Prevalence of multimorbidity and its associated risk factors among population of Mechinagar municipality of Nepal.

Background: Multimorbidity is a group of conditions, it has significant impact on the population as a whole, resulting in lower quality of life, higher mortality, frequent use of medical services, and consequently higher healthcare costs. The objective of this study is to document the prevalence of common multimorbidity and its associated risk factors among population of Mechinagar Municipality. Methods: Community-based cross-sectional study was conducted where selected multimorbidity were assessed in selected areas of Mechinagar municipality of Jhapa District . Systematic random sampling technique was used to select 590 adult participants from three pre-defined pocket areas. Pre-designed semi-structured multimorbidity assessment questionnaire for primary care (MAQ-PC)was used to assess prevalence of multimorbidity. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity. Results: The prevalence of multimorbidity was 22.4%.Hypertension, Diabetes mellitus and COPD was seen in 39.2%, 7.8.% and 4.4% of the participants respectively . Participants with advancing age i. e. 40-49yrs were 12.62 times (AOR) more likely to have multimorbidity compared to their counterparts who were 20-29yrs old( p=<0.01,CI3.01-15.28) after adjusting for occupation, physical activity and family history of kidney disease. Working individuals, Physical inactivity and positive family history of kidney disease were the strongest determinates of multimorbidity. Conclusions: The study revealed that participants with increasing age, working individuals, physical inactivity and family history of kidney disease were more vulnerable of having multimorbidity. The findings of our study indicate need of intervention strategies and community-based health promotion programs in reducing burden of chronic disease among adult population.

Catastrophic health expenditure on chronic non-communicable diseases among elder population: A cross-sectional study from a sub-metropolitan city of Eastern Nepal.

INTRODUCTION: This study was conducted with the objective to analyze the out-of-pocket (OOP) healthcare expenditure and catastrophic healthcare expenditure (CHE) on chronic non-communicable diseases (CNCD) among the elderly population, and the association of CHE on CNCD with associated factors among the same population. MATERIALS AND METHODS: We collected data from the elderly population of Dharan Sub-metropolitan city of the Eastern Nepal via door-to-door survey and face-to-face interview. The ten wards out of twenty were chosen by lottery method, and the equal proportion out of 280 samples was purposively chosen from each of ten wards (28 participants from each selected ward). The data were entered in Microsoft Excel 2019 v16.0 and statistical analysis was performed by using statistical package for social sciences, IBM SPSS® v21. The chi-square test was used to test the group differences. Multivariable logistic regression was used to determine independent factors associated with CHE (all variables with P < 0.20), and adjusted odds ratios (AOR) were calculated at 95% confidence interval (CI). RESULTS: The median household, food and health expenditures were 95325 (72112.50-126262.50), 45000 (33000-60000) and 2100 (885.00-6107.50) NPR respectively. The proportion of the participants with CHE was 14.6%. The single living participants had 3.4 times higher odds of catastrophic health expenditure (AOR = 3.4, 95% CI = 1.2-9.6, P-value = 0.022) than those who are married. Similarly, those who had cancer had 0.1 times lower odds of CHE (AOR = 0.1, 95% CI = 0.0-0.2, P-value = <0.001) than those without cancer. CONCLUSION: The elder population had significant financial health shocks due to chronic health ailments. There should be the provision of mandatory health insurance programmes for elderly to cut down the catastrophic healthcare expenditure. Similarly, there should be the provision of exemption scheme for vulnerable elderly who are more likely to face catastrophic expenditure from all available health facilities.

Forty years after Alma-Ata: primary health-care preparedness for chronic diseases in Mozambique, Nepal and Peru.

BACKGROUND: Four decades after the Alma-Ata Declaration, strengthening primary health care (PHC) remains a priority for health systems, especially in low- and middle-income countries (LMICs). Given the prominence of chronic diseases as a global health issue, PHC must include a wide range of components in order to provide adequate care. OBJECTIVE: To assess PHC preparedness to provide chronic care in Mozambique, Nepal and Peru, we used, as 'tracer conditions', diabetes, hypertension and a country-specific neglected tropical disease with chronic sequelae in each country. METHODS: By implementing a health system assessment, we collected quantitative and qualitative data from primary and secondary sources, including interviews of key informants at three health-system levels (macro, meso and micro). The World Health Organization's health-system building blocks provided the basis for content analysis. RESULTS: In total, we conducted 227 interviews. Our findings show that the ambitious policies targeting specific diseases lack the support of technical, administrative and financial resources. Data collection systems do not allow the monitoring of individual patients or provide the health system with the information it requires. Patients receive limited disease-specific information. Clinical guidelines and training are either non-existent or not adapted to local contexts. Availability of medicines and diagnostic tests at the PHC level is an issue. Although medicines available through the public health care system are affordable, some essential medicines suffer shortages or are not available to PHC providers. This need, along with a lack of clear referral procedures and available transportation, generates financial issues for individuals and affects access to health care. CONCLUSION: PHC in these LMICs is not well prepared to provide adequate care for chronic diseases. Improving PHC to attain universal health coverage requires strengthening the identified weaknesses across health-system building blocks.

