Effect of scion varieties and wrapping materials on success of tongue grafting in Kiwifruit (Actinidia deliciosa) in Dolakha, Nepal

This study was conducted at Boch, Bhimeshwor-8, Dolakha, Nepal from January to May, 2019 to study the effect of scion variety and wrapping materials on growth performance of kiwi seedling rootstock. The field experiment was carried out in Factorial Randomized Complete Block Design using four replications. The treatments consisted of four scion varieties (Monty, Bruno, Hayward, Allison) grafted onto one year old kiwi seedling (Actinidia deliciosa) and two types of wrapping material (Grafting tape and Polyethylene plastic). The measured traits included sprout length, diameter, number of leaves, and number of sprouted bud per graft, graft success, mortality and survival percentage of grafts. The success rate of kiwi grafting was significantly affected by the scion variety and the wrapping materials. Allison variety showed the minimum days (61.72 days) to first sprouting and the maximum length of sprouts, diameter, number of leaves and number of sprouted bud per graft at the final observation. Monty variety showed the lowest growth performance. The maximum graft success (96.87%) and survival percentage of grafts (93.75%) was observed in Allison variety statistically at par with Bruno and Hayward and the lowest graft success(73.44%) and survivability(64.21%) was observed in Monty due to high mortality of the sprouted grafts. Grafting tape was superior to polyethylene plastic in terms of days to first sprouting (64.08 days), number of sprouted buds per grafts, number of leaves, graft success (92.18%) and survival of the grafts (87.01%) at the final observation. Interactive effect was found non-significant. In a nutshell, Allison is the best scion variety for grafting under the climatic condition of Dolakha and the grafting tape was the suitable tying material

Gouty tophi

Gouty tophi presenting as multiple large periarticular masses could be mistaken for rheumatoid nodules, neoplasm, neurofibroma, or infection. Aspiration of synovial fluid from inflamed joints or examination of whitish material expressed though breaks in skin usually assists with the diagnosis of gout

Response of Wheat Genotypes to Different Levels of Nitrogen

A field experiment was conducted using six genotypes of wheat (Triticum aestivum L.) for response to different levels of nitrogen (N) use. The experiment was laid out in split plot design with four levels (0, 50, 100 and 150 kg N ha-1) as main plots and six wheat genotypes (BL 3623, BL 3629, BL 3872, NL 1008, NL 1055 and Vijay, a check variety) as sub-plots. Grain yield and other yield components increased linearly in response to N concentrations in both seasons. Only two parameters: days to heading (DOH) and days to maturity (DTM) varied significantly (p ≤ 0.05) among wheat genotypes in both the years. None of the parameters showed interaction effects in both seasons. Vijay showed highest grain yield of 3.12 t ha-1 in 2013 with the application of 100 kg N ha-1, and 3.23 t ha-1 in 2014 with 150 kg N ha-1. Spike length, productive tillers m-2, number of spikes m-2 and test weight were greater with higher N rates. The straw yield of wheat fertilized with 150 kg N ha-1 was the highest in Vijay (4.35 t ha-1) and BL 3872 (4.33 t ha-1), respectively. Vijay with 100 kg N ha-1 produced the highest number of productive tillers m-2 (276.33) in 2013 and 296.00 with the application of 150 kg N ha-1 in 2014

Individual patient-centered target-driven intervention to improve clinical outcomes of diabetes, health literacy, and self-care practices in Nepal: A randomized controlled trial

