Publications by authors named "Pratik Khanal"

22 Publications

  • Page 1 of 1

May Measurement Month 2019: an analysis of blood pressure screening results from Nepal.

Eur Heart J Suppl 2021 May 20;23(Suppl B):B110-B113. Epub 2021 May 20.

Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal.

May Measurement Month (MMM) is a global initiative to screen high blood pressure (BP) in the community and increase awareness at the population level. High BP is the leading risk factor for mortality worldwide and in Nepal. This study presents the results of the 2019 MMM in Nepal. Opportunistic BP screening was conducted in 30 out of 77 districts across Nepal and aged ≥18 years at the community and public places. BP was measured three times in a seated position. A total of 74 205 individuals participated in the study, mean age 39.9 years, and 58% were male. BP measurements for the second and third readings were available for 69 292 (93.3%) individuals. The proportion of the population that were hypertensive was 27.5% ( = 20 429). Among those hypertensives, 46.3% were aware of their hypertensive status and of these, 37.5% were on antihypertensive medication. Only 54.3% of those on antihypertensive medication had their BP controlled. Of the community screened, those self reporting to have diabetes, current tobacco users, and current alcohol drinkers were 6.7%, 23.6%, and 31.9%, respectively; 20.6% of the participants were overweight, and 6.5% were obese. Since the first BP screening campaign, MMM 2017 in Nepal, the number of participants screened has largely increased over the years. MMM's success in Nepal is through a coordinated mobilization of trained health science students and volunteers in the communities. The Nepal MMM data demonstrates that large community-based BP screening campaigns are possible in low resource settings.
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http://dx.doi.org/10.1093/eurheartj/suab042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141957PMC
May 2021

An outbreak investigation of scrub typhus in Nepal: confirmation of local transmission.

BMC Infect Dis 2021 Feb 18;21(1):193. Epub 2021 Feb 18.

Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal.

Background: Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness in the areas of tsutsugamushi triangle caused by Orientia tsutsugamushi. It is frequently diagnosed in South Asian countries, although clear epidemiological information is not available from Nepal. After the 2015 earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported. The objective of this study was to investigate epidemiology of scrub typhus and its causative agents in humans, animals, and chigger mites to understand the ongoing transmission ecology.

Methods: Scrub typhus cases with confirmed diagnosis throughout the country were included in the analysis. Studies were concentrated in the Chitwan district, the site of a major outbreak in 2016. Additional nation-wide data from 2015 to 2017 available from the government database included to analyse the disease distribution by geographical mapping.

Results: From 2015 to 2017, 1239 scrub typhus cases were confirmed with the largest outbreak occurring in 2016 with 831 (67.1%) cases. The case fatality rate was 5.7% in 2015 which declined to 1.1% in 2017. A nationwide outbreak of scrub typhus was declared as the cases were detected in 52 out of the 75 districts of Nepal. Seasonal trend was observed with a peak during August and September. In addition to the human cases, the presence of O. tsutsugamushi was also confirmed in animals (rodents) and chigger mites (Leptotrombidium imphalum) from the outbreak areas of southern Nepal.

Conclusion: The detection of O. tsutsugamushi in humans, animals, and chigger mites from outbreak locations and wide-spread reports of scrub typhus throughout the country consecutively for 3 years confirms the ongoing transmission of O. tsutsugamushi with a firmly established ecology in Nepal. The country's health system needs to be strengthened for systematic surveillance, early outbreak detection, and immediate actions including treatment and preventive measures.
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http://dx.doi.org/10.1186/s12879-021-05866-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893900PMC
February 2021

Health related quality of life among haemodialysis and kidney transplant recipients from Nepal: a cross sectional study using WHOQOL-BREF.

BMC Nephrol 2020 10 12;21(1):433. Epub 2020 Oct 12.

Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

Background: Very less is known about health-related quality of life (HRQOL) among patients with kidney diseases in Nepal. This study examined HRQOL among haemodialysis and kidney transplant recipients in Nepal.

