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Parajuli R, Dhakal P, Thapa S, Ghimire TR, Parajuli RP. Prevalence and contributing factors of intestinal parasitic infections among school children with malnutrition in Hetauda, Nepal: A cross-sectional study. Health Sci Rep 2024; 7:e2146. [PMID: 38812713 PMCID: PMC11130544 DOI: 10.1002/hsr2.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/04/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
Background and Aims With existing undernutrition in the developing world, the prevalence of obesity is increasing rapidly. Some studies reported an association of intestinal parasitic infection (IPIs) with undernutrition while few recent studies reported an inverse association of IPIs with overweight and obesity. This study evaluated the comparative risk and associated factors of IPIs among under (body mass index [BMI] < 18.5), normal (BMI: 18.5-24.9) and overweight (BMI > 24.9) school-aged adolescents. Methods A total of 105 fecal samples were collected, with 35 samples from each group. The collected samples were tested for the presence of intestinal parasites via concentration method, and the parasites were identified morphologically. Results Overall prevalence of IPIs was 5.71% with 3 protozoa viz Giardia lamblia (2.86%), Entamoeba histolytica (1.90%) and Endolimax nana (0.95%). Univariate and multivariable regression analysis indicated none of the nutritional, socioeconomic status, demographic, lifestyle and behavioral characteristics were significantly associated with the prevalence of overall IPIs. Yet, significant numbers of male reported undernutrition and elevated risk of IPIs in this study population. Conclusion Despite low prevalence of IPIs in this study, risk of IPIs is attributable to individual differences in behavior like "not using soap for hand washing". Relatively elevated malnutrition with risky hygiene behaviors, male adolescents appeared as risky cluster of school age population.
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Affiliation(s)
| | - Pitambar Dhakal
- Central Department of ZoologyTribhuvan UniversityKirtipurNepal
| | - Sandeep Thapa
- Kathmandu Center for Genomics and Research Laboratory (KCGRL)GwarkoNepal
| | - Tirth Raj Ghimire
- Department of Zoology, Tri‐Chandra CampusTribhuvan UniversityKirtipurNepal
| | - Rajendra Prasad Parajuli
- Central Department of ZoologyTribhuvan UniversityKirtipurNepal
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San Diego (UCSD)CaliforniaUSA
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Aly M, Ishihara T, Torii S, Kamijo K. Being underweight, academic performance and cognitive control in undergraduate women. Arch Womens Ment Health 2024; 27:249-258. [PMID: 38082003 DOI: 10.1007/s00737-023-01410-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 03/13/2024]
Abstract
The prevalence of underweight among young women is a serious international health issue. However, the evidence on how being underweight negatively affects brain health and cognition is still unclear. This study investigated the association between underweight status, academic performance, and neurocognitive control in young Japanese women using a cross-sectional design. We analyzed the academic performance of female undergraduates, comparing underweight and healthy-weight groups (n = 43; age 18-23 years, M = 21.1, SD = 1.3) based on their grade point average (GPA). We also analyzed their error-related negativity (ERN), an electrophysiological measure that potentially reflects academic performance, during an arrowhead version of the flanker task to assess cognitive control of action monitoring. Participants with a low body mass index were found to have lower GPAs. Furthermore, the underweight students exhibited smaller ERN amplitudes, which indicates decreased cognitive control in action monitoring. These findings suggest that a healthy weight status is essential for effective cognitive functioning and academic success in young adult women, among whom being underweight is a serious health problem.
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Affiliation(s)
- Mohamed Aly
- Faculty of Liberal Arts and Sciences, Chukyo University, Nagoya, Japan
- Department of Educational Sciences and Sports Psychology, Faculty of Physical Education, Assiut University, Assiut, Egypt
| | - Toru Ishihara
- Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Keita Kamijo
- Faculty of Liberal Arts and Sciences, Chukyo University, Nagoya, Japan.
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Seifu BL, Mare KU, Legesse BT, Tebeje TM. Double burden of malnutrition and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel multinomial logistic regression analysis. BMJ Open 2024; 14:e073447. [PMID: 38341217 PMCID: PMC10862289 DOI: 10.1136/bmjopen-2023-073447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Globally, malnutrition among women of reproductive age is on the rise and significantly contributing to non-communicable disease, deaths and disability. Even though the double burden of malnutrition (DBM) is a common problem among women in sub-Saharan Africa (SSA), there are limited studies examining the factors contributing to underweight, overweight, and obesity at the SSA level. OBJECTIVE To determine the factors associated with the DBM, and their relative magnitude, among women of reproductive age in SSA. DESIGN Cross-sectional study design. SETTING 33 SSA countries. PARTICIPANTS 240 414 women of reproductive age. PRIMARY AND SECONDARY OUTCOME MEASURES A multilevel multinomial logistic regression model was applied to identify factors associated with malnutrition. The adjusted relative risk ratio with 95% CI was used to declare the statistical significance of the association. RESULTS The pooled prevalence of underweight, overweight and obesity among women in SSA were 8.87%, 16.47% and 6.10%, respectively. Women who are from rural residence and smoke cigarettes were more likely to be underweight. Conversely, women between the age of 24-34 and 35-49, who have higher education, belong to a middle and rich household, are ever married, have high parity, use contraceptives, have media exposure and smoke cigarettes were more likely to be overweight and/or obese. CONCLUSION The findings of our study suggest that certain factors such as residence, education status, wealth, marital status, occupation, cigarette smoking, and contraceptive use have a significant assocation with malnutrition among women. Therefore, it is important for public health programs aimed at preventing the double burden of malnutrition to focus on these factors through comprehensive public awareness and cost-effective operational health interventions.
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Affiliation(s)
- Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of health sciences and Medicine, Dilla University, Dilla, Ethiopia
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Turjo EA, Rahman MH. Assessing risk factors for malnutrition among women in Bangladesh and forecasting malnutrition using machine learning approaches. BMC Nutr 2024; 10:22. [PMID: 38303093 PMCID: PMC10832135 DOI: 10.1186/s40795-023-00808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND This paper presents an in-depth examination of malnutrition in women in Bangladesh. Malnutrition in women is a major public health issue related to different diseases and has negative repercussions for children, such as premature birth, decreased infection resistance, and an increased risk of death. Moreover, malnutrition is a severe problem in Bangladesh. Data from the Bangladesh Demographic Health Survey (BDHS) conducted in 2017-18 was used to identify risk factors for malnourished women and to create a machine learning-based strategy to detect their nutritional status. METHODS A total of 17022 women participants are taken to conduct the research. All the participants are from different regions and different ages. A chi-square test with a five percent significance level is used to identify possible risk variables for malnutrition in women and six machine learning-based classifiers (Naïve Bayes, two types of Decision Tree, Logistic Regression, Random Forest, and Gradient Boosting Machine) were used to predict the malnutrition of women. The models are being evaluated using different parameters like accuracy, sensitivity, specificity, positive predictive value, negative predictive value, [Formula: see text] score, and area under the curve (AUC). RESULTS Descriptive data showed that 45% of the population studied were malnourished women, and the chi-square test illustrated that all fourteen variables are significantly associated with malnutrition in women and among them, age and wealth index had the most influence on their nutritional status, while water source had the least impact. Random Forest had an accuracy of 60% and 60.2% for training and test data sets, respectively. CART and Gradient Boosting Machine also had close accuracy like Random Forest but based on other performance metrics such as kappa and [Formula: see text] scores Random Forest got the highest rank among others. Also, it had the highest accuracy and [Formula: see text] scores in k-fold validation along with the highest AUC (0.604). CONCLUSION The Random Forest (RF) approach is a reasonably superior machine learning-based algorithm for forecasting women's nutritional status in Bangladesh in comparison to other ML algorithms investigated in this work. The suggested approach will aid in forecasting which women are at high susceptibility to malnutrition, hence decreasing the strain on the healthcare system.
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Affiliation(s)
- Estiyak Ahmed Turjo
- Department of Statistics and Data Science, Jahangirnagar University, Dhaka, Bangladesh
| | - Md Habibur Rahman
- Department of Statistics and Data Science, Jahangirnagar University, Dhaka, Bangladesh.
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El-Qushayri AE, Hossain MA, Mahmud I, Hashan MR, Gupta RD. Socio-demographic predictors of obesity among 12,975 adult ever married Egyptian women of reproductive age group: evidence from nationwide survey. BMC Public Health 2023; 23:2498. [PMID: 38093247 PMCID: PMC10717514 DOI: 10.1186/s12889-023-17397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
AIM We aimed to explore the predictors associated with obesity among adult ever-married Egyptian women aged 20-49 years based on the Egyptian Demographic and Health Survey (EDHS). METHOD We included adult ever married women from the EDHS conducted in 2014 that initially recruited 21,903 women. Univariate and multivariable analysis was conducted to identify socio-demographic predictors of women's obesity. RESULT We included 12,975 Egyptian women. Among them, 76% of the total respondents were obese where as 24% were with normal body mass index (BMI). In multivariable analysis, the results revealed that increasing age, higher wealth index, listening to radio at least once a week and women with primary and secondary education were at significant odds of developing obesity (p < 0.05). However, we found no association between residence of participants and the frequency of watching television upon the development of obesity (p > 0.05). CONCLUSION Appropriate and targeted interventions should be implemented among the Egyptian reproductive age women to reduce the obesity as well as non-communicable diseases load associated with obesity. National Health Service policy makers should take multilevel approach targeting high risk sub-groups to raise awareness and to provide prevention against obesity and the subsequent complications.
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Affiliation(s)
| | | | - Imteaz Mahmud
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Mohammad Rashidul Hashan
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, 1212, Bangladesh
- School of Medical, Health and Applied Sciences, Central Queensland University, Queensland, Australia
| | - Rajat Das Gupta
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka, 1213, Bangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
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Gupta RD, Frank HA, Akonde M, Mazumder A, Siddika N, Apu EH, Chakraborty PA. Rural-Urban Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults: Evidence from Bangladesh Demographic and Health Survey 2017-2018. EPIDEMIOLOGIA 2023; 4:505-520. [PMID: 38131674 PMCID: PMC10742748 DOI: 10.3390/epidemiologia4040042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of this study was to identify the differences in prevalence and associated factors of underweight and overweight/obesity among Bangladeshi adults (≥18 years) by analyzing the cross-sectional Bangladesh Demographic and Health Survey 2017-2018 data. Multilevel multivariable logistic regression was applied to identify the factors associated with underweight and overweight/obesity in urban and rural areas. The prevalence of underweight was 12.24% and 19.34% in urban and rural areas, respectively. The prevalence of overweight/obesity was 50.23% and 35.96%, respectively, in urban and rural areas. In the final multivariable analysis in both urban and rural areas, 30-49 years of age, female sex, being educated up to college or higher level, living in the wealthiest household, and being currently married or being separated/divorced/widowed had higher odds of being overweight/obese compared to other categories. Residence in the Mymensingh and Sylhet region was associated with decreased odds of overweight/obesity in urban and rural areas. On the other hand, being educated up to college or higher level, living in the wealthiest household, and being married were associated with reduced odds of being underweight in both areas. These high-risk groups should be brought under targeted health promotion programs to curb malnutrition.
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Affiliation(s)
- Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Hanna A. Frank
- School of Population and Public Health, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Ananna Mazumder
- Jahurul Islam Medical College (JIMC), Bajitpur, Kishoreganj 2336, Bangladesh
| | - Nazeeba Siddika
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
- Centre for International Public Health and Environmental Research, Bangladesh (CIPHER,B), Dhaka 1207, Bangladesh
| | - Ehsanul Hoque Apu
- Centre for International Public Health and Environmental Research, Bangladesh (CIPHER,B), Dhaka 1207, Bangladesh
- Department of Biomedical Engineering, Institute of Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI 48105, USA
- Department of Biomedical Science, College of Dental Medicine, Lincoln Memorial University, Knoxville, TN 37923, USA
| | - Promit Ananyo Chakraborty
- School of Population and Public Health, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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Ikoona EN, Toure MA, Njenga A, Namulemo L, Kaluya R, Kamara K, Oyat FWD, Aloyo J, Matovu JB, Kitara DL. Double burden of malnutrition among women in reproductive Age (15-49 years) in Sierra Leone: a secondary data analysis of the demographic health survey 2019 (SLDHS-2019). BMC Nutr 2023; 9:133. [PMID: 37986123 PMCID: PMC10662572 DOI: 10.1186/s40795-023-00795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The double burden of malnutrition (DBM) is rising globally, particularly in sub-Saharan Africa. In Sierra Leone, the incidence of overweight, obesity (OWOB), and overnutrition among women has sharply increased. This finding accompanies the high incidence of undernutrition, which has been prevalent for decades. This study aimed to determine the prevalence of different malnutrition categories (underweight, overweight, obesity, and overnutrition) and associated factors among women of reproductive age (15-49 years) in Sierra Leone using secondary data analysis of the Sierra Leone Demographic Health Survey of 2019 (SLDHS-2019). METHODS We conducted secondary data analysis of the SLDHS-2019 of 7,514 women aged 15-49 years. We excluded pregnant, post-natal, lactating, and post-menopausal women. Data was collected using validated questionnaires, and respondents were selected through a multistage stratified sampling approach. A multivariable logistic regression analysis was used to determine factors associated with malnutrition among 15-49-year-old women in Sierra Leone. RESULTS Among 15-49-year-old women in Sierra Leone, the prevalence of underweight was 6.7% (95%CI: 4.5-8.9%); overweight at 19.7% (95%CI: 17.7-21.7%); obesity was 7.4% (95% CI: 5.2-9.6%); and overnutrition, 27.1% (95%CI: 25.2-29.0%). Women aged 25-34 years were more likely to be underweight (adjusted Odds Ratios, aOR = 1.670, 95%CI: 1.254-2.224; p < 0.001) than those aged 15-24 years; women who were not married were less likely to be underweight (aOR = 0.594, 95%CI: 0.467-0.755; p < 0.001) than married women. Women from the North were less likely to be underweight (aOR = 0.734, 95%CI: 0.559-0.963; p = 0.026) than the East, and those who did not listen to the radio were less likely to be underweight (aOR = 0.673; 95%CI: 0.549-0.826; p < 0.001) than those who did. Overweight was less likely among 25-34 years (aOR = 0.609, 95%CI: 0.514-0.722; p < 0.001) and 35-49 years (aOR = 0.480, 95%CI: 0.403-0.571; p < 0.001) age-groups than 15-24 years; more likely among not married women (aOR = 1.470, 95%CI:1.249-1.730; p < 0.001) than married; less likely among working-class (aOR = 0.840, 95%CI: 0.720-0.980; p = 0.026) than not working-class; most likely in women from the North (aOR = 1.325, 95%CI:1.096-1.602; p = 0.004), and less likely among women from the South (aOR = 0.755, 95%CI: 0.631-0.903; p = 0.002) than the East; less likely among women of middle-wealth-index (aOR = 0.656, 95%CI: 0.535-0.804; p < 0.001), richer-wealth-index (aOR = 0.400, 95%CI: 0.309-0.517; p < 0.001), and richest-wealth-index (aOR = 0.317, 95%CI: 0.234-0.431; p < 0.001) than the poorest-wealth-index; and more likely among women who did not listen to radios (aOR = 1.149; 95%CI:1.002-1.317; p = 0.047) than those who did. The predictors of overweight among women 15-49 years are the same as obesity and overnutrition, except overnutrition and obesity were less likely in female-headed households (aOR = 0.717,95%CI: 0.578-0.889; p < 0.001). CONCLUSION The prevalence of all categories of malnutrition among women of reproductive age in Sierra Leone is high, affirming a double burden of malnutrition in this study population. Underweight was more likely among the 25-34-year age group than 15-24-year. The predictors of overweight, obesity, and overnutrition were being unmarried/single, residing in the North, and not listening to the radio. There is an urgent need for policymakers in Sierra Leone to design comprehensive educational programs for women of reproductive age on healthy lifestyles and the dangers of being underweight or over-nourished.
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Affiliation(s)
| | | | - Amon Njenga
- ICAP at Columbia University, Freetown, Sierra Leone
| | - Lucy Namulemo
- Foothills Community Based interventions, Monticello, Columbia, KY, USA
- Lindsey Wilson College, School of Professional Counseling, Columbia, KY, USA
- Uganda Counseling and Support Services, Kampala, Uganda
| | - Ronald Kaluya
- Uganda Counseling and Support Services, Kampala, Uganda
| | - Kassim Kamara
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Judith Aloyo
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu City, Uganda
- Rhites-N, Acholi, Gulu City, Uganda
| | | | - David Lagoro Kitara
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu City, Uganda.
- Gulu Centre for Advanced Medical Diagnostics, Research, Trainings, and Innovations (GRUDI BIONTECH INITIATIVE), Gulu, Uganda.
- Faculty of Medicine, Department of Surgery, Gulu University, P.0. Box 166, Gulu City, Uganda.
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Rawal L, Dahal P, Paudel G, Biswas T, Shrestha R, Makaju D, Shrestha A, Yadav U, Sahle BW, Iwashita H, Masuda G, Renzaho A, Shakya P, Shrestha A, Karmacharya B, Sakamoto H, Koju R, Sugishita T. Community-based lifestyle intervention for diabetes (Co-LID study) management rural Nepal: study protocol for a clustered randomized controlled trial. Trials 2023; 24:441. [PMID: 37403179 DOI: 10.1186/s13063-023-07451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) has increased globally; with a disproportionate burden in South and Southeast Asian countries, including Nepal. There is an urgent need for clinically and cost-effective culturally adapted T2DM management programs. In this study, we aim to assess the effectiveness of community based culturally appropriate lifestyle intervention in improving the management and care of people with T2DM. METHODS We will conduct a cluster randomized control trial to evaluate the effectiveness of community based culturally appropriate lifestyle intervention in improving T2DM outcomes. The trial will be conducted in 30 randomly selected healthcare facilities from two purposively selected districts (Kavrepalanchowk and Nuwakot districts) of Bagmati province, Nepal. The selected healthcare facilities are being randomized into 15 interventions (n = 15) and usual care (n = 15) groups. Those in the intervention will receive group-based 12 an hour-long fortnightly session delivered over 6 months period. The intervention package includes 12 planned modules related to diabetes care, ongoing support, supervision and monitoring, follow-up from the trained community health workers, and educational materials on diabetes self-management. The participants in the usual care groups will receive pictorial brochure on diabetes management and they will continue receiving the usual care available from the local health facilities. The primary outcome is HbA1c level, and the secondary outcomes include quality of life, health care utilization, and practice of self-care behaviour, depression, oral health quality of life, and economic assessment of the intervention. Two points measurements will be collected by the trained research assistants at baseline and at the end of the intervention. DISCUSSION This study will provide tested approaches for culturally adapting T2DM interventions in the Nepalese context. The findings will also have practice and policy implications for T2DM prevention and management in Nepal. TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819). Registered on May 6, 2021.
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Affiliation(s)
- Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, 2000, Australia.
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Padam Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, 2000, Australia
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, 2000, Australia
| | - Tuhin Biswas
- Science and Math Program, Asian University for Women, Chattogram, Bangladesh
| | - Rabina Shrestha
- Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Deepa Makaju
- Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Abha Shrestha
- Department of public health and community programs, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Uday Yadav
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, The National Centre for Epidemiology and Population Health, ACT, The Australian National University, Canberra, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Berhe W Sahle
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Hanako Iwashita
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Gaku Masuda
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Andre Renzaho
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Prabin Shakya
- Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of public health and community programs, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Department of public health and community programs, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Haruka Sakamoto
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Rajendra Koju
- Department of Internal Medicine/Cardiology, Kathmandu University of Medical Sciences, Dhulikhel, Nepal
| | - Tomohiko Sugishita
- Section of Global Health, Division of Public Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
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Asosega KA, Aidoo EN, Adebanji AO, Owusu-Dabo E. Examining the risk factors for overweight and obesity among women in Ghana: A multilevel perspective. Heliyon 2023; 9:e16207. [PMID: 37229171 PMCID: PMC10205511 DOI: 10.1016/j.heliyon.2023.e16207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
Overweight/obesity prevalence is on the increase in epidemic proportions across Low- and Middle-Income countries (LMICs). The public health burden associated with obesity/overweight cannot be underestimated due to its association with chronic health outcomes. This study investigated the individual- and community level risk factors for obesity/overweight among reproductive women. The data used consist of 4393 reproductive women and form part of the 2014 Ghana Demographic and Health Survey (GDHS). Information on these women are clustered within 427 communities. A 2-tier random intercept multilevel logistic model was used to assess the effect of individual- and community level factors on the likelihood of a woman to be obese/overweight. The obesity/overweight prevalence among reproductive women was estimated to be 35.5% (95% CI: 34.04, 36.90%), which significantly differed across clusters. Most at risk were women from middle-income households (aOR = 2.85; 95% CI: 2.28, 3.56), upper-income households (aOR = 5.019, 95% CI: 3.85, 6.55), attaining secondary education (aOR = 1.74; 95% CI: 1.41, 2.16), and higher (aOR = 1.63; 95% CI: 1.14, 2.33), old age (20-29 years (aOR = 4.26; 95% CI: 3.142,5.78); 30-39 years (aOR = 8.59; 95% CI: 6.15, 12.00); 40-49 years (aOR = 12.81; 95% CI: 9.10, 18.16)). Significant differences in the probability of being overweight/obese between different communities were observed (MOR = 1.39). The high prevalence of overweight/obesity requires urgent public health interventions to prevent future public health crises. Efforts to strengthen the healthcare system, encourage lifestyle modification, and public health education are needed to solidify the gains of ensuring a healthy population by 2030 (SDG 3).
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Affiliation(s)
- Killian Asampana Asosega
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
| | - Eric Nimako Aidoo
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Atinuke Olusola Adebanji
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Department of Global and International Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Does the place of residence influence your risk of being hypertensive? A study-based on Nepal Demographic and Health Survey. Hypertens Res 2023:10.1038/s41440-023-01217-x. [PMID: 36890270 DOI: 10.1038/s41440-023-01217-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 03/10/2023]
Abstract
Even though several studies have examined various risk factors for hypertension, residential influence is poorly explored especially in the low-income countries. We aim to investigate the association between residential characteristics and hypertension in resource limited and transitional settings like Nepal. A total of 14,652 individuals aged 15 and above were selected from 2016-Nepal Demographic and Health Survey. Individuals with blood pressure ≥140/90 mmHg or a history of hypertension (as identified by physicians/health professionals) or under antihypertensive medication were defined as hypertensive. Residential characteristics were represented by area level deprivation index, with a higher score representing higher level of deprivation. Association was explored using a two-level logistic regression. We also assessed if residential area modifies the association between individual socio-economic status and hypertension. Area deprivation had a significant inverse association with the risk of hypertension. Individuals from the least deprived areas had higher odds of hypertension compared to highly deprived areas 1.59 (95% CI 1.30, 1.89). Additionally, the association between literacy a proxy of socio-economic status and hypertension varied with a place of residence. Literate individuals from highly deprived areas were likely to have a higher odds of hypertension compared to those with no formal education. In contrast, literate from the least deprived areas had lower odds of hypertension. These results identify counterintuitive patterns of associations between residential characteristics and hypertension in Nepal, as compared with most of the epidemiological data from high-income countries. Differential stages of demographic and nutritional transitions between and within the countries might explain these associations.
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Rahman M, Haque SE, Islam MJ, Chau NH, Adam IF, Haque MN. The double burden of maternal overweight and short stature and the likelihood of cesarean deliveries in South Asia: An analysis of national datasets from Bangladesh, India, Maldives, Nepal, and Pakistan. Birth 2022; 49:661-674. [PMID: 35352380 DOI: 10.1111/birt.12632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim was to investigate: (a) whether there is an association between the maternal double burden of overweight and short stature and the risk of cesarean delivery and (b) whether socioeconomic status (SES) acts as a moderator in the association between the maternal double burden of overweight and short stature and the risk of cesarean birth (CB). MATERIALS AND METHODS The data for this study were obtained from the nationally representative Demographic and Health Survey databases of five South Asian countries. The analyses were based on responses from married women between 15 and 49 years of age. The risk of CB was the primary outcome, while the maternal double burden of overweight and short stature (coexistence of overweight and short stature) was the exposure of interest. RESULTS Maternal double burden of overweight and short stature was significantly associated with 179% higher likelihood of undergoing CB in South Asia (SA), with 304%, 200%, 167%, 155%, and 125% higher likelihood of undergoing CB in Nepal, Pakistan, India, Maldives, and Bangladesh, respectively. Findings also demonstrated that mothers belonging to low SES groups with a double overweight and short stature burden were not uniquely disadvantaged. CONCLUSIONS A significant marker in SA of higher risk of CB is the maternal double burden of overweight and short stature. The negative effect of the maternal double burden of overweight and short stature extends across all economic backgrounds in relation to the risk of CB. It is not limited to poor mothers who suffer from the double burden of overweight and short stature.
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Affiliation(s)
- Mosiur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Syed Emdadul Haque
- Department of Research and Training, UChicago Research Bangladesh, Dhaka, Bangladesh
| | - Md Jahirul Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, Queensland, Australia.,Skills for Employment Investment Program, Ministry of Finance, Dhaka, Bangladesh
| | - Nguyen Huu Chau
- Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | | | - Md Nuruzzaman Haque
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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Chong CT, Lai WK, Zainuddin AA, Pardi M, Mohd Sallehuddin S, Ganapathy SS. Prevalence of Obesity and Its Associated Factors Among Malaysian Adults: Finding From the National Health and Morbidity Survey 2019. Asia Pac J Public Health 2022; 34:786-792. [PMID: 36196901 DOI: 10.1177/10105395221129113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In 2016, World Health Organization (WHO) estimated more than 650 million obese adults, resulting in a country's health burden. This study aims to determine the prevalence of obesity and its associated factors among Malaysian adults. A total of 5820 respondents, aged 18 to 59 years, from the National Health and Morbidity Survey 2019, were included for the data analysis. The prevalence of obesity was described and multivariate analyses were conducted to determine the factors associated with obesity. The prevalence of obesity among Malaysian adults was 20.1%, based on the findings from this study. Multivariate analyses showed that women, being Malays, Indians, and other Bumiputeras, were significantly associated with a higher risk of obesity. Besides, those diagnosed with diabetes mellitus and hypertension were also significantly associated with greater risk of obesity. This information is crucial for policy makers in formulating effective strategies or targeted programs in preventing obesity among Malaysian adults.
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Affiliation(s)
- Chean Tat Chong
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Wai Kent Lai
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Ahmad Ali Zainuddin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Munawara Pardi
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Syafinaz Mohd Sallehuddin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Shubash Shander Ganapathy
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
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Aryal V, Ghimire D, Kandel S, Majumder A, Manna S. Obesity among Medical Students of a Medical College: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:943-946. [PMID: 36705181 PMCID: PMC9795093 DOI: 10.31729/jnma.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The prevalence of overweight and obesity is increasing these days. The adverse effect of obesity can be seen in different physiological functions. Relative fat mass is a newly identified parameter to estimate whole body fat. This study aimed to find out the prevalence of obesity among medical students of a medical college. Methods A descriptive cross-sectional study was carried out among medical students of a medical college from 1 September 2021 to 30 January 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: FNMC/539/078/79). Simple random sampling was done. Height was measured using a stadiometer and waist circumference was measured using non-stretchable tape. Relative fat mass was calculated using the relative fat mass equation. The data was categorised according to the distribution of fat mass. Point estimate and 95% Confidence Interval were calculated. Results Out of 180 medical students, 57 (31.67%) (24.87-38.47, 95% Confidence Interval) were obese according to relative fat mass cut-off. The mean fat mass among male and female participants with high relative fat mass was 27.057±1.42 and 35.674±2.63 respectively. Conclusions The prevalence of obesity was lower than in other studies done in similar settings. Keywords body fat; obesity; medical students.
