Prey selection by leopards (Panthera pardus fusca) in the mid-hill region of Nepal

Information on prey selection and the diet of the leopard (Panthera pardus fusca) is essential for leopard conservation. We conducted an investigation into the prey species and the proportion of each species in the leopard's diet in a human-dominated mid-hill region of Nepal. The analysis of 96 leopard scats collected between August 2020 and March 2021 revealed that leopards consumed 15 prey species, including small- and medium-sized mammals and livestock. In addition to these prey species, we also found plastic materials, bird feathers, and some unidentified items in the leopard scats. Wild ungulates (such as barking deer, Muntiacus muntjak and wild boar, Sus scrofa) constituted only 10% of the biomass in the scats, while livestock contributed 27%, and other wild prey contributed 50%. Among all species, domestic goats had the highest relative biomass in the scats, followed by the jungle cat (Felis chaus), domestic dog (Canis familiaris), and large Indian civet (Viverra zibetha). Similarly, the Indian hare (Lepus nigricollis) had the highest proportion of relative individuals present in the scat samples, followed by the jungle cat and the large Indian civet. A lower proportion of biomass from wild ungulates in the leopard's diet and a higher dependency of the leopard on domestic prey and other wild prey indicate a shortage of medium-sized wild prey, such as barking deer and wild boar, in leopard habitats. Therefore, the conservation of wild prey species, especially medium-sized prey, is crucial for reducing the leopard's dependence on livestock and mitigating human-leopard conflicts in the future.

Impact of climate change on distribution of common leopard (Panthera pardus) and its implication on conservation and conflict in Nepal

Climate change is projected to create alterations in species distributions over the planet. The common leopard (Panthera pardus) serves an important ecological function as a member of the big carnivore guild, but little is known about how climate change may affect their distribution. In this study, we use MaxEnt to simulate the geographic distributions by illustrating potential present and future ranges of common leopard by utilizing presence records alongside important topographic and bioclimatic variables based on two shared socioeconomic pathways (SSP2-4.5 and SSP5-8.5) scenarios. The goals of this study was to look into possible distribution ranges of common leopards due to climate change, as well as explore the implications for conservation and potential conflict with humans. At present, 4% of Nepal was found to be highly suitable for common leopards, 43% suitable, 19% marginally suitable, and 34% unsuitable. A large portion of the climatically suitable habitat was confined to non-protected areas, and the majority of the highly suitable habitat was encompassed by forest land, followed by agricultural areas. Elevation, mean temperature of driest quarter, annual precipitation, and precipitation seasonality were the variables influencing habitat suitability for the common leopard. A significant increase in marginally suitable habitat was observed in the high mountain region, indicating a shift of habitat in upper elevation areas due to the effects of climate change. We recommend timely management of these potential habitats to expand the range of this vulnerable species. At the same time, a combination of expanding new habitats and poor management practices could escalate human-leopard conflict. Therefore, further study on the impact of climate change on the distribution of prey species and proper habitat management techniques should be prioritized to mitigate conflicts.

Anthropogenic mortality of large mammals and trends of conflict over two decades in Nepal

Wildlife conservation in human-dominated landscapes faces increased challenges due to rising conflicts between humans and wildlife. We investigated the human and wildlife loss rates due to human-wildlife conflict between 2000 and 2020 in Nepal. We concentrated on Asian elephant (Elephas maximus), greater one-horned rhino (Rhinoceros unicornis), tiger (Panthera tigirs), and leopard (Panthera pardus) mortality, as well as human mortality caused by these species. Over the 21-year period, we recorded 1139 cases of wildlife mortality and 887 cases of human mortality. Leopard mortality was the highest, followed by that of greater one-horned rhinos, tigers, and Asian elephants. Overall, the rate of wildlife mortality has been increasing over the years. Asian elephants were found to be more responsible for crop damage than greater one-horned rhinos, while leopards were found to be more responsible for livestock depredation than tigers. The generalized linear model indicated that the mortality of wildlife in the districts is best predicted by the additive effect of human mortality, the proportion of agricultural land, and the literacy rate of the districts. Retaliatory wildlife mortality was the most challenging issue for wildlife conservation, especially for the large mammals. Findings from this study are important for mitigation of human-wildlife conflicts, controlling retaliatory killing, and conserving these threatened large mammals.

Dietary determinants of aflatoxin B1-lysine adduct among infants in Nepal

BACKGROUND

Aflatoxins are mycotoxins produced by naturally occurring fungi on food, and aflatoxin B₁ (AFB₁) is carcinogenic, immunotoxic and hepatotoxic. This study assesses the relationship between AFB₁ in Nepali infants at 12 months of age and their diet at 9 and 12 months of age.

METHODS

The study used data collected from 1329 infants enrolled in the AflaCohort Study. Aflatoxin exposure was assessed at 12 months using serum AFB₁-lysine pg/mg albumin biomarker measured using high performance liquid chromatography-fluorescent detection. Dietary data were collected using food frequency questionnaire. We conducted ordinary least squares and quantile regression analyses with backward elimination to assess lagged (9-month diet and 12-month AFB₁) and contemporaneous (12-month diet and 12-month AFB₁) associations.

RESULTS

Eighty-one percent of children at 12 months had detectable levels of serum AFB₁-lysine (geometric mean: 0.79 pg/mg albumin, 95% CI: 0.74-0.83). The levels ranged from 0.4 to 85 pg/mg albumin. Dietary diversity at 9 and 12 months were not associated with serum AFB₁-lysine levels. Consumption of fish and groundnuts at both 9 and 12 months and infant formula and cauliflower at 9 months were associated with higher serum AFB₁-lysine while consumption of bananas and mangoes at 12 months were negatively associated with serum AFB₁-lysine (p < 0.05).

CONCLUSIONS

High prevalence of detectable AFB₁-lysine among infants, and possible links to their dietary patterns argues for more urgent research into which foods in children's diets are most contaminated, and into optimal entry points in the food chain that would allow for effective actions to minimize exposure.

Exposure to multiple mycotoxins, environmental enteric dysfunction and child growth: Results from the AflaCohort Study in Banke, Nepal

Evidence of the impact of exposure to multiple mycotoxins and environment enteric dysfunction (EED) on child growth is limited. Using data from a birth cohort study, the objectives of this study were to (a) quantify exposure to multiple mycotoxins (serum aflatoxin [AFB₁] and ochratoxin A [OTA], urinary fumonisin [UFB₁] and deoxynivalenol [DON]), as well EED (lactulose:mannitol [L:M] ratio); (b) examine the potential combined effects of multiple mycotoxin exposure and EED on growth. Multivariate regressions were used to identify associations between growth measurements (length, weight, anthropometric z‐scores, stunting and underweight) at 24–26 months of age and exposure to mycotoxins and EED at 18–22 months (n = 699). Prevalence of AFB₁, DON, OTA and UFB₁ exposure ranged from 85% to 100%; average L:M ratio was 0.29 ± 0.53. In individual mycotoxin models, AFB₁ exposure was negatively associated with weight, WAZ, increased odds of stunting (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.08, 1.52; p = 0.004) and underweight (OR: 1.18, 95% CI: 1.00, 1.38; p = 0.046). Irrespective of other mycotoxin exposure and presence of EED, AFB₁ was negatively associated with length, weight, head circumference, LAZ and WAZ, and with increased odds of stunting and underweight, UFB₁ was associated with increased odds of underweight, and DON was negatively associated with head circumference. EED was associated with the impaired length and weight. These findings suggest that certain mycotoxins and EED may have independent impacts on different facets of growth and that aflatoxin dominates such impacts. Thus, programs reducing exposure to mycotoxin and EED through multi‐sectoral nutrition‐sensitive interventions have the potential to improve child growth.

Mycotoxin exposure was highly prevalent in children aged 18–22 months. Various mycotoxins and EED contribute independently to different manifestations of poor child growth

AFB1 was negatively associated with length, weight, head circumference, LAZ, as well as WAZ, and associated with increased odds of stunting and underweight. UFB1 was also associated with increased odds of underweight. DON was negatively associated with head circumference.

Leopard preyed on Jungle cat: evidence from the mid-hill of Nepal

In the pictures taken by the camera trap, the photo of a leopard hunting a jungle cat is rare. This type of evidence makes it easier to understand the current status of wildlife and also implement further conservation actions. This study was conducted from November 2020 to December 2020 in the mid-hill regions of Nepal. We installed the camera traps in l*1 km grid cell covering about 60 km2. Out of 36 camera trap locations, 1 leopard preying on a jungle cat was captured in one location. Our study concluded that carnivores could capture another sympatric family because of the lack of natural prey species. Therefore, conservation of the natural prey species including small carnivores or mammals is also essential to conserve the leopard population.

Potential risk zone for anthropogenic mortality of carnivores in Gandaki Province, Nepal

Anthropogenic pressures in human-dominated landscapes often contribute to wildlife mortality. Carnivores are especially vulnerable to human-induced mortality due to the perceived threat to livestock and humans. Despite having widespread conservation implications, carnivore mortality data have been largely underutilized within Nepal. This study utilized Maxent to identify high-risk areas and explore the contribution of habitat attributes associated with carnivore mortality using the casualty database within the Gandaki province of central Nepal. We categorized the risk to carnivore species in three taxonomic groups, Felid, Viverridae, and Herpestidae, and identified a 3704-km2 area within the province at high risk for carnivore casualty. The middle mountains were the riskiest physiographic zone, and the Annapurna Conservation Area represented the largest risk zone among the four protected areas. Agricultural land was the most problematic area in terms of carnivore casualty. The human population was positively associated with high-risk areas and the number of casualties, whereas protected area cover had a negative association. This study identified that the common leopard was at the highest risk of mortality and therefore would benefit from the implementation of an action plan and species-specific conservation strategies, especially within identified high-risk zones. An expansion of protected areas in the middle mountain region would serve to greatly reduce carnivore casualty. Species distribution modeling can be further used with national-level spatial and temporal mortality data to identify the most prominent casualty times and pinpoint potential casualty locations throughout the country.

Characterization and management of human-wildlife conflicts in mid-hills outside protected areas of Gandaki province, Nepal

With the intent to better management human wildlife conflict (HWC) and wildlife conservation in mid-hills outside protected areas of Gandaki province, Nepal, we analyzed the patterns and drivers of HWC. Using data collected from literature, government records and questionnaire survey, we investigated temporal, seasonal and spatial distribution of human casualties caused by wildlife attacks. We also appraised the perception of local people towards wildlife conservation. We have recorded 77 cases (69 human injuries and 8 mortalities) during the period of nine year between 2011 and 2019. The number of wildlife attacks increased over this period. Wildlife attacks were more frequent in winter with 50% (42) of attacks occurred between September and December. Common leopard (Panthera pardus) and Himalayan black bear (Ursus thibetanus laniger) were the major species involved in these conflicts. Common leopard was the most feared species that causes highest number of human mortalities (87%, n = 67); the most severe type of HWC outcome. Forty-eight percent (n = 37) attacks were reported at human settlement areas followed by 27% attacks in agriculture land (n = 21) and 24% (n = 19) in forest. Generalized linear model analysis on spatial variables showed that the probability of human attacks increases with decreasing elevation (β = -0.0021, Z = -1.762, p = 0.078) and distance from the forest (β = -0.608, Z = -0.789, p = 0.429). We recommend to decrease habitat degradation / fragmentation, carry out habitat management program within forest to increase prey availability to decrease the wildlife invasion into human settlement area, and decrease dependency of people on forest resources by providing alternative livelihood opportunities. Simplified relief fund distribution mechanism at local level also helps alleviate the impact of HWC. The knowledge obtained by this study and management measures are important for better human-wildlife co-existence.

Effective nutrition governance is correlated with better nutrition outcomes in Nepal

BACKGROUND

The public health burden of undernutrition remains heavy and widespread, especially in low-income countries like Nepal. While predictors of undernutrition are well documented, few studies have examined the effects of political will and quality of policy or program implementation on child growth.

METHODS

Data were collected from two nationwide studies in Nepal to determine the relationship between a metric of nutrition 'governance' (the Nutrition Governance Index), derived from interviews with 520 government and non-government officials responsible for policy implementation and anthropometry measured for 6815 children in 5556 households. We employed Generalized Estimating Equation (GEE) and multilevel regression models.

RESULTS

A higher NGI (more effective nutrition governance) is positively associated with height-for-age as well as weight-for-height in children over 2 years of age compared to younger children (HAZ; β = 0.02, p < 0.004, WHZ; β = 0.01, p < 0.37). Results from the hierarchical model show that a one-point increase in the NGI is significantly associated with a 12% increase in HAZ and a 4% increase in WHZ in older children (> 24 months old). Mothers' education, child's age, BMI and no fever in the past 30 days were also protective of stunting and wasting. Seven percent and 17% of the overall variance in HAZ and WHZ, respectively, are accounted for by variations across the 21 district locations in which sampled households were located. Mean HAZ differs considerably across districts (intercept = 0.116, p < 0.001).

CONCLUSIONS

These results highlight the importance of effective management of policy-based programming and resource use to bring about nutrition gains on the ground. The NGI explained a non-negligible amount of variation in HAZ and WHZ, which underscores the fundamental role that good governance plays in promoting child nutrition and growth, and the value of seeking to measure it to assist governments in moving policies from paper to practice.

Aflatoxin exposure and child nutrition: measuring anthropometric and long-bone growth over time in Nepal

BACKGROUND

Naturally occurring aflatoxins may contribute to poor growth and nutritional statuses in children.

