Possible high risk of transmission of the Nipah virus in South and South East Asia: a review.

Nipah virus (NiV) is a zoonotic, single-stranded RNA virus from the family Paramyxoviridae, genus Henipavirus. NiV is a biosafety-level-4 pathogen that is mostly spread by Pteropus species, which serve as its natural reservoir host. NiV is one of the major public health challenges in South and South East Asia. However, few molecular studies have been conducted to characterise NiV in a specific region. The main objective of this review is to understand the epidemiology, pathogenesis, molecular surveillance, transmission dynamics, genetic diversity, reservoir host, clinical characteristics, and phylogenetics of NiV. South and South East Asian nations have experienced NiV outbreaks. Phylogenetic analysis confirmed that two primary clades of NiV are in circulation. In humans, NiV causes severe respiratory illness and/or deadly encephalitis. NiV is mainly diagnosed by ELISA along with PCR. Therefore, we recommend that the governments of the region support the One Health approach to reducing the risk of zoonotic disease transmission in their respective countries.

Estimation of household health cost and climate adaptation cost with its health related determinants: empirical evidences from western Nepal.

Limited evidence is available concerning the household-level costs of prevailing diseases and the potential cost of climate adaptation in Nepal. This study estimates these costs and assesses the relationships between prevalent diseases and climate adaptation at the household level using survey data from 420 households. An ingredients-based approach was used to estimate the cost of health and adaptation, and a Probit regression model was used to analyze the relationship between prevalent diseases and climate adaptation costs. Household direct curative costs are the highest among health cost components. Two-thirds of total health costs are direct costs for households. On average, 15.90% of household income is used for direct cost of health care. The climate hazard cost among afflicted households is estimated to be high. In addition, diseases like malaria, typhoid and jaundice, their costs, climate awareness program, droughts, family size and loss of per capita income are more likely to raise the cost of climate adaptation. The occurrence of gastritis, prevalence of diarrhea and cold waves are less likely to affect the cost. Policymakers should implement health financing schemes and adaptation strategies to prevent the loss of human health in western Nepal.

An economic analysis of malaria elimination program in Nepal.

BACKGROUND: Governments have committed to eliminate malaria. But a decline in government investment in malaria interventions, particularly in developing countries such as Nepal, reveals a limited emphasis on malaria elimination that may be due to lack of strong evidence on benefits of the investment. This paper empirically analyses curative and preventive costs and benefits of Nepal's malaria elimination program from the perspectives of both service providers in the public sector and people who are at risk. METHODS: Cost benefit analysis of both curative and preventive interventions for malaria elimination was conducted using case and non-case household survey data. Secondary data were obtained from government sources. Ingredient approach and step-down methods were used to estimate costs of malaria elimination interventions, and willingness to pay (WTP) method and case averted approach to estimate benefits. RESULTS: Curative intervention of malaria elimination program is economically viable in Nepal with a net present value (NPV) of USD 23 million, benefit cost ratio (BCR) of 1.58 and internal rate of return of 63%. Malaria preventive intervention is highly beneficial with NPV of USD 435 million and BCR of 2.13. An annual investment of USD 36.59 million is required to continue the current pattern of malaria reduction that can generate societal benefits of USD 92.81 million. From this investment, the government can save USD 132 million by the end of 2025. The maximum WTP of case households for the intervention is USD 57 per household which is 63% higher than that of non-case households. CONCLUSION: Malaria elimination program in Nepal is economically viable and investment worthy. As the preventive intervention generates much higher net benefits than the curative intervention, the government should emphasize on preventive intervention while continuing the curative interventions.

Beyond Smoking: Environmental Determinants of Asthma Prevalence in Western Nepal.

BACKGROUND: Asthma is widely prevalent in Nepal, but the causes are not well known aside from some general associations with ambient air pollution and microbial exposures. Information on the wide-ranging determinants of asthma prevalence among the population at risk can help policy makers to reduce risk. OBJECTIVE: The present study is a preliminary investigation of the environmental, socioeconomic and behavioral determinants of asthma prevalence in western Nepal. METHODS: A survey was conducted among 420 randomly selected households in western Nepal. A cross-sectional analytical study design was employed with the primary data using econometric tools of probit and logistic regression. RESULTS: Environmental variables such as extreme cold winter, deteriorating river water quality and air pollution were associated with an increase in asthma prevalence. However, individual or household characteristics such as advancing age of household head, use of pesticides in the home for the control of pests, piped drinking water with old pipes and lack of participation in awareness programs were associated with an increase in asthma prevalence. DISCUSSION: Among environmental factors, decreasing river water quality, increasing air pollution, and extremely cold winters are more likely to contribute to asthma prevalence. In light of the effects of environmental factors on the prevalence of asthma in Nepal, the high public and private costs of asthma could further impoverish the rural poor. CONCLUSIONS: Environmental health policy makers should design adaptation strategies along with additional community programs addressing asthma-instigating factors. Programs to reduce environmental pollution can reduce morbidity due to asthma. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: This study was approved by the Ethical Committee of the Nepal Health Research Council. COMPETING INTERESTS: The authors declare no competing financial interests.

Effects of population, land cover change, and climatic variability on wetland resource degradation in a Ramsar listed Ghodaghodi Lake Complex, Nepal.

Wetlands support livelihoods of millions of people in developing countries. However, wetland land cover change, as a result of growing population and subsequent anthropogenic activities, has been evident at a global scale, and ongoing micro-climate alteration has further deteriorating its ecological condition. Nepal is equally vulnerable to wetland changes that can have direct effects on the sustenance of local wetland-dependent people. This study thus attempts to look at how wetland areas of Nepal are undergoing changes, taking a case of Ghodaghodi Lake Complex (GLC). Remote sensing technique, climate, and population data were used in the analysis aided by focus group discussions and key informant interviews. Results showed that total population of the study area has been increased drastically in recent decades. Landsat image analysis for 25 years (1989-2016) depicts changes in the GLC in its land cover, with maximum expansion observed in settlement followed by river and banks, whereas maximum reduction was observed in forests, followed by areas of agricultural land and lake. Similarly, diurnal temperature is increasing while total annual rainfall is slightly decreasing during the same period. Locals have perceived ecological degradation in the GLC due to both anthropogenic pressure and climatic variability. The study outlines linkage of drivers for GLC degradation and finally makes recommendations to achieve longer term sustainability of the lake complex.

Vulnerability and impacts of climate change on forest and freshwater wetland ecosystems in Nepal: A review.

Climate change (CC) threatens ecosystems in both developed and developing countries. As the impacts of CC are pervasive, global, and mostly irreversible, it is gaining worldwide attention. Here we review vulnerability and impacts of CC on forest and freshwater wetland ecosystems. We particularly look at investigations undertaken at different geographic regions in order to identify existing knowledge gaps and possible implications from such vulnerability in the context of Nepal along with available adaptation programs and national-level policy supports. Different categories of impacts which are attributed to disrupting structure, function, and habitat of both forest and wetland ecosystems are identified and discussed. We show that though still unaccounted, many facets of forest and freshwater wetland ecosystems of Nepal are vulnerable and likely to be impacted by CC in the near future. Provisioning ecosystem services and landscape-level ecosystem conservation are anticipated to be highly threatened with future CC. Finally, the need for prioritizing CC research in Nepal is highlighted to close the existing knowledge gap along with the implementation of adaptation measures based on existing location specific traditional socio-ecological system.

Cheaper fuel and higher health costs among the poor in rural Nepal.

Biomass fuels are used by the majority of resource poor households in low-income countries. Though biomass fuels, such as dung-briquette and firewood are apparently cheaper than the modern fuels indoor pollution from burning biomass fuels incurs high health costs. But, the health costs of these conventional fuels, mostly being indirect, are poorly understood. To address this gap, this study develops probit regression models using survey data generated through interviews from households using either dung-briquette or biogas as the primary source of fuel for cooking. The study investigates factors affecting the use of dung-briquette, assesses its impact on human health, and estimates the associated household health costs. Analysis suggests significant effects of dung-briquette on asthma and eye diseases. Despite of the perception of it being a cheap fuel, the annual health cost per household due to burning dung-briquette (US$ 16.94) is 61.3% higher than the annual cost of biogas (US$ 10.38), an alternative cleaner fuel for rural households. For reducing the use of dung-briquette and its indirect health costs, the study recommends three interventions: (1) educate women and aboriginal people, in particular, and make them aware of the benefits of switching to biogas; (2) facilitate tree planting in communal as well as private lands; and (3) create rural employment and income generation opportunities.