Santosh Bhatta

Nepal faces many natural hazards, including floods, landslides, earthquakes, and extreme weather, which severely impact infrastructure, public health, and community resilience. In 2025, we conducted a formative stakeholder and community engagement exercise to inform research on strengthening local preparedness. This included consultative meetings with national agencies, local government, and community members in two hazard-affected municipalities. Field notes from the meetings were thematically analysed to identify priority themes. Findings indicated that national legal and policy frameworks exist, but implementation at municipal and ward levels remains inconsistent and hindered by limited institutional capacity. Local actions were largely focused on relief and reconstruction rather than preparedness and risk reduction. Community members and local officials described limited awareness of preventive strategies but strong willingness to engage in preparedness planning. Stakeholders identified priorities including improved coordination, legal literacy, locally tailored early-warning communication, and better data systems. These findings will inform co-development of a practical preparedness resource.

Introduction: Unintentional home injuries are a leading cause of morbidity and mortality among children under five in Nepal, particularly in rural areas. Despite this burden, culturally appropriate community-based prevention strategies remain limited. This study explored community perspectives to inform the design and delivery of a parental education intervention for childhood home injury prevention. Methods: A qualitative study was conducted in Sunkoshi Rural Municipality, Sindhupalchok District, in December 2024. Seven focus group discussions were held with 56 mothers of preschool-aged children, and 11 key informant interviews were conducted with Female Community Health Volunteers (FCHVs), health-facility in-charges, a school health nurse, and local government officials. Data were analysed thematically using NVivo 14, guided by the Health Belief Model. Results: Five major themes were identified: (1) Perceived household hazards and common child injuries, (2) Behaviours leading to child injuries, (3) Barriers and facilitators for prevention, (4) Prevention and control practices, and (5) Design and delivery of Information, Education and Communication (IEC) materials. Burns and falls were the most frequently reported injuries, often resulting from unsafe cooking areas, open fires, and poor supervision. Barriers to prevention included limited parental awareness, competing household priorities, and unsafe home environments, whereas community cooperation and FCHV support acted as facilitators. Participants favoured simple, visual, and low-cost educational materials, such as posters, flipcharts, and videos, delivered through participatory group discussions led by FCHVs. Conclusion: Parents and community stakeholders demonstrated strong interest in home injury prevention education. Embedding culturally tailored parental education within existing community health platforms, particularly FCHVs and mothers’ groups, represents a feasible, scalable, and sustainable approach to reducing childhood injuries in rural Nepal.

Background: Injuries cause significant harm and may lead to disability yet are largely preventable. Understanding the epidemiology and determinants of injury in any given context is an essential step towards effective prevention. In Nepal, surveys suggest that injuries on the road, at home and at work are a problem, but in the absence of injury surveillance, robust death registration or police records, the true burden is unclear. For those who are injured, access to prehospital care is variable. Objectives: To understand the epidemiology of injuries. To identify potentially modifiable risk factors to inform the development of prevention interventions. To build capacity and capability for injury prevention research. Design: Observational, secondary data analysis and qualitative methods were used. We worked with communities, practitioners and stakeholders to identify potential participants, develop study protocols and disseminate findings. Setting: Nepal. Participants: Patients, communities and road users, health system practitioners and managers, professionals (e.g. police, engineers, journalists) and local and national decision-makers. Main outcome measures: Epidemiological evidence of the burden of injuries, evidence to inform future intervention development. Data sources: Participants, health services, police and information in the public domain. Review methods: Reviews were conducted systematically with evidence synthesised narratively. Results: The Nepal Injury Research Centre was established and a cadre of researchers trained. Three researchers and our data manager completed Master’s degree courses, and all researchers developed their skills by leading at least one project from protocol development through to publication. A review of publications reporting injuries indicated that existing epidemiological evidence mostly arose from case series at high risk of bias. A review of existing legislation showed policy gaps and incomplete implementation or enforcement. Surveillance studies and a household survey showed the high burden of injuries at home, at work and on the roads, and the neglected issue of suicide. Previously unreported inequalities by age, sex, ethnic group and income level were identified. Existing health, police and death registration data systems are at high risk of under-reporting and misclassification. Road traffic injury emerged as a major concern: road users fear being injured as pedestrians, passengers or drivers; the economic burden of road injuries has increased threefold over 8 years; and potentially modifiable risk factors were identified. The provision of first-response services is highly variable, and the public and practitioners are fearful of prosecution in the event of poor outcomes. We found it is feasible to train the traffic police in first response and for them to use their skills at traffic collisions. Research priorities for suicide prevention were identified. Limitations: Studies were limited by the quality of the data available through existing systems, with data often incomplete or poorly coded. Our studies were largely conducted in one district with topography typical of many areas of Nepal. However, our findings may not be generalisable to all districts. Conclusions: Our programme identified the inequitable and significant burden of injuries in Nepal. There is the potential to develop existing legislation and health and transport systems to reduce the incidence and consequences of injury. Future work: Research should focus on interventions to reduce injury risk on the roads and at home/work, to develop the first-response system and standardise care and to strengthen injury data systems. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research (GHR) programme as award number 16/137/49.