Methods: The Nepali version of World Health Organization Quality of Life Instruments -(WHOQOL-BREF) questionnaire was administered using face to face interviews among end stage renal disease (ESRD) patients, from two large national referral centers in Nepal. The differences in socio-demographic characteristics among ESRD patients were examined using the Chi-square test. The group differences in quality of life (QOL) were examined using the Mann-Whitney U test and Kruskal-Wallis tests.

Results: Of the 161 participants, 92 (57.1%) were renal transplant recipients and 69 (42.9%) patients were on maintenance haemodialysis. Hypertension (70.9%) was the most common co-morbidity among ESRD patients. Haemodialysis patients scored significantly lower than the transplant recipients in all four domains as well as in overall perception of quality of life and general health. Ethnicity (p = 0.020), socio-economic status (p < 0.001), educational status (p < 0.001) and employment status (p = 0.009) were significantly associated with the overall QOL in ESRD patients. Across patient groups, educational status (p = 0.012) was positively associated with QOL in dialysis patients, while urban residence (p = 0.023), higher socio-economic status (p < 0.001), higher educational status (p = 0.004) and diabetes status (p = 0.010) were significantly associated with better QOL in transplant recipients.

Conclusion: The overall QOL of the renal transplant recipients was higher than that of the patients on maintenance haemodialysis; this was true in all four domains of the WHOQOL-BREF. ESRD patients with low HRQOL could benefit from targeted risk modification intervention.
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http://dx.doi.org/10.1186/s12882-020-02085-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552453PMC
October 2020

Mental health impacts among health workers during COVID-19 in a low resource setting: a cross-sectional survey from Nepal.

Global Health 2020 09 25;16(1):89. Epub 2020 Sep 25.

National Academy for Medical Sciences, Kathmandu, Nepal.

Background: Health care workers exposed to COVID-19 might be at increased risk of developing mental health problems. The study aimed to identify factors associated with anxiety, depression and insomnia among health workers involved in COVID-19 response in Nepal.

Methods: This was a cross-sectional web-based survey conducted between April 26 and May 12, 2020. A total of 475 health workers participated in the study. Anxiety and depression were measured using a 14-item Hospital Anxiety and Depression Scale (HADS: 0-21) and insomnia was measured by using a 7-item Insomnia Severity Index (ISI: 0-28). Multivariable logistic regression analysis was done to determine the risk factors of mental health outcomes.

Results: Overall, 41.9% of health workers had symptoms of anxiety, 37.5% had depression symptoms and 33.9% had symptoms of insomnia. Stigma faced by health workers was significantly associated with higher odds of experiencing symptoms of anxiety (AOR: 2.47; 95% CI: 1.62-3.76), depression (AOR: 2.05; 95% CI: 1.34-3.11) and insomnia (AOR: 2.37; 95% CI: 1.46-3.84). History of medication for mental health problems was significantly associated with a higher likelihood of experiencing symptoms of anxiety (AOR: 3.40; 95% CI:1.31-8.81), depression (AOR: 3.83; 95% CI: 1.45-10.14) and insomnia (AOR: 3.82; 95% CI: 1.52-9.62) while inadequate precautionary measures in the workplace was significantly associated with higher odds of exhibiting symptoms of anxiety (AOR: 1.89; 95% CI: 1.12-3.19) and depression (AOR: 1.97; 95% CI: 1.16-3.37). Nurses (AOR: 2.33; 95% CI: 1.21-4.47) were significantly more likely to experience anxiety symptoms than other health workers.

Conclusion: The study findings revealed a considerate proportion of anxiety, depression and insomnia symptoms among health workers during the early phase of the pandemic in Nepal. Health workers facing stigma, those with history of medication for mental health problems, and those reporting inadequate precautionary measures in their workplace were more at risk of developing mental health outcomes. A focus on improving mental wellbeing of health workers should be immediately initiated with attention to reduction of stigma, ensuring an adequate support system such as personal protective equipments, and family support for those with history of mental health problems.
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http://dx.doi.org/10.1186/s12992-020-00621-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517059PMC
September 2020

Addressing Emerging Public Health Issues through Interdisciplinary Research.

J Nepal Health Res Counc 2020 Sep 7;18(2):I-II. Epub 2020 Sep 7.

