Chronic non infectious diseases that are silent and persecute mankind . non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, heart diseases, cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and other

1. OVERVIEW OF NON-
COMMUNICABLE DISEASES –
NCD’s
Sejojo Phaaroe FIBMS(UK) ; MGSc: CT(IAC) : MLSc(CNAA) : AHMP(YALE);
+266 50468036
Registered Charted -Medical Scientist- UK
Cytologist - International Academy of Cytology #6467
NLP Practitioner (Neuroscience ) Global Sciences Foundation
ISO17025 Regional Advisor- SADCAS
ISO15189 Lead Assessor , Master Trainer and Technical assessor ; SADC- EU

2. Learning Objectives
• At the end of this session participants are expected to be able to:
 Describe global burden of Non-communicable diseases
 Describe the WHO Global Strategies on Non-communicable diseases
 Decribe the regional strategy for Africa
 List additional diseases of importance in Africa
 Describe Lesotho response to burden of Non-communicable
diseases
 List NCDs Current efforts as well as documents in prevention and
control of NCD in Lesotho
 know risk factors for NCDs
 understand the importance of Integrating NCDs management with
other programmes

3. Sejojo Phaaroe
Cancer, Hypertension (HTN) and Diabetes Mellitus (DM), as well
as other non-communicable diseases (NCDs), are silent killers
and are about to overcome still highly prevalent HIV/TB , COVID
19 and maternal diseases.
MENTAL HEALTH

4. Defination

7. GLOBAL SITUATION
• The WHO NCD Strategic Plan, Global Action Plan 2013-2020, Global
Status Report on NCDs and several other documents indicated that
globally NCDs are the leading cause of death accounting for 63% of
the 57 Million deaths in 2008;
• 80% of these deaths were in low and low-middle income countries
including Lesotho .
1. The main causes were Cancer,
2. Cardio-Vascular Diseases (CVD),
3. Chronic Respiratory Diseases (CRD)
4. Diabetes.

8. MENTAL
HEALTH

10. Influence health equity in positive and
negative ways:
• Income and social protection
• Education
• Unemployment and job insecurity
• Working life conditions
• Food insecurity
• Housing, basic amenities and the
environment
• Early childhood development
• Social inclusion and non-
discrimination
• Structural conflict-VIOLANCE
• Access to affordable health services
of decent quality.
Demographic Health Survey (DHS) RUNUPS AND STEP SURVEYS
social determinants of health

11. •These diseases were also the cause of premature deaths
(below 60 years of age) with the highest age-standardized
death rates in low income countries
•(41% compared to 28% low-middle income, 25% upper
and middle income, and 13% high income countries).
NCDs

12. 4 main behavioural risk factors
• These diseases share the 4 main behavioural risk factors of
1. tobacco use,
2. Physical inactivity,
3. harmful use of alcohol,
4. and unhealthy diets.
• These diseases are increasing in a majority of low to middle income
countries.

13. road crushes

15. The 5 intermediate risk factors are
• each associated with 13%, 9%, 6%, 6%, and 5% of the deaths, respectively.
• The prevalence of the risk factors differs with income and gender,
• higher in men compared to women.
raised blood pressure, -BP
, FBS
raised blood cholesterol,
overweight ---- Wgt
obesity, ----wgt

16. ILLICIT DRUGS -Drug Screen Drug Test Substance Abuse
Testing Toxicology Screen Tox Screen Sports Doping Tests
SUBSTANCE ABUSE

17. OVERVEW OF NON-COMMUNICABLE DISEASES – NCD’s
• Noncommunicable 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
• behavioral factors.
• NCDs disproportionately affect people in low- and
middle-income countries, where more than three
quarters of global NCD deaths (31.4 million) occur
Sejojo Phaaroe

19. Population genomics
• large-scale application of genomic technologies to study
populations of individuals. are on the demand
• population genomics research is used to study human
ancestry, migrations and health including NCDs such as
CANCER, MENTAL HEALTH .
• Basically, population genomics allows Medical
Professionals to understand how groups are related over
time.
• It also allows scientists to understand our ancestral
backgrounds and how that ancestral background has been
shaped over time, in terms of the environment that our
ancestors have lived their lives.

