IntroductionMotorization has undeniably enhanced mobility and convenience, but it comes at a significant cost, as the increasing number of vehicles has led to a surge in road traffic injuries (RTIs) now a major global cause of disability and death. Over the past decade, the significant growth in two-wheelers has coincided with a rise in RTIs, creating an increasing concern for young individuals. This mixed-method study aims to explore epidemiology, assess their impact on undergraduate students, and gather key recommendations from stakeholders to improve road safety and reduce injury rates.MethodologyThe quantitative data collection was conducted among undergraduate students in the four colleges in Kathmandu district. The total number of participants in this study was 1217 students of 17-31 years of age. Furthermore, for the qualitative data collection, 5 Key informant interviews were conducted among various stakeholders.ResultsThe prevalence of RTI in 2021-2022 was 23%. The most common injuries were bruises in the upper and lower limbs. It was seen that only 78% of the respondents had a driving license. The injuries led to academic loss and caused financial strain due to healthcare and vehicle repair expenses. 5 key recommendations to decrease the ever-increasing burden of RTI have emerged from the qualitative data analysis.ConclusionThe study highlighted a high prevalence and impact of RTIs among undergraduate students along with 5 key recommendations that came forward from this study could be instrumental for road safety in Nepal.

BackgroundEnsuring respectful maternity care is crucial to promote positive childbirth experiences among women. Globally, 22-100% women report experiencing at least one form of disrespect and abuse during facility-based birth, with a study in Nepal reporting 100% prevalence. Thus, interventions like Forum Play are needed to promote respectful maternity care but remain scarce. Forum Play is a participatory theatre technique which encourages the participants to create scenes based on their own experiences illustrating a situation of oppression. This study aimed to assess the effectiveness of a pilot Forum Play intervention in promoting respectful maternity care by investigating self-reported perception and behaviour among care providers.MethodsA quasi-experimental pre-post study with a control group was conducted among doctors and nurses in two tertiary hospitals in Nepal. Participants involved in providing care or interacting with women during labour and delivery were purposively selected for the intervention and control groups. The intervention group comprised 25 care providers (14 nurses and 11 doctors), while the control group included 75 care providers (42 nurses and 33 doctors). Two half-day Forum Play workshops were conducted separately for nurses and doctors in the intervention hospital. Data were collected using a self-administered structured questionnaire at baseline and two months post-intervention in both groups; however, the design was not strictly parallel. In the control hospital, data were collected later at the same intervals to provide contextual comparison. Data were analysed using IBM statistical package for social sciences version 20. Descriptive statistics (frequency, percentage, mean and standard deviation) were used to measure the self-reported perception and behaviour on disrespect and abuse and perceptions of respectful maternity care. Mann Whitney U test was used to compare groups and Wilcoxon Signed Rank test was used to assess within-group changes before and after the intervention.ResultsThere were no differences in background characteristics between intervention and control groups (p=>0.05), nor in the overall disrespect and abuse of women at baseline (p = 0.09 to 0.35) whereas significant differences were observed at follow-up (p=<0.001 to 0.004, r = 0.33 to 0.61). There were no significant differences in perception scores towards respectful maternity care between the groups at baseline while significant differences were found at follow-up (z = -3.25, p = 0.001 and r = 0.32). The perception score was significantly higher in the intervention group after the intervention (z = -3.073, p = 0.002 and r = 0.61) while no significant difference was observed in the control group (z = -0.120, p = 0.90 and r = 0.05).ConclusionForum Play as a method of participatory intervention has the potential to enhance positive perception and behavioral change among care providers towards respectful maternity care. Scaling up the Forum Play intervention and systematically exploring women's experiences are essential to determine its actual effectiveness.

Nepal faces many natural hazards, including floods, landslides, earthquakes, and extreme weather, which severely impact infrastructure, public health, and community resilience. In 2025, we conducted a formative stakeholder and community engagement exercise to inform research on strengthening local preparedness. This included consultative meetings with national agencies, local government, and community members in two hazard-affected municipalities. Field notes from the meetings were thematically analysed to identify priority themes. Findings indicated that national legal and policy frameworks exist, but implementation at municipal and ward levels remains inconsistent and hindered by limited institutional capacity. Local actions were largely focused on relief and reconstruction rather than preparedness and risk reduction. Community members and local officials described limited awareness of preventive strategies but strong willingness to engage in preparedness planning. Stakeholders identified priorities including improved coordination, legal literacy, locally tailored early-warning communication, and better data systems. These findings will inform co-development of a practical preparedness resource.