OBJECTIVES

We analyzed the relationship between contemporary and lagged aflatoxin exposure and 1) length-for-age z-score (LAZ); and 2) length, knee-heel length, stunting, weight-for-age z-score (WAZ), and weight-for-length z-score (WLZ).

METHODS

We conducted a longitudinal birth cohort study involving 1675 mother-infant dyads in rural Nepal. Participants were repeatedly visited from pregnancy to 2 years of age (2015-2019). One blood sample was collected during pregnancy and 4 samples were collected from the children at 3, 6, 12, and 18-22 months of age to measure concentrations of aflatoxin B1 (AFB1)-lysine adduct. Multivariate linear fixed-effects and logistic models with generalized estimating equations were used to identify associations between child growth and aflatoxin exposure.

RESULTS

AFB1-lysine adducts were detected in the majority of children (at 3 months, 80.5%; at 6 months, 75.3%; at 12 months, 81.1%; and at 18-22 months, 85.1%) and in 94.3% of pregnant women. Changes in contemporary ln child AFB1-lysine adduct concentrations were significantly associated with changes in LAZ (β, -0.05; 95% CI, -0.09 to -0.02; P = 0.003), length (β, -0.19; 95% CI, -0.29 to -0.10; P < 0.001), knee-heel length (β, -0.09; 95% CI, -0.13 to -0.05; P < 0.001), and WAZ (β, -0.04; 95% CI, -0.07 to -0.005; P = 0.022). Serum aflatoxin concentrations were associated with stunting (OR, 1.18; 95% CI, 1.05-1.32; P = 0.005). Similar results were found in the models using changes in contemporary ln AFB1 adjusted for changes in child weight, with significant associations with changes in WLZ (β, -0.07; 95% CI, -0.10 to -0.03; P < 0.001). Changes in time-lagged ln AFB1 (unadjusted and adjusted for changes in child weight) were associated with changes in length and knee-heel length.

CONCLUSIONS

Our results add to the growing body of evidence confirming chronic aflatoxin exposure and suggest that exposure is significantly correlated with various negative growth outcomes, which may vary by child weight status. This trial was registered at clinicaltrials.gov as NCT03312049.

Factors that influence the plant use knowledge in the middle mountains of Nepal

An account of total of 58 plant species including 57 genera and 43 families was reported as useful in ethnomedicine from semi-structured questionnaire survey to the 76 participants of Kaski and Baitadi districts, Nepal. Fieldwork and participatory meetings were carried out between September 2017 and January 2018. A total of 419 emic use reports including 150 from Kaski and 269 from Baitadi were reported from 58 ethnomedicinal plant species. Each species was reported for 2-43 use reports and each participant recorded 1-12 use reports. About 25% (n = 104) use reports were associated with the treatment of digestive system disorders followed by 83 for general complaints. Of the species assessed, 53 species had IASc value < 0.25 and only five species had > 0.25. Species Swertia chirayita, Paris polyphylla, Bergenia ciliata, Valeriana jatamansi and Centella asiatica with > 0.25 IASc were found to be highly consented; however they were incongruent between the sample groups and sites. Divergent plant use knowledge specific to each sample district and group was corresponding to the heterogeneity of socio-economy and culture of the sites. Gender, ethnicity, household economy and food availability of the respondents were leading factors affecting the plant use knowledge. Despite the sites were relatively homogenous in eco-physiography, they possessed the distinct plant use knowledge, hinted that the socio-economic factors are more explanatory in plant use knowledge.

Gender Equality and the Global Gender Gap in Life Expectancy: An Exploratory Analysis of 152 Countries

When looking at life expectancy (LE) by sex, women live longer than men in all countries. Biological factors alone do not explain gender differences in LE, and examining structural differences may help illuminate other explanatory factors. The aim of this research is to analyse the influence of gender inequality on the gender gap in LE globally. We have carried out a regression analysis between the gender gap in relativised LE and the UN Gender Inequality Index (GII), with a sensitivity analysis conducted for its three dimensions, stratified by the six World Health Organization (WHO) regions. We adjusted the model by taking into consideration gross national income (GNI), democratic status and rural population. The results indicated a positive association for the European region (ß=0.184) and the Americas (ß=0.136) in our adjusted model. Conversely, for the African region, the relations between gender equality and the LE gender gap were found to be negative (ß=-0.125). The findings suggest that in the WHO European region and the Americas, greater gender equality leads to a narrowing of the gender LE gap, while it has a contrary relationship in Africa. We suggest that this could be because only higher scores in the GII between men and women show health benefits.

Measuring Governance: Developing a Novel Metric for Assessing Whether Policy Environments are Conducive for the Development and Implementation of Nutrition Interventions in Nepal

Background: The Nutrition Governance Index (NGI) defines a first standardized approach to quantifying the ‘quality of governance’ in relation to national plans of action to accelerate improvements in nutrition. It was created in response to growing demand for evidence-based measures that reveal opportunities and challenges as nutrition-related policies on paper are translated into outcomes on the ground. Numerous past efforts to measure ‘governance,’ most notably World Health Organization’s (WHO’s) NGI and the separate Hunger and Nutrition Commitment Index (HANCI), both of which lack granularity below the national level and each of which fails to capture pinch points related to necessary cross-sectoral actions. This paper addresses such caveats by introducing an innovative metric to assess self-reported practices of, and perceptions held by, administration officials tasked with implementing government policy at the sub-national level. The paper discusses the development of this metric, its methodology, and explores its application in the context of Nepal.

Methods: Conducted as part of a nationally representative longitudinal survey across 21 of Nepal’s 75 districts, the sub-study on which this paper is based used data from 520 government and non-government officials at different geographic and administrative tiers of authority. Using robust statistical techniques, structured questionnaire data were condensed into a score using a scale from 0 to 100.

Results: Six domains were identified through the analysis: Understanding Nutrition and related responsibilities; Collaboration; Financial Resources; Nutrition Leadership, Capacity, and Support. About half of all health sector representatives achieved a high score (>3 on 5-point scale) compared to representatives in other sectors of government activity (such as agriculture or education) (χ²=12.99, P <.003). The health sector also showed the most improvement in mean NGI score over a two-year follow-up period.

Conclusion: This paper shows that self-reported perceptions and behaviors of those responsible for policy implementation can be usefully quantified. The NGI can be used to assess countries’ readiness for the application of nutrition policies.

Dietary determinants of aflatoxin B1-lysine adduct in pregnant women consuming a rice-dominated diet in Nepal

Background

Aflatoxins are found in diverse foods widely consumed worldwide. This study investigated the association between aflatoxin exposure and (a) consumption of specific foods, (b) dietary diversity (DD), and (c) seasonality.

Methods

Women enrolled in the AflaCohort Study in Banke, Nepal (n = 1648) were asked how often they ate certain food items in the past 7 days and 24 h. Serum aflatoxin B₁-lysine (AFB₁-lys) adduct levels, measured during pregnancy, were determined using high-performance liquid chromatography. Multivariable ordinary least squares and quantile regression models were used to examine incremental increases in AFB₁-lys adduct levels per frequency of food consumption and the relationship between DD, seasonality, and increases in AFB₁-lys adduct.

Results

Roughly 94% of women were exposed to aflatoxin (geometric mean 1.37 pg/mg). Women in the 30th, 50th, and 70th quantiles of aflatoxin exposure who reported one more occasion of maize consumption in the past week showed increases in AFB₁-lys adduct levels: 0.094, 0.112, and 0.109 pg/mg (p < 0.05, all). Women in the 30th, 50th, 70th, and 90th quantiles of exposure who reported one more occasion of groundnut consumption in the past week also showed increases in AFB₁-lys adduct levels: 0.058 (p < 0.001), 0.085 (p < 0.01), 0.133 (p < 0.001), and 0.133 (p < 0.001) pg/mg. Winter month recruitment was positively associated with AFB₁-lys adduct levels at all quantiles of aflatoxin exposure (range: 0.313–1.101 pg/mg, p < 0.001). DD was not predictive of aflatoxin exposure.

Conclusions

Our findings justify integrated approaches to aflatoxin reduction, including regulatory, agricultural, and food safety interventions across the value chain and at the household level.

Relatively Low Maternal Aflatoxin Exposure Is Associated with Small-for-Gestational-Age but Not with Other Birth Outcomes in a Prospective Birth Cohort Study of Nepalese Infants

BACKGROUND

Exposure to aflatoxin has garnered increased attention as a possible contributor to adverse birth outcomes.

OBJECTIVE

The objective of this study was to investigate the relation of maternal aflatoxin exposure with adverse birth outcomes such as birth weight, birth length, anthropometric z scores, low birth weight (LBW), small-for-gestational-age (SGA), stunting, and preterm birth (PTB).

METHODS

This study used maternal and newborn data from the AflaCohort Study, an ongoing birth cohort study in Banke, Nepal (n = 1621). Data on aflatoxin B1 (AFB1)-lysine adducts in maternal serum were collected once during pregnancy (at mean ± SD: 136 ± 43 d of gestation). Maternal serum AFB1-lysine adduct concentration was measured via HPLC. Linear and logistic regression analyses were used to determine if maternal aflatoxin exposure was associated with 1) birth weight and length (primary outcomes) and 2) anthropometric z scores, LBW (weight <2.5 kg), SGA (weight <10th percentile for gestational age and sex), stunting at birth (length-for-age z score less than -2), or PTB (born <37 weeks of gestation) (secondary outcomes).

RESULTS

The geometric mean of maternal serum AFB1-lysine adduct concentration was 1.37 pg/mg albumin (95% CI: 1.30, 1.44 pg/mg albumin). Twenty percent of infants were of LBW and 32% were SGA. Sixteen percent of infants were stunted at birth. In addition, 13% of infants were born preterm. In logistic multivariate regression models, mean maternal serum AFB1-lysine adduct concentrations were significantly associated with SGA (OR: 1.13; 95% CI: 1.00, 1.27; P < 0.05).

CONCLUSIONS

Findings from this study suggest a small but significant association between serum AFB1-lysine adduct concentrations in pregnant women and SGA. Maternal aflatoxin exposure was not associated with other birth outcomes. These results highlight the need for future research on a threshold level of aflatoxin exposure needed to produce detectable adverse birth outcomes. This trial was registered at clinicaltrials.gov as NCT03312049.

Relationship Between Wasting and Stunting in Infants from Banke, Nepal (P10-002-19)

Objectives

Stunting and wasting in early life increase the risk of mortality. While assessed and diagnosed as individual conditions, these two forms of malnutrition often coexist within the same populations and possibly the same individual. The main objective of our analysis was to assess the magnitude of stunting and wasting among Nepali infants in the first 12 months of life and to investigate the association of early life wasting on later stunting.

Methods

For this analysis, we utilized anthropometric data collected in a longitudinal birth cohort study with 1675 maternal-infant dyads. Birth length and weight were collected within 72 hours of birth in 95% of the infants and 88% were followed through 12 months of age. Length, weight measurements were collected on the infants at 3, 6, 9 and 12 months of age. Measurements were converted to z-scores for weight-for-length (WLZ) and length-for-age (LAZ) using World Health Organization Standards. Outliers were defined as WLZ < -5 or >5 and LAZ < -6 or >6. Wasting was defined as WLZ < -2 and stunting as LAZ < -2. Statistical analyses were conducted in Stata® SE version 14.

Results

In the study population, 7%, 8%, 14% and 17% were wasted while 13%, 15%, 20% and 28% of infants were stunted at 3, 6, 9 and 12 months, respectively. Bivariate analyses showed significantly positive associations between wasting and stunting at 6, 9 and 12 months of age. After controlling for gender, birth weight, maternal height, maternal education, and household food insecurity, being wasted at any one visit during the first 9 months of life was associated with almost double the odds of being stunted at 9 months (AOR: 1.74 (CI: 1.23–2.48), P = 0.002), as was being wasted at any one visit during the first 12 months of life and stunting at 12 months (AOR: 2.21 (CI: 1.68–2.92), P = 0.000). The number of times wasted in the past year was not associated with higher odds of stunting.

Conclusions

Both wasting and stunting prevalence increased in Nepali infants in the first 12 months of life. Wasting was a significant predictor of stunting at 9 and 12 months of age. A single episode of wasting was sufficient to increase risk of stunting as observed by the lack of effect of cumulative wasting. Targeting and addressing the wasting observed is critical for long-term well being and development of Nepali infants.

Funding Sources

AID-OAA-L-1-00005, AID-OAA-L-1-00006, and AID-OAA-G-14-00002.

Punching above their weight: a network to understand broader determinants of increasing life expectancy

Background

Life expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected – they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available.

New research network

In order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following influences within a country: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens.

Conclusion

Further research using this framework has considerable potential to advance effective policies to advance health and equity.

Implementing Multisector Nutrition Programs in Ethiopia and Nepal: Challenges and Opportunities From a Stakeholder Perspective

Effective governance is essential for effective nutrition program implementation. There are additional challenges in launching multisector plans to enhance nutritional status. The present study compares the challenges and opportunities in Ethiopia and Nepal in designing and implementing a multisector plan for nutrition. A semi-quantitative questionnaire with open-ended questions was used to solicit information from senior national-level policy officials and other key stakeholders. The nature of the major nutrition problems in each country was similar; these include malnutrition (particularly stunting), food insecurity, and micronutrient malnutrition. The main challenges identified included the need for more specificity in the roles of agencies/individuals in program implementation, more effective mechanisms for linking national to subnational officials, methods for creating awareness of the plans, and a dedicated line item in the budgets of each agency. The level of enthusiasm was high in both countries. Respondents in both countries highlighted the need to identify a "champion" at the highest level who would keep the momentum for the respective plans alive.

Land-Use and Socioeconomic Change, Medicinal Plant Selection and Biodiversity Resilience in Far Western Nepal

Indigenous plant use-systems have evolved under, and constantly adapted to human and non-human impacts. In the last decades however, increasing socioeconomic and cultural transformations, including land-use change, outmigration, globalized markets, the introduction of new species, and climate change have led to a decreasing availability of indigenous resources, and are ultimately leading to a reduction of local use-knowledge. Participant observations, discussions, walks-in-the-woods, semi-structured interviews and informal meetings were carried out in 12 villages of far western Nepal between 2011 and 2015 to assess how sociocultural changes have affected the sustenance of indigenous systems and local biodiversity, when compared to studies carried out in the previous decades. Our findings show that there were no statistically significant differences in subject variable means, but differences were relatively important to plant parts-use and plant growth-forms (p = 0.183 and 0.088 respectively). Cissampelos pareira, Acorus calamus, Calotropis gigantea were found to have the greatest relative importance, whereas Ageratina adenophora, Melia azedarach, Carum carvi were most important based on use values. Among them, C. pareira and A. adenophora were introduced. The spatial distribution of species collected for medicine showed that all habitats were important for collection however, habitats close to villages were more favored. The use of non-indigenous and easily available species and more accessible habitats is becoming more prevalent as primary forests become increasingly overexploited, indigenous species become limited, and sociocultural cause of land use change expand. The utilization of indigenous and non-indigenous species and nearby habitats, although possibly affecting the quality of medicinal species, nonetheless reveals the dynamism of indigenous medicines as an adaptive asset mitigating human and non-human environmental changes.

Measuring Nutrition Governance

Background:

Global commitments to nutrition have supported calls for better evidence to support effective investments at national level. However, too little attention has so far been paid to the role of governance in achieving impacts.

Objective:

This article explores the ways by which the commitment and capabilities of policy implementers affect collaborative efforts for achieving nutrition goals.

Methods:

Over 1370 structured interviews were held with government and nongovernment officials over 3 years in 21 districts. Coded responses supported quantitative analysis of stakeholders’ knowledge, attitudes, and practices regarding policy implementation.

Results:

Stakeholder commitment was already high in 2013 when a new national policy was adopted, but capabilities were weak. Only one-third of interviewed respondents had any nutrition training. Rollout of training focusing on districts targeted for early implementation of multisector programming. This raised levels of nutrition training among interviewed respondents to 57% in 2015, which raised demand for technical information to support actions. Better understanding of the complexity of cross-sector work led to calls for higher budgets and more effective cross-sectoral collaboration.

Conclusion:

Nepal offers an example of effective efforts to improve nutrition governance across sectors at all levels of administration. The promotion of awareness, capacity, and new ways of working shows promise. Trainings, information sharing, and management support led to growing willingness among civil servants to engage across sectors. Structured surveys offer a viable way to track change across institutions and sectors.

Rural Community as Context and Teacher for Health Professions Education

Nepal is a low-income, landlocked country located on the Indian subcontinent between China and India. The challenge of finding human resources for rural community health care settings is not unique to Nepal. In spite of the challenges, the health sector has made significant improvement in national health indices over the past half century. However, in terms of access to and quality of health services and impact, there remains a gross urban-rural disparity. The Patan Academy of Health Sciences (PAHS) has adopted a community-based education model, termed “community based learning and education" (CBLE), as one of the principal strategies and pedagogic methods. This method is linked to the PAHS mission of improving rural health in Nepal by training medical students through real-life experience in rural areas and developing a positive attitude among its graduates towards working in rural areas.

This article outlines the PAHS approach of ruralizing the academy, which aligns with the concept of community engagement in health professional education. We describe how PAHS has embedded medical education in rural community settings, encouraging the learning context to be rural, fostering opportunities for community and peripheral health workers to participate in teaching-learning as well as evaluation of medical students, and involving community people in curriculum design and implementation.

Implementing a simplified neonatal resuscitation protocol-helping babies breathe at birth (HBB) - at a tertiary level hospital in Nepal for an increased perinatal survival

Background

Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. The development of the low cost interventions and their effective delivery are needed to reduce deaths from birth asphyxia. This study will assess the impact of a simplified neonatal resuscitation protocol provided by Helping Babies Breathe (HBB) at a tertiary hospital in Nepal. Perinatal outcomes and performance of skilled birth attendants on management of intrapartum-related neonatal hypoxia will be the main measurements.

