https://hdl.handle.net/20.500.14356/5 Thu, 21 May 2026 14:54:03 GMT 2026-05-21T14:54:03Z https://hdl.handle.net/20.500.14356/3003 Title: Cancer incidence and mortality in SSDM districts in 2018: Saptari, Siraha, Dhanusha & Mohattari districts Authors: Chapagain, Sandhya; Thakur, Chanda; Subedi, Ranjeeta; Khadka, Kopila; Kafle, Uma; Dhimal, Meghnath; Jha, Anjani Kumar; Budukh, Atul; Dikshit, Rajesh Abstract: Executive Summary: Background: Nepal Health Research Council (NHRC), an autonomous government body, is responsible to promote and conduct, coordinate and regulate all kinds of research activities to improve the health status of the people in the country. In the recent health developments of the country, cancer has become one of the major challenges for the government in terms of prevention, control and provision of necessary cancer care services to the patients. In this regard, NHRC, in close collaboration with Ministry of Health and Populations, has started Population Based Cancer Registry (PBCR) since January 2018 aiming to provide necessary evidences on cancer cases to the government in order to plan and implement cancer control policies and strategies. The registry is technically supported by the WHO and the International Agency for Research on Cancer (IARC) Regional Hub, Tata Memorial Centre, India. Three registries namely, Kathmandu Valley PBCR, Rukum PBCR and Siraha, Saptari, Dhanusha and Mohattari (SSDM) PBCR have been established covering 9 districts of the country representing urban, semi-urban and rural areas as well as the valley, hill, and terai regions in terms of geography. The objective of SSDM PBCR is to identify the cancer incidence, mortality and pattern of cancer in Siraha, Saptari, Dhanusha and Mohattari districts and to help in the development of cancer control strategies/activities to strengthen cancer care services in the areas. Population Covered: The SSDM PBCR covers four districts, Siraha, Saptari, Dhanusha and Mohattari with a total of 40 urban municipalities and 28 rural municipalities. The estimated population covered by the registry in 2018 is 2,846,035. Registration Method: The overall process of PBCR data collection is active method. There are two major approaches to collect the registry data. The first one is through the health facilities that include data collection from the cancer and/or the general hospitals having diagnostic and cancer treatment facilities, pathology laboratories and social security section. Due to the lack of cancer treatment facilities in SSDM districts, the neighboring healthcare facilities where the patients might visit for treatment have been considered for data collection. The data is collected from the records of the sources since January 2018 and recorded in the standard format. The second approach is through the trained data enumerators mobilized in the communities. They visit the health coordinators, health post in-charges, female community health volunteers (FCHVs), ward chairpersons and community leaders to identify the cancer cases and then visit the particular households to collect the information. The obtained data from all these sources are checked for the completeness and accuracy. Residence confirmation is done through individual phone call and the data are entered into the CanReg5 Software. Findings: Over the year (2018), SSDM PBCR has registered 1106 new cancer cases (564 males and 542 females) and 286 death cases (155 males and 131 females). The Age Adjusted Incidence Rates (AAR) for male was 47.1 per 100,000 populations whereas the AAR for the female was 44.6 per 100,000 populations. Similarly, the Age Adjusted Mortality Rate for male was 13.1 per 100,000 populations and for females, 11.1 per 100,000 populations. The Mortality to Incidence ratio (M/I) in SSDM was 26 %, which is less as compared to the registries in neighboring countries like India and other registries within Nepal due to under reported death cases. Since the civil registration in Nepal is facing challenges to collect the death cases with actual cause of death registered,and the cases with cause of death as cancer is not recorded at all. All the other possible ways to identify the incident and death cases have been followed; however, some of the death cases might have been missed. The higher cancer incidence is found among the age group of 70-74 years in males and 65-69 years in females with an age specific rate of 212.5 and 188.8 per 100,000 populations respectively. In males, the top leading cancer site is mouth followed by lung, gallbladder, liver and stomach whereas in females, the most common site is breast followed by cervix uteri, gallbladder, lung and stomach. In 2018, 8% of primary site unknown cases in males and 4.4% in females have been registered, while these cases represent the diagnostic quality, availability and accessibility