The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a ‘policy cube’ approach

Buse, Kent; Aftab, Wafa; Akhter, Sadika; Bui, Phuong Linh; Chemli, Haroun; Dahal, Minakshi; Feroz, Anam Shahil; Hofiani, Sayad; Pradhan, Nousheen Akber; Anwar, Iqbal; Skhiri, Hajer; Ati, Jalila El; Giang, Kim Bảo; Puri, Mahesh; Noormal, Bashir; Rabbani, Fauziah; Hawkes, Sarah

doi:10.1093/heapol/czz175

Cited by 22 publications

(26 citation statements)

References 40 publications

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“…The qualitative component of the study constituted the policy content review process using the policy-cube framework developed by Buse and colleagues [ 33 ]. Initially, the policy cube framework was developed to understand the strength of national policies to combat and prevent diet-related Non-Communicable Diseases (NCDs) [ 33 ].…”

Section: Methodsmentioning

confidence: 99%

A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication

Thakuri¹,

Thapa²,

Singh³

et al. 2021

PLoS ONE

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Background Chhaupadi is a deeply rooted tradition and a centuries-old harmful religio-cultural practice. Chhaupadi is common in some parts of Karnali and Sudurpaschim Provinces of western Nepal, where women and girls are considered impure, unclean, and untouchable in the menstrual period or immediately following childbirth. In Chhaupadi practice, women and girls are isolated from a range of daily household chores, social events and forbidden from touching other people and objects. Chhaupadi tradition banishes women and girls into menstruation huts’, or Chhau huts or livestock sheds to live and sleep. These practices are guided by existing harmful beliefs and practices in western Nepal, resulting in poor menstrual hygiene and poor physical and mental health outcomes. This study examined the magnitude of Chhaupadi practice and reviewed the existing policies for Chhaupadi eradication in Nepal. Methods We used both quantitative survey and qualitative content analysis of the available policies. First, a quantitative cross-sectional survey assessed the prevalence of Chhaupadi among 221 adolescent girls in Mangalsen Municipality of Achham district. Second, the contents of prevailing policies on Chhaupadi eradication were analysed qualitatively using the policy cube framework. Results The current survey revealed that most adolescent girls (84%) practised Chhaupadi in their most recent menstruation. The Chhaupadi practice was high if the girls were aged 15–17 years, born to an illiterate mother, and belonged to a nuclear family. Out of the girls practising Chhaupadi, most (86%) reported social and household activities restrictions. The policy content analysis of identified higher-level policy documents (constitution, acts, and regulations) have provisioned financial resources, ensured independent monitoring mechanisms, and had judiciary remedial measures. However, middle (policies and plans) and lower-level (directives) documents lacked adequate budgetary commitment and independent monitoring mechanisms. Conclusion Chhaupadi remains prevalent in western Nepal and has several impacts to the health of adolescent girls. Existing policy mechanisms lack multilevel (individual, family, community, subnational and national) interventions, including financial and monitoring systems for Chhaupadi eradication. Eradicating Chhaupadi practice requires a robust multilevel implementation mechanism at the national and sub-national levels, including adequate financing and accountable systems up to the community level.

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Section: Methodsmentioning

confidence: 99%

A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication

Thakuri¹,

Thapa²,

Singh³

et al. 2021

PLoS ONE

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“…The effectiveness of food policies to help prevent and combat noncommunicable diseases have variable impact. In Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia, and Vietnam, there was a lack of (i) consistent reference to populations potentially at risk or more vulnerable to noncommunicable diseases and (ii) policies protecting vulnerable populations or subsidizing their access to healthier foods (i.e., greater affordability) 136 . Fiscal interventions help to promote healthy food consumption and prevent noncommunicable diseases but more evidence is required in LMIC 137 .…”

Section: Noncommunicable Disease Prevention and Health Promotion: Crementioning

confidence: 99%

Healthy lifestyles and noncommunicable diseases: Nutrition, the life‐course, and health promotion

