KATHMANDU, JULY 14
In the last few decades, Nepal has witnessed substantial change in disease patterns. According to Nepal Burden of Disease Study 2019, non-communicable diseases (NCDs) are responsible for almost 71 per cent of total deaths, while communicable, maternal neonatal and nutritional (CMNN) diseases account for 21 per cent and injuries account for 8 per cent of total deaths.
The Housing and Population Census 2021 shows a similar trend. Of the total 198,463 deaths reported in the Housing and Population Census in the twelve months before the census, 98,736 deaths were due to NCDs.
Likewise, there were 3,808 deaths due to road accidents, 7,902 deaths due to other accidents, 653 pregnancy related deaths, 1,117 crime related deaths, 5,271 suicide deaths, and 9,595 natural disaster related deaths.
Notably, 22.7 per cent of the reported deaths were from unspecified causes which may pose a challenge to policy makers and planners. With increasing life expectancy, unhealthy diet, and sedentary lifestyle, the burden of NCDs is likely to increase in future.
Achyut Raj Pandey, health system researcher HERD International suggests, "If the disease pattern changes as it did between 1990 to 2019, approximately 79 per cent of deaths are likely to be due to NCDs in 2040 while CMNN diseases will be contributing 12 per cent of total deaths, with the remaining 9 per cent deaths due to other reasons."
"Nepal's health care delivery system was initially designed to cater to acute care needs. It is not sufficiently prepared for long term care that requires repeated visits. Although one in every four people experience health conditions in their lifetime that would benefit from rehabilitation services in Nepal, there is very limited infrastructure to provide such services," added Pandey.
In his paper published in Journal of Global Health, Pandey opines that there is need for increased investment in NCD care.
He also opines that Nepal has been facing protracted epidemiological transitions, meaning that NCDs are contributing to in-creasing proportion of deaths while CMNN diseases are still s oprevalent in notable proportion, thus making resource allocation decisions more challenging.
Improving efficiency within the health system and sparing additional resources for NCD control could be an option con-sidering that almost 42 per cent of the progress towards achieving Universal Health Coverage targets by 2030 could be achieved by improving efficiency within the health system with the current level of resources available in low and middle-income countries like Nepal," he said, adding, "Therefore, in the context where we have very limited additional resources that can be secured for NCDs in future, improving efficiency within the health system should be the top priority."
According to Bishnu Prasad Dulal, a demographer who analysed the Housing and Population Census report 2021, for last few decades road traffic accidents, crime, suicide, other accidents, and communicable diseases were the leading causes of death in the earlier stages of life.
Specifically, mortality rates due to crime and road accidents were significantly higher among adult males. The government should take measures to control road accidents and suicide among the young population.
According to an estimate of the World Health Organisation, suicide rate has marginally declined from 11 per 100,000 population in 2012 to 10 per 100,000 population in 2019, Housing and Population census sheds light on high suicide rate among the Nepalese population.
"Suicide rates were highest in the population aged 15-24 with higher mortality among males.
However, among adolescents, females were found to be more liable to commit to suicide compared to males," said Dulal, "Nepal needs to make major decisions on resource reallocation and reorientation of the health system to prepare itself better for responding to the increasing burden of NCDs."
A version of this article appears in the print on July 15, 2023, of The Himalayan Times.
