World Health Organization Noncommunicable Disease Research Articles

Barriers to and facilitators for creating, disseminating, implementing, monitoring and evaluating oral health policies in the WHO African region: A scoping review.

To advance oral health policies (OHPs) in the World Health Organization (WHO) African region, barriers to and facilitators for creating, disseminating, implementing, monitoring and evaluating OHPs in the region were examined. Global Health, Embase, PubMed, Public Affairs Information Service Index, ABI/Inform, Web of Science, Academic Search Complete, Scopus, Dissertations Global, Google Scholar, WHO's Institutional Repository for Information Sharing (IRIS), the WHO Noncommunicable Diseases Document Repository and the Regional African Index Medicus and African Journals Online were searched. Technical officers at the WHO Regional Office for Africa were contacted. Research studies and policy documents reporting barriers to and facilitators for OHP in the 47 Member States in the WHO African region published between January 2002 and March 2024 in English, French or Portuguese were included. Frequencies were used to summarize quantitative data, and descriptive content analysis was used to code and classify barrier and facilitator statements. Eighty-eight reports, including 55 research articles and 33 policy documents, were included. The vast majority of the research articles and policy documents were country-specific, but they were lacking for most countries. Frequently mentioned barriers across policy at all stages included financial constraints, a limited and poorly organized workforce, deprioritization of oral health, the absence of health information systems, inadequate integration of oral health services within the overarching health system and limited oral health literacy. Facilitators included a renewed commitment to establishing national OHPs, recognition of a need to diversify the oral health workforce, and an increased understanding of the influence of social determinants of health among oral health care providers. Most countries lack a country-specific body of evidence to assist policymakers in anticipating barriers to and facilitators for OHPs. The barriers and facilitators relevant to disparate subnational, national, and regional conditions and circumstances must be considered to advance the creation, dissemination, implementation, monitoring and evaluation of OHPs in the WHO African region.

Socio-demographic correlates of unhealthy lifestyle in Ethiopia: a secondary analysis of a national survey

BackgroundMultiple lifestyle risk factors exhibit a stronger association with non-communicable diseases (NCDs) compared to a single factor, emphasizing the necessity of considering them collectively. By integrating these major lifestyle risk factors, we can identify individuals with an overall unhealthy lifestyle, which facilitates the provision of targeted interventions for those at significant risk of NCDs. The aim of this study was to evaluate the socio-demographic correlates of unhealthy lifestyles among adolescents and adults in Ethiopia.MethodsA national cross-sectional survey, based on the World Health Organization's NCD STEPS instruments, was conducted in Ethiopia. The survey, carried out in 2015, involved a total of 9,800 participants aged between 15 and 69 years. Lifestyle health scores, ranging from 0 (most healthy) to 5 (most unhealthy), were derived considering factors such as daily fruit and vegetable consumption, smoking status, prevalence of overweight/obesity, alcohol intake, and levels of physical activity. An unhealthy lifestyle was defined as the co-occurrence of three or more unhealthy behaviors. To determine the association of socio-demographic factors with unhealthy lifestyles, multivariable logistic regression models were utilized, adjusting for metabolic factors, specifically diabetes and high blood pressure.ResultsApproximately one in eight participants (16.7%) exhibited three or more unhealthy lifestyle behaviors, which included low fruit/vegetable consumption (98.2%), tobacco use (5.4%), excessive alcohol intake (15%), inadequate physical activity (66%), and obesity (2.3%). Factors such as male sex, urban residency, older age, being married or in a common-law relationship, and a higher income were associated with these unhealthy lifestyles. On the other hand, a higher educational status was associated with lower odds of these behaviors.ConclusionIn our analysis, we observed a higher prevalence of concurrent unhealthy lifestyles. Socio-demographic characteristics, such as sex, age, marital status, residence, income, and education, were found to correlate with individuals' lifestyles. Consequently, tailored interventions are imperative to mitigate the burden of unhealthy lifestyles in Ethiopia.