Purpose: To examine the effectiveness of a culturally and linguistically appropriate, patient-centered, target-driven lifestyle intervention with video education training in improving clinical outcomes, health literacy, and diabetic self-care practices in newly diagnosed patients in Nepal. Methods: A total of 110 participants with newly and consequently diagnosed Type 2 were randomly allocated into intervention (mean age = 45 ± 9.7 years) and control (mean age = 47 ± 12.5 years) groups. Intervention group participants were trained on a culturally and linguistically appropriate diabetic video education program and were given a customized dietary and physical activity plan with specific targets to practice at home. Participants’ compliance was monitored weekly via telephone calls. Both groups received the usual treatment from their doctor and were followed up after three months. Outcome measures included changes in: i. diabetic health literacy, diet, and physical activity measured using self-reported questionnaires; and ii. blood glucose (glycated hemoglobin, HbA1c), cholesterol, blood pressure, body mass index, and visual acuity. Clinical outcome measures were blinded from randomization and intervention allocation. Results: After three months, HbA1c decreased to 6.1% from the baseline value of 7.2% in the intervention group compared to 6.6% in the control group from the baseline value of 7.1% (p <0.05). The intervention group had mean total cholesterol and low-density lipoprotein of 174 and 95.5 mg/dL, which were significantly lower than 186 and 107.5 mg/dL in the control group. Daily white rice consumption decreased by 36.5% in the intervention vs. 4% in the control group (p <0.05). After three months, the intervention group participants exercised more than the control group (p <0.05). All intervention group participants self-initiated retinal screening checks since the baseline visit among which 13% showed early diabetic retinopathy signs compared to 0% in the control group. Health literacy improvement in the intervention group was found to be sustained after three months too. Conclusions: A culturally appropriate, target-driven lifestyle intervention with video education training is effective in improving clinical outcomes, health literacy, and self-care practice in newly diagnosed diabetic patients in Nepal, i.e., at a time period when effective diabetes control is vital to prevent further complications. The training intervention could be rolled out nationwide in order to reduce the risk of diabetic-related complications and improve people’s quality of life and productivity

Selection of study sites and participants for research into Nepal’s federal health system

Introduction: This article offers insights into the process of selecting representative study sites and participants in a longitudinal study in Nepal. As part of the research design process, the selection of representative areas in a large-scale study requires both intellectual and practical considerations. Methods: We briefly introduce our study into the impact of federalization on Nepal’s health system before outlining the criteria considered for the identification of fieldwork sites and the most appropriate study participants for the qualitative interviews and participatory components of this research. Findings: The selected areas are presented with an overview of the areas selected and their justification. The study sites and participants should consider a broader coverage with diverse participants’ backgrounds. Several factors can influence the identification and recruitment of the right participants, including the use of appropriate gatekeepers, gaining access to recruit participants, logistical challenges, and participant follow-up. Conclusion: We conclude that longitudinal qualitative research requires a carefully selected diverse set of study sites and participants to assess the complexities and dynamics of the health system and service provision to ensure that longitudinal research is representative and effective in addressing the research question(s) being investigated

Health System Strengthening: The Role of Public Health in Federal Nepal

This article addresses some of the key Public Health approaches around the ongoing federalisation of the state of Nepal and the associated decentralisation processes in its health system. We start by outlining the main roles of the discipline of Public Health and the contribution it can make to the reform process. Then the next section introduces our on-going study into the effects of the establishment of the Federal Republic of Nepal on the organisation and running of the country’s health system. To capture the Public Health benefits of decentralisation, the process should not be only ‘top-down’, directed by policy elites. Although in theory Nepal’s health system has undergone a process of decentralisation, in practice policy and planning is often still being led by the Federal government, despite the clear roles and responsibilities of the three tiers of government in health service delivery. To improve policy and planning in the newly decentralised health system structure, there needs to be meaningful incorporation of the views of stakeholders at all levels (even the very lowest levels). Our project aims to play a part in addressing this by capturing a wide variety of experiences of the decentralisation process

Selection of study sites and participants for research into Nepal’s Federal Health System

Introduction: This article offers insights into the process of selecting representative study sites and participants in a longitudinal study in Nepal. As part of the research design process, the selection of representative areas in a large-scale study requires both intellectual and practical considerations. Methods: We briefly introduce our study into the impact of federalization on Nepal’s health system before outlining the criteria considered for the identification of fieldwork sites and the most appropriate study participants for the qualitative interviews and participatory components of this research. Findings: The selected areas are presented with an overview of the areas selected and their justification. The study sites and participants should consider a broader coverage with diverse participants’ backgrounds. Several factors can influence the identification and recruitment of the right participants, including the use of appropriate gatekeepers, gaining access to recruit participants, logistical challenges, and participant follow-up. Conclusion: We conclude that longitudinal qualitative research requires a carefully selected diverse set of study sites and participants to assess the complexities and dynamics of the health system and service provision to ensure that longitudinal research is representative and effective in addressing the research question(s) being investigated

