Epidemiologic and Economic Analysis of Avian Influenza in Nepal

Many countries, including Nepal, have been affected with highly pathogenic avian influenza (HPAI) outbreaks. There have been human mortalities in some countries and large numbers of poultry either died or were culled due to HPAI. The overall objective of this thesis was to improve our understanding of the epidemiology and economics of avian influenza (AI), and particularly HPAI, in Nepal. We determined the seroprevalence of and risk factors for AI virus antibodies presence in ducks in Kathmandu, Nepal. The estimated true prevalence of AI viruses (AIV) antibodies was 27.2% [95% Confidence Interval (CI): 24.6- 29.5]. Age of the ducks was identified as the only risk factor for AIV seropositivity. Ducks older than one year were more likely to be seropositive compared to ducks less than six months of age [Odds Ratio= 2.17 (95% CI: 1.07- 4.39)]. This study provided baseline information about seroprevalence of AIVs in Kathmandu that will benefit further research to differentiate the subtypes of AIVs circulating in Kathmandu. We also evaluated alternatives to the current control program (CCP) for HPAI in Nepal. The considered alternatives were: (i) absence of control measures (ACM) and (ii) vaccinating 60% of the domestic poultry flock twice per year. Cost-benefit analysis approach was used to evaluate the economic feasibility of the programs. In terms of the benefit-cost ratio, our findings indicated that there is a return of 1.96 dollars for every dollar spent in the CCP compared to ACM. The net present value of the CCP versus ACM was US$989,918. The vaccination program yielded a return of 2.41 dollars for every dollar spent when compared to the CCP. The net present value of vaccination versus implementing the CCP was US$ 13,745,454. These results support a continued investment into the CCP rather than ceasing to implement government regulated control measures and suggest that vaccination may be an even better control alternative. In summary, our studies have highlighted the value of epidemiologic and economic analysis in research of AI. Our results are expected to lead to an improved understanding and awareness of AI in Nepal and to formulation of better control strategies

Synthesis Attempts And Plausible Applications Of Dithiolated Ortho –Carboranyl Transition Metal Complexes And Synthesis Of Bulky Terphenyls

The reaction of coordination compounds of palladium, rhodium, ruthenium and nickel with thiolated ortho-carborane derivatives- 1,2-dimercapto-o-carborane (1,2-(HS)2-1,2- C2B10H10 ) and 9,12- dimercapto-o-carborane (9,12-(HS)2-1,2- C2B10H10 ) and with carbornanyl dicarboxylate has been studied. To further investigate the chemistry of o-carboranyl dithiolate, both of the reported literature dithiols have been employed to study the reactivity with some of the above mentioned transition metal coordination compounds. The 1,2-dimercapto-o-carborane reacts with bis(triphenylphosphine)palladium(II) chloride [PdCl2(PPh3)2] to form a square planar bis(triphenylphosphine)palladium(II) carboranyl dithiolate (PdC2B10S2(PPh3)2) complex. With the inspiration from the reactivity of the dithiols and versatility of carboranyldithiolate ligand in organometallic chemistry, new avenue of carboranyltetrathiolate coordination could be envisioned. The synthesis of 1,2,9,12- tetramercapto- ortho-Carborane has also been attempted. Extremely sterically demanding m-terphenyl amines are excellent ligands because of the ease in forming main group complexes in low coordination numbers but also provide a large area to study the reactivity between their nitrogen atom containing steric pocket and transition metal. Two well-known literature routes for the synthesis of m-terphenyl aniline has thoroughly been discussed within this paper in chapter 2. Additionally, terephenyl iodide (2’-iodo-3,3”,5,5”-tetramethyl-1,1’,3’,1”-terphenyl) has been synthesized following one of the reported synthetic route (Scheme 2.2, route A) and has paved a future foundation for our anticipated cyclization of the m-terphenyl aniline via borylation. Several attempts to synthesize m-terphenyl aniline has also been discussed within this paper as well

Structural, charge transport, gas sensing, magnetic, pseudocapacitive, and electrocatalytic properties of perovskite oxides.

