Understanding effects of armed conflict on health outcomes: the case of Nepal

Objective There is abundance of literature on adverse effects of conflict on the health of the population. In contrast to this, sporadic data in Nepal claim improvements in most of the health indicators during the decade-long armed conflict (1996-2006). However, systematic information to support or reject this claim is scant. This study reviews Nepal's key health indicators before and after the violent conflict and explores the possible factors facilitating the progress. Methods A secondary analysis has been conducted of two demographic health surveys- Nepal Family Health Survey (NFHS) 1996 and Nepal Demographic and Health Survey (NDHS) 2006; the latter was supplemented by a study carried out by the Nepal Health Research Council in 2006. Results The data show Nepal has made progress in 16 out of 19 health indicators which are part of the Millennium Development Goals whilst three indicators have remained static. Our analysis suggests a number of conflict and non-conflict factors which may have led to this success. Conclusion The lessons learnt from Nepal could be replicable elsewhere in conflict and post-conflict environments. A nationwide large-scale empirical study is needed to further assess the determinants of Nepal's success in the health sector at a time the country experienced a decade of armed conflict

Accessing research literature: A mixed-method study of academics in Higher Education Institutions in Nepal

Background: Research in Higher Education (HE), particularly in health and medical sciences plays a crucial role, not only in enhancing knowledge and skills of students and academics, but also in helping to develop managers and policy makers who rely on evidence-based planning and programming. This paper reports university teacher’s knowledge and practices in accessing electronic research-based evidence in health and medical sciences in Nepal. Material and Methods: This was mixed-methods study comprising a self-administered questionnaire completed by HE teachers and informant key interviews with authorities of HE institutions. A total of 15 out of the total 40 institutions offering HE above Bachelors level on health-related subjects were included for the study. Results: The response rate was 68%; 244 out of 360 HE teachers completed self-administered questionnaire. The respondents comprised nurses (36%), followed by doctors (23%), public health practitioners (18%), dentists (17%) and pharmacists (12%). Most of the HE teachers reported that they have computer skills and possess their own computer. Two-thirds (66%) of the HE teachers had work email and almost all (93%) have a personal email ID. All institutions had a computer lab and/or library. Almost all teachers had internet access at work but the internet was reportedly slow. Each institution had a librarian to support to the students and staff but only a third of teachers sought their help. Many do not know what kind of support librarians can provide. Less than half of the staff had accessed electronic research materials. This proportion varied between HE institutions ranging from 13 to 83%. HINARI and PubMed were the mostly used research databases. Less than half of respondents (48%) had published research papers in peer-reviewed journals, and only 19% published a paper based on a systematic review. Female HE teachers were less likely to publish (32%) than males (68%). More readers and professors had published (75%) than instructors/assistant lecturers (30%) and lecturers (45%). Conclusions: Accessing electronic research literature provides an opportunity to gathering up-to-date research-based information that should be core to all health curricula. We call upon curriculum developers and university authorities in Nepal to revise health curricula and help build electronic searching skills among staff and students

Economically Feasible Crop Production Alternatives to Peanuts in Southwestern Oklahoma

Changes in the U.S. peanut program have resulted in drastically decreased planted acres and forced many peanut producers in the Southwest to consider alternative crops. This study examined the economic risk associated with producing peanuts and common alternatives to peanuts. Seedless watermelon is an alternative for risk preferring farmers whereas, irrigated peanut is the best choice for risk averse farmers.Crop Production/Industries,

Rebel Health Services in South Asia: Comparing Maoist-led Conflicts in India and Nepal

This is the first paper comparing Indian and Nepali Maoist rebels providing health services and health promotion to the communities under their influence. The paper presents the key provisions either made by rebel health workers themselves or by putting political pressure on government health workers to deliver better services in the areas controlled by rebels. The paper is based on a mixed-method approach comprising 15 interviews and a questionnaire survey with 197 Nepalese Maoist health workers and a secondary analysis of policy documents and other published materials on the Maoist health services of India. The paper suggests that rebel health services in India and Nepal followed a fairly similar approach to what and how they offered health care services to local populations. Maoists becoming a government party changed the political landscape for the rebel health workers in Nepal. However, not incorporating the Maoist rebel health workers into the government health system was a missed opportunity. There are lessons that India and Nepal can learn from each other. Should the Maoist rebels and the Government of India come to an agreement, potential for rebel health workers to be integrated in the official health care system should be considered

