Impact of diabetic retinopathy awareness training on community health workers' knowledge and referral practices in Fiji: a qualitative study.

INTRODUCTION: Community health workers (CHWs) are effective in raising awareness about diabetes mellitus and diabetic retinopathy (DR). In Fiji, CHWs were trained in a 1-day diabetic retinopathy (DR) awareness to provide communities with adequate basic knowledge about diabetes and DR to improve awareness and enhance referrals for DR screening and treatment. This study aimed to explore the impact of this training on CHWs' knowledge of DR and their referral practices related to DR screening in Fiji 2 years post-training. METHODS: This qualitative study was conducted in 2021 across three out of the four administrative divisions of Fiji, namely the Western, Northern and Central divisions. A total of 14 CHWs from the three divisions of Fiji participated in this study. All participants had attended a 1-day DR awareness training 2 years before this study. Participants were chosen purposively and were invited to participate in focus group discussion (FGD). The FGDs were audio-recorded and transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes. RESULTS: CHWs indicated that their knowledge about both diabetes and DR improved significantly after the training. This boosted their confidence in talking about these issues and providing clarity regarding referrals for DR screening in their respective communities. Consequently, they have referred a significantly higher number of people for screening both in outreach and to health facilities. Challenges in referral included poverty, high transportation cost and social support needs, which hindered screening. Further, although CHWs felt some degree of integration within the health system, they thought more was needed. CONCLUSION: Investing in scalable models such as training CHWs is an important first step in tackling diabetes and DR in communities, particularly at the grassroots level in low-resource settings by increasing the community's knowledge of DR and improving access to screening, diagnosis and treatment.

Factors affecting utilization of sexual and reproductive health services among women with disabilities- a mixed-method cross-sectional study from Ilam district, Nepal.

BACKGROUND: Persons with disabilities can have physical, mental, intellectual, or sensory impairments which can hinder their social participation. Despite Sustainable Development Goals call for "universal access to sexual and reproductive health (SRH)", women with disabilities (WwDs) continue to experience barriers to access SRH services in Nepal. This study evaluated factors affecting the utilization of SRH services among WwDs in Ilam district, Nepal. METHODS: A mixed-method study with 384 WwDs of reproductive age was conducted in Ilam district, eastern Nepal. Quantitative data were collected using a structured questionnaire. Relationships between utilization of SRH services and associated factors were explored using multivariate logistic regression analysis. Qualitative data were collected from focus groups with female community health volunteers and interviews with WwDs, health workers and local political leaders. They were audio-recorded, translated and transcribed into English and were thematically analyzed. RESULTS: Among 384 respondents (31% physical; 7% vision,16% hearing, 7% voice&speech,12% mental/psychosocial, 9% intellectual, 18% multiple disabilities), only 15% of them had ever utilized any SRH services. No requirement (57%) and unaware of SRH services (24%) were the major reasons for not utilizing SRH services. A majority (81%) of them reported that the nearest health facility was not disability-inclusive (73%), specifically referring to the inaccessible road (48%). Multivariate analysis showed that being married (AOR = 121.7, 95% CI: 12.206-1214.338), having perceived need for SRH services (AOR = 5.5; 95% CI: 1.419-21.357) and perceived susceptibility to SRH related disease/condition (AOR = 6.0; 95% CI:1.978-18.370) were positively associated with the utilization of SRH services. Qualitative findings revealed that illiteracy, poor socioeconomic status, and lack of information hindered the utilization of SRH services. WwDs faced socioeconomic (lack of empowerment, lack of family support), structural (distant health facility, inaccessible-infrastructure), and attitudinal (stigmatization, bad behaviour of health care providers, perception that SRH is needed only for married) barriers to access SRH services. CONCLUSIONS: Utilization of SRH services among WwDs was very low in Ilam district, Nepal. The findings of this study warrant a need to promote awareness-raising programs to WwDs and their family members, sensitization programs to health service providers, and ensure the provision of disability-inclusive SRH services in all health facilities.

A scoping review on climate change and tuberculosis.

