Cardiovascular disease (CVD) is the most common complication of diabetes mellitus (DM). To prevent morbidity and mortality among patients with type 2 diabetes mellitus (T2DM), optimization of ...glycemic status and minimizing CVD risk factors is essential. As Nepal has limited data on these CVD risk parameters, we assessed the prevalence of poor glycemic control, CVD risk factors, and their clustering among patients with T2DM. Using a cross-sectional study design, we collected data of 366 patients with T2DM. We applied a multistage cluster sampling technique and used the WHO STEPS tools. Binary logistic and Poisson regression was applied to calculate odds and prevalence ratio of clustering of risk factors, considering P< 0.05 statistically significant. The mean age of participants was 54.5±10.7 years and 208 (57%) were male. The prevalence of poor glycemic control was 66.4% (95% C.I: 61.5-71.2). The prevalence of smoking, alcohol users, inadequate fruit and vegetables intake and physical inactivity were 18% (95% C.I:14 to 21.9), 14.8% (95% C.I:11.1 to 18.4), 98.1% (95% C.I: 96.7-99.4), and 9.8% (95% C.I:6.7-12.8), respectively. Overall, 47.3% (95% C.I: 42.1-52.4) were overweight and obese, 59% (95% C.I: 52.9-63) were hypertensive, and 68% (95% C.I: 63.2-72.7) had dyslipidemia. Clustering of two, three, four, five and more than five risk factors was 12.6%, 30%, 30%,19%, and 8.7%, respectively. Four or more risk factors clustering was significantly associated with gender, age, level of education, T2DM duration, and use of medication. Risk factors clustering was significantly higher among males and users of anti-diabetic medications with prevalence ratio of 1.14 (95% C.I:1.05-1.23) and 1.09 (95% C.I: 1.09-1.18), respectively. The majority of the patients with T2DM had poor glycemic control and CVD risk factors. Policies and programs focused on the prevention and better management of T2DM and CVD risk factors should be implemented to reduce mortality in Nepal.
Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support ...programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal.
We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months.
125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001).
Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal.
ClinicalTrial.gov: NCT02981251.
As a low-income country, Nepal is experiencing cardiovascular diseases as an emerging health problem. However, studies are lacking on the risk factors of cardiovascular diseases in peri-urban ...communities; where the socio-demographical transition is in progress. Therefore, this study aimed to identify the prevalence and socio-demographic distribution of cardiovascular disease risk factors in one of the peri-urban communities in Kathmandu, Nepal.
We conducted a cross-sectional study in Sitapaila Village Development Committee, Kathmandu from February 2014 to February 2015. Altogether, 347 adults from 18 to 70 years of age were selected randomly. Data were collected through modified WHO STEPS questionnaire for non-communicable disease (NCD) risk factors survey and analyzed in SPSS V.16.0 software.
Mean age of the participant was 42.5 ± 13.2 years. Majority of them were female (n = 206; 59.4%), one-third (34%) represented Brahman and Chetri, and over a quarter (29.1%) did not attend school. Cardiovascular disease risk factors included smoking (17.6%), alcohol consumption (29.4%), insufficient fruit and vegetables intake (98%), insufficient physical activity (21.0%), obesity (15.3%), hypertension (34.4%), diabetes (10.5%), and high triglyceride levels (10.8%). They were significantly associated with different socio-demographic characteristics: smoking with gender, age groups and education level; alcohol consumption was with gender, age groups, ethnicity and occupation; insufficient physical activity with gender, age groups and occupation; hypertension with gender, age groups, ethnicity, education level and occupation.
A high prevalence of cardiovascular disease risk factors and their disproportional distribution among the study population indicated an inevitable risk of cardiovascular events in near future.
Objective. This study aimed to assess the prevalence and associated factors of hypertension in newly declared municipalities of Kathmandu, Nepal. Design, Settings, and Participants. This was a ...community-based cross-sectional study conducted in the municipalities of Kathmandu District, Nepal, between January and July 2015. Study participants were aged 18 to 70 years, residing permanently in the study sites. Municipalities, Wards, households, and respondents were selected randomly. Results. Of the 587 participants, 58.8% were females, mean (SD) age was 42.3 (13.5) years, 29.3% had no formal education, 35.1% were Brahmins, and 41.2% were homemakers. Prevalence of hypertension was 32.5% (95% CI: 28.7–36.3). Age, gender, education, ethnicity, occupation, smoking, alcohol consumption, physical activity, diabetes, menopausal history, and family history of cardiovascular disease (CVD) and hypertension were significantly associated with hypertension. In multivariable analysis, smoking, alcohol consumption, physical activity, body mass index, and diabetes were identified as significant explanatory variables for hypertension. Conclusion. This study demonstrated that the people living in newly established municipalities of Kathmandu, Nepal, have a high burden of hypertension as well as its associated factors. Therefore, community-based preventive approaches like lifestyle modification and early detection and treatment of hypertension might bring a substantial change in tackling the burden effectively.
