Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.
Objective:Good governance and leadership to address non-communicable diseases and minimization of their risk factors is crucial to improve healthy life expectancy particularly in low- and middle-income countries. The objective of this study was to understand and document cardiovascular disease (CVD) programs and policy formulation process and epitomize the challenges and opportunities for leadership and good governance for the health system to address non-communicable diseases particularly cardiovascular diseases in Nepal.Design and method:A national level task force was formed to coordinate and steer the overall needs assessment process. A qualitative study design was adopted using The Health System Assessment Approach Manual. Eighteen indicators under six topical areas of leadership and governance in cardiovascular health were assessed. Health laws, policies, regulatory standards, planning and strategy documents and reports on civil society engagement were reviewed. Seven key stakeholders from ministry, professional councils and non-governmental organizations working on CVD were identified and in depth interviews were conducted. Field notes and tape records of interview were compiled and transcribed. Strength, weakness, opportunities and threats in each topical area of leadership and governance were analyzed.Results:Voice and accountability exist in planning for health from the local level. The government has shown strong willingness and has a strategy to work together with the private and non-government sectors in health however, the coordination with non-state actors during policy formulation has not been effective. There are strong rules in place for regulatory quality, control of corruption and maintaining financial transparency. The government frequently relies on evidence generated from large-scale surveys for health policy formulation and planning but research in cardiovascular health has been below par. There is a scarcity of CVD-specific treatment protocols at all levels of government coupled with weak reporting from the private sector. Expensive health care with ineffective cost control over drugs and services, medical malpractice with commission system and lack of interest among donors to invest in CVD were important challenges for strong leadership and governance.Conclusions:Despite plenty of opportunities, much homework is needed to improve leadership and governance in cardiovascular health in Nepal. The government needs to designate a workforce for specific programs to help monitor the enforcement of health sector regulations, allocate enough funding to encourage CVD research and work towards developing CVD-specific guidelines, protocols, and capacity building. The government needs to leverage the opportunities associated with the current decentralized health system.
Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most prominent causes of chronic liver disease. It is known that dyslipidemia in NAFLD patients may have more severe atherogenic potential with high triglyceride and low density lipoprotein (LDL) as well as less high density lipoprotein (HDL) level. Objective: To determine the atherogenic dyslipidemia and associated factors among patients with NAFLD, Visiting Tertiary Care Center Methodology: Prospective cross-sectional study was conducted at Dhulikhel Hospital-Kathmandu University Hospital (DH-KUH) from January, 2016 to December, 2016. All the patients (n= 973) diagnosed to have fatty liver during this study period were initially enrolled in this study. Patients were further asked to fill up the questioner. Out of total 973 cases, 169 patients were identified as NAFLD. Fasting blood sample and anthropometric measurements (BMI, WHR) were taken. After adjusting exclusion criteria, refusal to participate and dropout from the study, 101 patients and 92 apparently healthy age sex matched control group was selected for the study. Blood sugar level and lipid profile were analyzed to assess the risk of athrogenicity among the NAFLD. Result: High total cholesterol was found in 64.4 %, High LDL was found in 20.8 %, Low HDL is present in 72.2% and high triglyceride is present in 65.8 % patients with NAFLD. Non-HDL cholesterol was significantly higher in NAFLD compared to control group (116.75 ± 34.38 vs. 137.63 ± 39.76, p=0.00). Similarly, calculated cardiac risk ratio (TC/HDL) was significant higher (4.15 ± 1.18 vs. 5.25 ± 1.78, p=0.00) whereas atherogenic index of plasma (AIP) was higher (0.30 ± 0.13 vs. 0.33 ± 0.19, p=0.37). Conclusion: NAFLD is significantly associated with atherogenic dyslipidemia. Calculated cardiac risk and AIP is higher in patients with NAFLD. Therefore it may be helpful to assess dyslipidemia among the patients with NAFLD to prevent cardiovascular events.
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