Journal of Nepal Health Research Council
Journal of Nepal Health Research Council is published quarterly ( four times a year) and distributed by Nepal Health Research Council. The statements or opinions expressed in the Journal are the personal views of authors and do not represent the official views of JNHRC editorial board or Nepal Health Research Council.
RE: Serotype of Dengue Virus Causing Dengue Outbreak in Kathmandu
Copyright (c) 2026 Hinpetch Daungsupawong, Viroj Wiwanitkit https://creativecommons.org/licenses/by-nc/4.0
Ethical Issues in Establishing a Registry in Nepal: Experiences from the Population Based Cancer Registry
Copyright (c) 2026 Namita Ghimire, Dilip KC, Bishnu P. Marasini, Hari Dhakal, Pramod Joshi, Meghnath Dhimal, Aarati Shah https://creativecommons.org/licenses/by-nc/4.0
Screening and Management of Perinatal Depression in Nepal: The Need for Urgent Action
Perinatal depression is one of the most neglected public health concerns among reproductive-age women in resource-limited countries, such as Nepal. Currently, there is a lack of standardized protocols to screen and treat women for depression during pregnancy and the postpartum period in Nepal. Additionally, healthcare providers are often not adequately trained to identify and treat perinatal depression. This, coupled with the stigma related to mental health issues and a lack of community resources, can delay the identification and treatment of perinatal depression among women. The purpose of this paper is to highlight the need for routine screening and management guidelines for perinatal depression utilizing standardized and validated instruments and the establishment of community resources to enhance the outcomes of mothers and infants. Perinatal depression is the most common mental health issue among women of reproductive age. Collaborative efforts among healthcare workers and policymakers are essential to enhance maternal and child well-being. Fostering a comprehensive and culturally sensitive program Nepal can take a significant step toward reducing the burden of perinatal depression and improving the quality of life for women and their families. Routine screening for perinatal depression at different time points during pregnancy and postpartum for one year following childbirth as well as implementation of standardized screening and treatment guidelines to improve outcomes for women and their families. Keywords: Infants; perinatal depression; postpartum; pregnancy; screening.
Copyright (c) 2026 Sangita Pudasainee-Kapri, Mary Wunnenberg, Tumla Shrestha, Manisha Chapagai, Ram Hari Chapagain, Jeevan Gyawali https://creativecommons.org/licenses/by-nc/4.0
Perceptions of Undergraduate Medical Students Regarding Problem-Based Learning (PBL) at Kathmandu University : A Cross-sectional Study from Nepal
Background: Problem-based learning (PBL) is a student-centered innovative instructional approach in which students define their learning objectives using triggers from predefined problems in case scenarios. The PBL approach in medicine emphasizes real-world problem-solving and develops students’ capacity for clinical reasoning. It also contributes to the development of interpersonal and communication skills, promotes self-directed learning (SDL), improves the motivation and enthusiasm of students for their profession and maintains professional ethics and behavior. This study aims to explore the perceptions of undergraduate medical students in a medical college in Nepal toward the PBL tutorial incorporated into the curriculum of Kathmandu University (KU). Methods: A mixed-methods cross-sectional study was conducted at the Nepal Manipal College of Medical Sciences, Pokhara, Nepal. Qualitative data were gathered through face-to-face semi structured interviews with 12 preclinical undergraduate medical students (six from first and six from second year) selected via convenience sampling. Quantitative data were collected through an online survey of 200 first- and second-year students. Thematic analysis was used for qualitative data whereas Statistical Package for Social Sciences (SPSS) version 20 for quantitative data. Results: Three themes were identified via thematic analysis: effective learning, the role of tutors, and learning resources. There were 120 students who responded to the online survey with a response rate of 60%. Male students comprised 53.3% of the respondents. Most students agreed that PBL sessions enhanced collaborative learning (n=93, 77.5%) and decision-making skills (n=80, 66.7%). Conclusions: Students reported that PBL enhanced their clinical reasoning skills, interpersonal communication skills, decision-making skills and promoted SDL. The findings also highlighted the need for updated case scenarios and proper tutor training, which are essential for successful PBL sessions. Keywords: Communication skills; collaborative learning; problem-based learning; self-directed learning; medical education.
Copyright (c) 2026 Sushma Thapa, Alok Atreya, Roshani Rajbanshi, Inesh Khanal, Laxman Gnawali https://creativecommons.org/licenses/by-nc/4.0
Transforming the Nepal Health Research Council for Health Research and Innovation
Copyright (c) 2026 Meghnath Dhimal, Namita Ghimire, Madhusudan Subedi, Ganesh Dangal https://creativecommons.org/licenses/by-nc/4.0
Prevalence and Determinants of Anemia among Adolescent Girls in Rural Nepal
Background: Adolescence is a period of rapid growth and increased nutritional requirements, making girls in low- and middle-income countries, such as Nepal, vulnerable to iron deficiency anemia. In rural areas of Nepal, menstrual blood loss, poor diet, and socio-cultural barriers all increase this risk. Despite national programs, anemia remains a major public health concern, affecting cognition, immunity, and future reproductive health. This study assessed the prevalence and determinants of nutritional status, including anemia, in adolescent girls. Methods: A cross-sectional school-based study was conducted from July to August 2024, with 501 adolescent girls aged 10 to 19 years, using a census method in Annapurna Rural Municipality, Kaski, Nepal. Data were collected using face-to-face interviews, anthropometric assessments, and blood tests. BMI-for-age z-scores (BAZ) were computed using WHO Anthro-Plus, and anemia was categorized based on laboratory-established ferritin guidelines. Data were analysed using descriptive statistics, the ????2 test, and logistic regression (p < 0.05). Results: Considering ferritin (< 40.7 ng/mL) and hemoglobin (?12 g/dL), the prevalence of anemia was found to be 67.6% and (?12 g/dL), respectively. Maternal education, family type, and parental marital status were found to be significantly associated with anemia (p<0.05). Similarly, ethnicity, maternal education, and family type were found statistically associated with nutritional status (p <0.05). Conclusions: The study highlighted a concerning magnitude of anemia among adolescent girls in rural Nepal, with two-thirds being anaemic. The findings underscore that nutritional deficiencies are not merely biological issues but are deeply rooted in social and educational determinants such as maternal education, family structure, and ethnicity. Addressing this challenge requires a comprehensive approach such as strengthening nutrition education, promoting iron-rich diets, ensuring regular screening, and enhancing maternal awareness through community and school-based programs to effectively reduce anemia and improve adolescent health outcomes. Keywords: Adolescent girls; adolescent health; anemia; obesity; overweight.