Background: Road traffic injuries are the 12th leading cause of mortality globally. Nepal, one of the least developed countries in the world, has a rapidly rising rate of road traffic-related morbidity and mortality. There is incomplete reporting of traffic crashes in Nepal in the last three World Health Organization global status reports on road safety. Together with poor-quality coding of crashes, essential information to inform prevention interventions or make international comparisons is lacking. Objectives: The study aimed to critically analyse routinely collected traffic police data in Makwanpur district, Nepal, to identify the road user groups most likely to be involved and injured in traffic crashes in this part of the country. Design: Secondary data analysis. Setting: Makwanpur district, Nepal. Data sources: Road traffic crash records from the District Traffic Police Office, Makwanpur, over 2 years (April 2017–March 2018 and May 2019–April 2020). Data were extracted from paper-based records onto an electronic database, and the data were analysed descriptively using the Statistical Package for the Social Sciences version 24.0 (IBM Corporation, USA). Results: There were 291 crashes recorded in 2017–8 and 435 crashes in 2019–20. Two-wheeled vehicles (motorcycles/scooters) were the most frequently involved in police-reported crashes (35.5%). For most crashes (419/726, 58%), no cause was documented in the police record. Road users involved in crashes were mostly riders or passengers of motorised two-/three-wheelers (33.4%), four-wheeled vehicles (19.9%) or buses (16.7%). Of fatal injuries, 31.2% were riders or passengers of motorised two-/three-wheelers, and 24.8% were pedestrians. Limitations: The data used represent crashes reported to the traffic police and therefore underestimate the true number of crashes and injuries. At the end of the second period of study, local movement restrictions associated with the COVID-19 pandemic lockdown limited the traffic on the roads, resulting in fewer crashes in March and April 2020. In most crash records, there were missing data, limiting the ability to determine contributory factors with confidence. Conclusion: This study contributes to the evidence gap by describing crashes and mortality data by vehicle type and road user category. The findings suggest that the number and rates of crashes may be increasing over time. Action to improve the quality and completeness of data routinely collected by the traffic police is needed; a piloted web-based Road Accident Information Management System has the potential to support improved routine data collection. Future work: The data indicate crashes occurring in one district over 2 years. To better understand the apparent increase in crashes, an analysis over a longer period, and over multiple districts, would be necessary. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/49.

An increasing number of people are relocating to search for work, leading to substantial implications for both local and global health. Approximately 3.6% of the global population (281 million) migrates annually. Nepal has experienced a notable surge in labour migration in recent years, with a substantial proportion of its residents actively seeking work opportunities abroad. Understanding work-related risks is crucial for informing policies, interventions, and practices that can improve the welfare of this hard-to-reach population. This scoping review aims to systematically identify and analyse occupational health hazards encountered by Nepali migrant workers employed overseas. Medline, Scopus, Directory of Open Access Journals (DOAJ), and the NepJOL databases were systematically searched for primary research papers published in English up to July 2024. Relevant data, including workplace hazards and their impact on health outcomes, were extracted and narratively synthesised by highlighting key themes in the existing literature. A total of 24 articles met the inclusion criteria and were included in this review. Of these, twelve studies were conducted in Nepal, five in Gulf countries, four in Malaysia, two in Hong Kong, and one each in India and Korea. Workplace injuries (motor vehicle injuries, machinery injuries, falls from a height, and falls on a heavy object), poor working environment (including long working hours, work without leave, discrepancy in pay scale, limited access to drinking water and toilet/bathroom facilities), workplace abuse, sexual abuse, and torture were identified as key occupational health hazards faced by the Nepali migrant workers abroad. Multi-level intervention strategies, such as safety training standards, improving working conditions, and eliminating exploitative labour practices, are critical to improving occupational health and safety standards for Nepali migrant workers abroad. This includes creating a supportive working environment where employees can easily and timely access health services as needed.

