Publications by authors named "Raja Ram Dhungana"

27 Publications

  • Page 1 of 1

Burden of chronic kidney disease in the general population and high-risk groups in South Asia: A systematic review and meta-analysis.

PLoS One 2021 14;16(10):e0258494. Epub 2021 Oct 14.

Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.

Background: Chronic kidney disease (CKD) is an emerging public health issue globally. The prevalence estimates on CKD in South Asia are however limited. This study aimed to examine the prevalence of CKD among the general and high-risk population in South Asia.

Methods: We conducted a systematic review and meta-analysis of population-level prevalence studies in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). Three databases namely PubMed, Scopus and Web of Science were systematically searched for published reports of kidney disease in South Asia up to 28 October 2020. A random-effect model for computing the pooled prevalence was used.

Results: Of the 8749 identified studies, a total of 24 studies were included in the review. The pooled prevalence of CKD among the general population was 14% (95% CI 11-18%), and 15% (95% CI 11-20%) among adult males and 13% (95% CI 10-17%) in adult females. The prevalence of CKD was 27% (95% CI 20-35%) in adults with hypertension, 31% (95% CI 22-41%) in adults with diabetes and 14% (95% CI 10-19%) in adults who were overweight/obese. We found substantial heterogeneity across the included studies in the pooled estimates for CKD prevalence in both general and high-risk populations. The prevalence of CKD of unknown origin in the endemic population was 8% (95% CI 3-16%).

Conclusion: Our study reaffirms the previous reports that CKD represents a serious public health challenge in South Asia, with the disease prevalent among 1 in 7 adults in South Asian countries.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258494PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8516300PMC
October 2021

Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.

PLoS One 2021 12;16(10):e0258406. Epub 2021 Oct 12.

Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.

Background: Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal.

Methods: We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months.

Results: 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001).

Conclusions: Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal.

Trial Registration: ClinicalTrial.gov: NCT02981251.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258406PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509872PMC
October 2021

Yoga for hypertensive patients: a study on barriers and facilitators of its implementation in primary care.

Glob Health Action 2021 01;14(1):1952753

Institute for Health and Sport, Victoria University, Melbourne, Australia.

Background: International guidelines for hypertension treatment recommend the use of yoga, particularly among low-risk patients. However, evidence is lacking on the implementation potential of health-worker-led yoga interventions in low-resource, primary care settings.

Objective: To assess barriers to and facilitators of the implementation of a yoga intervention for hypertensive patients in primary care in Nepal.

Methods: The study was conducted using focus group discussions, in-depth interviews, key informant interviews, and telephone interviews. Data were collected from the 'Yoga and Hypertension' (YoH) trial participants, YoH intervention implementers, and officials from the Ministry of Health and Population in Nepal.

Results: Most YoH trial participants stated that: (1) it was easy to learn yoga during a five-day training period and practise it for three months at home; (2) practising yoga improved their health; and (3) group yoga sessions in a community centre would help them practise yoga more regularly. Most YoH intervention implementers stated that: (1) they were highly motivated to implement the intervention; (2) the cost of implementation was acceptable; (3) they did not need additional staff to effectively implement the intervention; (4) providing remuneration to the staff involved in the intervention would increase their motivation; and (5) the yoga programme was 'simple and easy to follow' and 'easily performed by participants of any age'. The government officials stated that: (1) yoga is considered as a key health promotional activity in Nepal; and (2) the integration of the yoga intervention into the existing health care programme would not be too challenging, because the existing personnel and other resources can be utilised.

Conclusion: While there is a good potential that a yoga intervention can be implemented in primary care, capacity development for health workers and the involvement of community yoga centres in the delivery of the interventions may be required to facilitate this implementation.
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http://dx.doi.org/10.1080/16549716.2021.1952753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330799PMC
January 2021

Prevalence, pattern and determinants of chronic disease multimorbidity in Nepal: secondary analysis of a national survey.

BMJ Open 2021 07 27;11(7):e047665. Epub 2021 Jul 27.

Nepal Public Health Foundation, Kathmandu, Nepal.

Objectives: To assess the prevalence, pattern and determinants of non-communicable diseases (NCDs) multimorbidity in Nepal.

Design: Secondary analysis of the data from the NCD survey 2018, which was conducted between 2016 and 2018.

Setting: The data belong to the nationally representative survey, that selected the study samples from throughout Nepal using multistage cluster sampling.

Participants: 8931 participants aged 20 years and older were included in the study.

Primary Outcomes: NCD multimorbidity (occurrence of two or more chronic conditions including hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease and cancer). Descriptive statistics, prevalence ratio and odds ratio were computed to assess pattern and determinants of multimorbidity.

Results: Mean (SD) age was 46.7 years (14.9 years). The majority of the participants were women (57.8%), without formal education (53.4%) and from urban areas (51.5%). Multimorbidity was present in 13.96% (95% CI: 12.9% to 15.1%). Hypertension and diabetes coexisted in 5.7%. Age, alcohol consumption, body mass index, non-high-density lipoprotein (non-HDL) level and rural-urban setting were significantly associated with multimorbidity.

Conclusion: Multimorbidity was prevalent in particular groups or geographical areas in Nepal suggesting a need for coordinated and integrated NCD care approach for the management of multiplicative co-comorbid conditions.
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http://dx.doi.org/10.1136/bmjopen-2020-047665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317126PMC
July 2021

Health-Related Quality of Life of Patients Receiving Cancer Treatment in Nepal: A Hospital-based Cross-Sectional Study.

J Nepal Health Res Counc 2021 Apr 23;19(1):26-31. Epub 2021 Apr 23.

Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

Background: Information on health-related quality of life of the patients enables healthcare providers to understand patients' concerns and guides to introduce appropriate treatment care. This study assessed the health-related quality of life of the cancer patients attending a tertiary hospital in Nepal.

Methods: A cross-sectional study was conducted among 294 cancer patients receiving treatment service from Bhaktapur Cancer Hospital between November 2016 and February 2017. We used the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire-Core 30 to record the scores in different domains of health-related quality of life. The scores were compared across different socio-economic characteristics using non-parametric tests.

