بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم الحمد لله رب العالمين والصلاة والسلام على نبينا محمد خاتم الأنبياء وسيد المرسلين وعلى آله وصحبه أجمعين وبعد

2. Epidemiology of Chronic diseases Non communicable diseases

3. Chronic diseases have been defined as : Chronic illnesses. • Non-Communicable. • Degenerative.

4. Characteristics: • Uncertain etiology. • multiple risk factors. • long latency period . • Prolonged course of illness. • non- contagious origin. • functional disability and sometimes incurability .

5. Latency period is the period between contact of the causative agent with susceptible host to the onset of first sign a symptoms. • The cause of many chronic diseases remains obscure, but risk factors identified for some of the leading chronic diseases. The most important among these risk factor is Tobacco use especially in COPD .

6. Strategies for the prevention • Approach to prevention of chronic diseases can be considered under three headings :

7. 1-Primordial prevention: prevention or avoiding the development of risk factors in the community to prevent the disease in the population and as such protects the individuals. This involves the avoidance of risk behaviors.

8. prevention of disease occurrence by altering susceptibility of the host or reducing exposure of susceptible persons to the risk factors • Examples : immunization , good nutrition , health education , • counseling, environmental sanitation, purification of water , protection against accidents at work place and seat belts.

9. Requires : accurate knowledge of causative agent and process of disease.

10. 2-Primary prevention : Modifying or reducing the risk factors associated with the development of a disease in individuals with or without the use of interventions, It involves modification of established risk behavior and risk factors with specific interventions to prevent clinically manifest disease

11. That is by early detection , screening by examinations altering the course of disease • Examples : high blood pressure , T.B. Diabetes , Cancer of the breast , Cancer of the cervix colo-rectal cancers, lung cancer etc.

12. 3- Secondary prevention : Modifying the risk factors in the presence of the manifested disease by changes in lifestyle and/or use of drugs.

13. 4- Tertiary Prevention : alleviation and limitation of disability improvement of quality of life , Rehabilitation and follow up.

14. What would be the top 10 causes of their deaths?

16. 9

17. The major non communicable diseases are : • Cardiovascular Diseases. • Chronic Obstructive Pulmonary Disease • Diabetes • Hypertension • Cancers • Accidents in its different types

18. Non communicable diseases also include injuries, which have an acute onset, but may be followed by prolonged convalescence and impaired function, as well as chronic mental diseases.

19. Out of all non-communicable illnesses, cardiovascular diseases stay as the leading cause of morbidity and mortality , especially in developed and rich countries. All over the world, almost 1.5 million adults and elderly died in 1995 from heart disease, stroke or other forms of circulatory disease.

20. Cancer is a growing health problem in developing countries, where more than half of the global total of six million deaths occur.

21. Noncommunicable diseases (NCDs) are a global challenge. During the next several decades, NCDs will govern the health care needs of populations in most low- and middle-income countries because of declines in communicable diseases, conditions related to childbirth and nutrition, changes in lifestyle factors (eg, smoking), and population aging (1).

22. We examined the burden of NCDs in the Hashemite Kingdom of Jordan. We computed the projected prevalence of diabetes, hypertension, and high blood cholesterol. All of these risk factors are associated with an increased risk of cardiovascular disease (CVD) — the leading cause of death in Jordan — and increased health care use.

23. In 2005, Jordan’s population was approximately 5.5 million. By 2050, the population is expected to increase to between 8.5 and 14.8 million people. (2) The proportion of older people (aged 60 years or older) is expected to be 15.6% (or approximately 1.8 million people) in 2050, more than 3 times that in 2000 (2).

24. During 2005, NCDs accounted for more than 50% of all deaths in Jordan. Heart disease and stroke (International Statistical Classification of Diseases, 10th Revision, codes I00-I99) accounted for 35% of all deaths; malignant neoplasms (C00-C97) were responsible for 13% of deaths (3).

25. Nearly 60% of deaths from malignant neoplasms occurred among people younger than 65 years, and approximately one-third of those who died from CVD were aged 65 or younger

26. During 2004, approximately 400,000 (15%) Jordanian adults had diabetes (an increase from 7% in 1996), and an estimated 350,000 (12%) had impaired fasting glucose (4,5). Approximately 15% of adults reported hypertension, and roughly 23% had high blood cholesterol — an increase from 9% in 1996 (4,5).

27. The proportion of all deaths attributable to NCDs in the World Health Organization's Eastern Mediterranean Region is projected to increase from 51% during 2005 to 66% by 2030 (6). 

28. Assuming prevalences are similar to that in Jordan, diabetes may affect nearly 10 million people in Egypt, one of the region’s largest countries, and 3 million people in Saudi Arabia. Hypertension may affect 18 million Egyptians and 6.5 million people in Saudi Arabia by 2050.

29. Programs to monitor and control risk factors, clinical services, and a robust health care system will be important to successfully improve NCD outcomes and reduce the burden of disease.

