Effectiveness of physical activity promotion interventions in low-income and middle-income countries: a systematic review and meta-analysis Rajan Shrestha, Susan Paudel, Tara Ballav Adhikari, Bijay Khatri, Santoshi Adhikari, et al. British Journal of Sports Medicine, 2026 Objective To evaluate the effectiveness of interventions on physical activity promotion in low-income and middle-income countries (LMICs). Design Systematic review and meta-analysis. Data sources PubMed, EMBASE, CINAHL and Cochrane CENTRAL. Eligibility criteria Randomised controlled trials and quasi-experimental studies published between January 2010 and September 2024. Primary outcomes included standardised mean difference (SMD) in physical activity outcomes reported mainly in metabolic equivalent to task (MET) minutes, physical activity minutes and sedentary behaviour. Data were synthesised using random-effects meta-analysis to calculate the SMD reported in a 95% CI, and the risk of bias was assessed using Cochrane Risk of Bias 2 (RoB 2) and Risk of Bias in Non-Randomised Studies of Interventions tools (ROBINS-I). SMDs of 0.2, 0.5 and 0.8 were interpreted as small, medium and large effects as per Cohen’s threshold. Results 23 studies involving 12 689 participants from LMICs were included in the meta-analysis. Results indicated a small but statistically significant overall effect on physical activity (SMD=0.29, 95% CI 0.13 to 0.46, I²=96%). Significant improvements were observed for MET minutes (SMD=0.42, 95% CI 0.21 to 0.64, I 2 =94%) and physical activity scores (SMD=0.86, 95% CI 0.38 to 1.35, I 2 =91%), but not in total physical activity minutes, sedentary time or energy expenditure, indicating interventions mainly enhanced activity intensity. Interventions via apps and interactive calls were most effective, though overall evidence certainty was low to very low because of heterogeneity and imprecision. Conclusions Interventions, primarily delivered through mobile apps or interactive calls, led to small improvements in physical activity intensity and could have significant public health benefits in LMICs. Future interventions should be context-specific and backed by robust trials to increase their impact and inform sustainable policy. PROSPERO registration number CRD42023412477.
Malnutrition among students with visual impairment studying in integrated public schools of Nepal Bijay Khatri, Rajan Shrestha, Manita Pyakurel, Madan Prasad Upadhyay Journal of Nutritional Science, 2025 Cross-cutting issues like nutrition have not been adequately addressed for children with severe visual impairment studying in integrated schools of Nepal. To support advocacy, this study aimed to determine the nutritional status of this vulnerable group, using a descriptive cross-sectional design involving 101 students aged 5–19 years from two integrated public schools near Kathmandu Valley and two in western Nepal. The weight-for-age z-score (WAZ), height-for-age z-score (HAZ), and body mass index-for-age z-score (BAZ) were computed and categorised using World Health Organization cut-off values (overnutrition: z-score > +2.0 standard deviations (SD), healthy weight: z-score −2.0SD to +2.0SD, moderate undernutrition: z-score ≥ −3.0SD to <−2.0SD, severe undernutrition: z-score < −3.0 SD) to assess nutritional status. A child was considered to have undernutrition for any z-scores <−2.0SD. Multivariate logistic regression was used to analyse variables linked to undernutrition. The mean age of participants was 11.86 ± 3.66 years, and the male-to-female ratio was nearly 2:1. Among the participants, 71.29% had blindness, and 28.71% had low vision. The mean BAZ and HAZ scores decreased with age. The WAZ, HAZ, and BAZ scores indicated that 6.46% were underweight, 20.79% were stunted, and 5.94% were thin, respectively. Overall, 23.76% of students had undernutrition and 7.92% had overnutrition. More than three in ten students had malnutrition and stunting was found to be prevalent. Older students and females were more likely to have undernutrition. These findings highlight the need for nutrition interventions within inclusive education settings, particularly targeting girls with visual impairments who may face compounded vulnerabilities.