Nepal Health Research Council, Ramshah Path, Kathamndu, Nepal.

N/A.
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http://dx.doi.org/10.33314/jnhrc.v18i2.3054DOI Listing
September 2020

Mitigating violence against women and young girls during COVID-19 induced lockdown in Nepal: a wake-up call.

Global Health 2020 09 21;16(1):84. Epub 2020 Sep 21.

Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal.

Nepal, a South Asian country, was in nationwide lockdown for nearly three months in 2020 with partial restrictions still in place. Much worryingly, COVID-19 induced restrictions have confined women and young girls in their home, increasing the risk of domestic violence. The available support system to respond to violence against women and girls (VAWG) has also been disrupted during this period. The figures of violence against women, and child sexual abuse are increasingly being reported during the lockdown and thereafter. To mitigate this, a response against VAWG should not be a missing agenda. This commentary focuses on the situation of VAWG during COVID-19 induced restrictions in Nepal and offers a way forward for addressing the issue.
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http://dx.doi.org/10.1186/s12992-020-00616-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503426PMC
September 2020

Cardiometabolic risk factors among patients with tuberculosis attending tuberculosis treatment centers in Nepal.

BMC Public Health 2020 Sep 5;20(1):1364. Epub 2020 Sep 5.

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Background: The co-morbidity of cardiometabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardiometabolic risk factors among patients with Tuberculosis.

Methods: This was a cross-sectional study conducted among patients with tuberculosis in 12 tuberculosis treatment centers from eight districts of Nepal between May and July 2017. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on-site blood glucose tests. Data were analyzed using descriptive and inferential statistics.

Results: Among 221 study participants, 138 (62.4%) had new smear-positive pulmonary tuberculosis, 24 (10.9%) had new smear-negative pulmonary tuberculosis and 34 (15.4%) had new extra- pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardiometabolic risk factor. The prevalence of at least one cardiometabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR = 0.47; CI: 0.23-0.94), those from Gandaki Province (AOR = 0.32; CI: 0.13-0.79) and literate (AOR = 0.49; CI: 0.25-0.96) had reduced risk of cardiometabolic disease risk factors.

Conclusions: This study highlights the role of gender and socio-demographic characteristics associated with the risk of cardiometabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.
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http://dx.doi.org/10.1186/s12889-020-09472-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487625PMC
September 2020

May Measurement Month 2018: an analysis of blood pressure screening results from Nepal.

Eur Heart J Suppl 2020 Aug 28;22(Suppl H):H92-H95. Epub 2020 Aug 28.

COBIN Project, Nepal Development Society, Bharatpur 10, Chitwan, Nepal.

Raised blood pressure (BP) is a leading risk factor for mortality globally and in Nepal. May Measurement Month (MMM) is a global initiative aimed at screening for hypertension and raising awareness on high BP worldwide. This study provides the results of the 2018 MMM (MMM18) in Nepal. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2018 nationwide. The standard MMM protocol was followed for BP measurement, the definition of hypertension, and statistical analysis. The campaign was publicized through various social media for recruiting volunteers and inviting participation. A total of 15 561 (58.7% male) from 35 districts of Nepal were screened in MMM18, of which 4 321 (27.8%) had hypertension. A total of 2 633 (19.0%) of 13 873 individuals who were not on antihypertensive treatment were found to be hypertensive. Of those on medication, 799 (47.4%) had uncontrolled BP. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher in people on antihypertensive treatment, smokers, and alcohol drinkers compared with those who were not on antihypertensive treatment, smokers, and alcohol drinkers, respectively. Likewise, SBP and DBP steadily increased across increasing body mass index categories. MMM18 was the largest BP screening campaign undertaken in Nepal. MMM has highlighted the importance of a periodic public health program at the national level to increase awareness on hypertension detection and control rate, and thus, the prevention of cardiovascular diseases.
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http://dx.doi.org/10.1093/eurheartj/suaa037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455271PMC
August 2020

G6PD deficiency in malaria endemic areas of Nepal.

Malar J 2020 Aug 12;19(1):287. Epub 2020 Aug 12.