Climate change is a global public health challenge. The changes in climatic factors affect the pattern and burden of tuberculosis, which is a worldwide public health problem affecting low and middle-income countries. However, the evidence related to the impact of climate change on tuberculosis is few and far between. This study is a scoping review following a five-stage version of Arksey and O'Malley's method. We searched the literature using the keywords and their combination in Google scholar, and PubMed. Climate change affects tuberculosis through diverse pathways: changes in climatic factors like temperature, humidity, and precipitation influence host response through alterations in vitamin D distribution, ultraviolet radiation, malnutrition, and other risk factors. The rise in extreme climatic events induces population displacement resulting in a greater number of vulnerable and risk populations of tuberculosis. It creates a conducive environment of tuberculosis transmission and development of active tuberculosis and disrupts tuberculosis diagnosis and treatment services. Therefore, it stands to reasons that climate change affects tuberculosis, particularly in highly vulnerable countries and areas. However, further studies and novel methodologies are required to address such a complex relationship and better understand the occurrence of tuberculosis attributable to climate change.

Performance evaluation of a continuous packed bed bioreactor: Bio-kinetics and external mass transfer study.

The biodegradation of naphthalene using low-density polyethylene (LDPE) immobilized Exiguobacterium sp. RKS3 (MG696729) in a packed bed bioreactor (PBBR) was studied. The performance of a continuous PBBR was evaluated at different inlet flow rates (IFRs) (20-100 mL/h) under 64 days of operation. The maximum naphthalene removal efficiency (RE) was found at low IFR, and it further decreased with increasing IFRs. In a continuous PBBR, the external mass transfer (EMT) aspect was analysed at various IFRs, and experimental data were interrelated between Colburn factor (JD) and Reynolds number (NRe) as [Formula: see text] . A new correlation [Formula: see text] was obtained to predict the EMT aspect of naphthalene biodegradation. Andrew-Haldane model was used to evaluate the bio-kinetic parameters of naphthalene degradation, and kinetic constant νmax, Js, and Ji were found as 0.386 per day, 13.6 mg/L, and 20.54 mg/L, respectively.

Biodegradation of methylene blue dye in a batch and continuous mode using biochar as packing media.

Bacterial species for metabolizing dye molecules were isolated from dye rich water bodies. The best microbial species for such an application was selected amongst the isolated bacterial populations by conducting methylene blue (MB) batch degradation studies with the bacterial strains using NaCl-yeast as a nutrient medium. The most suitable bacterial species was Alcaligenes faecalis (A. faecalis) according to 16S rDNA sequencing. Process parameters were optimized and under the optimum conditions (e.g., inoculum size of 3 mL, temperature of 30 °C, 150 ppm, and time of 5 days), 96.2% of MB was removed. Furthermore, the effectiveness for the separation of MB combining bio-film with biochar was measured by a bio-sorption method in a packed bed bioreactor (PBBR) in which microbes was immobilized. The maximum MB removal efficiencies, when tested with 50 ppm dye using batch reactors containing free A. faecalis cells and the same cells immobilized on the biochar surface, were found to be 81.5% and 89.1%, respectively. The PBBR operated in continuous recycle mode at high dye concentration of 500 ppm provided 87.0% removal of MB through second-order kinetics over 10 days. The % removal was found in the order of PBBR>Immobilized batch>Free cell. The standalone biochar batch adsorption of MB can be described well by the pseudo-second order kinetics (R2 ≥ 0.978), indicating the major contribution of electron exchange-based valence forces in the sorption of MB onto the biochar surface. The Langmuir isotherm suggested a maximum monolayer adsorption capacity of 4.69 mg g-1 at 40 °C which was very close to experimentally calculated value (4.97 mg g-1). Moreover, the Casuarina seed biochar was reusable 5 times.

Perception of the learning environment among the students in a nursing college in Eastern Nepal.

