The prevalence of metabolic syndrome in South Asia: A systematic review

© Research Society for Study of Diabetes in India 2015. The objective of this study was to estimate the prevalence of metabolic syndrome and its individual components in South Asia region. A search was conducted on PubMed, Scopus and OvidSP (MedLine and EMBASE) using the term ‘metabolic syndrome’, ‘prevalence’ and the name of each South Asian country for studies published on or after the year 2000. Reference lists and citation references of the included papers were also checked. Eligibility criteria were mainly population-based studies on both gender and healthy participants aged ≥18 years. Four definitions of metabolic syndrome were considered: the World Health Organisation (1999), Third Adult Treatment Panel (2001) and its modified version (2005) and International Diabetes Federation (2005). A total of 558 papers were retrieved from all sources, of which 16 relevant studies were identified comprising 14,515 males (44.1 %) and 18,390 females (55.9 %). The weighted mean prevalence of metabolic syndrome was 14.0 % (WHO), 26.1 % (ATPIII), 29.8 % (IDF) and 32.5 % (modified ATPIII). Low levels of HDL cholesterol and hypertension were prevalent in half of the study population. Overall, females had a higher prevalence of MS under all definitions except WHO. Females were more likely to have low levels of HDL cholesterol (68.8 vs 37.9 %) and central obesity (47.9 vs 37.9 %), whereas males were comparatively more hypertensive (42.3 vs 38.1 %). Despite the high rates of metabolic risk factors, research is extremely sparse in South Asia preventing knowledge of actual burden. Along with the increased access to clinical intervention, prevention strategies should be intensified with special attention to females

Antiretroviral treatment programmes in Nepal: Problems and barriers

Background: Antiretroviral (ARV) drugs have become the cornerstone of HIV (Human Immunodefi ciency Virus) care and treatment. Its use has led to a marked reduction in AIDS (Acquired Immune Defi ciency Syndrome) related morbidity and mortality. However, more than fi ve years after their introduction few HIV infected people in Nepal are receiving ARVs. Objective: The main aim of this study is to identify barriers and obstacles to providing and expanding ARV programmes in Nepal. Materials and methods: A qualitative approach consisting of in-depth interviews with three groups of stakeholders: policy makers, ARV service providers and ARV recipients were carried out. The transcripts were analysed using a thematic approach. Results: The estimated number of people in need was high compared with people currently receiving ARV in Nepal. With regards to the proper distribution of the ARVs, the main problems identifi ed in the interviews were: lack of infrastructure, lack of human resources, financial constraints, programmatic problems, weak leadership and management at national level, poor cooperation between management structures, geographical barriers, lack of awareness and low uptake of counselling and/or testing, stigmatization and discrimination felt by the health workers and the community, lack of coordination and limited access to services. Conclusion: Limited resources and administrative capacity coupled with strong underlying needs for services pose serious challenges to the government

Mixed-methods approaches in health research in Nepal

Combining and integrating a mixture of qualitative and quantitative methods in one single study is widely used in health and social care research in high-income countries. This editorial adds a few words of advice to the novice mixed-methods researcher in Nepal

Issues and Challenges of HIV/AIDS Prevention and Treatment Programme in Nepal

This paper explores some of the key issues and challenges of government HIV/AIDS prevention and treatment programme in Nepal. Providing HIV/AIDS prevention and treatment services in Nepal is associated with a number of issues and challenges which are shaped mostly on cultural and managerial issues from grass root to policy level. Numerous efforts have been done and going on by Nepal government and non-government organization but still HIV prevention and treatment service is not able to reach all the most at risk populations because cultural issues and managerial issues are obstructing the services. The existing socio-cultural frameworks of Nepal do not provide an environment for any safe disclosure for person who is HIV infected. Thus, there is an urgent need to address those issues and challenges and strengthen the whole spectrums of health systems through collaborative approach to achieve the millennium development goals. It will be the purpose of this paper to contribute to the policy makers by exploring the pertinent issues and challenges in the HIV/AIDS programme

In what way do Nepalese cultural factors affect adherence to antiretroviral treatment in Nepal?

Individuals’ self administration of medication is an essential component of disease management because incorrect and incomplete medication can result in increased morbidity, mortality and healthcare costs and also spreads drug resistance. Its impact is necessarily wider than just medical and includes the cultural and managerial considerations which govern success in medical interventions. This review paper is aimed at how Nepalese cultural factors (beliefs, religious practices, customs and traditions) may affect adherence to antiretroviral (ARV) medication among people living with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Results: Cultural factors (individual beliefs and perceptions) are notoriously complex concepts and shape people’s identities and influence their attitude and behaviours. The individual behaviours and beliefs about health and seeking treatment can adversely affect health care utilization and adherence to medication. These factors create a complicated and unforgiving environment for patients who are struggling to endure a chronic, life-threatening illness with life-long treatment. We cannot disregard patients’ cultural beliefs or practices in order to provide ARV treatment and their adherence because patients and clinicians come from different cultural groups. Conclusion: It is the purpose of this paper to contribute to the policy makers by exploring the pertinent cultural factors relating to the uptake of ARV treatment and its adherence

Public Health is truly interdisciplinary

There are some interesting on-going existential debates in Public Health. One of these is around the question whether Public Health is a single academic/professional discipline. There are two quite distinct and opposing views. Some argue that Public Health is a broad-ranging single discipline covering sub-disciplines such as epidemiology, management, health psychology, medical statistics, sociology of health & illness and research methods. Those who argue the latter, are implying that: (a) Public Health is the overarching dominant discipline, which brings these sub-disciplines together; and (b) that a true Public Health practitioner amalgamates all these individual elements. Others argue that Public Health is more an overarching world view or approach for wide-ranging group of professionals and academics. In this view some Public Health professionals are first trained as clinicians, others as psychologists, health economists, health management, statisticians, or demographers, and so on and have later specialised in Public Health. These debates are not purely theoretical debates as they can link to jurisdictional claims, about who can call themselves a Public Health practitioner and who can’t. This argument can go one step further to cover claims as to who can and who can’t legitimately practise or teach Public Health. The latter argument can be very divisive for Public Health, as it fails to recognise the important contribution made by other disciplines. But this is in fact not true as Public Health needs the full range of other professions and disciplines to lead and contribute to its teaching, research and consultancy practice. Public health has been a multidisciplinary enterprise since the latter half of the previous century

Factors Influencing Adherence to Antiretroviral Treatment in Nepal: A Mixed-Methods Study

Background Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. Methods A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. Results A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = 1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. Conclusion Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients’ lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients

Barriers to and facilitators of antiretroviral therapy adherence in Nepal: a qualitative study.

Patient's adherence is crucial to get the best out of antiretroviral therapy (ART). This study explores in-depth the barriers to and facilitators of ART adherence among Nepalese patients and service providers prescribing ART. Face-to-face semi-structured interviews were conducted with 34 participants. Interviews were audiotaped, transcribed, and translated into English before being analyzed thematically. ART-prescribed patients described a range of barriers for failing to adhere to ART. Financial difficulties, access to healthcare services, frequent transport blockades, religious/ritual obstacles, stigma and discrimination, and side-effects were the most-frequently discussed barriers whereas trustworthy health workers, perceived health benefits, and family support were the most-reported facilitators. Understanding barriers and facilitators can help in the design of an appropriate and targeted intervention. Healthcare providers should address some of the practical and cultural issues around ART whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients

Informed consent in health research: challenges and barriers in low-and middle-income countries with specific reference to Nepal

Obtaining 'informed consent' from every individual participant involved in health research is a mandatory ethical practice. Informed consent is a process whereby potential participants are genuinely informed about their role, risk and rights before they are enrolled in the study. Thus, ethics committees in most countries require 'informed consent form' as part of an ethics application which is reviewed before granting research ethics approval. Despite a significant increase in health research activity in low-and middle-income countries (LMICs) in recent years, only limited work has been done to address ethical concerns. Most ethics committees in LMICs lack the authority and/or the capacity to monitor research in the field. This is important since not all research, particularly in LMICs region, complies with ethical principles, sometimes this is inadvertently or due to a lack of awareness of their importance in assuring proper research governance. With several examples from Nepal, this paper reflects on the steps required to obtain informed consents and highlights some of the major challenges and barriers to seeking informed consent from research participants. At the end of this paper, we also offer some recommendations around how can we can promote and implement optimal informed consent taking process. We believe that paper is useful for researchers and members of ethical review boards in highlighting key issues around informed consent

The prevalence of exclusive breastfeeding practice in the first six months of life and its associated factors in Nepal: A systematic review and meta-analysis

Despite the global emphasis on breastfeeding, exclusive breastfeeding (EBF) in the first six months of life still lag behind the global recommendations in low- and middle-income countries, such as Nepal. This systematic review aims to determine the prevalence of EBF in the first six months of life and the associated factors determining EBF practices in Nepal. The databases PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, MIDIRS, DOAJ, and the NepJOL were searched for peer-reviewed literature published up to December 2021. The JBI quality appraisal checklist was used to assess the quality of studies. Analyses were performed by pooling together studies using the random-effect model, and the I2 test was used to assess the heterogeneity of the included studies. A total of 340 records were found, out of which 59 full-text were screened. Finally, 28 studies met the inclusion criteria and were selected for analysis. The pooled prevalence of EBF was 43 % (95 % confidence interval: 34–53). The odds ratio for the type of delivery was 1.59 (1.24–2.05), for ethnic minority groups 1.33 (1.02–1.75) and for first-birth order 1.89 (1.33–2.67). We found a lower prevalence of exclusive breastfeeding practice in Nepal compared to the national target. Multifaceted, effective, evidence-based interventions would encourage individuals in the exclusive breastfeeding journey. Incorporating the BEF counselling component into Nepal’s existing maternal health counselling package may help promote exclusive breastfeeding practice. Further research to explore the reasons for the suboptimal level of EBF practice would help develop the targeted interventions pragmatically