Manmohan Memorial Institute of Health Sciences

Nepal’s 2015 Constitution, federal governance system, and commitment to the Sustainable Development Goals (SDGs) offer important opportunities for bottom-up, participatory, and rights-based development of the Water, Sanitation and Hygiene (WASH) sector. However, the effects of these reforms on gender equality and social inclusion (GESI) in local WASH planning and decision-making remain poorly understood. This study examined six dimensions of change under federalism—policy frameworks; division of powers; actors, roles, and financing; WASH services; coordination and data; and GESI in governance—to assess how rights and inclusion are translated into practice. The research covered six rural municipalities in Madhesh, Bagmati, Lumbini, and Karnali provinces, using household surveys of 486 households, key informant interviews, and reviews of national and subnational policies and WASH literature. Findings show that constitutional guarantees and recent policies, including the National WASH Policy (2023) and the draft WASH Sector Development Plan (2024), create space for GESI-responsive WASH. However, they do not adequately address systemic barriers that limit the meaningful participation and benefits of women, people with disabilities, and marginalized groups. At the local level, WASH plans, budgets, coordination mechanisms, and gender-disaggregated data systems remain weak, while service delivery is dominated by technical approaches. Access to safe, piped water is still low, placing a disproportionate burden on women, and affordability remains a barrier for poorer households. Achieving the SDGs will require stronger gender-responsive local planning, improved financing, empowered user groups, and enhanced local government capacity to deliver inclusive, rights-based WASH services.

अञ्जान विरहीको अञ्जान विरहीका कथाहरू (२०५५) कथासङ्ग्रहमा सङ्कलित परिवर्तन आलोचनात्मक चेतले भरिएको कथा हो । यस कथामा २०४६ साल अघिको पञ्चायती व्यवस्था र २०४६ सालपछिको बहुदलीय प्रजातान्त्रिक व्यवस्था नेतृत्व र समाजले भोगेको विशेष अवस्थालाई विषयका रूपमा चयन गरिएको छ । यस कथामा नेपाली राजनीतिले पारेको असरलाई समाज र प्रतिनिधि पात्रहरूसँग जोड्ने काम भएको छ । परिवर्तन कथामा नेपाली समाजको चेतना स्तर, वर्ग दृष्टिकोण र वर्गीय स्वरूपको पाटोमा पर्याप्त बहस गर्न सकिने ठाउँ रहेको छ । यस कथामा रहेको मोटे नेता, साधुराम, शिवे जस्ता पात्रहरू र सानेजस्ता पात्रको मनोदशा र समाजसँगको सम्बन्धलाई देखाइएको छ । कथामा आएका समाज विकासको स्वरूप र नेतृत्व वर्गले आफूलाई जनताभन्दा भिन्न बनाउँदै लगेको विषयलाई रोचक ढङ्गले प्रस्तुत गरिएको छ । विश्लेष्य कथा ‘परिवर्तन’ले समाज विकासको गतिलाई पक्रिन नसके जनताले व्यवस्थाप्रति अपनत्व महसुस नगर्ने विचार अभिव्यक्त छ । कथा विधाको विधागत तत्व भन्दा सामाजिक सचेतता र नेतृत्व जिम्मेवार बन्नु पर्ने विषयलाई आलोचनात्मक कोणबाट बहसको विषय बनाइएको छ ।

Introduction: The requirement for mechanical ventilation is one of the major indications for admission in pediatric intensive care unit. Increased burden of disease, limited availability of pediatric critical care services, and lack of manpower make its use challenging in Nepal. The objective of this study was to determine the clinical characteristics and outcome of children requiring non-invasive and invasive ventilation in our setting. Methods: This is a retrospective study done at Patan Academy of Health Sciences from April 2021 to April 2024. All children from neonates to 15 years of age requiring mechanical ventilation were enrolled. Data analysis was done by JASP 0.18.3.0 version Results: Of 965 admitted children, 413 (43%) required mechanical ventilation and 45% were females. The mean age of patient was 30.1+43.7 months. Of 413 children, initially 101 (24.5%) patients were invasively ventilated and 312 (75.8%) were kept on non-invasive ventilation. The common indications for requirement of mechanical ventilation were respiratory failure in 259 (63%), shock in 64 (15%), low GCS-44 (11%), postoperative care in 41 (10%) and others in 5 (1%). Of 413 children, 302 (73%) survived, 71 (17%) expired. Sepsis with septic shock was the leading cause of death in 22 (31%) patients followed by oncological diseases in 15 (21%). In this cohort, mortality was statistically significant in children >5years (p=0.02) and children requiring inotropes (P<0.001). Conclusion: In this cohort, respiratory cause was most common indication for requirement of mechanical ventilation. Invasively ventilated patients of older age group and requirement of inotropes had poor outcome in our settings.