Results: Majority of the participants were female (57.5%), of age 50 years and above (64.7%) and had either lung or breast or cervical cancer (49.32%). Participants' median scores of the global health status (overall health) and quality of life, functionality, and symptoms were 83.3, 52.7 and 31.9 respectively. Among functionality, lower mean scores were of role (45.40) and social (53.17) functioning. Among symptoms and single items, higher mean scores were of appetite loss (49.88), fatigue (46.67), insomnia (43.99), and financial difficulty (68.02). The overall health and quality of life varied significantly with different characteristics of the participants.

Conclusions: Participants reported a higher score of overall health and quality of life that reflects subjective satisfactory condition. Improving respective functionality and relieving symptoms and difficulty could enhance health-related quality of life in respective domains.
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http://dx.doi.org/10.33314/jnhrc.v19i1.3052DOI Listing
April 2021

Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in Nepal between 2000 and 2025: A Systematic Review and Meta-Analysis.

Int J Hypertens 2021 2;2021:6610649. Epub 2021 Mar 2.

Institute for Health and Sport, Victoria University, Melbourne, Australia.

Background: Understanding the burden and trend of hypertension and the associated care cascade can provide direction to the development of interventions preventing and controlling hypertension. This study aimed to assess prevalence and trends of hypertension and its awareness, treatment, and control in Nepal.

Methods: We systematically searched CINAHL, Embase, ProQuest, PubMed, Web of Science, WorldCat, and government and health agency-owned websites to identify studies reporting prevalence of hypertension, awareness, treatment, and control in Nepal between 2000 and 2020. We applied the random-effects model to compute the pooled prevalence in the overall population and among subgroups in each 5-year interval period between 2000 and 2020. We used linear meta-regression analysis to predict hypertension from 2000 to 2025.

Results: We identified 23 studies having a total of 84,006 participants. The pooled prevalence of hypertension, awareness, treatment, and control for 2016-2020 was 32% (95% CI: 23-40%), 50% (95% CI: 30-69%), 27% (95% CI: 19-34%), and 38% (95% CI: 28-48%), respectively. The prevalence of hypertension varied by age, gender, education, and geographical area. Hypertension increased by 6 percentage points (pp), awareness increased by 12 pp, treatment increased by 11 pp, and control increased by 3 pp over the 20 years studied. Since 2000, the rate of increment of hypertension has been 3.5 pp per decade, where 44.7% of men are expected to suffer from hypertension by 2025.

Conclusion: The markedly increased prevalence of hypertension and relatively poor progress in hypertension awareness, treatment, and control in Nepal suggest that there is a need for hypertension preventive approaches as well as strategies to optimize hypertension care cascade.
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http://dx.doi.org/10.1155/2021/6610649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952181PMC
March 2021

Effects of a health worker-led 3-month yoga intervention on blood pressure of hypertensive patients: a randomised controlled multicentre trial in the primary care setting.

BMC Public Health 2021 03 20;21(1):550. Epub 2021 Mar 20.

Institute for Health and Sport, Victoria University, Melbourne, Australia.

Background: Hypertension control remains a major challenge globally. A recent systematic review suggested that yoga has beneficial effects on reducing blood pressure. However, the role of yoga in hypertension management in primary health care has received little attention, and no studies have evaluated the impact of a yoga program fully delivered by health care staff on hypertension. This study, therefore, assessed the effects of a health worker-led yoga intervention on blood pressure reduction among hypertensives patients in the primary care setting.

Methods: This was a multicentric, two-arm, randomised trial conducted among hypertensive patients in seven Ayurveda Health Centres in Nepal between March 2017 and June 2018. One hundred and twenty-one participants who were on or without medications were randomised to intervention (n = 61) and wait-list control (n = 60) groups using stratified block randomisation. Participants in the intervention arm received an intervention consisting of an initial five-day structured yoga training at the centres and then a further home-based practice of yoga for five days a week for the following 90 days. Both intervention and control groups also participated in a 2-h health education session. The primary outcome of this trial was systolic blood pressure at 90-day follow-up. Data were analysed on an intention-to-treat basis using linear mixed-effects regression models.

Results: We included all 121 study participants (intervention/control = 61/60) in the primary analysis (52.1% males; mean ± SD age = 47.8 ± 10.8 years). The difference in systolic blood pressure between the intervention group and the control group was - 7.66 mmHg (95% CI: - 10.4, - 4.93). For diastolic blood pressure, the difference was - 3.86 mmHg (95% CI: - 6.65, - 1.06). No adverse events were reported by the participants.

Conclusions: A yoga program for hypertensive patients consisting of a five-day training in health centres and 90 days of practice at home is effective for reducing blood pressure. Significant benefits for hypertensive patients could be expected if such programmes would become a part of the standard treatment practice.

Trial Registration: This trial was prospectively registered with the Clinical Trial Registry of India [ CTRI/2017/02/007822 ] on 10/02/2017.
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http://dx.doi.org/10.1186/s12889-021-10528-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981931PMC
March 2021

Factors associated with physical and sexual violence among school-going adolescents in Nepal: Findings from Global School-based Student Health Survey.

PLoS One 2021 18;16(3):e0248566. Epub 2021 Mar 18.

Nepal Health Research Council, Kathmandu, Nepal.

Background: Globally violence is a matter of public health concern with severe physical and mental health implications and social consequences. Evidence suggest that adolescents have an elevated risk of exposure to physical and sexual violence. However, there is a lack of nationally representative research on violence and its associated factors in Nepal to inform interventions. This paper attempts to find the factors associated with various forms of physical and sexual violence among school-going adolescents in Nepal.

Methods: We analysed the cross-sectional data from the Global School-based Student Health Survey (GSHS) 2015. The GSHS survey applied a two-stage cluster sampling process to select a representative sample of 7 to 11 grade students from 74 schools across the country. We applied logistic regression analysis to identify the factors associated with physical and sexual violence.