Perovskites are functional materials with the general formula ABO3 (A = alkali, alkaline earth or lanthanoid cations and B = transition metal or main group cations). These materials are marked by a variety of crystal structures and interesting properties such as colossal magnetoresistance, ferroelectricity, multiferroicity, superconductivity, pseudocapacitance, gas sensing, charge transport, and electrocatalytic properties. The formula of perovskite can be written as AA’BB’O6, when there is ordering between two cations over A and B-sites. Such compounds are called double perovskite oxides. Some amount of oxygen could be lost from crystal structure without decomposition of the phase. Such class of materials are termed oxygen deficient perovskites (ODPs). In this study, several double perovskite oxides and ODPs are utilized for systematic study of magnetic, charge transport, pseudocapacitive, and electrocatalytic properties. The magnetic and electrical properties of BaSrMMoO6 (M = Mn, Fe, Co, Ni) double perovskite oxides show an interesting property trend. BaSrFeMo6 shows a ferrimagnetic ordering of moments of Fe along with metallic behavior in variable temperature conductivity studies. However, Mn, Co, and Ni containing materials show an antiferromagnetic ordering of moments and semiconducting features from 25 – 800 . The oxygen deficient perovskite (ODP) in this study is explored to understand the high temperature gas interaction properties. Structurally stable Ca2Fe2O5 shows an outstanding gas sensing behavior that could be utilized in systems that operate at elevated temperature. Similarly, ODPs can be explored to understand hydroxide intercalation based pseudocapacitance. Two novel ODPs namely Ca3GaMn2O8 and SrCa2GaMn2O8, have shown great promise for energy devices with at least 5000 charge/discharge cyclability. Another focus of our research is to solve problems and issues of energy conversion process that is involved with an electrochemical water splitting to generate hydrogen gas for fuel. Water splitting has two half reactions namely oxygen evolution reaction (OER) and hydrogen evolution reaction (HER). Both reactions have significant amounts of overpotential and require catalysts to lower the overpotential and enhance the reaction kinetics. Overpotential has been reduced by catalyzing both OER and HER using commercial RuO2, IrO2, and Pt/C However, such catalysts are expensive, use precious metals, and some of them have stability issues in acidic condition. Our approach involves development of economic perovskite oxide-based catalysts that contain earth abundant metals. The main tools for the problem-solving approach of our research involved both A and B-sites modification, conductivity enhancement, structural transformation, and control of the oxygen content in perovskite structure. For example, A-site substitution strategy is adopted by substituting Sr with Ca in Sr2FeCoO6-δ and LaSr2Fe3O8. This leads to significant enhancement of OER/HER activity in structurally ordered compounds namely Ca2FeCoO6-δ and LaCa2Fe3O8. The B-site modification, on the other hand, is also utilized by systematically varying the Mn content in the series CaSrFe1−xCo1−xMn2xO6−δ (x = 0-1). This helped to identify a material with formula CaSrFe0.75Co0.75Mn0.5O6−δ (CSFCM), that has an eg occupancy of near unity, as required for optimized activity. Additionally, upon using both experimental and computation methods, we have studied the electronic structure of several materials, including CSFCM. This has led to the discovery of a new descriptor, namely free eg carrier. This could be a universal descriptor for both OER and HER for bifunctional catalysts. Similarly, we have discovered several other oxide catalysts such as CaSrFeMnO6-δ, BaSrCoMoO6, Sr3FeMnO6, Ca2Sr2Mn2CoO10-δ, and La3Co3O8, which have remarkably low overpotentials, as low as 0.25 V in both acidic and basic media. In most of these oxides, electrocatalytic properties arise from the combination of structure, enhanced electrical conductivity, and higher amount of oxygen vacancies

