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Background Plant species have long been used as principal ingredients of traditional medicine in far-west Nepal. The medicinal plants with ethnomedicinal values are currently being screened for their therapeutic potential but their data and information are inadequately compared and analyzed with the Ayurveda and the phytochemical findings. Methods The present study evaluated ethnomedicinal plants and their uses following literature review, comparison, field observations, and analysis. Comparison was made against earlier standard literature of medicinal plants and ethnomedicine of the same area, the common uses of the Ayurveda and the latest common phytochemical findings. The field study for primary data collection was carried out from 2006-2008. Results The herbal medicine in far-west Nepal is the basis of treatment of most illness through traditional knowledge. The medicine is made available via ancient, natural health care practices such as tribal lore, home herbal remedy, and the Baidhya , Ayurveda and Amchi systems. The traditional herbal medicine has not only survived but also thrived in the trans-cultural environment with its intermixture of ethnic traditions and beliefs. The present assessment showed that traditional herbal medicine has flourished in rural areas where modern medicine is parsimoniously accessed because of the high cost and long travel time to health center. Of the 48 Nepalese medicinal plants assessed in the present communication, about half of the species showed affinity with the common uses of the Ayurveda , earlier studies and the latest phytochemical findings. The folk uses of Acacia catechu for cold and cough, Aconitum spicatum as an analgesic, Aesculus indica for joint pain, Andrographis paniculata for fever, Anisomeles indica for urinary affections, Azadirachta indica for fever, Euphorbia hirta for asthma, Taxus wallichiana for tumor control, and Tinospora sinensis for diabetes are consistent with the latest pharmacological findings, common Ayurvedic and earlier uses. Conclusions Although traditional herbal medicine is only a primary means of health care in far-west Nepal, the medicine has been pursued indigenously with complementing pharmacology and the Ayurveda . Therefore, further pharmacological evaluation of traditional herbal medicine deserves more attention.

Background Traditional and complementary medicine (T&CM) is commonly used in South Asian countries such as Nepal. There are various causes and contributing factors for patients with cancer to consider using T&CM. However, little is known about the use of T&CM among the cancer population in this region. Methods The study followed a cross-sectional design using a structured survey questionnaire. Survey participants were recruited from two National hospitals in Kathmandu, Nepal. The survey instrument comprised 30 questions, including variables on demographics, use of T&CM, and perceived level of disease severity, and cancer treatment. Chi-square test and logistic regression were used for data analysis using SPSS ver. 23.0. Results Of 908 participants, 31.6% used one or more modalities of T&CM after a cancer diagnosis. The most commonly used T&CM was Ayurveda (46.5%), followed by yoga (32.4%). About 46% of T&CM users discussed their use with their doctors. The main source of information on T&CM was their family members and relatives (55.7%). Cancer type (head and neck cancer OR: 2.30, CI: 1.23–4.29; abdominal cancer OR: 2.69, CI: 1.47–4.95; lung cancer OR: 5.88, CI: 2.69–12.89), cancer stage (Stage I OR: 1.92¸CI: 1.14–3.25; Stage II OR: 1.76, CI: 1.06–2.94), and the patients’ self-rated disease severity (high perceived severity OR: 1.50, CI: 1.05–2.16) were strong predictors of T&CM use. Conclusion This study underlined that despite the widespread use of T&CM among cancer patients in Nepal, most patients obtained information on T&CM from informal sources and did not disclose their use to physicians. To ensure the safe use of T&CM modalities, physicians should integrate questions on T&CM use into routine patient assessments in order to facilitate active communication and improve the quality of care.

Strategies to increase COVID-19 vaccine coverage require an understanding of the extent and drivers of vaccine hesitancy and trust in government related to COVID-19 vaccine programs, especially in low-resource communities. We conducted a cross-sectional household survey post-COVID-19 vaccine introduction among adults (n = 362) in four municipalities in Sarlahi District, Nepal from August to December 2022. The survey included modules on participant demographics and socioeconomic factors and vaccine hesitancy, information seeking, and trust in authorities related to COVID-19 vaccination. Of the study participants, 38.4 % expressed hesitancy related to COVID-19 vaccination. The adjusted odds of being “vaccine hesitant” were significantly lower among the older adults (51+ years) relative to younger (<30 years) (aOR: 0.49, CI: 0.24–0.97) and among males relative to females (aOR: 0.51, CI: 0.26, 0.95). The study population highly trusted the government’s handling of the COVID-19 pandemic. While for most, self-reported access to vaccination opportunities was high (88.4 %), 70.4 % of participants did not know if vaccines were in stock at their local vaccination facility. Commonly reported statements of misinformation include the vaccine being developed in a rush or too fast (21.5 %), COVID-19 infection can be effectively treated with ayurvedic medicine(16.3 %) and obtaining immunity from natural infection is better than through vaccination (19.9 %). The primary sources of information on COVID-19 programs were family and friends (98.6 %), healthcare professionals (67.7 %), Female Community Health Volunteers (FCHVs) (61.9 %), television (56.4 %), and radio (43.1 %). Although many respondents expressed concerns about COVID-19 effectiveness and safety, a high proportion trusted COVID-19 information provided by healthcare workers and approved of the government’s response to the pandemic. This study highlights an opportunity to design new evidence-based communication strategies to improve vaccine confidence delivered through frontline government healthcare workers. Approaches could be targeted to certain communities in the region shown to have higher vaccine hesitancy, including younger people and women.

Background Hypertension control remains a major challenge globally. A recent systematic review suggested that yoga has beneficial effects on reducing blood pressure. However, the role of yoga in hypertension management in primary health care has received little attention, and no studies have evaluated the impact of a yoga program fully delivered by health care staff on hypertension. This study, therefore, assessed the effects of a health worker-led yoga intervention on blood pressure reduction among hypertensives patients in the primary care setting. Methods This was a multicentric, two-arm, randomised trial conducted among hypertensive patients in seven Ayurveda Health Centres in Nepal between March 2017 and June 2018. One hundred and twenty-one participants who were on or without medications were randomised to intervention ( n  = 61) and wait-list control ( n  = 60) groups using stratified block randomisation. Participants in the intervention arm received an intervention consisting of an initial five-day structured yoga training at the centres and then a further home-based practice of yoga for five days a week for the following 90 days. Both intervention and control groups also participated in a 2-h health education session. The primary outcome of this trial was systolic blood pressure at 90-day follow-up. Data were analysed on an intention-to-treat basis using linear mixed-effects regression models. Results We included all 121 study participants (intervention/control = 61/60) in the primary analysis (52.1% males; mean ± SD age = 47.8 ± 10.8 years). The difference in systolic blood pressure between the intervention group and the control group was − 7.66 mmHg (95% CI: − 10.4, − 4.93). For diastolic blood pressure, the difference was − 3.86 mmHg (95% CI: − 6.65, − 1.06). No adverse events were reported by the participants. Conclusions A yoga program for hypertensive patients consisting of a five-day training in health centres and 90 days of practice at home is effective for reducing blood pressure. Significant benefits for hypertensive patients could be expected if such programmes would become a part of the standard treatment practice. Trial registration This trial was prospectively registered with the Clinical Trial Registry of India [ CTRI/2017/02/007822 ] on 10/02/2017.

Medical pluralism is a global norm rather than an exception. However, the kind of medical pluralism that exists in many settings is exclusionary and undemocratic. In many nations, medical pluralism has official acceptance, allowing both biomedicine and traditional systems of medicine a legitimate space into the formal healthcare system. However, traditional systems of medicine fall far behind biomedicine in terms of structural superiority and institutional strengths. Moreover, various forms of traditional medicine, particularly of popular variants, remain excluded from formal healthcare system, and a variety of traditional healers lack official legitimacy. Though conceptually medical pluralism sounds more or less equal standing of co-existing systems of medicine, the reality is that biomedicine enjoys a dominant status over heterodox medical systems. Upon examining the amount of budgetary allocation, number of health facilities, size of health human resources, educational institutions and research output, this paper reveals an overemphasis on biomedicine, overshadowing both scholarly and popular traditional medicine. This arrangement underscores the undemocratic and exclusionary nature of medical pluralism in the country. In light of the published data sources this paper examines the structure of medical pluralism and proposes measures that can contribute to advancing inclusive and democratic medical pluralism in Nepal.

The use of medicinal plants for treating animal diseases is a longstanding and widespread practice in Nepal, providing farmers with an accessible and cost‐effective option. This study aimed to document traditional knowledge regarding medicinal plants used to treat ailments in captive elephants in Sauraha, Chitwan. A total of 56 mahouts, responsible for the care of privately and government‐owned captive elephants, were interviewed through face‐to‐face interactions. The study identified 42 plant species from 26 families used to treat 27 ailments in captive elephants. Among these, the Fabaceae family was the most dominant, followed by the Poaceae family. The most commonly used plant parts were leaves, bark, and seeds. Medicinal herbs were predominantly prepared in paste formulations (21 plant species), while raw formulations were used for 15 species. The oral route of administration was the most popular method of application. The highest citation frequencies were recorded for Azadirachta indica A. Juss, Brassica campestris L., and Trachyspermum ammi (L.) Sprague. These findings highlight the high level of knowledge among mahouts regarding elephant ailments and their treatment using herbal plants. Given the risk of its loss, this traditional knowledgemust be throughly documented. These findings could provide meaningful insights for treating diseases in other animal species, contributing significantly to the field of ethnoveterinary medicine. The study documented 42 plant species from 26 families used for treating 27 ailments of captive elephants in Sauraha, Nepal. Leaves were the most frequently used plant part, and the most common preparation method was paste formulation, followed by raw, juice, powder, roast, and decoction forms. Oral route of administration was the most prevalent, followed by dermal and ocular routes. Azadirachta indica (Neem) had the highest citation frequency, followed by Brassica campestris and Trachyspermum ammi.

In rural areas of Nepal, where it is difficult to get access to Government health care facilities, people depend on medicinal plants and local healers for health problems. This study concerns an ethnobotanical survey of the Kavrepalanchok District, reporting some unusual uses of medicinal plants and original recipes. A total of 32 informants were interviewed, 24 of them being key informants. Ethnobotanical uses concerned 116 taxa, of which 101 were medicinal plants, with the most representative species belonging to Asteraceae, Fabaceae, Lamiaceae, and Zingiberaceae. Ethnobotanical indexes were used to evaluate the ethnopharmacological importance of each plant species and the degree of agreement among the informants’ knowledge. Informant consensus factor (Fic) showed that the fever category had the greatest agreement. Highest fidelity level (FL) values were found for Calotropis gigantea used for dermatological diseases, Drymaria cordata for fever, Mangifera indica and Wrightia arborea for gastrointestinal disorders. Data document the richness of the local flora and the traditional knowledge on medicinal plant species used by ethnic communities in rural areas. The active involvement of local populations in the conservation and management of medicinal plant species will encourage future projects for the sustainable development of the biological and cultural diversity of these rural areas of Nepal.

Background Nepal has committed to achieving universal coverage of quality maternal and newborn health (MNH) services by 2030. Achieving this, however, requires urgently addressing the widening inequity gradient in MNH care utilisation. This qualitative study examined the multidomain systemic and organisational challenges, operating in multi-level health systems, that influence equitable access to MNH services in Nepal. Methods Twenty-eight in-depth interviews were conducted with health policymakers and program managers to understand supply-side perspectives of drivers of inequity in MNH services. Braun and Clarke’s thematic approach was employed in analysing the data. Themes were generated and explained using a multidomain (structural, intermediary, and health system) and multi-level (micro, meso and macro) analytical framework. Results Participants identified underlying factors that intersect at the micro, meso and macro levels of the health system to create inequity in MNH services. Key challenges identified at the macro (federal) level included corruption and poor accountability, weak digital governance and institutionalisation of policies, politicisation of the health workforce, poor regulation of private MNH services, weak health management, and lack of integration of health in all policies. At the meso (provincial) level, identified factors included weak decentralisation, inadequate evidence-based planning, lack of contextualizing health services for the population, and non-health sector policies. Challenges at the micro (local) level were poor quality health care, inadequate empowerment in household decision making and lack of community participation. Structural drivers operated mostly at macro-level political factors; intermediary challenges were within the non-health sector but influenced supply and demand sides of health systems. Conclusions Multidomain systemic and organisational challenges, operating in multi-level health systems, influence the provision of equitable health services in Nepal. Policy reforms and institutional arrangements that align with the country’s federalised health system are needed to narrow the gap. Such reform efforts should include policy and strategic reforms at the federal level, contextualisation of macro-policies at the provincial level, and context-specific health service delivery at the local level. Macro-level policies should be guided by political commitment and strong accountability, including a policy framework for regulating private health services. The decentralisation of power, resources, and institutions at the provincial level is essential for technical support to the local health systems. Integrating health in all policies and implementation is critical in addressing contextual social determinants of health.

Background Cancer is one of the major health problems worldwide and medicinal plants constitute a common alternative for cancer treatment having no or fewer side effects. This study aimed to assess total phenolic (TPC) and flavonoid (TFC) contents, antioxidant, biological activities (especially antibacterial, antifungal, and anticancer), and chemical composition of methanol extract of M. napaulensis DC. bark (MNBM). This is the first study evaluating its anticancer activity and chemical composition by LC–MS/MS analysis. Methods TPC, TFC, antioxidant, antimicrobial, and anticancer activities were determined by Folin-Ciocalteu, AlCl 3 , DPPH, Resazurin, and MTT assays, respectively. Its metabolite profiling was done by LC–MS/MS analysis. The statistical significance of differences between test groups was analyzed by a one-way ANOVA. Results The preliminary phytochemical screening revealed the presence of various phytochemicals viz. alkaloids, steroids, glycosides, polyphenols, tannins, flavonoids, coumarins, terpenoids, and quinone. MNBM showed 38.00 ± 1.50 mg GAE g −1 dry sample as TPC, 35.04 ± 4.87 mg QE g −1 dry sample as TFC, and 212.97 μg/mL IC 50 value ( P  < 0.05) as moderate antioxidant activity. MNBM showed minimal inhibitory concentration (MIC) values of 100.22 mg/mL, 50.15 mg/mL, and 25.08 mg/mL against S. aureus, E. coli , and C. albicans, respectively as weak antimicrobial activity. It showed no antibacterial effect against B. cereus and P. aeruginosa at 120 mg/mL. The anticancer activity of MNBM was moderate against human lung cancer cells A549 (228.97 μg/mL IC 50 value) and human cervical cancer cells HeLa (367.72 µg/mL IC 50 value) ( P  < 0.05). The LC–MS/MS analysis reported the presence of different anticancer compounds viz. dihydroberberine, d-berbamine, (S)-glaucine, protopine, grosheimin, mycophenolic acid, berberine, alpha-linolenic acid, etc. Conclusions MNBM showed dose-dependent moderate antioxidant, weak antibacterial, weak antifungal, and moderate anticancer activity due to the synergistic effect of different phytochemicals and anticancer compounds.

Alcohol chemically known as ethanol, causes several health, economic and social consequences across the world. Literatures suggest potential harm of alcohol drinking by pregnant women especially to the fetus and the mother. Despite a number of significant public health problems related to alcohol consumption, this area has been ignored in Nepal and information at the national level is limited. Thus this study aimed at finding the prevalence of alcohol consumption among married women of reproductive age. A nationally representative household survey was carried out from April to August 2013 by taking 16 districts across all 15 eco administrative regions. From the selected districts, 86 village development committees and 14 municipalities were selected as primary sampling units using probability proportionate to size, followed by random selection of 3 wards from each primary sampling unit. Finally, 30 households within each ward were selected using systematic random sampling, and one married women of reproductive age from each household. A total of 9000 married women of reproductive age were interviewed using a semi-structured questionnaire, on alcohol consumption practices including environmental factors and socio demographic characteristics and were included in the analysis. National prevalence of alcohol consumption ever among married women of reproductive age was 24.7% (95% CI:21.7-28.0), last 12 months 17.9% (95% CI:15.3-20.7) and last 30 days (current drinking) 11.8% (95% CI:9.8-14.1). There was substantial variation among the districts ranging from 2% to 60%. Multivariable analysis suggests women with no education or within formal education, dalit and janajatis ethnicity, whose husbands drink alcohol, who brew alcohol at home and women from mountains were significantly at higher risk of consuming alcohol. Among the women who drank alcohol in last 12 months, a substantial proportion of them drank home brewed alcoholic beverages (95.9%, 95% CI:94.3-97.4). Alcohol consumption was common practice among married women of reproductive age in Nepal with variation among the subgroups of population. Thus, further investigation and behavior change communication interventions to reduce alcohol consumption especially among the women with higher risk of drinking is essential.