Health Literacy on Chronic Kidney Disease among Adults of Morang, Eastern Nepal

Health Literacy on Chronic Kidney Disease among Adults of Morang, Eastern Nepal | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health Literacy on Chronic Kidney Disease among Adults of Morang, Eastern Nepal Deepika Khadgi, Angira Kumari Chaudhary, Saraswati Basnet This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5049922/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Chronic kidney disease (CKD) is a rapidly increasing health problem worldwide. Early diagnosis is possible with adequate health literacy. Unfortunately, majority of the CKD patients are diagnosed in the last stage which is the major challenge in the developing countries like Nepal. Thus, the researchers designed this study to find out the chronic kidney disease related health literacy among adults of Eastern Nepal. Methods A quantitative analytical cross-sectional study design with multi-stage sampling was used. One ward from each of one metropolitan, one urban and one rural municipality were selected randomly. And in the fourth stage, population proportionate samples, one sample from a household, were selected to meet the total sample size of 414. Data was collected using a semi-structured questionnaire with high internal consistency reliability of 0.84. Face-to-face interview was done after the ethical approval from Nepal Health Research Council, Nepal (Ref. No. 2162). Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 20.00. Descriptive and inferential i.e. regression analysis were used. Results The mean age and standard deviation of adults was 41.8014 ± 13.49 years respectively. About two-third (63.1%) were female, 86.5% married, 94.6% Hindu and 46.3% illiterate. One-fifth had habit of alcohol consumption and tobacco use. The median score for health literacy on CKD was 18 and there was no statistical difference in scores of adults residing in Sundarharaincha, Katahari and Biratnagar. More than half (54.1%) of the adults surveyed had low level of health literacy on CKD. Age, secondary and above education, alcohol consumption and tobacco use were found to be associated with health literacy during bivariate analysis. Similarly, the multivariate regression analysis showed that age (AOR 1.016, CI 0.970–0.998), education (AOR 3.17, CI 0.241–0.494) and tobacco use (AOR 2.079, CI 0.253–0.914) had statistically significant association as predictors of CKD health literacy. Conclusion Adults of Morang, Eastern Nepal had low level of health literacy on CKD. Implementing health awareness, disease screening and tobacco control programs by local governments local governments could contribute in early diagnosis and complication prevention of CKD in Morang. Adults Chronic Kidney Disease Health Literacy Morang Figures Figure 1 Background Globally, chronic kidney disease (CKD) is a major public health problem affecting 8–16% of the world population and with a high incidence in developing countries [ 1 ]. Diabetes and hypertension are the leading causes of CKD [ 2 ] that ultimately require dialysis and renal transplant as the main treatment option for survival [ 3 ]. Worse still, the majority affected are unable to sustain or achieve optimal dose of hemodialysis and other adjunctive treatments for ESRD due to the high cost [ 4 , 5 ]. These may cause negative thwack and burdens on patients, families, and healthcare system of that countries [ 1 ]. Prevalence of CKD in adults’ population in India, Pakistan and Bangladesh are 10.2%, 21.2% and 17.3% respectively [ 6 ]. Similarly, the overall prevalence of CKD among adult population in Nepal is 6% [ 7 ] with 10.6% in the community of Eastern Nepal [ 8 , 9 ]. Early diagnosis is possible with adequate health literacy on CKD and its associated risk factors [ 10 ] that not only reduces morbidity and mortality [ 11 ] but also aids in reduction of public health burden. Unfortunately, most of the people in community are unfamiliar about the CKD risk factors and remain clinically unrecognized [ 12 ] thus presenting at the health facilities in an advanced stage which is the major challenge in the developing countries like Nepal [ 13 ]. A study conducted in South West Nigeria among rural community people has shown that only 27.1% of people had good knowledge regarding chronic kidney disease [ 14 ]. Similarly, 60% and 57.6% of the respondents in Bangladesh and Nepal respectively had low knowledge [ 2 , 15 ]. Many studies have shown lack of awareness among general population regarding CKD [ 16 , 17 ] including Eastern Nepal [ 2 ]. Public awareness is not only an important determinant of the uptake of screening programs for early detection but also provides an opportunity for early therapeutic interventions to prevent or delay the onset of disease or complications and to improve outcome [ 18 , 19 ]. Studies conducted in both developed and developing countries have shown that the public understanding of CKD and its risk factors are relatively poor. Information and awareness not only help people to change or modify their health habits and other behavior but also help to achieve and maintain optimal health [ 2 ]. On the other hand, low level of awareness leads to poor perceived susceptibility [ 20 ]. Thus, it is high time for the need to shift from expensive hospital-based treatment to a much economic preventive strategy [ 14 ]. To date of our best knowledge, very few studies have been conducted regarding the phenomenon in community setting. Thus, the researchers designed this study to find out the health literacy on chronic kidney disease among adults of Eastern Nepal. Methods Health Literacy on CKD Health literacy was assessed as awareness. It means having awareness on CKD including its introduction, causes, risk factors, signs and symptoms, treatment, prevention and complication. It was assessed based on scoring of each correct response to the items in pre-validated structured questionnaire. Higher the score means higher the health literacy of respondents on CKD. Total score of the questionnaire is 37 and categorized as High and Low Level of Health Literacy on CKD based on median score [ 21 ]. Adults It refers to respondents of age > 20 years and residing in the respective communities at the time of data collection. Research design A quantitative analytical cross-sectional study was used to assess the health literacy on CKD among adults of Morang district, Eastern Nepal. Data was be collected from the primary sources ie adults residing in the communities of Morang. Setting and Population The setting of the study was Morang district of Koshi Province which is the second largest province. There are one metropolitan city, eight urban and eight rural municipalities in the district. The total area of Morang is 1855 km 2 . As of the 2011 Nepal Census, Morang district had a population of 965,370 [(22)]. The national data shows higher prevalence of NCDs like hypertension and diabetes among adults in Koshi Province which are the leading causes of CKD. Thus the study population were the adults aged 20 years and