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Assessment of Burden of Disease in Nepal

i

Assessment of Burden of Disease in

Nepal

2009

Report

Nepal Health Research Council

February, 2018


ii

Assessment of Burden of Disease in Nepal, 2009

© Nepal Health Research Council, Ramshah Path Kathmandu

No part of this report may be reproduced in any written, electronic, recording, or photocopying

without written permission of the Nepal Health Research Council. The exception would be in the

case of brief quotations embodied in the critical articles or reviews and pages where permission

is specifically granted by the Council.

Recommended Citation Nepal Health Research Council. Assessment of Burden f Disease in Nepal, 2009. Kathmandu, Nepal; Nepal Health Research Council, 2018.


iii

Acknowledgement

I would like to express my sincere thanks to all those research participants without whose

support this research work would not have been completed.

My special thanks are to the entire study team, the executive boards, the staring committee and

the sub committees the members of which are as stated here.

NHRC Executive Board 2007

NHRC Executive Board 2009

Dr Mahesh Kumar Maskey Prof Dr Chop Lal Bhusal

Dr Buddha Basnyat Dr Rishi Ram Koirala

Dr.Sharad Onta Dr Narendra Kumar Singh

Dr.Sri Krishna Giri Dr Suman Rijal

Dr.Somnath Aryal Dr Meeta Singh

Dr Basanta Raj Pant Dr Samjhana Dhakal

Dr.Kedar Prasad Baral Dr Devi Gurung

Mr.Prem Karki Mr Laxman Aryal

Dr Dirgh Raj RC Mr Atma Ram Pandey

Dr Lumeshwor Acharya Dr Senendra Raj Uprety

Dr Sheila Verma Prof Dr Arun Sayami

Dr Shital Kaji Sjrestha Dr Damodar Gajurel

Mr. Laxman Aryal Dr Sankher Pratap Singh

Mr. Atma Ram Pandey

Dr Senendra Raj Uprety

Prof Dr Arun Sayami

Dr Damodar Gajurel

Dr Sarita Upadhyay


iv

Steering Committee

Dr Mahesh Kumar Maskey

Dr Badri Raj Pandey

Dr Tirtha Rana

Dr Nirakarman Shrestha

Dr Mahendra Bahadur Bista

Dr Nilambar Jha

Dr Sarad Raj Onta

Dr Mahendra Keshari Chhetri

Prof Dr Madan Prasad Upadhya

Sub Committee members

Dr Chop Lal Bhusal

Dr Badri Raj Pandey

Dr Tirtha Rana

Dr Anjani Kumar Jha

Dr Kedar Prashad Baral

Prof Dr Madan Prashad Upadhya

Dr Mahendra Keshari Chhetri

Dr Babu Ram Marasini

Dr Shankar Pratap Singh

Dr Rajendra Kumar BC

Dr Meghnath Dhimal

Mr. Purushottam Dhakal

Mr. Bijay Kumar Jha

DoHS Representative


v

Project staffs

Ms. Alina Maharjan Mr. Shekhar Payhak Mr. Sobit Kunwar

Ms. Milima Singh Dangol Mr. Tikaram Ghimire Ms. Pooja Bariya

Mr. Krishna Kumar Karki Mr. Wakil Jha Ms. Gita Devi Poudyal

Mr. Prakash Kumar Baral Ms. Karauna Pulami Magar

Mr. Sudan Shrestha Mr. Dhan Bahadur Moktan

Mr. Bikesh Bajracharya Mr. Dipak Poudel

Ms. Alina Tandukar Mr. Uttam K.C

Ms. Sarada Dwadi Ms. Suna Sharma

Mr. Durga Prashad Adhkari Mr. Janak Bhusal

Mr. Rajendra Mahato Mr. Kshitiz Karki

Mr. Manoj Kumar Lal Mr. Md. Kafulwara

Mr. Bhauch Prashad Yadav Ms. Satyawan Sabitri Kasati

Mr. Kiran Lama Ghising Ms. Tuka Cheki Sherpa

Mr. Jay Prakash Yadav Mr. Khem Bhurtel

Mr. Nagerndra Prasad Yadav Mr. Kamal Raj pandit

Ms. Dipika Das Mr. Bharat Pd. Adhkari

Ms. Kimat Adhkari Mr. Toyanath Tiwari

Mr. Ramesh Adhkari Ms. Ranjani Shah

Mr. Paramod Katuwal Mr. Biswo Ratna Ghimire

Mr. Prasanna Sharma Mr. Baikuntha Sharma

Mr. Sumanta Ghimire Ms. Trishna Khanal

Mr. Ram Kumar Prasai Ms. Rita Rai

Mr. Om Bahadur Basnet Mr. Iswor Koirala

Mr. Basanta Budathoki Mr. Sobit Kunwar

Ms. Kopila Budhaprithi Mr. Balaram Adhkari

Mr. Uddim Bdr Devkota Mr. Ganga Poudel

Mr. Him Kanta Bhusal Ms. Tanka Maya pokherl

Mr. Gopal Sharma Mr. Hem Raj Chalise

Ms. Bandana Gautam Mr. Manoj Chettri

Last but not least, I would like to thank all those individuals and organizations who had helped

directly and indirectly to make this study successful.

Prof Dr Anjani Kumar Jha

Executive Chairman


vi

CONTENTS

Acknowledgement ................................................................................................... iii

List of Tables ........................................................................................................... xi

List of Figures ........................................................................................................ xiv

Abbreviations .........................................................................................................xvii

Key Findings .......................................................................................................... xix

1.1. Background ...................................................................................................... 1

1.2. History of Burden of Disease Studies ............................................................. 2

1.3. Rationale .......................................................................................................... 4

1.4. Objective ........................................................................................................... 6

Chapter 2 ................................................................................................................... 7

2.1 Methodology ...................................................................................................................................... 7

2.2 Sampling technique ........................................................................................................................... 7

2.3 Population .......................................................................................................................................... 8

2.4 Disease Categories ............................................................................................................................. 8

2.5 Discounting and Age weights ........................................................................................................... 9

2.6 Life Expectancy ................................................................................................................................. 9

2.7 Years of Life Lost (YLL) .................................................................................................................. 9

2.8 Tools and Techniques ....................................................................................................................... 9

2.9 Information collected ...................................................................................................................... 10

2.10 Selection and training of enumerators ........................................................................................ 10

2.11 Data collection process.................................................................................................................. 10

2.11 a) District level Orientation ......................................................................................................... 10

2.11 b) VDC level Orientation ............................................................................................................ 11

2.11 c) Community Level Activities ................................................................................................... 11

2.12 Data Coding ................................................................................................................................... 12

2.13 Data Quality .................................................................................................................................. 12

2.14 Data Entry and Analysis .............................................................................................................. 13


vii

2.15 Limitations of the Study ............................................................................................................... 13

Chapter 3: Results and findings .............................................................................14

3.1 Overview .......................................................................................................................................... 14

3.2 Broad Group wise YLL .................................................................................................................. 18

3.3 Group I: Communicable, Maternal, Perinatal and Nutritional Diseases .................................. 18

I-A Infectious and Parasitic Diseases .................................................................................................. 20

I-A1 Tuberculosis ............................................................................................................................... 22

I-A3 Human Immunodeficiency Virus (HIV)..................................................................................... 24

I-A4 Diarrhoeal Diseases .................................................................................................................... 25

I-A5 Childhood cluster diseases ......................................................................................................... 27

I-A5b Acute Flaccid Paralysis ........................................................................................................................ 28

I-A5c Diphtheria ............................................................................................................................................. 29

I-A5d Measles ................................................................................................................................................ 29

I-A5e Tetanus ................................................................................................................................................. 30

I-A6 Meningitis ................................................................................................................................... 32

I-A7 Hepatitis ...................................................................................................................................... 33

I-A8 Malaria ........................................................................................................................................ 35

I-A9 Tropical Cluster Disease ............................................................................................................. 36

I-A9d Leismaniasis ......................................................................................................................................... 37

I-A9e Lymphatic filariasis .............................................................................................................................. 39

I-A9g Rabies ................................................................................................................................................... 40

I-A10 Leprosy ..................................................................................................................................... 41

I-A12 Japanese Encephalitis ............................................................................................................... 43

I-A14 Worm Infestation ...................................................................................................................... 44

I-A15 Other Infectious Diseases ......................................................................................................... 44

I-B Respiratory Infections .................................................................................................................... 46

I-B1 Lower Respiratory Infections ..................................................................................................... 47

I-B2 Upper Respiratory Infections ...................................................................................................... 48

I-B3 Otitis Media ................................................................................................................................ 50

I.C. Maternal Conditions ..................................................................................................................... 51

I-C1 Maternal Haemorrhage ............................................................................................................... 53

I-C2 Maternal Sepsis ........................................................................................................................... 54

I-C3 Hypertensive disorders of pregnancy ......................................................................................... 54

I-C4 Obstructed labour........................................................................................................................ 55

I-C5 Abortion ...................................................................................................................................... 56

I-C6 Other Maternal Conditions ......................................................................................................... 57

I-D Neonatal Conditions ....................................................................................................................... 58

I-D1 Low Birth Weight ....................................................................................................................... 59

I-D2 Birth asphyxia and birth trauma ................................................................................................. 61

I.D.3 Other Perinatal conditions ......................................................................................................... 62

I.E. Nutritional Deficiencies ........................................................................................................... 63


viii

I-E1 Protein-Energy Malnutrition ......................................................................................................................... 64

I-E2 Iron-deficiency anaemia .................................................................................................................................. 66

I-E3 Other nutritional disorders ............................................................................................................................ 67

3.4 Group II: Non-Communicable Diseases .................................................................................... 69

II-A Malignant neoplasms ............................................................................................................. 71

II-A1 Mouth and oropharynx .................................................................................................................................. 73

II-A2 Oesophagus Cancer .......................................................................................................................................... 74

II-A3 Stomach Cancer ................................................................................................................................................. 75

II-A4 Colon and rectum Cancer .............................................................................................................................. 77

II-A5 Liver Cancer ........................................................................................................................................................ 79

II-A7 Trachea bronchus and lung Cancer .......................................................................................................... 80

II-A9 Breast Cancer ..................................................................................................................................................... 82

II-A10 Cancer of cervix .............................................................................................................................................. 84

II-A14 Bladder Cancer ................................................................................................................................................ 85

II-A16 Leukemia ........................................................................................................................................................... 85

II-A17 Other Malignant Neoplasms ...................................................................................................................... 86

II-B Other neoplasms .................................................................................................................... 87

II-C Diabetes mellitus.................................................................................................................... 89

II-D Endocrine disorders ............................................................................................................... 91

I-E Neuropsychiatric disorders ...................................................................................................... 93

II-E1 Unipolar depressive disorders .................................................................................................................... 95

I-E2 Bipolar affective disorders ............................................................................................................................. 95

I-E4 Epilepsy .................................................................................................................................................................. 95

I-E5 Alcohol use disorders ....................................................................................................................................... 97

I-E14 Migraine ............................................................................................................................................................... 98

I-E15 Mental retardation attributable to lead exposure ............................................................................. 99

I-E16 Other neuropsychiatric disorders ......................................................................................................... 100

II-F Sense organ disorders ........................................................................................................... 102

II-G Cardiovascular diseases ........................................................................................................ 103

II-G1 Rheumatic heart disease ............................................................................................................................ 105

II-G2 Hypertensive heart disease ....................................................................................................................... 106

II-G3 Ischaemic heart disease .............................................................................................................................. 108

II-G4 Cerebrovascular disease ............................................................................................................................. 109

II-G5 Other Cardiovascular disease ................................................................................................................... 112

II-H Respiratory diseases ............................................................................................................ 114

II-H1 Chronic Obstructive Pulmonary diseases ........................................................................................... 115

II-H2 Asthma ............................................................................................................................................................... 117

II-H4 Other respiratory diseases ........................................................................................................................ 118

II- I Digestive diseases................................................................................................................. 120


ix

II-I1 Peptic ulcer disease ........................................................................................................................................ 121

II-I2 Cirrhosis of the liver ...................................................................................................................................... 123

II-I3 Appendicitis ...................................................................................................................................................... 124

II-I4 Other digestive diseases .............................................................................................................................. 125

II-J Genito-urinary diseases ......................................................................................................... 127

II-J1 Nephritis and nephrosis ............................................................................................................................... 128

II-J2 Benign prostatic hypertrophy ................................................................................................................... 129

II-J3 Other genitourinary system ....................................................................................................................... 130

II-K Skin diseases ........................................................................................................................ 131

II-L Musculoskeletal diseases ...................................................................................................... 133

II-L1 Rheumatoid arthritis .................................................................................................................................... 135

II-L3 Gout ..................................................................................................................................................................... 136

II-L4 Low back pain.................................................................................................................................................. 136

II-L5 Other musculoskeletal diseases ............................................................................................................... 136

II-M Congenital anomalies .......................................................................................................... 138

II-M1 Unclassified Congenital anomalies ........................................................................................................ 139

II-M2 Anencephaly ................................................................................................................................................... 139

II-M3 Anorectal Atresia .......................................................................................................................................... 140

II-M4 Cleft Lip ............................................................................................................................................................. 140

II-M5 Cleft palate ....................................................................................................................................................... 140

II-M7 Renal agenesis................................................................................................................................................ 141

II-M9 Congenital heart anomalies ...................................................................................................................... 141

II-M10 Spina Bifida ................................................................................................................................................... 141

II-M11 Other Congenital Anomaly ..................................................................................................................... 141

II-N Blood Disorder ..................................................................................................................... 142

3.5 Injuries ................................................................................................................................. 144

III-A Unintentional Injuries ......................................................................................................... 145

III-A1 Road Traffic Accident ................................................................................................................................. 146

III-A2 Poisonings ....................................................................................................................................................... 148

III-A3 Falls .................................................................................................................................................................... 150

III-A4 Fires ................................................................................................................................................................... 152

III-A5 Drowning ......................................................................................................................................................... 153

III-A6 Other unintentional injuries .................................................................................................................... 154

III-A7 Snake Bite ........................................................................................................................................................ 156

III-B Intentional injuries .............................................................................................................. 157

III-B1 Self-inflicted injuries .................................................................................................................................. 158

III-B2 Violence ............................................................................................................................................................ 160

III-B3 War..................................................................................................................................................................... 161

III-B4 Other intentional injuries ......................................................................................................................... 162


x

3.6 Unidentified Cases ................................................................................................................ 164

ANNEX I - Disease and injuries categories ..................................................... 166

Annex II- Sampling ............................................................................................... 168

References ............................................................................................................... 189


xi

List of Tables TABLE 3.1.1: TOP 20 CAUSES OF YEARS OF LIFE LOST, NEPAL ................................................................................................... 15

TABLE 3.1.2 : TOP 20 YEARS OF LIFE LOST BY CAUSE AND SEX, NEPAL ....................................................................................... 16

TABLE 3.1.3: TOP 10 YEARS OF LIFE LOST IN 0-14 AND 15-29 YEARS OF AGE GROUP, NEPAL ......................................................... 17

TABLE 3.1.4: TOP 10 YEARS OF LIFE LOST IN 30-59 AND 60+ YEARS OF AGE GROUP ..................................................................... 17

TABLE 3.2.1: YLL DISTRIBUTION OF BROAD DISEASE CATEGORIES ............................................................................................... 18

TABLE 3.3.1. YLL DISTRIBUTION OF COMMUNICABLE, MATERNAL, PERINATAL AND NUTRITIONAL DISEASES ........................................ 19

TABLE 3.3.2: TOP 20 CAUSES OF YLL DUE TO COMMUNICABLE, MATERNAL, PERINATAL AND NUTRITIONAL DISEASES .......................... 20

TABLE 3.3.3 YLL DISTRIBUTION OF INFECTIOUS AND PARASITIC DISEASES .................................................................................... 22

TABLE 3.3.4 YLL DISTRIBUTION OF TUBERCULOSIS .................................................................................................................. 23

TABLE 3.3.5. YLL DISTRIBUTION OF HIV/AIDS ...................................................................................................................... 24

TABLE 3.3.6. YLL DISTRIBUTION OF DIARRHOEAL DISEASES ...................................................................................................... 25

TABLE 3.3.7. YLL DISTRIBUTION OF CHILDHOOD CLUSTER DISEASES .......................................................................................... 28

TABLE 3.3.8. YLL DISTRIBUTION OF ACUTE FLACCID PARALYSIS ................................................................................................. 28

TABLE 3.3.9. YLL DISTRIBUTION OF MEASLES ........................................................................................................................ 30

TABLE 3.3.10. YLL DISTRIBUTION OF TETANUS ...................................................................................................................... 31

TABLE 3.3.11.YLL DISTRIBUTION OF MENINGITIS .................................................................................................................. 33

TABLE 3.3.12. YLL DISTRIBUTION OF HEPATITIS ..................................................................................................................... 34

TABLE 3.3.13. YLL DISTRIBUTION OF MALARIA ...................................................................................................................... 36

TABLE 3.3.14. YLL DISTRIBUTION OF TROPICAL CLUSTER DISEASES ............................................................................................ 37

TABLE 3.3.15. YLL DISTRIBUTION OF LEISHMANIASIS .............................................................................................................. 38

TABLE 3.3.16. YLL DISTRIBUTION OF LYMPHATIC FILARIASIS..................................................................................................... 39

TABLE 3.3.17. YLL DISTRIBUTION OF RABIES ......................................................................................................................... 41

TABLE 3.3.18. YLL DISTRIBUTION OF LEPROSY ...................................................................................................................... 42

TABLE 3.3.19. YLL DISTRIBUTION OF JAPANESE ENCEPHALITIS .................................................................................................. 44

TABLE 3.3.20. YLL DISTRIBUTION OF OTHER INFECTIOUS DISEASES ............................................................................................ 45

TABLE 3.3.21. YLL DISTRIBUTION OF RESPIRATORY INFECTION ................................................................................................. 47

TABLE 3.3.22. YLL DISTRIBUTION OF LOWER RESPIRATORY INFECTIONS ...................................................................................... 48

TABLE 3.3.23. YLL DISTRIBUTION OF UPPER RESPIRATORY INFECTIONS ...................................................................................... 49

TABLE 3.3.24. YLL DISTRIBUTION OF OTITIS MEDIA ................................................................................................................ 51

TABLE 3.3.25. YLL DISTRIBUTION OF MATERNAL CONDITIONS .................................................................................................. 52

TABLE 3.3.26. YLL DISTRIBUTION OF MATERNAL HAEMORRHAGE .............................................................................................. 53

TABLE 3.3.27. YLL DISTRIBUTION OF MATERNAL SEPSIS .......................................................................................................... 54

TABLE 3.3.28. YLL DISTRIBUTION OF HYPERTENSIVE DISORDERS OF PREGNANCY .......................................................................... 55

TABLE 3.3.29.YLL DISTRIBUTION OF OBSTRUCTED LABOUR ...................................................................................................... 56

TABLE 3.3.30. YLL DISTRIBUTION OF ABORTION ................................................................................................................... 57

TABLE 3.3.31. YLL DISTRIBUTION OF OTHER MATERNAL CONDITIONS......................................................................................... 58

TABLE 3.3.32. YLL DISTRIBUTION OF NEONATAL CONDITIONS ................................................................................................. 59

TABLE 3.3.33. YLL DISTRIBUTION OF LOW BIRTH WEIGHT ....................................................................................................... 60

TABLE 3.3.34. YLL DISTRIBUTION OF BIRTH ASPHYXIA AND BIRTH TRAUMA ................................................................................. 61

TABLE 3.3.35. YLL DISTRIBUTION OF OTHER PERINATAL CONDITIONS ......................................................................................... 63

TABLE 3.3.36. YLL DISTRIBUTION OF NUTRITIONAL DEFICIENCIES .............................................................................................. 64

TABLE 3.3.37. YLL DISTRIBUTION OF PROTEIN-ENERGY MALNUTRITION ...................................................................................... 65

TABLE 3.3.38. YLL DISTRIBUTION OF IRON-DEFICIENCY ANAEMIA .............................................................................................. 66

TABLE 3.3.39.YLL DISTRIBUTION OF OTHER NUTRITIONAL DISORDERS ....................................................................................... 67


xii

TABLE 3.4.1: PERCENTAGE YLL DISTRIBUTION OF NON COMMUNICABLE DISEASES ....................................................................... 70

TABLE 3.4.3: PERCENTAGE YLL DISTRIBUTION DUE TO MALIGNANT NEOPLASM CATEGORIES ........................................................... 72

TABLE 3.4.4: YLL DISTRIBUTION OF MOUTH AND OROPHARYNX CANCERS ................................................................................... 74

TABLE 3.4.6: YLL DISTRIBUTION OF STOMACH CANCER ............................................................................................................ 76

TABLE 3.4.7: YLL DISTRIBUTION OF COLON AND RECTUM CANCERS ............................................................................................ 78

TABLE 3.4.8: YLL DISTRIBUTION OF LIVER CANCER ................................................................................................................. 80

TABLE 3.4.9: YLL DISTRIBUTION OF TRACHEA, BRONCHUS AND LUNG CANCERS ............................................................................ 82

TABLE 3.4.10: YLL DISTRIBUTION OF BREAST CANCER ............................................................................................................ 83

TABLE 3.4.11 : YLL DISTRIBUTION OF CERVIX UTERI CANCER .................................................................................................... 85

TABLE 3.4.12: YLL DISTRIBUTION OF OTHER CONGENITAL ANOMALIES ....................................................................................... 85

TABLE 3.4.13: YLL DISTRIBUTION OF OTHER MALIGNANT NEOPLASMS ....................................................................................... 87

TABLE 3.4.14 : YLL DISTRIBUTION OF OTHER NEOPLASMS ....................................................................................................... 88

TABLE 3.4.15: YLL DISTRIBUTION OF DIABETES MELLITUS ....................................................................................................... 90

TABLE 3.4.16: YLL DISTRIBUTION OF ENDOCRINE DISORDERS .................................................................................................. 93

TABLE 3.4.17: YLL DISTRIBUTION OF NEUROPSYCHIATRIC DISEASES .......................................................................................... 94

TABLE 3.4.18:YLL DISTRIBUTION OF EPILEPSY ....................................................................................................................... 96

TABLE 3.4.19: YLL DISTRIBUTION OF ALCOHOL USE DISORDERS ................................................................................................ 98

TABLE 3.4.20: YLL DISTRIBUTION OF MIGRAINE .................................................................................................................... 99

TABLE 3.4.21: YLL DISTRIBUTION OF MENTAL RETARDATION ATTRIBUTABLE TO LEAD EXPOSURE ................................................... 100

TABLE 3.4.22: YLL DISTRIBUTION OF OTHER NEUROPSYCHIATRIC DISORDERS ............................................................................. 101

TABLE 3.4.23: YLL DISTRIBUTION OF OTHER SENSE ORGAN DISORDERS .................................................................................... 103

TABLE 3.4.24: YLL DISTRIBUTION OF CARDIOVASCULAR DISEASES .......................................................................................... 104

TABLE 3.4.25:YLL DISTRIBUTION OF RHEUMATIC HEART DISEASE ............................................................................................ 106

TABLE 3.4.26: YLL DISTRIBUTION OF HYPERTENSIVE HEART DISEASE ........................................................................................ 107

TABLE 3.4.27: YLL DISTRIBUTION OF ISCHAEMIC HEART DISEASE ............................................................................................. 109

TABLE 3.4.28: YLL DISTRIBUTION OF CEREBROVASCULAR DISEASE ........................................................................................... 111

TABLE 3.4.29: YLL DISTRIBUTION OF OTHER CARDIOVASCULAR DISEASES .................................................................................. 113

TABLE 3.4.30: YLL DISTRIBUTION OF RESPIRATORY DISEASES .................................................................................................. 114

TABLE 3.4.31: YLL DISTRIBUTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE .................................................................... 116

TABLE 3.4.32: YLL DISTRIBUTION OF ASTHMA .................................................................................................................... 118

TABLE 3.4.33: YLL DISTRIBUTION OF OTHER RESPIRATORY DISEASES ........................................................................................ 119

TABLE 3.4.34: YLL DISTRIBUTION OF DIGESTIVE DISEASES ..................................................................................................... 121

TABLE 3.4.35: YLL DISTRIBUTION OF PEPTIC ULCER DISEASE ................................................................................................... 122

TABLE 3.4.36: YLL DISTRIBUTION OF CIRRHOSIS OF THE LIVER ................................................................................................ 124

TABLE 3.4.37: YLL DISTRIBUTION OF APPENDICITIS.............................................................................................................. 125

TABLE 3.4.38: YLL DISTRIBUTION OF OTHER DIGESTIVE DISEASES ........................................................................................... 126

TABLE 3.4.39: YLL DISTRIBUTION OF GENITO-URINARY DISEASES ........................................................................................... 127

TABLE 3.4.40: YLL DISTRIBUTION OF NEPHRITIS AND NEPHROSIS ............................................................................................ 129

TABLE 3.4.41: YLL DISTRIBUTION OF BENIGN PROSTATIC HYPERTROPHY ................................................................................... 130

TABLE 3.4.42: YLL DISTRIBUTION OF OTHER GENITOURINARY SYSTEM DISEASES ......................................................................... 131

TABLE 3.4.43: YLL DISTRIBUTION OF SKIN DISEASES ............................................................................................................. 133

TABLE 3.4.44: YLL DISTRIBUTION OF MUSCULOSKELETAL DISEASES ......................................................................................... 134

TABLE 3.4.45: YLL DISTRIBUTION OF RHEUMATOID ARTHRITIS ................................................................................................ 135

TABLE 3.4.46: YLL DISTRIBUTION OF LOW BACK PAIN ........................................................................................................... 136

TABLE 3.4.47: YLL DISTRIBUTION OF OTHER MUSCULOSKELETAL DISORDERS ............................................................................. 137

TABLE 3.4.48: YLL DISTRIBUTION OF CONGENITAL ANOMALIES .............................................................................................. 138


xiii

TABLE 3.5.1 : YLL DISTRIBUTION OF UNINTENTIONAL INJURIES ............................................................................................... 144

TABLE 3.5.2: YLL DISTRIBUTION OF INJURY CATEGORIES ........................................................................................................ 145

TABLE 3.5.3 : YLL DISTRIBUTION OF UNINTENTIONAL INJURIES ............................................................................................... 146

TABLE3.5.4: YLL DISTRIBUTION OF ROAD TRAFFIC ACCIDENTS ................................................................................................. 148

TABLE 3.5.5: YLL DISTRIBUTION OF POISONINGS ................................................................................................................. 149

TABLE 3.5.6: YLL DISTRIBUTION OF FALLS ........................................................................................................................... 151

TABLE 3.5.7: YLL DISTRIBUTION OF FIRES .......................................................................................................................... 152

TABLE 3.5.8: YLL DISTRIBUTION OF DROWNING................................................................................................................... 154

TABLE 3.5.9: YLL DISTRIBUTION OF OTHER UNINTENTIONAL INJURIES ...................................................................................... 155

TABLE 3.5.10: YLL DISTRIBUTION OF SNAKE BITE ................................................................................................... 157

TABLE 3.5.11 : YLL DISTRIBUTION OF INTENTIONAL INJURIES .................................................................................................. 158

TABLE 3.5.12: YLL DISTRIBUTION OF SELF INFLICTED INJURIES ................................................................................ 159

TABLE 3.5.13: YLL DISTRIBUTION OF VIOLENCE ....................................................................................................... 161

TABLE 3.5.14: YLL DISTRIBUTION OF WAR ......................................................................................................................... 162

TABLE 3.5.15: YLL DISTRIBUTION OF OTHER INTENTIONAL INJURIES ........................................................................................ 163


xiv

List of Figures FIGURE 2.1.1 MAP OF NEPAL REPRESENTING SELECTED DISTRICTS FOR BOD NEPAL .................................................... 7

FIGURE 3.1.1 REGION WISE DISTRIBUTION OF TOTAL YLL .......................................................................................... 14

FIGURE 3.3.1 REGION WISE DISTRIBUTION OF TOTAL YLL DUE GROUP I CATEGORY ................................................... 19

FIGURE 3.3.2 REGION WISE DISTRIBUTION OF TOTAL YLL DUE INFECTIOUS AND PARASITIC DISEASES ........................ 21

FIGURE 3.3.3 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TUBERCULOSIS ........................................................... 22

FIGURE 3.3.4 REGION WISE DISTRIBUTION OF TOTAL YLL DUE HIV ............................................................................ 24

FIGURE 3.3.5 REGION WISE DISTRIBUTION OF TOTAL YLL DUE DIARRHOEAL DISEASES ............................................. 27

FIGURE 3.3.6 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO CHILDHOOD CLUSTER DISEASES ........................... 27

FIGURE 3.3.8 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO MEASLES............................................................... 29

FIGURE 3.3.9 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO TETANUS ............................................................... 32

FIGURE 3.3.10 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO MENINGITIS......................................................... 32

FIGURE 3.3.11 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO HEPATITIS ........................................................... 35

FIGURE 3.3.12 REGION WISE DISTRIBUTION OF TOTAL YLL DUE MALARIA ................................................................. 35

FIGURE 3.3.13 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO TROPICAL CLUSTER DISEASE ............................... 37

FIGURE 3.3.14 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO LEISMANIASIS ..................................................... 38

FIGURE 3.3.15 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO LYMPHATIC FILARIASIS ....................................... 40

FIGURE 3.3.16 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO RABIES ................................................................ 40

FIGURE 3.3.17 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO LEPROSY ............................................................. 43

FIGURE 3.3.18 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO JAPANESE ENCEPHALITIS ..................................... 43

FIGURE 3.3.19 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO OTHER INFECTIOUS DISEASES .............................. 46

FIGURE 3.3.20.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO RESPIRATORY INFECTION.................................... 46

FIGURE 3.3.21 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO LOWER RESPIRATORY INFECTION ....................... 47

FIGURE 3.3.22 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO UPPER RESPIRATORY INFECTION ........................ 50

FIGURE 3.3.23 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO OTITIS MEDIA ..................................................... 50

FIGURE 3.3.24.REGION WISE DISTRIBUTION OF TOTAL YLL DUE MATERNAL CONDITIONS.......................................... 52

FIGURE 3.3.25 REGION WISE DISTRIBUTION OF TOTAL YLL DUE MATERNAL HAEMORRHAGE .................................... 53

FIGURE 3.3.26 REGION WISE DISTRIBUTION OF TOTAL YLL DUE MATERNAL SEPSIS .................................................... 54

FIGURE 3.3.27 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO HYPERTENSIVE DISORDERS OF PREGNANCY ........ 55

FIGURE 3.3.28 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO OBSTRUCTED LABOUR ......................................... 56

FIGURE 3.3.29.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO ABORTION ........................................................... 57

FIGURE 3.3.30 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO OTHER MATERNAL CONDITIONS........................... 58

FIGURE 3.3.31 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO NEONATAL CONDITIONS ..................................... 59

FIGURE 3.3.32 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO LOW BIRTH WEIGHT ........................................... 60

FIGURE 3.3.33 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO BIRTH ASPHYXIA AND BIRTH TRAUMA ................ 61

FIGURE 3.3.34 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO OTHER PERINATAL CONDITIONS .......................... 62

FIGURE 3.3.35 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO NUTRITIONAL DEFICIENCIES ................................ 63

FIGURE 3.3.36 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO PROTEIN ENERGY MALNUTRITION ...................... 64

FIGURE 3.3.37 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO IRON-DEFICIENCY ANAEMIA ................................ 66

FIGURE: 3.4.1 PERCENTAGE YLL DISTRIBUTION DUE TO NON-COMMUNICABLE DISEASES .......................................... 69

FIGURE 3.4.2: PERCENTAGE YLL DISTRIBUTION DUE TO MALIGNANT NEOPLASM CATEGORIES .................................. 72

FIGURE 3.4.4: PERCENTAGE YLL DISTRIBUTION DUE TO STOMACH CANCER............................................................... 75

FIGURE 3.4.5: PERCENTAGE YLL DISTRIBUTION DUE TO COLON AND RECTUM CANCER ............................................. 77

FIGURE 3.4.6: PERCENTAGE YLL DISTRIBUTION DUE TO LIVER CANCER ..................................................................... 79


xv

FIGURE 3.4.7: PERCENTAGE YLL DISTRIBUTION DUE TO TRACHEA BRONCHUS AND LUNG CANCER ............................ 81

FIGURE 3.4.8: PERCENTAGE YLL DISTRIBUTION DUE TO BREAST CANCER .................................................................. 83

FIGURE 3.4.9: PERCENTAGE YLL DISTRIBUTION DUE TO CANCER OF CERVIX .............................................................. 84

FIGURE 3.4.10: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER MALIGNANT NEOPLASMS ....................................... 86

FIGURE: 3.4.11 PERCENTAGE YLL DISTRIBUTION DUE TO OTHER NEOPLASMS ........................................................... 89

FIGURE 3.4.12: PERCENTAGE YLL DISTRIBUTION DUE TO DIABETES MELLITUS .......................................................... 90

FIGURE 3.4.13: PERCENTAGE YLL DISTRIBUTION DUE TO ENDOCRINE DISORDERS ..................................................... 92

FIGURE 3.4.14: PERCENTAGE YLL DISTRIBUTION DUE TO NEUROPSYCHIATRIC DISORDER .......................................... 93

FIGURE 3.4.15: PERCENTAGE YLL DISTRIBUTION DUE TO EPILEPSY ............................................................................ 95

FIGURE 3.4.16: PERCENTAGE YLL DISTRIBUTION DUE TO ALCOHOL USE DISORDERS .................................................. 97

FIGURE 3.4.17: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER NEUROPSYCHIATRIC DISORDERS ........................... 100

FIGURE 3.4.18: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER SENSE ORGAN DISORDERS ..................................... 102

FIGURE 3.4.19: PERCENTAGE YLL DISTRIBUTION DUE TO CARDIOVASCULAR DISEASES ........................................... 104

FIGURE 3.4.20: PERCENTAGE YLL DISTRIBUTION DUE TO RHEUMATIC HEART DISEASE ............................................ 105

FIGURE 3.4.21: PERCENTAGE YLL DISTRIBUTION DUE TO HYPERTENSIVE HEART DISEASE ....................................... 106

FIGURE 3.4.22: PERCENTAGE YLL DISTRIBUTION DUE TO ISCHAEMIC HEART DISEASE .............................................. 108

FIGURE 3.4.23: PERCENTAGE YLL DISTRIBUTION DUE TO CEREBROVASCULAR DISEASE ........................................... 110

FIGURE 3.4.24: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER CARDIOVASCULAR DISEASE ................................. 112

FIGURE 3.4.25: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER CARDIOVASCULAR DISEASE ................................. 114

FIGURE 3.4.26: PERCENTAGE YLL DISTRIBUTION DUE TO CHRONIC OBSTRUCTIVE PULMONARY DISEASES .............. 115

FIGURE 3.4.27: PERCENTAGE YLL DISTRIBUTION DUE TO ASTHMA ........................................................................... 117

FIGURE 3.4.28: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER RESPIRATORY DISEASES ....................................... 119

FIGURE 3.4.29: PERCENTAGE YLL DISTRIBUTION DUE TO DIGESTIVE DISEASES ........................................................ 120

FIGURE 3.4.30: PERCENTAGE YLL DISTRIBUTION DUE TO PEPTIC ULCER DISEASE ..................................................... 121

FIGURE 3.4.31: PERCENTAGE YLL DISTRIBUTION DUE TO CIRRHOSIS OF THE LIVER .................................................. 123

FIGURE 3.4.32: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER DIGESTIVE DISEASES ............................................. 125

FIGURE 3.4.33: PERCENTAGE YLL DISTRIBUTION DUE TO GENITO-URINARY DISEASES ............................................. 127

FIGURE 3.4.34: PERCENTAGE YLL DISTRIBUTION DUE TO NEPHRITIS AND NEPHROSIS .............................................. 128

FIGURE 3.4.35: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER GENITOURINARY SYSTEM ..................................... 130

FIGURE 3.4.36: PERCENTAGE YLL DISTRIBUTION DUE TO SKIN DISEASES ................................................................. 132

FIGURE 3.4.37: PERCENTAGE YLL DISTRIBUTION DUE TO MUSCULOSKELETAL DISEASES ......................................... 134

FIGURE 3.4.38: PERCENTAGE YLL DISTRIBUTION DUE TO RHEUMATOID ARTHRITIS ................................................. 135

FIGURE 3.4.39: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER MUSCULOSKELETAL DISEASES .............................. 136

FIGURE 3.4.40: PERCENTAGE YLL DISTRIBUTION DUE TO CONGENITAL ANOMALIES ................................................ 138

FIGURE 3.4.41: PERCENTAGE YLL DISTRIBUTION DUE TO UNCLASSIFIED CONGENITAL ANOMALIES ........................ 139

FIGURE 3.4.42: PERCENTAGE YLL DISTRIBUTION DUE TO ANORECTAL ATRESIA ...................................................... 140

FIGURE 3.4.43: PERCENTAGE YLL DISTRIBUTION DUE TO OTHER CONGENITAL ANOMALY ...................................... 141

FIGURE: 3.4.44: PERCENTAGE YLL DISTRIBUTION DUE TO BLOOD DISORDER ........................................................... 142

FIGURE 3.5.1 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO INJURIES .............................................................. 144

FIGURE 3.5.2 REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO UNINTENTIONAL INJURIES .................................. 145

FIGURE 3.5.3. REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO ROAD TRAFFIC ACCIDENTS ................................ 147

FIGURE 3.5.4.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO POISONINGS ........................................................ 150

FIGURE 3.5.5.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO FALLS ................................................................. 150

FIGURE 3.5.6.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO FIRES .................................................................. 153

FIGURE 3.5.7.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO DROWNING ......................................................... 153

FIGURE 3.5.8.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO OTHER UNINTENTIONAL INJURIES ........................ 156


xvi

FIGURE 3.5.9.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO SNAKE BITE ......................................................... 156

FIGURE 3.5.10.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO INTENTIONAL INJURIES ..................................... 158

FIGURE 3.5.11.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO SELF-INFLECTED INJURIES ................................. 160

FIGURE 3.5.12.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO VIOLENCE ......................................................... 160

FIGURE 3.5.13.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO WAR ................................................................. 161

FIGURE 3.5.14.REGION WISE DISTRIBUTION OF TOTAL YLL DUE TO OTHER INTENTIONAL INJURIES ......................... 164

FIGURE 3.6.1: PERCENTAGE YLL DISTRIBUTION DUE TO UNIDENTIFIED CASES ......................................................... 164


xvii

Abbreviations

ABDIS Assessment of Burden of Disease

AFP Acute Flaccid Paralysis

BCG Bacillus Calmette Guerin

BOD Burden of Disease

C Central Development Region

COPD Chronic Obstructive Pulmonary diseases

DALY Disability Adjusted Life Years

DHO District Health Office

DPHO District Public Health Office

E Eastern Development Region

FCHVs Female Community Health Volunteers

FW Far-Western Development Region

GBD Global Burden of Disease

GFD Group Focus Discussion

GTZ German Technical Co-operation

H Hill Region

HIV/AIDS Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome

HMIS Health Management Information System

ICD International Classification of Diseases

ICD -10 International Classification of Diseases, 10th revision

JE Japanese Encephalitis

LRIs Lower Respiratory Infections

M Mountain Region

MCHWs Maternal and Child Health Workers

MoH Ministry of Health

MoHP Ministry of Health and Population

Ms-Excel Microsoft Excel

MW Mid-Western Development Region


xviii

NCASC National Centre for AIDS & STD Control

NHRC Nepal Health Research Council

OAI Other Asia and Island

PEM Protein-Energy Malnutrition

RTA Road Traffic Accident

SPSS Statistical Package for Social Sciences

SQL Structured Query Language

T Terai Region

TB Tuberculosis

TBAs Traditional Birth Attendants

TT Tetanus Toxoid

UMN United Mission to Nepal

URIs Upper Respiratory Infections

VDC Village Development Committee

VHWs Village Health Workers

W Western Development Region

WB World Bank

WHO World Health Organization

YLL Years of life lost


xix

Key Findings

Total Mortality Burden

Premature mortality was responsible for more than 2.3 million Years of Life Lost (YLL).

Burden due to premature mortality (YLL) was almost similar in both sexes accounting for

1.25 million YLL in males and 1.04 million YLL in females.

Years of life lost of children (0-14 age group) was found to be about 900 thousand years

(40% of total YLL) while that of elderly population (60+) was 580 thousand YLL (25% of

total YLL).

Mortality burden was found to be highest in Central (26%) and lowest in Far-Western

Development Region (12%). Likewise, Terai region was estimated to have maximum

mortality burden (51%) followed by Hill (37%) and Mountain (12%).

Among the major three broad groups, Communicable, maternal, perinatal and nutritional

conditions (Group I) was the highest contributor in total YLL (45%) followed by non-

communicable diseases (36%) and injuries (12%).

Distribution of YLL among further disease and injuries categories showed that Chronic

Obstructive Pulmonary diseases (COPD), Lower respiratory infections (LRI) and

Tuberculosis constituted top three diseases accounting for about 26% of total YLL.

Group I burden (Communicable, maternal, perinatal and nutritional conditions)

Group I diseases and conditions were responsible for about 560 thousand life lost due to

premature mortality in men and 485 thousand in women. Highest burden was observed in

Central region (28%) and lowest in Mountain (13%). Likewise, Terai and Western regions

had almost similar burden of about 25% and lowest in Far-Western region (15%).

Among disease categories of group I, Infectious and parasitic diseases were observed to be

the leading causes of mortality (42%) followed by conditions arising during the neonatal

period (28%) and respiratory infections (21%).

Lower Respiratory Infections, Tuberculosis and Diarrhoeal diseases were the top three

specific diseases under group I which constituted 41 % of total YLL due to Group I.

Tuberculosis account for more than 120 thousand years of life lost in total with

approximately 58% of YLL in productive age group (15-59).


xx

More than 50 percent of burden due to HIV was found to be Hill region. Males of 30-59 age

group had the highest burden of HIV accounting more than 70% of total YLL due to HIV.

Diarrhoeal disease was responsible for almost a million years of life lost, majority of which

(65%) was seen in 0-14 age group.

Tetanus had the highest contribution (45%) in the total YLL due to Childhood cluster

diseases followed by Measles (41%). Burden of Measles was estimated to be very high in

western region (59%).

Hepatitis accounts for more than sixty thousand of YLL. Males had two times higher burden

than females.

Majority of burden due to Respiratory Infection was contributed by Lower Respiratory

Infection (98%). About 95% of burden due to Respiratory Infection observed in the below 14

age group.

Maternal haemorrhage was the highest contributor for mortality due to maternal conditions

accounting for 37% of total YLL.

More than 29 thousand of years of life was lost due to neonatal conditions responsible for

28% of total YLL due to Group I category. Birth asphyxia and birth trauma was the major

cause behind life lost due to neonatal conditions.

Protein-Energy malnutrition was the leading cause of YLL accounting for 92.7% of total

YLL due to nutritional deficiencies.

Group II burden (Non-Communicable Diseases)

Non-communicable diseases shared 830668 years of life lost (36.1%) nationally. The burden

was observed equally distributed among males (50.7 %) and females (49.3 %).

Approximately 50 percent of YLL was shared by terai region and least was observed in

mountain region (11 %). Likewise, Central and Western development region both shared

highest (27.4%) while far-western development region shared lowest percentage (9.4%) of

YLL.

Malignant neoplasms accounted 7.9 percent of YLL among the non-communicable diseases.

About 76 percent of YLL due to malignant neoplasms were observed in terai region.

Stomach cancer (23.8%), trachea bronchus and lung cancer (23.1%) and cervix cancer

(22.7%) were the top three causes of malignant neoplasm nationally.

More than half (51.1%) of YLL due to diabetes mellitus was observed among 30-59 years of

age group.


xxi

Neuropsychiatric disorders accounted 7.6 % among non-communicable diseases. Epilepsy

(32.9%) and Alcohol use disorder (23%) were observed ad the major causes of YLL among

neuropsychiatric disorders.

Cerebrovascular diseases were the leading cause of YLL among cardiovascular diseases. It

accounted 43.8 percent among this category. About 60 percent of burden due to

cerebrovascular diseases was observed in elderly age population (60+).

Respiratory diseases (32.5%), cardiovascular diseases (19.2%) and digestive diseases

(12.8%) collectively contributed more than sixty percent of YLL among non-communicable

diseases. Least was contributed by sense organ diseases (0.3%) and endocrine diseases

(0.2%).

Among the respiratory diseases COPD contributed 97.6 percent which was 11.4 percent of

the total YLL distribution nationally. Majority of COPD burden (73.6 %) was observed

among elderly age group.

Peptic ulcer accounted 14.9 percent of years of life lost among digestive diseases among

which 48.7 percent was observed in terai region. More than fifty percent of YLL due to

peptic ulcer was observed among 30-59 years of age group.

About 7.8 percent of YLL among genito-urinary diseases was observed due to nephritis and

nephrosis. The occurrence of YLL due to the problem was observed among 0-14 (97.5%) and

60+ (2.5%) age group only.

Skin diseases were observed highest in terai region among which maximum (66.1%) was

observed in 0-14 age group.

Musculoskeletal diseases contributed 0.8 % of YLL out of that more than half was observed

in terai region. Rheumatoid arthritis accounted one third percent of YLL due to

musculoskeletal diseases. All the YLL due to rheumatoid arthritis was observed in elderly

age group among which females accounted 53.8 percent of YLL.

Anorectal atresia was caused 9.9 percent of YLL among congenital anomalies out of which

53.3 percent of YLL was observed in males child.

Blood disorder was observed highest (78.4) among 0-14 years of age group and majority of

YLL was contributed by females (57.7%) group.

Group III burden (Injuries)

Total mortality burden due to injuries were estimated to be more than 270 thousand years of

life lost. Burden in males were twice the burden in females.


xxii

Injuries were distributed equally among all the development regions ranging from 21% to

23% except in Far-Western region (10%). Likewise, Terai and Hill regions were responsible

for almost equal share of about 40% while Mountain region has minimum share of 15% only.

Among disease categories of group III, more than 2/3rd

of total YLL was contributed by

unintentional injuries.

Road traffic accidents, Poisonings and Snake Bite were the top three specific diseases under

group III which constituted 56 % of total YLL due to Group III.

Among the specific conditions within unintentional injuries, majority of YLL (28%) was

contributed by fall which was followed by Road traffic Accidents (22.2%) and drowning

(20.3%).

Total burden due to Road traffic Accidents (RTA) was about 42 thousand YLL. Half of the

burden was concentrated in Hill region. Burden in males were almost 12 times higher than in

females. Majority of burden due to RTA (89%) was in productive age group (15-59).

More than 54 thousand of life lost was estimated due to Falls with more than half of the

burden in Hill region. Males were estimated to have higher burden of Falls.

Drowning was responsible for more than 38 thousand years of life lost with most of the

burden in under 14 age group.

Among the specific conditions within intentional injuries, majority of burden was due to self-

inflicted injuries (69.8%) followed by war (14%).


1

Chapter 1: Introduction

1.1. Background In the era when most of the countries are facing increasing demand of the health resources, either

due to increasing burden of diseases and injuries or due to the development in knowledge and

technology, strategic health planning has become very essential. Such health planning must take

into account the needs of the health system that is, the health planning should be evidence based.

Policy makers must be aware of the comparative burden of diseases and injuries and how this

burden is likely to change with the adoption of various policies and interventions. This requires

quantification of health status and health problems. Quantification sets boundaries on claims

made in health policy and, in some cases, can put new intervention options on the agenda.

In the past, mortality and its derivative, life expectancy, have been important indicators of health.

With the impressive increase in life expectancy at birth over the past decades, public health

attention has moved toward the quality of the life-years gained—that is, to morbidity and health-

related quality of life, in addition to mortality. This has led to the development of “composite

health measures,” in which health losses through mortality and morbidity are combined. One of

these is the disability-adjusted life-year (DALY) which was developed by The Harvard School of

Public Health in collaboration with The World Bank and World Health Organization in 1993 to

assess the Global Burden of Disease (GBD).i One DALY can be thought of as one lost year of

‘healthy’ life and the burden of disease as a measurement of the gap between current health

status and an ideal situation where everyone lives into old age free of disease and disability.ii

DALY for a disease or health condition are calculated as the sum of the years of life lost (YLL)

due to premature mortality in the population and the equivalent "healthy" years of life lost due to

disability (YLD) for incident cases of the health condition.

In 1993, when the GBD study got completed, several countries attempted to estimate national

BOD. Nepal also tried to estimate burden of disease in 1996 as a background study for

prioritizing health needs and as a participatory process to contribute in formulation of second


2

long term health plan (1997-2017). Though the study was used extensively in different policies

and plans at that time, Nepal Health Research Council (NHRC) felt the need to estimate burden

of disease from more representative data and decided to conduct National BOD study in Nepal.

However, NHRC had an aim to estimate the BOD as a whole but the associated technical and

financial problems made it had to shrink its idea just to calculate mortality burden of the country.

Hence, this study provides the overall mortality burden attributable by various diseases and

injuries in the country applying the methods developed by WHO and WB. The study

commenced in May 2007. This study has been carried out with the support of Ministry of Health

and Population (MoHP), Government of Nepal.

1.2. History of Burden of Disease Studies

Global Burden of Disease Study

Concept of BOD emerged in early 1990’s. In 1992, the WB commissioned the initial GBD study

to provide a comprehensive assessment of the disease burden in 1990. The study was undertaken

for the world as a whole. It further analyzed the global statistics into eight regions. In order to

recommend intervention packages for countries at different stages of development, the estimates

were combined with analyses of the cost effectiveness of interventions in different populations.

Earlier attempts to quantify global cause of death patterns were valuable initial contributions to

building the evidence base for policy, but they were largely restricted to broad cause of death

groups, for example, all infections and parasitic diseases were combined, and did not address

nonfatal health outcomes.

To prepare internally consistent estimates of incidence, prevalence, duration, and mortality for

almost 500 sequelae of the diseases and injuries under consideration, a mathematical model,

DisMod, was developed for the 1990 GBD study. This helped to convert partial, often

nonspecific, data on disease and injury occurrence into a consistent description of the basic

epidemiological parameters in each region by age group. To assess the burden of disease, the

1990 GBD study used a time-based metric that measures both premature mortality and disability.

The results of the 1990 GBD study confirmed what many health workers had suspected for

sometimes, that non-communicable diseases and injuries were a significant cause of health


3

burden in all regions and in some rapidly industrializing regions such as East Asia and Pacific

they were already by far the leading cause of death and disability i, iii

.

These estimates help in producing most comprehensive and consistent set of information of

mortality and morbidity by age, sex and region. The GBD 1990 study had assessed about 108

major diseases to quantify the burden of diseases which were categorized under three broad

groups. For further study and analysis the groups were again divided into several sub-groups.

Countries specific Burden of Disease study

Completion of the GBD study encouraged many countries to realize the necessity to estimate

national burden of disease. WHO and WB supported the member states in conducting BOD

studies to ensure better data for country level planning and performance. Many countries and

health development agencies have adopted the GBD approach as the standard for health

accounting and for guiding the determination of health research priorities.

Here are some countries who had already conducted the BOD study: Australia (1999) The

burden of disease and injury in Australia, Thailand (2002) Burden of Disease and Injuries in

Thailand, Malaysia (2000) Malaysian Burden of Disease and Injury Study, Himanchal Pradesh

state of India (2001-02) Himachal Burden of Disease - A Study, Andra Pradesh state of

India, Andhra Pradesh Burden of Disease Study, Mauritius (Vos and others 1995) Mauritius

Burden of Disease Study, Mexico (Lozano and others 1995), Turkey (2005) Turkey Burden of

disease study, The United States (2005), China (2001) Burden of Disease in China, Srilanka,

New-Zealand (2001) The Burden of Disease and Injury in New Zealand, Victoria (1996)

Victorian Burden of Disease Study, Korea (2002) Measuring the Burden of Disease in Korea

and South Africa (2003) Initial Burden of Disease Estimates for South Africa.

In Nepal, WB had conducted a study called "Nepal Operational Issues and Prioritization of

Resources in Health Sectors-1996" which estimated DALY using hospital based data through

indirect techniques. The current BOD study computes burden of more than 100 disease categories

identified to reflect the mortality pattern in Nepal. It applies the methods developed by WHO and

WB for the GBD study.


4

1.3. Rationale Addressing inequities in health around the world is one of the greatest challenges faced by public

health advocates globally. Developing nations are suffering from a double burden of disease. The

consequences of infections, malnutrition, and pregnancy and birth-related health problems, while

at the same time contending with heart disease, diabetes, cancer, and other non-communicable

diseases and injuries introduced with growing urbanization and globalization.

Health and provision of health facility is essential to every state and nation of this world. The

responsible authorities tend to prepare the short and long term health plans to obtain good health

for their citizens. The prerequisites for the formulation of plans and policies are the precise

information. Every country has its own information collection system. Various developing

countries still lack the efficient tools for information collection and sometimes important data are

missing. In Nepal though there is the provision of death registration, either record is not

maintained or is incomplete. The available information presents very dim situation of the

disease, but we cannot say the burden due to the specific disease. Lack of adequate information

may lead to inappropriate policies and misallocation of the scarce resources. Hence,

determination of the existing mortality burden of diseases is urgent, for enabling appropriate

policy formulation.

Development of second long term health plan (SLTHP-1997-2017) as a 20 years long term plan

was the turning point to decide on a package of affordable and most effective health service

package based on BOD analysis for the first time for the country. A study “Nepal Operational

Issues and Prioritization of Resources in Health Sectors 1996” was conducted by Health,

Nutrition and Population Unit, South Asia region with support from WHO, MoHP and GTZ to

identify the current and project demographic and burden of disease profile in Nepal helped in the

planning for SLTHP. The study used morbidity data from various sources like the Nepal Living

Standard Survey and the 1998 Human Development report which suggested a pattern of illness

that was consistent in both the sources, program based specific data were also used. Similarly,

the mortality data were obtained from the four hospitals of United Mission to Nepal (UMN)

located in Central, Western and Eastern region serving around 300,000 outpatients a year. In this

way the study calculated the burden of disease (DALY) in Nepal using various indirect


5

techniques. However, the previous team realized that the reliability of those national estimates

was reduced by the fact that they are based on data from hospitals in a catchment area in which

the population is healthier and better served than many. In reality health conditions are much

worse in other parts of the country which was least covered by the study. In Nepal, after “Nepal

Operational Issues and Prioritization of Resources in Health Sectors 1996” such study to

estimate the burden of disease has not been conducted. Hence, there is a great need to of

representative quantify the BOD.

The second long term health plan was formulated on the basis of detailed situation analysis of the

existing circumstances which was obtained through the various participatory processes. Among

the participatory processes the burden of disease estimation was one of the major studies which

contributed the formulation of the nation long term plan. As this long term plan is not a static,

immutable blue print for the future, it is dynamic rolling plan which allows for the development

of successive periodic and annual plans that would lead to improvement in the health status of

the population. Here, it emphasizes the burden of disease estimation to be beneficial in

development of the rational and the realistic strategies for the improvement of health status of the

nation continually.

The Annual Report, published by the Management Division, Ministry of Health and Population

(MoHP) at the end of every fiscal year, basically consists of health related information recorded

and reported by the various institutions under MoH. The health management information system

(HMIS) of Management Division is being strengthened time to time but there are yet some

limitations. For example mortality information is obtained from district hospital don't represent

the scenario of whole Nepal. Most of the deaths occur either in the community or on the way to

hospitals. Besides, there is need to cover mortality data from all the governmental,

nongovernmental, private hospital and various levels of health institutions. Therefore, there is

need to collected comprehensive information on mortality as well as morbidity to help actual

planning at the various levels.

For the purpose of GBD study the team divided globe into eight ecological regions. Among them

Nepal was categorized under the region of Other Asia and Island (OAI). The GBD study was


6

planned in order to quantify both years lost by premature death and years lived with disability in

a single measure using DALY. Through the indirect estimation methods overall DALY of the

world was estimated. The OAI region contributed 12.9 % of the total DALY of the world. iv

DALY is a unit measure which helps to identify the total burden of disease and can measure the

effectiveness of health interventions. It is beneficial for the comparisons of health status between

two populations or the same population over time. Essentially it facilitates the policy makers to

identify the trends of disease pattern and guides in setting priorities to utilize the scarce resources

to its optimum level. There is great need to estimate the national burden of disease to quantify

the burden of disease and injuries in Nepal to guide policy making procedures. As calculation of

DALY is a great challenge for Nepal due to lack of detailed information regarding mortality and

morbidity, this study attempts to quantify burden of disease due to premature mortality at this

stage.

1.4. Objective To quantify mortality burden of disease and injuries according to age, sex and region in

terms of Years of Life Lost (YLL) for the year 2006 in Nepal.


7

Chapter 2

2.1 Methodology

Nepalese burden of disease study aimed to estimate the disease burden in terms of years of life

lost. It required detailed information regarding mortality hence the study was designed to capture

all the age, sex and cause specific mortality from selected Village Development Committee

(VDCs) and Municipalities of the selected districts of Nepal. Cross sectional study design was

applied for the study.

2.2 Sampling technique

In the context of Nepalese BOD, cause specific death information was obtained from primary

source. Nepal is divided into five developmental and three ecological regions. Hence, regarding

the primary data collection for mortality estimates, 15 districts were selected randomly from each

eco-development region. Then the VDCs of selected districts were stratified on the basis of

health illakas. One VDC from each illaka were selected randomly. All the population of the

selected VDCs were included to collect the information.

North

Mountain Districts

Humla

Mugu

Sindhup

alchowk

Rolpa

Dolpa

Mustang

Manang

Jumla

Doti

Baitadi

Rukum

Kaski

Kavre

Tanahu

Palpa

Kanchanpu

r

Kailali

Kapilbastu

SelectedDistricts

Hill Districts

Terai Districts

Figure 2.1.1 Map of Nepal representing selected districts for BOD Nepal

In the districts having Municipality, in order to represent urban population, data was also

collected from the wards of Municipality. The number of selected wards of Municipality was


8

proportionate to the number of selected VDCs of respective districts. Primary data collection

aimed at quantifying total live births and total cause specific mortality of different diseases

among different sex and age group of the selected districts.

S.N. District Selected Total

VDCs

Selected

VDCs

Total

Municipalities

Selected

Municipalities

Selected

Wards of

Municipalities

Total

Selected

Wards

1 Sunsari 49 12 3 1 3 111

2 Illam 48 10 1 1 2 92

3 Solukhumbhu 34 11 0 0 0 99

4 Nuwakot 63 13 1 1 3 120

5 Sindhupalchowk 79 13 0 0 0 117

6 Mahottari 76 10 1 1 2 92

7 Manang 13 9 0 0 0 81

8 Kaplibastu 77 11 1 1 2 101

9 Palpa 65 12 1 1 3 111

10 Dang (14-1) 39 13 2 1 4 121

11 Humla 27 11 0 0 0 99

12 Rolpa 51 11 0 0 0 99

13 Bajhang 47 12 0 0 0 108

14 Kailali 42 13 2 1 3 120

15 Dadheldura 20 9 1 1 5 86

Total 730 170 13 9 27 1557

Altogether 170 VDCs and 9 Municipalities were selected from 15 districts. Due to some

practical problem one VDC from Dang i.e. Koilabas become inaccessible to collect information.

The study successfully captured 10,095 deaths from 1,085,207 population of 1557 wards of

selected districts of Nepal.

2.3 Population

Last census done in Nepal was in 2001. Projection of population figures have been made up to

2021 based on three scenarios: high, medium and low variants. The assumptions used in the

medium variant represent the most likely assumptions in future giving plausible estimates of the

population in future years.v Hence, this study used age and sex specific projected population of

2006 based on medium variant scenario.

2.4 Disease Categories

The GBD 2000 study defined mutually exclusive categories for more than 100 conditions and

400 disease sequelae using International Classification of Diseases (ICD). More in detail ICD-10

codes had classified disease and injury categories into a comprehensive list of three major

disease group, 22 categories of disease and injuries and 96 specific conditions following the

structure of GBD list of conditions. However, it was not possible for Nepalese BOD to include

all the categories of diseases. Hence, this study used only those diseases and specific conditions


9

of GBD 2000 cause categories that are relevant for Nepal. Total of three major groups, 21

categories of disease and injuries and 87 specific conditions were captured in this study.

2.5 Discounting and Age weights

There are three approaches of calculating YLL, i.e. a) with discounting and age weighting, b)

with discounting and no age weighting and c) without discounting and no age weighting. GBD

discounted YLL using 3% discount rate and applied age weights. Nepalese Burden of Disease

study had applied 3% discounting without age weights. This is mainly because, although age

weighting was intended to capture greater social responsibility in young and adult life for the

very young and old in the society, it is relatively controversial and does not essentially change

the overall burden estimates.

2.6 Life Expectancy

GBD uses standard life expectancy at birth (82.5 years for female and 80 years for male) to

calculate YLL. Even though estimated Nepalese life expectancy at birth is lower than that of

GBD (63.7 years for female and 62.9 years for male), use of standard life expectancy is required

for international comparison. Hence, this study used standard life table of reference year 2006 to

calculate YLL.

2.7 Years of Life Lost (YLL)

Years of Life Lost (YLL) is the mortality component of DALYs. YLL corresponds to the

number of deaths multiplied by the standard life expectancy at age at which the death occurs.

The basic formula for the calculation of YLL is:

The basic formula for the calculation of YLL is:

YLL=N*L where N is age and sex specific number of deaths and L is age and

sex specific mean life expectancy.

With discounting, the formula becomes:

YLL=N*(1-e-r

)/r where r = Discounting rate

2.8 Tools and Techniques

This study applied 'Motherhood Method' for data collection. In this method, information on birth,

death, health determinants and outcomes are collected in a geographic area as an unbiased census

would have but without visiting every household. It helps to measure and compare current

estimates of maternal, neonatal, infant and other mortality rates and ratios. Group Focus

Discussion is applied to conduct this method. Group Focus Discussion is a type of group

discussion in which 20-30 participants sit together and actively get involved in the discussion.

GFD is facilitated by a facilitator. In this type of discussion, questions are asked to the group and

are answered by the result of their discussion along this note taking is also done. GFD is

endorsed with the mothers as well as key informants (Maternal and Child Health Workers


10

(MCHWs), Village Health Workers (VHWs), Traditional Birth Attendants (TBAs) local leaders,

teachers, and Purohit (Priest) etc) to collect and verify the information collected with the help of

FCHVs.

Data collection tools were designed by the expert team. Formats to record live births and

mortality information were separate. Pretesting and field training was carried out at Chaimale

and Duwakot VDC of Kathmandu and Bhaktapur districts respectively. Those two VDCs were

selected for pretesting as resemble like many of the other rural and urban settings of Nepal.

Tools were revised on the basis of findings of pretesting.

2.9 Information collected

Information on births and deaths were recorded from the interaction with mothers group.

Live births occurred in the last one year (2063 Ashadh 1- 2064 Jestha 31)

Mortality occurred in the last two years (2062 Ashadh 1- 2064 Jestha 31)

2.10 Selection and training of enumerators

Selection: Candidates who have completed their Bachelors degree in Public health were selected

as Enumerators (Field supervisors) for the study.

Training: The enumerators were provided training with class-room orientation and practical

exposure in the VDCs that was not selected for study. Their queries regarding the study

procedure were answered and feedback to their performance was given during field training

2.11 Data collection process

Motherhood method consists of series of steps which can broadly be classified into three levels.

a) District level Orientation

b) VDC level Orientation

c) Community level Activities

2.11 a) District level Orientation

The initial step is to conduct a district level orientation with District Health Office (DHO) /

District Public Health Office (DPHO) and VDC Health facility in-charge.

i. Orientation program was organized to share objectives and expected help regarding the

study with DHO/DPHO staffs, VDC health facility in-charge.

ii. Micro level planning was carried with respective VDC health facility in-charge to conduct

data collection in the VDC/NP. Basic information about the study site (VDC/NP) like

staffing details of the health facility, population figures, geographic information etc were

collected.

iii. Appropriate time and venue for the VDC level orientation were consulted and set.


11

iv. As different registers (BCG, TT and Vitamin A) are required to prepare the list of mothers

who have given birth in the study period, VDC health facility incharge were also requested

to make the registers available at the time of meeting in their respective VDCs.

2.11 b) VDC level Orientation

In the selected VDCs, VDC level orientation was conducted. VDC health facility in-charge were

requested to invite Maternal and Child Health Workers (MCHWs), Village Health Workers

(VHWs), Female Community Health Volunteers (FCHVs) and Traditional Birth Attendants

(TBAs) at the health facility for VDC level meeting. Female Community Health Volunteers

(FCHVs) were the key persons who call the mothers of their respective area (ward).

i. Participants were explained about the objectives and steps of the Motherhood method.

ii. Detailed and stratified (according to 9 wards) information about VDC was collected from

the participants.

iii. The BCG record of the respective health facility was recorded ward wise in the formats

(Form no. 1) developed to collect live births during the study period.

iv. The T.T. record of the respective health facility was recorded ward wise in the formats

(Form no. 2) developed to collect details of mothers who gave live births during the study

period.

v. The list prepared was discussed, validated and augmented with the help of FCHVs of the

respective wards.

vi. After augmenting the list of mothers, details of deaths during the study period was

documented with the help of FCHVs.

vii. FCHVs were requested to call listed mothers and close relative (mother, mother-in-law or

husband) of recorded deceased person for GFD.

viii. Appropriate time and venue for the GFD was consulted with the FCHVs.

Time and venue for GFD was fixed in different wards and within the wards, on the basis of the

appropriateness of the route and time availability of the FCHVs and mothers.

2.11 c) Community Level Activities

Community level activities for data collection were mostly based upon the planning with FCHVs

during the VDC level meeting. Participants for GFD were called by FCHVs at the convenient

location. Mothers sharing community resources like water tap, exit road etc were called for the

common GFD. This increases accuracy of information as members know each other as well as

event happened in their neighborhood.

i. Enumerators were sent to each wards of the VDC. GFD was carried with the mothers,

FCHVs and key persons

ii. List of mothers who had given birth during the study period were verified and augmented

iii. List of deaths during the study period informed by FCHVs in VDC level orientation was

also verified and augmented


12

iv. Close relatives of the deceased were interviewed for sign/symptoms before death

including other details after GFD, if present, else done through home visit.

v. Information collected were finally verified and managed every evening.

Final set of data were brought to the center from all the selected sites.

Moreover, the basic steps that was followed by the enumerators while conducting Group Focus

discussion were

Participants called by FCHVs were warmly welcomed and rapport building was

done.

The participants were made clear about objective of field visit and the required

information.

Participants were encouraged to actively participate during the discussion.

Verification of the birth whether the mothers in the list had children born within the study

time frame.

Any additional births in their locality/ward during the study period were asked.

The deaths told by FCHVs were verified and any additional deaths were asked.

History of the deaths were probed carefully with close relative of the deceased and

noted.

Participants were thanked for their information and cooperation.

2.12 Data Coding

The information regarding cause of death was further coded by Medical doctors. Two Medical

doctors were assigned to code the cause of death separately. In case of differences in coding,

third Medical doctor was consulted and a final cause of death was assigned studying the whole

symptoms of death.

2.13 Data Quality

Data quality was the concern and challenge for this type of study. Information collected from one

source was triangulated and revalidated from other sources which helped to reduce recall bias to

great extent. For the case of birth it was first collected from the registers and FCHV's memory.

Later on during GFD, the mother of the child verified the date which was re-verified and

augmented by peer group. Similarly for the deaths, preliminary information of deaths in the ward

during the study period was obtained from FCHVs of the respective ward. Later in GFD, the

information was re-verified through consultation with close member of the deceased person and

group discussion along with some addition of missing cases and deletion of extra cases. Detailed

information on sign and symptoms were collected from close family member of deceased person

visiting their household with the help of FCHVs. In case of hospital death, medical evidences

provided by the health institution were also sought along with medical history.


13

2.14 Data Entry and Analysis

A special software 'Assessment of Burden of Disease (ABDIS) using SQL server and visual

basic was designed for entry of the information collected. All data entry forms were scrutinized

to detect errors and omissions each evening in the field site after the data collection. Data entry

work was carried by the team of public health graduates in the data entry format of ABDIS.

Double entry was done for accuracy of data. Data cleaning was done next as soon as data entry

was completed. Ms-Excel and Statistical Package for Social Sciences (SPSS) Version 11.5 was

further used for data processing and analysis.

2.15 Limitations of the Study

The study does not deal with the effect of co-morbidities on YLL estimates for individual

diseases.

The study does not estimate burden of disease due to various risk factors.

The study covers only those diseases whose information can be obtained.

Due to poverty and illiteracy many of respondents could not specify the exact date of

birth and death. Field Supervisors linked the dates with the seasonal calendar and

religious occasions and gave much effort to identify the dates.


14

Chapter 3: Results and findings

3.1 Overview

Lack of complete registration of deaths is a challenge for almost all the developing countries to

calculate burden of premature mortality and Nepal is not an exception. This chapter captures the

attempt of the study to calculate years of life lost (YLL) due to premature mortality. The

calculation of YLL is based on numbers of deaths attributed to each cause at each age. The

following section describes YLL due to different causes by age and sex given by GBD 2000 in

different categories.

It was estimated that more than 2.3 million years of life was lost due to premature mortality in

total due various categories of diseases among which about 1.25 million was observed in males

and about 1.05 million in females. The study attempts to provide detailed information regarding

years of life lost at eco-development region level also. Mortality burden was found to be highest

in Central (26%) and lowest in Far-Western Development Region (12%). Likewise, Terai region

was estimated to have maximum mortality burden (51%) followed by Hill (37%) and Mountain

(12%).

Eastern 20%

Central 26%

Western 24%

Mid-western

18%

Far-western

12% Hill 37%

Mountain 12%

Terai 51%

Figure 3.1.1 Region wise distribution of Total YLL

Ecological Region Development Region


15

COPD accounted highest mortality burden contributing around 263,734 years of life lost nationally.

Lower respiratory infections, tuberculosis, diarrhoeal diseases and birth asphyxia and birth trauma were

the top following causes of YLL in the country respectively. Self inflicted injuries, falls, road traffic

accidents and drowning are the various categories of injuries which were observed among the top 20

causes of YLL accounting approximately 9 percent of total YLL in the country.

Table 3.1.1: Top 20 causes of Years of Life lost, Nepal

Rank Disease category YLL Percent

1 COPD 263734 11.447

2 Lower respiratory infections 216819 9.411

3 Tuberculosis 121815 5.287

4 Diarrhoeal diseases 92080 3.997

5 Birth asphyxia and birth trauma 82532 3.582

6 Cerebrovascular disease 69750 3.027

7 Hepatitis 61594 2.673

8 Self-inflicted injuries 59449 2.580

9 Falls 54179 2.352

10 Road traffic accidents 42613 1.850

11 Drownings 38920 1.689

12 Protein-energy malnutrition 33602 1.458

13 Ischaemic heart disease 31028 1.347

14 Hypertensive heart disease 27133 1.178

15 Diabetes mellitus 23308 1.012

16 Maternal haemorrhage 22800 0.990

17 Epilepsy 20790 0.902

18 Snake Bite 17769 0.771

19 Peptic ulcer disease 15913 0.691

20 Stomach cancer 15574 0.676

Similar to the national distribution COPD and Lower respiratory infections were the top two leading

causes of YLL among males and females (Table: 3.1.2) nationally. COPD was observed to contribute

more percent of YLL among females (13.7 % in females and 9.5% in males) than the males. Tuberculosis

was observed at third rank contributing 6.8 percent of the total YLL among males while it was in fourth

rank contributing about 3.3 percent among females. Diarrhoeal diseases accounted 4.4 percent out of total

in the third rank among females while it was in the fifth position contributing 3.6 percent out of total

among males.


16

Table 3.1.2 : Top 20 Years of Life lost by Cause and Sex, Nepal

Rank Disease category (Males) YLL Percent Disease category (Females) YLL Percent

1 COPD 119493 9.514 COPD 144241 13.764

2 Lower respiratory infections 117444 9.351 Lower respiratory infections 99376 9.483

3 Tuberculosis 86248 6.867 Diarrhoeal diseases 46161 4.405

4 Birth asphyxia and birth trauma 55464 4.416 Tuberculosis 35567 3.394

5 Diarrhoeal diseases 45919 3.656 Cerebrovascular disease 31855 3.040

6 Hepatites 42021 3.346 Self-inflicted injuries 29580 2.823

7 Road traffic accidents 39233 3.124 Birth asphyxia and birth trauma 27068 2.583

8 Cerebrovascular disease 37894 3.017 Maternal haemorrhage 22800 2.176

9 Falls 35431 2.821 Hepatites 19574 1.868

10 Self-inflicted injuries 29869 2.378 Protein-energy malnutrition 19291 1.841

11 Drownings 25818 2.056 Falls 18748 1.789

12 Ischaemic heart disease 20421 1.626 Cervix uteri cancer 14379 1.372

13 Hypertensive heart disease 14399 1.146 Drownings 13102 1.250

14 Protein-energy malnutrition 14310 1.139 Hypertensive heart disease 12734 1.215

15 Diabetes mellitus 13747 1.094 Ischaemic heart disease 10607 1.012

16 Epilepsy 13527 1.077 Stomach cancer 9791 0.934

17 Alcohol use disorders 13289 1.058 Diabetes mellitus 9561 0.912

18 Conflict 11459 0.912 Peptic ulcer disease 9466 0.903

19 HIV/AIDS 10062 0.801 Snake Bite 9270 0.885

20 Cirrhosis of the liver 9099 0.724 Epilepsy 7263 0.693

The YLL distribution among different age categories is shown in the table: 3.1.3 and table: 3.1.4 below.

The distribution of the years of life lost among the children group (0-14) shows lower respiratory

infections as the leading cause of YLL contributing 22.6 percent out of total while self inflicted injuries

was the highest YLL contributing cause (10.9%) among 15-29 years of age group. Bbirth asphyxia and

birth trauma, diarrhoeal diseases, protein energy malnutritiom and drowning were the one after another

causes of YLL respectively among childrens age group. Similarly, among 15-29 years of age group the

top three causes of YLL including the sixth and the ninth cause were from the injury categories. RTA

was the second leading cause contributing 19698 YLL among the 15-29 age group (youth) which was

followed by falls (13830 YLL). Likewise maternal haemorrage was the top fifth cause of YLL among 15-

29 age category. Measles contributed 7271 YLL which occupied the tenth rank among the children group.


17

Table 3.1.3: Top 10 Years of life lost in 0-14 and 15-29 years of age group, Nepal

Rank Disease category (0-14) YLL Percent Disease category(15-29) YLL Percent

1 Lower respiratory infections 206013 22.677 Self-inflicted injuries 26018 10.935

2 Birth asphyxia and birth trauma 82532 9.085 Road traffic accidents 19698 8.279

3 Diarrhoeal diseases 59583 6.558 Falls 13830 5.813

4 Protein-energy malnutrition 33095 3.643 Hepatites 11923 5.011

5 Drownings 24306 2.675 Maternal haemorrhage 11355 4.772

6 Low birth weight 14265 1.570 Conflict 9951 4.183

7 Hepatites 12337 1.358 Tuberculosis 8946 3.760

8 Falls 12049 1.326 Epilepsy 7527 3.164

9 Snake Bite 11775 1.296 Drownings 6218 2.613

10 Measles 7271 0.800 Cerebrovascular disease 6119 2.572

Likewise, COPD and tuberculosis were observed as the top two causes of YLL among both 30-59 and the

elderly (60+) age groups. The percentage distribution shows COPD to contribute three times more YLL

among elderly age group than in 30-59 age group. Self inflicted injuries were on the third rank among 30-

59 years of age group. In the elderly age group YLL due to diarrhoeal diseases was observed in the fourth

position contributing 17345 YLL. Non-communicable diseases like cardiovascular diseases were also

observed as cause of YLL among elderly. Diabetes mellitus was observed in the tenth rank among both

the age groups.

Table 3.1.4: Top 10 Years of life lost in 30-59 and 60+ years of age group

Rank Disease category (30-59) YLL Percent Disease category (60+) YLL Percent

1 COPD 64321 11.157 COPD 194181 33.419

2 Tuberculosis 61587 10.683 Tuberculosis 45087 7.760

3 Self-inflicted injuries 28600 4.961 Cerebrovascular disease 41126 7.078

4 Hepatites 27809 4.824 Diarrhoeal diseases 17345 2.985

5 Cerebrovascular disease 21194 3.676 Hypertensive heart disease 14659 2.523

6 Road traffic accidents 18078 3.136 Ischaemic heart disease 13990 2.408

7 Falls 17669 3.065 Falls 10631 1.830

8 Ischaemic heart disease 14615 2.535 Hepatites 9525 1.639

9 Hypertensive heart disease 12210 2.118 Stomach cancer 7415 1.276

10 Diabetes mellitus 11908 2.066 Diabetes mellitus 7353 1.265


18

3.2 Broad Group wise YLL

Three broad categories of diseases given in GBD were used in to classify years of life lost due to

premature mortality. As the causes of deaths are ascertained through verbal autopsy, there were

some unidentified cases which are also categorized as a broad group.

Table 3.2.1: YLL distribution of broad disease categories

Background Characteristics

GROUP

Total Total YLL I II III IV

Development Region

Eastern 38.2 41.0 14.3 6.5 100 451178

Central 44.9 38.0 10.3 6.8 100 598694

Western 46.8 35.0 10.6 7.6 100 549450

Mid-western 45.1 34.8 15.4 4.6 100 423719

Far-western 56.6 27.8 9.7 5.9 100 280922

Ecological Region

Mountain 48.8 32.5 14.8 4.0 100 281914

Hill 42.0 39.1 13.4 5.5 100 842251

Terai 47.2 34.7 10.4 7.7 100 1179799

National 45.5 36.1 12.0 6.4 100 2303963

Note:

Group I Communicable, maternal, perinatal and nutritional conditions

Group II Non-communicable diseases

Group III Injuries

Group IV Unidentified

The YLL burden was estimated to be highest (45%) in communicable, maternal, perinatal and

nutritional conditions followed by non-communicable diseases (36%) and injuries (12%) in total.

Similar pattern was observed in broad group wise distribution among development and

ecological region except in case of eastern region where group II was the highest contributor

(41%) of total mortality burden rather than group I (38%). Similarly, about 6% of YLL was

attributed to group IV (unidentified).

3.3 Group I: Communicable, Maternal, Perinatal and Nutritional Diseases Total YLL due to group I category was estimated to be more than 1 million years responsible for

45 percent of total YLL. Total YLL distribution in males was 563,044 (54%) and that in female

was 485,805 (46%). YLL distribution of group I category also shows highest burden in Central


19

(28%) and Terai region (53%) similar to total YLL distribution. Table 3.3.1 shows the YLL

distribution due to the major sub groups in Group I. Infectious and parasitic diseases were

observed to be the leading causes of mortality constituting 42 percent of total YLL followed by

conditions arising during the neonatal period which constitutes 28 percent of total YLL due to group I

category. Least YLL contribution was observed to be of nutritional deficiencies.

,

Likewise, cause specific distribution of YLL of development regions is similar to that of national except

in case of Far western development region where YLL due to nutritional deficiencies (5.6%) exceeds that

due to maternal conditions (4%). Likewise, disease specific YLL distribution of ecological regions also

shows similar pattern as that of national except in case of Mountain region in which Respiratory Infection

is second leading cause of YLL (29.7%) rather than neonatal conditions (23%).

Table 3.3.1. YLL distribution of communicable, maternal, perinatal and nutritional diseases

Disease Categories

Development Region Eco-Region

National E C W MW FW M H T

Infectious and

parasitic diseases 36.9 45.5 42.9 45.1 34.9 34.2 44.8 41.7 41.8

Respiratory infection 27.9 18.0 16.7 22.9 24.3 29.7 20.0 19.7 21.1

Maternal conditions 5.7 6.8 6.5 5.3 4.0 5.5 7.2 5.1 5.8

Conditions arising

during the neonatal

period 27.1 26.8 30.6 23.0 31.3 23.3 24.5 30.9 27.8

Nutritional

deficiencies 2.4 2.9 3.3 3.7 5.6 7.3 3.4 2.5 3.5

Total 100 100 100 100 100 100 100 100 100

Total YLL 1723

75 268988 257294 191308 158885 137511 354130 557209 1048850

Note: E Eastern Developmental Region

C Central

W Western

MW Mid-Western

FW Far Western

0.0 10.0 20.0 30.0 40.0 50.0 60.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i

Dev-region Eco-region

16.4 25.6 24.5 18.2 15.1 13.1 33.8

53.1

M Mountain

H Hill

T Terai

Figure 3.3.1 Region wise distribution of total YLL due Group I category


20

Lower respiratory infections (LRI) were the major cause contributing one fifth percentage of total YLL

among group I category. Tuberculosis followed LRI contributing 11.6 percentage of total YLL in this

group. Diarrhoeal diseases were ranked at third position accounting 8.7 percent. Likewise HIV/AIDS

was observed to hold ninth position among the group I category. Maternal haemorrhage (2.1%),

obstructed labour (0.5%), hypertensive disorders of pregnancy (0.5%) and maternal sepsis (0.2%) causes

of maternal deaths was observed in the seventh, fifteenth, sixteenth and nineteenth position among the top

20 causes of YLL in group I.

Table 3.3.2: Top 20 causes of YLL due to Communicable, maternal, perinatal and

nutritional diseases


1 Lower respiratory infections 216819 20.672

2 Tuberculosis 121815 11.614

3 Diarrhoeal diseases 92080 8.779

4 Birth asphyxia and birth trauma 82532 7.869

5 Hepatites 61594 5.873

6 Protein-energy malnutrition 33602 3.204

7 Maternal haemorrhage 22800 2.174

8 Low birth weight 14265 1.360

9 HIV/AIDS 13056 1.245

10 Meningitis 10480 0.999

11 Tetanus 8187 0.781

12 Measles 7391 0.705

13 Leishmaniasis 6712 0.640

14 Japanese encephalitis 6337 0.604

15 Obstructed labour 5466 0.521

16 Hypertensive disorders of pregnancy 5275 0.503

17 Upper respiratory infections 4299 0.410

18 Leprosy 3587 0.342

19 Maternal sepsis 2847 0.271

20 Rabies 2512 0.240

I-A Infectious and Parasitic Diseases

Many developing countries like Nepal are still suffering from the burden of communicable

diseases. Communicable diseases like infectious and parasitic diseases could be prevented by

small medical and educational effort but unfortunately, these diseases solely contributed more

than four hundred thousand years of life lost which was 42 percent of total premature mortality

in Group I category. Region wise distribution showed that Central region was the highest

contributor (28%) of total YLL due to infectious and parasitic diseases followed by western

(25%). Likewise, among the ecological regions, Terai region was responsible for maximum YLL

(53%) followed by Hill (36%) and Mountain (11%).


21

Similarly, distribution of mortality burden among the disease categories within infectious and

parasitic disease group showed that majority of YLL (28 %) was contributed by tuberculosis

followed by Diarrhoeal diseases (21%). The mortality burden of hepatitis was also found to

significant accounting for 14% of total YLL due to infectious and parasitic diseases. Similar to

national estimates, eco-development region wise distribution also showed tuberculosis as top

cause of premature mortality except Far-Western Development region and mountain region

where diarroheal disease was the leading cause of mortality. Moreover, burden of Diarrhoeal

disease was more than double in mountain region (46%) in comparison to national estimates

(21%).

Likewise, YLL due to tuberculosis was found to be higher in hilly (36%) and central region

(32%) than other regions. Premature mortality due to HIV/AIDS was estimated to be almost

double in western region (5%) in comparison to national estimates (3%). Though mortality

burden due to meningitis was not very high but region wise distribution shows western and far

western region to have almost two times greater burden than national estimates. YLL due to

Childhood Cluster disease, which accounted for about 4 percent of total YLL, was found to be

highest in western development region (7%) and Terai region (7%). However, YLL of Tropical

cluster diseases was estimated to be more than two times higher in central development region

(5%) than national estimates (2%).

0.0

10.0

20.0

30.0

40.0

50.0

60.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


14.5

27.9 25.2 19.7

12.7 10.7

36.2

53.1

Figure 3.3.2 Region wise distribution of total YLL due infectious and parasitic diseases


22

Table 3.3.3 YLL distribution of Infectious and Parasitic Diseases

Disease Categories



Tuberculosis 25.2 32.4 26.9 29.8 19.2 17.5 36.6 23.9 27.8

Leprosy 0.1 2.0 0.4 0.4 0.8 0.9 0.1 1.3 0.8

Japanese encephalitis 1.3 0.0 1.9 2.2 2.8 0.0 0.3 2.5 1.4

Worm Infestation 0.0 0.0 0.0 0.0 0.2 0.3 0.0 0.0 0.0

Other infectious diseases 32.9 22.9 16.3 19.8 27.4 20.4 23.5 22.5 22.7

HIV/AIDS 0.0 1.9 5.3 2.9 4.3 0.7 4.6 2.3 3.0

Diarrhoeal diseases 15.8 20.1 21.5 21.0 28.2 46.6 10.3 23.1 21.0

Childhood-cluster diseases 4.5 3.4 6.8 2.7 2.4 0.8 1.0 7.0 4.2

Meningitis 1.0 1.6 5.0 0.1 4.2 1.0 1.5 3.2 2.4

Hepatites 16.3 10.2 15.3 19.8 8.7 10.1 20.7 10.3 14.1

Malaria 0.7 0.0 0.0 0.0 0.9 0.2 0.3 0.2 0.2

Tropical-cluster diseases 2.1 5.5 0.8 1.4 1.0 1.5 1.0 3.6 2.4

Total 100 100 100 100 100 100 100 100 100

Total YLL 63646 122433 110345 86316 55501 47025 158690 232526 438241

I-A1 Tuberculosis Tuberculosis is a major public health problem in Nepal. Department of Health Services, Annual

Report 2006/07 shows that about 45 percent of the total population is infected with TB, out of

which 60 percent are of productive age group only.

Total YLL due to Tuberculosis was found to be more than 120 thousand years in total which

accounted for 28% of total YLL due to infectious and parasitic diseases. Central development

region consistently showed highest YLL (32%) even in case of tuberculosis; however, ecological

region wise distribution is different. Figure 3.3.3 shows that YLL due to tuberculosis is little

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


13.2

32.6

24.4 21.1

8.7 6.7

47.7 45.58

Figure 3.3.3 Region wise distribution of total YLL due Tuberculosis


23

higher (48%) in hilly region than in Terai (45%) unlike total YLL distribution in which Terai

region had highest YLL.

Table 3.3.4 YLL distribution of Tuberculosis


Age Group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 0.0 9.2 55.2 35.5 100 12686

Female 19.4 4.5 23.0 53.1 100 3383

Total 4.1 8.3 48.4 39.2 100 16069

Central

Male 0.8 0.0 62.6 36.6 100 21866

Female 7.0 6.7 60.6 25.7 100 17835

Total 3.6 3.0 61.7 31.7 100 39701

Western

Male 5.0 8.3 44.3 42.3 100 22694

Female 11.1 21.6 25.3 42.0 100 6988

Total 6.5 11.4 39.9 42.2 100 29682

Mid-Western

Male 4.9 6.2 47.8 41.2 100 21387

Female 21.0 2.8 14.5 61.7 100 4321

Total 7.6 5.6 42.2 44.6 100 25708

Far-Western

Male 1.6 12.1 67.0 19.3 100 7613

Female 4.1 21.5 50.4 24.0 100 3040

Total 2.3 14.8 62.2 20.6 100 10655

Ecological Region

Mountain

Male 4.7 10.9 57.4 27.0 100 6341

Female 16.1 33.1 33.5 17.4 100 1871

Total 7.3 16.0 51.9 24.8 100 8212

Hill

Male 3.4 5.1 51.2 40.3 100 45687

Female 12.6 10.4 30.2 46.9 100 12400

Total 5.4 6.3 46.7 41.7 100 58085

Terai

Male 1.8 6.6 55.7 35.8 100 34222

Female 8.7 8.1 52.3 30.9 100 21296

Total 4.5 7.2 54.4 33.9 100 55518

National

Male 2.9 6.2 53.4 37.5 100 86248

Female 10.4 10.2 43.6 35.7 100 35567

Total 5.1 7.3 50.6 37.0 100 121815

Likewise, Table 3.3.4 shows that about 58 % of total YLL due to tuberculosis is estimated to be

in productive age group (15-59). Age wise distribution in region is similar to that of national

except in case of western and mid-western development region where burden above 60 years age

group is higher than in productive age group. Age wise distribution in ecological region is also

same like that of national estimates. Sex wise distribution of national YLL shows almost three


24

times higher YLL in male than in female. There is a vast difference in sex wise distribution

among the regions. Mid-Western region has the highest difference i.e. 5 times higher YLL in

male than in females whereas Central region has the minimum sex wise difference. Sex wise

distribution in remaining regions is 3-4 times higher YLL in males than in females.

I-A3 Human Immunodeficiency Virus (HIV) HIV epidemic in Nepal has evolved from low prevalence to concentrated epidemic. HIV

infection accounted for more than 13 thousand years of life lost responsible for 3 percent of total

years of life lost due to infectious and parasitic diseases. Figure 3.3.5 shows that central region,

which has been the highest contributor of total YLL, shared least percentage (18%) of total YLL

due to HIV. Instead of central region, western region has the highest (45%) YLL due to HIV

followed by Mid and Far Western region. Similarly, ecological distribution of YLL is similar

that of TB showing maximum percent in Hilly region (56%) followed by Terai (41%).

According to the age and sex wise distribution of years of life lost, YLL was observed high

(76%) among 30-59 age group and males were estimated to have almost three times higher

burden of premature mortality due to HIV than females. Similar pattern of high burden of

mortality is reported in age group 30-59 in all regions. Particularly in central development

region, total mortality was observed only in age group 30-59 in both sexes. Sex wise distribution

in ecological regions showed similar pattern of 3 times higher burden in males than in females;

however, the sex wise YLL distribution in development regions was much higher than national.

Highest difference was observed in mid-western region (18 times) followed by western (7 times)

while in central region the difference was negligible.

Table 3.3.5. YLL distribution of HIV/AIDS


Age Group

Total YLL 0-14 15-29 30-59 60+

0

10

20

30

40

50

60

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i Dev-region Eco-region

0

17.9

44.6

19.3 18.2

2.5

56.5

41.0

Figure 3.3.4 Region wise distribution of total YLL due HIV


25

Development region

Central

Male 0.0 0.0 100.0 0.0 100.0 767

Female 0.0 0.0 100.0 0.0 100.0 1565

Total 0.0 0.0 100.0 0.0 100.0 2332

Western

Male 0.0 20.4 79.6 0.0 100.0 5123

Female 0.0 52.4 47.6 0.0 100.0 696

Total 0.0 24.2 75.8 0.0 100.0 5819

Mid-Western

Male 5.4 5.1 86.6 2.9 100.0 2393

Female 100.0 0.0 0.0 0.0 100.0 130

Total 10.3 4.8 82.2 2.7 100.0 2523

Far-Western

Male 0.0 35.9 53.4 10.7 100.0 1778

Female 35.7 36.2 28.2 0.0 100.0 603

Total 9.0 36.0 47.0 8.0 100.0 2381

Ecological Region

Mountain

Male 0.0 0.0 79.6 20.4 100.0 329

Female 0.0 0.0 0.0 0.0 0.0 0

Total 0.0 0.0 79.6 20.4 100.0 329

Hill

Male 0.0 7.9 89.9 2.2 100.0 5589

Female 0.0 12.2 87.8 0.0 100.0 1783

Total 0.0 9.0 89.4 1.7 100.0 7372

Terai

Male 3.1 32.9 62.3 1.7 100.0 4144

Female 28.4 30.2 41.4 0.0 100.0 1210

Total 8.9 32.3 57.6 1.3 100.0 5354

National

Male 1.3 17.9 78.2 2.6 100.0 10062

Female 11.5 19.5 69.0 0.0 100.0 2993

Total 3.6 18.3 76.1 2.0 100.0 13055

I-A4 Diarrhoeal Diseases Diarrhoeal disease is one of the major killer diseases of under five years children, however, it is

not only limited to the specific age group. Diarrhoeal disease provokes epidemic regularly taking

life of hundreds of people. Diarrhoeal disease is responsible for almost a million years of life lost

in Nepal. According to Table 3.3.5, major burden of premature mortality due to diarrhoeal

disease (65%) was seen in 0-14 age group followed by age group 60+. Age wise distribution

among the regions was almost similar to that of national distribution, showing highest burden in

0-14 age group. Likewise, both sexes have almost similar burden at national level while

development region wise distribution shows higher burden in females in mid-western and far-

western development region and just opposite in remaining regions. Ecologically, females have

higher burden of Diarrohea in Hilly region only.

Table 3.3.6. YLL distribution of Diarrhoeal diseases


26

Region wise percentage distribution of Diarrhoea showed highest burden (27%) in central region

and lowest in Eastern region (11%). Similarly, Terai region had highest (58%) and hill region

had lowest (18%) burden of the disease.


Age Group

Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 71.6 11.5 5.1 11.8 100 5849

Female 49.5 0.0 21.4 29.1 100 4204

Total 62.4 6.7 11.9 19.0 100 10053

Central

Male 45.2 8.2 17.9 28.7 100 12586

Female 50.5 7.1 17.4 25.0 100 11984

Total 47.8 7.7 17.6 26.9 100 24573

Western

Male 70.7 6.0 4.5 18.8 100 12494

Female 69.0 3.4 9.8 17.8 100 11181

Total 69.9 4.8 7.0 18.3 100 23675

Mid-Western

Male 82.9 0.0 4.0 13.1 100 7986

Female 74.6 0.0 11.4 14.0 100 10127

Total 78.3 0.0 8.2 13.6 100 18113

Far-Western

Male 67.2 6.5 15.3 11.0 100 7005

Female 71.0 2.3 12.2 14.5 100 8663

Total 69.3 4.2 13.6 12.9 100 15668

Ecological Region

Mountain

Male 88.2 1.3 2.9 7.6 100 9228

Female 78.1

11.8 10.1 100 12708

Total 82.3 0.5 8.1 9.1 100 21936

Hill

Male 54.8 2.8 22.3 20.0 100 8201

Female 48.2 10.5 8.5 32.8 100 8114

Total 51.5 6.6 15.4 26.4 100 16317

Terai

Male 61.1 9.0 8.4 21.5 100 28490

Female 62.0 2.3 16.2 19.4 100 25339

Total 61.5 5.8 12.1 20.5 100 53829

National

Male 65.4 6.3 9.8 18.4 100 45920

Female 64.0 3.1 13.7 19.2 100 46162

Total 64.7 4.7 11.7 18.8 100 92082


27

I-A5 Childhood cluster diseases According to the GBD 2000 cause categories, childhood cluster disease includes five major

diseases viz Pertusis, Poliomyelitis, Diptheria, Mealses and Tetanus. The study captured all the

diseases except Pertusis. Total YLL due to childhood cluster diseases was estimated to be 18

thousand years which was responsible for 4% of total YLL due to infectious and parasitic

diseases.

Burden of this category of disease was found to be highest (41%) in western region and lowest

(7%) in Far-western region. Likewise, burden was highest in Terai region (89%). The

contributions of mountain and hill region were only 2% and 8.5% respectively.

Disease specific YLL distribution shows that Tetanus has the highest contribution (45%) in the

total YLL due to Childhood cluster diseases followed by Measles (41%) and Acute Flaccid

Paralysis (14%). Likewise, development region wise distribution shows the similar distribution

0.0 10.0 20.0 30.0 40.0 50.0 60.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


10.9

26.7 25.7 19.7 17.0

23.8 17.7

58.5

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


15.8 23.1

40.9

12.9 7.2 2.1 8.5

89.4

Figure 3.3.5 Region wise distribution of total YLL due Diarrhoeal Diseases

Figure 3.3.6 Region wise distribution of total YLL due to Childhood Cluster Diseases


28

as that of national except Western and Far-Western development region which shows highest

burden of Measles rather than Tetanus. However, ecological distribution is quite different. Only

Terai region was found to have burden of all the childhood cluster diseases while remaining

region had burden of single disease only, Measles in mountain and Tetanus in hill region.

Table 3.3.7. YLL distribution of Childhood Cluster Diseases

Cause Of Death



Acute Flaccid Paralysis 0.0 24.2 19.9 0.0 0.0 0.0 0.0 15.4 13.74

Diphtheria 0.0 0.0 0.0 5.6 0.0 0.0 0.0 0.8 0.72

Measles 24.5 25.3 58.3 21.4 58.6 100.0 0.0 43.1 40.58

Tetanus 75.5 50.5 21.8 73.0 41.4 0.0 100.0 40.7 44.95

Total 100 100 100 100 100 100 100 100 100

Total YLL 2877 4215 7457 2344 1320 377 1555 16281 18213

I-A5b Acute Flaccid Paralysis

AFP is a syndrome that occurs in some of diseases and conditions including Poliomyelitis. The

polio surveillance system is based upon surveillance for AFP.

Table 3.3.8. YLL distribution of Acute Flaccid Paralysis


Age Group

Total YLL 0-14 15-29

Development region

Central

Male 100.0 0.0 100.00 1020

Female 0.0 0.0 100.00 0

Total 100.0 0.0 100.00 1020

Western

Male 51.0 49.0 100.00 736

Female 48.0 52.0 100.00 748

Total 49.5 50.5 100.00 1484

Ecological Region

Terai

Male 79.4 20.6 100.00 1756

Female 48.0 52.0 100.00 748

Total 70.0 30.0 100.00 2504

National

Male 79.4 20.6 100.00 1756

Female 48.0 52.0 100.00 748

Total 70.0 30.0 100.00 2504

Total mortality burden due to Acute Flaccid Paralysis is estimated to be 2500 YLL only.

Majority of YLL (i.e. 70 percent) due to AFP was contributed in 5-15 years of age followed by

30 percent in 15-29 years age group. Males were more affected then females. All the cases of

AFP were found only in Terai region of central and western development region.


29

I-A5c Diphtheria

Total Years of Life Lost due to diphtheria is only 132 years. Total burden due to diphtheria

recorded in the study was found in female of 0-14 age group of mid-western Terai.

I-A5d Measles Targeted vaccination campaigns have had a major impact on reducing measles deaths, yet it

remains one of the leading causes of death among young children globally. Total mortality

burden of measles is estimated to be about 7300 YLL responsible for 41 percent of total YLL

due to Childhood cluster diseases. Burden of Measles was estimated to be very high in western

region (59%) in comparison to other development regions where the percentage share was in the

range of 6% to 15%. Similarly, most of the burden of measles (95%) was in Terai region and

remaining 5 percent burden was in mountain. No mortality due to measles was found in hill

region.

Likewise, Age wise distribution of total YLL shows that about 98 percent of burden was

observed in 0-14 age group and remaining in age group 15-29. Only Mid-Western and Terai

region had some burden in age group 15-29 while total burden in remaining regions was in only

0-14 age group. Burden of measles was found to be equally distributed among both sexes not

only in national estimates but also in all regions except Mid and Far Western development region

where males had almost three times higher burden than females.

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0

100.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i Dev-region Eco-region

9.5 14.4

58.8

6.8 10.5 5.1 0.0

94.9

Figure 3.3.8 Region wise distribution of total YLL due to Measles


30

Table 3.3.9. YLL distribution of Measles


Age Group

Total YLL 0-14 15-29

Development region

Eastern

Male 100.0 0.0 100 354

Female 100.0 0.0 100 350

Total 100.0 0.0 100 704

Central

Male 100.0 0.0 100 1065

Female 0.0 0.0 100 0

Total 100.0 0.0 100 1065

Western

Male 100.0 0.0 100 1456

Female 100.0 0.0 100 2891

Total 100.0 0.0 100 4347

Mid-Western

Male 100.0 0.0 100 381

Female 0.0 100.0 100 120

Total 76.0 24.0 100 501

Far-Western

Male 100.0 0.0 100 559

Female 100.0 0.0 100 215

Total 100.0 0.0 100 774

Ecological Region

Mountain

Male 100.0 0.0 100 377

Female 0.0 0.0 100 0

Total 100.0 0.0 100 377

Terai

Male 100.0 0.0 100 3438

Female 96.6 3.4 100 3576

Total 98.3 1.7 100 7014

National

Male 100.0 0.0 100 3815

Female 96.6 3.4 100 3576

Total 98.4 1.6 100 7391

I-A5e Tetanus Tetanus is an infectious disease caused by contamination of wounds from its causative bacteria

that live in the soil. Difficulties of diagnosis and management of Tetanus in the resource-

challenged health care setting of developing countries like Nepal is a major reason behind its

high burden. Tetanus is the leading cause of YLL due to childhood cluster diseases accounting

for 81 thousand years of life lost which is 45 percent of total mortality burden due to childhood

cluster disease.

According to age wise distribution, age group 0-14 was estimated to have highest burden of

Tetanus in national level as well as regional level except in hilly region where burden was


31

highest in age group 30-59. Likewise, Males were found to be three times more affected by

Tetanus than females. Sex wise distribution of all development regions showed lower male

female ratio than national while that in ecological region was found to be similar in Terai (3

times) and higher (5 times) in Hill region.

Table 3.3.10. YLL distribution of Tetanus


Age Group

Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 96.1 0.0 0.0 3.9 100 1473

Female 100.0 0.0 0.0 0.0 100 701

Total 97.3 0.0 0.0 2.7 100 2174

Central

Male 100.0 0.0 0.0 0.0 100 2130

Total 100.0 0.0 0.0 0.0 100 2130

Western

Male 40.2 0.0 59.8 0.0 100 906

Female 100.0 0.0 0.0 0.0 100 721

Total 66.7 0.0 33.3 0.0 100 1627

Mid-Western

Male 57.6 8.2 34.3 0.0 100 1581

Female 100.0 0.0 0.0 0.0 100 130

Total 60.8 7.5 31.7 0.0 100 1711

Far-Western

Male 75.1 0.0 24.9 0.0 100 301

Female 100.0 0.0 0.0 0.0 100 246

Total 86.3 0.0 13.7 0.0 100 545

Ecological Region

Hill

Male 17.3 0.0 82.7 0.0 100 1310

Female 100.0 0.0 0.0 0.0 100 246

Total 30.3 0.0 69.7 0.0 100 1556

Terai

Male 94.8 2.5 1.5 1.1 100 5080

Female 100.0 0.0 0.0 0.0 100 1552

Total 96.0 1.9 1.1 0.9 100 6631

National

Male 78.9 2.0 18.1 0.9 100 6390

Female 100.0 0.0 0.0 0.0 100 1797

Total 83.6 1.6 14.2 0.7 100 8187

Not much difference was found in burden of Tetanus among the development regions. Eastern

and Central region had similar burden (26%) followed by Western and Mid-western region

(20%). Conversely, majority of burden was observed in Terai (81%) and remaining 19% in

Mountain. There was no any mortality recorded in hilly region.


32

I-A6 Meningitis Total contribution of Meningitis is about 2.3 percent in total mortality burden due to infectious

and parasitic diseases. Total mortality burden due to Meningitis was more than 10 thousand

YLL. Unlike region wise distribution of infectious and parasitic diseases, Meningitis had highest

burden in western region (53%) and lowest in Mid-western region. However, ecological region

wise distribution was almost similar to distribution of infectious and parasitic diseases with

majority of burden in Terai (72%) followed by Hill (23%) and Mountain (5%).

Burden of Meningitis was found to be highest (66%) in age group 0-14. Burden in males was

estimated to be two times higher than in females. There was no much difference in age wise

distribution in regions from the national distribution. Both Terai and Hill region had two times

higher burden in males than females while development regions had almost equal distribution of

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


5.9

18.5

52.9

0.4

22.3

4.7

23.3

72.1

Figure 3.3.9 Region wise distribution of total YLL due to Tetanus

Figure 3.3.10 Region wise distribution of total YLL due to Meningitis

0.0 20.0 40.0 60.0 80.0

100.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


26.6 26.0 19.9 20.9 6.7

19.0 0.0

81.0


33

burden among both sexes except in Western development region where burden in male was four

times higher than in female.

Table 3.3.11.YLL distribution of Meningitis


Age Group

Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 0.0 0.0 0.0 100.0 100 120

Female 68.7 0.0 0.0 31.3 100 502

Total 55.5 0.0 0.0 44.5 100 622

Central

Male 100.0 0.0 0.0 0.0 100 789

Female 91.3 0.0 0.0 8.7 100 1147

Total 94.8 0.0 0.0 5.2 100 1936

Western

Male 74.5 7.4 6.5 11.6 100 4400

Female 65.9 34.1 0.0 0.0 100 1141

Total 72.8 12.9 5.1 9.2 100 5541

Mid-Western

Male 0.0 0.0 0.0 100.0 100 48

Total 0.0 0.0 0.0 100.0 100 48

Far-Western

Male 9.7 0.0 80.6 9.7 100 1083

Female 53.1 17.9 13.8 15.2 100 1250

Total 33.0 9.6 44.8 12.6 100 2333

Ecological Region

Mountain

Male 0.0 0.0 0.0 100.0 100 187

Female 41.5 0.0 0.0 58.5 100 303

Total 25.6 0.0 0.0 74.4 100 490

Hill

Male 53.4 0.0 43.9 2.6 100 1477

Female 35.9 23.3 17.9 22.9 100 961

Total 46.5 9.2 33.7 10.6 100 2438

Terai

Male 70.9 6.8 10.6 11.7 100 4775

Female 84.2 14.0 0.0 1.8 100 2777

Total 75.8 9.5 6.7 8.0 100 7552

National

Male 64.8 5.0 18.0 12.2 100 6440

Female 69.5 15.2 4.3 11.0 100 4040

Total 66.6 9.0 12.7 11.7 100 10480

I-A7 Hepatitis Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. Hepatitis is

the fourth largest contributor of mortality burden due to infectious and parasitic diseases

responsible for 14 % (61594 YLL) of total YLL. At national level, distribution of total YLL was

found to be two times more in males than in females. Likewise, burden was estimated to be


34

highest in age group 30-59 (45%). Even at regional level, age group 30-59 had the highest

contribution in total YLL due to Hepatitis. Sex wise distribution was also higher in males than in

females in same proportion as national except in central level where burden was 15 times higher

in males than in females.

Table 3.3.12. YLL distribution of Hepatitis


Age Group

Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 18.5 20.3 38.7 22.6 100 5748

Female 25.3 23.9 39.2 11.6 100 4654

Total 21.5 21.9 38.9 17.6 100 10402

Central

Male 35.8 17.7 37.7 8.7 100 11694

Female 0.0 41.7 35.2 23.1 100 787

Total 33.5 19.3 37.6 9.6 100 12481

Western

Male 0.0 15.6 75.4 8.9 100 10109

Female 28.5 28.8 11.6 31.1 100 6725

Total 11.4 20.9 49.9 17.8 100 16834

Mid-Western

Male 7.4 18.2 65.6 8.9 100 12141

Female 30.8 18.7 16.4 34.1 100 4908

Total 14.1 18.3 51.4 16.1 100 17049

Far-Western

Male 20.2 21.6 45.4 12.8 100 2330

Female 44.8 3.8 33.7 17.7 100 2498

Total 32.9 12.4 39.3 15.4 100 4828

Ecological Region

Mountain

Male 27.5 18.2 39.8 14.5 100 2745

Female 37.3 39.4 20.5 2.8 100 2018

Total 31.6 27.2 31.6 9.6 100 4763

Hill

Male 3.0 21.0 66.0 9.9 100 23310

Female 27.3 16.7 17.6 38.5 100 9597

Total 10.1 19.8 51.9 18.3 100 32906

Terai

Male 32.3 13.3 42.6 11.8 100 15967

Female 29.6 25.1 30.5 14.8 100 7958

Total 31.4 17.2 38.6 12.8 100 23925

National

Male 15.7 17.9 55.4 10.9 100 42021

Female 29.3 22.4 23.1 25.2 100 19573

Total 20.0 19.4 45.1 15.5 100 61594

Region wise distribution shows not much difference in the burden of Hepatitis. Both Western

and Mid-Western region had similar percent share (27%) followed by central (20%). Likewise

Hill region had highest burden (53%) followed by Terai (39%) and Mountain (8%).


35

I-A8 Malaria

Malaria is the most important parasitic infection endemic in 65 districts of Nepal. Since the

initiation of malaria control program in 1954, several control programs have been implemented

for the control of malaria. Total mortality burden shared by malaria among the total infectious

and parasitic disease was found to be very less accounting for about 1% of total YLL. The region

wise distribution of mortality burden due to malaria shows that Hill region comprises the highest

among the ecological region of the total figure (50.5%) followed by Terai (37.7%) and Mountain

(11.8%). However, mortality burden due to malaria was observed in Eastern and Far-western

development region only.

According to the table the total YLL lost due to malaria is 929 years. The mortality is found to be

more or less similiar between male and female group i.e. 469 and 460 years of life lost

respectively. Likwise, highest YLL was observed in above 60 age group(29%). Sex wise

distribution in Eastern region shows higher burden in males than females while Far-western

0.0 10.0 20.0 30.0 40.0 50.0 60.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


16.9 20.3 27.3 27.7

7.8 7.7

53.4

38.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Mountain Hill Terai

11.8

50.5

37.7

Ecological Region

Figure 3.3.11 Region wise distribution of total YLL due to Hepatitis

Figure 3.3.12 Region wise distribution of total YLL due Malaria


36

region had just opposite distribution. All ecological regions had burden in single sex only; males

in hill region and females in Mountain and Terai region.

Table 3.3.13. YLL distribution of Malaria


Age Group

Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 0.0 100.0 0.0 0.0 100 244

Female 0.0 0.0 0.0 100.0 100 211

Total 0.0 53.6 0.0 46.3 100 455

Far-Western

Male 100.0 0.0 0.0 0.0 100 225

Female 0.0 0.0 76.3 23.6 100 249

Total 47.4 0.0 40.0 12.4 100 474

Ecological Region

Mountain

Female 0.0 0.0 100.0 0.0 100 110

Total 0.0 0.0 100.0 0.0 100 110

Hill

Male 47.9 52.0 0.0 0.0 100 469

Total 47.9 52.0 0.0 0.0 100 469

Terai

Female 0.0 0.0 22.8 77.1 100 350

Total 0.0 0.0 22.8 77.1 100 350

National

Male 47.9 52.0 0.0 0.0 100 469

Female 0.0 0.0 41.3 58.7 100 460

Total 24.2 26.2 20.4 29.0 100 929

I-A9 Tropical Cluster Disease It accounts for more than 2 percent of total YLL due to Infectious and Parasitic diseases.

Different diseases like Trypanosomiasis, Chagas disease, Schistosomiasis, Leismaniasis,

Lymphatic Filariasis and Onchocerciasis are kept under Tropical Cluster disease by GBD 2000.

The region wise distribution of mortality burden due to tropical cluster disease shows that

Central development region is the highest contributor (63.2%) of the total YLL whereas Far-

western development region comprises the lowest percentage of the total figure (5%). Similarly

distribution of ecological region, terai area accounts the highest mortality burden (78.9%) and

the lowest percentage was found in mountain region (6.6%).


37

Mortality due to only two of the diseases i.e. Leishmaniasis and Lymphatic Filariasis were only

observed in the study. Besides, mortality due to Rabies was also included in this category as

given in table 3.3.13. Leishmaniasis was found to the highest contributor accounting for 63

percent of total YLL due to Tropical Cluster disease followed by Rabies (24 %). Western and

Far-western development region had highest mortality burden due to Rabies while the remaining

regions had leishmaniasis like national estimates. However, mortality burden was quite different

in ecological region. Terai region had burden of the entire three disease category, highest due to

Leishmaniasis (63 %) while Mountain region had burden due to Lymphatic filariasis and Rabies

only. Entire burden of 1559 YLL in Hilly region was due to Rabies only.

Table 3.3.14. YLL distribution of Tropical Cluster Diseases

Cause Of Death Development Region Eco-Region


Leishmaniasis 52.2 88.5 0.0 3.8 0.0 0.0 0.0 79.6 62.8

Lymphatic filariasis 21.6 10.5 9.0 28.3 6.9 91.7 0.0 9.7 13.6

Rabies 26.0 0.8 91.0 67.8 93.0 8.2 100.0 10.6 23.5

Total 100 100 100 100 100 100 100 100 100

Total YLL 1307 6751 856 1236 532 700 1559 8425 10684

I-A9d Leismaniasis

Leishmaniasis is one of the major infectious diseases affecting the poorest regions of the world.

Leismaniasis is the leading cause of mortality due to Tropical cluster disease accounting for 63

percent of total YLL. The region wise distribution of mortality burden due to leishmaniasis

shows that Central region comprises the highest among the developmental region of the total

figure (89.1%) and the lowest percentage was found in Mid-western region (0.7%). Mortality

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i

Developmental Region Ecological Region

12.2

63.2

8.0 11.6 5.0 6.6

14.6

78.9

Figure 3.3.13 Region wise distribution of total YLL due to Tropical cluster disease


38

due to leismaniasis was not found in Western and Far-western development region as well as in

hilly and mountain region.

According to the age and sex distribution of the mortality, it was observed more among the

males of age group 30-59. Age and sex wise distribution in the regions was similar to that of

national distribution except Eastern region where highest burden was observed in age group 0-14

(48%) instead of age group 30-59 (43%).

Table 3.3.15. YLL distribution of Leishmaniasis


Age Group

Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 0.0 0.0 83.6 16.3 100 355

Female 100.0 0.0 0.0 0.0 100 329

Total 48.1 0.0 43.4 8.4 100 684

Central

Male 0.0 28.5 56.9 14.5 100 3513

Female 0.0 0.0 84.6 15.3 100 2468

Total 0.0 16.7 68.3 14.8 100 5981

Mid-Western

Male 0.0 0.0 0.0 100.0 100 47

Total 0.0 0.0 0.0 100.0 100 47

Ecological Region

Terai

Male 0.0 25.5 58.7 15.7 100 3915

Female 11.7 0.0 74.6 13.5 100 2797

Total 4.9 14.9 65.3 14.8 100 6712

National

Male 0.00 25.5 58.7 15.7 100 3915

Female 11.7 0.0 74.6 13.5 100 2797

Total 4.9 14.9 65.3 14.8 100 6712

0.0

20.0

40.0

60.0

80.0

100.0

Eastern Central Mid-Western

10.2

89.1

0.7

Developmental Region

Figure 3.3.14 Region wise distribution of total YLL due to Leismaniasis


39

I-A9e Lymphatic filariasis

Lymphatic filariasis is one of the most disfiguring diseases and a major cause of clinical

morbidity. Years of life lost shared by lymphatic filariasis among the total infectious and

parasitic disease was found to be negligible accounting for less than 1% of total YLL. According

to the age and sex distribution of the mortality it was observed more among the males of age

group 30-59 at national level. Both Mountain and Terai region had similar age and sex wise

distribution while development regions had quite different pattern. Only Mid-Western region had

burden distributed in both sexes while remaining regions had total burden in single sex; females

in western region and males in remaining three development regions.

Table 3.3.16. YLL distribution of Lymphatic Filariasis


Age Group

Total YLL 15-29 30-59 60+

Development region

Eastern

Male 0.0 100.0 0.0 100 283

Total 0.0 100.0 0.0 100 283

Central

Male 0.0 100.0 0.0 100 712

Total 0.0 100.0 0.0 100 712

Western

Female 0.0 0.0 100.0 100 77

Total 0.0 0.0 100.0 100 77

Mid-Western

Male 0.0 100.0 0.0 100 94

Female 100.0 0.0 0.0 100 255

Total 73.0 26.9 0.0 100 349

Far-Western

Male 0.0 0.0 100.0 100 37

Total 0.0 0.0 100.0 100 37

Ecological Region

Mountain

Male 0.0 100.0 0.0 100 387

Female 100.0 0.0 0.0 100 255

Total 39.7 60.2 0.0 100 642

Terai

Male 0.0 94.9 5.0 100 739

Female 0.0 0.0 100.0 100 77

Total 0.0 86.0 13.9 100 816

National

Male 0.0 96.7 3.2 100 1126

Female 76.8 0.0 23.1 100 332

Total 17.4 74.6 7.8 100 1458

Similarly, region wise distribution of total mortality burden due to lymphatic filariasis shows that

Central development region is the highest contributor (48.8%) of the total YLL whereas Far-

western development region comprises the lowest percentage of the total figure (2.5%). Similarly


40

distribution of ecological region, terai area accounts the highest mortality burden (56%) and the

lowest percentage was found in mountain region (44%).

I-A9g Rabies

Rabies is a major zoonotic disease of public health importance in Nepal. Years of life lost shared

by rabies among the total infectious and parasitic disease was found to be negligible accounting

for less than 1% of total YLL. The total YLL lost due to rabies is 2513 years. The region wise

distribution of mortality burden due to lymphatic filariasis shows that Mid-western development

region is the highest contributor (33.4%) of the total YLL whereas Central development region

comprises the lowest percentage of the total figure (2.3%). Similarly distribution of ecological

region, Mountain region accounts the highest mortality burden (62%) and the lowest percentage

was found in Hill region (2.3%).

0.0

10.0

20.0

30.0

40.0

50.0

60.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Tera

i

Development region Ecological Region

19.4

48.8

5.3

23.9

2.5

44.0

56.0

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i

Development region Ecological Region

13.6 2.3

31.0 33.4

19.7

62.0

2.3

35.7

Figure 3.3.15 Region wise distribution of total YLL due to Lymphatic filariasis

Figure 3.3.16 Region wise distribution of total YLL due to Rabies


41

According to the age and sex distribution of the mortality it was observed more among the

females of 0-14 age group. Total burden in Hill region is observed in female of 0-14 age group

while that in mountain region is in male of 60 above population. In Terai region, highest

mortality is observed in 30-59 age group of male population. Among the development regions,

Eastern, Central and Far-western region had total burden in males only while Western region had

burden in females only. Mid-western region had burden in both sexes; higher in females than in

males.

Table 3.3.17. YLL distribution of Rabies


Age Group

Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 0.0 0.0 82.9 17.0 100 341

Total 0.0 0.0 82.9 17.0 100 341

Central

Male 0.0 0.0 0.0 100 100.00 58

Total 0.0 0.0 0.0 100 100.00 58

Western

Female 100.0 0.0 0.0 0.0 100 779

Total 100.0 0.0 0.0 0.0 100 779

Mid-Western

Male 0.0 0.0 0.0 100.0 100 60

Female 100.0 0.0 0.0 0.0 100 779

Total 92.8 0.0 0.0 7.1 100 839

Far-Western

Male 21.1 20.7 46.9 11.0 100 496

Total 21.1 20.7 46.9 11.0 100 496

Ecological Region

Mountain

Male 0.0 0.0 0.0 100.0 100 58

Total 0.0 0.0 0.0 100.0 100 58

Hill

Female 100.0 0.0 0.0 0.0 100 1559

Total 100.0 0.0 0.0 0.0 100 1559

Terai

Male 11.7 11.5 57.5 19.2 100 896

Total 11.7 11.5 57.5 19.2 100 896

National

Male 11.0 10.8 54.0 24.1 100 954

Female 100.0 0.0 0.0 0.0 100 1559

Total 66.2 4.1 20.5 9.1 100 2513

I-A10 Leprosy Leprosy is an endemic disease in Nepal from the time immemorial and is still one in five

countries in the world that have not yet achieved elimination. The total mortality burden of

leprosy in Nepal was estimated to be 3586 YLL. Its burden was found to be little more in males

than females. Age wise distribution shows highest burden (69%) in 30-59 age group. Age and


42

sex wise distribution of different regions is similar to that of national distribution. However, in

western and far-western development region, females had more burden than males.

Table 3.3.18. YLL distribution of Leprosy


Age Group

Total YLL 30-59 60+

Development region

Eastern

Male 0.0 100.0 100 58

Female 0.0 0.0 100 0

Total 0.0 100.0 100 58

Central

Male 40.2 59.8 100 1572

Female 100.0 0.0 100 838

Total 61.0 39.0 100 2410

Western

Male 0.0 100.0 100 60

Female 100.0 0.0 100 331

Total 84.7 15.3 100 390

Mid-Western

Male 76.8 23.2 100 306

Female 0.0 0.0 100 0

Total 76.8 23.2 100 306

Far-Western

Male 100.0 0.0 100 71

Female 100.0 0.0 100 351

Total 100.0 0.0 100 422

Ecological Region Mountain

Male 65.6 34.4 100 215

Female 100.0 0.0 100 187

Total 81.6 18.4 100 402

Hill

Male 0.0 100.0 100 107

Female 0.0 0.0 100 0

Total 0.0 100.0 100 107

Terai

Male 45.7 54.3 100 1745

Female 100.0 0.0 100 1333

Total 69.2 30.8 100 3077

National

Male 45.4 54.6 100 2066

Female 100.0 0.0 100 1520

Total 68.5 31.5 100 3586

Region wise distribution of total YLL shows majority of burden (67%) was in Central region

among the development regions. Likewise, Terai region had the maximum mortality burden

(86%) followed by Mountain (12%) and hill (3%).


43

I-A12 Japanese Encephalitis Total mortality burden of Japanese Encephalitis (JE) is about 6000 YLL. It accounts for 1.5% of

total mortality due to group I category. There was no much difference in burden distribution

among development regions; however, maximum YLL was observed in Western (33%) and

minimum in Eastern (13%). Likewise, more than 90% YLL was observed in Terai region. No

any burden was found in Central and mountain region.

Burden due to JE was found to higher in age group 0-14 (45%) followed by age group 30-59

(30%). Likewise, males were more prone to mortality due to JE in comparison to females.

Eastern development region showed different pattern of age and sex wise distribution to that of

national estimate. In this region, females had higher burden than males and highest contributing

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


1.6

67.2

10.9 8.5 11.8 11.2 3.0

85.8

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0

100.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


13.4 0.0

32.9 29.3 24.4

0.0 8.6

91.4

Figure 3.3.17 Region wise distribution of total YLL due to Leprosy

Figure 3.3.18 Region wise distribution of total YLL due to Japanese encephalitis


44

age group was 30-59 (61%) rather than 0-14 age group (38%). Remaining regions had almost

similar pattern to that of national estimates.

Table 3.3.19. YLL distribution of Japanese encephalitis

Background Characteristics Age Group

Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 0.0 0.0 100.0 0.0 100 215

Female 51.8 0.0 48.2 0.0 100 635

Total 38.7 0.0 61.3 0.0 100 850

Western

Male 54.2 0.0 32.5 13.3 100 1364

Female 100.0 0.0 0.0 0.0 100 721

Total 70.0 0.0 21.2 8.7 100 2085

Mid-Western

Male 14.2 28.5 44.2 13.2 100 882

Female 67.0 12.1 18.2 2.8 100 975

Total 41.9 19.9 30.5 7.7 100 1856

Far-Western

Male 21.2 42.9 21.4 14.4 100 1012

Female 20.6 36.0 32.4 11.0 100 534

Total 21.0 40.5 25.2 13.3 100 1546

Ecological Region

Hill

Male 0.0 42.2 39.2 18.6 100 548

Female 0.0 0.0 0.0 0.0 100 0

Total 0.0 42.2 39.2 18.6 100 548

Terai

Male 36.9 15.5 35.9 11.7 100 2924

Female 63.3 10.8 22.9 3.0 100 2865

Total 49.9 13.2 29.5 7.4 100 5789

National

Male 31.0 19.7 36.4 12.8 100 3472

Female 63.3 10.8 22.9 3.0 100 2865

Total 45.62 15.70 30.31 8.36 100 6337

I-A14 Worm Infestation Premature mortality due to worm infestation is rare; hence its mortality burden is also minimal of

about 118 years of life lost. Its contribution in total YLL due to Group I category is almost

negligible.

I-A15 Other Infectious Diseases Other infectious diseases included typhoid, septicemia, unclassified fever etc. They were

responsible for 23% of total YLL due to Group I category accounting about 1 million years of

life lost, similar to that of Diarroheal diseases. This category of disease was mostly found in age


45

group 0-14, more in females than in males. Age and sex wise distribution is similar to that of

national estimates.

Table 3.3.20. YLL distribution of Other infectious diseases


Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 58.95 10.88 8.41 21.76 100.00 9663

Female 45.37 7.98 13.67 32.98 100.00 11288

Total 51.63 9.32 11.25 27.81 100.00 20951

Central

Male 40.71 10.08 26.99 22.22 100.00 11248

Female 61.37 6.74 9.37 22.53 100.00 16791

Total 53.08 8.08 16.44 22.40 100.00 28039

Western

Male 54.32 9.98 11.66 24.04 100.00 8269

Female 44.46 7.89 18.43 29.23 100.00 9731

Total 48.99 8.85 15.32 26.84 100.00 18000

Mid-Western

Male 41.69 17.44 10.94 29.93 100.00 6882

Female 40.47 8.65 19.35 31.53 100.00 10253

Total 40.96 12.18 15.97 30.89 100.00 17135

Far-Western

Male 46.36 2.86 24.85 25.93 100.00 6929

Female 37.35 5.41 31.37 25.86 100.00 8297

Total 41.45 4.25 28.41 25.90 100.00 15226

Ecological Region

Mountain

Male 36.11 10.24 27.93 25.72 100.00 4716

Female 39.33 4.86 11.14 44.67 100.00 4874

Total 37.75 7.51 19.40 35.35 100.00 9590

Hill

Male 40.87 16.99 17.34 24.80 100.00 14022

Female 38.43 8.66 19.95 32.96 100.00 23313

Total 39.35 11.79 18.97 29.90 100.00 37335

Terai

Male 55.31 6.36 14.60 23.74 100.00 24251

Female 57.22 6.68 15.27 20.83 100.00 28174

Total 56.34 6.53 14.96 22.17 100.00 52425

National

Male 48.49 10.25 16.95 24.30 100.00 42990

Female 47.90 7.34 16.85 27.91 100.00 56360

Total 48.16 8.60 16.89 26.35 100.00 99350

Distribution of YLL among the regions is similar to that of category I-A (Infectious and parasitic

diseases). Central region has the highest burden (28%) among the development regions.

Likewise, Terai region has the maximum burden (53%) followed by Hill (38%) and Terai (10%).


46

I-B Respiratory Infections

Respiratory Infections are the third highest contributor for years of life lost due to Group I

category sharing 21 percent of total YLL. Altogether 221730 YLL had been lost due to

respiratory infections. Burden of Respiratory infection was almost equally distributed in all

development regions ranging from 21% to 17%. However, ecological region wise distribution

was highest in Terai region (50%) followed by Hill region (32%) and Mountain region (18%).

The YLL distribution due to Lower respiratory infections, Upper Respiratory infections and

Otitis media is shown in the Table 3.3.21. Majority of burden due to Respiratory Infection at

national level was contributed by Lower Respiratory Infection (98%) while Upper Respiratory

Infection and Otitis Media constituted remaining 2 percent. Region wise distribution was also

similar to that of national distribution.

0.0

10.0

20.0

30.0

40.0

50.0

60.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


21.1 28.2

18.1 17.2 15.3 9.7

37.6

52.8

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


21.7 21.8 19.4 19.7 17.4 18.4

32.0

49.6

Figure 3.3.20.Region wise distribution of total YLL due to Respiratory Infection

Figure 3.3.19 Region wise distribution of total YLL due to Other infectious diseases


47

Table 3.3.21. YLL distribution of Respiratory Infection

Respiratory

Infection



Lower respiratory

infections 100.0 97.6 97.6 94.6 99.0 97.1 97.4 98.3 97.8

Upper respiratory

infections 0.0 2.4 2.1 4.6 0.7 2.3 2.6 1.4 1.9

Otitis media 0.0 0.0 0.3 0.9 0.3 0.6 0.0 0.3 0.3

Total 100 100 100 100 100 100 100 100 100

Total YLL 48025 48409 42970 43779 38546 40819 70993 109918 221730

I-B1 Lower Respiratory Infections

Lower Respiratory Infections (LRIs) were the major cause of mortality among the total

Respiratory Infections comprising approximately 98 percent of total YLL (216818). Region wise

distribution of LRIs was similar to distribution of Respiratory Infections showing almost equal

distribution in all development regions and similar pattern in ecological regions highest in Terai

(50%) followed by Hill (32%) and Mountain (18%).

According to Table 3.3.22, highest YLL was observed in the below 14 age group (95%). Sex

wise distribution showed little higher mortality burden in males than in females. Region wise

distribution was similar to that of the national showing higher mortality burden in 0-14 age

group. Likewise, YLL was also estimated to be little higher in males in all eco-development

regions.

0.0

10.0

20.0

30.0

40.0

50.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


22.1 21.8 19.4 19.1 17.6 18.3

31.9

49.8

Figure 3.3.21 Region wise distribution of total YLL due to Lower Respiratory Infection


48

Table 3.3.22. YLL distribution of Lower respiratory infections

Background

Characteristics

Age Group

Total YLL 0-14 15-29 30-59 60+

Development region

Eastern

Male 90.0 1.2 4.1 4.6 100 27448

Female 84.3 2.3 9.3 4.0 100 20576

Total 87.6 1.7 6.4 4.4 100 48024

Central

Male 94.9 0.0 2.9 2.2 100 21364

Female 95.3 0.7 0.5 3.5 100 25906

Total 95.2 0.4 1.5 2.9 100 47270

Western

Male 99.1 0.0 0.0 0.9 100 23355

Female 99.5 0.0 0.0 0.5 100 18600

Total 99.3 0.0 0.0 0.7 100 41955

Mid-Western

Male 96.8 0.0 1.6 1.6 100 23630

Female 96.0 0.0 1.9 2.1 100 17770

Total 96.4 0.0 1.7 1.8 100 41400

Far-Western

Male 97.7 0.0 0.3 2.0 100 21646

Female 98.2 0.0 0.0 1.8 100 16524

Total 97.9 0.0 0.2 1.9 100 38170

Ecological Region

Mountain

Male

100 23591

Female 93.4 0.0 2.3 4.4 100 16028

Total 89.4 2.1 3.3 5.2 100 39619

Hill 91.8 0.8 2.7 4.7

Male

100 41458

Female 95.7 0.0 2.5 1.8 100 27713

Total 95.1 0.0 2.7 2.1 100 69171

Terai 95.5 0.0 2.6 1.9

Male

100 52393

Female 96.3 0.6 1.2 1.9 100 55634

Total 95.5 0.6 2.0 1.9 100 108027

95.9 0.6 1.6 1.9

National

Male

100 117443

Female 95.5 0.3 1.9 2.3 100 99375

Total 94.4 0.7 2.4 2.5 100 216818

I-B2 Upper Respiratory Infections

Upper Respiratory Infections (URIs) constituted about 2 percent (4300 YLL) of total Respiratory

Infections. Age wise distribution shows that mortality due to Upper Respiratory Infections was

observed highest in age group 60+ and lowest in 0-14 age group. Sex wise distribution was not

much different showing almost similar pattern in both male and female. Age wise distribution in


49

all the regions was similar to that of national estimates except in case of central development

region where the burden was found to be higher in 30-59 age group rather than in 60+ age group.

Regarding the regional sex wise distribution, the burden was found to be higher in females in

except in central development region. In contrast, ecological sex wise distribution showed higher

burden in females in only hilly region.

Table 3.3.23. YLL distribution of Upper respiratory infections


Age Group

Total YLL 0-14 30-59 60+

Development Region

Central

Male 0.0 87.9 12.1 100 692

Female 0.0 0.0 100.0 100 446

Total 0.0 53.4 46.6 100 1138

Western

Male 0.0 0.0 100.0 100 280

Female 0.0 0.0 100.0 100 611

Total 0.0 0.0 100.0 100 891

Mid-Western

Male 27.0 0.0 73.0 100 935

Female 0.0 12.3 87.7 100 1062

Total 12.6 6.6 80.8 100 1997

Far-Western

Male 0.0 0.0 100.0 100 112

Female 0.0 56.2 43.8 100 162

Total 0.0 33.2 66.8 100 274

Eco-Region

Mountain

Male 42.2 0.0 57.8 100 597

Female 0.0 37.3 62.7 100 351

Total 26.6 13.8 59.6 100 948

Hill

Male 0.0 0.0 100.0 100 599

Female 0.0 0.0 100.0 100 1222

Total 0.0 0.0 100.0 100 1821

Terai

Male 0.0 73.9 26.1 100 823

Female 0.0 12.9 87.1 100 708

Total 0.0 45.7 54.3 100 1531

National

Male 12.5 30.1 57.4 100 2019

Female 0.0 9.7 90.3 100 2281

Total 5.9 19.3 74.8 100 4300


50

Majority of burden due to URIs (46%) were estimated to be in Mid-Western region and least

(6.4%) in Far-Western region however no any mortality was recorded in Eastern region.

Ecological region wise distribution was quite different from distribution of Respiratory Infection

showing highest burden (42%) in Hill region rather than Terai while least burden was observed

in Mountain (22%) similar to Respiratory infections.

I-B3 Otitis Media Years of life lost shared by Otitis media among the total respiratory infection was found to be

minimum accounting for less than 1% of total YLL. Majority of burden of Otitis Media was

observed in Mid-Western region (63%) and Terai region (59%). Mortality due to Otitis Media

was not found in Eastern and Central development region as well as in hilly region.

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


0.0

26.5 20.7

46.4

6.4

22.0

42.3 35.6

0 10 20 30 40 50 60 70

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


0 0

20.3

62.8

16.9

41.2

0.0

58.8

Figure 3.3.22 Region wise distribution of total YLL due to Upper Respiratory Infection

Figure 3.3.23 Region wise distribution of total YLL due to Otitis Media


51

According to the age and sex distribution, burden was observed four times more among the

males than females. Likewise, the burden was highest (63%) in 0-14 age group.

Table 3.3.24. YLL distribution of Otitis media


Age group

Total YLL 0-14 15-29 60+

Development Region

Western

Male 0.0 0.0 100.0 100 124

Female 0.0 0.0 0.0 0 0

Total 0.0 0.0 100.0 100 124

Mid-Western

Male 100.0 0.0 0.0 100 384

Female 0.0 0.0 0.0 0 0

Total 100.0 0.0 0.0 100 384

Far-Western

Male 0.0 0.0 0.0 0 0

Female 0.0 100.0 0.0 100 103

Total 0.0 100.0 0.0 100 103

Ecological region

Mountain

Male 100.0 0.0 0.0 100 252

Female 0.0 0.0 0.0 0 0

Total 100.0 0.0 0.0 100 252

Terai

Male 51.6 0.0 48.4 100 256

Female 0.0 100.0 0.0 100 103

Total 36.8 28.7 34.5 100 359

National

Male 75.6 0.0 24.4 100 508

Female 0.0 100.0 0.0 100 103

Total 62.8 16.9 20.3 100 611

I.C. Maternal Conditions

Maternal mortality, which is a current issue of concern on the international health agenda,

remains one of the most important public health problems in developing countries. Nepal has

long suffered from one of the world’s worst levels of maternal mortality. Even though deaths due

to maternal conditions have decreased a lot, maternal mortality ratio is still high in Nepal.

Altogether 61296 YLL had been lost due to maternal conditions. The region wise distribution of

mortality burden due to maternal conditions shows that Central development region is the

highest contributor (29.8%) of the total YLL whereas Far-western development region comprises

the lowest percentage (10.3%) of the total figure. Similarly distribution of ecological region,


52

Terai area accounts the highest (46%) and the lowest percentage (12.3%) was found in mountain

region.

Maternal conditions are the least contributor for years of life lost due to Group I category sharing

only 5.8 percent of total YLL. The YLL distribution due to specific diseases under maternal

conditions is shown in the Table 3.3.25. Maternal haemorrhage and other maternal conditions are

the highest contributor for mortality due to maternal conditions having similar share 37.2% and

36.9% respectively. Likewise Obstructed labour and Hypertensive disorder of pregnancy

contribute almost similar burden 8.9 and 8.6 percentage respectively and the least count was

found in Abortion which is only 3.6%.

Comparing diseases among the eco-development region, haemorrhage is found to be highest in

hill region (68%) and Far-Western region (60%), much higher than national (37%). Likewise

sepsis is estimated to be three times higher in Western region (13%) than national (5%) and is

found solely in Terai region. Abortion is estimated to be highest in Hill (6.5%) and Central

region (9%), 2-3 times higher than national figures (3.6%).

Table 3.3.25. YLL distribution of Maternal Conditions

Maternal Conditions

Development Region Eco-Region Nation

al E C W MW FW M H T

Maternal Haemorrhage 37.8 33.6 29.9 40.3 60.3 67.9 31.3 34.3 37.2

Maternal Sepsis 3.1 0.0 13.2 2.3 1.6 0.0 0.0 10.0 4.6

Hypertensive disorder of

pregnancy 14.8 5.3 15.6 0.0 3.5 3.7 5.2 12.9 8.6

Obstructed labour 13.7 5.4 9.4 13.0 3.5 9.3 7.3 10.2 8.9

Abortion 1.3 9.2 0.0 1.1 4.8 3.2 6.5 1.1 3.6

Other maternal conditions 29.1 46.3 31.7 43.0 26.1 15.7 49.5 31.2 36.9

Total 100 100 100 100 100 100 100 100 100

Total YLL 9900 18281 16624 10203 6287 7562 25524 28210 61296

0.0 10.0

20.0 30.0 40.0 50.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i

Development Region Ecological Region

16.2

29.8 27.1

16.6 10.3 12.3

41.6 46.0

Figure 3.3.24.Region wise distribution of total YLL due Maternal Conditions


53

I-C1 Maternal Haemorrhage Maternal haemorrhage constituted about 37 percent of total YLL loss due to maternal conditions

which is the highest among the entire category. Maternal haemorrhage is significant causes of

morbidity and mortality among Nepalese women and remains a major public health problem in

developing countries with its very high prevalence. The total YLL lost due to maternal

haemorrhage is 22801 years. Region wise distribution shows that Central region is the highest

contributor (27%) of total YLL due to maternal haemorrhage followed by western (21.9%).

Likewise, among the ecological region, Terai region is responsible for maximum YLL (42.4%)

followed by Hill (35%) and Mountain (22.5%).

The mortality is found to be more or less similar to the both age group i.e. 49% and 50%

respectively. The age wise distribution of mortality shows that 15-29 age group holds highest

mortality than 30-59 age group for Mountain and Hilly region but Terai area shows 30-59 age

group contribute higher mortality than 15-29 age group. Likewise, Central and Western

development region holds almost double burden in 30-59 age group than 15-29 age group. The

pattern is reserved in case of Mid-western and Far-western region.

Table 3.3.26. YLL distribution of Maternal haemorrhage


Age Group

Total YLL 15-29 30-59

Development Region

Eastern 53.2 46.7 100 3742

Central 38.8 61.1 100 6159

Western 37.7 62.2 100 4984

Mid-Western 61.7 38.2 100 4121

Far-Western 67.0 32.9 100 3794

Ecological region

Mountain 54.6 45.3 100 5136

Hill 56.2 43.7 100 7989

Terai 41.9 58.1 100 9675

National 49.8 50.2 100 22801

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


16.4

27.0 21.9

18.1 16.6 22.5

35.0 42.4

Figure 3.3.25 Region wise distribution of total YLL due Maternal Haemorrhage


54

I-C2 Maternal Sepsis Maternal sepsis has been a common pregnancy-related condition. It is still prevalent in

developing countries and continues to present a significant risk of obstetric morbidity and

mortality to women in these regions. Maternal sepsis is estimated to constitute 4 percent of of the

total YLL lost due to maternal condtions.

Region wise distribution shows that Western region is the highest contributor (77.1%) of total

YLL due to maternal sepsis whereas Far-western region comprises the lowest percentage of the

total figure (3.6%). Among the ecological regions, all burden due to maternal sepsis is found in

Terai region only. Most of burden is estimated to be in 15-29 age group (88%). The age and sex

wise distribution for terai region is similar to the national figure. Among development regions,

Eastern, Mid-Western and Far-western region had total burden in age group 15-29 while Western

region had almost similar pattern like national distribution.

Table 3.3.27. YLL distribution of Maternal sepsis


Age Group

Total YLL 15-29 30-59

Development Region

Eastern 100.0 0.0 100 311

Western 84.6 15.3 100 2194

Mid-Western 100.0 0.0 100 238

Far-Western 100.0 0.0 100 103

Ecological region

Terai 88.1 11.8 100 2846

National 88.1 11.8 100 2846

I-C3 Hypertensive disorders of pregnancy

Hypertensive disorders are responsible for high maternal and perinatal mortality, especially in

developing countries. Hypertensive disorders of pregnancy are responsible for total 8% of YLL

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Eastern Central Western Mid-Western Far-Western

10.9

0.0

77.1

8.4 3.6

Development Region

Figure 3.3.26 Region wise distribution of total YLL due Maternal sepsis


55

lost i.e. 5275 years. The region wise distribution shows that Western region comprises the

highest mortality burden (49.4%) of total YLL due to hypertensive disorders of pregnancy

whereas Far-western region comprises the lowest percentage of the total figure (4.2%). Likewise,

among the ecological region, Terai region is responsible for maximum YLL (69.4%) followed by

Hill (25.2%) and Mountain (5.4%).

Age wise distribution shows that age group of 15-29 has higher burden (62%) than 30-59 (37%).

Region wise distribution is similar with national in case of Terai and western region while in

remaining region it is little different. Mountain and Far-western region had total burden in 15-29

age group while hill region had total burden in 30-59 age group. Likewise, Eastern and Central

region had higher burden in 30-59 age group.

Table 3.3.28. YLL distribution of Hypertensive disorders of pregnancy


Age Group

Total YLL 15-29 30-59

Development Region

Eastern 44.5 55.4 100 1469

Central 17.0 82.9 100 978

Western 87.1 12.8 100 2607

Far-Western 100.0 0.0 100 221

Ecological region

Mountain 100.0 0.0 100 286

Hill 0.0 100.0 100 1328

Terai 82.6 17.0 100 3661

National 62.8 37.1 100 5275

I-C4 Obstructed labour

Obstructed labour is an important cause of maternal deaths in communities. The total YLL lost

due to obstructed labor is 5465 years of life lost.

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

East

ern

Cen

tral

Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i

Development Region Ecological region

27.8 18.5

49.4

4.2 5.4

25.2

69.4

Figure 3.3.27 Region wise distribution of total YLL due to Hypertensive disorders of Pregnancy


56

The region wise distribution shows that Western region comprises the highest mortality burden

(28.7%) of total YLL due to obstructive labour followed by Eastern (24.8%) and Mid-western

(24.4%) whereas Far-western region comprises the lowest percentage of the total figure (4.2%).

Likewise, among the ecological region, Terai region is responsible for maximum YLL (52.9%)

followed by Hill (34.2%) and Mountain (12.9%). Among total YLL, age group of 15-29 years

accounts 85% and only 15 % for the age group of 30-59 years. Hill, Eastern and Mid-western

region had same pattern of age distribution while remaining regions had total burden in age

group 15-29 except mountain region where burden is higher in 30-59 age group (78%) than 15-

29 age group (22%).

Table 3.3.29.YLL distribution of Obstructed labour


Age Group

Total YLL 15-29 30-59

Development Region

Eastern 70.0 29.9 100 1357

Central 100.0 0.0 100 987

Western 100.0 0.0 100 1568

Mid-Western 68.9 31.0 100 1332

Far-Western 100.0 0.0 100 221

Ecological region

Mountain 22.2 77.7 100 705

Hill 85.5 14.4 100 1870

Terai 100.0 0.0 100 2890

National 85.0 15 100 5465

I-C5 Abortion

Worldwide millions of maternal deaths are attributable to unsafe abortions. However, years of

life lost by Abortion among the total maternal conditions was found to be negligible accounting

for less than 3% of total YLL. The total YLL lost due to abortion is 2240 years.

0.0

10.0

20.0

30.0

40.0

50.0

60.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


24.8 18.1

28.7 24.4

4.0 12.9

34.2

52.9

Figure 3.3.28 Region wise distribution of total YLL due to obstructed labour


57

The region wise distribution shows that Central region covers the highest mortality burden (75%)

of total YLL due to Abortion whereas Mid-western region comprises the lowest percentage of

the total figure (5.3%). Likewise, among the ecological region, Hill region is responsible for

maximum YLL (75%) followed by Terai (14%) and Mountain (10.9%). The mortality burden

was found to be more or less similar to the both age group i.e.58% and 41% respectively. Region

wise distribution shows similar age distribution like that of national in Hill, Central and Far-

Western region while total burden in Terai and Mid-Western region was in 15-29 age group and

that in Eastern and Mountain region was just opposite.

Table 3.3.30. YLL distribution of Abortion


Age Group

Total YLL 15-29 30-59

Development Region

Eastern 0.0 100.0 100 134

Central 59.7 40.2 100 1681

Mid-Western 100.0 0.0 100 119

Far-Western 64.0 35.9 100 306

Eco-Region

Mountain 0.0 100.0 100 244

Hill 59.7 40.2 100 1681

Terai 100.0 0.0 100 314

National 58.8 41.1 100 2240

I-C6 Other Maternal Conditions Maternal mortality rate in Nepal is getting more alarming every year. Here the total YLL

responsible for other maternal conditions is 22668 years of life lostwhich is about 36% of the

total YLL lost due to maternal conditions.

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


6.0

75.0

0.0 5.3

13.7 10.9

75.0

14.0

Figure 3.3.29.Region wise distribution of total YLL due to Abortion


58

The region wise distribution shows that Central region holds the highest mortality burden

(37.4%) of total YLL due to other maternal conditions whereas Far-western region comprises the

lowest percentage of the total figure (7.2%). Likewise, among the ecological region, Hill region

is responsible for maximum YLL (55.8%) followed by Terai (38.9%) and Mountain (5.2%). Age

wise distribution shows higher burden in age group 15-29 (60.5%) than 30-59 (39.5%). Similar

pattern is observed in all regions higher in age group 15-29 than 30-59.

Table 3.3.31. YLL distribution of Other maternal conditions


Total YLL 15-29 30-59

Development Region

Eastern 59.9 40.0 100 2888

Central 57.1 42.8 100 8475

Western 65.7 34.2 100 5269

Mid-Western 61.9 38.1 100 4394

Far-Western 58.1 41.9 100 1642

Ecological region

Mountain 86.8 13.1 100 1190

Hill 57.8 42.1 100 12657

Terai 60.7 39.2 100 8822

National 60.5 39.4 100 22668

I-D Neonatal Conditions

Altogether 291336 YLL had been lost due to neonatal conditions which are responsible for 28%

of total YLL due to Group I category. The region wise distribution of mortality burden due to

Nutritional deficiencies shows that Far-western development region is the highest contributor

(24.5%) of the total YLL whereas Eastern development region comprises the lowest percentage

of the total figure (11.4%). Similarly distribution of ecological region, Terai area accounts the

highest (39.1%) and the lowest percentage was found in mountain region (27.7%).

0.0

10.0

20.0

30.0

40.0

50.0

60.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


12.7

37.4

23.2 19.4

7.2 5.2

55.8

38.9

Figure 3.3.30 Region wise distribution of total YLL due to other maternal conditions


59

The YLL distribution due to Low birth weight, Birth asphyxia and birth trauma, and Other

perinatal conditions is shown in the Table 3.3.32. As shown in the table Low birth weight

comprises the least count for the mortality burden due to neonatal conditions which is only 4.9%.

Likewise birth asphyxia and birth trauma comprises 28.3% and the highest count was of other

perinatal conditions which is 66.7%. Region wise distribution of YLL among the diseases under

Neonatal conditions is also similar to national, however percentage share is little different. Share

of other perinatal conditions in mountain region (59.9%) is lower than national share (66.7%)

while remaining ecological regions has similar share. Likewise share of other perinatal

conditions among the development regions is higher in Far-Western (71%) and Eastern (79%)

than national. However, its share is lower in Western and similar in remaining two regions.

Table 3.3.32. YLL distribution of Neonatal Conditions

Neonatal Conditions Development Region Eco-Region


Low birth weight 1.1 2.1 5.6 7.0 9.3 7.9 7.9 2.7 4.9

Birth asphyxia and birth

trauma 19.9 32.9 36.9 24.4 19.3 32.0 24.5 29.5 28.3

Other perinatal

conditions 78.9 64.9 57.3 68.4 71.4 59.9 67.5 67.6 66.7

Total 100 100 100 100 100 100 100 100 100

Total YLL 46658 72152 78855 44012 49658 32079 86872 172385 291336

I-D1 Low Birth Weight

Birth weight is closely associated with the health and survival of infants in the developing world.

Deficiencies in micronutrients are common in women in developing countries and have been

associated with low birth weight and preterm delivery. Years of life lost shared by Low birth

weight among the total neonatal conditions was found to be only 4% of total YLL i.e. 14264

0.0

10.0

20.0

30.0

40.0

50.0

60.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


16.0 24.8 27.1

15.1 17.0 11.0

29.8

59.2

Figure 3.3.31 Region wise distribution of total YLL due to Neonatal Conditions


60

YLL. The region wise distribution shows that Far-western region comprises the highest mortality

burden (32.4%) of total YLL due to Low birth weight followed by Western region (31.3%) and

Eastern region accounts the lowest percentage of the total figure (3.7%). Likewise, among the

ecological region, Hill region is responsible for maximum YLL (48.3%) followed by Terai

(33.7%) and Mountain (18%).

The mortality is found to be more or less similar between male and female group i.e. 52 and 47%

of total years of life lost respectively. In hilly region, male population holds twice mortality

burden than female population while this pattern is just reversed in Mountain region. In Terai

region male contributes 40% and female 59% of mortality burden. All the development regions

had similar burden as that of national except Eastern region in which burden is higher in female

(76%) than in male (23%).

Table 3.3.33. YLL distribution of Low birth weight

Background characteristics

Sex

Total YLL Male Female

Development Region

Eastern 23.5 76.4 100 521

Central 59.5 40.5 100 1543

Western 58.5 41.5 100 4471

Mid-Western 56.2 43.8 100 3113

Far-Western 52.1 47.8 100 4616

Ecological Region

Mountain 33.7 66.2 100 2561

Hill 66.8 33.2 100 6894

Terai 40.9 59.0 100 4809

National 52.1 47.8 100 14264

0.0

20.0

40.0

60.0 Ea

ster

n

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


3.7 10.8

31.3 21.8

32.4

18.0

48.3

33.7

Figure 3.3.32 Region wise distribution of total YLL due to Low Birth Weight


61

I-D2 Birth asphyxia and birth trauma

Birth asphyxia is recognized as an important cause of neonatal morbidity and mortality. Birth

asphyxia and birth trauma are responsible for 28% of total YLL due to neonatal conditions i.e.

82531 years of life lost, among which the mortality for male population is found to be double of

female population.

The region wise distribution shows that Western region comprises the highest mortality burden

(35.3%) of total YLL due to Birth asphyxia and birth trauma whereas Eastern region accounts

the lowest percentage of the total figure (11.2%). Likewise, among the ecological region, Terai

region is responsible for maximum YLL (61.7%) whereas Mountain region holds the lowest of

the total figure (12.5%).

The region wise sex distribution for YLL shows that male population is responsible for double

mortality burden than female population. Distributing total years of life lost among ecological

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


11.2

28.8 35.3

13.0 11.6 12.5

25.8

61.7

Table 3.3.34. YLL distribution of Birth asphyxia and birth trauma


Sex


Development Region

Eastern 76.8 23.1 100 9283

Central 80.0 19.9 100 23757

Western 57.1 42.8 100 29145

Mid-Western 57.8 42.1 100 10760

Far-Western 66.9 33.0 100 9586

Ecological Region

Mountain 64.9 35.0 100 10279

Hill 75.4 24.5 100 21319

Terai 64.1 35.8 100 50933

National 67.2 32.8 100 82531

Figure 3.3.33 Region wise distribution of total YLL due to Birth asphyxia and birth trauma


62

region, male population was responsible for double mortality burden than female population in

Terai and Mountain region while Hill region had little higher percent share of males (75.5%)

than Females (24.5%). Likewise in Central region, male population accounts four times higher

mortality burden than female population and in Eastern region it is three times higher. Likewise

Far western region had double the mortality burden in male than female population. However,

remaining two regions had almost similar burden in both sexes.

I.D.3 Other Perinatal conditions

Perinatal mortality rate is high in Nepal. Hypothermia, neonatal sepsis, drug reaction during

perinatal period etc were categorized under other perinatal conditions. The total YLL lost due to

cause related to other perinatal conditions accounts the highest percentage (66%) among the

neonatal conditions i.e. 194539 years, among which male and female lost 55 and 44% of the total

YLL respectively. The region wise distribution shows that Central region is the highest

contributor for the mortality burden (24.1%) of total YLL due to other perinatal conditions

followed by Western region(23.3%) and Mid-Western region accounts the lowest percentage of

the total figure (15.5%). Likewise, among the ecological region, Terai region is responsible for

maximum YLL (60%) followed by Hill (30.2%) and Mountain (9.9%).

The region wise sex distribution for YLL shows that male population is responsible for little

higher mortality burden (55.1%) than female population (44.9%). Age wise distribution among

the regions was also similar to that of national distribution with males having higher burden than

females.

0.0

10.0

20.0

30.0

40.0

50.0

60.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


18.9 24.1 23.3

15.5 18.2 9.9

30.2

60.0

Figure 3.3.34 Region wise distribution of total YLL due to Other perinatal conditions


63

Table 3.3.35. YLL distribution of Other perinatal conditions

Background characteristics Sex


Development Region

Eastern 63.5 36.4 100 36854

Central 52.8 47.2 100 46853

Western 50.4 49.5 100 45238

Mid-Western 50.5 49.4 100 30139

Far-Western 59.3 40.6 100 35455

Ecological Region

Mountain 60.1 39.8 100 19238

Hill 57.3 42.6 100 58659

Terai 53.2 46.7 100 116642

National 55.1 44.8 100 194539

I.E. Nutritional Deficiencies

Altogether 36248 YLL had been lost due to neonatal conditions which accounts for 28% of total

YLL due to Group I category. The region wise distribution of mortality burden due to Nutritional

deficiencies shows that Far-western development region is the highest contributor (24.5%) of the

total YLL whereas Eastern development region comprises the lowest percentage of the total

figure (11.4%). Similarly distribution of ecological region, Terai area accounts the highest

(39.1%) and the lowest percentage was found in mountain region (27.7%).

The YLL distribution due to Protein-Energy malnutrition (PEM), Iron-deficiency anaemia (IDA)

and other nutritional disorders is shown in the Table 3.3.36. As given in the table below PEM is

the highest contributor for the mortality burden due to nutritional deficiencies i.e. 92.7%

followed by IDA which holds 6.9% and the least count were found for the category of other

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0

East

ern

Cen

tral

Wes

tern

Mid

-wes

tern

Far-

wes

tern

Mo

un

tain

Hill

Tera

i


11.4

21.3 23.5 19.3

24.5 27.7

33.2 39.1

Figure 3.3.35 Region wise distribution of total YLL due to Nutritional deficiencies


64

nutritional disorders which lists only 0.3%. Region wise distribution of YLL among the disease

categories is almost similar to national however percent share is little different across the

regions. Among the regions, burden of PEM was found to be much higher in Mountain region

(99.2%) and Far-Western region (97.9%) than national (92.7%) while Terai and Mid-Western

region had similar share (93%) as that of national. Likewise, Hill, Central and Western region

had little lower share (86%) of PEM than national. Particularly in Eastern region, total burden

due to nutritional deficiencies was contributed by PEM. Burden of IDA was found to be two

times higher in Hill, Central and Western region than national (6.9%).

Table 3.3.36. YLL distribution of Nutritional Deficiencies

Nutritional Deficiencies Development Region Eco-Region


Protein-energy malnutrition 100.0 87.10 87.7 93.9 97.9 99.2 86.1 93.6 92.7

Iron-deficiency anaemia 0.0 12.9 12.2 5.3 1.0 0.7 13.8 5.3 6.9

Other nutritional disorders 0.0 0.0 0.0 0.7 1.0 0.0 0.0 1.0 0.3

Total 100 100 100 100 100 100 100 100 100

Total YLL 4143 7714 8501 7000 8890 10027 12051 14170 36248

I-E1 Protein-Energy Malnutrition Malnutrition in Nepal is one of the major problems that people have been facing since a long

time. Nepal has made large strides in reducing other nutritional deficiencies; however PEM

remains at a high prevalence. PEM was the major cause of mortality among the total nutritional

deficiencies comprising approximately 92 percent (33603 YLL) of total YLL.

The region wise distribution of mortality burden due to PEM shows that Far-western

development region was the highest contributor (25.9%) of the total YLL whereas Eastern region

comprised the lowest percentage of the total figure (12.3%). Similarly distribution of ecological

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


12.3

20.0 22.2 19.6 25.9

29.6 30.9

39.5

Figure 3.3.36 Region wise distribution of total YLL due to Protein Energy Malnutrition


65

region, Terai area accounted the highest (39.5%) followed by Hill (30.9%) and Mountain

(29.6%).

Table 3.3.37. YLL distribution of Protein-energy malnutrition


Age Group

Total YLL 0-14 30-59 60+

Development Region

Eastern

Male 100.0 0.0 0.0 100 2540

Female 100.0 0.0 0.0 100 1603

Total 100.0 0.0 0.0 100 4143

Central

Male 100.0 0.0 0.0 100 1793

Female 96.8 3.1 0.0 100 4927

Total 97.7 2.2 0.0 100 6720

Western

Male 100.0 0.0 0.0 100 3389

Female 100.0 0.0 0.0 100 4069

Total 100.0 0.0 0.0 100 7458

Mid-Western

Male 99.3 0.0 0.6 100 3500

Female 100.0 0.0 100 3073

Total 99.6 0.0 0.3 100 6573

Far-Western

Male 95.1 0.0 4.8 100 3089

Female 96.8 0.0 3.1 100 5621

Total 96.2 0.0 3.7 100 8710

Ecological region

Mountain

Male 100.0 0.0 0.0 100 5125

Female 96.8 3.1 0.0 100 4829

Total 98.4 1.5 0.0 100 9954

Hill

Male 100.0 0.0 0.00 100 5154

Female 97.7 0.0 2.3 100 5225

Total 98.8 0.0 1.1 100 10379

Terai

Male 95.6 0.0 4.3 100 4033

Female 99.3 0.0 0.6 100 9238

Total 98.2 0.0 1.7 100 13271

National

Male 98.7 0.0 1.2 100 14311

Female 98.2 0.8 0.9 100 19292

Total 98.4 0.4 1.0 100 33603

According to the table 3.3.37, most of the total YLL lost due to PEM was estimated to be in age

group of 0-14 age group (98%). The mortality burden in female population (19292 YLL) was

greater than male (14311 YLL). Age wise distribution of YLL among all the regions was similar

to national distribution. Particularly in Eastern and Western region, total burden was in age group


66

0-14. Likewise sex wise distribution among the regions showed higher burden in females like

national except in Eastern, Mid-Western and Mountain regions where the burden was higher in

males.

I-E2 Iron-deficiency anaemia Anaemia is a significant major nutritional problem among the women and children of Nepal. The

total YLL lost due to Iron-deficiency Anaemia is about 6% of the entire category i.e. 2506 years.

The region wise distribution of mortality burden due to IDA shows that Western development

region is the highest contributor (41.6%) of the total YLL whereas Far-western region comprises

the lowest percentage of the total figure (3.7%). Similarly distribution of ecological region, Hill

area accounts the highest (66.8%) and the lowest percentage was found in mountain region (3%).

Table 3.3.38 shows that total YLL is two times higher in 30-59 age group (67%) than 60+ age

group (33%). Mortality burden was higher in 30-59 age group than 60+ age group in Hill,

Western and Central region while Terai region had all burden cumulated in 30-59 age group

only. Remaining regions had negligible burden which were all concentrated in single age group;

30-59 age group in Far-Western and 60+ in Mountain and Mid –western region.

Likewise, sex wise distribution of total YLL shows two times higher burden in females than

males. Similar pattern was observed in all regions, however, the ratio was little different 12 and 7

times higher burden in females than males in Central and Terai region respectively.

Table 3.3.38. YLL distribution of Iron-deficiency anaemia

Background Characteristics Age Group Total YLL

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


0.0

39.7 41.6

15.0 3.7 3.0

66.8

30.3

Figure 3.3.37 Region wise distribution of total YLL due to Iron-deficiency anaemia


67

30-59 60+

Development Region

Central

Male 0.0 100.0 100 74

Female 100.0 0.0 100 922

Total 92.5 7.4 100 996

Western

Male 0.0 100.0 100 376

Female 100.0 0.0 100 667

Total 63.9 36.0 100 1042

Mid-Western

Male 0.0 100.0 100 376

Total 0.0 100.0 100 376

Far-Western

Male 100.0 0.00 100 92

Total 100.0 0.00 100 92

Ecological region

Mountain

Male 0.00 100.0 100 74

Total 0.00 100.0 100 74

Hill

Male 0.0 100.0 100 751

Female 100.0 0.0 100 922

Total 55.1 44.8 100 1673

Terai

Male 100.0 0.0 100 92

Female 100.0 0.0 100 667

Total 100.0 0.0 100 759

National

Male 10.0 89.9 100 917

Female 100.0 0.0 100 1589

Total 67.0 32.9 100 2506

I-E3 Other nutritional disorders

Nutrition is an important determinant of immunological status; and under nutrition can impair

immuno competence and increase susceptibility and vulnerability to infections. Years of life lost

shared by other nutritional disorders among theutritionasssssssssssss jfaftotal nutritional

defiencies was found to be negligible accounting for less than 1% of total YLL. The total YLL

lost due to cause related to other nutritional disorders is 142 years, among which females had

higher burden than males. Burden was observed in Terai region only. Likewise, age group of 30-

59 accounted most of the YLL (64%).

Table 3.3.39.YLL distribution of Other nutritional disorders


Age Group

Total YLL 30-59 60+


68

Development Region

Mid-Western

Male 0.0 100.0 100 24

Female 0.0 100.0 100 27

Total 0.0 100.0 100 51

Far-Western

Female 100.0 0.0 100 91

Total 100.0 0.0 100 91

Ecological region

Terai

Male 0.0 100.0 100. 24

Female 77.1 22.8 100 118

Total 64.0 35.9 100 142

National

Male 0.0 100.0 100 24

Female 77.1 22.8 100 118

Total 64.0 35.9 100 142


69

3.4 Group II: Non-Communicable Diseases

Most of the developing countries like Nepal are suffering gravely from double burden of disease

i.e. of communicable as well as non-communicable diseases. The group-II, non-communicable

diseases share significant portion of mortality burden in Nepal. It was the second largest group

accounting 36.1 percent (830668 years of life lost) of total burden of mortality throughout the

country. The group-II YLL distribution was observed highest (49.4%) in terai and lowest (11%)

in mountain region of Nepal. The development region wise distribution of YLL showed highest

by central and western development region contributing 27.4 percent each and lowest by far-

western development region of Nepal.

The National Burden of Disease Manual 2000 classifies non-communicable disease into 14 sub

groups. Mortality due to all sub-groups is present in this study except the "oral conditions".

Table 3.4.1 shows the YLL distribution of non-communicable diseases according to its

subgroups. More than 60 percent of mortality burden in this category were accounted by

cardiovascular, respiratory and digestives diseases only. Respiratory disease was the leading

cause to contribute 32.5 percent of total years of life lost of this group and least (0.2 percent) was

contributed by endocrine disorders nationally. Similar to the national, ecological distribution also

shows respiratory disease to contribute highest share 39.2, 35, 29.1 percent in mountain, hill and

terai respectively and endocrine disorders contributed lowest percent in mountain and terai

region sharing 0.3 percent each. In hill region lowest contribution was observed due to skin

diseases (0.1 percent) while endocrine disorders and sense organ diseases did not accounted any

percent among non-communicable diseases. The ecological region wise distribution also shows

Figure: 3.4.1 Percentage YLL distribution due to Non-Communicable diseases


70

the similar sharing highest was contributed by respiratory diseases and endocrine disorders

contributed lowest percent in mid (0.2%) and far western (0.1%) development region. In

western and central development region skin diseases contributed least 0.3 percent and 0.1

percent respectively while in eastern development region sense organ diseases shared least

percent i.e. 0.3 percent among the non communicable diseases.

E C W MW FW M H T

1 Malignant neoplasms 8.7 8.4 7.5 7.1 6.7 5.5 8.7 7.8 7.9

2 Other neoplasms 5.9 5.4 2.8 4.2 3.6 2.4 3.6 5.7 4.5

3 Diabetes mellitus 2.9 3.0 3.5 2.6 0.8 0.5 2.8 3.3 2.8

4 Endocrine disorders 0.0 0.4 0.0 0.2 0.1 0.3 0.0 0.3 0.2

5 Neuropsychiatric disorders 11.0 5.9 8.1 6.0 6.3 5.1 7.2 8.5 7.6

6 Sense organ diseases 0.3 0.4 0.0 0.0 0.8 0.7 0.0 0.4 0.3

7 Cardiovascular diseases 19.9 21.6 17.7 18.4 15.3 18.4 20.0 18.6 19.2

8 Respiratory diseases 27.9 31.5 34.9 37.2 31.8 39.2 35.0 29.1 32.5

9 Digestive diseases 12.3 10.7 15.0 11.1 18.5 12.5 10.9 14.4 12.8

10 Genito-urinary diseases 6.8 10.6 7.0 9.4 10.0 10.8 8.8 8.1 8.6

11 Skin diseases 0.7 0.1 0.3 0.3 0.8 0.7 0.1 0.5 0.4

12 Musculoskeletal diseases 0.3 1.0 0.9 0.9 0.4 0.5 0.8 0.8 0.8

13 Congenital anomalies 1.9 1.0 1.9 1.8 4.9 3.0 1.5 2.1 1.9

14 Blood Disorder 1.4 0.0 0.4 0.8 0.0 0.4 0.6 0.5 0.6

Total 100 100 100 100 100 100 100 100 100

Total YLL 184881 227460 192535 147647 78145 91619 329099 409950 830668

Development Region Eco-RegionS.N.

Non-Communicable

DiseasesNational

Table 3.4.1: Percentage YLL distribution of Non Communicable diseases


71

Among the non-communicable diseases COPD was the leading cause of YLL contributing 31.7

percent nationally. Cerbrovascular diseases followed it by sharing 8.3 percent out of total.

Ischemic heart disease, hypertensive heart disease were the following cause of YLL contributing

3.7 and 3.2 percent respectively. Similarly Diabetes mellitus was observed at the top fifth rank

sharing 2.8 percent of YLL among the non communicable diseases. Colon and rectum cancer

was at the twentieth position among of this category contributing only 0.3 percent of YLL.

Table 3.4.2: Top 20 causes of YLL due to sub categories of Non-communicable diseases


1 COPD 263734 31.750

2 Cerebrovascular disease 69750 8.397

3 Ischaemic heart disease 31028 3.735

4 Hypertensive heart disease 27133 3.266

5 Diabetes mellitus 23308 2.806

6 Epilepsy 20790 2.503

7 Peptic ulcer disease 15913 1.916

8 Stomach cancer 15574 1.875

9 Trachea, bronchus and lung cancers 15099 1.818

10 Cervix uteri cancer 14849 1.788

11 Alcohol use disorders 14525 1.749

12 Cirrhosis of the liver 13200 1.589

13 Mouth and oropharynx cancers 10348 1.246

14 Unclassified Congenital Anomalies 6332 0.762

15 Nephritis and nephrosis 5599 0.674

16 Blood disorder 4621 0.556

17 Liver cancer 3321 0.400

18 Skin diseases 3097 0.373

19 Asthma 3085 0.371

20 Colon and rectum cancers 2794 0.336

II-A Malignant neoplasms

Cancer is a worldwide public health problem and it accounts for an increasing proportion of all

premature deaths. Malignant diseases are the second most frequent cause of death in developed

countries after cardiovascular disease while in developing countries, it accounts significant

portion of premature mortality. This study revealed that malignant neoplasm holds fifth rank

among causes of deaths due to non-communicable diseases. Altogether 65370 years of life lost

had been reported by malignant neoplasms. The YLL contribution due to malignant neoplasm

was observed highest (76 %) in Terai region of Nepal. Both mountain and hill region contributed

equal percentage (12 %) of remaining YLL due to malignant neoplasms. Similarly, the


72

development wise distribution showed majority of YLL (46 %) shared by central development

region and the least YLL (13%) was observed in far-western development region.

Among the malignant neoplasms, more than 20 percent of YLL was contributed by stomach

cancer, trachea, bronchus and lung cancer and cancer of cervix. Least percent was shared by

leukemia among malignant neoplasms category. The ecological distribution shows, stomach

cancer to contribute highest share (30.4 %) and lowest share (2.8 percent) by bladder cancer in

mountain region. In hill trachea, bronchus and lung cancer (36.3 %) was the leading cause of

YLL and lowest share was contributed by oesophagus cancer.

Similarly in terai region cervix cancer was the leading cause (31.9 percent) of YLL and least

E C W MW FW M H T

1 Mouth and oropharynx cancers 21.5 15.0 12.2 13.1 16.8 19.0 17.5 13.8 15.8

2 Cervix cancer 18.3 25.6 27.9 17.8 21.7 8.3 15.0 31.9 22.7

3 Bladder cancer 0.0 2.1 0.0 0.0 1.3 2.8 0.0 1.0 0.7

4 Leukaemia 0.0 0.0 2.3 0.0 0.0 0.0 0.0 1.0 0.5

5 Other malignant neoplasms 2.2 0.0 0.0 2.0 3.6 4.1 0.0 1.7 1.1

6 Oesophagus cancer 1.0 0.0 0.0 0.0 4.7 0.0 0.9 0.5 0.6

7 Stomach cancer 23.1 26.9 22.6 22.1 21.9 30.4 20.7 25.6 23.8

8 Colon and rectum cancers 3.8 4.0 1.9 4.1 13.6 17.3 2.0 4.2 4.3

9 Liver cancer 9.7 4.2 3.9 1.7 4.3 0.0 7.6 3.6 5.1

10 Trachea, bronchus and lung cancers 17.7 18.9 27.4 39.3 10.7 10.0 36.3 13.3 23.1

11 Breast cancer 2.7 3.4 1.9 0.0 1.5 8.0 0.0 3.2 2.2

Total 100 100 100 100 100 100 100 100 100

Total YLL 16049 19161 14348 10545 5266 5042 28479 31849 65370

Development Region Eco-RegionMalignant neoplasms CategoriesS.N. National

Table 3.4.3: Percentage YLL distribution due to Malignant neoplasm categories

Figure 3.4.2: Percentage YLL distribution due to Malignant neoplasm categories


73

percent was contributed by oesophagus cancer (0.5 percent). Stomach cancer was found

contributing higher share of YLL in each development region except in western development

region where cervix cancer was observed to be the leading cause of YLL. Bladder cancer

contributed least percent in far-western and central development region, Colon and rectum and

breast cancer shared equal 1.9 % in western region. least contribution was observed by liver

cancer (1.7%) and oesophagus cancer (1%) in mid-western and eastern development region

respectively.

II-A1 Mouth and oropharynx

Mouth and oropharynx cancer is a common public health problem in Nepal. Altogether 10348

years of life lost had been contributed due to mouth and oropharynx cancer. The ecological

distribution of mouth and oropharynx cancer was observed highest in hill (48.2 percent) and

lowest in mountain (9.3 percent). Similarly the development wise distribution shows highest

(33.4%) in eastern development and lowest (8.6%) in far-western development region.

The sex wise distribution of mouth and oropharynx cancer shows YLL shared by males is 1.5

times more than the females and highest YLL was contributed by elderly (60+) age group i.e.

52.3 percent nationally. Although about 7.7 percent of males of very young age i.e. 0-14 years

were also observed to be affected by mouth and oropharynx cancer. Ecological distribution of

mouth and oropharynx cancer was observed 3 times more in males than females in terai, 1.5

times more than females in mountain but found almost equal in hill region of Nepal. Similarly,

the development region wise distribution shows male YLL to be more in all the development

regions except in western and mid western development regions where females YLL was

observed to be more than males. At the same time around half of the years of life lost in western

region were contributed by the age group 0-14 years.

Figure 3.4.3: Percentage YLL distribution of Mouth and Oropharynx Cancer


74

Table 3.4.4: YLL distribution of Mouth and oropharynx cancers


Age Group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 0.0 0.0 43.3 56.7 100 1992

Female 0.0 21.3 56.6 22.1 100 1461

Total 0.0 9.0 48.9 42.1 100 3453

Central

Male 0.0 0.0 56.9 43.1 100 2568

Female 0.0 55.8 44.2 0.0 100 312

Total 0.0 6.0 55.5 38.4 100 2880

Western

Male 49.2 0.0 0.0 50.8 100 740

Female 0.0 0.0 0.0 100.0 100 1007

Total 20.8 0.0 0.0 79.2 100 1747

Mid-Western

Male 0.0 0.0 0.0 100.0 100 376

Female 0.0 0.0 0.0 100.0 100 1007

Total 0.0 0.0 0.0 100.0 100 1383

Far-Western

Male 18.6 34.0 35.0 12.4 100 662

Female 0.0 0.0 100.0 0.0 100 223

Total 13.9 25.4 51.4 9.3 100 885

Eco-region

Mountain

Male 21.5 0.0 0.0 78.5 100 573

Female 0.0 45.1 35.8 19.2 100 386

Total 12.8 18.1 14.4 54.6 100 959

Hill

Male 0.0 9.0 53.5 37.5 100 2501

Female 0.0 0.0 15.7 84.3 100 2483

Total 0.0 4.5 34.7 60.8 100 4984

Terai

Male 11.2 0.0 37.3 51.6 100 3263

Female 0.0 27.3 58.0 14.7 100 1140

Total 8.3 7.1 42.6 42.0 100 4403

National

Male 7.7 3.6 40.3 48.4 100 6337

Female 0.0 12.1 29.6 58.3 100 4011

Total 4.7 6.9 36.2 52.3 100 10348

II-A2 Oesophagus Cancer The majority of oesophagus cancer cases are diagnosed in developing countries where it is the

fourth most common cancer in men. This study revealed that oesophagus cancer lies among the


75

top ten malignant cancers in Nepal. Oesophagus cancer was observed contributing 413 years of

life lost which was 0.6 percent among the malignant cancers. The cancer was observed only in

hill and terai region of Nepal and among which highest was accounted by hill region (59.3%)

Similarly development region-wise distribution also showed the YLL contribution from only two

regions i.e. eastern and far-western development regions and among them highest percent

(59.3%) of oesophagus cancer was observed in far-western development region.

Table 3.4.5: YLL distribution of Oesophagus cancer



Development Region

Eastern 0.0 100.0 100 168

Far-Western 51.0 49.0 100 245

Eco-region

Hill 51.0 49.0 100 245

Terai 0.0 100.0 100 168

National 30.3 69.7 100 413

The following table 3.4.4 shows the age-sex wise YLL distribution of oesophagus cancer. The

cancer was entirely reported from the elderly males and females group. Majority of the cancer

was observed among elderly female group. YLL due to oesophagus cancer in Eastern

development and terai region was receorded among females group only.

II-A3 Stomach Cancer Stomach cancer is one of the common types of cancer among males in the developing countries.

Usually lung cancer is the most frequent and is followed by stomach cancer. This study showed

stomach cancer as the leading cause of years of life lost contributing 23.8 percent among

malignant neoplasms which was about 15573 years of life lost in a whole. This cancer was

distributed in all development as well as ecological regions of Nepal.

Figure 3.4.4: Percentage YLL distribution due to Stomach Cancer


76

The ecological distribution of stomach cancer was observed highest in terai (52.3) and lowest in

mountain (9.9%). Similarly the development wise distribution shows highest (33.1%) in central

development and lowest (7.4%) in far-western development region.

Table 3.4.6: YLL distribution of Stomach cancer


Age Group

Total YLL 15-29 30-59 60+

Development Region

Eastern

Male 0.0 52.8 47.2 100 1034

Female 0.0 57.6 42.4 100 2669

Total 0.0 56.3 43.7 100 3703

Central

Male 0.0 60.1 39.9 100 1672

Female 0.0 78.7 21.3 100 3478

Total 0.0 72.7 27.3 100 5150

Western

Male 0.0 22.1 77.9 100 1247

Female 0.0 44.0 56.0 100 1994

Total 0.0 35.6 64.4 100 3241

Mid-Western

Male 0.0 20.2 79.8 100 1279

Female 0.0 8.2 91.8 100 1047

Total 0.0 14.8 85.2 100 2326

Far-Western

Male 0.0 60.2 39.8 100 550

Female 31.7 51.6 16.7 100 605

Total 16.6 55.7 27.7 100 1155

Eco-region

Mountain

Male 0.0 26.1 73.9 100 1037

Female 0.0 71.0 29.0 100 497

Total 0.0 40.7 59.3 100 1534

Hill

Male 0.0 7.4 92.6 100 2190

Female 0.0 33.2 66.8 100 3706

Total 0.0 23.6 76.4 100 5896

Terai

Male 0.0 77.7 22.3 100 2556

Female 3.4 71.0 25.6 100 5588

Total 2.4 73.1 24.5 100 8144

National

Male 0.0 41.8 58.2 100 5783

Female 2.0 56.7 41.4 100 9790

Total 1.2 51.2 47.6 100 15573


77

The following table 3.4.5 shows total years of life lost distribution due to stomach cancer.

Altogether 15573 YLL was lost due to stomach cancer. The sex wise distribution shows females

reporting two times more years of life lost burden than males nationally. In all eco-development

regions females group accounted more YLL than males except in mid-western and mountain

region of Nepal. The YLL distribution was observed only after the age of 15 years and only in

terai and far western regions it was observed in the age group 15-29. About more than 90 percent

of years of life lost was recorded in the age group above thirty years.

II-A4 Colon and rectum Cancer Colon and rectal cancer is sixth leading cause contributing 4.3 percent of total years of life lost

due to malignant neoplasms.

Occurrence of colon and rectal cancer was distributed in all development and ecological regions.

The ecological distribution of colon and rectum cancer was observed highest in terai (27.3%) and

lowest in hill (20.6%) regions of Nepal. Similarly the development wise distribution shows

highest (33.1%) in central and lowest (9.6%) in western development region.

Majority of colon and rectal cancer was observed in elderly population (45.3%) which was

followed by 30-59 years of age group accounting 31.6 percent. Similarly, 0-14 years and 15-29

years of age group contributed 11.8 and 11.3 percent YLL respectively. In all the eco-

development regions males were observed to contribute higher YLL except in mid-western

development region where entire burden was contributed by females group.

Figure 3.4.5: Percentage YLL distribution due to Colon and rectum Cancer


78

Table 3.4.7: YLL distribution of Colon and rectum cancers

Background characteristics Age Group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 100.0 0.0 0.0 0.0 100 329

Female 0.0 0.0 0.0 100.0 100 285

Total 53.6 0.0 0.0 46.4 100 614

Central

Male 0.0 0.0 25.3 74.7 100 581

Female 0.0 0.0 0.0 100.0 100 183

Total 0.0 0.0 19.3 80.7 100 764

Western

Male 0.0 0.0 100.0 0.0 100 236

Female 0.0 0.0 100.0 0.0 100 32

Total 0.0 0.0 100.0 0.0 100 268

Mid-Western

Female 0.0 0.0 61.9 38.1 100 431

Total 0.0 0.0 61.9 38.1 100 431

Far-Western

Male 0.0 20.4 39.8 39.8 100 505

Female 0.0 100.0 0.0 0.0 100 213

Total 0.0 43.9 28.0 28.0 100 718

Eco-region

Mountain

Male 69.1 0.0 30.9 100 477

Female 0.0 0.0 53.8 46.2 100 398

Total 37.6 0.0 41.3 21.1 100 875

Hill

Male 0.0 0.0 55.2 44.8 100 364

Female 0.0 100.0 0.0 0.0 100 213

Total 0.0 36.8 34.9 28.3 100 577

Terai

Male 0.0 12.7 29.1 58.1 100 810

Female 0.0 0.0 16.1 83.9 100 533

Total 0.0 7.7 24.0 68.4 100 1343

National

Male 19.9 6.2 35.4 38.5 100 1651

Female 0.0 18.5 26.2 55.2 100 1144

Total 11.8 11.3 31.6 45.3 100 2795


79

II-A5 Liver Cancer Liver cancer, also called hepatocellular carcinoma is said to be fifth most common cancer in the

world. This study also revealed liver cancer to be the fifth leading cause contributing 5.1 percent

of years of life lost due to malignant neoplasms. Altogether 3322 years of life lost was accounted

due to liver cancer. Distribution of liver cancer was observed to be highest (65.2%) in hill region

which was followed by 34.8 percent in terai region while no cases were reported from mountain

region. Similarly, the development region wise distribution shows highest (46.7%) in eastern and

lowest (5.3%) in mid-western development region.

The age-wise distribution of liver cancer shows the contribution of YLL in the age group above

30 years only. More than half of YLL was accounted by 30-59 years of age group. Female

accounted three times more YLL than the males nationally. It was only observed in hill and terai

region of Nepal. Similarly, majority of YLL was contributed from Eastern region of Nepal which

was 46.7 percent. All the YLL was recorded in the population above 15 years of age. In all

Figure 3.4.6: Percentage YLL distribution due to Liver cancer


80

development regions females accounted more YLL than males but in central and mid-western

region no YLL was recorded from males group.

Table 3.4.8: YLL distribution of Liver cancer

Background

characteristics

Age Group Total YLL

30-59 60+

Development Region

Eastern

Male 63.8 36.2 100 665

Female 28.4 71.6 100 885

Total 43.5 56.5 100 1550

Central

Female 100.0 0.0 100 811

Total 100.0 0.0 100 811

Western

Male 0.0 100.0 100 60

Female 48.9 51.1 100 499

Total 43.6 56.4 100 559

Mid-Western

Female 0.0 100.0 100 177

Total 0.0 100.0 100 177

Far-Western

Male 100.0 0.0 100 133

Female 0.0 100.0 100 92

Total 59.1 40.9 100 225

Eco-region

Hill

Male 45.6 54.4 100 443

Female 47.1 52.9 100 1723

Total 46.8 53.2 100 2166

Terai

Male 85.5 14.5 100 415

Female 66.8 33.2 100 741

Total 73.5 26.5 100 1156

National

Male 64.9 35.1 100 858

Female 53.0 47.0 100 2464

Total 56.1 43.9 100 3322

II-A7 Trachea bronchus and lung Cancer Lung cancer is the commonest type of cancer in the world as well as the most frequent type of

cancer among males in the developing countries. Lung cancer was observed as second leading

cause to contribute 23.1 percent among the malignant neoplasms. Altogether 15099 years of life


81

lost was contributed due to trachea bronchus and lung cancer. The distribution of this cancer was

observed around all over the country. The ecological distribution of trachea bronchus and lung

cancer was observed highest in hill (68.6%) and lowest in mountain (3.3%). Similarly the

development wise distribution shows highest (27.5%) in mid-western and lowest (3.7%) in far-

western development region.

The following table no. 3.4.8 shows YLL distribution due to trachea bronchus and lung cancer.

Majority i.e. 8495 years of life lost (56.3%) was contributed by male's population nationally.

Males reported five times more YLL than the females in terai region while twice more than the

females in mountain but female constituted 1.2 times more YLL than the males in hill region.

The development region wise sex distribution shows males reporting more YLL than female in

eastern, central and far-western development regions. More than half of the YLL was recorded

from 30-59 years of age group which was followed by 43.9 perecent in elderly population. No

YLL was reported below 15 years of age group due to trachea bronchus and lung cancer.

Figure 3.4.7: Percentage YLL distribution due to Trachea bronchus and lung Cancer


82

Table 3.4.9: YLL distribution of Trachea, bronchus and lung cancers


Total YLL 15-29 30-59 60+

Development Region

Eastern

Male 17.3 37.9 44.8 100 1938

Female 0.0 54.9 45.1 100 905

Total 11.8 43.3 44.9 100 2843

Central

Male 0.0 79.8 20.2 100 2801

Female 0.0 79.3 20.7 100 811

Total 0.0 79.7 20.3 100 3612

Western

Male 0.0 31.4 68.6 100 1724

Female 0.0 55.1 44.9 100 2210

Total 0.0 44.7 55.3 100 3934

Mid-Western

Male 0.0 37.8 62.2 100 1681

Female 4.9 52.9 42.3 100 2466

Total 2.9 46.8 50.3 100 4147

Far-Western

Male 0.0 0.0 100.0 100 351

Female 100.0 0.0 100 212

Total 37.7 0.0 62.3 100 563

Eco-region

Mountain

Male 0.0 30.9 69.1 100 337

Female 0.0 100.0 100 168

Total 0.0 20.6 79.4 100 505

Hill

Male 0.0 28.1 71.9 100 4577

Female 3.7 57.6 38.7 100 5775

Total 2.0 44.6 53.4 100 10352

Terai

Male 9.4 77.0 13.6 100 3580

Female 18.1 50.9 31.0 100 662

Total 10.7 73.0 16.3 100 4242

National

Male 3.9 48.8 47.2 100 8495

Female 5.0 55.5 39.5 100 6604

Total 4.4 51.7 43.9 100 15099

II-A9 Breast Cancer Breast cancer is the leading cause of cancer deaths among women in the world and is the second

leading cause of cancer deaths among women in developing cancer.Breast cancer is rare among

males. This study revealed no YLL burden among males due to breast cancer. Breast cancer

contributed seventh rank among the malignant neoplasms. It contributed 1436 years of life lost in

a whole.


83

Breast cancer was reported from mountain and terai region only. The ecological distribution of

breast cancer was observed highest in terai 72.1% and remaining YLL was recorded from

mountain region i.e. 27.9% while no YLL due to breast cancer was reported from hill region.

Similarly, in mid-western region case was not reported and among other development regions

maximum was recorded from central development region (44.8%) and minimum from far-

western development region (5.6%).

Breast cancer was more observed among the women of adult and elderly age group. Entire YLL

in western and far-western development region was reported from 30-59 years of age group.

Table 3.4.10: YLL distribution of Breast cancer


Total YLL 30-59 60+

Development Region

Eastern 81.0 19.0 100 436

Central 17.4 82.6 100 643

Western 100.0 0.0 100 276

Far-Western 100.0 0.0 100 80

Eco-region

Mountain 79.3 20.7 100 401

Terai 48.6 51.4 100 1034

National 57.2 42.8 100 1436

Figure 3.4.8: Percentage YLL distribution due to Breast Cancer


84

II-A10 Cancer of cervix Cancer of the cervix is having a devastating impact on women’s health around the world,

especially in developing countries, where it is the most common cancer and the leading cause of

death from cancer in women. Although cervical cancer is a preventable disease of women group

it was observed to take third position causing YLL due to malignant neoplasms and it still

remains a major burden on public health area of Nepal.

A total of 14849 years of life lost was recorded due to cancer of cervix. Its distribution was

found in all development as well as ecological region. The ecological distribution of cancer of

cervix was observed to be highest in terai (68.5%) and lowest in mountain (2.8%) region.

Similarly, the development wise distribution shows highest (33.0%) in central while lowest

(7.7%) in far- western development region. The distribution due to cancer of cervix was

observed to be similar to the distribution of malignant neoplasms nationally.

The following table no 3.4.10 shows the age and sex-wise YLL distribution due to cancer of

cervix. Majority i.e. 67.9 percent of YLL were contributed by 30-59 years of women group.

Similarly, only 2.8 percent of YLL was recorded from the 15-29 years of female group. It was

observed that females of terai region were more affected by contributing 10168 years of life lost.

In hill region elderly women were observed more to be affected by this type of cancer while in

mountain 71.1 percent of YLL were contributed by women's of 30-59 age group. In eastern,

central and far-western development region majority of YLL was contributed by 30-59 years of

women group.

Figure 3.4.9: Percentage YLL distribution due to Cancer of cervix


85

Table 3.4.11 : YLL distribution of Cervix uteri cancer


Total YLL 15-29 30-59 60+

Development region

Eastern 10.6 62.7 26.7 100 2933

Central 0.0 98.0 2.0 100 4902

Western 0.0 44.5 55.5 100 3998

Mid-Western 0.0 40.3 59.7 100 1874

Far-Western 8.4 79.5 12.1 100 1142

Ecological region

Mountain 0.0 71.1 28.9 100 422

Hill 0.0 41.6 58.4 100 4259

Terai 4.0 78.8 17.2 100 10168

National 2.8 67.9 29.4 100 14849

II-A14 Bladder Cancer Bladder cancer contributed 465 years of life lost nationally. All the YLL due to bladder cancer

was observed only among the elderly aged (60+) population. Similarly, majority i.e. 69.9 percent

of years of life lost was observed in terai and it was followed by 30.1 percent of YLL in

mountain region. No YLL due to bladder cancer was recorded from hill region. YLL distribution

according to development region was observed in central and far-western regions only. Majority

i.e. 85.8 percent of years of life lost was observed in central development region. Nationally

males accounted six times more YLL than that of females due to bladder cancer.

Table 3.4.12: YLL distribution of Other congenital anomalies



Development Region

Central 100.0 0.0 100 399

Far-Western 0.0 100.0 100 66

Eco-region

Mountain 52.9 47.1 100 140

Terai 100.0 0.0 100 325

National 85.8 14.2 100 465

II-A16 Leukemia Leukemia is one of the frequently occurring cancers in all races or ethnicities and is a prominent

cause of premature mortality due to cancer worldwide. It can be observed in any age and sex of

Nepalese population. However, in this study it was totally observed among the 15-29 males

population. Altogether 325 years of life lost (i.e. 100 percent) was accounted by 15-29 years of

age group in western-terai region of country.


86

II-A17 Other Malignant Neoplasms The National Burden of Disease Manual-2000 had kept other malignant neoplasms category to

place all those conditions other than the above mentioned malignant neoplasms. Basically it

includes ………………………….etc. Among the category of malignant neoplasms only 1.1

percent of the YLL was contributed due to other malignant neoplasms. Three development

regions namely eastern, mid-western and far-western region reported altogether 745 years of life

lost. The ecological distribution of other malignant neoplasm was highest (72.2%) in Terai and

there was absence in Hill region. Similarly other Malignant Neoplasm was absent in central and

Western region and which was highest (47.0%) in Eastern development region.

Table 3.4.12 shows the age and sex-wise YLL distribution due to other malignant neoplasms.

Other malignant neoplasms were observed to be higher among females nationally (i.e. seven

times higher than the males), in all ecological and developmental regions. In the age group 0-14

and 15-29 the entire YLL burden was recorded from females group only.

Figure 3.4.10: Percentage YLL distribution due to Other Malignant Neoplasms


87

Table 3.4.13: YLL distribution of Other malignant neoplasms

Background

characteristics

Age Group

Total YLL 0-14 15-29 30-59

Development Region

Eastern

Female 100 0 0 100 350

Total 100 0 0 100 350

Mid-Western

Female 0 0.0 100 100 207

Total 0 0.0 100 100 207

Far-Western

Male 0 0 100 100 92

Female 0 100 0 100 96

Total 0 51.1 48.9 100 188

Eco-region

Mountain

Female 0 0 100 100 207

Total 0 0 100 100 207

Terai

Male 0 0 100 100 92

Female 78.5 21.5 0.0 100 446

Total 65.1 17.8 17.1 100 538

National

Male 0 0 100 100 92

Female 53.6 14.7 31.7 100 653

Total 47 12.9 40.1 100 745

II-B Other neoplasms

The following table no 3.4.13 shows YLL distribution of other neoplasms. The sex wise

distribution of YLL was observed to be more over similar in both sexes and more than half of

years of life lost due to other neoplasms were recorded in 30-59 years of age group. Years of life

lost contributed by females were observed to be slight more in mountain and terai region. In the

similar way central and eastern development region also showed females to account more YLL

than males but in western, mid-western and far-western regions males accounted to constitute

more YLL than the females.


88

Table 3.4.14 : YLL distribution of Other neoplasms


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 24.0 7.4 29.6 39.0 100 4355

Female 18.2 13.0 47.3 21.5 100 6465

Total 20.5 10.8 40.1 28.5 100 10820

Central

Male 26.1 21.1 18.0 34.9 100 4756

Female 14.2 2.2 75.4 8.2 100 7481

Total 18.9 9.5 53.1 18.6 100 12237

Western

Male 0.0 0.0 85.3 14.7 100 3374

Female 39.7 0.0 27.6 32.7 100 2039

Total 15.0 0.0 63.6 21.5 100 5413

Mid-Western

Male 11.8 5.5 65.1 17.6 100 4449

Female 47.6 0.0 43.7 8.7 100 1702

Total 21.7 4.0 59.2 15.1 100 6151

Far-Western

Male 26.3 12.6 32.9 28.2 100 1607

Female 0.0 17.0 61.4 21.6 100 1168

Total 15.2 14.5 44.9 25.4 100 2775

Eco-region

Mountain

Male 16.2 0.0 29.7 54.1 100 1091

Female 15.2 14.3 49.5 20.9 100 1121

Total 15.7 7.3 39.7 37.3 100 2212

Hill

Male 9.8 0.0 68.8 21.4 100 7204

Female 34.1 17.7 34.3 13.9 100 4748

Total 19.5 7.0 55.1 18.4 100 11952

Terai

Male 22.9 17.3 30.9 28.9 100 10249

Female 16.0 1.5 65.7 16.8 100 12983

Total 19.0 8.5 50.4 22.1 100 23232

National

Male 17.4 9.6 45.6 27.5 100 18542

Female 20.5 6.4 56.9 16.3 100 18854

Total 19.0 8.0 51.3 21.8 100 37396

Other neoplasms contributed 4.5 percent of YLL among non communicable diseases. Altogether

37396 years of life lost had been contributed by other neoplasms. Distribution of other

neoplasms was observed in all development and ecological regions. Ecological distribution

shows highest share of YLL in terai region (62.1%) and lowest in mountain region (5.9%).

Development region wise distribution shows central region to contribute highest share (32.7%)

and far-western development region to contribute lowest share (7.4%).


89

II-C Diabetes mellitus

The World Health Organization (WHO) recent reports says that the estimates that the number of

people living with diabetes have been increased significantly. Among the mortality due to

diabetes majority of deaths occur in low and middle-income countries. Almost half of diabetes

deaths occur in people under the age of 70 years, 55 percent of diabetes deaths are in women.

WHO projects that diabetes death will increase by more than 50 percent in the next 10 years

without urgent action. This study revealed that 2.8 percent i.e. 23309 years of life lost of total

due to non-communicable diseases were contributed by diabetes mellitus in Nepal.

Its distribution was observed in all development as well as ecological regions of Nepal. The

distribution shown by diabetes mellitus was more over similar to the distribution of non-

Figure: 3.4.11 Percentage YLL distribution due to Other Neoplasms


90

communicable diseases in the whole. Maximum percent (58.9%) of YLL was observed in terai

while minimum (1.9%) was recorded from mountain region of Nepal. Similarly, more than 20

percent was accounted by eastern, central and western development regions while least percent

(2.8%) was shared by far-western development region of Nepal.

Table no 3.4.14 shows the age and sex-wise distribution of diabetes mellitus according to

different region. It was observed that 58.9 percent (1.4 times more than that of females) of YLL

was accounted by males group nationally. YLL due to males was observed to be higher in all

eco- development region of Nepal. Around 82.6 percent of YLL due to diabetes mellitus was

recorded in above 30 years of age. Male showed highest (66.4%) years of life lost in national in

the age group (30-59).

Table 3.4.15: YLL distribution of Diabetes mellitus


Total YLL 0-14 15-29 30-59 60+

Figure 3.4.12: Percentage YLL distribution due to Diabetes Mellitus


91

Development Region

Eastern

Male 0.0 0.0 41.8 58.2 100 2207

Female 0.0 40.7 21.5 37.8 100 3151

Total 0.0 23.9 29.9 46.2 100 5358

Central

Male 0.0 21.5 44.4 34.0 100 5049

Female 0.0 0.0 43.8 56.2 100 1679

Total 0.0 16.2 44.3 39.6 100 6728

Western

Male 0.0 0.0 93.6 6.4 100 3760

Female 26.5 0.0 37.5 36.0 100 2937

Total 11.6 0.0 69.0 19.4 100 6697

Mid-Western

Male 0.0 0.0 91.1 8.9 100 2234

Female 47.6 7.3 6.7 38.4 100 1637

Total 20.1 3.1 55.4 21.4 100 3871

Far-Western

Male 0.0 0.0 81.7 18.3 100 498

Female 0.0 0.0 100.0 0.0 100 158

Total 0.0 0.0 86.1 13.9 100 656

Eco-region

Mountain

Male 0.0 0.0 100.0 0.0 100 350

Female 0.0 0.0 0.0 100.0 100 99

Total 0.0 0.0 78.0 22.0 100 449

Hill

Male 0.0 19.6 69.7 10.8 100 5557

Female 43.6 8.4 4.4 43.6 100 3577

Total 17.1 15.2 44.1 23.6 100 9134

Terai

Male 0.0 0.0 62.6 37.4 100 7840

Female 0.0 18.7 44.6 36.7 100 5886

Total 0.0 8.0 54.9 37.1 100 13726

National

Male 0.0 7.9 66.4 25.7 100 13747

Female 16.3 14.7 29.1 39.9 100 9562

Total 6.7 10.7 51.1 31.5 100 23309

II-D Endocrine disorders

Endocrine disorder includes adrenal gland disorders, amyloidosis, diabetes, fertility and

infertility, growth disorders, hyperinsulinemia, hyperparathyroidism, hypoparathyroidism,


92

hypopituitarism, menstruation problems, metabolic syndrome, multiple endocrine neoplasia,

osteoporosis, pancreatic cancer, pancreatitis, pituitary gland disorders, thyroid diseases etc.

Here, endocrine disorders excluding diabetes mellitus constituted only 0.2 percent i.e. 1368 years

of life lost among non-communicable diseases. Terai region accounted majority i.e. 78.4 percent

of total years of life lost due to endocrine causes which was followed by mountain region

(21.6%). No YLL was reported from hill region. Similarly 72.1 percent YLL was recorded from

central development region. Least percent (5.9%) of YLL was shared by far-western

development region. No YLL was reported from eastern and western development region.

Endocrine disorders were observed only among age group above 15 years and majority of YLL

(72.1%) was recorded in 15-29 years of age group. Similarly, female group contributed majority

of YLL in all the ecological as well as developmental regions. Nationally females contributed ten

times more YLL than the males due to endocrine disorders.

Figure 3.4.13: Percentage YLL distribution due to Endocrine Disorders


93

Table 3.4.16: YLL distribution of Endocrine disorders


Total YLL 15-29 30-59 60+

Development Region

Central

Female 100.0 0.0 0.0 100 987

Total 100.0 0.0 0.0 100 987

Mid-Western

Male 0.0 100.0 0.0 100 116

Female 0.0 46.5 53.5 100 185

Total 0.0 67.1 32.9 100 301

Far-Western

Female 0.0 100.0 0.0 100 80

Total 0.0 100.0 0.0 100 80

Eco-region

Mountain

Male 0.0 100.0 0.0 100 116

Female 0.0 44.7 55.3 100 179

Total 0.0 66.4 33.6 100 295

Terai

Female 92.0 8.0 0.0 100 1073

Total 92.0 8.0 0.0 100 1073

National

Male 0.0 100.0 0.0 100 116

Female 78.8 13.3 7.9 100 1252

Total 72.1 20.6 7.2 100 1368

I-E Neuropsychiatric disorders

Neuropsychiatric disorder is distributed into seven sub category viz. unipolar depressive

disorders, migraine, mental retardation attributable to lead exposure, other neuropsychiatry

disorders, bipolar affective disorder, epilepsy, and alcohol use disorders.

Figure 3.4.14: Percentage YLL distribution due to Neuropsychiatric disorder


94

The distribution of neuropsychiatric disorders was observed in all eco-developmental regions of

Nepal. The maximum YLL (55.2%) was observed in terai region while minimum (7.4%) was

recorded in mountain region of Nepal. Similarly, the eastern development was observed to

contribute highest (32%) while far-western development region showed lowest percent (8%) of

YLL in Nepal.

The total years of life loss due to neuropsychiatric disorder was 63191 years. In the table 3.4.16

below, nationally, other neuropsychiatric disorders, epilepsy and alcohol use disorder were found

to contribute 42.1, 32.9 and 23.0 percent YLL respectively. In mountain region epilepsy was

found to account highest share of YLL (i.e. 45.6%) while in hill and terai regions other

neuropsychiatric disorders accounted highest share i.e. 44.1 and 42.6 percent respectively.

Similarly, other neuropsychiatric disorders showed highest share in all the development regions

except in the central developmental region where most of the YLL (54.2%) was accounted due to

epilepsy.

Neuropsychiatric diseases Development Region Ecological Region


Unipolar depressive

disorders 0.0 0.0 0.9 0.0 0.0 0.0 0.0 0.4 0.2

Migraine 0.0 0.2 0.0 0.0 9.2 3.8 0.0 0.9 0.8

Mental Retardation

attributable to lead

exposure

1.7 0.0 0.2 0.0 2.5 3.4 0.0 1.0 0.8

Other neuropsychiatric

disorders 59.3 23.5 41.6 33.6 38.7 28.4 44.1 42.6 42.1

Bipolar affective disorder 0.0 0.0 0.8 0.0 0.0 0.0 0.0 0.4 0.2

Epilepsy 18.8 54.2 35.4 26.7 36.8 45.6 25.2 36.4 32.9

Alcohol use disorders 20.2 22.2 21.1 39.7 12.7 18.8 30.7 18.3 23.0

Total 100 100 100 100 100 100 100 100 100

Total YLL 20381 13366 15672 8858 4914 4678 23657 34856 63191

Table 3.4.17: YLL Distribution of Neuropsychiatric Diseases


95

II-E1 Unipolar depressive disorders Unipolar depressive disorders is a mental disorder characterized by an all-encompassing low

mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable

activities. Total years of life lost due to unipolar depressive disorders were 147 years and females

of 60 years and above were only the victim. The burden was found only in western terai region

of Nepla.

I-E2 Bipolar affective disorders

Bipolar affective disorders accounted negligible share of YLL among the neuropsychiatric

disorders. A total year of life lost due to bipolar affective disorder was found to be 124 years.

Male aged 60 and more were only affected and the burden was observed only in western terai

region of Nepal.

I-E4 Epilepsy Epilepsy in Nepal remains a big challenge. The high treatment gap, the widespread use of

traditional healers, and poor understanding among epilepsy patient is the bottleneck in the

treatment of epilepsy. Table no 3.4.17 shows the YLL distribution of Epilepsy in Nepal. The

total years of life lost due to epilepsy were found to be 20788 years among which 13526 years

and 7262 years were lost by males and females respectively. Distribution of Epilepsy was high

(61%) in terai while low (10.3%) in mountain region. Similarly, the distribution was observed to

be maximum (34.8%) in central and minimum (8.7%) in far-western development region of

Nepal.

Figure 3.4.15: Percentage YLL distribution due to Epilepsy

http://en.wikipedia.org/wiki/Mental_disorder

http://en.wikipedia.org/wiki/Depression_(mood)

http://en.wikipedia.org/wiki/Depression_(mood)

http://en.wikipedia.org/wiki/Self-esteem

http://en.wikipedia.org/wiki/Anhedonia


96

The age group-wise distribution of YLL burden shows major contribution by 15-29 and 30-59

age group with 36.2 and 38.2 percent of total burden due to epilepsy respectively. Children

below 14 and elders above 60 were also found to be affected with 14.9 and 10.7 percent of total

burden respectively. The sex-wise burden was observed approximately to be double than the

females nationally. Males were observed to contribute more YLL in all the ecological and

development regions of Nepal. In hill region of Nepal, males contributed 7.5 times more YLL

than females. Midwestern development region shows only male to account entire YLL burden.

Table 3.4.18:YLL distribution of Epilepsy


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 0.0 16.2 47.3 36.5 100 2074

Female 19.5 52.1 14.5 13.9 100 1754

Total 8.9 32.6 32.3 26.1 100 3828

Central

Male 8.5 46.6 45.0 0.0 100 4304

Female 36.3 33.6 27.8 2.3 100 2935

Total 19.7 41.3 38.0 0.9 100 7239

Western

Male 0.0 40.9 46.2 12.9 100 3965

Female 47.3 24.6 16.6 11.4 100 1581

Total 13.5 36.3 37.8 12.5 100 5546

Mid-Western

Male 10.7 34.9 54.5 0.0 100 2366

Total 10.7 34.9 54.5 0.0 100 2366

Far-Western

Male 0.0 39.9 39.0 21.1 100 817

Female 33.2 12.7 24.6 29.5 100 992

Total 18.2 25.0 31.1 25.7 100 1809

Eco-region

Mountain

Male 39.2 2.8 37.3 20.7 100 1570

Female 0.0 22.5 65.4 12.1 100 561

Total 28.9 8.0 44.7 18.4 100 2131

Hill

Male 0.0 35.7 59.2 5.1 100 5267

Female 0.0 38.8 0.0 61.2 100 701

Total 0.0 36.1 52.2 11.7 100 5968

Terai

Male 0.0 47.7 39.7 12.6 100 6687

Female 41.4 33.6 20.2 4.8 100 6002

Total 19.6 41.0 30.5 8.9 100 12689

National

Male 4.5 37.8 47.0 10.6 100 13526

Female 34.2 33.2 21.7 10.8 100 7262

Total 14.9 36.2 38.2 10.7 100 20788


97

I-E5 Alcohol use disorders Alcohol use remains major public health problem in Nepal. Many ethnic groups are allowed to

drink from their childhood as their cultural practice, similarly most social gathering also includes

alcohol use and a way of enjoyment, and hence the culture of alcohol use is increasing day by

day. Total years of life lost due to alcohol use disorders were 14525 years among which 13289

and 1236 YLL was accounted by males and females respectively. The ecological distribution

shows half of the YLL contribution by hill region of Nepal. The least (6%) was observed in

mountain region of Nepal. Similarly maximum (28.4%) in eastern and minimum (4.3%) YLL in

far-western development region was observed.

The following table 3.4.18 shows the age and sex-wise YLL distribution due to alcohol use

disorders. Majority of YLL i.e.63.9 percent was accounted by age group 30-59 which was

followed by 24.7 percent by elderly age group nationally. The sex-wise burden of YLL was

found to be ten times more in males than females in Nepal. In terai region of Nepal the

distribution of YLL was observed to be more in males and among females entire YLL burden

was recorded in 30-59 years of age group. In eastern and far-western development regions the

whole YLL burden was contributed by males group only and in all the remaining development

regions males accounted more YLL.

Figure 3.4.16: Percentage YLL distribution due to Alcohol use disorders


98

Table 3.4.19: YLL distribution of Alcohol use disorders

Background

characteristics

Age Group Total YLL

15-29 30-59 60+

Development Region

Eastern

Male 9.3 56.1 34.6 100 3611

Female 0.0 100.0 0.0 100 507

Total 8.1 61.5 30.4 100 4118

Central

Male 42.0 44.0 14.1 100 2311

Female 0.0 100.0 0.0 100 650

Total 32.8 56.3 11.0 100 2961

Western

Male 10.9 64.5 24.6 100 3301

Total 10.9 64.5 24.6 100 3301

Mid-Western

Male 0.0 71.6 28.4 100 3439

Female 0.0 100.0 0.0 100 79

Total 0.0 72.3 27.7 100 3518

Far-Western

Male 0.0 64.9 35.1 100 627

Total 0.0 64.9 35.1 100 627

Eco-region

Mountain

Male 0.0 100.0 0.0 100 878

Total 0.0 100.0 0.0 100 878

Hill

Male 0.0 71.7 28.3 100 7033

Female 0.0 100.0 0.0 100 232

Total 0.0 72.6 27.4 100 7265

Terai

Male 31.0 39.4 29.6 100 5378

Female 0.0 100.0 0.0 100 1004

Total 26.1 48.9 25.0 100 6382

National

Male 12.5 60.5 27.0 100 13289

Female 0.0 100.0 0.0 100 1236

Total 11.5 63.9 24.7 100 14525

I-E14 Migraine Total years of life lost due to migraine were found to be 478 years among which 245 years and

233 years of life were lost by male and female respectively. The ecological distribution of the

YLL due to migraine was observed in mountain (37.7%) and terai (62.3%) region only. Similarly

the development wise distribution was observed in central (5.6%) and far-western (94.4%)

development region of Nepal. The age group wise distribution was observed to be highest i.e.

71.3 percent in 30-59 years age group and remaining 28.7 percent in elderly age group. Sex


99

distribution shows that the YLL burden was observed to be slight more among males than in

females nationally while the entire YLL burden was contributed by males group in central

development region.

Table 3.4.20: YLL distribution of Migraine

Background

characteristics

Age Group Total YLL

30-59 60+

Development Region

Central

Male 0.0 100.0 100 27

Total 0.0 100.0 100 27

Far-Western

Male 79.8 20.2 100 218

Female 71.7 28.3 100 233

Total 75.6 24.4 100 451

Eco-region

Mountain

Male 76.3 23.7 100 114

Female 0.0 100.0 100 66

Total 48.3 51.7 100 180

Terai

Male 66.4 33.6 100 131

Female 100.0 0.0 100 167

Total 85.2 14.8 100 298

National

Male 71.0 29.0 100 245

Female 71.7 28.3 100 233

Total 71.3 28.7 100 478

I-E15 Mental retardation attributable to lead exposure Total years of life lost due to mental retardation attributable to lead exposure were found to be

511 years among which all the affected population were female and 93.2 percent of burden was

found in age group 0-14 years and 6.8 percent was of the age group 30-59 years. The burden

was found to be higher in terai region with 350 years of life lost (68.5%) and 161 years of life

(31.5) were lost in mountain region. Eastern development region accounted the maximum YLL

i.e. 351 years of life lost (68.7%) while least 35 years of life were lost (6.8%) was recorded from

western development region.


100

Table 3.4.21: YLL distribution of Mental Retardation attributable to lead exposure

Background

characteristics

Age Group Total YLL

0-14 30-59

Development Region

Eastern 100.0 0.0 100 351

Western 0.0 100.0 100 35

Far-Western 100.0 0.0 100 125

Ecological-region

Mountain 78.1 21.9 100 161

Terai 100.0 0.0 100 350

National 93.2 6.8 100 511

I-E16 Other neuropsychiatric disorders Other neuropsychiatric disorders were responsible to account 26616 years of life lost nationally.

The distribution of other neuropsychiatric disorders was observed maximum in terai region

(55.8%) while least was found in mountain region (5%). Similarly, highest YLL was recorded in

eastern (45.4%) and lowest share was contributed by far-western (7.1%) development region of

Nepal.

The age and sex-wise distribution of YLL due to other neuropsychiatric disorders is shown in the

table 3.4.21 below. The sex-wise distribution shows males reporting slight more YLL than the

females. Half the burden was found in age group above 60 years and least (7.3%) was observed

to be in the 0-14 years of age group. The YLL burden was found to be high among males in all

the ecological regions except in hill region. Similarly, the burden accounted by males was

observed to be higher among males than in females in all the development regions except in

eastern and central development regions of Nepal.

Figure 3.4.17: Percentage YLL distribution due to other neuropsychiatric disorders


101

Table 3.4.22: YLL distribution of Other neuropsychiatric disorders


Age Group Total YLL

0-14 15-29 30-59 60+

Development Region

Eastern

Male 0.0 10.2 37.1 52.7 100 5888

Female 0.0 4.4 25.2 70.4 100 6196

Total 0.0 7.2 31.0 61.8 100 12084

Central

Male 0.0 0.0 48.2 51.8 100 976

Female 0.0 8.1 56.4 35.6 100 2161

Total 0.0 5.5 53.8 40.6 100 3137

Western

Male 26.5 32.5 0.0 41.0 100 4114

Female 30.0 0.0 23.9 46.1 100 2405

Total 27.8 20.5 8.8 42.9 100 6519

Mid-Western

Male 8.2 7.9 6.1 77.8 100 1532

Female 0.0 0.0 47.4 52.6 100 1442

Total 4.2 4.1 26.1 65.6 100 2974

Far-Western

Male 0.0 40.5 33.4 26.2 100 959

Female 0.0 34.0 57.2 8.8 100 943

Total 0.0 37.3 45.2 17.6 100 1902

Eco-region

Mountain

Male 0.0 0.0 45.9 54.1 100 679

Female 0.0 45.0 32.1 22.9 100 651

Total 0.0 22.0 39.2 38.8 100 1330

Hill

Male 0.0 6.5 22.3 71.3 100 4600

Female 0.0 4.7 42.6 52.8 100 5823

Total 0.0 5.5 33.6 60.9 100 10423

Terai

Male 14.9 26.2 21.1 37.8 100 8190

Female 10.8 3.0 28.3 57.9 100 6673

Total 13.0 15.8 24.4 46.8 100 14863

National

Male 9.0 18.2 22.8 50.0 100 13469

Female 5.5 5.8 34.8 53.9 100 13147

Total 7.3 12.1 28.7 51.9 100 26616


102

II-F Sense organ disorders

GBD 2000 cause categories keep the sense organ related disorders in this group. Mortality due to

sense organ disorders were usually observed due to glaucoma and cataract in many countries.

Age related vision disorders and adult onset hearing loss rarely become the major cause of

mortality. All the YLL among this category was accounted due to other sense organ disorders.

Other sense organ disorder usually includes the complications in the human sense organs other

than the above mentioned. Altogether 2189 years of life lost were observed due to other sense

organ disorders. The following figure 3.4.18 shows the YLL distribution due to other sense

organ disorders. Majority of the YLL was recorded from the terai region (67.8%) and least was

recorded from hill region (2.1%). Similarly, the central development region accounted majority

of YLL (42%) and least was accounted from the western development region. No YLL was

recorded from mid-western development region due to other sense organ disorder.

Almost double YLL was contributed by male population due to the other sense organ disorder

nationally. The age distribution of YLL shows maximum share (56%) by 30-59 years age group

and least (21.8%) was observed in elderly age population. Majority of YLL were recorded from

terai region of Nepal among which 74.1 percent was recorded in 30-59 years of age group. Eco-

development wise distribution shows males contributing maximum YLL in all the regions.

Similarly, in western and far-western development regions all the YLL was reported by females

group only.

Figure 3.4.18: Percentage YLL distribution due to other sense organ disorders


103

Table 3.4.23: YLL distribution of Other sense organ disorders


Age Group Total YLL

0-14 30-59 60+

Development Region

Eastern

Male 0.0 0.0 100.0 100 198

Female 0.0 100.0 0.0 100 401

Total 0.0 66.9 33.1 100 599

Central

Male 0.0 89.5 10.5 100 851

Female 0.0 0.0 100.0 100 68

Total 0.0 82.9 17.1 100 919

Western

Female 0.0 0.0 100.0 100 77

Total 0.0 0.0 100.0 100 77

Far-Western

Male 85.8 14.2 0.0 100 438

Female 70.5 0.0 29.5 100 156

Total 81.8 10.4 7.7 100 594

Eco-region

Mountain

Male 80.9 0.0 19.1 100 465

Female 0.0 64.9 35.1 100 194

Total 57.1 19.1 23.8 100 659

Hill

Female 0.0 0.0 100.0 100 46

Total 0.0 0.0 100.0 100 46

Terai

Male 0.0 80.6 19.4 100 1022

Female 23.8 59.5 16.7 100 462

Total 7.4 74.1 18.5 100 1484

National

Male 25.3 55.4 19.3 100 1487

Female 15.7 57.1 27.2 100 702

Total 22.2 56.0 21.8 100 2189

II-G Cardiovascular diseases

Cardiovascular diseases comprises of rheumatic heart disease, hypertensive heart disease,

Ischaemic heart disease, cerebrovascular disease and other cardiovascular diseases. Altogether

159102 years of life lost have been accounted by cardiovascular diseases. Terai region accounted

48 percent of total YLL in this category while least was recorded in the mountain region

contributing only 11 percent. Similarly, the development region wise YLL was observed to be

highest in central (31%) and lowest in the far-western (8%) development region of Nepal.


104

Similarly, the following table no 3.4.23 shows the age and sex-wise distribution of

cardiovascular diseases. Among the cardiovascular diseases 43.8 percent of burden was

contributed by cerebro-vascular disease and only 1.6 percent of YLL was contributed by

rheumatic heart disease. The ecological distribution shows similar pattern of distribution of

cardiovascular diseases in hill and terai but in mountain region highest share was accounted by

cerebro-vascular diseases but no YLL was recorded due to rheumatic heart diseases. Likewise

the development wise distribution also shows the same pattern of the YLL except in eastern and

far-western development regions where no YLL was recorded due to rheumatic heart disease.

E C W MW FW M H T

1 Rheumatic heart disease 0.0 1.3 4.5 1.6 0.0 0.0 2.3 1.5 1.6

2 Hypertensive heart disease 30.4 13.0 15.9 14.2 2.4 11.8 16.8 18.4 17.1

3 Ischaemic heart disease 15.5 24.1 15.7 21.9 18.3 29.1 16.4 20.0 19.5

4 Cerebrovascular disease 22.2 42.5 57.8 53.0 54.9 32.9 50.3 40.6 43.8

5 Other cardiovascular diseases 31.9 19.1 6.0 9.2 24.4 26.3 14.1 19.4 18.0

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Total YLL 36761 49208 34078 27098 11957 16876 65969 76257 159102

Development Region Eco-RegionNational Cardiovascular diseasesS.N.

Table 3.4.24: YLL Distribution of Cardiovascular Diseases

Figure 3.4.19: Percentage YLL distribution due to Cardiovascular Diseases


105

II-G1 Rheumatic heart disease Rheumatic heart disease remains a major public health problem in developing countries with its

very high prevalence. Rheumatic heart diseases are significant causes of morbidity and mortality

among Nepalese schoolchildren and also can be chronic till elderly. The ecological distribution

of YLL shows 57.7 percent in hill region and 42.3 percent in terai region of Nepal. No YLL was

recorded from mountain region. Similarly highest YLL was observed in western development

region and lowest (16.6%) was observed in mid-western development region of Nepal. The two

extreme development regions, eastern and far-western development regions did not reported any

YLL due to rheumatic heart disease.

Though males are also supposed to be affected by rheumatic heart disease this study revealed all

the YLL among female group only.YLL due to rheumatic heart disease was recorded to be 2618

years. The mortality was found to be highest among 30-59 years group (37.4%) and lowest

(14.6%) among 15-29 years of age group. In hill majority (57.4%) of YLL was recorded from

elderly age group while in terai all age groups reported more than 30 percent of YLL except the

elderly age group which reported none of the YLL. Mid-western development region reported all

the YLL among elderly age group while the central development region reported all the YLL in

30-59 years age group. Western development region showed the almost equal percentage

distribution of YLL among all the age groups.

Figure 3.4.20: Percentage YLL distribution due to Rheumatic heart disease


106

Table 3.4.25:YLL distribution of Rheumatic heart disease


Total YLL 0-14 15-29 30-59 60+

Development Region

Central 0.0 0.0 100.0 0.0 100.00 643

Western 25.3 24.7 21.8 28.2 100.00 1541

Mid-Western 0.0 0.0 0.0 100.0 100.00 434

Eco-region

Hill 0.0 0.0 42.6 57.4 100.00 1510

Terai 35.2 34.4 30.4 0.0 100.00 1108

National 14.9 14.6 37.4 33.1 100.00 2618

II-G2 Hypertensive heart disease Hypertensive heart disease was supposed to be the disease of developed country but now, many

developing countries are in a phase of epidemiological transition and face the double burden of

communicable and non-communicable diseases. The prevalence of hypertensive heart disease is

increasing in Nepal too. The study shows, hypertensive heart disease to contribute 27134 years

of life lost, among which male and female lost 14400 years and 12734 years respectively. The

ecological distribution shows highest percent (51.8%) share in terai region and lowest (7.3%) in

mountain region of Nepal. Similarly, the following graph (figure no: 3.4.21) shows the

distribution of YLL among the development region in decreasing order from eastern to far-

western development region of Nepal. So, highest was observed in eastern (41.2%) and lowest

(1%) in far-western development region of Nepal.

Figure 3.4.21: Percentage YLL distribution due to Hypertensive heart disease


107

Among total YLL highest (54 %) was shared by elderly population and least (1%) was shared by

15-29 years of age group. Moreover female showed higher YLL in 30-59 years of age group

while male showed highest YLL in the elderly age group. Sex-wise distribution of YLL was

observed to be high (53.1 %) in male population. Similarly sex wise distribution showed males

comprising higher YLL in all regions except in central development and hill region of Nepal.

Table 3.4.26: YLL distribution of Hypertensive heart disease


Total YLL 15-29 30-59 60+

Development Region

Eastern

Male 0.0 46.9 53.1 100 5958

Female 0.0 32.7 67.3 100 5212

Total 0.0 40.3 59.7 100 11170

Central

Male 6.4 9.5 84.1 100 2571

Female 0.0 56.0 44.0 100 3836

Total 2.6 37.3 60.1 100 6407

Western

Male 0.0 40.5 59.5 100 3058

Female 0.0 81.5 18.5 100 2363

Total 0.0 58.4 41.6 100 5421

Mid-Western

Male 0.0 52.0 48.0 100 2586

Female 0.0 64.2 35.8 100 1265

Total 0.0 56.0 44.0 100 3851

Far-Western

Male 44.7 0.0 55.3 100 226

Female 0.0 0.0 100.0 100 59

Total 35.4 0.0 64.6 100 285

Eco-region

Mountain

Male 13.6 38.9 47.5 100 1203

Female 0.0 48.7 51.3 100 784

Total 8.3 42.8 49.0 100 1987

Hill

Male 0.0 43.3 56.7 100 6632

Female 0.0 48.9 51.1 100 4458

Total 0.0 45.6 54.4 100 11090

Terai

Male 1.5 34.7 63.8 100 6565

Female 0.0 53.8 46.2 100 7492

Total 0.7 44.9 54.4 100 14057

National

Male 1.8 39.0 59.1 100 14400

Female 0.0 51.8 48.2 100 12734

Total 1.0 45.0 54.0 100 27134


108

II-G3 Ischaemic heart disease The behavioral and lifestyle transition of developing countries is resulting to increase in burden

of ischaemic heart disease and Nepal is also showing the similar trend. Ischaemic heart disease is

responsible for 31028 years of life lost among which male and female lost 20421 years and

10607 years respectively. The highest YLL according to ecological regions was observed in the

terai (49.3%) and lowest (15.8%) was observed in the mountain region of Nepal. Similarly, the

development region-wise YLL distribution showed highest (38.2%) in the central and lowest

(7%) in the far-western development region.

Among all the age group, 30-59 years were observed to be affected mostly (47%) and only 0.3

percent of YLL was observed among the 0-14 years of age group due to Ischaemic heart disease.

The burden was almost double among males than the females. Males were found to contribute

more YLL in all the ecological and developmental region except in the central developmental

region where males contributed slight less YLL than the females.

Figure 3.4.22: Percentage YLL distribution due to Ischaemic heart disease


109

Table 3.4.27: YLL distribution of Ischaemic heart disease

Background

characteristics

Age Group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 0.0 0.0 45.2 54.8 100 3789

Female 0.0 14.3 50.6 35.1 100 1897

Total 0.0 4.8 47.0 48.2 100 5686

Central

Male 0.0 18.5 53.2 28.3 100 5888

Female 0.0 0.0 41.5 58.5 100 5966

Total 0.0 9.2 47.3 43.5 100 11854

Western

Male 0.0 0.0 50.2 49.8 100 4229

Female 0.0 0.0 50.8 49.2 100 1135

Total 0.0 0.0 50.4 49.6 100 5364

Mid-Western

Male 0.0 10.6 50.8 38.7 100 4918

Female 0.0 11.8 32.2 56.1 100 1020

Total 0.0 10.8 47.6 41.7 100 5938

Far-Western

Male 6.5 20.0 34.7 38.7 100 1598

Female 0.0 0.0 42.9 57.1 100 588

Total 4.8 14.6 36.9 43.7 100 2186

Eco-region

Mountain

Male 0.0 7.2 45.4 47.4 100 3732

Female 0.0 0.0 52.2 47.8 100 1171

Total 5.5 47.1 47.5 100 4903

Hill

Male 0.0 15.2 44.4 40.4 100 8646

Female 0.0 12.4 7.8 79.8 100 2193

Total 0.0 14.6 37.0 48.4 100 10839

Terai

Male 1.3 4.3 55.8 38.6 100 8043

Female 0.0 1.7 52.5 45.8 100 7243

Total 0.7 3.0 54.3 42.0 100 15286

National

Male 0.5 9.4 49.1 41.0 100 20421

Female 0.0 3.7 43.3 53.0 100 10607

Total 0.3 7.5 47.1 45.1 100 31028

II-G4 Cerebrovascular disease Years of life lost due to cerebrovascular diseases was observed to be 69759 years among which

37895 years and 31855 years were lost by male and female respectively. The ecological


110

distribution showed majority (47.6%) of YLL recorded from hill and least (8%) was recorded

from mountain region of Nepal. The development region wise distribution shows the highest

YLL contributed by central development region and lowest by far-western development region.

The following table no 3.4.27 shows the YLL distribution of the cerebrovascular diseases.

Majority (59%) of YLL burden was observed in the elderly age group and least (1.9%) was

observed in the 0-14 years age group. Around 54 percent of burden was accountable by males

population only. Males population accounted higher YLL in each ecological and developmental

region. Similarly, the age distribution shows highest in YLL contributed by the elderly

population group except, moreover equal contribution was observed among 30-59 and elderly

age group population.

Figure 3.4.23: Percentage YLL distribution due to Cerebrovascular disease


111

Table 3.4.28: YLL distribution of Cerebrovascular disease

Background

characteristics

Age Group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 6.7 0.0 46.8 46.5 100 4861

Female 0.0 0.0 39.4 60.6 100 3310

Total 4.0 0.0 43.8 52.2 100 8171

Central

Male 0.0 11.1 24.5 64.5 100 11356

Female 1.8 10.5 14.1 73.5 100 9568

Total 0.8 10.8 19.7 68.6 100 20924

Western

Male 0.0 11.2 20.4 68.4 100 9903

Female 0.0 7.8 42.0 50.2 100 9810

Total 0.0 9.5 31.1 59.3 100 19713

Mid-Western

Male 1.6 14.5 18.0 65.9 100 7682

Female 0.0 6.0 48.8 45.2 100 6692

Total 0.9 10.5 32.3 56.3 100 14374

Far-Western

Male 2.5 2.9 47.1 47.4 100 4093

Female 23.4 13.9 31.3 31.5 100 2475

Total 10.4 7.1 41.2 41.4 100 6568

Eco-region

Mountain

Male 8.8 7.8 18.4 65.0 100 3729

Female 16.5 22.4 28.4 32.7 100 1823

Total 11.3 12.6 21.7 54.4 100 5552

Hill

Male 0.0 14.7 25.0 60.3 100 17603

Female 2.9 7.8 38.8 50.5 100 15604

Total 1.4 11.5 31.5 55.7 100 33207

Terai

Male 1.4 4.4 31.9 62.3 100 16562

Female 0.0 6.2 29.5 64.4 100 14429

Total 0.7 5.2 30.8 63.3 100 30991

National

Male 1.5 9.5 27.4 61.6 100 37895

Female 2.4 7.9 34.0 55.8 100 31855

Total 1.9 8.8 30.4 59.0 100 69750


112

II-G5 Other Cardiovascular disease Years of life lost due to other cardiovascular diseases were 28573 years. Among the ecological

region terai showed the highest share (51.9%) and mountain region showed the lowest

percentage share (15.5%). Likewise, the eastern development region showed the highest (41.1%)

and western development region showed the lowest (7.1%) percentage share.

Altogether 12804 (44.8%) years of life lost was covered by male and 15769 years (55.2%) was

covered by female. The burden was found to be highest (38%) among population above 60 years

of age and lowest (14.1%) in the 15-29 years of age group. Males and females population

showed higher percentage share of YLL in the elderly age group. Sex-wise distribution shows

females to account more YLL than the males nationally. In all the eco-development regions of

Nepal female's share of YLL was observed to be higher except in the western, far-western and

mountain region of Nepal.

Figure 3.4.24: Percentage YLL distribution due to Other Cardiovascular disease


113

Table 3.4.29: YLL distribution of Other cardiovascular diseases

Background

characteristics

Age Group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 18.3 6.1 51.9 23.7 100 5333

Female 5.1 16.5 34.7 43.7 100 6400

Total 11.1 11.8 42.5 34.6 100 11733

Central

Male 27.1 34.1 6.3 32.5 100 3936

Female 22.5 44.7 32.8 100 5442

Total 24.4 14.3 28.6 32.7 100 9378

Western

Male 0.0 36.1 22.6 41.3 100 1041

Female 0.0 0.0 30.1 69.9 100 999

Total 0.0 18.4 26.3 55.3 100 2040

Mid-Western

Male 0.0 26.2 7.6 66.2 100 987

Female 17.3 7.9 18.7 56.1 100 1514

Total 10.5 15.1 14.3 60.1 100 2501

Far-Western

Male 15.1 29.4 9.3 46.2 100 1504

Female 16.3 8.3 47.0 28.4 100 1417

Total 15.7 19.2 27.6 37.6 100 2921

Eco-region

Mountain

Male 5.1 32.9 48.8 13.2 100 2414

Female 8.7 13.6 51.3 26.3 100 2018

Total 6.7 24.1 49.9 19.2 100 4432

Hill

Male 31.2 7.1 12.9 48.8 100 3131

Female 9.0 4.4 36.3 50.4 100 6192

Total 16.5 5.3 28.4 49.8 100 9323

Terai

Male 16.1 23.9 26.0 34.1 100 7259

Female 17.3 9.9 34.6 38.1 100 7560

Total 16.7 16.7 30.4 36.1 100 14819

National

Male 17.7 21.5 27.1 33.7 100 12804

Female 12.9 8.2 37.4 41.4 100 15769

Total 15.1 14.1 32.8 38.0 100 28573


114

II-H Respiratory diseases

Respiratory diseases include chronic obstructive pulmonary disease, asthma and other respiratory

diseases. Highest YLL due to respiratory diseases was observed in the terai region (44%) and

lowest was observed in mountain region (13%). In the similar way, YLL share was observed

highest (27%) in the central development region and lowest in the far-western development

region (9%) of Nepal.

Among respiratory diseases, burden of COPD was found to be highest i.e. 97.6 percent while the

burden of asthma and other respiratory diseases was 1.1 percent and 1.3 percent respectively.

COPD was found higher in all development regions with 95.7, 97.1, 99.2, 97.1 and 99.5 percent

of burden among respiratory diseases in eastern, central, western, mid-western and far-western

development region respectively. Similarly, COPD was higher in all 3 ecological regions with

94.6, 97.7 and 98.4 percent of burden among respiratory diseases in mountain, hill and terai

region respectively.

E C W MW FW M H T

1 Chronic obstructive pulmonary disease 95.7 97.1 99.2 97.1 99.5 94.6 97.7 98.4 97.6

2 Asthma 0.1 2.4 0.2 2.1 0.1 1.0 1.3 1.0 1.1

3 Other respiratory diseases 4.2 0.5 0.7 0.8 0.5 4.4 1.0 0.6 1.3

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Total YLL 51562 71689 67194 54962 24881 35919 115260 119109 270288

Development Region Eco-RegionRespiratory diseasesS.N. National

Table 3.4.30: YLL distribution of respiratory diseases

Figure 3.4.25: Percentage YLL distribution due to Other Cardiovascular disease


115

II-H1 Chronic Obstructive Pulmonary diseases Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and

mortality and represents a substantial economic and social burden throughout the world. It is one

of the leading cause of death worldwide and further increase in its prevalence and mortality are

expected in the coming decades. Years of life lost due to COPD were found to be 263734 years.

Terai shared maximum (44.4%) and mountain shared minimum (12.9%) years of life lost due to

COPD. Similarly central development region contributed highest (26.4%) and far-western

development region contributed lowest (9.4%) from the development regions of Nepal.

The sex distribution of YLL was observed higher among female 144241 (54.7%) while males

were responsible to contribute only 119493 (45.3%). Burden of COPD was found to be highest

among elderly population group (73.6%) and lowest among 15-29 years age group (0.8%). In all

the eco-development regions elderly age group population were observed to contribute majority

of YLL. Distributing ecologically, females were observed to contribute more YLL in terai and

hill region while males accounted more YLL in mountain region of Nepal. The YLL burden was

found to be accounted more by females in central, western and mid-western regions except in

eastern and far-western development region where males accounted more YLL due to COPD.

Figure 3.4.26: Percentage YLL distribution due to Chronic Obstructive Pulmonary diseases


116

Table 3.4.31: YLL distribution of Chronic obstructive pulmonary disease

Background

characteristics

Age Group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 0.0 0.0 29.9 70.1 100 25655

Female 0.0 0.0 22.2 77.8 100 23677

Total 0.0 0.0 26.2 73.8 100 49332

Central

Male 6.3 0.6 24.4 68.7 100 28796

Female 2.5 2.4 30.5 64.6 100 40839

Total 4.1 1.7 28.0 66.3 100 69635

Western

Male 1.3 1.1 18.3 79.3 100 29098

Female 0.0 0.0 18.4 81.6 100 37535

Total 0.6 0.5 18.3 80.6 100 66633

Mid-Western

Male 0.0 0.0 17.9 82.1 100 21903

Female 0.0 0.0 23.0 77.0 100 31482

Total 0.0 0.0 20.9 79.1 100 53385

Far-Western

Male 0.0 0.7 31.7 67.6 100 14040

Female 0.0 4.0 38.1 57.9 100 10709

Total 0.0 2.1 34.4 63.4 100 24749

Eco-region

Mountain

Male 0.0 0.9 34.5 64.6 100 19680

Female 0.0 0.0 32.0 68.0 100 14319

Total 0.0 0.5 33.4 66.0 100 33999

Hill

Male 1.6 0.0 12.8 85.5 100 48364

Female 0.0 0.7 16.3 83.0 100 64225

Total 0.7 0.4 14.8 84.1 100 112589

Terai

Male 2.7 0.8 29.9 66.5 100 51450

Female 1.6 1.5 31.8 65.2 100 65696

Total 2.1 1.2 31.0 65.8 100 117146

National

Male 1.8 0.5 23.8 73.9 100 119493

Female 0.7 1.0 24.9 73.4 100 144241

Total 1.2 0.8 24.4 73.6 100 263734


117

II-H2 Asthma Asthma is one of the common health problems in Nepal. Years of life lost due to asthma was

found to be 3086. The ecological distribution shows the highest (48.7%) YLL contributed by hill

and lowest (11.7%) by mountain region of Nepal. Central contributed more than 50 percent

(highest) YLL and least was contributed by far-western development region of Nepal.

The following table 3.4.31 shows the age and sex-wise YLL distribution of asthma. The sex

distribution shows males and females contributing almost equal YLL due to asthma. Similarly,

the age wise distribution shows the YLL recorded in the age group above 30 years of age and

majority (69.7%) of YLL was heaped in the elderly age group and remaining was recorded in

30-59 years age group. Ecologically distributing the mortality, hill region reported majority of

YLL among which females reported 1.6 times more YLL than males. In Eastern development

region all the YLL was accounted by elderly female population while far-western development

region entire YLL was reported by elderly male population.

Figure 3.4.27: Percentage YLL distribution due to Asthma


118

Table 3.4.32: YLL distribution of Asthma


Total YLL 30-59 60+

Development Region

Eastern

Female 0 100 100 74

Total 0 100 100 74

Central

Male 13.7 86.3 100 758

Female 52.8 47.2 100 971

Total 35.7 64.3 100 1729

Western

Male 0.0 100.0 100 124

Total 0.0 100.0 100 124

Mid-Western

Male 11.3 88.7 100 665

Female 51.3 48.7 100 474

Total 27.9 72.1 100 1139

Far-Western

Male 0.0 100.0 100 20

Total 0.0 100.0 100 20

Eco-region

Mountain

Male 53.9 46.1 100 194

Female 0.0 100.0 100 167

Total 29.0 71.0 100 361

Hill

Male 0.0 100.0 100 565

Female 54.7 45.3 100 938

Total 34.1 65.9 100 1503

Terai

Male 9.3 90.7 100 807

Female 58.6 41.4 100 415

Total 26.0 74.0 100 1222

National

Male 11.4 88.6 100 1565

Female 49.8 50.2 100 1521

Total 30.3 69.7 100 3086

II-H4 Other respiratory diseases Total years of life lost due to other respiratory diseases were found to be 3470 years.

Ecologically the majority of other respiratory diseases was observed highest in mountain (45%)

and lowest in the terai region (21.3%). The development region-wise distribution shows a

different pattern more than sixty (62.1%) percent of YLL was solely observed in the eastern

development region while least (3.3%) was reported by far-western development region.


119

The following table shows that the distribution of other respiratory diseases among which 2765

(79.7%) years of life lost was observed to be accounted by male and 705 (20.3%) was observed

to be accounted by female and respectively.

Table 3.4.33: YLL distribution of Other respiratory diseases


Age Group

Total YLL 15-29 30-59 60+

Development Region

Eastern

Male 19.3 65.7 15.0 100.0 1692

Female 33.8 0.0 66.2 100.0 464

Total 22.4 51.6 26.0 100.0 2156

Central

Male 0 0.0 100.0 100.0 84

Female 0 100.0 0.0 100.0 241

Total 0 74.2 25.8 100.0 325

Western

Male 0 0 100 100 437

Total 0 0 100 100 437

Mid-Western

Male 0 0 100 100 437

Total 0 0 100 100 437

Far-Western

Male 0 100 0 100 115

Total 0 100 0 100 115

Eco-region

Mountain

Male 30.0 62.3 7.7 100.0 1092

Female 33.3 51.1 15.7 100.0 472

Total 31.0 58.9 10.1 100.0 1564

Hill

Male 0 0 100 100 935

Female 0 0 100 100 233

Total 0 0 100 100 1168

Terai

Male 0 74.0 26.02 100 738

Total 0 74.0 26.02 100 738

National

Male 11.8 44.4 43.8 100 2765

Female 22.3 34.2 43.5 100 705

Total 13.9 42.3 43.7 100 3470

Figure 3.4.28: Percentage YLL distribution due to Other respiratory diseases


120

The burden was found to be highest (43.7%) in age group 60 and lowest (13.9%) in the age

group 15-29. Male accounted more share of YLL in each eco-development regions among

which western, mid-western and far-western development regions the entire YLL burden was

contributed by male group only

II- I Digestive diseases

Digestive diseases are most of the time related with poverty and are one of the predominant

cause of morbidity as well as mortality in Nepal. Basically digestive disease includes peptic ulcer

disease, cirrhosis of liver, appendicitis and other digestive diseases. Altogether 106578 years of

life lost were contributed by other digestive diseases. It contributed 12.8 percent of YLL among

the non-communicable diseases. Majority of YLL was observed in terai region (55.6%) and least

was observed in the mountain region (10.8%) of Nepal. The percentage distribution according to

development region was observed to be alike. Among which highest (27%) was contributed by

western and lowest (13.6%) was contributed by far-western development region of Nepal.

The burden of other digestive diseases was found to be the highest with 71.4 percent nationally.

Similarly, peptic ulcer disease and cirrhosis of the liver accounted 14.9 and 12.4 percent

respectively. Least percent was accounted by appendicitis. i.e. only 1.3 percent.Other digestive

diseases were found to be higher in all ecological as well as development region. Similarly,

appendicitis accounted the least YLL in all the regions except in central, mid-western, far-

western and hill regions which did not reported any YLL due to appendicitis.

Figure 3.4.29: Percentage YLL distribution due to Digestive diseases


121

II-I1 Peptic ulcer disease Peptic ulcer is a common type of digestive problem in Nepal. Among the digestive diseases it

ranked top second position accounting altogether 14.9 percent i.e. 15914 years of life lost. The

distribution of YLL burden was observed highest in the terai (48.7%) region and lowest in the

mountain (15.1%) region. The development wise distribution shows majority of share

contributed by western (32.2%) development and least was shared by eastern (7.1%)

development region of Nepal.

The table 3.4.33 shows the age and sex-wise distribution of YLL due to peptic ulcer. Majority of

YLL was accounted by female contributing 9466 YLL i.e. 59.5 percent nationally. Similarly, the

age distribution of YLL shows maximum (92.8%) reported by above 30 years of age and

E C W MW FW M H T

1 Peptic ulcer disease 5.0 19.8 17.8 16.9 14.6 20.9 16.1 13.1 14.9

2 Cirrhosis of the liver 5.4 17.4 17.7 15.8 0.5 11.9 14.7 11.1 12.4

3 Appendicitis 1.5 0.0 3.7 0.0 0.0 0.5 0.0 2.3 1.3

4 Other digestive diseases 88.1 62.8 60.8 67.3 84.9 66.7 69.2 73.6 71.4

Total 100 100 100 100 100 100 100 100 100

Total YLL 22676 24227 28820 16375 14480 11475 35889 59214 106578

Development Region Eco-RegionS.N. Digestive diseases National

Table 3.4.34: YLL Distribution of digestive diseases

Figure 3.4.30: Percentage YLL distribution due to Peptic ulcer disease


122

minimum (0.7%) by 0-14 years of age group. The sex distribution was observed to be higher

among females in all the eco-development regions except in eastern and far-western

development regions and all the eco-development regions except in mountain region where

males contributed more YLL than females.

Table 3.4.35: YLL distribution of Peptic ulcer disease


Age Group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 0 0 39.0 61.0 100 1043

Female 0 0 0.0 100.0 100 84

Total 0 0 36.1 63.9 100 1127

Central

Male 0 0 16.2 83.8 100 716

Female 0 0 44.2 55.8 100 4068

Total 0 0 40.0 60.0 100 4784

Western

Male 0 16.5 65.8 17.7 100 2191

Female 0 13.3 52.0 34.8 100 2933

Total 0 14.6 57.9 27.5 100 5124

Mid-Western

Male 0 0 96.4 3.6 100 1320

Female 0 0 55.7 44.3 100 1446

Total 0 0 75.1 24.9 100 2766

Far-Western

Male 0 16.6 49.7 33.7 100 1178

Female 11.2 11.0 37.6 40.1 100 935

Total 5.0 14.2 44.3 36.5 100 2113

Eco-region

Mountain

Male 0 0 51.9 48.1 100 1639

Female 0 0 47.5 52.5 100 758

Total 0 0 50.5 49.5 100 2397

Hill

Male 0 0 91.0 9.0 100 2625

Female 0 0 46.2 53.8 100 3140

Total 0 0 66.6 33.4 100 5765

Terai

Male 0 25.5 26.7 47.8 100 2184

Female 1.9 8.8 47.9 41.4 100 5568

Total 1.4 13.5 41.9 43.2 100 7752

National

Male 0 8.6 59.3 32.1 100 6448

Female 1.1 5.2 47.3 46.4 100 9466

Total 0.7 6.6 52.2 40.6 100 15914


123

II-I2 Cirrhosis of the liver Years of life lost due to cirrhosis of liver was found to be 13201 years which was 12.4 percent

among the digestive diseases. The eco-development wise distribution shows majority of YLL

accounted by terai (49.6%) and western development (38.6%) region and least was accounted by

the mountain (10.4%) and far-western (0.6%) development region of Nepal.

The sex-wise distribution shows that males accounted 9099 (68.9%) and female accounted 4102

(31.1%) YLL out of the total. Majority of YLL was contributed by the elderly (48.9%) age group

while least YLL was recorded in the 0-14 years of age group. In all the ecological regions males

contributed more YLL than females. Development region wise also more YLL was observed in

males group except in central development region where females accounted more YLL than

males. The entire YLL was reported by males in the far-western development region.

Figure 3.4.31: Percentage YLL distribution due to Cirrhosis of the liver


124

Table 3.4.36: YLL distribution of Cirrhosis of the liver


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 0 0 63.6 36.4 100 960

Female 0 0 0.0 100.0 100 268

Total 0 0 49.8 50.2 100 1228

Central

Male 0 0 79.1 20.9 100 1985

Female 0 47.8 31.5 20.8 100 2236

Total 0 25.3 53.9 20.8 100 4221

Western

Male 0 0 41.8 58.2 100 4022

Female 0 0 50.8 49.2 100 1070

Total 0 0 43.7 56.3 100 5092

Mid-Western

Male 12.3 5.9 5.6 76.2 100 2055

Female 0.0 0.0 0.0 100.0 100 526

Total 9.8 4.7 4.5 81.1 100 2581

Far-Western

Male 0 0 100 0 100 79

Total 0 0 100 0 100 79

Eco-region

Mountain

Male 18.9 0.0 52.9 28.2 100 1334

Female 0.0 0.0 0.0 100.0 100 36

Total 18.4 0.0 51.5 30.1 100 1370

Hill

Male 0 0 25.9 74.1 100 3999

Female 0 0 0.0 100.0 100 1285

Total 0 0 19.6 80.4 100 5284

Terai

Male 0 3.2 61.5 35.3 100 3766

Female 0 38.4 44.9 16.7 100 2781

Total 0 18.2 54.4 27.4 100 6547

National

Male 2.8 1.3 44.6 51.3 100 9099

Female 0.0 26.0 30.4 43.5 100 4102

Total 1.9 9.0 40.2 48.9 100 13201

II-I3 Appendicitis Appendicitis is not the serious public health problem in Nepal although this study shows

appendicitis to account 1419 years of life lost. Among the total YLL due to appendicitis males

shared 743 and females shared 676 years. The YLL was observed ecologically only in mountain

(4.2%) and terai (95.8%) region and developmental region wise only in eastern (24.5%) and

western (75.5%) development region. The sex-wise distribution showed males contributing more

(52.4%) YLL than the females. No YLL burden was observed below 15 years and the highest

share of YLL was contributed by the age group 15 to 29 years. The least was found in the elderly

age group.


125

Table 3.4.37: YLL distribution of Appendicitis


Total YLL 15-29 30-59 60+

Development Region

Eastern

Male 0 0 100 100 60

Female 0 100 0 100 287

Total 0 82.7 17.3 100.0 347

Western

Male 52.9 47.1 0 100 683

Female 100.0 0.0 0 100 389

Total 70.0 30.0 0 100 1072

Eco-region

Mountain

Male 0 0 100 100 60

Total 0 0 100 100 60

Terai

Male 52.9 47.1 0.0 100 683

Female 57.5 42.5 0.0 100 676

Total 55.2 44.8 0.0 100 1359

National

Male 48.6 43.3 8.1 100 743

Female 57.5 42.5 0.0 100 676

Total 52.9 42.9 4.2 100 1419

II-I4 Other digestive diseases Gastro-intestinal bleeding, abdominal pain cholilithiasis (gall stone), swollen abdomen etc were

kept under the category of other digestive diseases. Years of life lost due to other digestive

diseases were found to be 76046 years. The ecological distribution revealed that majority

(57.3%) of YLL was observed in the terai while least (10.1%) was observed in the mountain

region. Similarly eastern development region showed highest (26.2%) share of YLL and least

was observed in the mid-western development region of Nepal.

Figure 3.4.32: Percentage YLL distribution due to Other digestive diseases


126

The sex-wise distribution shows the majority (51.2%) i.e. 38998 YLL contributed by males. The

burden was found to be more in age group 30-59 (46.2%) nationally which was observed in all

the eco-development regions and all sex groups except in the central development where in the

females group elderly women showed the highest (50.3%) share of YLL. Sex-wise distribution

showed that in all the ecological region males accounted more YLL than females except in the

terai region. Similarly, only in the eastern, western and far-western development regions males

accounted more YLL than the females.

Table 3.4.38: YLL distribution of Other digestive diseases


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 11.9 13.1 38.9 36.1 100 8822

Female 10.6 8.3 48.3 32.9 100 11154

Total 11.1 10.4 44.1 34.3 100 19976

Central

Male 17.8 1.8 47.4 33.0 100 9035

Female 16.9 2.7 30.1 50.3 100 6188

Total 17.4 2.2 40.4 40.0 100 15223

Western

Male 9.3 9.0 52.1 29.6 100 7828

Female 11.2 11.6 53.1 24.1 100 9702

Total 10.4 10.4 52.7 26.5 100 17530

Mid-Western

Male 15.0 0.0 54.4 30.6 100 5151

Female 6.9 11.2 52.8 29.2 100 5877

Total 10.7 6.0 53.5 29.8 100 11028

Far-Western

Male 23.0 8.1 44.0 24.8 100 8162

Female 31.7 5.3 35.6 27.4 100 4127

Total 25.9 7.2 41.2 25.7 100 12289

Eco-region

Mountain

Male 31.5 9.0 39.4 20.2 100 4501

Female 25.8 26.1 30.9 17.1 100 3149

Total 29.2 16.0 35.9 18.9 100 7650

Hill

Male 5.3 3.5 50.2 40.9 100 13395

Female 6.3 2.4 57.4 33.9 100 11444

Total 5.8 3.0 53.5 37.7 100 24839

Terai

Male 18.5 8.6 46.0 27.0 100 21102

Female 15.6 8.9 42.0 33.6 100 22455

Total 17.0 8.7 43.9 30.4 100 43557

National

Male 15.5 6.9 46.7 31.0 100 38998

Female 13.6 8.4 45.8 32.3 100 37048

Total 14.5 7.6 46.2 31.6 100 76046


127

II-J Genito-urinary diseases

Genito-urinary diseases are divided into nephritis and nephrosis, benign prostatic hypertrophy,

and other genitourinary system diseases. Altogether 8.6% of YLL was contributed by

genitourinary diseases among non-communicable diseases. It was observed that terai accounted

majority of YLL (46.1%) and least aws contributed by mountain (13.7%) region. Similarly the

central development region accounted highest YLL and far-western development region sahred

the least YLL (10.9%) due to genitor-urinary diseases.

The following table 3.4.37 shows that the YLL burden of other genitourinary system disease to

be highest with 92 percent and similarly, benign prostatic hypertrophy was found to contribute

least YLL (0.2%) nationally. The trend was observed similar in all the ecological and

development regions of Nepal, highest was other genitourinary system disease and lowest was

contributed by benign prostatic hypertrophy.

E C W MW FW M H T

1 Nephritis and nephrosis 14.9 1.3 14.0 7.4 6.3 16.2 6.8 6.2 7.8

2 Benign prostatic hypertrophy 0.0 0.0 0.9 0.0 0.3 0.2 0.0 0.4 0.2

3 Other genitourinary system diseases 85.1 98.7 85.1 92.6 93.3 83.6 93.2 93.4 92.0

Total 100 100 100 100 100 100 100 100 100

Total YLL 12525 24081 13398 13951 7816 9870 28817 33082 71770

Development Region Eco-RegionS.N. Genito-urinary diseases National

Table 3.4.39: YLL Distribution of Genito-urinary Diseases

Figure 3.4.33: Percentage YLL distribution due to Genito-urinary diseases


128

II-J1 Nephritis and nephrosis Years of life lost due to Nephritis and Nephrosis was found to be 5598 years which was 7.8

percent out of the total genitor-urinary diseases. Terai region accounted majority of YLL

comprising 36.5 percent and mountain accounted least comprising only 28.5 percent of YLL in

this category. Similarly, eastern and western development regions accounted almost equal

number of percentage (i.e. 33.4 and 33.5 percent respectively) of YLL in this category and least

was accounted by central development region (5.8%).

The 0-14 years of age group was found to be most affected (97.5 percent) among the whole

burden in this cagtegory. The burden was distributed through all ecological regions with loss of

2044 years, 1957 years and 1558 years of life in Terai, Hill and Mountain respectively. Eastern

and western development region was found mostly affected than other development region with

1869 years and 1873 years of life lost. Similarly, 1037 years of life was lost at Midwestern

development region.

Figure 3.4.34: Percentage YLL distribution due to Nephritis and nephrosis


129

Table 3.4.40: YLL distribution of Nephritis and nephrosis


Total YLL 0-14 60+

Development Region

Eastern

Male 100 0 100 1347

Female 100 0 100 521

Total 100 0 100 1868

Central

Female 56.2 43.8 100 324

Total 56.2 43.8 100 324

Western

Male 100 0 100 1149

Female 100 0 100 724

Total 100 0 100 1873

Mid-Western

Male 100 0 100 785

Female 100 0 100 252

Total 100 0 100 1037

Far-Western

Female 100 0 100 496

Total 100 0 100 496

Eco-region

Mountain

Male 100 0 100 994

Female 100 0 100 603

Total 100 0 100 1597

Hill

Male 100 0 100 1569

Female 63.4 36.6 100 388

Total 92.7 7.3 100 1957

Terai

Male 100 0 100 718

Female 100 0 100 1326

Total 100 0 100 2044

National

Male 100 0 100 3281

Female 93.9 6.1 100 2317

Total 97.5 2.5 100 5598

II-J2 Benign prostatic hypertrophy Being a disease of males benign prostatic hypertrophy was found to account 147 years of life lost

which was 0.2 percent among the genitourinary system diseases nationally. It was only observed

among the elderly (60+) population. The burden was more in terai with 123 YLL (83.7%) and

only 24 YLL (16.3%) in mountain region. Similarly, the development region wise distribution

showed 124 years of life (83.7%) in western and only 24 YLL (16.3%) in far-western

development region of Nepal. Other regions did not report any YLL due to benign prostatic

hypertrophy.


130

Table 3.4.41: YLL distribution of Benign prostatic hypertrophy

Background characteristics Total YLL

Development Region

Western 100 123

Far-Western 100 24

Eco-Region

Mountain 100 24

Terai 100 123

National 100 147

II-J3 Other genitourinary system The other genitourinary system diseases were found to account 66023 years of life lost which

covered majority i.e. 92 percent of YLL among the genitor-urinary diseases. The ecological

distribution shows the majority of YLL contributed by the terai region (46.8%) and least was

contributed by the mountain region (12.5%). Likewise the distribution of YLL according to

development region shows majority of YLL contributed by central development region and

minimum was contributed by far-western development region of Nepal.

The following table shows the YLL distribution due to other genito-urinary diseases. Males were

found contributing 38428 years of life lost (58.2%) and females were responsible to account

27595 years of life (41.8%). Distribution according to the age group shows majority of YLL

contributed by elderly age group (42.1%) and least was observed in the 0-14 years of age group

Figure 3.4.35: Percentage YLL distribution due to Other genitourinary system


131

(8.7%) nationally. The sex distribution of YLL in all the eco-development regions was observed

higher among males except in mountain region where it was observed to be slight more among

females.

Table 3.4.42: YLL distribution of Other genitourinary system diseases


Age Group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 20.4 8.6 43.9 27.1 100 6648

Female 0.0 17.3 44.0 38.7 100 4008

Total 12.7 11.9 44.0 31.4 100 10656

Central

Male 9.3 23.2 30.7 36.8 100 12950

Female 0.0 1.5 54.6 43.8 100 10807

Total 5.1 13.4 41.6 40.0 100 23757

Western

Male 15.6 15.6 21.6 47.2 100 7423

Female 0.0 9.2 25.8 65.0 100 3977

Total 10.2 13.4 23.1 53.4 100 11400

Mid-Western

Male 10.1 17.2 29.3 43.4 100 7755

Female 11.3 2.3 36.1 50.3 100 5160

Total 10.6 11.3 32.0 46.2 100 12915

Far-Western

Male 18.9 3.2 36.7 41.1 100 3652

Female 0.0 2.6 59.2 38.1 100 3643

Total 9.5 2.9 48.0 39.6 100 7295

Eco-Region

Mountain

Male 27.1 11.0 42.1 19.9 100 4062

Female 13.9 7.6 41.7 36.9 100 4187

Total 20.4 9.3 41.9 28.5 100 8249

Hill

Male 9.9 12.1 24.8 53.2 100 15812

Female 0.0 4.9 33.2 61.9 100 11048

Total 5.8 9.1 28.2 56.8 100 26860

Terai

Male 13.6 20.7 34.9 30.8 100 18554

Female 0.0 4.7 59.1 36.2 100 12360

Total 8.2 14.3 44.6 33.0 100 30914

National

Male 13.5 16.1 31.5 38.9 100 38428

Female 2.1 5.2 46.1 46.6 100 27595

Total 8.7 11.6 37.6 42.1 100 66023

II-K Skin diseases

Skin diseases have been the disease with high morbidity in Nepal however its mortality is low.

Total years of life lost due to skin disease were found to be 3097 years. More than two third


132

(66%) was observed in the terai region while least (13.6%) was observed in the hill region of

Nepal. Similarly, according to the development regions, the highest YLL was observed in the

eastern region (42.1%) and the least was observed in the central development (6.7%) region of

Nepal.

The age and sex-wise distribution is presented in the table 3.4.41 below. The burden according to

the sex was observed higher among the females i.e. 1818 years of life lost and 1279 years of life

lost among males. The mortality burden was observed higher among females in all the eco-

development regions except in the far-western development and hill region of Nepal where

males accounted more YLL than the females. Similarly, the age distribution was found to be

more in the age group 0-14 (66%) and least was observed in the age group 30-59 (16.3%). No

YLL due to skin diseases was observed in the 15-29 years of age group. The age distribution was

observed dissimilar in all the regions like in hill and central development region all the YLL was

concentrated in the elderly group.

Figure 3.4.36: Percentage YLL distribution due to Skin diseases


133

Table 3.4.43: YLL distribution of Skin diseases


Age Group

Total YLL 0-14 30-59 60+

Development Region

Eastern

Male 58.7 41.3 0.0 100 603

Female 100.0 0.0 0.0 100 701

Total 80.9 19.1 0.0 100 1304

Central

Female 0.0 0.0 100.0 100 208

Total 0.0 0.0 100.0 100 208

Western

Male 0.0 0.0 100.0 100 140

Female 100.0 0.0 0.0 100 362

Total 72.1 0.0 27.9 100 502

Mid-Western

Male 0.0 37.5 62.5 100 224

Female 54.4 45.6 0.0 100 239

Total 28.1 41.7 30.2 100 463

Far-Western

Male 80.1 19.9 0.0 100 312

Female 81.5 0.0 18.5 100 308

Total 80.8 10.0 9.2 100 620

Eco-region

Mountain

Male 100.0 0.0 0.0 100 250

Female 66.9 0.0 33.1 100 375

Total 80.2 0.0 19.8 100 625

Hill

Male 0.0 0.0 100.0 100 280

Female 0.0 0.0 100.0 100 142

Total 0.0 0.0 100.0 100 422

Terai

Male 47.3 52.7 0.0 100 749

Female 91.6 8.4 0.0 100 1302

Total 75.4 24.6 0.0 100 2050

National

Male 47.2 30.9 21.9 100 1279

Female 79.4 6.0 14.6 100 1818

Total 66.1 16.3 17.6 100 3097

II-L Musculoskeletal diseases

Musculoskeletal diseases are classified into rheumatoid arthritis, gout, low back pain and other

musculoskeletal disorders. Altogether 6358 years of life lost was accounted by musculoskeletal

diseases nationally. The ecological distribution was observed more than half (52.9%) in the terai

and lowest (7.4%) in the mountain region of Nepal. Likewise, the burden was observed highest

(37.1%) in the central and lowest (4.7%) in far-western development region.


134

The highest burden was accounted by other musculoskeletal disorders i.e. 47.2 percent.

Similarly, rheumatoid arthritis contributed 33.1 percent and least YLL was accounted by gout

(0.7%). The YLL burden was observed similar in the terai region but in mountain rheumatoid

arthritis contributed more than half percent (59.4%) and in hill low back pain accounted largest

percent (45.4%) of YLL. According to the development regions, central development also

showed the similar distribution but eastern, western and far-western development regions highest

YLL accounted by rheumatoid arthritis 66.1, 40.8 and 85.3 percent respectively. Mid-western

development region showed the highest (44.2%) YLL accounted by low back pain and least

(18.3%) was accounted by other musculoskeletal disorders.

E C W MW FW M H T

1 Rheumatoid arthritis 66.1 9.8 40.8 37.5 85.3 59.4 29.0 32.5 33.1

2 Gout 0.0 0.0 0.0 0.0 14.7 0.0 0.0 1.3 0.7

3 Low back pain 10.1 0.0 31.8 44.2 0.0 12.7 45.4 0.0 19.0

4 Other musculoskeletal disorders 23.8 90.2 27.4 18.3 0.0 27.8 25.5 66.2 47.2

Total 100 100 100 100 100 100 100 100 100

Total YLL 596 2357 1807 1297 300 471 2525 3361 6358

Development Region Eco-RegionS.N. Musculoskeletal diseases National

Table 3.4.44: YLL Distribution of Musculoskeletal diseases

Figure 3.4.37: Percentage YLL distribution due to Musculoskeletal diseases


135

II-L1 Rheumatoid arthritis

Rheumatoid arthritis is a long-term disease that leads to inflammation of the joints and

surrounding tissues. It can also affect other organs. It can occur at any age and women get more

infected. Years of life lost due to rheumatoid arthritis was found to be 2106 years which was

33.1 percent of musculoskeletal diseases. Terai region showed the highest YLL (51.9%) and the

least was accounted by mountain region (13.3%). The development wise distribution showed that

western region accounted highest YLL (35%) and least was accounted by central development

region (11%).

The study revealed that females contributed more YLL (53%) nationally. Almost all the YLL

was observed among the elderly population. The proportion of YLL was observed five times

more among the females in eastern development region. The burden was found to be more

among females in all regions except in central, western and terai regions where males accounted

more YLL than the females.

Table 3.4.45: YLL distribution of Rheumatoid arthritis



Development Region

Eastern 15.7 84.3 100 394

Central 71.4 28.6 100 231

Western 76.0 24.0 100 738

Mid-Western 23.8 76.2 100 487

Far-Western 26.6 73.4 100 256

Eco-region

Mountain 33.6 66.4 100 280

Hill 23.1 76.9 100 733

Terai 64.8 35.2 100 1093

National 46.2 53.8 100 2106

Figure 3.4.38: Percentage YLL distribution due to Rheumatoid arthritis


136

II-L3 Gout Gout was observed to contribute negligible amount i.e. only 44 (0.7%) YLL among the

musculoskeletal diseases. Age distribution showed occurrence of gout among elderly population

only and was observed in the far-western terai region of Nepal.

II-L4 Low back pain Low back pain was responsible to lose 1207 years of life among which 340 years and 867 years

of life was lost by male and female respectively. The entire affected were of age 60 and above.

The burden was found to be more in hill region with 1147 years of life lost while only 60 years

of life were lost at mountain region. Western and Midwestern development region equally

accounts 574 years of life lost while 60 years of life were lost in eastern development region.

Table 3.4.46: YLL distribution of Low back pain

Background characteristics Sex Total YLL Male Female

Development region

Eastern 100 0 100 60

Western 24.4 75.6 100 573

Mid-Western 24.4 75.6 100 574

Ecological region

Mountain 100 0 100 60

Hill 24.4 75.6 100 1147

National 28.2 71.8 100 1207

II-L5 Other musculoskeletal diseases Years of life lost due to other musculoskeletal disorders was found to be 2999 years. About three

fourth (74.1%) of YLL was observed in the terai region and least was observed in the mountain

region (4.4%). Similarly, central development region accounted largest (70.9%) YLL while

lowest was observed in the eastern development region. Far-western development region did not

account any of the YLL.

Figure 3.4.39: Percentage YLL distribution due to Other musculoskeletal diseases


137

The age sex-wise distribution shows that females accounted more YLL (57.1%) due to other

musculoskeletal disorders than males. The burden was found highest (47.4%) among 0-14 years

which was followed by elderly age group (45.6%) and least (7%) was observed in 30-59 years of

age group. Females showed the higher YLL burden in all the regions except in the western

development region where all the YLL was contributed by males and in hill region where males

contributed slight higher YLL than the females. No YLL was contributed by males in the

eastern, mid-western and mountain region of Nepal.

Table 3.4.47: YLL distribution of Other musculoskeletal disorders


Total YLL 0-14 30-59 60+

Development Region

Eastern

Female 0.0 0.0 100.0 100 142

Total 0.0 0.0 100.0 100 142

Central

Male 0.0 0.0 100.0 100 791

Female 78.5 0.0 21.5 100 1334

Total 49.3 0.0 50.7 100 2125

Western

Male 75.8 0.0 24.2 100 495

Total 75.8 0.0 24.2 100 495

Mid-Western

Female 0.0 88.6 11.4 100 237

Total 0.0 88.6 11.4 100 237

Eco-Region

Mountain

Female 0.0 100.0 0.0 100 131

Total 0.0 100.0 0.0 100 131

Hill

Male 0.0 0.0 100.0 100 357

Female 0.0 0.0 100.0 100 287

Total 0.0 0.0 100.0 100 644

Terai

Male 40.4 0.0 59.6 100 929

Female 80.8 6.1 13.1 100 1295

Total 63.9 3.6 32.5 100 2224

National

Male 29.2 0.0 70.8 100 1286

Female 61.1 12.3 26.6 100 1713

Total 47.4 7.0 45.6 100 2999


138

II-M Congenital anomalies

Congenital anomalies include spina bifida, anencephaly, anorectal atresia, cleft lip, cleft palate,

renal agenesis, congenital heart anomalies, unidentified congenital anomaly and other congenital

anomalies. Terai region was observed to contribute highest (52.8%) YLL while mountain region

showed the least (16.9%). Likewise, the YLL distribution was observed more over similar in all

the development regions. More than 20 percent of YLL was accounted by eastern, mid-western

and far-western development regions each while least (14.3%) was accounted by central

development region.

Among the mentioned categories of congenital anomalies, majority of YLL was contributed by

unidentified congenital anomalies (39.5%) and least was contributed by spina bifida,

anencephaly and renal agenesis contributing 2.8 percent each nationally. The distribution was

observed similar in all the regions except in central development and mountain region of Nepal

where cleft lip and other congenital anomalies contributed highest YLL respectively.

S.N. Congenital anomalies Development Region Eco-Region

National E C W MW FW

M H T

1 Unclassified Congenital anomalies 51.4 7.9 31.6 70.8 33.5

6.7 72.0 31.3 39.5

2 Spina bifida 0.0 0.0 9.8 0.0 0.0

0.0 0.0 4.3 2.3

3 Other Congenital anomalies 38.9 0.0 29.3 24.2 6.5

56.3 12.9 14.4 21.0

4 Anencephaly 0.0 0.0 9.8 0.0 0.0

0.0 0.0 4.3 2.3

5 Anorectal atresia 0.0 0.0 9.7 5.0 28.6

23.2 5.0 8.4 9.9

6 Cleft lip 0.0 46.4 0.0 0.0 2.9

0.0 0.0 13.9 7.3

7 Cleft palate 9.7 45.6 0.0 0.0 0.0

0.0 0.0 16.5 8.7

8 Renal agenesis 0.0 0.0 0.0 0.0 9.9

13.8 0.0 0.0 2.3

9 Congenital heart anomalies 0.0 0.0 9.8 0.0 18.6

0.0 10.1 6.9 6.7

Total 100 100 100 100 100

100 100 100 100

Total YLL 3604 2294 3718 2612 3805 2708 4858 8467 16033

Table 3.4.48: YLL distribution of Congenital Anomalies

Figure 3.4.40: Percentage YLL distribution due to Congenital anomalies


139

II-M1 Unclassified Congenital anomalies The highest percentage (39.5%) of YLL due to congenital anomalies remained unclassified.

Among the YLL more than half (55.2%) was observed in the hill region and least (2.9%) was

recorded in mountain region of Nepal. The development-wise distribution shows majority of

percentage (29.2%) in eastern and mid-western development regions each and least (2.9%) was

observed in central development region.

The age and sex-wise distribution of YLL due to unclassified congenital anomalies shows most

of the YLL (98.4%) was recorded in 0-14 years age group and least (1.6%) was observed in 15-

29 years age group. Likewise 54.4 percent of YLL was contributed by males nationally. The age

distribution of the unclassified congenital anomalies was concentrated in the 0-14 age group in

all the regions. All the YLL was contributed by females in mountain and central development

region. The YLL share was higher among males in all the regions except in western, mid-

western, and hill region of Nepal.

II-M2 Anencephaly Years of life lost due to anencephaly were found to be 364 years which was only 2.3 percent of

all congenital anomalies. The entire burden was found to be concentrated in western terai region

of Nepal.

Figure 3.4.41: Percentage YLL distribution due to Unclassified Congenital anomalies


140

II-M3 Anorectal Atresia

Anorectal atresia is a type of birth defect which becomes fatal sometimes. Years of life lost due

to anorectal atresia were observed to be 1583 years which was 9.9 percent among the total YLL

due to congenital anomalies. Terai contributed highest YLL (45%) and mountain contributed

lowest YLL (15.4%). Far-western development region contributed majority of YLL (68.9%) and

least was observed in mid-western development region. No YLL was recorded from eastern and

central development regions due to anorectael atresia.

Being a birth defect YLL due to anorectael atresia was totally observed among the 0-14 years of

age group only. The sex distribution shows males to contribute 844 years (53.3%) and remaining

was observed among female group i.e. 739 years of life were lost. In mid-western and hill

regions all the YLL was contributed by males only while in the western development region all

the YLL was contributed by females. Similarly, the eastern and central development did not

report any YLL due to anorectael atresia.

II-M4 Cleft Lip Years of life lost due to cleft lip were found to be 1175 which was 7.3 percent among the

congenital anomalies category. Total YLL was observed among males group only. Similarly, the

entire burden was found in terai region. Development region-wise it was observed in Central

region (1065 YLL) and in far-western development region (110 YLL) of Nepal.

II-M5 Cleft palate Years of life lost due to cleft palate was found to be 1398 which was 8.7 percent among the

congenital anomalies category. This study revealed all the YLL accounted by females group

only. Similarly, the entire burden was found in terai region. Development region-wise it was

observed in central region (1048 YLL) and in far-western development region (350 YLL) of

Nepal.

Figure 3.4.42: Percentage YLL distribution due to Anorectal Atresia


141

II-M7 Renal agenesis Years of life lost due to renal agenesis was found to be 375 which were 2.3 percent of the

congenital anomalies category and the cases were from age group 0-14 years. The entire burden

was found to be concentrated in far-western mountain region of Nepal.

II-M9 Congenital heart anomalies Total years of life lost due to congenital heart anomalies were found to be 1072 years among

which entire YLL was recorded among males group. The burden was found in terai and hill

region with 583 years and 489 years of life lost respectively. Similarly, distributing the burden

among development region, 708 years and 364 years were lost in far-western and western

development regions respectively.

II-M10 Spina Bifida Negligible amount of YLL was contributed due to spina bifida. Among the congenital anomalies

category it accounted 2.3 percent which was about 364 years of life lost. The entire burden was

concentrated in western-terai region of Nepal.

II-M11 Other Congenital Anomaly Years of life lost due to other congenital anomalies was observed to be 3371 years. Majority of

life lost was observed in the mountain region (45.2%) and least was observed in the hill region

(18.6%). The eastern development region contributed majority of YLL (41.6%) and least was

observed in the far-western development region (7.3%). Central development region did not

report any YLL in this category.

The other congenital anomalies were observed among 0-14 years of age group. Among which

males accounted slight more (50.4%) YLL than the females (49.6%). The burden of YLL by

males was observed to be higher in all the regions except in the eastern development region

Figure 3.4.43: Percentage YLL distribution due to Other Congenital Anomaly


142

where females accounted more YLL and in the far-western development region and hill region

where all the YLL was accounted by females group only. Similarly all the YLL was contributed

by males group in mid-western development region.

II-N Blood Disorder

Mortality due to blood disorder is also found prevalent in our country. This study revealed that

altogether 4620 years of life lost was contributed due to blood disorder. Majority of YLL was

contributed from terai (47.4%) and hill (45.3%) regions while least was observed from the

mountain (7.3%) region of Nepal. Eastern development region contributed the highest YLL

(57.3%) and least was recorded from the western development region (17.5%). No YLL was

recorded from central and far-western development region.

The age and sex-wise distribution of blood disorder is given in the table 3.4.54 below. Majority

(57.8%) of YLL was contributed by females group nationally. Children of age group 0-14 were

observed to contribute highest YLL (78.4%) out of total burden due to blood disorder and least

(9.3%) was observed among the elderly age group. The YLL burden was found higher among

females in all the regions except in eastern development and terai regions. Similarly, the entire

burden was accounted by males of 0-14 years in mountain region. The age distribution was

observed highest among the 0-14 years age group in all the eco-development regions of Nepal.

Table 3.4.49: YLL distribution of Blood Disorder

Figure: 3.4.44: Percentage YLL distribution due to Blood Disorder


143


Total YLL 0-14 30-59 60+

Development region

Eastern

Male 87.6 0.0 12.4 100 1596

Female 33.4 44.4 22.2 100 1049

Total 66.1 17.6 16.3 100 2645

Western

Female 100 0 0 100 810

Total 100 0 0 100 810

Mid-Western

Male 71.8 28.2 0 100 355

Female 100.0 0.0 0 100 810

Total 91.4 8.6 0 100 1165

Eco-Region

Mountain

Male 100 0 0 100 338

Total 100 0 0 100 338

Hill

Female 77.4 11.5 11.1 100 2093

Total 77.4 11.5 11.1 100 2093

Terai

Male 81.5 6.2 12.3 100 1613

Female 60.8 39.2 0 100 576

Total 76.1 14.9 9.0 100 2189

National

Male 84.7 5.1 10.1 100 1951

Female 73.8 17.5 8.7 100 2669

Total 78.4 12.3 9.3 100 4620


144

3.5 Injuries

Injuries were observed to be responsible for 12 percent of total years of life lost nationally.

Injuries were distributed equally among all the development regions ranging from 21% to 23%

except in Far-Western region which was responsible for only 10% of total YLL. Distribution

among ecological regions shows that Terai and Hill regions are responsible for almost equal

share 44% and 41% respectively while Mountain region has minimum share 15% only.

Injuries are classified into two major categories i.e. unintentional and intentional injuries by

GBD 2000 classification. Among injury categories more than 2/3rd

of YLL (i.e. 69 percent) were

contributed by unintentional injuries. YLL due to injuries were observed in all the ecological and

developmental regions of Nepal. The entire ecological and developmental regions showed

similar distribution of the injury categories as the national. However, burden due to unintentional

injuries were found to be lower in Eastern region (62.5%) as compared to other regions as well

as national estimates.

Table 3.5.1 : YLL distribution of Unintentional Injuries

Injury Categories Development Region Ecological Region


Unintentional

Injuries 62.5 71.9 71.4 70.3 71.8 70.8 68.1 69.7 69.2

Intentional Injuries 37.5 28.1 28.6 29.7 28.2 29.2 31.9 30.3 30.8

Total 100 100 100 100 100 100 100 100 100

Total YLL 64606 61700 57993 65091 27369 41605 112782 122372 276759

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


23.3 22.3 21.0 23.5

9.9 15.0

40.8 44.2

Figure 3.5.1 Region wise distribution of total YLL due to Injuries


145

The distribution of injury category shows road traffic accident as the major cause of YLL sharing 21.8

percent out of total injuries. Likewise poisoning was the second leading cause of YLL in this category.

Snake bite covers 15.4 percent of YLL out of all. Conflict ranked 10th position contributing 1.8 percent of

YLL. At last 1.6 percent of YLL was contributed by other intentional injuries like Dakoits attack,

robberies etc.

Table 3.5.2: YLL distribution of Injury categories

Rank Injury categories YLL Percent

1 Road traffic accidents 59449 21.48

2 Poisonings 54179 19.58

3 Snake Bite 42613 15.40

4 Falls 38920 14.06

5 Fires 26796 9.68

6 Drownings 17769 6.42

7 Other unintentional injuries 12013 4.34

8 Self-inflicted injuries 9123 3.30

9 Violence 6099 2.20

10 Conflict 5186 1.87

11 Other intentional injuries 4613 1.67

Total 276759 100

III-A Unintentional Injuries The burden of injuries in Nepal has yet to be addressed in a systematic fashion. Altogether

191560 YLL had been lost due to injuries which are responsible for 69% of total YLL due to

injuries.

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


21.1 23.2 21.6 23.9

10.3 15.4

40.1 44.5

Figure 3.5.2 Region wise distribution of total YLL due to Unintentional Injuries


146

Region wise distribution shows similar pattern as that of total YLL distribution due to Injuries

with highest share of Terai (45%) followed by Hill (40%) and Mountain

(15%). Likewise burden is evenly distributed among the development regions except far-western

region which has only 10% burden.

Table 3.5.3 : YLL distribution of Unintentional Injuries



Road traffic accidents 14.4 25.5 27.7 22.4 19.2 10.6 27.7 21.3 22.2

Poisonings 2.7 5.1 2.8 2.0 3.5 3.2 1.9 4.3 3.2

Snake Bite 7.8 13.0 7.5 9.1 8.0 0.4 7.0 14.3 9.3

Falls 23.6 25.7 28.1 30.3 39.6 39.1 36.0 17.6 28.3

Fires 2.1 4.5 0.0 3.0 4.8 5.0 3.0 1.7 2.7

Drowning 31.1 19.6 23.8 11.0 14.3 16.4 11.4 29.7 20.3

Other unintentional

injuries 18.4 6.5 10.2 22.2 10.6 25.3 12.9 11.0 14.0

Total 100 100 100 100 100 100 100 100 100

Total YLL 40375 44361 41390 45776 19658 29460 76856 85244 191560

The YLL distribution due to Road Traffic Accident (RTA), Poisonings, Snake Bite, Falls, Fires,

Drowning and other unintentional injuries is shown in the Table 3.5.2. Majority of YLL i.e. 28.2

percent is contributed by fall which is followed by RTA (22.2%) and drowning (20.3%). Cause

specific YLL distribution among all the regions were similar to that of national except Terai and

Eastern region where the highest contributor is drowning instead of RTA. Even though the ranks

were similar to national, the percentage distribution was quite different. Percentage share of Falls

category was quite high in Mid-Western (30%), Far-Western (40%), Mountain (39%) and Hill

(36%) region as compared to national (28%). In contrast, its burden was only 18% in Terai.

Likewise, Burden of RTA were found to be little higher in Western and Hill region. Percentage

share of Poisonings were found to be almost two higher (5%) than national (3%) in Central

region. Eastern and Terai region had highest share of burden due to drowning; 31% and 30%

respectively.

III-A1 Road Traffic Accident Road traffic Accidents (RTA) has emerged as an important investigations during recent years in

Nepal. Years of life lost shared by RTA among the total unintentional injuries was found to be

the second highest responsible for about 22 percent of total YLL i.e. 42612 years. Development

region wise distribution shows the burden to be equally distributed in Central and Western region

(26%) followed by Mid-Western region (24%), Eastern (14%) and Far-Western (9%). While

ecological region wise distribution is different from that of distribution of total injuries. Unlike

total burden of injuries, Hill region has higher burden (50%) than Terai (43%), however,

Mountain region consistently shared minimum burden (7%).


147

According to the age and sex distribution of the mortality it was observed more among the males

almost 12 times higher than in females. All the regions also showed similar pattern, however the

difference varied with the regions. The male female difference was highest in Hill region with 20

times higher burden in males than in females. Likewise among the development regions this

difference was highest in Central region (16 times) followed by Eastern region (15 times). Age

wise distribution was higher in 15-29 age group (46%). Mountain and Terai regions had similar

distribution across the age groups except Hill region in which burden was highest in 30-59 age

group (51%). In contrast, all the regions had highest burden in 30-59 age group except Central

region.

0.0

10.0

20.0

30.0

40.0

50.0

60.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


13.7

26.6 26.9 24.0

8.9 7.4

50.0

42.6

Figure 3.5.3. Region wise distribution of total YLL due to Road traffic Accidents


148

Table3.5.4: YLL distribution of Road traffic accidents


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 18.6 38.7 42.7 0.0 100 5443

Female 0.0 0.0 62.0 38.0 100 374

Total 17.4 36.2 44.0 2.4 100 5817

Central

Male 1.7 72.6 25.7 0.0 100 10642

Female 52.1 47.9 0.0 0.0 100 685

Total 4.8 71.1 24.1 0.0 100 11327

Western

Male 10.5 36.5 49.0 4.0 100 10602

Female 0.0 0.0 79.0 21.0 100 844

Total 9.7 33.9 51.2 5.3 100 11446

Mid-Western

Male 1.3 44.7 53.3 0.7 100 9424

Female 0.0 29.1 41.3 29.6 100 814

Total 1.2 43.4 52.3 3.0 100 10238

Far-Western

Male 3.9 39.0 43.7 13.4 100 3121

Female 50.8 0.0 31.7 17.5 100 662

Total 12.1 32.1 41.6 14.1 100 3783

Ecological region

Mountain

Male 12.8 61.2 21.3 4.7 100 2384

Female 47.5 43.7 0.0 8.8 100 751

Total 21.1 57.0 16.2 5.7 100 3135

Hill

Male 3.3 43.9 51.5 1.2 100 20282

Female 22.5 0.0 42.9 34.6 100 1027

Total 4.3 41.8 51.1 2.8 100 21309

Terai

Male 9.5 52.9 34.3 3.3 100 16566

Female 6.6 14.8 62.6 16.0 100 1601

Total 9.2 49.5 36.8 4.4 100 18167

National

Male 6.5 48.8 42.4 2.3 100 39233

Female 20.5 16.7 42.7 20.0 100 3379

Total 7.6 46.2 42.4 3.7 100 42612

III-A2 Poisonings Poisoning with various substance is common everywhere. Years of life lost shared by Poisonings

among the total unintentional injuries was found to be only about 3 percent of total YLL i.e.

6099 years. According to the age and sex distribution of the mortality it was observed more

among the males of 0-14 age group (47%). Sex wise distribution was similar to that of national

in all ecological regions, however, among development regions only Western regions had higher


149

burden in males than females. While Central and Far-Western regions showed females had

higher burden than males. Eastern and Mid-Western region had total burden in males only. Age

wise distribution among the regions was not consistent. Only Central and Terai regions had

highest burden in 0-14 age group while in case of Eastern and Mountain regions, it was in 15-29

age group. Likewise, in Hill, Mid-Western and Western region, majority of burden was in 60+

age group.

Table 3.5.5: YLL distribution of Poisonings


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 0.0 61.0 26.6 12.4 100 1071

Total 0.0 61.0 26.6 12.4 100 1071

Central

Male 100.0 0.0 0.0 0.0 100 1065

Female 88.0 0.0 12.0 0.0 100 1190

Total 93.7 0.0 6.3 0.0 100 2255

Western

Male 0.0 42.7 0.0 57.3 100 762

Female 100.0 0.0 0.0 0.0 100 390

Total 33.9 28.2 0.0 37.9 100 1152

Mid-Western

Male 14.0 27.1 12.0 46.9 100 931

Total 14.0 27.1 12.0 46.9 100 931

Far-Western

Male 0.0 0.0 100.0 0.0 100 75

Female 39.9 0.0 60.1 0.0 100 616

Total 35.6 0.0 64.4 0.0 100 691

Ecological region

Mountain

Male 0.0 83.1 0.0 16.9 100 786

Female 0.0 0.0 100.0 0.0 100 143

Total 0.0 70.3 15.4 14.3 100 929

Hill

Male 0.0 0.0 0.0 100.0 100 873

Female 39.9 0.0 60.1 0.0 100 616

Total 16.5 0.0 24.8 58.6 100 1489

Terai

Male 53.3 25.7 21.0 0.0 100 2243

Female 100.0 0.0 0.0 0.0 100 1437

Total 71.5 15.7 12.8 0.0 100 3680

National

Male 30.6 31.5 12.1 25.8 100 3903

Female 76.6 0.0 23.4 0.0 100 2196

Total 47.2 20.2 16.1 16.5 100 6099

Distributing YLL among the regions, its burden was found to be highest in Central region (37%)

while remaining four development regions had little difference in their percentage share ranging


150

from 11% to 19 %. Likewise, Terai was estimated to have more than double burden contributed

by Hill (24%) and four times more burden than Mountain (15%).

III-A3 Falls Nepal has one of the highest rates of road accidents in the world. Years of life lost shared by falls

among the total unintentional injuries was found to be the highest of about 28 percent of total

YLL (54179 YLL). Burden of falls is found to be almost equally distributed among the

development regions, however, Mid-Western region had highest burden (26%) and Far-Western

region had the lowest burden (14%). Among the ecological regions, Hill region constituted more

than half of the total burden due to Falls while Mountain and Terai regions had almost similar

burden 21% and 28% respectively.

According to the four major age groups, highest YLL was observed in 30-59 age group (32%).

Sex wise distribution showed higher mortality burden in males than in females. All the regions

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


17.5

37.0

18.9 15.3 11.3 15.2 24.4

60.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


17.6 21.1 21.4 25.6

14.4 21.2

51.0

27.7

Figure 3.5.4.Region wise distribution of total YLL due to Poisonings

Figure 3.5.5.Region wise distribution of total YLL due to Falls


151

had similar pattern of sex wise distribution. Particularly in Eastern region, mortality burden in

males were four times higher than in females. Age wise distribution was also similar to national

distribution except in Western, Mid-Western and Hill region where higher burden was observed

in 15-29 age group.

Table 3.5.6: YLL distribution of Falls


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 23.3 14.9 42.7 19.1 100 7595

Female 18.3 8.3 33.7 39.8 100 1913

Total 22.3 13.5 40.9 23.2 100 9508

Central

Male 35.9 18.6 24.7 20.9 100 6297

Female 35.5 36.3 28.2 100 5114

Total 35.7 10.3 29.9 24.2 100 11411

Western

Male 9.6 46.9 22.4 21.1 100 8040

Female 21.5 53.1 25.5 100 3577

Total 6.6 39.1 31.8 22.4 100 11617

Mid-Western

Male 21.5 40.8 23.1 14.7 100 9538

Female 22.3 20.5 35.5 21.7 100 4328

Total 21.7 34.4 27.0 16.9 100 13866

Far-Western

Male 29.3 22.6 37.6 10.5 100 3960

Female 24.0 30.4 37.8 7.8 100 3816

Total 26.7 26.4 37.7 9.2 100 7776

Ecological region

Mountain

Male 24.7 17.4 45.2 12.7 100 7391

Female 24.7 24.1 33.9 17.3 100 4119

Total 24.7 19.8 41.2 14.3 100 11510

Hill

Male 22.2 37.9 20.7 19.2 100 18668

Female 20.8 19.6 39.6 20.1 100 8971

Total 21.7 32.0 26.8 19.5 100 27639

Terai

Male 21.8 26.5 32.9 18.8 100 9371

Female 20.5 3.9 42.9 32.6 100 5658

Total 21.3 18.0 36.7 24.0 100 15029

National

Male 22.6 30.6 29.0 17.7 100 35431

Female 21.6 15.9 39.3 23.2 100 18748

Total 22.2 25.5 32.6 19.6 100 54179


152

III-A4 Fires Years of life lost shared by fires among the total unintentional injuries was found to be negligible

accounting for only 2 percent of total YLL (5186 YLL). According to the four major age groups,

highest YLL was observed in 0-14 age group (64%). Region wise distribution also showed

similar distribution however, Eastern region is the only region where burden was highest in 60+

age group (62%). At national level, sex wise distribution showed five times higher mortality

burden in females than in males. All the regions had higher burden in females than in males at

almost same proportion as that of national except Eastern and Hill region where the burden was

six and eight times higher in females than males respectively.

Table 3.5.7: YLL distribution of Fires


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 0.0 0.0 0.0 100.0 100 120

Female 44.3 0.0 0.0 55.7 100 743

Total 38.1 0.0 0.0 61.9 100 863

Central

Female 50.0 50.0 0.0 0.0 100 1995

Total 50.0 50.0 0.0 0.0 100 1995

Mid-Western

Male 100.0 0.0 0.0 0.0 100 262

Female 100.0 0.0 0.0 0.0 100 1131

Total 100.0 0.0 0.0 0.0 100 1393

Far-Western

Male 81.5 0.0 18.5 0.0 100 454

Female 100.0 0.0 0.0 0.0 100 481

Total 91.0 0.0 9.0 0.0 100 935

Ecological region

Mountain

Male 51.0 0.0 0.0 49.0 100 245

Female 97.0 0.0 0.0 3.0 100 1215

Total 89.3 0.0 0.0 10.7 100 1460

Hill

Male 100.0 0.0 0.0 0.0 100 244

Female 51.5 48.5 0.0 0.0 100 2059

Total 56.7 43.3 0.0 0.0 100 2303

Terai

Male 75.7 0.0 24.3 0.0 100 346

Female 64.9 0.0 0.0 35.1 100 1076

Total 67.5 0.0 5.9 26.6 100 1422

National

Male 75.6 0.0 10.0 14.4 100 836

Female 67.5 22.9 0.0 9.5 100 4350

Total 68.8 19.2 1.6 10.3 100 5186


153

LIkewise, region wise distribution shows that Central region had the highest YLL due to Fires

(38.5%) followed by Mid-Western region (27%). Likewise, majority of burden is confined in

Hill region (44%) while Mountain and Terai regions had almost similar burden of about 28%.

III-A5 Drowning Years of life lost shared by drowning among the total unintentional injuries was found to be 20

percent of total YLL i.e. 38921 years. Distribution of mortality burden among the development

regions doesn't show much difference, however, highest contributor is Eastern region (32%) and

lowest is Far-western region (7%). Ecological region wise distribution shows majority of burden

in Terai region (65%).

According to the age and sex distribution of the mortality it was observed more among the males

of 0-14 age group (62%). Age and sex wise distribution was similar to national in all regions.

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


16.6

38.5

0

26.9

18.0

28.2

44.4

27.4

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


32.2 22.3 25.3

12.9 7.2

12.4 22.5

65.1

Figure 3.5.6.Region wise distribution of total YLL due to Fires

Figure 3.5.7.Region wise distribution of total YLL due to Drowning


154

Table 3.5.8: YLL distribution of Drowning


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 46.7 25.7 24.4 3.2 100 8950

Female 68.7 9.3 19.7 2.3 100 3596

Total 53.0 21.0 23.1 2.9 100 12546

Central

Male 61.9 8.9 29.3 0.0 100 4023

Female 84.0 0.0 3.1 13.0 100 4670

Total 73.7 4.1 15.2 7.0 100 8693

Western

Male 45.6 23.5 28.9 2.0 100 7432

Female 83.3 16.7 0.0 0.0 100 2426

Total 54.9 21.8 21.8 1.5 100 9858

Mid-Western

Male 72.3 18.7 7.0 2.0 100 3384

Female 89.5 0.0 10.5 0.0 100 1632

Total 77.9 12.6 8.1 1.4 100 5016

Far-Western

Male 71.3 11.1 11.4 6.2 100 2028

Female 61.7 28.0 10.2 0.0 100 781

Total 68.6 15.8 11.1 4.5 100 2809

Ecological region

Mountain

Male 29.3 47.5 23.2 0.0 100 4058

Female 61.2 20.3 18.5 0.0 100 774

Total 34.4 43.1 22.5 0.0 100 4832

Hill

Male 85.7 4.4 7.5 2.4 100 5152

Female 87.4 0.0 6.4 6.1 100 3615

Total 86.4 2.6 7.1 4.0 100 8767

Terai

Male 50.3 18.7 28.0 3.0 100 16607

Female 77.1 9.2 8.4 5.3 100 8714

Total 59.5 15.4 21.2 3.8 100 25321

National

Male 54.0 20.4 23.2 2.4 100 25819

Female 79.0 7.3 8.4 5.2 100 13102

Total 62.5 16.0 18.2 3.4 100 38921

III-A6 Other unintentional injuries Years of life lost shared by other unintentional injuries among the total unintentional injuries was

found only 13 percent of total YLL i.e. 26796 years. According to the age distribution of the

mortality, it was observed more in 15-29 age group (35%). All the regions also had similar

pattern of age distribution except Terai, Far-Western and Central region where the burden was

higher in 30-59 age group. Distributing total years of life lost among two sexes, the burden was

found to be two times higher in males than in females. Sex wise distribution in the regions also

showed similar pattern. Particularly in Mountain, Eastern and Western region, burden in males


155

was much higher (three, four and five times respectively) than females in comparison to other

regions.

Table 3.5.9: YLL distribution of Other unintentional injuries


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 22.1 31.9 32.6 13.4 100 6188

Female 42.3 21.9 20.4 15.4 100 1231

Total 25.5 30.2 30.5 13.7 100 7419

Central

Male 0.0 10.9 58.5 30.5 100 1635

Female 0.0 0.0 40.7 59.3 100 1260

Total 0.0 6.2 50.8 43.0 100 2895

Western

Male 0.0 69.0 26.8 4.1 100 3408

Female 0.0 0.0 78.4 21.6 100 821

Total 0.0 55.6 36.9 7.5 100 4229

Mid-Western

Male 20.2 46.1 29.7 4.0 100 6882

Female 32.1 28.5 34.0 5.4 100 3282

Total 24.0 40.4 31.1 4.5 100 10164

Far-Western

Male 25.3 37.8 31.3 5.6 100 1398

Female 31.2 17.1 45.7 6.1 100 690

Total 27.3 31.0 36.0 5.7 100 2088

Ecological region

Mountain

Male 22.2 40.3 35.0 2.5 100 5665

Female 24.6 51.9 11.5 12.0 100 1802

Total 22.8 43.1 29.3 4.8 100 7467

Hill

Male 7.9 49.5 30.1 12.4 100 7190

Female 0.0 9.9 77.2 13.0 100 2741

Total 5.7 38.6 43.1 12.6 100 9931

Terai

Male 19.3 35.5 33.4 11.9 100 6655

Female 49.0 4.4 18.8 27.8 100 2743

Total 28.0 26.4 29.1 16.5 100 9398

National

Male 15.9 42.1 32.6 9.4 100 19511

Female 24.6 18.2 39.0 18.3 100 7285

Total 18.3 35.6 34.4 11.8 100 26796

Region wise distribution showed that majority of burden due to other unintentional injuries was

found to be in two regions Mid-Western (38%) and Eastern (28%) region among the

development regions. However, there was not much difference in burden distribution among the

ecological regions; Hill (37%), Terai (35%) and Mountain (28%).


156

III-A7 Snake Bite Snakebite occurs in all parts of Nepal where there is tropical climate that favors the snakes.

Years of life lost shared by snake bites among the total unintentional injuries was found to be

about 9 percent of total YLL. Highest burden of snake bite was observed in Central region (32%)

followed by Mid-Western (23%). Likewise, majority of burden was observed in Terai region

(69%).

According to the age and sex distribution of the mortality it was observed more among the

females of 0-14 age group (66%). Central and Far-Western region were found to have highest

burden in age groups 15-29 (25%) and 30-59 (42%) while remaining regions had age distribution

similar to that of national distribution. Likewise, sex wise distribution was found to higher in

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


27.7

10.8 15.8

37.9

7.8

27.9

37.1 35.1

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


17.7

32.6

17.4 23.5

8.9 0.7

30.5

68.8

Figure 3.5.8.Region wise distribution of total YLL due to other unintentional injuries

Figure 3.5.9.Region wise distribution of total YLL due to snake bite


157

females than in males in all regions with an exception of Central, Mid-Western and Terai where

the pattern was just opposite.

Table 3.5.10: YLL distribution of Snake Bite


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 100.0 0.0 0.0 0.0 100 690

Female 80.7 13.6 0.0 5.8 100 2461

Total 84.9 10.6 0.0 4.5 100 3151

Central

Male 28.5 54.5 16.9 0.0 100 3733

Female 51.9 48.1 0.0 0.0 100 2052

Total 36.8 52.3 10.9 0.0 100 5785

Western

Male 100.0 0.0 0.0 0.0 100 1149

Female 81.9 0.0 0.0 18.1 100 1940

Total 88.6 0.0 0.0 11.4 100 3089

Mid-Western

Male 86.2 0.0 9.1 4.7 100 2260

Female 90.2 0.0 9.8 0.0 100 1909

Total 88.0 0.0 9.5 2.6 100 4169

Far-Western

Male 68.7 0.0 23.1 8.2 100 668

Female 11.6 25.2 56.8 6.5 100 909

Total 35.8 14.5 42.5 7.2 100 1577

Ecological region

Mountain

Female 0.0 100.0 0.0 0.0 100 126

Total 0.0 100.0 0.0 0.0 100 126

Hill

Male 100.0 0.0 0.0 0.0 100 1814

Female 88.2 0.0 11.8 0.0 100 3604

Total 92.2 0.0 7.8 0.0 100 5418

Terai

Male 52.3 30.5 14.8 2.4 100 6685

Female 59.3 25.7 5.0 9.9 100 5540

Total 55.5 28.3 10.4 5.8 100 12225

National

Male 62.5 24.0 11.7 1.9 100 8499

Female 69.8 16.7 7.6 5.9 100 9270

Total 66.3 20.2 9.5 4.0 100 17769

III-B Intentional injuries Total burden due to intentional injuries was estimated to be more than 85 thousands YLL

responsible for 31 percent of total YLL due to injuries. Intentional injuries are classified into sub

groups' viz. self-inflicted injuries, violence, war and other intentional injuries. Region wise

distribution showed not much difference in burden among the development regions with highest


158

burden in Eastern region (28%) followed by Mid-Western region. Among the ecological regions,

Terai and Hill regions had almost equal burden 44% and 42% respectively while mountain

region had only 14% mortality burden due to intentional injuries.

Distributing burden of intentional injuries among the specific diseases within it, burden of self-

inflicted injuries was high with 69.8 percent and 14.1 percent of life years were lost due to war.

The burden of self-inflicted injuries was higher in all regions followed by War. Only Eastern and

Western regions had other intentional injuries as second leading cause of mortality. Percentage

share of these causes in each region is quite different. Percentage share of self-inflicted injuries is

found to be highest in Terai (75%) among the ecological regions and in Far-Western region

(79%) among the development regions. Likewise, percentage share of burden due to war highest

in Mid-western region (25%).

Table 3.5.11 : YLL distribution of Intentional Injuries



Self-inflicted injuries 77.5 77.4 59.5 58.3 79.0 66.7 65.1 75.3 69.8

Violence 8.4 7.5 3.5 3.6 0.0 3.2 6.9 4.8 5.4

War 4.6 13.2 15.1 24.9 16.7 21.8 15.5 10.3 14.1

Other intentional injuries 9.5 1.8 21.9 13.1 4.3 8.3 12.6 9.7 10.7

Total 100 100 100 100 100 100 100 100 100

Total YLL 24231 17339 16601 19315 7712 12146 35925 37128 85199

III-B1 Self-inflicted injuries Self-inflected injuries are common in developing world however not much research have been

done in these areas. Years of life lost due to self-inflicted injuries were found to be 59450 yrs

responsible for 70% of total YLL due to intentional injuries. Age wise distribution showed that

age group 15-29 and 30-59 accounted most of the burden with 48.11 and 43.76 percent

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


28.4

20.4 19.5 22.7

9.1 14.3

42.2 43.6

Figure 3.5.10.Region wise distribution of total YLL due to Intentional injuries


159

respectively. Even among the regions, the burden was mainly distributed in these two age

groups. Eastern, Terai and Far-Western regions had higher burden in 15-29 age group while

remaining regions had higher burden in 30-59 age group. Sex wise distribution was also not

consistent among the regions. At national level, both sexes had almost equal burden. At regional

level, Central, Western and Terai regions had higher burden in females than males while the

remaining regions had higher burden in males.

Table 3.5.12: YLL distribution of self inflicted injuries


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 3.5 48.9 42.8 4.8 100 10067

Female 5.7 59.5 29.7 5.1 100 8709

Total 4.5 53.8 36.7 4.9 100 18776

Central

Male 0.0 68.3 27.1 4.6 100 5859

Female 0.0 25.4 73.2 1.3 100 7569

Total 0.0 44.1 53.1 2.8 100 13428

Western

Male 9.9 8.6 66.3 15.2 100 3791

Female 0.0 37.8 54.9 7.4 100 6090

Total 3.8 26.6 59.3 10.4 100 9881

Mid-Western

Male 0.0 27.7 62.9 9.5 100 6675

Female 0.0 37.7 52.8 9.4 100 4593

Total 0.0 31.8 58.8 9.5 100 11268

Far-Western

Male 3.0 63.6 31.1 2.2 100 3474

Female 0.0 59.8 38.6 1.6 100 2619

Total 1.7 62.0 34.3 2.0 100 6093

Ecological Region

Mountain

Male 0.0 42.5 51.9 5.6 100 5169

Female 5.6 45.3 45.2 3.9 100 2938

Total 2.0 43.5 49.5 5.0 100 8107

Hill

Male 3.0 37.0 49.8 10.3 100 11819

Female 0.0 31.2 59.3 9.5 100 11576

Total 1.5 34.1 54.5 9.9 100 23395

Terai

Male 3.7 52.3 39.8 4.2 100 12880

Female 2.2 51.5 44.6 1.7 100 15065

Total 2.9 51.9 42.4 2.8 100 27945

National

Male 2.8 44.5 45.8 6.8 100 29869

Female 1.7 43.0 50.4 5.0 100 29581

Total 2.2 43.8 48.1 5.9 100 59450


160

Region wise distribution shows its highest burden in Eastern region (32%) followed by Central

(22%) and Mid-Western region (19%). Likewise, Terai region is accounts almost half of the total

burden (i.e. 47%) while Mountain region has the minimum burden (14%).

III-B2 Violence Total mortality burden due to violence was 4615 YLL accounting for 5% of total YLL due to

intentional injuries. Among the regions, Eastern region had highest burden due to violence (44%)

followed by Central region (28%). Likewise, majority of burden was in hilly region (53%)

followed by Terai region (38%) and Mountain (8%).

Violence was reported five times higher in males than in females at national level. Region wise

distribution also showed higher burden in males with highest difference in Hill region with seven

times higher burden in males than females. Distributing the burden among age groups, 15-29 yrs

and 30-59 yrs of age were affected the most with 37.10 and 34.52 percent respectively. Region

wise distribution didn't show any consistency in age wise distribution. In Eastern and Terai

regions burden was highest in 15-29 age group while Hill and Central regions had highest burden

in 30-59 and 0-14 age group respectively. Regarding Western, Mid-Western and Mountain

region total burden was estimated to be in males only.

0.0 10.0 20.0 30.0 40.0 50.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


31.6 22.6 16.6 19.0

10.2 13.6

39.4 47.0

0.0 10.0 20.0 30.0 40.0 50.0 60.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Mo

un

tain

Hill

Tera

i


43.9

28.4

12.5 15.1 8.3

53.3 38.3

Figure 3.5.11.Region wise distribution of total YLL due to Self-inflected injuries

Figure 3.5.12.Region wise distribution of total YLL due to Violence


161

Table 3.5.13: YLL distribution of Violence

Background

Characteristics

Age Group Total YLL

0-14 15-29 30-59 60+

Development Region

Eastern

Male 0.0 74.7 25.3 0.0 100 1726

Female 0.0 100.0 0.0 100 302

Total 0.0 78.5 21.5 0.0 100 2028

Central

Male 93.1 0.0 0.0 6.9 100 846

Female 0.0 0.0 0.0 100.0 100 464

Total 60.2 0.0 0.0 39.8 100 1310

Western

Male 0.0 0.0 100.0 0.0 100 578

Total 0.0 0.0 100.0 0.0 100 578

Mid-Western

Male 0.0 17.3 82.7 0.0 100 699

Total 0.0 17.3 82.7 0.0 100 699

Ecological region

Mountain

Male 0.0 84.9 0.0 15.1 100 385

Total 0.0 84.9 0.0 15.1 100 385

Hill

Male 36.5 0.0 63.5 0.0 100 2159

Female 0.0 100.0 0.0 0.0 100 302

Total 32.0 12.3 55.7 0.0 100 2461

Terai

Male 0.0 83.0 17.0 0.0 100 1305

Female 0.0 0.0 0.0 100.0 100 464

Total 0.0 61.2 12.5 26.2 100 1769

National

Male 20.5 36.6 41.4 1.5 100 3849

Female 0.0 39.4 0.0 60.6 100 766

Total 17.1 37.1 34.5 11.3 100 4615

III-B3 War

A decade long political conflict has adversely affected health and development of people of

Nepal. It was estimated that war was responsible for more than twelve thousands years of life

lost which was 14 percent of total YLL due to intentional injuries.

0.0 10.0 20.0 30.0 40.0 50.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


9.3 19.0 20.9

40.1

10.7 22.0

46.3 31.7

Figure 3.5.13.Region wise distribution of total YLL due to War


162

Region wise distribution shows highest burden in Mid-Western region (40%) and lowest in

Eastern region (9%). Likewise, almost half of total burden was in Hill region (46%) followed by

Terai (32%) and Mountain (22%). According to table 3.5.13, mortality burden due to war was

found to be highest in 15-29 age group (83%) at national and similar distribution was observed in

all the regions. Males were found to be more affected by war at national level. Likewise at

regional levels also the pattern was similar, either whole burden was concentrated in males or

majority of burden was in males than their female counterpart.

Table 3.5.14: YLL distribution of War


Total YLL 0-14 15-29 30-59

Development Region

Eastern

Male 0.0 48.9 51.1 100 1116

Total 0.0 48.9 51.1 100 1116

Central

Male 0.0 100.0 0.0 100 2282

Total 0.0 100.0 0.0 100 2282

Western

Male 0.0 79.0 21.0 100 2512

Total 0.0 79.0 21.0 100 2512

Mid-Western

Male 0.0 100.0 0.0 100 4259

Female 0.0 100.0 0.0 100 555

Total 0.0 100.0 0.0 100 4814

Far-Western

Male 16.2 25.3 58.6 100 1291

Total 16.2 25.3 58.6 100 1291

Ecological region

Mountain

Male 0.0 85.0 15.0 100 2094

Female 0.0 100.0 100 555

Total 0.0 88.1 11.9 100 2649

Hill

Male 0.0 88.8 11.2 100 5557

Total 0.0 88.8 11.2 100 5557

Terai

Male 5.5 70.5 24.0 100 3808

Total 5.5 70.5 24.0 100 3808

National

Male 1.8 82.0 16.2 100 11459

Female 0.0 100.0 0.0 100 555

Total 1.7 82.8 15.4 100 12014

III-B4 Other intentional injuries Total Years of life lost due to other intentional injuries was found to be 9123 yrs. Distributing the

burden among age groups, majority of burden (58%) was found in 30-59 age group. Age wise

distribution was also similar in all development and ecological regions. Likewise, distributing

burden among males and females, it was found to be three times higher in males than females.

Among the regions also, males had higher burden than females, highest difference was observed

in Terai region with six times higher burden in males than females.


163

Table 3.5.15: YLL distribution of Other intentional injuries


Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 15.3 26.3 58.4 0.0 100 2311

Total 15.3 26.3 58.4 0.0 100 2311

Central

Male 0.0 100.0 0.0 0.0 100 179

Female 0.0 0.0 100.0 100 142

Total 0.0 55.8 0.0 44.2 100 321

Western

Male 14.6 0.0 85.4 0.0 100 2497

Female 0.0 100.0 0.0 0.0 100 1134

Total 10.0 31.2 58.7 0.0 100 3631

Mid-Western

Male 8.0 0.0 92.0 0.0 100 1635

Female 14.5 85.5 0.0 0.0 100 898

Total 10.3 30.3 59.4 0.0 100 2533

Far-Western

Male 0.0 0.0 100.0 0.0 100 272

Female 0.0 0.0 0.0 100.0 100 57

Total 0.0 0.0 82.7 17.3 100 329

Ecological region

Mountain

Male 0.0 18.9 81.1 0.0 100 949

Female 0.0 0.0 0.0 100.0 100 57

Total 0.0 17.8 76.5 5.7 100 1006

Hill

Male 0.0 0.0 100.0 0.0 100 2833

Female 0.0 91.5 0.0 8.5 100 1678

Total 0.0 34.1 62.8 3.1 100 4511

Terai

Male 27.2 19.5 53.2 0.0 100 3112

Female 26.3 73.7 0.0 100 495

Total 27.1 26.9 45.9 0.0 100 3607

National

Male 12.3 11.4 76.3 100 6892

Female 5.8 85.3 8.9 100 2231

Total 10.7 29.5 57.6 2.2 100 9123

Distributing YLL among the regions, the burden was mainly distributed among Western (40%),

Mid-Western (28%) and Eastern region (25%). Ecological wise distribution showed that half of

burden was concentrated in hill region (50%) followed by Terai (39%) and Mountain region

(11%).


164

3.6 Unidentified Cases

The mortality cases whose cause of death could not be identified were placed under this

category. Such cases contributed altogether 6.4 percent (147687 YLL) out of total years of life

lost captured nationally. The ecological distribution of YLL due to unidentified cases was

concentrated in the terai region (61.1%) and least was observed in the mountain region (7.6%).

Likewise, the YLL distribution according to development region was observed highest in the

western development region (28.2%) and least in the far-western development region of Nepal.

Majority of cases which were not identified were of the age group 0-14 while least was observed

in the 15-29 years of age group. The YLL due to unidentified cases were distributed in all the

regions of Nepal. The 0-14 years of age group showed the highest YLL in all the eco-

0.0 10.0 20.0 30.0 40.0 50.0

East

ern

Cen

tral

Wes

tern

Mid

-Wes

tern

Far-

Wes

tern

Mo

un

tain

Hill

Tera

i


25.3

3.5

39.8

27.7

3.6 11.0

49.4 39.5

Figure 3.6.1: Percentage YLL distribution due to Unidentified Cases

Figure 3.5.14.Region wise distribution of total YLL due to Other Intentional Injuries


165

development regions. Likewise sex wise distribution of total YLL due to unintentional injuries

showed higher burden in males than in females and similar pattern was found in all regions

except in Western region where the pattern was just reversed.

Table 3.6.1: YLL distribution of Unidentified causes

Background Characteristics Age group

Total YLL 0-14 15-29 30-59 60+

Development Region

Eastern

Male 59.7 8.1 16.1 16.2 100 14926

Female 59.0 2.2 15.4 23.3 100 14391

Total 59.4 5.2 15.8 19.7 100 29317

Central

Male 73.8 13.4 0.4 12.4 100 30739

Female 75.5

15.9 8.7 100 9807

Total 74.2 10.2 4.1 11.5 100 40546

Western

Male 44.8 6.0 20.8 28.4 100 20533

Female 49.4 1.8 13.6 35.1 100 21096

Total 47.2 3.9 17.2 31.8 100 41629

Mid-Western

Male 45.2 10.8 23.6 20.5 100 9925

Female 51.3 2.5 23.5 22.8 100 9745

Total 48.2 6.7 23.5 21.6 100 19670

Far-Western

Male 53.8 10.5 18.8 16.9 100 10756

Female 63.3 5.4 12.4 18.9 100 5767

Total 57.1 8.7 16.6 17.6 100 16523

Ecological region

Mountain

Male 75.7 6.6 8.5 9.2 100 7104

Female 69.1 2.9 12.7 15.3 100 4075

Total 73.3 5.2 10.0 11.4 100 11179

Hill

Male 56.7 9.5 17.5 16.3 100 27207

Female 60.1 0.0 14.3 25.6 100 19037

Total 58.1 5.6 16.2 20.2 100 46244

Terai

Male 57.6 10.9 11.0 20.6 100 52570

Female 54.9 3.0 17.0 25.0 100 37696

Total 56.5 7.6 13.5 22.4 100 90266

National

Male 58.8 10.1 12.8 18.3 100 86880

Female 57.5 2.1 15.9 24.5 100 60807

Total 58.3 6.8 14.1 20.9 100 147687


166

ANNEX I - Disease and injuries categories

GBD Cause Name

I. Communicable, maternal, perinatal and

nutritional conditions

II. Non-communicable diseases

A. Infectious and parasitic diseases A. Malignant neoplasms

1. Tuberculosis 1. Mouth and oropharynx cancers

3. HIV/AIDS 2. Oesophagus cancer

4. Diarrhoeal diseases 3. Stomach cancer

5. Childhood-cluster diseases 4. Colon and rectum cancers

b. Poliomyelitis 5. Liver cancer

c. Diphtheria 7. Trachea, bronchus and lung cancers

d. Measles 9. Breast cancer

e. Tetanus 10. Cervix uteri cancer

6. Meningitis 14. Bladder cancer

7. Hepatitis B 16. Leukaemia

Hepatitis C 17. Other malignant neoplasms

8. Malaria B. Other neoplasms

9. Tropical-cluster diseases C. Diabetes mellitus

d. Leishmaniasis D. Endocrine disorders

e. Lymphatic filariasis E. Neuropsychiatric disorders

g. Rabies 1. Unipolar depressive disorders

10. Leprosy 2. Bipolar affective disorder

12. Japanese encephalitis 4. Epilepsy

14. Intestinal nematode infections 5. Alcohol use disorders

a. Ascariasis 14. Migraine

b. Trichuriasis 15. Mental Retardation

attributable to lead exposure

c. Hookworm disease

(Ancylostomiasis and necatoriasis)

16. Other neuropsychiatric disorders

Other intestinal infections F. Sense organ diseases

15. Other infectious diseases G. Cardiovascular diseases

B. Respiratory infections 1. Rheumatic heart disease

1. Lower respiratory infections 2. Hypertensive heart disease

2. Upper respiratory infections 3. Ischaemic heart disease

3. Otitis media 4. Cerebrovascular disease

C. Maternal conditions 6. Other cardiovascular diseases

1. Maternal haemorrhage H. Respiratory diseases

2. Maternal sepsis 1. Chronic obstructive pulmonary disease

3. Hypertensive disorders of pregnancy 2. Asthma

4. Obstructed labour 3. Other respiratory diseases

5. Abortion I. Digestive diseases

6. Other maternal conditions 1. Peptic ulcer disease

D. Conditions arising during the perinatal

period

2. Cirrhosis of the liver

1. Low birth weight 3. Appendicitis

2. Birth asphyxia and birth trauma 4. Other digestive diseases

3. Other perinatal conditions J. Genito-urinary diseases

E. Nutritional deficiencies 1. Nephritis and nephrosis

1. Protein-energy malnutrition 2. Benign prostatic hypertrophy

4. Iron-deficiency anaemia 3. Other genitourinary system diseases

5. Other nutritional disorders


167

GBD Cause Name

II. Noncommunicable diseases (continued) III. Injuries

K. Skin diseases A. Unintentional injuries

L. Musculoskeletal diseases 1. Road traffic accidents

1. Rheumatoid arthritis 2. Poisonings

3. Gout 3. Falls

4. Low back pain 4. Fires

5. Other musculoskeletal disorders 5. Drowning

M. Congenital anomalies . 6. Other un intentional injuries

2. Anencephaly 7. Snake bite

3. Anorectal atresia B. Intentional injuries

4. Cleft lip 1. Self-inflicted injuries

5. Cleft palate 2. Violence

7. Renal agenesis 3. War

9. Congenital heart anomalies 4. Other intentional injuries

10. Spina bifida

11. Other Congenital anomalies IV. Unidentified

N. Blood disorder


168

Annex II- Sampling Ilaka wise VDCs sampling of Sunsari district (Total Ilaka-12, VDCs=49, N.P.=3)

S.N Name of Ilaka VDCs Selected VDCs

1 Chatara PHC

Barahchhetra

Mahendrenagar Bishnupaduka

Mahendrenagar

2 Itahari PHC

Khanar

Hanshaposha Aekamba

Hanshaposha

Panchakanya

3 Madhuban PHC

Madhuban

Haripur

Haripur

sripur jabdi

Paschimkusuha

Laikahi

4 Harinagar PHC

Harinagar

Harinagar Basantapur

Ramganj senuwari

Madhyeharsahi

5 Saterjhoa PHC

Santerjhora

Tanamuna

Chhitaha

Tanamuna

Aurabarni

Bhaluwa

6 Inaruwa PHC

Madhesa

Madhesa Bhokraha

Dumaraha

Babiya

7 Prakashpur PHC Prakashpur Prakashpur

8 Baklauri HP

Bakalauri

Pakali

Bharaul

Pakali

Bhadgau sinwari

Singiya

9 Madhilee HP

Madhilee

Madhilee

chadwela

Sonapur

Dubahi

simariya

10 Sitaganj HP

Ramganj Belgachhi

Ramganj Belgachhi

Amaduwa

Amahibelaha

Chimdi

Purbakusaha

11 Dewanganja HP

Dewanganja

Dhuskee Dhuskee

Kaptanganja

sahebganj

12 Bhutaha PHC

Ramnagar Bhutaha

Narsinghatappu Narsinghatappu

Gautampur

Jalpapur

S.N. Municipalities Selected N.P. Selected Wards

1 Dharan N. P. Inaruwa N. P. 2, 7, 8

2 Inaruwa N. P.

3 Itahari N. P.


169

Ilaka wise VDCs sampling of illam district (Total Ilaka-10, VDCs=48, N.P.=1)

S.N. Ilaka VDC Selected VDC

1 Pashupati Nagar Ilaka

PashupatiNagar

PashupatiNagar

ShreeAntu

Gorkhe

Jogmai

Namsaling

2 Fikal

Phikalbazar

Goduk Goduk

Panchakanya

Kanyam

3 Kolbung

Kolbung

Erautar

Shantipur

Samalbung

Jirmale

Erautar

Chulachuli

4 Pyang

Pyang

Soyang NayaBazar

Soyang

Jamuna

5 Luring tar

Sulubung

Barbote

Mabu

Maimajhuwa

Maipokhari

Sumbek

Barbote

6 Sakhejung

Sakhejung

Sakhejung Puwamajhuwa

Chameta

7 Magalbare

ShantiDanda

ShantiDanda

Mangalbare

Sangrumba

Siddhithumka

Jitpur

Dhuseni

8 Chisapani

Chisapani

Danabari

Sopak

Laxipur

Danabari

Mahamai

9 Amchowk

Amchok

Phakphok

Ektappa

Phakphok

Lumde

Gajurmukhi

Phyuatappa

10 Bajho

Bajho

Sakfara Sakfara

Ebhang

S.N. Municipality Selected ward

1 Illam Municipality 1, 5


170


171

Ilaka wise VDCs sampling of Solukhumbu district (Total Ilaka=11, VDCs=34)

S. N. Name of Ilaka Name of VDCs Selected VDC

1 Basa

Basa

Jubing Kaku

Jubing

2 Sotang PHC

Bung

Chheskam Chheskam

Mabe (Pawai)

Gudel

3 Nele HP

Nele

Deusa

Mukali

Deusa

Kangel

Panchan

4 Garma Garma Garma

Tingla

5 Gorakhani

Gorakhani

Kureng Kureng

Tapting

6 Chaulakharka

Chaulakharka

Goli Goli

Bhakanje

7 Jubu Jubu

Jubu Lokhim

8 Beni

Salleri

Takasindu Tamakhani

Beni

Takasindu

9 Salyan PHC Salyan Salyan

10 Nechabatase Nechabatase

Nechabatase Nechabedghari

11 Namche

Namche

Namche Khumjung

Chairikharka


172

Ilaka wise VDCs sampling of of Nuwakot district

S.N. Illaka VDCs (63) Selected VDCs (13)

1 Khagabhanjyang HP

KhadagBhanjyang

Jiling

Charghare

Jiling

Duipipal

Ratmate

Taruka

Budhasing

Dangsing

Gorsyang

2 Samari HP Samari

Kalyanpur Kalyanpur

3 Deurali PHC

Deurali

Deurali

Barsunchet

Kintang

Bugtang

Salme

4 Kaule HP

Kaule

Manakamana

Bhalche

Fikuri

Manakamana

Tupche

5 Nuwakot HP

Gerkhu

Bagesworichokade

Kalikahalde

Bagesworichokade

KholegaunKhanigaun

Chaughada

Ganesthan

6 Kharanitar PHC

Kharanitar

Ralukadevi

Narjamandap

Lachyang

Urleni

Ralukadevi

Kabilas

Panchkanya

7 Samundratar HP

Samundratar

Sundaradevi Balkumari

Thapek

Sundaradevi

8 Shikharbesi HP Shikharbesi

Shikharbesi Ghyanphedi

9 Rautbesi HP

Rautbesi

Rautbesi Gaunkharka

Beteni

10 Saryemaidan HP Likhu Sikre


173

Talakhu

Chhap

Sikre

Mahakali

11 Bhadratar HP

Bhadratar Bhadratar

Samundradevi

Sunkhani

Thanapati

Thansing

12 Chaturale HP

Chaturale

Suryamati Suryamati

13 Kakani PHC

Kakani

Okharpauwa

Chauthe Chauthe

Kumari

Belkot

Madanpur

S.N. Municipality Selected Wards

1 Bidur N.P 1,3,5


174

Ilaka wise VDCs sampling of of Sindhupalchok district (Ilaka=13, VDCs=79)

S.N. Illaka VDCs Selected VDCs

1 Barhabise PHC

Ghumthang

Ghorthali

Ghorthali

Ramche

Barhabise

Maneswora

Karthali

Choukati

2 Banskharka HP

Banskharka

Banskharka

Langarche

BhoteNamlang

Thampal Dhhap

Gunsakot

Thampalkot

Motang

Baruwa

3 Bhimtar HP

Bhimtar

Badegaun

Fatakshila

Badegaun

Sipa Pokhari

Bhotasipa

4 Danda Pakhar HP

/Thulo Pakhar

Danda Pakhar

Pangretar

Pangretar

Jethal

Mankha

ThumPakhar

Petaku

5 Devshthan HP

Sunkhani

Yamunadanda Yamunadanda

Thokarpa

Kalika

6 Jalbire PHC

Jalbire

pangtang

Baramchi

Fulpingkot

pangtang

Hagam

Gumba

Fulpingdandagau

Kubhinde

Batase

7 Lisankhu HP

Lisankhu

ThuloDhading ThuloDhading

Atarpur

8 Melamchi PHC Melamchi

Melamchi Talramarang


175

Mahankal

Ichok

Helumbu

Kiwool

Palchok

Dubachour

9 Nawalpur HP

Nawalpur

Kunchok

Sikharpur

Simpal Kavre

Jyamire

Kunchok

10 Piskar HP

Piskar

Tekanpur Dhumthang

Tekanpur

Tauthali

11 Selang HP

Selang

SyauleBazar

Choutara

Irkhu

SyauleBazar

Pipaldanda

Gloche

Sanusiruwari

ThuloSirubari

Kadambas

Sangachok

12 Sindhukot HP

Sindhukot

Bhotechaur

Bhotechaur

Haibung

Bansbari

Thakani

13 Tatopani HP

Tatopani

Marming

Fulpingkatti

Marming

Lisitikot

Gati


176

Ilaka wise VDCs sampling of Mahottari district, Ilaka= 10, VDCs= 76, NP=1

S. N. Ilaka VDCs Selected VDC

1 Simardahi HP

Simardahi

Pigouna

Dhirapur

Fulahatta Parikauli

Matihani

ParsaPateli

Pigouna

SugaVawani

2 Pipra HP

Pipra

Ratauli

Banauli Donauli

Barmarpura

Ekarahiya

Majhora Bishnupur

Mahottari

Ratauli

Sahorawa

3 Ekadarabela HP

Ekadarabela

Anakar

Bathanaha

Bhatauliya

Etaharwakatti

Halkhori

Manara

Anakar

Sisawakataiya

Nainhi

Sandha

4 BalawaHP

Balawa

Paraul

Bairgiya Banchauri

Banouta

Sonaul

Damhimarayee

Gonarpura

Kothuwa Bagiya

Paraul

Sarpallo

5 Ramgopalpur HP

Ramgopalpur

Basabitti

Laxminiya Bairgiya

Basabitti

Dhamaura

Shreepur

MeghanathGorahanna

Sahasaula

Sonamai

6 Shamsi HP Shamsi Khopi


177

Gaidaha Bhelpur

Khairbanni

Parsa Dewadh

Pokharibhinda

Raghunathpur

Sonama

Khopi

7 Gaushala PHC

Gaushala

Aurahi

Aurahi

Belgachhi

Bharatpur

Fulakaha

Laxminiya

Nigaul

Sundarpur

Ramnagar

8 Loharpatti PHC

Loharpatti

Hatisarwa

Bagada

Dnaramapur

Haripur harinmari

Hatisarwa

Khutta piparadhi

Mahadaiyatapanpur

Singyahi

Bhangaha

9 Bardibas HP

Bardibas

Gauribas

Bijalpura

Gauribas

Hathilet

Khayarmara

KisanNagar

Maisthan

Pashupatinagar

S.N. Municipality Selected Ward

1 Jaleshwor 5, 12


178

Ilaka wise VDCs sampling of Manang District (ilaka=9, VDC=13)

S.No. Name of Ilaka VDCs Selected VDC

1 Chame Chame Chame

2 Bhraka Bhraka Bhraka

3 TankiManang TankiManang TankiManang

4 Dharapani Dharapani Dharapani

5 Thoche Thoche

Thoche TachiBagarchhap

6 Khangsar Khangsar Khangsar

7 Manang Manang

Manang Nyawal

8 Nar Nar

Fu Fu

9 Ghyaru Ghyaru

Pisang Pisang


179

Ilaka wise VDCs sampling of Kapilvastu District ilaka=11, VDCs=77, NP=1


1 Haranampur PHC

Haranampur

Titirkhi

Baluhawa

Dumara

Titirkhi

Pipara

2 Pakadi HP

Pakadi

Pakadi

Hathihawa

Labani

Bithuwa

NandaNagar

Baskhaur

Abhirawa

Bijuwa

3 Hathausa HP

Hathausa

Fulika

Patna

Patariya

Fulika

Jahadi

Kopawa

4 Pipara PHC

Malwar

Malwar Banganga

Motipur

Gajehada

5 Tilaurakot HP

Tilaurakot

Tilaurakot

Nigalihawa

Gauri

Sauraha

Dohani

Dharmpaniya

Dhankauli

6 Gotihawa SHP

Gotihawa

Gotihawa

Badauli

Rangapur

Somdiha

Singhkhor

Parsohiya

Basantapur


180

7 Maharajganj PHC

Maharajganj

Bhalubari

Manpur

Lalpur

Ajigara

Balaramwapur

Udayapur

Bhalubari

Baraipur

Thunhiya

Chanai

8 Jayanagar HP

Jayanagar

Barakulpur

Mahuwa

Rajpur

Budhi

Mahendrakot

Hariharpur

Dubiya

Barakulpur

9 KrishnaNagar HP

KrishnaNagar

VidhyaNagar

VidhyaNagar

Ramnagar

Shipanagar

Bhagwanpur

Purusottampur

Sirsihawa

Ganeshpur

10 Patthardaihiya HP

Patthardaihiya

Bahadurganj

Bishunpur

Khurhuriya

Shivagadhi

Jawabhari

Shivapur

Gugauli

Bahadurganj

Birpur

11 Hardauna

Harduona

Milmi

Kajarhawa

Kushhawa

Sisawa

Milmi

Kapilbastu N.P.


1 Kapilbastu Municipality 1, 13


181

Ilaka wise VDCs sampling of Palpa District ilaka=12, VDC=65 NP=1


1 Chhahara HP

Chhahara

Somadi

Bhuwanpokhari

Somadi

Siddheswar

Juthapauwa

Baldengadhi

Satyawati

2 PalungMainadi

PalungMainadi

Timure Fek

Mujhung

Timure

3 Khasyoli PHC

Khasyoli

Khyaha

Argali

Khyaha

Deurali

Kusumkhola

Bhairabsthan

Bandipokhara

Boudhagumba

Bodhapokharathok

4 Nayarilaka

Nayarnamtales

Chidipani

Barangdi

Khanigau

Pokharathok

Chirtungdhara

Chappani

Yamgha

Darlamdanda

Kanichhap

Chidipani

Pipaldada

5 Madanpokhara ilaka

Madanpokhara

Koldada

Telgha

Masyam

Koldada

Kaseni

Rupse

Dobhan

Kachal


182

6 Tahu ilaka

Tahu

Devinagar

Humin

Haklang

Birkot

Ringneraha

Devinagar

7 Jadewa ilaka

Jadewa

Bahadurpur

Gothadi

Rahabas

Bahadurpur

Jalpa

8 Archale ilaka

Archale

Mityal Jyamire

Mityal

9 Hungi ilaka

Hungi

Hungi Foksingkot

Gejha

10 Rampur ilaka

Rampur

Siluwa Galdha

Khaliban

Siluwa

11 Darchha ilaka Darchha Darchha

12 Gadakot ilaka

Gadakot

Sahalkot Jhirubas

Sahalkot

Wakamalang


1 Tansen N.P 2,4,13


183

Ilaka wise VDCs sampling of Dang (ilaka=14,VDC= 39,NP=2)

S. N. Name of Ilaka VDCs Selected VDC

1 Lamahi

Chaulahi

Satbariya

Rajpur

Satbariya

2 Syuja Syuja

Syuja Saida

3 Tulsipur Tarigaun Tarigaun

4 Shreegaun

Shreegaun

Shatinagar

Dhanauri

Shatinagar

5 Panchakule

Panchakule

Panchakule

Baghmare

Purandhara

6 Hekuli

Hekuli

Hekuli

PawanNagar

Goltakuri

7 Phulbari Phulbari

Urahari Urahari

8 Manpur

Manpur

Bijauri

Halwar

Bijauri

9 Duruwa

Duruwa

Purandhara

Hapur

Dhikpur

Purandhara

10 Laxmipur

Laxmipur

Saudiyar

Dharna

Saudiyar

Rampur

Hansipur

11 Kabhre Kabhre

Loharpani Loharpani

12 Sisahaniya

Sisahaniya

Gobardiya

Lalmatiya

Sonpur

Gobardiya

13 Gadhawa

Gadhawa

Gadhawa

Bela

Gangapraspur

14 Koilabas Koilabas Koilabas

S.N. Municipalities Selected Municipality Selected Ward

1 Tulsipur Tulsipur 3,4,8,9

2 Tribhuwan Nagar


184

Ilaka wise VDCs sampling of Humla district (Ilaka=11, VDCs=27)

S.N Ilaka Name of VDCs Selected VDC

1 Dandafaya Dandafaya

Syada Syada

2 Darma

Darma

Mimi Shreemastha

Mimi

Melchham

3 Gothi

Gothi

Saya (Sama) Saya (Sama)

Rodikot

4 Hepka Hepka Hepka

5 Lali

Lali

Raya Chhipra

Raya

6 Nauthi Kalika HP

Kalika

Maila Maila

Madana

7 Muchu

Muchu

Khagalgaun Limi

Khagalgaun

8 Rip Baraigaun

Sarkeedeu Sarkeedeu

9 ShreeNagar Jair

Jair ShreeNagar

10 Thehe

Kharpunath

Kharpunath Thehe

Bargaun

11 Simikot (DHO) Simikot Simikot

Ilaka wise VDCs sampling of Rolpa District (Ilaka=11,VDCs=51)

S.N. Name of Ilaka VDCs Selected VDCs

1 Thawang

Thawang

Bhirul Bhirul

Kureli

2 Sakhi

Sakhi

Dubaring

Jhenam

Dubaring

Dubidanda

Masina

3 Gajul

Gajul

Gajul Fagaam

Jaiwang

Khumel

4 Jinawang Jinawang

GhartiGaun Pakhapani


185

Wot

GhartiGaun

Rank

5 Ghodagaun

Ghodagaun

Ghodagaun Khungri

Jedwang

JauliPokhari

6 Harjang

Harjang

Gumchal

Siuri

Pang

Gaam

Gumchal

7 Jaimakasala

Jaimakasala

Jaimakasala Uwa

Seram

8 Liwang

Liwang

Liwang

Jankot

Bhawang

Dhawang

Whama

Kotgaun

Korchawang

Kareti

9 Jungar

Jungar

Nuwagaun Gairigaun

Nuwagaun

Budagaun

10 Eriwang (Kebari)

Eriwang

Talawang

Paccawang

Rangkot

Rangsi

Talawang

11 Mijhing

Mijhing

Wadachaur

Wadachaur

Sirpa

Tewang

Aresh


186

Ilaka wise VDCs sampling of Bhajang (illaka=12, VDCs=47)

S.N. Ilaka wise VDCs Selected VDC

1 Bhairashthan HP

Bhairashthan

Chaudhari Maulali

Chaudhari

2 Kotbhairab HP

Kotbairab

Kotbairab Parakatne

Koiralakot

3 Lekhganu HP

Lekhgaun

Bhamchaur Bhamchaur

Sayen Pasela

4 Chainpur HP

Chainpur

Chainpur

Surma

Daulichaur

Sebeda

Hemantawada

Sunikot

Luenda

Rithapata

5 Byasi (Kot chauhanpata) Byasi

Byasi Kadel

6 Male Bisauna HP

Male bisauni

Rilu

Rilu

Kanda

Dhanena

Datola

7 Malumela HP Matela

Matela Malumela

8 Deulekh PHC

Deulekh

Sunpuda Syadi

Sunpuda

9 Rayal PHC

Rayal

Bhanjh Bhanjh

Dangaj

10 Chhanna HP

Chhanna

Lamatola

Gadraye

Kalukheti

Patadewaal

Lamatola

Pauwagadhi

11 Kotdewal HP

Kotdewal

Kotdewal Bhatekhola

Masta/mashdev

Kailash

12 Khiratadi SHP

Khiratadi

Dahabagar

Dahabagar

Kapal sheri

Deulikot

Pipalkot


187

Ilaka wise VDCs sampling of Kailali District (Ilaka=13,VDCs=42 ,NP=2)

S.N. Name of Ilaka VDCs Selected VDCs

1 Tikapur PHC

Narayanpur

Narayanpur Dansinhapur

Pathariya

Durgauli

2 Bhajani PHC

Bhajani

Bhajani Lalbhoji

Khailad

3 Chaumala PHC

Chaumala

Khairala Urma

Masuriya

Khairala

4 Joshipur PHC

Joshipur

Boniya Thapapur

Boniya

5 Udasipur PHC

Udasipur

Gadariya Gadariya

Phulwari

6 Malakheti PHC

Malakheti

Sahajpur Godawari

Nigali

Sahajpur

7 Pandaun HP Pandaun

Mohanyal Mohanyal

8 Dododhara HP

Dododhara

Sadepani

Kota Tulsipur

Chauha

Baliya

Sadepani

9 Munuwa HP

Munuwa

Pratapur Janakinagar

Pratapur

10 Pahalmanpur HP

Pahalmanpur

Darakh Ramshikhar Jhala

Darakh

11 Basauti HP

Basauti

Ratanpur Pawera

Ratanpur

Hasuliya

12 Sreepur HP

Sreepur

Beladevipur Geta

Beladevipur

13 Sugarkhal HP Sugarkhal Sugarkhal

S.N. Municipalities Selected Municipality Selected Wards

1 Tikapur Tikapur 1,2,5

2 Dhangadhi


188

Ilaka wise VDCs sampling of Dadeldhura District (Ilaka=9, VDCs=20, NP=1)

S. N. Ilaka VDCs Selected VDCs

1 Ajayameru HP

Ajayameru

Samayaji Bhadrapur

Samayaji

2 Asigram HP Asigram Asigram

3 Gankhet HP Gankhet Gankhet

4 Dewal Dibyapur HP Dewal Dibyapur HP

Chipur Chipur

5 GaneshpurHP Ganeshpur

Kailpalmandu Kailpalmandu

6 Jogbudha PHC

Jogbudha

Alital Alital

Sirsha

7 Manilekh HP Manilekh

Manilekh Koteli

8 Nawadurga HP

Nawadurga

Belapur Masastamandu

Belapur

9 Rupal HP

Rupal

Bhageswor Bhageswor

Bagarkot


1 Amargadhi 4,5,6,9,10


189

References

i World Health Organization Global Program on Evidence for Health policy. National Burden of Disease Studies: A

Practical Guide. Edition 2.0 October 2001;

ii Murray CJL, Salmon JA, Mathers, Lopez AD (eds.) WHO,Geneva. Summary measures of population health

concepts, ethics, measurement and applications (2002).Available at http://www.who.int/pub/smph/en/index.html.

iii

The Thai Working Group on Burden of Disease and Injury. Burden of Disease and Injury in Thailand. November

iv Murray CJ, Lopez AD. The Global Burden Of Disease-A comprehensive assessment of mortality and disability

from diseases, injuries and risk factors in 1990 and projected to 2020. 1996

v Ministry of Population and Environment, Central Bureau of Statistics. Population Projections For Nepal 2001-

2021.December 2003

http://www.who.int/pub/smph/en/index.html

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