Visceral leishmaniasis in new foci areas of Nepal: Sources and extent of infection.

Background & objectives: The successful elimination program of visceral leishmaniasis (VL) in Nepal decreased the incidence to less than 1 per 10,000 population leading to the consolidation phase. However, new VL cases have been recorded from new districts, threatening the elimination goal. This study monitors the geographical spread of VL and identifies potential risk factors. Methods: VL data of 2017-2020 were obtained from the Epidemiology and Disease Control Division (EDCD) of Nepal and mapped. Telephonic interviews with 13 VL patients were conducted. Results: The incidence maps indicate that VL is spreading to new areas. The target incidence exceeded four times in hilly and twice in mountainous districts. VL cases occurred in 64 of 77 districts in all three regions (mountainous, hilly and Terai). Interviews showed a correlation between travel history (private, commercial and for studies) and the spread of VL cases to new foci. Interpretation & conclusion: One major challenge of VL elimination in the maintenance phase is the spread of infection through travelers to new foci areas, which needs to be under continuous surveillance accompanied by vector control activities. This should be confirmed by a large-scale analytical study.

Impact of the Federal Conservation Program Participation on Conservation Practice Adoption Intensity in Louisiana, USA.

Conservation practices focusing on improving the soil and water quality of working lands are implemented across the United States, supported partially through the United States Department of Agriculture Natural Resources Conservation Service cost-share or incentive payment programs. We assess whether participation in federal conservation support programs induces a change in the number of conservation practices adopted by farmers. We also identify the factors that affect the adoption intensity of different best management practices. We use survey data collected from Louisiana farmers and estimate models using the matching method and Poisson quasi-likelihood model. We find that participation in the cost-share or incentive program leads to an increase in the number of conservation practices on the farms. Similarly, the use of precision technology application and farm being integrated are likely to have a higher number of on-farm conservation practices. Results have implications for federal working lands conservation support programs in the United States.

Migration, Remittance, and Adoption of Conservation Practices.

Temporary migration and the resulting flow of fund in terms of remittance has been one of the major sources of financing in developing countries. However, little is known about the role of remittance receipt by households on the adoption of environmental-friendly practices in the agricultural production system. We use the three-stage least squares (3-SLS) regression method to analyze the data obtained from face-to-face interview surveys of 338 Nepali households to understand the impact of migration and remittance on the adoption of conservation practices. Our analysis does not show the direct impact of remittance on the number of soil and water conservation practices adoption, but migration has a significant negative effect. Other variables positively affecting the adoption of conservation practices are agriculture as the main source of income, perceived notion that water quality is bad, and better utilization of existing agricultural infrastructures. Income and the perceived notion that productivity quality of soil is bad negatively affect conservation practices adoption. Farm households facing labor shortage resulting from out-migration should be assisted by providing cost-share or incentive payment to adopt readily available, effective, low labor-intensive, and low-cost conservation practices in Nepal or elsewhere in similar remittance-dependent developing countries.

Relatively Low Maternal Aflatoxin Exposure Is Associated with Small-for-Gestational-Age but Not with Other Birth Outcomes in a Prospective Birth Cohort Study of Nepalese Infants.

BACKGROUND: Exposure to aflatoxin has garnered increased attention as a possible contributor to adverse birth outcomes. OBJECTIVE: The objective of this study was to investigate the relation of maternal aflatoxin exposure with adverse birth outcomes such as birth weight, birth length, anthropometric z scores, low birth weight (LBW), small-for-gestational-age (SGA), stunting, and preterm birth (PTB). METHODS: This study used maternal and newborn data from the AflaCohort Study, an ongoing birth cohort study in Banke, Nepal (n = 1621). Data on aflatoxin B1 (AFB1)-lysine adducts in maternal serum were collected once during pregnancy (at mean ± SD: 136 ± 43 d of gestation). Maternal serum AFB1-lysine adduct concentration was measured via HPLC. Linear and logistic regression analyses were used to determine if maternal aflatoxin exposure was associated with 1) birth weight and length (primary outcomes) and 2) anthropometric z scores, LBW (weight <2.5 kg), SGA (weight <10th percentile for gestational age and sex), stunting at birth (length-for-age z score less than -2), or PTB (born <37 weeks of gestation) (secondary outcomes). RESULTS: The geometric mean of maternal serum AFB1-lysine adduct concentration was 1.37 pg/mg albumin (95% CI: 1.30, 1.44 pg/mg albumin). Twenty percent of infants were of LBW and 32% were SGA. Sixteen percent of infants were stunted at birth. In addition, 13% of infants were born preterm. In logistic multivariate regression models, mean maternal serum AFB1-lysine adduct concentrations were significantly associated with SGA (OR: 1.13; 95% CI: 1.00, 1.27; P < 0.05). CONCLUSIONS: Findings from this study suggest a small but significant association between serum AFB1-lysine adduct concentrations in pregnant women and SGA. Maternal aflatoxin exposure was not associated with other birth outcomes. These results highlight the need for future research on a threshold level of aflatoxin exposure needed to produce detectable adverse birth outcomes. This trial was registered at clinicaltrials.gov as NCT03312049.

