Dharanidhar Baral

The alcohol use disorders identification test (AUDIT): validation of a Nepali version for the detection of alcohol use disorders and hazardous drinking in medical settings

BackgroundAlcohol problems are a major health issue in Nepal and remain under diagnosed. Increase in consumption are due to many factors, including advertising, pricing and availability, but accurate information is lacking on the prevalence of current alcohol use disorders. The AUDIT (Alcohol Use Disorder Identification Test) questionnaire developed by WHO identifies individuals along the full spectrum of alcohol misuse and hence provides an opportunity for early intervention in non-specialty settings. This study aims to validate a Nepali version of AUDIT among patients attending a university hospital and assess the prevalence of alcohol use disorders along the full spectrum of alcohol misuse.MethodsThis cross-sectional study was conducted in patients attending the medicine out-patient department of a university hospital. DSM-IV diagnostic categories (alcohol abuse and alcohol dependence) were used as the gold standard to calculate the diagnostic parameters of the AUDIT. Hazardous drinking was defined as self reported consumption of ≥21 standard drink units per week for males and ≥14 standard drink units per week for females.ResultsA total of 1068 individuals successfully completed the study. According to DSM-IV, drinkers were classified as follows: No alcohol problem (n=562; 59.5%), alcohol abusers (n= 78; 8.3%) and alcohol dependent (n=304; 32.2%). The prevalence of hazardous drinker was 67.1%. The Nepali version of AUDIT is a reliable and valid screening tool to identify individuals with alcohol use disorders in the Nepalese population. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT ≥11 for both the gender) and hazardous drinkers (with AUDIT ≥5 for males and ≥4 for females). For alcohol dependence/abuse the cut off values was ≥9 for both males and females.ConclusionThe AUDIT questionnaire is a good screening instrument for detecting alcohol use disorders in patients attending a university hospital. This study also reveals a very high prevalence of alcohol use disorders in Nepal.

Violence, HIV risk behaviour and depression among female sex workers of eastern Nepal.

Objectives The primary objective of the study was to estimate the prevalence of depression among female sex workers (FSWs) of eastern Nepal. The secondary objective was to search for an association between depression, violence and HIV risk behaviour. Design Cross-sectional/observational study. Study setting This study was carried out in five cities of eastern Nepal (Dharan, Itahari, Biratnagar, Damak and Birtamode). Both restaurant-based and street-based FSWs were recruited in the study. Participants Women who had been involved in commercial sex activity in the past 6 months and gave informed consent were included in the study. Primary outcome measure A score of more than or equal to 16 on the Centre for Epidemiological Studies Depression (CESD) scale was considered as depression. Methodology Face-to-face interviews were conducted with respondents who were sought through a snowball sampling technique. Information regarding their depression status, HIV high-risk behaviour and violence was recorded. The estimated sample size was 210. Results We interviewed 210 FSWs (both restaurant-based and street-based). The prevalence of depression among respondents was 82.4%. FSWs who had experienced violence were five times more likely to be depressed than those who were not victims of violence. The odds of depression were six times higher among respondents who were involved in any HIV risk behaviour compared with those who were not involved. Conclusions The present study reports a high prevalence of depression, HIV risk behaviours and violence among FSWs of eastern Nepal. The mental health of FSWs should also be regarded as an important aspect of HIV prevention efforts which can help to promote the overall health of this population.

Alcoholic liver disease in Nepal: identifying homemade alcohol as a culprit.

Background Though the type of alcohol consumed is not thought to be associated with alcoholic liver disease (ALD), some studies have shown a beverage-specific effect. In the present study, we aim to study the effects of locally brewed alcoholic beverages on the development of liver disease. Patients and methods This cross-sectional study was conducted at the internal medicine department of a university hospital in Nepal. All patients classified as having either alcohol abuse or alcohol dependence by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition were evaluated for the presence of ALD. Results A total of 1,500 patients were screened, of which, 447 patients had ALD. Chronic liver disease (CLD) was detected in 144 patients (9.6%). Most of the patients consumed homemade locally brewed alcohol. On multivariate analysis, the following variables were found to be significantly associated with CLD: male sex (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.12–2.94; P=0.02): rakshi consumption ≥30 units (OR: 2.53; 95% CI: 1.07–6.01; P=0.04); and tongba consumption (OR: 3.02; 95% CI: 1.22–7.50; P=0.02). Conclusion There was a significant increase in the risk of developing ALD with the consumption of rakshi and tongba after adjusting for total units consumed. The absence of striking differences between our patients with CLD and non-CLD patients with regards to the amount of alcohol consumed demonstrates that, although alcohol consumption is a prerequisite for the development of ALD, other factors like type of alcoholic beverage consumed may be involved.

PS 09-23 PREVALENCE OF HYPERTENSION AND ASSOCIATED CARDIOVASCULAR RISK FACTORS IN A RURAL COMMUNITY OF EASTERN NEPAL

Objective: To find out the prevalence of hypertension along with other associated cardiovascular risk factors among adults in a rural community of Eastern Nepal. Design and Method: A community based cross sectional study was conducted in two of the randomly selected wards in Duhabi Village Development Committee, Sunsari, Nepal from September 2014-February 2015. A total of 624 participants above 40 years of age were interviewed by doing house to house survey. The data were collected using the WHO STEPS questionnaire. Hypertension was defined as systolic blood pressure (BP) = 140 and/or diastolic BP=90YmmHg or on treatment with BP lowering medications. Chi-square test and binary logistic regression analysis were used to show association between hypertension and selected variables. Results: The mean age (SD) of the participants was 51.47 (10.57) years. Hypertension was seen in 38.6% of participants. Obesity was seen in 11.2%, 41.5% were smokers, 20.2% consumed alcohol and 10.7% had elevated random blood glucose level (=200Ymg/dl). In binary logistic regression, age greater than 60 years (AORY=Y2.2, 95%CI; 1.37-3.67), stress (AORY=Y3.1, 95% CI; 1.80-5.36), alcohol consumption (AORY=Y1.60, 95%CI; 1.03-2.57), decreased physical activity (AORY=Y2.41; 95%CI; 1.66-3.49) and high waist circumference (AORY=Y1.73, 95%CIY=Y1.10-2.72) remained significantly associated with hypertension. Conclusions: The prevalence of hypertension in the rural community of Nepal was found to be high along with clustering of various risk factors. Thus effective intervention regarding prevention along with early diagnosis and treatment is necessary for control of increasing burden of hypertension in a rural setting.