Care In Nepal Research Articles

The impact of cultural practice and policy on dementia care in Nepal

BackgroundPeople’s wider culture plays a vital role in both dementia care and policy. This study aims to explore the cultural practice and policy influence around caring for People Living with Dementia (PLWD) in Nepal.MethodsAn exploratory qualitative study was designed to investigate dementia care in Nepal. The study comprised four in-depth interviews and four focus group discussions with 29 participants, including family members, health care professionals, and other stakeholders. Data were analysed using thematic analysis.ResultFour major themes (each with several sub-themes) were identified: (1) Cultural practice in dementia care; (2) Impact of policy on the dementia care; (3) Service provision; and (4) Education and training.ConclusionThere is a need for community-based awareness raising on dementia and its care, to sensitise all relevant stakeholders to meet the needs of PLWD. In addition, capacity building of health workforce is needed to enhance their knowledge of and skills in providing culturally appropriate dementia care.

Improving palliative care in Nepal through virtual education.

Improving palliative care in Nepal through virtual education.

An Analysis of The Constructs Influencing Public and Private Hospitals' Level of Service Quality: A Study in Context of Nepal

This research study examines the significance of the data collected as well as the service quality provided by hospitals in Nepal through a systematic review and analysis of the literature. Given the swift growth of the healthcare sector in Nepal, evaluating the caliber of hospital services is essential. The project's objectives are to compile all of the available data, pinpoint knowledge gaps, and offer wise counsel to academics, policymakers, and medical professionals. Using pre-established keywords linked to Nepali hospital service quality, a comprehensive search was carried out across several electronic databases, including PubMed, Scopus, and Web of Science. Studies released between January 2000 and April 2023 were taken into consideration. The systematic review comprised thirteen studies in all, including both qualitative and quantitative research methods. The systematic study's findings brought to light several essential elements of high-quality services, including tangibles, assurance, responsiveness, empathy, infrastructure, and assurance. An exploratory factor analysis technique was used to identify the contributing factors that are primarily responsible for the disparities in services offered between public and private sector hospitals in Nepal, based on the 600 valid responses to the survey that was conducted among the general public regarding private and public hospitals.
 Methods: To obtain an overall picture, a reliable data set was chosen from the sample data gathered from patient parties and administrative staffs throughout public and private sector hospitals using systematic statistical procedures.
 Results: The study's findings contribute to our understanding of the standard of hospital treatment in Nepal and could eventually raise public and professional awareness of the disparity in quality between hospital care in Nepal.
 Discussions: The impact of hospital services on the people who use them is determined in this study, and it is a major aspect in assessing the standard of healthcare provided by the various sectors.

Demography, Clinical Features and Outcome of Bacterial Keratitis Presenting in Tertiary Eye Care in Nepal

Background and Objectives: Bacterial keratitis is an important cause of ocular morbidity in developing country like Nepal and this warrants a detail study of it including its outcome.
 Material and Methods: Data of demography, clinical features and risk factors of bacterial keratitis were segregated from our previous cross-sectional study of microbial keratitis and retrospective data of treatment and outcome were taken from electronic medical record.
 Results: Among 123 cases of bacterial keratitis, 111 had bacteria isolated in the culture whereas 12 had bacteria seen only in Gram stain. Average age of patients was 52.6 years; 65(52.8%) were female; 68.3% of total subjects were farmers. Patients had visited the tertiary hospital at an average of 12.9 days since onset of symptoms. Of culture isolates, 55 were Streptococcus pneumonia followed by Staphylococcus aureus (n­­=25) and Streptococcus viridians (n=14). Regarding clinical characteristics, 78(63.4%) cases had hypopyon; 24.3% (n=30) had infiltrate size of >¼ of corneal surface; 16(13.0%) were either perforated or impending to perforate at presentation. Trauma was the main risk factor in 35% (n=43), followed by topical steroid (19.5%, n=24) and dacryocystitis (16.2%, n=20). Patients were treated with combination of fortified cefazoline and amikacin or monotherapy with moxifloxacin or ofloxacin. Overall, 90(73.2%) responded to medical treatment, 19(15.4%) underwent therapeutic penetrating keratoplasty and 3(2.4%) needed evisceration. Smaller sized ulcers had better healing rates (81%) with statistical significance.
 Conclusion: Patients with bacterial ulcers present late in tertiary eye center causing increased morbidity and even loss of eyes. Awareness, protective measures from trauma and proper treatment has to be undertaken for controlling its occurrence and for better prognosis of the ulcers.