Epidemiology and Disease Control Division, Department of Health Services Government of Nepal, Teku, Kathmandu, Nepal.

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is currently a threat to malaria elimination due to risk of primaquine-induced haemolysis in G6PD deficient individuals. The World Health Organization (WHO) recommends G6PD screening before providing primaquine as a radical treatment against vivax malaria. However, evidence regarding the prevalence and causing mutations of G6PD deficiency in Nepal is scarce.

Methods: A cross-sectional, population-based, prevalence study was carried out from May to October 2016 in 12 malaria-endemic districts of Nepal. The screening survey included 4067 participants whose G6PD status was determined by G6PD Care Start™ rapid diagnostic test and genotyping.

Results: The prevalence of G6PD deficiency at the national level was 3.5% (4.1% among males and 2.1% among females). When analysed according to ethnic groups, G6PD deficiency was highest among the Janajati (6.2% overall, 17.6% in Mahatto, 7.7% in Chaudhary and 7.5% in Tharu) and low among Brahman and Chhetri (1.3%). District-wise, prevalence was highest in Banke (7.6%) and Chitwan (6.6%). Coimbra mutation (592 C>T) was found among 75.5% of the G6PD-deficient samples analysed and Mahidol (487 G>A) and Mediterranean (563 C>T) mutations were found in equal proportions in the remaining 24.5%. There was no specific geographic or ethnic distribution for the three mutations.

Conclusions: This study has identified populations with moderate to high prevalence of G6PD deficiency which provides strong evidence supporting the WHO recommendations to screen G6PD deficiency at health facility level before the use of primaquine-based radical curative regimen for Plasmodium vivax.
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http://dx.doi.org/10.1186/s12936-020-03359-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425560PMC
August 2020

Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal.

Glob Health Action 2020 12;13(1):1788262

Global Health Section, Department of Public Health, University of Copenhagen , Copenhagen, Denmark.

Nepal is currently facing a double burden of non-communicable diseases (NCDs) and communicable diseases, with rising trends of NCDs. This situation will add great pressure to already fragile health systems and pose a major challenge to the country's development unless urgent action is taken. While the primary health care approach offers a common platform to effectively address NCDs through preventive and curative interventions, yet its potential is not fully tapped in Nepal. In line with the Alma Ata and Astana Declarations, we propose an integrated approach for Nepal, and other low-and middle-income countries, including six key reforms to enhance the primary care response to the increasing burdens of NCDs.
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http://dx.doi.org/10.1080/16549716.2020.1788262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480568PMC
December 2020

Factors associated with child health service delivery by female community health volunteers in Nepal: findings from a national survey.

BMC Health Serv Res 2020 Jun 19;20(1):561. Epub 2020 Jun 19.

JSI Research and Training Institute Inc., Kathmandu, Nepal.

Background: Nepal has made a significant improvement in child survival in the last few decades and the involvement of female community health volunteers (FCHVs) has been crucial in such achievement. While there have been many studies on child health in Nepal however, rarely explored the status and factors associated with the child health service provided by these volunteers. This study aimed to identify the factors associated with the child health service delivery by FCHVs.

Methods: A national survey was conducted in 2014 in Nepal that included 4302 FCHVs using the structured questionnaire across the 13 geopolitical domains of the country. Factors associated with the use of child health services was examined using Chi-square test (χ) followed by logistic regression.

Results: Overall, 62.6% of FCHVs provided at least one child health service. Those FCHVs who utilized money from the FCHV fund, conducted health mothers' group meeting, involved in local committees and those who supported antenatal care and outreach clinics related activities had higher odds of providing child health services. Similarly, FCHVs equipped with the stock of Cotrimoxazole tablet, Zinc tablet, Oral Rehydration Salt packets were more likely to provide child health services. The province-wise analysis showed that FCHVs from Province 5 and Sudur Paschim Province were more likely to provide child health services compared to their counterparts from province 1. Technology-wise, FCHVs who were using mobile were more likely to provide child health services.

