Neighborhood environment and quality of life of older adults in eastern Nepal: findings from a cross-sectional study.

INTRODUCTION: Quality of life (QoL) is a subjective measure reflecting individuals' evaluations based on their personal goals and values. While global research shows the role of neighborhood factors like ethnic diversity and socio-cultural dynamics on QoL, these are unexplored in the Nepali context. Therefore, this study examined the relationship between neighborhood environment and QoL among Nepali older adults in eastern Nepal. METHODS: This cross-sectional study involved 847 non-institutionalized older adults (aged ≥ 60 years) from two districts in eastern Nepal. QoL was evaluated using the 13-item brief Older People's Quality of Life questionnaire, where a mean score of < 3 indicated low/poor QoL. The neighborhood environment, conceptualized across three domains (demographic, socio-cultural, and built environment), included ethnic diversity, connections with family, friends, and neighbors, cultural ties, residential stability, and rurality. Their association with QoL was examined using multivariable logistic regression. RESULTS: Around 20% of older adults reported poor QoL. Higher ethnic diversity (adjusted Odds Ratio [aOR] = 0.12, 95% confidence interval [CI]: 0.04-0.36), moderate contact with family and relatives (aOR = 0.26, CI: 0.11-0.61), and high contact with neighbors (aOR = 0.09, CI: 0.03-0.21) were associated with lower odds of poor QoL. Conversely, high contact with friends (aOR = 2.29, CI: 1.30-4.04) and unstable residence (OR = 6.25, CI: 2.03-19.23) increased the odds of poor QoL. Additionally, among the covariates, chronic disease, tobacco use, unemployment, and lack of education were also significantly associated with poor QoL. CONCLUSION: Overall, the demographic environment, socio-cultural factors, and the built environment of the neighborhood influence QoL. Therefore, diversifying the neighborhood's ethnic composition, promoting social connections such as frequent contact with family, relatives, and neighbors, and ensuring residential stability can enhance the QoL of older adults.

Functional status and its associated factors among community-dwelling older adults in rural Nepal: findings from a cross-sectional study.

BACKGROUND: The high burden of chronic conditions, coupled with various physical, mental, and psychosocial changes that accompany the phenomenon of aging, may limit the functional ability of older adults. This study aims to assess the prevalence of poor functional status and investigate factors associated with poor functional status among community-dwelling older adults in rural communities of eastern Nepal. METHODS: Data on 794 older adults aged ≥ 60 years from a previous community-based cross-sectional study was used. Participants were recruited from rural municipalities of Morang and Sunsari districts of eastern Nepal using multi-stage cluster sampling. Functional status was assessed in terms of participants' ability to perform activities of daily living using the Barthel Index. Covariates included sociodemographic characteristics, lifestyle factors, and self-reported chronic conditions. A binary logistic regression model was used to investigate factors associated with poor functional status. RESULTS: The overall prevalence of poor functional status was 8.3 % (male: 7.0 % and female: 9.6 %), with most dependence noted for using stairs (17.3 %), followed by dressing (21.9 %) on Barthel Index. In the adjusted model, oldest age group (odds ratio [OR] = 2.83, 95 %CI: 1.46, 5.50), those unemployed (OR = 2.41, 95 %CI: 1.26, 4.65), having memory/concentration problems (OR = 2.32, 95 %CI: 1.30, 4.13), depressive symptoms (OR = 2.52, 95 %CI: 1.28, 4.95), and hypertension (OR = 1.78, 95 %CI: 1.03, 3.06) had almost or more than two times poor functioning. CONCLUSIONS: One in 12 older adults had poor functional status as indicated by their dependency on the items of the Barthel Index; those in the oldest age bracket were more likely to exhibit poor functional status. We suggest future studies from other geographies of the country to supplement our study from the rural setting for comprehensive identification of the problem, which could guide the development of prevention strategies and comprehensive interventions for addressing the unmet needs of the older adults for improving functional status.

Prevalence and determinants of frailty in the absence of disability among older population: a cross sectional study from rural communities in Nepal.

BACKGROUND: Longevity and frailty have significant implications for healthcare delivery. They increase demands for healthcare service and surge risk of hospitalization. Despite gaining global attention, determinants of frailty have remained unmeasured in the rural community settings in Nepal. This study aimed to address this gap by accessing the prevalence and determinants of frailty in the absence of disability among older population living in rural communities in eastern Nepal. METHODS: We conducted a cross-sectional analytical study of 794 older adults aged ≥60 living in the rural part of Sunsari and Morang district of eastern Nepal between January and April in 2018. Multi-stage cluster sampling was applied to recruit the study participants. Study measures included socio-demographics; Frail Non-disabled scale (FiND) measuring frailty, Barthel's Index measuring basic activities of daily living and Geriatric depression scale. Determinants of frailty in the absence of disability were identified using generalized estimating equation (GEE). RESULTS: About 65% of the participants self-reported the presence of frailty in the absence of disability. In the adjusted models, those from underprivileged ethnic groups, lack of daily physical exercise, presence of depressive symptoms and those not getting enough social support from family were found to be significantly associated with frailty among older participants. CONCLUSIONS: The prevalence of frailty in the absence of disability was high among rural community old population living in eastern Nepal. Our findings suggest that need of frailty awareness (both for clinicians and general public), so as to avoid negative consequences. To reduce the healthcare burden early screening frailty in primary care has potentials to prevent implications of frailty in Nepal.

Anemia among school children in eastern Nepal.

Anemia is one of the most common public health problems in developing countries like Nepal. This study was done to find the prevalence of anemia among the children aged 4-13 years in eastern Nepal. A cross-sectional study was conducted in 2012 in four districts (Morang, Udayapur, Bhojpur and Ilam) of eastern Nepal to find the prevalence of anemia among the school children of eastern Nepal. Children aged 4-13 years were selected randomly from different schools of above districts and 618 venous blood samples were collected. Hemoglobin level was estimated by using cyanmethemoglobin method. The mean hemoglobin level was 12.2 ± 1.82 gm/dl. About 37.9% (n = 234) children were found anemic. Anemia prevalence was 42.4% (n = 78), 31.6% (n = 60), 45.3% (n = 48) and 34.8% (n = 48) among school children of Morang, Udayapur, Bhojpur and Ilam district, respectively. The study finds anemia as a significant health problem among the school children of eastern Nepal.

The factors influencing inappropriate child feeding practices among families receiving nutrition allowance in the Himalayan region of Nepal.

BACKGROUND: Child feeding practices during the first two years of life are crucial to ensure good health and nutrition status. This study aimed to assess the factors influencing inappropriate child feeding practices in children aged 6 - 23 months in families receiving nutrition allowance in the remote Mugu district, Nepal. METHODS: A community-based cross-sectional study was conducted among 318 mothers who had children aged 6 - 23 months of age in the seven randomly selected wards. Systematic random sampling technique was used to select the desired number of respondents. Data were collected using pre-tested semi-structured questionnaire. Bivariate and multivariable binary logistic regression was used to estimate crude odds ratio (cOR), and adjusted odds ratio (aOR), and 95% confidence intervals (CIs) to understand factor associated with child feeding practices. RESULTS: Almost half of the children aged 6 - 23 months were not consuming a diverse diet (47.2%; 95% CI: 41.7%, 52.7%), did not meet the recommended minimum meal frequency (46.9%; 95% CI: 41.4%, 52.4%) and did not consume minimum acceptable diet (51.7%; 95% CI: 46.1%, 57.1%). Only 27.4% (95% CI: 22.7%, 32.5%) of children met the recommended complementary feeding practices. Multivariable analysis showed maternal characteristics such as mothers who gave birth at home (aOR = 4.70; 95% CI: 1.03, 21.31) and mothers in unpaid employment (aOR = 2.56; 95% CI: 1.06, 6.19) were associated with increased odds of inappropriate child feeding practices. Household economy (i.e. family with < 150 USD monthly income) was also associated with increased odds of inappropriate child feeding practices (aOR = 1.19; 95% CI: 1.05, 2.42). CONCLUSION: Despite the receipt of nutritional allowances, child feeding practices among 6 - 23 months children were not optimal. Additional context-specific behavior change strategies on child nutrition targeting mothers may be required.

Developmental vitamin D-deficiency produces autism-relevant behaviours and gut-health associated alterations in a rat model.

Developmental vitamin D (DVD)-deficiency is an epidemiologically established risk factor for autism. Emerging studies also highlight the involvement of gut microbiome/gut physiology in autism. The current study aims to examine the effect of DVD-deficiency on a broad range of autism-relevant behavioural phenotypes and gut health. Vitamin D deficient rat dams exhibited altered maternal care, DVD-deficient pups showed increased ultrasonic vocalizations and as adolescents, social behaviour impairments and increased repetitive self-grooming behaviour. There were significant impacts of DVD-deficiency on gut health demonstrated by alterations to the microbiome, decreased villi length and increased ileal propionate levels. Overall, our animal model of this epidemiologically validated risk exposure for autism shows an expanded range of autism-related behavioural phenotypes and now alterations in gut microbiome that correlate with social behavioural deficits raising the possibility that DVD-deficiency induced ASD-like behaviours are due to alterations in gut health.

Serum zinc status is a matter of concern among children and non-pregnant women in a nationwide survey of Nepal.

