 were collected from the nearest available weather stations. Backwards stepwise regression was used to generate the minimal adequate model for explaining the monthly variation in P. argentipes populations. The seasonality of P. argentipes is similar in India and Nepal, with two annual density peaks around May and October. Monthly P. argentipes density is positively associated with temperature and negatively associated with rainfall in both study sites. The multivariate climate model explained 57% of the monthly vectorial abundance. Vector control programs against P. argentipes (i.e., indoor residual spraying) should take into account the seasonal described here when implementing and monitoring interventions. Monitoring simple meteorological variables (i.e., temperature, rainfall) may allow prediction of VL epidemics on the Indian subcontinent.

Hearing loss is associated with decreased nonverbal intelligence in rural Nepal.

PubMed

Emmett, Susan D; Schmitz, Jane; Pillion, Joseph; Wu, Lee; Khatry, Subarna K; Karna, Sureshwar L; LeClerq, Steven C; West, Keith P

2015-01-01

To evaluate the association between adolescent and young-adult hearing loss and nonverbal intelligence in rural Nepal. Cross-sectional assessment of hearing loss among a population cohort of adolescents and young adults. Sarlahi District, southern Nepal. Seven hundred sixty-four individuals aged 14 to 23 years. Evaluation of hearing loss, defined by World Health Organization criteria of pure-tone average greater than 25 decibels (0.5, 1, 2, 4 kHz), unilaterally and bilaterally. Nonverbal intelligence, as measured by the Test of Nonverbal Intelligence, 3rd Edition standardized score (mean, 100; standard deviation, 15). Nonverbal intelligence scores differed between participants with normal hearing and those with bilateral (p = 0.04) but not unilateral (p = 0.74) hearing loss. Demographic and socioeconomic factors including male sex; higher caste; literacy; education level; occupation reported as student; and ownership of a bicycle, watch, and latrine were strongly associated with higher nonverbal intelligence scores (all p < 0.001). Subjects with bilateral hearing loss scored an average of 3.16 points lower (95% confidence interval, -5.56 to -0.75; p = 0.01) than subjects with normal hearing after controlling for socioeconomic factors. There was no difference in nonverbal intelligence score based on unilateral hearing loss (0.97; 95% confidence interval, -1.67 to 3.61; p = 0.47). Nonverbal intelligence is adversely affected by bilateral hearing loss even at mild hearing loss levels. Socio economic well-being appears compromised in individuals with lower nonverbal intelligence test scores.

Hearing Loss is Associated with Decreased Nonverbal Intelligence in Rural Nepal

PubMed Central

Emmett, Susan D.; Schmitz, Jane; Pillion, Joseph; Wu, Lee; Khatry, Subarna K.; Karna, Sureshwar L.; LeClerq, Steven C.; West, Keith P.

2014-01-01

Objective Evaluate the association between adolescent and young adult hearing loss and nonverbal intelligence in rural Nepal Study Design Cross-sectional assessment of hearing loss among a population cohort of adolescents and young adults Setting Sarlahi District, southern Nepal Patients 764 individuals aged 14–23 years Intervention Evaluation of hearing loss, defined by WHO criteria of pure-tone average (PTA) >25 decibels (0.5, 1, 2, 4 kHz), unilaterally and bilaterally Main Outcome Measure Nonverbal intelligence, measured by the Test of Nonverbal Intelligence, 3rd Edition (TONI-3) standardized score (mean 100; standard deviation (SD) 15) Results Nonverbal intelligence scores differed between participants with normal hearing and those with bilateral (p =0.04) but not unilateral (p =0.74) hearing loss. Demographic and socioeconomic factors including male sex, higher caste, literacy, education level, occupation reported as student, and ownership of a bicycle, watch, and latrine were strongly associated with higher nonverbal intelligence scores (all p <0.001). Subjects with bilateral hearing loss scored an average of 3.16 points lower (95% CI: −5.56, −0.75; p =0.01) than subjects with normal hearing after controlling for socioeconomic factors. There was no difference in nonverbal intelligence score based on unilateral hearing loss (0.97; 95% CI: −1.67, 3.61; p =0.47). Conclusions Nonverbal intelligence is adversely affected by bilateral hearing loss, even at mild hearing loss levels. Social and economic well being appear compromised in individuals with lower nonverbal intelligence test scores. PMID:25299832

Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse‐Midwife Provision of Medical Abortion, 2011‐2013

PubMed Central

Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu

2016-01-01

Introduction The termination of unwanted pregnancies up to 12 weeks’ gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse‐midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS‐11). Results By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary‐level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary‐level health facilities. Post‐training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. PMID:26860072

Development of leadership self-efficacy and collective efficacy: adolescent girls across castes as peer educators in Nepal.

PubMed

Posner, J; Kayastha, P; Davis, D; Limoges, J; O'Donnell, C; Yue, K

2009-01-01

Adolescent girls in Nepal face enormous social barriers to accessing education and health services due to exclusionary socio-religious traditions and years of conflict. The programme and study reported here address two issues that a national assembly of in-school and out-of-school adolescent girls, who had completed a basic life skills class, and, in the case of unschooled girls, an intensive literacy course, identified as important to their well-being - menstrual restrictions and HIV awareness and prevention. Local non-governmental organizations developed a peer education programme in three districts of Nepal that paired girls from different castes and different educational levels. The programme sought to increase peer educators' (PE) leadership and collective efficacy for informing peers and adults in their communities about the effects that these issues have on women and girls. In total, 504 girls were selected and trained as PEs. They conducted targeted discussion sessions with other girls and organised mass awareness events, reaching 20,000 people. Examination of the effects of participating in the programme on key outcome measures showed that leadership self-efficacy, which was a central theoretical construct for the programme, provided a strong predictor of both increased HIV knowledge and of practicing fewer menstrual restrictions at endline. The project demonstrated that girls from different caste and educational backgrounds are able to work together to change individual behaviour and to address socio-cultural norms that affect their lives and well-being within their communities.

Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study

PubMed Central

Shrestha, Khadka Narayan; Homer, Caroline S. E.

2017-01-01

Background Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers. Methods We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis. Results Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center. Conclusion The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries. PMID:28493987

Patients' attitudes towards privacy in a Nepalese public hospital: a cross-sectional survey.

PubMed

Moore, Malcolm; Chaudhary, Ritesh

2013-01-29

Many people in western countries assume that privacy and confidentiality are features of most medical consultations. However, in many developing countries consultations take place in a public setting where privacy is extremely limited. This is often said to be culturally acceptable but there is little research to determine if this is true. This research sought to determine the attitudes of patients in eastern Nepal towards privacy in consultations. A structured survey was administered to a sample of patients attending an outpatients department in eastern Nepal. It asked patients about their attitudes towards physical privacy and confidentiality of information. The majority of patients (58%) stated that they were not comfortable having other patients in the same room. A similar percentage (53%) did not want other patients to know their medical information but more patients were happy for nurses and other health staff to know (81%). Females and younger patients were more concerned to have privacy. The results challenge the conventional beliefs about patients' privacy concerns in Nepal. They suggest that consideration should be given to re-organising existing outpatient facilities and planning future facilities to enable more privacy. The study has implications for other countries where similar conditions prevail. There is a need for more comprehensive research exploring this issue.

Sexual health knowledge, sexual relationships and condom use among male trekking guides in Nepal: a qualitative study.

PubMed

Simkhada, Padam; van Teijlingen, Edwin R; Regmi, Pramod R; Bhatta, Prakash

2010-01-01

People in Nepal generally hold fairly traditional views about sex and sexual health, whilst Western tourists often have a more liberal approach towards sex and relationships. There is evidence that significant sexual interaction occurs between male trekking guides and female travellers and/or local female sex workers in Nepal. This qualitative study explored trekking guides' sexual health knowledge, sexual relationships and condom use with female trekkers and local female sex workers. A total of 21 in-depth interviews were conducted with male trekking guides. Most reported having had sexual relationships with female trekkers and local female sex workers. Explanations for intercourse with female trekkers included: financial support; getting future trekkers through word-of-mouth advertising from the women they have had sex with; and opportunities for emigration. Interestingly, sexual intercourse is reported as more likely to be initiated by female trekkers than by guides, and more so by older women. In contrast, the main reasons for having sex with local female sex workers included: romantic love or sexual excitement and novelty. Awareness regarding sexual health was high among guides, but several factors discouraged the regular use of condoms. Further research with female tourists would help understand the motivations and reasons for their sexual behaviour.

40 CFR 81.352 - American Samoa.

Code of Federal Regulations, 2010 CFR

2010-07-01

... noted. American Samoa—PM2.5 (Annual NAAQS) Designated area Designationa Date 1 Type Statewide: Eastern.../Attainment. Swains Island Unclassifiable/Attainment. Western District Unclassifiable/Attainment. a Includes...: Eastern District Unclassifiable/Attainment Unclassifiable/Attainment. Manu`a District Unclassifiable...

The role of auxiliary nurse-midwives and community health volunteers in expanding access to medical abortion in rural Nepal.

PubMed

Puri, Mahesh; Tamang, Anand; Shrestha, Prabhakar; Joshi, Deepak

2015-02-01

Medical abortion was introduced in Nepal in 2009, but rural women's access to medical abortion services remained limited. We conducted a district-level operations research study to assess the effectiveness of training 13 auxiliary nurse-midwives as medical abortion providers, and 120 female community health volunteers as communicators and referral agents for expanding access to medical abortion for rural women. Interviews with service providers and women who received medical abortion were undertaken and service statistics were analysed. Compared to a neighbouring district with no intervention, there was a significant increase in the intervention area in community health volunteers' knowledge of the legal conditions for abortion, the advantages and disadvantages of medical abortion, safe places for an abortion, medical abortion drugs, correct gestational age for home use of medical abortion, and carrying out a urine pregnancy test. In a one-year period in 2011-12, the community health volunteers did pregnancy tests for 584 women and referred 114 women to the auxiliary nurse-midwives for abortion; 307 women in the intervention area received medical abortion services from auxiliary nurse-midwives. There were no complications that required referral to a higher-level facility except for one incomplete abortion. Almost all women who opted for medical abortion were happy with the services provided. The study demonstrated that auxiliary nurse-midwives can independently and confidently provide medical abortion safely and effectively at the sub-health post level, and community health volunteers are effective change agents in informing women about medical abortion. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal.

PubMed

Fleming, Matthew; King, Caroline; Rajeev, Sindhya; Baruwal, Ashma; Schwarz, Dan; Schwarz, Ryan; Khadka, Nirajan; Pande, Sami; Khanal, Sumesh; Acharya, Bibhav; Benton, Adia; Rogers, Selwyn O; Panizales, Maria; Gyorki, David; McGee, Heather; Shaye, David; Maru, Duncan

2017-09-25

Patients in isolated rural communities typically lack access to surgical care. It is not feasible for most rural first-level hospitals to provide a full suite of surgical specialty services. Comprehensive surgical care thus depends on referral systems. There is minimal literature, however, on the functioning of such systems. We undertook a prospective case study of the referral and care coordination process for cardiac, orthopedic, plastic, gynecologic, and general surgical conditions at a district hospital in rural Nepal from 2012 to 2014. We assessed the referral process using the World Health Organization's Health Systems Framework. We followed the initial 292 patients referred for surgical services in the program. 152 patients (52%) received surgery and four (1%) suffered a complication (three deaths and one patient reported complication). The three most common types of surgery performed were: orthopedics (43%), general (32%), and plastics (10%). The average direct and indirect cost per patient referred, including food, transportation, lodging, medications, diagnostic examinations, treatments, and human resources was US$840, which was over 1.5 times the local district's per capita income. We identified and mapped challenges according to the World Health Organization's Health Systems Framework. Given the requirement of intensive human capital, poor quality control of surgical services, and the overall costs of the program, hospital leadership decided to terminate the referral coordination program and continue to build local surgical capacity. The results of our case study provide some context into the challenges of rural surgical referral systems. The high relative costs to the system and challenges in accountability rendered the program untenable for the implementing organization.

Maternal and Neonatal Health Knowledge, Service Quality and Utilization: Findings from a Community Based Quasi-experimental Trial in Arghakhanchi District of Nepal.

PubMed

Shrestha, J R; Manandhar, D S; Manandhar, S R; Adhikari, D; Rai, C; Rana, H; Poudel, M; Pradhan, A

2015-01-01

As part of the Partnership for Maternal and Newborn Health Project (PMNH), HealthRight International collaborated with Mother and Infant Research Activities (MIRA) to conduct operations research in Arghakhanchi district of Nepal to explore the intervention impact of strengthening health facility, improving community facility linkages along with Community Based Newborn Care Program (CB-NCP) on Maternal Neonatal Care (MNC) service quality, utilization, knowledge and care seeking behavior. This was a quasi-experimental study. Siddahara, Pokharathok, Subarnakhal,Narpani Health Posts (HPs) and Thada Primary Health Care Center(PHCC)in Electoral Constituency-2 were selected as intervention sites and Arghatosh, ,Argha, Khana, Hansapur HPs and Balkot PHCC in Electoral Constituency-1 were chosen as controls. The intervention started in February 2011 and was evaluated in August 2013. To compare MNC knowledge and practice in the community, mothers of children aged 0-23 months were selected from the corresponding Village Development Committees(VDCs) by a two stage cluster sampling design during both baseline (July 2010) and endline (August, 2013) assessments. The difference in difference analysis was used to understand the intervention impact. Local resource mobilization for MNC, knowledge about MNC and service utilization increased in intervention sites. Though there were improvements, many effects were not significant. Extensive trainings followed by reviews and quality monitoring visits increased the knowledge, improved skills and fostered motivation of health facility workers for better MNC service delivery. MNC indicators showed an upsurge in numbers due to the synergistic effects of many interventions.

Prevalence and risk factors for trachoma in Sarlahi district, Nepal.

PubMed Central

Katz, J; West, K P; Khatry, S K; LeClerq, S C; Pradhan, E K; Thapa, M D; Ram Shrestha, S; Taylor, H R

1996-01-01

AIMS: To estimate the prevalence of trachoma in preschool children in Sarlahi district, Nepal, and to identify risk factors for the disease. METHODS: A stratified random sample of 40 wards was selected for participation in a trachoma survey. Within each ward, a systematic 20% sample of children 24-76 months of age was chosen to determine the presence and severity of trachoma using the World Health Organisation grading system. RESULTS: A total of 891 children were selected and 836 (93.8%) were examined for trachoma from December 1990 to March 1991. The prevalence of active trachoma was 23.6% (21.9% follicular and 1.7% intense inflammatory). Cicatricial trachoma was not seen in this age group. The prevalence of trachoma ranged from 0 to 50% across wards with certain communities at much higher risk for trachoma than others. Three year old children had the highest prevalence of follicular (25.5%) and intense inflammatory trachoma (4.3%). Males and females had similar prevalence rates. Wards without any tube wells were at higher risk than those with one or more tube wells. Lower rates of trachoma were seen in families who lived in cement houses, had fewer people per room, more servants, more household goods, animals, and land. Hence, less access to water, crowding and lower socioeconomic status were risk factors for trachoma. CONCLUSIONS: Although follicular trachoma is prevalent, intense inflammatory trachoma is relatively rare and scarring was not observed in this preschool population. Hence, this population may not be at high risk for repeat infections leading to blindness in adulthood. PMID:9059265

Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal Demographic and Health Survey-2006.

PubMed

Sreeramareddy, Chandrashekhar T; Ramakrishnareddy, N; Harsha Kumar, Hn; Sathian, Brijesh; Arokiasamy, John T

2011-12-20

Nearly four-fifths of estimated 1.1 million smokers live in low or middle-income countries. We aimed to provide national estimates for Nepal on tobacco use prevalence, its distribution across demographic, socio-economic and spatial variables and correlates of tobacco use. A secondary data analysis of 2006 Nepal Demographic and Health Survey (DHS) was done. A representative sample of 9,036 households was selected by two-stage stratified, probability proportional to size (PPS) technique. We constructed three outcome variables 'tobacco smoke', 'tobacco chewer' and 'any tobacco use' based on four questions about tobacco use that were asked in DHS questionnaires. Socio-economic, demographic and spatial predictor variables were used. We computed overall prevalence for 'tobacco smoking', 'tobacco chewing' and 'any tobacco use' i.e. point estimates of prevalence rates, 95% confidence intervals (CIs) after adjustment for strata and clustering at primary sampling unit (PSU) level. For correlates of tobacco use, we used multivariate analysis to calculate adjusted odds ratios (AORs) and their 95% CIs. A p-value < 0.05 was considered as significant. Total number of households, eligible women and men interviewed was 8707, 10793 and 4397 respectively. The overall prevalence for 'any tobacco use', 'tobacco smoking' and 'tobacco chewing' were 30.3% (95% CI 28.9, 31.7), 20.7% (95% CI 19.5, 22.0) and 14.6% (95% CI 13.5, 15.7) respectively. Prevalence among men was significantly higher than women for 'any tobacco use' (56.5% versus 19.6%), 'tobacco smoking' (32.8% versus 15.8%) and 'tobacco chewing' (38.0% versus 5.0%). By multivariate analysis, older adults, men, lesser educated and those with lower wealth quintiles were more likely to be using all forms of tobacco. Divorced, separated, and widowed were more likely to smoke (OR 1.49, 95% CI 1.14, 1.94) and chew tobacco (OR 1.36, 95% CI 0.97, 1.93) as compared to those who were currently married. Prevalence of 'tobacco chewing' was higher in eastern region (19.7%) and terai/plains (16.2%). 'Tobacco smoking' and 'any tobacco use' were higher in rural areas, mid-western and far western and mountainous areas. Prevalence of tobacco use is considerably high among Nepalese people. Demographic and socioeconomic determinants and spatial distribution should be considered while planning tobacco control interventions.

Education Management and Performance after Rural Education Finance Reform: Evidence from Western China

ERIC Educational Resources Information Center

Liu, Mingxing; Murphy, Rachel; Tao, Ran; An, Xuehui

2009-01-01

Based on a survey of rural school districts in Western China, this essay explores the effects of fiscal centralisation on the relationship between local governance and school district management, most particularly on how managerial power is distributed in the rural education sector. The essay also examines some of the possible effects that changes…

Attitudes towards helminthic infection in the Jirel population of eastern Nepal.

PubMed

Williams-Blangero, S; Subedi, J; Upadhayay, R P; Manral, D B; Khadka, K; Jirel, S; Robinson, E S; Blangero, J

1998-08-01

Intestinal worm infections, including roundworm, hookworm, and whipworm, are major international health concerns, affecting approximately one fourth of the world's population. Many intervention schemes have been attempted to control these infections in heavily exposed populations, but success has been limited because individuals are readily reinfected upon renewed exposure. Few data are available concerning people's health beliefs about soil-transmitted helminthic infections in such populations. The purpose of this study was to assess health beliefs about common helminthiasis in a population experiencing moderate to high rates of infection. The focal population for the study was the Jirel population, a tribal group distributed across nine villages in the Jiri Region of Dolakha District, eastern Nepal. The results indicate that beliefs about the types, causes, and treatments of helminthic infections have been developed and reinforced by experience and empirical evidence. People's frequent inability to confirm the efficacy of drug therapy by observing worms in stools has led to dissatisfaction with biomedical approaches. Carefully planned education programs are required to alter prevailing attitudes and improve control of soil-transmitted helminthiasis in the region.

A Cultural Adaptation of Dialectical Behavior Therapy in Nepal

PubMed Central

Ramaiya, Megan K.; Fiorillo, Devika; Regmi, Upasana; Robins, Clive J.; Kohrt, Brandon A.

2017-01-01

Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia. PMID:29056846

Convergence rate across the Nepal Himalaya and interseismic coupling on the Main Himalayan Thrust: Implications for seismic hazard

NASA Astrophysics Data System (ADS)

Ader, Thomas; Avouac, Jean-Philippe; Liu-Zeng, Jing; Lyon-Caen, HéLèNe; Bollinger, Laurent; Galetzka, John; Genrich, Jeff; Thomas, Marion; Chanard, Kristel; Sapkota, Soma Nath; Rajaure, Sudhir; Shrestha, Prithvi; Ding, Lin; Flouzat, Mireille

2012-04-01

We document geodetic strain across the Nepal Himalaya using GPS times series from 30 stations in Nepal and southern Tibet, in addition to previously published campaign GPS points and leveling data and determine the pattern of interseismic coupling on the Main Himalayan Thrust fault (MHT). The noise on the daily GPS positions is modeled as a combination of white and colored noise, in order to infer secular velocities at the stations with consistent uncertainties. We then locate the pole of rotation of the Indian plate in the ITRF 2005 reference frame at longitude = - 1.34° ± 3.31°, latitude = 51.4° ± 0.3° with an angular velocity of Ω = 0.5029 ± 0.0072°/Myr. The pattern of coupling on the MHT is computed on a fault dipping 10° to the north and whose strike roughly follows the arcuate shape of the Himalaya. The model indicates that the MHT is locked from the surface to a distance of approximately 100 km down dip, corresponding to a depth of 15 to 20 km. In map view, the transition zone between the locked portion of the MHT and the portion which is creeping at the long term slip rate seems to be at the most a few tens of kilometers wide and coincides with the belt of midcrustal microseismicity underneath the Himalaya. According to a previous study based on thermokinematic modeling of thermochronological and thermobarometric data, this transition seems to happen in a zone where the temperature reaches 350°C. The convergence between India and South Tibet proceeds at a rate of 17.8 ± 0.5 mm/yr in central and eastern Nepal and 20.5 ± 1 mm/yr in western Nepal. The moment deficit due to locking of the MHT in the interseismic period accrues at a rate of 6.6 ± 0.4 × 1019 Nm/yr on the MHT underneath Nepal. For comparison, the moment released by the seismicity over the past 500 years, including 14 MW ≥ 7 earthquakes with moment magnitudes up to 8.5, amounts to only 0.9 × 1019 Nm/yr, indicating a large deficit of seismic slip over that period or very infrequent large slow slip events. No large slow slip event has been observed however over the 20 years covered by geodetic measurements in the Nepal Himalaya. We discuss the magnitude and return period of M > 8 earthquakes required to balance the long term slip budget on the MHT.

Single dose of SA 14-14-2 vaccine provides long-term protection against Japanese encephalitis: a case-control study in Nepalese children 5 years after immunization. drjbtandan@yahoo.com.

PubMed

Tandan, J B; Ohrr, Heechoul; Sohn, Young Mo; Yoksan, Sutee; Ji, Min; Nam, Chung Mo; Halstead, Scott B

2007-06-28

In July 1999, a single dose of live-attenuated SA 14-14-2 Japanese encephalitis (JE) vaccine was administered to children living in the Bardiya, Banke and Kailali districts of Nepal. In 2004, the original vaccinated population experienced a fifth seasonal exposure to JE. We performed a case-control study comparing the prevalence of the administration of vaccine in patients with JE hospitalized in the Bardiya and Bheri Zonal hospitals and in age-sex matched controls resident in the Bardiya district. Among the 219 village controls, 114 had been vaccinated (52.1%) while only one of 20 JE cases had received live-attenuated JE vaccine. Five years after administration of a single dose, SA 14-14-2 provided a protective efficacy of 96.2% (CI 73.1-99.9%).

Promoting small towns for rural development: a view from Nepal.

PubMed

Bajracharya, B N

1995-06-01

Two small villages in Nepal are the subjects of case studies that illustrate the role of small towns in provision of services, employment, and market operations. Some general findings are that small towns act as service centers for distribution of basic essential goods such as food grains, salt, kerosene, and fabric for hill and mountain areas. The role of small towns as market centers and in the provision of employment is limited. In resource-poor areas small towns are less diversified. Towns with agricultural surpluses are more developed. Small hill towns satisfy consumption rather than production needs. The growth of rural areas and towns in rural areas in Nepal is dependent on arable land and levels of production in hill areas. Limited land and low levels of production have an adverse impact. Movement of people, goods, and services is limited by difficult terrain and lack of access to good roads. Variability in access to off-farm jobs and services available in small towns varies with ethnicity and place of residence. The best development strategy for small towns in Nepal is market-oriented territorial development, which retains surpluses in the local area and integrates markets in the larger economy. The strategy would decentralize planning into small territorial units that include both small towns and groups of villages, provide institutional support for the rural poor, expand off-farm employment, and include investment in region-serving functions. Subsistence agriculture needs to include diversification of high value cash crops based on local comparative advantage suitable for hill climate and terrain. Small farmers must produce both cash and subsistence crops. Government should provide market space and paved areas, weighing facilities, and overnight storage facilities. Products would be processed at the village level. Subdistricts must be established according to spatial and social linkages between villages and the service center and coordinated at the district level. Group marketing, transport to large urban centers, and agricultural technical services are needed.

Service user and care giver involvement in mental health system strengthening in Nepal: a qualitative study on barriers and facilitating factors.

PubMed

Gurung, Dristy; Upadhyaya, Nawaraj; Magar, Jananee; Giri, Nir Prakash; Hanlon, Charlotte; Jordans, Mark J D

2017-01-01

Service user and caregiver involvement has become an increasingly common strategy to enhance mental health outcomes, and has been incorporated in the mental healthpolicies of many developed nations. However, this practice is non-existent or fragmented in low and middle income countries (LMICs). Instances of service user and caregiver involvement have been rising slowly in a few LMICs, but are rarely described in the literature. Very little is known about the context of user and caregiver participation in mental health system strengthening processes in a low-income, disaster- and conflict-affected state such as Nepal. This study explores (a) the extent and experiences of service user and caregiver involvement in policy making, service planning, monitoring, and research in Nepal; (b) perceived barriers to such involvement; and (c) possible strategies to overcome barriers. Key Informant Interviews (n = 24) were conducted with service users and caregivers who were either affiliated to a mental health organization or receiving menta health care integrated within primary care. Purposive sampling was employed. Data collection was carried out in 2014 in Chitwan and Kathmandu districts of Nepal. Data analysis was carried out in NVivo10 using a framework approach. The involvement of service users affiliated to mental health organizations in policy development was reported to be 'tokenistic'. Involvement of caregivers was non-existent. Perceived barriers to greater involvement included lack of awareness, stigma and discrimination, poor economic conditions, the centralized health system, and lack of strong leadership and unity among user organizations. Increased focus on reducing public as well as self-stigma, improved policy frameworks and initiatives, and decentralization of care are some strategies that may facilitate service user and caregiver involvement. The study highlighted need for user and caregiver networks free from competing interests and priorities. Improved policy frameworks and decentralization of care may support meaningful service user and caregiver involvement.

Urban air quality of Kathmandu valley

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sharma, C.K.

The oval shaped tectonic basin of Kathmandu valley occupying about 600 sq. km. of area is situated in the middle sector of Himalayan range. There are three districts in the alley, i.e. Kathmandu, Litilpur, and Bhaktapur. Out of the three the most populated is the Kathmandu city (the capital of Kingdom of Nepal) which has 668,000 population in an area of approximately 50 sq. km. The city population consumes energy about 1/3 of total imports of Nepal in the form of gasoline, diesel, kerosene, furnace oil and cooking gas. This has resulted heavy pollution of air in the city leadingmore » bronchitis, and throat and chest diseases. Vehicle has increased several fold leading in recent months to 100,000 in number in a road of about 900 kms., out of which 25% is only metalled. Most of two and three wheelers are polluting the air by emission gases as well as dust particulate. SO{sub 2} has been found to go as high as 202 micro grams per cubic meter and NO{sub 2} to 126 micro gram particularly in winter months when a thick layer of fog covers the valley up to 10:00 AM in the morning. All the gases are mixed within the limited air below the fog and the ground. This creates the problem. Furthermore, municipal waste of 500 m{sup 3} a day and also liquid waste directly dumping in Bagmati river to the tune of 500,000 liters per day makes city ugly and filthy. Unless pollution of air, water, and land are controlled in time, Nepal will lose much of its foreign exchange earnings from tourist industry. It is found that tourist arrivals are considerably reduced in recent years and most of hotels occupancy is 50 to 60% in peak time. Nepal is trying to introduce legal frame work for pollution control but it will take time to be effective like in other developing countries unless government is strong.« less

Association of Panton Valentine Leukocidin (PVL) genes with methicillin resistant Staphylococcus aureus (MRSA) in Western Nepal: a matter of concern for community infections (a hospital based prospective study).

PubMed

Bhatta, Dharm R; Cavaco, Lina M; Nath, Gopal; Kumar, Kush; Gaur, Abhishek; Gokhale, Shishir; Bhatta, Dwij R

2016-05-15

Methicillin resistant Staphylococcus aureus (MRSA) is a major human pathogen associated with nosocomial and community infections. Panton Valentine leukocidin (PVL) is considered one of the important virulence factors of S. aureus responsible for destruction of white blood cells, necrosis and apoptosis and as a marker of community acquired MRSA. This study was aimed to determine the prevalence of PVL genes among MRSA isolates and to check the reliability of PVL as marker of community acquired MRSA isolates from Western Nepal. A total of 400 strains of S. aureus were collected from clinical specimens and various units (Operation Theater, Intensive Care Units) of the hospital and 139 of these had been confirmed as MRSA by previous study. Multiplex PCR was used to detect mecA and PVL genes. Clinical data as well as antimicrobial susceptibility data was analyzed and compared among PVL positive and negative MRSA isolates. Out of 139 MRSA isolates, 79 (56.8 %) were PVL positive. The majority of the community acquired MRSA (90.4 %) were PVL positive (Positive predictive value: 94.9 % and negative predictive value: 86.6 %), while PVL was detected only in 4 (7.1 %) hospital associated MRSA strains. None of the MRSA isolates from hospital environment was found positive for the PVL genes. The majority of the PVL positive strains (75.5 %) were isolated from pus samples. Antibiotic resistance among PVL negative MRSA isolates was found higher as compared to PVL positive MRSA. Our study showed high prevalence of PVL among community acquired MRSA isolates. Absence of PVL among MRSA isolates from hospital environment indicates its poor association with hospital acquired MRSA and therefore, PVL may be used a marker for community acquired MRSA. This is first study from Nepal, to test PVL among MRSA isolates from hospital environment.

Predicting potential distribution of poorly known species with small database: the case of four-horned antelope Tetracerus quadricornis on the Indian subcontinent.

PubMed

Pokharel, Krishna Prasad; Ludwig, Tobias; Storch, Ilse

2016-04-01

Information gaps on the distribution of data deficient and rare species such as four-horned antelope (FHA) in Nepal may impair their conservation. We aimed to empirically predict the distribution of FHA in Nepal with the help of data from the Indian subcontinent. Additionally, we wanted to identify core areas and gaps within the reported range limits and to assess the degree of isolation of known Nepalese populations from the main distribution areas in India. The tropical part of the Indian subcontinent (65°-90° eastern longitude, 5°-30° northern latitude), that is, the areas south of the Himalayan Mountains. Using MaxEnt and accounting for sampling bias, we developed predictive distribution models from environmental and topographical variables, and known presence locations of the study species in India and Nepal. We address and discuss the use of target group vs. random background. The prediction map reveals a disjunct distribution of FHA with core areas in the tropical parts of central to southern-western India. At the scale of the Indian subcontinent, suitable FHA habitat area in Nepal was small. The Indo-Gangetic Plain isolates Nepalese from the Indian FHA populations, but the distribution area extends further south than proposed by the current IUCN map. A low to intermediate temperature seasonality as well as low precipitation during the dry and warm season contributed most to the prediction of FHA distribution. The predicted distribution maps confirm other FHA range maps but also indicate that suitable areas exist south of the known range. Results further highlight that small populations in the Nepalese Terai Arc are isolated from the Indian core distribution and therefore might be under high extinction risk.

76 FR 26314 - Notice of Public Meetings, Twin Falls District Resource Advisory Council, Idaho

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

... of Public Meetings, Twin Falls District Resource Advisory Council, Idaho AGENCY: Bureau of Land... (BLM) Twin Falls District Resource Advisory Council (RAC) will meet as indicated below. DATES: May 16, 2011. On May 16, 2011, the Twin Falls District RAC members will meet at the Best Western Sawtooth Inn...

Prevalence of Cutaneous Leishmaniasis in Districts of High and Low Endemicity in Mali.

PubMed

Traoré, Bourama; Oliveira, Fabiano; Faye, Ousmane; Dicko, Adama; Coulibaly, Cheick A; Sissoko, Ibrahim M; Sibiry, Samake; Sogoba, Nafomon; Sangare, Moussa Brema; Coulibaly, Yaya I; Traore, Pierre; Traore, Sekou F; Anderson, Jennifer M; Keita, Somita; Valenzuela, Jesus G; Kamhawi, Shaden; Doumbia, Seydou

2016-11-01

Historically the western sahelian dry regions of Mali are known to be highly endemic for cutaneous leishmaniasis (CL) caused by Leishmania major, while cases are rarely reported from the Southern savanna forest of the country. Here, we report baseline prevalence of CL infection in 3 ecologically distinct districts of Mali (dry sahelian, north savanna and southern savanna forest areas). We screened 195 to 250 subjects from 50 to 60 randomly selected households in each of the 6 villages (four from the western sahelian district of Diema in Kayes region, one from the central district of Kolokani and one from the southern savanna district of Kolodieba, region of Sikasso). The screening consisted of: 1] A Leishmanin Skin Test (LST) for detection of exposure to Leishmania parasites; 2] clinical examination of suspected lesions, followed by validation with PCR and 3] finger prick blood sample to determine antibody levels to sand fly saliva. LST positivity was higher in the western district of Diema (49.9%) than in Kolokani (24.9%) and was much lower in Kolondieba (2.6%). LST positivity increased with age rising from 13.8% to 88% in Diema for age groups 2-5 years and 41-65 years, respectively. All eight PCR-confirmed L. major CL cases were diagnosed in subjects below 18 years of age and all were residents of the district of Diema. Exposure to sand fly bites, measured by anti-saliva antibody titers, was comparable in individuals living in all three districts. However, antibody titers were significantly higher in LST positive individuals (P<0.0001). In conclusion, CL transmission remains active in the western region of Mali where lesions were mainly prevalent among children under 18 years old. LST positivity correlated to higher levels of antibodies to sand fly salivary proteins, suggesting their potential as a risk marker for CL acquisition in Mali.

Measuring sustainability as a programming tool for health sector investments: report from a pilot sustainability assessment in five Nepalese health districts.

PubMed

Sarriot, Eric; Ricca, Jim; Ryan, Leo; Basnet, Jagat; Arscott-Mills, Sharon

2009-01-01

Sustainability is a critical determinant of scale and impact of health sector development assistance programs. Working with USAID/Nepal implementing partners, we adapted a sustainability assessment framework to help USAID test how an evaluation tool could inform its health portfolio management. The essential first process step was to define the boundaries of the local system being examined. This local system-the unit of analysis of the study-was defined as the health district.We developed a standardized set of assessment tools to measure 53 indicators. Data collection was carried out over 4 weeks by a Nepalese agency. Scaling and combining indicators into six component indices provided a map of progress toward sustainable maternal, child, health, and family planning results for the five districts included in this pilot study, ranked from "no sustainability" to "beginning of sustainability."We conclude that systematic application of the Sustainability Framework could improve the health sector investment decisions of development agencies. It could also give districts an information base on which to build autonomy and accountability. The ability to form and test hypotheses about the sustainability of outcomes under various funding strategies-made possible by this approach-will be a prerequisite for more efficiently meeting the global health agenda.

Geomorphic changes induced by the April-May 2015 earthquake sequence in the Pharak-Khumbu area (Nepal): preliminary assessments.

