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This study aimed to provide updated evidence on the status of female breast cancer and cancer treatment facilities in Asia, with a special focus on Nepal. This review used search phrases that included, breast neoplasm or cancer, health status, epidemiology, breast cancer survivors, cancer care facilities, Asia, Nepal. Researchers examined databases from January 2011 to December 2020 (PubMed, PMC, Google Scholar, and the reference lists of included papers). Studies of any design and reviews, were included in the study, except for qualitative studies. The study findings are presented in a narrative synthesis format using Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews. An initial search resulted in 974 papers, and 896 were reviewed after being checked for duplication using the Zotero software. Accordingly, utilizing the inclusion and exclusion criteria, 188 publications were selected, and after review of titles and abstracts, an additional 98 papers were removed for different reasons. Finally, the study looked at 90 female breast cancer papers. Results showed that the number of cases of breast cancer is growing all around the world, including in Asia and Nepal. Age, early menarche, late menopause, nulliparity, positive family history, excessive fat consumption, alcohol, and smoking are all frequent risk factors for breast cancer found in Asian women. Breast self-examination, clinical breast examination, and mammography screening are common methods for detecting breast carcinoma. Chemotherapy, radiation, and modified mastectomy are commonly used options for treatment. The number of breast cancer survivors is growing throughout the world, indicating better clinical care. There is a paucity of survival data in many Asian countries, including Nepal. There is also a scarcity of health workforce specialized in cancer care and treatment, as well as a few health facilities that are available to treat cancer cases in many Asian countries, including Nepal. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, governments and researchers have used routine health data to estimate potential declines in the delivery and uptake of essential health services. This research relies on the data being high quality and, crucially, on the data quality not changing because of the pandemic. In this paper, we investigated those assumptions and assessed data quality before and during COVID-19. Methods: We obtained routine health data from the DHIS2 platforms in Ethiopia, Haiti, Lao People's Democratic Republic, Nepal, and South Africa (KwaZulu-Natal province) for a range of 40 indicators on essential health services and institutional deaths. We extracted data over 24 months (January 2019–December 2020) including pre-pandemic data and the first 9 months of the pandemic. We assessed four dimensions of data quality: reporting completeness, presence of outliers, internal consistency, and external consistency. Results: We found high reporting completeness across countries and services and few declines in reporting at the onset of the pandemic. Positive outliers represented fewer than 1% of facility-month observations across services. Assessment of internal consistency across vaccine indicators found similar reporting of vaccines in all countries. Comparing cesarean section rates in the HMIS to those from population-representative surveys, we found high external consistency in all countries analyzed. Conclusions: While efforts remain to improve the quality of these data, our results show that several indicators in the HMIS can be reliably used to monitor service provision over time in these five countries. [ABSTRACT FROM AUTHOR]

Background In South Asia, women often experience intimate partner violence (IPV) and have limited access to maternal health services (MHS). However, the effects of IPV on antenatal care (ANC) visits remain unclear. This study aimed to examine the impact of IPV of different forms and severities on ANC visits in South Asia. Methods This cross-sectional study used the latest available data from demographic and health surveys conducted in Bangladesh, India, Afghanistan, Nepal, Maldives, and Pakistan. The study sampled 4467 women who had given birth within the past 12 months and were interviewed for IPV. IPV was measured by binary variables indicating the presence of physical violence (PV), categorised into less severe (LSPV) and severe physical violence (SPV), emotional violence (EV), and sexual violence (SV). ANC utilization was measured using binary variables indicating whether respondents had any, at least four, or at least eight ANC visits, as recommended by World Health Organization (WHO). Logistic regressions adjusted for survey weights were used to assess associations between ANC utilization and exposure to IPV during pregnancy and lifetime. Results The prevalence of LSPV, SPV, EV, and SV during pregnancy were 14.5%, 4.4%, 11.6%, and 4.1%. LSPV experience during pregnancy was associated with decreased likelihoods of at least four ANC visits (odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.40-0.76) and eight ANC visits (OR = 0.53; 95% CI = 0.31-0.90). Results of lifetime exposure to IPV followed similar patterns. Lifetime exposure to LSPV was associated with decreased likelihoods of at least four ANC visits (OR = 0.55; 95% CI = 0.41-0.74) and eight ANC visits (OR = 0.47; 95% CI = 0.29-0.77). Conclusion This study highlights the negativities of LSPV on the frequency of women seeking ANC visits. Policies are necessary to identify women at risk of the often-overlooked LSPV early and provide protective interventions to promote maternal health in South Asia. [ABSTRACT FROM AUTHOR]

This paper aims to describe the prevalent forms of intimate partner violence (IPV), and the factors associated with IPV among women and men living in the two migrant communities of Baglung district, Nepal. 357 adult women and men were enrolled following a family model, interviewing young married women with daughter-in-law status in the home, their husbands, and mothers-in-law and fathers-in-laws using an electronic questionnaire. Random effects regression modelling compared men and women, as well as young married women with daughter-in-law status and older women with mothers-in-law with status. 28.6% of women had ever experienced physical and/or sexual violence by an intimate partner compared to 18.2% of men ever perpetrated these forms of violence against their wives. Being older, male controlling behaviour and poor relations with husband increased women’s IPV in their lifetime while perceptions that the mother-in-law is kind were protective. Being ashamed of being unemployed and childhood trauma were associated with men perpetrating IPV in their lifetime. Borrowing money or food increased young married women’s lifetime IPV risk while mother-in-law cruelty and male control increased older married women’s lifetime IPV exposure. Factors associated with IPV in the past year among men were being younger, job seeking, experiences of childhood trauma and depression exposure among men while difficulty accessing money for emergencies, holding inequitable gender attitudes, and depression was associated with women’s increased IPV exposure. Unemployment stress, holding inequitable gender attitudes and mother-in-law kindness were associated with young women’s increased IPV risk and hunger, mother-in-law cruelty and depression with older women’s IPV risk. There is a need to critically challenge harmful social and gender norms by using approaches that are sensitive to young married women’s position and unequal gender relations in the family. IPV prevention interventions need to employ a holistic approach that combines changing social and gender norms and improving socioeconomic conditions of women living in migrant communities. [ABSTRACT FROM AUTHOR]

