Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal... more 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 l...
<p>KAP scores were categorized into three categories based on the percentage of the maximum... more <p>KAP scores were categorized into three categories based on the percentage of the maximum possible scores: “poor” (0%-50%), “fair” (51%-75%), or “good” (76%-100%).</p
Background Sense of coherence (SOC) is a core concept of salutogenesis which relates to individua... more Background Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals' overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal. Objective To determine and evaluate women's SOC before and after a health education intervention. Method This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban JhaukhelDuwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1-7 years. Eight hundred and fifty-seven women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests an...
Behavioral risk factors, particularly the major four- tobacco consumption, harmful use of alcohol... more Behavioral risk factors, particularly the major four- tobacco consumption, harmful use of alcohol, unhealthy diet and physical inactivity- are accountable for a major proportion of cardiovascular disease burden. Driven by urbanization and globalization, these risk factors are rising in many of the low- income countries including Nepal. Population-based surveys and hospital reports indicate cardiovascular diseases are rising in Nepal. The first countrywide WHO-STEPS risk factor survey conducted in 2007-2008 showed that 23.8% are daily smokers, 28.5% are current drinkers, and 61.9% consumed less than five servings of fruits and vegetables, while 5.5% had low physical activity. Risk factors are generally more prevalent in urban areas than rural. We aimed to study the status of these behavioural risk factors in a community that is rapidly undergoing transition from a village to an urban community. We conducted the study in Duwakot and Jhaukhel, two urbanizing villages 13 kilometers from...
Background Mothers with young children in the peri-urban Jhaukhel-Duwakot Health Demographic Surv... more Background Mothers with young children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance site of Bhaktapur district have misconceptions and poor behavioural practice regarding diet and physical activity. We developed the Hearthealth Associated Research, Dissemination and Intervention in the Community trial - a health promotion intervention for mothers. Objective The objective of this study was to evaluate the intervention's feasibility, acceptability, potential for transferability and scaling up, and to determine its immediate outcome. Method Duwakot and Jhaukhel were randomly selected as the intervention and control communities, respectively. We trained 47 peer mothers from Duwakot, each of whom gave classes with 10 fellow mothers of their neighbourhood. The process evaluation was carried out on a continuous basis at different points of the intervention held from August to November 2016. Result In round one, the participation and completion rates were both >...
Background Nutritional transition toward a high-fat and high-energy diet, decreasing physical act... more Background Nutritional transition toward a high-fat and high-energy diet, decreasing physical activity level, and poor knowledge about cardiovascular health contribute to a rising burden of cardiovascular disease in low-income countries such as Nepal. Dietary and physical activity behaviors are formed early in life and influenced by family, particularly by mothers in the social context of Nepal. Aims This Thesis aimed to understand a community’s perception of cardiovascular health from the patients’ viewpoint. More specifically, it aimed to assess knowledge, attitude, and practice (KAP) including perceived barriers of mothers with young children regarding their own diet and physical activity and also how mothers perceived their children’s behavior. Based on these findings, the Thesis aimed to develop and implement a health promotion intervention tailored to the mothers’ needs and assess its impact on mothers’ KAP and their children’s behavior. Methods A mixed methods research approa...
BackgroundDespite a high burden, there is limited training available in non-communicable disease ... more BackgroundDespite a high burden, there is limited training available in non-communicable disease research in Nepal. In order to understand research capacity gap in non-communicable diseases in the country, we conducted a needs assessment. We aimed to assess existing research training capacity in academic health institutions of Nepal for the prevention and control of non-communicable diseases, identify gaps in research training in these institutions, and explore the feasibility of developing research training program in Nepal targeting non-communicable diseases and their risk factors. MethodsWe did qualitative and quantitative research and reviewed academic institution curricula review and scientific literature. We conducted 14 Focus Group Discussions with bachelor and Masters level students of public health and community medicine; 25 In-depth Interviews with department heads and faculties, and government stakeholders. We surveyed medical and public health students on their research ...
Background Cardiovascular diseases (CVDs) are the leading cause of death and disease burden globa... more Background Cardiovascular diseases (CVDs) are the leading cause of death and disease burden globally, disproportionately affecting low and middle-income countries. The continued scarcity of literature on CVDs burden in Nepal has thwarted efforts to develop population-specific prevention and management strategies. This article reports the burden of CVDs in Nepal including, prevalence, incidence, and disability basis as well as trends over the past two decades by age and gender. The findings from this study provide a base for public health priorities and for creating evidence-informed policies.Methods We used the Institute of Health Metrics and Evaluation (IHME)’s Global Burden of Diseases (GBD) database on cardiovascular disease mortality rates, prevalence, incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) from Nepal to describe the most recent data available (2017) and trends by age, gender and year from 1990 to 2017....