above residing at Morang Sampling technique Multi-stage sampling technique was used. At the first stage, Morang district was selected conveniently. Out of 17 municipalities of Morang district, one metropolitan, one urban and one rural municipality each were selected randomly in the second stage. Then in the third stage, one ward from each of three selected municipalities were again selected randomly. And in the fourth stage, population proportionate sampling technique was adopted to estimate number of samples from each setting. Cluster sampling was used for the inclusion of household from selected wards and one member who was encountered first was included as subject from a household. The first household was selected by bottle neck method. The bottle was rotated and the direction pointed by the bottle was selected as first household for sampling in each ward. Instrumentation A semi-structured interview questionnaire was used based on the objectives of the study. The study instrument was divided into two parts: Part I: Semi-structured questions related to Socio-demographic information and co-morbidities present in the participant, history of NCDs in parents, last health check-up for kidney disease, tobacco and alcohol use Part II: Structured questions related to awareness on chronic kidney disease. This part was a pre-validated tool which had been used and validated in Lebanese adult population. It consisted of total 37 items, both multiple choice question and yes/no questions, with the total score of 37. Crohnbach’s alpha score for internal consistency reliability was 0.84. Ethical Consideration After the approval of grant, administrative approval to collect data was obtained from concerned authorities of selected wards. Ethical clearance was obtained from the Nepal Health Research Centre (NHRC) to conduct the study (Ref no: 2162). Finally, the informed written consent were obtained from each participant before participation in the study. All the ethical principles as of Helsinki Declaration for medical research involving humans were maintained. Data Collection Procedure One respondent from a household was included as a sample. Data was collected via face-to face interviews using a semi- structured interview questionnaire. Each participant was explained the nature and purpose of the study. Informed consent (both verbal & written) was taken before performing the interview. The time duration for each interview was about 15–20 minutes. Collected data were checked for the completeness and editing was done on the same day to prevent recall bias, ensure the quality & accuracy of the study. Data Analysis Procedure Collected data were checked daily for completeness. All the data were entered in Statistical Package for the Social Sciences (SPSS) version 20 after editing and coding. Descriptive analysis i.e. frequency, percentage, mean, median, and standard deviation were used to assess health literacy on chronic kidney disease. Inferential analysis as bivariate and multivariate analyses were used to find the association between dependent and selected demographic variables. p -value of 0.05 was considered to indicate statistical significance at a 95% confidence level. Analyzed data were presented in the relevant tabular form. Results Nearly half (44.4%) of respondents were from the age group 20–30 years and only 15.2% were from 60 years and above with mean age 41.8 years. Similarly, more than half (63.1%) were female 86.5% were married and most (94.6%) were Hindu. Only 2.4% had attained education of higher secondary and above whereas nearly half (46.3%) were illiterate. More than half (51.5%) were home maker whereas only 6.6% were service holders and more than half had monthly income of rupees less than 25000. Table 1 reveals that more than two third (70.2%) of respondents were not enrolled in government’s health insurance. Regarding co-morbidity among respondents, less than one fourth (21.0%) had hypertension followed by diabetes mellitus (10.6%). Similarly, less than one forth (20.8%) of respondents’ family member had hypertension followed by diabetes (11.1%) and CVA (0.7%). Similarly, more than three forth (77.8%) did not know when they did health checkup and only 1.9% had done health check-up for kidney disease in the last 6 to 12 months period. Table 1 Health Related Information n = 423 Variable Frequency Percentage Provision of Health Insurance Non-insured 297 70.2 Insured 126 29.8 Co-morbidity among Respondents Hypertension 89 21.0 Diabetes 45 10.6 Hyperlipidemia 9 2.9 CKD 4 0.9 Cardiovascular Disease 2 0.5 Comorbidity among Family Members Hypertension 88 20.8 Diabetes 47 11.1 Hyperlipidemia 12 2.8 Cardiovascular Disease 7 1.7 CKD 4 0.9 CVA 3 0.7 Last Health Checkup Sought for Kidney Disease ≤ 6 moths 12 2.8 6–12 months 8 1.9 1–2 years 74 17.5 Don’t know 329 77.8 Table 2 displays that almost all (99.3%) had not attended awareness program on CKD, more than three-forth (84.4%) did not consume alcohol. Among those who consumed alcohol, majority consumed home-made alcohol, consumed more than 20 times a month and nearly 300ml at a time. More than one-third (37.9%) were taking since 10 to 20 years. Similarly, more than three-forth (81.6%) of respondents did not chew or smoke tobacco. Among those who used tobacco, khaini (62.8%) was most commonly used, nearly three forth (73.1%) used 6 times a day and nearly half (42.3%) were takin for 15–30 years. Table 2 Respondents’ Use of Alcohol and Tobacco n = 423 Awareness Program of CKD Frequency Percentage Attended 3 0.7 Not attended 420 99.3 Alcohol Consumption by Respondents Yes 66 15.6 No 357 84.4 Type of Alcohol Intake (n = 66) Home made 42 63.6 Bear 14 21.2 Others (Wine/Rum/Vodka/Jaad ) 10 15.2 Frequency of Alcohol Intake in a Months (n = 66) 20 days 39 59.1 Volume of Alcohol Intake per Day (ml) ≤ 300 47 71.2 > 300 19 28.8 Duration of alcohol Intake (in years) 20 17 25.7 Respondents using Tobacco Yes 78 18.4 No 345 81.6 Tobacco Type (n = 78) Khaini 49 62.8 Cigarette 20 7 Bidi 6 7.7 Hukka 3 3.8 Tobacco use frequency per day (n = 78) ≤ 6 57 73.1 > 6 21 26.9 Duration of Tobacco Use (in Years) (n = 78) 30 6 7.4 Table 3 reveals that more than half (54.1%) of respondents had low level of health literacy regarding CKD and there was no statistical difference in level of health literacy among the residents of Sundarharaincha, Katahari and Biratnagar (Kruskal-Wallis test p = 0.059) with mean rank 191.51, 202.75 and 225.24 respectively (Table 4 ). Table 3 Respondent’s Health Literacy on Chronic Kidney Disease Level of Health Literacy Frequency Percentage Low 229 54.1 High 194 45.9 Median score = 18, Q1 = 13 & Q2 = 18 Table 4 Comparison of Health Literacy by Place of Residence Place of Residence Frequency Mean Rank Kruskal-Wallis Test Sundarharaincha 86 191.51 p = 0.059 Katahari 120 202.75 Biratnagar 217 225.24 Table 5 illustrates the statistically significant association of health literacy with education (p = 0.001). However, the health literacy was not found to be associated with respondents’ co-morbidities and their family history of co-morbidities. Table 5 