The COVID‐19 Pandemic Not Only Poses Challenges, but Also Opens Opportunities for Sustainable Transformation

The COVID-19 pandemic has impacted social, economic, and environmental systems worldwide, slowing down and reversing the progress made in achieving the Sustainable Development Goals (SDGs). SDGs belong to the 2030 Agenda to transform our world by tackling humankind's challenges to ensure well-being, economic prosperity, and environmental protection. We explore the potential impacts of the pandemic on SDGs for Nepal. We followed a knowledge co-creation process with experts from various professional backgrounds, involving five steps: online survey, online workshop, assessment of expert's opinions, review and validation, and revision and synthesis. The pandemic has negatively impacted most SDGs in the short term. Particularly, the targets of SDG 1, 4, 5, 8, 9, 10, 11, and 13 have and will continue to have weakly to moderately restricting impacts. However, a few targets of SDG 2, 3, 6, and 11 could also have weakly promoting impacts. The negative impacts have resulted from impeding factors linked to the pandemic. Many of the negative impacts may subside in the medium and long terms. The key five impeding factors are lockdowns, underemployment and unemployment, closure of institutions and facilities, diluted focus and funds for non-COVID-19-related issues, and anticipated reduction in support from development partners. The pandemic has also opened a window of opportunity for sustainable transformation, which is short-lived and narrow. These opportunities are lessons learned for planning and action, socio-economic recovery plan, use of information and communication technologies and the digital economy, reverse migration and “brain gain,” and local governments' exercising authorities

A Short Report On The Diseases Pattern Observed Over Six Months Period In A ReCently Established Children's Hospital From June 1970 To December 1970

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Indoor Air Quality and ventilation assessment of rural mountainous households of Nepal

Cooking with open fire has been crucial for occupants’ health due to poor Indoor Air Quality (IAQ) in most of the rural households. IAQ is affected by many factors, such as firewood moisture, stove type, ventilation, etc. A monitoring system has been developed to find the general IAQ with Improved Cooking Stove (ICS) and Traditional Cooking Stove (TCS). Decay curve technique is utilized to calculate the Carbon Monoxide (CO) decay time. A preliminary health survey is also carried out to evaluate the dweller’s health complaints. The study is carried out in two adjoining remote villages of Palpa District in Western Nepal. The mean CO and PM2.5 concentration for ICS and TCS are 27.11 ppm and 825.4 μg/m3 (27.11 ± 14.24 ppm and 825.4 ± 730.9 μg/m3) with significant correlation (p < 0.0001) and 36.03 ppm and 1336 μg/m3 (36.03 ± 19.06 and 1336 ± 952.8) with significant correlation (p < 0.0481), respectively. From the overall sample, the mean CO and PM2.5 concentration is reduced by 29.9% and 39%, respectively. The ventilation analysis result shows more than an 80 percentage deficit in ventilation as per the minimal rate of ventilation as prescribed by American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE). Moreover, the placement of chimney at a short vertical height of 1.2 m adjoining to back window is the major cause of backflow. Therefore, the study has recommended a greater focus on ventilation to control IAQ of rural mountainous households

Surgical Antibiotic Prophylaxis Administration Improved after introducing Dedicated Guidelines: A Before-and-After Study from Dhulikhel Hospital in Nepal (2019–2023)

(1) Background: Surgical antibiotic prophylaxis (SAP) is important for reducing surgical site infections. The development of a dedicated hospital SAP guideline in the Dhulikhel Hospital was a recommendation from a baseline study on SAP compliance. Compliance with this new guideline was enhanced through the establishment of a hospital committee, the establishment of an antibiotic stewardship program and the funding and training of healthcare professionals. Using the baseline and a follow-up study after introducing dedicated hospital SAP guidelines, we compared: (a) overall compliance with the SAP guidelines and (b) the proportion of eligible and non-eligible patients who received initial and redosing of SAP; (2) Methods: A before-and-after cohort study was conducted to compare SAP compliance between a baseline study (July 2019–December 2019) and a follow-up study (January 2023–April 2023); (3) Results: A total of 874 patients were in the baseline study and 751 in the follow-up study. Overall SAP compliance increased from 75% (baseline) to 85% in the follow-up study (p p = 0.04). For those eligible for redosing, this increased from 14% to 22% but was not statistically significant (p = 0.272); (4) Conclusions: Although there is room for improvement, introduction of dedicated SAP guidelines was associated with improved overall SAP compliance. This study highlights the role of operational research in triggering favorable interventions in hospital clinical care

