Prevalence of common risk factors of major noncommunicable diseases among sexual and gender minorities in Kathmandu valley, Nepal.

Four noncommunicable diseases (NCDs): cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, account for 71% of global deaths. However, little is known about the NCDs risk profile of sexual and gender minorities (SGMs). This study aimed to determine the prevalence of NCDs risk factors among the SGMs of Kathmandu valley, Nepal. A cross-sectional study was conducted among SGMs in the Kathmandu valley, Nepal. We recruited 140 participants using the snowball sampling method. A face-to-face interview was done using a structured questionnaire adapted from World Health Organization Step Wise Approach to Surveillance (STEPS instruments V2.2 2019) along with blood pressure and anthropometric measurements. Data were analyzed using Statistical Package for Social Science (SPSS.v20). More than two-thirds of the participants, 96 (68.6%), had co-occurrence of NCDs risk factors. The prevalence of insufficient fruits and vegetables consumption, current smoking, harmful alcohol consumption, overweight/obesity, and hypertension were 95.7%, 40.0%, 32.9%, 28.5%, and 28.6%, respectively. There was a significant association between hypertension, harmful alcohol consumption, and overweight/obesity with the participants' age, employment status, and marital status, respectively. Study findings indicated a higher prevalence of NCDs risk factors among SGMs. National-level NCDs surveillance, policy planning, prevention, and targeted health interventions should prioritize the SGMs.

Appropriate complementary feeding practice and associated factors among mothers of children aged 6-23 months in Bhimphedi rural municipality of Nepal.

BACKGROUND: Appropriate complementary feeding plays a crucial role in the enhancement of child survival; and promotes healthy growth and development. Evidence has shown that appropriate complementary feeding is effective in preventing malnutrition and child mortality. Thus, the main objective of this study is to assess the prevalence of appropriate complementary feeding practice and associated factors among mothers of children aged 6-23 months. METHODOLOGY: A community-based cross-sectional study was conducted from August to December 2018. A total of 259 mothers who had children aged 6-23 months were selected randomly from the 714 eligible mothers. A structured questionnaire was used to collect the data from the respondents. The data were collected in a tablet phone-based questionnaire using the Open Data Kit mobile application by face-to-face interview. Data analysis was done in SPSS version 21. Multivariable logistic regression was used to identify the factor associated with appropriate complementary feeding practice. RESULT: The prevalence of appropriate complementary feeding practice was 25%. Mother and father with formal education (AOR 6.1, CI: 1.7-22.4 and AOR 5.6 CI: 1.5-21.2 respectively), counseling on IYCF (AOR 4.2, CI: 1.5-12.3), having kitchen garden (AOR 2.4, CI: 1.1-5.2) and food secured family (AOR 3.0, CI: 1.0-8.9) had higher odds of appropriate complementary feeding practice. CONCLUSION: This study revealed that a significant proportion of mothers had inappropriate complementary feeding practice for their children aged 6-23 months. This study highlights the need for behavior change communication and promotion of kitchen garden to address the associated factors and promote appropriate complementary feeding practice.

Prevalence of anemia and its associated factors among adolescent girls on Weekly Iron Folic Acid supplementation (WIFAS) implemented and non-implemented schools at Tokha municipality, Kathmandu.

Anemia, the prevailing nutritional disorder worldwide, exerts its greatest impact on individuals in developing nations, exhibiting a heightened prevalence among adolescents. There is a window of opportunity for children to improve their nutritional status during their adolescence period. Weekly iron-folic acid supplementation is the preventive measure to break the intergenerational cycle of anemia. The correlation between the consumption of iron folic acid supplements and the prevention of anemia has been firmly established by numerous studies, revealing a statistically significant association. Therefore, this study was undertaken with the aim to assess the difference in the prevalence of anemia and its associated factors among adolescent girls in Weekly Iron Folic Acid Supplementation (WIFAS) implemented and non-implemented schools at Tokha Municipality, Kathmandu. A cross-sectional study was carried out among 602 adolescent girls from grade six to ten equally divided into WIFAS implemented and WIFAS non-implemented schools. Hemoglobin estimation was done using the HemoCue Hb 301 method. The descriptive, univariate and multivariable logistic regression analysis was done using SPSS version 25 to identify a significant association between anemia and its associated variables at p-value<0.05. The overall prevalence of anemia among adolescent girls was found to be 17.4% out of which, 14% and 20.9% from WIFAS-implemented and non-implemented schools respectively. The factors like type of school, fathers' education and dietary diversity were found to be statistically significant with anemia during multivariable logistic regression analysis. Given the findings of this research, proper counseling and promotion of utilization of WIFAS in order to decrease the prevalence of anemia among adolescent girls are recommended.

