Assessing Hydropower Potential in Nepal's Sunkoshi River Basin: An Integrated GIS and SWAT Hydrological Modeling Approach.

This study assessed the hydropower potential of a mountain watershed within the Sunkoshi River basin in Sindhupalchok, Nepal, utilizing geographic information systems (GIS) and the soil and water assessment tool (SWAT) hydrological model. Topographical, soil, land use, meteorological, and discharge data were employed to assess the study area for the appropriateness of hydropower generation. SWAT was utilized to delineate the Sunkoshi basin into 23 distinct subbasins and involved the creation of a detailed river network, incorporating various hydrological attributes including stream links, stream order, stream length, and slope gradient. After that, it was employed to simulate river discharges within these subbasins. The Sequential Uncertainty Fitting Version 2 (SUFI-2) algorithm, integrated within the SWAT Calibration and Uncertainty Program (SWAT-CUP), was employed to calibrate and validate the model. This step involved the adjustment of 25 selected parameters to enhance the model's accuracy and reliability in representing the hydrological processes of the Sunkoshi basin. Model performance was assessed utilizing three well-established efficiency criteria: coefficient of determination (R2 = 0.79), Nash-Sutcliffe efficiency (NSE = 0.73), and percent bias (PBIAS = 17.59). The study identified 36 sites across streams of order 3, 4, and 5 as having potential for hydropower generation. The hydropower potential at each identified site was evaluated using estimated stream flow and topographical head at various probability of exceedance (PoE) levels (40%, 45%, 50%, and 60%). The aggregate hydropower potential of the basin was quantified, yielding a potential of 371.30 MW at a 40% PoE. The findings suggest that an integrated approach combining SWAT-based hydrological modeling within a GIS can accurately assess a river basin's hydropower potential and provide insights into further evaluation of the comprehensive environmental assessment of the fragile Himalayan watersheds.

Psychosocial Well-Being of People Living with HIV/AIDS in Chitwan District, Nepal: a Mixed Method Study.

BACKGROUND: Along with many physical issues associated with the HIV/AIDS there are socio-psychological ill-effects including depression, anxiety and stress. The antiretroviral therapy has been successful in prolonging the life but not much information is available on the psychosocial issues and social support from Nepal. METHODS: Sequential explanatory mixed method study design was followed. All the patients undergoing antiretroviral therapy in Bharatpur Hospital above 18 years of age and giving consent to participate were conveniently selected. Validated Nepalese version of Becks Depression Inventory and Becks Anxiety Inventory tool while translated and validated Multidimensional Scale of Perceived Social Support scale was used Purposive In-depth Interview was conducted with open ended questionnaire to obtain qualitative data. Chi-square and logistic regression were used for quantitative analysis while manual content analysis was used to analyze the qualitative data. RESULTS: The totals of 288 participants were included in the study About 43% had some level of depression, 98% had very low level of anxiety and almost half of the people had high support. In binary logistic regression model, the significant variables were sex, marital status and occupation. Females had 2.622 times more odds of depression than males, the risk of having depression in occupation group- agriculture and household was 3.661 and 2.508 time more as compared to jobholder respectively. Similarly, single individuals had 2.815 higher odds of depression than couples. Emotional disturbances and fear of vulnerability, stigmatization, dealing with difficulties were the major problems in these groups with good familial and organization support. CONCLUSIONS: Clinicians, health and AIDS professionals should routinely screen for depression among other interventions to promote psychological health in HIV/AIDS-positive individuals.

Quality of Life among People Living with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome in a Anti-Retroviral Therapy Clinic.

BACKGROUND: The increasing burden of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and its association with the stigma, disability, less productive life, diminished immune has overall affected the quality of well being. There are also many factors that directly or indirectly affect the quality of Life of People living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome. Thus, this study aims to assess Quality of Life among people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome. METHODS: A cross-sectional analytical study among 100 individuals of age 18 years and above and diagnosed from 6 month and above attending the ART clinic of Bharatpur Hospital was carried out between using simple random sampling technique. Quality of life was evaluated using World Health Organization Quality of life questionnaire (WHO QOL-BREF instrument). RESULTS: This study reveals that the Quality of Life median scores were highest for the environmental domain (25±2.6) and lowest for the social domain (11±1.4). The overall Quality of Life median scores in the other two domains were physical domain (23±2.4), and psychological domain (19±3.1). The Quality of Life scores of all four domains were strongly co-related with the total measure of the quality of life. The strongest correlation was seen in psychological domain .Sex, Education, Marital status, Cause of HIV, Co-morbidities of illness, and Family support was statistically associated with overall Quality of Life. CONCLUSIONS: Higher education, Good family support and no co-morbidties to the illness has a greater impact in improving the quality of Life.

Knowledge, attitude, and practice of stroke among high school students in Nepal.

