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Background: The taxonomic status and geographical distribution of M. tengara are vague. No genetic diversity and phylogenetic study have been done till now to resolve its identity and distribution. In the present study, an integrated taxonomic approach has been applied to clarify the taxonomic status, identity, and distribution of bagrid catfish, Mystus tengara., Methods and Results: Comparative morphometric evaluation of M. tengara identified in the present study from distant geographical locations revealed variations of the traits in response to body length and environment, without significant genetic distance. The observed morphometric traits of M. tengara were found to be overlapping with available morphometric traits of M. tengara, M. carcio and M. vittatus. Maximum likelihood and Bayesian phylogenetic analysis based on mitochondrial cytochrome c oxidase (COI) gene also could not resolve their identity, and five paraphyletic clades comprising of M. tengara, M. vittatus, and M. carcio from India, Nepal, and Bangladesh were observed. Morphological and genetic evidence along with comparative evaluation of M. tengara, from its type locality, we consider M. tengara identified in the present study to be true, with its distribution extending from North East India to West Bengal, North India, Central India, Northern peninsular India, and Bangladesh., Conclusion: The observation of paraphyletic subclades and evaluation of genetic distance between subclades reveals the presence of four cryptic species. Further confirmation on the identity of M. vittatus and M. carcio, by an integrated taxonomic approach based on fresh specimens collected from the type locality, is required., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Three instances of fast moving haemoglobins in heterozygous form have been found in Indian soldiers of Nepali Gorkha, during a routine screening for abnormal haemoglobins. The affected individuals were not related and seemed clinically well.

Purpose: This paper critically reviews and reflects on the processes for providing Assistive Technology (AT) services to Persons with Disabilities (PWD) in Bangladesh, India and Nepal. The aim is to investigate the AT service delivery systems in these countries and suggest improvements where weaknesses are identified., Materials and Methods: We carried out a descriptive qualitative exploratory study in Bangladesh, India and Nepal by conducting key informant interviews with policymakers (5), AT service providers (22) and mobility and hearing related AT service users (21). We used a directed content analysis approach guided by a seven-point AT service delivery process model to thematically analyse the existing processes for AT service delivery, from first contact through to follow-up and maintenance., Results: AT service delivery processes are sub-optimal in all three countries, and improvements are needed. No common AT service delivery process was found, although there are common features. In general, it is easier for PWDs in India and Nepal to access AT than for those in Bangladesh, but all three countries are failing to live up to their commitments to uphold the human rights of PWDs., Conclusions: Although good elements of AT service delivery processes can be identified, the systems in all three countries are fragmented and generally weak. A more holistic approach of looking at the process of AT service delivery, from first contact right through to follow-up and device maintenance, with a single door service delivery system, free of cost at the point of service is recommended in these countries. IMPLICATIONS FOR REHABILITATIONAlthough we found significant weaknesses in AT delivery in all three countries, there are some good AT service delivery practices and opportunities for these countries to learn from one another.A systematic and stepwise approach to assessing current AT service delivery processes in the three countries - examining the delivery system as a whole, from initiation to repair and management - can help identify opportunities to improve the process for (prospective) AT users.A more coherent single door system of AT service delivery will increase the quality and efficiency of the fragmented AT service delivery practices in Bangladesh, India and Nepal.

In this paper, the stochastic frontier gravity model is applied to analyze the trade potential between China and Nepal and the prospects of Lanzhou-Kathmandu South Asian rail-road freight trains (LKSARFT). Based on the statistical data, we test the Exports Efficiency (EE), Bilateral Trade Efficiency (BTE), Exports Trade Potential (ETP), Bilateral Trade Potential (BTP), Extended Exports Trade Potential (EETP), Extended Bilateral Trade Potential (EBTP), Improved Exports Trade Potential (IETP) and Improved Bilateral Trade Potential (IBTP) between China and Nepal, the following analysis results can be found: for the bilateral trade model, the bilateral non-efficiency factor decreasing at a rate of 0.057 with time increasing, bilateral trade increasing at a rate of 0.057 with time increasing. For the exports model, the exports non-efficiency factor increasing at a rate of 0.004 with time increasing, exports trade decreasing at a rate of 0.057 with time increasing. The BTE between China and Nepal increases when time changes, the EE from China to Nepal remains constant changing during the 18 years. The changing range of BTE is 0.002-0.05; the changing range of EE from China to Nepal is over 0.1, larger than the BTE. The BTE and EE ranking among the eight South Asian countries are ranking fifth and fourth during the 18 years. exports trade resistance from China to Nepal is larger than bilateral trade resistance; The import trade potential from Nepal to China is huge, the focus of bilateral trade between China and Nepal may be changed, there are more goods may be exported from Nepal to China, and China may become trade deficit when trading with Nepal. Then, the development bottlenecks of the LKSARFT are analyzed. Finally, we give policy directions to boost bilateral trade efficiency and tap the potential of bilateral trade between China and Nepal., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fei Tian. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The present paper describes a new species of Notodontidae Subniganda bambusoides Mazumder & Schintlmeister sp. nov. from the Himalayan and northeastern landscapes of India and Nepal. It also provides a comparative diagnosis with its congeners S. tristan (Schintlmeister, 1997) and S. isolde (Schintlmeister, 1997) along with detailed morphological and genitalic illustrations.

Leishmaniases are considered among the most neglected yet dangerous parasitic diseases worldwide. According to the recent WHO report (Weekly Epidemiological Record, Sep, 2021), 200 countries and territories reported leishmanises cases in 2020; of which 89 (45%) for CL, and 79 (40%) for VL were endemic. Indian subcontinent (India, Bangladesh and Nepal), one of the three eco-epidemiological hotspots of VL, currently reported 18% of the total cases of VL worldwide. Eastern Mediterranean region and the Region of the Americas together reported >90% of the new CL cases, of which >80% were from Afghanistan, Algeria, Brazil, Colombia, Iraq, Pakistan and the Syrian Arab Republic. While considering the current therapeutic options, conventional anti-leishmanial drugs have long been proved to be toxic and/or expensive and have resulted in extensive drug resistance in India. Recent searches for novel anti-leishmanial drugs have led to find out the prime cellular targets and metabolic pathways to bridge the gap between the known facts and unexplored data. Cutting edge knowledge based drug designing has simplified the search for novel molecules with leishmanicidal efficacy by identifying ligand-receptor interactions and has accelerated the cost effective primary discovery of molecules through computational validation against Leishmaniases. This review focuses on the limitations of conventional drugs, and discusses the chemotherapeutic potential of many novel natural and synthetic anti-leishmanial agents reported since the last decade. It is also interpreted that some of the reported molecules might be tested singly or as a part of combinatorial therapy on pre-clinical and clinical level., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Research calls for the sexual and reproductive rights field to prioritize gender norms to ensure that women can act on their reproductive rights. However, there is a gap in accepted measures. We addressed this by including important theoretical components of gender norms: differentiating between descriptive and injunctive norms and adding a referent group. Our team originally developed and validated the G-NORM, a gender norms scale, in India. In this paper, we describe how we subsequently adapted and validated it in Nepal. We administered items to women of reproductive age, conducted exploratory and confirmatory factor analysis, and examined associations between the subscales and reproductive health outcomes. Like the original G-NORM, our factor analyses showed that descriptive norms and injunctive norms comprise two distinct scales which fit the data well and had Cronbach alphas of 0.92 and 0.89. More equitable descriptive gender norms were associated with higher decision-making scores, increased odds of intending to use family planning, disagreeing that it is wrong to use family planning, and older ideal age at marriage. Injunctive gender norms were only associated with disagreeing that it is wrong to use family planning. Findings offer an improved measure of gender norms in Nepal and provide evidence that gender norms are critical for agency and reproductive health outcomes., (© 2022 The Authors. Studies in Family Planning published by Wiley Periodicals LLC on behalf of Population Council.)

Purpose: The purpose of this paper is to analyse and critically reflect on access to Assistive Technology (AT) for persons with disabilities (PWD) in Nepal, India and Bangladesh. This analysis aims to guide the development of a contextualised generic AT service delivery model suitable for these countries, based on the best practices identified., Materials and Methods: This paper is based on a comprehensive study conducted in Nepal, India and Bangladesh, observing mobility and hearing-related AT service delivery centres run by the government, as well as private and nongovernmental organisations, and interviews with key informants: policymakers (5), AT service providers (20) and AT service users (20) between December 2019 to February 2020. A descriptive, qualitative exploratory study design was followed. A quality assessment framework was used to structure the analysis and interpret the findings., Results: AT service provisions are poorly developed in all three countries. On all quality indicators assessed, the systems show major weaknesses. AT users have very limited awareness about their rights to these services and the availability of AT services, the range of services available is very limited, and eligibility is dependent on medical criteria related to visible and severe disabilities., Conclusions: Lack of accessibility, eligibility, reachability and affordability are the main barriers to access AT services for PWD in Nepal, India and Bangladesh. Increased community level awareness, increased Government funding and a community based, medically informed flexible social model of AT services is a way forward to ensure access to AT services for PWD in these countries.IMPLICATIONS FOR REHABILITATIONIncreased community awareness is necessary to increase access to Assistive Technology Services for Persons with Disabilities.Increased and flexible funding from the Government and philanthropists will improve rehabilitation.Establishment of community based Assistive Technology Services centres will increase access and improve rehabilitation.

The Nepal-India transboundary region hosts one of Asia's most complex large mammal assemblages, including a small (but growing) population of Asian elephants (Elephas maximus). These elephants occur in four widespread and geographically disjunct subpopulations, and some of them undergo seasonal transboundary movements. We conducted a broad-scale evaluation of the amount and quality of elephant habitat available in the region and of functional landscape connectivity between and within subpopulations using Maxent, circuit theory, and least-cost path analysis. Habitat suitability was highly influenced by abiotic geographical factors (altitude and precipitation) and less by ecological factors (habitat heterogeneity, plant productivity) and human disturbance (distance to settlements). The region had a relatively small amount of high and optimal suitability habitat (12.6% out of 93,700 km 2 ) but all subpopulations seem to be far from carrying capacity, suggesting ample potential for further population growth. Landscape connectivity was higher between and within the west and far-west subpopulations, which should be considered a single subpopulation. The central and ea st subpopulations, however, had low to very low between-subpopulation connectivity. Conservation priorities include maintaining the current connectivity in the west subpopulation and across the border in the east, and protecting high-quality habitats in eastern Nepal. Restoring connectivity between the central and other subpopulations is possible if the number of elephants continues growing, and it should be a long-term conservation aspiration. Maintaining and enhancing landscape connectivity in this region requires transboundary cooperation and coordination between Nepali and Indian authorities. If successful, it will bring considerable benefits for the conservation of elephants and other wildlife., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The Himalayan region is a fragile high mountain landscape where the population experiences acute vulnerability within a complex coupled human-natural system due to environmental, social, and economic linkages. The lack of significant regional and spatial knowledge of multi-faceted vulnerabilities hinders any potential recommendations to address these vulnerabilities. We systematically reviewed the literature to recommend mitigation interventions based on the region's socio-economic and ecological vulnerability research to date. We applied the PRISMA (Preferred Reporting of Items for Systematic Review and Meta-Analysis) criteria to search for results from four comprehensive databases. For our assessment, we compiled a final sample ( n = 59) of vulnerability research papers to examine the vulnerability types, spatial variation, assessment methodology, and significant drivers of change. Our study represented all Himalayan countries, namely, India, Nepal, Pakistan, China, and Bhutan. More than half of the vulnerability studies were conducted in the central Himalayan region, a quarter in the western Himalayas, and a few in the eastern Himalayas. Our review revealed that the primary drivers of change were climate change, land use/land cover, and glacial lake formation. The vulnerability assessments in the Himalayan region primarily used social science methods as compared to natural science methods. While the vulnerability studies seldom assessed mitigation interventions, our analysis identified fourteen recommendations. The recommended interventions mainly included policy interventions, livelihood improvement, and adaptation measures. This study emphasized that sustainable development requires cross-sectoral interventions to manage existing resources and mitigate the confronting vulnerabilities of the region.

