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Additional file 1: Thresholds and methods used for scoring people’s knowledge, attitude and practice (KAP).

Additional file 6: Survey Questionnaire.

Additional file 4: Participants’ attitudes towards dengue fever.

Additional file 2: Participant’s knowledge on signs and symptoms of dengue fever.

Additional file 5: Participants’ preventive and control measures against dengue fever.

Additional file 3: Participants knowledge on dengue virus transmission and vector.

Khem Bahadur Karki,1– 3,* Anil Poudyal,1,* Namuna Shrestha,1 Namra Kumar Mahato,1 Krishna Kumar Aryal,4 Milesh Jung Sijapati,5 Bihungum Bista,1 Nitisha Gautam,1 Ranjeeta Subedi,1 Noor Kutubul Alam Siddiquee,6 Pradip Gyanwali,1 Ulrich Kuch,3 David A Groneberg,3 Anjani Kumar Jha,1 Meghnath Dhimal1,3 1Nepal Health Research Council (NHRC), Kathmandu, Nepal; 2Department of Community Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal; 3Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt am Main, Germany; 4Monitoring Evaluation and Operational Research (MEOR) Project, Abt Associates, Kathmandu, Nepal; 5KIST Medical College, Lalitpur, Nepal; 6Public Health Foundation of India, Bangalore, India*These authors contributed equally to this workCorrespondence: Anil Poudyal Email poudyalanil123@gmail.comBackground: The Global Burden of Diseases Study 2017 predicted that chronic obstructive pulmonary disease (COPD) is the second leading cause of death, the fourth leading cause of premature death, and the third cause for DALYs lost in Nepal. However, data on the population-based prevalence of COPD in Nepal are very limited. This study aims to assess the prevalence of COPD and factors associated with the occurrence of COPD in Nepal.Methods: From a nationally representative, population-based cross-sectional study on chronic non-communicable diseases, the prevalence of COPD and its associated factors was determined. Of 12,557 participants aged over 20 years, 8945 participants completed a questionnaire and spirometry. Eligible participants were also asked to answer a COPD diagnostic questionnaire for screening COPD cases, and if needed underwent pre-bronchodilator and post-bronchodilator spirometry. COPD was defined as a post-bronchodilator FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio of < 0.70. Multivariate logistic regression was performed to identify factors associated with COPD. Sampling weights were used for all data analyses.Results: The prevalence of COPD in Nepal was 11.7% (95% CI: 10.5% to 12.9 %), which increased with age, and higher in those with a low educational level, those who had smoked ≥ 50 pack-years, persons having a low body mass index (BMI), and residents of Karnali province. Multivariate analysis revealed that being aged 60 years and above, having a low BMI, low educational status, having smoked more than 50 pack-years, provincial distribution, and ethnicity were independent predictors of COPD.Conclusion: COPD is a growing and serious public health issue in Nepal. Factor such as old age, cigarette smoking, low educational attainment, low BMI, ethnicity, and locality of residence (province-level variation) plays a vital role in the occurrence of COPD. Strategies aimed at targeting these risk factors through health promotion and education interventions are needed to decrease the burden of COPD.Keywords: COPD, prevalence, non-communicable diseases, Nepal

Background:Aedes aegypti is a potential vector for several arboviruses including dengue and Zika viruses. The species seems to be restricted to subtropical/tropical habitats and has difficulties in establishing permanent populations in southern Europe, probably due to constraints during the winter season. The aim of this study was to systematically analyze the cold tolerance (CT) of Ae. aegypti in its most cold-resistant life stage, the eggs. Methods: The CT of Ae. aegypti eggs was compared with that of Ae. albopictus which is well established in large parts of Europe. By systematically studying the literature (meta-analysis), we recognized that CT has been rarely tested in Ae. aegypti eggs, but eggs can survive at zero and sub-zero temperatures for certain exposure periods. To overcome potential bias from experimental differences between studies, we then conducted species comparisons using a harmonized high-resolution CT measuring method. From subtropical populations of the same origin, the survival (hatching in %) and emergence of adults of both species were measured after zero and sub-zero temperature exposures for up to 9 days (3 °C, 0 °C and − 2 °C: ≤ 9 days; − 6 °C: ≤ 2 days). Results: Our data show that Ae. aegypti eggs can survive low and sub-zero temperatures for a short time period similar to or even better than those of Ae. albopictus. Moreover, after short sub-zero exposures of eggs of both species, individuals still developed into viable adults (Ae. aegypti: 3 adults emerged after 6 days at − 2 °C, Ae. albopictus: 1 adult emerged after 1 day at − 6 °C). Conclusions: Thus, both the literature and the present experimental data indicate that a cold winter may not be the preventing factor for the re-establishment of the dengue vector Ae. aegypti in southern Europe.