Cerf

2021

Lifestyle Medicine

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Cardiovascular disease, cancer, diabetes, and chronic respiratory diseases, targeted by Sustainable Development Goal 3.4, afflict millions of people and account for the highest global morbidity and mortality. Obesity is associated with noncommunicable diseases. Globally, diets have become sweeter, saltier with higher fat content, whereas physical activity has declined; which triggers the onset of obesity and noncommunicable diseases. Healthy nutrition and regular exercise are the foundations for healthy living and important for preventing noncommunicable diseases, in alignment with health promotion. The preconception, gestational, and lactational periods present windows for improving and optimizing progeny growth and development for better health outcomes. Malnutrition is a major risk factor for noncommunicable diseases; therefore ingesting healthy nutritious food, over the life‐course, is critical for countering these global epidemics that have a more profound adverse impact on people from low‐ and middle‐income countries. To combat obesity and noncommunicable diseases, people's ownership of their health, government action, and private sector responsibility should be aligned and supported by global initiatives and enabled through partnerships and collaborations. Many noncommunicable diseases are avertable through health promotion strategies mainly directed at the maternal and child health lifecycle, by focusing on women of reproductive age (prior to and during pregnancy, and during lactation) and during infancy and childhood, adolescence, adulthood, and ageing. Healthy lifestyles support health promotion and disease prevention, which is cost‐effective for noncommunicable diseases. The global high burden of obesity and noncommunicable diseases remains a complex and prevalent challenge; therefore, the adoption of healthy lifestyles is critical to slow down their onset and exacerbation.

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“…Having functioning dietary guideline can be useful in achieving effective change in dietary behaviour at a consumer’s level [ 24 ]. A study has concluded that dietary policies in Nepal do not match the burden of disease, and the government actions are not designed to adequately target critical dietary drivers [ 25 ]. According to Popkin’s framework, Nepal is currently in the fourth stage of nutrition transition [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality and risk factors of disease in Nepal: Trend and projections from 1990 to 2040

et al. 2020

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Background Between 1990 and 2017, Nepal experienced a shift in the burden of disease from communicable, maternal, neonatal and nutritional (CMNN) diseases to non-communicable diseases (NCDs). With an increasing ageing population and life-style changes including tobacco use, harmful alcohol consumption, unhealthy diets, and insufficient physical activity, the proportion of total deaths from NCDs will continue to increase. An analysis of current diseases pattern and projections of the trends informs planning of health interventions. This analysis aims to project the mortality and risk factor of disease until 2040, based on past trends. Methods This study uses secondary data from the Global Burden of Disease (GBD) Study which analyses historic data from 1990 to 2016 to predict key variables such as, the mortality rates, life expectancy and Years of Life Lost for different causes of death from 2017 to 2040. ‘GBD Foresight Visualization’, a visualisation tool publicly available in the webpage of Institute for Health Metrics and Evaluation was the source of data for this analysis. GBD forecasting uses three-component modelling process: the first component captures variations due to risk factors and interventions, the second takes into consideration the variation due to measures of development quantified as social development index and the third uses an autoregressive integrated moving average model to capture the unexplained component correlated over time. We extracted Nepal specific data from it and reported number of deaths, mortality rates (per 100,000 population) as well as causes of death for the period 1990 to 2040. Results In 1990, CMNN diseases were responsible for approximately two-thirds (63.6%) of total deaths in Nepal. The proportion of the deaths from the CMNN diseases has reduced to 26.8% in 2015 and is estimated to be about a fifth of the 1990 figure (12.47%) in 2040. Conversely, deaths from NCDs reflect an upward trend. NCDs claimed a third of total deaths (29.91%) in the country in 1990, while in 2015, were responsible for about two-thirds of the total deaths (63.31%). In 2040, it is predicted that NCDs will contribute to over two-thirds (78.64%) of total deaths in the country. Less than a tenth (6.49%) of the total deaths in Nepal in 1990 were associated with injuries which increased to 13.04% in 2015 but is projected to decrease to 8.89% in 2040. In 1990, metabolic risk factors including high systolic blood pressure, high total cholesterol, high fasting plasma glucose, high body mass index and impaired kidney functions collectively contributed to a tenth of the total deaths (10.38%) in Nepal, whereas, in 2040 more than a third (37.31%) of the total deaths in the country could be attributed to it. Conclusion A reverse of the situation in 1990, NCDs are predicted to be the leading cause of deaths and metabolic risk factors are predicted to contribute to the highest proportion of deaths in 2040. NCDs could demand a major share of resources within the health sector requiring extensive multi-sectoral prevention measures, re-allocation of resources and re-organisation of the health system to cater for long-term care.

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The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a ‘policy cube’ approach

Cited by 22 publications

References 40 publications

A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication

A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication

Healthy lifestyles and noncommunicable diseases: Nutrition, the life‐course, and health promotion

Mortality and risk factors of disease in Nepal: Trend and projections from 1990 to 2040

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