Background: Depression is a common public health problem among elders worldwide and is associated with high morbidity and disability. This study aims to assess depression and its associated factors among elderly in old-age homes and a community of Kathmandu district.Method: A comparative cross-sectional study recruited 122 elderly from old-age homes and a community of Kathmandu district. Depression was measured using the Geriatric Depression Scale-short scale (GDS-15). Socio-demographic and medical history was collected using semi-structured questionnaire. We utilized bivariate logistic regression to assess the association of depression with each variable. Results: The prevalence of depression among elderly in old-age homes was 74.6% and in community was 41.8%. The study found that elderly residing at old age homes were four (OR=4.087; 95% CI=2.373-7.038) times more likely to have depression than those residing in the community. Age was found to be associated with depression among the respondent of both settings. In old-age homes, not receiving old-age allowance, bad perception of life, bad social relation, having a chronic disease, lack of care from family, stress and weeping as stress coping strategy were associated with depression. In the community, stress, non-involvement in family decision making, feeling of neglect, dysfunctional capability, bad social relation, lesser monthly income had positive relation with depression.Conclusion: Depression is highly prevalent among Nepalese elderly, with higher burden in those living in old-age homes. This emphasizes the need for screening of depression among elderly, to initiate early intervention measures.

Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.