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Purpose of Review: Health data sciences can help mitigate high burden of cardiovascular disease (CVD) management in South Asia by increasing availability and affordability of healthcare services. This review explores the current landscape, challenges, and strategies for leveraging digital health technologies to improve CVD outcomes in the region., Recent Findings: Several South Asian countries are implementing national digital health strategies that aim to provide unique health account numbers for patients, creating longitudinal digital health records while others aim to digitize healthcare services and improve health outcomes. Significant challenges impede progress, including lack of interoperability, inadequate training of healthcare workers, cultural barriers, and data privacy concerns. Leveraging digital health for CVD management involves using big data for early detection, employing artificial intelligence for diagnostics, and integrating multiomics data for health insights. Addressing these challenges through policy frameworks, capacity building, and international cooperation is crucial for improving CVD outcomes in region., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Food adulteration with toxic chemicals is a global public health threat. Lead chromate adulterated spices have been linked with lead poisoning in many countries, from Bangladesh to the United States. This study systematically assessed lead chromate adulteration in turmeric, a spice that is consumed daily across South Asia. Our study focused on four understudied countries that produce >80 % of the world's turmeric and collectively include 1.7 billion people, 22 % of the world's population. Turmeric samples were collected from wholesale and retail bazaars from 23 major cities across India, Pakistan, Sri Lanka, and Nepal between December 2020 and March 2021. Turmeric samples were analyzed for lead and chromium concentrations and maximum child blood lead levels were modeled in regions where samples had detectable lead. A total of 356 turmeric samples were collected, including 180 samples of dried turmeric roots and 176 samples of turmeric powder. In total, 14 % of the samples (n = 51) had detectable lead above 2 μg/g. Turmeric samples with lead levels greater than or equal to 18 μg/g had molar ratios of lead to chromium near 1:1, suggestive of lead chromate adulteration. Turmeric lead levels exceeded 1000 μg/g in Patna (Bihar, India) as well as Karachi and Peshawar (Pakistan), resulting in projected child blood lead levels up to 10 times higher than the CDC's threshold of concern. Given the overwhelmingly elevated lead levels in turmeric from these locations, urgent action is needed to halt the practice of lead chromate addition in the turmeric supply chain., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Despite progress, under-five mortality remains high, especially in Sub-Saharan Africa and South Asia, where around 13,400 children die daily. Environmental pollutants, including PM2.5 from outdoor air and household air pollution, significantly contribute to these preventable deaths., Methods: This cross-country study combined satellite data with 113 surveys from the IPUMS-DHS dataset (1998-2019) to examine under-five child mortality in 41 developing countries. The integration of Global Annual Particulate Matter with a diameter of 2.5 micrometres or less (PM2.5) Grids from Socioeconomic Data and Applications Center (SEDAC) and geospatial data from the DHS Program enabled a focused analysis of the association between indoor and outdoor air pollution, particularly PM2.5, and child mortality rates using both logistic and multilevel logistic regression models, as well as estimating Population Attributable Fractions (PAF) to quantify the mortality burden attributable to these pollutants., Results: Outdoor air pollution, measured by a one standard deviation increase in PM2.5, significantly increased the risk of child mortality (Odds Ratio [OR]: 1.14; 95% Confidence Interval [CI]: 1.10-1.18; p < 0.001). Moderate and high household air pollution exposure also heightened this risk, with increases of 37% (OR: 1.37; 95% CI: 1.24-1.53; p < 0.001) and 40% (OR: 1.40; 95% CI: 1.26-1.56; p < 0.001), respectively, compared to no exposure. Multilevel models (Models 5a and 10a) produced similar estimates to standard logistic regression, indicating robust associations. Additionally, Population Attributable Fraction analysis revealed that approximately 11.9% of under-five mortality could be prevented by reducing ambient PM2.5 exposure and 12.0% by mitigating household air pollution. The interaction between indoor and outdoor pollution revealed complex dynamics, with moderate and high household exposure associated with a reduction in mortality risk when combined with PM2.5. Geographical disparities were observed, with stronger correlations between outdoor air pollution and child mortality in Africa compared to Asia, and more pronounced impacts in low-income countries. However, household air pollution had stronger association with child mortality in Africa and lower- and middle-income countries., Conclusions: Our findings could serve as a guide for policy development aimed at reducing under-five mortality, ultimately contributing to the attainment of the Sustainable Development Goal (SDGs)., (© 2024. The Author(s).)

Background: Climate change is widely recognised to threaten human health, wellbeing and livelihoods, including through its effects on the emergence, spread and burdens of climate-and water-sensitive infectious diseases. However, the scale and mechanisms of the impacts are uncertain and it is unclear whether existing forecasting capacities will foster successful local-level adaptation planning, particularly in climate vulnerable regions in developing countries. The purpose of this scoping review was to characterise and map priority climate- and water-sensitive diseases, map existing forecasting and surveillance systems in climate and health sectors and scope out the needs and potential to develop integrated climate-driven early warning forecasting systems for long-term adaptation planning and interventions in the south Asia region., Methods: We searched Web of Science Core Collection, Scopus and PubMed using title, abstract and keywords only for papers focussing on climate-and water-sensitive diseases and explicit mention of either forecasting or surveillance systems in south Asia. We conducted further internet search of relevant national climate adaptation plans and health policies affecting disease management. We identified 187 studies reporting on climate-sensitive diseases and information systems in the south Asia context published between 1992 and 2024., Results: We found very few robust, evidenced-based forecasting systems for climate- and water- sensitive infectious diseases, which suggests limited operationalisation of decision-support tools that could inform actions to reduce disease burdens in the region. Many of the information systems platforms identified focussed on climate-sensitive vector-borne disease systems, with limited tools for water-sensitive diseases. This reveals an opportunity to develop tools for these neglected disease groups. Of the 34 operational platforms identified across the focal countries, only 13 (representing 38.2%) are freely available online and all were developed and implemented by the human health sector. Tools are needed for other south Asian countries (Afghanistan, Sri Lanka, Bhutan) where the risks of infectious diseases are predicted to increase substantially due to climate change, drought and shifts in human demography and use of ecosystems., Conclusion: Altogether, the findings highlight clear opportunities to invest in the co-development and implementation of contextually relevant climate-driven early warning tools and research priorities for disease control and adaptation planning., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Asaaga et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Diarrhoeal diseases cause a heavy burden in developing countries. Although studies have described the seasonality of diarrhoeal diseases, the association of weather variables with diarrhoeal diseases has not been well characterized in resource-limited settings where the burden remains high. We examined short-term associations between ambient temperature, precipitation and hospital visits due to diarrhoea among children in seven low- and middle-income countries., Methodology: Hospital visits due to diarrhoeal diseases under 5 years old were collected from seven sites in The Gambia, Mali, Mozambique, Kenya, India, Bangladesh, and Pakistan via the Global Enteric Multicenter Study from December 2007 to March 2011. Daily weather data during the same period were downloaded from the ERA5-Land. We fitted time-series regression models to examine the relationships of daily diarrhoea cases with daily ambient temperature and precipitation. Then, we used meta-analytic tools to examine the heterogeneity between the site-specific estimates., Principal Findings: The cumulative relative risk (RR) of diarrhoea for temperature exposure (95th percentile vs. 1st percentile) ranged from 0.24 to 8.07, with Mozambique and Bangladesh showing positive associations, while Mali and Pakistan showed negative associations. The RR for precipitation (95th percentile vs. 1st percentile) ranged from 0.77 to 1.55, with Mali and India showing positive associations, while the only negative association was observed in Pakistan. Meta-analysis showed substantial heterogeneity in the association between temperature-diarrhoea and precipitation-diarrhoea across sites, with I2 of 84.2% and 67.5%, respectively., Conclusions: Child diarrhoea and weather factors have diverse and complex associations across South Asia and Sub-Saharan Africa. Diarrhoeal surveillance system settings should be conceptualized based on the observed pattern of climate change in these locations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hossain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Air pollution in South Asia is a health emergency, responsible for 2 million deaths every year 1 . Crop residue burning accounts for 40-60% of peak pollution during the winter harvest months 2,3 . Despite being illegal, this practice remains widespread 4,5 . Any solution to curb the problem necessitates government action at scale. Here we study whether leveraging the incentives of bureaucrats tasked with controlling burning can mitigate this phenomenon. Using a decade of wind, fire and health data from satellites and surveys from the Demographic and Health Surveys Program, we show that crop burning responds to bureaucrat incentives: fires increase by 15% when wind is most likely to direct pollution to neighbouring jurisdictions, and decrease by 14.5% when it pollutes their own. These effects intensify with stronger bureaucratic incentives and capacity. We also find that bureaucrat action against burning deters future polluters, further reducing fires by 13%. Finally, using an atmospheric model, we estimate that one log increase in in utero exposure to pollution from burning raises child mortality by 30-36 deaths per 1,000 births, underscoring the importance of bureaucrat action. Contrary to the growing beliefs that the problem of crop burning is intractable 6,7 , these findings highlight specific ways in which existing bureaucrats, when properly incentivized, can improve environmental management and public health outcomes., (© 2024. The Author(s).)

