Nepalese Children Research Articles

Difficulties in Adapting at School Among Nepalese Immigrant Children in Japan.

Japan has experienced a shift toward a multicultural society, and an increasing number of immigrant children have enrolled in its educational systems. Unforeseen experiences may affect the mental well-being of these children and undermine their holistic development; however, research is scarce. This article explores parents' concern on Nepalese children's experiences in Japanese schools. We aim to reveal the issues that may inform healthcare professionals and schools in best supporting immigrant students. Qualitative survey methods were adopted in an online survey tool to access and collect data from 13 Nepalese parents whose children (age 6-18 years) attended the schools (elementary or junior high school) in four prefectures of Japan. Thematic analysis was used to analyze the data. The following four themes were identified: (i) interaction and relationship; (ii) feeling different and meals at school; (iii) academic exclusion-lack of assistance/review at home; and (iv) emotional distress, peer exclusion, and bullying. Our findings suggest that because of the linguistic and cultural differences, children had difficulty communicating, leading to poor interpersonal relationships. Subjects reported changes in daily living patterns at home and school, and children felt different, shy, and unable to make friends or get involved. There were problems with school meals as well, and parents expressed concern over a lack of academic assistance. Some noteworthy emotional aspects were inability to be happy at school and bullying or exclusion from peers. They did, however, express the impression that Japanese students and teachers are cooperative. Overall, these findings have implications for schoolteachers, nurses, health personnel, parents, and others who promote the mental well-being and holistic development of children. This study provides a basis for mental health educational programs targeting the relationship between migrant and native students to create an inclusive society for all.

An observational study on emerging antimicrobial resistance pattern in urinary tract Infection in Nepalese children

AIMS Evidence-based management and local antibiotic susceptibility pattern provides evidence to guide the development of urinary tract infection (UTI) treatments protocols decreasing the economic burden significantly. We aimed to investigate the aetiology and resistance pattern of bacterial uropathogens to commonly prescribed oral antibiotics (beta lactamase and fluoroquinolones) causing UTI and to recommend the most appropriate antibiotics.
 MATERIALS AND METHODS This study is cross sectional, retrospective study. We evaluated causative agents and antimicrobial resistance in urine, culture positive samples collected from July 2019 to June 2021 in a single hospital in Kathmandu, Nepal. To obtain urine samples, a midstream clean-catch method used in children who were toilet trained and transurethral catheterization performed in non-toilet-trained children. Urine samples were sent to the laboratory where they were inoculated using a 4 mm calibre loop on CLED (Cysteine Lactose Electrolyte Deficient) agar plate, and incubated at 37 °C for 18–24 h. Conventional methods (colony morphology, Gram stain) were opted. Different biochemical tests – catalase test, coagulase test and inoculation in Bile Esculin Agar was done for Gram-positive organisms, while Triple Sugar Indole (TSI) agar, Sulphide indole motility (SIM) agar, Simon's citrate agar and Christensen's urea agar were used for identification of Gram-negative bacilli. Significant growth was evaluated as ≥105 colony forming units (CFU)/ml of urine. Kirby-Bauer disc diffusion method was used to perform in vitro antimicrobial susceptibility tests in Mueller-Hinton agar plates. Total 13 drugs were tested for sensitivity pattern. To analyse resistance to antibiotics for different ages, subjects were divided into four age groups: Group I, 2 months - 1 year; Group II, 1 year - 5 year; Group III, 5 year - 10 year; Group IV, 10 year - 15 year.
 RESULTS Among 970 samples sent, a total of 230 positive urine cultures were identified, of which 116 (50.4%) were from girls and 114 (49.6%) were from boys. The most common age group was 2 months to 1 year (49.1%). The most common causative agent was Escherichia coli (49.1%) followed by Enterococcus faecalis (14.3%) and Klebsiella pneumoniae (11.3%). The overall resistance to Nalidixic acid (66%), Ceftriaxone (54.8%) Cefotaxime (48.3%) Ciprofloxacin (47.9%) and Co-trimoxazole (46.9%) was significant. The least resistance was for Chloramphenicol, Nitrofurantoin, and Norfloxacin was 9.5 %, 31.5 %, and 38.3 % respectively. Chloramphenicol (90.5%) was the most active agent against E. coli and Klebsiella, whereas Linezolid (92.7%) and cloxacillin (64.9%) was most active against Enterococcus and Staphylococcus species.
 CONCLUSION Escherichia coli was the most common causative agent of urinary tract infection in children. Nalidixic acid, Ceftriaxone, Cefotaxime, Ciprofloxacin and Co-trimoxazole had the highest resistance rates against urinary tract pathogens in our centre. For oral empirical antibiotic therapy, Chloramphenicol is the most appropriate choice for Escherichia coli and Klebsiella strains and Linezolid for Enterococcus species.