NASA Astrophysics Data System (ADS)

Fort, Monique

2016-04-01

Landsliding is a common process shaping mountain slopes. There are various potential landslide triggers (rainfall, bank erosion, earthquakes) and their effectiveness depends on their distribution, frequency and magnitude. In a Himalayan context, the effects of monsoon rainfall can be assessed every year whereas the unpredictability and low frequency of large earthquakes make their role in triggering slope instability more obscure. A 7.8 magnitude earthquake struck central Nepal (Gorkha District) on 25 April 2015 and was followed by many aftershocks exceeding magnitude 5, including another strong 7.3 magnitude earthquake on May 12, 2015 (Dolakha District). This seismic crisis provides an exceptional opportunity to assess the disruptions that earthquakes may cause in "regular" geomorphic systems controlled by rainfall. Here we present field observations carried out in the Pharak-Khumbu area (East Nepal, Dudh Kosi catchment) before and after the April-May 2015 earthquakes. The Pharak, a "middle mountains" (2000-4500 m) area, is affected by monsoon rains (3000 m/yr at 2500 m) and characterised by steep hillslopes, shaped by different geomorphic processes according to slope height and aspect, rock type and strength, inherited landforms, stream connectivity and current land use changes. This study focuses on the south of Lukla (Phakding District), and more specifically on the Khari Khola catchment and its surroundings. The area lies at the transition between the Higher Himalayan crystallines and the Lesser Himalayan meta-sediments. On the basis of our diachronic observations (March and November 2015), we surveyed and mapped new earthquake-induced slope instabilities such as rock falls, rockslides, landslides and debris flows and a combination of several of them. Interviews with local people also helped to assess the exact timing of some events. While the first M 7.8 earthquake produced significant impacts in the northern Khumbu area, the M 7.3 aftershock seems to have been more destructive in Pharak. In Pharak, the observed geomorphic changes are not as great as in the zone between the Gorkha and Dolaka Districts. Control factors are (1) slope steepness (>45°) and height (500-1000 m), both favouring landslide initiation near the ridge top and a series of cascading processes resulting in temporary valley damming, as observed near Nakchun, Bupsa and W of Kharikhola-Jubing; (2) lithology also appears significant: weak fractured bedrock supplied rock falls (upper Kharikhola catchment), whereas superficial deposits (alluvial, lacustrine, and colluvial soils, including landslide material) favoured larger failures (Paya, Cheubas), particularly because of (3) the proximity of the deeply incised stream network. The limited size and shallow depth of the newly generated slope failures are noteworthy. More generally, these geomorphic changes and their characteristics may be explained by the nature of the 2015 climate: while the 2014-2015 winter was unusually dry, snowfalls and rainfalls were abundant during March and April, hence increasing the pore pressure and the potential instability of slopes and/or snow cover. Conversely, the rather weak monsoon rainfall of the 2015 summer did not take advantage of the many cracks opened by seismic shaking. Yet this may leave only a short delay for large landslide development during the next monsoon seasons.

Sex Trafficking Related Knowledge, Awareness, and Attitudes among Adolescent Female Students in Nepal: A Cross-Sectional Study

PubMed Central

2015-01-01

Background Sex trafficking has been a long-standing concern in Nepal. Very little has been achieved, however, in terms of actual reduction in the number of victims despite numerous anti-sex trafficking programs. This situation may be attributable to a lack of empirical evidence upon which to formulate anti-sexual trafficking interventions. This study aimed to assess sex trafficking-related knowledge, awareness and attitudes, and factors associated with sex trafficking awareness and attitudes towards the victims of sex trafficking and/or anti-sex trafficking campaigns among adolescent female students in Nepal. Methods A cross-sectional study was conducted between August–September 2013 among 292 adolescent female students (>10 years old) using systematic random sampling from three high schools in Sindhupalchowk district, Nepal. As an initial step, descriptive analyses were employed to characterize the data and multivariate logistic regression analyses were used to explore factors associated with sex trafficking awareness and related attitudes. Results Seventy-six percent of sampled students reported that they were aware of sex trafficking and 94.6% indicated media (i.e., radio or television) as the primary sources of their knowledge. Fifty-one percent mentioned relatives/friends as mediators of sex trafficking, 60.4% reported promise for better jobs as the primary attraction behind sex trafficking, and 48.6% mentioned adolescent females as the most vulnerable group for sex trafficking. Over half (56.8%) of the respondents had positive attitudes towards the victims of sex trafficking and/or anti-sex trafficking campaigns. Age (OR = 3.38, 95% CI:2.51–4.55), parents’ occupation (OR = 3.89, 95% CI:1.58–9.58), and having a radio/TV at home (OR = 6.67, 95% CI:3.99–9.54) were significantly associated with awareness, whereas being younger (OR = 0.67, 95% CI:0.55–0.79) and having joint-family (OR = 2.67, 95% CI:1.49–4.80) were significantly associated with having a positive attitudes towards the victims of sex trafficking and/or anti-sex trafficking campaigns. Conclusion Findings presented have important implications for anti-trafficking programs, in particular those designed to educate the adolescent females who are at most-risk of sex trafficking. Educational programs need to include specific interventions to improve knowledge and attitudes towards sex trafficking among adolescent females in Nepal. PMID:26177534

Sex Trafficking Related Knowledge, Awareness, and Attitudes among Adolescent Female Students in Nepal: A Cross-Sectional Study.

PubMed

Shrestha, Roman; Karki, Pramila; Suwal, Asha; Copenhaver, Michael

2015-01-01

Sex trafficking has been a long-standing concern in Nepal. Very little has been achieved, however, in terms of actual reduction in the number of victims despite numerous anti-sex trafficking programs. This situation may be attributable to a lack of empirical evidence upon which to formulate anti-sexual trafficking interventions. This study aimed to assess sex trafficking-related knowledge, awareness and attitudes, and factors associated with sex trafficking awareness and attitudes towards the victims of sex trafficking and/or anti-sex trafficking campaigns among adolescent female students in Nepal. A cross-sectional study was conducted between August-September 2013 among 292 adolescent female students (>10 years old) using systematic random sampling from three high schools in Sindhupalchowk district, Nepal. As an initial step, descriptive analyses were employed to characterize the data and multivariate logistic regression analyses were used to explore factors associated with sex trafficking awareness and related attitudes. Seventy-six percent of sampled students reported that they were aware of sex trafficking and 94.6% indicated media (i.e., radio or television) as the primary sources of their knowledge. Fifty-one percent mentioned relatives/friends as mediators of sex trafficking, 60.4% reported promise for better jobs as the primary attraction behind sex trafficking, and 48.6% mentioned adolescent females as the most vulnerable group for sex trafficking. Over half (56.8%) of the respondents had positive attitudes towards the victims of sex trafficking and/or anti-sex trafficking campaigns. Age (OR = 3.38, 95% CI:2.51-4.55), parents' occupation (OR = 3.89, 95% CI:1.58-9.58), and having a radio/TV at home (OR = 6.67, 95% CI:3.99-9.54) were significantly associated with awareness, whereas being younger (OR = 0.67, 95% CI:0.55-0.79) and having joint-family (OR = 2.67, 95% CI:1.49-4.80) were significantly associated with having a positive attitudes towards the victims of sex trafficking and/or anti-sex trafficking campaigns. Findings presented have important implications for anti-trafficking programs, in particular those designed to educate the adolescent females who are at most-risk of sex trafficking. Educational programs need to include specific interventions to improve knowledge and attitudes towards sex trafficking among adolescent females in Nepal.

Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal.

PubMed

Budhathoki, Shyam Sundar; Bhattachan, Meika; Castro-Sánchez, Enrique; Sagtani, Reshu Agrawal; Rayamajhi, Rajan Bikram; Rai, Pramila; Sharma, Gaurav

2018-02-02

Menstrual hygiene management (MHM) is an essential aspect of hygiene for women and adolescent girls between menarche and menopause. Despite being an important issue concerning women and girls in the menstruating age group MHM is often overlooked in post-disaster responses. Further, there is limited evidence of menstrual hygiene management in humanitarian settings. This study aims to describe the experiences and perceptions of women and adolescent girls on menstrual hygiene management in post-earthquake Nepal. A mixed methods study was carried out among the earthquake affected women and adolescent girls in three villages of Sindhupalchowk district of Nepal. Data was collected using a semi-structured questionnaire that captured experiences and perceptions of respondents on menstrual hygiene management in the aftermath of the Nepal earthquake. Quantitative data were triangulated with in-depth interview regarding respondent's personal experiences of menstrual hygiene management. Menstrual hygiene was rated as the sixth highest overall need and perceived as an immediate need by 18.8% of the respondents. There were 42.8% women & girls who menstruated within first week of the earthquake. Reusable sanitary cloth were used by about 66.7% of the respondents before the earthquake and remained a popular method (76.1%) post-earthquake. None of the respondents reported receiving menstrual adsorbents as relief materials in the first month following the earthquake. Disposable pads (77.8%) were preferred by respondents as they were perceived to be clean and convenient to use. Most respondents (73.5%) felt that reusable sanitary pads were a sustainable choice. Women who were in the age group of 15-34 years (OR = 3.14; CI = (1.07-9.20), did not go to school (OR = 9.68; CI = 2.16-43.33), married (OR = 2.99; CI = 1.22-7.31) and previously used reusable sanitary cloth (OR = 5.82; CI = 2.33-14.55) were more likely to use the reusable sanitary cloth. In the immediate aftermath of the earthquake, women and girls completely depended on the use of locally available resources as adsorbents during menstruation. Immediate relief activities by humanitarian agencies, lacked MHM activities. Understanding the previous practice and using local resources, the reusable sanitary cloth is a way to address the menstrual hygiene needs in the post-disaster situations in Nepal.

Auditing chronic disease care: Does it make a difference?

PubMed

Essel, Vivien; van Vuuren, Unita; De Sa, Angela; Govender, Srini; Murie, Katie; Schlemmer, Arina; Gunst, Colette; Namane, Mosedi; Boulle, Andrew; de Vries, Elma

2015-06-26

An integrated audit tool was developed for five chronic diseases, namely diabetes, hypertension, asthma, chronic obstructive pulmonary disease and epilepsy. Annual audits have been done in the Western Cape Metro district since 2009. The year 2012 was the first year that all six districts in South Africa's Western Cape Province participated in the audit process. To determine whether clinical audits improve chronic disease care in health districts over time. Western Cape Province, South Africa. Internal audits were conducted of primary healthcare facility processes and equipment availability as well as a folder review of 10 folders per chronic condition per facility. Random systematic sampling was used to select the 10 folders for the folder review. Combined data for all facilities gave a provincial overview and allowed for comparison between districts. Analysis was done comparing districts that have been participating in the audit process from 2009 to 2010 ('2012 old') to districts that started auditing recently ('2012 new'). The number of facilities audited has steadily increased from 29 in 2009 to 129 in 2012. Improvements between different years have been modest, and the overall provincial average seemed worse in 2012 compared to 2011. However, there was an improvement in the '2012 old' districts compared to the '2012 new' districts for both the facility audit and the folder review, including for eight clinical indicators, with '2012 new' districts being less likely to record clinical processes (OR 0.25, 95% CI 0.21-0.31). These findings are an indication of the value of audits to improve care processes over the long term. It is hoped that this improvement will lead to improved patient outcomes.

Auditing chronic disease care: Does it make a difference?

PubMed Central

van Vuuren, Unita; De Sa, Angela; Govender, Srini; Murie, Katie; Schlemmer, Arina; Gunst, Colette; Namane, Mosedi; Boulle, Andrew; de Vries, Elma

2015-01-01

Background An integrated audit tool was developed for five chronic diseases, namely diabetes, hypertension, asthma, chronic obstructive pulmonary disease and epilepsy. Annual audits have been done in the Western Cape Metro district since 2009. The year 2012 was the first year that all six districts in South Africa's Western Cape Province participated in the audit process. Aim To determine whether clinical audits improve chronic disease care in health districts over time. Setting Western Cape Province, South Africa. Methods Internal audits were conducted of primary healthcare facility processes and equipment availability as well as a folder review of 10 folders per chronic condition per facility. Random systematic sampling was used to select the 10 folders for the folder review. Combined data for all facilities gave a provincial overview and allowed for comparison between districts. Analysis was done comparing districts that have been participating in the audit process from 2009 to 2010 (‘2012 old’) to districts that started auditing recently (‘2012 new’). Results The number of facilities audited has steadily increased from 29 in 2009 to 129 in 2012. Improvements between different years have been modest, and the overall provincial average seemed worse in 2012 compared to 2011. However, there was an improvement in the ‘2012 old’ districts compared to the ‘2012 new’ districts for both the facility audit and the folder review, including for eight clinical indicators, with ‘2012 new’ districts being less likely to record clinical processes (OR 0.25, 95% CI 0.21–0.31). Conclusion These findings are an indication of the value of audits to improve care processes over the long term. It is hoped that this improvement will lead to improved patient outcomes. PMID:26245615

Antimicrobial drug use in dermatology in a teaching hospital in western Nepal.

PubMed

Sarkar, C; Das, B; Sripathi, H

2002-05-01

Medical audit is supposed to oversee, monitor and analyse standards of medical treatment at all levels of the healthcare delivery system. This study was undertaken to monitor the prescribing of antimicrobial drugs for patients seeking treatment in the dermatology outpatient department of the Manipal Teaching Hospital in Nepal. A total of 292 dermatology prescriptions of patients attending the dermatology OPD were collected between July 2000 and June 2001. Prescriptions for antimicrobial agents were separated from the total prescriptions collected, and evaluated. There were more female patients (58.2%) than male (41.8%) in our study; most were in the 21-40 year age group. The commonest cutaneous infections were acne (15.8%) followed by fungal infections (14.8%). Of the 292 prescriptions audited, 149 contained antimicrobial agents, constituting 36% of the total number of drugs prescribed. Of 256 antimicrobials prescribed, 63% were topical and 37% systemic; 5% were generic, 29% were from the essential drug list of Nepal, and 15% were fixed-dose combinations. Most of the patients received one or two antimicrobials, 50% of which were antibacterials and 40% antifungals. Though the selection of antimicrobial drugs used in dermatology was largely rational, anomalies were observed, and these issues were discussed with clinicians in relation to various aspects of drug use. The results indicate there is scope for improving prescribing habits. A periodic audit of drug prescribing is desirable in rationalising prescribing practice.

Examination of Relationships among Organizational Characteristics and Organizational Commitment of Nurses in Western and Eastern Region of Nepal.

PubMed

Joshi, A S; Namba, M; Pokharela, T

2015-01-01

The objective of this study is to identify relationships between three components of organizational commitment and organizational characteristics of nurses in the western and the eastern region of Nepal. A self-administrated questionnaire was used to collect data from 310 nurses currently working at various hospitals in the eastern and the western region of the country. The questionnaire included three sections namely 1) personal characteristics 2) organizational characteristics and 3) organizational commitments scale. Descriptive analysis and multiple regression analysis were performed to identify significance in various relationships. Out of the 240 completed questionnaires, 226 were found valid for analysis. The mean age was 27.4 years. For each depended variable affective, continuance and normative commitment, multiple regression analysis was performed with personal Characteristics and organizational characteristics as independent variables. All independent variables were found significantly related to each of the two dependent variables; affective commitment and normative commitment (R2 adjusted=0.24, p<0.01 and R2 adjusted=0.05, p<0.01 respectively). However, they were not significantly related to the continuance commitment. Both support from boss (β=0.138, p<0.05) and satisfaction with training (β=0.301, p<0.05) were found to be positive and significant with affective commitment. On the other hand, satisfaction with training (β=0.191, p<0.05) was also positive and significant with normative commitment. Since both support from boss and training program were found to be positive and significant with affective commitment, hospitals must encourage supervisors to provide more assistance to the subordinate nurses. Moreover, hospitals should develop more training programs to keep nurses motivated.

Productivity of public hospitals in Nepal: a data envelopment analysis

PubMed Central

Ashton, Toni

2017-01-01

Objectives Public hospitals in Nepal account for a major share of the total health budget. Therefore, questions are often asked about the performance of these hospitals. Existing measures of performance are limited to historical ratio analyses without any benchmarks. The objective of this study is to explore the trends in inputs, outputs and productivity changes in Nepalese public hospitals from 2011–2012 to 2013–2014. Setting and participants The study was conducted among 32 Nepalese public hospitals (23 district level and 9 higher level) for the three fiscal years from 2011–2012 to 2013–2014. Outcome measures First, basic ratio analyses were conducted for the input and output measures over the study years. Then, Malmquist productivity change scores were obtained using data envelopment analysis. Aggregated as well as separate analyses were conducted for district level and higher level hospitals. Results Real expenditures of the sampled hospitals declined over the 3-year period from an average of US$ 371 000 in year 1 to US$ 368 730 in year 2 and US$ 328680 in year 3. The average aggregated hospital outputs increased marginally from 8276 in 2011–2012 to 8613 in 2013–2014. The total factor productivity of the study hospitals declined by 6.9% annually from 2011–2012 to 2013–2014. Of the total 32 hospitals, productivity increased in only 12 (37.5%) hospitals and declined in the remaining 20 hospitals. The total factor productivity loss was influenced by a decline in technology change, despite an increase in efficiency. Conclusions In general, productivity of the study hospitals declined over the study period. Availability and accessibility of accurate, detailed and consistent measures of hospital inputs and outputs is a major challenge for this type of analysis. PMID:28729314

Evidence-based evolution of an integrated nutrition-focused agriculture approach to address the underlying determinants of stunting.

PubMed

Haselow, Nancy J; Stormer, Ame; Pries, Alissa

2016-05-01

Despite progress in reducing hunger and malnutrition since the 1990s, many still suffer from undernutrition and food insecurity, particularly women and young children, resulting in preterm birth, low birthweight and stunting, among other conditions. Helen Keller International (HKI) has addressed malnutrition and household food insecurity through implementation of an Enhanced Homestead Food Production (EHFP) programme that increases year-round availability and intake of diverse micronutrient-rich foods and promotes optimal nutrition and hygiene practices among poor households. This paper reviews the evolution and impact of HKI's EHFP programme and identifies core components of the model that address the underlying determinants of stunting. To date, evaluations of EHFP have shown impact on food production, consumption by women and children and household food security. Sale of surplus produce has increased household income, and the use of a transformative gender approach has empowered women. EHFP has also realized nutrition improvements in many project sites. Results from a randomized control trial (RCT) in Baitadi district, Nepal showed a significant improvement in a range of practices known to impact child growth, although no impact on stunting. Additional non-RCT evaluations in Kailali district of Nepal, demonstrated a 10.5% reduction in stunting and in the Chittagong Hill Tracts in Bangladesh, revealed an 18% decrease in stunting. Based on evidence, the EHFP has evolved into an integrated package that includes agriculture, nutrition, water/hygiene/sanitation, linkages to health care, women's empowerment, income generation and advocacy. Closing the stunting gap requires long-term exposure to targeted multi-sectoral solutions and rigorous evaluation to optimize impact. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

Are Birth-preparedness Programmes Effective? Results From a Field Trial in Siraha District, Nepal

PubMed Central

McPherson, Robert A.; Moore, Judith M.; Sharma, Meena

2006-01-01

The birth-preparedness package (BPP) promotes active preparation and decision-making for births, including pregnancy/postpartum periods, by pregnant women and their families. This paper describes a district-wide field trial of the BPP implemented through the government health system in Siraha, Nepal, during 2003–2004. The aim of the field trial was to determine the effectiveness of the BPP to positively influence planning for births, household-level behaviours that affect the health of pregnant and postpartum women and their newborns, and their use of selected health services for maternal and newborn care. Community health workers promoted desired behaviours through inter-personal counselling with individuals and groups. Content of messages included maternal and newborn-danger signs and encouraged the use of healthcare services and preparation for emergencies. Thirty-cluster baseline and endline household surveys of mothers of infants aged less than one year were used for estimating the change in key outcome indicators. Fifty-four percent of respondents (n=162) were directly exposed to BPP materials while pregnant. A composite index of seven indicators that measure knowledge of respondents, use of health services, and preparation for emergencies increased from 33% at baseline to 54% at endline (p=0.001). Five key newborn practices increased by 19 to 29 percentage points from baseline to endline (p values ranged from 0.000 to 0.06). Certain key maternal health indicators, such as skilled birth attendance and use of emergency obstetric care, did not change. The BPP can positively influence knowledge and intermediate health outcomes, such as household practices and use of some health services. The BPP can be implemented by government health services with minimal outside assistance but should be comprehensively integrated into the safe motherhood programme rather than implemented as a separate intervention. PMID:17591345

Effect of an educational intervention on knowledge and attitude regarding pharmacovigilance and consumer pharmacovigilance among community pharmacists in Lalitpur district, Nepal.

PubMed

Jha, Nisha; Rathore, Devendra Singh; Shankar, Pathiyil Ravi; Bhandary, Shital; Pandit, Rabi Bushan; Gyawali, Sudesh; Alshakka, Mohamed

2017-01-03

Pharmacovigilance activities are in a developing stage in Nepal. ADR reporting is mainly confined to healthcare professionals working in institutions recognized as regional pharmacovigilance centers. Community pharmacists could play an important role in pharmacovigilance. This study was conducted among community pharmacists in Lalitpur district to examine their knowledge and attitude about pharmacovigilance before and after an educational intervention. Knowledge and attitude was studied before, immediately after and 6 weeks following the intervention among 75 community pharmacists. Responses were analysed using descriptive and inferential statistics. A pretested questionnaire having twelve and nine statements for assessing knowledge and attitude were used. The overall scores were obtained by adding the 'knowledge' and 'attitude' scores and 'overall' scores were summarized using median and interquartile range. Wilcoxon signed-rank test for repeated samples was used to compare the differences between knowledge and attitude of the pharmacists before and after the educational program. Knowledge scores [median (interquartile range)] improved significantly between pre-test [39 (44-46)], post-test [44 (44-44)] and retention period of 6 weeks after the intervention [46 (43-46)]. Knowledge score improved immediately post-intervention among both males [44 (41-47)] and females [44 (43-45)] but the retention scores (after 6 weeks) were higher [46 (42-48)] among males. Attitude scores improved significantly among females [46 (44-48)]. The overall scores were higher among pharmacists from rural areas. Knowledge and attitude scores improved after the educational intervention. Further studies in other regions of the country are required. The national pharmacovigilance center should promote awareness about ADR reporting among community pharmacists.

Participatory health development in rural Nepal: clarifying the process of community empowerment.

PubMed

Purdey, A F; Adhikari, G B; Robinson, S A; Cox, P W

1994-01-01

Community-based participatory development empowers villagers to develop community cohesion and confidence, increase their ability to identify, analyze, and priorize their own needs, and organize the resources to meet these needs. An important first step in the process involves establishing a cohesive and functional community group. The authors believe that this is best accomplished through villagers' critical examination of their experiences with development including their understanding of reasons for success or failure, and the gradual emergence of a model of working together that acknowledges and builds on participation and collective expertise. This approach to development is demonstrating encouraging results in a rural area of western Nepal in a university affiliated Canadian/Nepali Health Development Project. This paper describes two mini-projects to illustrate the evolution of group formation through reflection, analysis, and action, and identifies outcomes that could serve as indicators of community empowerment. The paper also presents a generic model of empowerment, and offers lessons learned by the project through the application of the empowerment process to sustainable health development.

77 FR 26001 - Southwest Power Pool; Western Area Power Administration; Basin Electric Cooperative; Heartland...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL12-60-000] Southwest Power Pool; Western Area Power Administration; Basin Electric Cooperative; Heartland Consumers Power District... 385.207, Southwest Power Pool (SPP), Western Area Power Administration (Western), Basin Electric Power...

School Districts Try a New Tack.

ERIC Educational Resources Information Center

Spitz, James A., Jr., Battaglia, Michael

1997-01-01

Politicians are increasingly pressuring school districts to improve instruction while holding down costs. To achieve this aim, western New York school districts are experimenting with mutual gains bargaining, an alternative negotiation process based on Roger Fisher and William Ury's 1991 book "Getting to Yes." Instead of bargaining from…

Barriers and facilitators to institutional delivery in rural areas of Chitwan district, Nepal: a qualitative study.

PubMed

Shah, Rajani; Rehfuess, Eva A; Paudel, Deepak; Maskey, Mahesh K; Delius, Maria

2018-06-20

Giving birth assisted by skilled care in a health facility plays a vital role in preventing maternal deaths. In Nepal, delivery services are free and a cash incentive is provided to women giving birth at a health facility. Nevertheless, about half of women still deliver at home. This study explores socio-cultural and health service-related barriers to and facilitators of institutional delivery. Six village development committees in hill and plain areas were selected in Chitwan district. We conducted a total of 10 focus group discussions and 12 in-depth-interviews with relevant stakeholder groups, including mothers, husbands, mothers-in-law, traditional birth attendants, female community health volunteers, health service providers and district health managers. Data were analyzed inductively using thematic analysis. Three main themes played a role in deciding the place of delivery, i.e. socio-cultural norms and values; access to birthing facilities; and perceptions regarding the quality of health services. Factors encouraging an institutional delivery included complications during labour, supportive husbands and mothers-in-law, the availability of an ambulance, having birthing centres nearby, locally sufficient financial incentives and/or material incentives, the 24-h availability of midwives and friendly health service providers. Socio-cultural barriers to institutional deliveries were deeply held beliefs about childbirth being a normal life event, the wish to be cared for by family members, greater freedom of movement at home, a warm environment, the possibility to obtain appropriate "hot" foods, and shyness of young women and their position in the family hierarchy. Accessibility and quality of health services also presented barriers, including lack of road and transportation, insufficient financial incentives, poor infrastructure and equipment at birthing centres and the young age and perceived incompetence of midwives. Despite much progress in recent years, this study revealed some important barriers to the utilization of health services. It suggests that a combination of upgrading birthing centres and strengthening the competencies of health personnel while embracing and addressing deeply rooted family values and traditions can improve existing programmes and further increase institutional delivery rates.

A Productive Partnership

ERIC Educational Resources Information Center

Patt, Mary Johnson

2010-01-01

On April 7, 2009, as the nation agonized over a worsening economy, voters in western Wisconsin's Elk Mound Area School District passed a $9.3 million referendum to upgrade its three aging, overcrowded schools. On that same day, similar referendums in surrounding school districts failed. This article profiles Elk Mound Area School District and…

78 FR 22900 - Notice of Lodging Proposed Consent Decree

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-17

... lodged with the United States District Court for the Western District of Wisconsin on April 10, 2013... District of Wisconsin, Robert W. Kastenmeier United States Courthouse, 120 North Henry Street, Room 320, Madison, WI 53703-2559. In addition, the proposed Consent Decree may be examined electronically at http...

Intervention studies on rational use of drugs in public and private sector in Nepal.

PubMed

Kafle, Kumud Kumar; Shrestha, Naveen; Karkee, Shiba Bahadur; Prasad, Radha Raman; Bhuju, Gajendra Bahadur; Das, Prabhakar Lal

2005-06-01

In developing countries, inappropriate, inefficient and ineffective use of pharmaceuticals have resulted into the poor health and medical cares for the community people. For improving the situation, various interventions have been tested and proved effective in different settings. In Nepal also, various strategies have been tested and found effective to improve the prescribing and dispensing practices. This paper has examined the process and results of different studies. The educational intervention, the training has not been effective in improving the prescribing practices but has limited effect on dispensing practices in the public sector. However, it becomes effective in improving prescribing practices if combined with a managerial intervention e.g. peer-group discussion. In private sector, training alone is effective in changing the drug recommendation practices of retailers. But none of interventions have been found to be effective in improving dispensing practices. After examining the effectiveness of different interventions, training combined with peer-group discussion is recommended for piloting in all Primary Health Care (PHC) outlets of a district to improve the prescribing practices. For improving the dispensing practices in both public and private sector, additional studies have to be carried out using different strategies.

Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal Demographic and Health Survey-2006

PubMed Central

2011-01-01

Background Nearly four-fifths of estimated 1.1 million smokers live in low or middle-income countries. We aimed to provide national estimates for Nepal on tobacco use prevalence, its distribution across demographic, socio-economic and spatial variables and correlates of tobacco use. Methods A secondary data analysis of 2006 Nepal Demographic and Health Survey (DHS) was done. A representative sample of 9,036 households was selected by two-stage stratified, probability proportional to size (PPS) technique. We constructed three outcome variables 'tobacco smoke', 'tobacco chewer' and 'any tobacco use' based on four questions about tobacco use that were asked in DHS questionnaires. Socio-economic, demographic and spatial predictor variables were used. We computed overall prevalence for 'tobacco smoking', 'tobacco chewing' and 'any tobacco use' i.e. point estimates of prevalence rates, 95% confidence intervals (CIs) after adjustment for strata and clustering at primary sampling unit (PSU) level. For correlates of tobacco use, we used multivariate analysis to calculate adjusted odds ratios (AORs) and their 95% CIs. A p-value < 0.05 was considered as significant. Results Total number of households, eligible women and men interviewed was 8707, 10793 and 4397 respectively. The overall prevalence for 'any tobacco use', 'tobacco smoking' and 'tobacco chewing' were 30.3% (95% CI 28.9, 31.7), 20.7% (95% CI 19.5, 22.0) and 14.6% (95% CI 13.5, 15.7) respectively. Prevalence among men was significantly higher than women for 'any tobacco use' (56.5% versus 19.6%), 'tobacco smoking' (32.8% versus 15.8%) and 'tobacco chewing' (38.0% versus 5.0%). By multivariate analysis, older adults, men, lesser educated and those with lower wealth quintiles were more likely to be using all forms of tobacco. Divorced, separated, and widowed were more likely to smoke (OR 1.49, 95% CI 1.14, 1.94) and chew tobacco (OR 1.36, 95% CI 0.97, 1.93) as compared to those who were currently married. Prevalence of 'tobacco chewing' was higher in eastern region (19.7%) and terai/plains (16.2%). 'Tobacco smoking' and 'any tobacco use' were higher in rural areas, mid-western and far western and mountainous areas. Conclusions Prevalence of tobacco use is considerably high among Nepalese people. Demographic and socioeconomic determinants and spatial distribution should be considered while planning tobacco control interventions. PMID:22185233

Hydrogeochemical Investigations of Historic Mining Districts, Central Western Slope of Colorado, Including Influence on Surface-Water Quality

USGS Publications Warehouse

Nash, J. Thomas

2002-01-01

This report describes reconnaissance hydrogeochemical investigations of 22 mining districts on the Western Slope of Colorado in the Gunnison and Uncompahgre National Forests and adjacent public lands administered by the Bureau of Land Management. Sources and fates of contaminants from historic mines, mine waste, and mill tailings are interpreted from chemical analyses for 190 samples of surface waters; 185 samples of mined rocks, mill tailings, and altered rocks; and passive leach analyses of 116 samples of those mineralized materials. Short reaches of several headwater streams show relatively low level effects of historic mining; the headwaters of the Uncompahgre River are highly contaminated by mines and unmined altered rocks in the Red Mountain district. There is encouraging evidence that natural processes attenuate mine-related contamination in most districts.

Characterization of the Genetic Diversity of Acid Lime (Citrus aurantifolia (Christm.) Swingle) Cultivars of Eastern Nepal Using Inter-Simple Sequence Repeat Markers.

PubMed

Munankarmi, Nabin Narayan; Rana, Neesha; Bhattarai, Tribikram; Shrestha, Ram Lal; Joshi, Bal Krishna; Baral, Bikash; Shrestha, Sangita

2018-06-12

Acid lime ( Citrus aurantifolia (Christm.) Swingle) is an important fruit crop, which has high commercial value and is cultivated in 60 out of the 77 districts representing all geographical landscapes of Nepal. A lack of improved high-yielding varieties, infestation with various diseases, and pests, as well as poor management practices might have contributed to its extremely reduced productivity, which necessitates a reliable understanding of genetic diversity in existing cultivars. Hereby, we aim to characterize the genetic diversity of acid lime cultivars cultivated at three different agro-ecological gradients of eastern Nepal, employing PCR-based inter-simple sequence repeat (ISSR) markers. Altogether, 21 polymorphic ISSR markers were used to assess the genetic diversity in 60 acid lime cultivars sampled from different geographical locations. Analysis of binary data matrix was performed on the basis of bands obtained, and principal coordinate analysis and phenogram construction were performed using different computer algorithms. ISSR profiling yielded 234 amplicons, of which 87.18% were polymorphic. The number of amplified fragments ranged from 7⁻18, with amplicon size ranging from ca. 250⁻3200 bp. The Numerical Taxonomy and Multivariate System (NTSYS)-based cluster analysis using the unweighted pair group method of arithmetic averages (UPGMA) algorithm and Dice similarity coefficient separated 60 cultivars into two major and three minor clusters. Genetic diversity analysis using Popgene ver. 1.32 revealed the highest percentage of polymorphic bands (PPB), Nei’s genetic diversity (H), and Shannon’s information index (I) for the Terai zone (PPB = 69.66%; H = 0.215; I = 0.325), and the lowest of all three for the high hill zone (PPB = 55.13%; H = 0.173; I = 0.262). Thus, our data indicate that the ISSR marker has been successfully employed for evaluating the genetic diversity of Nepalese acid lime cultivars and has furnished valuable information on intrinsic genetic diversity and the relationship between cultivars that might be useful in acid lime breeding and conservation programs in Nepal.

Prevalence and factors associated with childhood overweight/obesity of private school children in Nepal.

PubMed

Koirala, M; Khatri, R B; Khanal, V; Amatya, A

2015-01-01

Childhood overweight/obesity is a global health problem because of adverse health and nutrition consequences worldwide. Currently, there is a paucity of information on childhood overweight/obesity in Nepal. Therefore, the objective of this study was to assess the prevalence of, and the factors associated with, childhood overweight/obesity among primary school children. A cross-sectional study was conducted in June-December, 2013. We collected data using the structured self-administered questionnaire with parents of children aged 6-13 years in grades 1-6 studying at private schools of the Lalitpur district of Nepal. Height and weight measurements of 986 children were taken, and the corresponding body mass index (BMI)-for-age was calculated. The prevalence of childhood overweight/obesity was reported in proportion. Factors associated with childhood overweight/obesity were examined using the Chi-square tests followed by multiple logistic regression analyses. Of 986 children, 144 (14.6%) were overweight and 111 (11.3%) were obese. Overall, 255 (25.9%) children were found to be overweight/obese. Children from families, having ≤2 siblings (adjusted odds ratio (aOR)=1.958, 95% confidence interval (CI): 1.163-3.296), upper class family (aOR=3.672; 95% CI: 1.154-11.690), and advantaged ethnic group (aOR=1.561; 95% CI: 1.00-2.437) and children who were of larger birth weight (>4.0kg) had a greater likelihood of being (aOR=2.557, 95% CI: 1.222-5.349) overweight/obese. A quarter of children were found to be overweight/obese in private primary schools. Preventive interventions should focus on the advantaged ethnic groups, families with fewer siblings, and upper class families. A greater emphasis ought to be placed on formulation and implementation of policies aimed at addressing the newly emerging problems of childhood overweight/obesity in Nepal. New school health programs are to be launched and strengthened including avoidance of high energy junk food, and promoting outdoor activities. Copyright © 2014 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Clinic Attendance for Antiretroviral Pills Pick-Up among HIV-Positive People in Nepal: Roles of Perceived Family Support and Associated Factors.

PubMed

Ayer, Rakesh; Kikuchi, Kimiyo; Ghimire, Mamata; Shibanuma, Akira; Pant, Madhab Raj; Poudel, Krishna C; Jimba, Masamine

2016-01-01

HIV-positive people's clinic attendance for medication pick-up is critical for successful HIV treatment. However, limited evidence exists on it especially in low-income settings such as Nepal. Moreover, the role of family support in clinic attendance remains under-explored. Therefore, this study was conducted to examine the association between perceived family support and regular clinic attendance and to assess factors associated with regular clinic attendance for antiretroviral pills pick-up among HIV-positive individuals in Nepal. A cross-sectional study was conducted among 423 HIV-positive people in three districts of Nepal. Clinic attendance was assessed retrospectively for the period of 12 months. To assess the factors associated, an interview survey was conducted using a semi-structured questionnaire from July to August, 2015. Multiple logistic regression models were used to assess the factors associated with regular clinic attendance. Of 423 HIV-positive people, only 32.6% attended the clinics regularly. They were more likely to attend them regularly when they received high family support (AOR = 3.98, 95% CI = 2.29, 6.92), participated in support programs (AOR = 1.68, 95% CI = 1.00, 2.82), and had knowledge on the benefits of antiretroviral therapy (AOR = 2.62, 95% CI = 1.15, 5.99). In contrast, they were less likely to attend them regularly when they commuted more than 60 minutes to the clinics (AOR = 0.53, 95% CI = 0.30, 0.93), when they self-rated their health status as being very good (AOR = 0.13, 95% CI = 0.04, 0.44), good (AOR = 0.14, 95% CI = 0.04, 0.46), and fair (AOR = 0.21, 95% CI = 0.06, 0.70). HIV-positive individuals are more likely to attend the clinics regularly when they receive high family support, know the benefits of antiretroviral therapy, and participate in support programs. To improve clinic attendance, family support should be incorporated with HIV care programs in resource limited settings. Service providers should also consider educating them about the benefits of antiretroviral therapy.