Genotyping-by-Sequencing Reveals Population Differentiation and Linkage Disequilibrium in Alternaria linariae from Tomato.

Alternaria linariae is an economically important foliar pathogen that causes early blight disease in tomatoes. Understanding genetic diversity, population genetic structure, and evolutionary potential is crucial to contemplating effective disease management strategies. We leveraged genotyping-by-sequencing (GBS) technology to compare genome-wide variation in 124 isolates of Alternaria spp. (A. alternata, A. linariae, and A. solani) for comparative genome analysis and to test the hypotheses of genetic differentiation and linkage disequilibrium (LD) in A. linariae collected from tomatoes in western North Carolina. We performed a pangenome-aware variant calling and filtering with GBSapp and identified 53,238 variants conserved across the reference genomes of three Alternaria spp. The highest marker density was observed on chromosome 1 (7 Mb). Both discriminant analysis of principal components and Bayesian model-based STRUCTURE analysis of A. linariae isolates revealed three subpopulations with minimal admixture. The genetic differentiation coefficients (FST) within A. linariae subpopulations were similar and high (0.86), indicating that alleles in the subpopulations are fixed and the genetic structure is likely due to restricted recombination. Analysis of molecular variance indicated higher variation among populations (89%) than within the population (11%). We found long-range LD between pairs of loci in A. linariae, supporting the hypothesis of low recombination expected for a fungal pathogen with limited sexual reproduction. Our findings provide evidence of a high level of population genetic differentiation in A. linariae, which reinforces the importance of developing tomato varieties with broad-spectrum resistance to various isolates of A. linariae.

Comparing Additionality of Tuberculosis Cases Using GeneXpert or Smear-Based Active TB Case-Finding Strategies among Social Contacts of Index Cases in Nepal.

This study compares the yield and additionality of community-based active tuberculosis (TB) active case-finding strategies using either smear microscopy or GeneXpert as the TB diagnostic test. Active case-finding strategies screened social contacts of index cases and high-risk groups in four districts of Nepal in July 2017-2019. Two districts (Chitwan and Dhanusha) applied GeneXpert testing and two districts (Makwanpur and Mahotarri) used smear microscopy. Two control districts implemented standard national TB program activities. Districts implementing GeneXpert testing screened 23,657 people for TB, tested 17,114 and diagnosed 764 TB cases, producing a yield of 4.5%. Districts implementing smear microscopy screened 19,961 people for TB, tested 13,285 and diagnosed 437 cases, producing a yield of 3.3%. The screening numbers required were 31 for GeneXpert and 45.7 for smear districts. The test numbers required were 22.4 and 30.4 for GeneXpert and smear. Using the TB REACH additionality method, social contact tracing for TB through GeneXpert testing contributed to a 20% (3958/3322) increase in district-level TB notifications, smear microscopy 12.4% (3146/2798), and -0.5% (2553/2566) for control districts. Therefore, social contact tracing of TB index cases using GeneXpert testing should be implemented throughout Nepal within the TB FREE initiative to close the notification gap and accelerate progress toward END TB strategy targets.

Comparing cross-sectional and longitudinal approaches to tuberculosis patient cost surveys using Nepalese data.

