The alcohol use disorders identification test (AUDIT): validation of a Nepali version for the detection of alcohol use disorders and hazardous drinking in medical settings

BACKGROUND: Alcohol problems are a major health issue in Nepal and remain under diagnosed. Increase in consumption are due to many factors, including advertising, pricing and availability, but accurate information is lacking on the prevalence of current alcohol use disorders. The AUDIT (Alcohol Use Disorder Identification Test) questionnaire developed by WHO identifies individuals along the full spectrum of alcohol misuse and hence provides an opportunity for early intervention in non-specialty settings. This study aims to validate a Nepali version of AUDIT among patients attending a university hospital and assess the prevalence of alcohol use disorders along the full spectrum of alcohol misuse. METHODS: This cross-sectional study was conducted in patients attending the medicine out-patient department of a university hospital. DSM-IV diagnostic categories (alcohol abuse and alcohol dependence) were used as the gold standard to calculate the diagnostic parameters of the AUDIT. Hazardous drinking was defined as self reported consumption of ≥21 standard drink units per week for males and ≥14 standard drink units per week for females. RESULTS: A total of 1068 individuals successfully completed the study. According to DSM-IV, drinkers were classified as follows: No alcohol problem (n=562; 59.5%), alcohol abusers (n= 78; 8.3%) and alcohol dependent (n=304; 32.2%). The prevalence of hazardous drinker was 67.1%. The Nepali version of AUDIT is a reliable and valid screening tool to identify individuals with alcohol use disorders in the Nepalese population. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT ≥11 for both the gender) and hazardous drinkers (with AUDIT ≥5 for males and ≥4 for females). For alcohol dependence/abuse the cut off values was ≥9 for both males and females. CONCLUSION: The AUDIT questionnaire is a good screening instrument for detecting alcohol use disorders in patients attending a university hospital. This study also reveals a very high prevalence of alcohol use disorders in Nepal

Experiences and Lessons from a Multicountry NIDIAG Study on Persistent Digestive Disorders in the Tropics.

<p>Experiences and Lessons from a Multicountry NIDIAG Study on Persistent Digestive Disorders in the Tropics</p

The alcohol use disorders identification test (AUDIT): validation of a Nepali version for the detection of alcohol use disorders and hazardous drinking in medical settings

Abstract Background Alcohol problems are a major health issue in Nepal and remain under diagnosed. Increase in consumption are due to many factors, including advertising, pricing and availability, but accurate information is lacking on the prevalence of current alcohol use disorders. The AUDIT (Alcohol Use Disorder Identification Test) questionnaire developed by WHO identifies individuals along the full spectrum of alcohol misuse and hence provides an opportunity for early intervention in non-specialty settings. This study aims to validate a Nepali version of AUDIT among patients attending a university hospital and assess the prevalence of alcohol use disorders along the full spectrum of alcohol misuse. Methods This cross-sectional study was conducted in patients attending the medicine out-patient department of a university hospital. DSM-IV diagnostic categories (alcohol abuse and alcohol dependence) were used as the gold standard to calculate the diagnostic parameters of the AUDIT. Hazardous drinking was defined as self reported consumption of ≥21 standard drink units per week for males and ≥14 standard drink units per week for females. Results A total of 1068 individuals successfully completed the study. According to DSM-IV, drinkers were classified as follows: No alcohol problem (n=562; 59.5%), alcohol abusers (n= 78; 8.3%) and alcohol dependent (n=304; 32.2%). The prevalence of hazardous drinker was 67.1%. The Nepali version of AUDIT is a reliable and valid screening tool to identify individuals with alcohol use disorders in the Nepalese population. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT ≥11 for both the gender) and hazardous drinkers (with AUDIT ≥5 for males and ≥4 for females). For alcohol dependence/abuse the cut off values was ≥9 for both males and females. Conclusion The AUDIT questionnaire is a good screening instrument for detecting alcohol use disorders in patients attending a university hospital. This study also reveals a very high prevalence of alcohol use disorders in Nepal.</p

Genetic Polymorphism of Alcohol Dehydrogenase 3 (ADH1C) and Alcohol Dependence in Nepalese Population