Additional file 1. PRISMA checklist.

Sustainable Development Goals (SDGs) comprise of 17 goals and 169 targets. All SDGs are interlinked to produce synergetic eff ects and emphasize health in all policies. Among the 17 Goals, Goal 3 has a central focus on health, which is underpinned by 13 targets. Th e other 16 goals are also directly or indirectly related to health and will contribute to achieving the associated targets for Goal 3. Th e ambitious SDG agenda and their progress can be tracked by measuring numerous goals, targets, and indicators. The main objective of this paper is to provide an overview about how health- related SDGs and their targets and indicators are being tracked in the national context of Nepal. Adequate investment in research for knowledge generation, capacity building and innovation, and continous research communication among policy makers, researchers and external development partners will contribute to tracking the progress of SDGs in Nepal.

Diagnosing and treating acute severe and recurrent antivenom-related anaphylaxis (ARA) is challenging and reported experience is limited. Herein, we describe our experience of severe ARA in patients with neurotoxic snakebite envenoming in Nepal. Patients were enrolled in a randomised, double-blind trial of high vs. low dose antivenom, given by intravenous (IV) push, followed by infusion. Training in ARA management emphasised stopping antivenom and giving intramuscular (IM) adrenaline, IV hydrocortisone, and IV chlorphenamine at the first sign/s of ARA. Later, IV adrenaline infusion (IVAI) was introduced for patients with antecedent ARA requiring additional antivenom infusions. Preantivenom subcutaneous adrenaline (SCAd) was introduced in the second study year (2012). Of 155 envenomed patients who received ≥ 1 antivenom dose, 13 (8.4%), three children (aged 5−11 years) and 10 adults (18−52 years), developed clinical features consistent with severe ARA, including six with overlapping signs of severe envenoming. Four and nine patients received low and high dose antivenom, respectively, and six had received SCAd. Principal signs of severe ARA were dyspnoea alone (n=5 patients), dyspnoea with wheezing (n=3), hypotension (n=3), shock (n=3), restlessness (n=3), respiratory/cardiorespiratory arrest (n=7), and early (n=1) and late laryngeal oedema (n=1); rash was associated with severe ARA in 10 patients. Four patients were given IVAI. Of the 8 (5.1%) deaths, three occurred in transit to hospital. Severe ARA was common and recurrent and had overlapping signs with severe neurotoxic envenoming. Optimising the management of ARA at different healthy system levels needs more research. This trial is registered with NCT01284855.

Table S1. STROBE checklist of the study. (PDF 162 kb)

Completed of STROBE checklist of the study. (PDF 478 kb)

Detailed questions used to assess knowledge and attitude domain. (PDF 342 kb)

Additional file 1: Appendix S1. Detailed explanation of the scope of variables and analytical method.

Table S2. Questionnaire used in the study. (PDF 201 kb)

