NLR Nepal

Introduction: Trauma-related deaths are rising in low- and middle-income countries (LMICs) like Nepal, where pre-hospital care systems are limited. Community health responders (CHRs) could reduce the time to post-injury care in rural settings. This pilot study evaluates the feasibility and impact of a CHR-based trauma program in rural Nepal. Methods: A quasi-experimental study first adapted a trauma curriculum for CHRs in Achham, Nepal, using global guidelines from the World Health Organization and the American College of Surgeons, using a modified Delphi process. The final program included three components: a two-day skills training, a pictorial guidebook for reference, and a one day refresher after three months. Two municipalities in Achham were assigned to intervention or control, with only the intervention group’ CHRs receiving the training. Outcomes measured included CHRs’ knowledge and confidence assessed over six months, and patient-based pre-hospital care process indicators. Care process indicators were assessed at the hospital emergency department. Changes in knowledge over time were analyzed using repeated measures ANOVA. Bivariate analysis was performed to assess differences in pre-hospital trauma care indicators by study group. Results: The intervention group showed a significant increase in knowledge and confidence immediately post-course and sustained over six months. There was no significant difference in mean patient age (26.5 years versus 22.1) and trauma mechanism (p = 0.14) across the two groups. The most common mechanism was falls (n=165, 77.5%). Intervention municipalities had higher rates of pre-hospital care provision, including fracture immobilization (51.4% versus 17.1%, p < .001) and cervical collar use, compared to controls. Conclusion: This study adapted and implemented a contextual trauma training program for CHRs in rural Nepal. Results show early feasibility and appropriateness in this context. The program leverages existing community networks and offers a potential approach in LMICs to bridge the existing critical gaps in rural pre-hospital trauma care that require further investigation.

Human-wildlife conflict is increasing at an alarming rate despite government efforts and local community support, posing a threat to both humans and wildlife species. Relief support for people affected by wildlife induced damage is a widely applied post-conflict mitigation approach. We reviewed relief provisions from government (policies, act, regulation, directives and five-year plan) and non-government organisations, including CBD, FAO, IUCN, and relevant peer-reviewed articles. The relief program was initiated through the Buffer Zone program at periphery of Chitwan National Park. The Buffer Zone Management Committee of Chitwan formed under ‘Buffer Zone Management Regulations, 1996, piloted a relief distribution practice in 1998 for wildlife damage using the 50% of the park’s revenue provided to buffer zone as per the regulations. This relief provision was designed as a compassionate measure to secure local community support for protected area management, offering cash support for losses of livestock, crops or in cases of human casualties. The Government established a legal mechanism of relief support payments to victims for wildlife caused damage through the Directive related to distribution of relief for wildlife caused damage 2009 under the provision of the National Park and Wildlife Conservation Act, 1973, and its Regulations 1975. By incorporating one and half decades of lessons learnt, the most recent Directive was formulated in 2023 to provide relief support for damage caused by 16 wildlife species. Such a provision reduces economic risks to surrounding communities and is expected to minimize retaliatory killings of wildlife. The high number of human-wildlife conflict cases demands substantial financial resources, raising concerns about the long-term sustainability of such relief programs. This has prompted the exploration of alternative measures to minimize human wildlife conflict, including endowment funds and crop and livestock insurance.

Hydrogen is increasingly recognized as a clean, carbon-free energy carrier capable of supporting future sustainable energy systems. Water electrolysis provides a practical route for hydrogen generation, but its efficiency is determined by the catalytic performance of the hydrogen evolution reaction (HER). Transition metal phosphides (TMPs), particularly those derived from Fe, Co, Ni, and Mo, including their binary and multimetallic alloys, and alloys with other transition metals, have attracted significant attention due to their low overpotentials. Strong electrochemical stability and tunable catalytic activity. This review provides a comprehensive overview of the HER reaction mechanism, synthesis strategies, performance evaluation methods, and structural engineering approaches for TMP-based catalysts. Special emphasis is placed on alloyed phosphide systems incorporating these and other transition elements, which exhibit enhanced charge transfer, optimized hydrogen adsorption energies, and improved durability. The electrocatalytic behaviour of these phosphides under different phosphidation conditions is compared to reveal the structure–activity relationship. Despite considerable progress, several limitations persist, such as insufficient intrinsic activity, active-site instability, sluggish kinetics in alkaline media, and challenges in large-scale synthesis. To overcome these barriers, potential solutions and future research directions are proposed, including multi-metal alloy design, advanced in-situ/operando characterization, computationally guided catalyst screening and development. The advancements are expected to guide the development of high-performance Fe–, Co–, Ni–, and Mo–, based phosphide materials suitable for practical water splitting applications.

Natural calamities, disease and pest, and unpredictable weather possess a high risk in livestock farming and cost a heavy loss to the farmers. Livestock insurance is one of the important strategies to reduce the risks related to livestock production. To assess the adoption process and impact of livestock insurance on dairy farmers, a study was conducted at Chitwan district among the 98 farmers (insured and non insured) sampled using stratified random sampling. Descriptive statistics were used to analyze the socio-economic and demographic variables of insurer and non-insured farmers. Pro bit model regression was used to analyze the impact of different variables on adoption of livestock insurance. In addition, t-test was also done to compare the numeric mean value of the variables of two categories of respondent, insured and non-insured. The Pro bit model results revealed that the age, gender, income from livestock, awareness about insurance and awareness of subsidy on insurance have a significant (p<.05) effect on the adoption of livestock insurance. The result of Chi-square test suggests that members of a farmers group/cooperatives, subsidy, loan and members of community agents have a significant (p<.05) effect on the adoption of the livestock insurance. The study underscores the need for a strategic policy to promote livestock insurance in Chitwan district. Both the government and non-life insurance companies must prioritize enhancing farmer awareness and understanding through targeted advertising and training to establish credibility and reliability. These findings will be helpful for the improvement of different livestock insurance policy and programs implemented by different government bodies and insurance companies.