Knowledge And Practice of Preconception Care Among Women of Reproductive-Age in Bheerkot Municipality, Nepal

Background Preconception care is a crucial aspect of maternal and child healthcare services that aims to mitigate adverse pregnancy outcomes and enhance the desired health outcomes for women, newborns, and children. Despite the continuous multi-sectoral efforts in preconception care, maternal mortality and morbidity remain significant health concerns globally. This study aimed to assess the knowledge and practice of preconception care and its associated factors among women of reproductive age in Bheerkot Municipality, Nepal. Methodology A community-based descriptive cross-sectional study was conducted among 215 reproductive-age women to assess knowledge and practice regarding preconception care in Bheerkot Municipality, Nepal. Structured questionnaires were designed in the Nepali language and used in face-to-face interviews. We used a simple random sampling technique to collect quantitative data. In a statistical analysis, we employed the Chi-squared test and logistic regression analysis to identify possible predictors using the odds ratio and considered variables with p<0.05 statistically significant at a 95% confidence interval. Result Out of the 215 women who participated in the study, only 46.9% had a good knowledge of preconception care. Approximately half (43.7%) of the respondents had never practiced preconception care. Among respondents who had practiced preconception care before, 47.9% reported good practice, and 52.1% reported poor practice. Age of the respondent (χ2=14.2063, P=0.000823, df=1), marital status (χ2=17.9851, P=0.000022, df=1), time to reach a health facility (χ2=30.1371, P=0.00001, df=1), and age at first pregnancy (χ2=4.7975, P=0.0285, df=1) were statistically associated with knowledge about preconception care. Women who have foreign employment as a major source of family income and whose age is from 25 to 34 years were more likely to have a better practice of preconception care than their counterparts (COR 3.5000, CI 1.3343 to 9.1805, P = 0.0109) and (COR 3.4000, CI 1.1646 to 9.9265, P = 0.0252), respectively. Additionally, out of those who practiced preconception care, most respondents (93.4%) have practiced it in government health facilities. Conclusion Respondents had relatively poor knowledge and practice of preconception care. Collaboration of governmental health institutions between multiple sectors at local levels for more education and information and a specific national protocol or policy formulation would be beneficial in improving preconception care in Nepal.

Demographic Profile and Outcome of Pediatric Intensive Care Unit.

Pediatric intensive care provides better observation as well as an intensive treatment, which helps to cure, support, and provide better outcomes for sick children. This study aimed to describe the demographic profile and the outcome of PICU patients, and evaluate the relationship of diagnostic categories with treatment and outcome. This retrospective cross-sectional study was conducted in a six-bedded PICU from 1 March 2021 to 1 March 2022. Bivariate analysis was used to identify the association between dependent and independent variables. The infants admitted below 6 months of age were 63 (22.3%) and had male predominance accounting for 64%. The main portal of entry of the admitted cases was emergency ward 214(75.6%). Most of the patients 153(54.1%) were admitted for intensive monitoring of their abnormal vitals along with critical care according to our PICU protocol. Respiratory illness 122(43.1%), neurosurgical illness 59(20.8%), and primary infectious disease 52(18.3%) were the common reason for PICU admission. Post-major surgery 2(66.7%), hematological illness 3(37.5%), and cardiac disorders 1(20%) had high mortality rates. Among the portal of admission, the majority of the children (80.0 %) who were admitted to the PICU through the emergency ward died before exiting from the PICU (p<0.0001). Respiratory illness was the most common cause of admission and post-major surgery had the highest mortality rate. Portal of entry was statistically associated with patient characteristics and had a significant relationship with the outcome. Similar studies in other health institutions are required to further analyze the demographic profile and outcome of pediatric critical care in Nepal.