BACKGROUND: Learning environment is an important base for learning processes of students and for preferences of future workplaces. It is considered as an essential factor in determining the success of an effective curriculum and the students' academic achievements. This study attempts to assess the perception of learning environment among the nursing students. METHODS: A descriptive cross-sectional study design was used to conduct the study among 122 nursing students studying at B.P. Koirala Institute of Health Science. Data were collected following total enumerative sampling method using a self-administered questionnaire. Dundee Ready Educational Environment Measure (DREEM) inventory tool was used to assess the perception of learning environment. Descriptive statistics (frequency, percentage, mean and standard deviation) was used to describe the demographic and other related variables. One way Analysis of Variance (ANOVA) was used to find out the difference in the overall scale score and its subscales across the selected socio-demographic variables (age, ethnicity, residence, year of enrollment) of the respondents. RESULTS: The mean age of the students was 21 ± 1.46 years. Majority of the students were from Province no. 1 (57.4%) and largely from Sunsari district (25.4%). First year students were found to be more satisfied (68.23%) with the educational environment (136.45 ± 16.93) compared to student of other years. Academic self-perception (21.94 ± 3.42) was the highest scoring subscale (68.57%) while the social self-perception (16.43 ± 2.96) was the lowest (58.66%). The overall DREEM score (131.25 ± 15.82 out of 200) indicated that perception of learning environment among the students was positive. Despite overall positive perception, students perceived that the teachers were authoritative and there is lack of good support system for the students at the time of stress. The total DREEM score varied significantly between the years of enrollment (p < 0.05). CONCLUSION: The current study showed positive perception of learning environment which varied significantly according to the year of enrollment. However improvements are required across all the five domains for the high quality educational environment. Future qualitative studies are recommended to confirm and to have in-depth understanding of this finding.

Doxorubicin-Intercalated Li-Al-Based LDHs as Potential Drug Delivery Nanovehicle with pH-Responsive Therapeutic Cargo for Tumor Treatment.

Clinical oncology is currently experiencing a technology bottleneck due to the expeditious evolution of therapy defiance in tumors. Although drugs used in chemotherapy work for a sort of cell death with potential clinical application, the effectiveness of chemotherapy-inducing drugs is subject to several endogenous conditions when used alone, necessitating the urgent need for controlled mechanisms. A tumor-targeted drug delivery therapy using Li-Al (M+/M3+)-based layered double hydroxide (LDHs) family has been proposed with the general chemical formula [M+1-x M3+x (OH)]2x+[(Am-)2x/m. n(H2O)]2x-, which is fully biodegradable and works in connection with the therapeutic interaction between LDH nanocarriers and anticancerous doxorubicin (DOX). Compositional variation of Li and Al in LDHs has been used as a nanoplatform, which provides a functional balance between circulation lifetime, drug loading capacity, encapsulation efficiency, and tumor-specific uptake to act as self-regulatory therapeutic cargo to be released intracellularly. First-principle analyses based on DFT have been employed to investigate the interaction of bonding and electronic structure of LDH with DOX and assess its capability and potential for a superior drug carrier. Following the internalization into cancer cells, nanoformulations are carried to the nucleus via lysosomes, and the mechanistic pathways have been revealed. Additionally, in vitro along with in vivo therapeutic assessments on melanoma-bearing mice show a dimensional effect of nanoformulation for better biocompatibility and excellent synergetic anticancer activity. Further, the severe toxic consequences associated with traditional chemotherapy have been eradicated by using injectable hydrogel placed just beneath the tumor site, and regulated release of the drug has been confirmed through protein expression applying various markers. However, Li-Al-based LDH nanocarriers open up new design options for multifunctional nanomedicine, which has intriguing potential for use in cancer treatment through sustained drug delivery.

Awareness of personal safety among frontline healthcare workers working in COVID ward of BPKIHS during COVID-19 pandemic: a cross-sectional study authors.