Conclusions: FCHVs are important human resource in providing child health services in Nepal. To improve child health service delivery by FCHVs; availability of key commodities, involvement of FCHVs in regular health mothers' group meeting, use of mobile phone, involvement in other public health programs and social networks, and utilization of the FCHV fund need to be taken into consideration.
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http://dx.doi.org/10.1186/s12913-020-05424-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304139PMC
June 2020

An urgent call to address the nutritional status of women and children in Nepal during COVID-19 crises.

Int J Equity Health 2020 06 5;19(1):87. Epub 2020 Jun 5.

Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal.

Due to the ongoing nationwide lockdown in Nepal, women and children face a greater risk of malnutrition and eventually leading to mortality and morbidity. To harness the progress made so far in improving the nutritional status of women and children, a focus on nutrition should be a part of the COVID-19 response plan.
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http://dx.doi.org/10.1186/s12939-020-01210-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274565PMC
June 2020

Nepal's first case of COVID-19 and public health response.

J Travel Med 2020 05;27(3)

School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Subang Jaya, Selangor, Malaysia.

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http://dx.doi.org/10.1093/jtm/taaa024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107523PMC
May 2020

Prevalence and correlates of postabortion long-acting reversible contraceptive (LARC) use among young women (24 and below) in Nepal: Strategy in the search for improvements.

Reprod Health 2019 May 14;16(1):55. Epub 2019 May 14.

Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA.

Introduction: Postabortion contraceptive use differs across countries, suggesting the need for country-level research to identify barriers and suggest appropriate interventions. This study aimed to identify the prevalence and correlates of postabortion long-acting reversible contraceptive (LARC) use among women aged 24 or younger in Nepal.

Methods: This is a cohort study using Health Management Information System (HMIS) data where individual case records of women seeking induced abortion or postabortion care were documented using structured HMIS 3.7 records. Analysis was performed on the individual case records of 20,307 women 24 years or younger who received induced abortion or postabortion care services in the three-year period from July 2014 to June 2017 at 433 public and private health facilities.

Findings: Overall, LARC uptake during the study period was 11% (IUD: 3% and implant: 8%). The odds of LARC acceptance was higher for young women (24 and below) who belonged to Brahmin/Chhetri (AOR = 1.23; 95% CI: 1.02-1.47) and Janajatis (AOR = 1.20; 95% CI: 1.01-1.43) as compared to Dalits; young women who had an induced abortion (AOR = 3.75; 95% CI: 1.75-8.06) compared with postabortion care; and those receiving service from public sector health facilities (AOR = 4.00; 95% CI: 2.06-7.75) compared with private sector health facilities.

Conclusion: The findings from this study indicate the need to focus on barriers to acceptance of LARC among several groups of young women (24 and below) receiving abortion care in Nepal: Dalits, Madhesis and Muslims; nulliparous women; and those receiving services at private sector health facilities.
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http://dx.doi.org/10.1186/s12978-019-0708-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518755PMC
May 2019

Historical Development of Health Research Ethics in Nepal.

J Nepal Health Res Counc 2018 Mar 13;16(1):105-107. Epub 2018 Mar 13.

Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal.

Health research in Nepal initiated with a survey in malaria in 1952. The first regulatory body for health research was Nepal Medical Research Committee formed under Ministry of Health. Ethical Review Body is the first ethical review structure. Nepal Health Research Council is now an independent body to regulate health research in Nepal. Development of research ethics in Nepal is clearly evident with the development of ethical guidelines; functioning of Ethical Review Board; expansion of institutional review committees and initiation of online submission system. However, monitoring compliance with research ethics could be a challenge for the Nepal Health Research Council.
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March 2018

Synthesis, Characterization of Ethyl 5-(substituted)-1H-pyrazole- 3-carboxylate Derivative as Potent Anti-inflammatory Agents.

Antiinflamm Antiallergy Agents Med Chem 2018 ;17(1):32-38

Department of Pharmaceutical Chemistry, Hygia Institute of Pharmaceutical Education and Research, Lucknow-206020, India.

Background: Recently, pyrazole derivatives have shown significant antiinflammatory activity. Non-steroidal anti-inflammatory drugs have some side effects, mainly gastric irritation and gastric ulceration during the treatment of inflammation. So the current study deals with the synthesis and pharmacological evaluation of a series of novel pyrazole derivatives as anti-inflammatory agents.