Experience of primary healthcare workers in using the mobile app-based WHO mhGAP intervention guide in detection and treatment of people with mental disorders: A qualitative study in Nepal

This study assessed perception and experience of trained primary health care workers in using a mobile app-based version of the WHO mental health gap action programme (mhGAP) Intervention Guide in the assessment and management of people with mental health conditions in primary care in Nepal. A qualitative study was conducted with primary healthcare workers who were trained in using the WHO mhGAP mobile application in Jhapa, a district in eastern Nepal. Semi-structured interviews were carried out with 15 healthcare workers (3 females and 12 males) nine months after the training. Interviews were audio recorded, transcribed and translated into English for the thematic qualitative data analysis. Health care workers (HCWs) found the mobile app helpful to verify and confirm their assessment and diagnosis. The other benefits reported by the participants were: bringing uniformity in diagnosis and management of mental health conditions across primary healthcare facilities; reminding the HCWs specific assessment questions; creating awareness on the importance of psychosocial intervention; improving the interaction between patients and service providers; and the importance of follow-up care. Despite these advantages, lack of clarity about report submission modality; lack of electricity or internet connectivity; and low technology literacy among older HCWs were some of the barriers in using the app. The major recommendation made by the HCWs for the guide included revision of the assessment process and system; inclusion of a chat function with supervisors; minimizing the amount of patients’ data to be collected in the app; and addition of conversion and anxiety disorders to the app. This study concludes that the mobile decision support application could be acceptable and feasible in primary care settings if the suggested modifications are incorporated, in addition to addressing other systemic issues facing the primary care-based delivery of mental health services.

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

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.

Demography, clinical features, and outcome of fungal keratitis presenting in tertiary eye care in Nepal

Background: Fungal keratitis is an important cause of ocular morbidity in developing countries. Aims and Objectives: To study fungal keratitis in detail along with its outcome. Materials and Methods: This is a retrospective study of fungal keratitis that had presented between October 2013 and March 2015. Results: 168 fungal ulcers were enrolled. 145 had fungus isolated in the culture; 23 had fungal elements seen only in potassium hydroxide mount examination. The average age of patients was 46.7 years. 55.3% were male. 75% were farmers. Patients presented at an average of 23.6 days since the onset of symptoms. In 85 cases (50.6%), trauma was the risk factor followed by steroid use (12.5%, n=21) and diabetes mellitus (7.7%, n=13). 72 out of 85 cases of trauma were due to vegetative matter. 94 (55.9%) ulcers had hypopyon. 56 (33.3%) ulcers had infiltrate size of ≥¼ of corneal surface. 12 (7.1%) ulcers were perforated at presentation. Out of 145 fungal isolates, Aspergillus species and Fusarium species were isolated in equal numbers (n=41, 28.3% each), followed by unidentified hyaline fungus (14.4%, n=21). The ulcers were treated with combination of topical natamycin 5% and fluconazole 0.3% with or without oral fluconazole. 111 (66.1%) fungal ulcers improved with medical treatment, 37 (n=22.0%) underwent therapeutic penetrating keratoplasty, 6 (3.6%) were eviscerated and outcome unknown in 14 (8.3%). Smaller-sized ulcers, ulcers without hypopyon and those presenting within 7 days had better prognosis (&gt;80% healing with medical treatment) with statistical significance. Conclusion: Farmers were constantly at risk of fungal keratitis due to work-related trauma. Fungal ulcers presented late with large sized ulcers and with complications, thus making treatment challenging and necessitating surgical intervention. Timely treatment had better prognosis.

The Evolution of Alternative Care in Nepal over the Last Decade and Way Forward

Our article focuses on the national efforts advancing children’s right to alternative care services in Nepal. It presents the government’s existing laws and policies in providing responsible care to children in need of special protection and for children who cannot be placed in parental care due to various reasons for family separation. This article also looks into the history of alternative care in Nepal and discusses the alternative forms of care practised in the communities and their evolution, upholding the best interest of the child. We share the promising practices of kinship care and foster care (informal and formal) for children at risk of separation and child institutionalisation and for children removed from orphanages and children’s homes for family reintegration, implemented by The Himalayan Innovative Society in Nepal in partnership with Forget Me Not and Hope and Homes for Children. We, finally, conclude by sharing the key challenges and opportunities in the implementation of alternative care services for children in Nepal driving the care reform in the country.