Background: Frontline healthcare workers are at higher risk for COVID-19 infection and due to lack of availability of adequate personal protective equipment (PPE), lack of knowledge and good practices results in more deaths each year due to occupational accidents and diseases. Objective: The aim of the study was to assess the awareness of personal safety, the association between the level of awareness with selected socio-demographic variables and to identify the correlation between knowledge and practice of personal safety. Materials and methods: A descriptive cross-sectional study design was conducted among 106 Frontline Healthcare workers who have worked in the COVID ward. The study was conducted between 7 August 2022 and June 2023. A convenient sampling technique was used for sample selection. A validated self-administered questionnaire was used to assess the awareness of personal safety. Descriptive statistics (mean, SD frequency and percentage) and inferential statistics (χ2 and Spearman's correlation rank) were used for the data analysis. Results: Among the respondents, there were 38 doctors and 68 nurses. The majority of the respondents had a moderate level of knowledge (79.2%) and practice (52.8%) with a mean score of 13.52±2.10 and 14.51± 2.35, respectively. Doctors have slightly higher levels of knowledge (14.01±1.62) and practice (14.57±2.07) as compared to Nurses (13.19±2.27, 14.48±2.5), respectively. Knowledge was found to be associated with the education level and age of the respondents, and practice has a significant association with training/demonstration with a P value of less than 0.05. Knowledge and practice were found to have a partial positive correlation (r value of 0.27). Conclusion: This study concluded that those having higher levels of education had good levels of knowledge and those who have attended formal or informal training or demonstrations regarding personal safety had good practices regarding personal safety.

Potable water production through a low-cost single chamber solar still in north India.

The main aim of this study is to evaluate the performance of a single slope solar still and to assess the effect of nanofluid on its performance. A single basin single slope solar still was designed and fabricated at the Department of Chemical Engineering, IET Lucknow. Its performance was assessed in terms of the yield of potable water. The effect of various climatic parameters was also studied. Al2O3 nanofluid was used to enhance the yield of the solar still. In the presence of nanofluid, the total yield of the solar still improved by 16.6%. Its economic feasibility was analyzed and reported. The portability of the small size of solar stills, its better economics, easy fabrication, and good performance make them very useful for industrial as well as household purposes.

Imidacloprid biodegradation using novel bacteria Tepidibacillus decaturensis strain ST1 in batch and in situ microcosm study.

Imidacloprid is one of the frequently used insecticides. Indiscriminate use of imidacloprid makes it perilous to non-target organisms as well as the environment, including soil and water sources, thus, making its elimination from the environment an irresistible concern. Bioremediation is a technique that uses the degrading capabilities of bacteria to create an economical and reliable method of pesticide abatement. In an attempt to solve the problem arising due to imidacloprid contamination, bacterial strains possessing the ability to degrade imidacloprid were isolated from contaminated agricultural soil samples in the present study. Imidacloprid-degrading isolate, identified as Tepidibacillus decaturensis strain ST1, could effectively degrade imidacloprid in liquid media, slurry, and soil microcosms. The microcosm studies using the isolate resulted in the degradation of around 77.5% and 85% of imidacloprid (200 ppm) in sterile and unsterile soils within 45 days. In addition to biodegradation, sorption of insecticide by the plants and natural reduction of insecticide over time has also been reported. The degradation in soil follows first-order kinetics. Hydrazinecarboxamide and hydroxyurea were identified as metabolites on conducting GC-MS analysis of the degraded samples.

Construction and performance assessment of Recirculating packed bed biofilm reactor (RPBBR) for effective biodegradation of p-cresol from wastewater.

Wastewater containing excess phenolic compounds is considered a major environmental concern due to its adverse impacts on the ecosystem. In this work, an effort has been given to treat the p-cresol from wastewater using Recirculating Packed Bed Biofilm Reactor (RPBBR). The process parameters, namely inoculum dose, pH, and NaCl (w/v) concentration were optimized to enhance the specific growth and obtained to be 14 ml, 7.0, and 1% NaCl (w/100 ml), respectively. Maximum p-cresol removal efficiency of 99.36±0.2% was achieved at 100 mg L-1 of p-cresol. First-order rate constants were found to be 0.70 day-1 and 0.96 day-1 for batch and continuous mode, respectively. The intermediates were analysed using FT-IR and GC-MS analysis. Pseudomonas fluorescens was used to assess bacterial toxicity and observed that the toxicity was reduced in case of treated wastewater. Finally, the performance of continuous RPBBR was better than the batch mode.

Comparative study for sorption of arsenic on peanut shell biochar and modified peanut shell biochar.

