Rajendra Prasad Parajuli

Association of cord blood levels of lead, arsenic, and zinc with neurodevelopmental indicators in newborns: A birth cohort study in Chitwan Valley, Nepal

In this study, we aimed to investigate the association between in utero toxic (lead [Pb] and arsenic [As]) and essential element (zinc [Zn]) levels and neurodevelopmental indicators after birth in Chitwan Valley, Nepal. We conducted a hospital-based birth cohort study with 100 pregnant women in Chitwan, Nepal. We measured Pb, As, and Zn concentrations in cord blood. We assessed 100 infants at 1 day after birth, using the Brazelton neonatal behavioral assessment scale, third edition (NBAS III). Multivariate regression was performed to adjust for mothers age, parity, educational level, and body mass index (BMI); family income; and newborns birth weight, gestational age, and age in hours at the time of NBAS III assessment. Among the 7 clusters of NBAS III, the motor cluster score was inversely associated with the cord blood levels of Pb (coefficient=-2.15, at 95% confidence interval [CI]=-4.27 to -0.03). The cord blood levels of As were inversely associated with the state regulation cluster score (coefficient=-6.71, at 95% CI=-12.17 to -1.24). The cord blood levels of Zn were not associated with NBAS III scores. The cord blood levels of Pb and As, but not Zn, showed significant inverse association with the neurodevelopment of newborns. These results suggest that high levels of Pb or As exposure during the prenatal period may induce retardation during in utero neurodevelopment.

DIET AMONG PEOPLE IN THE TERAI REGION OF NEPAL, AN AREA OF MICRONUTRIENT DEFICIENCY

In the Terai region, despite its ecological richness, the people have long suffered from a deficiency of micronutrients such as vitamin A, iron and zinc. The aim of this study was to investigate dietary and nutritional intakes among people in the Terai region of Nepal. The results were compared by sex and ethnicity. Food consumption surveys (one-day weighed records) were conducted among 114 people (55 Mushar and 59 Tharu). Nutritional intakes were calculated using Nepali food composition and other tables. The diet in the Terai region was characterized by a large amount of rice consumed with a tiny amount of curry or dal as a side dish. Intakes of vitamin A, iron, riboflavin and selenium were less than 50% of the recommended daily allowance irrespective of ethnicity or sex (with the exception of iron intake among Tharu males). Intakes of thiamine, riboflavin, niacin, phosphorus and zinc were higher among the Tharu than the Mushar, while intakes of selenium and iodine were higher among the Mushar than the Tharu. The nutritional significance of these differences was slight. Protein intake (per kg body weight) was lower in females than in males, while the energy-adjusted micronutrient intakes did not differ by sex. Intakes of vitamin A, iron, riboflavin and selenium were deficient among the participants. Intervention projects such as the introduction of kitchen gardens or fish farming may be effective, but will increase the degree of inequality between the two ethnic groups.

Behavioral and nutritional factors and geohelminth infection among two ethnic groups in the Terai region, Nepal.

Geohelminthiasis is a major health problem in many developing countries. This study was designed to evaluate the role of behaviors and the nutritional status of people with geohelminth infection in two indigenous ethnic groups in lowland Terai, Nepal. One hundred and fourteen individuals (55 Mushar and 59 Tharu) aged 20–60 years participated, and a structured questionnaire was used to investigate socioeconomic status and behaviors. Nutritional status was assessed by anthropometric measurements. Ninety five stool samples of the participants were collected for parasitological analysis. The results showed that the prevalence of geohelminthiasis was 42.1%: 26.3% of the subjects were infected with roundworm, 9.5% with hookworms, and 6.3% with whipworm. Multivariate logistic regression analysis revealed that “not using soap for hand‐washing” (adjusted OR = 5.27; 95% CI: 1.41–19.78) and height (adjusted OR = 0.88, 95% CI: 0.79–0.99) were associated with the prevalence of roundworm. “Walking barefoot when outdoor” was associated with the prevalence of hookworm (χ‐square test, P = 0.01). Ethnicity was not associated with the prevalence of either of the geohelminths. Because unhygienic behaviors and chronic malnutrition were closely associated with the peoples recognition and subsistence pattern, elimination of geohelminth infection in Terai would be possible if deworming campaigns were implemented with in‐depth health education and modern agricultural technology. Am. J. Hum. Biol., 2009.

Home environment and prenatal exposure to lead, arsenic and zinc on the neurodevelopment of six-month-old infants living in Chitwan Valley, Nepal.

BACKGROUND We have previously reported the inverse associations between in utero levels of lead (Pb), arsenic (As) (i.e., toxic elements), and neurodevelopmental indicators (i.e., motor and state regulation cluster score) measured by the Brazelton Neonatal Behavioral Assessment Scale, third edition (NBAS III) in this cohort at birth. Using additional follow-up, this study investigated the effects of cord blood levels of Pb, As, and zinc (Zn) (an essential element) and the postnatal environment on the neurodevelopment of 6-month-old infants in Chitwan Valley, Nepal. METHODS In total, 100 mother-infant pairs were recruited from Chitwan District, Nepal. Pb, As, and Zn concentrations in cord blood were measured. Postnatal raising environment (i.e., HOME score or home environment hereafter) was evaluated using the Home Observation for Measurement of Environment (HOME) scale. Neurodevelopment of infants at 6 months (n=94) was assessed according to the Bayley Scale of Infant Development, second edition (BSID II). Multivariable regression adjusting for covariates was performed to determine the associations of in utero levels of toxic and essential elements and the home environment with neurodevelopment scores. RESULTS Cord blood levels of Pb, As, and Zn were not associated with any BSID II cluster scores in 6-month-old infants. The total HOME score was positively associated with the Psychomotor Development Index (PDI) score (coefficient=0.59, 95% confidence interval [CI]=0.04 to 1.13). CONCLUSION In this cohort, detrimental effects of in utero Pb and As on neurodevelopmental indicators observed at birth did not persist at 6 months of age, while it showed an association between the neurodevelopment and home environment.

