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Wildfires are increasingly threatening Nepal, particularly during the dry pre-monsoon months (March-May), leading to severe ecological impacts and disruptions to local communities. To improve wildfire prediction and preparedness, this study evaluated four advanced machine learning algorithms—Random Forest, Radial Basis Function Neural Network, Artificial Neural Network, and Support Vector Machine—using comprehensive dataset (2001–2023) of meteorological, topographical, anthropogenic, locational, and vegetation variables. The Random Forest (RF) model outperformed others, achieving the highest accuracy (88.6%) and predictive reliability (AUC: 0.96). Notably, vapor pressure deficit emerged as the strongest predictor, contrasting previous studies where precipitation was often considered dominant. Utilizing the robust RF model, a high resolution (1-km) wildfire risk map identified 11.1% of Nepal, encompassing 12 districts and 48 municipalities primarily in the southwestern region, as very high-risk areas. By integrating daily meteorological data into wildfire predictions, this research provides an innovative framework that enhances risk management strategies, offering actionable insights for decision-makers and supporting resilience-building efforts in fire prone regions.

Improvements in standard precaution related to infection prevention and control (IPC) at the national and local-level health facilities (HFs) are critical to ensuring patient's safety, preventing healthcare-associated infections (HAIs), mitigating Antimicrobial Resistance (AMR), protecting health workers, and improving trust in HFs. This study aimed to assess HF's readiness to implement standard precautions for IPC in Nepal. This study conducted a secondary analysis of the nationally-representative Nepal Health Facility Survey (NHFS) 2021 data and used the Service Availability and Readiness Assessment (SARA) Manual from the World Health Organization (WHO) to examine the HF's readiness to implement standard precautions for IPC. The readiness score for IPC was calculated for eight service delivery domains based on the availability of eight tracer items: guidelines for standard precautions, latex gloves, soap and running water or alcohol-based hand rub, single use of standard disposal or auto-disable syringes, disinfectant, safe final disposal of sharps, safe final disposal of infectious wastes, and appropriate storage of infectious waste. We used simple and multiple linear regression and quantile regression models to examine the association of HF's readiness with their characteristics. Results were presented as beta (β) coefficients and 95% confidence interval (95% CI). The overall readiness scores of all HFs, federal/provincial hospitals, local HFs, and private hospitals were 59.9±15.6, 67.1±14.4, 59.6±15.6, and 62.6±15.5, respectively. Across all eight health service delivery domains, the HFs' readiness for tuberculosis services was the lowest (57.8±20.0) and highest for delivery and newborn care services (67.1±15.6). The HFs performing quality assurance activities (β = 3.68; 95%CI: 1.84, 5.51), reviewing clients' opinions (β = 6.66; 95%CI: 2.54, 10.77), and HFs with a monthly meeting (β = 3.28; 95%CI: 1.08, 5.49) had higher readiness scores. The HFs from Bagmati, Gandaki, Lumbini, Karnali and Sudurpaschim had readiness scores higher by 7.80 (95%CI: 5.24, 10.36), 7.73 (95%CI: 4.83, 10.62), 4.76 (95%CI: 2.00, 7.52), 9.40 (95%CI: 6.11, 12.68), and 3.77 (95%CI: 0.81, 6.74) compared to Koshi. The readiness of HFs to implement standard precautions was higher in HFs with quality assurance activities, monthly HF meetings, and mechanisms for reviewing clients' opinions. Emphasizing quality assurance activities, implementing client feedback mechanisms, and promoting effective management practices in HFs with poor readiness can help to enhance IPC efforts.