When a child is born before 37 weeks or 259 days of pregnancy, it is termed as preterm birth. Pre-term birth is prevalent in both developed and developing country. However, difference lies in their survival. In lower and middle income countries, most preterm babies die due to lack of even simple interventions. India ranks top in the world for deaths due to complications of preterm birth. Similarly, other South Asian countries, Pakistan, Bangladesh, Afghanistan and Nepal rank 3rd, 6th, 9th and 20th in the same. The aim of this review paper is to provide a landscape analysis on the burden of pre-term birth and challenges in the context of South Asian region. Databases such as PubMed, Scopus and Google Scholar were searched from 2000 to 2020 and 27 articles are included in the study. It was found that pre-term birth causes huge burden in the form of morbidity, mortality as well as socio economic losses. Preterm birth was associated with increased sepsis, cardiovascular disease, respiratory illness, hypothermia, neurological and gastrointestinal complications. South Asian countries have distinct challenges in eliminating or reducing preterm births which are: poor quality health surveillance data, inadequate trained health workforce, insufficient finance and funding, service delivery and other methodological challenges. Ending pre-term birth is important as it is directly related to Sustainable Development Goal 3. Therefore, there should be increase in priority given to increase financing, quality data gathering, adopting innovative measures as well as joint efforts of all the sectors to control the pre-term birth.

Nepal is located in what was once known as the Himalayan Goitre Belt and once had one of the highest prevalence's of iodine deficiency disorders in the world. However, through a well-executed universal salt iodization program implemented over the past 25 years, it has achieved optimal iodine intake for its population, effectively eliminating the adverse consequences of iodine deficiency disorders. A comprehensive review of policy and legislation, surveys, and program reports was undertaken to examine the key elements contributing to the success of this program. The paper reviews the origins and maturation of salt iodization in Nepal, as well as trends in the coverage of iodized salt, the iodine content in salt, and population iodine status over the past two decades. The paper describes critical components of the program including advocacy efforts, trade issues with India, the role of the Salt Trading Corporation, monitoring, and periodic program reviews. The paper discusses the recent findings from the 2016 national micronutrient survey demonstrating the success of the salt iodization program and describes emerging challenges facing the program in the future., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

In radioecological studies, soil to plant transfer factors (TF) is commonly used to estimate the food chain transfer of radionuclides, which is an important parameter to assess ingestion doses to humans. Rice is an important (Oryza sativa L.) staple crop in tropical countries and is the major food crop consumed all over the world. Out of the seven countries (India, Pakistan, Bangladesh, Nepal, Bhutan, and the island nations like Sri Lanka and Maldives) of the Indian subcontinent, Bangladesh, Sri Lanka, and Maldives along with a major region of India fall under tropical climate class according to Köppen climate classification. Because, the soil to rice TF under equilibrium conditions are not available for all radionuclides, TF of naturally existing stable elements, which are analogues of radionuclides were compiled. This review paper presents the collection of the TF data of soil to grain and stems & shoots of rice plant for eighteen elements. Data were generated mainly from different sub climatic regions of the tropical environment of India and Bangladesh. An overview of the compilation, analysis, and discussion of the extent and limitations of the data is presented., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

While most of the countries around the globe are combating the pandemic of COVID-19, the level of its impact is quite variable among different countries. In particular, the data from Nepal, a developing country having an open border provision with highly COVID-19 affected country India, has shown a biphasic pattern of epidemic, a controlled phase (until July 21, 2020) followed by an outgrown phase (after July 21, 2020). To uncover the effective strategies implemented during the controlled phase, we develop a mathematical model that is able to describe the data from both phases of COVID-19 dynamics in Nepal. Using our best parameter estimates with 95% confidence interval, we found that during the controlled phase most of the recorded cases were imported from outside the country with a small number generated from the local transmission, consistent with the data. Our model predicts that these successful strategies were able to maintain the reproduction number at around 0.21 during the controlled phase, preventing 442,640 cases of COVID-19 and saving more than 1,200 lives in Nepal. However, during the outgrown phase, when the strategies such as border screening and quarantine, lockdown, and detection and isolation, were altered, the reproduction number raised to 1.8, resulting in exponentially growing cases of COVID-19. We further used our model to predict the long-term dynamics of COVID-19 in Nepal and found that without any interventions the current trend may result in about 18.76 million cases (10.70 million detected and 8.06 million undetected) and 89 thousand deaths in Nepal by the end of 2021. Finally, using our predictive model, we evaluated the effects of various control strategies on the long-term outcome of this epidemics and identified ideal strategies to curb the epidemic in Nepal., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Preventing modern slavery is of global interest, but evidence on interventions remains weak. This paper presents findings from a 5-year theory-based evaluation of an empowerment and knowledge-building intervention to prevent the exploitation of South Asian female migrant workers. The evaluation used realist evaluation techniques to examine the intervention mechanisms, outcomes, and context. Findings from qualitative and quantitative data from Nepal, India, and Bangladesh indicate that the intervention mechanisms (trainings) were not well-targeted, not delivered by appropriate trainers, and did not address participants' expectations or concerns. The outcomes of empowerment and migration knowledge were not achieved due to poor integration of context-related factors, flawed assumptions about the power inequalities, including barriers preventing women from asserting their rights. Ultimately, interventions to prevent exploitation of migrant workers should be developed based on strong evidence about the social, political, and economic realities of their migration context, especially in destination settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Zimmerman, Mak, Pocock and Kiss.)

In the present paper, two new genera of the Prabhasa Moore, 1878 / Zadadra Moore, 1878 generic complex are described: Dentadra gen. nov. (Type species: Prabhasa flavicosta Moore, 1878) and Prabadra gen. nov. (Type species: Prabadra occidentalis sp. nov.). Additionally, two new species are described: Prabadra occidentalis sp. nov. (NE India and N Thailand) and Zadadra confusa sp. nov. (Nepal, NE India, Bhutan and W China). The new synonymy is established: Zadadra distorta Moore, 1872 = Zadadra neodistorta Joshi, Kirti N. Singh, 2015, syn. nov. Two new combinations are established: Dentadra flavicosta (Moore, 1878), comb. nov. and Prabadra monastyrskii (Dubatolov, 2012), comb. nov. The lectotype is designated for Lithosia distorta Moore, 1872. Adults, male and female genitalia are illustrated. A checklist of the Prabhasa / Zadadra generic complex is provided.

