The costs of Suaahara II, a complex scaled-up multisectoral nutrition programme in Nepal.

Limited evidence exists on the costs of scaled-up multisectoral nutrition programmes. Such evidence is crucial to assess intervention value and affordability. Evidence is also lacking on the opportunity costs of implementers and participants engaging in community-level interventions. We help to fill this gap by estimating the full financial and economic costs of the United States Agency for International Development-funded Suaahara II (SII) programme, a scaled-up multisectoral nutrition programme in Nepal (2016-2023). We applied a standardized mixed methods costing approach to estimate total and unit costs over a 3.7-year implementation period. Financial expenditure data from national and subnational levels were combined with economic cost estimates assessed using in-depth interviews and focus group discussions with staff, volunteers, community members, and government partners in four representative districts. The average annual total cost was US$908,948 per district, with economic costs accounting for 47% of the costs. The annual unit cost was US$132 per programme participant (mother in the 1000-day period between conception and a child's second birthday) reached. Annual costs ranged from US$152 (mountains) to US$118 (plains) per programme participant. Personnel (63%) were the largest input cost driver, followed by supplies (11%). Community events (29%) and household counselling visits (17%) were the largest activity cost drivers. Volunteer cadres contributed significant time to the programme, with female community health volunteers spending a substantial amount of time (27 h per month) on SII activities. Multisectoral nutrition programmes can be costly, especially when taking into consideration volunteer and participant opportunity costs. This study provides much-needed evidence of the costs of scaled-up multisectoral nutrition programmes for future comparison against benefits.

Photonic reservoir computer using speckle in multimode waveguide ring resonators.

Photonic reservoir computers (RC) come in single mode ring and multimode array geometries. We propose and simulate a photonic RC architecture using speckle in a multimode waveguide ring resonator that requires neither the ultra-high-speed analog-digital conversion nor the spatial light modulator used in other designs. We show that the equations for propagation around a multimode (MM) ring resonator along with an optical nonlinearity, and optical feedback can be cast exactly in the standard RC form with speckle mixing performing the pseudo-random matrix multiplications. The hyperparameters are the outcoupling efficiency, the nonlinearity saturation intensity, the input bias, and the waveguide properties. In particular, the number of waveguide modes is a measure of the number of effective neurons in the RC. Simulations show a ring using a strongly guiding 50-µm planar waveguide gives 206 effective neurons and excellent predictions of Mackey-Glass waveforms for a broad range of the hyperparameters, while a weakly guiding MM 200-µm diameter fiber gives 4,238 effective neurons and excellent predictions of chaotic solutions of the Kuramoto-Sivashinsky equation. We discuss physical realizations for implementing the system with a chip-scale device or with discrete components and a MM optical fiber.

Ultra-high resolution and broadband chip-scale speckle enhanced Fourier-transform spectrometer.

Recent advancements in silicon photonics are enabling the development of chip-scale photonics devices for sensing and signal processing applications, among which on-chip spectrometers are of particular interest for precision wavelength monitoring and related applications. Most chip-scale spectrometers suffer from a resolution-bandwidth trade-off, thus limiting the uses of the device. Here we report on a novel passive, chip-scale, hybrid speckle-enhanced Fourier transform device that exhibits a two order-of-magnitude improvement in finesse (bandwidth/resolution) over the state-of-the art chip-scale speckle and Fourier transform spectrometers. In our proof-of-principle device, we demonstrate a spectral resolution of 140 MHz with 12-nm bandwidth for a finesse of 104 that can operate over a range of 1500-1600 nm. This chip-scale spectrometer structure implements a typical spatial heterodyne discrete Fourier transform interferometer network that is enhanced by speckle generated from the wafer substrate. This latter effect, which is extremely simple to invoke, superimposes the high wavelength resolution intrinsic to speckle generated from a strongly guiding waveguide with a more broadband but lower resolution discrete Fourier transform modality of the overarching waveguide structure. This hybrid approach signifies a new pathway for realizing chip-scale spectrometers capable of ultra-high resolution and broadband performance.

Classification of time-domain waveforms using a speckle-based optical reservoir computer.

