Sexual Dysfunctions among Diabetic and Non-diabetic People Attending in Tribhuvan University Teaching Hospital, Kathmandu Nepal.

BACKGROUND: Sexual dysfunctions including erectile dysfunction among men, a widespread sexual health issue, pose challenges to sexual satisfaction. This cross-sectional study aimed to assess the prevalence and determinants of sexual dysfunctions in both diabetic and non-diabetic individuals aged 30-70. METHODS: A study at Tribhuvan University Teaching Hospital in Kathmandu, Nepal, surveyed 350 participants (176 men, 174 women), aged 30-70, with 52.6% having diabetes. The structured interviews and validated questionnaires like IIEF-5 for men and FSFI-6 for women to assess the prevalence and factors associated with erectile dysfunction were used. Statistical tools were employed to measure the associations of different variables with Sexual dysfunctions. RESULTS: Overall, the prevalence of sexual dysfunction was 73.7% (95% CI: 72.4- 73.7) with higher rates in men 83.9% (95% CI: 83.1- 84.7) than women 63.6% (95% CI: 62.0 - 65.2). Individuals with diabetes experienced an 81.5% prevalence of sexual dysfunction (95% CI: 80.6-82.4), whereas non-diabetic individuals exhibited a 65.1% prevalence (95% CI: 63.5-66.7). In the diabetic male population, the prevalence of sexual dysfunction was 97.5% (95% CI: 97.4-97.6), while diabetic females had a prevalence of 68.9% (95% CI: 67.5-70.3). Among non-diabetic men, the percentage of erectile dysfunction was 72% (95% CI: 70.7-73.3), and among non-diabetic women, sexual dysfunction remained 56.2% (95% CI: 54.4-58.0). Among individuals with diabetes, those who used tobacco exhibited a sexual dysfunction prevalence of 93.8% (95% CI: 93.5-94.1), while non-tobacco users had a prevalence of 74.8% (95% CI: 73.6-76.0). In non-diabetic individuals, obesity was associated with a higher prevalence of sexual dysfunctions, reaching 84.6% (95% CI: 83.8-84.6). High blood pressure showed a strong association with sexual dysfunctions in both diabetic (83% with 95% CI: 81.9-83.4) and non-diabetic (70% with 95% CI: 67.7-70.1) groups. Individuals with diabetes for more than five years had a higher rate of sexual dysfunction as 87.8% (95% CI: 86.6-89.0) with 100% in men and 79% in women. However, there was no significant difference in the prevalence of sexual dysfunctions related to obesity and alcohol consumption between diabetics and non-diabetics. CONCLUSIONS: The research highlights a noteworthy association of sexual dysfunctions with individuals with diabetes, male sex, tobacco use, and hypertension. The observed high prevalence of sexual dysfunctions in both diabetic and non diabetic people is a public health concern, emphasizing the need for culturally tailored approaches to address the sexual health of the affected individuals.

Adherence to Dietary Recommendation and Its Associated Factors among People with Type 2 Diabetes: A Cross-Sectional Study in Nepal.

Introduction: Intensive lifestyle modification including a healthy diet changes the diagnostic status of patient from prediabetes to nondiabetes. In type 2 diabetes, improper eating habits increase insulin resistance. This study is aimed at assessing adherence to the dietary recommendation and its associated factors among people with type 2 diabetes. Methods: A cross-sectional descriptive study was conducted among systematically sampled type 2 diabetic patients using interview on Gandaki Medical College Teaching Hospital and Diabetes, Thyroid, and Endocrinology Care Center, Pokhara. The Perceived Dietary Adherence Questionnaire was used to assess dietary adherence. Data was entered in EpiData version 3.1 and analyzed on SPSS version 20. Logistic regression with adjusted odds ratio and the corresponding 95% confidence intervals were used to find out significance of association. Results: Among 204 participants, only 15.7% of the participants had good dietary adherence. The mean age and standard deviation were 53.03 ± 11.90 years. Factors such as participants living in single family (AOR 2.7, 95% CI 1.0-7.4), participants who could afford recommended diet (AOR 2.9, 95% CI 1.0-8.3), participants having self-control on food (AOR 4.1, 95% CI 1.2-14.1), participants who were engaged in moderate to heavy physical activities (AOR 3.3, 95% CI 1.2-9.2), and participants who had adherence to medication (AOR 3.5, 95% CI 1.2-10.1) were significantly associated with adherence to dietary recommendation. Conclusions: Adherence to dietary recommendation among people with type 2 diabetes was low. Factors such as family type, affordability of recommended diet, self-control on food, physical activity, and medication adherence were significantly associated with adherence to dietary recommendations among people with type 2 diabetes. These factors should be considered by nutrition counselors and clinical decision-makers in patient counseling regarding dietary adherence.

Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study.

OBJECTIVE: This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal. STUDY DESIGN: The study was a nationwide population-based cross-sectional study. SETTING AND PARTICIPANTS: Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression. RESULTS: The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3). CONCLUSION: This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to prevent it.

Translating evidence into policy: opinions and insights of Health Researchers and Policymakers in Nepal.

BACKGROUND: The Evidence-Based Policymaking (EBP) process in Nepal is rife with poor practices where often policymakers are portrayed as perpetrators for such practices. However, we need to think of the EBP as a two-sided coin where both research pull and research push play equally significant roles. This study aimed to assess the perception of Nepalese health policymakers and researchers on EBP and identify appropriate mechanisms to integrate evidence into policies. METHODS: Following the constructivist philosophical paradigm, qualitative research design was used in the study with the grounded theory approach. Purposive sampling was performed, and the 12 in-depth interviews were conducted, where number of interviews was finalized using saturation theory. All interviews were audio-recorded, transcribed, translated to English, coded line by line, and then developed into themes. Thematic analysis technique was used to manually analyze the data. RESULTS: Study participants highlighted that evidence is being utilized during policy formulation but not in the amount it should be, with a preference for anecdotal evidence further reducing the chance. Apart from these barriers, poor credibility of information obtained, poorly targeted dissemination, inadequate policy-based researches, and policymakers and researchers operating within the spheres of their own with a feeble link to channel the flow of information between them were identified by participants. On the other hand, the publication of one-pager research brief, conduction of nationally representative surveys especially quantitative studies, the practice of cost-effectiveness study, and policymaker's involvement during the research were some facilitators identified. CONCLUSIONS: Moreover, the study accentuates that better communication strategies such as the establishment of formal forums with policymakers and researchers, better-targeted dissemination, and identification of priority areas have wide potential to promote a unified front of health policymakers and researchers for EBP.

Prevalence, pattern and determinants of chronic disease multimorbidity in Nepal: secondary analysis of a national survey.

OBJECTIVES: To assess the prevalence, pattern and determinants of non-communicable diseases (NCDs) multimorbidity in Nepal. DESIGN: Secondary analysis of the data from the NCD survey 2018, which was conducted between 2016 and 2018. SETTING: The data belong to the nationally representative survey, that selected the study samples from throughout Nepal using multistage cluster sampling. PARTICIPANTS: 8931 participants aged 20 years and older were included in the study. PRIMARY OUTCOMES: NCD multimorbidity (occurrence of two or more chronic conditions including hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease and cancer). Descriptive statistics, prevalence ratio and odds ratio were computed to assess pattern and determinants of multimorbidity. RESULTS: Mean (SD) age was 46.7 years (14.9 years). The majority of the participants were women (57.8%), without formal education (53.4%) and from urban areas (51.5%). Multimorbidity was present in 13.96% (95% CI: 12.9% to 15.1%). Hypertension and diabetes coexisted in 5.7%. Age, alcohol consumption, body mass index, non-high-density lipoprotein (non-HDL) level and rural-urban setting were significantly associated with multimorbidity. CONCLUSION: Multimorbidity was prevalent in particular groups or geographical areas in Nepal suggesting a need for coordinated and integrated NCD care approach for the management of multiplicative co-comorbid conditions.

Factors Associated with Chronic Obstructive Pulmonary Diseases in Nepal: Evidence from a Nationally Representative Population-Based Study.