This study discusses year-long (October 2016-September 2017) observations of atmospheric black carbon (BC) mass concentration, its source and sector contributions using a chemical transport model at a high-altitude (28°12'49.21″N, 85°36'33.77″E, 4900 masl) site located near the Yala Glacier in the central Himalayas, Nepal. During a field campaign, fresh snow samples were collected from the surface of the Yala Glacier in May 2017, which were analysed for BC and water-insoluble organic carbon mass concentration in order to estimate the scavenging ratio and surface albedo reduction. The maximum BC mass concentration in the ambient atmosphere (0.73 μg m -3 ) was recorded in the pre-monsoon season. The BC and water-insoluble organic carbon analysed from the snow samples were in the range of 96-542 ng g -1 and 152-827 ng g -1 , respectively. The source apportionment study using the absorption Ångström exponent from in situ observations indicated approximately 44% contribution of BC from biomass-burning sources and the remainder from fossil-fuel sources during the entire study period. The source contribution study, using model data sets, indicated ∼14% contribution of BC from open-burning and ∼77% from anthropogenic sources during the study period. Our analysis of regional contributions of BC indicated that the highest contribution was from both Nepal and India combined, followed by China, while the rest was distributed among the nearby countries. The surface snow albedo reduction, estimated by an online model - Snow, Ice, and Aerosol Radiation - was in the range of 0.8-3.8% during the pre-monsoon season. The glacier mass balance analysis suggested that BC contributed to approximately 39% of the total mass loss in the pre-monsoon season., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This paper aims to scrutinize the validity of the greenhouse emissions-induced environmental Kuznets curve (EKC) hypothesis, controlling for liquefied petroleum gas (LPG) consumption, FDI inflows, and trade openness, in the context of six South Asian economies. Besides, the impacts of LPG use on both aggregate and disaggregated emissions of greenhouse gases are also evaluated. Using annual data from 1980 to 2016, the elasticity estimates from the autoregressive distributed lag (ARDL) regression analysis confirms the authenticity of the EKC hypothesis for Bangladesh, India, Sri Lanka, and Bhutan. In the cases of Pakistan and Nepal, economic growth, in the long-run, is evidenced to monotonically increase and decrease the greenhouse emissions, respectively. However, LPG consumption is found to homogenously reduce all types of greenhouse emissions in each of the selected South Asian nations. Moreover, in majority of the cases, statistical evidence of joint favorable impacts of economic growth and LPG consumption on the environment are ascertained. Furthermore, the Hacker and Hatemi-J bootstrapped causality analysis finds causal relationships between economic growth, greenhouse emissions, and LPG consumption. However, the causality estimates are found to be heterogeneous across the different South Asian nations considered in the analysis. The results, in a nutshell, denote that economic growth is both the cause and the solution to the greenhouse emission problems faced by the South Asian economies. Moreover, the results also assert that LPG can be a transitional fuel to reduce these emissions before the South Asian nations are ready to undergo transition from non-renewable to renewable energy consumption. Hence, the findings impose key fuel-diversification policy implications for the South Asian governments.

South Asia continues to be the global hub for child undernutrition with 35% of children still stunted in 2017. This paper aimed to identify factors associated with stunting among children aged 0-23 months, 24-59 months, and 0-59 months in South Asia. A weighted sample of 564,518 children aged 0-59 months from the most recent Demographic and Health Surveys (2014-2018) was combined of five countries in South Asia. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. The common factors associated with stunting in three age groups were mothers with no schooling ([adjusted odds ratio (AOR) for 0-23 months = 1.65; 95% CI: (1.29, 2.13)]; [AOR for 24-59 months = AOR = 1.46; 95% CI: (1.27, 1. 69)] and [AOR for 0-59 months = AOR = 1.59; 95% CI: (1.34, 1. 88)]) and maternal short stature (height < 150 cm) ([AOR for 0-23 months = 2.00; 95% CI: (1.51, 2.65)]; [AOR for 24-59 months = 3.63; 95% CI: (2.87, 4.60)] and [AOR for 0-59 months = 2.87; 95% CI: (2.37, 3.48)]). Study findings suggest the need for a balanced and integrated nutrition strategy that incorporates nutrition-specific and nutrition-sensitive interventions with an increased focus on interventions for children aged 24-59 months.

Governance failures undermine efforts to achieve universal health coverage and improve health in low- and middle-income countries by decreasing efficiency and equity. Punitive measures to improve governance are largely ineffective. Social accountability strategies are perceived to enhance transparency and accountability through bottom-up approaches, but their effectiveness has not been explored comprehensively in the health systems of low- and middle-income countries in south and Southeast Asia where these strategies have been promoted. We conducted a narrative literature review to explore innovative social accountability approaches in Bangladesh, Bhutan, India, Indonesia, the Maldives, Myanmar and Nepal spanning the period 2007-August 2017, searching PubMed, Scopus and Google Scholar. To augment this, we also performed additional PubMed and Google Scholar searches (September 2017-December 2019) to identify recent papers, resulting in 38 documents (24 peer-reviewed articles and 14 grey sources), which we reviewed. Findings were analysed using framework analysis and categorized into three major themes: transparency/governance (eight), accountability (11) and community participation (five) papers. The majority of the reviewed approaches were implemented in Bangladesh, India and Nepal. The interventions differed on context (geographical to social), range (boarder reform to specific approaches), actors (public to private) and levels (community-specific to system level). The initiatives were associated with a variety of positive outcomes (e.g. improved monitoring, resource mobilization, service provision plus as a bridge between the engaged community and the health system), yet the evidence is inconclusive as to the extent that these influence health outcomes and access to health care. The review shows that there is no common blueprint which makes accountability mechanisms viable and effective; the effectiveness of these initiatives depended largely on context, capacity, information, spectrum of actor involvement, independence from power agendas and leadership. Major challenges that undermined effective implementation include lack of capacity, poor commitment and design and insufficient community participation., (© The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Energy security and environmental sustainability have become an integral policy agenda worldwide whereby the global economic growth policies are being restructured to ensure the reliability of energy supply and safeguard environmental well-being as well. However, technological inefficiency is one of the major hindrances in attaining these over-arching goals. Hence, this paper probed into the non-linear impacts of ICT trade on the prospects of undergoing renewable energy transition, improving energy use efficiencies, enhancing access to cleaner cooking fuels, and mitigating carbon dioxide emissions across selected South Asian economies: Bangladesh, India, Pakistan, Sri Lanka, Nepal, and Maldives. The results from the econometric analyses reveal that ICT trade directly increases renewable energy consumption, enhances renewable energy shares, reduces intensity of energy use, facilitates adoption of cleaner cooking fuels, and reduces carbon-dioxide emissions. Moreover, ICT trade also indirectly mitigates carbon-dioxide emissions through boosting renewable energy consumption levels, improving energy efficiencies, and enhancing cleaner cooking fuel access. Hence, these results, in a nutshell, portray the significance of reducing the barriers to ICT trade with respect to ensuring energy security and environmental sustainability across South Asia. Therefore, it is ideal for the government to gradually lessen the trade barriers to boost the volumes of cross-border flows of green ICT commodities. Besides, it is also recommended to attract foreign direct investments for the potential development of the respective ICT sectors of the South Asian economies.

