A critical analysis of health system in Nepal; Perspective's based on COVID-19 response.

Background: Nepal moved from a unitary government to a federal system of government in 2015 under its constitution. Nepal is a federal democratic republic governed by three levels of government: a federal, provincial, and local level. The response to COVID-19 in Nepal has been majorly led and controlled by the federal government. All three levels of government are performing their responsibilities; however, they face various challenges in responding to COVID-19. This study aimed to critically analyze Nepal's health system in the context of the COVID-19 response. Methods: We conducted semi-structured in-depth interviews by telephone among the policymakers, health workers, and stakeholders at the federal, provincial, and local levels (n = 41) between January to July 2021. The interviews were audio recorded, transcribed into English, and coded using inductive-deductive approaches. Results: COVID-19 considerably impacted routine health care, mainly maternity services and immunization. Inadequate financial resources, inadequate human resources, and the lack of ventilators, ICUs, and X-ray services were the significant challenges in tackling and managing COVID-19 effectively. Conclusion: The study found that all three levels of government perform their roles and responsibilities and effectively manage the pandemic. The federal and provincial governments focused more on the plans and policy development, while the local government demonstrated greater accountability in implementing those plans and policies. Therefore, all three tiers of government need to coordinate together for preparing and communicating information in times of emergency. Besides, it is imperative to empower local governments to maintain Nepal's federal health system.

Adherence to Dietary Recommendation and Its Associated Factors among People with Type 2 Diabetes: A Cross-Sectional Study in Nepal.

Introduction: Intensive lifestyle modification including a healthy diet changes the diagnostic status of patient from prediabetes to nondiabetes. In type 2 diabetes, improper eating habits increase insulin resistance. This study is aimed at assessing adherence to the dietary recommendation and its associated factors among people with type 2 diabetes. Methods: A cross-sectional descriptive study was conducted among systematically sampled type 2 diabetic patients using interview on Gandaki Medical College Teaching Hospital and Diabetes, Thyroid, and Endocrinology Care Center, Pokhara. The Perceived Dietary Adherence Questionnaire was used to assess dietary adherence. Data was entered in EpiData version 3.1 and analyzed on SPSS version 20. Logistic regression with adjusted odds ratio and the corresponding 95% confidence intervals were used to find out significance of association. Results: Among 204 participants, only 15.7% of the participants had good dietary adherence. The mean age and standard deviation were 53.03 ± 11.90 years. Factors such as participants living in single family (AOR 2.7, 95% CI 1.0-7.4), participants who could afford recommended diet (AOR 2.9, 95% CI 1.0-8.3), participants having self-control on food (AOR 4.1, 95% CI 1.2-14.1), participants who were engaged in moderate to heavy physical activities (AOR 3.3, 95% CI 1.2-9.2), and participants who had adherence to medication (AOR 3.5, 95% CI 1.2-10.1) were significantly associated with adherence to dietary recommendation. Conclusions: Adherence to dietary recommendation among people with type 2 diabetes was low. Factors such as family type, affordability of recommended diet, self-control on food, physical activity, and medication adherence were significantly associated with adherence to dietary recommendations among people with type 2 diabetes. These factors should be considered by nutrition counselors and clinical decision-makers in patient counseling regarding dietary adherence.

Prevalence of low birth weight and its associated factors: Hospital based cross sectional study in Nepal.

Low birth weight is still an important public health problem worldwide. It is a major contributor to neonatal death in developing countries, including Nepal. The government of Nepal has developed and implemented different programs to improve maternal and neonatal health, including baby's birth weight. However, low birth weight is a major maternal and child health challenge. Maternal factors determining the birth weight of neonates have been poorly assessed in previous studies in Nepal. Thus, this study aims to assess the prevalence and risk factors associated with low birth weight in Nepal. An institution-based descriptive cross-sectional study was carried out in Paropakar Maternity Hospital and Tribhuvan University Teaching Hospital of Kathmandu district among 308 postnatal mothers. The data was collected through the face-to-face interview technique. The data was entered in EpiData 3.1 and exported to Statistical Package and Service Solutions version 21 for analysis. Multivariate logistic regression was used to obtain an adjusted odds ratio, while p-value < 0.05 with 95% Confidence Interval (CI) was considered significant. The findings showed that 15.3% of the children had low birth weight. The mean and standard deviation of childbirth weight was 2.96±0.59 kg. Mothers belonged to Dalit ethnic (AOR = 2.9, 95% CI = 1.2-7.1), Antenatal Care visited three or fewer (AOR = 2.6, 95%CI = 1.0-6.6) and did not comply with Iron and Folic Acid supplementation (AOR = 2.1, 95% CI = 1.0-4.4) were significantly associated with low birth weight. Nearly one in every six children had low birth weight. Maternal health services such as antenatal care and compliance with a recommended dose of maternal micronutrients significantly impact on birth weight. Maternal and neonatal health programs should consider these factors to reduce adverse birth outcomes in Nepal.

Factors associated with meat hygiene-practices among meat-handlers in Metropolitan City of Kathmandu, Nepal.

Meat hygiene refers to all conditions and measures necessary to ensure safety and suitability of meat at all stages of the food chain. Inadequate hygiene practices allow consumers to be exposed to pathogens causing public health problems. Inadequate facilities and hygiene practices in meat shops results in meat contamination. The study aimed to identify factors associated with meat hygiene practices among meat handlers in the Metropolitan City of Kathmandu, Nepal. A cross-sectional study was designed with a semi-structured questionnaire and observation checklist that collected information about hygiene practices from 320 consenting meat-handlers by interviewer-administered technique. Data was entered in EpiData and analyzed using IBM SPSS version 21. Descriptive statistics of frequency distribution were used to report meat hygiene-practices and other independent variables, with multivariate logistic regression to establish predictors of meat hygiene-practices at 5% level of significance. The study revealed that less than half (44.4%) of the meat handlers had satisfactory meat hygiene practices. The adjusted regression analysis showed, strong evidence (p<0.01) of association of higher education level (AOR = 2.8, 95% CI = 1.7-4.5), other occupational involvement (AOR = 2.2, 95% CI = 1.9-2.4), and being officially registered (AOR = 2.8, 95% CI = 1.2-6.8) with meat hygiene practices. However, there was fair evidence (p<0.05) of association between shorter duration of meat being processed to sale (AOR = 0.57, P = 0.042) and meat hygiene practices. In this study, the satisfactory meat hygiene practices of meat handlers was low. The educational level, registration status of shops, involvement in other jobs, and awareness on meat hygiene were identified as key factors associated with meat hygiene practices. Thus, these factors need to be considered while developing programs to improve meat hygiene practices among the meat handlers. Meat handlers should be provided with training and orientation program for improving the meat hygiene practices.

Frontline Healthcare Workers' Knowledge and Perception of COVID-19, and Willingness to Work during the Pandemic in Nepal.

This study investigated the contextual factors associated with the knowledge, perceptions, and the willingness of frontline healthcare workers (FHWs) to work during the COVID-19 pandemic in Nepal among a total of 1051 FHWs. Multivariable logistic regression analysis was applied to identify independent associations between predictors and outcome variables. Of the total study subjects, 17.2% reported inadequate knowledge on COVID-19, 63.6% reported that they perceived the government response as unsatisfactory, and 35.9% showed an unwillingness to work during the pandemic. Our analyses demonstrated that FHWs at local public health facilities, pharmacists, Ayurvedic health workers (HWs), and those with chronic diseases were less likely, and male FHWs were more likely, to have adequate knowledge of COVID-19. Likewise, nurses/midwives, public health workers, FHWs from Karnali and Far-West provinces, and those who had adequate knowledge of COVID-19 were more likely to have satisfactory perceptions towards the government response. Further, FHWs-paramedics, nurse/midwives, public health workers, laboratory workers-FHWs from Karnali Province and Far-West Province, and those with satisfactory perceptions of government responses to COVID-19 were predictors of willingness to work during the COVID-19 pandemic. These results suggest that prompt actions are required to improve FHWs' knowledge of COVID-19, address negative perceptions of government responses, and motivate them through specific measures to provide healthcare services during the pandemic.