District-Level Risk Factors for COVID-19 Incidence and Mortality in Nepal
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Extraction
2.2. COVID-19 Incidence and Mortality
2.3. Social Risk Factors
2.4. Factors Related to Hand Hygiene
2.5. Health-Related Factors
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report 51. 2020. Available online: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 (accessed on 1 November 2021).
- World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. Available online: https://covid19.who.int (accessed on 17 December 2021).
- Centers of Disease Control and Prevention. New Variants of the Virus that Causes COVID-19. Available online: https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant.html (accessed on 10 December 2021).
- Mackenzie, J.S.; Smith, D.W. COVID-19: A novel zoonotic disease caused by a coronavirus from China: What we know and what we don’t. Microbiol. Aust. 2020, 41, 45–50. [Google Scholar] [CrossRef]
- Davies, N.G.; Klepac, P.; Liu, Y.; Prem, K.; Jit, M.; CMMID COVID-19 working group; Eggo, R.M. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat. Med. 2020, 26, 1205–1211. [Google Scholar] [CrossRef]
- Ochi, S.; So, M.; Hashimoto, S.; Denda, K.; Sekizawa, Y. Behavioral factors associated with COVID-19 risk: A cross-sectional survey in Japan. Int. J. Environ. Res. Public Health 2021, 18, 12184. [Google Scholar] [CrossRef] [PubMed]
- Treskova-Schwarzbach, M.; Haas, L.; Reda, S.; Pilic, A.; Borodova, A.; Karimi, K.; Koch, J.; Nygren, T.; Scholz, S.; Schönfeld, V.; et al. Pre-existing health conditions and severe COVID-19 outcomes: An umbrella review approach and meta-analysis of global evidence. BMC Med. 2021, 19, 212. [Google Scholar] [CrossRef] [PubMed]
- Lee, W.; Kim, H.; Choi, H.M.; Heo, S.; Fong, K.C.; Yang, J.; Park, C.; Kim, H.; Bell, M.L. Urban environments and COVID-19 in three Eastern states of the United States. Sci. Total Environ. 2021, 779, 146334. [Google Scholar] [CrossRef] [PubMed]
- Federgruen, A.; Naha, S. Crowding effects dominate demographic attributes in COVID-19 cases. Int. J. Infect. Dis. 2021, 102, 509–516. [Google Scholar] [CrossRef]
- Government of Nepal, COVID-19 Nepal. Available online: https://covidnepal.org (accessed on 5 December 2021).
- United Nations. COVID-19 Nepal: Preparedness and Response Plan (NPRP) April-2020. Available online: https://www.who.int/docs/default-source/nepal-documents/novel-coronavirus/covid-19-nepal-preparedness-andresponse-plan-(nprp)-draft-april-9.pdf?sfvrsn=808a970a_2 (accessed on 5 December 2021).
- Epidemiology and Diseases Control and Division, Nepal. Epidemiological Update on COVID 19 (17 July 2020). Available online: http://edcd.gov.np/news/download/epidemiological-update-on-covid-19-17-july-2020 (accessed on 5 December 2021).
- Pantha, B.; Acharya, S.; Joshi, H.R.; Vaidya, N.K. Inter-provincial disparity of COVID-19 transmission and control in Nepal. Sci. Rep. 2021, 11, 13363. [Google Scholar] [CrossRef]
- Ministry of Health and Population, Government of Nepal. COVID-19 Update (2020). Available online: https://covid19.mohp.gov.np/ (accessed on 13 December 2021).
- Basnet, B.B.; Bishwakarma, K.; Pant, R.R.; Dhakal, S.; Pandey, N.; Gautam, D.; Ghimire, A.; Basnet, T.B. Combating the COVID-19 pandemic: Experiences of the first wave from Nepal. Front. Public Health 2021, 9, 613402. [Google Scholar] [CrossRef]
- Shah, M.R.T.; Ahammed, T.; Anjum, A.; Chowdhury, A.A.; Suchana, A.J. Finding the real COVID-19 case-fatality rates for SAARC countries. Biosaf. Health 2021, 3, 164–171. [Google Scholar] [CrossRef]
- Sapkota, K.; Dangal, G.; Koirala, M.; Sapkota, K.; Poudel, A.; Dhital, S.R. Strategies for prevention and control of COVID-19 in Nepal. J. Patan Acad. Health Sci. 2020, 7, 85–88. [Google Scholar] [CrossRef]
- Bedford, J.; Enria, D.; Giesecke, J.; Heymann, D.L.; Ihekweazu, C.; Kobinger, G.; Lane, H.C.; Memish, Z.; Oh, M.D.; Sal, A.A.; et al. COVID-19: Towards controlling of a pandemic. Lancet 2020, 395, 1015–1018. [Google Scholar] [CrossRef]
- Rubin, D.; Huang, J.; Fisher, B.T.; Gasparrini, A.; Tam, V.; Song, L.; Wang, X.; Kaufman, J.; Fitzpatrick, K.; Jain, A.; et al. Association of social distancing, population density, and temperature with the instantaneous reproduction number of SARS-CoV-2 in counties across the United States. JAMA Netw. Open 2020, 3, e2016099. [Google Scholar] [CrossRef]
- Ministry of Health and Population, Government of Nepal. Coronavirus Disease Outbreak Updates and Resources Materials. Available online: https://heoc.mohp.gov.np/update-on-novel-corona-virus-covid-19/ (accessed on 13 December 2021).
- National Disaster Risk Reduction and Management Authority, Government of Nepal. Nepal COVID-19 Dashboard. Available online: https://covid19.ndrrma.gov.np/ (accessed on 13 December 2021).
- Government of Nepal National Planning Commission; United Nations Development Programme. Nepal Human Development Report 2014 Beyond Geography, Unlocking Human Potential; Government of Nepal National Planning Commission: Kathmandu, Nepal, 2014.
- Government of Nepal National Planning Commission, Central Bureau of Statistics. National Population and Housing Census 2011 (Population Projection 2011–2031); Central Bureau of Statistics: Kathmandu, Nepal, 2014.
- Government of Nepal National Planning Commission, Central Bureau of Statistics. National Population and Housing Census 2011 (National Report); Central Bureau of Statistics: Kathmandu, Nepal, 2012.
- Ministry of Health, Nepal; New ERA; ICF. Nepal Demographic and Health Survey 2016; Ministry of Health: Kathmandu, Nepal, 2017.
- World Health Organization. WHO Housing and Health Guidelines; World Health Organization: Geneva, Switzerland, 2018. [Google Scholar]
- Ge, Y.; Martinez, L.; Sun, S.; Chen, Z.; Zhang, F.; Li, F.; Sun, W.; Chen, E.; Pan, J.; Li, C.; et al. COVID-19 transmission dynamics among close contacts of index patients with COVID-19: A population-based cohort study in Zhejiang province, China. JAMA Intern. Med. 2021, 181, 1343–1350. [Google Scholar] [CrossRef]
- Romero Starke, K.; Petereit-Haack, G.; Schubert, M.; Kämpf, D.; Schliebner, A.; Hegewald, J.; Seidler, A. The age-related risk of severe outcomes due to COVID-19 infection: A rapid review, meta-analysis, and meta-regression. Int. J. Environ. Res. Public Health 2020, 17, 5974. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention. Show Me the Science—Why Wash Your Hands? Available online: https://www.cdc.gov/handwashing/whyhandwashing.html (accessed on 15 October 2021).
- United Nations Children’s Fund; World Health Organization. Progress on Drinking Water, Sanitation and Hygiene in Schools: Special Focus on COVID-19; United Nations Children’s Fund and World Health Organization: New York, NY, USA, 2020. [Google Scholar]
- George, S.L. Identification and assessment of prognostic factors. Semin. Oncol. 1988, 15, 462–471. [Google Scholar]
- Durrleman, S.; Simon, R. Flexible regression models with cubic splines. Stat. Med. 1989, 8, 551–561. [Google Scholar] [CrossRef]
- Tamrakar, V.; Srivastava, A.; Saikia, N.; Parmar, M.C.; Shukla, S.K.; Shabnam, S.; Boro, B.; Saha, A.; Debbarma, B. District level correlates of COVID-19 pandemic in India during March–October 2020. PLoS ONE 2021, 16, e0257533. [Google Scholar] [CrossRef]
- Bahl, P.; Doolan, C.; de Silva, C.; Chughtai, A.A.; Bourouiba, L.; MacIntyre, C.R. Airborne or droplet precautions for health workers treating COVID-19? J. Infect. Dis. 2020, jiaa189. [Google Scholar] [CrossRef] [Green Version]
- van Doremalen, N.; Bushmaker, T.; Morris, D.H.; Holbrook, M.G.; Gamble, A.; Williamson, B.N.; Tamin, A.; Harcourt, J.L.; Thornburg, N.J.; Gerber, S.I.; et al. Aerosol and Surface Stability of SARS-CoV-2 as compared with SARS-CoV-1. N. Engl. J. Med. 2020, 382, 1564–1567. [Google Scholar] [CrossRef]
- Cook, T.M. Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic—A narrative review. Anaesthesia 2020, 75, 920–927. [Google Scholar] [CrossRef] [Green Version]
- Jefferson, T.; Del Mar, C.B.; Dooley, L.; Ferroni, E.; Al-Ansary, L.A.; Bawazeer, G.A.; van Driel, M.L.; Jones, M.A.; Thorning, S.; Beller, E.M.; et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst. Rev. 2020, 11, CD006207. [Google Scholar]
- World Health Organization; United Nations Children’s Fund. Water, Sanitation, Hygiene, and Waste Management for the COVID-19 Virus: Interim Guidance, 19 March 2020. Available online: https://apps.who.int/iris/handle/10665/331499 (accessed on 20 December 2021).
- Sharif, N.; Alzahrani, K.J.; Ahmed, S.N.; Opu, R.R.; Ahmed, N.; Talukder, A.; Nunia, R.; Chowdhury, M.S.; Nodi, I.J.; Saha, T.; et al. Protective measures are associated with the reduction of transmission of COVID-19 in Bangladesh: A nationwide cross-sectional study. PLoS ONE 2021, 16, e0260287. [Google Scholar] [CrossRef]
- Williamson, E.J.; Walker, A.J.; Bhaskaran, K.; Bacon, S.; Bates, C.; Morton, C.E.; Curtis, H.J.; Mehrkar, A.; Evans, D.; Inglesby, P.; et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020, 584, 430–436. [Google Scholar] [CrossRef]
- Peters, S.A.E.; MacMahon, S.; Woodward, M. Obesity as a risk factor for COVID-19 mortality in women and men in the UK biobank: Comparisons with influenza/pneumonia and coronary heart disease. Diabetes Obes. Metab. 2021, 23, 258–262. [Google Scholar] [CrossRef] [PubMed]
- Clift, A.K.; von Ende, A.; Tan, P.S.; Sallis, H.M.; Lindson, N.; Coupland, C.A.C.; Munafò, M.R.; Aveyard, P.; Hippisley-Cox, J.; Hopewell, J.C. Smoking and COVID-19 outcomes: An observational and Mendelian randomisation study using the UK Biobank cohort. Thorax 2022, 77, 65–73. [Google Scholar] [CrossRef] [PubMed]
