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Universities today devote serious effort to attract international students. The purpose of this research is to understand the motivation factors that impact international student choices in selecting Indian higher education as a study-abroad destination. This quantitative study examines the choice criteria of 249 full-time international students from the countries of Asia and Africa. A number of choice factors were identified. Results indicate that international students at Indian universities consider 'university characteristics' and 'influence of social networks' as the most important motivation factors that determine destination choice. The study findings suggest a value proposition canvas consisting of teaching quality, university rankings, safety and availability of academic courses as its foremost constituents. The paper notes decision-making influences and identifies implications for marketing actions of a developing host country operating in a competitive international student market.

Background: The COVID-19 pandemic resulted in significant physical and psychological impacts for survivors, and for the healthcare professionals caring for patients. Nurses and doctors in critical care faced longer working hours, increased burden of patients, and limited resources, all in the context of personal social isolation and uncertainties regarding cross-infection. We evaluated the burden of anxiety, depression, stress, post-traumatic stress disorder (PTSD), and alcohol dependence among doctors and nurses working in intensive care units (ICUs) in Nepal and explored the individual and social drivers for these impacts. Methods: We conducted a mixed-methods study in Nepal, using an online survey to assess psychological well-being and semi-structured interviews to explore perceptions as to the drivers of anxiety, stress, and depression. Participants were recruited from existing national critical care professional organisations in Nepal and using a snowball technique. The online survey comprised of validated assessment tools for anxiety, depression, stress, PTSD, and alcohol dependence; all tools were analysed using published guidelines. Interviews were analysed using rapid appraisal techniques, and themes regarding the drivers for psychological distress were explored. Results: 134 respondents (113 nurses, 21 doctors) completed the online survey. Twenty-eight (21%) participants experienced moderate to severe symptoms of depression; 67 (50%) experienced moderate or severe symptoms of anxiety; 114 (85%) had scores indicative of moderate to high levels of stress; 46 out of 100 reported symptoms of PTSD. Compared to doctors, nurses experienced more severe symptoms of depression, anxiety, and PTSD, whereas doctors experienced higher levels of stress than nurses. Most (95%) participants had scores indicative of low risk of alcohol dependence. Twenty participants were followed up in interviews. Social stigmatism, physical and emotional safety, enforced role change and the absence of organisational support were perceived drivers for poor psychological well-being. Conclusion: Nurses and doctors working in ICU during the COVID-19 pandemic sustained psychological impacts, manifesting as stress, anxiety, and for some, symptoms of PTSD. Nurses were more vulnerable. Individual characteristics and professional inequalities in healthcare may be potential modifiable factors for policy makers seeking to mitigate risks for healthcare providers. [ABSTRACT FROM AUTHOR]

Bamboo are the fastest growing perennial woody grasses that have versatile applications. Most of the local people inhabiting the riverine area of the Siwalik region of Nepal rely on bamboo products for economic benefits and medicinal uses. Our objective was to identify the diversity of bamboo species, their ethnomedicinal practices, and economic and ecological importance. Data were collected by direct observation, key informant interviews, participatory rural appraisal, inventory technique, focus group discussions, and a household survey using semi-structured and structured questionnaires. We recorded four genera and nine species of bamboo, of which eight species have been used for agriculture, five for medicine, four for construction, food, fodder, artifacts and religious purpose, three for river embankment, and two for ornamental purpose. As the local people in the study area were deprived of medical facilities, using traditional herbal medicine to cure various diseases was a common practice. The inhabitants responded that they use bamboo-based primary ethnomedicinal care even against snake and scorpion bites. Similarly, they use bamboo young culm for reducing body weight and control diabetes. The value of the informant consensus factor was found to be maximum for the bamboo against snake and scorpion bites (1.0) and minimum for weight loss (0.81). This study concludes that the traditional utilization of all kinds of bamboo in the region is vast despite their less diversity. The recorded bamboo species are used not only for food and fodder but also in preparing artifacts, soil nutrients restoration in the fallow land, construction materials for the rural people, river embankments, and religious and spiritual purposes. Therefore, if grown on a large scale, bamboo can provide sustainable benefits for the local users and ecological aspects. Bambusa tulda and Dendrocalamus strictus have a broad spectrum of pharmacological agents. Considering the multifaceted application of bamboo in the Siwalik area, it is worthwhile to encourage the local people to bamboo plantation, which would contribute to supplement their household requirements and be one of the alternative livelihood options. [ABSTRACT FROM AUTHOR]

Background An effective implementation of antimicrobial resistance (AMR) surveillance projects requires sustainable and multidisciplinary engagement with stakeholders from various backgrounds, interests and aims. The "Capturing Data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) project, funded by the Fleming Fund, initially targeted 12 countries in South Asia (SA) and Southeast Asia (SEA) to "expand the volume of historical and current data on AMR and antimicrobial usage" and support local agencies through capacity building activities. Methods In this article, we focus on early stakeholder engagement activities and present overall statistics on AMR data collated from 72 laboratories across seven countries. This included 2.3 million records of antimicrobial susceptibility testing (AST) data, which were curated, analyzed, and shared back to the facilities for informed decision making. Results Approximately 98% of the data collated by CAPTURA originated from laboratories based in SA countries. Furthermore, country-wide data were analyzed to identify commonly reported pathogens in each country, followed by descriptions of AST practices and multidrug-resistant (MDR) pathogens. Overall, we found meager adherence to standard guidelines to perform and record AST results, and a significant number of MDR pathogens were reported. Conclusions We conclude that close collaboration with the existing national mechanisms for identifying AMR data sources was crucial for the project's success. Although we show a vast retrospective dataset on AMR is available for data sharing in Asia, there remain critical gaps in data generation/management practice and analysis capacity for AMR data at most facilities. [ABSTRACT FROM AUTHOR]

Data on antimicrobial resistance (AMR) from sites not participating in the National AMR surveillance network, conducted by National Public Health Laboratory (NPHL), remain largely unknown in Nepal. The "Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) assessed AMR data from previously untapped data sources in Nepal. A retrospective cross-sectional data review was carried out for the AMR data recorded between January 2017 and December 2019 to analyze AMR data from 26 hospital-based laboratories and 2 diagnostic laboratories in Nepal. Of the 56 health facilities initially contacted to participate in this project activity, 50.0% (28/56) signed a data-sharing agreement with CAPTURA. Eleven of the 28 hospitals were AMR surveillance sites, whereas the other 17, although not part of the National AMR surveillance network, recorded AMR-related data. Data for 663 602 isolates obtained from 580 038 patients were analyzed. A complete record of the 11 CAPTURA priority variables was obtained from 45.5% (5/11) of government hospitals, 63.6% (7/11) of private hospitals, and 54.6% (6/11) of public-private hospitals networked with NPHL for AMR surveillance. Similarly, 80% (8/10) of clinics and 54.6% (6/11) of laboratories outside the NPHL network recorded complete data for the 10 Global Antimicrobial Resistance and Use Surveillance System (GLASS) priority variables and 11/14 CAPTURA priority variables. Retrospective review of the data identified areas requiring additional resources and interventions to improve the quality of data on AMR in Nepal. Furthermore, we observed no difference in the priority variables reported by sites within or outside the NPHL network, thus suggesting that policies could be made to expand the surveillance system to include these sites without substantially affecting the government's budget. [ABSTRACT FROM AUTHOR]