Demand, End-Uses, and Conservation of Alpine Medicinal Plant Neopicrorhiza scrophulariiflora (Pennell) D. Y. Hong in Central Himalaya

Neopicrorhiza scrophulariiflora (Pennell) D. Y. Hong of Scrophulariaceae family (hereinafter referred to as Neopicrorhiza) has medicinally important rhizomes with high levels of trade. What factors drive demand for Neopicrorhiza in Central Himalaya is unknown. In this context, a nationwide comprehensive survey was conducted from September 2016 to March 2017 to assess demand, end-uses, and conservation of dry Neopicrorhiza rhizomes in Nepal. A total of 2313 herbal products were surveyed for Neopicrorhiza as an ingredient in 38 retailer shops. Processing industries of Neopicrorhiza in Nepal were interviewed using structured questionnaire. There were 23 herbal industries manufacturing 45 types of ayurvedic medicines as end-products containing Neopicrorhiza. The volume and value of annual demand for dry rhizomes of Neopicrorhiza in Nepal were found as 6076 kg and NRs 8573236 (USD 83235.30), respectively, in 2015/016 with average 264.17 kg/industry and NRs 1410.87 (USD 13.69) per kg. The major uses of ayurvedic medicines containing Neopicrorhiza were to treat a number of disease categories: cardiovascular system/liver (17), cardiovascular system/blood (6), nervous system (6), dermatological system (4), musculoskeletal system (3), digestive system (2), respiratory system (2), genitourinal system (4), and others (1). Despite changing legal regulation, trade and consumption of Neopicrorhiza exist in Nepal. It can be concluded that domestic consumption is not the major cause of resource depletion of Neopicrorhiza in Nepal

Consumers Caring Health with End Products (Ayurvedic Medicines) Containing Neopicrorhiza scrophulariiflora in Nepal

Neopicrorhiza scrophulariiflora (Pennell) D. Y. Hong is an endangered herbaceous medicinal plant found in subalpine and alpine zone of eastern Himalayas comprising Sikkim, Nepal, Bhutan and China. Rhizomes of Neopicrorhiza scrophulariiflora (hereinafter referred to as Neopicrorhiza) have medicinal properties and are highly traded in Nepal, India and China. Information on driving factors for demand of Neopicrorhiza from consumer perspective is unknown, knowledge of which is important because it can allow insights into future demand and sustainability of future trade. In this context, a survey was conducted among purchasers and consumers (patients) of end products (Ayurvedic medicines) containing Neopicrorhiza (n=513) in five different cities of Nepal from March to July 2017 using structured questionnaire to explore characteristics of consumers and consumption of end products of Neopicrorhiza. The utilization of Ayurvedic medicines containing Neopicrorhiza for treatment of health disorders of human is prevalent in Nepal. Men and women patients of diverse ages and with different socio-economic profiles were found to consume Ayurvedic medicines containing Neopicrorhiza to treat health disorders associated with different organ systems of body. The patients receiving Ayurvedic medicines containing Neopicrorhiza were children, adults and elders ranging from 1 to 98 years old (av. 37.6 years). Employed and unemployed, educated and illiterate consumers were found to consume Ayurvedic medicines containing Neopicrorhiza to treat their health disorders in Nepal. Patients receiving those medicines were from households having diverse annual cash income levels. The purchase and consumption of Ayurvedic medicine containing Neopicrorhiza was most often guided by a doctor’s prescription. Most of the respondents believed that the prices of those Ayurvedic medicines were fairer than other types of medicines. Similar studies are recommended in other countries like India and China where the Neopicrorhiza is exported from Nepal