Emergence Time and Sequence of Primary Teeth in a Sample of Nepalese Children

Background Primary teeth emergence is an important milestone in children and timing of emergence varies among populations.
 Objective To determine the emergence time and sequence of primary teeth in a sample of Nepalese children visiting Dhulikhel Hospital.
 Method A descriptive cross-sectional study was conducted in children of 5 months to 4 years visiting Dhulikhel Hospital. The emergence of incisal tip to incisal margin for incisors and canines, cusp tip to occlusal margin of molars visible were recorded along with age in months and gender. Descriptive statistics was done to calculate the mean age of emergence of each tooth with standard deviation. Unpaired t-test was used to assess the difference between the mean age of emergence of teeth between right and left sides and between boys and girls.
 Result The first teeth to emerge was mandibular central incisor at the age of 9.37 ± 1.42 months and the last one was maxillary second molar at the age of 32.91 ± 6.39 months. There was no significant difference in the mean emergence time between the maxillary and mandibular jaws, between right and left sides of jaws and between boys and girls except for primary maxillary right central incisor and mandibular right second molar which was found to be emerged early in girls.
 Conclusion The emergence time and sequence of primary teeth observed in the present study can be used as a baseline data for the children of Kavre district.

Epidemiological and Clinical Presentation of Retinoblastoma among Nepalese Children in 2019.

Suresh B.K. RasailyObjectives Retinoblastoma (RB) is rare but potentially fatal if left untreated. This study aimed to evaluate the epidemiological profile, clinical manifestation, classification, and affordability of RB treatment among Nepalese children in the year 2019. Materials and Method A multicentric, multiethnic hospital-based cross-sectional study after ethical approval from the National Health Research Council was conducted from January 2019 to December 2019 by incorporating ophthalmologists all over the nation. Twenty-seven RB centers were selected. All the RB presented in the RB centers either newly diagnosed or ongoing treatment consented to the study were included and failed to consent for the study, RB survivors were excluded from the study. Data based on demographic profile, clinical manifestation, ethnical and geographical distribution, and treatment received were collected in the customized Google Form. Each case was classified at the time of diagnosis as per the International Classification of Retinoblastoma groups and different treatment modalities offered as per grouping and staging. The affordability of treatment was calculated using a catastrophic approach. Statistical Analysis Data were entered into Microsoft Excel 2010 and analyzed using Statistical Package for Social Sciences version 20. Result A total of 34 RB cases, 21 (61.76%) in ongoing treatment group and 13 (38.2%) in newly diagnosed group presented in the RB centers. Out of total, 32 (64.7%) had unilateral and 12 (35.3%) cases had bilateral involvement. The majority of patients was from Province 1 (35.3%) and belonged to the upper caste (38.2%). Leukocoria was the most common presentation (73.9%) followed by proptosis, red eye, and phthisis bulbi. More than 75% patients presented at advanced group D (54%) and E (21%) and stage 0 (90%). More than 90% of patients received systemic chemotherapy, and 42.6% received transpupillary thermotherapy. The average cost of RB treatment was estimated to be 521% of the nonfood expense of the family which is unaffordable to almost all cases (100%). Conclusion Leukocoria is the most common mode of clinical presentation in both unilateral and bilateral RBs. Early diagnosis and appropriate treatment are key to success for saving life, sight, and eye. However, community awareness programs against RB, active referral networks, and the establishment of chemotherapy centers with trained human resources are needed to reduce loss of life, sight, and eye.

