Life expectancy In 2010, the average Nepalese lived to 65.8 years. According to the
WHO data published in 2012, life expectancy in Nepal was increased to 68. Gradually life expectancy of Nepal increased to 70 years in 2021. According to estimates from Macrotrends latest life expectancy of Nepal for 2025 is 72.19, a 0.31% increase from 2024. Life expectancy in Nepal has shown steady growth since 1960. The most recent 2022 statistics from the United Nations Population Division indicate that women outlive men by roughly 3.75 years, with an average lifespan of 72.36 years compared to 68.61 years Life expectancy has historically increased from 38 years in 1960 to these current numbers, which are a result of advancements in living conditions, healthcare, and nutrition. Although Nepal still lags somewhat behind the global norms of 74.94 years for women and 69.65 years for men, the gender difference is consistent with the general trend of women living longer than men. Life expectancy at birth for both sexes increased by 6 years over the year 2010 and 2012. In 2012, healthy expectancy in both sexes was 9-year(s) lower than overall life expectancy at birth. This lost healthy life expectancy represents 9 equivalent year(s) of full health lost through years lived with morbidity and disability. The provinces of Bagmati, Karnali, and Gandaki have identical life expectancies at birth , with survival rates of 72.8, 72.4, and 72.3 years, respectively. While Lumbini Province (69.7) has the lowest life expectancy at birth, slightly less than a year lower than Koshi Province's average (70.7), Madhesh and Sudurpashchim provinces both display relatively close predicted years of life from birth, at 71.9 and 71.3 years. According to sex, men in Bagmati (70.2 years) and Madhesh (70.2 years) provinces live the longest, while women in Gandaki Province live the longest (75.9 years). Nepal's life expectancy at birth is lower than that of the SAARC countries like Bangladesh, Bhutan, Sri Lanka, and the Maldives, but it is comparable to that of India and South Asia. Compared to the SAARC nations, Nepal has a significantly larger gender disparity in life expectancy, with females living an average of 5.6 years longer than males.
Disease burden Disease burden or burden of disease is a concept used to describe the death and loss of health due to diseases, injuries and risk factors. One most common measure used to measure the disease burden is disability adjusted life year (DALY). Developed in 1993, the indicator is a health gap measure and simply the sum of years lost due to premature death and years lived with disability. One DALY represents a loss of one year of healthy life. Trend analysis DALYs of Nepal has shown to be dropping down since 1990 but it is still high compared to the global average. Fig 1 shows that the 69,623.23 DALYs lost per 100,000 individuals in Nepal in 1990 has decreased to almost half (34,963.12 DALYs) in 2017. This is close to the global average of 32,796.89 DALYs lost. According to the
Global Burden of Disease Study 2017, the eight leading causes of morbidity (illness) and mortality (death) in Nepal are: Neonatal disorders (9.97%),
Ischaemic Heart Disease (7.55%),
COPD (5.35%),
Lower respiratory infection (5.15%),
Diarrhoeal disease (3.42%), Road injury (3.56%),
Stroke (3.49%),
Diabetes (2.35%). The chart (Fig 3) shows the burden of disease prevalence in Nepal over a period of time. Diseases like neonatal disorder, lower respiratory tract infection, and diarrhoeal diseases have shown a gradual decrease in prevalence over the period from 1990 to 2017. The reason for this decrease in number is due to the implementation of several health programs by the government with the involvement of other international organizations such as
WHO and
UNICEF for maternal and child health, as these diseases are very common among the children. Whereas, there is a remarkable increment in the number of other diseases like Ischemic heart disease (IHD), Chronic obstructive pulmonary disease (COPD), Road injuries, Stroke, and Diabetes.
Ischemic heart disease Ischemic Heart Disease (IHD) is gradually emerging as one of the major health challenges in Nepal. It is the most common type of heart disease and cause of heart attacks. The rapid change in lifestyle, unhealthy habits (smoking, sedentary lifestyle etc.), and economic development are considered to be responsible for the increase. Despite a decrease in
Ischemic Heart Disease mortality in
developed countries, substantial increases have been experienced in developing countries like Nepal. IHD is the number one cause of death in adults from both low and middle-income countries as well as from high-income countries. The incidence of IHD is expected to increase by approximately 29% in women and 48% in men in the developed countries between 1990 and 2020. A total of 182,751 deaths are estimated in Nepal for the year 2017.
