Stakeholder Engagement in Planning the Design of a National Needs Assessment for Cardiovascular Disease Prevention and Management in Nepal.

BACKGROUND: There is growing support for stakeholder engagement in health research, but the actual impact of such engagement has not been well established. OBJECTIVES: This paper describes the stakeholder engagement process and evaluation during the planning of the national needs assessment for cardiovascular disease in Nepal. METHODS: We used personal and professional networks to identify relevant stakeholders within the 7Ps framework (Patients and the Public, Providers, Purchasers, Payers, Public Policy Makers and Policy Advocates, Product Makers and the Principal Investigators) to develop a plan for assessing cardiovascular health needs in Nepal. We consulted 40 stakeholders through 2 meetings in small groups and a workshop in a large group to develop the study methods, conceptual framework, and stakeholder engagement process. We interviewed 33 stakeholders to receive feedback on the stakeholder engagement process. RESULTS: We engaged 80% of the targeted stakeholders through small group discussions and a workshop. Three of 5 recommendations from the small group discussion were aimed at improving the stakeholder engagement process and 2 were aimed to improve the research methods. Eleven of 27 recommendations from the workshop aimed to improve the research methods, 4 aimed to improve stakeholder engagement, and 2 helped to expand the scope of dissemination. Ten were irrelevant or could not be incorporated due to resource limitation. Most stakeholders noted that the workshop provided an open platform for a multisectoral group to colearn from one another and share ideas. Others highlighted that the discussion generated insights to enhance research by incorporating expertise and ideas from different perspectives. The major challenges discussed were about committing the time for engagement. CONCLUSIONS: The stakeholder engagement process positively affected the design of our research. This study provides important insights for future researchers that aim to engage stakeholders in national-level assessment programs in the health care system in the context of Nepal.

Health-sector responses to address the impacts of climate change in Nepal

Nepal is highly vulnerable to global climate change, despite its negligible emission of global greenhousegases. The vulnerable climate-sensitive sectors identified in Nepal’s National Adaptation Programme of Action(NAPA) to Climate Change 2010 include agriculture, forestry, water, energy, public health, urbanization andinfrastructure, and climate-induced disasters. In addition, analyses carried out as part of the NAPA processhave indicated that the impacts of climate change in Nepal are not gender neutral. Vector-borne diseases,diarrhoeal diseases including cholera, malnutrition, cardiorespiratory diseases, psychological stress, andhealth effects and injuries related to extreme weather are major climate-sensitive health risks in the country.In recent years, research has been done in Nepal in order to understand the changing epidemiology ofdiseases and generate evidence for decision-making. Based on this evidence, the experience of programmemanagers, and regular surveillance data, the Government of Nepal has mainstreamed issues related toclimate change in development plans, policies and programmes. In particular, the Government of Nepal hasaddressed climate-sensitive health risks. In addition to the NAPA report, several policy documents have beenlaunched, including the Climate Change Policy 2011; the Nepal Health Sector Programme – ImplementationPlan II (NHSP-IP 2) 2010–2015; the National Health Policy 2014; the National Health Sector Strategy 2015–2020 and its implementation plan (2016–2021); and the Health National Adaptation Plan (H-NAP): climatechange and health strategy and action plan (2016–2020). However, the translation of these policies and plansof action into tangible action on the ground is still in its infancy in Nepal. Despite this, the health sector’sresponse to addressing the impact of climate change in Nepal may be taken as a good example for otherlow- and middle-income countries.

Modifiable determinants of attitude towards dengue vaccination among healthy inhabitants of Aceh, Indonesia: Findings from a community-based survey

OBJECTIVE@#To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh (northern Sumatra Island, Indonesia), the region that was most severely affected by the earthquake and tsunami of 26 December 2004.@*METHODS@#A community-based, cross-sectional study was conducted among 535 healthy inhabitants in nine regencies (Kabupaten or Kotamadya) of Aceh that were selected randomly from November 2014 to March 2015. A set of validated, pre-tested, structured questionnaires was used to guide the interviews. The questionnaires covered a range of explanatory variables and one outcome variable (attitude to dengue vaccination). Multi-step logistic regression analysis and Spearman's rank correlation were used to test the role of explanatory variables for the outcome variable.@*RESULTS@#More than 70% of the participants had a poor attitude towards dengue vaccination. Modifiable determinants associated with poor attitude to dengue vaccination were low education level, working as farmers and traditional market traders, low socioeconomic status and poor knowledge, attitude and practice regarding dengue fever (P < 0.05). The KAP domain scores were correlated strongly with attitude to dengue vaccination, rs = 0.25, rs = 0.67 and rs = 0.20, respectively (P < 0.001). Multivariate analysis found that independent predictors associated with attitude towards dengue vaccination among study participants were only sex and attitude towards dengue fever (P < 0.001).@*CONCLUSIONS@#This study reveals that low KAP regarding dengue fever, low education level and low socioeconomic status are associated with a poor attitude towards dengue vaccination. Therefore, inhabitants of suburbs who are working as farmers or traditional market traders with low socioeconomic status are the most appropriate target group for a dengue vaccine introduction program.

Modifiable determinants of attitude towards dengue vaccination among healthy inhabitants of Aceh, Indonesia: Findings from a community-based survey

Objective To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh (northern Sumatra Island, Indonesia), the region that was most severely affected by the earthquake and tsunami of 26 December 2004. Methods A community-based, cross-sectional study was conducted among 535 healthy inhabitants in nine regencies (Kabupaten or Kotamadya) of Aceh that were selected randomly from November 2014 to March 2015. A set of validated, pre-tested, structured questionnaires was used to guide the interviews. The questionnaires covered a range of explanatory variables and one outcome variable (attitude to dengue vaccination). Multi-step logistic regression analysis and Spearman's rank correlation were used to test the role of explanatory variables for the outcome variable. Results More than 70% of the participants had a poor attitude towards dengue vaccination. Modifiable determinants associated with poor attitude to dengue vaccination were low education level, working as farmers and traditional market traders, low socioeconomic status and poor knowledge, attitude and practice regarding dengue fever (P < 0.05). The KAP domain scores were correlated strongly with attitude to dengue vaccination, rs = 0.25, rs = 0.67 and rs = 0.20, respectively (P < 0.001). Multivariate analysis found that independent predictors associated with attitude towards dengue vaccination among study participants were only sex and attitude towards dengue fever (P < 0.001). Conclusions This study reveals that low KAP regarding dengue fever, low education level and low socioeconomic status are associated with a poor attitude towards dengue vaccination. Therefore, inhabitants of suburbs who are working as farmers or traditional market traders with low socioeconomic status are the most appropriate target group for a dengue vaccine introduction program.