• We analyse how TLM changes property rights, livelihoods and landscapes. • Remittances help households to cope with shocks and support livelihoods. • TLM can produce important agrarian-environmental changes. • However, TLM ultimately fails to transform entrenched structural inequalities. • Advance the rights of migrants and enhance state support to improve TLM outcomes. While scholars and policy makers have increasingly focused on transnational labour migration (TLM) in Asia, few comparative studies have analysed how TLM shapes poverty, livelihoods, vulnerability, and agrarian-forest change across different rural contexts. Based on focused comparative fieldwork and a critical review of the secondary literature, this paper identifies the salient patterns of TLM-led change affecting rural livelihoods and agrarian-forest landscapes in three migrant-sending Asian countries: Nepal, Indonesia and Laos. Depending on how social relations, including those based on gender and ethnicity, and how specific geographic places are integrated into migration pathways, TLM can result in patterns of changes involving agricultural deactivation and de-agrarianisation, as well as incipient re-agrarianisation. We also find that where remittances are integrated with diversified livelihood portfolios, and where state policies play a supportive role, transnational labour migration may improve household livelihoods. In the absence of these factors, the transformative potential of TLM can be overestimated, and TLM may end up reproducing underlying structural drivers of rural poverty and vulnerability. We, therefore, challenge the simplistic narrative that TLM provides an easy solution to the limitations of rural development in agrarian Asia. We suggest policy innovations that ameliorate critical issues of migrant vulnerability and precarity, and that support the mobilisation of labour remittances for agricultural development and livelihood diversification. [ABSTRACT FROM AUTHOR]

The Golden Window above the Golden Door of Caukoṭ Darbār, a building on the western side of the (former) Royal Palace complex, is a major attraction in the city of Patan (Nepal). The gilt window panel features a representation of Avalokiteśvara in his form as Sṛṣṭikartā (“creator”) emanating Hindu divinities from his body. The sides, base and tympanum of the window likewise display Hindu divinities. The construction of the window has been ascribed to different kings of the late Malla period (1483–1768) and is said to illustrate their support for the Buddhist practices of their subjects, while providing a Hindu interpretative framework for such practices. In this paper I identify the divinities on the window and examine textual and visual sources that shed light on the date of the window's construction, including the inscriptions above and at the sides of the Golden Door. I show that there is no evidence for such an early dating of the window and that the Golden Window was probably constructed sometime in the nineteenth century in either the Śāh period (1769–1846) or, more likely, the Rāṇā period (1846–1951). I conclude with some thoughts on the possible significance of the peculiar configuration of divinities surrounding the Bodhisattva on the window. [ABSTRACT FROM PUBLISHER]

Summary: This paper examines the role of social capital in the sustainability of induced community-based organizations (CBOs). Quantitative and qualitative data were collected from 14 villages and 129 CBOs in Southern Nepal. This paper argues that social capital can be both positive and negative, affecting collective action and the sustainability of CBOs. Major problems include rule breaking with impunity and elite capture of resources, especially during the transition phase from external to internal management. While external agencies play an important role in inducing and sustaining CBOs, they should also address the complex issue of social capital and its downside. [Copyright &y& Elsevier]

The continuing debates about trophy hunting should be underpinned by an understanding of at least the basic characteristics of the practice (e.g. species, quotas, areas, prices). Whilst many countries in Asia have established trophy hunting programmes of considerable importance to conservation and local livelihoods, there remains some ambiguity over the extent of trophy hunting in Asia as its basic characteristics in each country have not been compiled. In this study, we compile information on various ecological and socioeconomic characteristics of trophy hunting of mammals for countries across Asia by reviewing published and unpublished literature, analysing trade data, and obtaining contributions from in‐country contacts. Across Asia, established trophy hunting programmes exist in at least 11 countries and target at least 30 species and one hybrid (incl., five Vulnerable and one Endangered species). Trophy hunting in these countries varies markedly in areas (e.g. >1 million km2 in Kazakhstan, 37% of country, vs. 1325 km2 in Nepal, <1% of country) and annual offtakes (e.g. Kazakhstan: 4500 individuals from 4 of 5 trophy species; Pakistan: 229 from 4 of 7; Mongolia: 155 from 6 of 9; Tajikistan: 126 from 3 of 6; Nepal: 22 from 3 of the 4 that are trophy hunted in practice). Permit prices also vary across species and countries, with domestic and international hunters sometimes charged different rates. Hunters from the USA appear overwhelmingly prominent among international clients. National legislations typically mandate a proportion of trophy hunting revenue to accrue locally (range: 40–100%). We provide five key recommendations for research to inform trophy hunting policy in Asia: (1) Ecological impact assessments; (2) Socioeconomic impact assessments; (3) Evaluations of the contributions of trophy hunting to conservation spending; (4) Evaluations of the contributions of trophy hunting to the post‐2020 Global Biodiversity Framework; (5) Further examinations of perceptions of trophy hunting. [ABSTRACT FROM AUTHOR]

Sustainable Development Goal 3 focuses on reducing HIV/AIDS spread, for which disseminating correct information on the disease is required. This study investigated factors associated with HIV/AIDS knowledge among women in several Asian LMICs. Global Multiple Indicator Cluster Survey-6 (MICS-6) for Bangladesh, Lao, Mongolia and Nepal were assessed. Bivariate analysis and generalised linear regression models were fitted. Overall, 60% of the respondents were aware or heard of the existence of HIV/AIDS, with 63.2% having transmission knowledge and 80.4% misconception knowledge. Results revealed that several demographic factors such as wealth index, education and access to information had a significant association with HIV/AIDS knowledge. Mongolia and Nepal have formal programmes in place that may provide policy and implementation advantages compared to Bangladesh and Lao. [ABSTRACT FROM AUTHOR]

