Nepalese Community Research Articles

Perceived risks and ramifications of the COVID-19 pandemic by community and healthcare providers in Nepal

Background: The COVID-19 pandemic has inflicted real suffering in many parts of the world and is expected to impact different sectors. Lockdown is considered to be an effective measure in slowing the spread of coronavirus. The study expects to understand community and healthcare providers’ perspectives on COVID-19 and pandemic responses during and after the lockdown in Nepal. Methods and material: Data were collected through telephone interviews with six representatives of community-based organizations and nine healthcare providers, and the collation of information about COVID-19 from social media, news outlets and government announcements. Data were thematically coded and analyzed according to the themes. Results: Although rapid dissemination of educational information through various social media was found, people reported an information overload on COVID-19 while questioning the authenticity of their sources. Several misbeliefs on the COVID-19 virus are rooted in the Nepalese community. Lockdown for a longer period was deemed an unsustainable preventive measure that directly impacted the income source of daily-wage workers. The fear of contracting coronavirus among healthcare providers at their workplaces was further triggered by the poor working conditions and non-availability of personal protective equipment (PPE). In fighting the pandemic, screening and management of other health issues were ignored. Conclusion: The prevention measures against COVID-19 are important for the local context, however, the communities need access of basic commodities and access to reliable information to enable them to follow these measures. Availability of appropriate PPE for the healthcare providers is required to reduce the fear of contracting the virus from the patients and workplace. Essential health-care services must also be continued to help reduce excess mortality and morbidity. Keywords: COVID-19; perception; healthcare providers; Nepal.

Inter-religious Harmony between Hindu Muslim Groups in Nepal

Religious harmony is very important to maintain peace and stability in a country like Nepal where people are multi-religious. Failure to address religious harmony it could take the society into conflict. Though Nepal is a Hindu dominant secular country the Muslims are an important and inseparable part of Nepalese community. They have been living in Nepal since last 500 years with religious harmony. During this period there were negligible religious riots between Hindu and Muslims. Social acceptance and recognition given to the Nepali Muslims, they were integrated in such a way, became inseparable part of the society. But in recent years they have tried to differentiate themselves religiously challenging centuries old harmony and peace. In the process they have undergone a process of political Islamization and have emerged as a distinctive ethnic community. It has shown a danger of deadly encounter between Hindu-Muslim religion groups. This paper tries to discuss the fundamental factors contributing to religious in a multi-religious society. FGD and library research method is used in addressing the situation of religious harmony. This paper also emphasizes that elements such as acceptance, understanding, co-operation as well as right and justice are significant elements in sustaining religious harmony. Hence, the discussion is aimed to build a sustainable concept of multi-religious harmony in Nepal. The findings could encourage maintaining strong relationship among them.

Knowledge, attitude, and practice about rabies prevention and control: A community survey in Nepal.

Background and Aim:Rabies is a fatal zoonosis caused by RNA virus belonging to genus Lyssavirus. Nepal is one of the endemic countries in South Asia for rabies. This study was conducted to better understand the knowledge, attitude, and practice (KAP) of Nepalese community toward rabies across five developmental zones of the country.Materials and Methods:The cross-sectional study was carried out by face-to-face interview using structured questionnaires among 5000 respondents of five cities representing each of the five developmental regions of Nepal by adopting random cluster sampling procedure. The respondents were classified into four categories, including gender, age, education, and social status. The responses for KAP variables were analyzed using descriptive and Chi-square test.Results:The male and younger age respondents with higher education and social status were found more knowledgeable than their counterparts in terms of knowledge variables, including cause of rabies, mode of transmission, clinical signs, treatment, and preventive measures of this fatal disease. Similar findings were observed for attitude and practice variables such as vaccination practice, dog sterilization, health-seeking behavior, first aid practice, and use of first aid materials after dog bites. Some respondents in elderly age group still preferred to use traditional and local methods, which were application of turmeric powder and shrubs to cure dog bites rather than seeking medical facilities.Conclusion:There is a strong need for rabies awareness programs in the community targeting females, school, and college-level students, older age groups, and economically marginalized communities. The awareness materials need to focus on particular topics such as the risk of rabies, modes of transmission, the importance of first aid, health-seeking behavior following dog bite injuries, and practice preventive measures for their pets and community dogs.