Health facility availability and readiness for family planning and maternity and neonatal care services in Nepal: Analysis of cross-sectional survey data.

To determine the availability and readiness of health facilities to provide family planning, antenatal care and basic emergency obstetric and newborn care in Nepal in 2021. Secondary objectives were to identify progress since 2015 and factors associated with readiness. This is a secondary analysis of cross-sectional Nepal Health Facility Survey (NHFS) data collected in 2015 and 2021. The main outcome measures were availability and readiness of family planning, antenatal care, and basic emergency obstetric and newborn care services. Readiness indices were calculated using WHO-recommended service availability and readiness assessment (SARA) methods (score range 0 to 100%, with 100% indicating facilities are fully prepared to provide a specific service). We used independent t-tests to compare readiness indices in 2015 and 2021. Factors potentially associated with readiness (rurality setting, ecological region, managing authority, management meeting, quality assurance activities, and external supervision) were explored using multivariable linear regression. There were 940 and 1565 eligible health facilities in the 2015 and 2021 surveys, respectively. Nearly all health facilities provided family planning (2015: n = 919 (97.8%); 2021: n = 1530 (97.8%)) and antenatal care services (2015: n = 920 (97.8%); 2021: n = 1538 (98.3%)) in both years, but only half provided delivery services (2015: n = 457 (48.6%); 2021: n = 804 (51.4%)). There were suboptimal improvements in readiness indices over time: (2015-21: family planning 68.0% to 70.9%, p<0.001, antenatal care 49.5% to 54.1%, p<0.001 and basic emergency obstetric and newborn care 56.7% to 58.0%, p = 0.115). The regression model comprising combined datasets of both NHFSs indicates facilities with regular management meetings and/or quality assurance activities had significantly greater readiness for all three indices. Similarly, public facilities had greater readiness for family planning and basic emergency obstetric and newborn care while they had lower readiness for antenatal care. Readiness to deliver family planning, antenatal care and basic emergency obstetric and newborn care services in Nepal remains inadequate, with little improvement observed over six years.

Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective.

More than 60% of health care expenses comprise the direct medical cost, 15% direct nonmedical cost, and 24% patient productivity losses. The costs of diagnosis, hospitalization, and recommended foods were the main drivers of health care costs for managing type 2 diabetes.Health care expenses among patients living in urban communities and patients with comorbid conditions was higher compared with those in rural communities and those with without comorbidities.The results of this study are expected to help integrate diabetes care within the existing primary health care systems, thereby reducing health care expenses and improving the quality of diabetes care in Nepal.

Impact of Access Block Is Increasing Mortality in Emergency Departments in Nepal

Introduction:Emergency patients have to stay in the Emergency Department (ED) for hours to days to get ward admission for definite care in Nepal. Access block is a major issue in the ED of University Level Teaching Hospitals (ULTH) in Nepal. This study aimed to analyze the impact of access blocks in the EDs of Nepal.Method:Meta-analysis of different publications on ‘duration of ED Boarding’ and ‘mortality outcome of ED’ of ULTHs of Nepal till November 15, 2022Results:9.7% of ED patients were admitted to the ward. The time period from ED arrival to respective ward team consultation is 5.7 hours, consultation to ward admission is 5.6 hours, and admission to ward transfer is 8 hours. The average ED boarding time is 18.1 hours. 38% of patients arrived in ED via Ambulances. The time period from ED arrival to ward team consultation for those who need transfer to another center are 6.9 hours, consultation to admission is 5.7 hours, and admission to transfer is 8.7 hours (ED Boarding time 21.3 hours). Meta-analysis of three major ULTH’s showed mortality with respect to ED boarding time to be 17% in &lt; 1 hour, 40.4% in 1 - 6 hours, 27.4% in 6-12 hours, 9.1% in 12-24 hours, 4% in 24-28 hours and 2.1% in &gt;48 hours. Among them, higher age, greater mortality rate. The immediate causes of mortality comparing 2018 vs 2010 are Sepsis &amp; Septic shock 32.2% vs 18%, Cardiac Causes 21.8% vs 14.8%, Aspiration Pneumonia 19.5% vs 14.8%, Severe Lung Diseases 12.7% vs 16.4%, Hypovolumic &amp; Haemorrhagic Shock 9.2% vs 34.4% and Poisoning 4.6% vs 1.6%.Conclusion:Prolonged ED boarding due to Access Block is triggering increased mortality in the ED.

