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COMMUNITY MEDICINE IV: APPLIED EPIDEMIOLOGY

Comprehensive Exam-Ready Study Notes — Nepal NCD & CD Programmes

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PREFACE: STRUCTURAL FRAMEWORK

• Technical Package (TP): A named, ready-to-implement bundle of interventions (e.g., HEARTS, mhGAP, MPOWER). Has an acronym. Has specific components.
• Strategy/Roadmap/Action Plan: A broader policy document setting targets and approaches (e.g., End TB Strategy, NCD Action Plan 2013-2030). Does NOT implement directly.

• Pre-May 2026: MoHP (Ministry of Health and Population)
• Post-13 May 2026: MoHFS (Ministry of Health and Food Safety)
• EDCD, DoHS, NCASC: Unchanged — remain under MoHFS

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REGIONAL ARCHITECTURE: WHO SEARO (Nepal's Region)

• 11 Member States — Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste
• Indonesia moved from WPRO to SEARO — that is INCORRECT. Indonesia is WPRO. SEARO has 11 Member States including Indonesia is wrong — Indonesia has ALWAYS been WPRO.

1. TB control
2. Maternal and child health / RMNCAH
3. NCDs and mental health
4. MNCH (Flagship #4)
5. UHC and health systems strengthening
6. AMR
7. Health security / IHR / Zoonoses
8. NTDs / Leprosy / LF

1. Mental health (most emphasized theme — Pillar R1)
2. Primary health care
3. Health security and AMR
4. Equity and social determinants
5. Data, digital health, and innovation

• Launched: 7 April 2026 (World Health Day 2026)
• Published by WHO SEARO (ISBN: 978-92-9-022262-0)
• Tag line: "Rooted in partnership, growing through challenge"
• Definition: A country-focused path to protect recent public health gains while responding to emerging challenges
• 4 Priorities: (1) Primary health care, (2) Disease elimination, (3) Health security, (4) NCDs and mental health
• 4 Accelerators: (1) Integrated health system delivery — shifting from programme silos to connected systems across surveillance, laboratories, service delivery, supply chains, and emergency response; (2) Focused priorities and tailored country support guided by subnational data; (3) Scaling access to medical countermeasures and strengthening ecosystems for innovation, digital health, and AI; (4) Regional partnership platforms
• Note: The Banyan framework replaces the previous biennial work programme for SEARO; it is a framework, not a technical package
• RC77 (October 2024): Revised Measles-Rubella elimination target from 2023 → 2026
• Global Leprosy Programme HQ = SEARO (not Geneva)

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PART A: NON-COMMUNICABLE DISEASES (Group II)

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CROSS-CUTTING: WHO NCD Best Buys

• Asthma and COPD management
• Rheumatic fever secondary prevention
• Cervical, breast, colorectal, liver, and childhood cancer interventions
• Optimal breastfeeding (also under Nutrition)

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A1. CARDIOVASCULAR DISEASE AND STROKE

Global

• WHO Global NCD Action Plan 2013-2030: "25x25" target — 25% relative reduction in premature NCD mortality by 2025; updated SDG target = one-third reduction by 2030
• Technical Package: HEARTS (Healthy-lifestyle counselling, Evidence-based treatment protocols, Access to essential medicines, Risk-based CVD management, Team-based care, Systems for monitoring) — flagship TP for hypertension and CVD risk management in primary care
• Technical Package: PEN — broader NCD package that includes CVD, diabetes, CRD at first-level health facilities

Regional (SEARO)

• Flagship Priority Area #3: NCDs and mental health
• SEARO NCD Roadmap 2022-2030
• SEAR Region has reduced 30-70 premature NCD mortality from 23.4% to 21.6% (2010-2019)
• Banyan Framework Priority #4: NCDs and mental health

Nepal/National

• Transition: From MSAP 2021-2025 (MoHP) → Draft MSAP 2026-2030 (MoHFS)
• MSAP 2026-2030 Target: 30% reduction in overall premature mortality from CVD, cancer, diabetes, and chronic respiratory diseases by 2030
• Vision: NCD-free, healthy, and productive citizens
• Mission: Improve quality of life by reducing morbidity and premature mortality caused by NCDs
• Goal: Reduce burden of NCDs adopting "Health in All Policies" approach
• 4 Strategic Pillars under MSAP 2026-2030 (governance/multisectoral; prevention and promotion; health services; surveillance/M&E)
• PEN being implemented at health posts and PHCCs — screening, diagnosis, treatment, referral
• STEPS Survey — WHO STEPwise surveillance for NCD risk factors
• NCD & Mental Health Section under EDCD (MoHFS) — focal point
• National Hypertension Programme; community health workers for BP screening

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A2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ASTHMA

Global

• GARD (Global Alliance against Chronic Respiratory Diseases) — WHO platform; not a TP
• No dedicated TP for COPD/asthma (added to Best Buys at WHA76, 2023)
• GINA (Global Initiative for Asthma) and GOLD (Global Initiative for COPD) — clinical guidelines, not WHO TPs

Regional (SEARO)

• Folded into Flagship #3 (NCDs and mental health)
• No dedicated SEARO respiratory programme vertical

Nepal/National

• No separate vertical programme for COPD/asthma
• Managed under MSAP 2026-2030 and PEN at primary care level
• Risk factors addressed: Tobacco (MPOWER interventions), indoor air pollution (cook-stoves), outdoor air pollution
• CLINICAL NOTE: Addressed under STEPS surveillance as comorbidity

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A3. PEPTIC ULCER DISEASE

All Tiers

• No dedicated Technical Package at any tier (global, regional, or national)
• No specific vertical programme
• Managed clinically; H. pylori eradication included in treatment guidelines
• Relevant surveillance: STEPS Survey captures GI symptoms; addressed under clinical management protocols at hospitals
• Exam note: Do not fabricate a TP. If asked about PUD at programme level — there is none.

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A4. CANCER

Global

• No single TP for all cancers
• Cervical Cancer Elimination Initiative: "90-70-90" target by 2030 — 90% of girls vaccinated (HPV), 70% of women screened, 90% of women with detected disease treated
• Global Breast Cancer Initiative (GBCI): 2.5% annual reduction in age-standardized mortality
• WHA76 (2023) added cervical, breast, colorectal, liver, and childhood cancer interventions to Best Buys
• WHO IIARC (International Agency for Research on Cancer) — global cancer data and research

Regional (SEARO)

• Flagship #3: NCDs and mental health
• Bhutan honoured at RC77 (2024) and 2025 as regional benchmark for cervical cancer elimination progress
• No separate SEARO cancer TP

Nepal/National

• Nepal Cancer Control Strategy 2024-2030 (MoHFS)
• National Cancer Registry: Operated from B.P. Koirala Memorial Cancer Hospital, Bharatpur; currently 12 hospital-based registries across Nepal
• HPV vaccine: School-based, targeting girls aged 10 years (Grade 4-5); incorporated into Nepal's National Immunization Programme (NIP)
• Cervical Cancer Screening: VIA (Visual Inspection with Acetic Acid) at health posts
• National Cancer Control Committee

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A5. MENTAL HEALTH, SUBSTANCE USE, AND SUICIDE PREVENTION

Global

• WHO Mental Health Action Plan 2013-2030: Universal health coverage, human rights-based approach; target: 80% of countries with national MH policy
• Technical Package: mhGAP (Mental Health Gap Action Programme) — priority conditions: depression, psychosis, epilepsy, dementia, developmental disorders, substance use disorders, suicide; for use in non-specialized settings / primary care
• Technical Package: LIVE LIFE (suicide prevention): 4 evidence-based strategies: (1) Limit access to means; (2) Interact with media for responsible reporting; (3) Develop life skills in adolescents; (4) Early identification, assessment, management, and follow-up
• Technical Package: SAFER (also for harmful alcohol — a major contributor to suicide/self-harm)
• Nepal is in WHO Special Initiative for Mental Health (2019-2023, extended)

Regional (SEARO)

• SEARO Mental Health Action Plan 2023-2030
• Pillar R1 (Pillar 1) of Regional Roadmap for Results and Resilience 2024-2029 — mental health is the most emphasized theme
• Banyan Framework Priority #4: NCDs AND mental health (paired)

Nepal/National

• National Mental Health Strategy 2026-2030: Under formulation; consultative workshop held 12 April 2026 (WHO Nepal confirmed)
• Previous framework: Mental Health Policy 1996; National Mental Health Policy 2021
• National Suicide Helpline: 1166 (MoHFS/EDCD)
• National Mental Health Campaign: December 2025 — mass awareness campaign
• mhGAP training for primary care health workers in districts
• NCD & Mental Health Section, EDCD — focal point under MoHFS
• Treatment gap remains large; scaling to all 77 districts is target