The M w 7.9 2015 April 25 Gorkha earthquake is the latest of a millenary-long series of large devastating Himalayan earthquakes. It is also the first time a large Himalayan earthquake and its aftershocks were recorded by a local network of seismic stations. In the 5 yr following the main shock, more than 31 000 aftershocks were located by this permanent network within the ruptured area, including 14 362 events with M L greater than 2.5, 7 events with M L > 6, including one large aftershock with M w 7.2 on 2015 May 12. In 2020, 5 yr after the main shock, the seismicity rate along the ruptured fault segments was still about 5 times higher than the background seismicity before the Gorkha earthquake. Several bursts of earthquakes, sometimes organized in clusters, have been observed from a few days to several years after the main shock. Some of these clusters were located at the same place as the clusters that happened during the decades of interseismic stress build-up that preceded the large earthquake. They also happened in the vicinity of the high frequency seismic bursts that occurred during the main shock. These heterogeneities contribute to a persistent segmentation of the seismicity along strike, possibly controlled by geological structural complexities of the Main Himalayan Thrust fault. We suggest that these pre-2015 clusters revealed the seismo-geological segmentation that influences both the coseismic rupture and the post-seismic relaxation. [ABSTRACT FROM AUTHOR]

Background: High prevalence of smartphone addiction among medical students may contribute to adverse physical and mental health outcomes. Aim: To estimate the prevalence of smartphone addiction, and explore the influencing factors and related mental health symptoms of smartphone addiction among Asian medical students. Design: Systematic review and meta-analysis. Methods: PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials, and EMBASE were searched for relevant literature from the inception to September 10, 2021. Using Stata software 11.0, the meta-analysis of prevalence and the influencing factors of smartphone addiction were determined with 95% confidence intervals. Results: Nineteen articles, published between 2014 and 2019, were included, producing medical student studies from seven different Asian countries. The included studies were conducted in India (n = 11) and Malaysia (n = 3), with China, Saudi Arabia, Turkey, Nepal, and Iran each contributing one study. Among a total of 5,497 medical students, the participants included 3,214 females, of whom 2,181 were medical students with smartphone addiction. The prevalence of smartphone addiction among Asian medical students was 41.93% (95% CI [36.24%, 47.72%]). The influencing factors of smartphone addiction among medical students included gender, duration of smartphone use, smartphone function, and marital status. Ten studies (52.63%) explored related mental health symptoms of smartphone addiction among Asian medical students. Smartphone addiction was positively correlated with poor sleep quality (r = .17-.31), stress (r = .30-.40), anxiety, depression, neuroticism, and general health among Asian medical students. Conclusion: Smartphone addiction is highly prevalent among Asian medical students. Smartphone addiction may adversely affect mental health, resulting in sleep disturbance, stress, anxiety, depression, and neuroticism. It is necessary to take appropriate precautionary actions and interventions to prevent smartphone overuse among medical students. [ABSTRACT FROM AUTHOR]

This article critically evaluates the conventional Kanchan Arsenic Filter (KAF) in order to determine the main reasons for its reported poor performance. The KAF was introduced in 2004 in Nepal and makes use of non-galvanized nails as a Fe0 source for As removal. As early as 2009, the KAF was demonstrated to be ineffective for As removal in many cases. This was unambiguously attributed to the Fe0 layer which is placed on top of a sand filter instead of being incorporated into a sand matrix. Despite this conceptual mistake, the conventional KAF has been largely distributed in Asia, and recent articles have assessed its sustainability. This study reiterates that the suitability of the technology, rather than its sustainability, should be addressed. Evidence shows that the KAF has the following design limitations: (i) uses iron nails of unknown reactivity, and (ii) operates on the principle of a wet/dry cycle. The latter causes a decrease in the corrosion rate of the used nails, thereby limiting the availability of the iron corrosion products which act as contaminant scavengers. Taken together, these results confirm the unsuitability of the conventional KAF. Besides correcting the design mistakes, more attention should be paid to the intrinsic reactivity of the used iron nails, including using alternative Fe0 materials (e.g., iron filings, steel wool) for filters lasting for just 6 or 18 months. Specific design considerations to be addressed in the future are highlighted. [ABSTRACT FROM AUTHOR]

The Sustainable Development Goals (SDGs) are a universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity. To maintain the pace of development, local government institutions (LGIs) in many countries have started adapting innovative good practices. These practices are being generated as an offshoot of some projects, initiated by local governments, sub-national and/or national governments. However, these innovations are generally so closely associated, and depend so much on those projects, that once the projects officially phase out, the good practices also start falling apart. Those training institutions for LGIs in Asian countries are imparting training and applying participatory methodologies like peer learning. This enhances the capacities of the functionaries of the respective LGIs. However, the learning that emerges from the good practices, that have evolved, is often missed out in these course curricula, despite the fact that both the good practices and capacity for generating good practices, exist at the local level in the form of tacit learning. The Horizontal Learning Process (HLP) helps to overcome the inherent limitations of existing training methodology by capturing, upscaling, and nurturing tacit learning based on good practices. This paper highlights the concept and salient features of HLP, its evolution, process and steps, application areas, achievements and challenges--especially in the context of the SDGs and the role of LGIs.

The introduction of national qualification frameworks (NQFs), including frameworks specifically for the vocational sector (NVQFs), are policy initiatives that have far reaching implications for the management and delivery of education and training. Despite the caution called for by researchers and the challenging reality of implementation in both developed and developing countries, NQFs and NVQFs continue to be included in national reform programs in many regions of the world. This paper summarises current developments in the Asia-Pacific region, where enthusiasm for national qualification frameworks has reached new heights. The paper also draws on the author's experience in working on NVQF development and implementation in Bangladesh and Papua New Guinea to highlight the role of donors who are active partners in the expansion of the international trend to implement qualification frameworks. (Contains 3 tables.)

Sustainable Development Goals (SDGs) are a universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity. To maintain the pace of development, local government institutions (LGIs) in many countries have started adapting innovative good practices. These practices are being generated as an offshoot of some projects, initiated by local governments, sub-national and/or national governments. However, these innovations are generally so closely associated, and depend so much on those projects, that once the projects officially phase out, the good practices also start falling apart. Those training institutions for LGIs in Asian countries are imparting training and applying participatory methodologies like peer learning. This enhances the capacities of the functionaries of the respective LGIs. However, the learning that emerges from the good practices, that have evolved, is often missed out in these course curricula, despite the fact that both the good practices and capacity for generating good practices, exist at the local level in the form of tacit learning. The Horizontal Learning Process (HLP) helps to overcome the inherent limitations of existing training methodology by capturing, upscaling, and nurturing tacit learning based on good practices. This paper highlights the concept and salient features of HLP, its evolution, process and steps, application areas, achievements and challenges--especially in the context of the SDGs and the role of LGIs.

A new species of oribatid mites of the family Cepheidae (Oribatida)—Tritegeus janosbaloghisp. nov.—is described based on adults from soil-litter in Nepalese forest. The generic diagnosis of Tritegeus is updated. An identification key and data on distribution of known species of Tritegeus are provided. [ABSTRACT FROM AUTHOR]

It has long been orthodoxy among adult educators that those who teach adults need to take into account the existing knowledge, practices, perceptions and expectations of the learners. This is true at both central level where curricula and teaching-learning materials are developed and at local level where adult teacher/facilitator meets adult learners. The problem has been how to train adult educators in appropriate ways to discover the existing epistemologies and aspirations of the adult learners. This paper outlines such a training programme using ethnographic approaches to discovering the existing numeracy and literacy practices of "dalit" women learners in a rural part of India. The programme is aimed at a group of trainers working with the NGO Nirantar (India) and others from south Asia (India, Nepal, Pakistan and Bangladesh) with the support of ASPBAE (Asian South Pacific Bureau of Adult Education) and a UK-based NGO, Uppingham Seminars in Development. We begin the paper by looking at the theoretical background to the project and then reporting on the workshops held so far, and finally linking it to the next stage of the project. (Contains 3 notes.)

Night blindness during pregnancy caused by vitamin A deficiency is associated with an increased risk of morbidity and mortality among women. Because a history of maternal night blindness is simple and reliable to use, it is recommended as a population-based indicator of vitamin A deficiency. Furthermore, a maternal night blindness prevalence of >/=5% is recommended as a cut-off at which vitamin A deficiency may be considered to be a problem of public health significance within the community. This paper provides the justification for these recommendations. Night blindness during pregnancy is strongly associated with low serum and breast milk vitamin A concentration, abnormal conjunctival impression cytology and impaired dark adaptation, which suggests that it is a valid indicator of vitamin A deficiency. The prevalence of night blindness during pregnancy tends to be high in countries where the prevalence of xerophthalmia in children is high and in countries where interventions are in place to reduce childhood vitamin A deficiency. Existing data suggest that misclassification of self-reported maternal night blindness may account for a prevalence of up to 3%. The suggested cut-off, 5%, is set higher than this potential level of false-positive prevalence (3%). Illustrative data from India and Cambodia on childhood xerophthalmia and maternal night blindness rates are used to demonstrate the validity of using a 5% prevalence of maternal night blindness as indicative of a community vitamin A deficiency problem. Finally, it is recommended that night blindness history be elicited for a previous pregnancy that ended in a live birth in the past 3 y, using the local term for night blindness whenever possible. [ABSTRACT FROM AUTHOR]

Purpose: It is still unclear how Asian universities incorporate the theory or practice of sustainable development (SD) in their research and education programmes. To address this gap, the purpose of this paper is to report on a study that has examined how universities in Asian countries handle and address matters related to SD. Design/methodology/approach: The study used a bibliometric analysis and an online survey-method. The online survey data were analysed through descriptive analysis and one-sample student's "t"-test. Findings: The study indicates that there is considerable variation among the Asian countries regarding sustainability practices in higher education institutions (HEIs). The HEIs in far eastern countries, such as Indonesia, Malaysia and Thailand are perceived to demonstrate more sustainability practices. Research limitations/implications: Even though a substantial number of participants participated in the survey, it did not cover all Asian countries. The online survey was carried out over a limited period of time, and not all HEIs in the field may have received information about the study. Practical implications: Asia is the largest continent facing a number of sustainability challenges. In this context, the contribution of HEIs is very important. The findings of the current study may serve as a baseline for Asian HEIs to take more initiatives towards SD goals, as HEIs are responsible for the education and training of hundreds of thousands of students who will be occupying key positions in industry, government or education in the coming years. Originality/value: The study contributes to the existing literature in two distinct ways. First, it was possible to develop a comprehensive instrument to measure sustainability practices in HEIs. Second, this study has filled the gap of the scarcity of studies regarding sustainability practices in HEIs in Asia.