With high burden of maternal mortality and stagnant neonatal mortality, maternal and newborn health services have remained a priority program for Nepal. This study aims to assess the determinants of four or more antenatal care (≥4 ANC) visits, institutional delivery (ID), postnatal care (PNC) visit for mother and newborn within the first two days of delivery and the continuum of care. We performed weighted analysis of Nepal Demographic and Health Survey (NDHS) 2022 data accounting for complex survey design. The NDHS is a nationally representative cross-sectional survey that employs a two-stage stratified sampling technique to select participants. We analyzed data from 1,891 women who had live births within two years prior to the survey. Distribution of variables are described using frequency, percentage, and 95% confidence intervals (CI). We performed bivariate and multivariable logistic regression and the results are presented in crude odds ratio (COR), adjusted odds ratio (AOR) and 95% CI. In the study, 80.62% (95% CI: 77.95, 83.03) of participants had ≥ 4 ANC visits, 79.37% (95% CI: 76.68, 81.82) had ID, and 62.56% (95% CI: 56.67, 65.36) received PNC for mother and newborn within two days of delivery. Likewise, 67.59% (95% CI: 64.59, 70.45) had both ≥ 4 ANC visits and ID, while 51.01% (95% CI: 48.08, 53.93) had all three components of the continuum of care: ≥ 4 ANC visits, ID, and PNC visit within two days of delivery. The richest wealth quintile participants had three folds higher odds (AOR: 2.98, 95% CI: 1.83, 4.83) of completing continuum of care, while the odds were two folds (AOR: 2.04, 95% CI: 1.41, 2.94) higher for richer wealth quintile participants. Participants with birth order three or more had lower odds (AOR: 0.50, 95% CI: 0.36, 0.69) of completing all three continuum of care components. Among other variables associated with continuum of care were province, distance to facility and internet use. Significant disparities exist in continuum of care or its components based on wealth quintile, province, and place of residence. Tackling economic gaps, provincial disparities, and leveraging technology are crucial for ensuring fair access to essential maternal health services. Nepal's transition to a federal structure with 7 provinces and 753 local governments with decision making authority presents an opportunity to test and scale up innovative strategies for improving continuum of care coverage.

Cancer care in countries in the South Asian Association for Regional Cooperation (SAARC) is hindered by many challenges, including inadequate infrastructure, a shortage of skilled health-care professionals, and economic constraints. These factors contribute to disparities in timely diagnosis and treatment, leading to poorer health outcomes. Health-care systems within the region vary considerably, ranging from free public health care in Sri Lanka to predominantly out-of-pocket expenses in Bangladesh, highlighting inequities in financial access and service delivery for patients within this region. The absence of comprehensive national health insurance systems imposes substantial financial burdens on patients with cancer and their families, often resulting in catastrophic health-care costs. Paediatric oncology services reflect these disparities with greater clarity. Although Bangladesh has developed multiple treatment centres, issues such as delayed diagnoses and financial barriers persist. By contrast, countries such as Afghanistan and the Maldives have few specialised paediatric oncology services, necessitating costly referrals abroad that place large strains on families. Geriatric oncology remains underdeveloped across most SAARC nations, with few dedicated services and guidelines. Despite progress in India and Sri Lanka, gaps in specialised training and holistic care for older patients remain. Addressing these disparities requires coordinated efforts, including improving health-care infrastructure, expanding insurance coverage, and fostering regional collaborations. Implementing comprehensive national cancer control programmes across SAARC nations, leveraging intercountry networks, and ensuring political commitment are essential to achieving equitable cancer care and advancing Sustainable Development Goals in the region.

Background Participatory policy analysis (PPA) as a method in health policy and system research remains underexplored. Using our experiences of conducting PPA workshops in Nepal to explore the impact of the country’s move to federalism on its health system, we reflect on the method’s strengths and challenges. We provide an account of the study context, the design and implementation of the workshops, and our reflections on the approach’s strengths and challenges. Findings on the impact of federalism on the health system are beyond the scope of this manuscript. Main body We conducted PPA workshops with a wide range of health system stakeholders (political, administrative and service-level workforce) at the local and provincial levels in Nepal. The workshops consisted of three activities: river of life, brainstorming and prioritization, and problem-tree analysis. Our experiences show that PPA workshops can be a valuable approach to explore health policy and system issues – especially in a context of widespread systemic change which impacts all stakeholders within the health system. Effective engagement of stakeholders and activities that encourage both individual- and system-level reflections and discussions not only help in generating rich qualitative data, but can also address gaps in participants’ understanding of practical, technical and political aspects of the health system, aid policy dissemination of research findings, and assist in identifying short- and long-term practice and policy issues that need to be addressed for better health system performance and outcomes. Conducting PPA workshops is, however, challenging for a number of reasons, including the influence of gatekeepers and power dynamics between stakeholders/participants. The role and skills of researchers/facilitators in navigating such challenges are vital for success. Although the long-term impact of such workshops needs further research, our study shows the usefulness of PPA workshops for researchers, for participants and for the wider health system. Conclusions PPA workshops can effectively generate and synthesize health policy and system evidence through collaborative engagement of health system stakeholders with varied roles. When designed with careful consideration for context and stakeholders’ needs, it has great potential as a method in health policy and systems research.

