Determinants of wealth-related inequalities in full vaccination coverage among children in Nepal: a decomposition analysis of nationally representative household survey data.

BACKGROUND: Over the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn't been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality. METHODS: Data for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12-23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination. RESULTS: The coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers' awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake. CONCLUSIONS: There was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.

Deciphering genetic diversity phylogeny and assembly of Allium species through micro satellite markers on nuclear DNA.

The genus Allium is the most diverse, with cultivated crops such as onion, garlic, bunching onion, chives, leeks, and shallots, and several wild and semi-domesticated Allium species utilized as minor vegetables. These minor species are the genetic resources for various abiotic and biotic stresses. To employ underutilized species in breeding programmes, the magnitude of the genetic background of cultivated and semi-domesticated alliums, the phylogeny and diversity of the population must be known. In this study, nineteen SSR markers were employed to study the divergence and population structure of 95 Allium accessions which includes species, varieties, and interspecific hybrids, yielded 92 polymorphic loci, averaging 4.84 loci per SSR. PIC values range between 0.24 (ACM 018) and 0.98 (ACM 099). The cross transferability of ACM markers among Allium species ranges from 1.33 to 10.53 per cent, which is relatively low. The genotypes investigated were clustered into four primary clusters A, B, C, and D with 13 sub clusters I-XIII, conferring to the clustering results. The population structure investigations also found that K is a peak at value 4, implying that the population is predominantly segregated into four distinct groups, which associates the clustering pattern. The employed SSR markers adeptly unravel the complexities of diversity within alliums, holding promise for refining future breeding programs targeting elite progenies.

Spectrum of presentation in primary anorectal malignant melanoma and its management.

The article presents a series of four patients with primary anorectal melanoma presenting to our institute between 2016 and 2021. The primary objective of the series is to give an overview of the variable presentation of this rare entity from a high-volume colorectal tertiary care centre in a developing country. The patients ranged in age from 55 to 73 years and were mostly women (except one). The clinical presentation varied from bleeding per rectum to tenesmus and mucus in stools, overlapping with those of inflammatory bowel disease and primary anorectal adenocarcinoma. All patients were treated with surgery (laparoscopic or open), ranging from local excision to abdominoperineal resection. All our patients had a good outcome after surgery with no mortality at 30 or 90 days after surgery. The article aims to present a comprehensive overview of the various options of management with evidence from the surgical literature.