Background: Suicide is a significant public health concern in Nepal and there is a need for an evidence-based suicide prevention programme to facilitate stakeholders working towards suicide prevention in Nepal. Collaborative research between stakeholders focussing on shared priorities can help to prevent and control suicide. Hence, we aimed to develop a consensus list of research priorities for suicide prevention in Nepal.Methods: The Delphi expert consensus method was used to elicit the prioritized research questions for suicide prevention in Nepal. Participants comprised suicide prevention experts (psychologists, psychiatrists, psychiatric nurses, researchers and advocates) and people with lived experience. Three rounds of Delphi were conducted; round 1: one to one interviews involving open ended questions used to generate research questions; round 2: ranking of the research questions using a 5-point Likert scale, and round 3: re-ranking of research questions in light of individual and group responses.Results: Forty-two participants participated in round 1 followed by 38 in round 2 and 39 in round 3 . 522 research questions were generated through round 1 which were grouped together and reduced to 33 research questions sent for ranking in round 2. Using a cut off of at least 70% of the panel ranking questions as ‘very important’ or ‘important’, 22 questions were retained. These research questions were sent for re-rating in round 3 resulting in a final list of prioritized questions.Conclusions: This is the first expert consensus study to identify the top research priorities for suicide prevention in Nepal, and used experts in suicide prevention and those with lived experience. A consensus was reached regarding the studies needed to improve suicide data quality, assess the burden and identify factors associated with suicide. A priority driven approach to suicide prevention research may ensure that the research endeavour provides the most useful information for those whose day-to-day work involves trying to prevent suicide.

This study aimed to develop and evaluate a model of hospital-based injury surveillance and describe the epidemiology of injuries in adults. One-year prospective surveillance was conducted in two hospitals in Hetauda, Nepal. Data were collected electronically for patients presenting to emergency departments (EDs) with injuries between April 2019 and March 2020. To evaluate the model’s sustainability, clinical leaders, senior managers, data collectors, and study coordinators were interviewed. The total number of patients with injuries over one year was 10,154, representing 30.7% of all patients visiting the EDs. Of patients with injuries, 7458 (73.4%) were adults aged 18 years and over. Most injuries (6434, 86%) were unintentional, with smaller proportions due to assault (616, 8.2%) and self-harm (408, 5.5%). The median age of adult patients was 33 years (IQR 25–47). Males had twice the rate of ED presentation compared with females (40.4 vs. 20.9/1000). The most common causes were road traffic accidents (32.8%), falls (25.4%), and animal/insect related injuries (20.1%). Most injured patients were discharged after treatment (80%) with 9.1% admitted to hospital, 8.1% transferred to other hospitals, and 2.1% died. In Nepal, hospital-based injury surveillance is feasible, and rich injury data can be obtained by embedding data collectors in EDs.

In Nepal, unintentional home injury is a leading reason for death and disability among pre-school children. However, there is a lack of evidence to inform culturally appropriate interventions to reduce home injuries. This study explored the potential for home environmental change at a community level to prevent unintentional home injury in children and identified the barriers to, and facilitators of, such changes. Focus groups were conducted in the Nepali language with mothers, fathers, teachers, school students and community health volunteers in rural areas of Makwanpur district in Nepal. The discussions were audio-recorded, transcribed, translated into English and analysed thematically. NVivo software was used to support coding and identification of themes. Five focus groups, involving forty-seven participants, were completed leading to the development of four themes. Overall, the findings highlight that community people perceive injuries to be a normal part of childhood and, therefore, few prevention measures were considered. Parents were, however, able to identify ways to change their environment that made it safer. Changes included removing hazards or adding safety equipment, adapting the home or restricting access to potential hazards. Barriers to implementation included limited awareness about injury hazards and risk management, poor quality housing and financial constraint. Facilitators included raising community awareness, acquiring resources and financial support and involving the family and community. Development of interventions to prevent injuries at home in pre-school children should reflect local context and culture; this is best achieved through engagement with parents.

Background Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5–24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. Methods A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. Results The total number of children Conclusion Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.

Almost 10% of global deaths are secondary to injuries, yet in the absence of routine injury surveillance and with few studies of injury mortality, the number and cause of injury deaths in many countries are not well understood. This study aimed to develop and evaluate the feasibility of a method to identify injury deaths in rural Nepal. Working with local government authorities, health post staff and female community health volunteers (FCHVs), we developed a two-stage community fatal injury surveillance approach. In stage one, all deaths from any cause were identified. In stage two, an interview with a relative or friend gathered information about the deceased and the injury event. The feasibility of the method was evaluated prospectively between February 2019 and January 2020 in two rural communities in Makwanpur district. The data collection tools were developed and evaluated with 108 FCHVs, 23 health post staff and two data collectors. Of 457 deaths notified over one year, 67 (14.7%) fatal injury events were identified, and interviews completed. Our method suggests that it is feasible to collect data on trauma-related deaths from rural areas in Nepal. These data may allow the development of injury prevention interventions and policy.