12 research outputs found
Feasibility of an ecosystem-based management in an eastern Canadian boreal forest : testing for ecological suitability, economic viability, social acceptability and adaptability to wildfire and climate change
Dans la quête de la mise en place d’une stratégie d’aménagement écosystémique (AE) dans la forêt boréale de l’est du Canada, nous avons réalisé une étude de faisabilité sur la viabilité économique, l’acceptabilité sociale et la pertinence écologique. À l’aide de modèles d’approvisionnement en bois, nous avons comparé une stratégie AE à une stratégie de normalisation des forêts (status quo) afin d’en évaluer sa robustesse et son l’adaptabilité face à l'augmentation du taux de brûlage et des anomalies de croissance induites par les changements climatiques. Les modèles d'approvisionnement en bois utilisent le plus souvent un modèle de croissance et de rendement calibré à l'échelle du peuplement (tables de production) pour projeter l’évolution du volume marchand des strates d’aménagement. Puisque les stratégies d'aménagement écosystémique ont tendance à repousser l'âge d'exploitabilité, il est pertinent d'évaluer jusqu'à quel degré les tables de production actuelles peuvent être utilisées comme intrant dans un contexte d'aménagement écosystémique. Lorsqu’une table de production est évaluée relativement à un modèle de croissance calibré à l’échelle de l’arbre, nous montrons que bien que le modèle à l’échelle d'arbre semble moins biaisé, aucun modèle performe de manière adéquate pour prédire la croissance en volume marchand dans notre aire d’étude, particulièrement lorsque nous subdivisons les données par les attributs qui peuvent jouer un rôle pendant la mise en place d’AÉ. Pour les deux modèles, la source majeure d’erreur est liée à la densité du peuplement. Grâce à leur simplicité relative, nous avons préféré utiliser les tables de production pour élaborer nos modèles d’approvisionnement en bois. La programmation linéaire standard a été utilisée pour tester les effets de quatre enjeux clefs sur le niveau d’approvisionnement en bois: (1) tendre vers une structure d’âge forestière établie à partir du régime naturel des feux et de la dynamique forestière, (2) agglomérer les blocs de récolte dans des chantiers de récolte afin de reproduire les patrons de perturbation naturelle à l’échelle du paysage, (3) maintenir les taux cumulés de coupe totale et de perturbation naturelle à l’intérieur du domaine historique de variabilité, et (4) exclure de la récolte les aires d’intérêt potentiel pour les peuples autochtones. Comparé à un scénario de status quo, l’inclusion des trois premiers enjeux résulte en une baisse de 3 à 22% de l’approvisionnement périodique et une période de restauration requérant que la coupe totale soit exclue sur 43 à 67% de la superficie productive pour les prochains 50 ans. Une validation des filtres bruts utilisés dans cette étude (les trois premiers enjeux) a été faite en utilisant les besoins en habitats du caribou des bois (Rangifer tarandus caribou). Pratiquement tous les scénarios induisaient un taux de perturbation susceptible de permettre le maintien du caribou des bois d’ici 25 ans. Enfin, nous avons intégré le taux de brûlage et la sensibilité des tables de production au climat dans nos modèles d’approvisionnement afin de quantifier les incertitudes induites par le climat et les feux pour les deux stratégies d’aménagements. Les deux modèles suggèrent une réduction de l’approvisionnement périodique en bois entre 13 et 79%. Même si les indicateurs écologiques favorisent l’AE par rapport la normalisation des forêts, juste un changement de stratégie n’est pas suffisant faire face aux impacts du risque de feu et des changements climatiques en forêt boréale. Mots clefs: Forêt boréale, aménagement écosystémique, croissance et rendement, faisabilité, adaptation, feux de la forêt, changements climatiquesIn the quest of implementing an ecosystem-based management (EBM) in a boreal forest in eastern Canada, we conducted a feasibility study focusing on ecological suitability, economic viability and social acceptability. Through timber supply models, we compared the outputs of EBM with a business as usual (BAU) management to determine former’s robustness and adaptability to the increase in wildfire and growth anomalies induced by climate changes. Timber supply analyses use yield models, most often at the stand-level to project harvestable volume over the planning horizon. Since EBM tend to delay harvesting age, the question may be raised on to what extent existing yield tables can be used with such strategies. When a yield table is rated against a tree-level model, we show that although the tree-level model is less biased, none of the models performed adequately to predict the volume growth of our study area, especially when subdividing the data by attributes that may have an important role while implementing EBM. For both models, the major source of error was related to stand density. Due to its relative simplicity, we chose stand-level yield tables to build our timber supply models. We then carried out a feasibility study of implementing an EBM strategy in a boreal forest in eastern Canada. With standard linear programming, we tested four policy issues; age structure, harvest agglomeration; limit of cumulative disturbance, and land base of aboriginal interest. These issues were dealt with 3% – 22% reduction in periodic wood supply and a transition period of 50 years where clear-cut needs to be excluded in 43% – 67% of the productive area. Validation of the outputs through habitat requirement of woodland caribou (Rangifer tarandus caribou) as a fine filter showed that most of the scenarios should likely allow a self-sustaining caribou population within next 25-years. Finally, we integrated climate sensitive fire burn rates and yield tables in the timber supply models to quantify the uncertainty induced by climate and fire under both management strategies. Both models responded with a reduction of periodic wood supply by 13% – 79%. Although ecological indicators are relatively better under EBM, merely switching the management strategy is not enough to address the impacts of fire and climate change in the boreal forests. Key words: Boreal forest, ecosystem-based management, growth and yield, feasibility, adaptation, wildfire, climate chang
Comparing cross-sectional and longitudinal approaches to Tuberculosis Patient Cost Surveys using Nepalese data.
The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in study design (e.g. cross-sectional vs longitudinal) can generate different estimates making the design and impact evaluation of socioeconomic protection strategies difficult. The objective of the study was to compare the socio-economic impacts of TB estimated by applying cross-sectional or longitudinal data collections in Nepal. We analysed data from a longitudinal costing survey (patients interviewed at three-time points) conducted between April 2018 and October 2019. We calculated both mean and median costs from patients interviewed during the intensive (cross-sectional 1) and continuation phases of treatment (cross-sectional 2). We then compared costs, the prevalence of catastrophic costs and the socio-economic impact of TB generated by each approach. There were significant differences in the costs and social impacts calculated by each approach. The median total cost (intensive plus continuation phases) was significantly higher for the longitudinal compared to cross-sectional 2 (US$119.42 vs 91.63, P < 0.001). The prevalence of food insecurity, social exclusion and patients feeling poorer or much poorer were all significantly higher applying a longitudinal approach. In conclusion, the longitudinal design captured important aspects of costs and socioeconomic impacts which were missed by applying a cross-sectional approach. If a cross-sectional approach is applied due to resource constraints, our data suggest the start of the continuation phase is the optimal timing for a single interview. Further research to optimize methodologies to report patient incurred expenditure during TB diagnosis and treatment is needed
Comparing cross-sectional and longitudinal approaches to Tuberculosis Patient Cost Surveys using Nepalese data : Tuberculosis cost survey approaches
The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in study design (e.g. cross-sectional vs longitudinal) can generate different estimates making the design and impact evaluation of socioeconomic protection strategies difficult. The objective of the study was to compare the socioeconomic impacts of TB estimated by applying cross-sectional or longitudinal data collections in Nepal. We analysed data from a longitudinal costing survey (patients interviewed at three-time points) conducted between April 2018 and October 2019. We calculated both mean and median costs from patients interviewed during the intensive (cross-sectional 1) and continuation phases of treatment (cross-sectional 2). We then compared costs, the prevalence of catastrophic costs and the socio-economic impact of TB generated by each approach. There were significant differences in the costs and social impacts calculated by each approach. The median total cost (intensive plus continuation phases) was significantly higher for the longitudinal compared to cross-sectional 2 (US$119.42 vs 91.63,
Barriers and facilitators to accessing tuberculosis care in Nepal : a qualitative study to inform the design of a socioeconomic support intervention
OBJECTIVE: Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households. DESIGN: From August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically. SETTING: The study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB. PARTICIPANTS: Seven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme. RESULTS: The perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme. CONCLUSION: These results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal
How to reduce household costs for people with tuberculosis : a longitudinal costing survey in Nepal
The aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from April 2018 to October 2019. Costs were collected using the WHO TB Patient Costs Survey at three time points: intensive phase of treatment, continuation phase of treatment and at treatment completion. Direct and indirect costs and socio-economic impact (poverty headcount, employment status and coping strategies) were evaluated throughout the treatment. Prevalence of catastrophic costs was estimated using the WHO threshold. Logistic regression and generalized estimating equation were used to evaluate risk of incurring high costs, catastrophic costs and socio-economic impact of TB over time. A total of 111 ACF and 110 PCF patients were included. ACF patients were more likely to have no education (75% vs 57%, P = 0.006) and informal employment (42% vs 24%, P = 0.005) Compared with the PCF group, ACF patients incurred lower costs during the pretreatment period (mean total cost: US87, P < 0.001) and during the pretreatment plus treatment periods (mean total direct costs: US101, P < 0.001). Socio-economic impact was severe for both groups throughout the whole treatment, with 32% of households incurring catastrophic costs. Catastrophic costs were associated with ‘no education’ status [odds ratio = 2.53(95% confidence interval = 1.16–5.50)]. There is a severe and sustained socio-economic impact of TB on affected households in Nepal. The community-based ACF approach mitigated costs and reached the most vulnerable patients. Alongside ACF, social protection policies must be extended to achieve the zero catastrophic costs milestone of the End TB strategy