Introduction: A stroke is a medical emergency that occurs as a result of decreased blood supply or cessation of blood flow to the brain. Even though there are preventable risk factors still, it is one of the leading causes of disability worldwide. This study was carried out with the aim of assessing awareness of stroke among adults in a community. Method: A descriptive cross-sectional study was conducted among 106 adults in a community. Interview schedule was used to collect data by using self-developed structured questionnaire Data analysis was done using descriptive and inferential statistics in SPSS version 23 Result: More than half 50.9% had an adequate level of awareness on meaning of stroke(70.8), risk factors of stroke (70.8%) identified hypertension followed by stress (67.1%) symptoms (84.0%) identified severe headache followed by dizziness (69.8%).However, inadequate knowledge was present on immediate management of stroke(0%), time period to take the person to the hospital(17.9)%).There was a statistical association between sex and level of awareness (p=0.027), as well as between occupational status and level of awareness (p=0.000). Conclusion: More than half of the respondents had adequate level of awareness regarding stroke despite of this, there is inadequate level of knowledge regarding the risk factors, preventive measures, the time period to take the person to the hospital, and complications associated with stroke. Which indicates need awareness program on stroke

Introduction: The anti-bacterial resistance has risen in a hurry, and the scarcity of new anti-bacterial medications has become one of the foremost global issues in the 21st century. Antimicrobial resistance, specifically antibacterial resistance has emerged as an urgent global health issue that compromises the effectiveness of infection treatment and prevention. Antimicrobial resistance estimated in 2014 that by 2050, AMR might be the cause for 10 million deaths. Method: In-silico method was utilized to investigate identify potential anti-bacterial medicinal plants. PyRx integrated version of AutoDock, open babble, vina wizard and Biovia discovery studio were utilized to predict the scoring functions of active chemical constituent from different medicinal plants, with specific protein of gram-positive and gram-negative bacteria. Discovery studio visualizer and marvin sketch was used to create 2D and 3D structure, interaction, and various web server was utilized to predict and collect the data. Result: Thirty-one active chemical constituents of different medicinal plants were designed and docked with DNA gyrase of Escherichia coli PDB-ID [1KZN] and [5L3J], Penicillin binding protein of Staphylococcus aureus PDB-ID [3VSL] and [1VQQ]. Active chemical constituents of Allium sativum show very low binding affinity below -4.7 kcal/mol, Zanthoxylum armatum shows below -6.3 kcal/mol, Zingiber officinale shows moderate binding affinity below -6.9 kcal/mol, Curcuma longa shows highest binding affinity below -8.4 kcal/mol with DNA gyrase and Penicillin binding protein. Out of Thirty-one active chemical constituents A15 Curcumin (-7.2, -7.5, -7.7, -7.1 kcal/mol), A16 Demethoxycurcumin (-7.9, -7.5, -7.1, -7.6 kcal/mol) and A17 Bisdemethoxycurcumin (-8.2, -7.2 -6.9, -8.4) shows the highest binding affinity. Out of Thirty-one only two Active chemical constituents A16, A17 shows Lead likeness. Physiochemical, Lipinski’s Rule and Pharmacokinetic parameters analyses shows that all active constituents have good physiochemical, pharmacokinetics parameters and moderate toxicological profile. Conclusion: : In-silico analysis indicates a descending order of antibacterial potential Curcuma longa > Zingiber officinale > Zanthoxylum armatum > Allium sativum, based on molecular docking scores, physicochemical characteristics, Lipinski’s Rule of Five, predicted pharmacokinetic parameters, and toxicological profile. Molecular docking results demonstrated that bioactive constituents of Curcuma longa, particularly curcuminoids and its derivatives (A15 - Curcumin, A16 - Demethoxycurcumin, A17 - Bisdemethoxycurcumin), exhibited the most favorable binding affinities toward selected bacterial target proteins, suggesting strong ligand receptor interactions and high inhibitory potential. Hence, Curcuma longa shows potential antibacterial action among four locally available medicinal plants.

