The study, led by Dikshya Adhikari and colleagues, was conducted as a hospital-based cross-sectional observational survey over a single month, from September to October 2024. The team recruited 242 health workers from selected hospitals in Pokhara, located in the Kaski district of Nepal. Participants completed a self-administered questionnaire designed to capture both the prevalence of burnout and a wide range of personal, job-related, and work-life balance characteristics. Rather than relying on a single generic measure, the researchers used the Oldenburg Burnout Inventory, a validated instrument that assesses burnout along two distinct dimensions: exhaustion, the physical and emotional depletion that builds up over time, and disengagement, the cynical distancing from the job that often follows.

The headline number was stark. Overall, 61.6 percent of the health workers screened positive for burnout. When the researchers examined the two subscales separately, the picture became even more alarming. Slightly more than three-quarters of participants, 76.4 percent, scored high on disengagement, while 71.9 percent showed high exhaustion. In other words, the majority of the hospital workforce in this Nepali city was not merely tired at the end of a long shift; they were simultaneously worn down and psychologically pulling away from the very work that defines their professional lives. That combination matters, because burnout in health workers has been linked in prior research to compromised patient safety and reduced patient satisfaction, in addition to the direct harm it does to the workers themselves.

To understand what was driving these numbers, the team first used chi-square tests to identify factors associated with burnout in simple comparisons, and then applied multivariate logistic regression to isolate the independent predictors while controlling for other variables. This statistical approach, which produces adjusted odds ratios with 95 percent confidence intervals, allows researchers to estimate how strongly each factor predicts burnout when everything else is held constant. Three factors emerged as significant. Health workers who reported insufficient sleeping hours at night had more than twice the odds of burnout compared with those who slept adequately, with an adjusted odds ratio of 2.292 and a confidence interval of 1.193 to 4.404.

The second significant predictor was job satisfaction. Workers who described their satisfaction with the job as poor had roughly three and a half times the odds of being burned out, with an adjusted odds ratio of 3.391 and a confidence interval of 1.286 to 8.943. This finding aligns with a broad international literature showing that burnout is not simply a matter of individual resilience or personal weakness; it is deeply tied to how people experience the conditions of their employment, including workload, recognition, autonomy, and the sense that their work has meaning. When satisfaction collapses, disengagement tends to follow, and the Oldenburg inventory’s high disengagement scores in this sample suggest exactly that trajectory.

The strongest single predictor, however, was work-life balance. Health workers who rated their balance between professional demands and personal life as poor had more than five times the odds of burnout, with an adjusted odds ratio of 5.187 and a confidence interval of 2.600 to 10.350. That effect size is striking even by the standards of occupational health research, and it suggests that in Pokhara’s hospitals, the erosion of any boundary between work and home life may be the central mechanism through which burnout takes hold. Long shifts, unpredictable rosters, and the chronic understaffing that characterizes many hospitals in low- and middle-income countries can leave workers with little protected time for rest, family, or recovery, and the sleep findings in this study fit neatly into that pattern.

The connection between insufficient sleep and burnout deserves particular attention because it points to a vicious cycle. Sleep deprivation impairs emotional regulation, cognitive performance, and physical health, all of which make the demands of clinical work harder to meet. As performance suffers and fatigue accumulates, exhaustion deepens and disengagement grows, which in turn can make it harder to rest and recover even when the opportunity arises. The fact that inadequate night-time sleep roughly doubled the odds of burnout in this sample, even after adjusting for job satisfaction and work-life balance, indicates that sleep is not merely a byproduct of a demanding schedule but an independent lever that interventions could target.

Burnout syndrome has attracted growing attention over the last three decades, and high levels have been reported among health workers globally, from emergency departments in Europe to rural clinics in sub-Saharan Africa. Nepal, the study’s authors note, is no exception, with hospital settings in particular showing concerning levels. Yet the researchers argue that burnout in the country has not received sufficient attention in the literature, and their study was designed to fill that gap by providing prevalence estimates and associated factors from a specific, well-defined hospital population. Cross-sectional designs like this one cannot prove that insufficient sleep or poor work-life balance cause burnout, since the data capture a single moment in time and the relationships could run in either direction, but the strength and consistency of the associations make a compelling case for action.