Denial of legal abortion in Nepal.

In Nepal, abortion is legal on request through 12 weeks of pregnancy and up to 28 weeks for health and other reasons. Abortion is available at public facilities at no cost and by trained private providers. Yet, over half of abortions are provided outside this legal system. We sought to investigate the extent to which patients are denied an abortion at clinics legally able to provide services and factors associated with presenting late for care, being denied, and receiving an abortion after being denied. We used data from a prospective longitudinal study with 1835 women aged 15-45. Between April 2019 and December 2020, we recruited 1,835 women seeking abortions at 22 sites across Nepal, including those seeking care at any gestational age (n = 537) and then only those seeking care at or after 10 weeks of gestation or do not know their gestational age (n = 1,298). We conducted interviewer-led surveys with these women at the time they were seeking abortion service (n = 1,835), at six weeks after abortion-seeking (n = 1523) and six-month intervals for three years. Using descriptive and multivariable logistic regression models, we examined factors associated with presenting for abortion before versus after 10 weeks gestation, with receiving versus being denied an abortion, and with continuing the pregnancy after being denied care. We also described reasons for the denial of care and how and where participants sought abortion care subsequent to being denied. Mixed-effects models was used to accounting clustering effect at the facility level. Among those recruited when eligibility included seeking abortion at any gestational age, four in ten women sought abortion care beyond 10 weeks or did not know their gestation and just over one in ten was denied care. Of the full sample, 73% were at or beyond 10 weeks gestation, 44% were denied care, and 60% of those denied continued to seek care after denial. Nearly three-quarters of those denied care were legally eligible for abortion, based on their gestation and pre-existing conditions. Women with lower socioeconomic status, including those who were younger, less educated, and less wealthy, were more likely to present later for abortion, more likely to be turned away, and more likely to continue the pregnancy after denial of care. Denial of legal abortion care in Nepal is common, particularly among those with fewer resources. The majority of those denied in the sample should have been able to obtain care according to Nepal's abortion law. Abortion denial could have significant potential implications for the health and well-being of women and their families in Nepal.

INTEGRATION OF PALLIATIVE CARE INTO MEDICAL SCHOOL CURRICULUM IN NEPAL – An analytical study among medical students in Nepal

Introduction The holistic approach of palliative care aims at improving the life of patients with life-threatening diseases and their families through early identification, assessment, and treatment of physical, psychological, or spiritual pain. Despite the recognition of palliative care as a human right and essential for the improvement of the quality of life of patients – and their families, many low-income countries either lack palliative care services or have limited access to it. The WHO suggests that one of the steps that countries can take to eliminate these barriers is to include palliative care into the core curricula of all new health professionals. A study in 2019 showed that 58,000 adults required palliative care in Nepal in 2012, and most of them lived in rural areas. Palliative care in Nepal is still new and training programs for doctors and nurses are not fully developed and in place in undergraduate medical schools. This study evaluates the working knowledge of palliative care among undergraduate medical students, and the presence of it in their academic curriculum. Methods This analytical study was designed during an internship at the Binaytara Foundation Cancer Center in Nepal. The study was conducted among undergraduate medical students between March 6th, 2020 to July 6th, 2020. The questionnaire results were entered on Microsoft Excel and then analyzed. Results Results showed that 63.2% of the respondents had heard of “Palliative Medicine”, but 68.4% did not know the WHO definition of Palliative Care (Table 2 (135189)). Among all the students from the different universities, 33.3% said that palliative care is part of their curriculum, while 66.6% said it is not (Table 5 (135192)). Conclusions The results from the study demonstrated inadequate knowledge and perception of palliative care among undergraduate medical students in Nepali institutions. The EAPC indications on a palliative care curriculum could be taken as a blueprint for developing a tailored one for medical schools in Nepal to set a strong base for the next generation of doctors to be able to appropriately meet the needs of patients and their families.

Potential roles of pharmacists in HIV/AIDS care delivery in Nepal: A qualitative study.

