Insomnia among Elderly People in a selected urban Community.

BACKGROUND: Insomnia affects both physical and mental well-being of elderly people, also increasing risks of psychological problems such as depression and decreases quality of life. We assessed the proportion of elderly people with insomnia and associated factors in a selected community. METHODS: We carried out a cross sectional study interviewing 110 elderly people residing in Shankarapur-7, Sankhu, Kathmandu using convenient sampling technique. We used a structured questionnaire and included Insomnia Severity Index to identify level of insomnia. We analysed insomnia as clinically significant and non-significant and present the results as proportion and further bivariate analysis. RESULTS: About one third (29.1%) of the elderly had clinically significant insomnia. About half (53%) of the participants suffered from co-morbid disease conditions, mainly hypertension and diabetes mellitus. About 2 in 5 (38%) participants performed regular exercise for more than 15 minutes. Similarly, the proportion of clinically significant insomnia was higher among older age groups (50% among 70+ years & 21% among below 70 years), females 40% (males 19%), widowed 56% (currently married 21%), illiterate 42% (literate 13%). These were found to be significant during bivariate analysis. CONCLUSIONS: We found a substantial proportion of participants with clinically significant insomnia. Promoting the physical and mental health of elderly people is important for them to lead a quality life. Health promotion approaches with targeted interventions for elderly are important to cater the need of elderly population and this might help improve the quality of life of the elderly people.

Medication Adherence among Hypertensive Patients Attending a Tertiary Care Hospital in Nepal.

BACKGROUND: Drug therapy and adherence to the medication is critical to prevent complications of hypertension and more importantly in countries like Nepal where more than one quarter adults suffer from it. Primary aim was to measure adherence to anti-hypertensive medication and factors associated with low adherence. METHODS: Morisky Medication Adherence Scale was used for measuring medication adherence and a structured questionnaire for measuring background and illness related factors in a cross-sectional study among 216 hypertensive patients in a tertiary care hospital selected through sequential sampling. Data was analysed using descriptive and inferential statistics and results presented with proportion or odds ratio with 95% CI. RESULTS: It was found that 72% of the patients had low adherence to anti-hypertensive medication, with sub-group differences notably higher among females (77%); among those with co-morbidity (80%); and among those getting medicines free of cost (76%). Post multivariate logistic regression, it was found that patients with co-morbidity had higher odds of having low adherence (Adjusted Odds Ratio - AOR: 2.50; 95%CI:1.28-4.89) than those without; and those who get medicine free of cost had higher odds of having low adherence (AOR: 3.01; 95%CI:1.32-6.86) than those who pay for medicine. CONCLUSIONS: A substantial proportion of hypertensive patients had low adherence to medication. Presence of co-morbidity, getting medicine free of cost, and not having regular follow up were the major factors associated with low adherence to anti-hypertensive medication. Targeted interventions in hospitals and health care centers in Nepal would improve medication adherence.

Anxiety and Depression among Pregnant Women and Mothers of Children Under one Year in Sindupalchowk District.

BACKGROUND: Common mental disorders such as anxiety and depression among mothers of young children and expectants can silently deteriorate the health of the mother with significant impact on the newborn. The primary aims were to determine the proportion of pregnant women and mothers of children under one year with anxiety and depression and their associated factors in Sindhupalchowk. METHODS: We used the Hopkins Symptom Checklist 25 and a structured questionnaire in a cross-sectional study to collect information from 778 women (164 pregnant women, 614 mothers of children under one year) selected through multi-stage sampling. RESULTS: Among pregnant women, the study found that 21.3%(95%CI:15.7-28.3) had anxiety and 23.8% (95%CI:17.8-31.0) had depression. Being from the Dalit ethnic group was independently associated with anxiety and depression. Among mothers of children under one year, 18.7% (95%CI:15.7-22.1) had anxiety and 15.2% (95%CI:12.4-18.4) had depression. Among these women, low education level; primary source of family income being agriculture, animal husbandry or labour; history of unplanned pregnancy; and use of tobacco were independently associated with anxiety and history of unplanned pregnancy and use of tobacco were independently associated with depression. CONCLUSIONS: A substantial proportion of women had anxiety and depression with higher odds of anxiety and depression in certain group of women. Targeted health system interventions are needed for improving the psychological well being of women, including pregnant women, as well as newborn health and wellbeing.