Candidate of Master degree in Public Health, Institute of Medicine, Maharajgunj Medical Campus,Tribhuvan University, Nepal
To provide information on epidemiology of emerging diseases in Nepal
Recently Nepal has faced the burden of non communicable diseases (NCDs). NCDs are emerging health issues of Nepal due to rapid change in life-style of people. Cardiovascular diseases (CVD), Diabetes Mellitus, Chronic Kidney Diseases (CKD), Hypertension and Chronic Obstructive Pulmonary Diseases (COPD) contribute major NCDs of Nepal. Sedentary life-style, lack of physical exercise, obesity, higher intake of tobacco products, consumption of alcohol and lower consumption of fruits and vegetables are major risk factors responsible for NCDs. Nepal is low income country, due to cost constraints, maintaining the quality of life of NCDs patients may perhaps be a challenging issue in Nepal. Similarly Nepal is facing burden of communicable diseases too including Negated Tropical Diseases (NTDs) called diseases of poverty. Climate change is major risk factor for spreading vector borne diseases from plane region to hilly region. Malaria now becomes endemic problem in hilly region due to climate change. Currently Nepal is facing problem of outbreak of Scrub typhus, Dengue, Lymphatic fileriasis, Malaria and Chikungunya. In summary, vector borne diseases including NTDs are major public health problems in Nepal. The adverse health effects facing by climate change is major risk factor for vector borne diseases. Overall Nepal has faced the double burden of diseases including both NCDs and communicable diseases.
Abstract: Despite its largely mountainous terrain for which this Himalayan country is a popular tourist destination, Nepal is now endemic for five major vector-borne diseases (VBDs), namely malaria, lymphatic filariasis, Japanese encephalitis, visceral leishmaniasis and dengue fever. There is increasing evidence about the impacts of climate change on VBDs especially in tropical highlands and temperate regions. Our aim is to explore whether the observed spatiotemporal distributions of VBDs in Nepal can be related to climate change.A systematic literature search was performed and summarized information on climate change and the spatiotemporal distribution of VBDs in Nepal from the published literature until December 2014 following providing items for systematic review and meta-analysis (PRISMA) guidelines.We found 12 studies that analysed the trend of climatic data and are relevant for the study of VBDs, 38 studies that dealt with the spatial and temporal distribution of disease vectors and disease transmission. Among 38 studies, only eight studies assessed the association of VBDs with climatic variables. Our review highlights a pronounced warming in the mountains and an expansion of autochthonous cases of VBDs to non-endemic areas including mountain regions (i.e., at least 2,000 m above sea level). Furthermore, significant relationships between climatic variables and VBDs and their vectors are found in short-term studies.Taking into account the weak health care systems and difficult geographic terrain of Nepal, increasing trade and movements of people, a lack of vector control interventions, observed relationships between climatic variables and VBDs and their vectors and the establishment of relevant disease vectors already at least 2,000 m above sea level, we conclude that climate change can intensify the risk of VBD epidemics in the mountain regions of Nepal if other non-climatic drivers of VBDs remain constant.
