This document discusses epidemiology of non-communicable diseases, specifically accidents, road traffic accidents, home accidents, occupational accidents, and substance abuse. It notes that accidents are unexpected events that cause injury, death or property damage. Road traffic accidents are a leading cause of death in developing countries. Home accidents commonly involve burns, falls, electric shocks, wounds and poisoning. Occupational accidents are work-related injuries and the document outlines various risk factors. Substance abuse is also discussed, including types of drugs, risk factors, impacts, and prevention strategies. Prevention is addressed at primary, secondary and tertiary levels.

1. EPIDEMIOLOGY OF NON
COMMUNICABLE DISEASES
(NCDS) PART2
By Alaa Nouh
Under supervision
Of
Prof Dr. Mona Aboserea
Zagazig university

2. ACCIDENTS

3. It is unexpected, unplanned event that produces injury, death,
property loss or damage.
• An increasing problem in both developed & developing countries.
• It is the 2nd leading cause of deaths in developing countries
Road traffic accidents Home accidents Occupational accidents Natural disaster
Birth injuries Sport injuries War accidents

4. ROAD TRAFFIC ACCIDENTS
Injuries such as laceration, contusions, bleeding, paralysis,
fractures, and amputation are common.
Death is commonly associated with road traffic accidents.
Egypt loses about 12 000 lives due to road traffic crashes every year.
It has a road traffic fatality rate of 42 deaths per 100 000 population.

9. RISK FACTORS
Road defects:
Narrow
Crowded
Inadequate
lightening
Lack of traffic
signs
Vehicle defects:
Old models
Bad maintenance
Variability in size.
Host factors
(driver):
Impaired alertness.
Inadequate
training.
Negligence of
wearing seat belts
or helmets.
Psychic upset.
Pedestrian:
Extreme of age
Impaired alertness
Negligence of
traffic signals
Obesity.

10. PREVENTION OF ROAD TRAFFIC ACCIDENTS
Roads:
Town planning.
Good lightening.
Sufficient traffic
signals.
Drivers:
Proper medical
examination
before license.
Sufficient
training.
Using seat belt,
wearing helmets.
Pedestrians:
Raising
awareness.
Vehicles:
Periodic
maintenance.
Strict
legislations.

11. HOME ACCIDENTS
Burns
• Fire
• Boiling fluids
• Matches.
Falls
• On stairs
• Striking against
furniture
• Slippery floor.
Electric
shock
• Neglected
maintenance
• Exposed wire.
Wounds
• Sharp knives
• Pointed articles.
Chemical
poisoning
• Drugs
• Caustic soda
• Detergents.
Collapse of
old
buildings.
Animal bites

12. RISK FACTORS
Extreme of age. Epilepsy
Fainting
Loss of
consciousness.
Over
confidence in
repairing
electric
appliance.
Unsafe building
Bad
illumination
Slippery floor
or stairs.

13. PREVENTION
Storage of medications
& toxic substance in
closed places.
Close windows &
balcony
Matches, sharp knives
should be put in
hidden places.
Children should not
stay with mothers in
kitchens.
Proper arrangement of
furniture & using non
slippery tiles.
First aid must be
present in every house
Drying floor. Cover the electric plug
opening in the wall

14. OCCUPATIONAL ACCIDENTS
Accidents
occurring
during work
including acts
of violence
which result in
• a) fatal injury
• b) non-fatal
injury.
At risk group
• Construction
workers,
agricultural
workers, miners,
industrial
workers etc…
Common
body parts
injured
• Upper & lower
limbs, trunk,
back, head &
neck.
Injury nature
• Cuts, lacerations,
contusions,
sprains, strains,
fractures, &
burns.

16. Personal
factors
• Age
• Sex
• Lack of training
• Negligence of
wearing PPE
• Poor physical &
mental health
Environmental
factors
• Poor ventilation
• Poor illumination
• ↑ or ↓
temperature
• Noise
• Crowded places.
Machinery
factors
• Unshielded
• Exposed
electricity
• Poor maintenance
• Lack of safety
measures.
Working
conditions
• Prolonged
working hours &
inadequate rest
hours.
• Lack of training.
• Lack of
supervision.
• Poor
communication

17. INDICATORS OF OCCUPATIONAL ACCIDENTS

18. IMPACT OF ACCIDENTS ON WORKERS, INDUSTRY, AND
ECONOMY
Impaired
health,
disability &
handicapping,
& death.
Psychic
problems
(PTSD).
↑ absenteeism
& ↓
productivity.
↑ expenses on
medical care,
rehabilitation
&
compensation.

19. PREVENTION OF OCCUPATIONAL ACCIDENTS
• Improving work environment.
• Good machinery design, safety & good maintenance.
• Health education of workers & proper training before work
• Prevention of fatigue & solving psychological troubles.
• ttt of any illness & good nutrition.
• Research studies.
1ry prevention
• 1st aid & emergency services for proper management of injuries at all work places.
2ry prevention
• Change the job of injured worker & proper training
• Artificial limb in amputation & special aids for handicapped workers.
3ry prevention

21. IMPORTANCE OF MENTAL HEALTH
Nearly ½ the world's populations are
affected by mental illness (WHO)
Impact on their self-esteem,
relationships & ability to function in
everyday life.
Everyday stress & even rapid
technological advances make most
people under marked stress
Good mental health can enhance
one’s life, while poor mental health
can prevent someone from living a
normal life.

22. Mental Health
• State of well-being in which the
individual:
• Realizes his own abilities,
• Cope with normal stresses of life,
• Can work productively
• Able to make a contribution to
community.
Mental Illness
• Any disease or conditions that
affect way a person
• Thinks,
• Feels,
• Behaves
• Ability to relate to others & to
surroundings

23. CRITERIA OF INDIVIDUALS WITH GOOD MENTAL
HEALTH
Emotional
balance.
Social
adjustment.
Perceiving
things the way
they are.
Achievements
consistent
with the
individual's
abilities &
opportunities.

24. RISK FACTORS OF MENTAL DISORDERS
Sex Infections Genetic predisposition Age

25. Toxic
substances
Environmental
exposure
Homeless
Family problems
& loneliness
Malnutrition

26.  ↓ Iodine during pregnancy & ↓ O2 at birth, injuries & early childhood brain
infections → MR.
 Nutritional deficiencies “PEM” → MR.
 Depression interacts with CVDs & vice versa.
 Anxiety, depression & substance abuse can also complicate existing physical
disorders.
INTERACTION BETWEEN PHYSICAL & MENTAL HEALTH
PROBLEMS

27. Schizophrenia
Psychosis &
depression
Behavioral disorders as
maladjustment & absenteeism.
Psychopathic disorders:
aggressive antisocial acts
Impaired
intelligence
TYPESOFMENTALDISORDERS

28.  Mental illness & poor mental health are public problems
 Great impact on:
THE IMPACT OF MENTAL DISORDERS

29. Individuals
• Distressing symptoms.
• Unable to participate in
work & leisure.
• Poor QoL: stigma &
discrimination.
Family
• Economic burden
• Disruption of house
hold routine &
restricted social
activities.
• Lost work & social
opportunities.
Community
• Cost of providing care.
• Loss of productivity.
• Legal problems
including violence.

30. 2ry
3ry
1ry
Prevention of Mental Illness

31. PRIMARY PREVENTION
Mental health
promotion
• Mental health educational
programs.
Genetic counseling,
antenatal & natal care
• Ensure normal fetal
development.
Public health-related
factors
• Education, employment,
social well-being
• Availability of suitable
food & housing

32. PRIMARY PREVENTION
Raising public awareness
• Patients need ttt & kind care.
Awareness of psychological
development
• Development of human
being's cognitive, emotional,
intellectual & social
capabilities.
Life skills education &
training
• Interpersonal communication
skills
• Decision-making & critical
thinking skills
• Stress management.

33. • Screening: Early
detection.
• Early diagnosis.
Detection of mental
disorders/illness in PHC
• Complete psychiatric
assessment.
• Counseling,
psychotherapy &
medical ttt.
• Admission to
psychiatric
word/hospital.
Proper management and/or
referral to a psychiatrist
• Wars, disasters &
crisis.
• Social support
improves the course
of the disease & ↓ its
duration & intensity
& enhances rapid
recovery
Crisis intervention
Intervention undertaken to reduce complications & all specific ttt.
SECONDARY PREVENTION

34. Needy/disabled
group
• ↑ Self-esteem & confidence.
• ↑ Opportunities for physical & socio-economic integration.
Family &
Community
•↑ Society understanding of causes of disabilities & abilities “Public
information campaigns →↓Stigmatization”.
•Communicate to parents about disabilities of their disabled children.
•Providing facilities/ services-day care centers & counseling sites to families
& Improve physical accessibility to public places.
•Create incentives for employers to hire disabled people.
•Training HCWs about their needs & Improving approach toward them.
Interventions that ↓ disability & all forms of rehabilitation + prevention of relapses of
illness. The integration of needy groups in the society is needed.
TERTIARY PREVENTION

35. MENTAL HEALTH PROGRAM IN EGYPT:
In Egypt the national mental health program focuses on:
Decentralization of MH care
& community care in
different governorates.
Inclusion of mental health in
PHC.
Training of family doctors to
deal with main mental
disorders.
Awareness-raising among
public regarding recognition
of mental disorders &
methods of referral.
The new policy may ↓ no. of psychiatric inpatients.
After-care services are still limited because of the poor understanding of most
people

36. SUBSTANCE ABUSE

38. Substance abuse “drug abuse”
• Any use of non prescribed, non controlled substances or drugs without medical
reason.
Drug Dependence
• State of psychic or physical dependence (or both) on a drug occurring after
periodic or continuous administration of that drug.
Tolerance
• Need for increasing the dose of a drug to reach the original effect of it.
Psycho Active Drugs
• Exogenous substances that affect CNS for calming, energizing or pleasurable.
• Excessive use of these drugs leads to tolerance.
Addicted Person
• Person who is unable to free himself from a harmful habit or he is unable to stop
that habit.

40.  In Egypt, drug abuse is considered one of the most serious public health
problems, especially among the young people at working ages.
 In Middle Eastern Arab countries, there is scarce information on mental
health issues, including drug dependence. This is related to the context
of the conservative nature of these societies that reject disclosing about
drug intake as well as to stigmatization.
Magnitude of the problem

42. Narcotics
• Morphine, Heroin & Codeine
• Strong psychic dependence & early physical
dependence & tolerance.
• Euphoria, ↓pain perception, nausea, constipation,
RC depression & visual disturbance.
Depressant
• Alcohol & Barbiturates.
• Psychic dependence, sedation, hypnosis,
anesthesia, muscle relaxation & sleep
Stimulants
• Amphetamine & Cocaine.
• Excitatory for CNS, alertness, euphoria,
motor activity, depression of appetite & large
doses cause convulsions
Hallucinogens
• LSD & Mascaline
• Distort perception of time & distance, induce
delusions & hallucination.
• Alter mood & may cause psychotic episodes
Cannabis
• Hashish & Marijuana & Bango.
• Affect cognition, memory & mood
• Deterioration of self perception & sensation of
time
TYPES OF PSYCHO ACTIVE DRUGS

44. Risk factors of drug addiction
Drug pharmacological
effects, “highly
addictive drug”.
Availability & easy
accessibility of drugs.
Gender.
Psychic & neurological
illness.
Family history of
addiction.
Lack of family
involvement.
Anxiety, depression
and loneliness.
Peer pressure.

46. IMPACTS OF DRUG ABUSE
Health problems &
Communicable disease
“HIV, HBV”.
↑ Accidents.
Unconsciousness, coma &
sudden death.
↑ Crime & Violence &
Suicide.
Family problems.
↓School performance &
motivation.
↓ Work performance + ↑
Absenteeism
Financial problems

47. PATTERN OF SUBSTANCE ABUSE IN EGYPT
• Cannabis, Opium, Hypnoseditives, Heroin, and Cocaine.
1980s
• Cannabis, Alcoholic beverages, Synthetic psychoactive drug.
1990s
• Cannabis became prevalent in the form of Bango “leaves of Cannabis sativa”.
• This plant is increasingly widely cultivated in Egypt, especially in Sinai Peninsula.
2nd half of the 1990s
• Tramadol “Scheduled drug”, milder synthetic opioid painkiller similar to morphine.
• Easily accessible at cheap costs from the black market
• 30% of males “14-30 years” “Students, laborers & professionals” use it regularly “For
Premature ejaculation & for extended orgasm & increase sexual pleasure”
Since 2007

48. 70 % of admissions to the addiction wing of Cairo’s massive Qasr el-Aini
hospital were linked to tramadol in 2014 alone.

49. PREVENTION OF DRUG DEPENDENCE
2ry
3ry
1ry

50. PRIMARY PREVENTION
Empower laws
& legislations.
Health
education.
Encourage
youth for
physical
exercise & safe
recreation
activities.
Suitable
management of
family & social
problems.
Parental
supervision &
control
influence of
peers.

52. SECONDARY PREVENTION
Early diagnosis &
continuous
supervision.
Hospitalization of
severe cases.
Hot line service “rapid
management &
confidential service”.
Follow up of
recovered cases.

53. TERTIARY PREVENTION
Rehabilitation of addicts, find suitable jobs & no community
stigma