The practical implications are clear, and the authors are direct about them. Hospital administrators, policymakers, and health system leaders, they conclude, should prioritize interventions targeting burnout among health workers, with a particular focus on protecting work-life balance and improving job satisfaction. In practice, that could mean enforcing limits on consecutive working hours, building rosters that allow for genuine recovery time, creating channels through which staff can raise concerns about workload and recognition, and treating adequate sleep as a system-level safety issue rather than a private matter for individual workers. Given that burnout undermines patient safety and satisfaction as well as the health of the workforce itself, such investments would protect not only the roughly 242 health workers studied here but the patients who depend on them every day.

What makes the Pokhara study resonate beyond Nepal is its reminder that burnout is a global phenomenon with local textures. The same two dimensions, exhaustion and disengagement, appear wherever health systems are strained, but the specific drivers differ: in some settings it is administrative burden, in others it is violence in the workplace or inadequate pay. In this Nepali hospital sample, the dominant drivers were the most fundamental ones, sleep, satisfaction, and the space to live a life outside work. Nearly two-thirds of the health workers who keep Pokhara’s hospitals running are burning out, and the study’s message to health leaders everywhere is that the factors determining that outcome are measurable, identifiable, and, with deliberate policy effort, changeable.

Subject of Research: Burnout prevalence and associated factors among hospital health workers in Pokhara, Nepal

Article Title: Burnout and its’ associated factors among health workers: A hospital-based cross-sectional study from Pokhara, Nepal

Article References: Adhikari, D., Kaphle, H. P., Ojha, R., & Adhikari, C. (2026). Burnout and its’ associated factors among health workers: A hospital-based cross-sectional study from Pokhara, Nepal. PLOS One, 21(10), e0360067. https://doi.org/10.1371/journal.pone.0360067

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360067

Keywords: burnout, health workers, Nepal, Pokhara, Oldenburg Burnout Inventory, cross-sectional study, job satisfaction, work-life balance, sleep deprivation, hospital settings, occupational health, PLOS One

The research, published in the journal Discover Education, drew on data from 918 students across 12 randomly selected community schools in Pokhara Metropolitan City. The team, led by Sudesh Pandit with colleagues including Ramesh Adhikari, Om Chandra Thasineku and Sushil Sharma, chose grade VIII deliberately: in Nepal’s school system, this is the year students sit a standardized examination administered by the Metropolitan Department of Education, marking their transition from basic to secondary education. Educational achievement was measured with a self-administered test built from multiple-choice items drawn from the National Assessment of Student Achievement and model questions from the Curriculum Development Centre. The test covered four core subjects, English, Mathematics, Science and Social Studies, with 20 items per subject. Items were reviewed by subject experts and pre-tested on 48 students from schools outside the final sample to check clarity, difficulty and content validity before the main study began.

The headline numbers are striking. Roughly three quarters of the students, 75.1 percent, were active commuters, meaning they walked or cycled to school, while the remaining 24.9 percent used motorized transport such as school buses, public vehicles or private cars. Passive commuters averaged 13.54 points on the composite achievement score, with a standard deviation of 3.19, while active commuters averaged 11.49 points, with a standard deviation of 2.62. That difference of just over two points on a 20-point scale represents a meaningful academic gap. By contrast, differences tied to commuting time and distance were small. Students who traveled more than 20 minutes scored only marginally higher than those with shorter trips, and distance from home to school showed essentially no relationship with achievement. What mattered, the data suggested, was not how far or how long students traveled, but how they traveled.

To test whether that pattern would survive statistical scrutiny, the researchers built a series of multiple linear regression models, adding blocks of control variables step by step. The first model adjusted only for commuting time and distance; the second added demographic characteristics such as age, sex and ethnicity; the third introduced socio-economic factors including parental education, parental occupation, household income and housing ownership; and the final model incorporated measures of the supportive environment, such as parental support at home, parental engagement in school activities and teacher support, along with indicators of student proactiveness like homework regularity, extracurricular participation, absenteeism and peer relationships. Active commuting remained significantly and negatively associated with educational achievement in every model. The standardized coefficient started at minus 0.319 in the first model, fell to minus 0.268 after demographic controls, minus 0.244 after socio-economic controls, and settled at minus 0.121 in the fully adjusted model, still statistically significant at p less than 0.001.

