Study design: Observational cohort study. Objectives: To evaluate ongoing health and community reintegration of patients with spinal cord injury (SCI) after discharge from inpatient rehabilitation in Nepal. Setting: Nepal. Methods: This study follows a cohort of 37 patients with SCI in Nepal, 1-2 years after discharge from inpatient rehabilitation in 2007. Participants were visited at home and data were obtained through semi-structured interviews that evaluated health, independence in daily living (Modified Barthel Index), community participation (Participation Scale) and barriers due to socioeconomic issues, housing, accessibility, and availability and use of mobility aids. Results: One-quarter of the cohort had died (35% of wheelchair users). Secondary health concerns, such as pressure ulcers and urinary tract infections, were common in the 24 patients interviewed, and eight had been rehospitalized to treat them. Inappropriate wheelchairs, inadequate housing and rugged terrain restricted accessibility. 80% of wheelchair users could not enter their homes independently and 74% of those who were using mobility aids could not access the community independently because of the physical terrain. Of all those who were interviewed, half had no accessible toilet, access to a water source or road access to their home. Community participation was a challenge for most using mobility devices, and less than half earned any income. Conclusion: This study identifies important areas of focus for rehabilitation centres in less-resourced contexts like Nepal to help with reintegration after discharge: vocational training during or after rehabilitation; accessible housing; wheelchairs appropriate to the terrain and the need for strong community-based rehabilitation.

Recently there has been an increasing realization that for the prevention of transfusion-associated HIV infection, HIV screening alone is insufficient. In 1988, a treatment protocol for children under 5 years with severe anaemia, was introduced in Ekwendeni Hospital. Initial results showed that it was possible to reduce the number of blood transfusions without increasing the mortality rate. By January 1992 the protocol was being widely disregarded by ward staff, and transfusion rates had increased. Strict enforcement of the transfusion protocol from the 16 January produced a sharp drop in the percentage transfused from 44% to 11%. Mortality rates remained similar throughout the period of the study. Thus, it would appear to be possible, with the use of the transfusion protocol, to reduce the number of blood transfusions carried out, without affecting mortality rates, and hence to reduce the risk of transfusion-associated HIV.