This research investigates the intricate relationships between economic variables and how they affect South Asian nation's ability to develop sustainably. Given the growing concerns about climate change and global warming brought on by emissions of greenhouse gases, this study looks into the connection between emissions of CO 2 , green energy, industrialization, foreign direct investment, economic globalization, and financial development from 1995 to 2022. Second-generation panel techniques were employed in this study to look at the relationship between variables because of the potential of residual cross-sectional dependency and heterogeneity. The empirical outcomes display that green energy, economic globalization, and financial development reduce CO 2 emissions by 1.839%, 1.223%, and 3.902% respectively. Industrialization and foreign direct investment degrade the environment by 4.302% and 1.893% respectively. A bidirectional causality link between green energy, industrialization, economic globalization, and CO 2 emissions was found by Dumitrescu and Hurlin (D-H). Based on our findings, we recommend legislative support for renewable energy, cleaner technologies, and strict environmental regulations, aligning with the Sustainable Development Goals (SDGs). Encouraging FDI, sustainable practices, and financial development can drive economic growth while preserving the environment. As we approach COP28, this holistic approach to sustainable development becomes increasingly vital for South Asian countries to achieve their SDG targets and combat climate change., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The south Asian region (SAR) is home to 1·74 billion people, corresponding to 22% of the global population. The region faces several challenges pertaining to changing epidemiology, rapid urbanisation, and social and economic concerns, which affect health outcomes. Primary health care (PHC) is a cost-effective strategy to respond to these challenges through integrated service delivery, multi-sectoral action, and empowered communities. The PHC approach has historically been an important cornerstone of health policy in SAR countries. However, the region is yet to fully reap the benefits of PHC-oriented health systems. Our introductory paper in this Lancet Series on PHC in the SAR describes the existing PHC delivery structure in five SAR nations (ie, Bangladesh, India, Nepal, Pakistan, and Sri Lanka) and critically appraises PHC performance to identify its enablers and barriers. The paper proposes investing in a shared culture of innovation and collaboration for revitalisation of PHC in the region., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: SMT holds a NHMRC Investigator Grant helped cover time spent on this commentary; lead two paid consultancies for AHSPR in 2020 conducting literature reviews on the intersection of evolving COVID 19 responses and primary health care; and is an unpaid member of the Board of Directors of Health Systems Global. RG is Director of Research at the Family Health Centers at NYU Langone (FHC). The views expressed in this Comment are hers alone and do not necessarily reflect those of the FHC. All other authors declare no competing interests.

Adult survivors of childhood sexual abuse (CSA) may experience emotional, social, and psychological difficulties, heightened due to the interpersonal nature of harm. Despite the demonstrated effectiveness of trauma-focused treatments in the West, a culturally specific understanding of the needs of and treatments for survivors in South Asia is still in its infancy. The study aimed to systematically review research findings on the mental health impacts of CSA on adult survivors and current treatment approaches and their efficacy and acceptability in South Asia. Seven databases (Scopus, Ovid, CINAHL, ProQuest, EThOS, Google Scholar, and Dogpile) and five peer-reviewed South Asian journals were searched from inception until March 30, 2023. Searches included participants who were adult survivors of CSA of South Asian origin residing in South Asia. Studies on their mental health, different treatments, and the efficacy and acceptability of these treatments were included. Quality assessment tools were used to appraise the quality of included studies. The results were synthesized narratively. A total of 3,362 records were retrieved, and 24 articles were included in the final review. Twenty studies reported mental health impacts of CSA on adult survivors, four studies reported current treatments offered, and two studies were on recovery. However, no study focused on the efficacy or acceptability of the treatments being delivered. Even though the needs of adult CSA survivors in South Asia have been partly identified, there is very little research into the treatments for them., Competing Interests: DisclosureA conference abstract for a poster presentation of the review findings was published in July 2023: Talwar, S., Osorio, C., Appleton, R., & Billings, J. (2023). Experiences of and Interventions for Adult Survivors of Childhood Sexual abuse in South Asia: A systematic review. European Psychiatry, 66(Suppl 1), S980–S981. https://doi.org/10.1192/j.eurpsy.2023.2085).The findings have been presented at University College London interdisciplinary symposium and have been briefly mentioned in their blog on the University website: https://www.ucl.ac.uk/social-historical-sciences/our-departments/shs-health-mind-and-society/news/colonial-legacies-contemporary-inequities-early. Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

South Asia is rapidly urbanising. The strains of rapid urbanisation have profound implications for the health and equity of urban populations. This Series paper examines primary health care (PHC) in south Asian cities. Health and its social determinants vary considerably across south Asian cities and substantial socioeconomic inequities are present. Although cities offer easy geographical access to PHC services, financial hardship associated with health care use and low quality of care are a concern, particularly for low-income residents. Providing better PHC in south Asia requires a multi-sectoral response, with effective and resourced urban local bodies; increased public financing for health care; and new service delivery models aimed at low-income urban communities that involve strengthening public sector services, strengthening government engagement with private providers where necessary, and engaging with low-income communities and the PHC providers that serve them., Competing Interests: Declaration of interests We declare funding from the Department of Health Systems Development, WHO South-East Asia Regional Office (WHO SEAR) for this study., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Candida auris is a globally disseminated invasive ascomycetous yeast, that imposes a substantial burden on healthcare systems. It has been documented to have spread to over 40 countries across six continents, necessitating in-depth comprehension through advanced techniques like Whole-Genome Sequencing., Method: This study entailed the isolation and Whole-Genome Sequencing of a fluconazole-resistant C. auris strain (CA01) obtained from a patient's blood in Beijing. Genome analysis was conducted to classify the strain, and molecular docking was performed to understand the impact of mutations on drug resistance., Results: Genome analysis revealed that CA01 belongs to the South Asia Clade (I) and shares the closest genetic relationship with previously reported strains BJCA001 and BJCA002. Notably, unlike BJCA001, CA01 exhibits significant resistance to fluconazole primarily due to the A395T mutation in the ERG11 gene. Molecular docking studies demonstrated that this mutation leads to geometric changes in the active site where fluconazole binds, resulting in decreased binding affinity. Additionally, the present findings have identified several core virulence genes in C. auris, such as RBF1., Discussion: The findings from this study expand the understanding of the genetic diversity and adaptive mechanisms of C. auris within the South Asia Clade (I). The observed fluconazole resistance driven by the ERG11 mutation A395T highlights the need for heightened awareness and adaptation in clinical treatment strategies in China. This study provides critical insights into drug resistance and virulence profiles at a genetic level, which could guide future therapeutic and management strategies for C. auris infections., Competing Interests: Conflicts of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Non-communicable diseases (NCDs) are a global epidemic challenging global public health authorities while imposing a heavy burden on healthcare systems and economies., Aim: To explore and compare the prevalence of NCDs in South Asia, the Caribbean, and non-sub-Saharan Africa, aiming to identify both commonalities and differences contributing to the NCD epidemic in these areas while investigating potential recommendations addressing the NCD epidemic., Method: A comprehensive search of relevant literature was carried out to identify and appraise published articles systematically using the Cochrane Library, Ovid, Google Scholar, PubMed, Science Direct, and Web of Science search engines between 2010 and 2023. A total of 50 articles fell within the inclusion criteria., Results: Numerous geographical variables, such as lifestyle factors, socio-economic issues, social awareness, and the calibre of the local healthcare system, influence both the prevalence and treatment of NCDs. The NCDs contributors in the Caribbean include physical inactivity, poor fruit and vegetable intake, a sedentary lifestyle, and smoking, among others. While for South Asia, these were: insufficient societal awareness of NCDs, poverty, urbanization, industrialization, and inadequate regulation implementation in South Asia. Malnutrition, inactivity, alcohol misuse, lack of medical care, and low budgets are responsible for increasing NCD cases in Africa., Conclusion: Premature mortality from NCDs can be avoided using efficient treatments that reduce risk factor exposure for individuals and populations. Proper planning, implementation, monitoring, training, and research on risk factors and challenges of NCDs would significantly combat the situation in these regions., (© 2024. The Author(s).)

