Ankit Acharya

Background: Public health professionals (PHPs) constitute a critical component of health systems, but their ability to apply knowledge effectively across sectors is often constrained. Persistent issues such as inadequate training, limited career opportunities, and job dissatisfaction undermine workforce effectiveness and retention globally. In Nepal, these challenges are compounded by weak alignment between academic preparation and professional realities, creating barriers for graduates and professionals to thrive within the health system. Methods: Qualitative reflexive thematic analysis (RTA) was used to understand the educational and career experiences of PHPs in Nepal. Guided by principles of information power, we recruited 18 participants via purposive and snowball sampling, and semi‐structured interviews were conducted. Results: Through reflexive engagement, we constructed six key themes: (1) navigating a narrow job market, (2) struggling with practical gaps, (3) barriers to job placement, (4) foundations misaligned with practice, (5) overcoming challenges, and (6) hope and future vision. The participants reported a saturated and uncertain job market, limited mentorship, inadequate practical training, nepotistic recruitment practices, and curricula misaligned with contemporary public health practices. These factors constrain employability and career satisfaction, often prompting additional study or career shifts. Despite systemic barriers, participants expressed cautious optimism that Medical Education Commission (MEC)‐led reforms, including standardized entrance examinations and integrated scholarships, together with potential vacancies at local government levels, could enhance education, improve workforce retention, and create meaningful professional roles in Nepal. Conclusions: This study highlights the urgent need to realign Nepal's public health education with professional realities. Strengthening curricula with practical, competency‐based training, integrating modern technologies, providing mentorship and field exposure, and ensuring transparent employment and supportive policies can empower public health graduates and professionals. Such reforms enhance workforce resilience, career satisfaction, and professional identity, ultimately strengthening public health capacity to improve population health outcomes in resource‐constrained contexts.

Psychological distress, encompassing depression, anxiety, and stress, is common among individuals with cancer but remains inadequately recognized in many low- and middle-income countries, including Nepal. Despite growing emphasis on holistic cancer care, psychological aspects are often overshadowed by clinical and financial concerns. This study aimed to estimate the prevalence of psychological distress among cancer patients in Nepal and to identify its associated sociodemographic, clinical, and economic factors. A cross-sectional study was conducted among cancer patients in two tertiary level referral hospitals in Nepal. The validated Nepali version of the Depression, Anxiety and Stress Scale (DASS‑21) was used to assess psychological distress. A total of 262 participants were enrolled. SPSS version 27 was used to perform cleaning, coding and analyses. Associations were examined using binary logistic regression, and adjusted odds ratios were estimated using multivariate logistic regression, with p-values <0.05 considered statistically significant. More than two-thirds of cancer patients had depression (66.8%) and anxiety (68.7%) symptoms, and nearly three-fifths had symptoms of stress (58.0%). Higher odds of psychological distress were observed among participants who were older, unemployed, had fewer years of education, and had advanced-stage cancer. Compared with patients diagnosed at stage I, those diagnosed at II, III, and IV had significantly higher odds of depressive symptoms, with crude odds ratios of 2.75 (95% CI: 1.39-5.42), 2.81 (95% CI: 1.40-5.64), and 4.21 (95% CI: 1.39-12.76), respectively. Although households of cancer patients experienced out of pocket expense, catastrophic health expense and impoverishment, no significant association was found between these indicators and psychological distress. Psychological distress is highly prevalent among Nepali cancer patients and is linked primarily to sociodemographic and clinical factors rather than direct economic burden. Integrating routine mental health screening and basic counseling into oncology services is urgently needed to improve patients' overall well-being.

