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Analysing Health Challenges and Mortality of Nepali Diaspora in Hong Kong
(Kathmandu University, 2025) Rana Magar, U; Rana, J
ABSTRACT This study explores the health challenges and causes of mortality among the Nepali diaspora in Hong Kong. Despite the importance of accessible health services for all individuals, as emphasized in the World Health Organization’s (WHO) commitment to universal health coverage, this community faces significant obstacles. These challenges result in a higher prevalence of various diseases and a reduced life expectancy. By examining average mortality rates and identifying specific health issues and challenges affecting Nepali individuals, this research highlights critical health disparities and aims to inform targeted interventions to enhance the well-being of this population. Primary data for this study were randomly collected from 200 Nepalis living in Hong Kong using Survey Monkey survey software, supplemented by secondary data obtained from the High Court of Hong Kong. Descriptive statical methods were employed to analyse the data and interpret the findings as required. The findings reveal significant concerns regarding the lifestyle and health conditions of the Nepali diaspora in Hong Kong community. Key issues identified include high alcohol consumption, low health insurance coverage, and inadequate exercise habits. Alarmingly, the average age of death for Nepalis in Hong Kong is only 55 years. The most common causes of premature death include cardiovascular diseases, kidney and liver diseases, respiratory tract infections and diseases, sepsis, and cancer, with variations observed across different age groups and genders. The study recommends several interventions to address these health challenges, including health education initiatives, enhanced workplace safety measures, improved access to healthcare dietary improvements, promotion of healthy lifestyles, provision of mental health support, and collaboration among stakeholders. These efforts are essential to improve health outcomes for the Nepali population in Hong Kong. KEY WORDS Average death, Cause of death, Health issues, Nepali in Hong Kong
Undifferentiated Embryonal Sarcoma of the Liver in Adult Mimicking Hepatic Abscess
(Kathmandu University, 2025) Adhikari, K; Bhattarai, M; Devkota, K
ABSTRACT Undifferentiated embryonal sarcoma is an uncommon malignant tumor of liver of mesenchymal cell origin, usually observed in children. We report a case in a 34 years old male who presented with right upper quadrant pain. Ultrasonography showed a complex solid cystic lesion. However, on computed tomography it appeared as predominantly cystic with small solid components within. It was initially diagnosed as hepatic abscess. After failure to improve on conservative treatment, the patient underwent surgical resection and histopathology revealed undifferentiated embryonal sarcoma. Here we describe the typical clinical and radiologic features of this rare tumor. KEY WORDS Adult, CT scan, Undifferentiated embryonal sarcoma of liver, Ultrasonography
Chairside Relining of Mandibular Complete Denture for Management of Severe Lingual Undercut
(Kathmandu University, 2025) Basnet, BB
ABSTRACT Lingual undercuts in the mandibular alveolar ridge pose significant challenges to conventional complete denture fabrication and patient comfort. This case report details the management of a severe oblique lingual undercut using addition silicone to create a blockout, facilitating space for a soft liner. This technique was incorporated during the denture fabrication process, simplifying the chairside relining with soft liner and improving denture seating and retention. By preemptively accommodating the undercut, the procedure minimized patient discomfort and ensured a more stable and comfortable denture, offering an effective alternative to more invasive surgical interventions. KEY WORDS Alveolar bone resorption, Complte denture, Denture retention, Denture stabiltiy
First Successful Independent Peroral Endoscopic Myotomy (POEM) for Achalasia Cardia: A Milestone Case Report from Nepal
(Kathmandu University, 2025) Purbey, BK; Karki, S; Khanal, A; Khadka, D; Singla, V; Adhikari, S
