Planning and costing of agricultural adaptation with reference to integrated hill farming systems in Nepal.

1. Despite an existing information gap in scientific evidence regarding the effects of future changes in climate patterns and options for the future, the community-based adaptation process should nevertheless be initiated. This requires community involvement through participatory planning in order to make use of local experiences and knowledge. 2. The existing technologies at the community level, and among researchers supporting communities in undertaking adaptations to climate change, are currently inadequately disseminated. While the generation of additional technologies is regarded as a priority in the long term, transfer of already available technologies to the user community should be the immediate priority. 3. The local adaptation plan of action (LAPA) is an effective means to mainstream adaptation options in national and local governmental plans, and to support local communities in planning for adaptation. Although the initial costs of defining this methodology are high, they will decrease as soon as it is evolved and scaled up. Hence, the adaptation costs and resulting benefits will also remain at the local level. 4. The majority of the adaptation actions identified for the hill farming system in Nepal are long-term actions. In order to achieve sustainability, the adaptation actions should not be part of any project or one-time investment, but must be integrated into the regular agricultural development process. 5. Adaptation priorities for the hill farming system of Nepal mainly incorporate improved practices for integrated soil, land, hedgerow and water management – for instance, through water harvesting and small-scale irrigation measures

Energy Gardens for Small-Scale Farmers in Nepal Institutions, Species and Technology. Field Work Report

The Nepal Energy Garden forges new links across disciplines by integrating research on the institutional economics of energy and technology transfer with the knowledge of botanists and engineers. The objectives are fourfold: to investigate the institutional economics of energy biomass and biofuel production from local to national and global scales to undertake a technical assessment of resources and conversion routes to combine the institutional and technical analyses to devise ways for community cooperation on sustainable energy production to transfer the knowledge gained to a wide international audience. The energy garden concept originates from an idea developed by the Hassan Biofuels Park in India and will follow their approach for using local plant species as the source of biofuels, thereby avoiding loss of biodiversity as much as possible, and using marginal land to avoid competition with food crops. The project is a partnership of four organisations in Nepal and the Hassan Biofuels Park. The objectives will be achieved through a combination of policy analysis, reviews of plant species, analysis of technical options and field work in the villages. The aim is to test the feasibility of expanding the successful Energy Garden approach to Nepal and worldwide

HIV in Nepal: Is the Violent Conflict Fuelling the Epidemic?

Singh and colleagues discuss the HIV epidemic in Nepal, including the local and international response from the health and development community

Prevalence and determinants of frailty in the absence of disability among older population: a cross sectional study from rural communities in Nepal

BACKGROUND: Longevity and frailty have significant implications for healthcare delivery. They increase demands for healthcare service and surge risk of hospitalization. Despite gaining global attention, determinants of frailty have remained unmeasured in the rural community settings in Nepal. This study aimed to address this gap by accessing the prevalence and determinants of frailty in the absence of disability among older population living in rural communities in eastern Nepal. METHODS: We conducted a cross-sectional analytical study of 794 older adults aged ≥60 living in the rural part of Sunsari and Morang district of eastern Nepal between January and April in 2018. Multi-stage cluster sampling was applied to recruit the study participants. Study measures included socio-demographics; Frail Non-disabled scale (FiND) measuring frailty, Barthel\u27s Index measuring basic activities of daily living and Geriatric depression scale. Determinants of frailty in the absence of disability were identified using generalized estimating equation (GEE). RESULTS: About 65% of the participants self-reported the presence of frailty in the absence of disability. In the adjusted models, those from underprivileged ethnic groups, lack of daily physical exercise, presence of depressive symptoms and those not getting enough social support from family were found to be significantly associated with frailty among older participants. CONCLUSIONS: The prevalence of frailty in the absence of disability was high among rural community old population living in eastern Nepal. Our findings suggest that need of frailty awareness (both for clinicians and general public), so as to avoid negative consequences. To reduce the healthcare burden early screening frailty in primary care has potentials to prevent implications of frailty in Nepal

Prevalence and determinants of frailty in the absence of disability among older population: a cross sectional study from rural communities in Nepal

