Feasibility Assessment of Invigorating grassroots primary Healthcare for cardiovascular prevention and management in low-resource settings in Nepal (FAITH study)

Cardiovascular disease (CVD), is responsible for 17.5 million deaths worldwide in 2012. Although the rate of deaths from CVD has declined in high-income countries due to the reduction in risk factors and effective CVD management and control programs, CVD has become an increasing threat to most low- and middle-income countries (LMIC) where over 80% of cardiovascular deaths occur. It is estimated that the annual CVD mortality is projected to increase from 17.5 million in 2012 to 52 million in 2030 if no effective action was taken and the cumulative lost output in LMICs associated with CVD is projected to be more than US 3.76 trillion during the period of 2011 to 2025.

Nepal is considered to be a low-income country, in which both mental disorders and CVD are highly prevalent. In Gangalal National Heart Centre, the number of patients doubled every year from 2001 to 2008. The national prevalence of depression has been estimated at a staggering 41%; suicidal ideations an alarming 11%, and alcohol use disorders (AUDs) over 20%. Hypertension rates have been estimated from 23 to 39% of the population, and undiagnosed depression in hypertensive patients was found to be 15% (the total rate of co-morbid depression-hypertension, diagnosed and undiagnosed, is well above 15%). Nationwide, CVD affects about 6% of the entire Nepalese population, and about 40% of outpatients have some form of CVD.

In other (mostly high-income) countries, depression and AUDs have both been shown to have strong associations with CVD (e.g. alcoholic cardiomyopathy). Despite Nepal’s high rates of all these conditions, however, there are only three published studies that have explored the comorbidity of CVD and depression specifically in this country, and no known studies that specifically study co-morbid AUD and CVD in Nepal. The results of these findings underscore that these mental disorders may have implications for how CVD is prevented and managed.

Objectives:

General Objective: The general purpose of the study was to investigate the prevention and management of cardiovascular disease in primary healthcare settings in Nepal and gain an understanding of the associations between depression and alcohol abuse with cardiovascular disease.

Other Objectives:

• To identify and evaluate the association between CVD, Depression and Alcohol use disorder among CVD patients.
• To assess the capacity of primary healthcare facilities and identify gaps, barriers, enabling and reinforcing factors in delivering the CVD management and prevention at primary healthcare facilities in low-resource settings.
• To evaluate the accessibility and utilization of primary healthcare services on the secondary prevention of CVDs among CVD patients, and to gain a deeper understanding of the needs, concerns and suggestions of patients regarding strengthen the capacity of PHC on CVD management and control.
• To explore and make evidence-based recommendations on the strategies and intervention approaches that can be adopted to strengthen the PHC for the prevention and control of CVDs in resource-limited settings

Target group:

• National Level Policy Makers
• Regional Level Policy Makers
• Service Providers
• Patients ( CVD , Depression & AUD related)

Implementation district:

Sindhuli, Kailali and Kathmandu

Time frame:

 May 2017 to December 2017

Supported by:

Duke Kunshan University (DKU)