Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.

No abstract

No abstract

BackgroundWorld Health Organization recommends at least four pregnancy check-ups for normal pregnancies. Ministry of Health and Population Nepal has introduced various strategies to promote prenatal care and institutional delivery to reduce maternal and child deaths. However, maternal health service utilization is low in some selected socio-economic and ethnic groups. Hence, this study aims to assess barriers to the recommended four antenatal care (4ANC) visits in eastern Nepal.MethodsA cross-sectional quantitative study was conducted in Sunsari district. A total of 372 randomly selected women who delivered in the last year preceding the survey were interviewed using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis was carried out to identify barriers associated with 4ANC visits.ResultsMore than two-third women (69%) attended at least 4ANC visits. The study revealed that women exposed to media had higher chance of receiving four or more ANC visits with an adjusted odds ratio (aOR = 3.5, 95% CI: 1.2–10.1) in comparison to women who did not. Women from an advantaged ethnic group had more chance of having 4ANC visits than respondents from a disadvantaged ethnic group (aOR = 2.4, 95% CI: 2.1–6.9). Similarly, women having a higher level of autonomy were nearly three times more likely (aOR = 2.9, 95% CI: 1.5–5.6) and richer women were twice (aOR = 2.3, 95% CI: 1.1–5.3) as likely to have at least 4ANC visits compared to women who had a lower level of autonomy and were economically poor.ConclusionBeing from disadvantaged ethnicity, lower women’s autonomy, poor knowledge of maternal health service and incentive upon completion of ANC, less media exposure related to maternal health service, and lower wealth rank were significantly associated with fewer than the recommended 4ANC visits. Thus, maternal health programs need to address such socio-cultural barriers for effective health care utilization.

No abstract

No abstract

The subject of environmental economics is at the forefront of the green debate: the environment can no longer be viewed as an entity separate from the economy. Environmental degradation is of many types and have many consequences. To address this challenge a number of studies have been conducted in both developing and developed countries applying different methods to capture health benefits from improved environmental quality. Minimizing exposure to environmental risk factors by enhancing air quality and access to improved sources of drinking and bathing water, sanitation and clean energy is found to be associated with significant health benefits and can contribute significantly to the achievement of the Millennium Development Goals of environmental sustainability, health and development. In this paper, I describe the national and global causes and consequences of environmental degradation and social injustice. This paper provides a review of the literature on studies associated with reduced environmental risk and in particular focusing on reduced air pollution, enhanced water quality and climate change mitigation.

Introduction: Over the past several decades, Nepal has attempted to increase the access of health care services, however progress toward achieving high coverage of health care services in rural communities is still low. Therefore this study attempts to provide a perspective on access to basic healthcare services in government health facility. Methods: Descriptive cross-sectional study with quantitative and qualitative methods was designed and applied to identify the access to health care services. The study population were people who were sick within three months prior to the study where basic sampling unit was household. Total sample size was 96 through the application of simple random sampling method. Bivariate analysis with 95% confidence interval was used to identify the association of variables with access to health care services. Results: Among the total population, 28% of households in the study area received health care services at government health facility. The reasons for not accessing health care were insufficient drugs (61%), distance (22%), staff unavailability (19%), sickness (9%), money (7%), and facility hours (4%). Sex, ethnicity and distance were found significantly associated with access to health care services. Conclusions: Less than one third of households had access to health careservices in government health facility. Addressing the important factors such as drug problems, staff unavailability, long distance to health institutions and inconvenient health facility hours may help to increase access to health care services at government health facility. Keywords: Access, government health facility, health care services, perspective.