Search results for: Ishwor Paudel

Authors: Ishwor Paudel, Pratima Gautam, Sandeep Bhattarai

Abstract:

Bile spillage occurs frequently during laparoscopic cholecystectomy yet its impact on postoperative outcomes remains unknown. It might not be as innocuous as some surgeons tend to believe and in fact, might be associated with post-operative surgical site infections (SSI). It often leads to patient dissatisfaction, emergency department visits, with subsequent readmission and additional procedures. While some authors found no increase in SSI following bile spillage (BS) compared to non-bile spillage cases, others found bile spillage to be associated with SSI. Therefore we sought to examine whether bile spillage is indeed associated with an increased risk of postoperative wound infections after laparoscopic cholecystectomy. I hypothesize that patients who experience BS during operation, have an increased risk of SSI compared to those who do not. This is a prospective observational study conducted in the Department of Surgery, Patan Hospital over a period of one year. Patients undergoing Laparoscopic cholecystectomy were included and bile spillage, if happened was noted. All cases were followed up for 30 days and SSI was diagnosed as per CDC-defined criteria. Fisher’s test was applied to compare SSI in bile spillage versus non-bile spillage cases. A total of 112 patients were included in the final analysis. Bile spillage occurred in 20 cases and was absent in the rest i.e.92 cases. Among bile spillage cases, SSI was found in 4 cases (20%), whereas in nonbile spillage cases, SSI was found in 8 cases (8.7%). However, it was statistically not significant (p-value>0.05). Eleven (92%) cases were superficial SSI and one was an organ-space infection. No mortality or 30-day readmission. Spillage of Gallbladder content does not lead to an increase in SSIs. However as the rate of SSI is still higher, Surgeons should be careful to avoid iatrogenic gallbladder perforation and in case of bile spillage thorough peritoneal irrigation with normal saline should be done.

Keywords: organ space infection, Laparoscopic cholecystectomy, biliary spillage, surgical site infection

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Authors: Gupta Rajesh, Paudel Sagar, Sharma Utkarsh, Singh Amit Kumar

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Thermal stratification has drawn much attention because of the malfunctions at various nuclear plants in U.S.A that raised significant safety concerns. The concerns due to this phenomenon relate to thermal stresses in branch pipes connected to the reactor coolant system piping. This stress limits the lifetime of the piping system, and even leading to penetrating cracks. To assess origin of valve damage in the pipeline, it is essential to determine the effect of turbulence penetration on valve leakage; since stratified flow is generally generated by turbulent penetration or valve leakage. As a result, we concluded with the help of coupled fluent-structural analysis that the pipe with less turbulence has less chance of failure there by requiring less maintenance.

Keywords: nuclear reactor coolant system, thermal stratification, turbulent penetration, coupled fluent-structural analysis, Von-Misses stress

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Authors: Chhabi Paudel

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The food and nutrition security of the people of the mountain of Karnali province of Nepal is dependent on traditional crop biodiversity. The altitude range of the study area is 1800 meters to 2700 meters above sea level. The climate is temperate to alpine. Farmers are adopting subsistent oriented diversified farming systems and selected crop species, cultivars, and local production systems by their own long adaptation mechanism. The major crop species are finger millet, proso millet, foxtail millet, potato, barley, wheat, mountain rice, buckwheat, Amaranths, medicinal plants, and many vegetable species. The genetic and varietal diversity of those underutilized indigenous crops is also very high, which has sustained farming even in uneven climatic events. Biodiversity provides production synergy, inputs, and other agro-ecological services for self-sustainability. But increase in human population and urban accessibility are seen as threats to biodiversity conservation. So integrated conservation measures are suggested, including agro-tourism and other monetary benefits to the farmers who conserve the local biodiversity.