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Affiliation(s)
- Vibina Aryal
- Department of Physiology, National Medical College, Birgunj, Parsa, Nepal,Correspondence: Dr Vibina Aryal, Department of Physiology, National Medical College, Birgunj, Parsa, Nepal. , Phone: +977-9841392798
| | - Dayaram Ghimire
- Department of Physiology, National Medical College, Birgunj, Parsa, Nepal
| | - Sabita Kandel
- Department of Clinical Physiology, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | - Anirban Majumder
- Department of Physiology, National Medical College, Birgunj, Parsa, Nepal
| | - Sourav Manna
- Department of Physiology, National Medical College, Birgunj, Parsa, Nepal
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Rana K, Chimoriya R, Haque NB, Piya MK, Chimoriya R, Ekholuenetale M, Arora A. Prevalence and Correlates of Underweight among Women of Reproductive Age in Nepal: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11737. [PMID: 36142012 PMCID: PMC9516984 DOI: 10.3390/ijerph191811737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to examine the prevalence of underweight and determine the sociodemographic and household environmental correlates of underweight among women of reproductive age in Nepal. This study also compared the time trends in the prevalence of underweight with the trends in the prevalence of overweight and obesity. This cross-sectional study was a secondary data analysis of the nationally representative population-based Nepal Demographic and Health Surveys (NDHSs). Firstly, the time trends of the prevalence of underweight (body mass index (BMI) < 18.5 kg/m2) among women aged 15-49 years were examined at five-year intervals, from the 1996, 2001, 2006, 2011, and 2016 NDHSs (n = 33,507). Secondly, the sociodemographic and household environmental correlates of underweight were examined from the latest NDHS 2016 (n = 6165). Univariable and multivariable logistic regression analyses were performed to examine the sociodemographic and household environmental correlates of underweight. From 1996 to 2016, the prevalence of underweight decreased from 25.3% (95% confidence interval (CI) 23.8%, 26.8%) to 16.9% (95%CI 16.0%, 17.8%), while the prevalence of overweight and obesity increased from 1.6% (95%CI 1.2%, 2.1%) to 15.6% (95%CI 14.7%, 16.5%) and 0.2% (95%CI 0.1%, 0.4%) to 4.1% (95%CI 3.6%, 4.6%), respectively. Sociodemographic factors, such as age, educational status, marital status, wealth index, and religion, were independently associated with the risk of underweight. Similarly, household environmental factors, such as province of residence, ecological zone, type of toilet facility, and household possessions, including television and mobile phone, were independently associated with the risk of underweight. Despite the declining trends, the prevalence of underweight among Nepalese women remains a public health challenge. Understanding the key sociodemographic and household environmental correlates of underweight may assist in streamlining the content of health promotion campaigns to address undernutrition and potentially mitigate adverse health outcomes.
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Affiliation(s)
- Kritika Rana
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia
| | - Ritesh Chimoriya
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Nabila Binte Haque
- Department of Health Systems and Populations, Macquarie University, Macquarie Park, Sydney, NSW 2109, Australia
| | - Milan K. Piya
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
| | - Romila Chimoriya
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia
- Department of Pediatrics, Nepal Medical College Teaching Hospital, Kathmandu 44600, Nepal
| | - Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan 200214, Nigeria
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia
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Bhattarai S, Nerhus Larsen R, Shrestha A, Karmacharya B, Sen A. Association between socioeconomic positions and overweight/obesity in rural Nepal. Front Nutr 2022; 9:952665. [PMID: 36159479 PMCID: PMC9501994 DOI: 10.3389/fnut.2022.952665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionObesity and its association with socioeconomic factors are well-established. However, the gradient of this relationship among rural populations in low- and middle-income countries such as Nepal is not fully understood. We sought to assess the association of socioeconomic factors (education, income, and employment status) with overweight/obesity.MethodsThis cross-sectional study analyzed data from 260 participants aged ≥18 years and attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors was collected, and weight and height were measured for all the study participants. Those with a body mass index of <25 kg/m2 were regarded as non-overweight/obese and those with ≥25 kg/m2 were regarded as overweight/obese. Poisson regression models were used to estimate prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and overweight/obesity. In addition, we assessed the effect of modification by age and gender to study the effect of socioeconomic factors on overweight/obesity.ResultsThe age-standardized prevalence of overweight/obesity was higher for individuals with higher education (23%) and high-income (32%) and those who were unemployed (42%). Compared to the low-income and no formal education groups, the prevalence ratio of overweight/ obesity was 1.69 and 2.27 times more for those belonging to the high-income and high school and above groups, respectively. No evidence of effect modification by gender and age was observed.ConclusionsSocioeconomic factors, education, and income were positively associated with overweight/obesity prevalence in rural Nepal. Further large studies using longitudinal settings are necessary to replicate our findings.
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Affiliation(s)
- Sanju Bhattarai
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Implementation Science and Health, Kathmandu, Nepal
- *Correspondence: Sanju Bhattarai ;
| | | | - Archana Shrestha
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, United States
| | - Biraj Karmacharya
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Oral Health Services and Research Center, TkMidt, Trondheim, Norway
- Abhijit Sen
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Gupta RD, Haider SS, Eusufzai SZ, Hoque Apu E, Siddika N. Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults by Gender: Analysis of a Nationally Representative Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710698. [PMID: 36078414 PMCID: PMC9517755 DOI: 10.3390/ijerph191710698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 05/23/2023]
Abstract
The objective of this study was to find the differences in prevalence and associated factors of underweight and overweight/obesity among Bangladeshi adults by gender, using the nationally representative Bangladesh Demographic and Health Survey 2017-2018 data. To identify the factors associated with underweight and overweight/obesity in both genders, multilevel multivariable logistic regression was conducted. The prevalence of underweight was 19.79% and 15.49% among males and females, respectively. The prevalence of overweight/obesity was 32.67% and 45.60% among males and females, respectively. Among both genders, participants with the highest likelihood of overweight/obesity were aged 30-49 years and 50-69 years, had the highest educational attainment up to primary and secondary level, resided in a household that belonged to the middle, richer, or richest wealth quintiles, and were currently married. On the other hand, among both genders, increased educational attainment and wealth index were inversely associated with being underweight. Health promotion programs in Bangladesh should focus on these high-risk groups to address the burden of underweight and overweight/obesity.
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Affiliation(s)
- Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Shams Shabab Haider
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Sumaiya Zabin Eusufzai
- Department of Biostatistics, School of Dental Sciences, University Sains Malaysia, Kota Bharu 16150, Malaysia
| | - Ehsanul Hoque Apu
- Department of Biomedical Engineering, Institute of Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nazeeba Siddika
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
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Gardner H, Miles G, Saleem A, Dunin-Borkowska A, Mohammad H, Puttick N, Aksha S, Bhattarai S, Keene C. Social determinants of health and the double burden of disease in Nepal: a secondary analysis. BMC Public Health 2022; 22:1567. [PMID: 35978424 PMCID: PMC9387078 DOI: 10.1186/s12889-022-13905-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background As the global burden of disease evolves, lower-resource countries like Nepal face a double burden of non-communicable and infectious disease. Rapid adaptation is required for Nepal’s health system to provide life-long, person-centred care while simultaneously improving quality of infectious disease services. Social determinants of health be key in addressing health disparities and could direct policy decisions to promote health and manage the disease burden. Thus, we explore the association of social determinants with the double burden of disease in Nepal. Methods This is a retrospective, ecological, cross-sectional analysis of infectious and non-communicable disease outcome data (2017 to 2019) and data on social determinants of health (2011 to 2013) for 753 municipalities in Nepal. Multinomial logistic regression was conducted to evaluate the associations between social determinants and disease burden. Results The ‘high-burden’ combined double burden (non-communicable and infectious disease) outcome was associated with more accessible municipalities, (adjOR3.94[95%CI2.94–5.28]), municipalities with higher proportions of vaccine coverage (adjOR12.49[95%CI3.05–51.09]) and malnutrition (adjOR9.19E103[95%CI19.68E42-8.72E164]), lower average number of people per household (adjOR0.32[95%CI0.22–0.47]) and lower indigenous population (adjOR0.20[95%CI0.06–0.65]) compared to the ‘low-burden’ category on multivariable analysis. ‘High-burden’ of non-communicable disease was associated with more accessible municipalities (adjOR1.93[95%CI1.45–2.57]), higher female proportion within the municipality (adjOR1.69E8[95%CI3227.74–8.82E12]), nutritional deficiency (adjOR1.39E17[95%CI11799.83–1.64E30]) and malnutrition (adjOR2.17E131[95%CI4.41E79-1.07E183]) and lower proportions of population under five years (adjOR1.05E-10[95%CI9.95E-18–0.001]), indigenous population (adjOR0.32[95%CI0.11–0.91]), average people per household (adjOR0.44[95%CI0.26–0.73]) and households with no piped water (adjOR0.21[95%CI0.09–0.49]), compared to the ‘low-burden’ category on adjusted analysis. ‘High burden’ of infectious disease was also associated with more accessible municipalities (adjOR4.29[95%CI3.05–6.05]), higher proportions of population under five years (adjOR3.78E9[95%CI9418.25–1.51E15]), vaccine coverage (adjOR25.42[95%CI7.85–82.29]) and malnutrition (adjOR4.29E41[95%CI12408.29–1.48E79]) and lower proportions of households using firewood as fuel (adjOR0.39[95%CI0.20–0.79]) (‘moderate-burden’ category only) compared to ‘low-burden’. Conclusions While this study produced imprecise estimates and cannot be interpreted for individual risk, more accessible municipalities were consistently associated with higher disease burden than remote areas. Female sex, lower average number per household, non-indigenous population and poor nutrition were also associated with higher burden of disease and offer targets to direct interventions to reduce the burden of infectious and non-communicable disease and manage the double burden of disease in Nepal. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13905-3.
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Affiliation(s)
- Hannah Gardner
- Institute of Human Sciences, University of Oxford, Oxford, UK.
| | - Georgina Miles
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ayesha Saleem
- UCL Medical School, University College London, London, UK
| | | | - Hannah Mohammad
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natasha Puttick
- Institute of Human Sciences, University of Oxford, Oxford, UK
| | - Sanam Aksha
- School of Public Administration, National Center for Integrated Coastal Research, University of Central Florida, Orlando, USA
| | - Suraj Bhattarai
- Department of Global Health, Global Institute for Interdisciplinary Studies, Kathmandu, Nepal
| | - Claire Keene
- Health Systems Collaborative, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK
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Spatial Variations and Determinants of Anemia among Under-five Children in Nepal, DHS (2006-2016). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148664. [PMID: 35886516 PMCID: PMC9323660 DOI: 10.3390/ijerph19148664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023]
Abstract
Anemia among under-five children is the major health problem in Nepal. The lack of nutritional supplementation and lack of healthcare facilities are influential factors of anemia. Thus, the main objective of this study is to explore spatial variations and determinants of anemia among under-five children in Nepal. Nepal Demographic and Health Survey (NDHS) data from 2006 to 2016 were used in this study, which includes: household and individual-level data of 8555 under-five children, whose anemia was measured. In addition, a total of 260 (2006), 281 (2011), and 383 DHS clusters (2016) were taken in consideration for spatial analysis. The overall prevalence of anemia was 48.9%, 46.4%, and 52.2% in 2006, 2011, and 2016 respectively. The spatial analysis revealed a nonrandom spatial distribution, where statistically significant hotspots and coldspots were detected in different parts of the country. The results also identified mother’s age, mother’s educational level, socioeconomic status of household, number of under-5 children, household size, birth weight, underweight, stunting, diarrhea, and fever as associated factors of anemia among under-5 children. These findings may provide assistance to concerned health officials in adopting anemia-related programs and policies to address the anemia problems that plague Nepalese children under the age of five.
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Jiang Y, Zhang X, Xu T, Hong W, Chen Z, Gao X, Xu R. Secular Difference in Body Mass Index From 2014 to 2020 in Chinese Older Adults: A Time-Series Cross-Sectional Study. Front Nutr 2022; 9:923539. [PMID: 35799582 PMCID: PMC9253615 DOI: 10.3389/fnut.2022.923539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/30/2022] [Indexed: 01/04/2023] Open
Abstract
BackgroundBody mass index (BMI) is the most widely used parameter to assess the body weight status. Both the increase of BMI (overweight and obesity) and decrease of BMI (underweight) has been associated with high risk of adverse outcome, such as stroke, disability, and even death. However, recent data on secular differences in BMI in the Chinese aged population are limited. The present study provides robust new evidence about the evolving epidemic of obesity among aged adults in China.ObjectiveEvaluating secular difference in BMI in a group of Chinese older adults.Materials and MethodsWe analyzed 7 continuous survey years (2014–2020), including 50,192 Chinese aged participants (25,505 men and 24,687 women, aged 71.9 ± 6.1 years, age range: 65–99 years). Information on sex, age, height, and body weight, was collected based on medical history. Participants were classified into four groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI < 25 kg/m2), overweight (25 kg/m2 ≤ BMI < 30 kg/m2), and obesity (BMI ≥ 30 kg/m2). Linear regressions were used to assess the secular difference in BMI. Sex and age differences were also evaluated by stratified analyses.ResultsFrom 2014 to 2020, age-adjusted mean BMI increased by 0.3 kg/m2 (95% CI: 0.1, 0.5 kg/m2) in men, and 0.5 kg/m2 (95% CI: 0.2, 0.7 kg/m2) in women. Age-standardized prevalence of underweight decreased from 3.0 to 2.3% in men, and from 3.0 to 2.1% in women. Age-standardized prevalence of overweight increased in both men (from 40.1 to 41.7%) and women (from 37.8 to 39.8%), and so as obesity (men: from 4.1 to 6.1%; women: from 5.8 to 8.7%).ConclusionOur results confirmed that BMI gradually increased from 2014 to 2020. The age-adjusted mean BMI increased by 0.3 kg/m2 in older men, and 0.5 kg/m2 in older women. The age- and sex-standardized prevalence of overweight and obesity significantly increased, especially in 70–79-year age group, while the prevalence of underweight decreased. The combination of a balanced-diet and physical exercise is needed to maintain optimal BMI range for the aged population.
