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McLaren S, Adhikari P. Hope and Suicidal Ideation Among Older Adults Living in the Rural Mid-Hills of Nepal. Clin Gerontol 2023:1-15. [PMID: 37882778 DOI: 10.1080/07317115.2023.2274049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVES The current study investigated whether hope and its two components (agency and pathways) weakened the relations between perceived burdensomeness, thwarted belongingness, and fearlessness about death and suicidal ideation among older adults living in rural Nepal. METHODS A community sample of 300 people aged from 60 to 90 years (Mage = 67.07, SDage = 6.23) who resided in the rural mid-hills of Nepal completed standardized measures. RESULTS Hope and agency moderated the relationship between perceived burdensomeness and suicidal ideation and pathways moderated the relationship between thwarted belongingness and suicidal ideation. CONCLUSIONS Hope, and particularly agency, may play a protective role in reducing suicidal ideation among older Nepali adults living in rural areas who experience perceived burdensomeness. In contrast, pathways may be an additional risk factor for older adults experiencing unmet belongingness needs. Research is required to understand fearlessness about death and suicidality among older Nepali adults. CLINICAL IMPLICATIONS Increasing hope and particularly agency may be associated with a reduction in suicidal ideation among older Nepali adults who experience feelings of being a burden. However, increasing pathways may be associated with an increase in suicidal ideation among those who experience unmet belongingness needs. Research is needed to understand how to accurately assess suicide risk among Nepali older adults.
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Affiliation(s)
- Suzanne McLaren
- School of Psychology, Charles Sturt University, Port Macquarie, Australia
| | - Pralhad Adhikari
- Department of Psychology and Philosophy, TriChandra Multiple College, Kathmandu, Nepal
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Paul R, Muhammad T, Rashmi R, Sharma P, Srivastava S, Zanwar PP. Depression by gender and associated factors among older adults in India: implications for age-friendly policies. Sci Rep 2023; 13:17651. [PMID: 37848598 PMCID: PMC10582097 DOI: 10.1038/s41598-023-44762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/12/2023] [Indexed: 10/19/2023] Open
Abstract
Inspite of implementing policies to control mental health problems, depression remains a severe health concern among older adults in India. We examined self-reported differences in the depression among older men and women in India and examined associated factors for gender differences in depression at the population level. We utilized nationally representative data from the Longitudinal Aging Study in India (LASI) wave I, for years 2017-2019. Our analytical sample comprised of 30,637 older adults ages 60 years and above (14,682 men and 15,655 women). We conducted descriptive statistics and Chi-Square tests followed by binary logistic regression and multivariate decomposition analyses to examine our study objectives. Depression was reported in - 7.4% (95% CI 7.0, 7.8) of older men and 9.5% (CI 9.1, 10.0) of older women. Poor self-rated health, multimorbidity status, physical activity, difficulty in activities of daily living (ADL) and instrumental ADL (IADL) were the significant health-related factors associated with depression among older men and women. Not being satisfied with one's life, not being satisfied with their present living arrangement, receiving any type of ill-treatment, and being widowed were the significant factors associated with depression among older men and women. We found gender disparity in self-reported depression. Marital status contributed-to 36.7% of the gender gap in depression among older adults. Additionally, ADL and IADL difficulties among men and women contributed to 17.6% and 34.0%, gender gap, self-rated health contributed to 18.8% gap, whereas not having equal social participation (4.4%) and not satisfied in present living arrangements (8.1%) were other factors that contributed to gender gap for depression in India. Depression is a critical and persistent public health problem among-older females in India. Our findings provide a broader framework for policymakers and health practitioners to focus on gender-specific strategies to mitigate this highly emergent problem.
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Affiliation(s)
- Ronak Paul
- International Institute for Population Sciences, Mumbai, 400088, India
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, 400088, India
| | - Rashmi Rashmi
- International Institute for Population Sciences, Mumbai, 400088, India
| | - Palak Sharma
- International Institute for Population Sciences, Mumbai, 400088, India
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Adhikari P, McLaren S. Functional Impairment and Depressive Symptoms among Older Adults of Rural Nepal: The Moderating Role of Three Sources of Social Support. Clin Gerontol 2023; 46:832-843. [PMID: 36880604 DOI: 10.1080/07317115.2023.2187732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVES This study aimed to determine whether social support from family, friends, and significant others moderated the relationship between functional impairment and depressive symptoms among Nepali older adults living in rural areas. METHODS The participants were 147 women (Mage = 66.71, SDage = 5.97) and 153 men (Mage = 67.41, SDage = 6.47) aged 60 years and older who lived in the rural mid-hills of Nepal. They completed the Karnofsky Performance Status Scale, the Multidimensional Scale of Perceived Social Support, and the Geriatric Depression Scale-Short Form. RESULTS Only 6.3% participants experienced some degree of functional impairment. Almost half (44.33%) of participants had depressive symptoms. Social support from family and friends, but not significant others, moderated the relationship between functional impairment and depressive symptoms. Social support from family was protective for older adults with moderate to high levels of functional impairment. Social support from friends was protective at no to low levels of functional impairment. CONCLUSIONS Interventions aimed at increasing social support from family among Nepali older adults living in rural hilly areas may reduce depressive symptoms, particularly among those with high levels of functional impairment. CLINICAL IMPLICATIONS Family support is important to alleviate depressive symptoms among functionally impaired older adults.