Background: Unhealthy diet and physical inactivity contribute to the growing burden of cardiovasc... more Background: Unhealthy diet and physical inactivity contribute to the growing burden of cardiovascular diseases in Nepal. Lifestyle is formed in childhood and in the Nepalese context influenced mainly by mothers, it is to date unknown how influential mothers are. Objectives: To assess changes in children’s diet and physical activity as perceived by their mothers after a health promotion intervention. Methodology: The Heart-Health Associated Research, Dissemination and Intervention in the Community is a community trial conducted in the Jhaukhel-Duwakot Health Demographic Surveillance site, in Bhaktapur district of Nepal. We conducted a health promotion intervention on diet and physical activity targeted at mothers with children aged one to nine years old in August-November 2016. Duwakot was randomized as the intervention site and Jhaukhel as the control. We conducted a follow-up study after three months to determine the outcome of the intervention. Nine trained enumerators conducted d...
Background: Prehypertension is clinically defined as a level of blood pressure between normal and... more Background: Prehypertension is clinically defined as a level of blood pressure between normal and hypertension, i.e. elevated systolic blood pressure between120-139 or diastolic blood pressure between 80-89 mm Hg. Prehypertension remains neglected as a public health problem, and has not been explored in mothers with small children in Nepal.Objectives: We aimed to study prehypertension and its related factors including obesity-related parameters among mothers with children aged 1-7 years in Duwakot and Jhaukhel communities of Bhaktapur district, Nepal.Methods: We prepared a sampling frame of all the eligible mothers, and interviewed 962 mothers. The trained enumerators also measured their blood pressure, body weight, height, waist and hip circumferences. We analysed data with SPSS version 22. We received ethical approval from the Nepal Health Research Council to conduct the study, and obtained informed verbal consent from the participating mothers.Results: About one-third (31.8%) of ...
Background: Inadequate fruit and vegetable intake and other adverse dietary habits – along with t... more Background: Inadequate fruit and vegetable intake and other adverse dietary habits – along with tobacco and alcoholabuse and sub-optimal physical activity - make up the four most important behavioural risk factors of non-communicablediseases. Low fruit and vegetable intake is particularly associated with burden of high cardiovascular disease. It hasreceived more attention in the last decade, with studies that explore disparities and determinants in their intake, as wellas interventions that attempt to improve the intake.Objectives: Our study aimed to determine fruit and vegetable consumption in a peri-urban community of Nepal and tocompare this intake in relation to various socio-demographic variables.Methods: This cross-sectional study was conducted as a part of the HARDIC (Heart-Health Associated Research andDissemination in the Community) study in the Jhaukhel-Duwakot Health Demographic Surveillance Site in the Bhaktapurdistrict of Nepal during September-December 2011. Adults fro...
Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal... more 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 l...
<p>KAP scores were categorized into three categories based on the percentage of the maximum... more <p>KAP scores were categorized into three categories based on the percentage of the maximum possible scores: “poor” (0%-50%), “fair” (51%-75%), or “good” (76%-100%).</p
Background Sense of coherence (SOC) is a core concept of salutogenesis which relates to individua... more Background Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals' overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal. Objective To determine and evaluate women's SOC before and after a health education intervention. Method This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban JhaukhelDuwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1-7 years. Eight hundred and fifty-seven women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests an...
Behavioral risk factors, particularly the major four- tobacco consumption, harmful use of alcohol... more Behavioral risk factors, particularly the major four- tobacco consumption, harmful use of alcohol, unhealthy diet and physical inactivity- are accountable for a major proportion of cardiovascular disease burden. Driven by urbanization and globalization, these risk factors are rising in many of the low- income countries including Nepal. Population-based surveys and hospital reports indicate cardiovascular diseases are rising in Nepal. The first countrywide WHO-STEPS risk factor survey conducted in 2007-2008 showed that 23.8% are daily smokers, 28.5% are current drinkers, and 61.9% consumed less than five servings of fruits and vegetables, while 5.5% had low physical activity. Risk factors are generally more prevalent in urban areas than rural. We aimed to study the status of these behavioural risk factors in a community that is rapidly undergoing transition from a village to an urban community. We conducted the study in Duwakot and Jhaukhel, two urbanizing villages 13 kilometers from...
Background Mothers with young children in the peri-urban Jhaukhel-Duwakot Health Demographic Surv... more Background Mothers with young children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance site of Bhaktapur district have misconceptions and poor behavioural practice regarding diet and physical activity. We developed the Hearthealth Associated Research, Dissemination and Intervention in the Community trial - a health promotion intervention for mothers. Objective The objective of this study was to evaluate the intervention's feasibility, acceptability, potential for transferability and scaling up, and to determine its immediate outcome. Method Duwakot and Jhaukhel were randomly selected as the intervention and control communities, respectively. We trained 47 peer mothers from Duwakot, each of whom gave classes with 10 fellow mothers of their neighbourhood. The process evaluation was carried out on a continuous basis at different points of the intervention held from August to November 2016. Result In round one, the participation and completion rates were both >...