Keywords: crop biodiversity, climate change, in-situ conservation, resilience, sustainability, agrotourism

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Authors: Abhiyan Paudel, Maheshwaran M Pillai

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This paper deals with the optimization and comparison of slender delta wing and blended wing body. The objective is to study the difference between the two wing types and analyze the various aerodynamic characteristics of both of these types.The blended-wing body is an aircraft configuration that has the potential to be more efficient than conventional large transport aircraft configurations with the same capability. The purported advantages of the BWB approach are efficient high-lift wings and a wide airfoil-shaped body. Similarly, symmetric separation vortices over slender delta wing may become asymmetric as the angle of attack is increased beyond a certain value, causing asymmetric forces even at symmetric flight conditions. The transition of the vortex pattern from being symmetric to asymmetric over symmetric bodies under symmetric flow conditions is a fascinating fluid dynamics problem and of major importance for the performance and control of high-maneuverability flight vehicles that favor the use of slender bodies. With the use of Star CCM, we analyze both the fluid properties. The CL, CD and CM were investigated in steady state CFD of BWB at Mach 0.3 and through wind tunnel experiments on 1/6th model of BWB at Mach 0.1. From CFD analysis pressure variation, Mach number contours and turbulence area was observed.

Keywords: Coefficient of Lift, Coefficient of Drag, CFD=Computational Fluid Dynamics, BWB=Blended Wing Body, slender delta wing

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Authors: Milan Paudel, Fook Fah Yap, Anil K. Bastola

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The difficulties in riding small wheel bicycles and their lesser stability have been perceived for a long time. Although small wheel bicycles are designed using the similar approach and guidelines that have worked well for big wheel bicycles, the performance of the big wheelers and the smaller wheelers are markedly different. Since both the big wheelers and small wheelers have same fundamental geometry, most blame the small wheel for this discrepancy in the performance. This paper reviews existing guidelines for bicycle design, especially the front steering geometry for the bicycle, and provides a systematic and quantitative analysis of different wheel sized bicycles. A validated mathematical model has been used as a tool to assess the dynamic performance of the bicycles in term of their self-stability. The results obtained were found to corroborate the subjective perception of cyclists for small wheel bicycles. The current approach for small wheel bicycle design requires higher speed to be self-stable. However, it was found that increasing the headtube angle and selecting a proper trail could improve the dynamic performance of small wheel bicycles. A range of parameters for front steering geometry has been identified for small wheel bicycles that have comparable stability as big wheel bicycles. Interestingly, most of the identified geometries are found to be beyond the ISO recommended range and seem to counter the current approach of small wheel bicycle design. Therefore, it was successfully shown that the guidelines for big wheelers do not translate directly to small wheelers, but careful selection of the front geometry could make small wheel bicycles as stable as big wheel bicycles.

Keywords: big wheel bicycle, design approach, ISO requirements, small wheel bicycle, stability and performance

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Authors: Krishna Chandra Paudel

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This paper explores the association between the perceived classroom environment and mathematics learning and test anxiety among secondary level students in Nepal. Categorizing the students in three dominant variables- gender, ethnicity and previous schooling, and selecting sample students with respect to higher mathematics anxiety from five heterogeneous classes, the research explores disparities in student's mathematics cognition and reveals nexus between classroom environment and mathematics learning and test anxiety. This research incorporates social learning theory and social development theory as interpretive tool for analyzing themes through qualitative data. Focussing on the interviews with highly mathematics learning anxious students, the study sheds light on how mathematics anxiety among the targeted students is interlinked with multiple factors. The research basically exposes the students’ lack of mathematical passion, their association with other students and participation in classroom learning, asymmetrical content and their lack of preparedness for the tests as caustic factors behind such anxieties. The study further reveals that students’ lack of foundational knowledge and complexity of mathematical content have jointly contributed to mathematics anxiety. Admitting learning as a reciprocal experience, the study points out that the students’ gender, ethnicity and disparities in previous schooling in the context of Nepal has very insignificant impact on students’ mathematics anxiety. It finally recommends that the students who get trapped into the vicious cycle of mathematics anxiety require positive and supportive classroom environment along with inspiring comments/compliments and symmetrical course contents.