Introduction: Metalcraft is a centuries-old tradition in Lalitpur, Nepal. Workers are exposed to various ergonomic and respiratory risks due to prolonged exposure to metal dust, fumes, and repetitive physical tasks. The present study aims to assess the pulmonary function and musculoskeletal complaints among metal craftsmen, particularly involved in making sculptors . Methods: A pilot cross-sectional study was conducted among 30 metal craftsmen purposively selected in Lalitpur Metropolitan City ward no. 6 and 17. Pulmonary Function Tests (PFT) were performed using a digital spirometer. Musculoskeletal discomfort was assessed using the standardized Nordic Musculoskeletal Questionnaire. Results: 46.6% of metal craftsmen showed signs of respiratory disorders. Significant differences were found in % Predicted FEV1 and FEV1/FVC ratios (p < 0.05) between the different types of work in which metal craftsmen were involved. Lower back discomfort was the most common musculoskeletal complaint, but differences across work types and hours were not statistically significant. Conclusion: Occupational exposure among metal craftsmen may contribute to respiratory impairment. Musculoskeletal issues, although reported, were not significantly associated with work type or duration in this pilot sample. Further research with a larger sample is warranted.

IntroductionUnintentional home injuries are a leading cause of morbidity and mortality among children under five in Nepal, particularly in rural areas. Despite this burden, culturally appropriate community-based prevention strategies remain limited. This study explored community perspectives to inform the design and delivery of a parental education intervention for childhood home injury prevention.MethodsA qualitative study was conducted in Sunkoshi Rural Municipality, Sindhupalchok District, in December 2024. Seven focus group discussions were held with 56 mothers of preschool-aged children, and 11 key informant interviews were conducted with Female Community Health Volunteers (FCHVs), health-facility in-charges, a school health nurse, and local government officials. Data were analysed thematically using NVivo 14, guided by the Health Belief Model.ResultsFive major themes were identified: (1) Perceived household hazards and common child injuries, (2) Behaviours leading to child injuries, (3) Barriers and facilitators for prevention, (4) Prevention and control practices, and (5) Design and delivery of Information, Education and Communication (IEC) materials. Burns and falls were the most frequently reported injuries, often resulting from unsafe cooking areas, open fires, and poor supervision. Barriers to prevention included limited parental awareness, competing household priorities, and unsafe home environments, whereas community cooperation and FCHV support acted as facilitators. Participants favoured simple, visual, and low-cost educational materials, such as posters, flipcharts, and videos, delivered through participatory group discussions led by FCHVs.ConclusionParents and community stakeholders demonstrated strong interest in home injury prevention education. Embedding culturally tailored parental education within existing community health platforms, particularly FCHVs and mothers’ groups, represents a feasible, scalable, and sustainable approach to reducing childhood injuries in rural Nepal.

BACKGROUND:Social norms and gendered power relationships contribute to the acceptability of 'wife abuse' - a common form of domestic violence globally. OBJECTIVES:To estimate the prevalence and overlap of emotional abuse, forced heavy work, and food deprivation during pregnancy and examine their association with women's attitudes accepting of wife abuse in Nepal. METHODS:Baseline data were used from a randomized controlled trial involving pregnant women aged 18 and older attending routine antenatal care at two public hospitals in Nepal between January 2023 and March 2025. Participants completed a color-coded audio computer assisted self-interview. Attitudes toward wife abuse were assessed using 16 items drawn from three existing instruments. Exploratory factor analysis identified three distinct attitudinal factors. The dependent variable was a composite indicator of emotional abuse, forced heavy work, or food deprivation (coded as present if any were reported). Associations between the three attitudinal factors and composite outcome were analyzed using multiple logistic regression, adjusting for relevant sociodemographic variables. RESULTS:Emotional abuse, forced heavy work, or food deprivation was reported by 6.7% of participants. Acceptance of wife abuse for domestic shortcomings (Factor 1) was significantly associated with higher odds of experiencing abuse (aOR [1.75 (1.23-2.50)]. CONCLUSIONS:Pregnant women who endorsed attitudes accepting wife abuse - particularly for perceived domestic shortcomings - had higher odds of experiencing emotional abuse, forced heavy work, or food deprivation. These findings highlight importance of addressing harmful gender norms within households and ensuring antenatal care settings include safe opportunities to identify and support women at risk.