Distinct glycosylation and functional profile of typhoid vaccine-induced antibodies in a UK challenge study and Nepalese children

Vaccines against typhoid fever have been shown to be safe and effective in field trials. The mechanism through which the vaccines protect remains elusive. Recent data have implicated antibody glycosylation, and specifically afucosylated antibodies, as an important factor in vaccine-induced effector function for a range of viral infections, however this has not been evaluated for vaccines against bacterial infections such as Salmonella typhi. Here, we studied antibody glycosylation after either Vi-conjugate or Vi-polysaccharide vaccine in a UK cohort who were then challenged with virulent S. typhi, and compared findings to antibody glycosylation after Vi-conjugate vaccine in Nepalese children living in a typhoid endemic region. We compared vaccine-induced responses and correlated these measures with antibody-dependent function. Robust antigen-specific antibody galactosylation and sialylation modifications were induced by both vaccines in UK adults, with Vi-conjugate vaccine inducing Vi-specific glycan changes of higher magnitude than Vi-polysaccharide. Among those individuals diagnosed with typhoid fever after challenge, a distinct glycan profile was correlated with disease severity. Elevated galactosylation and sialylation was correlated with increased antibody-dependent phagocytosis by macrophages and neutrophils among UK adults. While bulk IgG glycosylation differed between Nepalese children and UK adults, vaccination with the Vi-conjugate vaccine overcame these differences to result in similar Vi-specific antibody glycosylation profiles 28 days after vaccination in both cohorts.

Clinical and histopathological study of renal biopsy in Nepalese children: A single center experience.

BackgroundGlomerular diseases are important causes of morbidity and mortality among children in developing countries. Renal biopsy is the gold standard for determining histological diagnosis, prognosis, and therapy options. This study aimed to investigate the clinical, histopathological, and direct immunofluorescence findings of renal biopsy results in Nepalese children under 18 years old.MethodsIn this retrospective cross-sectional study, the available data from children who had undergone kidney biopsy between 2016 and the end of 2020 were evaluated. Demographic data, indications of biopsy, histopathologic findings, and direct immunofluorescence findings were collected and presented.ResultsThe mean age of the patients was 12.14 ± 4.07 years. Male/female ratio was 1:1. The majority of biopsy cases were aged between 11–15 years of age. The most common indication for biopsy in children was nephrotic syndrome (68.25%). Lupus nephritis with 28 cases (22.22%) had the highest frequency in overall renal biopsies. Minimal change disease (MCD) with 22 cases (17.46%) followed by Ig A nephropathy with 16 cases (12.69%) were the most frequent primary glomerulonephritis. Lupus nephritis showed full house positivity, and MCD showed full house negativity in all Direct immunofluorescence (DIF) parameters, whereas immunoglobulin A nephropathy showed 100% positivity in Ig A in DIF.ConclusionsNephrotic syndrome was the most common indication for renal biopsy. The most common primary glomerulonephritis was MCD, while secondary glomerulonephritis was lupus nephritis. Clinical data, light microscopy, and direct DIF played an integral role in the overall final diagnosis.

Ex-situ Conservation: A Source of Revenue Generation and Visitors’ Attraction (A Study from Central Zoo, Lalitpur, Nepal)

