Background

Non-Communicable diseases (NCDs) are the leading causes of death globally with cardiovascular diseases (CVDs) accounting for the highest number of deaths followed by cancer, respiratory diseases and diabetes. The impact of NCDs in health has been varied with reduction of the disability adjusted life years due to various comorbidities. Additionally, it affects the families, health system and national economies of the country. Community based screening for NCDs is the most effective means for detection of undiagnosed NCD cases and early treatment initiation. Prevention strategies are not only effective for populations against developing an NCD, but also for mitigating and reducing the burden of various NCDs. Hence, NCD and Mental Health Campaign was started in one of the urbanized settings (A place called Saraswatinagar) in Central Nepal as part of the healthy city initiative envisioned by World Health Organization (WHO). The major objective of starting this campaign is to educate the Sarswatinagar Community regarding NCDs and Mental Health and its major risk factors. Furthermore, we aim to screen the population of Sarswatinagar for NCDs biomarkers and apply appropriate dietary and behavioral modification interventions to stop the further progression of diseases.

Site Selection

NCDs has boomed in the urbanized community in last decades or so. The major causes are urbanization, consumption of junk foods, inactive lifestyles and careless attitude of people towards their health. In rural terai region, hilly mountains people do physical activity by doing various sorts of physical activity. Additionally, they consume healthy food grown up in their own backyards. However, in the urbanized community this is seen less with people travelling in vehicles and consume various sorts of junk foods without adequate healthy lifestyles. Sarswatinagar community located in Kathmandu Nepal is an urbanized community and we anticipate similar behaviors of people as in other urbanized community. This initiative will give model health city initiative concept which could be replicated further.

Local Collaboration Concept

This activity has been collaborated with Local Fitness Club, 738 Fitness, Leo Club Parikalpana and Local Subunit, Sarswatinagar Sudhar Sang with Nepalese Society of Community Medicine (NESCOM) being the primary body leading the campaign. The concept behind collaboration with local fitness club is that there are only limited people who work on their physique as a means of staying disease-free and healthy. As per the literature, physical activity is one of the strongest means of reducing the burden of NCDs and Mental Health. Gym club trainers and the members do these activities regularly and could be advocate for change for NCDs and Mental Health Prevention in the community. They could be developed as “NCDs Champions. Leo Club Parikalpana is the youth wing of Lions international. Their role basically is in data collection. Sarswatinagar Sudhar Sang on the other hand is one of the active subunits in Kathmandu metropolitan city. They conduct their own election and nominate the team to work for the development of the Sarswatinagar locality. The local subunit was chosen because they could facilitate the NCD and Mental Health Campaign in the areas through various means. NESCOM furthermore is the primary body leading the campaign. It is a “not for profit” professional society of graduates in Community Medicine established in 2015 with the vision to ensure highest attainable health of people of Nepal. It is a network of over 200 residents and graduates who are actively engaged in academics, research, and development projects in Nepal and abroad. Nescom has been primarily chosen as they being varied expertise and can be a huge workforce leading the campaign.

Schedule of the Program

This awareness campaign is being conducted on 1^st week of every Saturday of Nepali Calendar month from 7 a.m. to 12 p.m. in the morning in the summer and 8 a.m. to 1 p.m. in the winter. In this program there is 1 hour of walking in the morning followed by 1 hour of lecture, discussion and interaction on varied topics related to NCD and Mental Health. Additionally, blood pressure and blood sugar are measured and appropriate advice given to the participants. Recently we have started collecting data for evidence generation through Kobo collect application.

Future plans

We plan to empower community of Sarswatinagar about the importance of early identification of prediabetes and prehypertension status and importance of lifestyle modification to slow the progression of diabetes and hypertension and various other NCDs. Construct a workout plan in coherence with standard physical activity suited for the local context. Screen Community Members of 30 -65 years of age in their locality. If found pre-diabetic (HbA1c of 5.7% to 6.4%) and prehypertensive (B.P = 120-139mmHg / 80-89mmHg) put them on workout plan, dietary modification and behavioral change modification. Assess the blood pressure and blood sugar and compare the changes before and after the workout plan. We also envision to scale up this campaign in all the 32 wards of Kathmandu Metropolitan city if the current model gets successful.

Short Term Impact of the Program

The program will help to create community awareness about NCDs and Mental Health. Additionally, this will also help in for community engagement and partnership with the local people, groups for the awareness and prevention in the matter of health and other areas.

Long Term Impact of the Program

The campaign will screen the population and identify the risk group for timely prevention through various intervention measures. This in turn will reduce premature deaths from NCDs, reduce out of pocket expenditures and long-term complications due to the effects of NCDs. This will further leverage the concept of Healthy city initiative envisioned by WHO

Current progress

Till date (as of December 2023) we have educated and screened around 1500 to 2000 participants in last 1.5 years. 

Photographs

Dr. Prajjwal Pyakurel, MD

Cardiovascular Epidemiologist and Community Physician

General Secretary, Nepalese Society of Community Medicine (NESCOM)