In this study, arsenite [As(III)] and arsenate [As(V)] removal efficiency of peanut shell biochar (PSB) and modified peanut shell biochar (MPSB) was compared in aqueous solutions. The modification was carried out with KMnO4 and KOH. Sorption efficiency of MPSB was relatively higher than PSB at pH 6 for As(III) (86%) and for As(V) (91.26%) for initial concentration of 1 mg/L, adsorbent dose of 0.5 g/L and 240 min equilibrium time at 100 rpm. Freundlich isotherm and pseudo-second order kinetic model suggested possible multilayer chemisorption. Fourier transform infrared spectroscopy showed that -OH, C-C, CC and C-O-C groups contributed significantly in adsorption for both PSB and MPSB. Thermodynamic study showed that the adsorption process was spontaneous and endothermic. Regeneration studies revealed that PSB and MPSB can be successfully used for three cycles. This study established that peanut shell is a low-cost, environment friendly and efficient biochar for removal of arsenic from water.

A synergistic approach combining Adsorption and Biodegradation for effective treatment of Acid Blue 113 dye by Klebsiella grimontii entrapped Graphene Oxide-Calcium Alginate Hydrogel Beads.

This study investigated the degradation of Acid Blue 113 (AB 113) dye using Klebsiella grimontii entrapped Graphene Oxide-Calcium Alginate Hydrogel beads (KG-GO-CA) in a Fluidized Bed Bioreactor (FBBR) under varying inlet loading rates. The minimum fluidization velocity of the KG-GO-CA hydrogel beads in FBBR was found to be 0.15 mm/s. The KG-GO-CA beads showed a maximum removal efficiency of 94.6% at an inlet flow rate of 20 mL/h over 15 days. Reusability studies indicated a removal efficiency of 70.6 ± 2.5% for AB 113 after the 12th cycle. Langmuir adsorption isotherm showed the best fit (R2 = 0.98724) with model parameters of Qm (203.83 mg/g) and Ki (0.0101 L/g). The study also confirmed that treated wastewater was more environmentally safe for domestic and commercial uses than untreated wastewater. The research highlights the potential use of KG-GO-CA hydrogel beads for removing dyes from wastewater.

Interaction of Antioxidant Trace Minerals Affecting Blood Picture Including Antioxidant Profile of Healthy Buffalo (Bubalus bubalis) Calves.

Copper (Cu) and selenium (Se) are antioxidants and essential trace elements that have mutual interaction and are reported to have beneficial effects at supranutritional levels. The experiment was executed to evaluate the individual impact of supranutritional levels of targeted elements with the effect of their interactions in buffalo calves. Twenty male Murrah buffalo calves of about 8-9 months (bodyweight 112.1 ± 7.69 kg) were distributed into four groups of five calves in each group and fed either a control (C) diet or supplemented with supranutritional levels of Cu (T1), Se (T2), or combination of both (T3) for 120 days. Higher (P = 0.015) values of packed cell volume were observed in group T2 at day 120; otherwise, all other hematological parameters remained comparable among groups. Over the period (day 120 vs. day 0), an enhancement in the percentage of lymphocytes (P = 0.006) with a reduction in neutrophils (P = 0.028) and hemoglobin (P = 0.024) values was observed in the control group. An enhancement in the percentage of monocytes (P = 0.031), with a reduced percentage of neutrophils (P = 0.022), was reported in groups T2 and T3, respectively. Interaction of Cu and Se at supranutritional level (T3) dramatically reduced plasma Cu (P = 0.008) level against the control values, with an improvement in Se markers (i.e., plasma Se, P = 0.041 and enzyme glutathione peroxidase, P = 0.057) over the values in calves fed supplemental Se alone (T2). Additionally, Cu (T1 and T3) was forced to decline (P < 0.05) Zn level in the plasma of buffalo calves. Cu (T1, P < 0.05) and Se (T2 and T3, P ≤ 0.01) supplementation was able to improve their respective plasma levels. The interaction of two trace elements at the supranutritional level further helped in reducing the lipid peroxidation (P = 0.01) values as well. Though antioxidant vitamins and cell-mediated immunity remained unaffected, humoral immunity against antigen P. multocida was high (P = 0.005) in the group T2. The conclusion may be drawn that supranutritional Cu and Se were capable to influence certain blood parameters with an additional interaction effect due to simultaneous supplementation in buffalo calves.

