This document provides an overview of non-communicable diseases (NCDs) including their characteristics, types, and risk factors. It discusses that NCDs are chronic conditions such as heart disease, cancer, diabetes, and lung disease. The document summarizes Nepal's NCD burden and risk factor data from the 2019 STEPS survey. It outlines strategies for NCD prevention through healthy lifestyles like healthy diet, physical activity, maintaining a healthy weight, avoiding tobacco and alcohol, and managing stress.

1. Non-Communicable Diseases
Management
Dr. Narendra Prasad Giri
MD (Kayachikitsa), (IOM, TU)
MHCM, (PU)
Consultant Ayurveda Physician

3. Non- Communicable Diseases
• Noncommunicable diseases (NCDs), also known as chronic diseases,
are not passed from person to person. They are of long duration
and generally slow in progression.
• Chronic conditions are characterized by the following: –
• Do not result from an (acute) infectious process
• Are “not communicable”
• Cause premature morbidity, dysfunction, and reduced quality of life
• Usually develop and progress over long periods
• Often initially insidious (बिस्तार शुरुवात हुने)
• Once manifested there is usually a protracted period of impaired
health.(लामो समय अस्वस्थ भईरहने)

4. • In some definitions of NCDs also include:
• Chronic mental illness
• Injuries, which have an acute onset, but may be followed by
prolonged convalescence and impaired function (बिक हुन लामो समय लाग्ने र
कबहले कााँही अपाङ्ग समेत हुन सक्ने)
• Types of NCDs
• Cardiovascular disease (Coronary heart disease, Stroke)
• Cancer
• Chronic lung disease
• Diabetes
• Chronic neurologic disorders (Alzheimer’s, dementias)
• Arthritis/Musculoskeletal diseases
• Mental disorders
• Genetic Diseases

5. Characteristics of NCDs
• Complex etiology (causes)
• Multiple risk factors
• Long latency period
• Non-contagious origin (non-communicable)
• Prolonged course of illness
• Functional impairment or disability
• Incurability
• Insidious (Slow) onset

6. Risk factors
Modifiable Risk Factor –
A risk factor that can be reduced or controlled by intervention, thereby reducing
the probability of disease. (ब्यवहार पररवततनिाट घटाउन वा हटाउन सबकने)
• WHO has prioritized the following four:
• Physical inactivity
• Tobacco use
• Alcohol use
• Unhealthy diets
• Others are:
• Stress
• Environment

7. Non-Modifiable Risk Factor-
• A risk factor that cannot be reduced or controlled by intervention
• for example:
• Age
• Gender
• Race
• Family history (genetics)

12. NCDs scenario in Nepal-STEPS Survey 2019
• NCDs are estimated to cause 66% of all deaths in 2016.
• Death caused by Four main NCD groups:
• Cardiovascular Disease-30%
• Cancer-9%
• Diabetes-4%
• Chronic Respiratory Disease-4%

13. NCDs Risk Factors Scenario in Nepal
According to STEPS Survey 2019
1.Tobacco use: in age group of 15-69 yrs
• Current tobacco users-28.9% (men-48.3%,
Women-11.6%)
• Current Tobacco smokers-17.1% (Men-28%,
Women-7.5%)
• Current users of Smokeless tobacco-18.3%
(Men-33.3%, Women-4.9%)

14. Alcohol Consumption in age group of 15-69 years:
1. Lifetime Alcohol Abstainer (Who do not drink)-72.2%
(56% men and 86% women). Only 4% (5.3% men and
2.7% women) were former Drinkers.
2. Current Drinkers-23.9% (38.6% men and 10.8%
women).
3. Daily or almost daily drinkers-11.7%

15. • Mean BMI-22.7% (Men-22.6%, Women-22.8%)
• Overweight (BMI >25 kg/Sq M)-24.3% (Men-
23.4%, Women-25.1%)
• Obese (BMI > 30 Kg/Sq M)-4.3% (Men-3.2%,
Women-5.3%)
Body weight in age group of 15-69 years:

16. NCDs Prevention
• NCDs prevention can be done by reducing or eliminating the
modifiable risk factors.
• Adopting Healthy Lifestyles and Health Promotion activities are
helpful for preventing NCDs.

18. Healthy Lifestyles
• A healthy lifestyle is one which helps to improve people's
health and well being. It improves critical health indicators
such as weight, blood sugar, blood pressure, and blood
cholesterol.
• These include healthy diet, physical activity, addressing
overweight/obesity, promoting tobacco cessation, avoiding
the harmful use of alcohol, and managing stress.

19. Healthy DietFood
Pyramid

20. Healthy Diet
Cereals, millets and pulses should be taken adequately; fruits and
vegetables liberally; animal foods moderately and oils and sugars in very
small amounts.
Dietary Advices:
• All meals to be taken at regular intervals.
• Wash food items properly before cooking.
• Boiling, steaming, roasting, cooking with minimal oil, as methods of
cooking should be used rather than deep frying or using excess amount of
oil.
• Include foods from each of the four basic food groups shown in the Food
Pyramid.

21. • Consume a variety of fresh, colorful, seasonal and locally available
fruits and vegetables (including green leafy vegetables)
• Eat whole fruits as they are rich in fiber or roughage. Fiber/roughage
helps in slowing down the absorption of sugar and fats into the blood
• Eat whole cereals and pulses (with outer covering) as they are high in
fiber or roughage rather than eating refined cereals and pulses
(without outer covering)
• Restrict eating processed foods or foods available in packets- these
have high amount of fat/oil, salt and sugar.
• Reduce the consumption of sugar rich foods. Those with family
history of diabetes should be careful of the amount and type of food
consumed.