ABSTRACT Achalasia cardia is an uncommon esophageal motility disorder characterized by failure of relaxation of the lower esophageal sphincter and loss of peristalsis in the lower part of the esophagus. Peroral Endoscopic Myotomy (POEM) has emerged as a minimally invasive intervention equivalent to Heller myotomy and an effective treatment modality. We present the first successful solo peroral endoscopic myotomy procedure performed in Nepal by an interventional gastroenterologist, who has managed a 45-year-old patient with long-standing dysphagia and a history of failed pneumatic dilatation with success. The procedure was uneventful. The patient showed symptomatic improvement postoperatively with minimal reflux. This case highlights the feasibility and safety of independently performed peroral endoscopic myotomy in a resource-limited setting. It shows the diaspora of interventional gastroenterology in Nepal and begins a new era for the same. KEY WORDS Achalasia cardia, Dysphagia, Eckardt score, Peroral endoscopic myotomy (POEM)
Non-necrotising Scleritis and Spherophakia in Marfan Syndrome: A Rare Situation Adhering to Hickam’s Dictum
(Kathmandu University, 2025) Parajuli, S; Sharma, S; Shrestha, R; Chapagain, S
ABSTRACT Marfan syndrome is an autosomal dominant, connective tissue disorder that affects various systems of the body including the eyes. We present a case of a 22 year old man with Marfan syndrome presented with a painful red left eye. On examination he was diagnosed to have non-necrotising scleritis and microspherophakia. Non-necrotising scleritis with microspherophakia is a rare and arduous situation. This is an interesting case where Hickam’s dictum prevails over its counter argument of Occam’s razor principle. KEY WORDS Marfan syndrome, Non-necrotising scleritis, Spherophakia
Guillain-Barré Syndrome Following Tetanus Toxoid Vaccination: A Rare Case Report From A Tertiary Care Centre
(Kathmandu University, 2025) Shah, BK; Sah, S; Pandey, P; Kurmi, S
ABSTRACT Guillain-Barré syndrome is an acute inflammatory polyneuropathy characterized by rapidly progressive, symmetric, ascending weakness often triggered by infection or rarely vaccination. Although influenza and Corona Virus Disease-19 vaccines have been more commonly implicated, there are limited reports of Guillain–Barré syndrome following tetanus- toxoid vaccination. We report a case of 12-years- old male who developed bilateral lower limbs weakness and hoarseness of voice 3 weeks after receiving tetanus toxoid vaccine given after injury. Neurological examination revealed bilateral hypotonia in lower limb. Cerebrospinal fluid analysis showed albuminocytologic dissociation. Nerve conduction studies were consistent with acute inflammatory demyelinating polyradiculoneuropathy. The patient was treated with intravenous immunoglobulin at 0.4 g/kg/day for 5 days and discharged on 10th day of admission. This case highlights a possible temporal association between tetanus toxoid vaccination and Guillain–Barré syndrome, though the causality cannot be definitively established. Further studies are required to clarify this potential link. KEY WORDS Guillain-Barré syndrome, Pediatrics, Tetanus toxoid, Vaccination
Experience of Surgical Resection and Reconstruction of Chest Wall Tumor in Dhulikhel Hospital
(Kathmandu University, 2025) Karmacharya, RM; Vaidya, S; Bhatt, S; Guragai, M; Sharma, S; Bhandari, S; Shrestha, M; Shah, B; Yadav, B
ABSTRACT Background Chest wall tumors are rare thoracic tumor which can be either primary or metastatic. Conventional radiography is the first line of investigation followed by further imaging like computed tomography or magnetic resonance imaging. When indicated preoperative biopsy by fine-needle aspiration need to be done. Small chest wall tumor can be surgically treated by excision and primary repair. Bigger chest wall tumor is treated by excision and chest wall reconstruction. Objective To know the features of chest wall tumor, symptoms, histopathological findings, surgical procedures performed and outcome following the surgery. Method This is the retrospective study that included chest wall tumor subjected for excision and repair during January 2018 till December 2023 in Thoracic surgical unit of Dhulikhel Hospital. Variables such as presenting complaints, size and extent of tumor, type of surgery, outcome of the surgery, hospital stay, neoadjuvant chemotherapy and post excision chemo or radiotherapy and recurrence of the tumor were included. When primary repair is not possible following wide excision, reconstruction using double prolene sandwich mesh was done. Result There were 38 cases of chest wall tumor. Mean age of the patient was 42 years (SD 15.25 years, range 20 - 68 years). Of them, 22 patients were female (57.9%) and 16 patients were male (42.1%). Chest pain was