30. Reducing the prevalence of NCDs will require a renewed commitment by governmental and nongovernmental institutions, by public health professionals and clinical practitioners, and by communities and individuals to acknowledge the burden of NCDs and the need for timely action.

31. Moreover, stimulating, strengthening, and sustaining regional efforts and programs are necessary to reduce the prevalence of NCDs through coordinated and integrated programs of health promotion and disease prevention.

32. These programs should involve networks for risk factor surveillance, information sharing, capacity building, advocacy, policy development, and collaboration in generating, disseminating, and applying knowledge.

33. Common CVD Risk Factors • 1-Tobacco use. • 2-Physical inactivity. • 3- Unhealthy diet. • Life expectancy in developing countries is rising sharply and people are exposed to these risk factors for longer periods.

34. Newly merging CVD risk factors: • Like low birth weight. • folate deficiency. • Infections. • Social class: more frequent among the poorest in low and middle income countries.

35. Hypertension • Prevalence: • Hypertension is estimated to cause 4.5% of current global disease burden and is as prevalent in many developing countries, as in the developed world. Blood pressure-induced cardiovascular risk rises continuously across the whole blood pressure range. Countries vary widely in capacity for management of hypertension, but worldwide the majority of diagnosed hypertensive are inadequately controlled.

36. Hypertension affects one in four adults, putting them at higher risk for heart • attacks, kidney disease, atherosclerosis, macular degeneration and stroke. It is • often termed the "silent killer" because as many as 35% of those who have • hypertension do not realize it.

37. More than 60% of all women over age 65 have hypertension. Women over age 75 are much morelikely to develop the disease than men..

38. HTN is a major public health problem of worldwide distribution and is the most common cardiovascular disease (CVD) risk factor . It is responsible for one half of coronary heart disease (CHD) and about two thirds of cerebrovascular accidents. By 2030, 23 million cardiovascular deaths are projected to have HTN, with about 85% occurring in low and middle-income countries .

39. Research published between 1980 and 2002 indicate the prevalence of HTN in developing countries increased at a higher rate than in developed countries . Prevention of HTN is possible, and early detection and treatment can reduce the incidence of complications including stroke, CHD, heart failure, and kidney disease , and yet the levels of control of hypertension are low worldwide.

40. Economically developed countries have higher rates of HTN than in developing countries . However, data reported in the last decade indicate that the prevalence, awareness, treatment, and control of hypertension in economically developing countries are coming closer to those in economically developed countries .

41. Recent epidemiological studies on prevalence, awareness, treatment, and control of HTN in Jordan are scarce. The few community-based studies conducted between 1994 and 1996 in Jordan demonstrated a 16.1 and 16.3% prevalence rates of HTN (cut-off point 160/90 mm Hg) with concomitant low levels of awareness, treatment, and control.

42. Since that time, several activities have been implemented to face this challenge in HTN which have not been evaluated. Moreover, the last decades showed a remarkable improvement in treatment of hypertension due to introduction of new antihypertensive medications and the development of international guidelines for detection and management .

43. Meyasser Zindah, head of the Health Ministry's cardiovascular disease department, warned of the high prevalence of heart disease, noting that 662,527 citizens over the age of 18 suffered from high blood pressure in 2007.

44. Risk Factors • Uncontrollable risk factors: • Increasing age. • Family history. • Race, African-Americans are at higher risk than Caucasians). • Sodium sensitivity..

45. Controllable risk factors: • Overweight or obesity. • Physical inactivity. • Heavy alcohol consumption. • Use of oral contraceptives. • Excessive sodium intake..

46. Diet: • Dairy, Fruits & Vegetables, and low fat, high Fibers food may Lower Blood Pressure • a recent study suggests that adding certain foods to the diet may also help. The dairy products act in lowering blood pressure in mildly hypertensive adults. • Fat: Fatty food increases the risk.

47. Coronary heart disease ( CHD) • is the leading cause of death in Industrialized countries • CHD is also called Ischemic heart disease or coronary artery disease . These are several disorders that reduce the blood supply to the heart muscle . The underlying impairment is the atherosclerosis which remains sub clinical .

48. Heart Disease Leading Cause of Death in Jordan     2008 • Heart disease has become a leading threat to the health of the Jordanian population, with 40.5 percent of deaths last year found to be related with heart ailments .

49. High risk groups: • Gender: Men have a higher CHD mortality rates than women twice for men than women , never the less, CHD is the single greatest mortality risk in women : 3 times the risk of breast cancer. • Age : CHD is the leading cause of death for men and women over 65 years of age. • For men- major increases in CHD begin in 35-44 year age group. • For women – marked increase is delayed until after menopause

50. Sub- clinical CHD is more prevalent in older than younger persons. • Black women die at a higher rate than white women from CHD • The Asians in American have approximately half( ½) the CHD mortality than white Americans.