Influence of Smriti Texts to Women Leadership Development in Cooperatives

The patriarchy under Hindu tradition has been an issue of shaping role of female in present society. Their role in the family and in the society has been taken as supportive on financial mobilization rather in leading position as compared to men. Financial mobilization through cooperatives has been accepted as a key component for economic development of Nepalese community. It may be the appropriate way of increasing income, generating employment opportunities and eradicating poverty. This study has aimed at analysing the relationship of female leadership within the circumstances of Hindu tradition, cooperative movement, and analyzed the effect of intervention factors of financial mobilization. This article has been prepared after the analytical review of Hindu ancient literatures and present policies, social customs and traditions. Information was analyzed and impact of the variables on female leadership was assessed. The result has demonstrated that the Hindu tradition has an average positive influence on financial mobilization, while investment opportunities and intervening variables have a strong positive influence on empowering women leadership in cooperatives. The Smriti texts including Manu Smriti texts were the factors that hindered the Nepalese women to take part the leadership role in their family and the community.

Failure to Initiate Medicine in Newly Diagnosed Hypertensives Despite Sustained High Blood Pressure in Nepal: an Under-discussed Dimension of Non-adherence.

Hypertension is growing challenge in Nepalese community which is evident from the growing concern from all sectors. Non-adherence to hypertensive medication pose challenge as patients are reluctant to start drug despite receiving physician's advice. Continuing drug life-long once started, is a fear factor that needs dealing urgently. Keywords: Adherence; barrier; hypertension.

Teachers’ Perception of English as Medium of Instruction in Nepalese Community Schools

English as Medium of Instruction (EMI) has been a burning issue of the pedagogical field among the concerned stakeholders including teachers. The objective of this study was to find out the perception of the community schools' teachers in shifting the medium of instruction to English in the multilingual classroom contexts. It also aimed to explore the opportunities and challenges of shifting the medium of instruction Nepali to English in community schools. It is a qualitative design with a phenomenological study. The participants of the study were two teachers of a community school of Sainamaina Municipality of Rupandehi who are teaching other than English subjects in English medium. A semi-structured interview technique was used to gather information from the participants. The main finding of the study was that the use of EMI in community schools is beneficial. It is also found that teachers of community schools were positive in implementing EMI in conducting their daily teaching and learning activities even though there are certain challenges like linguistic difficulties, inadequate language abilities of teachers, cultural diversity, less effective pedagogy, limited resources, etc.

Abuse Experienced by Elderly Residing in a Community of Pokhara, Nepal

Background: Abuse of the elderly is a hidden problem in Nepalese community. Pokhara city is highly affected by urbanization, modernization and migration that predispose older adults to social isolation and financial difficulties increasing their risk to abuse. This study aims to fill the gap in the knowledge in the area of abuse of elderly in Pokhara city.Objectives: The major objective of this study was to determine the prevalence of caregiver abuse experienced by the older adults and find out the factors associated with the abuse. Method: A cross sectional study was used for the study. Convenience sampling technique was used and data was collected from 192 elderly above the age of 60 years residing a community of Pokhara-28, Kaski at their households using a structured interview schedule. Data was collected in June 2018, for a period of one month. Before data collection, informed written consent was taken from participants. The data was analyzed by using SPSS-16 and chi-square test was used as inferential statistics to determine the association between the elder abuse and selected variables.Result: We found out that 65.6% of the elderly experienced at least one abuse in the last 6 months. The most common forms of abuse were caregiver neglect (55.2%) and psychological abuse (38.5%). The elderly abuse was statistically significant with female sex (p=0.001), unmarried/widow/widower/separated/divorced (p=.021), illiterate (p=0.002), and among those having chronic illness (p=0.003). Conclusion: Almost 7 out of 10 elderly experienced abuse in the past 6 months. The most common form of abuse was caregiver neglect followed by psychological and financial abuse. Older adults who were females, unmarried/widowed/separated/divorced, illiterate and those having chronic disease were at higher risk for abuse.