Non-communicable diseases (NCDs) are the leading causes of death – two-thirds (66%) of deaths are due to NCDs, with an additional 9% due to injuries. The remaining 25% are due to communicable,
maternal, neonatal, and nutritional (CMNN) diseases. Ischemic heart disease (16.4% of total deaths),
Chronic obstructive pulmonary disease (COPD) (9.8% of total deaths),
Diarrheal diseases (5.6% of total deaths),
Lower respiratory infections (5.1% of total deaths), and
Intracerebral hemorrhage (3.8% of total deaths), were the top five causes of death in 2017 Ischemic Heart Disease is second
burden of disease and the leading cause of death in
Nepal for the last 16 years, starting from 2002. Death due to IHD is increasing an alarming rate in Nepal from 65.82 to 100.45 death per 100,000 from 2002 to 2017. So, the large number of
epidemiological research is necessary to determine the incidence & prevalence of IHD in Nepal and to identify the magnitude of the problem so that timely primary and secondary
prevention can be done. As it is highly preventable and many
risk factor are related to our lifestyle like; smoking, obesity, unhealthy diet, etc. So, knowledge and awareness regarding these risk factors are important in the prevention of IHD.
Shahid Gangalal National Heart Center conducted a cardiac camp in different parts of Nepal from September 2008 to July 2011. The prevalence of heart disease was found higher in urban areas than rural areas where hypertension claims the major portion. The huge proportion of
hypertension in every camp suggests that Nepal is in daring need of preventive programs of heart disease to prevent the catastrophic effect of IHD in near future. Also, according to this study the proportion of IHD ranges from 0.56% (
Tikapur) to 15.12% (
Birgunj) in Nepal. Among
WHO region in the European region, African region, Region of the Americas and Eastern Mediterranean death rate is in decreasing trend while in Western Pacific, South East Asia it is increasing. Although most common
Mycobacterium species which causes tuberculosis is
M. tuberculosis, TB is also caused by
M. bovis and
M. africanum and occasionally by
opportunistic Mycobacteria which are:
M. Kansaii, M. malmoense, M. simiae, M. szulgai, M. xenopi, M. avium-intracellulare, M. scrofulacum, and
M. chelonei. Tuberculosis is the most common cause of
death due to single
organism among person over 5 years of age in
low-income countries. In addition, 80% of
deaths due to
tuberculosis occurs in young to middle age men and women. The
incidence of disease in a community may be affected by many factors, including the
density of population, the extent of overcrowding and the general standard of living and health care. Certain groups like refugees,
HIV infected, person with physical and psychological stress, nursing home residents and
impoverished have high risk to develop TB. The goal 3.3 within the goal 3 of
Sustainable Development Goals states "end the epidemics of
AIDS, tuberculosis,
malaria and
neglected tropical diseases and combat
hepatitis, water-borne diseases and other
communicable diseases" and the targets linked to the end TB strategy are: • Detect 100% of new sputum smear-positive TB cases and cure at least 85% of these cases. • Eliminate TB as a public health problem (<1 case per million population) by 2050. In
Nepal, 45% of the total population is
infected with TB, out of which 60% are in the productive age group (15–45). Former Director of National Tuberculosis Center
Dr. Kedar Narsingh KC stated that among an estimated 40,000 new TB patients every year, only around 25,000 visit health facilities. According to national TB prevalence survey around 69,000 people developed TB in 2018. In addition, 117,000 people are living with the disease in Nepal. There are 624 microscopy centers registered whereas the National TB Reference Laboratories, National tuberculosis centre and GENETUP perform culture and drug susceptibility testing service in Nepal.National Tuberculosis control program (NTP) employs directly observed treatment strategy (DOTS). In 1995,
World Health Organization recommended DOTS as one of the most cost
effective strategies available for tuberculosis control. DOTS is the strategy for improving treatment outcome by giving drugs to the
patients under direct observation of