Clinic Attendance for Antiretroviral Pills Pick-Up among HIV-Positive People in Nepal: Roles of Perceived Family Support and Associated Factors

PubMed Central

Kikuchi, Kimiyo; Ghimire, Mamata; Shibanuma, Akira; Pant, Madhab Raj; Poudel, Krishna C.; Jimba, Masamine

2016-01-01

Introduction HIV-positive people’s clinic attendance for medication pick-up is critical for successful HIV treatment. However, limited evidence exists on it especially in low-income settings such as Nepal. Moreover, the role of family support in clinic attendance remains under-explored. Therefore, this study was conducted to examine the association between perceived family support and regular clinic attendance and to assess factors associated with regular clinic attendance for antiretroviral pills pick-up among HIV-positive individuals in Nepal. Methods A cross-sectional study was conducted among 423 HIV-positive people in three districts of Nepal. Clinic attendance was assessed retrospectively for the period of 12 months. To assess the factors associated, an interview survey was conducted using a semi-structured questionnaire from July to August, 2015. Multiple logistic regression models were used to assess the factors associated with regular clinic attendance. Results Of 423 HIV-positive people, only 32.6% attended the clinics regularly. They were more likely to attend them regularly when they received high family support (AOR = 3.98, 95% CI = 2.29, 6.92), participated in support programs (AOR = 1.68, 95% CI = 1.00, 2.82), and had knowledge on the benefits of antiretroviral therapy (AOR = 2.62, 95% CI = 1.15, 5.99). In contrast, they were less likely to attend them regularly when they commuted more than 60 minutes to the clinics (AOR = 0.53, 95% CI = 0.30, 0.93), when they self-rated their health status as being very good (AOR = 0.13, 95% CI = 0.04, 0.44), good (AOR = 0.14, 95% CI = 0.04, 0.46), and fair (AOR = 0.21, 95% CI = 0.06, 0.70). Conclusion HIV-positive individuals are more likely to attend the clinics regularly when they receive high family support, know the benefits of antiretroviral therapy, and participate in support programs. To improve clinic attendance, family support should be incorporated with HIV care programs in resource limited settings. Service providers should also consider educating them about the benefits of antiretroviral therapy. PMID:27438024

Incidence and Risk Factors for Neonatal Jaundice among Newborns in Southern Nepal

PubMed Central

Scrafford, Carolyn G.; Mullany, Luke C.; Katz, Joanne; Khatry, Subarna K.; LeClerq, Steven C.; Darmstadt, Gary L.; Tielsch, James M.

2016-01-01

Objective To quantify the incidence of and risk factors for neonatal jaundice among infants referred for care from a rural, low-resource, population-based cohort in southern Nepal. Methods Study participants were 18,985 newborn infants born in Sarlahi District in Southern Nepal from May 2003 through January 2006 who participated in a cluster-randomized, placebo-controlled, community-based trial to evaluate the effect of newborn chlorhexidine cleansing on neonatal mortality and morbidity. Jaundice was assessed based on visual assessment of the infant by a study worker and referral for care. Adjusted relative risks (RR) were estimated to identify risk factors for referral for neonatal jaundice using Poisson regression. Results The incidence of referral for neonatal jaundice was 29.3 per 1,000 live births (95% Confidence Interval: 26.9, 31.7). Male sex, high birth weight, breastfeeding patterns, warm air temperature, primiparity, skilled birth attendance, place of delivery, prolonged labor, oil massage, paternal education, and ethnicity were significant risk factors (p-values<0.01). After multi-variable adjustment, sex, birth weight, difficulty feeding, prolonged labor, primiparity, oil massage, ambient air temperature, and ethnicity remained important factors. Among infants with difficulty feeding, exclusive breastfeeding was a risk factor for neonatal jaundice, whereas exclusive breastfeeding was protective among infants with no report of difficulty feeding. Conclusions Several known risk factors for neonatal jaundice in a low-resource setting were confirmed in this study. Unique observed associations of jaundice with ambient air temperature and oil massage may be explained by the opportunity for phototherapy based on the cultural practices of this study population. Future research should investigate the role of an infant’s difficulty in feeding as a potential modifier in the association between exclusive breastfeeding and jaundice. PMID:24112359

Uterine prolapse prevention in Eastern Nepal: the perspectives of women and health care professionals.

PubMed

Radl, Christina M; Rajwar, Ranjita; Aro, Arja R

2012-01-01

Uterine prolapse is a major reproductive health issue in Nepal. There is a wide range of literature available on the causes and risk factors of uterine prolapse and on the ways to prevent and treat it. There is still a lack of published evidence on what prevention and treatment services are working well or the attitudes toward them. This paper presents the findings of a qualitative study on primary and secondary prevention of uterine prolapse in Eastern Nepal. The study involved eight focus group discussions with 71 women in six villages of the eastern districts of Siraha and Saptari and 14 qualitative interviews with health professionals from the local to central level. The group discussions and interviews covered the awareness levels of uterine prolapse and its prevention and treatment, as well as participants' opinions on and experiences with the services offered. It was found that patriarchy, gender discrimination, and cultural traditions such as early marriage and pregnancy make it difficult for people to discontinue uterine prolapse risk behaviors. Women are aware of risk factors, prevention, and treatment, but are powerless to change their situations. Health professionals and women are fond of surgery as treatment, but opinions on the use of ring pessaries and pelvic floor muscle training are split. The main recommendation that can be drawn from this study is that research on the effectiveness of early treatments, such as ring pessaries and exercise, should be conducted. Furthermore, the involvement of other target groups (husbands, adolescents, and mothers-in-law) needs to be increased in order to make it easier for women to adapt low-risk behaviors. Finally, uterine prolapse prevention should be better integrated in national reproductive health services. Enforcing transparency, monitoring systems, and collaborations are important factors that should be considered as well.

Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences.

PubMed

Adhikari, Shiva R; Maskay, Nephil M; Sharma, Bishnu P

2009-03-01

Households obtaining health care services in developing countries incur substantial costs, despite services generally being provided free of charge by public health institutions. This constitutes an economic burden on low-income households, and contributes to deepening their level of poverty. In addition to the economic burden of obtaining health care, the method of financing these payments has implications for the distribution of household assets. This effect on resource-poor households is amplified since they have decreased access to health insurance. Recent literature, however, ignores the importance of the method of financing health care payments. This paper looks at the case of Nepal and highlights the impact on households of paying for hospital-based care of Kala-azar (KA) by analysing the catastrophic, impoverishment and economic consequences of their coping strategies. The paper utilizes micro-data on a random selection of 50% of the KA-affected households of Siraha and Saptari districts of Nepal. The empirical results suggest that direct costs of hospital-based treatment of KA are catastrophic since they consume 17% of annual household income. This expenditure causes more than 20% of KA-affected households to fall below the poverty line, with the remaining households being pushed into the category of marginal poor; the poverty gap ratio is more than 90%. Further, KA incidence can have prolonged and severe economic consequences for the household economy due to the mechanisms of informal sector financing to which households resort. A heavy burden of loan repayments can lead households on a downward spiral that eventually becomes a poverty trap. In other words, the method of financing health care payments is an important ingredient in understanding the economic burden of disease.

Electrocardiography in people living at high altitude of Nepal

PubMed Central

Aryal, Nirmal; Weatherall, Mark; Bhatta, Yadav Kumar Deo; Mann, Stewart

2017-01-01

Objective The main objective of this study was to estimate the prevalence of coronary heart disease (CHD) of high-altitude populations in Nepal determined by an ECG recordings and a medical history. Methods We carried out a cross-sectional survey of cardiovascular disease and risk factors among people living at four different altitude levels, all above 2800 m, in the Mustang and Humla districts of Nepal. 12-lead ECGs were recorded on 485 participants. ECG recordings were categorised as definitely abnormal, borderline or normal. Results No participant had Q waves to suggest past Q-wave infarction. Overall, 5.6% (95% CI 3.7 to 8.0) of participants gave a self-report of CHD. The prevalence of abnormal (or borderline abnormal) ECG was 19.6% (95% CI 16.1 to 23.4). The main abnormalities were: right axis deviation in 5.4% (95% CI 3.5 to 7.7) and left ventricular hypertrophy by voltage criteria in 3.5% (95% CI 2.0 to 5.5). ECG abnormalities were mainly on the left side of the heart for Mustang participants (Tibetan origin) and on the right side for Humla participants (Indo-Aryans). There was a moderate association between the probability of abnormal (or borderline abnormal) ECG and altitude when adjusted for potential confounding variables in a multivariate logistic model; with an OR for association per 1000 m elevation of altitude of 2.83 (95% CI 1.07 to 7.45), p=0.03. Conclusions Electrocardiographic evidence suggests that although high-altitude populations do not have a high prevalence of CHD, abnormal ECG findings increase by altitude and risk pattern varies by ethnicity. PMID:28243317

Assessing access to surgical care in Nepal via a cross-sectional, countrywide survey.

PubMed

Boeck, Marissa A; Nagarajan, Neeraja; Gupta, Shailvi; Varadaraj, Varshini; Groen, Reinou S; Shrestha, Sunil; Gurung, Susant; Kushner, Adam L; Nwomeh, Benedict; Swaroop, Mamta

2016-08-01

Adequate surgical care is lacking in many low- and middle-income countries because of diverse barriers preventing patients from reaching providers. We sought to assess perceived difficulties to accessing surgical care in Nepal using the Surgeons OverSeas Assessment of Surgical Need tool. Fifteen of 75 Nepali districts were selected proportionate to the population, with 1,350 households surveyed. Household heads answered questions regarding access to health facilities, and 2 household members were interviewed for medical history. Continuous and categorical variables were analyzed via Wilcoxon rank sum test and Pearson χ(2) test. Multivariable logistic regressions for independent predictors of care access were performed controlling for age, sex, location, and literacy. Of respondents with a surgical condition (n = 1,342), 650 (48.4%) accessed care and 237 (17.7%) did not. Unadjusted analyses showed greater median travel times to all facilities (P < .001) and median transport costs to secondary and tertiary centers (P < .001) for those who did not access care versus those who did. Literate respondents were more likely to access care across all facilities and access variables in adjusted models (odds ratio 1.66-1.80, P < .01). Those without transport money were less likely to access care at any facility in all analyses (P < .01). The data project that at least 2.4 million individuals lack access to needed surgical care in Nepal during their lifetimes, with those not accessing health facilities having lower literacy rates and fewer transport resources. Promoting education, outreach programs, and transportation access could lessen barriers but will require further exploration. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of changes in crop farming in the Dudh Koshi (Nepal) driven by climate changes

NASA Astrophysics Data System (ADS)

Gianinetto, Marco; Polinelli, Francesco; Frassy, Federico; Aiello, Martina; Rota Nodari, Francesco; Soncini, Andrea; Bocchiola, Daniele

2017-10-01

Nepal is one of the poorest nations of the world and the Koshi Basin includes some of the poorest regions of this country. It's farming system is subsistence agriculture, mainly rainfed, with crop productivity among the lowest in South Asia. Nepal is also severely impacted by climate changes, such as retreat of glaciers, rise in temperature, erratic rainfalls and increase in frequency of extreme weather. This paper describes the spatio-temporal evolution of cultivated land in Dudh Koshi during the last four decades (1970s-2010s), by mapping the farming of its four main cereals in the districts of Solukhumbu, Okhaldunga and Kothang from space. The analysis of satellite time series showed a 10% of increment in farmland from 1970s to 1990s, and about 60% in the following twenty years. With a shift of cropping to higher altitudes. Data belonging to of the second twenty years are strongly correlated with the population growth observed in the same period (0.97

Postpartum hemorrhage prevention in Nepal: a program assessment.

PubMed

Rajbhandari, Swaraj Pradhan; Aryal, Kamal; Sheldon, Wendy R; Ban, Bharat; Upreti, Senendra Raj; Regmi, Kiran; Aryal, Shilu; Winikoff, Beverly

2017-06-05

In 2009, the Nepal Ministry of Health and Population launched a national program for prevention of postpartum hemorrhage (PPH) during home births that features advance distribution of misoprostol to pregnant women. In the years since, the government has scaled-up the program throughout much of the country. This paper presents findings from the first large-scale assessment of the effectiveness of the advance distribution program. Data collection was carried out in nine districts and all three ecological zones. To assess knowledge, receipt and use of misoprostol, household interviews were conducted with 2070 women who had given birth within the past 12 months. To assess supply and provision of misoprostol, interviews were conducted with 270 Female Community Health Volunteers (FCHVs) and staff at 99 health facilities. Among recently delivered women, only 15% received information about misoprostol and 13% received misoprostol tablets in advance of delivery. Yet 87% who received advance misoprostol and delivered at home used it for PPH prevention. Among FCHVs, 96% were providing advance misoprostol for PPH prevention; however 81% had experienced at least one misoprostol stock out within the past year. About one-half of FCHVs were providing incomplete information about the use of misoprostol; in addition, many did not discuss side effects, how to recognize PPH or where to go if PPH occurs. Among health facilities, just one-half had sufficient misoprostol stock, while 95% had sufficient oxytocin stock, at the time of this assessment. In Nepal, women who receive advance misoprostol are both willing and able to use the medication for PPH prevention during home births. However the supply and personnel challenges identified raise questions about scalability and impact of the program over the long-term. Further assessment is needed.

Feasibility study of a family- and school-based intervention for child behavior problems in Nepal.

PubMed

Adhikari, Ramesh P; Upadhaya, Nawaraj; Satinsky, Emily N; Burkey, Matthew D; Kohrt, Brandon A; Jordans, Mark J D

2018-01-01

This study evaluates the feasibility, acceptability, and outcomes of a combined school- and family-based intervention, delivered by psychosocial counselors, for children with behavior problems in rural Nepal. Forty-one children participated at baseline. Two students moved to another district, meaning 39 children, ages 6-15, participated at both baseline and follow-up. Pre-post evaluation was used to assess behavioral changes over a 4-month follow-up period (n = 39). The primary outcome measure was the Disruptive Behavior International Scale-Nepal version (DBIS-N). The secondary outcome scales included the Child Functional Impairment Scale and the Eyberg Child Behavior Inventory (ECBI). Twelve key informant interviews were conducted with community stakeholders, including teachers, parents, and community members, to assess stakeholders' perceptions of the intervention. The study found that children's behavior problems as assessed on the DBIS-N were significantly lower at follow-up (M = 13.0, SD = 6.4) than at baseline (M = 20.5, SD = 3.8), p < 0.001, CI [5.57, 9.35]. Similarly, children's ECBI Intensity scores were significantly lower at follow-up (M = 9.9, SD = 8.5) than at baseline (M = 14.8, SD = 7.7), p < 0.005, 95% CI [1.76, 8.14]. The intervention also significantly improved children's daily functioning. Parents and teachers involved in the intervention found it acceptable and feasible for delivery to their children and students. Parents and teachers reported improved behaviors among children and the implementation of new behavior management techniques both at home and in the classroom. Significant change in child outcome measures in this uncontrolled evaluation, alongside qualitative findings suggesting feasibility and acceptability, support moving toward a controlled trial to determine effectiveness.

Women's Ideas about the Health Effects of Household Air Pollution, Developed through Focus Group Discussions and Artwork in Southern Nepal.

PubMed

Devakumar, Delan; Qureshi, Zeshan; Mannell, Jenevieve; Baruwal, Manju; Sharma, Neha; Rehfuess, Eva; Saville, Naomi M; Manandhar, Dharma S; Osrin, David

2018-02-01

Household air pollution is a major cause of ill health, but few solutions have been effective to date. While many quantitative studies have been conducted, few have explored the lived experiences and perceptions of women who do the cooking, and as a result are those most exposed to household air pollution. In this study, we worked with groups of home cooks, and sought to use art as a means of engaging them in discussions of how household air pollution from cooking affects their lives. In the Terai district of southern Nepal, we held four focus groups that included 26 local women from urban and peri-urban areas, as well as six local artists. The women then met approximately weekly over four months, and produced images related to air pollution. Transcripts from the focus groups were reviewed independently by two authors, who initially categorised data deductively to pre-defined nodes, and subsequently inductively reviewed emergent themes. Women identified a number of health effects from air pollution. The main physical effects related to the eye and the respiratory system, and women and young children were seen as most vulnerable. The psychosocial effects of air pollution included reduced food intake by women and lethargy. Suggested solutions included modifications to the cooking process, changing the location of stoves, and increasing ventilation. The main barriers were financial. The lived experiences of women in southern Nepal around the problem of air pollution offers a more nuanced and context-specific understanding of the perceptions and challenges of addressing air pollution, which can be used to inform future interventions.

Women’s Ideas about the Health Effects of Household Air Pollution, Developed through Focus Group Discussions and Artwork in Southern Nepal

PubMed Central

Qureshi, Zeshan; Mannell, Jenevieve; Baruwal, Manju; Sharma, Neha; Rehfuess, Eva; Manandhar, Dharma S.; Osrin, David

2018-01-01

Household air pollution is a major cause of ill health, but few solutions have been effective to date. While many quantitative studies have been conducted, few have explored the lived experiences and perceptions of women who do the cooking, and as a result are those most exposed to household air pollution. In this study, we worked with groups of home cooks, and sought to use art as a means of engaging them in discussions of how household air pollution from cooking affects their lives. In the Terai district of southern Nepal, we held four focus groups that included 26 local women from urban and peri-urban areas, as well as six local artists. The women then met approximately weekly over four months, and produced images related to air pollution. Transcripts from the focus groups were reviewed independently by two authors, who initially categorised data deductively to pre-defined nodes, and subsequently inductively reviewed emergent themes. Women identified a number of health effects from air pollution. The main physical effects related to the eye and the respiratory system, and women and young children were seen as most vulnerable. The psychosocial effects of air pollution included reduced food intake by women and lethargy. Suggested solutions included modifications to the cooking process, changing the location of stoves, and increasing ventilation. The main barriers were financial. The lived experiences of women in southern Nepal around the problem of air pollution offers a more nuanced and context-specific understanding of the perceptions and challenges of addressing air pollution, which can be used to inform future interventions. PMID:29389909

Micro-level social and structural factors act synergistically to increase HIV risk among Nepalese female sex workers.

PubMed

Deuba, Keshab; Anderson, Sarah; Ekström, Anna Mia; Pandey, Satish Raj; Shrestha, Rachana; Karki, Deepak Kumar; Marrone, Gaetano

2016-08-01

Sex workers face stigma, discrimination, and violence across the globe and are almost 14 times more likely to be HIV-infected than other women in low- and middle-income countries. In Asia, condom campaigns at brothels have been effective in some settings, but for preventive interventions to be sustainable, it is important to understand micro-level social and structural factors that influence sexual behaviours of sex workers. This study assessed the syndemic effects of micro-level social and structural factors of unprotected sex and the prevalence of HIV among female sex workers (FSWs) in Nepal. This quantitative study included 610 FSWs who were recruited using two-stage cluster sampling from September to November 2012 in 22 Terai Highway districts of Nepal. Rapid HIV tests and face-to-face interviews were conducted to collect biological and behavioural information. A count of physical (sexual violence and other undesirable events), social (poor social support and condom negotiation skills), and economic (unprotected sex to make more money) factors that operate at the micro-level was calculated to test the additive relationship to unprotected sex. The HIV prevalence was 1%; this is presumably representative, with a large sample of FSWs in Nepal. The prevalence of unprotected sex with clients was high (24%). For each additional adverse physical, social, and economic condition, the probability of non-use of condoms with clients increased substantially: one problem = 12% (p<0.005), two problems = 19% (p<0.001), and three to five problems = 38% (p<0.001). Interactions between two or more adverse conditions linked to physical, social, and economic environments increased the risk of unprotected sex among Nepalese FSWs. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Epidemic meningococcal disease: recommendations for travelers to Nepal.

PubMed

1985-03-08

In the Kathmandu Valley of Nepal, an epidemic of serogroup A meningococcal meningitis resulted in 875 cases and 95 deaths during the 1st 6 months of 1983. The overall annual attack rate was 103 cases/100,000 population; the case fatality ratio was 11%. The highest age-specific attack rate (223/100,000) occurred among children under age 1 year. 3 times as many cases occurred in Kathmandu during December 1983 and January 1984 as in the same period a year previously. A mass vaccination campaign was initiated on February 8, 1984, and 330,000 doses of bivalent A/C meningococcal vaccine were administered, achieving approximately 65% coverage of the target population. A marked decline in the number of meningitis cases occurred coincident with the initiation of the mass campaign. In 1985 meningococcal meningitis is occurring at a much lower rate than in 1984, but meningococcal disease among hikers now is being recognized. Over the January 1984-January 1985 period, 2 culture-confirmed and 4 clinically suspected cases of meningococcal disease were documented among tourists from western countries traveling in Nepal. Patients ranged in age from 16-40 years. 5 patients had evidence of meningococcemia; the other had meningitis alone. 2 patients died, and all became ill during or shortly after hiking outside kathmandu. 3 patients were from the US, 2 from Australia, and 1 from Switzerland. Tables present data on cases of specified notifiable diseases in the US.

Pattern of refractive errors among the Nepalese population: a retrospective study.

PubMed

Shrestha, S P; Bhat, K S; Binu, V S; Barthakur, R; Natarajan, M; Subba, S H

2010-01-01

Refractive errors are a major cause of visual impairment in the population. To find the pattern of refractive errors among patients evaluated in a tertiary care hospital in the western region of Nepal. The present hospital-based retrospective study was conducted in the Department of Ophthalmology of the Manipal Teaching Hospital, situated in Pokhara, Nepal. Patients who had refractive error of at least 0.5 D (dioptre) were included for the study. During the study period, 15,410 patients attended the outpatient department and 10.8% of the patients were identified as having refractive error. The age of the patients in the present study ranged between 5 - 90 years. Myopia was the commonest refractive error followed by hypermetropia. There was no difference in the frequency of the type of refractive errors when they were defined using right the eye, the left eye or both the eyes. Males predominated among myopics and females predominated among hypermetropics. The majority of spherical errors was less than or equal to 2 D. Astigmatic power above 1D was rarely seen with hypermetropic astigmatism and was seen in around 13 % with myopic astigmatism. "Astigmatism against the rule" was more common than "astigmatism with the rule", irrespective of age. Refractive errors progressively shift along myopia up to the third decade and change to hypermetropia till the seventh decade. Hyperopic shift in the refractive error in young adults should be well noted while planning any refractive surgery in younger patients with myopia. © Nepal Ophthalmic Society.

Condom Use at Last Sexual Intercourse and Its Correlates among Males and Females Aged 15–49 Years in Nepal

PubMed Central

Sharma, Bimala; Nam, Eun Woo

2018-01-01

This study aimed to assess the prevalence and correlates of condom use at last sexual intercourse among people aged 15–49 years in Nepal. Secondary data analysis was performed using the Nepal Demographic and Health Survey 2011. The study was restricted to the respondents who reported ever having had sexual intercourse; 9843 females and 3017 males were included. Condom use was assessed by asking if respondents used condoms in their most recent sexual intercourse. Chi-square test and multivariate logistic regression analysis were performed using Complex Sample Analysis Procedure to adjust for sample weight and multistage sampling design. Overall, 7.6% of total, and 16.3% of males and 6.2% of females reported using condoms in their last sexual intercourse. Living in Far-Western region, age and wealth quintile were positively associated with condom use in both males and females. Being unmarried was the most important predictor of condom use among males. Higher education was associated with increased likelihood of condom use in females. However, mobility, having multiple sexual partners, and HIV knowledge were not significant correlates of condom use in both sexes. A big difference was observed in the variance accounted for males and females; indicating use of condoms is poorly predicted by the variables included in the study among females. Condom use was more associated with sociodemographic factors than with sexual behavior and HIV knowledge. PMID:29547564

Prevalence of intestinal parasitosis among school children in Baglung districts of Western Nepal.

PubMed

Shrestha, A; Narayan, K C; Sharma, R

2012-01-01

This study was carried out to estimate the prevalence of intestinal parasites among school-going children of the Baglung municipality from December 2010 to January 2011. To find out prevalence of parasitosis among school aged children and to make necessary recommendations for preventive measures. A total of 260 stool samples were collected. A structured questionnaire was used to collect data on predisposing factors. Nails were observed without prior information to the subjects so as to find their hygienic practice. The stool samples were examined by direct wet mount and formal ether concentration technique. The total prevalence of the intestinal parasitosis was found to be 21.05%. The prevalence for individual parasites was as follows: Entamoeba histolytica (9.23%), Giardia lamblia (5.76%), Trichuris trichuria (5%), Ancylostoma duodenale (2.65%) and Ascaris lumbricoides (2.3%). Nail hygiene and level of education were significantly associated with intestinal parasitosis. The gender and age of the children, sanitary habits including toilet use, hand washing practice, and the use of the antihelminthic drug (albendazole) were not significantly associated with intestinal parasitosis. Higher prevalence was seen in boys, children belonging to age group 10-14 years, lower secondary students, among those who reported gastrointestinal problems within last six months, children from agriculture-based families and children with untrimmed nail. Major contributors for the prevalence of parasites were found to be poor personal hygiene and educational level of the children. Health education and mass treatment are recommended as a preventive measures.

Prevalence and correlates of tobacco use amongst junior collegiates in twin cities of western Nepal: A cross-sectional, questionnaire-based survey

PubMed Central

Sreeramareddy, Chandrashekhar T; Kishore, PV; Paudel, Jagadish; Menezes, Ritesh G

2008-01-01

Background College students are vulnerable to tobacco addiction. Tobacco industries often target college students for marketing. Studies about prevalence of tobacco use and its correlates among college students in Nepal are lacking. Methods A cross-sectional survey was carried out in two cities of western Nepal during January-March, 2007. A pre-tested, anonymous, self-administered questionnaire (in Nepali) adapted from Global Youth Tobacco Survey (GYTS) and a World Bank study was administered to a representative sample of 1600 students selected from 13 junior colleges by two-stage stratified random sampling. Results Overall prevalence of 'ever users' of tobacco products was 13.9%. Prevalence among boys and girls was 20.5% and 2.9% respectively. Prevalence of 'current users' was 10.2% (cigarette smoking: 9.4%, smokeless products: 6.5%, and both forms: 5.7%). Median age at initiation of cigarette smoking and chewable tobacco was 16 and 15 years respectively. Among the current cigarette smokers, 58.7% (88/150) were smoking at least one cigarette per day. Most (67.8%) 'Current users' purchased tobacco products by themselves from stores or got them from friends. Most of them (66.7%) smoked in tea stalls or restaurants followed by other public places (13.2%). The average daily expenditure was 20 Nepalese rupees (~0.3 USD) and most (59%) students reported of having adequate money to buy tobacco products. Majority (82%) of the students were exposed to tobacco advertisements through magazines/newspapers, and advertising hoardings during a period of 30 days prior to survey. The correlates of tobacco use were: age, gender, household asset score and knowledge about health risks, family members, teachers and friends using tobacco products, and purchasing tobacco products for family members. Conclusion School/college-based interventions like counseling to promote cessation among current users and tobacco education to prevent initiation are necessary. Enforcement of legislations to decrease availability, accessibility and affordability of tobacco products and policies to change social norms of tobacco use among parents and teachers are necessary to curb the tobacco use among college students. PMID:18366781

A cluster randomized implementation trial to measure the effectiveness of an intervention package aiming to increase the utilization of skilled birth attendants by women for childbirth: study protocol

PubMed Central

2014-01-01

Background Nepal is on track to achieve MDG 5 but there is a huge sub-national disparity with existing high maternal mortality in western and hilly regions. The national priority is to reduce this disparity to achieve the goal at sub-national level. Evidences from developing countries show that increasing utilization of skilled attendant at birth is an important indicator for reducing maternal death. Further, there is a very low utilization during childbirth in western and hilly regions of Nepal which clearly depicts the barriers in utilization of skilled birth attendants. So, there is a need to overcome the identified barriers to increase the utilization thereby decreasing the maternal mortality. The hypothesis of this study is that through a package of interventions the utilization of skilled birth attendants will be increased and hence improve maternal health in Nepal. Method/Design This study involves a cluster randomized controlled trial involving approximately 5000 pregnant women in 36 clusters. The 18 intervention clusters will receive the following interventions: i) mobilization of family support for pregnant women to reach the health facility, ii) availability of emergency funds for institutional childbirth, iii) availability of transport options to reach a health facility for childbirth, iv) training to health workers on communication skills, v) security provisions for SBAs to reach services 24/24 through community mobilization; 18 control clusters will not receive the intervention package. The final evaluation of the intervention is planned to be completed by October 2014. Primary study output of this study is utilization of SBA services. Secondary study outputs measure the uptake of antenatal care, post natal checkup for mother and baby, availability of transportation for childbirth, operation of emergency fund, improved reception of women at health services, and improved physical security of SBAs. Discussion The intervention package is designed to increase the utilization of skilled birth attendants by overcoming the barriers related to awareness, finance, transport, security etc. If proven effective, the Ministry of Health has committed to scale up the intervention package throughout the country. Trial registration number ISRCTN78892490. PMID:24646123

A cluster randomized implementation trial to measure the effectiveness of an intervention package aiming to increase the utilization of skilled birth attendants by women for childbirth: study protocol.

PubMed

Bhandari, Gajananda P; Subedi, Narayan; Thapa, Janak; Choulagai, Bishnu; Maskey, Mahesh K; Onta, Sharad R

2014-03-19

Nepal is on track to achieve MDG 5 but there is a huge sub-national disparity with existing high maternal mortality in western and hilly regions. The national priority is to reduce this disparity to achieve the goal at sub-national level. Evidences from developing countries show that increasing utilization of skilled attendant at birth is an important indicator for reducing maternal death. Further, there is a very low utilization during childbirth in western and hilly regions of Nepal which clearly depicts the barriers in utilization of skilled birth attendants. So, there is a need to overcome the identified barriers to increase the utilization thereby decreasing the maternal mortality. The hypothesis of this study is that through a package of interventions the utilization of skilled birth attendants will be increased and hence improve maternal health in Nepal. This study involves a cluster randomized controlled trial involving approximately 5000 pregnant women in 36 clusters. The 18 intervention clusters will receive the following interventions: i) mobilization of family support for pregnant women to reach the health facility, ii) availability of emergency funds for institutional childbirth, iii) availability of transport options to reach a health facility for childbirth, iv) training to health workers on communication skills, v) security provisions for SBAs to reach services 24/24 through community mobilization; 18 control clusters will not receive the intervention package. The final evaluation of the intervention is planned to be completed by October 2014. Primary study output of this study is utilization of SBA services. Secondary study outputs measure the uptake of antenatal care, post natal checkup for mother and baby, availability of transportation for childbirth, operation of emergency fund, improved reception of women at health services, and improved physical security of SBAs. The intervention package is designed to increase the utilization of skilled birth attendants by overcoming the barriers related to awareness, finance, transport, security etc. If proven effective, the Ministry of Health has committed to scale up the intervention package throughout the country. ISRCTN78892490.

Prevalence and correlates of tobacco use amongst junior collegiates in twin cities of western Nepal: a cross-sectional, questionnaire-based survey.

PubMed

Sreeramareddy, Chandrashekhar T; Kishore, Pv; Paudel, Jagadish; Menezes, Ritesh G

2008-03-26

College students are vulnerable to tobacco addiction. Tobacco industries often target college students for marketing. Studies about prevalence of tobacco use and its correlates among college students in Nepal are lacking. A cross-sectional survey was carried out in two cities of western Nepal during January-March, 2007. A pre-tested, anonymous, self-administered questionnaire (in Nepali) adapted from Global Youth Tobacco Survey (GYTS) and a World Bank study was administered to a representative sample of 1600 students selected from 13 junior colleges by two-stage stratified random sampling. Overall prevalence of 'ever users' of tobacco products was 13.9%. Prevalence among boys and girls was 20.5% and 2.9% respectively. Prevalence of 'current users' was 10.2% (cigarette smoking: 9.4%, smokeless products: 6.5%, and both forms: 5.7%). Median age at initiation of cigarette smoking and chewable tobacco was 16 and 15 years respectively. Among the current cigarette smokers, 58.7% (88/150) were smoking at least one cigarette per day. Most (67.8%) 'Current users' purchased tobacco products by themselves from stores or got them from friends. Most of them (66.7%) smoked in tea stalls or restaurants followed by other public places (13.2%). The average daily expenditure was 20 Nepalese rupees (approximately 0.3 USD) and most (59%) students reported of having adequate money to buy tobacco products. Majority (82%) of the students were exposed to tobacco advertisements through magazines/newspapers, and advertising hoardings during a period of 30 days prior to survey. The correlates of tobacco use were: age, gender, household asset score and knowledge about health risks, family members, teachers and friends using tobacco products, and purchasing tobacco products for family members. School/college-based interventions like counseling to promote cessation among current users and tobacco education to prevent initiation are necessary. Enforcement of legislations to decrease availability, accessibility and affordability of tobacco products and policies to change social norms of tobacco use among parents and teachers are necessary to curb the tobacco use among college students.

Administrator/Student Ratios in Large School Districts.

ERIC Educational Resources Information Center

Ornstein, Allan C.

1989-01-01

According to a survey of large school districts, the ratio of central office managers to students enrolled ranges from 1 administrator per 1,650 students to 1 administrator per 161 students. The average ratio was 1 administrator per 561 students. Western school districts appear most efficient. The ideal: 1 administrator per 1,000 to 1,200…

Leadership Development Institute: A California Community College Multi-College District Case Study

ERIC Educational Resources Information Center

Leon, Bianca R.

2016-01-01

The purpose of this study is to examine a community college district Grow Your Own (GYO) leadership program in the Western United States, the Multi College Leadership Development Institute (MCLDI). The MCLDI was developed in-house for a multi-campus community college district and offered to interested employees at all position levels with the…

No time to worship the serpent deities: women, economic change, and religion in north-western Nepal.

PubMed

Saul, R

1999-03-01

This paper explores the changing relationships between lay women, and the spiritual realm, in two ethnic Tibetan communities, Kag and Dzong, in northwestern Nepal. The study tackles how economic and social change has affected women's spiritual roles within the household and the community, and how these roles, in turn, have influenced the course of such change. In Kag, the introduction of tourism changed women's way of life. They became income-generating members of the community as lodge-owners. With new responsibilities to manage, Kag women eventually neglected their traditional social and spiritual obligations, much to the dismay of the older generation. On the other hand, women in Dzong still consider full social and physical participation in village life important despite the added obligations. They maintain spiritual harmony within the village. Dzongba women do not seem to feel the same conflicts as Kagpa women. The negative impact of Kag women's neglect of traditional social and spiritual responsibilities should be weighed against the possible benefits to women, household, and economy.

The Relationship between Schools' Costs per Pupil and Nevada School Performance Framework Index Scores in Clark County School District

ERIC Educational Resources Information Center

Rice, John; Huang, Min

2015-01-01

Clark County School District (CCSD) asked the Western Regional Education Laboratory (REL West) to examine the relationship between spending per pupil and Nevada School Performance Framework (NSPF) index scores in the district's schools. Data were examined from three school years (2011/12, 2012/13, 2013/14) and for three types of schools…

Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal.

PubMed

Gyawali, Sudesh; Rathore, Devendra S; Kc, Bhuvan; Shankar, P Ravi

2013-01-03

Unsafe injection practices and injection overuse are widespread in developing countries harming the patient and inviting risks to the health care workers. In Nepal, there is a dearth of documented information about injection practices so the present study was carried out: a) to determine whether the selected government health facilities satisfy the conditions for safe injections in terms of staff training, availability of sterile injectable equipment and their proper disposal after use and b) to assess knowledge and attitudes of healthcare workers in these health care facilities with regard to injection safety. A descriptive cross-sectional mixed type (qualitative and quantitative) survey was carried out from 18th May to 16th June 2012. In-depth interviews with the in-charges were conducted using a semi-structured questionnaire. Observation of the health facilities using a structured observation tool was done. The data were analysed manually by summarizing, tabulating and presenting in various formats. The in-charges (eight males, two females) who participated in the study ranged in age from 30 to 50 years with a mean age of 37.8 years. Severe infection followed by pain was the most important cause for injection use with injection Gentamicin being most commonly prescribed. New single use (disposable) injections and auto-disable syringes were used to inject curative drugs and vaccines respectively. Sufficient safety boxes were also supplied to dispose the used syringe. All health care workers had received full course of Hepatitis B vaccine and were knowledgeable about at least one pathogen transmitted through unsafe injection practices. Injection safety management policy and waste disposal guideline was not available for viewing in any of the facilities. The office staff who disposed the bio-medical wastes did so without taking any safety measures. Moreover, none of these staff had received any formal training in waste management. Certain safe injection practices were noticed in the studied health care facilities but there remain a number of grey areas where unsafe practices still persists placing patient and health workers at risk of associated hazards. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed.

Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal

PubMed Central

2013-01-01

Background Unsafe injection practices and injection overuse are widespread in developing countries harming the patient and inviting risks to the health care workers. In Nepal, there is a dearth of documented information about injection practices so the present study was carried out: a) to determine whether the selected government health facilities satisfy the conditions for safe injections in terms of staff training, availability of sterile injectable equipment and their proper disposal after use and b) to assess knowledge and attitudes of healthcare workers in these health care facilities with regard to injection safety. Methodology A descriptive cross-sectional mixed type (qualitative and quantitative) survey was carried out from 18th May to 16th June 2012. In-depth interviews with the in-charges were conducted using a semi-structured questionnaire. Observation of the health facilities using a structured observation tool was done. The data were analysed manually by summarizing, tabulating and presenting in various formats. Results The in-charges (eight males, two females) who participated in the study ranged in age from 30 to 50 years with a mean age of 37.8 years. Severe infection followed by pain was the most important cause for injection use with injection Gentamicin being most commonly prescribed. New single use (disposable) injections and auto-disable syringes were used to inject curative drugs and vaccines respectively. Sufficient safety boxes were also supplied to dispose the used syringe. All health care workers had received full course of Hepatitis B vaccine and were knowledgeable about at least one pathogen transmitted through unsafe injection practices. Injection safety management policy and waste disposal guideline was not available for viewing in any of the facilities. The office staff who disposed the bio-medical wastes did so without taking any safety measures. Moreover, none of these staff had received any formal training in waste management. Conclusions Certain safe injection practices were noticed in the studied health care facilities but there remain a number of grey areas where unsafe practices still persists placing patient and health workers at risk of associated hazards. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed. PMID:23286907

Infant feeding information, attitudes and practices: a longitudinal survey in central Nepal

PubMed Central

2014-01-01

Background Infant feeding is governed by environmental as well as cultural factors. Breastfeeding knowledge and attitudes are known to be associated with breastfeeding duration. This study investigated breastfeeding information, attitudes and supplementary feeding in the central hills district of Nepal. Methods A community-based prospective cohort study of 701 pregnant women was conducted. Information on breastfeeding attitudes, feeding practices and supplementary feeding was sought from the cohort at 4 weeks, 12 weeks and 22 weeks postpartum through repeated interviews using validated questionnaires. Results Average duration of intended breastfeeding was 28 months (SD 7.9) and average target time to introduce solid foods was 6.1 months (SD 1.2). About 80% of women reported their husband, mother/mother-in-law preferred breastfeeding. Eleven percent of the cohort said that breastfeeding was not enjoyable. At 12 weeks and 22 weeks after birth, about a quarter (24.8%) and half (52.8%) of the infants were introduced cow/buffalo milk, respectively, while only 6.3% and 13.4% of them were given infant formula. Overall, any breastfeeding rate remained high at over 98% throughout the follow up period. Conclusions Breastfeeding attitudes were encouraging in this population. Breastfeeding was almost universal. Use of infant formula was quite low, whereas cow or buffalo milk appeared to be popular supplementary foods. PMID:25177355

Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries

PubMed Central

Hanlon, Charlotte; Luitel, Nagendra P.; Kathree, Tasneem; Murhar, Vaibhav; Shrivasta, Sanjay; Medhin, Girmay; Ssebunnya, Joshua; Fekadu, Abebaw; Shidhaye, Rahul; Petersen, Inge; Jordans, Mark; Kigozi, Fred; Thornicroft, Graham; Patel, Vikram; Tomlinson, Mark; Lund, Crick; Breuer, Erica; De Silva, Mary; Prince, Martin

2014-01-01

Background Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. Methods A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. Results The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. Conclusions The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care. PMID:24558389

Ethnobotanical study on traditional use of medicinal plants in South-Western Serbia, Zlatibor district.

PubMed

Savikin, Katarina; Zdunić, Gordana; Menković, Nebojša; Zivković, Jelena; Cujić, Nada; Tereščenko, Milena; Bigović, Dubravka

2013-04-19

This paper provides significant ethnobotanical information on medicinal plant uses in the Zlatibor district, South-Western Serbia. A survey was performed using questionnaires with 220 informants (mean age 47, 79% female, 21% male). In addition, the use value and the relative importance of species were determined and the informant consensus factor was calculated for the medicinal plants included in the study. Intended plants usage was compared with previous ethnobotanical literature, with reference to the neighboring areas of Zlatibor district. The informants provided data for 69 medicinal plants belonging to 36 families. Rosaceae, Lamiaceae and Asteraceae were the predominant locally used families. The species with the highest use value were Mentha piperita, Matricaria chamomilla, Hypericum perforatum and Achillea millefolium. The most frequently reported medicinal uses were ones for treating gastrointestinal ailments, respiratory problems and skin diseases. Usually, the administration was primarily oral followed by topical applications. All different plant parts were utilized, however leaves were the most exploited parts of the plants. Folk medicine in South-Western Serbia, Zlatibor district is intended mainly as a mode of primary health care in healing of minor illnesses. The results indicate a slight reduction in the ethnobotanical and medical knowledge in this area, when compared with neighboring regions. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Discourse of Crisis in Public Meetings: Case Study of a School District's Multimillion Dollar Error

ERIC Educational Resources Information Center

Tracy, Karen

2007-01-01

School districts are both big businesses and a form of local governance that is part of American democracy. When a crisis makes a district's democratic face relevant, the organization will experience a dilemma that does not occur in business-only organizations. This study examines the public meetings of a school board in the western United States…

Pakistan: Summary Report. Education Financing and People's Aspirations in Pakistan. Asia-South Pacific Education Watch

ERIC Educational Resources Information Center

Lozada, Rebecca, Ed.

2008-01-01

This study was conducted across the country in a total of 23 districts, 5 districts each in the four provinces of Pakistan, i.e. Balochistan, Punjab, Sindh, North Western Frontier Province (NWFP), and 2 districts in Azad Jammu & Kashmir (AJK). The main purpose of the paper was to unravel the intricate budgeting process in the education sector,…

78 FR 49469 - Stephen Glen Guerra, Inmate #98595-279, FCI Yazoo City Medium, Federal Correctional Institution...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-14

... DEPARTMENT OF COMMERCE Bureau of Industry and Security Stephen Glen Guerra, Inmate 98595-279, FCI... Export Privileges On February 6, 2012, in the U.S. District Court, Western District of Texas, Stephen... conviction. [[Page 49470

Portable TMC-TMS Communications Demonstration : Western States Rural Transportation Technology Implementers Forum

DOT National Transportation Integrated Search

2008-06-01

In cooperation with the California Department of Transportation, Montana State University's Western Transportation Institute has conducted an evaluation of communication technologies for application to TMC-TMS communications in Caltrans District 1. W...

Incidence of Mastitis in the Neonatal Period in a Traditional Breastfeeding Society: Results of a Cohort Study.

PubMed

Khanal, Vishnu; Scott, Jane A; Lee, Andy H; Binns, Colin W

2015-12-01

Mastitis is a painful problem experienced by breastfeeding women, especially in the first few weeks postpartum. There have been limited studies of the incidence of mastitis from traditionally breastfeeding societies in South Asia. This study investigated the incidence, determinants, and management of mastitis in the first month postpartum, as well as its association with breastfeeding outcomes at 4 and 6 months postpartum, in western Nepal. Subjects were a subsample of 338 mothers participating in a larger prospective cohort study conducted in 2014 in western Nepal. Mothers were interviewed during the first month postpartum and again at 4 and 6 months to obtain information on breastfeeding practices. The association of mastitis and determinant variables was investigated using multivariable logistic regression, and the association with breastfeeding duration was examined using Kaplan-Meier estimation. The incidence of mastitis was 8.0% (95% confidence interval, 5.1%, 10.8%) in the first month postpartum. Prelacteal feeding (adjusted odds ratio = 2.76; 95% confidence interval, 1.03, 7.40) and cesarean section (adjusted odds ratio = 3.52; 95% confidence interval, 1.09, 11.42) were associated with a higher likelihood of mastitis. Kaplan-Meier estimation showed no significant difference in the duration of exclusive breastfeeding among the mothers who experienced an episode of mastitis and those who did not. Roughly one in 10 (8.0%) women experienced mastitis in the first month postpartum, and there appeared to be little effect of mastitis on breastfeeding outcomes. Traditional breastfeeding practices should be encouraged, and the management of mastitis should be included as a part of lactation promotion.

Evaluating Coupled Human-Hydrologic Systems in High Altitude Regions: A Case Study of the Arun Watershed, Eastern Nepal

NASA Astrophysics Data System (ADS)

Voss, K.; Bookhagen, B.; Tague, C.; Lopez-Carr, D.

2014-12-01

The Himalaya exhibit dynamic ecological, hydrological, and climatic extremes that magnify the variability and extent of natural hazards, resulting in destruction to both physical and human landscapes. Coupled with poverty, these factors intensify local communities' vulnerability to climate change. This study highlights the Arun watershed in eastern Nepal as a case study to evaluate how local communities in high altitude regions are managing their water for domestic and agricultural needs while coping with extreme events, such as floods and landslides. Remotely-sensed precipitation, snowpack and glacial extent data from the past decade are combined with preliminary results from extensive field-based community surveys in the Arun watershed. The analysis of remotely-sensed data will describe seasonal trends in water availability, glacial lake growth, and the spatial variation of these trends within the basin. These hydrologic changes will be linked to the human survey analysis, which will provide an understanding of locals' perceptions of water challenges and the current water management strategies within the basin. Particular attention will be given to a comparison between the eastern and western tributaries of the Arun River, where the catchments are mainly rain-fed (eastern) versus glacial-fed (western). This contrast will highlight how different hydrologic scenarios evidenced from remote-sensing data motivate diverse human water management responses as defined in field surveys. A particular focus will be given to management decisions related to agriculture expansion and hydropower development. This synthesis of remote-sensing and social research methodologies provides a valuable perspective on coupled human-hydrologic systems.

Suicidal ideation among students of a medical college in Western Nepal: a cross-sectional study.

PubMed

Menezes, Ritesh G; Subba, S H; Sathian, Brijesh; Kharoshah, Magdy A; Senthilkumaran, Subramanian; Pant, Sadip; Arun, M; Kundapur, Rashmi; Jain, Animesh; Lobo, Stany Wilfred; Ravi Shankar, P

2012-07-01

Many studies have been conducted in the developed countries to know the magnitude and factors influencing suicidal ideation among medical students, but such data are sparse in developing countries. This cross-sectional study was therefore conducted to find out the prevalence of suicidal ideation and factors influencing such ideation among students of a medical college in Western Nepal. A total of 206 students were selected using random sampling and questioned about their socio-demographic factors, other risk factors and suicidal ideation using a preformed validated questionnaire. The data were analyzed using SPSS for Windows Version 16.0 and the EPI Info 3.5.1 Windows Version. Descriptive statistics and testing of hypothesis were applied for the statistical methodology. The univariate and multivariate logistic regression methods were used to examine the association between different variables. Suicidal ideation in the last one year was present in nearly one tenth of the study population and in almost one fifth of them life-time suicidal ideation was present. Factors that were associated with suicidal ideation were primarily dissatisfaction with academic performance, being in the clinical semesters, having history of drug abuse and feeling neglected by parents. Most common reason reported for suicidal ideation was family related followed by self-related. Recognition of suicidal ideation among students and their associated factors can help in detecting it on time, making the right interventions and controlling the problem. Understanding the magnitude of the problem and their epidemiology via scientific study like this would be the first step in this process. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Investigation of antimicrobial use pattern in the intensive treatment unit of a teaching hospital in western Nepal.

PubMed

Shankar, P Ravi; Partha, Praveen; Shenoy, Nagesh; Brahmadathan, K N

2003-11-01

Inappropriate use of antimicrobials is of special importance in the intensive treatment unit because of the large number of drugs prescribed, the chance for drug errors, and the likelihood of development of drug resistance. A total of 297 records of patients admitted to the intensive treatment unit of the Manipal teaching hospital, a tertiary care hospital in Pokhara, western Nepal, were studied to determine the prescribing frequency and rationality of use of antimicrobials. Patient outcome, duration of stay in the intensive treatment unit, and the age and sex distribution of the patients were also studied. Mean+/-SD drugs per patient was 3.4+/-1.8. About half (50.2%) of the patients received an antimicrobial; 84.6% of the antimicrobials were used without obtaining bacteriologic evidence of infection. The commonest organisms isolated on culture were Pseudomonas aeruginosa, Klebsiella pneumoniae, Streptococcus pneumoniae, and Staphylococcus aureus. A total of 28.9% of the antimicrobials were prescribed for lower respiratory tract infections on the basis of the putative site of infection; 61.9% of the antimicrobials were prescribed by the parenteral route and mainly the older generation of antimicrobials were used. In 39 of the 149 patients prescribed an antimicrobial, the use was irrational. Prescriber education to improve prescribing patterns and regular auditing of antimicrobial prescriptions to prevent their inappropriate use and unnecessary cost to the patients are required. The high percentage of inappropriate use of antimicrobials raises concerns about the development and spread of drug resistance, which must be addressed.

Productivity of public hospitals in Nepal: a data envelopment analysis.

PubMed

Silwal, Pushkar Raj; Ashton, Toni

2017-07-20

Public hospitals in Nepal account for a major share of the total health budget. Therefore, questions are often asked about the performance of these hospitals. Existing measures of performance are limited to historical ratio analyses without any benchmarks. The objective of this study is to explore the trends in inputs, outputs and productivity changes in Nepalese public hospitals from 2011-2012 to 2013-2014. The study was conducted among 32 Nepalese public hospitals (23 district level and 9 higher level) for the three fiscal years from 2011-2012 to 2013-2014. First, basic ratio analyses were conducted for the input and output measures over the study years. Then, Malmquist productivity change scores were obtained using data envelopment analysis. Aggregated as well as separate analyses were conducted for district level and higher level hospitals. Real expenditures of the sampled hospitals declined over the 3-year period from an average of US$ 371 000 in year 1 to US$ 368 730 in year 2 and US$ 328680 in year 3. The average aggregated hospital outputs increased marginally from 8276 in 2011-2012 to 8613 in 2013-2014. The total factor productivity of the study hospitals declined by 6.9% annually from 2011-2012 to 2013-2014. Of the total 32 hospitals, productivity increased in only 12 (37.5%) hospitals and declined in the remaining 20 hospitals. The total factor productivity loss was influenced by a decline in technology change, despite an increase in efficiency. In general, productivity of the study hospitals declined over the study period. Availability and accessibility of accurate, detailed and consistent measures of hospital inputs and outputs is a major challenge for this type of analysis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Mothers' beliefs and barriers about childhood diarrhea and its management in Morang district, Nepal.

PubMed

Ansari, Mukhtar; Ibrahim, Mohamed Izham Mohamed; Hassali, Mohamed Azmi; Shankar, P Ravi; Koirala, Arun; Thapa, Noor Jang

2012-10-24

In developing countries, mothers usually manage diarrhea at home with the pattern of management depending on perceived disease severity and beliefs. The study was carried out with the objective of determining mothers' beliefs and barriers about diarrhea and its management. Qualitative methods involving two focus group discussions and eight in-depth interviews were used to collect the data. The study was conducted at the following places: Tankisinuwari, Kanchanbari and Pokhariya of Morang district, Nepal during the months of February and March 2010. Purposive sampling method was adopted to recruit twenty mothers based on the inclusion criteria. A semi-structured interview guide was used to conduct the interviews. Written informed consent was obtained from all of the participants before conducting the interviews. The interviews were moderated by the main researcher with the support of an expert observer from Nobel Medical College. The interviews were recorded with the permission of the participants and notes were written by a pre trained note-taker. The recordings were transcribed verbatim. All the transcribed data was categorized and analyzed using thematic content analysis. Twenty mothers participated in the interviews and most (80%) of them were not educated. About 75% of the mothers had a monthly income of up to 5000 Nepalese rupees (US$ 60.92). Although a majority of mothers believed diarrhea to be due to natural causes, there were also beliefs about supernatural origin of diarrhea. Thin watery diarrhea was considered as the most serious. There was diversity in mothers' beliefs about foods/fluids and diarrhea management approaches. Similarly, several barriers were noted regarding diarrhea prevention and/or management such as financial weakness, lack of awareness, absence of education, distance from healthcare facilities and senior family members at home. The elderly compelled the mothers to visit traditional healers. There were varied beliefs among the mothers about the types, causes and severity of diarrhea, classification of foods/fluids and beliefs and barriers about preventing or treating diarrhea.

Detection of tectonometamorphic discontinuities within the Himalayan orogen: Structural and petrological constraints from the Rasuwa district, central Nepal Himalaya

NASA Astrophysics Data System (ADS)

Rapa, Giulia; Mosca, Pietro; Groppo, Chiara; Rolfo, Franco

2018-06-01

A detailed structural, lithological and petrological study of different transects in the Rasuwa district of central Nepal Himalaya allows the characterization of the tectonostratigraphic architecture of the area. It also facilitates constraining the P-T evolution of the different units within the Lesser (LHS) and Greater (GHS) Himalayan Sequences. Peak P-T conditions obtained for the studied metapelite samples using the pseudosection approach and the Average PT method highlight the existence of four different T/P ratio populations in different tectonometamorphic units: 80 ± 11 °C/kbar (LHS), 66 ± 7 °C/kbar (RTS), 73 ± 1 °C/kbar (Lower-GHS) and 101 ± 12 °C/kbar (Upper-GHS). Integration of structural and petrological data emphasizes the existence of three tectonometamorphic discontinuities bounding these units, characterized by top-to-the-south sense of shear: the Ramgarh Thrust, which separates the LHS (peak metamorphism at ∼600 °C, 7.5 kbar) from the overlying RTS (peak metamorphism at ∼635 °C, 10 kbar); the Main Central Thrust, which separates the RTS from the Lower-GHS (peak at 700-740 °C, 9.5-10.5 kbar with a prograde increase in both P and T in the kyanite stability field), and the Langtang Thrust, which juxtaposes the Upper-GHS (peak at 780-800 °C, 7.5-8.0 kbar with a nearly isobaric heating in the sillimanite stability field) onto the Lower-GHS. An increase in the intensity of deformation, with development of pervasive mylonitic fabrics and/or shear zones, is generally observed approaching the discontinuities from either side. Overall, data and results presented in this paper demonstrate that petrological and structural analysis combined together, are reliable methods adequate to identify tectonometamorphic discontinuities in both the LHS and GHS. Geochronological data from the literature allow the interpretation of these discontinuities as in-sequence thrusts.

Foreign Assistance and Its Impact on Civil-Military Relations: A Case Study of Federal Democratic Republic of Nepal

DTIC Science & Technology

2014-03-01

China activities and keeping Nepal away from being too dependent in India. While assisting Kathmandu, Beijing is consciously making strategic inroads...112 Campbell, “Nepal Case Study,” 5. 113 M Humagain, “Aid Quantum : China the Rising Sun on Nepal Economic...military/library/congress/2006_hr/060407- hillen.pdf. Humagain, M. “Aid Quantum : China the Rising Sun on Nepal Economic Horizon.” Kathmandu Post

Impact of the community-based newborn care package in Nepal: a quasi-experimental evaluation

PubMed Central

Paudel, Deepak; Shrestha, Ishwar B; Siebeck, Matthias; Rehfuess, Eva

2017-01-01

Objective To evaluate the impact of the community-based newborn care package (CBNCP) on six essential practices to improve neonatal health. Methods CBNCP pilot districts were matched to comparison districts using propensity scores. Impact on birth preparedness, antenatal care seeking, antenatal care quality, delivery by skilled birth attendant, immediate newborn care and postnatal care within 48 hours were assessed using Demographic and Health Survey (DHS) and Health Management Information System (HMIS) data through difference-in-differences and multivariate logistic regression analyses. Findings Changes over time in intervention and comparison areas were similar in difference-in-differences analysis of DHS and HMIS data. Logistic regression of DHS data also did not reveal any significant improvement in combined outcomes: birth preparedness, adjusted OR (aOR)=0.8 (95% CI 0.4 to 1.7); antenatal care seeking, aOR=1.0 (0.6 to 1.5); antenatal care quality, aOR=1.4 (0.9 to 2.1); delivery by skilled birth attendant, aOR=1.5 (1.0 to 2.3); immediate newborn care, aOR=1.1 (0.7 to 1.9); postnatal care, aOR=1.3 (0.9 to 1.9). Health providers’ knowledge and skills in intervention districts were fair but showed much variation between different providers and districts. Conclusions This study, while representing an early assessment of impact, did not identify significant improvements in newborn care practices and raises concerns regarding CBNCP implementation. It has contributed to revisions of the package and it being merged with the Integrated Management of Neonatal and Childhood Illness programme. This is now being implemented in 35 districts and carefully monitored for quality and impact. The study also highlights general challenges in evaluating the impacts of a complex health intervention under ‘real life’ conditions. PMID:28982810

Implementing Nepal's national building code—A case study in patience and persistence

USGS Publications Warehouse

Arendt, Lucy; Hortacsu, Ayse; Jaiswal, Kishor; Bevington, John; Shrestha, Surya; Lanning, Forrest; Mentor-William, Garmalia; Naeem, Ghazala; Thibert, Kate

2017-01-01

The April 2015 Gorkha Nepal earthquake revealed the relative effectiveness of the Nepal Standard, or national building code (NBC), and irregular compliance with it in different parts of Nepal. Much of the damage to more than half a million Nepal's residential structures may be attributed to the prevalence of owner-built or owner-supervised construction and the lack of owner and builder responsiveness to seismic risk and training in the appropriate means of complying with the NBC. To explain these circumstances, we review the protracted implementation of the NBC and the role played by one organization, the National Society for Earthquake Technology-Nepal (NSET), in the NBC's implementation. We also share observations on building code compliance made by individuals in Nepal participating in workshops led by the Earthquake Engineering Research Institute's 2014 class of Housner Fellows.

Enhancing Community Based Early Warning Systems in Nepal with Flood Forecasting Using Local and Global Models

NASA Astrophysics Data System (ADS)

Dugar, Sumit; Smith, Paul; Parajuli, Binod; Khanal, Sonu; Brown, Sarah; Gautam, Dilip; Bhandari, Dinanath; Gurung, Gehendra; Shakya, Puja; Kharbuja, RamGopal; Uprety, Madhab

2017-04-01

Operationalising effective Flood Early Warning Systems (EWS) in developing countries like Nepal poses numerous challenges, with complex topography and geology, sparse network of river and rainfall gauging stations and diverse socio-economic conditions. Despite these challenges, simple real-time monitoring based EWSs have been in place for the past decade. A key constraint of these simple systems is the very limited lead time for response - as little as 2-3 hours, especially for rivers originating from steep mountainous catchments. Efforts to increase lead time for early warning are focusing on imbedding forecasts into the existing early warning systems. In 2016, the Nepal Department of Hydrology and Meteorology (DHM) piloted an operational Probabilistic Flood Forecasting Model in major river basins across Nepal. This comprised a low data approach to forecast water levels, developed jointly through a research/practitioner partnership with Lancaster University and WaterNumbers (UK) and the International NGO Practical Action. Using Data-Based Mechanistic Modelling (DBM) techniques, the model assimilated rainfall and water levels to generate localised hourly flood predictions, which are presented as probabilistic forecasts, increasing lead times from 2-3 hours to 7-8 hours. The Nepal DHM has simultaneously started utilizing forecasts from the Global Flood Awareness System (GLoFAS) that provides streamflow predictions at the global scale based upon distributed hydrological simulations using numerical ensemble weather forecasts from the ECMWF (European Centre for Medium-Range Weather Forecasts). The aforementioned global and local models have already affected the approach to early warning in Nepal, being operational during the 2016 monsoon in the West Rapti basin in Western Nepal. On 24 July 2016, GLoFAS hydrological forecasts for the West Rapti indicated a sharp rise in river discharge above 1500 m3/sec (equivalent to the river warning level at 5 meters) with 53% probability of exceeding the Medium Level Alert in two days. Rainfall stations upstream of the West Rapti catchment recorded heavy rainfall on 26 July, and localized forecasts from the probabilistic model at 8 am suggested that the water level would cross a pre-determined warning level in the next 3 hours. The Flood Forecasting Section at DHM issued a flood advisory, and disseminated SMS flood alerts to more than 13,000 at-risk people residing along the floodplains. Water levels crossed the danger threshold (5.4 meters) at 11 am, peaking at 8.15 meters at 10 pm. Extension of the warning lead time from probabilistic forecasts was significant in minimising the risk to lives and livelihoods as communities gained extra time to prepare, evacuate and respond. Likewise, longer timescale forecasts from GLoFAS could be potentially linked with no-regret early actions leading to improved preparedness and emergency response. These forecasting tools have contributed to enhance the effectiveness and efficiency of existing community based systems, increasing the lead time for response. Nevertheless, extensive work is required on appropriate ways to interpret and disseminate probabilistic forecasts having longer (2-14 days) and shorter (3-5 hours) time horizon for operational deployment as there are numerous uncertainties associated with predictions.

Structural reinterpretation of the Ajo mining district, Pima County, Arizona, based on paleomagnetic and geochronologic studies.

USGS Publications Warehouse

Hagstrum, J.T.; Cox, D.P.; Miller, R.J.

1987-01-01

The Ajo mining district of southern Arizona is divided into two main structural blocks by the Gibson Arroyo fault. The eastern Camelback Mountain block contains the Late Cretaceous-early Tertiary porphyry copper deposit which has been previously thought to be associated with the displaced apex of a large intrusion exposed by deeper erosion in the western Cardigan Peak block. However, unpublished U-Pb data support a mid-Tertiary age for the western intrusion. The following sequence of mid-Tertiary events in the district are indicated: 1) emplacement of the western intrusion, 2) movement along the Gibson Arroyo fault, 3) unroofing and perhaps tilting of the pluton approx 70o to the south along with the Camelback Mountain block, 4) syntectonic depositions of the Locomotive Fanglomerate and the Ajo Volcanics, 5) continued uplift and tilting to the south totaling 40o to 60o, 6) intrusion of the youngest dikes with attendant alteration and remagnetization of the host rocks, and 7) minor (?) oblique movement along the Gibson Arroyo fault.-from Authors

78 FR 36291 - Revocation of License of Small Business Investment Company

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-17

... SMALL BUSINESS ADMINISTRATION Revocation of License of Small Business Investment Company Pursuant to the authority granted to the United States Small Business Administration by the Wind-Up Order of the United States District Court for the Eastern District of Arkansas, Western Division, entered...

Pilot study to reduce emissions, improve health, and offset BC emissions through the distribution of improved cook stoves in Nepal

NASA Astrophysics Data System (ADS)

Banmali Pradhan, B.; Panday, A. K.; Surapipith, V.

2013-12-01

In most developing countries, wood and other biomass fuels are still the primary source of energy for the majority of the people, particularly the poor. It is estimated that cook stoves account for approximately 20% of global black carbon emissions. In Nepal 87% of energy is supplied from traditional biomass and 75% of households still depend on biomass as a cooking fuel. The substitution of traditional cook stoves with improved cook stoves provides an important way to reduce black carbon emissions. In 2013 the International Centre for Integrated Mountain Development (ICIMOD) has commenced a pilot study that both examines ways to effectively disseminate improved cookstoves across remote rural mountain regions, and also quantifies the resulting changes in emissions, air quality and health. The selected study area is in Bajrabarahi Village in Makawanpur district, to the southwest of Kathmandu. The study area consists of around 1600 households, which are divided into control groups and groups where the cook stove intervention is taking place. The study complements the ';Clean Cooking energy solution for all by 2017' announced by the Government of Nepal recently, and will provide insights to the government on ways to effectively reduce black carbon emissions from cook stoves. To make the study robust and sustainable, local women's group and a local medical institution are involved in the project right from the conceptualization stage. The study region has been chosen in part because the medical school Patan Academy of Health Sciences (PAHS) has already started a long term health assessment in the region, and has built up considerable local contacts. The local women's group is working on the modality of cook stove distribution through micro credit programmes in the village. We will distribute the best available manufactured, fan-assisted cook stoves that are expected to reduce BC emissions the most. Health assessments, emissions estimates, as well as measurements of indoor and outdoor air quality will be done before and after the stoves are disseminated. Having obtained funds for the purchase of improved cook stoves from Nepal's diesel automobile sector, we compare the emissions of black carbon from the sponsoring diesel vehicles with the reduction in black carbon emissions from the sponsored improved cook stoves, thereby pioneering methods to offset black carbon emissions.

Understanding effects of armed conflict on health outcomes: the case of Nepal

PubMed Central

2010-01-01

Objective There is abundance of literature on adverse effects of conflict on the health of the population. In contrast to this, sporadic data in Nepal claim improvements in most of the health indicators during the decade-long armed conflict (1996-2006). However, systematic information to support or reject this claim is scant. This study reviews Nepal's key health indicators before and after the violent conflict and explores the possible factors facilitating the progress. Methods A secondary analysis has been conducted of two demographic health surveys-Nepal Family Health Survey (NFHS) 1996 and Nepal Demographic and Health Survey (NDHS) 2006; the latter was supplemented by a study carried out by the Nepal Health Research Council in 2006. Results The data show Nepal has made progress in 16 out of 19 health indicators which are part of the Millennium Development Goals whilst three indicators have remained static. Our analysis suggests a number of conflict and non-conflict factors which may have led to this success. Conclusion The lessons learnt from Nepal could be replicable elsewhere in conflict and post-conflict environments. A nationwide large-scale empirical study is needed to further assess the determinants of Nepal's success in the health sector at a time the country experienced a decade of armed conflict. PMID:21122098

SERVIR Support to NSDI Efforts in Mesoamerica, Africa and the Himalayas

NASA Technical Reports Server (NTRS)

Delgado, Francisco

2014-01-01

SERVIR is a joint effort between NASA, USAID to build or improve capacities in developing regions to help adaptation to climate change by taking advantage of Earth Observation data for decision making. The project began in 2004, in Mesoamerica, partnering with the Central American Commission for Environment and Development(CCAD), the World Bank and CATHALAC. CATHALAC, located in Panama, serves as the regional hub for Mesoamerica since 2005. Two additional regional hubs have been established (in Easters & Western Africa - at RCMRD, Kenya, and The Himalayas- at ICIMOD, Nepal), and two more regional hubs are soon to be launched.

The Himalayas of Nepal, a natural laboratory for the search and measurement of CO2 discharge

NASA Astrophysics Data System (ADS)

Girault, Frédéric; Koirala, Bharat P.; Bhattarai, Mukunda; Rajaure, Sudhir; Richon, Patrick; Perrier, Frédéric

2010-05-01

Large CO2 flux has been found in the Trisuli Valley, North of Kathmandu, Central Nepal, in 2005. This leakage zone is located in the vicinity of the Syabru-Bensi hot springs, and is characterized by an average flux of CO2 of 6500±1100 g m-2 day-1 over an area of 15 m × 15 m (Perrier et al., Earth and Planetary Science Letters, 2009). The site is also located close to the Main Central Thrust Zone (MCT Zone), one of the large Himalayan thrust, connected at depth to the Main Himalayan Thrust, the main thrust currently accommodating the India-Tibet collision (Bollinger et al., Journal of Geophysical Research, 2004). Isotopic carbon ratios (δ13C) indicate that this CO2 may come from metamorphic reactions at about 15 km of depth (Becker et al., Earth and Planetary Science Letters, 2008; Evans et al., Geochemistry Geophysics Geosystems, 2008). Actually, this zone was originally found because of the large δ13C found in the water of the hot springs suggesting degassing (Evans et al., Geochemistry Geophysics Geosystems, 2008). In 2007, another zone of CO2 discharge was discovered 250 m away from the main Syabru-Bensi hot springs. This new zone, located next to the road and easy to access all over the year, was intensely studied, from the end of 2007 to the beginning of 2009. In this zone, an average value of CO2 flux of 1700±300 g m-2 d-1 was obtained over an area of about 40 m × 10 m. Using CO2 flux data from repeated measurements, similar flux values were observed during the dry winter season and the wet summer period (monsoon) (Girault et al., Journal of Environmental Radioactivity, 2009). Thus, in addition to fundamental issues related to global CO2 balance in orogenic belts and tectonically active zones, these small scale (100-meter) CO2 discharge sites emerge as a potentially useful laboratory for detailed methodological studies of diffusive and advective gas transport. Recently, the search for further gas discharge zones has been carried out using various clues: the presence of a hot spring with high δ13C, of H2S smell, of hot spots in thermal images, of a geological contact, of self-potential anomalies (Byrdina et al., Journal of Geophysical Research, 2009) or of large radon-222 flux. Preliminary results about the failures or successes of the various methods will be given in the Trisuli and Langtang valleys (Central Nepal), in the Kali Gandaki valley (Western Nepal) and in the Thuli Bheri valley (Lower Dolpo, Far Western Nepal). These various sites also offer an opportunity to test the optimal estimation of total CO2 flux, using the least amount of experimental measurements. Preliminary results complemented by simulations will also be given on the total CO2 flux. In parallel, monitoring methods are being studied in the Syabru-Bensi pilot site. First, CO2 flux has been studied as a function of time using repeated measurements. Furthermore, the high radon content of the geological CO2 allows cost-effective monitoring using BARASOL probes. More than two years of data are already available and give hints on the use of radon to follow CO2 discharge as a function of time. These first results show how experimental studies carried out in natural discharge zones provide a rich laboratory to test the methodological approaches useful for CO2 leakage and monitoring.

Trade in medicines and the public's health: a time series analysis of import disruptions during the 2015 India-Nepal border blockade.

PubMed

Sharma, Abhishek; Mishra, Shiva Raj; Kaplan, Warren A

2017-08-22

Nepal was struck by devastating earthquakes in April-May 2015, followed by the India-Nepal border blockade later that year. We used the United Nations Commodity Trade Statistics (UN Comtrade) database to analyse exports of various health commodities from India to Nepal from January 2011-September 2016. We used time-series regressions of trading volume vs. unit price to ask how well Nepal's trading history with India prior to the earthquake and blockade was able to predict unit prices of health commodities imported into Nepal during and after the earthquake and the blockade. Regression residuals were used to quantify the extent to which the blockade impacted the price of healthcare commodities crossing into Nepal. During the blockade period (September 2015-early February 2016), the volume of all retail medicines traded across the India-Nepal border was reduced by 46.5% compared to same months in 2014-2015. For medical dressings, large volumes were exported from India to Nepal during and shortly after the earthquakes (May-June 2015), but decreased soon thereafter. During the earthquake, the difference between observed and predicted values of unit price (residuals) for all commodities show no statistical outliers. However, during the border blockade, Nepal paid USD 22.3 million more for retail medicines than one would have predicted based on its prior trading history with India, enough to provide healthcare to nearly half of Kathmandu's citizens for 1 year. The India-Nepal blockade was a geopolitical natural experiment demonstrating how a land-locked country is vulnerable to the vagaries of its primary trading partner. Although short-lived, the blockade had an immediate impact on traded medicine volumes and prices, and provided a large opportunity cost with implications for public health.

Private Firms Run Two Mich. Districts

ERIC Educational Resources Information Center

Ash, Katie

2013-01-01

Educators and policy observers are keeping a close eye on two controversial experiments in private management of public schools now unfolding in the western Michigan city of Muskegon Heights and in the Detroit-area community of Highland Park. Citing chronic budget woes in the communities' low-performing school districts, Gov. Rick Snyder of…

Evaluating Public School Teachers in Western Pennsylvania: How and Why Has It Changed since NCLB?

ERIC Educational Resources Information Center

Scherrer, Robert J.

2009-01-01

The purpose of this study is to determine whether or not Western Pennsylvania public school districts have changed their teacher evaluation forms since the inception of the No Child Left Behind Act of 2001. Thirty-eight superintendents from the Tri-State Area School Study Council and the Forum for Western Pennsylvania School Superintendents…

The 2014 Karnali River Floods in Western Nepal: Making Community Based Early Warning Systems Work When Data Is Lacking

NASA Astrophysics Data System (ADS)

Dugar, S.; MacClune, K.; Venkateswaran, K.; Yadav, S.; Szoenyi, M.

