Elucidating the sustained decline in under‐three child linear growth faltering in Nepal, 1996-2016

Childhood linear growth faltering remains a major public health concern in Nepal. Nevertheless, over the past 20 years, Nepal sustained one of the most rapid reductions in the prevalence of stunting worldwide. First, our study analysed the trends in height-for-age z-score (HAZ), stunting prevalence, and available nutrition-sensitive and nutrition-specific determinants of linear growth faltering in under-three children across Nepal's Family Health Survey 1996 and Nepal's Demographic and Health Surveys 2001, 2006, 2001, and 2016. Second, we constructed pooled multivariable linear regression models and decomposed the contributions of our time-variant determinants on the predicted changes in HAZ and stunting over the past two decades. Our findings indicate substantial improvements in HAZ (38.5%) and reductions in stunting (-42.6%) and severe stunting prevalence (-63.9%) in Nepalese children aged 0-35 months. We also report that the increment in HAZ, across the 1996-2016 period, was significantly associated (confounder-adjustedp< .05) with household asset index, maternal and paternal years of education, maternal body mass index and height, basic child vaccinations, preceding birth interval, childbirth in a medical facility, and prenatal doctor visits. Furthermore, our quantitative decomposition of HAZ identified advances in utilisation of health care and related services (31.7% of predicted change), household wealth accumulation (25%), parental education (21.7%), and maternal nutrition (8.3%) as key drivers of the long-term and sustained progress against child linear growth deficits. Our research reiterates the multifactorial nature of chronic child undernutrition and the need for coherent multisectoral nutrition-sensitive and nutrition-specific strategies at national scale to further improve linear growth in Nepal

Catching Element Formation In The Act

Gamma-ray astronomy explores the most energetic photons in nature to address some of the most pressing puzzles in contemporary astrophysics. It encompasses a wide range of objects and phenomena: stars, supernovae, novae, neutron stars, stellar-mass black holes, nucleosynthesis, the interstellar medium, cosmic rays and relativistic-particle acceleration, and the evolution of galaxies. MeV gamma-rays provide a unique probe of nuclear processes in astronomy, directly measuring radioactive decay, nuclear de-excitation, and positron annihilation. The substantial information carried by gamma-ray photons allows us to see deeper into these objects, the bulk of the power is often emitted at gamma-ray energies, and radioactivity provides a natural physical clock that adds unique information. New science will be driven by time-domain population studies at gamma-ray energies. This science is enabled by next-generation gamma-ray instruments with one to two orders of magnitude better sensitivity, larger sky coverage, and faster cadence than all previous gamma-ray instruments. This transformative capability permits: (a) the accurate identification of the gamma-ray emitting objects and correlations with observations taken at other wavelengths and with other messengers; (b) construction of new gamma-ray maps of the Milky Way and other nearby galaxies where extended regions are distinguished from point sources; and (c) considerable serendipitous science of scarce events -- nearby neutron star mergers, for example. Advances in technology push the performance of new gamma-ray instruments to address a wide set of astrophysical questions.Comment: 14 pages including 3 figure

Characteristics of thermal comfort in the offices of North-East India

In the context of climate change and global warming, the nexus between energy and buildings is self-explanatory. As per the ministry of statistics and program implementation, Govt. of India data, the primary energy consumption in the building sector is 37% of total primary energy consumption and about 24% to total CO2 emissions. It is evident from the research that thermal comfort, energy efficiency in buildings and sustainable architecture are interlinked and interdependent. The present study is carried out in the Naturally ventilated offices of North-East India at three representative locations i.e., Tezpur, Imphal and Shillong, from warm and humid, Cool and humid and Cold and cloudy climates, respectively. Year-long thermal comfort surveys were carried out in 81 naturally ventilated office buildings, collecting 2326 samples spread over three locations from July 2016 to June 2017. Data analysis shows that neutral temperature through regression analysis is 26.4°C, 24.7°C, and 23.4°C for Tezpur, Imphal and Shillong, respectively. Preferred temperature and relative humidity in Tezpur, Imphal and Shillong offices are 24°C, 23.5 °C and 22 °C and 55%, 55% and 63%, respectively. Probit analysis showed that occupants are more adaptive toward the warmer side of the thermal sensation scale

A rare case of Crigler–Najjar syndrome type 2: A case report and literature review

