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Background: The study aimed to define the burden and underlying risk factors of malnutrition among children with cerebral palsy (CP) in Gorkha district, Nepal. Methods: The first population-based register of children with CP in Gorkha, Nepal (i.e., Nepal CP Register—NCPR) was established in 2018. Children aged <18 years with confirmed CP were registered following standard protocol. Nutritional status was determined based on anthropometric measurements (height/length, weight, mid-upper-arm-circumference) following WHO guidelines. Descriptive analyses and adjusted logistic regression were completed. Results: Between June–October 2018, 182 children with CP were registered into the NCPR (mean (SD) age at assessment: 10.3 (5.0) years, 37.4% female). Overall, 51.7%, 64.1%, and 29.3% children were underweight, stunted, and thin, respectively. Furthermore, 14.3% of children with CP aged <5 years had severe wasting. Underweight and stunting were significantly higher among children with spastic CP (p = 0.02, p < 0.001) and/or Gross Motor Function Classification System (GMFCS) level (III–V) (p = 0.01, p < 0.001) and/or who were not enrolled in school (p = 0.01, p < 0.001). In adjusted analysis, GMFCS level III–V and non-attendance to school significantly increased the odds of stunting by 8.2 (95% CI 1.6, 40.8) and 4.0 (95% CI 1.2, 13.2) times, respectively. Conclusions: the high rate of different forms of undernutrition among children with CP in Gorkha, Nepal is concerning. Need-based intervention should be taken as priority to improve their nutritional outcome.

Background Musculoskeletal impairment (MSI) in children is an under-recognised public health challenge. Although preventable, road injuries and other traumas continue to cause significant impairments to children worldwide. The study aimed to use the Key Informant Method (KIM) to assess prevalence and causes of MSI in children in two districts in Malawi, estimating the associated need for services provision, with a focus on traumatic aetiology. Methods The KIM was conducted in the districts of Thyolo (Southern Malawi) and Ntcheu (Central Malawi) in 2013. Five hundred key informants were trained to identify children who may have one of a range of MSI. The identified children were referred to a screening camp where they were examined by medical experts with standardised assessment protocols for diagnosing each form of impairment. Results 15,000 children were referred to screening camps. 7220 children were assessed (response rate 48%) for an impairment of whom 15.2% (1094) had an MSI. 13% of children developed MSI from trauma, while 54% had a neurological aetiology. For MSI of traumatic origin the most common body part affected was the elbow. Less than half of children with MSI (44.4%) were enrolled in school and none of these children attended schools with resources for disability. More than half of children with MSI (60%) had not received required services and 64% required further physical therapy. Conclusions The KIM method was used to identify a high prevalence of MSI among children in two districts of Malawi and estimates an unmet need for dedicated MSI services.

Background Epidemiological data on childhood disability are lacking in Low and Middle Income countries (LMICs) such as Malawi, hampering effective service planning and advocacy. The Key Informant Method (KIM) is an innovative, cost-effective method for generating population data on the prevalence and causes of impairment in children. The aim of this study was to use the Key Informant Method to estimate the prevalence of moderate/severe, hearing, vision and physical impairments, intellectual impairments and epilepsy in children in two districts in Malawi and to estimate the associated need for rehabilitation and other services. Methods Five hundred key informants (KIs) were trained to identify children in their communities who may have the impairment types included in this study. Identified children were invited to attend a screening camp where they underwent assessment by medical professionals for moderate/severe hearing, vision and physical impairments, intellectual impairments and epilepsy. Results Approximately 15,000 children were identified by KIs as potentially having an impairment of whom 7220 (48%) attended a screening camp. The estimated prevalence of impairments/epilepsy was 17.3/1000 children (95% CI: 16.9–17.7). Physical impairment (39%) was the commonest impairment type followed by hearing impairment (27%), intellectual impairment (26%), epilepsy (22%) and vision impairment (4%). Approximately 2100 children per million population could benefit from physiotherapy and occupational therapy and 300 per million are in need of a wheelchair. An estimated 1800 children per million population have hearing impairment caused by conditions that could be prevented or treated through basic primary ear care. Corneal opacity was the leading cause of vision impairment. Only 50% of children with suspected epilepsy were receiving medication. The majority (73%) of children were attending school, but attendance varied by impairment type and was lowest among children with multiple impairments (38%). Conclusion Using the KIM this study identified more than 2500 children with impairments in two districts of Malawi. As well as providing data on child disability, rehabilitation and referral service needs which can be used to plan and advocate for appropriate services and interventions, this method study also has an important capacity building and disability awareness raising component.

