A Season at the Himalayan Rescue Association Aid Post in Manang.

The Himalayan Rescue Association (HRA) has operated high altitude clinics in Nepal for 50 years, with rising visitor numbers, especially from India, China, and Nepal. New roads have eased access and increased the speed of ascent in some areas. Our aim was to provide a description of the activities, clinical problems, and lecture attendees of the HRA aid post in Manang over one season. We also highlight the evolving challenges of providing healthcare and education in the high Himalayan region. We describe the clinical and educational activities of the HRA aid post in Manang from September 24 to December 1, 2023. Prospective clinical data collection included anonymized patient demographics and diagnoses. Lecture data were taken from the attendee register and by daily manual counts of lecture attendees. We saw 376 patients, 62% of whom were Nepalis. Infectious diseases (42%) and altitude illness (16%) were the most common problems. A total of 846 people from 47 countries attended the daily altitude lectures. Only 5% of attendees were Nepali. Electrical supply interruptions and limitations in medical evacuation options were among the challenges of providing care at a high altitude clinic and preventing altitude illness using educational lectures. Altitude illness remains a common and potentially life-threatening problem, with risks increased by rapid ascent enabled by new road access and by ignorance of risks of altitude among travelers, especially Nepalis. Language barriers in educational outreach call for novel approaches and interventions that will ensure the effectiveness of altitude education.

Evaluation of circulating plasma miR-9, miR-29a, miR-192, and miR-375 as potential biomarkers for predicting prediabetes and type 2 diabetes in Nepali adult population.

Circulating plasma miRNAs have emerged as potential early predictors of glucometabolic disorders. However, their biomarker potential remains unvalidated in populations with diverse genetic backgrounds, races, and ethnicities. This study aims to validate the biomarker potential of plasma miR-9, miR-29a, miR-192, and miR-375 for early detection of prediabetes and type 2 diabetes mellitus (T2DM) in Nepali populations that represent distinct genetic backgrounds, races, and ethnicities. A total of 46 adults, categorized into healthy controls (n = 25), prediabetes (n = 9), and T2DM (n = 12) groups, were enrolled. Baseline sociodemographic, anthropometric, and clinical characteristics were collected. Fold change in plasma expression of all four miRNAs was quantified using RT-qPCR against the RNU6B reference gene. Their biomarker potential was determined by receiver operating characteristic (ROC) curve analysis. Multivariate discriminant function and hierarchical cluster analyses were used to evaluate the effectiveness of the miRNA panel in reclassifying study participants who were initially categorized according to their glucose tolerance status. Plasma expression of all four miRNAs was significantly upregulated in T2DM patients compared to normoglycemic controls. Furthermore, the expression of only miR-29a and miR-375 was upregulated in T2DM patients than in prediabetic individuals. Notably, only miR-192 expression was significantly upregulated in prediabetic individuals than in the normoglycemic controls. The miRNA expression profiles had the potential of reclassifying the participants into three original groups with an accuracy of 69.6 %. ROC curve analysis identified miR-192 as the predictor for both prediabetes and T2DM, while miR-9, miR-29a, miR-192, and miR-375 were predictive only for T2DM. The specific set of miRNA combinations significantly improved their predictive accuracy. This study validates the early predictive biomarker potential of plasma miR-9, miR-29a, miR-192, and miR-375 also in the Nepali population and paves the way for future translational studies to validate their utility in clinical laboratories.

Detection and characterization of vector-borne parasites and Wolbachia endosymbionts in greater one-horned rhinoceros (Rhinoceros unicornis) in Nepal.

