Carbon footprint of Nepalese healthcare system: A study of Dhulikhel Hospital [version 1; peer review: 2 approved, 1 approved with reservations, 1 not approved]

Background: Though direct greenhouse gas emissions cannot be observed in health care sectors, there can exist indirect emissions contributing to global climate change. This study addresses the concept of the carbon footprint and its significance in understanding the environmental impact of human activities, with a specific emphasis on the healthcare sector through gate-to-gate (GtoG) life cycle assessment. Transportation, energy consumption, and solid waste generated by hospitals are the primary sources of carbon emissions. Methods: Different standards, guidelines and parameters were used to estimate emissions from both the primary and secondary data. All steps and sub-steps involved in GtoG were accessed and analyzed within the standard ISO 14040:44 guideline. An extensive review of existing literature was carried out for the evaluation and verification of secondary data. Results: The total carbon footprint of generators, electricity consumption, transportation activities, LPG cylinders, PV systems was found to be 58,780 kg-CO2-eq/yr, 519,794 kg-CO2-eq/yr, 272,375 kg-CO2-eq/yr, 44,494 kg-CO2-eq/yr, 35,283 kg-CO2-eq/yr respectively and the emissions from non-biodegradable solid waste was found to be 489,835 kg-CO2/yr. Local air pollutants such as PM10, CO, SO2, NOX, and VOCs generated by generators and transportation were also estimated. The CH4 emissions from liquid waste were 1177.344 kg CH4/BOD yr, and those from biodegradables were 3821.6954 kg CH4/yr. Conclusions: Healthcare professionals and policymakers can take action to reduce the sector's carbon footprint by implementing best practices and encouraging sustainable behavior. This study can be taken as foundation for further exploration of indirect emissions from healthcare sectors not only in Nepal but also in south Asian scenario

Health related quality of life and associated factors with medication adherence among tuberculosis patients in selected districts of Gandaki Province of Nepal

Background Tuberculosis is one of the significant public health problems of Nepal. Adherence to medication is very important for improving quality of life and preventing complication. Adherence to tuberculosis medications has significant economic and therapeutic consequences as non-adherence patients are at greater risk of developing complications which affect their health status and overall quality of life. The study aims to determine the factors associated with medication adherence and its effect on health related quality of life among tuberculosis patients in selected districts of Gandaki Province. Methods A health facility based cross-sectional study was carried out among 180 tuberculosis patients registered under DOTS and receiving treatment more than or equal to 60 days. WHOQOL-BREF tools to assess quality of life and Morisky medication adherence scale (MMAS-8) was adopt to assess medication adherence. Data was entered in Epi-data and analysis was performed with the help of the Statistical Package for Social Science (SPSS). The odds ratio with a 95% CI was calculated and p-value of <0.05 was considered as cutoff for statistical significance. Results A total 180 TB patients were participated in this study. Overall quality of life ranges from 10.75 to 89.25 with Mean ± SD as 55.96 ± 14.65. More than three-fourth (79.4%) respondents were adhere to medication. Medication adherence and health related quality of life was found statistically significant with relationship with health workers, favourable time at DOTS centre, absence of co-infection. Participants who were highly adhered to medication had good quality of life. Conclusion Majority of tuberculosis patients adhering to medication had good quality of life. Especial emphasis should be given to tuberculosis patients with co-infection, health workers should behave friendly and provide appropriate counselling in order to maintain the medication adherence and quality of life

Impact of Land Cover Change on Ecosystem Services in a Tropical Forested Landscape

Ecosystems provide a wide range of goods, services or ecosystem services (ES) to society. Estimating the impact of land use and land cover (LULC) changes on ES values (ESV) is an important tool to support decision making. This study used remote sensing and GIS tools to analyze LULC change and transitions from 2001 to 2016 and assess its impact on ESV in a tropical forested landscape in the southern plains of Nepal. The total ESV of the landscape for the year 2016 is estimated at USD 1264 million year−1. As forests are the dominant land cover class and have high ES value per hectare, they have the highest contribution in total ESV. However, as a result of LULC change (loss of forests, water bodies, and agricultural land), the total ESV of the landscape has declined by USD 11 million year−1. Major reductions come from the loss in values of climate regulation, water supply, provision of raw materials and food production. To halt the ongoing loss of ES and maintain the supply and balance of different ES in the landscape, it is important to properly monitor, manage and utilize ecosystems. We believe this study will inform policymakers, environmental managers, and the general public on the ongoing changes and contribute to developing effective land use policy in the region

Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study

BackgroundThe Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal.MethodsWe conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers.ResultsA total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies.ConclusionGovernment stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized

Barriers to Treatment Compliance of Directly Observed Treatment Shortcourse among Pulmunary Tuberculosis Patients.