Floods pose significant risk to riparian buildings as evidenced during many historical events. Although structural resilience to tsunami flooding is well studied in the literature, high-velocity and debris-laden floods in steep terrains are not considered adequately so far. Historical floods in steep terrains necessitate the need for flood vulnerability analysis of buildings. To this end, we report vulnerability of riparian-reinforced concrete buildings using forensic damage interpretations and empirical/analytical vulnerability analyses. Furthermore, we propose the concept and implications of functionality loss due to flooding in residential reinforced concrete (RC) buildings using empirical data. Fragility functions using inundation depth and momentum flux are presented for RC buildings considering a recent flooding event in Nepal. The results show that flow velocity and sediment load, rather than hydrostatic load, govern the damages in riparian RC buildings. However, at larger inundation depth, hydrostatic force alone may collapse some of the RC buildings. [ABSTRACT FROM AUTHOR]

The recovery of wild tigers in India and Nepal is a remarkable conservation achievement, but it sets the stage for increased human–wildlife conflict where parks are limited in size and where tigers reside outside reserves. We deployed an innovative technology, the TrailGuard AI camera-alert system, which runs on-the-edge artificial intelligence algorithms to detect tigers and poachers and transmit real-time images to designated authorities responsible for managing prominent tiger landscapes in India. We successfully captured and transmitted the first images of tigers using cameras with embedded AI and detected poachers. Notifications of tiger images were received in real time, approximately 30 seconds from camera trigger to appearing in a smart phone app. We review use cases of this AI-based real-time alert system for managers and local communities and suggest how the system could help monitor tigers and other endangered species, detect poaching, and provide early warnings for human–wildlife conflict. [ABSTRACT FROM AUTHOR]

Ileosigmoidal knotting (ISK) is a rare, possibly fatal cause of intestinal obstruction. ISK is a compound volvulus that is more common in Africa and Asia. ISK is mostly seen in adults, pediatric cases reported in the literature are much rarer. In this report, we present the first reported case of ISK in a pediatric patient from Nepal. An 8-year-old male child presented with symptoms of abdominal pain, vomiting, and obstipation. The abdomen was distended with generalized tenderness. Erect abdominal X-ray showed multiple air-fluid levels. Intraoperatively, gangrenous ileum loops were entangled around the sigmoid, and resection of the gangrenous ileum and sigmoid was performed. An end-to-end colo-colic anastomosis from the descending colon to the remaining sigmoid with a double-loop ileostomy was performed. Pediatric ISK is a rare fatal form of intestinal obstruction that progresses quickly to gangrene. Clinical signs and symptoms are nonspecific, making preoperative diagnosis challenging. [ABSTRACT FROM AUTHOR]

The abuse and misuse of antibiotics is one of the main drivers of antimicrobial resistance (AMR). Globally, AMR in food-producing animals is a significant public health concern. This study, therefore, assessed the knowledge, attitudes, and practices related to antibiotic usage (AMU) and AMR among poultry farmers in Nepal. We conducted a cross-sectional survey of 605 poultry farmers from six districts of Nepal from May to June 2022 to assess the status of knowledge, attitude, as well as practices toward prudent antibiotic usage (AMU) and AMR. The majority of the participants in our study were from the Chitwan district (31.6%; n = 191/605), aged 30–44 (54.2%; n = 328/605), males (70.4%; n = 426/605), and farmers with a higher secondary (28.76%; n = 174/605) level of education. The tetracyclines (28%, n = 228/828), aminoglycosides (23%, n = 188/828), and fluoroquinolones (15%, n = 126/828) were the most used antibiotics classes among poultry farmers. Although 87.8% (n = 531/605) of poultry farmers used antibiotics, 49.8% (n = 301/605) of them were aware of AMR, and 55.7% (n = 337/605) knew that the misuse of antimicrobials could affect human and environmental health. There were significant differences in the knowledge, attitude, and practices toward prudent AMU and AMR among farmers who reared different birds. The mean knowledge, attitude, and practice score of the respondents were 7.81 ± 3.26, 5.8 ± 2.32, and 7.59 ± 3.38 when measured on a scale of 12, 10, and 15, respectively. Based on a cut-off of 75% of the maximum score, 49.4% (n = 299/605), 62.8% (n = 380/605), and 12.73% (n = 77/605) of the respondents had good knowledge, attitude, and practices toward prudent AMU and AMR, respectively. The multivariable logistic regression analyses revealed that the positive predictors of good knowledge and attitude were male gender, higher level of education, district, and the types of birds (layers). Similarly, those of the male gender (OR: 3.36; 95% CI: 1.38–8.20; p = 0.008) and those that rear layers (OR: 4.63; 95% CI: 1.75–12.25; p = 0.003) were more likely to practice prudent usage of antimicrobials. The findings of this study show poor practice toward prudent antibiotic usage despite good knowledge of AMR. This study provides essential baseline data on the knowledge, attitudes, and practices of poultry farmers in Nepal and offers valuable insights that could help in the design of interventions and policies aimed at addressing illicit AMU and AMR in poultry in Nepal. [ABSTRACT FROM AUTHOR]

Pediatric spontaneous gastric perforation is a rarely encountered condition with poorly understood causal mechanisms. We present a novel case of a two-month-old female infant from Nepal who previously experienced Croup and subsequently developed severe abdominal distention and vomiting. Abdominal X-ray findings confirmed pneumoperitoneum, prompting immediate laparotomy. Intraoperative examination revealed a substantial perforation along the posterior stomach wall, specifically along the lesser curvature. The surgical intervention involved gastrorrhaphy and omentopexy using 3-0 Vicryl sutures, leading to an uneventful postoperative recovery. This case report highlights the critical importance of early and efficient management of spontaneous gastric perforations in infants, emphasizing the need for timely intervention to achieve favorable outcomes. Pediatric spontaneous gastric perforation remains a rare condition, and reporting such cases contributes to our understanding and management of this unusual pathology. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Road traffic injury is one of the fastest growing health problems in Nepal with increasing number every year leading to morbidity and mortality. Blunt pulmonary contusion may not be seen in the initial plain radiographs as they evolve over 12-24 hours. Thus CT (Computed Tomography) scan can provide detailed information about the contusion and predict the need for mechanical ventilation. MATERIAL AND METHODS: This is a prospective, observational longitudinal study conducted at Universal College of Medical Sciences, Bhairahawa from 1st January 2020 to 31st December 2020. The predictors for requirement of mechanical ventilation like Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), GCS score and number of fractured ribs at the time of admission were recorded. RESULTS: In this study, 100 cases with blunt pulmonary contusion were evaluated. Average age of patients with blunt pulmonary contusion was around 39.10±17.56 years with male predominance (82%). Total of 7 patients required mechanical ventilation among whom the AIS chest was 3.0±0.82, ISS score was 29.14±6.89, and GCS 9.14±3.13. The ROC curve showed that ISS score predicted significantly about the requirement of mechanical ventilation with sensitivity of 85.5% and specificity of 99.8 %. CONCLUSION: Initial CT done in patients can show the presence or absence of pulmonary contusion and associated thoracic injuries and along with AIS, ISS and GCS scores we can predict early the requirement of mechanical ventilation. [ABSTRACT FROM AUTHOR]

Clinically diagnosing fungal keratitis (FK) is challenging; diagnosis can be assisted by investigations including in vivo confocal microscopy (IVCM), smear microscopy, and culture. The aim of this study was to estimate the sensitivity in detecting fungal keratitis (FK) using IVCM, smear microscopy, and culture in a setting with a high prevalence of FK. In this cross-sectional study nested within a prospective cohort study, consecutive microbial keratitis (MK) patients attending a tertiary-referral eye hospital in south-eastern Nepal between June 2019 and November 2020 were recruited. IVCM and corneal scrapes for smear microscopy and culture were performed using a standardised protocol. Smear microscopy was performed using potassium hydroxide (KOH), Gram stain, and calcofluor white. The primary outcomes were sensitivities with 95% confidence intervals [95% CI] for IVCM, smear microscopy and culture, and for each different microscopy stain independently, to detect FK compared to a composite referent. We enrolled 642 patients with MK; 468/642 (72.9%) were filamentous FK, 32/642 (5.0%) were bacterial keratitis and 64/642 (10.0%) were mixed bacterial-filamentous FK, with one yeast infection (0.16%). No organism was identified in 77/642 (12.0%). Smear microscopy had the highest sensitivity (90.7% [87.9–93.1%]), followed by IVCM (89.8% [86.9–92.3%]) and culture (75.7% [71.8–79.3%]). Of the three smear microscopy stains, KOH had the highest sensitivity (85.3% [81.9–88.4%]), followed by Gram stain (83.2% [79.7–86.4%]) and calcofluor white (79.1% [75.4–82.5%]). Smear microscopy and IVCM were the most sensitive tools for identifying FK in our cohort. In low-resource settings we recommend clinicians perform corneal scrapes for microscopy using KOH and Gram staining. Culture remains an important tool to diagnose bacterial infection, identify causative fungi and enable antimicrobial susceptibility testing. [ABSTRACT FROM AUTHOR]

The Gurkhas, who hail from Nepal and serve in the British Army, are considered one of the world's fiercest soldiers. Being transnational military migrants, they are away from their homes for extended periods, and as a result, they are physically and emotionally absent from their children's lives. Separation from loved ones is never easy; and transnational life is emotionally draining no matter how tough and brave the Gurkha soldiers are. Nevertheless, the children of Gurkhas hold their fathers in high regard for their sacrifices and for bringing them to the UK, thus, opening them up to scores of opportunities. However, they find it considerably challenging to live together with their otherwise absent fathers under the same roof. Consequently, many Gurkhas and their children have a detached relationship and have become estranged. Meanwhile, some have reconnected and fought to rekindle and rebuild their relationships after coming to the UK. In the process of rediscovering, some children also recognize the emotional side of their fathers whom they earlier thought to be introverted and cold. [ABSTRACT FROM AUTHOR]

Conservation agriculture-based sustainable intensification (CASI) is a package of practices that could improve the sustainability of smallholder farm productivity and profitability. However, existing extension systems are unable to facilitate widespread adoption to have the impact necessary to meet food security and livelihood requirements. This paper examines the utility of 'Innovation Platforms' (IPs) as a tool to catalyse adoption of CASI for smallholder farmers in South Asia and generate opportunities for rural micro-entrepreneurship in areas with high rates of poverty, small farm sizes and complex labour markets. We established 37 village-level and five District-level IPs across the Eastern Gangetic Plains of Nepal, Bangladesh, and India. IPs allowed widespread uptake of CASI with benefits to smallholder farmers, input and output suppliers, and enabled extension systems to be more efficient. There was variability across locations with different modes of IPs established, building on existing farmer or community youth groups, and enabling micro-entrepreneur business opportunities. IPs were effective in developing trust in communities, among stakeholders, empowering rural youth and women through direct engagement. Ensuring strong ownership was key. Further work is needed to provide opportunities for high-level policy support to assist IPs to have a wider impact in supporting large-scale adoption of CASI. [ABSTRACT FROM AUTHOR]

Background: The pyogenic infections includes a wide range of abnormalities like superficial skin infections, eyes infections, wound infections, infection of burns, boils, furuncles, peritonitis and abscesses. Some of the infections are endogenous that occurs by the patient's own normal flora. Many infections are exogenous that occur by direct and indirect airborne routes. Boils and furuncles are caused by Staphylococcus aureus. Gram negative infections rarely occur on healthy skin except moist area of skin and axilla. Aims and objectives: The purpose of this study was to illustrate the bacteria responsible for pyogenic infection and to determine their antibiotic susceptibility. Methods: The pyogenic bacteria were isolated from the samples collected from the Clinical Departments of Chitwan Medical College. The isolates were identified and antibiotic susceptibility test was performed by standard protocols. Results: Gram negative bacteria were frequently isolated pathogens than the Gram positive bacteria. Escherichia coli (E.coli) was the predominant isolate among the 138 positive samples, 49 (35.5%) of them was only the E.coli, followed by Staphylococcus aureus (15.21%), Klebsiella pneumoniae (K. pneumoniae) (13.04%), Acinetobacter species (11.59%), MRSA (11.59%), Pseudomonas aeruginosa (5.79%), Klebsiella oxytoca (3.62%), Enterobacter (2.17%), and Proteus mirabilis (1.44%). Gram negative bacteria were highly susceptible to Amikacin whereas most of the Gram-positive isolates were susceptible to vancomycin and linezolid. Conclusion: The knowledge of the most prevalent type of bacterial isolates and their antimicrobial susceptibility pattern is a must for the clinicians as it aids in the accurate selection of the therapeutic regimens. [ABSTRACT FROM AUTHOR]

Lumpy skin disease (LSD) is a transboundary viral disease of cattle and buffaloes transmitted by blood-feeding vectors and causes high morbidity and low-to-moderate mortality. Since the first observation of LSD in Zambia in 1929, it has spread in cattle populations across African countries, the Middle East, Europe, and Asia. Following the recent outbreaks of LSD in South Asian countries such as India and Bangladesh, the disease was first reported in cattle farms in Nepal in June 2020. This study investigated the Nepalese LSD outbreak and confirmed that the disease spread rapidly to three neighboring districts in a month, infecting 1300 animals. Both cattle and buffaloes showed common clinical signs of LSD, with the exception that the buffaloes presented small nodular lesions without centered ulcerations. The collected samples were first tested for the presence of LSDV by real-time PCR. We further applied molecular tools, RPO30, GPCR, EEV glycoprotein gene, and B22R, for additional characterization of the LSDV isolates circulating in Nepal. Using a PCR-based Snapback assay, we confirmed that samples collected from cattle and buffaloes were positive of LSDV. Furthermore, sequence analysis (phylogenetic and multiple sequence alignments) of four selected LSDV genes revealed that the Nepal LSDVs resemble the Bangladesh and Indian isolates and the historic isolates from Kenya. We also highlight the importance of a unique B22R gene region harboring single-nucleotide insertions in LSDV Neethling and LSDV KSGPO-240 vaccine strains, enabling us to differentiate them from the Nepalese isolates and other fields isolates. This study demonstrates the importance of disease surveillance and the need to determine the source of the disease introduction, the extent of spread, modes of transmission, and the necessary control measures. [ABSTRACT FROM AUTHOR]

In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community‐based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12‐fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level. [ABSTRACT FROM AUTHOR]

Childhood linear growth faltering remains a major public health concern in Nepal. Nevertheless, over the past 20 years, Nepal sustained one of the most rapid reductions in the prevalence of stunting worldwide. First, our study analysed the trends in height‐for‐age z‐score (HAZ), stunting prevalence, and available nutrition‐sensitive and nutrition‐specific determinants of linear growth faltering in under‐three children across Nepal's Family Health Survey 1996 and Nepal's Demographic and Health Surveys 2001, 2006, 2011, and 2016. Second, we constructed pooled multivariable linear regression models and decomposed the contributions of our time‐variant determinants on the predicted changes in HAZ and stunting over the past two decades. Our findings indicate substantial improvements in HAZ (38.5%) and reductions in stunting (−42.6%) and severe stunting prevalence (−63.9%) in Nepalese children aged 0–35 months. We also report that the increment in HAZ, across the 1996–2016 period, was significantly associated (confounder‐adjusted p <.05) with household asset index, maternal and paternal years of education, maternal body mass index and height, basic child vaccinations, preceding birth interval, childbirth in a medical facility, and prenatal doctor visits. Furthermore, our quantitative decomposition of HAZ identified advances in utilisation of health care and related services (31.7% of predicted change), household wealth accumulation (25%), parental education (21.7%), and maternal nutrition (8.3%) as key drivers of the long‐term and sustained progress against child linear growth deficits. Our research reiterates the multifactorial nature of chronic child undernutrition and the need for coherent multisectoral nutrition‐sensitive and nutrition‐specific strategies at national scale to further improve linear growth in Nepal. [Correction added on 6 November 2020, after first online publication: in abstract, the citation year in the fourth sentence has been changed from '2001' to '2011'.] [ABSTRACT FROM AUTHOR]

We used data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anaemia (World Health Organization cut‐points using altitude‐ and smoking‐adjusted haemoglobin [Hb]) among nationally representative samples of adolescents 10–19 years. Hb, biomarkers of micronutrients, infection and inflammation were assessed from venous blood. Sociodemographic and household characteristics, dietary diversity, pica and recent morbidity were ascertained by interview. We explored bivariate relationships between candidate predictors and anaemia among boys (N = 967) and girls (N = 1,680). Candidate predictors with P < 0.05 in bivariate analyses were included in sex‐specific multivariable logistic regression models. Anaemia prevalence was 20.6% (95% confidence interval [CI] [17.1, 24.1]) among girls and 10.9% (95% CI [8.2, 13.6]) among boys. Among girls, living in the Mountain and Hill ecological zones relative to the Terai (adjusted odds ratio [AOR] 0.28, 95% CI [0.15, 0.52] and AOR 0.42, 95% CI [0.25, 0.73], respectively), ln ferritin (μg/L) (AOR 0.53, 95% CI [0.42, 0.68]) and ln retinol binding protein (RBP) (μmol/L) (AOR 0.08, 95% CI [0.04, 0.16]) were associated with reduced anaemia odds. Older age (age in years AOR 1.19, 95% CI [1.12, 1.27]) and Janajati ethnicity relative to the Muslim ethnicity (AOR 3.04, 95% CI [1.10, 8.36]) were associated with higher anaemia odds. Among boys, ln RBP [μmol/L] (AOR 0.25, 95% CI [0.10, 0.65]) and having consumed flesh foods (AOR 0.57, 95% CI [0.33, 0.99]) were associated with lower anaemia odds. Open defecation (AOR 2.36, 95% CI [1.15, 4.84]) and ln transferrin receptor [mg/L] (AOR 3.21, 95% CI [1.25, 8.23]) were associated with increased anaemia odds. Anaemia among adolescents might be addressed through effective public health policy and programs targeting micronutrient status, diet and sanitation. [ABSTRACT FROM AUTHOR]

We used cross‐sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anaemia among a nationally representative sample of nonpregnant women 15– 49 years (n = 1, 918). Haemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood. Soil‐transmitted helminth and Helicobacter pylori infections were assessed from stool. Sociodemographic, household, and health characteristics and diet were ascertained by interview. We conducted bivariate analyses between candidate predictors and anaemia (haemoglobin <12.0 g/ dL, altitude‐ and smoking‐adjusted). Candidate predictors that were significant in bivariate models (P < 0.05) were included in the multivariable logistic regression model, accounting for complex sampling design. Anaemia prevalence was 20.2% (95% confidence interval [CI] [17.6, 22.8]). Associated with reduced anaemia odds were living in the Mountain and Hill ecological zones relative to the Terai (adjusted odds ratio [AOR] 0.35, 95% CI [0.21, 0.60] and AOR 0.41, 95% CI [0.29, 0.59], respectively), recent cough (AOR 0.56, 95% CI [0.38, 0.82]), hormonal contraceptive use (AOR 0.58; 95% CI [0.38, 0.88]), ln ferritin (micrograms per litre; AOR 0.43, 95% CI [0.35, 0.54]), and ln retinol binding protein (micrograms per litre; AOR 0.20, 95% CI [0.11, 0.37]). Residing in a house with an earth floor (AOR 1.74, 95% CI [1.18, 2.56]), glucose‐6‐ phosphate dehydrogenase deficiency (AOR 2.44, 95% CI [1.66, 3.60]), and haemoglobinopathies (AOR 6.15, 95% CI [3.09, 12.26]) were associated with increased anaemia odds. Interventions that improve micronutrient status, ensure access to hormonal birth control, and replace dirt floors to reduce infection risk might help reduce anaemia in this population. [ABSTRACT FROM AUTHOR]

Nepal is located in what was once known as the Himalayan Goitre Belt and once had one of the highest prevalence's of iodine deficiency disorders in the world. However, through a well‐executed universal salt iodization program implemented over the past 25 years, it has achieved optimal iodine intake for its population, effectively eliminating the adverse consequences of iodine deficiency disorders. A comprehensive review of policy and legislation, surveys, and program reports was undertaken to examine the key elements contributing to the success of this program. The paper reviews the origins and maturation of salt iodization in Nepal, as well as trends in the coverage of iodized salt, the iodine content in salt, and population iodine status over the past two decades. The paper describes critical components of the program including advocacy efforts, trade issues with India, the role of the Salt Trading Corporation, monitoring, and periodic program reviews. The paper discusses the recent findings from the 2016 national micronutrient survey demonstrating the success of the salt iodization program and describes emerging challenges facing the program in the future. [ABSTRACT FROM AUTHOR]

The effect of cations on the corrosion of galvanized steel (GS) is scarcely reported. In this study, a wet–dry cyclic test was conducted to study NH4+, Na+, and Mg2+ cation effect on the corrosion behavior of GS available in Nepal. Fourteen wet–dry cycles (18 h wet and 6 h dry) were performed by exposing samples at 298 K with a relative humidity of 90% in a wet cycle and 50% in a dry cycle for 14 days. The cations strongly affect the corrosion rate of the GS sample estimated by weight loss and potentiodynamic polarization. The potentiodynamic polarization curves showed the inhibition of cathodic and anodic reactions by Mg2+ ion, while the NH4+ ion only changed the cathodic reaction. Mg2+ ion was found to shift the corrosion potential to noble values compared with NH4+ and Na+ ions. A compact and thin corrosion products layer was developed in Mg2+ salt solution in contrast to a thick and porous corrosion products layer in NH4+ and Na+ salt solutions. Red rust due to corrosion of underlying steel appeared in the presence of NH4+ and Na+ salt solutions. Finally, the weight loss data revealed that the corrosivity of cations for GS decreased in the order Na+ > NH4+ > Mg2+. [ABSTRACT FROM AUTHOR]

Background: Nepal was under a severe lockdown for several months in 2020 due to the COVID-19 pandemic. There were concerns regarding misinformation circulating on social media. This study aimed to analyse the knowledge and awareness of COVID-19 amongst eye care professionals in Nepal during the first wave of the pandemic. Methodology: We invited 600 participants from 12 ophthalmic centres across Nepal to complete a qualitative, anonymous online survey. Altogether, 25 questions (both open and closed-ended) were used. An overall performance score was calculated from the average of the 12 "Knowledge" questions for all the participants. Results: Of the 600 eye care professionals invited, 310 (51%) participated in the survey. The symptoms of COVID-19 were known to 94%, whilst only 49% of the participants were aware how the disease was transmitted, with 54% aware that anyone can be infected with SARS-CoV-2. Almost 98% of participants recognized the World Health Organization's (WHO) awareness message, but surprisingly, 41% of participants felt that consumption of hot drinks helps to destroy the virus, in contradiction to WHO information. Importantly, 95% of the participants were aware of personal protective equipment (PPE) and what the acronym stands for. Social distancing was felt to be key to limiting the disease spread; whilst 41% disagreed that PPE should be mandatory for eye care practitioners. The mean overall "Knowledge" performance score was 69.65% (SD ± 22.81). Conclusion: There is still considerable scope to improve the knowledge of COVID-19 amongst ophthalmic professionals in Nepal. Opinion is also split on measures to prevent transmission, with misinformation potentially fuelling confusion. It is recommended to follow WHO and national guidelines, whilst seeking published scientific evidence behind any unofficial statements, to accurately inform one's clinical practice. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a non-communicable metabolic disease resulting from either insulin deficiency or insulin resistance. Liver enzymes (ALT and AST) are the well-known markers of hepatocellular health while GGT also shows biliary tract function. Increased activities of liver enzymes are indicators of hepatocellular injury, are associated with insulin resistance and Type 2 Diabetes Mellitus. Aims and Objective: To study the status of Liver Enzymes in type 2 diabetes patients residing in the eastern part of Nepal. Materials and Methods: This was a descriptive cross-sectional study conducted at the Department of Clinical Biochemistry, Nobel Medical College Teaching Hospital, Biratnagar, Nepal dated from 27th Dec 2019 to 27th Dec 2020. The blood sample was taken from the patients coming to the outpatient department at Diabetic and Endocrinology Clinic for a regular check-up and follow-up and those willing to participate in research. All the data collected was entered in Microsoft Excel and Statistical Package for Social Service (SPSS) version 16. p < 0.05 was considered to be statistically significant. Results: A total of 375 subjects (255 T2DM and 120 healthy) were included. The age of the T2Diabetic subjects ranges from 27-87 years with a mean of 56.91 ± 11.00 years while age of healthy subjects ranged from 31-86 years with the mean of 53.38 ± 13.28. Among the T2DM subjects, 11.76% (30/255) had raised AST, 17.25% (44/255) had raised ALT, 12.94% (33/255) had raised ALP, and 19.60% (50/255) had raised GGT. The level of liver enzymes (AST, p = 0.005, ALT, p = 0.007, ALP, p = 0.000 and GGT, p = 0.000) were showed statistically significant. Conclusion: This study concludes that liver enzyme activity was higher in T2DM subjects than individuals who do not have T2DM. In addition, Liver parameters were significantly correlated with diabetes mellitus in our study population; hence, timely diagnosis and management of the abnormal liver parameters may help to minimize liver-related morbidity and mortality in the diabetic population. [ABSTRACT FROM AUTHOR]

Objectives. Chikungunya and scrub typhus infection are important causes of undifferentiated fever in tropical zones. The clinical manifestations in both conditions are nonspecific and often overlap. This study compares the clinical manifestations and the outcome of chikungunya with chikungunya-scrub typhus coinfection in children. Methods. A hospital-based observational study was conducted in children below 15 years of age over 16-month duration in 2017-2018. Chikungunya was diagnosed by IgM ELISA. All positive chikungunya cases were subjected to scrub typhus testing, dengue testing, leptospira testing, and malaria testing. Clinical manifestations and outcomes of all patients were recorded. Results. Out of the 382 admitted cases with fever, 11% (n = 42) were diagnosed with chikungunya, and the majority (n = 30 , 71.4%) were male. Among the 42 chikungunya cases, 17 (40.5%) tested positive for scrub typhus and one positive for falciparum malaria. Out of a total of 42 chikungunya cases, myalgia, nausea/vomiting, headache, abdominal pain, lymphadenopathy, hepatomegaly, splenomegaly, and edema were 81%, 73.8%, 66.7%, 64.3%, 59.5%, 52.4%, 40.5%, and 38.1%, respectively. Besides, altered sensorium (31%), jaundice (26.2%), dry cough (21.4%), shortness of breath (19%), and seizures (16.7%) were other clinical manifestations present in this group of children. Patients with chikungunya-scrub typhus coinfection reported headaches, pain in the abdomen, dry cough, shortness of breath, seizures, and splenomegaly, significantly more (p value < 0.05) compared to those with chikungunya only. Thirteen (31%) children developed shock, five in the chikungunya group and eight in the chikungunya-scrub typhus coinfection group. Six children in the coinfection group received inotrope. Among the chikungunya-only cases, 22 recovered and one died, whereas in the chikungunya-scrub typhus coinfection group, fourteen recovered and three died. Conclusions. Both the chikungunya and scrub typhus coinfection groups shared many similar clinical manifestations. In children, coinfection with scrub typhus often leads to modification of the clinical profile, complications, and chikungunya outcome. [ABSTRACT FROM AUTHOR]

Background: Transgender women (trans women) in Nepal are underserved in the HIV response. Data are needed to determine the HIV prevalence disaggregated from other key populations and to identify the particular risks faced by this community. Trans women are marginalized around the world and research is also needed to determine the impact of stigma on HIV risk to inform trans-specific interventions. Methods: In 2019, we conducted the first population-based HIV behavioral surveillance study of trans women disaggregated from other key populations using respondent driven sampling (RDS). We estimated the HIV prevalence for trans women, and bivariate and multivariate Poisson binomial regression models were constructed to examine the relationship between HIV risk and stigma. Results: Trans women participants (N = 200) had a mean age of 33 years old (SD = 10.96). We found a weighted HIV prevalence of 11.3% (95% CI 6·82% - 18·13). We found that depression and anxiety (aPR 0.81; 95% CI 0.67-0.97; p = 0·02) and current engagement in sex work (aPR 1.31; 95% CI 1.01-1.71; p = 0·046) were significantly associated with greater prevalence of condomless receptive anal intercourse. We found that experienced stigma of ever being verbally abused due to gender identity was significantly associated with lower prevalence of depression and anxiety (aPR 0.42; 95% CI 0.20-0.87; p = 0·002). Feeling unaccepted in Nepali society and believing people thought they were a criminal because of their trans identity was significantly associated greater prevalence of current sex work (aPR 1.36; 95% CI 1.03-1.78; p = 0·03; aPR 1.45; 95% CI 1.03-2.07; p = 0.04). Every measure of experienced stigma assessed was significantly associated with greater prevalence of current engagement in sex work. Conclusions: Trans women are highly stigmatized in Nepal, leading to individual and systems factors that impact their risk for HIV. Interventions are needed that support the economic and mental wellbeing of trans women to prevent their heighted risk of HIV from stigma. [ABSTRACT FROM AUTHOR]

Chinese Pangolins (Manis pentadactyla) are Critically Endangered and one of the most illegally traded mammals globally. We generated first COI sequences from five individuals of this species from Nepal. BLASTn search of our 600 bp sequences at GenBank showed pair-wise identity between 99.17% and 100% to M. pentadactyla. There were three haplotypes and a total of five variable sites among five M. pentadactyla sequences. Neighbor-joining tree revealed that all M. pentadactyla from Nepal clustered into same group further splitting into two sub-groups albeit with low bootstrap value, suggesting potential multiple geographic origins. The K2P distance was 0.3% within group and 0.7% between four sequences from Bhaktapur and Kavrepalanchok districts (Mape2, Mape3, Mape5 and Mape6) and museum sample (Mape10). This study has generated reference samples for M. pentadactyla from Nepal and will be helpful in understanding dynamics of illegal trade of this species and in successful identification of M. pentadactyla from Nepal even in the absence of intact specimens. [ABSTRACT FROM AUTHOR]

The rusty-spotted cat Prionailurus rubiginosus is the smallest wildcat in the world, endemic to India, Nepal and Sri Lanka. Although new occurrence records have recently been reported from different geographic localities in India and Nepal, there is still a lack of information on its biology and habitat use that are required for its conservation planning. Herein, we report results from systematic, long-term (2014–2018) camera trapping in Kanha Tiger Reserve, India, to evaluate the habitat use, suitability and activity pattern of the rusty-spotted cat and model its local distribution with habitat and anthropogenic covariates. Thick canopied forest and rugged terrain were found to be extensively used and preferred by the rusty-spotted cat. It was also recorded in the multiple-use buffer zone forests in close proximity to agriculture. The species is nocturnal and its activity seems to coincide with its major prey. The guiding philosophy of tiger reserves in India is to use the tiger as an umbrella species for biodiversity conservation, and often these reserves are intensively managed to enhance tiger and prey populations. This approach, however, may not cater to the requirements of other less charismatic sympatric species, and those of the rusty-spotted cat also need to be considered for its continued survival. [ABSTRACT FROM AUTHOR]