Copyright (c) 2026 Tulsi Ram Bhandari; Nawaraj Chapagain; Shishir Paudel, Amar Nagila, Sushil Panta, Jenny Ojha, Yoko Oda Thapa, Hiroko Sakai https://creativecommons.org/licenses/by-nc/4.0
Emotional Intelligence among Undergraduate Physiotherapy Students at Kathmandu University School of Medical Sciences: A Cross-Sectional Study
Background: Emotional intelligence (EI) is the ability to use emotional awareness to guide thoughts and actions. In students, particularly in medicine and physiotherapy, higher EI enhances academic performance, self-awareness, social connectedness, and the ability to form meaningful patient relationships. Higher EI in healthcare professionals is associated with better clinical performance, empathetic patient care, and greater job satisfaction. This study aimed to determine EI in undergraduate physiotherapy students and identify its association with academic performance and year of study. Methods: A cross-sectional study was conducted at Kathmandu University School of Medical Sciences among undergraduate physiotherapy students. EI was measured using the Schutte Self Report Emotional Intelligence Test. EI scores were categorized as low (33-110), average (111-137), and high (138-165). The Pearson test was used to assess the correlation between EI scores and academic performance, while ANOVA was used to assess the association between EI scores and year of study. Results: A total of 102 students were included, of which 86% were female. The mean EI score was 125.63 indicating average status. The majority of students (80%) demonstrated average EI, while 15% had high EI, and 5% had low EI. There was no statistically significant relationship of EI with year of study and academic performance. Conclusions: The findings revealed that most students demonstrated an average level of EI, suggesting that they were reasonably competent in recognizing their own and others’ emotions, regulating their emotions, and engaging positively with others. Exploring various factors influencing students’ EI presents a promising avenue for future research. Keywords: Cross-sectional study; emotional intelligence; medical education; physical therapy.
Copyright (c) 2026 Deepak Joshi, Smriti Dhakal, Bipin Ghimire https://creativecommons.org/licenses/by-nc/4.0
Modified Shanfield Ureteric Reimplantation with or Without Ureteric Tailoring in Primary Obstructive Megaureter
Background: Obstructive megaureter is one of the leading cause of renal failure. If not resolve on time, surgical correction is necessary. Excision of stricture part and ureteric reimplantation is procedure of choice. Modified shanfield technique is one of the surgical procedures for ureteric reimplantation with good outcome. Those with huge megaureter, excisional tapering of distal ureter to facilitate ureteric reimplantation is mandatory. The objective of this study was to evaluate and assess the outcome of modified shanfield procedure in children with obstructive megaureter. Methods: A retrospective review of all patients with obstructive megaureter who underwent modified shanfield ureteric reimplantation with or without ureteric tailoring between April 2022 to March 2024 was done. The following were recorded for each patient: age, sex, laterality, ureteral diameter, operative time, hospital stay, outcome and complications. Results: This study consisted of 16 paediatric patients (6 boys and 10 girls) who underwent modified shanfield ureteric reimplantation with or without ureteric tailoring with a mean age of 47 months(12 months to 132 months). Left side repair was performed in 10 patients (62.5%). Mean operative time was 118 minutes. The mean length of hospital was 6.65 days (5- 9 days). None of the patients developed major complications including vesicoureteric reflux or stricture but three cases had febrile urinary tract infection. Follow up ultrasound and Di-ethylene triamine-penta-acetic acid (DTPA) scan was obtained after 6 months postoperatively, which showed improved renal function in DTPA in 14 patients (93.4%). Conclusions: Modified shanfield ureteric reimplantation is also an alternative procedure for ureteric reimplantation because of its easiness, quick and good outcome. Its implication in paediatric age group is also safe. For better outcome, patient selection and refinement technique should be pursued. Keywords: Modified shanfield; obstructed megaureter; ureteral tailoring; ureteric reimplantation.
Copyright (c) 2026 Suman Bikram Adhikari, Surendra Bikram Adhikari, Mridul Prasad Joshi, Bal Mukunda Basnet, Priyanka Sah, Amar Rupakheti, Kajal Singh Yadav, Susan Upreti, Bipin Nepal https://creativecommons.org/licenses/by-nc/4.0
Effect of Sleep on Cardiorespiratory Fitness of Apparently Healthy Young Adults
Background: Sleep dysfunction affects overall health of a person. Exact effect of sleep on cardiorespiratory fitness is less researched area. This study aimed to explore the effect of sleep on cardiorespiratory fitness by examining the difference in VO2 max between normal and poor sleep categories and examine the correlation between PSQI score with VO2 max of young medical students. Methods: A cross-sectional analytical study was conducted in Clinical Physiology Department, Maharajgunj Medical Campus from March 2023 to September 2024. Participants were categorised into normal and poor sleep categories on the basis of PSQI scores. Participants from both groups performed Queen’s college step test. Heart rate was monitored post exercise to calculate VO2 max. Independent samples t-test was used to compare the VO2 max between the categories. Pearson’s correlation test was used to examine correlation of PSQI score with VO2 max. Results: A total of 64 participants enrolled in the study out of which 45 were males and 19 were females. Mean PSQI score in male participants was 5.53 ± 2.76 and in female participants was 5.52 ± 3.44. The mean VO2 max in normal sleep category was 42.50 ± 8.61 mL/kg/min and mean VO2 max in poor sleep category was 41.89 ± 7.97 mL/kg/min. There was no significant difference in VO2 max between the two groups (p=0.77). Also, no correlation was found between PSQI score and VO2 max (r=0.029, p=0.591). Conclusions: Significant impact of sleep quality on cardiorespiratory fitness assessed by VO2 max could not be established in apparently healthy young adults. Keywords: Cardiorespiratory fitness; Nepal; queen’s college step test; sleep; VO2 max.
