Effect of altitude and shade on production and physical attributes of Coffee in Gulmi, Syangja and Palpa districts of Nepal

Coffee (Coffea spps.) is the second most traded commodity in the world after raw oil. Coffee is grown in mid hills of Nepal from an altitude of 700masl to 1500masl under different shade management practices. Nepalese coffee farmers grow coffee in a traditional way with almost zero application of inorganic fertilizers, pesticides and hence Nepalese coffee is popular as organic coffee or specialty coffee in the world. A study was carried out in three Coffee potent adjoining districts of Nepal: Gulmi, Syangja and Palpa. Ripe coffee cherries were harvested from every 200m altitude from 700masl to 1500masl under shade management and without shade management practices. Different physical attributes such as 1000 cherry weight, wet parchment weight, dry parchment weight, green beans weight, defected beans, and green bean diameter were observed. Production from each altitude level was recorded and highest production (7.04 kg per plant) was obtained from an altitude of 900-1100masl . The highest 1000 cherry weight (1297.17g) and the highest green bean weight (450.33 g) were obtained from 900-1100masl. Under no shade management, number of defected beans were 98 per 1000 beans whereas it was 64 under shade. The interaction of altitude and shade management practice had significant effect upon production (P=0.035), 1000 cherry weight (P<0.001), dry parchment weight (P=0.049) and green bean weight (P<0.05). Coffee produced at an altitude of 900-1100masl under shade management practice were found to have higher production and of better quality with fewer defected beans whereas that produced at extreme lower of 700-900masl and extreme higher altitude of  1300-1500masl were found to have lower production and poor quality

Needs, Challenges, and Opportunities in Establishing and Maintaining Medical Education in Karnali Academy of Health Sciences (KAHS)

The constitution of Nepal (2015), article 35 (Right relating to health) stated that every citizen shall have the right to free basic health services from the State, and no one shall be deprived of emergency health services. According to the World Bank report (collection of development indicators compiled from various official sources, 2016), Nepal has 81% rural and remote populations. Health service delivery is a complex reality for the rural and remote populations and faces enormous challenges. One of them is insufficient and uneven distribution of health workforce. The World Health Report concluded that "the severity of the health workforce crisis is in some of the world's poorest countries, of which 6 are in South East Asia out of 57 countries having critical shortages of health workforce."1Even after 13 years situation has not much improved. Nepal faces a critical shortage of trained health workforce, especially in rural and remote areas. Health workforce recruitment and retention in rural and remote areas is a difficult task challenged by the preferences and migration of health workforce to urban areas in country, or even abroad for better life and professional development.2 One of the most effective strategies for health workforce recruitment and retention for rural and remote areas could be that of establishing and maintaining Medical Education in rural and remote areas decentralized from urban academic medical centers. Rural and remote medical education is designed to enroll local students or others from rural and remote backgrounds. Medical literature suggests that the students from rural and remote backgrounds work experience are more likely than urban students inclined to practice in a rural and remote community after graduation. 3,4Greater exposure to diverse learning opportunities in rural and remote areas will make graduates confident to work anywhere. 5,6Further, extended and early exposure to rural and remote experience has a strong association to long-term rural and remote service. 7This could be the long-term solutions to long standing problems of recruitment and retention of doctors for underserved populations. In line with this, the Government of Nepal has established KAHS in Jumla. Karnali Academy of Health Sciences was established in October 20, 2011 (2068/07/03), by an Act of parliament of Nepal with the mission to prepare health professionals to deliver quality health care to marginalized /backward areas through educational excellence, innovative research, patient-centred care, public health and community. Karnali Academy of Health Sciences is the only one Stand Alone rural Academy of this kind in remote and rural Nepal. Establishing and maintaining a rural and remote Medical Educational requires a holistic approach fulfilling the needs of both the student and the community. This article describes the Needs, Challenges, and Opportunities in Establishing and Maintaining Medical Education in KAHS. Keywords: Karnali Province, Medical Education, KAHS (Karnali Academy of Health Sciences), MBBS Program, MDGP Program, MD/MS Program, Needs, Challenges, Opportunities DOI: http://doi.org/10.3126/jkahs.v2i2.2516

A Comparative Analysis of Micro Finances: An Economic Impact of Micro Finance upon Income Level of People in Kavrepalanchok District, Nepal