health workers. DOTS has been found to be 100% effective for tuberculosis control. There are around 4323 TB treatment centers in Nepal. The burden of drug resistance tuberculosis is estimated at 1500 (0.84 to 2.4) cases annually. But only 350 to 450 Multidrug resistance TB are reported yearly. So, in NTP's strategic plan 2016–2021, the main objective is to diagnose 100% of the MDR TB by 2021 and to successfully treat a minimum 75% of those cases. The epidemic in Nepal is driven by injecting drug users, migrants, sex workers & their clients and MSM. Results from the 2007 Integrated Bio-Behavioral Surveillance Study (IBBS) among IDUs in
Kathmandu,
Pokhara, and East and West
Terai indicate that the highest prevalence rates have been found among urban IDUs, 6.8% to 34.7% of whom are HIV-positive, depending on location. In terms of absolute numbers, Nepal's 1.5 million to 2 million labor migrants account for the majority of Nepal's HIV-positive population. In one subgroup, 2.8% of migrants returning from
Mumbai, India, were infected with HIV, according to the 2006 IBBS among migrants. As of 2007, HIV prevalence among female sex workers and their clients was less than 2% and 1%, respectively, and 3.3% among urban-based MSM. HIV infections are more common among men than women, as well as in urban areas and the far western region of Nepal, where migrant labor is more common. Labor migrants make up 41% of the total known HIV infections in Nepal, followed by clients of sex workers (15.5 percent) and IDUs (10.2 percent). Global Burden of Disease Study shows that diarrhoeal diseases account for 5.91% of total deaths among all age groups of Nepal in 2017. In the same year, the data indicates that diarrhoeal diseases has the highest cause of death of 9.14% in the age group 5–14 years followed by 8.91% deaths in 70+ age group. A study showed the presence of
enteropathogens in more than two-thirds of diarrhoeal faeces. A survey done in Kathmandu showed the presence of
Giardia cysts in 43% of the water samples tested. Similarly,
diarrhoea and
dysentery causing bacteria such as
Escherichia coli,
Shigella species,
Campylobacter species,
Vibrio cholerae are found to be more common in contaminated drinking water of Nepal. In 2009, a large
cholera outbreak occurred in Jajarkot and its neighboring districts affecting around thirty thousand people and over five hundred deaths, and it has been endemic for a long time in different parts of Nepal. Viral diarrhoea is mainly caused by
Rotavirus but a few cases of
Norovirus and
Adenovirus was also observed in a type of study. The following table shows the prevalence of diarrhea among under-five children in all five development regions of Nepal in the year 2006, 2011 and 2016.
Maternal and neonatal health Maternal and neonatal health (MNH) is one of the top priorities of the Ministry of Health and Population of Nepal (MoHP). Nepal is also a signatory to the Sustainable Development Goals (SDGs), which have set ambitious targets for the country to reduce the
Maternal Mortality Ratio (MMR) to 70 per 100,000 live births and
Neonatal Mortality Rate (NMR) to 12 per 1,000 live births, and to achieve coverage of 90% for four
Antenatal care visits (ANC), institutional delivery, Skilled Birth Attendant (SBA)delivery, and three
Post Natal care (PNC) check-ups by 2030. However, the country still has a high
Maternal Mortality Ratio (186 per 100,000 live births), compared to its neighboring South Asian countries such as India (145), Bhutan (183), Bangladesh (173), Pakistan (140), and Sri Lanka (36). Although, there have been decrease in maternal mortality ratio from 553 per 100,000 live births in 2000 to 183 per 100,000 live births in 2017, the change in trend is still not significant to meet SDG target. In the other hand, there has been some decrease in the neonatal death rate (19 per 1,000 live births) in 2018 compared to 33 per 1,000 live births in 2011, Safe Motherhood program consists of various activities and services provided in community level as well as institutional levels. Following are the activities included in safe motherhood program •
Birth Preparedness Package and community level maternal and newborn care This program is aimed to provide information about danger signs in pregnancy, after delivery and new born care as well as, importance of preparedness for delivery. Program is mainly focused on creating awareness of health facilities, preparedness of funds, transportation, blood donors etc. •
Emergency referral funds The program is aimed to support emergency referral transport of women from poor, marginalized groups and geographically disadvantaged communities. •