the most common symptoms (84.2%) followed by lesion in chest (81.6%). Average size of the tumor was 14.8 ± 3.6 cm (Range 5 cm to 25 cm). Most common histopathological finding was neurofibroma (31.6%) filled by schwannoma (15.8%). All the patients underwent wide local excision. In terms of repair, primary repair was possible in 68.4% while in 31.6% patients repair using double prolene and bone cement sandwich was done. Average hospital stay was 6.6 days (SD 2.3, range 3-9 days). Conclusion Chest wall tumor can have different histopathological findings. In patients where wide resection is possible, it can be repaired by either primary repair or by repair using double prolene and bone cement sandwich. KEY WORDS Chest wall tumor, Reconstruction, Resection
Association of Breast Cancer and Dyslipidemia in Nepali Women
(Kathmandu University, 2025) Karki, OB; Timilsina, B; Ghimire, P; Pokharel, D
ABSTRACT Background Breast cancer, which is a multi-factorial disease is one of the primary causes of cancer-related mortality in women. The association of serum lipids with breast cancer is being debated. Objective To examine any possible association between fasting lipid profile and breast cancer in Nepali women. Method A case-control study was conducted among 36 breast cancer patients, 40 patients with benign breast lump and 38 apparently healthy control women from February 2022 to December 2024. Ethical clearance was obtained from institutional review committee (MEMG/IRC/500/GA) prior to study. A convenient sampling technique was used. Data entry and analysis were done using SPSS version 20. Chi-square tests and analysis of variance (ANOVA) were used for statistical comparisons of categorical and continuous data respectively. P-value of <0.05 was considered statistically significant. Result Of the 114 participants included in this study, 36 were malignant breast cancer patients, 40 were benign breast lump patients and 38 controls with the mean ages of 52.75 ± 10.39, 48.45 ± 12.78 and 45.80 ± 10.14 years respectively. The prevalence of dyslipidemia was 75%, 25% and 26.31%, among malignant breast cancer patients, benign breast lump patients and control group respectively with the mean value of triglyceride (160.01 ± 78.34, 111.75 ± 60.40 and 97.99 ± 31.34) respectively and the difference was statistically significantly (p < 0.001). In addition, the mean serum concentrations of total cholesterol were significantly different between the three groups (1588.36 ± 39.95, 132.09 ± 39.95 and 138.31 ± 45.34, p=0.020). Conclusion The overall prevalence of dyslipidemia was high in breast cancer patients in comparison to patients with benign breast lump or normal controls. KEY WORDS Breast neoplasms, Dyslipidemias, Lipids
Visual Acuity Screening By by School Teachers in Far West Nepal: A randomized trial of alternate screening models
(Kathmandu University, 2025) Awasthi, S; Reddy, PA; Bassett, KL
ABSTRACT Background Studies have not examined alternate school visual acuity screening methods in Nepal in terms of accuracy and cost. Objective To validate recent evidence from India of the effectiveness and cost of alternate school visual acuity screening models involving all class teachers (ACTs) versus a few selected teachers (STs). Method This was a prospective cluster randomized controlled study. The sample size was 5000 students. Five schools were randomly selected for the all-class teachers or intervention arm and four schools for selected teachers or standard arm. Teachers from both arms were trained to identify children aged 6 years and above with Snellen visual acuity 6/9 or worse in either eye as well as obvious ocular abnormalities and refer them to an ophthalmic team. The screen positive and negative children as well as cost for screening were calculated in STATA software (version 11.0; StataCorp, Texas, USA). Result All class teachers (80 teachers) screened 3713 children and STs (9 teachers) screened 2064 children aged 6 to 15 years. All class teachers had better sensitivity, 95.1% (95% CI: 91.9-98.2) and specificity, 92.8% (95% CI: 92.0-93.6) compared to selected teachers: sensitivity, 73.2% (95% CI: 64.4-82.0) and specificity, 85.3% (95% CI: 83.8- 86.7). The cost of screening per child with refractive error and or other ocular abnormalities was $3.05 for all class teachers and $ 5.29 for selected teachers. Conclusion A school vision screening involving all class teachers in Nepal was more accurate than selected teachers in identifying refractive error and or other ocular abnormalities at approximately 60% of the cost. KEY WORDS Accuracy and cost, School, Screening, Teachers, Visual acuity