Knowledge, Attitude and Practice on Pesticide Use among Vegetable Farmers in Madhyapur Thimi Municipality, Nepal: An Observational Study Rajan Suwal, Ajay Kumar Rajbhandari, Vijaya Laxmi Shrestha, Mahima Bataju, Mahesh Sharma, et al. Journal of the Nepal Medical Association, 2025 Introduction: Pesticides are groups of toxic chemical compounds designed to use for increased productivity by killing pest. Inappropriately handling of pesticides cause risk to targeted as well as non-targeted organisms and also humans. Consumption of the pesticides is increasing globally and in Nepal. The study aimed to study the existing knowledge, attitude and practices of pesticides use among vegetable farmers. Methods: A cross-sectional study was conducted among vegetable farmers who had used pesticides in the past 12 months for their farming. A household survey was conducted among 395 farmers from January to April 2023 in Madhyapur Thimi Municipality. Ethical approval was taken from the Ethical Review Board, Nepal Health Research Council (Reference number: 1696). A semi-structured questionnaire was developed from literature review and expert advices. The data was collected through face-to-face interviews. Data was analysed using descriptive statistics using SPSS 20. Results: The mean age of the farm workers was 50.73±11.1 years. Nearly three in ten (29.62%) were illiterate. Insecticide was the most common form (97.21%) of pesticides used and 89.87% farmers received information of pesticides from friends and family. A total of 88.1% farmers had never received training on pesticide use. A total of 90.12% farmers had knowledge that use of personalprotective equipment is necessary during pesticide application. However, only 33.41% farmers always used to wear proper personal protective equipment in practice. Headache was the most common (69.51%) health adverse symptom after pesticides application. Conclusions: Our study shows that farmers have limited knowledge about pesticides and use them in unsafe ways.
Assessing the prevalence of insomnia and its socio-behavioral determinants among school going adolescents in Bagamati Province, Nepal Mahesh Sharma, Parvati Bista, Bijay Khatri, Dipak Prasad Upadhyaya, Vijay Kumar Khanal, et al. Plos Global Public Health, 2025 Insomnia among adolescents is a prevalent public health concern and is closely linked to suicidal tendencies, health risk behaviors, and other adverse health outcomes. This study builds on existing literature by exploring the multifaceted associations between insomnia and socio-behavioral factors, which are currently underexplored in the Nepalese context. It assesses the prevalence of insomnia and its association with socio-behavioral factors and internet addiction among adolescents in Bagmati Province, Nepal, to inform targeted public health interventions. From July to September 2022, a school-based descriptive cross-sectional study was conducted among grade 9 and 10 students (aged 13–19) using a self-administered semi-structured questionnaire. A questionnaire included the 7-item Insomnia Severity Index (ISI) for insomnia assessment and the 20-item Young’s Internet Addiction Test for evaluating internet addiction. Binary logistic regression analysis was utilized to identify factors associated with insomnia. The study identified a significant prevalence of insomnia at 24.2%. Key socio-behavioral determinants included religion [AOR 3.58; 95% CI 1.56–8.23, AOR 3.36; 95% CI 1.27–8.89], experience of a break up [AOR 1.67; 95% CI 1.10–2.55] absence of close friendships [AOR 2.62; 95% CI 1.32–5.19], exposure to bullying [AOR 1.74, 95% CI 1.12–2.70], and internet addiction [AOR 2.74; CI 1.83–4.11]. These findings highlight the complex interplay of individual and environmental factors influencing insomnia. The significant prevalence of insomnia among school-going adolescents in Bagmati Province underscores the necessity for enhancing the role of schools in health counselling that considers behavioural, social, and demographic factors. Addressing internet addiction, fostering healthy social connections, and acknowledging the impact of demographic factors like religion could enhance intervention strategies.
Surgical Removal of a Long-standing Impacted Tooth in Upper Alveolus Following Blast Injury: A Case Report Arun Adhikari, Shila Acharya, Sadhana Sharma, Luna Mathema, Bijay Khatri Journal of the Nepal Medical Association, 2025 Injuries sustained from foreign bodies and burns after oil drum explosions are addressed immediately. This case reports a rare long-standing retained tooth after such an explosion. A 65-year-old male with a history of a victim of explosion injury to the face dating 20 years back with complaints of repeated nasal vestibulitis was evaluated. An X-ray of paranasal sinus followed by computed tomography of the nose and paranasal sinuses revealed a radio-opaque foreign body in the region of upper alveolus near left nasal vestibule. After consultation and clearance from dental department, exploration through the vestibule was done and the foreign body was removed without complications. Our intervention involved surgical removal of foreign body under local anesthesia. The patient has recovered following the intervention and has resumed his normal activities.
Association of Adjunctive Vitamin D Supplementation with Hearing Recovery in Idiopathic Sudden Sensorineural Hearing Loss: A Prospective Observational Study A Adhikari, L Mathema, B Koirala, P Poudyal, M Neupane, B Khatri Birat Journal of Health Sciences 11 (1), 52-58 , 2026 2026
Quality of Life and Associated Factors among parents of children with autism spectrum disorder: a comparative study in Kathmandu valley, Nepal M Kayastha, SB Singh, KR Sharma, D Baral, A Chakravartty, ... 12th National Summit of Health and Population Scientists in Nepa , 2026 2026
Effectiveness of a female community health volunteer-led physical activity education intervention on accelerometer-derived outcomes in semi-urban Nepal: an open-label, cluster … R Shrestha, S Paudel, A Rijal, TB Adhikari, PJL Gradidge, B Khatri, ... International Journal of Behavioral Nutrition and Physical Activity , 2026 2026
Effectiveness of physical activity promotion interventions in low-income and middle-income countries: a systematic review and meta-analysis R Shrestha, S Paudel, TB Adhikari, B Khatri, S Adhikari, D Neupane, ... British Journal of Sports Medicine 60 (4), 286-299 , 2026 2026 Citations: 1
Pilot Study Comparing the Ocular Deviation Measures of Basic Intermittent Exotropia Using 2WIN-S and Prism Cover Test B Singh, B Khatri, R Suwal The British and Irish orthoptic journal 21 (1), 135 , 2025 2025
Designing and evaluating training for female community health volunteers to promote physical activity in semi-urban Nepal: a co-designed approach R Shrestha, S Paudel, A Rijal, TB Adhikari, B Khatri, L Dhakal, ... Archives of Public Health 83 (1), 289 , 2025 2025 Citations: 1
From Development to Deployment of AI-assisted Telehealth and Screening for Vision-and Hearing-threatening diseases in resource-constrained settings: Field Observations … M Shakya, B Adhikari, N Shrestha, B Koirala, A Adhikari, P Poudyal, ... arXiv preprint arXiv:2509.15558 , 2025 2025
Knowledge, Attitude and Practice on Pesticide Use among Vegetable Farmers in Madhyapur Thimi Municipality, Nepal: An Observational Study. R Suwal, AK Rajbhandari, VL Shrestha, M Bataju, M Sharma, B Khatri Journal of the Nepal Medical Association 63 (287) , 2025 2025 Citations: 1
Impact of a Community-based Intervention Program on Nutritional Status of Children Aged Under 5 Years With Undernutrition in Western Rural Nepal R Paudel, YB Gurung, B Khatri, AK Poudyal, D Acharya, DP Upadhyaya, ... Journal of Nutrition Education and Behavior 57 (7), 602-613 , 2025 2025 Citations: 3
Community-based promotion of physical activity in Nepal: study protocol for a cluster-randomized controlled trial R Shrestha, TB Adhikari, B Khatri, D Neupane, S Paudel, RØ Nielsen, ... Trials 26 (1), 170 , 2025 2025 Citations: 4
Surgical Removal of a Long-standing Impacted Tooth in Upper Alveolus Following Blast Injury: A Case Report A Adhikari, S Acharya, S Sharma, L Mathema, B Khatri JNMA: Journal of the Nepal Medical Association 63 (281), 57 , 2025 2025
Assessing the prevalence of insomnia and its socio-behavioral determinants among school going adolescents in Bagamati Province, Nepal M Sharma, P Bista, B Khatri, DP Upadhyaya, VK Khanal, BP Sapkota, ... PLOS Global Public Health 5 (1), e0004083 , 2025 2025 Citations: 4
Depressive Symptoms Among Adolescents with Low Vision and Blindness Attending Public Integrated Schools in Nepal B Khatri, R Shrestha, M Pyakurel, MP Upadhyay Journal of Indian Association for Child and Adolescent Mental Health … , 2025 2025
Malnutrition among students with visual impairment studying in integrated public schools of Nepal B Khatri, R Shrestha, M Pyakurel, MP Upadhyay Journal of Nutritional Science 14, e56 , 2025 2025
Comparison of Visual Acuity and Stereoacuity Outcomes with Vision Therapy between within-and Beyond-Critical-Period in Amblyopic Patients: A Pilot Study R Suwal, MK Dev, A Thakur, HN Dahal, B Khatri, D Khadka, A Shrestha, ... TNOA Journal of Ophthalmic Science and Research 63 (1), 30-38 , 2025 2025
Quantification of Metamorphopsia in Resolved Idiopathic Central Serous Chorioretinopathy: An Analysis Using M-CHARTS, Amsler Grid, and Optical Coherence Tomography B Suwal, D Khadka, A Shrestha, R Suwal, B Khatri Clinical Ophthalmology, 937-942 , 2024 2024 Citations: 3
Experience from Implementing Infant Hearing Screening Program at Immunization Centers in Kathmandu Valley, Nepal A Adhikari, B Khatri, L Mathema, P Poudyal, P Chaudhary, SK Upadhyay, ... Health Prospect 23 (3) , 2024 2024
Kaleidos-based binocular vision analyzer for the estimation of refractive errors and horizontal ocular deviation in children R Suwal, B Singh, S Adhikari, D Khadka, B Suwal, B Khatri, GS Shrestha Clinical and Experimental Optometry 107 (7), 731-738 , 2024 2024 Citations: 2
Utilisation of eye health services and compliance with spectacles wear among community school adolescents: a mixed-methods study from Bagmati province of Nepal B Khatri, R Shrestha, R Suwal, M Kayastha, S Sharma, D Khadka, ... BMJ open 14 (8), e087287 , 2024 2024 Citations: 4
Recurrence and Satisfaction in Patients after Pterygium Surgery in Tertiary Eye Hospital in Bhaktapur, Nepal S Sharma, D Khadka, A Shrestha, N Shrestha, B Suwal, B Khatri Nepalese Journal of Ophthalmology 16 (1), 53-61 , 2024 2024
MOST CITED SCHOLAR PUBLICATIONS
BMI, waist to height ratio and waist circumference as a screening tool for hypertension in hospital outpatients: a cross-sectional, non-inferiority study R Shrestha, SK Upadhyay, B Khatri, JR Bhattarai, M Kayastha, ... BMJ open 11 (11), e050096 , 2021 2021 Citations: 46
Perception and use of intrauterine contraceptive devices (IUCD) among married women of reproductive age in Bhaktapur, Nepal B Khatri, A Khadka, A Amatya, SM Shrestha, R Paudel Open access journal of contraception 10, 69-77 , 2019 2019 Citations: 21
Baseline predictive factors of visual outcome and persistence of subretinal fluid based on morphologic changes in spectral domain optical coherence tomography in patients with … B Suwal, D Khadka, A Shrestha, S Shrestha, N Shrestha, B Khatri Clinical Ophthalmology (Auckland, NZ) 13, 2439-2444 , 2019 2019 Citations: 19
Utilization of adolescent friendly health services and its associated factors among higher secondary students in mid-western Himalayan mountainous district of Nepal M Sharma, B Khatri, A Amatya, N Subedi, DP Upadhyaya, BP Sapkota, ... PLOS Global Public Health 3 (3), e0001616 , 2023 2023 Citations: 18
Impact of active vision therapy compared to conventional patching therapy on visual acuity and stereoacuity in children with amblyopia R Suwal, MK Dev, B Khatri, D Khadka, A Shrestha, S Sharma, ... Journal of Optometry 17 (1), 100484 , 2024 2024 Citations: 10
Hearing loss among children visiting Department of Otolaryngology and HNS of a tertiary care centre P Chaudhary, GB Chalise, A Adhikari, L Mathema, P Poudyal, B Khatri JNMA: Journal of the Nepal Medical Association 61 (267), 844 , 2023 2023 Citations: 9
Screen time and its correlates among children aged 3–10 years during COVID-19 pandemic in Nepal: a community-based cross-sectional study R Shrestha, B Khatri, S Majhi, M Kayastha, B Suwal, S Sharma, R Suwal, ... BMJ Open Ophthalmology 7 (1) , 2022 2022 Citations: 8
