Nepal National Research Articles

Exploring the Impact of Online Payment on Consumer Behaviour: A Case Study of Nepal

The emergence of online payment has completely changed how consumers and businesses interact on a global scale. Online payment refers to payment that are made for goods or services that are ordered online or offline and are initiated using internet. Understanding how digital financial services affect consumer decision-making is becoming more and more crucial, especially in developing nations like Nepal. In Nepal, Nepal Rastra Bank (NRB) is dedicated to the security and effectiveness of Nepal's National Payments System (NPS) in recognition that payment systems are an essential component of every nation's financial system and are essential for its soundness, as well as for the execution of monetary policy and the growth of capital markets. The rise in e-commerce and mobile commerce activities in recent years can be attributed to the widespread use of mobile devices and internet connectivity. Research has indicated that the incorporation of electronic payment systems might have a noteworthy impact on consumer conduct, providing convenience and effectiveness during transactions (Jakhiya et al., 2020). Given the dynamic nature of Nepal's digital infrastructure, analyzing the differences in the adoption of these technologies and the ensuing shifts in customer behaviour might yield insightful information.

The Hidden Hunger among Nepalese Non-Pregnant Women Aged 15-49 Years: The Role of Individual, Household, and Community-Level Factors.

Micronutrient deficiencies remain a public health burden among non-pregnant women in developing countries, including Nepal. Hence, this study examined micronutrient deficiencies among non-pregnant Nepalese women aged 15-49 using the 2016 Nepal National Micronutrient Status Survey (NNMSS). Data for 2143 non-pregnant women was extracted from the 2016 NNMSS. The study analysed the levels of ferritin, soluble transferrin receptor (sTfR), red blood cell (RBC) folate, and zinc of the participants. Multivariable logistic analysis was carried out to assess factors associated with micronutrient deficiencies. The prevalence of ferritin, sTfR, folate, and zinc was observed to be 19%, 13%, 16%, and 21%, respectively. Non-pregnant women from the Janajati region were significantly less prone to high levels of ferritin [adjusted odds ratio (AOR): 0.45; 95% confidence interval (CI): 0.25, 0.80], and those who had body mass index (BMI) of 25 kg/m2 or higher had significantly elevated ferritin levels [AOR: 2.69; 95% CI: 1.01, 7.17]. Non-pregnant women aged 35-49 years were significantly less predisposed to folate deficiency [AOR: 0.58; 95% CI: 0.40, 0.83], and the odds of zinc deficiency were significantly lower among non-pregnant women from wealthier households [AOR: 0.48; 95% CI: 0.31, 0.76]. This study provides further insight into screening high-risk subgroups and instituting public health interventions to address the prevailing micronutrient deficiencies among non-pregnant Nepalese women.

Evaluating and strengthening low-rise reinforced concrete buildings constructed in Nepal

In Nepal, the reinforced concrete (RC) frame system is commonly used to construct low-rise buildings. In last three decades, a significant number of such buildings were proportioned and constructed in accordance with Nepal National Building Code NBC 205:1994 and NBC 205:2012—also known as the Mandatory Rule of Thumb (MRT). In the aftermath of 2015 Gorkha Earthquake (Mw 7.8) which resulted in large scale social and economic losses, the efforts to formulate improved seismic design provisions led to the development of NBC 105:2020. Considering that MRT-designed low-rise RC frame buildings still constitute a significant part of existing building stock, this study is aimed to conduct a comparative seismic performance evaluation of several case study structures under a comprehensive set of ground motions. Using the nonlinear analysis and seismic fragility assessment of four low-rise RC frame buildings (designed using all three code versions), it is shown that the structural performance and seismic losses can be significantly reduced by following NBC 105:2020 provisions. Several retrofitting solutions are also explored to improve the seismic performance of buildings designed using MRT. It is shown that the concrete or steel jacketing of RC columns can significantly increase the lateral strength and energy dissipation, and reduce the damage probability of such buildings. Lastly, based on the developed results, a machine learning approach is employed to correlate the peak ground acceleration with structural drifts for convenient practical applications.

Civic and Ethnic Nationalism in Nepal: Distinct Features or Intertwined Essentials?

Civic and Ethnic Nationalism in Nepal: Distinct Features or Intertwined Essentials?

Why Nepal Needs Strong Defense and Security Institutions?