Spectrum of sudden cardiac death in Nepalese population - an institutional based study

Introduction: Sudden cardiac death (SCD) is non traumatic deaths occurring within 24 hours from the onset of symptom due to a cardiac cause. This study was designed with an objective to evaluate spectrum of SCD in the Nepalese community. Materials and Methods: This was a prospective analytical study, done at an autopsy center in Nepal, over one year. All SCD’s were verified using histopathological examination. Analysis was done using SPSS, Version-20. Mean and standard deviation was calculated for age. The frequency and percentage were calculated for gender, and cause of death. Stratification was done for age and post-stratification Chi square test or Fisher exact test was used. Results: There was a total of 51 cases, with 44 (86.3%) males and 7 (13.7%) females. Peak death was between 40 –60 years. The most common cause of death was coronary artery diseases (CAD) (62.7%). There was significant association of gender with the different spectrum of SCD, with male gender having tendencies towards CAD and cardiomyopathy (CM). Conclusion: Coronary artery disease is the commonest cause of sudden cardiac deaths, followed by cardiomyopathy. Both these diseases had significantly increased tendencies towards male gender.

STRUGGLE IN FORMAL EDUCATION BY DOMESTIC-WORKER STUDENTS

The various concept in education such as “Education for All (EFA)”, “Equity in Education”, “Inclusive Education” are the burning issues as well as implementation complexities in today’s education system in developing countries. Stepping on these issues, this article focuses on seeking equity in education in the Nepalese community schools. Education for all is an ongoing process in globally. Under the national and international education framework, Nepal is on the process of implementation of the School Sector Development Program (SSDP). But, equity in education is still far behind for some groups of students. Here, this study intends to focus on, one of the similar groups of students, who are living as domestic-worker and continuing their study at the school level. This study tries to throw light on the learning-struggle of a particular group of students in Nepali community schools. The study is based on the experiences of 7 domestic-worker students (DWS) and 3 teachers teaching them. The DWS faced numerous labor exploitation problems in the workplace and school premises.

Knowledge and Perception on Corona Virus Disease 2019 (COVID-19) Among the General Public in Nepal

The global pandemic of COVID-19 has created havoc worldwide with its high transmission rate. The vaccine and drugs are still under trial; thus, the only option is to break the chain of transmission of disease by imparting the knowledge and designing awareness campaigns to educate people about the risks and preventive measures of COVID-19. This study was conducted to explore the knowledge and perception on health behaviors related to prevention along with addressing several myths and practices for COVID-19. An online cross-sectional survey was carried out in the initial days of disease outbreak in Nepal. A structured questionnaire was used for the data collection and recruitment of participants was done using snowball sampling technique. A total of 358 participants from all over the country were recruited for the study. Output measures were portrayed through descriptive statistical analysis with the use of frequencies (n) and percentages (%). Most of the participants (94.1%) knew about the high-risk age group, 38.5% were unaware that SARS-CoV-2 can be transmitted even from objects. Participants had better knowledge on modes of transmission of disease (77.1%) while 49.2% thought that regular surgical mask is highly effective for the preventive measure. Findings of this study suggests that people of Nepal are required to be educated about false beliefs and misconceptions. The findings and concerns raised in the study would be beneficial to design awareness-raising campaigns tailored specifically to the need for and understanding of the Nepalese community.
 Int. J. Soc. Sc. Manage. Vol. 7, Issue-4: 183-190

Psychological distress in Nepalese residents during COVID-19 pandemic: a community level survey

BackgroundCOVID-19 pandemic has created unprecedented health and economic impact. Psychological stress, anxiety and depression are affecting not only COVID-19 patients but also health professionals, and general population. Fear of contracting COVID-19, forced restrictive social measures, and economic hardship are causing mental trauma. Nepal is a developing country from South Asia where the COVID-19 pandemic is still evolving. This online survey has been carried out to understand impact of COVID- 19 on mental health of Nepalese community dwellers.MethodsThe COVID-19 Peritraumatic Distress Index (CPDI) questionnaire adapted from the Shanghai Mental Health Centre was used for online data collection from 11 April-17 May 2020. Collected data were extracted to Microsoft excel-13 and imported and analyzed using SPSS (Statistical Package for Social Sciences) version-22. An initial univariate analysis was conducted for all variables to assess the distribution. Logistic regression analyses were done to estimate the odds ratios of relevant predicting variables.ResultsA total of 410 participants completed the self-rated questionnaires. Mean age of study participants was 34.8 ± 11.7 years with male preponderance. 88.5% of the respondents were not in distress (score less than 28) while, 11% had mild to moderate distress and 0.5% had severe distress. The prevalence of distress is higher among age group > 45 years, female gender, and post-secondary education group. Health professional were more likely to get distressed. Respondents with post-secondary education had higher odds (OR = 3.32; p = 0.020) of developing distress as compared to respondents with secondary education or lower.ConclusionThere is lower rate of psychological distress in city dwellers and people with low education. Adequate intervention and evaluation into mental health awareness, and psychosocial support focused primarily on health care workers, female and elderly individuals is necessary.