Isolation, speciation and antifungal susceptibility testing of Candida isolates from various clinical specimens at a tertiary care hospital, Nepal
Abstract Background Candida species are responsible for various clinical infections ranging from mucocutaneous infection to life threatening invasive diseases along with increased resistance to antifungal drugs has made a serious concern. Resistance to antifungal agents has increased during the last decade. Thus, identification of Candida up to species level and its antifungal susceptibility testing has a paramount significance in the management of Candidal infections. The aim of the study was to speciate Candida species and to determine antifungal susceptibility pattern of Candida species to antifungal agents. Methods A total of 100 consecutive Candida species were isolated from 1248 clinical specimens over 7Â months period. Growths on Sabouraud dextrose agar were evaluated for colony appearance, macroscopic examination, Gram staining, germ tube test and urea hydrolysis test. Further, they were processed for Candida speciation on CHROMagar. Antifungal susceptibility testing was performed as recommended by Clinical and Laboratory Standards Institute (CLSI) M44-A document. Results Out of 100 Candida isolates, Candida albicans (56%) was the most common species. Among the non-albicans Candida species, Candida tropicalis (20%) was the predominant isolate followed by Candida glabrata (14%). Regarding antifungal susceptibility pattern, Candida species were more susceptible to clotrimazole (82%) followed by fluconazole (64%) and miconazole (44%). Conclusions Candida albicans was the predominant species responsible for various Candidal infections. Among commonly used antifungal drugs clotrimazole, miconazole and fluconazole were most effective
Molecular epidemiology of Rotavirus causing diarrhea among children less than five years of age visiting national level children hospitals, Nepal
Abstract Background Rotaviruses are the major cause of diarrhea among the infants and young children all over the world causing over 500,000 deaths and 2.4 million hospitalizations each year. In Nepal Rotavirus infection positivity rates ranges from 17.0 to 39.0% among children less than 5 years. However, little is known about the molecular genotypes of Rotavirus prevailing. The objective of this study was to estimate the burden of Rotavirus gastroenteritis and determine the genotypes of Rotavirus among children less than 5 years. Methods The cross sectional study was conducted from January to November 2014 among children less than 5 years old visiting Kanti Children’s Hospital and Tribhuvan University Teaching Hospital. Rotavirus antigen detection was performed by Enzyme Linked Immunosorbent Assay (ELISA) using ProSpecT Rotavirus Microplate Assay. Among the Rotavirus antigen positive samples, 59 samples were used for Rotavirus RNA extraction. Multiplex PCR was performed to identify G type comprising G1-G4, G8-G10 and G12 and P type comprising P[4], P[6], P[8], P[9], P[10], and P[11]. Results A total of 717 diarrheal stool samples were collected from patients ranging from 10 days to 59 months of age. Rotavirus antigen positive was found among (N = 164)22.9% of patients. The highest number of the diarrhea was seen in January. Molecular analysis of Rotavirus genotypes revealed that the predominant G-Type was G12 (36%) followed by G9 (31%), G1 (21%), G2 (8.6%). The predominant P- type was P6 (32.8%) followed by P8 (31%), P10 (14.8%), P4 (14.8%). A total of seven G/P type combinations were identified the most common being G12P [6] (35.8%), G1P [8] (15.1%), G9P [8] (15.1%). Conclusion Rotavirus diarrhea is, mostly affecting children from 7 to 24 months in Nepal, mostly occurring in winter. The circulating genotypes in the country are found to be primarily unusual genotypes and predominance of G12P[6]. It is recommended to conduct genotyping of Rotavirus on large samples before starting vaccination in the country
Wintertime Air Quality in Lumbini, Nepal: Sources of Fine Particle Organic Carbon
International audienceThe Indo-Gangetic Plains (IGP) experience high levels of airborne particulate matter (PM), especially during the dry season. Contributing to PM are natural and anthropogenic emissions and the atmospheric transformation of gases to form particles. Regional smog events occur frequently during wintertime and provide an atmospheric medium for aerosol processing. Here, we investigate the chemical composition and sources of PM at a representative site in the northern IGP during the second Nepal Ambient Monitoring and Source Testing Experiment (NAMaSTE 2)
Stigma, depression and quality of life among people with pulmonary tuberculosis diagnosed through active and passive case finding in Nepal : a prospective cohort study
Background: The psychosocial consequences of tuberculosis (TB) are key barriers to ending TB globally. We evaluated and compared stigma, depression, and quality of life (QoL) among people with TB diagnosed through active (ACF) and passive (PCF) case-finding in Nepal.
