Papers by Archana Shrestha
Globalization and Health, May 2, 2019
This paper aims to explore the burgeoning burden of cardiovascular and metabolic disease (CMD) ri... more This paper aims to explore the burgeoning burden of cardiovascular and metabolic disease (CMD) risk factors among South Asian labor migrants to the Middle East. We conducted a qualitative synthesis of literature using PubMed/Medline and grey literature searches, supplemented by a policy review of policies from the South Asian countries. We found a high burden of cardio-metabolic risk factors among the migrants as well as among the populations in the home and the host countries. For example, two studies reported the prevalence of diabetes mellitus (DM) ranging between 9 and 17% among South Asian migrants. Overweight and obesity were highly prevalent amongst South Asian male migrants; prevalence ranged from 30 to 66% (overweight) and 17-80% (obesity) respectively. The home country population had a significant CMD risk factor burden. Nearly 14 to 40% have three or more risk factors: such as hypertension (17 to 37%), diabetes (3 to 7%), overweight (18 to 41%), and obesity (2 to 15%). The host country also exhibited similar burden of risk factors: hypertension (13 to 38%), diabetes (8 to 17%), overweight (33 to 77%) and obesity (35 to 41%). Only Nepal, Bangladesh and Sri Lanka have some provisions related to screening of CMDs before labor migration. Further, analysis of policy papers showed that none of the reviewed documents had requirements for screening of any specific CMDs, but chronic diseases were used generically, failing to specify specific screening target. Given the high burden of risk factors, migrants' health should become an urgent priority. The lack of specific focus on screening during different stages of labor migration should receive attention. The International Labour Organization and the International Office for Migration, through their country coordination teams should engage local stakeholders to create policies and plans to address this concern. Similarly, there is a need for the host country to become an equal partner in these efforts, as migrant's better cardiometabolic health is in the benefit of both host and home countries.
BMJ Open
IntroductionDespite having effective approaches for hypertension management including use of anti... more IntroductionDespite having effective approaches for hypertension management including use of antihypertensive medication, monitoring of blood pressure and lifestyle modification many people with hypertension in Nepal remain undetected and untreated. A comprehensive intervention which provides personalised counselling on lifestyle modification, medication adherence together with support for regular monitoring of blood pressure is expected to achieve well controlled blood pressure.Methods and analysisThis is a community-based, non-blinded, parallel group, two-arm cluster randomised controlled trial, with an allocation ratio of 1:1, conducted in Budhanilkantha municipality, Nepal. Ten health facilities and their catchment area are randomly allocated to either of the two arms. 1250 individuals aged 18 years and older with an established diagnosis of hypertension will be recruited. The intervention arm receives a comprehensive hypertension management package that includes blood pressure ...
Nutrition Reviews
In the past few decades, the Nepali government has endorsed several nutritional policies, strateg... more In the past few decades, the Nepali government has endorsed several nutritional policies, strategies, and guidelines. Given the lack of a comprehensive review of such policy documents, this review aims to describe the nutrition and food security policies and understand the existing policy gaps in Nepal. Findings from this study can be used to develop policies and programs to address Nepal's current and future nutritional needs. Policies relevant to nutrition and food security were identified by searching government websites and directly approaching relevant government ministries. Thematic analysis was conducted using framework methods under 8 predetermined themes: nutrition intervention, food security, food system, capacity building of human resources, nutrition education, nutrition governance, research, and monitoring and evaluation. The contents of each document reviewed were manually extracted in a spreadsheet stratified by the themes, and the findings were summarized for the...
Frontiers in Public Health
BackgroundNepal, in recent years, is witnessing an increasing problem of type 2 diabetes that has... more BackgroundNepal, in recent years, is witnessing an increasing problem of type 2 diabetes that has resulted significant premature deaths and disability. Prevention and management of non-communicable diseases (NCDs) including diabetes have been prioritized in the national policies and guidelines of the Nepal Government. However, research looking at the overview of the implementation of the existing policies and guidelines for diabetes prevention and control is scarce. Hence, this study reviewed diabetes related existing policies and its implementation process at the primary health care level in Nepal.MethodsThis study involved two phases: Phase I: situation analyses through review of documents and Phase II: qualitative exploratory study. In phase I, four databases (Medline, Web of Science, Embase and PubMed) were systematically searched using key search terms related to diabetes care and policies between January 2000 and June 2021. Also, relevant gray literature was reviewed to unders...
PS-P12-2: Needs Assessment of Leadership and Governance in Cardiovascular Health in Nepal
Journal of Hypertension
Europasian Journal of Medical Sciences
Background Implementation research (IR) is increasingly undertaken in the health field globally. ... more Background Implementation research (IR) is increasingly undertaken in the health field globally. This paper presents a scoping review of IR undertaken in Nepal. Methods We conducted a scoping review of literature on IR in Nepal according to the PRISMA- ScR checklist. The eligibility criteria were defined as papers conducted in Nepal that focused on studies of programs or policies that emphasize targeting health interventions, and addressed at least some aspects of IR. We searched Embase, PubMed, and the Global Health: Science and Practice database for papers from January 1, 2015 through November 30, 2022 using Medical Subject Headings terms based on our eligibility criteria. We reviewed the full text of the final set of articles and extracted relevant information for inclusion in this review. Results Twenty-three articles were included in the final stages for data extraction. The numbers of IR have increased over the years; the largest numbers were published in 2021. About 52% had a...
PLOS ONE
Background The co-existence of undernutrition and overnutrition is a global public health threat.... more Background The co-existence of undernutrition and overnutrition is a global public health threat. We aim to report the burden of both nutritional deficiency (Protein-Energy Malnutrition) and overweight (high Body Mass Index) in Nepal over a decade (2010–2019) and observe the changes through trend charts. Methods We did a secondary data analysis using the Institute for Health Metrics and Evaluation (IHME)’s Global Burden of Disease (GBD) database to download age-standardized data on Protein Energy Malnutrition (PEM) and high Body Mass Index (BMI). We presented the trend of death, Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL), and Years Lost due to Disability (YLD) of PEM and high BMI in Nepal from 2010 to 2019 and also compared data for 2019 among South Asian countries. Results Between 2010 and 2019, in Nepal, the Disability Adjusted Life Years (DALYs) due to PEM were declining while high BMI was in increasing trend. Sex-specific trends revealed that females had hi...
BMC Health Services Research
Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal... more Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers l...
Background: About one-fourth of Nepalese adults are estimated to be overweight or obese. No studi... more Background: About one-fourth of Nepalese adults are estimated to be overweight or obese. No studies have examined the risk factors for obesity, especially pertaining to diet, in Nepal. Objective: The present study aimed to identify dietary patterns in a suburban Nepalese community and to assess their association with overweight and obesity prevalence. Methods: This cross-sectional study utilized data from the 1,073 adults (18 years or older) participating in the baseline survey of the Dhulikhel Heart Study. We derived major dietary patterns from the dietary intake using a validated food frequency questionnaire by using principal component analysis. Overweight was defined as BMI of 25 kg/m or higher and obesity was defined as BMI of 30kg/m or higher. Weight was measured using an Omron Model HBF-400 scale and recorded to the nearest 0.1 pounds. Height was measured using a standard tape with participants standing against a wall and recorded to the nearest 0.1cm. Statistical analysis wa...
A rapid assessment study of health care waste management in Nepal
PLOS ONE, 2020
Non-communicable disease (NCD) prevention efforts have traditionally targeted high-risk and high-... more Non-communicable disease (NCD) prevention efforts have traditionally targeted high-risk and high-burden populations. We propose an alteration in prevention efforts to also include emphasis and focus on low-risk populations, predominantly younger individuals and low-prevalence populations. We refer to this approach as “proactive prevention.” This emphasis is based on the priority to put in place policies, programs, and infrastructure that can disrupt the epidemiological transition to develop NCDs among these groups, thereby averting future NCD crises. Proactive prevention strategies can be classified, and their implementation prioritized, based on a 2-dimensional assessment: impact and feasibility. Thus, potential interventions can be categorized into a 2-by-2 matrix: high impact/high feasibility, high impact/low feasibility, low impact/high feasibility, and low impact/low feasibility. We propose that high impact/high feasibility interventions are ready to be implemented (act), while...
