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Objective: To determine the prevalence and factors associated with anxiety and depression and the care-seeking behaviour among Nepalese population., Design and Settings: Secondary analysis of the data from nationally representative Nepal Demographic and Health Survey 2022., Participants: Analysed data of 12 355 participants (7442 females and 4913 males) aged 15-49 years., Outcome Measures: Depression and anxiety were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) tools, respectively., Statistical Analysis: We performed weighted analysis to account for the complex survey design. We presented categorical variables as frequency, per cent and 95% confidence interval (CI), whereas numerical variables were presented as median, inter-quartile range (IQR) and 95% CI. We performed univariate and multivariable logistic regression to determine factors associated with anxiety and depression, and results were presented as crude OR (COR), adjusted OR (AOR) and their 95% CI., Results: The prevalence of depression and anxiety were 4.0% (95% CI 3.5 to 4.5) and 17.7% (95% CI 16.5 to 18.9), respectively. Divorced or separated participants were found to have higher odds of developing anxiety (AOR 2.40, 95% CI 1.74 to 3.31) and depression (AOR 3.16, 95% CI 1.84 to 5.42). Among ethnic groups, Janajati had lower odds of developing anxiety (AOR 0.77, 95% CI 0.65 to 0.92) and depression (AOR 0.67, 95% CI 0.49 to 0.93) compared with Brahmin/Chhetri. Regarding disability, participants with some difficulty had higher odds of developing anxiety (AOR 1.81, 95% CI 1.56 to 2.10) and depression (AOR 1.94, 95% CI 1.51 to 2.49), and those with a lot of difficulty had higher odds of anxiety (AOR 2.09, 95% CI 1.48 to 2.96) and depression (AOR 2.04, 95% CI 1.06 to 3.90) compared with those without any disability. Among those who had symptoms of anxiety or depression, only 32.9% (95% CI 30.4 to 34.4) sought help for the conditions., Conclusions: Marital status and disability status were positively associated with anxiety and depression, whereas Janajati ethnicity had relatively lower odds of experiencing anxiety and depression. It is essential to develop interventions and policies targeting females and divorced individuals to help reduce the burden of anxiety and depression in Nepal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal., Study Design: The study was a nationwide population-based cross-sectional study., Setting and Participants: Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above., Primary and Secondary Outcome Measures: Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m 2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression., Results: The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3)., Conclusion: This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to prevent it., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study aims to determine the prevalence of joint pain and its association with demographic, socioeconomic and behavioural factors in Nepal., Design: The study was a national cross-sectional population-based study., Setting: We used the most recent nationally representative population-based cross-sectional health survey, The WHO STEPwise approach to surveillance (STEPS) survey, 2019 from all seven provinces of Nepal including both urban and rural areas., Participants: The participants were men and women aged 15-69 years, who were usual residents of the households for at least 6 months and have stayed the night before the survey., Primary and Secondary Outcome Measures: Primary outcome in this study was prevalence of joint pain. The secondary outcome measure was factors associated with joint pain in Nepal. Joint pain in our study was based on any self-reported symptoms of joint pain, stiffness and swelling lasting for more than 1 month in the past 12 months. Data were weighted to generate national estimates., Results: The prevalence of self-reported joint pain in Nepal was 17% (95% CI 14.3% to 20.2%) with higher prevalence for older adults, females, ever married, none/less than primary education, smoker, lowest wealth quintile, homemaker, those with sufficient physical activity and those living in the Karnali province of Nepal. In multivariable analysis self-reported joint pain was found to be associated with advanced age (adjusted OR (AOR)=2.36; 95% CI 1.56 to 3.55), sex (AOR=1.47; 95% CI 1.19 to 1.82) and sufficient physical activity (AOR=0.40; 95% CI 0.25 to 0.65)., Conclusions: The results showed a high prevalence of joint pain in Nepal. Considering the process of ageing and rapid growth in non-communicable disease, this study warrants the need for health policies directed to prevention, treatment and rehabilitation for people affected by chronic musculoskeletal conditions addressing related disabilities and loss of work in Nepal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To assess the prevalence, pattern and determinants of non-communicable diseases (NCDs) multimorbidity in Nepal., Design: Secondary analysis of the data from the NCD survey 2018, which was conducted between 2016 and 2018., Setting: The data belong to the nationally representative survey, that selected the study samples from throughout Nepal using multistage cluster sampling., Participants: 8931 participants aged 20 years and older were included in the study., Primary Outcomes: NCD multimorbidity (occurrence of two or more chronic conditions including hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease and cancer). Descriptive statistics, prevalence ratio and odds ratio were computed to assess pattern and determinants of multimorbidity., Results: Mean (SD) age was 46.7 years (14.9 years). The majority of the participants were women (57.8%), without formal education (53.4%) and from urban areas (51.5%). Multimorbidity was present in 13.96% (95% CI: 12.9% to 15.1%). Hypertension and diabetes coexisted in 5.7%. Age, alcohol consumption, body mass index, non-high-density lipoprotein (non-HDL) level and rural-urban setting were significantly associated with multimorbidity., Conclusion: Multimorbidity was prevalent in particular groups or geographical areas in Nepal suggesting a need for coordinated and integrated NCD care approach for the management of multiplicative co-comorbid conditions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Objectives: To assess the prevalence, clustering and sociodemographic distribution of non-communicable disease (NCD) risk factors in adolescents in Nepal., Design: Data originated from Global School Based Student Health Survey, Nepal conducted in 2015-2016., Setting: The study sites were the secondary schools in Nepal; 74 schools were selected based on the probability proportional to school enrolment size throughout Nepal., Participants: 5795 school-going children aged 13-17 years were included in the study., Primary Outcomes: NCD risk factors: smoking, alcohol consumption, insufficient fruit and vegetable intake, insufficient physical activity and overweight/obesity were the primary outcomes. Sociodemographic distributions of the combined and individual NCD risk factors were determined by Poisson regression analysis., Results: Findings revealed the prevalence of smoking (6.04%; CI 4.62 to 7.88), alcohol consumption (5.29%; CI 4.03 to 6.92), insufficient fruit and vegetable intake (95.33%; CI 93.89 to 96.45), insufficiently physical activity (84.77%; CI 81.04 to 87.88) and overweight/obesity (6.66%; CI 4.65 to 9.45). One or more risk factors were present in 99.6%, ≥2 were in 83% and ≥3 were in 11.2%. Risk factors were more likely to cluster in male, 17 years of age and grade 7. Prevalence of smoking (adjusted prevalence ratio (aPR)=2.38; CI 1.6 to 3.51) and alcohol consumption (aPR=1.81; CI 1.29 to 2.53) was significantly high in male, and in 16 and 17 years of age. Prevalence of insufficient physical activity and overweight/obesity was significantly lower in higher grades., Conclusion: Insufficient fruit and vegetable intake and insufficient physical activity were highly prevalent in the populations studied. Risk factors were disproportionately distributed and clustered in particular gender, age and grade. The study population requires an age and gender specific preventive public health intervention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)