Presentation on NCD prevention and control

1. Prevention
and Control
of
Non-
Communicabl
e Diseases
Dr Jaydeep Ghevariya
Resident Doctor
Department of community
medicine,
B J medical college, Ahmedabad.
1

2. NCD -
• Cardiovascular
diseases
• Coronary heart
disease
• Hypertension
• Stroke
• Rheumatic Heart
Disease
• Diabetes
• Cancers
• Obesity
• Blindness
• Oral Diseases
• COPD
• Mental problems
• Accidents and
injuries
2

3. Burden of
chronic
diseases:
the rising
tide
• contributed to an estimated 72% of deaths
globally in 2016, previously it was 53% in
2005.
• Nearly 2/3rd of this deaths occurs in low- and
middle- income countries.
• Leading causes of deaths in NCDs are
Cardiovascular disease (44%), Cancers (16%),
Respiratory diseases (9%), Diabetes
(4%)(2016).
• Many of these deaths occur at relatively
early ages, Compared with all other
countries.
3

4. Proportional Mortality in india
(2016)
4
Communicable,
Maternal, Perinatal
and nutritional
conditions
26%
Injuries
11%
CVD
27%
Cancers
9%
Chronic respiratory
Disease
11%
Diabetes
3%
Other NCDs
13%

5. WHO STEP-wise approach to NCD
surveillance
5
STEP -1 -Self
reported information
on - E status, H/o
tobacco and alcohol
use, physical activity
and measurement of
nutritional status
STEP -2 – Add
Physical
Measurement Like Ht,
Wt., BP, Waist
Circum.
STEP -3 – Add
Biochemical Analysis

6. Risk
factors
• Demographic, Economic, and Social factors
• Urbanization, Industrialization, and
Globalization – increases metabolic
syndrome, increases behavioral risk
• Age -Increased life expectancy
• Tobacco use –
• 7 million people die from tobacco from
each year.
• 0.6 million death by second hand smoke
out of which 28% are children.
• It causes lung cancers (71%), chronic
respiratory disease (42%), and
cardiovascular disease (10%).
• India is the world’s second largest
producer as well as consumer of tobacco.
6

7. Risk
factors
• Overweight and Obesity-
• 2.8 million people dies due to obesity or
overweight.
• Risk of heart disease, stroke and diabetes
increase steadily with increasing BMI.
• In 2016 11% of men and 15% of women
aged 18 years and above are obese.
• More than 42 million children under the
age of 5 years were overweight.
• Factors are poor- imbalanced diet, high
energy intake and lack of exercise.
• Insufficient physical activity-
• 1.6 million people die due to physical
inactivity.
• Insufficient physical activity have a 20%
to 30% increases risk of all-cause
mortality.
7

8. Risk
factors
• Harmful use of alcohol-
• 3.3 million people die due to harmful use
of alcohol, accounting 5.9% of all deaths.
• Harmful effect of alcohol determined by
volume of alcohol consumed, pattern of
consumption and quality of alcohol
consumption.
• Unhealthy diet-
• Inadequate consumption of fruit and
vegetables increase the risk of
cardiovascular disease, stomach and colon
cancer.
• High salt consumption increase risk of
cardiovascular and hypertension.
• Raised cholesterol-
• it increases the risk of heart disease and
stroke.
• Levels of awareness, treatment, and
adequate control are low for hypertension,
diabetes, and dyslipidemia, especially in
rural area
8

9. Gaps in
natural
history-
9
Absence of known agent
Multifactorial causation
Long latent period
Indefinite onset

10. Why
common
NHP -
• Up to 80% of heart disease, stroke and type 2
diabetes and over a third of cancers could be
prevented by eliminating shared risk factors,
mainly tobacco use, unhealthy diet, physical
inactivity and the harmful use of alcohol.
10

11. Why
comprehensi
ve
multisectoral
NHP -
11
Individual interventions for clinical
care are unlikely to be affordable on a
large scale
Health education alone would be
insufficient in the absence of
supportive environmental changes
policy interventions related to tobacco,
food supply, and urban design are
likely to have a far greater and quicker
effect on chronic disease prevention
through their population-wide effect.

12. Preventio
n
12
NCDs have multi factorial
causations, so prevention
demands complex mix of
prevention.
Earlier we are focused on
tertiary prevention to prevent
or delay further disability or
death, but now with
identification of risk factors
health promotion activities
aimed at primary prevention.

13. Preventio
n
• Interventions are-
1. Tobacco-
• Protect people from tobacco smoke,
• ban tobacco smoke in public,
• warning about tobacco use on packages,
• ban on tobacco advertising, promotion and
sponsorship,
• raising taxes on tobacco products.
2. Alcohol-
• Restriction on access to retailed alcohol,
• restriction on advertising
• Increase taxes.
3. Salt-
• Reduce salt intake and salt content of food
4. Fat-
• reducing trans fat with polyunsaturated fats
5. Health promotion-
• promoting public awareness about diet, and
physical activity,
• use of mass media for health promotion
13

14. Preventio
n
Other interventions to reduce risk factors –
1. Nicotine dependence treatment
2. Enforcing drink-driving law
3. Restriction of marketing of food with
high salt, sugar and fat
4. Food taxes and subsidies to promote
healthy diets
5. Healthy nutritional environment in
schools
6. Nutrition information and counseling in
health care.
7. National physical activity guidelines.
14

15. Preventio
n
Other interventions to reduce risk factors –
• Vaccination against hepatitis B; a
major cause of hepatic cancer
• Vaccination against HPV; main cause
of cervical cancer.
• Protection against environmental or
occupational risk factors for cancer,
such as aflatoxin, asbestosis and
contaminated drinking water.
15

16. Strategies
-
• Comprehensive strategy/ multisectoral
policies/ integrated approach for their
prevention and control is needed.
• P & C of NCD as part of Primary health care
system
• Primary prevention –
• Population approach
• health promotion,
• Risk reduction.
• High risk strategy - risk detection,
• Secondary prevention
• Tertiary prevention
16

17. Benefits
of
exercise
-
17
Reduce body fat -weight
Reduce risk of colon , breast and
prostate cancers
improves glucose metabolism
Improves anti oxidant level
Reduce symptoms of depression and
stress
Reduces blood pressure, LDL
Increases HDL

18. Legislation
s -
18
Indian Tobacco Control Act, 2003
production and supply of healthy
foods, regulation of unhealthy foods,
• Through amendments to the Prevention of Food
Adulteration Act of 1954, limitations can be
placed on the levels of salt, sugar, and
saturated fats in manufactured food products.
• Food labeling also needs to be introduced to
facilitate informed choice by consumers.
urban design and urban planning that
promotes physical activity;

19. Health
programs
-
19
National program for preventive and control of
cancer, diabetes, CVD, and stroke (NPCDCS)
National Cancer Control Program, 1975
The National Blindness Control Program
National Mental Health Program
National Program on Speech and Hearing
National Iodine Deficiency Disorders Control
Program
National Tobacco Control Cell, 2003
IDSP

20. NPCDCS (2010-
11)
• National program for preventive
and control of cancer, diabetes,
CVD, and stroke
20

21. NPCDCS
• Non-communicable diseases (NCDs) are the
leading cause of adult mortality and
morbidity worldwide.
• Keeping in view that there are common
preventable risk factors for Cancer, Diabetes,
CVD & Stroke, Government of India initiated
a National Programme for Prevention and
Control of Cancers, Diabetes, Cardiovascular
Diseases and Stroke (NPCDCS) during 2010-
11 after integrating the National Cancer
Control Programme (NCCP) with National
Programme for Prevention and Control of
Diabetes, Cardiovascular Diseases and
Stroke (NPDCS).
21

22. NPCDCS
• Two component s of NPCDCS-
1. DCS- Diabetes, cardiovascular disease
and stroke component
2. Cancer- component
• Objectives:
• Prevent and control common NCDs
through behaviour and life style changes,
• Provide early diagnosis and management
of common NCDs,
• Build capacity at various levels of health
care for prevention, diagnosis and
treatment of common NCDs,
• Train human resource within the public
health setup viz doctors, paramedics and
nursing staff to cope with the increasing
burden of NCDs
• Establish and develop capacity for
palliative and rehabilitative care.
22

23. NPCDCS
• Strategy
• Health promotion,
• Awareness generation and promotion
of healthy lifestyle
• Screening and early detection Timely,
• affordable and accurate diagnosis
• Access to affordable treatment,
• Rehabilitation
23

24. NPCDCS-
Activities/
Interventio
ns adopted
• Health promotion-
• Increased intake of healthy foods
• Salt reduction
• Increased physical activity/regular
exercise
• Avoidance of tobacco and alcohol
• Reduction of obesity
• Stress management
• Awareness about warning signs of cancer
etc.
• Regular health check-up
• Interpersonal communication is to be
carried out through ASHAs/ AWWs/Youth
clubs, panchayat members etc.
• Targeted intervention programmes are
being designed to bring awareness in
schools and workplaces.
24

