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

The global increase in non-communicable diseases (NCDs), primarily diabetes, cardiovascular disease, cancer, respiratory disease and mental health disorders, places a high burden on both individuals and societies, including health systems. It affects quality of life, education, and workforce productivity. Addressing major risk factors - poor diet, tobacco use, alcohol use, physical inactivity, and psychological ill-being – can prevent and reduce the risk of developing NCDs. It is recommended to intervene as early as possible; pregnancy and the postnatal periods therefore provide crucial opportunities to prevent NCD risks. However, there is a gap between what we know and what we do. The IpreventNCD project will work with users and stakeholders in Nepal to understand the barriers and enablers for implementing NCD risk reduction interventions in antenatal and postnatal care. We will use understanding of these barriers and enablers to develop implementation strategies. Finally, we will test if the interventions and implementation strategies are acceptable, feasible, and effective in reducing NCD risks among young women in Nepal during and after pregnancy. IpreventNCD will be carried out in close cooperation with partners at the Nepal Health Research Council (NHRC) and Kathmandu University School of Medical Sciences (KUSMS), and in partnership with the University of Bergen, University of Queensland, and Central Queensland University. This project was funded through an international joint call on a life course approach to common NCD risk factor prevention and reduction organized by the Global Alliance for Chronic Diseases, with co-funding from Australia’s National Health and Medical Research Council.

The high burden of non-communicable diseases (NCDs) disproportionally affects Low- and Middle-income Countries (LMICs), where 85% of premature NCD deaths occur. Most countries are off-track in achieving SDG target 3.4, to reduce NCD premature mortality (30-69 years of age). 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, including tobacco and alcohol avoidance, healthy eating, physical activity, 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. In the IpreventNCD project, we propose to implement interventions around tobacco and alcohol avoidance, healthy eating, physical activity, and psychosocial support taken from the WHO’s recommendations on antenatal care for a positive pregnancy experience, and maternal and newborn care for a positive postnatal experience. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework will guide our stepwise process, and our exploration of barriers and facilitators. We will build on the primary health care set up in Nepal, and co-adapt the selected interventions with users. We will use implementation mapping to tailor implementation strategies. We will use a hybrid effectiveness-implementation cluster randomized controlled trial to assess effectiveness and implementation outcomes including acceptability, feasibility, and cost.