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1. Non Communicable Diseases
Edenburgh International College
BPH 6th Semester
Group-B
2/28/2021 1

2. Group Member:
Mohan Bastola (Leader)
Sano Babu Katwal
Dharma raj Katwal
Saroj Dahal
Janki Chaudhary
Akriti Bhattrai

3. Content:
• Introduction to NCD and Its Scenario,
• CKD introduction its scenario, Risk factors and Prevention,
• Cancer introduction, scenario, causes and prevention
• COPD introduction, epidemiological determinants, Prevention
• CVD Introduction, Scenario, Risk Factors and its prevention
• Diabetes introduction, Scenario, Risk factors and its prevention.

4. Introduction:
• Non-communicable diseases (NCDs), also known as chronic
diseases, tend to be of long duration and are the result of a
combination of genetic, physiological, environmental and
behaviors factors.
• The main types of NCDs are cardiovascular diseases (like heart
attacks and stroke), cancers, chronic respiratory diseases (such as
chronic obstructive pulmonary disease and asthma) and diabetes
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5. Global scenario:
• Non-communicable diseases (NCDs) kill 41 million people each
year, equivalent to 71% of all deaths globally.
• Each year, 15 million people die from a NCD between the ages of
30 and 69 years;
• over 85% of these "premature" deaths occur in low- and middle-
income countries.
• Cardiovascular diseases account for most NCD deaths, or 17.9
million people annually, followed by cancers (9.0 million),
respiratory diseases (3.9million), and diabetes (1.6 million).
• These 4 groups of diseases account for over 80% of all premature
NCD deaths.
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6. Global Impact of NCDs
• In economic terms, Harvard School of Public Health said while
introducing a new study, non-communicable diseases would cost
the world $47 trillion in lost income in the next two decades
• An increase in life expectancy which places larger proportions of
the population in the age range (60 years and older) in which
chronic degenerative diseases become the major determinants of
health status
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7. Global Impact…..
• Epidemiological transition in diseases may also be brought about
by shifts in social and economic patterns which favor detrimental
changes in risk factors for the chronic degenerative diseases.
• Such changes may include health-related behaviour which
augments dietary consumption of fats and alcohol, increases
obesity, increases smoking and decreases physical activity.
• Currently more chronic disease deaths in developing than
developed countries and that as expectation of life increases in
developing countries the global chronic disease burden will be
greatly concentrated in the developing countries.
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8. SEAR Scenario:
• NCDs mainly CVD, chronic respiratory diseases, diabetes and cancer are top killer
in SEAR, claiming an estimated 8.5 million livers each year.
• One third of these death are premature and occur before the age of 70 year
• 48% of all deaths from NCDs in the Region are below 70 years of age.
• 8.5 million people die of non-communicable diseases every year.
• 62% of all death in the region are due to NCDs
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9. National scenario of NCD
• NCDs are estimated to cause 66% of al deaths in 2016.
• Death caused by four main NCD groups:
i. Cardiovascular Disease- 30%
ii. Cancer-9%
iii. Diabetes-4%
iv. Chronic Respiratory Disease- 4%
Sources-- Nepal- STEPS Survey 2019.
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10. Trends of Some NCD in Nepal:
Source: DoHS Annual Report 2075/76
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11. Chronic Kidney Disease:
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12. Introduction:
• Chronic kidney disease (CKD) is a long-term condition where the kidneys don't
work as well as they should.
• It's a common condition often associated with getting older. It can affect anyone,
but it's more common in people who are black or of south Asian origin.
• CKD can get worse over time and eventually the kidneys may stop working
altogether, but this is uncommon. Many people with CKD are able to live long
lives with the condition.
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13. Global scenario:
• In 2017, the global prevalence of CKD was 9.1% (697.5 million cases).
• In 2017, CKD resulted in 1.2 million deaths and was the 12th leading cause of
death worldwide.
• Prevalence of CKD was higher in women and girls (9.5%) than in men and boys
(7.3%).
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14. Sources: Siemens healthcare Diagnostics Inc. 2018
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15. National Scenario of CKD:
• The overall prevalence of chronic kidney disease was 6.0%. CKD increased with
age and was highest at 60 years and above with 11.5%. Prevalence in males
(6.5%) was slightly higher than females (5.7%).
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16. Risk Factors for CKD:
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17. Prevention of CKD:
Primordial
Prevention
Prevention of risk factors, healthy lifestyles
Primary Prevention
Identification of high risk person, manage obesity,
improve glycemic and BP control, avoid high salt diet,
encourage healthy food and lifestyles.
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18. Prevention of CKD:
Secondary
Prevention
Early CKD detection, BP Control, lower protein and
higher plant- based diet, avoid AKI( acute Kidney Injury)
Tertiary Prevention
Fluid management, cardiovascular and nutritional
therapy, pharmaco –therapy, dialysis, kidney
transplantation, supportive care
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19. Cancer
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20. Introduction:
• Cancer refers to any one of a large number of diseases
characterized by the development of abnormal cells that divide
uncontrollably and have the ability to infiltrate and destroy normal
body tissue. Cancer often has the ability to spread throughout your
body.
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21. Global scenario:
• Cancer is the second leading cause of death globally, and is
responsible for an estimated 9.6 million deaths in 2018. Globally,
about 1 in 6 deaths is due to cancer.
• Approximately 70% of deaths from cancer occur in low- and
middle-income countries.
• The most common causes of cancer death are cancers of:
• Lung (1.76 million deaths)
• Colorectal (862 000 deaths)
• Stomach (783 000 deaths)
• Liver (782 000 deaths)
• Breast (627 000 deaths)
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22. 2/28/2021 22

