Top Ten Public Health Issues in Nepal

1. Childhood Diseases

Childhood diseases including diarrheal and acute respiratory diseases: The seasonal diarrheal diseases and respiratory diseases affect substantial number of children in Nepal leading to deaths and developmental delays. The malnourished and undernourished children are equally prevalent and Hence childhood diseases are still the number one priority in public health in Nepal. Neonatal mortality rate (21 per 1000), infant mortality rate (32 per 1000) and under 5 mortality rate (39 per 1000), are still high enough making it number one public health problem in Nepal.

2. Water and Sanitation

The timeline of health and longevity of the people in the developed countries can be traced back to sanitary reforms in those countries and the resulting long life expectancy and healthy life can be attributed to the adequate supply of potable water, appropriate sanitary facilities, waste management. However, Nepal and other developing countries are miles away to reach that level as the waste management and other sanitary reforms are at nascent phase, though progressive. There are 38% of households without improved sanitary facilities in Nepal.

3. Maternal and perinatal health problems

Still women in Nepal die during pregnancy and childbirth due to untimely management of complications such as antepartum hemorrhage, postpartum hemorrhage, pre-eclampsia, eclampsia. This is especially intensified by lack of adequate facilities and manpower in rural area of the country. Even though the tertiary level care facilities are available in major cities, many parts of the countries are devoid of such care and it takes several hours or days to reach to such care resulting in delays in care, subsequently fatal consequences to many women and children.

4. Sexual transmitted diseases and Other communicable diseases

Tuberculosis is endemic in Nepal. Vector borne diseases such as malaria, Leishmaniasis (Kala-azar), Dengue, are also endemic in certain tropical regions (plains) of the Nepal. sexually transmitted disease such as HIV/AIDS is present as concentrated epidemic in certain groups such as sex workers, intravenous drug users, migrant workers, wives of migrant workers.

5. Epidemics/Pandemics and zoonotic diseases

Every country is at risk of pandemics and epidemics due to increasing interconnectedness between different parts of the world/ globalization. Most of the pandemics are the zoonotic diseases; they contract human easily as they are novel and human are susceptible due to their inability to fight against new diseases as they lack antibodies and memory cells against such diseases. The recent phenomena of unregulated mass production of poultry and close living provision with the animals also leads to the zoonotic diseases.

6. Non-communicable diseases

The occurrence of the non-communicable diseases such as hypertension, coronary heart diseases and other cardiovascular diseases, diabetes mellitus, chronic kidney diseases have surged along with modernization in life style. They are leading reasons of mortality and burden of diseases. Epidemiologic transition is evident through increased incidence of non-communicable diseases, once supposedly diseases of wealthy.

7. Natural disaster and preparedness

Nepal is continuously at risk of natural disaster due to its topographical/geographical features. Nepal is at constant threat of earthquakes as this lies in the Himalayan range; the floods during the rainy seasons pose equal threat to the lives of the residents of Hills and plain. The massive earthquake in 2015, the frequent landslides and yearly floods in the major rivers of Nepal create a chaotic condition that requires immediate attention of every sectors including public health professionals. As people in such situations are at risk of so many health problems such as injuries, diarrheal disease epidemic, devoid of water and sanitation, food and security, they require immediate first aid, safe sanitation and water facilities, food, security, reproductive health services and mental health counselling and management. Disaster preparedness and effective communication channel are must have public health program in Nepal.

8. Substance use disorders

Drinking alcohol is a ritual by a certain group of people specifically indigenous groups traditionally categorized as ‘Matwalis’ of Nepal, includes Rai, Limbu, Newar, Gurung etc. Alcoholic dependence and liver diseases are very common in those people though they are under-focused by the current health system. Alcohol dependence not only affect the health of the sufferer, it also affects the social relationship, economy and family relationship. Tobacco use is also a common substance and its use is ubiquitous in the form of smoking, chewing form in Nepal; shisha hookah is established as recent trend among youth. Other substances like Marijuana, Heroine are also threatening public health concern to the youth of Nepal.

9. Disparity in Health system

This is a significant challenge that needs immediate attention from the government. Though the number of hospitals and number of health professionals are increased significantly in last two decades, people from the rural area and poor of urban areas don’t have adequate access to health care. Disparity in health care access is affected by different elements ranging from individual attributes such as ignorance fueled by low education, low income; to systematic biases created by the system and policies.

10. Mental health Problems

Mental health needs of the populations is recently recognized as vital after the decades of neglect in mental health domain. Mental health problems were accepted as the result of bad deeds in previous or present life, hence stigmatized. Professional growth and advocacies have highlighted the need of mental health treatment and management. The years long political conflicts, low economy, disasters, increasing social distances, individualistic life approach, high pressure for achievement, rapid urbanization, employment abroad etc. aggravate the mental health need of the population.

NOTE: The data have been extracted from NDHS 2016