Vector-borne parasite infections affect both domestic and wild animals. They are often asymptomatic but can result in fatal outcomes under natural and human-induced stressors. Given the limited availability of molecular data on vector-borne parasites in Rhinoceros unicornis (greater one-horned rhinoceros), this study employed molecular tools to detect and characterize the vector-borne parasites in rescued rhinoceros in Chitwan National Park, Nepal. Whole blood samples were collected from thirty-six R. unicornis during rescue and treatment operations. Piroplasmida infections were first screened using nested polymerase chain reaction (PCR) targeting 18S ribosomal RNA gene. Wolbachia was detected by amplifying 16S rRNA gene, while filarial nematodes were detected through amplification of 28S rRNA, COI, myoHC and hsp70 genes. Our results confirmed the presence of Theileria bicornis with a prevalence of 75% (27/36) having two previously unreported haplotypes (H8 and H9). Wolbachia endosymbionts were detected in 25% (9/36) of tested samples and belonged to either supergroup C or F. Filarial nematodes of the genera Mansonella and Onchocerca were also detected. There were no significant association between T. bicornis infections and the age, sex, or location from which the animals were rescued. The high prevalence of Theileria with novel haplotypes along with filarial parasites has important ecological and conservational implications and highlights the need to implement parasite surveillance programs for wildlife in Nepal. Further studies monitoring vector-borne pathogens and interspecies transmission among wild animals, livestock and human are required.

The impact of widowhood on mental health: anxiety, depression, and stress among widowed women in Nepal.

Introduction: In South Asia, particularly in regions with strong patriarchal norms, widowhood is stigmatized, compounding the negative impact of grief and partner loss. This study measured the prevalence of mental health symptoms among widows in Nepal and its relationship to demographic variables. Methods: This cross-sectional study surveyed 588 Nepalese widows from six districts in Nepal (mean age = 52.62, SD = 13.99) who had lost their spouses within the past two years. Participants completed the Anxiety, Depression and Stress Scale (ADSS). Analyses examined prevalence of anxiety, depression, and stress symptoms, using standard ADSS cut-points. Level of anxiety, depression, and stress symptoms measured by the ADSS in the sample were also compared with female psychiatric and nonpsychiatric normative ADSS data, and were compared with one available comparison sample (a sample of older Nepalese women). Measures of association between ADSS scores and demographic variables were computed. Results: Results showed that a high percentage of the Nepalese widows reported moderate to severe symptoms of anxiety, depression, and stress. They also endorsed significantly higher levels of anxiety, depression, and stress symptoms relative to normative data and the comparison sample. Stress scores were significantly negatively correlated with age, Anxiety and Depression scores were associated with income under the poverty line, and Depression scores were associated with homemaker status. Discussion: These findings confirm the high emotional distress among widowed women in Nepal, and establish the relationship between emotional distress and poverty, homemaker status, and age. These findings can inform public health efforts and mental health care providers regarding the mental health needs of widows in Nepal.

Effect of four different types of vermicomposts on okra productivity and farm income.

Organic based fertilizers is crucial for maintaining soil fertility, increasing crop production, and mitigating climate change. Among various organic fertilizers, vermicompost (VC) has been found to be one of the promising options for enhancing soil fertility and productivity. However, there are limited studies on the agronomic effects of vermicomposts in Nepal. In this study, a pot culture experiment was conducted inside a greenhouse to assess the agronomic and economic effects of four different commercially available vermicomposts, available in both reduced and original moisture forms, on okra. Nine treatments with three replications were arranged in a completely randomized design (CRD). These treatments included Divya vermicompost with both reduced (DvRM: 28.82 %) and original moisture (DvOM: 62.17 %); Praramva vermicompost with reduced (PvRM: 29.63 %) and original moisture (PvOM: 54.65 %), Bio-Comp vermicompost with reduced (BvRM: 26.75 %) and original moisture (BvOM: 49.77 %), Sathi vermicompost with reduced (SvRM: 28.52 %) and original moisture (SvOM: 65.18 %), and a control (CK: non-fertilized treatment). All VC treatments, whether in reduced or original moisture forms, showed better performance on plant growth parameters and fruit yield compared to the control. There was no significant difference between the four types of VCs, in either moisture form. The average number of fruits per pot in VC treatments (ranging from 5.5 to 8.0 fruits per pot) increased by 94 % compared to CK (3.5 fruits). Similarly, total fruit yield increased by 126 % in VC treatments (ranging from 16213 kg ha-1 to 23193 kg ha-1) compared to the CK (8260 kg ha-1). The benefit to cost ratio (B:C) of all the VCs was above 1 (B:C > 1), ranging from 1.00 to 1.59, illustrating the economic benefit of using vermicompost in okra cultivation. The findings suggest that farmers should consider the widespread use of vermicomposts to increase both crop productivity and farm profitability, thereby sustaining their livelihoods.

