Asian Development Bank.Flickr (2015). Many affected by the earthquake are still dwelling in makeshift dwellings [Online Image]. Retrieved from http://cdn.downtoearth.org.in/uploads/0.58340200_1448620119_nepal-earthquake_large.jpg
Dinesh Neupane & Shiva Raj Mishra (Producer). (2014). Non-communicable diseases in Nepal. [Video]. Available from https://www.youtube.com/watch?v=jEko6WXH8_s
Institute for Health Metrics and Evaluation (IHME). Country profile, Nepal. Seattle, WA: IHME, University of Washington, 2016. Retrieved from http://www.healthdata.org/nepal
Communicated & Non-communicated Disease
Discussion of disease in Nepal has multiple areas of concern. Social determinants like: equality of gender, employment, and education; culture; resources; infrastructure; and urbanization; represent limiting factors. Disease can also be influenced by nutrition, environment, and occupational health. After Nepal had two Earthquakes, back to back, there was a break in continued progress combating disease. Organization groups analyze these areas when creating health promoting behaviors linked to the top communicable and non-communicable diseases (NCD).
​
Communicable
Disease
Non-communicable Disease
Statistical evidence for common Nepal communicable diseases looks promising. In the 2015, Institute for Health Matrix and Evaluation (IHME), the country data profile show a drop in ranking for Diarrheal infections, Tuberculosis (TB), and Lower respiratory infection cause of death, over a 15 year period. TB is a respiratory infection that requires precise compliance and monitoring, which can be difficult for rural families and costly for the underserved. The World Health Organization (WHO), in 2014, reported India had 24% and China had 11% of all global cases (as cited in Skolnick, 2016, p.330). Nepal is completely landlocked by both of these countries and TB possess a high risk of transmission. Diarrheal disease has the largest impact on children under 5-year-old. It can be caused from different bacteria, viruses or parasites and is easily transmitted. Families that are poor, house multiple generations, live close to animals, have unsafe water and lack education, are at higher risk for demonstrating poor hygiene (Skolnick, 2016, p.336). These two predictors show cause for the continued cause of death ranking.
Non-communicable diseases (NCD) are not only deadly, they are disabling due to their chronic nature. They can be prevented through modifying behaviors, however Nepal is still recovering from 2 earthquakes in 2015 and 10 years of political unrest. More people are moving to the cities, they don't eat directly from the land, and continue to cook on an open indoor fire. Cardiovascular disease (CVD) has not changed rankings from #1, as seen below, in the IHME data report. Cardiovascular Disease is 22% of the NCD's risks for Nepal. Multiple factors that contribute directly to CVD include: smoking, regular alcohol consumption, stress, and limited exercise. A couple of these also contribute to the increased ranking of Chronic Obstructive Pulmonary Disease (COPD), from the fourth, to the second position. Many people cook indoors and heat their homes with open fires using fuels that don't cleanly break down; this leaves residual air pollution that exposes entire family (World Health Organization, 2014).
Challenges to Prevention & Control
-
TB requires a larger role from the health care community. There is increased antibiotic resistant TB and it's 3.5% of the 9 million new cases each year. Because of this, it is crucial patients are closely monitored. The difficulty comes when there is not enough trained healthcare providers or the families live in rural communities Skolnik, 2016). As Nepal families tend to live in close quarters and have multiple generations in the home, the risk for contacting TB is high.
-
Diarrhea disease can also be a huge burden. A predominate number of women are "given" into child marriage. At that point, women's schooling is not the priority for her husband or his family. Most women have to quit school, start working, and ultimately get pregnant. Six months of breast feeding is limited in this restrictive environment. Also, women and children have a lack of knowledge about proper hygiene and using clean water (Skolnik, 2016).
-
CVD is seen in communities where bicycles are used for transportation, not exercise, and influential people own more cars. The poor lack knowledge and resources to provide a balanced diet. There is large societal inequality and it defines this disease with it's risk factors. The lack of exercise, increase in deleterious food choices and lacking proper nutrition, have produced younger people with CVD symptoms (Dinesh & Mishra, 2014).
-
Smoking and use of indoor fires are difficult factors to overcome. There are many poor families, urban and rural, that have to rely on bio fuels to cook and heat their homes. Also, smoking is the third leading cause of an estimated, 5 million deaths annually. Socioeconomic inequality and illiteracy are two factors that increase the likelihood of smoking and continued dependency on open fires (Skolnik, 2016).
Improvement or Prevention of Select Disease
Tuberculosis
-
Use of Xpert- a rapid bacteriological test that can identify drug resistance or opportunistic TB
-
Implement community based and primary care supervision to ensure patient compliance for required 6 month treatment and teaching
-
Develop a quality program that enlists more private and community responsibility
(Skolnik, 2014)
Diarrheal Disease​
-
Integrate community based teaching to improve breastfeeding for 6 months
-
Create community based groups that facilitate teaching programs and incorporate maternity and children.
-
Increase administration of measles vaccine
-
Improve water and sanitation infrastructure
-
Provide health behavior teaching through multiple media sources: TV, radio, phone, billboards, and fliers
(Skolnik, 2016)
Cardiovascular Disease
-
Provide more Primary Care mobile units to diagnose and case manage in rural areas
-
Continue the 1992 ban on public smoking and improve regulatory and enforcement laws
-
Continue the 1999 Health Ministry's ban on alcohol advertisement
-
Expand teaching on low salt/fat diet, limiting alcohol, smoking cessation, increase exercise, and CVD symptoms
(Dinesh & Mishra, 2014)
COPD
-
Continue multisectorial action plan that enlists stakeholders, private, government, and community
-
Improve research capabilities to ensure early disease detection
-
Expand clean energy sources to all homes
-
Empower communities to join improvement committees
-
Continue social mobilizing programs that teach disease symptoms and behavior modifications
(Dinesh & Mishra, 2014)