Diet, microbes, and host genetics: the perfect storm in inflammatory bowel diseases

The incidence of inflammatory bowel diseases (IBD), as well as other inflammatory conditions, has dramatically increased over the past half century. While many studies have shown that IBD exhibits a genetic component via genome-wide association studies, genetic drift alone cannot account for this increase, and other factors, such as those found in the environment must play a role, suggesting a “multiple hit” phenomenon that precipitates disease. One major environmental factor, dietary intake, has shifted to a high fat, high carbohydrate Western-type diet in developing nations, nearly in direct correlation with the increasing incidence of IBD. Recent evidence suggests that specific changes in dietary intake have led to a shift in the composite human gut microbiota, resulting in the emergence of pathobionts that can thrive under specific conditions. In the genetically susceptible host, the emerging pathobionts can lead to increasing incidence and severity of IBD and other inflammatory disorders. Since the gut microbiota is plastic and responds to dietary modulations, the use of probiotics, prebiotics, and/or dietary alterations are all intriguing complementary therapeutic approaches to alleviate IBD symptoms. However, the interactions are complex and it is unlikely that a one-size-fits all approach can be utilized across all populations affected by IBD. Exploration into and thoroughly understanding the interactions between host and microbes, primarily in the genetically susceptible host, will help define strategies that can be tailored to an individual as we move towards an era of personalized medicine to treat IBD

Health and Wellbeing of the Nepalese population: Access and experiences of health and social care services in the UK

To date there has been very little research on the health and well-being of Nepali citizens living int the UK. This mixed-methods study is crucial as the NHS and social services have minimal awareness of the specific health and related social care needs of the UK Nepali community compared to other larger Black and Minority Ethnic (BME) communities. Therefore, this study aims to identify health and social care needs to promote positive health and wellbeing for the Nepali population in the UK. It also assesses health inequalities amongst the Nepali population focusing on the need for national level prioritisation to reduce these inequalities experienced by the broader UK Nepali population using NHS services

Needs assessment of mental health training for Auxiliary Nurse Midwives: a cross-sectional survey

Mental health in pregnant women and new mothers is increasing recognised on the global health agenda. In Nepal mental health is generally a difficult to topic to discuss. THET, a London-based organisation, funded Bournemouth University, and Liverpool John Moores University in the UK and Tribhuvan University in Nepal to train community-based maternity workers on issues around mental health. This paper reports on a quantitative survey with nearly all Auxiliary Nurse Midwives in Nawalparasi (southern part of Nepal). The findings illustrate the lack of training on mental health issues related to pregnancy and childbirth in this group of health workers. Thus the paper’s conclusions stress the need for dedicated training in this field

Surviving research between Two Guns: Lessons Learnt from Nepal.

Nepal’s decade long violent conflict (1996-2005) between the Nepal Communist Party (Maoist) and the Government of Nepal resulted to over 14000 deaths and thousands others became disabled and lost their properties. During this violent war, the Maoists developed their own health cadres mainly to treat the combatants and the community people under their control areas to some extent. This paper is based on the first author’s personal account of field experiences while conducting PhD research using mixed methods study comprising in-depth interviews and self-administrated questionnaire on the former Maoist health workers in Nepal. This study suggests a few dilemmas the first author confronted with while undertaking this research. First and foremost is the risk involved to both the researcher and the participants in the absence of trust and security on both sides of the conflict. Secondly, the sources of information could easily be biased either deliberately (as propaganda) or more subtly based on respondents’ perspectives. The issues of accessing the research participants, relationships, complicity, representation and being rejected by a contact are pertinent issues when carrying out independent research. Thirdly, maintaining ethics and keeping a right between research, humanity and sense of justice is also the dilemma that might have affected the research findings derived from dangerous environments. Fourthly, lack of precise methods that are valid and reliable to investigate certain dynamics of conflict in the politically violent and crisis environment could be equally contested. Fifthly, undertaking cross-disciplinary research on a conflict-related topic during wartime by a researcher with background in allied field is even more challenging. The researcher need to have both an in-depth knowledge of conflict theories as well as being able to apply these to another discipline which can be cumbersome. This article presents a personal account of a Rotary fellow who conducted his public health research among the Maoists combatant health workers of Nepal. It presents his lived experiences that could be important in carrying out appropriate and credible research during violent conflict elsewhere in future