Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal : a retrospective cohort study

Objectives: Isoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has been no systematic assessment of IPT initiation and completion rates among PLHIV. We aimed to assess IPT initiation and completion rates in the Far-Western Region (FWR) of Nepal. Design: We conducted a retrospective cohort study using secondary data extracted from registers maintained at ART centres. Setting: All 11 ART centres in the FWR of Nepal. Participants: All PLHIV registered for care between January 2016 and December 2017 in 11 ART centres. Primary outcome measures: IPT initiation and completion rates were summarised as percentages with 95% CI. Independent association between patient characteristics and non-initiation of IPT was assessed using cluster-adjusted generalised linear model (log binomial regression) and adjusted relative risk (RR) with 95% CI was calculated. Result: Of the 492 PLHIV included, 477 (97.0%) did not have active TB at registration. Among 477 without active TB, 141 (29.8%, 95% CI 25.7% to 34.1%) had been initiated on IPT and 85 (17.8%) were initiated within 3 months of registration. Of 141 initiated on IPT, 133 (94.3%, 95% CI 89.1% to 97.5%) had completed 6 months of IPT. Being more than 60 years of age (RR-1.3, 95% CI 1.1 to 1.7), migrant worker (RR-1.3, 95% CI 1.1 to 1.4) and not being initiated on ART (RR-1.4, 95% CI 1.1 to 1.8) were significantly associated with IPT initiation. Conclusions: In FWR of Nepal, three out of 10 eligible PLHIV had received IPT. Among those who have received IPT, the completion rate was good. The HIV care programme needs to explore the potential reasons for this low coverage and take context specific corrective action to fix this gap

Economics of production and marketing of natural rubber (Hevea brasiliensis) in Jhapa, Nepal

A study was carried to assess the production and marketing status of natural rubber in Jhapa district in 2019, from a random sample of 70 households and 5 traders. Results were drawn using descriptive and inferential statistics employing SPSS and MS-Excel. The average area under natural rubber cultivation was 2.2 bigha and the productive area was 1.21 bigha. The average rubber sheet produced per household was 1167.092 kg and average yield was found to be 958.77 kg/bigha in the study area. The average annual household income from natural rubber was found to be NRs. 233418.57 which contributes 58.54 percent in the total household income. Three marketing channels were identified and the price spread ranged from NRs. 20 to 40. The producers’ share in consumers’ price ranged from 81.82% to 90.91%. The major production problem identified was the lodging by wind (0.80) and the major marketing problem faced by producers and traders was the absence of grading facility (0.82). Rubber farms were found to be a profitable farm enterprise with a discounted benefit-cost ratio of 1.88. The calculated NPV was 410992.40, IRR was 22% and PBP was 8.52 years respectively denoting the sustainability of rubber cultivation. RRIM 600, RRII 105 and GT1 were the major growing varieties of rubber in the study area. The cost of establishment in the first year (48.702%) is highest compared to the following years. The selling price of latex and sheet was found higher in 2015 and 2016 with a reduction of price in 2017 due to the high import of Indonesian rubber sheet. This research tries to present the general idea on the overall production and marketing status in the study area

SN~2012cg: Evidence for Interaction Between a Normal Type Ia Supernova and a Non-Degenerate Binary Companion

We report evidence for excess blue light from the Type Ia supernova SN 2012cg at fifteen and sixteen days before maximum B-band brightness. The emission is consistent with predictions for the impact of the supernova on a non-degenerate binary companion. This is the first evidence for emission from a companion to a SN Ia. Sixteen days before maximum light, the B-V color of SN 2012cg is 0.2 mag bluer than for other normal SN~Ia. At later times, this supernova has a typical SN Ia light curve, with extinction-corrected M_B = -19.62 +/- 0.02 mag and Delta m_{15}(B) = 0.86 +/- 0.02. Our data set is extensive, with photometry in 7 filters from 5 independent sources. Early spectra also show the effects of blue light, and high-velocity features are observed at early times. Near maximum, the spectra are normal with a silicon velocity v_{Si} = -10,500$ km s^{-1}. Comparing the early data with models by Kasen (2010) favors a main-sequence companion of about 6 solar masses. It is possible that many other SN Ia have main-sequence companions that have eluded detection because the emission from the impact is fleeting and faint.Comment: accepted to Ap

Cosmological Distance Measurement of 12 Nearby Supernovae IIP with ROTSE-IIIB

We present cosmological analysis of 12 nearby ($z<0.06$) Type IIP supernovae (SNe IIP) observed with the ROTSE-IIIb telescope. To achieve precise photometry, we present a new image differencing technique that is implemented for the first time on the ROTSE SN photometry pipeline. With this method, we find up to a 20\% increase in the detection efficiency and significant reduction in residual RMS scatter of the SN lightcurves when compared to the previous pipeline performance. We use the published optical spectra and broadband photometry of well studied SNe IIP to establish temporal models for ejecta velocity and photospheric temperature evolution for our SNe IIP population. This study yields measurements that are competitive to other methods even when the data are limited to a single epoch during the photospheric phase of SNe IIP. Using the fully reduced ROTSE photometry and optical spectra, we apply these models to the respective photometric epochs for each SN in the ROTSE IIP sample. This facilitates the use of the Expanding Photosphere Method (EPM) to obtain distance estimates to their respective host galaxies. We then perform cosmological parameter fitting using these EPM distances from which we measure the Hubble constant to be $72.9^{+5.7}_{-4.3}~{\rm kms^{-1}~Mpc^{-1}}$, which is consistent with the standard $\Lambda CDM$ model values derived using other independent techniques.Comment: 19 pages, 13 figure