Nepal is facing escalating infection rates of HIV/AIDS, a major global public health threat. Continuum of services is an identified strategic component of Joint United Nations Programme on HIV/AIDS (UNAIDS) commitment to end this public health crisis by 2030 and achieve the Sustainable Development Goal 6 (SDG 6). Pharmacists are integral members of the continuum of care in HIV/AIDS but the idea is novel to Nepal. Realizing need to explore and identify potential roles of pharmacists in HIV/AIDS care delivery, this study aimed to gain an insight into the views of stakeholders on the roles of pharmacists in this arena. A qualitative approach was used where 14 key informants were interviewed using a semi-structured interview protocol. Participants were selected through a sequence of purposive sampling and snowball sampling technique. The interviews were conducted, transcribed verbatim and analyzed using thematic analysis. Potential roles of pharmacists reside in adherence monitoring, pharmacovigilance, provincial and district level ART centers. Pharmacists and other stakeholders held divergent views on the pharmacist's role in dispensing and counseling antiretroviral medications. Barriers to the pharmacists' involvement were lack of workforce, advocacy and government support, frailty of professional organizations, self-limited scope, policy constraints, structural limitations, biasedness, and societal unawareness. Pharmacists themselves and organizations such as National Government Organizations (NGOs) and International Government Organizations (INGOs) were identified as the facilitators. Stakeholders are willing to expand role of pharmacists in HIV/AIDS care in Nepal. Nevertheless, some crucial impediments exist. Primarily, an aggressive and assertive advocacy is needed from pharmacists themselves and their professional organizations to establish their roles in HIV/AIDS care delivery. Additionally, unearthing potential of pharmacists as contributors in HIV/AIDS care delivery or any other chronic disease management equally demands a strong support from the government officials as well as the other health care professionals.

Healthcare use and costs among individuals receiving mental health services for depression within primary care in Nepal

BackgroundIntegrating mental health services into primary care is a key strategy for reducing the mental healthcare treatment gap in low- and middle-income countries. We examined healthcare use and costs over time among individuals with depression and subclinical depressive symptoms in Chitwan, Nepal to understand the impact of integrated care on individual and health system resources.MethodsIndividuals diagnosed with depression at ten primary care facilities were randomized to receive a package of integrated care based on the Mental Health Gap Action Programme (treatment group; TG) or this package plus individual psychotherapy (TG + P); individuals with subclinical depressive symptoms received primary care as usual (UC). Primary outcomes were changes in use and health system costs of outpatient healthcare at 3- and 12-month follow up. Secondary outcomes examined use and costs by type. We used Poisson and log-linear models for use and costs, respectively, with an interaction term between time point and study group, and with TG as reference.ResultsThe study included 192 primary care service users (TG = 60, TG + P = 60, UC = 72; 86% female, 24% formally employed, mean age 41.1). At baseline, outpatient visits were similar (− 11%, p = 0.51) among TG + P and lower (− 35%, p = 0.01) among UC compared to TG. Visits increased 2.30 times (p < 0.001) at 3 months among TG, with a 50% greater increase (p = 0.03) among TG + P, before returning to baseline levels among all groups at 12 months. Comparing TG + P to TG, costs were similar at baseline (− 1%, p = 0.97) and cost changes did not significantly differ at three (− 16%, p = 0.67) or 12 months (− 45%, p = 0.13). Costs among UC were 54% lower than TG at baseline (p = 0.005), with no significant differences in cost changes over follow up. Post hoc analysis indicated individuals not receiving psychotherapy used less frequent, more costly healthcare.ConclusionDelivering psychotherapy within integrated services for depression resulted in greater healthcare use without significantly greater costs to the health system or individual. Previous research in Chitwan demonstrated psychotherapy determined treatment effectiveness for people with depression. While additional research is needed into service implementation costs, our findings provide further evidence supporting the inclusion of psychotherapy within mental healthcare integration in Nepal and similar contexts.

