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3. Global status of NCDs
ďNCDs kill 41 million people each year (71% of all deaths
globally)
ďFour major NCDs account for over 80% of all premature
NCDs deaths (in 2016)
⢠Cardio-vascular disease: 17.9 million
⢠Cancer: 9 million
⢠Chronic respiratory diseases: 3.8million
⢠Diabetes: 1.6 million
ďOver 85% of premature deaths in low and middle income
countries
Source: World Health Statistics, 2018
Prabesh Ghimire 3
4. Growing nature of NCDs
ď Deaths by NCDs- more than all other causes combined
ď Projected to increase from 38 million in 2012 to 52 million
by 20301.
ď42% of all NCD deaths occurred before age of 70 years1
⢠17 million in 2015
⢠16 million in 2012
⢠14.6 million in 2000
ďRisk of dying from any one of the four main NCDs
between 30-70 yrs decreased from 22% in 2000 to 18%
in 20162.
1. Global Status Report on NCDs, 2014
2. World Health Statistics, 2018
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5. Growing nature of NCDs-Nepal
ďNCDs account for estimated 65% of total deaths in Nepal
(121,000 NCD deaths)1
⢠In 2014- 60% of total deaths2
ď The probability of dying between 30-70 years from 4
main NCDs â 22%
1. NCD progress monitor; WHO, 2017
2. NCD country profiles, 2014
Prabesh Ghimire 5
6. Risk Factors for NCDs
ďModifiable behavioral risk factors
⢠Tobacco consumption: 7.2 million deaths every year
⢠Excess salt/sodium intake: 4.1 million deaths
⢠Insufficient physical activity: 1.6 million deaths
⢠Alcohol use: More than half of 3.3 million annual deaths
attributable to alcohol use are from NCDs
ďNon-modifiable risk factors
⢠Age, race, gender, genetics
Prabesh Ghimire 6
7. Risk Factors for NCDs
ďMetabolic risk factors
⢠Increased blood pressure: 19% of global deaths
⢠Obesity/ overweight
⢠Increased blood glucose levels or hyperglycemia
⢠Increased levels of fat in the blood or hyperlipidemia
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9. Consequences of NCDs
ď NCDs exacerbate poverty
⢠Excessive health care costs >> Quickly drain
household resources>>> Catastrophic
expenditure>>>impoverishment
ď NCD is a major contributor to premature
mortality
ď NCD threatens progress towards 2030 agenda
for Sustainable Development
⢠SDG goal: Reduce premature deaths from NCDs by
one-third by 2030
Prabesh Ghimire 9
10. Strategies for prevention and control
1. Advocacy and partnership
⢠Integrating NCDs into health and development plans
with special attention to social determinants of health
⢠Raising political awareness
2. Health promotion and risk factors minimization
a) Reducing tobacco use
⢠Raising taxes and prices
⢠Warning people about dangers of tobacco
⢠Ban on tobacco advertising and promotion
⢠Establishing tobacco surveillance
Prabesh Ghimire 10
11. Strategies for prevention and control
b) Reducing harmful use of alcohol
⢠Increasing access to consumer information about harmful
effects of alcohol
⢠Ban on alcohol advertising and promotion
⢠Prevention and treatment services to individual and
families affected by alcohol-use disorders
c) Promoting healthy diet
⢠Reducing food with high transfat content and other junk
food
⢠Strengthening food safety and labeling regulations
⢠Raising awareness on benefits of reducing salt and high
unsaturated fatty acids.
Prabesh Ghimire 11
12. Strategies for prevention and control
d) Promoting physical activity
⢠Implementation of improved urban planning
⢠Improving access to right information on physical activity
promotion and healthy lifestyle.
e) Reducing indoor air pollution
⢠Promoting alternative sources of energy for cooking and
heating at homes
⢠Promote change in structural designs of housing for better
ventilation
⢠Encouraging the use of improved cooking stoves
⢠Behaviour change communication
Prabesh Ghimire 12
13. Strategies for prevention and control
3. Health system strengthening for early detection
and management
⢠Efficient procurement and supply chain mechanism for basic drugs
and diagnostic equipment and tests.
⢠Capacity building of health workforce for early identification and
management of common NCDs
⢠Integrating cost-effective NCD interventions (PEN package) into
basic primary health care package
⢠Strengthening referral system for management of NCDs
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14. Government Efforts on NCDs
ďMulti-sectoral action plan on prevention and control of
NCD 2014-20
ďScaling up PEN package to selected districts
ď Ratified WHO FCTC in 2006-
⢠MPOWER package into implementation,
⢠Tobacco law in existence
ď Population Based Cancer Registry System introduced in
Jan 2018.