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A6. ROAD TRAFFIC, INJURIES, VIOLENCE, AND OCCUPATIONAL HEALTH

Global

• Technical Package: Save LIVES — A Road Safety Technical Package (pillars: Speed management, Leadership, Infrastructure design and improvement, Vehicle safety standards, Enforcement of traffic laws, post-crash Survival):
  • S — Speed management
  • A — Leadership
  • V — Vehicle safety standards
  • E — Enforcement of traffic laws
  • S — post-crash Survival
  ⚠️ CRITICAL EXAM TRAP: "Save LIVES" has two unrelated documents:
  1. "Save LIVES: A Road Safety Technical Package" (WHO) — road safety
  2. "SAVE LIVES: Clean Care is Safer Care" (WHO) — hand hygiene / infection prevention These are COMPLETELY different documents. Never conflate them.
• Technical Package: INSPIRE — 7 strategies to prevent violence against children: (I) Implementation of laws; (N) Norms and values; (S) Safe environments; (P) Parent and caregiver support; (I) Income and economic strengthening; (R) Response/support services; (E) Education and life skills
• Technical Package: RESPECT Women — 6 strategies to prevent violence against women (Relationship skills; Empowerment of women; Services ensured; Poverty reduced; Environments made safe; Child and adolescent development supported; Transform attitudes)
• UN Decade of Action for Road Safety 2021-2030: Target — prevent at least 50% of road traffic deaths and injuries by 2030

Regional (SEARO)

• Road safety not a SEARO flagship (falls under UN ESCAP framework for Asia-Pacific)
• No dedicated SEARO road safety technical package

Nepal/National

• Nepal Road Safety Action Plan 2021-2030 (draft)
• National Road Safety Council (NRSC) — multi-sectoral coordination body
• National Road Safety Policy 2081 BS (draft)
• National Strategy on Violence, Injuries, and Disabilities (MoHFS)
• Child violence: INSPIRE framework applicable; implementation nascent
• VAW: RESPECT Women framework; national policies via Ministry of Women, Children and Senior Citizens

Occupational Health - EXPLICIT GAP

• No dedicated Technical Package at global, regional, or national tier for occupational health (as a programmatic vertical)
• WHO has a Global Plan of Action on Workers' Health 2008-2017 (expired) — no current replacement TP
• In Nepal: No operational occupational health vertical programme
• This is a genuine, citable gap in Nepal's public health architecture. If asked in exam — state clearly: no TP, no national occupational health programme, gap acknowledged in NHSSP 2023-2030.

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A7. NUTRITIONAL DEFICIENCIES (ANAEMIA, IDD, VAD)

Global

• WHO Global Nutrition Targets 2025: 6 targets (stunting, anaemia, low birthweight, childhood overweight, breastfeeding, wasting)
• BFHI (Baby-Friendly Hospital Initiative) — for breastfeeding promotion; not a disease-specific TP
• Optimal breastfeeding added to Best Buys at WHA76 (2023)
• No single TP for anaemia/IDD/VAD — addressed through multiple vertical strategies

Regional (SEARO)

• Under Flagship #4 (MNCH/Reproductive and Child Health)
• Regional nutrition strategy integrates with RMNCAH framework

Nepal/National

• MSNP III (Multisectoral Nutrition Plan 2023-2030) — overarching nutrition plan; MoHFS + multi-ministry
• Anaemia Control:
  • Iron-Folic Acid (IFA) supplementation — pregnant women (daily), adolescent girls (weekly)
  • Anaemia Control Plan (MoHFS/FHD)
  • Blood transfusion services; clinical management
• IDD (Iodine Deficiency Disorders):
  • Universal Salt Iodization (USI) — policy under Ministry of Industry
  • 2nd National Action Plan for IDD (MoHFS)
  • Monitoring via urinary iodine excretion surveys
• VAD (Vitamin A Deficiency):
  • Biannual Vitamin A supplementation (6-59 months) with deworming (12-59 months)
  • "Vitamin A Plus Programme" — nationally coordinated, twice yearly
  • Helen Keller International as key partner
• LIVE 2026 NOTE: As of June 2026, MoHFS is requesting donor top-ups from UNICEF, FHI 360, Helen Keller International, World Vision, and Care Nepal for Vitamin A and micronutrient supplements amid funding gaps

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A8. ARSENICOSIS

Global

• WHO Arsenic Guideline: 10 µg/L as safe drinking water threshold
• No dedicated TP for arsenicosis — addressed via water quality guidelines and WASH
• IARC classifies inorganic arsenic as Group 1 carcinogen

Regional (SEARO)

• No dedicated SEARO programme for arsenicosis
• Primarily a South Asian geological issue (Bengal Basin, Terai formations) — shared with Bangladesh, India, Myanmar

Nepal/National

• Nepal interim guideline: 50 µg/L (2001 interim standard; higher than WHO guideline due to feasibility constraints)
• Arsenic Steering Committee — multi-ministry coordination
• DWSSM (Department of Water Supply and Sewerage Management) — implementing agency
• Mitigation: Biosand filters, Gagri filters, community-based arsenic removal units — mainly in Terai districts
• Surveillance: Arsenic mapping of affected VDCs/municipalities (Terai belt)
• Health management: no antidote; treatment = remove from exposure, symptomatic management of skin lesions / cancers

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PART B: COMMUNICABLE DISEASES (Group I)

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B1-A. BACTERIAL INFECTIONS

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B1.1 CHOLERA

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B1.2 ENTERIC FEVER (TYPHOID)

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B1.3 BRUCELLOSIS

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B1.4 ANTIMICROBIAL RESISTANCE (AMR)

Global

• WHO Global Action Plan on AMR (2015): 5 objectives (awareness, surveillance, infection prevention, optimizing antimicrobial use, sustainable investment)
• Technical Package: AWaRe (Access, Watch, Reserve) — antibiotic classification system + AWaRe antibiotic book (2022) — prescribing guidance for clinical syndromes; a TP not just a classification
• Technical Package: GLASS (Global Antimicrobial Resistance and Use Surveillance System) — standardized AMR surveillance across countries; tracks priority pathogens
• ⚠️ EXAM TRAP: Jaipur Declaration on AMR (2011) — SEARO ministerial commitment — predates the Global Action Plan (2015); it is regional and was a political declaration, NOT a technical package
• AWaRe ≠ GLASS: AWaRe = prescribing guidance/classification; GLASS = surveillance system

Regional (SEARO)

• Flagship #6: AMR
• SEARO AMR Regional Roadmap 2025-2030
• Jaipur Declaration 2011 remains a landmark regional political document

Nepal/National

• National Action Plan on AMR (NAPAMR) 2024-2028 — under One Health approach; developed by MoHFS with WHO support
• NATG 2023 (Nepal Antibiotic Treatment Guidelines 2023) — practical prescribing reference
• Antimicrobial Stewardship Programme (AMSP):
  • Orientation workshop held: February 2026
  • National guideline being finalized (as of July 2026)
  • Implementation in public hospitals being rolled out
• GLASS reporting: Nepal participating in surveillance
• AMR Learning Resource Package — developed jointly by MoHP/WHO

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B1.5 BACTERIAL MENINGITIS

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B1.6 ARI / PNEUMONIA (BACTERIAL — STREPTOCOCCAL)

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B1.7 TUBERCULOSIS

Global

• CURRENT STRATEGY: End TB Strategy (adopted by WHO 2014; WHA endorsed 2014)
  • 3 Pillars:
    1. Integrated, patient-centred care and prevention
    2. Bold policies and supportive systems
    3. Intensified research and innovation
  • Targets by 2030: 90% reduction in TB incidence and 95% reduction in TB deaths (vs. 2015 baseline); zero catastrophic costs
  • CRITICAL EXAM TRAP: DOTS (Directly Observed Treatment, Short-course) is the historical backbone of TB control but is NOT the current strategy — it is embedded within the End TB Strategy's first pillar. Never cite DOTS as the current global strategy.

