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Diabetes Mellitus is a significant global public health burden. Although medication adherence is an inevitable consideration in managing and curing the disease, medication price is the major barrier to patients in Nepal, like any other low- and middle-income countries. Prescribing in brand-name inhibits the possibility of accessing cost-effective generic alternatives in Nepal. This study aimed to explore and examine price variations among the oral hypoglycaemic medicines (OHMs) available in the country and their distribution in various medicine-related characteristics. A cross-sectional study was conducted using a convenient sample of five tertiary care hospital pharmacies in Kathmandu, publicly accessible online pharmacy websites, and a government database to list the OHMs available in Nepal. The study determined price variations and statistically tested the association between these variations and the characteristics of the medicines. Fourteen OHMs were available as 57 generic medicine items with different formulations in Nepal. The maximum of 484.82% of price variation was found. Fourteen, fifteen and eighteen OHMs have variations of over 100%, more than 10 rupees and no price change, respectively. Except for Dipeptidyl Peptidase-IV (DPP-4) Inhibitors and Thiazolidinediones (TZDs), all other categories of OHMs have >100% of price variation in medicine items. Although Nepal itself produces most of the available OHMs, the available OHMs have price variations. Most fixed dose combinations showed no reduction in cost compared to their component medicine’s mean price. This study presented and discussed the price variation scenario of OHMs with their medicine-related characteristics to develop and implement effective drug policies and programs that can address medication price-related issues to ensure access to OHMs without placing an economic burden on patients.

Background Vaccines are effective and reliable public health interventions against viral outbreaks and pandemics. However, hesitancy regarding the Coronavirus disease (COVID-19) vaccine is evident worldwide. Therefore, understanding vaccination-related behavior is critical in expanding the vaccine coverage to flatten the infection curve. This study explores the public perception regarding COVID-19 vaccination and identifies factors associated with vaccine hesitancy among the general adult populations in six Southeast Asian countries. Methods Using a snowball sampling approach, we conducted a descriptive cross-sectional study among 5260 participants in Indonesia, Malaysia, Myanmar, Philippines, Thailand, and Vietnam between February and May 2021. Binary logistic regression analysis with a backward conditional approach was applied to identify factors associated with COVID-19 vaccine hesitancy. Results Of the total, 50.6% were female, and the median age was 30 years (range: 15–83 years). The majority of the participants believed that vaccination effectively prevents and controls COVID-19 (81.2%), and 84.0% would accept COVID-19 vaccines when they become available. They agreed that health providers’ advice (83.0%), vaccination convenience (75.6%), and vaccine costs (62.8%) are essential for people to decide whether to accept COVID-19 vaccines. About half (49.3%) expressed their hesitancy to receive the COVID-19 vaccines. After adjustment for other covariates, COVID-19 vaccine hesitancy was significantly associated with age, residential area, education levels, employment status, and family economic status. Participants from Indonesia, Myanmar, Thailand, and Vietnam were significantly more likely to express hesitancy in receiving COVID-19 vaccines than those from Philippines. Conclusions In general, participants in this multi-country study showed their optimistic perception of COVID-19 vaccines’ effectiveness and willingness to receive them. However, about half of them still expressed their hesitancy in getting vaccinated. The hesitation was associated with several socioeconomic factors and varied by country. Therefore, COVID-19 vaccination programs should consider these factors essential for increasing vaccine uptake in the populations.

Pharmaceutical care (PC) services reduce medication errors, improve the use of medicines, and optimize the cost of treatment. It can detect medication-related problems and improve patient medication adherence. However, PC services are not commonly provided in hospital pharmacies in Nepal. Therefore, the present study was done to determine the situation of PC in hospital pharmacies and explore the perception, practice, and barriers (and their determinants) encountered by hospital pharmacists while providing PC. A descriptive online cross-sectional study was conducted from 25th March to 25th October 2021 among pharmacists with a bachelor’s degree and above working in hospital pharmacies using non-probability quota sampling. The questionnaire in English addressed perception and practice regarding PC, and barriers encountered and were validated by experts and pre-tested among 23 pharmacists. Descriptive statistics were used to describe the data. Kendall’s correlation was used to explore the correlations among various perception and practice constructs. The scores were also compared among subgroups of respondents using the Mann–Whitney test for subgroups with two categories and Kruskal–Wallis test for greater than two categories. A total of 144 pharmacists participated in the study. Majority of the participants were male, between 22 and 31 years of age, and had work experience between 10 and 20 years. Over 50% had received no training in PC. The perception scores were higher among those with more work experience and the practice scores among those who had received PC training. Participants agreed that there were significant barriers to providing PC, including lack of support from other professionals, lack of demand from patients, absence of guidelines, inadequate training, lack of skills in communication, lack of compensation, problems with access to the patient medical record, lack of remuneration, and problems with accessing objective medicine information sources. A correlation was noted between certain perceptions and practice-related constructs. Hospital pharmacists who participated had a positive perception and practice providing PC. However, PC was not commonly practised in hospital pharmacies. Significant barriers were identified in providing PC. Further studies, especially in the eastern and western provinces, are required. Similar studies may be considered in community pharmacies.

Background Unintended pregnancy occurs due to incorrect or inconsistent use of a contraception method. Such pregnancies can create an economic burden on the family, society and nation as a whole. Unintended pregnancy is the underlying cause of abortion which can also result in infertility and maternal death. Adequate knowledge of emergency contraceptive pills (ECPs) and positive attitudes among the community pharmacy practitioners (CPPs) is a prerequisite for timely access of ECP, thus ultimately lessening the incidence of unintended pregnancies. This study intended to explore the knowledge, attitude and practice of CPPs toward ECPs in Kathmandu valley. Methods Cross-sectional study conducted in community pharmacies located in three districts of Kathmandu valley. A convenience sampling method was employed to interview CPPs in 227 community pharmacies using a validated questionnaire. Questionnaire assessed the demographic characteristics; knowledge, attitude and dispensing practice of the CPPs. Data were subjected to descriptive and inferential analysis using SPSS 18 (SPSS Inc., Chicago, IL, USA). Results Approximately 75% of respondents had a good practice on dispensing ECPs, and 70% of them counselled all the users. A significant association ( p -value< 0.05) was obtained between the dispensing practice of respondents and their knowledge level. ECP related knowledge was higher among the age group 40–49 years, BPharm degree holders with experience above 10 years and community pharmacies located inside the city and in the Kathmandu district. After adjusting the possible confounder variables, age, degree and district of pharmacy were significantly associated with knowledge. Similarly, respondents’ practice towards ECP was higher among the age group 40–49 years with experience above 10 years and community pharmacies located inside the city and in the Kathmandu district. Adjusted for other variables, only community pharmacies located at Kathmandu district was significantly associated with the practice. Conclusion CPPs lacked specific important information on ECP and opined against its’ availability as an over-the-counter drug, despite good overall knowledge and positive attitude. Many thought that ECP without prescription would increase promiscuity towards sexual behaviour and result in unsafe sex along with its’ repeated use. Hence, training and proper counselling strategies should be afoot to refine the delivery of service by CPPs.

Background: Improper disposal of medications is a growing global concern, leading to environmental contamination and public health risks, including accidental poisoning and antimicrobial resistance. This study assessed public knowledge, attitudes, and practices regarding disposing of unused and expired medications among community pharmacy visitors in Kathmandu, Nepal. Methods: A cross-sectional study was conducted using the Return and Disposal of Unused Medication questionnaire among 395 randomly selected participants, and a 100% response rate was achieved. Descriptive and inferential statistics, including chi-square tests, were used to identify significant associations with the Statistical Package for Social Sciences version 23. Results: Over half of the respondents (n = 247, 62%) understood the proper disposal methods for unused and expired medication. Additionally, a majority of participants (n = 366, 92%) exhibited a positive attitude, while more than two-thirds (88.1%) were aware of the detrimental effects of incorrect medicine disposal on the environment. Approximately 43% (n = 171) of respondents reported having unused medicines stored at home, with analgesics (46%) and antibiotics (42%) being the most common types. Most participants disposed of expired medicines in household garbage bins and retained unused medications at home until their expiration. Furthermore, a significant association was identified between respondents’ knowledge levels and their actual practices in medicine disposal (p < 0.001). Conclusion: Despite positive attitudes, gaps in practice highlight the urgent need for awareness campaigns and structured disposal programs. The findings suggest actionable measures, including national guidelines and pharmacy-led take-back programs, to mitigate improper disposal of unused and expired medicines.

There is substantial increment in nutraceutical consumption in Nepal, although the data on its efficacy and safety is scarce. The practices of nutraceutical supplements users in Nepal remain undocumented. Therefore, this study was conducted to study the prescription pattern, cost, knowledge, attitude and practice (KAP) of the patient towards nutraceutical. Descriptive cross-sectional study with stratified purposive sampling (n = 400) (patients from the out-patient departments of Scheer Memorial Adventist Hospital, Kavre, Nepal) was performed using a validated structured questionnaire assessing the socio-demographic characteristics, knowledge, attitude, practice of nutraceutical and total cost patients spent on nutraceutical alone. Pearson Chi-square test (x2) was used to investigate the association between socio-demographic variables and patients' KAP (knowledge, attitude and practice) towards nutraceutical. One way ANOVA was performed to compare the cost of nutraceutical among the different outpatient departments. More than 80% of patients were found to be consuming nutraceutical on their own. The mostly prescribed nutraceutical were vitamins (40.7%), minerals (23.7%), enzymes (21.1%), proteins (8.8%), probiotics (4.2%) and herbals (2.0%). With the most common reasons for consuming nutraceutical were to maintain good health (70.0%) and healthcare professionals (57.85%) were the most approached source of information for nutraceutical. Nearly half of the patients (46.5%) had an inadequate level of knowledge whereas more than two-third (71.5%) showed a moderate positive attitude towards nutraceutical use. The average amount patients spent was NRs.575.78 [equivalent to USD 4.85] per prescription on nutraceutical alone. The maximum cost amounted to NRs 757.18 [equivalent to USD 6.43] in Orthopedics, and the minimum cost was NRs 399.03 [equivalent to USD 3.36] in Obstetrics and gynecology, respectively. There was a significant difference (p <0.001) in cost of nutraceutical prescribed between the OPD clinics. The higher prevalence of inadequate knowledge despite moderate positive attitude towards nutraceutical among patients regarding some significant issues such as safety and interactions of nutraceutical consumption and its' substitution for meals reflects the need to develop an educational strategy to increase general public awareness on the rational use of nutraceutical.

The aim of this study was to address the problems associated with polypharmacy in elderly cancer patients and to highlight the role of pharmacists in such cases in resource‐limited settings. A narrative review of existing literature was performed to summarize the evidence regarding the impact of polypharmacy in elderly cancer patients and the pharmaceutical strategies to manage it. This review emphasizes the significance of polypharmacy, which is often ignored in real clinical practice. Polypharmacy in the elderly cancer population is mainly due to: chemotherapy with one or more neoplastic agents for cancer treatment, treatment for adverse drug reactions due to neoplastic agents, the patient's comorbid conditions, or drug interactions. The role of the clinical pharmacist in specialized oncology hospitals or oncology departments of tertiary care hospitals is well established; however, this is not the case in many developing countries. A clinical pharmacist can contribute to solving the problems associated with polypharmacy by identifying the risks associated with polypharmacy and its management in resource‐limited settings. As in many developed countries, the involvement of a clinical pharmacist in cancer care for elderly patients may play a vital role in the recognition and management of polypharmacy‐related problems. Further research can be conducted to support this role.

Several pharmacy standards exist within high-income countries for measuring standards of practice in clinical and hospital settings. Following the implementation of diverse hospital pharmacy standards in low- and middle-income countries (LMICs) like Nepal such as the hospital pharmacy service guideline 2015, minimum service standards, this study aims to assess compliance with Good Pharmacy Practice (GPP) standards as per the codes for sales and distribution of drugs (CSDD) 2024 guideline in one of the provincial hospital of Nepal, as a quality improvement project. A cross-sectional study design was conducted within the Hetauda Hospital pharmacy section to check the compliance nature of hospital pharmacy practice standards using the 16 components and 121 indicators mentioned in the CSDD, implemented by the National Drug Regulatory Authority of Nepal, Department of Drug Administration. CSDD is a publicly available guideline consisting of 5 chapters and 20 sections, where the codes specifically focus on structural, human resources, storage and documentation, pharmacovigilance, GPP, good storage and distribution practice license-related provisions. Following the checklist provided in the CSDD, data were collected and entered into the MS Excel and analyzed in terms of frequency and percentage compliance. If the indicators were found to be 100% compliant, it was categorized as fully compliant, if the indicators were scored from (>50%-99.9%), it was categorized as partially compliant whereas if it was in between (0.0%-≤50%), it was categorized as poorly compliant. Out of a total of 121 indicators mentioned in the CSDD, only 74 (61.2%) were compliant. Only 6 domains were fully compliant (100%), whereas 7 domains were partially compliant (≥50%-99.9%) and 10 domains were poorly compliant (<50%-0.0%). Following the CSDD guidelines, it was found that the hospital pharmacy lacked in domains such as quality policy, service strategy, training, client complaints, product recalls, counseling services, medication records, client follow-up and referral, and self-inspection process, underscoring the need for prompt attention and an action plan from the Drug and Therapeutic Committee and the executives.

Globally, cervical cancer is the fourth most common cancer among women, and more than 90% of all cervical cancer-related deaths worldwide are recorded in resource-limited countries. The present review investigated the uptake rate of cervical cancer screening and identified the factors associated with screening service utilisation in the female populations of least developed countries (LDCs). Five electronic databases (EMBASE, Ovid MEDLINE, CINAHL, Cochrane Library, and PubMed) and grey literature were searched for relevant literature using the keywords of the included studies. Both qualitative and quantitative studies were included. Three reviewers performed critical appraisals using the Mixed Methods Appraisal Tool. Meta-analysis was performed to pool the quantitative results from comparable studies. A total of twenty-five studies were included in the review. The cervical cancer screening uptake rate in LDCs ranged from 4% to 21%. Multiple factors were associated with screening service utilisation among women in the LDCs, namely socio-demographic characteristics, including employment status (odds ratio (OR): 2.72; 95% CI: 1.97-3.76; p < 0.001); knowledge of cervical cancer and its screening (OR: 3.39; 95% CI: 2.00-5.75; p < 0.001); sexual and reproductive health-related factors such as parity status (OR: 2.73; 95% CI: 1.61-4.64; p = 0.002); healthcare providers' recommendations (OR: 5.32; 95% CI: 2.44-11.58; p < 0.001); perceived risk of developing cervical cancer (OR: 3.76; 95% CI: 2.62-5.38; p < 0.001); use of media for cervical cancer screening promotion, including radio; cultural factors; and myths and misconceptions about cervical cancer and its screening. The uptake of cervical cancer screening among eligible women in the LDCs was notably low. The governments of these countries are advised to invest and allocate additional resources to advance policies and develop cervical cancer prevention programmes that are accessible, affordable, and acceptable.

Background: Drug recalls safeguard patients from potentially harmful existing pharmaceutical products in the market due to safety concerns or manufacturing issues. Objective: To analyze the drug recall patterns, frequencies, and causes based on the publicly available data from the Nepalese Drug Regulatory Authority, Department of Drug Administration (DDA). Design: A 2-year retrospective secondary analysis was conducted based on drug recalls in Nepal, which is available from the official website of DDA, Nepal. Methods: The substandard drug recalls data from April 17th, 2023 to May 14th, 2025 were included in the study from which information were extracted across various domains, including the drug name, dosage forms, manufacturing and expiry date, reasons for the recall, and recall date whereas, inclusion of falsified medicines and information regarding the “special permission,” “news & updates,” and “notices” sections within the DDA website were excluded from the studies to ensure only drug recalls were incorporated. Results: The study showed that 50 recalls were made over the 2 year period. The majority of the recalled drugs were antibiotics (16%). The most common reasons for drug recalls were assay failure (34%) and non-compliance with standards set out by the Indian Pharmacopoeia-2022 (40%), followed by United States Pharmacopoeia-2022 (28%). Oral formulations (74%) were most commonly recalled, out of which tablets (32%), suspensions (16%), and syrups (12%) were recalled in greater frequencies among all the recall notices. Most recalls were made from domestic pharmaceutical companies (84%). The majority of the drugs (34%) were recalled after 15 months of the finished product being in the market, whereas only 26% were recalled within the first 5 months. Conclusion: A robust and continuous evaluation of drug recalls by regulatory authorities can help reduce their frequency, lessen their impact on the healthcare system, and improve overall drug safety. Plain language summary A two-year retrospective secondary substandard drug recall analysis from Nepal 1. Drug recalls are crucial to protect the public by removing and recalling substandard drugs. 2. This unique study retrospectively analyzes the two-year publicly available drug recall data from the National Drug Regulatory Authority of Nepal. 3. Drug recalls in Nepal are increasing in order, with several quality control failures and non-compliance with good manufacturing practices. 4. The findings emphasize the effective development of testing sites and focus on quality control parameters of drugs to ensure drug safety.