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.

Examining the Quality of Life of Hearing-Impaired Children in Nepal with Cochlear Implants: Perspectives From Parents.

Millions of people worldwide suffer from hearing loss, a common sensory condition. However, new developments in cochlear implants have drastically transformed children's lives. However, there is still much to learn about the complex effects of cochlear implant interventions on children's lives and the unique difficulties experienced by Nepalese families. This study aims to comprehensively evaluate parents' perspectives regarding the quality of life of children with cochlear implants in Nepal. This study utilized the 'Children with Cochlear Implants: Parental Perspectives' (CCIPP) questionnaire, focusing on parents' viewpoints to assess the quality of life of Nepalese children with cochlear implants. A purposive sampling approach encompassed 22 families who completed the questionnaire. The study showed good parental ratings; the mean overall quality of life score was more than three (out of five), indicating significant gains following cochlear implantation. The greatest scores were for communication abilities, but issues with the implantation procedure and educational components persisted. A strong relationship existed between communication and several quality-of-life dimensions, highlighting communication's critical role in improving social interactions, well-being, and self-reliance. From the viewpoint of the parents of Nepalese children with cochlear implants, the current research represents a significant change in our knowledge of their quality of life. Even though there have been significant gains, targeted interventions are necessary to address post-implantation problems and educational challenges. The study recommends customized support networks and academic achievements to help Nepal's children with cochlear implant treatments.

Do school Water, Sanitation, and Hygiene facilities affect students' health status, attendance, and educational achievements? A qualitative study in Nepal.

Background and Aims: Access to safe and sufficient drinking Water, Sanitation, and good Hygiene (WASH) facilities in schools play a crucial role in preventing students from numerous Neglected Tropical Diseases, improving the learning environment in schools, and creating resilient communities living in a healthy environment. This study aims to explore the impact of combining WASH facilities on students' health status, school attendance, and educational achievements. Methods: Four schools, two with improved and two without improved WASH facilities, were selected purposively from Dhanusha and Chitwan districts of Nepal. A total of 24 participants, 16 students, and eight teachers were also purposively selected based on the Theory of Data Saturation. The participants were interviewed face-to-face using study guidelines; Key Informants Interview for teachers and In-depth Interview for students. The data were audio recorded and analyzed thematically using Dedoose 9.0.17 qualitative data management and analysis software. Results: School WASH facilities have a significant impact on students' health and well-being. Poor school-WASH facilities hindered students' school attendance, particularly for menstruating girls. School without separate toilets for girls, including menstruation hygiene facilities, lack of water and soap, sanitary pad, and secure toilet's door often have higher rates of absenteeism among girls. Poor teacher and students' relationships, students' low interest in education, household chores, and participation in social customs also contribute to students' absence from school and low educational performance. It is important to note that inadequate WASH facilities affect not only students, but also teachers in the same school. Conclusion: The lack of safe and sufficient drinking water, unimproved sanitation, and poor hygiene facilities were seen by students and teachers as reducing their health and well-being, school attendance, and academic performance. Thus, schools need prioritize and promote the provision of improved WASH facilities for the betterment of students' health, attendance, and educational proficiency.

Where have I got to? Associations of age at marriage with marital household assets in educated and uneducated women in lowland Nepal.

