PREVALENCE OF CARDIOVASCULAR DISEASE RISK FACTORS: A COMMUNITYBASED
CROSS-SECTIONAL STUDY IN A PERI-URBAN COMMUNITY OF KATHMANDU, NEPAL
Journal
Ò Indian Heart Journal
Ò Published on March 2018
Ò Impact Factor for 2017-
Authors
Ò Raja Ram Dhungana, Nepal Family Development
Foundation, Kathmandu,Nepal
Ò Puspa Thapa, Ministy of Health, Kathmandu, Nepal
Ò Surya Devkota , Manmohan Cardiothoracic, Vascular
and Transplant Centre, Institute of Medicine,
Tribhuvan University, Kathmandu, Nepal
Ò Palash Chandra Banik ,Bangladesh University of
Health Sciences, Dhaka, Bangladesh
Ò Yadav Gurung, Nepal Family Development Foundation,
Kathmandu,Nepal
Ò Shirin Jahan Mumu, Bangladesh University of Health
Sciences, Dhaka, Bangladesh
Ò Arun Shayami, Manmohan Cardiothoracic, Vascular
and Transplant Centre, Institute of Medicine,
Tribhuvan University, Kathmandu, Nepal
Ò Liaquat Alie ,Bangladesh University of Health
Sciences, Dhaka, Bangladesh
REASON FOR CHOOSING THIS ARTICLE
Ò NCDs are major public health problem .
Ò Among NCDs Cardiovascular diseases stand
first .
Ò Recently published article on Burning issue.
Ò Peri-urban and Urban area are epidemic for
NCDs .
Ò My area of interest .
NCDS PREVALENCE IN NEPAL –WHO,2016
INTRODUCTION
BACKGROUND
Ò Globally, cardiovascular diseases (CVDs) are the
leading cause of death(31%) , mainly due to
cardiac arrest and stroke(85%).
Ò It has been projected that the death rate would
reach 23 million by 2030.
Ò In Nepal, non-communicable diseases (NCDs) are
estimated to cause 60% of total deaths, with CVDs
contributing to 22% of the totol deaths.
Ò Heart disease contributed to 38% of NCDs.
CARDIOVASCULAR DISEASES
Cardiovascular diseases (CVDs) are a group of disorders of the heart
and blood vessels and they include:
Ò Coronary heart disease – disease of the blood vessels supplying
the heart muscle.
Ò Cerebrovascular disease – disease of the blood vessels supplying
the brain.
Ò Peripheral arterial disease – disease of blood vessels supplying
the arms and legs.
Ò Rheumatic heart disease – damage to the heart muscle and
heart valves from rheumatic fever, caused by streptococcal
bacteria.
Ò Congenital heart disease – malformations of heart structure
existing at birth.
Ò Deep vein thrombosis and pulmonary embolism – blood clots in
the leg veins, which can dislodge and move to the heart and
lungs.
HEALTH RISK FACTORS
Factors that raise the probability of adverse health outcomes. -WHO
RISK TRANSITION
RISK FACTORS FOR NCDS
1 Smoking
2 Harmful use of alcohol Behavioural
3 Physical inactivity
4 Unhealthy diets
5 Overweight and Obesity
6 Hypertension Biological
7 Diabetes
8 Hyperlipidemia
Ò Smoking is estimated to cause nearly 10% of all CVDs .
Ò physical inactivity (6%), and overweight and obesity (5%).
Ò Increase in blood pressure levels also accelerates the risk of stroke and coronary heart disease.
Ò people with diabetes also carry a two-fold risk of vascular disease.
Ò Raised cholesterol and triglyceride levels have been found to be independent risk factors for coronary
heart disease.
OBJECTIVES
Ò Estimate the prevalence of CVD risk factors
in a selected peri-urban community of
Kathmandu, Nepal.
METHODOLOGY
Ò Study Location –
Sitapaila Village Development Committee
(VDC) , near Kathmandu
Ò Funding –
Norwegian Award for Masters Studies
(NOMA) through Oslo University, Norway, awarded
to Bangladesh University of Health Sciences,
Bangladesh.
STUDY SITE PROFILE
Population –17,909
Area- 3.51 km²
Religions-Hindu, Buddhist
Languages –Nepali,
Newari
Ò Study Design –
Community-based, Cross-sectional study
Ò Actual Enrollment –
347
Ò Study Duration –
From February 2014 to February 2015.
Inclusion Criteria –
Ò Adult (>18 years)
Ò Any sex
Ò Residing for last six months
Exclusion Criteria-
Ò Adults with self-reported CVDs
Ò Pregnant women
METHODS
Ò WHO STEPS questionnaire for non-communicable
disease (NCD) risk factors survey .
Ò Anthropometric, clinical and biochemical
measurements.
Ò Systematic random sampling .
Ò In the case of more than one eligible participants in a
household, a single individual was enrolled ( Kish
method)
Ò Analyzed through Epidata V.2.1 and SPSS V.16.0
RESULTS
ANALYSIS AND DISCUSSION
PREVALENCE OF RISK FACTORS IN STUDY
SITE AND NATIONWIDE –A GLANCE
0
20
40
60
80
100
120
study Site
Step Survey
Nationwide
2013
Ò The proportion of current smoker (17.6%) is nearly equal
to that estimated in the nationwide NCD risk factors
survey 2013 (18.5%).