Association between Health Literacy and Selected Demographic Variables Variable Health Literacy p-value Age (in years) Low High 21–40 96 92 0.084 41–60 92 79 >60 41 23 Sex Male 75 81 0.127 Female 108 159 Marital status Single 28 29 0.338 Married 155 211 Religion Hindu 175 225 0.401 Others 8 15 Ethnicity Madhesi 122 175 0.164 Non-maadhesi 61 65 Level of Education Primary & Below 188 111 Secondary & Above 41 83 0.000 Occupation Employed 91 106 0.256 Unemployed 92 134 Income < 25000 106 123 0.173 ≥ 25000 77 177 Health Insurance Non-insured 130 167 0.746 Insured 53 73 * indicates significant association at p-value < 0.005 Table 6 depicts that there is statistically significant association of the level of awareness respondents’ habit of alcohol consumption (p = 0.006) and tobacco use (p = 0.000). Variable Health Literacy P-value Low High Alcohol Consumption Yes 46 20 0.006 No 183 174 Tobacco Use Yes 52 26 0.000 No 58 1720 Table 6 Association of Health Literacy with Alcohol and Tobacco Use * indicates significant association at p-value < 0.005 Table 7 shows that age (AOR 1.016, CI 0.970–0.998), education (AOR 3.17, CI 0.241–0.494) and tobacco use (AOR 2.079, CI 0.253–0.914) had statistically significant association as predictors of CKD health literacy. Table 7 Predictors of Health Literacy by Logistic Regression Variable B coefficient Adjusted OR CI p- value Age (in years) -0.16 0.984 0.970–0.998 0.029* Education Primary & Below 1 Secondary & Above -1.154 0.315 0.201–0.494 0.000 Alcohol Consumption Non-alcoholic 1 Alcoholic -0.388 0.678 0.345–1.134 0.261 Tobacco use Non-user 1 User -0.732 0.481 0.253–0.914 0.026 * indicates significant association at p-value < 0.005 Discussion Chronic kidney disease is a major public health burden with increasing prevalence globally, and even in Nepal (6.0%) [ 7 ] that at an alarming rate. About 1.3 million people die from kidney disease each year. CKD deaths increased by 41.5% from 1990 to 2020, and is the fastest growing cause of death. It is also known as a “silent killer”, as most people live with the disease for years before they have any symptoms. By the time the disease is detected, for many people it’s already too late making it very expensive to manage. However, it can usually be prevented by controlling key risk factors and can be detected early with simple blood and urine tests [ 13 ]. Thus this study was conducted with the aim to assess health literacy of adults in communities about CKD. The findings are based on the data obtained from the primary sources and put light on the CKD related health needs among general public. The mean age and standard deviation of adults was 41.8014 ± 13.49 years respectively. More than one-third (44.4%) of the respondents were from the age group 20–30 years which is similar to national data (33.15%) [ 23 ] whereas only 15.2% were of age more than 60 years and the mean age was 41.8 years. Similarly, about two-third (63.1%) were female which resembles the national data [ 24 ], majority (86.5%) were married and most (94.6%) of them were Hindu. Likewise, nearly half (46.3%) were illiterate similar to national education status[ 24 ], 24.3% with primary level education and only 2.4% had attained education of higher secondary and above. More than half (51.5%) were home maker whereas only 6.6% were service holders and more than half had monthly income of less than NRs 25000. Despite the provision of health insurance scheme by the government, only 29.8% of the people were enrolled in the scheme, though higher than the national figure of 10% [ 23 ]; this may be due to the low socio-economic status of the Nepalese people. Non-communicable diseases (NCDs) are the major cause of morbidity and mortality in the world, including developing countries like Nepal. Many nationally representative studies have shown that NCDs such as hypertension and diabetes are highly prevalent in the general population [ 25 ]. This study findings also revealed hypertension and diabetes as the common co-morbidities prevalent among both the respondents and their family members and the findings are consistent with many studies conducted among Nepalese general population[ 25 , 26 ] as well as in the neighboring countries [ 21 , 22 ]. These two NCDs are the leading causes of CKD if timely precaution and intervention are not adopted. Health seeking and disease screening depends greatly on socio-economic status of the people and the health services provided by the nation. Many studies have shown poor health screening and check-up for CKDs in developing nations [ 21 ] which is consistent in this study findings as well where only 1.9% had done health check-up in the last 6 to 12 months. Similarly, none had attended CKD awareness program. Around 20% of the respondents, also depicted by national level research [ 24 ], had habits of tobacco use and alcohol consumption which are the major risk factors for NCDs. Though preventable, CKD prevalence is increasing and it is a public health concern. Despite early detection is possible through simple blood and urine tests, most of the people come to health centers at a later stage with many complications. World Health Organization advocates for health literacy of general people through education awareness to prevent the CKD. However, the findings of this study has revealed low level of health literacy on CKD among more than half (54.1%) of the people of the communities which is consistent with the findings of Pandey et al. [ 26 ]. Similarly, studies from different regions of the world have also depicted the low level of awareness of CKD among general public [ 21 , 16 , 12 , 27 ]. This might be due to the fact that higher level of awareness prevailed among respondents from higher educational and higher economic backgrounds [ 16 ] as most of the respondents in this study belonged to low economic status with monthly income of less than 25000 per month and most of them were illiterate. The study also identified the association of health literacy among community people of Morang, Eastern Nepal using the bivariate and multivariate analyses of the different independent and dependent variables. During bivariate analysis, education, habit of tobacco use and alcohol consumption were found to be associated with health literacy on CKD [ 16 , 18 , 21 ] whereas multivariate logistic regression revealed age (AOR 1.016, CI 0.970–0.998), education (AOR 3.17, CI 0.241–0.494) and tobacco use (AOR 2.079, CI 0.253–0.914) as the independent predictors of CKD health literacy. Literate people and tobacco users have about half time chances of having high health literacy. This may be due to the impact of education that makes people more aware and familiar to different health information. Regarding tobacco users, because of their tobacco use habit, they might have been repeatedly counseled by health care professionals regarding the adverse effects of tobacco on health and they might have gained information on CKD as well. Similar findings were revealed from many studies conducted in Lebanon [ 21 ], Saudi Arabia [ 16 ] and Australia [ 18 ]. Various studies have found association of awareness with the positive history of chronic diseases like hypertension and diabetes among respondents [ 16 , 18 , 27 ] which is in contrast with the findings of this study which showed no association of health literacy with these variables. These variation might be due to the difference in health care services and public awareness. Conclusion Adults of Morang, Eastern Nepal had low level of health literacy on CKD. Age, education, alcohol consumption and tobacco use were found to be associated with health literacy on CKD. Educational status had positive impact whereas tobacco use had negative impact as predictors on health literacy. Implementing health awareness, disease screening and tobacco control programs by local governments local governments could contribute in early diagnosis and complication prevention of CKD in Morang. Recommendation It is recommended to future researchers to assess health literacy on CKD among CKD patients so that their practices in disease management and health seeking behavior can be explored. It is recommended to the local policy planners to conduct educational intervention campaigns to increase awareness on risk factors, prevention and early detection of CKD. Declarations Author Contribution a. DK prepared proposal, finalized questionnaire, data collection, data entry, final analysis, discussion, prepared the manuscriptb. 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[cited 2024 Jul 11]. https://dhsprogram.com/pubs/pdf/FR379/FR379.pdf STEPS Survey. 2019 Nepal [Internet]. [cited 2024 Jul 13]. https://nhrc.gov.np/wp-content/uploads/2019/11/National-Factsheet-English-1.pdf Aryal KK, Mehata S, Neupane S, Vaidya A, Dhimal M, Dhakal P, et al. The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey. PLoS ONE. 2015;10(8):e0134834. Pandey AR, Poudyal A, Adhikari B, Shrestha N. Burden of chronic kidney disease in Nepal: An analysis of the burden of disease from 1990 to 2019. PLOS Glob Public Health. 2023;3(7):e0001727. Muxunov A, Bulanov N, Makhmetov S, Sharapov O, Abdullaev S, Loboda O, et al. Awareness of chronic kidney disease and its risk factors in the former Soviet Union countries. ELECTRON J GEN MED. 2023;20(6):em528. Additional Declarations No competing interests reported. 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Diabetes and hypertension are the leading causes of CKD [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] that ultimately require dialysis and renal transplant as the main treatment option for survival [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Worse still, the majority affected are unable to sustain or achieve optimal dose of hemodialysis and other adjunctive treatments for ESRD due to the high cost [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These may cause negative thwack and burdens on patients, families, and healthcare system of that countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevalence of CKD in adults\u0026rsquo; population in India, Pakistan and Bangladesh are 10.2%, 21.2% and 17.3% respectively [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Similarly, the overall prevalence of CKD among adult population in Nepal is 6% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] with 10.6% in the community of Eastern Nepal [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Early diagnosis is possible with adequate health literacy on CKD and its associated risk factors [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] that not only reduces morbidity and mortality [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] but also aids in reduction of public health burden. Unfortunately, most of the people in community are unfamiliar about the CKD risk factors and remain clinically unrecognized [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] thus presenting at the health facilities in an advanced stage which is the major challenge in the developing countries like Nepal [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA study conducted in South West Nigeria among rural community people has shown that only 27.1% of people had good knowledge regarding chronic kidney disease [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, 60% and 57.6% of the respondents in Bangladesh and Nepal respectively had low knowledge [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Many studies have shown lack of awareness among general population regarding CKD [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] including Eastern Nepal [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePublic awareness is not only an important determinant of the uptake of screening programs for early detection but also provides an opportunity for early therapeutic interventions to prevent or delay the onset of disease or complications and to improve outcome [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Studies conducted in both developed and developing countries have shown that the public understanding of CKD and its risk factors are relatively poor. Information and awareness not only help people to change or modify their health habits and other behavior but also help to achieve and maintain optimal health [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. On the other hand, low level of awareness leads to poor perceived susceptibility [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThus, it is high time for the need to shift from expensive hospital-based treatment to a much economic preventive strategy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. To date of our best knowledge, very few studies have been conducted regarding the phenomenon in community setting. Thus, the researchers designed this study to find out the health literacy on chronic kidney disease among adults of Eastern Nepal.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cstrong\u003eHealth Literacy on CKD\u003c/strong\u003e \u003cp\u003eHealth literacy was assessed as awareness. It means having awareness on CKD including its introduction, causes, risk factors, signs and symptoms, treatment, prevention and complication. It was assessed based on scoring of each correct response to the items in pre-validated structured questionnaire. Higher the score means higher the health literacy of respondents on CKD. Total score of the questionnaire is 37 and categorized as High and Low Level of Health Literacy on CKD based on median score [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAdults\u003c/strong\u003e \u003cp\u003eIt refers to respondents of age\u0026thinsp;\u0026gt;\u0026thinsp;20 years and residing in the respective communities at the time of data collection.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eResearch design\u003c/strong\u003e \u003cp\u003eA quantitative analytical cross-sectional study was used to assess the health literacy on CKD among adults of Morang district, Eastern Nepal. Data was be collected from the primary sources ie adults residing in the communities of Morang.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSetting and Population\u003c/strong\u003e \u003cp\u003eThe setting of the study was Morang district of Koshi Province which is the second largest province. There are one metropolitan city, eight urban and eight rural municipalities in the district. The total area of Morang is 1855 km\u003csup\u003e2\u003c/sup\u003e. As of the 2011 Nepal Census, Morang district had a population of 965,370 [(22)].\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe national data shows higher prevalence of NCDs like hypertension and diabetes among adults in Koshi Province which are the leading causes of CKD. Thus the study population were the adults aged 20 years and above residing at Morang\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSampling technique\u003c/h2\u003e \u003cp\u003eMulti-stage sampling technique was used. At the first stage, Morang district was selected conveniently. Out of 17 municipalities of Morang district, one metropolitan, one urban and one rural municipality each were selected randomly in the second stage. Then in the third stage, one ward from each of three selected municipalities were again selected randomly. And in the fourth stage, population proportionate sampling technique was adopted to estimate number of samples from each setting. Cluster sampling was used for the inclusion of household from selected wards and one member who was encountered first was included as subject from a household. The first household was selected by bottle neck method. The bottle was rotated and the direction pointed by the bottle was selected as first household for sampling in each ward.\u003c/p\u003e\n\u003ch3\u003eInstrumentation\u003c/h3\u003e\n\u003cp\u003eA semi-structured interview questionnaire was used based on the objectives of the study. The study instrument was divided into two parts:\u003c/p\u003e \u003cp\u003ePart I: Semi-structured questions related to Socio-demographic information and co-morbidities present in the participant, history of NCDs in parents, last health check-up for kidney disease, tobacco and alcohol use\u003c/p\u003e \u003cp\u003ePart II: Structured questions related to awareness on chronic kidney disease. This part was a pre-validated tool which had been used and validated in Lebanese adult population. It consisted of total 37 items, both multiple choice question and yes/no questions, with the total score of 37.\u003c/p\u003e \u003cp\u003eCrohnbach\u0026rsquo;s alpha score for internal consistency reliability was 0.84.\u003c/p\u003e\n\u003ch3\u003eEthical Consideration\u003c/h3\u003e\n\u003cp\u003e After the approval of grant, administrative approval to collect data was obtained from concerned authorities of selected wards. Ethical clearance was obtained from the Nepal Health Research Centre (NHRC) to conduct the study (Ref no: 2162). Finally, the informed written consent were obtained from each participant before participation in the study. All the ethical principles as of Helsinki Declaration for medical research involving humans were maintained.\u003c/p\u003e\n\u003ch3\u003eData Collection Procedure\u003c/h3\u003e\n\u003cp\u003eOne respondent from a household was included as a sample. Data was collected via face-to face interviews using a semi- structured interview questionnaire. Each participant was explained the nature and purpose of the study. Informed consent (both verbal \u0026amp; written) was taken before performing the interview. The time duration for each interview was about 15\u0026ndash;20 minutes. Collected data were checked for the completeness and editing was done on the same day to prevent recall bias, ensure the quality \u0026amp; accuracy of the study.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis Procedure\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eCollected data were checked daily for completeness. All the data were entered in Statistical Package for the Social Sciences (SPSS) version 20 after editing and coding. Descriptive analysis i.e. frequency, percentage, mean, median, and standard deviation were used to assess health literacy on chronic kidney disease. Inferential analysis as bivariate and multivariate analyses were used to find the association between dependent and selected demographic variables. \u003cem\u003ep\u003c/em\u003e-value of 0.05 was considered to indicate statistical significance at a 95% confidence level. Analyzed data were presented in the relevant tabular form.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eNearly half (44.4%) of respondents were from the age group 20\u0026ndash;30 years and only 15.2% were from 60 years and above with mean age 41.8 years. Similarly, more than half (63.1%) were female 86.5% were married and most (94.6%) were Hindu. Only 2.4% had attained education of higher secondary and above whereas nearly half (46.3%) were illiterate. More than half (51.5%) were home maker whereas only 6.6% were service holders and more than half had monthly income of rupees less than 25000.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e reveals that more than two third (70.2%) of respondents were not enrolled in government\u0026rsquo;s health insurance. Regarding co-morbidity among respondents, less than one fourth (21.0%) had hypertension followed by diabetes mellitus (10.6%). Similarly, less than one forth (20.8%) of respondents\u0026rsquo; family member had hypertension followed by diabetes (11.1%) and CVA (0.7%). Similarly, more than three forth (77.8%) did not know when they did health checkup and only 1.9% had done health check-up for kidney disease in the last 6 to 12 months period.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHealth Related Information n\u0026thinsp;=\u0026thinsp;423\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvision of Health Insurance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-insured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCo-morbidity among Respondents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidity among Family Members\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLast Health Checkup Sought for Kidney Disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;6 moths\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e displays that almost all (99.3%) had not attended awareness program on CKD, more than three-forth (84.4%) did not consume alcohol. Among those who consumed alcohol, majority consumed home-made alcohol, consumed more than 20 times a month and nearly 300ml at a time. More than one-third (37.9%) were taking since 10 to 20 years. Similarly, more than three-forth (81.6%) of respondents did not chew or smoke tobacco. Among those who used tobacco, khaini (62.8%) was most commonly used, nearly three forth (73.1%) used 6 times a day and nearly half (42.3%) were takin for 15\u0026ndash;30 years.