This document is a term paper submitted by students of the Bachelor of Public Health program at La Grande International College in Nepal on the topic of the prevalence of non-communicable diseases. It provides background information on NCDs including risk factors. Global data shows NCDs account for 60% of deaths worldwide, with 80% occurring in low- and middle-income countries. In Nepal, NCDs account for 42% of all deaths currently and are projected to cause 66.3% of deaths by 2030. The term paper analyzes NCD prevalence in Nepal and compares communicable to non-communicable disease burdens. It also examines Nepal's NCD policies and strategies.

1. ‘‘PREVALENCE OF NON-COMMUNICABLE DISEASE’’
A Term paper submitted to fulfill the partial requirement of BPH second semester [Basic
Epidemiology TPP 3.1]
SUBMITTED TO:
DEPARTMENT OF PUBLIC HEALTH,
LA GRANDEE INTERNATIONAL COLLEGE,
SIMALCHAUR-8, POKHARA
2011
SUBMITTED BY:
SAMJHANA GURUNG ‘A’
SAMJHANA GURUNG ‘B’
SABITA TIMILSINA
SARALA KUMAL &
SAGUN PAUDEL

2. 1. Acknowledgement
The students of Bachelor of Public Health 2nd semester of 1 st year like to express our humbly
thanks to all those who have supported and helped us in accomplishing this term paper in the
topic ‘‘PREVALENCE OF NON-COMMUNICABLE DISEASE’’.
We would like to convey our heartfelt thanks to all those who were directly or indirectly
concerned with this and to all our well wishers.
First of all we would like to thank our respected subject teacher Mr. Dilip Kumar Yadav for
giving us opportunity to prepare this term paper. We are fully indebted to our him for expert
guidance, regular supervision, untiring encouragement, inspiration and valuable suggestion and
full support during preparation of term paper.
This term paper is written in simple language, with every bit of necessary information related to
the topic so that studying independently also would not find any difficulties. We think that this
effort will help every individual to understand about the information of the related topic.

3. 2. TABLE OF CONTENT
1. Acknowledgement ...................................................................................................................................... 2
2. TABLE OF CONTENT .................................................................................................................................... 3
3. INTRODUCTION ........................................................................................................................................... 4
Risk factors:...................................................................................................................................................... 5
Major behavioral risk factors: .................................................................................................................... 5
Major biological risk factors: ...................................................................................................................... 5
Other risk factors......................................................................................................................................... 5
4. Objectives: ................................................................................................................................................... 6
General Objectives: ......................................................................................................................................... 6
Specific Objectives: ......................................................................................................................................... 6
5. Methodology: .............................................................................................................................................. 7
6. Finding and Discussion: .............................................................................................................................. 8
Global scenario: ............................................................................................................................................... 8
South-east Asian countries: ............................................................................................................................ 8
Nepal: ............................................................................................................................................................... 9
Some prevalent NCDS in Nepal: ...............................................................................................................10
Status of NCD’s in Nepal8..........................................................................................................................10
Facts and figures: ..........................................................................................................................................11
7. NCD Risk Factors: ......................................................................................................................................13
8. NCD’s Policy and Strategies of Nepal 9: ....................................................................................................14
9. Conclusion: ................................................................................................................................................14
10. Recommendation: ................................................................................................................................14
11. References:............................................................................................................................................15

4. 3. INTRODUCTION
Prevalence: all current old and new of a disease existing at a given point at a time 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.1
Charasteristics of NCD’S:2
NCD’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.
• 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.
1–
EURO sumposium, 1997
2- Commission of Chronic Illness, USA.

5. Risk factors:
The risk factors for many of these conditions are associated with environmental and genetic
factors.
Major behavioral risk factors:
 Tobacco use (cigarette use and other forms of smoking)
 Harmful alcohol consumption
 Unhealthy diet(low fruit and vegetable consumption)
 physical in activity
 Stress factors etc.
Major biological risk factors:
 Overweight and obesity
 Raised blood pressure
 Raised blood glucose
 Abnormal blood lipids and its subset raised total cholesterol
Other risk factors
 Failure to obtain preventive services
 Environmental factors etc.
These risk factors have 80% contribution in the development of NCDs.