20. Next Genomic sequencing
• Next-generation sequencing (NGS) is a new technology used for DNA
and RNA sequencing and variant/mutation detection.
• NGS can sequence hundreds and thousands of genes or whole
genome in a short period of time.
• The sequence variants/mutations detected by NGS have been widely
used for disease diagnosis, prognosis, therapeutic decision, and
follow up of patients.
• The capacity of its massive parallel sequencing offers new
opportunities for personalized precision medicine.

21. World Health Assembly (WHA)
• World Health Assembly (WHA) endorsement of the Global Strategy for the
Prevention and Control of NCDs in 2000, the need for action on NCDs was globally recognized.
• Several efforts were made at assisting member countries, examples of which are the WHO
Framework Convention on Tobacco Control (FCTC) in 2003,
• WHO Global Strategy on Diet, Physical Activity and Health in 2003,
• WHO 2008-2013 Action Plan On the Global Strategy for the Prevention and Control of NCDs in
2004,
• WHO Global Strategy to Reduce the Harmful Use of Alcohol in 2008,
• First WHO Global Status Report on NCDs in 2009/2010,
• the WHO Non-communicable Diseases Country Profiles 2011
• WHO Global NCD Action Plan 2013-2020
• (9 Global Targets and 25 Indicators).
Sejojo Phaaroe

23. AFRICAN REGIONAL RESPONSE
• The strategy for Africa further indicates that there are additional NCDs of importance
for the continent;
risk accumulation over the life course and exposure to multiple risk factors also play a contributory
role.
These additional diseases of importance include
1. Oral Disease,
2. Neurological and Mental Disorders
3. Violence,
4. Injury and Disabilities,
5. Blindness,
6. Deafness,
7. Rare diseases , ( EDS,, Hemophilia, Sickle cell disease etc)
• Further, NCDs affect children as evidenced by the 10 year study in Manhica Mozambique in which
NCDs accounted for 13.5% of deaths while injuries and chronic diseases accounted for 3.9% and
9.5% of the deaths respectively.

24. Regional framework for action on NCDs
• The regional framework for action on the prevention and control of
NCDs is the road map for countries to implement the UN Political
declaration on NCDs
• It also serves as the regional adaptation of the Global action plan
on the prevention and control of NCDs 2013–2020 (extended to
2030).
• It consists of 19 strategic interventions for countries to implement
in the four key areas of:
• governance;
• prevention and reduction of risk factors;
• surveillance , research and innovation ,
• monitoring and evaluation;
• health care system stregnthening - Capacity building

25. Lesotho Historic account -on NCDs
• Lesotho adopted the Primary Health Care (PHC) strategy in 1979.
• The community level services are delivered through Village Health Posts and
around 6000 Village Health Workers (VHWs) [CHW Inventory 2004].
• the top ten causes of Adult and Child Morbidity and Mortality include communicable and non-
communicable diseases. [AJR 2012], LDHS 2009, and Programme reports,
• The major NCDs among adults, in Lesotho, are cardiovascular diseases, diabetes, and
trauma (accidents/injuries).
• ESTIMATES
• cancer accounts for 17.2% of NCDs and 4% of all deaths in Lesotho. Based on the WHO
Global Burden of Disease
• At the same time the AJR reports indicates that from 2007 to 2009 and in 2012 a maximum of
around
• 100 and a minimum of around 80 Road Traffic Accidents (RTAs) were recorded countrywide.

26. Lesotho Priority NCD’s
• Non Communicable Diseases (NCDs) such as
1. cancer,
2. cardiovascular diseases,
3. Hypetension
4. and diabetes
• kill a considerable number of the people in Lesotho, each year as it is the case with other low
and middle income countries (LMIC).
• The rise in the number of people affected each year is putting a great pressure on the
government to provide effective solutions, maximizing the scarce resources in order to
actively screen, diagnose early and timely treat these conditions.
a) road accidents, violance and Injuries,
b) oral health ,
c) eye health
d) MENTAL HEALTH
a) and mental health disorders are also other NCDs of importance that impose strain on
Lesotho health systems.
b) Recently focus is on Rare diseases- Haemophilia , sickle cell disease , aquired aplastic ,
EDS, MRKH etc - UNIVERSAL HEALTH