Yellow fever, a mosquito-borne viral hemorrhagic disease, remains a significant public health concern in endemic regions of Africa and South America. The development of the yellow fever vaccine marked a milestone in virology and immunization. In the 1930s, Max Theiler created the 17D live-attenuated vaccine, a breakthrough that has achieved global recognition and continues to underpin prevention strategies. This review outlines the historical evolution of the yellow fever vaccine, highlighting pivotal scientific advances, technological innovations, and global eradication initiatives. It examines the current landscape of immunization, focusing on the World Health Organization’s Eliminate Yellow Fever Epidemics (EYE) strategy, ongoing efforts to address vaccine supply constraints, and persistent surveillance gaps. Future directions in vaccine development, including next-generation platforms and improved delivery systems, are also discussed, alongside the need for sustained research investment and international collaboration. As yellow fever emerges in previously non-endemic areas due to climate change and globalization, strengthening vaccination programs remains critical to preventing outbreaks and ensuring effective disease control.

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.

BackgroundAdolescent suicidality currently ranks as the third leading cause of death among adolescents, affecting global adolescent population, particularly in low- and middle-income countries (LMICs) like Nepal. This study explores the assessment of suicidality as an adverse event in adolescent mental health research in Nepal and outlines practical strategies for integrating suicide management protocols into mental health surveys in LMICs. It offers guidance on suicide risk assessment and referral pathways for vulnerable adolescents and contribute to suicide prevention efforts.MethodsThis study, a part of a cross-sectional survey with 490 adolescents aged 13–15 in public secondary schools in Kathmandu valley, used a three step approach of the Suicide Management Protocol (SMP) to identify and manage participants at risk of suicidality. Using the specific item under the measurement of mental health among adolescents and young people at the population level (MMAPP) tool followed by administering the suicide screening tool, those at risk of suicidality were identified by the researchers. Clinical assessments were then conducted by the psychosocial counsellor to categorize risk levels using Beck Suicide Intent Scale (BSIS) and provided appropriate management according to the severity.ResultsOf total 490 participants, while the single item under the MMAPP assessment identified 33 (6.7%) participants at risk, further screening using the suicide screening tool confirmed 25(5.1%) as positives, by the researchers. The psychosocial counsellor clinically assessed the 25 participants screened as suicide risk positive and found that 10 (40%) as high risk, 8 (32%) as moderate, and 7 (28%) as low risk. The clinical management of the cases at a differing level of risk was then managed as per the designated clinical pathways by developing protective behavior and reducing suicide related risk factors. All the participants were found to be safe and functioning normally through the course of clinical management, ranging from 2 to 6 sessions.ConclusionsOverall, integrating suicidality measures in mental health surveys was found to be effective suicide assessment and preventive strategy for adolescents in Nepal. Developing suicide management protocols within mental health surveys is essential and feasible for real-time monitoring and response to suicidal behavior among at-risk populations in LMICs, including Nepal.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24943-y.

Background:Diabetic nephropathy is one of the most prevalent consequences of diabetes and is associated with increased morbidity and mortality in diabetic patients. The pathogenesis of Diabetic Nephropathy is very complex and is still not fully understood, resulting in poor therapeutic outcomes. Dapagliflozin is thought to be associated with decreased progression of diabetic nephropathy. However, fewer trials have been conducted for the role of dapagliflozin in human patients with diabetic nephropathy. This is the first systematic review and meta-analysis where we aim to generate appropriate evidence regarding the safety and efficacy of dapagliflozin in diabetic nephropathy.Methods:We searched the databases like PubMed, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase for studies published from inception to November 2023. Bias assessment was done using risk of bias tool for randomized controlled trial (RCT) and Newcastle-Ottawa scale for non-randomized studies. Synthesis of the data was done using RevMan 5.4 software. Efficacy was assessed in terms of lowering HbA1c level, serum creatinine, and urine albumin-to-creatinine ratio. Statistical heterogeneity was measured by using the I squared test and the results were reported using forest plots.Results:Two studies were selected, 1 RCT and 1 comparative study including 296 patients. The dapagliflozin-treated group showed significant improvements in lowering serum creatinine [Standardized mean difference (SMD): −0.56 (−1.08, −0.04), P < .00001] and HbA1c [SMD: −0.84 (−1.07, −0.61), P = .03] when compared to the control group. But there was no discernible change in urine albumin-to-creatinine ratio [SMD: −1.45 (−3.33, 0.42), P = .13] after dapagliflozin therapy. Hypoglycemia [risk ratio: 0.26 (0.08–0.82), P = .02] was considerably lower in the dapagliflozin treatment group than in the control group in terms of safety.Conclusion:This meta-analysis showed that dapagliflozin was more effective in treating diabetic nephropathy while having fewer side effects. Our results support to the endeavor of conducting bigger, multicentre RCTs that assess dapagliflozin’s efficacy and delineate its unfavorable risk profile.