Nationally representative population data on zinc status in Nepal is lacking at present. This study analyzed data from the recent Nepal National Micronutrient status survey 2016 to determine the prevalence of zinc deficiency and associated risk factors among children aged 6-59 months (n = 1462) and non-pregnant women aged 15-49 years (n = 1923). Venous blood was collected from the participants to measure micronutrients such as zinc, markers of anemia, RBP (vitamin A), and markers of inflammation. Stool samples were collected to assess soil-transmitted helminths and Helicobacter pylori infection. Socio-demographic, household, and other relevant factors were collected by a structured questionnaire. Serum zinc concentration was measured by Microwave Plasma Atomic Emission Spectrometry, and zinc deficiency was defined according to the International Zinc Nutrition Consultative Group's guidelines. Logistic regression was used to examine the predictors of zinc deficiency among the participants. The overall zinc deficiency in children was 22.9%, while it was higher in non-pregnant women (24.7%). The prevalence of anemia among zinc-deficient children was higher (21.3%) than the zinc non-deficit children (18.7%). The prevalence of anemia was 18% among zinc-deficient non-pregnant women compared to 22% non-deficit non-pregnant women. Predictors associated with zinc deficiency among the study children were living in rural areas (AOR = 2.25, 95% CI, [1.13, 4.49]), the occurrence of diarrhea during the two weeks preceding the survey (AOR = 1.57, 95% CI, [1.07, 2.30]), lowest household wealth quintile (AOR = 0.48, 95% CI, [0.25, 0.92]) and lower vitamin A status (AOR = 0.49, 95% CI, [0.28, 0.85]. The predictors associated with zinc deficiency among non-pregnant women were: being underweight (AOR = 1.55, 95% CI, [1.12, 2.15]), fever occurrence during two weeks preceding the survey (AOR = 1.43, 95% CI, [1.04, 1.98]), H. pylori in the stool (AOR = 1.33, 95% CI, [1.04, 1.71]), lowest household wealth quintile (AOR = 0.62, 95% CI,[0.40, 0.94]) and being at risk of folate deficiency (AOR = 0.58, 95% CI,[0.36, 0.94]). We conclude that community-level intervention programs focused on rural children and women to prevent diarrhea, improve nutrition counseling, and provide economic opportunities in rural communities may help to lower zinc deficiency and other micronutrient deficiencies in the Nepalese population. We believe that intervention programs to address zinc deficiency should not be isolated. Instead, integrated approaches are beneficial to improve overall micronutrient status, such as encouraging dietary diversity, providing livelihood opportunities to the unemployed, micronutrient supplementation to vulnerable populations, and consumption of zinc-rich animal-based foods.

Establishing Bio-bank in Nepal.

Globally, the establishment of bio-banks began around 1990s when scientists felt need for collaborative researches in biomedical field. Bio-banks collect and preserve biological specimens which are provided to researchers to investigate about specific disease or treatment. In Nepal, eye bank and skin bank are only two types of bio-banks currently in existence. However, specimens collected in these bio-banks are used only for medical treatment, not for research. With this regard, there is urgent need to establish bio-banks in Nepal. In this article, we aim to provide insights on current status of bio-banking and its benefits for scientific development of Nepal. Keywords: Bio-bank; eye bank; Nepal; skin bank.

Assessment of Zinc Status Among Pregnant Women Attending a Tertiary Level Hospital of Sunsari District, Nepal.

BACKGROUND: Zinc deficiency is one of the major public health problems especially in developing countries, with an estimation of over 80% of pregnant women to be zinc deficient worldwide. Maternal zinc deficiency elevates the risk of foetal growth restriction. This study aimed to assess zinc deficiency and to examine the factors associated with zinc status among pregnant women attending a tertiary level hospital in Sunsari district, province no. one, Nepal. METHODS: Pregnant women were selected by using time frame consecutive sampling at B. P. Koirala Institute of Health Sciences, Dharan from September to November 2018. Data on nutritional, socio-demographic and reproductive profiles were collected using a semi-structured questionnaire. Blood was collected from each pregnant woman to estimate serum zinc concentration by atomic absorption spectrophotometry. Association between serum zinc concentration and predictor variables were assessed using chi-square test. RESULTS: A total of 156 women participated in the study. The prevalence of zinc deficiency among the pregnant women was 22.6%. Our data did not show association of any of the socio-demographic, nutritional and reproductive variables with serum zinc status (p-value>0.05) in chi-square. CONCLUSIONS: Zinc deficiency was found to be prevalent in our targeted population. However, community based studies need to be conducted for exploring more precise relationship between zinc status and other variables.

Hepatitis C virus genotype and its correlation with viral load in patients from Kathmandu, Nepal.