Background: Nepal recorded 5754 suicides in 2018-19 - a high number for a relatively small country. Over 24% of these suicides were by poisoning, most by ingestion of highly concentrated agricultural pesticides. Nepal has actively regulated pesticides to reduce their health impacts since 2001. We aimed to analyse Nepal's history of pesticide regulation, pesticides responsible for poisonings, and relate them to national suicide rates.Methods: Information on pesticide regulation was collected from the Plant Quarantine and Pesticide Management Centre of the Ministry of Agriculture and Livestock Development. National data on suicides from 1980 to 2019 were obtained from the National Statistical Bureau and Nepal Police. Data on the pesticides responsible for self-poisoning and pesticide suicides over time were obtained from a systematic literature review.Results: As of June 2020, 171 pesticides were registered for use in Nepal, of which one was extremely hazardous (WHO Class Ia), one other highly hazardous (WHO Class Ib), and 71 moderately hazardous (WHO Class II). Twenty-four pesticides have been banned since 2001, with eight (including five WHO Class I compounds) banned in 2019. Although the suicide rate has increased more than twelve-fold since 1980, particularly for hanging (15-fold increase from 1980 to 2018), fatal pesticide self-poisoning has increased by 13-fold. Methyl-parathion is reported to be the key pesticide responsible for pesticide self-poisoning in Nepal, despite being banned in 2006.Conclusion: The full effect of the recent pesticide policy reform in Nepal remains to be seen. Our analysis shows a continuing increase in suicide numbers, despite bans of the most important pesticide in 2006. This may indicate smuggling across the border and the use of the brand name (Metacid) for pesticides in general making it difficult to identify the responsible pesticide. More information is required from forensic toxicology labs that identify the individual compounds found. The effect of recent bans of common suicide pesticides needs to be monitored over the coming years. Evidence from other Asian countries suggests that HHPs bans will lead to a marked reduction in suicides, as well as fewer cases of occupational poisoning. [ABSTRACT FROM AUTHOR]

Background Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan. Methods From September 2016–September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric fever. Antimicrobial resistance of isolates was determined by disc diffusion using Clinical and Laboratory Standard Institute cut-off points. We reported the frequency of multidrug resistance (MDR)(resistance to ampicillin, cotrimoxazole, and chloramphenicol), extensive drug resistance (XDR) (MDR plus non-susceptible to fluoroquinolone and any 3rd generation cephalosporins), and fluoroquinolone (FQ) and azithromycin non-susceptibility. Results We enrolled 8,705 blood culture confirmed enteric fever cases: 4,873 (56%) from Bangladesh, 1,602 (18%) from Nepal and 2,230 (26%) from Pakistan. Of these, 7,591 (87%) were Salmonella Typhi and 1114 (13%) were S. Paratyphi. MDR S. Typhi was identified in 17% (701/4065) of isolates in Bangladesh, and 1% (19/1342) in Nepal. In Pakistan, 16 % (331/2084) of S. Typhi isolates were MDR, and 64% (1319/2074) were XDR. FQ nonsusceptibility among S. Typhi isolates was 98% in Bangladesh, 87% in Nepal, and 95% in Pakistan. Azithromycin non-susceptibility was detected in 77 (2%) in Bangladesh, 9 (.67%) in Nepal and 9 (.59%) isolates in Pakistan. In Pakistan, three (2%) S. Paratyphi isolates were MDR; no MDR S. Paratyphi was reported from Bangladesh or Nepal. Conclusions Although AMR against S. Paratyphi was low across the three countries, there was widespread drug resistance among S. Typhi, including FQ non-susceptibility and the emergence of XDR S. Typhi in Pakistan, limiting treatment options. As typhoid conjugate vaccine (TCV) is rolled out, surveillance should continue to monitor changes in AMR to inform policies and to monitor drug resistance in S. Paratyphi, for which there is no vaccine. [ABSTRACT FROM AUTHOR]

Enteric fever remains a public health concern in communities lacking sanitation infrastructure to separate sewage from drinking water. To bridge the gap until large-scale civil-engineering projects are implemented in high-burden countries, typhoid conjugate vaccine presents a promising disease-prevention technology. A new typhoid conjugate vaccine was prequalified by the World Health Organization in 2017 and is beginning to be introduced in countries around the world. To help inform vaccine introduction, the Surveillance for Enteric Fever in Asia Project (SEAP) conducts prospective enteric fever surveillance in Bangladesh, Nepal, and Pakistan. This supplement presents findings from Phase II of the study (2016–2019) on burden of disease, clinical presentation, the growing spread of drug-resistant strains, and policy and economic ramifications. These findings are delivered to support policymakers in their deliberations on strategies to introduce typhoid conjugate vaccine as a preventive tool against enteric fever. [ABSTRACT FROM AUTHOR]

The authors of this perspectives-based paper analyze the research process and results of an undergraduate research (UR) partnership that involved both of us -- an undergraduate student and a faculty member with international backgrounds--, a local non-profit organization in North Carolina that connected the authors with research participants who are refugees from diverse origins in Africa and South Asia, and a foreign non-profit organization that connected the authors with Nepali research participants in Nepal. Learning about how this research partnership worked, its challenges and successes is important to better understand how faculty members of diverse origins can effectively mentor undergraduate students of diverse origins in both local and global contexts. Recommendations and lessons learned are offered.

