Dhulikhel Hospital

The COVID-19 pandemic caused widespread social disruption, with stigma emerging as a significant challenge for individuals who survived infection. This qualitative study explored the forms, drivers, and impacts of COVID-19-related stigma among survivors in Eastern Nepal. In-depth interviews were conducted with 15 COVID-19 survivors who had reported stigma in a preceding cross-sectional survey. Due to pandemic-related restrictions, interviews were conducted over the phone. Data were analysed thematically following the process outlined by Braun and Clarke. COVID-19 stigma was multifaceted, including social rejection, internalized stigma, and discriminatory practices by community members. Key drivers of stigma included self-directed fear of infection and death, misinformation and limited awareness about COVID-19 transmission and prevention, and a fragile health system and policy responses. Although COVID-19-related stigma may have declined as the pandemic evolved, the findings illustrate how stigma can emerge rapidly during health emergencies that can have social consequences related to trust, disclosure, and help-seeking behavior in future crisis. The study highlights the importance of outbreak preparedness strategies that integrate clear communication, strengthened health system capacity, and social protection measures to mitigate stigma and its harms during future public health crises.

Background:Pyrexia of Unknown Origin (PUO) remains a significant diagnostic challenge in low-resource settings, where limited laboratory capacity and fragmented health systems impede timely etiologic identification. In Nepal, evidence on institutional readiness, diagnostic capacity, and system-level barriers for PUO care is limited, hindering standardized clinical decision-making and timely diagnosis. This study assessed the diagnostic capacity, workforce expertise, and governance structures for PUO management across Nepal.Methods:A concurrent mixed-methods study was conducted across 11 tertiary care hospitals in six provinces of Nepal. Quantitative data on governance, service delivery, diagnostics, human resources, infrastructure, and financing were collected using standardized facility assessment tools and descriptively analyzed using SPSS version 23. Qualitative data were obtained from 33 key informant semi-structured interviews (hospital administrators, clinicians, and laboratory personnel), transcribed verbatim, and subjected to thematic analysis in NVivo with intercoder reliability assessment. Findings were integrated through triangulation.Results:Quantitative assessments revealed limited institutional preparedness for PUO management, characterized by the absence of dedicated clinical guidelines, formal referral pathways, and designated focal points in most hospitals. Basic diagnostic services were widely available; however, access to advanced molecular diagnostics was inconsistent and often dependent on external laboratories, contributing to diagnostic delays. Qualitative findings contextualized these gaps, highlighting fragmented governance, weak interdisciplinary coordination, and heavy reliance on empirical treatment of pyrexia, frequently influenced by prior antibiotic exposure. Human resource constraints were prominent, particularly shortages of infectious disease specialists, pediatric expertise, microbiologists, and trained laboratory personnel. Infrastructure limitations, inefficient referral mechanisms, and substantial out-of-pocket expenditures further constrained optimal care. Digital health tools, including electronic medical records and telemedicine, were inconsistently implemented despite being viewed as potential facilitators of improved coordination and follow-up.Conclusions:Management of PUO in Nepal is limited by system-level weaknesses in governance, diagnostic capacity, workforce skills, financing, and digital health integration. Closing these gaps through standardized clinical guidelines, strengthened laboratory systems, focused workforce training, improved referral pathways, and strategic digital health investments could shorten diagnostic timelines, improve patient outcomes, and advance national priorities such as antimicrobial stewardship and epidemic preparedness.