Methods: A series of novel ethyl 5-(substituted)-1H-pyrazole-3-carboxylate (2a-j) were synthesized and evaluated for anti-inflammatory activity using carrageenan-induced inflammation in rat paw edema model. In the first step, diethyl oxalate react with acetophenone derivatives in presense of sodium ethoxide to form substituted ethyl-2,4-dioxo-4- phenyl butanoate derivatives as intermediate (1a-j). Further the suspension was prepared from dioxo-esters with hydrazine hydrate in glacial acetic acid yielded novel ethyl 5- (substituted)-1H-pyrazole-3-carboxylate (2a-j) derivatives. The structure of the final analogues (2a-j) has been confirmed on the basis of elemental analysis, IR, 1 H NMR and mass spectra.

Results: All the values of elemental analysis, FTIR, 1H NMR, and mass spectra were found to be prominent. The anti-inflammatory activity test revealed that Ethyl 5-(3,4- dimethoxyphenyl)-1H-pyrazole-3-carboxylate (2f) and ethyl 5-(2,3-dimethoxyphenyl)-1Hpyrazole- 3-carboxylate (2e) exhibited significant anti-inflammatory activity as compared to control group.

Conclusion: The results of the current study indicate that the substitution at pyrazole scaffold could improve anti-inflammatory activity.
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http://dx.doi.org/10.2174/1871523017666180411155240DOI Listing
February 2019

Bringing all together for research capacity building in LMICs.

Authors:
Pratik Khanal

Lancet Glob Health 2017 09;5(9):e868

Nepal Health Research Council, 44600 Kathmandu, Nepal. Electronic address:

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http://dx.doi.org/10.1016/S2214-109X(17)30259-0DOI Listing
September 2017

Pride in autistic diversity: against treatment or for inclusion?

Lancet 2016 11;388(10059):2477

Nepal Health Research Council, Kathmandu, Nepal.

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http://dx.doi.org/10.1016/S0140-6736(16)32176-6DOI Listing
November 2016

Health beyond health to bridge the global health gap.

Lancet Glob Health 2016 11;4(11):e792

Nepal Public Health Foundation, Maharajgunj, Kathmandu, Nepal.

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http://dx.doi.org/10.1016/S2214-109X(16)30256-XDOI Listing
November 2016

Strengthening of information systems and research to tackle HIV and non-communicable diseases.

Lancet Diabetes Endocrinol 2016 10;4(10):815

Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

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http://dx.doi.org/10.1016/S2213-8587(16)30219-4DOI Listing
October 2016

National health insurance policy in Nepal: challenges for implementation.

Glob Health Action 2015 21;8:28763. Epub 2015 Aug 21.

Department of Public Health, Centre for Global Health, Aarhus University, Aarhus, Denmark.

The health system in Nepal is characterized by a wide network of health facilities and community workers and volunteers. Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. But the reality is a far cry. Only 61.8% of the Nepalese households have access to health facilities within 30 min, with significant urban (85.9%) and rural (59%) discrepancy. Addressing barriers to health services needs urgent interventions at the population level. Recently (February 2015), the Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme (SHS) after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Mechanisms should be built for monitoring unfair pricing and unaffordable copayments, and an overall benefit package be crafted to include coverage of major health services including non-communicable diseases. Regulations should include such issues as accreditation mechanisms for private providers. Health system strengthening should move along with the roll-out of SHS. Improving the efficiency of hospital, motivating the health workers, and using appropriate technology can improve the quality of health services. Also, as currently a constitution drafting is being finalized, careful planning and deliberation is necessary about what insurance structure may suit the proposed future federal structure in Nepal.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546934PMC
http://dx.doi.org/10.3402/gha.v8.28763DOI Listing
March 2016

Sustaining progress in maternal and child health in Nepal.

Lancet 2015 Jun 16;385(9987):2573. Epub 2015 Jun 16.

School of Public Health, Curtin University, Perth, Australia.

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http://dx.doi.org/10.1016/S0140-6736(15)60963-1DOI Listing
June 2015
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