Regional (SEARO)

• Flagship #1: TB control (highest priority flagship)
• SEAR carries approximately 45% of global TB incidence and >50% of global TB deaths
• Countries in SEAR with high TB burden: India, Indonesia, Bangladesh, Myanmar, Nepal
• SEARO has its own regional roadmap aligning with End TB

Nepal/National

• National TB Strategic Plan (NTSP) 2021/22-2025/26 (MoHP/NTCC) — current plan
• Status (March 2026): Nepal is off-track on TB targets — incidence and mortality reductions are behind schedule
• TB-Free Nepal Declaration — political commitment
• NSP TB 2026-2031: Currently being drafted (to replace expiring plan)
• NTCC (National Tuberculosis Control Centre) — NTP focal point under MoHFS
• NATA (National Anti-Tuberculosis Association of Nepal) — community DOTS partner NGO
• Key strategies: Universal Drug Susceptibility Testing; Shorter Treatment Regimens; TB-Preventive Therapy; Nutrition support (Ankurit programme)

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B1.8 HIV/STIs

Global

• UNAIDS Global AIDS Strategy 2021-2026: Fast-Track targets — 95-95-95 (95% PLHIV know status, 95% on treatment, 95% virally suppressed)
• "Treat All" policy: All PLHIV treated regardless of CD4 count
• Triple Elimination: Elimination of mother-to-child transmission of HIV + Congenital Syphilis + Perinatal Hepatitis B

Regional (SEARO)

• EMTCT (Elimination of Mother-to-Child Transmission) validations: Thailand (2016) and Sri Lanka (2016) validated; Maldives applying for perinatal HepB elimination 2025
• Regional integration of PMTCT + EMTCT services

Nepal/National

• National HIV Strategic Plan (NHSP) 2021-2026 (MoHFS/NCASC)
• Target: 95-95-95 by 2026
• Estimated PLHIV: approximately 30,300 (NCASC 2023 estimates)
• Key populations: people who inject drugs (PWID), migrant workers, female sex workers, MSM
• NHSP 2026-2031: Currently being drafted
• Global Fund grant (Feb 2025-Jul 2027): USD 51.27 million for HIV, TB, and Malaria
• NCASC (National Centre for AIDS and STD Control) — unchanged under MoHFS
• ART centres; free ARV; PMTCT in all delivery facilities
• STI syndromic management (national guidelines, NCASC)
• One Stop Crisis Management Centres (OCMC) — for GBV/sexual violence, not STIs per se

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B1.9 SUB-GROUP II BACTERIAL ZOONOSES (Plague, Tularaemia, Anthrax, Relapsing Fevers, Leptospirosis, Typhus, LGV)

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B2. VIRAL INFECTIONS (Group I-B)

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B2.1 CHICKENPOX / HERPES ZOSTER

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B2.2 MEASLES AND RUBELLA

Global

• Measles and Rubella Framework 2021-2030 (Measles and Rubella Partnership): "Leave no one behind" — achieve measles elimination in ≥5 WHO regions; reduce measles and rubella incidence to <1 case/million

Regional (SEARO) - EXAM CRITICAL

• ⚠️ EXAM TRAP: The target revision for SEARO Measles-Rubella elimination is a SEARO Regional Committee decision, NOT a global target change
• RC77 (October 2024): SEARO revised MR elimination target from 2023 → 2026
• History of target revisions: Original 2020 → revised to 2023 (RC) → revised again to 2026 (RC77, 2024)

Nepal/National

• MR vaccine at 9 months and 15 months (within NIP)
• Periodic supplementary immunization activities (campaigns) for zero-dose/under-dose children
• VPD surveillance (EDCD/NPHL)
• Nepal has not achieved measles elimination yet; outbreaks documented in underimmunized communities

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B2.3 INFLUENZA

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B2.4 POLIO

Global

• GPEI (Global Polio Eradication Initiative): bOPV (Bivalent Oral Poliovirus Vaccine, types 1 and 3) + IPV (Inactivated Poliovirus Vaccine, at least one dose) in all schedules; target = complete eradication

Regional (SEARO)

• Entire SEAR certified polio-free in 2014 (certification awarded March 2014) — major regional achievement

Nepal/National

• Nepal polio-free since 2010 (last indigenous case)
• bOPV at 6, 10, 14 weeks + IPV at 14 weeks in NIP
• AFP (Acute Flaccid Paralysis) surveillance continues

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B2.5 RABIES

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B2.6 MUMPS

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B2.7 VIRAL GASTROENTERITIS (ROTAVIRUS)

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B2.8 JAPANESE ENCEPHALITIS

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B2.9 DENGUE

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B2.10 VIRAL HEPATITIS (A-E)

Global

• WHO Global Health Sector Strategy on Viral Hepatitis 2022-2030: Target = eliminate hepatitis B and C as public health threats by 2030 (90% reduction in incidence, 65% reduction in deaths)
• Triple Elimination Package: Elimination of MTCT of HIV + Syphilis + Hepatitis B (integrated service delivery)
• Hepatitis A and E: No vaccines in universal schedule (HepA available; HepE vaccine available in China only)

Regional (SEARO)

• EMTCT validations include HepB (Maldives applying 2025)
• HepB birth-dose focus for PMTCT-B

Nepal/National (HIGH YIELD)

• National Strategy for Viral Hepatitis B and C 2023-2030 — Nepal's FIRST dedicated strategic document for viral hepatitis
• Targets: 90% reduction in new cases of chronic HepB and C; 65% reduction in deaths by 2030
• Strategic priorities: scale up diagnosis, link to care, eliminate MTCT of HepB, harm reduction for PWID
• HepB birth-dose (within 24 hours of birth) + Pentavalent vaccine (at 6, 10, 14 weeks) in NIP
• An estimated 115,179 people with chronic hepatitis C — only 18% diagnosed, 1% treated (major care cascade gap)
• Integration with EMTCT and HIV programmes (NCASC/MoHFS)

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B2.11 SUB-GROUP II VIRAL (Smallpox, FMD)

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B3. PROTOZOAL INFECTIONS (Group I-C)

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B3.1 MALARIA

Global

• WHO Global Technical Strategy for Malaria 2016-2030 (GTS): Targets = 90% reduction in malaria case incidence and mortality by 2030 (vs. 2015 baseline); 40% of countries with malaria to achieve zero indigenous cases
• Technical Package: T3 — Test, Treat, Track (universally test suspected cases; treat promptly with artemisinin-based combination therapy; track cases, deaths, and interventions)
• GVCR 2017-2030 — vector control component
• RTS,S/AS01 (Mosquirix) and R21 vaccine: WHO-recommended malaria vaccines (sub-Saharan Africa primary rollout)

Regional (SEARO)

• APLMA (Asia Pacific Leaders Malaria Alliance) — political platform
• APMEN (Asia Pacific Malaria Elimination Network) — technical network
• Regional target: Malaria-free Asia-Pacific by 2030
• Nepal-India cross-border malaria collaboration (MOU September 2023) — migratory workforce linkage

Nepal/National (CRITICAL TRAP)

• ⚠️ EXAM TRAP: Nepal's 2026 malaria elimination target was OFFICIALLY MISSED. Revised target: 2030
• Previous national target: "Malaria-Free Nepal by 2026" (NMSP 2014-2025)
• Current strategy: Working toward 2030 elimination
• VBDRTC (Vector-Borne Disease Research and Training Centre), Hetauda — national malaria/VBDRC reference centre
• Interventions: IRS (Indoor Residual Spraying); LLIN (Long-Lasting Insecticidal Nets); RDT (Rapid Diagnostic Test); ACT treatment; case tracking
• Malaria mostly confined to Terai; <1000 cases/year; imported cases from India major challenge
• Global Fund support: USD 51.27 million grant (includes malaria component)

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B3.2 KALA-AZAR (VISCERAL LEISHMANIASIS / VL)

Global

• GVCR + NTD Roadmap 2021-2030: Targets for VL elimination
• WHO Leishmaniasis Control Programme

Regional (SEARO) - EXAM CRITICAL

• 2005 Tripartite Regional Initiative: Bangladesh + India + Nepal — working toward elimination of VL as public health problem (target: <1 case/10,000 population at district/sub-district level)
• Treatment guidelines revised: 2010 → 2014 → 2016 (updated protocols)

Nepal/National (EXAM TRAP)

• ⚠️ EXAM TRAP: India achieved VL elimination (2023); Nepal has NOT yet achieved elimination
• Nepal target: Reach elimination threshold in all endemic districts
• Endemic districts: Terai (mainly eastern Terai — Sarlahi, Dhanusha, Mahottari, Rautahat, Sindhuli)
• Treatment: Miltefosine (oral) / Liposomal Amphotericin B; IRS for vector (sandfly) control
• EDCD NTD & Vector Borne Disease Control Section

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B3.3 AMOEBIASIS AND GIARDIASIS

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B3.4 TRICHOMONIASIS

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B3.5 VECTOR CONTROL

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B3.6 SUB-GROUP II PROTOZOAL (Toxoplasmosis, Trypanosomiasis, Cryptosporidiosis)

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B4. HELMINTHIASIS (Group I-D)

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B4.1 TAENIASIS AND HYDATID DISEASE (ECHINOCOCCOSIS)

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B4.2 LYMPHATIC FILARIASIS (LF)

Global

• GPELF (Global Programme to Eliminate Lymphatic Filariasis)
• Technical Package = MDA + MMDP:
  • MDA (Mass Drug Administration): Annual preventive chemotherapy (traditional: DEC + albendazole; newer IDA: Ivermectin + DEC + Albendazole for areas co-endemic with onchocerciasis)
  • MMDP (Morbidity Management and Disability Prevention): lymphoedema management, hydrocele surgery
• WHO NTD Roadmap 2021-2030: Revised elimination target from 2020 → 2030

Regional (SEARO)

• Flagship #8: NTDs and Leprosy
• Timor-Leste validated LF elimination (2024) — regional benchmark and most recently validated country in SEARO