Keywords: anxiety, asymmetry, cognition, habitus, pedagogy, preparedness

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Authors: Suchana Marahatta, Sabina Bhattarai, Bishnu Hari Paudel, Dilip Thakur

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Background: Every year thousands of patients develop nerve damage and disabilities as a result of leprosy which can be prevented by early detection and treatment. So, early detection and treatment of nerve function impairment is of paramount importance in leprosy. Objectives: To assess the electrophysiological pattern of the peripheral nerves in leprosy patients and to compare it with clinical assessment tools. Materials and Methods: In this comparative cross-sectional study, 74 newly diagnosed leprosy patients without reaction were enrolled. They underwent thorough evaluation for peripheral nerve function impairment using clinical tests [i.e. nerve palpation (NP), monofilament (MF) testing, voluntary muscle testing (VMT)] and nerve conduction study (NCS). Clinical findings were compared with that of NCS using SPSS version 11.5. Results: NCS was impaired in 43.24% of leprosy patient at the baseline. Among them, sensory NCS was impaired in more patients (32.4%) in comparison to motor NCS (20.3%). NP, MF, and VMT were impaired in 58.1%, 25.7%, and 9.4% of the patients, respectively. Maximum concordance of monofilament testing and sensory NCS was found for sural nerve (14.7%). Likewise, the concordance of motor NP and motor NCS was the maximum for ulnar nerve (14.9%). When individual parameters of the NCS were considered, amplitude was found to be the most frequently affected parameter for both sensory and motor NCS. It was impaired in 100% of cases with abnormal NCS findings. Conclusion: Since there was no acceptable concordance between NCS findings and clinical findings, we should consider NCS whenever feasible for early detection of neuropathy in leprosy. The amplitude of both sensory nerve action potential (SNAP) and compound nerve action potential (CAMP) could be important determinants of the abnormal NCS if supported by further studies.

Keywords: leprosy, nerve function impairment, neuropathy, nerve conduction study

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Authors: Ajay Kumar Yadav, Masum Paudel, Ritesh Chaudhary

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Background: Understanding the diagnosis and the treatment plan is very important for the patient which reflects the effectiveness of the patient care as well as counseling. Large groups of patients do not understand their emergency care plan or their discharge instructions. With only a little more than 2/3ʳᵈ of the adult population is literate and poorly distributed health service institutions in Nepal, exploring the current status of patient understanding of their diagnosis and treatment would help identify interventions to improve patient compliance with the provided care and the treatment outcomes. Objectives: This study was conducted to identify and describe the areas of patients’ understanding and confusion regarding emergency care and discharge instructions at the Emergency ward of B. P. Koirala Institute of Health Sciences teaching hospital, Dharan, Nepal. Methods: A cross-sectional study was conducted among 426 patients discharged from the emergency unit of BPKIHS. Cases who are leaving against medical advice absconded cases and those patients who came just for vaccination are excluded from the study. Patients’ understanding of the treatment plan and diagnosis was measured. Results: There were 60% men in this study. More than half of the participants reported not being able to read English. More than 90% of the respondents reported they could not read their prescription at all. While patient could point out their understanding of their diagnosis at discharge, most of them could not tell the names and the dosage of all the drugs prescribed to them at discharge. More than 95% of the patients could not tell the most common side effects of the drugs that they are prescribed. Conclusions: There is a need to further explore the factors influencing the understanding of the patients regarding their treatment plan. Interventions to understand the health literacy needs and ways to improve the health literacy of the patients are needed.

Keywords: discharge instruction, emergency ward, health literacy, treatment plan

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Authors: R. K. Yadav, S. Baral, H. R. Paudel, R. Basnet

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The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public healthcare providers in the fight against tuberculosis using international healthcare standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal. A total of 20 respondents participated in the study. Barriers to PPM were identified in the following three themes: 1) Obstacles related to TB case detection, 2) Obstacles related to patients, and 3) Obstacles related to the healthcare system. PPM implementation was challenged by following subthemes that included staff turnover, low private sector participation in workshops, a lack of training, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies. The study concludes that numerous barriers exist in the way of effective implementation of the PPM approach, including TB cases detection barriers such as knowledge of TB diagnosis and treatment, HW attitude, workload, patient-related barriers such as knowledge of TB, self-medication practice, stigma and discrimination, financial status, and health system-related barriers such as staff turnover and poor engagement of the private sector in workshops, training, recording, and re-evaluation. Government stakeholders must work together with private sector stakeholders to perform joint monitoring and supervision. Private practitioners should receive training and orientation, and presumptive TB patients should be given adequate time and counseling as well as motivation to visit a government health facility.