Assessment of biodegradation kinetics and mass transfer aspects in attached growth bioreactor for effective treatment of brilliant green dye from wastewater.

In this study, Bacillus licheniformis immobilized with low-density polyethylene (LDPE) was employed to degrade Brilliant Green (BG) dye from wastewater in a packed bed bioreactor (PBBR). Bacterial growth and extracellular polymeric substance (EPS) secretion were also assessed under different concentrations of BG dye. The impacts of external mass transfer resistance on BG biodegradation were also evaluated at different flow rates (0.3-1.2 L/h). A new mass transfer correlation [Formula: see text] was proposed to study the mass transfer aspects in attached-growth bioreactor. The intermediates, namely 3- dimethylamino phenol, benzoic acid, 1-4 benzenediol, and acetaldehyde were identified during the biodegradation of BG and, subsequently degradation pathway was proposed. Han - Levenspiel kinetics parameters µmax and Ks were found to be 0.185 per day and 115 mg/L, respectively. The new insight into mass transfer and kinetics support the design of efficiently attached growth bioreactor to treat a wide range of pollutants.

How dominant the load of bioaerosols in PM2.5 and PM10: a comprehensive study in the IGP during winter.

The winter period is most ideal for studying near-surface aerosols in the Indo-Gangetic plains (IGP) of India, since this period is inundated with significantly higher concentrations of aerosols across the unique geographical domain because of shallow atmospheric boundary layer. This study focuses on analysing the concentration of the biotic component of aerosols (bioaerosols) in a central location of the IGP and estimating their dominance in ambient particulate matter (PM) from 2021 to 2023. Observations showed that bioaerosol concentrations also increased significantly with the increasing concentrations of PM2.5 and PM10, suggesting that bioaerosols are a dominant component of the total aerosol load in the atmosphere. The total microbe's concentration (collectively fungi and bacteria) was found to be 94 to 226 cfu m-3 in PM2.5 and 167 to 375 cfu m-3 in PM10 where bacteria contributed 81.12 and 79.99%, respectively. The contribution of fungal spores in PM2.5 and PM10 remained as 18.88 and 20.01%, respectively, in the total microbes in the respective particulate matter. In the bioaerosols, fungi, namely Aspergillus, Cladosporium, and Penicillium, were dominant, and bacteria, namely E. coli, Mammaliicoccus and Enterobacter, were prevalent in both the PM size regimes. The most prominent microbial presence was observed when the temperature ranged between 16 and 20°C and relative humidity between 80 and 85%. The outcomes of the present study will be useful for further research on the health effect of the bioaerosols in the IGP.

Biodegradation of Congo Red Dye Using Lysinibacillus Species in a Moving Bed Biofilm Reactor: Continuous Study and Kinetic Evaluation.

The objective of this work was to develop a low-cost and efficient biocarrier for biodegradation of azo dye (i.e., Congo red (CR) dye). The potential bacterial species, i.e., Lysinibacillus fusiformis KLM1 and Lysinibacillus macrolides KLM2, were isolated from the dye-contaminated site. These bacterial species were immobilized onto the polypropylene-polyurethane foam (PP-PUF) and employed in a moving bed biofilm reactor (MBBR) for the treatment of CR dye. The effectiveness of the MBBR was investigated by operating the bioreactor in a continuous mode at various initial CR dye concentrations (50-250 mg/L) for 113 days. The removal efficiency was found in the range of 88.4-64.6% when the initial dye concentration was varied from 50 to 250 mg/L. The maximum elimination capacity (EC) of 213.18 mg/L.d was found at 250 mg/L of CR dye concentration. In addition, the CR dye utilization rate in the MBBR was studied by using two kinetics, namely, first-order and second-order (Grau) models. The high regression coefficients (R2 > 0.97) and the satisfactory root mean square (RMSE) values (0.00096-0.02610) indicated the reasonable prediction of CR dye degradation rate by the Grau model.

Clinical manifestations of delayed reaction following mass hornet envenomation: a case report.

