Strategy of Making Hand Washing a Routine Habit: Principles of 5Es and 3Rs.

Regular hand washing habit has potential to reduce morbidity and mortality due to diseases and improves child development and reduces absenteeism of children, teachers and workforce. Improving hand washing behavior is more cost effective than improving clean water and sanitation infrastructure. There are numbers of initiatives and interventions in place, which have gained momentum with key messages of a call to action with increasing investment in schools, engaging policy makers and demonstration them with evidence. However, change in behavior as a routine habit has not reached to an optimum level and requires institutionalizing hand washing practices in schools, from schools and by schools and develop it as a curriculum. Therefore, we are purposing principles of 5Es and 3Rs - a strategy to make hand washing a routine habit. These 5E principles are: i) Embedding in a system, ii) Enabling Environment, iii) Eliminating Friction, iv) Encouraging all, and v) Establishing intervention and 3Rs are practicing them Religiously, Routinely and Repeatedly. Numbers of interventions have well demonstrated that hand hygiene educational interventions can help maintaining good practices. Finally, if schools and community start doing today, we can observe behavioral change practices for hand washing as a routine habit by at least 10 years after.

Developing an Index to Measure Health System Performance: Measurement for Districts of Nepal.

Various frameworks for measuring health system performance have been proposed and discussed. The scope of using performance indicators are broad, ranging from examining national health system to individual patients at various levels of health system. Development of innovative and easy index is essential to measure multidimensionality of health systems. We used indicators, which also serve as proxy to the set of activities, whose primary goal is to maintain and improve health. We used eleven indicators of MDGs, which represent all dimensions of health to develop index. These indicators are computed with similar methodology that of human development index. We used published data of Nepal for computation of the index for districts of Nepal as an illustration. To validate our finding, we compared the indices of these districts with other development indices of Nepal. An index for each district has been computed from eleven indicators. Then indices are compared with that of human development index, socio-economic and infrastructure development indices and findings has shown the similarity on distribution of districts. Categories of low and high performing districts on health system performance are also having low and high human development, socio-economic, and infrastructure indices respectively. This methodology of computing index from various indicators could assist policy makers and program managers to prioritize activities based on their performance. Validation of the findings with that of other development indicators show that this can be one of the tools, which can assist on assessing health system performance for policy makers, program managers and others.

Leptospirosis in Nepal.

The study has demonstrated the evidence of leptospirosis infection in the country. It has also highlighted the challenges and the need of further researches on this disease, which seems to be under reported in the country.

Pandemic (H1N1) 2009 cases in Nepal.

We analyzed the data available in Nepal during this pandemic in order to determine the epidemiological, clinical and virological characteristics of pandemic influenza A in 2009. The test was conducted by real-time Reverse Transcription--Polymerase Chain Reaction on sample from patients with suspected influenza-like illnesses. Out of 538 cases were tested, 32% were positive for pandemic influenza A 2009 and the infection rate was highest for cases of 11-20 years and lowest in >50 years of age.

Mortality statistics from national censuses: a low cost viable method.

Information related to mortality is pivotal for evidence based policy and planning, resource mobilization and impact of intervention. This information is essential to monitor trends in health situation of the population, detect new epidemics, encourage research into avoidable causes of death, evaluate the success of control programs, and improve accountability for expenditures on disease control. Sixty percent of the countries of the world don't provide enough information on vital events and complete and representative information. Apart from vital registration system, other methods for getting mortality data are in current practices, such as facility based information system, censuses, household survey, research demographic surveillance sites, epidemiological studies and sample vital registration system, which complement the national health information system. All methods have their limitations. Piggy backing of national censuses for mortality statistics would follow the principle of Sample Registration System (SRS) using verbal autopsy tools to generate the mortality data just after the censuses. This method can be the suitable/useful mortality measuring system representing the population by age, sex, location and causes of death with less effort and at a lower cost. This method can be used to verify mortality data collected from other sources and/or for adjustment of existing mortality data.