Nepalese Adults Research Articles

Prevalence of the Metabolic Syndrome and its determinants among Nepalese adults: Findings from a nationally representative cross-sectional study

Metabolic syndrome (MetS) increases the risk of cardiovascular diseases and diabetes mellitus. This study is designed to assess the prevalence and determinants of MetS among Nepalese adults from a nationally representative study. This study is based on Stepwise Approach to Surveillance (STEPS) Survey from Nepal. This survey was done among 4200 adults aged 15–69 years from 210 clusters selected proportionately across Nepal’s three ecological zones (Mountain, Hill and Terai). Subsequently, using systematic sampling, twenty households per cluster and one participant per household were selected. The overall prevalence of MetS is 15% and 16% according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria respectively. A triad of low HDL-C, abdominal obesity and high BP was the most prevalent (8.18%), followed by abdominal obesity, low HDL-C cholesterol and high triglycerides (8%). Less than two percent of participants had all the five components of the syndrome and 19% of participants had none. The prevalence steadily rose across the age group with adults aged 45–69 years having the highest prevalence (28–30%) and comparable prevalence across two definitions of MetS. A notably high burden for females, urban, hill or Terai resident were seen among other factors.

A16463 Prevalence and determinants of the metabolic syndrome among Nepalese adults

A16463 Prevalence and determinants of the metabolic syndrome among Nepalese adults

The utility and validity of pain intensity rating scales for use in developing countries.

Introduction:Pain intensity is the domain most often assessed in pain research. Although the Numerical Rating Scale is recommended for use in western countries, the utility and validity of this scale, relative to others, has not been established in non–western developing countries, such as Nepal.Objectives:Here, we sought to (1) identify which of 4 commonly used pain scales is most preferred by Nepalese, (2) compare error rates, (3) determine whether preference and error rates are influenced by age or education level, and (4) evaluate construct validity of each scale using factor analysis.Methods:Two hundred two adults with musculoskeletal pain from Nepal rated their worst and average pain intensity using all 4 scales and selected their most preferred scale.Results:The results indicate that the Faces Pain Scale-Revised is the most preferred scale, followed by a Verbal Rating Scale. The Numerical Rating Scale and Visual Analogue Scale were both least preferred and had higher rates of incorrect responses, especially among the older participants. However, all the scales demonstrated adequate construct validity as measures of pain intensity among those participants who could accurately use all 4 scales.Conclusion:The findings indicate that the Faces Pain Scale-Revised should be the first choice for assessing pain intensity in Nepalese adults. Research is needed to determine whether these findings replicate in other non–western and developing countries, to identify the pain intensity measure that would be the best choice for use in cross-cultural pain research.

Public awareness regarding the use and resistance of antibiotics: A cross-sectional study among Nepalese adults in Kathmandu valley

Background: Antibiotics are considered to be among the most commonly sold drug classes globally. Antibiotic resistance is a recognized public health issue at the local, national and global levels.Objectives: The aim of this study was to identify awareness of general public regarding the use and resistance of antibiotics.Methodology: A descriptive cross-sectional study was conducted in Kathmandu in November 2016 using a quantitative questionnaire among 120 adult people aged 20–60 years. Convenience sampling method was used and information on use of antibiotics and resistance was obtained using semi-structured questionnaire through interview method. Descriptive statistics was done to describe the respondent’s level of awareness regarding use of antibiotics and resistance.Results: Among the total respondents, majority had incorrect awareness as regards to action, reasons for using antibiotics, possible side effects of the antibiotic. Seventy one percent of the respondents had not heard about antibiotic resistance. The study finding showed that about 66.7% of the participants had inadequate awareness towards use and resistance of antibiotics.Conclusion: The findings demonstrate that the overall awareness on antibiotic use and resistance is poorly understood among our respondents. This information can be utilized in future educational and antibiotic resistance awareness raising campaigns.