Delayed reaction following mass hornet envenomation is associated with various clinical manifestations. Case Presentation: The authors present a case of a 24-year-old male from eastern Nepal, who presented following mass envenomation by hornet stings. He had progressive yellowish discoloration of skin and sclera, myalgia, fever, and dizziness. He had passage of tea-coloured urine followed by anuria. Laboratory investigations suggested acute kidney injury, rhabdomyolysis, and acute liver injury. The authors managed the patient with supportive measures and haemodialysis. There was complete recovery of liver and renal function in the patient. Discussion: The findings in this patient were similar to other cases reported in the literature. These patients must be managed supportively, with few requiring renal replacement therapy. Most of these patients recover completely. In low-middle-income countries like Nepal, delay in seeking care and delay in reaching care is associated with severe clinical manifestations. Delayed presentation can lead to renal shutdown and mortality; hence, early intervention is simple, and, crucial. Conclusion: This case highlights the occurrence of delayed reaction following mass envenomation by hornets. Also, the authors show an approach to managing such patients, similar to managing any other case with acute kidney injury. In these cases, an early simple intervention can prevent mortality. It is crucial to train healthcare workers regarding toxin induced acute kidney injury and the importance of early identification and intervention.

Health and wellbeing of Nepalese migrant workers in Gulf Cooperation Council (GCC) countries: A mixed-methods study.

Introduction: Migrant workers support low- and middle-income economies through remittances, often bearing considerable health risks with long-term consequences. This study aims to understand the health and wellbeing issues of Nepalese migrant workers in Gulf Cooperation Council (GCC) countries, a major destination for low-skilled Nepalese workers. Methodology: We conducted a mixed-methods study in Dhading district of Nepal. A pilot survey was carried out with returnee migrants from GCC countries to understand key health and wellbeing issues faced by workers. In addition, in-depth interviews were conducted with a subset of these returnee migrants and their families, and related stakeholders. These aimed to understand broader societal and policy implications in relation to labour migration. Quantitative data from the survey were analysed using descriptive statistics and thematic analysis was used for qualitative interviews. Results: 60 returnee migrants (58 males, 2 females) took part in the survey (response rate, 100%). Median age of the survey participants was 34 (IQR, 9) years and 68% had completed school level education. Returnee migrants reported suffering from various physical and mental health issues during their stay in GCC countries including cold/fever (42%), mental health problems (25%) and verbal abuse (35%). 20 participants took part in the qualitative study:10 returnee migrants (8 males, 2 females), four family members (female spouses) and six key stakeholders working in organizations related to international migration. Interview participants reported severe weather conditions resulting in physical health problems (e.g. pneumonia, dehydration and kidney disease) as well as mental health issues (including anxiety, loneliness and depression). Participants raised concerns about the usefulness and appropriateness of pre-departure training, and the authenticity of medical tests and reports in Nepal. Female migrants reported facing stigma after returning home from abroad. Language difficulties, alongside issues related to payment, insurance and support at work were cited as barriers to accessing healthcare in destination countries. Conclusion: Our study shows that Nepalese migrant workers experience severe weather conditions and suffer from various physical and mental health issues, including workplace abuse and exploitation. The study highlights an urgent need for strategies to enforce compulsory relevant pre-departure orientation and appropriate medical screening in Nepal, and fair employment terms and full health insurance coverage in destination countries. Greater collaboration between the Nepalese government and GCC countries is needed to ensure necessary legislation and regulatory frameworks are in place to safeguard the health and wellbeing of migrant workers.

Influence of husband domestic support on maternal morbidity in rural Nepal.

This study aimed to determine the associations between socio-demographic factors, maternal health knowledge and husband domestic support and last pregnancy problems among reproductive age women (aged 15-49 years) in Bahuni, Morang, Nepal. Data were collected during February and March 2010 from 144 women who had at least one child <5 years old. The women completed a questionnaire designed to elicit socio-demographic status, maternal health care knowledge and recent delivery experience. The results were used to construct two indices, the first encapsulating the woman's knowledge of maternal health care and the second summarizing problems experienced during and after her last pregnancy; these indices were found to be negatively associated. The method used in this study may be applied more widely for health planning to reduce maternal morbidity in Nepal.