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Affiliation(s)
- Ying Jiang
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaomin Zhang
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tianwei Xu
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Weiqi Hong
- Caolu Community Health Service Center, Shanghai, China
| | - Zhiqi Chen
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai, China
| | - Renying Xu
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Renying Xu, ; orcid.org/0000-0003-2608-5586
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Biswas T, Townsend N, Magalhaes R, Hasan MM, Mamun AA. Geographical and socioeconomic inequalities in the double burden of malnutrition among women in Southeast Asia: A population-based study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 1:100007. [PMID: 37383092 PMCID: PMC10305935 DOI: 10.1016/j.lansea.2022.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Countries in the South and Southeast Asia region grapple with significant challenges due to the double burden of malnutrition (DBM) in women. An understanding of the country specific DBM geographical and socioeconomic distribution in South and Southeast Asian countries will enable targeting of DBM interventions towards high-risk populations in the region. This study aimed to analyse anthropometric indicators for women's nutrition at national and subnational levels in seven South and Southeast Asian countries and assess the association between nutritional status and socioeconomic factors. Methods We used population-representative cross-sectional data from the Demographic and Health Surveys conducted between 2000 and 2017, for seven South and Southeast Asian countries (Bangladesh, Cambodia, India, Myanmar, Nepal, Pakistan, and Timor-Leste) and estimated national and subnational prevalence of women underweight and overweight. Using a concentration index (CI), we measured relative and absolute inequality across underweight and overweight in urban and rural areas in these countries. In addition, we estimated the health achievement index, integrating mean coverage of nutritional status and the distribution of coverage by rural and urban populations. Findings The prevalence of underweight women ranged from 7.0% (95% CI: 7.0-8.0%) in Pakistan in 2017 to 44.0% (95% CI: 42-45%) in Bangladesh in 2000 and overweight from 11.0% (95% CI: 10-12%) in Bangladesh in 2000 to 67.0% (95% CI: 66-68%) in Pakistan in 2017. In most countries, underweight disproportionately affected the poorest. The concentration indices for underweight were significant in all countries and ranged from -0.04 in Cambodia in 2014 to -0.38 in Pakistan in 2017. In contrast, overweight disproportionately affected the richest, with concentration indices for overweight significant in all countries, ranging from 0.16 in Cambodia in 2010 to 0.45 in Bangladesh in 2007. In most of the countries an absolute measure of inequality decreased overtime, whereas relative measures increased. Disachievement of underweight is more pronounced in rural populations compared to the urban ones. Interpretations We noted large geographical and socioeconomic disparities in women DBM in South and Southeast Asian countries, at national and subnational levels. Planning, implementation, and evaluation of existing intervention programmes for food and nutrition should be based on subnational level needs and outcomes. Funding This research is partially funded by the Australian Government through the Australian Research Council's Centre of Excellence for Children and Families over the Life Course (Project ID CE200100025).
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Affiliation(s)
- Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Nick Townsend
- Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Ricardo Magalhaes
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, University of Queensland, Gatton, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Md. Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
- UQ Poche Centre for Indigenous Health,The University of Queensland, Brisbane, Queensland, Australia
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Chaudhary A, Nakarmi J, Goodman A. Association between intimate partner violence and nutritional status of married Nepalese women. Glob Health Res Policy 2022; 7:14. [PMID: 35585625 PMCID: PMC9118640 DOI: 10.1186/s41256-022-00248-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is physical, sexual, or psychological harm perpetrated by a spouse or an intimate partner. Its detrimental effects on women's physical, mental, sexual, and reproductive health are well-documented. However, its impact on nutritional status is not well-studied, and previous studies have led to contradictory findings. This study aimed to explore the association between intimate partner violence and the nutritional status of married Nepalese women. METHODS The study used the 2016 Nepal Demographic Health Survey data, which employed a modified version of the Conflict Tactics Scale to determine women's exposure to IPV. Anemia and low body mass index (BMI) were used as proxies of nutritional status. Multinomial regression was used to analyze the relationship between BMI and IPV; multivariable logistic regression was used to analyze the association between anemia and IPV. RESULTS The prevalence of underweight, overweight/obesity, and anemia were respectively 13.9%, 25.1%, and 38.7%. The prevalence of physical, sexual, and emotional IPVs experienced in the preceding year were respectively 9.8%, 4.6%, and 7.6%. Likewise, the prevalence of lifetime physical, sexual, emotional, and controlling behavior IPVs were respectively 21.8%, 7.4%, 12.3%, and 32.1%. The low intensity of emotional IPV (AOR 1.62; CI: 1.02-2.56) and moderate intensity of physical IPV (AOR 3.70; CI: 1.64-8.35) experienced in the preceding year, and low intensity of lifetime emotional IPV (AOR 1.69; CI: 1.11-2.58) were associated with an increased risk of overweight/obesity. Moderate intensity of sexual IPV (AOR 2.59; CI: 1.099-6.108) experienced in the preceding year was associated with an increased risk of underweight BMI. The low intensity of lifetime controlling behavior (AOR1.25; CI: 1.03-1.53) was associated with an increased risk of anemia. CONCLUSIONS Emotional and Physical IPVs are significantly associated with an increased risk of overweight/obesity. Sexual IPV is significantly associated with an increased risk of underweight BMI, and controlling behavior is significantly associated with an increased risk of anemia. Seeking help could offset the detrimental effects of IPV; therefore, IPV screening should be a part of regular healthcare assessment for married women, and appropriate rehabilitation should be offered to IPV survivors.
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Affiliation(s)
- Arun Chaudhary
- Center for Sustainable Development Research, Kathmandu, Nepal.
- Strength and Serenity: Global Initiative to End Gender-Based Violence, Boston, MA, USA.
| | - Janet Nakarmi
- Department of Mathematics, University of Central Arkansas, Conway, AR, USA
| | - Annekathryn Goodman
- Strength and Serenity: Global Initiative to End Gender-Based Violence, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA
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22
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Ferdausi F, Al-Zubayer MA, Keramat SA, Ahammed B. Prevalence and associated factors of underweight and overweight/obesity among reproductive-aged women: A pooled analysis of data from South Asian countries (Bangladesh, Maldives, Nepal and Pakistan). Diabetes Metab Syndr 2022; 16:102428. [PMID: 35219260 DOI: 10.1016/j.dsx.2022.102428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Underweight and overweight/obesity is a critical public health problem among women in South Asian countries. This study aimed to find the prevalence of underweight and overweight/obesity and discover its associated factors among women of reproductive age in four South Asian countries. METHODS Population-representative cross-sectional latest Demographic and Health Survey data from four South Asian countries, considering Bangladesh (2017-18), Maldives (2016-17), Nepal (2016), and Pakistan (2017-18), were pooled for this study. To investigate the factors related with underweight and overweight/obesity in women, a multivariate multinomial logistic regression model was deployed. RESULTS The overall prevalence of underweight and overweight/obesity among reproductive-age women in four South Asian countries was 11.8% and 36.3%, respectively. According to adjusted multivariate multinomial logistic regression analysis, women who lived in Pakistan, were older, had a better education, were from the wealthiest home, were currently in union and had media exposure had a considerably decreased probability of being underweight. In contrast, families with a large number of members had a considerably increased risk of becoming underweight. Additionally, women from the Maldives, older age, secondary education, a higher number of children, women from the richest household, currently in the union, the family had media exposure, and pregnant women have been found significantly positively associated with overweight/obesity. However, Nepalese women, large family members, rural residence, and work involvement were significantly negatively associated with overweight/obesity. CONCLUSION The problem of being underweight and overweight/obesity still exists in South Asian countries. Focusing on women's age, education, wealth index, and media exposure, different public health intervention approaches are imperative to reduce unhealthy weight conditions.
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Affiliation(s)
- Farzana Ferdausi
- Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh, Bangladesh
| | - Md Akib Al-Zubayer
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, 9208, Bangladesh
| | - Syed Afroz Keramat
- Economics Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
| | - Benojir Ahammed
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, 9208, Bangladesh.
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Paudel S, Owen AJ, Owen N, Smith BJ. Trends in television viewing and overweight /obesity among Nepalese women: Findings from 2006, 2011 and 2016 Nepal Demographic and Health Surveys. Nutr Metab Cardiovasc Dis 2022; 32:382-392. [PMID: 34895999 DOI: 10.1016/j.numecd.2021.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Associations between overweight/obesity and television (TV) viewing have been identified in high-income countries, but little evidence is available from low- and middle-income countries. This study examined the trends and correlates of television viewing and overweight/obesity among Nepalese women between 2006 and 2016. METHODS AND RESULTS We analysed the data from 22,161 women aged 15-49 years who took part in Nepal Demographic Health Surveys 2006 (n = 10,115), 2011 (n = 5,881) or 2016 (n = 6,165). Trained staff collected data on TV viewing and sociodemographic attributes from a face-to-face survey while height and weight were measured objectively to determine body mass index. Around 38% of the study participants watched TV at least once a week in 2006, which increased to 49% in 2011 and 46% in 2016. The prevalence of overweight and obesity increased from 8% in 2006 to 14.6% in 2011 and 19.8% in 2016. Compared to those who did not watch TV at all, those watching it at least once a week were at 1.54 (95% CI: 1.02-2.33), 1.79 (95% CI: 1.23-2.60) and 1.46 (95% CI: 1.13-1.88) times higher odds of being overweight/obese in 2006, 2011 and 2016 respectively. CONCLUSION The prevalence of TV viewing rose among women in Nepal between 2006 and 2016 and was associated with overweight/obesity, which also increased dramatically over this period. Future studies examining the use of multiple screen devices, daily usage duration and content viewed are recommended to understand better the health impacts of transitions to more sedentary living in Nepal and similar settings.
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Affiliation(s)
- Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Alfred Health, Melbourne, Australia.
| | - Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia.
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Amgain K, Subedi P, Yadav GK, Neupane S, Khadka S, Sapkota SD. Association of Anthropometric Indices with Menstrual Abnormality among Nursing Students of Nepal: A Cross-Sectional Study. J Obes 2022; 2022:6755436. [PMID: 35342646 PMCID: PMC8956380 DOI: 10.1155/2022/6755436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Obesity has been reported to be linked with menstrual abnormalities including abnormality in cycle length, duration, and period blood loss. However, which anthropometric parameter is a better marker of menstrual abnormality is yet unknown. This study aims to explore the association of BMI, waist-hip ratio (WHR), and waist-height ratio (WHtR) with menstrual abnormalities. METHODS This was a cross-sectional study conducted among 240 nursing students on two nursing campuses of Nepal. Demographic and menstrual characteristics related data were collected from the participants via the face-to-face interview technique followed by anthropometric measurements. Binary logistic regression was used to study the association of BMI, WHR, and WHtR with menstrual characteristics. Univariable and multivariable regression models were calculated at 95% confidence interval and a P value of 0.05 using a Statistical Package for Social Sciences, IBM SPSS® v21 (IBM, Armonk, New York). RESULTS Out of 240 participants, 52 participants (21.67%) were underweight (<18.5 kg/m2), and 47 participants (19.58%) were either overweight (≥23 kg/m2) or obese (≥25 kg/m2). Overweight and obese BMI was associated with abnormality in menstrual cycle length (AOR = 4.24; 95% CI = 1.77-10.17), duration of the menstrual period (AOR = 2.52; 95% CI = 1.09-5.81), and periodic menstrual blood loss (AOR = 9.04; 95% CI = 3.55-23.01). Increase in WHtR (>0.5) was associated with abnormal cycle length (AOR = 3.09; 95% CI = 1.09-8.80) and abnormal period duration (AOR = 3.05; 95% CI = 1.10-8.44). An increase in WHR (>0.8) was associated with abnormal cyclical menstrual blood loss (AOR = 4.93; 95% CI = 1.55-15.71). CONCLUSIONS Obesity predisposes to menstrual irregularities. BMI is a better predictor of menstrual irregularity as the increase in BMI is associated with abnormality in menstrual cycle length, period duration, and blood loss. Increased WHR was associated with periodic blood loss only. Increased WHtR was associated with abnormal cycle length and period duration, but not menstrual blood loss.
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Affiliation(s)
- Kapil Amgain
- Department of Clinical Anatomy and Cell Biology, Karnali Academy of Health Sciences, Jumla, Nepal
| | - Prativa Subedi
- Department of Emergency Medicine, Rolpa District Hospital, Rolpa, Nepal
| | - Gopal Kumar Yadav
- Department of Emergency Medicine, Kalaiya District Hospital, Bara, Nepal
| | - Sujana Neupane
- Department of Nursing, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Kathmandu, Nepal
| | - Sitaram Khadka
- Clinical Pharmacist and Pharmacologist, Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Ghimire U, Vatsa R. Spatial distribution of various forms of malnutrition among reproductive age women in Nepal: A Bayesian geoadditive quantile regression approach. SSM Popul Health 2021; 14:100781. [PMID: 33997241 PMCID: PMC8099780 DOI: 10.1016/j.ssmph.2021.100781] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 01/21/2023] Open
Abstract
Addressing both the under-and over-nutritional status of women is an eminent challenge for developing countries like Nepal. This paper examined a critical analysis of factors associated with various forms of malnutrition using Bayesian geoadditive quantile regression approach and assessed spatial variations of malnutrition among Nepalese women using Asian cut-off values. Data drawn from the 2016 Nepal Demographic and Health Survey was utilized to assess the spatial distributions of underweight, overweight and obesity at the provincial level. Spatial and nonlinear components were estimated using Markov random fields and Bayesian P-splines, respectively. The analysis of 4,338 women confirmed that women living in extremely urbanized areas and in Province 1, Province 3, and Province 4 were more likely to be overweight/obese. Similarly, the likelihood of being underweight was prominently high among women residing in rural municipality and women residing in Province 2 and Province 7. Women from the richest and richer quintiles, and with primary education were more likely to be obese. Furthermore, currently-working women and women having access to protected water source were less likely to be obese while improved toilet and access to electricity facility were associated with obesity. Women with access to newspaper and radio were less prone to obesity. Inconsistent distribution of under- and over-nutrition existed in Nepal, given that the high prevalence of overweight/obesity among women living in metropolitan and undernutrition among rural women. Specific intervention measures, addressing location-specific nutrition issues are urgent. Rigorous implementation of strategies incorporated in the national nutrition plan is called for to curb the burden of overweight/obesity. Involving mass media to promote healthier lifestyle and nutritious food could be advantageous at the population level, especially in rural municipalities.
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Affiliation(s)
- Umesh Ghimire
- New ERA, Rudramati Marga, Kalopul, Kathmandu, 44600, Nepal
| | - Richa Vatsa
- Central University of South Bihar, SH-7, Gaya Panchanpur Road, Village – Karhara, Post. Fatehpur, Gaya, 824236, Bihar, India
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Kapoor N, Sahay R, Kalra S, Bajaj S, Dasgupta A, Shrestha D, Dhakal G, Tiwaskar M, Sahay M, Somasundaram N, Reddy R, Bhattacharya S, Reddy VB, Viswanathan V, Krishnan D, Baruah M, Das AK. Consensus on Medical Nutrition Therapy for Diabesity (CoMeND) in Adults: A South Asian Perspective. Diabetes Metab Syndr Obes 2021; 14:1703-1728. [PMID: 33889005 PMCID: PMC8057793 DOI: 10.2147/dmso.s278928] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes and obesity are both increasing at a fast pace and giving rise to a new epidemic called diabesity. Lifestyle interventions including diet play a major role in the treatment of diabetes, obesity and diabesity. There are many guidelines on dietary management of diabetes or obesity globally and also from South Asia. However, there are no global or South Asian guidelines on the non-pharmacological management of diabesity. South Asia differs from the rest of the world as South Asians have different phenotype, cooking practices, food resources and exposure, medical nutrition therapy (MNT) practices, and availability of trained specialists. Therefore, South Asia needs its own guidelines for non-pharmacological management of diabesity in adults. The aim of the Consensus on Medical Nutrition Therapy for Diabesity (CoMeND) in Adults: A South Asian Perspective is to recommend therapeutic and preventive MNT in the South-Asians with diabesity.
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Affiliation(s)
- Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
- Non Communicable Disease Unit, The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rakesh Sahay
- Department of Endocrinology, Osmania MedicalA30 College, Hyderabad, Telangana, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India
| | - Arundhati Dasgupta
- Department of Endocrinology, Rudraksh Superspecialty Hospital, Siliguri, West Bengal, India
| | - Dina Shrestha
- Department of Endocrinology, Hospital for Advanced Medicine and Surgery (HAMS), Kathmandu, Nepal
| | - Guru Dhakal
- Department of Medicine, Khesar Gyalpo University of Medical Sciences, Thimphu, Bhutan
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Centre, Mumbai, Maharashtra, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College and Osmania General Hospital, Hyderabad, Telangana, India
| | - Noel Somasundaram
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Ravinder Reddy
- Department of Gastroenterology, CARE Super Specialty Hospital & Transplant Centre, Hyderabad, Telangana, India
| | | | | | - Vijay Viswanathan
- Department of Medicine, M.V. Hospital for Diabetes & Prof M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Dharini Krishnan
- Department of Food, Nutrition and Dietetics, Laksha Hospitals, Chennai, Tamil Nadu, India
| | - Manash Baruah
- Department of Endocrinology, Excel Care Hospitals, Guwahati, Assam, India
| | - A K Das
- Department of Medicine, JIPMER, Puducherry, India
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Afolabi RF, Palamuleni ME. Multilevel analysis of unhealthy bodyweight among women in Malawi: Does urbanisation matter? PLoS One 2021; 16:e0249289. [PMID: 33780505 PMCID: PMC8006991 DOI: 10.1371/journal.pone.0249289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Underweight and overweight constitute unhealthy bodyweight and their coexistence is symptomatic of the dual burden of malnutrition (DBM) of high public health concern in many sub-Saharan Africa countries. Little is known about DBM and its correlates in Malawi, a country undergoing urbanisation. The study examined net effects of urban residence on unhealthy weights amidst individual- and community-level factors among women in Malawi. METHODS Data on 7231 women aged 15-49 years nested within 850 communities extracted from 2015-16 Malawi Demographic and Health Survey were analysed. Women's weight status measured by body mass index, operationally categorised as underweight, normal and overweight, was the outcome variable while urban-rural residence was the main explanatory variable. Multilevel multinomial logistic regression analysis was employed at 5% significant level; the relative-risk ratio (RR) and its 95% confidence interval (CI) were presented. RESULTS Urban residents had a significantly higher prevalence of overweight than rural (36.4% vs. 17.2%; p< 0.001) but a -non-significant lower prevalence of underweight (6.2% vs. 7.4%; p = 0.423). Having adjusted for both individual- and community-level covariates, compared to rural, living in urban (aRR = 1.25; CI: 1.02-1.53) accounted for about 25% higher risk of being overweight relative to normal weight. Higher education attainment, being married and belonging to Chewa, Lomwe or Mang'anja ethnic group significantly reduced the risk of being underweight but heightened the risk of being overweight. Being older and living in wealthier households respectively accounted for about 3- and 2-times higher likelihood of being overweight, while breastfeeding (aRR = 0.65; CI: 0.55-0.76) was protective against overweight. Living in communities with higher poverty and higher education levels reduced and increased the risk of being overweight, respectively. Evidence of community's variability in unhealthy weights was observed in that 11.1% and 3.0% respectively of the variance in the likelihood of being overweight and underweight occurred across communities. CONCLUSIONS The study demonstrated association between urban residence and women overweight. Other important associated factors of overweight included breastfeeding, community education- and poverty-level, while education attainment, marital status and ethnicity were associated with the dual unhealthy weight. Thus, both individual- and community-level characteristics are important considerations for policy makers in designing interventions to address DBM in Malawi.
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Affiliation(s)
- Rotimi Felix Afolabi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Population Studies and Demography Programme & Population and Health Research Entity, Faculty of Humanities, North-West University, Mmabatho, South Africa
| | - Martin Enock Palamuleni
- Population Studies and Demography Programme & Population and Health Research Entity, Faculty of Humanities, North-West University, Mmabatho, South Africa
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Sex Differences in the Association between Internet Usage and Overweight/Obesity: Evidence from a Nationally Representative Survey in Nepal. SEXES 2021. [DOI: 10.3390/sexes2010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the associations between internet use and overweight/obesity in people aged 15–49 years in Nepal and the extent to which these associations differ by biological sex. Materials and methods: The study analyzed the nationally representative Nepal Demographic and Health Survey (NDHS) 2016 data. Multivariable ordinal logistic regression models were fitted to estimate the total effects of internet use (IU) in the last 12 months and frequency of internet use (FIU) in the last month on overweight/obesity adjusted for potential confounders. Results: Of the 10,380 participants, the prevalence of overweight/obesity by IU was 38% (95% confidence interval (CI): 35.9%, 40.1%) for males and 44.1% (95% CI: 41.6%, 46.6%) for female. The likelihood of overweight/obesity was significantly higher (adjusted odds ratio (aOR): 1.55; 95% CI: 1.40, 1.73; p < 0.001) among those participants who used the internet compared to the participants who did not use the internet in the last 12 months. Similar associations were observed when using the augmented measure of exposure-FIU in the last month. We observed the modification effect of sex in the associations of IU (p-difference < 0.001) and FIU (p-difference < 0.002) with overweight/obesity in Nepal. Conclusions: Our findings suggest that future overweight/obesity interventions in Nepal discourage unnecessary internet use, particularly among males.
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Ghimire S, Singh DR, McLaughlin SJ, Maharjan R, Nath D. Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 52:236-245. [PMID: 33430683 DOI: 10.1177/0020731420981928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to evaluate factors associated with health care utilization (HCU) and to assess vertical and horizontal equity in utilization among Nepali older adults. Data are from an existing cross-sectional study involving systematic random sampling of 260 older adults in Far-Western (Sudurpaschim) Province of Nepal. Andersen's theoretical framework was used to assess predisposing, enabling, and need factors that have the potential to influence health care utilization. Multivariable logistic regression analyses were conducted to examine potential correlates of HCU. Horizontal and vertical equity were assessed using concentration curve and index. More than one-third of participants had not visited a health facility in the prior 12 months. Nine in 10 participants did not know about the government's free health service for older adults. Joint/extended family type, Ayurvedic/Homeopathic health care preference, higher-income tertile, and presence of chronic conditions were associated with higher odds of health care utilization in adjusted analyses. The concentration curve for HCU lies below the line of equity, and the subsequent index is positive, indicating that HCU was concentrated among richer individuals. If the government of Nepal is to achieve its goal of universal health care, the existing pro-rich inequity in HCU needs to be addressed.
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Affiliation(s)
- Saruna Ghimire
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.,Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Devendra Raj Singh
- Department of Public Health, Asian College for Advanced Studies, Purbanchal University, Lalitpur, Nepal.,Research and Innovation Section, Southeast Asia Development Actions Network (SADAN), Lalitpur, Nepal
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Renusha Maharjan
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Dhirendra Nath
- Department of Public Health, Asian College for Advanced Studies, Purbanchal University, Lalitpur, Nepal.,Grande International Hospital, Kathmandu, Nepal
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Rawal L, Jubayer S, Choudhury SR, Islam SMS, Abdullah AS. Community health workers for non-communicable diseases prevention and control in Bangladesh: a qualitative study. Glob Health Res Policy 2020; 6:1. [PMID: 33407942 PMCID: PMC7786185 DOI: 10.1186/s41256-020-00182-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The increasing burden of Non-Communicable Diseases (NCDs) in Bangladesh underscores the importance of strengthening primary health care systems. In this study, we examined the barriers and facilitators to engaging Community Health Workers (CHWs) for NCDs prevention and control in Bangladesh. METHODS We used multipronged approaches, including a. Situation analyses using a literature review, key personnel and stakeholders' consultative meetings, and exploratory studies. A grounded theory approach was used for qualitative data collection from health facilities across three districts in Bangladesh. We conducted in-depth interviews with CHWs (Health Inspector; Community Health Care Provider; Health Assistant and Health Supervisor) (n = 4); key informant interviews with central level health policymakers/ managers (n = 15) and focus group discussions with CHWs (4 FGDs; total n = 29). Participants in a stakeholder consultative meeting included members from the government (n = 4), non-government organisations (n = 2), private sector (n = 1) and universities (n = 2). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses. RESULTS The CHWs in Bangladesh deliver a wide range of public health programs. They also provide several NCDs specific services, including screening, provisional diagnosis, and health education and counselling for common NCDs, dispensing basic medications, and referral to relevant health facilities. These services are being delivered from the sub-district health facility, community clinics and urban health clinics. The participants identified key challenges and barriers, which include lack of NCD specific guidelines, inadequate training, excessive workload, inadequate systems-level support, and lack of logistics supplies and drugs. Yet, the facilitating factors to engaging CHWs included government commitment and program priority, development of NCD related policies and strategies, establishment of NCD corners, community support systems, social recognition of health care staff and their motivation. CONCLUSION Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh. However, there is a need for building capacity of CHWs, maximizing CHWs engagement to NCD services delivery, facilitating systems-level support and strengthening partnerships with non-state sectors would be effective in prevention and control efforts of NCDs in Bangladesh.
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Affiliation(s)
- Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, Australia.
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia.
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia.
| | - Shamim Jubayer
- National Heart Foundation Hospital and Research Institute, Mirpur 2, Dhaka, 1216, Bangladesh.
| | - Sohel R Choudhury
- National Heart Foundation Hospital and Research Institute, Mirpur 2, Dhaka, 1216, Bangladesh
| | | | - Abu S Abdullah
- Global Health Research Center, Duke Kunshan University, 8 Duke Avenue, Kunshan, 215347, People's Republic of China.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
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Rawal LB, Kharel C, Yadav UN, Kanda K, Biswas T, Vandelanotte C, Baral S, Abdullah AS. Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study. BMJ Open 2020; 10:e040350. [PMID: 33318116 PMCID: PMC7737104 DOI: 10.1136/bmjopen-2020-040350] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/21/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/OBJECTIVE The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal. DESIGN We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders' consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically. SETTING Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level. PARTICIPANTS We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6). RESULTS The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation. CONCLUSION Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW's capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.
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Affiliation(s)
- Lal B Rawal
- School of Health Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, NSW, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia
- Translational Health Research Institute (THRI) and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | | | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kie Kanda
- School of Nursing and Midwifery, Western Sydney University, Australia, Sydney, New South Wales, Australia
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | | | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu 215347, China, Kunsan, China
- School of Medicine, Boston Medical Center, Boston University, Boston, Massachusetts, USA
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Spatial distribution and associated factors of underweight in Ethiopia: An analysis of Ethiopian demographic and health survey, 2016. PLoS One 2020; 15:e0242744. [PMID: 33259562 PMCID: PMC7707465 DOI: 10.1371/journal.pone.0242744] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background Underweight is one form of indicators of under-nutrition, which results from the poor nutrient intake and underlying health problems. Its impact is beyond an individual and extends to a country level. It has been known from the literature that underweight has a negative effect on income and development of a country. In the context of Ethiopia, factors predicting underweight remain unknown and there is a paucity of evidence on geographical distribution of underweight among individuals aged 15–49 years. Therefore, the aim of this study was to examine the geographic distribution of underweight and its associated factors among individuals aged 15–49 years in Ethiopia. Methods Secondary data analysis was done on a data set consisting of 28,450 individuals and obtained from the Ethiopian Demography and Health Survey (EDHS) 2016. The spatial distribution of underweight across the country was identified by ArcGIS software. Hotspots analysis was done using Getis-Ord Gi* statistic within ArcGIS. In SaTScan software, the Bernoulli model was fitted by Kulldorff’s methods to identify the purely spatial clusters of underweight. A binary logistic regression was applied to determine factors associated with being underweight. Result In Ethiopia, the spatial distribution of underweight was clustered with Global Moran’s I = 0.79 at p-value < 0.0001. The highest underweight clusters were observed in Tigray, Gambella, eastern part of Amhara, and western and central part of Afar regions. Male individuals [AOR = 1.21; 95% CI: (1.15 1.28)], never married [AOR = 1.14; 95% CI: (1.05, 1.24)], rural residents [AOR = 1.32; 95% CI: (1.18, 1.47)], rich [AOR = 0.85; 95% CI: (0.76, 0.94)], cigarette smoking [AOR = 1.25; 95% CI: (1.07, 1.46)], drinking treated water [AOR = 0.91; 95% CI: (0.83, 0.99)] and open filed defecation [AOR = 1.17; 95% CI: (1.08, 1.26)] were found to have a significant association with being underweight. Conclusions There was a significant clustering of underweight among individuals aged 15–49 years. Gender, age, marital status, place of residence, wealth index, cigarette smoking, using untreated water and types of toilet were the significant factors of being underweight. Therefore, effective public health interventions like building safe and supportive environments for nutrition, providing socio-economic protection and nutrition-related education for poor and rural resident would be better to mitigate these situations and associated risk factors in hot spot areas. In addition, policymakers should strengthen and promote nutrition sensitive policies and activities in order to alleviate the underlying and basic causes of underweight.