An Overview of the Available Health System for Monitoring Non-Communicable Diseases in Malawi

Background: Non-Communicable Diseases (NCDs) are a major cause of morbidity and mortality in Malawi and they come second as the leading cause of death in adults after HIV and AIDS. The World Health Organization (WHO) highlighted the importance of NCD monitoring as a key action which were adopted by the Member States in addressing NCDs. The framework is composed of nine global targets and 25 indicators aimed at combating global mortality for the four main NCDs. This study aimed to examine the existing national NCD monitoring tools, activities and gaps in Malawi based on WHO Global Monitoring Framework for NCDs. Methods: A desk review was conducted from June to August 2021, to examine the existing national NCD monitoring tool in Malawi from multiple sources. Policy and program documents relating to NCD monitoring in Malawi from 2011 to 2021 were identified and analyzed. Results: The findings of this review are presented according to the three major themes of the Global Monitoring Framework: Health systems capacity, monitoring of risk factors, and monitoring of mortality and morbidity outcomes. Malawi has an NCD monitoring tool in place that is adequate for the WHO NCD Global Monitoring Framework. However, there are still gaps with data from monitoring health systems indicators of the framework and hence requires strengthening. Conclusion: The country must also look beyond these set of indicators and target increasing burden and impact of COVID-19 pandemic.

Non-communicable Disease Surveillance in Malaysia: An Overview of Existing Systems and Priorities Going Forward.

In 2012, the World Health Organization (WHO) set a comprehensive set of nine global voluntary targets, including the landmark “25 by 25” mortality reduction target, and 25 indicators. WHO has also highlighted the importance of Non-Communicable Disease (NCD) surveillance as a key action by Member States in addressing NCDs. This study aimed to examine the current national NCD surveillance tools, activities and performance in Malaysia based on the WHO Global Monitoring Framework for NCDs and to highlight gaps and priorities moving forward. A desk review was conducted from August to October in 2020, to examine the current national NCD surveillance activities in Malaysia from multiple sources. Policy and program documents relating to NCD surveillance in Malaysia from 2010 to 2020 were identified and analyzed. The findings of this review are presented according to the three major themes of the Global Monitoring Framework: monitoring of exposure/risk factor, monitoring of outcomes and health system capacity/response. Currently, there is a robust monitoring system for NCD Surveillance in Malaysia for indicators that are monitored by the WHO NCD Global Monitoring Framework, particularly for outcome and exposure monitoring. However, Malaysia still lacks data for the surveillance of the health system indicators of the framework. Although Malaysia has an NCD surveillance in place that is adequate for the WHO NCD Global Monitoring Framework, there are areas that require strengthening. The country must also look beyond these set of indicators in view of the increasing burden and impact of the COVID-19 pandemic. This includes incorporating mental health indicators and leveraging on alternate sources of data relating to behaviors.

Assessing the characteristics of 110 low- and middle-income countries' noncommunicable disease national action plans

Noncommunicable diseases (NCDs) are a leading contributor to preventable mortality and impoverishment in low- and middle-income countries (LMICs). To support countries in developing holistic and integrated NCD plans, the World Health Organization (WHO) has produced get rid of this a NCD Multisectoral Action Plan (MSAP) guidance. To date, over 160 countries have produced MSAPs and uploaded them to the WHO's NCD document repository. We examined the content and comprehensiveness of the MSAPs uploaded by all 110 LMICs, with reference to the WHO guidance. Overall, the MSAPs included 71% of the elements recommended by the WHO, however, there was a tendency to present situational analyses and recommended actions without providing costings or an overall funding plan. We found no correlation between MSAP comprehensiveness (alignment with the WHO guidance) and policy implementation. There were no significant differences in MSAP alignment by region or income group. Countries with higher universal health coverage indices had lower MSAP alignment score. We concluded that the existence of a comprehensive MSAP is not enough to guarantee policy implementation, and that the WHO should focus its support on helping countries to translate plans and policies into concrete actions to address NCDs.