Small Change is Beautiful: Exploring Possibilities of Eco-san on School Garden for Transformative Pedagogy

This article explores the possibilities of the use of eco-san in the school garden in the Nepalese community school, focusing on transformative pedagogical impacts on the social learning environment of the school. In particular, the use of urine as a fertilizer in the school garden through eco-san and linking pedagogical alignment to provide a pleasant experience that has a positive impact on students’ meaningful engagement, social connections, and developing confidence. The main finding for the research question came from qualitative data collected from students, parents, and teachers through in-depth interviews, focus group discussions, participant observations and informal conversations. This was supported by analyses of qualitative data on students’ learning, collaborative inquiry, teachers' and parents' engagement and perceptions on the use of human urine as fertilizer from eco-san, and school gardening activities. Results showed that the gardening program attributes valued most highly by the parents and teachers included increased students' meaningful engagement, opportunities for experiential and integrated learning through dialogue conferences, collaborative inquiry, and building social skills like cooperation, sharing and argumentation. Future research should explore whether effects persist over time and if and how changes in students’ positive attitude affect learning through school gardening activities applying human. Suggestions for applying results to future studies are provided.

Association between depression and anxiety among the COPD patients in a Nepalese community hospital: a cross sectional study

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disabling illness characterized by persistent airflow limitation affecting physical, psychological and social aspect of the individual. Amongst the associated co morbidities, depression and anxiety has been identified as common modifiable psychiatric comorbidities of COPD which impacts the patient’s quality of life. 
 Objectives: To establish the prevalence of depression and anxiety among the COPD patient and determine the association between them.
 Methodology: The cross sectional study was conducted at Dhulikhel Hospital. We used a convenient sampling method to recruit seventy three COPD participants admitted in the Medicine ward. We interviewed the participants to evaluate anxiety and depression using the Nepali version of Hospital Anxiety and Depression Scale questionnaire. We considered positive result of anxiety and depression when the Hospital Anxiety and Depression score was above eight. 
 Results: Depressive and Anxiety symptoms were observed in 30 % and 33% of the participants respectively. Similarly 20% of the participants had both the symptoms of depression and anxiety. The association between depression and anxiety was found to be highly significant (p<0.001). In the multivariate model the odds of depression and anxiety was nine percent increase with every one year increase in age after adjusting for gender and duration of illness. (adjusted OR: 1.07; CI 1.00- 1.17; p-value: 0.03). In an unadjusted model depression was significantly associated to every year increase in age (unadjusted OR: 1.07; CI: 1.00- 1.13; p-value: 0.03)
 Conclusion: Depression and anxiety is prevalent among COPD patient at Dhulikhel hospital with one fifth of the patient demonstrating both depression and anxiety symptoms.

Evaluation of Fasting Capillary Glucose and Fasting Plasma Glucose as Screening Tests for Diabetes and Prediabetes among Adults in a Semi-Urban Area in the Kathmandu District, Nepal

