Adolescents with disabilities and caregivers experience of COVID-19 in rural Nepal

Introduction: Intersecting vulnerabilities of disability, low socio-economic status, marginalization, and age indicate that adolescents with disabilities in low-and middle-income countries were uniquely affected by the COVID-19 pandemic. Yet, there has been limited research about their experience. We conducted participatory research with adolescents with disabilities in rural, hilly Nepal to explore their experience of the pandemic and inform understanding about how they can be supported in future pandemics and humanitarian emergencies. Methods: We used qualitative methods, purposively sampling adolescents with different severe impairments from two rural, hilly areas of Nepal. We collected data through semi-structured interviews with five girls and seven boys between the age of 11 and 17 years old. Interviews used inclusive, participatory, and arts-based methods to engage adolescents, support discussions and enable them to choose what they would like to discuss. We also conducted semi-structured interviews with 11 caregivers. Results: We found that adolescents with disabilities and their families experienced social exclusion and social isolation because of COVID-19 mitigation measures, and some experienced social stigma due to misconceptions about transmission of COVID-19 and perceived increased vulnerability of adolescents with disabilities to COVID-19. Adolescents who remained connected with their peers throughout lockdown had a more positive experience of the pandemic than those who were isolated from friends. They became disconnected because they moved away from those they could communicate with, or they had moved to live with relatives who lived in a remote, rural area. We found that caregivers were particularly fearful and anxious about accessing health care if the adolescent they cared for became ill. Caregivers also worried about protecting adolescents from COVID-19 if they themselves got ill, and about the likelihood that the adolescent would be neglected if the caregiver died. Conclusion: Contextually specific research with adolescents with disabilities to explore their experience of the pandemic is necessary to capture how intersecting vulnerabilities can adversely affect particular groups, such as those with disabilities. The participation of adolescents with disabilities and their caregivers in the development of stigma mitigation initiatives and strategies to meet their needs in future emergencies is necessary to enable an informed and inclusive response

Drought risk assessment in central Nepal: temporal and spatial analysis

This paper presents temporal and spatial pattern of drought phenomena in central Nepal using standardized precipitation index (SPI) at multiple time scales. The study is based on 32 years of monthly precipitation data from 40 meteorological stations from 1981 to 2012. Results indicate that, while there is no distinct trend in regional precipitation, interannual variation is large. Trend analysis of drought index shows that most stations are characterized by increases in both severity and frequency of drought and trend is stronger for longer drought time scales. Over the study period, the summer season of 2004, 2005, 2006, 2009 and winters 2006, 2008 and 2009 were the worst widespread droughts. These dry periods have a serious impact on agriculture–livestock production of central Nepal. Better understanding of these SPI dynamics could help in understanding the characteristics of droughts and also to develop effective mitigation strategies

Medical students’ characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal’s first medical college

Objective: To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas. Design: Observational cohort study. Setting: Medical college registry, with internet, phone, and personal follow-up of graduates. Participants: 710 graduate doctors from the first 22 classes (1983-2004) of Nepal’s first medical college, the Institute of Medicine. Main outcome measures: Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student. Results: 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal. Conclusions: A cluster of medical students’ characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school

Describing Adolescents with Disabilities’ Experiences of COVID-19 and Other Humanitarian Emergencies in Low- and middle-income Countries: a Scoping Review

Background: The COVID-19 pandemic and other humanitarian emergencies exacerbate pre-existing inequalities faced by people with disabilities. They experience worse access to health, education, and social services, and increased violence in comparison with people without disabilities. Adolescents with disabilities are amongst those most severely affected in these situations. Using participatory research methods with adoles-cents can be more effective than other methods but may be challenging in such emergency contexts. Objectives: We conducted a scoping review to: 1) describe the literature and methods used in peer-reviewed and grey literature on adolescents (aged ten to nineteen) with disabilities’ experience of COVID-19 and other humanitarian emergencies in low- and middle-income countries, and 2) identify research gaps and make recommendations for future research. Methods: The review followed a protocol developed using PRISMA guidelines and the Arksey and O’Malley framework. We searched grey and peer-reviewed literature between 2011 and 2021. Results: Thirty studies were included. Twelve were peer-reviewed, and of those seven used participatory methods. Humanitarian emergencies had adverse effects on adolescents with disabilities across health, education, livelihoods, social protection, and community participa-tion domains. Surprisingly few studies collected data directly with adolescents with disabil-ities. Twenty-three studies combined data from non-disabled children, caregivers, and disabled adults which made it challenging to understand adolescents with disabilities’ unique experience. Conclusions: Our review highlights both the scarcity of literature and the importance of conducting research with adolescents with disabilities in humanitarian contexts. Despite challenges, our review shows that it has been possible to conduct research with adolescents with disabilities to explore their experiences of humanitarian emergencies, and that these experiences were different from those of non-disabled adolescents. There is a need to disaggregate findings and support the implementation and reporting of rigorous research methods. Capacity development through partnerships between non-governmental organisa-tions and researchers may improve reporting of methods

Spatial and temporal variability of rainfall in the Gandaki River Basin of Nepal Himalaya

Landslides, floods, and droughts are recurring natural disasters in Nepal related to too much or too little water. The summer monsoon contributes more than 80% of annual rainfall, and rainfall spatial and inter-annual variation is very high. The Gandaki River, one of the three major rivers of Nepal and one of the major tributaries of the Ganges River, covers all agro-ecological zones in the central part of Nepal. Time series tests were applied for different agro-ecological zones of the Gandaki River Basin (GRB) for rainfall trends of four seasons (pre-monsoon, monsoon, post-monsoon and winter) from 1981 to 2012. The non-parametric Mann-Kendall and Sen’s methods were used to determine the trends. Decadal anomalies relative to the long-term average were analyzed using the APHRODITE precipitation product. Trends in number of rainy days and timing of the monsoon were also analyzed. We found that the post-monsoon, pre-monsoon and winter rainfalls are decreasing significantly in most of the zones but monsoon rainfall is increasing throughout the basin. In the hill region, the annual rainfall is increasing but the rainy days do not show any trend. There is a tendency toward later departure of monsoon from Nepal, indicating an increase in its duration. These seasonally and topographically variable trends may have significant impacts for the agriculture and livestock smallholders that form the majority of the population in the GRB

The Impact of Climate Change on Biodiversity in Nepal: Current Knowledge, Lacunae, and Opportunities

Nepal has an extreme altitudinal range from 60–8850m with heterogeneous topography and distinct climatic zones. The country is considered a biodiversity hotspot, with nearly a quarter of the land area located in protected areas. Nepal and the surrounding Himalayan region are particularly vulnerable to climate change because of their abrupt ecological and climatic transitions. Tens of millions of people rely on the region’s ecosystem services, and observed and modeled warming trends predict increased climate extremes in the Himalayas. To study the ecological impacts of climate change in Nepal and inform adaptation planning, we review the literature on past, present, and predicted future climatic changes and their impacts on ecological diversity in Nepal. We found few studies focusing on organisms, while research on species and communities was more common. Most studies document or predict species range shifts and changes in community composition. Results of these few investigations highlight major lacunae in research regarding the effects of changing climate on species comprising the Himalayan biota. Further empirical work is needed at all levels of biological organization to build on information regarding direct ecological impacts of climatic changes in the region. Countries face an ever-increasing threat of climate change, and Nepal has strong physiographic, elevational, and climatic gradients that could provide a useful model for studying the effects of climate change on a mountainous, and highly biodiverse, area

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries