Impact of a Newly Constructed Motor Vehicle Road on Altitude Illness in the Nepal Himalayas

Risk factors associated with high altitude sickness among travelers: A case control study in Himalaya district of Nepal

High elevation adventures are popular among travelers; however, they carry significant health risks, such as altitude sickness. This study aims to identify risk factors associated with high altitude sickness among travelers to Mustang district. A health-facility-based, age-sex matched 1:1 case-control study was conducted in Mustang district hospital, Nepal. Measurements included Acute Mountain Sickness/High Altitude Cerebral Edema/High Altitude Pulmonary Edema assessment via LLS questionnaire, demographics, medical history, ascent rate, and prophylactic medicine intake. Data were collected between September and November, 2023 via predesigned structured questionnaire by trained medical officers in, and analyzed using SPSS version 25. Using binary logistic regression, the study tested potential risk factors associated with altitude sickness. Ethical approval was obtained from the NHRC, and written informed consent was obtained from all participants. A total of 63 cases (individuals with altitude sickness) and 63 controls (without) were interviewed. The mean age of cases and controls was 48.5 years (SD = 16.5) and 48 years (SD = 16.9) respectively. 38 were rapid ascenders, and 88 were slow ascenders. Awareness of altitude sickness was reported by 65 individuals, with 36 taking prophylactic medication (Acetazolamide 125/250mg). Among cases, 8 experienced HACE, 42 had AMS, and 13 had HAPE. Rapid ascent (Adjusted Odds Ratio [AOR]: 6.41, 95% Confidence Interval [CI]: 2.36-17.54), individuals with a previous history of illness (AOR: 10.20, 95% CI: 2.70-38.46), and failing to take prophylactic medication (AOR: 10.01, 95% CI: 1.896-10.680) were linked to an increased risk of altitude sickness. Our study highlights the critical role of ascent speed, previous history of illness, and use of prophylactic measures in development of altitude sickness.

A Season at the Himalayan Rescue Association Aid Post in Manang

The Himalayan Rescue Association (HRA) has operated high altitude clinics in Nepal for 50 years, with rising visitor numbers, especially from India, China, and Nepal. New roads have eased access and increased the speed of ascent in some areas. Our aim was to provide a description of the activities, clinical problems, and lecture attendees of the HRA aid post in Manang over one season. We also highlight the evolving challenges of providing healthcare and education in the high Himalayan region. We describe the clinical and educational activities of the HRA aid post in Manang from September 24 to December 1, 2023. Prospective clinical data collection included anonymized patient demographics and diagnoses. Lecture data were taken from the attendee register and by daily manual counts of lecture attendees. We saw 376 patients, 62% of whom were Nepalis. Infectious diseases (42%) and altitude illness (16%) were the most common problems. A total of 846 people from 47 countries attended the daily altitude lectures. Only 5% of attendees were Nepali. Electrical supply interruptions and limitations in medical evacuation options were among the challenges of providing care at a high altitude clinic and preventing altitude illness using educational lectures. Altitude illness remains a common and potentially life-threatening problem, with risks increased by rapid ascent enabled by new road access and by ignorance of risks of altitude among travelers, especially Nepalis. Language barriers in educational outreach call for novel approaches and interventions that will ensure the effectiveness of altitude education.

Ascent rate and the Lake Louise scoring system: An analysis of one year of emergency ward entries for high-altitude sickness at the Mustang district hospital, Nepal

More travellers are making swift ascents to higher altitudes without sufficient acclimatization or pharmaceutical prophylaxis as road connectivity develops in the Himalayan region of Nepal. Our study connects ascent rate with prevalence and severity of acute mountain sickness (AMS) among patients admitted to the emergency ward of the Mustang district hospital in Nepal. A register-based, cross-sectional study was conducted between June 2018 and June 2019 to explore associations of Lake Louise scores with ascent profile, sociodemographic characteristics, and comorbidities using chi-square test, t-test, and Bayesian logistic regression. Of 105 patients, incidence of AMS was 74%, of which 61%, 36%, and 3% were mild, moderate, and severe cases, respectively. In the Bayesian-ordered logistic model of AMS severity, ascent rate (odds ratio 3.13) and smoking (odds ratio 0.16) were significant at a 99% credible interval. Based on the model-derived counterfactual, the risk of developing moderate or severe AMS for a middle-aged, non-smoking male traveling from Pokhara to Muktinath (2978m altitude gain) in a single day is twice that of making the ascent in three days. Ascent rate was strongly associated with the likelihood of developing severe AMS among travellers with AMS symptoms visiting Mustang Hospital's Emergency Ward.

High-altitude illness: Menace in Himalayas of Nepal

Nepal is a country of Himalayas including Mt Everest, the tallest mountain in the world, where a lot of people travel to high altitudes. Significant number of people develop high-altitude illness which includes acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE) leading even to death. Addressing this issue demands more efforts on both the preventive and treatment aspects to decrease the sufferings of people in this modern time of advanced healthcare and technology.

Lower Incidence of COVID-19 at High Altitude: Facts and Confounders

Pun, Matiram, Rachel Turner, Giacomo Strapazzon, Hermann Brugger, and Erik R. Swenson. Lower incidence of COVID-19 at high altitude: Facts and confounders. High Alt Med Biol. 21:217-222, 2020.-The rapid transmission, increased morbidity, and mortality of coronavirus disease 2019 (COVID-19) has exhausted many health care systems and the global economy. Large variations in COVID-19 prevalence and incidence have been reported across and within many countries worldwide; however, this remains poorly understood. The variability and susceptibility across the world have been mainly attributed to differing socioeconomic status, burden of chronic diseases, access to health care, strength of health care systems, and early or late adoption of control measures. Environmental factors such as pollution, ambient temperature, humidity, and seasonal weather patterns at different latitudes may influence how severe the pandemic is and the incidence of infection in any part of the world. In addition, recent epidemiological data have been used to propose that altitude of residence may not only influence those environmental features considered key to lesser viral transmission, but also susceptibility to more severe forms of COVID-19 through hypoxic-hypobaria driven genomic or nongenomic adaptations specific to high-altitude populations. In this review, we critically examine these factors and attempt to determine based upon available scientific and epidemiological data whether living in high-altitude regions might be protective against COVID-19 as recent publications have claimed.