Despite a large population and limited health infrastructure, the incidence and mortality of Coronavirus Disease 2019 (COVID-19) has been lower in South Asia than many regions. The underlying reasons and mechanisms for this relative protection are not established. However both genetic and environmental factors might play a role. Polymorphisms in ACE2 gene, ACE gene and in genes for some of the host cell proteases could affect the viral entry and replication. There is some evidence that HLA polymorphisms and several pathways involved in immune and inflammatory response could contribute to ethnic variation. Cross immunity because of past exposure to viral infections as well as malaria is likely to protect from the severe manifestations of disease. Role of BCG vaccination in trained innate immunity is recognised and could be a protective factor against COVID-19. There is limited evidence of the possibility of a less virulent viral strain circulating in South Asia. There is evidence from different parts of the world that temperature and humidity can influence viral survival as well as the host immune response. Finally implementation of early containment measures by some South Asian countries has also contributed to a less disease burden., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Greater one-horned rhinoceros (Rhinoceros unicornis) is one of the most iconic wildlife species in the world. Once reduced to fewer than 500 during the 1960s, its global population has been recovering and is now over 3500, thanks to effective conservation programs in India and Nepal, the only two countries in the world where this species is found. It is one of the greatest success stories in biodiversity conservation given that hundreds of other species have disappeared, and thousands of species are on the verge of extinction. However, poaching is not the only threat for the long-term survival of rhinoceros. Loss and degradation of grassland habitat and the drying-up of wetlands are emerging threats predicted to worsen in the future, but the published information on rhinoceros has never been synthesized. In order to better understand the trends and current status of rhinoceros research and identify research gaps inhibiting its long-term conservation, we analyzed the themes discussed in 215 articles covering a period of 33 years between 1985 and 2018. Our findings suggest that studies on both free-ranging and captive rhinoceros are skewed towards biological aspects of the species including morphology, anatomy, physiology, and behaviour. There are no studies addressing the likely effects of climate change on the species, and limited information is available on rhinoceros genetics, diseases, habitat dynamics and the impacts of tourism and other infrastructure development in and around rhinoceros habitat. These issues will need addressing to maintain the conservation success of greater one-horned rhinoceros into the future., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Investigating the impact of climate variables on net primary productivity is crucial to evaluate the ecosystem health and the status of forest type response to climate change. The objective of this paper is (1) to estimate spatio-temporal patterns of net primary productivity (NPP) during 2001 to 2010 in a tropical deciduous forest based on the input variable dataset (i.e.meteorological and biophysical) derived from the remote sensing and other sources and (2) to investigate the effects of climate variables on NPP during 2001 to 2010. The study was carried out in Katerniaghat Wildlife Sanctuary that forms a part of a tropical forest and is situated in Uttar Pradesh, India, along the Indo-Nepal border. Mean annual NPP was observed to be highest during 2007 with a value of 878 g C m -2  year -1 and 781.25 g C m -2  year -1 for sal and teak respectively. A decline in mean NPP during 2002-2003, 2005 and 2008-2010 could be attributed to drought, increased temperature and vapour pressure deficit (VPD). The time lag correlation analysis revealed precipitation as the major variables affecting NPP, whereas combination of temperature and VPD showed dominant effect on NPP as revealed by generalized linear modelling. The carbon gain in NPP in sal forest was observed to be marginal higher than that of teak plantation throughout the study period. The decrease in NPP was observed during 2010, pertaining to increased VPD. Contribution of different climatic variables through some link process was revealed in statistical analysis and clearly indicated the co-dominance of all the variables in explaining NPP.

Palliative care is recognised as a fundamental component of Universal Health Coverage (UHC), which individual countries, led by the United Nations and the WHO, are committed to achieving worldwide by 2030-Sustainable Development Goal (SDG) 3.8. As the incidence of non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) increases, their prevention and control are the central aspects of UHC in these areas. While the main focus is on reducing premature mortality from NCDs (SDG 3.4), palliative care is becoming increasingly important in LMICs, in which 80% of the need is found. This paper discusses the challenges of providing comprehensive NCD management in LMICs, the role of palliative care in addressing the huge and growing burden of serious health-related suffering, and also its scope for leveraging various aspects of primary care NCD management. Drawing on experiences in India and Nepal, and particularly a project on the India-Nepal border in which palliative care, community health and primary care-led NCD management are being integrated, we explore the synergies arising and describe a model where palliative care is integral to the whole spectrum of NCD management, from promotion and prevention, through treatment, rehabilitation and palliation. We believe this model could provide a framework for integrated NCD management more generally in rural India and Nepal and also other LMICs as they work to make NCD management as part of UHC a reality., Competing Interests: Competing interests: VK and SK are employed by Duncan Hospital. DM undertook an evaluation of the CHETNA programme at Duncan Hospital, for which he received expenses but was not paid, and he evaluated the original EHA palliative care programme, for which he received an honorarium. LG has no conflict of interest to declare., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Vespa velutina nigrithorax is an invasive alien organism that has raised concerns in all beekeeping communities of invaded countries including the Republic of Korea, European countries and Japan. Known also as the yellow-legged hornet (or the 'Asian hornet'), it is native to northern India, eastern Nepal, Bhutan and the People's Republic of China. Given its climatic and biological characteristics and the effects of climate change, some coastal areas of North America, Argentina, South Africa, Australia and New Zealand are also susceptible to invasion. Vespa velutina nigrithorax notably affects managed honey-bee colonies by predation on foragers and causing a reduction in the collection of food resources. Being a generalist predator, the yellow-legged hornet also preys on other managed and wild pollinators, and therefore its impacts are not limited to the beekeeping sector but also represent a biodiversity concern. The purpose of this paper is to provide an assessment of V. v. nigrithorax against the four criteria established in Chapter 1.2. of the World Organisation for Animal Health (OIE) Terrestrial Animal Health Code for the inclusion of a disease, infection or infestation in the OIE list. The work was requested by the OIE Scientific Commission for Animal Diseases and presented to this Commission and to the OIE Terrestrial Animal Health Standards Commission in September 2017. Owing to the lack of effective measures to prevent its spread, the fact that its legal situation in some countries is under the mandate of environmental authorities rather than Veterinary Services, and because it is not considered a disease or parasite, V. v. nigrithorax is not currently being proposed for inclusion in the OIE list. At the end of the text, the statements from the two commissions are included and discussed.