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRespondents\u0026rsquo; Use of Alcohol and Tobacco n\u0026thinsp;=\u0026thinsp;423\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwareness Program of CKD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot attended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol Consumption by Respondents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Alcohol Intake (n\u0026thinsp;=\u0026thinsp;66)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome made\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers (Wine/Rum/Vodka/Jaad )\u003cb\u003e\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAwAAAAYCAYAAADOMhxqAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAAAB+SURBVDhP7ZJRDgARDERbZ3F3bmlN0wpNY/nbj30JjXaGCtw6dEHSeMxvMJiZcs66Wrk/AbthvGG6ZA+9M1kNWmlpZ5rFYNzBErVWicCLhb5YQKqUIjEot+W3+h2jE0ZLUdEbgRjCXhVvwiyZSDwzDF24Vzruv4bGYz5nIHoAM5hcXz0PBosAAAAASUVORK5CYII=\" width=\"12\" height=\"24\"\u003e\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFrequency of Alcohol Intake in a Months (n\u0026thinsp;=\u0026thinsp;66)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;20 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVolume of Alcohol Intake per Day (ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of alcohol Intake (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespondents using Tobacco\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTobacco Type (n\u0026thinsp;=\u0026thinsp;78)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKhaini\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCigarette\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBidi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHukka\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTobacco use frequency per day (n\u0026thinsp;=\u0026thinsp;78)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of Tobacco Use (in Years) (n\u0026thinsp;=\u0026thinsp;78)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e reveals that more than half (54.1%) of respondents had low level of health literacy regarding CKD and there was no statistical difference in level of health literacy among the residents of Sundarharaincha, Katahari and Biratnagar (Kruskal-Wallis test p\u0026thinsp;=\u0026thinsp;0.059) with mean rank 191.51, 202.75 and 225.24 respectively (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRespondent\u0026rsquo;s Health Literacy on Chronic Kidney Disease\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of Health Literacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian score\u0026thinsp;=\u0026thinsp;18, Q1\u0026thinsp;=\u0026thinsp;13 \u0026amp; Q2\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Health Literacy by Place of Residence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of Residence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean Rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKruskal-Wallis Test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSundarharaincha\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e191.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKatahari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e202.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiratnagar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e illustrates the statistically significant association of health literacy with education (p\u0026thinsp;=\u0026thinsp;0.001). However, the health literacy was not found to be associated with respondents\u0026rsquo; co-morbidities and their family history of co-morbidities.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between Health Literacy and Selected Demographic Variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHealth Literacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (in years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMadhesi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-maadhesi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary \u0026amp; Below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary \u0026amp; Above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003cb\u003e\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAwAAAAYCAYAAADOMhxqAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAAAB+SURBVDhP7ZJRDgARDERbZ3F3bmlN0wpNY/nbj30JjXaGCtw6dEHSeMxvMJiZcs66Wrk/AbthvGG6ZA+9M1kNWmlpZ5rFYNzBErVWicCLhb5YQKqUIjEot+W3+h2jE0ZLUdEbgRjCXhVvwiyZSDwzDF24Vzruv4bGYz5nIHoAM5hcXz0PBosAAAAASUVORK5CYII=\" width=\"12\" height=\"24\"\u003e\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth Insurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-insured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e* indicates significant association at p-value \u003c 0.005\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003edepicts that there is statistically significant association of the level of awareness respondents\u0026rsquo; habit of alcohol consumption (p\u0026thinsp;=\u0026thinsp;0.006) and tobacco use (p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHealth Literacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol Consumption\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAwAAAAYCAYAAADOMhxqAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAAAB+SURBVDhP7ZJRDgARDERbZ3F3bmlN0wpNY/nbj30JjXaGCtw6dEHSeMxvMJiZcs66Wrk/AbthvGG6ZA+9M1kNWmlpZ5rFYNzBErVWicCLhb5YQKqUIjEot+W3+h2jE0ZLUdEbgRjCXhVvwiyZSDwzDF24Vzruv4bGYz5nIHoAM5hcXz0PBosAAAAASUVORK5CYII=\" width=\"12\" height=\"24\"\u003e\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTobacco Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAwAAAAYCAYAAADOMhxqAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAAAB+SURBVDhP7ZJRDgARDERbZ3F3bmlN0wpNY/nbj30JjXaGCtw6dEHSeMxvMJiZcs66Wrk/AbthvGG6ZA+9M1kNWmlpZ5rFYNzBErVWicCLhb5YQKqUIjEot+W3+h2jE0ZLUdEbgRjCXhVvwiyZSDwzDF24Vzruv4bGYz5nIHoAM5hcXz0PBosAAAAASUVORK5CYII=\" width=\"12\" height=\"24\"\u003e\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u003cb\u003eAssociation of Health Literacy with Alcohol and Tobacco Use\u003c/b\u003e\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e* indicates significant association at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.005\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e shows that age (AOR 1.016, CI 0.970\u0026ndash;0.998), education (AOR 3.17, CI 0.241\u0026ndash;0.494) and tobacco use (AOR 2.079, CI 0.253\u0026ndash;0.914) had statistically significant association as predictors of CKD health literacy.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of Health Literacy by Logistic Regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.970\u0026ndash;0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.029*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary \u0026amp; Below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary \u0026amp; Above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.201\u0026ndash;0.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAwAAAAYCAYAAADOMhxqAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAAAB+SURBVDhP7ZJRDgARDERbZ3F3bmlN0wpNY/nbj30JjXaGCtw6dEHSeMxvMJiZcs66Wrk/AbthvGG6ZA+9M1kNWmlpZ5rFYNzBErVWicCLhb5YQKqUIjEot+W3+h2jE0ZLUdEbgRjCXhVvwiyZSDwzDF24Vzruv4bGYz5nIHoAM5hcXz0PBosAAAAASUVORK5CYII=\" width=\"12\" height=\"24\"\u003e\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol Consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-alcoholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcoholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.345\u0026ndash;1.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTobacco use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-user\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUser\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.253\u0026ndash;0.914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAwAAAAYCAYAAADOMhxqAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAAAB+SURBVDhP7ZJRDgARDERbZ3F3bmlN0wpNY/nbj30JjXaGCtw6dEHSeMxvMJiZcs66Wrk/AbthvGG6ZA+9M1kNWmlpZ5rFYNzBErVWicCLhb5YQKqUIjEot+W3+h2jE0ZLUdEbgRjCXhVvwiyZSDwzDF24Vzruv4bGYz5nIHoAM5hcXz0PBosAAAAASUVORK5CYII=\" width=\"12\" height=\"24\"\u003e\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003cp\u003e* indicates significant association at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.005\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eChronic kidney disease is a major public health burden with increasing prevalence globally, and even in Nepal (6.0%) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] that at an alarming rate. About 1.3\u0026nbsp;million people die from kidney disease each year. CKD deaths increased by 41.5% from 1990 to 2020, and is the fastest growing cause of death. It is also known as a \u0026ldquo;silent killer\u0026rdquo;, as most people live with the disease for years before they have any symptoms. By the time the disease is detected, for many people it\u0026rsquo;s already too late making it very expensive to manage. However, it can usually be prevented by controlling key risk factors and can be detected early with simple blood and urine tests [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Thus this study was conducted with the aim to assess health literacy of adults in communities about CKD. The findings are based on the data obtained from the primary sources and put light on the CKD related health needs among general public.\u003c/p\u003e \u003cp\u003eThe mean age and standard deviation of adults was 41.8014\u0026thinsp;\u0026plusmn;\u0026thinsp;13.49 years respectively. More than one-third (44.4%) of the respondents were from the age group 20\u0026ndash;30 years which is similar to national data (33.15%) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] whereas only 15.2% were of age more than 60 years and the mean age was 41.8 years. Similarly, about two-third (63.1%) were female which resembles the national data [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], majority (86.5%) were married and most (94.6%) of them were Hindu. Likewise, nearly half (46.3%) were illiterate similar to national education status[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], 24.3% with primary level education and only 2.4% had attained education of higher secondary and above. More than half (51.5%) were home maker whereas only 6.6% were service holders and more than half had monthly income of less than NRs 25000. Despite the provision of health insurance scheme by the government, only 29.8% of the people were enrolled in the scheme, though higher than the national figure of 10% [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]; this may be due to the low socio-economic status of the Nepalese people.\u003c/p\u003e \u003cp\u003eNon-communicable diseases (NCDs) are the major cause of morbidity and mortality in the world, including developing countries like Nepal. Many nationally representative studies have shown that NCDs such as hypertension and diabetes are highly prevalent in the general population [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This study findings also revealed hypertension and diabetes as the common co-morbidities prevalent among both the respondents and their family members and the findings are consistent with many studies conducted among Nepalese general population[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] as well as in the neighboring countries [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These two NCDs are the leading causes of CKD if timely precaution and intervention are not adopted.\u003c/p\u003e \u003cp\u003eHealth seeking and disease screening depends greatly on socio-economic status of the people and the health services provided by the nation. Many studies have shown poor health screening and check-up for CKDs in developing nations [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] which is consistent in this study findings as well where only 1.9% had done health check-up in the last 6 to 12 months. Similarly, none had attended CKD awareness program. Around 20% of the respondents, also depicted by national level research [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], had habits of tobacco use and alcohol consumption which are the major risk factors for NCDs.\u003c/p\u003e \u003cp\u003eThough preventable, CKD prevalence is increasing and it is a public health concern. Despite early detection is possible through simple blood and urine tests, most of the people come to health centers at a later stage with many complications. World Health Organization advocates for health literacy of general people through education awareness to prevent the CKD. However, the findings of this study has revealed low level of health literacy on CKD among more than half (54.1%) of the people of the communities which is consistent with the findings of Pandey et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Similarly, studies from different regions of the world have also depicted the low level of awareness of CKD among general public [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This might be due to the fact that higher level of awareness prevailed among respondents from higher educational and higher economic backgrounds [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] as most of the respondents in this study belonged to low economic status with monthly income of less than 25000 per month and most of them were illiterate.\u003c/p\u003e \u003cp\u003eThe study also identified the association of health literacy among community people of Morang, Eastern Nepal using the bivariate and multivariate analyses of the different independent and dependent variables. During bivariate analysis, education, habit of tobacco use and alcohol consumption were found to be associated with health literacy on CKD [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] whereas multivariate logistic regression revealed age (AOR 1.016, CI 0.970\u0026ndash;0.998), education (AOR 3.17, CI 0.241\u0026ndash;0.494) and tobacco use (AOR 2.079, CI 0.253\u0026ndash;0.914) as the independent predictors of CKD health literacy. Literate people and tobacco users have about half time chances of having high health literacy. This may be due to the impact of education that makes people more aware and familiar to different health information. Regarding tobacco users, because of their tobacco use habit, they might have been repeatedly counseled by health care professionals regarding the adverse effects of tobacco on health and they might have gained information on CKD as well. Similar findings were revealed from many studies conducted in Lebanon [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], Saudi Arabia [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and Australia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVarious studies have found association of awareness with the positive history of chronic diseases like hypertension and diabetes among respondents [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] which is in contrast with the findings of this study which showed no association of health literacy with these variables. These variation might be due to the difference in health care services and public awareness.