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Seidu AA, Ahinkorah BO, Agbaglo E, Nyaaba AA. Overweight and obesity among women of reproductive age in Mali: what are the determinants? Int Health 2020; 13:428-435. [PMID: 33210112 PMCID: PMC8417097 DOI: 10.1093/inthealth/ihaa094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/27/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background Existing evidence suggests that there has been a surge of overweight and obesity in low- and middle-income countries around the world. In this study we investigated the prevalence and factors associated with overweight and obesity among women in Mali. Methods We conducted the study among 5198 women using the 2018 Mali Demographic and Health Survey data. We used binary logistic regression for the analysis and pegged statistical significance at p<0.05. Results The prevalence of overweight and obesity was 26.9%. The likelihood of overweight and obesity was high among women 40–44 y of age (adjusted odds ratio [AOR] 5.94 [confidence interval {CI} 4.10 to 8.60]), those who were widowed/divorced/separated (AOR 1.59 [CI 1.04 to 2.43]), those with secondary education (AOR 1.41 [CI 1.13 to 1.75]), richest women (AOR 3.61 [CI 2.63 to 4.95]), those who watched television at least once a week (AOR 1.28 [CI 1.07 to 1.52]) and those who lived in the Kidal region (AOR 10.71 [CI 7.05 to 16.25]). Conversely, the likelihood of overweight and obesity was low among women who belonged to other religions compared with Muslims (AOR 0.63 [CI 0.43 to 0.92]). Conclusions This study found a predominance of overweight and obesity among women in Mali. The study showed that age, marital status, education, religion, region of residence, wealth status and frequency of watching television are associated with overweight and obesity among women in Mali. It is therefore critical for public health promotion programs in Mali to sensitize people to the negative effects associated with overweight and obesity. This implies that policies aimed at controlling overweight and obesity in Mali must take these factors into consideration.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Albert Apotele Nyaaba
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,Youth Harvest Foundation Ghana, Bolgatanga, Ghana
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Schwinger C, Chandyo RK, Ulak M, Hysing M, Shrestha M, Ranjitkar S, Strand TA. Prevalence of Underweight, Overweight, and Obesity in Adults in Bhaktapur, Nepal in 2015-2017. Front Nutr 2020; 7:567164. [PMID: 33072798 PMCID: PMC7536337 DOI: 10.3389/fnut.2020.567164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/18/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction: There is an increase in the double burden of malnutrition globally, with a particular rise documented in Asia. In Nepal, undernutrition has been prevalent for decades. Today, however, the incidence of overweight and obesity (OWOB) in the country has increased substantially. There is a need to conduct local studies reporting on the concurrent burden of both underweight and OWOB across adult populations. This study addresses this need by describing the distribution of body mass index (BMI) in a defined population of adults living in the peri-urban community of Bhaktapur, Nepal. Material and methods: For this cross-sectional analysis, we used data that were available from 600 women and 445 men whose children were enrolled in an individually randomized, double-blind, placebo-controlled trial assessing the effect of daily vitamin B12 supplementation. Upon enrolment of their 6–11-month old children, mothers and fathers were interviewed about their socio-demographic details. In addition, their weight and height were measured by trained field workers. Each parent's BMI was calculated as the ratio of body weight (in kg) and height squared (in m), expressed as kg/m2, and categorized according to the WHO recommendation. We used linear and multinomial logistic regression models to assess associations between the BMI of the mothers and fathers, and their baseline characteristics. Results: The mean BMI was 23.7 kg/m2 for both the mothers and fathers with a standard deviation (SD) of 3.6 and 3.7, respectively. The proportion categorized as underweight, overweight, and obese was also similar in the two groups with around 5% being underweight, 30% being overweight and 5% being obese. Age was positively associated with BMI in both groups. Those categorized as daily wage earner had a lower mean BMI than those in other occupational groups. Conclusion: Our results contribute to documenting the burden of both under- and overnutrition in a selected group of young adults living in a peri-urban community in Nepal. As Nepal is undergoing an improvement in its economic situation, as well as a nutrition transition, it is important to provide sufficient information to enable timely action, and evidence-based decision-making to prevent a further increase in Nepal's growing double burden of malnutrition.
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Affiliation(s)
- Catherine Schwinger
- Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Ram K Chandyo
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Manjeswori Ulak
- Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway.,Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Merina Shrestha
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Suman Ranjitkar
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Tor A Strand
- Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway.,Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
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Shrestha R, Rawal L, Bajracharya R, Ghimire A. Predictors of cardiac self-efficacy among patients diagnosed with coronary artery disease in tertiary hospitals in Nepal. J Public Health Res 2020; 9:1787. [PMID: 33437751 PMCID: PMC7789426 DOI: 10.4081/jphr.2020.1787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Cardiac self-efficacy determines how people feel, think, motivate themselves and behave with regards to improving their cardiac health subsequently preventing complications of coronary artery disease (CAD). Given almost one-third of global death is contributed by CAD with 10% of disability adjusted life years lost in low- and middle-income countries (including Nepal), it is important to identify factors that can promote cardiac self-efficacy. There are no studies in Nepal focusing on predictors of self-efficacy. Therefore, we aim to determine the predictors of cardiac self-efficacy of CAD patients in Nepal. Design and Methods: This is a cross-sectional study where we recruited 170 patients (≥30 years) diagnosed with CAD from two tertiary level hospitals. Multiple linear regression model was used to identify the predictors of cardiac self-efficacy. Results: The mean age of the participants was 60.45±10.39 years (range, 31-83). Most of the participants were diagnosed as myocardial infarction (91.2%), rest with unstable angina (6.5%) and stable angina (2.4%). The multivariate analysis shows age (p<0.001), health behaviors (p<0.001) and knowledge of the disease (p<0.001) were statistically significant predictors to cardiac self-efficacy. Every 1-year increase in age was associated with 0.23 units increase in cardiac self-efficacy score. Similarly, every unit increase in health behavior score and knowledge of disease score was associated with 0.432 units and 0.475 units increase in cardiac self-efficacy score respectively. Conclusion: Age and health behaviors were the strongest predictors of cardiac self-efficacy followed by knowledge of the disease. We conclude that those with poor health behavior are at a greater risk of poorer cardiac self-efficacy compared to those with relatively good level of self-efficacy. Public health interventions such as awareness raising about cardiac disease and health behavior modification along with early screening, diagnosis and appropriate care are essential to improving self-efficacy and cardiac care outcomes.
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Affiliation(s)
- Rabina Shrestha
- Dhulikhel Hospital Kathmandu University Hospital, Kathmandu, Nepal
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, Australia
| | | | - Anup Ghimire
- BP Koirala Institute of Health Sciences, Dharan, Nepal Research carried out in: Manmohan Cardiothoracic and Vascular Transplant Center, Maharajgunj and BP Koiral Institue of Health Science, Dharan, Nepal
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Ahmed KY, Abrha S, Page A, Arora A, Shiferaw S, Tadese F, Seifu CN, Yeneabat T, Alemu E, Gebremichael DY, Seiko A, Ogbo FA. Trends and determinants of underweight and overweight/obesity among urban Ethiopian women from 2000 to 2016. BMC Public Health 2020; 20:1276. [PMID: 32838771 PMCID: PMC7447570 DOI: 10.1186/s12889-020-09345-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nutritional, epidemiological and demographic transitions have been associated with the emergence of the double burden of malnutrition globally. In Ethiopia, there has been no nationally representative investigation of trends and determinants of both underweight and overweight/obesity among urban women. This study examined the trends and determinants of underweight and overweight/obesity in urban Ethiopian women from 2000 to 2016. METHODS Trends in the prevalence of underweight and overweight/obesity were investigated based on a series of the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 2559), 2005 (n = 1112), 2011 (n = 3569), and 2016 (n = 3106). Multivariable multinomial logistic regression was used to investigate the association between socioeconomic, demographic, behavioural, and community-level factors with underweight and overweight/obesity. RESULTS The prevalence of underweight in urban Ethiopian women reduced significantly from 23.2% (95% confidence interval [CI]: 20.3, 26.3%) in 2000 to 14.8% (95% CI: 13.1, 16.7%) in 2016, while overweight/obesity increased significantly from 10.9% (95% CI: 9.1, 13.0%) in 2000 to 21.4% (95% CI: 18.2, 25.1%) in 2016. Urban women from rich households and those who had never married were less likely to be underweight. Urban women who were from wealthy households and those who attained at least secondary education were more likely to be overweight/obese. Women who were informally employed and listened to the radio were less likely to be overweight/obese compared to those who were unemployed and did not listen to the radio, respectively. CONCLUSION The prevalence of overweight/obesity increased from 2000 to 2016, with a concurrent reduction in the prevalence of underweight. Interventions aiming to reduce overweight and obesity should target urban women with higher education, those who resided in wealthier households and those who watched the television.
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Affiliation(s)
- Kedir Y. Ahmed
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
- College of Medicine and Health Sciences, Samara University, Samara-Logia, Ethiopia
| | - Solomon Abrha
- School of Public Health, College of Medicine and Health Sciences, Wolayta Sodo University, Wolayta Sodo, Ethiopia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, Sydney, NSW Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Westmead, Sydney, NSW Australia
| | - Solomon Shiferaw
- School of Public Health, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fentaw Tadese
- College of Medicine and Health Sciences, School of Public Health, Wollo University, Dessie, Ethiopia
| | - Canaan Negash Seifu
- School of Nursing and Midwifery, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
| | - Tebikew Yeneabat
- Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW Australia
| | - Emana Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Abdulaziz Seiko
- CARE Ethiopia, Partner for The Resilience Project, Afar, Samara-Logia, Ethiopia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
- General Practice Unit, Prescot Specialist Medical Centre, Makurdi, Benue State Nigeria
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Ahmed KY, Rwabilimbo AG, Abrha S, Page A, Arora A, Tadese F, Beyene TY, Seiko A, Endris AA, Agho KE, Ogbo FA. Factors associated with underweight, overweight, and obesity in reproductive age Tanzanian women. PLoS One 2020; 15:e0237720. [PMID: 32834011 PMCID: PMC7444815 DOI: 10.1371/journal.pone.0237720] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania. METHODS This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity. RESULTS Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13). CONCLUSION Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.
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Affiliation(s)
- Kedir Y. Ahmed
- College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- * E-mail:
| | - Abdon G. Rwabilimbo
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Chato District Council, Geita Region, Northwestern Tanzania
| | - Solomon Abrha
- School of Public Health, College of Medicine and Health Science, Wolayta Sodo University, Wolayta Sodo, Ethiopia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Fentaw Tadese
- College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tigistu Yemane Beyene
- CDT Africa, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Kingsley E. Agho
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- General Practice Unit, Prescot Specialist Medical Centre Makurdi, Makurdi, Benue State, Nigeria
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Letamo G. Dual burden of underweight and overweight/obesity among adults in Botswana: prevalence, trends and sociodemographic correlates: a cross-sectional survey. BMJ Open 2020; 10:e038614. [PMID: 32641341 PMCID: PMC7348473 DOI: 10.1136/bmjopen-2020-038614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To estimate the prevalence and trends in underweight, overweight/obesity and identify their sociodemographic correlates among adults in Botswana from 2007 to 2017. DESIGN The study analysed cross-sectional and nationally representative data from 2007 to 2014 Botswana STEPS Surveys and the 2017 Botswana Demographic Survey. SETTING Botswana. PARTICIPANTS Botswana adults aged 25-64 years (n=4003 in 2007, n=2983 in 2014 and n=11 550 in 2017). PRIMARY OUTCOME Underweight and overweight/obesity. RESULTS The prevalence of underweight decreased from 18.1% (95% CI 12.0% to 26.3%) in 2007 to 11.6% (95% CI 9.5% to 13.9%) in 2014 and further dropped to 8.1% (95% CI 7.5% to 8.8%) in 2017. The prevalence of overweight/obesity increased slightly from 37.4% (95% CI 34.3% to 40.7%) in 2007 to 38.6% (95% CI 35.9% to 41.3%) in 2014 to 47.3% (95% CI 46.1% to 48.4%) in 2017. Underweight was more prevalent among males than females while overweight and obesity were more prevalent among females than males. The key risk factor for underweight was being male (adjusted OR (AOR) 2.21: 95% CI 1.80 to 2.72 in 2007, AOR 1.54: 95% CI 1.06 to 2.22 in 2014 and AOR 1.51: 95% CI 1.45 to 1.58 in 2017). For overweight/obesity, the main risk factors were being female (male AOR 0.23: 95% CI 0.15 to 0.35 in 2007, AOR 0.32: 95% CI 0.25 to 0.42 in 2014 and AOR 0.30: 95% CI 0.29 to 0.31 in 2017), being old (AOR 2.18: 95% CI 1.58 to 3.01 in 2007, AOR 2.37: 95% CI 1.71 to 3.29 in 2014) and AOR 2.10: 95% CI 1.94 to 2.27 in 2017 among those aged 55-64 years) and not working (AOR 1.70: 95% CI 1.20 to 2.42 in 2007, AOR 2.05: 95% CI 1.55 to 2.69 in 2014 and AOR 1.34: 95% CI 1.27 to 1.40 in 2017). CONCLUSIONS The findings presented in this study indicate coexistence of the double burden of underweight and overweight/obesity among adults aged 25-64 years in Botswana. Although underweight prevalence is on the decline, overweight/obesity is increasing over time. The problem of underweight and overweight/obesity needs immediate and effective interventions.
