title: Estimating the prevalence and burden of major disorders of the brain in Nepal: methodology of a nationwide population-based study.
abstract: BACKGROUND
  The major disorders of the brain (MDBs), in terms of their prevalence and the burdens of ill health, disability and financial cost that they impose on individuals and society, are headache, depression and anxiety. No population-based studies have been conducted in Nepal.
  
  
  OBJECTIVE
  Our purpose was to assess the prevalence and burden attributable to MDBs in Nepal in order to inform health policy. Here we report the methodology.
  
  
  METHODS
  The unusual sociocultural diversity and extreme geographical variation of the country required adaptation of standard methodology. We ran pre-pilot and pilot studies before embarking on the main study. The study design was cross-sectional. The population of interest were adults aged 18-65 years who were Nepali speaking and living in Nepal. We selected, employed and trained groups of interviewers to visit randomly selected households by cold-calling. Households were selected from 15 representative districts out of 75 in the country through multistage cluster sampling. One participant was selected randomly from each household. We used structured questionnaires (the HARDSHIP questionnaire, Hospital Anxiety and Depression Scale, and Eysenck Personality Questionnaire -Neuroticism), culturally adapted and translated into Nepali. We recorded blood pressure, weight, height and waist circumference, and altitude of each household. We implemented various quality-assurances measures.
  
  
  RESULTS
  We completed the survey in one month, prior to onset of the monsoon. Among 2,210 selected households, all were contacted, 2,109 were eligible for the study and, from these, 2,100 adults participated. The participation rate was 99.6%.
  
  
  CONCLUSIONS
  Standard methodology was successfully applied in Nepal, with some adaptations. The sociocultural and extraordinary geographic diversity were challenging, but did not require us to compromise the scientific quality of the study.
authors.forename: Kedar
authors.initials: K
authors.lastname: Manandhar
authors.forename: Ajay
authors.initials: A
authors.lastname: Risal
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Steiner
authors.forename: Are
authors.initials: A
authors.lastname: Holen
authors.forename: Rajendra
authors.initials: R
authors.lastname: Koju
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. mattias.linde@ntnu.no.
authors.forename: Mattias
authors.initials: M
authors.lastname: Linde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000208:ethnology*; D001927:Brain Diseases / Q000208:ethnology*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000208:ethnology*; D015340:Epidemiologic Research Design; D005260:Female; D006261:Headache / Q000208:ethnology*; D020773:Headache Disorders / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000208:ethnology; D015995:Prevalence; D055815:Young Adult