Estimating prevalence and burden of major disorders of the brain in Nepal: cultural, geographic, logistic and philosophical issues of methodology

The Journal of Headache and Pain

Methodology

Ajay Risal¹  Kedar Manandhar¹  Timothy J Steiner²  Mattias Linde³  Are Holen⁴  Rajendra Koju⁵ 

[1] Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway;Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Dhulikhel, Nepal;Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway;Division of Brain Sciences, Imperial College London, London, UK;Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway;Norwegian National Headache Centre, St Olavs University Hospital, Trondheim, Norway;Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway;Pain Unit, St Olavs University Hospital, Trondheim, Norway;Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Dhulikhel, Nepal;

关键词: Nepal;    Burden of disease;    Population-based survey;    Headache;    Anxiety;    Depression;    Global campaign against headache;   

DOI  :  10.1186/1129-2377-15-51

 received in 2014-06-16, accepted in 2014-08-06,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundHeadache, 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.MethodsExpert 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.ResultsThe 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.ConclusionAnticipating 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.

【 授权许可】

Unknown   
© Risal et al.; licensee Springer. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.