The continuing story of SN IIb 2013df: new optical and IR observations and analysis

This work has been supported by the Hungarian Scientific Research Fund (OTKA) Grants NN107637, K104607, K83790, and K113117. TS is supported by the OTKA Postdoctoral Fellowship PD112325. JCW’s Supernova group at the UT Austin is supported by NSF Grant AST 11-09881 grant. JMS is supported by an NSF Astronomy and Astrophysics Postdoctoral Fellowship under award AST-1302771. KS and AP are supported by the ‘Lend¨ulet-2009’ Young Researchers Program and the LP2012-31 grant of the Hungarian Academy of Sciences, respectively; KS is also supported by the ESA PECS Contract no. 4000110889/14/NL/NDe.SN 2013df is a nearby Type IIb supernova that seems to be the spectroscopic twin of the well-known SN 1993J. Previous studies revealed many, but not all interesting properties of this event. Our goal was to add new understanding of both the early- and late-time phases of SN 2013df. Our spectral analysis is based on six optical spectra obtained with the 9.2 m Hobby-Eberly Telescope during the first month after explosion, complemented by a near-infrared spectrum. We applied the SYNAPPS spectral synthesis code to constrain the chemical composition and physical properties of the ejecta. A principal result is the identification of 'high-velocity' He i lines in the early spectra of SN 2013df, manifest as the blue component of the double-troughed profile at ~5650 Å. This finding, together with the lack of clear separation of H and He lines in velocity space, indicates that both H and He features form at the outer envelope during the early phases. We also obtained ground-based BVRI and g'r'i'z' photometric data up to +45 d and unfiltered measurements with the ROTSE-IIIb telescope up to +168 d. From the modelling of the early-time quasi-bolometric light curve, we find Mej ~ 3.2-4.6 M⊙ and Ekin ~ 2.6-2.8 × 1051 erg for the initial ejecta mass and the initial kinetic energy, respectively, which agree well with the values derived from the separate modelling of the light-curve tail. Late-time mid-infrared excess indicates circumstellar interaction starting ~1 yr after explosion, in accordance with previously published optical, X-ray, and radio data.Publisher PDFPeer reviewe

Burden of injuries in Nepal, 1990–2017: Findings from the Global Burden of Disease Study 2017

Background: Nepal is a low-income country undergoing rapid political, economic and social development. To date, there has been little evidence published on the burden of injuries during this period of transition.Methods: The Global Burden of Disease Study (GBD) is a comprehensive measurement of population health outcomes in terms of morbidity and mortality. We analysed the GBD 2017 estimates for deaths, years of life lost, years lived with disability, incidence and disability-adjusted life years (DALYs) from injuries to ascertain the burden of injuries in Nepal from 1990 to 2017.Results: There were 16 831 (95% uncertainty interval 13 323 to 20 579) deaths caused by injuries (9.21% of all-cause deaths (7.45% to 11.25%)) in 2017 while the proportion of deaths from injuries was 6.31% in 1990. Overall, the injury-specific age-standardised mortality rate declined from 88.91 (71.54 to 105.31) per 100 000 in 1990 to 70.25 (56.75 to 85.11) per 100 000 in 2017. In 2017, 4.11% (2.47% to 6.10%) of all deaths in Nepal were attributed to transport injuries, 3.54% (2.86% to 4.08%) were attributed to unintentional injuries and 1.55% (1.16% to 1.85%) were attributed to self-harm and interpersonal violence. From 1990 to 2017, road injuries, falls and self-harm all rose in rank for all causes of death.Conclusions: The increase in injury-related deaths and DALYs in Nepal between 1990 and 2017 indicates the need for further research and prevention interventions. Injuries remain an important public health burden in Nepal with the magnitude and trend of burden varying over time by cause-specific, sex and age group. Findings from this study may be used by the federal, provincial and local governments in Nepal to prioritise injury prevention as a public health agenda and as evidence for country-specific interventions

SN 2012cg: Evidence for Interaction Between a Normal SN Ia and a Non-degenerate Binary Companion

We report evidence for excess blue light from the Type Ia supernova (Sn Ia) SN 2012cg at 15 and 16 days before maximum B-band brightness. The emission is consistent with predictions for the impact of the supernova on a non-degenerate binary companion. This is the first evidence for emission from a companion to a normal SN Ia. Sixteen days before maximum light, the color of SN 2012cg is 0.2 mag bluer than for other normal SN Ia. At later times, this supernova has a typical SN Ia light curve, with extinction-corrected mag and . Our data set is extensive, with photometry in seven filters from five independent sources. Early spectra also show the effects of blue light, and high-velocity features are observed at early times. Near maximum, the spectra are normal with a silicon velocity vSi = −10,500 km s−1. Comparing the early data with models by Kasen favors a main-sequence companion of about six solar masses. It is possible that many other SN Ia have main-sequence companions that have eluded detection because the emission from the impact is fleeting and faint

Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000–18: a geospatial modelling study

Background: More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. Methods: We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. Findings: Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000–257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. Interpretation: Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Funding: Bill & Melinda Gates Foundation

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas