Factors Influencing Time From Diagnosis to Treatment of Breast Cancer and the Impact of Longer Waiting Time on Survival in Kathmandu Valley, Nepal: A Population-Based Study.

PURPOSE: Longer time between breast cancer (BC) diagnosis and treatment initiation is associated with poorer survival, and this may be a factor behind disparities in global survival rates. We assessed time to BC treatment in the Kathmandu Valley, Nepal, including factors associated with longer waiting times and their impact on survival. METHODS: We conducted a retrospective population-based study of BC cases recorded in the Kathmandu Valley Population-Based Cancer Registry between 2018 and 2019. Fieldwork survey through telephone was undertaken to collect additional sociodemographic and clinical information. Logistic regression was performed to identify factors associated with longer time to treatment, and Kaplan-Meier and Cox proportional hazard regression was used to examine survival time and evaluate the association between longer time to treatment and survival. RESULTS: Among the 385 patients with BC, one third waited >4 weeks from diagnosis to initial treatment. Lower education was associated with longer time to treatment (adjusted odds ratio, 1.63 [95% CI, 1.03 to 2.60]). The overall 3-year survival rate was 88.6% and survival was not associated with time to treatment (P = .50). However, advanced stage at diagnosis was associated with poorer survival (adjusted hazard ratio, 4.09 [95% CI, 1.27 to 13.23]). There was some indication that longer time to treatment was associated with poorer survival for advanced-stage patients, but data quality limited that analysis. CONCLUSION: In the Kathmandu Valley, Nepal, women with a lower education tend to wait longer from BC diagnosis to treatment. Patients with advanced-stage BC had poorer survival, and longer waiting time may be associated with poorer survival for women diagnosed with advanced-stage disease.

Barriers and facilitators for strengthening physiotherapy services in Nepal: perspectives from physiotherapists and health providers.

BACKGROUND: Physiotherapy provides non-invasive and non-pharmaceutical intervention for curative, rehabilitation and preventative purposes. Physiotherapy is also a central provider of health promotion. As the global burden of non-communicable diseases and chronic health conditions is rising, the importance of physiotherapy services increases. Unfortunately, physiotherapy services in low- and middle-income countries (LMICs) are generally unsatisfactory. In Nepal, the earthquake in 2015 and the COVID pandemic have clearly illuminated the importance of physiotherapy. OBJECTIVE: This qualitative study aimed to identify barriers and facilitators at different system levels for strengthening physiotherapy services in Nepal. METHODS: Forty semi-structured individual interviews were performed with different health providers. Transcribed interviews were assessed with thematic analysis. A five-level socioecological framework conceptualised multilevel determinants of barriers and facilitators. RESULTS: The study revealed various factors that were potential barriers and facilitators across five different levels, namely individual (taking the lead, need for advocacy), interpersonal (lack of recognition and autonomy, networking for referrals and coordination), community (lack of knowledge and awareness, social and family support), organisational (accessibility, workplace and clinical practice, educational opportunities, role of organisations and rehabilitation centres), and public policy level (planning and implementation of policies and programs, medical hegemony, priorities). Government officials, local leaders, and clinicians, half of whom were physiotherapists, agreed on many of the same issues, where a lack of awareness of what physiotherapy is and knowledge about what physiotherapists do was central. CONCLUSIONS: The results provide information for the development of physiotherapy by pointing out key elements that need attention. Our broad and structured investigation strategy is applicable to others for a comprehensive analysis of barriers and facilitators for physiotherapy services.

Intestinal parasites in goats (Capra hircus Linnaeus, 1758) in Bhaktapur, Nepal.

The present study was conducted to determine the prevalence of gastrointestinal (GI) parasites in goats of Suryabinayak Municipality, Bhaktapur, Nepal. A total of 300 faecal samples of goats were collected from the study area from July to August 2021 and subjected to direct smear, sedimentation, and flotation techniques for coprological examination. The study revealed that 86% of samples were positive for GI parasites with 15 genera, including six genera of protozoan, and nine genera of helminths. Age-dependent prevalence of helminth parasites was higher in adult goats (75%) than that young ones. Single infection was recorded 31.01%, double was 35.27%, and multiple was 33.72%. Training on goat rearing, proper management of goat farms, awareness on GI diseases, and their control can help the owners increase productivity.