Exotic animal practice is at its infancy in South Asia. We lack the formal education for this subject. However, new policies and improvements in the veterinary education system and a positive shift in demographics of exotic animals as pets have led to an upsurge of knowledge about this subject. Earlier people were forced to treat exotic animals, however, now there are many veterinarians who make it a choice to treat these species. This shift in trend will help exotic animal practice grow in South Asia., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The rising burden of cancer significantly influences the global economy and healthcare systems. While local and contextual cancer research is crucial, it is often limited by the availability of funds. In South Asia, with 1.7 million new cancer cases and 1.1 million deaths due to cancer in 2020, understanding cancer research funding trends is pivotal., Methods: We reviewed funded cancer studies conducted between January 1, 2003, and Dec 31, 2022, using ClinicalTrials.gov, International Cancer Research Partnership (ICRP) Database, NIH World RePORT, and WHO International Clinical Trials Registry Platform (ICTRP). We included funded studies related to all cancer types, conducted in South Asian countries, namely Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka., Results: We identified 6561 funded cancer studies from South Asia between 2003 and 2022, increasing from 400 studies in 2003-2007 to 3909 studies in 2018-2022. India had the highest number of funded cancer studies, while Afghanistan, Bhutan, and the Maldives had minimal or no funded cancer research output. Interventional studies (67.3%) were the most common study type funded. The most common cancer sites funded were breast (17.8%), lung (9.9%), oropharyngeal (6.2%), and cervical (5.0%) cancers. On the WHO ICTRP, international funding agencies contributed to a majority of studies (57.5%), except in India where local funding agencies (58.2%) funded more studies., Conclusion: This study identified gaps in research funding distribution across cancer types and geographic areas in South Asia. This data can be used to optimize the distribution of cancer research funding in South Asia, fostering equitable advancement in cancer research., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: This study updates our findings from the COVID-19 pandemic surveillance we first conducted in South Asia in 2020 with 2 additional years of data for the region. We assess whether COVID-19 had transitioned from pandemic to endemic at the point the World Health Organization (WHO) ended the public health emergency status for COVID-19 on May 5, 2023., Objective: First, we aim to measure whether there was an expansion or contraction in the pandemic in South Asia around the WHO declaration. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aim to provide historical context for the course of the pandemic in South Asia., Methods: In addition to updating the traditional surveillance data and dynamic panel estimates from our original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional weekly speed or transmission rate per 100,000 population was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period., Results: Speed for the region had remained below the outbreak threshold for over a year by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1-day persistence coefficients remained statistically significant and positive (1.168), the 7-day persistence coefficient was negative (-0.185), suggesting limited cluster effects in which cases on a given day predict cases 7 days forward. Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, did not indicate any overall change in the persistence measure around the time of the WHO declaration. From December of 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 was statistically insignificant across the entire pandemic., Conclusions: While COVID-19 continued to circulate in South Asia, the rate of transmission had remained below the outbreak threshold for well over a year ahead of the WHO declaration. COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. Both standard and enhanced surveillance metrics confirm that the pandemic had ended by the time of the WHO declaration. Prevention policies should be a focus ahead of future pandemics. On that point, policy should emphasize an epidemiological task force with widespread testing and a contact-tracing system., (©Lori A Post, Alan G Soetikno, Scott A Wu, Claudia Hawkins, Maryann Mason, Egon A Ozer, Robert L Murphy, Sarah B Welch, Yingxuan Liu, Robert J Havey, Charles B Moss, Chad J Achenbach, Alexander L Lundberg. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 26.08.2024.)

Stroke causes around 730,000 deaths in South Asia, nearly half of stroke-related deaths in developing countries. This highlights the need to address health system responses, considering poverty, service quality, and availability. The article identifies four key challenges in stroke management and rehabilitation in South Asia, emphasizing long-term monitoring, risk factor control, and community surveillance, drawing on experiences from Nepal., Competing Interests: Shiva Raj Mishra serves as a deputy editor in Global Heart. The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

In the developing world, the twin challenges of depleted health and growing issue of food waste management loom large, demanding simultaneous attention and innovative solutions. This review explores how these issues can be effectively mitigated while shedding light on the transformative impact of food waste valorization on health management. A spotlight is cast on vitamin A deficiency (VAD), an acute public health concern, especially prevalent in South Asia, driven by economic constraints, sociocultural factors, inadequate diets, and poor nutrient absorption. VAD's devastating effects are exacerbated by limited education, lack of sanitation, ineffective food regulations, and fragile monitoring systems, disproportionately affecting children and women of childbearing age. Recent studies in South Asian countries have revealed rising rates of illness and death, notably among children and women of childbearing age, due to VAD. To address inadequate dietary intake in children utilizing vegetable waste, particularly from carrots and beetroot, which are rich in β-carotene, and betalains, respectively, offers a sustainable solution. Extracting these compounds from vegetable waste for supplementation, fortification, and dietary diversification could significantly improve public health, addressing both food waste and health disparities economically. This approach presents a compelling avenue for exploration and implementation. In summary, this review presents an integrated approach to tackle health and food waste challenges in the developing world. By tapping into the nutritional treasure troves within vegetable waste, we can enhance health outcomes while addressing food waste, forging a brighter and healthier future for communities in need., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Membrane sweeping promotes the spontaneous onset of labor, reducing the need for formal labor induction. In addition to the safety profile, membrane sweep is a cost-effective measure in a low-resource setting like South Asia., Objectives: To the best of our knowledge, previous reviews and meta-analyses have not explored the timing and frequency of membrane sweeping or its association with the period of gestation (POG) and parity. Additionally, the results should be interpreted with caution due to the inclusion of older studies and the analyses conducted regardless of ethnicity in previous literature. We addressed these gray areas in the current study to fill the research gap., Search Strategy: We searched PubMed, Google Scholar, Science Direct, and Cochrane Reviews. Study selection was performed using the semi-automated tool Rayyan., Selection Criteria: The selection criteria for this study encompassed the inclusion of randomized controlled trials (RCTs) published in English between January 2010 and May 2023, with accessible full-text articles. The focus was on low-risk pregnant women carrying a single fetus in a cephalic presentation at term (37-42 weeks) gestation, confirmed by reliable methods. Essential data for relative risk (RR) and 95% confidence interval (CI) calculation must be present., Data Collection and Analysis: The Cochrane risk-of-bias (RoB2) tool and funnel plots were used to assess bias. Review Manager (RevMan) 5.4 version was used for analysis. The Mantel-Haenszel statistics and random effects were used to calculate the overall effect of risk ratio with a 95% confidence interval. Study heterogeneity was calculated using the I 2 statistic. Two subgroups were used in the analysis: South Asia and the rest of the world., Main Results: A total of 13 RCTs with 2599 participants were analyzed. Overall, membrane sweep effectively reduced formal IOL with an effect size of 2.43 (95% CI: 1.51-3.91). It also promoted spontaneous labor with an effect size of 1.71 (95% CI: 1.15-2.55). In the South Asian subgroup, membrane sweeping significantly promoted the spontaneous onset of labor with an overall effect of 1.85 (95% CI: 1.37-2.51), and in the rest of the world subgroup, membrane sweeping significantly reduced formal labor induction with an overall effect of 1.93 (95% CI: 1.33-2.82). The pooled effects were significant in mulipara with a POG ≥40 W in the South Asian subgroup., Conclusions: Membrane sweeping effectively reduces the need for formal labor induction and promotes spontaneous labor. This may be particularly relevant in South Asian populations where a disproportionate ethnic contribution to stillbirth rates is noted. Due to the limited number of RCTs addressing the factors and study methodology heterogeneity, we had limited data in some subgroup analyses. Therefore, we encourage more RCTs and meta-analyses on POG, parity, timing and frequency of membrane sweeping, and ethnic differences., (© 2024 International Federation of Gynecology and Obstetrics.)