Intimate partner violence (IPV) is a well-established driver of mental health problems, often doubling the prevalence of depression. In Nepal, approximately one in four women experience IPV, with young women disproportionately affected by mental health issues. Many women in Nepal reside with their mothers-in-law (MILs), who can influence violence and restrict women's mobility, highlighting the importance of including them in interventions targeting IPV. To address this, we developed a Multi-component family Intervention to Lower depression and Address intimate Partner violence (MILAP) and will conduct a randomized controlled trial (RCT) to evaluate its effectiveness in reducing IPV and depression. This RCT will enroll 300 family triads, each comprising a young married woman (aged 15-24), her husband, and her MIL. Blinded staff will conduct baseline assessments, after which each triad will be randomly assigned to either the MILAP or enhanced usual care (EUC). MILAP comprises nine sessions delivered by trained psychosocial counselors and focuses on strengthening the supportive relationship between MILs and daughters-in-law (DILs), providing behavioral couples therapy, and enhancing overall family dynamics. EUC includes standard care, such as individual and group counseling for IPV, enhanced with crisis counseling and referral support to ensure participant safety and access to additional resources. All participants, regardless of intervention allocation, will be assessed at baseline and at 1-, 3-, 6-, 9-, and 12-month follow-ups. These assessments will measure the following: primary outcomes (depression using Patient Health Questionnaire-9, IPV using Indian Family Violence and Control Scale); secondary outcome (post-traumatic stress disorder (PTSD) using PTSD CheckList-Civilian Version); and other outcomes. We will also conduct serial in-depth interviews to explore the mechanisms underlying MILAP's effectiveness and perform a cost-effectiveness analysis to assess its potential for scalable implementation. MILAP is a culturally adapted, family-based intervention designed to reduce IPV and depression among young Nepali women by improving communication, strengthening coping skills, and fostering supportive family relationships. This trial will assess MILAP's effectiveness, ethical rigor, cultural relevance, and scalability, with the goal of reducing IPV and improving family dynamics in low- and middle-income settings. This trial is registered in ClinicalTrials.gov with the National Clinical Trial (NCT) number: NCT06834867; first registered on February 24, 2025.

Background Common mental health conditions (CMHCs) such as depression and anxiety often co-occur with noncommunicable diseases (NCDs) like hypertension and diabetes, compounding disability and mortality particularly in low- and middle-income countries (LMICs), with under-resourced health systems. This comorbidity is driven by shared behavioral risk factors including stress, isolation, tobacco use, inactivity, poor diet, and nonadherence to treatment. The World Health Organization recommends evidence-based stress reduction (EBSR), behavioral activation (BA), and motivational interviewing (MI) to address these modifiable risks, but the implementation of such multi-component behavioral interventions in community-based settings remains limited. There is a critical gap in implementation research on how best to deliver these combined interventions through community health workers (CHWs) within public health systems. This study addresses that gap by evaluating the effectiveness, implementation, and scalability of the BEhavioral Community-based COmbined Intervention for MEntal health and noncommunicable diseases (BECOME). The trial assesses clinical outcomes, implementation outcomes using the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework at patient, provider, and health system levels and conducts a comprehensive costing analysis to inform future scale-up. Methods This is a stepped-wedge cluster randomized controlled trial involving 20 geographic clusters across two provinces of Nepal and 700 participants aged 40 years and above with at least one CMHC and one NCD. CHWs will be trained to deliver BECOME, comprising EBSR, BA, and MI, while the control period will include enhanced usual care. Primary outcomes include changes in CMHC severity and secondary outcomes include NCD outcomes, behavioral factors, and implementation processes. Focus group discussions and in-depth interviews with CHWs, patients, healthcare providers, and health system leaders will explore intervention acceptability and mechanisms of change. Structured costing analysis will estimate the intervention costs. Discussion Participant recruitment began in July 2024 and is currently ongoing. We anticipate completing data collection for the primary outcome measures by January 2027, with the aim of disseminating preliminary findings within the same year. Findings from this study will provide evidence on the effectiveness and feasibility of a CHW-delivered, integrated behavioral intervention, BECOME, for CMHCs and NCDs in LMICs, informing potential scale-up. Trial registration ClinicalTrials.gov, NCT06449521, Registered on 25 April 2024, https://register.clinicaltrials.gov/prs/beta/studies/S000DZJN00000112/recordSummary .