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Ghimire U, Shrestha N, Gyawali B, Pradhan PMS, Mishra SR. Prevalence of American Heart Association defined ideal cardiovascular health metrics in Nepal: findings from a nationally representative cross-sectional study. Int Health 2020; 12:325-331. [PMID: 31693104 PMCID: PMC7322193 DOI: 10.1093/inthealth/ihz088] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/05/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The ever-increasing burden of non-communicable diseases (NCDs) is posing a serious health challenge for Nepal. This study examines the status of ideal cardiovascular health (ICH) and its associated determinants in Nepal using the American Heart Association (AHA) definition of ICH metrics. METHODS The AHA has defined ICH as having five to seven of the ideal health metrics. A representative sample from the NCD risk factors STEPS survey 2013 were drawn to analyse the prevalence and sociodemographic determinants of ideal, intermediate and poor cardiovascular health in Nepal. Multivariable logistic regression was used to measure the determinants of ICH. RESULTS More than half of the participants had ICH metrics (51.6%), with the 45-69 y age group having the lowest prevalence of ICH (28%) and females having better cardiovascular health compared with their male counterparts (60.6% vs 41.7%). The prevalence of low intake of fruit and vegetables, tobacco smoking and elevated blood pressure were quite high (99%, 18.8% and 31.4%, respectively). The status of ICH declined with age: individuals 15-29 y of age had 6 times (95% confidence interval [CI] 4.80-8.60) higher odds of having ICH compared with those who were 45-69 y, and it was low among urban residents (referent: rural; adjusted odds ratio 0.77 [95% CI 0.58-1.01]). CONCLUSIONS Nearly half of the participants had ICH, which declined with ageing. Further, urban residents had poor cardiovascular health. This highlights the need for a comprehensive population-based intervention targeting elderly and urban residents to improve overall cardiovascular health.
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Affiliation(s)
- Umesh Ghimire
- New ERA, Rudramati Marga, Kalopul, Kathmandu 44600, Nepal
| | - Nipun Shrestha
- Institute for Health and Sport, Victoria University, Melbourne, VC, Australia
| | - Bishal Gyawali
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Pranil Man Singh Pradhan
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Keramat SA, Alam K, Gow J, Biddle SJH. Impact of Disadvantaged Neighborhoods and Lifestyle Factors on Adult Obesity: Evidence From a 5-Year Cohort Study in Australia. Am J Health Promot 2020; 35:28-37. [PMID: 32458696 DOI: 10.1177/0890117120928790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aims to investigate the impact of disadvantaged neighborhoods and lifestyle factors on obesity among Australian adults. DESIGN Quantitative, longitudinal research design. SETTING Cohort. SAMPLE Data for this study came from a cohort of 10 734 adults (21 468 observations) who participated in the Household, Income and Labour Dynamics in Australia survey. The participants were interviewed at baseline in 2013 and were followed up in 2017. MEASURES Generalized Estimating Equation model with logistic link function was employed to examine within-person changes in obesity due to disadvantaged neighborhoods and lifestyle factors at 2-time points over a 4-year follow-up period. RESULTS Adults living in the most disadvantaged area were 1.22 (odds ratio [OR]: 1.22, 95% CI: 1.08-1.38) and 1.30 (OR: 1.30, 95% CI: 1.20-1.42) times, respectively, more prone to be overweight and obese compared with peers living at least disadvantaged area. Study results also revealed that adults who consume fruits regularly and perform high levels of physical activity were 6% (OR: 0.94, 95% CI: 0.91-0.98) and 12% (OR: 0.88, 95% CI: 0.85-0.92) less likely to be obese, respectively, compared to their counterparts. Current alcohol drinkers were 1.07 (OR: 1.07, 95% CI: 1.01-1.13) times more likely to be obese compared to peers not consuming alcohol. Highly psychologically distressed adults were 1.08 times (OR: 1.08, 95% CI: 1.02-1.13) more likely to be obese than their peers. CONCLUSION This study contributes to the literature regarding disadvantaged neighborhoods and lifestyle factors, which have an influence on adult obesity rates and thus help health decision-makers to formulate effective obesity prevention strategies.
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Affiliation(s)
- Syed Afroz Keramat
- School of Commerce, 7932University of Southern Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, Informatics and Economic Research, 7932University of Southern Queensland, Toowoomba, Queensland, Australia
- Economics Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Khorshed Alam
- School of Commerce, 7932University of Southern Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, Informatics and Economic Research, 7932University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Gow
- School of Commerce, 7932University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics, and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Stuart J H Biddle
- Centre for Health Research, Informatics and Economic Research, 7932University of Southern Queensland, Toowoomba, Queensland, Australia
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Neupane G, Acharya S, Bhattarai M, Upadhyay A, Belbase B, Bhandari M, Pandeya D, Pokharel S, Ghimire S, Thapa G, Karmacharya B, Bhatt MR, Spertus JA, Neupane D, Timsina L, Pokharel Y. Study, Design, and Rationale of Noncommunicable Diseases in Nepal (NCD Nepal) Study: A Community-Based Prospective Epidemiological and Implementation Study in Rural Nepal. Glob Adv Health Med 2020; 9:2164956120917379. [PMID: 32284911 PMCID: PMC7139172 DOI: 10.1177/2164956120917379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/24/2020] [Accepted: 03/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs) are the leading causes of deaths globally. Currently, there are limited high-quality data on the epidemiology and usefulness of community-based screening and treatment of NCDs in low-to-middle-income countries (LMIC), like Nepal. We describe the protocol of a community-based, longitudinal epidemiological study of screening and management of NCDs in rural Nepal. METHODS We organize monthly mobile health clinics to screen NCDs among 40- to 75-year-old residents from municipal subdivision wards 3, 4, 6, and 7 of Ghorahi submetropolitan city, Dang, Nepal (approximately 406 km west of the capital, Kathmandu). We estimate a total of 7052 eligible participants. After obtaining informed consent, trained personnel will collect sociodemographic and lifestyle data, medical, medication, and family history using validated questionnaires, plus anthropometric measures and capillary glucose levels. We will screen for hypertension, diabetes, obesity, dyslipidemia, tobacco and alcohol use, self-reported physical activity, dietary habits, cardiovascular disease, stroke, chronic lung disease, cancer, and chronic kidney disease. We will also check hemoglobin A1C, lipid panel, serum creatinine, sodium, potassium, urine dipstick, and urine albumin-to-creatinine ratio in high-risk participants. We will offer lifestyle counseling, pharmacotherapy or refer to higher level care, where appropriate; routinely follow participants with NCDs for continuity of care; and follow individuals without NCDs but with elevated glucose, prehypertension or other risk factors every year, and those without risk factors every 2 years. We will monitor participants in the community to reduce attrition and to track all-cause and disease-specific mortality. DISCUSSION Understanding the community burden of NCDs in resource-limited setting and testing effectiveness of community-based screening and management of NCDs will provide insights to develop national policy to address NCD burden in LMIC like Nepal.
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Affiliation(s)
- Gagan Neupane
- Health Foundation Nepal, Lalitpur, Nepal
- Shreegaun Primary Health Care Center, Dang, Nepal
| | - Sameer Acharya
- Health Foundation Nepal, Lalitpur, Nepal
- Shreegaun Primary Health Care Center, Dang, Nepal
| | - Manoj Bhattarai
- Health Foundation Nepal, Lalitpur, Nepal
- Department of Medicine/Nephrology, Kidney Specialists of the
Palm Beach, Palm Beach, Florida
| | - Ashish Upadhyay
- Health Foundation Nepal, Lalitpur, Nepal
- Section of Nephrology, Department of Medicine, Boston University
School of Medicine, Boston, Massachusetts
| | | | - Manoj Bhandari
- Health Foundation Nepal, Lalitpur, Nepal
- Department of Cardiology, Bronx Care Health System, New York,
New York
| | - Drona Pandeya
- Health Foundation Nepal, Lalitpur, Nepal
- Chemistry Department, Sonic Healthcare, Clinical Pathology
Laboratories, Austin, Texas
| | | | | | | | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu
University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel,
Nepal
- Sun Yat-sen Global Health Institute, Sun Yat-sen University,
Guangzhou, China
| | | | - John A Spertus
- Saint Luke’s Mid America Heart Institute, University of
Missouri, Kansas City, Missouri
| | - Dinesh Neupane
- Nepal Development Society, Chitwan, Nepal
- Welch Center for Prevention, Epidemiology and Clinical
Research, Johns Hopkins University, Baltimore, Maryland
| | - Lava Timsina
- Health Foundation Nepal, Lalitpur, Nepal
- Centers of Outcomes Research in Surgery, Department of Surgery,
Indiana University, Indianapolis, Indiana
| | - Yashashwi Pokharel
- Health Foundation Nepal, Lalitpur, Nepal
- America Nepal Medical Foundation, New York, USA
- Saint Luke’s Mid America Heart Institute, University of
Missouri Kansas City, Missouri
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Shrestha N, Mishra SR, Ghimire S, Gyawali B, Pradhan PMS, Schwarz D. Application of single-level and multi-level modeling approach to examine geographic and socioeconomic variation in underweight, overweight and obesity in Nepal: findings from NDHS 2016. Sci Rep 2020; 10:2406. [PMID: 32051421 PMCID: PMC7016110 DOI: 10.1038/s41598-019-56318-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/27/2019] [Indexed: 11/09/2022] Open
Abstract
Nepal's dual burden of undernutrition and over nutrition warrants further exploration of the population level differences in nutritional status. The study aimed to explore, for the first time in Nepal, potential geographic and socioeconomic variation in underweight and overweight and/or obesity prevalence in the country, adjusted for cluster and sample weight. Data came from 14,937 participants, including 6,172 men and 8,765 women, 15 years or older who participated in the 2016 Nepal Demography and Health Survey (NDHS). Single-level and multilevel multi-nominal logistic regression models and Lorenz curves were used to explore the inequalities in weight status. Urban residents had higher odds of being overweight and/or obese (OR: 1.89, 95% CI: 1.62-2.20) and lower odds of being underweight (OR: 0.81, 95% CI: 0.70-0.93) than rural residents. Participants from Provinces 2, and 7 were less likely to be overweight/obese and more likely to be underweight (referent: province-1). Participants from higher wealth quintile households were associated with higher odds of being overweight and/or obese (P-trend < 0.001) and lower odds of being underweight (P-trend < 0.001). Urban females at the highest wealth quintile were more vulnerable to overweight and/or obesity as 49% of them were overweight and/or obese and nearly 39% at the lowest wealth quintile were underweight.
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Affiliation(s)
- Nipun Shrestha
- Institute for Health and Sport (IHeS), Victoria University, Melbourne, Australia
| | | | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Bishal Gyawali
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pranil Man Singh Pradhan
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Dan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal.,Ariadne Labs, Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Thike TZ, Saw YM, Lin H, Chit K, Tun AB, Htet H, Cho SM, Khine AT, Saw TN, Kariya T, Yamamoto E, Hamajima N. Association between body mass index and ready-to-eat food consumption among sedentary staff in Nay Pyi Taw union territory, Myanmar. BMC Public Health 2020; 20:206. [PMID: 32041555 PMCID: PMC7011543 DOI: 10.1186/s12889-020-8308-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/31/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ready-to-eat (RTE) food consumption has become popular in the working community with the increase in full-time jobs and the limited time to prepare food. Although RTE food is essential for this community, its consumption causes obesity. In Myanmar, obesity is a modifiable risk factor for non-communicable diseases, causing increases in morbidity and mortality. This study aimed to identify the association between body mass index (BMI) and RTE food consumption among sedentary staff in Nay Pyi Taw Union Territory, Myanmar. METHODS A cross-sectional study was conducted in 2018, in which 400 respondents participated in face-to-face interviews. The study area was selected using simple random sampling and drawing method. Measuring tape and digital weighing scale were used to measure the height and weight of the respondents. BMI was calculated by dividing the weight by height squared (kg/m2). Overweight and obesity were categorized by World Health Organization cut-off points. The collected data were analyzed using multiple logistic regression to estimate the adjusted odds ratio (AOR), and the 95% confidence interval (CI). RESULTS This study revealed that sedentary staff who consumed RTE food once or more per month were nearly five times more likely to be overweight and obese (AOR = 4.78, 95% CI 1.44-15.85) than those who consumed RTE food less frequently. In addition, five factors namely being older than 32 years (AOR = 3.97, 95% CI 1.82-8.69), preference for RTE food (AOR = 8.93, 95% CI 2.54-31.37), light-intensity of physical exercise (AOR = 3.55, 95% CI 1.63-7.73), sedentary leisure activities (AOR = 3.32, 95% CI 1.22-9.03), and smoking (AOR = 5.62, 95% CI 1.06-29.90) were positively associated with overweight and obesity. CONCLUSION Frequent consumers of RTE food and less physically active sedentary staff were more likely to be overweight and obese. This study highlights the urgent need to raise awareness regarding healthy lifestyle behaviors among the working community to reduce the burden of obesity-related chronic diseases. Moreover, sedentary workers should be aware of the food-based dietary guidelines of the country. Policy makers should strictly enforce nutritional labeling of RTE food, and strictly prohibit over-branding of RTE food.
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Affiliation(s)
- Thin Zar Thike
- Department of Food and Drug Administration, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Htin Lin
- Department of Food and Drug Administration, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Khin Chit
- Department of Food and Drug Administration, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Ba Tun
- Directorate of Medical Service, Nay Pyi Taw, Myanmar
| | - Hein Htet
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Department of Preventative and Social Medicine, University of Medicine, Mandalay, Myanmar
| | - Su Myat Cho
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Aye Thazin Khine
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thu Nandar Saw
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
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Association between the frequency of television watching and overweight and obesity among women of reproductive age in Nepal: Analysis of data from the Nepal Demographic and Health Survey 2016. PLoS One 2020; 15:e0228862. [PMID: 32040537 PMCID: PMC7010261 DOI: 10.1371/journal.pone.0228862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 01/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of overweight and obesity, particularly among women, is increasing in Nepal. Previous studies in the South Asia have found television watching to be a risk factor for overweight and obesity among women of reproductive age. However, this association had not been studied in the context of Nepal. This study aims to identify the association between frequency of television watching and overweight and obesity among Nepalese women of reproductive age. Methods This cross-sectional study utilized the Nepal Demographic and Health Survey 2016 (NDHS 2016) data. A total weighted sample of 6,031 women were included in the final analyses. The women were 15–49 years of age and were either not pregnant or had not delivered a child within the two months prior to the survey. Body mass index (BMI) was the primary outcome of this study, which was categorized using an Asia-specific cutoff value. Normal and/or underweight was defined as a BMI <23.0 kg/m2, overweight was defined as a BMI between 23.0 kg/m2 and <27.5 kg/m2, and obesity was defined as a BMI ≥27.5 kg/m2. Frequency of watching television was the main independent variable of this study, which was divided into the following three categories: not watching television at all, watching television less than once a week, and watching television at least once a week. Multilevel ordered logistic regression was conducted to find the factors associated with overweight and obesity. A p-value <0.05 was considered significant in the final model. Results Around 35% of the participants were overweight or obese (overweight: 23.7% and obese: 11.6%). A majority of the study participants was aged between 15 and 24 years (36.5%), and resided in an urban area (63.2%), Province No. 3 (22.3%), and the Terai ecological region (49.5%). Around one-third (34.0%) of the participants received no formal education while an almost similar proportion (35.5%) completed secondary education. Approximately half of the study participants (50.6%) reported watching television at least once a week, whereas more than a quarter (28.7%) of them did not watch television at all. Women who watched television at least once a day had a higher prevalence of overweight and obesity than the other groups (p-value <0.0001). Women who watched television at least once a week were 1.3 times more likely to be overweight or obese in comparison to women who never watched television (Adjusted Odds Ratio (AOR): 1.3, 95% CI: 1.0–1.7; p-value <0.05). In the urban areas, women who watched television at least once a week were 40% more likely to be overweight or obese than those who did not watch television at all (AOR: 1.4, 95% CI: 1.1–1.7; p-value <0.01). No significant association between overweight and obesity and the frequency of viewing television was observed in the rural area. Conclusions Watching television at least once a week is associated with overweight and obesity in women of reproductive age living in the urban areas of Nepal. Public health promotion programs should raise awareness among women regarding harmful health consequences of sedentary lifestyle due to television watching.
