Imperial Journal of Interdisciplinary Research (IJIR)

Vol-3, Issue-5, 2017

ISSN: 2454-1362, http://www.onlinejournal.in

Cardiovascular Health Risk Behavior among the

Teaching Faculties of Medical School in Nepal
Babita Sharma1*, Anu Rai2 & Ram Sharan Mehata2
1
Nobel Medical College and Teaching Hospital, Nepal
2
College of Nursing, BP Koirala Institute of Health Sciences, Dharan, Nepal
Abstract: The risk of cardiovascular disease is deaths take place in low- and middle-income
increasing globally. This study was aimed at countries and occur almost equally in men and
assessing the cardiovascular health risk behavior women [6]. The number of people who die from
among the teaching staffs in BP Koirala Institute of CVDs, mainly from heart disease and stroke, will
health Sciences Nepal, and to document the increase to reach 23.3 million by 2030 [7]. CVDs are
association between the cardiovascular health risk projected to remain the single leading cause of death
behaviors with selected demographic variables. A [7].
descriptive cross-sectional study was conducted to Cardiovascular disease usually affects older
explore the cardiovascular health risk behavior adults, the antecedents of cardiovascular disease,
among the faculties at BP Koirala Institute of Health notably atherosclerosis, begin in early life, making
Sciences. 99 subjects meeting the eligibility criteria primary prevention efforts necessary from childhood
were recruited using a purposive sampling method. [8, 9]. There is therefore an increased emphasis on
Data were collected using self-administered preventing atherosclserosis by modifying risk
questionnaire method, and analyzed using SPSS 16. factors, for example by healthy eating, exercise, and
77.8% of respondents were of age group <40 years, avoidance of smoking tobacco [10, 11]. Evidence
and 70.7% were males. Similarly, 13.1% were light suggests a number of risk factors for heart diseases,
smoker, 54.5% consumed alcohol, 73.3% consumed like age, gender, high blood pressure,
high fat food occasionally, 48.5% consumed extra hyperlipidemia, diabetes mellitus, tobacco smoking,
salt in their diet, and 86.9% felt stress sometimes. processed meat consumption, excessive alcohol
The study showed that there is significant association consumption, sugar consumption, and family
between cardiovascular health risk behaviors with history, and obesity, lack of physical activity,
cardiovascular disease in family of the respondents. psychosocial factors, and air pollution [11, 12].
It was thus concluded that alcohol consumption, high While the individual contribution of each risk factor
fat food consumption and stress felt usually are the varies between different communities or ethnic
cardiovascular health risk behaviour found among groups the consistency of the overall contribution of
the respondents. these risk factors to epidemiological studies is
remarkably strong [13]. In Nepal, One third of
Key words: Cardiovascular disease, cardiovascular people over age 60 years had more than 10% chance
risk behaviour of developing cardiovascular disease whereas it has
been reported to increase to 50 % by the age of 70
1. INTRODUCTION years and older group [14]. The most important
behavioral risk factors of heart disease and stroke are
Cardiovascular disease primarily involves the unhealthy diet, physical inactivity, tobacco use and
disorders of the heart and blood vessels. Similarly, harmful use of alcohol [15]. Behavioral risk factors
coronary heart disease, stroke, hypertension, are responsible for about 80% of coronary heart
peripheral arterial disease, rheumatic heart disease disease and cerebrovascular disease [16]. Assessment
and congenital heart disease are broadly classified as of risk factors can predict the future cardiovascular
cardiovascular disease [1]. Although, cardiovascular events [17].
diseases (CVDs) are the number one cause of death It has been reported that the most prevalent
globally, mortality rates have declined in many high cardiovascular risk factors in the age group of 20-29
income countries and at the same time, year was sedentary lifestyle (63%), while from fourth
cardiovascular deaths and disease have increased at a decade and onwards, it was overweight/obesity (59-
fast rate in low and middle income countries [2, 3]. 85%) [4, 18]. The second most common prevalent
An estimated 17.3 million people died from CVDs in cardiovascular risk factor in the age group of 20-29
2008, representing 30% of all global deaths [4, 5]. Of year was overweight/obesity, in 30-49 years
these deaths, an estimated 7.3 million were due to sedentary lifestyle, in 50-69 years hypertension and
coronary heart disease and 6.2 million were due to in subjects ≥70 year, it was hypertriglyceridemia [4,
stroke. Low- and middle-income countries are 19]. The prevalence of overweight/obesity,
disproportionally affected [3]. Over 80% of CVD hypertension, dysglycaemia and smoking was almost

