Background: The increasing prevalence of cancer and lack of strong health financing system in low income countries like Nepal is exerting an enormous financial burden on cancer patients. However, there is scant information relating to the amount of expenditure on health services for cancer treatments in Nepal. Therefore, this study aimed to estimate the direct cost associated with the treatment of cancer on the patients attending a tertiary cancer treatment center in Nepal. Methods: A quantitative cross-sectional study was carried out on 294 cancer patients who were receiving treatment from Bhaktapur Cancer Hospital between 17th November 2016 and 13th February 2017. Direct medical cost and non-medical costs borne by the patients were calculated based on the cost of illness methodology. Medical cost included the cost of consultation, diagnosis and treatment while non-medical cost comprised the cost occurred out of the health facility such as the cost of food, travel, and accommodation. Result: Of those 294, 169 (57.5%) were female and 125 (42.5%) were male. The median (IQR) age was 54 (19) years. Cancer of the lung was present in 19.39%, breast cancer in 15.65% and cervical cancer in 14.29%. Mean (SD) and Median (IQR) direct cost of cancer was NRs 387.5 (196.8) and 346.1 (260.5) thousand. Medical cost contributed to 80.91% of the total direct cost. Almost everyone relied on out-of-pocket (OOP) payment for cancer treatment, where 253 (86.1%) participants reported that they were experiencing financial hardship, 230 (78.2%) took a loan, and 140 (47.6%) sold their property to manage the OOP. Both medical and non-medical costs varied significantly with age, socioeconomic status, types of cancer and the treatment. Conclusion: Medical cost contributed the most to the direct cost. OOP was dominant payment mechanism to utilize health services. Average direct cost of cancer was higher than the average income of patients, sufficient to cause financial catastrophe. This implies the need of improved health financing strategy to protect people from the financial hazards of health service utilization for cancer in Nepal.

BackgroundHypertension control remains a major global challenge. The behavioral approaches recommended for blood pressure reduction are stress reduction, increased exercise and healthy dietary habits. Some study findings suggest that yoga has a beneficial effect in reducing blood pressure. However, the role of yoga on blood pressure has received little attention in existing health care practices in developing countries. This study will be conducted in primary health care facilities in Nepal to assess the effectiveness of a pragmatic yoga intervention to complement standard practice in further reducing blood pressure.MethodsThis will be multicentric, two arms, randomized, nonblinded, pragmatic trial. It will be conducted in seven District Ayurveda Health Centers (DAHCs) in Nepal between July 2017 and June 2018. The study participants will consist of hypertensive patients with or without antihypertensive medication attending to the outpatient department (OPD). One hundred and forty participants will be randomized to treatment or control groups by using a stratified block randomization. At the study site, the treatment arm participants will receive an intervention consisting of five days of structured yoga training and practice of the same package at home with a recommendation of five days a week for the following 90 days. Both the intervention and control groups will receive two hours of health education on lifestyle modifications. The primary outcome of this trial will be the change in systolic blood pressure and it will be assessed after 90 days of the intervention.DiscussionThis study will establish the extent to which a yoga intervention package can help reduce blood pressure in hypertensive patients. If proven effective, study findings may be used to recommend the governing bodies and other stakeholders for the integration of yoga in the national healthcare system for the treatment and control of hypertension.Trial registrationClinical Trial Registry- India (CTRI); CTRI Reg. No- CTRI/2017/02/007822. Registered on 10/02/2017.