22. • Limit the intake of preserved, processed and packaged foods which
are salt-rich. Examples are: papads, pickles, salted namkeens, salted
biscuits, salted butter/yellow butter, chips, chutneys, sauces and
ketchups, etc.
• Adding extra salt to cooked food and salads should be avoided. Those
with family history of high blood pressure should especially reduce
their daily salt consumption.
• Reduce the amount of salt- not more than 1 teaspoon (5 gms) of salt
for each individual in the whole day.
• Restrict intake of red meat like mutton, liver, brain, etc. and consume
lean meats like chicken, fish, etc.
• Use vegetables oils like mustard oil, groundnut oil, soyabean oil, etc.
for cooking. In practice, it is best to use a mixture of oils.
• Ghee, butter, coconut oil are harmful and should be used in small
quantities

23. • Reduce the consumption of deep fried foods-samosa, pakoudas, etc.
• Roadside vendors who sell fried foods, heat the same oil over and over
again. Use of Vanaspati ghee should be avoided as it can lead to
blocking/clogging of blood vessels and possibly to a heart attack and
other Non-Communicable Diseases.
• Maintain healthy weight; people who are overweight need to lose
weight
• Drink plenty of water, at least 8-10 glasses of water daily.
• Beverages like buttermilk, lassi, coconut water, lemon water, etc. should
be consumed instead of bottled soft drinks and fruit juices which are
high in sugar.

24. Maintaining Normal Body Weight
Body Mass Index (BMI) Calculation
BMI=Body Weight in Kg/Square of Height in Meter

25. Being overweight/obese can result in health problems, such as:
• Cardiovascular diseases (heart diseases) and cerebrovascular diseases
(stroke)
• High levels of harmful blood fat/ Hyperlipidemia
• Hypertension
• Diabetes
• Musculoskeletal disorders (especially osteoarthritis)
• Sleep Disorder
• Cancer –cancer of breast, cervix, ovary, liver, gallbladder, kidney, colon,
rectum and prostrate
• Lung Disorders
• Formation of gallstones
Risks Associated with being Overweight/Obese

26. Physical Activities
• Regular physical activity helps in maintaining a healthy body weight,
healthy bones, muscles and joints and protects against the
development of heart diseases, stroke, hypertension, diabetes, joint
problems and some cancers.
• Exercise should increase the heart rate and respiratory rate.
• Examples: Walking, running, jogging, cycling, playing a sport, dancing,
swimming, climbing the stairs, yoga, work like farming, lifting and
moving heavy objects as in construction, household work like
sweeping, cleaning, washing, dusting, etc.

27. How Much Physical Activity is needed for an
adult?
• Adults should undertake at least 150 minutes of moderate exercise
per week.
• This can be spread throughout the week e.g. 30 minutes of activity 5
times per week.
• 10 minutes of moderate activity can be done three times a day, that
will add up to the 30 minutes of physical activity per day.
• Examples of exercises are brisk walking (walking fast), climbing stairs,
jogging, cycling, dancing, playing sports and games, yoga, carrying
/moving moderate loads

28. Avoiding/Quitting Tobacco use
• Tobacco use is dangerous and leads to diseases of the heart, lungs, kidney,
oral cavity including cancers, respiratory disorders, tuberculosis etc.
• It may also result in blindness, high blood pressure, diabetes, tooth
decay/gum disease, bad breath, etc.
• Tobacco use in pregnancy leads to low birth weight babies and still birth.
• Tobacco use leads to impotence and low fertility among men.
• Persons exposed to second hand smoke (Smoke from other person’s
cigarette/bidi/ hukkah/pipes/cigar) suffer from increased risk of lung
cancer, heart attack, difficulty in breathing, coughing, asthma, ear
infection, irritation to the eyes, nose and throat, long-term negative effects
on the brain.

29. Avoiding Drinking Alcohol
• Alcohol use is associated with diseases of heart, kidney, pancreas,
certain cancers-mouth, esophagus, throat, liver and breast, weakens the
body’s ability to fight against diseases.
• Results in stroke, high blood pressure, leads to increase in weight
(overweight/obesity), mind disorders including alcohol dependence,
suicidal tendencies, problems in behaviors leading to fights, violence,
depression, injuries and accidents (resulting in untimely death).
• Drinking during pregnancy leads to complications during delivery and
defects in the child.
• If a person is on diabetes medication, alcohol consumption increases
the risk of low blood sugar (hypoglycaemia).

30. Stress
• Stress may lead to digestive problems, back or neck pain, sleeping
problems, substance abuse(लागु औषध दुर्ब्यसन), headaches,
sleeplessness, depressed mood, anger and irritability.
• Stress contributes to health problems, such as heart disease, stroke,
ulcers, high blood pressure, diabetes, depression, anxiety disorder,
and other illnesses.
• Manage stress by identifying the stressor and solving the problem
rather than worrying.

31. Stress Management techniques
1.Change your Thinking
1.Re-framing
2.Positive Thinking
2.Change your Behavior
1.Be Assertive- confident on what you do, respect others
2.Get organized- properly organize everything you do
3.Time Management
4.Share your problem with your family or friends
5.Humor- Laughter and Entertainment
6.Diversion and Distraction

32. 3. Change your Lifestyle
1.Diet- Eat Healty diet
2.Smoking and Alcohol-Quit
3.Exercise
4.Sleep
5.Leisure- use it in your hobbies
6.Relaxation-Massage, Yoga, Meditation etc
7.Psychological Councelling

34. Any Questions ?