Keywords: barrier, tuberculosis, case finding, PPM, nepal

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Authors: Rabin Paudel, Dambar Bahadur Mahato, Prabin Poudel, Bijaya Neupane, Sakar Jha

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Understanding Human-Elephant Conflict (HEC) is very important in countries like Nepal, where solutions to escalating conflicts are urgently required. However, most of the HEC mitigation measures implemented so far have been done on an ad hoc basis without the detailed understanding of nature and extent of the damage. This study aims to assess the current scenario of HEC in regards to crop and property damages by Wild Asian Elephant and people’s perception towards existing mitigating measures and elephant conservation in Buffer zone area of Bardia National Park. The methods used were a questionnaire survey (N= 178), key-informant interview (N= 18) and focal group discussions (N= 6). Descriptive statistics were used to determine the nature and extent of damage and to understand people’s perception towards HEC, its mitigation measures and elephant conservation. Chi-square test was applied to determine the significance of crop and property damages with respect to distance from the park boundary. Out of all types of damage, crop damage was found to be the highest (51%), followed by house damage (31%) and damage to stored grains (18%) with winter being the season with the greatest elephant damage. Among 178 respondents, the majority of them (82%) were positive towards elephant conservation despite the increment in HEC incidents as perceived by 88% of total respondents. Among the mitigation measures present, the most applied was electric fence (91%) followed by barbed wire fence (5%), reinforced concrete cement wall (3%) and gabion wall (1%). Most effective mitigation measures were reinforced concrete cement wall and gabion wall. To combat increasing crop damage, the insurance policy should be initiated. The efficiency of the mitigation measures should be timely monitored, and corrective measures should be applied as per the need.

Keywords: crop and property damage, elephant conflict, Asiatic wild elephant, mitigation measures

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Authors: Sharmila Dahal Paudel

Abstract:

Background: There are around twenty-four thousand to twenty-eight thousand Female Sex Workers in Nepal. FSWs are the vulnerable groups for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) infections which directly and indirectly ease to reduce the quality of life of such groups. Due to their highly marginalized status, FSWs in Nepal have limited access to information about reproductive health and safe sex practices. The objectives of the study are to assess the quality of life of female sex workers and the factors affecting them. Materials and Methods: A descriptive cross-sectional study with methodological triangulation was conducted among 108 FSWs on the basis of service record of selected organization of Pokhara valley. The complete enumerative sampling was used to select FSWs. Structured interview schedule, WHOQOL-BREF and in-depth questionnaire were used to collect the data. The descriptive and inferential statistics were used to interpret the result. Results: The mean age of participants were 23.44 years and the mean quality of life score was 174.06 ranging from 56.54 to 370.78. Among the domain scores, the mean score is highest in social domain (55.89) followed by physical (45.42), psychological (39.27) and the environmental (34.23). Regarding the association of QOL with socio-demographic, occupation and health-related variables, the multi-linear regression suggests that the satisfaction with occupation was highly significant with the total QOL score (B=-50.50, SE=10.46; p= <0.001) and there is negative relation between QOL and feeling of exploitation and facing STI problems. This means those who feels exploited have significantly less QOL comparing with those who did not feel the same. In correlation analysis, all the domains are positively co-related with each domain which is found to be significant at 1% level of significance. Conclusion: The highest mean score was in social domain, and the lowest is in environmental domain which suggests that the items included in environmental domains could not be utilized or hindrance were there.

Keywords: FSWs, HIV, QOL, WHOQOL-BREF

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Authors: Ajaya Acharya, Prem Narayan Paudel, Rajendra Gyawali