The Zoo is famous example of ex-situ conservation. Central Zoo is only one Zoo of Nepal having high potentiality of ecotourism but the study regarding this is very limited. Thus, this research was objectively done to assess the trend of visitor in Central Zoo from 2009 to 2019 and revenue generation, visitor’s perception about the features in the Zoo. Total 108 visitors were interviewed to collect primary data to know their perception about features and facility in the Zoo. Among this, it was about 56.48% male and 43.52% female visitor. The secondary data were collected from published and unpublished report and documents of Central Zoo. The collected data were analyzed using descriptive statistics. Rating analysis was also done to know perception of visitors about different features and their satisfaction about the available facility. The highest record of visitors was 1,154,436 in 2018/2019 which was more in comparison to 1,063,217 in fiscal year 2009/2008. The highest number of visitors were Nepali Adult that was 6, 73,323 followed by Nepali Children with 2,156,352 and Nepali students and other with 1,414,961 from 2009 to 2019. The maximum revenue generated from visitors was US$124, 09, 32 in 2018/2019 while this was the lowest about US$ 5, 66,502 in 2009/2010. Similarly, most satisfied facility was sanitation of the toilet with mean score 6.5. The visitors choose the information was easily accessible in the Zoo as most important item with 6.4 score. The estimated highest coefficient of variance of revenue generation from Zoo was same 2.17 (inconsistency) in 2017/2018 but it was lowest 1.45 (consistency) in 2009/2010 which showed the variation of monthly flow of visitors. This study helps to improve the important feature of the Zoo’s such as signpost around the entrance, animals view point, and animal shelter and provision of the guide for visitors and ease of car parking and possible implication for Zoo management are discussed.

Early Results of Type I Tympanoplasty in Underprivileged Nepalese Children and Factors Influencing the Surgical Outcomes.

Introduction Type I Tympanoplasty is a common ear surgery performed in Nepalese children, but no studies have been published about the success rate of the procedure and the factors affecting surgical outcomes. Objectives To find out the surgical outcome of type I tympanoplasty and to evaluate the factors affecting the success of the surgery in Nepalese children. Methods This is a retrospective study conducted by analyzing the medical records of a five-year period. Children aged 8-16 years who underwent type I tympanoplasty were included in the study. Surgical pro-forma and records of pre and post-operative pure tone audiometry were documented. Outcome of the surgery was considered a success in terms of graft uptake and hearing improvement six months after surgery. Results Out of 629 children who underwent type I tympanoplasty, anatomical success was observed in 93.32% ( n = 587) and functional success in 76% ( n = 478). Factors such as age, site and size of the perforation, status of the middle ear and contralateral ear, surgical approach, and the graft used were not the predictors of the surgical outcome. Conclusions The surgical outcome of type I tympanoplasty in Nepalese children was good. Although surgical outcome was better with older children, post-aural approach, temporalis fascia, inferiorly positioned perforations, and in children with dry middle ear mucosa, none of the parameters considered in this study were found to be a significant predictive factor of the surgical outcome.

Spatial Variations and Determinants of Anemia among Under-five Children in Nepal, DHS (2006-2016).

Anemia among under-five children is the major health problem in Nepal. The lack of nutritional supplementation and lack of healthcare facilities are influential factors of anemia. Thus, the main objective of this study is to explore spatial variations and determinants of anemia among under-five children in Nepal. Nepal Demographic and Health Survey (NDHS) data from 2006 to 2016 were used in this study, which includes: household and individual-level data of 8555 under-five children, whose anemia was measured. In addition, a total of 260 (2006), 281 (2011), and 383 DHS clusters (2016) were taken in consideration for spatial analysis. The overall prevalence of anemia was 48.9%, 46.4%, and 52.2% in 2006, 2011, and 2016 respectively. The spatial analysis revealed a nonrandom spatial distribution, where statistically significant hotspots and coldspots were detected in different parts of the country. The results also identified mother’s age, mother’s educational level, socioeconomic status of household, number of under-5 children, household size, birth weight, underweight, stunting, diarrhea, and fever as associated factors of anemia among under-5 children. These findings may provide assistance to concerned health officials in adopting anemia-related programs and policies to address the anemia problems that plague Nepalese children under the age of five.

