Lessons from cholera response in Kathmandu Valley, Nepal

The first recorded cholera epidemic in Nepal took place in 1823, followed by a series of epidemics occurring in the Kathmandu Valley in 1831, 1843, 1856, 1862 and 1887. Kathmandu Valley still witnesses cholera and other water borne disease cases almost every year. In 2015 and 2016, cholera cases for the valley was highest with 76 and 150 confirmed cases respectively along is with huge caseload on Acute Watery Diarrhoea (AWD). WASH Situation of the Valley especially of City Centres comes with lots of challenges owing to the complexities of urban set-up and thus the city centres are the potential hotspots in context to outbreak vulnerabilities. Based on lesson learned in 2016 cholera response, this paper presents a way forward for minimizing the occurrence of cholera and AWD which includes developing a system for cholera prevention and outbreak response

‘Agents-in-focus’ and ‘Agents-in-context’: The strong structuration analysis of central government accounting practices and reforms in Nepal

Drawing on Stones’ (2005) strong structuration theory, the paper unfolds why and how the key stakeholders of central government accounting in Nepal are involved in the reproduction of routinised accounting practices, resisting the externally-propagated changes. Government accountants (the agents-in-focus) through their capability to control the budget routines have enjoyed a powerful social position in their position–practice relations with the agents-in-context, i.e. professional accountants and international consultants, higher-level officers and administrators, auditors, and politicians. Social position along with historically-imbued dispositions and their conduct and context analysis have enabled government accountants to strategically exercise their agency. Government accountants have articulated duality and a dialectic relation with the agents-in-context, which have resulted in the reproduction of everyday accounting practice and the resistance to the World Bank-led reforms, such as accrual accounting and, more recently, the Cash-Basis IPSAS

Aid conditionalities, international Good Manufacturing Practice standards and local production rights: a case study of local production in Nepal

© 2015 Brhlikova et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This work was supported by the Economic and Social Research Council and the Department for International Development [RES-167-25-0110] through the collaborative research project Tracing Pharmaceuticals in South Asia (2006 – 2009). In addition to the authors of this paper, the project team included: Soumita Basu, Gitanjali Priti Bhatia, Erin Court, Abhijit Das, Stefan Ecks, Patricia Jeffery, Roger Jeffery, Rachel Manners, and Liz Richardson. Martin Chautari (Kathmandu) and the Centre for Health and Social Justice (New Delhi) provided resources drawn upon in writing this paper but are not responsible for the views expressed, nor are ESRC or DFID. Ethical review was provided by the School of Social and Political Science at the University of Edinburgh, and ethical approval in Nepal for the study granted by the Nepal Health Research Council (NHRC)

Letter to the Editor

Introduction: A medical humanities (MH) module, Sparshanam has been conducted for all first year undergraduate medical students at KIST Medical College, Nepal, since 2008. Knowledge, attitude and perceived skills in empathy, what it means to be sick in Nepal, the doctor, the patient, the family, doctor-patient relationship and professional values in medicine were studied at the beginning and conclusion of the module conducted from December 2011 to March 2012. Methods: A questionnaire was developed to study respondents’ perception regarding knowledge, attitude and perceived skill levels in the areas mentioned above. Total scores in different areas and overall score were calculated. All scores were normally distributed (one sample Kolmogorov-Smirnov test). Scores among different subgroups of respondents and before and after the module were compared using appropriate tests (

Impact of climate change on WASH services: a case from Nepal

Nepal is one of the most vulnerable countries to climate change, water-induced disasters and hydrometeorological extreme events such as droughts, landslides and floods. A recent study conducted in Nepal on the impact of climate change on WASH revealed reduced yield, decreasing rainfall trend, change in rainfall pattern, increasing temperature, and high vulnerability water supply and sanitation schemes to risks. As per users’ perception, yield of water sources reduced by 40% on average while analysis of secondary data revealed over 50% reduction in yield. This forced the communities to resort to different adaptive mechanisms including use of alternate/additional sources (28%), and introducing controlled water distribution mechanism (21%). Of the 49 schemes thoroughly assessed, 75% schemes have resorted to alternate sources to cope with the reduced yield. This paper will share the major findings from the study and highlight community led coping mechanisms to deal with climate induced changes

Design, synthesis and evaluation of benzofuran-acetamide scaffold as potential anticonvulsant agent

A series of N-(2-(benzoyl/4-chlorobenzoyl)-benzofuran-3-yl)-2-(substituted) acetamide derivatives (4a-l, 5a-l) was synthesized in good yield. All the synthesized compounds were in agreement with elemental and spectral data. The anticonvulsant activity of all synthesized compounds was assessed against the maximal electroshock induced seizures (MES) model in mice. Neurotoxicity was evaluated using the rotarod method. The majority of compounds exhibited anticonvulsant activity at a dose of 30 mg kg–1 body mass during 0.5–4 h, indicating their ability to prevent seizure spread at low doses. Relative to phenytoin, compounds 5i [N-(2-(4-chlorobenzoyl)-benzofuran-3-yl)-2-(cyclohexyl(methyl)amino)-acetamide] and 5c [N-(2-(4-chlorobenzoyl)-benzofuran-3-yl)-2-(4-methylpiperidin-1-yl)acetamide] demonstrated comparable relative anticonvulsant potency of 0.74 and 0.72, respectively, whereas compound 5f [(N-(2-(4-chlorobenzoyl)-benzofuran-3-yl)-2-(4-(furan-2-carbonyl)-piperazin-1-yl) acetamide] exhibited the lowest relative potency of 0.16. The ALD50 of tested compounds ranged from 1.604 to 1.675 mmol kg–1 body mass. The ED50 of synthesized compounds ranged from 0.055 to 0.259 mmol kg–1 (~23.4 to 127.6 mg kg–1) body mass. The pharmacophore mapping of the examined compounds on standard drugs (phenobarbital, phenytoin, ralitolin and carbamazepine) strongly suggests that these compounds may exert their anticonvulsant activity via the same established mechanism as that of known drugs