Copyright (c) 2026 Sabita Kandel, Narayan B Mahotra, Lava Shrestha, Mahesh Man Bajimaya, Vibina Aryal https://creativecommons.org/licenses/by-nc/4.0
Alcohol Drinking Behaviours among Bus Drivers and Staffs of Banke District, Nepal
Background: Alcohol consumption is a significant public health concern worldwide, contributing substantially to disease burden and fatalities, especially among drivers. In Nepal, alcohol use is culturally accepted and widely prevalent, with evidence suggesting high consumption rates among bus drivers. This study aims to investigate alcohol consumption and drinking behaviours among bus drivers and staff’s in the Banke district of Nepal. Methods: A cross-sectional survey was conducted among 195 drivers and staff of public passenger vehicles categorized as “Kha” in Banke district, Nepal. Systematic sampling was employed to select participants. Data were collected using a semi-structured questionnaire adapted from the Nepal STEPS Survey 2019. Results: The study found that 64.6% of participants had ever consumed alcohol, with drivers reporting a higher prevalence (74.4%) compared to other staff (56.9%). Peer pressure (56.9%) was the most common reason for drinking, followed by family influence (20.8%) and curiosity (18.6%). A significant association was found between alcohol consumption and occupation (p = 0.0177), with drivers more likely to consume alcohol. No significant associations were found with age, marital status, education, or ethnicity. Conclusions: The findings highlight the high prevalence of alcohol consumption among public vehicle operators, driven by peer pressure and influence from family members. The study emphasizes the critical need for public health interventions to prevent alcohol-related harm in Nepal, such as educational campaigns, stricter enforcement of drunken driving laws, and workplace-based activities. Keywords: Alcohol consumption; Nepal; occupational group; transportation.
Copyright (c) 2026 Raymond B C, Sushhama Neupane, Reeone Khadka, Narayan Bhatta, Samir Bhatta, Chetan Bhatta https://creativecommons.org/licenses/by-nc/4.0
Maternal Health Outcomes in Nepalese Women After Mitral Valve Replacement
Background: The effects of anticoagulation on maternal health in patients with prosthetic valves remain understudied. Our study aims to assess maternal health post-mitral valve replacement (MVR), pregnancy-related complications, maternal mortality, coagulation issues, and fetal and neonatal outcomes post-MVR. Methods: This exploratory retrospective study, conducted from 2017-2020, included female patients of reproductive age who underwent MVR. Eligible participants were identified from hospital records, and pregnancy-related maternal outcomes were ascertained through review of medical records and a single cross-sectional telephone follow-up conducted between June and August 2023. Data on childbirth, abortion, anticoagulation management, and related complications were collected. Descriptive statistics were used for analysis. Results: Of 474 female patients of childbearing age who underwent MVR, 380 responded to our survey. Of these, 18 cases (4.73%) involved pregnancy post-MVR. All pregnant patients were on anticoagulant therapy during pregnancy, with no maternal deaths reported. However, one patient experienced heart failure post-delivery. Bleeding was the most common complication, occurring in 5/18 pregnancies (27.7%). Seven pregnancies resulted in live births (38.8%), with one low birth weight infant. There were no congenital anomalies, but there was one intrauterine fetal death at 7 months and 2 spontaneous abortions. Seven pregnancies were electively terminated, though the reasons were not studied. One pregnancy was ongoing at the time of the study. All but one delivery occurred under medical supervision, with most patients following a warfarin-to-heparin regimen. Conclusions: In this cohort, 4.73% of women experienced pregnancies post-MVR, with anticoagulation posing significant challenges. The low rate of maternal and fetal complications suggests a need for further research, particularly regarding the high rate of elective terminations. Keywords: Maternal health; Nepalese women; outcomes.
Copyright (c) 2026 Dikshya Joshi, Anushruti Shrestha, Smriti Bajracharya, Apurb Sharma https://creativecommons.org/licenses/by-nc/4.0
Evaluation of Access and Coverage of Integrated Management of Acute Malnutrition Program
Background: Wasting remains a critical public health concern in Nepal, with many children unable to access timely treatment despite national efforts. Evidence on program coverage is lacking in Syangja district. The objective of this study is to identify the underlying factors supporting and hindering the program and to estimate its coverage. Methods: The Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) approach was implemented in three stages using a mixed-method design. Stage I involved qualitative data collection through key informant interviews (KII), Focus Group Discussions (FGD), and direct observations (DO) in seventeen different locations. Stage II tested a hypothesis about proximity and coverage via small-area surveys using active and door-to-door case finding. Due to inconclusive results, Stage III was not executed. Quantitative data from DHIS-2 and IMAM registers were analyzed for trends and performance indicators, while qualitative data were thematically analyzed and triangulated across participants, types and methods. A Barriers, Boosters, and Questions (BBQ) scoring exercise informed prior coverage estimation. Results: Twelve boosters and twenty-five barriers affecting program access and coverage were identified. Boosters included strong family support, motivated frontline workers, and local government initiatives. Barriers involved stigma, logistical challenges, inconsistent protocol adherence, limited training, and stockouts. The estimated prior coverage was 34.3%. Hypothesis testing on distance-related coverage was inconclusive, halting progression to a wide-area survey. Additional qualitative investigation confirmed gaps in health worker capacity, community engagement, and IMAM protocol compliance. Conclusions: The IMAM program in Syangja district faces systemic and community-level challenges. To improve coverage, targeted interventions are needed to strengthen service delivery, enhance staff capacity, ensure supply availability, and increase community awareness and engagement. Keywords: Access; barriers; boosters; coverage.
Copyright (c) 2026 Sujay Nepali, Roshna Maharjan, Ashish Timalsina, Melkamnesh Alemu Nigussie, Phulgendra Prasad Singh; Manisha Katwal https://creativecommons.org/licenses/by-nc/4.0
Association Between Minimum Service Standards and Patient Satisfaction in Outpatient Departments of Nepal’s Government Hospitals
Background: Nepal’s Minimum Service Standards (MSS) tool assesses structural readiness of government hospitals but its relationship to patient satisfaction is unknown. We evaluated how well MSS scores correspond to outpatient satisfaction and patient reported gaps in the quality of services. Methods: A cross-sectional mixed-methods study utilized 839 patient satisfaction surveys conducted from July 2021 to May 2024 across 57 government hospitals, then linked responses to retrospective hospital-level MSS scores. Overall satisfaction was modeled with an ordinal mixed-effects logistic regression with hospital-level random intercepts. For qualitative insights, six hospitals were purposely sampled for six focus group discussions with OPD staff and six interviews with hospital leaders. Transcripts underwent thematic content analysis, and quantitative and qualitative findings were triangulated. Results: Each 1% rise in OPD MSS score increased satisfaction odds by 3% (OR?1.03, 95?%?CI?1.02–1.05; p?<?0.001), with variable effects below a 50?% MSS threshold. Key gaps in privacy, human resources, and patient counseling were identified across hospitals, regardless of their MSS score, highlighting areas where the MSS tool does not fully correlate to patient experience. Less frequently reported problems (privacy, staff behaviour, and counselling) had the greatest effect on patient satisfaction, whereas more frequently cited problems (cleanliness, waiting times, cost, and medicine availability) had smaller effects. Qualitative findings revealed that hospitals with higher MSS scores had better management systems, stronger leadership, and improved team support, contributing to a more conducive working environment. Conclusions: The MSS tool effectively reflects readiness in tangible aspects like cleanliness and equipment but fails to reflect gaps in privacy, human resources, and medicine availability. Addressing these misalignments is crucial to ensure that the MSS tool effectively addresses quality of care. Keywords: MSS, OPD, patient satisfaction, quality, readiness.
Copyright (c) 2026 Janardan Pathak; Abigail Knoble, Md Kashim Shah, Rabindra Bhandari, Archana Amatya, Ruma Rajbhandari https://creativecommons.org/licenses/by-nc/4.0
Screening for Postpartum Depression using Edinburg Postnatal Depression Scale
Background: Postpartum depression (PPD) is a non-psychotic depressive episode within one year post-delivery. If left untreated PPD can lead to chronic depression, neglect, substance abuse, or suicidal ideation. It is common and often undiagnosed complication of childbirth because routine screening is not standard during postnatal care. The Edinburgh Postnatal Depression Scale (EPDS) is a widely used screening tool recommended for early detection. This study assesses the prevalence of PPD and its association with socio-demographic, obstetric, perinatal, and psychiatric factors. Methods: A cross-sectional study was conducted at KIST Medical College and Teaching Hospital after ethical approval. A total of 167 postpartum women (6–10 weeks post-delivery) were recruited via simple random sampling. Data were collected through structured interviews from June to November 2022 using a Nepali-translated EPDS (PPD cutoff: ?13). Statistical analysis was performed using SPSS, with chi-square tests (p<0.05). Results: PPD prevalence was 17.4% (29/167). Significant associations were found with mode of delivery (p=0.031), neonatal ICU admission (p=0.021), past psychiatric history (p=0.000), and family psychiatric history (p=0.000). No significant associations were noted for age, education, employment, parity, or maternal complications. The odds ratio of PPD were 2.8 times higher in mothers who had their newborn admitted to neonatal ICU- and 14.8 times higher in those with a psychiatric history in family. Conclusions: PPD remains a significant concern despite a lower prevalence than regional studies. Routine EPDS screening should be integrated into postpartum care for early detection. Keywords: Depression; edinburg postnatal depression scale; postpartum; pregnancy; screening.
Copyright (c) 2026 Bibechan Thapa, Neena Rai, Prakriti Lamichhane, Subash Pandey, Anuja Acharya, Smrity Maskey, Meenu Maharjan, Aakriti Pandey, Prajwal Pudasaini, Reena Yadav https://creativecommons.org/licenses/by-nc/4.0
Clinico-epidemiological Profile of Facial Dermatoses among Adolescents
Background: The face is an important component of individual identity and undesirable changes in facial skin affect the quality of life of individuals, particularly adolescents (10–19 years). They often experience issues like acne vulgaris due to hormonal changes and the consequent psychosocial impact is higher. In Nepal, adolescents represent 23.6% of the population. This study investigates the prevalence and types of facial dermatoses among Nepalese adolescents attending a tertiary care center. Methods: A cross-sectional study was conducted among 290 adolescents with facial dermatoses presenting to Nepal Medical College Teaching Hospital from October 2023 to September 2024. Data was collected using a structured proforma and clinical examinations, with additional tests as required. Statistical analysis was performed using SPSS version 16. Results: Of the 290 participants, 48.62% were male and 51.38% female, predominantly aged 17–19 years (36.55%). The majority (66.90%) were Hindu. The most common facial dermatoses were appendageal disorders (43.07%), infections and infestations (20.34%), and eczemas (16.55%). In appendageal disorders, acne vulgaris was most common representing 42.07% of all facial dermatosis. In infections, viral infection was the most common (11.72%) of all facial dermatosis and pityriasis alba was most common (7.59%) of eczemas seen, Males had higher rates of infections (67.80%), while eczemas were more common in females (58.33%). No significant association was found between gender and acne status (p=0.1), severity (p=0.19), bacterial infection (p-value= 0.502), fungal infection (p- value= 1), viral infection (p= 0.85), eczema (p= 0.449), pigmentary disorder (p= 0.071), vascular lesions (p= 1.2) and nevus (p= 0.069). Conclusions: Facial skin disorders, particularly acne vulgaris, are prevalent among Nepalese adolescents and affect their well-being. The findings accentuate the importance of addressing these conditions to reduce their psychological and social impacts. Further research is needed to explore facial dermatoses across different regions of Nepal. Keywords: Acne; adolescent; facial dermatosis.
Copyright (c) 2026 Arnija Rana; Mohan Bhusal, Rit Shrestha , Deeptara Pathak Thapa, Shristi Shrestha, Amit Kumar Shah, Smriti Piya https://creativecommons.org/licenses/by-nc/4.0
Upper Limb Injuries in Children Presenting to a Tertiary Care Center in Rural Nepal
Background: Upper limb injuries are one of the common pediatric conditions presenting to our orthopedic department. The aim of this study is to identify the cause pattern and demographic characteristics of upper limb injuries in children so that various preventive strategies can be encouraged to reduce their morbidity. Methods: A descriptive cross-sectional study was conducted at Karnali Academy of Health Sciences after ethical permission from October 2022 to March 2024. An enumerative sampling technique was used. Age, sex, address, side, upper limb anatomical location, time of hospital presentation, mode of injury, seasonal trend, prehospital management and other associated injuries were noted in individual structured proforma. All the data were entered in MS EXCEL and analyzed using version 16 of the Statistical Package for Social Sciences. Results: A total of 437 children were involved in this study. Distal humerus fracture was seen in 149 (28%) patients, whereas distal radius fracture was observed in 131 (24.4 %) patients. Injury was common in children 6-9 years of age (27.5%). There were 313 (71.6%) boys and 124 (28.3%) girls. Delay of > 72 hours in presentation to hospital was noted in 88 (20%) patients. Out of 437 children, 76 (17%) received prehospital management. Conclusions: Upper limb injuries were prevalent around elbow and wrist joint. Injuries were common in boys and predominant in 6-9 years of age. Fall from cliff, tree, rooftop and ladder were the major mode of injury in our rural context. Keywords: Children; injuries; rural; upper limb.
Copyright (c) 2026 Poojan K Rokaya; Suresh Dulal, Tufan Singh Kathayat, Manoj Rajbanshi, Mangal Rawal, Pawan Marasini; Arun Upreti https://creativecommons.org/licenses/by-nc/4.0
Knowledge and Attitude on Ethical Conduct of Clinical Research Among Nurses Working in the University Hospital of Nepal
Background: Nurses are pivotal in primary healthcare and often serve as the first point of patient contact. Delivering evidence-based care is essential for ensuring high-quality services. Clinical research in hospital settings provides the evidence base that supports such care. This study aimed to assess nurses’ knowledge of clinical research ethics and their attitudes toward conducting research at a university hospital. Methods: A pretested semi-structured questionnaire, developed from literature and expert input, was used to collect data on demographics, research knowledge, and attitudes toward ethical conduct of clinical research among 279 nurses at the University Hospital. Ethical approval was obtained from the Institutional Review Committee, and data were analyzed using descriptive and inferential statistics (t-test and ANOVA) in SPSS version 26. Results: Most respondents were aged 26–30 years, held bachelor’s degrees, and lacked formal research training, though over half had prior research experience. Knowledge of clinical research, particularly ethics and trial procedures, was high, and attitudes were largely positive. Misconceptions persisted regarding vulnerable populations, the use of placebos, and blinding. Knowledge and attitude scores were significantly associated with education and research experience, while nearly all nurses acknowledged the necessity of clinical trials (98.9%) and ethical guidelines (93.5%). Conclusions: Nurses demonstrated strong knowledge of research ethics and positive attitudes toward clinical research, though gaps in specific ethical concepts highlight the need for enhanced formal training to strengthen their confidence and readiness for ethical research engagement. Keywords: Attitude; clinical research; ethics; knowledge; Nepal; nurses.
Copyright (c) 2026 Shreejana Singh , Deepak Raj Joshi, Ajanta Maharjan, Pratima Khatri, Bhibhooti Shahi , Manisha Chapagai , Bimala Parajuli, Mohan Raj Sharma https://creativecommons.org/licenses/by-nc/4.0
Prevalence and Associated Factors of Menopausal Symptoms Among Women
Background: Menopause is the transitional change in women from the reproductive to non-reproductive stage, a phenomenon unique to women. A variety of symptoms are present as part of this transition, brought by changes in female reproductive hormones, estrogen and progesterone. These symptoms include a range of physical symptoms of hot flushes, night sweats, irregular menstruation to depression, and insomnia. This study aimed to find out the menopausal symptoms and its associated factors among women in Dhorpatan Municipality, Baglung, Nepal. Methods: A cross-sectional study was conducted among menopausal women of three wards of Dhorpatan Municipality between the months of Chaitra and Bhadra, after approval from the Institutional Review Committee. A simple random sampling was used. This study involves 266 women who are willing to participate in the study and have given written consent. Results: Among the 266 respondents, 52.3% were aware of their symptoms. Among those with menopausal symptoms, 25.9% experience hot flashes, 74.1% have sweating, 29.5% report vaginal dryness, 38.1% mention heart discomfort, 37.4% face anxiety, and 19.4% deal with depressive mood during menopause. Education, marital status, number of children, regular physical exercise, and utilization of health services were the factors that were significantly associated with menopausal symptoms. Conclusions: About half of the respondents experienced menopausal symptoms, with most common being sweating, heart discomfort, anxiety, vaginal dryness, hot flashes and depression. Education, physical activity, and use of health services were linked to these symptoms. Local authorities should organize regular health camps, and women should be encouraged to discuss their issues. Keywords: factors; menopause; menopausal symptoms; Nepal; prevalence.
Copyright (c) 2026 Dilip KC; Jeevan Gyawali; Rama Paudel, Bhim Chauhan, Agnimshwor Dahal, Astha Thapa, Jay Bhushan Jha https://creativecommons.org/licenses/by-nc/4.0
Effectiveness of Intranasal Dexmedetomidine for Sedation in Children
Background: Preoperative sedation in children is necessary as it is a common source of distress, potentially leading to difficult induction. Intranasal dexmedetomidine bypasses hepatic metabolism and has good availability. It is non invasive, easy with minimal respiratory depression. This study aimed to observe safety, efficacy, sedation level and parental separation score following a fixed dose of 1.5 mcg/kg Methods: A cross sectional study design was conducted among 43 children posted for elective surgeries. After informed consent and assent were obtained, intranasal DEX 1.5mcg/kg was administered. Satisfactory sedation was defined as a Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) score of ? 3, and satisfactory parental separation as a score of ? 2 on a 4-point scale. Physiological parameters (HR, RR, SPO2 were monitored for 30 minutes. Statistical analysis involved the use of SAS version 9.4. Results: Satisfactory sedation ? 3 was achieved in 93.0% of subjects by 30 minutes (95% CI: 80.9%–98.5%). Similarly, satisfactory parent-child separation ? 2 score was achieved in 93.0% of subjects. Mean heart rate progressively decreased from 107.12±14.20 at baseline to 85.47 ± 7.29 beats per minute at 30 minutes, which was well tolerated. Conclusions: Intranasal DEX at a dose of 1.5 mcg/kg is safe and effective premedication for paediatric patients, which results in successful sedation with tolerated changes in vitals. Keywords: Dexmedetomidine; intranasal; paediatric; premedication; sedation.
