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Risk Factors for Cardiovascular Disease among School Children: Eastern Nepal

Author(s): Sanjib Kumar Sharma1, Slim Slama2, Basudha Khanal1, Bimal Agrawal1 Nirmal Baral, Dagmar Haller-Hester2, Ramesh Kadel1, Subhash Pandey1, Amir Bista1, Anup Ghimire1
Affiliation(s): 1B P Koirala Institute of Health Sciences, Dharan, Nepal. 2Geneva University Hospitals, Geneva, Switzerland.
1st country of focus: Nepal
Relevant to the conference theme: Non-communicable chronic diseases
Summary (max 100 words): A potential public health issue may be the increasing incidence of childhood obesity and related disorders in developing countries and the resulting socioeconomic and public health burden faced by these countries in the near future. Thus, it is important to identify unhealthy lifestyles early to promote healthy changes during childhood and adolescence period.  We conducted a survey in 49 schools of Dharan and evaluated 6428 students. 512 students were detected to have hypertension, overweight/obesity. A significant proportion of schoolchildren in Dharan have modifiable risk factors for cardiovascular disease such as physical inactivity, unhealthy dietary habits, overweight/obesity, and smoking.
Background (max 200 words): The burden of non-communicable diseases (NCDs) is escalating rapidly and is a major public health challenge for developing countries. NCDs are largely attributed to unhealthy life style such as unhealthy dietary habits, physical inactivity, overweight/obesity and smoking.  A potential emerging public health issue may be the increasing incidence of childhood obesity and related disorders in developing countries and the resulting socioeconomic and public health burden faced by these countries in the near future.   Nepal, one of the least developed countries of the world, is still fighting to eradicate hygiene related and infectious diseases, and cannot afford the increasing burden of NCD’s.  Thus it is important to identify unhealthy lifestyles and behaviors early to promote healthy changes during childhood and adolescence period However, there is no published data which provides information about the extent of cardiovascular disease (CVD) risk factors like the prevalence of childhood hypertension, obesity, smoking, life style factors inthe  school going children of Nepal. Moreover, the presence of albuminuria, an emerging independent risk for CVD may add to the understanding of future occurrence of CVD.
Objectives (max 100 words): The study was undertaken to assess the frequencies of various risk factors for cardiovascular disease in school children. This may help to design and implement interventions to modify unhealthy lifestyles and risk factors for cardiovascular disease
Methodology (max 400 words): Initially, the databases for the school were obtained from the municipality of Dharan.  Schools having the standard of 7 to 9 were considered eligible for the study. There were 50 eligible schools. A request was sent to all the schools by principal investigator to participate in the survey.  One of the schools refused to participate  A cross-sectional survey was conducted in 49 schools using predefined structured questionnaires. Children, studying in secondary school (class 7th to 9th) in both private and government schools, were included.   Informed written consent was sought from the guardian and/or schoolteacher. At the beginning of the survey students were informed regarding the aims and rationale of the study and were assured about the confidentiality of the information. All the data were collected and measurements done by trained health personnel by administrating a structured questionnaire to students. The questionnaire comprised of variables of various risk factors for cardiovascular disease, which included dietary habits, physical activity, smoking, concept of body image, disease status, knowledge about healthy and unhealthy food etc. Height, weight, waist hip ratio and blood pressure were measured in all the children. Children having either hypertension or overweight/obesitywere reevaluated for confirmation of the hypertension. They were also screened for proteinuria and albuminuria by spot urine albumin creatinine ratio.
Results (max 400 words): A total of 6428 students were evaluated with the questionnaire. A total of 528 students were found to have overweight/obesity and/or hypertension. 512 students participated in re-evaluation for the confirmation of previous findings by the physician. The frequencies of various risk factors for cardiovascular disease recorded were; physical inactivity in 58.43% (N=295), unhealthy dietary habits 42.14% (n=210), smoking as disclosed by the student 8.6%  (N=44). Out of 503 responders 29.22% (N=147) thought that their food habits were not healthy. History of smoking by household member was reported in 14.25% (N=73) by the children. Overweight and/or obesity were recorded in 65.82%  (N=337) and 17% (N=87) respectively. Hypertensive as per JNC criteria was recorded in 16.79% (N=86). Obesity and hypertension in combination was recorded only in 1 student.  Seven students also had albuminuria.
Conclusion (max 400 words): This study indicates that significant proportion of school children in Dharan have modifiable risk factors for cardiovascular disease such as physical inactivity, unhealthy dietary habits, overweight/obesity, smoking and exposure to household smoking. We suggest, a comprehensive research, involving population-based samples and incorporating other childhood age groups and social class to unmask the burden of risk factors for the development of cardiovascular disease. This may help to compile evidence for a cost-effective intervention in accordance to our local scenario.

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