Awareness and Adoption of Soil and Water Conservation Technologies in a Developing Country: A Case of Nabajuzi Watershed in Central Uganda.

Soil and water conservation technologies have been widely available in most parts of Uganda. However, not only has the adoption rate been low but also many farmers seem not to be aware of these technologies. This study aims at identifying the factors that influence awareness and adoption of soil and water conservation technologies in Nabajuzi watershed in central Uganda. A bivariate probit model was used to examine farmers' awareness and adoption of soil and water conservation technologies in the watershed. We use data collected from the interview of 400 households located in the watershed to understand the factors affecting the awareness and adoption of these technologies in the study area. Findings indicate that the likelihood of being aware and adopting the technologies are explained by the age of household head, being a tenant, and number of years of access to farmland. To increase awareness and adoption of technologies in Uganda, policymakers may expedite the process of land titling as farmers may feel secure about landholding and thus adopt these technologies to increase profitability and productivity in the long run. Incentive payments to farmers residing in the vulnerable region to adopt these considered technologies may help to alleviate soil deterioration problems in the affected area.

Adoption of Sustainable Agriculture Practices among Farmers in Kentucky, USA.

Promoting the sustainable agricultural practices at an individual farm level is essential to ensure agricultural sustainability. This study analyzed whether and how various factors related to farm or farmers' characteristics influence the adoption intensity of sustainable agriculture practices. We used a negative binomial regression model to fit the data collected from a mail survey of farmers in Kentucky, USA. Our results showed that the adoption intensity of sustainable agriculture practices varied significantly among agricultural districts in Kentucky. Farmers who grew row crops, had irrigation facilities, and were in favor of crop diversification were significantly more likely than their respective counterparts to adopt more sustainable agriculture practices. Similarly, having a college education and participating in the Tobacco Buyout Program also positively and significantly affected the intensity of adopting sustainable agriculture practices among Kentucky farmers. In contrast, a lack of adequate knowledge about sustainable farming and an unfamiliarity with technology significantly and negatively related to less adoption of sustainable agriculture practices.

Adapting Nepal's polio eradication programme.

PROBLEM: Many countries have weak disease surveillance and immunization systems. The elimination of polio creates an opportunity to use staff and assets from the polio eradication programme to control other vaccine-preventable diseases and improve disease surveillance and immunization systems. APPROACH: In 2003, the active surveillance system of Nepal's polio eradication programme began to report on measles and neonatal tetanus cases. Japanese encephalitis and rubella cases were added to the surveillance system in 2004. Staff from the programme aided the development and implementation of government immunization policies, helped launch vaccination campaigns, and trained government staff in reporting practices and vaccine management. LOCAL SETTING: Nepal eliminated indigenous polio in 2000, and controlled outbreaks caused by polio importations between 2005 and 2010. RELEVANT CHANGES: In 2014, the surveillance activities had expanded to 299 sites, with active surveillance for measles, rubella and neonatal tetanus, including weekly visits from 15 surveillance medical officers. Sentinel surveillance for Japanese encephalitis consisted of 132 sites. Since 2002, staff from the eradication programme have helped to introduce six new vaccines and helped to secure funding from Gavi, the Vaccine Alliance. Staff have also assisted in responding to other health events in the country. LESSON LEARNT: By expanding the activities of its polio eradication programme, Nepal has improved its surveillance and immunization systems and increased vaccination coverage of other vaccine-preventable diseases. Continued donor support, a close collaboration with the Expanded Programme on Immunization, and the retention of the polio eradication programme's skilled workforce were important for this expansion.

