Molecular and Entomological Characterization of 2023 Dengue Outbreak in Dhading District, Central Nepal.

In 2023, Nepal faced its second largest dengue outbreak ever, following a record-breaking number of dengue cases in 2022, characterized by the expansion of infections into areas of higher altitudes. However, the characteristics of the 2023 circulating dengue virus (DENV) and the vector density remain poorly understood. Therefore, we performed DENV serotyping, clinical and laboratory assessment, and entomological analysis of the 2023 outbreak in central Nepal. A total of 396 fever cases in Dhading hospital suspected of being DENV positive were enrolled, and blood samples were collected and tested by different techniques including PCR. Of these, 278 (70.2%) had confirmed DENV infection. Multiple serotypes (DENV-1, -2, and -3) were detected. DENV-2 (97.5%) re-emerged after six years in Dhading while DENV-3 was identified for the first time. Dengue inpatients had significantly higher frequency of anorexia, myalgia, rash, diarrhea, nausea, vomiting, abdominal pain, and thrombocytopenia (p < 0.05). In this area, Aedes mosquitoes largely predominated (90.7%) with the majority being A. aegypti (60.7%). We also found high levels of Aedes index (20.0%) and container index (16.7%). We confirmed multiple DENV serotype circulation with serotype re-emergence and new serotype introduction, and high vector density in 2023. These findings call for the urgent initiation and scaling up of DENV molecular surveillance in human and mosquito populations for dengue control and prevention in Nepal.

Knowledge and practices of commercial banana farmers related to pesticide use in Chitwan district, Nepal; a cross-sectional study and meta-analyses.

The exposure of farmers to pesticides due to inadequate safety measures is a concern in low-income countries in Africa and Asia. However, until now, there have been limited studies on the farmers' risk due to pesticide application to fruit crops. The knowledge of farmers' exposure related to pesticide use and their safety practices was studied among 100 banana farmers in three areas (Padampur, Jagatpur, and Thimura) of Chitwan district, Nepal. More than 75% of the farmers complained about problems related to insects. Most frequently used insecticides in the area were chlorpyrifos and cypermethrin. Ten percent (10%) of the applied pesticides were highly hazardous to humans, according to the World Health Organization hazard category, with skin rash being the most common acute symptom reported by 29% of the farmers. Banned organochlorine and organophosphate insecticides, such as endosulfan and triazophos, respectively, are still being used by farmers in the aforementioned areas. Spearman's correlation analysis revealed the lack of knowledge and safety practices among farmers leading to inadequate awareness related to the negative effects of pesticide use on human health and the environment. Therefore, government extension service can play a crucial role in improving banana farmers' knowledge of the toxic effects of pesticides as well as enforcing the Nepali language in the labeling of pesticide containers and packages.

Post-COVID syndrome: A prospective study in a tertiary hospital of Nepal.

INTRODUCTION: The post-coronavirus disease 2019 (COVID-19) syndrome is defined as the persistence of symptoms after viral clearance and the emergence of new symptoms after a few months following recovery from COVID-19. This study aimed to assess the prevalence of post-COVID-19 syndrome and the risk factors that contribute to its development. METHODS: This study was conducted prospectively in Tribhuvan University Teaching Hospital (TUTH), located in Maharajgunj, Kathmandu. The patients were followed up for three months. RESULTS: The post-COVID status of 300 patients admitted to the COVID emergency of TUTH was studied. The mean age of the patients was 46.6±15.7 years, and the proportion of male (56%) was slightly higher than female (44%). Most of the patients (81.7%) had fever on their presentation to the emergency which was followed by fatigue (81.3%) and cough (78.3%). During the post-COVID phase, fatigue was the most common persistent symptom, with 34% experiencing fatigue after 60 days and 28.3% even after 90 days from the onset of symptoms. Univariate logistic regression showed sore throat (OR 4.6; 95% CI (2.8-7.6)), rhinitis (OR 3.6; 95% CI (2.1-5.9)), fatigue (OR 3.7; 95% CI (1.8-7.6)), diarrhea (OR 4.1; 95% CI (2.4-6.9)), anosmia (OR 6.7; 95% CI (3.9-11.3)), ageusia (OR 7.8; 95% CI (4.5-13.4)) and shortness of breath (OR 14.9; 95% CI (1.8-119.6)) at admission were all predictors of post-COVID syndrome after three months. CONCLUSION: Even after recovering from COVID-19, people with COVID-19 may develop symptoms. As a result, COVID-19's long-term consequences should not be neglected, as they may lead to increased morbidity among patients, consumption of financial resources, and added burden on the health system.

