Shift from the countryside puts spotlight on hypertension in Nepal

10th June 2017Eugenie Verney

Shift from the countryside puts spotlight on hypertension in Nepal

In Nepal, volunteers ran May Measurement Month blood pressure screenings in a mix of  locations, among them communities with poor grass roots health provision. Shiva Raj Mishra, a cardiovascular epidemiologist affiliated with The Nepal Development Society and a PhD student in Statistical-epidemiology at The University of Queensland, Australia, offers an overview of the MMM17 campaign in this rapidly changing country.  

Nepal is an agrarian country situated in the lap of Himalayas. The plains accounting for 18% of the country’s area are home to nearly 40% of the population, with this percentage set to increase due to massive migration. The rest of Nepal’s population is scattered across many hilly and mountainous regions.

The bustling cities of Kathmandu, Pokhara and Chitwan already host a quarter of country’s population and are witnessing rapid urbanisation. Increasing access to high calorie and junk foods, and less need to walk, mean that as people’s lifestyles and eating habits change so their susceptibility to non-communicable disease increases. This sudden transition from an agrarian culture to city life has come with a price, and for many Nepalese, this has been a precursor for conditions like hypertension.

Unfortunately, Nepal does not have the capacity to address this tide of non-communicable diseases, but there are reasons to be hopeful. In 2015, the country formed a multisectoral plan on NCDs, which recognises the importance of having strong community-based action on prevention and management at the community level. In the spirit of this plan, some NGOs did start NCD management in Nepal but their work has largely been piecemeal, focusing on the urban population. The government meanwhile provides limited cardiovascular care at the community level with wide variations in the quality and coverage.

A nurse takes a blood pressure measurement using a manual machine in Motipur PHC, Rupandehi (left) and a health worker trains a community health worker on how to take MMM17 height measurements at Chaumala PHC, Kailali. Photo: Nepal Development Society

A 2015 Nepal health facility survey supported by the United States Agency for International Development (USAID), the UK Department for International Development (DFID), and The World Health Organization (WHO) showed that functioning blood pressure measurement equipment was available in 93.5% of health facilities, while only 73.1% had cardiovascular services available. (These services were defined as meaning providers could at least diagnose cardiovascular disease, prescribe treatment, or otherwise manage diagnosed patients.)

In general, most people are never screened for blood pressure in the community and even if they are, they are not aware of their hypertension status. Geographical barriers, illiteracy and health workers’ poor understanding of hypertension screening are some of the barriers.

To help bridge that gap, more than 20 screening sites were established to conduct hypertension screening across all federal regions of Nepal during May Measurement Month 2017, with community health workers taking part in screening campaigns.

They were trained to use digital as well as manual blood pressure measuring devices and portable height and weight measuring machines, and to give advice on diet and ceasing smoking and heavy alcohol use.

A woman has her blood pressure measured (left) while a woman from a rural community is helped to complete her MMM17 questionnaire, both atat Chaumala PHC, Kailali. Photo: Nepal Development Society

Dinesh Neupane, the MMM country leader for Nepal, said: “We are overwhelmingly satisfied with the participation of, and eagerness of, people to screen their blood pressure. Lots were actually being screened for the first time in their life.”  Pointing to Nepal’s poor record on cardiovascular disease management, he added: “Sooner or later, we have to overcome this tide of CVDs, and community screening for blood pressure could be the first step towards CVD care.

“Only a strengthened community response can addresses the tides of NCDs like hypertension we are facing today.”

Dr Indra Poudel, a medical doctor from the far western region of Nepal, goes further. He believes that community-based management of NCDs like hypertension is the single most important approach in Nepal. “People in the far-flung regions do not regularly visit health centres, if they are not required to do so for some urgent condition,” he said.

“Health services therefore have to come to the people, not the other way around.”