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Due to strong tyrosinase inhibition and antioxidant effects, green tea and Licorice are valuable in cosmetics for the skin. However, data on the addition of essential oils to green tea and Licorice in cream formulation to examine antioxidant activities are limited. The purpose of this study was to develop and assess a phytocosmetic cream’s antioxidant and tyrosinase inhibitory characteristics using crude aqueous extracts of green tea, Licorice, and loaded with essential oils. To load the best concentration on cream formulations, plant aqueous extracts were designed, evaluated, and correlated in terms of total phenolic content (TPC), total flavonoids content (TFC), and 2, 2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity. Moreover, o. tenuiflorum and o. basilicum essential oils were extracted and added to a cream formulation. The spreadability profile, water washability, centrifugation test, and organoleptic characteristics of formulated oil in water cream were all satisfactory. The cream exhibited a non-Newtonian rheological profile and pH range of 6.353 ± 0.065 to 6.467±0.050 over successive 0, 1, 2, and 3 months at normal room temperature. The 50% inhibition concentrations shown by herbal cream were 13.764 ± 0.153 µg/ml, 301.445 ± 1.709 µg/ml and 8.082 ± 0.055 respectively for 2, 2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity, ferric (Fe³⁺) reducing antioxidant power (FRAP) and 2, 2’-azinobis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) radical scavenging activity, and that of standard ascorbic acid were 6.716 ± 0.077 µg/ml, 171.604 ± 1.551µg/ml and 5.645±0.034µg/ml which showed formulated cream had strong antioxidant characteristics. The formulated herbal cream with a 50% tyrosinase inhibition concentration of 22.254 ± 0.369µg/ml compared to standard Kojic acid 12.535 ± 0.098µg/ml demonstrated a satisfactory tyrosinase inhibition profile for skin whitening property. Herbal cream was reportedly stable in physical and chemical parameters for successive 0, 1, 2, and 3 months at both real and accelerated time study zones, according to obtained stability study results.

Keywords: crude extracts, antioxidant, tyrosinase inhibition, green tea polyphenols

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Authors: Narayan Bhattarai, Arjun Bhattarai, Kabi Raj Paudyal, Lalu Paudel

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Palung granite is leucocratic, alkali feldspar granite, which is one of the six major granite bodies of the Lesser Himalaya of Nepal. The Cambro-Ordovician granite body has intruded on the Palaeozoic metasedimentary rock of the Kathmandu Complex in Central Nepal. The granite crystallized from magma that was mainly generated by anatexis of the Precambrian continental crust. The magma is heterogeneous with respect to the primary ages and/or metamorphic histories of the magma source rocks. This indicates either a derivation from (meta-) sediments or an intense mixing of different crustally derived magmas. The genesis of the Palung granite is possibly related to an orogeny which affected the Indian shield in lower Paleozoic times. The granite body has been mapped into different zones with visual inspection and petrographical study: i. Quartz rich granite: Quartz is smokey to grayish, euhedral to subherdal, 0.2 to 0.7 cm, and constitutes 30 to 40%. Feldspar is white to brownish, subhedral to euhedral, more than 3 cm, and constitutes 20–30%. Tourmaline is black, 0.1 to 0.2 cm in size, and consists of 10 to 20%. Biotite is black flakes up to o.2 cm, representing 5-8%. ii. Feldspar rich granite: white to grayish, medium to coarse-grained, containing feldspar, quartz, biotite, muscovite and tourmaline. Feldspar porphyritic crystals up to 2.5 cm subherdral represent 50–60%, quartz is smokey transparent and represents 30–40%, biotite is dark brown to black, crystals are irregular, 0.5 cm and represent 8–20%, tourmaline is black fractured, small needles represent 5–10%, and muscovite is white to brown and represents 1-4%. iii. Biotite granite: grey to white, medium to coarse-grained, containing quartz, feldspar, biotite and tourmaline. Feldspar crystals up to 2.5 cm represent 40–50%, quartz is smokey, representing 30–40%, biotite is dark brown to black, crystal size 0.5cm, representing 10–20%, tourmaline is black, small needle, 5–10%, and muscovite is white to brown, representing 3-5%. and iv. Muscovite granite: medium-coarse-grained, brown and gray, containing quartz, feldspar, muscovite and tourmaline. Feldspar is white to brown; crystal sizes 0.2–0.4 cm represents 40–50%; quartz is brown and white, transparent, crystals up to 1 cm represent 35–50%; tourmaline is black, opaque, needle shaped; size up to 7–20%; and muscovite is brownish to white, with flakes up to 0.3 cm representing 5–10%. The xenoliths are very common and are not genetically related. Xenoliths are composed mostly of fine-grained, grayish quartz biotite (muscovite) schist and garnetiferous quartz mica schist.