Cardiovascular diseases (CVD) are the main cause of mortality in low- and middle-income countries like Nepal. Different risk factors usually cluster and interact multiplicatively to increase the risk ...of developing acute cardiovascular events; however, information related to clustering of CVD risk factors is scarce in Nepal. Therefore, we aimed to determine the prevalence of CVD risk factors with a focus on their clustering pattern in a rural Nepalese population.
A community-based cross-sectional study was conducted among residents aged 40 to 80 years in Lamjung District of Nepal in 2014. A clustered sampling technique was used in steps. At first, four out of 18 wards were chosen at random. Then, one person per household was selected randomly (n = 388). WHO STEPS questionnaires (version 2.2) were used to collect data. Chi-square and independent t-test were used to test significance at the level of p < 0.05.
A total 345 samples with complete data were analyzed. Smoking 24.1% (95% CI: 19.5-28.6), harmful use of alcohol 10.7% (7.4-13.9), insufficient intake of fruit and vegetable 72% (67.1-76.6), low physical activity 10.1% (6.9-13.2), overweight and obesity 59.4% (54.2-64.5), hypertension 42.9% (37.6-48.1), diabetes 16.2% (14.0-18.3), and dyslipidemia 56.0% (53.0-58.7) were common risk factors among the study population. Overall, 98.2% had at least one risk factor, while 2.0% exhibited six risk factors. Overall, more than a half (63.4%) of participants had at least three risk factors (male: 69.4%, female: 58.5%). Age OR: 2.3 (95% CI: 1.13-4.72) and caste/ethnicity 2.0 (95% CI: 1.28-3.43) were significantly associated with clustering of at least three risk factors.
Cardiovascular risk factors and their clustering were common in the rural population of Nepal. Therefore, comprehensive interventions against all risk factors should be immediately planned and implemented to reduce the future burden of CVD in the rural population of Nepal.
Co-occurrence and spatial and temporal overlap of sympatric jungle and leopard cats are influenced by habitat preferences, and interspecific competition. Understanding these factors influence is ...crucial for developing effective conservation strategies. We conducted a camera survey in Parsa‒Koshi Complex (PKC), Nepal during December 2022-March 2023 to investigate factors influencing occupancy and spatial and temporal overlap between jungle cats (Felis chaus) and leopard cats (Prionailurus bengalensis). The mean detection probability (t = 0.664, p = 0.507) did not differ between jungle cats (p = 0.500 ± 0.289) and leopard cats (p = 0.501 ± 0.288); however, occupancy (t = 31.008, p < 0.001) was greater for jungle cats (ψ = 0.247 ± 0.020) than leopard cats (ψ = 0.178 ± 0.019). Jungle cats and leopard cats were positively associated with large predators, and jungle cats were positively associated with human presence and negatively associated with canopy cover. We observed high diel overlap between leopard cats and jungle cats (Dhat1 = 0.802, norm0CI: 0.720-0.884), with both species largely nocturnal. Co-existence of jungle cats and leopard cats in PKC appears to be facilitated by spatial segregation. These findings provide valuable insights into the complex ecological dynamics and interactions between sympatric jungle and leopard cats.
Abstract
Understanding factors associated with coexistence of human and wildlife in human‐dominated landscapes is crucial for effective species conservation. Among the wildlife species, the sloth ...bears
Melursus ursinus
are found both inside and outside the protected areas of Nepal, and with increasing cases of human and bear conflicts in both areas. This highlights the necessity for a comprehensive understanding of anthropogenic and ecological factors that affect the occurrence of sloth bear. The understanding of these factors is important for its coexistence and conservation in human‐dominated areas through establishing management and conservation action plan. We studied the sloth bear's occupancy and their coexistence in human‐dominated environments with other large predators in the Parsa–Koshi Complex of Nepal using camera traps from December 2022 to March 2023. We identified the occupancy and detection probability of the sloth bear as 0.12 and 0.31, respectively. Our analysis reveals a positive relationship between sloth bear occurrence and the presence of large predators (
βpredators
= 3.104 ± 0.968), such as tigers (
Panthera tigris
) and leopards (
Panthera pardus
), as well as the number of humans detected (
βhuman
= 1.428 ± 1.216) and canopy cover percentage (
βcc
= 1.002 ± 0.737). However, the number of livestock detected shows a negative interaction with the occurrence of sloth bears (
βlivestock
= −2.240 ± 1.467). There was insignificant interaction between sloth bear occupancy and distance to human settlements, roads, and water bodies. These findings underscore the complex dynamics between sloth bears, humans, large predators, and livestock in human‐dominated landscapes. To ensure the long‐term survival of sloth bear populations and promote species conservation, comprehensive conservation strategies that account for both ecological and socio‐economic factors are essential.