Background: Longevity and frailty have significant implications for healthcare delivery. They increase demands for healthcare service and surge risk of hospitalization. Despite gaining global attention, determinants of frailty have remained unmeasured in the rural community settings in Nepal. This study aimed to address this gap by accessing the prevalence and determinants of frailty in the absence of disability among older population living in rural communities in eastern Nepal. Methods: We conducted a cross-sectional analytical study of 794 older adults aged ≥60 living in the rural part of Sunsari and Morang district of eastern Nepal between January and April in 2018. Multi-stage cluster sampling was applied to recruit the study participants. Study measures included socio-demographics; Frail Non-disabled scale (FiND) measuring frailty, Barthel's Index measuring basic activities of daily living and Geriatric depression scale. Determinants of frailty in the absence of disability were identified using generalized estimating equation (GEE). Results: About 65% of the participants self-reported the presence of frailty in the absence of disability. In the adjusted models, those from underprivileged ethnic groups, lack of daily physical exercise, presence of depressive symptoms and those not getting enough social support from family were found to be significantly associated with frailty among older participants. Conclusions: The prevalence of frailty in the absence of disability was high among rural community old population living in eastern Nepal. Our findings suggest that need of frailty awareness (both for clinicians and general public), so as to avoid negative consequences. To reduce the healthcare burden early screening frailty in primary care has potentials to prevent implications of frailty in Nepal

Symptoms reported by patients with leprosy reactions.

<p>Symptoms reported by patients with leprosy reactions.</p

Frequency of reaction by type of episode.

<p>Frequency of reaction by type of episode.</p

Diagnosis and treatment of leprosy reactions in integrated services--the patients' perspective in Nepal.

UNLABELLED: Leprosy care has been integrated with peripheral health services, away from vertical programmes. This includes the diagnosis and management of leprosy reactions, which cause significant morbidity. We surveyed patients with leprosy reactions at two leprosy hospitals in Nepal to assess their experience of leprosy reaction management following integration to identify any gaps in service delivery. METHODS: Direct and referral patients with leprosy reactions were interviewed in two of Nepal's leprosy hospitals. We also collected quantitative and qualitative data from clinical examination and case-note review to document the patient pathway. RESULTS: Seventy-five patients were interviewed. On development of reaction symptoms 39% presented directly to specialist services, 23% to a private doctor, 17% to a district hospital, 10% to a traditional healer, 7% to a health post and 4% elsewhere. Those who presented directly to specialist services were 6.6 times more likely to start appropriate treatment than those presenting elsewhere (95% CI: 3.01 to 14.45). The average delay between symptom onset to commencing corticosteroids was 2.9 months (range 0-24 months). Obstacles to early presentation and treatment included diagnostic challenge, patients' lack of knowledge and the patients' view of health as a low priority. 40% received corticosteroids for longer than 12 weeks and 72% required an inpatient stay. Treatment follow-up was conducted at locations ranging from health posts to specialist hospitals. Inconsistency in the availability of corticosteroids peripherally was identified and 41% of patients treated for leprosy and a reaction on an outpatient basis attended multiple sites for follow-up treatment. CONCLUSION: This study demonstrates that specialist services are necessary and continue to provide significant critical support within an integrated health system approach towards the diagnosis and management of leprosy reactions

Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial

textabstractCONCLUSION: In our study, a 20-week course of prednisolone was as effective as a 32-week course in improving and restoring recent clinical NFI in leprosy patients. Twenty weeks is therefore the preferred initial treatment duration for leprosy neuropathy, after which likely only a minority of patients require further individualized treatment.BACKGROUND: While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this "Treatment of Early Neuropathy in Leprosy" (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function.METHODS: In this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Prednisolone was started at either 45 or 60 mg/day, depending on the patient's body weight, and was then tapered. Throughout follow up, NFI was assessed by voluntary muscle testing and monofilament testing. The primary outcome was the proportion of patients with improved or restored nerve function at week 78. As secondary outcomes, we analysed improvements between baseline and week 78 on the Reaction Severity Scale, the SALSA Scale and the Participation Scale. Serious Adverse Events and the need for additional prednisolone treatment were monitored and reported.RESULTS: We included 868 patients in the study, 429 in the 20-week arm and 439 in the 32-week arm. At 78 weeks, the proportion of patients with improved or restored nerve function did not differ significantly between the groups: 78.1% in the 20-week arm and 77.5% in the 32-week arm (p = 0.821). Nor were there any differences in secondary outcomes, except for a significant higher proportion of Serious Adverse Events in the longer treatment arm