Results: Out of the total 6,529 participants, 45.24% of them faced a physical attack, 39.25% were involved in a physical fight, and 11.65% were victims of sexual violence in the survey administered between 7 August 2015 to 14 March 2016. In a multiple regression analysis, the age of participants, parental supervision, feeling unsafe at school, and the number of close friends were found to be associated with a physical attack. Participants who were bullied, had multiple sex partners, and had received corporal punishment in school had a higher engagement in a physical fight. Likewise, school grade, having parents who understand the problems, having multiple sex partners, and corporal punishment at school were associated with instances of sexual violence.

Conclusion: The study identified multiple factors associated with experiences of physical attacks, involvement in a physical fight, and sexual violence among school-going adolescents. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions. Since various forms of violence share some common risk factors, a comprehensive strategy could be worth considering to prevent such acts of violence.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248566PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971533PMC
October 2021

Accessing health services in India: experiences of seasonal migrants returning to Nepal.

BMC Health Serv Res 2020 Oct 29;20(1):992. Epub 2020 Oct 29.

Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.

Background: Migration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India.

Methods: Six focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. A further 12 stakeholders working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data were analysed thematically.

Results: The interviewed returnee migrants worked in 15 of India's 29 states, most as daily-wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services.

Conclusions: Nepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to.
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http://dx.doi.org/10.1186/s12913-020-05846-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597057PMC
October 2020

Drivers of stunting reduction in Nepal: a country case study.

Am J Clin Nutr 2020 09;112(Suppl 2):844S-859S

Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.

Background: Chronic child malnutrition represents a serious global health concern. Over the last several decades, Nepal has seen a significant decline in linear growth stunting - a physical manifestation of chronic malnutrition - despite only modest economic growth and significant political instability.

Objective: This study aimed to conduct an in-depth assessment of the determinants of stunting reduction in Nepal from 1996 to 2016, with specific attention paid to national-, community-, household-, and individual-level factors, as well as relevant nutrition-specific and -sensitive initiatives rolled out within the country.

Methods: Using a mixed-methods approach, 4 types of inquiry were employed: 1) a systematic review of published peer-reviewed and gray literature; 2) retrospective quantitative data analyses using Demographic and Health Surveys from 1996 to 2016; 3) a review of key nutrition-specific and -sensitive policies and programs; and 4) retrospective qualitative data collection and analyses.

Results: Mean height-for-age z-scores (HAZ) improved by 0.94 SDs from 1996 to 2016. Subnational variation and socioeconomic inequalities in stunting outcomes persisted, with the latter widening over time. Decomposition analysis for children aged under 5 y explained 90.9% of the predicted change in HAZ, with key factors including parental education (24.7%), maternal nutrition (19.3%), reduced open defecation (12.3%), maternal and newborn health care (11.5%), and economic improvement (9.0%). Key initiatives focused on decentralizing the health system and mobilizing community health workers to increase accessibility; long-standing nationwide provision of basic health interventions; targeted efforts to improve maternal and child health; and the prioritization of nutrition-sensitive initiatives by both government and donors. National and community stakeholders and mothers at village level highlighted a mixture of poverty reduction, access to health services, improved education, and increased access to water, sanitation, and hygiene as drivers of stunting reduction.

Conclusions: Improvements in both nutrition-specific and nutrition-sensitive sectors have been critical to Nepal's stunting decline, particularly in the areas of poverty reduction, health, education, and sanitation.
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http://dx.doi.org/10.1093/ajcn/nqaa218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487432PMC
September 2020

Prevalence and determinants of non-communicable diseases risk factors among reproductive aged women of Nepal: Results from Nepal Demographic Health Survey 2016.

PLoS One 2020 16;15(3):e0218840. Epub 2020 Mar 16.

DFID/NHSP3/MEOR, Abt Associates, Kathmandu, Nepal.

Introduction: Non-Communicable Diseases (NCDs) are the major killer diseases globally. They share the common risk factors such as smoking, harmful use of alcohol, physical inactivity, and low fruits/vegetable consumption. The clustering of these risk factors multiplies the risk of developing NCDs. NCDs affect women inequitably causing significant threats to the health of women and future generations. But, the distribution and clustering of NCDs risk factors among Nepalese women are not adequately explored yet. This study aimed to assess the clustering and socio-demographic distribution of major NCD risk factors in Nepalese women.

Methods: We used the data of 6,396 women age 15 to 49 years from the recent Nepal Demographic and Health Survey (NDHS). The survey applied a stratified multi-stage cluster sampling method to select the eligible women participants from across Nepal. We analyzed data using the multiple Poisson regression and reported the adjusted prevalence ratio (APR).

Results: A total of 8.9% of participants were current smokers, 22.2% were overweight and obesity and 11.5% of the participants were hypertensive. Around 6% of participants had co-occurrence of two NCDs risk factors. Smoking, overweight and obesity and hypertension were significantly associated with age, education, province, wealth index, and ethnicity. Risk factors were more likely to cluster in women of age40-49 years (ARR = 2.95, 95%CI: 2.58-3.38), widow/separated (ARR = 3.09; 95% CI:2.24-4.28) and among Dalit women (ARR = 1.34; 95% CI:1.17-1.55).

Conclusion: This study found that NCDs risk factors were disproportionately distributed by age, education, socio-economic status and ethnicity and clustered in more vulnerable groups such as widow/separated women and the Dalit women.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218840PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075700PMC
May 2020

Understanding, Experience and Response to Sexual Harassment among the Female Students: A Mixed Method Study.

J Nepal Health Res Counc 2020 Jan 21;17(4):424-430. Epub 2020 Jan 21.

DFID/NHSP3/MEOR, Abt Associates, Nepal.

Background: Sexual harassment has received global attention and has been recognized as a public health problem with increased physical and mental health risks among the victims. This study attempted to assess understanding, experience, response and effect of sexual harassment among the secondary school female students in Kathmandu, Nepal.

Methods: It was a mixed method study conducted among 441 secondary level female students. In quantitative component, a structured questionnaire was used to collect information relating to socio-demographic characteristics, and understanding, experience, response and effect of sexual harassment from 441 participants from three clusters (schools) of Tokha Municipality, Kathmandu. For qualitative method, two focused group discussions were conducted to assess the understanding of and response to sexual harassment. Quantitative and qualitative data were analyzed using Chi square test and thematic analysis method respectively.

