Implementing Federalism in the Health System of Nepal: Opportunities and Challenges

Nepal moved from unitary system with a three-level federal system of government. As federalism accelerates, the national health system can also speed up its own decentralization process, reduce disparities in access, and improve health outcomes. The turn towards federalism creates several potential opportunities for the national healthcare system. This is because decision making has been devolved to the federal, provincial and local governments, and so they can make decisions that are more representative of their localised health needs. The major challenge during the transition phase is to ensure that there are uninterrupted supplies of medical commodities and services. This requires scaling up the ability of local bodies to manage drug procurement and general logistics and adequate human resource in local healthcare centres. This article documents the efforts made so far in context of health sector federalization and synthesizes the progress and challenges to date and potential ways forward. This paper is written at a time while it is critical to review the federalism initiatives and develop way forward. As Nepal progress towards the federalized health system, we propose that the challenges inherent with the transition are critically analysed and mitigated while unfolding the potential of federal health system

A mixed-mode ginger and turmeric solar dryer: design, simulation, biochemical and performance analysis

Postharvest loss of vegetables and fruits is higher in developing countries due to the lack of post-processing equipment. Although the production of ginger and turmeric is high in Nepal, farmers practices open sun drying, which leads to poor quality, and the products do not get to the market at reasonable prices. In this study, a simple, easy to assemble and disassemble mixed-mode solar dryer has been designed, fabricated, and biochemical and performance analyses were done. The dryer was designed considering the solar irradiation, sunshine hours, latitude of the location, locally available materials, moisture content (MC) of the product, and drying capacity. The Computational Fluid Dynamics (CFD) analysis was performed using ANSYS Fluent simulation software to predict the dryer’s temperature and air flow behavior. The experiment was carried out in November in the harvesting season of ginger. The dryer performance is compared with the open sun drying using ginger and turmeric. The biochemical properties such as Oleoresin and Essential oil were determined using Soxhlet and Steam distillation methods and compared with the product of open sun drying. The experiment results showed that ginger and turmeric took only about 14 sunshine hours to reach from 88% to 10-12% moisture content. The maximum collector and drying efficiency were recorded at about 45.32% and 31.364%, respectively. The temperature distribution inside the dryer obtained from the experiment correlated with the results obtained from the CFD analysis. The retention of essential oil was found more in product drying with dryer than open sun drying. Among the various drying models, Wang and Singh model was found suitable for describing the drying model. It is concluded that the designed dryer is suitable for ginger and turmeric drying into a safe moisture level, ensuring product quality. BIBECHANA 19 (2021) 40-6

A mixed-mode ginger and turmeric solar dryer: design, simulation, biochemical and performance analysis

Postharvest loss of vegetables and fruits is higher in developing countries due to the lack of post-processing equipment. Although the production of ginger and turmeric is high in Nepal, farmers practices open sun drying, which leads to poor quality, and the products do not get to the market at reasonable prices. In this study, a simple, easy to assemble and disassemble mixed-mode solar dryer has been designed, fabricated, and biochemical and performance analyses were done. The dryer was designed considering the solar irradiation, sunshine hours, latitude of the location, locally available materials, moisture content (MC) of the product, and drying capacity. The Computational Fluid Dynamics (CFD) analysis was performed using ANSYS Fluent simulation software to predict the dryer’s temperature and air flow behavior. The experiment was carried out in November in the harvesting season of ginger. The dryer performance is compared with the open sun drying using ginger and turmeric. The biochemical properties such as Oleoresin and Essential oil were determined using Soxhlet and Steam distillation methods and compared with the product of open sun drying. The experiment results showed that ginger and turmeric took only about 14 sunshine hours to reach from 88% to 10-12% moisture content. The maximum collector and drying efficiency were recorded at about 45.32% and 31.364%, respectively. The temperature distribution inside the dryer obtained from the experiment correlated with the results obtained from the CFD analysis. The retention of essential oil was found more in product drying with dryer than open sun drying. Among the various drying models, Wang and Singh model was found suitable for describing the drying model. It is concluded that the designed dryer is suitable for ginger and turmeric drying into a safe moisture level, ensuring product quality. BIBECHANA 19 (2021) 40-6

Seepage and slope stability modelling of rainfall-induced slope failures in topographic hollows

This study focuses on topographic hollows, their flow direction and flow accumulation characteristics, and highlights discharge of hillslope seepage so as to understand porewater pressure development phenomena in relation with slope failure in topographic hollows. For this purpose, a small catchment in Niihama city of Shikoku Island in western Japan, with a record of seven slope failures triggered by typhoon-caused heavy rainfall on 19–20 October 2004, was selected. After extensive fieldwork and computation of hydro-mechanical parameters in unsaturated and saturated conditions through a series of laboratory experiments, seepage and slope stability modellings of these slope failures were done in GeoStudio environment using the precipitation data of 19–20 October 2004. The results of seepage modelling showed that the porewater pressure was rapid transient in silty sand, and the maximum porewater pressure measured in an area close to the base of topographic hollows was found to be higher with bigger topographic hollows. Furthermore, a threshold relationship between the topographic hollow area and maximum porewater pressure in this study indicates that a topographic hollow of 1000 sq. m area can develop maximum porewater pressure of 1.253 kPa. However, the porewater pressures required to initiate slope instability in the upper part of the topographic hollows is relatively smaller than those in the lower part of the topographic hollows

Ischemic Portal Venous Gas and Pneumatosis Intestinalis Managed Conservatively in a Patient with Rheumatic Heart Disease and Warfarin Induced Coagulopathy: A Case Report

