Technical report: Trial experience and data capture in the Low Birth Weight South Asia Trial, a large cluster-randomised controlled trial in lowland Nepal

Objectives: i) to describe data capture in the Low Birth Weight South Asia Trial (LBWSAT) and factors affecting it; ii) to analyse to what extent differential data capture created bias in the available data. Methods: We describe the context, study design, data collection instruments used and their capture rates. Little of the data available were eligible for trial analyses, so use of the data for secondary analyses is important. Data capture was affected by data collector overload, pressure to enrol women in the food and cash transfer arms, delayed receipt of participant ID cards, enrolment of women at any gestational age (including after delivery at the start), in-migration into the food/cash arms to access transfers, political instability, conflict in the field team, logistical issues, establishment of a run-in period, hiatus of data collection during training, and lack of funds to extend the duration of the study. To assess the extent that differential data capture generated bias we described background characteristics by study arm and in-migration status. Then for each of the main data collection instruments we compared captured and not-captured enrolled women’s age, age at marriage, wealth score and height using t-tests and enrolled women’s and husband’s education using chi squared tests. Using mixed logistic regressions (adjusted for clustering using random effects) we assessed the odd of questionnaire capture in relation to these factors. Results: Small differences between captured and non-captured women were found. In-migrators were more prevalent in the cash/food transfer arms and compared with permanent residents were more likely to be living in their parental homes, younger, primigravida, adolescent, Muslim, slightly poorer and have some education. Analyses of captured and non-captured women by questionnaire revealed small differences in age, age at marriage, wealth score and education but mostly these differences were very small. The largest differences were between captured and non-captured women in the endline cross-sectional survey, when slightly older, less educated, poorer women were more likely to be captured. These women more likely to report to a measuring station in their community. Conclusions: Many challenges in implementing large-scale trials in the plains of Nepal affect rates of data capture, especially when several timebound follow-up data collection occasions are needed. Although in-migrated and permanent residents, and captured and non-captured women differed slightly, the differences were not large enough to be of concern

Biovar Differentiation and Variation in Virulence of Ralstonia Solanacearum Isolates Infecting Solanaceous Vegetables

Bacterial wilt caused by Ralstonia solanacearum E.F. Smith is one of the destructive diseases of solanaceous vegetables specially tomato (Lycopersicon esculentum L.) and eggplant (Solanum melongena L.). Experiments were conducted to determine biovar types existing among the strains or isolates of Nepal and variation in virulence in some vegetables belonging to solanaceae family. A total of 39 isolates infecting tomato, eggplant, chilli and potato collected from different parts of Nepal were analyzed for biovar types on the basis of 3 disaccharides and 3 hexose alcohols oxidation test. Experiments were conducted to determine variation in virulence or aggressiveness of some of the isolates under screen house conditions using three host differentials such as Pusa Ruby (susceptible), Bishesh (moderately resistant) and Srijana (resistant) tomato cultivars. Of the 39 isolates, 23 were biovar III, three biovar II, three biovar IV, and one was biovar I. Nine isolates could not be differentiated into any of the five biovars. For breeding and epidemiological purposes it is very important to analyze the variability of aggressiveness. A total of 5 isolates collected from different places were included in the test. Isolates from Bhaktapur was found the most virulent causing wilt in the variety Bishesh (moderately resistant). Other isolates had the negative impact with zero wilt on the differentials used. Isolates from Jungekhola of Dhading district did not induce wilt even on susceptible variety (Pusa Ruby), but exhibited only senescence reaction. The result indicated that there is some slight variation among the isolates tested. Some effective management tactics might be needed in those locations where highly aggressive or virulent strain of bacterial wilt is prevalent, because resistant variety may not be stable in such locations

Body composition in Nepalese children using isotope dilution: the production of ethnic-specific calibration equations and an exploration of methodological issues.