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAdults of Morang, Eastern Nepal had low level of health literacy on CKD. Age, education, alcohol consumption and tobacco use were found to be associated with health literacy on CKD. Educational status had positive impact whereas tobacco use had negative impact as predictors on health literacy. Implementing health awareness, disease screening and tobacco control programs by local governments local governments could contribute in early diagnosis and complication prevention of CKD in Morang.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRecommendation\u003c/h2\u003e \u003cp\u003eIt is recommended to future researchers to assess health literacy on CKD among CKD patients so that their practices in disease management and health seeking behavior can be explored.\u003c/p\u003e \u003cp\u003eIt is recommended to the local policy planners to conduct educational intervention campaigns to increase awareness on risk factors, prevention and early detection of CKD.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003ea. DK prepared proposal, finalized questionnaire, data collection, data entry, final analysis, discussion, prepared the manuscriptb. AKC conceptualized the problem, prepared proposal, data collection, contributed in data entry and interpretationc. SB contributed in preparing proposal, data collection, data entry and analysis\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe study has received research grant awarded by the provincial ministry of health, Koshi Province, Nepal to conduct the study. I would like to acknowledge for the grant\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHunegnaw A, Mekonnen HS, Techane MA, Agegnehu CD. Prevalence and Associated Factors of Chronic Kidney Disease among Adult Hypertensive Patients at Northwest Amhara Referral Hospitals, Northwest Ethiopia, 2020. Moreira TMM, editor. Int J Hypertens. 2021;2021:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhimire S, Neupane G, Sah C. Awareness Regarding Chronic Kidney Disease Among Adults in a Hospital of Siddharthanagar Municipality. 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BMC Nephrol. 2018;19(1):291.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoudyal A, Karki KB, Shrestha N, Aryal KK, Mahato NK, Bista B, et al. Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study. BMJ Open. 2022;12(3):e057509.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePradhan RR, Sigdel MR, Prevalence. Clinical Presentation, and Outcome of Tuberculosis in Patients with Chronic Kidney Disease at a Tertiary Care Hospital in Nepal. Mattoo T, editor. International Journal of Nephrology. 2020;2020:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarki et al. Assessment of Chronic Kideny Disease Support Program of Government of Nepal 2016 [Internet]. 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ELECTRON J GEN MED. 2023;20(6):em528.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adults, Chronic Kidney Disease, Health Literacy, Morang","lastPublishedDoi":"10.21203/rs.3.rs-5049922/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5049922/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChronic kidney disease (CKD) is a rapidly increasing health problem worldwide. Early diagnosis is possible with adequate health literacy. Unfortunately, majority of the CKD patients are diagnosed in the last stage which is the major challenge in the developing countries like Nepal. Thus, the researchers designed this study to find out the chronic kidney disease related health literacy among adults of Eastern Nepal.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quantitative analytical cross-sectional study design with multi-stage sampling was used. One ward from each of one metropolitan, one urban and one rural municipality were selected randomly. And in the fourth stage, population proportionate samples, one sample from a household, were selected to meet the total sample size of 414. Data was collected using a semi-structured questionnaire with high internal consistency reliability of 0.84. Face-to-face interview was done after the ethical approval from Nepal Health Research Council, Nepal (Ref. No. 2162). Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 20.00. Descriptive and inferential i.e. regression analysis were used.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age and standard deviation of adults was 41.8014\u0026thinsp;\u0026plusmn;\u0026thinsp;13.49 years respectively. About two-third (63.1%) were female, 86.5% married, 94.6% Hindu and 46.3% illiterate. One-fifth had habit of alcohol consumption and tobacco use. The median score for health literacy on CKD was 18 and there was no statistical difference in scores of adults residing in Sundarharaincha, Katahari and Biratnagar. More than half (54.1%) of the adults surveyed had low level of health literacy on CKD. Age, secondary and above education, alcohol consumption and tobacco use were found to be associated with health literacy during bivariate analysis. Similarly, the multivariate regression analysis showed that age (AOR 1.016, CI 0.970\u0026ndash;0.998), education (AOR 3.17, CI 0.241\u0026ndash;0.494) and tobacco use (AOR 2.079, CI 0.253\u0026ndash;0.914) had statistically significant association as predictors of CKD health literacy.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAdults of Morang, Eastern Nepal had low level of health literacy on CKD. Implementing health awareness, disease screening and tobacco control programs by local governments local governments could contribute in early diagnosis and complication prevention of CKD in Morang.\u003c/p\u003e","manuscriptTitle":"Health Literacy on Chronic Kidney Disease among Adults of Morang, Eastern Nepal","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-29 07:14:34","doi":"10.21203/rs.3.rs-5049922/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7913a6fb-ec48-4595-8bab-3ee5b2788378","owner":[],"postedDate":"November 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-02T06:24:43+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-29 07:14:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5049922","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5049922","identity":"rs-5049922","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}