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Background It is unknown whether Female Community Health Volunteers’ (FCHVs) can counsel for hyperlipidemia in rural Nepal. Methods Using the Health Belief Model, we evaluated FCHV’s knowledge, self-efficacy, and barriers to counsel for hyperlipidemia in two phases eleven months apart among 28 FCHVs from rural mid-Western Nepal. In each phase, we conducted four Focused Group Discussions (FGDs), hyperlipidemia-related training and two similar surveys before and after the training. We used inductive and deductive codes for thematic analysis and descriptive statistics for quantitative analysis. We integrated the results for complementarity and convergence using concurrent embedded design (Qual + quan). Results FCHVs’ mean age was 48 years and 21 out of 28 had worked for > 10 years. We found four themes in FGDs. In Phase 1, despite having interest, FCHVs had limited knowledge and confidence in counseling for hyperlipidemia. However, with sufficient training, they believed they could counsel. In Phase 2, FCHVs conveyed improved knowledge and self-efficacy. They expressed community might be concerned about their expertise, which improved in Phase 2. Quantitatively, FCHVs’ knowledge improved immediately after the initial training, which was stable in Phase 2. Inadequate training was identified less as a barrier in Phase 2, but inadequate time and incentive were identified more often, and community’s perception of FCHVs’ skills remained unchanged. Conclusion FCHVs want to provide hyperlipidemia counseling. Despite our trainings and FCHV’s perceived self-efficacy, knowledge gap persisted. FCHVs’ workload, inadequate incentives and knowledge were important barriers. Balanced workload, regular trainings and adequate incentives are important to engage FCHVs in hyperlipidemia management.

Background The number of people with multimorbidity is surging around the world. Although multimorbidity has been introduced in policy and practice in developed countries, developing countries like Nepal have not considered it as a matter of public health urgency due to the lack of enough epidemiological data. Multimorbidity profoundly affects older adults’ wellbeing; therefore, it is crucial to estimate its prevalence and determinants. This study aimed to estimate the prevalence of multimorbidity among older adults in Eastern Nepal and identify its correlates. Methodology A community-based cross-sectional survey was conducted in three districts of Eastern Nepal. Data were collected between July and September 2020, among 847 Nepali older adults, aged 60 and older, where study participants were recruited through a multi-stage cluster sampling technique. Semi-structured interviews were conducted at the community settings to collect data. Logistic regression assessed correlates of multimorbidity. SAS 9.4 was used to run all statistical tests and analyses. Results More than half (66.5%) of the participants had at least one of the five non-communicable chronic conditions; hypertension (31.6%), osteoarthritis (28.6%), chronic respiratory disease (18.0%), diabetes (13.5%), and heart disease (5.3%). The prevalence of multimorbidity was 22.8%. In the adjusted model, increased age (for 70–79 years, OR: 3.11, 95% CI: 1.87–5.18; for 80 + years, OR: 4.19, 95% CI: 2.32–7.57), those without a partner (OR: 1.52, 95% CI: 1.00–2.30), residing in urban areas (OR: 1.71, 95% CI: 1.16–2.51), and distant from health center (OR: 1.66, 95% CI: 1.04–2.64) were significantly associated with multimorbidity. Conclusions This study found one in five study participants had multimorbidity. The findings will assist policymakers and stakeholders in understanding the burden of multimorbidity among the older population and identifying the groups in most need of health promotion intervention. Future interventions may include developing horizontal multimorbid approaches and multisectoral strategies specifically tailored to meet the needs of those populations.

