The World Health Organization has identified universal health coverage (UHC) as a key approach in reducing equity gaps in a country, and the social health insurance (SHI) has been recommended as an important strategy toward it. This article aims to analyze the design, expected benefits and challenges of realizing the goals of UHC through the recently launched SHI in Nepal. On top of the earlier free health-care policy and several other vertical schemes, the SHI scheme was implemented in 2016 and has reached population coverage of 5% in the implemented districts in just within a year of implementation. However, to achieve UHC in Nepal, in addition to operationalizing the scheme, several other requirements must be dealt simultaneously such as efficient health-care delivery system, adequate human resources for health, a strong information system, improved transparency and accountability, and a balanced mix of the preventive, health promotion, curative, and rehabilitative services including actions to address the social determinants of health. The article notes that strong political commitment and persistent efforts are the key lessons learnt from countries achieving progressive UHC through SHI.

BackgroundAddressing family planning (FP) needs of people living with HIV is an effective response to HIV prevention. Healthy timing and spacing of births help ensure the health and well-being of all women and infants, regardless of their HIV-infection. In addition, preventing unintended pregnancies is an important strategy for prevention of mother to child transmission of HIV. The main purpose of this study was to explore the knowledge of family planning methods and identify factors affecting the utilization of such methods among HIV infected men and women attending two Anti-Retroviral Therapy (ART) sites of Kathmandu, Nepal.MethodsThis was a descriptive cross-sectional study. Two ART sites of Kathmandu were purposively chosen and a sample of 265 respondents (both men and women) was selected based on proportionate probability random sampling. A structured questionnaire was administered face to face to all of the eligible participants.ResultsThe mean ± SD age of the participants was 36.62 ± 7.58 years. Sixty five percent of the respondents’ spouses were HIV positive. A majority of the respondents (72%) had heard of seven modern family planning methods. Considerably high number (72%) of the respondents or their spouses were using at least one of the method of family planning. The most common method was condom (83%) and the least common was IUCD (0.50%). The use of short acting (pills, depo-provera) and long acting (implant, IUCD) family planning methods other than condom dropped from 56.6 to 2% after diagnosis. Utilization of family planning methods was significantly associated with gender, education and HIV status of spouse. Males (Adjusted Odds Ratio (AOR) = 2.48, 95% CI = 1.20–5.07, p = 0.01) educated respondents (AOR = 3.27, 95% CI = 1.41–7.54, p = < 0.01) and individuals whose spouse were not infected with HIV (AOR = 4.70, 95% CI = 1.41–15.67, p = 0.01) were more likely to use FP methods.ConclusionThe tendency for HIV infected men and women to avoid additional child bearing in Nepal is higher compared to sub-Saharan Africa. However, the use of effective methods of family planning is low. Therefore, more effective counselling sessions by service providers regarding the availability and use of alternative family planning methods besides condom is necessary.

Background: Pregnancy in people Living with HIV/AIDS (PLHIV) involves significant public health risks, including the risk of HIV transmission to uninfected partners and the fetus. Despite the growing importance of fertility issues for HIV-infected people, little is known about their fertility desires in Nepal. This study, therefore, aimed to determine the magnitude of and factors associated with the fertility desire of PLHIV. Patients and Methods: A cross-sectional study was conducted among 280 PLHIV attending the antiretroviral therapy (ART) clinic in Teku Hospital, Nepal. A standard semistructured questionnaire was administered to participants using systematic random sampling. Data were entered using Epi-data 3.1 and analyzed using SPSS software version 20. Results: Out of the total participants, 12.1% desired to have a child. Among those having this desire, 44.1% had not decided when to have a child. Reasons for desiring a child were having no children (44.1%), wanting to have a child of different sex than the previous one (29.4%), followed by wanting to have another child (26.5%). Factors such as being male (

DOI: 10.3126/njenthns.v1i1.4728 Nepalese J ENT Head Neck Surg Vol.1 No.1 (2010) p.6-7

Introduction: Acute appendicitis is the most common atraumatic surgical emergency in childhood. The accurate diagnosis of acute appendicitis is not always easy. Alvarado score (AS) and paediatric appendicitis score (PAS) are commonly used tools to assist diagnosis. This study compares the diagnostic accuracy between AS and PAS. Methods: A prospective study was conducted from September 2016 to September 2017 in Paediatric Surgery Unit of Tribhuvan University Teaching Hospital. All eligible patients (children up to 16 years) who were operated for acute appendicitis were included. AS and PAS were calculated for all patients preoperatively. Final diagnosis of acute appendicitis was based on histopathological examination and labeled as ‘appendicitis’ or ‘no appendicitis’. A cut off score of 7 for AS and 6 for PAS was compared with ‘appendicitis’ or ‘no appendicitis’ group. Results: A total of 70 patients were included in the study. Sixty five (93%) were histologically proven acute appendicitis and five (7%) were no appendicitis. The sensitivity, specificity, PPV, NPV and accuracy of AS were 89%, 40%, 95%, 22% and 85% respectively. For PAS, sensitivity, specificity, PPV, NPV and accuracy was 97%, 40%, 95.5%, 50% and 92% respectively. On Receiver Operating Characteristic curve, ‘area under curve’ of AS was 0.64 and that of PAS was 0.84. It was not statistically significant (p = 0.152). Conclusions: There was no statistical significant difference between AS and PAS for diagnosing acute appendicitis.