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Imperial Journal of Interdisciplinary Research (IJIR)
Vol-3, Issue-5, 2017
ISSN: 2454-1362, http://www.onlinejournal.in

double in subjects in the fourth decade of life, as 2.3 Sampling Technique

compared to those in the third decade of life [1, 7]. Purposive sampling technique was used to select
Similarly, a cross-sectional study conducted in the samples. Stratification was made to select the
patients with CVDs in Tribhuvan University samples from different Colleges and Departments.
Teaching Hospital Nepal, found that 22% were Strata was made of College of Nursing, School of
current smokers, 35% indulged in episodic heavy Public Health and Community Medicine, College of
drinking, 15.7% were overweight [20, 21]. Dental Surgery and School of Medicine (Basic
In Nepal, few community based studies have Science and Clinical Science) so that representation
suggested a very high prevalence risk factors of was made from all the areas.
CVDs in the general population that includes
diabetes mellitus, hypertension, overweight, 2.3 Research Instrument
inadequate physical activity, and tobacco Research instrument was based on WHO risk
consumption one way of combating this rising factor assessment guideline tool which include
epidemic of CVD is by raising the public health history of demographic data, diet, physical activity,
awareness about this disease11 . Furthermore, smoking, alcohol consumption, height, weight and
smoking, body mass index (BMI) and daily salt other co-variables.
intake were identified as significant predictors of
17, 19
hypertension. The consciousness of the general Research Tool Validity
population towards the health risk behaviors are very Content validity of the instrument was established by
challenging to predict. However, it makes an consultation with the research guide and concerned
intuitive sense to predict that awareness among the experts in the field of research.
academic faculty members in the medical school be
higher and they will adept the behavior in their Pre-testing of the tool
lifestyle. This research therefore aims to document Pre-testing was done in 10% of the sample size (i.e.
the cardiovascular health risk behavior among the 10) and those who were included in the pre-testing
faculty members in medical school in Nepal. was excluded in the study.

2. METHODS 2.4 Data Collection Procedure

Permission from Institutional Review
This descriptive cross-sectional study was Committee was obtained. Tool was identified and
conducted on 100 academic faculties at BP Koirala approved by concerned authority. Pre-testing of the
Institute of Health Sciences. The population of study tool was done and was finalised. List of the faculty
was all the faculties working in College of Nursing, was obtained. Information regarding the research
College of Dental Surgery, School of Public Health was circulated to the chief of College of Nursing,
and Community Medicine and School of Medicine chief of College of Dental Surgery, Chief of School
(Basic Science and Clinical Science) of BPKIHS of Public Health and Community Medicine and all
Nepal. the HODs of other departments. Informed consent
2.1 Sample Size Estimation from each faculty was obtained prior to the data
Sample size (n) = 4pq/L2 collection and their confidentiality was maintained
Where p= prevalence throughout the study.
q = (100-p)
L= (20% of p) 2.4 Data Analysis Procedure
P = 50% [21] There were total of 23 questions. The responses
Therefore, were related to cardiovascular health risk behavior
n = (4x50x50)/ (10)2 = 100 were converted to the percentage in respect to the
2.2 Ethical Consideration total marks and then divided into two categories. The
behavior cut off was taken as 45 % because there
Permission from Institutional Review was no such type of study done previously hence,
Committee was obtained. Informed written consent this is for learning purpose so we have taken at least
from each faculty was obtained prior to the data 45 % arbitrary value for the purpose of
collection and their confidentiality was maintained
calculation.<45 % = Behavior YES while 45 % =
throughout the study. All participants were informed
Behavior NO and the details are depicted in the
that participation in the study is voluntary and they
tables and figures below. Data was entered in MS-
can refuse to participate or withdraw from the study
Excel 2010 and converted into SPSS version 11.5 for
at any time without being penalized or losing any
statistical analysis. Descriptive statistics such as
benefits. The faculties were requested to participate
mean, median, percentage, frequency, standard
in this study and data collection was done.
deviation was used to describe the socio-
demographic variables. The inferential statistics chi-

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Imperial Journal of Interdisciplinary Research (IJIR)
Vol-3, Issue-5, 2017
ISSN: 2454-1362, http://www.onlinejournal.in

square (2) test was used to find out the association Physiological Number
Category
between cardiovascular health risk behaviors with Parameter (%)
selected demographic variables at 0.05 level of Normal Range
57 (57.6)
significance. BMI was calculated based on the height (18.50-24.99)
and weight of the respondents. Pre-obese (25.00-
BMI 38 (38.4)
29.99)
3. RESULTS Obese Class I
4 (4.0)
(30.00-34.99)
Out of 100 only 99 participants completed the
study. The maximum numbers of respondents were Normal 82 (82.8)
from School of Medicine (n =33) followed by School Blood Pressure Borderline 10 (10.1)
of Medicine, Clinical Science (n =27) and college of High 7 (7.1)
dental surgery (n = 18), College of Nursing (n =13) Don’t know -
and School of Public Health and Community Normal 92 (92.9)
Medicine (n =8). Blood sugar level Borderline 7 (7.1)
Don’t know 0 (0.0)
3.1 Socio-Demographic characteristics of the Yes 48 (48.5)
respondents HDL level above
No 12 (12.1)
45
Majority of the respondents were of age group Don’t know 39 (39.4)
<40 years (77.8%), 70.7 % of the respondents were Yes 40 (40.4)
males, 90.9 % followed Hinduism, 84.0% were LDL level below
No 17 (17.2)
100
married, and 55.6% had nuclear family type. Don’t Know 42 (42.4)
3.2 Health problems among respondents and Table 3. Smoking and Alcohol consumption habit
family members of the respondents among the respondents. (n=99)
12.1% respondents had hypertension as medical
condition, whereas, 56.6% had family history of Category Number
Habits
hypertension. Majority of the respondents were (%)
nonsmokers (82.8 %), while 54.5% of respondents Non-smoker 82
consumed alcohol sometimes. The details are Ex-smoker 4 (4.1)
depicted in table 1, whereas table 2 details the Light smoker (< 10 13 (13.1)
physiological variables in respondents. Smoking cigarettes/day)
Heavy smoker ( 0 (0.0)
Table 1: Health Problem among the respondents and 10 cigarettes/day)
their family members (n = 99) Never 44 (44.5)
Health Problems Category Number Alcohol
(Multiple response (%) Sometimes 54 (54.5)
consumption
Health problems in Diabetes 5(5.1) Usually 1 (1.0)
the respondents
Hypertension 12(12.2)
Cardiovascular 0(0.0) 3.3 Workload and stress among the
Disease
respondents
Kidney Disease 0(0.0)
Hyper 2(2.0) 76.8% of the respondents perceived their work
cholesterolemia
load as ‘all right’, whereas 7.7% indicated their work
Obesity 9(9.1)
load as ‘too much’. The details are depicted in table
Problems faced Chest Pain 3(3.0)
within last 3 4.
Palpitation 5(5.1)
months by the Swollen limbs/Edema 1(1.0)
respondents Dyspnea 3(3.0) Table 4. Workload among the respondents
Health problem in Diabetes 45 (45.5)
family members of Hypertension 56 (56.6) Category Number
Characteristics
the respondents Cardiovascular 9 (9.1) 9%)
Disease Too much 14(14.1)
Kidney Disease 2 (2.0) Work load All right 76(76.8)
Hypercholesterolemia 11 (11.2)
Not enough 9(9.1)
Obesity 15 (15.2)
Extra time spend during Usually 36(36.4)
Table 2 Physiological variables in respondents work Sometimes 48(48.5)

