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This article presents discussion and recommendations on approaches to retrospectively evaluating development interventions in the long term through a systems lens. It is based on experiences from the implementation of an 18-month study to investigate the impact of development interventions on economic and social change over a 40-year period in the Koshi Hills region of Nepal. A multi-disciplinary team used a mixed-methods approach to data collection and analysis. A theory-based analytical approach was utilized to produce narratives of plausible cause and effect and identify key drivers of change within the context of cumulative and interconnected impacts of multiple programs and factors. This article responds to increasing interest in development evaluation to look beyond intervention-specific impact to broader determinants of change to assist with intervention planning. It is the authors' hope that this will stimulate debate and progress in the use of high quality research to inform future development work.

The study was conducted in Nawalpur district of Nepal to assess status of on-farm management and associated knowledge of agrobiodiversity. Further, this study identified the farmers perception and their local interventions in on-farm agrobiodiversity conservation and management. The snowball and simple random sampling technique were used to identify the farmers practicing on-farm management and those who do not respectively. The pretested questionnaire was administered to 100 farmers of two villages, 50 from each village, from 2nd to 5th March 2018. Descriptive and analytical statistical tools were used to determine and compare the factors associated with on-farm management of agrobiodiversity. The study revealed that out of 98.0% of the respondents practicing on-farm management, almost all had home garden followed by 74.50% involved in value addition, 59.20% agrodiversity fair, 55.10% Community Biodiversity Management (CBM) and 36.10% travelling seminar. There was a significant relation between the type of the farming system and CBM (at p 0.00), travelling seminar (at p 0.043) and value addition (at p 0.036). The majority of respondents were commercial farmers, they sell what they produce for livelihood, and were practicing on-farm management of agrobiodiversity. Different means of information were used, where major being the information given by the respondents. Lack of government's technical support and information on Community based Biodiversity Management (CBD), were the major reasons for farmers for not being able to acquaint with it, and practice it on local conditions. Proper training and awareness, agricultural promotion programs are the absolute imperative to improve on-farm agrobiodiversity conservation and management status. [ABSTRACT FROM AUTHOR]

Background: Qatar is a major destination country for Nepali migrant workers (NMWs; main age range 25–35 years) in the construction trade. These 120,000+ NMWs are exposed to various occupational hazards, including excessive heat, and 3–4 workers die each week. Our study aimed to show whether heat exposure caused deaths. Methods: The worker population and mortality data of NMWs were retrieved from government institutions in Nepal. Heat exposure was assessed by monthly estimates of daily wet bulb globe temperature (WBGT), for in-shade conditions, from data collected at the Doha weather station from 2009 to 2017. Working in the sun during the middle of the day would add 2–3°C to the in-shade WBGT values. Daily deaths and their causes were obtained from the records of the Foreign Employment Promotion Board (FEPB) in Nepal, 2009–2017. Interviews with returning NMWs about their working conditions and the impacts of these conditions added information. The association between the heat variable and mortality was tested with standard statistical methods. Results: The average annual death rate for NMWs in Qatar was 150 deaths/100,000. According to interviews, the majority of NMWs were found working in high WBGT (>31°C) each working day during hot months. The major cause of these deaths was recorded as cardiovascular problems (cardiovascular disease; CVD). Unfortunately, the causes of death were poorly described, and many deaths were listed as "cardiac arrest." We included these deaths in the broader category of "cardiovascular causes." There was a strong correlation between average monthly afternoon heat levels (WBGT) and CVD mortality. It is likely that a large proportion of these CVD deaths during hot months were due to serious heat stroke. Global studies show that approximately 15% of deaths in the age group 25–35 years are due to CVD causes. However, in this NMW population, the figures were 22% during the cool season and 58% during the hot season. Conclusions: The increased CVD mortality during hot periods is most likely due to severe heat stress. As many as 200 of the 571 CVD deaths during 2009–2017 could have been prevented if effective heat protection had been implemented as a part of local occupational health and safety programs. There is an urgent need for protection against such heat effects among NMWs, and rising temperatures from ongoing climate change are further increasing the health risks. Cause of death records for workers dying in hot conditions should be more precise than "cardiac arrest." [ABSTRACT FROM AUTHOR]

