The online version of this article (doi:10.1186/1129-2377-15-51) contains supplementary material, which is available to authorized users.
TJS is a Director and Trustee of Lifting The Burden.
AR, KM, TS, AH, RK and ML: Conception and design. AR, KM, TS, ML: Acquisition of data. AR, KM, TS and ML: Analysis and interpretation of data. AR: Drafting the article. AR, KM, TS, AH, RK and ML: Revising it critically for important intellectual content. KM, TS, AH, RK and ML: Giving final approval of the version to be submitted.
Headache, anxiety and depression are major disorders of the brain in terms of their prevalence and the burdens and costs they impose on society. Nationwide population-based studies of these disorders are necessary to inform health policy but, in research-naïve and resource-poor countries such as Nepal, a host of methodological problems are encountered: cultural, geographic, logistic and philosophical.
Expert consensus was sought among researchers from different professional and cultural backgrounds in planning and conceptualizing an epidemiological study and adapting established methods to the special situation and circumstances of Nepal.
The methodological problems were sorted into different themes: study design; climate; geography, access and transport; sociocultural issues; safety of interviewers. Each of these was dealt with separately, and their inter-relationships explored, in finding solutions that were sometimes pragmatic. A cross-sectional questionnaire-based study, with teams of interviewers visiting households across the three physiographic divisions (with extremes in altitude) in each of the five development regions of the country, would enable national sampling with sociocultural representativeness. However, the study instruments and interviews would be in Nepali only. Transport and access challenges were considerable, and their solutions combined travel by air, bus, river and foot, with allowances for rain-damaged roads, collapsed bridges and cancelled scheduled flights. The monsoon would render many routes impassable, and therefore set an absolute time limitation. Engaging participants willingly in the enquiry would be the key to success, and several tactics would be employed to enhance the success of this, most importantly enlisting the support of local community volunteers in each study site.
Anticipating problems in advance of investing substantial resources in a large nationwide epidemiological study in Nepal was a sensible precaution. The difficulties could be resolved or circumvented without expected compromise in scientific quality. Expert consensus was an effective means of achieving this outcome.
Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, Dodel R, Ekman M, Faravelli C, Fratiglioni L, Gannon B, Jones DH, Jennum P, Jordanova A, Jonsson L, Karampampa K, Knapp M, Kobelt G, Kurth T, Lieb R, Linde M, Ljungcrantz C, Maercker A, Melin B, Moscarelli M, Musayev A, Norwood F, Preisig M, Pugliatti M, Rehm J, et al.: Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011, 21(10):718–779. 10.1016/j.euroneuro.2011.08.008 CrossRefPubMed
Linde M, Gustavsson A, Stovner LJ, Steiner TJ, Barre J, Katsarava Z, Lainez JM, Lampl C, Lanteri-Minet M, Rastenyte D, Ruiz de la Torre E, Tassorelli C, Andree C: The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol 2012, 19(5):703–711. doi:10.1111/j.1468–1331.2011.03612.x 10.1111/j.1468-1331.2011.03612.x CrossRefPubMed
Headache Classification Committee of the International Headache Society: The international classification of headache disorders, 3rd edition (beta version) (2013). Cephalalgia 2013, 33(9):629–808. doi:10.1177/0333102413485658 CrossRef
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basanez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, et al.: Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380(9859):2163–2196. doi:10.1016/s0140–6736(12)61729–2 10.1016/S0140-6736(12)61729-2 CrossRefPubMed
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basanez MG, Baxter A, Bell ML, Benjamin EJ, et al.: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380(9859):2197–2223. doi:10.1016/s0140–6736(12)61689–4 10.1016/S0140-6736(12)61689-4 CrossRefPubMed
Sadock BJ, Sadock VA, Kaplan HI: Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Lippincott Williams & Wilkins, Philadelphia; 2005.
World Health Organization: Lifting The Burden: Atlas of headache disorders and resources in the world 2011. WHO, Geneva; 2011.
GBD profile: Nepal: Global burden of diseases, injuries, and risk factors study 2010. Institute of Health Metrics and Evaluation, University of Washington; 2013. . Accessed 22 Feb 2014 http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_nepal.pdf
Bhattarai B, Pokhrel PK, Tripathi M, Rahman TR, Baral DD, Pande R, Bhattachaya A: Chronic pain and cost: an epidemiological study in the communities of Sunsari district of Nepal. Nepal Med Coll J 2007, 9(1):6–11. PubMed
Stovner LJ, Al Jumah M, Birbeck GL, Gururaj G, Jensen R, Katsarava Z, Queiroz LP, Scher AI, Tekle-Haimanot R, Wang SJ, Steiner TJ: The methodology of population surveys of headache prevalence, burden and cost: Principles and recommendations from the Global Campaign against Headache. J Headache Pain 2014, 15(1):5. doi:10.1186/1129–2377–15–5 10.1186/1129-2377-15-5 PubMedCentralCrossRefPubMed
Steiner TJ, Gururaj G, Andree C, Katsarava Z, Ayzenberg I, Yu S-Y, Jumah MA, Tekle-Haimanot R, Birbeck GL, Herekar A, Linde M, Mbewe E, Manandhar K, Risal A, Jensen R, Queiroz LP, Scher AI, Wang S-J, Stovner LJ: Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire. J Headache Pain 2014, 15: 3. 10.1186/1129-2377-15-3 PubMedCentralCrossRefPubMed
The World Bank Data-Country and Lending groups. 2014. . Accessed 2 April 2014 http://data.worldbank.org/about/country-classifications/country-and-lending-groups
Nepal in figures 2012: Central Bureau of Statistics. 2012. . Accessed 13 Jan 2014 http://cbs.gov.np/wp-content/uploads/2012/Nepal%20in%20figure/Nepal%20In%20Figures%202012_English.pdf
The World Factbook: Central Intelligence Agency, Office of Public Affairs. 2013. . Accessed 14 Jan 2014 https://www.cia.gov/library/publications/the-world-factbook/geos/np.html
Nepal Population Report 2011: Govenment of Nepal, Ministry of Health and Population. Population Division, Kathmandu, Nepal; 2011.
Climate Risk and Adaptation Country Profile: Nepal: World Bank. 2014. . Accessed 13 Jan 2014 http://sdwebx.worldbank.org/climateportalb/home.cfm?page=country_profile&CCode=NPL&ThisTab=Overview
Yu SY, Cao XT, Zhao G, Yang XS, Qiao XY, Fang YN, Feng JC, Liu RZ, Steiner TJ: The burden of headache in China: validation of diagnostic questionnaire for a population-based survey. J Headache Pain 2011, 12(2):141–146. doi:10.1007/s10194–011–0336–2 10.1007/s10194-011-0336-2 PubMedCentralCrossRefPubMed
Rao GN, Kulkarni GB, Gururaj G, Rajesh K, Subbakrishna DK, Steiner TJ, Stovner LJ: The burden of headache disorders in India: methodology and questionnaire validation for a community-based survey in Karnataka State. J Headache Pain 2012, 13(7):543–550. doi:10.1007/s10194–012–0474–1 10.1007/s10194-012-0474-1 PubMedCentralCrossRefPubMed
Herekar AD, Herekar AA, Ahmad A, Uqaili UL, Ahmed B, Effendi JA, Alvi SZ, Steiner TJ: The burden of headache disorders in Pakistan: methodology of a population-based nationwide study, and questionnaire validation. J Headache Pain 2013, 14(1):73. doi:10.1186/1129–2377–14–73 10.1186/1129-2377-14-73 PubMedCentralCrossRefPubMed
Ayzenberg I, Katsarava Z, Mathalikov R, Chernysh M, Osipova V, Tabeeva G, Steiner TJ: The burden of headache in Russia: validation of the diagnostic questionnaire in a population-based sample. Eur J Neurol 2011, 18(3):454–459. doi:10.1111/j.1468–1331.2010.03177.x 10.1111/j.1468-1331.2010.03177.x CrossRefPubMed
Monsoon onset and withdrawal: Ministry of Science, Technology and Environment Government of Nepal. 2013. . Accessed 19 Jan 2014 http://www.dhm.gov.np/uploads/climatic/535305507monsoon%20onset%20n%20withdrawal.pdf
Nepal Living Standards Survey 2010/11: vol 1. Government of Nepal, Kathmandu, Nepal. 2011.
Nepal Demographic and Health Survey 2011: Ministry of Health and Population. New ERA and ICF International, Calverton, Maryland, Kathmandu, Nepal; 2012.
Female Community Health Volunteers: WHO Country Office, Nepal. 2010. . Accessed 20 Aug 2014 http://www.searo.who.int/mediacentre/releases/2011/pr1532/en/
Nepal Living Standards Survey 2010/11: vol 2. Government of Nepal, Kathmandu, Nepal. 2011.
Nepal Standard Occupation Classification-NSOC-99: Government of Nepal, Kathmandu, Nepal. 1999.
International Standard Classification of Occupation-ISCO-88: International Labor Organization. 1988. . Accessed 13 Jan 2013 http://www.ilo.org/public/english/bureau/stat/isco/
Health System in Nepal: Challenges and Strategic Options: World Health Organization Country Office for Nepal. WHO Regional Office for South- East- Asia, New Delhi, India; 2007.
WHO Global Status Report on Alcohol 2011: World Health Organization. 2011. . Accessed 14 Jan 2013 http://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/npl.pdf?ua=1
Shrestha P: Policy initiatives for drug control in Nepal. Health 2011, 2(2):66–68.
Ayers B: Carrying Nepal on their backs. 2003. . Accessed 13 Jan 2013 http://nepalitimes.com/news.php?id=4747#.Ust_tNIW2Q4
- Estimating prevalence and burden of major disorders of the brain in Nepal: cultural, geographic, logistic and philosophical issues of methodology
Timothy J Steiner
- Springer Milan
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II