From Rhetoric to Reality: Embracing Evidence-Based Policy for Lasting Impact.

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Epidemiological, Serological, and Entomological Investigation of New Visceral Leishmaniasis Foci in Nepal.

The aim of this study was to explore epidemiological, serological, entomological, and social aspects of visceral leishmaniasis (VL) in new foci in Nepal. The study was conducted in 11 villages of five districts that had been previously free of VL but that reported new cases between 2019 and 2021. We screened 1,288 inhabitants using rK39 tests and investigated the epidemiological and clinical characteristics of 12 recent VL cases. A total of 182 community members were interviewed about knowledge, attitude, and practices regarding VL. They then underwent an awareness training; 40 of them had a second interview at 6 months to assess the training impact. Vector surveys were conducted in six houses per village to assess sandfly density and infection rates. The prevalence of VL infection was 0.5% and 3.2% among screened populations in Dolpa and Kavre districts, respectively, while the other districts had no rK39-positive cases. No association between travel history and VL infection was found. Phlebotomus argentipes sandflies were collected in three districts at high altitudes (from 1,084 to 4,450 m). None of the sandflies captured had Leishmania donovani DNA. People in new foci were not aware of VL symptoms, vectors, or preventive measures. The training significantly improved their knowledge and practice in seeking medical care in case of illness. The epidemiological, serological, and entomological investigations suggest indigenous focal transmission of VL. An integrated package of strategic interventions should be implemented by the national VL elimination program in districts with new VL foci.

Thoraco-lumbar Burst Fractures among Patients Admitted to Spine Unit of the Department of Orthopedics of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Burst fractures are the most common fractures in the thoracolumbar junction. Unstable burst fractures are mostly associated with neural injury. Early neurological and mechanical stabilisation are the goals of treatment. The aim of this study was to find out the prevalence of thoracolumbar burst fractures among patients admitted to the spine unit of the Department of Orthopedics of a tertiary care centre. Methods: This descriptive cross-sectional study was done in a tertiary care centre from 1 January 2021 to 31 December 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: 079/80-11/BHG). Demographic details, mode of injury, morphology, neurological level, and neurological grade using the American Association of Spinal injury, Visual analogue Scale, Oswestry Disability Index and kyphotic angle were recorded. A convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Results: Among 85 patients, the thoracolumbar burst fractures was found in 30 (35.25%) (26.73-43.77, 90% Confidence Interval). The mean age of patients was 39.73±13.91 years. Conclusions: The prevalence of thoracolumbar burst fracture was similar to other studies done in similar settings. Keywords: fracture; injuries; prevalence; spine.

Relationship between Animal Sourced Food Consumption and Early Childhood Development Outcomes.

Early-childhood development (ECD) is an important determinant of a child's cognitive ability, learning, productivity, and lifetime earnings. Animal-sourced food (ASF), which is a rich source of high-quality protein and micronutrients, has been linked with ECD outcomes. This study investigates the relationship between the number, frequency, and cumulative consumption of ASF at 6, 9, 12, and 18 months of age and ECD outcomes at 24 months of age, controlling for physical growth. The study uses data collected from 701 mother−child pairs from an observational birth cohort study carried out in Banke, Nepal. ECD outcomes were assessed through a standardized ages and stages questionnaire (ASQ-3) tool. Separate multivariable ordinary least squares regression models were used to test for associations. Significant positive association was seen between total ASQ-3 score at 24 months of age and any ASF consumption at 18 months (ß = 8.98, p-value < 0.01), controlling for growth outcomes. The study findings highlight the positive contribution and the accumulating benefit of consistent ASF consumption on ECD outcomes. This study recommends support and promotion of ASF intake among young children in Nepal through policy and programming actions relevant to female education; nutrition knowledge; quality ASF production; improved market access; cold storage; and poverty reduction.

Bacterial Assessment of Stethoscopes Used by Healthcare Workers at a Tertiary Care Government Hospital in Bharatpur, Nepal.