Epidemiology of Critically Ill Patients in Intensive Care Units in Dhulikhel Hospital, Nepal: a retrospective observational study
(Kathmandu University, 2025) Kharbuja, K; Ranjit, S; Aryal, D; Sapkota, P; Paudyal, G; Bajracharya, A; Pasachhen, S; Bhusal, S
ABSTRACT Background Critical care involves the management of acutely ill patients at risk of organ failure. The burden of critical illness is a major public health concerns, particularly in low and middle income countries like Nepal where access to intensive care services is limited. Objective To identify the clinical profile of patients admitted to the Level III Intensive Care Unit at Dhulikhel Hospital. Method Data over a period of six months were collected from the ICU registry. Severity and mortality risks were assessed using APACHE II and eTropics scoring systems. Clinical profiles and outcomes were analyzed using SPSS version 25. An independent samples t test was used to compare continuous variables between two independent groups. A p value < 0.05 was considered statistically significant. Result A total of 486 patients were included in the study, of whom 57% were male . The median age was 55 years (IQR: 41-69). Most patients were admitted from the emergency room (52.7%). Patients with medical conditions had a higher ICU admission compared to surgical patients. The majority of patients (63.6%) were transferred to the ward followed by discharge to home (16.2%). Non routine discharges included treatment withdrawal in 89 (18.3%) and patient leaving against medical advice 53 patients (11%). The overall mortality rate was 11.3%. Conclusion This study shows that most admissions were male, with median age of 55 years and medical cases were more prevalent than surgical cases. The observed mortality rate may underestimate mortality due to high rate of treatment withdrawal discharges. KEY WORDS Critically ill patient, Epidemiology, Intensive care unit, Outcome
Dietary Salt Intake in a Suburban Nepali Community: A Cross-sectional Study Using 24-Hour Urinary Sodium
(Kathmandu University, 2025) Bhatt, RD; Shrestha, A; Karmacharya, BM; Timalsena, D; Dhimal, MN; Pradhan, P; Oli, N; Bista, D; Pyakurel, M; Barakoti, R; Mishra, R; Risal, P
ABSTRACT Background High dietary salt intake is a recognized contributor to hypertension and cardiovascular diseases, particularly in low- and middle-income countries. Despite the high burden of hypertension in Nepal, robust estimates of salt intake using the gold standard 24- hour urinary sodium collection remain scarce, especially in suburban populations. Objective To accurately assess dietary salt intake using 24-hour urinary sodium excretion and evaluate factors influencing salt consumption in a suburban Nepali population. Method A cross-sectional study was conducted in 2023-2024 as part of the Dhulikhel Heart Study’s second phase. A total of 381 adult participants were recruited from randomly selected wards of Dhulikhel Municipality. Data on sociodemographic characteristics, dietary habits, salt-related knowledge, and anthropometry were collected. Salt intake was estimated from 24-hour urinary sodium excretion. Generalized Estimating Equations (GEE) and multivariate analyses were used to identify associated factors. Result The mean age of the participants was 49.9 ± 15.5 years and average salt consumption was 9.55 ± 3.2 g/day. The mean dietary salt intake significantly exceeded WHO recommendations, with notable variations by sex, education, and frequency of eating out. Conclusion This study highlights alarmingly high salt intake in a suburban Nepali community and underscores the need for population-specific strategies to reduce sodium consumption. Policy action, public education, and promotion of healthier dietary behaviors are essential to combat the growing burden of salt-related non- communicable diseases. KEY WORDS Blood pressure, Dietary salt intake, 24-hours urine sodium
A Study of Thyroid Dysfunction among Patients Diagnosed as Depressive Episodes Presenting in the Psychiatry OPD at a Tertiary Care Hospital in Pokhara
(Kathmandu University, 2025) Khattri, JB; Godar, ST
