Prevalence and Factors Associated with Tobacco Use among High School Students.

BACKGROUND: Tobacco use is the leading cause of morbidity and mortality worldwide. Tobacco use among school-level students is a growing a public health problem in Nepal. A number of factors may be associated with tobacco use, but there is lack of literature showcasing an in-depth understanding of the growing prevalence of tobacco use in the Nepalese context. Therefore, our study aims to determine the prevalence of tobacco use and examine the factors associated with tobacco use among high school students at public schools in Budhanilkantha municipality, Kathmandu, Nepal. METHODS: A cross-sectional survey was conducted, and 378 students were selected for this study. The schools were selected randomly. Data collection was carried out using the self-administered questionnaires adapted from the World Health Organization used Global Youth Tobacco Survey and the Center for Disease Control and Prevention used Youth Tobacco Survey. RESULTS: Overall, 31.7% of the students ever consumed any tobacco products, and 20.1% were current tobacco users. One in five students started smoking when they were less than ten years of age. The proportion of students seeing at least one family member smoking and using smokeless tobacco was 52.1% and 47.1% respectively. Male and older students were significantly more likely to consume tobacco products than female and young students. CONCLUSIONS: This study showed that a significant proportion of school students had experienced tobacco use. Age and sex of the students were significantly associated with the status of current smoking and the use of smokeless tobacco.

Prevalence and Causes of Visual Impairment and Blindness in Three Ecological Regions of Nepal.

INTRODUCTION: Visual impairment and blindness are significant public health issues worldwide. The objective of this study was to estimate the prevalence and causes of moderate to severe visual impairment (MSVI) and blindness in people aged 15 years and above across three ecological regions of Nepal. MATERIALS AND METHODS: A comparative cross-sectional study was conducted in one district in each of the three ecological regions of Nepal. Number of participants from each region was distributed as per the prevalence findings of pilot study, with 2815 participants enrolled in Dolakha, 1509 in Dhading and 910 in Sarlahi. Intensive training was provided to health workers on how to conduct door-to-door enumeration, visual acuity testing and referral when indicated for comprehensive ocular examination by technicians and ophthalmologists to diagnose and treat ocular morbidities. Collected data were analyzed using standard software. For categorical data, frequency, percentage and 95% CI were calculated and statistical tests were done using Chi-square/Fisher exact test. RESULTS: Altogether 5234 participants were enrolled in the study (participation rate 96.4%). The overall prevalence of MSVI was 9.5% (495). It was 4.7% (133) in the mountainous region, 11.2% (169) in the Hill and 21.2% (193) in the Tarai. In those aged 15-49 years, MSVI prevalence was 1.5% (52) and 25.1% (433) in ≥50 years. The overall prevalence of blindness was 0.9% (47). It was 0.2% (6) in 15-49 and 2.3% (41) in ≥50 age groups. More than 95% visual impairment and blindness were due to cataract and uncorrected refractive error. Cataract was the leading cause of visual impairment and blindness (290, 53.5%), followed by uncorrected refractive error. CONCLUSION: The prevalence of visual impairment and blindness varied significantly with age, ethnicity and locality. The management of uncorrected refractive error and operable cataract would reduce nine in ten cases of moderate to severe visual impairment and blindness.

Factors Associated with Practice of Chemical Pesticide Use and Acute Poisoning Experienced by Farmers in Chitwan District, Nepal.

In view of increasing irrational use and unsafe handling of pesticides in agriculture in Nepal, a descriptive cross-sectional study was conducted to assess the practice of chemical pesticide use and acute health symptoms experienced by farmers. A total of 790 farmers from the Chitwan district were randomly selected for the study. X2 test, T-test, and Multiple Logistic Regression were used for analysis. Among the farmers, 84% used exclusively chemical pesticide. Farmers with better knowledge on pesticide handling were 8.3 times more likely to practice safe purchasing, four times more likely to practice safe mixing and spraying, and two times more likely to practice safe storage and disposal. Similarly, perception/attitude of farmers about chemical pesticide policy and market management was significantly associated with the practice of farmers during purchasing, mixing and spraying, and storage and disposal. Among the users of chemical pesticides, 18.7% farmers experienced one or more pesticide related acute symptoms of health problems during the previous 12 months. Farmers with unsafe practices of pesticide handling were two times more likely to suffer from acute poisoning. It is concluded that knowledge about pesticide handling and favorable perception/attitude on pesticide policy and market management are the predictors of safe use of pesticide.