Safe abortion services comprehensive abortion services are provided under this program which includes pre and post counselling on abortion methods, post abortion contraceptives methods, termination of pregnancy as national protocol, diagnosis and treatment of reproductive tract infections and follow up for post abortion management. •
Rural Ultrasound Programme The programme focuses on 11 remote districts of Dhading, Mugu, sindupalchowk, Darchula, Bajura, Solukhumbu, Accham, Bajhang, Humla, Baitadi and Dhankuta. The main objective of this program is early identification and referral of pregnancy related complications by a health professional . •
Nyano Jhola Programme The program was launched in 2069/2070 with the aim of reducing hypothermia and infections in newborns and maximize institutional delivery. under this program every child born in an institution is given two sets of clothes and one set of wrapper for newborn and a gown for mother. •
Aama and Newborn Programme Government has introduced this program to improve care and encourage institutional delivery. This program has different provisions that are carried out in present one of the most important program that targeted promoting institutional delivery is transport incentive for institutional delivery, cash initiatives are given to women after institutional delivery ( NPR 3000 in mountains, NPR 2000 in hills and NPR 1000 in Terai districts). similarly, Incentive of NPR 800 is given to women on completion of 4 Antenatal Care visits at 4,6, 8 and 9 months of pregnancy. There is also provision of free institutional delivery, health institutions are paid for providing free delivery care. Despite all of the above-mentioned longstanding efforts of MoHP to improve maternal and neonatal health in Nepal, the progress has been slow and there is much more to improve to achieve the 2030 target. Economic, geographic and socio-cultural disparities are some of the bottlenecks in improving of maternal health services in the country. Women living under poverty, remote areas and with less education are less likely to access maternal health services. Therefore, the government has to develop and implement the intervention and programme that are more focused toward underserved and marginalized women population Table:
Trends in maternal and neonatal health indicators Oral health Oral health is an essential prerequisite for a healthy life. Attempting to maintain good oral health in developing countries like Nepal is a challenging task. According to the Annual report of Department of Health Services (2009/10), 392,831 have
dental caries/toothache, 73,309 have
periodontal diseases, 62,747 and 113,819 have
oral ulcer, mucosa and other related diseases. The data shows a high prevalence of oral health problems in the population of the country. Many of these diseases in the population are due to poverty and lack of oral health awareness. According to the
Journal of Nepal Dental Association National Oral Health 'Pathfinder' Survey 2004 shows prevalence of dental decay in adolescents studying in school is lower, which is 25.6% for 12 to 16 years of age. This can be due to the use of fluoridated toothpaste and awareness in the school going adults. However, periodontal/gum diseases cases tends to be higher in adolescents which is 62.8% for 12 to 13 years and 61% for 15 to 16 years. And the incidence of oral cancer ranges from 1 to 10 cases per 1,000,000 populations in most countries In countries like Nepal where majority of people are living under poverty, access to healthcare, education and awareness programs have been major constraints in improving oral health. High consumption of both smoked and smokeless form of tobacco in the people has been strongly associated with the majority of the oral health problems. Prevalence of cleaning teeth at least once a day was 94.9% , while that of cleaning teeth at least twice a day was measured to be only 9.9%. Use of fluoridated toothpaste was seen among 71.4%. It is also very common among people in the rural area to brush their teeth with the thin bamboo stick which is called "Datiwan" in the local language, sand and ash. And only 3.9% have made a dental visit in the last 6 months.
Table: Distribution of oral hygiene practices among different age groups The government of Nepal does not advocate for institutions like
WHO or
UNICEF to provide the kind of support that they do for other medical issues because they do not prioritize oral health. Also, several misconceptions are very relevant among people like loosening of teeth is normal with increasing age, and losing some teeth will not kill people. The majority of people only seek treatment when the disease has worsened or causes unbearable pain.