Dengue virus (DENV) infection is endemic in Nepal. Although infection rates are reported annually, little information is available about the circulating viral serotypes and genotypes. Here, we report the results of a multicentre cross-sectional study of DENV serotypes and genotypes sampled from individuals with suspected DENV infection in Nepal in 2017. Of the 50 patients sampled, 40 were serologically positive for DENV NS1, 29 for anti-DENV IgM, 21 for anti-DENV IgG and 14 were positive by qRT-PCR. The three serotypes DENV-1, 2 and 3 were detected and there was no DENV-4. Positive samples from serotyping were subjected to PCR amplification by envelope (E) gene specific primer and subsequent bidirectional sequencing of 5 samples. A time to most recent common ancestor phylogenetic tree was constructed from the new sequences obtained here together with historical DENV-1 and DENV-2 E gene sequences. The DENV-1 isolates (n = 2) from Nepalese individuals were closely related to Indian genotype V, whereas DENV-2 isolates (n = 3) belonged to Cosmopolitan genotype IVa, which is closely related to Indonesian isolates. Historical DENV isolates obtained between 2004 and 2013 clustered with Cosmopolitan IVb, Cosmopolitan IVa, and Asian II genotypes. All Nepalese isolates had different lineages with distinct ancestries. With the exception of isolates obtained in 2004, all other previously published isolates had ancestry to geographically distant part of the world. Molecular analysis revealed dengue epidemics to be comprised of different genotypes of serotype 1 and 2 raising concerns on potential role of different genotypes causing Dengue hemorrhagic fever. Also, our result indicated spread of DENV-2 in non-endemic area such as hilly region of Nepal which was considered to be free of dengue due to high altitude and cold weather. [ABSTRACT FROM AUTHOR]

Purpose: Vision 2020 and the Global Action Plan 2013–2019 prioritise primary eye care (PEC) as an important component of reducing avoidable blindness. Studies in sub-Saharan Africa have demonstrated that current PEC provision is poor. There has been no evaluation of the current practice of PEC among primary health care workers (PHCWs) in Nepal. Methods: A mixed methods descriptive cross-sectional study with semi-structured interviews and focus group discussions (FGDs) was carried out in Eastern Nepal. Government employed PHCWs working at health posts in three districts were invited to take part in a PEC knowledge and skills assessment. Each health post was assessed for ophthalmic equipment and medications. Three focus group discussions and eight semi-structured interviews were carried out with community ophthalmic assistants, PHCWs and a district health manager. Results: 107 PHCWs in 35 health posts took part in the quantitative study. Only 8.4% had received eye care training. 27.1% PHCWs could diagnose a corneal ulcer, 83.2% conjunctivitis, 75.7% cataract and 54.2% ophthalmia neonatorum. Only 14.0% could measure visual acuity, and 5.7% of HPs had a vision chart. Ophthalmic assistants described their concern for the low level of PEC at health posts. PHCWs were keen to receive training and highlighted the need for greater government support in the provision of eye care services. Conclusion: PEC knowledge and skills among PHCWs in eastern Nepal is inadequate to provide quality PEC services. There is a pressing need for PEC training in the region, provision of ophthalmic equipment and greater government support for eye care. [ABSTRACT FROM AUTHOR]

Background: Anemia is a major concern for children in Nepal; however, little is known about context-specific causes of anemia.Objective: We used cross-sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anemia in a nationally representative, population-based sample of children 6-59 mo (n = 1367).Methods: Hemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood samples. Soil-transmitted helminth (STH) and Helicobacter pylori infections were assessed from stool. Anthropometry was measured with standard procedures. Sociodemographic and household characteristics, diet, micronutrient powder (MNP) intake, pica, and morbidity recall were ascertained by caregiver interview. Multivariable logistic regression that accounted for complex sampling design, determined predictors of anemia (hemoglobin <11.0 g/dL, altitude adjusted); candidate predictors were variables with P < 0.05 in bivariate models.Results: Anemia prevalence was 18.6% (95% CI: 15.8, 21.4). MNP intake [adjusted OR (AOR): 0.25, 95% CI: 0.07, 0.86], log (ln) ferritin (μg/L) (AOR: 0.49, 95% CI: 0.38, 0.64), and ln RBP (μmol/L) (AOR: 0.42, 95% CI: 0.18, 0.95) were associated with reduced odds of anemia. Younger age (6-23 mo compared with 24-59 mo; AOR: 2.29, 95% CI: 1.52, 3.46), other Terai ethnicities (AOR: 2.59, 95% CI: 1.25, 5.35) and Muslim ethnicities (AOR: 3.15, 95% CI: 1.30, 7.65) relative to Brahmin/Chhetri ethnicities, recent fever (AOR: 1.68, 95% CI: 1.08, 2.59), ln C-reactive protein (mg/L) (AOR: 1.23, 95% CI: 1.03, 1.45), and glucose-6-phosphate dehydrogenase deficiency (AOR: 2.84, 95% CI: 1.88, 4.30) were associated with increased odds of anemia.Conclusion: Both nonmodifiable and potentially modifiable factors were associated with anemia. Thus some but not all anemia might be addressed through effective public health policy, programs, and delivery of nutrition and infection prevention and control. [ABSTRACT FROM AUTHOR]

E-tourism plays a pivotal role in delivering services to tourists by enhancing travel experiences. While small tourism service providers in the developed economies can efficiently take advantage of e-tourism by partnering with global online platforms such as TripAdvisor or Booking.com, small tourism service providers in developing countries often struggle to reach global markets due to factors that are unique to the country they operate in. The aim of this study, therefore, is to identify the key barriers and motivators of e-tourism adoption for small and medium tourism enterprises (SMTEs) in developing countries. Nepal is selected as the case study due to its enormous tourism potential that is plagued by typical challenges. Based on the 'Technology, Organization and Environment' framework and 'e-readiness' model, this study identified ten key factors that affect e-tourism adoption by SMTEs in Nepal. A mixed-method approach, using interviews with seven key stakeholders and a survey with 198 SMTEs, were employed for data collection and validation of the proposed factors. Finally, an e-tourism adoption model highlighting the barriers and motivators for e-tourism by SMTEs is presented. This research found that e-tourism adoption by SMTEs in Nepal is affected by environmental factors related to national infrastructure, market size, country-specific contextual factors and organizational factors comprising e-tourism awareness, ICT resources, value proposition, and top management support. This study offers implications for policy and practice towards effective e-tourism adoption in other developing countries. [ABSTRACT FROM AUTHOR]

Aim: Assessment of clinical symptoms followed by microbiological analysis and antibiogram profiling are obligatory for prompt treatment of bacterial conjunctivitis. In this study effort has been made to evaluate the microbiological profile of bacteria causing conjunctivitis along with clinical symptoms and their antibiotic sensitivity pattern in Birgunj adjoining area, Nepal. Materials and Methods: Clinical information and conjunctival swabs were collected from 260 patients and processed as per standard bacteriological methods. Data were statistically analyzed using one-way ANOVA in Sigma plot 11.0 (USA) to determine the significant difference between the means. Results: The incidence of bacterial conjunctivitis was found to be maximum among <10 years age group (28%) with an overall male preponderance of 62%. More than 60% of the patients have running nose (65%) followed by profuse discharge from the ocular area (52%). The commonest bacterial causative agent was Staphylococcus aureus (46%) followed by Streptococcus spp. (17%) and coagulase negative Staphylococcus spp. (12%). Among the gram negative isolates, Pseudomonas spp. are predominant (9%). Antimicrobial profiling revealed that S. aureus shows higher degree of resistance against erythromycin, chloramphenicol and cotrimoxazole. The most effective antibiotics against the isolated bacterial antibiotics were cloxacillin, amoxicillin/clavulinc acid and ceftriaxone. Conclusion: The knowledge of antibiogram for bacterial conjunctivitis is a prerequisite for the proper treatment and control of the infection. Systemic large scale studies should be conducted for regular monitoring of the antibiotic susceptibility pattern which might help in reducing the resistance of the commonly used drugs used against bacterial pathogens. [ABSTRACT FROM AUTHOR]