Background: Women's underage marriage (<18 years) is associated with adverse maternal and child health outcomes. Poverty in the natal household has been widely considered to be a key risk factor for underage marriage, but the evidence base is unreliable. When investigating this issue, most studies use marital wealth inappropriately, as a proxy for wealth in the natal household. In contrast, we investigated whether the timing of women's marriage was associated with the wealth of the households they marry into, and how this may vary by women's education level. This approach allows us to explore a different set of research questions which help to understand the economic value placed on the timing of women's marriage. Methods: We used data on 3,102 women aged 12-34 years, surveyed within 1 year of marriage, from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Linear mixed-effects regression models investigated independent associations of women's marriage age and education level with marital household wealth, and their interactive effects. Models adjusted for marital household traits. We analysed the full sample, and then only the uneducated women, who comprised a substantial proportion in our sample. Results: In the full sample, we found that each later year of women's marriage was associated with 1.5% lower asset score for those with primary education, and with 0.3% and 1.3% higher asset score for those with lower secondary or secondary/higher education, respectively. For uneducated women, relative to marrying ≤14 years, marrying at 15, 16, 17 and ≥18 years was associated with 1.5%, 4.4%, 2.4% and 6.2% greater marital asset score respectively. Conclusion: On average, marrying ≥18 years was associated with greater marital assets for secondary-educated women. There were only very modest benefits in terms of marital household wealth for delaying marriage beyond 16 years for uneducated women or those with low education. These findings elucidate potential trade-offs faced by families, including decisions over how much education, if any, to provide to daughters. They may help to understand the economic rationale underpinning the timing of marriage, and why early marriage remains common despite efforts to delay it.

Impacts of livelihood assets on hydropower displacees' livelihood strategies: Insights from the Tanahu hydropower project in Nepal.

Examination of livelihood assets is crucial for displaced people as it informs effective resource allocation and support. This study investigates the livelihood decisions of households displaced by Nepal's Tanahu Hydropower Project using multinomial logistic regression to evaluate how different assets affect their choices. Data were obtained using questionnaires, with a total of 185 questionnaires used for the analysis in this study. Descriptive and inferential statistics were used for data analysis. This study finds that physical assets substantially influence livelihood strategies, promoting diversification and nonfarming activities. Interestingly, social assets have a negative impact, whereas natural, financial, and human assets exert no significant effect. The study highlights the community's focus on economic stability, balancing immediate financial needs with long-term goals such as children's education. However, it reveals ongoing financial struggles, with an average daily income of only 1.962 USD and many households remaining in poverty, particularly those dependent on farming. The study also reflects on the mixed perceptions toward government policies, influenced by factors such as skill gaps and family aspirations. These findings provide essential insights for targeted support and resource allocation to displaced populations.

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.

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.

Neighborhood environment and quality of life of older adults in eastern Nepal: findings from a cross-sectional study.

INTRODUCTION: Quality of life (QoL) is a subjective measure reflecting individuals' evaluations based on their personal goals and values. While global research shows the role of neighborhood factors like ethnic diversity and socio-cultural dynamics on QoL, these are unexplored in the Nepali context. Therefore, this study examined the relationship between neighborhood environment and QoL among Nepali older adults in eastern Nepal. METHODS: This cross-sectional study involved 847 non-institutionalized older adults (aged ≥ 60 years) from two districts in eastern Nepal. QoL was evaluated using the 13-item brief Older People's Quality of Life questionnaire, where a mean score of < 3 indicated low/poor QoL. The neighborhood environment, conceptualized across three domains (demographic, socio-cultural, and built environment), included ethnic diversity, connections with family, friends, and neighbors, cultural ties, residential stability, and rurality. Their association with QoL was examined using multivariable logistic regression. RESULTS: Around 20% of older adults reported poor QoL. Higher ethnic diversity (adjusted Odds Ratio [aOR] = 0.12, 95% confidence interval [CI]: 0.04-0.36), moderate contact with family and relatives (aOR = 0.26, CI: 0.11-0.61), and high contact with neighbors (aOR = 0.09, CI: 0.03-0.21) were associated with lower odds of poor QoL. Conversely, high contact with friends (aOR = 2.29, CI: 1.30-4.04) and unstable residence (OR = 6.25, CI: 2.03-19.23) increased the odds of poor QoL. Additionally, among the covariates, chronic disease, tobacco use, unemployment, and lack of education were also significantly associated with poor QoL. CONCLUSION: Overall, the demographic environment, socio-cultural factors, and the built environment of the neighborhood influence QoL. Therefore, diversifying the neighborhood's ethnic composition, promoting social connections such as frequent contact with family, relatives, and neighbors, and ensuring residential stability can enhance the QoL of older adults.