6. 4. Objectives:
General Objectives:
• To find out the prevalence of non-communicable disease in Nepal.
Specific Objectives:
• To identify the prevalence of top non-communicable diseases.
• To compare the prevalence of patients in different Developmental area of Nepal.
• To compare the prevalence of NCD’s in different years.
• To compare the prevalence of communicable diseases and non-communicable diseases.
• To analyze the risk groups and factors of NCD’S in Nepal.
• To find out the NCD Policy and Strategies of Government of Nepal.

7. 5. Methodology:
Data Type : Secondary data.

8. 6. Finding and Discussion:
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.4
• 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.7
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.
3- World Health Report 2004
4-Menzies Research Institute Tasmania, Non-communicable Diseases. [Cited 2010 20 August]; Available from:
http://www.menzies.utas.edu.au5- World Health Report 2004
6- World Health Report 2005
7-
Habib SH, Soma S. Burden of non communicable disease: Global overview. Health Economics Unit, Diabetic
Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh (available online April 1,
2010)

9. Nepal:
Nepal, one of the poorest countries in the world - at 136th position of human
development index has grossly limited treatment options for NCDs and their end organ
effects.
Nepal is one of the developing countries of the world. It is facing double burden of
diseases with an added burden of NCDs. Many researches on NCDs were conducted in
Nepal but magnitude of NCDS is still unknown.
Death and DALY rates of the NCDs in Nepal (by, 2002)
Death Rate (age DALY Rate (age standardized,
standardized, per per 100,000 population)
100,000 population)
CVD 310 2,285
Cancers 120 1,186
Respiratory diseases 94.5 1,102
Diabetes 30.8 322
All NCDs 795.9 13,467
Road Traffic Injuries 19.7 526
Source: Nepal public health association.

10. Some prevalent NCDS in Nepal:
• Cardiovascular diseases such as; Ischemic 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 Nepal8
According to the WHO Global Report " Preventing Chronic Disease: A Vital Investment, 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 provides a
projection for the year 2030, which suggest a 66.2% increase in deaths caused by 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 Health Foundation,17 Sept, 2010.

11. Facts and figures:
According to Annual report of MOHP in Nepal (2006), In government hospital 81.5% outpatient
and 88% of in-patient attendance is due to morbidity related to NCD’s.
Annual report 2065-66:
Communicable and Non-Communicable Cases among the total OPD Cases by National and
Regions, FY 2065/66 (2008/2009)
Level Communicable Non communicable
Eastern 889,918 3,556,605
Central 1,037,141 4,240,881
Western 718,054 3,515,735
Mid Western 697,014 388,314
Far Western 386,611 1,517,650
National 3,728,738 15,219,185
Source: HMIS/MD, DoHS
From data:
This shows the communicable and non-communicable cases at the National level. 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 %.

12. Annual report 2066-67:
Communicable and Non-Communicable Cases among the total OPD Cases by National and
Regions, FY 2066/67 (2009/2010)
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 17,091,889
Source: HMIS/MD, DoHS
From data:
This shows the communicable and non-communicable cases at the National level. 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 %.
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.

13. Total number of Inpatient morbidity by communicable and non-communicable diseases :
Source: HMIS/MD, DoHS FY 2066-67
Communicable Non- Communicable Non-
diseases Communicable diseases Communicable
diseases diseases
Number of in (42,683) Source: HMIS/MD, 6,039) (264,327)
patient 14.28% DoHS 12.00% 88.00%
Death Rate 0.57% Source: HMIS/MD, 1.20% 1.00%
among DoHS
Inpatient
Source: HMIS/MD, DoHS
Description:
• In FY 2065-66: 86 % of the in patients were admitted for non-communicable diseases
where as only 14 % of the discharged patients were admitted for the communicable
diseases.
• Similarly in FY 2067-68: 88 % of the in patients were admitted for non-communicable
diseases where as only 12 % of the discharged patients were admitted for the
communicable diseases.
7. 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%.
• 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.

14. • And almost 95% of surveyed population was found to be engaged in either moderate or
high level of physical activity.
Source: Nepal public health foundation.
8. 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.
• 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 incurs huge cost in one hand and
the facilities to carry out secondary and tertiary prevention is unlikely to be available
everywhere 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.
9. Conclusion:
In conclusion, the magnitude of non communicable disease is substantial in Nepal and is
regarded as a public health problem. The governmental, non-governmental and
community based organizations are still fighting to tackle the burden of infectious
diseases. Unless urgent and specific focus on preventing, treating and control of NCDs
are targeted, the burden of the NCDs will be unbearable to the poor nation like Nepal.
10. 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

15. 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.
• 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.
11. 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)
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