Exploring the factors behind socioeconomic inequalities in Antenatal Care (ANC) utilization across five South Asian natiaons: A decomposition approach.

Maternal and child mortality rates remain a significant concern in South Asian countries, primarily due to limited access to maternal care services and socioeconomic disparities. While previous studies have examined the factors influencing the utilization of antenatal care (ANC) services in individual countries, there is a lack of comparative analysis across South Asian nations. This study aims to investigate the factors affecting ANC utilization among women aged 15-49 in Bangladesh, India, Nepal, Maldives, and Pakistan using the latest Demographic and Health Survey data. The study utilized a total weighted sample size of 262,531 women. Simple bivariate statistics and binary logistic regression were employed to identify potential factors influencing ANC utilization. Decomposition analysis and concentration curve (Lorenz curve) were used to assess inequality in ANC service utilization. The prevalence of ANC utilization varied across the countries, with Maldives having the highest (96.83%) and Bangladesh the lowest (47.01%). Women's and husbands' education, household wealth status, BMI, and urban residence were found to significantly influence maternal healthcare services utilization. Higher education levels, affluent wealth quintiles, and urban living were identified as significant contributors to socioeconomic disparities in accessing ANC services. This study highlights the crucial role of socioeconomic factors in the utilization of maternal healthcare services in South Asian countries. Governments should focus on improving healthcare infrastructure, addressing cultural barriers, and promoting education to address these disparities. Identifying context-specific causes of maternal healthcare utilization is essential to inform targeted interventions and policies aimed at improving access to ANC services and reducing maternal mortality rates.

Health literacy and its determinants among school-going children: a school-based cross-sectional study in Nepal.

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

The prevalence of pain catastrophising in nulliparous women in Nepal; the importance for childbirth.

In Lower-Middle-Income-Countries women are encouraged to present at a birthing facility for skilled care, but attending early can be associated with additional harm. Women admitted in latent labour are more likely to receive a cascade of unnecessary interventions compared with those attending a birthing facility during active labour. One reason that women present early is pain, with higher rates of admission among those who pain catastrophise. The aim of this study was to explore the prevalence of pain catastrophising in nulliparous women in Nepal and to identify predictors for pain catastrophising. A cross sectional study was conducted using a semi-structured survey. The survey was completed by 170 women (18-32 years) in one higher education institution in Kathmandu. The survey included the pain catastrophising scale (PCS), current and previous pain and information about period pain, sociodemographic variables of age, ethnicity, and religion. The prevalence of pain catastrophising reported at a cut off score of PCS≥20 was 55.9% and at a cut off score of PCS≥30 was 17.1%. All women with a PCS ≥30 reported having painful periods. Those with a PCS≥20 were four times [95%CI 1.93-8.42] more likely to report painful periods affecting their daily activities (p<0.001) and those with PCS≥30 three times [95%CI1.10-10.53] more likely (p<0.05). In both cases ethnicity and age were not associated. Women with higher PCS were less likely to take pain medication. A high prevalence of pain catastrophising was reported. It is important to understand how women's previous negative experiences of pain and pain catastrophising are perceived and if they are contributing to the rise in obstetric intervention, particularly caesarean births, in Nepal. We recommend repeating this study with a larger sample representing a more diverse population.

Prevalence, determinants and care-seeking behaviour for anxiety and depression in Nepalese population: a secondary analysis of data from Nepal Demographic and Health Survey 2022.