25. NPCDCS-
Activities/
Interventio
ns adopted
• Screening Diagnosis
• Screening and early detection of
diabetes, high blood pressure and
common.
•Target population (age 30 years and
above, and pregnant women) will be
conducted either through opportunistic
and/or camp approach at different levels
of health facilities and also in urban
slums of large cities.
•The screening of the urban slum
population would be carried out by the
local government/municipalities in cities
with population of more than 1 million.
•The screening of school children will be
carried out during the routine school
health check-up activity under the
school health programme.
•The suspected cases of diabetes and high
blood pressure will be referred to higher
health facilities for further diagnosis and
treatment.
25

26. NPCDCS-
Activities/
Interventio
ns adopted
• Screening Diagnosis
• Opportunistic screening for common cancers
(breast, cervical and oral) among the
population 30 years and above.
• Screening for prostate cancer at CHC and
DH levels in 60 years+ male
• The HW (F) will be trained for conducting
• For screening of diabetes, support for
glucometers, glucostrips and lancets would
be provided to the states under NHM.
• AYUSH doctors can play an important role
in prevention and control of NCDs through
primary health care network. They are
involved in health promotion activities
through behaviour change, counselling of
patients and their relatives on healthy
lifestyle (healthy diet, physical activity, salt
reduction, avoidance of alcohol and tobacco)
meditation, yoga, opportunistic screening for
early detection of non-communicable
diseases and their risk factors.
26

27. NPCDCS-
Activities/
Interventio
ns adopted
• Screening Diagnosis
• Hub and spoke model is proposed for
providing comprehensive care, where hub
would be the tertiary care
hospital/Medical College and spokes would
be the districts.
• The suspected cases from the periphery
will be referred to Tertiary Care
facilities.
• The common infrastructure/manpower is
utilised at peripheral level for early
detection of cases, diagnosis, treatment,
training and monitoring of programmes
such as National Programme for
Prevention and Control of Cancer,
Diabetes, CVDs and Stroke (NPCDCS),
National Programme for Health Care of
Elderly (NPHCE), National Tobacco
Control Programme (NTCP), National
Mental Health Programme (NMHP) etc.
27

28. NPCDCS
28
Programme is to be
implemented in 20,000 sub-
centres and 700 community
health centres (CHCs) in 100
districts across 21 states/UTs.
For long term sustainability
of the programme service
delivery will be through
existing public health
infrastructure and systems.

29. FACILITIES
AT
DIFFERENT
HEALTH
CARE
LEVEL
• Primary Health
Centres (PHC)
• Community Health
Centres (CHC)
• Tertiary Health
care Centres
(District hospitals
and Regional centres)

30. Primary
Health
Centres
(PHC)
• Health Promotion for behaviour
and life style changes carried out
by organising various camps,
interpersonal communication,
poster, banners etc.
• Opportunistic screening of
population above 30 years carried
out using BP measurement and
Blood Glucose by strip method.
• The suspected cases of diabetes
and hypertension will be referred
to CHC of higher health facilities
for further diagnosis and
management.

31. Communi
ty Health
Centres
(CHC)
• NCD clinics are being established at CHCs to manage
common NCDs like cancer, diabetes, hypertension,
cardiovascular diseases and stroke, where comprehensive
examination of patients referred by lower health
facility/Health Worker as well as of those reporting directly is
conducted for ruling out complications or advanced stages of
common NCDs.
• Screening, diagnosis and management (including diet
counselling, lifestyle management) and home based care are
the key functions of the clinic.
For providing effective care at CHC level under the
programme, financial assistance has been provided to each
CHC for purchase of furniture, equipment, computer etc and
recurring expenditure includes support for laboratory
investigations (blood sugar measurement, lipid profile,
ultrasound, X-ray and ECG etc.), contractual manpower,
home based care and other expenditures

32. District
Hospitals
• The selected districts have been strengthened to
provide comprehensive preventive, supportive and
curative services for cancer, diabetes, hypertension and
cardio vascular diseases.
The district hospital has been provided the financial
support for strengthening of Cardiac Care Unit (CCU),
NCD clinic, human resource on contract (1 specialist, 2
nurses, 1 physiotherapist, 2 counsellors, 1 data entry
operator and 1 care coordinator), drugs arid
consumables, transport of referred/serious patients,
IEC and miscellaneous expenditure.
• For care of cancer patients, each programme district
hospital has been provided the financial support for
day care chemotherapy facility, chemotherapy drugs,
hiring of manpower, investigations (e.g.
mammography) etc.

33. Tertiary
Cancer
Centre
(TCC)
• Under cancer component of the
programme, there was provision of one
time financial assistance for
strengthening of comprehensive cancer
care at medical
colleges/institutes/district hospitals as
TCCs. Recurring annual fund is provided
for continuation of comprehensive care.
• The comprehensive cancer care include
provision of radiotherapy, chemotherapy,
surgical oncology and diagnostic
facilities .

34. CANCER
COMPONEN
T UNDER
NPCDCS
Cancer is an important health
problem in India with nearly
10Lacs new cases occurring
every year in the country.
It is estimated that there were
2.8 Million cases in the country
at given point of time.
In 2010 National cancer
control Programme (NCP) was
integrated with NPCDCS.

35. National
cancer
control
Program
me
Objectives-
1. Primary prevention- health education
2. Secondary prevention- early detection
and diagnosis of common cancer of
mouth, cervix, breast, tobacco related
cancer by screening or self
examination.
3. Tertiary prevention- strengthening of
the institutes for comprehensive
therapy including palliative care.
Schemes-
• Financial assistance to voluntary
organizations
• District cancer control scheme
• Financial assistance for Cobalt Unit
installation
• Development of oncology wings in
Government Medical College hospitals
• Assistance for regional research and
treatment centers
35

36. CANCER
SERVICES
UNDER
NCPDCS
1. Common Diagnostic Service- Basic Surgery,
Chemotherapy and Palliative care for
cancer cases is made at 100 District
Hospitals.
2. Each district is being supported by Rs. 1.66
Crores per annum for the following-
• Chemotherapy drugs are provided for 100
patients at each District Hospital.
• Day care Chemotherapy facilities is being
established at 100 District Hospitals.
• Facility for lab investigation including
mammography is being provided at 100
District Hospitals.
3. Home based palliative care is being
provided for chronic, debilitating and
progressive cancer patients at 100 District
Hospitals.
4. Support is being provided by contractual
man power through 1 Medical Oncologist, 1
Cyto-pathologist, 1 Cyto-pathology
Technician, 2 Nurses for day care.

37. GUIDELINES
FOR
REFERRAL
AND
TREATMEN
T under
NPCDCS
• Government of India has developed
operational guidelines in for prevention,
screening and control of common, non-
communicable diseases.
1. Those who systolic BP more than 140 and
Diastolic BP more than 190, Random
Blood sugar 140 & above would be
referred to Medical Officer at the nearest
health facility for confirmation, conducting
lab investigation and initiation of
treatment.
2. Those who are found positive for pre
cancerous/ cancer lesion will be referred
by ANM/ Staff nurse in specified screening
site to the appropriate PHC/CHC/District
Hospital for confirmation and treatment
by trained specialists.

38. GUIDELINE
S FOR
REFERRAL
AND
TREATMEN
T under
NPCDCS
3. Once the diagnosis of DM/HTN is
established patient must receive at least
one month drug from PHC. Once the
condition is stable provide the patient
with a 3 month supply of Drug with the
ANM/ASHA visiting the patient each
month for ensuring, compliance, checking
on diet and life style modification BP &
Blood Sugar.
4. Patient will go to the PHC for first follow-
up at the end of the first three month after
diagnosis or sooner if required. An annual
specialist consultation at the nodal CHC
with NCD clinic is also recommended.
5. Those individual who are on treatment
under care of private practitioner they
could be offered the choice of taking drugs
from the Public Health System.

39. NPCDCS- indicator and targets
39

40. NEW
INITIATIVES
UNDER THE
PROGRAMME
Inclusion of guidelines for prevention and management of
COPD, CKD under NPCDCS.
For early detection of DM, HTN, Common Cancers in the
Community, guidelines are being issued for initiating
population-based screening of common NCDs.
Initiative of integration of AYUSH with NPCDCS and
practice of Yoga has been made an integral part of the
intervention.
Intervention has been initiated for prevention and control
of Rheumatic fever and RHD under the platform of NPCDS
and Rashtriya Bal Swasthya Karyakram (RBSK).
Screening of NCDs has been integrated with IDSP.
Integration of RNTCP with NPCDS wherein the national
framework for joint tuberculosis and diabetes collaborative
activities.

41. Key
provisions
of the
Indian
Tobacco
Control
Act, 2003
1. Ban on smoking in public places
2. Ban on direct and indirect advertisement
of cigarettes and other tobacco products in
print, electronic and outdoor media (ban
on tobacco use in films to be implemented
from October, 2005)
3. Ban on sales to and by people younger
than 18 years
4. Tobacco products cannot be sold near
educational institutions
5. Mandatory depiction of statutory health
warning (in one or more Indian languages)
and pictorial warning, on all tobacco
products
6. Product regulation: tar and nicotine levels
to be declared on tobacco product packages
41

42. 2030
Agenda for
Sustainabl
e
developme
nt
• Target 3.4-
• 1/3rd reduction of premature mortality
from NCDs by the year of 2030 and
extension of global NCD mortality target.
42

43. Thank you
43