This study investigated the impact of climate change on flood susceptibility in six South Asian countries Afghanistan, Bangladesh, Bhutan, Bharat (India), Nepal, and Pakistan-under two distinct Shared Socioeconomic Pathway (SSP) scenarios: SSP1-2.6 and SSP5-5.8, for 2041-2060 and 2081-2100. To predict flood susceptibility, we employed three artificial intelligence (AI) algorithms: the K-nearest neighbor (KNN), conditional inference random forest (CIRF), and regularized random forest (RRF). Predictions were based on data from 2452 historical flood events, alongside climatic variables measured over monthly, seasonal, and annual timeframes. The innovative aspect of this research is the emphasis on using climatic variables across these progressively condensed timeframes, specifically addressing eight precipitation factors. The performance evaluation, employing the area under the receiver operating characteristic curve (AUC) metric, identified the RRF model as the most accurate, with the highest AUC of 0.94 during the testing phase, followed by the CIRF (AUC = 0.91) and the KNN (AUC = 0.86). An analysis of variable importance highlighted the substantial role of certain climatic factors, namely precipitation in the warmest quarter, annual precipitation, and precipitation during the wettest month, in the modeling of flood susceptibility in South Asia. The resultant flood susceptibility maps demonstrated the influence of climate change scenarios on susceptibility classifications, signalling a dynamic landscape of flood-prone areas over time. The findings revealed variable trends under different climate change scenarios and periods, with marked differences in the percentage of areas classified as having high and very high flood susceptibility. Overall, this study advances our understanding of how climate change affects flood susceptibility in South Asia and offers an essential tool for assessing and managing flood risks in the region., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Through a comprehensive investigation into the historical profiles of black carbon derived from ice cores, the spatial distributions of light-absorbing impurities in snowpit samples, and carbon isotopic compositions of black carbon in snowpit samples of the Third Pole, we have identified that due to barriers of the Himalayas and remove of wet deposition, local sources rather than those from seriously the polluted South Asia are main contributors of light-absorbing impurities in the inner part of the Third Pole. Therefore, reducing emissions from residents of the Third Pole themselves is a more effective way of protecting the glaciers of the inner Third Pole in terms of reducing concentrations of light-absorbing particles in the atmosphere and on glaciers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: South Asian region contributes 59 % to the global mortality due to burns. However, we find a paucity of literature on the outcomes of burns from low- and middle-income countries (LMICs). South Asian Burn Registry (SABR) is a facility-based burns registry that collected data on in-patient burn care. This study assesses factors associated with mortality, length of hospital stay at the burns center, and functional status of burn patients., Methods: Prospective data was collected from two specialized public sector burn centers between September 2014 - January 2015 from Bangladesh and Pakistan. Multivariable logistic, linear, and ordinal logistic regression was conducted to assess factors associated with inpatient-mortality, length of hospital stay, and functional status at discharge, respectively., Results: Data on 883 patients was analyzed. Increased association with mortality was observed with administration of blood product (OR:3, 95 % CI:1.18-7.58) and nutritional support (OR:4.32, 95 % CI:1.55-12.02). Conversely, antibiotic regimens greater than 8 days was associated with decreased mortality (OR:0.1, 95 % CI:0.03-0.41). Associated increase in length of hospital stay was observed in patients with trauma associated with their burn injury, history of seizures (CE:47.93, 95 % CI 12.05-83.80), blood product (CE:22.09, 95 % CI:0.83-43.35) and oxygen administration (CE:23.7, 95 % CI:7.34-40.06). Patients who developed sepsis (OR:6.89, 95 % CI:1.92-24.73) and received blood products during hospitalization (OR:2.55, 95 % CI:1.38- 4.73) were more likely to have poor functional status at discharge., Conclusion: This study identified multiple factors associated with worse clinical outcomes for burn patients in South Asia. Understanding these parameters can guide targeted efforts to improve the process and quality of burn care in LMICs., Competing Interests: Declaration of Competing Interest The authors do not have any conflict of interest to declare., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Background: Cervical cancer is a preventable cancer by screening, vaccination and timely management of preinvasive cervical lesions. However, about 90% of the global burden of cervical cancer is reported from developing countries., Objective: This systematic review aimed to analyze the strategies implemented for cervical cancer screening in South Asia., Search Strategy: An electronic search of PubMed/MEDLINE, Scopus and Google Scholar was carried out for articles published in English, evaluating the implementation of cervical cancer screening between December 2000 and June 2023 in South Asia using appropriate search terms., Selection Criteria: Cross-sectional studies, randomized control trials (RCTs) or non-randomized controlled trials evaluating different cervical screening strategies were included., Data Collection and Analysis: A three-stage selection process was performed using a validated proforma including the title, author, year of publication, objective, country, study design, screening methods, strategies and outcomes, and results. The systematic review was designed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was evaluated with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools., Main Results: Out of the initial 1135 articles reviewed systematically, 23 studies met the inclusion criteria and were included in the qualitative synthesis of results. The implementation outcomes measured were acceptability (n = 23 100%), feasibility (n = 22, 95.7%), fidelity (n = 14, 60.9%), sustainability (n = 7, 30.4%), coverage (n = 4, 17.4%) and cost (n = 1, 4.3%)., Conclusion: Cervical cancer screening can be effectively implemented by restructuring the ongoing programs., (© 2024 International Federation of Gynecology and Obstetrics.)

Abstract: The manuscript summarizes the outcomes of a one-day conference by the South Asian College of American College of Clinical Pharmacology (SAC-ACCP) in July 2023, at Bhopal. The theme of the conference was "Advancing pediatric drug development in South Asia." SAC-ACCP organized this event in Bhopal to foster the discipline of clinical pharmacology and to motivate researchers and physicians in the in the central part of India. The conference featured presentations on regional approaches to pediatric drug development in Asia by pediatric scientific experts from the pharmaceutical industry, regulatory agencies, as well as independent consultancies. The speakers highlighted several important aspects of the evolving regulatory landscape in India and proposed numerous actionable steps in acceleration of pediatric drug development. This commentary provides insights from presentations and the panel discussion at this conference and also makes an attempt to connect to similar discussions that occurred at the SAC-ACCP drug development conference in 2017., (Copyright © 2024 Copyright: © 2024 Indian Journal of Pharmacology.)

