title: The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Nepal Health Research Council (NHRC), Government of Nepal, Kathmandu, Nepal.
authors.forename: Krishna Kumar
authors.initials: KK
authors.lastname: Aryal
authors.affiliation: Nepal Health Sector Support Programme (NHSSP), Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.
authors.forename: Suresh
authors.initials: S
authors.lastname: Mehata
authors.affiliation: Nepal Health Research Council (NHRC), Government of Nepal, Kathmandu, Nepal.
authors.forename: Sushhama
authors.initials: S
authors.lastname: Neupane
authors.affiliation: Kathmandu Medical College, Kathmandu, Nepal.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Vaidya
authors.affiliation: Nepal Health Research Council (NHRC), Government of Nepal, Kathmandu, Nepal.
authors.forename: Meghnath
authors.initials: M
authors.lastname: Dhimal
authors.affiliation: Nepal Health Research Council (NHRC), Government of Nepal, Kathmandu, Nepal.
authors.forename: Purushottam
authors.initials: P
authors.lastname: Dhakal
authors.affiliation: Nepal Health Research Council (NHRC), Government of Nepal, Kathmandu, Nepal.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Rana
authors.affiliation: Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: Chop Lal
authors.initials: CL
authors.lastname: Bhusal
authors.affiliation: Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.
authors.forename: Guna Raj
authors.initials: GR
authors.lastname: Lohani
authors.affiliation: World Health Organization Country Office, Kathmandu, Nepal.
authors.forename: Frank Herbert
authors.initials: FH
authors.lastname: Paulin
authors.affiliation: World Health Organization Regional Office for South East Asia, New Delhi, India.
authors.forename: Renu Madanlal
authors.initials: RM
authors.lastname: Garg
authors.affiliation: World Health Organization Headquarter, Geneva, Switzerland.
authors.forename: Regina
authors.initials: R
authors.lastname: Guthold
authors.affiliation: World Health Organization Headquarter, Geneva, Switzerland.
authors.forename: Melanie
authors.initials: M
authors.lastname: Cowan
authors.affiliation: World Health Organization Headquarter, Geneva, Switzerland.
authors.forename: Leanne Margaret
authors.initials: LM
authors.lastname: Riley
authors.affiliation: Nepal Health Research Council (NHRC), Government of Nepal, Kathmandu, Nepal.
authors.forename: Khem Bahadur
authors.initials: KB
authors.lastname: Karki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D001786:Blood Glucose / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D002784:Cholesterol