Background: The Global Burden of Diseases Study 2017 predicted that chronic obstructive pulmonary disease (COPD) is the second leading cause of death, the fourth leading cause of premature death, and the third cause for DALYs lost in Nepal. However, data on the population-based prevalence of COPD in Nepal are very limited. This study aims to assess the prevalence of COPD and factors associated with the occurrence of COPD in Nepal. Methods: From a nationally representative, population-based cross-sectional study on chronic non-communicable diseases, the prevalence of COPD and its associated factors was determined. Of 12,557 participants aged over 20 years, 8945 participants completed a questionnaire and spirometry. Eligible participants were also asked to answer a COPD diagnostic questionnaire for screening COPD cases, and if needed underwent pre-bronchodilator and post-bronchodilator spirometry. COPD was defined as a post-bronchodilator FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio of <0.70. Multivariate logistic regression was performed to identify factors associated with COPD. Sampling weights were used for all data analyses. Results: The prevalence of COPD in Nepal was 11.7% (95% CI: 10.5% to 12.9 %), which increased with age, and higher in those with a low educational level, those who had smoked ≥50 pack-years, persons having a low body mass index (BMI), and residents of Karnali province. Multivariate analysis revealed that being aged 60 years and above, having a low BMI, low educational status, having smoked more than 50 pack-years, provincial distribution, and ethnicity were independent predictors of COPD. Conclusion: COPD is a growing and serious public health issue in Nepal. Factor such as old age, cigarette smoking, low educational attainment, low BMI, ethnicity, and locality of residence (province-level variation) plays a vital role in the occurrence of COPD. Strategies aimed at targeting these risk factors through health promotion and education interventions are needed to decrease the burden of COPD.

Combination of convalescent plasma therapy and repurposed drugs to treat severe COVID-19 patient with multimorbidity.

Combination of convalescent plasma therapy and repurposed drugs such as dexamethasone and remdesivir could be beneficial for severe COVID-19 patients with obesity and chronic diseases such as diabetes and hypertension.

Quality of Drug in Health Facilities: A Cross-sectional Study.

BACKGROUND: Poor quality drugs result minor to detrimental effect on human health. The drug should be of standard quality and should be used appropriately in order to meet its therapeutic efficacy. This study aims to assess the quality of drug in Nepal. METHODS: A cross sectional study was conducted in randomly selected 88 health facilities in Nepal from 10th April to 30th June 2016. Selective medicines were collected from both private licensed pharmacies and selected public health facilities. Face to face interview with health facility in-charge of selected health facilities was carried out along with the direct observation of the medicine storage room. The collected medicine samples were dispatched to two laboratories for in-vitro analysis. The labels of the collected medicine were analyzed. The obtained data were entered in Epidata version 3.1, cleaned in Microsoft excel 2007 and analyzed in SPSS version 20. RESULTS: Out of 172 brands, nine brands of medicines were found substandard. Information regarding storage conditions, direction for use and category of the drug were lacking in the label of some brands of medicines. Some selected health facilities were found not meeting major requirements for drug storage: protection from sunlight, moisture, heat, well ventilation and proper sanitation. CONCLUSIONS: Few drugs were found to be substandard in Nepalese market from both public and private sectors. Adequate labeling and proper storage condition of medicines in health facilities were lacking.

Evaluation of Emergency Medical Team Coordination Following the 2015 Nepal Earthquake.

OBJECTIVES: After the Nepal earthquake in 2015, for the first time, the Emergency Medical Team Coordination Cell (EMTCC) was activated. This study aims to evaluate the emergency medical team (EMT) coordination in the aftermath of the Nepal earthquake in 2015. METHODS: This is a retrospective study that (a) describes the coordination process in Nepal, and (b) reviews and analyzes the EMT database in Nepal to classify the EMTs based on the World Health Organization (WHO) EMT classification, an online survey for EMT coordination, and the Geographic Information System-analyzed EMT distribution. RESULTS: We recorded 150 EMTs, which included 29 Type 1-Mobile, 71 Type 1-Fixed, 22 Type 2, 1 Type 3, and 27 specialist cell recorded EMTs including the military team. The EMTs were allocated based on the number of casualties in that area. The Type 1 EMTs were deployed around Type 2 EMTs. CONCLUSIONS: The EMT Classification is useful for the effective posting of EMTs. However, the method of onsite multi registration has room for improvement. The WHO should provide an opportunity for EMTCC training for better coordination of disasters.

