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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Type 2 Diabetes Mellitus in Nepal from 2000 to 2020: A systematic review and meta-analysis.

Aims: To evaluate the prevalence and risk factors of type 2 diabetes mellitus (T2DM) from 2000-2020 in various parts of Nepal.  Methods: PubMed, Embase, Scopus, and Google Scholar were searched using the appropriate keywords. All Nepalese studies mentioning the prevalence of T2DM and/or details  such as risk factors were included. Studies were screened using Covidence. Two reviewers independently selected studies based on the inclusion criteria. Meta-analysis was conducted using Comprehensive Meta-Analysis Software v.3.  Results: Total 15 studies met the inclusion criteria. The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal in the last two decades was 10% (CI, 7.1%- 13.9%), 19.4% (CI, 11.2%- 31.3%), and 11.0% (CI, 4.3%- 25.4%) respectively. The prevalence of T2DM in the year 2010-15 was 7.75% (CI, 3.67-15.61), and it increased to 11.24% between 2015-2020 (CI, 7.89-15.77). There were 2.19 times higher odds of having T2DM if the body mass index was ≥24.9 kg/m 2. Analysis showed normal waist circumference, normal blood pressure, and no history of T2DM in a family has 64.1%, 62.1%, and 67.3% lower odds of having T2DM, respectively.  Conclusion: The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal was estimated to be 10%, 19.4%, and 11% respectively.

Epidemiology of Road Traffic Accidents in Nepal from 2009/10 to 2019/20: A 10 Year Study.

BACKGROUND: Road traffic accidents are the leading cause of deaths worldwide among children and young adults aged between 5 to 29 years. The risk of road traffic accident-related death is higher in low-income countries. Thus, we aim to evaluate the epidemiology of road traffic accidents in Nepal during the fiscal years from 2009/10 to 2019/20. METHODS: This study is a secondary data analysis of the published police records publicly available on the official webpage of Nepal Police. A study was carried out after written permission from Nepal Police. The data obtained were analysed using Microsoft Excel-13. RESULTS: Analysing available data about reported road traffic accidents events showed an increasing trend in road traffic accidents from the fiscal years 2011/12 till 2019/20, with a steeper increase in the number of road traffic accidents in fiscal years 2017/18 and 2019/20. In fiscal years 2009/10, 11,747 vehicles collided; which rose to 25,788 in the fiscal years 2019/20. More cases of road traffic accidents were reported to occur from 12 noon-6 pm in a day. Among reported road traffic accidents commonest predispositions behind road traffic accidents was the negligence of driver followed by over speed. Among those individuals who died due to road traffic accidents, most of them were male. CONCLUSIONS: We found an increasing trend of road traffic accidents, vehicle collisions, and injuries in Nepal over the past ten years especially among two-wheelers and four-wheelers like the car, bus, and autorickshaw.

Witchcraft allegations and untouchability as forms of violence upon women in Nepal: A 7-year study.

The Nepalese constitution guarantees equal rights to both men and women regardless of caste, race, or ethnicity. However, the centuries-old superstitious practice of caste-based hierarchy in the Hindu community and discrimination against people of lower caste are still prevalent. Furthermore, witchcraft allegations are also not uncommon. Both these practices are derogatory and humiliating and violate human rights, and the law can penalise them in both instances. Due to the intersection of gender and caste, women often face multiple forms of discrimination and violence as the patriarchal society considers them a weaker gender. The present study aimed to see the trend of crimes upon women reported by Nepal Police in the form of witchcraft allegations and untouchability between the fiscal years 2013/14 and 2019/20.