Environmental factors associated with ocular morbidity among children in three ecological regions of Nepal: a phase II Nepal Pediatric Ocular Diseases Study.

PURPOSE: The Nepal Pediatric Ocular Diseases Study (NPODS) was a 3-year (January 2012-December 2014) longitudinal study carried out in three ecological regions of Nepal to understand the magnitude of the problems of childhood ocular morbidity and blindness. Based on the results of this study, a second phase of NPODS was undertaken to understand the risk factors associated with childhood ocular diseases. This paper analyzes environmental factors. METHOD: This was a nested case-control study with study population selected from the same cohort of children included in the baseline survey of NPODS. The study areas were the same (three districts from three ecological regions: Sindhupalchowk from mountain, Makawanpur from hills, and Sarlahi from terai). After sample size calculation, cases and controls were taken in 1:4 ratio and matched for age, sex, and location. RESULTS: A total of 830 children (166 cases, 664 controls) were selected with 5.4 % of cases and 2.7 % of control participants nonresponders. Among environmental factors, children who stayed with their mother during cooking, who had with fewer windows in their kitchen, and who used dusty roads to school had significant association with ocular morbidities. Similarly, children with cable TV in their house had higher chance of having refractive error. CONCLUSIONS: Many of the environmental factors associated with ocular diseases in children are modifiable. Improving the household environment is likely to effectively decrease the burden of eye diseases. The association of refractive error with increased indoor and near activities is an important finding, reported herein for the first time in Nepalese children.

Estimation of the impact of a Japanese encephalitis immunization program with live, attenuated SA 14-14-2 vaccine in Nepal.

Wider availability of the live, attenuated SA 14-14-2 Japanese encephalitis (JE) vaccine has facilitated introduction or expansion of immunization programs in many countries. However, information on their impact is limited. In 2006, Nepal launched a JE immunization program, and by 2009, mass campaigns had been implemented in 23 districts. To describe the impact, we analyzed surveillance data from 2004 to 2009 on laboratory-confirmed JE and clinical acute encephalitis syndrome (AES) cases. The post-campaign JE incidence rate of 1.3 per 100,000 population was 72% lower than expected if no campaigns had occurred, and an estimated 891 JE cases were prevented. In addition, AES incidence was 58% lower, with an estimated 2,787 AES cases prevented, suggesting that three times as many disease cases may have been prevented than indicated by the laboratory-confirmed JE cases alone. These results provide useful information on preventable JE disease burden and the potential value of JE immunization programs.