OBJECTIVE: To determine the prevalence and factors associated with anxiety and depression and the care-seeking behaviour among Nepalese population. DESIGN AND SETTINGS: Secondary analysis of the data from nationally representative Nepal Demographic and Health Survey 2022. PARTICIPANTS: Analysed data of 12 355 participants (7442 females and 4913 males) aged 15-49 years. OUTCOME MEASURES: Depression and anxiety were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) tools, respectively. STATISTICAL ANALYSIS: We performed weighted analysis to account for the complex survey design. We presented categorical variables as frequency, per cent and 95% confidence interval (CI), whereas numerical variables were presented as median, inter-quartile range (IQR) and 95% CI. We performed univariate and multivariable logistic regression to determine factors associated with anxiety and depression, and results were presented as crude OR (COR), adjusted OR (AOR) and their 95% CI. RESULTS: The prevalence of depression and anxiety were 4.0% (95% CI 3.5 to 4.5) and 17.7% (95% CI 16.5 to 18.9), respectively. Divorced or separated participants were found to have higher odds of developing anxiety (AOR 2.40, 95% CI 1.74 to 3.31) and depression (AOR 3.16, 95% CI 1.84 to 5.42). Among ethnic groups, Janajati had lower odds of developing anxiety (AOR 0.77, 95% CI 0.65 to 0.92) and depression (AOR 0.67, 95% CI 0.49 to 0.93) compared with Brahmin/Chhetri. Regarding disability, participants with some difficulty had higher odds of developing anxiety (AOR 1.81, 95% CI 1.56 to 2.10) and depression (AOR 1.94, 95% CI 1.51 to 2.49), and those with a lot of difficulty had higher odds of anxiety (AOR 2.09, 95% CI 1.48 to 2.96) and depression (AOR 2.04, 95% CI 1.06 to 3.90) compared with those without any disability. Among those who had symptoms of anxiety or depression, only 32.9% (95% CI 30.4 to 34.4) sought help for the conditions. CONCLUSIONS: Marital status and disability status were positively associated with anxiety and depression, whereas Janajati ethnicity had relatively lower odds of experiencing anxiety and depression. It is essential to develop interventions and policies targeting females and divorced individuals to help reduce the burden of anxiety and depression in Nepal.

Challenges and possible improvements for healthcare teams at outreach clinics in Nepal - a qualitative study.

BACKGROUND: All Nepalese citizens have the right to high-quality healthcare services free of charge. To achieve this, healthcare services for the rural population in Nepal need to be improved in terms of personnel, medicines, and medical equipment. OBJECTIVES: To explore challenges and possible improvements healthcare personnel experience when travelling to rural parts of Nepal to provide healthcare. METHOD: Data was collected from various health professionals using focus group discussions at Dhulikhel Hospital in Nepal. The data were transcribed and analysed using Systematic text condensation. RESULTS: Twenty-two professional healthcare personnel participated in five group discussions. Four categories emerged from the collected material: Finding ORC services being underutilised, Wanting to fulfil tasks and do a good job, Facing inadequate resources, and Seeing the need for improved organisation and cooperation. There was consensus that rural clinics are important to maintaining health for the rural population of Nepal. However, there was frustration that the rural population was not benefitting from all available healthcare services due to underutilisation. CONCLUSION: Rural healthcare clinics are not utilised appropriately, according to healthcare workers at the rural outreach clinics. Potential ways of overcoming the perceived challenges of underutilising available healthcare services include financial and human resources. The rural population´s health awareness needs to be increased, and the work environment for rural healthcare workers needs to be improved. These issues need to be prioritised by the government and policymakers.

Main findings: Outreach clinics in Nepal are perceived as underutilised by health providers.Added knowledge: Increased awareness among rural people on when to seek healthcare, improved work conditions for health providers and collaboration with other health facilities may strengthen the utilisation of offered care.Global health impact for policy and action: Updated policies reflecting these Nepalese suggestions on strengthening rural healthcare may be useful and benefit other rural populations in similar settings.

Association of serum homocysteine with vitamin B12 and folate levels in women with pre-eclampsia in a tertiary health care center in Nepal.