Key Clinical Message Crigler–Najjar syndrome type 2 should be suspected in any young patient presenting with isolated indirect hyperbilirubinemia where all other common etiologies have been excluded. It is a relatively benign condition that responds to phenobarbitone. Abstract Crigler–Najjar syndrome (CNS) type 2 is an inborn cause of isolated indirect hyperbilirubinemia characterized by a partial deficiency of the enzyme uridine 5′‐diphosphate‐glucuronosyltransferase (UGT) responsible for bilirubin conjugation. Typically, this condition is diagnosed based on clinical manifestations, supplemented by enzyme analysis if feasible, and exhibits a significant response to phenobarbitone, known for its enzyme‐inducing properties. In this case, we present a young male patient who had experienced recurrent isolated indirect hyperbilirubinemia since early childhood, with negative results in the hemolytic workup. The patient exhibited a UGT1A1 gene defect and demonstrated a highly favorable response to phenobarbitone treatment. The purpose of this report is to raise awareness among physicians about this benign condition and underscore the importance of avoiding unnecessary investigations

Correction: Renzaho, A.M.N., et al. The Synergetic Effect of Targeted Resource Transfers for Families, Child Sensitive Social Protection Programs, and Capacity Building for Effective Social Protection on Children’s Nutritional Status in Nepal. Int. J. Environ. Res. Public Health 2017, 14, 1502

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Association between Child Nutritional Anthropometric Indices and Iron Deficiencies among Children Aged 6–59 Months in Nepal

Developmental impairment remains an important public health problem among children in many developing countries, including Nepal. Iron deficiency in children may affect development and lead to anaemia. This study on 1702 children aged 6–59 months aimed to assess the association between nutritional anthropometric indices and iron deficiencies. Data for this study were extracted from the 2016 Nepal National Micronutrient Status Survey. Three nutritional anthropometric indices (stunting, wasting and underweight) and their association with anaemia and iron deficiencies (ferritin and sTfR biomarkers) were assessed by conducting multivariate statistical analyses. The prevalence of stunting, wasting and underweight among children aged 6–59 months was 35.6%, 11.7% and 29.0%, respectively. Most of the children were not stunted (64.4%), not wasted (71.0%) and not underweight (88.3%). Belonging to castes other than the Janajati, Dalit and Brahmin castes increased the odds of anaemia and iron deficiency (ferritin biomarker). Children in the age group 6–23 months were significantly at higher odds of having anaemia and iron deficiency (ferritin and sTfR biomarkers). Stunting significantly increased the odds of anaemia [adjusted odds ratio (OR): 1.55; 95% confidence interval (CI): (1.11, 2.17)], iron deficiency (ferritin biomarker [OR: 1.56; 95% CI: (1.16, 2.08)] and sTfR biomarker [OR: 1.60; 95% CI: (1.18, 2.15)]). Further, underweight significantly increased the odds of anaemia [OR: 1.69; 95% CI: (1.12, 2.54)] and iron deficiency (sTfR biomarker [OR: 1.48; 95% CI: (1.14, 1.93)]). Interventions to minimise the occurrence of anaemia and iron deficiencies among children in Nepal should focus on providing appropriate healthcare services that would reduce the burden of stunting and underweight

The synergetic effect of cash transfers for families, child sensitive social protection programs, and capacity building for effective social protection on children’s nutritional status in Nepal

Objective: The aim of this study was to evaluate the effectiveness of the synergetic effect of child sensitive social protection programs, augmented by a capacity building for social protection and embedded within existing government’s targeted resource transfers for families on child nutritional status. Design: A repeat cross-sectional quasi-experimental design with measures taken pre- (October-December 2009) and post- (December 2014-February 2015) intervention in the intervention and comparison district. The comparison district received standard social welfare services in the form of targeted resource transfers (TRTs) for eligible families. The intervention district received the TRTs plus a child cash payment, augmented by a capacity building for effective social protection outcomes. Propensity scores were used in difference-in-differences models to compare the changes over time between the intervention and control groups. Results: Propensity score matched/weighted models produced better results than the unmatched analyses, and hence we report findings from the radius matching. The intervention resulted in a 5.16 (95% CI: 9.55, 0.77), 7.35 (95% CI: 11.62, 3.08) and 2.84 (95% CI: 5.58, 0.10) percentage point reduction in the prevalence of stunting, underweight, and wasting among children under the age, respectively. The intervention impact was greater in boys than girls for stunting and wasting; and greater in girls than boys for underweight. The intervention also resulted in a 6.66 (95% CI: 2.13, 3.18), 11.40 (95% CI: 16.66, 6.13), and 4.0 (95% CI: 6.43, 1.78) percentage point reduction in the prevalence of stunting, underweight, and wasting among older children (≥24 months). No impact was observed among younger children (<24 months). Conclusions: Targeted resource transfers for families, augmented with a child sensitive social protection program and capacity building for social protection can address effectively child malnutrition. To increase the intervention effectiveness on younger children, the child cash payment amount needs to be revisited and closely embedded into infant and young child feeding initiatives, but also adjusted to equate to 20% of household expenditure or more to maximize the diversity of food available to young children. ***Please note a correction to this article (including a title correction) was published in The International Journal of Environmental Research and Public Health, 2018, 15(5), 869; The Synergetic Effect of Targeted Resource Transfers for Families, Child Sensitive Social Protection Programs, and Capacity Building for Effective Social Protection on Children's Nutritional Status in Nepal. https://doi.org/10.3390/ijerph15050869 The PDF displayed with this record includes the correction