Relationship Between Screen Time and Behavioral Problems in Primary School Students

Introduction: Rampant use of electronic based devices like television, mobile phones, gaming consoles, computers, etc. disregarding the beneficial effects of physical activity, social interaction, sleep and academic performance result in deficit of psychological well-being of children. The aim of our study was about screen use in Nepalese children and the relationship of screen time with behavioral problems in primary school students. In this study we collected important information based on our objectives on primary school students in our context and to avail the information to clinicians, parents, guardians, educators, policy makers and all those involved.
 Methodology: This study was done in Budhanilkantha municipality of Kathmandu district, Nepal. One community school and one private school were randomly selected from a list of schools. Data was collected from all primary school students of these schools with the help of questionnaires filled by parents. Screen _me and different socio demographic factors that might affect screen time was assessed with the help of questionnaires filled by parents. Behavioral problems were assessed using parent-filled Strength and Difficulties Questionnaire. Statistical analysis was done using SPSS version 24 for windows.
 Result: Our study sample contained 314 primary school students. 52.5% of them were from private school and 47.5% from community school. The mean daily screen time was 1.96 hours, and more than one-fourth of the students had daily screen time of more than two hours per day. Higher number of televisions in the house, presence of computer in the house, more frequent screen use while having meals, higher frequency of screen use with parents, having father with university degree were the factors having statistically significant association with higher screen time of children. Students with daily screen time of more than two hours per day had higher internalizing problem score (8.93±3.453), higher externalizing problem score (9.28±3.885) and total problem score (18.21±6.253) compared to those with screen time of two hours or less (6.97±3.285, 6.10±3.398, 13.07±5.402 respectively). The difference between the groups were statistically significant on all three scales on Mann Whitney U-test (p<0.001, p<0.001, p<0.001 for internalizing, externalizing and total problem score respectively).
 Conclusion: The higher screen time in children was significantly associated with higher behavioral problems. Our study findings re-emphasized the need to follow the guidelines and recommendations set by international regulatory bodies as well as develop guidelines on our own on limiting screen time in children for betterment of psychological wellbeing of children.

The stability of the Bayley scales in early childhood and its relationship with future intellectual abilities in a low to middle income country

BackgroundThe Bayley Scales of Infant and Toddler Development is widely used worldwide. The objective of the current study was to measure the stability of the Bayley Scales during early childhood and its relationship with intellectual abilities at four years in young Nepalese children. MethodsIn a prospective cohort we used the Bayley 3rd edition to measure early child development in 529 Nepalese children at 6–11, 18–23 and 30–35 months. At four years, we used the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) to measure intellectual abilities. We expressed the stability of the Bayley scores by intraclass correlation coefficients (ICCs) and concordance correlation coefficients (CCCs). The relationship between the Bayley scores and the WPPSI full-scale IQ (FSIQ) at four years was examined in regression models. ResultsThe ICCs between the Bayley scores across timepoints were 0.01 (95 % CI -0.06, 0.04), 0.19 (95 % CI 0.15, 0.26) and 0.22 (95 % CI 0.17, 0.28) for the Cognitive, Language and Motor composite scores. The CCC for the composite scores ranged from 0.05 to 0.20 between 6 and 11 and 30–35 months and from 0.20 to 0.36 between 18 and 23 and 30–35 months. The Bayley scores at 6–11, 18–23 and 30–35 months explained 3 %, 20 % and 36 % of the variation of the FSIQ. ConclusionThe stability of the Bayley scales is poor in early childhood, and its relationship with future intellectual abilities is poor in infancy but improves slightly with age in early childhood. Findings from this large community-based cohort of healthy at-risk children are relevant when measuring early child development worldwide.