Anthropogenic influences significantly modify the hydrochemical properties and material flow in riverine ecosystems across Asia, potentially accounting for 40-50% of global emissions. Despite the pervasive impact on Asian rivers, there is a paucity of studies investigating their correlation with carbon dioxide (CO 2 ) emissions. In this study, we computed the partial pressure of CO 2 (pCO 2 ) using the carbonate equilibria-based model (pCO 2 SYS) and examined its correlation with hydrochemical parameters from historical records at 91 stations spanning 2013-2021 in the Ganga River. The investigation unveiled substantial spatial heterogeneity in the pCO 2 across the Ganga River. The pCO 2 concentration varied from 1321.76 μatm, 1130.98 μatm, and 1174.33 μatm in the upper, middle, and lower stretch, respectively, with a mean of 1185.29 μatm. Interestingly, the upper stretch exhibited elevated mean pCO 2 and FCO 2 levels (fugacity of CO 2 : 3.63 gm 2 d -1 ) compared to the middle and lower stretch, underscoring the intricate interplay between hydrochemistry and CO 2 dynamics. In the context of pCO 2 fluctuations, nitrate concentrations in the upper segment and levels of biological oxygen demand (BOD) and dissolved oxygen (DO) in the middle and lower segments are emerging as crucial explanatory factors. Furthermore, regression tree (RT) and importance analyses pinpointed biochemical oxygen demand (BOD) as the paramount factor influencing pCO 2 variations across the Ganga River (n = 91). A robust negative correlation between BOD and FCO 2 was also observed. The distinct longitudinal patterns of both parameters may induce a negative correlation between BOD and pCO 2 . Therefore, comprehensive studies are necessitated to decipher the underlying mechanisms governing this relationship. The present insights are instrumental in comprehending the potential of CO 2 emissions in the Ganga River and facilitating riverine restoration and management. Our findings underscore the significance of incorporating South Asian rivers in the evaluation of the global carbon budget., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Clinical practice guidelines (CPGs) are a helpful tool for the evidence-based management of Type 2 Diabetes Mellitus (T2D). The aim of this systematic review was to synthesize and appraise the scope and quality of South Asian T2D CPGs., Methods: This PROPSERO registered (CRD42023425150) systematic review adhered to the 2020 PRISMA guidelines. We searched the PubMed, Embase, Cochrane, and Google Scholar databases for relevant guidelines. Data synthesis was performed using a qualitative approach and methodological quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool., Results: We identified eleven unique CPGs (three each from Pakistan and Sri Lanka, two from India, and one each from Bangladesh, Nepal, and Bhutan) which were published or updated between 2017 and 2023. The CPGs included recommendations regarding screening, diagnosis, prevention, and management of T2D and its acute and chronic complications, comorbidities, and fasting with T2D. The AGREE II mean domain scores ranged from 37 % to 80 %; three CPGs were 'recommended for clinical use,' seven were 'recommended for use with modifications' and one was deemed unfit for implementation., Conclusion: The present review summarized and appraised broadly CPGs from South Asia for T2D and can help direct improvements to future iterations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Post-kala-azar dermal leishmaniasis (PKDL) arises as a dermal complication following a visceral leishmaniasis (VL) infection. Current treatment options for PKDL are unsatisfactory, and there is a knowledge gap regarding the distribution of antileishmanial compounds within human skin. The present study investigated the skin distribution of miltefosine in PKDL patients, with the aim to improve the understanding of the pharmacokinetics at the skin target site in PKDL., Methods: Fifty-two PKDL patients underwent treatment with liposomal amphotericin B (20 mg/kg) plus miltefosine (allometric dosing) for 21 days. Plasma concentrations of miltefosine were measured on study days 8, 15, 22 and 30, while a punch skin biopsy was taken on day 22. A physiologically based pharmacokinetic (PBPK) model was developed to evaluate the distribution of miltefosine into the skin., Results: Following the allometric weight-based dosing regimen, median miltefosine concentrations on day 22 were 43.73 µg/g (IQR: 21.94-60.65 µg/g) in skin and 33.29 µg/mL (IQR: 25.9-42.58 µg/mL) in plasma. The median individual concentration ratio of skin to plasma was 1.19 (IQR: 0.79-1.9). In 87% (45/52) of patients, skin exposure was above the suggested EC90 PK target of 10.6 mg/L associated with in vitro susceptibility. Simulations indicated that the residence time of miltefosine in the skin would be more than 2-fold longer than in plasma, estimated by a mean residence time of 604 versus 266 hours, respectively., Conclusion: This study provides the first accurate measurements of miltefosine penetration into the skin, demonstrating substantial exposure and prolonged retention of miltefosine within the skin. These findings support the use of miltefosine in cutaneous manifestations of leishmaniasis. In combination with parasitological and clinical data, these results are critical for the future optimization of combination therapies with miltefosine in the treatment of PKDL., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Purpose: Retinoblastoma (RB) is the most common intraocular tumor in pediatric age group. The role of genetics has been explored in predicting survival prognosis, but its role in predicting globe salvage remains largely unexplored. We hereby aim to isolate cell-free DNA (cfDNA) from aqueous humor (AH) in RB eyes and validate its use for genetic studies., Methods: AH was obtained from 26 eyes undergoing enucleation (arm A) or intravitreal chemotherapy (arm B). Isolation of cfDNA was done using QIAamp ® Circulating Nucleic Acid kit, and the cfDNA was utilized for targeted sequencing of RB1 gene., Results: We could isolate cfDNA in all eyes (72% unilateral and 28% bilateral) with a distribution peak between 140 and 160 bp and a mean concentration of 27.75 ng/µl for arm A and 14 ng/µl for arm B. Targeted sequencing done on four samples showed RB1 gene mutations, namely, inframe deletion (c. 78-80del, p.Pro29del), start-loss mutation (c.1A>T, p.Met1?), nonsense mutations (c.2236G>T, p.Glu746Ter), (c.1659T>A, p.Cys553Ter), and (c.2065C>T, p.Gln689Ter), and novel missense mutations (c.672C>A, p.Asp224Glu) and c.692C>T (p.Pro231Leu). Genetic profile of cfDNA extracted from AH and genomic DNA from the tumor tissue was comparable., Conclusion: Our study supports the previous reports that AH may be used as a source of tumor-derived cfDNA. This is the first report from South Asia on isolation and genetic analysis of cfDNA from AH of RB eyes and, therefore, a big step forward in paving the role of tumor genetics in RB. Further studies are required to elucidate concordance between the tumor and AH genetic profile., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Background: Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes., Methods: We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120-129 and dBP < 80), stage 1 hypertension (sBP 130-139 or dBP 80-89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group., Results: From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes., Conclusion: The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension., (© 2024. The Author(s).)