- Kelly, C.; Hulme, C.; Farragher, T.; Clarke, G. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review. BMJ Open 2016, 6, e013059. [Google Scholar] [CrossRef]
- Bhattarai, S.; Parajuli, S.B.; Rayamajhi, R.B.; Paudel, I.S.; Jha, N. Clinical health seeking behavior and utilization of health care services in eastern hilly region of Nepal. JCMS Nepal 2015, 11, 8–16. [Google Scholar]
- Gesesew, H.A.; Koye, D.N.; Fetene, D.M.; Woldegiorgis, M.; Kinfu, Y.; Geleto, A.B.; Melaku, Y.A.; Mohammed, H.; Alene, K.A.; Awoke, M.A.; et al. Risk factors for COVID-19 infection, disease severity and related deaths in Africa: A systematic review. BMJ Open 2021, 11, e044618. [Google Scholar] [CrossRef] [PubMed]
- Mehraeen, E.; Karimi, A.; Barzegary, A.; Vahedi, F.; Afsahi, A.M.; Dadras, O.; Moradmand-Badie, B.; Seyed Alinaghi, S.A.; Jahanfar, S. Predictors of mortality in patients with COVID-19—A systematic review. Eur. J. Integr. Med. 2020, 40, 101226. [Google Scholar] [CrossRef] [PubMed]
- Ho, F.K.; Petermann-Rocha, F.; Gray, S.R.; Jani, B.D.; Katikireddi, S.V.; Niedzwiedz, C.L.; Foster, H.; Hastie, C.E.; Mackay, D.F.; Gill, J.M.R.; et al. Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants. PLoS ONE 2020, 15, e0241824. [Google Scholar] [CrossRef]
- Cifuentes, M.P.; Rodriguez-Villamizar, L.A.; Rojas-Botero, M.L.; Alvarez-Moreno, C.A.; Fernández-Niño, J.A. Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: A cohort nationwide study. J. Epidemiol. Community Health 2021, 75, 610–615. [Google Scholar] [CrossRef]
- Ahmadi, M.N.; Huang, B.H.; Inan-Eroglu, E.; Hamer, M.; Stamatakis, E. Lifestyle risk factors and infectious disease mortality, including COVID-19, among middle aged and older adults: Evidence from a community-based cohort study in the United Kingdom. Brain Behav. Immun. 2021, 96, 18–27. [Google Scholar] [CrossRef]
Characteristics | Mean | SD | Min | Max |
---|---|---|---|---|
COVID-19 infection characteristics | ||||
Number of cases | 3756.37 | 12,240.46 | 37 | 1035.23 |
Number of recovered cases | 3677.27 | 11,902.28 | 35 | 1005.84 |
Number of deaths | 27.18 | 86.66 | 0 | 738 |
Cases per 100,000 population | 552.29 | 649.21 | 56.83 | 4499.26 |
Recovered cases per 100,000 population | 540.26 | 635.53 | 53.76 | 4371.53 |
Deaths per 100,000 population | 4.55 | 4.94 | 0.00 | 32.07 |
Case fatality rate (%) a | 1.20 | 1.46 | 0.00 | 9.09 |
Recovery rate (%) a | 97.21 | 2.53 | 84.09 | 99.72 |
Socio-demographic and health-related characteristics | ||||
Population density (people per km2) | 320.59 | 595.48 | 4.65 | 4415.80 |
Household crowding (%) | 17.05 | 7.48 | 3.33 | 37.93 |
Sex ratio (number of males/females × 100) | 91.99 | 7.77 | 76.02 | 109.84 |
Percentage aged ≥ 60 years | 6.13 | 2.38 | 1.82 | 13.74 |
Obesity prevalence (%) | ||||
Women | 3.59 | 3.98 | 0.00 | 19.30 |
Men | 1.86 | 2.12 | 0.00 | 8.43 |
Smoking prevalence (%) | ||||
Women | 5.36 | 5.37 | 0.00 | 20.93 |
Men | 18.85 | 10.53 | 0.00 | 61.54 |
No access to handwashing facilities (%) | 60.90 | 20.19 | 9.76 | 100 |
Adult literacy rate (%) | 42.76 | 11.42 | 15.96 | 66.11 |
Access to a health facility (%) | 39.85 | 24.70 | 0.00 | 84.62 |
Per capita income (USD) | 1039.71 | 360.30 | 487.00 | 2764.00 |
Variables | Linear Regression | Negative Binomial Regression |
---|---|---|
β (95% CI) | RR (95% CI) | |
Incidence a | ||
Population density | 0.689 (0.571, 0.806) *** | 1.38 (1.09, 1.76) c ** |
Household crowding (%) | 15.18 (5.86, 24.51) ** | 1.04 (1.01, 1.06) ** |
Obesity prevalence in women (%) | 45.74 (13.87, 77.60) ** | 1.07 (1.02, 1.13) ** |
Smoking in men (%) | 3.00 (−1.65, 7.66) | 1.00 (0.98, 1.01) |
No access to handwashing facilities (%) | 5.52 (0.698, 10.35) * | 1.00 (0.99, 1.01) |
Adult literacy (%) | −15.32 (−22.43, −8.22) *** | 0.97 (0.96, 0.99) ** |
Percentage aged ≥ 60 years | −11.86 (−34.61, 10.90) | 0.98 (0.93, 1.03) |
R2/McFadden’s Pseudo R2 | 0.874 | 0.047 |
Recovered cases b | ||
Population density | 0.752 (0.618, 0.887) *** | 1.63 (1.18, 2.24) ** |
Sex ratio | 3.92 (−13.59, 21.44) | 1.01 (0.98, 1.04) |
Adult literacy (%) | 16.42 (0.744, 32.09) * | 1.03 (1.00, 1.06) * |
Access to a health facility (%) | −0.073 (−2.83, 2.68) | 1.00 (0.99, 1.01) |
Per capita income (USD) | 0.198 (−0.104, 0.500) | 1.08 (0.53, 2.22) d |
Percentage aged ≥ 60 years | −7.42 (−39.80, 24.97) | 0.99 (0.92, 1.07) |
R2/McFadden’s Pseudo R2 | 0.826 | 0.037 |
Variables | Linear Regression a | Negative Binomial Regression b |
---|---|---|
β (95% CI) | RR (95% CI) | |
Population density | 0.006 (0.004, 0.007) *** | 1.42 (1.07, 1.88) c * |
Sex ratio | −0.047 (−0.191, 0.096) | 0.99 (0.97, 1.03) |
Obesity prevalence in women (%) | 0.293 (−0.033, 0.618) + | 1.06 (1.00, 1.14) * |
Smoking in men (%) | 0.073 (−0.002, 0.148) + | 1.01 (1.00, 1.03) * |
Percentage aged ≥ 60 years | −0.107 (−0.506, 0.293) | 0.97 (0.88, 1.06) |
Access to a health facility (%) | −0.040 (−0.080, −0.001) * | 1.00 (0.99, 1.004) |
Per capita income (USD) | 0.001 (−0.003, 0.004) | 1.20 (0.54, 2.65) d |
R2/McFadden’s Pseudo R2 | 0.566 | 0.030 |
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Lamichhane, D.K.; Shrestha, S.; Kim, H.-C. District-Level Risk Factors for COVID-19 Incidence and Mortality in Nepal. Int. J. Environ. Res. Public Health 2022, 19, 2659. https://doi.org/10.3390/ijerph19052659
Lamichhane DK, Shrestha S, Kim H-C. District-Level Risk Factors for COVID-19 Incidence and Mortality in Nepal. International Journal of Environmental Research and Public Health. 2022; 19(5):2659. https://doi.org/10.3390/ijerph19052659
Chicago/Turabian StyleLamichhane, Dirga Kumar, Sabina Shrestha, and Hwan-Cheol Kim. 2022. "District-Level Risk Factors for COVID-19 Incidence and Mortality in Nepal" International Journal of Environmental Research and Public Health 19, no. 5: 2659. https://doi.org/10.3390/ijerph19052659