BACKGROUND: Pre-eclampsia is a syndrome that chiefly includes the development of new-onset hypertension and proteinuria after 20 weeks of pregnancy. Pre-eclampsia is one of the major causes of mortality and morbidity in Nepal. Hyperhomocysteinemia may be a cause of the endothelial dysfunction provoked by oxidative stress in pre-eclampsia. This study was designed to evaluate the association of homocysteine with Vitamin B12 and folate in patients with pre-eclampsia. METHOD: An observational cross sectional study was performed in the Gynecology and Obstetrics Department of TUTH involving seventy two subjects with pre-eclampsia. Blood pressure, urinary protein levels, serum homocysteine, Vitamin B12 and folate levels were compared in both mild and severe forms of pre-eclampsia. Concentration of Vitamin B12 and folate were measured using Vitros ECI and homocysteine was measured using CLIA. SPSS 23.0 was used to analyze the data. Tests were performed with Mann Whitney Test and Spearman's rank correlation test. A p-value < 0.05 was considered statistically significant. RESULTS: This study showed no significant difference in age and weeks of gestation in both mild and severe forms of pre-eclampsia. Mean concentration of homocysteine was higher (13.1 ± 6.4 micromol/L) in severe Pre-eclampsia as compared to mild cases (7.6 ± 2.8 micromol/L). Mean concentration of folate was lower in severe cases (35.4 ± 24.1 micromol/L) when compared with mild cases of pre-eclampsia (57 ± 23.4 micromol/L). CONCLUSION: Homocysteine levels were increased in severe Pre-eclampsia when compared with mild pre-eclampsia and this finding can be used to predict and prevent complications in patients with pre-eclampsia.

Medical students' experience and learning outcomes of overseas community involvement project: a qualitative study.

BACKGROUND: Medical students in Singapore engage in short term medical missions, locally known as Overseas Community Involvement Projects (OCIPs). Little is known about the learning outcomes of an OCIP and how this complements their medical education back home. Understanding this can help the medical educators structure the OCIP to optimise its learning value. OBJECTIVES: This study aims to gain an in-depth understanding of the experiences and learning outcomes of the medical students who participated in the OCIP. METHODS: This was a qualitative study involving Singaporean students from one medical school travelling to Nepal. Data was collected from reflective journals, overall group reflections and two focus group discussions. The data was thematically analysed using the Accreditation Council for Graduate Medical (ACGME) core competencies for medical professionals. RESULTS: The data could be classified under various themes within the six domains of the ACGME framework. The study revealed themes of: humanism, socioeconomic and cultural determinants of health under the domain of patient care, application of medical knowledge, investigating and evaluating the needs of a population and feedback to drive improvement under the domain of practice-based learning and improvement, use of non-verbal cues and communicating across language barriers under the domain of interpersonal and communication skills, healthcare systems and delivery, resourcefulness and adaptability, health equity and accessibility under the domain of systems-based practice, ethics, role-modelling, teamwork and leadership skills, interprofessional skills and resilience under the domain of professionalism. Understanding the students' motivations, utilising reflections, and following the patients' journey facilitated attainment of these outcomes. CONCLUSIONS: This OCIP experience translated to learning outcomes aligned with the ACGME framework. There is great potential for the experiential learning from a well-structured OCIP to help with personal and professional development and global health education.

Dating violence prevalence and factors associated among undergraduate public health students of Kathmandu metropolitan city, Nepal: a cross-sectional study.

OBJECTIVE: The objective of this research was to assess the prevalence of dating violence (DV) and factors associated among undergraduate public health students of Kathmandu metropolitan city (KMC), Nepal. DESIGN: A descriptive cross-sectional study was conducted involving undergraduate public health students in Kathmandu. We recruited the students using probability proportionate sampling techniques. Data collection was carried out using a self-administered questionnaire. The duration of study was from May 2022 to March 2023. SETTING: We conducted a quantitative study among undergraduate students of 11 colleges out of 14 public health colleges located within Kathmandu. PARTICIPANTS: 352 public health students including both men and women were involved in the study. College-going students who were willing to give consent were included in the study. OUTCOME MEASURE: A significant prevalence of DV was seen among undergraduate public health students of KMC. Both univariate and multivariate logistic regression techniques were applied to assess the relationship of factors associated with DV and reported adjusted ORs (aOR) with 95% CIs. All statistical analyses were executed using the SPSS V.24. RESULTS: Among 352 respondents, 182 were having current or past dating relationships. The study shows that the majority (78.02%) of respondents had experienced DV during the time of study or any time in the past. DV was more likely among male participants (aOR 3.95, 95% CI 1.14 to 13.58) and whose partners consumed alcohol (aOR 4.58, 95% CI 1.70 to 12.34). Participants who had ever been exposed to violence done by family members were more likely to experience DV (aOR 5.97, 95% CI 1.39 to 25.49). CONCLUSIONS: The study highlights a significant prevalence of DV among undergraduate public health students in Kathmandu, underscoring the urgency for implementing programmes aimed at addressing this issue.

