Rural Nepal Health Surveillance and Care Delivery: A Community Health Case Study

Purpose: Nepal is ranked 145^th on the United Nations Human Development Index, life expectancy is 68 and there are 0.46 nurses and midwives per 1,000 people. Limited resources and weak civil structure leave rural communities un-assessed and excluded from census data drawn from electronic health records. The purpose of this study is to examine patient self-reported health issues from community assessments conduced in 2013 and 2014 and to compare results to national and international data.

Methods: Secondary data was coded from the 2013 and 2014 Stanford Nepal Medical Project medical camp health assessments (n= 624). Results were processed with REDCap for prevalence of chief complaints and other assessment data. Data were then compared to publicly accessible data about Nepal.

Results:  Two prevalence measurements were taken using the secondary data: chief complaints and health assessments based on the medical diagnoses. Leading categories for seeking treatment locally and nationally overlapped: digestive (19% locally v. 11.4% nationally), respiratory (5% v. 7.7%), skin (15% v. 2.7%). Locally, eye problems were the 5^th leading complaint (11%) yet unlisted among national and international reports. The local assessment data further diverged: eye (13.06%), musculoskeletal (12.76%), cardiovascular (10.39%), skin (10.09%) and digestive problems (9.49%) were most common. National and international assessments list digestive (11.2% national, 18% international) and respiratory (7%, 12.7%) problems as the top two assessments. The findings suggest there may be a significant urban-rural disparity in health problems.

Conclusion: The study’ results demonstrate that these rural Nepali communities are not only underserved for basic health needs but that services may not match with patient reported problems. Similar rural communities remain unassessed with potential discordant health needs. Accurate assessment data for isolated communities can match supply and demand to drive efficient mobilization of limited resources to improve health outcomes. Nurses could be used to address the majority of problems found in theses communities.