Copyright (c) 2026 Mona Sharma, Swagat Gongal, Bijesh Yadav, Ashish lal Shrestha, Saurya Dhungel https://creativecommons.org/licenses/by-nc/4.0
Patterns, Indications, and Outcomes of Genetic Testing Among Pediatric Patients
Background: Genetic disorders contribute substantially to childhood morbidity, yet access to genetic testing in Nepal is limited by cost, availability, and a shortage of expertise. Evidence on testing practices and outcomes is scarce. This study aimed to describe the patterns, clinical indications, and outcomes of genetic testing among pediatric patients in a tertiary care hospital in Nepal. Methods: This retrospective study was conducted at the Department of Pediatrics, Tribhuvan University Teaching Hospital from February 2024 to July 2025. We included all patients from birth to 18 years who underwent genetic testing for diagnostic purpose along with parents or siblings tested for segregation analysis. Data including the genetic reports were extracted from the investigator records and analyzed using SPSS. Results: A total of 194 cases were included. Median age was three years (IQR 6.25) with males comprising 60.3%. Consanguinity was reported in 2.1%. Whole exome sequencing (WES) was the most commonly performed test (43.8%), followed by single-gene testing (20.1%) and karyotyping (15.9%). Neurodevelopmental disorders (18.0%) and congenital anomalies (15.0%) were the most frequent clinical indications. Overall diagnostic yield was 53.8%. Pathogenic or likely pathogenic variants were identified in 53.47% of WES/CES cases, while 31.7% yielded variants of uncertain significance. Down syndrome (7.7%), Duchenne muscular dystrophy (5.1%), and Lysosomal storage disorders (3.6%) were the most common diagnoses. Conclusions: WES emerged as the most effective diagnostic tool in this cohort. Over half of cases achieved a genetic diagnosis, with neurodevelopmental disorders and congenital anomalies as the leading indications. A range of genetic disorders was identified, with Down syndrome and Duchenne muscular dystrophy being more prevalent. Keywords: Diagnostic yield; genetic testing, Nepal; pediatrics; whole exome sequencing.
Copyright (c) 2026 Surabhi Aryal, Luna Bajracharya, Daman Raj Poudel, Surya Bahadur Thapa https://creativecommons.org/licenses/by-nc/4.0
Human Papillomavirus (HPV) Proportion and Genotype Distribution among Reproductive age Women of a Hilly District of Nepal
Background: Human papillomavirus (HPV) is a leading cause of cervical cancer, particularly in low- and middle-income countries (LMICs) with limited access to preventive services. This study was aimed to assess high-risk HPV prevalence and genotype distribution among reproductive-age women in Palpa district of Nepal and compare them with demographic and clinical data. Methods: A small, community based, non-probability convenience sampling approach was used for data collection in which cervical swabs were collected from 2,331 women aged 20 to 45 years from Rampur and Rambha municipalities of Palpa district, who attended the health camps organized from 7th February 2025 to 7th October 2025, after obtaining ethical approval from the Nepal Health Research Council (NHRC), Nepal. Out of 2,331 cervical swab samples, 2,024 swab samples were only processed due to pre-analytical errors for HPV DNA detection using the Nucleic Acid Extraction Kit and genotypes identified through RT-PCR using the Human Papillomavirus Nucleic Acid Amplification Test Kit. Results: HPV positivity among participants were found to be 3.5%. Other HPV genotype (non 16/18) were most frequently observed among HPV positive participant 35(49.3%), followed by HPV 16 genotype (29.5%) and HPV 18 (16.9%). The women between 35–40 years age group had the highest proportion of HPV positive cases (36 cases). The logistic regression between HPV infection and the presence of cervical lesions yielded an odds ratio of 2.999, indicating that women with cervical lesions were nearly three times more likely to have HPV infection than those without lesions. Conclusions: The study showed low HPV positive proportion rate, with non-16/18 genotypes predominating. Women aged 35–40 years had the highest HPV positivity, and HPV infection was found to be more common among women with cervical lesions. Keywords: Cervical swabs; genotypes; High risk- HPV; real time PCR.
Copyright (c) 2026 Rajesh Kumar Gupta; Kopila Shrestha, Bhawna Bhandari, Binod Manandhar, Krishna Das Manandhar https://creativecommons.org/licenses/by-nc/4.0
Disrespect and Abuse During Childbirth and Its Determinants among Women Delivering in Healthcare Facilities
Background: Providing respectful maternity care can enhance the maternal and child health outcomes by fostering the trust and positive relationships between healthcare providers and mothers. The objective of this study was to assess the status of disrespect and abuse during childbirth and its determinants among women delivering in healthcare facilities and its determinants in Pokhara, Nepal. Methods: A community-based cross-sectional study was conducted among 290 women in Pokhara Metropolitan, Nepal. Respondents were enrolled using a simple random sampling approach. A semi-structured questionnaire was developed based on Bowser and Hill’s seven domains of disrespect and abuse during childbirth. Data were analyzed using descriptive and inferential statistics. Results: Among the respondents, 69.0% delivered in government hospitals. Complications for the baby during labor were reported by 5.2% of women. 62.4% of the respondents reported that they experienced at least one form of disrespect and abuse during childbirth at the hospital. Among women who experienced disrespect and abuse, the most prevalent category was non-consented care (49.7%), followed by physical abuse (35.2%). No variables were significantly associated with disrespect and abuse during childbirth in the bivariate and multivariate analyses. Conclusions: The status of disrespect and abuse during childbirth was high. These findings highlight the need for systemic improvements within maternity care services, including strengthened provider accountability and promotion of respectful maternity care practices across all health facilities. Keywords: Disrespect and abuse; maternal health; Nepal; respectful maternity care.