Why do patients choose to consume Ayurvedic Medicines in Nepal? An exploratory study

Ayurvedic medicines are believed to bring harmony and balance in mind, body, spiritual well-being and social welfare of human. The reasons for preference for these medicines are of great interest for exploration. This study was carried out in Nepal in 2017 to explore the reasons for choosing to consume Ayurvedic medicines, with support of a separate survey focusing on these medicines containing Neopicrorhiza scrophulariiflora. An online survey (n=58) and face to face interviews (n=406) were administered using structured questionnaires to explore those reasons for choice. Neopicrorhiza scrophulariiflora (Pennell) D. Y. Hong (Scrophulariaceae) is a perennial alpine herb found in the subalpine as well as alpine zone of the eastern Himalayas comprising Sikkim, Nepal, Bhutan and China. Its rhizomes are medicinally important and in trade. Fewer or no side effects, preference to natural way of healing, belief regarding healing of disease, ease of access (availability and cost), and advertisement and recommendation from others were the major reasons that the patients chose to consume Ayurvedic medicines for own's healing. In case of Ayurvedic medicines containing Neopicrorhiza scrophulariiflora, majority of the patients believed that these medicines have fewer or no side effects, can cure illness particularly for long run of chronic diseases, were cheaper than allopathic medicines, were easily available to purchase and were recommended by family members. Healing was not successful in past from allopathic and other types of medicines of majority of the patients who preferred to consume Ayurvedic medicines containing Neopicrorhiza scrophulariiflora. Further scientific studies and interventions are recommended for concerned health authorities and nursing practitioners of Nepal to test and validate the safety and effectiveness of the consumption of Ayurvedic medicines. &nbsp

Culturally and developmentally adapting group interpersonal therapy for adolescents with depression in rural Nepal

Background Evidence-based interventions are needed to reduce depression among adolescents in low- and middle-income countries (LMICs). One approach could be cultural adaptation of psychological therapies developed in high-income countries. We aimed to adapt the World Health Organization’s Group Interpersonal Therapy (IPT) Manual for adolescents with depression in rural Nepal. Methods We used a participatory, multi-stage adaptation process involving: translation and clinical review of the WHO Manual; desk reviews of adaptations of IPT in LMICs, and literature on child and adolescent mental health interventions and interpersonal problems in Nepal; a qualitative study to understand experiences of adolescent depression and preferences for a community-based psychological intervention including 25 interviews with adolescent boys and girls aged 13–18 with depression, four focus group discussions with adolescents, four with parents/caregivers and two with teachers, six interviews with community health workers and one with a representative from a local non-governmental organisation (total of 126 participants); training of IPT trainers and facilitators and practice IPT groups; and consultation with a youth mental health advisory board. We used the Ecological Validity Framework to guide the adaptation process. Results We made adaptations to optimise treatment delivery and emphasise developmental and cultural aspects of depression. Key adaptations were: integrating therapy into secondary schools for delivery by school nurses and lay community members; adding components to promote parental engagement including a pre-group session with the adolescent and parent to mobilise parental support; using locally acceptable terms for mental illness such as udas-chinta (sadness and worry) and man ko samasya (heart-mind problem); framing the intervention as a training programme to de-stigmatise treatment; and including activities to strengthen relationships between group members. We did not adapt the therapeutic goals of IPT and conserved IPT-specific strategies and techniques, making edits only to the way these were described in the Manual. Conclusions Group IPT can be adapted for adolescents in Nepal and delivered through the education system. A randomised controlled trial is needed to assess the impact and costs of the intervention in this setting. Future research in LMICs to adapt IPT for adolescents could use this adapted intervention as a starting point