2015-12-01

Implementing Community Based Flood Early Warning System (EWS) in developing countries like Nepal is challenging. Complex topography and geology combined with a sparse network of river and rainfall gauges and little predictive meteorological capacity both nationally and regionally dramatically constrain EWS options. This paper provides a synopsis of the hydrological and meteorological conditions that led to flooding in the Karnali River, West Nepal during mid-August 2014, and analyses the effectiveness of flood EWS in the region. On August 14-15, 2014, a large, slow moving weather system deposited record breaking rainfall in the foothills of the Karnali River catchment. Precipitation depths of 200 to 500 mm were recorded over a 24-hour period, which led to rapid rise of river heights. At the Chisapani river gauge station used for the existing EWS, where the Karnali River exits the Himalaya onto the Indo-Gangetic Plain, water levels rapidly exceeded the 11 meter danger level. Between 3 to 6 am, water levels rose from 11 to 16. 1 meters, well beyond the design height of 15 meters. Analysis suggests that 2014 floods may have been a one-in-1000 year event. Starting with the onset of intense rainfall, the Chisapani gauge reader was in regular communication with downstream stakeholders and communities providing them with timely information regarding rising water level. This provided people just enough time to move to safe places with their livestock and key assets. Though households still lost substantial assets, without the EWS, floodwaters would have caught communities completely unaware and damage would almost certainly have been much worse. In particular, despite the complications associated with access to the Chisapani gauge and failure of critical communication nodes during the floods, EWS was instrumental in saving lives. This study explores both the details of the flood event and performance of the early warning system, and identifies lessons learned to help strengthen flood response in Nepal other regions facing similar data and technology constraints. This research also underscores the need to move from observation to forecast based EWS, ideally coupled with hydrological and meteorological models that would provide flood estimates well in advance to vulnerable communities.

'MATRI-SUMAN' a capacity building and text messaging intervention to enhance maternal and child health service utilization among pregnant women from rural Nepal: study protocol for a cluster randomised controlled trial.

PubMed

Singh, Jitendra Kumar; Kadel, Rajendra; Acharya, Dilaram; Lombard, Daniel; Khanal, Saval; Singh, Shri Prakash

2018-06-14

Capacity development of health volunteers and text messaging to pregnant women through mobile phones have shown improved maternal and child health (MCH) outcomes and is associated with increased utilisation of MCH services. However, such interventions are uncommon in Nepal. We aim to carry out an intervention with the hypothesis that capacity building and text messaging intervention will increase the MCH service utilisation. MATRI-SUMAN is a 12-month cluster randomized controlled trial (RCT). The trial involves pregnant women from 52 clusters of six village development committees (VDCs) covering 66,000 populations of Dhanusha district of Nepal. In the intervention clusters, Female Community Health Volunteers (FCHVs) will receive capacity development skills through reinforcement training, supervision and monitoring skills for the promotion of health seeking behaviour among pregnant women and study participants will receive periodic promotional text messaging service about MCH components through mobile phones. A sample of 354with equal numbers in each study arm is estimated using power calculation formula. The primary outcomes of this study are the rate of utilization of skilled birth attendants and consumption of a specified diversified meal. The secondary outcomes are: four antenatal (ANC) visits, weight gain of women during pregnancy, delivery of a baby at the health facility, postnatal care (PNC) visits, positive changes in child feeding practices among mothers, performance of FCHVs in MCH service utilization. The intervention is designed to enhance the capacity of health volunteers for the promotion of health seeking behaviour among pregnant women and text messaging through a mobile phone to expecting mothers to increase MCH service utilization. The trial if proven effective will have policy implications in poor resource settings. ISRCTN60684155, ( https://doi.org/10.1186/ISRCTN60684155 ). The trial was registered retrospectively.

Cognitive and motor skills in school-aged children following maternal vitamin A supplementation during pregnancy in rural Nepal: a follow-up of a placebo-controlled, randomised cohort.

PubMed

Buckley, Gillian J; Murray-Kolb, Laura E; Khatry, Subarna K; Leclerq, Steven C; Wu, Lee; West, Keith P; Christian, Parul

2013-05-09

To determine the effects of maternal vitamin A supplementation from preconception through postpartum on cognitive and motor development of children at 10-13 years of age in rural Nepal. Follow-up assessment of children born to women randomly assigned by a village to receive either supplemental vitamin A (7000 µg retinol equivalents) or placebo weekly during a continuous 3.5-year period from 1994-1997. The participants came from 12 wards, a subset of 270 wards in the original trial. Trained staff tested children for cognition by the Universal Nonverbal Intelligence Test (UNIT) and motor ability using four subtests from the Movement Assessment Battery for Children (MABC). Data on schooling, home environment and nutritional and socioeconomic status were also collected. Southern plains district of Sarlahi, Nepal. 390 Nepalese children 10-13 years of age. Raw scores on UNIT and square-root transformed scores on an abridged version of the MABC tests, expressed as cluster-summarised (mean±SD) values to account for the design of the original trial. There were no differences in UNIT (79.61±5.99 vs 80.69±6.71) or MABC (2.64±0.07 vs 2.49±0.09) test scores in children whose mothers were exposed to vitamin A vs placebo (mean differences: -1.07, 95% CI -7.10 to 9.26, p=0.78; 0.15, 95% CI 0.43 to -0.08, p=0.15), respectively. More children in the placebo group had repeated a grade in school (28% of placebo vs 16.7% of vitamin A, p=0.01). Preconceptional to postpartum maternal vitamin A supplementation, in an undernourished setting, does not improve cognition or motor development at ages 10-13 years.

The association of preterm birth and small birthweight for gestational age on childhood disability screening using the Ten Questions Plus tool in rural Sarlahi district, southern Nepal.

PubMed

Wu, L A; Katz, J; Mullany, L C; Khatry, S K; Darmstadt, G L; LeClerq, S C; Tielsch, J M

2012-05-01

The Ten Questions tool was developed in 1984 as a low-cost, simple screen for childhood disability and referral for diagnosis in low-resource settings, and its use in Nepal has not been previously evaluated. Preterm birth and intrauterine growth restriction are potential risk factors for child disability and loss of developmental potential, but there are few studies examining this relationship from developing settings.   To examine the associations of small for gestational age and preterm birth as predictors of Ten Questions Plus positivity. The Ten Questions Plus questionnaire was administered to caregivers of 680 children between 2 and 5 years of age from August 2007 to March 2008 in rural Sarlahi, southern Nepal. Participants had previously been enrolled in a randomized trial of chlorhexidine cleansing at birth. At 1 month of age, children were then enrolled into a randomized 2 × 2 factorial trial of daily iron and zinc supplementation between October 2001 and January 2006. None. Positive screen on the Ten Questions Plus tool defined as a positive response to one or more questions. Of preterm children, 37 (33.6%) had a positive response to at least one question on the Ten Questions Plus and were considered at risk for disability. One hundred and seventy term children (29.8%) were at risk for disability. The Ten Questions Plus tool can be used in this rural Nepali setting to identify children at increased risk for mental and physical disability to be targeted for further examination. The prevalence of parent-reported disabilities is high in this population (almost one-third of children); children who are both preterm and small-for-gestational age are at increased risk for motor milestone delay, reported learning difficulty, speech and behavioural problems. Intrauterine growth restriction may affect child development and result in disabilities later in childhood. © 2011 Blackwell Publishing Ltd.

Prevalence, antibiogram and risk factors of thermophilic campylobacter spp. in dressed porcine carcass of Chitwan, Nepal

PubMed Central

2014-01-01

Background Campylobacter is the primary cause of food borne gastroenteritis. Moreover, the emergence of multiple drug resistant campylobacters from poultry and pork has produced a potential threat to public health. Research addressing these issues is sparse in Nepal. So, this cross-sectional study aims at determining the prevalence, antibiogram and risk factors of campylobacters from dressed porcine carcass of Chitwan, Nepal. Results We collected 139 samples of dressed porcine carcass from 10 different pork shops located in Chitwan district and processed according to OIE Terrestrial Manual, 2008, chapter 2.8.10. Antibiogram of identified Campylobacter spp. was evaluated against nine commonly used antibiotics by using disc diffusion method following CLSI guidelines. The prevalence of Campylobacter spp. was 38.84% (C. coli 76% and C. jejuni 24%). There was no significant difference (p > 0.05) between the prevalence rate of male (32.4%) and female (41%) carcass. Ampicillin and erythromycin showed the highest resistance (92.59% each) followed by colistin (72.2%), tetracycline (61.1%), nalidixic acid and cotrimoxazole (44.4% each), ciprofloxacin (31.5%) and gentamicin (5.56%). Moreover, 77.8% of the isolates were resistant to more than two antimicrobials. Nalidixic acid and tetracycline showed significant difference (p < 0.05) in the resistivity pattern among different species of Campylobacters. The association between prevalence rate and regular sanitization of slaughter slab equipments was significant (p < 0.05). Similarly, prevalence rate was significantly associated (p < 0.01) with chilling and contamination of intestinal content with carcass. Conclusions The pork meat of Chitwan is highly contaminated with antibiotic-resistant Campylobacters and slaughtering practices play significant role in contamination. It is necessary to train the butchers about hygienic slaughtering practice. The consumers as well as butchers should adopt safety measures to prevent themselves from antibiotic resistant campylobacters. The veterinary practitioners should adopt prudent use of antibiotics in pigs. PMID:24708489

Psychotropic drugs in Nepal: perceptions on use and supply chain management.

PubMed

Upadhaya, Nawaraj; Jordans, Mark J D; Gurung, Dristy; Pokhrel, Ruja; Adhikari, Ramesh P; Komproe, Ivan H

2018-01-24

Psychotropic drugs play an important role in the treatment of mental, neurological and substance use disorders. Despite the advancement of the use of psycho-pharmaceuticals in the developed countries, the psychotropic drug production and supply chain management in low- and middle- income countries are still poorly developed. This study aims to explore the perceptions of stakeholders involved in all stages of the psychotropic drug supply chain about the need, quality, availability and effectiveness of psychotropic drugs, as well as barriers to their supply chain management. The study was conducted among 65 respondents from the Kathmandu, Chitwan and Pyuthan districts, grouped into four categories: producers, promoters and distributors (N = 22), policy makers and government actors (N = 8), service providers (N = 21) and service users/family members (N = 14). The respondents reported that psychotropic drugs, despite having side effects, are 1) needed, 2) available in major regional centers and 3) are effective for treating mental health problems. The stigma associated with mental illness, however, forces patients and family members to hide their use of psychotropic drugs. The study found that the process of psychotropic drug supply chain management is similar to other general drugs, with the exceptions of strict pre-approval process, quantity restriction (for production and import), and mandatory record keeping. Despite these regulatory provisions, respondents believed that the misuse of psychotropic drugs is widespread and companies are providing incentives to prescribers and retailers to retain their brand in the market. The production and supply chain management of psychotropic drugs is influenced by the vested interests of pharmaceutical companies, prescribers and pharmacists. In the context of the government of Nepal's policy of integrating mental health into primary health care and increased consumption of psychotropic drugs in Nepal, there is a need for massive education and awareness as well as strict monitoring and supervision to avoid the misuse of psychotropic drugs.

Factors Associated with Underweight among Children of Former-Kamaiyas in Nepal

PubMed Central

Khatri, Resham B.; Mishra, Shiva R.; Khanal, Vishnu; Choulagai, Bishnu

2015-01-01

Background: Bonded labor was a tradition in Nepal since the 16th century. In 2002, the Government of Nepal freed Kamaiyas and gave the newly freed individuals support for basic living. Many children of former-Kamaiyas live below subsistence level and are vulnerable to undernutrition. The aim of this study was to identify the factors associated with underweight among the children of former-Kamaiyas. Methods: We conducted the community based cross-sectional study from June to December, 2012. Face-to-face interviews were conducted using semi-structured questionnaires with randomly selected mothers of 280 children under 5 years of age from former-Kamaiya families residing in Banke district. We also measured the weight and height of the children. Undernutrition was defined according to the World Health Organization child growth standards. Factors associated with underweight were examined using a Chi-square test followed by multiple logistic regression. Results: Out of 280 children, 116 (41.4%) were underweight (≤2 SD weight-for-age), 156 (55.7%) were stunted (≤2 SD height-for-age), and 52 (18.6%) were wasted (≤2 SD weight-for-height). Females were more likely to be underweight than males [adjusted odds ratio (aOR) = 1.696, 95% confidence interval (CI) = 1.026–2.804]. Children were less likely to be underweight if they were having daily bath (aOR = 0.532; 95% CI = 0.314–0.899) or if their mothers were ≥24 years of age (aOR = 0.440; 95% CI = 0.266–0.727). Conclusion: The proportion of underweight, stunting, and wasting was more than the national average among the children of former-Kamaiyas. Female children were more likely to be underweight whereas children who were being bathed daily and with mothers whose age was ≥24 years were less likely to be underweight. PMID:25688344

Uterine prolapse prevention in Eastern Nepal: the perspectives of women and health care professionals

PubMed Central

Radl, Christina M; Rajwar, Ranjita; Aro, Arja R

2012-01-01

Uterine prolapse is a major reproductive health issue in Nepal. There is a wide range of literature available on the causes and risk factors of uterine prolapse and on the ways to prevent and treat it. There is still a lack of published evidence on what prevention and treatment services are working well or the attitudes toward them. This paper presents the findings of a qualitative study on primary and secondary prevention of uterine prolapse in Eastern Nepal. Method The study involved eight focus group discussions with 71 women in six villages of the eastern districts of Siraha and Saptari and 14 qualitative interviews with health professionals from the local to central level. The group discussions and interviews covered the awareness levels of uterine prolapse and its prevention and treatment, as well as participants’ opinions on and experiences with the services offered. Results It was found that patriarchy, gender discrimination, and cultural traditions such as early marriage and pregnancy make it difficult for people to discontinue uterine prolapse risk behaviors. Women are aware of risk factors, prevention, and treatment, but are powerless to change their situations. Health professionals and women are fond of surgery as treatment, but opinions on the use of ring pessaries and pelvic floor muscle training are split. Conclusion The main recommendation that can be drawn from this study is that research on the effectiveness of early treatments, such as ring pessaries and exercise, should be conducted. Furthermore, the involvement of other target groups (husbands, adolescents, and mothers-in-law) needs to be increased in order to make it easier for women to adapt low-risk behaviors. Finally, uterine prolapse prevention should be better integrated in national reproductive health services. Enforcing transparency, monitoring systems, and collaborations are important factors that should be considered as well. PMID:22927768

Cognitive and motor skills in school-aged children following maternal vitamin A supplementation during pregnancy in rural Nepal: a follow-up of a placebo-controlled, randomised cohort

PubMed Central

Buckley, Gillian J; Murray-Kolb, Laura E; Khatry, Subarna K; LeClerq, Steven C; Wu, Lee; West, Keith P; Christian, Parul

2013-01-01

Objective To determine the effects of maternal vitamin A supplementation from preconception through postpartum on cognitive and motor development of children at 10–13 years of age in rural Nepal. Design Follow-up assessment of children born to women randomly assigned by a village to receive either supplemental vitamin A (7000 µg retinol equivalents) or placebo weekly during a continuous 3.5-year period from 1994–1997. The participants came from 12 wards, a subset of 270 wards in the original trial. Trained staff tested children for cognition by the Universal Nonverbal Intelligence Test (UNIT) and motor ability using four subtests from the Movement Assessment Battery for Children (MABC). Data on schooling, home environment and nutritional and socioeconomic status were also collected. Setting Southern plains district of Sarlahi, Nepal. Participants 390 Nepalese children 10–13 years of age. Main outcome measures Raw scores on UNIT and square-root transformed scores on an abridged version of the MABC tests, expressed as cluster-summarised (mean±SD) values to account for the design of the original trial. Results There were no differences in UNIT (79.61±5.99 vs 80.69±6.71) or MABC (2.64±0.07 vs 2.49±0.09) test scores in children whose mothers were exposed to vitamin A vs placebo (mean differences: −1.07, 95% CI −7.10 to 9.26, p=0.78; 0.15, 95% CI 0.43 to −0.08, p=0.15), respectively. More children in the placebo group had repeated a grade in school (28% of placebo vs 16.7% of vitamin A, p=0.01). Conclusions Preconceptional to postpartum maternal vitamin A supplementation, in an undernourished setting, does not improve cognition or motor development at ages 10–13 years. PMID:23667158

Barriers to Utilization of Antenatal Care Services in Eastern Nepal.

PubMed

Deo, Krishna Kumar; Paudel, Yuba Raj; Khatri, Resham Bahadur; Bhaskar, Ravi Kumar; Paudel, Rajan; Mehata, Suresh; Wagle, Rajendra Raj

2015-01-01

World Health Organization recommends at least four pregnancy check-ups for normal pregnancies. Ministry of Health and Population Nepal has introduced various strategies to promote prenatal care and institutional delivery to reduce maternal and child deaths. However, maternal health service utilization is low in some selected socio-economic and ethnic groups. Hence, this study aims to assess barriers to the recommended four antenatal care (4ANC) visits in eastern Nepal. A cross-sectional quantitative study was conducted in Sunsari district. A total of 372 randomly selected women who delivered in the last year preceding the survey were interviewed using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis was carried out to identify barriers associated with 4ANC visits. More than two-third women (69%) attended at least 4ANC visits. The study revealed that women exposed to media had higher chance of receiving four or more ANC visits with an adjusted odds ratio (aOR = 3.5, 95% CI: 1.2-10.1) in comparison to women who did not. Women from an advantaged ethnic group had more chance of having 4ANC visits than respondents from a disadvantaged ethnic group (aOR = 2.4, 95% CI: 2.1-6.9). Similarly, women having a higher level of autonomy were nearly three times more likely (aOR = 2.9, 95% CI: 1.5-5.6) and richer women were twice (aOR = 2.3, 95% CI: 1.1-5.3) as likely to have at least 4ANC visits compared to women who had a lower level of autonomy and were economically poor. Being from disadvantaged ethnicity, lower women's autonomy, poor knowledge of maternal health service and incentive upon completion of ANC, less media exposure related to maternal health service, and lower wealth rank were significantly associated with fewer than the recommended 4ANC visits. Thus, maternal health programs need to address such socio-cultural barriers for effective health care utilization.

Free-Roaming Dogs in Nepal: Demographics, Health and Public Knowledge, Attitudes and Practices.

PubMed

Massei, G; Fooks, A R; Horton, D L; Callaby, R; Sharma, K; Dhakal, I P; Dahal, U

2017-02-01

In Nepal, most dogs are free to roam and may transmit diseases to humans and animals. These dogs often suffer from malnutrition and lack basic health care. Minimal information is available about their demographics and about public attitudes concerning dogs and diseases. We carried out a study in Chitwan District (central Nepal), to collect baseline data on free-roaming owned dog demographics, assess knowledge, attitudes and practices of dog owners concerning dogs and rabies, evaluate rabies vaccination coverage and anthelmintic treatment of dogs, measure dogs' response to rabies vaccination and assess dog health through body condition scores and parasites. We conducted household interviews with owners of free-roaming female dogs (n = 60) and administered dogs with rabies vaccination and anthelmintics. Dog owners regularly fed free-roaming dogs but provided minimal health care; 42% of respondents did not claim ownership of the dog for which they provided care. We collected skin, faecal and blood samples for parasite identification and for measuring rabies virus-specific antibodies. Ninety-two per cent of dog owners were aware of the routes of rabies virus transmission, but only 35% described the correct post-exposure prophylaxis (PEP) following a dog bite. Twenty-seven per cent of the dogs had measurable rabies virus-specific antibody titres and 14% had received anthelmintics in the previous year. Following rabies vaccination, 97% of dogs maintained an adequate antibody titre for ≥6 months. Most dogs appeared healthy, although haemoprotozoans, endoparasites and ectoparasites were identified in 12%, 73% and 40% of the dogs, respectively. Poor skin condition and parasite load were associated. Seventy-four per cent of the females had litters in 1 year (mean litter size = 4.5). Births occurred between September and February; we estimated 60% mortality in puppies. We concluded that vaccination coverage, PEP awareness and anthelmintic treatment should be emphasized in educational programmes focussed on animal welfare, veterinary and public health. © 2016 Blackwell Verlag GmbH.

Teaching English as a Foreign/Second Language in Nepal: Past and Present

ERIC Educational Resources Information Center

Bista, Krishna

2011-01-01

In this paper, the author reviews the history of English language teaching English as a second or foreign language in schools and colleges in Nepal. Teaching English language and literature in Nepal is of about a half a decade, starting from the mid of twentieth century. English learners in Nepal do not have enough exposure to various techniques…

Factors Associated with Pregnancy among Married Adolescents in Nepal: Secondary Analysis of the National Demographic and Health Surveys from 2001 to 2011

PubMed Central

Pradhan, Rina; Wynter, Karen; Fisher, Jane

2018-01-01

Pregnancy-related morbidity and mortality are much more prevalent among adolescents than adults, particularly in low-income settings. Little is known about risk factors for pregnancy among adolescents in Nepal, but setting-specific evidence is needed to inform interventions. This study aimed to describe the prevalence, and identify factors associated with pregnancy among adolescents in Nepal between 2001 and 2011. Secondary analyses of Nepal Demographic Health Surveys (NDHS) data from 2001, 2006, and 2011 were completed. The outcome was any pregnancy or birth among married adolescents; prevalence was calculated for each survey year. Although the rate of marriage among adolescent women in Nepal decreased significantly from 2001 to 2011, prevalence of pregnancy and birth among married adolescent women in Nepal remains high (average 56%) in Nepal, and increased significantly between 2001 and 2011. Regression analyses of this outcome indicate higher risk was associated with living in the least resourced region, early sexual debut, and older husband. Despite national efforts to reduce pregnancies among married adolescent women in Nepal, prevalence remains high. Integrated, cross-sectoral prevention efforts are required. Poverty reduction and infrastructure improvements may lead to lower rates of adolescent pregnancy. PMID:29385771

The Effect of Parents’ Attitudes on Sons’ Marriage Timing

PubMed Central

Jennings, Elyse A.; Axinn, William G.; Ghimire, Dirgha J.

2012-01-01

Theories of family stability and change, demographic processes, and social psychological influences on behavior all posit that parental attitudes and beliefs are a key influence on their children’s behavior. Though we have evidence of these effects in Western populations, there is little information regarding this social mechanism in non-Western contexts. Furthermore, comparisons of mothers’ and fathers’ independent roles in these crucial intergenerational mechanisms are rare. This paper uses measures from a ten-year family panel study featuring independent interviews with both mothers and fathers in rural Nepal to investigate these issues. We test the association of specific attitudes, rather than broad ideational domains, about childbearing and old-age care with sons’ subsequent marriage behavior. Our results indicate that both mothers’ and fathers’ attitudes have important and independent influences on sons’ marriage behavior. Simultaneous study of both parents’ attitudes reveals that gender-specific parenting contexts can shape the relationship between parental attitudes and children’s behaviors. This crucial mechanism of intergenerational continuity and change is strong in this non-Western setting, with substantial implications for studies of intergenerational influences on behavior in all settings. PMID:23483623

Molecular Epidemiology of Helicobacter pylori Infection in Nepal: Specific Ancestor Root

PubMed Central

Miftahussurur, Muhammad; Sharma, Rabi Prakash; Shrestha, Pradeep Krishna; Suzuki, Rumiko; Uchida, Tomohisa; Yamaoka, Yoshio

2015-01-01

Prevalence of Helicobacter pylori infection in Nepal, a low-risk country for gastric cancer, is debatable. To our knowledge, no studies have examined H. pylori virulence factors in Nepal. We determined the prevalence of H. pylori infection by using three different tests, and the genotypes of virulence factors were determined by PCR followed by sequencing. Multilocus sequence typing was used to analyze the population structure of the Nepalese strains. The prevalence of H. pylori infection in dyspeptic patients was 38.4% (56/146), and was significantly related with source of drinking water. In total, 51 strains were isolated and all were cagA-positive. Western-type-cagA (94.1%), cagA pre-EPIYA type with no deletion (92.2%), vacA s1a (74.5%), and m1c (54.9%) were the predominant genotypes. Antral mucosal atrophy levels were significantly higher in patients infected with vacA s1 than in those infected with s2 genotypes (P = 0.03). Several Nepalese strains were H. pylori recombinants with genetic features of South Asian and East Asian genotypes. These included all East-Asian-type-cagA strains, with significantly lesser activity and inflammation in the corpus than the strains of the specific South Asian genotype (P = 0.03 and P = 0.005, respectively). Although the population structure confirmed that most Nepalese strains belonged to the hpAsia2 population, some strains shared hpEurope- and Nepalese-specific components. Nepalese patients infected with strains belonging to hpEurope showed higher inflammation in the antrum than strains from the Nepalese specific population (P = 0.05). These results support that ancestor roots of Kathmandu`s people not only connected with India alone. PMID:26226153

Using Morphological, Molecular and Climatic Data to Delimitate Yews along the Hindu Kush-Himalaya and Adjacent Regions

PubMed Central

Poudel, Ram C.; Möller, Michael; Gao, Lian-Ming; Ahrends, Antje; Baral, Sushim R.; Liu, Jie; Thomas, Philip; Li, De-Zhu

2012-01-01

Background Despite the availability of several studies to clarify taxonomic problems on the highly threatened yews of the Hindu Kush-Himalaya (HKH) and adjacent regions, the total number of species and their exact distribution ranges remains controversial. We explored the use of comprehensive sets of morphological, molecular and climatic data to clarify taxonomy and distributions of yews in this region. Methodology/Principal Findings A total of 743 samples from 46 populations of wild yew and 47 representative herbarium specimens were analyzed. Principle component analyses on 27 morphological characters and 15 bioclimatic variables plus altitude and maximum parsimony analysis on molecular ITS and trnL-F sequences indicated the existence of three distinct species occurring in different ecological (climatic) and altitudinal gradients along the HKH and adjacent regions Taxus contorta from eastern Afghanistan to the eastern end of Central Nepal, T. wallichiana from the western end of Central Nepal to Northwest China, and the first report of the South China low to mid-elevation species T. mairei in Nepal, Bhutan, Northeast India, Myanmar and South Vietnam. Conclusion/Significance The detailed sampling and combination of different data sets allowed us to identify three clearly delineated species and their precise distribution ranges in the HKH and adjacent regions, which showed no overlap or no distinct hybrid zone. This might be due to differences in the ecological (climatic) requirements of the species. The analyses further provided the selection of diagnostic morphological characters for the identification of yews occurring in the HKH and adjacent regions. Our work demonstrates that extensive sampling combined with the analysis of diverse data sets can reliably address the taxonomy of morphologically challenging plant taxa. PMID:23056501

Phylogenetic evidence for the ancient Himalayan wolf: towards a clarification of its taxonomic status based on genetic sampling from western Nepal

PubMed Central

Kaden, Jennifer; Joshi, Jyoti; Bhattarai, Susmita; Kusi, Naresh; Sillero-Zubiri, Claudio; Macdonald, David W.

2017-01-01

Wolves in the Himalayan region form a monophyletic lineage distinct from the present-day Holarctic grey wolf Canis lupus spp. (Linnaeus 1758) found across Eurasia and North America. Here, we analyse phylogenetic relationships and the geographic distribution of mitochondrial DNA haplotypes of the contemporary Himalayan wolf (proposed in previous studies as Canis himalayensis) found in Central Asia. We combine genetic data from a living Himalayan wolf population collected in northwestern Nepal in this study with already published genetic data, and confirm the Himalayan wolf lineage based on mitochondrial genomic data (508 bp cytochrome b and 242 bp D-loop), and X- and Y-linked zinc-finger protein gene (ZFX and ZFY) sequences. We then compare the genetic profile of the Himalayan wolf lineage found in northwestern Nepal with canid reference sequences from around the globe with maximum likelihood and Bayesian phylogeny building methods to demonstrate that the Himalayan wolf forms a distinct monophyletic clade supported by posterior probabilities/bootstrap for D-loop of greater than 0.92/85 and cytochrome b greater than 0.99/93. The Himalayan wolf shows a unique Y-chromosome (ZFY) haplotype, and shares an X-chromosome haplotype (ZFX) with the newly postulated African wolf. Our results imply that the Himalayan wolf distribution range extends from the Himalayan range north across the Tibetan Plateau up to the Qinghai Lakes region in Qinghai Province in the People's Republic of China. Based on its phylogenetic distinction and its older age of divergence relative to the Holarctic grey wolf, the Himalayan wolf merits formal classification as a distinct taxon of special conservation concern. PMID:28680672

Posttraumatic Stress, Depression, and Coping Following the 2015 Nepal Earthquake: A Study on Adolescents.

PubMed

Sharma, Asmita; Kar, Nilamadhab

2018-05-24

The study aimed to gather data on posttraumatic stress and depression in adolescents following the 2015 Nepal earthquake and explore the adolescents' coping strategies. In a questionnaire-based, cross-sectional study about 1 year after the earthquake, adolescents in two districts with different degrees of impact were evaluated for disaster experience, coping strategies, and symptoms of posttraumatic stress and depression measured with the Child Posttraumatic Stress Scale and the Depression Self Rating Scale. In the studied sample (N=409), the estimated prevalence of posttraumatic stress disorder (PTSD) (43.3%) and depression (38.1%) was considerable. Prevalence of PTSD was significantly higher in the more affected area (49.0% v 37.9%); however, the prevalence figures were comparable in adolescents who reported a stress. The prevalence of depression was comparable. Female gender, joint family, financial problems, displacement, injury or being trapped in the earthquake, damage to livelihood, and fear of death were significantly associated with a probable PTSD diagnosis. Various coping strategies were used: talking to others, praying, helping others, hoping for the best, and some activities were common. Drug abuse was rare. Most of the coping strategies were comparable among the clinical groups. A considerable proportion of adolescents had posttraumatic stress and depression 1 year after the earthquake. There is a need for clinical interventions and follow-up studies regarding the outcome. Disaster Med Public Health Preparedness. 2018;page 1 of 7.

To Great and Useful Purpose: A History of the Wilmington District U.S. Army Corps of Engineers

DTIC Science & Technology

1984-05-01

Carolina, lacking good natural harbors like those in South Carolina, was further barred from the ocean by a forbidding coastline . .. The western boundary...into the interior. The Coastal Plain is divided into the Western Coastal Plain subregion and the Tidewater subregion. The Western Coastal Plain is...except for cities such as Wilmington and Beaufort, generally opposed state-sponsored internal im- provements that would benefit the western half of

Incidence of Mastitis in the Neonatal Period in a Traditional Breastfeeding Society: Results of a Cohort Study

PubMed Central

Scott, Jane A.; Lee, Andy H.; Binns, Colin W.

2015-01-01

Abstract Background: Mastitis is a painful problem experienced by breastfeeding women, especially in the first few weeks postpartum. There have been limited studies of the incidence of mastitis from traditionally breastfeeding societies in South Asia. This study investigated the incidence, determinants, and management of mastitis in the first month postpartum, as well as its association with breastfeeding outcomes at 4 and 6 months postpartum, in western Nepal. Subjects and Methods: Subjects were a subsample of 338 mothers participating in a larger prospective cohort study conducted in 2014 in western Nepal. Mothers were interviewed during the first month postpartum and again at 4 and 6 months to obtain information on breastfeeding practices. The association of mastitis and determinant variables was investigated using multivariable logistic regression, and the association with breastfeeding duration was examined using Kaplan–Meier estimation. Results: The incidence of mastitis was 8.0% (95% confidence interval, 5.1%, 10.8%) in the first month postpartum. Prelacteal feeding (adjusted odds ratio = 2.76; 95% confidence interval, 1.03, 7.40) and cesarean section (adjusted odds ratio = 3.52; 95% confidence interval, 1.09, 11.42) were associated with a higher likelihood of mastitis. Kaplan–Meier estimation showed no significant difference in the duration of exclusive breastfeeding among the mothers who experienced an episode of mastitis and those who did not. Conclusions: Roughly one in 10 (8.0%) women experienced mastitis in the first month postpartum, and there appeared to be little effect of mastitis on breastfeeding outcomes. Traditional breastfeeding practices should be encouraged, and the management of mastitis should be included as a part of lactation promotion. PMID:26488802

Land-Use and Socioeconomic Change, Medicinal Plant Selection and Biodiversity Resilience in Far Western Nepal

PubMed Central

Baral, Kedar; Paudel, Prashant; Acharya, Ram P.; Thapa-Magar, Khum B.; Cameron, Mary; Bussmann, Rainer W.

2016-01-01

Indigenous plant use-systems have evolved under, and constantly adapted to human and non-human impacts. In the last decades however, increasing socioeconomic and cultural transformations, including land-use change, outmigration, globalized markets, the introduction of new species, and climate change have led to a decreasing availability of indigenous resources, and are ultimately leading to a reduction of local use-knowledge. Participant observations, discussions, walks-in-the-woods, semi-structured interviews and informal meetings were carried out in 12 villages of far western Nepal between 2011 and 2015 to assess how sociocultural changes have affected the sustenance of indigenous systems and local biodiversity, when compared to studies carried out in the previous decades. Our findings show that there were no statistically significant differences in subject variable means, but differences were relatively important to plant parts-use and plant growth-forms (p = 0.183 and 0.088 respectively). Cissampelos pareira, Acorus calamus, Calotropis gigantea were found to have the greatest relative importance, whereas Ageratina adenophora, Melia azedarach, Carum carvi were most important based on use values. Among them, C. pareira and A. adenophora were introduced. The spatial distribution of species collected for medicine showed that all habitats were important for collection however, habitats close to villages were more favored. The use of non-indigenous and easily available species and more accessible habitats is becoming more prevalent as primary forests become increasingly overexploited, indigenous species become limited, and sociocultural cause of land use change expand. The utilization of indigenous and non-indigenous species and nearby habitats, although possibly affecting the quality of medicinal species, nonetheless reveals the dynamism of indigenous medicines as an adaptive asset mitigating human and non-human environmental changes. PMID:27936247

Synoptic-scale dust transport events in the southern Himalaya

NASA Astrophysics Data System (ADS)

Duchi, R.; Cristofanelli, P.; Marinoni, A.; Bourcier, L.; Laj, P.; Calzolari, F.; Adhikary, B.; Verza, G. P.; Vuillermoz, E.; Bonasoni, P.

2014-06-01

The variability of long-range dust transport events observed in the southern Himalaya and its relation with source areas have been studied thanks to five years’ continuous measurements which were carried out at the “Nepal Climate Observatory-Pyramid” (NCO-P, 27°57‧N, 86°48‧E), the highest Northern Hemisphere GAW-WMO global station sited at 5079 m a.s.l. in the high Khumbu valley (Nepal) on the southern Himalaya. During the period March 2006-February 2011, the analyses of the aerosol particle concentrations and LAGRANTO three-dimensional backward trajectories indicated the occurrence of 275 days affected by synoptic-scale dust transport, which account for 22.2% of the investigated period. The frequency of dust transport days (DTDs) showed a clear seasonal cycle, with the highest seasonal value observed during pre-monsoon season (33.5% of the pre-monsoon’s days are DTDs). Large enhancements in coarse aerosol number concentration N1-10 (average: +689%) and mass PM1-10 (average: +1086%) were observed during the dust transport events as compared to the days without dust (dust-free days, DFDs). In addition, the single scattering albedo (SSA) also showed higher values, ranging from 0.87 to 0.90, during DTDs with respect to DFDs (0.80-0.87). The predominant source of mineral dust reaching the measurement site was identified in the arid regions of the north-western Indian subcontinent (Thar desert), which accounted for 41.6% of the trajectories points associated with DTDs. Seasonal analysis also indicated that the winter season was significantly influenced by far western desert regions, such as North Africa and the Arabic Peninsula.

Land-Use and Socioeconomic Change, Medicinal Plant Selection and Biodiversity Resilience in Far Western Nepal.

PubMed

Kunwar, Ripu M; Baral, Kedar; Paudel, Prashant; Acharya, Ram P; Thapa-Magar, Khum B; Cameron, Mary; Bussmann, Rainer W

2016-01-01

Indigenous plant use-systems have evolved under, and constantly adapted to human and non-human impacts. In the last decades however, increasing socioeconomic and cultural transformations, including land-use change, outmigration, globalized markets, the introduction of new species, and climate change have led to a decreasing availability of indigenous resources, and are ultimately leading to a reduction of local use-knowledge. Participant observations, discussions, walks-in-the-woods, semi-structured interviews and informal meetings were carried out in 12 villages of far western Nepal between 2011 and 2015 to assess how sociocultural changes have affected the sustenance of indigenous systems and local biodiversity, when compared to studies carried out in the previous decades. Our findings show that there were no statistically significant differences in subject variable means, but differences were relatively important to plant parts-use and plant growth-forms (p = 0.183 and 0.088 respectively). Cissampelos pareira, Acorus calamus, Calotropis gigantea were found to have the greatest relative importance, whereas Ageratina adenophora, Melia azedarach, Carum carvi were most important based on use values. Among them, C. pareira and A. adenophora were introduced. The spatial distribution of species collected for medicine showed that all habitats were important for collection however, habitats close to villages were more favored. The use of non-indigenous and easily available species and more accessible habitats is becoming more prevalent as primary forests become increasingly overexploited, indigenous species become limited, and sociocultural cause of land use change expand. The utilization of indigenous and non-indigenous species and nearby habitats, although possibly affecting the quality of medicinal species, nonetheless reveals the dynamism of indigenous medicines as an adaptive asset mitigating human and non-human environmental changes.

Repeated glacial lake outburst flood threatening the oldest Buddhist monastery in north-western Nepal

NASA Astrophysics Data System (ADS)

Kropáček, J.; Neckel, N.; Tyrna, B.; Holzer, N.; Hovden, A.; Gourmelen, N.; Schneider, C.; Buchroithner, M.; Hochschild, V.

2015-10-01

Since 2004, Halji village, home of the oldest Buddhist Monastery in north-western Nepal, has suffered from recurrent glacial lake outburst floods (GLOFs). A sudden englacial drainage of a supraglacial lake, located at a distance of 6.5 km from the village, was identified as the source of the flood. The topography of the lake basin was mapped by combining differential Global Positioning System (DGPS) measurements with a structure-from-motion (SFM) approach using terrestrial photographs. From this model the maximum filling capacity of the lake has been estimated as 1.06 ×106 m3 with a maximum discharge of 77.8 m3 s-1, calculated using the empiric Clague-Mathews formula. A simulation of the flooded area employing a raster-based hydraulic model considering six scenarios of discharge volume and surface roughness did not result in a flooding of the village. However, both the village and the monastery are threatened by undercutting of the river bank formed by unconsolidated sediments, as it already happened in 2011. Further, the comparison of the GLOF occurrences with temperature and precipitation from the High Asia Reanalysis (HAR) data set for the period 2001-2011 suggests that the GLOF is climate-driven rather than generated by an extreme precipitation event. The calculation of geodetic mass balance and the analysis of satellite images showed a rapid thinning and retreat of Halji Glacier which will eventually lead to a decline of the lake basin. As the basin will persist for at least several years, effective mitigation measures should be considered. A further reinforcement of the gabion walls was suggested as an artificial lake drainage is not feasible given the difficult accessibility of the glacier.

77 FR 66081 - Notice of Lodging of Proposed Consent Decree Under the Clean Air Act

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-01

... District Court for the Western District of Michigan in the lawsuit entitled United States v. Kellogg USA... Implementation Plan, for violations at Kellogg's cereal and snack food manufacturing plants located in Battle Creek, Michigan and Grand Rapids, Michigan. The proposed Consent Decree requires Kellogg to reduce its...

75 FR 43519 - Parker-Davis Project; Transmission Capacity for Renewable Energy Between Electrical District No...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-26

... for Renewable Energy Between Electrical District No. 5 Substation and the Palo Verde Hub AGENCY... transmission service on the P- DP for the purpose of transmitting renewable energy. Specifically, Western is soliciting interest from entities looking to transfer renewable energy from the area south of Phoenix...

Superintendent Mentoring the State Way

ERIC Educational Resources Information Center

Beem, Kate

2007-01-01

Rick Rege arrived at his job as superintendent of his western Massachusetts school district the way most folks do--advancing from classroom teacher to mid-level administrator to the district's top position. In Rege's case, he spent the nine years before becoming superintendent of the Chicopee Public Schools as a middle school vice principal and…

Assessing American Indian Needs in New Mexico.

ERIC Educational Resources Information Center

French, Laurence; And Others

This paper focuses on New Mexico's high-risk Indian children and programs. Specifically, Western New Mexico University has been involved with the Gallup/McKinley public school district, the largest school district (5,000 square miles) in the United States (larger than New Jersey) with a school population that is 73% Indian. This paper examines…

Democracy in Schools: Are Educators Ready for Teacher Leadership?

ERIC Educational Resources Information Center

de Villiers, Elsabé; Pretorius, S. G.

2011-01-01

The aim of this research was to determine educators' perceptions of and readiness for teacher leadership. A total of 283 educators in the Eden and Central Karoo Education District in the Western Cape participated in the study. The participants included district officials, principals, and members of school management teams, as well as veteran,…

First Year Co-Teaching: Disclosed through Focus Group and Individual Interviews

ERIC Educational Resources Information Center

Isherwood, Robert; Barger-Anderson, Richael; Merhaut, Joseph; Badgett, Rebecca; Katsafanas, Jodi

2011-01-01

Focus group interviews and individual interviews were conducted with 47 faculty members and administrators in a rural school district in Western Pennsylvania to determine strategies for consideration when attempting to establish and implement a co-teaching program. Participants were part of a school district in its second year of adopting a…

Overview of depression: epidemiology and implications for community nursing practice.

PubMed

Lazarou, Chrystalleni; Kouta, Christiana; Kapsou, Margarita; Kaite, Charis

2011-01-01

Depressive disorders are among the most common psychological conditions currently affecting individuals living in the Westernized world. Yet, available data indicate that fewer than one third of adults with depression obtain appropriate professional treatment. This is attributed, among other reasons, to the under-recognition of the problem by health professionals, including district nurses. In order to improve recognition of the problem, it is imperative for nurses and especially those working in community settings, to appreciate the importance of prompt diagnosis which presumes both an understanding and knowledge of basic aspects of the problem and, an understanding of their role in dealing with depression. This overview presents epidemiological data and identifies the potential consequences of depression on daily functioning and other aspects of life among adults in Westernized countries, aiming to raise awareness and sensitize district nurses about the issue The article discusses how the role of district nurses can be enhanced to improve recognition rates.

Mineral resource potential of the Middle Santiam Roadless Area, Linn County, Oregon

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walker, G.W.

1984-01-01

This report discusses the results of a mineral survey of the Middle Santiam Roadless Area (06929), Willamette National Forest, Linn County Oregon. Middle Santiam Roadless Area is adjacent on the east of the Quartzville mining district, a district that has yielded small amounts of base- and precious-metal ores. Many rock types and alteration features that characterize the mining district occur only the western part of the roadless area, and analysis of a few samples from this part of the roadless area indicates evidence of weak mineralization. The western part of the roadless area is therefore identified as having a moderatemore » potential for small deposits of base and precious metals and a low potential for large very low-grade precious-metal deposits. The eastern part of the roadless area has a low potential for metalliferous deposits. 7 refs., 4 figs., 1 tab.« less

Health-sector responses to address the impacts of climate change in Nepal.

PubMed

Dhimal, Meghnath; Dhimal, Mandira Lamichhane; Pote-Shrestha, Raja Ram; Groneberg, David A; Kuch, Ulrich

2017-09-01

Nepal is highly vulnerable to global climate change, despite its negligible emission of global greenhouse gases. The vulnerable climate-sensitive sectors identified in Nepal's National Adaptation Programme of Action (NAPA) to Climate Change 2010 include agriculture, forestry, water, energy, public health, urbanization and infrastructure, and climate-induced disasters. In addition, analyses carried out as part of the NAPA process have indicated that the impacts of climate change in Nepal are not gender neutral. Vector-borne diseases, diarrhoeal diseases including cholera, malnutrition, cardiorespiratory diseases, psychological stress, and health effects and injuries related to extreme weather are major climate-sensitive health risks in the country. In recent years, research has been done in Nepal in order to understand the changing epidemiology of diseases and generate evidence for decision-making. Based on this evidence, the experience of programme managers, and regular surveillance data, the Government of Nepal has mainstreamed issues related to climate change in development plans, policies and programmes. In particular, the Government of Nepal has addressed climate-sensitive health risks. In addition to the NAPA report, several policy documents have been launched, including the Climate Change Policy 2011; the Nepal Health Sector Programme - Implementation Plan II (NHSP-IP 2) 2010-2015; the National Health Policy 2014; the National Health Sector Strategy 2015-2020 and its implementation plan (2016-2021); and the Health National Adaptation Plan (H-NAP): climate change and health strategy and action plan (2016-2020). However, the translation of these policies and plans of action into tangible action on the ground is still in its infancy in Nepal. Despite this, the health sector's response to addressing the impact of climate change in Nepal may be taken as a good example for other low- and middle-income countries.

Vision science literature of Nepal in the database "Web of Science".

PubMed

Risal, S; Prasad, H N

2012-01-01

Vision Science is considered to be a quite developed discipline in Nepal, with much research currently in progress. Though the results of these endeavors are published in scientific journals, formal citation analyses have not been performed on works contributed by Nepalese vision scientists. To study Nepal's contribution to vision science literature in the database "Web of Science". The primary data source of this paper was Web of Science, a citation database of Thomas Reuters. All bibliometric analyses were performed with the help of Web of Science analysis service. In the current database of vision science literature, Nepalese authors contributed 112 publications to Web of Science, 95 of which were original articles. Pokharel GP had the highest number of citations among contributing authors of Nepal. Hennig A contributed the highest number of article as a first author. The Nepal Eye Hospital contributed the highest number of articles as an institution to the field of Vision Science. Currently, only two journals from Nepal including Journal of Nepal Medical Association (JAMA) are indexed in the Web of Science database (Sieving, 2012). To evaluate the total productivity of vision science literature from Nepal, total publication counts from national journals and articles indexed in other databases such as PubMed and Scopus must also be considered. © NEPjOPH.

False Teeth Still a Public Health Problem among Children in Kanungu District--South Western Uganda 2006

ERIC Educational Resources Information Center

Stephen, Sebudde

2006-01-01

False teeth among children are a Public Health problem which has not received adequate attention in Uganda. This study was therefore developed as a community-based descriptive cross-sectional carried out in Kanungu District using qualitative methods of data collection among caregivers of children, Community Owned Resource Persons and Service…

Enhancing Teacher Leadership in Urban Education: The Oak Park Experience. Educating Students Placed at Risk

ERIC Educational Resources Information Center

Muchmore, James A.; Cooley, Van E.; Marx, Gary E.; Crowell, Ronald A.

2004-01-01

This article describes a long-term effort to improve student achievement in an urban school district through a unique school-university partnership. The Oak Park School District in Oak Park, Michigan, collaborated with Western Michigan University (WMU) to design and administer special master's and doctoral degree programs for nearly half the…

The Logistics of Implementing a Field-Based Comprehensive School Reform Initiative

ERIC Educational Resources Information Center

Reeves, Dawn E.

2014-01-01

This research is a qualitative, reflective case study regarding a cohort in the form of a district-university partnership between the Oak Park Schools in Oak Park, Michigan and the College of Education at Western Michigan University in Kalamazoo, Michigan. The initiators of the program envisioned a more successful urban school district by offering…

Decision-Making and Problem-Solving Practices of Superintendents Confronted by District Dilemmas

ERIC Educational Resources Information Center

Noppe, Rene; Yager, Stuart; Webb, Carol; Sheng, Bridget

2013-01-01

The purpose of this study was to determine the decision-making and problem-solving approaches most frequently used by school superintendents in two mid-western states when confronted with district dilemmas. The research replicated a study conducted by Polka, Litchka, Caizi, Denig and Mete (2011) in five Mid-Atlantic states. The survey used in both…

Rebuilding Government Legitimacy in Post-Conflict Societies: Case Studies of Nepal and Afghanistan

DTIC Science & Technology

2015-01-01

Post-conflict Societies: Case Studies of Nepal and Afghanistan 5a. CONTRACT NUMBER FA2386-12-1-4052 5b. GRANT NUMBER Grant 12RSZ057 AOARD...on the government of different groups in the Nepal , a list of 13 local and regional groups was compiled (see Appendix E). These comprised the eight... Nepal , and email and mobile phone use is inconsistent (especially in rural areas), alternative strategies needed to be developed for finding

Fostering good governance at peripheral public health facilities: an experience from Nepal.

PubMed

Gurung, G; Tuladhar, S

2013-01-01

The Nepalese primary healthcare system at sub-district level consists of three different levels of health facility to serve the mostly rural population. The Ministry of Health and Population decentralised health services by handing over 1433 health facilities in 28 districts to Health Facility Operation and Management Committees (HFOMCs), which were formed following a public meeting, and consist of 9 to 13 members, representing the health facility in-charge, elected members of the village development committee, dalit (disadvantaged caste) and women members. The purpose was to make this local committee responsible for managing all affairs of the health facility. However, the handing over of the health facilities to HFOMCs was not matched by an equivalent increase in the managerial capacity of the members, which potentially makes this initiative ineffective. The Health Facility Management Strengthening Program was implemented in 13 districts to foster good governance in the health facilities by increasing the capacity of HFOMCs. This effort focuses on capacity building of HFOMCs as a continuous process rather than a one-off event. Training, follow-up and promotional activities were conducted. This article focuses on how good governance at the peripheral public health facilities in Nepal can be fostered through the active engagement and capacity building of HFOMCs. This article used baseline and monitoring data collected during technical support visits to HFOMCs and their members between July 2008 and October 2011. The results show that the Health Facility Management Strengthening Program was quite successful in strengthening local health governance in the health facilities. The level of community engagement in governance improved, that is, the number of effective HFOMC meetings increased, the inclusion of dalit/women members in the decision-making process expanded, resource mobilization was facilitated, and community accountability, as measured by health facility opening days, increased. Furthermore, availability of technical staff, supervision and monitoring, and display of the citizen charter increased, and health services became more inclusive. Several lessons emerged. Functioning of HFOMCs is largely dependent on the process of selecting members, the staff and community's support of the HFOMC, and a sense of volunteerism and team spirit among the members. Similarly, to ensure the effective participation of dalit/woman members, the educational and livelihood empowerment of the members is deemed necessary. Furthermore, capacity building of and giving authority to HFOMCs should go hand-in-hand. Local governance of health facilities was fostered through the local people's active engagement in HFOMCs and capacity building of the HFOMC members.

Burnout among rural hospital doctors in the Western Cape: Comparison with previous South African studies.

PubMed

Liebenberg, Andrew R; Coetzee Jnr, Johan F; Conradie, Hofmeyr H; Coetzee, Johan F

2018-05-24

Burnout among doctors negatively affects health systems and, ultimately,patient care. To determine the prevalence of burnout among doctors working in the district health system in the Overberg and Cape Winelands districts of the Western Cape Province and to compare the findings with those of previous South African studies. Rural district hospitals. During 2013, a validated questionnaire (Maslach Burnout Inventory) was sent to 42 doctors working in the district health system within the referral area of the Worcester Hospital, consisting of the Overberg health district and the eastern half of the Cape Winelands. Response rate was 85.7%. Clinically significant burnout was found among 81% of respondents. High levels of burnout on all three subscales were present in 31% of participants.Burnout rates were similar to those of a previous study conducted among doctors working in the Cape Town Metropolitan Municipality primary health care facilities. Scores for emotional exhaustion (EE) and depersonalisation (DP) were greater than those of a national survey;however, the score for personal accomplishment (PA) was greater. EE and PA scores weresimilar to that of a study of junior doctors working in the Red Cross Children's Hospital;however, EE was smaller. This study demonstrates high burnout rates among doctors working at district level hospitals, similar to the prevalence thereof in the Cape Town Metropolitan primary health care facilities. Health services planning should include strategies to address and prevent burnout of which adequate staffing and improved work environment are of prime importance.

Disaster risk profile and existing legal framework of Nepal: floods and landslides

PubMed Central

Gaire, Surya; Castro Delgado, Rafael; Arcos González, Pedro

2015-01-01

Nepal has a complicated geophysical structure that is prone to various kinds of disasters. Nepal ranks the most disaster-prone country in the world and has experienced several natural calamities, causing high property and life losses. Disasters are caused by natural processes, but may be increased by human activities. The overall objective of this paper is to analyze the disaster risk profile and existing legal framework of Nepal. The paper is based on secondary data sources. Major causative factors for floods and landslides are heavy and continuous rainfall, outburst floods, infrastructure failure, and deforestation. Historical data of natural disasters in Nepal show that water-induced disasters have killed hundreds of people and affected thousands every year. Likewise, properties worth millions of US dollars have been damaged. There is an increasing trend toward landslides and floods, which will likely continue to rise if proper intervention is not taken. A positive correlation between water-induced disasters and deaths has been observed. Nepal has a poor Index for Risk Management (INFORM). There are fluctuations in the recording of death data caused by flood and landslides. The Government of Nepal focuses more on the response phase than on the preparedness phase of disasters. The existing disaster management act seems to be weak and outdated. There is a gap in current legal procedure, so the country is in dire need of a comprehensive legal framework. The new proposed act seems to take a much broader approach to disaster management. With a long-term vision of managing disaster risk in the country, the Government of Nepal has begun the Nepal Risk Reduction Consortium (NRRC) in collaboration with development and humanitarian partners. In order to improve the vulnerability of Nepal, an early warning system, mainstreaming disasters with development, research activities, community participation and awareness, and a rainfall monitoring system must all be a focus. PMID:26366106

Disaster risk profile and existing legal framework of Nepal: floods and landslides.

PubMed

Gaire, Surya; Castro Delgado, Rafael; Arcos González, Pedro

2015-01-01

Nepal has a complicated geophysical structure that is prone to various kinds of disasters. Nepal ranks the most disaster-prone country in the world and has experienced several natural calamities, causing high property and life losses. Disasters are caused by natural processes, but may be increased by human activities. The overall objective of this paper is to analyze the disaster risk profile and existing legal framework of Nepal. The paper is based on secondary data sources. Major causative factors for floods and landslides are heavy and continuous rainfall, outburst floods, infrastructure failure, and deforestation. Historical data of natural disasters in Nepal show that water-induced disasters have killed hundreds of people and affected thousands every year. Likewise, properties worth millions of US dollars have been damaged. There is an increasing trend toward landslides and floods, which will likely continue to rise if proper intervention is not taken. A positive correlation between water-induced disasters and deaths has been observed. Nepal has a poor Index for Risk Management (INFORM). There are fluctuations in the recording of death data caused by flood and landslides. The Government of Nepal focuses more on the response phase than on the preparedness phase of disasters. The existing disaster management act seems to be weak and outdated. There is a gap in current legal procedure, so the country is in dire need of a comprehensive legal framework. The new proposed act seems to take a much broader approach to disaster management. With a long-term vision of managing disaster risk in the country, the Government of Nepal has begun the Nepal Risk Reduction Consortium (NRRC) in collaboration with development and humanitarian partners. In order to improve the vulnerability of Nepal, an early warning system, mainstreaming disasters with development, research activities, community participation and awareness, and a rainfall monitoring system must all be a focus.

Communicating awareness of light pollution with the schools in Nepal

NASA Astrophysics Data System (ADS)

Acharya, Jayanta

2015-08-01

Nepal is also highly polluted by the lights and other dusts partials, but lacks the formal education of light pollutions and effect of light for astronomy observations. When we get Sky Quality Meter (SQM) last year (2014) we have installed it in Kathmandu.This paper will highlight about installation SQM in Nepal, measurement of brightness of the night sky in magnitudes per square arc second. Research work of light pollution of Kathmandu will be more in focus. Highlight of the Astronomy programs by different Schools in Nepal along with the background of coverage of Astronomy education in the syllables of different education level. The various procedure , technique and idea used in providing the space education through different activities and program to school studentsThe paper will also deal with the Importance of light and use of artificial light. Beside it will also highlight the possibility of development of various observatories in Nepal because of its tremendous topography increasing the Astro tourism in Nepal.Hence the paper would focus on the light pollution of the city like Kathmandu and light system in Nepal and Astronomy education to its implementation along with its outreach to Nepalese society.

Pharmacy workforce to prevent and manage non-communicable diseases in developing nations: The case of Nepal.

PubMed

Khanal, Saval; Nissen, Lisa; Veerman, Lennert; Hollingworth, Samantha

2016-01-01

Non-communicable diseases (NCDs, e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) are the main causes of mortality and morbidity in developing countries, including Nepal. Nearly half of the deaths in Nepal are caused by NCDs. Nepal lacks adequate human resources to prevent and manage NCDs, but the skills and expertise of pharmacists in Nepal are underused. There is evidence from many countries that pharmacists can contribute substantially to the prevention and management NCD. We aim to describe the opportunities and challenges for pharmacists to prevent and manage NCDs in Nepal. Pharmacists can contribute by screening and monitoring NCDs; counseling on lifestyle; providing medication therapy management services; promoting public health; and providing other pharmaceutical services. Challenges to the implementation of some of these activities in the current context include inadequate training of pharmacists in NCD prevention and management, the cost of pharmaceutical services to patients and government, and the existing health care service delivery model. There is a need for health services research to determine how pharmacists can be best used to prevent and manage NCDs in Nepal. Copyright © 2015 Elsevier Inc. All rights reserved.

Application of geologic-mathematical 3D modeling for complex structure deposits by the example of Lower- Cretaceous period depositions in Western Ust - Balykh oil field (Khanty-Mansiysk Autonomous District)

NASA Astrophysics Data System (ADS)

Perevertailo, T.; Nedolivko, N.; Prisyazhnyuk, O.; Dolgaya, T.

2015-11-01

The complex structure of the Lower-Cretaceous formation by the example of the reservoir BC101 in Western Ust - Balykh Oil Field (Khanty-Mansiysk Autonomous District) has been studied. Reservoir range relationships have been identified. 3D geologic- mathematical modeling technique considering the heterogeneity and variability of a natural reservoir structure has been suggested. To improve the deposit geological structure integrity methods of mathematical statistics were applied, which, in its turn, made it possible to obtain equal probability models with similar input data and to consider the formation conditions of reservoir rocks and cap rocks.

76 FR 16805 - Notice of Call for Nominations for the Bureau of Land Management's California Desert District...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-25

... represent different interests and advise BLM officials on policies and programs concerning the management of... those positions. Section 309 of the Federal Land Policy and Management Act (FLPMA) directs the Secretary... in San Diego, western Riverside, western San Bernardino, Orange, and Los Angeles Counties (known as...

Changing Concepts of Health and Illness among Children of Primary School Age in Western Kenya

ERIC Educational Resources Information Center

Onyango-Ouma, W.; Aagaard-Hansen, J.; Jensen, B. B.

2004-01-01

This paper examines changes in children's concepts of health and illness following an action-oriented health education intervention in Bondo district of Western Kenya. The study is a feasibility study exploring a specific educational approach, and it combines elements of health education research and anthropological research. Forty primary…

Incidence Rate of Acute Encephalitis Syndrome without Specific Treatment in India and Nepal

PubMed Central

Potharaju, Nagabhushana Rao

2012-01-01

Background: A performance target (PT) for the incidence rate (IR) of acute encephalitis syndrome (AES) was not defined by the World Health Organization (WHO) due to lack of data. There is no specific treatment for ~90% of the AES cases. Objectives: (1) To determine the IR of AES not having specific treatment (AESn) in two countries, India and Nepal. (2) To suggest the PT. Subjects and Methods: This was a record-based study of the entire population of India and Nepal from 1978 to 2011. The WHO definition was used for inclusion of cases. Cases that had specific treatment were excluded. IR was calculated per 100,000 population per annum. Forecast IR was generated from 2010 to 2013 using time-series analysis. Results: There were 165,461 cases from 1978 to 2011, of which 125,030 cases were from India and 40,431 were from Nepal. The mean IR of India was 0.42 (s 0.24) and that of Nepal was 5.23 (σ 3.03). IRs of 2010 and 2011 of India and that of 2011 of Nepal were closer to the mean IR rather than the forecast IR. IR of 2010 of Nepal was closer to the forecast IR. The forecast IR for India for 2012 was 0.49 (0.19-1.06), for 2013 was 0.42 (0.15-0.97) and for Nepal for both 2012 and 2013 was 5.62 (1.53-15.05). Conclusions: IRs were considerably different for India and Nepal. Using the current mean IR as PT for the next year was simple and practical. Using forecasting was complex and, less frequently, useful. PMID:23293439

78 FR 49470 - Adrian Jesus Reyna, Inmate Number #80629-280, FCI Bastrop, Federal Correctional Institution, P.O...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-14

... DEPARTMENT OF COMMERCE Bureau of Industry and Security Adrian Jesus Reyna, Inmate Number 80629-280... Privileges On January 27, 2012, in the U.S. District Court, Western District of Texas, Adrian Jesus Reyna.... Until January 27, 2022, Adrian Jesus Reyna, with a last known address at: Inmate Number 80629-280, FCI...

75 FR 13225 - Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco To Protect...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-19

... an injunction issued by the United States District Court for the Western District of Kentucky... 1996 final rule codified the provisions at part 897, a part used for device regulations, because the... use a trade or brand name of a nontobacco product as the trade or brand name for a cigarette or...

Impact of the community-based newborn care package in Nepal: a quasi-experimental evaluation.

PubMed

Paudel, Deepak; Shrestha, Ishwar B; Siebeck, Matthias; Rehfuess, Eva

2017-10-05

To evaluate the impact of the community-based newborn care package (CBNCP) on six essential practices to improve neonatal health. CBNCP pilot districts were matched to comparison districts using propensity scores. Impact on birth preparedness, antenatal care seeking, antenatal care quality, delivery by skilled birth attendant, immediate newborn care and postnatal care within 48 hours were assessed using Demographic and Health Survey (DHS) and Health Management Information System (HMIS) data through difference-in-differences and multivariate logistic regression analyses. Changes over time in intervention and comparison areas were similar in difference-in-differences analysis of DHS and HMIS data. Logistic regression of DHS data also did not reveal any significant improvement in combined outcomes: birth preparedness, adjusted OR (aOR)=0.8 (95% CI 0.4 to 1.7); antenatal care seeking, aOR=1.0 (0.6 to 1.5); antenatal care quality, aOR=1.4 (0.9 to 2.1); delivery by skilled birth attendant, aOR=1.5 (1.0 to 2.3); immediate newborn care, aOR=1.1 (0.7 to 1.9); postnatal care, aOR=1.3 (0.9 to 1.9). Health providers' knowledge and skills in intervention districts were fair but showed much variation between different providers and districts. This study, while representing an early assessment of impact, did not identify significant improvements in newborn care practices and raises concerns regarding CBNCP implementation. It has contributed to revisions of the package and it being merged with the Integrated Management of Neonatal and Childhood Illness programme. This is now being implemented in 35 districts and carefully monitored for quality and impact. The study also highlights general challenges in evaluating the impacts of a complex health intervention under 'real life' conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Earth observations taken from shuttle orbiter Columbia during STS-87 mission

NASA Image and Video Library

1997-11-27

STS087-716-080 (19 November – 5 December 1997) --- Featured in this view is Mount Everest. It is called “Sagarmatha” in Nepal and “Qomolangma Feng” Qomolangma in China (both names meaning “Goddess Mother of the World”), but is known to the western world as Mount Everest. At an altitude of 29,028 feet (8,848 meters) the summit of tallest mountain on Earth (above sea level) reaches two-thirds of the way through the atmosphere. Situated on the border between Nepal and China (27°59’N, 86°56’E), Mount Everest with its low oxygen levels, powerful winds, and extremely cold temperatures has captured the imagination of adventuresome men and women. Sir Edmund Hillary and Tenzing Norgay were the first persons to surmount Mount Everest in 1953. While climbing Everest can be challenging, it can also be tragic. On May 10, 1996, after reaching the summit and descending to camp, several climbers were trapped by a severe and sudden storm. A total of eight people died, making this day the deadliest single tragedy in the history of Mount Everest. This picture is one of the 70mm Earth observations visuals used by the crew at its post flight presentation events.

SPECIES COMPOSITION, DISTRIBUTION, LIFE FORMS AND FOLK NOMENCLATURE OF FOREST AND COMMON LAND PLANTS OF WESTERN CHITWAN, NEPAL

PubMed Central

Dangol, D. R.

2012-01-01

This paper enumerates 349 plant species belonging to 77 families of vascular plants collected in the winter seasons of 1996 and 2000 by the flora teams of the Population and Ecology Research Laboratory, Nepal. Of the total species, 249 species belong to dicotyledons, 87 species to monocotyledons and 13 species to pteridophytes. Among the families, dicotyledons contributed the highest number of families (55 in number) followed by monocotyledons and pteridophytes. In the study areas, species composition varies with the type of habitats in the study plots. Some species are unique in distribution. The highest unique species are contributed by common lands (87 spp.), followed by the Chitwan National Park forest (36 spp.) and Tikauli forest (32 spp.). Ageratum houstonianum Mill., Cynodon dactylon (L.) Pers., Imperata cylindrica (L.) Beauv., Rungia parviflora (Retz.) Nees, Saccharum spontaneum L. and Thelypteris auriculata (J. Sm.) K. Iwats are the most common species across all the research blocks. Of the listed plants, many plants have local names either in Nepalese or other tribal languages. Plants are named in different ways on the basis of habit, habitat, smell, taste, and morphological characters of the plants, which are also the basis of nomenclature in plant taxonomy. PMID:22962539

Social determinants that lead to poor knowledge about, and inappropriate precautionary practices towards, avian influenza among butchers in Kathmandu, Nepal

PubMed Central

2013-01-01

Background Avian influenza (AI) is a global public health threat. Understanding the knowledge that butchers have about it and the precautionary practices they take against it is crucial for designing future preparedness programs. This study aimed to identify the social determinants of knowledge and precautionary measures of AI among butchers in the Kathmandu district in Nepal. Methods The study was based on a cross-sectional study design using structured interview questionnaires and checklists to observe social determinants and the precautionary measures of 120 butchers aged 15 years and above from the Kathmandu district. Results The majority of the respondents were male (69.2%) and more than half (53.3%) were from the age group of 25–39 years (mean: 31.08, SD: ±9.82). Nearly two-thirds (61.3%) of the respondents had a ‘poor knowledge’, and the remaining had ‘some knowledge’, about AI. More than half (55.4%) of the respondents were in the category of displaying ‘poor practice’ towards AI and the remaining half were in the ‘satisfactory practice’ category. None of the respondents had ‘adequate knowledge’ or displayed ‘good practice’. The respondents in the >25 years of age group were less likely [OR 0.169; 95% CI (0.056-0.512)] compared to those in the <25 years age group to have a poor knowledge about AI; and the respondents with ‘primary education’ were more likely [OR 3.265; 95% CI (1.326-8.189)] to have a poor knowledge about AI as compared to those who had a secondary or above level of education. Respondents who did not know the correct definition of AI were more likely to follow poor practices [OR 4.265; 95% CI (1.193-15.242)]; and the respondents who did not know the risk groups associated with AI were also more likely to follow poor practices [OR 3.103; 95% CI (1.191-8.083)]. Conclusion This study points out the need to address butchers to improve their knowledge of, and more importantly their compliance with, the precautionary measures to prevent avian influenza. PMID:23849460

Women's experiences and health care-seeking practices in relation to uterine prolapse in a hill district of Nepal.

PubMed

Shrestha, Binjwala; Onta, Sharad; Choulagai, Bishnu; Poudyal, Amod; Pahari, Durga Prasad; Uprety, Aruna; Petzold, Max; Krettek, Alexandra

2014-02-03

Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women's experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices. Using a convenience sampling method, we conducted 115 semi-structured and 16 in-depth interviews with UP-affected women during September-December 2012. All interviews occurred in outreach clinics in villages of the Dhading district. Study participants were 23-82 years of age. Twenty-four percent were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to make healthcare decisions. Most participants (>85%) described the major physical discomforts of UP as difficulty with walking, standing, working, sitting, and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%), and difficulty with sexual activity (73.9%). Due to inability to perform household chores or fulfill their husband's sexual desires, participants endured humiliation, harassment, and torture by their husbands and other family members, causing severe emotional stress. Following disclosure of UP, 24% of spouses remarried and 6% separated from the marital relationship. Women perceived the causes of UP as unsafe childbirth, heavy work during the postpartum period, and gender discrimination. Prior to visiting these camps some women (42%) hid UP for more than 10 years. Almost half (48%) of participants sought no health care; 42% ingested a herb and ate nutritious food. Perceived barriers to accessing health care included shame (48%) and feeling that care was unnecessary (12.5%). Multiple responses (29%) included shame, inability to share, male service provider, fear of stigma and discrimination, and perceiving UP as normal for childbearing women. UP adversely affects women's daily life and negatively influences their physical, mental, and social well-being. The results of our study are useful to generate information on UP symptoms and female health care seeking practices. Our findings can be helpful for effective development of UP awareness programs to increase service utilization at early stages of UP and thereby might contribute to both primary and secondary prevention of UP.

Validating a tool to measure auxiliary nurse midwife and nurse motivation in rural Nepal.

PubMed

Morrison, Joanna; Batura, Neha; Thapa, Rita; Basnyat, Regina; Skordis-Worrall, Jolene

2015-05-12

A global shortage of health workers in rural areas increases the salience of motivating and supporting existing health workers. Understandings of motivation may vary in different settings, and it is important to use measurement methods that are contextually appropriate. We identified a measurement tool, previously used in Kenya, and explored its validity and reliability to measure the motivation of auxiliary nurse midwives (ANM) and staff nurses (SN) in rural Nepal. Qualitative and quantitative methods were used to assess the content validity, the construct validity, the internal consistency and the reliability of the tool. We translated the tool into Nepali and it was administered to 137 ANMs and SNs in three districts. We collected qualitative data from 78 nursing personnel and district- and central-level stakeholders using interviews and focus group discussions. We calculated motivation scores for ANMs and SNs using the quantitative data and conducted statistical tests for validity and reliability. Motivation scores were compared with qualitative data. Descriptive exploratory analysis compared mean motivation scores by ANM and SN sociodemographic characteristics. The concept of self-efficacy was added to the tool before data collection. Motivation was revealed through conscientiousness. Teamwork and the exertion of extra effort were not adequately captured by the tool, but important in illustrating motivation. The statement on punctuality was problematic in quantitative analysis, and attendance was more expressive of motivation. The calculated motivation scores usually reflected ANM and SN interview data, with some variation in other stakeholder responses. The tool scored within acceptable limits in validity and reliability testing and was able to distinguish motivation of nursing personnel with different sociodemographic characteristics. We found that with minor modifications, the tool provided valid and internally consistent measures of motivation among ANMs and SNs in this context. We recommend the use of this tool in similar contexts, with the addition of statements about self-efficacy, teamwork and exertion of extra effort. Absenteeism should replace the punctuality statement, and statements should be worded both positively and negatively to mitigate positive response bias. Collection of qualitative data on motivation creates a more nuanced understanding of quantitative scores.

Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study.

PubMed

Upadhaya, Nawaraj; Jordans, Mark J D; Pokhrel, Ruja; Gurung, Dristy; Adhikari, Ramesh P; Petersen, Inge; Komproe, Ivan H

2017-01-01

Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements. In-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis. The mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level. In the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms.

Health Care Waste Management Practice in Health Care Institutions of Nepal.

PubMed

Joshi, H D; Acharya, T; Ayer, R; Dhakal, P; Karki, K B; Dhimal, M

2017-01-01

Medical waste is considered as a major public health hazard. In a developing country like Nepal, there is much concern about the management practice of medical waste. This study aimed to assess Health Care Waste Management practice among Health Care Institutions in Nepal. A cross sectional study was carried out between July 2012 to June 2013 in 62 different Health Care Institutions, selected from stratified proportionate random sampling technique from all administrative regions of Nepal. A structured questionnaire and observation checklist were used for data collection. The waste generation rate is found significantly correlated with bed capacity, patient flow rate and annual budget spent in the hospital. It is found significantly higher in Teaching hospital than other Health Care Institutions of Nepal. An average of 3.3 kg/day/patient of medical waste (2.0 kg/day/patient non-hazardous and 1.0 kg/day/patient hazardous waste) was generated during the study period. Further, it was found that most of the Health care wastes were not disinfected before transportation to waste disposal sites. Very limited number of Health Care Institutions had conducted Environmental Assessment. Similarly, some of the Health Care Institutions had not followed Health care waste management guideline 2009 of Nepal Government. We found poor compliance of medical waste management practice as per existing legislation of Government of Nepal. Hence, additional effort is needed for improvement of Health care waste management practice at Health Care Institutions of Nepal.

Attempts to bring the trained teachers in the schools of Nepal

NASA Astrophysics Data System (ADS)

Lamsal, Jeevan

2016-07-01

To develop space activities and to industrialize astronomy, base of space education in the high schools must be very effective. This paper highlights the present scenario of space education and discusses the syllabus of astronomy in the different education level of Nepal. Astronomy is included in the curriculum of science book of middle school and high school which contains very few contents of solar system, constellations, galaxy, black holes and formation of stars. There is no any degree for higher studies in astronomy as a separate department in any university of Nepal. This paper also highlights the space activities and national level programs conducting in Nepal to support astronomy education. With the rise of many astronomical clubs and societies in the different regions of Nepal, astronomy education has been more effective in the recent time. Series of Galileo Teacher's Training Program in the different parts of Nepal being organized by Global Hands on Universe in cooperation with local astronomy clubs will be discuss in brief. The attempts to bring more trained and skilled teachers in the classroom by the government and non-government agencies are now gradually increasing. The competition of private schools and their capacity building workshops to their teachers to attract more students is also playing active role to shape the school education effective. The challenges, prospects and the practice of effective astronomy education prevailing in Nepal will be discuss. Key Words: Nepal, Astronomy Education, GTTP, Trained Teachers

Unplanned roads impacts assessment in Phewa Lake watershed, Western region, Nepal

NASA Astrophysics Data System (ADS)

Leibundgut, Geoffroy; Sudmeier-Rieux, Karen; Devkota, Sanjaya; Jaboyedoff, Michel; Penna, Ivanna; Adhikari, Anu; Khanal, Rajendra

2015-04-01

This work describes current research being conducted in the Phewa Lake watershed, near Pokhara in Nepal's Siwaliks/Middle hills, a moist sub-tropical zone with the highest amount of annual rainfall in Nepal (4,500 - 5,000 mm). The watershed lithology is mainly siltstone, sandstones and intensively weathered rocks, highly prone to erosion and shallow landslides (Agrawala et al., 2003). The main purpose of this study is to focus on the impact of unplanned earthen road construction in the Phewa Lake watershed as part of land use changes over 30 years in one of Nepal's most touristic regions. Over the past three decades, the road network has expanded exponentially and a majority of rural earthen roads are often funded by communities themselves, with some government subsidies. They are usually constructed using a local bulldozer contractor with no technical or geological expertise increasing erosion processes, slope instabilities risk and impacts to settlements, forests, water sources, agriculture lands, and infrastructure. Moreover, these human-induced phenomena are being compounded by increasingly intense monsoon rains, likely due to climate change (Petley, 2010). Research methods were interdisciplinary and based on a combination of remote sensing, field observations and discussions with community members. The study compared 30 year-old aerial photos with current high resolution satellite images to correlate changes in land use with erosion and slope instabilities. Secondly, most of the watershed's roads were surveyed in order to inventory and quantify slope instabilities and soil loss events. Using a failure-characteristics grid, their main features were measured (location, size, type and extension of damage areas, etc.) and a GIS data base was created. We then estimated economic impacts of these events in terms of agriculture lands losses and road maintenance, based on field observations and discussions with affected people. Field work investigations have shown that unplanned road excavations are producing mainly embankment failures and/or gullying which affect primarily roads themselves, wiping them out and blocking vehicle circulation, and secondly, destroying or burying agriculture lands. Initial results of the remote sensing analysis demonstrate that there is high probability of a correlation between the expansion of the road network and increased erosion/deposition in the watershed. Finally a few deep-seated and potentially very destructive failures were observed in the watershed, in large part triggered by road construction. All phenomena present economic impacts for communities due to costly interventions for clearing roads and losses of crop production. References: Agrawala, S., et al. (2003). Development and Climate Change in Nepal: Focus on Water Resources and Hydropower. Paris, OECD: 64pp. Petley, D. N. (2010). On the impact of climate change and population growth on the occurrence of landslides in Asia. Quarterly Journal of Engineering Geology and Hydrogeology, 43 (4), 487-496.

The geology and ore deposits of the Coeur d'Alene district, Idaho

USGS Publications Warehouse

Ransome, F. L.; Calkins, Frank Cathcart

1908-01-01

The area commonly known as the Coeur d'Alene district (although for purposes of record and administration it has been divided into a number of local mining districts) is situated, so far as its productive part is concerned in Shoshone County, in that narrow portion of Idaho which extends northward between the States of Washington and Montana to the international boundary. It lies almost entirely upon the western slope of Coeur d'Alene Mountains, a broad and rather complex member of the North American Cordillera.

Supreme Court of the United States Syllabus: San Antonio Independent School District Et. Al. v. Rodriguez Et. Al. Appeal from the United States District Court for the Western District of Texas. No. 71-1332, Argued October 12, 1972 -- Decided March 21, 1973.

ERIC Educational Resources Information Center

Supreme Court of the U. S., Washington, DC.

In this landmark educational finance opinion (presented here in full) the U.S. Supreme Court held that the Texas case was not a proper case in which to examine a State's laws under standards of strict judicial scrutiny. That test, according to the Court, is reserved for cases involving laws that operate to the disadvantage of suspect classes or…

PLANT DIVERSITY OF WESTERN CHITWAN FLORISTIC APPROACH

PubMed Central

Dangol, D. R.; Shivakoti, G. P.

2012-01-01

This paper identifies and documents the plant biodiversity of western Chitwan, Nepal. Specifically, our attention was focussed on the plants of forests, grasslands and common lands based on our “Reciprocal Relation of Population and Environment Study Project” conducted during January-April 1996. This species-diversity of trees, shrubs and herbaceous flora was recorded from 117, 117, and 1049 sampling quadrats of 10×10, 3×3 and 1×1 m2, respectively. The flora of our study plots contains 236 species that belong to 191 genera and 66 families. Of 236 species of plants, 119, 113, 59, 35 and 119 species were recorded from Tikauli forest, National Park forest, forests along the Narayani river, grasslands of National Park and common lands of the western Chitwan, respectively. Dicotyledons represent 184 (77.97%) species of the total flora species followed by monocotyledons (46 spp., 19.49%) and ferns (6 spp., 2.54%), respectively. The five largest families are Leguminosae (38 spp.), Poaceae (27 spp.), Asteraceae (22 spp.), Rubiaceae (10 spp.), and Scrophulariaceae (9 spp.). Hedyotis, Grewia and Lindernia, each with 4 spp., are the most speciose genera in the flora. PMID:22899874

Participatory evaluation of disaster resilience performance with urban stakeholders: An implementation case study before and after the 2015 Nepal Ghorka earthquake

NASA Astrophysics Data System (ADS)

Khazai, B.; Anhorn, J.; Burton, C.

2016-12-01

Approaches that make resilience tangible and operational for decision makers have to deal effectively with the degree of impact and change required through different strategic actions in addressing agreed-upon resilience goals. A Resilience Performance Scorecard (RPS) has been designed to enable local stakeholders in identifying existing strengths and weaknesses through providing information on key performance targets along six dimensions of urban resilience both at the city and sub-city district level of geography. The purpose in the development of the Scorecard approach is to build a tool that can provide information on the overall resilience performance and capture the key functional and organizational areas for urban resilience with local government officials. The Resilience Performance Scorecard (RPS) was developed jointly by the Center for Disaster Management and Risk Reduction Technology (CEDIM) at Karlsruhe Institute of Technology, the South Asia Institute (SAI) at Heidelberg University, the and Global Earthquake Model (GEM) Foundation. It was initially implemented with the Lalitpur Sub-Metropolitan Municipality in Nepal one year before the 25 April 7.8 magnitude Gorkha earthquake event as a self-evaluation tool through a fully participatory process with local stakeholders. In a follow-up participatory assessment and implementation of the RPS one month after the earthquake, the results of the participatory resilience investigation demonstrate areas where action towards resilience should be prioritized and reflect the change in perception of resilience among the stakeholders in the face of a large damaging event.

Relationship between the surrogate anthropometric measures, foot length and chest circumference and birth weight among newborns of Sarlahi, Nepal.

PubMed

Mullany, L C; Darmstadt, G L; Khatry, S K; Leclerq, S C; Tielsch, J M

2007-01-01

Classification of infants into low birth weight (LBW, <2500 g) or very low birth weight (VLBW, <2000 g) categories is a crucial step in targeting interventions to high-risk infants. To compare the validity of chest circumference and foot length as surrogate anthropometric measures for the identification of LBW and VLBW infants. Newborn infants (n=1640) born between March and June 2004 in 30 Village Development Committees of Sarlahi district, Nepal. Chest circumference, foot length and weight (SECA 727, precise to 2 g) of newborns were measured within 72 h after birth. The sensitivity, specificity and predictive values for a range of cutoff points of the anthropometric measures were estimated using the digital scale measurements as the gold standard. Among LBW infants (469/1640, 28.6%), chest circumference measures <30.3 cm were 91% sensitive and 83% specific. Similar levels of sensitivity for foot length were achieved only with considerable loss of specificity (<45%). Foot length measurements <6.9 cm were 88% sensitive and 86% specific for the identification of VLBW infants. Chest circumference was superior to foot length in classification of infants into birth weight categories. For the identification of VLBW infants, foot length performed well, and may be preferable to chest circumference, as the former measure does not require removal of infant swaddling clothes. In the absence of more precise direct measures of birth weight, chest circumference is recommended over foot length for the identification of LBW infants.

Health and mineral nutrition status of yaks in southern Mustang, Nepal.

PubMed

Kumagai, Hajime; Nakajima, Mitsumi; Anzai, Hiroki; Sakai, Takashi; Oishi, Kazato; Hirooka, Hiroyuki; Shah, Manoj Kumar

2017-08-01

Biochemical values and mineral concentrations in blood plasma were investigated to evaluate the statuses of health and mineral nutrition among yaks in Mustang District, Nepal. In total, 118 plasma samples of female yaks collected in April and September/October of 2013-2015 were offered. Seventy-four percent of yaks showed lower plasma total-cholesterol concentrations than the lowest limit of reference range (100 mg/dL) and the values in spring (83.41 mg/dL) were lower (P < 0.05) than those in autumn (95.05 mg/dL). All the yaks had lower plasma albumin concentrations than the lowest limit of reference range (3.0 g/dL) and 66% of yaks showed lower plasma inorganic phosphorus concentrations than the critical level of phosphorus deficiency (4.5 mg/dL). Thirty-five percent of yaks showed lower plasma calcium concentrations than the lowest limit of normal range (8 mg/dL) and the concentrations were lower in spring than in autumn (P < 0.01). Seventy-five percent of yaks presented lower copper concentrations than the critical level (0.65 mg/L) and the concentrations were lower in spring than in autumn (P < 0.01). Since the low plasma total-cholesterol might have indicated shortage of dry matter and energy intake, attention should be paid to the nutritional statuses of energy, phosphorus, calcium and copper in winter and early spring. © 2016 Japanese Society of Animal Science.

Anxiety, Depression and Post-Traumatic Stress Disorder after Earthquake.

PubMed

Thapa, Prakash; Acharya, Lumeshor; Bhatta, Bhup Dev; Paneru, Suman Bhatta; Khattri, Jai Bahadur; Chakraborty, Prashant Kumar; Sharma, Rajasee

2018-03-13

Prevalence of anxiety, depression and post traumatic stress disorder is high after earthquake. The aim of the study is to study the prevalence and comorbidity of commonly occurring psychological symptoms in people exposed to Nepal mega earthquake in 2015 after a year of the event. A community based, cross sectional, descriptive study was carried out in Bhumlichaur area of Gorkha district, Nepal after around 14 months of the first major earthquake. We used self-reporting questionnaire 20, Post-traumatic stress disorder 8 and hospital anxiety and depression scale to screen for presence of symptoms of anxiety and depression or post-traumatic stress disorder in this population. The risk of having these disorders according to different socio-demographic variable was assessed by calculating odds ratio. All calculations were done using predictive and analytical software (PASW) version 16.0. A total of 198 participants were included in the final data analysis. The mean age of study participants was 35.13 years (SD=18.04). Borderline anxiety symptoms were found in 104 (52.5%) while significant anxiety symptoms were found in 40 (20%) of respondents. Borderline depressive symptoms were seen in 40 (20%) while significant depressive symptoms were seen in 16 (8%) of subjects. Around 27% (n= 53) of respondents were classified as having post-traumatic stress disorder. The prevalence of anxiety and depressive symptoms and post-traumatic stress disorder seems to be high even after one year in people exposed to earthquake.

Hydrological system dynamics of glaciated Karnali River Basin Nepal Himalaya using J2000 Hydrological model

NASA Astrophysics Data System (ADS)

Khatiwada, K. R.; Nepal, S.; Panthi, J., Sr.; Shrestha, M.

2015-12-01

Hydrological modelling plays an important role in understanding hydrological processes of a catchment. In the context of climate change, the understanding of hydrological characteristic of the catchment is very vital to understand how the climate change will affect the hydrological regime. This research facilitates in better understanding of the hydrological system dynamics of a himalayan mountainous catchment in western Nepal. The Karnali River, longest river flowing inside Nepal, is one of the three major basins of Nepal, having the area of 45269 sq. km. is unique. The basin has steep topography and high mountains to the northern side. The 40% of the basin is dominated by forest land while other land cover are: grass land, bare rocky land etc. About 2% of the areas in basin is covered by permanent glacier apart from that about 12% of basin has the snow and ice cover. There are 34 meteorological stations distributed across the basin. A process oriented distributed J2000 hydrologial model has been applied to understand the hydrological system dynamics. The model application provides distributed output of various hydrological components. The J2000 model applies Hydrological Response Unit (HRU) as a modelling entity. With 6861 HRU and 1010 reaches, the model was calibrated (1981-1999) and validated (2000-2004) at a daily scale using split-sample test. The model is able to capture the overall hydrological dynamics well. The rising limbs and recession limbs are simulated equally and with satisfactory ground water conditions. Based on the graphical and statistical evaluation of the model performance the model is able to simulate hydrological processes fairly well. Calibration shows that Nash Sutcliffe efficiency is 0.91, coefficient of determination is 0.92 Initial observation shows that during the pre-monsoon season(March to May) the glacial runoff is 25% of the total discharge while in the monsoon(June to September) season it is only 13%. The surface runoff contributed about 40%, 20% in subsurface while there is about 13% in the base flow. For better understanding and interpretation of the area there is still need of further coherent research and analysis for land use change and future climate change impact in the glaciered alpine catchment of Himalayan region.

Dating and Sex among Emerging Adults in Nepal

ERIC Educational Resources Information Center

Regmi, Pramod R.; van Teijlingen, Edwin R.; Simkhada, Padam; Acharya, Dev R.

2011-01-01

Social and cultural changes in Nepal, including better communication facilities and transport, more urbanization and a rising age at which people marry, have created more opportunities for young people for "dating." Our qualitative study explores whether the existence of dating cultures influences young people's sexual behavior in Nepal.…

Development of Earthquake Emergency Response Plan for Tribhuvan International Airport, Kathmandu, Nepal

DTIC Science & Technology

2013-02-01

Kathmandu, Nepal 5a. CONTRACT NUMBER W911NF-12-1-0282 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER ...In the past, big earthquakes in Nepal (see Figure 1.1) have caused a huge number of casualties and damage to structures. The Great Nepal -Bihar...UBC Earthquake Engineering Research Facility 2235 East Mall, Vancouver, BC, Canada V6T 1Z4 Phone : 604 822-6203 Fax: 604 822-6901 E-mail

Orthopedic Activity in Field Hospitals Following Earthquakes in Nepal and Haiti : Variability in Injuries Encountered and Collaboration with Local Available Resources Drive Optimal Response.

PubMed

Bar-On, Elhanan; Blumberg, Nehemia; Joshi, Amit; Gam, Arnon; Peyser, Amos; Lee, Evgeny; Kashichawa, Shree Krishna; Morose, Alexander; Schein, Ophir; Lehavi, Amit; Kreiss, Yitshak; Bader, Tarif

2016-09-01

Field hospitals have been deployed by the Israel Defense Forces (IDF) Medical Corps in numerous disaster events. Two recent deployments were following earthquakes in Haiti in 2010 and in Nepal in 2015. Despite arrival in similar timetables, the mode of operation was different-independently in Haiti and in collaboration with a local hospital in Nepal. The pathology encountered in the two hospitals and the resultant treatment requirements were significantly different between the two events. The purpose of this study was to analyze these differences and their implications for preparation and planning of future deployments. Data were obtained from IDF records and analyzed using SPSS™ software. 1686 patients were treated in Nepal versus 1111 in Haiti. The caseload in Nepal included significantly less earthquake-related injuries (26 vs. 66 %) with 28 % of them sustaining fractures versus 47 % in Haiti. Femoral fractures accounted for 7.9 % of fractures in Nepal versus 26.4 % in Haiti with foot fractures accounting for 23.8 and 6.4 %, respectively. The rate of open fracture was similar at 29.4 % in Nepal and 27.5 % in Haiti. 18.1 % of injured patients in Nepal underwent surgery, and 32.9 % of which was skeletal compared to 32 % surgical cases (58.8 % skeletal) in Haiti. 74.2 % of patients in Nepal and 34.3 % in Haiti were treated for pathology unrelated to the earthquake. The reasons for the variability in activities between the two hospitals include the magnitude of the disaster, the functionality of the local medical system which was relatively preserved in Nepal and destroyed in Haiti and the mode of operation which was independent in Haiti and collaborative with a functioning local hospital in Nepal. Emergency medical teams (EMTs) may encounter variable caseloads despite similar disaster scenarios. Advance knowledge of the magnitude of the disaster, the functionality of the local medical system, and the collaborative possibilities will help in planning and preparing EMTs to function optimally and appropriately. However, as this information will often be unavailable, EMTs should be capable to adapt to unexpected conditions.

75 FR 6837 - Notice of Call for Nominations for Bureau of Land Management's California Desert District...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-11

... consists of 15 private individuals who represent different interests and advise BLM officials on policies... additional 3-year term. Section 309 of the Federal Land Policy and Management Act directs the Secretary of... Area and 300,000 acres of scattered parcels in San Diego, western Riverside, western San Bernardino...

Evaluation of Color and Color Infrared Photography from the Goldfield Mining District, Esmerelda and Nye Countries, Nevada

NASA Technical Reports Server (NTRS)

Ashley, R. P.

1970-01-01

The determination of geological features characteristic of the Goldfield epithermal ore deposits is considered and which of them can be identified from color and color infrared aerial photography. The Goldfield mining district in the western part of the Basin and Range Province is the area of study, located in desert terrain of relatively low relief.

78 FR 44599 - Notice of Lodging of Proposed Consent Decree Under the Clean Water Act

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-24

... DEPARTMENT OF JUSTICE Notice of Lodging of Proposed Consent Decree Under the Clean Water Act On July 15, 2013, the Department of Justice lodged a proposed consent decree with the United States District Court for the Western District of Arkansas in the lawsuit entitled United States v. Lion Oil Company, Civil Action No. 1:13-cv-01059-SOH. The...

78 FR 42802 - Notice of Lodging of Proposed Consent Decree Under the Clean Water Act, Clean Air Act, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-17

... DEPARTMENT OF JUSTICE Notice of Lodging of Proposed Consent Decree Under the Clean Water Act, Clean Air Act, and Resource Conservation and Recovery Act On July 11, 2013, the Department of Justice lodged a proposed consent decree with the United States District Court for the Western District of Arkansas in the lawsuit entitled United States v....

78 FR 65384 - Notice of Lodging of Consent Decree Pursuant to the Clean Water Act

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

... DEPARTMENT OF JUSTICE Notice of Lodging of Consent Decree Pursuant to the Clean Water Act On September 30, 2013, the Department of Justice lodged a proposed Consent Decree (``Decree'') in the United States District Court for the Western District of Tennessee in the lawsuit entitled United States of America v. ConAgra Foods, Inc., and ConAgra...

78 FR 46369 - Notice of Lodging of Proposed Consent Decree Under the Clean Water Act

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-31

... DEPARTMENT OF JUSTICE Notice of Lodging of Proposed Consent Decree Under the Clean Water Act On July 23, 2013, the Department of Justice lodged a proposed Consent Decree with the United States District Court for the Western District of Texas in the lawsuit entitled United States and State of Texas v. San Antonio Water System, Civil Action No. 5...

78 FR 41422 - Notice of Lodging of Proposed Consent Decree Under the Clean Water Act

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-10

... DEPARTMENT OF JUSTICE Notice of Lodging of Proposed Consent Decree Under the Clean Water Act On July 3rd, 2013, the Department of Justice lodged a proposed consent decree with the United States District Court for the Western District of Arkansas in the lawsuit entitled United States v. Great Lakes Chemical Company, Civil Action No. 1:13-cv-01058...

Options for developing modernized geodetic datum for Nepal following the April 25, 2015 Mw7.8 Gorkha earthquake

NASA Astrophysics Data System (ADS)

Pearson, Chris; Manandhar, Niraj; Denys, Paul

2017-09-01

Along with the damage to buildings and infrastructure, the April 25, 2015 Mw7.8 Gorkha earthquake caused significant deformation over a large area of eastern Nepal with displacements of over 2 m recorded in the vicinity of Kathmandu. Nepal currently uses a classical datum developed in 1984 by the Royal (UK) Engineers in collaboration with the Nepal Survey Department. It has served Nepal well; however, the recent earthquakes have provided an impetus for developing a semi-dynamic datum that will be based on ITRF2014 and have the capacity to correct for tectonic deformation. In the scenario we present here, the datum would be based on ITRF2014 with a reference epoch set some time after the end of the current sequence of earthquakes. The deformation model contains a grid of the secular velocity field combined with models of the Gorkha Earthquake and the May 12 Mw7.3 aftershock. We have developed a preliminary velocity field by collating GPS derived crustal velocities from four previous studies for Nepal and adjacent parts of China and India and aligning them to the ITRF. Patches for the co-seismic part of the deformation for the Gorkha earthquake and the May 12, 2015 Mw 7.2 aftershock are based on published dislocation models. High order control would be a CORS network based around the existing Nepal GPS Array. Coordinates for existing lower order control would be determined by readjusting existing survey measurements and these would be combined with a series of new control stations spread throughout Nepal.

Platinum potential of mafic-ultramafic massifs in the western part of the Dambuka ore district (Upper Amur Region, Russia)

NASA Astrophysics Data System (ADS)

Melnikov, A. V.; Stepanov, V. A.; Moiseenko, V. G.

2016-02-01

New data on the Pt potential of mafic-ultramafic massifs of the Khani-Maya, Uldegit, and Dzhalta complexes in the western part of the Dambuka ore district are discussed. The Khani-Maya Complex is represented by metamorphosed gabbro, gabbronorites, gabbro anorthosites, subordinate pyroxenites, hornblendites, and peridotites. The Uldegit Complex is composed of pyroxenites, hornblendites, gabbro, gabbronorites, norites, troctolites, peridotites, dunites, actinolite-tremolites, serpentinites, anthophyllites, and tremolite-plagioclase rocks. The Dzhalta Complex is formed of peridotites, gabbro, eclogitized gabbro, hornblendites, cortlandites, and pyroxenites. All these complexes differ from each other by the concentrations of Ni, Cu, Co, Au, and platinoids depending on the composition of the constituting rocks and the presence of sulfide minerals.

Sino-Indian War 1962 -- Where do India and China Stand Today?

DTIC Science & Technology

2013-06-14

interests in Nepal stem from its concerns over movement of large numbers of Tibetans into Nepal . Therefore, India is not only concerned with growing...Tibetan refugee community. Beijing has been pressing Nepal to tighten its borders with Tibet, which has led to a major decrease in the number of

Language Learning Strategies Profiles of EFL Learners in Nepal

ERIC Educational Resources Information Center

Dawadi, Saraswati

2017-01-01

This study investigated language learning strategies (LLS) used by English as foreign language (EFL) learners in Nepal. For this study, 370 undergraduate level students from a university in Nepal responded to a questionnaire. The quantitative software SPSS was used to analyse the data. Results indicated that students were moderate users of those…

Rights of the Child in Nepal.

ERIC Educational Resources Information Center

Schonveld, Ben

This report to the United Nations Committee on the Rights of the Child contains observations of the World Organisation Against Torture (OMCT) concerning the application of the U.N. Convention on the Rights of the Child by the country of Nepal. The report's introductory summary asserts that although the Nepal government's passage of the Act to…

Concepts of mental deficiency among the Tamang of Nepal.

PubMed

Peters, L G

1980-01-01

The Tamang of the Kathmandu Valley have an agrarian society with little demand for literacy and schooling, yet they recognize and label mental retardation. The criteria for labeling are based partially upon insufficiency of intelligence and behavioral adaptation but primarily upon speech incompetence. There is stigma attached to the label, and it has a limiting effect upon social status and role. While the Western conception of mental deficiency is not primarily contingent upon verbal ability, speech function is a consideration in the evaluation of intelligence, as is the case in other parts of the world. In fact, verbal skill is one useful referent for future cross-cultural research on mental deficiency.

Is the Job Satisfaction Survey a good tool to measure job satisfaction amongst health workers in Nepal? Results of a validation analysis.

PubMed

Batura, Neha; Skordis-Worrall, Jolene; Thapa, Rita; Basnyat, Regina; Morrison, Joanna

2016-07-27

Job satisfaction is an important predictor of an individual's intention to leave the workplace. It is increasingly being used to consider the retention of health workers in low-income countries. However, the determinants of job satisfaction vary in different contexts, and it is important to use measurement methods that are contextually appropriate. We identified a measurement tool developed by Paul Spector, and used mixed methods to assess its validity and reliability in measuring job satisfaction among maternal and newborn health workers (MNHWs) in government facilities in rural Nepal. We administered the tool to 137 MNHWs and collected qualitative data from 78 MNHWs, and district and central level stakeholders to explore definitions of job satisfaction and factors that affected it. We calculated a job satisfaction index for all MNHWs using quantitative data and tested for validity, reliability and sensitivity. We conducted qualitative content analysis and compared the job satisfaction indices with qualitative data. Results from the internal consistency tests offer encouraging evidence of the validity, reliability and sensitivity of the tool. Overall, the job satisfaction indices reflected the qualitative data. The tool was able to distinguish levels of job satisfaction among MNHWs. However, the work environment and promotion dimensions of the tool did not adequately reflect local conditions. Further, community fit was found to impact job satisfaction but was not captured by the tool. The relatively high incidence of missing responses may suggest that responding to some statements was perceived as risky. Our findings indicate that the adapted job satisfaction survey was able to measure job satisfaction in Nepal. However, it did not include key contextual factors affecting job satisfaction of MNHWs, and as such may have been less sensitive than a more inclusive measure. The findings suggest that this tool can be used in similar settings and populations, with the addition of statements reflecting the nature of the work environment and structure of the local health system. Qualitative data on job satisfaction should be collected before using the tool in a new context, to highlight any locally relevant dimensions of job satisfaction not already captured in the standard survey.

The role of husbands in maternal health and safe childbirth in rural Nepal: a qualitative study.

PubMed

Lewis, Sarah; Lee, Andrew; Simkhada, Padam

2015-08-04

The role of husbands in maternal health is often overlooked by health programmes in developing countries and is an under-researched area of study globally. This study examines the role of husbands in maternity care and safe childbirth, their perceptions of the needs of women and children, the factors which influence or discourage their participation, and how women feel about male involvement around childbirth. It also identifies considerations that should be taken into account in the development of health education for husbands. This qualitative study was conducted in four rural hill villages in the Gorkha district of Nepal. Semi-structured, in-depth interviews were conducted with husbands (n = 17), wives (n = 15), mothers-in-law (n = 3), and health workers (n = 7) in Nepali through a translator. Interviews were transcribed and analysed using axial coding. We found that, in rural Nepal, male involvement in maternal health and safe childbirth is complex and related to gradual and evolving changes in attitudes taking place. Traditional beliefs are upheld which influence male involvement, including the central role of women in the domain of pregnancy and childbirth that cannot be ignored. That said, husbands do have a role to play in maternity care. For example, they may be the only person available when a woman goes into labour. Considerable interest for the involvement of husbands was also expressed by both expectant mothers and fathers. However, it is important to recognise that the husbands' role is shaped by many factors, including their availability, cultural beliefs, and traditions. This study shows that, although complex, expectant fathers do have an important role in maternal health and safe childbirth. Male involvement needs to be recognised and addressed in health education due to the potential benefits it may bring to both maternal and child health outcomes. This has important implications for health policy and practice, as there is a need for health systems and maternal health interventions to adapt in order to ensure the appropriate and effective inclusion of expectant fathers.

The epidemiology of ocular trauma in rural Nepal

PubMed Central

Khatry, S K; Lewis, A E; Schein, O D; Thapa, M D; Pradhan, E K; Katz, J

2004-01-01

Aims: To estimate the incidence of ocular injury in rural Nepal and identify details about these injuries that predict poor visual outcome. Methods: Reports of ocular trauma were collected from 1995 through 2000 from patients presenting to the only eye care clinic in Sarlahi district, Nepal. Patients were given a standard free eye examination and interviewed about the context of their injury. Follow up examination was performed 2–4 months after the initial injury. Results: 525 cases of incident ocular injury were reported, with a mean age of 28 years. Using census data, the incidence was 0.65 per 1000 males per year, and 0.38 per 1000 females per year. The most common types of injury were lacerating and blunt, with the majority occurring at home or in the fields. Upon presentation to the clinic, 26.4% of patients had a best corrected visual acuity worse than 20/60 in the injured eye, while 9.6% had visual acuity worse than 20/400. 82% were examined at follow up: 11.2% of patients had visual acuity worse than 20/60 and 4.6% had vision worse than 20/400. A poor visual outcome was associated with increased age, care sought at a site other than the eye clinic, and severe injury. 3% of patients were referred for further care at an eye hospital at the initial visit; 7% had sought additional care in the interim between visits, with this subset representing a more severe spectrum of injuries. Conclusions: The detrimental effects of delayed care or care outside of the specialty eye clinic may reflect geographic or economic barriers to care. For optimal visual outcomes, patients who are injured in a rural setting should recognise the injury and seek early care at a specialty eye care facility. Findings from our study suggest that trained non-ophthalmologists may be able to clinically manage many eye injuries encountered in a rural setting in the “developing” world, reducing the demand for acute services of ophthalmologists in remote locations of this highly agricultural country. PMID:15031153

Estimation of leisure time physical activity and sedentary behaviour among school adolescents in Nepal.

PubMed

Paudel, Susan; Subedi, Narayan; Bhandari, Ramjee; Bastola, Ramesh; Niroula, Rakshya; Poudyal, Amod Kumar

2014-06-22

Leisure-time physical activity is essential for healthy and physically active life; however, this domain of physical activity is less common in developing countries. Information on leisure time physical activity and sedentary behaviour among Nepalese population is not available. The study was carried out to assess leisure time physical activity and sedentary behaviour among high school adolescents and identify the associated factors in Nepal. A cross-sectional descriptive study was carried out in Banke district, Nepal in 2013 among higher secondary school students using self-administered questionnaire based on International Physical Activity Questionnaire. A sample of 405 students, 178 females and 227 males, of the age-group 15 to 20 years from seven schools were included in the study. Multivariate logistic regression analysis was carried out to identify factors associated with participation in leisure time physical activity and sedentary behaviour. Engagement of female in leisure time physical activity was lower but mean time spent on sitting per day was higher. Students who walked to school and have playground/parks near home, younger females (OR = 3.09, 95% CI: 1.18-8.08), females living in nuclear families (OR: 2.16, 95% CI: 1.01-4.62) and males who cycled to school (OR: 8.09, 95% CI: 2.35-27.80) and have provision of extra-curricular activities (OR: 2.49, 95% CI: 1.04-5.97) were more likely to be engaged in leisure time physical activity. On the other hand, students who did not have playground in school and lived in rural areas were more likely to sit for more than 6 hours a day. Likewise, male students of private school (OR: 6.41, 95% CI: 2.89-14.21), who used vehicle to reach school (OR: 5.90, 95% CI: 1.26-27.75) and have no provision of extra-curricular activities (OR: 2.98, 95% CI: 1.09-8.07) had longer sitting time. Difference in leisure time physical activity and sedentary behaviour was found among male and female school adolescents. Interventions are needed not only to promote leisure time physical activity but also to reduce sedentary behaviour among this group.

Scalability and Sustainability in Uncertain Environments: Recovery from the Nepal Earthquakes, April 25 and May 12, 2015.

NASA Astrophysics Data System (ADS)

Comfort, L. K.; Joshi, J. B. D.; Yuldashev, F.

2015-12-01

Decision making in disaster recovery involves both rapid scaling up of resources and personnel from external sources, to rebuild a damaged community, and consequent scaling down of this influx of new actors, organizations, and resources as the community returns to daily operations. How to integrate new concepts, technologies, and resources into communities to rebuild the social, economic, and political infrastructure in stronger, more sustainable ways, as well to reconstruct the damaged technical infrastructure represents a challenging set of problems for any community. This problem is critical in environments exposed to recurring risk of interacting hazards that characterize metropolitan regions today. This analysis will examine the process of decision making that is being initiated at national, regional, district, and municipal levels in Nepal following the April 25 and May 12, 2015 Earthquakes as a field study of this process in action. We will build on an initial brief reconnaissance trip to Nepal, June 30 - July 10, 2015, just as response operations were ending and the transition to recovery was beginning. It will capture this transition process to identify the organizational structure through which it operates and the communication and coordination processes that enhance or impede the development of sustainable, disaster-resilient communities as they recover from disaster. We will collect three types of data from different sources, and use appropriate methods of analysis for each type of data. For documentary analysis, we will trace the logic of governmental action for managing risk and recovering from disaster that is stated in public laws, policies, and documents. For electronic media, we will use content analysis to identify key actors, organizations, transactions, and interactions among actors, and conduct a network analysis, using standard measures of centrality, distance, closeness, and clustering. We will use expert interviews and satellite maps to validate findings from other methods of analysis. We anticipate developing a Bayesian Influence Diagram to identify strategies of action and points where the process can be strengthened to achieve the intended results of rebuilding sustainable, disaster resilient communities at different scales of operation in a complex, national system.

Assessing the feasibility of integration of self-care for filarial lymphoedema into existing community leprosy self-help groups in Nepal.

PubMed

Pryce, Joseph; Mableson, Hayley E; Choudhary, Ramesh; Pandey, Basu Dev; Aley, Dambar; Betts, Hannah; Mackenzie, Charles D; Kelly-Hope, Louise A; Cross, Hugh

2018-01-30

Lymphatic filariasis (LF) and leprosy are disabling infectious diseases endemic in Nepal. LF infection can lead to lymphoedema and hydrocoele, while secondary effects of leprosy infection include impairments to hands, eyes and feet. The disabling effects of both conditions can be managed through self-care and the supportive effects of self-help groups (SHGs). A network of SHGs exists for people affected by leprosy in four districts in Nepal's Central Development Region, however no such service exists for people affected by LF. The aim of this study was to determine the feasibility of integrating LF affected people into existing leprosy SHGs in this area. A survey was conducted using a semi-structured questionnaire to elicit information on: (i) participant characteristics, clinical manifestation and disease burden; (ii) participants' knowledge of management of their condition and access to services; and (iii) participants' knowledge and perceptions of the alternate condition (LF affected participants' knowledge of leprosy and vice versa) and attitudes towards integration. A total of 52 LF affected and 53 leprosy affected participants were interviewed from 14 SHGs. On average, leprosy affected participants were shown to have 1.8 times greater knowledge of self-care techniques, and practiced 2.5 times more frequently than LF affected participants. Only a quarter of LF affected participants had accessed a health service for their condition, compared with 94.3% of leprosy affected people accessing a service (including SHGs), at least once a week. High levels of stigma were perceived by both groups towards the alternate condition, however, the majority of LF (79%) and leprosy (94.3%) affected participants stated that they would consider attending an integrated SHG. LF affected participants need to increase their knowledge of self-care and access to health services. Despite stigma being a potential barrier, attitudes towards integration were positive, suggesting that the SHGs may be a good platform for LF affected people to start self-care in this area. This is not a registered trial.

Evaluating the electronic tuberculosis register surveillance system in Eden District, Western Cape, South Africa, 2015.