Copyright (c) 2026 Pooja Bhandari Subedi, Sagar Parajuli, Kusumsheela Bhatta, Sabina Lamichhane, Sunita Sharma, Sharada Paudel https://creativecommons.org/licenses/by-nc/4.0
Prevalence of Pulmonary Tuberculosis in HIV-Infected Individuals
Background: Tuberculosis (TB) is a significant cause of mortality among people living with HIV (PLWH), in Nepal. HIV increases the risk of progression from latent to active TB, increasing mortality. Despite established TB control programs, there is a significant lack of recent data measuring the tuberculosis burden among PLWH specially within the Western region of Nepal. This study was conducted to assess the prevalence of pulmonary tuberculosis among HIV-positive patients attending a tertiary care centre in Gandaki Province, Nepal. Methods: A hospital-based cross-sectional study was conducted at Western Regional Hospital, Pokhara Academy of Health Sciences, from August 2025 to January 2026. First, HIV-positive patients attending the ART clinic were screened, and those aged ?18 years without prior tuberculosis were included. Next, participants were recruited using convenience sampling. After obtaining informed consent, sociodemographic and clinical data were collected through a structured questionnaire and medical record review. Subsequently, CD4 counts were measured using the PIMA CD4 analyser, and sputum samples were examined using Ziehl–Neelsen staining for acid-fast bacilli. Finally, data were analysed using SPSS version 22, with p < 0.05 considered statistically significant. Results: Prevalence of pulmonary TB was found to be 5.1% among 137 participants. TB co-infection was found to be higher among males and in the 20-29 years and >70 years age groups. TB was more common among those with CD4 counts <200 cells/µL, but was not statistically significant. Conclusions: The study found a 5.1% prevalence of pulmonary TB among PLWH in western Nepal and highlights the need for regular TB screening. Keywords: CD4 count; pulmonary tuberculosis Nepal; TB–HIV co-infection.
Copyright (c) 2026 Shisir Pokhrel; Sanjib Mani Regmi; Kripa Ghimire, Samjhana Paudel; Aarjawee Paudel, Sanjog Timilsina, Nirmala Shrestha, Amrita Paudel, Bedana Pokhrel, Damodar Sharma, Bidhya Koirala, Sudip Bhattarai, Pratikshya Joshi, Roshan Bhatta https://creativecommons.org/licenses/by-nc/4.0
The Trends and Determinants of Continuity in the Government Health Insurance Program
Background: Nepal Government Health Insurance enrollment has increased, and sustaining continuous coverage remains difficult. Health insurance continuity is changed by social, household, and service-related factors. This study assessed trends in continuity among insured households in Gandaki Province and the associated factors. Methods: A cross-sectional survey was conducted among 411 insured individuals. Data was collected using a structured questionnaire. Participants’ characteristics and continuity patterns were summarized using descriptive statistics. Determinants of continuity in health insurance program were investigated through bivariate and multivariate logistic regression analyses. Results: The mean age of respondents was 46.4 years; most were Hindu and over half had a bachelor’s degree or higher. While 92.5% intended to renew their insurance annually, only 16.3% discontinuous enrollment. Discontinuation was primarily due to poor service quality, low perceived need, and limited awareness. Continuity of enrollment was significantly associated with ethnicity (AOR 3.63), source of drinking water (AOR 0.32), female involvement in household health decision-making (AOR 3.63), and use of private health facilities (AOR 0.12). No independent predictors of discontinuation were identified after adjustment. Conclusion: The study identified a notable gap between high intentions to renew health insurance and actual continuity of enrollment in Gandaki Province. Although Most respondents intended to renew their insurance. Continuity was influenced by socio-cultural factors, household decision-making, and service utilization, while dropout is driven by system and service delivery challenges. Improving service quality, user experience, benefit alignment, and community awareness is essential for sustaining the program. Keywords: Determinants; Enrollment Retention; Health Insurance; Healthcare Utilization; Insurance Continuity; Nepal
Copyright (c) 2026 Ramesh Prasad Adhikirai, Ajay Thapa; Indra Prasad Tiwari https://creativecommons.org/licenses/by-nc/4.0
Changes in Stroop Task Performance Across the Life Span
Background: The Stroop test assesses attention and cognition. The selective attention assessed by this test varies in bilingualism, education, gender and advancing age. Thus, this study aimed to examine age related changes in reaction time using the Stroop test. Methods: A cross-sectional study was conducted at Kathmandu University School of Medical Sciences between March 2025 and November 2025. A total of 210 participants aged 18 – 80 years were recruited through convenience sampling. Participants were categorized into three age groups: Group 1 (18–30 years), Group 2 (31–60 years), and Group 3 (>60-80 years). Each group consist 70 participants, 35 males and females. Each participant was assessed individually and instructed to read the control, congruent, and incongruent Stroop cards. Reaction time was measured using a digital stopwatch for each task. Results: Reaction time demonstrated a significant age related increase across all task conditions. In the control condition, the mean reaction time increased from 21.19 ± 6.80 seconds to 30.38 ± 10.76 seconds and further to 45.13 ± 12.69 seconds (p < 0.001). A comparable pattern was observed in the congruent condition, where mean reaction times rose from 20.41 ± 5.32 seconds to 28.34 ± 9.27 seconds and 41.27 ± 9.69 seconds (p < 0.001). The most pronounced differences were evident in the incongruent condition, with reaction times increasing markedly from 63.64 ± 30.72 seconds to 104.48 ± 34.25 seconds and 141.32 ± 47.97 seconds (p < 0.001). Conclusions: Reaction time is significantly influenced by age. Older participants demonstrated slower responses, indicating an age-related decline in executive function and cognitive processing speed. Keywords: Aging: attention; cognition; reaction time.
