Problems of Mathematics Teachers in Teaching Mathematical Content Online in Nepal

The study aimed to explore the problems of teachers in teaching mathematical contents through the online mode during COVID-19 in Nepal. A cross-sectional survey study was carried out among 415 mathematics teachers from basic school to the university level. A self-constructed questionnaire was administered online, and the data were analyzed using the t-test, ANOVA, and the hierarchical multiple regression. The result shows that Algebra, Statistics, Vectors, Geometry, and Analysis are problematic areas for teachers teaching mathematics online. The institution types, ICT training status, and years of using the laptop by teachers at the secondary level were found to be the key factors determining the problem of mathematical content teaching during online instruction although the level of problems varied with respect to the teachers' age and experience at the university level. Copyright © 2022, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

Spectrum of echocardiographic findings in patients with severe and critical COVID-19: a single center experience

Introduction: Information on the cardiac manifestations of coronavirus disease 2019 (COVID-19) is scarce. In this study we assessed the echocardiogram of consecutive patients with COVID-19 infection to assess the frequency of cardiac abnormalities. Materials and Methods: This retrospective descriptive study examined the echocardiographic study of 43 patients with severe and critical COVID-19 infection admitted at the ICU of Chitwan Medical College from May 16, 2021 to June 05, 2021. The study focused on left ventricle (LV) and right ventricle (RV) function. The results were then compared between severe and critical infections to examine if any differences exist between them. Results: The mean age of the study population was 54 years and predominately males. One-third were classified as critical COVID-19 while the remaining were severe COVID-19. Majority(83.7%) had a normal echocardiogram. Among the patients with abnormal reports, the distribution of echocardiographic pattern were biventricular dilation with biventricular dysfunction in two patients (4.6%), LV dialtion with LV dysfunction in two patients (4.6%) and isolated LV dysfunction (diastolic and systolic) in three patients (6.9%). None of the echocardiographic parameters were significantly different between the severe and the critical infection. Conclusion: COVID-19 in primarily a respiratory disease and the cardiac complications is largely attributed to the critical nature of the illness than the specific infection. Considering the risk of infection spread, routine echocardiography for all patients with COVID-19 infection is not advisable.

Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study.

Caesarean section is performed when there are pregnancy related complications and vaginal delivery cannot be tried or fails. The effect of pandemic lockdown on the availability as well as accessibility of health services is a global concern. The aim of this study was to find out the caesarean section rate and its indication at a tertiary care hospital during COVID-19 pandemic. Methods: A hospital-based cross-sectional study was conducted among women admitted for delivery in the Department of Obstetrics and Gynecology of a tertiary teaching hospital during the second wave of COVID-19 (1 May 2021-30 July 2021). Convenience sampling technique was applied and 1350 women were categorized into groups using Robson ten group classification system. Group size, group caesarean rate, absolute and relative contribution of each group to overall caesarean rate were calculated. Results: Out of 1350 total deliveries during COVID-19, lower segment caesarean section was done in 446 (33.04%) (30.53-35.55 at 95% Confidence Interval). Major indication for caesarean section was previous caesarean in 185 (41.48%). Most women 202 (45.29%) were from the age group 24-30 years and gestational age between 37 and 42 weeks. Major contributor to the overall caesarean section rate was Robson group 5 (37%). Conclusions: This study showed higher prevalence of caesarean section delivery rate during COVID-19 pandemic than that compared with 2016 national statistics of Nepal. Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too.

Association of workload and practice of respectful maternity care among the healthcare providers, before and during the early phase of COVID-19 pandemic in South Western Nepal: a cross-sectional study.

INTRODUCTION: Respectful maternity care is an approach that involves respecting women's belief, choices, emotions, and dignity during the childbirth process. As the workload among maternity care workforce affects intrapartum quality care, respectful maternity care might have also been affected, particularly during the pandemic. Thus, this study was conducted to examine the association between workload among healthcare providers and their practice of respectful maternity care, before and during the early phase of pandemic. METHODS: A cross-sectional study was conducted in South Western Nepal. A total of 267 healthcare providers from 78 birthing centers were included. Data collection was done through telephone interviews. The exposure variable was workload among the healthcare providers, and the outcome variable was respectful maternity care practice before and during the COVID-19 pandemic. Multilevel mixed-effect linear regression was used to examine the association. RESULTS: The median client-provider ratio before and during the pandemic was 21.7 and 13.0, respectively. The mean score of respectful maternity care practice was 44.5 (SD 3.8) before the pandemic, which was decreased to 43.6 (SD 4.5) during the pandemic. Client-provider ratio was negatively associated with respectful maternity care practice for both times; before (Coef. -5.16; 95% CI -8.41 to -1.91) and during (Coef. -7.47; 95% CI -12.72 to -2.23) the pandemic. CONCLUSIONS: While a higher client-provider was associated with a lower respectful maternity care practice score both before and during the COVID-19 pandemic, the coefficient was larger during the pandemic. Therefore, workload among the healthcare providers should be considered before the implementation of respectful maternity care, and more attention should be given during the pandemic.

A critical analysis of health system in Nepal; Perspective's based on COVID-19 response.

Background: Nepal moved from a unitary government to a federal system of government in 2015 under its constitution. Nepal is a federal democratic republic governed by three levels of government: a federal, provincial, and local level. The response to COVID-19 in Nepal has been majorly led and controlled by the federal government. All three levels of government are performing their responsibilities; however, they face various challenges in responding to COVID-19. This study aimed to critically analyze Nepal's health system in the context of the COVID-19 response. Methods: We conducted semi-structured in-depth interviews by telephone among the policymakers, health workers, and stakeholders at the federal, provincial, and local levels (n = 41) between January to July 2021. The interviews were audio recorded, transcribed into English, and coded using inductive-deductive approaches. Results: COVID-19 considerably impacted routine health care, mainly maternity services and immunization. Inadequate financial resources, inadequate human resources, and the lack of ventilators, ICUs, and X-ray services were the significant challenges in tackling and managing COVID-19 effectively. Conclusion: The study found that all three levels of government perform their roles and responsibilities and effectively manage the pandemic. The federal and provincial governments focused more on the plans and policy development, while the local government demonstrated greater accountability in implementing those plans and policies. Therefore, all three tiers of government need to coordinate together for preparing and communicating information in times of emergency. Besides, it is imperative to empower local governments to maintain Nepal's federal health system.

Exploring separated children's experience of migration in Nepal

Most Nepalese children live in rural areas where poverty, employment and education act as key drivers in their decision to migrate to urban centres. This paper reports on a study which researched the experiences of separated children who migrated, as reported through interviews with 20 practitioners working in NGOs in Kathmandu. It describes children's motivations, migratory journeys and situations, when 'promises of work' often failed to materialise. Having seen more children migrating to Kathmandu and recently fearful that the impact of the COVID-19 pandemic may lead to further increase, practitioners identify the need for an urgent, coherent and multi-faceted response.

Impact of COVID-19 on Nepal's Labour Migration

For many years, Nepal has relied on the import of labour by foreign countries to sustain its economy with income from remittances having approached 30% of the national gross domestic product for close to a decade. Besides being the most valuable source of hard currency, earnings by labour migrants have also contributed to reducing poverty levels drastically in recent years while also providing the impetus for rapid urbanization and rising consumerism. All of that has now been put in jeopardy as the result of the COVID-19 pandemic that has led to tens of thousands of Nepali workers being laid off in the Gulf Cooperation Council countries, the major destination for Nepalis in foreign employment. This chapter explores how the pandemic has affected the foreign employment sector with a particular focus on the number of Nepalis returning home, how the government plans to deal with a large number of unemployed young men and women, the expected reduction in remittances, and the possible social dislocations as a result of sudden loss of inflow of cash in the rural hinterlands of the economy. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Outbreaks of different viral etiologies amidst COVID-19 pandemic

The COVID-19 pandemic has severely affected public health system and surveillance of other communicable diseases across the globe. The lockdown, travel constraints and COVID phobia turned down the number of people with illness visiting to the clinics or hospitals. Besides this, the heavy workload of SARS-CoV-2 diagnosis has led to the reduction in differential diagnosis of other diseases. Consequently, it added to the underlying burden of many diseases which remained under-diagnosed. Amidst the pandemic, the rise of emerging and re-emerging infectious diseases was observed worldwide and reported to the World Health Organization i.e., Crimean Congo Hemorrhagic Fever (2022, Iraq;2021 India), Nipah virus (2021, India), Zika virus (2021, India), and H5N1 influenza (2021, India), Monkeypox (2022, multicountry outbreak), Ebola virus disease (2022, DRC, Uganda;2021, DRC, Guinea;2020, DRC), Marburg (2022, Ghana;2021, Guinea), Yellow fever (2022, Uganda, Kenya, West and Central Africa;2021, Ghana, Venezuela, Nigeria;2020, Senegal, Guinea, Nigeria, Gabon;2020, Ethiopia, Sudan, Uganda), Dengue (2022, Nepal, Pakistan, Sao Tome, Temor-Leste;2021, Pakistan), Middle east respiratory syndrome coronavirus (2022, Oman, Qatar;2021, Saudi Arabia, UAE;2020, Saudi Arabia, UAE), Rift valley fever (2021, Kenya;2020, Mauritania), wild poliovirus type 1 (2022, Mozambique), Lassa fever (2022, Guinea, Togo, Nigeria;2020, Nigeria), Avian Influenza (H3N8) (2022, China), Avian Influenza (H5N1) (2022, USA), H10N3 influenza (2021, China), Hepatitis E virus (2022, Sudan), Measles (2022, Malawi, Afghanistan;2020, Burundi, Mexico), Mayaro virus disease (2020, French Guiana), Oropouche virus disease (2020, French Guiana). All these diseases were associated with high morbidity and burdened the public health system during the COVID-19 pandemic. During this critical public health menace, majority of the laboratory workforce was mobilized to the SARS-CoV-2 diagnosis. This has limited the surveillance efforts that likely led to under diagnosis and under-detection of many infectious pathogens. Lockdowns and travel limitations also put a hold on human and animal surveillance studies to assess the prevalence of these zoonotic viruses. In addition, lack of supplies and laboratory personnel and an overburdened workforce negatively impacted differential diagnosis of the diseases. This is especially critical given the common symptoms between COVID-19 and other pathogens causing respiratory illnesses. Additionally, the vaccination programs against various vaccine preventable diseases were also hampered which might have added to the disease burden. Despite these challenges, the world is better prepared to detect and respond to emerging/re-emerging pathogens. India now has more than 3000 COVID-19 diagnostic laboratories and an enhanced hospital infrastructure. In addition, mobile BSL-3 facilities are being validated for onsite sampling and testing in remote areas during outbreak situations and surveillance activities. This will undoubtedly be valuable as the COVID-19 pandemic evolves as well as during future outbreaks and epidemics. In conclusion, an increase in the emergence and re-emergence of viruses demonstrates that other infectious diseases have been neglected during the COVID-19 pandemic. Lessons learned from the infrastructure strengthening, collaborations with multiple stakeholders, increased laboratory and manufacturing capacity, large-scale COVID-19 surveillance, extensive network for laboratory diagnosis, and intervention strategies can be implemented to provide quick, concerted responses against the future threats associated with other zoonotic pathogens.

The precarity of gender, migration, and locations: case studies from Bangladesh and Nepal

While migration debates point to both empowerment and disempowerment in the range of choices that women can experience due to patriarchal norms in the home country and families, migration norms themselves can at the same time be disempowering. This paper explores the idea of precarity as a way through this paradox. By using Key Informant Interviews in case studies from Nepal and Bangladesh, we show how the precarity of migration can change not only due to patriarchal norms at the origin and host country but also events such as COVID-19 can have a profound effect on women's choices and agency.

A University Collaboration in Creating a Powered Air Purifying Respirator: An Emergency Innovative Response

Purpose of Study In March of 2020, the World Health Organization declared the coronavirus (COVID-19) a global pandemic. As the number of cases increased worldwide, existing hospital infrastructure struggled to keep up with the demand for equipment and supplies.This exposed healthcare workers to contracting the disease. The purpose of this study is to demonstrate an emergency innovation response in overcoming shortages of personal protective equipment within a university hospital setting, with a special focus on powered air purifying respirators (PAPRs). Methods Used The Center for Medical Innovation (CMI)-a center designed to promote research and development of high-impact healthcare products at the University of Utah (UofU)-enlisted university engineers to develop an open source PAPR system made from readily available commercial materials. Parts were selected to meet filtration, airflow, and protection specifications as outlined by industry standards. Commercially available parts consistent with these specifications were assembled into a novel PAPR system which utilized 3D printed pieces on demand to achieve compatibility. Once assembled, each PAPR went through protection testing to demonstrate health worker safety. A fit factor of 200 is the minimum requirement needed as defined by NIOSH. Testing procedures were carried out with industry standard equipment. Summary of Results A human centered design approach was utilized in iterating versions of the product based on repeated fit testing. Failures were addressed in subsequent models. All PAPRs passed fit testing with a score of > 1000. Following the lean processing standard of just in time inventory, materials to fabricate 1000 PAPRs were procured and assembled on demand. PAPRs are now being used by the UofU Hospital as well as other affiliate entities globally and are filling the gap needed for PPE. Approximately 200 units have been donated to Navajo Nations hospitals in the state of Utah and others have been donated to university sister entities in India, Nepal, and Kenya. Conclusions The Center for Medical Innovation at the University of Utah has facilitated a rapid emergency innovative response in filling the PPE needs locally and abroad by creating this open source accessible PAPR system.

Development of a Questionnaire on Access to Sickle Cell Disease Care in the Indigenous Tharu Population of Nepal

Purpose of Study Sickle cell disease (SCD) disproportionately affects the Tharu population of Nepal, a marginalized indigenous group concentrated in the Dang district. SCD is a structural hemoglobinopathy resulting in abnormal red blood cells with a tendency to occlude microvasculature. Since 2015, University of British Columbia medical students and a local community partner, Creating Possibilities, have improved access to SCD screening and diagnosis for the Tharu population. However, interviews conducted in 2016- 2017 found that SCD-afflicted community members encounter a number of challenges to obtain treatment once diagnosed. The purpose of this study was to develop a questionnaire on barriers to accessing SCD care in this community. Methods Used The Barriers to Accessing SCD Care Questionnaire was developed from items in existing scales, deductive and inductive item generation, and feedback from expert local partners. Reviewing literature on barriers to accessing healthcare in the Western region of Nepal informed region-specific questionnaire items, while literature on accessing SCD treatment in resource-limited settings informed SCD-specific questionnaire items. We also reviewed the literature on barriers to treatment for various stigmatized chronic health conditions in low-resource settings. Summary of Results Qualitative interviews with SCD-afflicted Tharu individuals in 2016-2017 identified inadequate local medical resources, transportation, financial strain, and limited awareness as barriers to care. Based on the literature review, we organized all survey items under the themes transportation, medical infrastructure, finances, community attitudes, and personal attitudes. The questionnaire includes closed-ended questions using a Likert scale, as well as open-ended interview prompts. It was made in collaboration with local community members to ensure it is culturally appropriate, needs-specific, and easily understandable. The questionnaire received ethics board approval, and interviews will begin once local health authorities lift COVID-19 restrictions. Conclusions Results from the Barriers to Accessing SCD Care questionnaire will guide future community-based interventions.

Access to Sickle Cell Disease Treatment in the Indigenous Tharu Population of Nepal

Purpose of Study: Sickle cell disease (SCD) is a hemoglobinopathy that disproportionately affects the indigenous Tharu population of Nepal, a marginalized ethnic group concentrated in the Dang district. There are significant global disparities in the prognosis of SCD;in low-income countries, which lack screening and management infrastructure, up to 80% of those born with SCD are undiagnosed and less than half survive beyond 5 years of age. Since 2015, University of British Columbia medical student teams have collaborated with a local community partner, Creating Possibilities (CP), to improve SCD awareness, screening, diagnosis, and management for the Tharu population in and around Dang. Community members with SCD have previously expressed numerous challenges in obtaining treatment once diagnosed. This study aims to better understand difficulties in accessing SCD care for this community. Methods Used: The Access to SCD Care Questionnaire was developed from items in existing scales, deductive and inductive item generation, and feedback from expert local partners to ensure it is culturally appropriate, needs-specific, and easily understandable. The questionnaire includes closed-ended questions using a Likert scale and open-ended interview prompts. It centers around five core themes: personal beliefs, community attitudes, finances, transportation, and medical infrastructure. Interviews were conducted in Tharu (local dialect) by CP staff members in January to March 2022. Themes and sub-themes were qualitatively analyzed. Summary of Results: Participants aged from 14 to 42 with an equal sex ratio, a total of 12 interviews were conducted before study saturation was reached. All participants reported at least one minor or major problem with access to SCD care in each of the five core themes of the questionnaire. Inadequate healthcare infrastructure was the most frequently reported barrier, with participants reporting lack of local medication accessibility and low supplies at further district hospitals. Additionally, despite government funding for treatment coverage, participants reported difficulties obtaining the necessary legal documents to prove eligibility. The second largest perceived barrier to care was transportation, which was reported to be costly, time-consuming, and not readily available. Regardless of sub-theme, participants reported that system-wide effects from COVID-19 perpetuated these issues. Conclusion(s): Results from the Access to SCD Care Questionnaire demonstrate that availability and accessibility to medications and transportation services are the primary challenges to receiving SCD care in this indigenous community. Therefore, future interventions for this community should focus on these findings. In contrast with previous literature, community stigma and personal beliefs were not often reported as hindering SCD treatment. This may be attributed to successful education campaigns within this specific community or due to participation bias.

Clinical severity of patients with COVID-19 presenting to Nepal armed police force hospital: a descriptive cross-sectional study

Introduction: Coronavirus Disease 2019 (COVID-19), since its emergence, has spread rapidly as a pandemic causing massive loss of human life. This study aims to describe clinical severity of the disease in relation to age, mode of oxygen delivery and clinical outcome of patients admitted to a tertiary care center in Nepal. Methods: This was a descriptive cross-sectional study of data records of 130 COVID-19 patients 18 years and above admitted in Nepal Armed Police Force Hospital from April 2021 to June 2021 with Severe Acute Respiratory syndrome SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction positive status. Ethical approval was obtained from Nepal Health research Council. Data were collected using structured proforma and analyzed using SPSS version 23. Results: Patients with severe illness (52/130) constituted 40% of the bulk of COVID-19 patients, 48 of them requiring intensive care. Among them, 38.5% required non-invasive ventilation and 32.7% were intubated during treatment. Severity of illness was variable among different age groups but mortality was high among severely ill patients, 19/52 (36.5%) and with increasing age. The overall mortality was 19/130 (14%) over the study period, all of which were among severely ill patients. Conclusions: Most of the clinically severe cases required Intensive Care Unit admission, the majority receiving oxygen therapy via non-invasive or invasive mechanical ventilation, with a high mortality rate. The number of severely ill COVID-19 patients was variable in different age groups. Mortality, however, was observed in severely ill patients only and proportionately increased in COVID-19 patients with advancing age.

Impact of COVID-19 lockdown on particulate matter (PM₂.₅) concentration in Kathmandu, Nepal

This paper reports a study on the statistics for particulate matter pollution (PM₂.₅) and the COVID-19 lockdown in the Kathmandu valley. The PM₂.₅ decreased during the COVID-19 pandemic lockdown periods 2020 compared to the average value of the previous three years (2017, 2018, and 2019). Further, analysis of active fire and air mass trajectory for April and May in 2019 and 2020 shows that the particulate matter trend associated with Kathmandu is not directly influenced by the long-range transport of wind carrying aerosols from the active fire regions. Statistical tests indicate a reduction of particulate matter pollution during the period.

University of British Columbia Nepal Sickle Cell Project Status Report 2015-2020

Purpose of Study In 2015 the University of British Columbia partnered with Creating Possibilities (CP), a charitable organization located in Dang, Nepal. Each year, a team of medical students is sent to assist CP in the long term management of sickle cell disease (SCD) in rural Western Nepal. Due to COVID-19 limitations, we were unable to travel to Nepal this year for the field component of our project. Instead, we took this opportunity to reflect on the project as a whole and create a project status report, outlining the past five years of work. The purpose of this report included: summarizing overall project progress, identifying future project directions, and improving communication amongst project stakeholders. Methods Used To create the project status report, our team reviewed all project documents since 2015. We also conducted virtual interviews with previous team leads to clarify questions and fill in gaps. Project progress was assessed by comparing activities completed to date to the project's initial three main objectives. Summary of Results The first objective of characterizing the prevalence of SCD among the Tharu population is currently ongoing. Since 2015, we have conducted large-scale screening of the Tharu population, with 4483 individuals having been screened by our team. Thus far, a hemoglobin S prevalence of 9.3% has been estimated. Our second objective of identifying barriers to SCD management is also ongoing. Since 2016, yearly focus groups and needs assessments have been conducted with community members and health workers. Common themes of barriers included accessibility, financial limitations, and education. Finally, our third objective of implementing sustainable solutions for long term detection and management of SCD still needs to be addressed. Conclusions Screening and needs assessments will continue as we progress toward addressing our first two objectives. Following consultation with experts and a literature review, we have identified a pilot newborn screening program for SCD as the first step in addressing our third objective.

COVID-19 related Symptoms and Vaccination Usage among Informal Waste Workers of Kathmandu, Nepal

Introduction: About 56% of the total population of Nepal has been fully immun-ized against COVID-19. But still, migrant workers outside of Nepal are struggling to get COVID vaccines. This study was intended to study the COVID-19 symptoms among IWWs of Kathmandu and the usage of vaccines by them. Methods: A Cross-sectional study was conducted among 107 IWWs of Kath-mandu Valley from Balkhu, Sanepa, Kalimati and Teku areas. A convenience sam-pling method was used to find the respondents based on their willingness to par-ticipate in the study. A face-to-face interview was conducted using a structured questionnaire to collect data from IWWs. Results: Following the COVID-19 symptoms, most of the waste workers had a fe-ver (89.7%) followed by cough (86%) and respiratory problems (55.1%). Despite of majority of waste workers having COVID-related symptoms, only 19.6% of waste workers had done COVID tests. The majority of IWWs of Kathmandu were afraid to take the COVID vaccine. Around 77.6% of waste workers hadn't still taken the COVID vaccine with a majority (93.9 %) of them identified as Indian nationals. Conclusion: Despite having COVID-related symptoms, IWWs haven't gone for COVID tests. Though interested, the IWWs need identity cards for vaccination which counts fewer waste workers being vaccinated. © 2023 The Author(s).

Impact of the CARE Tipping Point Program in Nepal on adolescent girls' agency and risk of child, early, or forced marriage: Results from a cluster-randomized controlled trial.

Background: Girl child, early, and forced marriage (CEFM) persists in South Asia, with long-term effects on well-being. CARE's Tipping Point Initiative (TPI) sought to address the gender norms and inequalities underlying CEFM by engaging participant groups on programmatic topics and supporting community dialogue to build girls' agency, shift power relations, and change norms. We assessed impacts of the CARE TPI on girls' multifaceted agency and risk of CEFM in Nepal. Methods: The quantitative evaluation was a three-arm, cluster-randomized controlled trial (control; Tipping Point Program [TPP]; Tipping Point Plus Program [TPP+] with emphasized social-norms change). Fifty-four clusters of ∼200 households each were selected from two districts (27:27) with probability proportional to size and randomized evenly to study arms. A pre-baseline census identified unmarried girls 12-16 years (1,242) and adults 25 years or older (540). Questionnaires covered marriage; agency; social networks/norms; and discrimination/violence. Baseline participation was 1,140 girls and 540 adults. Retention was 1,124 girls and 531 adults. Regression-based difference-in-difference models assessed program effects on 15 agency-related secondary outcomes. Cox-proportional hazard models assessed program effects on time to marriage. Sensitivity analyses assessed the robustness of findings. Results: At follow-up, marriage was rare for girls (<6.05%), and 10 secondary outcomes had increased. Except for sexual/reproductive health knowledge (coef.=.71, p=.036) and group membership (coef.=.48, p=.026) for TPP + versus control, adjusted difference-in-difference models showed no program effects on secondary outcomes. Results were mostly unmoderated by community mean: gender norms, household poverty, or women's schooling attainment. Cox proportional hazard models showed no program effect on time-to-marriage. Findings were robust. Discussion: Null findings of the Nepal TPI may be attributable to low CEFM rates at follow-up, poor socio-economic conditions, COVID-19-related disruptions, and concurrent programming in control areas. As COVID-19 abates, impacts of TPP/TPP + on girls' agency and marriage, alone and with complementary programming, should be assessed. Trial registration number: NCT04015856.

Estimating the number of undetected COVID-19 cases among travellers from mainland China [version 1, peer review: awaiting peer review]

Background: Since the start of the COVID-19 epidemic in late 2019, there have been more than 152 affected regions and countries with over 110,000 confirmed cases outside mainland China. Methods: We analysed COVID-19 cases among travellers from mainland China to different regions and countries, comparing the region- and country-specific rates of detected and confirmed cases per flight volume to estimate the relative sensitivity of surveillance in different regions and countries. Results: Although travel restrictions from Wuhan City and other cities across China may have reduced the absolute number of travellers to and from China, we estimated that more than two thirds (70%, 95% CI: 54% - 80%, compared to Singapore;75%, 95% CI: 66% - 82%, compared to multiple countries) of cases exported from mainland China have remained undetected. Conclusions: These undetected cases potentially resulted in multiple chains of human-to-human transmission outside mainland China.

The sociomateriality of digitalisation in Nepalese NGOs

Drawing on the concept of sociomateriality, this paper investigates the digitalisation of Non-Governmental Organisations (NGOs) in developing countries during the COVID-19 pandemic. NGOs represent one sector in which the consequences of digitalisation have been particularly striking. Nationwide lockdowns, travel restrictions and strict government guidelines led to NGOs embarking on a transition towards digitalisation for their continuity and survival. Adhering to a qualitative approach, data for the study have been derived through semi-structured interviews with stakeholders, focus group discussions with beneficiaries and a review of documentary sources. Outlining both the benefits and consequences of digitalisation, the findings of the study illustrate the way how the NGOs' digitalisation has triggered changes in both their operations and modes of communication, altered their relationships with beneficiaries and other stakeholders, and transformed their identity. The key contribution made by the paper involves moving beyond the human-centred and techno-centric approaches to digitalisation, which dominate the existing accounting literature, and illustrating how the performance of technologies evolves in everyday life. In doing so, the paper delineates the role that the technology itself can play in shaping NGOs' day-to-day practices in developing countries. © 2023 The Author(s)

The Coronavirus Came with the (One of the) World: What the Ritual Treatment of Coronavirus in a Himalayan Valley Can Teach Us

April 2019. In an indigenous community in the Nepalese Himalayas, a ritual is performed for Sansari, "the One of the World," to ward off coronavirus. Why respond to an epidemic with a ritual? On what basis do we associate a virus with a spiritual entity? How do we articulate anchoring in tradition and innovation? What does all this tell us about the relationship of this population to the world? In addition to a film on this ritual, this article proposes avenues of analysis and reflection on procedures of interpretation, of integration of the new and the foreign into a local system of knowledge and defense. © OpenEditions Journals. All Rights Reserved.