Background Nutritional transition toward a high-fat and high-energy diet, decreasing physical act... more Background Nutritional transition toward a high-fat and high-energy diet, decreasing physical activity level, and poor knowledge about cardiovascular health contribute to a rising burden of cardiovascular disease in low-income countries such as Nepal. Dietary and physical activity behaviors are formed early in life and influenced by family, particularly by mothers in the social context of Nepal. Aims This Thesis aimed to understand a community’s perception of cardiovascular health from the patients’ viewpoint. More specifically, it aimed to assess knowledge, attitude, and practice (KAP) including perceived barriers of mothers with young children regarding their own diet and physical activity and also how mothers perceived their children’s behavior. Based on these findings, the Thesis aimed to develop and implement a health promotion intervention tailored to the mothers’ needs and assess its impact on mothers’ KAP and their children’s behavior. Methods A mixed methods research approa...
BackgroundDespite a high burden, there is limited training available in non-communicable disease ... more BackgroundDespite a high burden, there is limited training available in non-communicable disease research in Nepal. In order to understand research capacity gap in non-communicable diseases in the country, we conducted a needs assessment. We aimed to assess existing research training capacity in academic health institutions of Nepal for the prevention and control of non-communicable diseases, identify gaps in research training in these institutions, and explore the feasibility of developing research training program in Nepal targeting non-communicable diseases and their risk factors. MethodsWe did qualitative and quantitative research and reviewed academic institution curricula review and scientific literature. We conducted 14 Focus Group Discussions with bachelor and Masters level students of public health and community medicine; 25 In-depth Interviews with department heads and faculties, and government stakeholders. We surveyed medical and public health students on their research ...
Background Cardiovascular diseases (CVDs) are the leading cause of death and disease burden globa... more Background Cardiovascular diseases (CVDs) are the leading cause of death and disease burden globally, disproportionately affecting low and middle-income countries. The continued scarcity of literature on CVDs burden in Nepal has thwarted efforts to develop population-specific prevention and management strategies. This article reports the burden of CVDs in Nepal including, prevalence, incidence, and disability basis as well as trends over the past two decades by age and gender. The findings from this study provide a base for public health priorities and for creating evidence-informed policies.Methods We used the Institute of Health Metrics and Evaluation (IHME)’s Global Burden of Diseases (GBD) database on cardiovascular disease mortality rates, prevalence, incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) from Nepal to describe the most recent data available (2017) and trends by age, gender and year from 1990 to 2017....
Background: Unhealthy diet and physical inactivity contribute to the growing burden of cardiovasc... more Background: Unhealthy diet and physical inactivity contribute to the growing burden of cardiovascular diseases in Nepal. Lifestyle is formed in childhood and in the Nepalese context influenced mainly by mothers, it is to date unknown how influential mothers are. Objectives: To assess changes in children’s diet and physical activity as perceived by their mothers after a health promotion intervention. Methodology: The Heart-Health Associated Research, Dissemination and Intervention in the Community is a community trial conducted in the Jhaukhel-Duwakot Health Demographic Surveillance site, in Bhaktapur district of Nepal. We conducted a health promotion intervention on diet and physical activity targeted at mothers with children aged one to nine years old in August-November 2016. Duwakot was randomized as the intervention site and Jhaukhel as the control. We conducted a follow-up study after three months to determine the outcome of the intervention. Nine trained enumerators conducted d...
Background: Prehypertension is clinically defined as a level of blood pressure between normal and... more Background: Prehypertension is clinically defined as a level of blood pressure between normal and hypertension, i.e. elevated systolic blood pressure between120-139 or diastolic blood pressure between 80-89 mm Hg. Prehypertension remains neglected as a public health problem, and has not been explored in mothers with small children in Nepal.Objectives: We aimed to study prehypertension and its related factors including obesity-related parameters among mothers with children aged 1-7 years in Duwakot and Jhaukhel communities of Bhaktapur district, Nepal.Methods: We prepared a sampling frame of all the eligible mothers, and interviewed 962 mothers. The trained enumerators also measured their blood pressure, body weight, height, waist and hip circumferences. We analysed data with SPSS version 22. We received ethical approval from the Nepal Health Research Council to conduct the study, and obtained informed verbal consent from the participating mothers.Results: About one-third (31.8%) of ...
Background: Inadequate fruit and vegetable intake and other adverse dietary habits – along with t... more Background: Inadequate fruit and vegetable intake and other adverse dietary habits – along with tobacco and alcoholabuse and sub-optimal physical activity - make up the four most important behavioural risk factors of non-communicablediseases. Low fruit and vegetable intake is particularly associated with burden of high cardiovascular disease. It hasreceived more attention in the last decade, with studies that explore disparities and determinants in their intake, as wellas interventions that attempt to improve the intake.Objectives: Our study aimed to determine fruit and vegetable consumption in a peri-urban community of Nepal and tocompare this intake in relation to various socio-demographic variables.Methods: This cross-sectional study was conducted as a part of the HARDIC (Heart-Health Associated Research andDissemination in the Community) study in the Jhaukhel-Duwakot Health Demographic Surveillance Site in the Bhaktapurdistrict of Nepal during September-December 2011. Adults fro...
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