Background: The objective of this study is to conduct a temporal analysis of rheumatic heart disease (RHD) disease burden trends over a 30-year period (1991 to 2021), focusing on prevalence, deaths, and disability-adjusted life years (DALYs) in the South Asia (SA)., Methods: In this ecological study, we analyzed data regarding burden of RHD from the Global Burden of Diseases (GBD) study spanning the years 1991 to 2021 for the SA Region. Estimates of the number RHD-related prevalence, deaths, and DALYs along with age-standardized rates (ASR) per 100,000 population and 95% uncertainty intervals (UI) were evaluated., Results: The overall prevalent cases of RHD in the 2021 were 54785.1 × 10 3 (43328.4 × 10 3 to 67605.5 × 10 3 ), out of which 14378.8 × 10 3 (11206.9 × 10 3 to 18056.9 × 10 3 ) were from SA. The ASR of point prevalence showed upward trend between 1991 and 2021, at global level and for SA with an average annual percentage change (AAPC) of 0.40 (0.39 to 0.40) and 0.12 (0.11 to 0.13), respectively. The overall number of RHD-related deaths in the 2021 were 373.3 × 10 3 (324.1 × 10 3 to 444.8 × 10 3 ), out of which 215 × 10 3 (176.9 × 10 3 to 287.8 × 10 3 ) were from SA, representing 57.6% of the global deaths. The ASR of deaths also showed downward trend between 1991 and 2021, at global level and for SA with an AAPC of -2.66 (-2.70 to -2.63) and -2.07 (-2.14 to -2.00), respectively. The ASR of DALYs showed downward trend between 1990 and 2019, at global level and for South Asian region with an AAPC of -2.47 (-2.49 to -2.44) and -2.22 (-2.27 to -2.17), respectively., Conclusion: The rising age-standardized prevalence of RHD remains a global concern, especially in South Asia which contribute to over 50% of global RHD-related deaths. Encouragingly, declining trends in RHD-related deaths and DALYs hint at progress in RHD management and treatment on both a global and regional scale., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Diabetes control is poor globally and leads to burdensome microvascular and macrovascular complications. We aimed to assess post hoc between-group differences in sustained risk factor control and macrovascular and microvascular endpoints at 6.5 years in the Center for cArdiovascular Risk Reduction in South Asia (CARRS) randomized trial., Methods and Findings: This parallel group individual randomized clinical trial was performed at 10 outpatient diabetes clinics in India and Pakistan from January 2011 through September 2019. A total of 1,146 patients with poorly controlled type 2 diabetes (HbA1c ≥8% and systolic BP ≥140 mm Hg and/or LDL-cholesterol ≥130 mg/dL) were randomized to a multicomponent quality improvement (QI) strategy (trained nonphysician care coordinator to facilitate care for patients and clinical decision support system for physicians) or usual care. At 2.5 years, compared to usual care, those receiving the QI strategy were significantly more likely to achieve multiple risk factor control. Six clinics continued, while 4 clinics discontinued implementing the QI strategy for an additional 4-year follow-up (overall median 6.5 years follow-up). In this post hoc analysis, using intention-to-treat, we examined between-group differences in multiple risk factor control (HbA1c <7% plus BP <130/80 mm Hg and/or LDL-cholesterol <100 mg/dL) and first macrovascular endpoints (nonfatal myocardial infarction, nonfatal stroke, death, revascularization [angioplasty or coronary artery bypass graft]), which were co-primary outcomes. We also examined secondary outcomes, namely, single risk factor control, first microvascular endpoints (retinopathy, nephropathy, neuropathy), and composite first macrovascular plus microvascular events (which also included amputation and all-cause mortality) by treatment group and whether QI strategy implementation was continued over 6.5 years. At 6.5 years, assessment data were available for 854 participants (74.5%; n = 417 [intervention]; n = 437 [usual care]). In terms of sociodemographic and clinical characteristics, participants in the intervention and usual care groups were similar and participants at sites that continued were no different to participants at sites that discontinued intervention implementation. Patients in the intervention arm were more likely to exhibit sustained multiple risk factor control than usual care (relative risk: 1.77; 95% confidence interval [CI], 1.45, 2.16), p < 0.001. Cumulatively, there were 233 (40.5%) first microvascular and macrovascular events in intervention and 274 (48.0%) in usual care patients (absolute risk reduction: 7.5% [95% CI: -13.2, -1.7], p = 0.01; hazard ratio [HR] = 0.72 [95% CI: 0.61, 0.86]), p < 0.001. Patients in the intervention arm experienced lower incidence of first microvascular endpoints (HR = 0.68 [95% CI: 0.56, 0.83), p < 0.001, but there was no evidence of between-group differences in first macrovascular events. Beneficial effects on microvascular and composite vascular outcomes were observed in sites that continued, but not sites that discontinued the intervention., Conclusions: In urban South Asian clinics, a multicomponent QI strategy led to sustained multiple risk factor control and between-group differences in microvascular, but not macrovascular, endpoints. Between-group reductions in vascular outcomes at 6.5 years were observed only at sites that continued the QI intervention, suggesting that practice change needs to be maintained for better population health of people with diabetes., Trial Registration: ClinicalTrials.gov NCT01212328., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: MKA has received research support (to Emory University) from Merck and consulting fees from Bayer and Eli Lilly, all outside the scope of this work. SP received research funding in the area of CVD implementation sciences. All other authors have declared that no competing interests exist., (Copyright: © 2024 Ali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

A fecal survey in Tamil Nadu, India, revealed 2 persons passed schistosome eggs, later identified as Schistosoma incognitum, a parasite of pigs, dogs, and rats. We investigated those cases and reviewed autochthonous schistosomiasis cases from India and Nepal. Whether the 2 new cases represent true infection or spurious passage is undetermined.

Although there is growing global momentum behind food systems strategies to improve planetary and human health-including nutrition-there is limited evidence of what types of food systems interventions work. Evaluating these types of interventions is challenging due to their complex and dynamic nature and lack of fit with standard evaluation methods. In this article, we draw on a portfolio of 6 evaluations of food systems interventions in Africa and South Asia that were intended to improve nutrition. We identify key methodological challenges and formulate recommendations to improve the quality of such studies. We highlight 5 challenges: a lack of evidence base to justify the intervention, the dynamic and multifaceted nature of the interventions, addressing attribution, collecting or accessing accurate and timely data, and defining and measuring appropriate outcomes. In addition to more specific guidance, we identify 6 cross-cutting recommendations, including a need to use multiple and diverse methods and flexible designs. We also note that these evaluation challenges present opportunities to develop new methods and highlight several specific needs in this space., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Predatory journals offer the promise of prompt publication to those willing to pay the article submission or processing fee. However, these journals do not offer rigorous peer review. Studies have shown that a substantial share of corresponding authors in predatory journals come from South Asia, particularly India. This scoping review aims to assess what is known about the reasons why healthcare researchers working in South Asia publish in predatory journals. 66 reports (14 editorials, 20 letters, 5 research reports, 10 opinion articles, 14 reviews, 2 commentaries and 1 news report) were included in the data charting and analysis. The analysis of the reports identified three main reasons that made South Asian healthcare researchers publish in predatory journals: pressure to publish, lack of research support, and pseudo benefits. The review shows that predatory publishing in South Asia is a complex phenomenon. Combating predatory publications requires a holistic strategy that supersedes merely blacklisting these journals or listing criteria for journals that do meet academic standards., (© 2023 John Wiley & Sons Ltd.)

Competing Interests: The authors declare that they do not have any conflicts of interest.