Nepal/National (HIGH YIELD — CURRENT DATA)

• MDA since 2003 (DEC + Albendazole annual programme)
• IDA regimen introduced in persistent transmission districts
• As of March 2026: MDA has been stopped in 57 of 64 endemic districts — reflecting years of sustained MDA and successful transmission assessment surveys
• Remaining 7 districts with ongoing MDA (including Jhapa, Sarlahi, Rautahat, Banke, etc.)
• January 2026: Government launched LF MDA campaigns in Jhapa, Sarlahi, Rautahat, and Banke — districts with ongoing transmission; target coverage ≥80%
• Next steps: Epidemiological Monitoring Survey (EMS) 9 months post-IDA-MDA → IDA Impact Survey (IIS) → Stop MDA decision
• Nepal target: LF elimination by 2030
• Global Fund co-financing; WHO Nepal technical support

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B4.3 SOIL-TRANSMITTED HELMINTHIASIS (STH)

Global

• WHO Preventive Chemotherapy: Albendazole / Mebendazole — school-age children, pre-school children, women of reproductive age
• NTD Roadmap 2021-2030: Target = eliminate morbidity in children by 2030 (rather than elimination of transmission)

Regional and Nepal

• Integrated with Vitamin A supplementation delivery

Nepal/National

• School-Based Biannual Deworming — albendazole twice yearly for school-age children
• National Deworming Day (coordinated with Vitamin A Plus campaign)
• Vitamin A + Deworming package: Combined delivery to maximize coverage and cost-efficiency
• Ministry of Education co-involvement for school-based delivery

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B4.4 SUB-GROUP II HELMINTHS (Foodborne Trematodiases: Fascioliasis, Clonorchiasis, Opisthorchiasis, Paragonimiasis)

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BONUS SECTION: LEPROSY

Global

• Technical Package: MDT (Multi-Drug Therapy) — Rifampicin + Dapsone + Clofazimine
  • Paucibacillary (PB): 6 months MDT
  • Multibacillary (MB): 12 months MDT
  • Free globally since 1995 (WHO provides free MDT blister packs)
• Global Leprosy Strategy 2021-2030: "Zero Leprosy" targets — zero new child leprosy cases with grade-2 disability; zero new leprosy cases in virgin communities; zero countries with legislation allowing discrimination
• ⚠️ SEARO EXAM TRAP: Global Leprosy Programme (GLP) headquarters = SEARO (not Geneva, not AFRO)

Regional (SEARO)

• Flagship #8: NTDs, Leprosy, and LF
• GLP HQ at New Delhi (SEARO)
• Regional Leprosy Coordinator based at SEARO

Nepal/National (HIGH YIELD)

• Nationally eliminated 2009 (< 1 case/10,000 population); Declaration made 2010
• ⚠️ BUT: Despite national elimination, 17 districts in 3 provinces still have leprosy prevalence above the 1/10,000 threshold — affecting approximately 41% of Nepal's population
• National Leprosy Strategy 2021-2025 (MoHFS)
• National Roadmap for Zero Leprosy 2021-2030 (MoHFS)
• Khokana Leprosarium (historical institution): Now restructured as Leprosy Control & Disability Management Section, EDCD under MoHFS
• Ongoing activities: Active case finding, MDT delivery, contact tracing, disability prevention, stigma reduction, rehabilitation

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BONUS SECTION: TRACHOMA

Global

• Technical Package: SAFE Strategy (Surgery for trichiasis, Antibiotic mass treatment [azithromycin], Facial cleanliness promotion, Environmental improvement — latrines, water)
• Delivered through GET2020 Alliance (WHO Alliance for the Global Elimination of Trachoma by 2020)
• Note: The "2020" in GET2020 was an aspirational target — not yet achieved globally; programme continues

Nepal and India (SEARO milestone)

• Nepal eliminated trachoma as a public health problem: 2018 (SEARO first in sub-continent)
• India eliminated trachoma: 2024 — India became the third country in WHO SEARO to do so (after Nepal and Myanmar)

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PART C: HEALTH SERVICES INSTITUTIONS (Group III)

EDCD (Epidemiology and Disease Control Division) — Under MoHFS

Six Sections of EDCD:

1. NTD & Vector Borne Disease Control Section — Malaria, Dengue, JE, LF, Kala-azar, STH, Trachoma
2. Zoonotic & Other Communicable Disease Control Section — Rabies, Brucellosis, Leptospirosis, Toxoplasmosis, Taeniasis, Hydatid disease (6 priority zoonoses)
3. Disease Surveillance & Research Section — EWARS, SPAR, VPD surveillance, epidemiological research
4. Epidemiology & Outbreak Management Section — outbreak investigation, response coordination, IHR
5. NCD & Mental Health Section — NCD programme coordination, STEPS, mental health policy
6. Leprosy Control & Disability Management Section — formerly Khokana Leprosarium; MDT delivery, disability prevention

Key Associated Institutions:

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QUICK REFERENCE TABLE: WHO TECHNICAL PACKAGES

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HIGH-YIELD VIVA TRAP SUMMARY

Trap 1: DOTS vs. End TB Strategy — 3 Pillars

1. Integrated, patient-centred care and prevention
2. Bold policies and supportive systems
3. Intensified research and innovation

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Trap 2: Malaria — GVCR+T3 vs. APLMA/APMEN vs. Missed 2026

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Trap 3: Measles-Rubella Target — 2026, RC77, SEARO Decision

• Original SEARO MR elimination target: 2020 → revised to 2023 → RC77 (2024) revised to 2026
• The global Measles and Rubella Framework 2021-2030 has its own separate milestones.
• Nepal has NOT yet achieved MR elimination.

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Trap 4: AMR — Jaipur Declaration (2011) vs. Global Action Plan (2015); AWaRe vs. GLASS

• Jaipur Declaration on AMR (2011): SEARO ministerial commitment — regional, political, pre-dates global plan
• WHO Global Action Plan on AMR (2015): Global framework — 5 objectives
• Jaipur is NOT global; it is NOT a TP; it was not endorsed by WHA; it predates the Global Action Plan.

• AWaRe = Antibiotic classification (Access/Watch/Reserve) + prescribing guidance (AWaRe Antibiotic Book 2022) — guides how to USE antibiotics
• GLASS = Surveillance system — tracks resistance patterns globally; does not guide prescribing

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Trap 5: Two "Save LIVES" Documents — Road Safety vs. Hand Hygiene

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Trap 6: Rabies — 3 Documents (Global, SEARO, Nepal)

1. "United Against Rabies: Zero by 30" — Global Strategic Plan (WHO + FAO + WOAH); eliminate dog-mediated human rabies by 2030; components = mass dog vaccination + PEP access + surveillance
2. SEARO Sub-Regional Framework for Elimination of Dog-Mediated Rabies (2012) — SEARO operational framework; predates global "Zero by 30" document; still valid for regional reference
3. Nepal National Rabies Elimination Strategy 2024-2030 (MoHFS) — Nepal-specific; aligns with global Zero by 30; includes One Health approach

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Trap 7: Trachoma — SAFE vs. GET2020 vs. 2018 Elimination

1. SAFE Strategy = the Technical Package for trachoma (Surgery, Antibiotics/azithromycin, Facial cleanliness, Environmental improvement) — it is a TP
2. GET2020 Alliance = the implementation platform (WHO Alliance for the Global Elimination of Trachoma by 2020) — not a TP; it is the delivery mechanism/alliance
3. Nepal eliminated trachoma: 2018 (SEARO first in sub-continent); India eliminated: 2024 (third in SEARO, after Nepal and Myanmar)

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Trap 8: Ministry Naming — MoHP → MoHFS (May 2026)

• EDCD — remains EDCD
• DoHS (Department of Health Services) — remains DoHS
• NCASC — remains NCASC
• NTCC — remains NTCC

• "MSAP 2021-2025 was formulated under MoHP..."
• "Draft MSAP 2026-2030 is owned by MoHFS..."
• "National Mental Health Strategy 2026-2030 is under formulation by MoHFS..."
• "National Strategy for Viral Hepatitis B and C 2023-2030 was developed under MoHP; currently implemented by MoHFS..."

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BONUS TRAPS (Frequently Confused)

India vs. Nepal Eliminations:

LF MDA Status (July 2026):

• 57 of 64 endemic districts have STOPPED MDA — but this is a milestone toward elimination, NOT elimination itself
• Remaining 7 districts: ongoing MDA + monitoring
• Nepal national LF elimination target: 2030

SEARO TB Burden (exam numbers):

• SEAR carries approximately 45% of global TB incidence
• SEAR accounts for >50% of global TB deaths
• Nepal TB targets: OFF-TRACK as of March 2026

Hepatitis Care Cascade Gap (Nepal, exam figure):

• Estimated 115,179 people with chronic Hepatitis C
• Only 18% diagnosed
• Only 1% treated — a critical gap to cite in policy discussions

PLHIV in Nepal:

• Estimated ~30,300 PLHIV (2023 NCASC estimate)
• Target: 95-95-95 by 2026 under NHSP 2021-2026

WHO SEARO Indonesia Clarification:

• Indonesia is a member of WPRO (Western Pacific Region), NOT SEARO
• SEARO has 11 Member States: Bangladesh, Bhutan, DPR Korea, India, Indonesia... STOP — Indonesia is WPRO. SEARO = Bangladesh, Bhutan, DPR Korea, India, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste = 10 Member States. (Some exam materials cite 11 — verify your exam's accepted answer; WHO officially lists 11 SEARO members including Indonesia for historical reasons but current operational maps place Indonesia in WPRO)

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COMMUNITY MEDICINE IV: APPLIED EPIDEMIOLOGY

Comprehensive Exam-Ready Study Notes

Nepal NCD and CD Programmes — Three-Tier Framework

CRITICAL CORRECTION ON MINISTRY NAME: Your prompt states "Ministry of Health and Food Hygiene (MoHFH)." Verified from The Rising Nepal Daily (6 July 2026): the official English name is "Ministry of Health and Food Safety (MoHFS)" — not "Food Hygiene." Use MoHFS in all exam answers.

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FRAMEWORK: DOCUMENT TYPES — NEVER CONFUSE

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MINISTRY NAMING — EXAM-CRITICAL RULE

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WHO SEARO — REGIONAL ARCHITECTURE (2025-2026)

Member States (Post-May 2025)

• 10 Member States: Bangladesh, Bhutan, DPR Korea, India, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste
• Indonesia transferred to WPRO effective 23 May 2025 (approved at WHA78, Geneva, May 2025; document A78/31)
• SEARO HQ: New Delhi, India

8 Flagship Priority Areas

1. End TB by 2030
2. Measles elimination and rubella control
3. Prevent and control NCDs
4. Reduce maternal, under-5, and neonatal mortality
5. UHC — human resources and essential medicines
6. Combat AMR
7. Scale up emergency risk management (Health Security / IHR)
8. Eliminate NTDs (including Leprosy, LF, Trachoma)

Regional Roadmap for Results and Resilience 2024-2029

• Endorsed: May 2024
• 5 Pillars: (1) Mental health — most emphasized theme (Pillar R1); (2) Primary health care; (3) Health security and AMR; (4) Equity and social determinants; (5) Data, digital health, and innovation

Banyan Framework for Health and Well-Being in WHO SEARO (2026-2028)

• Launched: 7 April 2026 (World Health Day 2026) — ISBN: 978-92-9-022262-0
• Tagline: "Rooted in partnership, growing through challenge"
• A country-focused path protecting recent public health gains while responding to emerging challenges
• 4 Priorities: (1) Primary health care, (2) Disease elimination, (3) Health security, (4) NCDs and mental health
• 4 Accelerators:
  • Integrated health system delivery — shifting from programme silos to connected systems
  • Focused priorities and tailored country support guided by subnational data
  • Scaling access to medical countermeasures; digital health, AI; moving from pilots to system-wide solutions
  • Regional partnership platforms
• Note: This is a framework, not a Technical Package

Other Key Regional Decisions

• RC77 (October 2024): Revised SEARO Measles-Rubella elimination target: 2023 → 2026 (SEARO RC decision — not WHA global decision)
• Global Leprosy Programme (GLP) HQ = SEARO (New Delhi), not Geneva, not AFRO

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PART A: NON-COMMUNICABLE DISEASES (Group II)

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CROSS-CUTTING: WHO NCD BEST BUYS

Core Best Buys — Technical Packages

WHA76 (May 2023) Additions to Best Buys

• Asthma and COPD management interventions
• Rheumatic fever secondary prevention
• Cervical, breast, colorectal, liver, and childhood cancer interventions
• Optimal breastfeeding practices (also under Nutrition)

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A1. CARDIOVASCULAR DISEASE AND STROKE

Global

• WHO Global NCD Action Plan 2013-2030: "25x25" target — 25% relative reduction in premature NCD mortality by 2025; aligned SDG 3.4 target = one-third reduction by 2030
• Technical Package: HEARTS — flagship TP for hypertension and CVD risk management at primary care level
  • H — Healthy-lifestyle counselling
  • E — Evidence-based treatment protocols
  • A — Access to essential medicines and technology
  • R — Risk-based CVD management
  • T — Team-based care
  • S — Systems for monitoring

Regional (SEARO)

• Flagship #3: Prevent and control NCDs
• SEARO NCD Roadmap 2022-2030: Regional targets align with Global NCD Action Plan
• SEAR reduced 30-70 premature NCD mortality from 23.4% to 21.6% (2010-2019)
• Banyan Framework Priority #4: NCDs and mental health

Nepal / National

• Transitioning: MoHP MSAP 2021-2025 → MoHFS Draft MSAP 2026-2030
• Draft MSAP 2026-2030 target: 30% reduction in overall premature mortality from CVD, cancer, diabetes, and chronic respiratory diseases by 2030
• 4 Strategic Pillars of MSAP 2026-2030:
  1. Leadership, Advocacy, and Partnership
  2. Health Promotion and Risk Reduction
  3. Health System Strengthening
  4. Surveillance, Monitoring, Evaluation, and Research
• PEN implementation at health posts and PHCCs (screening, diagnosis, treatment, referral)
• STEPS Survey — WHO STEPwise approach to surveillance for NCD risk factors (periodic)
• NCD & Mental Health Section — under EDCD, MoHFS — programmatic focal point
• National Hypertension Programme; Community Health Workers (FCHVs) supporting BP screening

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A2. COPD AND ASTHMA

Global

• No dedicated Technical Package for COPD/asthma
• GARD (Global Alliance against Chronic Respiratory Diseases) — WHO-coordinated platform; not a TP
• GINA (Global Initiative for Asthma) and GOLD (Global Initiative for Chronic Obstructive Lung Disease) — clinical guidelines; not WHO TPs
• Added to Best Buys at WHA76 (May 2023) — management interventions now "best buy"

Regional (SEARO)

• Folded into Flagship #3 (NCDs and mental health)
• No separate SEARO respiratory programme vertical

Nepal / National

• No dedicated vertical programme for COPD/asthma
• Managed under MSAP 2026-2030 and PEN at primary care
• Key risk factors targeted: Tobacco (MPOWER), indoor air pollution, outdoor air pollution, occupational dust
• STEPS Survey captures CRD prevalence data

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A3. PEPTIC ULCER DISEASE

All Tiers

• No dedicated Technical Package at global, regional, or national tier
• No specific vertical programme anywhere
• Managed clinically (H. pylori eradication; PPI therapy)
• Relevant surveillance: STEPS Survey; hospital-based records
• Exam rule: Do not fabricate a TP or programme for PUD

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A4. CANCER

Global

• No single TP covering all cancers
• Cervical Cancer Elimination Initiative: "90-70-90" target by 2030 — 90% of girls HPV-vaccinated by age 15; 70% of women screened by age 35 and 45; 90% of identified women treated
• Global Breast Cancer Initiative (GBCI): Target — 2.5% annual reduction in age-standardized breast cancer mortality
• WHA76 (2023) added cervical, breast, colorectal, liver, and childhood cancer interventions to Best Buys

Regional (SEARO)

• Flagship #3: Prevent and control NCDs
• Bhutan honoured at RC77 (2024) and 2025 as regional benchmark for cervical cancer elimination progress

Nepal / National

• Nepal Cancer Control Strategy 2024-2030 (MoHFS)
• National Cancer Registry: Operated from B.P. Koirala Memorial Cancer Hospital, Bharatpur — currently 12 hospital-based registries across Nepal
• HPV vaccine: School-based, targeting girls (~Grade 4-5, ~10 years); incorporated into NIP (National Immunization Programme)
• Cervical cancer screening: VIA (Visual Inspection with Acetic Acid) at health posts and PHCCs
• National Cancer Control Committee — multi-stakeholder coordination

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A5. MENTAL HEALTH, SUBSTANCE USE, AND SUICIDE PREVENTION

Global

• WHO Mental Health Action Plan 2013-2030 — rights-based; target: 80% of countries with operational national MH policies/plans
• Technical Package: mhGAP (Mental Health Gap Action Programme)
  • Targets: Depression, psychosis, epilepsy, dementia, developmental disorders, substance use, suicide/self-harm
  • For use in non-specialized settings — primary care and community
• Technical Package: LIVE LIFE (suicide prevention) — 4 evidence-based strategies:
  1. Limit access to means of suicide
  2. Interact and report responsibly — media guidelines
  3. Viable life skills in adolescents and youth
  4. E — Early identification, assessment, management, and follow-up of persons at risk
• Technical Package: SAFER (also addresses harmful alcohol — a key suicide/self-harm driver)

Regional (SEARO)

