Psychological impact of COVID-19 pandemic and lockdown among the population involved in tourism sector in Lakeside of Pokhara: A qualitative study.

Background and Aims: The COVID-19 pandemic has exerted a substantial influence on every sector of people's lives worldwide, including Nepal. The tourism industry is not exceptional. Lakeside Pokhara is one of the country's major tourist hubs and relies both on national and international visitors. The people residing in this area who depend on tourism-related businesses to regulate their daily living faced numerous stressors and psychological impacts due to the pandemic. This study aimed to explore the COVID-19 pandemic-related stressors and their psychological impact among people dependent on the tourism business in the Lakeside of Pokhara, located in the Gandaki Province of Nepal. Method: Via the qualitative approach, semi-structured in-depth interviews were conducted to collect the data from 20 individuals related to tourism business stakeholders in Lakeside of Pokhara. Thematic analysis was performed to analyze the data. Results: The study found business-related stressors among the people dependent on the tourism businesses, and these stressors were found to increase the experiences of psychological issues, including suicidal ideation. The pandemic has not only affected their economy but has also had an impact on their personal, familial, and social life. However, to combat the problems most of the study participants were found to be utilizing positive coping mechanisms, whereas some respondents were observed to consume more alcohol as a negative coping strategy. Conclusions: People indulging in the tourism sectors were at greater risk of vulnerability in the future pandemic. Tourism business stakeholders struggled to combat the numerous stressors and psychological impacts carried out by the COVID-19 pandemic and lockdown. Therefore, there is a growing need for government bodies to implement favorable business-related policies, and Mental Health and Psychosocial Support (MHPSS) related programs to these stakeholders.

Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a cross-sectional study.

BACKGROUND: Large inequalities in child health remain in Nepal, with caste, ethnicity and sex being major determinants of deprivation and negative outcomes. The purpose of this study was to explore whether key demographics of under 5s were associated with health seeking behaviours, utilisation of health care, and treatment received. METHODS: Data came from Integrated Management of Neonatal & Childhood Illness (IMNCI) records of 23 health centres across five districts. After digitising the paper records, the data was analysed by district, caste/ethnicity, sex, and age to investigate differences in the time taken to present at a health facility after the onset of symptoms of ARI, diarrhoea and fever; accuracy of diagnosis for pneumonia; and whether the correct treatment was prescribed for pneumonia as per IMNCI guidelines. RESULTS: From 116 register books spanning 23 health centres, 30,730 child patient records were considered for analysis. The median age of attendance was 18 months (Inter-Quartile Range = 10, 32), while were more male children that attended (55.7% vs. 44.3% for females). There were statistically significant differences for the time taken to attend a health centre between different districts for ARI, diarrhoea and fever, with children in the remote Humla and Mugu districts taking significantly longer to present at a health facility after the onset of symptoms (all p < 0.001, except Mugu for ARI days). Children from underprivileged ethnic groups, Madhesi and Dalit, were less likely to be given a correct diagnosis of pneumonia (p = 0.014), while males were more likely to receive a correct diagnosis than females (73% vs. 67%, p = 0.001). This sex difference remained in the adjusted regression models for diagnosis of pneumonia (p < 0.001) but not for treatment of pneumonia (p = 0.628). All districts, in comparison to Gorkha, had increased odds of correct diagnosis and treatment of pneumonia, but only significant in children from Mugu after adjustment (p ≤ 0.001). CONCLUSION: Significant demographic differences were found based on ethnicity, sex, and district when examining health seeking behaviours for ARI, diarrhoea, and fever. Significant associations were seen for these same factors when exploring accuracy of diagnoses of pneumonia, but not for treatment. This study has emphasised the importance of a digitalised healthcare system, where inequalities can be identified without the reliance on anecdotal evidence.

Newspaper reporting of suicide in Nepal: Quality assessment against World Health Organization media guidelines.

Background: Sensible media reporting of suicide is a population-based suicide prevention strategy. However, the quality of media reporting of suicide has not been assessed in Nepal. Objectives: We aimed to assess the newspaper reporting status of suicide in Nepal with reference to World Health Organization (WHO) media guidelines for suicide reporting. Method: We retrospectively searched eight major newspapers in Nepal between January 2020 and May 2021 and assessed 167 news reports against WHO suicide reporting guidelines. Results: Potentially harmful characteristics were found to be reported in both the title and main text of the reports. About half of them mentioned sex (48.5%) and 38.3% mentioned the location of suicide in the title. Of the 167 reports, 74.3%, 95.2%, 34.7%, 92.2%, 98.8%, and 52.7% mentioned the name, sex, occupation, method of suicide, the location of suicide, and life events, respectively, in their main content. On the other hand, only 6% and 2.4% of reports mentioned linkage of suicides with mental illness and substance abuse, respectively. While lesser than 1% of reports narrated educative information regarding suicide prevention, none mentioned contact information for help-seeking for the vulnerable. Conclusion: Newspaper reporting of suicide in Nepal poorly adheres to WHO guidelines, substantiated by the high presence of potentially harmful characteristics and negligible presence of potentially helpful characteristics.

Mental health law in Nepal.

During the past three decades Nepal has gone through series of reforms to address the mental health needs of the Nepalese population by promulgation of an exclusive National Mental Health Policy and related Strategic Action Plan. Small but significant improvements have been achieved in Nepal with regard to mental health policies and plans. This article discusses the evolution of mental health policies in Nepal and analyses the challenges to be overcome for their effective implementation.

Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths.

South Asia accounts for the majority of the world's suicide deaths, but typical psychiatric or surveillance-based research approaches are limited due to incomplete vital surveillance. Despite rich anthropological scholarship in the region, such work has not been used to address public health gaps in surveillance and nor inform prevention programs designed based on surveillance data. Our goal was to leverage useful strategies from both public health and anthropological approaches to provide rich narrative reconstructions of suicide events, told by family members or loved ones of the deceased, to further contextualize the circumstances of suicide. Specifically, we sought to untangle socio-cultural and structural patterns in suicide cases to better inform systems-level surveillance strategies and salient community-level suicide prevention opportunities. Using a mixed-methods psychological autopsy approach for cross-cultural research (MPAC) in both urban and rural Nepal, 39 suicide deaths were examined. MPAC was used to document antecedent events, characteristics of persons completing suicide, and perceived drivers of each suicide. Patterns across suicide cases include (1) lack of education (72% of cases); (2) life stressors such as poverty (54%), violence (61.1%), migrant labor (33% of men), and family disputes often resulting in isolation or shame (56.4%); (3) family histories of suicidal behavior (62%), with the majority involving an immediate family member; (4) gender differences: female suicides were attributed to hopeless situations, such as spousal abuse, with high degrees of social stigma. In contrast, male suicides were most commonly associated with drinking and resulted from internalized stigma, such as financial failure or an inability to provide for their family; (5) justifications for suicide were attributions to 'fate' and personality characteristics such as 'stubbornness' and 'egoism'; (5) power dynamics and available agency precluded some families from disputing the death as a suicide and also had implications for the condemnation or justification of particular suicides. Importantly, only 1 out of 3 men and 1 out of 6 women had any communication to family members about suicidal ideation prior to completion. Findings illustrate the importance of MPAC methods for capturing cultural narratives evoked after completed suicides, recognizing culturally salient warning signs, and identifying potential barriers to disclosure and justice seeking by families. These findings elucidate how suicide narratives are structured by family members and reveal public health opportunities for creating or supplementing mortality surveillance, intervening in higher risk populations such as survivors of suicide, and encouraging disclosure.