Climate change is adversely impacting the burden of diarrheal diseases. Despite significant reduction in global prevalence, diarrheal disease remains a leading cause of morbidity and mortality among young children in low- and middle-income countries. Previous studies have shown that diarrheal disease is associated with meteorological conditions but the role of large-scale climate phenomena such as El Niño-Southern Oscillation (ENSO) and monsoon anomaly is less understood. We obtained 13 years (2002–2014) of diarrheal disease data from Nepal and investigated how the disease rate is associated with phases of ENSO (El Niño, La Niña vs ENSO Neutral) monsoon rainfall anomaly (below normal, above normal vs normal), and changes in timing of monsoon onset, and withdrawal (early, late vs normal). Monsoon season was associated with a 21% increase in diarrheal disease rates (Incident Rate Ratios (IRR): 1.21; 95% Confidence Interval (CI): 1.16 -1.27). El Niño was associated with an 8% reduction in risk while the La Niña was associated with a 32% increase in under five diarrheal disease rates. Likewise, higher-than-normal monsoon rainfall was associated with increased rates of diarrheal disease, with considerably higher rates observed in the mountain region (IRR 1.51, 95% CI: 1.19–1.92). Our findings suggest that under-five diarrheal disease burden in Nepal is significantly influenced by ENSO and changes in seasonal monsoon dynamics. Since both ENSO phases and monsoon can be predicted with considerably longer lead time compared to weather, our findings will pave the way for the development of more effective early warning systems for climate sensitive infectious diseases.

Indoor air pollution caused by combustion is a common problem in low-and middle-income countries which negatively affects human health. In Asian countries, burning incense in temples, pagodas, or residences is popular. This study consists of three contents (i) monitoring air quality parameters, including total volatile organic compounds (TVOCs), particulate matter (i.e. PM10 and PM2.5), and CO2 concentration in five pagodas in Ho Chi Minh City and Binh Duong province; (ii) determining air pollutants concentration generated by incense burning in room; and (iii) investigating incense smoke removal ability of photocatalytic devices. The results showed that the average air pollutants concentration in the pagodas was 625-1,108 ppb of TVOCs, 1,935-2,967 ppm of CO2, 1,175-2,137 μg/m3 of PM2.5, and 1,589-2,871 μg/m3 of PM10 in which TVOCs, PM2.5, and PM10 were presented at the threshold of direct impact on human health. Burning seven types of incense in a room revealed that the cinnamon incense smoke contained the highest concentration of TVOCs. Using photocatalytic devices for incense smoke treatment showed that the photocatalyst provided the best removal efficiency of VOCs (48.13%) was zinc salt-impregnated titanium dioxide with Zn/Ti molar ratio of 0.5% and calcined at 500 oC. This result was initially successful in finding a way to low down VOCs concentration generated from incensation to allowable level (490 ppb).