Prevalence of Intimate Partner Violence and Associated Factors Among Married Nepalese Men in Kathmandu Metropolitan City.

BACKGROUND: Intimate Partner Violence is defined as the intentional use of physical force, or power, threatened or actual against on self/others or groups that results in injury, death, psychological harm. METHODS: A community-based cross-sectional study was conducted in Kathmandu Metropolitan city in 2018. An adequate sample of 210 married men was selected from randomly selected 10 wards of Kathmandu Municipality. A semi-structured questionnaire including standard scales was used for data collection. Multivariate analysis was performed to find out the association of Intimate Partner Violence with different variables. RESULTS: The mean age of male respondents was 40.19 years. More than half of the respondents were Janajatis. Overwhelming respondents were Hindu (religion). Intimate Partner Violence was estimated in forms of Physical violence, 31.9%, Sexual violence, 4.3%, and Psychological violence, 50.5%. Age, age at marriage, marriage type, marriage decision, spousal age gap, family income, education, smoking habit and depression were independently associated with violence. However, family income and education were found to be significant factors associated with violence even after adjusting the effects of other potential factors. CONCLUSIONS: Strong association of Intimate Partner Violence with family income, and education of male respondents was observed. More than half of the males had psychological violence and nearly one-third of the participants had Physical violence. The study concludes that Intimate Partner Violence among males could not be neglected.

Study of Health-Related Quality of Life and Healthcare Utilization among Type 2 Diabetic Population in an Urban Area of Eastern Nepal.

INTRODUCTION: Diabetes mellitus is a major cause of morbidity and mortality and places huge burden on public health funding. Diabetes affects quality of life through associated complications, comorbidity, and disease burden. Consequently, people have frequent healthcare visits. This study assessed quality of life and healthcare utilization patterns among type 2 diabetic populations in an urban area of eastern Nepal. METHODS: A cross-sectional study was conducted among 270 participants of age ≥20 years with type 2 diabetes in Itahari using a semistructured questionnaire. A D-39 questionnaire was used to assess quality of life. Five wards were selected by systematic random sampling, and the population was proportionate according to the sample size. Multiple linear regressions were conducted to identify the factors associated with quality of life and its domains. RESULTS: The highest mean score ± SD was found in the domain anxiety and worry (57.34 ± 11.08). About 18.5% of the participants perceived extremely affected quality of life. Hypertension (55.55%) was the most common comorbidity. Age, marital status, literacy, alcohol, disease duration, comorbidity, and complications were significantly associated with overall quality of life. In last 6 months of duration, 93.7% had hospital visits. Among them, 8.1% had emergency visit and 5.9% were admitted in the hospital. CONCLUSION: People with diabetes in this study were more affected in the domain anxiety and worry. The frequency of healthcare access and utilization in patients with type 2 diabetes was high. The quality of life among them could be improved by taking care on healthy behavior, comorbid conditions, and complications.

Disruption, changes, and adaptation: Experiences with chronic conditions in Mozambique, Nepal and Peru.

Chronic conditions are an increasing problem in Low- and Middle-Income Countries (LMICs) yet, the challenges faced by low-income populations with these conditions in such countries are not well understood. Based on in-depth interviews with people affected by chronic conditions and their family members, this paper describes the experience of patients suffering from diabetes or hypertension in rural communities of Mozambique, Nepal, and Peru. We analysed our data using the concepts of disruption and adaptive strategies, finding that despite being very different countries, the implications in daily lives, interpersonal relationships, and family dynamics are similar, and that oftentimes such impact is defined along gender lines. We show that adjustments to living with a chronic disease are not always easy, particularly when they imply changes and reconfiguration of roles and responsibilities for which neither the individual nor their families are prepared. The study adds to the literature on the disruptive effects of chronic conditions and stresses the importance of contextualising disruptive experiences among disadvantaged populations within weak health systems. Our findings highlight the relevance of understanding the challenges of developing adaptive solutions to chronic care in resource-scarce contexts.