That shrinking but stubborn coefficient tells a nuanced story. Each layer of controls absorbed part of the raw gap, confirming that active commuters in Pokhara tend to come from families with fewer educational and economic resources. Maternal education, in particular, emerged as a strong socio-economic predictor of achievement, consistent with a large international literature linking mothers’ schooling to children’s academic outcomes. Yet even after fifteen control variables were accounted for, commuting mode retained an independent association with test scores. The authors checked the assumptions of their regression models carefully, examining residual plots for normality and homoscedasticity, confirming low autocorrelation with a Durbin-Watson statistic of 1.642, and verifying that multicollinearity was not a problem using variance inflation factors. Some variables, including father’s education and certain occupation categories, had to be dropped from the final model because of perfect multicollinearity.

Why would walking to school, so often promoted as a cognitive booster, be linked to poorer grades in this setting? The authors point to the starkly different meaning of active commuting in Nepal compared with high-income countries. In cities like Pokhara, walking or cycling to school is rarely a lifestyle choice; it is frequently an involuntary consequence of financial constraints, with narrow lanes, unsafe roads and difficult terrain making the daily journey a burden rather than a pleasure. Long, physically demanding trips can produce fatigue that erodes the energy available for homework and classroom concentration. Carrying heavy school bags over long distances adds a further psychological and physical toll, and prior research cited by the team suggests students forced into such commutes may feel less motivated toward their studies. Passive commuters, by contrast, arrive feeling safe, comfortable and rested, and more than 81 percent of them commute for more than 20 minutes each day, a duration that in the fully adjusted model showed a weakly positive association with achievement for this group alone.

The study’s demographic findings add further texture. The sample was 55.9 percent female and 44.1 percent male, with the largest ethnic group being Janajati at 38 percent, followed by Brahmin or Chhetri at 31.8 percent and Dalit at 27.6 percent. Sex showed no significant association with achievement, echoing international evidence that the gender gap in education is closing. Age and ethnicity did matter, with older students and certain ethnic groups scoring lower, but neither explained away the commuting effect. Household economics painted a familiar picture of urban Nepal: more than half of families earned between 21,000 and 40,000 Nepalese rupees per month, over half lived in rental housing, and a large share of fathers worked in foreign employment or daily wage labor while most mothers reported household work as their primary occupation. Parental support at home was reported by 59.7 percent of students, teacher support by 61.5 percent, and 78.6 percent participated in extracurricular activities, though the latter showed no significant link to achievement.

The findings carry real weight for policy. Nepal’s government has pursued a policy of ensuring schools lie within a 20-minute walking distance of children’s homes, and recent measures such as customs duty exemptions for school buses have expanded motorized options. Yet the School Sector Development Plan and the constitutional guarantee of free and compulsory basic education, the authors note, pay little attention to the environmental and geographical barriers that shape how children actually get to school. The study does not argue that walking is inherently harmful; rather, it argues that when active commuting is unsafe, exhausting and imposed by poverty, its cognitive benefits are unlikely to outweigh its structural and psychosocial burdens. The authors call for safe, comfortable, convenient and efficient commuting arrangements, suggesting that well-designed transport systems and safer routes could transform the daily journey from a drain on learning into a neutral or even positive experience.

As with any cross-sectional study, caution is warranted. The design captures associations at a single point in time and cannot establish that commuting mode causes differences in achievement; unmeasured factors such as neighborhood safety or school quality could still play a role. The authors themselves emphasize that the results should be interpreted as associations, not causal effects, and they call for longitudinal and mixed-method research to unpack why active commuting appears to work against academic success in this context despite its well-documented health benefits. Still, the study is a vivid reminder that the same behavior can mean entirely different things in different places. In Copenhagen or Portland, a child walking to school is exercising a healthy choice. In Pokhara, that same walk may signal a family’s lack of options, and the weight of that daily journey, the researchers suggest, follows the child into the classroom.

Subject of Research: The association between active and passive commuting modes to school and educational achievement among students in Pokhara, Nepal

Article Title: Association between commuting modes to school and educational achievement among students in Pokhara, Nepal

Article References: Pandit, S., Adhikari, R., Thasineku, O. C., & Sharma, S. (2026). Association between commuting modes to school and educational achievement among students in Pokhara, Nepal. Discover Education, 5(1), Article 1108. https://doi.org/10.1007/s44217-026-02252-9

Image Credits: AI Generated

DOI: 10.1007/s44217-026-02252-9

Keywords: active commuting, educational achievement, Nepal, Pokhara, school transport, students, public health, socio-economic status, regression analysis, education policy, commuting time, Discover Education