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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.
Subject(s)
Cause of Death , Death Certificates , Humans , Nepal/epidemiology , Cross-Sectional Studies , Data Accuracy , Tertiary Care Centers , FemaleABSTRACT
In Nepal, suicidal behaviour among adolescents is a growing concern, and the country has been in the grip of a major mental health disaster for many years. The issue must be addressed immediately, and there must be urgent and concerted action by state institutions, healthcare practitioners, and society. Official statistics show the increased rates of completed suicide, whereas those cases that attempted suicide and survived the event remain unaccounted for. The fortunate suicide victims, who were timely rescued, resuscitated, and survived; in the recent years as witnessed at a tertiary hospital in the western region of Nepal, depict a grim picture of suicidality among youths, particularly among teenagers and young adults. The authors recognize the urgent need to tackle and address the problem of youth suicide in the country. Keywords: Cultural factors; mental health crisis; Nepal; risk-taking behaviour; suicide prevention.
Subject(s)
Suicide , Humans , Nepal/epidemiology , Adolescent , Suicide/statistics & numerical data , Young Adult , Suicide Prevention , Male , Female , Suicide, Attempted/statistics & numerical data , Risk-TakingABSTRACT
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.
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Post-mortem examination of the eye provides valuable forensic information yet is often overlooked. This brief review focuses on determining the cause/manner of death and post-mortem interval. External eye findings like corneal haziness and tache noire, combined with post-mortem changes in the iris, lens, retina and vitreous humour, can help estimate time since death. Ocular biometrics (iris/retinal scans) may facilitate identification. Age-related ocular changes can provide insights. The eye offers clues into personality (corneal tattooing, trichotillomania) and cause of death (petechiae in strangulation, retinal haemorrhages in abusive head trauma). Ocular trauma and underlying eye disease may be evident. Toxicology of vitreous humour can detect drugs/poisons. As a window into systemic disease and age-related changes, the eye aids pathology interpretations and, accordingly, post-mortem examinations have value. Ocular findings should not be overlooked in forensic examinations as they provide distinct information in determining cause/manner of death and post-mortem interval.
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Eye examination plays an important role when living individuals are forensically investigated. The iris colour, retinal scans and other biometric features may be used for identification purposes while visual impairments may have legal implications in employment, driving and accidents. Ocular manifestations provide clues regarding substance abuse, poisoning and toxicity, and evidence of trauma, abuse or disease can be revealed along with psychological traits and lifestyle. Thus, the eye is a valuable tool in forensic investigations of living subjects, providing identifying characteristics along with health information. This review focuses on the medico-legal aspects of the eye's contribution when the living are subjected to forensic examination.
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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.
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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.
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Background and aims: Medical education requires regular reforms to include emerging best practices and technologies, while also critically evaluating effectiveness of traditional didactic teaching methods. This manuscript examines the challenges and opportunities associated with modernizing the anesthesiology curriculum. Methods: Narrative review of literature on innovations in medical education, with a specific emphasis on anesthesiology training. Results: Educators face difficulties implementing new teaching approaches and evaluating their effectiveness. However, active learning methods, blended with selected traditional techniques, can enhance learner engagement and competencies. Self-directed learning and simulations prepare students for real-world practice, while flipped classrooms and online platforms increase accessibility. Conclusions: A blended approach, integrating interactive technology alongside modified lectures and seminars, may optimize anesthesiology education. Despite the promise of improved pedagogies, further research is required to assess outcomes. By embracing innovation while retaining certain foundational methods, programs can equip anesthesiologists with modern skills. This evolution is key to meeting the needs of 21st-century anesthesia care needs. Remaining at the forefront of this transformation will be vital in preparing competent future anesthesiologists through state-of-the-art education.
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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.
Subject(s)
Organ Transplantation , Tissue and Organ Procurement , Humans , Brain Death , Nepal , ReligionABSTRACT
The majority of literature on homicide-suicide addresses the fact that victims are predominantly female, and offenders are typically adult males (older than the victims) who share a familial, marital, or consortial relationship with them. The probability of fatalities involving murder-suicides in the bedrooms of middle-class households is higher. We present a case where an adolescent domestic helper strangled his landlady, twice his age, only to commit suicide by hanging thereafter. We go on to discuss homicide-suicide by servants outside the consortial relationship and the possible reasons for it in the Nepalese context.