Background The Asian tiger mosquito Aedes albopictus is an extremely invasive, globally distributed and medically important vector of various human and veterinary pathogens. In Germany, where this species was recently introduced, its establishment may become modulated by interspecific competition from autochthonous mosquito species, especially Culex pipiens (s.l.). While competitive superiority of Ae. albopictus to Cx. pipiens (s.l.) has been described elsewhere, it has not been assessed in the epidemiological conditions of Germany. The present study aimed to determine if such superiority exists under the physicochemical and microclimatic conditions typical for container habitats in Germany. Methods In a replacement series experiment, the larval and pupal responses of Ae. albopictus and Cx. pipiens (s.l.) (mortality, development time, growth) to interspecific interaction (five larval ratios) at (sub-)optimal temperatures (15, 20 and 25 °C) and differing food supply (3 and 6 mg animal-based food larva-1) were investigated using a randomized split-plot design. In addition to physicochemical measurements of the test media, natural physicochemical conditions were determined for comparative analyses in mosquito breeding sites across the Rhine-Main metropolitan region of Germany. Results Under the physicochemical and microclimatic conditions similar to the breeding sites of the Rhine-Main region, competitive superiority of Cx. pipiens (s.l.) to Ae. albopictus in terms of larval survival was more frequently observed than balanced coexistence. Food regime and multifactorial interactions, but not temperature alone, were controlling factors for interspecific competition. Larval food regime and the larval ratio of Ae. albopictus influenced the physicochemistry and algal growth at 15 °C, with increased Ae. albopictus mortality linked to a decreasing number of Scenedesmus, Oocystis and Anabaena algae. Conclusions Under the present environmental conditions, the spread of Ae. albopictus from isolated foci in Germany may generally be slowed by biotic interactions with the ubiquitous Cx. pipiens (s.l.) (and potentially other container-breeding mosquito species) and by limnic microalgae in microhabitats with high resource levels. Detailed knowledge of the context dependency in temperate mosquito ecology, and interrelations of physicochemistry and phycology may help to achieve a better understanding of the upcoming Ae. albopictus colonization processes in central and northern Europe. Electronic supplementary material The online version of this article (10.1186/s13071-018-2665-3) contains supplementary material, which is available to authorized users.

Pupal size. Abdominal length [AL, mm, mean ± SD] of female Ae. albopictus and Cx. pipiens in pure and mixed cohorts in dependence of temperature and larval food regime. Line - linear regression. Dotted lines - 95% confidence interval. (PPTX 558 kb)

Dates of egg collections and experimental onsets. Table S2. Age at pupation, age at emergence and age at adult death analysed for males and females. Table S3. Exponential curve parameters to estimate the generation time. The exponential curves are described as following: y = a × exp.(−bx) + c. The estimate of the duration of one generation is the age at emergence plus shifted 14 days up for taking blood meal and reproduction into account [offset c + 14 (days)]. Table S4. Selection of localities of present occurrence and number of potential generations per year. Table S5. Test statistics for sex ratio tests. Table S6. R1 wing vein length measurements. Figure S1. Median mortality per temperature. Boxplots show quartile ranges and medians and whiskers depict 1.5 times the interquartile range. Mortality was calculated considering individuals, which did not survive to emergence. Mortality of the 5 °C experiment was assessed on day 113 (see Table 1). Figure S2. Thermal performance: results of model selection. Model selection using the github R package thermPerf with the cumulative larval survival as performance variable. A: The importance of each model is shown as AIC weights with low weights showing models better fitting to the data. B: Fits of all ten models with the best fit as green line. During model selection, the empirical constants were calculated to a = 0.00006 and m = 2.127 for Briere et al. [46] eq. 2. Since m = 2 is implemented in Briere et al. [46] eq. 1 and since this model was considered best for fitting the data, non-linear regression of temperature-dependent cumulative female survival was done with this model (R2adj = 0.68) in order to calculate minimum, optimum and maximum temperatures for cumulative female survival. Figure S3. Life trait parameters as functions of temperature. Exponential curves fitted to the life cycle parameters age at pupation, age at emergence and age at adult death. The curve parameters are given in Table S3. (DOCX 112 kb)

Completed of STROBE checklist of the study. (PDF 236Â kb)

Distribution of the knowledge regarding dengue fever among participant groups with different socioeconomic level. (PDF 154Â kb)

Parameter-specific relative crowding coefficients. Relative crowding coefficient values for female and male Ae. albopictus (RCCAe) and Cx. pipiens (RCCCx) based on biomass accumulation rate (BA), pupal dry weight (DW), pupal abdominal length (AL) and mean pupation time (PT50) are listed for the different experimental treatments. (DOCX 15 kb)

Sampled localities positive for mosquito larvae in the Rhine-Main region. (PPTX 3726 kb)

Pupal weight. Dry weight [DW, mg, mean ± 95% CI] of female Ae. albopictus and Cx. pipiens in pure and mixed cohorts in dependence of temperature and larval food regime. Line - linear regression. Dotted lines - 95% confidence interval. (PPTX 558 kb)