Background: Evidence regarding the complex relationship between childhood disability and malnutrition is limited in low and middle income countries. We aimed to measure the association between childhood disability and malnutrition in rural Bangladesh. Method: We conducted a population-based case control study among children aged <18 years in a rural sub-district (i.e., Shahjadpur) in Bangladesh. Children with permanent disability (i.e., Cases) and their age/sex-matched peers (i.e., Controls) were identified from the local community utilizing the key informant method. Socioeconomic, anthropometric, and educational information was collected using a pre-tested questionnaire. Only Cases underwent detailed medical assessment for clinical and rehabilitation information. Descriptive and bivariate analyses were performed. Results: Between October 2017 and February 2018, 1274 Cases and 1303 Controls were assessed. Cases had 6.6 times and 11.8 times higher odds of being severely underweight and severely stunted respectively than Controls. Although epileptic children had the highest overall prevalence of malnutrition, the age/sex-adjusted odds of malnutrition were significantly higher among children with physical impairments. Underweight and/or stunting among children with disability was significantly associated with parental educational qualification, socioeconomic status and mainstream school attendance. Conclusion: The significantly high proportion of severe malnutrition among children with disability calls for urgent action and implementation of inclusive nutrition intervention programs in rural Bangladesh.

This article discusses the methodology and application of the Key Informant Monitoring (KIM) tool as used by the Nepal Safer Motherhood Project (NSMP). NSMP aims to achieve a sustained increase in the uptake of midwifery and essential obstetric care services by addressing, among other things, constraints on access to such services. Data collected by community-based Key Informant Researchers (KIRs) are synthesised and used by NSMP and key project partners for monitoring and planning purposes. NSMP has used KIM findings to modify its main interventions at the local level. International and Nepali NGOs have adopted KIM in their safe motherhood and other development programmes. Village Development Committees, with support from NGOs and NSMP, have responded to issues raised by KIM by running maternal health awareness-raising campaigns, working with traditional healers, improving the quality of care, and facilitating local emergency transport and funding schemes. KIRs have proved effective as sources of information and as change agents, spreading safe motherhood messages to promote behaviour change.

Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world's health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.

In an effort to establish and enhance the accuracy of key informant data, organizational survey studies are increasingly relying on triangulation techniques by including supplemental data sources that complement information acquired from key informants. Despite the growing popularity of triangulation, little guidance exists as to when and how it should be conducted. Addressing this gap, the authors develop hypotheses linking a comprehensive set of study characteristics at the construct, informant, organizational, and industry levels to key informant accuracy. Two studies test these hypotheses. The first study is a metaanalysis of triangulation applications. Using data from 127 studies published in six major marketing and management journals, the authors identify antecedents to key informant reliability. The second study, using eight multi-informant data sets, analyzes antecedents to key informant validity. The results from these studies inform survey researchers as to which conditions particularly call for the use of triangulation. The authors conclude by offering guidelines on when and how to employ triangulation techniques.

Background Key informant interviews (KII) are a widely used method in qualitative health research to gain in-depth insights from individuals with specialized knowledge, experience, or access that is crucial to the research topic. However, there is growing criticism regarding how the selection of key informants is insufficiently described in research. This opacity is problematic as the authority and knowledge of key informants may be given undue weight in research findings, potentially overshadowing other non-expert samples. The resulting imbalance in representation can lead to favoring certain viewpoints while marginalizing others, and thereby reinforcing existing inequities. Methods Using our KII study as an example, we demonstrate how we initially composed an ideal sample based on theoretical considerations and subsequently operationalized it in the field. We employed a selective recruitment strategy informed by intersectional theory, targeting physicians with migration backgrounds from Middle Eastern countries for a study on cancer prevention and screening. Our recruitment process combined direct methods, including database searches and email outreach, with indirect methods like snowball sampling and engagement with multipliers. The recruitment strategy was iterative, allowing for ongoing assessment and adaptation to ensure a diverse and representative sample. Results The KII study successfully recruited 21 physicians with diverse social categories, including different genders, migration backgrounds, language skills, and medical specialties. Direct recruitment was more effective than indirect methods and allowed for greater control in reaching out to specific subsamples. It highlights the importance of flexible and persistent recruitment strategies to achieve the desired sample. Conclusions This KII study underscores the interplay between methodological ideals and the practical realities of recruiting a diverse, carefully composed sample of key informants in health research. Our intersectional approach aimed to ensure equitable representation by considering power dynamics and refining recruitment strategies, while balancing the challenges of real-world fieldwork-such as engaging busy physicians with specific recruitment criteria-with practical adaptability. Our KII study emphasizes the need for ongoing reflexivity to balance ideality and equity with practical feasibility.

