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Although the Government of Nepal has achieved high and sustained childhood vaccination coverage, reaching under-immunized and zero-dose children requires different approaches. Behavioral science offers promise in better understanding the drivers of vaccination and development of more effective programs; however, the application of behavioral science to immunization programs in Nepal is nascent. Through the Behavioral Science Immunization Network, JSI, UNICEF Nepal, and Dhulikhel Hospital–Kathmandu University School of Medical Sciences established a Behavioral Science Center to engage a diverse group of stakeholders in increasing the capacity of practitioners to use behavioral science in immunization programming. As a result of the engagement during formative research, government stakeholders requested and applied tools from behavioral science to solve different immunization challenges. Of particular value was the use of the Journey to Health and Immunization framework, which helped stakeholders identify behavioral and social drivers of zero-dose communities in Kathmandu. Our experience in Nepal demonstrates that there is strong demand for approaches and tools from behavioral science to use in relation to immunization and that this type of engagement model is effective for generating demand for and strengthening capacity to use behavioral science approaches. [ABSTRACT FROM AUTHOR]

Background: The prevalence of antimicrobial resistance (AMR) among Gram-negative bacteria is alarmingly high. Reintroduction of colistin as last resort treatment in the infections caused by drug-resistant Gram-negative bacteria has led to the emergence and spread of colistin resistance. This study was designed to determine the prevalence of drug-resistance among beta-lactamase-producing strains of Escherichia coli and Klebsiella pneumoniae, isolated from the clinical specimens received at a tertiary care centre of Kathmandu, Nepal during the period of March to August, 2019. Methods: A total of 3216 different clinical samples were processed in the Microbiology laboratory of Kathmandu Model Hospital. Gram-negative isolates (E. coli and K. pneumoniae) were processed for antimicrobial susceptibility test (AST) by using modified Kirby-Bauer disc diffusion method. Drug-resistant isolates were further screened for extended-spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL), carbapenemase and K. pneumoniae carbapenemase (KPC) production tests. All the suspected enzyme producers were processed for phenotypic confirmatory tests. Colistin resistance was determined by minimum inhibitory concentration (MIC) using agar dilution method. Colistin resistant strains were further screened for plasmid-mediated mcr-1 gene using conventional polymerase chain reaction (PCR). Results: Among the total samples processed, 16.4% (529/3216) samples had bacterial growth. A total of 583 bacterial isolates were recovered from 529 clinical samples. Among the total isolates, 78.0% (455/583) isolates were Gram-negative bacteria. The most predominant isolate among Gram-negatives was E. coli (66.4%; 302/455) and K. pneumoniae isolates were 9% (41/455). In AST, colistin, polymyxin B and tigecycline were the most effective antibiotics. The overall prevalence of multidrug-resistance (MDR) among both of the isolates was 58.0% (199/343). In the ESBL testing, 41.1% (n = 141) isolates were confirmed as ESBL-producers. The prevalence of ESBL-producing E. coli was 43% (130/302) whereas that of K. pneumoniae was 26.8% (11/41). Similarly, 12.5% (43/343) of the total isolates, 10.9% (33/302) of E. coli and 24.3% of (10/41) K. pneumoniae were resistant to carbapenem. Among 43 carbapenem resistant isolates, 30.2% (13/43) and 60.5% (26/43) were KPC and MBL-producers respectively. KPC-producers isolates of E. coli and K. pneumoniae were 33.3% (11/33) and 20% (2/10) respectively. Similarly, 63.6% (21/33) of the E. coli and 50% (5/10) of the K. pneumoniae were MBL-producers. In MIC assay, 2.2% (4/179) of E. coli and 10% (2/20) of K. pneumoniae isolates were confirmed as colistin resistant (MIC ≥ 4 µg/ml). Overall, the prevalence of colistin resistance was 3.1% (6/199) and acquisition of mcr-1 was 16.6% (3/18) among the E. coli isolates. Conclusion: High prevalence of drug-resistance in our study is indicative of a deteriorating situation of AMR. Moreover, significant prevalence of resistant enzymes in our study reinforces their roles in the emergence of drug resistance. Resistance to last resort drug (colistin) and the isolation of mcr-1 indicate further urgency in infection management. Therefore, extensive surveillance, formulation and implementation of effective policies, augmentation of diagnostic facilities and incorporation of antibiotic stewardship programs can be some remedies to cope with this global crisis. [ABSTRACT FROM AUTHOR]

