Post-implementation Review of the Himalaya Home Care Project for Home Isolated COVID-19 Patients in Nepal

Background: The emergence of coronavirus disease 2019 (COVID-19) has resulted in a pandemic that has significantly impacted healthcare systems at a global level. Health care facilities in Nepal, as in other low- and middle-income countries, have limited resources for the treatment and management of COVID-19 patients. Only critical cases are admitted to the hospital resulting in most patients in home isolation. Methods: Himalaya Home Care (HHC) was initiated to monitor and provide counseling to home isolated COVID-19 patients for disease prevention, control, and treatment. Counselors included one physician and four nurses. Lists of patients were obtained from district and municipal health facilities. HHC counselors called patients to provide basic counseling services. A follow-up check-in phone call was conducted 10 days later. During this second call, patients were asked about their perceptions of the HHC program. Project objects were: (1) To support treatment of home isolated persons with mild to moderate COVID-19, decrease burden of hospitalizations, and decrease risks for disease transmission; and, (2) To improve the health status of marginalized, remote, and vulnerable populations in Nepal during the COVID-19 pandemic. Results: Data from 5823 and 3988 patients from May 2021-February 2022 were entered in initial and follow-up forms on a REDCap database. The majority of patients who received counseling were satisfied. At follow-up, 98.4% of respondents reported that HHC prevented hospitalization, 76.5% reported they could manage their symptoms at home, and 69.5% reported that counseling helped to limit the spread of COVID-19 in their household. Conclusions: Telehealth can be an essential strategy for providing services while keeping patients and health providers safe during the COVID-19 pandemic

Institutionalization of Minimum Service Standards (MSS) for Health Facilities in Nepal:

Access to health facilities alone, without quality services, does more harm than the benefit to the people’s health. Nepal has invested more than two decades in expansion of number of health facilities and the journey is still on to balance level of health facilities based on the federal structure. Institutionalization of Minimum Service Standards (MSS) for health facilities in Nepal implemented by Ministry of Health and Population is an exemplary Plan-Do-Study-Act (PDSA) cycle for health facilities readiness and service availability for quality improvement. From its design, development, stakeholders’ engagement, implementation to development of action plan makes MSS lively and outcome oriented tool. MSS for health facilities in Nepal is an effort of government to prepare foundation of readiness and service availability to move ahead with effective quality service utilization. Digitalization of the all sets of MSS, development of MSS to cover the existing type of the health facilities currently present in the country and access of data set for researchers is the way forward. Developing standards for national accreditation system and international collaboration is the next step to embrace. Furthermore, MSS gradually reported through self assessment of the health facilities with occasional monitoring by the local, provincial and federal government and gap fulfillment through routine annual work plan and budgeting is the future direction.  It is high time MoHP moves ahead with service specific quality improvement tools integrated with MSS assessment prepare them for high quality health systems that can adapt to changing health needs and health shocks

Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal

Mechanistic Association of Quantitative Trait Locus with Malate Secretion in Lentil (Lens culinaris Medikus) Seedlings under Aluminium Stress

Aluminium (Al) toxicity acts as a major delimiting factor in the productivity of many crops including lentil. To alleviate its effect, plants have evolved with Al exclusion and inclusion mechanisms. The former involves the exudation of organic acid to restrict the entry of Al3+ to the root cells while latter involves detoxification of entered Al3+ by organic acids. Al-induced secretion of organic acids from roots is a well-documented mechanism that chelates and neutralizes Al3+ toxicity. In this study, F6 recombinant inbred lines (RILs) derived from a cross between L-7903 (Al-resistant) and BM-4 (Al-sensitive) were phenotyped to assess variation in secretion levels of malate and was combined with genotypic data obtained from 10 Al-resistance linked simple sequence repeat (SSRs) markers. A major quantitative trait loci (QTL) was mapped for malate (qAlt_ma) secretion with a logarithm of odd (LOD) value of 7.7 and phenotypic variation of 60.2%.Validated SSRs associated with this major QTL will be useful in marker assisted selection programmes for improving Al resistance in lentil

Synthesis, self-assembly and surface-active properties of alkyl halide mediated imidazolium monomeric surfactants

Two imidazolium monomeric surfactants, that is, 1-tetradecyl-1H-imidazole [14IM] and 1-hexadecyl-1H-imidazole [16IM] has been synthesized and characterized by 1H NMR,13C NMR, FTIR, HRMS spectroscopies and thermogravimetric analysis (TGA) for number and types of protons and carbon, functional groups, estimation of molecular weight and thermal stability of these compounds. The conductivity was measured in double distilled water at four different temperatures, 288, 293, 298, and 303 K. The results showed that these surfactants behave as weak electrolytes. The density and viscosity data have shown the existence of strong interactions between imidazolium surfactants and solvent (water) molecules. The results obtained from Root’s equation indicate that surfactant–solvent interactions are important than surfactant–surfactant interactions in dilute solutions, that is, below critical micellar concentration. The values of constants obtained from Einstein and Moulik equations have revealed that there was stronger and significant interaction between imidazolium surfactants and water molecules below critical micellar region. The surface tension parameters have indicated that these surfactants are good contenders to lower the surface tension of air/water interface. The results obtained from surface tension data have shown that standard change in free energy of micellization (ΔG°mic) and adsorption (ΔG°ads) were negative, indicating that these surfactants molecules have spontaneous tendencies to form micelles in solution at higher concentration and to get adsorb at the air/water interface at lower concentration. The TGA has indicated good thermally stability and activation energy for thermal decomposition was found in the range of 37.26.26–98.20.20 kJ/mol.</p

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially