The document summarizes information on non-communicable diseases (NCDs) presented by a group of students. It discusses the global and national scenarios of major NCDs such as cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, chronic kidney disease, and COPD. The leading causes and risk factors of these diseases are also presented along with strategies for prevention at different levels from primordial to tertiary prevention. The document contains information on disease burden, trends, and risk factors specific to Nepal.
Health for all- primary health care- millennium development goalsAhmed-Refat Refat
PHC is the essential care based on practical, scientifically sound and socially acceptable method and technology made universally accessible to individuals and families in the community through their full participation and at a cost they and the country can afford to maintain in the spirit of self reliance and self determination.
Al
Non-communicable Diseases And Interventions to minimize itGaaJeen Parmal
Rise of non-communicable diseases like RTA, obesity, psychological disturbance, etc. Its impact towards the healthcare of a nation. The steps or approach that can be taken to minimize the disease.
Health for all- primary health care- millennium development goalsAhmed-Refat Refat
PHC is the essential care based on practical, scientifically sound and socially acceptable method and technology made universally accessible to individuals and families in the community through their full participation and at a cost they and the country can afford to maintain in the spirit of self reliance and self determination.
Al
Non-communicable Diseases And Interventions to minimize itGaaJeen Parmal
Rise of non-communicable diseases like RTA, obesity, psychological disturbance, etc. Its impact towards the healthcare of a nation. The steps or approach that can be taken to minimize the disease.
Epidemiology of Non Communicable Diseases (NCDs)Prabesh Ghimire
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
The course offers an opportunity to develop a holistic understanding of Global health, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
Class presentation at Pokhara University, MPH program
Point wise data on situation of cardiovascular disease focused on ischemic heart disease in Nepal.
Epidemiology of Non Communicable Diseases (NCDs)Prabesh Ghimire
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
The course offers an opportunity to develop a holistic understanding of Global health, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
Class presentation at Pokhara University, MPH program
Point wise data on situation of cardiovascular disease focused on ischemic heart disease in Nepal.
The Future of Cardiology (2018 – 2030): Advanced Treatments to Combat the Global Advance of Cardiovascular Diseases. I presented this at Conference Series Cardiology Conference 2017 in Philadelphia, Pennsylvania on 09/01/2017. I first look the the number of people globally affected by cardiovascular diseases. Then I look at the cumulative "lost productivity" globally as a result of people suffering from cardiovascular diseases. Following that, I look at the total costs of treating cardiovascular diseases globally. Then I present the reasons why cardiovascular diseases are rising so rapidly throughout the world - lifestyle/clinical. Then I look at the rates of smoking throughout the world; one of the main culprits of cardiovascular diseases (CVDs). The next slides look at the "Gold Standard" of care for coronary artery diseases (CAD), congestive heart failure (CHF), and aortic valve disease. I also present what is driving industry consolidation and associated major transactions. I then provide some perspective on the future of interventional cardiology. And finally, I provide some insight into "evolving technologies" for cardiovascular care and interventional cardiovascular care. It was a lengthy presentation, but I feel, all critical. This is a very complex field. It takes at least 12 continuous years of education and training to become an interventional or non-interventional cardiologist (4 years pre-med, 3 years medical school, 3 years medical residency, 2 years fellowship (where a cardiologist selects and trains on their cardiovascular specialties)). Some authorities are even calling for post-fellowship training for procedures like transcatheter aortic valve implantation (TAVI) and pacemaker/ICD implantation.
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3. Content:
• Introduction to NCD and Its Scenario,
• CKD introduction its scenario, Risk factors and Prevention,
• Cancer introduction, scenario, causes and prevention
• COPD introduction, epidemiological determinants, Prevention
• CVD Introduction, Scenario, Risk Factors and its prevention
• Diabetes introduction, Scenario, Risk factors and its prevention.
4. Introduction:
• Non-communicable diseases (NCDs), also known as chronic
diseases, tend to be of long duration and are the result of a
combination of genetic, physiological, environmental and
behaviors factors.
• The main types of NCDs are cardiovascular diseases (like heart
attacks and stroke), cancers, chronic respiratory diseases (such as
chronic obstructive pulmonary disease and asthma) and diabetes
2/28/2021 4
5. Global scenario:
• Non-communicable diseases (NCDs) kill 41 million people each
year, equivalent to 71% of all deaths globally.
• Each year, 15 million people die from a NCD between the ages of
30 and 69 years;
• over 85% of these "premature" deaths occur in low- and middle-
income countries.
• Cardiovascular diseases account for most NCD deaths, or 17.9
million people annually, followed by cancers (9.0 million),
respiratory diseases (3.9million), and diabetes (1.6 million).
• These 4 groups of diseases account for over 80% of all premature
NCD deaths.
2/28/2021 5
6. Global Impact of NCDs
• In economic terms, Harvard School of Public Health said while
introducing a new study, non-communicable diseases would cost
the world $47 trillion in lost income in the next two decades
• An increase in life expectancy which places larger proportions of
the population in the age range (60 years and older) in which
chronic degenerative diseases become the major determinants of
health status
2/28/2021 6
7. Global Impact…..
• Epidemiological transition in diseases may also be brought about
by shifts in social and economic patterns which favor detrimental
changes in risk factors for the chronic degenerative diseases.
• Such changes may include health-related behaviour which
augments dietary consumption of fats and alcohol, increases
obesity, increases smoking and decreases physical activity.
• Currently more chronic disease deaths in developing than
developed countries and that as expectation of life increases in
developing countries the global chronic disease burden will be
greatly concentrated in the developing countries.
2/28/2021 7
8. SEAR Scenario:
• NCDs mainly CVD, chronic respiratory diseases, diabetes and cancer are top killer
in SEAR, claiming an estimated 8.5 million livers each year.
• One third of these death are premature and occur before the age of 70 year
• 48% of all deaths from NCDs in the Region are below 70 years of age.
• 8.5 million people die of non-communicable diseases every year.
• 62% of all death in the region are due to NCDs
2/28/2021 8
9. National scenario of NCD
• NCDs are estimated to cause 66% of al deaths in 2016.
• Death caused by four main NCD groups:
i. Cardiovascular Disease- 30%
ii. Cancer-9%
iii. Diabetes-4%
iv. Chronic Respiratory Disease- 4%
Sources-- Nepal- STEPS Survey 2019.
2/28/2021 9
10. Trends of Some NCD in Nepal:
Source: DoHS Annual Report 2075/76
2/28/2021 10
12. Introduction:
• Chronic kidney disease (CKD) is a long-term condition where the kidneys don't
work as well as they should.
• It's a common condition often associated with getting older. It can affect anyone,
but it's more common in people who are black or of south Asian origin.
• CKD can get worse over time and eventually the kidneys may stop working
altogether, but this is uncommon. Many people with CKD are able to live long
lives with the condition.
2/28/2021 12
13. Global scenario:
• In 2017, the global prevalence of CKD was 9.1% (697.5 million cases).
• In 2017, CKD resulted in 1.2 million deaths and was the 12th leading cause of
death worldwide.
• Prevalence of CKD was higher in women and girls (9.5%) than in men and boys
(7.3%).
2/28/2021 13
15. National Scenario of CKD:
• The overall prevalence of chronic kidney disease was 6.0%. CKD increased with
age and was highest at 60 years and above with 11.5%. Prevalence in males
(6.5%) was slightly higher than females (5.7%).
2/28/2021 15
17. Prevention of CKD:
Primordial
Prevention
Prevention of risk factors, healthy lifestyles
Primary Prevention
Identification of high risk person, manage obesity,
improve glycemic and BP control, avoid high salt diet,
encourage healthy food and lifestyles.
2/28/2021 17
18. Prevention of CKD:
Secondary
Prevention
Early CKD detection, BP Control, lower protein and
higher plant- based diet, avoid AKI( acute Kidney Injury)
Tertiary Prevention
Fluid management, cardiovascular and nutritional
therapy, pharmaco –therapy, dialysis, kidney
transplantation, supportive care
2/28/2021 18
20. Introduction:
• Cancer refers to any one of a large number of diseases
characterized by the development of abnormal cells that divide
uncontrollably and have the ability to infiltrate and destroy normal
body tissue. Cancer often has the ability to spread throughout your
body.
2/28/2021 20
21. Global scenario:
• Cancer is the second leading cause of death globally, and is
responsible for an estimated 9.6 million deaths in 2018. Globally,
about 1 in 6 deaths is due to cancer.
• Approximately 70% of deaths from cancer occur in low- and
middle-income countries.
• The most common causes of cancer death are cancers of:
• Lung (1.76 million deaths)
• Colorectal (862 000 deaths)
• Stomach (783 000 deaths)
• Liver (782 000 deaths)
• Breast (627 000 deaths)
2/28/2021 21
23. National Scenario:
• Cancer mortality in Nepal is higher in females as compare to males- 7400 and
6900 respectively
• Based on hospital data 8000-10000 of new cases are identified every year in
Nepal
• A total of 13997 cases were reported in OPD attending patients all over Nepal
according to DoHS 16/17.
2/28/2021 23
25. National Data:
Males Females Both Sexes
Population 13348435 29136808 29136808
No. of new cancer Cases 8943 11565 20508
Risk of developing cancer Before the
age of 75 (%)
8.1 8.6 8.4
No of cancer deaths 6244 7385 13629
Risk of dying from cancer before the
age of 75 (%)
6.0 5.8 5.9
5 year Prevalent cases 15073 21833 36906
Top 5 most frequent Cancers (
Ranked by Cases)
Lung
Stomach
Colorectum
Lip. oral
cancer
Thyroid
Cervix uteri
Breast
Lung
Gallbladder
Ovary
Lung
Cervix Uteri
Breast
Stomach
Colorectum
Sources---Nepal- Global Cancer Observatory
2/28/2021 25
26. Causes of Cancers:
A. Environmental factors:
• Tobacco
• Alcohol
• Dietary factors
• Occupational exposure
• Virus
• Parasites: Schistosomiasis causes Cause cancer of bladder
• Factors like sunlight, radiation, medications like oestrogen, pesticides
are related to cancer
2/28/2021 26
27. Contd……
B. Genetic factors: Mongols are more likely to blood cancer than
children of others
C. Age
2/28/2021 27
28. Prevention of cancer:
Primordial Prevention:
• Efforts to be directed towards discouraging children from
adopting harmful lifestyles.
Primary Prevention:
• Control of tobacco and alcohol consumption
• Personal hygiene
• Minimize exposure to radiation
• Foods, drugs, cosmetics tested for carcinogens
• Cancer Awareness
2/28/2021 28
29. Secondary prevention:
• Action which halts the progress of a disease at its incipient stage
and prevent complications.
Tertiary Prevention
• Tertiary prevention refers to care aimed at reducing morbidity and
disability in people diagnosed with, and being treated for disease.
2/28/2021 29
31. Introduction:
• Chronic obstructive pulmonary disease is the name for a group of lung conditions
that cause breathing difficulties. It includes : emphysema-damage to the air sacs
in the lungs. Chronic bronchitis- long term inflammation of the airways.
2/28/2021 31
32. Global scenario:
• The Global Burden of Disease Study reports a prevalence of 251
million cases of COPD globally in 2016.
• Globally, it is estimated that 3.17 million deaths were caused by the
disease in 2015 (that is, 5% of all deaths globally in that year).
• More than 90% of COPD deaths occur in low and middle-income
countries.
2/28/2021 32
33. National Scenario
Source--DoHS Annual Report 75/76
Fiscal
year
Province
1
Province
2
Bagmati
Province
Gandaki
Province
Province
5
Karnali
province
Su. Pa
Province Total
2072/73 21817 14590 60485 35978 33960 14136 20263 201229
2073/74 24014 12848 74478 34368 28148 14652 21663 210171
2074/75 33234 18805 78350 32039 38705 19833 24802 231685
2075/76 33234 18805 78350 32039 38705 19833 24802 245768
2/28/2021 33
34. Factors for COPD:
1. Smoking
2. Air pollution ( Indoor and outdoor)
3. Occupation: coal mine, cement factory
4. Socioeconomic status
5. Respiratory infection of childhood
6. Family and genetic factors
• α1 Anti-trypsin deficiency cause emphysema
• LBW is a risk factors of COPD
7. Respiratory infection
2/28/2021 34
36. Host factors:
• Age: Middle and older age
• Gender : more male due to more exposure
• Race: Asian people have low susceptibility
• Occupation related to smoke and dust
2/28/2021 36
37. Prevention of COPD:
1. Primordial Prevention:
• Avoidance of tobacco, smoke and other inhaled particulates and toxins.
2. Primary prevention:
• Discouragement of cigarette smoking
• By legal approach: banned at public place
• Promotion of electric and safa tempoos
• Forestation
• Bypass road
2/28/2021 37
38. Secondary prevention:
• Early detection and prevention of COPD cases
• Proper mgmt. with drugs and oxygen
• Timely mgmt. by bronchodilators, antibiotics, steroids,
mechanical ventilator support.
Tertiary prevention:
• Physiotherapy
• Oxygen therapy
• Lung transplantation
• Rehabilitation patient by change in occupation
2/28/2021 38
40. Global Scenario:
• According to the World Health Organization (WHO), CVD is the
leading cause of death worldwide.
• In 2016, around 17.9 million people died from CVD, accounting
for 31% of all registered premature deaths.
• Of these, 85% resulted from a heart attack or stroke. These
conditions affect equal numbers of men and women.
• The WHO estimate that by 2030, 23.6 million people will die
from CVD conditions annually — mostly due to stroke and heart
disease.
• Although these conditions remain prevalent in global mortality
rates, people can start taking steps to prevent them.
2/28/2021 40
41. South East Asia Scenario
• Cardiovascular Diseases (CVDs) account for 27% of all
deaths in the Region.
• In Nepal various studies have shown that the prevalence of
hypertensions in adult population is around 20% in urban
population
• In 2003, the prevalence of CHD in India was estimated to be
3-4 % in rural areas, and 8-10 % in urban areas, with a total
of 29.8 million affected.
• In Pakistan, one third of people of aged 45 years or above
have HTN. In Sri Lanka the prevalence of HTN was estimated
to be 17% in urban and 8% in rural areas.
2/28/2021 41
42. National Scenario:
• According to Government Report CVD is the leading cause of Death.
• In 2017, CVDs contributed to 26·9% of total deaths.
• Ischemic heart disease was the predominant CVDs
2/28/2021 42
44. Primordial
Prevention
Primary Prevention
Prevention of risk factor of CVD, such as efforts aimed to
prevent HTN, obesity
Modification of these and other known risk factors, is
aimed at preventing the clinical manifestation of CVD
Prevention of CVD:
2/28/2021 44
45. Secondary Prevention
Tertiary Prevention
Focuses on those who already have manifestation of
disease, but where aggressive control of risk factors can
have a major impact in preventing recurrences of diseases.
Use of coronary interventional procedures such as
coronary angioplasty, stent, bypass surgery, pacemakers,
defibrillators, and left ventricular assist devices (LVAD)
Prevention Contd…
2/28/2021 45
47. Introduction:
• Diabetes is a chronic disease that occurs either when the pancreas does not
produce enough insulin or when the body cannot effectively use the insulin it
produces.
• Insulin is a hormone that regulates blood sugar.
• Adults with diabetes have a two- to three-fold increased risk of heart attacks and
strokes .
2/28/2021 47
48. Global scenario:
• WHO estimates that diabetes was the seventh leading cause of death in 2016. In
2016, an estimated 1.6 million deaths were directly caused by diabetes.
• 1 in every 2 people with diabetes globally remain undiagnosed.
• According to WHO, an estimated 91 million population in the Southeast Asia
region have diabetes and around 49 million are still unaware of their condition.
2/28/2021 48
49. South East Asia Scenario:
• 88 millions of age group 20-79 are living with diabetes in the
SEA region in 2019. this figure is estimated to increase to
1153 million by 2045 acc. to IDA.
• Diabetes was responsible for 1.2 million deaths in SEAR in
2019.
• 1 in 4 live births in the SEAR are affected by hyperglycaemia
in pregnancy.
Sources-- IDA
2/28/2021 49
50. National Scenario:
• In Nepal total 36.5 percent people suffered from NCDs out of them 10 per cent
are suffered from diabetes.
• According to Nepal Diabetes association(NDA) Among people aged 2o years and
older living in urban areas, 15 per cent are affected by diabetes.
• Among people aged 40 years and older in urban areas this number climbed upto
19 per cent.
• Prevalence of diabetes in Nepal is 9.1 per cent.
• Obesity is found to be a cause of diabetes among 16.6 per cent female population
and 13.6 per cent male as stated by World Health Organization
2/28/2021 50
52. Prevention of DM:
Maintenance of normal
body weight through the
adoption of healthy
nutritional habits and
physical exercise
Primordial
Physical activities aimed at
preventing diabetes from
occurring in susceptible
population
Primary
2/28/2021 52
53. Prevention of DM Contd….
Early diagnosis and
effective control of
diabetes in order to
delay the progress of the
disease.
Secondary
Prevent complication
and disabilities due to
diabetes.
Tertiary
2/28/2021 53
56. Global Scenario:
• Each year, 1.35 million people are killed on roadways around the
world
• Every day, almost 3,700 people are killed globally in crashes
involving cars, buses, motorcycles, bicycles, trucks.
• 93% of the world's fatalities on the roads occur in low- and middle-
income countries, even though these countries have
approximately 60% of the world's vehicles.
• Road traffic injuries are the leading cause of death for children and
young adults aged 5-29 years.
2/28/2021 56
57. South East Asia Scenario
• Road traffic injuries kill approximately 316 000 people each year in WHO's South-
East Asia Region
• These deaths account for 25% of the global total of road traffic deaths.
• The South-East Asia region has a road traffic death rate of 17.0 per 100 000
population, compared to the global rate of 17.4
https://www.who.int/violence_injury_prevention/road_safety_status/2015/Road_S
afety_SEAR_3_for_web.pdf
2/28/2021 57
59. Epidemiological factors:
A. Agent Factors (Vehicle)
• Old and poorly maintained vehicles
• No mirror and side lights
• No horns
• Uncomfortable interiors
• Excess speed
• Low driving standards
• Gas leaks e.g. CO when leaked into driver compartment makes
him unconscious leading to accident
2/28/2021 59
60. Epidemiological factors Contd..
B. Host Factors ( Human):
• Age : Younger ( over excitement) Older age group ( poor sight and
hearing)
• Sex: males are higher risk due to high exposure
• Education : High in illiterate due to ignorance
• Medical condition: sudden heart failure, epileptic seizure
• Fatigue: long route driving
• Psychological factor
• Loss of body protection: Helmet, seat belt
• Loss of attention : mobile, opposite sex
• Not obeying traffic rules etc.
2/28/2021 60
61. Epidemiological factors Contd…..
C. Environmental Factors:
• Related to roads: narrow and turning road, no traffic signs, poor
lighting, defective speed breakers, unfamiliar road
• Weather condition: rain, fog, mist, storm
• Mixed traffic
• Inadequate enforcement of the existing law
• Social pressure: use of stolen vehicle, festival
• Others : alcohol and drugs,
2/28/2021 61
62. Prevention of accidents:
• Safety education
• Promotion of safety measures: seat belt. Helmet, leather clothing and
boots, children in rear seat, use of door locks
• Alcohol and other drugs prohibited during driving
• Primary care – Trauma Hospital
• Elimination of causative factors- improve road, speed limit, marking of
danger points, provision of fire guards
• Law enforcement
• Research related to RTA
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smoked fish and meat is related to stomach cancer, fiber to intestinal cancer, high biber diet to breast cancer
accounts 1-10% of all cancers. It includes exposure to arsenics, Cadmium, benzene etc
HPV for cervial cancer, Hep. B and C are related to hepatocellular cancer
Cancer registration (Hospital &Population based)
Early detection of cases
Screening and Treatment
Chronic obstructive pulmonary disease (COPD) is a progressive lifethreatening lung disease that causes breathlessness (initially with exertion) and predisposes to exacerbations and serious illness.
Refers to a group of diseases that cause airflow blockage and breathing-related problems