Anemia is a condition in which the number of red blood cells is not sufficient to meet the physiological need of the body. Women of reproductive age and pregnant women are at a high risk of anemia, which in turn may contribute to maternal morbidity and mortality. We aimed to describe the prevalence of anemia and the factors associated with the risk of developing anemia in women of reproductive age in Nepal. Additionally, we examined the association of women’s decision-making autonomy regarding healthcare and experience of intimate partner violence (IPV) with anemia. Data from the 2016 Nepal Demographic and Health Survey (NDHS) were used in this study. The data were adjusted for sampling weight, stratification, and cluster sampling design. A battery-operated portable HemoCue was used to measure hemoglobin and detect anemia. Using complex sample logistic regression, the association between dependent and independent variables were examined; crude and adjusted odds ratio were reported. The mean (± SD) hemoglobin concentration was 12.13 g/dL (± 1.48). Overall, about 41% (95% CI 38.6–43.0%) of women aged 15–49 years were anemic. Women in households with wells as the source of drinking water (aOR 1.93; 95% CI 1.58–2.37) were significantly associated with an increased risk of developing anemia. While women who were currently using hormonal contraceptives (aOR 0.63, 95% CI 0.52–0.76) were significantly less likely to be anemic. After adjusting for background characteristics among women who were married at the time of the survey, decision-making autonomy regarding healthcare, and experience of IPV did not have a significant association with anemia. The high prevalence of anemia suggests the need for substantial improvement in the nutritional status of women. The increased disease burden compared with the past survey highlights the needs to reconsider the existing nutritional policy in Nepal. [ABSTRACT FROM AUTHOR]

Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- and -middle income countries, members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions. A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups such as Dalits, Madhesi, Muslim, Chepang and Tamang. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres. We conclude that community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups, and the programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the FCHVs and local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in low- and -middle income countries. [ABSTRACT FROM AUTHOR]

Background: While Nepal’s maternal mortality ratio (MMR) has improved overall, the proportion of maternal deaths occurring in health facilities and attended to by skilled birth attendants (SBAs), has nearly doubled over 12 years. Although there are numerous socioeconomic, environmental and other factors at play, one possible explanation for this discrepancy between utilization of skilled maternal care services and birth outcomes lies in the quality of care being provided by SBAs. The objective of this study is to determine how competent SBAs are after training, across multiple settings and facility types in Nepal. Methods: We used a quantitative cross-sectional analysis to evaluate a sample of 511 SBAs, all female, from 276 sub-health posts (SHP), health posts (HP), primary healthcare centers (PHC), and district and regional hospitals in the mountain, hill, and terai districts of Nepal. Any SBA actively employed by one of these health facilities was included. SBAs who had received less than three months of training were excluded. Outcomes were measured using SBAs’ scores on a standardized knowledge assessment, clinical skills assessment, and monthly delivery volume, particularly as it compared with the WHO’s recommendation for minimum monthly volume to maintain competence. Results: SBAs on average exhibit a deficiency of both knowledge and clinical skills, failing to meet even the 80-percent standard that is required to pass training (knowledge: 75%, standard deviation 12%; clinical skills: 48%, standard deviation 15%). Moreover, SBAs are conducting very few deliveries, with only 7 percent (38/511) meeting the minimal volume recommended to maintain competence by the WHO, and a substantial fraction (70/511, 14%) performing an average of no monthly deliveries at all. Conclusions: Taken together, our findings suggest that while countries like Nepal have made important investments in SBA programs, these healthcare workers are failing to receive either effective training or sufficient practice to stay clinically competent and knowledgeable in the field. This could in part explain why institutional deliveries have generally failed to deliver better outcomes for pregnant women and their babies. [ABSTRACT FROM AUTHOR]

Introduction: Antepartum depression is a contributing factor for adverse maternal and perinatal outcome. The study aimed to assess the antepartum depressive symptoms in selected public health facilities of Nepal. Methodology: This is a mixed-method cross-sectional study that included 143 pregnant women attending the antenatal checkup in four public health facilities of Kathmandu. Edinburgh Postnatal Depression Scale (EPDS) tool with cut-off score > = 10 was used to assess the antepartum depressive symptoms. Bivariate and multivariable analysis was carried out to identify factors associated with the depressive symptoms. Further semi-structured interviews were conducted with 12 pregnant women identified with the depressive symptoms. Result: Of the total 143 pregnant women, 26 (18%, CI at 95% 12.6–25.5) reported depressive symptoms. Multivariable analysis reported higher odds of antepartum depressive-symptoms with health problem, early gestational age, sex preference, and spousal alcohol intake. Thematic analysis of qualitative data further revealed participants’ apprehension on; birth outcome, a family expectation of male child, inadequate support from the family/husband and disturbed family environment. Conclusion: Notable proportion of pregnant women were reported with antepartum depressive symptoms. Women’s perception on patriarchal values for childbirth was revealed to be important factor for the depressive symptoms. The study draws an attention to a need for screening for antepartum depression into primary health care system. Strengthening ongoing efforts on gender equity could contribute the psychological well-being of pregnant women. [ABSTRACT FROM AUTHOR]

Background: In low-income countries, care for people with mental, neurological, and substance use (MNS) disorders is largely absent, especially in rural settings. To increase treatment coverage, integration of mental health services into community and primary healthcare settings is recommended. While this strategy is being rolled out globally, rigorous evaluation of outcomes at each stage of the service delivery pathway from detection to treatment initiation to individual outcomes of care has been missing.Methods and Findings: A combination of methods were employed to evaluate the impact of a district mental healthcare plan for depression, psychosis, alcohol use disorder (AUD), and epilepsy as part of the Programme for Improving Mental Health Care (PRIME) in Chitwan District, Nepal. We evaluated 4 components of the service delivery pathway: (1) contact coverage of primary care mental health services, evaluated through a community study (N = 3,482 combined for all waves of community surveys) and through service utilisation data (N = 727); (2) detection of mental illness among participants presenting in primary care facilities, evaluated through a facility study (N = 3,627 combined for all waves of facility surveys); (3) initiation of minimally adequate treatment after diagnosis, evaluated through the same facility study; and (4) treatment outcomes of patients receiving primary-care-based mental health services, evaluated through cohort studies (total N = 449 depression, N = 137; AUD, N = 175; psychosis, N = 95; epilepsy, N = 42). The lack of structured diagnostic assessments (instead of screening tools), the relatively small sample size for some study components, and the uncontrolled nature of the study are among the limitations to be noted. All data collection took place between 15 January 2013 and 15 February 2017. Contact coverage increased 7.5% for AUD (from 0% at baseline), 12.2% for depression (from 0%), 11.7% for epilepsy (from 1.3%), and 50.2% for psychosis (from 3.2%) when using service utilisation data over 12 months; community survey results did not reveal significant changes over time. Health worker detection of depression increased by 15.7% (from 8.9% to 24.6%) 6 months after training, and 10.3% (from 8.9% to 19.2%) 24 months after training; for AUD the increase was 58.9% (from 1.1% to 60.0%) and 11.0% (from 1.1% to 12.1%) for 6 months and 24 months, respectively. Provision of minimally adequate treatment subsequent to diagnosis for depression was 93.9% at 6 months and 66.7% at 24 months; for AUD these values were 95.1% and 75.0%, respectively. Changes in treatment outcomes demonstrated small to moderate effect sizes (9.7-point reduction [d = 0.34] in AUD symptoms, 6.4-point reduction [d = 0.43] in psychosis symptoms, 7.2-point reduction [d = 0.58] in depression symptoms) at 12 months post-treatment.Conclusions: These combined results make a promising case for the feasibility and impact of community- and primary-care-based services delivered through an integrated district mental healthcare plan in reducing the treatment gap and increasing effective coverage for MNS disorders. While the integrated mental healthcare approach does lead to apparent benefits in most of the outcome metrics, there are still significant areas that require further attention (e.g., no change in community-level contact coverage, attrition in AUD detection rates over time, and relatively low detection rates for depression). [ABSTRACT FROM AUTHOR]