A Plasma Cuprome Exists With Predictors of Copper Status in Nepalese Children

ObjectivesCopper (Cu) is an essential micronutrient but, due to difficulties of measuring Cu by atomic absorption spectroscopy (AAS), plasma Cu status is rarely assessed in low income countries. A less costly assay is needed. We have explored whether plasma Cu concentration can be predicted by modelling strongly associated plasma proteins, assessed by mass spectrometry (MS), that could be assayed with other nutriproteomic biomarkers on one platform in the future.MethodsIn plasma samples from 500 Nepalese children 6–8 y of age, the mean (SD) plasma Cu concentration measured by AAS was 23.3 ± 5.7 mmol/L, with 13.6% classified as deficient (< 10 mmol/L). We quantified relative abundance of 982 plasma proteins by iTRAQ tandem MS following affinity depletion of six high abundance proteins (Cole J Nutr 2013) and correlated their relative abundance with plasma Cu by linear mixed effects regression. We defined a stringent plasma cuprome comprising proteins associated with Cu at a false discovery rate (q) < 0.01. Missing values were imputed and proteins were fit by forward, stepwise regression analysis, meeting an AIC reduction of ≥ 30, to model plasma Cu status.ResultsThere were 134 (q < 0.01) proteins in the plasma cuprome. Among 62 positive correlates were ceruloplasm (r = 0.65), 9 complement proteins (r = 0.29 to 0.45), 4 serpin protease inhibitors (r = 0.31 to 0.43) with others involved in coagulation, 5 LRR structural motifs as found in toll-like receptors (r = 0.35 to 0.58), signaling enzymes such as CDC42BPA (r = 0.70) and proinflammatory reactants and regulators such as CRP, AGP, amyloids and TNIP1 (r = 0.40 to 0.56). Among 72 negative correlates (r = −0.29 to −0.42) are lipid and sterol binding and transport proteins including apolipoproteins/lipocalins, enzyme regulating proteins, extracellular adhesion, signaling and matrix proteins. Different members of serine peptidase inhibitor members were among + and – correlates. Forward stepwise regression fit 6 proteins (CP, CDC42BPA, LRRC47, TDRD9, LLRIQ1, LRRCC1) that explain 76.5% of the variance (R2) in plasma Cu, sufficient for predicting plasma Cu status of a population.ConclusionsA large, diverse plasma cuprome exists, as revealed in young Nepalese children, from which six proteins may adequately predict plasma Cu status.Funding SourcesBill & Melinda Gates Foundation (OPPGH5241) & Johns Hopkins University.

Pediatric Research Challenge, Alignment with the National Research Agenda

Pediatric Research Challenge, Alignment with the National Research Agenda

Socioeconomic status biases among children and adolescents: The role of school diversity and teacher beliefs in Nepal.

Investigating socioeconomic status (SES) biases, Nepalese children and adolescents (N=605, 52% girls, Mage =13.21, SDage =1.74) attending schools that varied by SES composition were asked to anticipate whether a peer would include a high or low SES character as a math partner. Novel findings were that students attending mixed SES schools were more likely to expect inclusion of a low SES character than were students attending high SES schools. With age, high SES participants attending mixed SES schools increasingly expected the inclusion of the low SES character. Moreover, teachers' democratic beliefs in high SES schools predicted inclusive expectations. Teacher beliefs and school diversity play a significant role for fostering students' inclusivity in educational contexts.

The impacts of the 2015 Gorkha earthquake on Children’s health in Nepal

• This study uses the Demographic Health Survey (DHS) to assess the impacts of the 2015 Gorkha Earthquake of Nepal on the children’s health outcomes using a difference-in-difference identification strategy. • The results show that the earthquake caused an increased prevalence of diarrhea, fever, and cough among children less than five years old in the earthquake-affected districts. • As indicated by the low vaccination rate, disruption of health services could be the primary mechanism behind the higher prevalence of listed health outcomes. • The results suggest that natural disasters could affect children’s health, especially in low-income countries with fragile health care systems and poor water and sanitation facilities. A 7.8 Richter-scale magnitude earthquake hit central Nepal in 2015, affecting multiple facets of the economy. This study explores the health impacts of this earthquake on the prevalence of diarrhea, cough, and fever among Nepalese children less than five years old. To this end, I use data from two recent waves of the Demographic Health Survey (2011 and 2016) and employ difference-in-difference as an identification strategy. Results show that the prevalence of diarrhea, cough, and fever was between 3.9 and 6.3 percentage points higher among children in earthquake-affected areas. These results are equivalent to an increase in diarrhea, fever, and cough cases among the children in earthquake-affected districts by 32.2, 35.5, and 25.7 percent, respectively. A drop in the vaccination rate suggests a lack of health care facilities in the earthquake-affected areas that could have contributed to child health problems. A decrease in the availability of clean drinking water in the earthquake-affected regions could also be a mechanism behind the prevalence of the diseases. Disaster-preparedness plans in disaster-prone low-income countries should prioritize child health by making necessary health care services available and ensuring the supply of safe drinking water.

