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Investing in health drives individual wellbeing, productivity, educational achievements, and economic growth. Collective global efforts have historically eradicated diseases like smallpox and are making progress against others, such as polio and malaria. In many low- and middle-income countries (LMICs), public health spending is insufficient, with per capita expenditure far below what is needed to deliver and sustain essential health services. High-income countries, such as the United States, are contributing to LMICs to bridge these gaps through bilateral and multilateral development assistance. The United States Government's longstanding support in Nepal has helped to strengthen the health systems and resulted remarkable achievements. However, the new United States administration's abrupt decisions to halt the development assistance and closure of most of the projects will significantly impact global health initiatives, jeopardize health gains, and pose a risk to global health security. This call-for-action urge stakeholders to evaluate the current and potential impact of these decisions and adopt a cohesive approach to maintain development cooperation. LMICs also must reassess their health investments and implement reforms to build resilient, self-sustaining health systems.

Background Intra-aural tick infestations, though uncommon, pose a serious clinical challenge owing to the risk of acute labyrinthitis—an inflammatory condition of the inner ear. This inflammation can lead to severe complications such as sensorineural hearing loss, vertigo, and facial nerve palsy. Prompt recognition and management are crucial to prevent these adverse outcomes. Case presentation A 21-year-old female patient of Limbu ethnicity from Dharan presented with sudden-onset right-sided otalgia, accompanied by vertigo, emesis, and auditory impairment. Otoscopic examination revealed a tick lodged in the anteroinferior aspect of the external auditory canal, and audiological assessment indicated profound sensorineural hearing loss on the affected side. Treatment involved careful tick removal using suction and forceps, supplemented by pharmacotherapy including antiinflammatory agents, analgesics, systemic steroids, and prophylactic antibiotics. Her symptoms resolved completely within 4 weeks, with postinterventional audiometry confirming restored auditory acuity. Conclusion This case underscores the importance of prompt clinical assessment and treatment in cases of aural tick infestation. The successful use of a multimodal approach highlights the effectiveness of comprehensive management. Further research is warranted to optimize treatment strategies and improve outcomes in similar cases.

Background Nepal is committed to achieving the Sustainable Development Goal (SDG) 2030 target 3.1 of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. Along with increasing access to health facility (HF)-based delivery services, improving HF readiness is critically important. The majority of births in Nepal are normal low-risk births and most of them take place in public HFs, as does the majority of maternal deaths. This study aims to assess changes in HF readiness in Nepal between 2015 and 2021, notably, if HF readiness for providing high-quality services for normal low-risk deliveries improved; if the functionality of basic emergency obstetric and neonatal care (BEmONC) services increased; and if infection prevention and control improved. Methods Cross-sectional data from two nationally representative HF-based surveys in 2015 and 2021 were analyzed. This included 457 HFs in 2015 and 804 HFs in 2021, providing normal low-risk delivery services. Indices for HF readiness for normal low-risk delivery services, BEmONC service functionality, and infection prevention and control were computed. Independent sample T-test was used to measure changes over time. The results were stratified by public versus private HFs. Results Despite a statistically significant increase in the overall HF readiness index for normal low-risk delivery services, from 37.9% in 2015 to 43.7%, in 2021, HF readiness in 2021 remained inadequate. The availability of trained providers, essential medicines for mothers, and basic equipment and supplies was high, while that of essential medicines for newborns was moderate; availability of delivery care guidelines was low. BEmONC service functionality did not improve and remained below five percent facility coverage at both time points. In private HFs, readiness for good quality obstetrical care was higher than in public HFs at both time points. The infection prevention and control index improved over time; however, facility coverage in 2021 remained below ten percent. Conclusions The slow progress and sub-optimal readiness for normal, low-risk deliveries and infection prevention and control, along with declining and low BEmONC service functionality in 2021 is reflective of poor quality of care and provides some proximate explanation for the moderately high maternal mortality and the stagnation of neonatal mortality in Nepal. To reach the SDG 2030 target of reducing maternal deaths, Nepal must hasten its efforts to strengthen supply chain systems to enhance the availability and utilization of essential medicines, equipment, and supplies, along with guidelines, to bolster the human resource capacity, and to implement mechanisms to monitor quality of care. In general, the capacity of local governments to deliver basic healthcare services needs to be increased.