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15. Government Efforts on NCDs
ďCash support up to 100,000 to poverty stricken citizens
for treatment of selected NCDs: Cardiovascular diseases,
cancer, renal diseasesâŚ
ďResearch: Risk factor STEPS survey
ďCommitments to SDG
ďInformation, Communication and Education
ďTobacco Quit-Line Telephone Counseling: 01-521200
Prabesh Ghimire 15
17. Cardiovascular Diseases (CVDs)
ď Group of disorders of the heart and blood vessels
ďIncludes
⢠coronary heart disease (blood vessels supplying heart
muscle)
⢠cerebrovascular disease (blood vessels supplying brain)
⢠rheumatic heart disease (damage to hear muscle and hear
valves for rheumatic fever)
⢠other conditions (Congenital heart disease, deep vein
thrombosis, pulmonary embolism)
ďFour out of five CVD deaths are due to heart attacks and
strokes.
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18. Growing nature of CVDs
ďProjected to be leading cause of death in all
countries by 2020
ďEstimated 17.9 million die people every year-
32% of all global deaths
⢠Coronary heart disease â 7.5 million
⢠Stroke- 6.7 million
ďOver 17 million premature deaths (under 70
years) due to non-communicable disease (2015)
⢠About 40% caused by CVDs
ď Over 80% of CVD deaths occur in LMICs
ďBy 2030, 25 million people will die from CVDs
Source: WHO Reports
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19. Growing nature of CVDs- Nepal
ď Upto one-quarter (22.4) of all deaths in the Nepal were
caused by CVDs
ďExpected increase: 35% by 2030
ďOne-fourth (25.7%) population 15-69 years were found
with raised blood pressure
Source: WHO STEPS survey, 2013
Prabesh Ghimire 19
20. Risk Factors for CVDs
Major Modifiable risk factors
⢠High blood pressure
⢠Abnormal blood lipids
⢠Tobacco use
⢠Physical inactivity
⢠Obesity
⢠Unhealthy diet (salt)
⢠Diabetes
Other modifiable risk factors
⢠Low socioeconomic status
⢠Mental ill health (depression)
⢠Psychosocial stress
⢠Heavy alcohol use
⢠Lipoprotein
Non-modifiable risk factors
⢠Age
⢠Heredity or family history
⢠Gender
⢠Ethnicity or race
Novel risk factors
⢠Excess homocysteine in blood
⢠Abnormal blood coagulation
(elevated blood levels of
fibrinogen)
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21. Underlying determinants of CVDs
ďCauses of the causes- âSocial determinants of
healthâ
⢠Socio-economic and political contexts
⢠Socio-economic position
⢠Material circumstances
⢠Behavioral factors
⢠Health system factors
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22. Prevention and Control of CVDs
ď Modifying risk factors: blood-pressure, alcohol use,
smoking cessation, physical activity (exercises)
ďImproving dietary practices, reduced salt intake
ďLipid lowering pharmacotherapy
ďAntihypertensive medication
ďAction on Social Determinants of Health
Learning resource: Priority non-communicable diseases and conditions (wpro.who.int)
Prabesh Ghimire 22
23. Cancer
ď Group of diseases affecting any part of body
ďRapid creation of abnormal cells invading the adjoining
parts and organs >>metastases
ďAlso called Malignant tumors and neoplasms
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24. Growing nature of cancer
ď Second leading cause of death globally
ď Globally, 1 in 6 deaths is due to cancer.
ď8.8 million deaths in 2015.
ďCommon causes of cancer deaths
⢠Lung cancer: 1.69 million deaths
⢠Liver cancer: 788 thousand deaths
⢠Colorectal: 774 thousand deaths
⢠Stomach: 754 thousand death
⢠Breast: 571 thousand deaths
Source: Cancer factsheet, www.who.int
Prabesh Ghimire 24
25. Growing nature of cancer
ď70% of all deaths from cancer occur in low and
middle income countries1
ďNepal: 7% of all deaths attributed to cancer2
ďBy 2030 cancer deaths projected to increase by
30%2
ď Mortality between 30-70 years of age: 6.7 per
10,000 population3
1. WHO.Cancer factsheet, www.who.int, 2018.
2. WHO Multisectoral action plan on NCD prevention and control.
3. NHRC, 2013
Prabesh Ghimire 25
26. Growing nature of cancer
ďCancer deaths in Nepal1
⢠Males: 6,900 (17% respiratory tract, lung cancer, 13%
mouth cancer, 9% stomach)
⢠Females: 7,400 (18% cervical cancer, 14% respiratory
tract, lung cancer, 12% breast cancer)
1. WHO. Cancer country profiles, 2014
Prabesh Ghimire 26
27. Prediction of cancer incidence in Nepal
(2013-2020)
Figure source: Poudel, Krishna Kanta et al. âPrediction of the Cancer Incidence in Nepal.â Asian Pacific
Journal of Cancer Preventionâ: APJCP 18.1 (2017): 165â168. PMC.