Factors Affecting Land Use Change and Its Impacts in the Eastern Hills of Nepal. The objective of this paper is to explore factors causing change in land use and land cover categories in the Eastern Hills of Nepal's during the past 24 years between 1986 and 2010. The paper draws data and information from three different map sources --land resource mapping project 1986, toposheet 1996 and Landsat imagery 2010. In addition, the mapping data being generated were verified in the field through using observation, reality check approach and consultation workshops held at different places in the Eastern Hills of Nepal. The study area comprises four contagious hill districts such as Bhojpur, Dhankuta, Sankhuwasabha and Terhathum. A significant change has occurred particularly in two major categories of land use and land cover in the Eastern Hills of Nepal over the past two and half decades. While forest land increased consistently over the past 24 years, cultivated land area increased during the years 1986-1996 but decreased between 1996 and 2010. In agriculture, patches of abandoned agricultural land have also been observed in areas away from road facility in the recent years due to out-migration of youths. Intensification of agriculture practice was found along and around roads, wherein traditional subsistence cereals crops have been replaced with commercial vegetables and high value crops such as large cardamom, ginger, seeds and fruits. Three major factors comprising community forestry program, construction of roads, and introduction of improved agriculture development programs have contributed to internal trading between major land use and land cover categories. Further, these changes have offered benefits like nature conservation, internal and international trade of local products, and better living conditions of local communities. These development efforts should be kept in mind for policy measures in regard to conservation and development management of land use and land cover categories in other areas of Nepal. [ABSTRACT FROM AUTHOR]

This study focuses on awareness and an experimental demonstration about the use of human urine and wood ash as a fertilizer. This study was conducted in Chanauta, central Nepal, from November 2009 to February 2010. The villagers ( N = 27) were asked about their awareness of eco-sanitation and fertilizer value of urine and ash. All the participants agreed that the use of urine and ash was a good idea. In the experimental study, the fertilizer value of urine+ash was compared with animal manure and no-fertilizer in the cultivation of radish, potato, broadleaf mustard, cauliflower, and cabbage. Different plants cultivated plots received 54-81 kgN/ha with urine+ash or manure fertilizer. The urine+ash fertilizer produced significantly ( p < 0.05) higher broadleaf mustard biomass than obtained from animal manure and without fertilization. Urine+ash-fertilized plots growing radish, potato, cauliflower, and cabbage produced similar or slightly higher yields biomass compared to those achieved with manure fertilization. This might be because of high P, K as well as greater availability of N in applied urine compared to manure. It is concluded that urine+ash fertilizer can be used instead of animal manure; in this study, a dose of 4 L of urine was equal to 1 kg of dry cattle manure and produced a similar or greater yield of vegetable biomass than manure fertilization. To be able to generalize this conclusion, it is important to conduct these kinds of experiments with different seasonal crops and in other parts of the world. [ABSTRACT FROM AUTHOR]

This study is based on a visual inspection and a questionnaire survey about sanitation in central Nepal. A total of 201 people from different groups were asked about their knowledge about eco-toilets, the fertilizer value of human urine and wood ash. Farmers were the least educated and least aware of most of the topics asked. Although the majority of educated people were aware about urine fertilizer, 68% of them were not interested in its use in their home, and 39% of them said that it might be not accepted. The visual inspection revealed that environmental hygiene depends on education. It is concluded that farmers need to receive practical demonstrations about the use of eco-toilets and wood ash to appreciate the direct benefits. It can be assumed that since urine fertilizer is a bonus obtained from eco-toilets, this could encourage even poor people to construct these kinds of facilities. [ABSTRACT FROM AUTHOR]