Evaluation of a chest rehabilitation project in Nepal using the St. George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test.

[Purpose] The incidence of chronic obstructive pulmonary disease is rapidly increasing worldwide. In Nepal, it has the highest mortality rate among all noninfectious diseases. Since 2015, we have been involved in a project that aims to facilitate chest rehabilitation for patients with chronic obstructive pulmonary disease in Nepal. We compared the Nepali version of the St. George's Respiratory Questionnaire with the Chronic Obstructive Pulmonary Disease Assessment Test, the latter of which was translated into Nepali for this project. We also evaluated the extent to which patient quality of life improved after the rehabilitation program. [Participants and Methods] The Nepali St. George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test were used to assess the health status of patients both before the intervention's initiation and one year after it. Between May and September of 2016, 122 patients with chronic obstructive pulmonary disease participated in this program. [Results] We collected valid responses from 57 patients both before and after the intervention. The scores of both screening tools were significantly lower after the intervention than before and showed a significant correlation with one another. [Conclusion] These results suggest that the Nepali version of the Chronic Obstructive Pulmonary Disease Assessment Test is a reliable tool for the evaluation of chronic obstructive pulmonary disease and that the intervention used in the project might be effective for patients afflicted with the disease. However, there are limitations to the research design, such as the limited number of participants used in the study.

Medicine Prescribing Pattern and Knowledge on Medicine Use at Different Level of Health Care Settings in Nepal.

BACKGROUND: It is imperative to have adequate knowledge about medicines being used for their proper administration so as to obtain desirable therapeutics effects. This study aims to assess the medicine prescribing pattern and patients' knowledge about medicine use at different level of health care settings in Nepal. METHODS: A cross sectional study was conducted in randomly selected 88 health facilities in Nepal. Altogether 2200 patients, taken randomly after the doctor visit, were interviewed and assessed for the prescription. RESULTS: Out of total drugs prescribed from 88 health facilities (6,175), 68.91% were essential drugs, 23.74 % were antibiotics and 61 % of medicines were prescribed in generic names. And among patients receiving medicines, adequate response on medicine use was received on 49% of medicines out of 3,806 medicines dispensed. CONCLUSIONS: Greater percentages of medicines were prescribed from essential drug list in health facilities. Knowledge on medicine use was poor among people.

Prevalence of Selected Chronic Non-Communicable Diseases in Nepal.

BACKGROUND: The burden of non-communicable diseases has increased in the last few decades in low-and middle-income countries including in Nepal. There is limited data on population based prevalence of non-communicable diseases. Hence, this study aims to determine the nationwide prevalence of selected chronic non-communicable diseases in Nepal. METHODS: A nationwide cross-sectional population-based study was conducted from 2016 to 2018. Data was collected electronically on android device inbuilt with research and monitoring software from 13200 eligible participants aged 20 years and above. Data was cleaned in SPSS version 20.0 and analyzed using Stata version 13.1. RESULTS: The overall prevalence of selected non-communicable diseases was found to be chronic obstructive pulmonary disease 11.7% (95% CI: 10.5-12.9), diabetes mellitus 8.5% (95% CI: 7.8-9.3), chronic kidney disease 6.0% (95% CI: 5.5-6.6) and coronary artery disease 2.9% (95% CI: 2.4-3.4) in Nepal. Prevalence of non-communicable diseases varied across provinces. Higher prevalence of chronic obstructive pulmonary disease (25.1%, 95% CI: 18.1-33.8) in Karnali Province, diabetes (11.5%, 95% CI: 9.8-13.4) in Province 3, chronic kidney disease (6.8%, 95% CI: 5.6-8.1) in Gandaki Province and coronary artery disease in Gandaki (3.6%, 95% CI: 2.2-5.7) and Sudurpaschim Province (3.6%, 95% CI: 2.1-6.1) was observed. CONCLUSIONS: The study reported substantial proportion of adult population was found to have chronic non-communicable diseases in Nepal. The findings of this study may be useful for revising/updating multi-sectoral action plans on prevention and control of non-communicable diseases in Nepal.