Reservoir computing is a recurrent machine learning framework that expands the dimensionality of a problem by mapping an input signal into a higher-dimension reservoir space that can capture and predict features of complex, non-linear temporal dynamics. Here, we report on a bulk electro-optical demonstration of a reservoir computer using speckles generated by propagating a laser beam modulated with a spatial light modulator through a multimode waveguide. We demonstrate that the hardware can successfully perform a multivariate audio classification task performed using the Japanese vowel speakers public data set. We perform full wave optical calculations of this architecture implemented in a chip-scale platform using an SiO2 waveguide and demonstrate that it performs as well as a fully numerical implementation of reservoir computing. As all the optical components used in the experiment can be fabricated using a commercial photonic integrated circuit foundry, our result demonstrates a framework for building a scalable, chip-scale, reservoir computer capable of performing optical signal processing.

Direct excitation of a single quantum dot with cavity-SPDC photons.

The ability to generate mode-engineered single photons to interface with disparate quantum systems is of importance for building a quantum network. Here we report on the generation of a pulsed, heralded single photon source with a sub-GHz spectral bandwidth that couples to indium arsenide quantum dots centered at 942 nm. The source is built with a type-II PPKTP down-conversion crystal embedded in a semi-confocal optical cavity and pumped with a 76 MHz repetition rate pulsed laser to emit collinear, polarization-correlated photon pairs resonant with a single quantum dot. In order to demonstrate direct coupling, we use the mode-engineered cavity-SPDC single-photon source to resonantly excite an isolated single quantum dot.

Optimizing single-mode collection from pointlike sources of single photons with adaptive optics.

The collection efficiency of light from a point-like emitter may be extremely poor due to aberrations induced by collection optics and the emission distribution of the source. Analyzing the aberrant wavefront (e.g., with a Shack-Hartmann sensor) and correcting accordingly can be infeasible on the single-photon level. We present a technique that uses a genetic algorithm to control a deformable mirror for correcting wavefront aberrations in single-photon signals from point emitters. We apply our technique to both a simulated point source and a real InAs quantum dot, achieving coupling increases of up to 50% and automatic reduction of system drift.

Perceptions of key stakeholders on taxes on tobacco and alcohol products in Nepal.

BACKGROUND: Non-communicable diseases (NCDs) are on the rise in Nepal. Consumption of alcohol and tobacco products remains high. Taxes on these products are significantly below the rate recommended by the WHO. In an effort to understand the reasons behind the slow progress towards the adoption of higher health taxes to curb NCDs, we documented the perceptions of key stakeholders on health taxes, including perceived barriers and facilitators to adopting higher health taxes. METHODS: We conducted 45 in-depth interviews with individuals comprising government officials; producers, wholesale distributors and sellers of alcohol and tobacco products; and consumers and representatives from civil society organisations. We conducted a thematic analysis of the resulting data. RESULTS: Respondents from alcohol and tobacco industries are not supportive of higher health taxes. They argued that higher taxes can increase illicit trade and worsen inequality. Strikingly, several government officials shared the industries' concerns, arguing that health taxes have limited potential to reduce consumption of alcohol and tobacco products to help curb NCDs. In terms of barriers to adoption of higher health taxes, several local government representatives opined that close ties between industries and politicians at the federal level is a major hindrance. CONCLUSIONS: In order to adopt higher health taxes, the government will need to counter the false narrative pushed by alcohol and tobacco industries on the negative economic effects of such taxes. Health taxes earmarked for NCDs need to reflect the amount of revenue raised, reoriented towards prevention efforts and communicated clearly to the public.

Environmental Determinants of Malaria Prevalence and the Adaptation Strategies in Western Nepal.

BACKGROUND: Current literatures seem devoted only on relating climate change with malaria. Overarching all possible environmental determinants of malaria prevalence addressed by scanty literature in Nepal is found apposite research at this moment. This study aims to explore the environmental determinants of malaria prevalence in western Nepal. METHODS: Cross-sectional data collected from community people were used to identify the environmental determinants of malaria prevalence in western Nepal. Probit and logistic regressions are used for identifying determinants. RESULTS: The results reveal that environmental variables: winter temperature (aOR: 2.14 [95% CI: 1.00-4.56]), flooding (aOR: 2.45 [CI: 1.28-4.69]), heat waves (aOR: 3.14 [CI: 1.16-8.46]) and decreasing river water level (aOR: 0.25 [CI: 0.13-0.47]) are found major factors to influence malaria prevalence in western Nepal. Besides, pipeline drinking water (aOR: 0.37 [0.17-0.81]), transportation facility (aOR: 1.18 [1.07-1.32]) and awareness programs (aOR: 2.62 [0.03-6.65]) are exigent social issues to influence malaria prevalence in Nepal. To be protected from disease induced by environmental problems, households have used extra season specific clothes, iron nets and mosquito nets, use of insecticide in cleaning toilet and so on. CONCLUSIONS: Adaptation mechanism against these environmental issues together with promoting pipeline drinking water, transportation facility and awareness programs are the important in malaria control in Nepal. Government initiation with incentivized adaptation mechanism for the protection of environment with caring household attributes possibly help control malaria in western Nepal.

Household Food Security Access and Nutritional Status among Early Adolescents in a Poor Neighborhood of Sinamangal, Nepal.

BACKGROUND: Early adolescence is an important period of the life cycle wherein the food system plays a critical role in protecting food security as well as the nutritional needs essential for a healthy transition from childhood to adulthood. Despite the surging concerns regarding the food and nutrition security of adolescents throughout the nation, people in a poor neighborhood are often neglected and considered the most vulnerable. OBJECTIVES: This research aims to assess the status of household food security and nutritional status among early adolescents living in a poor neighborhood of Kathmandu, Nepal. METHODS: Using a cross-sectional study design, data was collected with the Household Food Insecurity Access Scale (HFIAS) tool. Nutritional status was measured using the WHO Child Growth Standard Reference 2007 Statistical Software for Social Science (SPSS) macro package based on BMI-for-age z-score, height-for-age z-score, and weight-for-age z-score, respectively. Data were entered in a predetermined format of SPSS version 20.0 and imported into STATA version 13.1 for univariate and bivariate analyses. Ethical approval was sought from the Ethical Review Board of Nepal Health Research Council (NHRC) prior to the study. RESULTS: More than one-fifth (21%) of the households were food insecure. Based on BMI-for-age, 5.5% of the adolescents were found to be moderately undernourished and 2.6% were severely undernourished. The percentage of moderately and severely stunted adolescents were 8.4% and 5.8%, respectively, based on height-for-age. Based on weight-for-age, moderately and severely underweight adolescents accounted for 13.0% and 1.3% of the total. CONCLUSION: The prevalence of underweight, stunting, and wasting among early adolescents was high. The households in a poor neighborhood were also experiencing some form of food insecurity. This calls for targeted efforts to address malnutrition and improve the nutritional status of early adolescents, particularly in poor neighborhoods.

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.

The Final Frontier: China, Taiwan, and the United States in Strategic Competition for Central America.

China's rise as a global power corresponded with a diminution of Taiwanese diplomacy, which has left Central America as the last region to host a continuous bloc of countries that recognize the ROC. In this article, we argue that China's success in gaining diplomatic recognition from Taiwan's former allies has largely resulted from China's economic policy, specifically its promises of large-scale infrastructure projects and the integration of Central American economies with Chinese markets. However, there are limits to how far China has advanced in gaining full recognition from the region. The competing political and economic interests of China, Taiwan, the United States, and the Central American countries themselves, continue to influence patterns of diplomatic switching. More specifically, we argue that the threat of punitive measures from the United States combined with a turn in Taiwanese diplomacy toward assistance efforts to combat Covid-19 may deter future switching in the short to medium-term. Our analysis offers case studies of four Central American countries (Costa Rica, Panama, El Salvador and Nicaragua) to illustrate the multi-year processes by which China's economic strategy leads to diplomatic switching and examine the paths ahead for the remaining holdouts facing the prospect of economic and political penalties by the United States.