Participatory policy analysis in health policy and systems research: reflections from a study in Nepal

Background Participatory policy analysis (PPA) as a method in health policy and system research remains underexplored. Using our experiences of conducting PPA workshops in Nepal to explore the impact of the country’s move to federalism on its health system, we reflect on the method’s strengths and challenges. We provide an account of the study context, the design and implementation of the workshops, and our reflections on the approach’s strengths and challenges. Findings on the impact of federalism on the health system are beyond the scope of this manuscript. Main body We conducted PPA workshops with a wide range of health system stakeholders (political, administrative and service-level workforce) at the local and provincial levels in Nepal. The workshops consisted of three activities: river of life, brainstorming and prioritization, and problem-tree analysis. Our experiences show that PPA workshops can be a valuable approach to explore health policy and system issues – especially in a context of widespread systemic change which impacts all stakeholders within the health system. Effective engagement of stakeholders and activities that encourage both individual- and system-level reflections and discussions not only help in generating rich qualitative data, but can also address gaps in participants’ understanding of practical, technical and political aspects of the health system, aid policy dissemination of research findings, and assist in identifying short- and long-term practice and policy issues that need to be addressed for better health system performance and outcomes. Conducting PPA workshops is, however, challenging for a number of reasons, including the influence of gatekeepers and power dynamics between stakeholders/participants. The role and skills of researchers/facilitators in navigating such challenges are vital for success. Although the long-term impact of such workshops needs further research, our study shows the usefulness of PPA workshops for researchers, for participants and for the wider health system. Conclusions PPA workshops can effectively generate and synthesize health policy and system evidence through collaborative engagement of health system stakeholders with varied roles. When designed with careful consideration for context and stakeholders’ needs, it has great potential as a method in health policy and systems research

The COVID-19 pandemic in Nepal: Emerging evidence on the effectiveness of action by, and cooperation between, different levels of government in a federal system

A new coronavirus disease (COVID-19) caused by a novel pathogen (SARS-CoV-2) spread rapidly around the world in the early months of 2020, and was declared a pandemic by the World Health Organization (WHO) on 11 March. COVID-19 has, and continues to have, large implications for individuals, societies, and for national health systems across the globe. Due to its novelty and impact, it has challenged all health care systems where the virus has taken hold. The ways in which governments and health systems have responded have varied widely across the world. In the case of Nepal, the pandemic represented a major test for the newly decentralised health system, created as a result of the implementation of the 2015 federal constitution. This paper, which forms a part of our large on-going study of the decentralisation of the health system in the country, presents some of the early evidence on the effectiveness of the actions taken by Federal, Provincial and Local Governments and the levels of cooperation and coordination between them

Response of Wheat Genotypes to Different Levels of Nitrogen

A field experiment was conducted using six genotypes of wheat (Triticum aestivum L.) for response to different levels of nitrogen (N) use. The experiment was laid out in split plot design with four levels (0, 50, 100 and 150 kg N ha-1) as main plots and six wheat genotypes (BL 3623, BL 3629, BL 3872, NL 1008, NL 1055 and Vijay, a check variety) as sub-plots. Grain yield and other yield components increased linearly in response to N concentrations in both seasons. Only two parameters: days to heading (DOH) and days to maturity (DTM) varied significantly (p ≤ 0.05) among wheat genotypes in both the years. None of the parameters showed interaction effects in both seasons. Vijay showed highest grain yield of 3.12 t ha-1 in 2013 with the application of 100 kg N ha-1, and 3.23 t ha-1 in 2014 with 150 kg N ha-1. Spike length, productive tillers m-2, number of spikes m-2 and test weight were greater with higher N rates. The straw yield of wheat fertilized with 150 kg N ha-1 was the highest in Vijay (4.35 t ha-1) and BL 3872 (4.33 t ha-1), respectively. Vijay with 100 kg N ha-1 produced the highest number of productive tillers m-2 (276.33) in 2013 and 296.00 with the application of 150 kg N ha-1 in 2014