Consumption of Fruits and Vegetables Among Individuals 15 Years and Older in 28 Low- and Middle-Income Countries.

BACKGROUND: The WHO recommends 400 g/d of fruits and vegetables (the equivalent of ∼5 servings/d) for the prevention of noncommunicable diseases (NCDs). However, there is limited evidence regarding individual-level correlates of meeting these recommendations in low- and middle-income countries (LMICs). In order to target policies and interventions aimed at improving intake, global monitoring of fruit and vegetable consumption by socio-demographic subpopulations is required. OBJECTIVES: The aims of this study were to 1) assess the proportion of individuals meeting the WHO recommendation and 2) evaluate socio-demographic predictors (age, sex, and educational attainment) of meeting the WHO recommendation. METHODS: Data were collected from 193,606 individuals aged ≥15 y in 28 LMICs between 2005 and 2016. The prevalence of meeting the WHO recommendation took into account the complex survey designs, and countries were weighted according to their World Bank population estimates in 2015. Poisson regression was used to estimate associations with socio-demographic characteristics. RESULTS: The proportion (95% CI) of individuals aged ≥15 y who met the WHO recommendation was 18.0% (16.6-19.4%). Mean intake of fruits was 1.15 (1.10-1.20) servings per day and for vegetables, 2.46 (2.40-2.51) servings/d. The proportion of individuals meeting the recommendation increased with increasing country gross domestic product (GDP) class (P < 0.0001) and with decreasing country FAO food price index (FPI; indicating greater stability of food prices; P < 0.0001). At the individual level, those with secondary education or greater were more likely to achieve the recommendation compared with individuals with no formal education: risk ratio (95% CI), 1.61 (1.24-2.09). CONCLUSIONS: Over 80% of individuals aged ≥15 y living in these 28 LMICs consumed lower amounts of fruits and vegetables than recommended by the WHO. Policies to promote fruit and vegetable consumption in LMICs are urgently needed to address the observed inequities in intake and prevent NCDs.

Smokeless Tobacco Use is "Replacing" the Smoking Epidemic in the South-East Asia Region.

Background: The sustained anti-tobacco campaign initiated in response to the mounting evidence against tobacco smoking has driven tobacco companies and smokers to look for alternative choices, such as smokeless tobacco (SLT) products. If this strategy advances, it could undermine several gains made by the campaign over the years. Our objective was to examine the trends in the prevalence of different tobacco types in three countries (Bangladesh, India, and Nepal) of South-East Asia. Methods: Data from national surveys were used to estimate the trends of weighted and age-standardized prevalence (along with 95% CI) of different tobacco products. The share of each tobacco type was then calculated as a percentage of total tobacco use for each time point and country. Results: In all the three countries, smoking prevalence declined (by 6% in Bangladesh, 3% in India, and 7% in Nepal) but SLT use increased (by 3% in Bangladesh, 6% in India, and 4% in Nepal) over the study period. SLT use increased irrespective of whether the total tobacco use increased or decreased. The share of SLT as a percentage of total tobacco use increased from 15% to 19% among Bangladeshi men, from 46% to 61% in India, and from 29% to 41% in Nepal. Conclusions: In South-East Asia, a clear shift in the product preference from smoking to SLT was noted. Misleading advertising by tobacco companies may be responsible for the increase in the SLT prevalence, which is as harmful as smoking. Countries should strengthen policies to restrict SLT usage and prevent the rise of its use. Implications: It has been documented that the smoking prevalence has been declining in most countries of the South-East Asia region where effective anti-tobacco laws have been implemented. But, due to a number of factors, the prevalence of smokeless tobacco has been increasing steadily, making the entire anti-tobacco movement less effective in terms of reducing the tobacco-attributable disease burden. In this context, this study has provided a detailed comparative analysis of the prevalence of smokeless tobacco use and smoking in three countries of the SEAR where such data were available. It can be clearly seen that the preference for smoking has shifted towards the smokeless tobacco in all the three study countries. This study recommends that tobacco control interventions should be aligned with the changing dynamics of the tobacco epidemic, and the need of the hour is placing restrictions of smokeless tobacco use so as to drive forward the gains of the anti-tobacco movement.

