Non-communicable Disease Project
Background
The prevalence of non-communicable diseases (NCD) in Nepal is expected to have surged in the past few decades due to longer life expectancy from improved care of communicable diseases. True epidemiology of NCD is unknown due to lack of well-designed prospective cohort studies. Thus, a large number of rural community residents may be living with undiagnosed and untreated NCDs. The NCD Nepal project is a community-level intervention that encompasses two arms: a comprehensive, multidimensional and longitudinal clinical care; and a community-based prospective epidemiological study.
 
Objectives
  1. To screen for NCD among rural community residents 40 to 75 years living in Ghorahi Sub-Metropolitan City wards 3, 4, 6 and 7 in Dang.
  2. Provide continuity of care for people with established NCD with a special focus on management of hypertension, diabetes, hyperlipidemia, tobacco use using evidence-based therapies; and to refer people with advanced disease to appropriate higher level of care.
  3. Follow people with higher risk for development of NCD every year and those without NCDs every 2 years.
  4. Ascertain development of incident NCDs based on regular follow up in the clinic as well as a comprehensive community surveillance program by mobilization of community health workers, mothers’ group for health and other community resources.
  5. Ascertain death and causes of deaths using World Health Organization verbal autopsy tool.
  6. Promote evidence-based practice, medical education and research.
  7. Engage community in educational activities to reduce NCD burden.
 
Hypothesis
Our primary hypotheses are as follows.
  1. The prevalence and incidence of NCDs are high in rural Nepal.
  2. There is high rate of complications and mortality from NCDs in rural Nepal.
  3. Community-based screening and treatment of NCDs are cost effective strategies in reducing the burden of NCDs.
 
Brief protocol and procedures
The most recent census of the area (2018) showed a total of 7052 residents who are 40-75 year old (3349 men and 3703 women), which will be our target population. 
  1. We will screen for lifestyle related risk factors including salt, fruit, vegetables and red meat intake, physical activity (work, leisure time and commute related), inactivity time, diabetes, hypertension, hyperlipidemia, any forms of tobacco use, household smoke exposure, passive smoke exposure, obesity, unhealthy alcohol use, illicit drug use, coronary artery disease, stroke, peripheral artery disease, heart failure, kidney stone, albuminuria, chronic kidney disease including end-stage renal disease, chronic lung disease, bleeding tendency and cancer.
  2. Every year follow up will target people at risk for development of NCD and includes those with prehypertension, elevated glucose but without diabetes, unhealthy alcohol use, family history of premature coronary artery disease, obesity, microalbuminuria but without chronic kidney disease. Rest of the people will be followed up every 2 years.
  3. Follow up and ascertainment of diseases and deaths will be obtained both in the clinic and using a comprehensive community surveillance program. Follow up will be obtained for at least 10 years.
An example of a clinical care and study algorithm developed based on international practice guidelines is shown below. Our study methods paper will be published soon and then will be publicly available. Please contact us at HealthFoundation.Nepal1@gmail.com for further questions about the study.
​Milestones
2017 - Initiated cardiovascular and kidney diseases screening camps in Dang; collaborated with National Reference Laboratory

2018 - Developed research tools and clinical protocols for management of diabetes, hypertension, hyperlipidemia, and tobacco cessation; Received Institutional Review Board (IRB) approval from Nepal Health Research Council

2019 - Collaborated with Karma Health, a local non-profit organization, to assist in effective implementation of the NCD project.
We have already provided first round of care/screening for 936 individuals, of which 331 received 2nd round of care/follow up (updated on April 23, 2019).
 
Future directions
We are actively looking for collaboration locally, nationally and internationally. Some of these include partnership with medical, nursing, public health and allied health schools, their students and professionals to foster medical education and research; collaboration with industry partners to create a comprehensive and reliable database including biomarkers and imaging; and collaboration with international academic institutions, among others. In the future, we will also test other novel strategies to address NCDs. We will deploy trained community health workers as first line intervention to deliver home-based services in prevention and early management of NCDs. We will also look forward to expand NCD program to different geographic locations of Nepal.

Opportunities 
If you have any interest in our work, we encourage you to collaborate and work with us for mutual opportunities that will benefit both you and the community we serve. 

  1. Professional opportunities: We provide comprehensive training opportunities for preventive health using evidence-based clinical practice, community-based research, including hands-on experience in research, research methods, design, conduct and professional writing. If you have interest in the above areas and especially if you are a health care worker or students from allied health profession such as health assistant, nurse, physician, public health professional or established investigators, please contact us for further opportunities. Please email your CV/resume with a brief summary of why you are interested to HealthFoundation.Nepal1@gmail.com.

  2. Biomedical industry: We look for collaboration with biomedical industry to foster medical science and to provide medical care to rural population. If you are interested in furthering science and medical care in rural communities, please email us at HealthFoundation.Nepal1@gmail.com.

  3. Anyone interested in global health and equity: If you care about global health and disparity, please support us in any way you can including financial, technical, expertise or any other support. We work through a non-profit organization and our activities are transparent. Our work is currently possible through several donors. On behalf of the community we serve, we are highly grateful for your kindness and look forward for continuous future support.
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