COMMUNITY HEALTH WORKER LED HYPERTENSION PREVENTION AND

CONTROL (CHPC) IN NEPAL: AN IMPLEMENTATION TRIAL

&
DHULIKHEL HEART STUDY (DHS)

PRACTICUM CONCEPT

SUBMITTED BY: SUBMITTED TO:

Pushpa Adhikari Department of Public Health
Msc. Public Health Kathmandu University of Medical Sciences
3rd Batch
Table of Contents

Contents Page No.

Background 3
Learning Objective 4
Activities 4
Timeline 4
Site Supervisor 4
References 5

Background
Global targets for noncommunicable diseases(NCD) is to reduce the prevalence of hypertension
by 33% between 2010 and 2030. 1 About 7.6 million premature deaths (about 13.5% of the global
total) and 92 million DALYs (6·0% of the global total) are attributed to high BP worldwide. 2
Additionally, approximately 54% of strokes and 47% of coronary heart disease (CHD)
worldwide were attributed to hypertension.3 The number of adults with hypertension has
increased from 594 million in 1975 to 1.13 billion in 2015, mainly in low- and middle-income
countries.1 The prevalence of adult hypertension was higher in LMICs (31.5%, 1.04 billion
people) than in high-income countries (28.5%, 349 million people).4

In Nepal, the prevalence of hypertension is high and increasing. Hypertension was the 5th
contributing factor, rising to the 4th most important risk factor for deaths and disability-adjusted
life years in 2019.5 Comparatively, hypertension is less prevalent in rural settings. In 2019, the
prevalence of hypertension was 28.4%, 25.5%, and 24.4% among urban, suburban, and rural
populations, respectively.6 Overall, 18% of participants aged 15-69 years in 2016 had
hypertension7 whereas its prevalence increased to 20.3% in 2019.5 The prevalence of
hypertension control is only 3.8%.8

The Community Health Workers (CHWs) can contribute to lowering the prevalence of
hypertension by encouraging members of the community, including those who are at risk, to
adopt healthy lifestyle choices.9 The study from south Africa shows that CHW found it difficult
to comprehend the fact that people without risk factors such as obesity or a family history of
hypertension can develop hypertension.9 CHW believe that people who take medical treatment
become sicker and that their health deteriorates rapidly. CHWs responses highlighted their
insufficient knowledge about hypertension as a chronic disease of lifestyle. 9 Another study from
India shows that CHW is motivated by individual and community level factors rather than health
system determinants. 10

I am planning to do my practicum in research project tittle Dhulikhel Heart Study (DHS) and
Community health worker led hypertension prevention and control (CHPC) in nepal: an
implementation trial.

Learning Objective
1. Data analysis of large sampled longitudinal study

2. Develop SOP for community health worker training

3. Support team of DHS for Manuscript writing

Activities & Timeline

S.N. Activities Timeline

1 Topic Identification 6th Dec – 9th Dec., 2023
2 Concept writing 10th & 11th Dec.,2023
3 Concept Submission 12th Dec., 2023
4 Data analysis of DHS 13th Dec – 20th Dec., 2023
5 Develop SOP for community health worker training 21st Dec – 31st Dec., 2023
6 Support team of DHS for manuscript writing 1st Jan - 15th Jan., 2024
7 Report Writing 16th Jan -30th Jan., 2024
8 Final Report Submission 31st Jan., 2024

Site Supervisor: Dr. Archana Shrestha/ Dinesh Timilsina/ Bandna Paneru

References
1. WHO. Hypertension. Geneva,Switzerland: World Health Organization; 2021 Aug.

2. Lawes CM, Hoorn SV, Rodgers A. Global burden of blood-pressure-related disease,

2001. The Lancet. 2008 May 3;371(9623):1513–8.

3. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden
of disease and risk factors, 2001: systematic analysis of population health data. Lancet Lond
Engl. 2006 May 27;367(9524):1747–57.

4. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev

Nephrol. 2020 Apr;16(4):223–37.

5. Institute for Health Metrics and Evaluation. Risk factors drive the most death and
disability combined [Internet]. Nepal; 2019 [cited 2022 Dec 14]. Available from:
https://www.healthdata.org/nepal

6. Huang Y, Guo P, Karmacharya BM, Seeruttun SR, Xu DR, Hao Y. Prevalence of

hypertension and prehypertension in Nepal: a systematic review and meta-analysis. Global
Health Research and Policy. 2019 Apr 30;4(1):11.

7. Mehata S, Shrestha N, Mehta R, Vaidya A, Rawal LB, Bhattarai N, et al. Prevalence,

awareness, treatment and control of hypertension in Nepal: data from nationally representative
population-based cross-sectional study. Journal of Hypertension. 2018 Aug;36(8):1680–8.

8. Dhungana RR, Pedisic Z, Dhimal M, Bista B, de Courten M. Hypertension screening,

awareness, treatment, and control: a study of their prevalence and associated factors in a
nationally representative sample from Nepal. Global Health Action. 2022 Dec 31;15(1):2000092.

9. Sengwana MJ, Puoane T. Knowledge, beliefs and attitudes of community health workers
about hypertension in the Cape Peninsula, South Africa. Curationis. 2004 Sep 28;27(1):65–71.

10. Gopalan SS, Mohanty S, Das A. Assessing community health workers’ performance
motivation: a mixed-methods approach on India’s Accredited Social Health Activists (ASHA)
programme. BMJ Open. 2012 Jan 1;2(5):e001557.