Brain Death and Organ Transplantation in Nepal: Navigating Cultural, Legal, and Ethical Landscapes.

Organ transplantation after brain death is challenging in Nepal due to cultural beliefs, legal frameworks, and ethical considerations. The Human Body Organ Transplantation (Regulation and Prohibition) Act (HBOTA) has not met with substantial success after its amendment. This review critically appraises the current state of brain death and organ transplantation in Nepal. It explores challenges, evaluates progress, and provides recommendations. Literature review of databases was conducted to find articles on brain death, organ donation, and transplantation in Nepal. Analysis of cultural, legal, ethical, and practical factors influencing implementation. Key challenges include limited awareness, religious beliefs, infrastructure gaps, and family consent barriers. HBOTA amendments in 2016 enabled brain death donations, however, donation rates remain low. Strategies are needed to improve public education, resources, personnel training, and collaboration. Cultural sensitivity and stakeholder engagement are crucial. A multifaceted approach addressing cultural, legal, ethical and practical dimensions is essential to improve organ donation rates in Nepal. Despite progress, substantial challenges persist requiring evidence-based strategies focused on awareness, capacity building, policy improvements, and culturally appropriate community engagement.

Knowledge and Perception of Community Based Integrated Management of Neonatal and Childhood Illnesses among Medical Students at a Medical College: A Descriptive Cross-sectional Study.

INTRODUCTION: Community-Based Integrated Management of Neonatal and Childhood Illnesses (CBIMNCI) is the integrated approach for the management of children's common health concerns in outpatient primary health care settings and interventions at the family and community level. This study aimed to assess the knowledge and perception regarding CB-IMNCI in medical students studying in the clinical phase of a medical college. METHODS: A descriptive cross-sectional study was conducted from February to June 2023 among 218 clinical-year medical students after obtaining ethical clearance from the Institutional Review Committee (Reference number: IRC-LMC-04/M-022). A self-administered questionnaire with CB-IMNCI-related multiple-choice questions was used for data collection and the responses to knowledge-related questions were evaluated using a predefined answer key. The results were expressed in terms of the number and percentage of the participants who answered each questions correctly. RESULTS: Of the 218 students, 111 (50.92%) were male and 107 (49.08%) were female. Among the participants, 164 (75.23%) (70-80% at 95% Confidence Interval) demonstrated basic knowledge of CB-IMNCI, successfully answering 50% or more of the questions. Among the males, 81 (72.97%), and among the females, 83 (77.57%) had basic knowledge of CBIMNCI. In terms of semester-wise distribution, 33(53.22%) in the 5th semester, 43 (82.69%) in the 7th semester, 41 (80.39%) in the 9th semester and 47 (88.67%) were able to answer 50% or more of the questions correctly. CONCLUSIONS: This study showed that one fourth of the students lack the basic knowledge about CB-IMNCI. It suggests the need for further work to enhance effectiveness of pre-service CB-IMNCI training.

Evaluation of Errors on Death Certificates.

BACKGROUND: Death certificates provide vital data for disease surveillance and health policy. However, errors are common globally, undermining data reliability. This study analyzed prevalence and types of errors in death certificates at a tertiary hospital in Nepal. METHODS: A cross-sectional study reviewed all death certificates issued at Lumbini Medical College, Nepal from April 2020 to April 2022. Certificates were assessed for errors including improper sequencing, absent time intervals, abbreviations, illegible writing, and inaccurate immediate, antecedent, and underlying causes of death as per international guidelines. Errors were classified as major or minor. RESULTS: Of 139 certificates, none were error-free. The most common error was incorrectly or incompletely filling the immediate cause of death (77.7%). Other errors included absent time of death (17.3%), abbreviations (57.6%), illegible writing (22.3%), and omitting the hospital stamp/medical council registration number (8.6%). Based on international criteria, 76.3% had minor errors, 23% had both major and minor errors. CONCLUSIONS: This study found a high rate of errors in death certification at a tertiary hospital in Nepal, undermining data accuracy. Regular training and monitoring with feedback are recommended to improve certification practices. Accurate cause-of-death data is vital for healthcare policy and decision-making in Nepal.

Delayed diagnosis of pemphigus vulgaris in rural Nepal due to healthcare inaccessibility and harmful traditional practices: A case report.

Early intervention is imperative for potentially fatal dermatologic diseases such as pemphigus vulgaris. In rural Nepal, limited public awareness, home remedies, and delays in healthcare access lead to poor outcomes. Although biopsy confirms the diagnosis, experienced dermatologists can make an accurate clinical diagnosis when characteristic skin lesions are present.

