Management of COVID-19 and vaccination in Nepal: A qualitative study.

OBJECTIVE: The aim of this research is to investigate the perspective of citizens of Nepal on the management COVID-19, the roll-out of the vaccine, and to gain an understanding of attitudes towards the governments' handling of the COVID-19 pandemic. METHOD: A qualitative methodology was used. In-depth interviews were conducted with 18 males and 23 females aged between 20 and 86 years old from one remote and one urban district of Nepal. Interviews were conducted in November and December 2021. A thematic approach was used to analyse the data, utilising NVivo 12 data management software. RESULT: Three major themes were identified: (1) Peoples' perspective on the management of COVID-19, (2) people's perception of the management of COVID-19 vaccination and (3) management and dissemination of information. It was found that most participants had heard of COVID-19 and its mitigation measures, however, the majority had limited understanding and knowledge about the disease. Most participants expressed their disappointment concerning poor testing, quarantine, vaccination campaigns and poor accountability from the government towards the management of COVID-19. Misinformation and stigma were reported as the major factors contributing to the spread of COVID-19. People's knowledge and understanding were mainly shaped by the quality of the information they received from various sources of communication and social media. This heavily influenced their response to the pandemic, the preventive measures they followed and their attitude towards vaccination. CONCLUSION: Our study concludes that the study participants' perception was that testing, quarantine centres and vaccination campaigns were poorly managed in both urban and rural settings in Nepal. Since people's knowledge and understanding of COVID-19 are heavily influenced by the quality of information they receive, we suggest providing contextualised correct information through a trusted channel regarding the pandemic, its preventive measures and vaccination. This study recommends that the government proactively involve grassroots-level volunteers like Female Community Health Volunteers to effectively prepare for future pandemics. PATIENT AND PUBLIC CONTRIBUTION: This study was based on in-depth interviews with 41 people from diverse socioeconomic backgrounds. This study would not have been possible without their participation.

Dalit's livelihoods in Nepal: income sources and determinants.

This paper focuses on the lack of income opportunities for Dalits in Nepal, as they are the most affected group in any disaster. The presence of vulnerable family members in Dalit households may further increase their income deprivation. We therefore studied Dalit households' income sources and identified income determinants in Gandaki Rural Municipality in Gorkha District-the epicentre of the 2015 earthquake. We observed a higher dependency of Dalit households on daily wages, livestock sales, social security allowances, and vegetables sales; however, remittance and seasonal job earnings represented the largest share of household incomes. We observed a significant difference in per capita income between farm (US$46) and non-farm (US$273) income sources, with the difference smallest in the lowest income quantile and the largest in the highest quantile. When the household head was a single woman, we observed a reduction in non-farm (by 29%) and total incomes (by 23%). Likewise, when the household head had a chronic health problem, or the household included an elderly family member, there was a reduction in the household's income. We suggest economic interventions for Dalit households to prevent increased social exclusion in the development process, specifically focusing on vulnerable individuals and households in the lowest income quantile.

Mental Health Risks Among Informal Waste Workers in Kathmandu Valley, Nepal.

Informal waste workers are a vulnerable population group who are often socio-economically marginalized and disadvantaged, with more likelihood of experiencing ill health than the general population. To explore the determinants of mental ill health in this group, we conducted a cross-sectional survey of 1278 informal waste-workers in Nepal in 2017, using a demographic health assessment questionnaire and a modified Patient Health Questionnaire (PHQ-9). We looked at the potential associations between various exposure factors and mental health outcomes and found that 27.4% of waste-workers had depressive symptoms, more likely to be reported by female (OR 2.290), older person (OR 7.757), divorced/separated (5.859), and those with ill health (OR 2.030), or disability (OR 3.562). Waste-workers with access to social protection (OR 0.538) and financial savings (OR 0.280) were less likely to have depressive symptoms. There are key risk factors that may enable identification of particularly vulnerable persons within this group and also protective factors that may help improve their mental health resilience.

Risks and risk mitigation in waste-work: A qualitative study of informal waste workers in Nepal.

Objectives: To explore how informal waste workers (IWWs) working in Kathmandu Valley perceive risks associated with waste work and what they do to mitigate them. Study design: Qualitative Study Design. Methods: A mix of one-to-one semi-structured interviews (n â€‹= â€‹18) and focus group discussions (n â€‹= â€‹4) with IWWs were undertaken. Participants were recruited purposively using snowball sampling. All interviews and discussions were audio-recorded, transcribed verbatim, translated and subsequently analysed thematically. Results: The IWWs perceived discrimination and health risks as the main risks associated with waste work. IWWs reported considerable stigma and discrimination not only from the wider society but also from family members and within their own profession. Similarly, the occupational risks most frequently recognized were physical injuries and cuts from working with waste. However, the potential risks from hazardous chemicals present in or generated from waste were not articulated by participants. Mitigation strategies to combat the risks included avoidance, greater care and the use of informal means of "protection". Awareness of the importance of personal protective equipment (PPE) was limited. The key barriers to the use of PPE identified included costs, the lack of easy availability of PPE and the inconvenience of working with PPE. Conclusions: The vulnerability of informal waste workers in Nepal is multifaceted. A range of policy and regulatory measures, along with interventions that promote greater social inclusion and occupational support are needed to promote IWW's health and safety.