The prevalence of psychosocial risk factors and disability are increasing in Nepal calling for biopsychosocial tools for evaluation of musculoskeletal pain and prediction of risk factors. Örebro Musculoskeletal Screening Questionnaire (OMSQ) is a 21-item tool that is used to identify patients at risk of developing disability from nonspecific musculoskeletal pain conditions. The purpose of this study was to translate OMSQ, validate and test the reliability of the Nepali version of the OMSQ in both the urban and rural population. OMSQ was translated into Nepali according to Beaton and tested for validity and reliability in urban and rural clinics by adult persons with chronic non-specific musculoskeletal pain (n = 147). Internal consistency was calculated by Cronbach’s alpha and test–retest reliability was evaluated by intraclass correlation coefficient, ICC. Responsiveness using a ROC curve was used to estimate sensitivity and specificity to detect a change in OMSQ between the test and retest. Floor and ceiling effects of the OMSQ scores were analyzed. The experience with OMSQ was surveyed with closed- and open-ended questions. The narratives were assessed with categoric content analysis. Meaning and measurement properties of Nepali OMSQ were retained when translated into Nepali and found reliable (ICC > 0.75) and valid for use in both urban and rural settings in Nepal showing high internal consistency (Cronbach’s alpha urban pre-post; 0.790 and 0.768, rural pre-post; 0.827 and 0.783). ROC showed good responsiveness for urban and rural, area under curve (AUC) 0.751 and 0.760 respectively). Total scores were evenly distributed without floor or ceiling effects. In general, OMSQ was considered easy/moderate to understand/complete, though respondents in the rural sample needed more time to complete. Some of the participants had difficulties with long words and understanding of the Likert-scale. OMSQ was successfully translated to Nepali and found to be a reliable and valid instrument for assessing psychosocial parameters associated with nonspecific musculoskeletal pain across diverse settings in Nepal. Not applicable.

Background Injuries cause significant harm and may lead to disability yet are largely preventable. Understanding the epidemiology and determinants of injury in any given context is an essential step towards effective prevention. In Nepal, surveys suggest that injuries on the road, at home and at work are a problem, but in the absence of injury surveillance, robust death registration or police records, the true burden is unclear. For those who are injured, access to prehospital care is variable. Objectives To understand the epidemiology of injuries. To identify potentially modifiable risk factors to inform the development of prevention interventions. To build capacity and capability for injury prevention research. Design Observational, secondary data analysis and qualitative methods were used. We worked with communities, practitioners and stakeholders to identify potential participants, develop study protocols and disseminate findings. Setting Nepal. Participants Patients, communities and road users, health system practitioners and managers, professionals (e.g. police, engineers, journalists) and local and national decision-makers. Main outcome measures Epidemiological evidence of the burden of injuries, evidence to inform future intervention development. Data sources Participants, health services, police and information in the public domain. Review methods Reviews were conducted systematically with evidence synthesised narratively. Results The Nepal Injury Research Centre was established and a cadre of researchers trained. Three researchers and our data manager completed Master’s degree courses, and all researchers developed their skills by leading at least one project from protocol development through to publication. A review of publications reporting injuries indicated that existing epidemiological evidence mostly arose from case series at high risk of bias. A review of existing legislation showed policy gaps and incomplete implementation or enforcement. Surveillance studies and a household survey showed the high burden of injuries at home, at work and on the roads, and the neglected issue of suicide. Previously unreported inequalities by age, sex, ethnic group and income level were identified. Existing health, police and death registration data systems are at high risk of under-reporting and misclassification. Road traffic injury emerged as a major concern: road users fear being injured as pedestrians, passengers or drivers; the economic burden of road injuries has increased threefold over 8 years; and potentially modifiable risk factors were identified. The provision of first-response services is highly variable, and the public and practitioners are fearful of prosecution in the event of poor outcomes. We found it is feasible to train the traffic police in first response and for them to use their skills at traffic collisions. Research priorities for suicide prevention were identified. Limitations Studies were limited by the quality of the data available through existing systems, with data often incomplete or poorly coded. Our studies were largely conducted in one district with topography typical of many areas of Nepal. However, our findings may not be generalisable to all districts. Conclusions Our programme identified the inequitable and significant burden of injuries in Nepal. There is the potential to develop existing legislation and health and transport systems to reduce the incidence and consequences of injury. Future work Research should focus on interventions to reduce injury risk on the roads and at home/work, to develop the first-response system and standardise care and to strengthen injury data systems. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research (GHR) programme as award number 16/137/49.

