Archana Shrestha

Background: Domestic violence is a widespread public health problem and a serious human rights violation. It occurs worldwide, across all generations, nationalities, communities and spheres of societies, irrespective of age, ethnicity, disability or other background. Domestic violence victims have a higher risk of post-traumatic stress disorder and suicide. Despite a critical link between domestic violence and mental health, very few such studies exist in Nepal. Aims: To investigate the association between depressive symptoms and physical, sexual and emotional domestic violence. Method: A cross-sectional study was conducted among 429 women aged 30–60 years who underwent cervical cancer screening in Dhulikhel and Banepa municipalities, Kavrepalanchowk District, Nepal. Univariate and multivariate logistic regression models were used to assess the association between depressive symptoms and domestic violence and abuse. Results: Findings suggest 2.99 times (95% CI 1.57–5.67, p = 0.001) higher odds of having depressive symptoms in women experiencing any type of violence. Similarly, the odds of having depressive symptoms were 2.5 times (95% CI 1.26–4.98, p = 0.009) higher in participants who had experienced physical violence and 6.21 times (95% CI 2.49–15.46, p < 0.001) higher among participants who had experienced sexual violence or emotional abuse. Conclusions: Women experiencing physical, sexual or emotional abuse are more likely to experience depressive symptoms. To better understand the factors contributing to these symptoms, further in-depth and exploratory studies are needed. Community-based interventions are needed to offer counselling, support groups and safe spaces for women affected by violence.

Objective: To determine the prevalence and factors associated with stress, anxiety and depression among married women in Chandrapur municipality, Nepal. Design: We conducted a cross-sectional study. Setting: Household Survey of Chandrapur municipality, Nepal. Participants: We enrolled 545 married women from June to August 2022. Outcome measures: We administered the Depression, Anxiety and Stress Scale (DASS-21) through face-to-face interviews to determine the prevalence of stress, anxiety and depression. We performed univariable and multivariable linear regression to identify factors associated with stress, anxiety and depression. We reported 95% CIs with p values <0.05. We conducted all the analyses in Stata 14. Results: The prevalence of stress, anxiety and depression was 28.8%, 16.7% and 31.1% respectively. Univariable and multivariable linear regression analysis were conducted to identify factors associated with symptoms of stress, anxiety and depression. Symptoms of stress were significantly associated with Janajati and Dalit ethnicity (β=2.64; 95% CI 1.12 to 4.16; p value: 0.001) and Terai ethnicity (β=2.07; 95% CI 0.33 to 3.80; p value: 0.02), non-Hindu religion (β=-5.02; 95% CI −7.53 to −2.52; p value <0.001), residence other than husband’s house (β=4.37; 95% CI 0.57 to 8.17; p value=0.02) and women’s occupational status (β=3.30; 95% CI 0.64 to 5.96; p value: 0.01). Symptoms of anxiety were significantly associated with residence other than husband’s house (β=2.62; 95% CI 0.11 to 5.13; p value: 0.04) and women’s occupational status (β=5.10; 95% CI 3.34 to 6.86; p value <0.001). Symptoms of depression were significantly associated with non-Hindu religion (β=−3.23; 95% CI−5.24 to −1.22; p value=0.002), and living in joint family (β=−1.51; 95% CI −2.53 to −0.49; p value=0.004) after adjusting for age, ethnicity, religion, education, age of marriage, family type, residence, occupation and migrant husband. Other prespecified variables like age, age of marriage and migrant husband were not significantly associated with the symptoms of stress, anxiety and depression in adjusted analysis. Conclusion: Stress, anxiety and depression symptoms were present in a significant proportion of women in Chandrapur municipality. Policy makers and health practitioners must provide significant attention in reducing the magnitude of these mental health conditions and reducing its impact on women and families.

Introduction: Quitting tobacco is challenging and often requires multiple attempts. Effective tobacco cessation programmes depend on understanding the factors associated with the intention to quit in specific contexts. The study aimed to determine the prevalence of intention to quit and its associated factors among people who smoke currently visiting the outpatient department of a tertiary hospital in a semi-urban area of Nepal. Methods: An analytical cross-sectional study was conducted from 1 May to 30 June 2021, among 375 people who smoke currently selected using purposive sampling from the outpatient department of Dhulikhel Hospital. Intention to quit was assessed using a question on whether participants planned to quit smoking, with response options: (1) within the next month, (2) within the next 6 months, (3) sometime in the future but not within 6 months and (4) not planning to quit. Data on socio-demographic characteristics, nicotine dependence, motivational factors and awareness of cessation aids and services were collected using a standard structured questionnaire. Multivariate logistic regression was used to determine the factors associated with intention to quit smoking. Results: Overall, 72.5% (95% CI 67.8% to 76.8%) of participants reported an intention to quit smoking, with 64.8% in the pre-contemplation stage, 24.8% in the contemplation stage and 10.4% in the preparation stage. Higher education (high school or above), longer duration of smoking and moderate nicotine dependence were significantly associated with higher intention to quit, whereas having a history of family member smoking was associated with lower likelihood of intending to quit. Conclusions: A substantial proportion of patients reported an intention to quit, with most in the pre-contemplation stage. These findings highlight the need for targeted outpatient cessation strategies, including brief advice from healthcare workers, mobile or telephone-based quit-line services and family-centred educational campaigns, to support quitting efforts and inform culturally appropriate tobacco control interventions in Nepal.

Background: Menstrual restrictions remain widespread in Nepal, where approximately 90% of women and girls follow at least one restriction. One of the most harmful practices, chhaupadi (severe menstrual seclusion), requires women and girls to isolate in huts during menstruation and is associated with substantial physical and psychological risks, including injury, assault, smoke inhalation, and social exclusion. Although interventions have attempted to address chhaupadi, effectiveness has varied, and no comprehensive assessment has identified which components work, for whom, and under what conditions. Few prior efforts have meaningfully engaged communities in intervention design to ensure contextual relevance and sustainability. Objective: This protocol describes a three-aim study designed to (1) elucidate mechanisms underlying the success or failure of chhaupadi interventions; (2) co-design a culturally grounded, theory- and evidence-informed intervention in partnership with communities; and (3) pilot and evaluate the intervention using a controlled trial design. Methods: This multiphase study integrates realist synthesis, intervention mapping, human-centered design, and arts-based research. In aim 1, we will conduct a realist synthesis of published and gray literature, complemented by knowledge-sharing workshops and expert interviews to identify underlying mechanisms explaining chhaupadi intervention success or failure. In aim 2, synthesis findings will inform participatory intervention development. Using the intervention mapping framework, we will convene a co-design workshop incorporating human-centered design and arts-based research methods (eg, asset mapping, impact ladder, concept posters, and communal storytelling) with women, adolescents, and community collaborators to develop intervention components and implementation strategies. In aim 3, the co-designed intervention will be piloted in a controlled trial comparing intervention communities (full community-designed intervention) with control communities (menstrual health education only). Quantitative measures will assess knowledge, attitudes, and practices related to chhaupadi, self-efficacy, mental health, and reproductive health outcomes. Implementation indicators (eg, enrollment, acceptability, appropriateness, and feasibility) will also be assessed. Qualitative interviews and discussions will examine implementation processes, barriers, facilitators, and contextual influences. Results: The study was funded in September 2023. Aim 1 activities began in April 2024. To date, 69 materials met the inclusion criteria, and a workshop with 8 organizations and 44 interviews has been conducted. Analysis was completed in February 2026, with results expected in the summer of 2026. Aim 2 co-design workshops began in March 2025; eleven women participated in the workshop, and an additional 123 community members have been consulted. This has resulted in a draft intervention called “Our Voice: Transforming Lives through Ending Chhaupadi.” Aim 2 results are expected in Fall 2026. Aim 3 data collection will begin in Winter 2027. Conclusions: By systematically identifying effective intervention mechanisms and embedding community leadership throughout design and implementation, this study aims to develop a sustainable strategy to reduce harms associated with chhaupadi and improve women’s and girls health. This integrated framework may also inform interventions addressing other socially embedded health practices in low-resource settings.

Objectives Hypertension remains poorly controlled globally, highlighting the need for scalable community-based strategies. Although community health worker (CHW)-facilitated interventions show promise, implementation evidence from low- and middle-income countries remains limited. This study assessed the implementation processes, mechanisms of impact and contextual factors influencing a CHW-facilitated home visit intervention for hypertension management. Design Mixed-methods process evaluation nested within a randomised cluster trial. Setting An urban municipality in Nepal. Participants Individuals with hypertension were surveyed at baseline (n=1252) and follow-up (n=1098). CHWs completed routine monitoring forms and home visits were observed (n=47). In-depth interviews were conducted with individuals with hypertension (n=20), spouses (n=7), adult children (n=13), CHWs (n=8) and public primary healthcare providers (n=5). Results Overall, 86% of participants completed all six planned home visits. Visits were generally delivered with fidelity, with minor adaptations to fit participant and family contexts. Participants reported high satisfaction and perceived benefits, including improved knowledge, family support and uptake of self-blood pressure monitoring. However, developed behavioural action plans often lacked specificity, limiting progress follow-up and accountability. Weak public primary care capacity, medication stockouts and preference for higher-level or private facilities constrained care linkage. Conclusion CHW-facilitated home visits addressed key individual and family-level barriers to hypertension management, but impact was limited by uneven behaviour uptake and constrained public primary healthcare capacity for medication supply and titration. Strengthened CHW training and mentorship are needed to support effective behaviour change. Integration of community interventions with functional primary care systems is essential for sustained hypertension control in low-resource urban settings. Trial Registration number NCT05292469; date of registration: 22 March 2022; URL: https://clinicaltrials.gov/ct2/show/NCT05292469?cntry=NP&draw=2&rank=6.