Child health Nepal is also on track to achieve MDG 4, having attained a rate of 35.8 under 5 child deaths per 1000 live births in 2015, down from 162 in 1991 according to national data. Global estimates indicate that the rate has been reduced by 65% from 128 to 48 per 1000 live births between 1991 and 2013. Nepal has successfully improved coverage of effective interventions to prevent or treat the most important causes of child mortality through a variety of community-based and national campaign approaches. These include high coverage of semiannual vitamin A supplementation and deworming; CB-IMCI; high rates of full child immunization; and moderate coverage of exclusive breastfeeding of children under 6 months. However, in the past few years, the NMR has remained stagnant with it being stated at around 22.2 deaths per 1000 live births in 2015. This compares to a rate of 27.7 in India (2015) and 45.5 in Pakistan (2015).
Child health programmes The Nepalese Child Health Division of the Ministry of Health and Population (MOHP), has launched several child survival interventions, including various operational initiatives, to improve the health of children in Nepal. These include the Expanded Program on Immunisation (EPI), the Community-Based Integrated Management of Childhood Illnesses (CB-IMCI) program, the Community-Based Newborn Care Program (CB-NCP), the Infant and Young Child Feeding program, a micro-nutrients supplementation program, vitamin A and deworming campaign, and the Community-Based Management of Acute Malnutrition program. Two more vaccines were introduced between 2014 and 2015 – the inactivated poliomyelitis vaccine (IPV) and the pneumococcal conjugate vaccine (PCV). Six districts of Nepal are declared with 99.9% immunization coverage. Nepal achieved polio-free status on 27 March 2014. Neonatal and maternal tetanus was already eliminated in 2005 and Japanese encephalitis is in a controlled state. Nepal is also on track to meet the target of the elimination of measles by 2019.
Community-Based Newborn Care Program (CB-NCP) The Nepal Family Health Survey 1996, Nepal Demographic and Health Surveys, and
World Health Organization estimations over time have shown that neonatal mortality in Nepal has been decreasing at a slower rate than infant and child mortality. The Nepal Demographic and Health Survey 2011 has shown 33 neonatal deaths per 1,000 live births, which accounts for 61% of under 5 deaths. The major causes of neonatal death in Nepal are an infection, birth asphyxia, preterm birth, and hypothermia. Given Nepal's existing health service indicators, it becomes clear that strategies to address neonatal mortality in Nepal must consider the fact that 72% of births take place at home (NDHS 2011). Malnutrition remains a serious obstacle to child survival, growth, and development in Nepal. The most common form of malnutrition is protein-energy malnutrition (PEM). Other common forms of malnutrition are iodine, iron, and vitamin A deficiency. These deficiencies often appear together in many cases. Moderately acute and severely acutely malnourished children are more likely to die from common childhood illnesses than those adequately nourished. In addition, malnutrition constitutes a serious threat to young children and is associated with about one-third of child mortality. Major causes of PEM in Nepal is low birth weight of below 2.5 kg due to poor maternal nutrition, inadequate dietary intake, frequent infections, household food insecurity, poor feeding behaviour and poor care & practices leading to an intergenerational cycle of malnutrition. An analysis of the causes of stunted growth in Nepal reveals that around half is rooted in poor maternal nutrition, and the other half in poor infant and young child nutrition. Around a quarter of babies are born with a low birth weight. As per the findings of Nepal Demographic and Health Survey (NDHS, 2011), 41 percent of children below 5 years of age are stunted. A survey by NDHS and NMICS also showed that 30% of the children are underweight and 11% of children below 5 years are wasted. After six months, a child requires adequate complementary foods for normal growth. Lack of appropriate complementary feeding may lead to malnutrition and frequent illnesses, which in turn may lead to death. However, even with complementary feeding, the child should continue to be breastfed for two years or more. According to
WHO, exclusive breastfeeding is defined as no other food or drink, not even water, except
breastmilk (including milk expressed or from a wet nurse) for 6 months of life, but allows the infant to receive ORS, drops and syrups (
vitamins,
minerals and
medicines). Exclusive breastfeeding for the first 6 months of life is the recommended way of feeding infants, followed by continued breastfeeding with appropriate complementary foods for up to 2 years or beyond. As per the study carried out in Paropakar Maternity & Women's Hospital, Thapathali, 2017, the participants of normal delivery had an opportunity to breastfeed within an hour while almost all participants going through
C-section were not offered to do so.
