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The number of medical students trained in Nepal each year has increased nearly fifty-fold in the last 15 years, primarily through the creation of private medical schools. It is unknown where this expanding cohort of new physicians will ultimately practice. We distributed an anonymous survey to students in their last 2 years of medical school at four medical schools in Nepal to examine two dimensions of career intention: the intention to practice in Nepal and the intention to practice in rural areas. Eighty-five per cent of the eligible study population participated, for a total of 469 medical students. Of these, 88% thought it was likely they would practice in Nepal and 88% thought it likely they would practice in urban areas. Those students who indicated a greater likelihood of practicing abroad came from families with higher incomes, were more likely to think earning a good salary was very important to their decision to become a physician, and were less likely to think they could earn a good salary in Nepal. Students whose tuition was paid by the government were no more likely to indicate an intention to practice in Nepal than students paying their own tuition at private medical schools. Students who indicated a greater likelihood of practicing in rural areas were more likely to be male, to have gone to a government secondary school, to have been born in a village, or to have received a scholarship from the Ministry of Education that requires rural service. Based on our findings, we suggest the following policy changes: (1) medical schools consider selecting for students from rural backgrounds or government secondary schools who are more likely to intend to practice in rural areas, and (2) increase the number of post-graduate positions--weighted toward rural health needs--to retain students in Nepal.

Diarrheal diseases are major problem of developing countries. Though precise data on childhood mortality associated with diarrheal diseases in Nepal is not available, it has been estimated that approximately 25% of child death are associated with diarrheal disease, particularly acute diarrhea. The purpose of this study was to assess the incidence of parasitic pathogens causing acute diarrhea in children under 5 years of age. A total of 525 children with acute diarrhea in a children's hospital of Kathmandu, Nepal were enrolled between April 2011 and September 2011. The higher prevalence of diarrhea was in the age group of less than 2 years. Out of total 525 enrolled cases, protozoal parasites were found in 10.7% (56/525) of cases and helminthic parasites were found in 1.3% (7/525) of cases. Highest prevalence of 60.3% (38/63) of parasitic infection was found in the age group of 6 -24 months followed by 7.9% (5/63) in the age group of less than 6 months. Of the total enrolled cases E. histolytica were 6.7% (35/525) followed by Giardial lamblia 3.4% (18/525) and the least frequency was due to A. lumbricoides constituting 0.6% (3/525). The aim of this study was to know the parasitic agents causing acute diarrhea in children.

Diarrhoeal diseases are a major problem in developing countries. Though precise data on childhood mortality associated with diarrhoeal diseases in Nepal are not available, it has been estimated that approximately 25 % of child deaths are associated with diarrhoeal disease, particularly acute diarrhoea. The purpose of this study was to assess the incidence of rotavirus causing acute diarrhoea in children less than 5 years of age. A total of 525 children with acute diarrhoea in a children's hospital of Kathmandu, Nepal, were enrolled between April and September 2011. The incidence of acute diarrhoea due to rotavirus was 25.9 % (136/525) as determined by ELISA. The percentage of rotavirus-infected males was higher (64.5 %) than females (35.5 %). The frequency of rotavirus cases was higher in children less than 2 years of age, among which the majority of cases (80.2 %) were in children between 6 and 24 months old (P,0.01). Genotypic characterization by RT-PCR revealed that the serotype G12 represented 55.9 % of cases in this study associated with P-types of either P[6], P[4] or P [8]. Further to this, a total of eight G/P combinations were identified, G12P[6] being the most common strain type of rotavirus in Nepal, with a prevalence rate of 46.4 %. The aim of this study was to find out the major genotypes of rotavirus causing acute diarrhoea in children.

Occupational safety and health are key issues today, with growing industrialization and labor market. To introduce and maintain a high standard of safety and health at workplace, it is essential to have an overall picture of the present workplace scenario, different hazards and probable health effects. This is a review of all previously published articles on occupational safety and health in Nepal. Key words such as Nepal, Occupation, Safety, and Health were used to search for relevant articles in PUBMED and Google Scholar. A total of 15 research articles were found, which dealt with different forms of work, like agriculture, health services, child labor, small scale household industries, brick kilns, and textile factories. The overall status of occupational safety and health does not look satisfactory. Standard work situations and criteria have to be set up and regular monitoring should be done to ensure the maintenance of quality at work. Key Words: environment; exposure; hazards; labor; work place DOI: http://dx.doi.org/10.3126/ijosh.v1i1.4725 International Journal of Occupational Safety and Health, Vol 1 (2011) 19-26

Introduction: Studies conducted amongst the inhabitants of high altitude suggested that systolic and diastolic blood pressures are lower in the high than in low altitude population. So a study was designed to look at the blood pressure values among permanent residents of high altitudes of rural Western Nepal. Methods: This is a descriptive cross sectional study conducted at two different altitudes (2670 and 2950 meters) of Humla District, Nepal, looking at the blood pressure values among the permanent inhabitants at these altitudes.  Results: Total number of 137 subjects with 73 (53.3%) from 2950 meters and 64 (46.7%) from 2670 meters altitude were enrolled. Mean age of the study population was 35.29 years. Male were 57 (41.6%) and female 80 (58.4%). The difference in systolic blood pressures (118.59 and 114.66 mmHg, P=0.01) and mean arterial pressures (92.0 and 89.5 mmHg, P=0.02) at the altitudes of 2670 and 2950 meters were statistically significant whereas the difference in diastolic BP at these altitudes were not statistically significant. There was no significant correlation of BMI with blood pressure values and no difference was noted in the blood pressure values among the two different ethnic groups at the given altitudes.  Conclusions: Lower rate of hypertension was observed among the inhabitants of high altitude of rural western Nepal. Blood pressure was found to decreases with increase in altitude among permanent inhabitants of high altitude.  Keywords: altitude; blood pressure; high altitude inhabitants; hypertension; physiological change.

A B S T R A C TObjectives: The aim of this study was to describe the emergence in Nepal of clinical isolates of Klebsiella pneumoniae harboring both bla NDM-5 and bla OXA-181/-232 . Methods: Six clinical isolates of K. pneumoniae highly resistant to carbapenems and aminoglycosides were obtained from inpatients in Nepal. Their whole genomes were sequenced by a next generation sequencer.Results: The minimum inhibitory concentrations of meropenem, amikacin and ciprofloxacin were 128 m g/ml, >1024 mg/ml and 256 mg/ml, respectively. All six isolates co-harbored bla NDM-5 , bla OXA-181 or -232 and rmtB. Of them, 1 also harbored rmtF. The bla NDM-5 , bla OXA-232 and rmtB in all six isolates were located on plasmids. Of the six isolates tested, one isolate harbored two copies of bla OXA-181 and rmtF on the chromosome. Conclusions: This is the first report of clinical isolates of K. pneumoniae co-harboring bla NDM-5 , bla OXA-181 or -232 and rmtB in Nepal. These strains were highly carbapenem-and aminoglycoside-resistant, and belonged to ST147 or ST395. Of them, ST147 isolate harbored two copies of bla OXA-181 on the chromosome.

Of 250 clinical isolates of Escherichia coli obtained in Nepal, 38 were carbapenem resistant, with MICs of imipenem or meropenem of Ն4 g/ml. All 38 isolates harbored the following bla NDM s: bla NDM-1 , bla NDM-3 , bla , bla , bla , bla , and bla . Most of these isolates also harbored the 16S rRNA methylase gene(s) armA, rmtB, and/or rmtC.