Implementing a life course approach in antenatal and postnatal care settings for prevention and reduction of non-communicable disease risks in Nepal

Co-creating tailored strategies to integrate non-communicable disease risk prevention into maternal health care in Nepal, aiming to improve long-term health outcomes across generations. 

The high burden of non-communicable diseases (NCDs) disproportionally affects Low- and Middle-income Countries (LMICs), where 85% of premature NCD deaths occur. Maternal and child health is inextricably linked with NCDs and their risk factors, and maternal and child health and NCD service integration is recommended for efficient use of limited resources. Behavioural change interventions in the pregnancy and post-pregnancy periods, for tobacco and alcohol avoidance, healthy eating, and psychosocial support, can prevent and reduce the risk of NCDs in current and future generations. However, the implementation of this evidence base is insufficient, especially in LMICs.

Our aim is to work with stakeholders and co-create tailored implementation strategies to support the delivery of NCD risk prevention and reduction interventions in antenatal (ANC) and postnatal (PNC) primary healthcare settings in Nepal. Our objectives are to:

• Conduct a needs and assets assessment to identify potential barriers and facilitators to implementation of the proposed NCD risk reduction interventions for ANC and PNC primary health care settings, and state relevant implementation outcomes and performance objectives.
• Tailor implementation strategies and adapt the proposed NCD risk reduction interventions to the Nepali context through an iterative co-creation process with relevant stakeholders and women during and after pregnancy.
• Initiate NCD risk reduction interventions using tailored strategies and evaluate implementation, service and client outcomes in an effectiveness-implementation cluster randomised trial.

Taking a theory-driven implementation science and life course approach to reduce the risks for NCDs in young people and next generation, will contribute to the ongoing efforts directed at achieving the SDG 3.4; reducing health inequities; improving quality of life across the life course, and informing and advancing preventive health programs and policies, in Nepal and globally.