IntroductionNepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes.Methods/designCluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker’s performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed.DiscussionIn contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality.Trial registration number ISRCTN30829654.

BackgroundAlbinism poses a significant threat to visual functions and causes remarkable ocular morbidity often resulting in visual disabilities. The study aimed at describing the visual status in patients with diagnosed cases of complete oculocutaneous albinism (OCA) attending to a tertiary eye hospital in Nepal.MethodsThis was a cross-sectional descriptive hospital-based study of all diagnosed oculocutaneous albinotic cases (16 males and 9 females; mean age of 16 years) who visited the Department of Ophthalmology at the Institute of Medicine, for ocular consultation between September 1, 2011 and December 1, 2013.ResultsTwenty-five cases (50 eyes) with OCA were enrolled in the study. All the participants had maximally reduced visual acuity (mean: 1.24 ± 0.50 logMAR). Myopic astigmatism was the most common refractive error (n = 17; 34%). 58% of all participants had with-the-rule astigmatism.Considering the spherical equivalent power, most of the eyes (n = 30; 60%) had myopia, with overall mean SE refractive error of −1.59 ± 5.39 D. Visual acuity improved significantly with refractive correction in place (paired sample t-test, p < 0.05). Horizontal pendular nystagmus was the most common nystagmus (n = 34 eyes; 68%). Alternating esotropia and alternating exotropia each were observed in 16% of participants who had strabismus (40% of all cases). The diaphanous iris, foveal hypoplasia and poliosis were the most consistent clinical features.ConclusionPatients with OCA present with a broad spectrum of visual deficits that impair the visual functions. Significant improvement in visual acuity following optical correction serves as an impetus to the reduction of visual disabilities in individuals with albinism.

Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices.

PurposeTo record the normative values for macular thickness and macular volume in normal Nepalese eyes.MethodsIn all, 126 eyes of 63 emmetropic subjects (mean age: 21.17±6.76 years; range: 10–37 years) were assessed for macular thickness and macular volume, using spectral domain-optical coherence tomography over 6×6 mm2 in the posterior pole. A fast macular thickness protocol was employed. Statistics such as the mean, median, standard deviation, percentiles, and range were used, while a P-value was set at 0.05 to test significance.ResultsAverage macular thickness and total macular volume were larger in males compared to females. With each year of increasing age, these variables decreased by 0.556 μm and 0.0156 mm3 for average macular thickness and total macular volume, respectively. The macular thickness was greatest in the inner superior section and lowest at the center of the fovea. The volume was greatest in the outer nasal section and thinnest in the fovea. The central subfield thickness (r=−0.243, P=0.055) and foveal volume (r=0.216, P=0.09) did not correlate with age.ConclusionMales and females differ significantly with regard to macular thickness and macular volume measurements. Reports by other studies that the increase in axial length reduced thickness and volume, were negated by this study which found a positive correlation among axial length, thickness, and volume.

Background: Drug Promotional Literatures are usually relied upon for drug promotion, however studies have shown them to contain several pitfalls. World Health Organization has time and often revised the guideline to address the issue and World Health Organization Ethical Criteria for Medicinal Drug Promotion was established. Based on this guideline, several regional as well as national guidelines have been formulated. Though laws to regulate drug promotion is existent, studies have shown problems with drug promotional literatures in Nepal also. This study was carried out to analyse the drug promotional literatures distributed by pharmaceutical companies in Nepal as per World Health Organization Ethical Criteria for Medicinal Drug Promotion.Methods: A cross-sectional study over a period of one year was conducted at our department. Pharmaceutical companies registered in Department of Drug Administration, Kathmandu and consenting for the study were requested to provide ten unique drug promotional literatures of their products. Collected drug promotional literatures were analysed for inclusion of essential information as per World Health Organization Ethical Criteria for Medicinal Drug Promotion, level of biasness. Different drug promotional literatures were also classified and compared for these aspects. Results: A total of 48 pharmaceutical companies were included in the study. Drug promotional literatures (n = 372) were analysed during the study. Adherence to criteria concerned with positive attributes of the promoted medicine was found to be higher, most of the drug promotional literatures adhered to 5-8 criteria of World Health Organization Ethical Criteria for Medicinal Drug Promotion and were categorised into grade B. Difference in adherence as well as number of biased drug promotional literatures was also seen when drug promotional literatures were compared on different basis. Conclusions: Adherence to World Health Organization Ethical Criteria for Medicinal Drug Promotion was found to vary when drug promotional literatures were classified as per pharmaceutical company, type of formulation being promoted, type of drug promotional literatures.Keywords: Drug act Nepal 1978; drug promotional literatures; WHO-ethical drug criteria for medicinal drug promotion.

Men and women suffering from the problems of various psychoactive substance abuse were helped to comeout of the problem by the Department of Psychiatry and Mental Health since it’s establishment in 1986.Since the De-addiction ward started functioning under the Department of Psychiatry and Mental Health,T.U. Teaching Hospital (TUTH) from February, 2000 A.D., people suffering from various drugs relatedproblems have received in-patient care. This study describes the profile of first 100 psychoactive substanceabusers admitted in this ward. The first hundred patients were admitted in a period of 5 months and 2weeks, in an average of 18 patients per month. Eighty eight males, the average age being 33.3+10.98 years.Seventy were married. The average years of education was 8.56+4.94 years. Alcohol (n=58) was the commonestinitial substance, followed by cannabis (n=19) and cigarette (n=11). Currently 60 were predominantly alcoholusers and 36 predominantly opiate users. The majority were multiple substance users: 79 used alcohol, 37used opiates, 25 used cannabis and 18 used benzodiazepines. Age at first use was 19.57+5.54 years andduration of continuous use was 5.88+4.47 years. Eleven (8 males) were HIV ELISA reactive, all of whomwere parenteral opiate abusers. Thirty-nine (35 males) had fatty changes in liver and 6 (all males) hadcirrhotic changes in liver. Those 45 persons with liver abnormality were all alcohol users.Key Words: psychoactive substance, alcohol, opiates, HIV, liver changes.

Blindness, which is a major burden on the individual and the society, was observed to be pervasively present in a region inhabited by an undermined, disadvantaged ethnic people, the Chepang (Köberlein et al., 2013). Such a plight heralds escalating, already- fragile eye health care in the remote region of Nepal (Ghimire, 2015).

To address this terrible situation, we propose the following solutions: in the short term, conduct regular eye health camps with appropriate management locally. In the long term, to strengthen primary eye care and integrate it into general health, by training primary health care workers in primary eye care (more specifically assessing visual acuity) establishing adequate referral channels. Currently, unfortunately, much of eye care service delivery remains centered on the district headquarters and accessible places, with other remote regions left unattended. We hope our report will awaken all concerned to the dire need for equitable eye care across the country.