Non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, respiratory diseases, and diabetes account for the majority of deaths globally. The document discusses NCDs in depth, including their definition, common risk factors, reasons for their increasing prevalence, and strategies for prevention and management. The key strategies discussed are health promotion through lifestyle changes, early detection via screening programs, and proper long-term medical management of diagnosed cases.

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

2. LEARNING OBJECTIVES:
1. To understand the definition, risk factors & prevention of the NCDs
& to recognize the epidemiology of some common NCDs.
2. To understand the types, risk factors & prevention of accidents.
3. To Recognize the definition of mental health &mental illness, to
describe the risk factors affecting mental health, to identify the
interaction between physical and mental illness, & to understand
different levels of prevention in mental health.
4. To understand the magnitude, new trends in Egypt, risk factors,
consequences, and prevention of substance abuse.

3. DEFINITION OF NCD
Non-infectious & Non-
transmissible between
persons.
Mostly chronic diseases
of long duration & slow
progression which require
chronic care management.

5. CVDs
56%Cancer
25%
Resp.dis.
14%
DM
5%
The leading causes of NCD deaths in 2008

7. COMMON RISK FACTORS OF (NCDS)
Almost all NCDs have unknown cause, but they have some related RFs.
• Genetics
• Age
• Sex
• Race
Non
modifiable
• Smoking
• Alcoholism
• Unhealthy diet
• Physical inactivity
• Stress
• Environmental pollution
• Socio-economic conditions
Modifiable

8. WHO global status Report 2014: identified 5 important RFs for NCDs
in the top 10 leading risks to health.
↑ Blood pressure ↑ Cholesterol level Tobacco use
Alcohol
consumption
Overweight
Insufficient
physical activity.

11. REASONS OF THE INCREASING PREVALENCE OF NCDS
Demographic
transition
Epidemiologic
transition
Nutritional
Transition
Multi-factorial
nature of RFs
Migration
International
communication
Environmental
changes
Epidemiology of
NCDs differs
across countries
Epidemiology of
NCDs changing
all the time
Limited use of
scientific
progress in
management

12. Transition
Items
Demographic Epidemiologic Nutrition transition
Past
situations
-↑ Fertility
-↑ Mortality
↑ Infectious diseases ↑ Under nutrition
Interventi
ons
-Family planning
-Prevention & control
of infectious disease
-Env. sanitation
-Immunization
-Antibiotics
-Insecticides
Food production
Reducing Famines
Shift To -↓ Fertility
-↑ Life expectancy
-Aging
-↓ Infectious diseases
-↓ Mortality from
infectious diseases
↑ intake of saturated fat
& refined carb. + ↓
dietary fibers
Present
situation
NCDs associated with
aging.
NCDs predominates ↑ Obesity “↑ fat &
carb. intake +
Sedentary life”

13. • Compared to communicable diseases are difficult to identifying the specific cause-
effect relationship.
• RFs Multiplicity limit the opportunities to have specific intervention for prevention
& control.
• RFs are difficult to be controlled by medical technology (in communicable diseases ,
immunization & antibiotics are effective in prevention & control of diseases)
• RFs are related to genetic, environmental, culture and behavior which represent a
challenging issue to public health programs.
Multi-factorial nature of the risk factors for NCDs

14. Migration from low risk culture (e.g. rural areas) to high risk culture
(e.g. Urban areas ) follow the new life style → ↑NCDs risk.
Migration of population across different cultures

15. International
communication,
multinational business &
new food technologies →
new life-style & new food
products.
Communication through
the mass media∕ satellites∕
internet, overseas travel,
and international food
marketing → Introduction
of different concepts &
dietary pattern.
Adolescents & youth are
population segments who
are exposed to such
modernization in concepts
and behavior.
Early exposure →
development of large
cohort with health
problems during
adulthood & older age.
International communication