Pub.: 19 Jun '15, Pinned: 10 Jun '17
Abstract: World Health Organization (WHO) estimates for deaths attributed to Non Communicable Diseases (NCDs) in Nepal have risen from 51% in 2010 to 60% in 2014. This study assessed the distribution and determinants of NCD risk factors among the Nepalese adult population.A nationally representative cross-sectional survey was conducted from Jan to June 2013 on the prevalence of NCD risk factors using the WHO NCD STEPS instrument. A multistage cluster sampling method was used to randomly select the 4,200 respondents. The adjusted prevalence ratio (APR) was used to assess the determinants of NCD risk factors using a Poisson regression model. The prevalence of current smoking (last 30 days) was 19% (95%CI:16.6-20.6), and harmful alcohol consumption (≥60 g of pure alcohol for men and ≥40 g of pure alcohol for women on an average day) was 2% (95%CI:1.4-2.9). Almost all (99%, 95%CI:98.3-99.3) of the respondents consumed less than five servings of fruits and vegetables combined on an average day and 3% (95%CI:2.7-4.3) had low physical activity. Around 21% (95%CI:19.3-23.7) were overweight or obese (BMI≥25). The prevalence of raised blood pressure (SBP≥140 mm of Hg or DBP≥90 mm of Hg) and raised blood glucose (fasting blood glucose ≥126 mg/dl), including those on medication were 26% (95%CI:23.6-28.0) and 4% (95%CI:2.9-4.5) respectively. Almost one quarter of respondents, 23% (95%CI:20.5-24.9), had raised total cholesterol (total cholesterol ≥190 mg/dl or under current medication for raised cholesterol). he study revealed a lower prevalence of smoking among women than men (APR:0.30; 95%CI:0.25-0.36), and in those who had higher education levels compared to those with no formal education (APR:0.39; 95%CI:0.26-0.58). Harmful alcohol use was also lower in women than men (APR:0.26; 95%CI:0.14-0.48), and in Terai residents compared to hill residents (APR:0.16; 95%CI:0.07-0.36). Physical inactivity was lower among women than men (APR:0.55; 95%CI:0.38-0.80), however women were significantly more overweight and obese (APR:1.19; 95%CI:1.02-1.39). Being overweight or obese was significantly less prevalent in mountain residents than in hill residents (APR:0.41; 95%CI:0.21-0.80), and in rural compared to urban residents (APR:1.39; 95%CI:1.15-1.67). Lower prevalence of raised blood pressure was observed among women than men (APR:0.69; 95%CI: 0.60-0.80). Higher prevalence of raised blood glucose was observed among urban residents compared to rural residents (APR:2.05; 95%CI:1.29-3.25). A higher prevalence of raised total cholesterol was observed among the respondents having higher education levels compared to those respondents having no formal education (APR:1.76; 95%CI:1.35-2.28).The prevalence of low fruit and vegetable consumption, overweight and obesity, raised blood pressure and raised total cholesterol is markedly high among the Nepalese population, with variation by demographic and ecological factors and urbanization. Prevention, treatment and control of NCDs and their risk factors in Nepal is an emerging public health problem in the country, and targeted interventions with a multi-sectoral approach need to be urgently implemented.
Pub.: 06 Aug '15, Pinned: 10 Jun '17
Abstract: Type 2 diabetes mellitus (T2DM) is an emerging global health problem in Nepal. However, there is still a paucity of information on its burden and its risk factors among service users from a hospital based setting. This is a cross sectional study conducted among the service users of diabetes clinic in Tribhuvan University Teaching Hospital of Nepal. A sample size of 154 was selected systematically from the patient registration from 30th July to 16th August, 2013. Of the 154 participants, 42.85 % had T2DM. Higher mean body mass index (26.50 ± 5.05 kg/m(2)) and waist circumference (92.47 ± 11.30 cm) was found among the individuals with T2DM and, compared to those without diabetes (Body mass index 25.13 ± 4.28 kg/m(2): waist circumference 88.91 ± 12.30 cm) (P = 0.013). In further analysis, the sedentary occupation (aOR 3.088; 95 % CI 1.427-6.682), measure of high waist circumference (aOR 2.758; 95 % CI 1.238-6.265) individuals from lower socioeconomic status (aOR 3.989; 95 % CI 1.636-9.729) right knowledge on symptoms of diabetes (aOR 3.670; 95 % CI 1.571-8.577) and right knowledge on prevention of diabetes (aOR 3.397; 95 % CI 1.377-8.383) were significantly associated with T2DM status. The current findings suggest that health programs targeting T2DM should focus increasing awareness on harmful health effects of sedentary occupation, symptoms of T2DM and its prevention among the urban population.
Pub.: 18 Sep '16, Pinned: 10 Jun '17