PubMed

Mlotshwa, Mandla; Smit, Sandra; Williams, Seymour; Reddy, Carl; Medina-Marino, Andrew

2017-01-01

Tuberculosis (TB) surveillance data are crucial to the effectiveness of National TB Control Programs. In South Africa, few surveillance system evaluations have been undertaken to provide a rigorous assessment of the platform from which the national and district health systems draws data to inform programs and policies. Evaluate the attributes of Eden District's TB surveillance system, Western Cape Province, South Africa. Data quality, sensitivity and positive predictive value were assessed using secondary data from 40,033 TB cases entered in Eden District's ETR.Net from 2007 to 2013, and 79 purposively selected TB Blue Cards (TBCs), a medical patient file and source document for data entered into ETR.Net. Simplicity, flexibility, acceptability, stability and usefulness of the ETR.Net were assessed qualitatively through interviews with TB nurses, information health officers, sub-district and district coordinators involved in the TB surveillance. TB surveillance system stakeholders report that Eden District's ETR.Net system was simple, acceptable, flexible and stable, and achieves its objective of informing TB control program, policies and activities. Data were less complete in the ETR.Net (66-100%) than in the TBCs (76-100%), and concordant for most variables except pre-treatment smear results, antiretroviral therapy (ART) and treatment outcome. The sensitivity of recorded variables in ETR.Net was 98% for gender, 97% for patient category, 93% for ART, 92% for treatment outcome and 90% for pre-treatment smear grading. Our results reveal that the system provides useful information to guide TB control program activities in Eden District. However, urgent attention is needed to address gaps in clinical recording on the TBC and data capturing into the ETR.Net system. We recommend continuous training and support of TB personnel involved with TB care, management and surveillance on TB data recording into the TBCs and ETR.Net as well as the implementation of a well-structured quality control and assurance system.

New climatic classification of Nepal

NASA Astrophysics Data System (ADS)

Karki, Ramchandra; Talchabhadel, Rocky; Aalto, Juha; Baidya, Saraju Kumar

2016-08-01

Although it is evident that Nepal has an extremely wide range of climates within a short latitudinal distance, there is a lack of comprehensive research in this field. The climatic zoning in a topographically complex country like Nepal has important implications for the selection of scientific station network design and climate model verification, as well as for studies examining the effects of climate change in terms of shifting climatic boundaries and vegetation in highly sensitive environments. This study presents a new high-resolution climate map of Nepal on the basis of long-term (1981-2010) monthly precipitation data for 240 stations and mean air temperature data for 74 stations, using original and modified Köppen-Geiger climate classification systems. Climatic variables used in Köppen-Geiger system were calculated (i) at each station and (ii) interpolated to 1-km spatial resolution using kriging which accounted for latitude, longitude, and elevation. The original Köppen-Geiger scheme could not identify all five types of climate (including tropical) observed in Nepal. Hence, the original scheme was slightly modified by changing the boundary of coldest month mean air temperature value from 18 °C to 14.5 °C in order to delineate the realistic climatic condition of Nepal. With this modification, all five types of climate (including tropical) were identified. The most common dominant type of climate for Nepal is temperate with dry winter and hot summer (Cwa).

Defense.gov Special Report: Disaster Relief - Nepal Earthquake

Science.gov Websites

You have reached a collection of archived material. The content available is no longer being updated and may no longer be applicable as a result of changes in law, regulation and/or administration U.S. Troops Continue Aid, Relief in Nepal U.S. Troops Load Humanitarian Aid Supplies in Nepal U.S

Determinants of Child Immunization in Nepal: The Role of Women's Empowerment

ERIC Educational Resources Information Center

Pandey, Shanta; Lee, Hae nim

2012-01-01

Background: Approximately 1.4 million or 13% of all children who die each year could be prevented with widely-available vaccines. Objective: We examined if women's empowerment improved child immunization using data on 1,056 mothers with young children from Nepal. Methods: The study utilized the 2006 Nepal Demographic and Health Survey, a…

Overview of Integrated Child Development Services Programme in India: Some Policy Implications for Nepal.

ERIC Educational Resources Information Center

Shrestha, Kishor

This paper presents an overview of the Integrated Child Development Services (ICDS) program in India, discusses the context of Early Childhood Education (ECE) in Nepal, analyzes the best practices of the ICDS, and draws some policy implications for improving ECE in Nepal. The ICDS program is an integrated child development program with the…

Public and Private School Performance in Nepal: An Analysis Using the SLC Examination

ERIC Educational Resources Information Center

Thapa, Amrit

2015-01-01

Using data from the survey of the Ministry of Education, Nepal-2005 for School Leaving Certificate Exam, this paper analyzes public and private school performance in Nepal. The ordinary least square estimates suggest that private school students perform better than public school students. However, the problem of self-selection bias arises, as…

How School Choice Is Framed by Parental Preferences and Family Characteristics: A Study of Western Area, Sierra Leone

ERIC Educational Resources Information Center

Dixon, Pauline; Humble, Steve

2017-01-01

This research set out to investigate how, in a post-conflict area, parental preferences and household characteristics affect school choice for their children. A multinomial logit is used to model the relationship between education preferences and the selection of schools for 954 households in Freetown and neighboring districts, Western Area,…

Why resort to illegal abortion in Zambia? Findings of a community-based study in Western Province.

PubMed

Koster-Oyekan, W

1998-05-01

This article presents part of the findings of a community-based study on the causes and effects of unplanned pregnancies in four districts of Western Province, Zambia. The study broke the silence around abortion in Western Province and revealed that induced abortion poses a public health problem. Using innovative methodology of recording and analyzing histories of deaths from induced abortion, the abortion mortality ratio was calculated for the study districts. Findings reveal all extremely high induced abortion mortality ratio of 120 induced abortion-related deaths per 100,000 live births. More than half the deaths were of schoolgirls. Although abortion in Zambia is legal on medical and social grounds, most women in Western Province resort to illegal abortions because legal abortion services are inaccessible and unacceptable. The main reasons women resort to abortion is for fear of being expelled from school, their unwillingness to reveal a secret relationship, to protect the health of their previous baby and common knowledge that postpartum sexual taboos have been transgressed. An inventory was made of abortion methods, taboos and abortion-providers. The article describes how health staff were involved throughout the study, and shows how recommendations were made by involving all parties concerned.

Learning styles of preclinical students in a medical college in western Nepal.

PubMed

Shankar, P R; Dubey, A K; Binu, V S; Subish, P; Deshpande, V Y

2006-01-01

Information on the learning styles of medical students are lacking in medical colleges in Nepal. Learning styles may be associated with student understanding and may predict success in examination. The present study was carried out to obtain information on learning styles and preferences for teaching of fourth semester medical students and note the association, if any, between respondents' personal characteristics and preferences for learning styles and types of teaching. The correlation between preferences for learning styles and types of teaching and performance in the second year university examination was also explored. The study was carried out during October 2003 at the Manipal College of Medical Sciences, Pokhara, Nepal using the Approaches and Study Skills Inventory (ASSIST) instrument. Information on the respondents' personal characteristics was collected. Respondents had to indicate their degree of agreement with a set of statements using a modified Likert-type scale. The statements were grouped into three main learning styles and two types of teaching. The median scores among different subgroups of respondents were compared using appropriate non-parametric tests (p<0.05). Ninety-two students (92%) participated; fifty-six were male. Thirty-one respondents were Nepalese, 48 were Indians. Majority were educated in English medium schools. The median scores for deep and surface learning styles were 64 and 49 respectively (maximum score=80). The scores for strategic learning was 75.5 (maximum score=100). There was no clear preference for any particular type of teaching. Indian students used more surface apathetic learning strategies compared to others. There was a negative correlation between surface learning and marks obtained in the final examination. The students mainly used deep and strategic learning styles. Differences in preference for learning styles and types of teaching were noted according the respondents' personal characteristics. This was a preliminary study and further studies are required.

Study on the refractive errors of school going children of Pokhara city in Nepal.

PubMed

Niroula, D R; Saha, C G

Refractive errors are the one of the most common visual disorders found worldwide in school going children and also it is one of the causes of blindness. It can easily be prevented, if timely proper measures are taken. In Kathmandu valley and Mechi Zone of Nepal, the distribution of refractive errors was found to be very high. No records are available from the Western part of Nepal. Considering the importance of the refractive errors the present study had been undertaken in Pokhara city. 964 subjects (474 boys, 490 girls) were selected between age groups 10 to 19 years from 6 schools representing different region of Pokhara. After Preliminary examination: on acuity of vision with Snellen's and Jaeger's charts, the subjects were referred to the Manipal Teaching Hospital, Pokhara for confirmation of the refractive errors. Sixty two schools children (6.43%), out of 964 had refractive errors. The myopia was found to be most common (4.05%). The refractive errors were found more in Private school children (9.29%) than Government school children (4.23%), which is statistically significant (P < 0.05). More boys (7.59%) were found to have suffered from refractive errors than girls (5.31%). Further, children with vegetarian diet (10.52%) had greater number of refractive errors than non-vegetarian diet children (6.17%). In the present study, percentage distribution of myopia was found to be higher (4.05%) than the hyperopia (1.24%) and astigmatism (1.14%). Interestingly, in the present study the refractive errors were found significantly higher in Private schools children than Government schools because the children who read in Private schools have higher socioeconomic status; spend more time in home work, watching Television and Computer as compared to government schools children. These near activities of the eyes causes stress on eyes of the children and might be one of the causes of developing myopia.

Women's autonomy in household decision-making: a demographic study in Nepal.

PubMed

Acharya, Dev R; Bell, Jacqueline S; Simkhada, Padam; van Teijlingen, Edwin R; Regmi, Pramod R

2010-07-15

How socio-demographic factors influence women's autonomy in decision making on health care including purchasing goods and visiting family and relatives are very poorly studied in Nepal. This study aims to explore the links between women's household position and their autonomy in decision making. We used Nepal Demographic Health Survey (NDHS) 2006, which provided data on ever married women aged 15-49 years (n = 8257). The data consists of women's four types of household decision making; own health care, making major household purchases, making purchase for daily household needs and visits to her family or relatives. A number of socio-demographic variables were used in multivariable logistic regression to examine the relationship of these variables to all four types of decision making. Women's autonomy in decision making is positively associated with their age, employment and number of living children. Women from rural area and Terai region have less autonomy in decision making in all four types of outcome measure. There is a mixed variation in women's autonomy in the development region across all outcome measures. Western women are more likely to make decision in own health care (1.2-1.6), while they are less likely to purchase daily household needs (0.6-0.9). Women's increased education is positively associated with autonomy in own health care decision making (p < 0.01), however their more schooling (SLC and above) shows non-significance with other outcome measures. Interestingly, rich women are less likely to have autonomy to make decision in own healthcare. Women from rural area and Terai region needs specific empowerment programme to enable them to be more autonomous in the household decision making. Women's autonomy by education, wealth quintile and development region needs a further social science investigation to observe the variations within each stratum. A more comprehensive strategy can enable women to access community resources, to challenge traditional norms and to access economic resources. This will lead the women to be more autonomous in decision making in the due course.

Modeling the intraurban variation in nitrogen dioxide in urban areas in Kathmandu Valley, Nepal.

PubMed

Gurung, Anobha; Levy, Jonathan I; Bell, Michelle L

2017-05-01

With growing urbanization, traffic has become one of the main sources of air pollution in Nepal. Understanding the impact of air pollution on health requires estimation of exposure. Land use regression (LUR) modeling is widely used to investigate intraurban variation in air pollution for Western cities, but LUR models are relatively scarce in developing countries. In this study, we developed LUR models to characterize intraurban variation of nitrogen dioxide (NO 2 ) in urban areas of Kathmandu Valley, Nepal, one of the fastest urbanizing areas in South Asia. Over the study area, 135 monitoring sites were selected using stratified random sampling based on building density and road density along with purposeful sampling. In 2014, four sampling campaigns were performed, one per season, for two weeks each. NO 2 was measured using duplicate Palmes tubes at 135 sites, with additional information on nitric oxide (NO), NO 2 , and nitrogen oxide (NOx) concentrations derived from Ogawa badges at 28 sites. Geographical variables (e.g., road network, land use, built area) were used as predictor variables in LUR modeling, considering buffers 25-400m around each monitoring site. Annual average NO 2 by site ranged from 5.7 to 120ppb for the study area, with higher concentrations in the Village Development Committees (VDCs) of Kathmandu and Lalitpur than in Kirtipur, Thimi, and Bhaktapur, and with variability present within each VDC. In the final LUR model, length of major road, built area, and industrial area were positively associated with NO 2 concentration while normalized difference vegetation index (NDVI) was negatively associated with NO 2 concentration (R 2 =0.51). Cross-validation of the results confirmed the reliability of the model. The combination of passive NO 2 sampling and LUR modeling techniques allowed for characterization of nitrogen dioxide patterns in a developing country setting, demonstrating spatial variability and high pollution levels. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessment of Historic Landscape, Highway 45 Borrow Pit, Jefferson Parish, Louisiana

DTIC Science & Technology

2003-10-01

Resources Survey of the Mississippi River -Gulf Outlet, Orleans and St. Bernard Parishes , Louisiana . Submitted to the New Orleans District, U.S. Army...US Army Corps of Engineers New Orleans District ASSESSMENT OF HISTORIC LANDSCAPE, HIGHWAY 45 BORROW PIT, JEFFERSON PARISH , LOUISIANA Final Report...LaFourche and Belle Pass forming the western boundary, and the Mississippi River and Red Pass forming the eastern boundary. It encompasses approximately

The use of ERTS-1 images in the search for large sulfide deposits in the Chagai District, Pakistan

NASA Technical Reports Server (NTRS)

Schmidt, R. G. (Principal Investigator)

1974-01-01

The author has identified the following significant results. Visual examination of color composites was tested under relatively ideal conditions for direct detection of large hydrothermal sulfide deposits at the low-grade porphyry copper deposit at Saindak, western Chagai District, Pakistan. The Saindak deposit is characterized by an elongate zone of easily eroded sulfide-rich rock surrounded by a resistant rim of hornfels and propylitically altered rock. The geomorphic features related to the Saindak deposit are easily distinguished on ERTS-1 images. Attempts to detect a color anomaly using false-color composites were not successful. About 36,000 square km of the western Chagai District were examined on false-color composites for direct evidence of large sulfide deposits. New geologic information acquired from the images was used in conjunction with the known geology to evaluate two previously known proposed areas and to suggest seven additional targets for field checking, one of which is proposed on the basis of tonal anomaly alone. The study also showed that Saindak-type deposits are not likely to be present in some extensive areas of the Chagai District; and also that a rim like that at Saindak does not form if regional metamorphism has increased the resistance of the country rock to erosion.

Factors influencing specialist outreach and support services to rural populations in the Eden and Central Karoo districts of the Western Cape.

PubMed

Schoevers, Johan; Jenkins, Louis

2015-04-21

Access to health care often depends on where one lives. Rural populations have significantly poorer health outcomes than their urban counterparts. Specialist outreach to rural communities is one way of improving access to care. A multifaceted style of outreach improves access and health outcomes, whilst a shifted outpatients style only improves access. In principle, stakeholders agree that specialist outreach and support (O&S) to rural populations is necessary. In practice, however, factors influence whether or not O&S reaches its goals, affecting sustainability.Aim and setting: Our aim was to better understand factors associated with the success or failure of specialist O&S to rural populations in the Eden and Central Karoo districts in the Western Cape. An anonymous parallel three-stage Delphi process was followed to obtain consensus in a specialist and district hospital panel. Twenty eight specialist and 31 district hospital experts were invited, with response rates of 60.7%-71.4% and 58.1%-74.2% respectively across the three rounds. Relationships, communication and planning were found to be factors feeding into a service delivery versus capacity building tension, which affects the efficiency of O&S. The success of the O&S programme is dependent on a site-specific model that is acceptable to both the outreaching specialists and the hosting district hospital. Good communication, constructive feedback and improved planning may improve relationships and efficiency, which might lead to a more sustainable and mutually beneficial O&S system.

Save the Children Nonformal Education and Early Childhood Development Activities in Rural Nepal.

ERIC Educational Resources Information Center

Reinhold, Amy Jo

In 1981, Save the Children (SC) opened an office in Nepal to support projects related to health, education, income generation, and resource management. Statistics show that between 7 and 8 million of Nepal's 19 million people live below the poverty line, and almost 2 out of 3 adolescent girls do not attend school, placing the overall female…

Universal Primary Education in Nepal: Fulfilling the Right to Education

ERIC Educational Resources Information Center

Lohani, Shiva; Singh, Ram Balak; Lohani, Jeevan

2010-01-01

With the net enrollment ratio in primary education in Nepal at 94%, most children are in the school system, but the system fails to ensure that all enrolled children will continue in school cycle and complete primary education of acceptable quality. Given the system's poor internal efficiency, Nepal is not likely to achieve the MDG and EFA goals…

Exploring the Nature and Reasons for Sexual Violence within Marriage among Young Women in Nepal

ERIC Educational Resources Information Center

Puri, Mahesh; Shah, Iqbal; Tamang, Jyotsna

2010-01-01

Sexual violence within marriage (SVWM) is a major public health and human right issue and yet remains a much neglected research area, especially in Nepal. An exploratory study using free listing, in-depth case histories and causal flow analysis was conducted among two major ethnic groups in Nepal. Descriptive data collected from free listing…

Epidemic of Hysteria in a School of Rural Eastern Nepal: A Case Report

ERIC Educational Resources Information Center

Shakya, Rabi

2005-01-01

Introduction: The headmaster of a school (NRMV) in rural eastern Nepal, pleaded for help from the public health Department of Psychiatry, BKIHS, Dharan, Nepal, to prevent closure of his school as guardians of many students refused to send their children to his school, which was supposedly haunted by evil spirits. The author, along with his staff,…

Does Private School Competition Improve Public School Performance? The Case of Nepal

ERIC Educational Resources Information Center

Thapa, Amrit

2013-01-01

Using data from the survey of the Ministry of Education, Nepal-2005 for school leaving certificate (SLC) exam, this paper attempts to estimate the impact of private school competition on public school performance for the case of Nepal. The study uses the number of private schools in the neighborhood as a measure of competition. The identification…

Effects of Variety and Postharvest Handling Practices on Microbial Population at Different Stages of the Value Chain of Fresh Tomato (Solanum lycopersicum) in Western Terai of Nepal.

PubMed

Khadka, Ram B; Marasini, Madan; Rawal, Ranjana; Gautam, Durga M; Acedo, Antonio L

2017-01-01

Background . Fresh vegetables such as tomato should have low microbial population for safe consumption and long storage life. The aerobic bacterial count (ABC) and coliform bacterial count (CBC), yeast, and mold population are the most widely used microbial indicators in fresh vegetables which should be lower than 4 log CFU g -1 for safe consumption. The stages of the supply chain, postharvest handling methods, and crop varieties had significant effects on microbial population. ABC, CBC, yeast, and mold population were significantly highest ( P < 0.05) at retail market (5.59, 4.38, 2.60, and 3.14 log CFU g -1 , resp.), followed by wholesale market (4.72, 4.71, 2.43, and 2.44 log CFU g -1 , resp.), and were least at farm gate (3.89, 3.63, 2.38, and 2.03 log CFU g -1 , resp.). Improved postharvest practices (washing in clean water and grading and packaging in clean plastic crate) helped to reduce ABC, CBC, and mold population by 2.51, 32.70, and 29.86 percentage as compared to the conventional method (no washing and no grading and packaging in mud plastered bamboo baskets). Among varieties, Pusa ruby had the lowest microbial load of 2.58, 4.53, 0.96, and 1.77 log CFU g -1 for ABC, CBC, yeast, and mold count, respectively. Significantly negative correlation ( P < 0.05) was observed between fruit pH & ABC and pH & mold count. Although the microbial quality of fresh tomato is safe in the local market of western Terai of Nepal both in conventional and in improved practices however still it is essential to follow improved postharvest handling practices in production and marketing of newly introduced tomato cultivars (high-pH cultivars) for ensuring the safe availability of fresh tomato in the market.

Effects of Variety and Postharvest Handling Practices on Microbial Population at Different Stages of the Value Chain of Fresh Tomato (Solanum lycopersicum) in Western Terai of Nepal

PubMed Central

Marasini, Madan; Rawal, Ranjana; Gautam, Durga M.; Acedo, Antonio L.

2017-01-01

Background. Fresh vegetables such as tomato should have low microbial population for safe consumption and long storage life. The aerobic bacterial count (ABC) and coliform bacterial count (CBC), yeast, and mold population are the most widely used microbial indicators in fresh vegetables which should be lower than 4 log CFU g−1 for safe consumption. The stages of the supply chain, postharvest handling methods, and crop varieties had significant effects on microbial population. ABC, CBC, yeast, and mold population were significantly highest (P < 0.05) at retail market (5.59, 4.38, 2.60, and 3.14 log CFU g−1, resp.), followed by wholesale market (4.72, 4.71, 2.43, and 2.44 log CFU g−1, resp.), and were least at farm gate (3.89, 3.63, 2.38, and 2.03 log CFU g−1, resp.). Improved postharvest practices (washing in clean water and grading and packaging in clean plastic crate) helped to reduce ABC, CBC, and mold population by 2.51, 32.70, and 29.86 percentage as compared to the conventional method (no washing and no grading and packaging in mud plastered bamboo baskets). Among varieties, Pusa ruby had the lowest microbial load of 2.58, 4.53, 0.96, and 1.77 log CFU g−1 for ABC, CBC, yeast, and mold count, respectively. Significantly negative correlation (P < 0.05) was observed between fruit pH & ABC and pH & mold count. Although the microbial quality of fresh tomato is safe in the local market of western Terai of Nepal both in conventional and in improved practices however still it is essential to follow improved postharvest handling practices in production and marketing of newly introduced tomato cultivars (high-pH cultivars) for ensuring the safe availability of fresh tomato in the market. PMID:29124068

Evaluation of a monitoring program for assessing the effects of management practices on the quantity and quality of drainwater from the Panoche Water District, western San Joaquin Valley, California

USGS Publications Warehouse

Leighton, David A.; Fio, John L.

1995-01-01

An evaluation was made of an existing monitoring program in the Panoche Water District for 1986-93. The Panoche Water District is an agricultural area located in the western San Joaquin Valley of California. Because irrigation drainage from this area has high concentrations of dissolved solids and selenium, management strategies have been developed to improve the quality of drainwater discharge. The purpose of the Panoche Water District's monitoring program is to assess the effects of water- and land-use practices on local ground water and drain flow from the district. Drainflow from the district consists of the discharge from 50 separate on-farm underground tile-drainage systems. The Panoche Water District maintains information on water deliveries, planned and actual crop types, and planned and actual acreages planted each year. In addition, the water district monitors ground-water and drainage-system discharges using a variety of data-collection methods. A total of 62 observation well sites are used to monitor ground-water level and quality. A total of 42 sites were monitored for drainflow quantity, and drain flow quality samples were collected from the outlets of each of the 50 drainage systems. However, these data were collected inconsistently and (or) intermittently during the period studied. All data obtained from the water district were compiled and stored in a geographic information system database. Water delivered for irrigation by the Panoche Water District is a mix of imported water and local ground water pumped directly into delivery canals. Although delivered water is a mix, information on the proportion of water from the two sources is not reported. Also, individual growers pump directly to their crops unknown quantities of ground water, the total of which could be greater than 60 percent of total applications during years when water district deliveries are greatly reduced (for example, the years during and following a drought). To evaluate the effects of irrigation on ground-water and drainflow quality, data on the combined chemical characteristics and the volume of water applied to crops are needed as part of the district's monitoring program. For example, without these data, this study could estimate only the effects of irrigation on ground-water recharge for 1986 (60.4 106 m3/y), 1987 (74.2 106 m3/y), and 1988 (56.0 106 m3/y) in the Panoche Water District water years when the amount of ground water pumped by individual growers was probably small. Water-level data show a significant decline of the water table in the upslope, undrained parts of the study area, and little or no significant change in the down slope, drained parts of the study area. Pumping from productions wells, most of which are located in the upslope part of the study area, may have contributed to the decline of the water table in the upslope area. The quantities of drainflow, dissolved solids, and selenium discharged from the study area decreased during the study period. However, drainflow, dissolved solids, and selenium discharged from individual on-farm drainage systems did not decrease. These data also illustrate the need for consistent and regular monitoring of the factors that affect drainage in the western San Joaquin Valley.

A multidisciplinary analysis to constrain exhumation and recent erosion history of the Tethyan Himalaya, based on apatite (U-Th-Sm)/He and cosmogenic nuclides dates from Central Nepal (Takkhola graben and the Mustang granite)

NASA Astrophysics Data System (ADS)

Rosenkranz, Ruben; Sahragard Sohi, Mohammad; Spiegel, Cornelia

2015-04-01

The exhumation of the Himalayan arc has been studied intensively throughout the last decades. For the Tethyan Himalaya, however, the youngest exhumation history is still unclear, mostly because of the lack of a significant apatite content in most Tethyan sediments (Crouzet et al. 2007). For this study we are using apatite (U-Th-Sm)/He thermochronology and cosmogenic nuclides for investigating exhumation and denudation of the Tethyan Himalaya back through time. Apatite (U-Th-Sm)/He thermochronology is sensitive to temperatures of ~40 to 85°C and thus to movements within the upper ~1.5 to 3 km of the earth's crust. During a recent field campaign, we sampled the Mustang granite, that intrudes the Tethyan marine sediments and the Takkhola-Graben. The graben can be seen as an inusual southern part of the normal faulting system affecting the whole Tibetan Plateau (Colchen, 1999). The timing of the activation of these faulting is still highly debated. The syntectonics filling of the Takkhola-Mustag graben consists of Mio-Pliocene fluvio-lacustrine deposits (Garzione et al. 2003). These were described as containing significant amounts of apatite, derived from the past erosion of the Mustang granitic body (Adhikari and Wagreich, 2011). Being only up to 1km thick, a post depositional thermal resetting of the apatite (U-Th-Sm)/He system is unlikely, so that the (U-Th-Sm)/He dates of the sediments are expected to have retained their information regarding source area exhumation. We took several sand samples from the Kali Gandaki River draining the present-day exposure of the Mustang granite. Furthermore, we sampled different stratigraphic levels of the Mio-Pliocene sedimentary rocks, i.e., from the Tetang and Takkahola formation deposited between 11 and 7 Ma. This sampling approach will not only provide information about the youngest denudation history of the Mustang granite /Tethyan Himalaya, but will also reveal insights into its past denudation and changes of denudation rates through time for the region north to the South Tibetan Detachment. It is our expectation to link the results to the tectonic behavior of the South Tibetan Detachment or to the newly recognized Western Nepal Fault System. Corroborating our results with other ages and diverse methods will provide a robust constraint on the exhumation and erosion history of the Tethyan Himalaya, as well as insights on the U-Th/He dating technique. References Adhikari, B.R. and Wagreich, M., 2011. Provenance evolution of collapse graben fill in the Himalaya-The Miocene to Quaternary Thakkhola-Mustang graben (Nepal). Sedimentary Geology, 233(1), pp.1-14. Blythe, A.E., Burbank, D.W., Carter, A., Schmidt, K., Putkonen, J., 2007. Plio-Quaternary exhumation history of the central Nepalese Himalaya: 1. Apatite and zircon fission track and apatite [U-Th]/He analyses. Tectonics, 26(3). Crouzet, C. et al., 2007. Temperature and age constraints on the metamorphism of the Tethyan Himalaya in Central Nepal: A multidisciplinary approach. Journal of Asian Earth Sciences, 30(1), pp.113-130. Garzione, C.N, DeCelles, P.G., Hokinson, D.G., Ojha, T.P., Upreti, B.N., 2003. East-west extension and Miocene environmental change in the southern Tibetan plateau: Thakkhola graben, central Nepal. Geological Society of America Bulletin, 115(1), pp.3-20. Colchen, M., 1999. The Takkhola-Mustang graben in Nepal and the latee Cenozoic extension in the Higher Himalayas. Journal of Asian Earth Sciences, 17, pp. 683-702.

Involving diaspora and expatriates as human resources in the health sector in Nepal.

PubMed

Devkota, A; Devkota, B; Ghimire, J; Mahato, R K; Gupta, R P; Hada, A

2013-05-01

Health professional mobility has increased in the recent years and is one of the public health concerns in the developing countries including Nepal. On the other hand, we can't ignore a positive shift of Nepali diaspora coming back to Nepal for some work related projects. The objective of this study was thus to estimate the number of Nepalese Diaspora and foreign expatriate those are coming to Nepal and explore the ways and process of their engagement in the health sector of Nepal. Mixed method was used. In total, 13 Key Informant Interviews were conducted at the central level along with record review from professional councils. Nepalese Diasporas mainly come through Diaspora Volunteering Organizations, Non Resident Nepali Association and personal connections to the place of their origin. Nepalese Diasporas have supported as health specialists, health camps and project organizers, trainer and hospital promoters, supplier of equipment including ambulances etc. The Nepalese Diasporas are unrecorded with professional organizations such as NMC and NHPC. As such the real status and results of support from Nepalese Diaspora are not known. Overall, 5,120 foreign medical professionals have served to Nepal through NMC followed by 739 nursing professionals through NNC and 189 paramedical staff through NHPC as of 2012. Systematic information on number and characteristics of the Nepalese Diaspora and their role in the health sector of Nepal is limited. The health professional bodies have some record systems but they lack uniformity and systematic process.

An exemplary developing astronomy movement in Nepal

NASA Astrophysics Data System (ADS)

Neupane, Sudeep

2015-03-01

Astronomy and space science education had been given least importance by Nepalese government in the past. The modern astronomy movement is believed to have started when an official observation programme of Haley's comet was organized by Royal Nepal Academy of Science and Technology (RONAST) in 1986. Following the huge pressure from the scientific community, the Nepal government (Kingdom of Nepal at that time) established B.P. Koirala Memorial Planetarium, Observatory and Science Museum Development Board in 1992. Initiatives of the project started with observatory set up and the development of astrophysics syllabus for university students. Astrophysics is included as an elective paper in the Physics masters course. The lead astrophysicist of Nepal Dr. Binil Aryal is running a research group in Tribhuvan University since 2005 which has a significant number of international publications. The developing government initiatives and achievements will be discussed. In 2007, a group of astronomy enthusiastic students along with amateurs working independently in past established Nepal Astronomical Society (NASO), which surprisingly increased the amateur activities and inspired other amateur groups to revive. During IYA 2009, more than 80 outreach and observation events were organized solely by NASO. NASO was able to collaborate with many international programmes and projects like GHOU/GTTP, EurAstro, AWB, UNAWE, SGAC, Star Peace, TWAN etc during and beyond IYA2009. Currently Nepal is recognized as the most eventful country of outreach and astronomy education among the amateur community. The success story of the astronomy movement and the local difficulties while organizing the events will be explained.

Monsoon Rainfall and Landslides in Nepal

NASA Astrophysics Data System (ADS)

Dahal, R. K.; Hasegawa, S.; Bhandary, N. P.; Yatabe, R.

2009-12-01

A large number of human settlements on the Nepal Himalayas are situated either on old landslide mass or on landslide-prone areas. As a result, a great number of people are affected by large- and small-scale landslides all over the Himalayas especially during monsoon periods. In Nepal, only in the half monsoon period (June 10 to August 15), 70, 50 and 68 people were killed from landslides in 2007, 2008 and 2009, respectively. In this context, this paper highlights monsoon rainfall and their implications in the Nepal Himalaya. In Nepal, monsoon is major source of rainfall in summer and approximately 80% of the annual total rainfall occurs from June to September. The measured values of mean annual precipitation in Nepal range from a low of approximately 250 mm at area north of the Himalaya to many areas exceeding 6,000 mm. The mean annual rainfall varying between 1500 mm and 2500 mm predominate over most of the country. In Nepal, the daily distribution of precipitation during rainy season is also uneven. Sometime 10% of the total annual precipitation can occur in a single day. Similarly, 50% total annual rainfall also can occur within 10 days of monsoon. This type of uneven distribution plays an important role in triggering many landslides in Nepal. When spatial distribution of landslides was evaluated from record of more than 650 landslides, it is found that more landslides events were concentrated at central Nepal in the area of high mean annual rainfall. When monsoon rainfall and landslide relationship was taken into consideration, it was noticed that a considerable number of landslides were triggered in the Himalaya by continuous rainfall of 3 to 90 days. It has been noticed that continuous rainfall of few days (5 days or 7 days or 10 days) are usually responsible for landsliding in the Nepal Himalaya. Monsoon rains usually fall with interruptions of 2-3 days and are generally characterized by low intensity and long duration. Thus, there is a strong role of antecedent rainfall in triggering landslides. It is noticed that a moderate correlation exists between the antecedent rainfalls of 3 to 10 days and the daily rainfall at failure in the Nepal Himalaya. The rainfall thresholds are utilized to develop early warning systems. Taking reference of the intensity-duration threshold and normalized rainfall intensity threshold, two proto-type models of early warning systems (RIEWS and N-RIEWS) are proposed. Early warning models show less time for evacuation in the case of short duration and high intensity rainfall, whereas for long duration rainfall, warning time is enough and when warning information disseminate to the people, people will aware to possible landslide risk. In the meantime, they will be mentally ready to tackle with possible disaster of coming hours or days and will avoid the consequences. On the basis of coarse hydro-meteorological data of developing country like Nepal, this simple and rather easy model of early warning will certainly help to reduce fatalities from landslides.

Paleozoic sedimentary rocks in the Red Dog Zn-Pb-Ag district and vicinity, western Brooks Range, Alaska: provenance, deposition, and metallogenic significance

USGS Publications Warehouse

Slack, John F.; Dumoulin, Julie A.; Schmidt, J.M.; Young, L.E.; Rombach, Cameron

2004-01-01

The distribution and composition of Paleozoic strata in the western Brooks Range may have played a fundamental role in Zn-Pb mineralization of the Red Dog district. In our model, deposition and early lithification of biogenic chert and bedded siliceous rocks in the upper part of the Kuna Formation served as a regional hydrologic seal, acting as a cap rock to heat and hydrothermal fluids during Late Mississippian base-metal mineralization. Equally important was the iron-poor composition of black shales of the Kuna Formation (i.e., low Fe/Ti ratios), which limited synsedimentary pyrite formation in precursor sediments, resulting in significant H2S production in pore waters through the interaction of aqueous sulfate with abundant organic matter. This H2S may have been critical to the subsurface deposition of the huge quantities of Zn and Pb in the district. On the basis of this model, we propose that low Fe/Ti and S/C ratios in black shale sequences are potential basin-scale exploration guides for giant sediment-hosted, stratiform Zn-Pb-Ag deposits.

Photocopy of plan (in collection of U.S. Coast Guard Civil ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of plan (in collection of U.S. Coast Guard Civil Engineering Unit Providence, Warwick, RI), U.S. Coast Guard Civil Engineering, third district, Sandy Hook L/B Station showing boat basin plan, circa 1945 Detail of western docking structure - U.S. Coast Guard Sandy Hook Station, Western Docking Structure, West of intersection of Canfield Road & Hartshorne Drive, Highlands, Monmouth County, NJ

The Higher Education-Economy Tie: A Sampling of Exemplary Programs in the West. Higher Education and the Economy of the West. Working Paper #3.

ERIC Educational Resources Information Center

Western Interstate Commission for Higher Education, Boulder, CO.

This paper, one of a series from the Western Interstate Commission for Higher Education's project "Higher Education and the Economy of the West," describes 31 programs in 16 western states that illustrates higher education's contribution to the economy. Four school-university partnerships are described: the Pueblo School District 60/University of…

Establishing a Computerized Substance Abuse Surveillance System for District Social Workers in the Western Cape Province, South Africa: Methods, Successes and Challenges

ERIC Educational Resources Information Center

Burnhams, Nadine Harker; Myers, Bronwyn; Fakier, Nuraan; Parry, Charles; Carelse, Jermaine

2011-01-01

The provision of accurate, in-depth data on substance abuse trends and service needs has become increasingly important in light of the growing wave of substance abuse in South Africa and particularly in the Western Cape Province. This article describes the design and implementation of an electronic substance abuse surveillance system (SASS)…

Nepali Private Schools and Tolerated Illegality: A Foucauldian Analysis of Privatisation of Education in Nepal

ERIC Educational Resources Information Center

Sharma Poudyal, Chandra

2017-01-01

The Education Act 1971 is the main policy document under which schools in Nepal are operated. With the change in political regime, this policy has been amended as per the ideology of the incoming regime. Although private schools started to show their influence in Nepal in the late 1980s, excessive growth of private schools began with the…