23. National Scenario:
• Cancer mortality in Nepal is higher in females as compare to males- 7400 and
6900 respectively
• Based on hospital data 8000-10000 of new cases are identified every year in
Nepal
• A total of 13997 cases were reported in OPD attending patients all over Nepal
according to DoHS 16/17.
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24. Sources---Nepal- Global Cancer Observatory
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25. National Data:
Males Females Both Sexes
Population 13348435 29136808 29136808
No. of new cancer Cases 8943 11565 20508
Risk of developing cancer Before the
age of 75 (%)
8.1 8.6 8.4
No of cancer deaths 6244 7385 13629
Risk of dying from cancer before the
age of 75 (%)
6.0 5.8 5.9
5 year Prevalent cases 15073 21833 36906
Top 5 most frequent Cancers (
Ranked by Cases)
Lung
Stomach
Colorectum
Lip. oral
cancer
Thyroid
Cervix uteri
Breast
Lung
Gallbladder
Ovary
Lung
Cervix Uteri
Breast
Stomach
Colorectum
Sources---Nepal- Global Cancer Observatory
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26. Causes of Cancers:
A. Environmental factors:
• Tobacco
• Alcohol
• Dietary factors
• Occupational exposure
• Virus
• Parasites: Schistosomiasis causes Cause cancer of bladder
• Factors like sunlight, radiation, medications like oestrogen, pesticides
are related to cancer
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27. Contd……
B. Genetic factors: Mongols are more likely to blood cancer than
children of others
C. Age
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28. Prevention of cancer:
Primordial Prevention:
• Efforts to be directed towards discouraging children from
adopting harmful lifestyles.
Primary Prevention:
• Control of tobacco and alcohol consumption
• Personal hygiene
• Minimize exposure to radiation
• Foods, drugs, cosmetics tested for carcinogens
• Cancer Awareness
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29. Secondary prevention:
• Action which halts the progress of a disease at its incipient stage
and prevent complications.
Tertiary Prevention
• Tertiary prevention refers to care aimed at reducing morbidity and
disability in people diagnosed with, and being treated for disease.
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30. COPD
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31. Introduction:
• Chronic obstructive pulmonary disease is the name for a group of lung conditions
that cause breathing difficulties. It includes : emphysema-damage to the air sacs
in the lungs. Chronic bronchitis- long term inflammation of the airways.
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32. Global scenario:
• The Global Burden of Disease Study reports a prevalence of 251
million cases of COPD globally in 2016.
• Globally, it is estimated that 3.17 million deaths were caused by the
disease in 2015 (that is, 5% of all deaths globally in that year).
• More than 90% of COPD deaths occur in low and middle-income
countries.
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33. National Scenario
Source--DoHS Annual Report 75/76
Fiscal
year
Province
1
Province
2
Bagmati
Province
Gandaki
Province
Province
5
Karnali
province
Su. Pa
Province Total
2072/73 21817 14590 60485 35978 33960 14136 20263 201229
2073/74 24014 12848 74478 34368 28148 14652 21663 210171
2074/75 33234 18805 78350 32039 38705 19833 24802 231685
2075/76 33234 18805 78350 32039 38705 19833 24802 245768
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34. Factors for COPD:
1. Smoking
2. Air pollution ( Indoor and outdoor)
3. Occupation: coal mine, cement factory
4. Socioeconomic status
5. Respiratory infection of childhood
6. Family and genetic factors
• α1 Anti-trypsin deficiency cause emphysema
• LBW is a risk factors of COPD
7. Respiratory infection
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35. Environmental factors:
• Air pollution
• Dusty environment
• Poor housing
• Cooking
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36. Host factors:
• Age: Middle and older age
• Gender : more male due to more exposure
• Race: Asian people have low susceptibility
• Occupation related to smoke and dust
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37. Prevention of COPD:
1. Primordial Prevention:
• Avoidance of tobacco, smoke and other inhaled particulates and toxins.
2. Primary prevention:
• Discouragement of cigarette smoking
• By legal approach: banned at public place
• Promotion of electric and safa tempoos
• Forestation
• Bypass road
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38. Secondary prevention:
• Early detection and prevention of COPD cases
• Proper mgmt. with drugs and oxygen
• Timely mgmt. by bronchodilators, antibiotics, steroids,
mechanical ventilator support.
Tertiary prevention:
• Physiotherapy
• Oxygen therapy
• Lung transplantation
• Rehabilitation patient by change in occupation
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39. Cardiovascular Diseases
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40. Global Scenario:
• According to the World Health Organization (WHO), CVD is the
leading cause of death worldwide.
• In 2016, around 17.9 million people died from CVD, accounting
for 31% of all registered premature deaths.
• Of these, 85% resulted from a heart attack or stroke. These
conditions affect equal numbers of men and women.
• The WHO estimate that by 2030, 23.6 million people will die
from CVD conditions annually — mostly due to stroke and heart
disease.
• Although these conditions remain prevalent in global mortality
rates, people can start taking steps to prevent them.
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41. South East Asia Scenario
• Cardiovascular Diseases (CVDs) account for 27% of all
deaths in the Region.
• In Nepal various studies have shown that the prevalence of
hypertensions in adult population is around 20% in urban
population
• In 2003, the prevalence of CHD in India was estimated to be
3-4 % in rural areas, and 8-10 % in urban areas, with a total
of 29.8 million affected.
• In Pakistan, one third of people of aged 45 years or above
have HTN. In Sri Lanka the prevalence of HTN was estimated
to be 17% in urban and 8% in rural areas.
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42. National Scenario:
• According to Government Report CVD is the leading cause of Death.
• In 2017, CVDs contributed to 26·9% of total deaths.
• Ischemic heart disease was the predominant CVDs
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43. Risk Factor for CVDs:
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44. Primordial
Prevention
Primary Prevention
Prevention of risk factor of CVD, such as efforts aimed to
prevent HTN, obesity
Modification of these and other known risk factors, is
aimed at preventing the clinical manifestation of CVD
Prevention of CVD:
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45. Secondary Prevention
Tertiary Prevention
Focuses on those who already have manifestation of
disease, but where aggressive control of risk factors can
have a major impact in preventing recurrences of diseases.
Use of coronary interventional procedures such as
coronary angioplasty, stent, bypass surgery, pacemakers,
defibrillators, and left ventricular assist devices (LVAD)
Prevention Contd…
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46. 2/28/2021 46