Common mental health conditions (CMHCs) such as depression and anxiety often co-occur with noncommunicable diseases (NCDs) like hypertension and diabetes,

The global health literature reflects the need to restructure systems that balance power, remove financial barriers, and ultimately enhance equity, but immediate strategies to enhance equity are often underappreciated, particularly with regard to navigating the publishing ecosystem. Our paper describes how researchers can navigate the publishing ecosystem to create greater equity within their author teams, including those related to communication, supporting junior investigators in building their writing and professional skills, selecting journals that prioritize equity, ensuring transparent recognition of all contributors, and understanding institutional requirements for professional advancement. We also suggest changes in the publishing ecosystem to further enhance equity related to the presentation and recognition of joint authorship, developing a system for identifying predatory journals, and how publishing agreements might better promote equity in authorship. Our advice can help research teams position themselves to achieve greater equity among themselves. Additionally, our suggested changes to the publishing ecosystem will encourage future efforts toward equity.

Background Domestic violence is a widespread public health problem and serious violation of human’s right. It occurs worldwide, across all generations, nationalities, communities and spheres of societies, irrespective of age, ethnicity, disability or other background. While men may also fall victim to domestic violence, it is women who bear the more serious implications for their health. Domestic violence victims have a higher risk of post-traumatic stress disorders, and suicide. Despite a critical link between domestic violence and mental health, very few studies have been done to identify the link between violence and mental health problems in Nepal. Thus, to bridge the gap this study aims to investigate the association between depressive symptoms and different forms of domestic violence; physical, sexual and emotional violence. Methods We conducted a cross-sectional study among 429 women aged 30 to 60 years who underwent cervical cancer screening in Dhulikhel and Banepa municipalities, Kavrepalanchowk district, Nepal. We conducted the study amid the COVID-19 pandemic. Therefore, interviews were conducted over the phone for infection prevention. We used univariable and multivariable logistic regression models to assess the association between depressive symptoms and domestic violence and abuse. Results Findings of our study suggest 2.99 times (95% CI: 1.57, 5.67, p = 0.001) higher odds of having depressive symptoms in women experiencing any type of violence. Similarly, the odds of having depressive symptoms were 2.5 times (95% CI: 1.26, 4.98, p=0.009) higher in participants who had experienced physical violence and 6.21 times (95% CI: 2.49, 15.46, pConclusion Those women who have experienced physical violence, sexual abuse, or emotional abuse are more likely to experience depressive symptoms. To better understand the factors contributing to these symptoms, further in-depth and exploratory studies are needed. Community-based interventions are needed to offer counseling, support groups, and safe spaces for women affected by violence.

Objective To assess factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 at primary healthcare (PHC) facilities in Nepal after healthcare workers received training. Design Cross-sectional study. Setting PHC facilities across various provinces in Nepal. Participants A total of 180 healthcare workers trained in PEN, recruited from a random selection of 105 basic healthcare facilities. Main outcome measures The adoption of PEN Protocol 1 components: blood pressure measurement, blood glucose screening, 10-year cardiovascular disease (CVD) risk assessment using WHO/International Society of Hypertension risk charts and body mass index (BMI) assessment. Factors associated with protocol adoption were assessed using generalised estimating equations for ORs. Results Among participants, 100% reported measuring blood pressure, while 56% measured blood sugar, 28% assessed CVD risk and 27% assessed BMI. The adoption of the CVD risk prediction chart was positively associated with the availability of amlodipine (adjusted OR (aOR) 3.00; 95% CI 1.09 to 8.27). The adoption of BMI assessment was positively associated with access to a stadiometer (aOR 3.23; 95% CI 1.26 to 8.30) and a glucometer (aOR 3.07; 95% CI 1.12 to 8.40), and negatively associated with lack of motivation/inertia of previous practice (aOR 0.60; 95% CI 0.42 to 0.87) and environmental factors such as lack of time and resources (aOR 0.57; 95% CI 0.37 to 0.89). Blood glucose level measurements were positively associated with being at a PHC centre (aOR 7.34; 95% CI 2.79 to 19.3) and the availability of metformin (OR 2.40; 95% CI 1.08 to 5.29). Conclusion Adoption of PEN Protocol 1 varied by component and was influenced by resource availability, provider motivation and system barriers. Addressing these factors is key to optimising implementation in low-resource settings.