Aims: To estimate the incidence of ocular injury in rural Nepal and identify details about these injuries that predict poor visual outcome. Methods: Reports of ocular trauma were collected from 1995 through 2000 from patients presenting to the only eye care clinic in Sarlahi district, Nepal. Patients were given a standard free eye examination and interviewed about the context of their injury. Follow up examination was performed 2-4 months after the initial injury. Results: 525 cases of incident ocular injury were reported, with a mean age of 28 years. Using census data, the incidence was 0.65 per 1000 males per year, and 0.38 per 1000 females per year. The most common types of injury were lacerating and blunt, with the majority occurring at home or in the fields. Upon presentation to the clinic, 26.4% of patients had a best corrected visual acuity worse than 20/60 in the injured eye, while 9.6% had visual acuity worse than 20/400. 82% were examined at follow up: 11 .2% of patients had visual acuity worse than 20/60 and 4.6% had vision worse than 20/400. A poor visual outcome was associated with increased age, care sought at a site other than the eye clinic, and severe injury. 3% of patients were referred for further care at an eye hospital at the initial visit; 7% had sought additional care in the interim between visits, with this subset representing a more severe spectrum of injuries. Conclusions: The detrimental effects of delayed care or care outside of the specialty eye clinic may reflect geographic or economic barriers to care. For optimal visual outcomes, patients who are injured in a rural setting should recognise the injury and seek early care at a specialty eye care facility. Findings from our study suggest that trained non-ophthalmologists may be able to clinically manage many eye injuries encountered in a rural setting in the "developing" world, reducing the demand for acute services of ophthalmologists in remote locations of this highly agricultural country. [ABSTRACT FROM AUTHOR]

Abstract Objective: To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women. Design: Double blind cluster randomised controlled trial. Setting: Rural community in south eastern Nepal. Participants 4926 pregnant women and 4130 live born infants. Interventions: 426 communities were randomised to five regimens in which pregnant women received daily supplements of folic acid, folic acid-iron, folic acid-iron-zinc, or multiple micronutrients all given with vitamin A, or vitamin A alone (control). Main outcome measures: Birth weight, length, and head and chest circumference assessed within 72 hours of birth. Low birth weight was defined < 2500 g. Results Supplementation with maternal folic acid alone had no effect on birth size. Folic acid-iron increased mean birth weight by 37 g (95% confidence interval--16 g to 90 g) and reduced the percentage of low birthweight babies (< 2500 g) from 43% to 34% (16%; relative risk=0.84, 0.72 to 0.99). Folic acid-iron-zinc had no effect on birth size compared with controls. Multiple micronutrient supplementation increased birth weight by 64 g (12 g to 115 g) and reduced the percentage of low birthweight babies by 14% (0.86, 0.74 to 0.99). None of the supplement combinations reduced the incidence of preterm births. Folic acid-iron and multiple micronutrients increased head and chest circumference of babies, but not length. Conclusions: Antenatal folic acid-iron supplements modestly reduce the risk of low birth weight. Multiple micronutrients confer no additional benefit over folic acid-iron in reducing this risk. [ABSTRACT FROM AUTHOR]

Anemia and iron deficiency during pregnancy are prevalent in developing countries, but their causes are not always known. We assessed the prevalence and severity of anemia and iron deficiency and their association with helminths, malaria and vitamin A deficiency in a community-based sample of 336 pregnant women in the plains of Nepal. Hemoglobin, erythrocyte protoporphyrin (EP) and serum ferritin were assessed in venous blood samples. Overall, 72.6% of women were anemic (hemoglobin < 110 g/L), 19.9% had moderate to severe anemia (hemoglobin < 90 g/L) and 80.6% had iron deficiency (EP > 70 micromol/mol heme or serum ferritin < 10 microg/L). Eighty-eight percent of cases of anemia were associated with iron deficiency. More than half of the women (54.2%) had a low serum retinol concentration (<1.05 micromol/L), 74.2% were infected with hookworms and 19.8% had Plasmodium vivax malaria parasitemia. Hemoglobin, EP and serum ferritin concentrations were significantly worse and the prevalence of anemia, elevated EP and low serum ferritin was increased with increasing intensity of hookworm infection. Hookworm infection intensity was the strongest predictor of iron status, especially of depleted iron stores. Low serum retinol was most strongly associated with mild anemia, whereas P. vivax malaria and hookworm infection intensity were stronger predictors of moderate to severe anemia. These findings reinforce the need for programs to consider reducing the prevalence of hookworm, malaria infection and vitamin A deficiency where indicated, in addition to providing iron supplements to effectively control anemia. [ABSTRACT FROM AUTHOR]