The natural history of type 2 diabetes includes a preceding period of impaired fasting glucose or impaired glucose tolerance which is referred to as prediabetes. During the asymptomatic phase of prediabetes, an estimated 20-30% of persons may develop complications like retinopathy, cardiovascular disease, neuropathy and nephropathy. Screening and lifestyle management may help to delay or arrest progression to diabetes. In primary care settings, point of care devices that measure glucose in capillary blood can be used for diagnosis of diabetes. This study was carried out to evaluate the performance of fasting capillary glucose (FCG) and fasting plasma glucose (FPG) measurement in screening for diabetes and prediabetes among adults in a semi-urban community in the Kathmandu district of Nepal. An observational, cross-sectional study design was used and FCG, FPG performance was evaluated by the 2-hour plasma glucose levels (2-hr PG) following Oral glucose tolerance test (75g glucose) using WHO 1998 criteria. Linear regression was performed to assess correlation co-efficient (r) between FPG, FCG and 2 hr PG. Bland Altman plot and Receiver operator characteristic (ROC) curves were constructed to assess concordance, measure ROC AUC and determine sensitivity and specificity of the measurements at recommended cut-off values for identifying diabetes and prediabetes. Among the study participants (n=162), 104 were female and 58 were male. Prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI 1.75% to 8.70%) and 7.14% (95% CI 3.89% to 12.58%). Strong positive correlation was seen between FPG and FCG (Spearman’s r 0.67). FPG & FCG had a moderate positive correlation (r = 0.49 & 0.45) with 2 hr PG levels (p<0.0001). FCG and FPG ROC AUC was 0.91 (95% CI 0.85 to 0.97) and 0.87 (95% CI 0.78 to 0.97) in comparison to 0.98 (95% CI 0.97 to 1.0) for the gold standard 2 hr PG. At 110 mg/dl and above, FCG had an optimal sensitivity and specificity of 84.21% and 81.12% in comparison to 47.37% and 100% for FPG. At 100 mg/dl, the sensitivity and specificity of FCG was 100% and 51.75% in comparison to 57.89% and 97.20% for FPG. In conclusion, at each recommended cut-off value, FCG was more sensitive than FPG with no significant difference between ROC AUCs of the two tests. Hence, FCG may be a suitable, sensitive, and convenient screening tool for diabetes and prediabetes in community-based settings. Larger prospective studies may validate the cost-effectiveness and efficiency of similar screening strategies in the Nepalese community.

Assessment of Socio-Demographic Factors, Mother and Child Health Status, Water, Sanitation, and Hygienic Conditions Existing in a Hilly Rural Village of Nepal.

In many low income developing countries, socioeconomic, environmental and demographic factors have been linked to around half of the disease related deaths that occur each year. The aim of this study is to investigate the sociodemographic factors, mother and child health status, water, sanitation, and hygienic conditions of a Nepalese community residing in a hilly rural village, and to identify factors associated with mother and child health status and the occurrence of diarrheal and febrile disease. A community-based cross-sectional survey was carried out and 315 households from the village of Narjamandap were included in this study. Factors associated with diarrhea, febrile disease, and full maternal and under-five immunizations were assessed using logistic regression. Results showed that higher education level (middle school versus primary education; Odds Ratio (OR): 0.55, p = 0.04; high school versus primary education; OR 0.21, p = 0.001) and having a toilet facility at home were significantly associated with a lower risk of developing diarrhea and febrile disease (OR 0.49, p = 0.01), while, interestingly, the use of improved water supply was associated with higher risk (OR 3.07, p = 0.005). In terms of maternal immunization, the odds of receiving a tetanus toxoid vaccination were higher in women who had regular antenatal checkups (OR 12.9, p < 0.001), and in those who developed complications during pregnancy (OR 4.54, p = 0.04); for under-five immunization, the odds of receiving full vaccination were higher among children from households that reported diarrhea (OR 2.76, p < 0.001). The findings of this study indicated that gaps still exist in the mother and child healthcare being provided, in terms of receiving antenatal checkups and basic immunizations, as evidenced by irregular antenatal checkups, incomplete and zero vaccination cases, and higher under-five deaths. Specific public health interventions to promote maternal health and the health of under-five children are suggested.

Livelihoods Strategies of Satar/Santhal: A Resilience Perspective

This paper tries to explore the livelihoods strategies of Santhal; a minority and socially isolated group, in the context of Nepalese community through the resilience perspective with narrative inquiry paradigm.

Metabolic Syndrome in Patients with Non-alcoholic Fatty Liver Disease: A Community Based Cross-sectional study.

BackgroundNon-alcoholic fatty liver disease (NAFLD) is the deposition of fat inside liver cells in the absence of secondary causes. It is considered as a hepatic complication of metabolic syndrome. The metabolic syndrome consists of dyslipidemia, hypertension, diabetes, and obesity. This study aims to determine the prevalence of metabolic syndrome in Nepalese patients with NAFLD from mid-Western part of Nepal.MethodThis was a descriptive cross-sectional study. Three different sites were chosen in and around Butwal sub-metropolitan city of Rupandehi district, Nepal. A one-day health camp for the screening of fatty liver disease by ultrasonography (USG) was conducted at these sites. Participants with fatty liver were then classified into three grades by USG and the presence of metabolic syndrome was assessed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria.ResultsA total of 385 participants with NAFLD were evaluated. Presence of metabolic syndrome by NCEP-ATPIII criteria was found to be in 57.6% participants; whereas, at least one component of metabolic syndrome was found in 91.4% of participants with radiologic features of fatty liver. Higher proportion of patients with NAFLD were males. Increased waist circumference followed by low high-density lipoprotein (HDL) level were the most common components of metabolic syndrome in participants with NAFLD.ConclusionsMetabolic syndrome is common in Nepalese community patients with NAFLD.

Cannabis in Nepal and scopes of its re-legalization

The inception of legalization of Cannabis in America has paved way for the extensive research on this medicinal and religious plant all over the world. Despite the long relationship of Nepalese community with Cannabis since time immemorial, where it used to be used for both medical as well as recreational purposes, its illegalization during 1970s led to significant drop in one of the major source of income for numerous household and their families thereby impacting GDP of the country. Due to the geographical diversity of Nepal with most parts covered by hills and mountains along with the fertile land of plain region, the country has been a home to many landraces of Cannabis and we believe that it has the potential to be one of the major hub of harvest of Cannabis and Cannabis derived pharmaceutical industry. In this review, we have focused on the native strains of Cannabis in Nepal which are sold in the markets all over the world legally and how the legalization of Cannabis would bring remarkable upgrade to the country reeling under low economy and would be a great boost for the country to rise above its status of developing country. Apart from this, we have also proposed the steps that have to be taken at the government level for the stepwise legalization, substantial growth of the native strains and be a major leader in the world market by the export of Cannabis and its derived products.

Mental Disorders in Ethnic Community: A Prevalence Study from Thakali Community of Nepal.

Introduction:Mental disorders are common and major source of disability around the world. Though Nepal lacks national data on the prevalence of mental disorders, many studies have been conducted in specific groups of people. The Thakali community is one of the indigenous communities of Nepal. We aim to look at the prevalence of mental disorders in this group.Materials and Methods:This is a cross-sectional study with multiphasic sampling conducted in the Thakali community in six distinct geographical regions of Nepal. The first stage was a household survey done by field researchers using screening questionnaires to detect a probable diagnosis of mental disorders. The second stage was detailed clinical assessment and diagnosis (ICD-10) by two independent psychiatrists.Results:Among the 917 participants, after the first phase, a probable diagnosis (as per the screening questionnaire) was found to be 12.5%. After the psychiatrists' assessment and addition of already diagnosed cases, the prevalence was 6.1%. In both the cases, prevalence of alcohol use disorder was comparatively higher (34.8% and 31.9%, respectively).Conclusion:Despite many shortcomings, this study has provided an estimate of the prevalence and pattern of mental disorders among an indigenous Nepalese community. We emphasize the need of validation of tools for Nepal and estimation of prevalence at the national level.

Gender inclusiveness in disaster risk governance for sustainable recovery of 2015 Gorkha Earthquake, Nepal

Disaster impacts vary in two distinct stages including immediate and long-term impacts. The current disaster management practices focus mainly on immediate search and rescue overlooking long-term disaster impacts. This study explores the neglected gender sensitive aspect particularly women's roles and participation during disaster recovery, gaps in gender inclusive disaster risk governance framework, and attempts to highlight the current needs for sustainable recovery of the 2015 Gorkha Earthquake. The study uses a mixed-methods approach and examines the historical Kathmandu city and Sankhu town which were severely affected by the 2015 earthquake. By employing household surveys, key informant interviews, focus group discussions, field observation, and literature review, the study found that understanding of the gender sensitivity in post-disaster recovery was oblivious among the Nepalese community due to lack of knowledge, traditional patriarchal culture, awareness and exposure. Further, the unfavorable political situation, limited capacity and policy implementation failures to gender inclusiveness have been the biggest challenge for post-disaster recovery. The findings have implications for the ongoing recovery process in Nepal and other least developed countries engaged in disaster risk reduction.