A Term Paper Presentation to fulfill the partial requirement of BPH second semester [Basic Epidemiology 1st -TPP 3.1]05/11/12 prevalance of NCDs in Nepal 3
IntroductionPrevalance :All current cases (old and new) of a disease existing at a given point at a time or over a period of time.Non-communicable disease:Impairment of bodily structure or functions that necessitates a modification of the patient’s normal life and has persisted over extended life period of time.11– EURO sumposium, 1997 05/11/12 prevalance of NCDs in Nepal 4
Charasteristics of NCD’S :2NCD’s or chronic diseases are impairment or deviation from normal with these characteristics;• Are permanent• Leave residual disability• Caused by non- reversible pathological alteration• Require special training of the patient rehabilitation• Requires long period of observations. 05/11/12 prevalance of NCDs in Nepal 52- Commission of Chronic Illness, USA.
Have long latent period between the exposure and causes. Disability and fatality rate is high. Mostly irreversible. Are slow in onset and development and long term impact. They require a long term systemic approach to treatment. Most chronic diseases are the result of multiple causes. NCDs have emerged as the major causes of morbidity and mortality worldwide. 05/11/12 prevalance of NCDs in Nepal 6
Risk factors:The risk factors for many of these conditions are associated with environmental and genetic factors.• Major behavioural risk factors: Tobacco use (cigarette use and other forms of smoking) Harmful alcohol consumption Unhealthy diet(low fruit and vegetale consumption) physical in activity Stress factors etc. 05/11/12 prevalance of NCDs in Nepal 7
1. Major biological risk factors: Overweight and obesity Raised blood pressure Raised blood glucose Abnormal blood lipids and its subset raised total cholesterol6. Other risk factors Failure to obtain preventive services Environmental factors etc.These risk factors have 80% contribution in the development of NCDs. 05/11/12 prevalance of NCDs in Nepal 8
Objective:General Objectives:• To find out the prevalence of non-communicable diseasein Nepal. Specific Objectives:• To identify the prevalence of top non-communicablediseases.• To compare the prevalance of patients in differentDevelopmental area of Nepal.•To compare the prevalence of NCD’s in different years.• To compare the prevalence of communicable diseasesand non-communicable diseases.• To analyze the risk groups and factors of NCD’S in Nepal.• To find out the NCD Policy and Strategies of GoN.
Finding and Discussion :1. Global scenario :• NCDs account for almost 60% of deaths and 47% of the global burden of disease.3• Today, non-communicable diseases, mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes represent a leading threat to human health and development. These four diseases are the world’s biggest killers, causing an estimated 35 million deaths each year - 60% of all deaths globally - with 80%in low- and middle-income countries.43- World Health Report 20044-Menzies Research Institute Tasmania. Non-communicable Diseases. [cited 2010 20 August]; Available from: http://www.menzies.utas.edu.au/information.php?Doo=ViewData&type=Disease&ID=40
• 75% of the total deaths due to NCDs occur in developing countries.5• out of 58 million deaths from all,NCDs account for 35 million deaths.6• Estimated that in 2020, the no. of deaths caused by NCD’s in developing countries will equal the death caused by communicable diseases.• By 2020,chronic heart disease are expected to account for7 of 10 deaths in world.75- World Health Report 20046- World Health Report 20057- Habib SH, Soma S. Burden of non communicable disease: Global overview. Health Economics Unit, Diabetic Association of Bangaladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangaladesh (available online April 1, 2010) 05/11/12 prevalance of NCDs in Nepal 12
South-east Asian countries:• World Health Organization (WHO) estimates about 54% of deaths and 44% of morbidity is attributed to NCDs in this region.• In Nepal, NCDs accounts for 42% of all deaths and is projected to cause 66.3% of all deaths by 2030.05/11/12 prevalance of NCDs in Nepal 13
Nepal:Facts;•Nepal, one of the poorest countries in the world - at136th position of human development index has grosslylimited treatment options for NCDs and their end organeffects.•Nepal is one of the developing countries of the world. It isfacing double burden of diseases with an added burden ofNCDs. Many researches on NCDs were conducted in Nepalbut magnitude of NCDS is still unknown.