GERIATRIC HEALTH Geriatrics is a branch of medicine concerned with the diagnosis, treatment and prevention of disease in older people and the problems specific to ageing. According to an article published in The Lancet in 2014, 23% of the total global burden of disease is attributable to disorders in people aged 60 years and older. Although the proportion of the burden is highest in high-income regions, DALYs per head are 40% higher in low-income and middle-income regions. The leading contributors to disease burden in older people are cardiovascular diseases (30·3%), malignant neoplasms (15·1%), chronic respiratory diseases (9·5%), musculoskeletal diseases (7·5%), and neurological and mental disorders (6·6%).
Background The Senior Citizens Acts 2063, Nepal defines the senior citizens (elderly population) as "people who are 60 years and above". About 9% of the total population accounts for 60+ population and the number is projected to be around 20% by 2050. The elderly population has been increasing rapidly and one of the main reasons behind this is positive development in
life expectancy. The other reason is the reduction in mortality and fertility rates which has shown dramatic increase in the proportion of elderly people in the country. This is seen to have a profound impact on the individuals, families and communities. The increase in the population of elderly has given rise to challenges in both developmental and humanitarian areas in terms of promoting their well-being by meeting their social, emotional, health, financial and developmental needs. Various observations show that the proportion of elderly population is high in Mountain and Hilly regions in comparison to Terai. Similarly, it is noted that the female elderly population is higher than the male elderly population among three ecological regions. With the ongoing growth in the geriatric population and insufficient availability of healthcare services in a developing country like Nepal, ageing seems to be a challenging domain.
Geriatric health disorders The
Nepal Living Standard Survey (NLSS III (2010–2011)) has reported that the percentage of population reporting chronic illness by gender has been the highest at 38 percent in the age group 60 years and above. Of them, women are the worse sufferer with 39.6 percent reporting chronic illness compared to 36.4% for men. This means that the incidence of chronic illness among the elderly population remains quite acute and widespread, and more so for women elderly. Prevalence of chronic diseases in old age is a common phenomenon. Most of the common geriatric diseases in
Nepal include
gastritis,
arthritis,
hypertension,
COPD,
infections,
eye problems,
back pain,
dementia,
headache,
diabetes,
paralysis and
heart problems. it was seen that more than half of elderly population with chronic illness had low adherence to medication. The existence of comorbidities was associated with deteriorating health-related quality of life (HRQOL) among older people. For the elderly population of 2.1 million (2011 census), only 3 registered geriatric specialists are available. Nepal not only lacks geriatric specialists, but geriatric nurses and caregivers are also lacking.
Health in the context of old age homes Official data of the Social Welfare Council shows that the total number of old age homes (OAHs) registered as of 2005 was 153. However, most of these homes either do not exist today or operate in very poor condition. At present, about 70 registered old age homes (OAH) are available in the country out of which 11 get government grants. There are about 1500 elderly residing in these institutions. In a case study Another study that was done among the elderly of private and government old age homes concluded that the elderly people living in the private old age homes have better health status than the government old age homes despite the minimum amenities available. The elderly in government old homes suffered more with endemic diseases than private old age homes. Following the healthy habits and the clean dwelling surroundings of the private old homes had led to their better health compared to government old age homes. Major health problems of elderly living in government OAH were
joint pain (73.5%),
backache (60.7%),
insomnia (39.3%),
loss of appetite (36.8%),
cough (50.4%),
constipation (14.5%),
tiredness (24.8%),
stomach ache (33.3%) and
allergy (18.8%). Similarly, major health problems of elderly living in private OAH were
joint pain (69.0%),
backache (53.5%),
insomnia (18.3%),
loss of appetite (18.3%),
cough (18.3%),
constipation (5.6%),
tiredness (4.2%),
stomach ache (23.9%) and
allergy (9.9%). This study points out that OAHs seek the attention of government and concerned organizations for bringing the rules, policies and checklist for elderly homes on elderly facilities and welfare.