Suicide contagion and psychosocial risks among Nepali youth through a near-hanging case study.

The phenomenon of suicide contagion: some individuals, especially vulnerable young people, exhibit increased susceptibility to suicidal ideation when exposed to the suicide of other people. Significant research suggests that exposure to media portrayals, suicide groups and peer suicides may lead to suicide contagion. Prevalent psychosocial and cultural factors in Nepal such as interpersonal conflict, domestic violence, gender inequity and social exclusion probably contribute to suicidal behaviour. This case study investigates a high school student in a rural mountainous community in Nepal, who attempted suicide by hanging following his girlfriend's suicide, and demonstrates how peer suicide exposure prompts imitative behaviour in a vulnerable young person and confirms suicide grief as an underrepresented risk factor. Prompt, supportive interventions for high-risk grievers and societal prevention strategies tailored to adolescents are essential to curb imitative deaths.

Striving toward safe abortion services in Nepal: A review of barriers and facilitators.

Background and Aims: Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion-related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services. Methods: A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed. Results: Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal/policy, socio-cultural, health systems, and other factors. Facilitators improving access were categorized as economic/geographic/societal, legal/policy, socio-cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal/policy, socio-cultural, geographic/accessibility, and health systems factors. Conclusion: The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse-midwives and community health volunteers are key facilitators.

Barriers to mental health care access in Nepal.

Mental disorders are stigmatised in Nepal. There are many instances where mentally ill people are tormented by their family members and society and where patients with mental illness are shackled and kept under house arrest. Physical illness attracts early medical care, but not mental illness. There are no asylums for patients suffering from mental illness. The Nepalese government must prioritise it as a serious health issue and allocate more money and take steps to tackle the stigma and deficiencies associated with it.

The tragic consequence of false honour: Understanding the phenomenon of "honour-killings" and its legal implications in Nepal.

"Honour-killings" are the intentional execution of women who are perceived to have disrespected their families; in Nepal this is frequently considered socially acceptable while the United Nations condemns them as arbitrary executions that violate the right to life. In Nepal, "honour-killing" is typically a caste-based hate crime which is not limited to women as there have been reports of male victims as well. The perpetrators are sentenced to life imprisonment for murder, with the perpetrator serving 25 years. Pride-killing is common in the animal kingdom, but there is no logic in killing a family member to maintain family pride in a civilised human society.

Human sacrifice: From religious ritual to legal sentence in Nepal.

Human sacrifice is a gruesome and controversial practice where one or more individuals are killed as part of a religious ceremony or as a gift to a deity. While the practice has been widely condemned globally, it still persists in some communities in some countries. Nepal, in particular, has a history of animal sacrifice with larger offerings taking place every five years. While animal sacrifice is legal, the ultimate punishment for engaging in human sacrifice is a legal sentence. This article examines the historical and cultural context of sacrifice in Nepal and explores some contemporary cases of human sacrifice reported in the media. The article also considers the impact of superstitious beliefs and the need for evidence-based attitudes to support human rights.

Levonorgestrel Implant Continuation among Postpartum Women Admitted to the Department of Obstetrics and Gynecology of a Tertiary Care Centre.

Introduction: Jadelle (Levonorgestrel) implant is a long-acting reversible contraceptives which is recommended for post-partum contraceptive device due to their high efficacy, convenience, and cost-effectiveness. The continuation of Jadelle implant prevents unintended pregnancies and maintain healthy spacing between the pregnancies, thus improving maternal and child health outcomes. However, Government has endorsed the long-acting reversible contraceptives as immediate post-partum contraception, the status of Jadelle implant continuity is unknown. The aim of this study was to find out the prevalence of levonorgestrel implant continuation among postpartum women admitted to the Department of Obstetrics and Gynecology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among women who had Jadelle implant inserted within 48 hours of delivery admitted to the Department of Obstetrics and Gynecology at a tertiary care centre. Ethical approval was taken from the Institutional Review Committee. Data from 1 July 2020 to 31 December 2020 were collected between 1 July 2022 to 31 December 2022 from the hospital records. Patients were interviewed after 2 years through phone calls. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 157 post-partum women, 145 (92.36%) (88.20-96.52, 95% Confidence Interval) had levonorgestrel implant in-situ. Conclusions: The prevalence of levonorgestrel implant continuation among postpartum women admitted to the Department of Obstetrics and Gynecology was similar to other studies done in similar settings. Keywords: contraception; family planning; levonorgestrel; postpartum period; pregnancy.

Suicidal Ideation Among Medical and Nursing Students.