Multilevel determinants of antiretroviral therapy initiation and retention in the test-and-treat era of Nepal: a qualitative study.

BACKGROUND: The transition to the "test-and-treat" policy in Nepal in 2017, coupled with the rapid initiation of antiretroviral therapy (ART) in 2020, necessitates an in-depth understanding of factors influencing ART initiation and retention. This study investigates these factors from the perspectives of healthcare providers, families/communities, and people living with HIV (PLHIV). METHODS: Employing a qualitative design, in-depth interviews were conducted with 24 ART clients and 26 healthcare providers across different provinces of Nepal. A comprehensive interview guide facilitated the exploration of experiences and perceptions. Interviews were transcribed verbatim, and thematic analysis was applied to distill key insights. Guided by a socio-ecological model, interviews were analyzed to identify the barriers and facilitators to ART initiation and continuation at the individual, family/community, and health system levels. RESULTS: Facilitators and barriers were identified at three levels. Individual-level facilitators included fear of death, perceived health benefits, knowledge about HIV/ART, confidentiality, and financial support. Barriers encompassed concerns about lifelong medication, side effects, denial of HIV status, fear of disclosure, and financial constraints. At the family/community level, support from family and community health workers facilitated ART adherence, while social stigma and discrimination posed barriers. The health system's role was dual; the provision of free treatment, a client tracking system and a robust drug supply chain were facilitators, whereas logistical challenges and service accessibility during the COVID-19 pandemic were notable barriers. CONCLUSIONS: This study highlights the various factors that influence ART initiation and retention in Nepal during the test-and-treat era. Tailored interventions should focus on increasing awareness about HIV and ART, strengthening healthcare systems, ensuring availability of medications, and providing accessible treatment during service disruptions. Furthermore, these interventions should encourage supportive environments at the individual, community, and healthcare system levels. Taking this holistic approach is essential for effectively implementing ART and achieving long-term health outcomes in light of changing public health policies.

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.

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.

Measuring Community Urbanicity and Its Influence on Household Food Security Across Nepal's Agroecological Zones.

Background: Urbanization influences food systems and food security, but research on these associations in low- and middle-income countries remain limited, partly because of the binary and unstandardized "urban compared with rural" classifications. Objectives: To develop a community urbanicity scale, to assess its associations with household food security, and to explore whether agricultural occupation modifies this relationship across the 3 agroecological zones (mountain, hill, Tarai) of Nepal. Methods: Data came from a nationally and agroecologically representative, multistaged 2013 agri-food system survey of 4285 households with children <5 y in 63 communities (wards) in Nepal. A novel community-level urbanicity scale was constructed using factor analysis that included 8 domains. Multilevel mixed effects logistic regression was used to assess associations between urbanicity and household food security (measured using the validated Household Food Insecurity Access Scale), and to investigate modifying effects of agricultural occupation. Results: Urbanicity scores ranged between 13 and 69, of a possible 80 points. Most agricultural households in the mountains (67%) and hills (54%) were categorized food insecure. Increases in urbanicity were negatively associated with food insecurity, controlling for other factors (odds ratio [OR] per 10-unit urbanicity difference OR: 0.82; confidence interval [CI]: 0.71, 0.94; P ≤ 0.05). Agricultural occupation may have positively influenced this association though was not a statistically significant effect measure modifier (P = 0.07). Conclusions: The novel scale shows more nuance within Nepal's agroecological zones, which had similar urbanicity-to-food security relationships as well as overlapping urbanicity score distributions. Research and policy efforts should consider using scales providing more precise urbanicity measurement, and thus informative assessments on its role in predicting food insecurity, especially in agriculturally reliant populations.

Modeling measles transmission in adults and children: Implications to vaccination for eradication.