of the diagnostic centers and the improper documentation of medical records. As this is the first year report, there may be under registration of the cases. However, the community approach for PBCR by mobilizing field enumerators and other stakeholders within the community has reduced the under-reporting of the cases to a greater extent. Besides, there is a plan to have cross sectional survey of the 5% population to check the completeness of the cancer registry in the future registries. Because of the lack of cancer diagnostic and treatment facilities in SSDM districts, people have to travel 90 km to 2000 km for diagnosis and treatment of cancer. Hence, establishing the early detection centers in SSDM district is very important. For some cases, the date of diagnosis and primary site relied on the verbal information of the patient and their relatives. Due to lack of scientific way of data recording and reporting in health facilities, the cases obtained through community could not be traced back in the hospitals affecting the exact representation of the cases. It is recommended to have digital and uniformed medical recording system with some mandatory variables in all government and private health facilities. Similarly, MoHP, related provincial government and local authority are advised to develop cancer prevention and control policy and intervention based on the evidence given by the registry. Wed, 01 Jan 2020 00:00:00 GMT https://hdl.handle.net/20.500.14356/3003 2020-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/3002 Title: Cancer Incidence and Mortality in Rukum Districts in 2018: east and west Rukum Authors: Subedi, Ranjeeta; Khadka, Kopila; Kafle, Uma; Thakur, Chanda; Dhimal, Meghnath; Chapagain, Sandhya; Jha, Anjani Kumar; Budukh, Atul; Dikshit, Rajesh Abstract: Background: Nepal Health Research Council (NHRC), an autonomous government body, is responsible to promote and conduct, coordinate and regulate all kinds of research activities to improve the health status of the people in the country. In the recent health developments of the country, cancer has become one of the major challenges for the government in terms of prevention, control and provision of necessary cancer care services to the patients. In this regard, NHRC, in close collaboration with Ministry of Health and Populations, has started Population Based Cancer Registry (PBCR) since January 2018 aiming to provide necessary evidences on cancer cases to the government in order to plan and implement cancer control policies and strategies. The registry is technically supported by WHO and International Agency for Research on Cancer (IARC) Regional Hub, Tata Memorial Centre, India. Three registries namely, Kathmandu Valley PBCR, Rukum PBCR and Siraha, Saptari, Dhanusha and Mohattari (SSDM) PBCR have been established covering 9 districts of the country representing urban, semi-urban and rural areas as well as the valley, hill, and terai regions in terms of geography. The objective of Rukum PBCR is to identify the cancer incidence, mortality and pattern of cancer in Rukum districts and to help in the development of cancer control strategies/activities to strengthen cancer care services in the areas. Population Covered: The Rukum PBCR covers two districts, East and West Rukum with a total of 3 urban municipalities and 6 rural municipalities. The estimated population covered by the registry in 2018 is 2, 21,376. Registration Method: The overall process of PBCR data collection is of active method. There are two major approaches to collect the registry data. The first one is through the health facilities that include data collection from the cancer and/or the general hospitals having diagnostic and cancer treatment facilities, pathology laboratories and social security section. Due to the lack of cancer treatment facilities in Rukum, the neighboring facilities where the patients from Rukum visit were taken. The data is collected from the records of the sources since January 2018 and recorded in the standard format. The second one is through the trained data enumerators mobilized in the communities. The enumerators personally visit the health coordinators, health post in-charges, FCHVs, ward chairpersons and community leaders to identify the cancer cases and visit the particular households to collect the information. The obtained data from all these sources are checked for the completeness and accuracy. Residence confirmation is done through individual phone call and the data are entered into the CanReg5 Software. Findings: Over the year (2018), Rukum PBCR has registered 87 new cancer cases (44 males and 43 females) and 38 mortality cases (16 males and 22 females). The Age Adjusted incidence Rates (AAR) for male was 59.1 per 100,000 populations whereas the AAR for the females was 51.4 per 100,000 populations. Similarly, the age