Physical activity and its correlates among school teachers in a semi-urban district of Nepal R Shrestha, DP Pahari, S Adhikari, B Khatri, S Majhi, TB Adhikari, ... PLOS Global Public Health 3 (10), e0002000 , 2023 2023 Citations: 7
Diabetic Retinopathy among Patients with Prediabetes Attending the Outpatient Department of Ophthalmology in a Tertiary Eye Care Centre: A Descriptive Cross-sectional Study A Shrestha, R Suwal, S Adhikari, N Shrestha, B Shrestha, B Khatri Journal of the Nepal Medical Association 61 (260), 351-354 , 2023 2023 Citations: 7
Urinary Tract Infection among Post-renal Transplant Patients in the Department of Nephrology of a Tertiary Care Centre: A Descriptive Cross-sectional Study B Khatri, S Maharjan, J Lamsal, B Khatri, DS Shah Journal of the Nepal Medical Association 60 (250), 507-510 , 2022 2022 Citations: 7
Effect of educational intervention based on theory of planned behaviour on physical activity intention among secondary school teachers of Nepal R Shrestha, DP Pahari, S Adhikari, B Khatri, S Majhi, A Vaidya BioMed Research International 2022 (1), 6953632 , 2022 2022 Citations: 7
Anxiety, Depression and Functional Impairment among Health Care Workers during COVID-19 Pandemic: A Cross-Sectional Online Survey R Shrestha, B Khatri, S Adhikari, P Poudyal Kathmandu University Medical Journal 75 (3), 351-355 , 2021 2021 Citations: 7
Socio-demographic and Healthcare-seeking Predictors of Undernutrition among Children Under-five Years of Age in a Western District of Nepal R Paudel, YB Gurung, AK Poudyal, B Khatri, DR Bhatta, D Acharya, ... Journal of Nepal Health Research Council 18 (3), 488-494 , 2020 2020 Citations: 7
Chronic Otitis Media among patients visiting community-based static outreach clinics L Mathema, A Adhikari, P Poudyal, GB Chalise, P Chaudhary, B Khatri JNMA: Journal of the Nepal Medical Association 61 (268), 923 , 2023 2023 Citations: 6
Use of telemedicine and artificial intelligence in Eye and ENT: a boon for developing countries P Upadhyaya, SK Upadhyay, A Shrestha, N Shrestha, R Shrestha, ... 2022 4th International Conference on Artificial Intelligence and Speech … , 2022 2022 Citations: 6
Community-based promotion of physical activity in Nepal: study protocol for a cluster-randomized controlled trial R Shrestha, TB Adhikari, B Khatri, D Neupane, S Paudel, RØ Nielsen, ... Trials 26 (1), 170 , 2025 2025 Citations: 4
Assessing the prevalence of insomnia and its socio-behavioral determinants among school going adolescents in Bagamati Province, Nepal M Sharma, P Bista, B Khatri, DP Upadhyaya, VK Khanal, BP Sapkota, ... PLOS Global Public Health 5 (1), e0004083 , 2025 2025 Citations: 4
Utilisation of eye health services and compliance with spectacles wear among community school adolescents: a mixed-methods study from Bagmati province of Nepal B Khatri, R Shrestha, R Suwal, M Kayastha, S Sharma, D Khadka, ... BMJ open 14 (8), e087287 , 2024 2024 Citations: 4
Diabetes Mellitus among Adult Outpatients Visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study B Khatri, M Kayastha, R Shrestha, JR Bhattarai, S Majhi, SK Upadhyay, ... Journal of the Nepal Medical Association 60 (251), 592-595 , 2022 2022 Citations: 4
Impact of a Community-based Intervention Program on Nutritional Status of Children Aged Under 5 Years With Undernutrition in Western Rural Nepal R Paudel, YB Gurung, B Khatri, AK Poudyal, D Acharya, DP Upadhyaya, ... Journal of Nutrition Education and Behavior 57 (7), 602-613 , 2025 2025 Citations: 3