The association of sleep problem, dietary habits and physical activity with weight status of adolescents in Nepal.

Overweight/obesity among adolescents is an emerging public health issue worldwide. However, the evidence on the determinants of body weight status and lifestyle behaviors among Nepalese adolescents is limited. This study aims to explore the sleep characteristics, dietary habits, and physical activity and its association with body mass index (BMI) among Nepalese adolescents. A cross-sectional study was conducted between July and November 2019 among 627 randomly selected adolescents from eight schools located in Kathmandu Metropolitan City, Nepal. A self-administrated structure questionnaire was used to collect the data. Anthropometric measurements (adolescent's BMI), sleep characteristics, dietary habits, and physical activity were assessed using validated tools. Multinomial logistic regression analyses assessed the association between covariates and BMI categories. The statistical significance was considered at p-value < 0.05 and 95% confidence intervals (CIs). The overall prevalence of underweight and overweight/obesity among adolescents was 9.1% (95% CI: 7.1-11.6) and 23.7% (95% CI: 20.6-27.7) respectively. In multinomial logistic regression, adolescents who reported sleep problem compared to those with no such problem (Relative risk ratio (RRR) = 13.37, 95% CI: 7.14-25.05), adolescents who had obstructive sleep apnea (OSA) symptoms (RRR = 3.21, 95% CI:1.31-7.86), who consumed soft drink ≥1 time/day in past 1 months (RRR = 5.44, 95% CI: 2.93-10.10), consumed high-fat dietary ≥2 times/day (RRR = 2.17, 95% CI: 1.18-3.99), and had a habit of junk food consumptions (RRR = 5.71, 95% CI:2.55-12.82), adolescents who had 5-6 h/day sedentary behavior (RRR = 3.21, 95% CI: 1.14-9.09), adolescents from Terai/Madhesi castes (RRR = 2.81, 95% CI: 1.19-6.64) and adolescents whose father was employed (RRR = 2.04, 95% CI: 1.04-3.98) were at increased risk of being overweight/obesity. In contrast, adolescents aged 14-16 years had 71% lower (RRR = 0.29, 95% CI: 0.16-0.52), and adolescents who consumed less than five food groups had 45% lower (RRR = 0.55, 95% CI: 0.31-0.97) risk of being overweight/obesity compared to 12-14 years age groups and consumed more than five food groups respectively. The findings of this study warrant immediate interventions to improve the lifestyle to reduce overweight/obesity among Nepalese adolescents. Creating a conducive environment, both at school and home is essential to encourage adolescents for the adoption of healthy lifestyle behaviors

Food insecurity during COVID-19 pandemic: A genuine concern for people from disadvantaged community and low-income families in Province 2 of Nepal.

Background: Food insecurity is a serious social and public health problem which is exacerbated by the COVID-19 pandemic especially in resource-poor countries such as Nepal. However, there is a paucity of evidence at local levels. This study aims to explore food insecurity among people from the disadvantaged community and low-income families during the COVID-19 pandemic in Province-2 of Nepal. Methods: The semi-structured qualitative interviews were conducted virtually among purposively selected participants (n = 41) from both urban and rural areas in eight districts of Province 2 in Nepal. All the interviews were conducted in the local language between July and August 2020. The data analysis was performed using thematic network analysis in Nvivo 12 Pro software.ResultsThe results of this study are grouped into four global themes: i) Impact of COVID-19 on food security; ii) Food insecurity and coping strategies during the COVID-19 pandemic, iii) Food relief and emergency support during the COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and wellbeing. Most participants in the study expressed that families from low socioeconomic backgrounds and disadvantaged communities such as those working on daily wages and who rely on remittance had experienced increased food insecurity during the COVID-19 pandemic. Participants used different forms of coping strategies to meet their food requirements during the pandemic. Community members experienced favouritism, nepotism, and partiality from local politicians and authorities during the distribution of food relief. The food insecurity among low-income and disadvantaged families has affected their health and wellbeing making them increasingly vulnerable to the COVID-19 infection.ConclusionFood insecurity among low-income and disadvantaged families was found to be a serious problem during the COVID-19 pandemic. The study suggests that the relief support plan and policies should be focused on the implementation of immediate sustainable food security strategies to prevent hunger, malnutrition, and mental health problems among the most vulnerable groups in the community

