Background: Though cardiovascular diseases are mostly seen in adulthood, foundation of diet and physical activity is largely formed during childhood. The study aimed to explore children's preference for diet and physical activity in a peri-urban area of Nepal because this is an important dimension to explore in the life-course approach to combat non-communicable diseases. Methods:We conducted a cross-sectional study to enquire young peri-urban children of Duwakot and Jhaukhel villages of Bhaktapur district, Nepal on their preferences for diet and physical activity. All eligible households with children in the age range 5-10 years as enlisted from the Jhaukhel-Duwakot Health Demographic Surveillance Site database were selected for the study. Twelve enumerators visited the selected households and facilitated the eligible children to fill in the questionnaire. We used a child-friendly photo-assisted questionnaire with face-scales that easily enabled the children to select a particular preference for each of the food item and physical activity. During analysis, food items were categorized into 'green', 'yellow' and 'red' on the basis of their nutritive values. Physical activity was categorized based on severity of the activity.Results: Four hundred and thirty seven children filled up the questionnaires. Overall, median preference scores for 'red' food were higher than for healthier 'green' food (4.16 vs. 4.03), particularly, if mothers were self-employed. Likewise, the children preferred low over moderate-to-severe physical activity (4.16 vs. 3.50), and preference was affected by parents' occupation and income. Conclusions:The study objectively revealed that most of the children preferred unhealthier food-items and low physical activities. It shall be useful to consider these findings while planning health promotional activities targeted at them.
Background: Prehypertension is clinically defi ned as a level of blood pressure between normal and hypertension, i.e. elevated systolic blood pressure between120-139 or diastolic blood pressure between 80-89 mm Hg. Prehypertension remains neglectedas a public health problem, and has not been explored in mothers with small childrenin Nepal. Objectives: We aimed to study prehypertensionand its related factors including obesity-related parameters among mothers with children aged 1-7 years in Duwakot and Jhaukhel communities of Bhaktapur district, Nepal. Methods: We prepared a sampling frame of all the eligible mothers, and interviewed 962 mothers. The trained enumerators also measured their blood pressure, body weight, height, waist and hip circumferences.We analysed data with SPSS version 22. We received ethical approval from the Nepal Health Research Council to conduct the study, and obtained informed verbal consent from the participating mothers. Results: About one-third (31.8%) of the mothers had prehypertension. It was more common among Newars and those aged 30-34 years. Multivariate analysis did not reveal signifi cant association with sociodemographic variables except for education. We found positive correlations between blood pressure and obesity parameters.Overweight and obese participants were 2.24 (95% confi dence interval: 1.06-4.73) and 4.65 (95% confi dence interval: 1.92-11.23) times, respectively, more likely to have prehypertension than underweight mothers. Conclusions: Our study demonstrated a high prevalence of prehypertension, coupled with high obesity parameters, among young mothers of peri-urban Nepal. Primordial preventive efforts at community level are needed not only for the mothers themselves, but for heart-health of their offspring as well.
BackgroundDespite a high burden, there is limited training available in non-communicable disease research in Nepal. In order to understand research capacity gap in non-communicable diseases in the country, we conducted a needs assessment. We aimed to assess existing research training capacity in academic health institutions of Nepal for the prevention and control of non-communicable diseases, identify gaps in research training in these institutions, and explore the feasibility of developing research training program in Nepal targeting non-communicable diseases and their risk factors. MethodsWe did qualitative and quantitative research and reviewed academic institution curricula review and scientific literature. We conducted 14 Focus Group Discussions with bachelor and Masters level students of public health and community medicine; 25 In-depth Interviews with department heads and faculties, and government stakeholders. We surveyed medical and public health students on their research knowledge and skills development. Further, we reviewed university curricula of bachelors in medicine and public health Masters in community medicine and public health. We also reviewed non-communicable disease related scientific articles authored by Nepali researchers. ResultsWe found that the research methodology component was addressed differently across academic programs. One-third (33.7%) of students expressed lack of skills for analysis and interpretation of data. They felt that there is a wide scope and career-interest in non-communicable diseases research in Nepal. However, specific objectives in the curriculum and practical aspects regarding non-communicable diseases were lacking. Most of the non-communicable diseases research in Nepal are prevalence studies. Most of the studies did not have any financial support. Lack of funding, conflicting priorities with curative services, and inadequate training for advanced research tools were reported as major barriers. Likewise, availability of trained human resources and international funding for non-communicable diseases research were perceived facilitators.ConclusionsNepal must strengthen the whole spectrum of research capacity: epidemiological skills, research management, and fund generation. University curricula should match up with the disease burden and must emphasize on applied practical research projects. Generation of a critical mass of non-communicable disease researchers must go together with improved funding from the government, non-governmental organizations, and external funding organizations.
Behavioral risk factors, particularly the major four- tobacco consumption, harmful use of alcohol, unhealthy diet and physical inactivity- are accountable for a major proportion of cardiovascular disease burden. Driven by urbanization and globalization, these risk factors are rising in many of the low- income countries including Nepal. Population-based surveys and hospital reports indicate cardiovascular diseases are rising in Nepal. The first countrywide WHO-STEPS risk factor survey conducted in 2007-2008 showed that 23.8% are daily smokers, 28.5% are current drinkers, and 61.9% consumed less than five servings of fruits and vegetables, while 5.5% had low physical activity. Risk factors are generally more prevalent in urban areas than rural. We aimed to study the status of these behavioural risk factors in a community that is rapidly undergoing transition from a village to an urban community. We conducted the study in Duwakot and Jhaukhel, two urbanizing villages 13 kilometers from the capital Kathmandu. Six clusters were randomly selected. Altogether 777 adults aged 25-59 years consented to participate. Questions were based on the WHO-STEPS survey. Current smokers included those who affirmed to the question ‘Do you smoke?’ Current drinkers had ‘consumed alcohol in the previous one month’. Inadequate fruit and vegetable intake indicated those who were taking less than five servings of combined fruit and vegetable in a day. Physical activity was subjectively measured by asking about the respondent’s activities at work, travel and leisure. Having low physical activity meant not meeting any of the GPAQ (Global Physical Activity Questionnaire) criteria of adequate physical activity. Prevalence of the four major behavioral risk factors was high in the community. Addictive behavioural risk factors were particularly higher in the males than in the females: current smoking (33.5% vs. 14.7%), current smokeless tobacco consumption (20.2% vs. 3.3%), and current alcohol drinking (34.5 % vs. 12.6%). Only 2% of the study population fulfilled the recommended minimum five servings of fruits and vegetables. Low physical activity was present in 43.3% of the respondents, with a higher prevalence seen among the females, elderly, more educated and those on non-agro works. In conclusion, there is particularly high physical inactivity and low fruit and vegetable intake in the community indicating negative effects of urbanization such as changing dietary habit and escalating sedentary lifestyle. Because the community is still beginning to urbanize, it is important that timely population-based health promotional strategies and favourable environmental modifications are implemented to counteract the effects of urbanization.
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