The prevention of‑ and first response to‑ injuries in Nepal: A review of policies and legislation

Background: Injuries, the cause of an estimated 4.5 million deaths annually and many more disabilities worldwide each year, are the predictable outcome of particular circumstances. One of the most effective ways to prevent injuries is through policy and legislation. The aim of this research study was to identify and critically review all policy and legislation in Nepal that had the potential to prevent injuries. Methods: We identified legislation and policy that met inclusion criteria through a stakeholder meeting, networks and contacts, and websites and electronic resources. Each included document was critically reviewed to identify areas of strength and opportunities for improvement. We compared the included documents against WHO’s recommendations of known effective interventions. Results: Sixty-two documents met the inclusion criteria for this review. Of these, 24 (38.7%) were exclusively related to road injuries, 11 (17.7%) to occupational injuries, 6 (9.7%) to injuries in the home and 5 (8.1%) to injuries at school; 30 (48.4%) documents included text related to the first response to injuries. Of 127 strategic recommendations by WHO that provided an area for policy or legislative focus, 21 (16.5%) were considered adequately met by Nepali policy and legislation, 43 (33.9%) were considered partially met and 63 (49.6%) were not met. Conclusion: We drew five conclusions from this critical policy review, which we have related to recommendations as follows: widening the scope of legislation and policy for injury prevention to emphasize injuries occurring at home or school; addressing the causes of injuries and promoting proven preventive measures; greater clarity on both individual and institutional roles and responsibilities; trustworthy data and quality evidence to inform decision-making; and financial investment and capacity-strengthening for injury prevention and first response. The current system of federal governance in Nepal has potential for strengthening injury prevention and first response at the central, provincial and local levels

Factors Associated with Self-Rated Health Among Elderly People Living in Old Age Homes of Kathmandu Valley, Nepal

Background: Self-rated health (SRH) is the subjective assessment of own general health. It has been used frequently to predict future health, disability, functional ability and mortality. Exploring factors associated with SRH is vital as it will help inform efforts aimed at promoting health among the elderly. However, there are limited studies regarding SRH and factors associated with SRH among elderly people living in old age homes in Nepal. Objective: The purpose of the study was to describe SRH and explore the factors associated with it among elderly people residing in old age homes in Nepal. Methods: A cross-sectional study was conducted in Kathmandu valley, Nepal. A sample of 208 elderly people aged over 60 years living in one governmental and three private old age homes were randomly selected through multi-stage cluster sampling. An interviewer-administered questionnaire was used to collect data. Descriptive analyses were first conducted. Univariable and multivariable logistic regression analyses were then used to explore the association between socio-demographic factors, self-reported chronic illnesses, lifestyle factors, functional status, social network, satisfaction with health services and SRH. Results: Seventy-four percent of the participants reported good SRH while the remaining twenty-six percent rated their health as “poor”. Females were significantly more likely to rate their health as good compared to males (adj OR 3.69, CI= 1.92-11.03, p<0.000); the same was true for unmarried elderly compared to married ones (adj OR=4.55, CI=1.29-9.87, p<0.000). Those who were functionally independent were more likely to report good SRH (adj OR 7.00, CI=5.79- 9.31, p< 0.005); the same was true for those who did physical exercise (adj OR= 1.96, CI=0.67-5.67, p<0.019) and who were members of a social network (adj OR 1.70, CI= 0.78-3.71, p<0.017) compared to their counterparts. Those who consumed alcohol (adj OR=0.23, CI=0.07-0.78, p<0.019) and those who did not have a friend circle (adj OR=0.62, CI=0.29-1.34, p<0.023) were less likely to report good SRH. Education and participation in recreational activities were significantly associated with SRH in univariable analysis. However, the association disappeared in the final model. Conclusion: The study found that sex, marital status, functional status, physical exercise, alcohol consumption, membership in a social network and the presence of friend circles were independently significantly associated with SRH among elderly people living in old age homes of Kathmandu valley. These findings can be used to develop public health interventions and allocate resources to mainstream physical, behavioral and social support to elderly people living in old age homes. Functional dependence appears to be particularly important, and therefore services to address it including physical rehabilitation need to be promoted