Background. Body composition is important as a marker of both current and future health. Bioelectrical impedance (BIA) is a simple and accurate method for estimating body composition, but requires population-specific calibration equations. Objectives. (1) To generate population specific calibration equations to predict lean mass (LM) from BIA in Nepalese children aged 7-9 years. (2) To explore methodological changes that may extend the range and improve accuracy. Methods. BIA measurements were obtained from 102 Nepalese children (52 girls) using the Tanita BC-418. Isotope dilution with deuterium oxide was used to measure total body water and to estimate LM. Prediction equations for estimating LM from BIA data were developed using linear regression, and estimates were compared with those obtained from the Tanita system. We assessed the effects of flexing the arms of children to extend the range of coverage towards lower weights. We also estimated potential error if the number of children included in the study was reduced. Findings. Prediction equations were generated, incorporating height, impedance index, weight and sex as predictors (R (2) 93%). The Tanita system tended to under-estimate LM, with a mean error of 2.2%, but extending up to 25.8%. Flexing the arms to 90° increased the lower weight range, but produced a small error that was not significant when applied to children <16 kg (p 0.42). Reducing the number of children increased the error at the tails of the weight distribution. Conclusions. Population-specific isotope calibration of BIA for Nepalese children has high accuracy. Arm position is important and can be used to extend the range of low weight covered. Smaller samples reduce resource requirements, but leads to large errors at the tails of the weight distribution

A rare case of tension pneumocephalus in a patient diagnosed with nasopharyngeal squamous cell carcinoma (NPC)

Tension pneumocephalus occurs when air is trapped within the cranial cavity. It is associated with neurosurgical procedures, trauma and meningitis. Here, we report a rare case of tension pneumocephalus in a patient diagnosed with NPC after concurrent chemoradiation

Management of Root Knot Nematode on Tomato Through Grafting Root Stock of Solanum Sisymbriifolium

The root-knot nematodes (Meloidogyne spp) are difficult to manage once established in the field because of their wide host range, and soil-borne nature. Thus, the aim of the present study was to examine the use of resistant root stock of wild brinjal (Solanum sisymbriifolium) to reduce the loss caused by the nematodes on tomato. For the management of root-knot nematodes, grafted plant with resistant root stock of the wild brinjal was tested under farmers\u27 field conditions at Hemza of Kaski district. Grafted and non-grafted plants were produced in root-knot nematode-free soil. Around three week-old grafted and non-grafted tomato plants were transplanted in four different plastic tunnels where root-knot nematodes had been reported previously. The plants were planted in diagonal position to each other as a pair plot in 80 × 60 cm2 spacing in an average of 20 × 7 m2 plastic tunnels. Galling Index (GI) was recorded three times in five randomly selected plants in each plot at 60 days intervals. The first observation was recorded two months after transplanting. Total fruit yield was recorded from same plants. In the grafted plants, the root system was totally free from gall whereas in an average of 7.5 GI in 0-10 scale was recorded in the non-grafted plants. Fruits were harvested from time to time and cumulated after final harvest to calculate the total fruit yield. It was estimated that on an average tomato fruit yield was significantly (P&gt;0.05) increased by 37 percent in the grafted plants compared with the non-grafted plants. Grafting technology could be used effectively for cultivation of commonly grown varieties, which are susceptible to root-knot nematodes in disease prone areas. This can be used as an alternative technology for reducing the use of hazardous pesticides for enhancing commercial organic tomato production.Journal of Nepal Agricultural Research Council Vol.3 2017: 27-3

Blood pressure and the capacity-load model in 8-year-old children from Nepal: Testing the contributions of kidney size and intergenerational effects.