BACKGROUND: Baseline stroke knowledge in a targeted population is indispensable to promote the effective stroke education. We report the baseline knowledge, attitude, and practice (KAP) of high school students with respect to stroke from Nepal. MATERIALS AND METHODS: A self-structured questionnaire survey regarding KAP about stroke was conducted in high school students of 33 schools of Bharatpur, Nepal. Descriptive statistics including Chi-square test was used, and the significant variables were subjected to binary logistic regression. RESULTS: Among 1360 participants, 71.1% had heard or read about stroke; 30.2% knew someone with stroke. 39.3% identified brain as the organ affected. Sudden onset limb/s weakness/numbness (72%) and hypertension (74%) were common warning symptom and risk factor identified. 88.9% would take stroke patients to a hospital. Almost half participants (55.5%) felt ayurvedic treatment be effective. 44.8% felt stroke as a hindrance to a happy life and 86.3% believed that family care was helpful for early recovery. Students who identified at least one risk factor were 3.924 times (P < 0.001, confidence interval [CI] = 1.867-8.247) or those who identified at least one warning symptom were 2.833 times (P ≤ 0.023, CI = 1.156-6.944) more likely to take stroke patients to a hospital. CONCLUSION: KAP of high school Nepalese students regarding stroke was satisfactory, and the students having knowledge about the risk factors and warning symptoms were more likely to take stroke patients to a hospital. However, a few misconceptions persisted.

Stroke subtype, age, and baseline NIHSS score predict ischemic stroke outcomes at 3 months: a preliminary study from Central Nepal.

BACKGROUND: The combined medications practice of using antithrombotic agents and statins with or without antihypertensive agents is common in the treatment of acute ischemic stroke in Nepal. Short-term outcomes of the current practice have been studied. We aim to explore the predictors of ischemic stroke outcomes at 3 months, with the current combined medications practice. METHODS: The study population (N=56) included acute ischemic stroke patients treated at the Neurology Department of the College of Medical Sciences-Teaching Hospital, Chitwan, Nepal, from May 2014 to August 2014 and followed up at 3 months. Death or disability (modified Rankin scale >2) was defined as poor outcomes. Multivariate logistic regression analysis (P<0.10) using potential variables from bivariate analysis (P≤0.20) was adjusted to predict outcomes at 3 months. RESULTS: At 3 months, 29 (51.8%) patients were independent, eleven (19.6%) were dependent, while 16 (28.6%) died. Stroke subtype and baseline National Institute of Health Stroke Scale (NIHSS) scores were associated with death/disability (27, 48.2%) at 3 months. Regression analysis showed that large-artery stroke (odds ratio [OR] =284.145, 95% confidence interval [CI] =5.221-15,465.136, P=0.006), age (OR =1.113, 95% CI =1.002-1.236, P=0.045), and baseline NIHSS score (OR =1.557, 95% CI =1.194-2.032, P=0.001) were significant predictors of poor outcome at 3 months. CONCLUSION: Stroke subtype, age, and baseline NIHSS score are predictors of ischemic stroke outcomes in Nepalese population treated with the current practice of using combined antithrombotic and statins with or without antihypertensive agents, and these predictors can be used for the improvement of selection of patients for the appropriate treatment.

Intravenous Thrombolysis and Risk Factors for Ischemic Stroke.

Thrombolysis is one of the proven potential treatments for the management of acute ischemic stroke. Intravenous recombinant tissue-plasminogen activator (rt-PA) is the only medically approved biological thrombolysing agent for the treatment of acute ischemic stroke within 4.5h of stroke (2.2% symptomatic intracerebral haemorrhage, 12.7% mortality and 58.0% functional independence), but following the guideline and criteria provided by National Institute of Neurological Disorder and Stroke (NINDS) and SITS (Safe Implementation of Thrombolysis in Stroke) studies. Nepal needs to evidently introduce intravenous rt-PA in its clinical setting for treatment of acute ischemic stroke, which has been approved for more than a decade ago in developed countries. Several modifiable and non-modifiable risk factors can affect the outcomes of the treatment with intravenous rt-PA. Early modification of factors predicting the risk outcomes can be a beneficial tool to justify the thrombolytic treatment. This review aims to discuss the major studies on thrombolysis using rt-PA and main factors that can affect the outcomes of treatment in ischemic stroke.

Pattern of abortion care in a tertiary level maternity hospital in Nepal.

INTRODUCTION: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries and not to mention the cost it imparts to the health system of a country. Therefore, it is equally important to find out the prevalence and the pattern of abortion among the women who utilize the safe abortion care services and provide a framework to target various health promotion programs including safe-motherhood and reproductive health; such that the future interventions to avoid the unintended pregnancy and unsafe abortion can be implemented accordingly. METHODS: A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal. Social and demographic information of all the women seeking induced abortions from January 2011 to December 2012 were included and the result was analyzed. RESULT: Abortion contributed to about 1.68% of the total patient served in the hospital that provides both obstetrical and gynecological services. Of the total 4830 patients who underwent induced abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two parity and belonged to higher caste. CONCLUSION: The socio-demographic profile of the abortion clients in Nepal has remained similar over the years. We need to address the accessibility and availability to the safe abortion care services along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion care to all group of women and also, women education regarding contraception to avoid repeated abortions or unwanted pregnancy in the future.