The transmission of healthcare-associated infections (HCAIs) in healthcare settings is a serious challenge in the medical fraternity. Medical devices, such as stethoscopes used by healthcare workers (HCWs), are likely to harbor a considerable number of pathogenic microbes, which may result in the transmission of HCAIs. This study sought to investigate bacterial contamination of stethoscopes used by HCWs at Bharatpur Hospital, Nepal. During the study period of 3 months from December 2019 to February 2020, a total of 87 stethoscopes were examined; bacterial pathogens were isolated and identified by culture and biochemical tests, and their susceptibilities against different antibiotics were determined using standard protocols of the Clinical and Laboratory Standards Institute (CLSI). The disc diffusion method was used primarily to screen for extended-spectrum beta-lactamase (ESBL)- and metallo-beta-lactamase (MBL)-producing isolates, followed by their confirmation using cephalosporin/clavulanate combination discs and the disc potentiation methods, respectively. In addition, molecular detection of blaCTX-M and blaVIM genes was performed using conventional polymerase chain reaction (PCR). Of the 87 stethoscopes examined, more than a quarter (28.7%) were colonized with different pathogenic bacteria. Bacterial contamination of stethoscopes was found to be significantly associated with various factors, such as disinfecting routine, method of disinfection, and department of the hospital (p < 0.05). A higher rate of bacterial contamination was observed on the diaphragm of the stethoscope (12.64%) and among HCWs who overlooked hand hygiene practices (45.45%). The prevalence of methicillin-resistant S. aureus (MRSA) was 44.44%, and approximately half of the Gram-negative isolates (47%) were multidrug resistant (MDR). Imipenem (81.25%) and chloramphenicol (83.33%) were found to be the most effective antibiotics for Gram-negative and Gram-positive bacteria, respectively. Phenotypic screening showed that 43.75% of isolates were ESBL producers, and 18.75% were MBL producers, but blaCTX-M and blaVIM genes were detected in only 31.25% and 6.25% of isolates, respectively. The results of the study call for effective stethoscope disinfection practices along with the judicious use of antibiotics by HCWs in order to minimize cross-contamination, emergence of resistance, and spread of nosocomial infections in clinical settings.

Evaluating active leprosy case identification methods in six districts of Nepal.

BACKGROUND: Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal's population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment. METHODS: Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated. RESULTS: New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24-5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26-2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07-0.94%) and PB cases (0.13%, 95% CI 0.03-0.73) (χ2 = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1-0.46) and PB cases (0.48%, 0.19-0.98) (χ2 = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22-0.81). CONCLUSIONS: The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection.

Follow-up assessment of visceral leishmaniasis treated patients and the impact of COVID-19 on control services in Nepal.

BACKGROUND: Follow-up assessment of visceral leishmaniasis (VL) treated cases is important to monitor the long term effectiveness of treatment regimens. The main objective of this study was to identify the gaps and challenges in the follow-up of treated VL cases, to monitor treatment outcome and to assess the impact of COVID-19 on VL elimination services and activities. METHODS: Clinicians treating VL patients, district focal persons for VL, and patients treated for VL in seven high endemic districts in Nepal during 2019-2022 were interviewed to collect data on challenges in the follow-up of VL treated patients as per national strategy. RESULTS: Follow up status was poor in two districts with the largest number of reported cases. The majority of cases were children under 10 years of age (44.2%). Among 104 VL treated cases interviewed, 60.6% mentioned that clinicians had called them for follow-up but only 37.5% had complied. Among 112 VL treated cases followed up, 8 (7.14%) had relapse and 2 (1.8%) had PKDL. Among 66 cases who had VL during the COVID-19 lock down period, 32 (48.5%) were diagnosed within 1 week; however, 10 (15.1%) were diagnosed only after 4 weeks or more. During the COVID-19 pandemic, there was no active search for VL because of budget constraints and lack of diagnostic tests, and no insecticide spraying was done. CONCLUSION: Relapses and PKDL are challenges for VL elimination and a matter of concern. Successful implementation of the national strategy for follow up of treated VL cases requires addressing elements related to patients (awareness, transport, communication) clinicians (compliance) and organization of service delivery (local health worker training and deployment). COVID-19 did not have much impact on VL diagnosis and treatment; however, public health programmes including active case detection and insecticide spraying for vector control were severely reduced.