Background: Night blindness (XN) is the most common clinical symptom of vitamin A deficiency among children in developing countries. Yet little is known about the aetiology or associated risks of maternal XN. Emerging evidence from South East Asia suggests that it may be more frequent than previously thought in women of reproductive age, especially during pregnancy.Methods: A population-based, case-control study was conducted to reveal the epidemiology of XN among pregnant Nepali women. Night blind cases were identified by history through a weekly community surveillance system. Controls were randomly selected from a pool of pregnant women without XN and pair-matched for gestational age of the cases. A home-based assessment was done within a week of selection, at which 7-day food frequency and morbidity histories were collected, anthropometry measured, and capillary blood drawn for serum retinol, beta-carotene and haemoglobin (Hb) estimation.Results: Cases and controls did not differ by age or number of previous pregnancies. However, cases were more likely to be from the lower castes, be illiterate, live in poorer quality homes, and own no land. The mean serum retinol level of cases was approximately 0.30 mumol/l lower than controls (P < 0.001), indicating a low vitamin A status of night blind pregnant women. Mean Hb level was significantly lower (by 0.7 g/dl, P < 0.004), and the risk of severe anaemia (Hb < 7.0 g/dl) higher among cases than controls (odds ratio = 3.0, 95% CI: 1.25-7.23). Cases were more under-nourished than controls reflected by lower mean weight (-2.6 kg), body mass index (-0.8), arm circumference (-0.9 cm) and triceps skinfold (-0.8 mm). Night blindness was associated with less frequent consumption of preformed vitamin A (milk products, fish and meat) and provitamin A (dark green leafy vegetables and mangoes) foods, especially in summer. Night blind women were 2-3 times more likely to report symptoms of urinary/reproductive tract infections such as lower abdominal pain, painful and burning urination, or vaginal discharge, symptoms of diarrhoea/dysentery, of pre-eclampsia or eclampsia, and of nausea, vomiting or poor appetite throughout pregnancy than controls.Conclusion: Women who experience XN during pregnancy have a low vitamin A status, although several other risk factors appear to cluster among these women as well. Night blind women are also more likely to be anaemic, ill, and acutely under-nourished, and to be consuming a nutritionally poorer diet in pregnancy than non-night blind pregnant women. A simple history of XN can identify women at high risk during pregnancy who may require special nutritional support, antenatal care and counselling. [ABSTRACT FROM AUTHOR]

We investigated the effect of supplementing women weekly with 7000 microg retinol equivalents as preformed vitamin A or beta-carotene vs. a placebo, on the incidence of night blindness during pregnancy and the postpartum period in the rural plains of Nepal. Over a period of approximately 3 y, approximately 29,000 women of child-bearing age, living in 171 wards that were randomized to one of the three supplements, contributed 9932 first pregnancies. A prospective, weekly surveillance identified night blindness in pregnant women, verified further by detailed questioning about nighttime vision. After delivery, women were also interviewed at approximately 3 and approximately 6 mo postpartum to elicit a night blindness history over the preceding 3 mo. Vitamin A supplementation reduced the incidence of night blindness during pregnancy from 10.7% among controls to 6.7% (relative risk 0.62, 95% confidence interval: 0.45-0.85). beta-Carotene supplementation had less of an effect (0. 83, 0.63-1.11). Among women who took >95% of their vitamin A supplements during pregnancy, incidence of verified night blindness was reduced by 67%. Incidence (per 100 person-years) of night blindness during the first 3 mo postpartum was 11.3 in the control, 4.3 in the vitamin A and 8.7 in the beta-carotene groups, yielding corresponding relative risks of 0.38 (0.26-0.55) and 0.77 (0.57-1. 04). In the second 3 mo postpartum, both vitamin A and beta-carotene reduced night blindness by approximately 50%. Vitamin A intakes approaching a recommended amount for pregnancy markedly reduced but did not eliminate night blindness in Nepali women. Greater intakes of vitamin A than provided and/or other nutrients may be needed to prevent maternal night blindness in rural South Asia. [ABSTRACT FROM AUTHOR]