Environmental Determinants of Disease Study Papers.
Environmental determinants causing unexpected disease rampant are seemed major challenges to be protective from inevitable hazards and to deal the future consequences in terms of human health loss.Environmental Determinants of Disease Study Papers.
This paper explores the major environmental determinants stimulating disease prevalence in western hilly areas of Nepal. Cross-sectional analytical research design for household level primary data was treated with the binary logit regression model to identify the determinants of disease prevalence. Extreme winter temperature, decreasing winter rainfall, sporadic rain, drying spout and decreasing the tree species are the major environmental determinants; hand washing, proper management of solid waste from kitchen and habit of drinking boiled water are as household behavioral determinants; and adequate family members, higher education, use of pesticide to control the insects and use of clean cooking fuels are socioeconomic determinants encouraging disease prevalence. Plantation of large perennial and medicinal plants, proper management of warm clothes or heaters especially for old people and children having respiratory problems for extreme winter; management of water tank for long drought in winter and community awareness campaign for the protection of spout are urgent needs for the prevention of current disease prevalence. Ergo, the recommendations are made accordingly.Environmental Determinants of Disease Study Papers.
Western Nepal, Disease Prevalence, Logit Model, Environmental Change
1. IntroductionAlmost one third of global diseases can be directly related to environmental risk factors owing to poor access to sanitation and safe water supply, the potential cause of infection-forming conditions, mainly in the developing countries  . Therefore, environmental health science needs enough inputs from meteorologists, chemists, biologists, geologists and health economist to explore robust interdisciplinary findings of global environmental changes  . A study argued that South East Asia could face disastrous consequences due to climate change if not apply measures that can mitigate the effects by focusing on advanced knowledge and training; and by developing collaborative work  . However, some recent efforts commenced by the relevant government agencies seem to be less effective in stopping further environmental quality deterioration, because the actions taken are weakly coordinated and poorly integrated especially to implement laws regarding the threat to human security in terms of value     .Environmental Determinants of Disease Study Papers.Environmental change plays an important role in controlling ecosystem variability and potential for outbreaks of several new diseases following deaths and morbidity associated with extreme and erratic weather in Nepal    . Nepal is one of the most vulnerable countries due to environmental changes including climate change and household characteristics. Vulnerability depends upon not only the environmental exposure  but also the household daily behaviors including economic aspects. A study  based on central part of Nepal claimed that namely central and western parts of Nepal are the most vulnerable for the climatic effects, giving way out for designing site-specific intervention strategies to apply mitigation measure.The remarkable differences in natural environmental conditions are primarily related to an enormous range of elevation within a short north-south distance. Therefore, it is important to identify and analyze the environmental determinants controlling household behavioral determinants; where environmental indicators include climate change and other issues that associate with human health.Environmental Determinants of Disease Study Papers. A clear picture of the association between environmental change and the sudden outbreak of diseases may help to identify the total cost incurred at present and can predict the future consequences possibly concocted by exogenous natural hazards. Moreover, household level mitigation measures for the health effects of climate change may also be potential guidance for risky region all around the world.Several outbreaks of malaria, Kala-azar, and Japanese encephalitis in the countryside of Nepal seem to be allied with changes in temperature  . More specifically, Jajarkot is one of the poorest and remotest districts of Nepal. Access to drinking water is estimated to be 49.4 percent of total households, ignoring the quality of available water to be further investigated. Access to sanitation is less than 22 percent, compared to the national average of 46 percent  . Open defecation is a common phenomenon and the lack of safe drinking water and hygienic practices make communities more vulnerable. This shows an alarming trend of climate change impact on human health and wellbeing.Diarrhea is one of the leading causes of morbidity and mortality among children under five in Nepal, with 10,500 dying every year. Since some years before, every year in monsoon season, Jajarkot district and other districts in its surrounding belonging to the western region of Nepal has been suffering more often from high disease occurrence.Environmental Determinants of Disease Study Papers. Nepal government has also been there at the time of high prevalence of the diseases (Cholera and Diarrhea) and has spent a lot of money which might have the alternative use for welfare generation if there were no such seasonal events. This single example may lead to such many events in the country if we focused only on curative aspects, ignoring the impacts of other exogenous effects.Some districts in the hilly region of Nepal have similar socio economic characteristics such as remoteness, lack of access to facility, low level of education, low Human Development Index (HDI), and poor health facilities among others but Jajarkot and other nearby districts are facing a high rate of new and old disease outbreaks every year.Environmental Determinants of Disease Study Papers. This is an unreached area of the researchers as well as an urgent information required to save a gigantic societal cost and for having an economically prosperous society. Therefore, Jajarkot is chosen as a potential study area to yield diseases and environment related primary information.Scanty literatures based on Nepal are devoted only on the effects of climate on agriculture and other sectors but few literatures    are mainly devoted on exploring trend of disease occurrence in Nepal. Of the few literatures, none of the literature is found addressing whether environmental factors would be significant predictors of the disease prevalence or not. Moreover, indirect mitigation measures applied by the households to reduce the climatic effects on disease incidence are also unknown. Therefore, this research aims to identify factors influencing the disease prevalence in rural hilly areas of western Nepal.2. Materials and MethodsCross sectional analytical economic evaluation design has been employed using both primary and secondary data. National level data were collected from WHO, Epidemiology and Disease Control Division, Ministry of Health and Population, Department of Health, United Nation Children’s Fund and Center for Disease Control, Central Department of Environmental Science and other concerning agencies working in disease interventions.2.1. Study AreaThe study areas are three wards of Bheri Municipality of Jajarkot district, as identified as high disease prevalence area and the place of the poorest in the mid-western region of Nepal. The study area (red colored area in Figure 1) is announced by the government as the area with extreme poverty and high disease afflicted. The district has 30 Village Development Committees. Darim Lek (5440 m) is the highest altitude and 610 m is the lowest altitude within the district. The climate of the district ranges from subtropical to the alpine condition. Hilly and mountainous region of Nepal are claimed to be more climate sensitive areas where there is evidence of having new seasonal diseases unknowingly. Environmental Determinants of Disease Study Papers.Every year incidence of new viral diseases and other diseases have been occurring to dare the health challenge among people living in this area, death tolled already moreFigure 1. Study area (red color) of Nepal.than 150 and more than 20,000 people are affected  . Study based on Jajarkot district can be representative to the hilly and mountainous region of western Nepal, and ultimately the study can cover the hilly rural region having high disease prevalence. Therefore, Jajarkor is selected for the potential informative area to obtain a valid association between environmental change and disease prevalence.2.2. Study SettingThis study is by nature based on the disease prevalence due to environmental indicators changed over the last 15 years. The key informants of the research are household heads of age above 35 years.Environmental Determinants of Disease Study Papers. Therefore, a household based semi-structured questionnaire was developed for data collection. Both qualitative and quantitative response related questions were set in questionnaire balancing the flow of questions. The questionnaire incorporated both climatic and household behavioral related quires including the cost incurred by households for the treatment of the particular disease as well as task for mitigation of effect of climate change. Initially, a pilot survey was conducted for finding the area sensitive to the sudden disease outbreaks with the help of District Public Health Office of Jajarkot. After the completion of pilot survey conducted in the districts, Bheri municipality, one of the most affected area was selected based on the high disease occurrence with heterogeneity in the population.2.3. Sampling Technique and Sample SizeRapid assessment type of study was carried out before the application of sampling strategy and developing the data collection tools to understand the local situation and dimensions. This assessment first opened the avenues to carry out the research from different perspective. After the identification of affected Wards of Bheri Municipality of Jajarkot, a sampling frame was prepared from the list of households available in the office of the municipality. Different disease faced households list of the last 5 years was obtained from local health centers. With the help of this information, a simple random sampling method was applied in the selection of sample households.Environmental Determinants of Disease Study Papers. Therefore, samples from three Wards of the municipality which have been affected from diseases many often, where households are highly scattered and place of extreme poverty was selected by simple random sampling method. This gives a total of 200 households as the sample size for this study.2.4. Data Collection and ManagementData were collected with the help of semi-structured pretested questionnaire containing both qualitative and quantitative aspects. Record reviews, and in-depth interviews with health professionals and community people were the fundamental techniques for data collection. First, questionnaire was pre-tested in Kavre district, then the required corrections were made based on the problem in pre-testing. Then, the questionnaire was finalized as per the suggestions of experts. Then, four enumerators were selected and trained them with ethical issues. So far the logistics were prepared to move towards the field from March 10 to 22, 2018. A field supervisor monitored the information collected and confirmed the information accuracy. Collected data were entered into the data entry software SPSS and transformed into STATA for the analysis.Environmental Determinants of Disease Study Papers.