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Dutta M, Selvamani Y, Singh P, Prashad L. The double burden of malnutrition among adults in India: evidence from the National Family Health Survey-4 (2015-16). Epidemiol Health 2019; 41:e2019050. [PMID: 31962037 PMCID: PMC6976728 DOI: 10.4178/epih.e2019050] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES India still faces the burden of undernutrition and communicable diseases, and the prevalence of overweight/obesity is steadily increasing. The discourse regarding the dual burden of underweight and overweight/obesity has not yet been widely explored in both men and women. The present study assessed the determinants of underweight and overweight/obesity in India among adult men and women aged 15-49. METHODS Population-based cross-sectional and nationally representative data from the National Family Health Survey-4 (2015-16), consisting of a sample of men and women, were analyzed. Stratified 2-stage sampling was used in the NFHS-4 study protocol. In the present study, bivariate and adjusted multinomial logistic regression analyses were performed to determine the correlates of underweight and overweight/obesity. RESULTS The results suggested a persistently high prevalence of underweight coexisting with an increased prevalence of overweight/obesity in India. The risk of underweight was highest in the central and western regions and was also relatively high among those who used either smoking or smokeless tobacco. Overweight/obesity was more prevalent in urban areas, in the southern region, and among adults aged 35-49. Furthermore, level of education and wealth index were positively associated with overweight/obesity. More educated and wealthier adults were less likely to be underweight. CONCLUSIONS In India, underweight has been prevalent, and the prevalence of overweight/obesity is increasing rapidly, particularly among men. The dual burden of underweight and overweight/obesity is alarming and needs to be considered; public health measures to address this situation must also be adopted through policy initiatives.
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Affiliation(s)
- Mili Dutta
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - Y Selvamani
- Department of Development Studies, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Pushpendra Singh
- Department of Humanities and Social Sciences, Indian Institute of Technology Roorkee, Roorkee, India
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Hasan M, Tasfina S, Haque SMR, Saif-Ur-Rahman KM, Khalequzzaman M, Bari W, Islam SS. Association of biomass fuel smoke with respiratory symptoms among children under 5 years of age in urban areas: results from Bangladesh Urban Health Survey, 2013. Environ Health Prev Med 2019; 24:65. [PMID: 31775610 PMCID: PMC6882069 DOI: 10.1186/s12199-019-0827-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Little is known regarding the effect of exposure to biomass fuel smoke inhalation on respiratory symptoms in the Bangladeshi population which is a major health hazard in most of the developing countries. This study aims to explore the association between respiratory symptoms and biomass fuel smoke exposure among children under 5 years of age. METHODS Data were extracted from the Bangladesh Urban Health Survey conducted in 2013. A total of 10,575 mothers with at least one surviving children were selected. Respiratory symptoms among children under 5 years of age were considered as the primary outcome. Sequential multiple logistic regression models were used to observe the association between respiratory symptoms and biomass fuel smoke exposure adjusting the effect of residential factors and mother and child characteristics. RESULTS Around 40% of the mothers exclusively used biomass fuel irrespective of the kitchen location and 54% of them were habituated in indoor cooking. The prevalence of respiratory symptoms of under-five children among in-house and outdoor biomass fuel users was 23.0% and 21.9%, respectively. Results of fitted multiple logistic regression models showed that the odds of having respiratory symptoms among children under 5 years of age were increased due to in-house biomass fuel use [OR = 1.18; 95% CI, 1.04-1.36] compared with the non-biomass user. An increased risk of respiratory symptoms was also significantly associated with mother's birth complication [OR = 1.51; 95% CI, 1.36-1.67], non-government organization (NGO) membership of mothers [OR = 1.32; 95% CI, 1.16-1.51], age of the child (6-23m) [OR = 1.29; 95% CI, 1.10-1.52], and nutritional status (stunting) [OR = 1.18; 95% CI, 1.06-1.31]. CONCLUSION This study found the use of in-house biomass fuel as a significant risk factor associated with respiratory symptoms of children under 5 years of age. More longitudinal studies should be designed to establish a causal relationship between HAP (household air pollution) and respiratory symptoms among children with more direct measures of HAP and clinical procedure.
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Affiliation(s)
- Md Hasan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
| | - Sadia Tasfina
- School of Public Health, Independent University, Dhaka, Bangladesh
| | - S M Raysul Haque
- School of Public Health, Independent University, Dhaka, Bangladesh
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Department of Public Health and Health Systems, University of Nagoya, Nagoya, Japan
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Wasimul Bari
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Pokharel N, Katwal G, Adhikari SK. Comparison of preoperative Nutritional Risk Index and Body Mass Index for predicting immediate postoperative outcomes following major gastrointestinal surgery: Cohort-study. Ann Med Surg (Lond) 2019; 48:53-58. [PMID: 31719977 PMCID: PMC6838228 DOI: 10.1016/j.amsu.2019.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 01/10/2023] Open
Abstract
Background Malnutrition is a major risk factor for morbidity and mortality following gastrointestinal (GI) surgery. Nutritional Risk Index (NRI) and Body Mass Index (BMI) are the two well-validated tools that are readily available and do not add financial burden to the patients. The study aimed to analyze NRI and BMI as a preoperative nutritional indicator of postoperative complications following GI surgeries. Methods It is an observational study, where preoperative nutritional status and early postoperative complications <30 days (infectious or noninfectious) were studied. The patients admitted between July 2015 to May 2017, who underwent major GI surgeries were included in the study. The correlation between NRI and BMI of these patients were evaluated. Results The rate of wound infection was 4 (30.7%) out of 13 in severe malnutrition subgroup defined by NRI <83.5 which was found to be statistically significant (p = 0.003). However, it was not significant in a subgroup of patients with undernutrition defined by BMI <18.49%. In a subgroup analysis, abnormal NRI was found to be statistically significant (p = 0.004) in patients with malignant disease and malnutrition 64 (47.76%) out of 97 (72.3%). The mean NRI (94.49 ± 9.164) better correlated with advancing age (p < 0.05) and the correlation coefficient of 0.3100 showed a significant negative correlation. With 10 fold increase in age (r2 = 0.096) the likelihood of malnutrition was 9.6% and subsequently increased postoperative complications. Conclusion In cases of malignancy and advanced age, NRI is a better predictor of immediate postoperative outcome than BMI. Nutritional Risk Index (NRI) and Body mass Index (BMI) were used to screen the preoperative patients. NRI and BMI are the two well validated tools which is readily available and does not add financial burden to the patients. NRI better correlated with postoperative wound infections and the length of hospital stay. The patients with advanced age and malignant diseases were at higher risk of malnutrition and postoperative complications.
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Affiliation(s)
- Nabin Pokharel
- National Academy of Medical Science (NAMS), Department of Surgical Gastroenterology, Bir Hospital, Mahabaudha, Kathmandu, 44600, Nepal
| | - Gaurav Katwal
- National Academy of Medical Science (NAMS), Department of Surgical Gastroenterology, Bir Hospital, Mahabaudha, Kathmandu, 44600, Nepal
| | - Subodh Kumar Adhikari
- National Academy of Medical Science (NAMS), Department of Surgical Gastroenterology, Bir Hospital, Mahabaudha, Kathmandu, 44600, Nepal
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Rawal LB, Kanda K, Biswas T, Tanim MI, Poudel P, Renzaho AMN, Abdullah AS, Shariful Islam SM, Ahmed SM. Non-communicable disease (NCD) corners in public sector health facilities in Bangladesh: a qualitative study assessing challenges and opportunities for improving NCD services at the primary healthcare level. BMJ Open 2019; 9:e029562. [PMID: 31594874 PMCID: PMC6797278 DOI: 10.1136/bmjopen-2019-029562] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To explore healthcare providers' perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services delivery at the primary healthcare level. DESIGN We used a grounded theory approach involving in-depth qualitative interviews with healthcare providers. We also used a health facility observation checklist to assess the NCD corners' service readiness. Furthermore, a stakeholder meeting with participants from the government, non-government organisations (NGOs), private sector, universities and news media was conducted. SETTING Twelve subdistrict health facilities, locally known as upazila health complex (UHC), across four administrative divisions. PARTICIPANTS Participants for the in-depth qualitative interviews were health service providers, namely upazila health and family planning officers (n=4), resident medical officers (n=6), medical doctors (n=4) and civil surgeons (n=1). Participants for the stakeholder meeting were health policy makers, health programme managers, researchers, academicians, NGO workers, private health practitioners and news media reporters. RESULTS Participants reported that diabetes, hypertension and chronic obstructive pulmonary disease were the major NCD-related problems. All participants acknowledged the governments' initiative to establish the NCD corners to support NCD service delivery. Participants thought the NCD corners have contributed substantially to increase NCD awareness, deliver NCD care and provide referral services. However, participants identified challenges including lack of specific guidelines and standard operating procedures; lack of trained human resources; inadequate laboratory facilities, logistics and medications; and poor recording and reporting systems. CONCLUSION The initiative taken by the Government of Bangladesh to set up the NCD corners at the primary healthcare level is appreciative. However, the NCD corners are still at nascent stage to provide prevention and management services for common NCDs. These findings need to be taken into consideration while expanding the NCD corners in other UHCs throughout the country.
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Affiliation(s)
- Lal B Rawal
- School of Health Medical and Allied Sciences, CQUniversity Sydney, Sydney, New South Wales, Australia
- Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Kie Kanda
- Health Section, Japanese International Cooperation Agency (JICA), Accra, Ghana
| | - Tuhin Biswas
- Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Institute for Social Science Research, University of Queensland, Long Pocket Precinct, Indooroopilly Queensland, Brisbane, Queensland, Australia
| | - Md Imtiaz Tanim
- Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- mPower Social Enterprises Ltd, Dhaka, Bangladesh
| | - Prakash Poudel
- Collaboration for Oral Health Outcomes, Research, Translation and Evaluation (COHORTE) Research Group, Western Sydney University, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu, Kunsan, China
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Syed Masud Ahmed
- Centre of Excellence for Universal Health Coverage (CoE-UHC), James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Affiliation(s)
- Shweta Khandelwal
- 1 Department of Nutrition, Public Health Foundation of India, New Delhi, India
| | - Anura Kurpad
- 2 Department of Physiology, St John's Medical College, Bangalore, Karnataka, India
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Rai A, Gurung S, Thapa S, Saville NM. Correlates and inequality of underweight and overweight among women of reproductive age: Evidence from the 2016 Nepal Demographic Health Survey. PLoS One 2019; 14:e0216644. [PMID: 31075139 PMCID: PMC6510472 DOI: 10.1371/journal.pone.0216644] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/26/2019] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Understanding socio-economic correlates and inequality of underweight and overweight is crucial to develop interventions to prevent adverse health outcomes. MATERIALS AND METHODS We analysed Nepal Demographic and Health Survey 2016 data from 6,069 women aged 15-49 years. WHO cut-offs for Body Mass Index categorised as: underweight (<18.5 kg/m2), normal weight (18.5kg/m2 to 24.9kg/m2) and overweight/ obesity (> = 25.0 kg/m2) were used. We used multinomial logistic regression to explore associations of factors with Body Mass Index and concentration indices to estimate socio-economic inequalities. RESULTS Higher risk of underweight was found in age group 15-19 (RRR 3.08, 95% CI: 2.29-4.15), 20-29 (RRR 1.64, 95% CI: 1.29-2.08) and in lowest (RRR 1.60, 95% CI: 1.03-2.47) and second wealth quintiles (RRR 1.77 (95% CI: 1.18-2.64). Education, occupation, urban/rural residence and food security were not associated with underweight (p>0.05). Lower risk of overweight/obesity was found in age group 15-19 (RRR 0.07, 95% CI: 0.05-0.10), 20-29 (RRR 0.40, 95% CI: 0.32-0.51), in manual occupation (RRR 0.58, 95% CI: 0.46-0.74) and in lower quintiles. Women with primary (RRR 1.91, 95% CI: 1.36-2.67), secondary education (RRR 1.42, 95% CI 1.00, 2.01) were at increased risk of overweight/obesity. Household food security and urban/rural residence were not associated with overweight/obesity (p>0.05). Socioeconomic inequalities were detected, with overweight/obesity strongly concentrated (concentration index: 0.380) amongst the higher quintiles and underweight concentrated (concentration index: -0.052) amongst the poorest. CONCLUSION Nutrition programmes should target younger and poor women to address undernutrition and higher wealth group women to address overnutrition. Equity based nutrition interventions improving socio-economic status of poor households may benefit undernourished women. Interventions to encourage physical activity as women age and among wealthier women as well as healthy eating for prevention of under- and over-nutrition are needed.
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Affiliation(s)
- Anjana Rai
- Independent researcher, Kathmandu, Nepal
- * E-mail:
| | | | - Subash Thapa
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Visiting Researcher, Prince Naif Bin Abdulaziz Health Research Centre, King Saud University, Riyadh, Saudi Arabia
| | - Naomi M. Saville
- Institute for Global Health, University College London, London, United Kingdom
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