Late presentation of Ellis van Creveld Syndrome with Common atrium anomaly: A case report in a Nepalese Adult

Ellis Van Creveld syndrome (EVC) is a rare genetic disorder having autosomal recessive inheritance characterized by chondrodystrophy, polydactyly, ectodermal dysplasia, and various cardiac anomalies. Acromelic shortening of upper and lower limbs, genu valgum, deformed teeth, short ribs and narrow thorax and other systemic anomalies complete the picture of this syndrome. The patients with the syndrome rarely survive into adulthood. Here, we report a 30 year old male with EVC presenting for the first time in middle age with Common atrium anomaly.

Examining the Oral Communication Strategies Used by a Group of Nepalese Adult Learners in an ESL Context

This paper sought to examine the oral communication strategies (CSs) used by a group of Nepalese adult learners in an oral task in an ESL context. There has been a long history of CS studies in L2 acquisition research; however, there are no studies yet reporting the CSs employed by Nepalese learners in an ESL context. Hence, six Nepalese learners with intermediate language proficiency were engaged in a picture storytelling task . Their narrations were recorded and transcribed, and their responses during the interview were elicited. Four significant results were revealed. Firstly, the Nepalese learners experienced a considerable amount of communication difficulties as manifested by various gap markers. To overcome these problems, the learners simultaneously used a variety of non-verbal CSs alongside verbal CSs. Secondly, linguistic errors were abound in their narrations but were ignored due to their communication goal. Hence, there are areas of communication (e.g., vocabulary and sentence structure) where the learners were having trouble, and these concerns should require instructional attention. Thirdly, the majority of the verbal CSs were avoidance strategies while most of the non-verbal CSs were achievement strategies. Lastly, examining the CSs used by the learners paved the way to culture-based strategies that were employed during storytelling. These CSs provided new inputs to the existing CS frameworks used by English language learners. Implications for language teaching and learning as well as future research are discussed. Keywords: oral communication; communication strategies; gap markers; Nepalese adult learners in an ESL context; culture-based strategies

Uncorrected and corrected refractive error experiences of Nepalese adults: a qualitative study

ABSTRACTPurpose: The aim of this study was to explore the impact of corrected and uncorrected refractive error (URE) on Nepalese people’s quality of life (QoL), and to compare the QoL status between refractive error subgroups.Methods: Participants were recruited from Tilganga Institute of Ophthalmology and Dhulikhel Hospital, Nepal. Semi-structured in-depth interviews were conducted with 101 people with refractive error. Thematic analysis was used with matrices produced to compare the occurrence of themes and categories across participants. Themes were identified using an inductive approach.Results: Seven major themes emerged that determined refractive error-specific QoL: activity limitation, inconvenience, health concerns, psycho-social impact, economic impact, general and ocular comfort symptoms, and visual symptoms. Activity limitation, economic impact, and symptoms were the most important themes for the participants with URE, whereas inconvenience associated with wearing glasses was the most important issue in glasses wearers. Similarly, possibilities of having side effects or complications were the major concerns for participants wearing contact lens. In general, refractive surgery addressed socio-emotional impact of wearing glasses or contact lens. However, the surgery participants had concerns such as possibility of having to wear glasses again due to relapse of refractive error.Conclusion: Impact of refractive error on people’s QoL is multifaceted. Significance of the identified themes varies by refractive error subgroups. Refractive correction may not always address QoL impact of URE but often add unique QoL issues. This study findings also provide content for developing an item-bank for quantitatively measuring refractive error-specific QoL in developing country setting.

Anthropometric risk factors of cardiovascular disease in adult population of Dharan Municipality, Eastern Nepal: Gender and age differences