ABSTRACT Background The prevalence of thyroid dysfunctions is not clear in depression, and more studies are needed. Objective To find the prevalence of thyroid dysfunctions among patients diagnosed with depressive episodes. The second objective was to test the association between thyroid dysfunctions and different sociodemographic variables. Method The patients diagnosed with depressive episodes according to the International Classification of Disease – 10 Classification of Mental and Behavioural Disorders (Diagnostic Criteria for Research) were selected from the Psychiatry Out-Patient Department of Manipal Teaching Hospital, Pokhara. The pro forma was used to collect the socio-demographic profile of the patient. The serum sample of the 398 patients was sent for thyroid estimations. Result The overall prevalence of thyroid dysfunction was 13.07%. The mean age of the abnormal thyroid function patients was 44.88 years with a standard deviation of 13.39 years. Thyroid dysfunction was more prevalent in the socio-demographic variables like female gender and in the patients living in the rural area as compared to other variables, but in a statistically insignificant way. Conclusion The result shows that thyroid dysfunction is common in the patients with depression. Clinicians should screen every depressive patient for thyroid function. Further larger- scale studies are needed before generalizing these results. KEY WORDS Depression, Hypothyroidism, Nepal, Thyroid Dysfunction
Stress and Coping Strategies among Mothers of Neonates in Neonatal Intensive Care Unit
(Kathmandu University, 2025) Bhandari, N; Shrestha, S; Bajracharya, J; Siluwal, N
ABSTRACT Background The birth of a baby is a happy moment for parents. When a newborn is admitted to Neonatal Intensive Care Unit due to morbidities, stress provoking for the parents. To overcome stress, parents, especially mothers adopt different types of coping strategies. Objective To assess the stressor and coping strategies adopted by mothers of neonates in Neonatal Intensive Care Unit. Method This is a cross-sectional, analytical study design conducted in mothers whose neonates were admitted 72 hours prior to data collection in the Neonatal Intensive Care Unit. The study was conducted after the approval received from the Institutional Review Committee-Kathmandu University School of Medical Sciences. Consecutive sampling methods was used to select the mothers. Data was collected using Parent Stressor Scale (PSS: NICU) for stress and BRIEF Coping Orientation to Problems Experiences (COPE) Inventory for coping strategies. Four points Likert scale was used to collect data. Data was analyzed using descriptive analysis, independent t-test and pearson correlation was used to see the correlation between independent and dependent variables. Result Overall stress among mothers is 111.4 ± 9.82 and among which most stressful events is neonates, looks and behaviour 54.4 ± 6.56 followed by parental role 34.10 ± 2.50 and sight and sounds of Neonatal Intensive Care Unit 23.06 ± 2.85 respectively. The direction of the relationship is positive between stress and coping strategies in neonates mothers (p < 0.001) in Neonatal Intensive Care Unit. Conclusion Understanding the stress of mothers and their coping strategies when their neonates admitted in Neonatal Intensive Care Unit will help the nurses to plan care for admitted neonates. KEY WORDS Coping strategies, Mothers, Neonates, Neonatal intensive care unit, Stress
Prevalence of Fibularis Tertius: Insights from a Surface Anatomical Study
(Kathmandu University, 2025) Shrestha, S; Mansur, DI; Shrestha, P; Maskey, S; Shrestha, M; Kunwar, A; Poudel, B; Dahal, P; Gautam, B
ABSTRACT Background The fibularis tertius muscle, a variant muscle in the crural compartment of the leg, is thought to have evolved in humans in response to the development of bipedalism. Acting as both an ankle dorsiflexor and foot everter, it plays a crucial role in enabling efficient terrestrial locomotion, especially in mid-foot biomechanical stabilization. The origin and insertion of this muscle have been reported to exhibit significant variation. Objective The aim is to determine the prevalence of this muscle by conducting a surface anatomical examination of the foot among pre-clinical sciences students at Kathmandu University School of Medical Sciences. Method Each participant’s fibularis tertius muscle (FTM) was assessed on both feet using a standardized surface palpation technique based on protocols that Tixa and Kendall had validated. To ensure accuracy, each foot was subjected to two separate evaluations by qualified evaluators that lasted 120 seconds each. During dorsiflexion and eversion, muscles were identified using sequential palpation techniques. Visibility was categorized into three graded responses (G1–G3) according to muscle activation. SPSS