Colon cancer associated genes exhibit signatures of positive selection at functionally significant positions

Background Cancer, much like most human disease, is routinely studied by utilizing model organisms. Of these model organisms, mice are often dominant. However, our assumptions of functional equivalence fail to consider the opportunity for divergence conferred by ~180 Million Years (MY) of independent evolution between these species. For a given set of human disease related genes, it is therefore important to determine if functional equivalency has been retained between species. In this study we test the hypothesis that cancer associated genes have different patterns of substitution akin to adaptive evolution in different mammal lineages. Results Our analysis of the current literature and colon cancer databases identified 22 genes exhibiting colon cancer associated germline mutations. We identified orthologs for these 22 genes across a set of high coverage (>6X) vertebrate genomes. Analysis of these orthologous datasets revealed significant levels of positive selection. Evidence of lineage-specific positive selection was identified in 14 genes in both ancestral and extant lineages. Lineage-specific positive selection was detected in the ancestral Euarchontoglires and Hominidae lineages for STK11, in the ancestral primate lineage for CDH1, in the ancestral Murinae lineage for both SDHC and MSH6 genes and the ancestral Muridae lineage for TSC1. Conclusion Identifying positive selection in the Primate, Hominidae, Muridae and Murinae lineages suggests an ancestral functional shift in these genes between the rodent and primate lineages. Analyses such as this, combining evolutionary theory and predictions - along with medically relevant data, can thus provide us with important clues for modeling human diseases

Antioxidant, antiinflammatory and antiinvasive activities of biopolyphenolics

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Utilisation of Postnatal Care among Rural Women in Nepal

Background: Postnatal care is uncommon in Nepal, and where it is available the quality is often poor. Adequate utilisation of postnatal care can help reduce mortality and morbidity among mothers and their babies. Therefore, our study assessed the utilisation of postnatal care at a rural community level. Methods: A descriptive, cross-sectional study was carried out in two neighbouring villages in early 2006. A total of 150 women who had delivered in the previous 24 months were asked to participate in the study using a semi-structured questionnaire. Results: The proportion of women who had received postnatal care after delivery was low (34%). Less than one in five women (19%) received care within 48 hours of giving birth. Women in one village had less access to postnatal care than women in the neighbouring one. Lack of awareness was the main barrier to the utilisation of postnatal care. The woman's own occupation and ethnicity, the number of pregnancies and children and the husband's socio-economic status, occupation and education were significantly associated with the utilisation of postnatal care. Multivariate analysis showed that wealth as reflected in occupation and having attended antenatal are important factors associated with the uptake of postnatal care. In addition, women experiencing health problems appear strongly motivated to seek postnatal care. Conclusion: The postnatal care has a low uptake and is often regarded as inadequate in Nepal. This is an important message to both service providers and health-policy makers. Therefore, there is an urgent need to assess the actual quality of postnatal care provided. Also there appears to be a need for awareness-raising programmes highlighting the availability of current postnatal care where this is of sufficient quality

The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study

Background Antenatal care (ANC) has been recognised as a way to improve health outcomes for pregnant women and their babies. However, only 29% of pregnant women receive the recommended four antenatal visits in Nepal but reasons for such low utilisation are poorly understood. As in many countries of South Asia, mothers-in-law play a crucial role in the decisions around accessing health care facilities and providers. This paper aims to explore the mother-in-law’s role in (a) her daughter-in-law’s ANC uptake; and (b) the decision-making process about using ANC services in Nepal. Methods In-depth interviews were conducted with 30 purposively selected antenatal or postnatal mothers (half users, half non-users of ANC), 10 husbands and 10 mothers-in-law in two different (urban and rural) communities. Results Our findings suggest that mothers-in-law sometime have a positive influence, for example when encouraging women to seek ANC, but more often it is negative. Like many rural women of their generation, all mothers-in-law in this study were illiterate and most had not used ANC themselves. The main factors leading mothers-in-law not to support/ encourage ANC check ups were expectations regarding pregnant women fulfilling their household duties, perceptions that ANC was not beneficial based largely on their own past experiences, the scarcity of resources under their control and power relations between mothers-in-law and daughters-in-law. Individual knowledge and social class of the mothers-in-law of users and non-users differed significantly, which is likely to have had an effect on their perceptions of the benefits of ANC. Conclusion Mothers-in-law have a strong influence on the uptake of ANC in Nepal. Understanding their role is important if we are to design and target effective community-based health promotion interventions. Health promotion and educational interventions to improve the use of ANC should target women, husbands and family members, particularly mothers-in-law where they control access to family resources