Abstract Introduction: Cardiovascular diseases (CVD) besides cancer are the most serious threat to the health and life of the population of both developed and developing countries. The aim of the study was to know the gender and age differences with anthropometric CVD risk factors among Nepalese adults of Dharan Municipality. Materials and Methods: A population based cross-sectional study was conducted using a pretested self-administered structured questionnaire on anthropometric parameters which can affect CVD. A systematic random sampling technique was applied to cover the estimated 280 households with 900 adult population. The parameters of anthropometric risk factors for cardiovascular diseases were Body Mass Index (BMI), Waist Hip Ratio (WHR) and Body Fat Percentage (BFP). The result was expressed as mean ± SD. Independent student t test and ANOVA were applied to find out the gender and age differences respectively. “P” value of < 0.05 was considered to indicate statistical significance. Results: The mean and SD of BMI, WHR and BFP were found to be 24.17±4.13, 1.01±2.83 and 26.91±7.15 respectively. The gender differences of BFP were found to be statistically significant, whereas for BMI and WHR were not significant (p>0.05). The age differences in BMI and BFP were statistically significant (<0.05) whereas for WHR was not found to be significant (p>0.05). The signiicant positive correlations were found among these parameters (p< 0.01). Conclusion:The results of this study emphasize the need for a comprehensive study (both lipid and anthropometric) for providing baseline data to prevent CVD in eastern Nepal.

Awareness, treatment and control of hypertension in Nepal: findings from the Dhulikhel Heart Study

ObjectivesAlthough previous studies have suggested alarming rise in the prevalence of hypertension in Nepal, there is dearth of information on its awareness, treatment and control. In this cross-sectional study, we...

Oral hygiene practices and their socio-demographic correlates among Nepalese adult: evidence from non communicable diseases risk factors STEPS survey Nepal 2013.

BackgroundOral diseases remain a significant public health problem in Nepal, as do oral health behaviours. Socio-demographic factors play a crucial role in driving oral hygiene practices. This study aims to identify oral hygiene practices and associated socio-demographic factors in Nepalese population.MethodsThis descriptive, cross-sectional study recruited 4200 adults (15–69 years) through multistage cluster sampling. Data obtained from the WHO NCD STEPS instrument version 2.2 were analysed in STATA 13.0 using complex sample weighted analysis.ResultsPrevalence of cleaning teeth at least once a day was 94.9 % (95 % CI: 93.7–95.9), while that of cleaning teeth at least twice a day was 9.9 % (95 % CI: 8.2–11.9). Use of fluoridated toothpaste was seen among 71.4 % (95 % CI: 67.9–74.7) respondents. A 3.9 % (95 % CI: 3.1–5.0) made a dental visit in the last 6 months.The 45–69 years age group had lesser odds of cleaning teeth at least once a day (AOR: 0.4; 95 % CI: 0.2–0.8), in comparison to 15–29 years age group. Women had greater odds of cleaning teeth at least twice a day (AOR: 1.7; 95 % CI: 1.1–2.4) and having visited a dentist in the last 6 months (AOR: 2.2; 95 % CI: 1.2–3.8) compared to men. With reference to rural residents, urban population had higher odds of using fluoridated toothpaste (AOR: 2.3; 95 % CI: 1.4–3.4) and making a dental visit within the last 6 months (AOR: 1.9; 95 % CI:1.1–3.6). Inhabitants of the Terai had five-fold (AOR: 4.9; 95 % CI: 3.1–7.8) greater odds of cleaning teeth once per day than did hill residents. Those with higher education had greater odds than non-formal education holders of cleaning teeth at least once a day (AOR: 9.0; 95 % CI: 2.9–27.7), cleaning teeth at least twice a day (AOR: 5.6; 95 % CI: 2.9–10.6), using fluoridated toothpaste (AOR: 13.9; 95 % CI: 8.4–23.1), and having visited a dentist in the last 6 months (AOR: 2.8; 95 % CI: 1.4–5.4).ConclusionsCleaning teeth at least once a day is widely prevalent in Nepal and a substantial number of population use fluoridated toothpaste. However, cleaning teeth twice a day and visiting a dentist is less common. Being women, Terai residents, urban residents, and educated were significantly associated with oral hygiene practices assessed in this study.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-016-0294-9) contains supplementary material, which is available to authorized users.

Symptom Levels in Care-Seeking Bangladeshi and Nepalese Adults With Advanced Cancer.