INTRODUCTION: Knowledge about the distribution of hepatitis C virus (HCV) genotype and its correlation with viral load are important for the decision of treatment and the prediction of disease progression, however such information is very limited in Nepal. Here, we investigated the distribution of HCV genotypes and viral load for HCV-infected patients from Kathmandu, Nepal. METHODOLOGY: Ninety-six patients with HCV infection and not on antiviral therapy were enrolled from three different medical centers in Kathmandu valley, Nepal. Demographics were recorded and blood samples were collected. Plasma was separated and HCV RNA was extracted. Reverse transcriptase PCR (RT-PCR) was performed to measure the viral load, and virus genotype was determined. RESULTS: Genotype 3a (n = 53, 55.2%) was the most prevalent, followed by 1b (n = 19, 19.8%), 1a (n = 18, 18.8%), 5a (n = 3, 3.1%), and mix types (n = 3, 3.1%). The median viral load for HCV genotype 1a was 770,942 IU/mL (IQR, 215,268-3,720,075), 1b was 700,000 IU/mL (IQR, 431,560-919,000), 3a was 1,060,000 IU/mL (IQR, 641,050-6,063,500), 5a was 673,400 IU/mL, and mixed was 6,428,000 IU/mL. A correlation between genotype and viral load was observed (p = 0.02), of which genotype 3a showed a high viral load. CONCLUSIONS: HCV genotypes 1a, 1b, 3a, and 5a were identified in Kathmandu, Nepal, and mixed genotype patients were observed in the patients studied. HCV genotype showed a correlation with viral load in patient plasma. This finding may contribute to the treatment and prevention of hepatitis C in Kathmandu, Nepal.

Excess urinary iodine concentration and thyroid dysfunction among school age children of eastern Nepal: a matter of concern.

OBJECTIVES: Deficiency as well as excess dietary iodine is associated with several thyroid disorders including Grave's disease and goitre. Previously, cross sectional studies conducted among school children in Nepal showed high prevalence of iodine deficiency. In contrast, recently, few studies have revealed emerging trends of excess urinary iodine concentration in children. This paper, reports excess urinary iodine excretion and thyroid dysfunction among school age children from eastern Nepal. RESULTS: It was a community based cross sectional study in which we measured urinary iodine excretion levels among school age children at baseline and after educational program. The educational program consisted of audio-visual and pamphlets on thyroid health. We also screened them for thyroid function status by physical examination and measuring serum thyroid hormones. Our results show that 34.4% of the children had excess urinary iodine concentration above the WHO recommended levels. Overall, 3.2% of the children were identified to have thyroid dysfunction. Urinary iodine concentration was significantly different between types of salt used and between salt iodine content categories.

Nutritional assessment and factors associated with malnutrition among the elderly population of Nepal: a cross-sectional study.

OBJECTIVES: This study aimed at assessing the nutritional status among the elderly population and factors associated with malnutrition in the community setting in rural Nepal. RESULTS: Out of 339 participants, 24.8% (95% CI 20.21-29.30) fell into the normal nutritional status range; 49.6% (95% CI 44.29-54.91) were at risk for malnutrition while 24.8% (95% CI 20.21-29.30) were in the malnourished range, based on Mini Nutritional Assessment scores. Our findings revealed that belonging to a Dalit community, being unemployed, having experience of any form of mistreatment, lack of physical exercise, experiencing problems with concentration in past 30 days and taking medication for more than one co-morbidity was significantly associated with the malnutrition status of the elderly.

The time has come to eliminate the gaps in the under-recognized burden of elder mistreatment: A community-based, cross-sectional study from rural eastern Nepal.

BACKGROUND: Elder mistreatment is a well-recognized public health issue with complex underlying factors. The current study hypothesized that there is no effect of any of the following factors on any type of elder mistreatment: ethnicity, age group, education status, gender, living arrangement, concentration problems, medication for any disease, income level of caregiver, use of alcohol and tobacco products, and dependence on family or caregivers for daily activities. MATERIALS AND METHODS: We conducted a cross-sectional study of 339 elders adults aged 60 or above residing in a rural part of eastern Nepal between August and November 2016. Multi-stage cluster sampling was adopted to select the study subjects. Information was collected using semi-structured questionnaires administered to elderly people by a designated interviewer. Factors associated with elder mistreatment were analyzed using logistic regression. RESULTS: Our findings revealed that 61.7% of 60+-year-olds experienced some form of mistreatment (physical 2.4%, psychological 22.4%, caregiver neglect 57.5%, financial 12.1% and stranger-inflicted 8.3%). Elder mistreatment was associated with the following characteristics of elders: dependent on family for daily living activities, illiterate, experiencing concentration problems, residing in a living arrangement with their son(s)/daughter(s)-in-law, taking regular medications, belonging to the Dalit community according to the Hindu traditional caste system, and residing with a caregiver having a monthly family income of less than NRs. 20,000 (193USD). CONCLUSIONS: Our data show that elder mistreatment is prevalent in a rural community of Nepal. Addressing the lower socio-economic or socio-cultural classes of caregivers and elders via community-focused development programs might have significant implications for improving the well-being of elders.