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Infectious Diseases and Health Access in Nepal

Infectious diseases are a major cause of health problems and deaths in Nepal, accounting for 70% of the burden. Many children die from preventable diseases like diarrhea and respiratory illnesses. There is diversity in disease distribution across the country. While infectious diseases are most common, non-communicable diseases are on the rise and need early treatment to prevent long-term effects. Tuberculosis remains a major public health problem, infecting 45% of the population and causing thousands of deaths each year despite treatment programs.

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13 views4 pages

Infectious Diseases and Health Access in Nepal

Infectious diseases are a major cause of health problems and deaths in Nepal, accounting for 70% of the burden. Many children die from preventable diseases like diarrhea and respiratory illnesses. There is diversity in disease distribution across the country. While infectious diseases are most common, non-communicable diseases are on the rise and need early treatment to prevent long-term effects. Tuberculosis remains a major public health problem, infecting 45% of the population and causing thousands of deaths each year despite treatment programs.

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Dash Cam
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© All Rights Reserved
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Keynotes:

Infectious diseases are rampart in Terai. About 70% of all health problems and deaths in Nepal
are attributed to the infectious diseases. Many children die from easily preventable and
treatable such as diarrhea, dysentery acute respiratory diseases etc. Ono et al reported various
types of organism (bacteria virus and parasites associated with diarrhea in Nepal. Infectious
diseases also known as transmissible diseases or communicable diseases, comprise
clinically evident illness (i.e. Characteristic medical signs and/symptoms of disease)
resulting from the infection, presence and growth of pathogenic biological agents in an
individual host organism. In certain cases, infectious diseases may be asymptomatic for
much or even their entire course in a given host .In the latter case, the disease may only be
defined as a “disease” (which by definition means an illness) in hosts who secondarily become
ill after contact with an asymptomatic carrier. Nepal indicating high prevalence of infectious
and parasitic infections. A lot of factors play a great role in distribution of infectious diseases in
various parts of the country. There is diversity of disease distribution. Though infectious and
communicable disease is most common in Nepal, non-communicable diseases like liver
disease, renal disease, chronic bronchitis, diabetes, hypertension, cancer and coronary artery
disease are also on the rise. They are in need of early diagnosis and therapy to avoid long term
morbidity and mortality. Properly organized Health camps can be helpful for this purpose.
Tuberculosis (TB) remains one of the major Public Health problems in Nepal. About 45%
population is infected with TB, of which 60% are adult. Every year, 40,000 people develop
active TB, of whom 20,000 have infectious type of pulmonary TB. Although introduction of
DOTS has already reduced the numbers of deaths, however 5,000 to 7,000 people still continue
to die each year. The lack of access to medicines in most developing countries reflects the lack
of sufficient incentives for developing new medicines to target those communicable
diseases that disproportionately afflict the poorest countries, and also their inability to pay for
and effectively distribute those that do exist. The result is what the government of the United
Kingdom has called a “mismatch between pharmaceutical needs in developing countries
and the current nature of the global pharmaceutical market”. The government expanded the
distribution of free essential medicines to the district hospital level, apart from Health posts and
Sub health Posts, with the objective of increasing the access of people to the public health
facilities. In spite of government’s efforts the patients in the rural areas are lacking the access to
the essential medicines and are being deprived of the healthcare facilities due to the
different types of causations. These are defined as the limited number of objective measures that
can describe the drug use pattern and prescribing behavior in a country, a region or an individual
health facility. Such measures or indicators that will allow health planners, managers of
researchers to make basic comparisons between different situations at different times. Also when
an intervention is undertaken to improve aspects of drug use, the indicators can be used to
measure impact. Indicators can also serve as supervisory tools to detect problems in performance
by individual providers or health facilities. Health Posts and Sub-health Posts are the basic
health care facilities in a Village Committee level below the district hospital and primary health
centers in the hierarchy of healthcare distribution. The Health post is provided with 5 staff and
32 essential medicines free of cost from the government whereas the Sub-Health posts are given
a staff of 4 and 22 essential medicines. In spite of government’s efforts the patients in the rural
areas are lacking the access to the essential medicines and are being deprived of the healthcare
facilities due to the different types of causations. There are a lot of health related problems in
Nepal including regular access to essential medicines to treat various infectious and non-
infectious diseases. The intensity of this problem is high in rural area in comparison to urban
area. The essential drug list was developed in Nepal in 1986 AD for the first time whose last
revision as done in 2009 AD (fourth revision). There are over 310 essential medicines in Nepal’s
essential medicines list. The working draft of the WHO strategy 2008-2013 considers
selection, price, financing and supply systems for essential medicines as access indicators
reflecting the government efforts towards making essential medicines available to all its
population. High costs of treatments with new essential medicines that are used for the treatment
of bacterial infections and malaria will be unaffordable for many low and middle income
countries. Following are the basic list of disease, problem or events that has been killing people
in Terai region

 Snake Bite, Cuts and Wounds


 Infection due to unhygienic drinking water, Arsenic contamination of groundwater
 Diarrhea, Dysentery, Dengue, Malaria, Black Fever
 Road and fire accidents
According to the Global Burden of Disease Study 2017, the eight leading causes of morbidity
(illness) and mortality (death) in Nepal are: Neonatal disorders[34] (9.97%), Ischaemic Heart
Disease (7.55%), COPD (5.35%), Lower respiratory infection (5.15%), Diarrhoeal disease
(3.42%), Road injury[35] (3.56%), Stroke (3.49%), Diabetes (2.35%).

The chart shows the burden of disease prevalence in Nepal over a period of time. Diseases like
neonatal disorder, lower respiratory tract infection, and diarrheal diseases have shown a gradual
decrease in prevalence over the period from 1990 to 2017. The reason for this decrease in
number is due to the implementation of several health programs by the government with the
involvement of other international organizations such as WHO and UNICEF for maternal and
child health, as these diseases are very common among the children. Whereas, there is a
remarkable increment in the number of other diseases like Ischemic heart disease (IHD), Chronic
obstructive pulmonary disease (COPD), Road injuries, Stroke, and Diabetes.

Common questions

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The high prevalence of infectious diseases in Nepal's Terai region is attributed to several factors including poverty, lack of access to clean water, and inadequate healthcare infrastructure. Many diseases are preventable and treatable, such as diarrhea and respiratory infections, yet they cause high mortality due to these socio-economic factors . Furthermore, the diversity in disease distribution and the presence of asymptomatic carriers exacerbate the spread .

International organizations such as the WHO and UNICEF have played a critical role in reducing disease prevalence in Nepal by implementing health programs focused on maternal and child health. These programs contributed to the decreased prevalence of neonatal disorders, lower respiratory infections, and diarrheal diseases from 1990 to 2017 . Their involvement facilitated improvements in healthcare delivery and public health education, which significantly impacted disease control .

Socio-economic factors profoundly impact healthcare challenges in Nepal's remote regions. Poverty limits individuals' ability to afford transportation to healthcare facilities and buy medications, while inadequate infrastructure restricts both access to, and quality of, healthcare services. These challenges are further compounded by limited educational opportunities, which affect public awareness and health literacy, undermining preventive measures and early diagnosis .

Improving the distribution of essential medicines in Nepal's rural areas can be achieved by strengthening infrastructure, such as better supply chains and transportation networks, to ensure consistent delivery. Expanding healthcare facilities with more staff and increasing the number of essential medicines available at health and sub-health posts can also help . Moreover, incentivizing pharmaceutical companies to focus on affordable solutions for low-income populations could further improve accessibility .

The rise of non-communicable diseases in Nepal reflects a larger global health trend where chronic diseases are becoming more prevalent in developing countries due to lifestyle changes and urbanization. These trends correlate with global priorities shifting towards addressing the growing burden of chronic diseases alongside infectious diseases. In Nepal, this shift is visible in the increasing rates of diseases such as diabetes and ischemic heart disease, as infrastructure and policy investments adapt to these evolving health needs .

The lack of access to essential medicines in rural Nepal results in poorer healthcare outcomes, as individuals are deprived of necessary treatments for both infectious and non-infectious diseases. This situation is exacerbated by the government's inability to fully reach rural areas despite efforts such as distributing free medicines to health posts . Moreover, the high costs of new medicines used for bacterial infections and malaria remain unaffordable for low-income populations .

There has been an increasing trend in non-communicable diseases such as ischemic heart disease, COPD, strokes, and diabetes in Nepal. Factors explaining this trend include changes in lifestyle, urbanization, and possibly an increase in risk factors such as smoking and unhealthy diets. Despite government and international efforts to address healthcare needs, these diseases require chronic management and prevention strategies which are still developing in the region .

There is a significant 'mismatch' between the healthcare needs of Nepal's population and the global pharmaceutical market, as identified by the UK government. This discrepancy stems from insufficient incentives for pharmaceutical companies to develop medicines for diseases that predominantly affect low-income regions. Additionally, even when such medicines exist, the financial constraints make them inaccessible to the populations that need them most .

Health camps are crucial in managing both infectious and non-communicable diseases in Nepal by providing early diagnosis and initiating timely therapy. This is vital for reducing long-term morbidity and mortality, given the limited access to healthcare facilities in remote areas. These camps help bridge the gap between healthcare needs and available resources .

Controlling tuberculosis in Nepal involves several challenges, including extensive prevalence with about 45% of the population infected, with many cases being of the infectious type. Despite the implementation of the DOTS program, which has reduced death rates, 5,000 to 7,000 people still die annually. Contributing factors include inadequate healthcare infrastructure, lack of access to medicines, and insufficient incentives for pharmaceutical companies to develop targeted treatments for diseases that primarily affect poorer nations .

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