Implementing a life course approach in antenatal and postnatal care settings for prevention and reduction of non-communicable disease risks in Nepal (IpreventNCD)

Background

The high burden of non-communicable diseases (NCDs) disproportionally affects Low- and Middle-income Countries (LMICs), where 85% of premature NCD deaths occur. Most countries are off-track in achieving the SDG target 3.4, to reduce NCD premature mortality (30-69 years of age). Maternal and child health is inextricably linked with NCDs and their risk factors, and maternal and child health and NCD service integration is recommended for efficient use of limited resources. Behavioural change interventions in the pregnancy and post-pregnancy periods, for tobacco and alcohol avoidance, healthy eating, physical activity, and psychosocial support, can prevent and reduce the risk of NCDs in current and future generations. However, the implementation of this evidence base is insufficient especially in LMICs.

By taking a life course approach to reduce the risks for NCDs in young people and the next generation, we will contribute to the ongoing efforts directed at achieving the SDG 3.4; reducing health inequities; improving quality of life across the life course, and informing and advancing preventive health programs and policies, in Nepal and globally.

Aims

Our overarching aims are to:

• work with stakeholders and co-create tailored implementation strategies to support the delivery of a life course approach for the prevention and reduction of non-communicable disease risks in antenatal and postnatal primary health care settings in Nepal

• evaluate the impact of the implementation and effectiveness of the interventions on women and offspring

Project plan

1. Conduct a needs and assets assessment to identify potential barriers and facilitators to implementation of the proposed NCD risk reduction interventions for ANC and PNC primary health care settings, and state relevant implementation outcomes and performance objectives.

2. Tailor implementation strategies and adapt the proposed NCD risk reduction interventions to the Nepali context through an iterative co-creation process with relevant stakeholders, including health cadres, MoHP officials, and women during and after pregnancy.

3. Initiate NCD risk reduction interventions using tailored strategies and evaluate implementation, service and client outcomes in an effectiveness-implementation cluster randomized trial.

Findings from WP1, will inform WP2, which will inform WP3, and our work will be guided by implementation research methods and frameworks. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework , guides our stepwise, process and exploration of barriers and facilitators. We will use implementation mapping to tailor implementation strategies. We will build on the primary health care set up in Nepal. We will co-adapted interventions with users, and propose to use the healthy lifestyle intervention from the SU-13 GACD funded project in Nepal, using the WHO ANC and PNC recommendations as a foundation. We will use hybrid effectiveness-implementation cluster randomized controlled trial to assess effectiveness and implementation outcomes including acceptability, feasibility, and cost.

Principal investigators

Funding organisations

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