Background: Fairness products are an essential component of daily beauty routines for many individuals in subcontinental Asia. However, it is important to be aware that these products often contain ingredients that can be detrimental to the skin and are banned in several developed countries., Objective: Our study aims to analyze the content of fairness cream commercials in order to gain a deeper understanding of the information used to persuade and influence consumers to use these products., Methods: Fairness cream commercials originating from countries in subcontinental Asia, including India, Pakistan, Bangladesh, Sri Lanka, and Nepal, were specifically searched and analyzed on the YouTube platform., Results: An analysis of 152 fairness cream commercials on YouTube identified 84.21% of commercials targeted female consumers, while only 15.79% targeted male consumers. 77.63% of commercials used celebrities in their commercials and 47.37% of commercials mentioned specific ingredients., Conclusions: Based on our findings, it is crucial for dermatologists to take an active role in educating patients and consumers about the potential risks associated with certain ingredients found in fairness creams. Dermatologists should emphasize the importance of prioritizing overall skin health rather than solely focusing on skin lightening., (© 2024 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Ambient fine particulate matter (PM2.5) pollution is a leading health risk factor for children under- 5 years, especially in developing countries. South Asia is a PM 2.5 hotspot, where climate change, a potential factor affecting PM2.5 pollution, adds a major challenge. However, limited evidence is available on under-5 mortality attributable to PM2.5 under different climate change scenarios. This study aimed to project under-5 mortality attributable to long-term exposure to ambient PM 2.5 u nder seven air pollution and climate change mitigation scenarios in South Asia. We used a concentration-risk function obtained from a previous review to project under-5 mortality attributable to ambient PM 2.5 . With a theoretical minimum risk exposure level of 2.4 μg/m 3 , this risk function was linked to gridded annual PM2.5 concentrations from atmospheric modeling to project under-5 mortality from 2010 to 2049 under different climate change mitigation scenarios. The scenarios were developed from the Aim/Endues global model based on end-of-pipe (removing the emission of air pollutants at the source, EoP) and 2 °C target measures. Our results showed that, in 2010-2014, about 306.8 thousand under-5 deaths attributable to PM 2.5 occurred in South Asia under the Reference (business as usual) scenario. The number of deaths was projected to increase in 2045-2049 by 36.6% under the same scenario and 7.7% under the scenario where EoP measures would be partially implemented by developing countries (EoPmid), and was projected to decrease under other scenarios, with the most significant decrease (81.2%) under the scenario where EoP measures would be fully enhanced by all countries along with the measures to achieve 2 °C target (EoPmaxCCSBLD) across South Asia. Country-specific projections of under-5 mortality varied by country. The current emission control strategy would not be sufficient to reduce the number of deaths in South Asia. Robust climate change mitigation and air pollution control policy implementation is required., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To identify barriers and enablers for access to and participation in rehabilitation for people with LLA in East, South, and Southeast Asian developing countries from the perspective of rehabilitation professionals., Material and Methods: A mixed-method study involving an anonymous cross-sectional screening survey followed by in-depth interviews of rehabilitation professionals in these regions following the COREQ guidelines. Participants were surveyed online using convenience and snowball sampling techniques to inform a purposive heterogenic sample for semi-structured online interviews, between September 2021 to February 2022. Interview transcripts were analysed and thematically coded using the modified Health Care Delivery System Approach (HCDSA) framework., Results: A total of 201 quantitative survey responses shaped the interview questions and participation of 28 participants from 13 countries for the qualitative investigation. Important factors at the patient level were sex, economics, health issues, language differences, and lack of awareness; at the care team level, peer and/or family support, referrals, and the gender of the professional; at the organizational level, service availability, resources, and quality; and at the environmental level, policies, supports, and physical and/or social accessibility., Conclusions: Identified interlinked factors at multiple levels of the HCDSA underpin the need for a systems approach to develop and address regional rehabilitation service provision but requires contextually adapted policy.

Introduction: Improvement in burn injury data collections and the quality of databanks has allowed meaningful study of the epidemiologic trends in burn care. The study assessed factors associated with disposition of burn injury patients from emergency department accounting for pre-hospital care and emergency care., Methods: This prospective observational pilot study of the South Asia Burn Registry project was conducted at selected public sector burn centers in Bangladesh and Pakistan (September 2014 - January 2015). All age groups with an initial presentation to the burn centers were enrolled. Descriptive and regression analysis is presented., Results: A total of 2749 patients were enrolled. The mean age was 21.7 ± 18.0 years, 55.3% were males, and about a quarter were children < 5 years. About 46.9% of the females were housewives. Scald burns were common among children (67.6%) while flame burns were common among adults (44.3%). About 75% of patients were brought in via non-ambulance mode of transport. More than 55% of patients were referrals from other facilities or clinics. The most common first aid given pre-hospital was the use of water or oil. About 25% were admitted for further care. The adjusted odds of being admitted compared to being sent home were highest for children < 5 yrs, those with higher total body surface area burnt, having arrived via ambulance, scald and electrical burn, having an associated injury and inhalational injury., Conclusion: The study provides insight into emergency burn care and associated factors that influenced outcomes for patients with burn injuries., Competing Interests: Declaration of Competing Interest The authors do not have any conflict of interest to declare., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Linguistic data from South Asia identified several language isolates in the subcontinent. The Vedda, an indigenous population of Sri Lanka, are the least studied amongst them. Therefore, to understand the initial peopling of Sri Lanka and the genetic affinity of the Vedda with other populations in Eurasia, we extensively studied the high-resolution autosomal and mitogenomes from the Vedda population of Sri Lanka. Our autosomal analyses suggest a close genetic link of Vedda with the tribal populations of India despite no evidence of close linguistic affinity, thus suggesting a deep genetic link of the Vedda with these populations. The mitogenomic analysis supports this association by pointing to an ancient link with Indian populations. We suggest that the Vedda population is a genetically drifted group with limited gene flow from neighbouring Sinhalese and Sri Lankan Tamil populations. Interestingly, the genetic ancestry sharing of Vedda neglects the isolation-by-distance model. Collectively, the demography of Sri Lanka is unique, where Sinhalese and Sri Lankan Tamil populations excessively admixed, whilst Vedda largely preserved their isolation and deep genetic association with India., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. and Mitochondria Research Society. All rights reserved.)

Most South Asian countries' economies have grown dramatically during the past few decades. However, in light of their environmental sustainability goals, the quality of such growth performances by South Asian nations is called into doubt by the concurrent degradation in environmental quality. Consequently, reducing the environmental challenges these nations encounter is prioritized on the agendas of the relevant authorities. This study aimed to analyze the effect of the top 11 most polluted countries' levels of financial inclusion, technological innovation, consumption of renewable energy, and adoption of climate technology on environmental deterioration from 2000 to 2022. Therefore, this research aims to use cutting-edge panel data econometric techniques to investigate the factors contributing to high carbon footprints in the world's most polluted nations. The results support an inverted U-shaped relationship between economic growth and carbon footprints, crediting the environmental Kuznets curve concept. In addition, it has been shown that TECH, REC, and CT can reduce carbon footprints in both the short and long term, while GDP and financial inclusion only affect carbon footprints in the long term. The results further endorsed the pollution haven hypothesis by showing that GDP positively affects carbon footprint. As a result, leading polluting economies need to strengthen their financial sectors, create green technology, migrate to renewable energy, and limit financial inclusion to improve environmental quality., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Accurate mapping and monitoring of tropical forests aboveground biomass (AGB) is crucial to design effective carbon emission reduction strategies and improving our understanding of Earth's carbon cycle. However, existing large-scale maps of tropical forest AGB generated through combinations of Earth Observation (EO) and forest inventory data show markedly divergent estimates, even after accounting for reported uncertainties. To address this, a network of high-quality reference data is needed to calibrate and validate mapping algorithms. This study aims to generate reference AGB datasets using field inventory plots and airborne LiDAR data for eight sites in Central Africa and five sites in South Asia, two regions largely underrepresented in global reference AGB datasets. The study provides access to these reference AGB maps, including uncertainty maps, at 100 m and 40 m spatial resolutions covering a total LiDAR footprint of 1,11,650 ha [ranging from 150 to 40,000 ha at site level]. These maps serve as calibration/validation datasets to improve the accuracy and reliability of AGB mapping for current and upcoming EO missions (viz., GEDI, BIOMASS, and NISAR)., (© 2024. The Author(s).)

Leishmaniases are a group of diseases under the category of neglected tropical diseases targeted for global elimination. However, they continue to pose major clinical and public health problems, especially among those living in poor socioeconomic conditions. Here, we summarize leishmaniasis elimination efforts in Bhutan. Between 1994 and 2022, Bhutan recorded 54 cases of leishmaniasis across 14 of its 20 districts. There are seven species of Phlebotomus and three species of Sergentomyia sand flies documented in the country. At a subnational level, all endemic districts recorded a visceral leishmaniasis annual incidence <1 per 10,000 population, meeting the regional elimination targets. Serological testing with ELISA and molecular testing with polymerase chain reaction were established at the Royal Center for Disease Control in 2022. A leishmaniasis prevention and management guideline was adopted in 2023 to aid clinicians in diagnosis and management. Active and passive case surveillance was integrated with the national infectious disease early warning and response system. Risk-based entomological surveillance and control have also been prioritized. Climate change may play a major role in rendering districts in the temperate zone favorable for vector proliferation. The country's medical university introduced a diploma course in medical entomology in 2023 to augment the human resources needed for vector surveillance efforts. However, leishmaniasis elimination lacks dedicated programmatic management amid competing priorities for resources against other infectious diseases. Leishmaniasis elimination requires a targeted and programmatic approach in Bhutan, including cross-border collaborative efforts with neighboring Indian states. Bhutan remains highly committed to achieving leishmaniasis elimination targets.

Background: Food insecurity and environmental degradation pose significant threats to health outcomes in South Asia, necessitating effective policy interventions. Therefore, this study aims to examine the impact of food insecurity and environmental degradation on health outcome indicators amidst global inflationary shocks and institutional quality arrangements. Additionally, it aims to explore the intricate moderating role of institutional quality on the relationship between food insecurity, endogenous variables, and external shocks., Method: In alignment with the study's objectives, a set of panel data spanning from 2000 to 2021 is compiled for South Asia. The study introduces a novel variable representing inflationary shock, crafted through the integration of inflation datapoints and the application of the generalized autoregressive conditional heteroskedasticity model. Additionally, a distinctive aggregate institutional quality index is formulated, drawing from six key measures of the Worldwide Governance indicators. To scrutinize the effects of food insecurity, environmental degradation, and other explanatory variables, the study employs the two-step system generalized method of moment technique, offering a robust analytical approach to uncover complex relationships and dynamics in the region., Results: The results indicate that the prevalence of undernourishment, inequality in per capita calorie intake, and CO 2 emissions significantly reduce life expectancy and increase mortality rates. Additionally, it shows that per capita kilocalorie supply, per capita GDP, per capita health expenditures, and urbanization are statistically significant for increasing life expectancy and decreasing mortality rates. The findings reveal that inflationary shocks severely affect food insecurity and environmental factors, exerting further pressure on contemporary life expectancy and mortality rates. In rebuttal, the institutional quality index is found to have significant effects on increasing and decreasing life expectancy and mortality rates, respectively. Furthermore, the institutional quality index is effective in moderating the nexus between food insecurity, environmental degradation, and health outcomes while also neutralizing the negative impact of inflationary shocks on the subject., Conclusion: The results verify triple health constraints such as food insecurity, environmental factors, and economic vulnerability to global shocks, which impose severe effects on life expectancy and mortality rates. Furthermore, poor institutional quality is identified as a hindrance to health outcomes in South Asia. The findings suggest specific policy implications that are explicitly discussed., (© 2024. The Author(s).)

Background: Retention of participants is a challenge in community-based longitudinal cohort studies. We aim to evaluate the factors associated with loss to follow-up and estimate attrition bias., Methods: Data are from an ongoing cohort study, Center for cArdiometabolic Risk Reduction in South Asia (CARRS) in India (Delhi and Chennai). Multinomial logistic regression analysis was used to identify sociodemographic factors associated with partial (at least one follow-up) or no follow-up (loss to follow-up). We also examined the impact of participant attrition on the magnitude of observed associations using relative ORs (RORs) of hypertension and diabetes (prevalent cases) with baseline sociodemographic factors., Results: There were 12 270 CARRS cohort members enrolled in Chennai and Delhi at baseline in 2010, and subsequently six follow-ups were conducted between 2011 and 2022. The median follow-up time was 9.5 years (IQR: 9.3-9.8) and 1048 deaths occurred. Approximately 3.1% of participants had no follow-up after the baseline visit. Younger (relative risk ratio (RRR): 1.14; 1.04 to 1.24), unmarried participants (RRR: 1.75; 1.45 to 2.11) and those with low household assets (RRR: 1.63; 1.44 to 1.85) had higher odds of being lost to follow-up. The RORs of sociodemographic factors with diabetes and hypertension did not statistically differ between baseline and sixth follow-up, suggesting minimal potential for bias in inference at follow-up., Conclusion: In this representative cohort of urban Indians, we found low attrition and minimal bias due to the loss to follow-up. Our cohort's inconsistent participation bias shows our retention strategies like open communication, providing health profiles, etc have potential benefits., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network., Methods: In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards., Findings: Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus., Interpretation: Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens., Funding: Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests CGW received honoraria from the University of St Andrews for speaking to alumni about CHAMPS and global health work. SAM has received grants from the Bill & Melinda Gates Foundation, GSK, Pfizer, Minervax, Novavax, Merck, Providence, Gritstone, and ImmunityBio. SAM has received honoraria from GSK for lecturing. GR has received grants from Fleming Fund Kenya Country, Deutsche Forschungsgemeinschaft, and bioMerieux. SA and JAGS have received support for attending meetings or travels, or both, for WHO, Bill & Melinda Gates Foundation (SA) and the International Society of Pneumonia & Pneumococcal Diseases (JAGS). CGW, JAGS, and SAM report serving on data safety monitoring boards for Safety Platform for Emergency VACcines (SPEAC; CGW), PATH (SAM), Centre for the AIDS Programme of Research in South Africa (CAPRISA; SAM), MRC The Gambia (JAGS) and ILiAD Biotechnologies (JAGS). All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The share of solar energy in the energy mix has become a major concern, and the global effort is to increase its contribution. Photovoltaic technology is an environment-friendly way of electricity production compared to fossil fuels. Currently, third generation of solar cells with a maximum average conversion efficiency of 20% has been achieved. Asia is an emerging market for photovoltaic technology, and it has recorded the highest installation capacity for 2018 (280 MW), 2030 (1860 MW), and 2050 (4837 MW). Meanwhile, Asia is estimated to be the highest producer of PV waste by 2040, with 5,580,000 metric tons of waste volume. Solid waste management is already a big environmental issue in South Asian countries, and untested landfilling of solar cells can further increase the burden. This review emphasizes the end-of-life scenario of solar cells in developing South Asian countries. Solar cell waste is hazardous e-waste that can lead to environmental and health impacts if not managed properly. It consists of metals with market value, which can be waste or gold, depending on its management. The study finds that recycling is the economically and environmentally effective waste management option for solar cells in South Asia. This paper reviews the deficiencies in the existing solar cell waste management framework in South Asian countries. Moreover, practical implications are presented for designing an effective waste management plan for solar cells in South Asian countries. Strong legislation, sufficient recycling infrastructure, and high stakeholders' interests are required to resolve this environmental concern., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Prior literature is substantive in highlighting the nexus between pollutant and socio-economic predictors; however, the role of human interaction has not been sufficiently explored. Thus, the present study examines the validity of the environmental Kuznets Curve (EKC) hypothesis in the presence of energy consumption, overpopulation, and human capital index in five South Asian countries. It employs fixed effects, random effects, and dynamic panel causality techniques with a set of panel data from 1972 to 2021. The baseline results validate the existence of the EKC hypothesis in the recipient panel. Nevertheless, the findings reveal that energy consumption and population density have positive effects, while human capital has negative impacts on CO 2 emissions. Furthermore, the study observes that energy consumption and per capita GDP have a significant causal link with CO 2 emissions, whereas CO 2 emissions are evident to have causality with population density and human capital index. The results are robust and suggest that the consolidation of an effective regulatory framework and technological improvements are substantial measures to improve environmental quality in South Asia. Moreover, allocating sufficient resources to uplift contemporary educational and health status would be imperative to improving environmental quality as aspired to by the Paris Agreement., (© 2024. The Author(s).)