Master thesis Business Administration - University of Agder 2016Micro Finance, one of the essential banking services providing institution has a major contribution upon the economic development of people and nation. It targets mostly to low income generating people and assist them to enhance their life style in a better way. It provides financial services to such people and tries to eradicate the poverty from the nation. Kavrepalanchok district in Nepal, with an area of 1,396 square kilometer with the population of more than 450,000 is a gateway to capital city Kathmandu. The people in this district rely upon business and agricultural income. Micro Finance has significant effect upon the level of income in this district. The distance from the main city Kathmandu has also adverse effect upon the level of income and economic development of the people in Kavrepalanchok district. It assists to uplift the level of income of the people here by providing small loan with lower interest rate. It provides loan in a group of people. Micro Finance in this region generally provides its financial services only to women from a single family. Further, Micro Finances with different established dates and locations have their individual economic impact upon their clients. This comparative economic impacts result to their level of financial performance. Keywords: Agriculture, Business, Economic Development, Income Level, Micro Financ

Need of The Ministry of Health in Federal Democratic Republic of Nepal

The constitution of Nepal provides appointing a council of ministers both at federal and provincial levels without defining portfolios. There is a political agreement that MOH will be retained at the federal level. This article draws evidences around the world to meet health needs of Nepalese, the role of provincial ministry of health and coordinating structure at district/local level. The constitution emphasises on health and pronounced in 46 articles which provides guidance for the creation of federalized governance levels at federal, provincial and local levels. Retaining ministry of health at federal level without creating devolved structure at province and local levels in health sector will create difficulty in translating the spirit of the constitution and may not be effective in addressing health issues nationally and meeting global achievements like SDGs. It is suggested to establish an elaborate health system accordingly in Nepal to ensure constitutional mandate of health as a basic human right. Keywords:constitution; federalism; health sector,ministy of health. [PubMed

Spousal migration and human papillomavirus infection among women in rural western Nepal

In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Technocratic childbirth models

Technology in childbirth is one of the most debatable topics around childbirth. The metaphor of the body-as-machine (and the related image of the female body as a defective machine) eventually formed the philosophical foundations of contemporary technocratic childbirth model. 'Physicians, for instance, can present us with numerous examples of women who would have died had they not given birth in the hospital. What they refuse to see, however, is that they, and the women they deliver, all believe that childbirth is painful and dangerous—otherwise they would not be doing it in a hospital equipped with all the latest technology'1. Their belief, then, is precisely what makes it so. 'It is believed that the bigger the hospital, and the bigger the intensive care baby unit, the safer the birth'2.  Medicalisation of childbirth is the ritual of technocratic model. WHO defines medicalisation as: By medicalizing birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her (and some of this may occasionally be necessary), the woman’s state of mind and body is so altered that her ways of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result is that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what ‘non-medicalized’ birth is. This is an overwhelmingly important issue3. As has been seen the medicalised approach to childbirth is based on the belief that every birth has a high potential for pathology 4. According to this approach it is critical to tackle this pathology with medical or surgical interventions. Among the medical interventions, the active management of labour has become a common practice 5. Active management is viewed as the health worker’s domain. Connor 6 argues that oxytocin, the artificial uterine muscle-contracting hormone that has been in use for active management of labour has potential side effects. These include rare cases of maternal deaths, intrapartum foetal deaths, uterine rupture, a salient factor in infant brain damage, and a slight increase in jaundice in the newborn. In addition, many birthing women dislike the feelings associated with such procedures. In one study8% of mothers said labour hurt more, and over half would not want it again 7. Another study surveyed hundred and fifty-nine new mothers and found that sixty-five of them said oxytocin drips were stressful 8.  Several authors have expressed various opinions towards the surgical procedures in childbirth. ‘Medical and social prejudices against women sidestepping their biblical sentence to painful childbirth are still with us and a consumer advocate states I do not believe that anyone has the right to demand women give birth vaginally’ 9 . However, James 10has identified the emotional trauma attached to surgical procedures. He notes that surgery holds high-level significance for many people. It disrupts their personal, professional and economic lives, as well as their physical bodies. He adds that fear, anxiety, depression and a range of other emotions, accompany the patient to the surgical suite. Strong emotions, both happy and terrifying, are stored in our long-term memory. Some feelings, thoughts and images can be recalled with clarity years later. Frightening recollections may be pushed deep into the subconscious. While we do not consciously remember these impressions, they nevertheless color our thinking, feeling and behaviour in subtle ways. It is important here to review some of the controversial and commonly used surgical procedures associated with childbirth, notably episiotomy and caesarean section. Episiotomies are the surgical enlargement of the vaginal orifice by an incision of the perineum during the last part of the second stage of labour. Episiotomies have become one of the most commonly performed surgical procedures in the world 11,12. Unfortunately, this procedure brings with it considerable side effects, both emotional and physical.  Another common obstetric operation, caesarean section, has been part of human culture since ancient times (3000 B.C. in Egypt). There are tales in both Western and non-Western cultures of this procedure resulting in live mothers and offspring 13. Despite rare references to the operation on living women, the initial purpose was essentially to retrieve the infant from a dead or dying mother. Above all, it was a measure of last resort, never intended to preserve the mother’s life. It was not until the 19th century that the possibility of saving the mother really came within the grasp of the medical profession. Caesarean sections have since become among the most commonly performed surgical procedures. For example, France currently has a national cesarean section rate of 30% 14, while the combined operative and instrumental delivery rate in Spain is 40% 12. However, ‘we should be concerned, not at what the caesarean section rate should be but at what the true section rate is now and why’ 15? The tales of pain, trauma and injuries inspire little confidence in attempting a vaginal delivery for many women 16. These reasons are understandable in a culture where medical intervention is a normal occurrence and caesarean sections are considered a safe alternative.  During its evolution, caesarean section has meant different things, to different people, at different times. The indications for it have changed dramatically from the ancient to the modern times 17. The most quoted indication of caesarean section is the dictum of ‘once caesarean section forever caesarean sections’ has been disproved by some studies. Studies indicate that when a woman attempts to have a vaginal delivery after having a past caesarean section, the odds that her baby will die during labour, or soon thereafter, are quite low 18. Moreover, 'psychological trauma associated with these surgical procedures is even so noteworthy' 12. Caesarean sections leave a woman with a number of emotions that do not seem to be understood, nor how they should be addressed 19. Women who have a caesarean section often report feeling dehumanized, humiliated and distressed by the experience, and this often has a profoundly adverse effect on their future lives and that of their babies. While childbirth technology is blessing, it could be curse as well in women’s lives. Hence, the most difficult task for the 21stcenturion obstetrician is that of rationalizing childbirth technology. DOI: http://dx.doi.org/10.3126/jkahs.v2i1.24388