Background Hypertension is a major preventable risk factor for cardiovascular disease. Occupational factors such as having served or serving in armed forces may be associated with hypertension. This study aimed to assess the prevalence and factors associated with hypertension among veterans of the Indian Gorkha army living in western Nepal. Methods A community-based cross-sectional study was conducted among the veterans living in the Pokhara metropolitan city. Data on blood pressure (BP), anthropometric measurements, and behavioral factors were collected by face-to-face interviews using the World Health Organization's non-communicable disease risk factor surveillance (STEPS) tool. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mm Hg and/or diastolic BP of ≥ 90 mm Hg or currently on antihypertensive medication. Results The age-adjusted prevalence of hypertension was 66.2 % among the study participants (317). Mean systolic and diastolic blood pressure was 144.5 mmHg (± 18.3) and 89.3mmHg (± 16.0), respectively. Among the hypertensive participants, 67 % were aware of their disease, 90 % of them were under treatment, and 14 % of the individuals who received treatment had their hypertension under control. The proportion of smokers was 12.9 % and alcohol drinker was 86.1 %. One-fourth (25.9 %) of the participants had a family history of hypertension. Veterans aged 55-64 years had higher odds (AOR: 5.3; 95 % CI: 1.8–15.9; p  = 0.003) of being associated with hypertension as compared to 35–44 years. Being a current alcohol drinker (AOR: 2.5; 95 % CI: 1.4–4.5; p  = 0.003), overweight (AOR: 1.9; 95 % CI: 1.0-3.5; p  = 0.04), obese (AOR: 3.1; 95 % CI: 1.1–8.3; p  = 0.03) and family history of hypertension (AOR: 2.9; 95 % CI: 1.5–5.8; p  = 0.002) were independently associated with hypertension. Conclusions Hypertension was prevalent in retired Nepal veterans. Hypertension was associated with a number of modifiable lifestyle and behavioral factors. Our findings suggest the need for screening, education and management of Nepal veterans for hypertension.

Background Physiotherapy is a growing profession in Nepal. Despite efforts to promote strengthening and development, there are still challenges in providing equitable access and availability to services, particularly in underserved areas. Updated information is needed to address challenges to provide proper planning for resource allocation. Objective To assess implementation of physiotherapy services and to explore plans, policies and the general status of physiotherapy in Nepal. Method Implementation was assessed with a cross-sectional survey conducted in Province III containing closed-ended questions addressing physiotherapy services, human resources, charging and record-keeping systems, and accessibility. Stratified purposive sampling was used to select eligible facilities from the list of Department of Health Services. Official records were explored through visits to governing institutions and by reviews of registers and reports to obtain data and information on status, plans and policy. Results The survey included 25 urban and 4 rural facilities, covering hospitals and rehabilitation centres; both public (37.9%) and non-public (62.1%). Most facilities (79.3%) employed physiotherapists with bachelor’s degrees. Average number of visits were 29.55 physiotherapy outpatients and 14.17 inpatients per day. Patient records were mainly paper based. Most (69%) used the hospital main card, while others (31%) had their own physiotherapy assessment card. Most referrals came from doctors. The most offered services were musculoskeletal, neurological, and paediatric physiotherapy. Daily basis charging was common. A single visit averaged 311 Nepalese rupees ≈ 2.33 US$. Convenience for persons with disabilities was reported as partial by 79% of outpatient departments. Official register data showed 313 master’s and 2003 bachelor’s graduates. Six colleges offered physiotherapy bachelor’s degree, whereof one also offered a master’s program. Government records revealed significant progress in physiotherapy in Nepal. Conclusion The study highlights variations in physiotherapy services within a province owing to type, size and location, but also unwarranted variations. Despite the progress, implementation of physiotherapy services in the perspective of official records imply a need of systems for proper planning and monitoring. Physiotherapy provision in underserved areas warrants further attention.