27. Acquired aplastic anemias -
rare disease

28. • RARE DISEASES OF THE BLOOD
Acquired aplastic anemia is linked to-
Autoimmune disorders that lead to the
immune system to attack the bone marrow
Toxic substances, Drugs, alchohol, tobacco
Chemotherapy or radiotherapy treatment
Pregnancy
Viral infection such as Epstein-Barr virus, SVD,
Hepatitis, or HIV now COVID 19
Certain medications including some antibiotics
Cancer that affects has spread to the bone
marrow
Inherited conditions that lead to aplastic
anemia include:
Fanconi anemia
Schwachman-Diamond syndrome

29. CAPACITY BUILDING AND HUMAN RESOURCE DEMAND
• human and capital resources and shortage of critical
skills and expertise (National Health Policy 2011).
IDENTIFIED THE NEED FOR NCDs SPECIALISTS
• Oncologists, Internal medicine, Cytologists,
Radiologists, histotechnologists, Pathologists,
urologists, psychologists, Palliatice care specialists,
Surgeans, Gynacologists,Psychiatrists etc
• SOME OF US WERE SECONDED TO THE UNIT
• Necessary comprehensive training was provided to us
in and outside the Country - inservice training , Formal
• There was no Data or concrete information about the
current burden of NCD’s in Lesotho so a STEP SUVEY
was conducted 2012

30. TOTAL MALE FEMALE BEHAVIOUR
24.5% (48.7% male 0.7% female of the population above 25-64
years currently smoke,
30.7% 48.7% 14.4% take alcohol
92.7% 93.3% 92.2% take less than 5 servings of
fruits/vegetables per day
72.9% 78.7% 67.4% high level of activity
compared
11.1%, 10.4% 11.8% low level
of activity
41.5% 24.8% 58.2% were overweight
19.9% 7.9% 31.9% Obese
31% 26.3% 35.6% elevated blood pressure;
83.8% 91.8 91.8 were not on treatment
First implementation 2012 The Lesotho STEPS Survey

31. The key risk factors for NCDs were:
1. current smoking,
2. less than five (%) servings of fruits/vegetables a
day,
3. low levels of physical activity,
4. overweight,
5. elevated blood pressure.
A significant proportion (total 26.7%; 25.2% males

32. chronic diseass Key Findings
Breast cancer screening: 10% of women age 15-49 have had a clinical exam for
breast cancer in the past 12 months.
Cervical cancer screening: 11% of women age 15-49 have ever had a Pap smear,
and 4% have had a Pap smear in the past 12 months.
Knowledge of diabetes: Although M most women (91%) and men (87%) age 15-
49 have heard of diabetes; only 43% and 53% respectively do not know any
symptoms of diabetes.
Blood pressure: 19% of women and 13% of men age 15-49 have hypertension.
5% of all women and 2% of all men age 15-49 have hypertension that has been
controlled with medication

33. current efforts and demands
• Current efforts in prevention and control of NCD in Lesotho
• Developed a comprehensive NCD strategic Plan that includes NCDs information, prevention,
early detection, diagnosis and treatment, and palliative care, and established a unit for
coordination of NCDs program in the Ministry of Health
• Tobacco – bill submitted to cabinet for approval
• Alcohol – policy needs to be developed and to be submited to cabinet
• Physical activity : Ministry of Gender, Youth, Sports and Recreation and Ministry of Health
Lesotho have launched an aerobic marathon March 2014
• HPV vaccination – young girls aged 9-13 years has incorporated in vaccination agenda for the
country since 2012. now resussisated
• Screening for cancer of cervix: VIA for early detection of precancerous lesions and treatment
of eligible women with cryotherapy or LEEP as appropriate.
• Introduction of integrated programmes on HIV/AIDS and NCDs
• Lesotho Government has started to fund a capital Project for Establishment of a National
Radiotherapy Facility to be operational in 2020.
• 12th SCCA CONFERENCE- Maseru declaration on CANCER PREVENTION 2018