Government initiatives Government has initiated to provide geriatric care services by formulating certain plans and policies but these have not been quite effective due to lack of resources. Madrid Plan of Action on Aging (2002), Senior Citizen Policy (2002), National Plan of Action on Aging (2005), Senior Citizen Act (2006) and The senior Citizens regulations (2008) are the initiatives taken by Nepal government. Nepal has introduced a non-contributory social pension scheme since 1994/95 to ensure the social security to the elderly citizens. This system is unique to Asia being the primary universal pension scheme in the region and a model for other developing countries. The primary motive behind this scheme is to promote long established tradition of taking care of elderly by their family. At present, senior citizens above 65 years are entitled to receive Rs 4,000 in monthly social security allowance. Currently, there are 12 hospitals with geriatric wards. The government has decided to establish geriatric wards in four more hospitals across the country this fiscal (2077/78). According to the
Ministry of Health and Population, geriatric wards will be set up in Mechi Hospital, Janakpur Hospital, Hetauda Hospital and Karnali Province Hospital. The ministry has decided to extend the services in the hospitals having more than 100-bed capacity. Though the government has directed hospitals to give health services to the elderly population from a separate geriatric ward, many hospitals do not have separate wards for the elderly. Bir Hospital has been providing services to patients from its general wards and cabins. "We have not been able to allocate a separate ward for elderly people. We have been admitting them to the general ward or at times to the cabin as per the situation," said Dr Kedar Century, director at Bir Hospital. Also, the hospital has not been able to spend budget allocated for geriatric services. About 45 patients visit the geriatric OPD daily in the hospital, said Dr Century. The
Ministry of Health and Population in 2077 (BS) has endorsed a guideline for Geriatrics (Senior Citizens) Health Service Program Implementation. It provides 50 percent discount for senior citizens (aged 60 years+) in certain health services as prescribed by hospital management.
Conclusion The 2030 Agenda for Sustainable Development sets out a universal plan of action to achieve sustainable development in a uniform manner and aspires to realize the human rights of all people. It calls for ensuring that the Sustainable Development Goals (SDGs) are met for every component of the society, at all ages, with a discreet focus on the most vulnerable population group, which includes the elderly. But sadly, in the context of Nepal, specific and exact data related to geriatric population is lacking behind as this area is not emphasized as much as child and women health. More research and explorations need to be conducted from the public level to get a better scenario of geriatrics to develop effective and equitable health policies for the elderly. Looking at the data from the old age homes in terms of geriatric health, it is recommended that the government should formulate and regulate policies for elderly to live together with their family, with the provision of incentives and consequences respectively. Since the percentage of geriatric health disorders contributing to GBD is higher in low-income countries like Nepal, there is a dire need to address the health issues of elderly to enhance and maintain their health and well-being as they are an integral part of the nation.
Road traffic accidents Road traffic injuries are one of the global health burdens, an eighth leading cause of death worldwide. Globally, approximately 1.25 million lives are cut short every year because of a road traffic injuries. Ranging from 20 to 50 million people become victims of non-fatal injuries, with many acquiring a disability for the rest of the life as a result of their injury. In Nepal, a road traffic accident rank eighth among killer causes of
disability-adjusted life years and also eighth among premature cause of death after
Non-Communicable Diseases and Communicable Diseases. A substantial problem of road traffic accident with fatalities occurs mainly on highways caused by bus crashes in
Nepal. Due to the country's geography, bus accidents mostly happen in the hilly region and along the long-distance route causing 31 percent of fatalities and serious injuries every year. Accidents involving motorcycles, micro-buses, cars etc. highly prevail in the capital city, Kathmandu compared to other cities and lowland areas. The number of Road Traffic Accidents in the capital city was (53.5±14.1) of the number for the entire country. People between 15 and 40 ages are the most affected group followed by those above 50 years and majorities were male making 73 percent of
disability-adjusted life years. The number of registered vehicles in
Bagmati Zone was 129,557, a 29.6 percent of the whole nation in fiscal year 2017/2018. Mental health is one of the least focused healthcare segment in Nepal. Less focused in terms of awareness and treatment. Now also most of the people choose to visit traditional healers, if it does not work, a psychiatrist will be the second choice. Very few psychiatrists, and more psychiatric cases, makes a hospital a crowded place, providing quality service is challenging. Only few number of trained psychologists are working either in private clinic or very few in government hospitals. Most of the psychologists are working within Kathmandu Valley only. == Antimicrobial resistance in Nepal ==