Significant sex difference in the association between C-reactive protein concentration and anthropometry among 13- to 19-year olds, but not 6- to 12-year olds in Nepal

Life history theory predicts a trade-off between immunostimulation and growth. Using a cross-sectional study design, this study aims to test the hypothesis that C-reactive protein (CRP) is negatively associated with height-for-age z-scores (HAZ scores) and BMI-for-age z-scores (BAZ scores) among 6- to 19-year olds (N = 426) residing in five Nepalese communities. Dried blood spot (DBS) samples were collected and assayed for CRP using an in-house enzyme immunoassay (EIA). Sex- and age-group-specific CRP quartiles were used to examine its association with growth in linear mixed-effects (LME) models. A significant difference was found in the proportion of elevated CRP (>2 mg/L, equivalent to ∼3.2 mg/L serum CRP) between 13- and 19-year-old boys (12%) and girls (4%). Concentrations of CRP were positively associated with HAZ score among adolescent (13-19 years) boys, which may indicate that individuals with greater energy resources have better growth and a better response to infections, thus eliminating the expected trade-off between body maintenance (immunostimulation) and growth. Adolescent boys with low BAZ and HAZ scores had low CRP values, suggesting that those who do not have enough energy for growth cannot increase their CRP level even when infected with pathogens. Among adolescent girls a positive association was observed between CRP and BAZ scores suggesting the possible effects of chronic low-grade inflammation due to body fat rather than infection. The association between CRP and growth was less evident among children (6-12 years) compared with adolescents, indicating that the elevated energy requirement needed for the adolescent growth spurt and puberty may play some role.

Home environment and cord blood levels of lead, arsenic, and zinc on neurodevelopment of 24 months children living in Chitwan Valley, Nepal.

In a birth cohort living in Chitwan Valley, lowland Nepal, we have previously reported inverse associations between in utero levels of lead (Pb), arsenic (As) and neurodevelopment at birth measured by the Brazelton Neonatal Behavioral Assessment Scale, third edition (NBAS III). In the present paper, a follow-up of the same cohort was made on 24-month-old infants regarding the neurodevelopmental effects of these metals, taking the postnatal environment into account. In total, the same100 mother-infant pairs as the previous study, whose Pb, As, and Zn concentrations in cord blood were known, were recruited. Postnatal raising environment was evaluated using the Home Observation for Measurement of Environment (HOME) scale. Neurodevelopment of children at 24 months of age (n=74) was assessed using the Bayley Scale of Infant Development, Second Edition (BSID II). Multivariable regression adjusting for covariates was performed to determine the associations of in utero levels of toxic and essential elements and the home environment with neurodevelopment scores. Unlike the NBAS III conducted for newborns, none of the BSID II cluster scores in 24-month-old infants were associated with cord blood levels of Pb, As, and Zn. The total HOME score was positively associated with the mental development scale (MDI) score (coefficient=0.67, at 95% CI=0.03 to 1.31). In this cohort, a detrimental effect of in utero Pb and As on neurodevelopmental indicators observed at birth disappeared at 24 months, while an association between neurodevelopment and home environment continued.

Prevalence and risk factors of soil-transmitted helminth infection in Nepal.

BACKGROUND The purpose of this study is to evaluate the prevalence and intensity and examine the risk factors of soil transmitted helminth (STH; i.e., roundworm [Ascaris lumbricoides], hookworms [Ancylostoma duodenale and Necator americanus], and whipworm [Trichuris trichiura]) infections in Nepal. METHODS Five hundred and ninety-four adults (256 men and 338 women) were selected via convenience sampling from five communities in Nepal. The Kato-Katz method was used to assess the prevalence and intensity of STH infection in this population. RESULTS Prevalence of STH infection ranged from 3.3% in Birendranagar in Chitwan, 3.5% in Kuleshor in Kathmandu, 11.7% in Kanyam in Ilam, 17.0% in Dhikurpokhari in Kaski and 51.4% in Khokana in Lalitpur District [corrected]. Multivariable regression analysis revealed that not using soap for hand-washing was significantly associated with the prevalence and infection intensity of roundworm, hookworms and whipworm. Similarly, not wearing sandals or shoes outside was significantly associated with the prevalence and infection intensity of roundworm and hookworms, but not with infection intensity of whipworm. Literacy, being underweight or overweight, anemia and occupation were not associated with prevalence and intensity of roundworm and hookworms infection, but there was an association between occupation and the prevalence of whipworm infection. CONCLUSION STH infection was associated with individual hygiene behavior, but not with nutritional status or socio-demographic characteristics. Health policy focusing on changing individual hygiene behaviors might be useful in addressing STH infection in Nepal.