The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in the study design (e.g. cross-sectional vs longitudinal) can generate different estimates making the design and impact evaluation of socio-economic protection strategies difficult. The objective of the study was to compare the socio-economic impacts of TB estimated by applying cross-sectional or longitudinal data collections in Nepal. We analysed the data from a longitudinal costing survey (patients interviewed at three time points) conducted between April 2018 and October 2019. We calculated both mean and median costs from patients interviewed during the intensive (cross-sectional 1) and continuation (cross-sectional 2) phases of treatment. We then compared costs, the prevalence of catastrophic costs and the socio-economic impact of TB generated by each approach. There were significant differences in the costs and social impacts calculated by each approach. The median total cost (intensive plus continuation phases) was significantly higher for the longitudinal compared with cross-sectional 2 (US$119.42 vs 91.63, P < 0.001). The prevalence of food insecurity, social exclusion and patients feeling poorer or much poorer were all significantly higher by applying a longitudinal approach. In conclusion, the longitudinal design captured important aspects of costs and socio-economic impacts, which were missed by applying a cross-sectional approach. If a cross-sectional approach is applied due to resource constraints, our data suggest that the start of the continuation phase is the optimal timing for a single interview. Further research to optimize methodologies to report patient-incurred expenditure during TB diagnosis and treatment is needed.

Depression, anxiety, and stress among undergraduate health sciences students during COVID-19 pandemic in a low resource setting: a cross-sectional survey from Nepal.

Mental health is an important issue for students during the time of the COVID-19 pandemic and uncertainty. Students suffer from mental health issues due to delayed academic years and prolong stay at home during the lockdown. This study aimed to identify factors associated with depression, anxiety, and stress among undergraduate health sciences students of different medical institutions in Nepal. Materials and Methods: A web-based cross-sectional survey was conducted among 493 health sciences students between 14 July and 16 August 2020. Depression, anxiety, and stress were measured using the Depression, Anxiety, Stress Scale-21 (DASS-21). Multivariable logistic regression analysis was performed to determine the risk factors of mental health outcomes. Results: Overall, 50.5, 52.5, and 44.6% of students had symptoms of depression, anxiety, and stress, respectively. Significantly higher odds of experiencing stress symptoms [adjusted odds ratio (AOR): 2.166; 95% CI: 1.075-4.363] were found with the participants whose relatives were infected with COVID-19. Participants with age less than or equal to 21 years among undergraduate health sciences students were significantly associated with higher odds of experiencing symptoms of stress (AOR: 1.626; 95% CI: 1.110-2.383) and anxiety (AOR: 1.6251; 95% CI: 1.110-2.379) in comparison with age above 21. Staying in quarantine was significantly associated with higher odds of experiencing depressive symptoms (AOR: 2.175; 95% CI: 1.142-4.143). Participants who had internet facilities at the residence had less likely to have depressive symptoms than those who are lacking internet services (AOR: 0.420; 95% CI: 0.195-0.905). Conclusions: Staying in quarantine had higher odds of having depression and students who had internet facilities had lower odds of having depression. While staying in quarantine or isolation, it would be better to provide things to engage like the internet. A focus on improving the mental well-being of health sciences students should be initiated immediately after such a pandemic and lockdown.

Burden and risk factors of chronic respiratory diseases in Nepal, 1990-2019: An analysis of the global burden of diseases study.

Background and Aims: Chronic respiratory diseases (CRDs) substantially contribute to morbidity and mortality globally and in Nepal. However, there is a paucity of evidence on the trend and the burden of CRDs in Nepal. This study reports the trend of the burden and contribution of major risk factors to CRDs in Nepal from 1990 to 2019. Methods: This study is an observational study using publicly available data from Global Burden of Disease 2019 estimations for Nepal. The age-standardized and age-specific prevalence, incidence, mortality, disability-adjusted life years (DALYs), and risk factors for CRDs in Nepal were extracted to measure the burden and its trend. The data are presented as percentages or as rates per 100,000 population. Results: The age-standardized incidence rate of CRDs in Nepal in 2019 was 913.6 per 100,000 (95% uncertainty interval [UI]: 828.7-1000.1), which was an increase of 7.7% from 848.6 per 100,000 (95% UI: 780.2-918.2) in 1990. However, the age-standardized prevalence rate [4453/100,000 (4234.2-4671.8) in 1990; 4457.1/100,000 (4255.2-4666.8) in 2019] was almost stagnant. Most CRDs attributed to deaths and DALYs were due to chronic obstructive pulmonary disease. Conclusions: Air pollution and smoking are the main risk factors for DALYs due to CRDs in Nepal. This surging burden of the incidence rate of CRDs in Nepal calls for more effective actions to curb the risk factors and diseases.