Respiratory Problems among Workers of Udayapur Cement Factory in Eastern Nepal.

BACKGROUND: There have been very limited studies regarding health of the cement factory workers in Nepal. This study aimed to find out the prevalence of health problems and the factors associated with respiratory symptoms among the workers of Udayapur cement factory. METHODS: This is a cross-sectional study conducted from March to August 2015 in Udayapur cement factory in eastern Nepal. All the workers working in the factory more than a year were included in the study. Thedata was collected by using a semi-structured questionnaire consisting of socio-demographic characteristics,type of work, reported health problems, use of personal protective measures.Chi-square test was used to determine the association of respiratory symptoms with related variables. RESULTS: A total of 295 workers were included in this study with mean age of 45.9 years (SD=7.7). Majority 279 (94.6%) were males. The most common health problems were musculoskeletal pain (55.6%) followed by eye problems (33.2%). Among them, 17(21.1%) reported that they had at least one respiratory problem and chest tightness while running/climbing and wheeze were the most common. A total of 233 participants (79%) used at least one form of personal protective equipment. Low education, longer duration of work and smoking were found to be positively associated with respiratory symptoms. CONCLUSIONS: Respiratory problems were high among the workers of the cement factory. Proper use of PPEs and dust control measures should be promoted among the workers.

Use of Pesticides and Health Risk among Farmers in Sunsari District, Nepal.

BACKGROUND: An increasing widespread use of Pesticides is as an issue in the agricultural sector. Pesticides use is one of the occupational risks in farmers of low-income countries including Nepal. Objective of this study was to explore the health effects of Pesticides among agricultural farmers of Sunsari. METHODS: A community based cross sectional study was carried out in Duhabi-Bhaluwa of Sunsari District, Nepal from September 2015 to February 2016. Non-probability sampling technique was used to enroll the total 300 study participants. Data were collected by face to face interview with farmers using pre-tested semi structured questionnaire. Data were recorded by reading the original container of the Pesticides. RESULTS: Fungicides (60.3%), Herbicides (56.3%), pyrethrum (35.3%) and Organophophate (11.6%) Pesticides were commonly used by the agricultural farmers in their farms. The health problem within 48 hours after application of pesticides was reported by more than one-sixth (17%) of the farmers. Dizziness (74.5%) and headache (58.8%) were the most common health problems found among the farmers. Skin irritation (19.6%), nausea (13.7%), paraesthesia (9.8%), restlessness (5.8%), eye irritation (5.8%) and vomiting (1.9%) were also reported by pesticides handlers. Factors associated with health problems were hazardous pesticides use (AOR=26.95, CI 6.15 - 118.0), good knowledge on impacts of pesticides (AOR=3.16, CI 1.09-9.13), determination of wind direction first and spray (AOR=2.25, CI 1.08-4.67), working experience of 20-29 years on farm (AOR=3.38, CI 1.05-10.83). CONCLUSIONS: One-sixth of the farmers reported health problems. Farmers working with hazardous Pesticides were in need of special attention in terms of safe handling, determing the wind direction and spray.

Respiratory Disorders among Dust Exposed Workers.

INTRODUCTION: Exposure to dusts and hard physical work is common in developing industrialized countries. Acute and chronic respiratory illnesses are highly been reported from jute and textile industry. This study was undertaken to explore status of respiratory health among the workers of jute and textile industries. METHODS: This descriptive cross-sectional study enrolled 315 workers from each of textile and jute industry of Eastern Nepal. Almost all the workers were selected from the textile industry whereas those from dust prone areas of jute industry. Workers were interviewed using pre-tested questionnaires. Measurement of height, weight and peak expiratory flow rate was done. RESULTS: Majority were non-smokers in both the industries 230 (73%) in Jute vs. 223 (70.8%) in Textile. Most of the workers had the working experience of less than five years; jute 134 (42.5%) vs. textile 180 (57.1%). Upper respiratory disorder was found in more than 1/5 of workers (68) in jute vs. 1/20 of workers (18) in textile industry. One and two workers suffered from chronic bronchitis in the jute and the textile industry respectively. Chest tightness was reported among 4 (1.3%) in jute vs. 17 (5.4%) in textile workers, cough symptoms among 86 (27.3%) in jute vs. 26 (8.3%) in textile industry. Low practice of personal protective measure was seen in both industries. The mean score of PEFR of workers in jute mill was lower than the workers in textile industry. CONCLUSIONS: Workers with acute respiratory disorders were more in the jute industry while chest tightness was more in the textile industry. Chronic respiratory problems did not appear to be alarming in both the industries. Use of personal protective measures should be promoted among the dust exposed workers.