• SEARO Mental Health Action Plan 2023-2030
• Pillar R1 (Pillar 1) of Regional Roadmap 2024-2029 — mental health is the single most emphasized theme
• Banyan Framework Priority #4: NCDs and mental health (explicitly paired)

Nepal / National

• National Mental Health Strategy 2026-2030: Under formulation by MoHFS; consultative workshop held 12 April 2026 (confirmed: WHO Nepal)
• Nepal in WHO Special Initiative for Mental Health (2019-ongoing)
• Previous framework: National Mental Health Policy 2021 (MoHP)
• National Suicide Helpline: 1166 (MoHFS/EDCD)
• National Mental Health Campaign: December 2025 — mass awareness campaign
• mhGAP training: rolled out to primary care health workers in districts
• NCD & Mental Health Section, EDCD — focal point under MoHFS
• Challenge: Scaling up to all 77 districts; treatment gap remains large

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A6. ROAD TRAFFIC, INJURIES, VIOLENCE, AND OCCUPATIONAL HEALTH

Global

• S — Speed management
• A — Leadership (institutional management)
• V — Vehicle safety standards
• E — Enforcement of traffic laws
• S — post-crash Survival (emergency response)

• Implementation of laws; Norms and values; Safe environments; Parent/caregiver support; Income and economic strengthening; Response and support services; Education and life skills

• Relationship skills strengthened; Empowerment of women; Services ensured; Poverty reduced; Environments made safe; Child and adolescent development supported; Transformative attitudes

Regional (SEARO)

• Road safety is NOT a SEARO Flagship — falls under UN ESCAP (Economic and Social Commission for Asia and the Pacific) framework
• No dedicated SEARO road safety flagship

Nepal / National

• Nepal Road Safety Action Plan 2021-2030 (draft, MoHFS)
• National Road Safety Council (NRSC) — multisectoral coordination body (chaired by Ministry of Physical Infrastructure)
• National Road Safety Policy 2081 BS (draft)
• National Strategy on Violence, Injuries, and Disabilities (MoHFS)

Occupational Health — EXPLICIT GAP (Cite This)

• No dedicated Technical Package at global, regional, or national tier for occupational health as a programmatic vertical
• WHO Global Plan of Action on Workers' Health 2008-2017 — expired; no current WHO replacement TP
• In Nepal: No operational national occupational health programme
• Acknowledged gap in NHSSP 2023-2030
• Exam instruction: State clearly — "No TP, no national occupational health programme; this is a citable gap in Nepal's public health architecture."

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A7. NUTRITIONAL DEFICIENCIES (ANAEMIA, IDD, VAD)

Global

• WHO Global Nutrition Targets 2025 — 6 targets: reduce stunting 40%; reduce anaemia in women of reproductive age 50%; reduce low birthweight 30%; no increase in childhood overweight; increase breastfeeding to 50%; reduce wasting to <5%
• BFHI (Baby-Friendly Hospital Initiative) — for breastfeeding promotion; not a disease-specific TP
• Optimal breastfeeding added to Best Buys at WHA76 (May 2023)
• No single TP for anaemia/IDD/VAD collectively

Regional (SEARO)

• Under Flagship #4 (Reduce maternal, under-5, and neonatal mortality — MNCH)
• Regional nutrition strategy integrated with RMNCAH framework

Nepal / National

• MSNP III (Multisectoral Nutrition Plan 2023-2030) — overarching national nutrition framework; MoHFS + 11 line ministries
• Anaemia:
  • IFA (Iron-Folic Acid) supplementation — pregnant women (daily), adolescent girls (weekly)
  • National Anaemia Control Plan (MoHFS/FHD)
• IDD (Iodine Deficiency Disorders):
  • Universal Salt Iodization (USI) — policy mandate (Ministry of Industry/MoHFS coordination)
  • 2nd National Action Plan for IDD (MoHFS) — ongoing
  • Monitoring: Urinary iodine excretion surveys (NHRC)
• VAD (Vitamin A Deficiency):
  • Biannual Vitamin A supplementation (children 6-59 months) combined with deworming (12-59 months)
  • Delivered twice yearly — "Vitamin A Plus Programme"
  • Partners: Helen Keller International, UNICEF
• June 2026 live note: MoHFS requesting donor top-ups from UNICEF, FHI 360, Helen Keller International, World Vision, and Care Nepal amid funding gaps for Vitamin A and micronutrient supplements

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A8. ARSENICOSIS

Global

• No dedicated Technical Package — addressed via water quality guidelines and WASH
• WHO Safe Drinking Water Guideline: 10 µg/L (arsenic)
• IARC: Inorganic arsenic = Group 1 carcinogen (sufficient evidence in humans)

Regional (SEARO)

• No dedicated SEARO programme for arsenicosis
• Primarily a South Asian geological issue (Bengal Basin / Holocene sedimentary formations of Terai)

Nepal / National

• Nepal interim guideline: 50 µg/L (2001 interim standard — higher than WHO threshold; set due to technical/economic feasibility constraints)
• Arsenic Steering Committee — inter-ministry coordination body
• DWSSM (Department of Water Supply and Sewerage Management) — implementing agency for mitigation
• Mitigation: Biosand filters, Gagri filters, community-based arsenic removal units — mainly in Terai VDCs/municipalities
• Surveillance: Arsenic mapping of affected Terai belt districts
• Health management: No antidote; treatment = remove from arsenic exposure; symptomatic treatment of skin lesions, keratosis, cancers

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PART B: COMMUNICABLE DISEASES (Group I)

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B1. BACTERIAL INFECTIONS (Group I-A)

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B1.1 CHOLERA

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B1.2 ENTERIC FEVER (TYPHOID)

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B1.3 BRUCELLOSIS

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B1.4 ANTIMICROBIAL RESISTANCE (AMR)

Global

• WHO Global Action Plan on AMR (2015) — 5 objectives: (1) improve awareness/education; (2) strengthen AMR surveillance/research; (3) reduce incidence of infection (IPC); (4) optimize antimicrobial use; (5) ensure sustainable investment
• Technical Package: AWaRe — antibiotic classification system:
  • A — Access (first-line antibiotics; wide use justified)
  • W — Watch (higher resistance potential; use for specific indications)
  • R — Reserve (last resort; protect to preserve)
  • AWaRe Antibiotic Book (2022) — TP extension: prescribing guidance for 34 clinical syndromes — guides how to prescribe
• Technical Package: GLASS (Global Antimicrobial Resistance and Use Surveillance System) — standardized AMR surveillance framework; tracks priority pathogens' resistance patterns across countries

⚠️ VIVA TRAP: AWaRe vs. GLASS

⚠️ VIVA TRAP: Jaipur Declaration vs. Global Action Plan

• Jaipur Declaration on AMR (2011): SEARO ministerial political commitment — regional, predates Global Action Plan; it is NOT a TP; NOT global; NOT endorsed by WHA
• Global Action Plan on AMR (2015): WHA-endorsed; global; 5 objectives

Regional (SEARO)

• Flagship #6: Combat AMR
• SEARO AMR Regional Roadmap 2025-2030
• Jaipur Declaration 2011 — landmark regional political document; still citable as regional commitment

Nepal / National

• National Action Plan on AMR (NAPAMR) 2024-2028 (MoHFS + One Health partners — human, animal, environment sectors)
• NATG 2023 (Nepal Antibiotic Treatment Guidelines 2023) — practical hospital-level prescribing reference
• AMR Learning Resource Package — developed jointly with WHO Nepal
• Antimicrobial Stewardship Programme (AMSP):
  • Orientation workshop: February 2026
  • National guideline: being finalized (as of July 2026)
  • Implementation phase: Rolling out in public hospitals
• GLASS reporting: Nepal participating in global surveillance
• Nepal participating in SPAR (State Party Self-Assessment Annual Reporting) under IHR

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B1.5 MENINGITIS (BACTERIAL)

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B1.6 ARI / PNEUMONIA (BACTERIAL — STREPTOCOCCAL/PNEUMOCOCCAL)

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B1.7 TUBERCULOSIS

Global

• CURRENT STRATEGY: End TB Strategy (adopted WHA 2014; implemented 2016-2030)
  • 3 Pillars:
    1. Integrated, patient-centred TB care and prevention
    2. Bold policies and supportive systems
    3. Intensified research and innovation
  • 2 Principles: Government stewardship; Coalitions with civil society; Human rights
  • Targets by 2030: 90% reduction in TB incidence and 95% reduction in TB deaths (vs. 2015 baseline); zero catastrophic costs for TB-affected families
  • Intermediate 2025 milestones: 75% reduction in deaths, 50% reduction in incidence

⚠️ EXAM TRAP: DOTS vs. End TB Strategy

Regional (SEARO)

• Flagship #1: End TB by 2030 (highest priority flagship)
• SEAR carries approximately 45% of global TB incidence and >50% of global TB deaths
• Countries: India, Indonesia (now WPRO), Bangladesh, Myanmar, Nepal account for majority of burden

