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Non-Communicable Diseases in LMICs: Myths, Facts and Opportunities

Non-Communicable Diseases in LMICs: Myths, Facts and Opportunities. Gerald S. Bloomfield, MD, MPH DGHI, Division of Cardiology, Duke University September 2013. Outline. Trends in selected NCDs in LMICs Epidemiologic transition Data challenges Approaches to NCD research in LMICs.

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Non-Communicable Diseases in LMICs: Myths, Facts and Opportunities

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  1. Non-Communicable Diseases in LMICs: Myths, Facts and Opportunities Gerald S. Bloomfield, MD, MPH DGHI, Division of Cardiology, Duke University September 2013

  2. Outline • Trends in selected NCDs in LMICs • Epidemiologic transition • Data challenges • Approaches to NCD research in LMICs

  3. Cardiovascular disease

  4. Classic Teaching on Cardiovascular Diseases in SSA • Common CVDs: Rheumatic, infectious, pericardial, high BP • Heart failure is endemic in SSA • Dilated cardiomyopathy: 48% of admissions • Causes: RHD, Hypertension, Peripartum, Idiopathic • Coronary heart disease “distinctly rare” • Diagnostic limitations • Lack of specialized investigations • Viral, nutritional, familial, alcohol, immune, ischemia • 68% of ‘idiopathic’ can be mislabeled RHD = Rheumatic Heart Disease Watkins and Mayosi. Cardiovascular Journal of Africa 2009 BP = blood pressure Oyooand Ogola. East African medical journal 1999 Mokhobo. S Afr Med J 1980

  5. History of chronic CVD in Africa “Africans are immune to heart/coronary disease” 40% hospital admissions with any CVD No change in BP with age Kalahari San. No increase in BP with age Uganda. N= 1500 “High tension pulses not often met with” Kenya.2 years, 1800 patients. 0% HTN, arteriosclerosis Prev. HTNGhana 13% Nigeria 25% Lesotho 7% 1958-72: 8-11% admissions due to CVD Uganda.2 years 0% HTN Heavy Heart is a Bad Heart Ancient Egypt 1370 BC 1901 1920s 1941 1960 1970s 1976-8 1980-90s 2010:CVD is the 2nd most common cause of death in SSA

  6. LuoMiGration Study • 325 migrants, 267 controls followed for 24 months • SBP changes over 24 months Poulter BMJ 1990

  7. Pulmonary disease

  8. Deaths Due to Pulmonary Disease www.healthmetricsandevaluation.org 2013

  9. Adult Smoking Prevalence, 2009 Youth Smoking Prevalence, 2009 Tobacco Control Report from the Region of the Americas 2011

  10. http://www.who.int/tobacco/en/atlas19.pdf

  11. Proportion of Patients with COPD Who are Non-smokers Salvi and Barnes. Lancet 2009

  12. www.who.int/ceh/publications/en/map09b.jpg

  13. Household Air Pollution • 85% of all global particulate exposure occurs indoors • HAP levels are typically higher than developed world standards for ambient air quality • EPA Standard: 150 micrograms/cubed meter • Households with HAP: 300-3000 • During cooking 30,000 • 50x more carbon monoxide HAP in Nigeria http://magazine.uchicago.edu/1102/investigations/indoor_air_pollution.shtml

  14. Diabetes and high blood sugar

  15. % High blood pressure 12.8 Tobacco use 8.7 High blood glucose 5.8 Physical inactivity 5.5 Overweight and obesity 4.8 High cholesterol 4.5 Unsafe sex 4.0 Alcohol use 3.8 Childhood underweight 3.8 Indoor smoke from solid fuels 3.3 59 million total global deaths in 2004 % Childhood underweight 5.9 Unsafe sex 4.6 Alcohol use 4.5 Unsafe water, sanitation, hygiene 4.2 High blood pressure 3.7 Tobacco use 3.7 Suboptimal breastfeeding 2.9 High blood glucose 2.7 Indoor smoke from solid fuels 2.7 Overweight and obesity 2.3 1.5 billion total global DALYs in 2004 Leading causes of attributable global mortality and burden of disease, 2004 Attributable Mortality Attributable DALYs

  16. Epicenters of Diabetes Deaths from diabetes

  17. Hu. Diabetes Care 2011

  18. From Gersh et al. European Heart Journal 2010

  19. The Perfect Storm of CVD in LMICs LMICs: low- and middle-income countries Gersh et al. EHJ 2010

  20. Diet Development Sedentary lifestyle Tobacco Urbanization Technology Industry

  21. Projected Deaths by Cause Beaglehole and Bonita. Lancet 2008

  22. Where do we go from here?

  23. Percent of CVD studies from SSA by Country/Region, 1980-2008

  24. Contemporary Causes of heart failure in ssa Bloomfield et al. CurrCardiol Reviews 2013

  25. “FLTR” for ncds Current scenario Proposed scenario HOSPITAL HOSPITAL • Find • Link • Treat • Retain Health Center Dispensary Optimizing Linkage and Retention to Hypertension Care in Kenya: LARK Hypertension Study. Slide courtesy of R. Vedanthan, Mt. Sinai COMMUNITY COMMUNITY

  26. Optimizing Linkage and Retentionto Hypertension Care: LARK Hypertension

  27. An opportunity for primary prevention Oxford Health Alliance 2006

  28. The good news: Prevention works http://www.ktl.fi

  29. Thank you Non-Communicable Diseases in LMICs: Myths, Facts and Opportunities Gerald S. Bloomfield, MD, MPH Duke Global Health Institute Division of Cardiology Duke University

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