Treatment compliance is an important aspect for tuberculosis prevention and control. Poor compliance to treatment can lead to the development of drug-resistant tuberculosis. The aim of this study was to explore the factors affecting treatment compliance for tuberculosis patients. Facility based unmatched case control study was done among the forty non-compliance and eighty compliance pulmonary tuberculosis patients registered at selected directly observed treatment short-course centers of six districts. Data were collected using in-depth interview guideline with the tuberculosis focal person and Focus Group Discussion with tuberculosis patients. A total of 120 respondents, 40 cases and 80 controls were enrolled in the study. About 72.5% of the cases and 56.2% of the controls were male. Five significant independent risk factors for non-compliance to TB treatment were identified. The qualitative session confirmed geographical barriers, inaccessibility to health facility, economic barriers, difficulty in convincing people, knowledge about Directly observed treatment shortcourse program, longer medication period, migration and stigma as a major barrier for treatment compliance. Wider ranges of barriers are prevalent in context of tuberculosis treatment pathway and outcome. Knowledge of the tuberculosis patients and attitude of the family plays a vital role in treatment compliance. Directly observed treatment shortcourse playing tremendous role to ensure treatment adherence has been identified as major barrier to adherence as well. Enablers of adherence need to be emphasized to address the barriers

Prevalence of and risk factors for overweight among adolescents of a sub-metropolitan city of Nepal.

BackgroundOverweight is a global public health problem with increasing trend especially in middle to lower socioeconomic country like Nepal. The nutritional status of adolescents being shaped by socio-cultural, environmental, and economic factors has also been impacted by their food habits and level of physical activity. The current nutritional shift and rapid urbanization had emerged overweight as an additional burden for consistently prevalent undernutrition issues. So, the study aimed to identify the prevalence of and risk factors for overweight among school adolescents.MethodsA cross-sectional analytical study was carried out among random sample of 279 adolescents from nine schools of a Sub-metropolitan city of Nepal. The anthropometric measurement of the height and the weight were taken as per the standard. The odds ratio with a 95% CI was calculated and a p-value of ≤0.05 was considered as cut off for statistical significance by fitting into the final multivariable logistic regression.ResultsThe overall prevalence of overweight was obtained as 9.31% (95% CI: 6.40-13.3). The early aged adolescents were more overweight than compared to middle-aged adolescents (AOR: 0.27, CI: 0.028-2.67) and late adolescents (AOR: 0.66, CI: 0.068-6.44) respectively. Similarly, adolescents residing in rural areas had 0.35 (AOR = 0.33, CI: 0.030-3.71) odds of being overweight compared to their counterparts. Adolescents with sedentary behavior were about 4 times (AOR = 3.51, CI: 0.79-15.54) more likely of being overweight than their counterparts.ConclusionOverweight among adolescents residing in urban areas has emerged as an alarming issue due to their unhealthy lifestyle habits. It is therefore pertinent to emphasize adolescents to maintain healthy weight status through health food habits and physical activity

A Comparative Study on Ascorbic Acid Concentration, Total Phenol, and Flavonoid Content in Citrus Species Grown in a Different Region of Western Nepal

