Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal.

Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal's Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000 i.e. USD 73.5, the basis of which is unclear. We aimed to estimate the costs of treatment in neonates and young infants fulfilling clinical criteria for sepsis, defined as clinical severe infection (CSI) to identify determinants of increased cost. This study assessed costs for treatment of 206 infants 3-59 days old, enrolled in a clinical trial, and admitted to the Kanti Children's Hospital in Nepal through June 2017 to December 2018. Total costs were derived as the sum of direct costs for bed charges, investigations, and medicines and indirect costs calculated by using work time loss of parents. We estimated treatment costs for CSI, the proportion exceeding NPR 8000 and performed multivariable linear regression to identify determinants of high cost. Of the 206 infants, 138 (67%) were neonates (3-28 days). The median (IQR) direct costs for treatment of CSI in neonates and young infants (29-59 days) were USD 111.7 (69.8-155.5) and 65.17 (43.4-98.5) respectively. The direct costs exceeded NPR 8000 (USD 73.5) in 69% of neonates with CSI. Age <29 days, moderate malnutrition, presence of any sign of critical illness and documented treatment failure were found to be important determinants of high costs for treatment of CSI. According to this study, the average treatment cost for a newborn with CSI in a public tertiary level hospital is substantial. The maximum limit offered for free newborn care in public hospitals needs to be revised for better acceptance and successful implementation of the FNC service to avert catastrophic health expenditures in developing countries like Nepal. Trial Registration: CTRI/2017/02/007966 (Registered on: 27/02/2017).

Efficacy of typhoid conjugate vaccine in Nepal: final results of a phase 3, randomised, controlled trial.

BACKGROUND: Typhoid fever is a major public health problem in low-resource settings. Vaccination can help curb the disease and might reduce transmission. We have previously reported an interim analysis of the efficacy of typhoid conjugate vaccine (TCV) in Nepali children. Here we report the final results after 2 years of follow-up. METHODS: We did a participant-masked and observer-masked individually randomised trial in Lalitpur, Nepal, in which 20 019 children aged 9 months to younger than 16 years were randomly assigned in a 1:1 ratio to receive a single dose of TCV (Typbar TCV, Bharat Biotech International, India) or capsular group A meningococcal conjugate vaccine (MenA). Participants were followed up until April 9, 2020. The primary outcome was blood culture-confirmed typhoid fever. Cases were captured via passive surveillance and active telephone surveillance followed by medical record review. The trial is registered at ISRCTN registry, ISRCTN43385161 and is ongoing. FINDINGS: From Nov 20, 2017, to April 9, 2018, of 20 119 children screened, 20 019 participants were randomly assigned to receive TCV or MenA vaccine. There were 75 cases of blood culture-confirmed typhoid fever included in the analysis (13 in the TCV group and 62 in the MenA group) over the 2-year period. The protective efficacy of TCV against blood culture-confirmed typhoid fever at 2 years was 79·0% (95% CI 61·9-88·5; p<0·0001). The incidence of typhoid fever was 72 (95% CI 38-123) cases per 100 000 person-years in the TCV group and 342 (95% CI 262-438) cases per 100 000 person-years in the MenA group. Adverse events occurring within the first 7 days post-vaccination were reported previously. INTERPRETATION: The final results of this randomised, controlled trial are in keeping with the results of our published interim analysis. There is no evidence of waning protection over a 2-year period. These findings add further support for the WHO recommendations on control of enteric fever. FUNDING: Bill & Melinda Gates Foundation.

Application of deep neural network to capture groundwater potential zone in mountainous terrain, Nepal Himalaya.

This study aims to capture groundwater potential zones integrating deep neural network and groundwater influencing factors. The present work was carried out for Gopi khola watershed, mountainous terrain in Nepal Himalaya as the watershed mainly relies upon the groundwater assets; it is a need to explore groundwater potential for better management of the aquifer framework. Ten groundwater influencing factors were collected such as elevation, slope, curvature, topographic positioning index, topographic roughness index, drainage density, topographic wetness index, geology, lineament density, and land use thematic layers. Among those influencing factors, topographic roughness index was removed because of multicollinearity issue to reduce the dimension of the dataset. A spring inventory map of 145 spring locations was prepared using field survey method and an equal number of spring absence points were randomly generated. The 70% of spring and spring absence pixels were used as training dataset and remaining as test dataset. The final map was created based on predicted probabilities ranging from 0 to 1. The validation was done using the receiver operating characteristic curve, which shows that the area under the curve is 76.1% for the training dataset and 82.1% for the test dataset. The sensitivity analysis was performed using Jackknife test which shows that the lineament density is the most important factor. The experimental results demonstrated that deep neural network is highly capable to capture groundwater potential zone in mountainous terrain. The present study might be useful and preliminary work to exploit the groundwater. The consequences of the current study may be valuable to water administrators to settle on appropriate choices on the ideal utilization of groundwater assets for future arranging in the basic investigation zone.

Dark and bright spots in the shadow of the pandemic: Rural livelihoods, social vulnerability, and local governance in India and Nepal.

The global COVID-19 pandemic has brought unprecedented disruption to lives and livelihoods around the world. These disruptions have brought into sharp focus experiences of vulnerability but also, at times, evidence of resilience as people and institutions gear up to respond to the crisis. Drawing on intensive qualitative enquiry in 16 villages of Himalayan India and Nepal, this paper documents both dark and bright spots from the early days of the pandemic. We find intense experiences of fear and uncertainty, heightened food insecurity, and drastic reductions in livelihood opportunities. However, we also find a wide range of individual and collective responses as well as a patchwork of policy support mechanisms that have provided at least some measure of basic security. Local elected governments have played a critical role in coordinating responses and delivering social support, however the nature of their actions varies as a result of different institutional arrangements and state support systems in the two countries. Our findings highlight the changing nature of vulnerability in the present era, as demographic shifts, growing off-farm employment and dependence on remittances, and increasing market integration have all brought about new kinds of exposure to risk for rural populations in the context of the present disruption and beyond. Most importantly, our research shows the critical importance of strong systems of state support for protecting basic well-being in times of crises. Based on these findings, we argue that there is a need for greater knowledge of how local institutions work in tandem with a broader set of state support mechanisms to generate responses for urgent challenges; such knowledge holds the potential to develop governance systems that are better able to confront diverse shocks that households face, both now and in the future.

Economics of climate adaptive water management practices in Nepal.

This study analyses costs and benefits of the selected climate adaptive and equitable water management practices and strategies (CAEWMPS) in Dhulikhel Municipality and Dharan Sub-metropolitan city of Nepal. The CAEWMPS adopted the construction of water recharge pit at household level in Dharan and recharge ponds at community level in Dhulikhel. The results of household survey reveal that households have employed different coping strategies including minimizing consumption, purchasing from market, harvesting rain water and installing equipment for storing and pumping in both cities. In Dhulikhel, a significant number of households (18.56%) minimize consumption during the dry season but this is not the case in Dharan. Rather, around one-fifth (19.27%) of the households harvest rainwater in Dharan. In addition, households are forced to give-up their regular activities in order to implement coping strategies such as household chores, leisure time, meeting and gardening. The average estimated annual coping cost in Dharan (USD 87.5) is eight times higher than in Dhulikhel (USD 11.05); however, per unit coping cost is nearly equal in both the cities. In terms of benefit-cost ration, the community level recharge ponds in Dhulikhel (5.15) were found to be cost effective compared to the household level recharge pits of Dharan (1.72). These results provide policy makers with a comparative basis for adopting appropriate strategies to tackle problems related to water shortage under city-specific contexts.