Health assistants play a crucial role in healthcare delivery, particularly in remote and rural areas of Nepal. They should have adequate lifesaving and resuscitation skills. Therefore, assessing their cardiopulmonary resuscitation (CPR) knowledge is essential. To evaluate the knowledge of CPR among health assistants (HAs) in Nepal and explore if there were variations in knowledge scores based on the demographic characteristics of the participants. A quantitative cross-sectional research design was used. The study population included HAs registered with the Nepal Health Professional Council (NHPC) who completed three years of training. Non-probability convenience sampling was employed. Data was collected using an online survey based on the 2020 American Heart Association guidelines. Demographic information and participants' knowledge levels were noted. The study involved 500 HAs, with the majority being male and working in government hospitals. Most participants were from Madhesh Province, and the median age was 26 years. Only a fraction of the participants had received training in CPR, and none of them had ever performed CPR. The median knowledge scores were higher among males and among respondents from Madhesh, Lumbini, Karnali, and Sudhurpaschim provinces. The HA's knowledge of the correct depth of CPR compression for children (21%) and infants (17.4%) was limited. CPR scores were different according to variables like training, theory understanding, and practice duration, among others. The findings highlighted the need for more practical training and regular refresher courses to enhance HAs ability to provide life-saving interventions. The study revealed less CPR knowledge and a lack of practical training among HAs in Nepal. To improve healthcare outcomes, providing practical training and ongoing education on CPR is crucial. The findings can contribute to curriculum development and policy changes in healthcare delivery.

Background: High test anxiety negatively impacts students, affecting academic performance, well-being, focus, and retention rates. Cognitive Behavioral Therapy (CBT) is a promising approach to reducing test anxiety, and we aimed to assess the effectiveness of group-based CBT in reducing test anxiety among undergraduate students. Material and Method: This experimental, independent two-group design enrolled 80 test-anxious participants, randomly assigning them to a control or intervention group (40 participants each). Westside Test Anxiety Scale was the primary outcome measure, and participant's feedback was collected. The intervention group received ten sessions of group-based CBT. Baseline and endline data were analyzed, and effect size was reported. Results: Participant feedback was analyzed qualitatively. The intervention group demonstrated 16% reduction in test anxiety score from their baseline, while the control group showed only 5.54% reduction from their baseline. In contrast, the control group showed a 2-point reduction, representing a 5.54% decrease. This difference was statistically significant (effect size= -0.53), supporting moderate effectiveness. Further, scores in specific test anxiety areas, such as worry about forgetting during the study and performance after exams, showed notable improvement. Participant feedback highlighted improved stress management, self-awareness, and understanding of emotions. Suggestions incorporating visual aids and increasing interactivity for the future. Conclusion: This study demonstrates utility of group-based CBT in reducing test anxiety among undergraduate students. A larger scale randomized controlled trial is needed to evaluate the effectiveness of group CBT in a larger population, and future studies can focus on examining the effect of group CBT delivered by non-specialists in a broader population.

AbstractIn this article, we explore the experiences of women construction workers in Nepal and the strategies that these workers have adopted to challenge the exploitation and inequalities they confront. We firstly argue that the experiences of women construction workers in Nepal are shaped by compulsive engagement in labor markets under conditions of informality, precarity, and gendered responsibility for social reproduction. These experiences reflect multiple intersections of gender, class, caste, and ethnicity in the arenas of the household, the workplace, trade unions, and the state. However, policy interventions related to women's participation in labor markets and inspired by the Gender Equality as Smart Economics approach, such as Nepal's post‐earthquake mason training scheme targeting women construction workers, render invisible these structures of inequality, exploitation, and violence. Second, we argue that women construction workers negotiate—and in some cases challenge and change—working conditions, primarily through a variety of informal and formal collective strategies. Women construction workers' own narratives and practices, we find, bear little resemblance to the narratives promoted by the International Financial Institutions and the state, in which women workers appear as resilient, altruistic, and industrious entrepreneurial subjects seeking individual self‐improvement within the neoliberal framework. They rather invoke informal and organized collectivities, negotiate, and often resist, gendered norms of behavior and at times radically re‐envision the scope of trade union struggles.