PurposeThree-fourths of patients with advanced cancer are reported to suffer from pain. A primary barrier to provision of adequate symptom treatment is failure to appreciate the intensity of the symptoms patients are experiencing. Because data on Bangladeshi and Nepalese patients’ perceptions of their symptomatic status are limited, we sought such information using a cell phone questionnaire.MethodsAt tertiary care centers in Dhaka and Kathmandu, we recruited 640 and 383 adult patients, respectively, with incurable malignancy presenting for outpatient visits and instructed them for that single visit on one-time completion of a cell phone platform 15-item survey of questions about common cancer-associated symptoms and their magnitudes using Likert scales of 0 to 10. The questions were taken from the Edmonton Symptom Assessment System and the Brief Pain Inventory instruments.ResultsAll but two Bangladeshi patients recruited agreed to study participation. Two-thirds of Bangladeshi patients reported usual pain levels ≥ 5, and 50% of Nepalese patients reported usual pain levels ≥ 4 (population differences significant at P < .001).ConclusionBangladeshi and Nepalese adults with advanced cancer are comfortable with cell phone questionnaires about their symptoms and report high levels of pain. Greater attention to the suffering of these patients is warranted.

Self-Care Behaviors of Nepalese Adults With Type 2 Diabetes: A Mixed Methods Analysis.

Most previously reported literature on diabetes self-care is either solely quantitative or qualitative research conducted in developed countries; findings may not be generalizable to developing countries with different sociodemographic and cultural factors. The study aims to develop an explanatory mediation model for self-care and enhance model interpretation through qualitative input. A quantitatively driven, sequential, mixed method design was used. Structured questionnaires were used to collect data for the quantitative component from 230 participants. Participants for the qualitative interview were selected using maximum variation sampling (n = 13), and interviewing was guided by semistructured questions. Diabetes management self-efficacy had the strongest influence on diabetes self-care (standardized path coefficient = .42, p < .001), followed by perceived social support (standardized path coefficient = .26, p < .001), and educational status (standardized path coefficient = -.22, p < .001). Diabetes management self-efficacy significantly and partially mediated the relationship between diabetes duration and diabetes self-care (Sobel's z = 2.65, p < .001) and between expectation regarding aging and diabetes self-care (Sobel's z = 3.03, p < .001). Perceived social support significantly and partially mediated the relation between educational status and diabetes self-care (Sobel's z = -2.81, p < .001). The qualitative component elucidated nine themes interwoven in Nepalese culture, social structure, and religious belief. Responsibilities toward family and belief in God acted as boosters for self-care in the case of Nepalese adults, which differed by age, gender, and literacy status. The results from this study suggest that tailored psychosocial interventions to promote diabetes management self-efficacy may be beneficial in promoting self-care among Nepalese adults with diabetes mellitus.

Depression and its association with glycemic control in Nepalese adults with diabetes mellitus

Depression and its association with glycemic control in Nepalese adults with diabetes mellitus

Anxiety and depression in Nepal: prevalence, comorbidity and associations.

BackgroundAnxiety and depression are two important contributors to the global burden of disease. In many developing countries, including Nepal, their prevalences are yet to be assessed.MethodsA nationwide cross-sectional study was conducted among a representative sample of Nepalese adults aged 18–65 years (N = 2100), selected by multistage random cluster sampling and interviewed at home during unannounced visits. The validated questionnaires included the Hospital Anxiety and Depression Scale (HADS), to detect cases of anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD), the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N), and the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Logistic regression analyses were used to explore associations of caseness with four groups of variables: demographic, domicile, substance use, and behavioural and health.ResultsAge- and gender-adjusted point prevalences of HADS-A, HADS-D and HADS-cAD were 16.1, 4.2 and 5.9 % respectively. In a multivariate model, HADS-A was positively associated with urban residence (AOR = 1.82; p < 0.001) and neuroticism (AOR = 1.32; p < 0.001), and negatively with alcohol consumption (AOR = 0.71; p = 0.041). HADS-D was positively associated with marijuana use (AOR = 3.61; p = 0.017) and negatively with quality of life (QoL) (AOR = 0.86; p < 0.001). HADS-cAD was positively associated with widowhood (AOR = 2.71; p = 0.002), urban residence (AOR = 2.37; p = 0.001), living at altitude ≥2000 m (AOR = 2.32; p = 0.002) and neuroticism (AOR = 1.26; p < 0.001), and negatively with alcohol use (AOR = 0.56; p = 0.026) and QoL (AOR = 0.79; p < 0.001).ConclusionDepression and anxiety are important mental health conditions in Nepal, and major contributors to public ill health, being very highly prevalent, comorbid and associated with psychosocial burden. They are also linked to the unique topography, habitation and social structure of the country. High prevalence coupled with the disabling nature of these disorders establishes their health-care priority and their importance in national health policy.