Household Expenditure on Diarrhea Treatment among Under Five Children in Godawari Municipality of Nepal.

BACKGROUND: Diarrheal disease is a global public health problem. In Nepal, diarrhea is still the leading cause of waterborne disease, which constitutes 48% among all hospitalized disease cases who come to health center for treatment. Despite low treatment cost of diarrhea, out-of-pocket expenditure required at the time of treatment is a major barrier to seek health care. This study, therefore, aims to explore household expenditure for the diarrheal treatment in under five children and its financial burden in households. METHODS: A community based cross sectional study was carried out in 14 wards of Godawari Municipality among under five children with diarrhea from June 2018 to September 2018. We conducted financial burden survey among 371 household with diarrhea cases. RESULTS: Prevalence rate of diarrhea was found 50% among under five children. The average out-of-pocket expenditure was NRs 568.62 (US $5.06) per episode for diarrhea treatment. The total average direct cost for diarrheal treatment was NRs 183.58 (US $1.63). The two major cost driver during each episode were loss of wage by parents NRs 360.97 (US $3.21) and medicine costs NRs 114.15 (US $1.01). CONCLUSIONS: The Diarrheal prevalence rate in the study area was found higher than the National. The indirect cost of each diarrheal episode is more than three times of the direct cost.

Heat Stress Impacts on Cardiac Mortality in Nepali Migrant Workers in Qatar.

BACKGROUND: Qatar is a major destination country for Nepali migrant workers (NMWs; main age range 25-35 years) in the construction trade. These 120,000+ NMWs are exposed to various occupational hazards, including excessive heat, and 3-4 workers die each week. Our study aimed to show whether heat exposure caused deaths. METHODS: The worker population and mortality data of NMWs were retrieved from government institutions in Nepal. Heat exposure was assessed by monthly estimates of daily wet bulb globe temperature (WBGT), for in-shade conditions, from data collected at the Doha weather station from 2009 to 2017. Working in the sun during the middle of the day would add 2-3°C to the in-shade WBGT values. Daily deaths and their causes were obtained from the records of the Foreign Employment Promotion Board (FEPB) in Nepal, 2009-2017. Interviews with returning NMWs about their working conditions and the impacts of these conditions added information. The association between the heat variable and mortality was tested with standard statistical methods. RESULTS: The average annual death rate for NMWs in Qatar was 150 deaths/100,000. According to interviews, the majority of NMWs were found working in high WBGT (>31°C) each working day during hot months. The major cause of these deaths was recorded as cardiovascular problems (cardiovascular disease; CVD). Unfortunately, the causes of death were poorly described, and many deaths were listed as "cardiac arrest." We included these deaths in the broader category of "cardiovascular causes." There was a strong correlation between average monthly afternoon heat levels (WBGT) and CVD mortality. It is likely that a large proportion of these CVD deaths during hot months were due to serious heat stroke. Global studies show that approximately 15% of deaths in the age group 25-35 years are due to CVD causes. However, in this NMW population, the figures were 22% during the cool season and 58% during the hot season. CONCLUSIONS: The increased CVD mortality during hot periods is most likely due to severe heat stress. As many as 200 of the 571 CVD deaths during 2009-2017 could have been prevented if effective heat protection had been implemented as a part of local occupational health and safety programs. There is an urgent need for protection against such heat effects among NMWs, and rising temperatures from ongoing climate change are further increasing the health risks. Cause of death records for workers dying in hot conditions should be more precise than "cardiac arrest."

Situation of Water, Sanitation and Hygiene and Diarrhoeal Diseases After Open Defecation Free Declaration.

BACKGROUND: Makwanpur district was declared Open Defecation Free in 2013 as the movement started in Nepal since 2003 to address the high burden of diarrhoeal disease among under five children. As the water supply, sanitation and hygiene situation of the district is not known after the declaration, the need for this study was visualized. METHODS: It was a cross sectional study among randomly sampled 178 households using interview and observation. Water, sanitation and hygiene situation was assessed in terms of related facilities, knowledge and practices of mothers. Results were compared with the standard open defecation free criteria of Nepal. Five years trend of diarrhoeal disease was analysed from the health facility records to assess the impact of declaration. RESULTS: Of the total households 92% had toilets and 90% had access to improved water source. About 79% mothers had high knowledge on safe water, sanitation and hygiene and 43% practiced hand washing with soap at critical times. Proper disposal of solid and liquid waste was found among 32% and 46% of households respectively. About 68% of households had good water, sanitation and hygiene situation and was found to be significantly associated with related knowledge among mothers irrespective of their economic status. Diarrhoeal disease among under five children was found declining after open defecation free declaration. CONCLUSIONS: Water, sanitation and hygiene status in the study area is found lower than the criteria for open defecation free declaration. However, diarrhoeal disease among children under five is declining after the declaration.