A body of evidence suggests that vaccines support the development of the immune system and also improve overall health. To study the effect of the complete basic vaccination schedule (Bacille Calmette-Guerin, i.e., BCG; measles; polio 3; and Diphtheria, Tetanus toxoids, and Pertussis, i.e., DTP3) on nutritional status of children under 2 years of age. Recent DHS data from 16 countries conducted after 2013 were used. After a bivariate descriptive analysis, a logistic regression analysis was conducted to predict the likelihood of underweight, stunting, and wasting by immunization status. A combined odds ratio was computed and adjusted for background variables. A significantly higher prevalence of underweight was found among children with incomplete vaccination schedules in seven countries. Similarly, wasting and stunting were frequently observed in under-vaccinated children in four countries. Moreover, logistic regression adjusted for background variables revealed a relation between incomplete vaccination and underweight in Angola, Chad, and Guatemala (95% CI lower bound > 1). Combining data of all countries, underweight (adjusted Odds Ratio, aOR 1.21, 95% CI 1.11-1.31), wasting (aOR 1.18, 95% CI 1.05-1.33), and stunting (aOR 1.07, 95% CI 1.00-1.14) were associated with poor vaccination status. The overall effect was consistent with both sexes except the results for wasting for females and stunting for males, though insignificant.

Background Compliance with standards of care is required for sustained improvement in the quality of delivery services. It thus represents a key challenge to improving maternal survival and meeting the Sustainable Development Goal (SDG) target of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. This study examines the extent to which normal low-risk health facility deliveries in Nepal meet the standards of quality of care and assesses the effect of the standards of quality of care and various contextual factors on women’s satisfaction with the services they receive. Methods Drawing on the 2021 Nepal Health Facility Survey, the sample comprised 320 women who used health facilities for normal, low-risk delivery services. A weighted one-sample t-test was applied to examine the proportion of deliveries meeting the eight standards of care. Women’s overall satisfaction level was computed from seven satisfaction variables measured on a Likert scale, using principal component analysis. The composite measure was then dichotomized. Binary logistic regression was used to analyze the determinants of women’s satisfaction with delivery care services. Results Deliveries complying with the eight standards of care and its 53 indicators varied widely; output indicators were more frequently met than input indicators. Of the eight standards of care, the “functional referral system” performed highest (92.0%), while “competent, motivated human resources” performed the least (52.4%). Women who were attended by a provider when they called for support (AOR: 5.29; CI: 1.18, 23.64), who delivered in health facilities that displayed health statistics (AOR 3.16; CI: 1.87, 5.33), who experienced caring behaviors from providers (AOR: 2.59; CI: 1.06, 6.30) and who enjoyed audio-visual privacy (AOR 2.13; CI: 1.04, 4.38) had higher satisfaction levels compared to their counterparts. The implementation of the Maternity Incentive Scheme and presence of a maternal waiting room in health facilities, however, were associated with lower satisfaction levels. Conclusions Nepal performed moderately well in meeting the standards of care for normal, low-risk deliveries. To meet the SDG target Nepal must accelerate progress. It needs to focus on people-centered quality improvement to routinely assess the standards of care, mobilize available resources, improve coordination among the three tiers of government, and implement high-impact programs.

Early marriage is one of the major traditional practices that affects the life of both boys and girls in many different ways. In this context, this research assessed the prevalence of early marriage and derived its underlying causes. Adopting a mixed methods approach, first, the study surveyed a sample of 1350 households of Nepal in which at least a marriage took place within the five years before the survey. Following a survey, secondly, the study explored 30 unique cases of early marriage, and ten among them were studied in more depth through face-to-face interviews. Logistic regression was applied to determine the factors that could influence the prevalence of early marriage. It was then followed by an analysis of the qualitative data. The research findings demonstrate that there is a high prevalence of early marriage (49.6%) among households within Nepal; nevertheless, the overall trend of early marriage is noted at a decreasing trend over the years. Undoubtedly, factors such as the level of education of the family members, the gender of the head of the household, and religion, influence the predisposition to early marriage within Nepal. Early marriage is undeniably a subjective phenomenon; however, such subjectivity is shaped by the socio-economic situation, as well as individual and family values. Thus, among others, the study implied that improving the strategies that promote higher formal schooling could reduce the prevalence of early marriage and thereby result in associated beneficial welfare effects in Nepal.

Vagal schwannoma is a benign tumor that can occasionally develop into malignant degeneration from the Schwann cells surrounding the cranial, peripheral, and autonomic nerves. The schwannomas arising in the head and neck region are rare, and rarer is their origin from the cervical vagus nerve. Despite being challenging, multiple treatment options are available, including observation, complete tumor excision with nerve transaction, and nerve preservation, depending on clinicoradiological factors. The cervical vagal schwannoma is a rare entity. We report a rare case of a 50‐year‐old female with painless swelling on the right side of the neck associated with mild discomfort during swallowing, diagnosed as cervical vagal schwannoma.

