Raj Kumar Subedi

Mexico has reported 18,092 confirmed cases of measles from January 2025-June 2026, shortly before the 2026 FIFA World Cup matches in Guadalajara, Mexico City and Monterrey. Using national surveillance data and the Generalized Richards Model, we generated 6-week forecasts for the two highest-burden venue states. Jalisco was projected to report 118 cases (95% PI: 5-427) and Ciudad de México 22 (95% PI: 0-89). Pre-departure check of MMR vaccination status and enhanced event-associated surveillance are warranted.

The COVID-19 pandemic highlighted deep-rooted health inequities globally, with marginalized populations showing disproportionate disease burden. We employed Serfling regression models and multivariable analyses to estimate excess mortality across geographic, demographic, and poverty groups from 2020 to 2022 in Chile. Elderly populations (80+ years) experienced the highest excess mortality (267.35 per 10 000 population), more than 8 times higher than those under 80 years (30.80 per 10 000 population). Multivariable linear regression models showed both Indigenous proportion (coefficient = 53.66, P < .001) and elderly population proportion (coefficient = 5.68, P < .01) as the strong predictors of comuna level excess mortality. Poverty correlated significantly with excess mortality (r = 0.23, P < .001) but this association weakened after adjustment for other covariates in multivariable models. Excess mortality peaked in 2021 rather than in 2020 for most groups, with males initially experiencing higher rates during early pandemic waves. Spatial analyses revealed statistically significant clustering (Moran’s I = 0.119, P < .001) with identifiable hotspots in northern Chile and parts of the south. These findings indicated persistent mortality disparities by age and Indigenous status, independent of poverty, and highlight the urgent need for equity-focused pandemic preparedness. An effective pandemic response should integrate biomedical measures, such as vaccination, with culturally grounded strategies that address structural barriers and the broader social determinants of health.

Background: Health system-delivered evidence-based interventions (EBIs) are important to reducing amenable under-5 mortality (U5M). Implementation research (IR) can reduce knowledge gaps and decrease lags between new knowledge and its implementation in real world settings. IR can also help understand contextual factors and strategies useful to adapting EBIs and their implementation to local settings. Nepal has been a leader in dropping U5M including through adopting EBIs such as integrated management of childhood illness (IMCI). We use IR to identify strategies used in Nepal’s adaptation and implementation of IMCI. Methods: We conducted a mixed methods case study using an implementation research framework developed to understand how Nepal outperformed its peers between 2000–2015 in implementing health system-delivered EBIs known to reduce amenable U5M. We combined review of existing literature and data supplemented by 21 key informant interviews with policymakers and implementers, to understand implementation strategies and contextual factors that affected implementation outcomes. We extracted relevant results from the case study and used explanatory mixed methods to understand how and why Nepal had successes and challenges in adapting and implementing one EBI, IMCI. Results: Strategies chosen and adapted to meet Nepal’s specific context included leveraging local research to inform national decision-makers, pilot testing, partner engagement, and building on and integrating with the existing community health system. These cross-cutting strategies benefited from facilitating factors included community health system and structure, culture of data use, and local research capacity. Geography was a critical barrier and while substantial drops in U5M were seen in both the highest and lowest wealth quintiles, with the wealth equity gap decreasing from 73 to 39 per 1,000 live births from 2001 to 2016, substantial geographic inequities remained. Conclusions: Nepal’s story shows that implementation strategies that are available across contexts were key to adopting and adapting IMCI and achieving outcomes including acceptability, effectiveness, and reach. The value of choosing strategies that leverage facilitating factors such as investments in community-based and facility-based approaches as well as addressing barriers such as geography are useful lessons for countries working to accelerate adaptation and implementation of strategies to implement EBIs to continue achieving child health targets.

Background Between 2000-2015, many low- and middle-income countries (LMICs) implemented evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M). Even among LMICs successful in reducing U5M, this drop was unequal subnationally, with varying success in EBI implementation. Building on mixed methods multi-case studies of six LMICs (Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal) leading in U5M reduction, we describe geographic and wealth-based equity in facility-based delivery (FBD), a critical EBI to reduce neonatal mortality which requires a trusted and functional health system, and compare the implementation strategies and contextual factors which influenced success or challenges within and across the countries. Methods To obtain equity gaps in FBD coverage and changes in absolute geographic and wealth-based equity between 2000-2015, we calculated the difference between the highest and lowest FBD coverage across subnational regions and in the FBD coverage between the richest and poorest wealth quintiles. We extracted and compared contextual factors and implementation strategies associated with reduced or remaining inequities from the country case studies. Results The absolute geographic and wealth-based equity gaps decreased in three countries, with greatest drops in Rwanda – decreasing from 50% to 5% across subnational regions and from 43% to 13% across wealth quintiles. The largest increases were seen in Bangladesh – from 10% to 32% across geography – and in Ethiopia – from 22% to 58% across wealth quintiles. Facilitators to reducing equity gaps across the six countries included leadership commitment and culture of data use; in some countries, community or maternal and child health insurance was also an important factor (Rwanda and Peru). Barriers across all the countries included geography, while country-specific barriers included low female empowerment subnationally (Bangladesh) and cultural beliefs (Ethiopia). Successful strategies included building on community health worker (CHW) programs, with country-specific adaptation of pre-existing CHW programs (Rwanda, Ethiopia, and Senegal) and cultural adaptation of delivery protocols (Peru). Reducing delivery costs was successful in Senegal, and partially successful in Nepal and Ethiopia. Conclusion Variable success in reducing inequity in FBD coverage among countries successful in reducing U5M underscores the importance of measuring not just coverage but also equity. Learning from FBD interventions shows the need to prioritize equity in access and uptake of EBIs for the poor and in remote areas by adapting the strategies to local context.