Background: Local people in the Himalayan region use a wide range of wild and non-cultivated edible plants (WNEPs) for food, spice, medicinal, and cultural purposes. However, their availability, use, status and contribution to livelihood security are poorly documented, and they have been generally overlooked in recent agro-biodiversity conservation and management programmes. The study aimed to investigate WNEP diversity and current status in a part of the Kailash Sacred Landscape--a transboundary landscape shared by Nepal, India and PR China--in terms of collection, use, management and conservation initiatives. Methods: Multiple methodologies and tools were used for data collection. A series of participatory tools (45 key informant interviews, 10 focus group discussions, a crop diversity fair, direct observation of species through a transect walk and rapid market assessments) was followed by a household survey (195 respondents) and complemented by a literature review. Results: The study recorded 99 WNEPs belonging to 59 families of which 96 were angiosperms, one gymnosperm and two pteridophytes. Species were used for food, spice, medicine, rituals and income generation. Thirty-five species had multiple uses, including these: 40 species were used for fruit and 31 for vegetables. WNEPs contribute significantly to daily food requirements, especially the vegetables. The use value of Dryopteris cochleata was found highest (0.98) among frequently used vegetable species. The values of informant consensus factor were found maximum for worms in the stomach (0.99) and minimum for skin disease treatment (0.67). Nearly 85% of households depended exclusively on WNEPs for at least more than a month per year. Results on the importance and use of different species, gender roles in WNEP activities and conservation approaches are presented. Conclusions: People living in the Kailash Sacred Landscape depend significantly on WNEPs, and this is especially critical in times of food shortage. The WNEPs have considerable potential as an important supplement to cultivated food crops. Farmers prioritise species with multiple use values and popular vegetables. However, there are numerous challenges and interventions needed to ensure conservation and management of species and their continued availability to support food security and local livelihoods. [ABSTRACT FROM AUTHOR]

Purpose: We provide rare evidence of factors producing psychiatric variation in a general population sample from rural South Asia. The setting is particularly useful for demonstrating that variations in the social organization of communities, often difficult to observe in rich countries, are associated with important variations in mental health. Methods: Clinically validated survey measures are used to document variation in psychiatric disorders among 401 adults. This sample is chosen from a systematic sample of the general population of rural Nepal, in a community-level-controlled comparison design. Multilevel logistic regression is used to estimate multivariate models of the association between community-level nonfamily social organization and individual-level psychiatric disorders. Results: Schools, markets, health services and social support groups each substantially reduce the odds of depression, post-traumatic stress disorder (PTSD), intermittent explosive disorder and anxiety disorders. Associations between schools, health services and social support groups and depression are statistically significant and independent of each other. The association between access to markets and PTSD is statistically significant and independent of other social organization and support groups. Conclusions: Community integration of some nonfamily social organizations promotes mental health in ways that may go unobserved in settings with many such organizations. More research on the mechanisms producing these associations is likely to reveal potential avenues for public policy and programs to improve mental health in the general population. [ABSTRACT FROM AUTHOR]

This article synthesises findings from two systematic reviews that examined evidence of the link between large-scale assessments (LSAs) and education policy in economically developing countries and in countries of the Asia-Pacific. Analyses summarise evidence of assessment characteristics and policy goals of LSAs that influence education policy, when LSAs are used in the policy-making cycle and types of education policies impacted, and factors that influence the use of LSAs in policy-making. Results show national assessments conducted at both primary and secondary school levels to have an impact on education policy. LSAs are used more often for monitoring education quality and equity purposes followed by accountability purposes. International assessments are more often used to leverage policy priorities than other assessment types. LSAs feature mainly at the monitoring and evaluation stage of the policy cycle. The education policies impacted by LSAs relate considerably more to curricular reforms and performance standards as well as assessment bodies and activities and far less to resource allocation and teaching and learning policies. Finally, whereas the quality of assessment programmes facilitate impact, financial constraints and uncertainty as well as weak assessment bodies hinder the impact of LSAs on education policy.

