Nepalese Health System Response to Fight Against COVID-19 Pandemic

The novel coronavirus or COVID-19 is a new highly infectious virus affecting a large population across the globe. There is no specific therapeutic drug available against covid-19 hence the most effective public health measures need to strictly be adhered to without delay. Range of issues were reported to fight against COVID-19 in the current health system of Nepal which should be addressed and strengthened the full spectrum of the health system for its effective and sustainable response. It is crucial to understand the current health system at the local and provincial level and strictly adhere the federal government policies and plan as per the protocol for maintaining minimum infection prevention and control measures with having preventive and safety measures to both service providers and community people. To tackle those daily increasing number of COVID-19 cases, it provides an opportunity for the three tires of governments to reprioritize the health service in the national agenda for the effective prevention and response it. Although National health policy 2019 clearly articulated the need for equitable access and quality of health care services to all. Evidence shows that Nepal is in risk zone because of comparably weak health system that should be aware of all three tires of governments of Nepal and strengthen and control the present threat posed the daily increasing cases of pandemic

The Interdisciplinary Research Team not the Interdisciplinarist

Worldwide there is a growing interest in multidisciplinary and interdisciplinary research.  This overview paper addresses some of the pitfalls and barriers to being an interdisciplinary researcher. Being involved in interdisciplinary research is not an easy option for an individual discipline expert. It requires individual skills, ability to see beyond one’s discipline and perhaps personality characteristics such as a great team player. Interdisciplinary research may involve a mixed-methods approach underpinned by conflicting, and according to some incommensurable, research philosophies. The paper uses some examples from our own experiences of working in interdisciplinary teams to illustrate its potential

Factors Influencing COVID-19 Vaccine Uptake among Nepali People in the UK: A Qualitative Study.

Vaccination saves lives and can be an effective strategy for preventing the spread of the COVID-19, but negative attitudes towards vaccines lead to vaccine hesitancy. This study aimed to explore the factors influencing the uptake of the COVID-19 vaccine in the Nepali community in the United Kingdom (UK). This qualitative study included in-depth interviews with 20 people from Nepal living in the UK. Interviews were conducted by a native-Nepali speaker and all interviews were audio-recorded, transcribed, and translated into English before being analysed thematically. Our study found that attitudes towards COVID-19 are generally positive. Nine overlapping themes around barriers to COVID-19 vaccination were identified: (a) rumours and mis/disinformation; (b) prefer home remedies and yoga; (c) religion restriction; (d) concern towards vaccine eligibility; (e) difficulty with online vaccine booking system; (f) doubts of vaccine effectiveness after changing the second dose timeline; (g) lack of confidence in the vaccine; (h) past bad experience with the influenza vaccine; and (i) worried about side-effects. Understanding barriers to the uptake of the COVID-19 vaccine can help in the design of better targeted interventions. Public health messages including favourable policy should be tailored to address those barriers and make this vaccination programme more viable and acceptable to the ethnic minority communities in the UK

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study.

BACKGROUND: There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs. METHODS: This study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household's perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations. RESULTS: Average total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$30.2/month), which was 28.5$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs. CONCLUSIONS: The study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households

Factors Associated with Adherence to Treatment with Isoniazid for the Prevention of Tuberculosis amongst People Living with HIV/AIDS: A Systematic Review of Qualitative Data

Objective To systematically identify from qualitative data in the published literature the main barriers to adherence to isoniazid preventive therapy (IPT) for tuberculosis (TB) among people living with HIV/AIDS (PLWHA). Methods We searched ten data sources, including MEDLINE and EMBASE for articles published in peer-reviewed journals from inception through to December 2011 for evidence relevant to IPT for TB in relation to PLWHA. Studies were assessed for quality using the CASP critical appraisal tool for qualitative studies. Data extracted from studies were then analysed thematically using thematic synthesis. Results Eight studies, two of which were conducted within the same clinical trial, met the inclusion criteria. In addition to the influence of personal characteristics, five overarching themes were identified: Individual personal beliefs; HIV treatment and related issues; Socio-economic factors; Family and other social support factors, and Relationships with health providers. The review confirms current understanding of adherence to treatment as influenced by patients' understanding of, and beliefs related to treatment regimens. This is in-turn influenced by broader factors, namely: socio-economic factors such as poverty and lack of health facilities; the level of support available to patients from family and other networks and the stigma that emanates from these relationships; and relationships with health providers, which in-turn become a delicate issue given the sensitivity of dealing with two chronic diseases of significant morbidity and mortality toll. HIV treatment related issues also influence adherence to IPT, whereby challenges related to the acceptance, organisation and administration of these two long-term treatment regimens and stigma related to HIV/AIDS, are seen to be major factors. Conclusion Understanding this complex interplay of factors more clearly is essential for healthcare decision-makers to be able to achieve the level of adherence required to effectively mitigate the threat posed by co-infection with TB and HIV/AIDS in developing countries

Individual and contextual factors of influence on adherence to antiretrovirals among people attending public clinics in Rio de Janeiro, Brazil.

PMC3710472BACKGROUND: There are inconsistencies in the determinants of adherence to antiretrovirals (ARVs) across settings as well as a lack of studies that take into consideration factors beyond the individual level. This makes it necessary to examine factors holistically in multiple settings and populations while taking into consideration the particularities of each context, in order to understand the patterns of ARV adherence. This research explored ARV adherence and individual, relational and environmental-structural factors. METHODS: A cross-sectional survey was conducted from August 2008 through July 2009 among participants currently on ARVs recruited from 6 public health clinics, selected to maximize diversity in terms of caseload and location, representing the range of clinics within Rio de Janeiro city, Brazil. Multivariate logistic regression analysis was used to assess the association between our multilevel factors with ARV adherence among participants with complete cases (n = 632). RESULTS: Eighty-four percent of respondents reported adherence to all of their ARV doses in the last 4 days. Of the socio-demographic variables, those who had one child were positively associated with adherence (AOR 2.29 CI [1.33-3.94]). On the relational level, those with high social support (AOR 2.85 CI [1.50-5.41]) were positively associated with adherence to ARVs. On the environmental-structural level, we found gender was significant with women negatively associated with adherence to ARVs (AOR 0.58 CI [0.38-0.88]) while those with a high asset index (AOR 2.47 CI [1.79-3.40]) were positively associated with adherence to ARVs. CONCLUSIONS: This research highlights the importance of examining the multiple levels of influence on ARV adherence. Intervention research in lower and middle-income settings should address and evaluate the impact of attending to both gender and economic inequalities to improve ARV adherence, as well as relational areas such as the provision of social support.JH Libraries Open Access Fun

Review Article Antiretroviral treatment programmes in Nepal: Problems and barriers

Background: Antiretroviral (ARV) drugs have become the cornerstone of HIV (Human Immunodeficiency Virus) care and treatment. Its use has led to a marked reduction in AIDS (Acquired Immune Deficiency Syndrome) related morbidity and mortality. However, more than five years after their introduction few HIV infected people in Nepal are receiving ARVs. Objective: The main aim of this study is to identify barriers and obstacles to providing and expanding ARV programmes in Nepal. Materials and methods: A qualitative approach consisting of in-depth interviews with three groups of stakeholders: policy makers, ARV service providers and ARV recipients were carried out. The transcripts were analysed using a thematic approach. Results: The estimated number of people in need was high compared with people currently receiving ARV in Nepal. With regards to the proper distribution of the ARVs, the main problems identified in the interviews were: lack of infrastructure, lack of human resources, financial constraints, programmatic problems, weak leadership and management at national level, poor cooperation between management structures, geographical barriers, lack of awareness and low uptake of counselling and/or testing, stigmatization and discrimination felt by the health workers and the community, lack of coordination and limited access to services. Conclusion: Limited resources and administrative capacity coupled with strong underlying needs for services pose serious challenges to the government. Despite this, better use could be made of existing services and resources to help benefit more people from ARV

The Growing Importance of Mixed-Methods Research in Health

This paper illustrates the growing importance of mixed-methods research to many health disciplines ranging from nursing to epidemiology. Mixed-methods approaches requires not only the skills of the individual quantitative and qualitative methods but also a skill set to bring two methods/datasets/findings together in the most appropriate way. Health researchers need to pay careful attention to the 'best' approach to designing, implementing, analysing, integrating both quantitative (number) and qualitative (word) information and writing this up in a way offers greater insights and enhances its applicability. This paper highlights the strengths and weaknesses of mixed-methods approaches as well as some of the common mistakes made by researchers applying mixed-methods for the first time