Background Hypertension control remains a major challenge globally. A recent systematic review suggested that yoga has beneficial effects on reducing blood pressure. However, the role of yoga in hypertension management in primary health care has received little attention, and no studies have evaluated the impact of a yoga program fully delivered by health care staff on hypertension. This study, therefore, assessed the effects of a health worker-led yoga intervention on blood pressure reduction among hypertensives patients in the primary care setting. Methods This was a multicentric, two-arm, randomised trial conducted among hypertensive patients in seven Ayurveda Health Centres in Nepal between March 2017 and June 2018. One hundred and twenty-one participants who were on or without medications were randomised to intervention (n = 61) and wait-list control (n = 60) groups using stratified block randomisation. Participants in the intervention arm received an intervention consisting of an initial five-day structured yoga training at the centres and then a further home-based practice of yoga for five days a week for the following 90 days. Both intervention and control groups also participated in a 2-h health education session. The primary outcome of this trial was systolic blood pressure at 90-day follow-up. Data were analysed on an intention-to-treat basis using linear mixed-effects regression models. Results We included all 121 study participants (intervention/control = 61/60) in the primary analysis (52.1% males; mean ± SD age = 47.8 ± 10.8 years). The difference in systolic blood pressure between the intervention group and the control group was − 7.66 mmHg (95% CI: − 10.4, − 4.93). For diastolic blood pressure, the difference was − 3.86 mmHg (95% CI: − 6.65, − 1.06). No adverse events were reported by the participants. Conclusions A yoga program for hypertensive patients consisting of a five-day training in health centres and 90 days of practice at home is effective for reducing blood pressure. Significant benefits for hypertensive patients could be expected if such programmes would become a part of the standard treatment practice. Trial registration This trial was prospectively registered with the Clinical Trial Registry of India [CTRI/2017/02/007822] on 10/02/2017.

Background International guidelines for hypertension treatment recommend the use of yoga, particularly among low-risk patients. However, evidence is lacking on the implementation potential of health-worker-led yoga interventions in low-resource, primary care settings. Objective To assess barriers to and facilitators of the implementation of a yoga intervention for hypertensive patients in primary care in Nepal. Methods The study was conducted using focus group discussions, in-depth interviews, key informant interviews, and telephone interviews. Data were collected from the ‘Yoga and Hypertension’ (YoH) trial participants, YoH intervention implementers, and officials from the Ministry of Health and Population in Nepal. Results Most YoH trial participants stated that: (1) it was easy to learn yoga during a five-day training period and practise it for three months at home; (2) practising yoga improved their health; and (3) group yoga sessions in a community centre would help them practise yoga more regularly. Most YoH intervention implementers stated that: (1) they were highly motivated to implement the intervention; (2) the cost of implementation was acceptable; (3) they did not need additional staff to effectively implement the intervention; (4) providing remuneration to the staff involved in the intervention would increase their motivation; and (5) the yoga programme was ‘simple and easy to follow’ and ‘easily performed by participants of any age’. The government officials stated that: (1) yoga is considered as a key health promotional activity in Nepal; and (2) the integration of the yoga intervention into the existing health care programme would not be too challenging, because the existing personnel and other resources can be utilised. Conclusion While there is a good potential that a yoga intervention can be implemented in primary care, capacity development for health workers and the involvement of community yoga centres in the delivery of the interventions may be required to facilitate this implementation.

Objective: To explore the pattern of the antihypertensive medication use among Nepali patients. Design and method: This cross-sectional study in Nepal analysed data from the May Measurement Month 2019 (MMM19). We converted all trade names to generic names and further categorized according to class of medication. Participants who provided the information about the name of their antihypertensive medication at the time of interview were included. Blood pressure (BP) control was defined as a systolic BP < 140 mmHg and diastolic BP < 90. Results: Out of 72,320 who participated in the MMM19, three BP readings were available for 66,955 (93%). Among them, 15,872 (24%) had hypertension and 7,507 (47%) were taking antihypertensive medication. Out of them, 1,434 (19%) provided the information about the antihypertensive medication. The mean (SD) of systolic and diastolic blood pressure were 135 mmHg (17 mmHg) and 86 mmHg (11 mmHg). Among those treated for BP, 85%,14% and 1% used 1, 2 and > 2 drugs respectively and 63% were controlled. The proportion of patient taking calcium channel blockers (CCB), angiotensin II receptor blockers (ARBs), and CCB plus ARB were 56%, 24% and 10%, respectively. Amlodipine was the most widely used medicine (55 %) followed by losartan (15%). Blood pressure control rate among participants using telmisartan, losartan plus hydrochlorothiazide, amlodipine plus losartan, losartan and amlodipine were 75%, 68%, 64%, 62% and 62%, respectively. Conclusions: Among individuals taking antihypertensive medications in Nepal, 85% of patients were taking monotherapy, mostly amlodipine. Improvements in BP control will likely require intensification of therapy, potentially through greater use of fixed dose combination therapy.