This article engages with current debates surrounding China's security by employing the concept of structural power and the Copenhagen School approach to security studies to measure threats to China's security. Building on existing Chinese and English language research on China's security drivers, the article develops a mechanism for determining how China's economic relations with small states in Asia negatively affect their domestic stability and how this instability then loops back to undermine China's strategic position. The article uses China's relations with Cambodia, Nepal and Mongolia as case studies. [ABSTRACT FROM PUBLISHER]

Background: Over 133,000 children present to hospitals with Acute Encephalitis Syndrome (AES) annually in Asia. Japanese encephalitis (JE) accounts for approximately one-quarter of cases; in most cases no pathogen is identified and management is supportive. Although JE is known to result in neurological impairment, few studies have examined the wider impact of JE and AES on patients and their families. Methodology/Principal Findings: Children (aged 1 month–14 years) with AES were assessed 5–12 months after discharge from two Nepali hospitals. Assessment included clinical examination, the Liverpool Outcome Score (LOS) - a validated assessment of function following encephalitis, questionnaires about the child's social participation since discharge, and out-of-pocket costs to the family. Children were classified as JE or 'other AES' based on anti-JE virus antibody titres during acute illness. Contact was made with the families of 76% (73/96) of AES children. Six children had died and one declined participation. 48% (32/66) reported functional impairment at follow-up, most frequently affecting behaviour, language or limb use. Impairment was more frequent in JE compared to 'other AES' cases (68% [13/19] versus 40% [19/47]; p = 0.06). 49% (26/53) had improvement in LOS between discharge and follow-up. The median out-of-pocket cost to families, including medical bills, medication and lost earnings was US$ 1151 (10 times their median monthly income) for children with severe/moderate impairment and $524 (4.6 times their income) for those with mild/no impairment (P = 0.007). Acute admission accounted for 74% of costs. Social participation was limited in 21% of children (n = 14). Conclusions/Significance: Prolonged functional impairment was common following AES. Economic impact to families was substantial. Encouragingly, almost half the children improved after discharge and most reported sustained social participation. This study highlights a need for long-term medical support following AES. Rationalisation of initial expensive hospital treatments may be warranted, especially since only supportive treatment is available. Author Summary: More than 133,000 children present annually to hospitals in Asia with clinical features of acute brain infection (Acute Encephalitis Syndrome [AES]). Japanese encephalitis accounts for one-quarter of cases in Asia. With no specific treatments for AES, management is largely supportive. AES commonly causes neurological problems. However, few studies have examined long-term outcome or the economic cost of AES. We followed up 72 Nepali children 5–12 months after acute hospital admission for AES and studied their neurological function, social participation and the out-of-pocket costs to the family. At follow-up, 6 children had died and 48% of survivors had impaired function. Behaviour, language or limb impairments were common. Encouragingly, almost half the children reported improved function at follow-up compared to hospital discharge. The economic impact was substantial; $1151 US dollars (10 times their monthly income) among families with children suffering severe/moderate impairment. Acute admission represented 74% of total costs. Few families reported limitations in their child's social participation. The functional problems experienced by these children highlights their need for long-term medical support. The substantial economic costs to families suggest rationalisation of acute care costs may be warranted. Families reported their child maintaining social participation, implying a positive attitude to social engagement. [ABSTRACT FROM AUTHOR]

We describe volumetric changes in three benchmark glaciers in the Nepal Himalayas on which observations have been made since the 1970s. Compared with the global mean of glacier mass balance, the Himalayan glaciers showed rapid wastage in the 1970s-1990s, but similar wastage in the last decade. In the last decade, a glacier in an arid climate showed negative but suppressed mass balance compared with the period 1970s-1990s, whereas two glaciers in a humid climate showed accelerated wastage. A mass balance model with downscaled gridded datasets depicts the fate of the observed glaciers. We also show a spatially heterogeneous distribution of glacier wastage in the Asian highlands, even under the present-day climate warming. [ABSTRACT FROM AUTHOR]

Conventional wisdom suggests that armed conflicts with religious dimensions are inherently difficult to end. Religious appeals seem to make conflict issues indivisible. Yet, religious conflicts do end. In order to understand this puzzle, there is a need to examine the empirical records of the termination process of these types of armed conflicts. In this study, we argue that there is a potential for conflict resolution of religious conflicts without necessarily requiring concessions on the core beliefs and aspirations. We explore this proposition by examining the empirical pattern of Asian armed conflicts with explicit religious dimensions as stated incompatible positions and scrutinize how they are ended. Our empirical analysis reveals that none of the parties raising religious demands has made concessions on those demands. Yet, in about half of the cases, there are accommodations that do not imply concessions on the religious goals. Based on these findings, the study draws out the potential implications for the debate about the role of religion, armed conflicts, and peaceful resolution. [ABSTRACT FROM AUTHOR]

The higher elevation regions of Darchula District in the northwest of Nepal provide a unique example of a basic Cannabis agricultural system whereby all three major products-seeds and resin from the female flowers as well as fiber from the stems-are extracted from the same crop. For centuries prior to the relatively recent influences of market economics and law enforcement, this simple cropping system was much more widespread throughout neighboring regions of Asia, wherever and whenever Cannabis seed, drugs and fiber were in demand. doi:10.1300/J237v12n02_03 [ABSTRACT FROM PUBLISHER]

This article focuses on Lamaism, a development of phase of Buddhism in Tibet. Possibly it is on account of this secluded character of their natural surroundings that they have laid hold of the idea of Peace. Peace is the central idea in practical Lamaism, Peace, almost at any price, is what the Tibetans aim at. To obtain it they are ready to sacrifice their national independence. Mohamedanism does not to anything like the same extent enjoin peace. Many Mohamedans in fact think themselves bound to spread their faith even by means of the sword. It is a much more militant faith than Lamaism. The Tibetans were never as warlike as the Mongols. But in their early history they once carried their arms to the capital of China, at Siningefu, and at another time a king of Tibet extended his sway through Nepal to the borders of India. And one sees in the course of their history that as Buddhism gained an increasing hold over the people and, as the Lamas acquired greater political influence, the idea of peace more fully permeated the Tibetans and they gradually lost their warlike propensities.