BackgroundNearly four-fifths of estimated 1.1 million smokers live in low or middle-income countries. We aimed to provide national estimates for Nepal on tobacco use prevalence, its distribution across demographic, socio-economic and spatial variables and correlates of tobacco use.MethodsA secondary data analysis of 2006 Nepal Demographic and Health Survey (DHS) was done. A representative sample of 9,036 households was selected by two-stage stratified, probability proportional to size (PPS) technique. We constructed three outcome variables 'tobacco smoke', 'tobacco chewer' and 'any tobacco use' based on four questions about tobacco use that were asked in DHS questionnaires. Socio-economic, demographic and spatial predictor variables were used. We computed overall prevalence for 'tobacco smoking', 'tobacco chewing' and 'any tobacco use' i.e. point estimates of prevalence rates, 95% confidence intervals (CIs) after adjustment for strata and clustering at primary sampling unit (PSU) level. For correlates of tobacco use, we used multivariate analysis to calculate adjusted odds ratios (AORs) and their 95% CIs. A p-value < 0.05 was considered as significant.ResultsTotal number of households, eligible women and men interviewed was 8707, 10793 and 4397 respectively. The overall prevalence for 'any tobacco use', 'tobacco smoking' and 'tobacco chewing' were 30.3% (95% CI 28.9, 31.7), 20.7% (95% CI 19.5, 22.0) and 14.6% (95% CI 13.5, 15.7) respectively. Prevalence among men was significantly higher than women for 'any tobacco use' (56.5% versus 19.6%), 'tobacco smoking' (32.8% versus 15.8%) and 'tobacco chewing' (38.0% versus 5.0%). By multivariate analysis, older adults, men, lesser educated and those with lower wealth quintiles were more likely to be using all forms of tobacco. Divorced, separated, and widowed were more likely to smoke (OR 1.49, 95% CI 1.14, 1.94) and chew tobacco (OR 1.36, 95% CI 0.97, 1.93) as compared to those who were currently married. Prevalence of 'tobacco chewing' was higher in eastern region (19.7%) and terai/plains (16.2%). 'Tobacco smoking' and 'any tobacco use' were higher in rural areas, mid-western and far western and mountainous areas.ConclusionsPrevalence of tobacco use is considerably high among Nepalese people. Demographic and socioeconomic determinants and spatial distribution should be considered while planning tobacco control interventions.

IntroductionHealth professionals play an important role in providing advice to their patients about tobacco prevention and cessation. Health professionals who use tobacco may be deterred from providing cessation advice and counselling to their patients. We aimed to provide prevalence estimates of tobacco use among student health professionals and describe their attitudes towards tobacco cessation training.MethodsCountry-wise aggregate data from the Global Health Professions Student Survey on ‘current cigarette smoking’ (smoking cigarettes on 1 or more days during the past 30 days), and ‘current use of tobacco products other than cigarettes’ (chewing tobacco, snuff, bidis, cigars or pipes, 1 or more days during the past 30 days) were analysed. For each WHO region, we estimated mean prevalence rates of tobacco use weighted by the population of the sampling frame and aggregate proportions for ‘health professionals’ role’ and ‘cessation training’ indicators using ‘metaprop’ command on Stata V.11.ResultsA total of 107 527 student health professionals participated in 236 surveys done in four health profession disciplines spanning 70 countries with response rates ranging from 40% to 100%. Overall, prevalence of smoking was highest in European countries (20% medical and 40% dental students) and the Americas (13% pharmacy to 23% dental students). Other tobacco use was higher in eastern Mediterranean (10%–23%) and European countries (7%–13%). In most WHO regions, ≥70% of the students agreed that health professionals are role models, and have a role in advising about smoking cessation to their patients and the public. Only ≤33% of all student health professionals in most WHO regions (except 80% dental students in the Eastern Mediterranean region) had received formal training on smoking cessation approaches and ≥80% of all students agreed that they should receive formal cessation training.ConclusionsTobacco control should take place together with medical educators to discourage tobacco use among student health professionals and implement an integrated smoking cessation training into health professions’ curricula.

