Perceptions and Practices of Cardiovascular Health: A Population Perspective from a Peri-Urban Nepalese Community

Background Global phenomena such as urbanization and individual traits such as health literacy affect people’s exposure and vulnerability to cardiovascular risk factors. Nepal, a low-income South Asian country undergoing epidemiological transition, has limited data and understanding of cardiovascular health issues, particularly regarding cardiovascular health literacy, perception and practice on the community level. Aims This Thesis investigated issues of cardiovascular health from a population perspective. Specifically, it first aimed to establish a Health Demographic Surveillance Site in a peri-urban Nepalese setting; then, assess knowledge, attitude, and practice (KAP)/behavior regarding cardiovascular risk factors, manifestations, and preventability; understand behavioral and life-style risk factors such as physical activity and diet in terms of their sociodemographic correlates; and finally, explore the perceptions of cardiovascular health and disease among those already affected. Methods A health demographic surveillance site was established in Jhaukhel and Duwakot, two peri-urban villages near Kathmandu. A mixed methods research approach was then used. Quantitative studies assessed cardiovascular health literacy, knowledge and attitude in a sample population. Cardiovascular health behaviour, particularly physical inactivity and fruit and vegetable intake, were studied. Additionally, a qualitative study to explore perceptions and experiences of patients with cardiometabolic diseases was conducted. Results Forty four percent of the study population had poor knowledge of cardiovascular health. Moreover, only 14.7% and 13.9% of respondents with highly satisfactory knowledge also had highly satisfactory attitude and practices, respectively. Behavioral cardiovascular risk factors were high (low physical activity: 43.3%, inadequate fruit and vegetable consumption: 97.9%) and varied by sociodemographic correlates. Furthermore, patients understood the importance of lifestyle modification only after diagnosis. Conclusions The studies presented in this Thesis demonstrate the current inadequacy of health literacy in Nepal. In addition, gaps exist between cardiovascular health knowledge, attitude, and practice/behavior, even among those already affected. The coupling of high behavioral risk burden with low cardiovascular health literacy implies need for multi-sector health promotional strategies in the country

Diet and physical activity for children’s health: a qualitative study of Nepalese mothers’ perceptions

Published version, also available at http://dx.doi.org/10.1136/bmjopen-2015-008197Objectives: Non-communicable diseases account for 50% of all deaths in Nepal and 25% result from cardiovascular diseases. Previous studies in Nepal indicate a high burden of behavioural cardiovascular risk factors, suggesting a low level of knowledge, attitude and practice/behaviour regarding cardiovascular health. The behavioural foundation for a healthy lifestyle begins in early childhood, when mothers play a key role in their children’s lives. This qualitative study, conducted in a Nepalese peri-urban community, aimed to explore mothers’ perception of their children’s diet and physical activity. Design: We notated, tape-recorded and transcribed all data collected from six focus group discussions, and used qualitative content analysis for evaluation and interpretation. Setting: The study was conducted in the Jhaukhel- Duwakot Health Demographic Surveillance Site in the Bhaktapur district of Nepal. Participants: Local health workers helped recruit 61 women with children aged 5–10 years. We distributed participants among six different groups according to educational status. Results: Although participants understood the importance of healthy food, they misunderstood its composition, perceiving it as unappetising and appropriate only for sick people. Furthermore, participants did not prioritise their children’s physical activities. Moreover, mothers believed they had limited control over their children’s dietary habits and physical activity. Finally, they opined that health educational programmes would help mothers and recommended various intervention strategies to increase knowledge regarding a healthy lifestyle. Conclusions: Our data reveal that mothers of young children in a peri-urban community of Nepal lack adequate and accurate understanding about the impact of a healthy diet and physical activity. Therefore, to prevent future cardiovascular disease and other noncommunicable diseases among children, Nepal needs health education programmes to improve mothers’ cardiovascular health knowledge, attitude and behaviour

Knowledge, attitude and practice on diet and physical activity among mothers with young children in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal

Source at https://doi.org/10.1371/journal.pone.0200329. The prevalence of cardiovascular diseases is increasing in low and middle-income countries; Nepal’s population shows a high prevalence of behavioral risk factors. Our cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), located near the capital Kathmandu, explored knowledge, attitude, and practice (KAP) of mothers with young children regarding diet and physical activity and mothers’ perception of their children’s attitude and behavior toward the same issues. The purpose of our study was to assess needs of the mothers concerning cardiovascular health in general and more specifically regarding diet and physical activity, and to establish a baseline for future intervention in the community by comparing two villages of JD-HDSS. In August–November 2014, nine trained enumerators interviewed all mothers of children aged 1–7 years (N = 962). We scored responses on dietary and physical activity KAP, then categorized the scores based on the percentage obtained out of the maximum possible scores into “poor,” “fair,” and “good.” More highly educated mothers scored higher for KAP (all pp = 0.007). Most respondents were unfamiliar with the concept of healthy and unhealthy food. Overall, 57% of respondents in JD-HDSS had “good” knowledge, 44.6% had “good” attitude, and most (90%) had “poor” practice. We observed no significant differences between the villages regarding mothers’ knowledge and attitude or children’s behavior. Practice score of mothers in Jhaukhel was higher than those in Duwakot regarding diet and physical activity (p<0.001). Mothers’ perceived barriers for improving lifestyle were high cost of healthy food, taste preference of other family members, and lack of knowledge regarding healthy food. Barriers for physical activity were lack of leisure time, absence of parks and playgrounds, busy caring for children and old people, feeling lazy, and embarrassed to be physically active in front of others. Our findings suggest that a health education intervention promoting a healthy lifestyle for mothers and children might improve KAP and also improve cardiovascular health. To address mothers’ gap between knowledge and practice, a future intervention should consider perceived barriers

Developing Relational Work as a Design Tool in activities with health professionals

This poster explores relations that emerge between professionals in different roles in the public health systems in low-and-middle income countries (LMICs) as they engage in activities related to the surveillance of antimicrobial resistance (AMR). It illustrates the potential for a designed learning activity to promote relational expertise among participants based at the same workplace. Grounded in sociocultural theory and leveraging theoretical contributions from the field of professional learning, we draw on qualitative digital data across a period of six months to examine the development of an AMR Toolkit - a set of activities to encourage dialogic reflection about new sets of relations that are needed as work evolves - and the organization of activities that the Toolkit enabled. Analysis of accounts generated by lead participants (written proformas (n=12); interviews (n=11)) across 12 public health organisations in two LMICs reveal how the concept of relational expertise combined with maintaining a view of the new object of activity in the local system serve in the design of an artefact that supports professionals to come to understanding and negotiate wider work arrangements and practices, envision new practices and engage in re-configurations of relational aspects of work

Knowledge, attitude and practice on diet and physical activity among mothers with young children in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal

The prevalence of cardiovascular diseases is increasing in low and middle-income countries; Nepal's population shows a high prevalence of behavioral risk factors. Our cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), located near the capital Kathmandu, explored knowledge, attitude, and practice (KAP) of mothers with young children regarding diet and physical activity and mothers' perception of their children's attitude and behavior toward the same issues. The purpose of our study was to assess needs of the mothers concerning cardiovascular health in general and more specifically regarding diet and physical activity, and to establish a baseline for future intervention in the community by comparing two villages of JD-HDSS. In August-November 2014, nine trained enumerators interviewed all mothers of children aged 1-7 years (N = 962). We scored responses on dietary and physical activity KAP, then categorized the scores based on the percentage obtained out of the maximum possible scores into "poor," "fair," and "good." More highly educated mothers scored higher for KAP (all p<0.001); the children's behavior score reflected their mother's education level (p = 0.007). Most respondents were unfamiliar with the concept of healthy and unhealthy food. Overall, 57% of respondents in JD-HDSS had "good" knowledge, 44.6% had "good" attitude, and most (90%) had "poor" practice. We observed no significant differences between the villages regarding mothers' knowledge and attitude or children's behavior. Practice score of mothers in Jhaukhel was higher than those in Duwakot regarding diet and physical activity (p<0.001). Mothers' perceived barriers for improving lifestyle were high cost of healthy food, taste preference of other family members, and lack of knowledge regarding healthy food. Barriers for physical activity were lack of leisure time, absence of parks and playgrounds, busy caring for children and old people, feeling lazy, and embarrassed to be physically active in front of others. Our findings suggest that a health education intervention promoting a healthy lifestyle for mothers and children might improve KAP and also improve cardiovascular health. To address mothers' gap between knowledge and practice, a future intervention should consider perceived barriers