34. NCDs INTEGRATION journey
That is why you are here
• The Ministry of Health has reviewed the 2nd edition of the Lesotho Standard
• Treatment Guidelines (STGs) to address the changing disease patterns and new eruptions. The 3 rd edition of Adult STGs incorporates WHO-
recommended HTN/DM treatment.,
• Hemophilia Standard treatment guidelines
• PUBLIC PRIVATE PARTNERSHIPS are increasing with focus on NCDs integration (SOLIDAMED, EGPATH,BAYLOR,PIH,M2M,ETC
• THE INTEGRATION MODEL HAVE BEEN SELECTED VALIDATED AND RECOMMENDED BY NEW NCDs TWG
• STRONG COORDINATION- NCD PROGRAM--*-* IPR, PPP, MONITORING, DATA-REPORTING, UNISON WORKFLOW ) EACH PARTNER
SHOULD REVEW MOU s AND ADDENDUM SUBMITTED FOR GOVERNMENT APPROAVAL
• GOFURTHER PROJCT
• AFRICA-CDC
• EU-AFRICA 4 MED PROMISING PROJECT ------------
MY JOB IS TO DUPLICATE EFFORTS FOR IMPLEMENTATION , LOBBIE , FORGE PARTNERSHIPS AND CONSORTIUM
ESTABLISHMENT IN THE REGION WITH EXISTING STRUCTURES
• https://youtu.be/j1sHU1G_qz8

35. capacitate health care providers in all Pathways of service and
referral

36. • COVID-19 has been a powerful reminder of the importance of integrated molecular disease surveillance systems
in advancing public health systems. Scientists from around the world have published open-source analyses of
next-generation sequencing data for SARS-CoV-2, the virus that causes COVID-19, collaborating to further track
the spread of the pathogen and to provide information for critical response efforts. In the coming months and
years, NGS will continue to contribute to better understanding of SARS-CoV-2 including how it may evolve over
time, which has important implications for vaccine and drug development.COVID-19 has been a powerful
reminder of the importance of integrated molecular disease surveillance systems in advancing public health
systems. Scientists from around the world have published open-source analyses of next-generation sequencing
data for SARS-CoV-2, the virus that causes COVID-19, collaborating to further track the spread of the pathogen
and to provide information for critical response efforts. In the coming months and years, NGS will continue to
contribute to better understanding of SARS-CoV-2 including how it may evolve over time, which has important
implications for vaccine and drug development. COVID-19 has been a powerful reminder of the importance of
integrated molecular disease surveillance systems in advancing public health systems. Scientists from around
the world have published open-source analyses of next-generation sequencing data for SARS-CoV-2, the virus
that causes COVID-19, collaborating to further track the spread of the pathogen and to provide information for
critical response efforts. In the coming months and years, NGS will continue to contribute to better
understanding of SARS-CoV-2 including how it may evolve over time, which has important implications for
vaccine and drug development.
cytogenetics and genomics

39. OMICS- Med Lab Frontiers
• GENOMICS
• PROTEONOMICS
• METABOLOMICS
• IMMUNOCYTOCHEMISTRY
• HISTOCHEMISTRY
• PHARMACOGENOMICS
• PHARMACOEPIDEMIOLOGY
• GENE REPLACEMENT THERAPY
• PRECISION MEDICINE
• GENOMIC PUBLIC HEALTH
• COMMUNITY PUBLIC HEALTH
• IKS AND THE FUTURE PREDICTIONS- PREDICTION MEDICINE
PATIENT SCREEN DIAGNOSIS + AI + TREATMENT
INFECTIOUS DISEASES
NCDs AND CANCER+ MH

40. 40
Cervical Cancer Cascade, FY18-FY23 Q2
Source: Pano Initial Data Release (includes Mil)

41. Working together with
government leaders,
community stakeholders,
and the pharmaceutical
industry provides a
comprehensive approach
to cervical cancer control
for women living with
HIV/AIDS
Leverages its convening powers, educational efforts, and
leadership; raises the profile of cervical cancer in the global
arena.​
Engages civil society, young women; supports countries during
Global Fund application process; improves access to & quality
of radiotherapy for women with invasive cervical cancer.
Provides HPV vaccine for use in a cohort of HIV-positive
women in Eswatini through an exploratory research study to
determine appropriate dosage levels.
The Value of
Partnership
Works to understand the patient journey of WLHIV and
cervical cancer, along with mobilizing key stakeholders, to
seek solutions to strengthen countries efforts in the prevention,
screening, treatment and disease management of cervical
cancer.

42. • EU-AFRICA 4 MED PROJECTS
• OPPRTUNITY ARISE FOR LESOTHO TO IMPROVE

43. thank you
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