OBJECTIVES: Growth patterns in early life are increasingly linked with subsequent cardio-metabolic risk, but the underlying mechanisms require elucidation. We have developed a theoretical model of blood pressure, treating it as a function of homeostatic metabolic capacity, and antagonistic metabolic load. We sought to differentiate prenatal and postnatal components of metabolic capacity, and to identify intergenerational contributions to offspring capacity and load. METHODS: We followed up at 8 years a cohort of children originally recruited into a randomized trial of maternal micronutrient supplementation in pregnancy. Maternal anthropometry was measured at recruitment. Offspring anthropometry was measured at birth, 2 years and 8 years. Offspring blood pressure, kidney size, and body composition were measured at 8 years. Regression analysis was used to investigate potential associations of maternal phenotype, birth phenotype, and current body composition with kidney size and blood pressure. RESULTS: Blood pressure was positively associated with body fat, but negatively associated with birth weight and relative leg length. Kidney size was positively associated with birth weight but not with relative leg length. Adjusting for adiposity, blood pressure was independently negatively associated with birth weight, relative leg length, and kidney length. Maternal height and BMI predicted offspring size at birth and at 8 years, but not blood pressure. CONCLUSIONS: Our data provide support for the capacity-load model of blood pressure in Nepalese children. Fetal and postnatal growth and kidney dimensions all contribute to metabolic capacity. Maternal phenotype contributed to offspring capacity and load, but these associations did not propagate to blood pressure. Am. J. Hum. Biol., 2016. © 2016 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc

Community interventions to reduce child mortality in Dhanusha, Nepal: study protocol for a cluster randomized controlled trial

Background: Neonatal mortality remains high in rural Nepal. Previous work suggests that local women's groups can effect significant improvement through community mobilisation. The possibility of identification and management of newborn infections by community-based workers has also arisen.Methods/Design: The objective of this trial is to evaluate the effects on newborn health of two community-based interventions involving Female Community Health Volunteers.MIRA Dhanusha community groups: a participatory intervention with women's groups. MIRA Dhanusha sepsis management: training of community volunteers in the recognition and management of neonatal sepsis. The study design is a cluster randomized controlled trial involving 60 village development committee clusters allocated 1:1 to two interventions in a factorial design.MIRA Dhanusha community groups: Female Community Health Volunteers (FCHVs) are supported in convening monthly women's groups. Nine groups per cluster (270 in total) work through two action research cycles in which they (i) identify local issues around maternity, newborn health and nutrition, (ii) prioritise key problems, (iii) develop strategies to address them, (iv) implement the strategies, and (v) evaluate their success. Cycle 1 focuses on maternal and newborn health and cycle 2 on nutrition in pregnancy and infancy and associated postpartum care practices. MIRA Dhanusha sepsis management: FCHVs are trained to care for vulnerable newborn infants. They (i) identify local births, (ii) identify low birth weight infants, (iii) identify possible newborn infection, (iv) manage the process of treatment with oral antibiotics and referral to a health facility to receive parenteral gentamicin, and (v) follow up infants and support families.Primary outcome: neonatal mortality rates. Secondary outcomes: MIRA Dhanusha community group: stillbirth, infant and under-two mortality rates, care practices and health care seeking behaviour, maternal diet, breastfeeding and complementary feeding practices, maternal and under-2 anthropometric status. MIRA Dhanusha sepsis management: identification and treatment of neonatal sepsis by community health volunteers, infection-specific neonatal mortality

Understanding parents and professionals knowledge and awareness of autism in Nepal

Autism is a global phenomenon. Yet, there is a dearth of knowledge of how it is understood and its impact in low-income countries. We examined parents’ and professionals’ understanding of autism in one low-income country, Nepal. We conducted focus groups and semi-structured interviews with parents of autistic and non-autistic children and education and health professionals from urban and rural settings (n = 106), asking questions about typical and atypical development and presenting vignettes of children to prompt discussion. Overall, parents of typically developing children and professionals had little explicit awareness of autism. They did, however, use some distinctive terms to describe children with autism from children with other developmental conditions. Furthermore, most participants felt that environmental factors, including in-utero stressors and birth complications, parenting style and home or school environment were key causes of atypical child development and further called for greater efforts to raise awareness and build community capacity to address autism. This is the first study to show the striking lack of awareness of autism by parents and professionals alike. These results have important implications for future work in Nepal aiming both to estimate the prevalence of autism and to enhance support available for autistic children and their families