BackgroundWe investigated the efficacy, safety and cost of lime wash of household walls plus treatment of sand fly breeding places with bleach (i.e. environmental management or EM), insecticide impregnated durable wall lining (DWL), and bed net impregnation with slow release insecticide (ITN) for sand fly control in the Indian sub-continent.MethodsThis multi-country cluster randomized controlled trial had 24 clusters in each three sites with eight clusters per high, medium or low sand fly density stratum. Every cluster included 45–50 households. Five households from each cluster were randomly selected for entomological measurements including sand fly density and mortality at one, three, nine and twelve months post intervention. Household interviews were conducted for socioeconomic information and intervention acceptability assessment. Cost for each intervention was calculated. There was a control group without intervention.FindingsSand fly mortality [mean and 95%CI] ranged from 84% (81%-87%) at one month to 74% (71%-78%) at 12 months for DWL, 75% (71%-79%) at one month to 49% (43%-55%) at twelve months for ITN, and 44% (34%-53%) at one month to 22% (14%-29%) at twelve months for EM. Adjusted intervention effect on sand fly density measured by incidence rate ratio ranged from 0.28 (0.23–0.34) at one month to 0.62 (0.51–0.75) at 12 months for DWL; 0.72 (0.62–0.85) at one month to 1.02 (0.86–1.22) at 12 months for ITN; and 0.89 (0.76–1.03) at one months to 1.49 (1.26–1.74) at 12 months for EM. Household acceptance of EM was 74% compared to 94% for both DWL and ITN. Operational cost per household in USD was about 5, 8, and 2 for EM, DWL and ITN, respectively. Minimal adverse reactions were reported for EM and ITN while 36% of households with DWL reported transient itching.InterpretationDWL is the most effective, durable and acceptable control method followed by ITN. The Visceral Leishmaniasis (VL) Elimination Program in the Indian sub-continent should consider DWL and ITN for sand fly control in addition to IRS.

BackgroundThe sand fly Phlebotomus argentipes is the vector for visceral leishmaniasis (VL) in the Indian sub-continent. In Bangladesh since 2012, indoor residual spraying (IRS) was applied in VL endemic areas using deltamethrin. In Nepal, IRS was initiated in 1992 for VL vector control using lambda-cyhalothrin. Irrational use of insecticides may lead to vector resistance but very little information on this subject is available in both countries. The objective of this study was to generate information on the susceptibility of the vector sand fly, P. argentipes to insecticide, in support of the VL elimination initiative on the Indian sub-continent.MethodsSusceptibility tests were performed using WHO test kits following the standard procedures regarding alpha cypermethrin (0.05%), deltamethrin (0.05%), lambda-cyhalothrin (0.05%), permethrin (0.75%), malathion (5%) and bendiocarb (0.1%) in six upazilas (sub-districts) in Bangladesh. In Nepal, the tests were performed for two insecticides: alpha cypermethrin (0.05%) and deltamethrin (0.05%). Adult P. argentipes sand flies were collected in Bangladesh from six VL endemic upazilas (sub-districts) and in Nepal from three endemic districts using manual aspirators.ResultsThe results show that VL vectors were highly susceptible to all insecticides at 60 minutes of exposure in both countries. In Bangladesh, corrected mortality was 100% at 15 minutes as well as 30 minutes of exposure. The study sites in Nepal, however, showed some diverse results, with a mortality rate less than 90% for 15 minutes of exposure with alpha cypermethrin and deltamethrin in two districts but was above 95% after 30 minutes of exposure.ConclusionsThese results suggest that the insecticides tested can still be used in the national programmes of Bangladesh and Nepal. However, insecticide rotation should be performed to mitigate the possible development of insecticide resistance. Periodic susceptibility tests should be performed by the countries to get timely alerts regarding insecticide resistance.