Mesenteric ischemia is a surgical emergency. The presence of hepatic portal venous gas and pneumatosis intestinalis is a frequent finding in computed tomography. Not all hepatic portal venous gas and pneumatosis intestinalis are due to mesenteric ischemia. A 70-year-old female, with a known case of diabetes mellitus, rheumatic heart disease and atrial fibrillation under warfarin presented with diffuse abdominal pain, multiple episodes of vomiting and ecchymosis in bilateral flanks. Evaluation of the coagulation profile suggested warfarin-induced coagulopathy. Portal venous gas was detected during an ultrasound examination. Subsequent contrast-enhanced computed tomography abdomen showed hepatic portal venous gas, pneumatosis intestinalis, paucity of branches of the ileocolic artery, and reduced enhancement of caecum and ascending colon. Mild ascites were present in the pelvis. Arterial blood gas analysis revealed compensated metabolic acidosis. The patient was managed conservatively and discharged after nine days of hospital admission. Conservative approach can be considered for suspected mesenteric ischemia in surgically unfit candidates

Deterministic slope failure hazard assessment in a model catchment and its replication in neighbourhood terrain

In this work, we prepare and replicate a deterministic slope failure hazard model in small-scale catchments of tertiary sedimentary terrain of Niihama city in western Japan. It is generally difficult to replicate a deterministic model from one catchment to another due to lack of exactly similar geo-mechanical and hydrological parameters. To overcome this problem, discriminant function modelling was done with the deterministic slope failure hazard model and the DEM-based causal factors of slope failure, which yielded an empirical parametric relationship or a discriminant function equation. This parametric relationship was used to predict the slope failure hazard index in a total of 40 target catchments in the study area. From ROC plots, the prediction rate between 0.719–0.814 and 0.704–0.805 was obtained with inventories of September and October slope failures, respectively. This means September slope failures were better predicted than October slope failures by approximately 1%. The results show that the prediction of the slope failure hazard index is possible, even in a small catchment scale, in similar geophysical settings. Moreover, the replication of the deterministic model through discriminant function modelling was found to be successful in predicting typhoon rainfall-induced slope failures with moderate to good accuracy without any use of geo-mechanical and hydrological parameters

Groundwater potential zonation in the Siwalik of the Kankai River Basin, Eastern Nepal

For the globally degrading groundwater resources in terms of quantity and quality, proper assessment and management become crucial for their sustainable use. This study aims to delineate the groundwater potential zones using an integrated approach of geographic information system (GIS) and the Analytical Hierarchy Process (AHP) in the Siwalik of the Kankai River Basin, Eastern Nepal. Different thematic layers like hydrogeomorphology, land use/land cover, lithology, slope, topographic wetness index, drainage density, normalized difference vegetation index, lineament density, and aspect were prepared and processed with suitable weights on Saaty's scale. The delineated groundwater potential zones in the study area were categorized as low, moderate, and high. The results showed that approximately 49.38% (130.85 km2) of the total study area has a low potential for groundwater. The moderate zone includes approximately 35.5% (94.07 km2) and the high potential zone includes only 15.05% (39.88 km2) of the area. The potential map was validated with a 70.6% prediction rate using the spatial distribution of the springs in the area. The analysis shows that hydrogeomorphology, LULC, and lithology have a significant control on the occurrences of groundwater. The study signifies the scarcity of groundwater resources, which needs a better management plan and strategies for sustainable use. HIGHLIGHTS The study deals with the delineation of groundwater potential zones using geospatial analysis along the Siwalik of the Kankai River Basin.; The occurrence of groundwater along the Siwalik is mainly controlled by hydrogeomorphology, LULC, geology, and slope.; About 50% of the area lies on the low potential zone for groundwater occurrence.

Corona virus fear among health workers during the early phase of pandemic response in Nepal: A web-based cross-sectional study.

Health workers involved in the COVID-19 response might be at risk of developing fear and psychological distress. The study aimed to identify factors associated with COVID-19 fear among health workers in Nepal during the early phase of the pandemic. A web-based survey was conducted in April-May 2020 among 475 health workers directly involved in COVID-19 management. The Fear Scale of COVID 19 (FCV-19S) was used to measure the status of fear. Multivariable logistic regression was performed to identify factors associated with COVID fear. The presence of COVID-19 fear was moderately correlated with anxiety and depression, and weakly correlated with insomnia. Nurses, health workers experiencing stigma, working in affected district, and presence of family members with chronic diseases were significantly associated with higher odds of developing COVID-19 fear. Based on the study findings, it is recommended to improve the work environment to reduce fear among health workers, employ stigma reduction interventions, and ensure personal and family support for those having family members with chronic diseases

Correlation of solar wind velocity with different parameters during geomagnetic disturbances

We have studied the solar wind velocity and it’s relation with solar wind pressure, southward component of IMF-Bz, solar wind temperature (Tsw), solar wind density (Nsw) and geomagnetic indices during different geomagnetic disturbances. During disturbed days, there is a fluctuation of energy and plasma inside the magnetosphere, which changes the parameters like pressure, velocity, IMF-Bz, SYM-H and AE indices. The solar wind velocity shows very remarkable relationship with pressure. There is weak connection of solar wind pressure with IMF-Bz, although it is more geo-effective.BIBECHANA 16 (2019) 165-176</p

Dolutegravir‐induced acquired sideroblastic anemia in a HIV positive patient: A challenging hematologic complication

Key Clinical Message Dolutegravir, the most recent antiretroviral drug with high efficacy, good tolerability, infrequent drug–drug interactions, and a favorable safety profile has not been reported in current literature as a cause of acquired sideroblastic anemia. Here, we present a 35‐year‐old male patient who was diagnosed with acquired sideroblastic anemia to Dolutegravir therapy