Introduction: Subclinical hypothyroidism (SCH) and metabolic syndrome (MetS) both prevalent disorders associated with an elevated risk of cardiovascular disease (CVD). Thyroid hormones are crucial regulators of lipid and glucose metabolism, suggesting a significant pathophysiological link between SCH and the components of MetS. This study aimed to determine the burden of MetS among individuals with SCH in a Nepalese cohort. Method: Cross-sectional study of 111 adults (≥18 years) undergoing thyroid function tests at Manmohan Memorial Teaching Hospital, Kathmandu (October 2021–March 2022). Participants were classified as euthyroid (n=35), SCH (n=57), or hyperthyroid (n=19). Blood pressure, BMI, and WC were measured, and biochemical parameters FBS, lipid profile, and Thyroid profile were estimated by a fully automated biochemistry analyzer and chemiluminescence immunoassay. MetS was defined according to the NCEP ATP III criteria. Analysis used done in SPSS v23 using ANOVA, post-hoc tests, t-tests, and Pearson’s correlation (p<0.05). Results: Subclinical hypothyroidism exhibited dyslipidemia (elevated TC, TG, LDL-C; reduced HDL-C) and higher BMI versus euthyroid and hyperthyroid groups (p<0.01). Among thyroid disorders, the majority (71.05%) of the cases were with subclinical hypothyroidism (SCH). The overall incidence of MetS was 27.9% where the incidence was higher (90.8%) among females and major (41.94%) affected age group was 36-55 years. The incidence of MetS was higher (35.18%) among SCH (35.18%) as compared to other thyroid disorders. SCH with MetS showed significantly elevated blood pressure, waist circumference, and adverse lipids (p<0.05) as compared to SCH without MetS. TSH was positively correlated with waist circumference (r = 0.325, p = 0.017), implicating TSH in promoting central obesity. Conclusion: Subclinical hypothyroidism is strongly associated with an adverse cardiometabolic profile and a high burden of metabolic syndrome. The coexistence of SCH and MetS identifies individuals with the worst parameters, highlighting a critical subgroup for targeted intervention to reduce diabetes and CVD risk

Introduction: The unsafe and indiscriminate use of pesticide in agriculture represents a major human health problem. The aim of this study was to assess the level of safety practices regarding pesticides use and its effect on health among farmers of Rampur municipality. Method: The research was a descriptive cross-sectional study in the rural area of the Lumbini Province and purposive sampling was used to collect data. The study assessed pesticide safety practices and health effects among 227 farmers in Rampur Municipality, Palpa. Result: While all farmers recognized pesticides as harmful, 79.29% used them in crops, and 96.5% had no formal training. Unsafe practices were common, including storing pesticides in living areas (26.11%) and improper disposal methods. Pesticide exposure occurred mainly via the oral route (48.5%), with 14.5% unaware of the entry route. Only 31.11% bathed fully after pesticide use. Despite high awareness, safety practices were poor. Conclusion: The study recommends safety training, stricter law enforcement, and promotion of integrated and non-synthetic pest control methods. Strengthening farmers’ access to protective equipment and ensuring routine monitoring and follow-up will further support safer pesticide handling and reduce long-term health risks.

Evidence on the economic burden and costs of road traffic crashes (RTCs) in Nepal remains limited. This study assessed the disability-adjusted life-years (DALYs), costs and sociodemographic and injury-related factors associated with RTCs. A retrospective cross-sectional study was conducted among 107 RTC victims from Kaski district, Nepal, covering cases that occurred from 1 year to 45 days before the survey. Victims were identified via hospital, police and insurance records. Data were collected using a semistructured interview schedule that included sociodemographics, injury details, direct and indirect medical costs, and DALYs. Descriptive statistics and inferential analysis, including the Relative Concentration Index (RCI), were used to explore inequalities and associations with DALYs. Over one-third (37.4%) of victims were aged 25-44, and 60.7% were male. Each RTC and DALY cost an estimated US$391 and US$82, respectively. The DALY burden was about 1021 per million person-years, with over 99% from years of life lost. Most victims were young, unemployed, highly educated motorcyclists from wealthier groups. Recovery took an average of 153±86 days. RCI showed pro-rich inequality (0.0598, p=0.016), with poorer individuals requiring nine more days to recover. Uninsured and unemployed victims also faced longer recovery. RTCs in Kaski impose a significant economic and health burden, particularly affecting young, unemployed motorcyclists. Socioeconomic disparities were evident, with poorer, uninsured and unemployed individuals experiencing longer recovery periods. These findings highlight the need for equitable health policies and further research into broader RTC-related costs.