Alcohol has complex, historic, and deep cultural significance in Nepal. Countries from the global majority, such as Nepal, experience the highest burden of harm from alcohol with increasing consumption rates compared with high-income countries. Therefore, alcohol harm reduction initiatives that engage meaningfully with cultural and community practices are needed. The Alcohol Co-design and Community Engagement (ACE) study aimed to co-create new understanding of harmful use of alcohol through applying creative and participatory approaches to inform future alcohol research and policy in Nepal. This article reports on the creative methodological process used to co-create knowledge exchange with diverse communities, co-researchers, and policy makers in Nepal. We co-produced a range of creative alcohol policy review activities, including scoping community and cultural assets that could be harnessed to reduce harmful use of alcohol by working with communities, including those with lived experience. This allowed us to understand the nature of any existing health and community support available locally, while highlighting the absence of much-needed support. We achieved this through using multi-modal, participatory approaches to critically review current policy and explored other forms of knowledge – centring indigenous knowledge – for its cultural and contextual relevance to reduce harmful use of alcohol and make recommendations for alcohol research and policy development and implementation in Nepal.

Background Although sexuality remains a taboo in Nepali society, the prevalence of premarital sexual activities is increasing. Youth who begin early premarital sexual activity are more likely to be engaged in unsafe sex. This study aims to determine the prevalence and associated factors of premarital sex among college-going youths of Dhangadhi Sub-Metropolitan City, Kailali (DSMC). Methodology This descriptive cross-sectional study was conducted in management colleges with Bachelor of Business Studies (BBS) programs in DSMC. The sample size for the study was 374. The probability proportionate to size sampling technique was adopted for sample estimation for the selected colleges. The data was entered, cleaned, and analyzed in SPSS26. Bivariate analysis was done using Pearson’s chi-square test was used to determine differences between groups. A simple logistic regression model was conducted to assess the association between several characteristics of the respondents and the outcome variable- premarital sex, followed by multiple logistic regression to evaluate the combined impacts of various predictors on premarital sex. Results The prevalence of premarital sex among undergraduate college youths was 35.3%, of which 52.3% were males. Among those undergraduate youths, more than half (51.5%) had experienced their first intercourse before 18 years of age. At least 1 out of 10 respondents reported that their intercourse led to pregnancy. In model I, in simple logistic regression, predictors such as age, gender, relationship status, dating experience (p-value < 0.001), communication with parents (p-value = 0.002), family type (p-value = 0.020), and family income (p-value = 0.002) were significantly associated with premarital sex. Furthermore, not living with parents, parent’s education level, friends with sex partners, friends having dating experience, and awareness that friends have sex were also among the factors significantly associated with premarital sex. In the multiple logistic regression, in Model II, relationship status (aOR, 44.47; 95% CI: 7.88, 251.08), dating experience (aOR, 24.00; 95% CI: 5.36, 107.58), discussion about sexual health with parents (aOR, 8.16; 95% CI: 2.25, 29.62), and knowing friends who had premarital sex (aOR, 15.82; 95% CI: 2.92, 85.61) were significantly associated with premarital sex after controlling for potential confounding predictors. Conclusion Sex education interventions within and beyond educational institutions are crucial to increase the level of awareness and protect the physical, mental, and social health of young unmarried partners in Nepal.

Objective: This study aims to assess the acceptability of a novel technology, MAchine Learning Application (MALA), among the mothers of newborns who required resuscitation. Setting: This study took place at Bharatpur Hospital, which is the second-largest public referral hospital with 13 000 deliveries per year in Nepal. Design: This is a cross-sectional survey. Data collection and analysis: Data collection took place from January 21 to February 13, 2022. Self-administered questionnaires on acceptability (ranged 1–5 scale) were collected from participating mothers. The acceptability of the MALA system, which included video and audio recordings of the newborn resuscitation, was examined among mothers according to their age, parity, education level and technology use status using a stratified analysis. Results: The median age of 21 mothers who completed the survey was 25 years (range 18–37). Among them, 11 mothers (52.4%) completed their bachelor’s or master’s level of education, 13 (61.9%) delivered first child, 14 (66.7%) owned a computer and 16 (76.2%) carried a smartphone. Overall acceptability was high that all participating mothers positively perceived the novel technology with video and audio recordings of the infant’s care during resuscitation. There was no statistical difference in mothers’ acceptability of MALA system, when stratified by mothers’ age, parity, or technology usage (p>0.05). When the acceptability of the technology was stratified by mothers’ education level (up to higher secondary level vs. bachelor’s level or higher), mothers with Bachelor’s degree or higher more strongly felt that they were comfortable with the infant’s care being video recorded (p = 0.026) and someone using a tablet when observing the infant’s care (p = 0.046). Compared with those without a computer (n = 7), mothers who had a computer at home (n = 14) more strongly agreed that they were comfortable with someone observing the resuscitation activity of their newborns (71.4% vs. 14.3%) (p = 0.024). Conclusion: The novel technology using video and audio recordings for newborn resuscitation was accepted by mothers in this study. Its application has the potential to improve resuscitation quality in low-and-middle income settings, given proper informed consent and data protection measures are in place.

