District-Level Risk Factors for COVID-19 Incidence and Mortality in Nepal

Abstract

The recent global pandemic of the novel coronavirus disease 2019 (COVID-19) is affecting the entire population of Nepal, and the outcome of the epidemic varies from place to place. A district-level analysis was conducted to identify socio-demographic risk factors that drive the large variations in COVID-19 mortality and related health outcomes, as of 22 January 2021. Data on COVID-19 extracted from relevant reports and websites of the Ministry of Health and Population of Nepal, and the National Population and Housing Census and the Nepal Demographic and Health Survey were the main data sources for the district-level socio-demographic characteristics. We calculated the COVID-19 incidence, recovered cases, and deaths per 100,000 population, then estimated the associations with the risk factors using regression models. COVID-19 outcomes were positively associated with population density. A higher incidence of COVID-19 was associated with districts with a higher percentage of overcrowded households and without access to handwashing facilities. Adult literacy rate was negatively associated with the COVID-19 incidence. Increased mortality was significantly associated with a higher obesity prevalence in women and a higher smoking prevalence in men. Access to health care facilities reduced mortality. Population density was the most important driver behind the large variations in COVID-19 outcomes. This study identifies critical risk factors of COVID-19 outcomes, including population density, crowding, education, and hand hygiene, and these factors should be considered to address inequities in the burden of COVID-19 across districts.

Epidemiology of COVID‐19 mortality in Nepal: An analysis of the National Health Emergency Operation Center data

“…A higher proportion of deaths occurred among the age group 60-79-year age group compared to their younger counterparts, and this was greater in the first wave than in the second (Table 1). The finding is consistent with the previous findings from Nepal [10], Bangladesh, and India [2]. The higher number of deaths among the older age group may be linked to weaker immune systems among older people [2].…”

“…Moreover, living in overcrowded houses and having lower literacy are also associated with a higher incidence of COVID‐19 [9]. The burden of COVID‐19 is higher in low‐resource settings, with age‐specific mortality rates twofold higher than in high‐income countries [10].…”

Water, sanitation, hygiene practices, health and nutritional status among children before and during the COVID-19 pandemic: longitudinal evidence from remote areas of Dailekh and Achham districts in Nepal

“…In contrast, hygiene behavior such as the frequency of handwashing improved. The mortality rate due to COVID-19 was relatively high in the study areas we surveyed and was similar to other parts of the country [71]. It is likely that the high mortality rates due to COVID-19 in Dailekh and particularly in Achham were associated with weak and inadequate WASH infrastructure, inadequate local public health infrastructure, and the government's limited efforts, capacities, and expertise to chart any emergency measures or to set up health care facilities for treating COVID-19 patients [9,72].…”

Risk perception and intent to take precautionary actions against COVID-19 among adult population during pandemic in Nepal

“…Two districts were chosen purposively from each province as per the magnitude of the COVID-19 pandemic. Those districts were selected where the population density and risk of COVID-19 was higher compared to other districts in the province (Lamichhane et al, 2022). A total of 14 districts were selected for this study.…”