There are multiple threats to Nepal's National Interests. A country with strong political, diplomatic, economic, military, and informational foundations will have multiple policy options, but Nepal does not have that luxury at present. Therefore, Nepal must maintain a strong and professional Nepali Army and other national security institutions to effectively deter and counter possible threats to its National Interests.

Association between Child Nutritional Anthropometric Indices and Iron Deficiencies among Children Aged 6-59 Months in Nepal.

Developmental impairment remains an important public health problem among children in many developing countries, including Nepal. Iron deficiency in children may affect development and lead to anaemia. This study on 1702 children aged 6-59 months aimed to assess the association between nutritional anthropometric indices and iron deficiencies. Data for this study were extracted from the 2016 Nepal National Micronutrient Status Survey. Three nutritional anthropometric indices (stunting, wasting and underweight) and their association with anaemia and iron deficiencies (ferritin and sTfR biomarkers) were assessed by conducting multivariate statistical analyses. The prevalence of stunting, wasting and underweight among children aged 6-59 months was 35.6%, 11.7% and 29.0%, respectively. Most of the children were not stunted (64.4%), not wasted (71.0%) and not underweight (88.3%). Belonging to castes other than the Janajati, Dalit and Brahmin castes increased the odds of anaemia and iron deficiency (ferritin biomarker). Children in the age group 6-23 months were significantly at higher odds of having anaemia and iron deficiency (ferritin and sTfR biomarkers). Stunting significantly increased the odds of anaemia [adjusted odds ratio (OR): 1.55; 95% confidence interval (CI): (1.11, 2.17)], iron deficiency (ferritin biomarker [OR: 1.56; 95% CI: (1.16, 2.08)] and sTfR biomarker [OR: 1.60; 95% CI: (1.18, 2.15)]). Further, underweight significantly increased the odds of anaemia [OR: 1.69; 95% CI: (1.12, 2.54)] and iron deficiency (sTfR biomarker [OR: 1.48; 95% CI: (1.14, 1.93)]). Interventions to minimise the occurrence of anaemia and iron deficiencies among children in Nepal should focus on providing appropriate healthcare services that would reduce the burden of stunting and underweight.

Making Sense of Nepal’s Nationalism: Implications for the India–Nepal Relationship

The assertion of (territorial) nationalism by Nepal has serious implications for its bilateral relationship with India. Once dominant, the singular narrative of the upper-caste Hindu Parbatiya nationalism is increasingly encountering competing narratives emerging from the marginalised Janajatis and the Madhesis of Nepal. Accordingly, several nationality sentiments that were sidelined earlier have now become salient. While the India factor in these competing perspectives of nationalist discourses in Nepal appears to be subtle (but important), the growing territorial dimensions to it invariably locates India in a prominent position. This article investigates the implications of the changing dynamics of Nepal’s nationalism on its bilateral relationship with India. Looking at the internal dynamics of nationalism discourses in Nepal, the article offers a critical analysis of the territorial disputes between India and Nepal, and its implications on nationalism in Nepal and on the bilateral relationships between India and Nepal.

Status of Occupational Health and Safety in Nepal: Current Scenario and Strategies for Improvement

Occupational health is a vital aspect of public health that aims to ensure the well-being of workers in various occupations. It encompasses multiple academic fields, such as occupational medicine, nursing, ergonomics, psychology, hygiene, and safety. Despite global efforts to improve occupational health, access to occupational health and safety (OHS) services remains low in many countries, including South Africa, Zimbabwe, Zambia, Botswana, China, and Nepal. This review paper was conducted through an extensive literature review. Databases such as Science Direct, Springer, NepJol, PubMed, and Google Scholar were searched to access a wide range of scholarly articles, research papers, and reports. The findings reveal that occupational workers face various hazards, including exposure to infectious diseases, radiation, hazardous chemicals, noise, and psychosocial risks. In Nepal, workers in industries such as agriculture, construction, and brick manufacturing are particularly vulnerable to these hazards. Lack of proper safety measures, inadequate access to clean drinking water and sanitation, child labor, and physical strain contribute to the high incidence of work-related diseases and injuries among workers. The study also highlights the policies and initiatives undertaken by the government of Nepal to improve occupational health and safety, including the Labor Act of 1992, the Occupational Safety and Health Project, and the Nepal National Building Code. The study emphasizes the urgent need to improve occupational health and safety conditions in Nepal. It highlights the importance of implementing preventive measures, raising awareness, providing training and education, and establishing standards to protect the health and well-being of workers.