Menstrual restriction has persisted in Nepalese society for centuries, driven by ignorance and myth. This practice is imposed on women through various Hindu mythologies and leads to significant limitations in their daily activities. The most severe form of menstrual restriction, known as Chaupadi, has resulted in numerous deaths of women and young children due to suffocation, snakebite, rape, and other serious forms of harm. Despite its criminalization by law, there has been no visible impact on the practice of menstrual restriction. This discriminatory practice not only causes hormonal imbalance and physical pain but also has significant mental health implications for adolescent girls, which have yet to be fully explored. Therefore, this study aims to investigate the prevalence and perceived stress associated with menstrual restriction among adolescent girls attending lower secondary school in Far-Western Region, Kailali District, Nepal The study utilized a descriptive, cross-sectional design and recruited 370 respondents using a proportionate random sampling technique. The study was conducted at the secondary school of Godawari Municipality in Kailali, Nepal. Prior to the study, a structured questionnaire and a Likert scale were pretested among 10% of the population in Kathmandu. Data Analysis was done using Univariate Analysis, Bivariate Analysis (Chi-square) and Multi-variate Analysis (Logistic Regression). The findings revealed that perceived stress was comparatively higher among upper-caste groups and Dalits who followed menstrual restrictions religiously, as compared to disadvantaged Janajati from the hills. Moreover, the level of perceived stress was moderately high among households with larger family sizes. Significant associations were observed between menstrual restriction and perceived stress for each type of menstrual restriction studied, with more than 80% of the different measured levels of restrictions showing a significant association. Menstrual restriction-related practices, such as being restricted from entering inside the house, being sent to Chau-Goth, being restricted from touching male members, being restricted from touching livestock or animals, being restricted from eating together with the family, being restricted from consuming dairy products, being restricted from participating in cultural rituals, being restricted from sleeping in any bed, and being restricted from using heavy blankets and mattresses, were associated with perceived stress. The relationship between menstrual restrictions and perceived stress level was examined. Results showed that respondents with restrictions to enter or reside inside the house had 3.78 times higher odds of perceived stress (OR=3.78; CI=1.96-7.33), while those sent to Chhau Goth had 2.98 times higher odds (OR=2.98; CI=1.94-4.57). Respondents with restrictions on touching food, cooking food, plants with holy belief, livestock or animals, dairy products, eating together with family, participating in cultural rituals, having Prasad, sleeping in any bed, using packed pads, common toilet, or common taps during menstruation also had higher odds of perceived stress. Given the findings, further research is necessary to measure the level of perceived stress among adolescent girls in the population. This research has significant implications for the physical, social, and psychological well-being of adolescent girls and the community at large.

Background: The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal. Methods: A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression. Result: In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45^th postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant. Conclusion: Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.

Background: Sustainable Development Goal (SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal. Methods: Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for all sick newborns admitted in public hospitals in Nepal from November 2017. We conducted this pre-post quasi-experimental study with four months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period. Results: A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17 % of mothers paid for sick newborn care while after implementation 15.3 % mothers (p-value = 0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean ± SD: US dollar 14.3 + 12.1 and after implementation was Mean ± SD: USD 13.0 ± 9.6 (p-value = 0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value < 0.001) while the cost for medicine increased (p-value = 0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value = 0.04) and neonatal sepsis (p-value < 0.001) after the FNC program was implemented. Conclusions: We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such programs in hospitals of Nepal. Trial registration: ISRCTN- 30829654, Registered on May 02, 2017.