Aid agencies are urging Nepal to implement stronger water and sanitation measures to prevent diarrhoea outbreaks, which claim hundreds of lives each year.
Ahead of next month's monsoon season - the four- to five-month period when there is a spike in diarrhoea-related deaths - aid workers have been calling on the government to prepare for a deluge of cases.
"This is the period of water-borne disease, and there is a lack of effective awareness programmes, which has to be stressed a lot to reduce the outbreak," said Richard Ragan, country representative of the UN World Food Programme, which is involved in public health education about safe drinking water and sanitation practices.
In 2009, there were more than 370 diarrhoea deaths, mostly in western Nepal, according to figures from the government's Epidemiology and Disease Control Division (EDCD). There were more than 67,000 diarrhoea cases reported last year, most of them in 18 of the country's 75 districts.
The east of the country is also vulnerable, with the number of children five and under who fell ill with diarrhoea increasing from 241 cases per 1,000 children in 2007, to 550 in 2009, the regional health directorate said.
Even before the monsoon has started, 15 people have died from diarrhoea-related causes in the last two months in five districts of western Nepal, according to the government.
Better preparation needed
|Simply giving health education and providing emergency response are not enough|
The Nepal Red Cross Society (NRCS), the country's largest humanitarian organization, is concerned that the mistakes of last year might be repeated: improper distribution of medicines, untimely reporting of cases and poor coordination with remote districts.
"Preparedness measures are the top priority of the government, but it needs to do a lot in terms of action in the field or we will be faced with a major disaster like last year," said Pitamber Acharya, NRCS disaster director.
Acharya said the government needs to invest more in hygiene, water purification and safe drinking water supplies - the lack of which are the main causes of diarrhoea outbreaks every year.
"Simply giving health education and providing emergency response are not enough," he said.
According to the latest UN Millennium Development Goal statistics, 89 percent of the population has access to improved drinking water sources - such as piped water into a home, a dug well, rainwater or bottled water - and 27 percent have access to clean sanitation.
Twenty-six districts across the country remain at risk from diarrhoea outbreaks, according to the EDCD. Some impoverished, food-insecure districts, where people survive on less than US$1 a day, endure the worst water and sanitation conditions, and health services.
Thir Bahadur, head of the Home Ministry's disaster risk management unit, said the government has stocked medicines and formed rapid response teams in vulnerable districts to prepare for the monsoon.