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 5   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.