South Asian Association for Regional Collaboration (SAARC) countries, home to 24% of the world's population, are facing the double burden of disease (ie, where a population experiences both an increasing incidence of cancers typically associated with affluence and a sustained or rising burden of cancers linked to infections and poverty) with non-communicable diseases (NCDs) attributing to 47% of the global burden of disease and to about 60% of all deaths. In 2022, cancer in this region accounted for approximately 9·3% of incidence worldwide and 12% of global mortality. Cancer is one of the major NCDs affecting South Asia, accounting for a large proportion of disability-adjusted life-years lost in this region. The most common cancers are lung, head and neck, and gastrointestinal cancers in both sexes, and cervix and breast cancers in females. The cancer burden is high in SAARC countries, although there are differences among countries and within urban and rural regions of each country, depending on the level of available resources, development, and epidemiological shift. Here we discuss various cancer care issues and challenges throughout the cancer care continuum in the SAARC region. We make an urgent call for regional collaboration to develop, modify, and implement a holistic cancer control plan and formulate a systematic approach directed to address the growing burden of cancer in this region. It is crucial to establish strong political will and commitment to take forward the recommended actions outlined in this Series to overcome and address the cancer crisis in the SAARC region, aligning with Sustainable Development Goal 2030 targets.

Cancer is a major global health threat, with 35 million new cases projected by 2050, predominantly in low-income and middle-income-countries. Within South Asian Association for Regional Cooperation (SAARC) countries, a notable gap in cancer research investment and output compared with high-income countries highlights the need to strengthen research capacity. The rising cancer incidence across SAARC countries is not being matched by local research, particularly in clinical trials in molecular biology, targeted therapy, immunotherapy, and cancer vaccines. This paucity of research is problematic as guidelines and therapies developed in high-income countries might not be directly applicable to low-income and middle-income countries due to distinct regional sociocultural, genetic, and environmental factors and are often impractical in these countries due to cost and implementation challenges. This Series paper examines the cancer research landscape within SAARC countries, focusing on Bangladesh, Nepal, Sri Lanka, India, Pakistan, Afghanistan, Bhutan, and Maldives. We analyse PubMed publication rates and examine available infrastructure, current research (including clinical trials), and limitations and disparities among SAARC countries in terms of cancer research. Key challenges include disparities in health-care access, cultural and economic barriers, and little funding and infrastructure. Strengthening cancer research in SAARC countries requires building collaborative networks, improving research facilities and training, focusing on local epidemiological studies, and developing affordable technologies and treatments. Effective policy and stakeholder engagement could greatly advance cancer care in the region.

The education and training of the oncological health-care workforce is vital for building effective health-care systems that deliver optimal care to patients with cancer. In the South Asian Association for Regional Cooperation (SAARC) nations, there is a notable shortage of both physician and non-physician oncology professionals, including oncologists, medical physicists, radiotherapy technologists, and oncology nurses. This shortage is primarily caused by inadequate education and training programmes. Oncology professionals across SAARC countries face several challenges, including a scarcity of trained personnel, poor health-care infrastructure (including resources and equipment), and insufficient educational opportunities. This Series paper examines the current state of oncology education and training programmes within the SAARC region, identifies the challenges faced by oncology professionals, and offers recommendations for improvement. Short-term strategies focus on developing a skilled, multidisciplinary oncology workforce and enhancing existing training programmes. In the long term, the goals are to establish self-sufficient cancer care systems, promote regional collaboration, and strengthen research infrastructure. Achieving these objectives will require comprehensive approaches, increased financial resources, advanced cancer care infrastructure, and innovative educational models. Regional and international collaborations are essential to raise awareness of cancer as a major public health concern, advance prevention and early detection efforts, and bolster research initiatives.