"Leaving no one behind" is at the heart of the agenda of the Sustainable Development Goals, requiring that health systems be vigilant to how interventions can be accessed equitably by all, including population subgroups that face exclusion. In the World Health Organization (WHO) South-East Asia Region, inequalities can be found across and within countries but there has been a growing commitment to examining and starting to tackle them. Over the past decade in particular, WHO has been developing an armamentarium of tools to enable analysis of health inequalities and action on health equity. Tools include the Health Equity Assessment Toolkit in built-in database and upload database editions, as well as the Innov8 tool for reorientation of national health programmes. Countries across the region have engaged meaningfully in the development and application of these tools, in many cases aligning them with, or including them as part of, ongoing efforts to examine inequities in population subgroups domestically. This paper reflects on these experiences in Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand, where efforts have ranged from workshops to programme reorientation; the creation of assemblies and conferences; and collation of evidence through collaborative research, reviews/synthesis and conferences. This promising start must be maintained and expanded, with greater emphasis on building capacity for interpretation and use of evidence on inequalities in policy-making. This may be further enhanced by the use of innovative mixed methodologies and interdisciplinary approaches to refine and contextualize evidence, with a concomitant shift in attention, developing solutions to redress inequities and anchor health reform within communities. There are many lessons to be learnt in this region, as well as mounting political and popular will for change., Competing Interests: None

Children are particularly vulnerable to environmental hazards because they receive higher doses of pollutants in any given environment and often do not have equitable access to social protection mechanisms such as environmental and health care services. The World Health Organization established a global network of collaborating centres that address children's environmental health (CEH). The network developed a focus on low- and middle-income countries (LMICs) and is broadening its reach by conducting regional workshops for CEH.Objective: This paper reports on the outcomes of a workshop held in conjunction with the 17th International Conference (November 2017) of the Pacific Basin Consortium for Environment and Health, focused on the state of CEH in South and Southeast Asia as presented by seven countries from the region (India, Bangladesh, Nepal, Bhutan, Vietnam, Thailand, Sri Lanka).Workshop outcomes: Country reports presented at the meeting show a high degree of similarity with respect to the issues threatening the health of children. The most common problems are outdoor and household air pollution in addition to exposure to heavy metals, industrial chemicals, and pesticides. Many children still do not have adequate access to clean water and improved sanitation while infectious diseases remain a problem, especially for children living in poverty. Child labour is widely prevalent, generally without adequate training or personal protective equipment. The children now face the dual burden of undernutrition and stunting on the one hand and overnutrition and obesity on the other.Conclusion: It is evident that some countries in these regions are doing better than others in varying areas of CEH. By establishing and participating in regional networks, countries can learn from each other and harmonise their efforts to protect CEH so that all can benefit from closer interactions., Competing Interests: The authors have no competing interests to declare., (© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.)

Background: As Bangladesh, India and Nepal progress towards visceral leishmaniasis (VL) elimination, it is important to understand the role of asymptomatic Leishmania infection (ALI), VL treatment relapse and post kala-azar dermal leishmaniasis (PKDL) in transmission., Methodology/ Principal Finding: We reviewed evidence systematically on ALI, relapse and PKDL. We searched multiple databases to include studies on burden, risk factors, biomarkers, natural history, and infectiveness of ALI, PKDL and relapse. After screening 292 papers, 98 were included covering the years 1942 through 2016. ALI, PKDL and relapse studies lacked a reference standard and appropriate biomarker. The prevalence of ALI was 4-17-fold that of VL. The risk of ALI was higher in VL case contacts. Most infections remained asymptomatic or resolved spontaneously. The proportion of ALI that progressed to VL disease within a year was 1.5-23%, and was higher amongst those with high antibody titres. The natural history of PKDL showed variability; 3.8-28.6% had no past history of VL treatment. The infectiveness of PKDL was 32-53%. The risk of VL relapse was higher with HIV co-infection. Modelling studies predicted a range of scenarios. One model predicted VL elimination was unlikely in the long term with early diagnosis. Another model estimated that ALI contributed to 82% of the overall transmission, VL to 10% and PKDL to 8%. Another model predicted that VL cases were the main driver for transmission. Different models predicted VL elimination if the sandfly density was reduced by 67% by killing the sandfly or by 79% by reducing their breeding sites, or with 4-6y of optimal IRS or 10y of sub-optimal IRS and only in low endemic setting., Conclusion/ Significance: There is a need for xenodiagnostic and longitudinal studies to understand the potential of ALI and PKDL as reservoirs of infection.

This paper explores immigrant community leaders' perspectives on culturally appropriate diabetes education and care. We conducted exploratory workshops followed by focus groups with Punjabi, Nepali, Somali, and Latin American immigrant communities in Ottawa, Ontario. We used the constant comparative method of grounded theory to explore issues of trust and its impact on access and effectiveness of care. Detailed inquiry revealed the cross cutting theme of trust at the "entry" level and in relation to "accuracy" of diabetes information, as well as the influence of trust on personal "privacy" and on the "uptake" of recommendations. These four dimensions of trust stood out among immigrant community leaders: entry level, accuracy level, privacy level, and intervention level and were considered important attributes of culturally appropriate diabetes education and care. These dimensions of trust may promote trust at the patient-practitioner level and also may help build trust in the health care system.

