Global school based student health survey Nepal, 2015.

Research Report.

SUMMARY: Establishing healthy behaviors during childhood and adolescent period is easier and more effective than trying to change unhealthy behaviors and treating diseases during adulthood. Schools can play a vital role in promoting the health and safety of young people helping them establish lifelong healthy behavior patterns. Realizing the importance of youth health, many developing countries like Nepal have taken some actions to prevent and control risk factors among youth. The country has had the information on key risk behaviors in particular the NCD risk factors on adult population (15-69 years) recently. Similarly, the country also has information of overall adolescents (10-19 years) with focus on issues like fertility, health behavior, sexually transmitted infection and HIV/AIDS. Besides these findings, Government of Nepal has also developed the national multi-sector action plan for prevention and control of NCDs. The action plan emphasizes the evidence need for NCDs and envisioned the GSHS in 2016. It is therefore expected that the essential information on health risk behaviors is acquired at national level to complement the evidence gap on NCD risk factors among adult population. The National GSHS was carried out to identify the prevalence of health behaviors and protective factors among the students attending 7 to 11 grades in Nepal. The 2015 Nepal GSHS employed a two-stage cluster sample design to produce a representative sample of students of class 7 -11. The first-stage sampling frame consisted of all schools containing any of class 7 -11. Schools were selected with probability proportional to school enrolment size, which ended with selection of 75 schools to participate in the Nepal GSHS. The second stage of sampling consisted of random selection of intact classrooms (using a random start) from each school to participate. All classrooms in each selected school were included in the sampling frame. All students in the sampled classrooms were eligible to participate in the GSHS. The Nepal GSHS questionnaire contained 91 questions addressing the issue of; Alcohol and other drug use. Dietary behaviors, Hygiene, Mental health, Physical activity, Protective factors, Sexual behaviors that contribute to HIV infection, other STIs, unintended pregnancy, Tobacco use, Violence and unintentional injury. The standard GSHS questionnaire was adapted after discussion with Ministry of Health, Ministry of Education and WHO Nepal. The Questionnaire was then sent to CDC Atlanta followed by translation into Nepali and back translation into English. The Nepali version of GSHS questionnaire contained 91 questions of which, 58 questions were core questionnaire module and 33 were core expanded questions. Both the core and expanded questions included questions related to demography, dietary behaviors, hygiene, violence and unintentional injury, mental health, tobacco use, alcohol and drug use, sexual behaviors, physical activity and protective factors. For the Nepal GSHS, 6529 questionnaires were completed in 74 schools. The school response rate was 92%, the student response rate was 75%, and the overall response rate was 69%. Among 6529 participants, slightly higher proportion of participants were female (51.3%) and the remaining were male (48.7%). Similarly, most of the adolescent were from class 7 (27.7%), class 8 (27.7%) and class 9 (23.7%). Regarding age distribution of participants, majority (64.2%) were from 13-15 years age group followed by (21.5%), 16-17 years age group.Current alcohol user (at least one drink of alcohol during the 30 days before the survey) among the adolescent students was about 5.5%. A significantly higher proportion of male students (7.1%, CI: 5.6 - 8.9) were current alcohol users compared to female students (3.7%, CI: 2.5 - 5.3). Similarly, 74.6% of adolescent students who ever drank alcohol had their first drink before the age of 14 years. Nine percent (male-11.8%, female-5.4%) of adolescent students were current tobacco user and a higher proportion of males (8.9%, CI: 6.9 - 11.5) were current tobacco user in comparison to females (5.4%, CI: 3.8 - 7.8). Similarly, 6.4% of adolescent students were current cigarette smoker with higher proportion of males (8.9%, CI: 6.9 - 11.5) compared to female adolescents (3.5%, CI: 2.3 - 5.4). Seventyeight percent adolescent students used cigarettes before the age of 14 years among those who ever smoked. Regarding the nutritional status of students, 10.9% (male-13.8%, female-8.1%) adolescent students were underweight (BMI < -2 SD). The proportion of underweight among males (13.8%, CI: 10.8 - 17.5) was higher in comparison to female (8.1%, CI: 6.3 - 10.3). Regarding fruit intake in last 30 days, 12% of adolescent students did not eat fruits in last 30 days. Similarly, only 32.3% of adolescent students ate vegetables less than one time per day during 30 days. Furthermore, 77.4% of adolescent student were taught about benefits of eating fruits and vegetables. Four percent of adolescent students never or rarely washed their hands before eating. Similarly, 4.8% students never or rarely washed their hands after using the toilet or latrine. Five percent of students never or rarely used soap when washing their hands. Regarding mental health status of adolescent, 6.6% of adolescent students felt lonely most of the time or always during the last 12 months preceding the survey. Similarly, 13.9% of adolescent students seriously considered attempting suicide in the last 12 months. Almost 50% of adolescents were physically inactive during the 7 days before the survey. Furthermore, 34% did not attend weekly physical education classes during this school year. Overall, 49.1% of adolescent students reported that parents or guardians checked if their homework was completed during the past 30 days. Similarly, 52.6% adolescent students reported that most of the time or always parents understood their problems and worries during the past 30 days. Furthermore, 50.9% of adolescent students were bullied one or more days during the 30 days and more males (55.7%, CI: 51.1 - 60.2) were bullied in comparison to females (46.2%, CI: 42.4 - 50.0). Almost 21% of adolescent students had sexual intercourse, and among those 66.9% had sexual intercourse before age of 14 years of age. Similarly, only 57.4% (male-64.4%) of adolescent students used condom during their last sexual intercourse. Nearly 39.3% (male-43.7%, female-34.9%) adolescent students had physical fight one or more times during the past 12 months and 64.4% adolescent students suffered from serious injury one or more times during past 12 months. Overall, Nepal GSHS 2015 fulfilled information gap related with adolescent students and identified some of the core areas (tobacco use, alcohol use, violence and injury) which need special focus to address the issues of adolescent health risk behaviors with a coordinated effort from educational as well as health sector.