adjusted mortality rate for the males was 21.4 per 100,000 populations and for females, 25.1 per 100,000 populations. The Mortality to Incidence ratio (M/I) in Rukum district was 43.6%, which shows that the death case was under reported as compared to the registries in neighboring countries like India. Since the civil registration in Nepal is facing challenges to collect the death cases and for the death registered cases, the cause of death as cancer is not recorded at all. All the other possible ways to identify the incident and death cases have been followed; however, we might have missed some of the death cases. The higher cancer incidence is found among the age group of 65-69 years in males and 55-59 years in females with an age specific rate of 372.4 and 254.5 per 100,000 populations respectively. In male, the top leading cancer site is lung followed by stomach, thyroid, prostate, gallbladder and liver. Among females, the most common site is cervix uteri followed by lung, uterus, ovary and breast. In 2018, 9% of primary unknown cases in males and 21% in females have been registered, that may be due to inadequate staging workup and documentation failing to establish the primary site of the cancer. Again, these kinds of cases represent the diagnostic quality, availability and accessibility of the diagnostic centers and the proper documentation of medical records. As this is the first year report, there may be under registration of the cases. However, the community based approach of PBCR by mobilizing field enumerators and other stakeholders within the community has reduced the under-reporting of the cases to a greater extent. Besides, there is a plan to have cross sectional survey of the 5% population to check the completeness of the cancer registry in the future registries. Because of the lack of cancer diagnostic and treatment facilities in Rukum, people have to travel 170 km to 1200 km for diagnosis and treatment of cancer. Hence, establishing the early detection centers in Rukum district is very important. For some cases, the date of diagnosis and primary site relied on the verbal information of the patient and their relatives. Due to lack of scientific way of data recording and reporting in health facilities, the cases obtained through community could not be traced back in the hospitals affecting the exact representation of the cases. It is recommended to have digital and uniform medical recording system with some mandatory variables in all government and private health facilities. Similarly, MoHP, related provincial government and local authority are advised to develop cancer prevention and control strategies and intervention based on the evidence given by the registry. Wed, 01 Jan 2020 00:00:00 GMT https://hdl.handle.net/20.500.14356/3002 2020-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/3001 Title: Cancer incidence and mortality in Kathmandu valley in 2018: Kathmandu, Lalitpur & Bhaktapur Authors: Dhimal, Meghnath; Subedi, Ranjeeta; Kafle, Uma; Thakur, Chanda; Khadka, Kopila; Chapagain, Sandhya; Jha, Anjani Kumar; Budukh, Atul; Dikshit, Rajesh Abstract: Executive Summary: BACKGROUND: Nepal Health Research Council (NHRC), a national apical body of Government of Nepal, responsible for promoting scientific study and quality health research in the country, has started Population Based Cancer Registry (PBCR) in Nepal since January 2018. Starting with the Kathmandu Valley, the PBCR has been expanded to other 6 districts with a total of three registries in order to obtain representative information of the country on cancer incidence. The Kathmandu valley cancer registry covers the population of Kathmandu, Bhaktapur and Lalitpur districts of Province 3, whereas the other registries are established in provinces 2, 5 and 6 (Karnali).The objective of Kathmandu valley PBCR is to generate evidence on cancer incidence, patterns and trends of disease and mortality related to cancer in the Kathmandu valley, and to enhance national capacity for sustainable PBCR in Nepal. The NHRC is working in close collaboration with Ministry of Health and Population (MoHP) and WHO to establish the registrie in Nepal that has been technically supported by International Agency for Research on Cancer (IARC). The council has made partnership with 38 health facilities in Kathmandu valley to obtain cancer registry data on regular basis, while the registry also receives data from other inter/national sources like B.P Koirala Memorial Cancer Hospital, Chitwan and Tata Memorial Hospital, India. POPULATION COVERED: The Kathmandu valley PBCR covers 21 urban/rural municipalities of Kathmandu, Bhaktapur and Lalitpur districts with an estimated population of 30,71,932 in 2018. The registry predominantly represents the urban region of the country. REGISTRATION METHODOLOGY: The registry has used both the active