Prabesh Ghimire 27
28. Major killers
Men Women
Lung cancer
Liver cancer
Stomach cancer
Colorectal cancer
Prostate cancer
Breast cancer
Lung cancer
Colorectal cancer
Cervical cancer
Stomach cancer
Source: WHO fact file, 2015 data
Prabesh Ghimire 28
29. Cervical Cancer
ďCancer of female reproductive system
ď99% cases linked to genital infection with HPV
virus
ďRisk factors
⢠HPV infection
⢠Smoking
⢠Immune deficiency
⢠Family history of cervical cancer
Prabesh Ghimire 29
30. Lung Cancer
ď Cancer that forms in tissues of the lung, usually in the
cells lining air passages
ďLeading cause of cancer deaths, 1.69 million deaths
globally
ďAffects more men than women
ďRisk factors
⢠Smoking
⢠Exposure to second hand smoke
⢠Radiation therapy of breast or chest
⢠Exposure to asbestos, radon, chromium, arsenic, soot or tar
⢠Exposure to air pollution
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31. Breast cancer
ďCancer that forms in the tissues of the breast,
usually in the ducts or in the lobules
ďOccurs commonly in women, rarely occurs in
men
ďRisk factors
⢠Hormone therapies
⢠Weight and physical inactivity
⢠Age: risk increases with age
⢠Genetics or family history
⢠BRCA1 and BRCA2 genes
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32. Colorectal cancer
ďThird most common type of cancer
ďForms in large intestine
ďRisk factors
⢠Aging
⢠Unhealthy diet
⢠Diabetes
⢠Family history of colorectal cancer
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33. Causes of cancer
ďInteraction of personâs genetic factors and 3
categories of external agents
⢠Physical carcinogens- UV and ionizing radiation
⢠Chemical carcinogens- asbestos, components of
tobacco smoke, aflatoxin (food contaminant), and
arsenic
⢠Biologic carcinogens- infections from certain viruses
and parasites
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34. Risk factors for Cancer
ďOne third of deaths from cancer are due to the 5
leading behavioral and dietary risks:
⢠Tobacco use: 22% cancer deaths globally
⢠Alcohol use
⢠High body mass index
⢠Low fruit and vegetable intake
⢠Lack of physical activity
ďCancer may also have infectious origin
⢠HPV and hepatitis virus: 25% cancer cases in LMICs
Source: Cancer factsheet, www.who.int
Prabesh Ghimire 34
35. Prevention and control
ďRisk factors modification
⢠Control of tobacco use including cigarettes and
smokeless tobacco
⢠Healthy eating with increased fruit and vegetable
intake
⢠Increasing physical activity
⢠Control of harmful use of alcohol
⢠Prevention from sexually transmitted HPV-infection
⢠Reduced exposure to indoor smoke from use of solid
fuels.
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36. Prevention and control
ďVaccination against HPV and hepatitis B virus:
(can prevent 1 million cases each year)
ďControl of occupational hazards
ďReducing exposure to ultraviolet radiation
ďReducing exposure to ionizing radiation
(occupational and medical diagnostic imaging)
Prabesh Ghimire 36
37. Prevention and control
ďScreening and early detection
⢠VIA for cervical cancer
⢠HPV testing for cervical cancer
⢠PAP cytology test
⢠Mammography screening for breast cancer
ď Treatment
⢠Surgery
⢠Radiotherapy
⢠Chemotherapy
ďPalliative care
Prabesh Ghimire 37
38. Chronic Respiratory Disease
ď One of the leading causes of deaths globally
ď High under-diagnoses rates
ď90% of deaths occur in low income countries
ďIn Nepal, Mortality between 30-70 years of age: 8 per
10,000 population
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39. Chronic Obstructive Pulmonary Disease
(COPD)
ďUmbrella term for chronic disease of lung
ďPrevents proper airflow in the lungs
ďChronic bronchitis, emphysema
ďNot curable
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40. Growing nature of COPD
ď Prevalence: 251 million cases in 2016 (Global burden of
disease study)
ď 2015: 3.17 million deaths globally (5% of all deaths)
ď2016: 3.8 million deaths (9% of all deaths)
ď Estimates show that COPD becomes in 2030 the third
leading cause of death worldwide.