Introduction: Hypothyroidism adversely affects lipid metabolism and increases cardiovascular risk. The Lipid Accumulation Product index, based on waist circumference and triglycerides levels, is a simple marker of central lipid accumulation. Hormone deficiency in hypothyroidism leads to elevated cholesterol and triglycerides, both of which contribute to higher lipid accumulation product scores. Exploring this association may provide insight into the cardio metabolic burden of thyroid dysfunction. Objective: To compare the Lipid Accumulation Product Index in hypothyroid and Euthyroid adults and assess its correlation with serum Thyroid Stimulating hormone level. Methods: Cross-sectional comparative study conducted at Dhulikhel Hospital in 130 hypothyroid and 130 euthyroid adults after ethical clearance from Institutional review committee, Kathmandu University School of medical Sciences. Lipid Accumulation Product was calculated using standard gender-specific formulas. Statistical analysis was performed using Spearman correlation and logistic regression. Results: Median Lipid Accumulation Product is higher in the hypothyroid group (54.1) compared to the euthyroid group (38.3), suggesting that hypothyroid patients tend to have greater lipid accumulation (p < 0.001). Thyroid Stimulating hormone was significantly associated with Lipid Accumulation Product even after adjustment for age and sex (p < 0.05). Conclusion: Patients with hypothyroidism have significantly higher levels of Lipid Accumulation Product index. Thyroid Stimulating hormone and lipid accumulation product are positively correlated, supporting it as a metabolic risk marker in thyroid dysfunction.

Menopause is a natural phenomenon, however symptoms persist in many women. Geographical location and individual factors influence the perception and care-seeking behavior. There are virtually very limited studies exploring the perception and health seeking behavior of women in post menopause. Thus, this study aims to explore the perception of women regarding menopausal symptoms and individual, family, institutional and community level support for addressing the symptoms among post-menopausal women. An exploratory qualitative study design was conducted among the post menopausal women with symptoms residing in Dhulikhel Municipality. In-depth interviews were taken among 14 participants following a socio-ecological framework. The recorded interviews were transcribed and analyzed using deductive inductive thematic analysis approach. Findings revealed the low level of awareness among women regarding knowledge and perception of menopausal symptoms. Furthermore, most of the women perceived menopause as a normal phase of life and didn't recognize the symptoms. Limited awareness, past reliance on home births, and discomfort with male doctors reduced women's use of health facilities. Community engagement varied some women shared experiences through local networks, while others avoided participation due to age, low literacy, or perceived irrelevance. The findings from the study highlight the need for culturally sensitive and gender-responsive interventions that strengthen health education, family involvement, community engagement, and empathetic healthcare to improve women's well-being during and after menopause.

Abstract Introduction Atrial fibrillation (AF) is the most common arrhythmia globally and a leading cause of stroke, heart failure, and cardiovascular disease. In low- and middle-income countries (LMICs), including Nepal, managing AF is challenging due to limited access to timely diagnosis and traditional treatments like Vitamin K Antagonists (VKAs). Non-Vitamin K antagonist oral anticoagulants (NOACs) have improved stroke prevention in AF patients, but affordability and accessibility remain significant barriers. This study explores barriers and facilitators to NOAC use for stroke prevention among AF patients in Nepal. Materials and Methods This qualitative study involved in-depth interviews with 57 stakeholders in cardiovascular disease programs, policies, and management in Bagmati province, Nepal. Interviews were digitally recorded, transcribed verbatim, and analyzed using NVivo software. Results Barriers included low awareness among healthcare providers regarding NOACs rural health workers and patients, lack of essential equipment, insufficient human resources, absence of dedicated policies, and limited specialized training. The cost and unavailability of advanced medications like NOACs further hindered access. Challenges in Prothrombin time Internalized Normalized Ration(INR) monitoring for Warfarin users also persisted. Key facilitators were increased awareness among healthcare workers about AF at macro urban levels and the implementation of the Package of Essential Noncommunicable (PEN) disease interventions protocol for managing cardiovascular diseases. Conclusion This study identifies critical gaps in AF management in Nepal, particularly in rural settings, where limited infrastructure, inadequate training, and low public awareness hinder effective diagnosis and treatment. The high cost and restricted access to NOACs, coupled with challenges in using Warfarin, exacerbate these issues. Addressing these gaps through national guidelines, improved infrastructure, training programs, and cost-effective policies is essential. Embedding an educational program in a broader quality improvement initiative can enhance healthcare workers’ knowledge and ensure equitable and effective AF management across Nepal.