16. Environmental changes

17. Place
• Differences in prevalence of
RFs (genetic, environmental,
cultural & behavioral) across
countries → Limitations for
generalization.
• National Public health
specialists should have specific
surveillance system for different
NCDs (e.g. ↑ spicy food
→↑peptic ulcers & stomach
neoplasm).
Time
• Some countries succeeded in
improving pattern of some
NCDs (i.e. ↓ coronary heart
diseases by extensive anti-
smoking programs).
Epidemiology of NCDs differs across countries &changing all the time

18. Rapid & successful achievements in the science of risk detection, use
of medication & technologies to prevent & control NCDs.
However, in the developing countries high cost of NCDs prevention &
control programs is challenging.
Limited use of scientific progress in management of NCDs

19. 3ry
Rehabilitate the complicated cases
2ry
Early detection of cases “Screening tests” Proper management
1ry
Health promotion & Health
education
Healthy life style
Enhancing the role of laws &
governance
PREVENTION OF NCD

20. Health promotion &
Health education
Adopting healthy
life style
• Balanced diet
• Physical activity
• Social activity
• Avoid SAD
“Smoking, Alcohol,
Drugs”
• Living in a healthy
environment
Enhancing the role of
laws & governance
• Improving access to
ttt
• Addressing social
impacts of illness (↑
taxes on tobacco,
Smoking bans in
public places,
Improving food
labeling).

21. HPN DM CVDs
Cancer cervix Cancer breast Cancer liver
Screening tests

26. EGYPT NATIONAL MULTISECTORAL ACTION PLAN FOR
PREVENTION & CONTROL OF NCD 2018-2022 (EGYPT MAP-NCD)
Framework Element Baseline Target 2021 Target 2025
Premature mortality from NCD 25% 15% relative reduction 20% relative reduction
Physical inactivity 32.1% 5% relative reduction 10% relative reduction
Salt/sodium intake 12.8 g/day 20% relative reduction
(10.0 g/ day)
10% relative reduction
(9.0 g/ day)
Tobacco use 24.4% 10% relative reduction
(22.0 %)
20% relative reduction
(20 %)
Raised blood Pressure 39% 15%relative reduction
(33%)
10 %relative reduction
(30%)
Diabetes & obesity 17.2% DM
31.3% Obesity
Halt the rise in DM & obesity
Drug therapy to prevent CVD *N/A % 10 % coverage 15% coverage
Essential NCDs medicines & basic
technologies to treat major NCDs
60% 70% availability 80 % availability
*As there is currently no available baseline data, the approach will be piloted in selected PHC settings.

32. HYPERTENSION

33. Hypertension “HPN” is one of the major risk factors for
CVDs.

34. TYPES & RF OF HYPERTENSION
1ry
No identified
cause (in most
cases).
Genetic or
familial
tendency.
Middle age
Males but equal
sex incidence
after menopause.
↑Cholesterol &
LDL or ↓ HDL.
Unhealthy
lifestyle
Smoking
Alcohol intake
Physical
inactivity
Stress,
↑ Salt, ↓ K
intake
Obesity
DM
2ry
Renal &
endocrine causes
Hormonal &
drug intake.

38. SCREENING TESTS FOR HPN
For screening purpose in the
community-based epidemiological
cross-sectional studies, these
standards could be used.
2 readings should be taken at least 5
minutes apart & average result
represents current Bl.Pr.
measurement
In the medical settings, diagnosis of
HPN depends on findings of Bl.Pr.
levels for >2 times few weeks apart.

39. COMPLICATIONS

40. Life style
modifications
(key management)
as ↓weight,
avoidance of
smoking & alcohol
intake, dietary salt &
fat restriction,
avoidance of stress
& keeping physical
exercise.
Early detection
Frequent blood
pressure
measurements after
age of 40 years.
Antihypertensive
drugs
If the lifestyle
modifications are
ineffective alone or
the level of HPN at
the start is so high.
Management of
causes of 2ry HPM.
Prevention

41. DIABETES MELLITUS

43. It is a common metabolic disorder of
impaired carbohydrate utilization by
the body due to insulin deficiency.
• Intermediate
conditions
between normality
& DM.
• At high risk of
progressing to
T2DM.
Impaired
Glucose
Tolerance
(IGT) &
Impaired
Fasting
Glycaemia
(IFG)