ďIn Nepal, respiratory diseases (including COPD and
asthma) accounted for 7 percent of NCD burden
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41. Risk factors of COPD
ďTobacco smoking
ďIndoor air pollution (use of solid fuel)
ďOutdoor air pollution
ďOccupational dusts and chemicals (vapours, irritants and
fumes)
ďFrequent lower respiratory infections during childhood
ďAge: usually becomes apparent after 40 or 50 years of
age)
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42. Asthma
ďChronic disease of the air passages of the lungs which
inflames and narrows them
ďRecurrent attacks of breathlessness and wheezing
ďCommon disease among children
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43. Growing nature of Asthma
ď383,000 deaths due to Asthma in 2015 (2016 WHO
estimates)
ď235 million people currently suffer from Asthma
ď80% asthma-related deaths occur in LMICs
Source: www.who.int
Prabesh Ghimire 43
44. Causes and risk factors of Asthma
ďFundamental causes unknown
ďRisk factors are combination of genetic
predisposition with environmental exposures to
inhaled particles
⢠Indoor allergens (dust, mites, etc.)
⢠Outdoor allergens (such as pollens and moulds)
⢠Tobacco smoke
⢠Chemical irritants in workplace
⢠Air pollution
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45. Causes and risk factors of Asthma
ďTriggers of Asthma
⢠Cold air
⢠Extreme emotional arousal such as arousal, fear,
excitement
⢠Physical exercise
⢠Certain medications: aspirin, NSAIDs and beta blockers
(for high blood pressure, heart disease, migraine)
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46. Prevention and control
ďPrimary prevention: Reducing exposure to risk factors
⢠Tobacco smoke
⢠Frequent lower respiratory tract infections in childhood
⢠Air pollution (indoor, outdoor and occupational exposure)
ďSecondary prevention: Cost-effective interventions and
medications
⢠Corticosteroids, inhalers
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47. Diabetes
ď Disorder of metabolism
ď4 types of diabetes: Type 1, Type 2, Gestational and Pre-
diabetes (impaired glucose tolerance)
ďType 2 is caused by modifiable risk factors and is most
common worldwide
⢠>90% of all adult diabetes cases are Type 2
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48. Growing nature of diabetes
ďNumber of adults adults living with diabetes quadrupled
between 1980 and 20141
⢠422 million adults with diabetes in 2014 (108 in 1980)
ďGlobal prevalence of diabetes double between 1980 to
2014 in adult population (4.7% to 8.5%)1
ď1.6 million deaths in 20162
ďWHO projects that diabetes death will increase by two
thirds between 2008 and 2030
1. Global Report on Diabetes, 2016
2. World Health Statistics, 2018
Prabesh Ghimire 48
49. Diabetes in South-East Asia & Nepal
ďIn SEAR, prevalence (18+yrs) doubled from 4.1% in 1980
to 8.6% in 2014
ďNational Prevalence- 3.6%
⢠4.6% in men and 2.7% in women
ďPrevalence up to 11 percent in certain areas
Prabesh Ghimire 49
50. Risk factors for diabetes
Major Modifiable risk factors
⢠Unhealthy diets
⢠Physical inactivity
⢠Obesity and overweight
⢠High blood pressure
⢠High cholesterol
Other modifiable risk factors
⢠Low socioeconomic status
⢠Heavy alcohol use
⢠Psychosocial stress
⢠High consumption of sugar
sweetened beverages
⢠Low consumption of fiber
Non-modifiable risk factors
⢠Increased age
⢠Family history/ genetics
⢠Race
Other risk factors
⢠Low birth weight
⢠Presence of autoantibodies
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51. Prevention and control of diabetes
ďPromote healthier eating- Avoiding sugar and saturated
fat intake
ďIncreasing physical activity and maintaining body weight
ďControl of blood glucose
ďScreening for early detection and treatment of
complications
ďMedications for associated CVD risk factors and diabetic
complications
⢠control of blood pressure
⢠Control of lipids
ďAction on social determinants of health
Prabesh Ghimire 51
52. Learning Resources
ď World Health Statistics, 2018
ďGlobal Report on Diabetes
ďNon-communicable diseases progress monitor, 2017
ďNon-communicable disease country profiles, 2014
ďMulti-sectoral action plan on prevention and control of
NCD in Nepal 2014-20
ďNon-communicable diseases risk factors: STEPS survey
Nepal 2013
ďGlobal status report on NCDs 2014
ďCDC. Overview of non-communicable disease and
related risk factors
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