Ò Particularly, male and 41–50 years aged participants
had more tendency to be a smoker.
Ò one third of the participants (29.4%) had consumed
alcohol in the last 30 days. The proportion is higher than
that reported in the NCD risk factors survey (17.4%),
may be due to Newari dominant population area .
Ò This study found that 98 % people takes inadequate fruit
and vegetables (400gm/day) is similar to that of national
survey(99%).
Ò Finding on physical activity level suggests that sedentary
lifestyle could be a major public health threat in future. The
proportion of insufficient physical activity (<600 METs/week)
in the study population was nearly six times higher than that
of the national level.
Ò The prevalence of immediate CVD risk factors such as
obesity, diabetes and hypertension were considerably high in
the study population as compared to other studies in Nepal.
Ò Most of the respondents (93.2%) had at least one risk
factor.
Ò One third of the participants were presented with three
and more risk factors.
Ò Five and more risk factors was noted in 4.1% of the
participants.
Ò Risk transition time is very short in peri-urban areas.
Ò Risk factors are disproportionally distributed among age groups, ethnicity and
education which are consistent with other Nepalese studies too.
Ò Role of the existing predisposing factors such as shifting demographics of a rapidly
expanding elderly population, growing socio-economic inequalities, rural-to peri-urban
migration, unplanned urbanization and deteriorating air pollution
Ò Peri-urban communities may also have the same level of risk of developing the
cardiovascular diseases like the urban communities in future.
Ò The Urban Health Policy of 2015, provision of Urban Health Promotion Centre (UHPC)
should be extended beyond the territory of urban communities for greater cause of
serving semi-urban population and ensuring delivery of quality essential health care
services and health promotion activities, with particular focus on prevention and control
of NCDs including CVDs among the poor, women, children, and marginalized groups.
Ò The recently endorsed Multi-sectoral Action Plan for the Prevention and Control of NCDs
(2014–2020) should be implemented effectively for health promotion and risk reduction
in peri-urban areas as well.
LIMITATIONS
Ò Do not take multiple measurements for the
confirmation of the diagnosis of diabetes and
hypertension.
Ò There was a risk of recall bias while recording dietary
and medication history and assessing seven days
physical activities.
Ò This study might also have encountered measurement
errors while collecting data through anthropometric,
clinical and biochemical measurements.
CONCLUSION
Ò Findings on prevalence and distribution of CVD
risk profile of a peri-urban community in
Kathmandu suggest that study population is at
high risk of developing cardiovascular disease in
near future.
Ò This study shows there is urgent need of planning
,budgeting and implementation CVD preventative
programs targeting different social strata in Nepal.
REFERENCES
REFERENCES
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CRITICAL APPRAISAL
1. What is the study’s objective /Hypothesis
/question?
➢ To estimate the prevalence of CVD risk
factors in a selected peri-urban community of
Kathmandu, Nepal
2 What is the rationale and relevance of the
question? (i.e. why was the study done?)
➢ To access the status of cardiovascular risk among
peri-urban population .
➢ Government is implementing different programs in
urban and rural area which do not address the
current or upcoming health problems.
➢ It draws attention of policy maker or concern
authority to consider the health need of citizens
residing in peri-urban areas.
3 What is the relevance of this topic/question to
Public Health? (i.e. is it urgent or essential reading
for a Public Health practitioner?)
➢ Health problems are different in rural, peri-urban
and urban area .Focuses should be given to
transitional areas from health prospective.
➢ Since peri-urban population are at higher risk of
NCDs ,health programs focused on prevention of
NCDs should be implemented timely .
4 What methodological approach (design,
analysis, etc.) has been used? (i.e. what was
done?)
➢ Study was carried out appropriately and
scientifically .
➢ Community based cross sectional study
➢ Followed globally accepted WHO step survey
Questionnaires and analysis tools.
5 What were the results of the study? (i.e. what
did the investigators find?)
➢ Peri –urban population are at high risk of
cardiovascular diseases in near future.
➢ Urgent need of programs to mitigate the risk.
6 What were the strengths & weaknesses of this study? Are the results
valid?
Ò Study design-Appropriately done
Ò Appropriateness of the method(s)-yes
Ò Relevant study group-yes
Ò Sufficient sample size- yes
Ò Data gathering-Adequate data gathered and presented .
Ò Subject follow-up- Being cross sectional study not done .
Ò Influences of bias-Not seen.(Recall bias accepted by author himself)
Ò Method of analysis-statistically analysed and compared with national
scenario to make picture clear .
Ò Discussion-made thorough interpretation
Ò Currentness and comprehensiveness of the listed references-used
adequate no of articles published in different scenarios.
7 Do the conclusions follow logically from the
design and results?
➢ Seems logical and meaningful
8 How do the results relate to current practice
and how might they influence future practice?
(i.e. what does the answer mean anyway? So
what and who cares?)
➢ Provides insight in formulation of policy
,budgeting and programming .
➢ Implementation of PEN in those areas .
➢ Establishment of Urban health promotion
centers early.
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