Effect of masonry wall on Strength and Ductility in common RC frame low storey buildings

The Nepal National Building code (NBC) was promulgated in 2003 and is divided into four different parts in order to cover buildings constructed in Nepal. NBC 105 has undergone a major update in 2020 with its repercussions on existing prevalent buildings. So, in this paper effort has been made to understand municipal drawings submitted to municipalities constructed with current prevalent building construction practice with column size of 300mm x 300mm, 300mm x 230mm and 230mm x 230mm. Moreover, effects of masonry infill are considered with a separate model considering an equivalent strut as per IS 1893:2016. Ten sample buildings were selected after a rigorous sampling process of over 5000 municipal drawings to represent typical buildings. Non-linear static pushover analysis was conducted on those ten buildings and twenty models. There has been an increase in the over-strength factor of the buildings while there was reduction in ductility factor of the buildings. Equations are proposed based on non-linear regression analysis to determine the changes in over-strength and ductility factor of the buildings.

From the Shadows to the Spotlight: Unveiling Nepal's hidden kingdom of mushrooms and lichens through digitization

The digitization of herbarium collections has brought forth a transformative journey, transitioning Nepal's hidden kingdom of mushrooms and lichens from the shadows into the spotlight. Through a collaborative work within the framework of Global Biodiversity Information Facility's Biodiversity Information Fund for Asia (GBIF-BIFA), involving the herbaria (KATH: Nepal's National Herbarium and Plant Laboratories and TUCH: Natural History Museum, Tribhuvan University, Nepal), and the research institute, Global Institute for Interdisciplinary Studies (GIIS), a successful unveiling of Nepal's mycological treasures has been achieved through digital means. A comprehensive digitization effort has resulted in the complete digitization of 3,971 mushroom specimens and 2,462 lichen specimens, illuminating a wealth of information for researchers, citizen scientists, and the general public. GBIF and the online database maintained by Nepal's National Herbarium and Plant Laboratories, Department of Plant Resources, serve as the gateway to this work (KATH 2021). Prior to this work, the specimens resided in the shadows, lacking the recognition they deserved. Through meticulous collection management, sorting, curation, and labeling, their secrets were unveiled, and their stories brought to our fingertips. These previously obscured specimens now possess registered individual catalogue numbers, allowing the quantification of Nepal's fungal wealth within the participating institutions. This project serves as a testament to the vital role of capturing available field-level data, preserving specimens, and harnessing the power of digitization to showcase Nepal's mycological and lichenological wonders to a global audience. Meanwhile, it has also emphasized the significance of sharing this knowledge and fostering appreciation for the overlooked world of mushrooms and lichens.

The Changing Dynamics of Nationalism: A Reading of Select Fiction from Nepal

The monarchy, Nepali language, and Hinduism have been instrumental in the development of Nepali nationalism, and issues related to ethnicity, language, race, and region have been systematically ignored in the formation of the Nepali state. Likewise, the national literature of Nepal until the 1990s was dominated by writers from the Hindu upper caste who spoke primarily of and for the ruling class, often undermining the diversity of an otherwise heterogeneous nation. However, the political upheavals witnessed by Nepal in the 21st century have led to an upsurge of groups searching for ‘national identities’ on ethnic and regional grounds. This has also brought key changes to the literary landscape of Nepal, and contemporary writers have been increasingly drawn to the emerging new voices and identity movements aimed at questioning the prevalent notion of ‘inclusive nationalism’ with its central axis on the monarchical base and Parbatiya supremacy. Against the backdrop of a renewed debate on nationalism and the structure of the state in Nepal, this paper seeks to examine the changing dynamics of Nepali nationalism as encapsulated in contemporary fiction from Nepal. The paper examines the rising ethnocultural and regional nationalism in Nepal in two contemporary novels, Karnali Blues (2010) and The Wayward Daughter (2018), by two prominent Nepali writers, Buddhisagar Chapain and Shradha Ghale, respectively. Karnali Blues has been hailed as a pioneering work in introducing ‘new regionalism’ in the context of Nepali literature. It narrates the story of mid- and far-western Nepal and aptly captures the lives of groups belonging to the margins. Shradhe Ghale’s The Wayward Daughter focuses on a Janajati family and portrays a rich cross-section of Nepali society influenced by the lived realities of class and caste. The paper explores the diversity of life, region, and population in Nepal as depicted in both novels, thereby validating the necessity to understand Nepali nationalism in terms of region, class, religion, and ethnicity. This is also reflective of the changing narrative of Nepali nationalism.

Design Demands of RC Buildings Due to Irregularities

The RC-framed building is one of the most common construction technique for seismic-resistant structures due to its ductile nature. However, the seismic performance of RC structures can be significantly influenced by different factors, irregularities being one of the most important aspect. Irregularities on buildings increase the lateral seismic forces and inter-storey drifts thus increasing seismic demands in the structural elements. Due to architectural or functional requirements, many times irregularities cannot be avoided even though such arrangements are discouraged in the building codes including the Nepal National Building Code (NBC) 105:2020. Although many studies have been performed to quantify the effects of such irregularities internationally, design effect has not been analyzed in the context of Nepal and NBC 105:2020. Therefore, this study aims to present the variation in design demand for RC buildings in different irregularities scenarios. Three buildings models exhibiting irregularities in torsion, stiffness, and diaphragm are taken and analyzed in Finite Element platform SAP 2000 and compared with a regular building in terms of storey drift, internal forces, etc. The final design of the structural elements shows that the design demand in terms of section size and reinforcements can be significantly influenced by the presence of such irregularities.

Changes in Global Power Relations, Geopolitical Complexity and Nepal's National Security Challenges


 There are clear signs that the balance of power in the globe is shifting. The USA, an established superpower, and China, a developing superpower, are vying for the world's attention. Eventually, Russia is showing strength to establish herself as one of the other axis powers to transform the global order from unipolar to multipolar. India, Nepal's immediate neighbor with an open border and decades-old, strong bilateral links, is also evolving into a regional power, or at the very least, is on track to appear as the world's second-largest economy in near future. In this juncture, Nepal is more of security significance to China, India, and the US due to its geostrategic location. Nepal, which is constrained by a number of treaties with India, has already declared its support for both the US Millennium Challenge Corporation and China's Belt and Road Initiative. The New World Order has seen a new regional security climate in South Asia and growing polarization leading to large power rivalry forming a China-India plus the US . Additionally, attempts are being made to strengthen the security ties between the US and Nepal through the State Partnership Program (SPP) and with China through the Chinese Global Security Initiative (GSI), both of which may pose serious challenges to Nepal's national security. Thus, Nepal must maintain strict nonalignment foreign policy, increase the use of soft powers, and take a proactive, impartial, and balanced attitude in its diplomatic operations in order to face the expanding national security challenges resulted from geopolitical complexity. Also, Nepal needs to maintain strategic balance among the great powers, promoting the value of green energy and nurturing soft power. For Nepal, accomplishments of such goals and objectives through the preservation of the Himalayas, promoting Nepal's rich cultural heritage of the Buddha and accelerating mililtary diplomacy in the UNPKO have been indispensable. Nepal's foreign and national security policy should be both inside and outward looking, fostering her regional and the multilateral engagements in SAARC, BIMSTEC, Shanghai Cooperation, and the United Nations.

Associations Between Inflammation Biomarkers and Serum Ferritin and Zinc Concentrations in Preschool Children in Nepal

Concentration of trace nutrients is affected by inflammation; however, there has been limited research on iron and zinc, particularly in children. The objective of the current was to assess associations between inflammation biomarkers and serum ferritin and zinc concentrations., The study used α-1 glycoprotein (AGP) as a second biomarker because C-reactive protein (CRP) detection as a biomarker for inflammation is less sensitive in chronic infections The study utilized cross-sectional data of 1649 preschool Nepalese children from Nepal National Micronutrient Status Survey 2016. A standardized, highly sensitive technique was used to measure CRP and AGP. To obtain associations between CRP and AGP, nutrient concentrations were stratified across classifications of CRP and AGP. Concentrations level greater and smaller than several CRP and AGP cut-off points, namely, 0.5 mg/L, 1.0 mg/L, 3.0 mg/L and 5.0 mg/L (CRP) and 0.5 mg/L, 1.0 mg/L, 1.5 mg/L and 2.0 mg/L (AGP). With CRP biomarker at interval of > 0.5-1 mg/L, the median (25^th and 75^th percentiles) was 21.6 (11.5, 37.8) mg/L for ferritin; and 83.9 (63.8, 108.8) mg/L for zinc. Corresponding values for ferritin and zinc with AGP biomarker were 22.2 (10.9, 35.9) mg/L and 83.9 (65.6, 106.9) mg/L respectively. CRP concentration at interval of ≥ 5 mg/L was negatively associated with ferritin concentration [adjusted odds ratio (aOR)= 0.44, 95% confidence interval (CI): (0.24, 0.82)]. AGP concentration at interval of ≥ 1.0 mg/L was negatively associated with zinc concentration [aOR: 0.71; 95% CI: (0.50, 1.00)]. High CRP and AGP levels as defined by their low cut-off points (below0.5 mg/L) had no influence on zinc and ferritin concentrations. Using both CRP and AGP as biomarkers for inflammation provides higher precision in the detection of inflammation. This combination of biomarkers is therefore recommended in future research for assessing zinc and iron deficiencies. The negative association of CRP and AGP with serum ferritin and zinc concentrations highlight the need to pay special attention to non-biological factors with elevated levels of the two inflammation biomarkers.

Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial.

BACKGROUND:The World Health Organization's End TB (tuberculosis) Strategy advocates social and economic support for TB-affected households but evidence from low-income settings is scarce. We will evaluate the feasibility and acceptability of a locally-appropriate socioeconomic support intervention for TB-affected households in Nepal. METHODS:We will conduct a pilot randomised-controlled trial with mixed-methods process evaluation in four TB-endemic, impoverished districts of Nepal: Pyuthan, Chitwan, Mahottari, and Morang.We will recruit 128 people with TB notified to the Nepal National TB Program (NTP) and 40 multisectoral stakeholders including NTP staff, civil-society members, policy-makers, and ASCOT (Addressing the Social Determinants and Consequences of Tuberculosis) team members. People with TB will be randomised 1:1:1:1 to four study arms (n=32 each): control; social support; economic support; and combined social and economic (socioeconomic) support. Social support will be TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT's implementation and scale-up.A sample of ~100 people with TB is recommended to estimate TB-related costs.Information power is estimated to be reached with approximately 25 FGD and 15 KII participants. CONCLUSIONS:The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention's impact on catastrophic costs mitigation and TB outcomes. The trial is registered with the ISRCTN ( ISRCTN17025974).

Civil servants’ integrity in public sector: the case of Nepal

Civil servants' integrity in delivering public service is the heart and soul of public sector governance worldwide, including in Nepal. Ensuring a higher level of integrity for civil servants is complex, as it is affected by several factors. With this consideration, this study aims to examine the factors affecting the integrity of civil servants in the delivery of public services in Nepal. Data on this subject were derived from the Nepal National Governance Survey 2017/18, and analyzed using a logistic regression model. The findings revealed that citizens perceived civil servants’ integrity in public service was positively affected by civil servants’ compliance with rules, their responsiveness in delivering service, their service on time, their hassle-free service, and their adequate salary, whereas negatively affected by civil servants’ prior network/connection with citizens and their asking or receiving a bribe for public service. Therefore, the concerned authorities should focus on these factors to build and maintain civil servants' integrity in delivering public service. Our findings provide empirical evidence for concerned authorities who can contribute to adopting innovative governance approaches and appropriate policies to build and maintain civil servants’ integrity in the coming days. The study contributes to the field of integrity and public service by highlighting the factors affecting the integrity of civil servants in the delivery of public services.

Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial.

BACKGROUND:The World Health Organization's End TB (tuberculosis) Strategy advocates social and economic support for TB-affected households but evidence from low-income settings is scarce. We will evaluate the feasibility and acceptability of a locally-appropriate socioeconomic support intervention for TB-affected households in Nepal. METHODS:We will conduct a pilot randomised-controlled trial with mixed-methods process evaluation in four TB-endemic, impoverished districts of Nepal: Pyuthan, Chitwan, Mahottari, and Morang.We will recruit 128 people with TB notified to the Nepal National TB Program (NTP) and 40 multisectoral stakeholders including NTP staff, civil-society members, policy-makers, and ASCOT (Addressing the Social Determinants and Consequences of Tuberculosis) team members. People with TB will be randomised 1:1:1:1 to four study arms (n=32 each): control; social support; economic support; and combined social and economic (socioeconomic) support. Social support will be TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT's implementation and scale-up.A sample of ~100 people with TB is recommended to estimate TB-related costs.Information power is estimated to be reached with approximately 25 FGD and 15 KII participants. CONCLUSIONS:The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention's impact on catastrophic costs mitigation and TB outcomes. The trial is registered with the ISRCTN ( ISRCTN17025974).

Seismic performance evaluation of masonry infill R.C. frame considering soil-structure interaction

The structural damage due to recent seismic events in Nepal has led to a dire need for studies considering soil-structure interaction (SSI) as the majority of designers still adopt conventional design principles. These damages may be the result of the conventional fixed base method’s failure to take into account the underlying soil properties. Post $$M_w$$ 7.8 Gorkha earthquake, revised Nepal National Building code NNBC 105:2020 has classified soil types based on the rigidity of the soil. A comparative analysis is carried out using linear-static and nonlinear static (Pushover) analysis considering the fixed and flexible base of a masonry infill RC frame. The seismic performance parameter evaluated for a target inelastic drift of 2% are in terms of their fundamental time period, peak floor displacement, inter-storey drift ratio (IDR), ultimate load carrying capacity and yield mechanism. The consideration of SSI drastically influenced the fundamental time period, peak floor displacement and IDR with decreasing rigidity of soil. The fixed base structure exhibited a higher ultimate load-carrying capacity than the flexible base structure for all soil types. The masonry infill dissipated the seismic energy by the failure of the majority of struts. Furthermore, the post-yield behaviour of all models highlighted that the damage level of RC frame and masonry infill elements were higher for fixed base.

Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial

BACKGROUND:The World Health Organization's End TB (tuberculosis) Strategy advocates social and economic support for TB-affected households but evidence from low-income settings is scarce. We will evaluate the feasibility and acceptability of a locally-appropriate socioeconomic support intervention for TB-affected households in Nepal. METHODS:We will conduct a pilot randomised-controlled trial with mixed-methods process evaluation in four TB-endemic, impoverished districts of Nepal: Pyuthan, Chitwan, Mahottari, and Morang.We will recruit 128 people with TB notified to the Nepal National TB Program (NTP) and 40 multisectoral stakeholders including NTP staff, civil-society members, policy-makers, and ASCOT (Addressing the Social Determinants and Consequences of Tuberculosis) team members. People with TB will be randomised 1:1:1:1 to four study arms (n=32 each): control; social support; economic support; and combined social and economic (socioeconomic) support. Social support will be TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT's implementation and scale-up.A sample of ~100 people with TB is recommended to estimate TB-related costs.Information power is estimated to be reached with approximately 25 FGD and 15 KII participants. CONCLUSIONS:The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention's impact on catastrophic costs mitigation and TB outcomes. The trial is registered with the ISRCTN ( ISRCTN17025974).

Predictors of annual membership renewal to increase the sustainability of the Nepal National Health Insurance program: A cross-sectional survey.

Expanding membership coverage and retention of the National Health Insurance (NHI) programs among informal sector workers (ISWs) continues to be a significant challenge in most low and lower-middle-income countries (LMICs). The Nepal NHI program is also facing a similar problem, but to date, there are no studies that focus on identifying key predictors of annual membership renewal and retention in Nepal. This study therefore aimed to determine the predictors of intention to renew annual subscription to the NHI program among enrolled members. This cross-sectional quantitative study was part of a larger mixed-methods study conducted in three districts in Nepal. A random sample of 182 current NHI members and 61 dropped out NHI members who met the inclusion criteria were interviewed. The study's dependent variable was the intention to renew annual membership and employed univariate regression to assess the bivariate associations with the independent variables. The multivariate logistic regression examined the net effect of the independent variables on the odds of intention to renew. Our results showed that the household (HH) with high monthly income had lower odds of renewing their annual NHI membership (adjusted OR: 0.14, 95% CI: 0.03-0.58). Similarly, households (HHs) with overall health service satisfaction (adjusted OR:3.59, 95%CI: 1.23-10.43) and increased frequency of visits after NHI membership (adjusted OR: 10.09, 95% CI: 1.39-73.28) had high odds of renewing their membership. The top three dropout reasons were health services underutilization (43.3%), poor health services (26.9%), and the inadequacy of the benefits package (14.9%). Almost 64% of the respondents were willing to renew their membership upon improved services. The study found that the Nepal NHI annual membership renewal key predictors are HH income, health service quality, and health service utilization. Among these three key predictors, health service quality and service utilization were among the top three dropout reasons. The study, however, did not differentiate between moral hazards or actual service utilization, demanding further studies on the health service utilization of the insured members.