BackgroundNew methods for controlling sand fly are highly desired by the Visceral Leishmaniasis (VL) elimination program of Bangladesh, India and Nepal for its consolidation and maintenance phases. To support the program we investigated safety, efficacy and cost of Durable Wall Lining to control sand fly.MethodsThis multicentre randomized controlled study in Bangladesh, India and Nepal included randomized two intervention clusters and one control cluster. Each cluster had 50 households except full wall surface coverage (DWL-FWSC) cluster in Nepal which had 46 households. Ten of 50 households were randomly selected for entomological activities except India where it was 6 households. Interventions were DWL-FWSC and reduced wall surface coverage (DWL-RWSC) with DWL which covers 1.8 m and 1.5 m height from floor respectively. Efficacy was measured by reduction in sand fly density by intervention and sand fly mortality assessment by the WHO cone bioassay test at 1 month after intervention. Trained field research assistants interviewed household heads for socio-demographic information, knowledge and practice about VL, vector control, and for their experience following the intervention. Cost data was collected using cost data collection tool which was designed for this study. Statistical analysis included difference-in-differences estimate, bivariate analysis, Poisson regression model and incremental cost-efficacy ratio calculation.ResultsMean sand fly density reduction by DWL-FWSC and DWL-RWSC was respectively −4.96 (95 % CI, −4.54, −5.38) and −5.38 (95 % CI, −4.89, −5.88). The sand fly density reduction attributed by both the interventions were statistically significant after adjusting for covariates (IRR = 0.277, p < 0.001 for DWL-RWSC and IRR = 0.371, p < 0.001 for DWL-FWSC). The efficacy of DWL-RWSC and DWL-FWSC on sand fly density reduction was statistically comparable (p = 0.214). The acceptability of both interventions was high. Transient burning sensations, flash on face and itching were most common adverse events and were observed mostly in Indian site. There was no serious adverse event. DWL-RWSC is cost-saving compared to DWL-FWSC. The incremental cost-efficacy ratio was −6.36, where DWL-RWSC dominates DWL-FWSC.ConclusionsDWL-RWSC intervention is safe, efficacious, cost-saving and cost-effective in reducing indoor sand fly density. The VL elimination program in the Indian sub-continent may consider DWL-RWSC for sand fly control for its consolidation and maintenance phases.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1881-8) contains supplementary material, which is available to authorized users.

Background. According to the WHO STEPS survey 2013 in Nepal, 17% of the surveyed population had consumed alcohol within the last 30 days. Alcohol consumption in Nepal is socially and culturally accepted in many ethnic groups. The purpose of this study was to determine various factors associated with problematic alcohol consumption among adults in Putalibazar Municipality of Syangja district. Methods. A community-based cross-sectional study was conducted between September 2020 and January 2021 among 300 adults between ages of 18–64 years in Putalibazar Municipality of Syangja district of Nepal. Using a pretested semistructure questionnaire, a face-to-face interview was performed for collecting the data. An Alcohol Use Disorder Identification Test (AUDIT) developed by the World Health Organization (WHO) was used as a guiding tool to determine the audit-risk level category among adults according to their drinking status. Respondents with scores 0–7 in AUDIT scores were considered as nonproblematic drinkers, while respondents scoring 8–40 in the AUDIT scores were considered as problematic drinkers. Bivariate and multivariable analysis was performed to find out the association between dependent and independent variables. Variables which were found statistically significant at 95% CI ( p  ≤ 0.05) during bivariate analysis were further analyzed using the logistic regression model in multivariable analysis to identify determinants associated with problematic alcohol consumption among adults. Results. The mean age of participants was 36.72 years with a ±10.81 standard deviation. A total of 56.3% of adults were problematic drinkers. The multivariable regression analysis model identified adults within the age group of 25–34 years and 35–44 years along with males significantly associated with problematic alcohol consumption. Adults within the age group of 25–34 years and 35–44 years were 7.4 times (AOR = 7.4, CI: 1.97–27.60) and 5.7 times (AOR = 5.7, CI: 1.58–20.56) more likely to be problematic drinkers than their counterparts who were from the age group of 55–64 years. Males were 6.9 times more likely to be (AOR = 6.9, CI: 3.35–14.26) problematic drinkers than females. Conclusion. Problematic alcohol consumption among males was common and significantly associated within the age group of 25–34 years and 35–44 years. This study concerns the need for policy makers to launch awareness programs and community-based interventional programs considering identified factors associated with excessive drinking.

Background: Despite the several efforts made in the development plans to reduce the population growth rate, the population of Nepal has rapidly been increasing from last few decades. This study aims to find the associated factors to have more than two children in Suddhodhan rural municipality of Rupandehi, Nepal.Methods: A cross sectional descriptive study was conducted in a Suddhodhan rural municipality of Rupandehi district, Nepal among 440 ever married women selected by using disproportionate stratified random sampling. Chi Square test was used to find the associated factors to have more than two children.Results:The study found that mean number of children ever born on Suddhodhan Rural Municipality of Rupandehi district, Nepal was 4.1. Among 440 women included in the study, 57.27% women had more than two children. There was statistically significant association between children ever born with religion, age of women and husband, age at marriage, literacy rate of respondents and her spouse, respondent occupation, knowledge of contraceptive methods, exposure to mass media.Conclusions: The study concluded that religion, age of women and husbands, age at marriage, literacy rate of husband and wife, respondents occupation, knowledge of contraceptive methods, exposure to mass media were the main factors for determining the children ever born. Hence local level policy maker, planner and stakeholders of local municipal office should focused on providing informal education such as PraoudSikshya involving both the women and their husbands, should provide the intervention related to contraceptive methods through group discussion as well as through the use of mass media. Keyword: Children ever born; fertility; population.