Maternal and child health care practice of Tamang community

Health is the most important factor of human life. It is a multi-dimensional process and a quality of life which entails a dynamic interact among the physical, mental, social, emotional and spiritual aspects of life. Good health improves the quality of life. The major health problems of Nepal are highly related to maternal and child health care practices. So, MCH care is the very important component of primary health care in Nepal. Most of the women of Nepal are illiterate and ignorant regarding the high maternal and child mortality rate in Nepal. This research was based on descriptive research design with both quantitative and qualitative nature of information. The major results from the findings of this study reveals that 29.5 percent respondents had not antenatal checked up and 70.4 percent respondents had antenatal checked up. The majority of the respondent (34.1 percent) women had antenatal checked up of three times during pregnancy period, whereas 38 percent of the pregnant women had checked up for four times, few (6.9 percent) of the pregnant women had five times antenatal checked up during pregnancy period. It was found that majority of the respondents (63.6 percent) had antenatal checked in health post and most of the respondent’s (64.8 percent) first child bearing age was found to be 15-19 years of age and least of the (4.5 percent) respondent’s first child bearing age was found 25-29 years of age. Similarly, 47.7 percent of respondent mothers had taken one dose of TT injection and 31.9 percent of respondent mothers had taken non dose of TT injection.

Trend Analysis of Maternal Health Care Services in Nepal

This study attempts to analyze the trend in maternal health care utilization: antenatal care, delivery care, and postnatal care in Nepal. Maternal health remains a major challenge in developing countries despite improvements in medical technology and several efforts to improve maternal health care services. This study is based on Nepal Demographic and Health Survey data from 2006, 2011, and 2016. It covers 4,066 women in 2006, 4,148 in 2011 and 3,998 in 2016 for antenatal care. In the study, this analysis is confined to women aged (15-49) who had a live birth in the five years preceding the survey. Data on delivery care were obtained for all births that occurred in the five or two years preceding the survey. This study comprises 2030 women in 2011 and 1,978 women in 2016 aged 15–49 years who had a live birth in the two years preceding the survey on childbirth, and postnatal care. Especially, the study deals with antenatal, delivery care, and postnatal care. There is a substantial increase in the utilization of antenatal care (ANC) by skilled health providers from, 44 percent in 2006 to 84 percent in 2016 respectively. Still, six percent percentage do not seek even one-time ANC care and the percentage of women who seek 4 or more ANC care from a skilled service provider is low. Still, two fifth percent of delivery take place at home. postnatal service is still very low in Nepal. This study’s results suggest the need for efforts to be addressed to improve the use of maternal health care services in Nepal. There is a need to increase the use of postnatal checkup as well as delivery assisted by skilled attendants.

A needs assessment survey to inform a general practitioner in oncology (GPO) training program in Nepal.

11024 Background: Nepal is a low-income country with a population of over 30 million that faces a significant burden of cancer, with approximately 60,000 patients receiving a cancer diagnosis per year. However, a lack of cancer care providers is recognized as a major barrier to cancer care in Nepal. To address this gap, a national GPO training program may be an effective task-shifting strategy to increase the oncology workforce. A needs assessment survey was conducted to determine baseline oncology training for Nepalese General Practitioners (GPs) and the feasibility and desirability of establishing a GPO training program in Nepal. Methods: A survey was distributed to 171 GPs in Nepal. The survey was distributed via the REDCap electronic database, a secure-web-based software platform based at Queen’s University in Kingston, Ontario, Canada. Reminders were sent out via social media accounts. The survey results were recorded anonymously from February to July 2021. Results: Data was collected from 71 GPs in Nepal. Data revealed significant gaps in oncology training, with only 6% of respondents reporting undergoing a mandatory oncology rotation during their training, and 15% indicating their training adequately prepared them to care for patients with cancer. Although respondents reported seeing an average of 1-5 cancer patients per day, only 9% reported providing chemotherapy treatment, and 36% indicated regular provision of follow-up cancer care. Only 1 in 5 general practitioners reported having radiation oncology services available at their institution or an institution within the same zone. 96% of GPs surveyed agreed that there is a need for a GPO program, and 71% reported they would be very interested in participating in this type of training. A majority of respondents indicated a preference for self-directed and small-group learning as the preferred modes of content delivery in a GPO training program. Conclusions: Our findings indicate a need and high level of desirability for a national GPO training program in Nepal. Further, the needs assessment provides insight into practitioner perspectives on information needs and content delivery. This data will be used to guide future curriculum development for the Nepal GPO program. [Table: see text]