Objective Health Technology Assessment (HTA) is a comprehensive and important tool for assessment and decision-making in public health and healthcare practice. It is recommended by the WHO and has been applied in practice in many countries, mostly the developed ones. HTA might be an important tool to achieve universal health coverage (UHC), especially beneficial to low-and-middle-income countries (LMIC). Even though the Package for Essential Non-communicable Diseases (PEN) has already been initiated, there is a clear policy gap in the HTA of any health device, service, or procedure, including the assessment of cardiovascular risk factors (CVRFs) in Nepal. Hence, we carried out the review to document the HTA supported evidence of hypertension and diabetes screening, as CVRFs in Nepal. Materials and methods We searched in PubMed, Cochrane, and Google Scholar, along with some gray literature published in the last 6 years (2016–2021) in a systematic way with a controlled vocabulary using a well-designed and pilot tested search strategy, screened them, and a total of 53 articles and reports that matched the screening criteria were included for the review. We then, extracted the data in a pre-designed MS-Excel format, first in one, and then, from it, in two, with more specific data. Results Of 53 included studies, we reported the prevalence and/or proportion of hypertension and diabetes with various denominators. Furthermore, HTA-related findings such as cost, validity, alternative tool or technology, awareness, and intervention effectiveness have been documented and discussed further, however, not summarized due to their sparingness. Conclusion Overall, the prevalence of DM (4.4–18.8%) and HTN (17.2–70.0%) was reported in most studies, with a few, covering other aspects of HTA of DM/HTN. A national policy for establishing an HTA agency and some immediately implementable actions are highly recommended.

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Need for HTA supported risk factor screening for hypertension and diabetes in Nepal: A systematic scoping review

This study aimed to investigate the view of prediabetes and prehypertension elderly patients living around temple on long-term self-management in proficient way underneath the lifestyle intervention program based on both focus-group discussion and In-depth interview methods to fill the gap in partially successful intervention. 62 participants were selected from 220 participants of the quantitative published study by 2 researchers. The triangulation method was used to put great emphasis on the consistency and the credibility of the results. Almost all of the participants had benefited from the program regarding proper foods, suitable exercise and an inspiration of lifestyle modification. They made changes of eating behavior and exercise behavior during program attendance, however, after the program had finished, they had minimal concern to take care of themselves. Nonetheless, more than half of them demonstrated some health-related behaviors changes due to they gave the value of the suggestion in different aspects. Moreover, high-frequency program attendance was not related to blood results improvement. The knowledge obtained from program intervention together with adequate contact between the patient and the program staff, personal problems solving, personal attitude, practice and acceptable played a key role for long-term lifestyle modification and completely successful intervention.

https://journals.sagepub.com/doi/pdf/10.1177/00469580211025209

Participants' Views on Lifestyle Intervention Program Enhancing Long-Term Health-Related Behaviors Improvement among Prehypertension and/or Prediabetes Mellitus Older Adults: A Qualitative Study Examined in Thailand at Health Promoting Hospitals.

The natural history of type 2 diabetes includes a preceding period of impaired fasting glucose or impaired glucose tolerance which is referred to as prediabetes. During the asymptomatic phase of prediabetes, an estimated 20-30% of persons may develop complications like retinopathy, cardiovascular disease, neuropathy and nephropathy. Screening and lifestyle management may help to delay or arrest progression to diabetes. In primary care settings, point of care devices that measure glucose in capillary blood can be used for diagnosis of diabetes. This study was carried out to evaluate the performance of fasting capillary glucose (FCG) and fasting plasma glucose (FPG) measurement in screening for diabetes and prediabetes among adults in a semi-urban community in the Kathmandu district of Nepal. An observational, cross-sectional study design was used and FCG, FPG performance was evaluated by the 2-hour plasma glucose levels (2-hr PG) following Oral glucose tolerance test (75g glucose) using WHO 1998 criteria. Linear regression was performed to assess correlation co-efficient (r) between FPG, FCG and 2 hr PG. Bland Altman plot and Receiver operator characteristic (ROC) curves were constructed to assess concordance, measure ROC AUC and determine sensitivity and specificity of the measurements at recommended cut-off values for identifying diabetes and prediabetes. Among the study participants (n=162), 104 were female and 58 were male. Prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI 1.75% to 8.70%) and 7.14% (95% CI 3.89% to 12.58%). Strong positive correlation was seen between FPG and FCG (Spearman’s r 0.67). FPG & FCG had a moderate positive correlation (r = 0.49 & 0.45) with 2 hr PG levels (p<0.0001). FCG and FPG ROC AUC was 0.91 (95% CI 0.85 to 0.97) and 0.87 (95% CI 0.78 to 0.97) in comparison to 0.98 (95% CI 0.97 to 1.0) for the gold standard 2 hr PG. At 110 mg/dl and above, FCG had an optimal sensitivity and specificity of 84.21% and 81.12% in comparison to 47.37% and 100% for FPG. At 100 mg/dl, the sensitivity and specificity of FCG was 100% and 51.75% in comparison to 57.89% and 97.20% for FPG. In conclusion, at each recommended cut-off value, FCG was more sensitive than FPG with no significant difference between ROC AUCs of the two tests. Hence, FCG may be a suitable, sensitive, and convenient screening tool for diabetes and prediabetes in community-based settings. Larger prospective studies may validate the cost-effectiveness and efficiency of similar screening strategies in the Nepalese community.

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Evaluation of Fasting Capillary Glucose and Fasting Plasma Glucose as Screening Tests for Diabetes and Prediabetes among Adults in a Semi-Urban Area in the Kathmandu District, Nepal

Objective To evaluate effects of five screening methods for asymptomatic type 2 diabetes,i.e.fasting capillary blood glucose(FCBG),fasting plasma glucose(FPG),2-hour plasma glucose(2HPG),glycosylated haemoglobin(HbA1c) and Diabetes Risk Score(DRS) by establishing receiver operating characteristic(ROC) curve models.Methods Data from a cross-sectional survey of 4 070 subjects who underwent the oral glucose tolerance tests(OGTT) for type 2 diabetes screening in the Qingdao Diabetes Prevention Program in 2006 were analyzed.All the subjects had no history of diabetes and were required to test FCBG,FPG,2HPG,HbA1c and finished the DRS designed for the program at the same time.The sensitivity,specificity,and the area under the ROC curve(AUROC) of the five methods for detecting asymptomatic diabetes were calculated to evaluate their effects.Results The sensitivity,specificity and AUROC of the five methods were as follows:① FCBG: 64.08%,69.81% and 0.712;② FPG:60.10%,100.00% and 0.896;③ 2HPG: 67.12%,100.00% and 0.898;④ HbA1c: 40.21%,81.96% and 0.673;and ⑤ DRS: 61.50%,63.72 and 0.679.FPG and 2HPG had significant differences in AUROC from the other three screening methods(P0.001).The difference of AUROC between FPG and 2HPG and the differences of AUROC between FCBG,HbA1c and DRS were not significant(P0.05).Conclusion FCBG and DRS may be simple and effective methods in primary detection for symptomless diabetics.HbA1c is not suitable for screening T2DM at present in the community until conditions permit.If the diagnosis thresholds of FPG and 2HPG are properly lowered,their diagnostic sensitivity will be enhanced and the rate of missed diagnosis reduced.

Evaluation of effects of five screening methods for asymptomatic type 2 diabetes

Introduction: Glucose meters are gaining popularity in monitoring of blood glucose at household levels and in health care set-ups due to their portability, affordability and convenience of use over the laboratory based reference methods. Still they are not free of limitations. Operatorâ€™s technique, extreme temperatures, humidity, patientsâ€™ medication, hematocrit values can affect the reliability of glucose meter results. Hence, the accuracy of glucose meter has been the topic of concern since years. Therefore, present study aims to evaluate the analytical and clinical accuracy of glucose meter using International Organization for Standardization 15197 guideline.
Methods: A community based descriptive cross-sectional study was conducted in Kapan, Kathmandu, Nepal in April 2018. Glucose levels were measured using glucose meter and reference laboratory method simultaneously among 203 adults â‰¥20 years, after an overnight fasting and two hours of ingestion of 75 grams glucose. Modified Bland-Altman plots were created by incorporating ISO 15197 guidelines to check the analytical accuracy and Park error grid was used to evaluate the clinical accuracy of the device.
Results: Modified Bland-Altman plots showed>95% of the test results were beyond the acceptable analytical criteria of ISO 15197:2003 and 2013. Park Error Grid-Analysis showed 99% of the data within zones A and B of the consensus error grid.
Conclusions: Glucose meter readings were within clinically acceptable parameters despite discrepancies on analytical merit. Possible sources of interferences must be avoided during the measurement to minimize the disparities and the values should be interpreted with caution.

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Accuracy of Glucose Meter Among Adults in a Semi-urban Area in Kathmandu, Nepal

Diabetes has been recognized as a “global health emergency” with an estimated 9% of adults being affected. However, about half of these adults remain undiagnosed. Conventional screening tools like fasting plasma glucose (FPG), oral glucose tolerance testing (OGTT) and glycosylated haemoglobin (HbA1c) can be inconvenient and expensive in a community-based setting. The Indian Diabetes Risk Score (IDRS) is a simple, non-invasive tool which has been validated for use in the Indian population. Age, abdominal obesity, family history of diabetes and physical activity levels have been weighted for a maximum score of 100. Persons with IDRS of 60 as high risk for diabetes. A community based, cross-sectional, analytical study was planned to assess the performance of IDRS among adults in a semi-urban area in Kathmandu, Nepal. A total of 256 (170 female, 86 male) persons without diabetes from 260 households were screened during the study period. A majority (46.09%) were classified as high risk, 44.53% as moderate risk and 9.38% as low risk for developing diabetes. Among them, 162 (63.28%) volunteered for definitive testing. The prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI: 1.75% to 8.70%) and 7.14% (95% CI: 3.89% to 12.58%) respectively. IDRS predicted the combined risk of diabetes and prediabetes with sensitivity of 84.21% and specificity of 55.24% in adults with score of 60 and above. The area under the ROC curve (AUC) of IDRS for identifying diabetes and prediabetes was 0.69 as compared to the gold standard (2hour Plasma Glucose) AUC of 0.98. IDRS may be a suitable screening tool for diabetes and prediabetes in the adult Nepalese study population.
Keywords : Diabetes, IDRS, prediabetes,screening, sensitivity, specificity

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Community based screening for diabetes and prediabetes using the Indian Diabetes Risk Score among adults in a semi-urban area in Kathmandu, Nepal

Introduction: Psychoactive substance use among medical students is common. This may not only pose a threat to their health and academic performance but may have medico-legal and ethical ramifications. The aim of this study was to find out the prevalence of six psychoactive substances (alcohol, tobacco, cannabis, cocaine, benzodiazepines, opioids) among second year and third year medical students.
Methods: A descriptive cross-sectional study was done in a medical college. Whole sampling was done and ethical approval was taken from the Institutional Review Committee (Reference Number: 54-074/075). The study was conducted from May 2018 to June 2018. A semi-structured self-administered questionnaire modified and adapted from World Health Organization's guidelines for student substance use survey was used to collect data from second year and third year medical students. Statistical Package for Social Sciences version 16.0 was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.
Results: Out of 226 total respondents, 95 (42.0%) (35.55- 48.45 at 95% Confidence Interval) reported current use of one or more psychoactive substances. Most frequently used substance was alcohol with current use prevalence of 87 (38.5%), followed by smoking 39 (17.3%) and cannabis 27 (11.9%). Cocaine, benzodiazepines and opioids were the least consumed substances with current use prevalence of 2 (0.9%) each.
Conclusions: Almost half of the students were currently using one or more psychoactive substances which is concerning, and therefore strategies must be adopted to alleviate such use.

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Vinutha Silvanus

Papers

Community based screening for diabetes and prediabetes using the Indian Diabetes Risk Score among adults in a semi-urban area in Kathmandu, Nepal

Evaluation of Fasting Capillary Glucose and Fasting Plasma Glucose as Screening Tests for Diabetes and Prediabetes among Adults in a Semi-Urban Area in the Kathmandu District, Nepal

Accuracy of Glucose Meter Among Adults in a Semi-urban Area in Kathmandu, Nepal

Psychoactive Substance Use among Second-Year and Third-Year Medical Students of a Medical College: A Descriptive Cross-sectional Study.