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Affiliation(s)
- Pralhad Adhikari
- Department of Psychology and Philosophy, TriChandra Multiple College, Kathmandu, Nepal
| | - Suzanne McLaren
- School of Psychology, Charles Sturt University, Port Macquarie, NSW, Australia
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Gao Z, Liu C, Yang L, Mei X, Wei X, Kuang J, Zhou K, Xu M. Longitudinal Association Between Depressive Symptoms and Cognitive Function Among Older Adults: A Latent Growth Curve Modeling Approach. Int J Public Health 2022; 67:1605124. [PMID: 36213141 PMCID: PMC9537360 DOI: 10.3389/ijph.2022.1605124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives: Although the evidence from numerous longitudinal studies has indicated a remarkable change in cognitive function (CF) and depressive symptoms (DS) over time, the parallel latent growth curve model (LGCM) has seldom been used to simultaneously investigate the relationship between their change trajectories. This study aimed to examine whether a change in DS was associated with CF over time using an LGCM. Methods: Data were collected from the Chinese Longitudinal Healthy Longevity Survey’s 2011, 2014, and 2018 waves. A parallel LGCM examined the association between CF and DS. Results: The multivariate conditioned model’s goodness of fit supported the validity of the longitudinal model (Tucker-Lewis index [TLI] = 0.90, comparative fit index [CFI] = 0.96, root mean square error of approximation [RMSEA] = 0.04). The results showed that the CF intercept was positively to the DS slope (β = 0.42, p = 0.004). The CF and DS slopes were significantly linked (β = −0.65, p = 0.002). Conclusion: The findings expand the knowledge about CF’s effect on DS in older adults.
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Affiliation(s)
- Zihan Gao
- School of Nursing, Qingdao University, Qingdao, China
| | - Cuiping Liu
- School of Nursing, Qingdao University, Qingdao, China
| | - Li Yang
- School of Nursing, Qingdao University, Qingdao, China
- *Correspondence: Li Yang,
| | - Xinyi Mei
- School of Nursing, Wuhan University of Science and Technology, Wuhan, China
| | - Xiao Wei
- School of Nursing, Qingdao University, Qingdao, China
| | - Jinke Kuang
- School of Nursing, Qingdao University, Qingdao, China
| | - Kexin Zhou
- School of Nursing, Qingdao University, Qingdao, China
| | - Mengfan Xu
- School of Nursing, Qingdao University, Qingdao, China
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Liu X, Liu F, Ruan W, Chen Y, Qu S, Wang W. Mental health status and associated contributing factors among the Hakka elderly in Fujian, China. Front Public Health 2022; 10:928880. [PMID: 35937219 PMCID: PMC9354451 DOI: 10.3389/fpubh.2022.928880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Little is known about the mental health of the Hakka elderly. This study explores the status of, and factors associated with mental health among Hakka elderly populations from Fujian, China. Methods This is a cross-sectional, community-based survey study containing a total of 1,262 valid samples. The Chinese version Symptom Checklist-90-R (SCL-90-R) was used to assess the mental health status of the Hakka elderly. We used t-tests to compare the differences for 10 dimensions of SCL-90-R scores between the Chinese national norm and the Hakka elderly. Univariate and multivariate analysis were performed by using linear regression analysis to identify the main socio-demographic factors that were most predictive of the total score of SCL-90-R in the Hakka elderly. Results The scores of somatization (1.78 ± 0.55 vs. 1.40 ± 0.46, P < 0.001) and phobic anxiety (1.21 ± 0.36 vs. 1.17 ± 0.31, P < 0.001) for the Hakka elderly in Fujian appeared to be significantly higher than the Chinese norm. The higher total scores of SCL-90-R were found among females (β = 0.030, P = 0.044), widowed persons (β = 0.053, P = 0.021), those with parent(s) alive (β = 0.047, P = 0.019), and those with poorer self-rated health status (β = 0.110, P < 0.001). The lower total scores of SCL-90-R were found among those who were currently living in town, those with lower education level, those with higher average annual household incomes, and those who were living with spouse or children. Conclusion The worse mental health conditions of the Hakka elderly in somatization and phobic anxiety were detected. The overall mental health status was shown to be worse among females, widowed persons, those who were living in village, those with lower education, and those with father or/and mother alive.
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Affiliation(s)
- Xiaojun Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Fengyu Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Wenqian Ruan
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yating Chen
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Shuming Qu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Wenxin Wang
- Department of Public Administration, Law School/Institute of Local Government Development, Shantou University, Shantou, China
- *Correspondence: Wenxin Wang
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Xiao Y, Huang W. Association of Dietary Inflammatory Index With Depression and Suicidal Ideation in Older Adult: Results From the National Health and Nutrition Examination Surveys 2005-2018. Front Psychiatry 2022; 13:944154. [PMID: 35865298 PMCID: PMC9294216 DOI: 10.3389/fpsyt.2022.944154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The relationship between diet and psychological disorders in older adults has attracted considerable attention as the global trend of aging. This study examines the relationship between Dietary inflammatory index (DII) and the risk of depression and suicide in older adults using the National Health and Nutrition Examination Survey (NHANES) as a large cross-sectional study. METHODS The data were extracted from NHANES from 2005 to 2018, and cross-sectional studies were conducted on older adults (age ≥ 60 years). According to their median DII, participants were classified into High-DII (DII ≥ 1.23) and Low-DII (DII < 1.23) groups. Depression was the primary outcome, and suicidal ideation was a secondary outcome. Utilizing multi-factor logistic regression to correlate DII with outcomes. RESULTS There were 10,956 elderly participants included in the analysis. In comparison to Low-DII group, High-DII group exhibited a higher rate of depression (8.9% vs. 6.7%; P < 0.001) and higher ideation to commit suicide (3.7% vs. 3.0%; P = 0.039). Moreover, in terms of gender ratio, men accounted for 44% of the High-DII group, which was significantly lower than 56.2% of the Low-DII group (P < 0.001). Furthermore, logistic regression revealed that High-DII group had a higher risk of depression in the previous 2 weeks (OR = 1.358, 95% CI: 1.180-1.564; P < 0.001) and a higher risk of suicidal ideation (OR = 1.244, 95% CI: 1.010-1.532; P = 0.040). Additionally, after adjusting for demographic covariates such as age, gender and race, High-DII group still had a higher risk of depression (OR = 1.293, 95% CI: 1.121-1.493; P < 0.001) and suicidal ideation (OR = 1.261, 95% CI: 1.021-1.55; P = 0.031). Furthermore, after adjusting for various covariates like demographic, social factors, and comorbidities, the High-DII group remained at higher risk for depression (OR = 1.178, 95% CI: 1.019-1.363; P = 0.027), and the risk of comorbid suicidal ideation remained high (OR = 1.136, 95% CI: 0.917-1.408), but the difference was not significant (P = 0.243). CONCLUSION In older adults, high levels of DII are associated with depression and suicidal ideation. Multiple factors affect the mental health of older adults, and it is unknown to what extent a pro-inflammatory diet contributes to depression and suicidal thoughts in older adults. Nonetheless, daily dietary management in older adults should be emphasized.
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Affiliation(s)
- Yingqi Xiao
- Department of Pulmonary and Critical Care Medicine, Dongguan Tungwah Hospital, Dongguan, China
| | - Wei Huang
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
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Yadav UN, Yadav OP, Singh DR, Ghimire S, Rayamajhee B, Kanti Mistry S, Rawal LB, Ali ARMM, Kumar Tamang M, Mehta S. Perceived fear of COVID-19 and its associated factors among Nepalese older adults in eastern Nepal: A cross-sectional study. PLoS One 2021; 16:e0254825. [PMID: 34310639 PMCID: PMC8312955 DOI: 10.1371/journal.pone.0254825] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has affected all age groups worldwide, but older adults have been affected greatly with an increased risk of severe illness and mortality. Nepal is struggling with the COVID-19 pandemic. The normal life of older adults, one of the vulnerable populations to COVID-19 infection, has been primarily impacted. The current evidence shows that the COVID-19 virus strains are deadly, and non-compliance to standard protocols can have serious consequences, increasing fear among older adults. This study assessed the perceived fear of COVID-19 and associated factors among older adults in eastern Nepal. METHODS A cross-sectional study was conducted between July and September 2020 among 847 older adults (≥60 years) residing in three districts of eastern Nepal. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S). Multivariate logistic regression identified the factors associated with COVID-19 fear. RESULTS The mean score of the FCV-19S was 18.1 (SD = 5.2), and a sizeable proportion of older adults, ranging between 12%-34%, agreed with the seven items of the fear scale. Increasing age, Dalit ethnicity, remoteness to the health facility, and being concerned or overwhelmed with the COVID-19 were associated with greater fear of COVID-19. In contrast, preexisting health conditions were inversely associated with fear. CONCLUSION Greater fear of the COVID-19 among the older adults in eastern Nepal suggests that during unprecedented times such as the current pandemic, the psychological needs of older adults should be prioritized. Establishing and integrating community-level mental health support as a part of the COVID-19 preparedness and response plan might help to combat COVID-19 fear among them.
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Affiliation(s)
- Uday Narayan Yadav
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
- Centre for Research, Policy and Implementation, Biratnagar, Nepal
- Torrens University, Sydney, Australia
- School of Health Medical and Social Sciences, Central Queensland University, Sydney, Australia
| | | | - Devendra Raj Singh
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Biratnagar, Nepal
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, United States of America
| | - Binod Rayamajhee
- School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, UNSW, Sydney, Australia
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences, Lalitpur, Nepal
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
- BRAC University, Dhaka, Bangladesh
| | - Lal Bahadur Rawal
- School of Health Medical and Social Sciences, Central Queensland University, Sydney, Australia
| | - ARM Mehrab Ali
- Aureolin Research, Consultancy and Expertise Development Foundation, Dhaka, Bangladesh
| | - Man Kumar Tamang
- Centre for Research, Policy and Implementation, Biratnagar, Nepal
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Suresh Mehta
- Ministry of Health and Population, Kathmandu, Nepal
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Ghimire S, Paudel G, Mistry SK, Parvez M, Rayamajhee B, Paudel P, Tamang MK, Yadav UN. Functional status and its associated factors among community-dwelling older adults in rural Nepal: findings from a cross-sectional study. BMC Geriatr 2021; 21:335. [PMID: 34034657 PMCID: PMC8152303 DOI: 10.1186/s12877-021-02286-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high burden of chronic conditions, coupled with various physical, mental, and psychosocial changes that accompany the phenomenon of aging, may limit the functional ability of older adults. This study aims to assess the prevalence of poor functional status and investigate factors associated with poor functional status among community-dwelling older adults in rural communities of eastern Nepal. METHODS Data on 794 older adults aged ≥ 60 years from a previous community-based cross-sectional study was used. Participants were recruited from rural municipalities of Morang and Sunsari districts of eastern Nepal using multi-stage cluster sampling. Functional status was assessed in terms of participants' ability to perform activities of daily living using the Barthel Index. Covariates included sociodemographic characteristics, lifestyle factors, and self-reported chronic conditions. A binary logistic regression model was used to investigate factors associated with poor functional status. RESULTS The overall prevalence of poor functional status was 8.3 % (male: 7.0 % and female: 9.6 %), with most dependence noted for using stairs (17.3 %), followed by dressing (21.9 %) on Barthel Index. In the adjusted model, oldest age group (odds ratio [OR] = 2.83, 95 %CI: 1.46, 5.50), those unemployed (OR = 2.41, 95 %CI: 1.26, 4.65), having memory/concentration problems (OR = 2.32, 95 %CI: 1.30, 4.13), depressive symptoms (OR = 2.52, 95 %CI: 1.28, 4.95), and hypertension (OR = 1.78, 95 %CI: 1.03, 3.06) had almost or more than two times poor functioning. CONCLUSIONS One in 12 older adults had poor functional status as indicated by their dependency on the items of the Barthel Index; those in the oldest age bracket were more likely to exhibit poor functional status. We suggest future studies from other geographies of the country to supplement our study from the rural setting for comprehensive identification of the problem, which could guide the development of prevention strategies and comprehensive interventions for addressing the unmet needs of the older adults for improving functional status.
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Affiliation(s)
- Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, 45056, Oxford, OH, USA
| | - Grish Paudel
- Centre for Research Policy and Implementation, Biratnagar, Nepal
| | - Sabuj Kanti Mistry
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mahmood Parvez
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Binod Rayamajhee
- School of Optometry, University of New South Wales, Sydney, Australia
| | - Pravash Paudel
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Man Kumar Tamang
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Uday Narayan Yadav
- Centre for Research Policy and Implementation, Biratnagar, Nepal. .,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia. .,School of Population Health, University of New South Wales, Sydney, Australia. .,Torrens University, Sydney, Australia.
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Linkage of Depression with Elder Abuse among Institutionalized Older Persons in Kathmandu Valley, Nepal. PSYCHIATRY JOURNAL 2021; 2021:5546623. [PMID: 34007844 PMCID: PMC8102113 DOI: 10.1155/2021/5546623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022]
Abstract
Background To identify the association between elderly abuse and depression among elderly living in old age homes of Kathmandu Valley, Nepal. Materials and Methods A cross-sectional study was carried out in 5 old age homes of Kathmandu Valley, Nepal. The Geriatric Mistreatment Scale and the Geriatric Depression Scale were used to collect information from 220 elderly aged 65 or above, and face-to-face interviews were conducted. Bivariate and multivariate logistic regression analyses were carried out to identify the association between elderly abuse and geriatric depression. Results Among the different types of abuse analyzed, the multivariate analysis showed that neglect (AOR = 2.995; CI: 1.249-7.181) and economical abuse (AOR = 4.728, CI: 1.836-12.173) were significantly associated with increased risk of geriatric depression. Furthermore, the study identified that future saving and absence of chronic disease significantly reduced the risk of psychological abuse, neglect, and geriatric depression. Conclusions Neglect and economical abuse are a predictor of geriatric depression. Efforts should be directed to increase awareness about the different forms of abuse among the primary caregivers of the elderly. Counseling services and support programs should be introduced in old age homes to address the high burden of geriatric depression.
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Yadav UN, Ghimire S, Mistry SK, Shanmuganathan S, Rawal LB, Harris M. Prevalence of non-communicable chronic conditions, multimorbidity and its correlates among older adults in rural Nepal: a cross-sectional study. BMJ Open 2021; 11:e041728. [PMID: 33632751 PMCID: PMC7908905 DOI: 10.1136/bmjopen-2020-041728] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study's objectives were to estimate the prevalence of major non-communicable conditions and multimorbidity among older adults in rural Nepal and examine the associated socioeconomic and behavioural risk factors. DESIGN This was a community-based cross-sectional study conducted between January and April 2018. SETTING Rural municipalities of Sunsari and Morang districts in eastern Nepal. PARTICIPANTS 794 older Nepalese adults, 60 years and older, were recruited using a multistage cluster sampling approach. PRIMARY OUTCOME MEASURES Prevalence of four major non-communicable chronic conditions (osteoarthritis, cardiovascular disease, diabetes and chronic obstructive pulmonary disease (COPD) and multimorbidity. RESULTS Almost half (48.9%: men 45.3%; women 52.4%) of the participants had at least one of four non-communicable chronic conditions, and 14.6% (men 12.5%; women 16.8%) had two or more conditions. The prevalence of individual conditions included: osteoarthritis-41.7% (men 37.5%; women 45.9%), cardiovascular disease-2.4% (men 2.8%; women 2.0%), diabetes-5.3% (men 6.0%; women 4.6%) and COPD-15.4% (men 13.3%; women 17.5%). In the adjusted model, older adults aged 70-79 years (adjusted OR (AOR): 1.62; 95% CI: 1.04 to 2.54), those from Madhesi and other ethnic groups (AOR: 1.08; 95% CI: 1.02 to 1.72), without a history of alcohol drinking (AOR: 1.53; 95% CI: 1.18 to 2.01) and those physically inactive (AOR: 5.02; 95% CI: 1.47 to 17.17) had significantly higher odds of multimorbidity. CONCLUSIONS This study found one in seven study participants had multimorbidity. The prevalence of multimorbidity and associated socioeconomic and behavioural correlates need to be addressed by integrating social programmes with health prevention and management at multiple levels. Moreover, a longitudinal study is suggested to understand the temporal relationship between lifestyle predictors and multimorbidity among older Nepalese adults.
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Affiliation(s)
- Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- Center for Research Policy and Implementation, Biratnagar, Nepal
- Torrens University, Sydney, New South Wales, Australia
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Selvanaayagam Shanmuganathan
- Torrens University, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Lal B Rawal
- School of Health Medical and Allied Sciences, Central Queensland University-Sydney Campus, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Mistry SK, Ali AM, Rahman MA, Yadav UN, Gupta B, Rahman MA, Huque R. Changes in Tobacco Use Patterns during COVID-19 and Their Correlates among Older Adults in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041779. [PMID: 33673087 PMCID: PMC7918812 DOI: 10.3390/ijerph18041779] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
The present study explored the changes in tobacco use patterns during the COVID-19 pandemic and their correlates among older adults in Bangladesh. This cross-sectional study was conducted among 1032 older adults aged ≥60 years in Bangladesh through telephone interviews in October 2020. Participants’ characteristics and COVID-19-related information were gathered using a pretested semi-structured questionnaire. Participants were asked if they noted any change in their tobacco use patterns (smoking or smokeless tobacco) during the COVID-19 pandemic compared to pre-pandemic (6 months prior to the survey). Nearly half of the participants (45.6%) were current tobacco users, of whom 15.9% reported increased tobacco use during the COVID-19 pandemic and all others had no change in their tobacco use patterns. Tobacco use was significantly increased among the participants from rural areas, who had reduced communications during COVID-19 compared to pre-pandemic (OR = 2.76, 95%CI:1.51–5.03). Participants who were aged ≥70 years (OR = 0.33, 95% CI: 0.14–0.77), widowed (OR = 0.36, 95% CI: 0.13–1.00), had pre-existing, non-communicable, and/or chronic conditions (OR = 0.44, 95% CI: 0.25–0.78), and felt themselves at the highest risk of COVID-19 (OR = 0.31, 95% CI: 0.15–0.62), had significantly lower odds of increased tobacco use. Policy makers and practitioners need to focus on strengthening awareness and raising initiatives to avoid tobacco use during such a crisis period.
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Affiliation(s)
- Sabuj Kanti Mistry
- Department of Health Research, ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka 1216, Bangladesh;
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia;
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
- Correspondence: ; Tel.: +61-40-6863358
| | - Armm Mehrab Ali
- Department of Health Research, ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka 1216, Bangladesh;
- Global Research and Data Support, Innovations for Poverty Action, 101 Whitney Avenue, New Haven, CT 06510, USA
| | | | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia;
- Center for Research, Policy and Implementation, Biratnagar 56613, Nepal
- Department of Public Health, Torrens University, Melbourne, VIC 3000, Australia;
| | - Bhawna Gupta
- Department of Public Health, Torrens University, Melbourne, VIC 3000, Australia;
| | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, VIC 3806, Australia;
- Australian Institute of Primary Care and Ageing, La Trobe University, Melbourne, VIC 3086, Australia
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka 1000, Bangladesh;
- Research and Development, ARK Foundation, Gulshan, Dhaka 1212, Bangladesh
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Prevalence and correlates of depressive symptoms among Rohingya (forcibly displaced Myanmar nationals or FDMNs) older adults in Bangladesh amid the COVID-19 pandemic. Glob Ment Health (Camb) 2021; 8:e23. [PMID: 34226848 PMCID: PMC8245337 DOI: 10.1017/gmh.2021.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Depression is globally a crucial communal psychiatric disorder, which is more common in older adults. The situation is considerably worse among millions of older (forcibly displaced Myanmar nationals or FDMNs) Rohingya adults, and the coronavirus disease-2019 (COVID-19) pandemic may exacerbate the already existing precarious situation. The present study investigated depressive symptoms and their associated factors in older adult Rohingya FDMNs in Cox Bazar, Bangladesh, during the COVID-19 pandemic. METHOD A total of 416 older adults aged 60 years and above residing in Rohingya camps situated in the South Eastern part of Bangladesh were interviewed using a 15-item Geriatric Depression Scale (GDS-15) in Bengali language. Chi-square test was performed to compare the prevalence of depressive symptoms within different categories of a variable and a binary logistic regression model was performed to determine the factors associated with depressive symptoms. RESULTS More than 41% of Rohingya older adults had depressive symptoms (DS). Socio-demographic and economic factors such as living alone, dependency on family for living, poor memory, feelings of being left out, difficulty in getting medicine and routine medical care during COVID-19, perception that older adults are at highest risk of COVID-19 and pre-existing non-communicable chronic conditions were found to be significantly associated with developing DS. Higher DS was also evident among older female Rohingya FDMNs. CONCLUSION DS are highly prevalent in older Rohingya FDMNs during COVID-19. The findings of the present study call for immediate arrangement of mental health care services and highlight policy implications to ensure the well-being of older FDMNs.
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Mistry SK, Ali ARMM, Hossain MB, Yadav UN, Ghimire S, Rahman MA, Irfan NM, Huque R. Exploring depressive symptoms and its associates among Bangladeshi older adults amid COVID-19 pandemic: findings from a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1487-1497. [PMID: 33661353 PMCID: PMC7930102 DOI: 10.1007/s00127-021-02052-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Depression, one of the most common mental disorders, is up-surging worldwide amid the ongoing coronavirus disease 2019 (COVID-19) pandemic, especially among the older population. This study aims to measure prevalent depressive symptoms and its associates among older adults amid the COVID-19 pandemic in Bangladesh. METHODS This cross-sectional study was carried out among 1032 older Bangladeshi adults, aged 60 years and above, through telephone interviews in October 2020. We used a semi-structured questionnaire to collect data on participants' socio-demographic and lifestyle characteristics, pre-existing medical conditions, and COVID-19-related information. Meanwhile, depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15). The binary logistic regression model was used to identify the factors associated with depressive symptoms. RESULTS Two-in-five participants showed depressive symptoms on the GDS-15 scale. Poor socioeconomic characteristic such as low family income, dependency on the family for living, recipient of financial support during the pandemic was associated with higher odds of depressive symptoms. Participants with pre-existing medical conditions had 91% higher odds of depressive symptoms. Social isolation, captured in terms of living alone (aOR = 2.11, 95% CI 1.11-4.01), less frequent communication during pandemic (aOR = 1.55, 95% CI 1.07-2.26), perceived loneliness (aOR = 2.25, 95% CI 1.47-3.45), and isolation from others (aOR = 2.45, 95% CI 1.62-3.70) were associated with higher odds of depressive symptoms. CONCLUSIONS Our study found a sizeable proportion of study participants with depressive symptoms amidst the ongoing pandemic. The findings of the present study call for the urgent need for mental health support package targeting this vulnerable group of population.
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Affiliation(s)
- Sabuj Kanti Mistry
- ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka, Bangladesh. .,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia. .,BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - A. R. M. Mehrab Ali
- ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka, Bangladesh ,Innovations for Poverty Action, New Haven, USA
| | - Md. Belal Hossain
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh ,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia ,Center for Research, Policy and Implementation, Biratnagar, Nepal
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH USA
| | | | - Nafis Md. Irfan
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh ,Interdisciplinary Graduate Program in Human Toxicology, University of Iowa, Iowa, USA
| | - Rumana Huque
- ARK Foundation, Gulshan, Dhaka, Bangladesh ,Department of Economics, University of Dhaka, Dhaka, Bangladesh
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Yadav UN, Thapa TB, Mistry SK, Ghimire S, Yadav KK, Boateng GO, O’Callaghan C. Biosocial and disease conditions are associated with good quality of life among older adults in rural eastern Nepal: Findings from a cross-sectional study. PLoS One 2020; 15:e0242942. [PMID: 33253232 PMCID: PMC7704002 DOI: 10.1371/journal.pone.0242942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/12/2020] [Indexed: 12/25/2022] Open
Abstract
Background The ageing population in most low-and middle-income countries is accompanied by an increased risk of non-communicable diseases culminating in a poor quality of life (QOL). However, the factors accelerating this poor QOL have not been fully examined in Nepal. Therefore, this study examined the factors associated with the QOL of older adults residing in the rural setting of Nepal. Methods Data from a previous cross-sectional study conducted among older adults between January and April 2018 in in rural Nepal was used in this study. The analytical sample included 794 older adults aged ≥60 years, selected by a multi-stage cluster sampling approach. QOL was measured using the Older People’s Quality of Life tool; dichotomized as poor and good QOL. Other measures used included age, gender, ethnicity, religion, marital status, physical activity, and chronic diseases such as osteoarthritis, cardiovascular disease, diabetes, chronic obstructive pulmonary disease (COPD), and depression. The factors associated with QOL were examined using mixed-effects logistic regression. Results Seven in ten respondents (70.4%) reported a poor QOL. At the bivariate level, increasing age, unemployment, intake of alcohol, lack of physical activity as well as osteoarthritis, COPD and depression were significantly associated with a lower likelihood of a good QOL. The adjusted model showed that older age (AOR = 0.50, 95% CI: 0.28–0.90), the Christian religion (AOR = 0.38, 95% CI: 0.20–0.70), and of an Indigenous (AOR: 0.25; 95% CI: 0.14–0.47), Dalit (AOR: 0.23; 95% CI: 0.10–0.56), and Madheshi (AOR: 0.29; 95% CI: 0.14–0.60) ethnic background were associated with lower odds of good QOL. However, higher income of >NRs 10,000 (AOR = 3.34, 95% CI: 1.43–3.99), daily physical activity (AOR: 3.33; 95% CI: 2.55–4.34), and the absence of osteoarthritis (AOR: 1.9; 95% CI: 1.09–3.49) and depression (AOR: 3.34; 95% CI: 2.14–5.22) were associated with higher odds of good QOL. Conclusion The findings of this study reinforce the need of improving QOL of older adults through implementing programs aimed at addressing the identified biosocial and disease conditions that catalyse poor QOL in this older population residing in rural parts of Nepal.
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Affiliation(s)
- Uday Narayan Yadav
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
- Torrens University, Sydney, Australia
- Centre for Research, Policy and Implementation-Nepal, Biratnagar, Nepal
- * E-mail: ,
| | | | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, United States of America
| | | | - Godfred O. Boateng
- The University of Texas at Arlington, Arlington, Texas, United States of America
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Shrestha R, Shrestha AP, Shrestha A, Kamholz B. Unrecognized geriatric depression in the emergency Department of a Teaching Hospital in Nepal: prevalence, contributing factors, and metric properties of 5 item geriatric depression scale in this population. BMC Psychiatry 2020; 20:533. [PMID: 33176730 PMCID: PMC7656752 DOI: 10.1186/s12888-020-02910-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is prevalent but poorly recognized in the Emergency Department (ED). We aimed to identify the frequency of unrecognized geriatric depression and its possible determinants in the ED using the 15-item geriatric depression scale (GDS). We also aimed to explore the performance of the shorter, five-item GDS as compared to the 15-item GDS. METHODS This was a cross-sectional study of the ED patients ≥ 60 years. The previously validated Nepali version of GDS-15 screened the sample into "no", "mild-moderate" and "severe" depression using cutoff values of 4/5, and 8/9 respectively. Demographic and socioeconomic factors, comorbidities and health seeking behaviors were studied and the relation was assessed with binary (Chi-square and Kruskal-Wallis test) and multinomial regression analysis. The performance of GDS-5 was compared with the GDS-15 as standard. Cronbach's alpha was calculated to investigate reliability. Validity was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, Spearman's correlation, receiver operating characteristic curve, and kappa coefficient. RESULTS Two hundred eighty patients were enrolled with an overall prevalence of unrecognized depression of 45.7% [104 (81.3%) mild-moderate depression, and 24 (18.8%) severe depression]. The mean age of the sample was 71.36 with female predominance (61%), and 82.5% were illiterate. In the binary analysis, those who had more pain, visited the ED more often, had musculoskeletal diseases and sleep problems, mobility problems, visited local healers previously, and who reported self-perceived "heart and mind" disease showed statistically significant differences among the three categories. In multinomial regression analysis, visits to local healers, sleep problems and frequency of pain were significantly related to depression. The sensitivity, specificity, area under curve and Spearman's correlation of GDS-5 were 75.8%, 96%, 0.919, and 0.827 respectively. Cronbach's alpha for GDS-5 was low (0.416), therefore a new version was proposed which improved the sensitivity to 90.6% and Cronbach's alpha to 0.623. CONCLUSIONS Unrecognized geriatric depression was highly prevalent which urges the need for ED-based interventions for screening and referral. The proposed brief GDS-5 correlated well with the GDS-15 with better validity and internal reliability and offers a more expeditious form of screening for geriatric depression in emergency settings in Nepal.
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Affiliation(s)
- Roshana Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
| | - Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Barbara Kamholz
- Volunteer Clinical Professor of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
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Yadav UN, Rayamajhee B, Mistry SK, Parsekar SS, Mishra SK. A Syndemic Perspective on the Management of Non-communicable Diseases Amid the COVID-19 Pandemic in Low- and Middle-Income Countries. Front Public Health 2020; 8:508. [PMID: 33102414 PMCID: PMC7545493 DOI: 10.3389/fpubh.2020.00508] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022] Open
Abstract
The global coronavirus disease (COVID-19) pandemic has greatly affected the lives of people living with non-communicable diseases (PLWNCDs). The health of PLWNCDs worsens when synergistic epidemics or “syndemics” occur due to the interaction between socioecological and biological factors, resulting in adverse outcomes. These interactions can affect the physical, emotional, and social well-being of PLWNCDs. In this paper, we discuss the effects of the COVID-19 syndemic on PLWNCDs, particularly how it has exposed them to NCD risk factors and disrupted essential public health services. We conclude by reflecting on strategies and policies that deal with the COVID-19 syndemic among PLWNCDs in low- and middle-income countries.
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Affiliation(s)
- Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales (UNSW), Sydney, NSW, Australia.,Forum for Health Research and Development, Dharan, Nepal
| | - Binod Rayamajhee
- School of Optometry and Vision Science, Faculty of Science, University of New South Wales, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales (UNSW), Sydney, NSW, Australia.,James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Shradha S Parsekar
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Shyam Kumar Mishra
- School of Optometry and Vision Science, Faculty of Science, University of New South Wales, Sydney, NSW, Australia.,Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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