The impact of unconditional child cash grant on child malnutrition and its immediate and underlying causes in five districts of the Karnali Zone, Nepal : a trend analysis

Background: The impact of unconditional cash transfers on child malnutrition and its determinants remains poorly understood. The aim of this study was evaluate the impact of an unconditional child cash grant on children's nutritional status and its immediate (infant and young child feeding, dietary diversity, food consumption, and child infection and care) and underlying (household food security; Water, Hygiene and Sanitation (WASH) determinants among children younger than five years in the Karnali Zone, Nepal. Methods: The five districts of the Karnali Zone received standard social welfare services in the form of targeted resource transfers for eligible families, plus an unconditional child cash payment, augmented by a capacity building and behavioural change education. Repeated cross-sectional surveys, with measures taken at baseline (2009, N=3750), midline (2013, N=3750) and endline (2015, N=3647), were carried out using a two-stage cluster sampling method. Multi-level Generalized Linear Mixed Models (GLMMs) with normal, binomial, Poisson, or multinomial link were performed to detect the unadjusted and adjusted trends. Results: There was a linear growth among children, with a corresponding increase of 0.41 height-for-age Z-scores (p < 0.001), 0.50 weight-for-age Z-scores (p<0.001), and 0.34 weight-for-height Z-scores (p<0.001) between the study period, equating to a decline in child undernutrition of 9.4, 16.5, and 5.1 percentage points (p<0.001) for stunting, underweight, and wasting respectively. Improvements were also observed in WASH outcomes, care and health seeking behaviours, and food availability. Conclusion: Unconditional child cash grant embedded within a government sponsored cash transfer program for families and complemented by capacity building and behavioural change strategies improves child nutritional status and its determinants

Impact of a multidimensional child cash grant programme on water, sanitation and hygiene in Nepal

The study evaluated the impact of a multidimensional child cash grant (CCG) programme on safe water, sanitation and hygiene (WASH) outcomes. The intervention district received a CCG providing 200 Nepalese Rupee per month for up to two children for poor families with children under five, a capacity building component for effective child sensitive social protection, and behaviour change activities in addition to existing standard social welfare services in the form of targeted resource transfers (TRTs) for eligible families. The control district received only TRTs for eligible families. Propensity scores were used in difference-in-differences models to compare the changes over time between the intervention and control groups. The intervention resulted in a 5.5% (p < 0.01), 46.6% (p < 0.001) and 42.2% (p < 0.001) percentage points reduction in the proportion of households reporting drinking water from unimproved sources, having unimproved sanitation facilities, and practising unsanitary disposal of children’s faeces, respectively. However, the prevalence of households practising inadequate water treatment methods did not differ between the intervention and comparison districts. In order to achieve WASH coverage in Nepal, strategies to scale up the intervention need to consider a social protection programme embedding different financial incentive and integrated capacity mechanisms

An Ecological Assessment of Critically Endangered Chinese Pangolin Manis pentadactyla (Mammalia: Pholidota: Manidae) in the Midhills Region of Nepal

The Chinese Pangolin (Manis pentadactyla) is a “Critically Endangered” insectivorous mammal. There is a lack of information on the ecology, distribution and behavior of this species in Nepal, even though community forests in the Midhills Region of Nepal are considered to be prime habitats for the species. We conducted an ecological assessment of the habitat use of this species in nine community forests covering an area of 170.69 ha in Balthali village in Kavrepalanchok district, Nepal. We divided each forest into 50 × 50 m grids and searched for Chinese Pangolin burrows along 50 m transects in each grid. We categorized burrows into two types, new and old burrows, and recorded 10 environmental variables for each burrow. We found a total of 542 burrows, including 323 old burrows and 219 new burrows. The average width and height of a burrow opening was 21.66 ± 3.94 cm (n = 542) and 22.42 ± 5.02 cm (n = 542). The total density of burrows in the study area was 3.1 ha−1, with new burrows density of 1.2 ha−1 and old burrows density of 1.8 ha−1. We found most burrows in sites with an elevation range of 1400 - 1500 m above sea level, gentle slopes, brown colored soil, high density of tree crown cover and undergrowth vegetation, southern exposure, within 150 m from a water source and less than 200 m from a human settlement. Our study has generated baseline data on the habitat use of Chinese Pangolin, which we hope will help in designing site-specific action plans for Chinese Pangolin conservation in Kavrepalanchok district, Nepal