Background As malaria cases have declined throughout Nepal, imported cases comprise an increasing share of the remaining malaria caseload, yet how to effectively target mobile and migrant populations (MMPs) at greatest risk is not well understood. This formative research aimed to confirm the link between imported and indigenous cases, characterize high-risk MMPs, and identify opportunities to adapt surveillance and intervention strategies to them. Methods The study used a mixed-methods approach in three districts in far and mid-western Nepal, including (i) a retrospective analysis of passive surveillance data, (ii) a quantitative health facility-based survey of imported cases and their MMP social contacts recruited by peer-referral, and (iii) focus group (FG) discussions and key informant interviews (KIIs) with a subset of survey participants. Retrospective case data were summarised and the association between monthly indigenous case counts and importation rates in the previous month was investigated using Bayesian spatio-temporal regression models. Quantitative data from structured interviews were summarised to develop profiles of imported cases and MMP contacts, including travel characteristics and malaria knowledge, attitudes and practice. Descriptive statistics of the size of cases’ MMP social networks are presented as a measure of potential programme reach. To explore opportunities and barriers for targeted malaria surveillance, data from FGs and KIIs were formally analysed using a thematic content analysis approach. Results More than half (54.1%) of malaria cases between 2013 and 2016 were classified as imported and there was a positive association between monthly indigenous cases (incidence rate ratio (IRR) 1.02 95% CI 1.01–1.03) and the previous month’s case importation rate. High-risk MMPs were identified as predominantly adult male labourers, who travel to malaria endemic areas of India, often lack a basic understanding of malaria transmission and prevention, rarely use ITNs while travelling and tend not to seek treatment when ill or prefer informal private providers. Important obstacles were identified to accessing Nepali MMPs at border crossings and at workplaces within India. However, strong social connectivity during travel and while in India, as well as return to Nepal for large seasonal festivals, provide opportunities for peer-referral-based and venue-based surveillance and intervention approaches, respectively. Conclusions Population mobility and imported malaria cases from India may help to drive local transmission in border areas of far and mid-western Nepal. Enhanced surveillance targeting high-risk MMP subgroups would improve early malaria diagnosis and treatment, as well as provide a platform for education and intervention campaigns. A combination of community-based approaches is likely necessary to achieve malaria elimination in Nepal.

Background Population mortality is an important metric that sums information from different public health risk factors into a single indicator of health. However, the impact of COVID-19 on population mortality in low-income and crisis-affected countries like Sudan remains difficult to measure. Using a community-led approach, we estimated excess mortality during the COVID-19 epidemic in two Sudanese communities. Methods Three sets of key informants in two study locations, identified by community-based research teams, were administered a standardised questionnaire to list all known decedents from January 2017 to February 2021. Based on key variables, we linked the records before analysing the data using a capture-recapture statistical technique that models the overlap among lists to estimate the true number of deaths. Results We estimated that deaths per day were 5.5 times higher between March 2020 and February 2021 compared to the pre-pandemic period in East Gezira, while in El Obeid City, the rate was 1.6 times higher. Conclusion This study suggests that using a community-led capture-recapture methodology to measure excess mortality is a feasible approach in Sudan and similar settings. Deploying similar community-led estimation methodologies should be considered wherever crises and weak health infrastructure prevent an accurate and timely real-time understanding of epidemics’ mortality impact in real-time.