Objective: To examine the association between household food insecurity score and Z-scores of childhood nutritional status indicators. Design: Population-based, cross-sectional survey, Nepal Demographic and Health Survey 2011. Setting: A nationally representative sample of 11 085 households selected by a two-stage, stratified cluster sampling design to interview eligible men and women. Subjects: Children (n 2591) aged 0-60 months in a sub-sample of households selected for men's interview. Results: Prevalence of moderate and severe household food insecurity was 23·2 % and 19·0 %, respectively, for children aged 0-60 months. Weighted prevalence rates for stunting (height-for-age Z-score (HAZ) <−2), wasting (weight-for-height Z-score (WHZ) <−2) and underweight (weight-for-age Z-score (WAZ) <−2) were 41·6 % (95 % CI 38·9, 44·3 %), 11·5 % (95 % CI 9·8, 13·2 %) and 30·1 % (95 % CI 27·5, 32·8 %), respectively. Prevalences of stunting, severe stunting (HAZ <−3) and underweight by level of household food insecurity were statistically significant (P < 0·001). By multiple linear regression analyses and after adjustment for sociodemographic, child and environmental factors, household food access insecurity score was associated with HAZ (β = − 0·02, P = 0·01) and WAZ (β = − 0·01, P = 0·01) but was not associated with WHZ and BMI-for-age Z-score. A 10-point increase in household food access insecurity score was associated with a decrease in HAZ of 0·2 (95 % CI 0·05, 0·39) and decrease in WAZ of 0·1 (95 % CI 0·03, 0·27). Conclusions: Our results from a nationally representative sample confirm the previously reported association of household food insecurity with stunting and underweight. Community nutrition interventions may use household food insecurity scales for identifying those households where children may be at risk of growth faltering.

BackgroundFood insecurity is a very common problem in developing countries particularly among the poorer households. Very few studies have tested the association between adult smoking and food insecurity.MethodsWe analysed the data from a nationally representative sample of 10,826 households in which women and men (in a sub sample of 4121 households) aged 15-49 years were interviewed in Nepal Demographic and Health Survey 2011. Data from households in which both men and women were interviewed were analysed for association of household food insecurity access score (HFIAS), with tobacco use among men and women, socio-demographic and spatial factors. Univariate comparisons followed by zero-inflated negative binomial regression analyses were done to determine the association between HFIAS and individual, household and spatial factors.ResultsMean HFIAS score was 3.5 (SD, 4.6) whereas the median was 0 (IQR 0-6). Prevalence of tobacco use among men and women was 50.2% (95% CIs 47.9, 52.6), and 17.3% (95% CIs 15.7, 18.9). HFIAS scores were significantly higher among households where men used tobacco (4.96), and men either smoked or use SLT (3.82) as compared to those without tobacco users (2.79). HFIAS scores were not significantly different by tobacco use status of women. HFIAS score was highest in the poorest households and vice versa. After adjusting for covariates association between HFIAS score and male tobacco use remained significant but effect size decreased when covariates were included into regression models (adjusted OR 1.11). HFIAS score was also associated wealth index (adjusted OR 0.86-0.62) and ecological region (adjusted OR 1.33) and development regions (adjusted OR 1.10-1.21).ConclusionTobacco users in poor(er) households should be encouraged to ‘quit’ their habit. Less affluent sectors of the population also need to be educated about the non-health benefits of quitting, such as improved economic status and reduced food insecurity.

BackgroundChanging epidemiology and diagnostic difficulties of paediatric tuberculosis (TB) are being increasingly reported. Our aim was to describe clinico-epidemiological profile and diagnostic procedures used for paediatric TB.MethodsA retrospective case-series analysis was carried out in a tertiary care teaching hospital of western Nepal. All pediatric TB (age 0-14 years) patients registered in DOTS clinic during the time period from March, 2003 to July, 2008 were included. Medical case files were reviewed for information on demography, clinical findings, investigations and final diagnosis. Analysis was done on SPSS package. Results were expressed as rates and proportions. Chi square test was used to test for statistical significance.ResultsAbout 17.2% (162/941) of TB patients were children. Common symptoms were cough, fever and lymph node swelling. The types of TB were pulmonary TB (46.3%, 75/162), followed by extra-pulmonary TB (41.4%, 67/162). Twelve patients (7.4%) had disseminated TB. Distribution of types of TB according to gender was similar. PTB was common in younger age than EPTB which was statistically significant. EPTB was mainly localized to lymph node (38, 50.7%), and abdomen (9, 12%). Five main investigations namely Mantoux test, BCG test, chest radiograph, erythrocyte sedimentation rate (ESR) and fine needle aspiration cytology (FNAC) or biopsy were carried out to diagnose TB.ConclusionsPaediatric TB in both pulmonary and extrapulmonary forms is a common occurrence in our setting. Age incidence according to type of TB was significant. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations.