Background Malnutrition has various adverse effects in children. This study aimed to determine risk factors for malnutrition among hospitalised children, changes in nutritional status at admission and discharge and effects of use of systematic anthropometric measurement in identification of malnutrition. Methods We enrolled 426 children, aged between 6 months and 15 years, admitted to Siddhi Memorial Hospital, Bhaktapur, Nepal, from November 2016 to June 2017. Anthropometric measurements were performed at the time of admission and discharge. Risk factors were assessed by multivariable logistic regression models. Results Median age of children was 26 months (IQR: 13–49), and males were 58.7%. The prevalence of wasting was 9.2% (39/426) at admission and 8.5% (36/426) at discharge. Risk factors associated with wasting at admission were ethnic minority (aOR: 3.6, 95% CI 1.2–10.8), diarrhoeal diseases (aOR = 4.0; 95% CI 1.3–11.8), respiratory diseases (aOR: 3.4, 95% CI 1.4–8.1) and earthquake damage to house (aOR = 2.6; 95% CI 1.1–6.3). Clinical observation by care providers identified only 2 out of 112 malnutrition cases at admission and 4 out of 119 cases at discharge that were detected by the systematic anthropometric measurement. Conclusions Ethnic minority, diarrhoeal diseases, respiratory infections and house damage due to the earthquake were risk factors associated with wasting. Systematic anthropometric examination can identify significantly more malnourished children than simple observation of care providers.

Dengue has become a recurrent and growing threat to public health in Nepal. The epidemic in 2022 was the largest ever reported, with cases being reported in all of the country’s seven provinces and 77 districts. Despite the establishment of an early-warning and reporting system (EWARS) in 1997, the lack of clear criteria for alarm signals and outbreak definitions in national guidelines delayed the epidemic declaration in 2022, which resulted in an increased number of cases and fatalities. For this article, we analyzed national data from previous years, which demonstrate that an epidemic could have been declared early in July, and that that would have resulted in fewer cases and fatalities if clear criteria for outbreak declarations had also been put in place. We also reviewed the existing national guidelines for dengue prevention and control, and propose recommendations to improve their implementation, particularly with regard to vector control measures. This article also highlights the need for a coordinated effort between multisector stakeholders, strengthened disease surveillance systems, and the establishment of predefined alarm signals and epidemic declaration criteria so that future epidemics are identified in a timely manner. The early outbreak warning system can potentially prevent future large outbreaks and minimize their negative impacts on the country’s health systems and economy.

Staphylococcus toxic shock syndrome (TSS) is not well described in neonates. The present criteria for diagnosis of TSS have not yet been validated in neonates. Here, we present a case of a 13-day-old female baby who presented with acute kidney injury (AKI). She had a pus-draining lesion on the head, and the pus grew Staphylococcus aureus. Based on the clinical criteria of fever, desquamation, hypotension, and AKI and laboratory criteria of absence of growth of any organisms in blood and cerebrospinal fluid, we diagnosed the case as TSS. She was treated with antibiotics, oxygen, and fluids, along with inotropic support and mechanical ventilation, and she recovered fully and was discharged on day 17 of admission. As there is no single test to diagnose TSS and it is uncommon in neonates, physicians should be familiar with the clinical presentation of the disease to make early diagnosis.