"If you will counsel properly with love, they will listen": A qualitative analysis of leprosy affected patients' educational needs and caregiver perceptions in Nepal.

BACKGROUND: Leprosy remains a disease of concern in many countries including Nepal. To achieve the target of elimination, the WHO strategy promotes comprehensive education of patients, healthcare workers (HCWs), and the public on leprosy-related issues. However most educational programs are based on the concerns of HCWs and not on patients' needs. The objective of this paper is to explore the educational needs of leprosy affected patients in Nepal and compare them to the needs perceived by HCWs. METHODOLOGY/PRINCIPAL FINDINGS: Semi directive interviews were conducted with patients and HCWs. The data was analyzed using the basic interpretative qualitative framework. The study was conducted in two leprosy referral centers, one university hospital and one primary health care center: Lalgadh Leprosy Hospital and Services Centre, Anandaban Hospital and its satellite clinic in Patan, B. P. Koirala Institute of Health Sciences in Dharan, and the Itahari primary health care centre. The results show that there remains a lack of knowledge regarding the disease (origins, manifestations, prevention and treatment) contributing to late care seeking behavior and high levels of stigma, with an important psychological and financial stress for patients. All of the HCWs displayed a good understanding of patients' difficulties and needs and acknowledged the key role of patient education. However, they expressed several challenges in managing patients due to lack of time, human resources and training in patient education. CONCLUSIONS/SIGNIFICANCE: Further efforts need to be made to increase patients' general knowledge of the disease in order to motivate them to seek healthcare earlier and change their perception of the disease to reduce stigma. HCWs need proper training in patient education and counseling for them to acquire the necessary skills required to address the different educational needs of their patients. The use of lay and peer counselors would be an option to address the workload and lack of time expressed by HCWs.

Moving from formative research to co-creation of interventions: insights from a community health system project in Mozambique, Nepal and Peru.

Different methodological approaches for implementation research in global health focusing on how interventions are developed, implemented and evaluated are needed. In this paper, we detail the approach developed and implemented in the COmmunity HEalth System InnovatiON (COHESION) Project, a global health project aimed at strengthening health systems in Mozambique, Nepal and Peru. This project developed innovative formative research at policy, health system and community levels to gain a comprehensive understanding of the barriers, enablers, needs and lessons for the management of chronic disease using non-communicable and neglected tropical diseases as tracer conditions. After formative research, COHESION adopted a co-creation approach in the planning of interventions. The approach included two interactions with each type of stakeholder at policy, health system and community level in each country which aimed to develop interventions to improve the delivery of care of the tracer conditions. Diverse tools and methods were used in order to prioritise interventions based on support, resources and impact. Additionally, a COHESION score that assessed feasibility, sustainability and scaling up was used to select three potential interventions. Next steps for the COHESION Project are to further detail and develop the interventions propositioned through this process. Besides providing some useful tools and methods, this work also highlights the challenges and lessons learned from such an approach.

Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study.

OBJECTIVES: The study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal. METHODS: We conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health. RESULTS: Of 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71-282) and US$36 (19-61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector. CONCLUSION: Industrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered.

Health Literacy and Knowledge of Chronic Diseases in Nepal.