47. Introduction:
• Diabetes is a chronic disease that occurs either when the pancreas does not
produce enough insulin or when the body cannot effectively use the insulin it
produces.
• Insulin is a hormone that regulates blood sugar.
• Adults with diabetes have a two- to three-fold increased risk of heart attacks and
strokes .
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48. Global scenario:
• WHO estimates that diabetes was the seventh leading cause of death in 2016. In
2016, an estimated 1.6 million deaths were directly caused by diabetes.
• 1 in every 2 people with diabetes globally remain undiagnosed.
• According to WHO, an estimated 91 million population in the Southeast Asia
region have diabetes and around 49 million are still unaware of their condition.
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49. South East Asia Scenario:
• 88 millions of age group 20-79 are living with diabetes in the
SEA region in 2019. this figure is estimated to increase to
1153 million by 2045 acc. to IDA.
• Diabetes was responsible for 1.2 million deaths in SEAR in
2019.
• 1 in 4 live births in the SEAR are affected by hyperglycaemia
in pregnancy.
Sources-- IDA
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50. National Scenario:
• In Nepal total 36.5 percent people suffered from NCDs out of them 10 per cent
are suffered from diabetes.
• According to Nepal Diabetes association(NDA) Among people aged 2o years and
older living in urban areas, 15 per cent are affected by diabetes.
• Among people aged 40 years and older in urban areas this number climbed upto
19 per cent.
• Prevalence of diabetes in Nepal is 9.1 per cent.
• Obesity is found to be a cause of diabetes among 16.6 per cent female population
and 13.6 per cent male as stated by World Health Organization
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51. 2/28/2021 51

