Journal Issue: Volume: 19, No 3, Issue 75, Special JULY - SEPT, 2021
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Volume
Number
Issue Date
2021
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Cardiovascular Disease Prevention and Management Efforts in Nepal
(Kathmandu University, 2021) Koju, RP
NA
Burden of Stroke in Nepal: Findings from Global Burden of Disease Dataset 2017
(Kathmandu University, 2021) Pyakurel, M; Bhattarai, S; Joshi, B; Koju, RP; Shrestha, A
ABSTRACT
Background
Stroke is the second leading cause of death and disability worldwide including Asian
countries, surpassing ischemic heart disease. Stroke accounts for 10% of global
death, of which more than three fourth occur in low- and middle-income countries.
An exact estimate of the burden of stroke in Nepal is not available.
Objective
To assess the burden of stroke including disability and death over time in Nepal and
compare it with other South Asian countries.
Method
We retrieved data from the Institute of Health Metrics and Evaluation’s Global
Burden of Diseases database of 2017 on stroke deaths, disability-adjusted life years,
incidence, and prevalence rates, for both genders from Nepal, Bangladesh, Pakistan,
Bhutan, and India by year. We assessed the trend of deaths and Disability-Adjusted
Life Years (DALYs) due to stroke from 1990 to 2017; and the contribution of major risk
factors to stroke burden in 2017.
Result
Stroke contributed 7.6% of total deaths and 3.5% of total DALYs in Nepal, with a
higher burden among the male and old age population. Intracerebral hemorrhage
was the dominant type of stroke in Nepal with the highest proportion of deaths and
DALYs. Among the South Asian countries, incidence, prevalence, and burden of stroke
were highest in Bangladesh. Intracerebral hemorrhage contributed the highest DALYs
in South Asian countries. High systolic blood pressure was contributing the maximum
DALYs due to stroke in Nepal.
Conclusion
Hemorrhagic stroke causes high mortality and DALYs in Nepal. Most of the burden of
stroke is attributed to high blood pressure in Nepal.
KEY WORDS
Global burden of disease (GBD), Nepal, Prevalence, Risk factor, Stroke
Medical Products for Cardiovascular Disease Management in Nepal: a needs assessment study
(Kathmandu University, 2021) Sapkota, S; Shrestha, S; Bista, D; Shrestha, A; Maharjan, R; Bajracharya, S; Jha, N; Koju, RP; Shrestha, R
ABSTRACT
Background
Medical Products and Technologies is a key component of the health system. Quality
medicines and efficient management of the medical products can secure effective
cardiovascular diseases management.
Objective
To collate information and identify strengths, weaknesses, opportunities and
threats (SWOT) associated with medical products and technology component for
cardiovascular disease management in Nepal.
Method
This study is a part of a larger rapid assessment of Nepal’s health system for
cardiovascular disease management and based on The Health System Assessment
Approach: A How-To Manual (USAID). The authors conducted a desk review of
documents related to the WHO “medical product and technology” building block
component and key informant interviews using a pre-tested interview protocol.
The first eight interviews were transcribed verbatim and analysed inductively to
generate a codebook; and the remaining, transcribed and deductively coded based
on the codebook. Findings were categorised into relevant topical area and SWOT
components.
Result
Nepal has laws and provisions for medicine regulation, pharmacovigilance, post
marketing surveillance, registration and licensing provisions for pharmacy industries/
outlets, essential medicine lists and national formulary. These provisions also apply
to medicines used for cardiovascular diseases. The challenge however, is the lack of
effective implementation and monitoring, due to shortages of technical workforce
and state of art information and technologies. Information on pharmaceutical
expenditures for cardiovascular disease management is scarce; there are no standard
national level guidelines that are consistently used to manage cardiovascular diseases
in health facilities.
Conclusion
There are limited provisions and information on medical products for cardiovascular
disease management in Nepal, and a need to strengthen existing provisions for
medicine regulations and surveillance.
KEY WORDS
Cardiovascular Disease, Health System, Medicines, Medical Products, Nepal
Human Resources for Cardiovascular Disease Management in Nepal: A National Need Assessment
(Kathmandu University, 2021) Thapa, B; Sharma, S; Shrestha, A; Maharjan, R; Jha, N; Bajracharya, S; Shrestha, S; Neupane, T; Sapkota, BP; Koju, RP; Oli, N
ABSTRACT
Background
Human resources are the mainstay of the healthcare system. Higher numbers of
health workers have better healthcare coverage and outcomes. Availability of trained
human resources to address the exponential rise in cardiovascular disease in Nepal
is a national concern.
Objective
To assess the need of human resources for cardiovascular disease management in
Nepal.
Method
We conducted an exploratory sequential mixed-method study. We developed a task
force and organized a national workshop to engage stakeholders and collect feedback
on the research process. We did a desk review and conducted 24 key informant
interviews. We did thematic analysis from the codes generated.
Result
There is no clear definition and required estimation of health workers for
cardiovascular disease management. There is a shortage of health workers with
8.9 doctors, 20.8 nurses, 0.05 cardiologist/cardiac surgeon, 4.2 pharmacist, 10.2
laboratory technicians per 10,000 population. There is a comprehensive human
resource plan but it does not provide details of human resources for cardiovascular
disease management. There is a lack of public private collaboration for human
resource management. However, there is production of human resources for
cardiovascular disease management through pre-service specialized courses and in-
service training.
Conclusion
A clear definition and estimation of health workers with stringent human resource
plan for cardiovascular disease management is essential. The government can still
address these gaps by establishing a well-equipped central health workforce unit and
expanding collaboration with private sectors.
KEY WORDS
Cardiovascular diseases, Human Resource for health, National need assessment,
Nepal
Needs Assessment of Leadership and Governance in Cardiovascular Health in Nepal
(Kathmandu University, 2021) Pradhan, PMS; Bhatt, RD; Pandit, R; Shrestha, A; Maharjan, R; Jha, N; Bajracharya, S; Shrestha, S; Koju, RP; Karmacharya, BM
ABSTRACT
Background
Good governance and leadership are essential to improve healthy life expectancy
particularly in low and middle-income countries (LMICs). This study aimed to
epitomize the challenges and opportunities for leadership and good governance for
the health system to address non-communicable diseases particularly cardiovascular
diseases (CVD) in Nepal.
Objective
The objective of this study was to understand and document CVD programs and
policy formulation processes and to identify the government capacity to engage
stakeholders for planning and implementation purposes.
Method
A national-level task force was formed to coordinate and steer the overall need
assessment process. A qualitative study design was adopted using “The Health
System Assessment Approach”. Eighteen indicators under six topical areas in
leadership and governance in cardiovascular health were assessed using desk review
and key informant interviews.
Result
Voice and accountability exist in planning for health from the local level. The
government has shown a strong willingness and has a strategy to work together
with the private and non-government sectors in health however, the coordination
has not been effective. There are strong rules in place for regulatory quality, control
of corruption, and maintaining financial transparency. The government frequently
relies on evidence generated from large-scale surveys for health policy formulation
and planning but research in cardiovascular health has been minimum. There is a
scarcity of cardiovascular disease-specific protocols.
Conclusion
Despite plenty of opportunities, much homework is needed to improve leadership
and governance in cardiovascular health in Nepal. The government needs to
designate a workforce for specific programs to help monitor the enforcement of
health sector regulations, allocate enough funding to encourage CVD research, and
work towards developing CVD-specific guidelines, protocols, and capacity building.
KEY WORDS
Cardiovascular diseases, Governance, Leadership, Needs assessment, Nepal