Results: Around 76% of the participants had experienced some forms of sexual harassment in their life. Sexual harassment was significantly associated with religion and parental occupation. Majority of participants who faced sexual harassment reported that the perpetrators were strangers and they either ignored it or did nothing at the time of events. School, roads and public places were the most common settings where participants encountered sexual harassment.

Conclusions: Sexual harassment is prevalent among female secondary students in Kathmandu. However, they lacked a clear understating of and ways to respond to sexual harassment. Raising awareness to recognize and respond to different forms of harassment and to change the victim-blaming attitudes can be a potential strategy for tackling the problem in Nepalese society.
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http://dx.doi.org/10.33314/jnhrc.v17i4.2313DOI Listing
January 2020

Psychological morbidity in Nepali cross-border migrants in India: a community based cross-sectional study.

BMC Public Health 2019 Nov 15;19(1):1534. Epub 2019 Nov 15.

Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.

Background: Since Nepali cross-border migrants can freely enter, work and stay in India, they are largely undocumented. The majority is involved in semi-skilled or unskilled jobs with limited labour rights and social security, a fact which predisposes them to psychological distress. We aimed to assess the prevalence of and factors associated with psychological morbidity among Nepali migrants upon their return from India.

Methods: A community based cross-sectional study was conducted in six districts of Nepal between September 2017 and February 2018. A total of 751 participants who had worked at least six months in India and returned to Nepal were interviewed from 24 randomly selected clusters. The General Health Questionnaire (GHQ)-12 was used to measure the psychological morbidity. Data were analysed using Poisson regression analysis.

Results: The majority was younger than 35 years (64.1%), male (96.7%), married (81.8%), had at least a primary education (66.6%), and belonged to Dalit, Janajati and religious minorities (53.7%). The prevalence of psychological morbidity was 13.5% (CI: 11.2-16.1%). Participants aged 45 years and above (adjusted prevalence ratio (aPR) = 2.74), from the Terai (aPR = 3.29), a religious minority (aPR = 3.64), who received no sick leave (aPR = 2.4), with existing health problems (aPR = 2.0) and having difficulty in accessing health care (aPR = 1.88) were more likely than others to exhibit a psychological morbidity.

Conclusion: This study demonstrated that psychological morbidity was prevalent in the study participants and varied significantly with individual characteristics, work conditions and health. Multifaceted approaches including psychological counselling for returnees and protection of labour and health rights in the workplace are recommended to help reduce psychological morbidity.
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http://dx.doi.org/10.1186/s12889-019-7881-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858657PMC
November 2019

Changes in patterns of the double burden of undernutrition and overnutrition in Nepal over time.

Obes Rev 2019 09 19;20(9):1321-1334. Epub 2019 Jul 19.

Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.

Knowledge regarding nutrition transition in Nepal remains limited. This systematic review examined the shifts in undernutrition and overnutrition in Nepal during the past two decades. We searched PubMed for studies and reports published between January 1, 2000, and June 30, 2018. Publications with a sample size greater than or equal to 500 that reported prevalence of nutritional status were included. Six large national reports and 36 studies met study inclusion criteria and were included. Overall, available nationally representative data remained limited. The Nepal Demographic and Health Survey 2001 to 2016 showed that underweight prevalence decreased from 26.7% to 17.2% and prevalence of overweight/obesity increased from 6.5% to 22.1% among women of reproductive age (15-49 years). In preschool children, prevalence of stunting, wasting, and underweight decreased from 57.2% to 35.8%, 11.2% to 9.7%, and 42.7% to 27.0%, respectively. Prevalence of overweight/obesity was low among children and was higher in higher socio-economic status (SES) groups. The overweight-obesity/underweight ratios indicate a shift from undernutrition to overnutrition problem; it was more evident in urban areas and higher SES groups. In conclusion, Nepal is experiencing a nutrition transition. More research is warranted to address this shift, and well-tailored public health efforts need to combat the double burden of overweight/obesity and undernutrition.
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http://dx.doi.org/10.1111/obr.12883DOI Listing
September 2019

Estimating the Direct Cost of Cancer in Nepal: A Cross-Sectional Study in a Tertiary Cancer Hospital.

Front Public Health 2019 21;7:160. Epub 2019 Jun 21.

Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

The increasing prevalence of cancer and lack of strong health financing system in low income countries like Nepal is exerting an enormous financial burden on cancer patients. However, there is scant information relating to the amount of expenditure on health services for cancer treatments in Nepal. Therefore, this study aimed to estimate the direct cost associated with the treatment of cancer on the patients attending a tertiary cancer treatment center in Nepal. A quantitative cross-sectional study was carried out on 294 cancer patients who were receiving treatment from Bhaktapur Cancer Hospital between 17th November 2016 and 13th February 2017. Direct medical cost and non-medical costs borne by the patients were calculated based on the cost of illness methodology. Medical cost included the cost of consultation, diagnosis and treatment while non-medical cost comprised the cost occurred out of the health facility such as the cost of food, travel, and accommodation. Of those 294, 169 (57.5%) were female and 125 (42.5%) were male. The median (IQR) age was 54 (19) years. Cancer of the lung was present in 19.39%, breast cancer in 15.65% and cervical cancer in 14.29%. Mean (SD) and Median (IQR) direct cost of cancer was NRs 387.5 (196.8) and 346.1 (260.5) thousand. Medical cost contributed to 80.91% of the total direct cost. Almost everyone relied on out-of-pocket (OOP) payment for cancer treatment, where 253 (86.1%) participants reported that they were experiencing financial hardship, 230 (78.2%) took a loan, and 140 (47.6%) sold their property to manage the OOP. Both medical and non-medical costs varied significantly with age, socio-economic status, types of cancer and the treatment. Medical cost contributed the most to the direct cost. OOP was dominant payment mechanism to utilize health services. Average direct cost of cancer was higher than the average income of patients, sufficient to cause financial catastrophe. This implies the need of improved health financing strategy to protect people from the financial hazards of health service utilization for cancer in Nepal.
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http://dx.doi.org/10.3389/fpubh.2019.00160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598213PMC
June 2019

Prevalence, clustering and sociodemographic distributions of non-communicable disease risk factors in Nepalese adolescents: secondary analysis of a nationwide school survey.

