title: Climate Change and Spatiotemporal Distributions of Vector-Borne Diseases in Nepal--A Systematic Synthesis of Literature.
abstract: BACKGROUND
  Despite its largely mountainous terrain for which this Himalayan country is a popular tourist destination, Nepal is now endemic for five major vector-borne diseases (VBDs), namely malaria, lymphatic filariasis, Japanese encephalitis, visceral leishmaniasis and dengue fever. There is increasing evidence about the impacts of climate change on VBDs especially in tropical highlands and temperate regions. Our aim is to explore whether the observed spatiotemporal distributions of VBDs in Nepal can be related to climate change.
  
  
  METHODS
  A systematic literature search was performed and summarized information on climate change and the spatiotemporal distribution of VBDs in Nepal from the published literature until December 2014 following providing items for systematic review and meta-analysis (PRISMA) guidelines.
  
  
  RESULTS
  We found 12 studies that analysed the trend of climatic data and are relevant for the study of VBDs, 38 studies that dealt with the spatial and temporal distribution of disease vectors and disease transmission. Among 38 studies, only eight studies assessed the association of VBDs with climatic variables. Our review highlights a pronounced warming in the mountains and an expansion of autochthonous cases of VBDs to non-endemic areas including mountain regions (i.e., at least 2,000 m above sea level). Furthermore, significant relationships between climatic variables and VBDs and their vectors are found in short-term studies.
  
  
  CONCLUSIONS
  Taking into account the weak health care systems and difficult geographic terrain of Nepal, increasing trade and movements of people, a lack of vector control interventions, observed relationships between climatic variables and VBDs and their vectors and the establishment of relevant disease vectors already at least 2,000 m above sea level, we conclude that climate change can intensify the risk of VBD epidemics in the mountain regions of Nepal if other non-climatic drivers of VBDs remain constant.
authors.affiliation: Nepal Health Research Council (NHRC), Ministry of Health and Population Complex, Kathmandu, Nepal; Biodiversity and Climate Research Centre (BiK-F), Senckenberg Gesellschaft für Naturforschung, Frankfurt am Main, Germany; Institute for Atmospheric and Environmental Sciences (IAU), Goethe University, Frankfurt am Main, Germany; Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
authors.forename: Meghnath
authors.initials: M
authors.lastname: Dhimal
authors.affiliation: Biodiversity and Climate Research Centre (BiK-F), Senckenberg Gesellschaft für Naturforschung, Frankfurt am Main, Germany; Institute for Atmospheric and Environmental Sciences (IAU), Goethe University, Frankfurt am Main, Germany.
authors.forename: Bodo
authors.initials: B
authors.lastname: Ahrens
authors.affiliation: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kuch
mesh_terms: D000818:Animals; D057231:Climate Change; D003715:Dengue / Q000453:epidemiology* / Q000635:transmission; D004605:Elephantiasis, Filarial / Q000453:epidemiology* / Q000635:transmission; D004672:Encephalitis, Japanese / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007303:Insect Vectors / Q000502:physiology; D007313:Insecta; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000635:transmission; D008288:Malaria / Q000453:epidemiology* / Q000635:transmission; D009390:Nepal / Q000453:epidemiology