52. Prevention of DM:
Maintenance of normal
body weight through the
adoption of healthy
nutritional habits and
physical exercise
Primordial
Physical activities aimed at
preventing diabetes from
occurring in susceptible
population
Primary
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53. Prevention of DM Contd….
Early diagnosis and
effective control of
diabetes in order to
delay the progress of the
disease.
Secondary
Prevent complication
and disabilities due to
diabetes.
Tertiary
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54. Road Traffic Accident
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55. Past and Present
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56. Global Scenario:
• Each year, 1.35 million people are killed on roadways around the
world
• Every day, almost 3,700 people are killed globally in crashes
involving cars, buses, motorcycles, bicycles, trucks.
• 93% of the world's fatalities on the roads occur in low- and middle-
income countries, even though these countries have
approximately 60% of the world's vehicles.
• Road traffic injuries are the leading cause of death for children and
young adults aged 5-29 years.
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57. South East Asia Scenario
• Road traffic injuries kill approximately 316 000 people each year in WHO's South-
East Asia Region
• These deaths account for 25% of the global total of road traffic deaths.
• The South-East Asia region has a road traffic death rate of 17.0 per 100 000
population, compared to the global rate of 17.4
https://www.who.int/violence_injury_prevention/road_safety_status/2015/Road_S
afety_SEAR_3_for_web.pdf
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58. Fiscal Year 2077/78 Accidental Description
in Nepal
SN Month No. of Accident Fatality Serious Injuries Normal
Injuries
1 Shrawan 715 10 20 536
2 Bhadra 338 5 15 280
3 Aswin 785 14 27 628
4 Kartik 817 21 21 673
5 Mangsir 1092 18 20 778
6 Poush 1213 21 21 774
7 Magh 1023 14 10 695
8 Total 5983 103 134 4364
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59. Epidemiological factors:
A. Agent Factors (Vehicle)
• Old and poorly maintained vehicles
• No mirror and side lights
• No horns
• Uncomfortable interiors
• Excess speed
• Low driving standards
• Gas leaks e.g. CO when leaked into driver compartment makes
him unconscious leading to accident
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60. Epidemiological factors Contd..
B. Host Factors ( Human):
• Age : Younger ( over excitement) Older age group ( poor sight and
hearing)
• Sex: males are higher risk due to high exposure
• Education : High in illiterate due to ignorance
• Medical condition: sudden heart failure, epileptic seizure
• Fatigue: long route driving
• Psychological factor
• Loss of body protection: Helmet, seat belt
• Loss of attention : mobile, opposite sex
• Not obeying traffic rules etc.
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61. Epidemiological factors Contd…..
C. Environmental Factors:
• Related to roads: narrow and turning road, no traffic signs, poor
lighting, defective speed breakers, unfamiliar road
• Weather condition: rain, fog, mist, storm
• Mixed traffic
• Inadequate enforcement of the existing law
• Social pressure: use of stolen vehicle, festival
• Others : alcohol and drugs,
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62. Prevention of accidents:
• Safety education
• Promotion of safety measures: seat belt. Helmet, leather clothing and
boots, children in rear seat, use of door locks
• Alcohol and other drugs prohibited during driving
• Primary care – Trauma Hospital
• Elimination of causative factors- improve road, speed limit, marking of
danger points, provision of fire guards
• Law enforcement
• Research related to RTA
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63. References:
• https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
• DoHS Annual Report 2075/76
• K. Park 24th Edition
• https://www.nhs.uk/conditions/kidney-disease/
• https://www.who.int/news-room/fact-sheets/detail/cancer
• https://gco.iarc.fr/today/data/factsheets/populations/524-nepal-fact-sheets.pdf
• https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
• https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2020000300101
• https://www.siemens-healthineers.com/de/news/chronic-kidney-disease.html
• https://www.nature.com/articles/s41581-020-0268-
7#:~:text=The%20new%20analysis%20suggests%20that,men%20and%20boys%20(7.3%25)
• https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
• https://www.cdc.gov/injury/features/global-road-safety/index.html
• https://traffic.nepalpolice.gov.np/index.php/news/traffic-activities/425-annually-accidental-descriptions
• https://thehimalayantimes.com/nepal/road-accidents-in-nepal-claim-9000-lives-in-five-years
• https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries

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