Impact of COVID-19 on health services utilization in Province-2 of Nepal: a qualitative study among community members and stakeholders

Background The COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aimed to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal. Methods The semi-structured qualitative interviews were conducted among purposively selected participants (n = 41) from a mix of rural and urban settings in all districts (n = 8) of the Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro. Results The findings of this research are categorized into four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and anxious about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions in health services were mostly due to the closure of health services at local health care facilities, limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health care workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from the government at all levels towards health services continuation/management during the COVID-19 pandemic. Conclusions This study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is critical to expand and continue the service coverage, and its quality (even more during pandemics), as well as increase public-private sector engagement to ensure the essential health services are available for the population

Combination of convalescent plasma therapy and repurposed drugs to treat severe COVID-19 patient with multimorbidity.

Combination of convalescent plasma therapy and repurposed drugs such as dexamethasone and remdesivir could be beneficial for severe COVID-19 patients with obesity and chronic diseases such as diabetes and hypertension

Experimental and Life Cycle Analysis of a Solar Thermal Adsorption Refrigeration (STAR) Using Ethanol - Activated Carbon

The off-grid location and unreliable electricity supply to medical clinics in remote parts of India make it difficult to safely store vaccines and other medications using traditional refrigeration systems. The Engineers in Technical Humanitarian Opportunities of Service-learning (ETHOS) program at the University of Dayton, in collaboration with Solar Alternative and Associated Programmes (SAAP) of Patna India, are developing a novel refrigeration system which works on the principle of solar thermal adsorption. This refrigeration system does not require electricity for operation and uses safe, environmentally benign and locally available adsorption pair of ethanol-activated carbon. A bench -scale prototype was developed at the University of Dayton using ethanol-activated carbon as working pair which can generate evaporative temperatures between 2°C and 8°C. The existing horizontally oriented system can achieve targeted refrigeration temperatures (2 - 8°C) during the adsorption cycle and ethanol can be desorbed from the activated carbon during desorption. However, the horizontal geometry inhibited the return of liquid ethanol to the evaporation chamber. A new vertical oriented bench scale system was built to addresses the limitation of the original prototype. The effects of desorption heating temperature, desorption time duration, double activation of activated carbon on evaporative cooling, and possible decomposition of ethanol during desorption were analyzed. Experimental results suggested better desorption happens at elevated temperature (90-125°C) and most of the desorption happens in the first 1-2 hours of heating the adsorbent bed. The high pressure on the evaporator side for multiple adsorption-desorption process, and analysis of GC/MS of desorbed ethanol obtained from the analytical chemist showed possible decomposition of ethanol. The ethanol decomposition prevented multiple cycle operation of the system. The use of double activation technique of the activated carbon helped to achieve as low as -12.7°C evaporator temperature in the first adsorption process. However, no adsorptive cooling was obtained in multiple cycle. However, activated carbon prepared at high temperature 800°C on inert condition showed initial pressure condition on evaporator and activated carbon side after first cycle of adsorption-desorption. This suggest multiple adsorptive cooling can be achieved on multiple cycle operation by using activated carbon prepared at high temperature on inert condition

Experimental and Life Cycle Analysis of a Solar Thermal Adsorption Refrigeration (STAR) Using Ethanol - Activated Carbon