Factors Associated with Acute Malnutrition among Pregnant Women in Flood Affected Region.

BACKGROUND: Adequate nutrition before and during pregnancy is necessary to maintain women's reproductive health and to ensure healthy foetal outcome. Pregnant women are at high risk of acute malnutrition specifically during humanitarian crisis leading to adverse effects in foetal outcomes and women's health. This study aimed to assess the factors associated with acute malnutrition among pregnant women visiting Antenatal Clinics in two hospitals and a Primary Health Care Centre of Siraha district in the south-eastern plains of Nepal immediately after 2017 flash flood. METHODS: A health-institution based cross-sectional study was conducted among 444 pregnant women of reproductive age (15-49 years) in second and third trimester in three health institutions. Data collection was done in the aftermath of 2017 flash floods through face to face interview. Multiple logistic regression analysis was used to identify the factors associated with acute malnutrition defined as Mid Upper Arm Circumference less than or equals to 21 centimetres. RESULTS: Out of 444 participants, 9.9% were found to be acutely malnourished. Participant's education (AOR[Adjusted Odds Ratio]: 3.09, 95% CI[Confidence Interval]: 1.43-6.70), occupation (AOR: 3.16, 95% CI: 1.08-9.22), husband's occupation (AOR: 6.61, 95% CI: 2.17-20.12), household food security (AOR: 3.39, 95% CI: 1.36-8.49) and participant's dietary diversity (AOR:10.06, 95% CI: 3.35-30.27) were found to be statistically significant factors associated with acute malnutrition among pregnant women. CONCLUSIONS: Participants' silliteracy, unemployment, husband not employed for cash, household food insecurity and low dietary diversity were found to be statistically significant predictors of acute malnutrition among pregnant women during flash floods.

Habitat occupancy of sloth bear Melursus ursinus in Chitwan National Park, Nepal.

Mammals have experienced a massive decline in their populations and geographic ranges worldwide. The sloth bear, Melursus ursinus (Shaw, 1791), is one of many species facing conservation threats. Despite being endangered in Nepal, decades of inattention to the situation have hindered their conservation and management. We assessed the distribution and patterns of habitat use by sloth bears in Chitwan National Park (CNP), Nepal. We conducted sign surveys from March to June, 2020, in 4 × 4 km grids (n = 45). We collected detection/non-detection data along a 4-km trail that was divided into 20 continuous segments of 200 m each. We obtained environmental, ecological, and anthropogenic covariates to understand determinants of sloth bear habitat occupancy. The data were analyzed using the single-species single-season occupancy method, with a spatially correlated detection. Using repeated observations, these models accounted for the imperfect detectability of the species to provide robust estimates of habitat occupancy. The model-averaged occupancy estimate for the sloth bear was 69% and the detection probability was 0.25. The probability of habitat occupancy by sloth bears increased with the presence of termites and fruits and in rugged, dry, open, undisturbed habitats. Our results indicate that the sloth bear is elusive, functionally unique, and widespread in CNP. Future conservation interventions and action plans aimed at sloth bear management must adequately consider their habitat requirements.

Sleep quality and its correlates among undergraduate medical students in Nepal: A cross-sectional study.

Poor sleep quality has been found to affect students' learning abilities, academic performance, and interpersonal relationships. However, little is known about this issue in Nepal. This study aimed to identify the factors associated with poor sleep quality among undergraduate medical students in Nepal. A web-based survey was conducted in March 2021 among 212 undergraduate medical students at the Institute of Medicine, Kathmandu, Nepal. Sleep quality was measured using a 19-item Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression analysis was done to assess the factors associated with sleep quality. In the study participants, 38.2% of the students were identified as poor sleepers. Factors like being depressed (AOR = 4.5, 95% CI; 1.2-5.4), current alcohol use (AOR = 2.5, 95% CI; 1.8-10.8), poor academic achievement (AOR = 3.4, 95% CI; 1.1-10.9), and being a fourth-year student (AOR = 3.6, 95% CI; 1.1-11.8) were significantly associated with poor sleep quality. Poor sleep quality was common among undergraduate medical students. Routine screening of sleep quality and depressive symptoms is necessary to mitigate their impact among medical students. Medical students of the fourth year, current alcohol users, and those who did not have good academic achievement had poor sleep quality. Special attention on these population subgroups is thus needed to enhance sleep quality.

Leopard (Panthera pardus) occupancy in the Chure range of Nepal.

Conservation of large carnivores such as leopards requires large and interconnected habitats. Despite the wide geographic range of the leopard globally, only 17% of their habitat is within protected areas. Leopards are widely distributed in Nepal, but their population status and occupancy are poorly understood. We carried out the sign-based leopard occupancy survey across the entire Chure range (~19,000 km2) to understand the habitat occupancy along with the covariates affecting their occupancy. Leopard signs were obtained from in 70 out of 223 grids surveyed, with a naïve leopard occupancy of 0.31. The model-averaged leopard occupancy was estimated to be 0.5732 (SE 0.0082) with a replication-level detection probability of 0.2554 (SE 0.1142). The top model shows the additive effect of wild boar, ruggedness, presence of livestock, and human population density positively affecting the leopard occupancy. The detection probability of leopard was higher outside the protected areas, less in the high NDVI (normalized difference vegetation index) areas, and higher in the areas with livestock presence. The presence of wild boar was strong predictor of leopard occupancy followed by the presence of livestock, ruggedness, and human population density. Leopard occupancy was higher in west Chure (0.70 ± SE 0.047) having five protected areas compared with east Chure (0.46 ± SE 0.043) with no protected areas. Protected areas and prey species had positive influence on leopard occupancy in west Chure range. Similarly in the east Chure, the leopard occupancy increased with prey, NDVI, and terrain ruggedness. Enhanced law enforcement and mass awareness activities are necessary to reduce poaching/killing of wild ungulates and leopards in the Chure range to increase leopard occupancy. In addition, maintaining the sufficient natural prey base can contribute to minimize the livestock depredation and hence decrease the human-leopard conflict in the Chure range.

Carotid Intima-media Thickness in Patients with Non-alcoholic Fatty Liver Disease Attending a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Non-alcoholic fatty liver disease is fatty infiltration of the liver in the absence of other causes of steatosis. It is strongly associated with central adiposity, high body mass index, insulin resistance states, hypertension, hyperlipidemia which are features of metabolic syndrome. The objective of study is to find out the carotid intima-media thickness of non alcoholic fatty liver disease patients attending a tertiary care center. METHODS: This was a descriptive cross sectional study conducted at National Academy of Medical Sciences, Bir Hospital from July 2018 to June 2019 among 70 diagnosed cases of non alcoholic fatty liver disease based on ultrasound findings. Data collection was started after receiving ethical approval from Institutional Review Board of the Institute. Convenience sampling method was used. Data were entered using Microsoft Excel. The carotid intima-media thickness of both sides were measured by ultrasound. Statistical Package for Social Sciences version 20 was used for analysis. RESULTS: Out of 70 cases, the mean carotid intima-media thickness was 0.7140±0.1796mm on right and 0.7161±0.1828mm on left side. Among 70 cases 45 (64.3%) were Grade II non alcoholic fatty liver disease and 25 (35.7%) were Grade I. It was 0.5720±0.1275mm and 0.7929±0.1546mm in Grade I and II non alcoholic fatty liver disease cases respectively on right side whereas it was 0.5676±0.1259mm and 0.7987±0.1557mm respectively on left side. CONCLUSIONS: This study showed increased carotid intima-media thickness in non alcoholic fatty liver disease cases.