Utilisation of eye health services and compliance with spectacles wear among community school adolescents: a mixed-methods study from Bagmati province of Nepal.

OBJECTIVES: This study aims to determine the factors influencing eye care service utilisation and compliance with spectacles wear among school students. DESIGN: Mixed-methods study. SETTING: 27 community schools from 6 districts of Bagmati province of Nepal. PARTICIPANTS: Adolescents with mild vision impairment who were screened at schools by their trained peers for visual acuity measurement and subsequently received subsidised spectacles for refractive error correction. For the quantitative study, 317 students from 21 schools completed the survey. For qualitative study, 62 students from 6 schools participated in 6 focus group discussions. PRIMARY OUTCOME MEASURES: Utilisation of eye care services and compliance with spectacles wear. RESULTS: Among 317 students, 53.31% were aged 15-19, and 35.96% were male. More than half (52.68%, n=167) did not use eye health services. Among students who did not go, 51.50% reported eye health facilities being far away. Thematic analysis showed that distance, COVID-19 and awareness were influential in the utilisation of eye care. The multivariate analysis showed urban residents were likelier (adjusted OR (AOR) 4.347, 95% CI 2.399 to 7.877, p<0.001) to use eye care services. During an unannounced visit to schools after 3-4 months of spectacles distribution, 188 (59.31%) students were wearing spectacles. 20.16% of students not wearing spectacles reported they did not feel the need. Thematic analysis showed the influence of family and peers, affordability, aesthetic appearance, comfortability and symptomatic relief in spectacles compliance. The multivariate analysis showed that urban residents (AOR 2.552, 95% CI 1.469 to 4.433, p<0.001), older adolescents (AOR 1.758, 95% CI 1.086 to 2.848, p=0.022), mothers with paid jobs (AOR 2.440, 95% CI 1.162 to 5.125, p=0.018) and students visiting eye care centres (AOR 1.662, 95% CI 1.006 to 2.746, p=0.047) were more likely to be compliant with spectacles wear. CONCLUSIONS: There are multiple barriers for students to use eye care services and stay compliant with spectacles wear. Eye health programmes should include eye health promotion and be accessible, affordable and equitable.

Carbapenem Resistance in Acinetobacter calcoaceticus-baumannii Complex Isolates From Kathmandu Model Hospital, Nepal, Is Attributed to the Presence of bla OXA-23-like and bla NDM-1 Genes.

The Acinetobacter calcoaceticus-baumannii (ACB) complex, also known as ACB complex, consists of four bacterial species that can cause opportunistic infections in humans, especially in hospital settings. Conventional therapies for susceptible strains of the ACB complex include broad-spectrum cephalosporins, ß-lactam/ß-lactamase inhibitors, and carbapenems. Unfortunately, the effectiveness of these antibiotics has declined due to increasing rates of resistance. The predominant resistance mechanisms identified in the ACB complex involve carbapenem-resistant (CR) oxacillinases and metallo-ß-lactamases (MBLs). This research, conducted at Kathmandu Model Hospital in Nepal, sought to identify genes associated with CR, specifically blaNDM-1, blaOXA-23-like, and blaOXA-24-like genes in carbapenem-resistant Acinetobacter calcoaceticus-baumannii (CR-ACB) complex. Additionally, the study is aimed at identifying the ACB complex through the sequencing of the 16s rRNA gene. Among the 992 samples collected from hospitalized patients, 43 (approximately 4.334%) tested positive for the ACB complex. These positive samples were mainly obtained from different hospital units, including intensive care units (ICUs); cabins; and neonatal, general, and maternity wards. The prevalence of infection was higher among males (58.14%) than females (41.86%), with the 40-50 age group showing the highest infection rate. In susceptibility testing, colistin and polymyxin B exhibited a susceptibility rate of 100%, whereas all samples showed resistance to third-generation cephalosporins. After polymyxins, gentamicin (30.23%) and amikacin (34.88%) demonstrated the highest susceptibility. A substantial majority (81.45%) of ACB complex isolates displayed resistance to carbapenems, with respiratory and pus specimens being the primary sources. Polymerase chain reaction (PCR) revealed that the primary CR gene within the ACB complex at this hospital was bla OXA-23-like, followed by bla NDM-1. To ensure the accuracy of the phenotypic assessment, 12 samples were chosen for 16s rRNA sequencing using Illumina MiSeq™ to confirm that they are Acinetobacter species. QIIME 2.0 analysis confirmed all 12 isolates to be Acinetobacter species. In the hospital setting, a substantial portion of the ACB complex carries CR genes, rendering carbapenem ineffective for treatment.

Occurrence of biofilm forming Escherichia coli in drinking water supply system in Kathmandu.

Biofilm development in gram negative bacterial contaminants in water supply systems is linked to persistence as well as antibiotic resistance, which threatens water quality and hence the public health. This study aimed to investigate phenotypic and genetic capacity of biofilm formation by Escherichia coli isolated from supply water with their antibiotic susceptibility pattern. Altogether fifty water samples collected from a city supply water distribution scheme in Kathmandu were analyzed to assess the physicochemical and microbiological quality. Comparing Nepal's national drinking water quality standards 2022, conductivity (4%), turbidity (18%), iron (28%), and residual chlorine (8%) were found exceeding the values above the standards. Among total, 40% of water samples were contaminated with total coliform bacteria. E. coli and Citrobacter species were dominant and isolated from 20 (64.52%) and 11 (35.48%) water samples, respectively. Antibiotic susceptibility testing revealed that E. coli isolates were resistant to ampicillin (20%), nitrofurantoin (10%), and cefotaxime (10%). Citrobacter spp. (54.54%) were found multidrug resistant (MDR) while none of the isolates of E. coli were MDR. Of total, 45% of the isolates developed biofilm while testing with the Microtiter plate method. Biofilm-forming genes bcsA and csgD in E. coli isolates were detected with polymerase chain reaction (PCR) employing specific primers. bcsA and csgD genes were detected in 55% and 45% of the isolates, respectively. This study confirms the occurrences of biofilm forming and antibiotic resistant bacteria like E. coli in the drinking water supply system in Kathmandu alarming its environmental circulation and possible public health threat. Although further study is warranted, this study suggests public health and drinking water treatment interventions to mitigate the biofilm forming antibiotic resistant potential pathogens from supply water in Kathmandu, Nepal. PRACTITIONER POINTS: Forty percent of tested drinking water samples in Kathmandu were contaminated with total coliform bacteria. E. coli and half of Citrobacter spp. isolates were resistant to multiple antibiotics. bcsA and csgD genes were detected in biofilm producing E.coli isolates.

Intimate partner violence in Nepal: Analysis of Nepal Demographic and Health Survey 2022.

INTRODUCTION: Intimate partner violence (IPV) is a major public health issue in Nepal. IPV has social and economic impacts on women, family, and the wider society. In this study, we aimed to determine factors associated with IPV among currently partnered women aged 15-49. METHODS: We conducted a secondary data analysis of the Nepal Demographic and Health Survey (NDHS) 2022. The study examines the lifetime prevalence of IPV. IPV was measured in three domains: experience of physical violence, emotional violence, and sexual violence. Weighted univariate and multivariable logistic regression analysis were applied to determine factors associated with IPV. The results of logistic regression were presented as crude odds ratio (COR) and adjusted odds ratio (AOR) and their 95% confidence interval (CI). RESULTS: Of 3853 women, 27.2% had experienced any form of IPV. The lifetime prevalence of physical violence, emotional violence, and sexual violence were 23.2%, 12.8%, and 7.1%, respectively. Higher odds of physical violence were reported among women aged 35-49 years (AOR: 2.13, 95% CI: 1.58-2.87), women without formal education (AOR: 1.51, 95% CI: 1.10-2.06), and women who justified wife-beating (AOR: 1.23, 95% CI: 1.00-1.52). Women from poor households (AOR: 1.61, 95% CI: 1.12-2.35) and women with uneducated partners (AOR: 1.66, 95% CI: 1.08-2.58) were at higher risk of experiencing sexual violence. Women with unemployed husbands reported a higher risk of physical violence (AOR: 2.72, 95% CI: 1.45-5.06) and emotional violence (AOR: 1.61, 95% CI: 1.12-2.35). CONCLUSION: Almost one in three currently partnered women experienced some form of IPV in their lifetime. Various sociodemographic, partner-related, and women's empowerment-related factors were associated with experiencing IPV. Acknowledging and addressing these factors is essential to mitigating the high rates of IPV among reproductive aged women.