Cardiovascular diseases (CVDs) account for the largest proportion of all deaths in Nepal (30%). Studies report that CVDs often begin with modifiable lifestyle risk behaviours established during adolescence which manifest later. This study aimed to measure changes in the five mortality-associated CVD risk behaviours (i.e., consumption of tobacco, alcohol, and junk food, physical inactivity, and stress among school adolescents) using an integrative intervention with the experiential learning approach. The study was carried out for 24 weeks (25 credit hours) among 4,225 students from grades 8 to 10 in community schools in seven provinces in Nepal. Pre- and post-intervention in-class self-reported surveys were conducted for assessing change in the students’ aggregate risk behaviours. These percent changes were assessed through bivariate analysis. Key-informant interviews of teachers were conducted to assess their perceptions of the effectiveness of the intervention. At 24 weeks, the percentages of students reporting consumption of cigarettes and smokeless tobacco declined by 25% and 28% respectively, consumption of alcohol declined by 29%, consumption of instant noodles by 11%, and consumption of coke by 43%. The proportion of students reporting ‘going to school by foot every day’ increased by 11%, and those ‘exercising until they sweat’ increased by 29%. The percentage of students who reported feeling that their ‘life has been running as desired’ increased by 16%. Key-informant interviews of the teachers revealed that the intervention had contributed to improved motivation, knowledge, and attitude among students towards mitigating the risk behaviours. These interviews also recommended continuation of the intervention. The sample in this study has shown positive changes in school adolescents’ self-reported aggregate CVD risk behaviours using the experiential learning approach. However, further research should be conducted to explore the sustainability and scaling of these learning modules through the existing non-communicable disease (NCD) school curriculum activities in Nepal.

Menopause is an unavoidable and sometimes problematic condition in which women may suffer from a number of health problems. Knowledge of the major symptoms associated with menopause helps reduce the burden and stress associated with the condition. In this context, a study was conducted to establish baseline data regarding menopausal health problems among Nepalese women. A descriptive cross-sectional study was conducted among 2000 women aged over 40 years to identify their knowledge, attitude and practice related to menopausal health problems. Data was collected by interviewing the women and doing physical examination. Analysis was done using descriptive statistics and SPSS software was used for data analysis. A cohort of 2073 women (ages 40-60 years) participated in the research, among them 2000 yielded complete response. The study revealed that 820 (41%) women had reached menopause. The average age of menopause was 48.7 years. Majority of the women 1183 (59.2%) in the study did not know about menopausal health problems. Abnormal bleeding 353 (17.65%), sweating 315 (15.75%), hot flushes 299 (14.95%), joint/muscle pain 285 (14.25%) were the most common menopausal symptoms known by the women. Joint pain 736 (36.8%), hot flushes 584 (29.2%), irregular bleeding 582 (29.1%) were the most common experienced symptoms of menopause and only 586 (29.3%) consulted the health workers to alleviate menopausal symptoms. Moreover, most of the women 926 (46.3%) accepted menopause as a part of life. The research has tried to establish the baseline of menopausal health problems in the Nepalese women. The average age of menopause was 48.7 years. Majority did not know about menopausal health problems. Further researches with nationally representative sample are recommended to further explore the menopausal health problems of Nepalese women.

Insomnia is one of the major and unsolved problems in older people. Most of the sleep studies report that the different forms of insomnia like Difficulty Initiating Sleep (DIS), Difficulty Maintaining Sleep (DMS) and Non-Restorative Sleep (NRS) are common among the elderly that are associated to many factors. The objective of the study was to measure the prevalence of insomnia and the factors associated to it among the elderly people. A cross-sectional study was conducted among 142 elderly people of and above 60 years of age in Sarangdanda VDC of Panchthar District of Eastern Nepal. The presence or absence of insomnia and the associated factors were assessed on them by the help of interview schedule. The results were analyzed using chi-square test in SPSS (version 11.5). DMS was the most common reported form of insomnia among the elderly followed by DIS and NRS. Association between insomnia and each of factors like use of tobacco before sleeping hours, eating too close to bedtime, use of tea/coffee before sleeping hours and use of alcohol before sleeping hours were statistically significant at 95% level of confidence. Insomnia affects a large proportion of elderly and is triggered by many factors like use of tobacco before sleeping hours, use of tea/coffee before sleeping hours, eating too close to bedtime and use of alcohol before sleeping hours. Keywords: Alcohol; tea/coffee; difficulty initiating sleep (DIS); difficulty maintaining sleep (DMS); non-restorative sleep (NRS); tobacco DOI: 10.3126/dsaj.v4i0.4517 Dhaulagiri Journal of Sociology and Anthropology Vol.4 2010 pp.129-142