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Imperial Journal of Interdisciplinary Research (IJIR)
Vol-3, Issue-5, 2017
ISSN: 2454-1362, http://www.onlinejournal.in

Rarely 14(14.1) Table 6 shows that hypertension in the

Never 1(1.0) respondents has statistically significant association
Usually 8(8.1) with the cardiovascular health risk behavior while
Stress felt there is no statistical significant association between
Sometimes 86(86.9)
cardiovascular health risk behavior with medical
Never 5(5.0) conditions in family members of the respondents and
problems faced within last 3 months by the
3.4 Cardiovascular Health Risk Behavior
respondents.
among the Respondents
Majority of the respondents had alcohol Table 6: Association between cardiovascular health
consumption as major Cardiovascular Health Risk risk Behavior and the medical conditions
Behavior as 54 which is followed by extra salt Health risk
consumption as 48 and further is depicted in the Health
Category behavior P value
Figure No. 1. Problems
Yes No
Diabetes 5 0 0.855**
Figure 1. Cardiovascular Health Risk Behavior
Health Hypertension 3 9 0.676**
among the Respondents
problems Hypercholester
0 2 0.940**
olemia
6 5.1% Obesity 7 2 0.749**
4 3.0% 3.0% Chest Pain 1 2 0.911**
Problems
Palpitation 3 2 0.855**
1.0% faced
2 Swollen
within last 1 0 0.970**
limbs/Edema
0 3 months
Dyspnea 2 1 0.911**
Palpitation Chest Pain Dyspnea Swollen Diabetes 31 14 0.569**
limbs/Edema Hypertension 42 14 0.177**
Health
Figure 2. Health Problems Faced by the Respondents problem in Cardiovascular 6 3 0.021**
within last 3 months. (n=99) family Kidney
members 2 0 0.940**
Disease
3.5 Association between cardiovascular Obesity 10 5 0.393**
Health risk Behavior and selected socio- **= Fisher’s Exact Test
demographic variables.
Table 5 shows that there is no significant 3.7 Association between cardiovascular
association between cardiovascular health risk health risk Behaviors with BMI.
behavior and selected demographic variable like age,
There was no significant association between
sex, religion, marital status and family type.
cardiovascular health risk behaviors with the BMI of
Table 5: Health risk behavior the respondents
CVS risk
Factors Category behavior P value 4. DISCUSSION
Yes No
<40 54 23 The main finding of this study is that the most
Age
40 – 50 12 3 0.905* common cardiovascular health risk behavior among
≥50 6 1 the teaching faculties at medical school studied was
Male 48 22 alcohol consumption and extra salt diet consumption.
Sex 0.651**
Female 24 5 Furthermore, statistically significant relation was
Marital status Married 13 2 found between cardiovascular health risk behavior
0.607**
Unmarried 59 25 and cardiovascular disease present in the family of
Family type Nuclear 41 14 the respondents. Whereas, no statistically significant
0.584**
Joint 31 13 association was observed between health risk
*= Linear-by-Linear Association behavior and selected variables like age, sex,
**= Fisher’s Exact Test religion, marital status, family type, medical
3.6 Association between cardiovascular condition in respondents, problems faced within last
health risk Behavior and the medical 3 months and BMI.
conditions The current descriptive cross sectional research
design was designed to assess the cardiovascular risk
behavior among the teaching faculties in BP Koirala
Institute of Health Sciences (BPKIHS). From the

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Imperial Journal of Interdisciplinary Research (IJIR)
Vol-3, Issue-5, 2017
ISSN: 2454-1362, http://www.onlinejournal.in

total of 203 teaching faculties were working in conducted by Giri et al. [21] among the Medical
BPKIHS, 100 participants were recruited for this Students in teaching hospital reported 21.0 %
study, and only 99 out of 100 participants completed engaged in recommended amount of physical activity
this study. The study revealed that about 77.8% of which is low as compared to findings of this study.
the respondents belonged to age group <40 years The study shows that 87.9 % of the respondents
among. About 70% of the respondents were males. consumed mixed diet. The respondents consuming
Among female respondents 3.0% were pregnant and fruits sometimes was found to be 50.5 % while 99.0
3.0% were under menopause. In the study, 90.9% of % of the respondents consumes vegetables usually.
the respondents were Hindu among. Maximum Among the usual consumers of vegetables 57.6 % of
respondents were married which was 84% and 55.6 the respondents consumed at least two servings of
% of the respondents were from nuclear family vegetables per day. Similar study carried out on
among. undergraduate medical students in Delhi by Rustagi
12.1% of the respondents reported having et al. [16, 22, 23] reported 12.0 % of students
hypertension, and majority of medical condition in compiled with the recommended servings of fruits
family members of respondents had hypertension as and vegetables per day which is low as compared to
56(56.6%). In the study 5.1% of the respondents had findings of this study.
experienced palpitation within last 3 months. The study shows that 66.7% of the respondents
Majority of respondents had BMI of normal range consumed high fat snack foods sometimes. Similar
which was 57.0%, and the mean BMI was study conducted by Rustagi [22] among the
24.72±2.72. In the study 82.8% of respondents undergraduate medical students in Delhi reported
reported to have normal blood pressure, 92.9% of the 32.0 % of students consumed fat food frequently
respondents have normal blood sugar level. Around which is low as compared to the findings of this
half of the respondents (48.5 %) had HDL level study. The study shows that 48.5 % of the
above 45, while 40.4 % respondents had LDL level respondents consumed extra salt usually. Similar
below 100 among. The data also revealed that 13.1% study conducted by Bhandari [20] among
of the respondents were light smoker, 54.5% were Hypertensive patients in Eastern Nepal reported
used to consume alcohol. Regarding the dietary 46.8% had habit of taking high salt diet which is
pattern 87.9% of the respondents consumed mixed similar to this study [20]. The study shows that only
diet. Regarding the work experience, 71.72% of the 3.0 % of the respondents never consumed extra salt
respondents had an experience of <10 years, in normal diet. Thus the current study concludes that
maximum of the respondents (76.8%) perceived the major cardiovascular health risk behavior among
workload as alright, maximum of the respondents the respondents was alcohol consumption and extra
that is 48.5% spend extra time during work and salt diet consumption. The study documents a
maximum of the respondents felt stress sometimes significant relation was found between
which was 86.9%. cardiovascular health risk behavior and
The result of current study showed that there was cardiovascular disease present in the family of the
a statistically significant positive association between respondents. We would like to acknowledge that the
cardiovascular health risk behavior and lifestyle of individual varies from person to person,
cardiovascular disease present in the family of the as such it might not be appropriate to generalize the
respondents. Whereas, no statistically significant findings to all the health care professionals.
relation was found between behavior and selected
variables like age, sex, religion, marital status, family
type, designation, discipline, medical condition in 5. ACKNOWLEDGEMENT
respondents, problems faced within last 3 months
The Authors would like to thank all the staffs at
and BMI. The findings of the study show that only
BP Koirala Institute of Health Sciences who helped
13.1 % of the respondents were light smokers (<10
in successfully completion of this study through
cigarettes/ day). Similar study conducted by Giri et
al., [21] among the Medical Students in Teaching participation.
Hospital reported 22.0 % students were current
smoker which is similar to this study. The study 6. REFERECES
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Imperial Journal of Interdisciplinary Research (IJIR)
Vol-3, Issue-5, 2017
ISSN: 2454-1362, http://www.onlinejournal.in

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