Background: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care., Methods: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts., Results: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care., Conclusions: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.

The Global Vaccine Action Plan includes a goal of meeting global and regional measles and rubella elimination targets, noting that such efforts should not operate in silos but be coordinated with other immunization efforts. Similarly, the Global Measles and Rubella Strategic Plan for 2012-2020 emphasizes the need for integrated approaches to achieve and maintain very high levels of population immunity using both routine immunization and supplemental immunization activities (SIAs). The strategic plan also includes routine vaccination coverage targets, highlighting the critical role of strong routine immunization systems as a cornerstone for sustainable measles control/elimination efforts. It encourages exploiting the resources and visibility of SIAs to strengthen routine immunization, thereby reducing the frequency with which SIAs are needed. Documented examples of doing so include training health workers, procuring cold chain equipment, and improving injection safety and adverse events management. However, the concept has been put into practice only to a limited extent and missed opportunities persist regarding this aspect of SIA planning and execution. This paper draws on recent studies of the interaction between measles activities and health systems as well as country experiences in using SIAs to strengthen routine immunization. It identifies obstacles and enabling factors to doing so and proposes options for systematically strengthening routine immunization as part of a best practice SIA., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

High densities of people living around protected areas (PAs) in South Asia require management strategies to balance conservation goals and livelihood needs. Based on a survey of 777 households around five PAs in India and Nepal, this paper provides a comparative perspective of Indian and Nepali households' views of protected area benefits and costs, their attitude toward conservation in general, and attitude toward protected area staff. Results indicate mixed responses towards tourism, varying from very favorable in Nepal to less favorable in India. The majority (81%) held positive attitudes towards the existence and importance of PAs but had negative perceptions of PA staff (69%). Most residents perceived benefits from access to fuel wood, fodder and other PA resources including benefits from tourism, while crop and livestock losses from wildlife were the main costs. Households overall positive attitudes towards the PAs and conservation despite high losses from living around PAs suggests that local residents may support conservation if their livelihood needs are met. Comparisons of household attitudes and perceptions suggest that locally based strategies rather than top-down approaches are likely to be more effective. Extending PA benefits to smaller landholders, households that are highly resource-dependent or experiencing higher income losses from human-wildlife conflicts, and less educated residents are particularly important to balance costs and losses from living around protected areas.

Populations of oriental white-backed vulture (Gyps bengalensis), long-billed vulture (Gyps indicus) and slender-billed vulture (Gyps tenuirostris) crashed during the mid-1990s throughout the Indian subcontinent. Surveys in India, initially conducted in 1991-1993 and repeated in 2000, 2002, 2003 and 2007, revealed that the population of Gyps bengalensis had fallen by 2007 to 0.1% of its numbers in the early 1990s, with the population of Gyps indicus and G. tenuirostris combined having fallen to 3.2% of its earlier level. A survey of G. bengalensis in western Nepal indicated that the size of the population in 2009 was 25% of that in 2002. In this paper, repeat surveys conducted in 2011 were analysed to estimate recent population trends. Populations of all three species of vulture remained at a low level, but the decline had slowed and may even have reversed for G. bengalensis, both in India and Nepal. However, estimates of the most recent population trends are imprecise, so it is possible that declines may be continuing, though at a significantly slower rate. The degree to which the decline of G. bengalensis in India has slowed is consistent with the expected effects on population trend of a measured change in the level of contamination of ungulate carcasses with the drug diclofenac, which is toxic to vultures, following a ban on its veterinary use in 2006. The most recent available information indicates that the elimination of diclofenac from the vultures' food supply is incomplete, so further efforts are required to fully implement the ban.

Ophiocordyceps sinensis is one of the best known fungi in Traditional Chinese Medicine. Many efforts have been devoted to locating the production areas of this species resulting in various reports; however, its geographic distribution remains incompletely understood. Distribution of O. sinensis at the county level is clarified in this work based on both a literature search and fieldwork. More than 3600 publications related to O. sinensis were investigated, including scientific papers, books, and online information. Herbarium specimens of O. sinensis and field collections made by this research group during the years 2000-2010 were examined to verify the distribution sites. A total of 203 localities for O. sinensis have been found, of which 106 are considered as confirmed distribution sites, 65 as possible distribution sites, 29 as excluded distribution sites and three as suspicious distribution sites. The results show that O. sinensis is confined to the Tibetan Plateau and its surrounding regions, including Tibet, Gansu, Qinghai, Sichuan, and Yunnan provinces in China and in certain areas of the southern flank of the Himalayas, in the countries of Bhutan, India and Nepal, with 3,000 m as the lowest altitude for the distribution. The fungus is distributed from the southernmost site in Yulong Naxi Autonomous County in northwestern Yunnan Province to the northernmost site in the Qilian Mountains in Qilian County, Qinghai Province, and from the east edge of the Tibetan Plateau in Wudu County, Gansu Province to the westernmost site in Uttarakhand, India. The clarification of the geographic distribution of O. sinensis will lay the foundation for conservation and sustainable use of the species.

Evidences of reappearance of chloroquine sensitive Plasmodium falciparum haplotypes after cessation of chloroquine in many countries provide a rationale for the search of chloroquine sensitive haplotypes in P. falciparum isolates in Nepal where the use of chloroquine for falciparum malaria treatment has been ceased since 1988. P. falciparum chloroquine resistant transporter gene (pfcrt) haplotypes were determined and the factors associated with pfcrt haplotypes in the Eastern and Central regions of Nepal were identified. Blood samples from 106 microscopy-positive falciparum malaria patients (62 from the Eastern and 44 from the Central region) were collected on filter paper. Pfcrt region covering codons 72-76 was amplified by PCR and sequenced. SVMNT haplotype was predominant in the Central region, whereas CVIET haplotype significantly more common in the Eastern region. In multivariable analysis of factors associated with CVIET haplotype, the Eastern region and parasite isolates from patients visiting India within one month are significant at 5% level of significance. These findings suggest that antimalarial pressure is different between Eastern and Central regions of Nepal and there is a need of an effective malaria control program in the border areas between India and Nepal.