version 23 was used to analyze the data. While the Chi-square test evaluated sex-based associations, with statistical significance set at p < 0.05, descriptive statistics summarized prevalence. Result A total of 226 students (54.42% males, 45.58% females; mean age 20.8 ± 1.88 years) participated in the study. The fibularis tertius muscle had a prevalence of 95.58%, with a similar gender distribution. It was bilateral in 187 participants and unilateral in 29, mostly on the right foot. Multivariable logistic regression revealed no significant association between fibularis tertius presence and body mass index, with both crude and adjusted odds ratios (0.83 and 0.89, respectively) and p-values exceeding 0.05. Conclusion The fibularis tertius muscle is essential for ankle stability, reducing injury risk and aiding recovery during high-impact activities. Its absence increases instability and recurrent sprains. Understanding the anatomy of fibularis tertius muscle is crucial for surgical planning, tendon repair, and rehabilitation, influencing diagnosis, treatment, and injury prevention. KEY WORDS Anatomy, Bilateral traits, Fibularis tertius, Muscle anatomy, Prevalence, Unilateral traits
Double Burden of Malnutrition among Mother-Child Dyads in a Rural Area of West Bengal, India: A Comprehensive Analysis of Contributing Factors
(Kathmandu University, 2025) Sengupta, T; Mallick, AK; Sahu, M; Sarkar, S
ABSTRACT Background The double burden of malnutrition (DBM), where undernutrition and overnutrition coexist, is a new paradigm in the global nutritional landscape. With an increasing rate of obesity and a gradual decline in undernutrition, India is currently experiencing this public health challenge. At the household level, among mother-child pairs, this disparity in nutritional status is becoming evident. Objective To assess the prevalence and patterns of the double burden of malnutrition among mother-child dyads and to determine the factors associated with this condition. Method In this observational, cross-sectional study, the nutritional status (double burden of malnutrition) of 360 mothers and their children (aged 0 - 23 months) from a rural community of West Bengal, India, was assessed. Data were collected via interviews using a pre-tested, semi-structured questionnaire and through standard anthropometric measurements. The collected data were subsequently analyzed using SPSS (Version 25). Result The findings showed that 16.1% of the mother-child pairs had double burden of malnutrition, the highest being the pair of overweight/obese mother-stunted children (10%). Mother’s education (aOR 4.19, CI 1.65-10.62), food-insecure households (aOR 3.27, CI 1.51-9.16), and lower socio-economic class (aOR 2.70, CI 1.09-6.67) were found to be significantly associated with the presence of double burden of malnutrition among participants. Conclusion The double burden of malnutrition among mother-child dyads can be seen as a dual nutrition challenge that needs to be addressed with paramount importance. This contrasting form of malnutrition claims a renewed focus and program intervention through the equity-focused policies of Double Duty Action. KEY WORDS Double burden, India, Malnutrition, Mother-child Dyad, Rural
Pitfalls in diagnosing Gallbladder Carcinoma – A Single Center Histopathology Study
(Kathmandu University, 2025) Dhakal, B; Makaju, R; Maharjan, P; Basnet, D; Shrestha, B
ABSTRACT Background Gallbladder carcinoma is a rare cancer with incidence of less than 2 per 100,000 populations worldwide. It is the fifth most frequent gastrointestinal malignancy. Radiological or gross examination of majority of gallbladder carcinoma detects no mass. This may lead to under or over diagnosis of cases in histological examination. Objective To identify pathologic features that contribute to the difficulty in diagnosis of gallbladder carcinoma. Method Between 2018 and 2023, 22 patients with gallbladder carcinoma were identified using the histopathology registry book at the department of pathology. Blocks, slides, reports and history of those cases were retrieved and reviewed. The slides were analyzed by two or more pathologist noting some of the diagnostic difficulties which could have been encountered. The number and percentage with interpretations of the cases were noted. Result Nine of 22 primary gallbladder carcinoma cases had tumor masses. Nine cases in histological examination provided diagnostic challenges. The major pitfalls encountered while diagnosing gallbladder carcinoma was mistakenly