Ecological risk assessment of pesticide residues in soils from vegetable production areas: A case study in S-Nepal.

Pesticides pose a serious risk to ecosystems. In this study, we used European Food Safety Authority methods, such as risk quotient (RQ) and toxicity exposure ratios (TER), to assess the potential ecological risks of 15 pesticide residues detected in agricultural soils in the Gaidahawa Rural Municipality of Nepal. The mean and maximum concentrations of the detected pesticide residues in the soil were used for risk characterization related to soil organisms. RQmean, TERmean and RQmaximum, TERmaximum were used to determine general and the worst-case scenarios, respectively. Of all the detected pesticides in soils, the no observed effect concentration (NOEC) for 27% of the pesticides was not available in literature for the tested soil organisms and their TER and RQ could not be calculated. RQ threshold value of ≥1 indicates high risk for organisms. Similarly, TER threshold value of ≥5, which is acceptable trigger point value for chronic exposure, indicates an acceptable risk. The results showed that the worst-case scenario (RQmaximum) indicated a high risk for soil organisms from chlorpyrifos [RQmaximum > 9 at depths (cm) of 0-5, 15-20 and 35-40 soil layer]; imidacloprid (1.78 in the 35-40 cm soil layer) and profenofos (3.37 in the 0-5 cm and 1.09 in the 35-40 cm soil layer). Likewise, for all the soil depths, the calculated TER for both the general and worst-case scenarios for chlorpyrifos ranged from 0.37 to 3.22, indicating chronic toxicity to F. candida. Furthermore, the risk of organophosphate pesticides for soil organisms in the sampling sites was mainly due to chlorpyrifos, except for two study sites where the risk was from profenofos. Ecological risk assessment (EcoRA) of the pesticide use in the study area indicated that the EFSA soil organisms were at risk at some of the localities where farmers practiced conventional farming.

Concentration and distribution of pesticide residues in soil: Non-dietary human health risk assessment.

Soil contamination by pesticide residues is a primary concern because of the high soil persistence of pesticides and their toxicity to humans. We investigated pesticide concentration and distribution at 3 soil depths in 147 soil samples from agricultural land and assessed potential health risks due to non-dietary human exposure to pesticides in Nepal. About sixty percent of the soil samples had pesticides (25% of the soil samples had single residue, 35% of the soil samples had mixtures of 2 or more residues) in 39 different pesticide combinations. Pesticide residues were found more frequently in topsoil. Overall, the concentration of pesticides ranged from 1.0 µg kg-1 to 251 µg kg-1, with a mean of 16 µg kg-1. The concentration of the primary group, organophosphates (OPs), ranged from 1.23 µg kg-1 to 239 µg kg-1, with a mean of 23 µg kg-1. Chlorpyrifos and 3,5,6-trichloro-2-pyridinol (TCP) were the predominant contaminants in soils. The ionic ratio of DDT and its degradation products suggested a continuing use of DDT in the area. Human health risk assessment of the observed pesticides in soil suggested negligible cancer risks and negligible non-cancer risks based on ingestion as the primary route of exposure. The predicted environmental concentrations (PECs) of pesticides were higher than the values found in the guidance for soil contamination used internationally. Low concentrations of residues in the soils from agricultural farms practicing integrated pest management (IPM) suggest that this farming system could reduce soil pollution in Nepal.

