https://hdl.handle.net/20.500.14356/5 2026-09-22T04:10:06Z 2026-09-22T04:10:06Z Marks, Florian Bhandari, Amit Poudyal, Nimesh Gallagher, Patrick https://hdl.handle.net/20.500.14356/3103 2026-09-18T07:45:27Z 2022-09-01T00:00:00Z

Title: Expanding the volume of historical data on Antimicrobial resistance, use and consumption in the human health in Nepal: a CAPTURA undertaking Authors: Marks, Florian; Bhandari, Amit; Poudyal, Nimesh; Gallagher, Patrick Abstract: Executive Summary: As part of the large Fleming Fund (FF) portfolio of grants funded by the Government of the United Kingdom and established as a response to the global problem of AMR, in 2019 the CAPTURA project was awarded with the specific objective of expanding the volume of historical data on antimicrobial resistance (AMR), consumption (AMC), and use (AMU) in the human health care sector across 12 countries in South and Southeast Asia, including Nepal. AMR context in Nepal AMR is a growing threat for Nepal with high level resistance to commonly used antimicrobials in the country. The AMR-National Action Plan (2018-2022) has identified several challenges to be addressed for achieving its objectives to guide various sectors to ensure a coherent, multi-sectoral approach towards combatting AMR. Nepal has a well-established AMR surveillance system, which is being expanded over time to incorporate new surveillance of emerging resistance and pathogens of interest for the country. Data generated through the network is routinely being shared within the country and externally different mechanisms.The government and private sector players provide Healthcare in Nepal. The Ministry of Health and Population (MoHP), along with multinational development agencies and external partners in the country, are working closely to upgrade the existing infrastructures and technologies to generate standardized quality data. In addition, they are also providing trainings to prepare future leaders to champion the AMR containment efforts. The authority to regulate production, import, sales and prescription of antimicrobials in the country lies with the Department of Drug Administration (DDA). The government has already made efforts to ban over-the-counter sales of antibiotics and their use in animal feed, and has been monitoring the import, production, and sales of antimicrobial agents. But, due to resource limitations, the endeavor has not been highly effective, and a large number of unregistered facilities selling drugs has posed a great challenge. Consolidated antimicrobial production, procurement, and distribution data is not available and there is an urgent need to collect it in a systematic way. With Nepal joining the GLASS-AMC,establishing a future data collection network following the GLASS methodology will enable the country to analyze, use, and share AMC data at both the local and global levels in the coming years. To generate data on antimicrobial use, antimicrobial audits are currently piloted with support from FF Country Grant and is planned to be extended across the country’s major hospitals. The continued collection of national AMR/C/U data will allow Nepal to further establish its national surveillance system as well as to implement evidence-based approaches for treating and managing infectious diseases, tracking AMR trends, and formulating AMR containment strategies. CAPTURA experience CAPTURA’s early engagement with the AMR stakeholders and subsequent effective coordination between the project team and the MoHP led to an expedited approval and work initiation. Although early progress was slowed down by the COVID-19 pandemic, CAPTURA was able to successfully achieve its objectives of identifying and assessing existing microbiology capacity, collecting and analyzing retrospective AMR data, and providing WHONET trainings to technical laboratory staff from both the human and animal health sectors. Further, a subset of AMU data was collected and analyzed as part of a piloting exercise.CAPTURA findings CAPTURA activities in Nepal have enabled capacity building within data management and analysis for future AMR and AMU surveillance efforts. In this report, we present a summary of findings from the scoping and analytical work conducted by CAPTURA in collaboration with the MoHP since 2019. The data content for this final report was selected after discussions with the CAPTURA in-country team and AMR stakeholders at the MoHP. Comprehensive analytical outputs and visualization tools will be shared with the National AMR program, QSRD, NPHL, and data owners before the closure of the project. The main utility of the retrospective data collected on AMR and AMU through the CAPTURA project in Nepal has been to identify the data sources and establish a preliminary data baseline. It is our hope that it can be a useful contribution to planning future investments in combatting AMR in Nepal and the Asian region. Description: Research report.

2022-09-01T00:00:00Z Frongillo JR, Edward Joshi, Nira https://hdl.handle.net/20.500.14356/3102 2026-09-18T07:45:34Z 2021-01-01T00:00:00Z

Title: Suaahara II good nutrition program: evaluating a decade of multisectoral nutrition interventions: impact evaluation report Authors: Frongillo JR, Edward; Joshi, Nira Abstract: Suaahara, funded by USAID, is a comprehensive multi-sectoral nutrition program. Implemented in two phases – Suaahara I (2011-2016) and Suaahara II (2016-2022) – the program aimed to improve maternal and child nutrition in 42 of Nepal’s 77 districts. To achieve this goal, Suaahara delivered interventions in 3,353 wards/communities depending on local needs across nutrition, health and family planning, agriculture and markets, water, sanitation, and hygiene, and nutrition governance. Through these interventions, Suaahara aimed to achieve four Intermediate Results (IRs): IR1) Improved household nutrition, WASH, and health behaviors; IR2) Increased use of quality nutrition and health services by women and children; IR3) Improved access to diverse and nutrient-rich foods by women and children; and IR4) Accelerated rollout of Multi-Sector Nutrition Plan (MSNP) through strengthened local governance. Suaahara was extensively built upon government structures, community platforms and national programs to target marginalized and socially vulnerable groups. To evaluate the impact of Suaahara, a series of independent impact evaluation studies were conducted. This report presents each of the evaluation studies separately. Each evaluation was geared towards assessing the impact of Suaahara on each of the intermediate results (IRs) as outlined in the foreword. The evaluation of IR1 observed that Suaahara improved mother’s lives as manifested by improved maternal dietary diversity, weight, and rate of institutional delivery. Possibly reflecting improved prenatal conditions, the length of infants 0-5.9 months improved. Complementary feeding of infants and young children ages 6 to 23.9 months improved as reflected in improved dietary diversity, minimum acceptable diet, minimum meal frequency, and offering children more food when sick. Availability of soap and water at handwashing stations improved. These improvements in intervention districts relative to comparison districts were achieved despite substantial challenges Suaahara faced during the ten years of intervention. The evaluation of IR2 assessed Suaahara’s impact on health system strengthening. This evaluation observed that health facility workers and FCHVs in the intervention districts reported better knowledge on CB-IMCI, and GMP than in comparison districts. In terms of improved service delivery, the mean scores for service availability were higher in the intervention districts for maternal nutrition services, child nutrition services, ANC services, and FP services. Health facilities in intervention districts, compared to comparison districts, had better availability and use of reference materials and guidelines for GMP service, and counseling aids to provide nutrition assessment and GMP, FP, ANC, and PNC services. Also, a higher proportion of FCHVs from the intervention districts (36% vs. 4%) mentioned implementing the Self-Applied Technique for Health (SATH) approach in the mother groups they facilitate. In short, Suaahara interventions contributed to strengthen the health system across the two components (capacity building and improved quality service delivery). For evaluating IR3, two separate studies were conducted – quantitative and qualitative. The quantitative study aimed to understand the role of the HFP program in improving availability, accessibility, and consumption of diverse nutrient-rich foods in the marginalized and food insecure communities in Darchula. The evaluation observed that vegetable production diversity increased by 49% after the households received the HFP program. In addition, the likelihood of production of dark-green leafy vegetables and beans and pulses increased for the households after receiving the HFP program. Income from the sale of surplus vegetables was about USD 69 greater among the households after participating in the HFP program than before the program. Women’s knowledge on child nutrition and health improved after receiving the HFP program. Women were more empowered after being enrolled into the HFP program as indicated by their improved decision-making power over the use of income and the control of productive assets in the households. To substantiate the findings of the quantitative evaluation, a qualitative study was conducted in the same district (Darchula) with participating HFP members. This qualitative evaluation also observed that knowledge and practice related to homestead gardening improved among program participants. The knowledge HFP-participants had on consumption of nutrient-rich foods was also being translated into practice. For example, the knowledge and practice on child’s dietary diversity was quite high. The evaluation found the increased availability of nutrient-rich food at both household and community levels. There was increased income among HFP households through selling of surpluses which was largely due to growing off-season vegetables. However, a few barriers that prevented from yielding better results were lack of necessary materials (building fences, constructing semi-intensive coops etc.), lack of financial resources (purchasing polyhouses, purchasing materials for fence or coops etc.), lack of skilled manpower (installing polyhouses, constructing semi-intensive coops etc.) and lack of space (constructing semi-intensive coops, land availability to undertake tunnel farming etc.). The qualitative evaluation suggests that there’s need to establish strong linkages between farmers and local markets. Also, one of the key criteria for VMF selection should be based on their dedication and commitment for full engagement. The final part of the evaluation assessed Suaahara’s impact on improving multi-sector coordination for implementing the MSNP at the national, provincial, and municipal levels in Nepal. This study followed a rigorous qualitative design. The study observed that most multi-sector stakeholders understand their role in implementing the MSNP to promote nutrition in Nepal and can articulate specific programs within their sector that advances multi-sector nutrition activities. Suaahara II has positively contributed to building stakeholders’ capacity and facilitating an effective implementation of the MSNP, however challenges remain. Suaahara II has been particularly effective at promoting awareness for multi-sector roles, leadership, and coordination for promoting nutrition; demanding budgets for multi-sector nutrition activities; and nutrition-related concepts and practices across sectors and government levels. Suaahara II was effective at navigating and adapting to the shift to federalism and leveraging existing networks to strengthen their implementation of nutrition-focused activities, particularly at the local level. Yet, there exist gaps and challenges that hinder the effective implementation of the MSNP. Such challenges include insufficient human resources at the provincial level to adequately coordinate implementation at the municipal level and the lack of a formal reporting mechanism to enable provincial and municipal level stakeholders to effectively monitor progress towards goals and implementation activities. Additionally, the lack of a formal coordination mechanism hinders productive provincial and municipal level stakeholder collaboration, as does the limited capacity of available trained, technical specialists at the municipal level to design and implement activities. The study observed that the GoN heavy relied on Suaahara II to implement nutrition-focused awareness raising and promotion activities, to strengthen capacity building, facilitate multi-sector coordination, and to enable vertical coordination. Suaahara II was effective at reaching local communities to promote nutrition, as evidenced by the differences in nutrition knowledge and awareness reported by municipal-level stakeholders in intervention and comparison areas. Description: Research report.