Knowledge, Attitude, and Practices Associated with COVID-19 Among School Students in Bharatpur, Chitwan District of Nepal

Background: The virus causing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has reached pandemic proportions. Understanding people’s perceptions of the disease will provide tools to improve strategies to limit its transmission. This study aims to assess the knowledge, attitude, and practices (KAP) associated with the disease among high school students. Methods: Cross-sectional study conducted among secondary level students (grade 8th and 9th) in an urban high-school at Bharatpur, Chitwan, Nepal to assess KAP using a pre-tested questionnaire. Data were analyzed using Epi Info 7.2.3.1. Results: We collected 101 surveys (response rate 100%). Most of the students were found to be knowledgeable about the timeline of the first outbreak (92.08%), and nearly three-fourths of participants knew about hand-washing for 20 seconds (73.27%). Information about the presence of the disease in Nepal (50.50%), its causative agent (65.53%), and symptoms (57.43%) showed that there is a knowledge gap among participants. Most of the participants were found to have a positive attitude towards the prevention and control of the disease. The majority of the respondents reported using face mask (77.23%) and adopting hand-washing measures (79.21%) as preventive strategies. The majority of the students were highly concerned about the disease. Conclusion: Secondary level students of Chitwan, Nepal were found to have fair knowledge and understanding of the disease, showed a moderately positive attitude towards preventive measures, and reported appropriate preventive practices against the disease. It is recommended that a similar study with a wider population be conducted to assess KAP of Nepalese people towards SARS-CoV-2

Characteristics and effects of integrated nutrition and stimulation interventions to improve the nutritional status and development of children under 5 years of age : a systematic review and meta-analysis

Introduction Around 250million children in low-income and middle-income countries are at risk of not fulfilling their developmental potential. There is a need to update syntheses investigating the effects of combined nutrition and stimulation interventions on children’s growth and development and identify intervention characteristics associated with positive effects. Methods We did a systematic review to: (1) understand the effects of integrated nutrition and stimulation interventions versus (i) usual care and (ii) standalone nutrition or stimulation interventions, on the growth and development of children under five; (2) explore intervention characteristics (delivery strategies, behaviour change techniques, intensity and personnel) associated with positive effects. We searched eight databases for studies published from inception to 16 November 2020. Eligible studies were randomised and non-randomised controlled trials of integrated nutrition and stimulation interventions examining growth and developmental outcomes. We performed meta-analyses for length-for-age/height-forage, weight-for-age and weight-for-length/weight-for-height Z scores and cognitive, motor and language development scores, and subgroup analyses by intervention characteristics.We conducted random-effects metaregression to assess potential subgroup differences in outcomes by intervention characteristics. Results Twenty trials were included in the meta-analysis. Pooled effect sizes showed significant benefits of integrated interventions on developmental outcomes compared with usual care and standalone nutrition interventions (Ҏ >75%) but not on growth outcomes. Moreover, integrated interventions have non-significant effects on developmental outcomes compared with standalone stimulation interventions. Integrated interventions showed greater effects on cognitive (p=0.039) and language (p=0.040) outcomes for undernourished children compared with adequately nourished children. The effects of integrated interventions on developmental outcomes did not differ by intervention characteristics. Conclusion Integrated interventions have greater benefits for children’s development than usual care or standalone nutrition interventions, especially in settings with high levels of undernutrition. Future studies should use standardised reporting of implementation processes to identify intervention characteristics linked to positive effects

Epidemiology, impact and control of rabies in Nepal : a systematic review

Background: Rabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal. Methods: We performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal. Findings: So far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10–100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle. Interpretation: Better data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal

Feeding, caregiving practices, and developmental delay among children under five in lowland Nepal: a community-based cross-sectional survey