Methods/Design

The study will be carried out at a tertiary level maternity hospital in Nepal. A prospective cohort-study will include a six-month baseline a six month intervention period and a three-month post intervention period. A quality improvement process cycle will introduce the neonatal resuscitation protocol. A surveillance system, including CCD cameras and pulse oximeters, will be set up to evaluate the intervention.

Discussion

Along with a technique to improve health workers performance on the protocol, the study will generate evidence on the research gap on the effectiveness of the simplified neonatal resuscitation protocol on intrapartum outcome and early neonatal survival. This will generate a global interest and inform policymaking in relation to delivery care in all income settings.

Trial registration

ISRCTN97846009

Dyselectrolytemia in chronic obstructive pulmonary diseases with acute exacerbation

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality and morbidity world wide. Due to lack of awareness about the precipitating factors and predictors of prognosis, cases of acute exacerbation of COPD often suffer the fatal outcomes. In our study we assessed the levels of serum sodium and potassium in subjects with acute episodes of COPD and their healthy controls. We found a significantly low level of serum sodium (133± 6.86 meq/lit) and potassium (3.39 ± 0.96 meq/L)) in subjects with acute exacerbation of COPD than their healthy counterparts [sodium-142 ± 2.28 meq/L and potassium- 4.52 ± 0.02 meq/L (p <0.05)]. Therefore, our study findings suggest that, serum sodium and potassium levels may get deranged in subjects with acute exacerbations of COPD which should be routinely checked for to avoid fatal outcomes.

Environmental burden of acute respiratory infection and pneumonia due to indoor smoke in Dhading

BACKGROUND

ARI and pneumonia is one of the major public health problems in Nepal which always ranks highest position among the top ten diseases. One of the risk factor of ARI and pneumonia is indoor smoke from kitchen where primary source of cooking is solid biomass fuel. This study was carried out in order to estimate the burden of ARI and pneumonia due to indoor smoke. ARI and pneumonia was chosen as it is one of the significant public health problem among under five children in Nepal and responsible for high number of premature deaths.

METHODS

A cross-sectional study was conducted in Dhading district. Multistage cluster sampling technique was used for data collection considering ward as a cluster. The environmental burden of ARI and pneumonia due to indoor smoke was calculated using the WHO Environmental Burden of Disease Series.

RESULTS

About 87 percent of households were using solid biomass fuel as a primary source of fuel. The under five children exposed to solid fuel use was 41313. The total 1284 Disability Adjusted Life Years were lost due to ARI and pneumonia and about 50 percent of it was attributed by Indoor smoke in household.

CONCLUSIONS

The solid biomass fuel was primary source of energy for cooking in Dhading district which is attributing about 50 percent of burden of ARI and pneumonia among under five children.

Community ear care delivery by community ear assistants and volunteers: a pilot programme

Hearing impairment is a major public health problem in Nepal. The present service delivery, however, is mainly hospital based and is limited to large towns. Those people residing in rural areas lack many basic needs including ear care services. The collaborative community volunteer-based ear care pilot programme implemented in Banke, Nepal aims to reach out to those rural areas by establishing sustainable primary ear care services, empowering and utilizing local resources. The focus of the programme is to promote multi-sector improvement in sanitation, nutrition, immunization, breast-feeding and timely care and support to ear patients to help prevent hearing impairment mainly from the sequelae of otitis media.

Reliability of clinical diagnosis in identifying infectious trachoma in a low-prevalence area of Nepal

The WHO Alliance for Global Elimination of Trachoma by 2020 has increased the need to identify ocular chlamydial infections by clinical examination in areas of both high and low prevalence. The relationship between clinically active trachoma (as defined by clinical examination) and chlamydial infection is known for areas with hyperendemic trachoma, but not for areas with a low prevalence of the clinical disease. In the present study, we examined, photographed, and DNA tested the conjunctivae of children in the Surkhet district of mid-western Nepal, an area known to have a low prevalence of clinically active trachoma. Although 6% of the children aged 10 years and under were found to have clinically active trachoma, none were found to have chlamydia infection by the most sensitive DNA amplification tests available. A very low prevalence of clinically active trachoma is not necessarily evidence of the presence of chlamydial infection. Therefore, the WHO policy of not recommending an intensive trachoma control effort when the prevalence of clinically active trachoma is less than 10% in children is appropriate for this area of Nepal.