and passive method of data collection. There are two major approaches to collect the registry data in the field. The first one is through the health facilities that includes data collection from the cancer and/or the general hospitals having diagnostic and cancer treatment facilities, pathology laboratories, hospices, ayurvedic centers and social security sections. The next is through the communities where the health coordinators, health in-charges and the female community health volunteers (FCHVs) at urban/rural municipalities have been oriented on PBCR. The FCHVs collect data through household visits in the given populations and submit them to the health in-charges, while the in-charges submit the data to the health coordinators, and the health coordinators directly to the NHRC office on monthly basis. Beside this, in places with very less reporting of cancer cases and low incidence rate compared to the estimated incidence rates for Nepal, the data enumerators are trained and mobilized in the communities. They personally visit the health coordinators, health post in-charges, female community health volunteers, ward chairpersons and community leaders to identify the cancer cases and then visit the particular households to collect the information. Then, the obtained data from all these sources are verified for the completeness, accuracy and residence followed by the entry into the CanReg5 Software at the NHRC office. FINDINGS: In 2018, out of 11,600 cancer cases obtained by Kathmandu Valley PBCR, a total of 2156 new cancer cases were registered (999 males and 1157 females). The Age Adjusted Incidence Rate (AAR) for male was 95.3 per 100,000 populations and for females, 98.1 per 100,000 populations. Similarly, 670 death cases due to cancer were registered in 2018. The Age Adjusted Mortality Rate (AAMR) for male was 36.3 per 100,000 populations (365 cases) and for female, 27.0 per 100,000 populations (305 cases). The mortality to incidence ratio (M/I) was 31%.The Government of Nepal is facing challenges in collecting death information since the cause of death as cancer is not registered by Civil Registration and still people feel reluctant to share cause of deaths including of cancer. The community-based approach followed by the PBCR has helped to get information on death cases in community; however, some death cases might have been missed in the registry. In Kathmandu Valley, the leading sites of cancer in males have been found to be lungs, stomach, urinary bladder, gallbladder and Non-Hodgkin’s Lymphoma. Both the cancer incidence and mortality are highest in 70-74 years age group. In females, the commonest sites are breast, lungs, cervix uteri, gallbladder and ovary with the peak age of incidence in them is above 75 years followed by the age group of 65-69 years, and it is same for cancer death. Being the first year of registry, the unknown primary cases were only 4.5% in males and 3.2% in females indicating the good quality of the registry. However, with the improvement in record keeping and diagnostic and treatment facilities, the unknown primary cases will be minimized in future. In 90.5% of the cancer cases registered had microscopic basis of diagnosis. Remaining cases were registered based on non-microscopic ways like clinical, radiology, verbal information and Death Certificate Only. With the improvement in record keeping and continuation of registry, cases registered through non- microscopic basis will be reduced in future. Due to lack of scientific technique of data recording and reporting in health facilities and lack of culture in reporting in civil registration, Kathmandu Valley PBCR incurs extra cost/burden in terms of man, money, time and materials; as for the residence, the registry cannot fully rely on the residence address given by the sources. Hence, each individual patient/relative are contacted to confirm the residence. Therefore, it is recommended to have digital and uniformed medical recording system with determined mandatory variables in all government and private health facilities. Similarly, the death registration system needs to be strengthened and improved with the inclusion of cancer as a cause of death. The MoHP, concerned provincial government and local authority are recommended to develop area specific cancer prevention and control policy and interventions based on the evidence provided by the registry. Wed, 01 Jan 2020 00:00:00 GMT https://hdl.handle.net/20.500.14356/3001 2020-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/3000 Title: Noncommunicable Disease Risk Factors: STEPS Survey Nepal 2019 Authors: Dhimal, Meghnath; Bista, Bihungum; Bhattarai, Saroj; Dixit, Lonim Prasai; Hyder, Md Khursid Alam; Agrawal, Naveen; Rani, Manju; Jha, Anjani Kumar Abstract: NA Wed, 01 Jan 2020 00:00:00 GMT https://hdl.handle.net/20.500.14356/3000 2020-01-01T00:00:00Z