45. Age
• IDDM: young age
• NIDDM and glucose
intolerance: old age .
Sex
• Both sexes are equal.
• Males “stress”
• Females “pregnancy &
obesity”.
Race/ethnicity
• Native American, African
American, Latino, Asian
American, Pacific Islander
Obesity
• 80% of NIDDM patients
are obese.
Genetic or familial
tendency
• Children whom parents are
diabetic.
Autoimmunity
• To islet cells of pancreas.
Stress
• Trauma, operation,
depression, anxiety or
severe infection.
Pancreatic disorder
• Viral Infection (mumps,
coxsackie, enterovirus)
• Cancer pancreas
• Pancreatectomy.
Drugs
• Diuretics
• Corticosteroids
• Contraceptive pills.
Hormone
disturbance
• ↑ Thyroid & Growth
hormones “insulin
antagonistic action”.
RFs

46. Non-modifiable RF for T2DM Modifiable RF for T2DM

49. LABORATORY DIAGNOSIS OF DM

56. 1ry prevention: Prevent predisposing factors. Dietary
education. Screening youth: children & adolescents <18 years of
age who are overweight or obese (BMI >85th percentile for age
and sex, weight for height >85th percentile, or weight >120% of
ideal for height), & have one or more additional RFs.
2ry prevention: Early case finding by screening tests for
glucose intolerance, or during check up for at risk groups.
Proper management of diagnosed cases: health education for
adherence to diet & ttt to prevent complications. Frequent check
up on retina & renal functions every 6 months & diet regimen.

58. HEALTH TECHNOLOGY & DIABETES MANAGEMENT
Continuous glucose monitoring (CGM) technology: helps improve
glycemic control for adults with T1DM starting at age 18.

59. DIABETES MANAGEMENT IN SPECIFIC GROUPS
Individualizing pharmacologic therapy for older adults to reduce the
risk of hypoglycemia, avoid overtreatment & simplify complex
regimens while maintaining personalized blood glucose targets.

60. New guideline recommends all
pregnant women with preexisting
T1DM or T2DM should consider
daily low-dose aspirin starting at the
end of the 1st trimester → ↓ the risk
of pre-eclampsia.

62. DEFINITION
It is an abnormal proliferation of cells in any organ in the body forming
mass or tumor. It invades the surrounding tissues and destroys them.

63. RISK FACTORS
• Age: >40 years.
• Sex: males.
• Residence: urban.
• Genetic & familial
susceptibility.
Demographic
or personal
factors
• Food.
• Smoking “30%”.
• Obesity.
• Alcohol.
Life style
• Human papilloma
virus.
• HCV, HBV &
bilharziasis.
• Helicobacter pylori.
Infectious
agents
• Drugs (OCPs) &
hormones (estrogen
replacement
therapy).
Drugs &
hormones
• Asbestos &
Pesticides
• Radiation
• Pollution
• Fungi (Aflatoxin in
grains & peanuts).
Environmental
& Occupational
risks

66. PREVENTION OF CANCER
1ry
• Stop smoking & alcohol
drinking
• Avoid food preservatives,
spicy foods
• Proper storage of grains
& peanuts
• Avoid hormone intake
expect under medial
supervision
• Vaccination for HBV.
• Early ttt of any disease
• Control of environmental
pollution
• Encourage breast feeding.
2ry
• Early diagnosis:screening
tests for at risk groups.
• Breast self-examination
• Cervical smear
• Sputum or X-ray for
cancer lung
• Tumor markers
• Biopsy for benign tumors.
3ry
• Rehabilitation
• Psychological assurance
• Palliative ttt.

67. BRONCHIAL ASTHMA

71. PRIMARY PREVENTION
Stop smoking
Control of
environmental pollution
Prevention of infection
Avoidance of allergic
foods
Pre-marital examination Physical exercise Early case detection. Skin tests

72. SECONDRY PREVENTION

73. TERTIARY PREVENTION
Breathing exercises
Psychological
support
Rehabilitation