Assessing the prevalence and impact of preserved ratio impaired spirometry in low-income and middle-income countries: a post-hoc cross-sectional analysis.

BACKGROUND: More than 90% of the morbidity and mortality from chronic respiratory disease occurs in low-income and middle-income countries (LMICs), with substantial economic impact. Preserved ratio impaired spirometry (PRISm) is a prevalent lung function abnormality associated with increased mortality in high-income countries. We aimed to conduct a post-hoc analysis of a cross-sectional study to assess the prevalence of, the risk factors for, and the impact of PRISm in three diverse LMIC settings. METHODS: We recruited a random, age-stratified and sex-stratified sample of the population in semi-urban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda. Quality-assured post-bronchodilator spirometry was performed to American Thoracic Society standards and PRISm was defined as a forced expiratory volume in one second (FEV1) of less than 80% predicted with a FEV1/forced vital capacity ratio of 0·70 or more. We used t tests and χ2 analyses to assess the relationships between demographic, biometric, and comorbidity variables with PRISm. Multivariable logistic models with random intercept by site were used to estimate odds ratios (ORs) with 95% CIs. FINDINGS: 10 664 participants were included in the analysis, with a mean (SD) age of 56·3 (11·7) years and an equal distribution by sex. The prevalence of PRISm was 2·5% in Peru, 9·1% in Nepal, and 16·0% in Uganda. In multivariable analysis, younger age (OR for each decile of age 0·87, 95% CI 0·82-0·92) and being female (1·37, 1·18-1·58) were associated with increased odds of having PRISm. Biomass exposure was not consistently associated with PRISm across sites. Individuals with PRISm had impairment in respiratory-related quality of life as measured by the St George's Respiratory Questionnaire (OR by decile 1·18, 95% CI 1·10-1·25). INTERPRETATION: The prevalence of PRISm is heterogeneous across LMIC settings and associated with age, female sex, and biomass exposure, a common exposure in LMICs. A diagnosis of PRISm was associated with worse health status when compared with those with normal lung function. Health systems in LMICs should focus on all spirometric abnormalities as opposed to obstruction alone, given the disease burden, reduced quality of life, and size of the undiagnosed population at risk. FUNDING: Medical Research Council.

Burn pain management in a female patient with severe burn injuries in Nepal: a case study and review.

Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals. Pharmacological interventions are impacted by financial constraints and a lack of protocols, while nonpharmacological approaches have not been explored and contextualized for the Nepalese context due to similar financial issues. Comprehensive burn pain management requires addressing resource constraints through collaborative health-aid partnerships.

Burn injuries are among the most painful conditions. Burn injury treatment poses a significant challenge to low-resource countries like Nepal. This review focuses on the case of a 35-year-old woman from rural Nepal who suffered severe burns from boiling water. It depicts the journey and ordeal of the patient to receive burn pain treatment in Kathmandu, Nepal.Effective management of burn pain requires a multidisciplinary approach, including pharmacological and nonmedical treatments such as wound care and psychological support. However, in Nepal, these treatments are often limited due to resource shortages and a lack of specialized medical centers. The patient was eventually transferred to a burn injury treatment center in Kathmandu, Nepal, where multiple surgeries, including skin grafts donated by family members, helped her survive.The review also discusses various aspects of burn injuries in Nepal and the challenges of burn injury treatment and burn pain management in Nepal. It highlights the necessity for establishing specialized burn injury treatment centers and implementing a comprehensive burn injury management plan. These measures aim to enhance outcomes and alleviate suffering for burn patients in Nepal and other low-resource settings.

Technology in farming: Unleashing farmers' behavioral intention for the adoption of agriculture 5.0.