Globally, biodiversity is declining due to habitat loss and degradation, over‐exploitation, climate change, invasive species, pollution, and infrastructure development. These threats affect the ...populations of large waterbird species, such as Sarus crane (Grus antigone), which inhabits agricultural–wetland ecosystems. Despite the burgeoning built‐up areas and diminishing agricultural and wetland spaces, scant research investigates the impact of these changing land uses on the globally vulnerable Sarus crane in Nepal. During the pre‐breeding season from April to June 2023, our comprehensive study meticulously scrutinized Sarus crane population status and factors associated with the occurrences and conservation challenges across 10 specific districts of Nepal. Our study documented a total of 690 individuals of Sarus cranes in five districts. The Lumbini Province has 685 individuals, occupying 11 roosting sites. Conversely, the remaining five districts have no Sarus cranes presence during this period. Wetland, farmland and built‐up areas exhibited a significantly positive influence on Sarus crane occurrences in the Lumbini Province. Additionally, we recorded 47 fatalities of Sarus cranes over the past 13 years in the Lumbini Province due to electrocution and collisions. Our study provides a baseline dataset crucial for developing conservation policies, particularly during the dry season when Sarus crane populations tend to congregate in larger flocks. The adaptation of the Sarus crane to urbanized landscapes exposes them to several anthropogenic threats in the coming days. Therefore, protecting wetlands and farmland areas and adopting transboundary conservation approaches are imperative for the long‐term conservation of the Sarus crane and its habitat.
The first record of the population status of Sarus crane can be used as a baseline data for developing a management plan.
Myocardial bridging is a congenital anomaly in which a segment of epicardial coronary artery takes an intramyocardial course, the systolic compression of which could be asymptomatic or may lead to ...major hemodynamic changes such as myocardial ischemia, arrhythmias or sudden cardiac death. The prevalence is highly variable depending upon different investigational modalities to diagnose it. Here we have aimed to study the prevalence through invasive coronary angiography.
This retrospective study was carried out at Manmohan Cardiothoracic Vascular and Transplant center, Kathmandu, Nepal. The invasive coronary angiography of 5096 patients were studied from March 2018 to April 2021 done for various indications.
Among all the patients, the myocardial bridging was identified in 257 (5.04%) patients. About 177 (68.9%) were males and 80 (31.1%) were females. The mean age of the patients having myocardial bridging was 54.52 ± 10.31years. Diabetes mellitus was found in 33(12.8%) and hypertension was found in 77(29.9%) patients with myocardial bridging. Stable angina (29.2%) was the most common clinical presentation. Treadmill test was positive in about 70 (27.2%) patients. Majority of patients had myocardial bridge in left anterior descending artery alone (89.9%) and located mostly in mid-part (74.9%).
The myocardial bridging is not an uncommon finding on invasive coronary angiography in middle aged people who present with typical angina.
Aims/Introduction
The global burden of diabetes mellitus is rising substantially, with a further increase in cardiovascular and kidney disease burden. These public health problems are highly ...prevalent in low‐ and middle‐income countries, including Nepal. However, there is limited evidence on cardiac and renal conditions among patients with type 2 diabetes mellitus. We determined the status of electrocardiogram (ECG) abnormalities and renal impairment among patients with type 2 diabetes mellitus in Nepal.
Methods
We carried out a cross‐sectional study in Tulsipur Sub‐Metropolitan City of Nepal using a multistage stratified sampling technique to recruit patients with type 2 diabetes mellitus. We used World Health Organization stepwise approach to surveillance (WHO STEPS) questionnaires and carried out resting ECG to collect data of 345 patients with type 2 diabetes mellitus. Logistic regression analysis assessed the factors associated with ECG abnormalities and renal impairment.
Results
The study showed that 6.1% of participants had major ECG abnormalities (95% confidence interval CI 3.8–8.6%), which were associated with hypertension (P = 0.01%) and low socioeconomic status (P = 0.01). The proportion of major and/or minor ECG abnormalities was 47.8% (95% CI 40.5–51%), and were significantly associated with age (odds ratio OR 1.04, 95% CI 1.01–1.07), higher education (OR 3.50, 95% CI 1.31–9.33), unemployment (OR 3.02, 95% CI 1.08–8.48), body mass index (OR 1.09, 95% CI 1.02–1.17) and duration of type 2 diabetes mellitus >5 years (OR 2.42, 95% CI 1.19–4.93). The proportion of renal impairment was 3.5% (95% CI 1.5–4.5%) which was associated with older age (OR 1.08, 95% CI 1.00–1.17) and hypertension (OR 12.12, 95% CI 1.07–138.22).
Conclusion
A significant proportion of patients with type 2 diabetes mellitus had ECG abnormalities and renal impairment, which were significantly associated with hypertension. Therefore, hypertension management and early screening are essential to prevent future cardiorenal complications among patients with type 2 diabetes mellitus.
Data on cardiorenal disease among type 2 diabetes mellitus patients of the semi‐urban population of Nepal are limited. Therefore, a resting electrocardiogram and estimated glomerular filtration rate were carried out in 345 patients with type 2 diabetes mellitus. Almost half of the participants had major and/or minor electrocardiogram abnormalities, whereas <5% had renal impairment. Major electrocardiogram abnormalities and renal impairment were significantly associated with hypertension.
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