Association between subthreshold depression and self-care behaviours in adults with type 2 diabetes: A cross-sectional study.

AIMS AND OBJECTIVES: The aim of the study was to test the association between subthreshold depression and self-care behaviours in adults with type 2 diabetes (T2D) attending a tertiary healthcare service. BACKGROUND: Suboptimal adherence to self-care behaviours is associated with poor glycaemic control. The estimated point prevalence of subthreshold depression in people with T2D is 17%. Two previous studies have examined the association between subthreshold depression and self-care behaviours in T2D, reported observations were inconsistent. DESIGN: A cross-sectional observational study. METHODS: We surveyed adults with T2D attending a tertiary healthcare facility in Nepal. Self-care behaviours and subthreshold depression were assessed using the Summary of Diabetes Self-care Activities and the Patient Health Questionnaire-9, respectively. We used linear and logistic regression to test the association of subthreshold depression with total and individual self-care behaviours. Our reporting complies with STROBE reporting guideline for observational research. RESULTS: Just over a third (37%) of the participants had subthreshold depression. People with subthreshold depression had slightly lower total diabetes self-care score compared to those with no depression. More than half of participants with subthreshold depression had suboptimal adherence to diet, physical activity and foot care. Subthreshold depression was associated with total self-care score (B = -0.27, 95% CI: -0.54, -0.01). In addition, association between subthreshold depression and diet adherence was observed (AOR = 0.26, 95% CI: 0.15, 0.44). CONCLUSIONS: Subthreshold depression is associated with decreased adherence to self-care behaviour in people with T2D. Identification and treatment of subthreshold depression in T2D may lead to better adherence to diabetes self-care behaviours. RELEVANCE TO CLINICAL PRACTICE: The recognition and treatment of subthreshold depression warrants further investigation as a strategy to improve the adherence to self-care behaviours.

Factors associated with dietary diversity among pregnant women in the western hill region of Nepal: A community based cross-sectional study.

BACKGROUND: Dietary diversity can play an important role in providing essential nutrients for both mother and fetus during pregnancy. This study aimed to assess the factors associated with dietary diversity during pregnancy in the western hill region of Nepal. METHODS: A cross-sectional study of 327 pregnant women was conducted in an urban municipality of Baglung district in the western hill region of Nepal. A semi-structured questionnaire was used to collect information on household demographic and socioeconomic status, food taboos, household food security status, nutrition-related knowledge in pregnancy, and women's empowerment. Women consuming ≥5 of 10 food groups in the past 24 hours were defined as consuming a diverse diet using the Minimum Dietary Diversity Score for Women (MDD-W) tool. Bivariate and multivariate logistic regression was used to estimate crude odds ratio (cOR) and adjusted odds ratios (aOR) and 95% confidence intervals (CIs) to understand factors associated with dietary diversity. RESULTS: Almost 45% (95% CI: 39.6-50.4) of the participants did not consume a diverse diet and the mean dietary diversity score was 4.76 ± 1.23. Multivariable analysis revealed that women with greater empowerment (aOR = 4.3, 95% CI: 1.9-9.9), from wealthier households (aOR = 5.1, 95% CI: 2.7-9.3), joint families (aOR = 2.7, 95% CI: 1.4-5.1), employment (aOR = 2.2, 95% CI: 1.2-4.1), and had adequate nutrition knowledge (aOR: 1.9, 95% CI 1.1-3.4) had higher odds of dietary diversity. CONCLUSION: Along with socioeconomic status, women's empowerment and nutrition knowledge were modifiable risk factors that should be considered as targets for programs to improve women's health during pregnancy.

Health literacy and associated factors among undergraduates: A university-based cross-sectional study in Nepal.