‘The broker also told me that I will not have problems after selling because we have two and we can survive on one kidney’: findings from an ethnographic study of a village with one kidney in Central Nepal

Kidney selling is a global phenomenon engraved by poverty and governance in low-income countries with the higher-income countries functioning as recipients and the lower-income countries as donors. Over the years, an increasing number of residents in a village near the capital city of Nepal have sold their kidneys. This study aims to explore the drivers of kidney selling and its consequences using ethnographic methods and multi-stakeholder consultations. An ethnographic approach was used in which the researcher lived and observed the residents’ life and carried out formal and informal interactions including in-depth interviews with key informants, community members and kidney sellers in Hokse village, Kavrepalanchok district. Participants in the village were interacted by researchers who resided in the village. In addition, remote interviews were conducted with multiple relevant stakeholders at various levels that included legal workers, government officers, non-government organization (NGO) workers, medical professionals, and policymaker. All formal interviews were audio-recorded for transcription in addition to field notes and underwent thematic analysis. The study identified processes, mechanisms, and drivers of kidney selling. Historically, diversion of a major highway from the village to another village was found to impact the livelihood, economy and access to the urban centres, ultimately increasing poverty and vulnerability for kidney selling. Existing and augmented deprivation of employment opportunities were shown to foster emigration of villagers to India, where they ultimately succumbed to brokers associated with kidney selling. Population in the village also maintained social cohesion through commune living, social conformity (that had a high impact on decision making), including behaviours that deepened their poverty. Behaviours such as alcoholism, trusting and following brokers based on the persuasion and decision of their peers, relatives, and neighbours who became the new member of the kidney brokerage also contributed to kidney selling. The other reasons that may have influenced high kidney selling were perceived to be a poor level of education, high demands of kidneys in the market and an easy source of cash through selling. In Hokse village, kidney selling stemmed from the interaction between the brokers and community members’ vulnerability (poverty and ignorance), mainly as the brokers raised false hopes of palliating the vulnerability. The decision-making of the villagers was influenced heavily by fellow kidney sellers, some of whom later joined the network of kidney brokers. Although sustained support in livelihood, development, and education are essential, an expanding network and influence of kidney brokers require urgent restrictive actions by the legal authority

Impact of COVID-19 on health services utilization in Province-2 of Nepal: a qualitative study among community members and stakeholders

Background The COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aimed to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal. Methods The semi-structured qualitative interviews were conducted among purposively selected participants (n = 41) from a mix of rural and urban settings in all districts (n = 8) of the Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro. Results The findings of this research are categorized into four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and anxious about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions in health services were mostly due to the closure of health services at local health care facilities, limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health care workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from the government at all levels towards health services continuation/management during the COVID-19 pandemic. Conclusions This study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is critical to expand and continue the service coverage, and its quality (even more during pandemics), as well as increase public-private sector engagement to ensure the essential health services are available for the population

Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000–2021 : a systematic analysis from the Global Burden of Disease Study 2021

This online publication has been corrected. The corrected version first appeared at thelancet.com on July 31, 2023BACKGROUND : Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. METHODS : We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures—borrowing strength from predictive covariates and across age, time, and geography—and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). FINDINGS : Between 2000 and 2021, national incidence rates of sickle cell disease were relatively stable, but total births of babies with sickle cell disease increased globally by 13·7% (95% uncertainty interval 11·1–16·5), to 515 000 (425 000–614 000), primarily due to population growth in the Caribbean and western and central sub-Saharan Africa. The number of people living with sickle cell disease globally increased by 41·4% (38·3–44·9), from 5·46 million (4·62–6·45) in 2000 to 7·74 million (6·51–9·2) in 2021. We estimated 34 400 (25 000–45 200) cause-specific all-age deaths globally in 2021, but total sickle cell disease mortality burden was nearly 11-times higher at 376 000 (303 000–467 000). In children younger than 5 years, there were 81 100 (58 800–108 000) deaths, ranking total sickle cell disease mortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across all causes estimated by the GBD in 2021. INTERPRETATION : Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease.Bill & Melinda Gates Foundation.www.thelancet.com/haematologyam2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal Demographic and Health Survey