BMJ Open 2019 05 19;9(5):e028263. Epub 2019 May 19.

Centre for Chronic Diseases, Victoria University, St Albans, Victoria, Australia.

Objectives: To assess the prevalence, clustering and sociodemographic distribution of non-communicable disease (NCD) risk factors in adolescents in Nepal.

Design: Data originated from Global School Based Student Health Survey, Nepal conducted in 2015-2016.

Setting: The study sites were the secondary schools in Nepal; 74 schools were selected based on the probability proportional to school enrolment size throughout Nepal.

Participants: 5795 school-going children aged 13-17 years were included in the study.

Primary Outcomes: NCD risk factors: smoking, alcohol consumption, insufficient fruit and vegetable intake, insufficient physical activity and overweight/obesity were the primary outcomes. Sociodemographic distributions of the combined and individual NCD risk factors were determined by Poisson regression analysis.

Results: Findings revealed the prevalence of smoking (6.04%; CI 4.62 to 7.88), alcohol consumption (5.29%; CI 4.03 to 6.92), insufficient fruit and vegetable intake (95.33%; CI 93.89 to 96.45), insufficiently physical activity (84.77%; CI 81.04 to 87.88) and overweight/obesity (6.66%; CI 4.65 to 9.45). One or more risk factors were present in 99.6%, ≥2 were in 83% and ≥3 were in 11.2%. Risk factors were more likely to cluster in male, 17 years of age and grade 7. Prevalence of smoking (adjusted prevalence ratio (aPR)=2.38; CI 1.6 to 3.51) and alcohol consumption (aPR=1.81; CI 1.29 to 2.53) was significantly high in male, and in 16 and 17 years of age. Prevalence of insufficient physical activity and overweight/obesity was significantly lower in higher grades.

Conclusion: Insufficient fruit and vegetable intake and insufficient physical activity were highly prevalent in the populations studied. Risk factors were disproportionately distributed and clustered in particular gender, age and grade. The study population requires an age and gender specific preventive public health intervention.
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http://dx.doi.org/10.1136/bmjopen-2018-028263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530381PMC
May 2019

Prevalence, clustering and sociodemographic distributions of non-communicable disease risk factors in Nepalese adolescents: secondary analysis of a nationwide school survey.

BMJ Open 2019 05 19;9(5):e028263. Epub 2019 May 19.

Centre for Chronic Diseases, Victoria University, St Albans, Victoria, Australia.

Objectives: To assess the prevalence, clustering and sociodemographic distribution of non-communicable disease (NCD) risk factors in adolescents in Nepal.

Design: Data originated from Global School Based Student Health Survey, Nepal conducted in 2015-2016.

Setting: The study sites were the secondary schools in Nepal; 74 schools were selected based on the probability proportional to school enrolment size throughout Nepal.

Participants: 5795 school-going children aged 13-17 years were included in the study.

Primary Outcomes: NCD risk factors: smoking, alcohol consumption, insufficient fruit and vegetable intake, insufficient physical activity and overweight/obesity were the primary outcomes. Sociodemographic distributions of the combined and individual NCD risk factors were determined by Poisson regression analysis.

Results: Findings revealed the prevalence of smoking (6.04%; CI 4.62 to 7.88), alcohol consumption (5.29%; CI 4.03 to 6.92), insufficient fruit and vegetable intake (95.33%; CI 93.89 to 96.45), insufficiently physical activity (84.77%; CI 81.04 to 87.88) and overweight/obesity (6.66%; CI 4.65 to 9.45). One or more risk factors were present in 99.6%, ≥2 were in 83% and ≥3 were in 11.2%. Risk factors were more likely to cluster in male, 17 years of age and grade 7. Prevalence of smoking (adjusted prevalence ratio (aPR)=2.38; CI 1.6 to 3.51) and alcohol consumption (aPR=1.81; CI 1.29 to 2.53) was significantly high in male, and in 16 and 17 years of age. Prevalence of insufficient physical activity and overweight/obesity was significantly lower in higher grades.

Conclusion: Insufficient fruit and vegetable intake and insufficient physical activity were highly prevalent in the populations studied. Risk factors were disproportionately distributed and clustered in particular gender, age and grade. The study population requires an age and gender specific preventive public health intervention.
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http://dx.doi.org/10.1136/bmjopen-2018-028263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530381PMC
May 2019

Prevalence of cardiovascular disease risk factors: A community-based cross-sectional study in a peri-urban community of Kathmandu, Nepal.

Indian Heart J 2018 Dec 10;70 Suppl 3:S20-S27. Epub 2018 Mar 10.

Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Background: As a low-income country, Nepal is experiencing cardiovascular diseases as an emerging health problem. However, studies are lacking on the risk factors of cardiovascular diseases in peri-urban communities; where the socio-demographical transition is in progress. Therefore, this study aimed to identify the prevalence and socio-demographic distribution of cardiovascular disease risk factors in one of the peri-urban communities in Kathmandu, Nepal.

Methods: We conducted a cross-sectional study in Sitapaila Village Development Committee, Kathmandu from February 2014 to February 2015. Altogether, 347 adults from 18 to 70 years of age were selected randomly. Data were collected through modified WHO STEPS questionnaire for non-communicable disease (NCD) risk factors survey and analyzed in SPSS V.16.0 software.

Results: Mean age of the participant was 42.5 ± 13.2 years. Majority of them were female (n = 206; 59.4%), one-third (34%) represented Brahman and Chetri, and over a quarter (29.1%) did not attend school. Cardiovascular disease risk factors included smoking (17.6%), alcohol consumption (29.4%), insufficient fruit and vegetables intake (98%), insufficient physical activity (21.0%), obesity (15.3%), hypertension (34.4%), diabetes (10.5%), and high triglyceride levels (10.8%). They were significantly associated with different socio-demographic characteristics: smoking with gender, age groups and education level; alcohol consumption was with gender, age groups, ethnicity and occupation; insufficient physical activity with gender, age groups and occupation; hypertension with gender, age groups, ethnicity, education level and occupation.

Conclusion: A high prevalence of cardiovascular disease risk factors and their disproportional distribution among the study population indicated an inevitable risk of cardiovascular events in near future.
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http://dx.doi.org/10.1016/j.ihj.2018.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309148PMC
December 2018

Impact of a structured yoga program on blood pressure reduction among hypertensive patients: study protocol for a pragmatic randomized multicenter trial in primary health care settings in Nepal.

BMC Complement Altern Med 2018 Jul 5;18(1):207. Epub 2018 Jul 5.

Nepal Development Society, Bharatpur, Chitwan, 10, Nepal.

Background: Hypertension control remains a major global challenge. The behavioral approaches recommended for blood pressure reduction are stress reduction, increased exercise and healthy dietary habits. Some study findings suggest that yoga has a beneficial effect in reducing blood pressure. However, the role of yoga on blood pressure has received little attention in existing health care practices in developing countries. This study will be conducted in primary health care facilities in Nepal to assess the effectiveness of a pragmatic yoga intervention to complement standard practice in further reducing blood pressure.

Methods: This will be multicentric, two arms, randomized, nonblinded, pragmatic trial. It will be conducted in seven District Ayurveda Health Centers (DAHCs) in Nepal between July 2017 and June 2018. The study participants will consist of hypertensive patients with or without antihypertensive medication attending to the outpatient department (OPD). One hundred and forty participants will be randomized to treatment or control groups by using a stratified block randomization. At the study site, the treatment arm participants will receive an intervention consisting of five days of structured yoga training and practice of the same package at home with a recommendation of five days a week for the following 90 days. Both the intervention and control groups will receive two hours of health education on lifestyle modifications. The primary outcome of this trial will be the change in systolic blood pressure and it will be assessed after 90 days of the intervention.

Discussion: This study will establish the extent to which a yoga intervention package can help reduce blood pressure in hypertensive patients. If proven effective, study findings may be used to recommend the governing bodies and other stakeholders for the integration of yoga in the national healthcare system for the treatment and control of hypertension.

Trial Registration: Clinical Trial Registry- India (CTRI); CTRI Reg. No- CTRI/2017/02/007822 . Registered on 10/02/2017.
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http://dx.doi.org/10.1186/s12906-018-2275-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034305PMC
July 2018

Prevalence and clustering of cardiovascular disease risk factors in rural Nepalese population aged 40-80 years.

BMC Public Health 2018 05 31;18(1):677. Epub 2018 May 31.

Institute of Medicine (IOM), Tribhuvan University, Kathmandu, Nepal.

Background: Cardiovascular diseases (CVD) are the main cause of mortality in low- and middle-income countries like Nepal. Different risk factors usually cluster and interact multiplicatively to increase the risk of developing acute cardiovascular events; however, information related to clustering of CVD risk factors is scarce in Nepal. Therefore, we aimed to determine the prevalence of CVD risk factors with a focus on their clustering pattern in a rural Nepalese population.

Methods: A community-based cross-sectional study was conducted among residents aged 40 to 80 years in Lamjung District of Nepal in 2014. A clustered sampling technique was used in steps. At first, four out of 18 wards were chosen at random. Then, one person per household was selected randomly (n = 388). WHO STEPS questionnaires (version 2.2) were used to collect data. Chi-square and independent t-test were used to test significance at the level of p < 0.05.

Results: A total 345 samples with complete data were analyzed. Smoking [24.1% (95% CI: 19.5-28.6)], harmful use of alcohol [10.7% (7.4-13.9)], insufficient intake of fruit and vegetable [72% (67.1-76.6)], low physical activity [10.1% (6.9-13.2)], overweight and obesity [59.4% (54.2-64.5)], hypertension [42.9% (37.6-48.1)], diabetes [16.2% (14.0-18.3)], and dyslipidemia [56.0% (53.0-58.7)] were common risk factors among the study population. Overall, 98.2% had at least one risk factor, while 2.0% exhibited six risk factors. Overall, more than a half (63.4%) of participants had at least three risk factors (male: 69.4%, female: 58.5%). Age [OR: 2.3 (95% CI: 1.13-4.72)] and caste/ethnicity [2.0 (95% CI: 1.28-3.43)] were significantly associated with clustering of at least three risk factors.

Conclusions: Cardiovascular risk factors and their clustering were common in the rural population of Nepal. Therefore, comprehensive interventions against all risk factors should be immediately planned and implemented to reduce the future burden of CVD in the rural population of Nepal.
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http://dx.doi.org/10.1186/s12889-018-5600-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984400PMC
May 2018

Prevalence, associated factors, awareness, treatment, and control of hypertension: Findings from a cross sectional study conducted as a part of a community based intervention trial in Surkhet, Mid-western region of Nepal.

PLoS One 2017 5;12(10):e0185806. Epub 2017 Oct 5.

Ministry of Health, Mid-western Regional Hospital, Surkhet, Nepal.

Background: Hypertension is one of the leading public health problems globally. About half of the deaths from cardiovascular diseases were attributed to hypertension in 2008. Reduction of blood pressure to normal range is one of the major challenges in preventing complications and future burden of cardiovascular diseases. Therefore, this study aims to determine prevalence, awareness, treatment and control of hypertension and its associated factors in Nepal.

Methods: This was a community based cross-sectional study conducted as a part of a community based intervention trial in Birendranagar Municipality of Surkhet district located at the Mid-western region of Nepal. We enrolled 1159 subjects aged 30 years and above. Out of 12 wards (administrative unit), four wards were selected randomly. Three hundred participants were recruited from each selected ward. Trained enumerator collected socio-demographic, anthropometric, and clinical data using standard STEPS questionnaires.

Results: Out of all participants, women were 71% and mean age was 47±12.6 years. The overall prevalence of hypertension was 38.9% (95% CI: 36-41.7) while age and sex adjusted prevalence was 40.6%. The hypertension was present in 48.1% (95% CI: 45.2-50.9) of men and 35.2% (95% CI: 32.4-37.9)] of women. Male gender (OR = 1.49), older age (OR = 1.04 per year), Dalit caste (OR = 1.71), past history of cigarettes smoking (OR = 2.78), current alcohol consumption (OR = 1.75), and raised body mass index (OR = 1.17 per unit) were identified as significant factors associated with hypertension. Of total hypertensive respondents, 53.4% (95% CI: 48.7-58) were aware, 29% (95% CI: 24.8-33.1) were receiving treatment for high blood pressure, and 8.2% (95% CI: 5.6-10.7) had controlled blood pressure. The awareness, treatment, and control status were worse in younger participants.

Conclusions: The study revealed high prevalence with low awareness, treatment, and control of hypertension in Nepal. Gender, age, ethnicity, smoking, drinking alcohol, and body mass index were associated with hypertension. Immediate public health and individual measures are warranted to reduce future burden of cardiovascular diseases.

Trial Registration: ClinicalTrial.gov (NCT02981251).
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185806PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628876PMC
October 2017

Total cardiovascular risk for next 10 years among rural population of Nepal using WHO/ISH risk prediction chart.

BMC Res Notes 2017 Mar 7;10(1):120. Epub 2017 Mar 7.

Institute of Medicine (IOM), Tribhuvan University, Kathmandu, Nepal.

Background: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality globally. Primary prevention of CVD based on total CVD risk approach using WHO/ISH risk prediction chart would be more effective to stratify population under different risk levels, prioritize and utilize the scarce resources of low and middle-income countries. This study estimated total 10-year CVD risk and determined the proportion of population who need immediate drug therapy among the rural population of Nepal.

Methods: A community based cross-sectional study conducted among 345 participants aged 40-80 years in rural villages of Lamjung District of Nepal. They were selected randomly from total eighteen wards. Data were collected using WHO STEPS questionnaires. WHO/ISH risk prediction chart for SEAR D was used to estimate total cardiovascular risk. Chi-square and independent t-test were used to test significance at the level of p < 0.05 in SPSS version 16.0.

Results: Of the total participants, 55.4% were female. The mean age (standard deviation) of the participants was 53.5 ± 10.1 years. According to WHO/ISH chart proportions of low, moderate and high CVD risk were 86.4%, 9.3%, and 4.3%, respectively. Eleven percent of participants were in need of immediate pharmacotherapy. Age (p = 0.001), level of education (p = 0.01) and occupation (p = 0.001) were significantly associated with elevated CVD risk.

Conclusion: A large proportion of Nepalese rural population is at moderate and high CVD risk. Immediate pharmacological interventions are warranted for at least one in every ten individuals along with lifestyle interventions. Both population-wise and high-risk approaches are required to minimize CVD burden in the future.
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http://dx.doi.org/10.1186/s13104-017-2436-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341399PMC
March 2017

Barriers to Treatment and Control of Hypertension among Hypertensive Participants: A Community-Based Cross-sectional Mixed Method Study in Municipalities of Kathmandu, Nepal.

Front Cardiovasc Med 2016 2;3:26. Epub 2016 Aug 2.

Manmohan Cardiothoracic, Vascular and Transplant Centre, Institute of Medicine, Tribhuvan University , Kathmandu , Nepal.

Introduction: Despite the established evidence on benefits of controlling raised blood pressure and development of several guidelines on detection and management of hypertension, people often have untreated or uncontrolled hypertension. In this context, we undertook this study to identify the barriers existing in hypertension treatment and control in the municipalities of Kathmandu district in Nepal.

Methods: This was a community based, cross-sectional mixed method study conducted in the municipalities of Kathmandu district in Nepal between January and July 2015. Among 587 randomly selected participants, the aware hypertensive participants were further assessed for the treatment and control of hypertension. For qualitative component, 20 participants having uncontrolled hypertension took part in two focused group discussions and two cardiac physicians participated in in-depth interviews.

Results: Out of 587 participants screened, 191 (32.5%) were identified as hypertensive. Among 191 hypertensive participants, 118 (61.8%) were aware of their problem. Of the 118 aware hypertensive participants, 93 (78.8%) were taking medicines, and among those treated, 46 (49.6%) had controlled hypertension. Proportions of participants taking anti-hypertensive medications varied significantly with age groups, ethnicity, occupation and income. Hypertension control was significantly associated with use of combination therapy, adherence to medication, follow-up care, counseling by health-care providers, and waiting time in hospital. Being worried that the medicine needs to be taken lifelong, perceived side effects of drugs, non-adherence to medication, lost to follow-up, inadequate counseling from physician, and lack of national guidelines for hypertension treatment were the most commonly cited barriers for treatment and control of hypertension in qualitative component of the research.

Conclusion: Large proportion of the hypertensive population has the untreated and the uncontrolled hypertension. Efforts to dispel and dismantle the myths and barriers related to hypertension treatment and control are warranted to reduce the consequences of uncontrolled hypertension.
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http://dx.doi.org/10.3389/fcvm.2016.00026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969292PMC
August 2016

Prevalence and Associated Factors of Hypertension: A Community-Based Cross-Sectional Study in Municipalities of Kathmandu, Nepal.

Int J Hypertens 2016 12;2016:1656938. Epub 2016 May 12.

Manmohan Cardiothoracic, Vascular and Transplant Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

Objective. This study aimed to assess the prevalence and associated factors of hypertension in newly declared municipalities of Kathmandu, Nepal. Design, Settings, and Participants. This was a community-based cross-sectional study conducted in the municipalities of Kathmandu District, Nepal, between January and July 2015. Study participants were aged 18 to 70 years, residing permanently in the study sites. Municipalities, Wards, households, and respondents were selected randomly. Results. Of the 587 participants, 58.8% were females, mean (SD) age was 42.3 (13.5) years, 29.3% had no formal education, 35.1% were Brahmins, and 41.2% were homemakers. Prevalence of hypertension was 32.5% (95% CI: 28.7-36.3). Age, gender, education, ethnicity, occupation, smoking, alcohol consumption, physical activity, diabetes, menopausal history, and family history of cardiovascular disease (CVD) and hypertension were significantly associated with hypertension. In multivariable analysis, smoking, alcohol consumption, physical activity, body mass index, and diabetes were identified as significant explanatory variables for hypertension. Conclusion. This study demonstrated that the people living in newly established municipalities of Kathmandu, Nepal, have a high burden of hypertension as well as its associated factors. Therefore, community-based preventive approaches like lifestyle modification and early detection and treatment of hypertension might bring a substantial change in tackling the burden effectively.
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http://dx.doi.org/10.1155/2016/1656938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880705PMC
June 2016

Risk of ARI among Non-exclusively Breastfed Under-Five Passive Smoker Children: A Hospital-Based Cross-sectional Study of Nepal.