Primary thyroid lymphoma (PTL) is a rare malignancy, comprising 1%–5% of thyroid cancers and 2%–5% of extranodal lymphomas, with diffuse large B‐cell lymphoma (DLBCL) being the most common subtype. PTL often coexists with Hashimoto thyroiditis, leading to diagnostic delays. We report a case of a man in his early 70s who presented with a progressively enlarging, painless anterior neck mass over 2.5 years. Initial fine needle aspiration cytology (FNAC), repeated twice over 18 months, suggested lymphocytic thyroiditis. Due to persistent growth and inconclusive FNAC results, the patient underwent a right hemithyroidectomy with central neck dissection. Histopathological examination and immunohistochemistry confirmed DLBCL, activated B cell (ABC) subtype. He was started on R‐CHOP chemotherapy. FNAC, although a first‐line diagnostic tool for thyroid nodules, has a low sensitivity to PTL, especially in the context of underlying thyroiditis. Advanced diagnostic techniques such as immunohistochemistry, flow cytometry, and core needle biopsy (CNB) significantly improve accuracy but are often inaccessible in low‐resource settings. CNB offers a preserved tissue architecture and a higher diagnostic yield, reducing unnecessary surgeries. This case underscores the diagnostic limitations of FNAC in PTL and highlights the need for improved diagnostic approaches, including CNB and auxiliary tests, to ensure early and accurate diagnosis, especially in settings with limited resources.

Background Despite recent improvements in the overall health status of Nepal’s population, newborn morbidities and mortalities have remained a challenge. This study explores the situation and care strategies for newborn health problems in the Gandaki Province of Nepal. Methods This is a retrospective hospital records analysis. A structured questionnaire was employed to collect data on socio-demographic, clinical, and outcome variables in 1,355 newborns admitted to the Special Newborn Care Unit (SNCU) between May 1, 2021, and April 30, 2022, in five hospitals within the Gandaki Province. Results Among all newborns, 60% were male, and 40% belonged to Janajati indigenous families. The mean age of mothers at the time of delivery was 24.4 years; the average birth weight of babies was 2.8 kg; and the gestational week was 38 weeks. Around 96% of births occurred in healthcare facilities. The average inpatient hospital stay was 4.7 days. The reasons for SNCU admission were newborn sepsis (51%), neonatal hyperbilirubinemia (23%), respiratory distress syndrome (18%), and low birth weight (11%). Approximately 7% of the newborns were found to have died due to various causes, including sepsis, asphyxia, and indirect medical reasons. Female newborns had a 0.45-times (CI: 0.23–0.84) lower risk of mortality compared to male newborns. Underweight newborns had 8.8 times (CI: 4.5–17.2) higher risk of death than newborns with a normal birth weight, even after adjusting for other factors like sex, delivery site, mode of delivery, mother’s age, respiratory distress syndrome, neonatal hyperbilirubinemia, neonatal sepsis, and age at admission to SNCU. The most common treatments included injectable antibiotics (73%), intravenous fluids (53%), oxygen delivery (39%), and phototherapy (36%), while 3% received “Kangaroo Mother Care (KMC)”. Conclusions The study showed that newborns suffered from multiple health complications such as sepsis, hyperbilirubinemia, or asphyxia, and many newborns received essential medical services from hospitals. Birth weight, sex of the newborn, and respiratory distress syndrome were significantly associated with neonatal mortality. Hospitals should focus on reinforcing KMC, neonatal resuscitation, and early infection control measures.

Background Giving birth assisted by skilled care in a health facility plays a vital role in preventing maternal deaths. In Nepal, delivery services are free and a cash incentive is provided to women giving birth at a health facility. Nevertheless, about half of women still deliver at home. This study explores socio-cultural and health service-related barriers to and facilitators of institutional delivery. Methods Six village development committees in hill and plain areas were selected in Chitwan district. We conducted a total of 10 focus group discussions and 12 in-depth-interviews with relevant stakeholder groups, including mothers, husbands, mothers-in-law, traditional birth attendants, female community health volunteers, health service providers and district health managers. Data were analyzed inductively using thematic analysis. Results Three main themes played a role in deciding the place of delivery, i.e. socio-cultural norms and values; access to birthing facilities; and perceptions regarding the quality of health services. Factors encouraging an institutional delivery included complications during labour, supportive husbands and mothers-in-law, the availability of an ambulance, having birthing centres nearby, locally sufficient financial incentives and/or material incentives, the 24-h availability of midwives and friendly health service providers. Socio-cultural barriers to institutional deliveries were deeply held beliefs about childbirth being a normal life event, the wish to be cared for by family members, greater freedom of movement at home, a warm environment, the possibility to obtain appropriate “hot” foods, and shyness of young women and their position in the family hierarchy. Accessibility and quality of health services also presented barriers, including lack of road and transportation, insufficient financial incentives, poor infrastructure and equipment at birthing centres and the young age and perceived incompetence of midwives. Conclusion Despite much progress in recent years, this study revealed some important barriers to the utilization of health services. It suggests that a combination of upgrading birthing centres and strengthening the competencies of health personnel while embracing and addressing deeply rooted family values and traditions can improve existing programmes and further increase institutional delivery rates.