Abstract Background: Malnutrition in mothers and children is a significant public health challenge in developing countries such as Nepal. Although undernutrition in children has been gradually decreasing, the coexistence of various forms of malnutrition in mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of various forms of malnutrition and associated factors among mother-child pairs residing in the same household. Methods: A total sample of 2,261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements and hemoglobin levels of children and anthropometric measurements of their mothers were collected. Bivariate and multivariable logistic regression models were used to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM). Results: Prevalence of DBM and TBM was 6.60 % (95 % CI: 5.13-8.84) and 7.00 % (95 % CI: 5.42-8.99) respectively in the same households. In the adjusted multivariable logistic regression models, mothers with short stature (AOR=4.18, 95 % CI: 2.04-8.52), from the richest wealth quintile (AOR=2.46, 95 % CI: 1.17-5.15), aged over 35 years (AOR=3.08, 95 % CI: 1.20-7.86), and those who had achieved at least secondary level education (AOR=2.05, 95 % CI: 1.03-4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature (AOR=5.01, 95 % CI: 2.45-10.24), from the richest wealth quintile(AOR=2.66, 95 % CI: 1.28-5.54), aged over 35 years (AOR=3.41, 95 % CI: 1.26-9.17), and those who had achieved at least secondary level education (AOR=2.05, 95 % CI: 1.00-4.18) were more likely to suffer from the TBM. Conclusions: Overall, there is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Older mothers with short stature and those from richer wealth quintiles were more likely to suffer from double and triple burden of malnutrition.</jats:p

Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal Demographic and Health Survey

Abstract Background: Malnutrition among mothers and children is a major public health challenge in developing countries like Nepal. Although undernutrition among children has been gradually decreasing, the coexistence of different forms of malnutrition among mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of different forms malnutrition among children and associated factors among the mother-child pairs in the same household. Methods: A total sample of 2,261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 was included in the study. Anthropometric measurements and hemoglobin levels of the children and anthropometric measurements of their mothers were taken. The bivariate and multivariable logistic regression were performed to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM). Results: Prevalence of DBM and TBM was 6.60(5.13-8.84) % and 7(5.42-8.99) % respectively in the same household. In the adjusted multivariable logistic regression, mothers with short stature compared to normal height (AOR=4.18, 95% CI: 2.04-8.52), from the richest wealth status compared to poor wealth status (AOR=2.46, 95% CI= 1.17-5.15), from age group of above 35 years compared to 15-24 years (AOR=3.08, 95% CI:1.20-7.86), and those who had attended at least a secondary level of education compared to no education (AOR=2.05, 95% CI: 1.03-4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature compared to normal height (AOR=5.01, 95% CI:2.45-10.24), from the richest wealth status compared to poor wealth status (AOR=2.66, 95% CI=1.28-5.54), age groups of above 35 years compared to 15-24 years (AOR=3.41, 95% CI:1.26-9.17), and those who had attended at least a secondary level of education compared to no education (AOR=2.05, 95% CI: 1.00-4.18) were more likely to suffer from the TBM. Conclusions: There is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Mothers with short stature, belonging to the richest family and in older age were more prone to double and triple burden of malnutrition</jats:p

Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey

Abstract Background Malnutrition in mothers and children is a significant public health challenge in developing countries such as Nepal. Although undernutrition in children has been gradually decreasing, the coexistence of various forms of malnutrition in mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of various forms of malnutrition and associated factors among mother-child pairs residing in the same household. Methods A total sample of 2261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements and hemoglobin levels of children and anthropometric measurements of their mothers were collected. Bivariate and multivariable logistic regression models were used to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM). Results Prevalence of DBM and TBM was 6.60% (95% CI: 5.13–8.84) and 7.00% (95% CI: 5.42–8.99) respectively in the same households. In the adjusted multivariable logistic regression models, mothers with short stature (AOR = 4.18, 95% CI: 2.04–8.52), from the richest wealth quintile (AOR = 2.46, 95% CI: 1.17–5.15), aged over 35 years (AOR = 3.08, 95% CI: 1.20–7.86), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.03–4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature (AOR = 5.01, 95% CI: 2.45–10.24), from the richest wealth quintile (AOR = 2.66, 95% CI: 1.28–5.54), aged over 35 years (AOR = 3.41, 95% CI: 1.26–9.17), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.00–4.18) were more likely to suffer from the TBM. Conclusions Overall, there is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Older mothers with short stature and those from richer wealth quintiles were more likely to suffer from double and triple burden of malnutrition. </jats:sec

Factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey

Abstract Background Double and triple burden of malnutrition is defined by the coexistence of overweight/obese mother and undernourished child and coexistence of overweight/obese mother and undernourished and anemic child at the same household level respectively. The aims of this study were to explore the coexistence of overweight/obesity among mothers and undernourished and anemia among children and associated factors among the mother-child pairs in the same household. Methods A total sample of 5018 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements, hemoglobin level of the children and their mothers were taken. The bivariate and multivariate logistic regression were performed to observe the factors associated with the double and triple burden of malnutrition. To assess the outcome, we created the categories such as the double and triple burden of malnutrition where the overweight/obese mother and undernourished (stunted or wasted or underweight) child and overweight/obese mother and undernourished (stunted or wasted or underweight) child and anemic child respectively. Results Prevalence of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) was 6.59(5.13-8.84)% and 7(5.42-8.99)% respectively at the same household. In the adjusted multivariate logistic regression, mothers with short stature (AOR=3.94, 95% CI: 1.94-8.00), from the richest wealth status (AOR=2.59, 95% CI= 1.27-5.28), age groups of 26-49 years (AOR=2.38, 95% CI: 1.18-4.77), attended at least a secondary level of education (AOR=1.93, 95% CI: 1.01-3.69) were more likely to have the double burden of malnutrition. Similarly, mothers who had short stature (AOR=4.48, 95% CI: 2.19-9.16), the richest wealth status (AOR=2.46, 95% CI= 1.19-5.08) and age groups of 26-49 years (AOR=2.27, 95% CI: 1.16-4.44) were more likely to suffer from the triple burden of malnutrition. Conclusions Our study concludes with the prevalence of double and triple burden of malnutrition existence among mothers and children in Nepal. Mothers having short stature and from the richest family are more prone to double and triple burden of malnutrition. Integration of maternal health promotion and nutrition education program would be a good strategy to prevent mother overweight/obesity and stunting among children under five years of age in Nepal.</jats:p

Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal Demographic and Health Survey

Abstract Background: Malnutrition among mothers and children is a major public health challenge in developing countries like Nepal. Although undernutrition among children has been gradually decreasing, the coexistence of various forms of malnutrition among mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of various forms of malnutrition and associated factors among the mother-child pairs in the same household. Methods: A total sample of 2,261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements and hemoglobin levels of the children and anthropometric measurements of their mothers were taken. The bivariate and multivariable logistic regression were performed to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM). Results: Prevalence of DBM and TBM was 6.60(5.13-8.84) % and 7(5.42-8.99) % respectively in the same household. In the adjusted multivariable logistic regression, mothers with short stature compared to normal height (AOR=4.18, 95% CI: 2.04-8.52), from the richest wealth status compared to poor wealth status (AOR=2.46, 95% CI= 1.17-5.15), from age group of above 35 years compared to 15-24 years (AOR=3.08, 95% CI:1.20-7.86), and those who had attended at least a secondary level of education compared to no education (AOR=2.05, 95% CI: 1.03-4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature compared to normal height (AOR=5.01, 95% CI:2.45-10.24), from the richest wealth status compared to poor wealth status (AOR=2.66, 95% CI=1.28-5.54), age groups of above 35 years compared to 15-24 years (AOR=3.41, 95% CI:1.26-9.17), and those who had attended at least a secondary level of education compared to no education (AOR=2.05, 95% CI: 1.00-4.18) were more likely to suffer from the TBM. Conclusions: There is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Older mothers with short stature and from richer wealth status were more likely to suffer from double and triple burden of malnutrition.</jats:p