Structural Barriers to Health-provider Training Programmes for Ethnic Minorities: The Case of the Katu and Diabetes Management in Vietnam

Background: Training of primary care practitioners is one of the most implemented interventions in medical international development programmes targeting non-communicable diseases (NCD). Yet in many cases their effectiveness is below expectations. One potential cause of this is that they struggle to account for local context, especially when working with ethnic minorities. Here we begin to address this gap through a qualitative case-study of how local contextual factors have impacted the success of a World Health Organization (WHO) healthcare training programme on Type 2 diabetes with an ethnic minority group in rural central Vietnam.
 Design: A qualitative case-study collected data during 2018. We conducted 25 semi-structured interviews, two focus groups, and participant observation with patients, healthcare professionals, and members of a local non-governmental organisation involved in the programme. We used thematic coding to identify important contextual factors and how they helped or hindered programme delivery. Next, we synthesised each of these themes in a narrative style, drawing on the rich detail provided by respondents.
 Results: We found that, despite using a notionally decentralised approach, the effectiveness of the training was hindered by social, political, and economic determinants of health which influenced the inhabitants’ relations to healthcare and diabetes. Particular barriers were the political perceptions of minorities, their economic access to services, the healthcare prejudices toward ethnic rural populations and the rigidity of medical training.
 Conclusions: Given the similarity of our case with other WHO NCD programmes, we view that our findings are of wider relevance to global public health policy and practice. We suggest that better recognising and addressing local contextual factors would make such programmes more polyvocal, grounded, and resilient, as well as enabling them to better support long-term transformative change in public health systems. We conclude by discussing methods for implementing this in practice.

Corporations in global health: an investigation of food industry political activity at the WHO

Abstract Background With over ten million annual deaths now attributable to unhealthy diets, there is an urgent need for action, yet, political progress is too slow. Policy interference by major corporations is well documented in the area of tobacco control. Evidence shows similar behaviours by the food industry at country level, but global-level policymaking remains under-researched. Thus, this study explores how food industry actors seek to influence dietary non-communicable disease (NCD) policy at the World Health Organization (WHO). Methods We identified relevant industry documents from the Food Industry Documents Library and academic articles, using these initial findings and an existing model of corporate political activity as the basis for sixteen key informant interviews. Key industry strategies were identified in an iterative process of qualitative thematic coding. Additionally, food industry responses to five WHO consultations on NCD policy and governance (2015-2018) were analysed to explore how evidence was used. Results Food industry actors have substantial access to the WHO through formal routes. These interactions largely take place through business associations rather than individual companies, owing at least partly to the agency's own guidelines. Food industry actors can also access global-level policymaking indirectly, for example, by lobbying national political actors to adopt favourable positions in member state-led WHO decision-making, or by co-opting civil society. In consultation responses, the majority of evidence cited by commercial actors was either industry-linked or industry-funded, and less than half was peer-reviewed. Conclusions Focusing on the WHO's NCD agenda, we provide new insights into the ways food industry actors seek to influence global public health policy. Although their political behaviour bears similarities with that of the tobacco industry, multinational food companies are, in contrast, widely treated as part of the solution. Key messages By mapping how food industry actors seek to shape WHO policy, this research adds to evidence from national contexts and highlights a need for better safeguards across levels of governance. While the tobacco industry is prohibited from engagement with global NCD policy, multinational food corporations enjoy significant access and legitimacy, despite similarities in political behaviour.

Balneotherapy and hydrotherapy in chronic respiratory disease.