Seroprevalence of SARS-CoV-2 infection in the general population of Nepal during the first and second generalized waves of the COVID-19 pandemic-2020-2021.

Few seroprevalence studies have been conducted on coronavirus disease (COVID-19) in Nepal. Here, we aimed to estimate seroprevalence and assess risk factors for infection in the general population of Nepal by conducting two rounds of sampling. The first round was in October 2020, at the peak of the first generalized wave of COVID-19, and the second round in July-August 2021, following the peak of the wave caused by the delta variant of SARS-CoV-2. We used cross-sectional probability-to-size (PPS)-based multistage cluster sampling to estimate the seroprevalence in the general population of Nepal at the national and provincial levels. We tested for anti-SARS-CoV-2 total antibody using the WANTAI SARS-CoV-2 Ab ELISA kit. In Round 1, the overall national seroprevalence was 14.4%, with provincial estimates ranging from 5.3% in Sudurpaschim to 27.3% in Madhesh Province. In Round 2, the estimated national seroprevalence was 70.7%, with the highest in the Madhesh Province (84.8%) and the lowest in the Gandaki Province (62.9%). Seroprevalence was comparable between males and females (Round 1, 15.8% vs. 12.2% and Round 2, 72.3% vs. 68.7%). The seroprevalence in the ecozones-Terai, hills, and mountains-was 76.3%, 65.3%, and 60.5% in Round 2 and 17.7%, 11.7%, and 4.6% in Round 1, respectively. In Nepal, COVID-19 vaccination was introduced in January 2021. At the peak of the first generalized wave of COVID-19, most of the population of Nepal remained unexposed to SARS-CoV-2. Towards the end of the second generalized wave in April 2021, two thirds of the population was exposed.

Traumatic Spinal Injury among Patients with Spinal Injuries Admitted to the Spine Unit of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Traumatic spinal injury is a major source of morbidity and mortality throughout the world. The number of spinal injuries is growing annually but epidemiological and demographic features may be different in different regions. This study aims to find out the prevalence of traumatic spinal injury among patients with spinal injuries admitted to the spine unit of a tertiary care centre. Methods: This was a descriptive cross-sectional study was done on a total of 102 traumatic spinal injury patients admitted to the spine unit of a tertiary care centre from 1st June, 2019 to 31st May, 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: 077/78-09). Demographic details, mode of injury, morphology, patterns of fractures, neurological level, and management methods in the hospital were recorded. Convenience sampling was done. Data were analysed using the Statistical Package for the Social Science version 24.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Among 130 spinal injury patients, the prevalence of traumatic spinal injury was found to be 102 (78.46%) (71.39-85.53 at 95% Confidence Interval). The most common mode of spinal injury was due to falls in 80 (78.43%) cases. Conclusions: The prevalence of traumatic spinal injury was higher when compared to the other studies done in similar settings. Keywords: falls; polytrauma; spinal cord injuries; trauma.

Determinants of Telehealth Service Use among Mental Health Patients: A Case of Rural Louisiana.

The COVID-19 pandemic decreased the in-person outpatient visits and accelerated the use of telehealth services among mental health patients. Our study investigated the sociodemographic and clinical correlates of the intensity of telehealth use among mental health patients residing in rural Louisiana, United States. The study sample included 7069 telehealth visits by 1115 unique patients encountered from 1 April 2020 to 31 March 2021 at six mental health outpatient clinics managed by the Northeast Delta Human Services Authority (NEDHSA). We performed a negative binomial regression analysis with the intensity of service use as the outcome variable. Being younger, female, and more educated were associated with a higher number of telehealth visits. The prevalence of other chronic conditions increased telehealth visits by 10%. The telehealth service intensity varied across the nature of mental health diagnoses, with patients diagnosed with the schizophrenia spectrum and other psychotic disorders utilizing 15% fewer telehealth visits than patients diagnosed with depressive disorders. The promotion of telehealth services among mental health patients in the rural setting might require the elimination of the digital divide with a particular focus on the elderly, less educated, and those with serious mental health illnesses such as schizophrenia and psychotic disorders.

Influence of high-temperature stress on rice growth and development. A review.

High-temperature stress (HS) has become an alarming threat to the global food system. Rice, an important crop that supports almost half of the global population, is vulnerable to heat stress. Under the influence of HS, it shows various physiological and morphological symptoms that increase spikelet sterility, reduce grain yield, and even cause total crop failure. HS affects growth and yield in two ways: hindrance in the process of pollination and fertilization and reduction of the grain weight. The former is caused by (i) distortion of floral organs, (ii) tapetum degeneration, (iii) low pollen protein concentration, (iv) decline in pollen viability, (v) reduction in dehiscence of anther, (vi) low pollen dispersal, (vii) decrease in number of pollens on stigma, (viii) reduction in pollen grain germination, (ix) hindrance in extension of pollen tubes, and (x) shrinkage of stigma which ultimately cause spikelet infertility. The latter is caused by (i)reduced photosynthetic rate, (ii) a boost in senescence of functional leaves, (iii) reduction of biological synthesis of starch, (iv)reduced starch augmentation, (v) shrunk duration of grain filling, and (vi) declined grain weight which ultimately reduce the grain yield. However, some agronomic and breeding approaches have been adopted for developing thermo-resistant cultivars but the success is limited. In this paper, we have summarized the the morpho-physiological and molecular response of plant to HS, and a few possible management strategies.

Operational Gaps in Implementing the COVID-19 Case Investigation and Contact Tracing in Madhesh Province of Nepal, May-July 2021.

In Nepal, case investigation and contact tracing (CICT) was adopted as an important public health measure to reduce COVID-19 transmission. In this study, we assessed the performance of CICT in Madhesh Province of Nepal against national benchmarks, using routine programmatic data reported by district CICT teams. Between May and July 2021, 17,943 COVID-19 cases were declared in the province, among which case investigation was performed for 30% (95% CI: 29.6-31.0%) within 24 h (against 80% benchmark). As a result of case investigations, 6067 contacts were identified (3 contacts per 10 cases), of which 40% were traced and tested for SARS-CoV-2 infection (against 100% benchmark). About 60% of the contacts tested positive. At most 14% (95% CI: 13.1% to 14.9%) of traced contacts underwent a 14-day follow-up assessment (against 100% benchmark). We found the performance of the CICT program in Madhesh Province to be sub-optimal and call for corrective measures to strengthen CICT in the province and the country at large. Similar studies with wider geographical scope and longer time frames are needed to identify and address deficiencies in data recording and reporting systems for COVID-19, in low- and middle-income countries like Nepal and others.

Dietary determinants of aflatoxin B1-lysine adduct among infants in Nepal.

BACKGROUND: Aflatoxins are mycotoxins produced by naturally occurring fungi on food, and aflatoxin B1 (AFB1) is carcinogenic, immunotoxic and hepatotoxic. This study assesses the relationship between AFB1 in Nepali infants at 12 months of age and their diet at 9 and 12 months of age. METHODS: The study used data collected from 1329 infants enrolled in the AflaCohort Study. Aflatoxin exposure was assessed at 12 months using serum AFB1-lysine pg/mg albumin biomarker measured using high performance liquid chromatography-fluorescent detection. Dietary data were collected using food frequency questionnaire. We conducted ordinary least squares and quantile regression analyses with backward elimination to assess lagged (9-month diet and 12-month AFB1) and contemporaneous (12-month diet and 12-month AFB1) associations. RESULTS: Eighty-one percent of children at 12 months had detectable levels of serum AFB1-lysine (geometric mean: 0.79 pg/mg albumin, 95% CI: 0.74-0.83). The levels ranged from 0.4 to 85 pg/mg albumin. Dietary diversity at 9 and 12 months were not associated with serum AFB1-lysine levels. Consumption of fish and groundnuts at both 9 and 12 months and infant formula and cauliflower at 9 months were associated with higher serum AFB1-lysine while consumption of bananas and mangoes at 12 months were negatively associated with serum AFB1-lysine (p < 0.05). CONCLUSIONS: High prevalence of detectable AFB1-lysine among infants, and possible links to their dietary patterns argues for more urgent research into which foods in children's diets are most contaminated, and into optimal entry points in the food chain that would allow for effective actions to minimize exposure.