Nepali Children’s Health Under the Radar of Statistical Metrics:  

Untold Burden of Non-communicable Diseases in Children 

          Nepal, a low middle-income country, rarely comes to the prime attention of international partners. Except the ones who are deeply connected with Nepal for various initiating reasons, most of the activities are undercurrent of the global affairs. With globalization and outreach of the Nepali born individuals, professionals to the developed world, the voices are spreading and audible. English colonial expansion efforts were most likely the first to notice the diverse geographic and cultural country of Nepal. The participation of Gurkhas in the English military has been mostly discussed historically. The matters of attention are usually the ones, most Nepalis would rather prefer not to be the reason. In the recent decades, Nepal has drawn international attention for the Royal Massacre, Civil Insurgency, overthrowing of Monarchy or something to do with the Himalayas or Mount Everest. For the philanthropists and good-hearted global citizens, the devastating earthquake of 2015 was the period of involvement in supporting the amicable residents of Nepal.  

          Recently, Nepal was engulfed by the COVID-19 pandemic overwhelming the existing health infrastructure. Lives that could otherwise be saved in a robust health care system were tragically lost. A single acute disease exposed the inadequacy of the health care system at baseline, let alone the testing times like this. Nepal, in the recent decades has made strides in improving the statistical indicators for maternal, neonatal, infant and child mortality. Fortunately, the number of preventable deaths keep shrinking. The life expectancy at birth keeps growing over the years. The median age of the population at 25.3 years, ranking 163 in the world (according to CIA World Factbook, 2020 estimate) indicates the young distribution of the population (compare median age, Monaco 55.4 rank 1 and the United States 38.5 rank 62). Out of Nepal's’ estimated 30 million population, around 40% is below the age of 19. Children below 14 years of age constitute 29% of the population.  

Healthcare for the young population is integrated into the overall health system. Child health care system is rightly focused on preventing neonatal, infant and child mortality. The major child health metrics that are routinely reported include, fever, acute respiratory infections, diarrhea, malnutrition and other causes that can be significantly lowered by simple and timely interventions. The effective national and international efforts over the years continue to improve the indexes in communicable diseases and improve the overall survival impacting life expectancy in a positive way. The burden of non-communicable diseases, oncologic, congenital, genetic, hereditary, immunologic and psychiatric will affect the quality of child health proportionately more in the future. It is important to plan for the management of non-communicable diseases in children. These facets may not be reflected on the immediate health care indexes. The quality of life affected and the human potential lost would be irreparable. This needs to be prioritized for a better future of the children surviving the preventable illnesses or acquiring non-communicable diseases.  

          Skilled manpower to support this major share of the population of Nepal is inadequate. As of December 2020, Nepal Medical Council record, 689 (8.3%) of the 8314 registered medical specialists in Nepal are pediatricians or pediatric specialists. This number includes all registered practicing and non-practicing (non-clinical, retired, expired or doctors abroad). The community level child health programs are run through integration to the health care system and training the local allied medical staff. This has improved the immunization rate, care of acute respiratory infections, management of fever, diarrhea etc. or referral to the next best level of care if available. When there is a need for specialty care for children, it is overall limited and disproportionately centralized if available. Foremost of all, training the adequate human resource and proper planning has to be integrated in the national agenda for a long-term solution. Deficit of skilled manpower is coupled with the deficit of facilities providing general or specialty pediatric care. Of the roughly less than two thousand assigned pediatric beds throughout the country three hundred and twenty are in a single tertiary level public hospital in the capital. Under the given circumstances, it is natural to focus on the most impactful indicators of child health as set by international regulatory agencies. While, the current focus will uplift the level of health and quality of life in children, it will fall short on the conditions mentioned above. 

          Majority of the pediatric specialty providers are focused on providing much-needed clinical care. Research and development of the child health care needs to be organized and led in order to prepare the health system for the non/communicable disease burden. Kathmandu Institute of Child Health envisions to explore, incorporate, establish the innovative aspects of child healthcare in Nepal and employ, lead, train and deploy qualified manpower.  

"Contributing to raising healthy children is not just philanthropy or social work,

it is moral responsibility of a civilized society."

Prakash Paudel, MD, President, Founder Kioch Partners of America K-PALS Inc.