Biomass fuel use for cooking in Nepalese families and child cognitive abilities, results from a community-based study

BackgroundBiomass fuel use for cooking is widespread in low to middle income countries. Studies on the association between biomass fuel use and cognitive abilities in children are limited. ObjectiveTo examine the association between biomass fuel use for cooking and cognitive abilities in Nepalese children at 4 years of age. MethodsIn a cohort design we have information on biomass fuel use in the households of 533 children in infancy and cognitive abilities when they were 4 years old from a community-based sample. Cognitive abilities were measured by the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-IV) and the NEPSY-II. We examined the associations between biomass fuel use and scores on the WPPSI-IV Full-Scale IQ (FSIQ) (primary outcome), and WPPSI index and NEPSY-II subtest scores in multiple linear regression models. The associations were also examined in predefined subgroups. ResultsNinety-nine (18.6%) of the families used biomass fuel for cooking. Children in these families had lower mean FSIQ than children in families with no biomass use (83.3 (95%CI 81.7, 85.0) vs. 85.3 (95%CI 84.5, 86.0)), with a mean difference of −2.2 (95%CI -3.9, −0.5) adjusting for demographics and socio-economic status. The association between biomass fuel use and cognitive abilities was strongest in subgroups of children from households with more than three rooms, with separate kitchen and bedroom, and with higher wealth-score. These interactions were significant for number of rooms in the home (p = 0.04), if the household had separate bedroom and kitchen (p = 0.05), and for the wealth-score (p = 0.03). ConclusionBiomass fuel use for cooking in Nepalese families was associated with lower overall cognitive abilities at 4 years. Uncertainties include exposure misclassification and unmeasured confounding. The associations between biomass fuel use and neurodevelopment in children needs further investigation with more precise measurements of the exposure.

Suppurative complications following BCG vaccine in 2 Nepalese children

BackgroundThe Bacillus Calmette–Guérin (BCG) vaccine is one of the most common vaccines administered worldwide and awareness regarding its usual and adverse reactions is important. Local and systemic complications require accurate identification for timely therapy. We hereby report two patients with rare suppurative local complications of BCG. Case presentationCase 1: A nine-month-old boy presented with swelling over the right deltoid for one month with low-grade fever and purulent discharge for two days. The active discharge occurred from the same site of previous BCG inoculation, the regression of which was achieved conservatively. Case 2: The second case was a 14-month-old boy who presented with a swelling over the lower part of the right axilla for one year, later diagnosed as a tuberculous lymph nodal abscess. Needle aspiration was done and anti-tubercular therapy was started based on positive Gene Xpert reports. Both the cases resolved completely without complications. ConclusionPharmacovigilance surveillance of BCG scar reactions and occurrence of suppurative complications should be known by clinicians for correct identification and management.

Nasal colonization by potential bacterial pathogens in healthy kindergarten children of Nepal: a prevalence study.