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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.
Subject(s)
Ceremonial Behavior , Human Rights , Humans , Nepal , ReligionABSTRACT
This case highlights the complex interplay of mental health, stigma, and lack of contraceptive access underlying tragic instances of infanticide. Comprehensive medicolegal investigation paired with cross-sector efforts to expand reproductive services and transform cultural attitudes is crucial to protect vulnerable women and children.
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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.
Subject(s)
Academic Performance , Mental Disorders , Students, Nursing , Humans , Suicidal Ideation , NepalABSTRACT
In Nepal, police inquests have several limitations. When they receive information about a death, the police visit the crime scene and write an inquest report. Then, they arrange for the body to be autopsied. However, most autopsies are performed by medical officers in government hospitals who lack specialised training in conducting autopsies. Although all Nepalese medical schools teach forensic medicine to undergraduate students and require them to witness some autopsies, most private institutions are not authorised to perform them. Autopsies performed without expertise can be subpar and, even when trained personnel are available, these facilities are inadequately equipped. In addition, there is a lack of sufficient manpower to provide expert medico-legal services. The Honourable Judges and District Attorneys of all district courts believe that the medico-legal reports prepared by the doctors are inappropriate, incomplete and inadequate for use as evidence in court. Moreover, the police are more concerned with establishing criminality than other aspects of medico-legal death investigation, such as autopsies. Therefore, the quality of medico-legal investigations, including death investigations, will not improve until government stakeholders recognise the importance of forensic medicine in the judiciary and for the resolution of crimes.
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"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.
Subject(s)
Crime Victims , Homicide , Humans , Male , Female , Nepal , FamilyABSTRACT
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.
Subject(s)
Breast Neoplasms , Quality of Life , Male , Humans , Female , Quality of Life/psychology , Cross-Sectional Studies , Bangladesh/epidemiology , Breast Neoplasms/psychology , Hospitals, TeachingABSTRACT
Background: Suicide is a global health concern. There are reproductive health-related factors that are responsible for increasing the risk of female suicide. There are a number of studies examining the association between suicide and the menstrual cycle, but still, there are no conclusive findings. Aim: We aimed to pool data from all the studies reporting data on suicides and the menstrual cycle phase to report the following outcomes: incidence of suicidal deaths in the menstrual, secretory, and proliferative phases, and to find out whether the burden of suicide in the menstrual phase in particular, was more at a young age (18-35 years) or middle age (36-50years). Methods: The PubMed database was extensively searched from inception till 12th April 2022. The data for the number of events occurring for each outcome were pooled using random-effects model and forest plots were created. Results: Five articles were shortlisted for inclusion in our analysis. Incidence of suicide in the secretory phase was highest at 45.2% [95% CI, 0.367-0.537]. The incidence of suicide, when occurring in the menstrual phase, was reported to be 68.4% (95 CI, 0.317-1.052) and 31.6% (95 CI, -0.052.3-0.68) for young-aged and middle-aged victims, respectively. Conclusion: Our results demonstrate that the menstrual phase has a lower risk of mortality due to suicide when compared to the other two phases of the menstrual cycle. Nevertheless, when suicide occurred in the menstrual phase, the incidence of suicide among the younger age-group was higher than for those in the middle age-group.
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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.
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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.
Subject(s)
Intimate Partner Violence , Pregnancy , Female , Humans , Asia, Southern , Risk Factors , Nepal/epidemiology , Cross-Sectional Studies , PrevalenceABSTRACT
Air guns used for plinking are weapons with a short range and low velocity. Because of their low velocity, the ammunition usually enters the body without causing any immediate life-threatening complications. Lead toxicity is a potential side effect of a pellet lodged in the body. However, there are cases where blood lead level was below the reference value even after decades of an air gun pellet remaining in the body. We report a case of 40-year-old man whose X-ray of the skull revealed a metallic foreign body that appeared to be an air gun pellet in the maxillary sinus. The patient recalled receiving a gunshot wound to his left cheek ten years ago. The wound healed, the pain subsided, and the patient was symptom-free, so he did not seek medical attention. The present case study illustrates the incidental finding of impacted foreign body and its medico-legal aspects in the Nepalese context.