Copyright (c) 2026 Reena Kumari Jha, Abadhesh Kumar Mishra; Niraj Chaurasiya, Ojashwi Nepal https://creativecommons.org/licenses/by-nc/4.0
Predictive Performance of the Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score in Critically ill Patients in Intensive Care Unit
Background: Severity scoring systems are widely used in intensive care units to assess illness severity, predict mortality, and support clinical decision-making. However, most systems, including the Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, and Sequential Organ Failure Assessment, were developed in high-income countries, and their validity in low- and middle-income settings such as Nepal remains uncertain. This study evaluated and compared the predictive performance of Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, and Sequential Organ Failure Assessment among critically ill patients admitted to a tertiary hospital intensive care units in Nepal. Methods: A prospective observational study was conducted among 501 adult intensive care units’ patients over one year. Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, and Sequential Organ Failure Assessment scores were calculated using the worst physiological values within the first 24 hours of intensive care units’ admission. Patients were followed until intensive care units discharge and categorized as survivors or non-survivors. Discrimination was assessed using the area under the receiver operating characteristic curve, and calibration was evaluated using the Hosmer–Lemeshow test and standardized mortality ratio. The Mann–Whitney U test compared median scores between outcome groups. Results: The intensive care units mortality rate was 36.9%. Sequential Organ Failure Assessment demonstrated excellent discrimination (Area under receiver operating characteristics curve 0.895), outperforming Simplified Acute Physiology Score II (0.748) and Acute Physiology and Chronic Health Evaluation II (0.722). Sequential Organ Failure Assessment showed good model fit (p=0.129), while Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II had poor calibration by Hosmer–Lemeshow testing. Although Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II showed moderate standardized mortality ratio calibration, SOFA significantly overestimated mortality (Standardized mortality ratio 0.38, p<0.001). All three scores were significantly higher among non-survivors (p<0.001). Conclusions: All three scoring systems effectively differentiated survivors from non-survivors. Sequential Organ Failure Assessment demonstrated superior discriminative ability and overall predictive performance, making it the most reliable mortality predictor in this intensive care units setting, although recalibration may be required for accurate absolute mortality estimation in resource-limited contexts. Keywords: APACHE II score; critical illness; intensive care units; SAPS II score; SOFA.
Copyright (c) 2026 Raj Kumar Mehta, Hafizah Che Hassan, Bishnu Bista, Mamata Sharma Neupane https://creativecommons.org/licenses/by-nc/4.0
Association of Laboratory Parameters with Clinical Outcomes of SARS-CoV-2 Patients
Background: The COVID-19 pandemic has imposed a significant burden on healthcare systems, particularly in resource-limited settings. Laboratory biomarkers may help predict disease outcomes and guide clinical decisions. However, there is limited evidence from Nepal regarding the prognostic value of these markers among hospitalized COVID-19 patients. Methods: A hospital-based observational study was conducted among 348 RT-PCR–confirmed COVID-19 patients admitted to the COVID ICUs and wards of a tertiary care hospital in Nepal between March 2022 and June 2023. Data on sociodemographic characteristics, haematological parameters, liver and inflammatory markers, urine microscopy, and SARS-CoV-2 molecular gene markers were collected prospectively. Clinical outcomes were categorized as survived or died. Descriptive statistics, chi-square tests, and binary logistic regression were used to analyse associations and identify predictors of mortality. Results: Out of the total 348 patients included in the study, 71 patients (20.4%) died, while 277 patients (79.6%) survived. Among 348 patients, significant associations with mortality were observed for lymphopenia (p = .001), neutrophilia (p < .001), elevated ALT (p < .001), elevated AST (p = .001), and positive D-dimer (p < .001). High viral load (Ct value ?20) for E, N, and ORF1ab ab genes was also significantly associated with mortality in univariate analysis. Logistic regression identified D-dimer positivity (OR = 0.027, p = .001) and elevated ALT (OR = 0.356, p = .016) as independent predictors of mortality. Conclusions: Laboratory parameters, especially lymphocyte count, D-dimer, and ALT levels, are valuable prognostic indicators of clinical outcomes in hospitalized COVID-19 patients. Integrating these markers into clinical assessment may enhance early risk stratification and resource allocation. Keywords: Biomarkers; C-Reactive protein; COVID-19; critical care; d-dimer.
Copyright (c) 2026 Mamata Sharma Neupane; Hafizah Che Hassan, Surendra Kumar Uranw, Raj Kumar Mehta https://creativecommons.org/licenses/by-nc/4.0
Association of Post-Operative Cardiac Enzyme Levels with Early Mortality Following Coronary Artery Bypass Grafting
Background: Post-operative myocardial injury is an important determinant for mortality and morbidity following Coronary Artery Bypass Graft surgery. This study evaluated the role of serial post-operative cardiac biomarker and enzyme (CK-MB, Troponin I) measurement in predicting in-hospital mortality following CABG surgery. Methods: This retrospective study included patients undergoing CABG procedure at Manmohan Cardiothoracic Centre from January 2020 to January 2021. Cardiac Biomarkers (CK-MB and Troponin I) were measured at 6,12 and 24 hours post-operatively. The Mann–Whitney U test was used for comparison of biomarkers between survivors (n=40) and non-survivors (n=3). Receiver Operating Characteristic (ROC) curve analysis with Youden Index was used to determine optimal cutoffs values. Results: A total of 43 patients were enrolled in the study. In-hospital mortality was 7% (3/43) with 40 survivors and 3 non-survivors. No significant differences were observed in cardiac enzymes measured at 6 hours, between the survivors and non-survivors (Troponin I, p=0.206; CK-MB, p=0.391). However, biomarkers were significantly higher in non-survivors at 12 hours (Troponin I p=0.038; CK-MB p=0.004) and 24 hours (Troponin I p=0.007; CK-MB p=0.005). ROC demonstrated excellent predictive performance of CK-MB at 12 hours (AUC=1.00, cutoff at 146 IU/L, sensitivity 100%, specificity 100%), CK-MB at 24 hours (AUC =0.95, cutoff at 155 IU/L) and Troponin I at 24 hours (AUC=0.92, cutoff at 5.17ng/ml). However, these findings should be interpreted cautiously due to only three mortality events. Conclusions: Post operative Cardiac biomarkers (Troponin I >5.17 ng/ml at 24 hours and CK-MB >146 IU/L at 12 hours and >155 IU/L at 24 hours) were associated with in-hospital mortality following CABG and warrants further evaluation as a post-operative risk stratification marker. Keywords: Cardiac biomarkers; coronary artery bypass surgery; creatine kinase MB; myocardial injury; troponin I.
Copyright (c) 2026 Prashiddha Bikram Kadel, Anil Bhattarai, Ravi Kumar Baral, Prabhat Khakural, Krishnaprasad Bashyal, Srijana Thapa https://creativecommons.org/licenses/by-nc/4.0