The off-grid location and unreliable electricity supply to medical clinics in remote parts of India make it difficult to safely store vaccines and other medications using traditional refrigeration systems. The Engineers in Technical Humanitarian Opportunities of Service-learning (ETHOS) program at the University of Dayton, in collaboration with Solar Alternative and Associated Programmes (SAAP) of Patna India, are developing a novel refrigeration system which works on the principle of solar thermal adsorption. This refrigeration system does not require electricity for operation and uses safe, environmentally benign and locally available adsorption pair of ethanol-activated carbon. A bench -scale prototype was developed at the University of Dayton using ethanol-activated carbon as working pair which can generate evaporative temperatures between 2°C and 8°C. The existing horizontally oriented system can achieve targeted refrigeration temperatures (2 - 8°C) during the adsorption cycle and ethanol can be desorbed from the activated carbon during desorption. However, the horizontal geometry inhibited the return of liquid ethanol to the evaporation chamber. A new vertical oriented bench scale system was built to addresses the limitation of the original prototype. The effects of desorption heating temperature, desorption time duration, double activation of activated carbon on evaporative cooling, and possible decomposition of ethanol during desorption were analyzed. Experimental results suggested better desorption happens at elevated temperature (90-125°C) and most of the desorption happens in the first 1-2 hours of heating the adsorbent bed. The high pressure on the evaporator side for multiple adsorption-desorption process, and analysis of GC/MS of desorbed ethanol obtained from the analytical chemist showed possible decomposition of ethanol. The ethanol decomposition prevented multiple cycle operation of the system. The use of double activation technique of the activated carbon helped to achieve as low as -12.7°C evaporator temperature in the first adsorption process. However, no adsorptive cooling was obtained in multiple cycle. However, activated carbon prepared at high temperature 800°C on inert condition showed initial pressure condition on evaporator and activated carbon side after first cycle of adsorption-desorption. This suggest multiple adsorptive cooling can be achieved on multiple cycle operation by using activated carbon prepared at high temperature on inert condition

Delayed CSF rhinorrhea presenting as a lethal acute bacterial meningitis 5 years post trauma

Key clinical message Delayed presentation of cerebrospinal fluid rhinorrhea is rare following head trauma. It is frequently complicated by meningitis if not addressed in time. This report highlights the importance of its timely management, the lack of which can lead to a fatal outcome. Abstract A 33‐year‐old man presented with meningitis in septic shock. He had a history of severe traumatic brain injury 5 years back following which he had a history of intermittent nasal discharge for the past 1 year. On investigation, he was found to have Streptococcus pneumoniae meningitis, and CT scan of his head showed defects in the cribriform plate which established the diagnosis of meningoencephalitis secondary to cerebrospinal fluid rhinorrhea. The patient did not survive despite appropriate antibiotics

Comparative analysis of knowledge and management practices of insect pests of maize among IPM adopters and non-adopters in Sindhupalchok, Nepal

Integrated pest management (IPM) is a decision-based approach that involves optimizing the pest population below the economic threshold by the coordinated use of multiple tactics in an economically and environmentally sound manner. The adoption of IPM in farming practices prevents long-term pest damage by combining biological control, modification of cultural practices, habitual manipulation, and use of resistant varieties. In Nepal, mostly in hilly regions, haphazard chemical pesticide application has inevitable effects on human health, the environment, and the ecosystem. The haphazard chemical pesticide application in Sindhupalchok, Nepal originated mostly due to a knowledge gap in the identification of the stages of the lifecycle of pests, and the distinction between beneficial and harmful insects.  To compare the effectiveness of management practices between IPM adopters and non-adopters this study was framed for six months in Sangachokgadi municipality, Sindhupalchok, Nepal.  The knowledge gap among the maize growers in Sindhupalchok was assessed using both primary and secondary data collection methods. For primary data collection a comprehensive and structured questionnaire, face-to-face interview, phone call interview, and Key Informant Interview was conducted. Similarly, secondary data was collected from various articles and publications from Maize Zone, the Ministry of Agriculture and Livestock Development (MoALD), Nepal Agriculture Research Council (NARC), and National Maize Research Program (NMRP). The collected data were then analyzed (descriptive statistics, chi-square test, and indexing) by using computer software packages i.e., Statistical Package for Social Science (SPSS) version 26, and Microsoft Excel 2010. The analyzed data revealed maize growers adopting IPM practices for crop management are known to have significantly better knowledge of the life cycle of pests, were able to distinguish between beneficial and harmful insects, and had knowledge of appropriate fertilizer doses.  Further, the findings revealed IPM adopters had better knowledge of chemical pesticide handling which could minimize the chemical hazards among the farmers

Socio-economic and demographic characteristics of respondents.

Socio-economic and demographic characteristics of respondents.</p

Conceptual framework for institutional delivery service utilization in Nepal.

Conceptual framework for institutional delivery service utilization in Nepal.</p