2004-12-31-世界卫生组织-2005_STEPS_Country_Report_Nepal_79页_3mb

报告摘要

Summary of NCD Risk Factors Surveillance in Nepal (Ilam, Lalitpur, Tanahu)

Core Content

This report presents the findings of the WHO STEPwise approach to surveillance of non-communicable disease (NCD) risk factors in three districts of Nepal: Ilam, Lalitpur, and Tanahu, conducted in 2004/5. The study aimed to assess the distribution of selected NCD risk factors among the 15-64 years age group, using standardized methods to inform prevention and control strategies.

Main Objectives

To estimate the distribution of NCD risk factors as part of a sequential process to establish a comprehensive, integrated, systematic, and sustainable population-based data collection system.
To establish an NCD surveillance sentinel network in Nepal.
To determine the baseline level of population-level risk factors for NCDs.

Key Findings

Demographic Information

Total participants: 7,792 (3,674 males and 4,118 females)
Sex ratio: 0.9:1 (male to female)
Mean number of adults over 15 years per household: ~4
Literacy rate: 39% were illiterate; 48% had primary and secondary education; 11% had intermediate or higher education
Employment status: 71% were unemployed; 22% were self-employed; 4% were in non-government sectors; 3% were government employed

Tobacco Use

41% of the total respondents used tobacco (smoking or smokeless)
21% had ever smoked; 20% had ever used smokeless tobacco
Average age of initiation: 19 years (16.42 years for 15-24 years group)
Mean duration of smoking: ~27 years; 40 years for 55-64 years group
23% of participants had quit smoking, indicating a positive anti-smoking trend among younger age groups

Alcohol Use

38% of the population had ever consumed alcohol
37% were current consumers
Mean weekly standard drinks: 3.3 (M: 3.7, F: 1.9)
Mean daily standard drinks: 4.36 (M: 5.03, F: 3.45)
Largest number of drinks in a single occasion: 8.7 for males and 4.8 for females
Mean occasions for >5 standard drinks per week: 79 for males and 65 for females

Diet

Daily vegetable servings: 2.49 (M: 2.57, F: 2.42)
Daily fruit servings: 2.53 for males and 2.14 for females

Physical Activity

Median time of total physical activity per day: 30 minutes
74% of males and 91% of females were physically inactive
27% of males and 42% of females were overweight

Health Conditions

20% of males and 17% of females were hypertensive
24.84% of total hospital deaths were due to NCDs
Cardiovascular deaths accounted for 44.38% of NCD-related deaths; COPD accounted for 37.38%

Study Design

Type: Descriptive cross-sectional study
Sampling Method: Multi-stage cluster sampling
Sample Size: 8,500 individuals from 19 VDCs and 2 municipalities
Sampling Frame: Based on the 2001 census data, with a focus on urban and rural areas
Inclusion Criteria: Individuals aged 15-64 years who were permanent residents
Exclusion Criteria: Institutionalized individuals, temporary residents, and those in conflict zones

Data Collection and Management

Data Collection: Face-to-face interviews using a structured questionnaire
Language: Questionnaire translated into Nepali and back to English for consistency
Training: Conducted for data collectors, data managers, and supervisors
Quality Assurance:
- 25% of interviews were randomly checked by supervisors
- 10% of questionnaires were re-interviewed
- Double data entry and verification on 5% of the sample
- Standardized procedures and neutral questioning to ensure reliability and minimize bias

Ethical Considerations

The study followed NHRC research guidelines
Informed consent was obtained from all participants
No interventions were performed; participants with health issues were referred to nearby health institutions

Constraints and Limitations

The study was limited to three districts, making it non-representative of the national population
Overestimation of the capacity of supervisors, data operators, and interviewers
Challenges in standardizing the measurement of local context-based variables like physical activity and diet

Key Stakeholders

Implementing Agency: Society for Local Integrated Development Nepal (SOLID Nepal)
Principal Investigator: Dr. Nirakar Man Shrestha
Co-Investigators: Dr. Rajendra Raj Wagle and Dr. Khem Bdr. Karki
Steering Committee: Includes high-level officials from the Ministry of Health and Population, WHO, and CBS
Organization Committee: Composed of health professionals and administrators
Statisticians: From CBS and SOLID Nepal
Report Writing: Dr. Khem Bdr. Karki and Anju Regmi

Methodology

STEP 1: Behavioral risk factor assessment through interviews
STEP 2: Physical measurements including height, weight, waist circumference, and blood pressure
Data Analysis: Conducted using SPSS version 10, focusing on percentages, means, medians, and confidence limits

Conclusion and Recommendations

The study highlights the prevalence of NCD risk factors in the sampled districts
Emphasis on tobacco and alcohol use, poor diet, and physical inactivity was noted
Recommendations include enhancing surveillance systems, promoting healthy behaviors, and implementing targeted interventions for NCD risk reduction

References

WHO STEPwise approach to NCD surveillance
Nepal World Health Survey (2002)
World Health Report (2003)
Annual report of DoHS (2002)

Annexes

Annex 4: Workshop schedule details
Annex 7: Ethical clearance details

Summary of Key Risk Factors

Tobacco Use: 41% of respondents used tobacco; 21% smoked; 20% used smokeless tobacco
Alcohol Use: 38% had ever consumed alcohol; 37% were current consumers
Physical Inactivity: 74% of males and 91% of females were inactive
Poor Diet: Low fruit and vegetable intake; 0.4% of males consumed 5+ servings per day
Overweight: 27% of males and 42% of females were overweight
Hypertension: 20% of males and 17% of females were hypertensive