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Non-Communicable Diseases Control Program _________________________________

Non-Communicable Diseases Control Program _________________________________ K R Thankappan MD, MPH Additional Professor and Head Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum. Death, by broad cause group, 1999.

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Non-Communicable Diseases Control Program _________________________________

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  1. Non-Communicable Diseases Control Program_________________________________ K R Thankappan MD, MPH Additional Professor and HeadAchutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum

  2. Death, by broad cause group, 1999 Noncommunicable conditions (59.8%) Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (31.1%) Injuries (9.1%) Source: WHO Report 2000

  3. Global burden of disease in disability-adjusted life years (DALYs), 1999 Noncommunicable conditions (43.2%) Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (42.8%) Injuries (13.9%) Source: WHO Report 2000

  4. Deaths, by broad cause group and WHO Region, 1999 % Noncommunicable conditions 75 Injuries Communicablediseases, maternal and perinatal conditions and nutritional deficiencies 50 25 EMR SEAR WPR EUR AFR AMR Source: WHO 2000

  5. DALYS, by broad cause group and WHO Region, 1999 DALY = Disability adjusted life-year % 75 Noncommunicable conditions Injuries Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 50 25 AFR EMR SEAR WPR AMR EUR Source: WHO 2000

  6. DALYs, by broad cause group 1990 - 2020 in developing countries (baseline scenario) DALY = Disability-Adjusted Life Year % % Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 22 49 21 Injuries 14 15 Neuropsychiatric disorders 9 43 Noncommunicable conditions 27 Source: WHO, Evidence, Information and Policy, 2000

  7. Low- and middle-income countries suffer the greatest impact on non-communicable diseases 77% of the total number of deaths attributable to NCDs occurred in developing countries 85% of the global NCD disease burden borne by low- and middle-income countries Source: WHO:, 2000

  8. Distribution of causes of death in South-East Asia, 1999 (000s) Injuries (1301) Other causes (236) Perinatal conditions (851) Nutritional deficiencies (159) Malaria (69) HIV/AIDS (360) Tuberculosis (723) Noncommunicable conditions (7370) Diarrhoeal diseases (978) Respiratory infections (1523) Childhood diseases (542) Maternal conditions (158) Source: WHO 2000

  9. Burden of disease in disability-adjusted life years (DALYs) in South-East Asia,1999 (000s) Other causes (19693) Injuries (65289) Perinatal conditions (32715) Nutritional deficiencies (16866) Malaria (3071) HIV/AIDS (8866) Tuberculosis (14101) Diarrhoeal diseases (30017) Noncommunicable conditions (156536) Respiratory infections (38144) Childhood diseases (19449) Maternal conditions (7733) Source: WHO 2000

  10. Remains as first cause of death & disability Rapid increase Reach the peak Progressive decline Reach the peak in some countries First cause of death & disability Slow increase Rapid increase Rapid increase in most countries First cause of death & disability in most countries Low rates Slow increase Cardiovascular (CVD) epidemicin countries of different stages of development -----1940-----1950-----1960-----1970-----1980-----1990-----2000----- High Income Economies Economies in Transition Middle and Low Income Countries

  11. DALYs, by broad cause group 1990 - 2020 in developing countries (baseline scenario) % 50 1990 2020 25 DALY = Disability adjusted life-year Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Injuries Noncommunicable conditions Source: WHO, Evidence, Information and Policy, 2000

  12. Source: K S Reddy. Lancet 1998.

  13. Coronary Heart Disease Prevalence Studies in India (Urban)Study Year Sample CHD PrevalenceAgra 1960 1046 11 1.05Delhi 1962 1642 17 1.04Chandigarh 1968 2030 134 6.60Rohtak 1975 1407 51 3.63Delhi 1990 13723 1327 9.67Jaipur 1995 2212 168 7.59Moradabad 1995 152 13 8.55Trivandrum 1995 506 41 12.65________________________Source: Gupta et al. Indian Heart Journal 1995.

  14. Prevalence Of Hypertension in the elderly Loacation % 95% CIKerala Urban 69 (63-75)Kerala Rural 55 (49-61)Maharashtra Urban 72 (69-75) Dhaka Urban 65 (62-67)Dhaka Rural 53 (47-59)___________________________________ Source. Hypertension study group AMCHSS of SCTIMST. WHO Bulletin 2001.

  15. Prevalence of Hypertension (40-60 Yrs)Trivandrum CityAge group Prevalence40-44 42.245-49 55.350-54 55.755-60 67.2Total 54.5Manu Zachariah, Thankappan K R et al. Indian Heart Journal 2003

  16. Non-modifiable • Risk Factors • Age • Male gender • Genetic • Hypertensive • heart disease • Coronary • heart disease • Cerebrovascular • disease (Stroke) • Peripheral • vascular disease Endpoints Modifiable Risk Factors predisposition • Smoking • Unhealthy diet • -High in saturated fat & salt • -Inadequate intake of fruits • and vegetables • Excessive alcohol use • Sedentary life-style • Hypertension • Elevated LDL cholesterol • Decreased HDL cholesterol • Diabetes • Insulin resistance • Obesity Behavioural Risk Factors Adverse Socio-economic, Cultural & Environmental Conditions Cardiovascular risk factors

  17. Tobacco: deaths by World Bank regions estimates for 1990 and 2020 8.4 million Middle Eastern Crescent Latin America & Caribbean Sub-Saharan Africa Other Asia and Islands China India 3 million Former Socialist Countries Established Market Economies Source: Murray CJL, Lopez AD 1996

  18. Tobacco use and educational level among females in Bombay 1992-1994 Users % Source: Gupta, 1996

  19. Body Mass Index in Indian Women 15-49 Years. State BMI <18.5 BMI 25+ BMI 30+ Delhi 12.0 33.8 9.2 Punjab 16.9 30.2 9.1 Kerala 18.7 20.6 3.8 Orissa 48.0 04.4 0.6 Assam 27.1 04.2 0.7 Bihar 39.3 03.7 0.5 India 35.8 10.6 2.2 Urban 22.6 23.5 5.8 Rural 40.6 05.9 0.9 Source: NFHS 1998-99.

  20. No National Program for NCDMore than 50% of disease burden in India is due to NCDsMany National Programs for Communicable diseases

  21. How to address Monitoring of Risk factors Tobacco Use Diet (Fruits and Vegetables) Body Mass Index Physical activity Blood Sugar Blood Lipid levels

  22. Disease Specific ProgramCancerDiabetesBronchial AsthmaHypertension?

  23. Need to develop a ProgramSentinel Health Monitoring Centres AssamDelhi Kerala MaharashtraTamil Nadu

  24. Address Risk factors and determinantsat community level Inter-sectoral coordination

  25. LegislationFor example Tobacco ControlAlcoholDiet, salt restrictionExercise

  26. Global strategy for Diet and Physical activity

  27. Primary Health Care SystemNeed to re-orient focusTraining of health workersMonitoring of blood pressure and urine sugar can be done at grass root levelHealth education programs

  28. Capacity BuildingManpower -PH specialistsNew Public Health Schools Social Science componentsMPH-SCTIMST, AllahabadPGI Chandigarh, CMC Vellore, EHAExpand the current MD programsFETP Programs- MAE at NIE

  29. Start From Children

  30. THANK YOU

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