Challenges of investigative journalism in Nepal : the case of Kantipur Daily, Nagarik Daily, and Nayapatrika Daily

This research is about the challenges of investigative journalism in Nepal. This thesis has explored the challenges, and experiences of investigative journalists working in three different print media outlets: Kantipur Daily, Nagarik Daily, and Nayapatrika Daily. This qualitative research is prepared on the basis of in-depth interviews with ten informants. The research is focused on challenges and experiences of investigative journalists and the processes they use while doing investigative reporting. The findings are analyzed using the 'muckraking model' of investigative journalism. The lack of a separate bureau of investigative journalism in the media outlets, low investment in the media for investigative journalism and deadline pressure to do investigative reporting are the basic challenges. Moreover, the impact of commercialization in the media, and the media’s alliance with interest groups have impacted investigative journalism in Nepal. To improve the quality of investigative journalism in Nepal, it is needed to assure professional safety and security of journalists and establish aseparate bureau of investigative journalism. Trainings and guidance should be provided to journalists to refine their skills of investigative reporting

Ensuring patient satisfaction with second-trimester abortion in resource-poor settings

Objective: To evaluate patient satisfaction with the new second-trimester abortion services in Nepal. Method: Depending on the patient's literacy level, a questionnaire was read and filled out by the patient herself or by an interviewer. Indicators were developed and assessed to determine the patient's experience of the services, focusing on her physical, emotional, and social comfort. Results: Satisfaction was found to be high for characteristics associated with counseling and the caring attitude of the physician. However, dissatisfaction was expressed regarding some aspects of the delivery of care, especially the lack of privacy and confidentiality and the absence of a support person from the patient's own family. Conclusion: The patients described privacy, confidentiality, and a support person designated by them as factors that would greatly contribute to their satisfaction with the services. Maximizing patient satisfaction is necessary for the program's success but will be challenging

Contemporary childbirth practices in Nepal: improving outcomes

Nepal has one of the highest infant and maternal mortality rates in the world, second only to parts of Africa. Using in-depth interviews, fifteen postpartum mothers and eight mothers-in- law were interviewed to examine current cultural, social and contextual birthing process in Nepal. Analysis of this qualitative data through a grounded theory approach identified the dichotomy between 'traditional birthing' and modern medical obstetric care. This dichotomy limits technical, social and cultural collaborative birthing practices between the many traditional birthing attendants and medical staff. The emerging themes suggest other approaches for childbirth care; bringing harmony to traditional as well as modern clinical approaches. The outcomes of this study hope to enfranchise women with safer and more acceptable birthing experiences and outcomes not only in Nepal but also in other developing countries