The agriculture sector has undergone a remarkable revolution known as Agriculture 5.0 (Ag 5.0), emphasizing digital technology to boost efficiency and profitability of farm business. However, little is known about farmers' behavioral intension to adopt Ag 5.0. In this study we examine factors influencing farmer's behavioral intension for Agriculture 5.0, identify implementation obstacles and provide managerial solutions to promote Ag 5.0 in Madhesh Province, Nepal, using the Technology Acceptance Model (TAM) and Structural Equation Model (SEM). We tested total of 20 different hypotheses. Primary data were collected from 271 farmers across 9 municipalities in Saptari District, Nepal. The study reveals that technology anxiety [(ß = 0.101, p<0.01); (ß = 0.188, p<0.01)], self-efficacy [(ß = 0.312, p<0.01, (ß = 0.170, p<0.05)] and social influence [(ß = 0.411, p<0.01), (ß = 0.170, p<0.05)] significantly impact the perceived usefulness as well as perceived ease of use, respectively. Individual innovativeness also affects the perceived usefulness (ß = 0.004, p<0.05) and perceived ease of use (ß = 0.281, p<0.01). Moreover, the study found that attitude towards using Ag 5.0 is significantly influenced by perceived usefulness (ß = 0.083, p<0.10) and ease of use (ß = 0.189, p<0.01), which, in turn, affects the intention to use Ag 5.0 (ß = 0.858, p<0.01). Farmers perceive training programs, government assistance, and subsidies as helpful in overcoming challenges associated with adopting Ag 5.0. This study provides valuable insights for policymakers, development partners, and farmers' organizations, enabling them to understand the factors influencing the readiness for Ag 5.0 adoption in Nepal.

Exploring lifestyles, work environment and health care experience of Nepalese returnee labour migrants diagnosed with kidney-related problems.

In recent years, international media and the scientific community have expressed concerns regarding rising kidney health-related risks among Nepalese labour migrants in Gulf countries and Malaysia. Previous studies have highlighted poor lifestyles and work conditions among Nepalese migrants, which could potentially impact their kidney health. This qualitative study aims to explore the lifestyles and work environment of returnee Nepalese migrants who were diagnosed with kidney health problems. In-depth interviews were carried out with twelve returnee migrants, all males, with half having worked abroad for at least a decade. Our analysis yielded seven themes: (a) living and lifestyles; (b) work environment; (c) exposure to pollutants; (d) Chronic Kidney Disease (CKD) experience; (e) use of painkillers and healthcare; (f) medical expenses for CKD patients; and (g) pre-departure training. This study indicates that Nepalese migrants face numerous challenges, including limited access to clean water and sanitation facilities, poor diets, exposure to occupational hazards, and overuse of pain medication, all of which may contribute to an increased risk of kidney disease. An enhanced pre-departure and on-arrival orientation programme focusing on kidney health-related topics, including the necessary advocacy at the country of destination to provide access to basic services, may encourage migrants to adopt healthy lifestyles and safe working environments, as well as help sensitise migrants to their kidney health risks.

Bacteriospermia in men among infertile couples in the Nepalese population.

Infection of the male urogenital tract or male accessory glands is considered one of the important causes of male infertility, and results in the presence of bacteria in semen affecting the fertility potential of men. This study aims to understand the rate of seminal infection in infertile men, and its association with semen parameters related to fertility potential. The study was carried out from June 2021 to July 2022, in which 217 semen samples were collected from male partners of couples consulting for fertility complaints in a fertility center in Nepal. Analysis of semen parameters was done following the WHO guidelines for human semen analysis, 2021. Microbiological assessment of semen by culture-based approach showed bacteriospermia among 25.3% of samples. Staphylococcus aureus was the predominant isolate in semen. The volume of semen was reduced (p = 0.001 at 95% confidence interval) with bacteriospermia. The concentration, total motility, morphology, and vitality of spermatozoa in the samples tended to be negatively impacted due to bacteriospermia, however, the associations were insignificant at 95% CI. Our study indicates impairment of semen parameters is partially associated with bacterial infection, and hence bacteriospermia may be an important cause of male infertility. Our data represent a baseline for future in-depth studies on bacterial infection in the semen of infertile men in Nepal.