Nepal / National

• National TB Strategic Plan (NTSP) 2021/22-2025/26 (MoHP; now implemented by MoHFS/NTCC)
• Status (March 2026): Nepal is OFF-TRACK on TB incidence and mortality reduction targets
• TB-Free Nepal Declaration — political commitment (date: aligns with End TB goals)
• NSP TB 2026-2031: Currently being drafted by MoHFS/NTCC (to replace expiring plan)
• NTCC (National Tuberculosis Control Centre) — NTP focal point (see Part C)
• NATA (National Anti-Tuberculosis Association of Nepal) — community DOTS partner NGO (see Part C)
• Key strategies: Universal Drug Susceptibility Testing (uDST); Shorter Treatment Regimens; TB Preventive Therapy (TPT); Nutrition support (Ankurit Programme)
• Global Fund grant: USD 51.27 million (Feb 2025-Jul 2027) includes TB component

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B1.8 HIV / STIs

Global

• UNAIDS Global AIDS Strategy 2021-2026: Fast-Track targets — 95-95-95: 95% of all PLHIV know their status; 95% of diagnosed PLHIV on treatment; 95% of those on treatment virally suppressed
• "Treat All" policy: All PLHIV treated regardless of CD4 count or clinical stage
• Triple Elimination Package: Elimination of MTCT of HIV + Congenital Syphilis + Perinatal Hepatitis B (integrated PMTCT)

Regional (SEARO)

• EMTCT (Elimination of Mother-to-Child Transmission) validated countries: Thailand (2016), Sri Lanka (2016)
• Maldives applying for perinatal HepB elimination validation (2025)

Nepal / National

• National HIV Strategic Plan (NHSP) 2021-2026 (MoHP; now MoHFS/NCASC)
• Target: 95-95-95 by 2026
• Estimated PLHIV: approximately ~30,300 (NCASC 2023 estimates)
• Key populations: PWID, migrant workers, female sex workers, MSM, transgender
• NHSP 2026-2031: Currently being drafted by MoHFS/NCASC
• NCASC (National Centre for AIDS and STD Control) — unchanged under MoHFS
• Free ART; ART centres nationwide; PMTCT in all delivery facilities
• STI syndromic management (national guidelines, NCASC)
• Global Fund grant: USD 51.27 million includes HIV component

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B1.9 SUB-GROUP II BACTERIAL ZOONOSES

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B2. VIRAL INFECTIONS (Group I-B)

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B2.1 CHICKENPOX / HERPES ZOSTER

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B2.2 MEASLES AND RUBELLA

Global

• Measles and Rubella Framework 2021-2030 (Measles and Rubella Partnership): Target — eliminate measles and rubella in ≥5 WHO regions by 2030; reduce incidence to <1 case per million population

Regional (SEARO) — CRITICAL TRAP

• History of SEARO MR elimination target revisions:
  • Original SEARO target: 2020 → Revised to 2023 (earlier RC) → RC77 (October 2024) revised to 2026
• These revisions apply to SEARO member states only

Nepal / National

• MR vaccine: Given at 9 months and 15 months in NIP (two-dose schedule)
• Periodic Supplementary Immunization Activities (SIA campaigns) for zero-dose/under-dose children
• VPD surveillance (EDCD/NPHL)
• Nepal has NOT yet achieved measles elimination; outbreaks in underimmunized communities

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B2.3 INFLUENZA

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B2.4 VIRAL PNEUMONIA

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B2.5 VIRAL MENINGITIS

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B2.6 POLIOMYELITIS

Global

• GPEI (Global Polio Eradication Initiative): Two vaccines in schedules:
  • bOPV (Bivalent Oral Poliovirus Vaccine — types 1 and 3)
  • IPV (Inactivated Poliovirus Vaccine — at least 1 dose mandatory per schedule)
  • Target: Complete global eradication of wild poliovirus (WPV1 remains in Pakistan and Afghanistan)

Regional (SEARO)

• Entire SEAR certified polio-free: March 2014 — landmark achievement

Nepal / National

• Nepal declared polio-free: 2010 (last indigenous case)
• NIP schedule: bOPV at 6, 10, 14 weeks + IPV at 14 weeks
• AFP (Acute Flaccid Paralysis) surveillance — ongoing for certification maintenance
• Environmental surveillance for poliovirus (ongoing)

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B2.7 RABIES

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B2.8 MUMPS

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B2.9 VIRAL GASTROENTERITIS (ROTAVIRUS)

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B2.10 JAPANESE ENCEPHALITIS (JE)

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B2.11 DENGUE

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B2.12 VIRAL HEPATITIS (A-E)

Global

• WHO Global Health Sector Strategy on Viral Hepatitis 2022-2030: Target — eliminate hepatitis B and C as public health threats by 2030: 90% reduction in incidence and 65% reduction in deaths
• Triple Elimination Package: Elimination of MTCT of HIV + Congenital Syphilis + Perinatal Hepatitis B (integrated service delivery)
• Hepatitis A: HAV vaccine available; not in most universal schedules
• Hepatitis E: HEV vaccine available in China only; WHO does not recommend universal use

Regional (SEARO)

• EMTCT framework includes perinatal HepB elimination (Maldives applying 2025)
• HepB birth-dose as cornerstone of perinatal prevention

Nepal / National — HIGH YIELD

• National Strategy for Viral Hepatitis B and C 2023-2030 (MoHP; now implemented by MoHFS) — Nepal's FIRST dedicated strategic document for viral hepatitis
• Targets by 2030: 90% reduction in new cases of chronic HepB and C; 65% reduction in deaths
• Strategic priorities: Scale up diagnosis; link to care; eliminate MTCT of HepB; harm reduction for PWID
• HepB birth-dose (within 24 hours of birth) + Pentavalent vaccine (at 6, 10, 14 weeks) in NIP
• Care cascade gap: Estimated 115,179 people with chronic Hepatitis C — only 18% diagnosed, only 1% on treatment
• Integration with EMTCT and HIV programmes (NCASC/MoHFS)

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B2.13 SUB-GROUP II VIRAL (Smallpox, FMD)

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B3. PROTOZOAL INFECTIONS (Group I-C)

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B3.1 MALARIA

Global

• WHO Global Technical Strategy for Malaria 2016-2030 (GTS):
  • Targets by 2030 (vs. 2015): 90% reduction in malaria case incidence, 90% reduction in mortality; ≥35 countries achieve zero indigenous cases
• Technical Package: T3 — Test, Treat, Track:
  • Test all suspected malaria cases (RDT or microscopy)
  • Treat promptly with artemisinin-based combination therapy (ACT)
  • Track all cases, deaths, and interventions
• GVCR 2017-2030 — vector control component (IRS, ITNs/LLINs)

Regional (SEARO)

• APLMA (Asia Pacific Leaders Malaria Alliance) — political platform for heads of government/ministers
• APMEN (Asia Pacific Malaria Elimination Network) — technical and operational network
• Regional target: Malaria-free Asia-Pacific by 2030
• Nepal-India cross-border malaria collaboration MOU: September 2023 — addresses migratory workforce challenge

Nepal / National — EXAM TRAP

• Historical plan: NMSP 2014-2025 — "Malaria-Free Nepal by 2026" — not achieved
• Current status: Working toward 2030 elimination (aligns with global GTS)
• Remaining burden: Mostly Terai; <1,000 cases/year; imported cases from India dominant challenge
• VBDRTC (Vector-Borne Disease Research and Training Centre), Hetauda — national reference centre for vector-borne diseases
• Interventions: IRS (Indoor Residual Spraying); LLIN (Long-Lasting Insecticidal Nets); RDT; ACT treatment; case tracking
• Global Fund support included in USD 51.27 million grant

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B3.2 KALA-AZAR (VISCERAL LEISHMANIASIS — VL)

Global

• GVCR 2017-2030 — vector (sandfly) control component
• WHO NTD Roadmap 2021-2030: Target — achieve VL elimination as public health problem in South Asia (threshold: <1 case/10,000 population at sub-district/upazila level)

Regional (SEARO) — CRITICAL TRAP

• 2005 Tripartite Regional Initiative: Bangladesh + India + Nepal — joint commitment to eliminate VL as public health problem
• VL treatment guidelines revised: 2010 → 2014 → 2016 (protocol updates) ⚠️ EXAM TRAP: India achieved VL elimination threshold in 2023; Nepal has NOT yet achieved elimination
• Nepal target: Reach <1/10,000 threshold in all endemic districts

Nepal / National

• Endemic districts: Terai (primarily eastern — Sarlahi, Dhanusha, Mahottari, Rautahat, Sindhuli)
• Treatment: Miltefosine (oral); Liposomal Amphotericin B (L-AmB); combination regimens
• Vector control: IRS (DDT → later pyrethroids)
• EDCD NTD & Vector Borne Disease Control Section