BACKGROUND: Suicidal ideation is a major predictor of suicide attempts. The present study was conducted to compare the prevalence of suicidal ideation and its risk factors among medical and nursing students in Nepal. METHODS: An online survey was carried out among a cohort of medical and nursing students of Lumbini Medical College using questions derived from General Health Questionnaire-28 and Patient Health Questionnaire-9. RESULTS: 153 medical and 148 nursing students participated in the study. Lifetime suicidal ideation was present in 20.6%(n=62) medical and 13.95%(n=42) nursing students. Suicidal ideation in the last one year was present in 48 medical and 36 nursing students. There were higher odds of suicidal ideation in medical students who had parental neglect, psychiatric disorder, physical and sexual abuse, substance abuse, and academic performance dissatisfaction (p<0.05), whereas the odds were higher in nursing students with psychiatric disorder, parental demands, alcohol consumption, and academic performance dissatisfaction but was not statistically significant. Thematic analysis of the responses for open-ended question for reasons for previous suicide plans or attempts among four medical and eight nursing students revealed relationship issues, history of adverse childhood experiences, academics-related circumstances, and other individual problems as suicide antecedents. CONCLUSIONS: Periodic motivational speeches and counselling sessions during all the semesters of professional schooling would help decrease suicidal ideation. Mental health awareness programs for medical and nursing students should be aimed at reducing mental illness-associated stigma and promoting timely professional help-seeking behavior.

Suicide attempts due to child abuse: A perspective into the Nepalese legal framework and societal norms.

Children who experience violence are more prone to develop high-risk behaviour, mental illness and anxiety disorder. Nepalese law is against any form of physical violence but corporal punishment by parents on children continues in patriarchal Nepalese society. We describe a case of a young boy who attempted suicide twice due to maltreatment and discuss the legal and social issues involved.

Assessment of quality of life (QOL) in cancer patients attending oncology unit of a Teaching Hospital in Bangladesh.

BACKGROUND: The quality of life (QoL) of a cancer patient is their perception of their physical, functional, psychological, and social well-being. QoL is one of the most important factors to consider when treating someone with cancer and during follow-up. The aim of this study was to understand the state of QoL among cancer patients in Bangladesh and to determine the factors that affect it. METHODS: This cross-sectional study was conducted on 210 cancer patients who attended the oncology unit of Delta Medical College & Hospital, Dhaka during the period between 1 May 2022 and 31 August 2022. Data were collected using the Bengali version of the European Organization for Research and Treatment of Cancer (EORTC) questionnaire. RESULTS: The study reported a high number of female cancer patients (67.6%), who were married, Muslims by religion, and non-residents of Dhaka. Breast cancer was more common among women (31.43%), while lung and upper respiratory tract cancer was more prevalent among men (19.05%). The majority of the patients (86.19%) were diagnosed with cancer in the past year. The overall mean score for functional scales was higher for physical functioning (54.92) whereas it was lower for social functioning (38.89). The highest score on the symptom scale was for financial problems (63.02), while the lowest was for diarrhea (33.01). The overall QoL score of cancer patients in the study was 47.98 and it was lower for males (45.71) compared to females (49.10). CONCLUSIONS: The overall QoL was poor among Bangladeshi cancer patients compared to those in developed countries. A low QoL score was observed for social and emotional functions. Financial difficulty was the main reason behind the lower QoL score on the symptom scale.

Intimate Partner Violence During Pregnancy in South Asia: Systematic Review and Meta-Analysis.

BACKGROUND: This systematic review collated the literature on the prevalence rate of different types of intimate partner violence (IPV) during pregnancy in South Asia. METHODS: Systematic literature searches were conducted in four major databases (Embase, Scopus, PubMed, PubMed Central) to identify relevant articles published from the inception of each database to May 2021, which reported data on the prevalence of intimate partner violence during pregnancy in South Asia. The Joanna Briggs Institute critical appraisal tool for prevalence studies was used to assess the risk of bias in individual studies. A random-effects model was used to calculate the pooled prevalence and corresponding 95% confidence interval due to significant between-study heterogeneity. RESULTS: Thirty-seven studies were reviewed which showed an overall prevalence of IPV from South Asian countries was 23.4% (physical violence: 13.6%; sexual violence: 8.5%; emotional violence: 20.2%). CONCLUSIONS: There was a higher prevalence of intimate partner violence during pregnancy reported, with an overall prevalence ranging from 1.7% to 66.4% across studies. Emotional violence was more prevalent form when compared to sexual or physical violence.

