The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey

World Health Organization (WHO) estimates for deaths attributed to Non Communicable Diseases (NCDs) in Nepal have risen from 51% in 2010 to 60% in 2014. This study assessed the distribution and determinants of NCD risk factors among the Nepalese adult population. A nationally representative cross-se...

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Published in:	PloS one Vol. 10; no. 8; p. e0134834
Main Authors:	Aryal, Krishna Kumar, Mehata, Suresh, Neupane, Sushhama, Vaidya, Abhinav, Dhimal, Meghnath, Dhakal, Purushottam, Rana, Sangeeta, Bhusal, Chop Lal, Lohani, Guna Raj, Paulin, Frank Herbert, Garg, Renu Madanlal, Guthold, Regina, Cowan, Melanie, Riley, Leanne Margaret, Karki, Khem Bahadur
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 05-08-2015 Public Library of Science (PLoS)
Subjects:	Adolescent Adult Aged Alcohol Alcohol Drinking - epidemiology Alcohol use Alcoholic beverages Alcohols Blood Blood glucose Blood Glucose - analysis Blood pressure Body mass Body weight Care and treatment Cholesterol Cholesterol - blood Communicable diseases Councils Cross-Sectional Studies Demographics Diabetes Diet Disease Disease prevention Drugs Education Exercise Female Fruits Glucose Health risk assessment Health risks Health Surveys Humans Hypertension Hypertension - epidemiology Male Management Medical research Men Middle Aged Nepal - epidemiology Obesity Obesity - epidemiology Overweight Overweight - epidemiology Physical activity Poisson density functions Population Prevalence Public health Regression models Risk analysis Risk Factors Rural areas Rural Population Rural populations Sampling methods Smoking Smoking - epidemiology Socioeconomic Factors Statistical analysis Surveys Tobacco Urbanization Vegetables Young Adult Nepal India East Asia Maldives Malawi Switzerland
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Summary:	World Health Organization (WHO) estimates for deaths attributed to Non Communicable Diseases (NCDs) in Nepal have risen from 51% in 2010 to 60% in 2014. This study assessed the distribution and determinants of NCD risk factors among the Nepalese adult population. A nationally representative cross-sectional survey was conducted from Jan to June 2013 on the prevalence of NCD risk factors using the WHO NCD STEPS instrument. A multistage cluster sampling method was used to randomly select the 4,200 respondents. The adjusted prevalence ratio (APR) was used to assess the determinants of NCD risk factors using a Poisson regression model. The prevalence of current smoking (last 30 days) was 19% (95%CI:16.6-20.6), and harmful alcohol consumption (≥60 g of pure alcohol for men and ≥40 g of pure alcohol for women on an average day) was 2% (95%CI:1.4-2.9). Almost all (99%, 95%CI:98.3-99.3) of the respondents consumed less than five servings of fruits and vegetables combined on an average day and 3% (95%CI:2.7-4.3) had low physical activity. Around 21% (95%CI:19.3-23.7) were overweight or obese (BMI≥25). The prevalence of raised blood pressure (SBP≥140 mm of Hg or DBP≥90 mm of Hg) and raised blood glucose (fasting blood glucose ≥126 mg/dl), including those on medication were 26% (95%CI:23.6-28.0) and 4% (95%CI:2.9-4.5) respectively. Almost one quarter of respondents, 23% (95%CI:20.5-24.9), had raised total cholesterol (total cholesterol ≥190 mg/dl or under current medication for raised cholesterol). he study revealed a lower prevalence of smoking among women than men (APR:0.30; 95%CI:0.25-0.36), and in those who had higher education levels compared to those with no formal education (APR:0.39; 95%CI:0.26-0.58). Harmful alcohol use was also lower in women than men (APR:0.26; 95%CI:0.14-0.48), and in Terai residents compared to hill residents (APR:0.16; 95%CI:0.07-0.36). Physical inactivity was lower among women than men (APR:0.55; 95%CI:0.38-0.80), however women were significantly more overweight and obese (APR:1.19; 95%CI:1.02-1.39). Being overweight or obese was significantly less prevalent in mountain residents than in hill residents (APR:0.41; 95%CI:0.21-0.80), and in rural compared to urban residents (APR:1.39; 95%CI:1.15-1.67). Lower prevalence of raised blood pressure was observed among women than men (APR:0.69; 95%CI: 0.60-0.80). Higher prevalence of raised blood glucose was observed among urban residents compared to rural residents (APR:2.05; 95%CI:1.29-3.25). A higher prevalence of raised total cholesterol was observed among the respondents having higher education levels compared to those respondents having no formal education (APR:1.76; 95%CI:1.35-2.28). The prevalence of low fruit and vegetable consumption, overweight and obesity, raised blood pressure and raised total cholesterol is markedly high among the Nepalese population, with variation by demographic and ecological factors and urbanization. Prevention, treatment and control of NCDs and their risk factors in Nepal is an emerging public health problem in the country, and targeted interventions with a multi-sectoral approach need to be urgently implemented.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Conceived and designed the experiments: KKA SM SN CLB FHP RMG RG. Performed the experiments: KKA SM SN AV CLB. Analyzed the data: KKA SM SN RG MC LMR. Contributed reagents/materials/analysis tools: FHP RMG RG MC LMR. Wrote the paper: KKA SM AV MD PD SR GRL KBK. Current Address: London Borough of Merton, London, United Kingdom Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0134834