BACKGROUND: Understanding of risk factors and developing healthy lifestyles is a way of tackling the surging burden of chronic diseases in low-to-middle income countries such as Nepal. Health literacy (HL) has a pivotal role in prevention, adherence to treatment, self-care, and better use of health care; therefore, factors associated with HL need to be studied in the context of Nepal. OBJECTIVE: This study was conducted to assess the level of HL and explore disease-specific knowledge among patients with chronic diseases. METHODS: A cross-sectional study was conducted among 426 respondents with hypertension, diabetes mellitus, or chronic obstructive pulmonary disease from a tertiary care hospital and primary care clinics using face-to-face interviews. HL was measured using a translated and pretested HL questionnaire (the Europe-Asia Health Literacy Survey Questionnaire). Disease-related knowledge was assessed using a validated questionnaire. KEY RESULTS: The study found that 27% of the respondents had sufficient HL, 19% had marginal HL, and 54% had inadequate HL. Factors associated with inadequate HL included being older and female, and having lower or no education, unemployment or retired status, poverty, and having a history of smoking or a history of consuming alcohol. HL was a strong predictor of knowledge regarding hypertension (ß = 0.32; p < .05), diabetes mellitus (ß = 0.41; p < .05), and chronic obstructive pulmonary disease (ß = 0.37; p < .05) in multiple regression analyses after adjusting for age, gender, education, marriage, family history of disease, attendance at follow-up clinics at recommended intervals, information received regarding disease at clinics, smoking, and alcohol intake. CONCLUSIONS: A sufficient level of HL was uncommon among participants in our study. People with sufficient HL knew significantly more about their diseases or conditions than those with inadequate HL. [HLRP: Health Literacy Research and Practice. 2018;2(4):e221-e230.]. PLAIN LANGUAGE SUMMARY: Very little is known about health literacy in Nepal. We conducted a study to learn how much people in Nepal with hypertension, diabetes, or chronic obstructive pulmonary disease knew about their condition and sought to check its association with health literacy. We found that more than one-half of the participants did not have adequate health literacy levels. Participants who were older, female, uneducated, retired from work, or poor had lower levels of health literacy. We also found that those with high levels of health literacy had better knowledge of their disease. Therefore, we recommend that in Nepal health literacy should be measured for each patient and support regarding management of his or her condition should be provided if necessary.

Latrine coverage and its utilisation in a rural village of Eastern Nepal: a community-based cross-sectional study.

BACKGROUND: A little more than 1/3rd of the rural households in Nepal have improved latrine facility. The government of Nepal is working towards making an open defecation free area all over Nepal. There is no data found in literature searches regarding the status of latrines and its utilisation in Nepal. This study aims to estimate the coverage and utilisation of latrine and its associated factors in a rural community of Nepal. METHODS: We conducted a cross sectional study in March 2015-September 2015 among 625 households in Hattimuda Village, Morang district in Eastern Nepal using semi-structured pre-tested questionnaire with observational checklists. RESULTS: Out of 623 households, 473 (76.9%) have latrine facilities. There is an increase in latrine coverage in Hattimuda by 37% (38.9% in 2011 to 75.9% in 2016). Majority of the latrines (89.9%) were functional, however 32.3% needs maintenance. The extent of latrine utilisation among those households with a toilet at home was satisfactory (94.3%). Presence of child below 5 years of age at home (OR 2.37, 95% CI 0.05-0.46), functional latrine (OR 27.37, 95% CI 6.84-109.45), frequency of cleaning (OR 3.66, 95% CI 1.09-12.29) and latrine constructed with self-initiation (OR 4.21, 95% CI 1.06-16.66) are factors significantly associated with the utilisation of the latrine. CONCLUSIONS: While the coverage needs to be increased, appropriate interventions to increase the utilisation of latrine needs to be in place so that the village moves closer to open defecation free (ODF) status. As other studies are not found from Nepal, the findings from this study can be used a reference for other rural areas of Nepal.

Morbidity patterns among the welders of eastern Nepal: a cross-sectional study.

BACKGROUND: Welding process has many hazards that the welders are exposed to resulting in numbers of health effects and diseases. Safety measures and practices among welders are important ways of preventing or reducing the health hazards associated with this occupation. We conducted this study to find out the morbidity patterns among the welders working in eastern Nepal. METHODS: A cross sectional study was conducted among 300 welders using semi structured questionnaire. Morbidity categories were classified based on symptoms experienced in past 6 months. RESULTS: All the welders learned welding by apprenticeship, without any formal health and safety training. Injury was the most common problem at work followed by skin problems and eye symptoms. Age of the welders, duration of employment & welding hours per day were associated with the morbidities among the welders. CONCLUSIONS: There is a need for occupational health services for welders in Nepal. While further research may be required to make policy recommendations, the current study provides a baseline morbidity burden among these welders to look for interventions to promote health and safety at work for this neglected group of workers in Nepal.

Work-related injuries among farmers: a cross-sectional study from rural Nepal.