Keywords: leucocratic granite, cambro-ordovician granite, lesser himalayan granite, pegmatite

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Authors: Dipendra Kumar Yadav, Nabaraj Paudel, Anjana Yadav

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Background: Low Birth weight (LBW) is defined as the weight at birth less than 2500 grams, irrespective of the period of their gestation. LBW is an important indicator of general health status of population and is considered as the single most important predictors of infant mortality especially of deaths within the first month of life that is birth weight determines the chances of newborn survival. Objective of this study was to identify the maternal risk factors associated with low birth weight neonates. Materials and Methods: A hospital based case-control study was conducted in maternity ward of Manipal Teaching Hospital, Pokhara, Nepal from 23 September 2014 to 12 November 2014. During study period 59 cases were obtained and twice number of control group were selected with frequency matching of the mother`s age with ± 3 years and total controls were 118. Interview schedule was used for data collection along with record review. Data were entered in Epi-data program and analysis was done with help of SPSS software program. Results: From bivariate logistic regression analysis, eighteen variables were found significantly associated with LBW and these were place of residence, family monthly income, education, previous still birth, previous LBW, history of STD, history of vaginal bleeding, anemia, ANC visits, less than four ANC visits, de-worming status, counseling during pregnancy, CVD, physical workload, stress, extra meal during pregnancy, smoking and alcohol consumption status. However after adjusting confounding variables, only six variables were found significantly associated with LBW. Mothers who had family monthly income up to ten thousand rupees were 4.83 times more likely to deliver LBW with CI (1.5-40.645) and p value 0.014 compared to mothers whose family income NRs.20,001-60,000. Mothers who had previous still birth were 2.01 times more likely to deliver LBW with CI (0.69-5.87) and p value 0.02 compared to mothers who did not has previous still birth. Mothers who had previous LBW were 5.472 times more likely to deliver LBW with CI (1.2-24.93) and p value 0.028 compared to mothers who did not has previous LBW. Mothers who had anemia during pregnancy were 3.36 times more likely to deliver LBW with CI (0.77-14.57) and p value 0.014 compared to mothers who did not has anemia. Mothers who delivered female newborn were 2.96 times more likely to have LBW with 95% CI (1.27-7.28) and p value 0.01 compared to mothers who deliver male newborn. Mothers who did not get extra meal during pregnancy were 6.04 times more likely to deliver LBW with CI (1.11-32.7) and p value 0.037 compared to mothers who getting the extra meal during pregnancy. Mothers who consumed alcohol during pregnancy were 4.83 times more likely to deliver LBW with CI (1.57-14.83) and p value 0.006 compared to mothers who did not consumed alcohol during pregnancy. Conclusions: To reduce low birth weight baby through economic empowerment of family and individual women. Prevention and control of anemia during pregnancy is one of the another strategy to control the LBW baby and mothers should take full dose of iron supplements with screening of haemoglobin level. Extra nutritional food should be provided to women during pregnancy. Health promotion program will be focused on avoidance of alcohol and strengthen of health services that leads increasing use of maternity services.

Keywords: low birth weight, case-control, risk factors, hospital based study

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Authors: Prajwal Paudel, Shreeprasad Adhikari, Shailendra Bir Karmacharya, Kalpana Upadhyaya