Overweight and its associated risk factors among urban school adolescents in Nepal: a cross-sectional study.

OBJECTIVES: The prevalence of non-communicable diseases is increasing in Nepal. Overweight and obesity are the major risk factors of many non-communicable diseases. Adolescence is a critical phase for development of overweight and obesity. Risk factors associated with overweight and obesity are not well understood in Nepal. The objective of the study was to identify the factors associated with overweight and obesity among adolescent students. SETTING: A cross-sectional descriptive study was carried out on higher secondary school students in the Lalitpur sub-metropolitan city, Nepal. PARTICIPANTS: A random sample of 360 students aged 16-19 years from eight schools was included in the study. RESULTS: The prevalence of overweight among adolescent students was 12.2% (95% CI 8.9 to 15.5). Factors associated with being overweight included being male (adjusted OR (AOR) 2.64, 95% CI 1.18 to 4.88), studying in private school (AOR 2.10, 95% CI 1.03 to 4.28), high socioeconomic status family (AOR 4.77, 95% CI 1.36 to 16.72), watching television for more than 2 h per day (AOR 8.86, 95% CI 3.90 to 20.11), and consuming fruit four times or less per week (AOR 3.13, 95% CI 1.39 to 7.01). There was no statistically significant association between adolescent overweight and age, ethnicity, mother's education level, mother's occupation, number of siblings or family type. CONCLUSIONS: Socioeconomic status, watching television for a longer time and consuming less fruit are major risk factors for overweight among adolescents in Nepal. Interventions are needed to increase awareness about the risk factors of adolescent overweight and obesity to decrease prevalence of overweight-associated non-communicable diseases.

Performance characteristics of qPCR assays targeting human- and ruminant-associated bacteroidetes for microbial source tracking across sixteen countries on six continents.

Numerous quantitative PCR assays for microbial fecal source tracking (MST) have been developed and evaluated in recent years. Widespread application has been hindered by a lack of knowledge regarding the geographical stability and hence applicability of such methods beyond the regional level. This study assessed the performance of five previously reported quantitative PCR assays targeting human-, cattle-, or ruminant-associated Bacteroidetes populations on 280 human and animal fecal samples from 16 countries across six continents. The tested cattle-associated markers were shown to be ruminant-associated. The quantitative distributions of marker concentrations in target and nontarget samples proved to be essential for the assessment of assay performance and were used to establish a new metric for quantitative source-specificity. In general, this study demonstrates that stable target populations required for marker-based MST occur around the globe. Ruminant-associated marker concentrations were strongly correlated with total intestinal Bacteroidetes populations and with each other, indicating that the detected ruminant-associated populations seem to be part of the intestinal core microbiome of ruminants worldwide. Consequently tested ruminant-targeted assays appear to be suitable quantitative MST tools beyond the regional level while the targeted human-associated populations seem to be less prevalent and stable, suggesting potential for improvements in human-targeted methods.

Assessing climate change and heat stress responses in the Tarai region of Nepal.

This paper intends to analyse responses of the working people to heat stress in Nepal's Tarai region. Here, the heat stress responses refer to the working environments- indoor and outdoor settings, prevailing diseases, and adaptive measures by the workers. Data were gathered from the sample households by using household survey, observation, and informal discussions. Environmental conditions in terms of heat exposure in the working areas have been measured with heat index, humidity index, and WBGT, based on the HOTHAPS approach. The findings are that: the average temperature during the peak hot months reached to over 39°C and the environmental conditions in the selected factories during the hot summer months were too hot to the workers to work continuously during the day, where there was inadequacy of facilities to combat against the hot. Males were more exposed than females to the heat due to heavy type of works in outdoor settings. Few workers found to have adapted coping measures such as shift in working time, wearing thin cotton clothes, etc but they were inadequate against the heat stress. More quantitative measurements of workers' health effects and productivity loss will be of interest for future works.