Chronic respiratory diseases (CRD) belong to major noncommunicable diseases (NCD) targeted by World Health Organization (WHO) NCD Action Plan and United Nations (UN) Sustainable Development Goal (STG) 3.4 to achieve 30% decline of mortality by the year 2030. Strong evidence is now available in the literature for therapeutic aquatic exercise interventions in improving health status of chronic obstructive pulmonary diseases (COPD) patients. However, gym-based exercises can be difficult for patients with COPD who are mainly elderly and often have co-morbidities—such as severe arthritis and obesity—which may impair their ability to exercise at an adequate intensity. Besides improving respiratory function and health status in COPD, exercise in water helps overcoming patient’s fears and promote socialization, contrasting the risk of depression, which is a major condition often associated with long term COPD condition. Susceptibility to respiratory infections plays a role in exacerbations of COPD. Sulphur-rich water inhalations improve muco-ciliary clearance, reduce inflammatory cytokines production and inflammatory mucosal infiltration, reduce elastase secretion by neutrophils, preserving elastic properties of pulmonary interstitium and thus facilitating expectoration. Repeated cold water stimulations in COPD also reduce frequency of infections. Finally, sauna bathing reduces the risk of pneumonia. On the other side, hydrotherapy/balneotherapy also help obesity control, which is one of the most difficult NCD risk factors to modify and consequently is an important component of the WHO preventive strategy to achieve STG 3.4. Along with high prevalence and mortality, CRD cause increasing pharmaceutical and hospital costs. In this perspective, Health Resort Medicine should not be ignored as a resource in the WHO NCD strategy and Universal Health Coverage, providing a multi-stakeholder platform (including the network of health resorts and their facilities) able to give a real help to the achievement of UN goal STG 3.4 by the year 2030.

Selection of WHO-recommended essential medicines for non-communicable diseases on National Essential Medicines Lists.

BackgroundNon-communicable diseases (NCDs) are the leading cause of death worldwide. Inadequate and inequitable access to essential NCD medicines is a major concern, particularly in low- and middle-income countries. National Essential Medicines Lists (EMLs) are important policy tools that indicate which medicines are prioritized as essential within a country’s health system. This study sought to analyze a wide range of national essential medicines lists (EMLs) for their inclusion of priority non communicable disease (NCD) interventions recommended by the World Health Organization (WHO).MethodsThree lists of WHO endorsed priority NCD interventions were included. A database with 137 national EMLs and the WHO EML was created from the WHO Repository and these EMLs were compared for listing of priority NCD interventions.ResultsAcross 137 countries with national EMLs, the median percentage of 20 Best Buys interventions listed was 90% (IQR 80–95) and 31 Package of essential noncommunicable disease interventions (PEN) interventions listed was 94% (IQR 90–97), of 9 HEARTS interventions was 100% (IQR 89–100), and of the 43 unique interventions across the three priority lists was 88% (IQR 84–93). Less than 80% of the 43 interventions were listed by 22 (16%) countries and less than half of the interventions were listed by 2 countries: Angola (35%) and Cambodia (23%). Interventions listed on the fewest number of national EMLs were: influenza vaccine, HPV vaccine, hepatitis B vaccine, cervical cancer chemotherapy, codeine, promethazine, senna, and oxygen.ConclusionMost NCD interventions have been prioritized in national policy in most cases. The majority of priority medicines for NCDs described within key WHO NCD technical packages are listed on nearly all national EMLs across 137 countries of all income levels. Most NCD interventions have been prioritized in national policy in most cases, but in some countries and for select interventions such as the HPV vaccine, prioritization may be reviewed.

Burden and Management of Noncommunicable Diseases After Earthquakes and Tsunamis.

This integrative review examines extant literature assessing the burden and management of noncommunicable diseases 6 months or more after earthquakes and tsunamis. We conducted an integrative review to identify and characterize the strength of published studies about noncommunicable disease-specific outcomes and interventions at least 6 months after an earthquake and/or tsunami. We included disasters that occurred from 2004 to 2016. We focused primarily on the World Health Organization noncommunicable disease designations to define chronic disease, but we also included chronic renal disease, risk factors for noncommunicable diseases, and other chronic diseases or symptoms. After removing duplicates, our search yielded 6,188 articles. Twenty-five articles met our inclusion criteria, some discussing multiple noncommunicable diseases. Results demonstrate that existing medical conditions may worsen and subsequently improve, new diseases may develop, and risk factors, such as weight and cholesterol levels, may increase for several years after an earthquake and/or tsunami. We make 3 recommendations for practitioners and researchers: (1) plan for noncommunicable disease management further into the recovery period of disaster; (2) increase research on the burden of noncommunicable diseases, the treatment modalities employed, resulting population-level outcomes in the postdisaster setting, and existing models to improve stakeholder coordination and action regarding noncommunicable diseases after disasters; and (3) coordinate with preexisting provision networks, especially primary care.