Pesticide residues in Nepalese vegetables and potential health risks.

We conducted this study in order to assess the pesticide residues in vegetables and examine the related human health risk. Therefore, residues of 23 pesticides (organophosphates, organochlorines, acaricides, fungicides, and insecticides of biological origin) were analysed in the three main vegetable crops grown in Southern Nepal: 27 eggplant, 27 chilli and 32 tomato samples representing (i) conventional (N = 67) and ii) integrated pest management (IPM) fields (N = 19). Pesticide residues were found in 93% of the eggplant samples and in all of the chilli and tomato samples. Multiple residues were observed in 56% of the eggplant samples, 96% of chilli samples and all of the tomato samples. The range (µg/kg) of total detected pesticide residues in eggplants, chillies and tomatoes was 1.71-231, 4.97-507, 13.1-3465, respectively. The most frequently detected pesticides in these vegetables were carbendazim and chloropyrifos. Pesticide residues in 4% of the eggplant, 44% of the tomato and 19% of the chilli samples exceeded the EU maximum residue limits (MRLs). The residues of triazophos, omethoate, chloropyrifos and carbendazim exceeded the EU MRLs. Compared to chilli and eggplant crops, more carbendazim was sprayed onto tomato crops (p < 0.05). We assessed adolescent and adult dietary exposure using hazard quotient (HQ) and hazard index (HI) equations for the identified pesticides. HQ> 1 was observed for chloropyrifos, triazophos and carbendazim in eggplants; profenofos, triazophos, dimethoate, omethoate, chloropyrifos and carbendazim in tomatoes; and dichlorvos and chloropyrifos in chillies. Of all of the HQs, the highest acute HQ (aHQ) was for triazophos (tomato) in adolescents (aHQ=657) and adults (aHQ=677), showing the highest risks of dietary exposure. The cumulative dietary exposure showed a higher HI for organophosphates (HI>83) and a lower HI for organochlorines, acaricides and biological insecticides (HI<1). The concentration of pesticide residues in the vegetable crops from the IPM field was considerably lower, suggesting a greater ability of IPM systems to reduce the dietary risks from exposure to pesticides.

Factors affecting pesticide safety behaviour: The perceptions of Nepalese farmers and retailers.

Indiscriminate use of pesticides in vegetable farming is an emerging problem resulting in increasing health and environmental risks in developing countries including Nepal. As there are limited studies focusing on farmers' and retailers' knowledge related to pesticide use and associated risks as well as safety behaviour, this study assesses their perceptions of pesticide use, associated impacts on human and environmental health and safety behaviours. This study is also intended to quantify pesticide use in vegetable farming. We used the Health Belief Model (HBM) to evaluate farmers' and retailers' safety behaviour associated with pesticides. We interviewed 183 farmers and 45 retailers. The study revealed that farmers applied pesticides at an average of 2.9kga.i./ha per crop per season; and insecticides, especially pyrethrins and pyrethroids as well as organophosphate, were the most frequently used. Retailers were more aware of the threats surrounding pesticide use and were thus more aware of the risks to their own health as well as to the health of animals, birds, fishes, and honey bees. Headache (73.8%) was the most commonly reported acute health symptom of pesticide use. Farmers often did not adopt the appropriate safety measures when handling pesticides sighting the constrained perceived barriers (direct path coefficient, DPC=-0.837) such as feeling uncomfortable and the unavailability of safety measures. Likewise, retailers lacked the incentive (direct path coefficient, DPC=0.397) to adopt the necessary safety measures while handling pesticides. Training and awareness programs addressing safe handling practices and safety measures as well as education concerning the long-term risks of pesticide exposure on health and the environment, through radio, television and posters, may improve the safety behaviour of farmers and retailers.