making a diagnosis of carcinoma when only deeply penetrating Rokitansky–aschoff sinuses are present. Similarly, pathologists misdiagnose carcinoma with minimal disease as benign disease, Adenomyosis as Adenocarcinoma. Under sampling of specimen, grossly occult disease, misinterpreting extracellular mucin pools were other potential pitfalls. Conclusion Deeply penetrating Rokitansky-aschoff sinus or Adenomyosis can be mistakenly diagnosed as gallbladder carcinoma. Careful attention to any evidence of mural thickening and close examination of deeply situated glandular structures were crucial for proper diagnosis of gallbladder carcinoma. KEY WORDS Adenomysois, Gallbladder carcinoma, Histology, Necrosis, Pitfalls, Rokitansky– Aschoff sinuses
Deployment of COVID-19 Vaccines for Refugees and Migrants in Nepal
(Kathmandu University, 2025) Karmacharya, BM; Joshi, A; Marasini, S; Rai, P; Sharma, S; Kunwar, S; Kampalath, VN; Czapka, EA; Benavente, P; Zan, ML; Tran, NT; Hosseinalipour, SM; Blanchet, K
ABSTRACT Background The needs and determinants of COVID-19 vaccination uptake and coverage among refugees, migrants in regular situations (MIRS), and migrants in irregular situations (MIIS) remain undocumented. This hinders advocacy toward inclusive vaccination policies and ultimately undermines effective vaccine rollout. Objective To estimate vaccination coverage and produce evidence on the barriers and facilitators to COVID-19 vaccination for refugees and migrants in Nepal. Method Mixed-method study was conducted in Koshi, Bagmati and Gandaki provinces of Nepal. In total, 210 household surveys were conducted among the refugees and migrants, and eight key informant interviews were conducted locally among Nepal’s major stakeholders of COVID-19 vaccination. Result A total of 210 participants were included in this study: 101 refugees, 66 MIRS, and 43 MIIS. Among them, 52.9% (111/210) were fully vaccinated with two or more COVID-19 doses, 43.3% (91/210) were partially vaccinated with one dose, and 3.8% (8/210) were unvaccinated. Inclusive vaccination policies were an enabling factor for wide access to COVID-19 vaccines among refugees and migrants. The availability of vaccines free of cost, timely information on vaccinations, and multiple vaccination centers facilitated COVID-19 vaccine uptake. However, barriers like requirement of identity documents, safety misconceptions, fear of side effects, and language challenges hindered access. Conclusion This study highlights the overlooked issue of vaccination uptake among refugees and migrants, emphasizing the lack of data on their needs and determinants. This gap hinders inclusive vaccination policies and rollout effectiveness. Tailored strategies are crucial to address their specific needs, alongside ongoing research and advocacy for inclusive policies and targeted interventions to overcome barriers. KEY WORDS COVID-19, Immunization, Migrants, Nepal, Refugees, Vaccines
Comparison of Alert, Response to Verbal Stimulus, Response to Pain, Unresponsive (AVPU) Scale with Pediatric Glasgow Coma Scale for Assessing Level of Consciousness in Infants and Children
(Kathmandu University, 2025) Prakash, B; Shrestha, NJ; Prakash, K; Sah, SK; Prakash, P; Raymajhi, A
ABSTRACT Background Altered consciousness is a neurological emergency in pediatrics, with high morbidity and mortality. The Pediatric Glasgow Coma Scale (pGCS) is commonly used to assess altered sensorium in children. The Alert, Verbal, Pain, Unresponsive (AVPU) scale is a simple and easy-to-use alternative assessment tool that records patient response to verbal, painful stimuli, and unresponsiveness. Objective To compare the effectiveness of the Alert, Verbal, Pain, Unresponsive with the pediatric glasgow coma scale in assessing conscious level in infant and children with altered sensorium. Method This hospital-based observational study was conducted in Kanti Children’s Hospital, Maharajgunj, Kathmandu Nepal, for 12 months. All children aged from 2 months to 14 years with altered sensorium in the emergency department and pediatric intensive care unit (PICU), who met inclusion criteria, were enrolled and assessed using AVPU and pGCS scales. Result The study included 55 cases, with a male-to-female ratio of 1.2:1. Most cases (60%) were under 5 years old, with a mean age of 2.16 years. Infectious origin was the most common etiology (64%), where meningitis was the most common diagnosis (38%). AVPU and pGCS scores varied based on patient response: A/V/P/U of AVPU scale corresponded with mean pGCS score of 14, 12.5, 9.29 and 3.80 respectively. Conclusion After the statistically comparison, it was significantly easier to use AVPU scale for assessing conscious level in infants and children at peripheral and tertiary centers with busy emergency departments as compared to the pGCS scale. KEY WORDS Alert, response to verbal stimulus, response to pain, unresponsive scale (AVPU), Glasgow coma scale, Level of consciousness, Pediatric glasgow coma scale
Study of Neighborhood Environment for Cardiovascular Health in a Squatter Area in Nepal
(Kathmandu University, 2025) Oli, N; Vaidya, A; Rijal, D; Suwal, PS; Maharjan, B
ABSTRACT Background Behavioral risk factors for cardiovascular diseases are prevalent among the urban poor in Nepal. Understanding environmental factors such as the availability of retailers selling tobacco, alcohol, and junk food, as well as neighbourhood access to and the built environment’s support for physical activity is critical for addressing the rising burden of cardiovascular disease in the community. Objective To identify aspects of the community environment that contribute to behavioral risk factors, focusing on the food supply system, built environment, walkability, and the marketing, availability, and accessibility of tobacco and alcohol. Method Spatial data were collected in the Sinamangal-Minbhawan squatter area of Kathmandu using a mixed-method approach. Geographic Information System tool, direct field observations, including spot observation and transect walk, and Market Basket Surveys were done by a trained research team during the period March-May 2022. Data were analyzed using methodological triangulation, combining interviews, observations, GPS data, and Google Earth imagery in ArcMap 10.8. Thematic analysis of market basket survey interviews involved coding transcripts for cardiovascular disease-related behaviors, with codes refined into six key themes, including sociodemographic characteristics. Result We reported a few vegetable outlets and no fruit shops. There were 84 fast-food outlets and local restaurants with junk food and soft drinks available. We observed 77 tobacco outlets with a variety of tobacco products easily available to all. There were 48 alcohol outlets in the area, which, except for four outlets, were present together with tobacco and junk food outlets. Tobacco and alcohol products were largely consumed by men of all age groups. Conclusion Community-based health programs can raise awareness about the importance of healthy behavior. Advocacy efforts to promote policies that support improved access to healthy foods, smoke-free public spaces, and safe environments for physical activity are important to provide community members with healthy choices. KEY WORDS Food supply environment, Geographic information system, Market basket survey, Spatial analysis
Quality of Life (QOL) of Patients Diagnosed with Alcohol Dependence Syndrome Presenting to a Tertiary Care Centre
(Kathmandu University, 2025) Kunwar, D; Risal, A
ABSTRACT Background Among many factors behind the declined health, alcohol dependence plays a crucial role. It has been a significant problem in many countries and around the world. Objective To find out the detrimental quality of life of people dependent on alcohol. Method This was a hospital based cross-sectional study conducted within six months. The study participants were both male and female alcohol dependents taking treatment in de-addiction centers of Kathmandu University School of Medical Sciences. The mean (± SD) of the total and domain specific quality of life score were calculated. Bivariate analysis was done by comparing mean by using independent sample t test. Result The total sample comprised of 300, out of them 85.3% were males and remaining 14.7% were females. Among them 63.3% were using alcohol for more than 22 years, 40% were dependent on alcohol for 13 years and above, and 59.3% were using other substance. In terms of association, variables sex, education and demography were found to be statistically significant. Conclusion This study highlights the impact of alcohol on individuals’ quality of life. Contrary to some previous research, this study did not find significant relationships between age, marital status, comorbidities, and duration of alcohol use with quality of life. Holistic approach could lead to better outcomes for individuals with alcohol dependence syndrome. KEY WORDS Alcohol dependence, Quality of life, Tertiary care center

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