Despite the availability of successful vaccines, measles outbreaks have occurred frequently in recent years, presumably due to the lack of proper vaccination implementation. Moreover, measles cases in adult groups, albeit small in number, indicate that the previously neglected adult group may need to be brought into vaccine coverage to achieve WHO's goal of measles eradication from the globe. In this study, we develop a novel transmission dynamics model to describe measles cases in adults and children to evaluate the role of adult infection in persistent measles cases and vaccination programs for eradication. Analysis of our model, validated by measles cases from outbreaks in Nepal, provides the vaccination reproduction number (conditions for measles eradication or persistence) and the role of contact network size. Our results highlight that while children are primary targets for measles outbreaks, a small number of infections in adults may act as a reservoir for measles, causing obstacles to eradication. Furthermore, our model analysis shows that while impactful controls can be achieved by children-focused vaccines, a combined adult-child vaccination program may help assert eradication of the disease.

A longitudinal multi-centric cohort study assessing infant neurodevelopment delay among women with persistent postpartum depression in Nepal.

BACKGROUND: Infant neurodevelopment in the first years after birth is determined by multiple factors, including parental care and maternal mental wellbeing. In this study, we aim to assess the impact of persistent maternal depressive symptoms during the first 3 months postpartum on infant neurodevelopment at 6 months. METHODS: Using a longitudinal cohort design, 1253 mother-infant pairs were followed up at 7, 45, and 90 days to assess postpartum depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS); infants were followed up at 6 months to assess neuro-developmental status using the WHO's Infant and Young Child Development (IYCD) tool. A generalized linear regression model was used to assess the association between persistent postpartum depressive symptoms and infant neurodevelopmental delay at 6 months. A generalized linear mixed model (GLMM) with a hospital as a random intercept was used to assess the persistent postpartum depressive symptoms with an IYCD score. Linear regression was used to compare the IYCD scores between exposure groups. RESULTS: In the study population, 7.5% of mothers had persistent depressive symptoms, and 7.5% of infants had neurodevelopmental delay. Infants born to mothers with persistent depressive symptoms had a higher proportion of neurodevelopmental delay than infants born to women without persistent symptoms (48.6% vs 5.1%; p < 0.001). In the adjusted regression model, infants whose mothers had persistent depressive symptoms at 7, 45, and 90 days had a 5.21-fold increased risk of neurodevelopmental delay (aRR, 5.21; 95% CI, 3.17, 8.55). Mean scores in the motor domain (12.7 vs 15.2; p < 0.001) and language domain (6.4 vs 8.5; p < 0.001) were significant when a mother had persistent depression vs. no depression. Mean scores in the general behavioral domain (5.9 vs 10.4, p < 0.001) and the socio-emotional domain (15.4 vs 17.7; p < 0.001) were significantly different when a mother had persistent depression vs no persistent depression. CONCLUSIONS: Our results suggest that 6-month-old infants are at higher risk for neurodevelopment delays if their mother reports persistent symptoms of depression from 7 to 90 days postpartum. The neurodevelopmental delay can be observed in all functional domains. Preventive intervention to reduce maternal postpartum depression may reduce the impact on infant developmental delay.

Addressing Challenges for Psychotherapy Supervision in Global Mental Health: Experiential Learnings From Rural Nepal.

Background: As the field of global mental health grows, many psychotherapy trainees will work across cultures in low-resource settings in high-income countries or in low- and middle-income countries. Faculty members and mentors may face several challenges in providing supervision for psychologists in low-resource settings. As such, there is a need to develop best practices for psychotherapy supervision in global mental health. Methods: We describe the common challenges and potential strategies in psychotherapy supervision based on our research, clinical, and academic partnerships between academic institutions, a nonprofit organization, and the Nepali government. Results: The strategies and considerations we have found helpful include focusing on therapies with strong behavioral and interpersonal (rather than emotional or cognitive) components and using locally validated therapies or standard manuals that have been endorsed by the WHO for low-resource settings. Other strategies include providing psychotherapy training for local psychiatrists who may be in supervisory roles and gaining competence in navigating different expectations of social structures and family dynamics. Conclusion: Supervisors face many challenges while supporting trainees and early psychologists in global mental health settings. While ensuring local adaptation, key considerations can be developed into best practices to support psychiatrists, supervisors, and trainees based in low- and middle-income countries.