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1.  Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community 
Global Health Action  2014;7:10.3402/gha.v7.24023.
Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice.
This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients’ viewpoint.
We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories.
Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness.
This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community's cardiovascular health literacy and preventive practices.
PMCID: PMC4007028  PMID: 24802386
cardiovascular disease; health behavior; health promotion; Nepal; perceptions; qualitative research
2.  Physical activity level and its sociodemographic correlates in a peri-urban Nepalese population: a cross-sectional study from the Jhaukhel-Duwakot health demographic surveillance site 
Physical inactivity is a leading risk factor for cardiovascular and other noncommunicable diseases in high-, low- and middle-income countries. Nepal, a low-income country in South Asia, is undergoing an epidemiological transition. Although the reported national prevalence of physical inactivity is relatively low, studies in urban and peri-urban localities have always shown higher prevalence. Therefore, this study aimed to measure physical activity in three domains—work, travel and leisure—in a peri-urban community and assess its variations across different sociodemographic correlates.
Adult participants (n = 640) from six randomly selected wards of the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) near Kathmandu responded to the Global Physical Activity Questionnaire. To determine total physical activity, we calculated the metabolic equivalent of task in minutes/week for each domain and combined the results. Respondents were categorized into high, moderate or low physical activity. We also calculated the odds ratio for low physical activity in various sociodemographic variables and self-reported cardiometabolic states.
The urbanizing JD-HDSS community showed a high prevalence of low physical activity (43.3%; 95% CI 39.4–47.1). Work-related activity contributed most to total physical activity. Furthermore, women and housewives and older, more educated and self-or government-employed respondents showed a greater prevalence of physical inactivity. Respondents with hypertension, diabetes or overweight/obesity reported less physical activity than individuals without those conditions. Only 5% of respondents identified physical inactivity as a cardiovascular risk factor.
Our findings reveal a high burden of physical inactivity in a peri-urban community of Nepal. Improving the level of physical activity involves sensitizing people to its importance through appropriate multi-sector strategies that provide encouragement across all sociodemographic groups.
PMCID: PMC3984675  PMID: 24628997
Cardiovascular disease; Ethnicity; Occupation; Smoking; Hypertension; Diabetes
3.  Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site 
BMJ Open  2013;3(10):e002976.
This study determined the knowledge, attitude and practice/behaviour of cardiovascular health in residents of a semiurban community of Nepal.
To increase the understanding of knowledge, attitude and practice/behaviour towards cardiovascular health, we conducted in-home interviews using a questionnaire based on the WHO STEPwise approach to surveillance and other resources, scoring all responses. We also recorded blood pressure and took anthropometric measurements.
Our study was conducted as part of the Heart-Health-Associated Research and Dissemination in the Community project in the Jhaukhel-Duwakot Health Demographic Surveillance Site in two urbanising villages near Kathmandu.
The study population included 777 respondents from six randomly selected clusters in both villages.
Seventy per cent of all participants were women and 26.9% lacked formal education. The burden of cardiovascular risk factors was high; 20.1% were current smokers, 43.3% exhibited low physical activity and 21.6% were hypertensive. Participants showed only poor knowledge of heart disease causes; 29.7% identified hypertension and 11% identified overweight and physical activity as causes, whereas only 2.2% identified high blood sugar as causative. Around 60% of respondents did not know any heart attack symptoms compared with 20% who knew 2–4 symptoms. Median percentage scores for knowledge, attitude and practice/behaviour were 79.3, 74.3 and 48, respectively. Nearly 44% of respondents had insufficient knowledge and less than 20% had highly satisfactory knowledge. Among those with highly satisfactory knowledge, only 14.7% had a highly satisfactory attitude and 19.5% and 13.9% had satisfactory and highly satisfactory practices, respectively.
Our study demonstrates a gap between cardiovascular health knowledge, attitude and practice/behaviour in a semiurban community in a low-income nation, even among those already affected by cardiovascular disease.
PMCID: PMC3808775  PMID: 24157816
Public Health; Preventive Medicine; Epidemiology
4.  Establishing a health demographic surveillance site in Bhaktapur district, Nepal: initial experiences and findings 
BMC Research Notes  2012;5:489.
A health demographic surveillance system (HDSS) provides longitudinal data regarding health and demography in countries with coverage error and poor quality data on vital registration systems due to lack of public awareness, inadequate legal basis and limited use of data in health planning. The health system in Nepal, a low-income country, does not focus primarily on health registration, and does not conduct regular health data collection. This study aimed to initiate and establish the first HDSS in Nepal.
We conducted a baseline survey in Jhaukhel and Duwakot, two villages in Bhaktapur district. The study surveyed 2,712 households comprising a total population of 13,669. The sex ratio in the study area was 101 males per 100 females and the average household size was 5. The crude birth and death rates were 9.7 and 3.9/1,000 population/year, respectively. About 11% of births occurred at home, and we found no mortality in infants and children less than 5 years of age. Various health problems were found commonly and some of them include respiratory problems (41.9%); headache, vertigo and dizziness (16.7%); bone and joint pain (14.4%); gastrointestinal problems (13.9%); heart disease, including hypertension (8.8%); accidents and injuries (2.9%); and diabetes mellitus (2.6%). The prevalence of non-communicable disease (NCD) was 4.3% (95% CI: 3.83; 4.86) among individuals older than 30 years. Age-adjusted odds ratios showed that risk factors, such as sex, ethnic group, occupation and education, associated with NCD.
Our baseline survey demonstrated that it is possible to collect accurate and reliable data in a village setting in Nepal, and this study successfully established an HDSS site. We determined that both maternal and child health are better in the surveillance site compared to the entire country. Risk factors associated with NCDs dominated morbidity and mortality patterns.
PMCID: PMC3494612  PMID: 22950751
5.  Prevalence of hypertension in Nepalese community triples in 25 years: a repeat cross-sectional study in rural Kathmandu 
Indian Heart Journal  2012;64(2):128-131.
The objective of the study was to examine if there has been any change in the prevalence of hypertension (HTN) in the Nepalese population in the last two and half decades.
A population-based cross-sectional study was done in Bhadrabas village area of Kathmandu valley to estimate the prevalence of HTN and the findings were compared to the study done in the same location 25 years ago.
The study shows that there has been a three-fold increment in the prevalence of HTN in the same location. The major causes behind this increment appear to be increased salt intake and increased body mass index (BMI).
This is the first repeat cross-sectional study on blood pressure (BP) in a Nepalese population. There is a very high prevalence as well as a sharp rise in HTN prevalence in this society largely because of changing lifestyle which is most likely because of socio-economic transition.
PMCID: PMC3861166  PMID: 22572484
Hypertension; Kathmandu; Repeat cross-sectional
6.  Obesity Prevalence in Nepal: Public Health Challenges in a Low-Income Nation during an Alarming Worldwide Trend 
The future toll of the obesity epidemic will likely hit hardest in low- and middle-income countries. Ongoing urbanization promotes risk factors including sedentary lifestyle and fat- and sugar-laden diets. Low-income countries like Nepal experience a double disease burden: infectious diseases as well as rising incidence of noncommunicable diseases (e.g., cardiovascular disease and diabetes mellitus) frequently characterized by obesity. Nepal currently directs efforts towards curing disease but pays little attention to preventive actions. This article highlights obesity prevalence in Nepal, delineates the challenges identified by our pilot study (including low health literacy rates), and suggests strategies to overcome this trend.
PMCID: PMC2905575  PMID: 20644698
obesity; Nepal; epidemic; diabetes; cardiovascular disease

Results 1-6 (6)