Death and DALY rates of the NCDs in Nepal (by, 2002)Source: www.nphfoundation.org Death Rate (age DALY Rate (age standardized, per 100,000 standardized, per 100,000 population) population)CVD 310 2,285Cancers 120 1,186Respiratory diseases 94.5 1,102Diabetes 30.8 322All NCDs 795.9 13,467Road Traffic Injuries 19.7 526
Some prevalent NCDS in Nepal :• Cardiovascular diseases such as; Ischaemic heart disease(IHD),Hypertension, Rheumatic heart disease (RHD’s)• Diabetes• Mental disorders• cancers• Chronic respiratory disease• Obesity• Blindness• Hearing impairment• Oral health and other chronic diseases• Accidents and injuries etc.
Status of NCD’s in Nepal8According to the WHO Global Report " Preventing Chronic Disease: A VitalInvestment, 2005’’42% of total deaths are caused by NCD, of which; CVD holds the top most position with 21% of all deaths, followed by cancer (7%), Chronic respiratory disease (5%), and Diabetes (2%).Road traffic injuries account for 9% of all deaths, other chronic disease and rest of the chronic diseases being 7%.• This composition is similar to Regional scenario. WHO global info base providesa projection for the year 2030, which suggest a 66.2% increase in deaths causedby CVD and 71.4% by Cancer.8-Non-communicable Diseases: Emerging Trends and Socio-economic impact ,Dr. Mahesh Maskey MBBS, MPH, DSc. ,Executive Chair, Nepal Public HealthFoundation,17 Sept, 2010.
According to Annual report of MOHP in Nepal (2006),In government hospital 81.5% outpatient and 88% ofin-patient attendance is due to morbidity related toNCD’s.
Facts and figures :05/11/12 prevalance of NCDs in Nepal 19
Annual report 2065-66 : Communicable and Non-Communicable Cases among the total OPD Cases by National and Regions, FY 2065/66 (2008/2009) Source: HMIS/MD, DoHSLevel Communicable Non communicableEastern 889,918 3,556,605Central 1,037,141 4,240,881Western 718,054 3,515,735Mid Western 697,014 388,314Far Western 386,611 1,517,650National 3,728,738 15,219,185
From data :The communicable and non-communicable cases at the National level. Of the total OPD new visits more than 80.0 % of the total patients have visited for non communicable diseases where as patients visiting for communicable diseases represent only less than 20.0 %.05/11/12 prevalance of NCDs in Nepal 21
Annual report 2066-67 : Communicable and Non-Communicable Cases among the total OPD Cases by National and Regions, FY 2066/67 (2009/2010) Source: HMIS/MD, DoHS Level Communicable Non communicable Eastern 968,735 3,917,213 Central 1,015,132 4,660,491 Western 625,523 4,059,816 Mid Western 760,996 2,648,755 Far Western 431,843 1,805,614 National 3,802,229 17,091,88905/11/12 prevalance of NCDs in Nepal 22
From this data:The communicable and non-communicable cases at the National level. Of the total OPD new visits more than 81 % of the total patients have visited for non communicable diseases where as patients visiting for communicable diseases represent only less than 19.0 %.05/11/12 prevalance of NCDs in Nepal 23
Comparative study :• In 2065-66, 80% of OPD patients are suffered from NCD’S and in 2066-67, there is increase in the % of patients by 1%.• Similarly the no. of patient who suffered from NCD’S is increased rapidly in compare with communicable diseases.• In every developmental region there is high number of OPD patient suffered from NCD’S. 05/11/12 prevalance of NCDs in Nepal 24
Total number of In patient morbidity by communicable and non-communicable diseases : Source: HMIS/MD, DoHS Source: HMIS/MD, DoHS FY 2066-67 Communicable Source: HMIS/ Communicabl Non- diseases MD, DoHS e diseases Communicable diseasesNumber of (42,683) Source: HMIS/ 6,039) (264,327)in patient 14.28% MD, DoHS 12.00% 88.00%Death Rate 0.57% Source: HMIS/ 1.20% 1.00%among MD, DoHSInpatient05/11/12 prevalance of NCDs in Nepal 25
Description:• In FY 2065-66: 86 % of the in patients were admitted fornon-communicable diseases where as only 14 % of thedischarged patients were admitted for the communicablediseases.• Similarly in FY 2067-68 : 88 % of the in patients wereadmitted for non-communicable diseases where as only12 % of the discharged patients were admitted for thecommunicable diseases.
NCD Risk Factors:• Several surveys have been conducted to measure the NCD risk factors in Nepal. All these survey show high prevalence of risk factors.• According the national survey of 2008, among the four major risk factors current tobacco use (both smoke and smokeless) was 37%. Regarding alcohol consumption current consumers were 28.5% .Source: www.nphfoundation.org 05/11/12 prevalance of NCDs in Nepal 27
• Among the daily drinkers ,One in three men and one in ten women were drinking harmful amount of alcohol (>60 gms of alcohol).• More than five serving of fruits and vegetables were recommended for healthy living. However, the survey shows that 60.5% women are currently consuming less than 5 serving of fruit and vegetable daily in Nepal.• And almost 95% of surveyed population was found to be engaged in either moderate or high level of physical activity.05/11/12 prevalance of NCDs in Nepal 28
NCD’s Policy and Strategies of Nepal 9 :• Regional Framework of WHO SEARO provides a comprehensive and stepwise approach to prepare the national policy, strategy and build capacity for prevention and control of NCD.• In Nepal a draft of "National policy, strategy and plan of action for prevention and control of non- communicable disease" has been prepared by MOHP .• This document was prepared in the year 2009 but has not been endorsed by the government as yet. Though there are enough room for improvisation, nonetheless, this document correctly advocates for a comprehensive and integrated approach in reducing the burden of disease in Nepal. prevalance of NCDs in Nepal 05/11/12 29
• . This approach is most pointedly expressed in following paragraph:• "Primary prevention of NCD is the most cost effective method to tackle the growing epidemics of NCDs. Secondary and tertiary prevention incur huge cost in one hand and the facilities to carry out secondary and tertiary prevention is unlikely to be available every where in Nepal in near future. The only resort that Nepal can afford is to go for primary prevention and is feasible if integrated approach is adopted’’9- MOHP, (2009) "Nepal National Policy, Strategy and Plan of Action " for Prevention and Control of Non-Communicable Diseases" (draft), Government of Nepal. Kathmandu 05/11/12 prevalance of NCDs in Nepal 30
Conclusion:In conclusion, the magnitude of non communicabledisease is substantial in Nepal and is regarded as a publichealth problem. The governmental, non-governmentaland community based organizations are still fighting totackle the burden of infectious diseases. Unless urgent andspecific focus on preventing, treating and control of NCDsare targeted, the burden of the NCDs will be unbearable tothe poor nation like Nepal.
Recommendation:• Prevention of NCDs requires an integrated action across a range of sectors at local, regional and national levels. Each individual sector can perform a specific role to contribute from their level. Health care and public health must play a fundamental role in providing care and support for the patients but also in applying the unique public health models to prevent the associated risk of NCDs.• Infrastructure of hospital for NCDs and Diagnostic and treatment facilities.• Physicians and health workers should be routinely trained and re-trained on the prevention and control measures of NCDs. prevalance of NCDs in Nepal 05/11/12 32
• There should be provision of supply of low cost drugs to the diabetic patients by the Government of Nepal.• Preventive part of non communicable disease should be emphasized and given high priority in treating NCDs.• Health promotional activities using media should be of priority.• Most of the health institutions do not have separate unit for NCDs where a patient could receive a quality treatment. There should have separate unit for NCDs patients at least at the tertiary level health facilities. 05/11/12 prevalance of NCDs in Nepal 33
References:• EURO sumposium, 1997• Commission of Chronic Illness, USA• World Health Report 2004• Menzies Research Institute Tasmania. Non-communicable Diseases. [cited 2010 20 August]• World Health Report 2004• World Health Report 2005• Habib SH, Soma S. Burden of non communicable disease: Global overview. Health Economics Unit, Diabetic Association of Bangaladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangaladesh (available online April 1, 2010)
8) Non-communicable Diseases: Emerging Trends and Socio-economicimpact ,Dr. Mahesh Maskey MBBS, MPH, DSc. ,Executive Chair, Nepal PublicHealth Foundation,17 Sept, 2010.9) MOHP, (2009) "Nepal National Policy, Strategy and Plan of Action " forPrevention and Control of Non-Communicable Diseases" (draft), Governmentof Nepal. KathmanduOther:•www.google.com•Nepal Public Health Foundation (NPHF) (www.nphfoundation.org)• www.nhrc.gov.np•Prevalance of NCD’S in Nepal hospital based study. Conducted by NHRC.• Annual Report 2064-65 & 66-67
05/11/12 धनयवाद prevalance of NCDs in Nepal Have a Nice Day… 37