Background The World Health Organization (WHO) recommends ongoing surveillance of non-communicable diseases (NCDs) and their risk factors, using the WHO STEPwise approach to surveillance (STEPS). The aim of this study was to assess the distribution and determinants of NCD risk factors in Nepal, a low-income country, in which two-thirds (66%) of annual deaths are attributable to NCDs. Methods A nationally representative NCD risk factors STEPS survey (instrument version 3.2), was conducted between February and May 2019, among 6,475 eligible participants of age 15–69 years sampled from all 7 provinces through multistage sampling process. Data collection involved assessment of behavioral and biochemical risk factors. Complex survey analysis was completed in STATA 15, along with Poisson regression modelling to examine associations between covariates and risk factor prevalence. Results The most prevalent risk factor was consumption of less than five servings of fruit and vegetables a day (97%; 95% CI: 94.3–98.0). Out of total participants, 17% (95% CI: 15.1–19.1) were current smoker, 6.8% (95% CI: 5.3–8.2) were consuming ≥60g/month alcohol per month and 7.4% (95% CI:5.7–10.1) were having low level of physical activity. Approximately, 24.3% (95% CI: 21.6–27.2) were overweight or obese (BMI≥25kg/m2) while 24.5% (95% CI: 22.4–26.7) and 5.8% (95% CI: 4.3–7.3) had raised blood pressure (BP) and raised blood glucose respectively. Similarly, the prevalence of raised total cholesterol was 11% (95% CI: 9.6–12.6). Sex and education level of participants were statistically associated with smoking, harmful alcohol use and raised BP. Participants of age 30–44 years and 45–69 years were found to have increased risk of overweight, raised BP, raised blood sugar and raised blood cholesterol. Similarly, participants in richest wealth quintile had higher odds of insufficient physical inactivity, overweight and raised blood cholesterol. On average, each participant had 2 NCD related risk factors (2.04, 95% CI: 2.02–2.08). Conclusion A large portion of the Nepalese population are living with a variety of NCD risk factors. These surveillance data should be used to support and monitor province specific NCD prevention and control interventions throughout Nepal, supported by a multi-sectoral national coordination mechanism.

Background Bullying is an emerging risk factor for poor mental health outcomes adversely affecting children and adolescents. However, it has rarely caught the attention of the health and education sector due to lack of evidence in many countries including Nepal. This study aimed to assess the prevalence and factors associated with bullying behavior among adolescent students in Nepal. Methods We used nationally representative data from the Nepal Global School-Based Student Health Survey that involved two-stage cluster sampling design with the use of a standard set of self-administered questionnaires. Complex sample analysis was done to determine the prevalence and correlates of bullying among 6529 students of 68 schools studying in grade 7 to 11 using descriptive analysis and multivariable logistic regression. Results The overall prevalence of bullying among Nepalese school adolescents was 51% (55.67% in male and 46.17% in female). Bullied adolescents more commonly reported mental health problems with higher risk of loneliness (

Background Globally violence is a matter of public health concern with severe physical and mental health implications and social consequences. Evidence suggest that adolescents have an elevated risk of exposure to physical and sexual violence. However, there is a lack of nationally representative research on violence and its associated factors in Nepal to inform interventions. This paper attempts to find the factors associated with various forms of physical and sexual violence among school-going adolescents in Nepal. Methods We analysed the cross-sectional data from the Global School-based Student Health Survey (GSHS) 2015. The GSHS survey applied a two-stage cluster sampling process to select a representative sample of 7 to 11 grade students from 74 schools across the country. We applied logistic regression analysis to identify the factors associated with physical and sexual violence. Results Out of the total 6,529 participants, 45.24% of them faced a physical attack, 39.25% were involved in a physical fight, and 11.65% were victims of sexual violence in the survey administered between 7 August 2015 to 14 March 2016. In a multiple regression analysis, the age of participants, parental supervision, feeling unsafe at school, and the number of close friends were found to be associated with a physical attack. Participants who were bullied, had multiple sex partners, and had received corporal punishment in school had a higher engagement in a physical fight. Likewise, school grade, having parents who understand the problems, having multiple sex partners, and corporal punishment at school were associated with instances of sexual violence. Conclusion The study identified multiple factors associated with experiences of physical attacks, involvement in a physical fight, and sexual violence among school-going adolescents. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions. Since various forms of violence share some common risk factors, a comprehensive strategy could be worth considering to prevent such acts of violence.

Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

Background : Bullying is an emerging risk factor for poor mental health outcomes adversely affecting children and adolescents. However, it has rarely caught the attention of the health and education sector due to lack of evidence in many countries including Nepal. The aim of this study was to assess the prevalence and factors associated with bullying behavior among adolescent students in Nepal.Methods : We used nationally representative data from the Nepal Global School-Based Student Health Survey that involved two-stage cluster sampling design with the use of a standard set of self-administered questionnaires. Complex sample analysis was done to determine the prevalence and correlates of bullying among 6529 students of 68 schools studying in grade 7 to 11 using descriptive analysis and multivariable logistic regression.Results : The overall prevalence of bullying among Nepalese school adolescents was 51% (55.7% in male and 46.1% in female). Bullied adolescents more commonly reported mental health problems with higher risk of loneliness (aOR 1.39, 95% CI: 1.14, 1.69), anxiety (aOR 1.97, 95% CI: 1.57, 2.47), suicide attempt (aOR 1.99, 95% CI: 1.48, 2.67), school absenteeism due to fear (aOR 1.72, 95% CI: 1.36, 2.19) and school truancy (aOR 1.43, 95% CI: 1.14, 1.79). A significant association was seen between bullying victimization and negative health behaviors like involvement in physical fights (aOR 3.70, 95% CI: 3.00, 4.56) and tobacco use (aOR 1.99, 95% CI: 1.09, 3.61).Conclusion: School bullying is significantly associated with mental health factors like loneliness, anxiety, suicide attempt, school absenteeism and risky behavioral factors like smokeless tobacco use and involvement in physical fight. The insights provided by these findings have important implications for planning anti-bullying strategies in school settings in the Nepalese context.