GARD, a new way to battle with chronic respiratory diseases, from disease oriented programmes to global partnership.

Initiated by World Health Organization (WHO) Global Chronic Respiratory Disease (CRD)-oriented programmes, Global Initiative on Asthma (GINA), GOLD-Global Initiative for Chronic Obstructive Pulmonary Disease (COPD), Allergic Rhinitis and its Impact on Asthma (ARIA), and Practical Approach to Lung Health (PAL) have catalyzed creation of the Global Alliance Against CRD (GARD). Forty-five countries sharing GARD's goal to reduce the burden of CRD joint GARD. In 20 countries with reliable death estimates, CRD mortality has been analyzed in 2000, 2005, 2010 and 2015. Dramatic decline in CRD mortality is seen in Kyrgyzstan, Netherlands, Italy and Republic of Korea (69%, 55%, 48%, and 48%). Positive trend in COPD mortality is seen for Lithuania (36% decline) and Spain (21%). In France, Japan, Mexico, Romania and Costa Rica, positive trend for asthma mortality is obvious from 2000 to 2015 from about 40% in France and Romania, 50% and Mexico and Czech Republic, 65% in Japan and 69% in Belgium. In Costa Rica zero asthma mortality was registered in 2015. In Czechia and Belgium decline is seen from 2000 to 2005, which then stabilized in Czech Republic and went further down in Belgium. In Finland initially, low asthma mortality remains practically unchanged with slight decline in 2015. In other countries analyzed, we did not see any positive trend in CRD mortality. In all countries with positive CRD dynamic WHO introduced activities remained active, they have been taken into local guidelines and practice and supported national authorities in implementing these evidence-based guidelines. Before GARD launch WHO initiated activities produced a good basis for further GARD movement and by 2010 we see a visible positive trend in CRD mortality in success countries. By 2015 when WHO noncommunicable disease (NCD) Global Action Plan 2013-2020 rollouts globally dramatic decline in total CRD mortality and particularly in Asthma and COPD mortality became obvious. Global disease oriented programmes, national and international partnerships combined with the Global NCD Action Plan most probable produce a positive synergistic effect on the mortality from CRD.

National palliative care capacities around the world: Results from the World Health Organization Noncommunicable Disease Country Capacity Survey

Background: Previous estimates of global palliative care development have not been based on official country data. Aim: The World Health Organization Noncommunicable Disease Country Capacity Survey of World Health Organization member state officials monitors countries’ capacities for the prevention and control of noncommunicable diseases. In 2015, for the first time, questions were included on a number of palliative care development metrics to generate baseline data for monitoring global palliative care development. Design: Participants were given instructions, a glossary of terms, and 3 months to complete this closed, non-randomized, online survey. Questions were developed through a consultative process with relevant technical World Health Organization departments. Setting/participants: Health ministry officials serving as noncommunicable disease focal points from 177 out of 194 (91%) of World Health Organization Member States completed the voluntary survey. Results: This survey reveals that (a) a minority (37%) of countries have an operational national policy for noncommunicable diseases that includes palliative care, (b) palliative care is least likely to have funding available compared with other core noncommunicable disease services, and (c) there is a large country-income gradient for palliative care funding, oral morphine availability, and integration of palliative care services at the primary levels of the health system. Conclusion: Palliative care for noncommunicable disease patients must be strengthened in a majority of countries. These data provide a baseline for trend measurement of official country-level and global palliative care development. A repeat assessment is taking place in the first half of 2017.

Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations

Objective To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide.Design Global modeling study.Setting 183 countries.Population...

Obesity and obstructive sleep apnea risk among Nigerians.

BackgroundThe contribution of obesity to obstructive sleep apnea (OSA) is poorly described in Nigeria. We aimed to compare OSA risk between obese and nonobese adults in urban Nigeria.Materials and MethodsAn analytic cross-sectional study was conducted. Participants were interviewed using the World Health Organization Non-Communicable Disease questionnaire. OSA risk assessment was performed using the STOP-BANG questionnaire. A total score of ≥3 on the STOP-BANG questionnaire indicated OSA risk, whereas a score ≥5 indicated high OSA risk. Obesity was defined as body mass index (BMI) >30 kg/m2. Relationship between obesity and OSA was tested using chi-square and logistic regression models used to control for confounding factors.ResultsThere were 744 respondents, with a mean age of 44 (standard deviation 10) years. A total of 206 [27.7%, 95% confidence interval (CI) 24.46–30.9] respondents were obese (BMI ≥30 kg/m2). A total of 307 (41.3%, 95% CI 37.7–44.9) respondents scored ≥3 on the STOP-BANG questionnaire, whereas 37 (4.9%, 95% CI 3.6–6.7) scored ≥5. More number of obese than nonobese [57.8% (119/206) versus 34.9% (188/538)] respondents met the criteria for OSA risk (P < 0.001). Similarly, more obese persons [10.3% (21/206)] met the criteria for high-risk OSA compared to the nonobese [3% (16/538)]; P < 0.001. In logistic regression models adjusted for cigarette smoking and alcohol consumption, the odds for OSA risk was 15.76 (95% CI 7.44–33.9) in persons with BMI >35 kg/m2 compared to those with a BMI range of 18.5–24.99.ConclusionObesity and OSA may be more prevalent in Nigeria than previously predicted. Obesity independently increased OSA risk in this population.

Non Communicable Disease Risk Factors and their Trends in India

Background:India is a populous country of about 1.3 billion. Non communicable diseases (NCDs) contribute to around 5.87 million (60%) of all deaths in India. Hence, the objectives of this paper are to find baseline information on different NCD risk factors coverage and to determine their trends in India.Methods:For this systematic review, PubMed, Google and different surveillance systems were searched. Of the search results, 41 papers/survey reports were eventually assessed for eligibility. National and state representative data on NCD risk factors (for the major NCDs like cardiovascular diseases, chronic respiratory disease, cancer and diabetes) having World Health Organization(WHO) indicator definitions, covering rural and urban population, were included in the study. Thereafter, state-wise population proportion was added and divided by the total Indian population to determine the percentage of population coverage for each risk factor by the surveys. Also, the old and current data of the periodic surveys were compared to assess prevalence trends.Results:Various national/state level surveys in India include single or multiple risk factors. Nationwide coverage is available for tobacco use, alcohol drinking, raised blood pressure and overweight and obesity. Periodic National Family Health Surveys provide information on selected risk factors during 2005-16 among adults aged 15-49 years. An overall significant increase was noted in overweight and obesity while decline was noted in tobacco and alcohol use during the same period. From GATS 1 (2009-10) to 2 (2016-17) also, the prevalence of tobacco consumption decreased in India.Conclusion:India has a much delayed response on NCD risk factors surveillance and information of the same are sporadic and incomplete. In order to increase information comprehensiveness, standard WHO NCD risk factors questions must be incorporated in the ongoing surveys. India should also plan for cost and time effective NCD surveillance system.

The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey.

BackgroundWorld Health Organization (WHO) estimates for deaths attributed to Non Communicable Diseases (NCDs) in Nepal have risen from 51% in 2010 to 60% in 2014. This study assessed the distribution and determinants of NCD risk factors among the Nepalese adult population.Methods and FindingsA nationally representative cross-sectional survey was conducted from Jan to June 2013 on the prevalence of NCD risk factors using the WHO NCD STEPS instrument. A multistage cluster sampling method was used to randomly select the 4,200 respondents. The adjusted prevalence ratio (APR) was used to assess the determinants of NCD risk factors using a Poisson regression model. The prevalence of current smoking (last 30 days) was 19% (95%CI:16.6-20.6), and harmful alcohol consumption (≥60 g of pure alcohol for men and ≥40 g of pure alcohol for women on an average day) was 2% (95%CI:1.4-2.9). Almost all (99%, 95%CI:98.3-99.3) of the respondents consumed less than five servings of fruits and vegetables combined on an average day and 3% (95%CI:2.7-4.3) had low physical activity. Around 21% (95%CI:19.3-23.7) were overweight or obese (BMI≥25). The prevalence of raised blood pressure (SBP≥140 mm of Hg or DBP≥90 mm of Hg) and raised blood glucose (fasting blood glucose ≥126 mg/dl), including those on medication were 26% (95%CI:23.6-28.0) and 4% (95%CI:2.9-4.5) respectively. Almost one quarter of respondents, 23% (95%CI:20.5-24.9), had raised total cholesterol (total cholesterol ≥190 mg/dl or under current medication for raised cholesterol). he study revealed a lower prevalence of smoking among women than men (APR:0.30; 95%CI:0.25-0.36), and in those who had higher education levels compared to those with no formal education (APR:0.39; 95%CI:0.26-0.58). Harmful alcohol use was also lower in women than men (APR:0.26; 95%CI:0.14-0.48), and in Terai residents compared to hill residents (APR:0.16; 95%CI:0.07-0.36). Physical inactivity was lower among women than men (APR:0.55; 95%CI:0.38-0.80), however women were significantly more overweight and obese (APR:1.19; 95%CI:1.02-1.39). Being overweight or obese was significantly less prevalent in mountain residents than in hill residents (APR:0.41; 95%CI:0.21-0.80), and in rural compared to urban residents (APR:1.39; 95%CI:1.15-1.67). Lower prevalence of raised blood pressure was observed among women than men (APR:0.69; 95%CI: 0.60-0.80). Higher prevalence of raised blood glucose was observed among urban residents compared to rural residents (APR:2.05; 95%CI:1.29-3.25). A higher prevalence of raised total cholesterol was observed among the respondents having higher education levels compared to those respondents having no formal education (APR:1.76; 95%CI:1.35-2.28).ConclusionThe prevalence of low fruit and vegetable consumption, overweight and obesity, raised blood pressure and raised total cholesterol is markedly high among the Nepalese population, with variation by demographic and ecological factors and urbanization. Prevention, treatment and control of NCDs and their risk factors in Nepal is an emerging public health problem in the country, and targeted interventions with a multi-sectoral approach need to be urgently implemented.

Could breastfeeding be protective for cardiovascular disease?

There is an on-going epidemiological transition from communicable to non-communicable disease (NCD) in the developing world, with cardiovascular disease accounting for most NCD deaths (17.5 million annually) [ [1] World Health Organization Noncommunicable diseases. http://www.who.int/mediacentre/factsheets/fs355/en/Date: 2015 Google Scholar ]. Finding the best ways to protect against cardiovascular risk must therefore be a primary objective for medical and public health professionals globally.

Four Opportunities to Prevent Diabetes and Coronary Heart Disease

Starting with the North Karelia Project in Finland, continuing with the large community-based heart disease prevention trials in the United States,1,2 and organizing CardioVision 2020 in Olmsted County, Minnesota,3 I have been involved with heart disease prevention programs for 40 years. During that time period, the prevalence of type 2 diabetes in the United States increased by one-third, and it is predicted to increase even more.4 Because the disease more than doubles the risk of death from heart disease5 and now contributes significant population-attributable risk, I am excited to have added my perspective, and perhaps contributed to the control of diabetes, by accepting the role of guest editor of this Diabetes Spectrum From Research to Practice section. Randomized, clinical trials are prima facie evidence that type 2 diabetes can be prevented. I clearly remember a day in Helsinki more than 10 years ago, when I was teaching at the World Health Organization noncommunicable disease prevention seminar. Jaakko Tuomilehto, MD, PhD, the principal investigator of the Finnish Diabetes Prevention Trial took me aside and told me that their results would be coming out in the New England Journal of Medicine . The publication of this landmark study6 was followed about a year later by the report of the larger, American Diabetes Prevention Program.7 The …

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