Health literacy among patients with non-communicable diseases at a tertiary level hospital in Nepal- A cross sectional study.

Health literacy (HL) is crucial in achieving the Sustainable Development Goal of reducing one-third of premature mortality by 2030 from Non-Communicable Diseases (NCDs) and improving Universal Health Coverage. Low health literacy is linked to poor health outcomes, and evidence shows that levels of limited HL are high, even among highly educated individuals. This study aims to assess HL levels and related factors among patients with NCDs at Tribhuvan University Teaching Hospital (TUTH) in Nepal. A cross-sectional survey was conducted at TUTH among 303 patients with NCDs with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, Hypertension, Epilepsy, Asthma and Cancer who came for follow-up from December 2022 to February 2023. Data was collected via face-to-face interviews by the trained enumerators using a structured Health Literacy Questionnaire (HLQ) containing 44 items (divided into nine domains). Multivariate logistic regression analysis was performed using SPSS version 26, with statistical significance at 0.05, to determine the associated factors of HL. The mean ±SD age of the respondents was 47.4±16.18 years. More than half of the respondents were female (56.1%). The patients had higher HL in all HL domains except 'Navigating the healthcare system'. Educational status was significantly associated with six out of nine HL domains. Co-morbidity, attendance at health-related seminars, regular physical activity, and social connectedness were associated with at least one of the domains of HL. This study identified the important factors of HL, such as socio-demographic and medical factors among patients with NCDs. This highlights the need for a comprehensive approach to address identified gaps in HL, considering its multifaceted and composite nature and promoting interventions to improve HL in high-risk populations.

Ecosystem-based adaptation for increased agricultural productivity by smallholder farmers in Nepal.

The impacts of climate change are evident in the agriculture sector globally. These impacts are more severe and pronounced in a mountainous country like Nepal due to the high reliance on agro-economy and subsistence-based livelihoods by smallholder farmers that increase vulnerability and risks. Several ecosystem-based adaptation measures have proved to build the adaptive capacity of both agro-ecosystems and smallholder farmers by offering simple and affordable technologies however, these are yet to be prioritized by policy and programs for scaling. In this paper, we provide science-based evidence to traditionally used practices, such as jholmal (locally prepared bio-fertilizer and pesticides) and straw mulching by comparing their efficacy in terms of yield and reduction in disease pest infestation. The study was conducted in Kavre district of Nepal during 2017 and 2018 using participatory on-farm field trials for jholmal and straw mulching designed separately with Randomized Complete Block Design for selected vegetable crops like bitter gourd and tomato. The application of jholmal showed significant increase in bitter gourd yield both at the foothill and hilltop sites compared to the farmer's business usual practice (in 2017 and 2018, bitter gourd yield increased by 30.5% and 31.1% in foothill, while 26.6% and 28.7% in hilltops respectively). Further, a significant reduction on fruit infestation was observed in jholmal treated plots. Similarly, there was increase in tomato yield when straw mulch was used compared to the non-mulched trials (in 2017 and 2018, tomato yield increased by 16.5% and 20.3% respectively). These findings suggest that traditionally used practices have scientific basis and offer simple, affordable and climate friendly practices to improve the health of agro-ecosystem while supporting smallholder farmers to adapt to adverse impacts of climate change and build socio-ecological resilience. These practices can be also customized depending on the local context for wider adoption and scaling across Nepal and elsewhere as ecosystem-based adaptation measures for smallholder farmers.

Popliteal artery thrombosis as a rare complication of paroxysmal nocturnal hemoglobinuria (PNH): A case report.

INTRODUCTION AND IMPORTANCE: Popliteal artery thrombosis a rare but life-threatening complication of Paroxysmal Nocturnal Hemoglobinuria caused due to hemolysis. Complications of further thrombotic event are common after initial management. CASE PRESENTATION: A 38 years old male, known case of PNH for 2 years, presented with the history of loss of pain sensation, coldness and loss of movement in left lower leg for 5 days and history of multiple blood transfusion. The patient underwent knee amputation because of possible complication of PNH. CLINICAL DISCUSSION: Intermittent claudication along with paresthesia, lower extremity weakness, stiffness, and cool extremities are seen in patients of Peripheral Artery Disease. Ultrasound color duplex is a sensitive and specific examination for peripheral flow while gold standard techniques like MRI and CT angiogram to detect and diagnose arterial lesions. CONCLUSION: The risk of thrombo-embolism in a patient of PNH should be considered by a treating doctor while early imaging and management should be done to reduce the complications and risk of amputation.