BACKGROUND: Agriculture work is one of the most hazardous occupations across countries of all income groups. In Nepal, 74 % of people are working in the agricultural sector. This study aims to identify patterns and factors associated with injuries among farmers of rural Nepal. METHODS: A community-based cross-sectional study was conducted in a rural village in eastern Nepal. House to house visit was done to collect data from the farmers. The study included 500 farmers from Shanishchare village in Morang district of Nepal. A pre-tested semi-structured questionnaire was used to collect data on socioeconomic profile, agriculture work and injury. Prevalence of injuries among farmers in the last 12 months was calculated along with factors associated with the injuries. RESULTS: The overall prevalence of work- related injuries among farmers was 69 % in the last 12 months. Common injuries among the farmers were cuts (79.7 %), puncture wound (11.3 %) and laceration (7.5 %). Hand tools were responsible for most of the injuries followed by slipping at work, sharp instruments, animals and fall from height. Upper limb injury comprised of 67 % of all injuries and the most involved part was fingers (43 %). The average number of years worked in farming by the respondents was 23.6 ± 13.6 years. Age and working experience of the farmers was found to be significantly associated with the occurrence of injuries among the farmers. CONCLUSIONS: The prevalence of injury among farmers in this study was high. Further research is needed to identify interventions to reduce the agricultural injuries in Nepal.

Awareness of occupational hazards and use of safety measures among welders: a cross-sectional study from Eastern Nepal.

OBJECTIVE: The proper use of safety measures by welders is an important way of preventing and/or reducing a variety of health hazards that they are exposed to during welding. There is a lack of knowledge about hazards and personal protective equipments (PPEs) and the use of PPE among the welders in Nepal is limited. We designed a study to assess welders' awareness of hazards and PPE, and the use of PPE among the welders of eastern Nepal and to find a possible correlation between awareness and use of PPE among them. MATERIALS AND METHODS: A cross-sectional study of 300 welders selected by simple random sampling from three districts of eastern Nepal was conducted using a semistructured questionnaire. Data regarding age, education level, duration of employment, awareness of hazards, safety measures and the actual use of safety measures were recorded. RESULTS: Overall, 272 (90.7%) welders were aware of at least one hazard of welding and a similar proportion of welders were aware of at least one PPE. However, only 47.7% used one or more types of PPE. Education and duration of employment were significantly associated with the awareness of hazards and of PPE and its use. The welders who reported using PPE during welding were two times more likely to have been aware of hazards (OR=2.52, 95% CI 1.09 to 5.81) and five times more likely to have been aware of PPE compared with the welders who did not report the use of PPE (OR=5.13, 95% CI 2.34 to 11.26). CONCLUSIONS: The welders using PPE were those who were aware of hazards and PPE. There is a gap between being aware of hazards and PPE (90%) and use of PPE (47%) at work. Further research is needed to identify the underlying factors leading to low utilisation of PPE despite the welders of eastern Nepal being knowledgeable of it.

Tobacco use and associated factors among adolescent students in Dharan, Eastern Nepal: a cross-sectional questionnaire survey.

INTRODUCTION: The tobacco use among the youth, in both smoking and smokeless forms, is quite high in the South East Asian region. Tobacco use is a major proven risk factor and contributes substantially to the rising epidemic of non-communicable diseases. OBJECTIVES: To estimate the prevalence of tobacco use and determine associated factors among adolescent students of Dharan municipality. DESIGN: Cross-sectional study. SETTING: Secondary and higher secondary schools of Dharan municipality in Sunsari district of Nepal. PARTICIPANTS: Students in middle (14-15 years) and late adolescence (16-19 years) from grades 9, 10, 11 and 12 were included. PRIMARY OUTCOME MEASURE: Ever tobacco use which was defined as one who had not used any form of tobacco in the past 1 month but had tried in the past. METHODOLOGY: Self-administered questionnaire adapted from Global Youth Tobacco Survey was used to assess tobacco use among the representative sample of 1312 adolescent students selected by stratified random sampling from July 2011 to July 2012. RESULTS: Out of 1454 students, 1312 students completed the questionnaires with a response rate of 90.23%. Prevalence of ever use of any tobacco product was 19.7% (95% CI 17.7 to 21.6). More than half of the tobacco users (51.9%) consumed tobacco in public places whereas almost a third (75.6%) of the consumers purchased tobacco from shops. Multivariate analysis showed that tobacco use was associated with late adolescence (OR: 1.64; 95% CI 1.17 to 2.28), male gender (OR: 12.20; 95% CI 7.78 to 19.14), type of school (OR=1.72; 95% CI 1.01 to 2.94), Janajati ethnicity (OR: 2.05; 95% CI 1.39 to 3.01) and receiving pocket money ≥Nepalese rupees 500/month (OR: 1.45; 95% CI 1.04 to 2.03). CONCLUSIONS: Tobacco-focused interventions are required for school/college going students to promote cessation among users and prevent initiation, focussing on late adolescence, male gender, government schools, Janajati ethnicity and higher amount of pocket money.