AbstractPublic lands including forests and community pastures are still crucial means of local livelihood, social security, and environmental conservation in many developing countries including Nepal. However, these resources are increasingly managed primarily to offset greenhouse gas emissions of developed countries. The new management has exacerbated many local problems: livelihood constriction, social crises, human casualties (deaths and serious injuries), biodiversity degradation, and water scarcity including cryosphere retreating. Drawing data from multiple sources, this study attempted to explain the international political objectives and processes that dispossessed developing societies of public land resources for the benefit of developed countries. It shows that representatives of the developed countries were proactively and strategically involved in agenda formation, solutions negotiations, and decision-making while developing international environmental policies, and succeeded to structure the policies for managing the resources of developing countries for the best benefit of their own countries. The developed countries provided funds and experts, as strategic tools, through international aid agencies to implement the policies of their interest in institutionally weak countries. In Nepal, the aid agencies influenced the thinking of the public and the decisions of the government and other stakeholders through a series of strategic measures. They propagandized false crises, worked with a coalition of powerful international agencies, offered free technical support, and changed national policies proactively to manage the land resources for achieving their missions. Active involvement in policy implementation also helped the agencies to monitor implementation hurdles and apply other tactics to resolve them. Lucrative flash incentives were provided to motivate and get the support of communities, powerful stakeholders, and politicians to implement the policies. Psychosocial pressures were also applied to persuade local communities and their leaders for getting local cooperation in making and practicing new legal institutions (government authority rules or orders, user group rules, and forest management plans) that bind and control local communities for forest protection. The institutions obliged local communities to contribute free labor or cash for developing, modifying, and protecting the forests. These two levels of interventions led to the further development of reinforcing institutions, resource conditions, and social-ecological systems that secured benefits for developed countries and deprived local communities of power to control, produce and access the public land resources in their own backyard for years. This study also showed that international environmental policies and aid agencies have respectively served as institutional weapons and vehicles for materially and institutionally powerful countries to colonize the land resources of weaker countries, without using of physical coercion or deplyment of military forces.

BackgroundWith an increasing burden of stroke, it is essential to minimize the incidence of stroke and improve stroke care by emphasizing areas that bring out the maximum impact. The care situation remains unclear in the absence of a national stroke care registry and a lack of structured hospital-based data monitoring. We conducted this systematic review and meta-analysis to assess the status of stroke care in Nepal and identify areas that need dedicated improvement in stroke care.MethodsA systematic literature review was conducted to identify all studies on stroke epidemiology or stroke care published between 2000 and 2020 in Nepal. Data analysis was done with Statistical Package for Social Sciences (SPSS) and Comprehensive Meta-analysis (CMA-3).ResultsWe identified 2533 studies after database searching, and 55 were included in quantitative and narrative synthesis. All analyses were done in tertiary care settings in densely populated central parts of Nepal. Ischemic stroke was more frequent (70.87%) than hemorrhagic (26.79%), and the mean age of stroke patients was 62,9 years. Mortality occurred in 16.9% (13-21.7%), thrombolysis was performed in 2.39% of patients, and no studies described thrombectomy or stroke unit care.ConclusionThe provision of stroke care in Nepal needs to catch up to international standards, and our systematic review demonstrated the need to improve access to quality stroke care. Dedicated studies on establishing stroke care units, prevention, rehabilitation, and studies on lower levels of care or remote regions are required.

Abstract Background The global elimination of leprosy transmission by 2030 is a World Health Organization (WHO) target. Nepal’s leprosy elimination program depends on early case diagnosis and the performance of health workers and facilities. The knowledge and skills of paramedical staff (Leprosy Focal Person, LFP) and case documentation and management by health facilities are therefore key to the performance of health care services. Methods The performance of health workers and facilities was evaluated through a combined cross-sectional and retrospective study approach of 31 health facilities and their LFPs in Dhanusa and Mahottari Districts in Madhesh Province, Nepal. An average of 6 patients (paucibacillary, PB, or multibacillary, MB) per health facility registered within the 2018/2019 fiscal year were also enrolled in the study. LFP knowledge (e.g., of the three cardinal signs) and skills (e.g., nerve palpation) and facility processes (e.g., record keeping) were scored (e.g., 0, 1) and then rescaled to a proportion, where 1 is perfect. Internal benchmarking was used to guide performance management. Results Overall LFP knowledge and skill scores ranged from 0.16 to 0.63 (median 0.53, 95% confidence interval (CI), 0.46-0.6). Case documentation scores ranged from 0.15 to 0.87 (median 0.37, 95% CI 0.36-0.38), case management scores from 0.38 to 0.79 (median 0.54, 95% CI 0.53-0.55) and overall healthcare scores from 0.36-0.62 (median 0.48, 95% CI 0.47-0.49). Leprosy-related training was significantly related to the knowledge and skills of the health workers. All identified cases (n =187) adhered to the complete treatment and release after treatment (RFT) scheme, out of which 84.5% were satisfied with the service they were provided. Leprosy disability and ear hand and feet (EHF) scores were not significantly reduced in treated patients during the study period, but counseling by LFPs significantly improved cases’ positive beliefsand practices regarding self-care. Conclusion Overall leprosy care performance was low (43%) and can be improved by evidenced-based training, onsite coaching, monitoring, and supervision to facilitate leprosy transmission elimination. The results highlight many of the challenges facing leprosy elimination programs.