Spatial and temporal variations have been found in the levels of arsenic (As) throughout the groundwater of the Ghaghara basin. Fifteen out of twenty-five districts in this basin are reported to be affected by As, where the levels of As in groundwater and soil exceed the permissible limits set by the WHO (10 μgl−1) and FAO (20 mgkg−1) respectively. These districts include a total of four municipalities in Nepal and eighty-six blocks in India, all of which have varying degrees of As contamination. Approximately 17 million people are at risk of As poisoning, with more than two orders of magnitude higher potential lifetime incremental cancer risk, constituting over 153 thousand potential additional cases of cancer due to As-contaminated drinking water. Out of the 90 As-contaminated blocks in the Ghaghara basin, 4 blocks have about 7-fold higher potential risk of developing cancer, 49 blocks have 8–37-fold higher risk, and 37 blocks have up to 375-fold higher risk compared to the upper limit of the USEPA acceptable range, which is 1 × 10−6-1 × 10−4. High accumulation of As has been reported in the nails, hair, and urine of local inhabitants, with higher levels observed in females than males. The toxicity of As is manifested in terms of a higher occurrence of various diseases. Reproductive endpoints, such as increased incidences of preterm birth, spontaneous abortion, stillbirth, low-birth weight, and neonatal death, have also been reported in the basin. The level of As in tube wells has been found to be negatively correlated with the depth (r = −0.906), and tube wells with high levels of As (>150 μgl−1) are generally located within close proximity (<10 km) to abandoned or present meander channels in the floodplain areas of the Ghaghara river. In addition to As contamination, the water quality index (WQI) in the Ghaghara basin is poor according to the BIS standards for drinking water. Groundwater in six out of fifteen districts is unsuitable for drinking purposes, with a WQI exceeding 100. The levels of As in agricultural soil in many villages of Ballia, Bahraich, and Lakhimpur Kheri districts have exceeded the FAO limit. Water from deep tube wells has been found to be relatively safe in terms of As content, and thus can be recommended for drinking purposes. However, the use of surface water needs to be encouraged for irrigation purposes in order to preserve soil health and reduce As contamination in the food chain, thereby minimizing the risk of cancer. [Display omitted] • More than 17 million people are at risk of arsenic poisoning in the Ghaghara basin. • Potential cancer risk is more than two orders of magnitude higher than USEPA limit. • Arsenic accumulation is higher in hair and nails of female compared to males. • Area within 10 km distance from midstream of Ghaghara river is most contaminated. • Groundwater arsenic levels and depth of tube wells are inversely related. [ABSTRACT FROM AUTHOR]

Cuscuta reflexa (C. reflexa Roxb.), is an endogenous parasitic plant found in Nepal and has been used by various ethnic communities of Nepal. However, there has been cases of toxicity in humans which needs attention. Here we discuss a case of C. reflexa Roxb. accidental self-poisoning while being used for liver ailments that presented with gastrointestinal symptoms initially and local health facility and visited two health facilities before presenting to Tribhuvan University Teaching Hospital with multiple complaints. Appropriate risk assessment was done and the patient was managed conservatively at our center for three days following which he was discharged. [ABSTRACT FROM AUTHOR]

Knowledge, awareness, and practices with regard to diabetes management in south Asia are not known. This study aimed to determine current clinical practices with regard to managing diabetes in Nepal and India. Doctors attending conferences in Delhi, Guwahati, and Kathmandu were evaluated regarding their diabetes treatment preferences using a standardized questionnaire having 34 multiple-choice questions. The questionnaire evaluated doctor's preferences on therapeutic lifestyle modification, pharmacotherapy, and insulin injection practices. From a total of 409 filled questionnaires which were collected, 261, 75, and 73 questionnaires from New Delhi, Guwahati, and Kathmandu, respectively, which fulfilled all criteria, were analyzed. The mean age of doctors was 42.26 ± 11.99 years. Low carbohydrate, high protein was the most frequently recommended diet plan. The use of carbohydrate counting in practice was non-existent. Self-monitoring of blood glucose (SMBG) is commonly used in practice with 1–2 times per day checking. The preferred second, third, and fourth oral agents after metformin were sulfonylureas (53.05%), glucosidase inhibitors (37.16%), and dipeptidyl-peptidase-4 inhibitors (DPP4i) (42.79%) respectively. Glimepiride (73.83%) and gliclazide (28.60%) were the most preferred sulfonylureas. Teneligliptin (31.54%), sitagliptin (23.71%), linagliptin (22.24%), and vildagliptin (16.38%) were the preferred DPP4i. Dapagliflozin (30.56%), empagliflozin (20.29%), and canagliflozin (8.85%) were the preferred sodium-glucose co-transporter-2 inhibitor (SGLT2i). Insulin use was delayed in type-2 diabetes, typically initiated only after glycemic control not adequate with five oral anti-diabetes agents (OADs) (50.36%). The most preferred insulin was basal insulin analogue (47.68%) followed by neutral protamine hagedorn (NPH) insulin (22.24%). Most patients received < 20 U of insulin/day (56.96%). The most commonly used short-acting insulin in pregnancy was lispro (204; 49.88%). The preferred long-acting insulin in pregnancy was NPH insulin (180; 44.01%). Lack of use of digital technology, less use of lifestyle modifications, delayed use of insulin, preference for multiple OADs, popularity of sulfonylureas and alpha-glucosidase inhibitors (AGIs), and late use of SGLT2i were some of the key highlights of diabetes practice in south Asia. [ABSTRACT FROM AUTHOR]

Background: Pharmaceutical care (PC) has a significant impact on optimizing pharmacotherapy and improving patients' quality of life. We aimed to determine the attitudes and perceived barriers of final year pharmacy undergraduates towards provision of PC services in Nepal. Methods: A cross-sectional study was conducted among 232 students using a 13-item-standard PC attitude survey (PCAS) questionnaire and 12-itemed PC barrier questionnaires. Mann–Whitney U test and Kruskal–Wallis tests were used to measure the median difference between groups, at alpha=0.05, and Spearman's rho test was used to measure the strength of the correlation. Results: Majority of students were self-motivated in undertaking the current pharmacy education (178, 76.7%) and had no previous incomplete grades that could delay their graduation (177, 76.3%). Over 80% of students had a positive attitude toward all items of PCAS (agreed and strongly agreed) except for two items. Whereas, 61 (26.3%) disagreed and strongly disagreed that providing PC takes too much time and effort. The major barriers perceived were inadequate PC training (176, 75.9%), inadequate drug information resources in the pharmacy (170, 73.3%), and lack of access to patient medical records in the pharmacy (165, 71.1%). A significant relationship was noticed between positive attitude towards PC and three factors; source of motivation, current employment in pharmacy job, and incomplete grades delaying graduation. Age factor was significant but negatively correlated with the scores of positive attitudes namely "I would like to perform PC as a pharmacist practitioner", "Providing PC is professionally rewarding" and "I feel that the PC is the right direction for the provision to be headed". Conclusion: Nepalese undergraduate pharmacy students had positive attitudes toward PC. Exercising proper pharmacy practice regulations and educational efforts to overcome the perceived barriers may lead to better delivery of PC. [ABSTRACT FROM AUTHOR]