Different genetic and environmental factors like altitude, temperature, light radiation, etc. affect the production of phytoconstituents like ascorbic acid, phenol, flavonoid, tannin, etc. So, it is necessary to evaluate phytoconstituents quantitatively and qualitatively because of their different medicinal values. This study is aimed at evaluating and comparing ascorbic acid concentration, total phenol, and flavonoid content in citrus species grown in different places in Western Nepal. For this, fruit collected from Lamjung and Nawalparasi was peeled, and collected juice was extracted with ethanol. Ascorbic acid was estimated using titration with dichlorophenolindophenol dye, and total phenol was estimated using Folin reagent; whereas, flavonoid content was determined by aluminum chloride colorimetric assay. The result showed the maximum ascorbic acid concentration in the fruit juice of Citrus maxima collected from Lamjung, i.e., 2.98±0.161 mg/100 ml, and the least concentration was recorded on extract of Citrus limon collected from Nawalparasi, i.e., 1.005±0.205 mg/100 ml. The total phenol content was comparatively higher in Citrus maxima and Citrus aurantifolia collected from Lamjung, i.e., 12.48±0.40 mg GAE/gm, respectively. Flavonoid content was comparatively higher in Citrus maxima collected from Nawalparasi, i.e., 484.466±3.055 mg QE/gm. This study showed a variation in the concentration of chemical constituents between different places in Western Nepal. This might be due to differences in climatic conditions, environmental factors, altitude, temperature, etc. This study helps to reflect the best-suited altitude for commercial cultivation of the citrus species as these phytochemicals have different medicinal values. Also, this study can help the food industry to use an alternative source of synthetic antioxidant such as ascorbic acid, phenol, and flavonoid. And local people will economically benefit by the commercial cultivation of citrus fruits

Growing City and Rapid Land Use Transition: Assessing Multiple Hazards and Risks in the Pokhara Valley, Nepal

Pokhara is one of the most naturally beautiful cities in the world with a unique geological setting. This important tourist city is under intense pressure from rapid urbanization and population growth. Multiple hazards and risks are rapidly increasing in Pokhara due to unsustainable land use practices, particularly the increase in built-up areas. This study examines the relationship among urbanization, land use/land cover dynamics and multiple hazard and risk analysis of the Pokhara valley from 1990 to 2013. We investigate some of the active hazards, such as floods, landslides, fire, sinkholes, land subsidence and earthquakes, and prepare an integrated multiple hazard risk map indicating the highly vulnerable zones. Land use and land cover maps from 1990 and 2013 from Landsat images (30 m resolution) have been prepared and analyzed for the spatial dynamics of urbanization and the transition of land use and land cover. In the 23-year period, the built-up area more than doubled from 24.03 km² to 54.20 km². Although the landscape in the urban, peri-urban and rural areas appears to be fragmented, different drivers play pivotal roles in landscape change in these areas. The results provide substantial information for establishing innovative action plans for disaster risk management in the valley. Recommendations are made for the most suitable places for future urban expansion in the valley. This study is important for raising awareness among policy makers and other public officials to include multiple hazard risk mitigation in land use policies and plans. Establishing connections between urban expansions, escalating population growth and multiple hazards and risk assessment will also improve in modelling the latent impact of future catastrophes and emergency preparedness

Carbon footprint of Nepalese healthcare system: A study of Dhulikhel Hospital [version 2; peer review: 2 approved, 1 approved with reservations, 1 not approved]

Background Though direct greenhouse gas emissions cannot be observed in health care sectors, there can exist indirect emissions contributing to global climate change. This study addresses the concept of the carbon footprint and its significance in understanding the environmental impact of human activities, with a specific emphasis on the healthcare sector through gate-to-gate (GtoG) life cycle assessment. Transportation, energy consumption, and solid waste generated by hospitals are the primary sources of carbon emissions. Methods Different standards, guidelines and parameters were used to estimate emissions from both the primary and secondary data. All steps and sub-steps involved in GtoG were accessed and analyzed within the standard ISO 14040:44 guideline. An extensive review of existing literature was carried out for the evaluation and verification of secondary data. Results The total carbon footprint of generators, electricity consumption, transportation activities, LPG cylinders, PV systems was found to be 58,780 kg-CO2-eq/yr, 519,794 kg-CO2-eq/yr, 272,375 kg-CO2-eq/yr, 44,494 kg-CO2-eq/yr, 35,283 kg-CO2-eq/yr respectively and the emissions from non-biodegradable solid waste was found to be 489,835 kg-CO2/yr. Local air pollutants such as PM10, CO, SO2, NOX, and VOCs generated by generators and transportation were also estimated. The CH4 emissions from liquid waste were 1177.344 kg CH4/BOD yr, and those from biodegradables were 3821.6954 kg CH4/yr. Conclusions Healthcare professionals and policymakers can take action to reduce the sector's carbon footprint by implementing best practices and encouraging sustainable behavior. This study can be taken as foundation for further exploration of indirect emissions from healthcare sectors not only in Nepal but also in south Asian scenario