Multimorbidity in Diabetic Patients Admitted to a Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: Multimorbidity is defined as the co-occurrence of two or more chronic conditions in the same individual. Type 2 Diabetes Mellitus rarely occurs without coexisting diseases. With an increasing elder population and longevity, elder adults have a higher prevalence of chronic morbidity, thus increasing the chances of experiencing more than one non-communicable chronic condition, where the impact of multimorbidity is greater than the cumulative effect of the single condition. The study aimed to find out the prevalence of multimorbidity in diabetic patients admitted to a tertiary care centre. Methods: A descriptive cross-sectional study was conducted utilising hospital records of patients with type 2 diabetes mellitus admitted to the Department of Medicine from 1 April 2021 to 1 April 2022. Ethical clearance was obtained from the Institutional Review Committee of the same institute (Reference number: 12082022/07). The diagnosed cases of type 2 diabetic patients aged more than 18 years and confirmed with serum glucose levels were included in the study. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of the 107 diabetic patients, multimorbidity was present in 75 patients (70.10%) (61.42-78.77, 95% Confidence Interval). Conclusions: The prevalence of multimorbidity is higher than the similar studies done in similar settings

Obesity Prevalence in Nepal: Public Health Challenges in a Low-Income Nation during an Alarming Worldwide Trend

The future toll of the obesity epidemic will likely hit hardest in low- and middle-income countries. Ongoing urbanization promotes risk factors including sedentary lifestyle and fat- and sugar-laden diets. Low-income countries like Nepal experience a double disease burden: infectious diseases as well as rising incidence of noncommunicable diseases (e.g., cardiovascular disease and diabetes mellitus) frequently characterized by obesity. Nepal currently directs efforts towards curing disease but pays little attention to preventive actions. This article highlights obesity prevalence in Nepal, delineates the challenges identified by our pilot study (including low health literacy rates), and suggests strategies to overcome this trend

Pretreatment of garden biomass using Fenton’s reagent: influence of Fe2+ and H2O2 concentrations on lignocellulose degradation

Abstract Garden biomass (GB) is defined as low density and heterogeneous waste fraction of garden rubbish like grass clippings, pruning, flowers, branches, weeds; roots. GB is generally different from other types of biomass. GB is mostly generated through maintenance of green areas. GB can be processed for bio energy production as it contains considerably good amount of cellulose and hemicellulose. However, pretreatment is necessary to delignify and facilitate disruption of cellulosic moiety. The aim of the present investigation was to pretreat GB using Fenton’s reagent and to study the influence of Fe2+ and H2O2 concentrations on degradation of lignin and cellulose. The data were statistically analyzed using ANOVA and numerical point prediction tool of MINITAB RELEASE 14 to optimize different process variables such as temperature, concentration of Fe2+ and H2O2. The results of the present investigation showed that Fenton’s reagent was effective on GB, however, concentration of Fe2+ and H2O2 play crucial role in determining the efficiency of pretreatment. An increase in H2O2 concentration in Fenton’s reagent significantly increased the rate of cellulose and lignin degradation in contrast to increasing concentration of Fe2+ ion which led to a decrease in lignocellulosic degradation.</jats:p

Reinforcement of Peer-Coaching and Clinical Audit to improve Implementation of the Package of Essential Non-Communicable Diseases (PEN) in Nepal: A Pilot Implementation Study Method

Introduction: Nepal endorsed and implemented the WHO Package of Essential Non-communicable Disease Intervention. However, its implementation is far from satisfactory. We designed and implemented an intervention to reinforce peer coaching and clinical audit mechanisms in primary- level health facilities, and tested its feasibility and preliminary effectiveness. This paper details the methodology used in designing, implementing and assessing the intervention. Methods: The study adoptes a hybrid type II implementation trial design. The intervention assignment followed a non-blinded, two-arm, parallel randomized controlled trial design with a 1:1 allocation ratio. Seventeen primary-level public health facilities with at least one trained staff were randomized. The clinical staff at the intervention health facilities received peer-coaching and clinical audit reinforcement, while the control group followed their usual practice. The study was conducted over a 12-month duration. A mixed-method approach, applying pre-post assessment and thematic analysis, to inform the intervention development and assess implementation outcomes and its effectiveness was. The study was guided by the Proctor framework. Ethical clearance was obtained from the Nepal Health Research Council (Registraion number: 30212021). Discussion: The tools and methods that guide intervention implementation and assessment have the potential to be replicated in various settings to design strategies to improve Package of Essential Non-communicable Disease Intervention adoption and sustainment. Trial Registration: This trial is registered with ClinicalTrials.gov (www.clinicaltrials.gov) on 30 May 2025, Identifier: NCT05794399