Introduction: Slaughterhouse workers experience many health risks. Workers have a high prevalence of musculoskeletal disorders (MSD) including the most common discomfort located in the upper body parts. This study aimed to determine the prevalence of MSD and to identify the MSD in relation to age, and work experience amongst workers of a buffalo slaughterhouse in Kathmandu. Methods: A cross-sectional study was conducted in ward number 19 of Kathmandu Municipality from September to October 2023 using a Nordic questionnaire among the workers of twelve buffalo slaughterhouses and included 96 workers by census method. Results: The prevalence of MSD amongst workers of buffalo slaughterhouses was 30.2%. Most common musculoskeletal disorders in workers were in the lower back (14.6%), followed by the shoulder (13.5%), and neck (11.5%). Age group and work experience were strongly associated with musculoskeletal disorder and pain in the lower back, shoulder, neck, hands/wrists, and ankles/feet. Conclusion: The prevalence of musculoskeletal disorders is very common among buffalo slaughterhouse workers. These workers were more susceptible to MSD, so we need to propose appropriate preventative strategies to control and reduce the occurrence of these disorders in workers of the buffalo slaughterhouse.

An increase in life expectancy has raised a concern about whether these extra added years are characterized by good health and independence or health problems and dependency on others for care. Maximum life satisfaction (LS) is necessary to have healthy aging. The current study aimed to analyze the morbidity burden, associated expenditure, and life satisfaction among elderly population. A cross-sectional study was conducted at four different Municipalities of Bhaktapur district from February 1 to Sep 31, 2023 after obtaining ethical approval from Institutional Review Committee. A total sample size was 212 elderly participants above 60 years were included in this study. Stratified sampling method was applied. The questionnaire consisted of: a) socio-demographic b) morbidity and treatment cost c) coping strategy d) life satisfaction (LISAT-11). Descriptive statistics, chi-square (χ2) test, T-test and Anova was applied. This study involved 212 elderly participants (median age 69), primarily female (56.1%) and mostly from privileged ethnic backgrounds (86.8%).This study highlighted gender disparities, income sources, health conditions, and healthcare costs. Chronic conditions were prevalent among females and illiterate individuals. Cardiovascular issues were common. Females used outpatient services more, while males were hospitalized. Health expenses were significant, mainly covered by insurance and personal savings. Life satisfaction varied based on demographics and lifestyle factors.The elderly population bears a burden of morbidity, marked by a notable presence of health conditions and diseases. This burden leads to considerable personal expenses on healthcare services, especially concerning medication costs. Despite the financial pressures from healthcare expenditures, older individuals exhibit diverse degrees of life satisfaction.

Background Road traffic crashes and injuries are increasing in Nepal, and post-crash response services are early in their development. Ambulance services are offered by multiple providers and most of them lack trained emergency medical technicians. Once an ambulance arrives at the hospital, trauma victims are transported to the emergency department. Since emergency departments are busy with dynamic environments, the handover process between prehospital providers and emergency department staff can be challenging. The quality of the handover can have a significant impact on patient outcomes. Objective To understand the current handover practices of road traffic injured (RTI) patients in the emergency departments of tertiary hospitals in Nepal to inform progress to standardising patient care. Methods In order to improve collaboration and communication between hospitals that may manage mass casualties following major incidents and earthquakes, 25 hospitals were identified throughout the country as tertiary centres for trauma care. We invited staff in these hospitals to participate in a survey. An online questionnaire using Microsoft Forms was used to capture information about how they manage the handover of RTI patients between prehospital and in-hospital staff in the emergency department. The survey was circulated through email to the in-charge of the emergency department or their designated deputy. Quantitative data were analysed using descriptive statistics while qualitative data were analysed thematically using NVivo. Results The handover process for RTI patients varied between the hospitals that responded to the survey. No standardised handover process was found. Some of the hospitals either received pre-information but not in any standard way or did not receive any information about the critically injured RTI patients before they arrived. Therefore, the staff at the emergency department in some of the hospitals were not sufficiently prepared. Conclusions The survey findings suggest that the handover of RTI patients in emergency departments may benefit from standardisation. Future work will include interviews with staff and ethnographic observation of the handover of RTI patients in emergency departments to inform the development of a handover protocol and training guide.

Abstract Introduction The current climate change scenario poses significant challenges for mountaineering expeditions. The accelerated melting of glaciers, altered climbing conditions, and changing weather patterns are reshaping the mountaineering process. The changing climate has significantly amplified the hazards linked to climbing, leading to increased frequency and intensity of avalanches and rockfall. The objective of this study was to study the effect of climate change factors on the job of Sherpa mountaineers on expedition to Mount Everest. Materials and Methods A cross-sectional study was conducted among 94 Sherpas residing in the Solukhumbu District, Nepal. Ethical clearance was obtained from the Institutional Review Committee of Kathmandu Medical College. Sherpas who were present for the expedition during the data collection period and gave informed consent were included in the study. Similarly, secondary data on climate change-related events in the Everest region were analyzed. Results Approximately forty three percent (42.6%) of respondents experienced different incidents during expeditions; 33% had encountered avalanches, 14.9% had fallen from cliffs or paths, and 12.6% had fallen into crevasses. Sixteen percent of participants encountered the death of family members, 69.1% experienced the loss of colleagues from their team, and 21.3% encountered the death of clients during expeditions. Conclusion The study highlights the multifaceted OSH challenges related to climate change faced by Sherpas guiding summit expeditions on Mount Everest. Their need for targeted interventions is evident and to ensure their well-being, a comprehensive approach encompassing health education, psychological support, and improved safety practices is essential.

Background Road traffic injuries are a major global public health problem despite being avoidable and preventable. In many low- and middle-income countries, the victims of road traffic crashes do not receive care at the scene and may die before reaching hospital. In low- and middle-income countries where prehospital emergency medical services are not well established, bystanders have the potential to save lives by providing first aid. Nepal has rising rates of road traffic injuries and emergency medical services are early in development. There is limited evidence on the factors that influence people in Nepal to become trained in first aid and to use their first aid skills. Objectives To understand the barriers and facilitators to learning first aid and to applying those skills to help road traffic crash victims in Nepal. Design Qualitative study using semistructured interviews. Setting Kathmandu, Lalitpur, Bhaktapur, Kaski and Makwanpur districts in Nepal. Participants We interviewed three groups of participants: (1) members of the public who had never been trained in first aid, (2) members of the public who had been trained in first aid and (3) first aid trainers. Data sources Interviews explored reasons why people may be interested in being trained and factors that would inhibit being trained or applying their first aid skills. Interviews were transcribed, translated into English and analysed thematically. Results Respect from the public, a desire to help those in need and confidence to apply skills were important factors in encouraging people to learn and apply first aid. Barriers included lack of time and financial implications of providing first aid. The fear of social and legal consequences if the patient had a poor outcome, a lack of confidence to apply skills and lack of trust shown to first aiders by some members of the community discouraged learning and using first aid skills. Limitations Participants were mostly from urban and semiurban areas. People with more difficult access to health care may have held different views. People who were untrained in first aid and agreed to participate may hold different views to those who were not recruited, as they had interest in the topic. Conclusions Members of the public can be encouraged to learn and apply first aid skills to help road traffic crash victims, but there are multiple barriers to engagement in first aid. Providing legal protection from prosecution for first aiders, raising public awareness of the value of first aid, addressing financial constraints and provision of refresher training may address these barriers. Future work Research to address the barriers to the creation of a Good Samaritan law appears warranted. The perspectives of other groups often involved in the care and/or transport of road traffic crash victims, such as taxi drivers, would add to our understanding of factors affecting the application of first aid. The gendered stereotypes reported by female first aiders warrant further exploration. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/49.

This study culturally adapted and validated a Nepalese version of the Abuse Assessment Screen (AAS) tool for identifying domestic violence among pregnant women in Nepal, creating the Nepalese Abuse Assessment Screen (N-AAS). International and national topic experts reviewed the initial N-AAS version using the Delphi method, and pregnant women participated in cognitive interviews, providing feedback on the N-AAS as user experts. Subsequent pre-testing of a comprehensive questionnaire, which included the translated version of the N-AAS, occurred in two tertiary care hospitals using an electronic format known as Color-Coded Audio Computer-Assisted Self-Interview (C-ACASI). The study assessed the content validity index, compared the concurrent validity of the N-AAS with the gold standard interview, estimated the prevalence of domestic violence from two hospitals, and calculated the Kappa coefficient. The reliability of the entire questionnaire was also evaluated through a test-retest analysis, with content validity rated as "good to excellent" by topic and user experts and high test-retest reliability (91.2-98.9%), indicating consistency across questionnaires completed at two different time points, with 12% of participants reporting any form of violence. The N-AAS demonstrated ≥91.7% specificity for all forms of abuse, accurately identifying non-abuse cases. In addition, moderate to excellent sensitivity was observed for emotional abuse (52.5%) and physical abuse since marriage (50%), while sensitivity for physical abuse in the past 12 months was 100%. Thus, the N-AAS demonstrated reliable test-retest results with a good Kappa coefficient and specificity, as well as showing excellent sensitivity for detecting recent physical abuse and moderate sensitivity for detecting emotional abuse and physical abuse since marriage. Because cultural context often leads women to normalize and tolerate abuse from spouses and family members and women are thus reluctant to report abuse, the results imply that the N-AAS can serve as a valuable screening tool for domestic abuse in antenatal care settings in Nepal.

Background Road traffic injuries are the 12th leading cause of mortality globally. Nepal, one of the least developed countries in the world, has a rapidly rising rate of road traffic-related morbidity and mortality. There is incomplete reporting of traffic crashes in Nepal in the last three World Health Organization global status reports on road safety. Together with poor-quality coding of crashes, essential information to inform prevention interventions or make international comparisons is lacking. Objectives The study aimed to critically analyse routinely collected traffic police data in Makwanpur district, Nepal, to identify the road user groups most likely to be involved and injured in traffic crashes in this part of the country. Design Secondary data analysis. Setting Makwanpur district, Nepal. Data sources Road traffic crash records from the District Traffic Police Office, Makwanpur, over 2 years (April 2017–March 2018 and May 2019–April 2020). Data were extracted from paper-based records onto an electronic database, and the data were analysed descriptively using the Statistical Package for the Social Sciences version 24.0 (IBM Corporation, USA). Results There were 291 crashes recorded in 2017–8 and 435 crashes in 2019–20. Two-wheeled vehicles (motorcycles/scooters) were the most frequently involved in police-reported crashes (35.5%). For most crashes (419/726, 58%), no cause was documented in the police record. Road users involved in crashes were mostly riders or passengers of motorised two-/three-wheelers (33.4%), four-wheeled vehicles (19.9%) or buses (16.7%). Of fatal injuries, 31.2% were riders or passengers of motorised two-/three-wheelers, and 24.8% were pedestrians. Limitations The data used represent crashes reported to the traffic police and therefore underestimate the true number of crashes and injuries. At the end of the second period of study, local movement restrictions associated with the COVID-19 pandemic lockdown limited the traffic on the roads, resulting in fewer crashes in March and April 2020. In most crash records, there were missing data, limiting the ability to determine contributory factors with confidence. Conclusion This study contributes to the evidence gap by describing crashes and mortality data by vehicle type and road user category. The findings suggest that the number and rates of crashes may be increasing over time. Action to improve the quality and completeness of data routinely collected by the traffic police is needed; a piloted web-based Road Accident Information Management System has the potential to support improved routine data collection. Future work The data indicate crashes occurring in one district over 2 years. To better understand the apparent increase in crashes, an analysis over a longer period, and over multiple districts, would be necessary. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/49.

Research suggests that the built environment and transport services affect the health and well-being of people with a disability. In Nepal, there is limited evidence describing the safety of road users in transport environments. The perceptions of safety in people with a disability while travelling across urban centres in Nepal is unknown. We explored the experiences of people with a disability regarding their mobility and identified facilitators and barriers to achieving safe and inclusive travel in Kathmandu. We used video-elicitation interviews with seven people with a disability and interviewed five advocacy practitioners and five decision-makers. All participants considered poor road conditions and transport infrastructure, and drivers' speeding behaviour hindered their ability to travel safely. The absence of coordination between government agencies and disability-friendly infrastructure standards was the major reason impeding inclusive and safe travel. Our study suggests that the key issue to be addressed is the implementation of existing policies. This study explored the views of people with a disability, advocacy practitioners, and decision-makers regarding the safety of road environments in Kathmandu, and the actions that could improve safety for all road users.We used video footage, filmed by people with a disability, to enable them, and advocacy practitioners and decision-makers to engage on the topic.Traffic and the physical road environment, the behaviours of drivers, and street vendors hindered mobility and increased the risk of injuries for people with disability.Implementing/enforcing existing policies would be the first step to make the road environments safer-and more inclusive-for all road users.

BACKGROUND:Police road crash and injury data in low-income and middle-income countries are known to under-report crashes, fatalities and injuries, especially for vulnerable road users. Local record keepers, who are members of the public, can be engaged to provide an additional source of crash and injury data. METHODS:This paper compares the application of a local record keeper method to capture road crash and injury data in Bangladesh and Nepal, assesses the quality of the data collected and evaluates the replicability and value of the methodology using a framework developed to evaluate the impact of being a local record keeper. OUTCOME:Application in research studies in both Bangladesh and Nepal found the local record keeper methodology provided high-quality and complete data compared with local police records. The methodology was flexible enough to adapt to project and context differences. The evaluation framework enabled the identification of the challenges and unexpected benefits realised in each study. This led to the development of an 11-step process for conducting road crash data collection using local record keepers, which is presented to facilitate replication in other settings. CONCLUSION:Data collected by local record keepers are a flexible and replicable method to understand the strengths and limitations of existing police data, adding to the evidence base and informing local and national decision-making. The method may create additional benefits for data collectors and communities, help design and assess road safety interventions and support advocacy for improved routine police data.

Background The built environment and transport services can affect the health and well-being of people with a disability. Improving road safety while ensuring the needs of those most exposed to injury are met is fundamental to achieving Sustainable Development Goal 11.2. Research regarding mobility among people with disability is growing. However, there is little evidence to understand their experiences in the road environment including in Nepal. Objective To explore the safety of road environments in Kathmandu, Nepal, for people with disability, and the potential actions that could improve safety. Methods Using participatory research techniques, a qualitative study was conducted in Kathmandu, to interview three groups of participants: people with a disability with or without the support of a caregiver, advocacy practitioners and decision-makers. Participants with a disability were offered the opportunity to use a body-worn camera to record and capture elements of their journeys in urban road environments which they considered relevant to the research topic. These participants were then asked to describe their journey experiences narratively during a semi-structured interview. Anonymised extracts of the material generated by people with disability were presented to the advocates and decision-makers during their interviews, to engage them with specific local examples of the issues, and to gather their perspectives on barriers and facilitators to change. Interviews were transcribed, translated and analysed thematically. Results Seven participants with a disability, five advocacy practitioners and five decision-makers took part in the study. All participants considered traffic and the physical road environment, together with the behaviours of drivers and street vendors, impeded mobility and increased the risk of injuries for people with a disability. The absence of coordination between government agencies and disability-friendly infrastructure standards were major reasons impeding inclusive and safe travel. Conclusions Multiple factors make travel difficult and dangerous for people with disabilities in Kathmandu. Enforcing existing policies and laws would start to address the concerns raised by participants to make the road environments safer - and more inclusive - for all road users.