EPIDEMIOLOGY OF CHRONIC NON COMMUNICABLE DISEASES AND CONDITIONS

CHRONIC NON COMMUNICABLE DISEASES “An Impairment of bodily structure and function that necessitates a modification of the patient’s normal life , and has persisted over an extended period of time”

IMPORTANT CHRONIC DISEASES AND CONDITIONS 1)Cardiovascular diseases 2)Cancer 3)Diabetes Mellitus 4)Obesity 5)Blindness 6)Accidents and Injuries

CARDIO VASCULAR DISEASES • Ischemic heart disease(Coronary heart disease) • Hypertension • Stroke • Congenital heart diseases • Rheumatic heart disease

Coronary Heart Disease Definition: “Impairment of heart function due to Inadequate blood flow to the heart compared to its needs, caused by obstructive changes in the coronary circulation to the heart”

Coronary Heart Diseases Risk Factors NON MODIFIABLE Age Cigarette smoking Sex High Blood pressure Family history Elevated serum cholesterol Genetic Factors Diabetes Sedentary habits Stress

Prevention of Coronary Heart Disease Primary Prevention • Population strategy • High-risk strategy Secondary Prevention

Primary prevention of a disease • Primary Prevention has been defined as “all measures to reduce the incidence of disease in a population by reducing the risk of onset”

Primary prevention strategy • • • Nutrition/dietry changes Weight reduction Exercise promotion Behavioural changes Health education Self care

Secondary prevention of a disease Secondary prevention is to “detect and control the prevalence of disease in affected individuals”

Interventions for Primary Prevention • Healthy nutrition • Cessation of Smoking • Maintenance of normal levels of Blood pressure • Health promotion for Regular Physical Activity. • Health Education about the risk factors

Interventions for Secondary Prevention • • • Ø Ø Ø Aim is to prevent recurrence and progression of disease. Drug trials Coronary surgery Use of pace-makers Cessation of smoking(Achieve a smoke-free society , by a comprehensive health program , legislative measures) Control of hypertension and diabetes Dietry Changes Reduction of Fat intake. Increase in complex carbohydrate consumption Reduction of salt • Exercise promotion

CANCER Group of diseases characterized by • Abnormal growth of cells • Ability to invade adjacent tissues and distant organs • Death of the patient , if not diagnosed and treated early.

Causes of cancer • Environmental Factors ü Tobacco usage ü Excessive Alcohol intake ü Dietary factors(high fat intake, food additives) ü Occupational exposures(benzene , asbestos , arsenic , cadmium) ü Viruses(HIV, EBV, CMV) ü Parasites(Schistosomiasis) ü Others(Radiation , sunlight , pesticides etc) • Genetic Factors

Interventions For Cancer 1)Cancer control • Primary prevention • Secondary prevention 2)Cancer screening

Primary Prevention Of Cancer Control of Tobacco and Alcohol consumption Personal hygiene Reduce exposure to radiation Reduce occupational exposures Immunization against hepatitis B Legislative measures to control environmental carcinogens (e. g. Tobacco, alcohol) • Cancer education • • •

Secondary Prevention Of Cancer 1) Cancer Registration • Hospital based registration • Population based registration 2) Early Detection of Cases through Cancer screening 3) Availability of Treatment facilities

Cancer Screening • Mass screening by comprehensive cancer detection(e. g examination of one or more body parts by Physician) • Mass screening at single sites(examinations of single sites for e. g lung, breast etc. ) • Selective screening(e. g chronic smokers for cancer of Lungs)

Diabetes Mellitus According to WHO Clinical Classification of Diabetes Mellitus 1. Diabetes Mellitus • Insulin dependent DM • NIDDM • Malnutution –related DM • Other types (genetic , secondary to pancreatic) 1. Impaired glucose tolerance (IGT) 2. Gestational DM

Screening for Diabetes • Urine Examination • Blood Sugar testing Risk factors • • sedentary life style high saturated fat intake excusive alcohol intake Host factors age sex genetic factors obesity

Prevention & Care of DM Primary Prevention • adoption of healthy nutritional habits • physical exercise • cessation of alcohol intake Secondary Prevention • maintain blood glucose levels within normal limits • maintain ideal body weight • treatment with diet , oral anti diabetics or insulin

OBESITY Definition: “Abnormal growth of the adipose tissues due to an enlargement of fat cell size (hypertrophic obesity)or an increase in fat cell number (hyper plastic obesity) or a combination of both”. It is expressed in terms of Body mass Index (BMI)

Factors Related to Obesity • Physical in activity • Eating habits • Psychosocial factors (Emotional Disturbance Depression) • Familial tendency • Endocrine factors (Cushing’s syndrome) • Alcohol in take • Drugs (Contraceptives , Corticosteroid) Hazards of Obesity • Increased Morbidity Obesity is positive risk factor in the development of hypertension, diabetes , CHD e. t. c. • Increased Mortality

Prevention & Control of Obesity 1. Dietary changes • Intake of fat and carbohydrate should be reduced • Fibre content of diet should be increased 1. Behavior changes to loose weight and maintain the ideal weight 2. Increased Physical activity 3. Others (Surgical treatments)

BLINDNESS WHO has defined blindness as “visual acuity of less than 3/60 or equivalent” Causes • Accidents • Glaucoma • DM • HTN • Cataract • Occupational(air borne particles, welding flash, radiations) • Social factors (more common in poorer, treatments by quacks) • Malnutrition (PEM, vitamin A deficiency)

Steps In The Prevention Of Blindness 1) Primary Eye Care provided by primary health workers, they can treat on grass-root level or refer difficult cases. 2) Secondary Care providing treatment for cataract , glaucoma e. t. c at the RHC’s or District hospitals 3) Tertiary Care Provided at tertiary care hospitals or specialized institutions for the blind by the government 4) Specific programmes • School eye health services • Vitamin A prophylaxis • Occupational Eye health services

ACCIDENTS & INJURIES Definition “An un expected , unplanned occurrence which may involve injury”.

Types of Accidents a) b) • • • a) b) c) Road Traffic Accidents Domestic Accidents drawing burns poisoning falls injuries from sharp instruments bites and injuries from animals Industrial Accidents Railway Accidents Violence

Prevention of Accidents o Data Collection o Safety education o Promotion of safety measures o Prohibition of Alcohol and drug Intake o Provision for primary care for accidents o Elimination of causative factors o Enforcement of laws o rehabilitation