ABSTRACT Genetic polymorphism of the enzymes involved in alcohol metabolism is mostly ethnic and race dependent. This study sought to determine whether an association exists between ADH1C and alcohol dependence in Nepalese population. Blood was collected from 200 Nepalese respondents, where 100 were alcohol dependent cases and 100 were control. The ADH3 genotype together with alleles frequencies (ADH3*1 and ADH3*2) were examined by PCR-RFLP methods in blood DNA. The differences in allele or genotype frequencies between cases and controls were examined by Fisher&apos;s exact test. Chi-square tests were employed to evaluate the deviations from Hardy-Weinberg equilibrium (HWE) and statistical significance is considered at p ≤ 0.05. We found the distribution of ADH1C genotypes was different in alcoholics and controls. Homozygous ADH1C*1 was significantly higher in alcohol dependence compared to control (P=0.03). However, the genotype frequency of ADH1C*2 was more in both group than ADH1C*1, the heterozygous ADH1C*1/*2 (Ile/Val) was almost equal frequency in both group. Interestingly, the frequency of fast allele γ 1 (A or *1) was significantly higher in alcohol dependence (0.215) than control (0.13) whereas slow allele γ 2 (G or *2) was marginally lower in alcohol dependence (0.785) than control (0.87) (P=0.024). Our results support for ADH1C as a candidate gene that affects vulnerability to alcoholism. ADH1C variants (ADH1C*1or ADH1C*350Ile) were associated with an increase in alcohol dependence

Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal.

BackgroundDespite direct-acting antivirals (DAA), aims to "eradicate" viral hepatitis by 2030 remain unlikely. In Nepal, an expert consortium was established to treat HCV through Nepal earthquakes aftermath offering a model for HCV treatment expansion in a resource-poor setting.Methodology/principal findingsIn 2015, we established a network of hepatologists, laboratory experts, and community-based leaders at 6 Opioid Substitution Treatment (OST) sites from 4 cities in Nepal screening 838 patients for a treatment cohort of 600 individuals with HCV infection and past or current drug use. During phase 1, patients were treated with interferon-based regimens (n = 46). During phase 2, 135 patients with optimal predictors (HIV controlled, without cirrhosis, low baseline HCV viral load) were treated with DAA-based regimens. During phase 3, IFN-free DAA treatment was expanded, regardless of HCV disease severity, HIV viremia or drug use. Sustained virologic response (SVR) was assessed at 12 weeks. Median age was 37 years and 95.5% were males. HCV genotype was 3 (53.2%) or 1a (40.7%) and 32% had cirrhosis; 42.5% were HIV-HCV coinfected. The intention-to-treat (ITT) SVR rates in phase 2 and 3 were 97% and 81%, respectively. The overall per-protocol and ITT SVR rates were 97% and 85%, respectively. By multivariable analysis, treatment at the Kathmandu site was protective and substance use, treatment during phase 3 were associated with failure to achieve SVR.Conclusions/significanceVery high SVR rates may be achieved in a difficult-to-treat, low-income population whatever the patient's profile and disease severity. The excellent treatment outcomes observed in this real-life community study should prompt further HCV treatment initiatives in Nepal

Principal elements of the NIDIAG digestive study and the respective standard operating procedures (SOPs) used.

<p>Principal elements of the NIDIAG digestive study and the respective standard operating procedures (SOPs) used.</p

Set of standard operating procedures (SOPs) used in the NIDIAG study on persistent digestive disorders.

<p>Set of standard operating procedures (SOPs) used in the NIDIAG study on persistent digestive disorders.</p

Country-specific enrolment characteristics of patients and controls in the NIDIAG study on persistent digestive disorders.

<p>Country-specific enrolment characteristics of patients and controls in the NIDIAG study on persistent digestive disorders.</p

Diagnostic challenges encountered during the NIDIAG study on persistent digestive disorders and proposed solutions.

<p>Diagnostic challenges encountered during the NIDIAG study on persistent digestive disorders and proposed solutions.</p

Laboratory diagnostic techniques used and internally compared in the NIDIAG study on persistent digestive disorders.

<p>Laboratory diagnostic techniques used and internally compared in the NIDIAG study on persistent digestive disorders.</p