• NCD a very large catch-all term – Chronic diseases – Reproductive health – Mental health – injuries• Often used for chronic conditions
NCDs• Biggest cause of death worldwide. – More than 36 million people died from NCDs in 2008 – More than 9 million of these deaths occurred prematurely (before the age of 60) and could have largely been prevented.• Premature deaths from NCDs by sex and country category – 22% among men and 35% among women in low-income countries – 8% among men and 10% among women in high-income countries.
NCDS• Main NCD causes of death – cardiovascular diseases (48%) – cancers (21%) – Chronic respiratory diseases (12%) – diabetes (3%)• Other NCDs – blood disorders – renal disease – Arthritis – epilepsy
NCD Risk factors• 4 main behavioral risk factors that contribute to NCDs – tobacco use, – physical inactivity, – harmful use of alcohol – unhealthy diet
Other key factors• Level of investment in health/health systems• Globalization - promotes diets rich in calories, salt and fat• Poverty - affects affordability of healthy food and health care, affects access to health information and means of prevention• Rapid urbanization - contributes to physical inactivity;• Obesity- as a result of diet and reduction in physical activity;• High levels of indoor and outdoor air pollution;• Increasing prevalence of alcohol abuse;• Poor governance, corruption and lack of accountability of governments and systems, including health systems;• Ageing of populations.
% deaths from NCDs• Low- and lower-middle-income countries have the highest proportion of deaths under 60 from NCDs. – for high-income countries - 13% – for upper-middle-income countries- 25% – for lower-middle-income countries -28% – for low-income countries - 41%
NCD Care• Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low-Resource Settings – Prevention – Treatment – Rehabilitation – palliative care
Sexual and Reproductive Health• Defined in the Programme of Action of the International Conference on Population and Development (ICPD) held in Cairo, Egypt, in September 1994 includes: – family-planning – Safe delivery – prevention and appropriate treatment of infertility; – prevention of abortion and the management of the consequences of abortion; – treatment of reproductive tract infections, STI including HIV – prevention, early detection and treatment of breast cancer and cancers of the reproductive system, and other RH conditions; – active discouragement of harmful traditional practices, such as female genital mutilation.
SRH & MDGs• GOAL 5: IMPROVE MATERNAL HEALTH• Target 5.A: Reduce by three quarters the maternal mortality ratio – 5.1 Maternal mortality ratio – 5.2 Proportion of births attended by skilled health personnel• Target 5.B: Achieve universal access to reproductive health – 5.3 Contraceptive prevalence rate – 5.4 Adolescent birth rate – 5.5 Antenatal care coverage (at least one visit and at least four visits) – 5.6 Unmet need for family planning
SRH in crises• Previously ignored• BUT now recognized as critical in crises ( MISP), CERF life-saving criteria• Investments needed for SRH also critical for other health issues – Blood transfusion – Surgical capacity – Referral system …
Key Indicators for SRH• # HF with basic essential obstetric care/500 000 population, by admin unit o >= 4 BOEC/500 000• # HF with comprehensive essential obstetric• care/500 000 population, by admin unit o >= 1 CEOC/500 000• % births assisted by skilled attendant o > 90%• % expected deliveries by Caesarean section, by admin unit o >= 5% and <= 15%
Abortions• 10-15% of all pregnancies may spontaneously abort before 20 weeks gestation• 90% of these will occur during the first three months• 15-20% of all spontaneous abortions that occur require medical interventionsHypertension• 5-20% of all pregnancies will develop hypertensive disorder of pregnancy (HDP)• 5-25% of all primigravida pregnancies will develop HDP or Pre-eclampsia
Labor and delivery complications– 15% of all pregnancies will require some type of intervention at delivery– 5-15% of all pregnancies will require a Caesarean section– 10-15% of all women will have some degree of cephalopelvic disproportion (higher in poorer socioeconomic populations)– 10% of deliveries will involve a primary postpartum hemorrhage (within 24 hours of delivery)– 0.1-1.0% of deliveries will involve a secondary postpartum hemorrhage (occurring 24 hours or more after delivery)– 0.1-0.4% deliveries will result in uterine rupture– 0.25-2.4% of all deliveries will result in some type of birth trauma to the baby– 1.5% of all births will have a congenital malformation(does not include cardiac malformations diagnosed later in neonatal period).– 31% of these malformations will result in death.
MISP• Focuses on minimum set of services that must be available even in crisis• Basis for expanded set of SRH services• Often services do not exist before
Maternal mortality• Key causes – Postpartum hemorrhage (bleeding after delivery) – Sepsis (infection after delivery) – Unsafe abortion – Hypertension or eclampsia (high blood pressure or severe high blood pressure) – Obstructed labor – Other direct obstetric causes – Indirect causes such as malaria, anaemia, heart disease, or other pre-existing conditions
Preventing maternal deaths• 3 delays – Delay in recognizing a complication – Delay in deciding to seek health care/in reaching a health care facility – Delay in receiving appropriate treatment/quality care
Key SRH in Crises initiatives• Inter-agency Working Group on Reproductive Health in Crises (IAWG)• Reproductive Health Response in Conflict (RHRC) Consortium• Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative• Sexual and Reproductive Health Programme In Crisis and Post-Crisis Situations (SPRINT Initiative)
Exercise: Estimating number of pregnant women in population (per 100,000)• Need to know: CBR, affected population size
MHPSS in emergencies• Previously under-addressed• Important for: – Dignity – Rights – Reduction of risk for death• IASC Task Force - reference group – Guidelines + – Specific emergency support• Addition of 5 psychotropic drugs in IEHK revision
For next week….• You are a research assistant to a prominent journalist who frequently highlights issues of sexual violence in his writings about humanitarian settings (but not always accurately and not always covering other issues of violence in the settings). Prepare a brief about the data available about violence including sexual violence in the crisis you are following.