Violence against female was there since ancient times, which include dowry harassment and domestic violence. Dowry is the transfer of any kind or cash from bride’s family to bridegroom or his family voluntarily, but as time passed, the voluntary element decreased and forcible element came up. The system of dowry is now commonly practiced in India, Bangladesh, Pakistan, Nepal etc. The idea of present study came from the light of increasing number of dowry deaths and low level of reporting in the society. The aim of the study was to sort out various socio-etiological factors of alleged dowry deaths in and around Puducherry. Out of 65 cases, mean age was 24 years and 56.91% cases occurred within three years of marriage. Most of the cases happened in a rural area (90.8%), in those who are living in a joint family (63.1%), and in low-income family (70.8%). Majority of them were housewives, studied up to high school standard (8th to 10th), and having one child. We observed that of most of them died to burns (73.84%), followed by poisoning (18.46%). Commonest manner of death was suicidal. Quarrel with spouse or in-laws were the most common reason or motive behind the death. [ABSTRACT FROM AUTHOR]

The study of persistent organic pollutants (POPs) in low-latitude tropical and subtropical urban cities is necessary to assess their local and global impacts on ecosystems and human health. Despite studies on levels of POPs in water, soils, and sediments, analysis of the distribution patterns, seasonality, and sources of POPs in urban regions of Nepal remain limited. Polyurethane foam (PUF)-based passive air samplers were deployed in three major cities in Nepal: Kathmandu (the capital city), Pokhara, and Hetauda (agricultural cities). Dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH) were the dominant organochlorine pesticides in the atmosphere at all sites. The average concentrations of POPs were Σ DDTs, 8.7- 1.0×103 pgm-3; Σ HCHs, 5.3-3.3×103 pgm-3; HCB, 5.8-3.4×102 pgm-3; Σ endosulfan, BDL-51 pgm-3 Σ ; and 6ΣCBs, 1.4-47 pgm-3. Isomer and metabolite ratio analyses suggested that the concentrations present were from both new and historical applications of the POPs. Vegetable production sites and their market places appeared to be the major DDT and HCH source areas. Higher atmospheric concentrations of DDT and HCH occurred during the pre-monsoon and monsoon seasons, and winter, respectively, closely associated with their local application for soil preparation and vegetable spraying. The estimated travel distances of the POPs (HCB, p'-HCH, -HCH, and p;p0-DDT) under the Nepalese tropical climate were all above 1000 km, suggesting that high precipitation levels in the tropical climate were not enough to scavenge the POPs and that Nepal could be an important source region for POPs. Due to their close proximity and cold trapping (driven by low temperatures), the high Himalayas and the Tibetan Plateau are likely the key receptors of POPs emitted in Nepal. These results add to the information available on POPs from tropical developing countries. [ABSTRACT FROM AUTHOR]

Introduction: Globally, the proportion of elderly people is increasing at an unprecedented rate. Geriatric health problems are important issues even in developing countries like Nepal. The main objective of the study is to identify the disease patterns among the elderly people coming in Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Methods: A cross sectional descriptive study was done among 100 patients, aged 60 years and above, in General Health Checkup clinic of Tribhuvan University Teaching Hospital in Kathmandu. Written consent was maintained in the study. The obtained data through questionnaire method were managed by coding and entered and analyzed by using IBM SPSS V20. Results: More than half (53%) of the patients were male. The mean (±SD) age was 67.35 (±6.927) years. Most of them were suffering from more than one disease. Hypertension was the commonest morbidity found in 47% of the patients. The other health problems were diabetes mellitus, dyslipidemia, coronary artery disease, hypothyroidism, cholelithiasis, cataract, chronic obstructive airway disease, benign hyperplasia of prostate and hysterectomy. Conclusion: From the study, it can be concluded that non-communicable diseases are the major bulk of diseases in elderly population and have substantial impact on public health. Clinical settings like general health checkup clinics should focus on disease prevention and management including life style modifications, early detection and treatment, and self-management education. Effective geriatric health care services need to stress ranging from family-based community care approach to convenient access to primary health care. Family caregivers and health care professionals need training and support in this field. [ABSTRACT FROM AUTHOR]

Background: Economic burden to households due to out-of-pocket expenditure (OOPE) is large in many Asian countries. Though studies suggest increasing household poverty due to high OOPE in developing countries, studies on association of multidimensional poverty and household health spending is limited. This paper tests the hypothesis that the multidimensionally poor are more likely to incur catastrophic health spending cutting across countries. Data and methods: Data from the Poverty and Vulnerability Assessment (PVA) Survey carried out by the International Center for Integrated Mountain Development (ICIMOD) has been used in the analyses. The PVA survey was a comprehensive household survey that covered the mountainous regions of India, Nepal and Myanmar. A total of 2647 households from India, 2310 households in Nepal and 4290 households in Myanmar covered under the PVA survey. Poverty is measured in a multidimensional framework by including the dimensions of education, income and energy, water and sanitation using the Alkire and Foster method. Health shock is measured using the frequency of illness, family sickness and death of any family member in a reference period of one year. Catastrophic health expenditure is defined as 40% above the household's capacity to pay. Results: Results suggest that about three-fifths of the population in Myanmar, two-fifths of the population in Nepal and one-third of the population in India are multidimensionally poor. About 47% of the multidimensionally poor in India had incurred catastrophic health spending compared to 35% of the multidimensionally non-poor and the pattern was similar in both Nepal and Myanmar. The odds of incurring catastrophic health spending was 56% more among the multidimensionally poor than among the multidimensionally non-poor [95% CI: 1.35-1.76]. While health shocks to households are consistently significant predictors of catastrophic health spending cutting across country of residence, the educational attainment of the head of the household is not significant. Conclusion: The multidimensionally poor in the poorer regions are more likely to face health shocks and are less likely to afford professional health services. Increasing government spending on health and increasing households' access to health insurance can reduce catastrophic health spending and multidimensional poverty. [ABSTRACT FROM AUTHOR]

Background: The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care.Methods: The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness.Results: Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3-50 %) and alcohol consumption during pregnancy (5-51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community.Conclusions: It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services. [ABSTRACT FROM AUTHOR]

Background: This is a prevalence study of ear diseases and hearing impairment done in a combined eye and ear set up of Biratnagar Eye Hospital. This study was conducted in the Sunsari and Morang districts of Nepal. Its aim is to find out the ear disease and hearing impairment prevalent in the community. Materials and Methods: A total of 2259 people who visited eye camps were screened for ear diseases. Patients were examined by the eye and ear assistants under supervision of otolaryngologist. A head mirror, an otoscope, an aural syringe, kidney trays and light source and a set of tuning forks (512 and 256 Hz) were used to assess the ear diseases and hearing loss. Results: A total of 1094 patients presented with ear diseases. Males were more than females [608(55.42%) vs. 486(44.57%)]. Children up to and below 15 years were 386 (35.28%). The frequency of ear diseases were as follows: Impacted wax-319 (29.15%), chronic suppurative otitis media mucosal type - 307(28.06%), otomycosis - 66 (6.03%), furunculosis/otitis externa - 46 (4.29%), Acute suppurative otitis media - 46 (4.2%), tubal catarrhal - 34(3.1%), otitis media with effusion - 24 (2.19%), perichondritis - 21(1.91%), Unsafe otitis media - 14(1.27%), Foreign body in the ear - 4 (0.36%) cases, Postraumatic perforation of tympanic membrane - 2 (0.18%), deaf and mute - 12 (1.09%). presbyacusis and other sensorineural hearing loss-199(18.19%). The point prevalence of otitis media was 17.3% (391) people. Hearing impairment was 64.99 %(635 out of 977 patients above 5 years). Conclusion: Ear diseases and hearing impairment are very common in Sunsari and Morang districts of Nepal demanding immediate treatment. [ABSTRACT FROM AUTHOR]