Background: Nurturing care, including adequate nutrition, responsive caregiving and early learning, is critical to early childhood development. In Nepal, national surveys highlight inequity in feeding and caregiving practices for young children. Our objective was to describe infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under five in Dhanusha district, Nepal, and to explore socio-demographic and economic factors associated with these practices. Methods: We did a cross-sectional analysis of a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N = 1360), sampled when children were median age 46 days and a follow-up survey of the same mother-child dyads (N = 1352) when children were median age 38 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators. Results: The prevalence of feeding indicators varied. IYCF indicators, including ever breastfed (99%), exclusive breastfeeding (24-hour recall) (89%), and vegetable/fruit consumption (69%) were common. Problem areas were early initiation of breastfeeding (16%), colostrum feeding (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), minimum dietary diversity (49%) and animal-source food consumption (23%). Amongst caregiving indicators, access to 3+ children’s books (7%), early stimulation and responsive caregiving (11%), and participation in early childhood education (27%) were of particular concern, while 64% had access to 2+ toys and 71% received adequate care. According to the Early Child Development Index score, only 38% of children were developmentally on track. Younger children from poor households, whose mothers were young, had not received antenatal visits and delivered at home were at higher risk of poor IYCF and caregiving practices. Conclusions: Suboptimal caregiving practices, inappropriate early breastfeeding practices, delayed introduction of complementary foods, inadequate dietary diversity and low animal-source food consumption are challenges in lowland Nepal. We call for urgent integrated nutrition and caregiving interventions, especially as interventions for child development are lacking in Nepal

Effectiveness of Systematic Echocardiographic Screening for Rheumatic Heart Disease in Nepalese Schoolchildren: A Cluster Randomized Clinical Trial.

Importance Echocardiographic screening allows for early detection of subclinical stages of rheumatic heart disease among children in endemic regions. Objective To investigate the effectiveness of systematic echocardiographic screening in combination with secondary antibiotic prophylaxis on the prevalence of rheumatic heart disease. Design, Setting, and Participants This cluster randomized clinical trial included students 9 to 16 years of age attending public and private schools in urban and rural areas of the Sunsari district in Nepal that had been randomly selected on November 17, 2012. Echocardiographic follow-up was performed between January 7, 2016, and January 3, 2019. Interventions In the experimental group, children underwent systematic echocardiographic screening followed by secondary antibiotic prophylaxis in case they had echocardiographic evidence of latent rheumatic heart disease. In the control group, children underwent no echocardiographic screening. Main Outcomes and Measures Prevalence of the composite of definite or borderline rheumatic heart disease according to the World Heart Federation criteria in experimental and control schools as assessed 4 years after intervention. Results A total of 35 schools were randomized to the experimental group (n = 19) or the control group (n = 16). After a median of 4.3 years (interquartile range [IQR], 4.0-4.5 years), 17 of 19 schools in the experimental group (2648 children; median age at follow-up, 12.1 years; IQR, 10.3-12.5 years; 1308 [49.4%] male) and 15 of 16 schools in the control group (1325 children; median age at follow-up, 10.6 years; IQR, 10.0-12.5 years; 682 [51.5%] male) underwent echocardiographic follow-up. The prevalence of definite or borderline rheumatic heart disease was 10.8 per 1000 children (95% CI, 4.7-24.7) in the control group and 3.8 per 1000 children (95% CI, 1.5-9.8) in the experimental group (odds ratio, 0.34; 95% CI, 0.11-1.07; P = .06). The prevalence in the experimental group at baseline had been 12.9 per 1000 children (95% CI, 9.2-18.1). In the experimental group, the odds ratio of definite or borderline rheumatic heart disease at follow-up vs baseline was 0.29 (95% CI, 0.13-0.65; P = .008). Conclusions and Relevance School-based echocardiographic screening in combination with secondary antibiotic prophylaxis in children with evidence of latent rheumatic heart disease may be an effective strategy to reduce the prevalence of definite or borderline rheumatic heart disease in endemic regions. Trial Registration ClinicalTrials.gov Identifier: NCT01550068