Transorbital sonographic evaluation of normal optic nerve sheath diameter in healthy Nepalese adults

Abstract Background: Sonographic evaluation of optic nerve sheath diameter (ONSD) is increasingly being used as a non-invasive technique for detecting raised intracranial pressure. Aims: The aim of this study is to find out the normal ONSD in healthy Nepalese adults. Settings and Design: It is a cross-sectional observational study. Subjects and Methods: ONSD was measured 3 mm behind the globe using 6–13 MHz linear probe. Subjects were examined in the supine position with their eyes closed and in neutral position. Transducer was placed horizontally and in each eye, an average of three readings were documented. Statistical Analysis Used: Data were represented as mean and standard deviation. Paired t-test was used to compare ONSD between the right and left eye. Independent t-test was used to compare ONSD between males and females. Pearson correlation coefficient was used to assess the correlation between age and ONSD. Results: Eighty-eight healthy subjects above 18 years of age were enrolled in the study. The median ONSD was 4.1 mm with 95% of subjects in the range of 3.1–4.6 mm. There was no significant difference in ONSD measurement between males and females (P = 0.09) and between the right and left eye (P = 0.72). There was no relationship between ONSD and age ( R2=0.06, P = 0.55). Conclusions: The range for normal ONSD in healthy adult Nepalese subjects is 3.1–4.6 mm with no significant relationship with gender, age and side of the body.

Reinforcement of correct answers raised stage of performance in traditional nonliterate Nepalese adults.

Reinforcement of correct answers raised stage of performance in traditional nonliterate Nepalese adults.

Food patterns measured by principal component analysis and obesity in the Nepalese adult.

About one-fourth of Nepalese adults are overweight or obese but no studies have examined their risk factors, especially pertaining to diet. The present study aimed to identify dietary patterns in a suburban Nepalese community and assess their associations with overweight and obesity prevalence. This cross-sectional study used data from 1073 adults (18 years or older) participating in the baseline survey of the Dhulikhel Heart Study. We derived major dietary patterns from a principal component analysis of reported intake from a Food Frequency Questionnaire. Overweight was defined as Body Mass Index (BMI) of 25 kg/m(2) or higher and obesity was defined as BMI of 30 kg/m(2) or higher. Statistical analysis was conducted using generalised estimating equations with multivariate logistic regression (with household as cluster) adjusting for age, sex, ethnicity, religion, marital status, income, education, alcohol consumption, smoking, physical activity and systolic blood pressure. Four dietary patterns were derived: mixed, fast food, refined grain-meat-alcohol and solid fats-dairy. The refined grain-rice-alcohol pattern was significantly associated with overweight (adjusted OR 1.19, 95% CI 1.03 to 1.39; p=0.02) after adjusting for demographic and traditional cardiovascular risk factors. In adults of 40 years or older, the fast food pattern was associated with obesity controlling for demographic and traditional risk factors (adjusted OR 1.69, 95% CI 1.19 to 2.39; p value=0.003). Our results suggest that refined grains-meat-alcohol intake is associated with higher prevalence of overweight, and fast food intake is associated with higher prevalence of obesity in older adults (40 years or above) in suburban Nepalese adults.

Orthodontic treatment need and self-perception of malocclusion among nepalese young adults

Introduction: The objective of this study was to investigate the need of orthodontic treatment among young Nepalese adults by determining and comparing the threshold of esthetic impairment where orthodontic treatment would be sought by a sample of Nepalese Dental and Nursing students. Methods: Using the 10-grade esthetic component (AC) scale of the Index of Orthodontic Treatment Need (IOTN), 250 university students (100 dental and 150 nursing students) selected the level of esthetic impairment that represented the point at which they would seek orthodontic treatment. A questionnaire was answered by both the sample populations. The results obtained were compared between both groups. Results: The AC photograph Grade 4 and Grade 5 were found to be the most commonly selected threshold photographs by the nursing students and the dental students, respectively. Subjects who visited the dentist every 6 months, in both groups, were more likely to choose a threshold photograph closer to the attractive end of the scale. Conclusion: The information regarding the need and demand of orthodontic treatment allows a treatment priority to be set up to allocate appropriate resources. This study, using dental and nursing students suggests that as currently used the AC does not reflect the Nepalese general society's esthetic expectations. The results indicate that the esthetic expectations of the dental and nondental professionals differ so when using the AC of the IOTN the “no need for treatment” category should be Grades 1–3 of the AC, rather than Grades 1–4.

Association between Body Mass Index and Gastroesophageal Reflux Symptoms in Nepalese Adult Population. A Single Centered Hospital Based Study

Background &amp; Objectives: Gastroesophageal reflux disease (GERD) is a common disorder, and studies have reported inconsistent association between high BMI and its elevated risk of GERD symptoms. The aim of the present study was to estimate the strength of the association between body mass index and reflux symptoms in Nepalese adults.Materials &amp; Methods: This was a cross-sectional study conducted at National Academy of Medical Science, Bir Hospital, Kathmandu, Nepal. All patients of age 18 years or above who underwent endoscopy and diagnosed to have esophagitis were recruited for the analysis. Symptoms were identified by using a self-administered validated questionnaire regarding GERD that identify the onset for GERD symptoms and grade the frequency and severity of symptoms experienced over a period of one year. BMI data, the cut off points were based on the WHO classification of overweight and obesity. A BMI value ?25–30 represents overweight and BMI &gt;30 indicates obesity. A BMI value &lt;25 is considered as normal. Severity of erosive esophagitis was graded according to the Los Angeles classification.Results: The Among 127 enrolled esophagitis subjects, about 43% were under 20 BMI, 43% overweight and about 24% were obese. Obesity measured by BMI revealed no significant association among age, sex, smoker, alcoholics, hernia and severity grade of esophagitis (p&gt;0.05). Ages with various categories (18-40, &gt;40-60,&gt;60) were significantly associated with the GERD symptoms (P=0.021). We categorize BMI in three categories. A BMI value &lt; 25 (normal), ?25–30 (overweight), and BMI &gt;30 (obesity). Categorical analysis of BMI with GERD symptoms confirmed the absence of any tendency towards an association (p&gt;0.05).Conclusion: The tendency of reflux symptoms towards BMI is null, and weight reduction may not be the adequate justifiable for the symptoms therapy.JCMS Nepal. 2015; 11(2):23-26

Evaluating a Modular Design Approach to Collecting Survey Data Using Text Messages.

This article presents analyses of data from a pilot study in Nepal that was designed to provide an initial examination of the errors and costs associated with an innovative methodology for survey data collection. We embedded a randomized experiment within a long-standing panel survey, collecting data on a small number of items with varying sensitivity from a probability sample of 450 young Nepalese adults. Survey items ranged from simple demographics to indicators of substance abuse and mental health problems. Sampled adults were randomly assigned to one of three different modes of data collection: 1) a standard one-time telephone interview, 2) a "single sitting" back-and-forth interview with an interviewer using text messaging, and 3) an interview using text messages within a modular design framework (which generally involves breaking the survey response task into distinct parts over a short period of time). Respondents in the modular group were asked to respond (via text message exchanges with an interviewer) to only one question on a given day, rather than complete the entire survey. Both bivariate and multivariate analyses demonstrate that the two text messaging modes increased the probability of disclosing sensitive information relative to the telephone mode, and that respondents in the modular design group, while responding less frequently, found the survey to be significantly easier. Further, those who responded in the modular group were not unique in terms of available covariates, suggesting that the reduced item response rates only introduced limited nonresponse bias. Future research should consider enhancing this methodology, applying it with other modes of data collection (e. g., web surveys), and continuously evaluating its effectiveness from a total survey error perspective.