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Background: Human milk banks have been recommended by the World Health Organization (WHO) for newborn and child nourishment in the provision of optimum nutrition as an alternative to breastfeeding in circumstances when direct breastfeeding is inaccessible. The vulnerable group of babies, mainly preterm, low birth weight, and sick newborns, are at a greater risk of mortality and possibly benefit from the safe use of donated human milk through milk banks. In this study, we aimed to shed light on the process involved during the setting up of the nation’s first milk bank and its vitality in small and sick newborn nutrition and care. Methods: The study was conducted in Paropakar Maternity and Women’s Hospital, where the first human milk (HMB) was established. The establishment involved a stepwise process of need assessment meeting, formation of the HMB committee, learning visit to HMB in India, studying the strengths and weaknesses of promoting breastfeeding and HMB system integration, procurement, installation, and setting up the infrastructure, and developing technical competency, launching of the HMB. After the initiation of HMB services, information regarding the recruited donor mothers and the volume of milk pasteurized and consumed by the needy recipient babies were recorded. Descriptive statistics with frequencies and percentages were used to describe the utilization of HMB services. Results: During the study period, a total of 506113 ml of milk was collected, while 49930 ml of milk was pasteurized. Of the pasteurized milk, 381248 ml of milk was dispensed. The total volume of milk received was from a total of 883 after proper routine screening tests. Similarly, the total number of babies who received the donated human milk (DHM) was 912 with different neonatal conditions. Among the babies who received DHM, 527(57.7%) were born via CS, and 385 (42.21%) were delivered normally. In the birth weight category,9 (1%) of the babies were less than 1000 grams, 75 (8.2%) were less than 1500 grams, 405 (44.4%) were between 1500 to less than 2500 grams whereas, 423 (46.4%) of the babies who received DHM were normal weight babies. Among the sick newborns, perinatal asphyxia accounted for 166 (18.2%), preterm with other complications 372 (40.7%), preterm 23 (2.02%), respiratory distress 140 (15.35%), neonatal jaundice 150 (16.44%), sepsis 94 (10.30%), meconium aspiration syndrome 9(1%), seizure disorder 28 (3.07%), congenital anomalies 13 (1.42%) and others 33(3. 61%). The neonatal mortality rate dropped to 6.2/1000 live births from 7.5/1000 live births in the first year of establishment as compared to the previous year. Conclusion: The establishment of the first HMB in Nepal involved a comprehensive approach to integrate a new system with the existing newborn care in the provision of safe DHM. Premature babies with complication, babies born via CS, perinatal asphyxia and babies with sepsis consumed the greater proportion of DHM. Rigorous research is warranted to assess the impact of DHM in small and sick newborn who otherwise would be fed formula milk.

Keywords: human milk bank, sick-newborn, mortality, neonatal nutrition

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Authors: Purushottam P. Khatiwada, Bikash Paudel, Ram B. Rana, Parshuram Biswakarma, Roshan Pudasaini

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Nepal has been putting its efforts into securing food and nutrition security for its citizens adopting different models and approaches. Home Garden approach, that integrates vegetables, fruits, small livestock, poultry along with other components like fish, honeybee, mushroom, spices for the promotion of nutritional security of resource-poor and disadvantaged groups was implemented during March 2009 to July 2013 spreading over 16 districts of Nepal covering 115 farmers groups, directly working with 3500 households. Sustained long-term impact of development interventions targeted to the resource-poor and disadvantaged groups has been a recurrent issue for donors, policymakers and practitioners alike. Considering the issue, a post-project evaluation was carried out in a selected project group (Dangibari of Jhapa) after four years of project completion in 2017 in order to evaluate the impact and understand the factors associated with its success. Qualitative information was collected through focus group discussion with group members and associated local institutions. For quantitative information, a quick survey was carried out to the same group members only selecting few indicators. The results are compared with the data obtained from the baseline study conducted by the project in March 2009. The impact of project intervention was evident as compared to the benchmarks established during the baseline, even after four years of project completion. The area under home garden is increased to 729 m² from 386 m² and average food self-sufficiency months increased to 10.22 from 8.11. Seven to eleven fruit species are maintained in the home gardens. An average number of vegetable species grown increased to 15.85 from 9.86. It has resulted in an increase in vegetables self-sufficient month to 8.74 from 4.74 and a huge increase in cash income NPR 6142.8 (USD 59.6) from NPR 385.7 (USD 3.9) from the sale of surplus vegetables. Coaching and mentoring including nutrition sensitization by the project staff at the beginning, inputs and technical support during the project implementation phase and projects effort on the institutional building of disadvantaged farmers were the key drivers of home garden sustainability and expansion. Specifically, package of home garden management trainings provided by the project staff, availability of group funds for buying inputs even after the project, uniting home garden group members in a cooperative, resource leveraging by local institutions through group lobbying, farmers innovations for maintaining home garden diversity and continuous backstopping support by few active members as local resource persons to other members are some additional factors contributing to sustain and/or improve the home garden status by the resource-poor and disadvantaged group.

Keywords: food-based nutrition, home garden, resource-poor and disadvantaged group, sustained impact

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