ABSTRACTHyperthyroid Hypokalemic Periodic Paralysis (HHPP), marked by acute weakness and hypokalemia. Prompt potassium replacement and hyperthyroidism management are essential to prevent life‐threatening outcomes. This case highlights its presentation in a Nepali male, reinforcing the need for high clinical suspicion.

Abstract Background As more countries plan and launch human papillomavirus (HPV) vaccination campaigns, reliable self-sampling methods are essential for detecting high-risk HPV (HR-HPV) types and assessing public health impact. This study compared HR-HPV detection in self-collected vaginal swabs (SCVS) and first-void urine (FVU) among sexually active girls and women aged 15-25 years in Bangladesh, Nepal, and Pakistan. Methods Within the Global Burden Estimation of HPV (GLOBE-HPV) project, which aims to estimate HPV prevalence and incidence across eight low- and middle-income countries in South Asia and Sub-Saharan Africa, we analyzed paired SCVS and FVU samples from 753 participants in Bangladesh, Pakistan, and Nepal using standardized protocols. DNA was extracted using the QIAamp DNA Mini Kit, and HPV testing was performed with the Allplex HPV28 Detection PCR assay. We evaluated HPV detection and type-specific concordance using Cohen’s Kappa, McNemar’s test, and a 3×3 agreement table, along with accuracy and positive/negative agreement metrics. Results The overall prevalence of 14 HR-HPV types was 8.6% in SCVS and 7.2% in FVU samples. Detection rates for 7 HR-HPV vaccine types were similar (5.3% in SCVS versus 5.0% in FVU), with nearly identical HPV 16/18 rates (2.3% in SCVS and 2.4% in FVU). Bi-directional type-specific discordance was noted, with each sample type detecting unique types. SCVS demonstrated higher sensitivity for detecting HPV types beyond the 9 vaccine types with McNemar p-values of 0.013 and <0.001 for 14 and 28 types, respectively, while overall concordance remained high (Kappa >0.7). Samples with lower viral load (indicated by higher real-time PCR cycle threshold values) were more likely to yield discordant results. Conclusion SCVS and FVU yielded similar HR-HPV results, including those targeted by the 9-valent HPV vaccine, in sexually active young women. Both non-invasive self-sampling methods have potential for use in large-scale HPV surveillance programs in resource-limited settings.

BackgroundEffective triage is critical for prioritizing emergency care. However, many low- and middle-income countries lack standardized triage systems. Nepal has been working to introduce the WHO’s Interagency Integrated Triage Tool (IITT) into emergency departments nationwide. Still, successful implementation requires context-specific adaptations to address operational realities and resource constraints.ObjectiveThis study aimed to collaboratively adapt the IITT for use in the Dhulikhel Hospital Emergency Department by incorporating frontline staff insights to develop a feasible, sustainable triage workflow.MethodsFive focus groups composed of doctors, nurses, and paramedics were conducted. Through semi-structured discussions, we explored staff perceptions of areas for improvement in the existing triage processes. Participants then generated site-specific workflow models through iterative brainstorming sessions, progressively refining the design into a final consensus-based model.ResultsParticipants, representing over 80% of clinical staff, identified key barriers to effective triage, including inconsistent communication, unclear handoff responsibilities, and insufficient training. The final triage workflow addressed many critical challenges raised in discussion sessions, provided a standardized and customized triage process, and resulted in high reported confidence in its utility.ConclusionThis study demonstrates the value of a bottom-up, staff-centered approach to triage system development and implementation. Our focus group design offers a practical, replicable framework for low-resource emergency departments seeking to implement the IITT or similar protocols into their ED operations. Future efforts should focus on validating the workflow’s impact on patient outcomes and triage efficiency and investing in thorough and longitudinal training to support sustained adoption.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12245-025-00961-w.