BackgroundDespite a high burden, there is limited training available in non-communicable disease ... more BackgroundDespite a high burden, there is limited training available in non-communicable disease research in Nepal. In order to understand research capacity gap in non-communicable diseases in the country, we conducted a needs assessment. We aimed to assess existing research training capacity in academic health institutions of Nepal for the prevention and control of non-communicable diseases, identify gaps in research training in these institutions, and explore the feasibility of developing research training program in Nepal targeting non-communicable diseases and their risk factors. MethodsWe did qualitative and quantitative research and reviewed academic institution curricula review and scientific literature. We conducted 14 Focus Group Discussions with bachelor and Masters level students of public health and community medicine; 25 In-depth Interviews with department heads and faculties, and government stakeholders. We surveyed medical and public health students on their research ...
International Journal of Hypertension, 2021
Introduction. Hypertension and its association with socioeconomic positions are well established.... more Introduction. Hypertension and its association with socioeconomic positions are well established. However, the gradient of these relationships and the mediating role of lifestyle factors among rural population in low- and middle-income countries such as Nepal are not fully understood. We sought to assess the association between socioeconomic factors (education, income, and employment status) and hypertension. Also, we assessed whether the effect of education and income level on hypertension was mediated by lifestyle factors. Methods. This cross-sectional study was conducted among 260 participants aged ≥18 years attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors were collected, and blood pressure, weight, and height were measured for all study participants. Those with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or administrating high blood pressure-lowering medicines were regarded as ...
Background Nepal has made significant strides towards its commitment to achieve universal health ... more Background Nepal has made significant strides towards its commitment to achieve universal health coverage in the past few decades. However, the paucity of evidence on morbidity, mortality and trends in non-communicable diseases (NCDs) has posed a significant hindrance in targeting resources for prevention, screening and treatment services. Thus, we conducted a systematic review of the existing evidence on the distribution of NCDs and their trends in Nepal from 1990 to 2017.Methods We analysed data on disability adjusted life years (DALYs), years lived with disability, years of life lost due to NCDs in Nepal and its comparator countries (Afghanistan, Bangladesh, Bhutan, India, Maldives, Pakistan and Sri Lanka) from 1990 to 2017 using all available data sources from Global Burden of Disease 2017. We also conducted supplemental analysis using data from the 2016 Nepal Demographic Health Survey (NDHS) to further elucidate the provincial level prevalence of key NCD risk factors.Results Th...
Background Cardiovascular diseases (CVDs) are the leading cause of death and disease burden globa... more Background Cardiovascular diseases (CVDs) are the leading cause of death and disease burden globally, disproportionately affecting low and middle-income countries. The continued scarcity of literature on CVDs burden in Nepal has thwarted efforts to develop population-specific prevention and management strategies. This article reports the burden of CVDs in Nepal including, prevalence, incidence, and disability basis as well as trends over the past two decades by age and gender. The findings from this study provide a base for public health priorities and for creating evidence-informed policies.Methods We used the Institute of Health Metrics and Evaluation (IHME)’s Global Burden of Diseases (GBD) database on cardiovascular disease mortality rates, prevalence, incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) from Nepal to describe the most recent data available (2017) and trends by age, gender and year from 1990 to 2017....
Nepalese Heart Journal, 2019
Introduction: Nepal lacks a comprehensive, integrated health information system (HIS) to address ... more Introduction: Nepal lacks a comprehensive, integrated health information system (HIS) to address the growing burden of cardiovascular diseases (CVDs). Method: We performed a literature search and reviewed papers, government reports, and websites related to HIS. We included existing situations of HIS, major gaps, strength weakness opportunity threat (SWOT) analysis and role of different stakeholders to address CVD burden in Nepal. Results: Health data from different health facility level are filled in district health information software (DHIS-2). DHIS-2 has been implemented in 10 districts in full-fledged manner and partial phase in 22 districts. Data are collected by means of paper-based registers, tally sheets, and monthly data collation forms. The collated data are sent monthly to the district level and entered into the computer using DHIS-2 software and submitted to the national health departments. Major gaps in health management information system (HMIS) are lack of separate h...
Globalization and Health, 2019
This paper aims to explore the burgeoning burden of cardiovascular and metabolic disease (CMD) ri... more This paper aims to explore the burgeoning burden of cardiovascular and metabolic disease (CMD) risk factors among South Asian labor migrants to the Middle East. We conducted a qualitative synthesis of literature using PubMed/Medline and grey literature searches, supplemented by a policy review of policies from the South Asian countries. We found a high burden of cardio-metabolic risk factors among the migrants as well as among the populations in the home and the host countries. For example, two studies reported the prevalence of diabetes mellitus (DM) ranging between 9 and 17% among South Asian migrants. Overweight and obesity were highly prevalent amongst South Asian male migrants; prevalence ranged from 30 to 66% (overweight) and 17-80% (obesity) respectively. The home country population had a significant CMD risk factor burden. Nearly 14 to 40% have three or more risk factors: such as hypertension (17 to 37%), diabetes (3 to 7%), overweight (18 to 41%), and obesity (2 to 15%). The host country also exhibited similar burden of risk factors: hypertension (13 to 38%), diabetes (8 to 17%), overweight (33 to 77%) and obesity (35 to 41%). Only Nepal, Bangladesh and Sri Lanka have some provisions related to screening of CMDs before labor migration. Further, analysis of policy papers showed that none of the reviewed documents had requirements for screening of any specific CMDs, but chronic diseases were used generically, failing to specify specific screening target. Given the high burden of risk factors, migrants' health should become an urgent priority. The lack of specific focus on screening during different stages of labor migration should receive attention. The International Labour Organization and the International Office for Migration, through their country coordination teams should engage local stakeholders to create policies and plans to address this concern. Similarly, there is a need for the host country to become an equal partner in these efforts, as migrant's better cardiometabolic health is in the benefit of both host and home countries.
Heart Asia, 2018
Objective Hypertension is a significant and rising burden in Nepal. The disease remains undetecte... more Objective Hypertension is a significant and rising burden in Nepal. The disease remains undetected and inadequately managed. However, no studies have been conducted to understand the inhibiting and facilitating factors to hypertension treatment among newly diagnosed cases. This qualitative study aimed to explore barriers and facilitators to treatment among patients with newly diagnosed hypertension aged ≥18 years in Dhulikhel, Nepal. Methods We conducted seven focus group discussions with 35 patients with newly diagnosed hypertension identified through community surveillance of the Dhulikhel Heart Study, an observational cohort of Dhulikhel Hospital, Kathmandu University. Audiotaped discussions were transcribed, inductively coded and analysed by the thematic framework method using Atlas. ti V.7. results Hypertension was viewed as a rising problem in the community. Participants had limited knowledge and many misbeliefs regarding hypertension and its treatment. The major barriers included absence of symptoms, reluctance to take medicine, low perceived seriousness of the disease, challenges in behaviour change (diet and exercise), lack of family support, and lack of communication and trust with the provider. The major reported facilitating factors were fear of consequences of the disease, and family support in controlling diet and adhering to treatment. Conclusions A number of factors emerged as barriers and facilitators to hypertension treatment. This information can be useful in designing appropriate health interventions to improve hypertension management.
Work-Site Intervention Study to Prevent Diabetes in Nepal
Case Medical Research, 2019
Case Medical Research, 2019
The purpose of this study will be to improve diabetes prevention, access to care and advocacy thr... more The purpose of this study will be to improve diabetes prevention, access to care and advocacy through a novel cost-effective nurse-led continuum of care approach that incorporates diabetes prevention, awareness, screening and management for low-income settings, and furthermore utilizes the endeavor to advocate for establishing a standard diabetes program in Nepal. Methods: We will conduct a two-arm, parallel group, stratified cluster randomized controlled trial of the NUrse-led COntinuum of care for people with Diabetes (N 1 = 200) and prediabetes (N 2 = 1036) (NUCOD) program, with primary care centers (9 outreach centers and 17 government health posts) as a unit of randomization. The NUCOD program will be delivered through the trained diabetes nurses in the community to the intervention group and the outcomes will be compared with the usual treatment group at 6 and 12 months of the intervention. The primary outcome will be the change in glycated hemoglobin (HbA1c) level among diabetes individuals and progression to type 2 diabetes among prediabetes individuals, and implementation outcomes measured using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. Outcomes will be analyzed on an intentionto-treat basis. Discussion: The results of this trial will provide information about the effectiveness of the NUCOD program in improving clinical outcomes for diabetes and prediabetes individuals, and implementation outcomes for the organization. The continuum of care model can be used for the prevention and management of diabetes and other noncommunicable diseases within and beyond Nepal with similar context.
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Papers by Archana Shrestha