In low- and middle-income countries including Nepal, respiratory tract infection (RTI) is considered as one of the most prominent public health problems in children. Multiple carriage of respiratory pathogens is common in children, especially in preschoolers as they are easily transmitted through close contact and poor hygienic condition. Thus, this research is based on the study of prevalence, co-existence, associated factors and antibiogram of nasal isolates among healthy preschoolers. The study was conducted in four randomly selected kindergarten schools (two government run and two private run) of Bhaktapur Municipality. Out of a total 140 students, 136 eligible participants of age group 2-5 years old were involved in the study. Nasal swab was collected for the isolation of five target isolates (Staphylococcus aureus, Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae and Haemophilus parainfluenzae) and their antibiotic resistance determination. Of 136 participants involved, 128 (94.5%) were positive for carriage of at least one of the target bacteria. The most common isolate was M. catarrhalis 62.5% (80/128) followed by S. aureus 43.0% (55/128). There was a significant difference in bacterial carriage with respect to type of school (p value<0.05, OR=0.50, CI=0.20-0.90). Regarding bacterial co-existence, the most common co-existence was of S. aureus and M. catarrhalis & S. pneumoniae and M. catarrhalis 48.8%. Multiple logistic regression analysis showed that S. aureus was negatively associated with S. pneumoniae, M. catarrhalis and H. influenzae and S. pneumoniae was positively associated with M. catarrhalis and H. influenzae. Multidrug resistance was seen in 63 isolates (29.4%). Nepalese kindergarten children are at a high risk of respiratory tract infection by multidrug resistant bacteria.

Medical Problems of Internationally Adopted Children from Nepal

Background: Spain is one of the main countries in the world in international adoption, and Nepali children account for 0.8% of all adoptees. According to United Nations, Nepal is a poorly developed country. Due to the quality of medical care that Nepali children receive in orphanages, it has been reported that the diagnoses described in the pre-adoptive medical reports do not offer an absolute guarantee of accuracy, and sometimes these reports are not provided to adoptive families. The objective of this study was to describe epidemiological characteristics, pre-adoptive history, and medical problems observed in the post-adoption evaluation in a cohort of children adopted from Nepal. Material and Methods: Retrospective descriptive study on 11 Nepali adopted children from 2005 to 2011, examined according to a standardized protocol. Variables were collected from pre-adoption medical reports, interviews with the family, and post-adoption evaluation records. Results: Epidemiological characteristics and pre-adoptive history: females, 63.6%; all were abandoned and adopted from orphanages; mean age at institutionalization was 32 months, and at adoption was 55 months. 72.7% had a pre-adoptive medical report, and all were diagnosed as "healthy". 54.5% had a vaccination certificate. Medical problems most frequent diagnosed in post-adoption evaluation were iron deficiency anemia (72.7%), xerosis cutis (54.4%), neurodevelopmental delay (45.5%), underweight and stunting (36.4%), and acute bronchitis (36.4%). Only one child had a serious problem (cerebral palsy). The BCG vaccination scar was present in 81.8%. 72.7% showed vaccination immunity against hepatitis B virus. Conclusion: The pre-adoption medical information for the Nepali children was unreliable, and all showed more than one medical problem in the post-adoption evaluation. Adoptive families should seek pre-travel specialized medical advice regarding the medical reports and health of the child to be adopted, the updating of routine immunizations, and the destination-specific health problems.

Family correlates of emotional and behavioral problems in Nepali school children.

There is a substantial gap in our knowledge about family correlates of child emotional and behavioral problems in low- and middle-income countries (LMIC). The present study contributes to filling this gap by examining such correlates in a larger population study in Nepal. Our study is a cross-sectional, observational study among 3840 Nepali children aged 6-18 years from 64 schools and 16 districts in the three main geographical regions in the country. We used the Nepali version of the Child Behavior Checklist (CBCL)/6-18 to assess children's internalizing and externalizing problems and an additional background information questionnaire to assess possible family correlates which included parental education, family structure, migrant worker parents, parental mental and physical illness, family conflicts, and child-rearing. The associations between family variables and child internalizing and externalizing problems were analyzed using bivariate correlations and multiple regression. Using bivariate analysis, we found that mental and physical illness in parents, conflict in the family, parental disagreement in child-rearing, and physical punishment of child correlated positively with both Internalizing Problems and Externalizing Problems. The same associations were found by using multiple regression analysis. In addition, parental education, family structure, and migrant worker mothers were associated with Externalizing Problems. However, the effect sizes were small. The results suggest that in Nepal, child mental problems were associated with several family risk factors. Further, the study points to the need of strengthening prevention- and intervention measures to minimize family risk factors of child mental health disorders.