Project Summary

Over the last two decades, Nepal has undergone a rapid change in terms of rapid but unplanned urbanization; however, currently, over 70% of the population lives in rural areas. Socioeconomic development and globalization are changing these communities, introducing new risk factors for chronic conditions (e.g. unhealthy lifestyles, increase in environmental exposures including the impact of climate change) alongside prevailing poverty-related risks (e.g. malnutrition and exposure to household air pollution), which is predicted to lead to a significant rise in non-communicable diseases (NCDs) in adults and retarded growth, a higher burden of respiratory diseases (including lung impairment) in children. In addition, sedentary lifestyles and access to more carbohydrate-rich food has caused a growing percentage of population suffer from type 2 diabetes which eventually leads to nephropathy. Local healthcare, which is largely private, is ill-equipped to manage the current health burden and associated disability, leaving rural populations highly vulnerable to catastrophic health expenditures and potential loss of economic productivity, which could derail further economic development. The social structure of rural communities (e.g. strong social networks and extended households) further presents unique threats (e.g. disease transmission, particularly during a pandemic such as COVID-19 and high health expenditure incurred by older household members), as well as opportunities to mitigate the impact of increasing NCDs burden.

There are some reports from cross-sectional studies that have estimated the burden and risk factors of NCDs in Nepalese adults; however, the lack of well-designed prospective studies in rural and peri-urban Nepal has resulted in lacking incidence data for major NCDs. Cross-sectional studies from certain regions, the majority from the Kathmandu valley, have provided wide prevalence estimates for major NCDs, often fluctuating widely based on the risk and outcome assessment criteria and seasonality. This could be a grossly underestimate of true disease prevalence as the data are not representative of the wider geographical regions of Nepal. Longitudinal studies from high-income countries have identified several life-course factors (e.g. under- and overweight, tobacco use, blood pressure) and environmental (e.g. air pollution) risk factors associated with multiple chronic conditions (e.g. cardio-respiratory, cancers, kidney, diabetes, mental health and cognitive decline), and social determinants of multi-morbidity. Currently, there are no longitudinal studies in the Terai and Hilly (except Kathmandu) regions that have investigated the life-course and environmental risk factors of individual chronic conditions in adults and respiratory diseases in children. We plan to set up life-course epidemiological studies in two regions (Lumbini Sanskritik Municipality of Lumbini Pradesh and Waling Municipality of Gandaki Pradesh).

Project goals

We plan to establish a longitudinal prospective cohort in two geographical regions (Terai and Mid-hill) of Nepal. The study will study the relationship between various risk factors, including socio-demographic changes with both non-communicable diseases in adults, respiratory and overall health in children over the next 15 years.

Objective 1: To collect data on the medical history of parents and children followed by a baseline study on various risk factors

We will enroll and collect health-related data from 12000 individuals (parents (~8000) and their children (4000). The health-related data will be mainly based on self-reported various symptoms, frailty, quality of life, self-reported health status, and comorbidities such as hypertension, stroke, diabetes, COPD, asthma, kidney diseases, cancer, arthritis, mental health, cataracts, tuberculosis, and access to healthcare facilities. We plan to collect data on socio-demographic status, lifestyles factors (smoking, alcohol, dietary patterns, physical measurement), occupational history, anthropometry, blood pressure, frailty, environmental exposures (air pollution, occupational exposures), lung function, spot urine test for urine protein, pH, blood cells, etc.

The baseline data will be analyzed to understand the various risk factors and burden of various health conditions. The findings will be widely shared to peer-reviewed scientific publications, reports to concerned government agencies for policy formulation purposes, international and national conferences/workshops.

Objective 2: To explore the feasibility of establishing a disease surveillance system

Our plan is to establish a diseases surveillance system to monitor the current and future health status and excess to healthcare facilities. Initially, we will obtain copies of health records kept at home and seek consent to obtain a copy of the corresponding medical record from the healthcare provider if there are any. We will then review the availability, accessibility, and quality of medical records (from the two approaches) and the accuracy of medical diagnosis (against our data). Based on the findings, we will explore (with the local community and healthcare providers) the feasibility of creating a local electronic health record (EHR) system, which could be maintained by the healthcare providers or the participants themselves in HIPAA compliant manner (using their mobile phones to input data and/or share images of their medical records with the research team to upload). This secure EHR database will be used in disease surveillance system for future years for up to 15 years, making it a first-of-its-kind longitudinal cohort in Nepal.