BackgroundMental wellbeing encompasses life satisfaction, social connectedness, agency and resilience. In adolescence, mental wellbeing reduces sexual health risk behaviours, substance use and violence; improves educational outcomes; and protects mental health in adulthood. Mental health promotion seeks to improve mental wellbeing and can include activities to engage participants in sport. However, few high-quality trials of mental health promotion interventions have been conducted with adolescents, especially in low- and middle-income countries. We sought to address this gap by testing SMART (Sports-based Mental heAlth pRomotion for adolescenTs) in a pilot cluster-randomised controlled trial (cRCT) in Bardiya, Nepal.MethodsThe objectives of the trial are to assess the acceptability and feasibility of SMART, test trial procedures, explore outcome distributions in intervention and control clusters and calculate the total annual cost of the intervention and unit cost per adolescent. The trial design is a parallel-group, two-arm superiority pilot cRCT with a 1:1 allocation ratio and two cross-sectional census surveys with adolescents aged 12–19, one pre-intervention (baseline) and one post-intervention (endline). The study area is four communities of approximately 1000 population (166 adolescents per community). Each community represents one cluster. SMART comprises twice weekly football, martial arts and dance coaching, open to all adolescents in the community, led by local sports coaches who have received psychosocial training. Sports melas (festivals) and theatre performances will raise community awareness about SMART, mental health and the benefits of sport. Adolescents in control clusters will participate in sport as usual. In baseline and endline surveys, we will measure mental wellbeing, self-esteem, self-efficacy, emotion regulation, social support, depression, anxiety and functional impairment. Using observation checklists, unstructured observation and attendance registers from coaching sessions, and minutes of meetings between coaches and supervisors, we will assess intervention fidelity, exposure and reach. In focus group discussions and interviews with coaches, teachers, caregivers and adolescents, we will explore intervention acceptability and mechanisms of change. Intervention costs will be captured from monthly project accounts, timesheets and discussions with staff members.DiscussionFindings will identify elements of the intervention and trial procedures requiring revision prior to a full cRCT to evaluate the effectiveness of SMART.Trial registrationISRCTN, ISRCTN15973986, registered on 6 September 2022; ClinicalTrials.gov, NCT05394311, registered 27 May 2022.

The Many Hosts of Mycobacteria (MHM) meeting series brings together basic scientists, clinicians and veterinarians to promote robust discussion and dissemination of recent advances in our knowledge of numerous mycobacterial diseases, including human and bovine tuberculosis (TB), nontuberculous mycobacteria (NTM) infection, Hansen's disease (leprosy), Buruli ulcer and Johne's disease. The 9th MHM conference (MHM9) was held in July 2022 at The Ohio State University (OSU) and centered around the theme of “Confounders of Mycobacterial Disease.” Confounders can and often do drive the transmission of mycobacterial diseases, as well as impact surveillance and treatment outcomes. Various confounders were presented and discussed at MHM9 including those that originate from the host (comorbidities and coinfections) as well as those arising from the environment (e.g., zoonotic exposures), economic inequality (e.g. healthcare disparities), stigma (a confounder of leprosy and TB for millennia), and historical neglect (a confounder in Native American Nations). This conference report summarizes select talks given at MHM9 highlighting recent research advances, as well as talks regarding the historic and ongoing impact of TB and other infectious diseases on Native American Nations, including those in Southwestern Alaska where the regional TB incidence rate is among the highest in the Western hemisphere.