For the past three decades, the burden of diabetes in Nepal has been steadily increasing, with an estimated 3 % annual increase since the year 2000. Although the burden is increasing, the methods of addressing the challenge have remained largely unchanged. This study sought to assess the current state of diabetes services provided by health facilities and to identify the major barriers that people with diabetes commonly face in Nepal. For this qualitative study, we selected five health facilities of varying levels and locations. At each site, we employed three unique methods: a process evaluation of the diabetes treatment and prevention services available, in-depth interviews with patients and focus group discussions with community members without diabetes. We used thematic analysis to analyse the data. Our findings were organized into the five categories of the Ecological Model: Individual, Interpersonal, Organizational, Community and Public Policy. Sub-optimal knowledge and behaviors of patients often contributed to poor diabetes management, especially related to diet control, physical activity and initiation of drug treatment. Social support was often lacking. Organizational challenges included health provider shortages, long wait times, high patient loads and minimal time available to spend with patients, often resulting in incomprehensive care. Public policy challenges include limited services in rural settings and financial burden. The scarcity of financial and human resources for health in Nepal often results in the inability of the current healthcare system to provide comprehensive prevention and management services for chronic diseases. A multilevel, coordinated approach is necessary to address these concerns. In the short-term, adding community-based supplementary solutions outside of the traditional hospital-based model could help to increase access to affordable services. Au cours des trois dernières décennies, le fardeau du diabète au Népal a connu une croissance constante, avec une augmentation annuelle estimée à 3% depuis l’an 2000. Bien que le fardeau soit en augmentation, la plupart des méthodes utilisées pour relever ce défi sont restées inchangées. La présente étude visait à évaluer l’état actuel des services de lutte contre le diabète fournis par les formations sanitaires et à identifier les principaux obstacles rencontrés par les personnes atteintes de diabète au Népal. Pour cette étude qualitative, nous avons sélectionné cinq formations sanitaires dont la catégorisation et la localisation diffèrent. Dans chaque site, nous avons utilisé trois méthodes uniques: une évaluation des procédés disponibles au sein des services de traitement et de prévention du diabète, des entrevues approfondies avec des patients et des discussions de groupe avec des membres non diabétiques de la communauté. Nous avons eu recours à l’analyse thématique pour les données. Nos résultats ont été regroupés dans les cinq catégories du Modèle écologique: individuel, interpersonnel, organisationnel, communautaire et public. Les connaissances et les comportements sousoptimaux des patients ont souvent entraîné une mauvaise prise en charge du diabète, en particulier en ce qui concerne le contrôle de l’alimentation, l’activité physique et le début du traitement médicamenteux. Le soutien social faisait souvent défaut. Les défis organisationnels comprenaient les pénuries au niveau des prestataires de soins de santé, les longs délais d’attente, le nombre élevé de patients et le peu de temps à consacrer aux patients, entraînant souvent des soins incomplets. Les défis à relever par la politique publique comprennent la pénurie des services offerts en milieu rural ainsi que le fardeau financier. La rareté des ressources financières et humaines pour la santé au Népal entraîne souvent l’incapacité du système de santé actuel à fournir des services complets de prévention et de prise en charge des maladies chroniques. Une approche coordonnée à plusieurs niveaux est nécessaire pour répondre à ces préoccupations. À court terme, l’ajout de solutions communautaires supplémentaires en dehors du modèle hospitalier traditionnel pourrait contribuer à améliorer l’accès à des services de santé abordables. 过去30年, 尼泊尔的糖尿病负担一直持续增长, 自2000年起年 增长率约为3%。尽管如此, 应对糖尿病负担的措施基本没有 变化。