Methods: We prospectively recruited adults with TB diagnosed through ACF and PCF in four districts of Nepal between August 2018 and April 2019. Participants were interviewed at 8–12 weeks (baseline) and 22–26 weeks (follow-up) following treatment initiation. TB stigma was measured using an adapted Van Rie Stigma Scale (0 = no stigma to 30 = highest stigma). Depression was measured using a locally-validated Patient Health Questionnaire (PHQ-9). Mild and major depression were indicated by PHQ-9 scores 5–9 and ≥ 10, respectively. QoL was measured using the EuroQoL 5-Dimension 5-level (EQ-5D-5L) from 0 to 1 (optimal QoL); and self-rated health from 0 to 100 (optimal self-rated health).
Results: We recruited 221 participants (111 ACF; 110 PCF) with a mean age of 48 years (standard deviation [SD] = ± 16), of whom 147/221 (67%) were men. The mean TB stigma score was 12 (SD = 7.3) at baseline and 12 (SD = 6.7) at follow-up. The most commonly perceived elements of TB stigma at baseline were that people with TB experienced guilt (110/221, 50%) and feared disclosure outside their household (114/221, 52%). Self-rated health and EQ-5D-5L scores increased from baseline to follow-up (69.3 to 80.3, p < 0.001; 0.92 to 0.9, p = 0.009). Nearly one-third of participants (68/221, 31%) had mild or major depression at baseline. The proportion of participants with major depression decreased from baseline to follow-up (11.5% vs. 5%, p = 0.012). There was a moderate, significant positive correlation between depression and stigma scores (r = 0.41, p < 0.001). There were no differences found in TB stigma, self-rated health, QoL, or prevalence of mild/major depression between ACF and PCF participants.
Conclusions: We found a substantial, persistent, and clustered psychosocial impact among adults with TB diagnosed through both ACF and PCF strategies in Nepal. These findings suggest an urgent need to develop effective, evidence-based psychosocial support interventions with the potential to be integrated with existing ACF strategies and routine TB service activities
Stigma, depression, and quality of life among people with pulmonary tuberculosis diagnosed through active and passive case finding in Nepal: a prospective cohort study
Abstract
Background
The psychosocial consequences of tuberculosis (TB) are key barriers to ending TB globally. We evaluated and compared stigma, depression, and quality of life (QoL) among people with TB diagnosed through active (ACF) and passive (PCF) case-finding in Nepal.
Methods
We prospectively recruited adults with TB diagnosed through ACF and PCF in four districts of Nepal between August 2018 and April 2019. Participants were interviewed at 8–12 weeks (baseline) and 22–26 weeks (follow-up) following treatment initiation. TB stigma was measured using an adapted Van Rie Stigma Scale (0 = no stigma to 30 = highest stigma). Depression was measured using a locally-validated Patient Health Questionnaire (PHQ-9). Mild and major depression were indicated by PHQ-9 scores 5–9 and ≥ 10, respectively. QoL was measured using the EuroQoL 5-Dimension 5-level (EQ-5D-5L) from 0 to 1 (optimal QoL); and self-rated health from 0 to 100 (optimal self-rated health).
Results
We recruited 221 participants (111 ACF; 110 PCF) with a mean age of 48 years (standard deviation [SD] =  ± 16), of whom 147/221 (67%) were men. The mean TB stigma score was 12 (SD = 7.3) at baseline and 12 (SD = 6.7) at follow-up. The most commonly perceived elements of TB stigma at baseline were that people with TB experienced guilt (110/221, 50%) and feared disclosure outside their household (114/221, 52%). Self-rated health and EQ-5D-5L scores increased from baseline to follow-up (69.3 to 80.3, p < 0.001; 0.92 to 0.9, p = 0.009). Nearly one-third of participants (68/221, 31%) had mild or major depression at baseline. The proportion of participants with major depression decreased from baseline to follow-up (11.5% vs. 5%, p = 0.012). There was a moderate, significant positive correlation between depression and stigma scores (r = 0.41, p < 0.001). There were no differences found in TB stigma, self-rated health, QoL, or prevalence of mild/major depression between ACF and PCF participants.
Conclusions
We found a substantial, persistent, and clustered psychosocial impact among adults with TB diagnosed through both ACF and PCF strategies in Nepal. These findings suggest an urgent need to develop effective, evidence-based psychosocial support interventions with the potential to be integrated with existing ACF strategies and routine TB service activities.
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