Sero-epidemiology and associated risk factors of brucellosis among sheep and goat population in the south western Nepal: a comparative study.

BACKGROUND: Brucellosis is a zoonotic disease caused by Brucella spp. In Nepal, the presence of brucellosis in small ruminants, namely sheep and goats, has impacted farmers' livelihood and the food safety of consumers. A cross-sectional study was conducted in Rupandehi district of Nepal during January to March 2020 to investigate the seroepidemiology and associated risk factors of brucellosis in the sheep and goat population. Altogether, 19 sheep and 60 goat farms in the district were visited. Owners were interviewed to get information on animals, including their management and movement patterns. Three hundred fifty-seven samples (80 sheep and 277 goat samples) were collected proportionately based on farm sizes. Each serum sample was tested with Rose Bengal Test and ELISA to estimate the seropositivity of brucellosis. Logistic regression was carried out to calculate corresponding odds ratios of each variable associated with detection of brucellosis. RESULTS: At the farm level, 31.6% (6/19; 95% CI: 12, 54%) of sheep farms and 3.3% (2/60, 95% CI: 0.9, 11.4%) of goat farms were seropositive to brucellosis. Out of 80 sheep serum samples, 12 (15%; 95% CI: 8.79-24.41%) and out of 277 goat serum samples, three (1.1%; 95% CI: 0.37-3.14%) were seropositive to brucellosis. Age greater than 1.5 years (OR = 5.56, 95% CI: 1.39, 29.38; p = 0.02) and herd size of greater than 100 (OR = 4.74, 95% CI: 1.23, 20.32, p = 0.03) were identified as significant risk factors for seropositivity of brucellosis in the sheep population. While in the goat population, none of the variables was identified as a significant risk factor. CONCLUSION: The study provides evidence that the older sheep and the sheep from the large herds were at higher risk of brucellosis. A control program should be put in place immediately in the sheep population because they may transmit infections to other livestock as they were regularly moved for grazing and selling purposes. Also, strict biosecurity measures should be implemented among pastoralists to prevent brucellosis transmission in them. We suggest further one health-based study to reveal the transmission dynamics of brucellosis between animals and humans.

Immunomodulatory effect of Stinging nettle (Urtica dioica) and Aloe vera (Aloe barbadensis) in broiler chickens.

A study was conducted to identify the immunomodulatory effect of Stinging nettle (Urtica dioica) and Aloe vera (Aloe barbadensis) in broiler chicken. A total of 240 birds were divided into 4 treatment groups with 4 replications in each group, each replication containing 15 birds. Treatments were comprised of no Nettle and Aloe vera (T0); Nettle 5% (T1), Aloe vera @5 ml/lit drinking water (T2) and Nettle 5% and Aloe vera @5 ml/lit drinking water (T3). The study was conducted under a randomized design. The immunomodulating effect was evaluated by measuring antibody titer against NDV vaccine; and by estimating the albumin, globulin and total protein upto 40 days of age. The effect on liver was estimated by measuring liver enzymes alanine aminotransferase (ALT). The hypoglycemic effect was estimated by measuring glucose level in the serum, and morphological changes in the spleen and bursa were estimated by measuring the ratio score of the respective organs to the body weight. Throughout the experiment, the value for HI titer, albumin, globulin, total protein, spleen weight ratio score, bursa weight ratio score, liver function test and blood glucose of all treatment group were non significant (p > 0.05) except for albumin on 10th day, globulin on 0th day, total protein on 0th day and ratio score of spleen were found to be significant (p ≤ 0.05) at 30 days in all treatment compared to control group. Histopathology of spleen and bursa appeared normal in all treatment and control groups. Result thus suggests that nettle and Aloe vera have non-significant immunomodulatory effects.

Community intervention to promote rational treatment of acute respiratory infection in rural Nepal.

OBJECTIVE: To evaluate a community education program about treatment of acute respiratory infection (ARI). METHODS: First, community case definitions for severe and mild ARI were developed. The intervention was then evaluated using a controlled before-and-after design. Household surveys collected data about ARI treatment in 20 clusters, each based around a school and health facility. Treatment indicators included percentages of cases attending health facilities and receiving antibiotics. The intervention consisted of an education program in schools culminating in street theater performances, discussions with mothers after performances and training for community leaders and drug retailers by paramedics. The intervention was conducted in mid-2003. Indicators were measured before the intervention in Nov/Dec 2002 and again in Dec 2003/Jan 2004. RESULTS: Two thousand and seven hundred and nineteen households were surveyed and 3654 under-fives were identified, of whom 377 had severe ARI. After implementing the intervention, health post (HP) attendance rose by 13% in under-fives with severe ARI and fell by 9% in under-fives with mild ARI (test of interaction, P = 0.01). Use of prescribed antibiotics increased in under-fives with severe ARI by 21% but only by 1% in under-fives with mild ARI (test of interaction, P = 0.38). Irrespective of ARI severity, the use of non-prescribed antibiotics dropped by 5% (P = 0.002), and consultation with female community health volunteers (FCHVs)and use of safe home remedies increased by 6.7% (P not estimated) and 5.7% (P = 0.008) respectively. CONCLUSION: The intervention was implemented using local structures and in difficult circumstances, yet had a moderate impact. Thus it has the potential to effect large scale changes in behaviour and merits replication elsewhere.

The effect of user fees on prescribing quality in rural Nepal: two controlled pre-post studies to compare a fee per drug unit vs. a fee per drug item.

OBJECTIVE: To compare prescribing quality with a fee per drug unit vs. a fee per drug item. METHODS: Prescribing data were collected prospectively over 10 years from 21 health facilities in two districts of rural eastern Nepal. In 1995, both districts charged a fee per drug item. By 2000, one district was charging a fee per drug unit, and the second district continued to charge a fee per drug item (control group). By 2002, the second district was also charging a fee per drug unit. These fee changes allowed two pre-post 'cohort' with control analyses to compare INRUD/WHO drug use indicators for a fee per drug unit vs. a fee per drug item. RESULTS: Charging a fee per drug unit increased the percentage of antibiotics prescribed in under-dosage by 11-12% (P = 0.02 and 0.02), decreased the percentage of patients prescribed injections by 4-6% (P = 0.002 and 0.02), reduced the units per drug item prescribed by 1.7 (P = 0.02 and 0.03), and decreased compliance with standard treatment guidelines by 11-15% (P = 0.02 and 0.06). CONCLUSION: A fee per unit was associated with prescription of fewer units of drugs and fewer expensive drugs (such as injections), resulting in significantly poorer compliance with standard treatment guidelines. This finding is of great concern for public health in countries where patients are charged a fee per unit of drug.

Improving access to drugs by poor households through a cost sharing drug scheme: a wealth ranking approach.

In Nepal lack of drugs in government health institutions has markedly reduced access to essential drugs by poor patients. Despite the implementation of a drug scheme with adequate availability of drugs and with provision of fee exemption for the poor, the poorest people still had no access to drugs. We carried out a wealth ranking process to identify poorest of the poor households in a village. Each of the poorest household was provided with a free treatment card and information about the availability of free service at the local health post. Baseline and post intervention data on service utilisation and prescribing practices were collected using carbon copies of prescriptions. Data were also collected about the attitude of patients, using qualitative interviews. About 1.8% of the total annual patient visits to the Health Post were from cardholder households. The annual health post utilization rate for the poor patients was about 1.2, whereas among other patients it was 0.7. On average, about 2.4 drugs were prescribed to any of the cardholder patients, and 50.8% of prescriptions included at least one antibiotic drug. No injection was prescribed. Within 18 months, the total fee exemption provided to a poorest household was equivalent to about US dollars 1.6. Since the method is valued by local people, and is also feasible to implement through the communities' efforts, it is recommended to initiate it in other drug scheme areas as well.

Rumen ciliate faunae of water buffalo (Bubalus bubalis) and goat (Capra hircus) in Nepal.

Rumen ciliate composition of river-type water buffalo and goat in Nepal was surveyed. As the result of survey, 13 genera representing 52 species and 20 formae of the ciliates were identified. Of them 13 genera with 44 species and 9 formae were found from the water buffalo and 8 genera with 21 species and 12 formae from the goat. The present paper shows the first report of Hsiungella triciliata, Entodinium brevispinum, E. convexum, E. javanicum, E. rectangulatum f. rectangulatum, E. rectangulatum f. lobosospinosum, Diplodinium nanum, D. psittaceum, D. sinhalicum and Ostracodinium quadrivesiculatum from water buffalo and Epidinium ecaudatum f. parvicaudatum from goat.