本研究意图评估卫生机构糖尿病服务的现状, 明确尼泊 尔糖尿病人群普遍面对的主要障碍。在本定性研究中, 我们选 取了5家不同级别、不同地理位置的卫生机构。我们在各个点 采用了三种独特方法：糖尿病治疗和预防服务的过程评估, 患 者深度访谈, 无糖尿病社区成员的焦点小组讨论。采用主题分 析处理数据。分析结果划分为生态模型中的个人、人际、组 织、社区和公共政策。患者知识和行为未达到最佳水平通常 导致糖尿病管理差, 尤其是饮食控制、锻炼和开始药物治疗。 社会支持不足。组织方面的挑战包括缺少卫生服务提供者、 候诊时间长、患者多、接待每位患者的时间很少, 经常导致卫 生服务不到位。公共政策挑战包括农村地区服务有限以及经 济负担。尼泊尔用于卫生的经济和人力资源稀缺, 导致目前的 卫生体系不能为慢性疾病提供全面的预防和管理。需要采取 多层次协调措施来解决这些问题。短时间内, 在传统的以医院 为基础的模式之外增加社区解决方法有助于提高可负担服务 的可及性。 Durante las últimas tres décadas, la carga de la diabetes en Nepal ha ido en constante aumento, con un aumento anual estimado del 3% desde el año 2000. Aunque la carga va en aumento, los métodos para abordar el desafío se han mantenido sin mayores cambios. Este estudio buscó evaluar el estado actual de los servicios de diabetes brindados por los centros de salud e identificar las principales barreras que comúnmente enfrentan las personas con diabetes en Nepal. Para este estudio cualitativo, seleccionamos cinco establecimientos de salud de diferentes niveles y ubicaciones. En cada sitio, empleamos tres métodos únicos: una evaluación del proceso de los servicios disponibles de tratamiento y prevención de la diabetes, entrevistas en profundidad con los pacientes y discusiones de grupos focales con miembros de la comunidad sin diabetes. Usamos análisis temático para analizar los datos. Nuestros hallazgos se organizaron en las cinco categorías del Modelo Ecológico: Individual, Interpersonal, Organizacional, Comunitario y Políticas Públicas. El conocimiento y los comportamientos subóptimos de los pacientes a menudo contribuyeron al manejo deficiente de la diabetes, especialmente en relación con el control de la dieta, la actividad física y el inicio del tratamiento farmacológico. A menudo faltaba el apoyo social. Los desafíos organizativos incluyeron escasez de proveedores de salud, largos tiempos de espera, altas cargas de pacientes y mínimo tiempo disponible con los pacientes, lo que a menudo resulta en una atención incomprensiva. Los desafíos de las políticas públicas incluyeron servicios limitados en entornos rurales y carga financiera. La escasez de recursos financieros y humanos para la salud en Nepal a menudo resulta en la incapacidad del actual sistema de salud para proporcionar servicios integrales de prevención y manejo de enfermedades crónicas. Un enfoque multinivel coordinado es necesario para abordar estas preocupaciones. En el corto plazo, agregar soluciones complementarias basadas en la comunidad fuera del modelo tradicional basado en el hospital podría ayudar a aumentar el acceso a servicios asequibles.

Non-communicable diseases (NCDs) such as hypertension and diabetes are rapidly emerging public health problems worldwide, and they associate with primary open-angle glaucoma (POAG). POAG is the most common cause of irreversible blindness. The most effective ways to prevent glaucoma blindness involve identifying high-risk populations and conducting routine screening for early case detection. This study investigated whether POAG associates with hypertension and diabetes in a Nepalese population. To explore the history of systemic illness, our hospital-based case-control study used non-random consecutive sampling in the general eye clinics in three hospitals across Nepal to enroll patients newly diagnosed with POAG and controls without POAG. The study protocol included history taking, ocular examination, and interviews with 173 POAG cases and 510 controls. Data analysis comprised descriptive and inferential statistics. Descriptive statistics computed the percentage, mean, and standard deviation (SD); inferential statistics used McNemar's test to measure associations between diseases. POAG affected males more frequently than females. The odds of members of the Gurung ethnic group having POAG were 2.05 times higher than for other ethnic groups. Hypertension and diabetes were strongly associated with POAG. The overall odds of POAG increased 2.72-fold among hypertensive and 3.50-fold among diabetic patients. POAG associates significantly with hypertension and diabetes in Nepal. Thus, periodic glaucoma screening for hypertension and diabetes patients in addition to opportunistic screening at eye clinics may aid in detecting more POAG cases at an early stage and hence in reducing avoidable blindness.