Women’s experiences with management of pregnancy-induced hypertension & diabetes in Nepal hos Institut for Folkesundhedsvidenskab - Københavns Universitet

Background

Nepal is undergoing a major epidemiological transition towards non-communicable diseases (NCDs) (1). NCDs contributed to the largest proportion of total Disability Adjusted Life Years (DALYs) accounting for just over half (51%) of all deaths in Nepal in 2018 (2). Nearly 30% of the Nepalese adult population (15-69 years) have hypertension, 8.4% have type 2 diabetes, 21% are overweight/ obese, and 23% have raised cholesterol levels (1). Pregnancy-related conditions, such as pre-eclampsia and gestational diabetes mellitus are associated with significant perinatal mortality and morbidity and carry independent risks for future cardiometabolic disorders in mothers (3). Women with pre-eclampsia/eclampsia have an almost four-fold risk of developing hypertension post-pregnancy and a three-fold higher risk of type 2 diabetes and approximately a two-fold increased risk of ischemic heart disease and stroke (3). Eclampsia is the leading direct cause of maternal mortality in Nepal, occurring in 1 in 25 women and resulting in an estimated 21% of maternal deaths annually (4). Two-thirds of the Nepalese population live in rural areas. Those who live in rural areas are particularly vulnerable to complications because they are not aware of the risk factors for cardiometabolic disorders, and their access to healthcare is limited. Moreover, screening and treatment of pregnancy-related complications related to hypertension and diabetes are not part of the routine package for antenatal services in Nepal and are only available at tertiary care hospitals. Studies in high-income countries have shown that many women with pregnancy-related complications related to hypertension and diabetes are unaware of such complications and do not realize how serious or life-threatening they are (5, 6). The experiences, perceptions, and behaviours of women regarding the management of pregnancy-induced hypertension and diabetes remain largely unexplored in the Nepalese context. The study will investigate women’s experiences, perceptions, and behaviours toward pregnancy-induced hypertension and diabetes and their management in Nepal.

External Partner(s)

Dhulikhel Hospital- Kathmandu University

Duration of stay outside Denmark

Two-three weeks field stay in Nepal.

Funding

Travel grant is available.

Type of support provided by an external partner

Office space and internet access at the project office are provided. Students have to bring their own PC. Research assistants experienced with qualitative fieldwork, including data collection, translation, and analysis of qualitative data will be provided. However, they will have to be paid for their fieldwork (per day approx. 80-100 DKK per person). Partner will issue a letter of invitation. Accommodation: Dhulikhel Hospital guest house where students are required to pay some amount (approx. DKK 2560 per month). Flight, visa, and cost of living are to be covered by the students.

Contact

Bishal Gyawali, Global Health Section: bigyawali@sund.ku.dk

References

  1. Gyawali B, Khanal P, Mishra SR, van Teijlingen E, Wolf Meyrowitsch D. Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal. Glob Health Action. 2020 Dec 31;13(1):1788262. doi: 10.1080/16549716.2020.1788262. 
  2. Nepal NCDI Poverty Commission. An equity initiative to address noncommunicable diseases and injuries. Kathmandu (Nepal); 2018. cited 2019 June 19. Available from https://static1.squarespace.com/static/55d4de6de4b011a1673a40a6/t/5abe85111ae6cfa98183e7a9/1522435346791/Nepal+NCDI+Poverty+Commission+National+Report+2018.pdf
  3. Gongora MC, Wenger NK. Cardiovascular Complications of Pregnancy. Int J Mol Sci. 2015 Oct 9;16(10):23905-28.
  4. Suvedi B, Pradhan A, Barnett S, Puri M, Chitrakar S, Poudel P, Sharma S, Hulton L. Nepal Maternal Mortality and Morbidity Study 2008/2009: Summary of preliminary findings. Kathmandu, Nepal: Family Health Division, Department of Health Sciences, Ministry of Health, Government of Nepal; 2009. 
  5. East C, Conway K, Pollock W, Frawley N, Brennecke S. Women’s experiences of preeclampsia: Australian action on preeclampsia survey of women and their confidants. J Pregnancy. 2011.
  6. Ouasmani F, Engeltjes B, Haddou Rahou B, Belayachi O, Verhoeven C. Knowledge of hypertensive disorders in pregnancy of Moroccan women in Morocco and in the Netherlands: a qualitative interview study. BMC Pregnancy Childbirth. 2018;18(1):344.

 

 

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