Objectives: To investigate the DDT and deltamethrin susceptibility of Phlebotomus argentipes, the vector of Leishmania donovani, responsible for visceral leishmaniasis (VL), in two countries (India and Nepal) with different histories of insecticide exposure., Methods: Standard WHO testing procedures were applied using 4% DDT and 0.05% deltamethrin impregnated papers. The effect of the physiological status (fed and unfed) of females on the outcome of the bioassays was assessed and the optimal time of exposure for deltamethrin was evaluated on a colony population. Field populations from both countries were tested., Results: Fed and unfed females responded in a similar way. For exposure time on field samples 60 min was adopted for both DDT and deltamethrin. In Bihar, knockdown and mortality with DDT was respectively 20 and 43%. In Nepal almost all sand flies were killed, except at the border with Bihar (mortality 62%). With 0.05% deltamethrin, between 96 and 100% of the sand flies were killed in both regions., Conclusions: Based on literature and present data 4% DDT and 0.05% deltamethrin seem to be acceptable discriminating concentrations to separate resistant from susceptible populations. Resistance to DDT was confirmed in Bihar and in a border village of Nepal, but the sand flies were still susceptible in villages more inside Nepal where only synthetic pyrethroids are used for indoor spraying. The low effectiveness of indoor spraying with DDT in Bihar to control VL can be partially explained by this resistance hence other classes of insecticides should be tested. In both countries P. argentipes sand flies were susceptible to deltamethrin.

Background & Objectives: Visceral leishmaniasis, locally known as kala-azar (KA) has been considered as a major public health problem in Bangladesh, India and Nepal that affects 100,000 people per year with 147 million people at risk. Elimination of infectious disease is an ultimate goal of the public health system, therefore, the efforts have recently gained momentum from various organizations and governments to expand KA interventions in the endemic countries. The paper aims to estimate discounted net benefits and internal rate of return (IRR) to evaluate the economic feasibility for elimination of KA by utilizing available secondary information., Methods: Cross-sectional data were collected from different sources to estimate societal costs of and benefits from KA interventions with a 13-year project period. Total costs are estimated based on the unit cost of inputs used for interventions. The benefits are derived from productivity change and resources saved due to reduction of KA incidence. Net benefits and IRRs are estimated based on standard procedures used in the field of economics, subsequently the sensitivity analysis is conducted., Results: A total discounted net benefit of KA intervention is Nepalese Rupees (NRs) 65,287 million with 35% IRR. The result suggests that for every rupee invested in KA intervention at present will yield NRs 71 in future. The regional benefits from the interventions will be greater than the sum of benefits gained by the individual country due to its nature of public goods., Conclusion: Elimination of KA is a good investment opportunity for the Government and international partners involved in the health sector.

Context: The Indian subcontinent is one of the most populous regions in the world. Given the projected rapid population growth and ageing of the population, age-related macular degeneration (AMD) is likely to emerge as a major public health threat in the near future. However, existing literature on AMD in the region is scarce., Methods: This paper reviews the epidemiology and risk factors of AMD in the Indian subcontinent., Results: Data on AMD in India show prevalences ranging from 1.8% to 4.7%. Blindness prevalence studies in Pakistan, Bangladesh and Nepal have also reported rates of 2.1% to 8.7% for all blindness attributable to AMD. Age-related macular degeneration is therefore a significant cause of visual morbidity in these countries. To date, no reliable epidemiological data on AMD or blindness have been published for Sri Lanka, Afghanistan, Maldives or Bhutan., Conclusions: The prevalence of AMD in the region is likely to follow a trend similar to that seen in the developed world in the coming years. Eye care policies should therefore make provisions for this chronic age-related eye disease. In addition, there is an urgent need for more data on the epidemiology of AMD in the Indian subcontinent.

Sukako maacha, gnuchi, sidra and sukuti are traditional smoked and sun-dried fish products of the Eastern Himalayan regions of Nepal and India. A total of 40 samples of sukako maacha (14), gnuchi (6), sidra (10) and sukuti (10) were collected and were analysed for microbial load. Population of lactic acid bacteria (LAB) as well as aerobic mesophilic counts ranged from 4.7-8.3 to 5.1-8.5 log cfu g(-1), respectively. A total of 189 strains of LAB were isolated from sukako maacha, gnuchi, sidra and sukuti samples, out of which 171 strains were cocci and 15 strains, were heterofermentative lactobacilli. LAB were identified on the basis of phenotypic characters including API system as Lactococcus lactis subsp. cremoris, Lactococcus lactis subsp. lactis, Lactococcus plantarum, Leuconostoc mesenteroides, Enterococcus faecium, Enterococcus faecalis, Pediococcus pentosaceus and Weissella confusa. LAB strains produced a wide spectrum of enzymes. Some strains of LAB showed antagonistic properties against pathogenic strains. None of the strains produced biogenic amines in the method applied. This paper is the first report on the microbial composition, mostly lactic acid bacteria, of traditionally processed fish products of Eastern Himalayas.

Though the history of in-country training of doctors in Nepal is not long, Nepal had started training doctors in abroad long ago. This is probably the first paper of its kind to correlate the developmental and ecological region to the country of training of Nepali doctors. This retrospective analysis reveals that nearly 38% doctors are trained in India, 22% each from former USSR and Nepal, 10% from Bangladesh, and 2.5% from Pakistan. Other countries contribute very few in the list. Nearly 2/3rd of the doctors represent the central developmental region and most of them are from Kathmandu valley. Ecologically mountain and hills are in great minority compared to Kathmandu valley and Terai. Interestingly training in former USSR shows a bit wider base regarding the origin in terms of developmental region. And Nepal has a clear broad base both in terms of developmental and ecological regions. As most of the doctors among Nepal trained ones are from IOM, the role of IOM way of selecting medical students need a deeper look into it.

Currently the majority of the world's elderly reside in less developed countries and their proportion is increasing. This paper presents evidence that the process of modernization can have a negative impact on the elderly in even the most remote rural Third World settings, even though those settings are not modernized or in the process of modernization in any of the normal uses of that concept. Fieldwork was conducted in Helambu, Nepal on a sample of 37 persons over the age of 50 that included 86% of population aged 60 and over. Despite high levels of activity, health, social and economic status, the elderly were greatly dissatisfied with their situation. The paper demonstrates the manner in which modernization in India has profoundly changed household/family organization in Helambu and produced this situation.