Health literacy is one of the most critical aspects of health promotion. Limited health literacy is also accounted for adverse health outcomes and a huge financial burden on society. However, a gap exists in the level of health literacy, especially among undergraduates. This study aimed to assess the levels of health literacy and its socio-demographic determinants among undergraduate students of Tribhuvan University, Nepal. A web-based cross-sectional survey was conducted among 469 undergraduate students from five institutes of Tribhuvan University, Nepal. The 16-item short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) was used to measure students' health literacy levels. Associated factors were examined using Chi-square tests followed by multivariate logistic regression analyses at the level of significance of 0.05. Nearly 61% of students were found to have limited health literacy (24.5% had "inadequate" and 36.3% had "problematic" health literacy). Female students (aOR = 1.6, 95% CI: 1.1-2.5), students from non-health related majors (aOR = 1.9, 95% CI: 1.2-3.0), students with unsatisfactory health status (aOR = 2.8, 95% CI: 1.7-4.5), students with poor financial status (aOR = 2.9, 95% CI: 1.2-6.8) and students with low self-esteem (aOR = 2.5, 95% CI: 1.5-4.1) were significantly more likely to have limited health literacy. The majority of the undergraduates were found to have limited health literacy. Gender, sector of study, self-rated health status, self-rated financial status, and self-esteem were significantly associated with limited health literacy. This study indicates university students should not be assumed to be health-literate and interventions to improve students' health literacy especially for those whose majors are not health-related should be implemented. Further studies using a longer version of the health literacy survey questionnaire and qualitative methods to explore more on determinants of health literacy are recommended.

Frontline Healthcare Workers' Knowledge and Perception of COVID-19, and Willingness to Work during the Pandemic in Nepal.

This study investigated the contextual factors associated with the knowledge, perceptions, and the willingness of frontline healthcare workers (FHWs) to work during the COVID-19 pandemic in Nepal among a total of 1051 FHWs. Multivariable logistic regression analysis was applied to identify independent associations between predictors and outcome variables. Of the total study subjects, 17.2% reported inadequate knowledge on COVID-19, 63.6% reported that they perceived the government response as unsatisfactory, and 35.9% showed an unwillingness to work during the pandemic. Our analyses demonstrated that FHWs at local public health facilities, pharmacists, Ayurvedic health workers (HWs), and those with chronic diseases were less likely, and male FHWs were more likely, to have adequate knowledge of COVID-19. Likewise, nurses/midwives, public health workers, FHWs from Karnali and Far-West provinces, and those who had adequate knowledge of COVID-19 were more likely to have satisfactory perceptions towards the government response. Further, FHWs-paramedics, nurse/midwives, public health workers, laboratory workers-FHWs from Karnali Province and Far-West Province, and those with satisfactory perceptions of government responses to COVID-19 were predictors of willingness to work during the COVID-19 pandemic. These results suggest that prompt actions are required to improve FHWs' knowledge of COVID-19, address negative perceptions of government responses, and motivate them through specific measures to provide healthcare services during the pandemic.

Socio-demographic and Healthcare-seeking Predictors of Undernutrition among Children Under-five Years of Age in a Western District of Nepal.

BACKGROUND: Undernutrition is highly prevalent in Nepal, which interferes with physical and mental development among children. It is one of the severe health problems contributing to the significant portion of the disease burden. This study aimed to explore socio-demographic and healthcare-seeking related predictors of undernutrition among children under five years old in Dang, Nepal. METHODS: This was a descriptive cross-sectional study. A sample of 426 children was participated through stratified proportionate random sampling to identify socio-demographics and healthcare-seeking predictors of undernutrition. Multivariable regression was applied to identify the independent predictors of undernutrition. RESULTS: This study found that children below 24 months of age were more likely to be undernourished than children aged 24-36 months. Female children (OR=2.32, 95% CI: 1.19-4.54), illiterate or non-formally educated women (OR=4.09, 95% CI: 1.84-9.08), mother's occupation other than a housewife (OR=13.05, 95% CI: 4.19-40.68), labor work of father (OR=2.40, 95% CI: 1.04-5.57) had increased risk of undernutrition among children. Similarly, food insufficiency from their land, antenatal care visit, postnatal care visit, and delivery place were significantly associated with childhood undernutrition among children.  Conclusions: The study showed that undernutrition among children is associated with age and gender of children, educational attainment of the mother, food sufficiency, health-seeking practices of the mother during pregnancy, delivery, and postnatal. Socio-demographics and health-seeking practices related predictors must be explicitly considered to address undernutrition among children under the age of five years.

Effects of Female Community Health Volunteer Capacity Building and Text Messaging Intervention on Gestational Weight Gain and Hemoglobin Change Among Pregnant Women in Southern Nepal: A Cluster Randomized Controlled Trial.

Introduction: Public health interventions such as text messaging are commonly evaluated in high-income countries and that the evaluation reports of the effectiveness of community health volunteers in low-income countries like Nepal is scarce. This study aimed to determine whether female community health volunteer (FCHV) capacity building and text messaging to expectant mother increases gestational weights and hemoglobin levels of pregnant women living in southern Nepal. Methods: A cluster randomized control trial was carried out in 52 clusters of 6 Village Development Committees in southern Nepal between July 2015 and March 2016. A total of 413 pregnant mothers of gestation age between 13 and 28 weeks (214 in the intervention group and 199 in the control group) were included in the analysis. Intervention consisted of FCHV capacity building followed by regular supervision and monitoring and mobile phone text messaging to expectant mothers. Regression analysis, controlled for confounders, was conducted to assess gestational weight gains and changes in hemoglobin levels. Results: At the end of the pregnancy, the mean weight gain difference between the intervention and control groups was 1.1 kg (95% CI: 1.0, 1.9). Rates of weight increases in the intervention and control groups were 0.504 kg/week (95% CI: 0.371, 0.528), and 0.399 kg/week (95% CI: 0.362, 0.465), respectively. Similarly, the mean inter group difference in hemoglobin levels was 0.11 gm/dl (95% CI: 0.09, 0.15), and rates of hemoglobin increases (gm/dl/week) in the intervention and control groups were 0.02 gm/dl (95% CI: 0.01, 0.09) and 0.004 gm/dl (95% CI: 0.02, 0.12), respectively. Conclusions: The study shows that FCHV capacity building and mobile text messaging have a positive effect on the gestational weights and hemoglobin levels of expectant mothers. Our findings suggest that mobile text messaging coupled with FCHV capacity building services should be supported and would usefully expand in resource poor settings. Trial registration: ISRCTN60684155.

Adapting Biased Gene Conversion theory to account for intensive GC-content deterioration in the human genome by novel mutations.

We examined seventy million well-characterized human mutations, and their impact on G+C-compositional dynamics, in order to understand the formation and maintenance of major genomic nucleotide sequence patterns. Among novel mutations, those that change a strong (S) base pair G:C/C:G to a weak (W) pair A:T/T:A occur at nearly twice the frequency of the opposite mutations. Such imbalance puts strong downward pressure on overall GC-content. However, along protracted paths to fixation, S→W mutations are much less likely to propagate than W→S mutations. The magnitude of relative propagation disadvantages for S→W mutations is inexplicable by any currently-accepted model. This fact forced us to re-examine the quantitative features of Biased Gene Conversion (BGC) theory. Revised parameters of BGC that, per average individual, convert 7-14 W base pairs into S pairs, would account for the S-content turnover differences between new and old mutations, and make BGC an instrumental force for nucleotide dynamics and evolution. BGC should thus be considered seriously in both theories and biomedical practice. In particular, BGC should be taken into account during allele imputations, where missing SNP alleles are computationally predicted based on the information about several neighboring alleles. Finally, we analyzed the effect of neighboring nucleotide context on the mutation frequencies, dynamics, and GC-composition turnover. For this purpose, we examined genomic regions having extremely biased nucleotide compositions (enriched for S-, W-, purine/pyrimidine strand asymmetry, or AC/GT-strand asymmetry). It was found that point mutations in these regions preferentially degrade the nucleotide inhomogeneities, decreasing the sequence biases. Degradation of sequence bias is highest for novel mutations, and considerably lower for older mutations (those widespread across populations). Besides BGC, there may be additional, still uncharacterized molecular mechanisms that either preserve genomic regions with biased nucleotide compositions from mutational degradation or fail to degrade such inhomogeneities in specific chromosomal regions.