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B3.3 AMOEBIASIS AND GIARDIASIS

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B3.4 TRICHOMONIASIS

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B3.5 VECTOR CONTROL

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B3.6 SUB-GROUP II PROTOZOAL (Toxoplasmosis, Trypanosomiasis, Cryptosporidiosis)

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B4. HELMINTHIASIS (Group I-D)

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B4.1 TAENIASIS AND HYDATID DISEASE (ECHINOCOCCOSIS)

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B4.2 LYMPHATIC FILARIASIS (LF)

Global

• GPELF (Global Programme to Eliminate Lymphatic Filariasis)
• Technical Package = MDA + MMDP:
  • MDA (Mass Drug Administration) — annual preventive chemotherapy:
    • Standard: DEC (Diethylcarbamazine) + Albendazole
    • IDA regimen (for co-endemic areas): Ivermectin + DEC + Albendazole (3-drug)
  • MMDP (Morbidity Management and Disability Prevention) — lymphoedema management, hydrocele surgery, wound care
• WHO NTD Roadmap 2021-2030: LF elimination target revised from 2020 → 2030

Regional (SEARO)

• Flagship #8: Eliminate NTDs (including LF)
• Timor-Leste validated LF elimination: 2024 — most recently validated country in SEARO; serves as regional benchmark

Nepal / National — HIGH YIELD (Current data)

• MDA since 2003 (DEC + Albendazole annually)
• IDA regimen introduced from 2023 in districts with persistent transmission (≥2% antigen prevalence)
• As of March 2026: MDA successfully stopped in 57 of 64 endemic districts
• Remaining 7 districts with active MDA (Jhapa, Sarlahi, Rautahat, Banke — ongoing as of January 2026 campaign)
• January 2026: Government launched IDA-MDA campaigns in Jhapa, Sarlahi, Rautahat, Banke; target coverage ≥80%
• Post-MDA monitoring pathway: Epidemiological Monitoring Survey (EMS) 9 months after completing ≥2 effective IDA rounds → IDA Impact Survey (IIS) → Stop MDA decision
• Nepal LF elimination target: 2030
• Partners: WHO Nepal (technical/operational support), Global Fund (financing)

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B4.3 SOIL-TRANSMITTED HELMINTHIASIS (STH)

Global

• WHO Preventive Chemotherapy: Albendazole 400mg or Mebendazole 500mg — school-age children, pre-school children (12-59 months), women of reproductive age (in endemic areas)
• NTD Roadmap 2021-2030: Target — eliminate morbidity due to STH in children by 2030 (morbidity elimination, not transmission interruption)

Regional and Nepal

• Integrated delivery with Vitamin A supplementation

Nepal / National

• School-Based Biannual Deworming — Albendazole twice yearly for school-age children (via schools and communities)
• National Deworming Day — nationally coordinated, twice yearly
• Vitamin A Plus Programme: Combined Vitamin A + Deworming delivery — maximizes coverage and cost-efficiency
• Ministry of Education co-involvement for school-based delivery

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B4.4 SUB-GROUP II HELMINTHS (Foodborne Trematodiases: Fascioliasis, Clonorchiasis, Opisthorchiasis, Paragonimiasis)

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BONUS SECTION 1: LEPROSY

Global

• Technical Package: MDT (Multi-Drug Therapy):
  • Paucibacillary (PB) leprosy: Rifampicin + Dapsone — 6 months
  • Multibacillary (MB) leprosy: Rifampicin + Dapsone + Clofazimine — 12 months
  • Free globally since 1995 (WHO provides free MDT blister packs via national governments)
• Global Leprosy Strategy 2021-2030 — "Zero Leprosy" targets:
  • Zero new child leprosy cases with Grade-2 disability
  • Zero new leprosy cases in previously virgin communities
  • Zero countries with discriminatory leprosy legislation

Regional (SEARO)

• Flagship #8: NTDs — includes Leprosy
• ⚠️ EXAM TRAP: Global Leprosy Programme (GLP) HQ = SEARO (New Delhi) — NOT Geneva, NOT AFRO

Nepal / National

• National elimination: 2009 (<1 case/10,000 population achieved); formal declaration: 2010
• ⚠️ BUT: Despite national elimination, 17 districts in 3 provinces still have prevalence above 1/10,000 threshold — approximately 41% of Nepal's population lives in these sub-nationally endemic areas
• National Leprosy Strategy 2021-2025 (MoHFS)
• National Roadmap for Zero Leprosy 2021-2030 (MoHFS)
• Ongoing activities: Active case detection, MDT delivery, contact tracing, Grade-2 disability prevention, stigma reduction, rehabilitation
• Khokana Leprosarium (historical): Now restructured as the Leprosy Control & Disability Management Section, EDCD under MoHFS

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BONUS SECTION 2: TRACHOMA

Global

• Technical Package: SAFE Strategy (adopted by WHO 1996):
  • S — Surgery for trichiasis (eyelid surgery to prevent blindness)
  • A — Antibiotic mass treatment (Azithromycin single dose)
  • F — Facial cleanliness promotion
  • E — Environmental improvement (latrines, water supply)
• GET2020 Alliance (WHO Alliance for the Global Elimination of Trachoma by 2020):
  • This is the implementation platform/alliance — NOT a Technical Package
  • "2020" was aspirational; global elimination not yet achieved; programme continues
  • SAFE is the TP; GET2020 is the delivery mechanism/alliance — they are different entities

Nepal and SEARO Elimination Milestones

• Nepal eliminated trachoma as a public health problem: 2018 — first in the South Asian subcontinent
• Myanmar followed
• India eliminated trachoma: 2024 — confirmed as the third country in SEARO to achieve elimination (after Nepal and Myanmar)

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PART C: HEALTH SERVICES INSTITUTIONS (Group III)

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EDCD (Epidemiology and Disease Control Division)

Six Sections of EDCD

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Key Associated Institutions

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MASTER REFERENCE TABLE: WHO TECHNICAL PACKAGES

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HIGH-YIELD VIVA TRAP SUMMARY

Trap 1: TB — DOTS vs. End TB Strategy (3 Pillars)

• DOTS = historical backbone (WHO endorsed 1994); 5 elements (political commitment; microscopy; supervised treatment; drug supply; recording/reporting)
• Current strategy = End TB Strategy (2014; implemented 2016-2030) with 3 Pillars:
  1. Integrated, patient-centred TB care and prevention
  2. Bold policies and supportive systems
  3. Intensified research and innovation
• DOTS is embedded in Pillar 1 — it is NOT cited as the strategy name
• Targets: 90% incidence reduction and 95% mortality reduction by 2030 (vs. 2015 baseline)
• Nepal: Off-track as of March 2026; new NSP 2026-2031 being drafted

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Trap 2: Malaria — GVCR+T3 vs. APLMA/APMEN vs. Missed 2026

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Trap 3: Measles-Rubella Target — 2026, RC77, SEARO Decision

• 2020 (original SEARO target) → 2023 (earlier RC revision) → 2026 (RC77, October 2024)
• The global Measles and Rubella Framework 2021-2030 (Measles and Rubella Partnership) has its own separate global milestones
• Nepal has not achieved MR elimination; MR vaccine at 9 and 15 months in NIP

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Trap 4: AMR — Jaipur (2011) vs. Global (2015); AWaRe vs. GLASS

• Jaipur Declaration on AMR (2011): SEARO ministerial political commitment — regional; predates Global Action Plan; NOT a TP; NOT global
• WHO Global Action Plan on AMR (2015): WHA-endorsed; 5 objectives — this is the global framework
• Do not confuse sequence: Jaipur precedes Global (4 years earlier); Jaipur does not override the Global Plan

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Trap 5: Two "Save LIVES" — Road Safety vs. Hand Hygiene

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Trap 6: Rabies — 3 Documents (Global, SEARO, Nepal)

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Trap 7: Trachoma — SAFE vs. GET2020 vs. 2018 Elimination

1. SAFE Strategy = the Technical Package (Surgery + Antibiotics/azithromycin + Facial cleanliness + Environment); adopted by WHO 1996
2. GET2020 Alliance = the implementation platform/alliance (WHO Alliance for the Global Elimination of Trachoma by 2020); not a TP; delivers SAFE strategy globally
3. Nepal eliminated trachoma: 2018 (SEARO first in sub-continent); Myanmar followed; India eliminated: 2024 (3rd in SEARO)

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Trap 8: Ministry Naming — MoHP → MoHFS (13 May 2026)

FINAL NOTE ON MINISTRY NAME: Your prompt says "Food Hygiene (MoHFH)" — this is incorrect. Verified from The Rising Nepal Daily (6 July 2026): "Minister for Health and Food Safety." Official English name = Ministry of Health and Food Safety (MoHFS). Use MoHFS in all exam answers.

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BONUS RAPID-FIRE TRAPS (Frequently Confused in Vivas)

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