This paper presents an investigation of the collapse of a 325-year-old multi-tiered heritage temple during the 2015 Gorkha earthquake in Kathmandu, Nepal. The research comprises a reconnaissance survey followed by a geotechnical investigation and numerical back-analysis carried out to understand the potential causes of the collapse. The assessment of the structural configuration of the temple indicated seismic vulnerability in the design due to the presence of discontinuous columns over the height of the temple and age-weakened bonding in the masonry walls. The geotechnical investigation revealed the presence of competent soil strata at the location, assisting the survey which indicated no differential or excessive settlement in the foundation. A series of cyclic triaxial tests were conducted on samples recovered during the geotechnical investigation to determine dynamic behaviour of the soil. Further, dynamic analysis of the plinth of the temple under the recorded acceleration–time history indicated a maximum drift percentage of 1.4% and residual relative displacement of 32 mm suggesting the potential reason behind the collapse. The output of this research will support seismic rehabilitation of ancient structures within World Heritage sites across Nepal and effective action plans to safeguard them against future earthquake hazard. [ABSTRACT FROM AUTHOR]

Nosocomial infection is the infection that has been caught in a hospital and is potentially caused by organisms that are not susceptible to antibiotics. Nosocomial infections are transmitted directly or indirectly through air and may cause different types of infections. This study was undertaken with an objective to determine the prevalence of nosocomial bacteria present in hospital indoor environment. A total of 16 air samples were taken from general wards and emergency wards of 8 different hospitals using an impactor air sampler in nutrient agar, mannitol salt agar, blood agar, cetrimide agar, and MacConkey agar. The bacteriological agents were isolated and identified by cultural characteristics, Gram staining, and biochemical tests, and their antibiotic susceptibility pattern was determined using CLSI Guideline, 2015. According to the European Union Guidelines to Good Manufacturing Practices, the hospitals were under C- and D-grade air quality. According to the European Commission, most of the hospitals were intermediately polluted. Out of 16 indoor air samples, 47.18% of Staphylococcus aureus and 1.82% Pseudomonas spp. were isolated. CoNS, Streptococcus spp., Micrococcus spp., and Bacillus spp. and Gram-negative bacteria E.coli and Proteus spp. were identified. The bacterial load was found to be high in the emergency ward (55.8%) in comparison to that in the general ward (44.2%). There is statistically no significant difference between bacterial load and 2 wards (general and emergency) of different hospitals and among different hospitals. The most effective antibiotic against S. aureus was gentamicin (81.81%) and ofloxacin (81.81%). Among the antibiotics used for Pseudomonas spp., ceftriaxone (83.3%) and ofloxacin (83.3%) were effective. High prevalence of S. aureus and Gram-negative bacteria was found in this study; it is therefore important to monitor air quality regularly at different hospitals to prevent HAI. [ABSTRACT FROM AUTHOR]

Background and Aim: Kathmandu is a densely populated metropolitan city in Nepal. In recent years, however, the metropolis has been ranked as one of the most polluted cities worldwide. Both humans and animals are susceptible to various respiratory diseases due to chronic exposure to polluted air. Due to the relative similarities in the anatomical structure and physiological functions of the respiratory system between humans and dogs, polluted environments may lead to respiratory illness in similar ways in both species living in the valley. On the basis of information on the air quality in the valley, this study was conceived to assess pulmonary illness in street dogs to discern the health hazards caused by polluted air. Materials and Methods: A total of 76 dogs with clinical signs of tachypnea, dyspnea, sneezing, coughing, mucopurulent discharge, moderate hyperthermia, and anorexia admitted from July 2020 to November 2020 in Animal Nepal for treatment were included in this study. Among them, 24 animals responded to treatment, and 52 dogs died during their stay in the hospital. The 52 dead animals were necropsied, and the lesions that resembled pulmonary anthracosis were further studied grossly and histologically in a blinded fashion by trained veterinary pathologists. Results: Significant morphological alterations were observed in the lungs and associated lymph nodes of 25 animals, indicating pulmonary anthracosis. Gross morphological changes included multiple black foci with hemorrhage, congestion, nodular, and emphysema on the parietal and visceral surfaces of the lungs. The alveolar septa and visceral pleura exhibited deposition of black particles. Congestion, emphysema, and inflammatory exudates were also detected in the lung tissues and lymph nodes. Conclusion: The clinical, gross, and microscopic findings accurately resembled those of pulmonary anthracosis. This lifethreatening condition in stray canines may be caused by a critical level of air pollution from different sources and carbon emissions from vehicles. To protect animals and humans living in the Kathmandu Valley, concerned government and nongovernment agencies should work toward reducing air pollution levels as soon as possible. [ABSTRACT FROM AUTHOR]