2021-01-01T00:00:00Z Thapa, Raba https://hdl.handle.net/20.500.14356/3101 2026-09-18T07:45:35Z 2022-01-01T00:00:00Z

Title: Genetic aetiology of age related macular degeneration in population of Nepal: Hospital based comparative study Authors: Thapa, Raba Abstract: Background Age related macular degeneration (AMD) is the leading cause of blindness after cataract among elderly in developing countries. AMD is the most common retinal disorder and one of the leading cause of blindness among elderly in Nepal. Various modifiable and non-modifiable risk factors have been identified for the development of AMD. Genetics of AMD has been extensively studied in the recent years and genetic susceptibility of AMD has been identified. The two major susceptibility genes for AMD are CFH (1q31) which codes for complement factor H, and ARMS2 (10q26) for which the gene product and function are poorly understood. The mutations in these genes increased the chance of AMD. Although many studies are conducted in the developed world, only limited studies are from low and middle income countries. To the best of our knowledge, there are no reported studies on genetics of AMD in Nepal. This study aimed to assess the genetic etiology of AMD among Nepalese population in a hospital setting. Methodology: This study is a hospital based cross sectional study. Patients at the age 65 years and above with all types of AMD were enrolled for AMD cases. Control groups for the AMD cases included age matched subjects at the age 65 years and above and those without AMD and other retinal pathologies that hinders the grading of AMD. The number of cases and controls necessary for this study was estimated for chi-squared tests of association and linear regression models. We estimated that recruiting 160 cases and 160 controls sufficient to identify associations between selected risk variants and AMD in the Nepalese population with a power of 95%. However, as there are no other baseline data from Nepal on genetic components, we enrolled additional 40 participants in each groups to address any unforeseen contingency such as poor image quality, problems in DNA extraction and genetic analysis etc. So, the total study participants included 200 cases of AMD and 200 cases of control in this study. Detailed history, ocular examination under mydriasis, fundus photography, macular OCT were taken from all study participants. 5 ml blood will be drawn to prepare DNA extraction and haplotype and diplotype analysis of DNA extraction were carried out to assess the genetic etiology. Results/Conclusion: A total of 400 study participants were enrolled, which included 200 AMD cases and 200 control individuals aged 65 year and above. The mean age for AMD cases (200) was 72.86 years (SD 5.10) and the control group (200) was 72.58 (SD 5.33). The prevalence of AMD-associated loci in Nepal was ascertained. Nepali individuals show significant associations with key variants in the CFH-CFHR5, ARMS2/HTRA1, C2/CFB, and C3 loci. Nepalis exhibit a particularly high frequency of the risk allele of ARMS2/HTRA1. At the CFH-CFHR5 locus, the frequency of AMD risk at CFH rs1061170 is lower than what is observed in Europeans, but higher than what is observed in East Asians. The frequency of the protective allele CFH I62 (rs800292) is higher than what is observed in Europeans, while the incidence of the protective CFHR3/CFHR1 deletion appears comparable, assuming that the rs12144939 variant is an effective tag for the CFHR/CFHR1 deletion. Nepali haplotype structure in the CFH-CFHR5 region appears similar to that observed in Europeans and other non-African populations. AMD haplotype associations largely mirror what is observed in well-studied European cohorts. Description: Research Report.

2022-01-01T00:00:00Z Khatri, Bishnu Bahadur https://hdl.handle.net/20.500.14356/3100 2026-09-18T07:45:23Z 2023-09-01T00:00:00Z

Title: Navigating the cyber menace: a study on online safety among children in Nepal Authors: Khatri, Bishnu Bahadur Abstract: NA

2023-09-01T00:00:00Z