Road Traffic Injuries among Patients Visiting the Emergency Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Road traffic injuries are preventable yet one of the most neglected public health issues. Road traffic injuries not only impact the health of the victim but also cause financial burden to the entire family. This study aimed to find out the prevalence of road traffic injuries in patients visiting the Emergency Department in a tertiary care centre. Methods: A descriptive study was conducted among patients visiting the Emergency Department in a tertiary care centre from 1 January 2021 to 30 June 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: IRC-LMC 07-J/020). Demographic information of the patients, accident profile and type of intervention at the hospital, and outcome were studied. Point estimate and 95% Confidence Interval were calculated. Results: Among 8,765 patients visiting the emergency department, road traffic injuries were seen in 112 (1.28%) (1.04-1.52, 95% Confidence Interval). Conclusions: The prevalence of road traffic injuries was found to be similar to other studies conducted in a similar setting. Keywords: automobiles; demography; Nepal; soft tissue injuries; traffic accidents.

Assessment of fear, anxiety, obsession and functional impairment due to COVID-19 amongst health-care workers and trainees: A cross-sectional study in Nepal.

BACKGROUND: The emergence of the COVID-19 epidemic threw the world into turmoil. The medical community bore the brunt of the pandemic's toll. Long work hours, and a lack of personal protective equipment (PPE) and social support all had an influence on mental health. METHODS: This cross-sectional study was conducted among Lumbini Medical College Teaching Hospital students and employees in Palpa, Nepal. Data entailing their demographic details, pre-existing comorbidities, or death in the family due to COVID-19 was collected using a self-administered survey. In addition, the level of fear, anxiety, obsession, and functional impairment due to COVID-19 was recorded using previously validated respective scales. RESULTS: In total, 403 health-care workers and trainees participated in our study. The mean age of the study participants was 23±4 years, and more than half of them (n=262, 65%) were females. A significant association was found between fear score with age (p-value=0.04), gender (p-value <0.01) and occupation (p-value<0.001). The participants suffering from chronic diseases (p-value=0.36), were not found to be significantly obsessed with COVID-19. Age (p-value=0.34), was not found to be significantly associated with higher anxiety levels. Nursing students suffered from a significantly greater functional impairment than other health-care professionals (mean rank score=269.15, p-value < 0.001). A moderately positive correlation was observed between fear, anxiety, obsession, and functional impairment scales. CONCLUSION: This study revealed various socio-demographic characteristics as risk factors for psychological stress in the people related to the health-care profession of Nepal during the COVID-19 pandemic. A viable answer to this quandary might be adequate psychosocial intervention by health-care authorities, increased social support, and the introduction of better mental health management measures for the front-line health-care workers.

Accusations of witchcraft: A form of violence against women in Nepal.

Accusations of witchcraft and witch-hunting activities remain serious problems in Nepal, where many women are subjected to violence or torture following accusation and persecution. Many experience serious physical and mental injury, and some die. However, most of these incidents are not reported because women and their families fear reprisals. Poverty, systemic gender inequality and weak state laws provide a context in which this behaviour occurs. Allegations of witchcraft will, however, not be fully eradicated without improvements in education and legal safeguards.

Safe abortion services during the COVID -19 pandemic: a cross-sectional study from a tertiary center in Nepal.

Background: Abortion is an essential service, the need for which has increased during the coronavirus disease 2019 (COVID-19) pandemic. Because of the lockdowns at several periods, these services were hampered. This study analyzed the pattern of Safe Abortion Services (SAS) at a tertiary healthcare center during the first six months of the COVID-19 pandemic in Nepal. Methods: This is a cross-sectional analytical study. We compared the pattern of safe abortion services between the first three months of the pandemic when a lockdown was implemented and the second three months when the lockdown was eased. Demographic and obstetric profile of women, their abortion choices, method of termination, difficulty in accessibility, and level of psychological distress were studied. Results: A total of 52 women were provided SAS during the study period. The number of women coming for SAS during lockdown was 47.1% less than that after easing of the lockdown. During the lockdown, women came at a later period of gestation with a mean of 9.5 weeks compared to 7.5 weeks in the later three months. Because of fear of COVID-19, 19.2% (n=10) women opted for termination of pregnancy. Increased need of contraception was felt but 40% (n=12) had problems of accessibility. More women had probable serious mental illness during the lockdown period (p=0.008). Conclusion: Lockdown during the pandemic decreased the number of women coming for SAS due to barriers in accessibility. Contraceptive needs are also increased but access is difficult. The need for safe abortion services and contraception has increased during the pandemic but the lockdown caused inaccessibility. Psychological distress is prevalent, and fear of COVID-19 has become a common reason for termination of pregnancy. This pandemic can be taken as an opportunity to provide and improve contraception and abortion accessibility, and quality with integration of mental health support.