Front Public Health 2016 23;4:23. Epub 2016 Feb 23.

Nepal Development Society , Bharatpur , Nepal.

Background: As Nepal witnesses high burden of both acute respiratory infection (ARI) and passive smoking among under-five children, studies on effect modification of exclusive breastfeeding on passive smoking and ARI carry huge significance. With Nepal holding no evidence in this regard, findings would be useful to promote a cost-effective intervention: exclusive breastfeeding. This study was therefore conceived as an effort to bring to light the modifying effect that exclusive breastfeeding may have on the association between household passive smoking and ARI among under-five children.

Methods: One hundred and ninety-eight parents of under-five children from Kanti Children's Hospital, Kathmandu, Nepal, participated in this descriptive, cross-sectional study carried out in October 2012. Data collected from a semi-structured questionnaire were subjected to univariate, bivariate, and multivariable analysis in R version 3.1.2.

Results: Non-exclusively breastfed children with presence of anyone smoking at their house [aOR = 4.8, 95% confidence interval (CI): 1.7-13.2] and smoking in presence of children (aOR = 6.4, 95% CI: 1.1-38.3) had higher chances of ARI; nevertheless, this remained insignificant among the exclusively breastfed ones. Having a separate kitchen in the house showed protective effect against ARI among exclusively breastfed children (aOR = 0.2, 95% CI: 0.1-0.6). Children whose mothers spent at least 2 h per day in the kitchen had a higher chance of developing ARI, regardless of being exclusively breastfed (aOR = 4.5, 95% CI: 1.5-13.1) or non-exclusively breastfed (aOR = 4.5, 95% CI: 1.4-14.2) compared to those who spent <2 h per day.

Conclusion: Non-exclusive breastfeeding may increase the chances of deleterious effects of household passive smoking, such as ARI, among under-five children. As these findings are not conclusive, studies with better design and larger samples are warranted to confirm the effect.
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http://dx.doi.org/10.3389/fpubh.2016.00023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763072PMC
March 2016

Illness Perception and Depressive Symptoms among Persons with Type 2 Diabetes Mellitus: An Analytical Cross-Sectional Study in Clinical Settings in Nepal.

J Diabetes Res 2015 7;2015:908374. Epub 2015 Jul 7.

Psychology Department, Tribhuvan University, Kathmandu, Nepal.

Background. This study aimed to assess the relationship between illness perception and depressive symptoms among persons with diabetes. Method. This was an analytical cross-sectional study conducted among 379 type 2 diabetic patients from three major clinical settings of Kathmandu, Nepal. Results. The prevalence of depressive symptoms was 44.1% (95% CI: 39.1, 49.1). Females (p < 0.01), homemakers (p < 0.01), 61-70 age group (p = 0.01), those without formal education (p < 0.01), and people with lower social status (p < 0.01) had significantly higher proportion of depressive symptoms than the others. Multivariable analysis identified age (β = 0.036, p = 0.016), mode of treatment (β = 0.9, p = 0.047), no formal educational level (β = 1.959, p = 0.01), emotional representation (β = 0.214, p < 0.001), identity (β = 0.196, p < 0.001), illness coherence (β = -0.109, p = 0.007), and consequences (β = 0.093, p = 0.049) as significant predictors of depressive symptoms. Conclusion. Our study demonstrated a strong relationship between illness perception and depressive symptoms among diabetic patients. Study finding indicated that persons living with diabetes in Nepal need comprehensive diabetes education program for changing poor illness perception, which ultimately helps to prevent development of depressive symptoms.
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http://dx.doi.org/10.1155/2015/908374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508465PMC
March 2016

Prevalence of cardiovascular health risk behaviors in a remote rural community of Sindhuli district, Nepal.

BMC Cardiovasc Disord 2014 Jul 28;14:92. Epub 2014 Jul 28.

Nepal Family Development Foundation, Kathmandu, Nepal.

Background: Cardiovascular disease (CVD) is emerging as a public health menace among low and middle income countries. It has particularly affected the poorest. However, there is paucity of information about CVD risk factors profile among Nepalese rural communities where the majority of people live in poverty. Therefore, this study aimed to identify the prevalence of cardiovascular health risk behaviors in an outback community of Nepal.

Methods: We conducted a descriptive cross-sectional study in Tinkanya Village Development Committee (VDC), Sindhuli between January and March, 2014. Total 406 participants of age 20 to 50 years were selected randomly. Data were collected using WHO-NCD STEPwise approach questionnaires and analyzed with SPSS V.16.0 and R i386 2.15.3 software.

Result: The mean age of participants was 36.2 ± 9 years. Majority of participants (76.3%) were from lower socio-economic class, Adibasi/Janajati (63.1%), and without formal schooling (46.3%). Smoking was present in 28.6%, alcohol consumption in 47.8%, insufficient fruits and vegetables intake in 96.6%, insufficient physical activity in 48.8%; 25.6% had high waist circumference, 37.4% had overweight and obesity. Average daily salt intake per capita was 14.4 grams ±4.89 grams. Hypertension was detected in 12.3%. It had an inverse relationship with education and socio-economic status. In binary logistic regression analysis, age, smoking, body mass index (BMI) and daily salt intake were identified as significant predictors of hypertension.

Conclusion: Present study showed high prevalence of smoking, alcohol consumption, insufficient fruit and vegetable intake, daily salt intake, overweight and obesity and hypertension among remote rural population suggesting higher risk for developing CVD in future. Nepalese rural communities, therefore, are in need of population-wide comprehensive intervention approaches for reducing CVD health risk behaviors.
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http://dx.doi.org/10.1186/1471-2261-14-92DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115072PMC
July 2014
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