Prevalence and correlates of anemia among adolescents in Nepal: Findings from a nationally representative cross-sectional survey.

Anemia is regarded as major public health problem among adolescents in Low and Middle-Income Countries (LMICs) but there is limited primary data in many countries, including Nepal. This study investigated the prevalence and correlates of anemia in a nationally representative sample of adolescents within the 2014 National Adolescent Nutrition Survey in Nepal. A total of 3780 adolescents aged 10 to 19 years were selected from a cross-sectional survey through multi-stage cluster sampling. Structured interviews, anthropometric measurements and hemoglobin assessments of capillary blood were obtained. Bivariate and multivariable analyses were undertaken to compute the Adjusted Odds Ratio (aOR) for socio-demographic, behavioral and cluster characteristics. The overall prevalence of anemia was 31% (95%CI: 28.2, 33.5), 38% (95%CI: 34.0, 41.8) in female and 24% (95%CI: 20.6, 27.1) in male. The likelihood of anemia was significantly higher among older adolescents (aOR 1.75, 95%CI: 1.44, 2.13), females (aOR 2.02; 95%CI: 1.57, 2.60), among those who walk barefoot (aOR 1.78, 95%CI: 1.08, 2.94), and those residing in the Terai (aOR 1.80, 95%CI: 1.18, 2.77). Food consumption from more than four food groups (aOR 0.71, 95%CI: 0.57, 0.88) was protective against anemia. In conclusion, anemia is common in Nepali adolescents. Efforts to improve the nutritional status of this high-risk age group require nutrition that focus on eating habits, sanitation, iron supplementation and the treatment of hookworm infection.

Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal.

Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems.

Outbreak Investigation Following the 2015 Earthquake Disaster in Nepal.

BACKGROUND: Infectious disease outbreaks following natural disasters are reported in literature. Outbreaks were documented following natural disasters in many countries including Haiti. Such possibility following 2015 Nepal earthquake was a public health concern. Risk factors needed evaluation by post-disaster outbreak investigation. Hence, present study was undertaken to investigate potentials for such outbreak and to generate evidence for public health intervention. METHODS: The study was conducted between April - May, 2015, with the cooperation of National Public Health Laboratory, Epidemiology and Disease Control Division, Nepal Health Research Council and the Chinese team. Rapid Response Teams visited earthquake affected districts and collected samples for analysis. Syndromic surveillance approach was followed. Samples were collected from syndromic patients under supervision. Those sick prior to earthquake or receiving treatment were excluded. Blood, stool and throat swab samples, as indicated, were collected. Drinking water and food samples including captured live mosquitoes from inhabited areas were obtained for study with the help of EDCD. Laboratory analysis was performed at the NPHL. RESULTS: Total samples were 360 (114 biological, 246 environmental). Salmonella spp. was detected in two and Varicella zoster in one blood sample. Influenza B virus was detected in one throat swab. Rota virus was detected in two, Shigella dysenteriae in one and Salmonella spp. in one stool sample. No pathogen detected in water or food samples. Mosquitoes tested negative for dengue virus. CONCLUSIONS: Post-earthquake outbreak investigated in disaster phase-2. Diarrheal, enteric fever pathogens and Influenza B virus were detected. Environmental samples tested negative for pathogens. Vigilance is necessary for other risk factors.

Historical Development of Health Research Ethics in Nepal.

Health research in Nepal initiated with a survey in malaria in 1952. The first regulatory body for health research was Nepal Medical Research Committee formed under Ministry of Health. Ethical Review Body is the first ethical review structure. Nepal Health Research Council is now an independent body to regulate health research in Nepal. Development of research ethics in Nepal is clearly evident with the development of ethical guidelines; functioning of Ethical Review Board; expansion of institutional review committees and initiation of online submission system. However, monitoring compliance with research ethics could be a challenge for the Nepal Health Research Council.

Correction: High blood levels of lead in children aged 6-36 months in Kathmandu Valley, Nepal: A cross-sectional study of associated factors.

[This corrects the article DOI: 10.1371/journal.pone.0179233.].

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal.

BACKGROUND: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. OBJECTIVES: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. METHODS: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. RESULTS: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. CONCLUSIONS: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians.